This article explains Madava nidana 28th chapter “Gulma Nidanam”. Causes, pathology and symptoms of Gulma are explained in this chapter.
Read – Acharya Madhavakara: His Work ‘Madhava Nidana’, Legacy, Amazing Facts
Gulma
Samprapti
Pathogenesis of Gulma – Due to excessive indulgence in incompatible / erroneous foods and activities (habits and daily activities) Vata and other doshas undergo severe vitiation. These doshas cause five types of gulma which are of the form and shape of a cyst / tumour inside the abdomen (abdominal cavity).
Seats of Gulma – Gulma manifests in five seats. The five common sites of gulma are – two parsva (flanks, sides of the abdomen), hrdaya (heart, cardiac region, epigastrium), nabhi (umbilicus, umbilical region) and vasti (region of urinary bladder). (1)
Read – Gulma- Abdominal Tumor- A Unique Disease In Ayurveda
Definition of Gulma
Gulma is defined as a mass in between the region of the heart and the umbilicus, which is either moving (from one place to the other) or stationary, round in shape and undergoing increase or decrease in size. (2)
Bheda – Types of gulma
There are five types of gulma. Among these four types of gulma are caused in both men and women (common in men and women). These four types of gulma are caused due to vitiation of individual doshas i.e., vata, pitta, kapha, combined vitiation of all three doshas together. The fifth type of gulma is caused by an increase of rakta (blood) and is manifested only in women. (3)
In short, the five types of gulma are –
Purvarupa
Premonitory symptoms of Gulma
The premonitory symptoms of gulma are excessive belching, constipation, disinterest towards food (a morbid feeling of contentment), lack of endurance, gurgling sounds in the abdomen (intestines), painful irritation in the abdomen, distension of abdomen and poor digestion capacity. (4)
Gulma Samanya Lakshana
General symptoms / presentation of gulma
The symptoms commonly seen in all types of gulma are – loss of taste, difficulty in elimination of faeces, urine and flatus, gurgling sounds in the abdomen (intestines), flatulence, & upward movement of vata. (5)
Read – Charaka – Gulma Chikitsa – 5th Chapter
Vataja Gulma
Etiological factors – Excessive indulgence in dry foods and drinks (foods devoid of fats), imbalanced and incompatible foods, and excessive consumption of foods (in large quantities), unsuitable physical activities, suppression of natural urges, excessive grief, trauma, excessive depletion of faeces and starvation (not consuming food) are the etiological factors of vataja gulma.
Symptoms – In vataja gulma the seat, shape and nature of pain keeps changing constantly (they are not fixed or well defined, fluctuant in nature). The other symptoms include – obstruction to (non elimination) the elimination of faeces and flatus, dryness of throat and mouth, blackish or reddish discolouration, fever accompanied by cold, pain in the region of heart, abdomen, flanks, shoulder blades (shoulders) and head. The pain increases after the digestion of food and subsides immediately after consuming food. The pain and discomfort are not relieved (worsened, increased) by consumption of foods which are dry, astringent, bitter and pungent. (6-8)
Read – Charaka Vatavyadhi Chikitsa 28th Chapter
Pittaja Gulma
Etiological factors – Excessive indulgence in foods which are pungent, sour, penetrating, causing burning sensation (corrosive) and dry (devoid of fats and unctuous substances), anger, excessive use of alcohol, excessive exposure to sunlight and fire, excessive accumulation of ama in the body, injury, and vitiation (contamination) of blood are the causative factors for pittaja gulma.
Symptoms – The symptoms of pittaja gulma are – fever, thirst, redness of the face and body, severe pain (colic) in the abdomen experienced during the digestion of food, excessive sweating, burning sensation, and tenderness as found in (resembling) ulcers. (9-10)
Kaphaja Gulma
Etiological factors – Excessive indulgence in foods which are too cold, heavy to digest, and excessively unctuous (fatty), sedentary life devoid of any physical activities or exercise, eating foods till satiation (eating in excess) & excessive sleep during day time are the causative factors of kaphaja gulma.
Etiological factors of sannipataja Gulma – Sannipataja or Tridoshaja Gulma are caused by a combination of etiological factors mentioned for individual doshaja gulma.
Symptoms of kaphaja gulma – The symptoms of kaphaja gulma are – feeling as if the body (abdomen) has been covered by wet cloth, fever with cold, weakness, nausea, cough, tastelessness, and heaviness of the body. The gulma is cold in touch (person feels cold), has mild pain, hard and elevated (bulged out). (11-12)
Dwandwaja Gulma
Tumors of abdomen caused by two doshas
The combination of any two doshas will also cause three other types of gulma. This should be identified and diagnosed based on the availability of etiological factors, symptoms and strength of two doshas together. They are recognised for the purpose of providing suitable treatment. (13)
Sannipataja Gulma Symptoms
Sannipataja or Tridoshaja Gulma is marked by the presence of severe pain and burning sensation, the mass is bulged out and has stone-like feel and consistency (on touch). The mass will undergo suppuration very quickly and is considered to be very dreadful. This condition would produce weakness of the mind, body, digestive fire and strength. This gulma is incurable in nature. (14)
Read – How To Make Prognosis Of Disease According To Ayurveda?
Rakta Gulma
Causes of Rakta Gulma – Consumption of unsuitable / incompatible foods and indulgence in incompatible activities by women who have recently delivered a child, have undergone miscarriage or abortion or during menstruation.
Pathogenesis – In women consuming the above-mentioned etiological factors, vata gets aggravated in the uterus (reproductive system of the women). This vata causes obstruction of rakta (menstrual blood) and causes gulma (tumour) along with pain and burning sensation. This condition is called rakta gulma.
Symptoms – Rakta Gulma is associated with pain and burning sensation. The symptoms are similar to those of pittaja gulma. In addition, this condition will also have some special symptoms. Due to the mass, the woman experiences all the signs of pregnancy but on palpation (by the doctor) the gulma pulsates in a single mass and not by organs i.e., the palpating hands of the physician can appreciate a pulsating mass (single) but will not be able to detect different parts of the fetus (since the foetus is not there in the womb). The pulsating pain occurs at long intervals along with signs of pregnancy. This condition occurs only in women. It shall be treated only after the completion of ten months. (This is to rule out pregnancy in case of chance of wrong diagnosis. If it is pregnancy, the foetus will be naturally delivered at the end of 9 months. If it is rakta gulma it doesn’t get delivered. This will confirm the diagnosis and hence shall be treated after 10 months.) (15-16)
Read – Signs And Symptoms Of Pregnancy – Ayurvedic Perspective
Symptoms of incurability
Gulma is incurable when the mass –
- grows steadily,
- has assumed very big size,
- occupies the entire abdomen
- is deeply rooted,
- has visible networks of veins on the abdomen (mass), i.e. accompanied with venous engorgement,
- is elevated like the shell of a tortoise,
It is also incurable when associated with the below mentioned symptoms –
- weakness / debility
- tastelessness
- nausea
- cough
- vomiting
- restlessness
- fever
- thirst
- drowsiness / stupor
- running in the nose,
Other symptoms of incurability are –
- continuous fever
- dyspnoea
- vomiting
- diarrhoea
- swelling / oedema in the region of the heart, umbilicus, hands and feet (17-19)
Other symptoms of incurability of gulma
Dyspnoea (difficulty in breathing), colic, thirst, aversion towards food, sudden disappearance of the mass (of gulma), and severe tiredness are the fatal signs of gulma. (20)
Thus ends the chapter on Gulma Nidanam in Madhava Nidana text written by Acharya Madhavakara.
