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Gulma Nidana (view source)

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|title=Gulma Nidana

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|keywords=Gulma, mahasrotas, koshtha, dhatukshaya, avarana, abdominal lumps, intra-abdominal swellings, tumors

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|keywords=Gulma, mahasrotas, koshtha, dhatukshaya, avarana, abdominal lumps, intra-abdominal swellings, tumors", charak samhita, ayurveda

|description=Nidana Sthana Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps

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=== Introduction ===

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== Introduction ==

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While there are ''gulma'' variants like ''paittika'' and ''kaphaja gulma'' caused by an excess of ''pitta'' and ''kapha'' respectively, it is essentially a ''vata'' disorder. ''Sannipatika gulma'' is caused due to the vitiation of all the three ''doshas''. Since abdominal organs have ''mamsadhatu'' as the main component, all the ''siragranthi'' (glandular/tumorous) types of ''srotodushti'' (vitiation of channels carrying body components) of abdominal viscera have also been covered under ''gulma''. This chapter also covers obstruction and inflammation of viscera having no swelling.

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===Sanskrit Text, Transliteration and English Translation===

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==Sanskrit Text, Transliteration and English Translation==

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Now I shall ~~explain~~ the chapter ~~on etiopathogenesis~~ of ~~''gulma''~~. Thus said Lord Atreya.[1-2]

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Now we shall expound the chapter "Gulma Nidana"(Diagnosis and etio-pathogenesis of Abdominal lumps). Thus said Lord Atreya.[1-2]

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==== Classification of ''gulma'' ====

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=== Classification of ''gulma'' ===

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There are five types of ''gulma''- ''vata'' dominant ''gulma'', ''pitta'' dominant ''gulma'', ''shleshma''/''kapha'' dominant ''gulma'', ''nichaya'' (''tridosha'' dominant) ''gulma'', and ''shonita gulma''.[3]

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==== Agnivesha’s question ====

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=== Agnivesha’s question ===

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Lord Atreya replied, “Agnivesha! Specific characteristics of the five ''gulma'' as well as other diseases are defined on the basis of their etiology, prodromal symptoms, clinical features with various types of pains, and therapeutic applicability.”[5]

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==== Etio-pathogenesis of ''vata''-dominant ''gulma'' ====

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=== Etio-pathogenesis of ''vata''-dominant ''gulma'' ===

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Such vitiated ''vata'', on entering the ''mahasrotas'', hardens due to dryness forming a mass or swelling localised in the regions of heart, urinary bladder, sides and the navel. The condition, ''gulma'' (or ''vata gulma''), is painful and can take the shape of a single swelling or multiple nodules of various types. It sometimes gets aggravated and enlarged, sometimes diminished, and causes mild or severe pain due to instability of ''vayu''. Sometimes there are tingling sensations like ants crawling on body and frequent onset and diminution of various types of painful sensations such as piercing, breaking, twitching, extension, contraction, numbness, hyperaesthesia, etc. These sensations could be accompanied by a rise in temperature usually in the evenings, dryness of mouth, difficulty in expiration, horripilation at the onset of pain and complications such as spleen (enlargement), distension and gurgling sound in the abdomen, indigestion, ''udavarta'' (upward movement of ''vata''), bodyache, pain in the lateral side of the neck, head and temple regions and ''bradhana'' (swellings of the inguinal region) with appearance of blackness, reddishness and roughness in skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. These are characteristic features of ''vata gulma''. [7]

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==== ''Pitta''-dominant ''gulma'' ====

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=== ''Pitta''-dominant ''gulma'' ===

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Aggravated ''vata'', along with vitiated ''pitta'', gets (completely or partially) collected in the ''amashaya'' and produces the same types of pain as mentioned for ''vata gulma''. Due to aggravation of ''pitta'' in certain cases, the patient feels a burning sensation (with hyperacidity) in the belly, cardiac region, chest and throat while letting out smoky and sour eructations at the same time. In the location of ''gulma'', there is burning sensation, pain, sensations of fuming, sweating and moistening, laxity, tenderness and slight horripilation. The patient could exhibit symptoms such as fever, giddiness, burning pain, thirst, dryness of throat, palate and mouth, fainting and diarrhea, and develops greenish or yellowish discoloration of skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. This variant of ''gulma'' is called ''pitta gulma''. [9]

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==== ''Kapha''-dominant ''gulma'' ====

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=== ''Kapha''-dominant ''gulma'' ===

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==== ''Tridosha'' dominant ''gulma'' ====

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=== ''Tridosha'' dominant ''gulma'' ===

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When the symptoms of three ''doshas'' are exhibited, a ''gulma'' patient is said to be ailing from ''sannipatika gulma''. This condition is incurable. [12]

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==== ''Shonita gulma'' ====

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=== ''Shonita gulma'' ===

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This vitiated ''vata'' gets into the cervico-vaginal canal and checks the menstrual flow. If this continues for a prolonged period, the menstrual blood being obstructed accumulates and enlarges the abdomen. The patient consequently suffers from pain, cough, diarrhea, vomiting, anorexia, indigestion, bodyache, excess sleep, lassitude, dampness, and excessive salivation. There occurs appearance of milk in breasts, dark coloration of lips and areolar region, excessive heaviness in eyes, fainting, nausea, longing for certain food articles as seen during pregnancy, swelling in feet, dilatation of the vaginal orifice and foul smelling discharge from the vagina. There is pulsation in the entire mass of ''gulma'', confusing the patient (or her attendants) into thinking that she is pregnant. [14]

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==== Prodormal symptoms ====

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=== Prodormal symptoms ===

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These five types of ''gulma'' have the following prodormal symptoms just prior to occurring: aversion to food, anorexia and indigestion, disturbed metabolism, burning sensation after taking meals, vomiting and unusual eructations, reduced urge for flatus, urine and bowel movements, pain, distension, gurgling sound, horripilation and diarrhea due to ''vata'', loss of appetite, debility, and inability to endure satiety. [15]

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==== Prognosis and general principles of management ====

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=== Prognosis and general principles of management ===

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In the case of ''gulma'', all the measures for pacification of ''vata'' should be administered properly because after ''vayu'' is controlled over, other aggravated ''doshas'' can be alleviated even with small remedies. [17]

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==== Summary ====

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=== Summary ===

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

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==~~= ''~~Tattva Vimarsha'' Fundamental Principles===

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== Tattva Vimarsha (Fundamental Principles) ==

*''Gulma'' is a disease of the ''mahastrotas'' (gastro-intestinal tract/abdomen) and is caused due to predominance of ''vata''. It is of five types depending upon its location (limited to the gastro-intestinal region between the heart and the bladder). Four types of ''gulma'' are common to both males and females while the fifth, ''raktaja gulma'', is a condition limited to females.

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*Treatment of ''vata gulma'' includes ''vata''-alleviating unction, fomentation, mild unctuous purgation, enema, and use of sweet, sour and salty substances. If ''vata dosha'' is pacified in ''gulma'' disease, then other two ''dosha'' can also be controlled.

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==~~= ''~~Vidhi Vimarsha~~'' /~~ Applied Inferences ===

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== Vidhi Vimarsha (Applied Inferences) ==

A comprehensive effort has been made in [[Ayurveda]] to describe different types of swellings occurring in the body e.g. ''gulma, udara roga, vriddhi roga, granthi, arbuddha, shopha,'' and ''vidradhi'', etc. They can be distinguished from each other according to their specific characteristics as written in different classics of [[Ayurveda]]. Generalized abdominal swellings have been described under the heading of ''udara roga'' (abdominal diseases including ascitis), while localized, non-suppurated swellings are ''gulmas''. Other localized swellings, such as ''vriddhi roga'' (hernia and hydrocele), have also been described by ancient authors but such swellings are in regions other than the gastro-intestinal region, or in parts of the body such as the scrotal and inguinoscrotal region.

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''Shopha'' is a localized inflammatory swelling. ''Vidradhi'' (abscess) are also localized but large suppurative lesions and are deep - rooted that may develop either from external surfaces or internal body cavities. ''Granthi'' (cyst) and ''arbuda'' (tumor) are also localized, progressively increasing knotty lesions and are primarily non suppurative in nature. Such swellings may arise in any part of the body and are commonly known as neoplastic lesions.

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

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

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.

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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'').

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

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

#''Sanchaya-Vata'' accumulates in ''vatasthana'' (''pakwashaya'', or the intestines) with the consumption of ''vatika'' food and activities such as excessive exercise, suppressing emergent urges etc., further aggravating it.

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#''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.

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==== Location of ''gulma'' ====

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=== Location 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>

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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.

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==== ''Vataja gulma'' ====

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=== ''Vataja gulma'' ===

''Vataja gulma'' are mostly irregular, transitory swellings. These are accompanied with different intensities of colicky pain.

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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 occurring 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.

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==== ''Pittaja gulma'' ====

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=== ''Pittaja gulma'' ===

They are painful abdominal lumps characterized 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.

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==== ''Kaphaja gulma'' ====

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=== ''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 tumors of the abdomen which may or may not be associated with obstructive features of the gastrointestinal tract.

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==== ''Sannipataja gulma'' ====

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=== ''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 tumors.

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==== ''Raktaja gulma'' ====

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=== ''Raktaja gulma'' ===

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

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

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=== Researches ===

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== Researches ==

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

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

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=== Reference Books ===

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== Reference Books ==

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

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*Madhavanidana- gulmanidana

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~~=== Glossary ===~~

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== Related Chapters ==

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~~<div>~~

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*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.

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*k)j guLm (phonetic:kaphaja gulma; Sanskrit: dफt xwYe ) : Solid lump in abdomen; A subtype of gulma characterized by heaviness and hardness of the lump with mild pain.

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*ipÄj guLm (phonetic :pittaja gulma; Sanskrit: fiRrt xwYe ) : Infective lump in abdomen; A subtype of gulma characterized by fever, superficial tenderness over the region and increase of pain during digestion of food.

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*r´j guLm (phonetic :raktaja gulma; Sanskrit :jDrt xwYe ) : Uterine tumor ; A subtype of gulma characterized by bolus like formation resembling to that of fetus devoid of limbs and having features like that of pittaja gulma; and mainly reported in females.

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*vatj guLm (phonetic:vätaja gulma;Sanskrit; okrt xwYe) Gaseous lump : A subtype of gulma characterized by fleeting type of pain in the abdomen increasing post prandial.

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*saiÚpatj guLm ( phonetic: sännipätaja gulma; Sanskrit: lUufikrt xwYe);A subtype of gulma characterized by formation of stone like hard lump in abdomen which is fatal in nature.

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*ämaù (phonetic:Aam; Sanskrit: vke) Form of Toxins It is used as a technical word for anything that exists in a state of incomplete transformation. It is mentioned in various contexts like:

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**In particular, it can refer to a toxic byproduct generated due to improper or incomplete digestion.

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**Toxins that were produced at any stage of metabolism and that are circulating through the channels are also sometimes.

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**The first stage of any disease is also frequently.

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**Any substance which is present in its abnormal state and is unwanted in the body. It represents, in a gross sense, mere indigestion which begins in the stomach, to, in a finer sense, even a faulty enzymatic pathway that prevents or hampers a metabolic cycle or chain. It is a very important factor playing a pivotal role in the genesis of any disease. It is also important in determining the prognosis, drug selection and all other stages of therapy.

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*Ajirnah(phonetic :Ajeerna; Sanskrit: vth.kZ ) : Dyspepsia, all kinds of digestive and metabolic disorders; A disease characterized by difficulty in digesting food, accompanied by abdominal pain, heartburn and belching and also considered the root cause of all the intrinsic diseases. It is classified into six types:

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**Āntrakūjana (phonetic :Antrakujana ; Sanskrit: आU(kकूजन ) The term signifies increased bowel sounds which reflect the increased intestinal peristaltic movements; this can sometimes occur in diarrhea or after taking food.

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**Adhmānaḥs (phonetic: Adhmana ; Sanskrit: आ/ekन Distension, Inflation; The term signifies distension or inflation of a body part caused due to stagnation of the substances inside it; but generally is taken for distension of the abdomen associated with pain due to various reasons like obstruction to the urine and feces, accumulation of blood in abdomen etc.

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**Atisāraù (phonetic :Atisara; Sanskrit:अfतसार ) Diarrhea ; A disease of large intestine having cardinal feature as excessive and frequent defecation of liquid or unformed stools.

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**Adhyaśanam (phonetic :Adhyashana ; Sanskrit: अ/;शनम ) Eating in undigested state; Eating before the complete digestion of the previous food.

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**Aṭopaù (phonetic :atopa; Sanskrit: आटोप ) Puffing, Swelling ; The term signifies abnormal expansion of the body tissue due to exertion of pressure within.

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**Avipākaḥ (Avipaka) Non- conversion ; The term signifies a state of non- conversion any substance in the body. Generally used to denote non-conversion of food.

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*arocakaḥ (phonetic :Arochaka; Sanskrit: अरोचक) Anorexia ; A disease where in the person has dislikes towards all kinds of food and drink.

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*Amagarbha(phonetic: Amagarbha; Sanskrit: vkexZHk) Abnormal formation of embryo/embryo associated with endogenous toxins; An abnormal condition of the fetus resulting in any form of wastage of pregnancy till the end of 6 months.

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*Anannabhilasha (phonetic: anannabhilasha; Sanskrit: vuUukfHkykषा ); Aversion to food; The term signifies abnormal aversion to intake of food.

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*anupaśayaḥ (phonetic: Anupshaya Sanskrit:अनुपशयः) Interventions neither good for disease nor for the health; Intervention of the diet and medicine which is neither good for health nor for diseases. And it is one of the tools of the diagnosis where the diseases cannot be diagnosed by referring merely its clinical features.

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*kaZy R(phonetic: kärçya ; Sanskrit: dk’Z; ) Asthenia /emaciation; The disease characterized by excessive reduction in the mass of the body and weight loss.

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*Vyavaya (phonetic:vyavaya; Sanskrit: O;ok; ) ; It indicates sexual intercourse /sexual regimen.

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*Prashamana (phonetic: prashamana;Sanskrit: iz’keu); Palliative therapeutics

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*Pürvarüpa (phonetic: Poorvarupa ; Sanskrit: iwZojwIk) Premonitory, Prodromal symptoms; It is the premonitory symptom by learning about which one can avoid the manifestation of the disease. Depending on their nature they are classified into two types.

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*Linga (phonetic:linga; Sanskrit: fyax); A distinguishing mark or a feature,attribute or trait that points towards a co-relation.

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*Vdna(phonetic :Vedna ; Sanskrit: osnuk) ; Sensation of pain/discomfort; The term signifies sensation of discomfort or pain in the body.

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*Vmn km (phonetic :Vamana karma Sanskrit: oeudZe) Therapeutic emesis; Vamana is first of the bio-cleansing series and causing vomiting of vitiated dosha, especially kapha from the upper region of the body, by means of consuming suitable drugs which are repulsive, nauseating, indigestible and tending to move upwards.mainly used for diseases manifesting in upper part of body and caused by kapha dosha.

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*ivcn km (phonetic :Virechanakarma Sanskrit: fojspudZe) Therapeutic catharsis; Virechana literally means catharsis, consists in administration of the purgative drugs which are pleasant and tending to move downward in order to eliminate the vitiated dosha especially pitta from the lower regions of the body.

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*Cankramana (phonetic:chankramana ;Sanskrit: pUdze.k); Person after taking food should walk for a hundredfeet slowly that way reduces the heaviness of the body and aid in easy digestion of consumed food.

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*Prakopa (phonetic:Prakupita; Sanskrit: izdksi); Provocative stage Second stage ; The Stage of provocation or aggravation (mainly due to liquefaction of the vitiated doñä in solid form attained during Sancaya stage). It is the second stage of kriyäkäla.

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*Granthi (phonetic:granthi Sanskrit: xzfU; ); Knot like projection.

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*Muhurpipilikasamprachara-iva angeshu ( Sanskrit: eqgqZfififydklaizpkjbovaxs’kq )Formication

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*Todau(phonetic : Toda Sanskrit: ; rksn ) Needling,pinning sensation

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*Bhedah (phonetic Bheda Sanskrit:भॆद); The term signified an act of splitting or breaking.

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*āyāmaḥ (phonetic Ayama Sanskrit आयामः ) Extension /Expansion /Stretching /Broadening ; The term signifies pathological condition wherein there is expansion of (or any similar meaning) elastic structures in the body. It also denotes therapeutic created conditions wherein the channels or other body parts become extended so that the normal flow and the functional physiology of the bodily constituents may continue and the pathology may be alleviated.

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*samkoca (phonetic Sankocha Sanskrit संकॊच) Contraction of body parts

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*Siyta (phonetic Supti Sanskrit) Numbness; Term for abnormal sensation, including absent or reduced sensory perception as well as perception.

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*Harsha(phonetic Harsha Sanskrit हष ); Exhilaration; A feeling of great enthusiasm.

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*Pralaya;( phonetic Pralaya Sanskrit पलय) fainting

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*Samviddha; (phonetic Samviddha Sanskrit संविद )Sting/arrow poison

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*Sula (phonetic Shoola Sanskrit शूल); algia ; The terms, indicate continuous pinning like pain arising in different entities of the body.

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*Daraù (phonetic Davathu Sanskrit दवथु ) Tearing pain. The term signifies a kind of tearing pain

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*Jvr( phonetic jvara Sanskrit जवर); Pyrexia / fever ; A sense of non well being in senses, mind and body along with raised body temperature and associated by obstruction to the skin.

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*Bhramau (phonetic Bhrama Sanskrit भम ) Vertigo/dizziness; A sensation of spinning or whirling motion or a definite sensation of rotation of the subject or of objects about the in any plane.

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*Moha (phonetic Moha Sanskrit मोह); disorientation; Because of the sharpness property of poison, it overwhelmes the mind (produces disorientations)and tends to disintegrate the marmas.

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*chardiḥ (phonetic Chardi Sanskrit छदि ) Vomiting; A disease in which vomiting is the main symptom

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*Nidra (phonetic Nidra Sanskrit निदा)Sleep; When the mana (mind)and indriya(sense organs )get exhausted,they withdraw themselves from the objects and the individual get sleep.

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*Ālasyam (phonetic Ālasyam Sanskrit आलसयम् ); Lassitude at the somatic as well as psychological level; The term signifies desire of ecstasy along with vacillation or weariness of body or mind from strain, oppressive climate, etc. it is mainly caused due to psychological factors which are reflected on sensory and motor organs.

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*Gaurava (phonetic Gaurava Sanskrit गौरव); ; Feeling heaviness

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*Shiroabhitatapa(phonetic Shiroabhitatapa Sanskrit शिरोअभिताप); ; Rage of provocation

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*Käsa (phonetic Kasa Sanskrit कास); Cough ; A disease characterized by excessive cough either dry or with mucous.

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*Cvasa; (phonetic Shwasa Sanskrit श्वास); Dyspnoea due to respiratory disease; It is a respiratory diseases marked by recurrent paroxysmal attacks of shortness of breath, a subjective, difficulty or distress in breathing, with or without wheezing due to obstruction in respiratory airways.

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*Upakrama(phonetic Upakrama Sanskrit उपकम); Therapeutic measures; The main therapeutic measures to counteract the disease conditions.

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*Ko..tha (phonetic Koshtha; Sanskrit कोष्ठ); A closed space or area, typically indicative of organs in the abdominal, thoracic and pelvic cavities physiologically koshtha is also indicative of git. depending on the dominance of dosa, depending on the ability to digest the food, and depending on the bowel movements.

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*Artava (phonetic Artava Sanskrit अ तव);; One of the updhatu of rasa dhatu.indicative of either menstrual fluid or ovum.it is dominant of Agni dhatu.

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*glāniḥ ((phonetic Glani Sanskrit ग्लानिः ); Mental fatigue/Regret; Fatigue in mind leading to dislike towards thinking.

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*Shwayathu(phonetic Shwayathu Sanskrit श्वयथु);; Swelling ; oedema

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*Romaraji; (phonetic Romaraji Sanskrit रोमराजि); Appearance of hairy lines

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*Vidaha ((phonetic Vidaha Sanskrit विदाह); Heartburn) An abnormal condition characterized by heartburn.

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*Basti (phonetic Basti Sanskrit बस्ति); bladder

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*Apacayam (phonetic Apacayam Sanskrit अपचयम) Decrease, get shrink, not nourishing; The term signifies decrease of the body constituents which are abnormally increased.

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~~</div>~~

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=== Related Chapters ===

* [[Gulma Chikitsa]]

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=== References ===

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== References ==

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