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Line 2,400: − • Gulma occurs predominantly due to excessive excretion of faeces, kapha and pitta or due to pressure exerted by their excessive aggravation and other causes leading to vitiation of vata dosha.+ − • Cavities like that in urinary bladder (hypo gastric region), umbilical region (nabhi), cardiac region (hrudi) and two flanks (parshva) are susceptible sites for gulma.+ − • All gulma are treated after consideration of dosha dominance, stage, site and strength of patient. + − • Internal administration of sneha (unctuous substance) in various modes like oral administration, massage, unctuous enema is the principle of management of vata dominant gulma. + − • If pitta gulma is caused due to unctuous and hot substances, then virechana shall be administered. If it is caused by dry and hot substances, then ghee shall be administered. + − • If Kapha-gulma is caused by indulgence in cold, heavy and unctuous diet and in those not eligible for vamana, langhana (depletion) therapy should be prescribed in the beginning. Vamana is indicated in a patient of gulma who is having low digestion, anorexia, nausea and mild pain, heaviness and stiffness in abdomen.+ − • Kapha gulma is treated with langhana, agni dipana, swedana, vamana, snehana, kshara karma and agni karma.+ − • If kapha-gulma has a deep root and is large in size, hard in consistency and heavy, then the patient should be treated with alkali preparation-kshara, arishta and agni karma (cauterization).+ − • With decrease in digestive-power (agni) the gulma is aggravated, while on augmentation of the digestion (agni) the gulma is pacified. Therefore, to the patient of gulma neither excessive nutritional food nor excessive fasting or light food/treatment should be prescribed (112).+ − • Pitta gulma requires immediate treatment (atyayika) and the patient should be given ghee prepared with purgative and bitter drugs (114).+ − • Equilibrium or provocation of all the dosha depend upon the condition of agni (digestion and metabolism), hence one should always take its care and avoid such causes which disturb it.+ − • Vamana karma should be done in kapha gulma provided the patient is fit for it. + − • The excessively increased stage of gulma needs surgical intervention. + − • The gulma which gradually goes on increasing, spreading over a large area, has taken firm root, is covered by veins, has convex surface like that of tortoise, and which is accompanied with weakness, anorexia, thirst, nausea, vomiting, fever, cough, coryza and drowsiness is considered malignant and as incurable.+ − • Rakta gulma should be treated only after observation for 10 months. This waiting period is essential for achieving a stage suitable for intervention. The patient should be given unctuous virechana after preparing with snehana and swedana.+
→Tattva Vimarsha
=== ''Tattva Vimarsha'' ===
=== ''Tattva Vimarsha'' ===
*Gulma occurs predominantly due to excessive excretion of faeces, kapha and pitta or due to pressure exerted by their excessive aggravation and other causes leading to vitiation of vata dosha.
*Cavities like that in urinary bladder (hypo gastric region), umbilical region (nabhi), cardiac region (hrudi) and two flanks (parshva) are susceptible sites for gulma.
*All gulma are treated after consideration of dosha dominance, stage, site and strength of patient.
*Internal administration of sneha (unctuous substance) in various modes like oral administration, massage, unctuous enema is the principle of management of vata dominant gulma.
*If pitta gulma is caused due to unctuous and hot substances, then virechana shall be administered. If it is caused by dry and hot substances, then ghee shall be administered.
*If Kapha-gulma is caused by indulgence in cold, heavy and unctuous diet and in those not eligible for vamana, langhana (depletion) therapy should be prescribed in the beginning. Vamana is indicated in a patient of gulma who is having low digestion, anorexia, nausea and mild pain, heaviness and stiffness in abdomen.
*Kapha gulma is treated with langhana, agni dipana, swedana, vamana, snehana, kshara karma and agni karma.
*If kapha-gulma has a deep root and is large in size, hard in consistency and heavy, then the patient should be treated with alkali preparation-kshara, arishta and agni karma (cauterization).
*With decrease in digestive-power (agni) the gulma is aggravated, while on augmentation of the digestion (agni) the gulma is pacified. Therefore, to the patient of gulma neither excessive nutritional food nor excessive fasting or light food/treatment should be prescribed (112).
*Pitta gulma requires immediate treatment (atyayika) and the patient should be given ghee prepared with purgative and bitter drugs (114).
*Equilibrium or provocation of all the dosha depend upon the condition of agni (digestion and metabolism), hence one should always take its care and avoid such causes which disturb it.
*Vamana karma should be done in kapha gulma provided the patient is fit for it.
*The excessively increased stage of gulma needs surgical intervention.
*The gulma which gradually goes on increasing, spreading over a large area, has taken firm root, is covered by veins, has convex surface like that of tortoise, and which is accompanied with weakness, anorexia, thirst, nausea, vomiting, fever, cough, coryza and drowsiness is considered malignant and as incurable.
*Rakta gulma should be treated only after observation for 10 months. This waiting period is essential for achieving a stage suitable for intervention. The patient should be given unctuous virechana after preparing with snehana and swedana.
=== ''Vidhi Vimarsha'' ===
=== ''Vidhi Vimarsha'' ===