In the condition, fever, thirst, redness of the face, pain, sweating, burning and tenderness are complained by the patients.

1

NIDANA

1. Katu, amla, tikshna, ushna, vidahi anna sevana: Intake of pungent, sour, sharp, hot, Vidahi (which cause acidity or burning sensation in the stomach) and dry articles of diet.

2. Krodha – anger

3. Ama abhighata: Affliction by Ama (Product of improper digestion and metabolism) and

4. Madya sevana: Excessive intake of alcohol and exposure to sun as well as fire.

5. Rudhira dushtam: Vitiation of blood.

2

LAKSHANA

1. Jwara and pipasa: Fever and excessive thirst

2. Anga raga: Redness of face and limbs

3. Shulam mahat jeeryate bhojanam: Excruciating pain during digestion of food

4. Sveda and vidaha: Sweating and burning sensation,

5. Vrana vaccha gulma: Tenderness of the affected part as if it is wounded.

3

PRICIPAL OF CHIKITSA

If Paitika Gulma is caused by unctuous and hot things, then administration of Sramsana is useful. (mild – moderate laxative).

If it is caused by dry and hot things, then administration of ghee is best.

If Pitta or Paittika Gulma gets lodged in Pakvasaya (colon), then keeping in view the appropriateness of time, patient should immediately be given Tikta Ksheera basti. (enema by milk processed with bitter herbs).

Alternatively, the patient can be given Virechana treatment with milk, warm milk processed with bitter herbs or with Tilvaka ghrita depending upon his digestive power and strength [33-35]

UTILITY OF BLOOD LETTING:

If a patient of Gulma is associated with

Trushna – morbid thirst

Jvara – fever

Paridaha – excessive burning sensation

Shula – colic pain, Sweda – sweating

Agni mardava – suppression of the power of digestion and

Aruchi – anorexia, then this is treated by blood-letting.

In Gulma, blood gets vitiated and becomes sour. By blood- letting, this does not happen and the patient remains free from pain [36-37]

REMOVAL OF RESIDUAL DOSHAS:

After removal of vitiated blood, the patient becomes emaciated. He is given Jangala mamsarasa – soup of meat of animals of arid land. He is consoled, and for relieving the residual pain, he is regularly given ghee again. [38]

SURGERY:

If Rakta and Pitta are aggravated in excess in a patient suffering from Gulma, and if blood letting therapy is not administered, then Gulma may get suppurated. To cure this ailment surgery has to be performed [39]

APAKVA OR UNSUPPURATED GULMA

Following signs and symptoms indicate that the Gulma has not undergone suppuration:

1. Guru Kathina: Heaviness and hardness

2. Gudha mamsa antarashaya: Located deep inside the muscle tissue

3. Avivarna: No change in the colour of the skin and

4. Sthira: Remaining firmly fixed and elevated

PACHYAMANA GULMA

SIGNS AND SYMPTOMS OCCUR WHEN THE GULMA IS IN THE PROCESS OF SUPPURATION:

Daha: Burning sensation

Shoola: colic pain

Arti: sawing pain

Sankshoba: irritation,

Swapna nasha – insomnia,

disliking for everything and

Jwara – fever.

Treatment: Upanaha – Poultice, hot ointment is applied over it [41]

PAKVAGULMA LAKSHANA, CHIKITSA

SUPPURATION OF GULMA IS CHARACTERIZED BY:

Vidaha – sloughing

Bahih tunge: outward protrusion

Unnata- elevation

Syava rakta – Grayish colour with a red margin

A feeling as if touching a bladder full of water. It comes back to original position after pressing.

Localisation in a round form

Supti – numbness and

Parshwapeedana – pain in the sides of Gulma – Tumours of the abdomen

Treatment of this condition is done by surgeons (Dhanvantanra school) who are well versed in the art of puncturing, purification and pressing through its sides.

When the Gulma is located in the Antar bhaga (interior of the body), the same signs and symptoms of Pachyamana Gulma are manifested. There will be swelling in the cardiac region (Hrutkroda) and in case of Gulma located in the exterior of the body there will be protuberance towards the sides of the abdomen [42-45]

SVAYAMPRAVRUTTA GULMA

MANAGEMENT OF SVAYAMPRAVRUTTA GULMA: (MOBILE)

At times, the suppurated Gulma, having softened the passage moves upwards or downwards. Like this, if the Doshas are in the process of elimination on their own (Svayampravrutta) then the physician should ignore it and should only pay attention to prevent any complication for 10 – 12 days. Thereafter, the patient should take ghee for the elimination of Doshas. When the body is purified (made free from morbid Doshas) the patient is given ghee boiled with bitter drugs by adding honey [46-47]

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

PITTA GULMA AYURVEDIC MEDICINES

MEDICINES FOR PITTAJA GULMA CHIKITSA:

TRAYAMANADI GHURTA

AMALAKADI GHRTA

DRAKSHADYA GHRITA

VASA GHRUTHA

TRAYAMANA KSHEERA YOGA

RECIPES FOR PURGATION

For purgation, the patient suffering from Paittika Gulma should take the juice or decoction of Draksha – Raisin – Vitis vinifera and Abhaya – Terminalia chebula mixed with jaggery.

He may also take Kampillaka in the form of linctus by mixing it with honey. [130]

MASSAGE THERAPY

Burning sensation in a patient of pittaja Gulma can be alleviated by using ghee or Chandanadya Taila – Sesame (Sesamum indicum) or Madhuka– Licorice – Glycyrrhiza glabra Taila for massage [131]

MEDICATED ENEMA

Recipes of Ksira- basti (medicated enema made of milk and other drugs)prepared by boiling milk with bitter drugs, which alleviate Pitta- Jwara, are also useful for Pitta- Gulma. Such recipes are also described in Siddhi Sthana. [132]

9

DIET FOR VATA GULMA

Different types of Shali rice, meat of animals inhabiting arid land, cow milk, goat milk, ghee Kharjura – Dates – Phoenix dactylifera , amalaka, draksha, Dadima – Pomegranate – Punica granatum and Parusaka these is given as diet to the patient suffering from Pitta Gulma. To such patients, water boiled with Bala – Country mallow (root) – Sida cordifolia, Vidarigandha etc, is given for drinking [134]

STIMULATION OF DIGESTIVE POWER

After administration of fasting therapy in Pittaja Gulma, Vataja Gulma or Kaphaja Gulma, when these are associated with Ama, the patient is given Yavagu (gruel), Khada and Yusha (soup) for stimulating his powder of digestion. [135]

IMPORTANCE OF AGNI

Alleviation and aggravation of all Doshas is dependent upon Agni (power of digestion and metabolism). Therefore, it is always necessary to maintain Agni and to avoid factors responsible for the vitiation of Agni. [136]

PATTIK GULMA

(JWAR,PIPASA,SARIR KA LAL HONA,BHOJAN PARIPAK PE ATI VEDANA)

SANSODHANA

1.SNEHAPANA-Triphala ghrita

2.Bahya snehan-svedan(sos)

3.MRIDU VIRECHANA KALP

Nisoth 20 gm +

Choti harad 20gm +

Amaltash 20gm-->kada + castor oil 40ml-->mridu virechana

4.KSHEER BASTI

A. Anuvasana-Narayan taila-30ml (JARURI NHI H)

B. KSHEER BASTI-

Panchtikta dravya-->400ml kada + 200ml dugdha -->pakaye->200 bachne pe thanda karke add Satavari ghrita/triphala ghrita 50ml + madhu 50ml --> basti

(fir bhi thik na ho to raktmokshan karaye

RAKTMOKSHAN-same side hand se)

***Mamsa rasa & brihman peya prayoga.

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)