Changes

ityagniveshakRute tantre tantre carakapratisaMskRute nidAnasthAne gulmanidAnaM nAma tRutIyo~adhyAyaH||3||

ityagniveshakRute tantre tantre carakapratisaMskRute nidAnasthAne gulmanidAnaM nAma tRutIyo~adhyAyaH||3||

Thus ends the third chapter on the diagnosis of ''gulma'' in the treatise composed by Agnivesha and redacted by Charaka.

Thus ends the third chapter on the diagnosis of ''gulma'' in the treatise composed by Agnivesha and redacted by Charak.

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

==== Etiopathogenesis of ''gulma'' ====

==== Etiopathogenesis of ''gulma'' ====

In [[Charaka Samhita]], vitiated ''vata dosha'' is considered as major etiological factor for the development of any type of ''gulma''.<ref>CH Chi 28/58</ref> Among the five types of ''vata'' mentioned in [[Charaka Samhita]], vitiated ''apana'' and/or ''samana vata'' seem to be the primary etiological factors of ''gulma'', since these are mainly responsible for the normal physiological functions of ''mahastrotas''. The prodromal symptoms of ''gulma'' also point towards these two e.g. aversion to food, anorexia, and diminished urge to pass flatus, urine and feces.  

In [[Charak Samhita]], vitiated ''vata dosha'' is considered as major etiological factor for the development of any type of ''gulma''.<ref>CH Chi 28/58</ref> Among the five types of ''vata'' mentioned in [[Charak Samhita]], vitiated ''apana'' and/or ''samana vata'' seem to be the primary etiological factors of ''gulma'', since these are mainly responsible for the normal physiological functions of ''mahastrotas''. The prodromal symptoms of ''gulma'' also point towards these two e.g. aversion to food, anorexia, and diminished urge to pass flatus, urine and feces.  

In  [[Chikitsa Sthana]], Charaka states that ''vata'' gets vitiated by two basic means i.e. ''dhatukshaya'' (tissue wasting) and ''margavarana'' (obstruction).  The etiology given in this chapter could also include excess consumption of food with ''ruksha guna'', trauma and faulty ''shodhana'' procedures, excessive loss of ''mala'' and ''dhatu'' responsible for ''dhatukshaya'' and various other factors that vitiate ''doshas'' and ''mala'' causing obstruction of different channels, further aggravating ''vata''.

In  [[Chikitsa Sthana]], Charak states that ''vata'' gets vitiated by two basic means i.e. ''dhatukshaya'' (tissue wasting) and ''margavarana'' (obstruction).  The etiology given in this chapter could also include excess consumption of food with ''ruksha guna'', trauma and faulty ''shodhana'' procedures, excessive loss of ''mala'' and ''dhatu'' responsible for ''dhatukshaya'' and various other factors that vitiate ''doshas'' and ''mala'' causing obstruction of different channels, further aggravating ''vata''.

While analysing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''doshas'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''doshas'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further  that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear.  

While analysing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''doshas'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''doshas'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further  that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear.  

Also, in the absence of any ''dushya'' (''dhatu'' and ''mala''), these swellings are commonly non-suppurative in nature.<ref>Su Utt 42/6-7</ref> There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charaka has mentioned that suppuration may takes place in ''pittaja gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), ''pachyamana'' (intermediary stage) and ''pakwa awastha'' (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''pitta gulma'' is not treated timely, ''pitta dosha'' and ''rakta dhatu'' get aggravated (together or separately), and involves the deeper structure (''kritmulam'').

Also, in the absence of any ''dushya'' (''dhatu'' and ''mala''), these swellings are commonly non-suppurative in nature.<ref>Su Utt 42/6-7</ref> There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charak has mentioned that suppuration may takes place in ''pittaja gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), ''pachyamana'' (intermediary stage) and ''pakwa awastha'' (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''pitta gulma'' is not treated timely, ''pitta dosha'' and ''rakta dhatu'' get aggravated (together or separately), and involves the deeper structure (''kritmulam'').

==== ''Shadkriyakala'' (lifecycle) of ''Gulma'' ====

==== ''Shadkriyakala'' (lifecycle) of ''Gulma'' ====

With respect to the ''adhishthana'' (location) of ''gulma'', five major sites have been mentioned<ref>CH. Chi. 5/8</ref>, 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 ''pittagulma'' occurs most commonly in the ''nabhi'' region, and ''kaphagulma'' in the ''hridaya'' and ''parshwadwaya'' regions.<ref>Vagbhata Gulma Nidana</ref> 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''.<ref>Harita samhita gulma nidana</ref>  

With respect to the ''adhishthana'' (location) of ''gulma'', five major sites have been mentioned<ref>CH. Chi. 5/8</ref>, 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 ''pittagulma'' occurs most commonly in the ''nabhi'' region, and ''kaphagulma'' in the ''hridaya'' and ''parshwadwaya'' regions.<ref>Vagbhata Gulma Nidana</ref> 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''.<ref>Harita samhita gulma nidana</ref>  

The pathogenesis of ''pittaja'' and ''kaphaja gulma'' takes place in ''amashaya'' that lies in the region between ''hridaya'' and ''basti''.<ref>Chakrapani commentary on Charaka gulma sites</ref>. 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''.<ref>Chakrapani commentary on Charak gulma sites</ref>. 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:

{|class = "wikitable"

{|class = "wikitable"

!scope = "col"| ''Adhisthana''

!scope = "col"| ''Adhisthana''

!scope = "col"| Anatomical site

!scope = "col"| Anatomical site

!scope = "col"| ''Charaka''

!scope = "col"| ''Charak''

!scope = "col"| ''Sushruta''

!scope = "col"| ''Sushruta''

!scope = "col"| ''Vagbhata''

!scope = "col"| ''Vagbhata''

=== Reference Books ===

=== Reference Books ===

*[[Charaka Samhita]], translation by Acharya P. V. Sharma.  

*[[Charak Samhita]], translation by Acharya P. V. Sharma.  

*[[Charaka Samhita]], translation by Acharya Bhagvanadasa.  

*[[Charak Samhita]], translation by Acharya Bhagvanadasa.  

*Sushruta Samhita Uttaratantra 42.

*Sushruta Samhita Uttaratantra 42.

*Ashtanga Hridaya Nidana Sthana 11.

*Ashtanga Hridaya Nidana Sthana 11.