Understanding the samprapti of gulma in Charak Nidan Sthana

1. Presented By:
Dr. Priyanka Buragohain
Guided By:
Dr. Anup Baishya
Department of Roga Nidan
Govt. Ayurvedic College and
Hospital,Jalukbari,Guwahati-14

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

3. 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-
Hṛdaya,Nabhi,2 Parśva and Basti .

4. 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. 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.  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. 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
iÉκ¨ÉxÉ ʽý nIÉÉv´É®v´ÉƺÉä näʽýxÉÉÆ xÉÉxÉÉÊnIÉÖ Ê´É
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 mῑyata iti
nirukti
(Ma.Ni.28/2 madhukośa tika),
4. MÉÖÊ{ÉiÉÉÊxɱɨÉÚ±Éi´ÉÉiÉÂ
MÉÖgù¨ÉÚ±ÉÉänùªÉÉnùÊ{É
MÉÖ±¨É´ÉuùÉ Ê´É¶ÉɱÉi´ÉÉiÉÂMÉÖ±¨É

9. Acharya Susruta,while defining the swarupa of gulma says---
“A knotty lump in between hṛdaya and basti either moving or
stationary ,undergoing increase or decrease and round in
shape is described as Gulma..(su.u.42/4)”
¾þiÉ ¤ÉºiªÉÉä®úxiÉ®äú OÉÎxlÉ&ºÉSÉÉ®úÒ ªÉÊnù
´ÉÉ%SɱÉ&*
SɪÉÉ{ÉSɪɴÉÉxÉ ´ÉÞkÉ& ºÉ MÉÖ±¨É <ÊiÉ EòÒÌiÉiÉ&** (Su.U.
42/4)
Hṛdbastyorantare covers the entire abdomen.
ºÉSÉÉ®úÒ - SɱÉxɶÉÒ±É& ´ÉÉiÉÉÊvÉEòªÉÉiÉÂ
+SÉ±É - BEòºlÉÉxɶÉɪÉÒ ´ÉɪÉÉä®ú±{Éi´ÉÉiÉÂ
SɪÉÉ{ÉSɪɴÉÉxÉ - EònùÉÊSÉnÖù{ÉÊSÉiÉ&
EònùÉÊSÉnù{ÉÊSÉiÉ

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.SAṚNGDHARA 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-
TYPESNUMBER
1.Yakṛta Gulma- Hṛṣdaypradeśastha
2.Aṣthila—Kukṣipradeśastha
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 Piḍana
- 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
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. 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. 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. 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.  Udgara bahulya
 Purishabandha
 Triptakshamatwa
 Antravikujana
 Atopa
 Adhmana
 Apakti shakti
A. H. Ni. 11/63

18. SAMANYA SAMPRAPTI OF GULMA:
Eò¡Æò SÉ Ê{ÉkÉÆSÉ ºÉ nÖù¹]õ´ÉɪÉÖ¯ûrÚùªÉ ¨ÉÉMÉÉxÉÂÊ´ÉÊxɤÉnÂùvªÉ
iÉɦªÉɨÉ*
¾þzÉÉʦÉ{ÉÉ·ÉÉènù®ú¤ÉκiɶÉÚ±ÉÆEò®úÉäiªÉvÉÉäªÉÉÊiÉ xÉ ¤Érù¨ÉÉMÉÇ&**
{ÉC´ÉɶɪÉäÊ{ÉkÉEò¡òɶɪÉä´ÉÉκlÉiÉ&º´ÉiÉxjÉ&{É®úºÉƸɪÉÉä´ÉÉ*
º{ɶÉÉæ{ɱɦªÉ& {ÉÊ®úÊ{ÉÎhb÷i´ÉÉiÉÂMÉÖ±¨ÉÉäªÉlÉÉnùÉä¹É¨ÉÖ{ÉèÊiÉ xÉɨÉ**
( 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. 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. 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. 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{ÉJɱ´ÉäiÉä¹ÉÖMÉÖ±¨Éä¹ÉÖxÉ EòÊ·ÉuùÉiÉÉiÉÂ@ñiÉä
ºÉƦɴÉÊiÉMÉÖ±¨É—
(C. Ni. 3/16)
ºÉ´ÉÉÇi¨ÉEú: ºÉ´ÉÇÊ´ÉEúÉ®ªÉÖHú: ºÉÉä%ºÉÉvªÉ=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

23. GULMA LAKSANA: VATAJ GUKMA LAKSANA
CARAKA
-ºlÉÉxɺÉƺlÉÉxÉ ¯ûVÉÉÊ´ÉEò±{ÉÆ
-Ê´ÉbÂ÷´ÉÉiɺÉÆMÉ
-MɱɴÉGò¶ÉÉä¹É¨ÉÂ
-¶ªÉÉ´ÉɯûhÉi´ÉÆ
-ʶÉʶɮúV´É®ú¨É
-Eò®úÉäÊiÉ VÉÒhÉæ%¦ªÉÉÊvÉEÆò |ÉEòÉä{ÉÆ
-¦ÉÖHòÉä¨ÉÞnÖùi´ÉÆ
-¾þiEÖòÊIÉ{ÉÉ·ÉÉǶÉʶɮúÉä¯ûVÉÆ
-xÉ SÉ iÉjÉ ¯ûIÉÆEò¹ÉɪÉÊiÉHÆò
Eò]ÖõSÉÉä{ɶÉäiÉä
SUSRUTA
•¨ÉxªÉʶɮú&¶ÉÚ±ÉÆ
•V´É®ú, {±ÉÒ½þÊ´ÉEòÉ®ú,
• +xjÉEÖòVÉxÉ, ´ªÉvÉ&ºÉÚSªÉä´É
• Ê´É]õºÉRÂóMÉ
•EÞòSUôÉänÖùSUô´ÉºÉxÉ ¨ÉÖ½Öþ
ºiɨ¦ÉÉäMÉÉjÉä
•¨ÉÖJɶÉÉä¹É& ,EòɶªÉÇ
•Ê´É¹É¨É¤ÉμxÉiÉÉ
• ¯ûIÉEÞò¹hÉi´ÉMÉÉÊnùi´ÉÆ
•+ÊiɯûÊ{ÉiɺÉƺlÉÉxɺlÉÉxÉ´ÉÞÊrùIɪɴ
ªÉlÉ &
• Ê{É{ÉÒʱÉEòÉ´ªÉÉ{iÉ
• MÉÖ±¨Éº¡Öò®úÊiÉiÉÖtiÉä
-¾þiEÖòÊIɶÉÚ±ÉÆ
-¨ÉÖJÉEòh`ö¶ÉÉä¹ÉÉä
-´ÉɪÉÉäÌxÉ®úÉävÉ
-ʴɹɨÉÉÎMxÉiÉÉ
-Ê´ÉEòÉ®úÉ&
{É´ÉxÉÉi¨ÉEòÉ·É
ASTANGA HRDAYA
Su.Utt. 42/10Ch. Chi. 5/7-8
A. H.Ni. 11/41-43

24. CARAKA SUSRUTA
•º´Éänù
•V´É®ú
•+ɽþÉ®úÊ´Énùɽþ
•iÉÞ¹hÉÉ
•+RÂóMÉ®úÉMÉ
•Eò]Öõ´ÉEòjÉiÉÉ
•Ê{ÉiɺªÉ ˱ÉMÉÉÊxÉ
+ÊJɱÉÉÊxɪÉÉÊxÉ
Ê{ÉiÉÉi¨ÉEäò
ASTANGA HRDAYA
•nùɽþÉä
•+¨±ÉEòÉä
•¨ÉÚSUôÉÇ
•Ê´Éb÷¦Éänù
•º´Éänù
• iÉÞ¹hÉÉ
•V´É®ú
•½þÉÊ®úpùi´ÉÆ
i´ÉMÉtä¹ÉÖ
• MÉÖ±¨É¶SÉ
º{ɶÉÇxÉɺɽþ&
• nÚùªÉiÉä
•nùÒ{ªÉiÉä
•ºÉÉ乨ɺ´ÉlÉÉxÉ
PITTAJ GULMA LAKSANA
-V´É®ú
-Ê{É{ÉɺÉÉ
-´ÉùnùxÉÉRÂóMÉ®úÉMÉ
-¶ÉÚ±ÉÆ
¨É½þVVÉÒªÉÇÊiÉ
¦ÉÉäVxÉä
-º´ÉänùÉä
-Ê´ÉnùɽþÉä
-µÉhÉ´ÉkSÉ MÉÖ±¨É&
º{ɶÉÉǺɽþ
Ch.Chi. 5/10 Su. Utt. 42/11
A. H. Ni. 11/44-45

25. CARAKA
ºiÉèʨÉiªÉ
¶ÉÒiÉV´É®ú
MÉÉjɺÉÉnù
EòɺÉ
+¯ûÊSÉ
MÉÉä®ú´É
¶ÉèiªÉÆ
¯ûMɱ{ÉÉ
EòÊ`öxÉÉäzÉi´ÉÆ
SUSRUTA ASTANGA HRDAYA
ºiÉèʨÉiªÉ
+zÉ+¯ûÊSÉ
+ÆMɺÉÉnù
UôÌnù
|ɺÉäEò
¨ÉvÉÖ®úɺªÉiÉÉ
Eò¡òºªÉ ʱÉMÉÉÆÊxÉ
+ÊJɱÉÉÊxÉ
ºiÉèʨÉiªÉ
+´ÉMÉÉg MÉÖ±¨É
+¯ûÊSÉ EòÊ`öxÉ
MÉÖ±¨É
ºÉnùxÉ MÉÖ¯û
MÉÖ±¨É
ʶÉʶɮúV´É®ú ºÉÖ{iÉ
{ÉÒxÉºÉ ÎºlÉ®
ºÉɱɺªÉ
+±{ɯûEò
¾þ±±ÉɺÉ
EòɺÉ
¶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®úÒiɨÉ
•+¶¨É´ÉnùPÉxÉÉäzÉiÉÆ
•¶ÉÒQÉÊ´ÉnùÉäʽþ,
nùɯûhɨÉ
•¨ÉxÉ&
¶É®úÒ®úÎMxɤɱÉÉ{ɽþ
Ê®úhÉÆ
•asadhya
ASTANGA HRDAYASUSRUTA
•iÉҵɯûEò-nùɽþ
•¶ÉÒQÉ{ÉÉEòÒ
•ùPÉxÉÉäzÉiÉÆ
•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±¨ÉºiÉÖJÉ™Öü ÊÛɪÉÉB´É ¦É´ÉÊiÉxÉ {ÉÖ¯þ¹ÉºªÉ, MɦÉÇEúÉä¢ÉiÉÇ´ÉÉMɨ
(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
ªÉÉäÊxɨÉÖJɨÉxÉÖ|ÉʴɶªÉÉiÉǴɨÉÖ{ɯûhÉÊrùú¨ÉÉʺɨÉÉʺÉ
iÉnùÉiÉǴɨÉÖ{ɯûrùªÉ¨ÉÉxÉÆEÖòÊIɨÉʦɴÉvÉǪÉÊiÉ* (
Ca.Ni.3/14)
xÉ´É|ɺÉÚiÉÉ%ʽþiɦÉÉäVÉxÉɪÉÉ ªÉÉ SÉɨÉMɦÉÇ
ʴɺÉÞVÉäoùjÉÉè ´ÉÉ*
´ÉɪÉÖ̽þ iɺªÉÉ&{ÉÊ®úMÉÞÁ ®úHÆò Eò®úÉäÊiÉMÉÖ±¨ÉÆ
ºÉ¯ûVÉƺÉnùɽþ¨ÉÂ**
(Su. Utt. 42/14)
@ñiÉÉ´ÉxÉɽþÉ®úiɪÉÉ ¦ÉªÉäxÉ
ʴɯûIÉhÉè´ÉæMÉÊ´ÉÊxÉOɽèþ¶SÉ*
ºÉƺiɨ¦ÉxÉÉä±±ÉäJÉxɪÉÉäÊxÉnùÉä¹ÉèOÉÖ±¨É&κjɪÉÆ
®úHò¦É´ÉÉä%¦¨ÉÖ{ÉèÊiÉ**

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.  MÉÖ¯þ: EúÊ`xɺÉƺlÉÉxÉÉä MÉÚf¨ÉÉƺÉÉxiɮɸɪÉ: *
+Ê´É´ÉhÉÇ: κlÉ®õÉè´É Á{ÉFúÉäMÉÖ±¨É =SªÉiÉä ** Ch. Chi. 5/40
 nɽý¶ÉÚ™üÉÌiɺÉÆIÉÉä¦Éº´É{ÉîxÉɶÉÉ®ÊiÉV´É®è: *
Ê´ÉnÁ¨ÉÉxÉÆVÉÉxÉÒªÉɱ¨ÉÆiɨÉÖ{ÉxÉɽýªÉäiÉ ** Ch. Chi.
5/41
 Ê´Énɽý™IÉhÉäMÉÖ±¨Éä ¤ÉʽýºiÉÖƒäû ºÉ¨ÉÖzÉiÉä*
¶ªÉÉ´ÉäºÉ®Hú{ɪÉÇxiÉä ºÉƺ{ɶÉæ¤ÉκiɺÉÆÊxɦÉä**
ÊxÉ{ÉÒÊbiÉÉäzÉiÉä ºiɤvÉäºÉÖ”ÉäiÉi{ÉÉ·ÉÇ{ÉÒbxÉÉiÉ *
iÉjÉè´É Ê{ÉÎhbiÉä¶ÉÚ™äüºÉÆ{ÉFÆú MÉÖ±¨É¨ÉÉÊn¶ÉäiÉ **
iÉjÉvÉÉx´ÉxiɮҪÉÉhÉɨÉÊvÉEúÉ®: ÊGúªÉÉÊ´ÉvÉÉè *
´ÉètÉxÉÉÆEÞúiɪÉÉäMªÉÉxÉÉÆ´ªÉvɶÉÉävÉxÉ®Éä{ÉhÉä ** Ch. Chi.
5/42-44

31. +xiɦÉÉÇMɺªÉ SÉÉ{ªÉäiÉiÉÂ{ÉSªÉ¨ÉÉxɺªÉ ™IÉhɨÉÂ*
¾ýiGúÉäb¶ÉÚxÉiÉÉ%xiÉ:ºlÉä ¤Éʽý:ºlÉä
{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.  ºÉÆÊSÉiÉ: Gú¨É¶ÉÉä MÉÖ±¨ÉÉä ¨É½ýÉ´ÉɺiÉÖ{ÉÊ®Oɽý: *
EÞúiɨÉÚ™ü: ʺɮÉxÉrÉä ªÉnÉEÚú¨ÉÇ<´ÉÉäzÉiÉ: **
nÉè¤ÉDZªÉɯþÊSɾýšüɺÉEúɺɴɨªÉ®ÊiÉV´É®è: *
iÉÞ¹hÉÉiÉxpÉ|ÉÊiɶªÉɪÉèªÉÖÇVªÉiÉäxÉ ºÉ ʺÉvªÉÊiÉ**
MÉÞ½ýÒi´ÉÉ ºÉV´É®·ÉɺÉƴɨªÉiÉÒºÉÉ®{ÉÒÊbiɨÉÂ
¾ýzÉÉʦɽýºiÉ{ÉÉnä¹ÉÖ¶ÉÉä¡ú: Eú¹ÉÇÊiÉMÉÖα¨ÉxɨÉÂ**Ch. Chi.
5/169- 171
 ·ÉÉºÉ ¶ÉÚ™üÊ{É{ÉɺÉÉ%zÉÊ´Éuäü¹ÉOÉÎxlɨÉÚfiÉÉ: **
¦É´ÉÎxiÉnÖ¤ÉÇ™üi´ÉÆSÉ MÉÖα¨ÉxÉÉä ¨ÉÞiªÉÖ¨É乪ÉiÉ: ** Su. Su.
33/21

33.  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.  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 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. 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,
asmadghanon
natam,
shighra vidahi
Striya
avum
prajayate
UDBHAV
STHAN
Mahasrotas Amashaya Amashaya Gabhashay
a
CHIKITSA
SUTRA
Snehan swedan,
vaman,
virechan, vasti,
raktamokshan
Sramsana/ mridu
virechan-ghrita
pana, basti,
raktamokshan,
sastrakarma,
sodhan-samana
Langhan-
vaman-
virechan,
kshara-Agni
karma,
raktamoksha
n
Asadhya Gabhakalo
vyatikrame
, 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

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

43. 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.

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

45. Lumps due to regional ileitis
Appendicular abscess
Psoas abscess
Empyema of gall bladder
Hepatic abscess
Cholecystitis

46. Psoas abscesscholecystitis

47. 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.

48. Hydatid cyst

49. 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.

50. 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

52. 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.

54. 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
?

55. 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,Accumulatio
n of rakta in the
uterus .
Molar Pregnancy
(Hydatid Mole),
Psuedopregnancy,
Acquired
Crytomenorrhea
As per Textbook of Kayachikitsa @ Proff. R. H. Singh
?

56. Phantom 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 inter
lobular spaces, which may be seen on a plain chest
film in congestive heart failure.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

57. .
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

58. 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

59. 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.

60. 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).

61. 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.

62. 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

63.  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.

64.  Vagbhata in Astanga Hriday have mentioned
simirarity between Vidradhi, Vriddhi and
Gulma along with Anaha, Asthila,
pratyasthila, tuni and Pratituni in the same
chapter.

65. 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.

66. 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.

67.  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