Chapter 28 — Gulma Nidana

The 28th Chapter of Madhava Nidana is Gulma nidana which deals with  Abdominal Tumors. An abdominal mass is an abnormal growth in the abdomen. An abdominal mass causes visible swelling and may change the shape of the abdomen. A person with an abdominal mass may notice weight gain and symptoms such as abdominal discomfort, pain, and bloating.

 

Causes of Gulma — 

दुष्टा वातादयो अत्यर्थं मिथ्याहार विहारतः |
कुर्वन्ति पञ्चधा गुल्मं कोष्टान्तर्ग्रन्थिरूपिणं |
तस्य पञ्चविधं स्थानं पार्श्व – हृन्नाभि – बस्तयः || १ || 

duṣṭā vātādayō atyarthaṁ mithyāhāra vihārataḥ |
kurvanti pañcadhā gulmaṁ kōṣṭāntargranthirūpiṇaṁ |
tasya pañcavidhaṁ sthānaṁ pārśva – hr̥nnābhi – bastayaḥ || 1 ||

By indulgence in unhealthy eating practices and habits, vitiated vata and other doshas generate five kinds of tumour (gulma) inside the stomach. The parts affected are the

• two sides of the stomach,
• hypochondrium,
• lumbar ,and scapular regions (parsvas),
• the region of the epigastrium (hrdaya),
• the region of the umbilical region (naabhi) and
• the hypogastric region (basti). 1

Definition of Gulma —

हृन्नाभ्योरन्तरे ग्रन्थिः सञ्चारी यदि वा अचलः |
वृत्तश्चयापचयवान् स ‘गुल्म’ इति कीर्तितः || २ ||

hr̥nnābhyōrantarē granthiḥ sañcārī yadi vā acalaḥ |
vr̥ttaścayāpacayavān sa ‘gulma’ iti kīrtitaḥ || 2 ||

The gulma could be identified as a mass in between the region of the heart and umbilicus; either moving from place to place or stationary, round in shape and undergoing increase or decrease in size. 2

The types of Gulma —

स व्यस्तैर्जायते दोषैः समस्तैरपि चोच्छ्रितैः |
पुरुषाणां, तथा स्त्रीणां ज्ञेयो रक्तेन चापरः || ३ || 

sa vyastairjāyatē dōṣaiḥ samastairapi cōcchritaiḥ |
puruṣāṇāṁ, tathā strīṇāṁ jñēyō raktēna cāparaḥ || 3 ||

The disease caused by increase in blood (rakta) due to provocation of anyone of the doshas or by combination of all the three doshas together. The disease relates to men a well as women. 3

Premonitary Symptoms of Gulma —

उद्गारबाहुल्य – पुरीषबन्ध तृप्त्य क्षमत्वान्त्रविकूजनानि |
आटोप आध्मानपक्तिशक्तिरासन्न गुल्मस्य वदन्ति चिह्नं || ४ ||

udgārabāhulya – purīṣabandha tr̥ptya kṣamatvāntravikūjanāni |
āṭōpa ādhmānapaktiśaktirāsanna gulmasya vadanti cihnaṁ || 4 ||

The premonitary symptoms of gulma are —

• Bahula Udgar — Excessive belching
• Purisha Bandha — Constipation
• Trupti — A morbid feeling of contentment
• Lack of endurance
• Aantra kujana — gurgling in the intestines
• Aadhmana — Distension of the stomach and
• Poor digestive capacity. 4

Vata Type of Gulma —

अरुचिः कृच्छ्रविण्मूत्र – वातता आन्त्रविकूजनम् |
आनाहश्चोर्ध्ववातत्वं सर्वगुल्मेषु लक्षयेत् || ५ ||

aruciḥ kr̥cchraviṇmūtra – vātatā āntravikūjanam |
ānāhaścōrdhvavātatvaṁ sarvagulmēṣu lakṣayēt || 5 ||

In all varieties of Gulma symptoms like

• Aruchi — Loss of taste
• Difficulty in elimination or non elimination of faeces, Urine and flatus
• Aantra kujana — Intestinal gurgling
• Enlargement of the stomach
• Upward movement of Gulma are seen. 5

Causes of Vata Gulma — 

रुक्षान्नपानं विषमातिमात्रं विचेष्टनं वेगविनिग्रहश्च |
शोको अभिघातो अतिमललक्ष्यश्च निरन्नता चानिलगुल्महेतुः || ६ ||
यः स्थानसंस्थानरुजां विकल्पं विड्वातसङ्गं गल – वक्त्रशोषं |
श्यावारुणत्वं शिशिरज्वरं च हृत्कुक्षि – पार्श्वांस – शिरोरुजं च || ७ ||
करोति जीर्णे त्वधिकं प्रकोपं भुक्ते मृदुत्वं समुपैति यश्च |
वातात् स गुल्मो न च तत्र रूक्षं कषाय – तिक्तं कटु चोपशेते || ८ ||

rukṣānnapānaṁ viṣamātimātraṁ vicēṣṭanaṁ vēgavinigrahaśca | 
śōkō abhighātō atimalalakṣyaśca nirannatā cānilagulmahētuḥ || 6 ||
yaḥ sthānasansthānarujāṁ vikalpaṁ viḍvātasaṅgaṁ gala – vaktraśōṣaṁ |
śyāvāruṇatvaṁ śiśirajvaraṁ ca hr̥tkukṣi – pārśvānsa – śirōrujaṁ ca || 7 ||
karōti jīrṇē tvadhikaṁ prakōpaṁ bhuktē mr̥dutvaṁ samupaiti yaśca |
vātāt sa gulmō na ca tatra rūkṣaṁ kaṣāya – tiktaṁ kaṭu cōpaśētē || 8 ||

The causes of Vata Gulma are

• Indulgence in eatables and drinks that are devoid of fat
• That are incompatibles
• are in large quantities; and
• Indulgence in unsuitable physical activities
• Suppression of natural urges, grief, trauma
• Excessive depletion of feaces and also
• the lack of eatables.

It manifests with pain related to its site or organ involved. It is also marked by

• Non elimination of feces and flatus
• dryness of faeces and mouth,and
• blackish – red discoloration.

There is fever accompanied by

• Cold
• Pain in the region of heart, epigastrium, flanks, shoulders, and head.

The condition is under control after digestion of food. Moreover, uses of eatables that are dry, astringent, and pungent increases the discomfort. 6-8

Pitta type of gulma —

कट्वम्ल – तीक्ष्णोष्ण – विदाहि – रुक्ष – क्रोधातिमध्यार्कहुताशसेवा |
आमाभिघातो रुधिरं च दुष्टं पैत्तस्य गुल्मस्य निमित्तमुक्तम् || ९ ||
ज्वरः पिपासा वदनाङ्गरागः शूलं महज्जीर्यति भोजने च |
स्वेदो विदाहो व्रणवच्च गुल्मः स्पर्शासहः पैत्तिकगुल्मरुपम् || १० ||

kaṭvamla – tīkṣṇōṣṇa – vidāhi – rukṣa – krōdhātimadhyārkahutāśasēvā |
āmābhighātō rudhiraṁ ca duṣṭaṁ paittasya gulmasya nimittamuktam || 9||
jvaraḥ pipāsā vadanāṅgarāgaḥ śūlaṁ mahajjīryati bhōjanē ca |
svēdō vidāhō vraṇavacca gulmaḥ sparśāsahaḥ paittikagulmarupam || 10 ||

The causes for pittaja gulma are —

• indulgence in eatables that are pungent, sour, are devoid of fat;
• Penetrating like alkalis, hot causing burning sensation as well as
• Indulgence in anger,
• Excess use of alcoholic drinks, sun light and fire;
• Accumulation of undigested eatables (aama) inside the body,
• Injury
• Vitiation of blood (rakta)

Its features are —

• fever
• Thirst
• redness of the face and body
• severe pain in the stomach after intake of eatables and during digestion
• Excessive perspiration
• Feeling of burning sensation resembling the one produced by an ulcer and tenderness. 9-10

Shleshma Type of Gulma –

शीतं गुरु स्निग्धचेष्टनं च संपूरणं प्रस्वपनं दिवा च |
गुल्मस्य हेतुः कफसम्भवस्य, सर्वस्तु दुष्टो निचयात्मकस्य || ११ ||
स्तैमित्य – शीतज्वर – गात्रसाद – हृल्लास – कासारुचि – गौरवाणि |
शैत्यं रुगल्पा कठिनोन्नतत्वं गुल्मस्य रूपाणि कफात्मकस्य || १२ ||

śītaṁ guru snigdhacēṣṭanaṁ ca sampūraṇaṁ prasvapanaṁ divā ca |
gulmasya hētuḥ kaphasambhavasya, sarvastu duṣṭō nicayātmakasya| 11 ||
staimitya – śītajvara – gātrasāda – hr̥llāsa – kāsāruci – gauravāṇi |
śaityaṁ rugalpā kaṭhinōnnatatvaṁ gulmasya rūpāṇi kaphātmakasya | 12 ||

The causes for kaphaja gulma are —

• Eatables that are hard to digest and are fatty
• Lack of physical exercise
• Eating large amount of eatables and
• Having sleep during the day and
• lack of physical activity.

Its symptoms include —

• Fever with cold
• weakness
• Oppression in the chest
• cough
• Loss of taste and
• feeling of heaviness in the body.

The tumour that occurs in the disease is

• cold
• Hard and
• Bulging out significantly and
• is mildly painful. 11-12

Involvement of dosha – duo in causing gulma —

निमित्तरूपाण्युपलभ्य गुल्मे द्विदोषजे दोषबलाबलं च |
व्यामिश्रलिङ्गानपरांश्च गुल्मांस्त्रीनादिशेदौषधकल्पनार्थम् || १३ ||

nimittarūpāṇyupalabhya gulmē dvidōṣajē dōṣabalābalaṁ ca |
vyāmiśraliṅgānaparānśca gulmānstrīnādiśēdauṣadhakalpanārtham | 13 ||

Three other kinds of gulma are caused by the combination of any two of the doshas. By the presence of etiology and features of the dosha, they are recognized for providing suitable treatment. 13

 Sannipata Gulma —

महारुजं दाहपरीतमश्मवद्घनोन्नतं शीघ्रविदाहि दारुणम् |
मनः – शरीराग्निबलापहारिणं त्रिदोषजं गुल्ममसाध्यमादिशेत् || १४ ||

mahārujaṁ dāhaparītamaśmavadghanōnnataṁ śīghravidāhi dāruṇam | manaḥ – śarīrāgnibalāpahāriṇaṁ tridōṣajaṁ gulmamasādhyamādiśēt |14||

The symptoms that are seen in Sannipataja Gulma, and that is considered as incurable include —

• Severe pain and
• Burning sensation,
• hardness like stone in the mass and its bulging space.

It causes quick morbidity and is dreadful. It causes weakness of the mind, body and of digestive capacity. 14

Rakta Gulma —

नवप्रसूता अहितभोजना या या चामगर्भं विसृजेद्रुतौ वा |
वायुर्हि तस्याः परिगृह्या रक्तं करोति गुल्मं सरुजं सदाहम् |
पैतस्य लिङ्गेन समानलिङ्गं विशेषणं चाप्यपरं निबोध || १५ ||
यः स्पन्दते पिण्डित एव नाङ्गैश्चिरात् सशूलः समगर्भलिङ्गः |
स रौधिरः स्त्रीभव एव गुल्मो मासे व्यतीते दशमे चिकित्स्यः || १६ ||

navaprasūtā ahitabhōjanā yā yā cāmagarbhaṁ visr̥jēdrutau vā |
vāyurhi tasyāḥ parigr̥hyā raktaṁ karōti gulmaṁ sarujaṁ sadāham |
paitasya liṅgēna samānaliṅgaṁ viśēṣaṇaṁ cāpyaparaṁ nibōdha || 15 ||
yaḥ spandatē piṇḍita ēva nāṅgaiścirāt saśūlaḥ samagarbhaliṅgaḥ |
sa raudhiraḥ strībhava ēva gulmō māsē vyatītē daśamē cikitsyaḥ || 16 ||

The causes of Rakta Gulma that resembles pittaja gulma in features are the vata undergoing morbid increase along with rakta. It affects the women who have delivered recently and those indulging in unsuitable eatables, and the women who had frequent abortions or quick deliveries. In addition, it will have special features also such as emergence of mass inside the stomach resembling a fetus. Nevertheless, the palpating hand of the physician is unable to detect its different parts.

The gulma causes pain at long intervals and has other features of pregnancy. After completion of ten months (of pseudo pregnancy) this rakta gulma, special to women could be treated. 15-16

Symptoms of Incurable Gulma — 

सञ्चितः क्रमशो गुल्मो महावास्तुपरिग्रहः |
कृतमूलः सिरानद्धो यदा कूर्म इवोतिथतः || १७ ||
दौर्बल्यारुचि – हृल्लास – कास – च्छर्द्यरति – ज्वरैः |
तृष्णा – तन्द्रा – प्रतिश्यायैर्युज्यते स न सिध्यति || १८ ||
गृहीत्वा सज्वरं श्वास – च्छर्द्यतीसारपीडितम् |
हृन्नाभि – हस्त – पादेषु शोथः कर्षति गुल्मिनम् || १९ ||

sañcitaḥ kramaśō gulmō mahāvāstuparigrahaḥ |
kr̥tamūlaḥ sirānaddhō yadā kūrma ivōtithataḥ || 17 ||
daurbalyāruci – hr̥llāsa – kāsa – cchardyarati – jvaraiḥ |
tr̥ṣṇā – tandrā – pratiśyāyairyujyatē sa na sidhyati || 18 ||
gr̥hītvā sajvaraṁ śvāsa – cchardyatīsārapīḍitam |
hr̥nnābhi – hasta – pādēṣu śōthaḥ karṣati gulminam || 19 ||

When the mass goes on increasing steadily and assumes a large size, and is deeply rooted and is accompanied with venous engorgement resembling a tortoise, the gulma becomes incurable.

The symptoms of an incurable gulma include the following:

• Debility
• Loss of taste
• Oppression in the chest
• cough
• Vomiting
• Restlessness
• Fever and
• Thirst
• Drowsiness
• Running of the nose
• Continuous fever
• Difficult breathing
• Diarrhoea and
• Oedema in the umbilicus, hands, and feet. 17-19

इति श्री माधवकरविरचिते माधवनिदाने गुल्मनिदानं समाप्तम् ||28 || 

iti śrī mādhavakaraviracitē mādhavanidānē gulmanidānaṁ samāptam ||28 ||

Thus concludes the chapter of Gulma Nidana.

Source — 

1. Abdominal Tumors