Changes

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

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

*Gulma occurs predominantly due to excessive excretion of faeces, kapha and pitta or due to pressure exerted by their excessive aggravation and other causes leading to vitiation of vata dosha.

*''Gulma'' occurs predominantly due to excessive excretion of feces, ''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.

*Cavities like that in urinary bladder (hypo gastric region), umbilical region (''nabhi''), cardiac region (''hridi'') and two flanks (''parshva'') are susceptible sites for ''gulma''.

*All gulma are treated after consideration of dosha dominance, stage, site and strength of patient.  

*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.  

*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 ''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.

*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.

*''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).

*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).

*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).

*''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.

*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.  

*''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 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.

*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.

*''Rakta gulma'' should be treated only after observation for 10 months. This waiting period is essential for achieving a stage suitable for intervention. The patient should be given unctuous ''virechana'' after preparing with ''snehana'' and ''swedana''.

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===