Difference between revisions of "Gulma Chikitsa"
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=== 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: | + | 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: |
| − | Since Gulma can occur as complication of raktapitta (bleeding disorders) | + | |
| + | Since Gulma can occur as complication of raktapitta (bleeding disorders) Charaka describes this chapter after the raktapitta chapter. Jwara is the disease of rasavah srotas whereas, raktapitta is a disease of raktavah srotas, in that sequence gulma is a disease of mansavah srotas and further prameha is of medavah srotas. However, gulma chapter seems to be designed with greater implication and term mahasrotasa has been used because manifestation of disease is in the viscera/ organs up to uterus. Even then the involvement of vata dosha and mansa dhatu is predominant in final manifestation of disease gulma. | ||
It should also be noted that the same pathogenesis route and treatment procedure should be kept in mind for the disease of the mahasrotasa occurring without the true manifestation of growth/tumor. Hence peptic ulcer and ulcer dyspepsia should be treated like pitta gulma etc. | It should also be noted that the same pathogenesis route and treatment procedure should be kept in mind for the disease of the mahasrotasa occurring without the true manifestation of growth/tumor. Hence peptic ulcer and ulcer dyspepsia should be treated like pitta gulma etc. | ||
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 doṣha 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 doṣha 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. | ||
Revision as of 03:51, 12 October 2017
Chikitsa Sthana Chapter 5 Gulma Chikitsitam
Treatment of Gulma (Abdominal Lumps)
Abstract
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 gulma 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 have been recommended. 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.
Keywords: Gulma (abdominal lumps), Pathya (whole some), Rakta Mokshana (bloodletting), Apathya (unwholesome)
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:
Since Gulma can occur as complication of raktapitta (bleeding disorders) Charaka describes this chapter after the raktapitta chapter. Jwara is the disease of rasavah srotas whereas, raktapitta is a disease of raktavah srotas, in that sequence gulma is a disease of mansavah srotas and further prameha is of medavah srotas. However, gulma chapter seems to be designed with greater implication and term mahasrotasa has been used because manifestation of disease is in the viscera/ organs up to uterus. Even then the involvement of vata dosha and mansa dhatu is predominant in final manifestation of disease gulma. It should also be noted that the same pathogenesis route and treatment procedure should be kept in mind for the disease of the mahasrotasa occurring without the true manifestation of growth/tumor. Hence peptic ulcer and ulcer dyspepsia should be treated like pitta gulma etc. 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 doṣha 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.
गुल्मचिकित्सितोपक्रमः
Management of Gulma (abdominal Lumps)
अथातो गुल्मचिकित्सितं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athātō gulmacikitsitaṁ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātrēyaḥ||2||
athAto gulmacikitsitaM vyAkhyAsyAmaH||1||
iti ha smAha bhagavAnAtreyaH||2||
Now we will expound the chapter entitled ‘Gulma Cikitsitam’ . Thus said Lord Atreya (1-2).
सर्वप्रजानां पितृवच्छरण्यः पुनर्वसुर्भूतभविष्यदीशः|
चिकित्सितं गुल्मनिबर्हणार्थं प्रोवाच सिद्धं वदतां वरिष्ठः||३||
sarvaprajānāṁ pitr̥vaccharaṇyaḥ punarvasurbhūtabhaviṣyadīśaḥ|
cikitsitaṁ gulmanibarhaṇārthaṁ prōvāca siddhaṁ vadatāṁ variṣṭhaḥ||3||
sarvaprajAnAM pitRuvaccharaNyaH punarvasurbhUtabhaviShyadIshaH|
cikitsitaM gulmanibarhaNArthaM provAca siddhaM vadatAM variShThaH||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:
विट्श्लेष्मपित्तातिपरिस्रवाद्वा तैरेव वृद्धैः परिपीडनाद्वा|
वेगैरुदीर्णैर्विहतैरधो वा बाह्यभिघातैरतिपीडनैर्वा||४||
रूक्षान्नपानैरतिसेवितैर्वा शोकेन मिथ्याप्रतिकर्मणा वा|
विचेष्टितैर्वा विषमातिमात्रैः कोष्ठे प्रकोपं समुपैति वायुः||५||
viṭślēṣmapittātiparisravādvā tairēva vr̥ddhaiḥ paripīḍanādvā|
vēgairudīrṇairvihatairadhō vā bāhyabhighātairatipīḍanairvā||4||
rūkṣānnapānairatisēvitairvā śōkēna mithyāpratikarmaṇā vā|
vicēṣṭitairvā viṣamātimātraiḥ kōṣṭhē prakōpaṁ samupaiti vāyuḥ||5||
viTshleShmapittAtiparisravAdvA taireva vRuddhaiH paripIDanAdvA|
vegairudIrNairvihatairadho vA bAhyabhighAtairatipIDanairvA||4||
rUkShAnnapAnairatisevitairvA shokena mithyApratikarmaNA vA|
viceShTitairvA viShamAtimAtraiH koShThe prakopaM samupaiti vAyuH||5||
Followings are the general causative factors of gulma: Excessive excretion of faeces, kapha and pitta or due to pressure exerted by their excessive aggravation, Suppression of downward natural urges (like faeces, flatus and urine), Physical trauma, By excessive pressure (on abdomen), By taking food articles and drinks having excessive dry property, Excessive grief, Improper implementation of panchakarma procedures, Excessive wrongful body activities, Due to the above mentioned factors vata gets aggravated in koshtha i.e. thoraco-abdominal cavity (4-5). General Pathogenesis of gulma: कफं च पित्तं च स दुष्टवायुरुद्धूय मार्गान् विनिबद्ध्य ताभ्याम्| हृन्नाभिपार्श्वोदरबस्तिशूलं करोत्यथो याति न बद्धमार्गः||६|| kaphaṁ ca pittaṁ ca sa duṣṭavāyuruddhūya mārgān vinibaddhya tābhyām| hr̥nnābhipārśvōdarabastiśūlaṁ karōtyathō yāti na baddhamārgaḥ||6|| kaphaM ca pittaM ca sa duShTavAyuruddhUya [1] mArgAn vinibaddhya tAbhyAm| hRunnAbhipArshvodarabastishUlaM karotyatho yAti na baddhamArgaH||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). Cardinal Signs of gulma: पक्वाशये पित्तकफाशये वा स्थितः स्वतन्त्रः परसंश्रयो वा| स्पर्शोपलभ्यः परिपिण्डितत्वाद्गुल्मो यथादोषमुपैति नाम||७|| pakvāśayē pittakaphāśayē vā sthitaḥ sVātantraḥ parasaṁśrayō vā| sparśōpalabhyaḥ paripiṇḍitatvādgulmō yathādōṣamupaiti nāma||7|| pakvAshaye pittakaphAshaye vA sthitaH svatantraH parasaMshrayo vA| sparshopalabhyaH paripiNDitatvAdgulmo yathAdoShamupaiti nAma||7|| Formation of a palpable mass in colon, gall-bladder or stomach which may be independent or associated with other dosha is known as gulma. It is named according to the dosha involved. (7) Five sites of gulma: बस्तौ च ना भ्यां हृदि पार्श्वयोर्वा स्थानानि गुल्मस्य भवन्ति पञ्च|८| पञ्चात्मकस्य प्रभवं तु तस्य वक्ष्यामि लिङ्गानि चिकित्सितं च||८|| bastau ca nābhyāṁ hr̥di pārśvayōrvā sthānāni gulmasya bhavanti pañca|8| pañcātmakasya prabhavaṁ tu tasya vakṣyāmi liṅgāni cikitsitaṁ ca||8|| bastau ca nAbhyAM hRudi pArshvayorvA sthAnAni gulmasya bhavanti pa~jca|8| pa~jcAtmakasya prabhavaM tu tasya vakShyAmi li~ggAni cikitsitaM ca||8|| Five places of gulma are urinary bladder (hypogastric region), umbilical region (Nabhi), cardiac region (Hrudi) and two flanks (Parshva). Henceforth I will explain the causes, symptoms and the treatment of these five types of gulma (8). Causative factors of vata dominant gulma: रूक्षान्नपानं विषमातिमात्रं विचेष्टितं वेगविनिग्रहश्च| शोकोऽभिघातोऽतिमलक्षयश्च निरन्नता चानिलगुल्महेतुः||९||
rūkṣānnapānaṁ viṣamātimātraṁ vicēṣṭitaṁ vēgavinigrahaśca| śōkō'bhighātō'timalakṣayaśca nirannatā cānilagulmahētuḥ||9|| rUkShAnnapAnaM viShamAtimAtraM viceShTitaM vegavinigrahashca| shoko~abhighAto~atimalakShayashca nirannatA cAnilagulmahetuH||9||
Excessive use of dry articles of food and drinks, excessive or wrong body activities, suppression of natural urges, excessive grief, too-much diminution of faeces, trauma and excessive fasting are the causes of vata-gulma (9). Symptoms of vata gulma: यः स्थानसंस्थानरुजां विकल्पं विड्वातसङ्गं गलवक्त्रशोषम्| श्यावारुणत्वं शिशिरज्वरं च हृत्कुक्षिपार्श्वांसशिरोरुजं च||१०|| करोति जीर्णेऽभ्यधिकं प्रकोपं भुक्ते मृदुत्वं समुपैति यश्च| वातात् स गुल्मो न च तत्र रूक्षं कषायतिक्तं कटु चोपशेते||११|| yaḥ sthānasaṁsthānarujāṁ vikalpaṁ viḍvātasaṅgaṁ galavaktraśōṣam| śyāvāruṇatvaṁ śiśirajvaraṁ ca hr̥tkukṣipārśvāṁsaśirōrujaṁ ca||10|| karōti jīrṇē'bhyadhikaṁ prakōpaṁ bhuktē mr̥dutvaṁ samupaiti yaśca| vātāt sa gulmō na ca tatra rūkṣaṁ kaṣāyatiktaṁ kaṭu cōpaśētē||11|| yaH sthAnasaMsthAnarujAM vikalpaM viDvAtasa~ggaM galavaktrashoSham| shyAvAruNatvaM shishirajvaraM ca hRutkukShipArshvAMsashirorujaM ca||10|| karoti jIrNe~abhyadhikaM prakopaM bhukte mRudutvaM samupaiti yashca| vAtAt sa gulmo na ca tatra rUkShaM kaShAyatiktaM kaTu copashete||11|| Frequent change in the site, shape and pain of the lump along with obstruction of faeces and flatus, dryness in throat and mouth, dusky-red colour of body, fever with chills, pain in the cardiac, umbilical, flanks and shoulder regions and headache are the sign and symptoms of vata gulma. The symptoms decrease on taking of food but increase on completion of digestion as well as by taking dry substances or having astringent, bitter and pungent tastes (10-11). Causative factors and pathogenesis of pitta dominant gulma: कट्वम्लतीक्ष्णोष्णविदाहिरूक्षक्रोधातिमद्यार्कहुताशसेवा| आमाभिघातो रुधिरं च दुष्टं पैत्तस्य गुल्मस्य निमित्तमुक्तम्||१२|| kaṭvamlatīkṣṇōṣṇavidāhirūkṣakrōdhātimadyārkahutāśasēvā| āmābhighātō rudhiraṁ ca duṣṭaṁ paittasya gulmasya nimittamuktam||12|| kaTvamlatIkShNoShNavidAhirUkShakrodhAtimadyArkahutAshasevA| AmAbhighAto [2] rudhiraM ca duShTaM paittasya gulmasya nimittamuktam||12||
Taking of food articles having pungent and sour tastes and piercing, hot, irritant (vidahi) and dry properties; excessive wines; exposure to sun and heat; indulgence in anger, affliction by ama and vitiation of rakta are the causative factors of pitta-gulma (12). Symptoms of pitta-gulma: ज्वरः पिपासा वदनाङ्गरागः शूलं महज्जीर्यति भोजने च| स्वेदो विदाहो व्रणवच्च गुल्मः स्पर्शासहः पैत्तिकगुल्मरूपम्||१३|| jvaraḥ pipāsā vadanāṅgarāgaḥ śūlaṁ mahajjīryati bhōjanē ca| svēdō vidāhō vraṇavacca gulmaḥ sparśāsahaḥ paittikagulmarūpam||13|| jvaraH pipAsA vadanA~ggarAgaH shUlaM mahajjIryati bhojane ca| svedo vidAho vraNavacca gulmaH sparshAsahaH paittikagulmarUpam||13|| Fever, thirst, redness of mouth and other organs, excessive pain during digestion, sweating, burning sensation and tenderness in the lesion like that of ulcer are the signs and symptoms of pitta-gulma (13). Causative factors of kapha-gulma and nichaya-gulma: शीतं गुरु स्निग्धमचेष्टनं च सम्पूरणं प्रस्वपनं दिवा च| गुल्मस्य हेतुः कफसम्भवस्य सर्वस्तु दिष्टो निचयात्मकस्य||१४|| śītaṁ guru snigdhamacēṣṭanaṁ ca sampūraṇaṁ prasvapanaṁ divā ca| gulmasya hētuḥ kaphasambhavasya sarvastu diṣṭō nicayātmakasya||14|| shItaM guru snigdhamaceShTanaM ca sampUraNaM prasvapanaM divA ca| gulmasya hetuH kaphasambhavasya sarvastu diShTo nicayAtmakasya||14|| Excessive intake of food articles having cold, heavy and unctuous properties and excessive eating, sedentary life style and day-sleep are the causative factors of kapha-gulma. All the causative factors mentioned for all the above three types of dosha gulma are also of nichaya (tridosha)-gulma (14).
Symptoms of kapha dominant gulma: स्तैमित्यशीतज्वरगात्रसादहृल्लासकासारुचिगौरवाणि| शैत्यं रुगल्पा कठिनोन्नतत्वं गुल्मस्य रूपाणि कफात्मकस्य||१५|| staimityaśītajvaragātrasādahr̥llāsakāsārucigauravāṇi| śaityaṁ rugalpā kaṭhinōnnatatvaṁ gulmasya rūpāṇi kaphātmakasya||15|| staimityashItajvaragAtrasAdahRullAsakAsArucigauravANi| shaityaM rugalpA kaThinonnatatvaM gulmasya rUpANi kaphAtmakasya||15|| Feeling as covered by wet cloth, fever with chills, exhaustion of limbs, nausea, cough, anorexia, heaviness, cold and mild pain with palpable hard and protruded mass are the signs and symptoms of kaphaja-gulma.(15) Dvi-doshaja gulma: निमित्तलिङ्गान्युपलभ्य गुल्मे द्विदोषजे दोषबलाबलं च| व्यामिश्रलिङ्गानपरांस्तु गुल्मांस्त्रीनादिशेदौषधकल्पनार्थम्||१६|| nimittaliṅgānyupalabhya gulmē dvidōṣajē dōṣabalābalaṁ ca| vyāmiśraliṅgānaparāṁstu gulmāṁstrīnādiśēdauṣadhakalpanārtham||16|| nimittali~ggAnyupalabhya gulme dvidoShaje doShabalAbalaM ca| vyAmishrali~ggAnaparAMstu gulmAMstrInAdishedauShadhakalpanArtham||16|| Three types of dvi-doshaja gulma (vata-pitta, vata-kapha and kapha-pitta) are produced by the mixture of causative factors of two involved dosha. These gulma manifest the signs and symptoms of two involved dosha. These varieties are mentioned here for the purpose of the treatment which can be planned on the basis of degree of provocation of each dosha (16). Signs and symptoms of tri-doshaja gulma: महारुजं दाहपरीतमश्मवद्घनोन्नतं शीघ्रविदाहि दारुणम्| मनःशरीराग्निबलापहारिणं त्रिदोषजं गुल्ममसाध्यमादिशेत्||१७|| mahārujaṁ dāhaparītamaśmavadghanōnnataṁ śīghravidāhi dāruṇam|
manaḥśarīrāgnibalāpahāriṇaṁ tridōṣajaṁ gulmamasādhyamādiśēt||17||
mahArujaM dAhaparItamashmavadghanonnataM shIghravidAhi dAruNam| manaHsharIrAgnibalApahAriNaM tridoShajaM gulmamasAdhyamAdishet||17|| The symptoms of tri-dosha gulma are, agonizing pain and excessive burning sensation, elevated mass, stony hard and quick to mutilate. It is a very serious condition and leads to diminution of strength of body, mind and digestion. It is incurable (17). Causative factors of rakta gulma: ऋतावनाहारतया भयेन विरूक्षणैर्वेगविनिग्रहैश्च| संस्तम्भनोल्लेखनयोनिदोषैर्गुल्मः स्त्रियं रक्तभवोऽभ्युपैति||१८|| r̥tāvanāhāratayā bhayēna virūkṣaṇairvēgavinigrahaiśca| saṁstambhanōllēkhanayōnidōṣairgulmaḥ striyaṁ raktabhavō'bhyupaiti||18|| RutAvanAhAratayA bhayena virUkShaNairvegavinigrahaishca| 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). Symptoms of rakta gulma: यः स्पन्दते पिण्डित एव नाङ्गैश्चिरात् सशूलः समगर्भलिङ्गः| स रौधिरः स्त्रीभव एव गुल्मो मासे व्यतीते दशमे चिकित्स्यः||१९|| yaḥ spandatē piṇḍita ēva nāṅgaiścirāt saśūlaḥ samagarbhaliṅgaḥ| sa raudhiraḥ strībhava ēva gulmō māsē vyatītē daśamē cikitsyaḥ||19|| yaH spandate piNDita eva nA~ggaishcirAt sashUlaH samagarbhali~ggaH| 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). क्रियाक्रममतः सिद्धं गुल्मिनां गुल्मनाशनम्| प्रवक्ष्याम्यत ऊर्ध्वं च योगान् गुल्मनिबर्हणान्||२०|| kriyākramamataḥ siddhaṁ gulmināṁ gulmanāśanam| pravakṣyāmyata ūrdhvaṁ ca yōgān gulmanibarhaṇān||20|| kriyAkramamataH siddhaM gulminAM gulmanAshanam| 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). Treatment of Vata-Gulma: रूक्षव्यायामजं गुल्मं वातिकं तीव्रवेदनम्| बद्धविण्मारुतं स्नेहैरादितः समुपाचरेत्||२१|| rūkṣavyāyāmajaṁ gulmaṁ vātikaṁ tīvravēdanam| baddhaviṇmārutaṁ snēhairāditaḥ samupācarēt||21|| rUkShavyAyAmajaM gulmaM vAtikaM tIvravedanam| 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: भोजनाभ्यञ्जनैः पानैर्निरूहैः सानुवासनैः| स्निग्धस्य भिषजा स्वेदः कर्तव्यो गुल्मशान्तये||२२|| bhōjanābhyañjanaiḥ pānairnirūhaiḥ sānuvāsanaiḥ| snigdhasya bhiṣajā svēdaḥ kartavyō gulmaśāntayē||22|| bhojanAbhya~jjanaiH pAnairnirUhaiH sAnuvAsanaiH| 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). Benefit of swedana therapy for vata-gulma: स्रोतसां मार्दवं कृत्वा जित्वा मारुतमुल्बणम्| भित्त्वा विबन्धं स्निग्धस्य स्वेदो गुल्ममपोहति||२३|| srōtasāṁ mārdavaṁ kr̥tvā jitvā mārutamulbaṇam| bhittvā vibandhaṁ snigdhasya svēdō gulmamapōhati||23|| srotasAM mArdavaM kRutvA jitvA mArutamulbaNam| 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: स्नेहपानं हितं गुल्मे विशेषेणोर्ध्वनाभिजे| पक्वाशयगते बस्तिरुभयं जठराश्रये||२४|| snēhapānaṁ hitaṁ gulmē viśēṣēṇōrdhvanābhijē| pakvāśayagatē bastirubhayaṁ jaṭharāśrayē||24|| snehapAnaM hitaM gulme visheSheNordhvanAbhije| 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). दीप्तेऽग्नौ वातिके गुल्मे विबन्धेऽनिलवर्चसोः| बृंहणान्यन्नपानानि स्निग्धोष्णानि प्रयोजयेत्||२५|| dīptē'gnau vātikē gulmē vibandhē'nilavarcasōḥ| br̥ṁhaṇānyannapānāni snigdhōṣṇāni prayōjayēt||25|| dIpte~agnau vAtike gulme vibandhe~anilavarcasoH| 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: पुनः पुनः स्नेहपानं निरूहाः सानुवासनाः| प्रयोज्या वातगुल्मेषु कफपित्तानुरक्षिणा||२६|| punaḥ punaḥ snēhapānaṁ nirūhāḥ sānuvāsanāḥ| prayōjyā vātagulmēṣu kaphapittānurakṣiṇā||26|| punaH punaH snehapAnaM nirUhAH sAnuvAsanAH| 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).
कफो वाते जितप्राये पित्तं शोणितमेव वा| यदि कुप्यति वा तस्य क्रियमाणे चिकित्सिते||२७|| यथोल्बणस्य दोषस्य तत्र कार्यं भिषग्जितम्| आदावन्ते च मध्ये च मारुतं परिरक्षता||२८|| kaphō vātē jitaprāyē pittaṁ śōṇitamēva vā| yadi kupyati vā tasya kriyamāṇē cikitsitē||27|| yathōlbaṇasya dōṣasya tatra kāryaṁ bhiṣagjitam| ādāvantē ca madhyē ca mārutaṁ parirakṣatā||28|| kapho vAte jitaprAye pittaM shoNitameva vA| yadi kupyati vA tasya kriyamANe cikitsite||27|| yatholbaNasya doShasya tatra kAryaM bhiShagjitam| 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: वातगुल्मे कफो वृद्धो हत्वाऽग्निमरुचिं यदि| हृल्लासं गौरवं तन्द्रां जनयेदुल्लिखेत्तु तम्||२९|| vātagulmē kaphō vr̥ddhō hatvā'gnimaruciṁ yadi| hr̥llāsaṁ gauravaṁ tandrāṁ janayēdullikhēttu tam||29|| vAtagulme kapho vRuddho hatvA~agnimaruciM yadi| 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). शूलानाहविबन्धेषु गुल्मे वातकफोल्बणे| वर्तयो गुटिकाश्चूर्णं कफवातहरं हितम्||३०|| śūlānāhavibandhēṣu gulmē vātakaphōlbaṇē| vartayō guṭikāścūrṇaṁ kaphavātaharaṁ hitam||30|| shUlAnAhavibandheShu gulme vAtakapholbaNe| 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: पित्तं वा यदि संवृद्धं सन्तापं वातगुल्मिनः| कुर्याद्विरेच्यः स भवेत् सस्नेहैरानुलोमिकैः||३१|| pittaṁ vā yadi saṁvr̥ddhaṁ santāpaṁ vātagulminaḥ| kuryādvirēcyaḥ sa bhavēt sasnēhairānulōmikaiḥ||31|| pittaM vA yadi saMvRuddhaM santApaM vAtagulminaH| 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). Blood-letting in vata gulma: गुल्मो यद्यनिलादीनां कृते सम्यग्भिषग्जिते| न प्रशाम्यति रक्तस्य सोऽवसेकात् प्रशाम्यति||३२|| gulmō yadyanilādīnāṁ kr̥tē samyagbhiṣagjitē| na praśāmyati raktasya sō'vasēkāt praśāmyati||32|| gulmo yadyanilAdInAM kRute samyagbhiShagjite| 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). Treatment of pitta dominant gulma:
स्निग्धोष्णेनोदिते गुल्मे पैत्तिके स्रंसनं हितम्| रूक्षोष्णेन तु सम्भूते सर्पिः प्रशमनं परम्||३३|| snigdhōṣṇēnōditē gulmē paittikē sraṁsanaṁ hitam| rūkṣōṣṇēna tu sambhūtē sarpiḥ praśamanaṁ param||33|| snigdhoShNenodite gulme paittike sraMsanaM hitam| 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).
पित्तं वा पित्तगुल्मं वा ज्ञात्वा पक्वाशयस्थितम्| कालविन्निर्हरेत् सद्यः सतिक्तैः क्षीरबस्तिभिः||३४|| पयसा वा सुखोष्णेन सतिक्तेन विरेचयेत्| भिषगग्निबलापेक्षी सर्पिषा तैल्वकेन वा||३५|| pittaṁ vā pittagulmaṁ vā jñātvā pakvāśayasthitam| kālavinnirharēt sadyaḥ satiktaiḥ kṣīrabastibhiḥ||34|| payasā vā sukhōṣṇēna satiktēna virēcayēt| bhiṣagagnibalāpēkṣī sarpiṣā tailvakēna vā||35|| pittaM vA pittagulmaM vA j~jAtvA pakvAshayasthitam| kAlavinnirharet sadyaH satiktaiH kShIrabastibhiH||34|| payasA vA sukhoShNena satiktena virecayet| 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). Blood-letting in pitta dominant gulma: तृष्णाज्वरपरीदाहशूलस्वेदाग्निमार्दवे| गुल्मिनामरुचौ चापि रक्तमेवावसेचयेत्||३६|| tr̥ṣṇājvaraparīdāhaśūlasvēdāgnimārdavē| gulmināmarucau cāpi raktamēvāvasēcayēt||36|| tRuShNAjvaraparIdAhashUlasvedAgnimArdave| 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). छिन्नमूला विदह्यन्ते न गुल्मा यान्ति च क्षयम्| रक्तं हि व्यम्लतां याति, तच्च नास्ति न चास्ति रुक्||३७|| chinnamūlā vidahyantē na gulmā yānti ca kṣayam| raktaṁ hi vyamlatāṁ yāti, tacca nāsti na cāsti ruk||37|| chinnamUlA vidahyante na gulmA yAnti ca kShayam| 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). Diet after blood-letting: हृतदोषं परिम्लानं जाङ्गलैस्तर्पितं रसैः| समाश्वस्तं सशेषार्तिं सर्पिरभ्यासयेत् पुनः||३८|| hr̥tadōṣaṁ parimlānaṁ jāṅgalaistarpitaṁ rasaiḥ| samāśvastaṁ saśēṣārtiṁ sarpirabhyāsayēt punaḥ||38|| hRutadoShaM parimlAnaM jA~ggalaistarpitaM rasaiH| samAshvastaM sasheShArtiM sarpirabhyAsayet punaH||38|| The patient may become weak due to elimination of vitiated blood; hence he should be nourished by the diet comprising of meat soup of wild animals and comforted. To pacify the remaining complaints, he should be prescribed the medicated ghee again (38). रक्तपित्तातिवृद्धत्वात् क्रियामनुपलभ्य च| यदि गुल्मो विदह्येत शस्त्रं तत्र भिषग्जितम्||३९|| raktapittātivr̥ddhatvāt kriyāmanupalabhya ca| yadi gulmō vidahyēta śastraṁ tatra bhiṣagjitam||39|| raktapittAtivRuddhatvAt kriyAmanupalabhya ca| yadi gulmo vidahyeta shastraM tatra bhiShagjitam||39|| In case of excessive increase of pitta and rakta or due to unavailability of proper treatment, if suppuration occurs then surgery should be performed by the surgeon (39). Apakva gulma (intial non-suppurative stage): गुरुः कठिनसंस्थानो गूढमांसान्तराश्रयः| अविवर्णः स्थिरश्चैव ह्यपक्वो गुल्म उच्यते||४०|| guruḥ kaṭhinasaṁsthānō gūḍhamāṁsāntarāśrayaḥ| avivarṇaḥ sthiraścaiva hyapakvō gulma ucyatē||40|| guruH kaThinasaMsthAno gUDhamAMsAntarAshrayaH| avivarNaH sthirashcaiva hyapakvo gulma ucyate||40|| Immovable lump of gulma which is deeply situated under the flesh and hard and heavy to palpate and whose colour remains unchanged is considered as apakva i.e. non-suppurative (40). Symptoms of suppurating (vidahamana) gulma: दाहशूलार्तिसङ्क्षोभस्वप्ननाशारतिज्वरैः| विदह्यमानं जानीयाद्गुल्मं तमुपनाहयेत्||४१|| dāhaśūlārtisaṅkṣōbhasvapnanāśāratijvaraiḥ| vidahyamānaṁ jānīyādgulmaṁ tamupanāhayēt||41|| dAhashUlArtisa~gkShobhasvapnanAshAratijvaraiH| vidahyamAnaM jAnIyAdgulmaM tamupanAhayet||41|| The gulma with symptoms of burning sensation, much pain, very much irritation and discomfort, loss of sleep and fever indicates that it is about to suppurate. In this condition upanaha (poultice) is indicated. (41) Symptoms of suppurated gulma: विदाहलक्षणे गुल्मे बहिस्तुङ्गे समुन्नते| श्यावे सरक्तपर्यन्ते संस्पर्शे बस्तिसन्निभे||४२|| निपीडितोन्नते स्तब्धे सुप्ते [४] तत्पार्श्वपीडनात्| तत्रैव पिण्डिते शूले सम्पक्वं गुल्ममादिशेत्||४३|| vidāhalakṣaṇē gulmē bahistuṅgē samunnatē| śyāvē saraktaparyantē saṁsparśē bastisannibhē||42|| nipīḍitōnnatē stabdhē suptē [4] tatpārśvapīḍanāt| tatraiva piṇḍitē śūlē sampakvaṁ gulmamādiśēt||43|| vidAhalakShaNe gulme bahistu~gge samunnate| shyAve saraktaparyante saMsparshe bastisannibhe||42|| nipIDitonnate stabdhe supte [4] tatpArshvapIDanAt| tatraiva piNDite shUle sampakvaM gulmamAdishet||43|| If gulma protrudes pointing toward outside and skin over the lesion becomes stiff and numb and its colour changes to dusky with red margins. On palpation, the lump resembles as bladder filled with water, pitting on pressure, but on pressing from side the mass becomes tense with mild pain, otherwise it feels compressed mass with acute pain; all these signs and symptoms indicate that the gulma has suppurated (42-43). तत्र धान्वन्तरीयाणामधिकारः क्रियाविधौ| वैद्यानां कृतयोग्यानां व्यधशोधनरोपणे||४४|| tatra dhānvantarīyāṇāmadhikāraḥ kriyāvidhau| vaidyānāṁ kr̥tayōgyānāṁ vyadhaśōdhanarōpaṇē||44|| tatra dhAnvantarIyANAmadhikAraH kriyAvidhau| vaidyAnAM kRutayogyAnAM vyadhashodhanaropaNe||44|| The suppurated Gulma requires surgical intervention such as incision, cleansing and healing therefore it should be treated by a surgeon (44). अन्तर्भागस्य चाप्येतत् पच्यमानस्य लक्षणम्| हृत्क्रोडशूनताऽन्तःस्थे [५] बहिःस्थे पार्श्वनिर्गतिः||४५|| antarbhāgasya cāpyētat pacyamānasya lakṣaṇam| hr̥tkrōḍaśūnatā'ntaḥsthē [5] bahiḥsthē pārśvanirgatiḥ||45|| antarbhAgasya cApyetat pacyamAnasya lakShaNam| hRutkroDashUnatA~antaHsthe [5] bahiHsthe pArshvanirgatiH||45|| The above mentioned symptoms also occur in suppurating (pachyamana) internal gulma. Only difference is that in the internal gulma there is swelling in cardiac region of the abdomen while exterior gulma protrudes towards sides of abdomen (45). Management of pus discharging gulma: पक्वः स्रोतांसि सङ्क्लेद्य व्रजत्यूर्ध्वमधोऽपि वा| स्वयम्प्रवृत्तं तं दोषमुपेक्षेत हिताशनैः [६] ||४६|| दशाहं द्वादशाहं वा रक्षन् भिषगुपद्रवान्| pakvaḥ srōtāṁsi saṅklēdya vrajatyūrdhvamadhō'pi vā| svayampravr̥ttaṁ taṁ dōṣamupēkṣēta hitāśanaiḥ [6] ||46|| daśāhaṁ dvādaśāhaṁ vā rakṣan bhiṣagupadravān| pakvaH srotAMsi sa~gkledya vrajatyUrdhvamadho~api vA| svayampravRuttaM taM doShamupekSheta hitAshanaiH [6] ||46|| dashAhaM dvAdashAhaM vA rakShan bhiShagupadravAn| Suppurated gulma on softening of the passage discharges the pus upwards or downwards. In case of gulma starts discharging at its own then the physician should wait and watch for ten or twelve days while taking care that no complication occurs (46). अत ऊर्ध्वं हितं पानं सर्पिषः सविशोधनम्||४७|| शुद्धस्य तिक्तं सक्षौद्रं प्रयोगे सर्पिरिष्यते|४८| ata ūrdhvaṁ hitaṁ pānaṁ sarpiṣaḥ saviśōdhanam||47|| śuddhasya tiktaṁ sakṣaudraṁ prayōgē sarpiriṣyatē|48| ata UrdhvaM hitaM pAnaM sarpiShaH savishodhanam||47|| shuddhasya tiktaM sakShaudraM prayoge sarpiriShyate|48| Oral administration of ghee with cleansing of the discharging ulcer with shodhana drugs are beneficial. After the cleansing, medicated ghee prepared with bitter drugs should be given with honey (48). Management of kaphaja gulma: Indications of langhana: शीतलैर्गुरुभिः स्निग्धैर्गुल्मे जाते कफात्मके||४८|| अवम्यस्याल्पकायाग्नेः कुर्याल्लङ्घनमादितः| śītalairgurubhiḥ snigdhairgulmē jātē kaphātmakē||48|| avamyasyālpakāyāgnēḥ kuryāllaṅghanamāditaḥ| shItalairgurubhiH snigdhairgulme jAte kaphAtmake||48|| avamyasyAlpakAyAgneH kuryAlla~gghanamAditaH| Kapha-gulma if 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. (48) Indications of vamana: मन्दोऽग्निर्वेदना मन्दा गुरुस्तिमितकोष्ठता||४९|| सोत्क्लेशा चारुचिर्यस्य स गुल्मी वमनोपगः| mandō'gnirvēdanā mandā gurustimitakōṣṭhatā||49|| sōtklēśā cāruciryasya sa gulmī vamanōpagaḥ| mando~agnirvedanA mandA gurustimitakoShThatA||49|| sotkleshA cAruciryasya sa gulmI vamanopagaH| Vamana is indicated in a patient of gulma who is having low digestion, anorexia, nausea and mild pain, heaviness and stiffness in abdomen (49).
उष्णैरेवोपचर्यश्च कृते वमनलङ्घने||५०|| योज्यश्चाहारसंसर्गो भेषजैः कटुतिक्तकैः| uṣṇairēvōpacaryaśca kr̥tē vamanalaṅghanē||50|| yōjyaścāhārasaṁsargō bhēṣajaiḥ kaṭutiktakaiḥ| uShNairevopacaryashca kRute vamanala~gghane||50|| yojyashcAhArasaMsargo bheShajaiH kaTutiktakaiH|
After the treatment with vamana and langhana, the patient should be given hot (ushna) therapy and food mixed with pungent and bitter substances (50).
सानाहं सविबन्धं च गुल्मं कठिनमुन्नतम्||५१|| दृष्ट्वाऽऽदौ स्वेदयेद्युक्त्या स्विन्नं च विलयेद्भिषक्| sānāhaṁ savibandhaṁ ca gulmaṁ kaṭhinamunnatam||51|| dr̥ṣṭvādau svēdayēdyuktyā svinnaṁ ca vilayēdbhiṣak| sAnAhaM savibandhaM ca gulmaM kaThinamunnatam||51|| dRuShTvA~a~adau svedayedyuktyA svinnaM ca vilayedbhiShak| If the gulma is hard and protruded accompanied with constipation and distension of abdomen then physician should give sudation locally to dissolve it (51). लङ्घनोल्लेखने स्वेदे कृतेऽग्नौ सम्प्रधुक्षिते||५२|| कफगुल्मी पिबेत् काले सक्षारकटुकं घृतम्| laṅghanōllēkhanē svēdē kr̥tē'gnau sampradhukṣitē||52|| kaphagulmī pibēt kālē sakṣārakaṭukaṁ ghr̥tam| la~gghanollekhane svede kRute~agnau sampradhukShite||52|| kaphagulmI pibet kAle sakShArakaTukaM ghRutam| After performing langhana, vamana and swedana therapies when digestion is improved, the patient of kapha gulma should be given ghee prepared with bitter substances and kshara (alkali preparation) at the proper time (52). स्थानादपसृतं ज्ञात्वा कफगुल्मं विरेचनैः||५३|| सस्नेहैर्बस्तिभिर्वाऽपि शोधयेद्दाशमूलिकैः| sthānādapasr̥taṁ jñātvā kaphagulmaṁ virēcanaiḥ||53||
sasnēhairbastibhirvā'pi śōdhayēddāśamūlikaiḥ|
sthAnAdapasRutaM j~jAtvA kaphagulmaM virecanaiH||53|| sasnehairbastibhirvA~api shodhayeddAshamUlikaiH|
By the above treatments when kapha gulma dislodges from its place, the patient should be given virechana for purification. Anuvasana basti with oil prepared with dashamula drugs can also be given for this purpose (53).
मन्देऽग्नावनिले मूढे ज्ञात्वा सस्नेहमाशयम्||५४|| गुटिकाचूर्णनिर्यूहाः प्रयोज्याः कफगुल्मिनाम्| mandē'gnāvanilē mūḍhē jñātvā sasnēhamāśayam||54|| guṭikācūrṇaniryūhāḥ prayōjyāḥ kaphagulminām| mande~agnAvanile mUDhe j~jAtvA sasnehamAshayam||54|| guTikAcUrNaniryUhAH prayojyAH kaphagulminAm| In the condition when digestion is low and dysfunction of vata, after proper oleation of the affected site (ashaya), the drugs in the form of pills, powder or decoction are administered to the patient of kapha gulma (54).
कृतमूलं महावास्तुं कठिनं स्तिमितं गुरुम्||५५|| जयेत्कफकृतं गुल्मं क्षारारिष्टाग्निकर्मभिः|| kr̥tamūlaṁ mahāvāstuṁ kaṭhinaṁ stimitaṁ gurum||55|| jayētkaphakr̥taṁ gulmaṁ kṣārāriṣṭāgnikarmabhiḥ|| kRutamUlaM mahAvAstuM kaThinaM stimitaM gurum||55|| jayetkaphakRutaM gulmaM kShArAriShTAgnikarmabhiH|56| 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)(55).
दोषप्रकृतिगुल्मर्तुयोगं बुद्ध्वा कफोल्बणे||५६|| बलदोषप्रमाणज्ञः क्षारं गुल्मे प्रयोजयेत्| एकान्तरं द्व्यन्तरं वा त्र्यहं विश्रम्य वा पुनः||५७|| शरीरबलदोषाणां वृद्धिक्षपणकोविदः| dōṣaprakr̥tigulmartuyōgaṁ buddhvā kaphōlbaṇē||56|| baladōṣapramāṇajñaḥ kṣāraṁ gulmē prayōjayēt| ēkāntaraṁ dvyantaraṁ vā tryahaṁ viśramya vā punaḥ||57|| śarīrabaladōṣāṇāṁ vr̥ddhikṣapaṇakōvidaḥ| doShaprakRutigulmartuyogaM buddhvA kapholbaNe||56|| baladoShapramANaj~jaH kShAraM gulme prayojayet| ekAntaraM dvyantaraM vA tryahaM vishramya vA punaH||57|| sharIrabaladoShANAM vRuddhikShapaNakovidaH| A physician expert in assessing the degree of strength of patient as well as of dosha should prescribe alkali preparation–kshara to the patient of kapha gulma by considering its dosha and nature as well as prevailing season. The expert physician should use kshara treatment on alternate day or at the interval of two or three days depending on the increase or decrease in the strength of the body and dosha (56-57).
श्लेष्माणं मधुरं स्निग्धं मांसक्षीरघृताशिनः||५८|| छित्त्वा छित्त्वाऽऽशयात् क्षारः क्षरत्वात क्षारयत्यधः| ślēṣmāṇaṁ madhuraṁ snigdhaṁ māṁsakṣīraghr̥tāśinaḥ| |58|| chittvā chittvāśayāt kṣāraḥ kṣaratvāta kṣārayatyadhaḥ| shleShmANaM madhuraM snigdhaM mAMsakShIraghRutAshinaH||58|| chittvA chittvA~a~ashayAt kShAraH kSharatvAta kShArayatyadhaH|
Kapha is sweet and unctuous, so it is increased by indulging in the diet comprising of excessive meat, milk and ghee. Alkali preparation-kshara has an action of erosion (ksharana) due to which it erodes the gulma and tickles it down from its habitat(58).
मन्देऽग्नावरुचौ सात्म्ये मद्ये सस्नेहमश्नताम्||५९|| प्रयोज्या मार्गशुद्ध्यर्थमरिष्टाः कफगुल्मिनाम्|| mandē'gnāvarucau sātmyē madyē sasnēhamaśnatām||59|| prayōjyā mārgaśuddhyarthamariṣṭāḥ kaphagulminām|| mande~agnAvarucau sAtmye madye sasnehamashnatAm||59|| prayojyA mArgashuddhyarthamariShTAH kaphagulminAm|60| The diminution in digestion and loss of appetite occur in a patient of kapha gulma due to excessive indulgence in unctuous diet, therefore for the purification of the channels medicated fermented preparation-arishta should be given provided the patient is habituated of taking alcohol (59). Daha karma and rakta mokshana in kapha gulma: लङ्घनोल्लेखनैः स्वेदैः सर्पिःपानैर्विरेचनैः||६०|| बस्तिभिर्गुटिकाचूर्णक्षारारिष्टगणैरपि| श्लैष्मिकः कृतमूलत्वाद्यस्य गुल्मो न शाम्यति||६१|| तस्य दाहो हृते रक्ते शरलोहादिभिर्हितः| laṅghanōllēkhanaiḥ svēdaiḥ sarpiḥpānairvirēcanaiḥ||60|| bastibhirguṭikācūrṇakṣārāriṣṭagaṇairapi| ślaiṣmikaḥ kr̥tamūlatvādyasya gulmō na śāmyati||61|| tasya dāhō hr̥tē raktē śaralōhādibhirhitaḥ|
la~gghanollekhanaiH svedaiH sarpiHpAnairvirecanaiH||60|| bastibhirguTikAcUrNakShArAriShTagaNairapi| shlaiShmikaH kRutamUlatvAdyasya gulmo na shAmyati||61|| tasya dAho hRute rakte sharalohAdibhirhitaH|
If the kapha gulma does not subside by langhana, vamana, swedana, oral administration of medicated ghee, virechana, basti, pills, powder, kshara and arishta due to its firm root in the body, then first bloodletting should be done and then cauterization with such means as arrow head should be done (61).
औष्ण्यात्तैक्ष्ण्याच्च शमयेदग्निर्गुल्मे कफानिलौ||६२|| तयोः शमाच्च सङ्घातो गुल्मस्य विनिवर्तते| auṣṇyāttaikṣṇyācca śamayēdagnirgulmē kaphānilau||62|| tayōḥ śamācca saṅghātō gulmasya vinivartatē| auShNyAttaikShNyAcca shamayedagnirgulme kaphAnilau||62|| tayoH shamAcca sa~gghAto gulmasya vinivartate|
The fire heat due to its hot and sharp properties relieves kapha and vata in gulma, which in turn leads to dissolving the mass of gulma (62). दाहे धान्वन्तरीयाणामत्रापि भिषजां बलम्||६३|| क्षारप्रयोगे भिषजां क्षारतन्त्रविदां बलम्|| dāhē dhānvantarīyāṇāmatrāpi bhiṣajāṁ balam||63|| kṣāraprayōgē bhiṣajāṁ kṣāratantravidāṁ balam|| dAhe dhAnvantarIyANAmatrApi bhiShajAM balam||63|| kShAraprayoge bhiShajAM kShAratantravidAM balam|64| Cauterization comes under the perview of surgeon and use of kshara is the field of specialist in kshara karma (63). व्यामिश्रदोषे व्यामिश्र एष एव क्रियाक्रमः||६४|| vyāmiśradōṣē vyāmiśra ēṣa ēva kriyākramaḥ||64|| vyAmishradoShe vyAmishra eSha eva kriyAkramaH||64|| If the gulma is due to two dosha then the mix treatment of the involved two dosha should be done (64).
सिद्धानतः प्रवक्ष्यामि योगान् गुल्मनिबर्हणान्| siddhānataḥ pravakṣyāmi yōgān gulmanibarhaṇān| siddhAnataH pravakShyAmi yogAn gulmanibarhaNAn|
Now the specific preparations for the cure of gulma will be described (64 ½).
Tryuṣhaṇadi-ghrutam: त्र्यूषणत्रिफलाधान्यविडङ्गचव्यचित्रकैः||६५|| कल्कीकृतैर्घृतं सिद्धं सक्षीरं वातगुल्मनुतिति त्र्यूषणादिघृतम् | tryūṣaṇatriphalādhānyaviḍaṅgacavyacitrakaiḥ||65|| kalkīkr̥tairghr̥taṁ siddhaṁ sakṣīraṁ vātagulmanutiti tryūṣaṇādighr̥tam || tryUShaNatriphalAdhAnyaviDa~ggacavyacitrakaiH||65|| kalkIkRutairghRutaM siddhaM sakShIraM vAtagulmanutiti tryUShaNAdighRutam | Ghee prepared with a paste of trayushna (dry ginger, black and long pepper), Triphala, coriander, Vidanga, Chavya and Chitraka by adding milk is known as Tryushanadighrutam. It is curative of vata gulma; thus described trayushanadighrutam (65).
Parama trayushanadighrutam: एत एव च कल्काः स्युः कषायः पाञ्चमूलिकः ||६६||
द्विपञ्चमूलिको वाऽपि तद्घृतं गुल्मनुत् परमिति त्र्यूषणादिघृतमपरम् ēta ēva ca kalkāḥ syuḥ kaṣāyaḥ pāñcamūlikaḥ ||66||
dvipañcamūlikō vā'pi tadghr̥taṁ gulmanut paramiti tryūṣaṇādighr̥tamaparam || eta eva ca kalkAH syuH kaShAyaH pA~jcamUlikaH [7] ||66|| dvipa~jcamUliko vA~api tadghRutaM gulmanut paramiti tryUShaNAdighRutamaparam Above mentioned paste if prepared with decoction of brihat pancamula or dashamula is known as parama tryushanadighritama. It is very much effective in curing gulma; thus described parama tryushanadighritama (66).
(षट्पलं वा पिबेत् सर्पिर्यदुक्तं राजयक्ष्मणि)||६७|| (ṣaṭpalaṁ vā pibētsarpiryaduktaṁ rājayakṣmaṇi)||67||
(ShaTpalaM vA pibetsarpiryaduktaM rAjayakShmaNi)||67|| (ṣaṭpalam ghrita described for the treatment of rajayakshma may also be used orally) (67). प्रसन्नया वा क्षीरार्थं सुरया दाडिमेन वा| दध्नः सरेण वा कार्यं घृतं मारुतगुल्मनुत्||६८|| prasannayā vā kṣīrārthaṁ surayā dāḍimēna vā| dadhnaḥ sarēṇa vā kāryaṁ ghr̥taṁ mārutagulmanut||68|| prasannayA vA kShIrArthaM [8] surayA dADimena vA| dadhnaH sareNa vA kAryaM ghRutaM mArutagulmanut||68|| In place of milk in above preparation of tryushanadighrutam, ghrita can also be prepared with prasanna wine, sura wine, pomegranate juice or cream of yogurt (curd). It also cures vata gulma (68). Hiṅgusauvarchaladya ghrita: हिङ्गुसौवर्चलाजाजीबिडदाडिमदीप्यकैः| पुष्करव्योषधन्याकवेतसक्षारचित्रकैः||६९|| शटीवचाजगन्धैलासुरसैश्च विपाचितम्| शूलानाहहरं सर्पिर्दध्ना चानिलगुल्मिनाम्||७०|| इति हिङ्गुसौवर्चलाद्यं घृतम् hiṅgusauvarcalājājībiḍadāḍimadīpyakaiḥ| puṣkaravyōṣadhanyākavētasakṣāracitrakaiḥ||69|| ṣativacājagandhailāsurasaiṣca vipācitam śūlānāhaharaṁ sarpirdadhnā cānilagulminām||70|| iti hiṅgusauvarcalādyaṁ ghr̥tam hi~ggusauvarcalAjAjIbiDadADimadIpyakaiH| puShkaravyoShadhanyAkavetasakShAracitrakaiH||69|| shaTIvacAjagandhailAsurasaishca vipAcitam| shUlAnAhaharaM sarpirdadhnA cAnilagulminAm||70|| iti hi~ggusauvarcalAdyaM ghRutam A ghrita prepared with paste of asafoetida, rock salt, cumin, Vit-salt, pomegranate, ajwan, pushkaramula, trikatu, coriander, vetas, yavakshara, chitraka, shati, vacha, ajagandha, cardamom and holy basil by adding curd/yogurt is known as hingusauvarchaladyam ghritam. It cures vata gulma, acute pain and distension of abdomen due to retention of gases (anaha). Thus hiṅgusauvarchaladyam ghrritam is described (69-70). Hapushadya ghrritam: हपुषाव्योषपृथ्वीकाचव्यचित्रकसैन्धवैः| साजाजीपिप्पलीमूलदीप्यकैर्विपचेद्घृतम्||७१|| सकोलमूलकरसं सक्षीरदधिदाडिमम्| तत् परं वातगुल्मघ्नं शूलानाहविमोक्षणम्||७२|| योन्यर्शोग्रहणीदोषश्वासकासारुचिज्वरान्| बस्तिहृत्पार्श्वशूलं च घृतमेतद्व्यपोहति||७३|| इति हपुषाद्यं घृतम् hapuṣāvyōṣapr̥thvīkācavyacitrakasaindhavaiḥ| sājājīpippalīmūladīpyakairvipacēdghr̥tam||71|| sakōlamūlakarasaṁ sakṣīradadhidāḍimam| tat paraṁ vātagulmaghnaṁ śūlānāhavimōkṣaṇam||72|| yōnyarśōgrahaṇīdōṣaśvāsakāsārucijvarān| bastihr̥tpārśvaśūlaṁ ca ghr̥tamētadvyapōhati||73|| iti hapuṣādyaṁ ghr̥tam hapuShAvyoShapRuthvIkAcavyacitrakasaindhavaiH| sAjAjIpippalImUladIpyakairvipacedghRutam||71|| sakolamUlakarasaM sakShIradadhidADimam| tat paraM vAtagulmaghnaM shUlAnAhavimokShaNam||72|| yonyarshograhaNIdoShashvAsakAsArucijvarAn| bastihRutpArshvashUlaM ca ghRutametadvyapohati||73|| iti hapuShAdyaM ghRutam Ghee prepared with a paste of hapusha, trikatu, cardamom, chavya, chitraka, rock salt, cumin, root of long pepper and ajwain along with juice of jujubes, radish and pomegranate, by adding milk and curd is known as hapushadyam ghritam. It is best drug to cure vata gulma, abdominal pain and distension of abdomen. It also provides relief in gynecological disorders, piles, grahani (assimilation disorders), dyspnea, cough, anorexia, fever and pain in hypogastric, epigastric and flanks regions of the abdomen. Thus, hapushadyam ghrritam is described (71-73). Pippalyadyam ghrritam: पिप्पल्या पिचुरध्यर्धो दाडिमाद्द्विपलं पलम्| धान्यात्पञ्च घृताच्छुण्ठ्याः कर्षः क्षीरं चतुर्गुणम्||७४|| सिद्धमेतैर्घृतं सद्यो वातगुल्मं व्यपोहति| योनिशूलं शिरःशूलमर्शांसि विषमज्वरम्||७ ५|| इति पिप्पल्याद्यं घृतम् pippalyā picuradhyardhō dāḍimāddvipalaṁ palam| dhānyātpañca ghr̥tācchuṇṭhyāḥ karṣaḥ kṣīraṁ caturguṇam||74|| siddhamētairghr̥taṁ sadyō vātagulmaṁ vyapōhati| yōniśūlaṁ śiraḥśūlamarśāṁsi viṣamajvaram||75|| iti pippalyādyaṁ ghr̥tam pippalyA picuradhyardho dADimAddvipalaM palam| dhAnyAtpa~jca ghRutAcchuNThyAH karShaH kShIraM caturguNam||74|| siddhametairghRutaM sadyo vAtagulmaM vyapohati| yonishUlaM shiraHshUlamarshAMsi viShamajvaram||75|| iti pippalyAdyaM ghRutam Ghee prepared with paste of one and half part of long pepper, eight parts of pomegranate seeds, four parts of coriander and one part of dry ginger in 20 parts of ghee and 80 parts of milk is known as pippalyadyam ghrrtam. It provides quick relief in vata gulma, pain in vagina, headache, piles and irregular fever. Thus pippalyadyam ghrritam is described (74-75).
घृतानामौषधगणा य एते परिकीर्तिताः| ते चूर्णयोगा वर्त्यस्ताः कषायास्ते च गुल्मिनाम्||७६|| ghr̥tānāmauṣadhagaṇā ya ētē parikīrtitāḥ| tē cūrṇayōgā vartyastāḥ kaṣāyāstē ca gulminām||76|| ghRutAnAmauShadhagaNA ya ete parikIrtitAH| te cUrNayogA vartyastAH kaShAyAste ca gulminAm||76||
The drugs mentioned in the above Ghrita preparations may also be used in form of powders, suppositories or decoctions for the treatment of Gulma (76). Peya (liquid gruel): कोलदाडिमघर्माम्बुसुरामण्डाम्लकाञ्जिकैः| शूलानाहहरी पेया बीजपूररसेन वा||७७|| kōladāḍimagharmāmbusurāmaṇḍāmlakāñjikaiḥ| śūlānāhaharī pēyā bījapūrarasēna vā||77|| koladADimagharmAmbusurAmaNDAmlakA~jjikaiH| shUlAnAhaharI peyA bIjapUrarasena vA||77||
The liquid gruel prepared from jujube, pomegranate, warm water, supernatant liquid of sura-wine (sura-manda), sour kanji or citron juice relieves abdominal pain and distension of abdomen (77). चूर्णानि मातुलुङ्गस्य भावितानि रसेन वा| कुर्याद्वर्तीः सगुटिका गुल्मानाहार्तिशान्तये||७८|| cūrṇāni mātuluṅgasya bhāvitāni rasēna vā| kuryādvartīḥ saguṭikā gulmānāhārtiśāntayē||78|| cUrNAni mAtulu~ggasya bhAvitAni rasena vA| kuryAdvartIH saguTikA gulmAnAhArtishAntaye||78|| Or prepare the suppositories and pills by impregnating the powders of the above drugs in the juice of pomelo (matulunga) and use them for providing relief in gulma, distension of abdomen and discomfort (78). Hiṅgvadi churṇa and gutika:
हिङ्गु त्रिकटुकं पाठां हपुषामभयां शटीम्|
अजमोदाजगन्धे च तिन्तिडीकाम्लवेतसौ||७९|| दाडिमं पुष्करं धान्यमजाजीं चित्रकं वचाम्| द्वौ क्षारौ लवणे द्वे च चव्यं चैकत्र चूर्णयेत्||८०|| चूर्णमेतत् प्रयोक्तव्यमन्नपानेष्वनत्ययम्| प्राग्भक्तमथवा पेयं मद्येनोष्णोदकेन वा||८१|| पार्श्वहृद्बस्तिशूलेषु गुल्मे वातकफात्मके| आनाहे मूत्रकृच्छ्रे च शूले च गुदयोनिजे [९] ||८२|| ग्रहण्यर्शोविकारेषु प्लीह्नि पाण्ड्वामयेऽरुचौ| उरोविबन्धे हिक्कायां कासे श्वासे गलग्रहे||८३|| भावितं मातुलुङ्गस्य चूर्णमेतद्रसेन वा| बहुशो गुटिकाः कार्याः कार्मुकाः स्युस्ततोऽधिकम्||८४|| इति हिङ्ग्वादिचूर्णं गुटिका च | hiṅgu trikaṭukaṁ pāṭhāṁ hapuṣāmabhayāṁ śaṭīm| ajamōdājagandhē ca tintiḍīkāmlavētasau||79|| dāḍimaṁ puṣkaraṁ dhānyamajājīṁ citrakaṁ vacām| dvau kṣārau lavaṇē dvē ca cavyaṁ caikatra cūrṇayēt||80|| cūrṇamētat prayōktavyamannapānēṣvanatyayam| prāgbhaktamathavā pēyaṁ madyēnōṣṇōdakēna vā||81|| pārśvahr̥dbastiśūlēṣu gulmē vātakaphātmakē| ānāhē mūtrakr̥cchrē ca śūlē ca gudayōnijē [9] ||82|| grahaṇyarśōvikārēṣu plīhni pāṇḍvāmayē'rucau| urōvibandhē hikkāyāṁ kāsē śvāsē galagrahē||83|| bhāvitaṁ mātuluṅgasya cūrṇamētadrasēna vā| bahuśō guṭikāḥ kāryāḥ kārmukāḥ syustatō'dhikam||84|| iti hiṅgvādicūrṇaṁ guṭikā ca | hi~ggu trikaTukaM pAThAM hapuShAmabhayAM shaTIm| ajamodAjagandhe ca tintiDIkAmlavetasau||79|| dADimaM puShkaraM dhAnyamajAjIM citrakaM vacAm| dvau kShArau lavaNe dve ca cavyaM caikatra cUrNayet||80|| cUrNametat prayoktavyamannapAneShvanatyayam| prAgbhaktamathavA peyaM madyenoShNodakena vA||81|| pArshvahRudbastishUleShu gulme vAtakaphAtmake| AnAhe mUtrakRucchre ca shUle ca gudayonije [9] ||82|| grahaNyarshovikAreShu plIhni pANDvAmaye~arucau| urovibandhe hikkAyAM kAse shvAse galagrahe||83|| bhAvitaM mAtulu~ggasya cUrNametadrasena vA| bahusho guTikAH kAryAH kArmukAH syustato~adhikam||84|| iti hi~ggvAdicUrNaM guTikA ca Make fine powder of equal parts of asafoetida, trikatu, patha, hapusha, haritaki, shati, ajamoda, ajagandha, tintidika, amlavetas, pomegranate, pushkaramula, coriander, cumin, chitraka, vacha, two types of kshara, two types of salt and chavya. It is known as hingvadichurnam. This powder is to be given with food and drinks or it may be taken before meal as drink mixed with wine or hot water. This has no harmful effect. It is useful in vata-kapha gulma, pain in hypogastric, epigastric and hypochondric regions of the abdomen, distension of abdomen, dysuria, pain in anus and vagina, assimilation disorders, piles, spleen disorders, anaemia, anorexia, tightness of chest, hiccup, cough, dyspnoea and sore-throat. The pills may also be prepared by repeatedly impregnating the above mentioned powders in juice of citron, which is more effective than administration of the simple powders. Thus hingvadichurnam and gutika have been described (79-84).
मातुलुङ्गरसो हिङ्गु दाडिमं बिडसैन्धवे| सुरामण्डेन पातव्यं वातगुल्मरुजापहम्||८५|| mātuluṅgarasō hiṅgu dāḍimaṁ biḍasaindhavē| surāmaṇḍēna pātavyaṁ vātagulmarujāpaham||85||
mAtulu~ggaraso hi~ggu dADimaM biDasaindhave| surAmaNDena pAtavyaM vAtagulmarujApaham||85||
Mix asafetida, pomegranate and bid and rock salts in juice of citron and take with supernatant fluid of surā wine. It cures pain of vata gulma (85). Shatyadi churnam and gutika: शटीपुष्करहिङ्ग्वम्लवेतसक्षारचित्रकान्| धान्यकं च यवानीं च विडङ्गं सैन्धवं वचाम्||८६|| सचव्यपिप्पलीमूलामजगन्धां सदाडिमाम्| अजाजीं चाजमोदां च चूर्णं कृत्वा प्रयोजयेत्||८७|| रसेन मातुलुङ्गस्य मधुशुक्तेन वा पुनः| भावितं गुटिकां कृत्वा सुपिष्टां कोलसम्मिताम्||८८|| गुल्मं प्लीहानमानाहं श्वासं कासमरोचकम्| हिक्कां हृद्रोगमर्शांसि विविधां शिरसो रुजम्||८९|| पाण्ड्वामयं कफोत्क्लेशं सर्वजां च प्रवाहिकाम्| पार्श्वहृद्बस्तिशूलं च गुटिकैषा व्यपोहति||९०|| śaṭīpuṣkarahiṅgvamlavētasakṣāracitrakān| dhānyakaṁ ca yavānīṁ ca viḍaṅgaṁ saindhavaṁ vacām||86|| sacavyapippalīmūlāmajagandhāṁ sadāḍimām| ajājīṁ cājamōdāṁ ca cūrṇaṁ kr̥tvā prayōjayēt||87|| rasēna mātuluṅgasya madhuśuktēna vā punaḥ| bhāvitaṁ guṭikāṁ kr̥tvā supiṣṭāṁ kōlasammitām||88|| gulmaṁ plīhānamānāhaṁ śvāsaṁ kāsamarōcakam| hikkāṁ hr̥drōgamarśāṁsi vividhāṁ śirasō rujam||89|| pāṇḍvāmayaṁ kaphōtklēśaṁ sarvajāṁ ca pravāhikām| pārśvahr̥dbastiśūlaṁ ca guṭikaiṣā vyapōhati||90|| shaTIpuShkarahi~ggvamlavetasakShAracitrakAn| dhAnyakaM ca yavAnIM ca viDa~ggaM saindhavaM vacAm||86|| sacavyapippalImUlAmajagandhAM sadADimAm| ajAjIM cAjamodAM ca cUrNaM kRutvA prayojayet||87|| rasena mAtulu~ggasya madhushuktena vA punaH| bhAvitaM guTikAM kRutvA supiShTAM kolasammitAm||88|| gulmaM plIhAnamAnAhaM shvAsaM kAsamarocakam| hikkAM hRudrogamarshAMsi vividhAM shiraso rujam||89|| pANDvAmayaM kaphotkleshaM sarvajAM ca pravAhikAm| pArshvahRudbastishUlaM ca guTikaiShA vyapohati||90||
Mix fine powders of shati, pushkaramula, asafetida, amlavetasa, kshara, chitraka, coriander, ajwain (yavani), vidanga, rock-salt, vacha, chavya, pippalimula, ajagandha, pomegranate, ajaji and ajamoda. It may be used in powder form or in the form of pills made of size of jujube by impregnating these powders in juice of citron or vinegar of honey by rubbing well. This pill cures gulma, spleen disorders, distension of abdomen, dyspnoea, anorexia, hiccup, heart diseases, piles, various types of headache, anaemia, excessive of secretions (kaphotklesha), all types of dysenteries and pain in hypogastric, epigastric and hypochondric regions of the abdomen (86-90). Nagara prepartion: नागरार्धपलं पिष्ट्वा द्वे पले लुञ्चितस्य च| तिलस्यैकं गुडपलं क्षीरेणोष्णेन ना पिबेत्||९१|| वातगुल्ममुदावर्तं योनिशूलं च नाशयेत्| nāgarārdhapalaṁ piṣṭvā dvē palē luñcitasya ca| tilasyaikaṁ guḍapalaṁ kṣīrēṇōṣṇēna nā pibēt||91|| vātagulmamudāvartaṁ yōniśūlaṁ ca nāśayēt|
nAgarArdhapalaM piShTvA dve pale lu~jcitasya ca|
tilasyaikaM guDapalaM kShIreNoShNena nA pibet||91|| vAtagulmamudAvartaM yonishUlaM ca nAshayet| Make paste of 25 gm of dried ginger, 100 gm pealed sesame and 50 gm of jaggery and administer to the patient with warm milk. It cures vata gulma, udavarta ( disorder due to improper direction of vata) and pain in vagina (91½).
पिबेदेरण्डजं तैलं वारुणीमण्डमिश्रितम्||९२|| तदेव तैलं पयसा वातगुल्मी पिबेन्नरः| श्लेष्मण्यनुबले पूर्वं हितं पित्तानुगे परम्||९३|| pibēdēraṇḍajaṁ tailaṁ vāruṇīmaṇḍamiśritam||92|| tadēva tailaṁ payasā vātagulmī pibēnnaraḥ| ślēṣmaṇyanubalē pūrvaṁ hitaṁ pittānugē param||93|| pibederaNDajaM tailaM vAruNImaNDamishritam||92|| tadeva tailaM payasA vAtagulmI pibennaraH| shleShmaNyanubale pUrvaM hitaM pittAnuge param||93|| The patient of vata gulma associated with kapha dominance, then should take castor oil with supernatant of varuni wine and if pitta is associated then take castor oil with milk (92-93). Lashuna-kshiram: साधयेच्छुद्धशुष्कस्य लशुनस्य चतुष्पलम्| क्षीरोदकेऽष्टगुणिते क्षीरशेषं च ना पिबेत्||९४|| वातगुल्ममुदावर्तं गृध्रसीं विषमज्वरम्| हृद्रोगं विद्रधिं शोथं साधयत्याशु तत्पयः||९५|| इति लशुनक्षीरम् | sādhayēcchuddhaśuṣkasya laśunasya catuṣpalam| kṣīrōdakē'ṣṭaguṇitē [10] kṣīraśēṣaṁ ca nā pibēt||94|| vātagulmamudāvartaṁ gr̥dhrasīṁ viṣamajvaram| hr̥drōgaṁ vidradhiṁ śōthaṁ sādhayatyāśu tatpayaḥ||95|| iti laśunakṣīram | sAdhayecchuddhashuShkasya lashunasya catuShpalam| kShIrodake~aShTaguNite [10] kShIrasheShaM ca nA pibet||94|| vAtagulmamudAvartaM gRudhrasIM viShamajvaram| hRudrogaM vidradhiM shothaM sAdhayatyAshu tatpayaH||95|| iti lashunakShIram Take 160 gm of dried and peeled garlic, add to it 640 ml of milk and 640 ml of water and boil on slow fire till only milk remains. It is known as lashuna kshiram and its oral administration provides quick relief in vata gulma, udavarta, sciatica, irregular fever, heart disease, abscess and inflammation (94-95). Taila panchakam: तैलं प्रसन्ना गोमूत्रमारनालं यवाग्रजम्| गुल्मं जठरमानाहं पीतमेकत्र साधयेत्||९६|| इति तैलपञ्चकम् | tailaṁ prasannā gōmūtramāranālaṁ yavāgrajam| gulmaṁ jaṭharamānāhaṁ pītamēkatra sādhayēt||96|| iti tailapañcakam | tailaM prasannA gomUtramAranAlaM yavAgrajam| gulmaM jaTharamAnAhaM pItamekatra sAdhayet||96|| iti tailapa~jcakam The mixture of castor oil, prasanna wine, cow’s urine, aranala (sour Kanji) and yavakshara is known as tailapanchakam. Its oral administration cures gulma, gastric disorders and distension of abdomen (96). shilajatu-prayoga: पञ्चमूलीकषायेण सक्षारेण शिलाजतु| पिबेत्तस्य प्रयोगेण वातगुल्मात् प्रमुच्यते||९७|| इति शिलाजतुप्रयोगः | pañcamūlīkaṣāyēṇa sakṣārēṇa śilājatu| pibēttasya prayōgēṇa vātagulmāt pramucyatē||97|| iti śilājatuprayōgaḥ |
pa~jcamUlIkaShAyeNa sakShAreNa [11] shilAjatu|
pibettasya prayogeNa vAtagulmAt pramucyate||97|| iti shilAjatuprayogaH Taking of shilajatu with kshara and decoction of panchamula cures vata gulma. Thus administration of shilajatu is described (97). Vaṭyam or barley preparation: वाट्यं पिप्पलीयूषेण मूलकानां रसेन वा| भुक्त्वा स्निग्धमुदावर्ताद्वातगुल्माद्विमुच्यते||९८|| vāṭyaṁ pippalīyūṣēṇa mūlakānāṁ rasēna vā| bhuktvā snigdhamudāvartādvātagulmādvimucyatē||98||
vATyaM pippalIyUSheNa mUlakAnAM rasena vA|
bhuktvA snigdhamudAvartAdvAtagulmAdvimucyate||98|| Taking of barley meal mixed with unctuous substances along with soup of long pepper or juice of radish, provides relief in vata gulma and udavarta (98). Swedana: शूलानाहविबन्धार्तं स्वेदयेद्वातगुल्मिनम्| स्वेदैः स्वेदविधावुक्तैर्नाडीप्रस्तरसङ्करैः||९९|| śūlānāhavibandhārtaṁ svēdayēdvātagulminam| svēdaiḥ svēdavidhāvuktairnāḍīprastarasaṅkaraiḥ||99||
shUlAnAhavibandhArtaM svedayedvAtagulminam|
svedaiH svedavidhAvuktairnADIprastarasa~gkaraiH||99|| If the patient of vata gulma is also having the complaints of distension of abdomen and constipation then swedana therapy should be given in the form of nadi (cattle sudation), prastara (stone slab sudation) and sankara (mix sudation) sweda as described in chapter 14 of Sutra Sthana of Charaka Samhita (99) Basti karma: बस्तिकर्म परं विद्याद्गुल्मघ्नं तद्धि मारुतम्| स्वे स्थाने प्रथमं जित्वा सद्यो गुल्ममपोहति||१००|| तस्मादभीक्ष्णशो गुल्मा निरूहैः सानुवासनैः| प्रयुज्यमानैः शाम्यन्ति वातपित्तकफात्मकाः||१०१|| गुल्मघ्ना विविधा दिष्टाः सिद्धाः सिद्धिषु बस्तयः| bastikarma paraṁ vidyādgulmaghnaṁ taddhi mārutam| svē sthānē prathamaṁ jitvā sadyō gulmamapōhati||100|| tasmādabhīkṣṇaśō gulmā nirūhaiḥ sānuvāsanaiḥ| prayujyamānaiḥ śāmyanti vātapittakaphātmakāḥ||101|| gulmaghnā vividhā diṣṭāḥ siddhāḥ siddhiṣu bastayaḥ| bastikarma paraM vidyAdgulmaghnaM taddhi mArutam| sve sthAne prathamaM jitvA sadyo gulmamapohati||100|| tasmAdabhIkShNasho gulmA nirUhaiH sAnuvAsanaiH| prayujyamAnaiH shAmyanti vAtapittakaphAtmakAH||101|| gulmaghnA vividhA diShTAH siddhAH siddhiShu bastayaH|102| Basti Karma is the best treatment of gulma because it first conquers vata at its natural site and then cures gulma quickly. Therefore niruha and anuvasana basti should be administered repeatedly for cure of vata, pitta and kapha gulma. Various types of basti for the cure of gulma shall be described in Siddhi Sthana (Charaka Siddhi sthana chapter-10) (100-101). Medicated oils: गुल्मघ्नानि च तैलानि वक्ष्यन्ते वातरोगिके||१०२|| तानि मारुतजे गुल्मे पानाभ्यङ्गानुवासनैः| प्रयुक्तान्याशु सिध्यन्ति तैलं ह्यनिलजित्परम् [१२] ||१०३|| gulmaghnāni ca tailāni vakṣyantē vātarōgikē||102|| tāni mārutajē gulmē pānābhyaṅgānuvāsanaiḥ| prayuktānyāśu sidhyanti tailaṁ hyanilajitparam [12] ||103|| gulmaghnAni ca tailAni vakShyante vAtarogike||102|| tAni mArutaje gulme pAnAbhya~ggAnuvAsanaiH| prayuktAnyAshu sidhyanti tailaM hyanilajitparam [12] ||103||
The various types of medicated oil useful for gulma will be described in the chapter on vata vyadhi (Charaka Chikitisa Sthana chapter28). The medicated oils are used for oral administration, massage and anuvasana basti. As oil is best therapy for vata therefore it cures vata gulma quickly (102-103). नीलिनीचूर्णसंयुक्तं पूर्वोक्तं घृतमेव| समलाय प्रदातव्यं शोधनं वातगुल्मिने||१०४|| nīlinīcūrṇasaṁyuktaṁ pūrvōktaṁ ghr̥tamēva| samalāya pradātavyaṁ śōdhanaṁ vātagulminē||104|| nIlinIcUrNasaMyuktaM pUrvoktaM ghRutameva| samalAya pradAtavyaM shodhanaM vAtagulmine||104|| Accumulated faeces of the patient of vata gulma should be eliminated by giving earlier mentioned ghrita mixed with powder nilini .(104)
Nilinyadyam ghritam: नीलिनीत्रिवृतादन्तीपथ्याकम्पिल्लकैः सह| शोधनार्थं घृतं देयं सबिडक्षारनागरम्||१०५|| nīlinītrivr̥tādantīpathyākampillakaiḥ saha| śōdhanārthaṁ ghr̥taṁ dēyaṁ sabiḍakṣāranāgaram||105|| nIlinItrivRutAdantIpathyAkampillakaiH saha| shodhanArthaM ghRutaM deyaM sabiDakShAranAgaram||105|| The ghee prepared with nilini, trivrita, danti, haritaki and kampillaka along with bid-salt and kshara should be given for shodhana (105). Nilinyadyam ghritam: नीलिनीं त्रिफलां रास्नां बलां कटुकरोहिणीम्| पचेद्विडङ्गं व्याघ्रीं च पलिकानि जलाढके||१०६|| तेन पादावशेषेण घृतप्रस्थं विपाचयेत्| दध्नः प्रस्थेन संयोज्य सुधाक्षीरपलेन च||१०७|| ततो घृतपलं दद्याद्यवागूमण्डमिश्रितम्| जीर्णे सम्यग्विरिक्तं च भोजयेद्रसभोजनम्||१०८|| गुल्मकुष्ठोदरव्यङ्गशोफपाण्ड्वामयज्वरान्| श्वित्रं प्लीहानमुन्मादं घृतमेतद्व्यपोहति||१०९|| इति नीलिन्याद्यं घृतम् nīlinīṁ triphalāṁ rāsnāṁ balāṁ kaṭukarōhiṇīm| pacēdviḍaṅgaṁ vyāghrīṁ ca palikāni jalāḍhakē||106|| tēna pādāvaśēṣēṇa ghr̥taprasthaṁ vipācayēt| dadhnaḥ prasthēna saṁyōjya sudhākṣīrapalēna ca||107|| tatō ghr̥tapalaṁ dadyādyavāgūmaṇḍamiśritam| jīrṇē samyagviriktaṁ ca bhōjayēdrasabhōjanam||108|| gulmakuṣṭhōdaravyaṅgaśōphapāṇḍvāmayajvarān| śvitraṁ plīhānamunmādaṁ ghr̥tamētadvyapōhati||109|| iti nīlinyādyaṁ ghr̥tam nIlinIM triphalAM rAsnAM balAM kaTukarohiNIm| pacedviDa~ggaM vyAghrIM ca palikAni jalADhake||106|| tena pAdAvasheSheNa ghRutaprasthaM vipAcayet| dadhnaH prasthena saMyojya sudhAkShIrapalena ca||107|| tato ghRutapalaM dadyAdyavAgUmaNDamishritam| jIrNe samyagviriktaM ca bhojayedrasabhojanam||108|| gulmakuShThodaravya~ggashophapANDvAmayajvarAn| shvitraM plIhAnamunmAdaM ghRutametadvyapohati||109|| iti nIlinyAdyaM ghRutam Take 50 gm each of nilini, triphala, rasna, bala, katuki, vidanga and kantakari and add to it 2.5 litres of water and prepare the decoction by reducing it to one-fourth. Add to it 640 ml of ghee, 640 ml of curd and 50 ml of latex of snuhi and prepare ghee as per method of sneha-paka. Its 40 ml mixed with manda (liquid obtained by filtering the boiled rice) should be given for virechana. When the patient is well purged and the drug is digested then meat soup is given in diet. This ghrita cures gulma, kushtha, udara roga, vyanga (freckles), swellings, anemia, fever, leukoderma, splenomegaly and psychic disorders (unmada). Thus nilinyadi ghritam is described (106-109). Pathya in vata gulma: कुक्कुटाश्च मयूराश्च तित्तिरिक्रौञ्चवर्तकाः| शालयो मदिरा सर्पिर्वातगुल्मभिषग्जितम्||११०|| हितमुष्णं द्रवं स्निग्धं भोजनं वातगुल्मिनाम्| समण्डवारुणीपानं पक्वं वा धान्यकैर्जलम्||१११|| kukkuṭāśca mayūrāśca tittirikrauñcavartakāḥ| śālayō madirā sarpirvātagulmabhiṣagjitam||110|| hitamuṣṇaṁ dravaṁ snigdhaṁ bhōjanaṁ vātagulminām| samaṇḍavāruṇīpānaṁ pakvaṁ vā dhānyakairjalam||111|| kukkuTAshca mayUrAshca tittirikrau~jcavartakAH| shAlayo madirA sarpirvAtagulmabhiShagjitam||110|| hitamuShNaM dravaM snigdhaM bhojanaM vAtagulminAm| samaNDavAruNIpAnaM pakvaM vA dhAnyakairjalam||111|| Hot, liquid and unctuous diet is beneficial for the patient of vata gulma. Red rice, wine and ghee; meats of cock, peacock, partridge (tittara), krauncha (demolselle) and quell (vartaka) are beneficial for the patient of vata gulma. Similarly a potion of varuni wine with manda (supernatant fluid of boiled rice) or water boiled with coriander is beneficial (110-111).
Protection of agni: मन्देऽग्नौ वर्धते गुल्मो दीप्ते चाग्नौ प्रशाम्यति| तस्मान्ना नातिसौहित्यं कुर्यान्नातिविलङ्घनम्||११२|| mandē'gnau vardhatē gulmō dīptē cāgnau praśāmyati| tasmānnā nātisauhityaṁ kuryānnātivilaṅghanam||112||
mande~agnau vardhate gulmo dIpte cAgnau prashAmyati|
tasmAnnA nAtisauhityaM kuryAnnAtivila~gghanam||112||
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).
Oleation therapy: सर्वत्र गुल्मे प्रथमं स्नेहस्वेदोपपादिते| या क्रिया क्रियते सिद्धिं सा याति न विरूक्षिते||११३|| sarvatra gulmē prathamaṁ snēhasvēdōpapāditē| yā kriyā kriyatē siddhiṁ sā yāti na virūkṣitē||113|| sarvatra gulme prathamaM snehasvedopapAdite| yA kriyA kriyate siddhiM sA yAti na virUkShite||113|| In all types of gulma, only that successive treatment is fruitful which is given after subjecting first the patient to snehana and then swedana, but it never success if given after un-unctuous (ruksha) treatment (113).
Management of pitta gulma: भिषगात्ययिकं बुद्ध्वा पित्तगुल्ममुपाचरेत्| वैरेचनिकसिद्धेन सर्पिषा तिक्तकेन वा||११४|| bhiṣagātyayikaṁ buddhvā pittagulmamupācarēt| vairēcanikasiddhēna sarpiṣā tiktakēna vā||114|| bhiShagAtyayikaM buddhvA pittagulmamupAcaret| vairecanikasiddhena sarpiShA tiktakena [14] vA||114||
Physician while dealing with pitta gulma should know that it requires immediate treatment (atyayika). Pitta gulma patient should be given ghee prepared with purgative and bitter drugs (114).
Rohiṇyadya ghritam: रोहिणीकटुकानिम्बमधुकत्रिफलात्वचः| कर्षांशास्त्रायमाणा च पटोलत्रिवृतोः पले||११५|| द्वे पले च मसूराणां साध्यमष्टगुणेऽम्भसि| शृताच्छेषं घृतसमं सर्पिषश्च चतुष्पलम्||११६|| पिबेत् सम्मूर्च्छितं तेन गुल्मः शाम्यति पैत्तिकः| ज्वरस्तृष्णा च शूलं च भ्रमो मूर्च्छाऽरुचिस्तथा||११७|| इति रोहिण्याद्यं घृतम् rōhiṇīkaṭukānimbamadhukatriphalātvacaḥ| karṣāṁśāstrāyamāṇā ca paṭōlatrivr̥tōḥ palē||115|| dvē palē ca masūrāṇāṁ sādhyamaṣṭaguṇē'mbhasi| śr̥tācchēṣaṁ ghr̥tasamaṁ sarpiṣaśca catuṣpalam||116|| pibēt sammūrcchitaṁ tēna gulmaḥ śāmyati paittikaḥ| jvarastr̥ṣṇā ca śūlaṁ ca bhramō mūrcchā'rucistathā||117|| iti rōhiṇyādyaṁ ghr̥tam rohiNIkaTukAnimbamadhukatriphalAtvacaH| karShAMshAstrAyamANA ca paTolatrivRutoH pale||115|| dve pale ca masUrANAM sAdhyamaShTaguNe~ambhasi| shRutAccheShaM ghRutasamaM sarpiShashca catuShpalam||115|| pibet sammUrcchitaM tena gulmaH shAmyati paittikaH| jvarastRuShNA ca shUlaM ca bhramo mUrcchA~arucistathA||117|| iti rohiNyAdyaM ghRutam
Take 10 gm each of katuka, neem, liquorices, triphala and trayamana; 40 gm each of patola and trivrita; 80 gm of lentil (Masura) and add to it 8 times water; boil on low fire till it reduces to 160 ml. Add to it equal quantity of ghee i.e. 160 ml and administer it to the patient orally. It alleviates pitta gulma, fever, thirst, abdominal pain, giddiness, fainting and anorexia. Thus rohinyadi ghrita is described (117).
Trayamaṇadi ghritam: जले दशगुणे साध्यं त्रायमाणाचतुष्पलम्| पञ्चभागस्थितं पूतं कल्कैः संयोज्य कार्षिकैः||११८|| रोहिणी कटुका मुस्ता त्रायमाणा दुरालभा| कल्कैस्तामलकीवीराजीवन्तीचन्दनोत्पलैः||११९|| रसस्यामलकानां च क्षीरस्य च घृतस्य च| पलानि पृथगष्टाष्टौ दत्त्वा सम्यग्विपाचयेत्||१२०|| पित्तरक्तभवं गुल्मं वीसर्पं पैत्तिकं ज्वरम्| हृद्रोगं कामलां कुष्ठं हन्यादेतद्घृतोत्तमम्||१२१|| इति त्रायमाणाद्यं घृतम् jalē daśaguṇē sādhyaṁ trāyamāṇācatuṣpalam| pañcabhāgasthitaṁ pūtaṁ kalkaiḥ saṁyōjya kārṣikaiḥ||118|| rōhiṇī kaṭukā mustā trāyamāṇā durālabhā| kalkaistāmalakīvīrājīvantīcandanōtpalaiḥ||119|| rasasyāmalakānāṁ ca kṣīrasya ca ghr̥tasya ca| palāni pr̥thagaṣṭāṣṭau dattvā samyagvipācayēt||120|| pittaraktabhavaṁ gulmaṁ vīsarpaṁ paittikaṁ jvaram| hr̥drōgaṁ kāmalāṁ kuṣṭhaṁ hanyādētadghr̥tōttamam||121|| iti trāyamāṇādyaṁ ghr̥tam jale dashaguNe sAdhyaM trAyamANAcatuShpalam| pa~jcabhAgasthitaM pUtaM kalkaiH saMyojya kArShikaiH||118|| rohiNI kaTukA mustA trAyamANA durAlabhA| kalkaistAmalakIvIrAjIvantIcandanotpalaiH||119|| rasasyAmalakAnAM ca kShIrasya ca ghRutasya ca| palAni pRuthagaShTAShTau dattvA samyagvipAcayet||120|| pittaraktabhavaM gulmaM vIsarpaM paittikaM jvaram| hRudrogaM kAmalAM kuShThaM hanyAdetadghRutottamam||121|| iti trAyamANAdyaM ghRutam Make decoction by adding 10 times of water to 160 gm of trayamana and reducing it to one fifth. To this decoction add 10 gm paste of katuka, mustaka, trayamana and duralabha; 10 gm paste of tamalaki, veera, jivanti, sandal and lotus; add to it 320 ml juice of amalaki, milk and ghee. From all these, prepare ghrita as per method of sneha pāka. It is best ghrita to cure pitta and rakta-gulma, visarpa, pitta jwara, heart disease, jaundice and kushtha. Thus trayamanadi ghritam is described (118-121). Amalakadi ghritam: रसेनामलकेक्षूणां घृतपादं विपाचयेत्| पथ्यापदं पिबेत्सर्पिस्तत्सिद्धं पित्तगुल्मनुत्||१२२|| इत्यामलकाद्यं घृतम् rasēnāmalakēkṣūṇāṁ ghr̥tapādaṁ vipācayēt| pathyāpadaṁ pibētsarpistatsiddhaṁ pittagulmanut||122|| ityāmalakādyaṁ ghr̥tam rasenAmalakekShUNAM ghRutapAdaM [15] vipAcayet| pathyApadaM pibetsarpistatsiddhaM pittagulmanut||122|| ityAmalakAdyaM ghRutam Prepare ghrita with four parts of juice of amalaki and sugarcane juice, one-fourth part of paste of haritaki and one part of ghee. It is to be taken orally to cure pitta gulma. Thus amalakadyam ghritam is described (122). Drakṣhadi ghritam: द्राक्षां मधूकं खर्जूरं विदारीं सशतावरीम्| परूषकाणि त्रिफलां साधयेत्पलसम्मितम्||१२३|| जलाढके पादशेषे रसमामलकस्य च| घृतमिक्षुरसं क्षीरमभयाकल्कपादिकम्||१२४|| साधयेत्तद्घृतं सिद्धं शर्कराक्षौद्रपादिकम्| प्रयोगात् पित्तगुल्मघ्नं सर्वपित्तविकारनुत्||१२५|| इति द्राक्षाद्यं घृतम् drākṣāṁ madhūkaṁ kharjūraṁ vidārīṁ saśatāvarīm| parūṣakāṇi triphalāṁ sādhayētpalasammitam||123|| jalāḍhakē pādaśēṣē rasamāmalakasya ca| ghr̥tamikṣurasaṁ kṣīramabhayākalkapādikam||124|| sādhayēttadghr̥taṁ siddhaṁ śarkarākṣaudrapādikam| prayōgāt pittagulmaghnaṁ sarvapittavikāranut||125|| iti drākṣādyaṁ ghr̥tam drAkShAM madhUkaM kharjUraM vidArIM sashatAvarIm| parUShakANi triphalAM sAdhayetpalasammitam||123|| jalADhake pAdasheShe rasamAmalakasya ca| ghRutamikShurasaM kShIramabhayAkalkapAdikam||124|| sAdhayettadghRutaM siddhaM sharkarAkShaudrapAdikam| prayogAt pittagulmaghnaM sarvapittavikAranut||125|| iti drAkShAdyaM ghRutam Take 40 gm each of raisin, madhuka (mahva), date, vidari, shatavari, parushaka and triphala and add to it 2560 ml of water and boil till reduced to one-fourth. To this decoction add 640 gm each of ghee, sugar-cane juice, juice of amalaki and milk and its one fourth part of paste of haritaki; and prepare ghrita as per method of sneha-paka. Take this ghee by adding one fourth quantities of sugar and honey. It cures pitta-gulma and all types of pitta disorders. Thus drakshdyam ghritam is described (123-125). Vasaghr̥itam: वृषं समूलमापोथ्य पचेदष्टगुणे जले| शेषेऽष्टभागे तस्यैव पुष्पकल्कं प्रदापयेत्||१२६|| तेन सिद्धं घृतं शीतं सक्षौद्रं पित्तगुल्मनुत्| रक्तपित्तज्वरश्वासकासहृद्रोगनाशनम्||१२७|| इति वासाघृतम् vr̥ṣaṁ samūlamāpōthya pacēdaṣṭaguṇē jalē| śēṣē'ṣṭabhāgē tasyaiva puṣpakalkaṁ pradāpayēt||126|| tēna siddhaṁ ghr̥taṁ śītaṁ sakṣaudraṁ pittagulmanut| raktapittajvaraśvāsakāsahr̥drōganāśanam||127|| iti vāsāghr̥tam vRuShaM samUlamApothya pacedaShTaguNe jale| sheShe~aShTabhAge tasyaiva puShpakalkaM pradApayet||126| tena siddhaM ghRutaM shItaM sakShaudraM pittagulmanut| raktapittajvarashvAsakAsahRudroganAshanam||127|| iti vAsAghRutam Take whole plant of vasa including its root and make decoction by adding to it eight times water and reducing to one-eighth. Add to the decoction, paste of its flower and ghee and prepare the ghrita. It is to be taken with honey which cures pitta gulma, piles, fever, dyspnoea, cough and heart disease. Thus vasaghritam is described (126-127).
द्विपलं त्रायमाणाया जलद्विप्रस्थसाधितम्| अष्टभागस्थितं पूतं कोष्णं क्षीरसमं पिबेत्||१२८|| पिबेदुपरि तस्योष्णं क्षीरमेव यथाबलम्| तेन निर्हृतदोषस्य गुल्मः शाम्यति पैत्तिकः||१२९|| dvipalaṁ trāyamāṇāyā jaladviprasthasādhitam| aṣṭabhāgasthitaṁ pūtaṁ kōṣṇaṁ kṣīrasamaṁ pibēt||128|| pibēdupari tasyōṣṇaṁ kṣīramēva yathābalam| tēna nirhr̥tadōṣasya gulmaḥ śāmyati paittikaḥ||129|| dvipalaM trAyamANAyA jaladviprasthasAdhitam| aShTabhAgasthitaM pUtaM koShNaM kShIrasamaM pibet||128|| pibedupari tasyoShNaM kShIrameva yathAbalam| tena nirhRutadoShasya gulmaH shAmyati paittikaH||129|| Take 80 gm of trayamana and make decoction by adding 1.280 litre of water and reducing to one-eighth and filter it. Take it by adding equal quantity of warm milk and thereafter take as much milk as one can digest. This preparation eliminates the toxic substances and thus cures pitta gulma (128-129).
द्राक्षाभयारसं गुल्मे पैत्तिके सगुडं पिबेत्| लिह्यात्कम्पिल्लकं वाऽपि विरेकार्थं मधुद्रवम्||१३०|| drākṣābhayārasaṁ gulmē paittikē saguḍaṁ pibēt| lihyātkampillakaṁ vā'pi virēkārthaṁ madhudravam||130|| drAkShAbhayArasaM gulme paittike saguDaM pibet| lihyAtkampillakaM vA~api virekArthaM madhudravam||130|| In patient of pitta gulma the virechana can be performed by administration of decoction of raisins and haritaki with jaggery or by licking powder of kampillaka with honey (130).
Massage: दाहप्रशमनोऽभ्यङ्गः सर्पिषा पित्तगुल्मिनाम्| चन्दनाद्येन तैलेन तैलेन मधुकस्य वा||१३१|| dāhapraśamanō'bhyaṅgaḥ sarpiṣā pittagulminām| candanādyēna tailēna tailēna madhukasya vā||131|| dAhaprashamano~abhya~ggaH sarpiShA pittagulminAm| candanAdyena tailena tailena madhukasya vA||131|| For relieving burning sensation in the patient of gulma, massage with ghee or chandanadi taila or medicated oil prepared with madhuka should be done (131). Kshira-basti for pitta gulma: ये च पित्तज्वरहराः सतिक्ताः क्षीरबस्तयः| हितास्ते पित्तगुल्मिभ्यो वक्ष्यन्ते ये च सिद्धिषु||१३२|| yē ca pittajvaraharāḥ satiktāḥ kṣīrabastayaḥ| hitāstē pittagulmibhyō vakṣyantē yē ca siddhiṣu||132|| ye ca pittajvaraharAH [16] satiktAH kShIrabastayaH| hitAste pittagulmibhyo vakShyante ye ca siddhiShu||132|| Kshira-basti comprising of bitter drugs described for pitta fever as well as which will be described in Siddhi sthana are also beneficial for curing pitta gulma (132).
Pathya for pitta gulma : शालयो जाङ्गलं मांसं गव्याजे पयसी घृतम्| खर्जूरामलकं द्राक्षां दाडिमं सपरूषकम्||१३३|| आहारार्थं प्रयोक्तव्यं पानार्थं सलिलं शृतम्| बलाविदारीगन्धाद्यैः पित्तगुल्मचिकित्सितम्||१३४|| śālayō jāṅgalaṁ māṁsaṁ gavyājē payasī ghr̥tam| kharjūrāmalakaṁ drākṣāṁ dāḍimaṁ saparūṣakam||133|| āhārārthaṁ prayōktavyaṁ pānārthaṁ salilaṁ śr̥tam| balāvidārīgandhādyaiḥ pittagulmacikitsitam||134|| shAlayo jA~ggalaM mAMsaM gavyAje payasI ghRutam| kharjUrAmalakaM drAkShAM dADimaM saparUShakam||133|| AhArArthaM prayoktavyaM pAnArthaM salilaM shRutam| balAvidArIgandhAdyaiH pittagulmacikitsitam||134|| Red rice, meat of wild animals, milk and ghee of cow and goat, dates, grapes, pomegranates, amalaki and parushaka are wholesome diet articles for eating and water boiled with bala-vidarigandhadi drugs for drinking for the patient of pitta gulma (133-134). Management of ama associated gulma: आमान्वये पित्तगुल्मे सामे वा कफवातिके| यवागूभिः खडैर्यूषैः सन्धुक्ष्योऽग्निर्विलङ्घिते||१३५|| āmānvayē pittagulmē sāmē vā kaphavātikē| yavāgūbhiḥ khaḍairyūṣaiḥ sandhukṣyō'gnirvilaṅghitē||135|| AmAnvaye pittagulme sAme vA kaphavAtike| yavAgUbhiH khaDairyUShaiH sandhukShyo~agnirvila~gghite||135|| Pitta gulma or kapha-vata gulma if associated with ama, first it should be subjected to langhana and then given cooked rice (yavagu) and vegetable or pulse soup to enhance the digestion (135). Importance of agni: शमप्रकोपौ दोषाणां सर्वेषामग्निसंश्रितौ| तस्मादग्निं सदा रक्षेन्निदानानि च वर्जयेत्||१३६|| śamaprakōpau dōṣāṇāṁ sarvēṣāmagnisaṁśritau| tasmādagniṁ sadā rakṣēnnidānāni ca varjayēt||136|| shamaprakopau doShANAM sarveShAmagnisaMshritau| tasmAdagniM sadA rakShennidAnAni ca varjayet||136|| 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 (136).
Treatment of kaphaja gulma Vamana in kaphaja gulma: वमनं वमनार्हाय प्रदद्यात् कफगुल्मिने| vamanaṁ vamanārhāya pradadyāt kaphagulminē| vamanaM vamanArhAya pradadyAt kaphagulmine| Vamana Karma should be done in Kapha Gulma provided the patient is fit for it (136½). Surgical treatment of kapha gulma: स्निग्धस्विन्नशरीराय गुल्मे शैथिल्यमागते||१३७|| परिवेष्ट्य प्रदीप्तांस्तु बल्वजानथवा कुशान्| भिषक्कुम्भे समावाप्य गुल्मं घटमुखे न्यसेत्||१३८|| सङ्गृहीतो यदा गुल्मस्तदा घटमथोद्धरेत्| वस्त्रान्तरं ततः कृत्वा भिन्द्याद्गुल्मं प्रमाणवित्||१३९|| विमार्गाजपदादर्शैर्यथालाभं प्रपीडयेत्| मृद्नीयाद्गुल्ममेवैकं न त्वन्त्रहृदयं स्पृशेत्||१४०|| snigdhasvinnaśarīrāya gulmē śaithilyamāgatē||137|| parivēṣṭya pradīptāṁstu balvajānathavā kuśān| bhiṣakkumbhē samāvāpya gulmaṁ ghaṭamukhē nyasēt||138|| saṅgr̥hītō yadā gulmastadā ghaṭamathōddharēt| vastrāntaraṁ tataḥ kr̥tvā bhindyādgulmaṁ pramāṇavit||139|| vimārgājapadādarśairyathālābhaṁ prapīḍayēt| mr̥dnīyādgulmamēvaikaṁ na tvantrahr̥dayaṁ spr̥śēt||140|| snigdhasvinnasharIrAya gulme shaithilyamAgate||137|| pariveShTya pradIptAMstu balvajAnathavA kushAn| bhiShakkumbhe samAvApya gulmaM ghaTamukhe nyaset||138|| sa~ggRuhIto [17] yadA gulmastadA ghaTamathoddharet| vastrAntaraM tataH kRutvA bhindyAdgulmaM [18] pramANavit||139|| vimArgAjapadAdarshairyathAlAbhaM prapIDayet| mRudnIyAdgulmamevaikaM na tvantrahRudayaM [19] spRushet||140||
First make the Kapha gulma loose (shaithilya) by Snehana and Svedana therapies then following operation should be performed on the patient: Cover the brim of gulma with a piece of cloth and on the inner portion of the brim put an earthen lid containing ignited balvaja or small sacrificial grass (kusha). Then place the mouth of an inverted empty pot on it in such a way so that it covers and fit on the brim. Due to negative pressure produced inside the pot by the fire, the mouth of the pot will strongly adhere to the brim and the lump will be pulled into the pot. Then remove the pot and tightly tie the bottom of this bulged portion of the gulma and then puncture it. Thereafter, with the help of any available instruments such as vimarga, ajapada and adarsha, only the gulma part is squeezed or compressed, without touching the intestines and heart. This operation should be done only by the expert surgeon in the technique (137-140). Post operative measures: तिलैरण्डातसीबीजसर्षपैः परिलिप्य च| श्लेष्मगुल्ममयःपात्रैः सुखोष्णैः स्वेदयेद्भिषक्||१४१|| tilairaṇḍātasībījasarṣapaiḥ parilipya ca| ślēṣmagulmamayaḥpātraiḥ sukhōṣṇaiḥ svēdayēdbhiṣak||141|| tilairaNDAtasIbIjasarShapaiH parilipya ca| shleShmagulmamayaHpAtraiH sukhoShNaiH svedayedbhiShak||141|| After the above operation apply the paste made from sesame, castor seed, linseeds and mustard seeds on the Gulma and do its sudation through bearable hot iron pot (141). Dashamuli ghrita: सव्योषक्षारलवणं दशमूलीशृतं घृतम्| कफगुल्मं जयत्याशु सहिङ्गुबिडदाडिमम्||१४२|| इति दशमूलीघृतम्| savyōṣakṣāralavaṇaṁ daśamūlīśr̥taṁ ghr̥tam| kaphagulmaṁ jayatyāśu sahiṅgubiḍadāḍimam||142|| iti daśamūlīghr̥tam | savyoShakShAralavaNaM dashamUlIshRutaM ghRutam| kaphagulmaM jayatyAshu sahi~ggubiDadADimam||142|| iti dashamUlIghRutam Prepare a medicated ghee with decoction of dashamula, paste of trikatu, yavakshara, salt, asafoetida, bid-salt and pomegranate, and ghee. Its oral use quickly subsides kapha gulma. Thus dashamuli-ghritam is described. (142) Bhallatakadi ghritam: भल्लातकानां द्विपलं पञ्चमूलं पलोन्मितम्| साध्यं विदारीगन्धाद्यमापोथ्य सलिलाढके||१४३|| पादशेषे रसे तस्मिन् पिप्पलीं नागरं वचाम्| विडङ्गं सैन्धवं हिङ्गु यावशूकं बिडं शटीम्||१४४|| चित्रकं मधुकं रास्नां पिष्ट्वा कर्षसमं भिषक्| प्रस्थं च पयसो दत्त्वा घृतप्रस्थं विपाचयेत्||१४५|| एतद्भल्लातकघृतं कफगुल्महरं परम्| प्लीहपाण्ड्वामयश्वासग्रहणीरोगकासनुत्||१४६|| इति भल्लातकाद्यं घृतम् bhallātakānāṁ dvipalaṁ pañcamūlaṁ palōnmitam| sādhyaṁ vidārīgandhādyamāpōthya salilāḍhakē||143|| pādaśēṣē rasē tasmin pippalīṁ nāgaraṁ vacām| viḍaṅgaṁ saindhavaṁ hiṅgu yāvaśūkaṁ biḍaṁ śaṭīm||144|| citrakaṁ madhukaṁ rāsnāṁ piṣṭvā karṣasamaṁ bhiṣak| prasthaṁ ca payasō dattvā ghr̥taprasthaṁ vipācayēt||145|| ētadbhallātakaghr̥taṁ kaphagulmaharaṁ param| plīhapāṇḍvāmayaśvāsagrahaṇīrōgakāsanut||146|| iti bhallātakādyaṁ ghr̥tam bhallAtakAnAM dvipalaM pa~jcamUlaM palonmitam| sAdhyaM vidArIgandhAdyamApothya salilADhake||143|| pAdasheShe rase tasmin pippalIM nAgaraM vacAm| viDa~ggaM saindhavaM hi~ggu yAvashUkaM biDaM shaTIm||144|| citrakaM madhukaM rAsnAM piShTvA karShasamaM bhiShak| prasthaM ca payaso dattvA ghRutaprasthaM vipAcayet||145|| etadbhallAtakaghRutaM kaphagulmaharaM param| plIhapANDvAmayashvAsagrahaNIrogakAsanut||146|| iti bhallAtakAdyaM ghRutam Take coarse powder of 80 gm of bhallataka, 40 gm of laghu panchamula and 40 gm of vidarigandhadi and prepare a decoction by adding 2.5 liters of water and reducing to one-fourth. To this decoction add paste made of 10 gm each of long pepper, dry ginger, vacha, vidanga, rock and bid salts, asafoetida, yavakshara, chitraka, shati, liquorices and rasna; 640 ml each of milk and ghee and make ghrita as per method of sneha paka. Oral use of bhallatakadyam ghritam is best for providing cure to kapha gulma. It also provides relief in spleen disorders, anaemia, asthma, assimilation disorders and cough. Thus bhallatakadyam ghritam is described (143-146). Kshiraṣhaṭpalaka ghrita: पिप्पलीपिप्पलीमूलचव्यचित्रकनागरैः| पलिकैः सयवक्षारैर्घृतप्रस्थं विपाचयेत्||१४७|| क्षीरप्रस्थं च तत् सर्पिहन्ति गुल्मं कफात्मकम्| ग्रहणीपाण्डुरोगघ्नं प्लीहकासज्वरापहम्||१४८|| इति क्षीरषट्पलकं घृतम् pippalīpippalīmūlacavyacitrakanāgaraiḥ| palikaiḥ sayavakṣārairghr̥taprasthaṁ vipācayēt||147|| kṣīraprasthaṁ ca tat sarpirhanti gulmaṁ kaphātmakam| grahaṇīpāṇḍurōgaghnaṁ plīhakāsajvarāpaham||148|| iti kṣīraṣaṭpalakaṁ ghr̥tam pippalIpippalImUlacavyacitrakanAgaraiH| palikaiH sayavakShArairghRutaprasthaM vipAcayet||147|| kShIraprasthaM ca tat sarpihanti gulmaM kaphAtmakam| grahaNIpANDurogaghnaM plIhakAsajvarApaham||148|| iti kShIraShaTpalakaM ghRutam Make a paste of 40 gm each of fruits and roots of long pepper, chavya and chitraka, yavakshara and dried ginger and add to it 640 gm each of ghee and milk, and prepare a medicated ghee. This ghrita cures kapha gulma, grahani (chronic assimilation disorders), anaemia, spleen disorders, cough and fever. Thus kshirashatpalakam ghritam is described (147-148). Mishraka sneha: त्रिवृतां त्रिफलां दन्तीं दशमूलं पलोन्मितम्| जले चतुर्गुणे पक्त्वा चतुर्भागस्थितं रसम्||१४९|| सर्पिरेरण्डजं तैलं क्षीरं चैकत्र साधयेत्| स सिद्धो मिश्रकस्नेहः सक्षौद्रः कफगुल्मनुत्||१५०|| कफवातविबन्धेषु कुष्ठप्लीहोदरेषु च| प्रयोज्यो मिश्रकः स्नेहो योनिशूलेषु चाधिकम्||१५१|| इति मिश्रकः स्नेहः trivr̥tāṁ triphalāṁ dantīṁ daśamūlaṁ palōnmitam| jalē caturguṇē paktvā caturbhāgasthitaṁ rasam||149|| sarpirēraṇḍajaṁ tailaṁ kṣīraṁ caikatra sādhayēt| sa siddhō miśrakasnēhaḥ sakṣaudraḥ kaphagulmanut||150|| kaphavātavibandhēṣu kuṣṭhaplīhōdarēṣu ca| prayōjyō miśrakaḥ snēhō yōniśūlēṣucādhikam||151|| iti miśrakaḥ snēhaḥ trivRutAM triphalAM dantIM dashamUlaM palonmitam| jale caturguNe paktvA caturbhAgasthitaM rasam||149|| sarpireraNDajaM tailaM kShIraM caikatra sAdhayet| sa siddho mishrakasnehaH sakShaudraH kaphagulmanut||150|| kaphavAtavibandheShu kuShThaplIhodareShu ca| prayojyo mishrakaH sneho yonishUleShu cAdhikam||151|| iti mishrakaH snehaH Prepare a decoction of 40 gm each of trivrit, triphala, danti and dashamula by adding four times of water and reducing to one-fourth. In this decoction add ghee, castor oil and milk and prepare medicated ghee. This miśraka sneha taken orally by adding honey cures kapha gulma. It also provides relief in constipation due to kapha and vata, kushtha (chronic skin disorders), spleen disorders and udara-roga (generalized enlargement of abdomen) and especially useful in vaginal pain. Thus mishrakah sneha is described (149-151).
Virechana in kapha gulma: यदुक्तं वातगुल्मघ्नं स्रंसनं नीलिनीघृतम्| द्विगुणं तद्विरेकार्थं प्रयोज्यं कफगुल्मिनाम्||१५२|| सुधाक्षीरद्रवे चूर्णं त्रिवृतायाः सुभावितम्| कार्षिकं मधुसर्पिभ्यां लीढ्वा साधु विरिच्यते||१५३|| yaduktaṁ vātagulmaghnaṁ sraṁsanaṁ nīlinīghr̥tam| dviguṇaṁ tadvirēkārthaṁ prayōjyaṁ kaphagulminām||152|| sudhākṣīradravē cūrṇaṁ trivr̥tāyāḥ subhāvitam| kārṣikaṁ madhusarpibhyāṁ līḍhvā sādhu viricyatē||153|| yaduktaM vAtagulmaghnaM sraMsanaM nIlinIghRutam| dviguNaM tadvirekArthaM prayojyaM kaphagulminAm||152|| sudhAkShIradrave cUrNaM trivRutAyAH subhAvitam| kArShikaM madhusarpibhyAM lIDhvA [20] sAdhu viricyate||153|| Nilini-ghrita already described as laxative for the cure of vata gulma should be used in double the dose for virechana in the patient of kapha gulma. 10 gm powder of trivrit well impregnated with latex of snuhi taken with ghee and honey may also be used to produce a good virechana (152-153). Danti-haritaki: जलद्रोणे विपक्तव्या विंशतिः पञ्च चाभयाः| दन्त्याः पलानि तावन्ति चित्रकस्य तथैव च||१५४|| अष्टभागावशेषं तु रसं पूतमधिक्षिपेत्| दन्तीसमं गुडं पूतं क्षिपेत्तत्राभयाश्च ताः||१५५|| तैलार्धकुडवं चैव त्रिवृतायाश्चतुष्पलम्| चूर्णितं पलमेकं तु पिप्पलीविश्वभेषजम्||१५६|| तत् साध्यं लेहवच्छीते तस्मिंस्तैलसमं मधु| क्षिपेच्चूर्णपलं चैकं त्वगेलापत्रकेशरात्||१५७|| ततो लेहपलं लीढ्वा जग्ध्वा चैकां हरीतकीम्| सुखं विरिच्यते स्निग्धो दोषप्रस्थमनामयम्||१५८|| गुल्मं श्वयथुमर्शांसि पाण्डुरोगमरोचकम्| हृद्रोगं ग्रहणीदोषं कामलां विषमज्वरम्||१५९|| कुष्ठं प्लीहानमानाहमेषा हन्युपसेविता| निरत्ययः क्रमश्चास्या द्रवो मांसरसौदनः||१६०|| इति दन्तीहरीतकी jaladrōṇē vipaktavyā viṁśatiḥ pañca cābhayāḥ| dantyāḥ palāni tāvanti citrakasya tathaiva ca||154|| aṣṭabhāgāvaśēṣaṁ tu rasaṁ pūtamadhikṣipēt| dantīsamaṁ guḍaṁ pūtaṁ kṣipēttatrābhayāśca tāḥ||155|| tailārdhakuḍavaṁ caiva trivr̥tāyāścatuṣpalam| cūrṇitaṁ palamēkaṁ [21] tu pippalīviśvabhēṣajam||156|| tat sādhyaṁ lēhavacchītē tasmiṁstailasamaṁ madhu| kṣipēccūrṇapalaṁ caikaṁ tvagēlāpatrakēśarāt||157|| tatō lēhapalaṁ līḍhvā jagdhvā caikāṁ harītakīm| sukhaṁ viricyatē snigdhō dōṣaprasthamanāmayam||158|| gulmaṁ śvayathumarśāṁsi pāṇḍurōgamarōcakam| hr̥drōgaṁ grahaṇīdōṣaṁ kāmalāṁ viṣamajvaram||159|| kuṣṭhaṁ plīhānamānāhamēṣā hanyupasēvitā| niratyayaḥ kramaścāsyā dravō māṁsarasaudanaḥ||160|| iti dantīharītakī jaladroNe vipaktavyA viMshatiH pa~jca cAbhayAH| dantyAH palAni tAvanti citrakasya tathaiva ca||154|| aShTabhAgAvasheShaM tu rasaM pUtamadhikShipet| dantIsamaM guDaM pUtaM kShipettatrAbhayAshca tAH||155|| tailArdhakuDavaM caiva trivRutAyAshcatuShpalam| cUrNitaM palamekaM [21] tu pippalIvishvabheShajam||156|| tat sAdhyaM lehavacchIte tasmiMstailasamaM madhu| kShipeccUrNapalaM caikaM tvagelApatrakesharAt||157|| tato lehapalaM lIDhvA jagdhvA caikAM harItakIm| sukhaM viricyate snigdho doShaprasthamanAmayam||158|| gulmaM shvayathumarshAMsi pANDurogamarocakam| hRudrogaM grahaNIdoShaM kAmalAM viShamajvaram||159|| kuShThaM plIhAnamAnAhameShA hanyupasevitA| niratyayaH kramashcAsyA dravo mAMsarasaudanaH||160|| iti dantIharItakI Prepare a decoction of 25 haritaki and 50 gm each of danti and chitraka in 10 liters of water by reducing it to one-eighth. Add jaggery equal to quantity of danti to the decoction and filter again and add to it haritaki, 80 ml of sesame oil, 160 gm of trivrit powder and 40 gm each of long pepper and dry ginger and by heating made into constituency of the jam. On cooling add 80 gm of honey, 40 gm powder of cinnamon, cardamom, tamalapatra and keshara. Administer its 40 gm with one haritaki daily to a person who has already been prepared with snehana and swedana for a good virechana. It will remove 640 gm of morbid material (dosha prastha) without producing any side effect. This decoction for virechana will cure gulma, swellings, piles, anaemia, anorexia, heart disease, chronic assimilation disorders, jaundice, irregular fever, Kuṣṭha, spleen disorders and distension of abdomen. The therapy does not produce any complication. During this therapy liquid diet and rice with meat soup are given to eat. Thus dantiharitaki is described (154-160). Basti in kapha gulma: सिद्धाः सिद्धिषु वक्ष्यन्ते निरूहाः कफगुल्मिनाम्| अरिष्टयोगाः सिद्धाश्च ग्रहण्यर्शश्चिकित्सिते||१६१|| siddhāḥ siddhiṣu vakṣyantē nirūhāḥ kaphagulminām| ariṣṭayōgāḥ siddhāśca grahaṇyarśaścikitsitē||161|| siddhAH siddhiShu vakShyante nirUhAH kaphagulminAm| ariShTayogAH siddhAshca grahaNyarshashcikitsite||161|| The most effective niruha basti for kapha gulma will be described in Siddhi Sthana and most effective medicated wines (arishta) will be described in the chapter on Grahani chikitsa (Charaka chikitsa chapter 15) and Arsha chikitsa (Charaka chikitsa chapter 14)-(161).
Powders and pills: यच्चूर्णं गुटिका याश्च विहिता वातगुल्मिनाम्| द्विगुणक्षारहिङ्ग्वम्लवेतसास्ताः कफे हिताः||१६२|| yaccūrṇaṁ guṭikā yāśca vihitā vātagulminām| dviguṇakṣārahiṅgvamlavētasāstāḥ kaphē hitāḥ||162|| yaccUrNaM guTikA yAshca vihitA vAtagulminAm| dviguNakShArahi~ggvamlavetasAstAH kaphe hitAH||162||
Powder and pills which are described for the treatment of vata gulma should also be used for kapha gulma but added with double the quantity of mixture of kshara, asafetida and amlavetasa (162).
Kshara and daha karma: य एव ग्रहणीदोषे क्षारास्ते कफगुल्मिनाम्| सिद्धा निरत्ययाः शस्ता दाहस्त्वन्ते प्रशस्यते||१६३|| ya ēva grahaṇīdōṣē kṣārāstē kaphagulminām| siddhā niratyayāḥ śastā dāhastvantē praśasyatē||163|| ya eva grahaNIdoShe kShArAste kaphagulminAm| siddhA niratyayAH shastA dAhastvante prashasyate||163|| Kshara preparations mentioned in the chapter of grahani dosha (Caraka chikitsa chapter 15) are also beneficial for kapha gulma without any side effect. If above mentioned treatment does not cure kapha gulma then cauterization should be done as a last resort (163). Pathya for kapha gulma: प्रपुराणानि धान्यानि जाङ्गला मृगपक्षिणः| कौलत्थो मुद्गयूषश्च पिप्पल्या नागरस्य च||१६४|| शुष्कमूलकयूषश्च बिल्वस्य वरुणस्य च| चिरबिल्वाङ्कुराणां च यवान्याश्चित्रकस्य च||१६५|| prapurāṇāni dhānyāni jāṅgalā mr̥gapakṣiṇaḥ| kaulatthō mudgayūṣaśca pippalyā nāgarasya ca||164|| śuṣkamūlakayūṣaśca bilvasya varuṇasya ca| cirabilvāṅkurāṇāṁ ca yavānyāścitrakasya ca||165|| prapurANAni dhAnyAni jA~ggalA mRugapakShiNaH| kaulattho mudgayUShashca pippalyA nAgarasya ca||164|| shuShkamUlakayUShashca bilvasya varuNasya [22] ca| cirabilvA~gkurANAM ca yavAnyAshcitrakasya ca||165|| More than one year old grains, meat of wild animals and birds, soup of horse-gram (kulattha) or green gram (mudga), long pepper, dry ginger, dry radish, bilva, varuna, sprouts of chirabilva, yavani and chitraka are beneficial diet articles for the patient of kapha gulma (165).
बीजपूरकहिङ्ग्वम्लवेतसक्षारदाडिमैः| तक्रेण तैलसर्पिर्भ्यां व्यञ्जनान्युपकल्पयेत्||१६६|| bījapūrakahiṅgvamlavētasakṣāradāḍimaiḥ| takrēṇa tailasarpirbhyāṁ vyañjanānyupakalpayēt||166|| bIjapUrakahi~ggvamlavetasakShAradADimaiH| takreNa tailasarpirbhyAM vya~jjanAnyupakalpayet||166|| Citron, asafoetida, amlavetas, kshara, pomegranate, butter milk, oil and ghee preparations are also wholesome for kapha gulma (166).
पञ्चमूलीशृतं तोयं पुराणं वारुणीरसम्| कफगुल्मी पिबेत्काले जीर्णं माध्वीकमेव वा||१६७|| pañcamūlīśr̥taṁ tōyaṁ purāṇaṁ vāruṇīrasam| kaphagulmī pibētkālē jīrṇaṁ mādhvīkamēva vā||167|| pa~jcamUlIshRutaM toyaM purANaM vAruNIrasam| kaphagulmI pibetkAle jIrNaM mAdhvIkameva vA||167||
Water boiled in Laghu panchamula or old Varuni or old honey wine should be given to drink on getting the thirst to the patient of Kapha Gulma (167).
यवानीचूर्णितं तक्रं बिडेन लवणीकृतम्| पिबेत् सन्दीपनं वातकफमूत्रानुलोमनम् ||१६८|| yavānīcūrṇitaṁ takraṁ biḍēna lavaṇīkr̥tam| pibēt sandīpanaṁ vātakaphamūtrānulōmanam [23] ||168|| yavAnIcUrNitaM takraM biDena lavaNIkRutam| pibet sandIpanaM vAtakaphamUtrAnulomanam [23] ||168|| Taking of butter milk mixed with yavani (Ajwain) and salted with bid-salt acts as a digestive stimulant and the regulator of flatus, urine and kapha (168). Signs and symptoms of incurable gulma: सञ्चितः क्रमशो गुल्मो महावास्तुपरिग्रहः| कृतमूलः सिरानद्धो यदा कूर्म इवोन्नतः||१६९|| दौर्बल्यारुचिहृल्लासकासवम्यरतिज्वरैः | तृष्णातन्द्राप्रतिश्यायैर्युज्यते न स सिध्यति||१७०|| sañcitaḥ kramaśō gulmō mahāvāstuparigrahaḥ| kr̥tamūlaḥ sirānaddhō yadā kūrma ivōnnataḥ||169|| daurbalyārucihr̥llāsakāsavamyaratijvaraiḥ | tr̥ṣṇātandrāpratiśyāyairyujyatē na sa sidhyati||170|| sa~jcitaH kramasho gulmo mahAvAstuparigrahaH| kRutamUlaH sirAnaddho yadA kUrma ivonnataH||169|| daurbalyArucihRullAsakAsavamyaratijvaraiH [24] | tRuShNAtandrApratishyAyairyujyate na sa sidhyati||170||
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 as incurable (169-170).
Signs and symptoms of bad prognosis:
गृहीत्वा सज्वरश्वासं वम्यतीसारपीडितम्| हृन्नाभिहस्तपादेषु शोफः कर्षति गुल्मिनम्||१७१|| gr̥hītvā sajvaraśvāsaṁ vamyatīsārapīḍitam| hr̥nnābhihastapādēṣu śōphaḥ karṣati gulminam||171|| gRuhItvA sajvarashvAsaM vamyatIsArapIDitam| hRunnAbhihastapAdeShu shophaH karShati gulminam||171|| The patient of Gulma accompanied with fever, dyspnoea, vomiting and diarrhoea along with oedema in the epigastric and umbilical regions and on hands and feet indicate that the patient is approaching to death (171). Treatment of rakta gulma: रौधिरस्य तु गुल्मस्य गर्भकालव्यतिक्रमे| स्निग्धस्विन्नशरीरायै दद्यात् स्नेहविरेचनम्||१७२|| raudhirasya tu gulmasya garbhakālavyatikramē| snigdhasvinnaśarīrāyai dadyāt snēhavirēcanam||172|| raudhirasya tu gulmasya garbhakAlavyatikrame| snigdhasvinnasharIrAyai dadyAt snehavirecanam||172|| The treatment of rakta gulma should be under taken only after completion of normal period of gestation i.e. 10 months. The patient should be given unctuous virechana after preparing with snehana and swedana (172).
पलाशक्षारपात्रे द्वे द्वे पात्रे तैलसर्पिषोः| गुल्मशैथिल्यजननीं पक्त्वा मात्रां प्रयोजयेत्||१७३|| palāśakṣārapātrē dvē dvē pātrē tailasarpiṣōḥ| gulmaśaithilyajananīṁ paktvā mātrāṁ prayōjayēt||173|| palAshakShArapAtre dve dve pAtre tailasarpiShoH| gulmashaithilyajananIM paktvA mAtrAM prayojayet||173||
Make a semisolid preparation by heating 5 Kg of palasha-kshara with 5 Kg each of ghee and oil. Administer it in sufficient dose to make the gulma soft/loose.
प्रभिद्येत न यद्येवं दद्याद्योनिविशोधनम् | क्षारेण युक्तं पललं सुधाक्षीरेण वा पुनः||१७४||
आभ्यां वा भावितान् दद्याद्योनौ कटुकमत्स्यकान्|
वराहमत्स्यपित्ताभ्यां लक्तकान् वा सुभावितान्||१७५||
अधोहरैश्चोर्ध्वहरैर्भावितान् वा समाक्षिकैः|
किण्वं वा सगुडक्षारं दद्याद्योनिविशोधनम्||१७६|| prabhidyēta na yadyēvaṁ dadyādyōniviśōdhanam |
kṣārēṇa yuktaṁ palalaṁ sudhākṣīrēṇa vā punaḥ||174||
ābhyāṁ vā bhāvitān dadyādyōnau kaṭukamatsyakān|
varāhamatsyapittābhyāṁ laktakān vā subhāvitān||175||
adhōharaiścōrdhvaharairbhāvitān vā samākṣikaiḥ|
kiṇvaṁ vā saguḍakṣāraṁ dadyādyōniviśōdhanam||176||
prabhidyeta na yadyevaM dadyAdyonivishodhanam [25] |
kShAreNa yuktaM palalaM sudhAkShIreNa vA punaH||174||
AbhyAM vA bhAvitAn dadyAdyonau kaTukamatsyakAn|
varAhamatsyapittAbhyAM laktakAn vA subhAvitAn||175||
adhoharaishcordhvaharairbhAvitAn vA samAkShikaiH|
kiNvaM vA saguDakShAraM dadyAdyonivishodhanam||176||
If the above mentioned treatments do not break the rakta gulma then the preparations which cleans vagina should be used locally.
A swab well saturated with one of the following pastes may be inserted in the vagina:
Sesame paste mixed with kṣāra or latex of snuhi or
Pungent fish impregnated with both kshara and latex of snuhi
Bile of hog or fish or emetic or purgative drugs or with honey
Or yeast mixed with jaggery and honey may be used for cleansing the vagina (174-176).
रक्तपित्तहरं क्षारं लेहयेन्मधुसर्पिषा|
लशुनं मदिरां तीक्ष्णां मत्स्यांश्चास्यै प्रदापयेत्||१७७|| raktapittaharaṁ kṣāraṁ lēhayēnmadhusarpiṣā|
laśunaṁ madirāṁ tīkṣṇāṁ matsyāṁścāsyai pradāpayēt||177||
raktapittaharaM kShAraM lehayenmadhusarpiShA|
lashunaM madirAM tIkShNAM matsyAMshcAsyai pradApayet||177||
Kshara which cures raktapitta may be licked with honey and ghee. Or garlic mixed with strong wine and fish may be given in diet (177). बस्तिं सक्षीरगोमूत्रं सक्षारं दाशमूलिकम्| अदृश्यमाने रुधिरे दद्याद्गुल्मप्रभेदनम्||१७८|| bastiṁ sakṣīragōmūtraṁ sakṣāraṁ dāśamūlikam| adr̥śyamānē rudhirē dadyādgulmaprabhēdanam||178|| bastiM sakShIragomUtraM sakShAraM dAshamUlikam| adRushyamAne rudhire dadyAdgulmaprabhedanam||178||
Basti prepared with milk, cow’s urine, kshara and decoction of dashamula should be given. Even after all these treatments, if blood does not flow from vagina then surgical intervention is required (178).
प्रवर्तमाने रुधिरे दद्यान्मांसरसौदनम्|
घृततैलेन चाभ्यङ्गं पानार्थं तरुणीं सुराम्||१७९|| pravartamānē rudhirē dadyānmāṁsarasaudanam|
ghr̥tatailēna cābhyaṅgaṁ pānārthaṁ taruṇīṁ surām||179||
pravartamAne rudhire dadyAnmAMsarasaudanam|
ghRutatailena cAbhya~ggaM pAnArthaM taruNIM surAm||179||
When blood starts flowing through vagina then rice with meat soup should be given to eat. Massage with ghee or oil is done and for drink new wine may be given (179)
रुधिरेऽतिप्रवृत्ते तु रक्तपित्तहरीः क्रियाः| कार्या वातरुगार्तायाः सर्वा वातहरीः पुनः||१८०|| rudhirē'tipravr̥ttē tu raktapittaharīḥ kriyāḥ| kāryā vātarugārtāyāḥ sarvā vātaharīḥ punaḥ||180|| rudhire~atipravRutte tu raktapittaharIH kriyAH| kAryA vAtarugArtAyAH sarvA vAtaharIH punaH||180|| In case of excessive bleeding, the measures curative of raktapitta should be prescribed. If the patient gets vata type of pains then all the remedies curative of vata are given (180).
घृततैलावसेकांश्च तित्तिरींश्चरणायुधान्| सुरां समण्डां पूर्वं च पानमम्लस्य सर्पिषः||१८१|| प्रयोजयेदुत्तरं वा जीवनीयेन सर्पिषा| अतिप्रवृत्ते रुधिरे सतिक्तेनानुवासनम्||१८२|| ghr̥tatailāvasēkāṁśca tittirīṁścaraṇāyudhān| surāṁ samaṇḍāṁ pūrvaṁ ca pānamamlasya sarpiṣaḥ||181|| prayōjayēduttaraṁ vā jīvanīyēna sarpiṣā| atipravr̥ttē rudhirē satiktēnānuvāsanam||182|| ghRutatailAvasekAMshca tittirIMshcaraNAyudhAn| surAM samaNDAM pUrvaM ca pAnamamlasya sarpiShaH||181|| prayojayeduttaraM vA jIvanIyena sarpiShA| atipravRutte rudhire satiktenAnuvAsanam||182|| Affusion with ghee and oil should be performed. Meat of pariridge (tittara) and cock (charanayudha), sura-wine along with its upper fluid (manda) and ghee prepared with sour drugs may be given in diet. Uttara basti with ghee prepared with jivaniya drugs should be given. In case of the excessive blood flow, anuvasana basti with ghee/oil prepared with bitter drugs should be given (181-182). Summary: तत्र श्लोकाः- स्नेहः स्वेदः सर्पिर्बस्तिश्चूर्णानि बृंहणं गुडिकाः| वमनविरेकौ मोक्षः क्षतजस्य च वातगुल्मवताम्||१८३|| सर्पिः सतिक्तसिद्धं क्षीरं प्रस्रंसनं निरूहाश्च| रक्तस्य चावसेचनमाश्वासनसंशमनयोगाः||१८४|| उपनाहनं सशस्त्रं पक्वस्याभ्यन्तरप्रभिन्नस्य| संशोधनसंशमने पित्तप्रभवस्य गुल्मस्य||१८५|| स्नेहः स्वेदो भेदो लङ्घनमुल्लेखनं विरेकश्च| सर्पिर्बस्तिर्गुटिकाश्चूर्णमरिष्टाश्च सक्षाराः||१८६|| गुल्मस्यान्ते दाहः कफजस्याग्रेऽपनीतरक्तस्य| गुल्मस्य रौधिरस्य क्रियाक्रमः स्त्रीभवस्योक्तः||१८७|| पथ्यान्नपानसेवा हेतूनां वर्जनं यथास्वं च| नित्यं चाग्निसमाधिः स्निग्धस्य च सर्वकर्माणि||१८८|| हेतुर्लिङ्गं सिद्धिः क्रियाक्रमः साध्यता न योगाश्च| गुल्मचिकित्सितसङ्ग्रह एतावान् व्याहृतोऽग्निवेशस्य||१८९||
tatra ślōkāḥ-
snēhaḥ svēdaḥ sarpirbastiścūrṇāni br̥ṁhaṇaṁ guḍikāḥ| vamanavirēkau mōkṣaḥ kṣatajasya ca vātagulmavatām||183|| sarpiḥ satiktasiddhaṁ kṣīraṁ prasraṁsanaṁ nirūhāśca| raktasya cāvasēcanamāśvāsanasaṁśamanayōgāḥ||184|| upanāhanaṁ saśastraṁ pakvasyābhyantaraprabhinnasya| saṁśōdhanasaṁśamanē pittaprabhavasya gulmasya||185|| snēhaḥ svēdō bhēdō laṅghanamullēkhanaṁ virēkaśca| sarpirbastirguṭikāścūrṇamariṣṭāśca sakṣārāḥ||186|| gulmasyāntē dāhaḥ kaphajasyāgrē'panītaraktasya| gulmasya raudhirasya kriyākramaḥ strībhavasyōktaḥ||187|| pathyānnapānasēvā hētūnāṁ varjanaṁ yathāsvaṁ ca| nityaṁ cāgnisamādhiḥ snigdhasya ca sarvakarmāṇi||188|| hēturliṅgaṁ siddhiḥ kriyākramaḥ sādhyatā na yōgāśca| gulmacikitsitasaṅgraha ētāvān vyāhr̥tō'gnivēśasya||189|| tatra shlokAH- snehaH svedaH sarpirbastishcUrNAni bRuMhaNaM guDikAH| vamanavirekau mokShaH kShatajasya ca vAtagulmavatAm||183|| sarpiH satiktasiddhaM kShIraM prasraMsanaM nirUhAshca| raktasya cAvasecanamAshvAsanasaMshamanayogAH||184|| upanAhanaM sashastraM pakvasyAbhyantaraprabhinnasya| saMshodhanasaMshamane pittaprabhavasya gulmasya||185|| snehaH svedo bhedo la~gghanamullekhanaM virekashca| sarpirbastirguTikAshcUrNamariShTAshca sakShArAH||186|| gulmasyAnte dAhaH kaphajasyAgre~apanItaraktasya| gulmasya raudhirasya kriyAkramaH strIbhavasyoktaH||187|| pathyAnnapAnasevA hetUnAM varjanaM yathAsvaM ca| nityaM cAgnisamAdhiH snigdhasya ca sarvakarmANi||188|| heturli~ggaM siddhiH kriyAkramaH sAdhyatA na yogAshca| gulmacikitsitasa~ggraha etAvAn vyAhRuto~agniveshasya||189|| this chapter sneha, sweda, sarpi-basti, churna, brumhana, gudika, vamana, virechana and rakta mokshana for the patient suffering from vata-gulma are described. For the treatment of pitta gulma, sarpi prepared with tikta drugs, kshira, samshamana-niruha basti, bloodletting, counselling (ashvasana), samshamana-preparations are described. For pakva (suppurated) gulma surgical procedure and poultice (upanaha) are described and for that which is ruptured internally the purification (samshodhana) and palliative (samshamana) treatments are mentioned. For kapha gulma snehana, swedana, bhedana, langhana, vamana, virechana, sarpirbasti, gutika, churna, arishta, kshara, bloodletting followed by cauterization of the gulma as a last resort are described. Line of treatment for rakta-guma occurring in women is also described. Use of wholesome (pathya) eats and drinks, avoidance of the respective etiological factors, continuously protection of digestive power (agni), the instruction for the patient who has undergone snehana are described Etiological factors, signs and symptoms, successful line of treatment, curability and otherwise and therapeutic measures are described in concise form in this chapter of Gulma-Chikitsā as described by Agnivesa (183-189).
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते चिकित्सितस्थाने गुल्मचिकित्सितं नाम पञ्चमोऽध्यायः||५|| ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsitasthānē gulmacikitsitaṁ nāma pañcamō'dhyāyaḥ||5|| ityagniveshakRute tantre carakapratisaMskRute cikitsitasthAne 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).
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 Contemporary understanding of gulma: In Ayurveda, a comprehensive description is given for abdominal swellings. While the generalized swellings have been described under the heading of udara roga (ascites), localized inflammatory swellings are described under the heading of vidradhi. However, there are other varieties of localized abdominal lumps which are non inflammatory in nature and are considered primarily under the heading of gulma. On analyzing the features described by Charaka, it appears that the vataja gulma are irregular, mobile swellings of waxing and waning nature and are associated with pain of different characters. Such features can be seen in conditions like chronic intestinal obstructions of various etiology, intestinal tuberculosis, pyloric stenosis, mobile caecum etc. The treatment modalities like snehan, swedan and basti/vamana help in alleviating the symptoms by elimination of faeces and flatus as well as improving the gut motility. Pittaja gulma have been described as tender abdominal lumps associated with fever, thirst, burning sensation etc. which usually progress through various stages of inflammation i.e. ama-avastha and pachyaman avastha and finally suppurate. It is mentioned that the pittaja gulma situated in antarbhag (inside i.e. intra-abdominal) can produce swelling in the hrid pradesh (upper abdomen) and when suppurate, may penetrate into the adjacent mahasrotas i.e. gastrointestinal tract and burst open culminating with discharge of pus either through oral or rectal route. The discharge of pus may usually continue for a couple of weeks (ten to twelve days) during which, no aggressive measure should be taken except that the nutritional status of the patient should be managed by proper diet. On examining these features, these can be correlated with clinical condition like empyema of gall bladder which may adhere and penetrate into the adjacent organs like stomach, duodenum or colon and may burst open into the lumen leading to the discharge of pus either through oral or rectal route. Similarly, a subphrenic abscess or liver abscess may rupture into the pleural cavity and may result into discharge of pus during coughing. In addition, suppurative pathologies of pelvic organs leading to pelvic abscesses and a diverticular abscess may erode into rectal lumen and result into pus discharge through rectum. The other variants of gulma that is bahistha (externally located) may present with a visible swelling over the surface of abdomen usually in the flanks. These inflammatory pathologies seem to be located extraperitoneally or in the wall of abdomen. Ileopsoas or iliac abscess, perinephric abscess are some of the examples. Some other clinical conditions like infected urachal cyst or infected vitellointestinal duct cysts may also resemble with bahistha pittaja gulma. The features described in kaphaja gulma like a firm, fixed, elevated, non-tender lump are comparable to solid mass lesions of the abdomen. Charak has also added that these lumps can be treated surgically and a detailed surgical procedure has been described as under. An earthen pitcher (ghati) of suitable size is taken and fire is put inside for a while. Once the fire is extinguished, the pitcher is placed over the gulma in upside down position. This creates a negative pressure inside the earthen pitcher resulting a part of the gulma to gradually move inside the pitcher. The pitcher is separated after a while. As the mass has risen above rest of the surface of abdominal wall sufficiently, a tourniquet is tied firmly at the narrow part i.e. the base of the gulma for further surgical procedure. Tying of tourniquet at the base of gulma facilitate proper holding as well as minimize bleeding during surgical procedure. An incision is made and the gulma is compressed firmly by vimarga yantra (a wooden instrument to apply pressure). The contents of gulma are removed by scrapping with the help of other yantras like ajpada and adarsha (ref. commentary by Yogindranath Sen). During this procedure, he has cautioned not to injure aantra (gut) or hridaya (vital organ). This surgical technique suggests that kaphaja gulma includes the benign lesions of the abdominal wall, epigastric or paraumbilical hernia containing extraperitoneal fat or omentum etc. In addition to above varieties of gulma, a tridoshaja gulma is also described which is considered as incurable. The features described like an elevated, stony hard lump with excessive pain and burning sensation and loss of vitality suggest more towards a malignant tumor of the abdomen. Moreover, the bad prognostic characters defined for an incurable gulma viz. a gradually increasing, deep rooted, elevated hard mass like a turtle shell which is associated with visibly engorged vessels and poor general condition like generalized oedema, loss of appetite, cough, vomiting, persistent fever etc. point more towards an advanced malignant lesion of abdomen e.g. hepatoma or the metastatic involvement of liver or other solid malignant tumors of abdominal organs. In conclusion, vataja gulma are mobile swellings of waxing and waning nature due to partial obstructive lesions of gut lumen. Pittaja gulma are intraperitoneal or extraperitoneal inflammatory or suppurative lesions of abdomen whereas the kaphaja gulma are non inflammatory benign lesions of abdominal wall. Tridoshaja gulma seems to be malignant intraabdominal lesions with poor prognosis. Sites of gulma: Five regions of the abdomen where gulma occurs are hrid (epigastric), nabhi (umbilical), basti (hypogastric) and two parshva (right and left flanks). If both flanks are further subdivided into three urdhva (upper), madhya (middle) and adho (lower), then whole abdomen is divided into 9 parts which is similar to the modern clinical method where abdomen is also divided into nine parts as shown in Table-1. Some of the organs situated in these regions as mentioned by Warner (1964) are also depicted therein and on that basis exact location of the Gulma can be traced.
Table1. Nine division of abdomen according to Ayurveda and allopathic medicine: Parts of Right Side with organs situated therein Parts of Middle with organs situated therein Parts of Left side with organs situated therein 1. Dakśina Urdhva Pārśva (Right hypochondriac) Organs: Right lobe of liver, gall-bladder, part of duodenum, hepatic flexure of colon, part of right kidney, right suprarenal gland 2. Hrid (Epigastric)
Organs: Pyloric end of stomach, duodenum, pancreas, aorta & part of liver 3. Vāma Urdhva Pārśva
(Left hypochondriac)
Organs: Stomach, spleen, tail of pancreas, splenic flexure of colon, upper part of left kidney, part of the left lobe of liver (some time)
4. Dakśina Madhya Pārśva
(Right Lumbar)
Organs: Ascending colon, lower part of right kidney & part of duodenum and jejunum 5. Nabhi (Umbilical)
Organs: Omentum, transverse colon, lower part of jejunum & ileum 6. Vāma Madhya Pārśva (Left Lumbar) Organs: Descending colon, lower half of left kidney & portions of jejunum and ileum 7. Dakśina Adho Pārśva (Right iliac) Organs: Caecum, appendix, lower end of ileum, right ureter, right spermatic cord in male & right ovary in female 8. Basti ( Hypogastric)
Organs: Ileum, bladder, gravid pregnant uterus 9. Vāma Adho Parshava
(Left iliac)
Organs: Sigmoid colon, left ureter, left spermatic cord in male & left ovary in female
Differential diagnosis of gulma : Ayurveda is a clinical science; therefore, the diseases are classified in such a way so that they can be systematically diagnosed on the basis of the symptoms. Gulma is a good example for it. Mainly three resembling diseases occur in the abdominal cavity viz. udara roga, gulma and pliha doṣha which require differential diagnosis. Udararoga comprises of eight diseases which cause general enlargement of the abdomen. Five types of gulma have protruding and palpable localized swellings related to the abdominal organs and appendages. Under Pliha dosha benign enlargement of spleen or liver occurs (Bhavaprakasha Chikitsa-prakarana chapter 33). Therefore, on the basis of these clear demarcations, it may not be difficult to differentiate these three kinds of diseases clinically. Chikitsa sutra (principles of management) of gulma:
Prinicples: 1. Anulomana 2. Pachana Main drugs: 1. Bhallataka 2. Lashuna 3. Castor oil 4. Tamra bhasma Internal medicines: Type Medicine Dose Time of administration Anupana Vata dominant 1. Lashunadi vati 500 to 1000 mg Before meals two times Lemon water 2. Vata vidhvansa 250 to 500 mg Before meals two times Lemon water 3. Chukra oil 20-40 drops Before meals two times Milk Pitta dominant 1. Praval panchamrutam 250- 500 mg Before and after meals four times Milk + sugar 2. Shatavari-truna panchamula decoction 20 to 40 ml Between two meals two times Milk 3. Shatavari mandura 500-1000 mg Before meals two times Milk Kapha dominant 1. Swarna vasant 250-500 mg After meals Milk 2. Bhallataka oil 5 to 10 drops Before meals two times Milk 3. Arogya kshara mixture 500-1000 mg Before meals two times Kumaryasava Raktaja 1. Shatavari-truna panchamula decoction 20 to 40 ml Between two meals two times Milk 2. Loha parpati mixture 500-750 mg Before meals two times Honey Sannipatika Varunadi kwatha 20-40 ml Between two meals two times Milk
Panchakarma: Type Formulation Dose Time Anupana Virechana Castor oil 20-40 ml Morning 1 time Milk Virechana decoction 20-40 ml Morning 1 time Milk Niruha Dashamula decoction 320 ml Morning 1 time Anuvasana Sahachara oil 40 to 70 ml Morning 1 time Anulomana Triphala mixture 1 to 3 grams Frequently Honey Blood letting 100 to 150 ml
Glossary Agni-karma (अग्निकर्म) cauterization Ānāha (आनाह) distension of abdomen Apakva Gulma (अपक्व गुल्म) non-suppurate Gulma Gulma (गुल्म) palpable mass in abdomen, abdominal lump Kriyākramaḥ (क्रियाक्रमः) management Kṣāra karma (क्षारकर्म) application of special alkali preparation Kṣaratva (क्षरत्व) erosion Kṣira-Basti (क्षीरबस्ति) Basti prepared with milk Mahāvāstuṁ (महावास्तुं) involving extensive area Nicaya Gulma (निचय गुल्म) Tridoṣaja Gulma Sparśāsahaḥ (स्पर्शासहः) tenderness Sthānasaṁsthānarujāṁ vikalpaṁ (स्थानसंस्थानरुजां विकल्पं) frequent change in the site, shape and pain of the lump
References
1. Bhāvaprakāsha: Bhāvaprakāsha . Published by Chaukhamba Sanskrit Series office Banaras. Cikitsa Prakarana 2. Charaka: Charaka Samhita, Edited by Yadavaji T. Acharya. Niranaya sagar Press, Bombay. 3. Madhava: Madhava Nidana; published by Chaukhamba Samskrit series office, Varanasi, 4. Sushruta: Sushruta Samhita. Edited by Yadavaji T. Acharya. Niranaya sagar Press, Bombay. 5. Vagbhata Junior: Ashtanga Hridaya with Sarvanga-Sundra commentry by Arunadatta, published by Chaukhamba Samskrit series office, Varanasi, 6. Warner E. C. (1964): Savills System of clinical medicine. Orient Longmans Ltd.New Delhi, 14th Edition p.341