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→Causative factors of rakta gulma
saMstambhanollekhanayonidoShairgulmaH striyaM raktabhavo~abhyupaiti||18||
saMstambhanollekhanayonidoShairgulmaH striyaM raktabhavo~abhyupaiti||18||
During ritu-kala (ovulation period) if a woman does fasting or takes dry food articles or indulges in fear and suppression of natural urges; or misuses styptic (stambhana) drugs i.e. try to stop the menstrual bleeding; improper conduction of vomiting therapy and disorders of genital organs, all these may lead to formation of rakta gulma in woman (18).
During ritu-kala (ovulation period) if a woman does fasting or takes dry food articles or indulges in fear and suppression of natural urges; or misuses styptic (stambhana) drugs i.e. try to stop the menstrual bleeding; improper conduction of vomiting therapy and disorders of genital organs, all these may lead to formation of rakta gulma in woman [18]
Symptoms of rakta gulma:
==== Symptoms of rakta gulma ====
यः स्पन्दते पिण्डित एव नाङ्गैश्चिरात् सशूलः समगर्भलिङ्गः|
यः स्पन्दते पिण्डित एव नाङ्गैश्चिरात् सशूलः समगर्भलिङ्गः|
स रौधिरः स्त्रीभव एव गुल्मो मासे व्यतीते दशमे चिकित्स्यः||१९||
स रौधिरः स्त्रीभव एव गुल्मो मासे व्यतीते दशमे चिकित्स्यः||१९||
yaH spandate piNDita eva nA~ggaishcirAt sashUlaH samagarbhali~ggaH|
yaH spandate piNDita eva nA~ggaishcirAt sashUlaH samagarbhali~ggaH|
sa raudhiraH strIbhava eva gulmo mAse vyatIte dashame cikitsyaH||19||
sa raudhiraH strIbhava eva gulmo mAse vyatIte dashame cikitsyaH||19||
The lump slowly grows in the form of round mass which has pulsation as a whole but not in its part. It is associated with acute pain and signs and symptoms mimicking pregnancy. Raktaja gulma occurs only in women and should be treated after the completion of ten months (19).
The lump slowly grows in the form of round mass which has pulsation as a whole but not in its part. It is associated with acute pain and signs and symptoms mimicking pregnancy. Raktaja gulma occurs only in women and should be treated after the completion of ten months [19]
क्रियाक्रममतः सिद्धं गुल्मिनां गुल्मनाशनम्|
क्रियाक्रममतः सिद्धं गुल्मिनां गुल्मनाशनम्|
प्रवक्ष्याम्यत ऊर्ध्वं च योगान् गुल्मनिबर्हणान्||२०||
प्रवक्ष्याम्यत ऊर्ध्वं च योगान् गुल्मनिबर्हणान्||२०||
pravakShyAmyata UrdhvaM ca yogAn gulmanibarhaNAn||20||
pravakShyAmyata UrdhvaM ca yogAn gulmanibarhaNAn||20||
Now onward first the successful line of treatment shall be described for the cure of gulma. Thereafter, the remedies and recipes for its cure shall be described (20).
Now onward first the successful line of treatment shall be described for the cure of gulma. Thereafter, the remedies and recipes for its cure shall be described [20]
Treatment of Vata-Gulma:
==== Treatment of Vata-Gulma ====
रूक्षव्यायामजं गुल्मं वातिकं तीव्रवेदनम्|
रूक्षव्यायामजं गुल्मं वातिकं तीव्रवेदनम्|
बद्धविण्मारुतं स्नेहैरादितः समुपाचरेत्||२१||
बद्धविण्मारुतं स्नेहैरादितः समुपाचरेत्||२१||
rUkShavyAyAmajaM gulmaM vAtikaM tIvravedanam|
rUkShavyAyAmajaM gulmaM vAtikaM tIvravedanam|
baddhaviNmArutaM snehairAditaH samupAcaret||21||
baddhaviNmArutaM snehairAditaH samupAcaret||21||
As vata gulma is produced due to excessive dryness and exercise and is associated with severe pain and retention of faeces and flatus, therefore in the beginning snehana (unctuous) therapy should be prescribed (21).
Snehana for vata-gulma:
As vata gulma is produced due to excessive dryness and exercise and is associated with severe pain and retention of faeces and flatus, therefore in the beginning snehana (unctuous) therapy should be prescribed [21]
==== Snehana for vata-gulma ====
भोजनाभ्यञ्जनैः पानैर्निरूहैः सानुवासनैः|
भोजनाभ्यञ्जनैः पानैर्निरूहैः सानुवासनैः|
स्निग्धस्य भिषजा स्वेदः कर्तव्यो गुल्मशान्तये||२२||
स्निग्धस्य भिषजा स्वेदः कर्तव्यो गुल्मशान्तये||२२||
bhojanAbhya~jjanaiH pAnairnirUhaiH sAnuvAsanaiH|
bhojanAbhya~jjanaiH pAnairnirUhaiH sAnuvAsanaiH|
snigdhasya bhiShajA svedaH kartavyo gulmashAntaye||22||
snigdhasya bhiShajA svedaH kartavyo gulmashAntaye||22||
Snehana is performed by administration of unctuous substances in the form of food and drink, oil massage and anuvasana basti along with niruha basti. After proper snehana, physician should subject the patient to swedana therapy (22).
Snehana is performed by administration of unctuous substances in the form of food and drink, oil massage and anuvasana basti along with niruha basti. After proper snehana, physician should subject the patient to swedana therapy [22]
Benefit of swedana therapy for vata-gulma:
==== Benefit of swedana therapy for vata-gulma ====
स्रोतसां मार्दवं कृत्वा जित्वा मारुतमुल्बणम्|
स्रोतसां मार्दवं कृत्वा जित्वा मारुतमुल्बणम्|
भित्त्वा विबन्धं स्निग्धस्य स्वेदो गुल्ममपोहति||२३||
भित्त्वा विबन्धं स्निग्धस्य स्वेदो गुल्ममपोहति||२३||
srotasAM mArdavaM kRutvA jitvA mArutamulbaNam|
srotasAM mArdavaM kRutvA jitvA mArutamulbaNam|
bhittvA vibandhaM snigdhasya svedo gulmamapohati||23||
bhittvA vibandhaM snigdhasya svedo gulmamapohati||23||
Swedana therapy administered to a patient who has already undergone oil massage produces softness in the channels leading to alleviation of vata. Thus by breaking the obstruction and opening the channels the vata-gulma is cured (23).
Mode of Administration of sneha according to sites of vata gulma:
Swedana therapy administered to a patient who has already undergone oil massage produces softness in the channels leading to alleviation of vata. Thus by breaking the obstruction and opening the channels the vata-gulma is cured [23]
==== Mode of Administration of sneha according to sites of vata gulma ====
स्नेहपानं हितं गुल्मे विशेषेणोर्ध्वनाभिजे|
स्नेहपानं हितं गुल्मे विशेषेणोर्ध्वनाभिजे|
पक्वाशयगते बस्तिरुभयं जठराश्रये||२४||
पक्वाशयगते बस्तिरुभयं जठराश्रये||२४||
snehapAnaM hitaM gulme visheSheNordhvanAbhije|
snehapAnaM hitaM gulme visheSheNordhvanAbhije|
pakvAshayagate bastirubhayaM jaTharAshraye||24||
pakvAshayagate bastirubhayaM jaTharAshraye||24||
Oral administration of unctuous substances is beneficial in vata gulma particularly if it is situated above the umbilicus i.e. in stomach. Anuvasana (unctuous) basti is beneficial if gulma is situated in colon and both oral administration of unctuous substances and unctuous basti are beneficial if it is situated in the middle of jathara i.e. in small intestine (24).
Oral administration of unctuous substances is beneficial in vata gulma particularly if it is situated above the umbilicus i.e. in stomach. Anuvasana (unctuous) basti is beneficial if gulma is situated in colon and both oral administration of unctuous substances and unctuous basti are beneficial if it is situated in the middle of jathara i.e. in small intestine [24]
दीप्तेऽग्नौ वातिके गुल्मे विबन्धेऽनिलवर्चसोः|
दीप्तेऽग्नौ वातिके गुल्मे विबन्धेऽनिलवर्चसोः|
बृंहणान्यन्नपानानि स्निग्धोष्णानि प्रयोजयेत्||२५||
बृंहणान्यन्नपानानि स्निग्धोष्णानि प्रयोजयेत्||२५||
dIpte~agnau vAtike gulme vibandhe~anilavarcasoH|
dIpte~agnau vAtike gulme vibandhe~anilavarcasoH|
bRuMhaNAnyannapAnAni snigdhoShNAni prayojayet||25||
bRuMhaNAnyannapAnAni snigdhoShNAni prayojayet||25||
In vata gulma if the retention of faeces and flatus is present but digestion is good then unctuous, hot and nourishing (brumhana) diet and drinks should be given (25).
Repeated basti in vata gulma:
In vata gulma if the retention of faeces and flatus is present but digestion is good then unctuous, hot and nourishing (brumhana) diet and drinks should be given [25]
==== Repeated basti in vata gulma ====
पुनः पुनः स्नेहपानं निरूहाः सानुवासनाः|
पुनः पुनः स्नेहपानं निरूहाः सानुवासनाः|
प्रयोज्या वातगुल्मेषु कफपित्तानुरक्षिणा||२६||
प्रयोज्या वातगुल्मेषु कफपित्तानुरक्षिणा||२६||
prayojyA vAtagulmeShu kaphapittAnurakShiNA||26||
prayojyA vAtagulmeShu kaphapittAnurakShiNA||26||
In vata gulma repeated use of unctuous drink and alternative use of anuvasana (unctuous) and niruha (un-unctuous) basti are advised in taking care of kapha and pitta (26).
In vata gulma repeated use of unctuous drink and alternative use of anuvasana (unctuous) and niruha (un-unctuous) basti are advised in taking care of kapha and pitta [26]
कफो वाते जितप्राये पित्तं शोणितमेव वा|
कफो वाते जितप्राये पित्तं शोणितमेव वा|
yatholbaNasya doShasya tatra kAryaM bhiShagjitam|
yatholbaNasya doShasya tatra kAryaM bhiShagjitam|
AdAvante ca madhye ca mArutaM parirakShatA||28||
AdAvante ca madhye ca mArutaM parirakShatA||28||
During the treatment when vata has almost subsided but kapha, pitta or rakta gets provoked, then routine treatment of these provoked dosha should be done. In this condition, the treatment should be according to the predominance of dosha but care should be taken to protect vata in the beginning, middle and at the end of the treatment (27-28).
Vamana in vata gulma:
During the treatment when vata has almost subsided but kapha, pitta or rakta gets provoked, then routine treatment of these provoked dosha should be done. In this condition, the treatment should be according to the predominance of dosha but care should be taken to protect vata in the beginning, middle and at the end of the treatment [27-28]
==== Vamana in vata gulma ====
वातगुल्मे कफो वृद्धो हत्वाऽग्निमरुचिं यदि|
वातगुल्मे कफो वृद्धो हत्वाऽग्निमरुचिं यदि|
हृल्लासं गौरवं तन्द्रां जनयेदुल्लिखेत्तु तम्||२९||
हृल्लासं गौरवं तन्द्रां जनयेदुल्लिखेत्तु तम्||२९||
vAtagulme kapho vRuddho hatvA~agnimaruciM yadi|
vAtagulme kapho vRuddho hatvA~agnimaruciM yadi|
hRullAsaM gauravaM tandrAM janayedullikhettu tam||29||
hRullAsaM gauravaM tandrAM janayedullikhettu tam||29||
In vata gulma if kapha gets increased, it causes diminution in digestion leading to anorexia, nausea, heaviness and sleepiness; such condition should be treated with vamana therapy (29).
In vata gulma if kapha gets increased, it causes diminution in digestion leading to anorexia, nausea, heaviness and sleepiness; such condition should be treated with vamana therapy [29]
शूलानाहविबन्धेषु गुल्मे वातकफोल्बणे|
शूलानाहविबन्धेषु गुल्मे वातकफोल्बणे|
वर्तयो गुटिकाश्चूर्णं कफवातहरं हितम्||३०||
वर्तयो गुटिकाश्चूर्णं कफवातहरं हितम्||३०||
shUlAnAhavibandheShu gulme vAtakapholbaNe|
shUlAnAhavibandheShu gulme vAtakapholbaNe|
vartayo guTikAshcUrNaM kaphavAtaharaM hitam||30||
vartayo guTikAshcUrNaM kaphavAtaharaM hitam||30||
In vata-kapha dominant gulma if there is acute pain, distension of abdomen and constipation then it should be treated with suppositories, pills and powders which are prepared from vata and kapha pacifying drugs (30).
Virechana in vata gulma:
In vata-kapha dominant gulma if there is acute pain, distension of abdomen and constipation then it should be treated with suppositories, pills and powders which are prepared from vata and kapha pacifying drugs [30]
==== Virechana in vata gulma ====
पित्तं वा यदि संवृद्धं सन्तापं वातगुल्मिनः|
पित्तं वा यदि संवृद्धं सन्तापं वातगुल्मिनः|
कुर्याद्विरेच्यः स भवेत् सस्नेहैरानुलोमिकैः||३१||
कुर्याद्विरेच्यः स भवेत् सस्नेहैरानुलोमिकैः||३१||
pittaM vA yadi saMvRuddhaM santApaM vAtagulminaH|
pittaM vA yadi saMvRuddhaM santApaM vAtagulminaH|
kuryAdvirecyaH sa bhavet sasnehairAnulomikaiH||31||
kuryAdvirecyaH sa bhavet sasnehairAnulomikaiH||31||
In vata gulma if increased pitta causes burning sensation then virechana should be done with laxative drugs mixed with unctuous substances (31).
In vata gulma if increased pitta causes burning sensation then virechana should be done with laxative drugs mixed with unctuous substances [31]
Blood-letting in vata gulma:
==== Blood-letting in vata gulma ====
गुल्मो यद्यनिलादीनां कृते सम्यग्भिषग्जिते|
गुल्मो यद्यनिलादीनां कृते सम्यग्भिषग्जिते|
न प्रशाम्यति रक्तस्य सोऽवसेकात् प्रशाम्यति||३२||
न प्रशाम्यति रक्तस्य सोऽवसेकात् प्रशाम्यति||३२||
gulmo yadyanilAdInAM kRute samyagbhiShagjite|
gulmo yadyanilAdInAM kRute samyagbhiShagjite|
na prashAmyati raktasya so~avasekAt prashAmyati||32||
na prashAmyati raktasya so~avasekAt prashAmyati||32||
If gulma does not subside even after proper treatment of vata etc. mentioned above then bloodletting is advised to cure it (32).
If gulma does not subside even after proper treatment of vata etc. mentioned above then bloodletting is advised to cure it [32]
Treatment of pitta dominant gulma:
==== Treatment of pitta dominant gulma ====
स्निग्धोष्णेनोदिते गुल्मे पैत्तिके स्रंसनं हितम्|
स्निग्धोष्णेनोदिते गुल्मे पैत्तिके स्रंसनं हितम्|
rUkShoShNena tu sambhUte sarpiH prashamanaM param||33||
rUkShoShNena tu sambhUte sarpiH prashamanaM param||33||
If pitta gulma is caused by indulging in unctuous and hot substances then virechana is beneficial. But if it is caused by indulging in dry and hot substances then ghee is a choice of drug (33).
If pitta gulma is caused by indulging in unctuous and hot substances then virechana is beneficial. But if it is caused by indulging in dry and hot substances then ghee is a choice of drug [33]
पित्तं वा पित्तगुल्मं वा ज्ञात्वा पक्वाशयस्थितम्|
पित्तं वा पित्तगुल्मं वा ज्ञात्वा पक्वाशयस्थितम्|
payasA vA sukhoShNena satiktena virecayet|
payasA vA sukhoShNena satiktena virecayet|
bhiShagagnibalApekShI sarpiShA tailvakena vA||35||
bhiShagagnibalApekShI sarpiShA tailvakena vA||35||
If pitta or pitta-gulma is situated in colon, the physician expert in proper and timely treatment should eliminate it by giving kshira-basti mixed with bitter drugs immediately. The physician aiming to increase the digestive power should perform virechana with milk mixed with bitter drugs or with tilvaka ghrita (34-35).
If pitta or pitta-gulma is situated in colon, the physician expert in proper and timely treatment should eliminate it by giving kshira-basti mixed with bitter drugs immediately. The physician aiming to increase the digestive power should perform virechana with milk mixed with bitter drugs or with tilvaka ghrita [34-35]
Blood-letting in pitta dominant gulma:
==== Blood-letting in pitta dominant gulma ====
तृष्णाज्वरपरीदाहशूलस्वेदाग्निमार्दवे|
तृष्णाज्वरपरीदाहशूलस्वेदाग्निमार्दवे|
गुल्मिनामरुचौ चापि रक्तमेवावसेचयेत्||३६||
गुल्मिनामरुचौ चापि रक्तमेवावसेचयेत्||३६||
gulminAmarucau cApi raktamevAvasecayet||36||
gulminAmarucau cApi raktamevAvasecayet||36||
The patient of pitta-gulma if having thirst, fever, burning sensation, pain, perspiration, impaired digestion and anorexia is treated with bloodletting (36).
The patient of pitta-gulma if having thirst, fever, burning sensation, pain, perspiration, impaired digestion and anorexia is treated with bloodletting [36]
छिन्नमूला विदह्यन्ते न गुल्मा यान्ति च क्षयम्|
छिन्नमूला विदह्यन्ते न गुल्मा यान्ति च क्षयम्|
रक्तं हि व्यम्लतां याति, तच्च नास्ति न चास्ति रुक्||३७||
रक्तं हि व्यम्लतां याति, तच्च नास्ति न चास्ति रुक्||३७||
chinnamUlA vidahyante na gulmA yAnti ca kShayam|
chinnamUlA vidahyante na gulmA yAnti ca kShayam|
raktaM hi vyamlatAM yAti, tacca nAsti na cAsti ruk||37||
raktaM hi vyamlatAM yAti, tacca nAsti na cAsti ruk||37||
Provoked rakta is responsible for inflammation (Vidaha) which is removed by bloodletting; thus when root-cause is removed then there will be no inflammation resulting in vanishing of swelling and pain (37).
Provoked rakta is responsible for inflammation (Vidaha) which is removed by bloodletting; thus when root-cause is removed then there will be no inflammation resulting in vanishing of swelling and pain [37]
Diet after blood-letting:
==== Diet after blood-letting ====
हृतदोषं परिम्लानं जाङ्गलैस्तर्पितं रसैः|
हृतदोषं परिम्लानं जाङ्गलैस्तर्पितं रसैः|
समाश्वस्तं सशेषार्तिं सर्पिरभ्यासयेत् पुनः||३८||
समाश्वस्तं सशेषार्तिं सर्पिरभ्यासयेत् पुनः||३८||
ityagniveshakRute tantre carakapratisaMskRute cikitsitasthAne
ityagniveshakRute tantre carakapratisaMskRute cikitsitasthAne
gulmacikitsitaM nAma pa~jcamo~adhyAyaH||5||
gulmacikitsitaM nAma pa~jcamo~adhyAyaH||5||
Thus fifth chapter named Gulamchikitstam in Chikitsa Sthana in the treatise compiled by Agnivesha and revised by Charaka is completed (5).
Thus fifth chapter named Gulamchikitstam in Chikitsa Sthana in the treatise compiled by Agnivesha and revised by Charaka is completed (5).
=== ''Tattva Vimarsha'' ===
=== ''Tattva Vimarsha'' ===