Understanding the samprapti of gulma in Charak Nidan Sthana

Understanding the samprapti of gulma in Charak Nidan Sthana

1. Understanding the samprapti of Gulma in contemporary context Presented By: Dr. Priyanka Buragohain Guided By: Dr. Anup Baishya Department of Roga Nidan Govt. Ayurvedic College and Hospital,Jalukbari,Guwahati-14

2. 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 Ko ṣ tha ( mahasrotasa ) but having bahyamargaja and abhyantara margaja forms ( Ca.Su.11/ 48-1,Ca. Su. 11/ 49) )

3. 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-H ṛ daya,Nabhi,2 Parśva and Basti .

4. 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).

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).

6. 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

7. 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. 8/11 iÉÎ º¨ ÉxÉ ʽý nIÉÉv´É®v´ÉƺÉä näʽýxÉÉÆ xÉÉxÉÉÊnIÉÖ Ê´Ép´ÉiÉɨÉʦÉp´ÉhÉiÉ®hÉvÉÉ´ÉxÉ´ÉxÉ xÉÉtènæ½ýÊ´ÉIÉÉä¦ÉhÉè: {ÉÖ®É MÉÖ±¨ ÉÉäi { ÉÊkÉ ®¦ ÉÚiÉ ,

8. 1. Sa piṇditatvāt gulma iti abhidhiyate (Ca.Ni.3/7), 2.Sparśa-upalabhya paripiṇditatvāt gulmo (Ca.Ci.5/7), 3.Sampiṇdita dośo gudḍakena m ῑ yata 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 :

9. Gulma swarupa : Acharya Susruta, while defining the swarupa of gulma says--- “ A knotty lump in between h ṛ daya and basti either moving or stationary ,undergoing increase or decrease and round in shape is described as Gulma ..(su.u.42/4)” ¾ þiÉ ¤ ɺiªÉÉä®úxiÉ®äú OÉÎxlÉ & ºÉ\ SÉÉ®úÒ ª ÉÊnù ´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

10. SAMKHYA SAMPRAPTI: ACHARYA 1.CARAKA 5 V, P, K, Raktaja , and Niccaya gulma 2.SUSRUTA 5 V, P, K , R, Kshataja gulma 3.VAGBHATTA 8 V, P, K, R, S, and 3 Dvidosaja gulma 4.MADHAVA 5 V, P, K, R, and S 5.BHAVAPRAKASA 5 V, P, K, R, and S 6. SA Ṛ NGDHARA 8 V, P, K, R, S and 3 Dvidosaja gulma 6.BHELA 5 V, P, K, S and Lohita gulma 7.KASYAPA 5 V, P, K, R ,and S 8.HARITA 5 Sthananusara gulma bheda - TYPES NUMBER 1.Yak ṛ ta Gulma - H ṛṣ daypradeśastha 2. A ṣ thila —Kuk ṣ ipradeśastha 3. Granthi —Nbhiparadeśasth 4. Candavivrddhaka -Bastipradeśatha 4. Pliha Gulma - Udara Madhyavarti

11. 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 Pi ḍ ana - Vita- slesma - pitta ati-parisraavadva - vrdhe : paripidanadava Ca.Ci.5/4-5 All these factors aggravate Vayu in the kostha either directly on indirectly.

12. 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 GULMA The 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

13. Contd.VISISTHA HETU: VATAJA GULMA………… Manashika hetu shoka Anya hetu Asneha purve va vamana-virechane pibati Udirnana vata - mutra - purisha -vegan- nirunaddhi Abhighata Atimala-kshaya These factors mentioned above produce vatika gulma even in people having non vatik type of prakriti . Ch. Ni. 3/6

14. 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 individual emaciated either due to jwara , vamana , virechana or atisara

15. 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 - udakapanat Viharaja hetu : Sandharanad Sanshobha Diva swapna The following factors aggravate kapha along with vata in an individual emaciated either due to jwara , vamana , virechana or atisara

16. 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

17. Contd. Purvarupa ...... Udgara bahulya Purishabandha Triptakshamatwa Antravikujana Atopa Adhmana Apakti shakti A. H. Ni. 11/63

18. SAMANYA SAMPRAPTI OF GULMA : Eò¡Æò SÉ Ê{ ÉkÉÆ SÉ ºÉ nÖù¹] õ´ÉɪÉÖ¯ûrÚùªÉ ¨ ÉÉMÉÉxÉ ʴÉÊxɤÉnÂùvªÉ iÉÉ ¦ªÉɨÉ* ¾þzÉÉʦÉ{ ÉÉ·ÉÉènù®ú¤ÉκiɶÉÚ±ÉÆ Eò®úÉäiªÉvÉÉä ª ÉÉÊiÉ 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 xÉÉ¨É ** ( 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

19. 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

20. 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

21. 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

22. 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 º ÉƦɴÉÊiÉ MÉÖ±¨É— ( C. Ni. 3/16)   º É´ÉÉÇi¨ÉEú : º É´ÉÇÊ´ÉEúÉ ®ª ÉÖHú : º ÉÉä %º ÉÉvªÉ = 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)

23. GULMA LAKSANA : VATAJ GUKMA LAKSANA CARAKA - º lÉÉxɺÉƺlÉÉxÉ ¯ ûVÉÉ Ê´ÉEò ±{ÉÆ - Ê´ÉbÂ÷´ÉÉiɺÉÆMÉ -MɱɴÉGò¶ÉÉä¹É¨É -¶ª ÉÉ´ÉɯûhÉi´ÉÆ - ʶÉʶɮúV´É®ú¨É - Eò®úÉäÊiÉ VÉÒhÉæ %¦ª ÉÉÊvÉEÆò | 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 , ´ª ÉvÉ & º ÉÚSªÉä´É Ê´É] õºÉRÂóMÉ EÞòSUôÉänÖùSUô´ÉºÉxÉ ¨ÉÖ½Öþ º iÉ ¨¦ ÉÉä MÉÉjÉä ¨ÉÖJɶÉÉä¹É& , EòÉ ¶ªÉÇ 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 . 42/10 Ch. Chi. 5/7-8 A. H.Ni . 11/41-43

24. CARAKA SUSRUTA º´ Éänù V´É®ú +ɽþÉ®ú Ê´Énùɽþ iÉÞ¹hÉÉ + RÂóMÉ®úÉMÉ Eò ] Öõ´ÉEòjÉiÉÉ Ê{ ÉiÉ ºªÉ ˱ÉMÉÉÊxÉ + ÊJɱÉÉÊxÉ ª ÉÉÊxÉ Ê{ ÉiÉÉi¨ÉEäò ASTANGA HRDAYA nùɽþÉä +¨± ÉEòÉä ¨ ÉÚSUôÉÇ Ê´Éb ÷¦ Éänù º´ Éän ù iÉÞ¹hÉÉ V´É®ú ½þÉÊ®úpùi´ÉÆ i´ÉMÉtä¹ÉÖ MÉÖ±¨É¶SÉ º{ɶÉÇxÉɺɽþ & nÚùªÉiÉä nùÒ {ª ÉiÉä 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 - µ ÉhÉ´ÉkSÉ MÉÖ±¨É& º{ɶÉÉǺɽþ Ch.Chi . 5/10 Su. Utt . 42/11 A. H. Ni. 11/44-45

25. CARAKA º iÉèʨÉiªÉ ¶ ÉÒiÉV´É®ú MÉÉjɺÉÉnù EòÉºÉ +¯ ûÊSÉ MÉÉä®ú´É ¶ ÉèiªÉÆ ¯ ûMÉ ±{ÉÉ EòÊ`öxÉÉäzÉi´ÉÆ SUSRUTA ASTANGA HRDAYA º iÉèʨÉiªÉ + zÉ +¯ ûÊSÉ + ÆMɺÉÉnù UôÌnù | ɺÉäEò ¨ ÉvÉÖ®úÉ ºª ÉiÉÉ Eò¡ò ºªÉ ʱÉMÉÉÆÊxÉ + ÊJɱÉÉÊxÉ º iÉèʨÉiªÉ +´ ÉMÉÉg MÉÖ±¨É +¯ ûÊSÉ EòÊ`öxÉ MÉÖ±¨É º ÉnùxÉ MÉÖ¯û MÉÖ±¨É ʶÉʶɮúV´É®ú ºÉÖ{ iÉ { ÉÒxÉºÉ ÎºlÉ ® ºÉɱɺªÉ +±{ ɯûEò ¾þ±±ÉÉºÉ EòÉºÉ ¶ ÉÖC±Éi´ÉMÉÉÊnùiÉÉ KAPHAJA GULMA LAKSANA Ch. Chi. 5/11 Su. Utt . 42/12 A.Hi . 11/46

26. SANNIPATAJ GULMA LAKSANA CARAKA ¨É½þɯûVÉÆ nùɽþ{ É®úÒiÉ¨É +¶¨ É´ÉnùPÉxÉÉäzÉiÉÆ ¶ÉÒQÉÊ´ÉnùÉäʽþ , nùɯûhÉ¨É ¨ ÉxÉ & ¶ É®úÒ®úÎMxɤɱÉÉ {ɽþÊ®úhÉÆ asadhya ASTANGA HRDAYA SUSRUTA iÉҵɯûEò-nùɽ þ ¶ÉÒQÉ{ ÉÉEòÒ ù PÉxÉÉäzÉiÉÆ asadhya Sarvatmak : Sarvavikara - yukta : asadhya Ch.Chi . 5/14 Su.Utt . 42/13 A. Hi. 11/48

27. RAKTA GULMA By the rakta gulma here ,we should consider only the ARTAVA Gulma,That’s why caraka says ¶ ÉÉäÊhÉiÉMÉÖ ±¨ ɺiÉÖ 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 males Because 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 )

28. RAKTAJ GULMA SAMPRȦPTI: ºÉ | ÉEÖòÊ { ÉiÉÉä ª ÉÉäÊxɨÉÖJɨÉxÉÖ|ÉÊ´É ¶ª ÉÉ iÉǴɨÉÖ { ɯûhÉÊrùú ¨ÉÉ漃 ¨ÉÉ漃 iÉnùÉiÉǴɨÉÖ { ɯûrùªÉ¨ÉÉxÉÆ EÖòÊIɨÉʦɴÉvÉǪÉÊiÉ * ( Ca.Ni.3/14 ) xÉ´É|ɺÉÚiÉÉ%ʽþiɦÉÉäVÉxÉÉ ªÉÉ ªÉÉ SÉɨÉMɦÉÇ Ê´ÉºÉÞVÉäoùjÉÉè ´ÉÉ* ´ÉɪÉÖ̽þ iÉ ºªÉÉ& { ÉÊ®úMÉÞÁ ® úHÆò Eò®úÉäÊiÉ MÉÖ±¨ÉÆ º ɯûVÉÆ ºÉnùɽþ¨É ** ( Su. Utt . 42/14 ) @ñiÉÉ´ÉxÉɽþÉ®úiɪÉÉ ¦ ɪÉäxÉ Ê´É¯ûIÉhÉè´ÉæMÉÊ´ÉÊxÉOɽèþ¶SÉ* º ÉƺiÉ ¨¦ ÉxÉÉä ±±ÉäJÉxɪÉÉäÊxÉnùÉä¹ÉèOÉÖ±¨É& κjɪÉÆ ® úHò¦É´ÉÉä %¦¨ÉÖ{ ÉèÊiÉ ** ªÉ& º{ ÉxnùiÉä Ê{ ÉÎhb÷iÉ B´É xÉÉRÂóMÉèζSÉ®úÉiÉ ºÉ¶ÉÚ±É& º ɨÉMɦÉÇʱÉRÂóMÉ &* ºÉ ® úÉèÊvÉ®ú & º jÉÒ¦É´É B´É MÉÖ±¨ ÉÉä ¨ ÉɺÉä ´ª ÉiÉÒiÉä nù¶É¨Éä ÊSÉÊEòi ºªÉ&* ( C. Ci . 5/18-19 )

29. 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, indigestion Pregnancy related- breast changes, increase in size of uterus,delayed quivering with pain and movement like a solid mass, Dohrda,appearance of lnea nigra Reproductive 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 food during menstruation -Suppression of natural Urges - fear Other hetu —improper use of stambhaka , vamana , Having yoni roga . Rakta gulma samprapti contd …..

30. Ama - pakwa gulma          MÉÖ¯þ : EúÊ`xɺÉƺlÉÉxÉÉä MÉÚf¨ÉÉƺÉÉxiÉ®É¸ÉªÉ : * + 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 VÉÉxÉÒªÉÉ ±¨ÉÆ iɨÉÖ {ÉxÉɽýªÉäiÉ ** Ch. Chi. 5/41         Ê´Énɽý™IÉhÉä MÉÖ±¨ Éä ¤ÉʽýºiÉÖƒäû º ɨÉÖzÉiÉä *         ¶ª ÉÉ´Éä º É®Hú { ɪÉÇxiÉä ºÉƺ{ ɶÉæ ¤ ÉκiɺÉÆÊxɦÉä **         ÊxÉ { ÉÒÊbiÉÉäzÉiÉä º iɤvÉä º ÉÖ”Éä iÉi {ÉÉ·ÉÇ{ ÉÒbxÉÉiÉ *      iÉjÉè´É Ê{ ÉÎhbiÉä ¶ ÉÚ™äü ºÉÆ{ ÉFÆú MÉÖ±¨ ɨÉÉÊn¶ÉäiÉ **         iÉjÉ vÉÉx´ÉxiɮҪÉÉhÉɨÉÊvÉEúÉ ®: ÊGúªÉÉÊ´ÉvÉÉè *        ´ ÉètÉxÉÉÆ EÞúiɪÉÉäMªÉÉxÉÉÆ ´ª ÉvɶÉÉävÉxÉ®Éä { ÉhÉä ** Ch. Chi. 5/42-44

31. Bahya-Abhyantara gulma + xiɦÉÉÇMÉ ºªÉ SÉÉ{ª ÉäiÉiÉ { ÉSªÉ¨ÉÉxÉ ºªÉ ™ IÉhɨÉ *     ¾ýiGúÉäb¶ÉÚxÉiÉÉ%xiÉ:º lÉä ¤Éʽý:º lÉä { 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

32. Asadhya lakshan of gulma : º ÉÆÊSÉiÉ : Gú¨É¶ÉÉä MÉÖ±¨ ÉÉä ¨É½ýÉ´ÉɺiÉÖ{ÉÊ®Oɽý: *    EÞúiɨÉÚ™ü : ʺɮÉxÉrÉä ª ÉnÉ EÚú¨ÉÇ <´ ÉÉäzÉiÉ : ** nÉè¤ÉÇ ±ªÉɯþÊSɾýšüɺÉEúɺɴɨª É®ÊiÉV´É®è : *   iÉÞ¹hÉÉiÉxpÉ|ÉÊiɶª ÉɪÉèªÉÖÇVªÉiÉä xÉ ºÉ ʺÉvªÉÊiÉ ** MÉÞ½ýÒi´ÉÉ ºÉV´É®·ÉɺÉÆ ´É¨ª ÉiÉÒºÉÉ ®{ ÉÒÊbiɨÉ     ¾ýzÉÉʦɽýºiÉ{ÉÉnä¹ÉÖ ¶ ÉÉä¡ú : Eú¹ÉÇÊiÉ MÉÖα¨ ÉxɨÉ ** Ch. Chi. 5/169- 171   ·ÉÉºÉ ¶ ÉÚ™üÊ {É{ÉɺÉÉ%zÉÊ´Éuäü¹ÉOÉÎxlɨÉÚfiÉÉ: **     ¦ É´ÉÎxiÉ nÖ¤ÉÇ™üi´ÉÆ SÉ  MÉÖα¨ ÉxÉÉä ¨ÉÞiªÉÖ¨É乪ÉiÉ: ** Su. Su. 33/21

33. 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

34. 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

35. 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

36. Differential diagnosis of various gulma VATAJA PITTAJA KAPHAJA SANNIPATAJA RAKTAJA 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

37. 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

38. Both gulma and abhyantara vidrdhi occurs in kostha,both are 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

39. 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)

40. 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 ) NEAREST MODERN TUMOUR ABSCESS ABDOMINAL CORRELATION LUMP

41. hrid nabhi basti parswa parswa parswa parswa parswa parswa Acc to Ayurveda nine division of Abdomen

42. 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.

43. Vatik gulma Lumps due to intestinal tuberculosis chronic intussusception umbilical or epigastric hernia appendicular lump(without inflammation) phantom tumor

44. Paittik gulma Lumps due to regional ileitis Appendicular abscess Psoas abscess Empyema of gall bladder Hepatic abscess Cholecystitis

45. Psoas abscess cholecystitis

46. 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.

47. Hydatid cyst

48. RAKTAJA GULMA- taking into account etiopathogenesis and clinical features of 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 all the features of early months of pregnancy,followed by P/V Bleeding . Due to association of infection fever,cough and foul smelling vaginal discharges 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 cardinal symptom as amenorrhoea in association with fever,diarrhoea,colic,cough and dyspnoe etc. can be considered under rakta gulma .

49. 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. Causes Congenital 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

50. PSUEDOPREGNANCY- --A condition in which a patient has nearly all of the usual signs and symptoms of pregnancy,such as enlargement of 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 with Menorrhagia rather than Amenorrhoea.Moreover , these are made up of muscle fibres wth fibrous tissues not of blood.

51. 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 ?

52. 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 ?

53. P hantom 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.

54. . WHAT CAUSES AN ABDOMINAL MASS? Abdominal masses can be the result of a number of factors, including an injury, cyst, tumor, cancer, or disease. Cysts A 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 ovaries Cholecystitis - 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 Cancer Cancers that often cause abdominal masses are: Colon cancer Kidney cancer Liver cancer Stomach cancer

55. Diseases Certain 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 Conditions Other 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 legs Pancreatic abscess - a pus-filled hollow in the pancreas Diverticulitis - 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 spots Hydronephrosis - enlarged kidney due to the backup of urine Enlarged liver Enlarged spleen

56. 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 gain Pain Inability to urinate Abdominal discomfort Inability to pass stool Nausea Feeling full Vomiting Fever Abdominal masses may be hard, soft, stable, or moveable.

57. 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).

58. 3.An Imaging Test –to determine the size and location. Also determine the type of mass.Commonly used imaging Tests are: Abdominal Computed Axial Tomography (CAT) Scan Abdominal X-ray Adominal Ultrasound When 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.

59. 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

60. 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.

61. 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.

62. CONCLUSION Gulma is a very unique disease in Ayurveda,which is a vatapradhana kosthagata roga , signifying a group of diseases with 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,signs and symtomps and Upasaya .

63. 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 into a 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 gulma caused by 2 dosas dhould be treated by sadharana cikitsa . The serious upadrava should be attempted first immediately Than 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.

64. 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