UNDERSTANDING THE SAMPRAPTI OF GULMA IN

CONTEMPORARY CONTEXT Presented By:

Dr. Priyanka BuragohainGuided By:

Dr. Anup Baishya

Department of Roga NidanGovt. Ayurvedic College and

Hospital,Jalukbari,Guwahati-14

INTRODUCTION :

The word Gulma literally means a bush /a shrub,a cluster or clump of trees, a troop or division of army which signifies a collection of something together, having a specific shape,size, mass, or specific form to defined.

But in Ayurveda ,it signifies a very unique diseaseWhich occurs only in the Koṣtha ( mahasrotasa) but having

bahyamargaja and abhyantara margaja forms ( Ca.Su.11/ 48-1,Ca. Su. 11/ 49) )

CONTD.INTRODUCTION…..

Which is one of the Raktapradosaja vikara (Ca.Su.28/11).

Is one of the 48 Samanyaja vikara (Ca.Su.19/3)

Is one of the Ekadesiya śotha / sthaniya sotha prakaraja roga (Ca.Su.18/ 29)

Which manifests only in 5 Sthanasa-Hṛdaya,Nabhi,2 Parśva and Basti .

CONTD.INTRODUCTION….. which is characterised by pain

(vedana) as the most important symptom and a palpable lump as the most important sign.

which can be judged by 5 diagnostic criteria—Samutthāna, Pūrvarupa, Liṇga,Vedana and Upaśaya(Ca.Ni.3)

Samprapti does not help in ascertaining the specific features of Gulma(Ca.Ni.5).

CONTD.INTRODUCTION…..

Which is said to be a disease without any dusya involvement i.e, Nirāśraya but, in Kṛtavāstuparigraha state, there is involvement of mamsadi dhatu and if not treated properly may get suppurated with the involment of rakta just like vidradhi.(Ca. Chi. 5/44. Chakrapani)

Gulma roga has been named on the basis of its Ȧkṛti (shape).

REFERENCES Ch. Su 11 Ch. Su. 18 Ch. Su. 19 Ch. Su. 28 Ch. Ni. 3 Ch. Ni. 8 Ch. Chi. 5 Su. Su. 21 Su. Utt. 42 A. Hi. Ni. 11

A. Sa. Ni. 11 M. Ni. 28 Sa. Sa. Pratham

khanda 7/53 K. Sa. Chi. 8 Bh. Sa. Ni. 3 Ha. Sa. Tritiya

Sthana 4 Bhavaprakash

madhyam khanda 32

MYTHOLOGICAL ORIGIN OF GULMA

During the destruction of Daksha’s sacrifice, gulma first manifested itself in human beings, who fled in all directions, due to agitation in their body because of fleeing , swimming, running, flying, jumping etc

Ch. Ni. 8/11iÉκ¨ÉxÉ ʽý nIÉÉv´É®v´ÉƺÉä näʽýxÉÉÆ xÉÉxÉÉÊnIÉÖ Ê´Ép´ÉiÉɨÉʦÉp´ÉhÉiÉ®hÉvÉÉ´ÉxÉ´ÉxÉxÉÉtènæ½ýÊ´ÉIÉÉä¦ÉhÉè: {ÉÖ®É MÉÖ±¨ÉÉäi{ÉÊkÉ®¦ÉÚiÉ,

1.Sa piṇditatvāt gulma iti abhidhiyate (Ca.Ni.3/7),

2.Sparśa-upalabhya paripiṇditatvāt gulmo (Ca.Ci.5/7),

3.Sampiṇdita dośo gudḍakena mῑyata iti nirukti (Ma.Ni.28/2 madhukośa tika),

4. MÉÖÊ{ÉiÉÉÊxɱɨÉÚ±Éi´ÉÉiÉ MÉÖgù¨ÉÚ±ÉÉänùªÉÉnùÊ{É MÉÖ±¨É´ÉuùÉ Ê´É¶ÉɱÉi´ÉÉiÉ MÉÖ±¨É <iªÉʦÉvÉÒªÉiÉä* (.Su.U.42/6)

NIRUKTI OF GULMA :

GULMA SWARUPA:Acharya Susruta,while defining the swarupa of gulma says---

“A knotty lump in between hṛdaya and basti either moving or stationary ,undergoing increase or decrease and round in shape is described as Gulma..(su.u.42/4)” ¾þiÉ ¤ÉºiªÉÉä®úxiÉ®äú OÉÎxlÉ& ºÉ\SÉÉ®úÒ ªÉÊnù ´ÉÉ%SɱÉ&*SɪÉÉ{ÉSɪɴÉÉxÉ ´ÉÞkÉ& ºÉ MÉÖ±¨É <ÊiÉ EòÒÌiÉiÉ&** (Su.U. 42/4) Hṛdbastyorantare covers the entire abdomen. ºÉ\SÉÉ®úÒ - SɱÉxɶÉÒ±É& ´ÉÉiÉÉÊvÉEòªÉÉiÉ +SÉ±É - BEòºlÉÉxɶÉɪÉÒ ´ÉɪÉÉä®ú±{Éi´ÉÉiÉ SɪÉÉ{ÉSɪɴÉÉxÉ - EònùÉÊSÉnÖù{ÉÊSÉiÉ& EònùÉÊSÉnù{ÉÊSÉiÉ <ÊiÉ Ê´ÉÊSÉjÉÊGòªÉi´ÉÉuùɪÉÉä& ´ÉÞkÉ - ´ÉiÉÖDZÉ

SAMKHYA SAMPRAPTI:

ACHARYA

1.CARAKA 5 V, P, K, Raktaja, and Niccaya gulma2.SUSRUTA 5 V, P, K, R, Kshataja gulma3.VAGBHATTA 8 V, P, K, R, S, and 3 Dvidosaja gulma4.MADHAVA 5 V, P, K, R, and S5.BHAVAPRAKASA 5 V, P, K, R, and S6.SAṚNGDHARA 8 V, P, K, R, S and 3 Dvidosaja gulma 6.BHELA 5 V, P, K, S and Lohita gulma7.KASYAPA 5 V, P, K, R ,and S8.HARITA 5 Sthananusara gulma bheda-

TYPESNUMBER

1.Yakṛta Gulma- Hṛṣdaypradeśastha 2.Aṣthila—Kukṣipradeśastha3.Granthi—Nbhiparadeśasth4.Candavivrddhaka-Bastipradeśatha4.Pliha Gulma -Udara Madhyavarti

HETU OF GULMA:SAMANYA HETU AHARA HETU - Ruksa-annapana- atisevana VIHARA HETU - Vega-udirane:vihate: adho -Mithyapratikarma -Vicestite: va visamaatimatre: MANASHIKA -Soka, ANYA HETU - Bahya-abhighata - Ati Piḍana - Vita-slesma-pitta ati-parisraavadva -vrdhe: paripidanadava Ca.Ci.5/4-5All these factors aggravate Vayu in the kostha eitherdirectly on indirectly.

Aharaja : vatalam-ahara Atyashittou va

pivati navoudakam-atimatram

Madya Ruksha-

annapanam Nirannata

Viharaja: Shitam va vishesena-

atimatram Anudirnam va chardim-

udiryate Atisamshobhina va yanena

yati Ativyavaya-vyayam Visamashana-sayana-sthana-

sankramana sevi va bhabati Vishama atimatram

vyayama Vishama atimatram

vichestanam

VISISTHA HETU:VATAJA GULMAThe following factors aggravate vata in the body of an individual who is of vatik prakriti and is emaciated due to jwara, vamana, virechana or atisara

CONTD.VISISTHA HETU:VATAJA GULMA…………

Manashika hetu shoka

Anya hetu Asneha purve va

vamana-virechane pibati

Udirnana vata-mutra-purisha-vegan-nirunaddhi

Abhighata Atimala-kshayaThese factors mentioned above produce vatika gulma even in

people having non vatik type of prakriti.Ch. Ni. 3/6

PITTAJA GULMA HETU

Aharaja hetu: Amla-lavana-katu-

kashaya-ushna-tikshna-sukta-vyapannamadya-haritaphala amlanam-vidahinam cha- sakadhanya-mamsadinam-upayoga

Ajeerna-adhyasana

Viharaja hetu: Ruksha-anugate-cha-

amashaye vamanam Ativelam

sandharanam Vata- atopa atisevam Krodha Ama abhighata Rudhiram cha

dustam

The following factors aggravate pitta along with vata in an individualemaciated either due to jwara, vamana, virechana or atisara

KAPHAJA GULMA HETU:

Aharaja hetu : Atyasanad- atisnigdha-guru-madhura-shita-

asanata Pista-ikshu-kshira-tila-masa-guda vikriti sevana madya ati panat- ritaka ati panayanat Haritaka-ati-anupa-udaka-gramya-mamsa-

atibhaksanat Bubhushyaksha- cha- ati- pragaham- udakapanatViharaja hetu: Sandharanad Sanshobha Diva swapna

The following factors aggravate kapha along with vata in an individualemaciated either due to jwara, vamana, virechana or atisara

PURVARUPA: Ca.Ni.3/15, Su. Utt. 42/9-Anannabhilasanam(annadvesa by susruta.U.42)-Arocaka-avipakou-Agnivaisamyam (manda agni by susruta.U/42)-Vidaha bhuktasya-Pakakale ca-ayuktyachardyaudgar-Vatamutrapurisaveganam ca-apraadurbhava: pradurbhutanam ca-apravrtti-Isadagaamanam va-Vatasula-atop-antrakujana-apariharsana-Ativrttapurisata-Abubhuksa-Dourbalyam (sadana by susruta.U.42.) -Sauhityasya-ca-asahatvam

CONTD. PURVARUPA......

Udgara bahulya Purishabandha Triptakshamatwa Antravikujana Atopa Adhmana Apakti shakti

A. H. Ni. 11/63

SAMANYA SAMPRAPTI OF GULMA: Eò¡Æò SÉ Ê{ÉkÉÆ SÉ ºÉ nÖù¹]õ´ÉɪÉÖ¯ûrÚùªÉ ¨ÉÉMÉÉxÉ ʴÉÊxɤÉnÂùvªÉ iÉɦªÉɨÉ* ¾þzÉÉʦÉ{ÉÉ·ÉÉènù®ú¤ÉκiɶÉÚ±ÉÆ Eò®úÉäiªÉvÉÉä ªÉÉÊiÉ xÉ ¤Érù¨ÉÉMÉÇ&** {ÉC´ÉɶɪÉä Ê{ÉkÉEò¡òɶɪÉä ´ÉÉ ÎºlÉiÉ& º´ÉiÉxjÉ& {É®úºÉƸɪÉÉä ´ÉÉ* º{ɶÉÉæ{ɱɦªÉ& {ÉÊ®úÊ{ÉÎhb÷i´ÉÉiÉ MÉÖ±¨ÉÉä ªÉlÉÉnùÉä¹É¨ÉÖ{ÉèÊiÉ xÉɨÉ** ( Ca.Ci.5/6-7)

The vitiated vayu provokes either kapha or pitta or

both of them

Along with them vayu obstructs the

channels of circulations (margas)

cause pain in the region of

hridaya ,nabhi,parsva,udara, basti

It is not eliminated through downward path

because of the obstruction

So ,it remains confined to

pakvasaya/,pittasaya/ kaphasaya

Either singly,independently

or in association with other dosas.

Becomes palpable because of its

round shape ,for which it is called

as gulma

VISISHTA SAMPRAPTI OF VATIK GULMA:

Vata prakopak ahara vihara

Vata prakopa

Enters the alimentary

tract/mahasrotas

Rukshat, kathinibhuta,

aplutya, pindita

avasthana korouti

Specially in hridaya, basti, parswa,nabhi

Pindita avasthite,

shulam upajanayati, aneka vidha

granthi

Muhuradhamati muhuralpatwam, aniyatabipulaanuvedanasya, muhur pipilika samprasar ebangesu, toda, bheda, sphurana, ayama, sancocha, supti, harsa, pralay, suchayeba, sankuneba, diva sa ante jwara, romani vedana,

Pleeha, atopa, antrakujana, avipaka, udavarta,

angamarda, manya shira sankha shula,

bradhna(inguinal lymph nodes), krishna- aruna- parusha twak- nakha-

nayana-badana-mutra-purisha

VISISHTA SAMPRAPTI OF PAITTIK GULMA:

Pitta prakopak ahara vihara

pitta and vata prakopa

Vata carries the pitta and gets localised in a

part of Amashaya

Pitta causes vidaha in

kukshi, hriday, urah, kantha

Dhuma pitta udgara,

gulmaavakashashya dahyate-

duyate, dhupyate-

ushmayate, swidyati, klidyati,

sithil, sparsha-asahauolpa romancha

Produces different

types of pain

Jwara, bhrama, davathu, pipasa, gala-talu-mukha-sosha, sosha, pramoha,

vidbheda,harita- haridra twak- nakha- nayana- badana-mutra-purisha

Ch. Ni. 3/9

VISHISTA SAMPRAPTI OF KAPHAJA GULMA:

Vata and Kapha

prakopak ahara vihara

Kapha, Vata prakopa

Vata carries kapha to one

part of Amashaya

Kasa, swasa, pratishaya,

rajayakshma, sweta twak-

nakha- nayana- badana-

mutra-purisha

Kapha causes sheetajwara,

arochaka, avipaka,

angamarda, harsa, hridroga,

chardi, nidra, alashya,

staimitya, gourava,

shiroavitapa,

Produces different types of pain and

causes gulma which is sthaiya,

gourava, kathinya,

avagaha, suptata

Ch. Ni. 3/11

In Sannipatika Gulma due to vitiation of all the three dosas(vikritivisamasamnipata), shares the symptoms of all the three types of Gulma. It is also known as Nicchay Gulma which is incurable.

So, in the pathogenesis of all types of Gulma, Vayu

invariably plays the primary role.

ºÉ´Éæ¹´ÉÊ{É Jɱ´ÉäiÉä¹ÉÖ MÉÖ±¨Éä¹ÉÖ xÉ EòÊ·ÉuùÉiÉÉiÉ @ñiÉä ºÉƦɴÉÊiÉ MÉÖ±¨É—(C. Ni. 3/16)  ºÉ´ÉÉÇi¨ÉEú: ºÉ´ÉÇÊ´ÉEúÉ®ªÉÖHú: ºÉÉä%ºÉÉvªÉ =Hú:, IÉiÉVÉÆ |É´ÉIªÉä ** (S. Utt. 42/13) It is mentioned that almost all the gulmas manifest in their own site and in their own time.Swa dosha sthana adhamanah swe swe kale swa ruka karah (A. Hi. Ni 11/ 47)

GULMA LAKSANA: VATAJ GUKMA LAKSANA

CARAKA

-ºlÉÉxɺÉƺlÉÉxÉ ¯ûVÉÉ Ê´ÉEò±{ÉÆ -Ê´ÉbÂ÷´ÉÉiɺÉÆMÉ -MɱɴÉGò¶ÉÉä¹É¨ÉÂ-¶ªÉÉ´ÉɯûhÉi´ÉÆ -ʶÉʶɮúV´É®ú¨É-Eò®úÉäÊiÉ VÉÒhÉæ%¦ªÉÉÊvÉEÆò |ÉEòÉä{ÉÆ -¦ÉÖHòÉä ¨ÉÞnÖùi´ÉÆ -¾þiEÖòÊIÉ{ÉÉ·ÉÉǶÉʶɮúÉä¯ûVÉÆ -xÉ SÉ iÉjÉ ¯ûIÉÆ Eò¹ÉɪÉÊiÉHÆò Eò]Öõ SÉÉä{ɶÉäiÉä

SUSRUTA

•¨ÉxªÉʶɮú& ¶ÉÚ±ÉÆ •V´É®ú, {±ÉÒ½þ Ê´ÉEòÉ®ú,• +xjÉEÖòVÉxÉ , ´ªÉvÉ& ºÉÚSªÉä´É• Ê´É]õºÉRÂóMÉ •EÞòSUôÉänÖùSUô´ÉºÉxÉ ¨ÉÖ½Öþ ºiɨ¦ÉÉä MÉÉjÉ䕨ÉÖJɶÉÉä¹É& ,EòɶªÉÇ •Ê´É¹É¨É¤ÉμxÉiÉÉ• ¯ûIÉEÞò¹hÉi´ÉMÉÉÊnùi´ÉÆ •+ÊiɯûÊ{ÉiɺÉƺlÉÉxɺlÉÉxÉ´ÉÞÊrùIɪɴªÉlÉ &• Ê{É{ÉÒʱÉEòÉ´ªÉÉ{iÉ• MÉÖ±¨É º¡Öò®úÊiÉ iÉÖtiÉä

-¾þiEÖòÊIɶÉÚ±ÉÆ-¨ÉÖJÉEòh`ö¶ÉÉä¹ÉÉä-´ÉɪÉÉäÌxÉ®úÉävÉ -ʴɹɨÉÉÎMxÉiÉÉ-Ê´ÉEòÉ®úÉ& {É´ÉxÉÉi¨ÉEòÉ·É

ASTANGA HRDAYA

Su.Utt. 42/10Ch. Chi. 5/7-8A. H.Ni. 11/41-43

CARAKA SUSRUTA

•º´Éänù •V´É®ú•+ɽþÉ®ú Ê´Énùɽþ•iÉÞ¹hÉÉ•+RÂóMÉ®úÉMÉ•Eò]Öõ´ÉEòjÉiÉÉ•Ê{ÉiɺªÉ ˱ÉMÉÉÊxÉ +ÊJɱÉÉÊxÉ ªÉÉÊxÉ Ê{ÉiÉÉi¨ÉEäò

ASTANGA HRDAYA• nùɽþÉä

•+¨±ÉEòÉä

•¨ÉÚSUôÉÇ

•Ê´Éb÷¦Éänù

•º´Éänù• iÉÞ¹hÉÉ•V´É®ú •½þÉÊ®úpùi´ÉÆ i´ÉMÉtä¹ÉÖ• MÉÖ±¨É¶SÉ º{ɶÉÇxÉɺɽþ&• nÚùªÉiÉä •nùÒ{ªÉiÉä •ºÉÉ乨ɺ´ÉlÉÉxÉ nù½þiÉÒ´É

PITTAJ GULMA LAKSANA

-V´É®ú-Ê{É{ÉɺÉÉ -´ÉùnùxÉÉRÂóMÉ®úÉMÉ -¶ÉÚ±ÉÆ ¨É½þVVÉÒªÉÇÊiÉ ¦ÉÉäVxÉä -º´ÉänùÉä -Ê´ÉnùɽþÉä -µÉhÉ´ÉkSÉ MÉÖ±¨É& º{ɶÉÉǺɽþCh.Chi. 5/10 Su. Utt. 42/11 A. H. Ni. 11/44-45

CARAKA

ºiÉèʨÉiªÉ ¶ÉÒiÉV´É®úMÉÉjɺÉÉnùEòÉºÉ +¯ûÊSÉ MÉÉä®ú´É ¶ÉèiªÉÆ ¯ûMɱ{ÉÉEòÊ`öxÉÉäzÉi´ÉÆ

SUSRUTA ASTANGA HRDAYA

ºiÉèʨÉiªÉ +zÉ +¯ûÊSÉ+ÆMɺÉÉnù UôÌnù|ɺÉäEò¨ÉvÉÖ®úɺªÉiÉÉEò¡òºªÉ ʱÉMÉÉÆÊxÉ +ÊJɱÉÉÊxÉ

ºiÉèʨÉiªÉ+´ÉMÉÉg MÉÖ±¨É+¯ûÊSÉ EòÊ`öxÉ MÉÖ±¨ÉºÉnùxÉMÉÖ¯û MÉÖ±¨ÉʶÉʶɮúV´É®úºÉÖ{iÉ{ÉÒxɺÉκlÉ®ºÉɱɺªÉ +±{ɯûEò¾þ±±ÉÉºÉ EòɺɶÉÖC±Éi´ÉMÉÉÊnùiÉÉ

KAPHAJA GULMA LAKSANA

Ch. Chi. 5/11 Su. Utt. 42/12 A.Hi. 11/46

SANNIPATAJ GULMA LAKSANA

CARAKA

•¨É½þɯûVÉÆ

•nùɽþ{É®úÒiɨɕ+¶¨É´ÉnùPÉxÉÉäzÉiÉÆ •¶ÉÒQÉÊ´ÉnùÉäʽþ, nùɯûhɨɕ¨ÉxÉ& ¶É®úÒ®úÎMxɤɱÉÉ{ɽþÊ®úhÉÆ•asadhya

ASTANGA HRDAYASUSRUTA

•iÉҵɯûEò-nùɽþ•¶ÉÒQÉ{ÉÉEòÒ •ùPÉxÉÉäzÉiÉÆ •asadhya

Sarvatmak: Sarvavikara-yukta: asadhya

Ch.Chi. 5/14 Su.Utt. 42/13 A. Hi. 11/48

RAKTA GULMA

By the rakta gulma here ,we should consider only the ARTAVA Gulma,That’s why caraka says ¶ÉÉäÊhÉiÉMÉÖ±¨ÉºiÉÖ JÉ™Öü ÊÛɪÉÉ B´É ¦É´ÉÊiÉ xÉ {ÉÖ¯þ¹ÉºªÉ, MɦÉÇEúÉä¢ÉiÉÇ´ÉÉMɨÉxÉ´Éè¶É乪ÉÉiÉ * (Ca.Ni.3/13) That is sonita gulma develops only in females not in malesBecause the women possess garbhasaya (uterus) and have regular appearance of artava which is accumulated in this disease.Cakrapani,opine that this disease develops in the active reproductive age ,neither to the young girls (kumari ) ,nor to the aged women (ativrdha). (Ca.Ci.5/18 CK tika) The same concept is also accepted by Indu ,but Indu also mention non development of Rakta Gulma even in the women having pratanu artava( As.Ni.11/44.indu tika)

RAKTAJ GULMA SAMPRȦPTI:

ºÉ |ÉEÖòÊ{ÉiÉÉä ªÉÉäÊxɨÉÖJɨÉxÉÖ|ÉʴɶªÉÉiÉǴɨÉÖ{ɯûhÉÊrùú ¨ÉÉ漃 ¨ÉÉ漃 iÉnùÉiÉǴɨÉÖ{ɯûrùªÉ¨ÉÉxÉÆ EÖòÊIɨÉʦɴÉvÉǪÉÊiÉ* ( Ca.Ni.3/14)

xÉ´É|ɺÉÚiÉÉ%ʽþiɦÉÉäVÉxÉÉ ªÉÉ ªÉÉ SÉɨÉMɦÉÇ Ê´ÉºÉÞVÉäoùjÉÉè ´ÉÉ* ´ÉɪÉÖ̽þ iɺªÉÉ& {ÉÊ®úMÉÞÁ ®úHÆò Eò®úÉäÊiÉ MÉÖ±¨ÉÆ ºÉ¯ûVÉÆ ºÉnùɽþ¨ÉÂ** (Su. Utt. 42/14) @ñiÉÉ´ÉxÉɽþÉ®úiɪÉÉ ¦ÉªÉäxÉ Ê´É¯ûIÉhÉè´ÉæMÉÊ´ÉÊxÉOɽèþ¶SÉ* ºÉƺiɨ¦ÉxÉÉä±±ÉäJÉxɪÉÉäÊxÉnùÉä¹ÉèOÉÖ±¨É& κjɪÉÆ ®úHò¦É´ÉÉä%¦¨ÉÖ{ÉèÊiÉ** ªÉ& º{ÉxnùiÉä Ê{ÉÎhb÷iÉ B´É xÉÉRÂóMÉèζSÉ®úÉiÉ ºÉ¶ÉÚ±É& ºÉ¨ÉMɦÉÇʱÉRÂóMÉ&* ºÉ ®úÉèÊvÉ®ú& ºjÉÒ¦É´É B´É MÉÖ±¨ÉÉä ¨ÉɺÉä ´ªÉiÉÒiÉä nù¶É¨Éä ÊSÉÊEòiºªÉ&* (C. Ci. 5/18-19)

HETU SEVANA Aggravated vayu entrs into yoni mukha and obstruct the menstrual blood— it gets accumulated every month and as a result there is enlargement of Kuksi.

Clinical features------------ General—fever,cough,pain,bodyache,sleepiness,lethargy.stillness,oedema of feet, drooping of eyelids, anaemia,emaciation,etc.Digestive system-colic, nausea, vomiting , diarrhoea, anorexia, indigestionPregnancy related- breast changes, increase in size of uterus,delayed quivering with pain and movement like a solid mass,Dohrda,appearance of lnea nigraReproductive system-Amennorrhea,Pain in uterus,foul smelling vaginal discharge,Accumulation of rakta in the uterus.,

During menstruation, Who has recently Delivered,Who aborts amagarbha

-Intake of vatala ahara-vihara,-remaining without foodduring menstruation-Suppression of natural Urges-fear Other hetu—improper use of stambhaka ,vamana, Having yoni roga.

Rakta gulma samprapti contd…..

AMA- PAKWA GULMA        MÉÖ¯þ: EúÊ`xɺÉƺlÉÉxÉÉä MÉÚf¨ÉÉƺÉÉxiɮɸɪÉ: * +Ê´É´ÉhÉÇ: κlÉ®õÉè´É Á{ÉFúÉä MÉÖ±¨É =SªÉiÉä ** Ch.

Chi. 5/40

       nɽý¶ÉÚ™üÉÌiɺÉÆIÉÉä¦Éº´É{ÉîxÉɶÉÉ®ÊiÉV´É®è: *   Ê´ÉnÁ¨ÉÉxÉÆ VÉÉxÉÒªÉɱ¨ÉÆ iɨÉÖ{ÉxÉɽýªÉäiÉ **

Ch. Chi. 5/41

       Ê´Énɽý™IÉhÉä MÉÖ±¨Éä ¤ÉʽýºiÉÖƒäû ºÉ¨ÉÖzÉiÉä *        ¶ªÉÉ´Éä ºÉ®Hú{ɪÉÇxiÉä ºÉƺ{ɶÉæ ¤ÉκiɺÉÆÊxɦÉä **       ÊxÉ{ÉÒÊbiÉÉäzÉiÉä ºiɤvÉä ºÉÖ”Éä iÉi{ÉÉ·ÉÇ{ÉÒbxÉÉiÉÂ

*     iÉjÉè´É Ê{ÉÎhbiÉä ¶ÉÚ™äü ºÉÆ{ÉFÆú

MÉÖ±¨É¨ÉÉÊn¶ÉäiÉ **        iÉjÉ vÉÉx´ÉxiɮҪÉÉhÉɨÉÊvÉEúÉ®: ÊGúªÉÉÊ´ÉvÉÉè *        ´ÉètÉxÉÉÆ EÞúiɪÉÉäMªÉÉxÉÉÆ ´ªÉvɶÉÉävÉxÉ®Éä{ÉhÉä

** Ch. Chi. 5/42-44

BAHYA-ABHYANTARA GULMA +xiɦÉÉÇMɺªÉ SÉÉ{ªÉäiÉiÉ {ÉSªÉ¨ÉÉxɺªÉ ™IÉhɨÉ *

   ¾ýiGúÉäb¶ÉÚxÉiÉÉ%xiÉ:ºlÉä ¤Éʽý:ºlÉä {ÉÉ·ÉÇÊxÉMÉÇÊiÉ: **45**

Gulme antar ashraye basti kukshi hrid pleeho vedanah. Agni varna bala bhramso veganam cha pravartanam. A. H. Ni. 11/58

Atah viparyayobahye kostha angeshu tu na ati rukah. Vaivarnyam avakashashya bahirunnata adhikam. A. H. Ni. 11/59

ASADHYA LAKSHAN OF GULMA: ºÉÆÊSÉiÉ: Gú¨É¶ÉÉä MÉÖ±¨ÉÉä ¨É½ýÉ

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MÉÖα¨ÉxɨÉ ** Ch. Chi. 5/169- 171  ·ÉÉºÉ ¶ÉÚ™üÊ{É{ÉɺÉÉ%zÉÊ´Éuäü¹ÉOÉÎxlɨÉÚfiÉÉ: **    ¦É´ÉÎxiÉ nÖ¤ÉÇ™üi´ÉÆ SÉ  MÉÖα¨ÉxÉÉä

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SAMPRAPTI GHATAK 0F GULMA

Dosa – vata pradhan tridosa Dushya- Nirashray Adhisthan- Hriday, Nabhi, Basti, Parswa,

Amashaya, Pakwashaya Agni- Jatharagni, Dhatwagni Agnidusti – Visamagni, Mandagni Srotas- Annavaha, Purishavaha Srotodusti- Sanga, Vimargagaman,

Atipravritti Sancarasthana- Mahasrotas

CONTD. SAMPRAPTI GHATAK OF GULMA.......

Vyaktasthana-Hriday, Nabhi, Basti, Parswa, Amashaya, Pakwashaya, garbhashaya

udbhavasthana- Amasayottha, Pakvasayottha

Swabhava- Asukari, Chirakari Prabhava- Ekadoshaja-Sadhya Tridosaja- Asadhya Roga bheda- 5 types

As per Ayurvediya Vikriti- Vijnan & Roga Vijnan By: P.S. Byadgi and Kayachikitsa by prof R. H. Singh

RAKTA GULMA AND GARBHA :Rakta gulma Garbha

1. Angarahit pindakar spandan.

1. Angasahita garbhapinda spandan

2. Chira kalika spandan 2. Niyatakalita spandan

3. Sashula spandan 3. Sularahita spandan

4. Vriddhi gati anichita 4. Niyata kram / pratimash vriddhi

5. Mashe vyatite dashame

5. Dasham me prashava

DIFFERENTIAL DIAGNOSIS OF VARIOUS GULMA VATAJA PITTAJA KAPHAJA SANNIPAT

AJARAKTAJA

DOSA Vata Vata pitta Vata kapha tridosa Rakta / Artava

PRATYATMA LINGA

Aneka vidha granthi, pinditwa, granthi

sparsha, asaha, duyate, dipyate, cha ushma, cha-sthana, deha ativa cha

Avagaha, kathina, guru, supta, sthiro,

Maha ruja, dahaparitam, asmadghanonnatam, shighra vidahi

Striya avum prajayate

UDBHAV STHAN

Mahasrotas Amashaya Amashaya Gabhashaya

CHIKITSA SUTRA

Snehan swedan, vaman, virechan, vasti, raktamokshan

Sramsana/ mridu virechan-ghrita pana, basti, raktamokshan, sastrakarma, sodhan-samana

Langhan- vaman- virechan, kshara-Agni karma, raktamokshan

Asadhya Gabhakalovyatikrame, snehan- swedan- virechan

GULMA VIDRADHI

paripinditvat gulma itiabhidhiyate due to its rounded/ condensed form it is called as gulma. (Ca.Ni.3/7),

Anibandana-without any base have only the causative dosas as their base. (Su. Ni, 9/31)

They undergo paka after a long time or not at all.(Su. Ni. 9/33)

Sparsha upalabhyam gulmakhyam utplutam granthirupitama. (A. H. Ni 11/38)

Vrittah shyada adau yo va smritah chaudha sa vidradhi(A.H. Ni. 11/3)

sighra vidahitvat vidradhi itiabhidhiyate (A.H. Ni. 11/57)

Sanibandana-having defined base like mamsa,rakta etc quickly(Su. Ni, 9/31)

undergoes paka.(Su. Ni. 9/33)

Maha mula, maharuja, sopha

Both gulma and abhyantara vidrdhi occurs in kostha,bothare having local swelling( utsedha), and pain(sula) .

Arvuda –The large vegetation of mamsa which appears at any part of the body, becomes slightly painful, rounded, immovable and deep-seated, and has its root sunk considerably deep in the affected part, and which is due to the vitiation of the Mamsa , Rakta and Meda by the aggravated Doshas(Váyu, Pittam and Kapham) is called an Arvuda. The growth of an Arvuda is often found to be slow, and it seldomes suppurates.

Su. Ni. 11/ 13-14

VRIDDHI Due to ahita ahara vihara Apana Vayu gets

obstructed and this vitiated vayu which on reaching vrishana via vangshana affects the phalakosha avibahini and causes sopha and shula. (A. H. Ni. 11/21-22) Su. Ni. 12

SHULA Bina gulmena yatshulam gulma sthanesu

jayate(Su. Utt. 42/77) Sanku spotanavat tasya yasma tibrasya

vedanah| shula asaktasya lakshyante tasmat shulam hi ucchyate (Su. Utt. 42/81)

FEATURES ARBUDA VIDRADHI GULMA

DOSA Kapha pradhana Pitta pradhana Vata pradhana Tridosa Tridosa Tridosa DUSYA Mamsa,Rakta Twak, Rakta , meda Mamsa, meda, Nirasraya

ADHISTHANA Any parts of the Hrdaya,Kloma, Hrdaya, body Yakrt, Pliha, Vrka, Nabhi,Basti, Nabhi,Kuksi, Dvayaparsva Basti, Vamksana, Guda, Asthi

BHEDA 6 ( V,P,K,R, 6 (V,P, K, S, 5 (V, P, K, R, Mamsaja, Ksataja,Raktaja) S ) Medaja)

NEARESTMODERN TUMOUR ABSCESS ABDOMINAL CORRELATION LUMP

hrid

nabhi

basti

parswaparswa

parswa

parswa parswa

parswa

Acc to Ayurveda nine division of Abdomen

GULMA IN MODERN SCIENCE When we look for its modern interpretation, Gulma is not a single disease.It is a single name representing a collection of many medical and surgical conditions which even includes Gynaecological and Obstetrics conditions.It represents a bunch of disease conditions which occurs in Intra- abdominal organs.Any types of pain associated with a palpable lump/mass which occur in any quadrantsof the abdomen may create a suspician of GULMA.

VATIK GULMA Lumps due to intestinal tuberculosis

chronic intussusception umbilical or epigastric hernia

appendicular lump(without inflammation)

phantom tumor

PAITTIK GULMA

Lumps due to regional ileitis Appendicular abscess Psoas abscess Empyema of gall bladder Hepatic abscess Cholecystitis

Psoas abscesscholecystitis

KAPHAJA GULMA- Any palpable mass which is stable,painless or with less pain,hard in consistency,elevated associated with fatigue,nausea,and heaviness in body . Tumours connected with liver ,spleen,stomach,kidneys, pancrease,tranverse colon and pelvic organs which are painless and benign in nature may come under Kaphaja gulma.

SANNIPATAJA GULMA -Any palpable mass with severe excruciating pain,excessive burning sensation,stone like compactness and elevation of the affected parts,quick suppuration,disappearance of the strength of the mind,body,digestion as well as metabolism. This type can be consider as any malignant condition of abdomen with the above clinical features.

Hydatid cyst

RAKTAJA GULMA- taking into account etiopathogenesis and clinical featuresof rakta gulma,all the local (reproductive system) and general conditions described in modern medicines giving rise to amenorrhoea can be considered under rakta gulma.However rakta gulma seems to be specifically analogus to Molar Pregnancy( carneous mole and hydatiform mole). In molar pregnancy,there is initial ammenorrhoe,and presence of allthe features of early months of pregnancy,followed by P/V Bleeding.Due to association of infection fever,cough and foul smelling vaginaldischarges can be seen.The product of conception assumes a shape of rounded mass in carneous mole and bunch of grapes in hydatiform mole.The trace of exact fetus is rarely found.Fetal parts are not felt ,nor fetal movements, there is absence of fetal heart sound. Vomiting,varrying degree of lower abdominal pain are present,patient looks more ill than accounted for,pallor is also present.(D.C.Dutta Obst.) Normally all those conditions arising after menstruation,labour, uterine curettage or other yoni rogas(gynac disorders),,having cardinalsymptom as amenorrhoea in association with fever,diarrhoea,colic,cough and dyspnoe etc. can be considered under rakta gulma.

CRYPTOMENORRHOEA is anoher condition which can be correlated with rakta gulma.In cryptomenorrhea ,there is shedding of the endometrium and bleeding but the menstrual blood fails to come out from the genital tract due to obstruction in the passage.CausesCongenital causes—Imperforate hymen,Transverse vaginal septum, Atresia of upper-third of vagina and cervix.Acquired causes—Stenosis of the cervix following amputation,deep Cauterisation and conisation,, - Secondary vaginal atresia following neglected and difficult vaginal delivery.Pathology—There is only accumulation of blood in the uterine cavity resulting in haematometra,then haematosalpinx.Clinical Features-Amenorrhoea dated back from the events,periodic pain in the lower abdomen,symmetrically enlarged Uterus, abdominal examination reveals an uniform globular mass in the hypogastrium,rectal examination confirm a uterine mass .Treatment---Dilatation of the cervix to drain the collected blood

PSUEDOPREGNANCY---A condition in which a patient has nearlyall of the usual signs and symptoms of pregnancy,such as enlargementof abdomen,weight gain,ammenorrhoea and morning sickness but is not pregnant.It is usually seen in women who either are very desirous of having children or wish to avoid pregnancy.Treatment usually is done by psychiatric means.It is also known as Pseudocyesis,phantom pregnancy.Psuedocyesis also occurs in men.

OVARIAN TUMOURS —Are usually not associated with Amenorrhoea,They are not caused due to abnormality or collection of menstrual blood,while rakta gulma developes due to accumulation of unexcreted rakta.

UTERINE FIBROMYOMAS/TUMOURS - Are usually associated withMenorrhagia rather than Amenorrhoea.Moreover, these are made up of muscle fibres wth fibrous tissues not of blood.

NEAREST MODERN CORRELATION :VATAJA Alteration in shape

& region, obstruction in purisha and vayu, vedana in hrid, parswa, kukshi

Lumps due to intestinal tuberculosis, chronic intussusception, umbilical or epigastric, appendicular lump(without inflammation), phantom tumor,

PITTAJA sparsha-asahauolpa romancha, Jwara, pipasa, shula, sithila

Lumps due to regional ileitis, appendicular abscess,psoas abscess, empyema of gall bladder, Hepatic abscess, cholecystitis

KAPHAJA sthaiya, gourava, kathinya, avagaha, suptata, aruchi, kasa, swasa, sosha

Lump due to caecal amoebiasis, Mucocele of gall bladder, Hydatid cyst of Liver, Pseudopancreatic cyst, Glandular tuberculosis,Lump due to intestinal tuberculosis, Polycystic kidney, Ovarian cyst

?

SANNIPATAJA Maha ruja, daha parita, asmabadh ghannatwa, shighra vidahi,daruna, asadhya

Lumps due to malignancy of any abdominal organs, caecum, lymph gland, gall bladder etc

RAKTAJA Occurs only in females, increase in size of uterus, pain and movement like a solid mass,Amennorrhea,Pain in uterus,foul smelling vaginal discharge,Accumulation of rakta in the uterus .

Molar Pregnancy (Hydatid Mole), Psuedopregnancy, Acquired Crytomenorrhea

As per Textbook of Kayachikitsa @ Proff. R. H. Singh

?

Phantom tumor

An accumulation of fluid in the interlobar spaces of the lung occurring as a result of congestive heart failure and appearing radiologically as a neoplasm. A swelling resembling a tumor, usually caused by muscle contraction or gaseous distension of the intestines.

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevie.

A circumscribed accumulation of fluid in the interlobular spaces, which may be seen on a plain chest film in congestive heart failure. Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

.WHAT CAUSES AN ABDOMINAL MASS?

Abdominal masses can be the result of a number of factors, including an injury, cyst, tumor, cancer, or disease.

CystsA cyst (abnormal mass in the body, filled with fluid or infected matter) is sometimes to blame for an abdominal mass.Cysts that commonly cause abdominal masses are:Ovarian cysts - cysts that form in or around the ovariesCholecystitis - gallstones (abnormal mass of hardened digestive fluid) often cause this condition. Gallstones block the tube leading out of the gallbladder, leading to gallbladder inflammation.Uterine fibroids - noncancerous tumors that grow in or around uterus

CancerCancers that often cause abdominal masses are:Colon cancerKidney cancerLiver cancerStomach cancer

DiseasesCertain diseases may also cause abdominal masses. These diseases include:Crohn’s disease - an inflammatory bowel disease (IBD) that causes inflammation of your digestive track lining,

Other ConditionsOther conditions that can cause an abdominal mass include:Abdominal aortic aneurysm - an enlargement and/or protrusion of the large blood vessel that supplies blood to the abdomen, pelvis, and legsPancreatic abscess - a pus-filled hollow in the pancreasDiverticulitis - inflammation or infection of the diverticula. Diverticula are quite common pouches that form in places such as your intestines and colon that protrude out of the organ’s weak spotsHydronephrosis - enlarged kidney due to the backup of urineEnlarged liverEnlarged spleen

Volvulus (twisted piece of the gastrointestinal tract),Uretero-pelvic junction obstruction,Bladder distention,Cholecystitis (an inflammation of the gallbladder)Bowel obstruction,Gallbladder tumor,Pancreatic pseudocyst

Signs and Symptoms of an Abdominal Mass

Swelling in the area affected Unintentional weight gainPain Inability to urinateAbdominal discomfort Inability to pass stoolNausea Feeling fullVomitingFever

Abdominal masses may be hard, soft, stable, or moveable.

How Are Abdominal Masses Diagnosed? 1. Medical History and Physical Examination During physical examination, the clinician must identify the location of the mass (usually specified in terms of quadrants). The mass should be assessed for whether it is rigid or mobile.It should also be characterized for pulse or peristalsis,or tenderness,as these would help in further identifying the mass.2. Routine blood tests  They should include a full blood count, blood urea nitrogen (BUN),creatinine, and liver function tests such as albumin,  international normalized ratio (INR),partial thromboplastin time (PTT), serum amylase and total bilirubin (TB).

3.An Imaging Test –to determine the size and location.Also determine the type of mass.Commonly used imagingTests are:Abdominal Computed Axial Tomography (CAT) ScanAbdominal X-rayAdominal UltrasoundWhen imaging tests are not enough, and needed a closer look at the area involved.Then , a Colonoscopy may be done. This is especially true if the digestive system is involved.Women who have ovarian or uterine cysts will require a special imaging scan called a Transvaginal ultrasound. Unlike an abdominal ultrasound, which views organs on the inside by sliding a probe over the abdomen, a transvaginal ultrasound is performed by inserting a probe into the vagina. This allows the doctor to have a closer look at the uterus and ovaries.

Future Health Complications

Abdominal masses that choke off organs may damage the organ.If any part of the organ is damaged, it may need to be removed surgically.If there are multiple masses in the abdomen, you may need several forms of treatment or surgical procedures to eliminate the masses. Cancerous masses may come back after treatment.Women with polycystic ovary syndrome may develop multiple cysts in their ovaries on a monthly basis. These cysts may go away without treatment;however, some may grow large enough to warrant surgical removal

KEY POINTS ABOUT GULMA : Charak has mentioned Gulma just after

raktapitta because due to raktapitta vata dosha is aggravated and vata is the main dosa for causation of Gulma.

Sushruta has mentioned Gulma along with Shula in Uttar tantra as both possess vedana as their feature and differentiated it from vidradhi in Nidana Sthana

Madhavkara have mentioned gulma after Anaha as anaha is present in gulma also.

DIFFERENTIAL DIAGNOSIS CONTD........ Vagbhata in Astanga Hriday have

mentioned simirarity between Vidradhi, Vriddhi and Gulma along with Anaha, Asthila, pratyasthila, tuni and Pratituni in the same chapter.

CONCLUSION Gulma is a very unique disease in Ayurveda,which is avatapradhana kosthagata roga, signifying a group of diseaseswith pain and localised abdominal lump as the cardinal features along with many gastro intestinal symptoms.Its correlation with a single modern disease in not possible at all.Because, it covers a group of diseases occuring intra-abdominally ranging from simple gaseous obstruction in the intestine to a an incurable malignant conditions including intra abdominal abscess as one of its chronic condition. It includes many medical,surgical ,gynaecological,and obstetrical conditions in modern medicine.But for judging gulma we have to look for causative factors,signsand symtomps and Upasaya.

As indicated by its name, it is a collection of morbid dosas in condensed form ,like a shrub having its concealed root .This gulma may vitiate mamsaadi dhatu and may make deep seated extensive base/root or sometimes may involve amlatayukta dusta rakta finally termnating intoa vidrdhi.Summarising the treatment procedure we can said that,Gulma caused by only one of the three dosas should be treated according to the dosa vitiated.The types of gulmacaused by 2 dosas dhould be treated by sadharana cikitsa.The serious upadrava should be attempted first immediatelyThan the other one which is less serious..If we are not able to ascertain its type,we should start with the treatment of vata dosa. By observing the features of gulma, it can be said that GULMA roga of Ayurveda is GULMA(cluster) of different medical ,surgical,gynaecological,and obstetrical conditions which occur intra-abdominally.

OVERVIEW Introduction Nirukti with mythological origin Samhkya Samprapti Hetu- samanya and vishista Samprapti- samanya and vishista Purvarupa and Laksana Samprapti ghatak Differential Diagnosis Ama- pakwa gulma lakshana Lakshana of asadhya gulma Gulma in Modern Science Conclusion