Changes

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

#'''''Bheda'''''-When the ''gulma'' is not treated at the fourth and fifth stage, complications like ''bradhna roga'' (inguinal swelling), ''jwara'' (fever), ''vidbheda'' (loose stools/diarrhea), 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 [[Sharira Sthana]].''Vata gulma'' most commonly occurs in ''basti'', while ''pitta gulma'' occurs most commonly in the ''nabhi'' region, and ''kapha gulma'' 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

Granthi gulma Nabhi umbilical region Not mentioned Not mentioned Not mentioned Same

Granthi gulma Nabhi umbilical region Not mentioned Not mentioned Not mentioned Same

Prognosis –Sannipatika gulma is incurable, rest four are curable when treated timely.  

Prognosis –''Sannipatika gulma'' is incurable, rest four are curable when treated timely.  

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.  

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.  

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-