This produces inertia, shivering, fever, body ache, nausea, cough, tastelessness, heaviness, and hard elevated non inflammatory masses.

1

NIDANA

1. Sheeta, guru snigdha: Indulgence in cold, heavy and unctuous foods

2. Achesta: Lack of exercise

3. Sampoorana – Over-nourishment and

4. Diva swapna: Sleep during day time.

The Sannipatika type of Gulma is produced by all causative factors of Vatika, Paittika and Kaphaja Gulma [14]

2

LAKSHANA

1. Staimitya – numbness or a feeling as if covered with a wet-cloth

2. Sheeta Jvara: Fever associated with feelings of cold

3. Gatra sada, Hrullasa, Kasa, Aruchi, Gaurava: Body stiffness, Nausea, cough, anorexia and heaviness and

4. Kathina unnatam: The affected part of the body is hard to touch and is elevated. It is cold in touch and there is less pain.[15]

3

PRICIPAL OF CHIKITSA

If caused by cold, heavy and unctuous substances – Langhana (Fasting / lightening therapy) is administered.

If he is having less power of digestion, less of pain, heaviness, immobility of gastro-intestinal tract, nausea and anorexia – Vamana – emetic therapy.

After Vamana and Langhana, patient is given hot regimens. Diet is mixed with pungent and bitter drugs.

If the Gulma is hard and elevated and if the patient is also suffering from bloating and constipation, then in the beginning Swedana – fomentation therapy is applied.

By fasting, emetic and fomentation therapies, Agni (power of digestion) gets stimulated and the patient suffering from Kaphaja Gulma should take ghee boiled with alkalies and pungent herbs, at the appropriate time.

Having ascertained that the Kaphaja gulma is dislodged from the place of its manifestation, the patient is administered Virechana. He can also be administered Snehabasti (oil enema), or Niruha with Dashamoola Kashaya.

If there is Mandagni – low digestion strength and bloating, then Snehana is given followed by medicines in the form of pills, herbal powder or decoction is administrated.

If Kaphaja Gulma has a strong foundation and is extensive in size, hard, immobile and heavy, then the patient is treated with alkalies, Aristas (Alcoholic preparations) and by cauterization (agni Karma) [48 ½ +1/2 56]

KSHARA USE IN GULMA

GULME KSHARA PRAYOGA – ADMINISTRATION OF ALKALIES:

In Kaphaja Gulma, after ascertaining the Dosha, Prakruti (body constitution), season, the physician should administer Kshara.

It is repeated at an interval of 1, 2 or 3 days by the physician who is conversant with the science of reducing a particular Dosha by promoting the physical strength of the patient.

Kapha which is sweet and unctuous gets aggravated in a person who indulges in meat, milk and ghee. Kshara (Alkali) has the property of Ksharana (Liquefaction). Thus it gradually erodes Kaphaja Gulma and brings it downwards. [56 ½ – ½ 59]

ARISHTA THERAPY

In the course of administering Sneha (unctuous substance) to a patient suffering from Kaphaja Gulma, if he suffers from Mandagni – low digestion strength and Aruchi – anorexia and if he is accustomed to alcohol intake, Arishtas (a type of alcoholic medicine) is administered with a view to clearing his channels. [59- ½ 60]

AGNI KARMA

AGNI KARMA – CAUTERIZATION THERAPY:

If by Langhana, Vamana, Swedana, ghee intake, Virechana, enema, pills, powders, alkalies and various types of Arishta, Kaphaja Gulma does not get alleviated because of its obstinacy, then Agnikarma is done, prepared with the help of arrow, iron rod etc.

After blood-letting therapy because of its heating and sharp effects, cauterization therapy in Gulma alleviates Kapha and Vata as a result of which Gulma loses its compactness.

In Agnikarma, physicians belonging to Dhanvantara School have proficiency. Similarly, for the administration of Kshara (Alkali therapy), services of physicians who are Kshara-Tantra-vidhi (proficient in the administration Of Alkalies) is better utilized. (60 ½ – 1/9 64)

SURGICAL MANAGEMENT

The patient of Kapha Gulma is administered Snehana and Swedana, thereafter, Vamana therapy is administered if needed.

After the mass of Gulma has become soft by the administration of these therapies, at the brim, it is covered with a piece of cloth and made to enter the mouth of a jar containing ignited Balvaja or Kusha.

When because of the negative pressure created inside the jar, the mouth of the jar becomes strongly adhered to brim of the mass of Gulma, the jar is pulled. Then though another piece of cloth, the mass of Gulma is tied at its Root (peduncle) and punctured by a physician well versed in this technique. Thereafter, with the help of implements like Vimarga, Ajapada and Adarsha, what ever is available, the mass of Gulma is squeezed.

Thereafter with the paste of Tila – Sesamum indicum, Eranda – Castor, seeds of Atasi – Linseed – Linum usitatissimum and sarshapa and fomented with the help of an iron pan made tolerably warm. [137-141]

4

PROGNOSIS OF GULMA

Tumor associated with the features of breathlessness, abdominal pain, thirst, anorexia, body ache, stiffness, and debility are critical; likewise, the tumor with the features of all the three Doshas is also incurable.

INCURABILITY AND COMPLICATIONS

When Gulma, gradually accumulated, surrounds a large area, deep-rooted, when it is engrossed with veins, when it is elevated like a tortoise and when it is associated with weakness, anorexia, Nausea, Cough, vomiting, Arati (Disliking for every thing), fever, morbid thirst, drowsiness as well as coryza, it becomes incurable.

Oedema in cardiac region, umbilical region and upper as well as lower limbs in a patient of Gulma who is afflicted with fever, dyspnoea, vomiting and diarrhoea drag him towards death.

5

MANAGEMENT OF GULMA (GASEOUS TUMOR)

All measures are undertaken to control Vata. To achieve this,

Snehana – oleation,

Swedana – sudation (sweating therapy),

Mild purgation,

Asthapana Basti – Decoction enema,

and sour mixed sweet eatables are recommended.

6

SINGLE DRUGS RECOMMENDED

1. Lashuna – garlic – Allium sativa Linn.

2. Hapusha – Juniperus communis Linn.

3. Hingu – asafetida – Ferula narthex Boiss.

4. Draksha – raisins – Vitis vinifera Linn.

5. Vacha – Acorus calamus Linn.

6. Eranda – castor- Ricinus communis Linn.

7. Ajamoda – Celery – Trachyspermum roxburghianum (DC.) Sprague.

8. Saindhava lavana – rock salt

9. Pippali-long pepper- Piper longum Linn.

10. Chavya- Piper chaba Hunter.

11. Danti – Baliospermum montanum (Willd.) Muell. Arg.

12. Haritaki – chebulic myrobalan – Terminalia chebula Retz.

13. Varuna – Crataeva nurvala Buch-Hem. etc

7

AYURVEDIC MEDICINES

1. Dashamoola kwatha

2. Hapushadi ghrita

3. Hingwadi choorna

4. Hingusauvarchala ghrita

5. Pippalyadi ghrita

6. Lashuna ksheerapaka

7. Shankha vati

8. Vaishwanara choorna

9. Agnimukha choorna

10. Dantiharitaki lehya

11. Chavikasava

12. Pravala Panchamrita rasa

13. Dashamoola ghrita

14. Varunadi kwatha

15. Kumaryasava

16. Ksheera Shatpala ghrita etc.

8

KAPHAJA GULMA AYURVEDIC MEDICINES

MEDICINE AND TREATMENT FOR KAPHAJA GULMA:

DASHAMULI GHRITA

BHALLATAKADYA GHRTA

KSHEERA SHATPALA GHRUTA

MISHRAKA SNEHA

PURGATION THERAPY

DANTI HARITAKI

RECIPE

The recipe of Nilini Ghrta which is prescribed for Sramsana (mild purgation) in the treatment of Vata –Gulma (wide verses 106-109) can also be used in double dose (2 Palas) for purgation in the treatment of Kapha- Gulma.

1 Karsa of the powder of Trivrt well impregnated with the milky latex of Sudha is given to this patient by mixing with honey and ghee for proper purgation. [152-153]

OTHER RECIPES

Effective recipes of Niruha basti(decoction enema) for the successful treatment of Kapha- Gulma will be described in the Siddhi section. Similarly, effective recipes of Arista (a type of alcoholic preparation) for the effective treatment of this ailment will be described in chapters dealing with the treatment of spore syndrome (Cikitsa 15) and piles (Cikitsa 14).

Powders and pills described in this chapter for the treatment of Kapha-Gulma provide Ksara (alkalies), Hingu – Asafoetida and Amala- Vetasae taken in double the prescribed quantity.

Recipes of Alkalies (Ksharas) prescribed for the treatment of sprue syndrome (in Cikitsa 15) is also effective and safe for the treatment of Kapha- Gulma. At the end Daha (cauterisation) therapy is useful in this condition. [161-163]

9

DIET FOR VATA GULMA

1) Old corns and cereals, meat of animals inhabiting arid land and birds, and soups of Kulattha and Mudga

2) Vegetable dishes prepared of Pippali, Nagara, Soup of dried Radish, Bilva, Varuna, tender( leaves) of Cirabilva, Yavani and Chitraka prepared by adding Beejapuraka, Hingu, Amlavestasa, Ksara, Dadima, Butter- milk , oil and Ghee;

3) Water boiled with Panca- Mula and

4) Old Varuni (a type of alcoholic drink) is taken by the patient at the appropriate time. After the digestion of food Madhvika (another type of alcoholic drink) is taken. [164-167]

DIGESTIVE STIMULANTS

Butter- milk sprinkled with the powder of Yavani and made saline by adding Lavana (rock- salt) is given to the patient to drink. This potion stimulates the power of digestion and helps in the downward movement of Vata, Kapha and urine. [168]

KAPHAJA GULMA

(SHEETA JVAR,ALPA VEDANA,KASA,ARUCHI)

1. ATI MANDAGNI TO LANGHAN KARE

2. VAMAN-TIKSNA KSHAR

3. AGNIKARMA

4. ASAV -ARISTA

#D#.RAKTAJA GULMA

10 MONTH NO TREATMENT

UTTER BASTI

Dashmula kvatha 30ml +

go mutra 10ml +

Yavakshar 250mg-->utter basti

WHOLESOME DIET AND HABITS

1. Purana shali (old rice)

2. Kulattha (horse gram)

3. Jangala mamsa (desert animals)

4. Kooshmanada (ash gourd)

5. Amalaki (goose berry)

6. Dadima (pomegranate)

7. Eranda taila (castor oil)

8. Ardraka (ginger)

9. Jiraka (cumin seeds)

10. Hingu (asa foetida)

11. Deepana (easily digestible, carminative food) etc

UNWHOLESOME FOOD AND HABITS

1. Guru ahara (heavy food)

2. Viruddha Ahara (incompatible food)

3. Vishama Ahara (improper food)

4. Shushka shaka (dry vegetable)

5. Shushka mamsa (dried meat)

6. Kanda moola (tubers and roots)

7. Matsya (fish)

8. Vegadharana (suppression of the urges) etc.

GULMAHARA KASHAYAS

A. DASAMOOLADI KASHAYAM

Ref – Sahasrayogam, Kashaya Prakaranam,

Dashamula (Ten roots)

Ginger (Zingiber officinale)

Devadaru (Cedrus Deodara)

The decoction prepared with these ingredients should be served fresh

uses-1. Gulma – abdominal tumors

B. CHITRAKADI KASHAYAM

Ref – Sahasrayogam, Kashaya Prakaranam,

Chitraka (Plumbago zeylanica)

Pippali mula (Roots of Piper longum)

Eranda (Ricinus communis)

Ginger (Zingiber officinale)

The decoction prepared with these ingredients should be served fresh

uses- 1. Gulma – abdominal tumors

C. VARSHABVADI KASHAYAM

Ref – Sahasrayogam, Kashaya Prakaranam,

Rakta Punarnava (Boerhavia diffusa, red variety )

Bilwa (Aegle Marmelos)

Horse gram (Dolichos biflorus )

Castor (Ricinus communis )

Sahachara (Strobilanthes heynianus)

Ginger (Zingiber officinale )

Agnimantha (Clerodendrum phlomidis )

The decoction prepared with these ingredients should be served fresh with jaggery, rock salt, Piper longum and asafetida

uses-1. Constipation 2. Indigestion 3. Severe pain in vagina 4. Pain in the cardiac region 5. Pain in flanks 6. Backache 7. Pelvic pain 8. Enlargement of prostate gland 9. Abdominal tumors 10. Enlargement of spleen

D. KANADI KASHAYAM

Ref – Sahasrayogam, Kashaya Prakaranam,

Pippali (Piper longum)

Shatahva (Anethum graveolens)

Dwi Karanja (Pongamia pinnata & Caesalpinia crista)

Devadaru (Cedrus deodara)

Bharangi (Cerodendron serratum)

Horse gram (Dolichos biflorus)

Sesame (Sesamum indicum / sesame )

Garlic (Allium sativum)

The decoction prepared with these ingredients should be served fresh with powder of asafetida

uses-1. Abdominal tumor caused by vitiated blood

RASODHI/BHASMA/PISTI-(120-250MG WITH MADHU/USHNODAKA)

- Gulmakuthar rasa-(parad,gandhak,hartal,tamra,tankan,yavkshar,trikatu)

- Badvanal rasa-(parad,gandhak,tamra,abhrak,tankan,samundri lavana,yavakshar,vatsanabh,palashkshar,apamarga)

- Agnikumar rasa-(parad,gandhak,tankan,vatsanabh,raka bhasma,karpada bhasma)

- Kravyadi rasa-(parad,gandhak,tamra,loha,panchkola,tankan)

- Rasayanamrit loha-(triphala,trikatu,trimada,trivrita,danti,saindhav,abhrak)

- Praval panchamrit-(praval,mukta,shankh,sukti,varatika)

- Panchanan ras-(rakt gulma)(parad,gandhak,tuthya,jaypal,pippali,amaltas)

- Pranballabha rasa-(loha,tamra,varat,tuthya,hingu,triphala)

- Sarveshver rasa-(svarna,tamra,triphala,trikatu,loha)

VATI-(250-500MG WITH USHNA JALA)

- Hingvadi vati-(hing,ajmoda,amlaveta,vrikshamla,pippali)

- Kankayan gutika-(kacura,pushkarmula,dantimula,chitrak,sonth,vacha,nisoth,hinga)

CURNA-(3-6GM WITH MADHU/USHNODAKA)

- Hingvadi curna-(hing,trikatu,patha,haubera,harad,ajmoda)

- Shatyadi curna-(kachra,pushkermula,hing,amlavet,yavkshar,dhaniya)

- Nagaradi curna-(south,krishna tila,guda)

- Vachadi curna-(vacha,harad,hinga,saindhav,yavkshar,ajwain)

- Yamanyadi curna-(ajvain,hing,saindhav,yavkshar,sauvarchal,harad)

- Lavangadi curna-(lavang,danti,trivrit,yamani,sunthi,kutaj beej)

KVATHA/ASAV/ARISTHA-(20-30ML WITH JALA)

- Til kvath-(sonf,karanjchal,devdaru,bharangi)

- Panchmul kwatha-(brihat panchmoola)

- Draksha-triphala kvath-(draksha,triphala,guda)

- Lehsuna ksheera-(lehsun,guda)

- Varunadi kvatha-(varun,agatsya,bilvachal,apamarga,chitrak)

- Kumaryasava-(kumari,chitrak,triphala,loha,tamra)

GHRITA/TAILA-(15-20ML WITH USNA JALA/MILK)

- Triyushnadhya ghrita-(trikatu,triphala,guda,goghrita)

- Hingusouvarchladhya ghrita-(hing,souchar namak,jeera,anardana,ajvain)

- Pippaliyadhya ghrita-(pippali,anardana,dhaniya)

- Drakshadhya ghrita-(amla,ikshu,goghrita,harad)

- Vasa ghrita-(adusha)

- Dashamuladi ghrita-(dashmula,pipper,sunthi,yavakshar)