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Journal of Natural & Ayurvedic Medicine Research Article 8 min read

Gulma Roga

Puri B*
* Corresponding author
ISSN: 2578-4986  10.23880/jonam-16000400  Received: April 03, 2023  Published: June 05, 2023
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Keywords
Gulma Abdominal Lump Charaka Samhita Rakta Gulma Pregnancy
Abstract

Gulma is diseases entity which is caused due to aggravation and encapsulation of Vata Dosha (Kupita Anila Moodhatwa), which does not give clue about its site of origin (Goodha Gulmodhaya) which spreads widely like shrubs (Gulmavat Vishaltwat). It covers various gastro-intestinal and gynecological diseases, but its diagnosis becomes difficult, due to its complex clinical presentation. Hence, it's essential to understand gulma in a comprehensive way for accurate and easy diagnosis. gulma is Vata pradhana Udara Vikara, any type of gulma cannot deny without vayu. It is merely compared with abdominal lump with different names like Cysts, Tumours, Herniation, Fibroid, Inflammed condition, Abscess etc. Any type of pain with palpable mass which occur in any quadrant of abdomen may create a suspicion of gulma. Various types mentioned by Various Acharyas (Vataj, Pittaja Kaphaja, Sannipataja &Raktaja). Here, Rakta gulma is mentioned by some Acharyas which is a diseases having accumulation of only blood within the uterus, in the women of active reproductive age, having normal menstruation. In this article Nidana, Purvarupa, Lakshen, Samprapti, Sites, Types, Stages and Management of gulma has been reviewed along with gulma nashaka yogas.

Introduction

Gulma has been named based on its akriti (shape). It is characterized by pain as most important symtom and palpable lump as most important sign. It is merely being compared with abdominal lump or uterine fibroid, but that’s neither accurate nor sufficient. The meaning of word “Gulma” is a cluster clump of trees, bush or shrubs [1]. The word is found in various ancient Indian texts, denoting the same meaning [2]. In Ayurveda gulma is Vata pradhan Udara Vikara. It manifests only in five sthan Hridaya, Nabhi Vasti and two Parshwa [3]. The nomenclature of the diseases itself indicates the Avritta Vata (Covered or Obstructed movement/ functioning of Vata) is its root from which several branches in form of various diseases arise [4]. That’s why comprehensive knowledge of form, location and features of the diseases is inevitable for correct diagnosis and treatment. Gulma is a single name representing a collection of many medical and surgical condition which occur in intra- abdominal organ. Any type of pain with palpable which occur in any quadrant of abdomen may create a suspicion of gulma.

Methodology

Classicall texts of Ayurveda, especially Charaka Samhita, Sushruta Samhita were studied along with Sanskrit commentaries to collect relevant references. A thorough search was made on Google, PubMed, Research Gate. Also various textbooks and published powerpoint presen-tation were checked to fetch important points.

Result

Nidan (Etiology): Vayu gets vitiated in belly due to excessive discharge of faeces, kapha & pitta compression because of their excessive accumulation or suppression of impelled downward urges or external injury or excessive pressure or excessive intake of food and drinks or grief or uneven and excessive movement [5].

Purvarupa (Prodromal Symptoms)

Excessive belching, Constipation, Fullness of abdomen, Inability to work, Gargling sound of abdomen, Flatulence, Tympanitis, Indigestion, Weakness are prodromal symptom [6].

Lakshana (Sign and Symptoms)

Location, signs and symptoms, pattern and timing of pain vary in accordance of the dominant Dosha Common symptoms are Variable abdominal lump, Anorexia, Obstruction of urine, faeces and flatus, Excessive belching [7].

Samprapti (Etiopathogenesis)

Due to above described Nidana Vayu gets vitiated thus vayu aggravates Kapha and pitta and obstruting the passage through them producing pain in Cardiac region, Navel sides, abdomen, and pelvis and does not move downwards due to blocking of passage, thus located in pakwasaya (Colon), and Pittashaya or Kaphashaya, independent or dependent known by palpation acquires the name of gulma (Lump) due to its lumpy nature according to Dosha [7].

Difference in Pathogenesis Mentioned in Nidan And Chikitsa Sthan of Charaka Samhita

In Nidan Sthan, only elevation and provocation of Vata have been emphasized. Here, provoked subtype of Vata itself causes Avarana of another Irritant subtype of Vata. While in Chikitsa Sthan, Avarana of Vata is indicated by Pureesha (Faeces), Mootra (Urine), Kapha, Pitta and Aama (Incompletely Metabolized entities) too [8]. In accordance of same the etiological factors mentioned in both sthana also differ [9].

Types of Gulma

According to Aacharya Charaka [9], Sushruta [10] and Madhukoshakara five types of Gulma have been mentioned: Viz. Vataja, Pittaja, Kaphaja, Raktaja, and Nichaya (Gulma caused by all the three bodily humours). Nichaya Gulma has been termed as “Nichaya” instead of Sannipata to illustrate its incurable nature [11]. As per Aacharya Vagbhata “Antargulma” and “Vahyagulma” is also explained. As per Astanga Sangraha and Astanga Hridayakar “Dwandajan Gulma” (Gulma caused by two provoked Humours) have also been explained. As per Madhav Nidana [12] and Ayurveda Deepika [13] another type of Raktaja Gulma mentioned in males, which is caused by vitiation of Rakta Dhatu intead of Artava (Menstrual fluid).

Vatika Gulma

Causes [14]: Rough foods and drinks, Uneven and excessive Activities Suppression of Urges Injury Excessive loss of Excretion Fasting Symptoms: Obstruction in Faeces and Flatus Dryness in throat and mouth Blackish and Reddish Complexion Fever with Shivering Pain in Heart, Abdomen Aggravates in empty stomach and becomes mild on taking food.

Paittika Gulma

Causes [14]: Excessive intake of Pungent, Sour hot, Burning, Rough Substances Aama Dosha Impure blood Anger Injury Irritant Symptoms: Fever, Thirst Reddishness of face and body, Pain Aggravates during digestion Burning tenderness as in abscess Sweating

Kaphaja Gulma

Causes [14]: Cold, Heavy, Unctuous food Lack of movement Excessive sleep in day Symptoms: Feeling of weakness Nausea, Cough, Anorexia Hardness with elevation Cold fever Malaise

Dwidosaja

Fever, Roughening Suppression of Urges Other uterine Disorders Astringents Symptoms: Pulsates only as a lump not with limbs Has symptom similar to that of Pregnancy Caused by Menstrual fluid Occuring only in female.

  • When the etiology and Symptoms of two Dosaja are found (Caused by two dosas)
  • Sannipataja
  • Three Gulma having mixed symptoms
  • SYMPTOMS [15]:
  • Intense pain
  • Burning, Stony hard and elevated
  • Severe which takes away the strength of mind
  • Incurable
  • Rakataja Gulma
  • CAUSES [15]: Fasting during period of menses,
  • Raktagulma
  • Pregnancy
  • Gulma quivers just like a solid mass or muller, below umbilicus in restricted way sometimes it does not quiver.
  • Quickening in pregnancy is in free manner, relatively more and fetus quivers with different body parts
  • Quivering is delayed and is associated with pain
  • Quivering starts earlier, and is without pain
  • Only gulma increase in size not the Kuksi (Uterus)
  • Corresponding to the development of fetus Kuksi also develops.
  • Glands appear over the abdomen and blue spots in between breasts and around umbilicus.
  • No such sign in Pregnancy
  • Growth of Gulma is very slow and does not follow a definite sequences
  • Fetus grows comparatively earlier and follows a definite pattern of development according to gestational months.

Table 1: Difference between Raktagulma and Pregnancy [16].

S.NO.SthanaBody PartsDosa
1VastiUrinary bladder, AbdomenVata
2NabhiPara-umbilical regionPitta
3HridayaCardiac regionKapha
4,5ParshwaLatral of;
i. Vasti parshwaUterus, Inguinal canalVata, Rakta
ii. Nabhi parshwaLarge intestineVata Pitta
iii.Hridaya ParshwaLungs, Liver, SpleenVata, Pitta, Kapha & Rakta
  • When the etiology and Symptoms of two Dosaja are found (Caused by two dosas)
  • Sannipataja
  • Three Gulma having mixed symptoms
  • SYMPTOMS [15]:
  • Intense pain
  • Burning, Stony hard and elevated
  • Severe which takes away the strength of mind
  • Incurable
  • Rakataja Gulma
  • CAUSES [15]: Fasting during period of menses,
  • Raktagulma
  • Pregnancy
  • Gulma quivers just like a solid mass or muller, below umbilicus in restricted way sometimes it does not quiver.
  • Quickening in pregnancy is in free manner, relatively more and fetus quivers with different body parts
  • Quivering is delayed and is associated with pain
  • Quivering starts earlier, and is without pain
  • Only gulma increase in size not the Kuksi (Uterus)
  • Corresponding to the development of fetus Kuksi also develops.
  • Glands appear over the abdomen and blue spots in between breasts and around umbilicus.
  • No such sign in Pregnancy
  • Growth of Gulma is very slow and does not follow a definite sequences
  • Fetus grows comparatively earlier and follows a definite pattern of development according to gestational months.

Table 1: Difference between Raktagulma and Pregnancy [16].

Stages of Gulma

1. Immature (Recent Onset Tumour) Tumours are Heavy, Hard Situated beneath the muscles. without changes of colour and fixed firmly.

2. Maturing Tumours The tumours are burning, Painful, Causing agony, Loss of sleep, Irritation and fever

3. Matured (Suppurated) Gaseous Tumours) The tumours are burning, bluish red in colour Palpable like bladder and severe painful in nature.

Prognosis of Gulma

Gulma associated with features of breathlessness abdominal pain, Thirst, Anorexia, Body ache, debility and Stiffness are critical, likewise the tumour with features of all the three Doshas is incurable [17].

Management of Gulma

All measures are undertaken to control Vata To achieve following measure are applied: Asthapana Basti (Decoction enema) Snehana (Oleation) Swedana (Sudation) Mild purgation

For Vataj Gulma

Unction Fomentation Ghrita Enema Powders, Pills Emesis Purgation & Blood letting [18]

For Pittaja Gulma

Ghee cooked with bitters Non unctuous enema Pacificatory, Poultice Surgical operation of mature and internally burst one Other Evacuative and alleviative measures [18]

For Kaphaja Gulma

Unction, Fomentation Incision, Lightening Emesis, Purgation, Ghrita Arista, Alkali At last Cauterization after blood letting [19]

For Raktaja Gulma

It should be treated after ten months is passed. After the time of labour has elapsed, Oleation, Sudation Followed by unctuous Laxative should be prescribed [17]. Should be treated just like Pittaja Gulma Oleation with Kakolyadi Ghrita followed by Laxation and Niruha basti made with Madhura Drugs [20]. To Avoid Suppuration, Oleation followed Venesection of cubital vein should adopt. To Remove left over Dosas, Samsaman (Suppressive) treatment should be given.

Vataj Gulma Nashaka Yoga

Trayushaadi Ghrita Hingusauvarchalaadi Ghrita Satphala Ghrita Pippalyadi Ghrita Nilini Ghrita [21]

Pittaja Gulma Nashaka Yoga

Rohiniyaadhi Ghrita Trayamanadi Ghrita Aamalakadi Ghrita Drakshadi Ghrita Vasadi Ghrita [22]

Kaphaja Gulma Nashaka Yoga

Nilini Ghrita Dashmuli Ghrita Bhallatakadi Ghrita Kshirshatphalaka Ghrita [15]

Raktaja Gulma Nashaka Yoga

Jivaniya Groups of Drugs Pippalyadi Ghrita Treatment is aimed to: Cure Amenorrhea Loosen Gulma Expel the Gulma [19]

Discussion

In this article, definition of Gulma, Nidan, Purvarup lakshen, Samprapti Classification, Sites of Gulma and Its Managemets with Yogas have been reviewed along with difference of Raktagulma and Pregnancy.

References

  1. Williams M, Leumann E, Cappeller C (1997) The digital Monier-Williams Sanskrit-English dictionary. In: Malten T (Ed.), 1st (Edn.) Cologne: Cologne Digital Sanskrit Lexicon. The Sanskrit Library, Köln Universität, Köln, Germany.
  2. Dalhanacarya (2019) Sushruta Gulmaroga pratished. In: Thakral K (Ed.) Sushruta Samhita with Nibandhasamgraha Commented by Dalhana. 1st (Edn.) Varanasi Chaukhamba Orientalia, India, pp: 357.
  3. Dalhanacarya (2019) Sushruta Gulmaroga pratished. In: Thakral K (Ed.) Sushruta Samhita with Nibandhasamgraha Commented by Dalhana. 1st (Edn.) Varanasi Chaukhamba Orientalia, India, 358.
  4. Dalhanacarya (2003) Sushruta Gulmaroga pratished. In: Thakral K (Ed.) Sushruta Samhita with Nibandhasamgraha Commented by Dalhana. 1st (Edn.) Varanasi Chaukhamba Surbharati publication, India, pp: 717.
  5. Agnivesha (1998) Gulmachikitsa. In: Sharma VPV (Ed.) Charaka Samhita Elaborated by Charaka and Dridhbala. 4th (Edn.) Chaukhamba Orientalia, India, pp: 98.
  6. Trikamji VAJ (2013) Agnivesha Gulma Nidana. In: Trikamji VAJ (Ed.) Charaka Samhita elaborated by Charaka and Dridhbala. 1st (Edn.) Chaukhamba publication, Varanasi, India, pp: 211.
  7. Agnivesha (2013) Agnivesha Gulma Nidana. In: Trikamji VAJ (Ed.) Charaka Samhita elaborated by Charaka and Dridhbala. 1st (Edn.) Chaukhamba publication, Varanasi, India, pp: 436.
  8. Agnivesha (2013) Agnivesha Gulma Nidana. In: Trikamji VAJ (Ed.) Charaka Samhita elaborated by Charaka and Dridhbala. 1st (Edn.) Chaukhamba publication, Varanasi, India, pp: 435.
  9. Agnivesha (1998) Gulmachikitsa. In: Sharma VPV (Ed.) Charaka Samhita Elaborated by Charaka and Dridhbala. 4th (Edn.) Chaukhamba Orientalia, India, pp: 208.
  10. Dalhana (2019) Sushruta Gulmaroga pratished. In: Thakral K (Ed.) Sushruta Samhita with Nibandhasamgraha Commented by Dalhana. 1st (Edn.) Chaukhamba Orientalia, Varanasi, India, pp: 359.
  11. Dalhana (2013) Agnivesha Gulma Nidana. In: Trikamji VAJ (Ed.) Charaka Samhita elaborated by Charaka and Dridhbala. 1st (Edn.) Chaukhamba publication, Varanasi, India, pp: 208.
  12. Dayal P (1996) Vijayarakshita, Shree Kanthadatta, Gulma Nidana. In: Dayal P (Ed.) Madhav Nidana with Madhukosha commentary by Vijayarakshita and Kanthadatta. Saraswati Pustaka Bhandar, Ahmedabad, India, pp: 714.
  13. Agnivesha (2013) Agnivesha Gulma Nidana. In: Trikamji VAJ (Ed.) Charaka Samhita. elaborated by Charaka and Dridhbala with Ayurveda-Dipika commentary by Chakrapanidatta. 1st (Edn.) Chaukhamba publication, Varanasi, India, pp: 210.
  14. Agnivesha (1998) Gulmachikitsa. In: Sharma VPV (Ed.) Charaka Samhita Elaborated by Charaka and Dridhbala. 4th (Edn.), Chaukhamba Orientalia, Varanasi, India, pp: 99.
  15. Agnivesha (1998) Gulmachikitsa. In: Sharma VPV (Ed.) Charaka Samhita Elaborated by Charaka and Dridhbala. . 4th (Edn.), Chaukhamba Orientalia, Varanasi, India, pp: 100.
  16. Agnivesha (2019) Agnivesha Gulmachikitsa. In: Tripathi B (Ed.) Charaka Samhita elaborated by Charaka and Dridhabala. 1st (Edn.) Chaukhamba: Surbharati prakashan, Varanasi, India, pp: 247.
  17. Agnivesha (2019) Agnivesha Gulmachikitsa. In: Tripathi B (Ed.) Charaka Samhita elaborated by Charaka and Dridhabala. 1st (Edn.) Chaukhamba: Surbharati prakashan, Varanasi, India, pp: 275.
  18. Agnivesha (1998) Gulmachikitsa. In: Sharma VPV (Ed.) Charaka Samhita Elaborated by Charaka and Dridhbala. 4th (Edn.) Chaukhamba Orientalia, Varanasi, India, pp: 116
  19. Agnivesha (2019) Gulmachikitsa. In: Tripathi B (Ed.), Charaka Samhita elaborated by Charaka and Dridhabala. 1st (Edn.) Chaukhamba: Surbharati prakashan, Varanasi, India, pp: 273.
  20. Sushruta (2019) Sushruta Gulmaroga pratished. In: Thakral K (Ed.) Sushruta Samhita with Nibandhasamgraha Commented by Dalhana. 1st (Edn.) Chaukhamba Orientalia, Varanasi, India, pp: 362.
  21. Agnivesha (2019) Gulmachikitsa. In: Tripathi B (Ed.) Charaka Samhita elaborated by Charaka and Dridhabala. 1st (Ed.) Chaukhamba: Surbharati prakashan, Varanasi, India, pp: 265.
  22. Agnivesha (2019) Agnivesha Gulmachikitsa. In: Tripathi B (Ed.) Charaka Samhita elaborated by Charaka and Dridhabala. 1st (Edn.) Chaukhamba: Surbharati prakashan, Varanasi, India, pp: 266.
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@article{puri2023,
  title   = {Gulma Roga},
  author  = {Puri B},
  journal = {Journal of Natural & Ayurvedic Medicine},
  year    = {2023},
  volume  = {7},
  number  = {2},
  doi     = {10.23880/jonam-16000400}
}
Puri B (2023). Gulma Roga. Journal of Natural & Ayurvedic Medicine, 7(2). https://doi.org/10.23880/jonam-16000400
TY  - JOUR
TI  - Gulma Roga
AU  - Puri B
JO  - Journal of Natural & Ayurvedic Medicine
PY  - 2023
VL  - 7
IS  - 2
DO  - 10.23880/jonam-16000400
ER  -