Chapter 3. Gulma Nidana (Chapter on Abdominal lumps)
अथातो गुल्मनिदानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athātō gulmanidānaṁ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātrēyaḥ||2||
Now I shall explain the chapter on etiopathogenesis of gulma. Thus said Lord Atreya.[1-2]
Classification of gulma
इह खलु पञ्च गुल्मा भवन्ति; तद्यथा- वातगुल्मः, पित्तगुल्मः, श्लेष्मगुल्मो, निचयगुल्मः, शोणितगुल्म इति||३||
iha khalu pañca gulmā bhavanti; tadyathā- vātagulmaḥ, pittagulmaḥ, ślēṣmagulmō, nicayagulmaḥ, śōṇitagulma iti||3||
There are five types of gulma-
1. vata dominant gulma,
2. pitta dominant gulma,
3. shleshma/kapha dominant gulma,
4. nichaya (tridosha dominant) gulma, and
5. shonita gulma.[3]
Agnivesha’s question
एवंवादिनं भगवन्तमात्रेयमग्निवेश उवाच- कथमिह भगवन् पञ्चानां गुल्मानां विशेषमभिजानीमहे; नह्यविशेषविद्रोगाणामौषधविदपि भिषक् प्रशमनसमर्थो भवतीति||४||
ēvaṁvādinaṁ bhagavantamātrēyamagnivēśa uvāca- kathamiha bhagavan pañcānāṁ gulmānāṁ viśēṣamabhijānīmahē; nahyaviśēṣavidrōgāṇāmauṣadhavidapibhiṣak praśamanasamarthō bhavatīti||4||
After Lord Atreya said this, Agnivesha asked,
- “Sir, How can we know the specific characteristics of these five gulmas?
- Because without this knowledge, such patients cannot be successfully treated by a physician even though he is well versed in the selection and usage of drugs.”[4]
तमुवाच भगवानात्रेयः- समुत्थानपूर्वरूपलिङ्गवेदनोपशयविशेषेभ्यो विशेषविज्ञानं गुल्मानां भवत्यन्येषां च रोगाणामग्निवेश! तत्तु खलु गुल्मेषूच्यमानं निबोध||५||
tamuvāca bhagavānātrēyaḥ- samutthānapūrvarūpaliṅgavēdanōpaśayaviśēṣēbhyō viśēṣavijñānaṁ gulmānāṁ bhavatyanyēṣāṁ ca rōgāṇāmagnivēśa! tattu khalu [1]gulmēṣūcyamānaṁ nibōdha||5||
Lord Atreya replied, “Agnivesha!
Specific characteristics of the five gulma as well as other diseases are defined on the basis of their
- etiology समुत्थान
- prodromal symptoms पूर्वरूप
- clinical features with various types of pains लिङ्गवेदनो
- therapeutic applicability उपशय
1. Etio-pathogenesis / Nidana of vata-dominant gulma
यदा पुरुषो वातलो विशेषेण ज्वरवमनविरेचनातीसाराणामन्यतमेन कर्शनेन कर्शितो वातलमाहारमाहरति, शीतं वा विशेषेणातिमात्रम् अस्नेहपूर्वे वा वमनविरेचने पिबति, अनुदीर्णां वा छर्दिमुदीरयति, उदीर्णान् वातमूत्रपुरीषवेगान्निरुणद्धि,
yadā puruṣō vātalō viśēṣēṇa jvaravamanavirēcanātīsārāṇāmanyatamēna karśanēna karśitō vātalamāhāramāharati, śītaṁ vā viśēṣēṇātimātram [3] , asnēhapūrvē vāvamanavirēcanē pibati, anudīrṇāṁ vā chardimudīrayati, udīrṇān vātamūtrapurīṣavēgānniruṇaddhi,
When a person of vatika constitution, particularly emaciated due to one of the debilitating factors like fever ज्वर, emesis वमन, विरेचन purgation and diarrhoea अतीसार,
- consumes vata- aggravating food or excessively cold food, in excessive quantities,
- or is administered emesis वमन or purgation विरेचन without prior unction अस्नेहपूर्वे
- he vomits profusely अनुदीर्णां वा छर्दिमुदीरयति
- holds उदीर्णान् up impelling urges वेगान्निरुणद्धि of वात flatus,मूत्र urine, पुरीष bowel movement.
अत्यशितो वा पिबति नवोदकमतिमात्रम्, अतिसङ्क्षोभिणा वा यानेन याति, अतिव्यवायव्यायाममद्यशोकरुचिर्वा, अभिघातमृच्छति वा, विषमासनशयनस्थानचङ्क्रमणसेवी वा भवति, अन्यद्वा किञ्चिदेवंविधं विषममतिमात्रं व्यायामजातमारभते, तस्यापचाराद्वातः प्रकोपमापद्यते||६||
atyaśitō vā pibati navōdakamatimātram, atisaṅkṣōbhiṇā vā yānēnayāti, ativyavāyavyāyāmamadyaśōkarucirvā, abhighātamr̥cchati vā, viṣamāsanaśayanasthānacaṅkramaṇasēvī [4] vā bhavati, anyadvā kiñcidēvaṁvidhaṁviṣamamatimātraṁ vyāyāmajātamārabhatē, tasyāpacārādvātaḥ [5] prakōpamāpadyatē||6||
- drinks a lot of fresh water / अत्यशितो वा पिबति नवोदकमतिमात्रम्,
- or travels by an excessively jerking vehicle / अतिसङ्क्षोभिणा वा यानेन याति,
- indulges in excessive sexual intercourse / अतिव्यवाय
- intensive physical exercise / अतिव्यायाम
- or drinks alcoholic drinks / अतिमद्य
- or suffers from excessive anxiety / अतिशोक
- or is subjected to injury / अभिघातमृच्छति
- or uses uneven विषमा
- postures in sitting आसन
- sleeping शयन
- standing स्थान
- and walking / चङ्क्रमणसेवी
- or starts some other similar sort of irregular and excessive physical exercises / विषममतिमात्रं व्यायामजातमारभते
Vataja gulma samprapti / pathogenesis
स प्रकुपितो वायुर्महास्रोतोऽनुप्रविश्य रौक्ष्यात् कठिनीभूतमाप्लुत्य पिण्डितोऽवस्थानं करोति हृदि बस्तौ पार्श्वयोर्नाभ्यां वा;
sa prakupitō vāyurmahāsrōtō'nupraviśya raukṣyāt kaṭhinībhūtamāplutya [6] piṇḍitō'vasthānaṁ karōti hr̥di bastau pārśvayōrnābhyāṁ vā;
Such vitiated vata, on entering the mahasrotas,
- hardens due to dryness रौक्ष्यात् कठिनीभूत
- forming a mass or swelling पिण्डितो
- localised in the regions of
- heart हृदि
- urinary bladder,बस्तौ
- sides पार्श्वयो and
- the navel. र्नाभ्यां
स शूलमुपजनयति ग्रन्थींश्चानेकविधान्, पिण्डितश्चावतिष्ठते, स पिण्डितत्वाद् ‘गुल्म’ इत्यभिधीयते;
sa śūlamupajanayatigranthīṁścānēkavidhān, piṇḍitaścāvatiṣṭhatē, sa piṇḍitatvād ‘gulma’ ityabhidhīyatē;
The condition, gulma (or vata gulma), is शूलमुपजनयति painful and
ग्रन्थींश्चानेकविधान् can take the shape of
- पिण्डित a single swelling or
- multiple nodules of various types.
Lakshana / symptoms of vataja gulma
स मुहुराधमति मुहुरल्पत्वमापद्यते; अनियतविपुलाणुवेदनश्च भवति चलत्वाद्वायोः, मुहुः पिपीलिकासम्प्रचार इवाङ्गेषु, तोदभेदस्फुरणायामसङ्कोचसुप्तिहर्षप्रलयोदयबहुलः; तदातुरः सूच्येव शङ्कुनेव चाभिसंविद्धमात्मानं मन्यते, अपि च दिवसान्ते ज्वर्यते शुष्यति चास्यास्यम्, उच्छ्वासश्चोपरुध्यते, हृष्यन्ति चास्य रोमाणि वेदनायाः प्रादुर्भावे;प्लीहाटोपान्त्रकूजनाविपाकोदावर्ताङ्गमर्दमन्याशिरःशङ्खशूलब्रध्नरोगाश्चैनमुपद्रवन्ति; कृष्णारुणपरुषत्वङ्नखनयनवदनमूत्रपुरीषश्च भवति,
sa muhurādhamati [7] , muhuralpatvamāpadyatē; aniyatavipulāṇuvēdanaścabhavati calatvādvāyōḥ, muhuḥ pipīlikāsampracāra ivāṅgēṣu, tōdabhēdasphuraṇāyāmasaṅkōcasuptiharṣapralayōdayabahulaḥ; tadāturaḥ sūcyēva śaṅkunēvacābhisaṁviddhamātmānaṁ manyatē, api ca divasāntē jvaryatē [8] , śuṣyati cāsyāsyam, ucchvāsaścōparudhyatē, hr̥ṣyanti cāsya rōmāṇi vēdanāyāḥ prādurbhāvē;plīhāṭōpāntrakūjanāvipākōdāvartāṅgamardamanyāśiraḥśaṅkhaśūlabradhnarōgāścainamupadravanti; kr̥ṣṇāruṇaparuṣatvaṅnakhanayanavadanamūtrapurīṣaścabhavati,
- मुहुराधमति - It sometimes gets aggravated and enlarged,
- मुहुरल्पत्वमापद्यते - sometimes diminished, and
- अनियतविपुलाणुवेदनश्च - causes mild or severe pain due to instability of vayu.
Sometimes there are
- पिपीलिकासम्प्रचार इवाङ्गेषु - tingling sensations like ants crawling on body and
frequent onset and diminution of various types of painful sensations such as
- piercing तोद
- breaking, भेद
- twitching, स्फुरणा
- extension, आयाम
- contraction, सङ्कोच
- numbness, सुप्ति
- hyperaesthesia, हर्ष etc.
These sensations could be accompanied by
- a rise in temperature usually in the evenings,
- शुष्यति चास्यास्यम् - dryness of mouth,
- उच्छ्वासश्चोपरुध्यते -difficulty in expiration,
- हृष्यन्ति चास्य रोमाणि वेदनायाः प्रादुर्भावे; -horripilation at the onset of pain and
Upadrava / Complications of vataja gulma
complications such as
- प्लीहा spleen (enlargement),
- आटोपा - distension and आन्त्रकूजना - gurgling sound in the abdomen,
- अविपाको - indigestion,
- उदावर्ता - udavarta (upward movement of vata),
- अङ्गमर्द - bodyache,
- मन्याशिरःशङ्खशूल - pain in the lateral side of the neck, head and temple regions and
- कृष्णारुणपरुष appearance of blackness, reddishness and roughness in
- त्वङ् - skin,
- नख - nails,
- नयन - eyes,
- वदन - face,
- मूत्र - urine and
- पुरीषश्च - feces
These are characteristic features of vata gulma. [7]
Treatment principle of vataja gulma
nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti vātagulmaḥ||7||
The disease aggravates due to these etiological factors and pacifies due to opposite factors.
2. Pitta-dominant gulma
Nidana / Etiology Of Pittaja Gulma
तैरेव तु कर्शनैः कर्शितस्याम्ललवणकटुकक्षारोष्ण तीक्ष्ण शुक्तव्यापन्न मद्यहरितकफलाम्लानां विदाहिनां च शाकधान्य मांसादीनामुपयोगादजीर्णाध्यशनाद्रौक्ष्यानुगते चामाशये वमनमतिवेलं सन्धारणं वातातपौ चातिसेवमानस्य पित्तं सह मारुतेन प्रकोपमापद्यते||८||
tairēva tu karśanaiḥ karśitasyāmlalavaṇakaṭukakṣārōṣṇatīkṣṇaśuktavyāpannamadyaharitakaphalāmlānāṁ vidāhināṁ caśākadhānyamāṁsādīnāmupayōgādajīrṇādhyaśanādraukṣyānugatē cāmāśayē vamanamativēlaṁ [10] sandhāraṇaṁ vātātapau cātisēvamānasya pittaṁ sahamārutēna prakōpamāpadyatē||8||
If a person, weakened by ailments or various etiological factors (as mentioned above in verse 6),
uses
- अम्ल sour, लवण salty, कटुक pungent, and क्षार alkaline substances
- with उष्ण hot and तीक्ष्ण sharp potency,
- शुक्त vinegar,
- व्यापन्नमद्य improperly prepared or denatured alcoholic drinks,
- हरितक salads,
- फलाम्लानां sour fruits and
- विदाहिनां च शाक acidic vegetables, धान्य grains, मांसादीनाम meat etc.,
- takes जीर्णाध्यशनाद्
- food during indigestion,
- रौक्ष्यानुगते चामाशये वमन is administered emesis when amashaya is dry (or not properly oleated),
- अतिवेलं सन्धारणंsuppresses natural urges for long,
- or वातातपौ चातिसेवमानस्य is exposed excessively to the sun and wind,
- his pitta along with vata gets vitiated or aggravated. [8]
Samprapti / Pathogenesis of Pittaja Gulma
तत् प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति, य उक्ता वातगुल्मे;
tat prakupitaṁ māruta āmāśayaikadēśē saṁvartya [11] tānēva vēdanāprakārānupajanayati, ya uktā vātagulmē;
Aggravated vata, along with vitiated pitta,
- gets (completely or partially) collected in the amashaya and
- produces the same types of pain as mentioned for vata gulma.
Lakshanas / Symptoms of Pittaja Gulma
पित्तं त्वेनं विदहति कुक्षौ हृद्युरसि कण्ठे च; स विदह्यमानः सधूममिवोद्गारमुद्गिरत्यम्लान्वितं,
pittaṁ tvēnaṁ vidahati kukṣau hr̥dyurasi kaṇṭhē ca; savidahyamānaḥ sadhūmamivōdgāramudgiratyamlānvitaṁ,
Due to aggravation of pitta in certain cases,
- विदहति the patient feels a burning sensation (with hyperacidity) in the कुक्षौ belly, हृद्य cardiac region, उरसि chest and कण्ठे throat
- सधूममिवोद्गार while letting out smoky and उद्गिरत्यम्लान्वितं sour eructations at the same time.
गुल्मावकाशश्चास्य दह्यते दूयते धूप्यते ऊष्मायते स्विद्यति क्लिद्यति शिथिल इव स्पर्शासहोऽल्परोमाञ्चश्च भवति;
gulmāvakāśaścāsya dahyatē dūyatē dhūpyatē [12] ūṣmāyatē svidyati klidyati śithila [13] ivasparśāsahō'lparōmāñcaśca [14] bhavati;
In the location of gulma,
there is
- दह्यते - burning sensation,
- दूयते - pain,
- धूप्यते ऊष्मायते - sensations of fuming,
- स्विद्यति -sweating and
- क्लिद्यति - moistening,
- शिथिल - laxity,
- स्पर्शासहो - tenderness and
- अल्परोमाञ्चश्च - slight horripilation.
Upadrava / Complications of Pittaja gulma
ज्वरभ्रमदवथुपिपासागलतालुमुखशोषप्रमोहविड्भेदाश्चैनमुपद्रवन्ति; हरितहारिद्रत्वङ्नखनयनवदनमूत्रपुरीषश्च भवति;
jvarabhramadavathupipāsāgalatālumukhaśōṣapramōhaviḍbhēdāścainamupadravanti;haritahāridratvaṅnakhanayanavadanamūtrapurīṣaśca bhavati;
|
The patient could exhibit symptoms such as
- ज्वर - fever,
- भ्रम - giddiness,
- दवथु - burning pain,
- पिपासा - thirst,
- शोष - dryness of गल throat, तालु palate and मुख mouth,
- प्रमोह - fainting and
- विड्भेदा - diarrhea, and
develops
हरित greenish or हारिद्र yellowish discoloration of
- त्वङ् - skin,
- नख - nails,
- नयन - eyes,
- वदन - face,
- मूत्र - urine and
- पुरीषश्च - feces.
Treatment Principle of Pittaja Gulma
निदानोक्तानि चास्य नोपशेरते, विपरीतान्युपशेरत इति पित्तगुल्मः||९||
nidānōktāni cāsya nōpaśēratē, viparītānyupaśērata iti pittagulmaḥ||9|
The disease aggravates due to these etiological factors and pacifies due to opposite factors.
This variant of gulma is called pitta gulma. [9]
3. Kapha-dominant gulma
Nidana/ Etiology of Kaphaja Gulma
तैरेव तु कर्शनैः कर्शितस्यात्यशनादतिस्निग्धगुरुमधुरशीताशनात् पिष्टेक्षुक्षीरतिलमाषगुडविकृतिसेवनान्मन्दकमद्यातिपानाद्धरितकातिप्रणनयादानूपौदकग्राम्यमांसातिभक्षणात् सन्धारणादबुभुक्षस्य चातिप्रगाढमुदपानात् सङ्क्षोभणाद्वा शरीरस्य श्लेष्मा सह मारुतेन प्रकोपमापद्यते||१०||
tairēva tu karśanaiḥ karśitasyātyaśanādatisnigdhagurumadhuraśītāśanātpiṣṭēkṣukṣīratilamāṣaguḍavikr̥tisēvanānmandakamadyātipānāddharitakātipraṇanayādānūpaudakagrāmyamāṁsātibhak
ṣaṇāt [16] sandhāraṇādabubhukṣasya [17]cātipragāḍhamudapānāt saṅkṣōbhaṇādvā śarīrasya ślēṣmā saha mārutēna prakōpamāpadyatē||10||
If a person weakened by diseases or aforesaid factors (in verse 6)
- takes too अतिस्निग्ध much unctuous, गुरु heavy, मधुर sweet and शीता cold things,
- habitually takes preparations of (rice) अशनात् पिष्टे flour, इक्षु sugarcane, क्षीर milk, तिल sesame, माष black gram and गुड coarse, unrefined sugar (jaggery),
- विकृतिसेवनान्मन्दक uses excessively immature curd, मद्यातिपानाद् alcoholic drinks, हरितका salads,
- eats meat of marshy - anupa, aquatic - udaka and domesticated animals / gramya in excessive quantities, अतिप्रणनयादानूपौदकग्राम्यमांसातिभक्षणात्
- सन्धारणादबुभुक्षस्य suppresses natural urges,
- चातिप्रगाढमुदपानात् drinks too much water when hungry,
- सङ्क्षोभणाद्वा or is subjected to excessive shaking of the body (caused by travelling on rough roads, etc.),
- his kapha along with vata gets vitiated or aggravated. [10]
तं प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति य उक्ता वातगुल्मे;
taṁ prakupitaṁ māruta āmāśayaikadēśē saṁvartya [18] tānēva vēdanāprakārānupajanayati ya uktā vātagulmē;
taṁ prakupitaṁ māruta āmāśayaikadēśē saṁvartya [18] tānēva vēdanāprakārānupajanayati ya uktā vātagulmē;
Such aggravated vata along with vitiated kapha,
- when accumulated in the amashaya (upper part of abdomen) region or a part of it,
- causes the same types of painful symptoms as mentioned for vata gulma.
Lakshana / Symptoms of Kaphaja Gulma
श्लेष्मा त्वस्य शीतज्वरारोचकाविपाकाङ्गमर्द हर्षहृद्रोगच्छर्दिनिद्रालस्यस्तैमित्यगौरवशिरोभितापानुपजनयति,
ślēṣmā tvasyaśītajvarārōcakāvipākāṅgamardaharṣahr̥drōgacchardinidrālasyastaimityagauravaśirōbhitāpānupajanayati,
ślēṣmā tvasyaśītajvarārōcakāvipākāṅgamardaharṣahr̥drōgacchardinidrālasyastaimityagauravaśirōbhitāpānupajanayati,
Kapha causes
- शीतज्वर fever accompanied with cold sensation,
- अरोचका anorexia,
- अविपाका indigestion,
- अङ्गमर्द bodyache,
- हर्ष horripilation,
- हृद्रोग heart disease,
- छर्दि vomiting,
- निद्रा excess sleep,
- आलस्य lassitude,
- स्तैमित्य sweating, and
- गौरवशिरोभिताप a feeling of heaviness and distress in the head.
अपि च गुल्मस्यस्थैर्यगौरवकाठिन्यावगाढसुप्तताः,
api ca gulmasyasthairyagauravakāṭhinyāvagāḍhasuptatāḥ,
In the region where the gulma is located,
there is
- स्थैर्य fixity,
- गौरव heaviness,
- काठिन्या hardness
- अवगाढ deep seated and
- सुप्तताः numbness.
Upadrava / Complications of Kaphaja Gulma
तथाकासश्वासप्रतिश्यायान् राजयक्ष्माणं चातिप्रवृद्धः,
tathā kāsaśvāsapratiśyāyān rājayakṣmāṇaṁ cātipravr̥ddhaḥ,
tathā kāsaśvāsapratiśyāyān rājayakṣmāṇaṁ cātipravr̥ddhaḥ,
Complications could occur such as
- कास cough,
- श्वास dyspnoea,
- प्रतिश्यायान् coryza and,
- राजयक्ष्माणं चातिप्रवृद्धः even tuberculosis in much advanced stages.
श्वैत्यं त्वङ्नखनयनवदनमूत्रपुरीषेषूपजनयति,
śvaityaṁtvaṅnakhanayanavadanamūtrapurīṣēṣūpajanayati,
In terms of physical appearance, the patient develops
- whiteness / श्वैत्यं in
- त्वङ् - skin,
- नख - nails,
- नयन - eyes,
- वदन - face,
- मूत्र - urine and
- पुरीषश्च - feces
Treatment Principle of Kaphaja Gulma
निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत इति श्लेष्मगुल्मः||११||
nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti ślēṣmagulmaḥ||11||
The disease aggravates due to these etiological factors and pacifies due to opposite factors.
This variant of gulma is called kapha gulma. [11]
त्रिदोषहेतुलिङ्गसन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति कुशलाः| स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचयगुल्मः||१२||
tridōṣahētuliṅgasannipātē tu sānnipātikaṁ gulmamupadiśanti kuśalāḥ| sa vipratiṣiddhōpakramatvādasādhyō [19] nicayagulmaḥ||12||
When the symptoms of three doshas are exhibited, a gulma patient is said to be ailing from sannipatika gulma. This condition is incurable. [12]
शोणितगुल्मस्तु खलु स्त्रिया एव भवति न पुरुषस्य, गर्भकोष्ठार्तवागमन वैशेष्यात्|
śōṇitagulmastu khalu striyā ēva bhavati na puruṣasya, garbhakōṣṭhārtavāgamanavaiśēṣyāt|
śōṇitagulmastu khalu striyā ēva bhavati na puruṣasya, garbhakōṣṭhārtavāgamanavaiśēṣyāt|
Shonita or raktagulma occurs specifically only in women and not in men
- because of presence of uterus गर्भकोष्ठा and
- आर्तवागमन menstrual flow in the former.
Nidana/ Etiology of Rakta Gulma
पारतन्त्र्यादवैशारद्यात् सततमुपचारानुरोधाद्वा वेगानुदीर्णानुपरुन्धत्या
pāratantryādavaiśāradyāt satatamupacārānurōdhādvā vēgānudīrṇānuparundhatyā
In woman,
- who suppress their natural urges वेगानुदीर्णानुपरुन्धत्या because of - dependence,
- ignorance or
- a constant attendance to service of others
आमगर्भे वाऽप्यचिरपतितेऽथवाऽप्यचिरप्रजाताया ऋतौ वा वातप्रकोपणान्यासेवमानायाः क्षिप्रंवातः प्रकोपमापद्यते||१३||
āmagarbhē vā'pyacirapatitē'thavā'pyaciraprajātāyā r̥tau vāvātaprakōpaṇānyāsēvamānāyāḥ kṣipraṁ vātaḥ prakōpamāpadyatē||13||
- or uses vata aggravating substances soon after
- abortion,
- delivery or
- during menstruation,
- vata gets vitiated or aggravated quickly. [13]
Samprapti / Pathogenesis of Rakta Gulma
स प्रकुपितो योनिमुखमनुप्रविश्यार्तवमुपरुणद्धि, मासि मासि तदार्तवमुपरुध्यमानं |कुक्षिमभिवर्धयति|
sa prakupitō yōnimukhamanupraviśyārtavamuparuṇaddhi, māsi māsi tadārtavamuparudhyamānaṁ kukṣimabhivardhayati|
स प्रकुपितो योनिमुखमनुप्रविश्यार्तवमुपरुणद्धि, मासि मासि तदार्तवमुपरुध्यमानं |कुक्षिमभिवर्धयति|
sa prakupitō yōnimukhamanupraviśyārtavamuparuṇaddhi, māsi māsi tadārtavamuparudhyamānaṁ kukṣimabhivardhayati|
This vitiated vata
- gets into the cervico-vaginal canal and
- checks the menstrual flow.
If this continues for a prolonged period,
- the menstrual blood being obstructed accumulates and
- enlarges the abdomen.
तस्याः शूलकासातीसारच्छर्द्यरोचकाविपाकाङ्गमर्दनिद्रालस्यस्तैमित्य कफप्रसेकाः समुपजायन्ते,
tasyāḥ śūlakāsātīsāracchardyarōcakāvipākāṅgamardanidrālasyastaimityakaphaprasēkāḥ samupajāyantē,
tasyāḥ śūlakāsātīsāracchardyarōcakāvipākāṅgamardanidrālasyastaimityakaphaprasēkāḥ samupajāyantē,
The patient consequently suffers from
- शूल pain,
- कासा cough,
- अतीसार diarrhea,
- छर्दि vomiting,
- अरोचका anorexia,
- अविपाका indigestion,
- अङ्गमर्द bodyache,
- निद्रा excess sleep,
- आलस्य lassitude,
- स्तैमित्य dampness, and
- कफप्रसेकाः excessive salivation.
स्तनयोश्च स्तन्यम्, ओष्ठयोः स्तनमण्डलयोश्च कार्ष्ण्यम्, अत्यर्थं ग्लानिश्चक्षुषोः, मूर्च्छा, हृल्लासः, दोहदः, श्वयथुश्च पादयोः, ईषच्चोद्गमो रोमराज्याः, योन्याश्चाटालत्वम्, अपि च योन्या दौर्गन्ध्यमास्रावश्चोपजायते, केवलश्चास्या गुल्मः
stanayōśca stanyam, ōṣṭhayōḥ stanamaṇḍalayōścakārṣṇyam, atyarthaṁ glāniścakṣuṣōḥ, mūrcchā, hr̥llāsaḥ, dōhadaḥ, śvayathuśca pādayōḥ, īṣaccōdgamō rōmarājyāḥ, yōnyāścāṭālatvam, api ca yōnyādaurgandhyamāsrāvaścōpajāyatē, kēvalaścāsyā gulmaḥ
There occurs
- स्तनयोश्च स्तन्यम् appearance of milk in breasts,
- ओष्ठयोः स्तनमण्डलयोश्च कार्ष्ण्यम् dark coloration of lips and areolar region,
- अत्यर्थं ग्लानिश्चक्षुषोः excessive heaviness in eyes,
- मूर्च्छा fainting,
- हृल्लासः nausea,
- दोहदः longing for certain food articles as seen during pregnancy,
- श्वयथुश्च पादयोः swelling in feet,
- ईषच्चोद्गमो रोमराज्याः -appearence of small hair in small quantity
- योन्याश्चाटालत्वम्, dilatation of the vaginal orifice and
- योन्या दौर्गन्ध्यमास्राव foul smelling discharge from the vagina.
पिण्डित एव स्पन्दते, तामगर्भां गर्भिणीमित्याहुर्मूढाः||१४|
piṇḍita ēva spandatē, tāmagarbhāṁ garbhiṇīmityāhurmūḍhāḥ||14||
There is pulsation in the entire mass of gulma, confusing the patient (or her attendants) into thinking that she is pregnant. [14]
एषां तु खलु पञ्चानां गुल्मानां प्रागभिनिर्वृत्तेरिमानि पूर्वरूपाणि भवन्ति; तद्यथा-अनन्नाभिलषणम्, अरोचकाविपाकौ, अग्निवैषम्यं, विदाहो भुक्तस्य, पाककाले चायुक्त्या छर्द्युद्गारौ, वातमूत्रपुरीषवेगानां चाप्रादुर्भावः, प्रादुर्भूतानां चाप्रवृत्तिरीषदागमनं वा, वातशूलाटोपान्त्रकूजनापरिहर्षणातिवृत्तपुरीषताः, अबुभुक्षा, दौर्बल्यं,सौहित्यस्य चासहत्वमिति||१५||
ēṣāṁ tu khalu pañcānāṁ gulmānāṁ prāgabhinirvr̥ttērimāni pūrvarūpāṇi bhavanti; tadyathā- anannābhilaṣaṇam, arōcakāvipākau, agnivaiṣamyaṁ, vidāhō bhuktasya,pākakālē cāyuktyā chardyudgārau, vātamūtrapurīṣavēgānāṁ cāprādurbhāvaḥ, prādurbhūtānāṁ cāpravr̥ttirīṣadāgamanaṁ vā,vātaśūlāṭōpāntrakūjanāpariharṣaṇātivr̥ttapurīṣatāḥ, abubhukṣā, daurbalyaṁ, sauhityasya cāsahatvamiti||15||
These five types of gulma have the following prodormal symptoms just prior to occurring:
- अनन्नाभिलषणम् aversion to food,
- अरोचका anorexia and
- अविपाकौ indigestion,
- अग्निवैषम्यं disturbed metabolism,
- विदाहो भुक्तस्य, पाककाले burning sensation after taking meals,
- छर्दि vomiting and
- चायुक्त्या उद्गारौ, unusual eructations,
- वेगानां चाप्रादुर्भावःreduced urge for वात flatus, मूत्र urine and पुरीष bowel movements,
- वातशूला pain,
- आटोपा distension,
- आन्त्रकूजना gurgling sound,
- परिहर्षणा horripilation and
- अतिवृत्तपुरीषताः diarrhea due to vata,
- अबुभुक्षा loss of appetite,
- दौर्बल्यं debility, and
- सौहित्यस्य inability to endure satiety. [15]
Prognosis - Sadhya Asadhyatha
सर्वेष्वपि खल्वेतेषु गुल्मेषु न कश्चिद्वातादृते सम्भवति गुल्मः| तेषां सान्निपातिकमसाध्यं ज्ञात्वा नैवोपक्रमेत,
sarvēṣvapi khalvētēṣu gulmēṣu na kaścidvātādr̥tē sambhavati gulmaḥ| tēṣāṁ sānnipātikamasādhyaṁ jñātvā naivōpakramēta,
As is evident from the descriptions of gulma, no variant is caused without vitiation of vata.
Amongst these variants,
- sannipatika gulma is asadhya / incurable and
- should not be treated.
General principles of management
एकदोषजे तु यथास्वमारम्भं प्रणयेत्,
ēkadōṣajē tu yathāsvamārambhaṁ praṇayēt,
The variant caused by just one dosha, should be treated with suitable therapeutics prescribed for respective dosha.
संसृष्टांस्तु साधारणेन कर्मणोपचरेत्|
saṁsr̥ṣṭāṁstu sādhāraṇēna karmaṇōpacarēt|
Those caused by a combination of two doshas (vata – pitta or vata – kapha) should be managed with the general therapeutic measures applicable to dwidoshic ailments.
यच्चान्यदप्यविरुद्धं मन्येत तदप्यवचारयेद्विभज्य गुरुलाघवमुपद्रवाणां, गुरूनुपद्रवांस्त्वरमाणश्चिकित्सेज्जघन्यमितरान्|
yaccānyadapyaviruddhaṁ manyēta tadapyavacārayēdvibhajya gurulāghavamupadravāṇāṁ, gurūnupadravāṁstvaramāṇaścikitsējjaghanyamitarān|
The measures that are not contrary to the dosha can be applied according to severity of complications.
त्वरमाणस्तु विशेषमनुपलभमानो गुल्मेष्वात्ययिके कर्मणि वातचिकित्सितं प्रणयेत्, स्नेहस्वेदौ वातहरौ स्नेहोपसंहितं च मृदु विरेचनं बस्तींश्च; अम्ललवणमधुरांश्च रसान् युक्त्याऽवचारयेत्|
tvaramāṇastu viśēṣamanupalabhamānō gulmēṣvātyayikē karmaṇi vātacikitsitaṁ praṇayēt, snēhasvēdau vātaharau snēhōpasaṁhitaṁ ca mr̥du virēcanaṁ bastīṁśca;amlalavaṇamadhurāṁśca rasān yuktyā'vacārayēt|
In case of emergency situations,
- the measures applicable in treatment of vata gulma, such as
- वातहरौ स्नेह vata-alleviating unction,
- वातहरौ स्वेदौ fomentation,
- स्नेहोपसंहितं च मृदु विरेचनं mild unctuous purgation,
- स्नेहोपसंहितं च मृदु बस्तींश्च enema, and
- use of मधुरां sweet, अम्ल sour and लवण salty substances
should be administered.
मारुते ह्युपशान्ते स्वल्पेनापि प्रयत्नेन शक्योऽन्योऽपि दोषो नियन्तुं गुल्मेष्विति||१६||
mārutē hyupaśāntē svalpēnāpi prayatnēna śakyō'nyō'pi dōṣō niyantuṁ gulmēṣviti||16||
If vata is pacified, then the disease can be cured even with little efforts and other types of gulma can also be treated. [16]
भवति चात्र- गुल्मिनामनिलशान्तिरुपायैः सर्वशो विधिवदाचरितव्या| मारुते ह्यवजितेऽन्यमुदीर्णं दोषमल्पमपि कर्म निहन्यात्||१७||
bhavati cātra- gulmināmanilaśāntirupāyaiḥ sarvaśō vidhivadācaritavyā| mārutē hyavajitē'nyamudīrṇaṁ dōṣamalpamapi karma nihanyāt||17||
In the case of gulma, all the measures for pacification of vata should be administered properly because
- after vayu is controlled over,
- other aggravated doshas can be alleviated even with small remedies. [17]
Summary
तत्र श्लोकः- सङ्ख्या निमित्तं रूपाणि पूर्वरूपमथापि च| दिष्टं निदाने गुल्मानामेकदेशश्च कर्मणाम्||१८||
tatra ślōkaḥ- saṅkhyā nimittaṁ rūpāṇi pūrvarūpamathāpi ca| diṣṭaṁ nidānē gulmānāmēkadēśaśca karmaṇām||18||
Now, to summarize:
In the chapter on diagnosis of gulma
- सङ्ख्या the number,
- निमित्तं causative factor,
- रूपाणि symptoms and
- पूर्वरूप prodromal symptoms
- गुल्मानामेकदेशश्च कर्मणाम् along with a portion of treatment of gulmas
have been described.[18]
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने गुल्मनिदानं नाम तृतीयोऽध्यायः||३||
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē gulmanidānaṁ nāma tr̥tīyō'dhyāyaḥ||3||
Thus ends the third chapter on the diagnosis of gulma in the treatise composed by Agnivesha and redacted by Charaka.
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