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<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

 

''Gulma'' is defined as large palpable, rounded, intra- abdominal swellings between ''hridaya'' (cardiac region) and the ''basti'' (bladder) regions, which develop due to excess accumulation of ''doshas'' with predominance of ''vata''. Such swellings are either transitory or static, and display the properties of spontaneous regression and reappearance.  This chapter on the treatment of ''gulma'' (abdominal lumps) first describes its general etiological factors and pathogenesis along with five places in the abdomen where the swelling occurs. The treatment of ''vata gulma'' includes ''snehana'' (oleation), ''swedana'' (sudation), ''brimhana'' (repletion), ''basti'' with ''ghee'', ''virechana'', ''vamana'' and preparations in the form of powders, pills and medicated ''ghrita'' and as a last resort bloodletting. For the treatment of ''pitta gulma'', the ''ghrita'' prepared with bitter (''tikta'') drugs, ''virechana'', recipes for ''niruha basti'', blood-letting (''rakta-mokshana''), use of milk, counseling (''ashvasana'') and oral recipes have been elaborated. ''Upanaha'' (poultice), ''shodhana'' and surgical measures for suppurated and internally ruptured ''gulma'' have also been described.  

''Gulma'' is defined as large palpable, rounded, intra- abdominal swellings between ''hridaya'' (cardiac region) and the ''basti'' (bladder) regions, which develop due to excess accumulation of ''doshas'' with predominance of ''vata''. Such swellings are either transitory or static, and display the properties of spontaneous regression and reappearance.  This chapter on the treatment of ''gulma'' (abdominal lumps) first describes its general etiological factors and pathogenesis along with five places in the abdomen where the swelling occurs. The treatment of ''vata gulma'' includes ''snehana'' (oleation), ''swedana'' (sudation), ''brimhana'' (repletion), ''basti'' with ''ghee'', ''virechana'', ''vamana'' and preparations in the form of powders, pills and medicated ''ghrita'' and as a last resort bloodletting. For the treatment of ''pitta gulma'', the ''ghrita'' prepared with bitter (''tikta'') drugs, ''virechana'', recipes for ''niruha basti'', blood-letting (''rakta-mokshana''), use of milk, counseling (''ashvasana'') and oral recipes have been elaborated. ''Upanaha'' (poultice), ''shodhana'' and surgical measures for suppurated and internally ruptured ''gulma'' have also been described.  

For ''kapha gulma snehana'', ''swedana'', ''bhedana'' (puncturing), ''langhana'' (lightening therapy), ''vamana'', ''virechana'', medicated ''ghee'', ''basti'', pills, powder, ''arishta'', and ''kshara'' are described. Bloodletting followed by cauterization of the ''gulma'' as a last resort is explained. A surgical procedure for ''rakta gulma'', which occurs only in women is also described.  

For ''kapha gulma snehana'', ''swedana'', ''bhedana'' (puncturing), ''langhana'' (lightening therapy), ''vamana'', ''virechana'', medicated ''ghee'', ''basti'', pills, powder, ''arishta'', and ''kshara'' are described. Bloodletting followed by cauterization of the ''gulma'' as a last resort is explained. A surgical procedure for ''rakta gulma'', which occurs only in women is also described.  

Wholesome (''pathya'') food and drinks, avoidance of etiological factors, continuous protection of digestive power (''agni'') and the instructions for a patient who undergoes ''snehana'' are discussed in detail.

Wholesome (''pathya'') food and drinks, avoidance of etiological factors, continuous protection of digestive power (''agni'') and the instructions for a patient who undergoes ''snehana'' are discussed in detail.

'''Keywords''': ''Gulma'' (abdominal lumps), ''Pathya'' (whole some), ''Rakta Mokshana'' (bloodletting), ''Apathya'' (unwholesome)

'''Keywords''': ''Gulma'' (abdominal lumps), ''Pathya'' (whole some), ''Rakta Mokshana'' (bloodletting), ''Apathya'' (unwholesome)

== Introduction ==

== Introduction ==

 

The word ''gulma'' stands for an entity that encircles, envelops or covers something. Situations such as panic, stress, or grief, usually associated with chaotic, cataclysmic event would lead to vitiation of ''vata'' causing the appearance of ''vata''-dominant diseases like ''gulma'', etc. The vitiated ''vata'', in conjunction with other ''doshas'', gets into the ''mahasrotas'' and get lodged either in the ''amashaya'' (stomach), ''pittashaya'' (gall bladder), ''pakwashaya'' (cecum) or in other regions like ''hridaya'' (epigastric), ''basti'' (bladder) and ''nabhi'' (umblicus) leading to formation of deep-rooted shrub-like mass. As mentioned earlier, ''gulma'' afflicts the gastrointestinal region between the heart and the bladder. Depending upon the region it afflicts, it can be classified into four general types common to males and females: ''vata gulma'', ''pitta gulma'', ''kapha gulma'', and ''sannipatik gulma''.

The word ''gulma'' stands for an entity that encircles, envelops or covers something. Situations such as panic, stress, or grief, usually associated with chaotic, cataclysmic event would lead to vitiation of ''vata'' causing the appearance of ''vata''-dominant diseases like ''gulma'', etc. The vitiated ''vata'', in conjunction with other ''doshas'', gets into the ''mahasrotas'' and get lodged either in the ''amashaya'' (stomach), ''pittashaya'' (gall bladder), ''pakwashaya'' (cecum) or in other regions like ''hridaya'' (epigastric), ''basti'' (bladder) and ''nabhi'' (umblicus) leading to formation of deep-rooted shrub-like mass. As mentioned earlier, ''gulma'' afflicts the gastrointestinal region between the heart and the bladder. Depending upon the region it afflicts, it can be classified into four general types common to males and females: ''vata gulma'', ''pitta gulma'', ''kapha gulma'', and ''sannipatik gulma''.

''Gulma'' is defined as a palpable round compact lump in the abdomen. Thus, all the localized palpable masses in the abdomen are classified under ''gulma'', but they are named depending upon the dominance of ''dosha'' or the place. Its four types belong to ''dosha'' i.e. three of single ''dosha'' and one of a combination of all the three ''dosha'' and the fifth one is ''rakta gulma'' which occurs only in females in uterine cavity (''garbhashayashroni''). ''Sannipata Gulma'' has been given synonym as ''nichaya-gulma''.

''Gulma'' is defined as a palpable round compact lump in the abdomen. Thus, all the localized palpable masses in the abdomen are classified under ''gulma'', but they are named depending upon the dominance of ''dosha'' or the place. Its four types belong to ''dosha'' i.e. three of single ''dosha'' and one of a combination of all the three ''dosha'' and the fifth one is ''rakta gulma'' which occurs only in females in uterine cavity (''garbhashayashroni''). ''Sannipata Gulma'' has been given synonym as ''nichaya-gulma''.

 

== Sanskrit text, Transliteration and English Translation ==

== Sanskrit text, Transliteration and English Translation ==

iti ha smAha bhagavAnAtreyaH||2||

iti ha smAha bhagavAnAtreyaH||2||

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Now we shall expound the chapter "Gulma Chikitsa" (Management of abdominal lumps and other diseases) . Thus said Lord Atreya. [1-2]

Now we shall expound the chapter "Gulma Chikitsa" (Management of abdominal lumps and other diseases) . Thus said Lord Atreya. [1-2]

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cikitsitaM gulmanibarhaNArthaM provAca siddhaM vadatAM variShThaH||3||

cikitsitaM gulmanibarhaNArthaM provAca siddhaM vadatAM variShThaH||3||

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Punarvasu the fatherly figure for all, who has knowledge of past and future, who is the best among the exponents, describes the treatment for the complete eradication of ''gulma'' [3]

Punarvasu the fatherly figure for all, who has knowledge of past and future, who is the best among the exponents, describes the treatment for the complete eradication of ''gulma'' [3]

 

=== Etio-pathogenesis  of ''gulma'' ===

=== Etio-pathogenesis  of ''gulma'' ===

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viceShTitairvA viShamAtimAtraiH koShThe prakopaM samupaiti vAyuH||5||

viceShTitairvA viShamAtimAtraiH koShThe prakopaM samupaiti vAyuH||5||

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Following are the general causative factors of ''gulma'':

Following are the general causative factors of ''gulma'':

Due to the above mentioned factors ''vata'' gets aggravated in ''koshtha'' i.e. thoraco-abdominal cavity [4-5]

Due to the above mentioned factors ''vata'' gets aggravated in ''koshtha'' i.e. thoraco-abdominal cavity [4-5]

 

=== General Pathogenesis of ''gulma'' ===

=== General Pathogenesis of ''gulma'' ===

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hRunnAbhipArshvodarabastishUlaM karotyatho yAti na baddhamArgaH||6||  

hRunnAbhipArshvodarabastishUlaM karotyatho yAti na baddhamArgaH||6||  

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The provoked ''vata'' takes out ''kapha'' and ''pitta'' from their sites and in turn gets blocked its own passage by them. Thus, blocked ''vata'' is unable to move properly leading to pain in the regions of heart, umbilicus, both sides of abdomen and urinary bladder [6]

The provoked ''vata'' takes out ''kapha'' and ''pitta'' from their sites and in turn gets blocked its own passage by them. Thus, blocked ''vata'' is unable to move properly leading to pain in the regions of heart, umbilicus, both sides of abdomen and urinary bladder [6]

#Vagbhata Junior: Ashtanga Hridaya with Sarvanga-Sundra commentry by Arunadatta, published by Chaukhamba Samskrit series office, Varanasi,  

#Vagbhata Junior: Ashtanga Hridaya with Sarvanga-Sundra commentry by Arunadatta, published by Chaukhamba Samskrit series office, Varanasi,  

#Warner E. C. (1964): Savill's System of clinical medicine. Orient Longmans Ltd.New Delhi, 14th Edition p.341

#Warner E. C. (1964): Savill's System of clinical medicine. Orient Longmans Ltd.New Delhi, 14th Edition p.341

 

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