Changes

e. Vyakti- Clinical features of different types of gulma manifest at this stage so management can be done depending upon specific dosha characteristics.

e. Vyakti- Clinical features of different types of gulma manifest at this stage so management can be done depending upon specific dosha characteristics.

f. Bheda-When the gulma is not treated at the fourth and fifth stage, complications like bradhna roga (inguinal swellig), jwara (fever), vidbheda (loose stools/diarrhoea), and suppuration (in case of pittaja gulma ) occur where surgical intervention could be necessary.  

f. Bheda-When the gulma is not treated at the fourth and fifth stage, complications like bradhna roga (inguinal swellig), jwara (fever), vidbheda (loose stools/diarrhoea), and suppuration (in case of pittaja gulma ) occur where surgical intervention could be necessary.

Location of gulma :

==== Location of gulma ====

 

With respect to the adhishthana (location) of gulma, five major sites have been mentioned , including the  hridaya, nabhi, basti, and parshwadwaya (flanks).  In the context of this chapter, hridaya should be taken as  the upper part of the abdominal cavity rather than the thoracic cage as described in Sharirasthana. Vata gulma most commonly occurs in basti, while pittagulma occurs most commonly in the nabhi region, and kaphagulma in the hridaya and parshwadwaya regions.  The yakrita gulma occurs in the region of hridaya, ashtheela gulma in the region of kukshi (hypogastrium), pleeha gulma in the Madhya (central) region, chandravivardhaka gulma  in the region of basti , and granthi gulma afflicts the region of nabhi.  

With respect to the adhishthana (location) of gulma, five major sites have been mentioned , including the  hridaya, nabhi, basti, and parshwadwaya (flanks).  In the context of this chapter, hridaya should be taken as  the upper part of the abdominal cavity rather than the thoracic cage as described in Sharirasthana. Vata gulma most commonly occurs in basti, while pittagulma occurs most commonly in the nabhi region, and kaphagulma in the hridaya and parshwadwaya regions.  The yakrita gulma occurs in the region of hridaya, ashtheela gulma in the region of kukshi (hypogastrium), pleeha gulma in the Madhya (central) region, chandravivardhaka gulma  in the region of basti , and granthi gulma afflicts the region of nabhi.  

The pathogenesis of pittaja and kaphaja gulma takes place in amashaya that lies in the region between hridaya and basti. Thus these two variants of gulma (i.e., pittaja and kaphaja) cannot occur in basti. The five sites of gulma can be mapped to the following anatomical sites of the abdomen:

The pathogenesis of pittaja and kaphaja gulma takes place in amashaya that lies in the region between hridaya and basti. Thus these two variants of gulma (i.e., pittaja and kaphaja) cannot occur in basti. The five sites of gulma can be mapped to the following anatomical sites of the abdomen:

 

Types of gulma Adhisthana Anatomical site Charaka Sushruta Vagbhat Harita

Types of gulma Adhisthana Anatomical site Charaka Sushruta Vagbhat Harita

Vataja Basti lower abdomen Does not specify Does not specify Same Not mentioned

Vataja Basti lower abdomen Does not specify Does not specify Same Not mentioned

Management- All the four types of gulma can be managed according to the prevalent doshas. In  emergency  conditions  if there is no time to diagnose the type of gulma, vata dosha should be managed first as it is prevalent in all types of gulma.

Management- All the four types of gulma can be managed according to the prevalent doshas. In  emergency  conditions  if there is no time to diagnose the type of gulma, vata dosha should be managed first as it is prevalent in all types of gulma.

Considering the various clinical features of gulma it can be said that the majority of gulmas are non-inflammatory and non-malignant intra-abdominal swellings.  But some gulmas show indications of inflammatory swellings, some benign while some show the characteristics of malignant growths.  

Considering the various clinical features of gulma it can be said that the majority of gulmas are non-inflammatory and non-malignant intra-abdominal swellings.  But some gulmas show indications of inflammatory swellings, some benign while some show the characteristics of malignant growths.  

Vataja gulma-     

Vataja gulma-     

              Vataja gulma are mostly irregular, transitory swellings. These are accompanied with different intensities of colicky pain. Complications like inguinal swelling (bradhna roga) gurgling sound in the intestines (antrakoojana), fever/elevated temperature in the evenings,  splenomegaly (pleehavriddhi), difficulty in breathing, bodyache (angamarda), and headache are commonly in the advanced stages of gulma.  The above clinical features can be seen in chronic intestinal obstruction, intestinal tuberculosis, pyloric stenosis and in mobile caecum. Intestinal tuberculosis is a chronic condition with common symptoms including transitory nodules of varying sizes occuring due to partial intestinal obstruction, often accompanied with gurgling sounds from the abdomen, poor appetite, and evening fevers,  as seen in the advanced stages of vatika gulma. Mobile upper abdominal lump, with nausea and breathing difficulty are the features present in the case of pyloric stenosis. In mobile caecum there is also chronic progressive pain in the right flank and in the lower abdomen.  

 

Vataja gulma are mostly irregular, transitory swellings. These are accompanied with different intensities of colicky pain. Complications like inguinal swelling (bradhna roga) gurgling sound in the intestines (antrakoojana), fever/elevated temperature in the evenings,  splenomegaly (pleehavriddhi), difficulty in breathing, bodyache (angamarda), and headache are commonly in the advanced stages of gulma.  The above clinical features can be seen in chronic intestinal obstruction, intestinal tuberculosis, pyloric stenosis and in mobile caecum. Intestinal tuberculosis is a chronic condition with common symptoms including transitory nodules of varying sizes occuring due to partial intestinal obstruction, often accompanied with gurgling sounds from the abdomen, poor appetite, and evening fevers,  as seen in the advanced stages of vatika gulma. Mobile upper abdominal lump, with nausea and breathing difficulty are the features present in the case of pyloric stenosis. In mobile caecum there is also chronic progressive pain in the right flank and in the lower abdomen.  

 

Pittaja gulma-  

Pittaja gulma-  

            They are painful abdominal lumps characterised with fever, sweating, thirst, burning sensations and burning eructations. These features are suggestive of inflammatory and suppurative changes in the intra-abdominal lump. In due course of time, pittaja gulma develops yellow discoloration of nail, eyes and skin, fever, and vertigo as an added complication. These features can be seen in obstructive biliary tract.

 

They are painful abdominal lumps characterised with fever, sweating, thirst, burning sensations and burning eructations. These features are suggestive of inflammatory and suppurative changes in the intra-abdominal lump. In due course of time, pittaja gulma develops yellow discoloration of nail, eyes and skin, fever, and vertigo as an added complication. These features can be seen in obstructive biliary tract.

 

Kaphaja gulma-  

Kaphaja gulma-  

                  These are fixed, solid abdominal lumps associated with heaviness, vomiting, mild pain and poor appetite. Further, if the exposure to etiological factors is continued, the patient may develop cough, breathing difficulty and rajayakshma (tuberculosis) etc. Such swellings can be compared with solid tumours of the abdomen which may or may not be associated with obstructive features of the gastrointestinal tract.

 

These are fixed, solid abdominal lumps associated with heaviness, vomiting, mild pain and poor appetite. Further, if the exposure to etiological factors is continued, the patient may develop cough, breathing difficulty and rajayakshma (tuberculosis) etc. Such swellings can be compared with solid tumours of the abdomen which may or may not be associated with obstructive features of the gastrointestinal tract.

 

Sannipataja gulma –

Sannipataja gulma –

      These swellings are progressively increasing in size, fixed, deep rooted, covered with prominent veins, bulged out, and associated with weakness, nausea, vomiting, fever and thirst. Such features can be seen in malignant abdominal tumours.

 

These swellings are progressively increasing in size, fixed, deep rooted, covered with prominent veins, bulged out, and associated with weakness, nausea, vomiting, fever and thirst. Such features can be seen in malignant abdominal tumours.

 

Raktaja gulma-   

Raktaja gulma-   

        These exhibit symptoms similar to those of pregnancy, so it is essential to differentiate them from the point of view of treatment:

 

These exhibit symptoms similar to those of pregnancy, so it is essential to differentiate them from the point of view of treatment:

Raktaja gulma Garbha (Pregnancy)

Raktaja gulma Garbha (Pregnancy)

Slight movement may be present in later stage  

Slight movement may be present in later stage  

It may be associated with fever, cough, pain etc.        Presence of other constitutional features of pregnancy, including bodily changes

It may be associated with fever, cough, pain etc.        Presence of other constitutional features of pregnancy, including bodily changes

        The features of Hydatidiform mole  and chorionic carcinoma closely resemble the  features of raktaja gulma.

The features of Hydatidiform mole  and chorionic carcinoma closely resemble the  features of raktaja gulma.

A study was conducted in 50 patients of abdominal swellings,  gulmas were analysed using clinical tests and radio-imaging techniques such as plain X ray abdomen, Barium studies, USG, intra-operative findings and HPE of the lumps.  

A study was conducted in 50 patients of abdominal swellings,  gulmas were analysed using clinical tests and radio-imaging techniques such as plain X ray abdomen, Barium studies, USG, intra-operative findings and HPE of the lumps.  

o The study showed that vataja gulma has chronic obstructive lesions associated with gastrointestinal tract as in the cases of intestinal tuberculosis, pyloric obstruction due to carcinoma of the stomach, etc.

o The study showed that vataja gulma has chronic obstructive lesions associated with gastrointestinal tract as in the cases of intestinal tuberculosis, pyloric obstruction due to carcinoma of the stomach, etc.

o Raktaja gulma features are found in hydatidiform mole and chorio-carcinoma.

o Raktaja gulma features are found in hydatidiform mole and chorio-carcinoma.

Researches done: 

=== Researches done ===

 

Thesis work done- Ultrasonographic and other radiological investigative studies on gulma in relation to malignancy (Kumar Satish et al in 1986).

Thesis work done- Ultrasonographic and other radiological investigative studies on gulma in relation to malignancy (Kumar Satish et al in 1986).

Books –

=== Books ===

 

• Caraka Samhita translation by Acharya P. V. Sharma.  

• Caraka Samhita translation by Acharya P. V. Sharma.  

• Caraka Samhita translation by Acharya Bhagvanadasa.  

• Caraka Samhita translation by Acharya Bhagvanadasa.  

• Madhavanidana- gulmanidana

• Madhavanidana- gulmanidana

      Glossary-

=== Glossary ===

• guLm (phonetic:gulma ; Sanskrit: xwYe) Lump in abdomen : A lump like formation occurring in the abdomen either mobile or static in nature, circular in shape and constantly increasing and decreasing in size.

• guLm (phonetic:gulma ; Sanskrit: xwYe) Lump in abdomen : A lump like formation occurring in the abdomen either mobile or static in nature, circular in shape and constantly increasing and decreasing in size.

cōpaśērata

cōpaśērata

 

=== References ===

 

References: