Charaka – Gulma Chikitsa – 5th Chapter

5th Chapter of Chikitsa Sthana of Charak Samhita deals with Gulma Chikitsa – Treatment of different types of abdominal tumour.  This chapter has very useful Ayurvedic medicines like Ksheera shatpal Ghruta, Lashuna ksheerapaka, Shatyadi Churna, Trayamana Ghrita etc.

For a simple version of this chapter, read here

अथातो गुल्मचिकित्सितं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athāto gulmacikitsitaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||

We shall now expound the chapter on the treatment of Gulma (Tumour)
Thus, said Lord Atreya [1-2]

सर्वप्रजानां पितृवच्छरण्यः पुनर्वसुर्भूतभविष्यदीशः|
चिकित्सितं गुल्मनिबर्हणार्थं प्रोवाच सिद्धं वदतां वरिष्ठः||३||
sarvaprajānāṃ pitṛvaccharaṇyaḥ punarvasurbhūtabhaviṣyadīśaḥ|
cikitsitaṃ gulmanibarhaṇārthaṃ provāca siddhaṃ vadatāṃ variṣṭhaḥ||3||

Punarvasu, the foremost among teachers, who is courteous like the father of all living beings, the paramount seer of the past and the future, expounded the effective treatment for the cure of Gulma (tumour) [3]

Causative factors

Gulma Nidana – Causative Factors:
विट्श्लेष्मपित्तातिपरिस्रवाद्वा तैरेव वृद्धैः परिपीडनाद्वा|
वेगैरुदीर्णैर्विहतैरधो वा बाह्यभिघातैरतिपीडनैर्वा||४||
रूक्षान्नपानैरतिसेवितैर्वा शोकेन मिथ्याप्रतिकर्मणा वा|
विचेष्टितैर्वा विषमातिमात्रैः कोष्ठे प्रकोपं समुपैति वायुः||५||
viṭśleṣmapittātiparisravādvā taireva vṛddhaiḥ paripīḍanādvā|
vegairudīrṇairvihatairadho vā bāhyabhighātairatipīḍanairvā||4||
rūkṣānnapānairatisevitairvā śokena mithyāpratikarmaṇā vā|
viceṣṭitairvā viṣamātimātraiḥ koṣṭhe prakopaṃ samupaiti vāyuḥ||5||

Vata Dosha gets aggravated in the Koshta (Gastro- intestinal tract) because of the following factors:
1. Ati parisrava of vit, Sleshma and Pitta: Excessive production of feces, Kapha and Pitta
2. Paripeedana.i.e pressure on or obstruction of Vayu by the increase in the quantity of feces, Kapha and Pitta.
3. Suppression of Vegas (manifested natural urges) moving downwards like urine, flatus and feces.
4. Shoka: Affliction by grief
5. Improper administration of elimination therapies and
6. Excessive or abnormal physical behavior [4-5]

Pathogenesis

Gulma Samprapti – Pathogenesis:
कफं च पित्तं च स दुष्टवायुरुद्धूय मार्गान् विनिबद्ध्य ताभ्याम्|
हृन्नाभिपार्श्वोदर बस्तिशूलं करोत्यथो याति न बद्धमार्गः||६||
पक्वाशये पित्तकफाशये वा स्थितः स्वतन्त्रः परसंश्रयो वा|
स्पर्शोपलभ्यः परिपिण्डितत्वाद्गुल्मो यथादोषमुपैति नाम||७||
kaphaṃ ca pittaṃ ca sa duṣṭavāyuruddhūya mārgān vinibaddhya tābhyām|
hṛnnābhipārśvodarabastiśūlaṃ karotyatho yāti na baddhamārgaḥ||6||
pakvāśaye pittakaphāśaye vā sthitaḥ svatantraḥ parasaṃśrayo vā|
sparśopalabhyaḥ paripiṇḍitatvādgulmo yathādoṣamupaiti nāma||7||

The vitiated Vayu provokes either Kapha or Pitta or both. They obstruct the channels of circulation to cause pain in the regions of heart, umbilicus, and sides of the chest, abdomen and urinary bladder. Doshas do not get eliminated and are confined to Pakvashaya (colon) Pittashaya (small intestine) or Kaphashaya (Stomach) either independently (Svatantra) or in association with other Doshas (paratantra) it becomes palpable because of its round shape for which it is called Gulma. Depending upon the Doshas involved in the manifestation of this ailment, it is classified into several categories [6-7]

Locations

Gulma Sthana – Locations:
बस्तौ च नाभ्यां हृदि पार्श्वयोर्वा स्थानानि गुल्मस्य भवन्ति पञ्च|
पञ्चात्मकस्य प्रभवं तु तस्य वक्ष्यामि लिङ्गानि चिकित्सितं च||८||
bastau ca nābhyāṃ hṛdi pārśvayorvā sthānāni gulmasya bhavanti pañca|
pañcātmakasya prabhavaṃ tu tasya vakṣyāmi liṅgāni cikitsitaṃ ca||8||

The 5 sites of manifestation of Gulma are:
Basti – Urinary bladder,
Nabhi – umbilicus,
Hridi- heart and
Parshva sthana – 2 sides of the abdomen (parsva)
Now signs, symptoms and treatment of the 5 categories of Gulma, viz
Vatika,
Paittika
Kaphaja
Sannipatika and
Raktaja will be explained [8]

Vataja Gulma

Causes Signs, and Symptoms of Vatika Gulma:
रूक्षान्नपानं विषमातिमात्रं विचेष्टितं वेग विनिग्रहश्च|
शोकोऽभिघातोऽतिमलक्षयश्च निरन्नता चानिलगुल्महेतुः||९||
यः स्थान संस्थानरुजां विकल्पं विड्वातसङ्गं गलवक्त्रशोषम्|
श्यावारुणत्वं शिशिरज्वरं च हृत्कुक्षिपार्श्वांस शिरोरुजं च||१०||
करोति जीर्णेऽभ्यधिकं प्रकोपं भुक्ते मृदुत्वं समुपैति यश्च|
वातात् स गुल्मो न च तत्र रूक्षं कषायतिक्तं कटु चोपशेते||११||
rūkṣānnapānaṃ viṣamātimātraṃ viceṣṭitaṃ vega vinigrahaśca|
śoko’bhighāto’timalakṣayaśca nirannatā cānilagulmahetuḥ||9||
yaḥ sthāna saṃsthānarujāṃ vikalpaṃ viḍvātasaṅgaṃ galavaktraśoṣam|
śyāvāruṇatvaṃ śiśirajvaraṃ ca hṛtkukṣipārśvāṃsa śirorujaṃ ca||10||
karoti jīrṇe’bhyadhikaṃ prakopaṃ bhukte mṛdutvaṃ samupaiti yaśca|
vātāt sa gulmo na ca tatra rūkṣaṃ kaṣāyatiktaṃ kaṭu copaśete||11||

Causes for Vataj Gulma are –
1. Rooksha annapanam: Intake of dry diet and drinks
2. Ati matra vichestitam: Excessive and abnormal physical behaviour
3. Vega vinigraha: Suppression of manifested natural urges
4. Shoka: Affliction by grief
5. Abhighata: Affliction by external injury
6. Ati mala: Excessive elimination of excreta and
7. Nirannata: Fasting for a long time.

Signs, symptoms as well as characteristic features of Vatika Gulma are:
1. Momentary changes in the location, shape and intensity of pain
2. Vit vata sanga: Obstruction to the passage of the feces and flatus
3. Gala vaktra shosham: Dryness in the throat and mouth,
4. Shyava aruna shareera: Grey and reddish coloration of body
5. Shishira jvara: Fever with cold
6. Hrut, kukshi, Parshva, Shiro rujam: Pain in the region of heart, abdomen, sides of the abdomen (parshva), scapula and head
7. Aggravation of the disease after food is digested and alleviation of ailment by the intake of food.
8. In Vataja Gulma, dry, astringent, bitter and pungent types of food are not wholesome.[10-11]

Pittaja Gulma

Causes, Signs and Symptoms of Paittika Gulma:
कट्वम्लतीक्ष्णोष्ण विदाहि रूक्ष क्रोधातिमद्यार्कहुताशसेवा|
आमाभिघातो रुधिरं च दुष्टं पैत्तस्य गुल्मस्य निमित्तमुक्तम्||१२||
ज्वरः पिपासा वदनाङ्गरागः शूलं महज्जीर्यति भोजने च|
स्वेदो विदाहो व्रणवच्च गुल्मः स्पर्शासहः पैत्तिकगुल्मरूपम्||१३||
kaṭvamlatīkṣṇoṣṇa vidāhi rūkṣa krodhātimadyārkahutāśasevā|
āmābhighāto rudhiraṃ ca duṣṭaṃ paittasya gulmasya nimittamuktam||12||
jvaraḥ pipāsā vadanāṅgarāgaḥ śūlaṃ mahajjīryati bhojane ca|
svedo vidāho vraṇavacca gulmaḥ sparśāsahaḥ paittikagulmarūpam||13||

The causative factors of Paitika Gulma: 
1. Katu, amla, tikshna, ushna, vidahi anna sevana: Intake of pungent, sour, sharp, hot, Vidahi (which cause acidity or burning sensation in the stomach) and dry articles of diet.
2. Krodha – anger
3. Ama abhighata: Affliction by Ama (Product of improper digestion and metabolism) and
4. Madya sevana: Excessive intake of alcohol and exposure to sun as well as fire.
5. Rudhira dushtam: Vitiation of blood.
Signs and symptoms and characteristic features of Paittaika Gulma:
1. Jwara and pipasa: Fever and excessive thirst
2. Anga raga: Redness of face and limbs
3. Shulam mahat jeeryate bhojanam: Excruciating pain during digestion of food
4. Sveda and vidaha: Sweating and burning sensation,
5. Vrana vaccha gulma: Tenderness of the affected part as if it is wounded. [12-13]

Causes for Kaphaja and Sannipatika Gulma
शीतं गुरु स्निग्धमचेष्टनं च सम्पूरणं प्रस्वपनं दिवा च|
गुल्मस्य हेतुः कफसम्भवस्य सर्वस्तु दिष्टो निचयात्मकस्य||१४||
śītaṃ guru snigdhamaceṣṭanaṃ ca sampūraṇaṃ prasvapanaṃ divā ca|
gulmasya hetuḥ kaphasambhavasya sarvastu diṣṭo nicayātmakasya||14||

Kaphaja Gulma

The causative factors of Kaphaja Gulma are –
1. Sheeta, guru snigdha: Indulgence in cold, heavy and unctuous foods
2. Achesta: Lack of exercise
3. Sampoorana – Over-nourishment and
4. Diva swapna: Sleep during day time.

The Sannipatika type of Gulma is produced by all causative factors of Vatika, Paittika and Kaphaja Gulma [14]
Signs and symptoms of Kaphaja Gulma:
स्तैमित्य शीतज्वर गात्रसाद हृल्लास कासारुचि गौरवाणि|
शैत्यं रुगल्पा कठिनोन्नतत्वं गुल्मस्य रूपाणि कफात्मकस्य||१५||
staimitya śītajvara gātrasāda hṛllāsa kāsāruci gauravāṇi|
śaityaṃ rugalpā kaṭhinonnatatvaṃ gulmasya rūpāṇi kaphātmakasya||15||

Signs and symptoms of Kaphaja Gulma:
1. Staimitya – numbness or a feeling as if covered with a wet-cloth
2. Sheeta Jvara: Fever associated with feelings of cold
3. Gatra sada, Hrullasa, Kasa, Aruchi, Gaurava: Body stiffness, Nausea, cough, anorexia and heaviness and
4. Kathina unnatam: The affected part of the body is hard to touch and is elevated. It is cold in touch and there is less pain.[15]

Dvi-Doshaja Gulma

निमित्तलिङ्गान्युपलभ्य गुल्मे द्विदोषजे दोषबलाबलं च|
व्यामिश्रलिङ्गानपरांस्तु गुल्मांस्त्रीनादिशेदौषधकल्पनार्थम्||१६||
nimittaliṅgānyupalabhya gulme dvidoṣaje doṣabalābalaṃ ca|
vyāmiśraliṅgānaparāṃstu gulmāṃstrīnādiśedauṣadhakalpanārtham||16||
Because of the combination of etiological factors of 2 or 3 Doshas, other varieties of Gulma, having signs and symptoms of the respective Doshas are manifested. These are called DviDoshaja (2 Doshas are simultaneously vitiated). [16]

Sannipatika Gulma

Signs and Symptoms of Sannipatika Gulma:
महारुजं दाहपरीतमश्मवद्घनोन्नतं शीघ्रविदाहि दारुणम्|
मनःशरीराग्निबलापहारिणं त्रिदोषजं गुल्ममसाध्यमादिशेत्||१७||
mahārujaṃ dāhaparītamaśmavadghanonnataṃ śīghravidāhi dāruṇam|
manaḥ śarīrāgni balāpahāriṇaṃ tridoṣajaṃ gulmamasādhyamādiśet||17||

Features of Sannipatika Gulma are as follows;
1. Maha rujam: Excruciating pain
2. Daha: Excessive burning sensation
3. Ashma vad: Stone-like compact elevation of the affected part,
4. Vidahi: Quick sloughing
5. Darunam: Seriousness of the condition and
6. Disappearance of the strength of the mind, body and digestion as well as metabolism. This variety of Gulma is incurable.[17]

Raktaja Gulma

Causes, Samprapti, Signs and Symptoms of Raktaja Gulma:
ऋतावनाहारतया भयेन विरूक्षणैर्वेगविनिग्रहैश्च|
संस्तम्भनोल्लेखनयोनिदोषैर्गुल्मः स्त्रियं रक्तभवोऽभ्युपैति||१८||
यः स्पन्दते पिण्डित एव नाङ्गैश्चिरात् सशूलः समगर्भलिङ्गः|
स रौधिरः स्त्रीभव एव गुल्मो मासे व्यतीते दशमे चिकित्स्यः||१९||
ṛtāvanāhāratayā bhayena virūkṣaṇairvegavinigrahaiśca|
saṃstambhanollekhanayonidoṣairgulmaḥ striyaṃ raktabhavo’bhyupaiti||18||
yaḥ spandate piṇḍita eva nāṅgaiścirāt saśūlaḥ samagarbhaliṅgaḥ|
sa raudhiraḥ strībhava eva gulmo māse vyatīte daśame cikitsyaḥ||19||

Causes for Raktaja Gulma in ladies:
1. Rutau Anahara – Avoiding food during menstruation
2. Bhaya, Rooksha, Vega Vinigraha: Fear, intake of excessively dry food and suppression of manifested natural urges:
3. Improper administration of Stambhana treatment (astringent, blocking treatment) and emetic therapies
4. Yoni dosha: Gynaecological disorder

Raktaja Gulma Lakshana:
Spandate – palpitates
Pindita – round mass
Sashoola – associated with colic-pain and
signs and symptoms suggestive of pregnancy.
This Rakthaja Gulma occurs only in women and is treated only after the passage of 10 months. [18- 19]

Gulma Chikitsa

Line of Treatment – Gulma Chikitsa Sutra:
क्रियाक्रममतः सिद्धं गुल्मिनां गुल्मनाशनम्|
प्रवक्ष्याम्यत ऊर्ध्वं च योगान् गुल्मनिबर्हणान्||२०||
रूक्षव्यायामजं गुल्मं वातिकं तीव्रवेदनम्|
बद्धविण्मारुतं स्नेहैरादितः समुपाचरेत्||२१||
भोजनाभ्यञ्जनैः पानैर्निरूहैः सानुवासनैः|
स्निग्धस्य भिषजा स्वेदः कर्तव्यो गुल्मशान्तये||२२||
स्रोतसां मार्दवं कृत्वा जित्वा मारुतमुल्बणम्|
भित्त्वा विबन्धं स्निग्धस्य स्वेदो गुल्ममपोहति||२३||
स्नेहपानं हितं गुल्मे विशेषेणोर्ध्वनाभिजे|
पक्वाशयगते बस्तिरुभयं जठराश्रये||२४||
दीप्तेऽग्नौ वातिके गुल्मे विबन्धेऽनिलवर्चसोः|
बृंहणान्यन्नपानानि स्निग्धोष्णानि प्रयोजयेत्||२५||
पुनः पुनः स्नेहपानं निरूहाः सानुवासनाः|
प्रयोज्या वातगुल्मेषु कफपित्तानुरक्षिणा||२६||
Kriyā kramamataḥ siddhaṃ gulmināṃ gulmanāśanam|
pravakṣyāmyata ūrdhvaṃ ca yogān gulmanibarhaṇān||20||
rūkṣavyāyāmajaṃ gulmaṃ vātikaṃ tīvravedanam|
baddhaviṇmārutaṃ snehairāditaḥ samupācaret||21||
bhojanābhyañjanaiḥ pānairnirūhaiḥ sānuvāsanaiḥ|
snigdhasya bhiṣajā svedaḥ kartavyo gulmaśāntaye||22||
srotasāṃ mārdavaṃ kṛtvā jitvā mārutamulbaṇam|
bhittvā vibandhaṃ snigdhasya svedo gulmamapohati||23||
snehapānaṃ hitaṃ gulme viśeṣeṇordhvanābhije|
pakvāśayagate bastirubhayaṃ jaṭharāśraye||24||
dīpte’gnau vātike gulme vibandhe’nilavarcasoḥ|
bṛṃhaṇānyannapānāni snigdhoṣṇāni prayojayet||25||
punaḥ punaḥ snehapānaṃ nirūhāḥ sānuvāsanāḥ|
prayojyā vātagulmeṣu kaphapittānurakṣiṇā||26||                                       Now the line of treatment is explained, followed by recipes for eradication of these diseases.
Vataja Gulma Chikitsa Sutra:
A patient suffering from Vataja Gulma, caused by dry food and excessive physical activities, associated with excruciating pain and obstruction to feces and flatus should, in the beginning be administered with-
Snehakarma – Oleation,
oil massage,
Oily foods and drinks,
Niruha basti(decoction enema) and
Anuvasana  basti– Oil enema.

After this, Swedana – sweating treatment is adopted.

Sweating therapy causes-
Srotasam Mardava – softness of channels of circulation,
Jitva Marutam ulbanam – alleviates aggravated Vata Dosha
Bhitva Vibandham – relieves constipation,
as a result of which Gulma gets cured.

Administration of Snehapana (unctuous liquid) is useful in Gulma, especially when this disease is located above the umbilical region.
If Gulma is manifested either in Pakvashaya – colon or in Jatara, (other part of abdomen), then Niruha (decoction enema) and Anuvasana (fat enema) is useful.

The Vataja Gulma patient accompanied with constipation and bloating is given unctuous, hot and nourishing diet and drinks after his digestive-power is stimulated;

In Vata Gulma, Sneha Pana (oral administration of Sneha), Niruha (a type of medicated enema) and Anuvasana (another type of medicated enema) is administered very frequently. But care is taken against Kapha and Pitta. That is, it is ensured that these therapies do not aggravate Kapha and Pitta in any way. [20-26]

Management of other Doshas:
कफो वाते जितप्राये पित्तं शोणितमेव वा|
यदि कुप्यति वा तस्य क्रियमाणे चिकित्सिते||२७||
यथोल्बणस्य दोषस्य तत्र कार्यं भिषग्जितम्|
आदावन्ते च मध्ये च मारुतं परिरक्षता||२८||
kapho vāte jitaprāye pittaṃ śoṇitameva vā|
yadi kupyati vā tasya kriyamāṇe cikitsite||27||
yatholbaṇasya doṣasya tatra kāryaṃ bhiṣagjitam|
ādāvante ca madhye ca mārutaṃ parirakṣatā||28||

If, by the therapies for alleviation of Vayu, other Doshas – Pitta, Kapha and Rakta get vitiated, then carefully, treatment is done to pacify the aggravated Dosha, while taking extra precautions for Vata Dosha balance. [27-28]

Dvandvaja Gulma Chikitsa

Line of Treatment of Dvandvaja Gulma

वातगुल्मे कफो वृद्धो हत्वाऽग्निमरुचिं यदि|
हृल्लासं गौरवं तन्द्रां जनयेदुल्लिखेत्तु तम्||२९||
शूलानाह विबन्धेषु गुल्मे वातकफोल्बणे|
वर्तयो गुटिकाश्चूर्णं कफवातहरं हितम्||३०||
पित्तं वा यदि संवृद्धं सन्तापं वातगुल्मिनः|
कुर्याद्विरेच्यः स भवेत् सस्नेहैरानुलोमिकैः||३१||

vātagulme kapho vṛddho hatvā’gnimaruciṃ yadi|
hṛllāsaṃ gauravaṃ tandrāṃ janayedullikhettu tam||29||
śūlānāha vibandheṣu gulme vātakapholbaṇe|
vartayo guṭikāścūrṇaṃ kaphavātaharaṃ hitam||30||
pittaṃ vā yadi saṃvṛddhaṃ santāpaṃ vātagulminaḥ|
kuryādvirecyaḥ sa bhavet sasnehairānulomikaiḥ||31||

Dwandwaja Gulma Chikitsa:
If in a patient of Vataja Gulma, Kapha is aggravated, leading to
Agnisada – low digestion strength
Aruchi – anorexia, Hrullasa – nausea, Gaurava – heaviness, Tandra – drowsiness, fatigue, then he is administered Vamana – emetic therapy.

If Gulma is caused by the predominance of Vata and Kapha, and if it is associated with colic pain, Anaha (distension of the abdomen) and constipation, then the patient is given Varti (rectal suppository), pills and powders which alleviate both Kapha and Vata.[29-31]

Gulma Raktamokshana

गुल्मो यद्यनिलादीनां कृते सम्यग्भिषग्जिते|
न प्रशाम्यति रक्तस्य सोऽवसेकात् प्रशाम्यति||३२||

gulmo yadyanilādīnāṃ kṛte samyagbhiṣagjite|
na praśāmyati raktasya so’vasekāt praśāmyati||32||
Blood letting:
In spite of administration of appropriate therapies for the alleviation of Vata, etc, if Gulma is not cured, then blood letting is done to eradicate the disease. [32]

Pittajagulma Chikitsasutra

स्निग्धोष्णेनोदिते गुल्मे पैत्तिके स्रंसनं हितम्|
रूक्षोष्णेन तु सम्भूते सर्पिः प्रशमनं परम्||३३||
पित्तं वा पित्तगुल्मं वा ज्ञात्वा पक्वाशयस्थितम्|
कालविन्निर्हरेत् सद्यः सतिक्तैः क्षीरबस्तिभिः||३४||
पयसा वा सुखोष्णेन सतिक्तेन विरेचयेत्|
भिषगग्निबलापेक्षी सर्पिषा तैल्वकेन वा||३५||

snigdhoṣṇenodite gulme paittike sraṃsanaṃ hitam|
rūkṣoṣṇena tu sambhūte sarpiḥ praśamanaṃ param||33||
pittaṃ vā pittagulmaṃ vā jñātvā pakvāśayasthitam|
kālavinnirharet sadyaḥ satiktaiḥ kṣīrabastibhiḥ||34||
payasā vā sukhoṣṇena satiktena virecayet|
bhiṣagagnibalāpekṣī sarpiṣā tailvakena vā||35||

If Paitika Gulma is caused by unctuous and hot things, then administration of Sramsana is useful. (mild – moderate laxative).
If it is caused by dry and hot things, then administration of ghee is best.
If Pitta or Paittika Gulma gets lodged in Pakvasaya (colon), then keeping in view the appropriateness of time, patient should immediately be given Tikta Ksheera basti. (enema by milk processed with bitter herbs).
Alternatively, the patient can be given Virechana treatment with milk, warm milk processed with bitter herbs or with Tilvaka ghrita depending upon his digestive power and strength [33-35]

Utility of blood letting:
तृष्णा ज्वर परीदाह शूलस्वेदाग्निमार्दवे|
गुल्मिनामरुचौ चापि रक्तमेवावसेचयेत्||३६||
छिन्नमूला विदह्यन्ते न गुल्मा यान्ति च क्षयम्|
रक्तं हि व्यम्लतां याति, तच्च नास्ति न चास्ति रुक्||३७||
tṛṣṇā jvara parīdāha śūlasvedāgnimārdave|
gulmināmarucau cāpi raktamevāvasecayet||36||
chinnamūlā vidahyante na gulmā yānti ca kṣayam|
raktaṃ hi vyamlatāṃ yāti, tacca nāsti na cāsti ruk||37||

If a patient of Gulma is associated with
Trushna – morbid thirst
Jvara – fever
Paridaha – excessive burning sensation
Shula – colic pain, Sweda – sweating
Agni mardava – suppression of the power of digestion and
Aruchi – anorexia, then this is treated by blood-letting.
In Gulma, blood gets vitiated and becomes sour. By blood- letting, this does not happen and the patient remains free from pain [36-37]

Removal of Residual Doshas:
हृतदोषं परिम्लानं जाङ्गलैस्तर्पितं रसैः|
समाश्वस्तं सशेषार्तिं सर्पिरभ्यासयेत् पुनः||३८||
hṛtadoṣaṃ parimlānaṃ jāṅgalaistarpitaṃ rasaiḥ|
samāśvastaṃ saśeṣārtiṃ sarpirabhyāsayet punaḥ||38||

After removal of vitiated blood, the patient becomes emaciated. He is given Jangala mamsarasa – soup of meat of animals of arid land. He is consoled, and for relieving the residual pain, he is regularly given ghee again. [38]

Surgery:
रक्तपित्तातिवृद्धत्वात् क्रियामनुपलभ्य च|
यदि गुल्मो विदह्येत शस्त्रं तत्र भिषग्जितम्||३९||

raktapittātivṛddhatvāt kriyāmanupalabhya ca|
yadi gulmo vidahyeta śastraṃ tatra bhiṣagjitam||39||

If Rakta and Pitta are aggravated in excess in a patient suffering from Gulma, and if blood letting therapy is not administered, then Gulma may get suppurated. To cure this ailment surgery has to be performed [39]

Apakva or Unsuppurated Gulma

गुरुः कठिनसंस्थानो गूढमांसान्तराश्रयः|
अविवर्णः स्थिरश्चैव ह्यपक्वो गुल्म उच्यते||४०||

guruḥ kaṭhinasaṃsthāno gūḍhamāṃsāntarāśrayaḥ|
avivarṇaḥ sthiraścaiva hyapakvo gulma ucyate||40||

Following signs and symptoms indicate that the Gulma has not undergone suppuration:
1. Guru Kathina: Heaviness and hardness
2. Gudha mamsa antarashaya: Located deep inside the muscle tissue
3. Avivarna: No change in the colour of the skin and
4. Sthira: Remaining firmly fixed and elevated

Pachyamana Gulma

दाहशूलार्तिसङ्क्षोभ स्वप्ननाशारतिज्वरैः|
विदह्यमानं जानीयाद्गुल्मं तमुपनाहयेत्||४१||
dāhaśūlārtisaṅkṣobha svapnanāśāratijvaraiḥ|
vidahyamānaṃ jānīyādgulmaṃ tamupanāhayet||41||

Signs and symptoms occur when the Gulma is in the process of suppuration:
Daha: Burning sensation
Shoola: colic pain
Arti: sawing pain
Sankshoba: irritation,
Swapna nasha – insomnia,
disliking for everything and
Jwara – fever.
Treatment: Upanaha – Poultice, hot ointment is applied over it [41]

Pakvagulma Lakshana, Chikitsa

विदाहलक्षणे गुल्मे बहिस्तुङ्गे समुन्नते|
श्यावे सरक्तपर्यन्ते संस्पर्शे बस्तिसन्निभे||४२||
निपीडितोन्नते स्तब्धे सुप्ते तत्पार्श्वपीडनात्|
तत्रैव पिण्डिते शूले सम्पक्वं गुल्ममादिशेत्||४३||
तत्र धान्वन्तरीयाणामधिकारः क्रियाविधौ|
वैद्यानां कृतयोग्यानां व्यधशोधनरोपणे||४४||
अन्तर्भागस्य चाप्येतत् पच्यमानस्य लक्षणम्|
हृत्क्रोडशूनताऽन्तःस्थे बहिःस्थे पार्श्वनिर्गतिः||४५||

vidāhalakṣaṇe gulme bahistuṅge samunnate|
śyāve saraktaparyante saṃsparśe bastisannibhe||42||
nipīḍitonnate stabdhe supte tatpārśvapīḍanāt|
tatraiva piṇḍite śūle sampakvaṃ gulmamādiśet||43||
tatra dhānvantarīyāṇāmadhikāraḥ kriyāvidhau|
vaidyānāṃ kṛtayogyānāṃ vyadhaśodhanaropaṇe||44||
antarbhāgasya cāpyetat pacyamānasya lakṣaṇam|
hṛtkroḍaśūnatā’ntaḥsthe bahiḥsthe pārśvanirgatiḥ||45||

Suppuration of Gulma is characterized by:
Vidaha – sloughing
Bahih tunge: outward protrusion
Unnata- elevation
Syava rakta – Grayish colour with a red margin
A feeling as if touching a bladder full of water. It comes back to original position after pressing.
Localisation in a round form
Supti – numbness and
Parshwapeedana – pain in the sides of Gulma – Tumours of the abdomen
Treatment of this condition is done by surgeons (Dhanvantanra school) who are well versed in the art of puncturing, purification and pressing through its sides.
When the Gulma is located in the Antar bhaga (interior of the body), the same signs and symptoms of Pachyamana Gulma are manifested. There will be swelling in the cardiac region (Hrutkroda) and in case of Gulma located in the exterior of the body there will be protuberance towards the sides of the abdomen [42-45]

Svayampravrutta Gulma

Management of Svayampravrutta Gulma: (mobile)
पक्वः स्रोतांसि सङ्क्लेद्य व्रजत्यूर्ध्वमधोऽपि वा|
स्वयम्प्रवृत्तं तं दोषमुपेक्षेत हिताशनैः ||४६||
दशाहं द्वादशाहं वा रक्षन् भिषगुपद्रवान्|
अत ऊर्ध्वं हितं पानं सर्पिषः सविशोधनम्||४७||
शुद्धस्य तिक्तं सक्षौद्रं प्रयोगे सर्पिरिष्यते|४८|
pakvaḥ srotāṃsi saṅkledya vrajatyūrdhvamadho’pi vā|
svayampravṛttaṃ taṃ doṣamupekṣeta hitāśanaiḥ ||46||
daśāhaṃ dvādaśāhaṃ vā rakṣan bhiṣagupadravān|
ata ūrdhvaṃ hitaṃ pānaṃ sarpiṣaḥ saviśodhanam||47||
śuddhasya tiktaṃ sakṣaudraṃ prayoge sarpiriṣyate|48|

At times, the suppurated Gulma, having softened the passage moves upwards or downwards. Like this, if the Doshas are in the process of elimination on their own (Svayampravrutta) then the physician should ignore it and should only pay attention to prevent any complication for 10 – 12 days. Thereafter, the patient should take ghee for the elimination of Doshas. When the body is purified (made free from morbid Doshas) the patient is given ghee boiled with bitter drugs by adding honey [46-47]

Kaphaja Gulma chikitsa

शीतलैर्गुरुभिः स्निग्धैर्गुल्मे जाते कफात्मके||४८||
अवम्यस्याल्पकायाग्नेः कुर्याल्लङ्घनमादितः|
मन्दोऽग्निर्वेदना मन्दा गुरुस्तिमितकोष्ठता||४९||
सोत्क्लेशा चारुचिर्यस्य स गुल्मी वमनोपगः|
उष्णैरेवोपचर्यश्च कृते वमनलङ्घने||५०||
योज्यश्चाहारसंसर्गो भेषजैः कटुतिक्तकैः|
सानाहं सविबन्धं च गुल्मं कठिनमुन्नतम्||५१||
दृष्ट्वाऽऽदौ स्वेदयेद्युक्त्या स्विन्नं च विलयेद्भिषक्|
लङ्घनोल्लेखने स्वेदे कृतेऽग्नौ सम्प्रधुक्षिते||५२||
कफगुल्मी पिबेत् काले सक्षारकटुकं घृतम्|
स्थानादपसृतं ज्ञात्वा कफगुल्मं विरेचनैः||५३||
सस्नेहैर्बस्तिभिर्वाऽपि शोधयेद्दाशमूलिकैः|
मन्देऽग्नावनिले मूढे ज्ञात्वा सस्नेहमाशयम्||५४||
गुटिकाचूर्णनिर्यूहाः प्रयोज्याः कफगुल्मिनाम्|
कृतमूलं महावास्तुं कठिनं स्तिमितं गुरुम्||५५||
जयेत्कफकृतं गुल्मं क्षारारिष्टाग्निकर्मभिः|५६|

śītalairgurubhiḥ snigdhairgulme jāte kaphātmake||48||
avamyasyālpakāyāgneḥ kuryāllaṅghanamāditaḥ|
mando’gnirvedanā mandā gurustimitakoṣṭhatā||49||
sotkleśā cāruciryasya sa gulmī vamanopagaḥ|
uṣṇairevopacaryaśca kṛte vamanalaṅghane||50||
yojyaścāhārasaṃsargo bheṣajaiḥ kaṭutiktakaiḥ|
sānāhaṃ savibandhaṃ ca gulmaṃ kaṭhinamunnatam||51||
dṛṣṭvā”dau svedayedyuktyā svinnaṃ ca vilayedbhiṣak|
laṅghanollekhane svede kṛte’gnau sampradhukṣite||52||
kaphagulmī pibet kāle sakṣārakaṭukaṃ ghṛtam|
sthānādapasṛtaṃ jñātvā kaphagulmaṃ virecanaiḥ||53||
sasnehairbastibhirvā’pi śodhayeddāśamūlikaiḥ|
mande’gnāvanile mūḍhe jñātvā sasnehamāśayam||54||
guṭikācūrṇaniryūhāḥ prayojyāḥ kaphagulminām|
kṛtamūlaṃ mahāvāstuṃ kaṭhinaṃ stimitaṃ gurum||55||
jayetkaphakṛtaṃ gulmaṃ kṣārāriṣṭāgnikarmabhiḥ|56|                                   If caused by cold, heavy and unctuous substances – Langhana (Fasting / lightening therapy) is administered.
If he is having less power of digestion, less of pain, heaviness, immobility of gastro-intestinal tract, nausea and anorexia – Vamana – emetic therapy.

After Vamana and Langhana, patient is given hot regimens. Diet is mixed with pungent and bitter drugs.

If the Gulma is hard and elevated and if the patient is also suffering from bloating and constipation, then in the beginning Swedana – fomentation therapy is applied.

By fasting, emetic and fomentation therapies, Agni (power of digestion) gets stimulated and the patient suffering from Kaphaja Gulma should take ghee boiled with alkalies and pungent herbs, at the appropriate time.

Having ascertained that the Kaphaja gulma is dislodged from the place of its manifestation, the patient is administered Virechana. He can also be administered  Snehabasti (oil enema), or Niruha with Dashamoola Kashaya.

If there is Mandagni – low digestion strength and bloating, then Snehana is given followed by medicines in the form of pills, herbal powder or decoction is administrated.

If Kaphaja Gulma has a strong foundation and is extensive in size, hard, immobile and heavy, then the patient is treated with alkalies, Aristas (Alcoholic preparations) and by cauterization (agni Karma) [48 ½ +1/2 56]

Kshara use in Gulma

Gulme Kshara Prayoga – Administration of Alkalies:
दोष प्रकृति गुल्मर्तुयोगं बुद्ध्वा कफोल्बणे||५६||
बलदोषप्रमाणज्ञः क्षारं गुल्मे प्रयोजयेत्|
एकान्तरं द्व्यन्तरं वा त्र्यहं विश्रम्य वा पुनः||५७||
शरीरबलदोषाणां वृद्धिक्षपणकोविदः|
श्लेष्माणं मधुरं स्निग्धं मांसक्षीरघृताशिनः||५८||
छित्त्वा छित्त्वाऽऽशयात् क्षारः क्षरत्वात क्षारयत्यधः|

doṣa prakṛti gulmartuyogaṃ buddhvā kapholbaṇe||56||
baladoṣapramāṇajñaḥ kṣāraṃ gulme prayojayet|
ekāntaraṃ dvyantaraṃ vā tryahaṃ viśramya vā punaḥ||57||
śarīrabaladoṣāṇāṃ vṛddhikṣapaṇakovidaḥ|
śleṣmāṇaṃ madhuraṃ snigdhaṃ māṃsakṣīraghṛtāśinaḥ||58||
chittvā chittvā”śayāt kṣāraḥ kṣaratvāta kṣārayatyadhaḥ|

Administration of Alkalies

In Kaphaja Gulma, after ascertaining the Dosha, Prakruti (body constitution), season, the physician should administer Kshara.

It is repeated at an interval of 1, 2 or 3 days by the physician who is conversant with the science of reducing a particular Dosha by promoting the physical strength of the patient.

Kapha which is sweet and unctuous gets aggravated in a person who indulges in meat, milk and ghee. Kshara (Alkali) has the property of Ksharana (Liquefaction). Thus it gradually erodes Kaphaja Gulma and brings it downwards. [56 ½ – ½ 59]

Arishta Therapy

मन्देऽग्नावरुचौ सात्म्ये मद्ये सस्नेहमश्नताम्||५९||
प्रयोज्या मार्गशुद्ध्यर्थमरिष्टाः कफगुल्मिनाम्|६०|
mande’gnāvarucau sātmye madye sasnehamaśnatām||59||
prayojyā mārgaśuddhyarthamariṣṭāḥ kaphagulminām|60|

In the course of administering Sneha (unctuous substance) to a patient suffering from Kaphaja Gulma, if he suffers from Mandagni – low digestion strength and  Aruchi – anorexia and if he is accustomed to alcohol intake, Arishtas (a type of alcoholic medicine) is administered with a view to clearing his channels. [59- ½ 60]

Agni Karma

Agni karma – Cauterization Therapy:

लङ्घनोल्लेखनैः स्वेदैः सर्पिःपानैर्विरेचनैः||६०||
बस्तिभिर्गुटिकाचूर्णक्षारारिष्टगणैरपि|
श्लैष्मिकः कृतमूलत्वाद्यस्य गुल्मो न शाम्यति||६१||
तस्य दाहो हृते रक्ते शरलोहादिभिर्हितः|
औष्ण्यात्तैक्ष्ण्याच्च शमयेदग्निर्गुल्मे कफानिलौ||६२||
तयोः शमाच्च सङ्घातो गुल्मस्य विनिवर्तते|
दाहे धान्वन्तरीयाणामत्रापि भिषजां बलम्||६३||
क्षारप्रयोगे भिषजां क्षारतन्त्रविदां बलम्|६४|

laṅghanollekhanaiḥ svedaiḥ sarpiḥpānairvirecanaiḥ||60||
bastibhirguṭikācūrṇakṣārāriṣṭagaṇairapi|
ślaiṣmikaḥ kṛtamūlatvādyasya gulmo na śāmyati||61||
tasya dāho hṛte rakte śaralohādibhirhitaḥ|
auṣṇyāttaikṣṇyācca śamayedagnirgulme kaphānilau||62||
tayoḥ śamācca saṅghāto gulmasya vinivartate|
dāhe dhānvantarīyāṇāmatrāpi bhiṣajāṃ balam||63||
kṣāraprayoge bhiṣajāṃ kṣāratantravidāṃ balam|64|

Agni karma – Cauterization Therapy:

If by Langhana, Vamana, Swedana, ghee intake, Virechana, enema, pills, powders, alkalies and various types of Arishta, Kaphaja Gulma does not get alleviated because of its obstinacy, then Agnikarma is done, prepared with the help of arrow, iron rod etc.

After blood-letting therapy because of its heating and sharp effects, cauterization therapy in Gulma alleviates Kapha and Vata as a result of which Gulma loses its compactness.

In Agnikarma, physicians belonging to Dhanvantara School have proficiency. Similarly, for the administration of Kshara (Alkali therapy), services of physicians who are Kshara-Tantra-vidhi (proficient in the administration Of Alkalies) is better utilized. (60 ½ – 1/9 64)

Vata Gulma Ayurvedic medicines

Ayurvedic medicines for Gulma:

Trayushanadi Ghrta

सिद्धानतः प्रवक्ष्यामि योगान् गुल्मनिबर्हणान्|
त्र्यूषण त्रिफला धान्य विडङ्ग चव्य चित्रकैः||६५||
कल्की कृतैर्घृतं सिद्धं सक्षीरं वातगुल्मनुत्|
इति त्र्यूषणादिघृतम्|

siddhānataḥ pravakṣyāmi yogān gulmanibarhaṇān|
tryūṣaṇa triphalā dhānya viḍaṅga cavya citrakaiḥ||65||
kalkī kṛtairghṛtaṃ siddhaṃ sakṣīraṃ vātagulmanut|
iti tryūṣaṇādighṛtam|

Now effective medicines for the successful treatment of Gulma will be described.
Ghee prepared by boiling with the paste of
Trayushana  – Trikatu – Pepper, long pepper and ginger
Triphala – Amla, Harad, Baheda
Dhanyaka – Coriander
Vidanga – False black pepper – Embelia ribes,
Chavya – Piper retrofractum and
Chitraka – Plumbago zeylanica and
Milk cures Vata Gulma. [65-1/2 – ½ 66]

Trayushanadi ghrta 2

Another Trayushanadi Ghrta:
एत एव च कल्काः स्युः कषायः पाञ्चमूलिकः  ||६६||
द्विपञ्चमूलिको वाऽपि तद्घृतं गुल्मनुत् परम्|
इति त्र्यूषणादिघृतमपरम्|
(षट्पलं वा पिबेत् सर्पिर्यदुक्तं राजयक्ष्मणि)||६७||
प्रसन्नया वा क्षीरार्थं सुरया दाडिमेन वा|
दध्नः सरेण वा कार्यं घृतं मारुतगुल्मनुत्||६८||
eta eva ca kalkāḥ syuḥ kaṣāyaḥ pāñcamūlikaḥ  ||66||
dvipañcamūliko vā’pi tadghṛtaṃ gulmanut param|
iti tryūṣaṇādighṛtamaparam|
(ṣaṭpalaṃ vā pibet sarpiryaduktaṃ rājayakṣmaṇi)||67||
prasannayā vā kṣīrārthaṃ surayā dāḍimena vā|
dadhnaḥ sareṇa vā kāryaṃ ghṛtaṃ mārutagulmanut||68||

Ghee is boiled with the paste of drugs mentioned above (verse 65) and the decoction of either PanchaMoola or DashaMoola.
This medicated ghee is the best recipe for curing Gulma.

In this recipe, Prasanna, Sura, juice of Dadima (Pomegranate) \or cream of milk is added while processing in place of milk [66-1/2 68]

Hingu Sauvarchaladi Ghrta

हिङ्गु सौवर्चलाजाजी बिड दाडिम दीप्यकैः|
पुष्कर व्योष धन्याक वेतस क्षार चित्रकैः||६९||
शटी वचाजगन्धैलासुरसैश्च विपाचितम्|
शूलानाहहरं सर्पिर्दध्ना चानिलगुल्मिनाम्||७०||
इति हिङ्गुसौवर्चलाद्यं घृतम्|
hiṅgu sauvarcalājājībiḍa dāḍima dīpyakaiḥ|
puṣkara vyoṣa dhanyāka vetasa kṣāra citrakaiḥ||69||
śaṭī vacājagandhailāsurasaiśca vipācitam|
śūlānāhaharaṃ sarpirdadhnā cānilagulminām||70||
iti hiṅgusauvarcalādyaṃ ghṛtam|

Ghee prepared with
Hingu – Asafoetida
Sauvarchala – Black salt
Ajaji – Cumin – Cuminum cyminum,
Bida salt
Dadima – Pomegranate – Punica granatum
Dipyaka – Ajowan (fruit) – Trachyspermum roxburghianum,
Pushkara – Inula racemosa
Vyosha – Operculina turpethum
Dhanyaka – Coriander – Coriandrum sativum,
Kshara – Yavakshara
Vetasa – Salix tetrasperma,
Chitraka – Plumbago zeylanica
Shati – Hedyium spicatum
Vacha – Acorus calamus
It is useful for patients suffering from Vataja Gulma. [69-70]

Hapushadi Ghrita

हपुषा व्योष पृथ्वीका चव्य चित्रक सैन्धवैः|
साजाजी पिप्पलीमूल दीप्यकैर्विपचेद्घृतम्||७१||
सकोल मूलकरसं सक्षीर दधि दाडिमम्|
तत् परं वातगुल्मघ्नं शूलानाहविमोक्षणम्||७२||
योन्यर्शोग्रहणीदोषश्वासकासारुचिज्वरान्|
बस्तिहृत्पार्श्वशूलं च घृतमेतद्व्यपोहति||७३||
इति हपुषाद्यं घृतम्|

hapuṣā vyoṣa pṛthvīkā cavya citraka saindhavaiḥ|
sājājī pippalīmūla dīpyakairvipacedghṛtam||71||
sakola mūlakarasaṃ sakṣīra dadhi dāḍimam|
tat paraṃ vātagulmaghnaṃ śūlānāhavimokṣaṇam||72||
yonyarśograhaṇīdoṣaśvāsakāsārucijvarān|
bastihṛtpārśvaśūlaṃ ca ghṛtametadvyapohati||73||
iti hapuṣādyaṃ ghṛtam|

Hapusha – Juniperus communis
Vyosa – Operculina turpethum
Prithvika –
Chavya – Piper retrofractum
Chitraka – Plumbago zeylanica
Saindhava Lavana – Black salt
Ajaji – Cumin – Cuminum cyminum
PipaliMula – Long pepper root and
Dipyaka – Ajowan (fruit) – Trachyspermum roxburghianum along with these herbs, ghee is prepared by adding
Juice of Kola – Ber fruit – Ziziphus jujuba and Mulaka, milk, curd and juice of Dadima – Pomegranate – Punica granatum.
It is an excellent recipe for the treatment of Vata Gulma.
It cures-
Shoola – abdominal colic pain
Anaha – abdominal distension of the female genital tract,
Piles
Sprue syndrome – Grahani Dosha
Shwasa – Asthma
Kasa – Cough
Aruchi – Anorexia
Jwara – Fever and
Parshva, hrut, basti shoola: Pain in the region of urinary bladder including kidney, heart as well as sides of the chest [71-73]

Pippalyadya Ghrta

पिप्पल्या पिचुरध्यर्धो दाडिमाद्द्विपलं पलम्|
धान्यात्पञ्च घृताच्छुण्ठ्याः कर्षः क्षीरं चतुर्गुणम्||७४||
सिद्धमेतैर्घृतं सद्यो वातगुल्मं व्यपोहति|
योनिशूलं शिरःशूलमर्शांसि विषमज्वरम्||७५||
इति पिप्पल्याद्यं घृतम्|

pippalyā picuradhyardho dāḍimāddvipalaṃ palam|
dhānyātpañca ghṛtācchuṇṭhyāḥ karṣaḥ kṣīraṃ caturguṇam||74||
siddhametairghṛtaṃ sadyo vātagulmaṃ vyapohati|
yoniśūlaṃ śiraḥśūlamarśāṃsi viṣamajvaram||75||
iti pippalyādyaṃ ghṛtam|

5 Palas of Ghee is processed with
1½ of Pippali – Long pepper fruit – Piper longum
2 Palas of Dadima – Pomegranate – Punica granatum,
1 Pala of Dhanya – Coriander sativum
1 karsha of Sunthi – Ginger and
20 palas of milk
This medicated ghee is indicated in-
Vatika- Gulma
Yoni shoolam – Pain in the female genital organ
Shira shoola -Headache
Arshas – Piles and
Vishama Jvara – irregular fever [74-75]

Other Recipes:
घृतानामौषधगणा य एते परिकीर्तिताः|
ते चूर्णयोगा वर्त्यस्ताः कषायास्ते च गुल्मिनाम्||७६||
कोल दाडिम घर्माम्बुसुरामण्डाम्लकाञ्जिकैः|
शूलानाहहरी पेया बीजपूररसेन वा||७७||
चूर्णानि मातुलुङ्गस्य भावितानि रसेन वा|
कुर्याद्वर्तीः सगुटिका गुल्मानाहार्तिशान्तये||७८||

ghṛtānāmauṣadhagaṇā ya ete parikīrtitāḥ|
te cūrṇayogā vartyastāḥ kaṣāyāste ca gulminām||76||
kola dāḍima gharmāmbusurāmaṇḍāmlakāñjikaiḥ|
śūlānāhaharī peyā bījapūrarasena vā||77||
cūrṇāni mātuluṅgasya bhāvitāni rasena vā|
kuryādvartīḥ saguṭikā gulmānāhārtiśāntaye||78||

Groups of drugs described in the above verses, for different recipes of herbal Ghee can also be used in different other forms like powder, Varti (Suppository) and decoctions for the treatment of a patient suffering from Gulma. \

These recipes in powder form can be used along with the
Juice of Kola – Ber fruit – Ziziphus jujuba and
Dadima – Pomegranate – Punica granatum,
Hot water
Sura Manda (upper portion of an alcoholic preparation),
Sour Kanji (vinegar) or the juice of bija Pura.
They cure:
Colic pain and
Anaha – abdominal distension
These recipes in powder from can be impregnated with the juice of Matulunga and made to a form of suppository or pill.
These are also useful in curing abdominal distension and pain of a patient suffering from Gulma. [76-78]

Hingvadi churna, gutika

Hingvadi Churna & Hingvadi Gutika:
हिङ्गु त्रिकटुकं पाठां हपुषामभयां शटीम्|
अजमोदाजगन्धे च तिन्तिडीकाम्लवेतसौ||७९||
दाडिमं पुष्करं धान्यमजाजीं चित्रकं वचाम्|
द्वौ क्षारौ लवणे द्वे च चव्यं चैकत्र चूर्णयेत्||८०||
चूर्णमेतत् प्रयोक्तव्यमन्नपानेष्वनत्ययम्|
प्राग्भक्तमथवा पेयं मद्येनोष्णोदकेन वा||८१||
पार्श्वहृद्बस्तिशूलेषु गुल्मे वातकफात्मके|
आनाहे मूत्रकृच्छ्रे च शूले च गुदयोनिजे ||८२||
ग्रहण्यर्शोविकारेषु प्लीह्नि पाण्ड्वामयेऽरुचौ|
उरोविबन्धे हिक्कायां कासे श्वासे गलग्रहे||८३||
भावितं मातुलुङ्गस्य चूर्णमेतद्रसेन वा|
बहुशो गुटिकाः कार्याः कार्मुकाः स्युस्ततोऽधिकम्||८४||
इति हिङ्ग्वादिचूर्णं गुटिका च|

hiṅgu trikaṭukaṃ pāṭhāṃ hapuṣāmabhayāṃ śaṭīm|
ajamodājagandhe ca tintiḍīkāmlavetasau||79||
dāḍimaṃ puṣkaraṃ dhānyamajājīṃ citrakaṃ vacām|
dvau kṣārau lavaṇe dve ca cavyaṃ caikatra cūrṇayet||80||
cūrṇametat prayoktavyamannapāneṣvanatyayam|
prāgbhaktamathavā peyaṃ madyenoṣṇodakena vā||81||
pārśvahṛdbastiśūleṣu gulme vātakaphātmake|
ānāhe mūtrakṛcchre ca śūle ca gudayonije ||82||
grahaṇyarśovikāreṣu plīhni pāṇḍvāmaye’rucau|
urovibandhe hikkāyāṃ kāse śvāse galagrahe||83||
bhāvitaṃ mātuluṅgasya cūrṇametadrasena vā|
bahuśo guṭikāḥ kāryāḥ kārmukāḥ syustato’dhikam||84||
iti hiṅgvādicūrṇaṃ guṭikā ca|

Hingu- Asa foetida
Trikatuka – Pepper, long pepper and ginger
Patha – Cyclea peltata,
Jwara – fever
Hapusha – Juniperus communis
Abhaya – Chebulic Myrobalan fruit rind – Terminalia chebula,
Shati – Hedyium spicatum
Ajamoda – Ajowan (fruit) – Trachyspermum roxburghianum,
Ajagandha – Cleome gynandra
Tintidika –
Amla – Indian gooseberry fruit – Emblica officinalis Gaertn. –vetasa,
Dadima – Pomegranate – Punica granatum,
Puskara – Inula racemosa
Dhanya – Coriandrum sativum
Ajaji – Cuminum cyminum,
Chitraka – Plumbago zeylanica
Vacha – Acorus calamus
2 types of ksara (alkalies),
2 types of Lavana (salt) and
Chavya – Piper retrofractum all these is made administered along with food and drinks.
It can be given before food along with alcoholic drink or hot water.
It cures:
Pain in the sides of the chest, Cardiac region and Basti (urinary bladder including kidneys)
Gulma caused by Vata and Kapha,
Anaha (abdominal distension),
Dysuria
Pain in anus and female genital tract,
Grahani – Sprue syndrome
Piles
Splenic disorders,
Pandu – Anemia
Aruchi – anorexia,
Urovibandha (stiffness of the chest),
Hikka – hiccup
Kasa – cough
Shwasa – asthma and
Obstruction in the throat
If this powder is impregnated for 7 days with the juice of Matulunga and then made into pills, it becomes therapeutically more effective. [79-84]

Hingvadi Yoga

मातुलुङ्गरसो हिङ्गु दाडिमं बिडसैन्धवे|
सुरामण्डेन पातव्यं वातगुल्मरुजापहम्||८५||
mātuluṅgaraso hiṅgu dāḍimaṃ biḍasaindhave|
surāmaṇḍena pātavyaṃ vātagulmarujāpaham||85||
Juice of Matulunga – Citrus medica
Hingu – Asa foetida
Dadima – Pomegranate – Punica granatum
Bida salt
Saindhava Lavana – Black salt- these is administered along with Suramanda (upper portion of an alcoholic preparation) for the cure of the pain of Vata Gulma [85]

Shatyadi churna, gutika

Shatyadi Curna and Shatyadi Gutika:
शटी पुष्कर हिङ्ग्वम्लवेतस क्षार चित्रकान्|
धान्यकं च यवानीं च विडङ्गं सैन्धवं वचाम्||८६||
सचव्य पिप्पलीमूलामजगन्धां सदाडिमाम्|
अजाजीं चाजमोदां च चूर्णं कृत्वा प्रयोजयेत्||८७||
रसेन मातुलुङ्गस्य मधुशुक्तेन वा पुनः|
भावितं गुटिकां कृत्वा सुपिष्टां कोलसम्मिताम्||८८||
गुल्मं प्लीहानमानाहं श्वासं कासमरोचकम्|
हिक्कां हृद्रोगमर्शांसि विविधां शिरसो रुजम्||८९||
पाण्ड्वामयं कफोत्क्लेशं सर्वजां च प्रवाहिकाम्|
पार्श्वहृद्बस्तिशूलं च गुटिकैषा व्यपोहति||९०||
śaṭī puṣkara hiṅgvamlavetasa kṣāra citrakān|
dhānyakaṃ ca yavānīṃ ca viḍaṅgaṃ saindhavaṃ vacām||86||
sacavya pippalīmūlāmajagandhāṃ sadāḍimām|
ajājīṃ cājamodāṃ ca cūrṇaṃ kṛtvā prayojayet||87||
rasena mātuluṅgasya madhuśuktena vā punaḥ|
bhāvitaṃ guṭikāṃ kṛtvā supiṣṭāṃ kolasammitām||88||
gulmaṃ plīhānamānāhaṃ śvāsaṃ kāsamarocakam|
hikkāṃ hṛdrogamarśāṃsi vividhāṃ śiraso rujam||89||
pāṇḍvāmayaṃ kaphotkleśaṃ sarvajāṃ ca pravāhikām|
pārśva hṛd basti śūlaṃ ca guṭikaiṣā vyapohati||90||
Shati – Hedyium spicatum
Pushkara – Inula racemosa
Hingu – Asafoetida,
AmlaVetasa – Salix tetrasperma,
Kshara – Yavakshara
Chitraka – Plumbago zeylanica
Dhanyaka – Coriander – Coriandrum sativum
Yavani – Trachyspermum roxburghianum
Vidanga – False black pepper – Embelia ribes,
Saindava – Rock Salt
Vacha – Acorus calamus
Chavya – Piper retrofractum
Pippalimula – Long pepper fruit – Piper longum,
Ajagandha – Cleome gynandra
Dadima – Pomegranate – Punica granatum
Ajaji – Cuminum cyminum and
Ajamoda – Ajowan (fruit) – Trachyspermum roxburghianum is made to a powder and administered.

This powder may be impregnated with the-
Juice of Matulunga – Citrus medica or
Madhu- Sukta and made to a fine paste.
Then pills of the size of Kola – Ziziphus jujuba fruit is made out of it.
This pill cures:
Gulma
Splenic disorders
Anaha – abdominal distension
Shwasa – asthma
Kasa – cough,
Aruchi – Anorexia,
Hikka – hiccup
Hrut pida – heart disease
Shira shoola – headache
Pandu – anaemia
Nausea caused by aggravation of Kapha, Sannipatika type of Pravahika and
Parshva, hrd, basti shula: Pain in side of the chest, cardiac region and Basti (urinary bladder including kidneys) [86-90]

Nagaradi Yoga

नागरार्धपलं पिष्ट्वा द्वे पले लुञ्चितस्य च|
तिलस्यैकं गुडपलं क्षीरेणोष्णेन ना पिबेत्||९१||
वात गुल्ममुदावर्तं योनिशूलं च नाशयेत्|
nāgarārdhapalaṃ piṣṭvā dve pale luñcitasya ca|
tilasyaikaṃ guḍapalaṃ kṣīreṇoṣṇena nā pibet||91||
vāta gulmamudāvartaṃ yoniśūlaṃ ca nāśayet|
Ingredients:
1/2 Pala of nagara – Ginger
2 Palas of Tila – Sesamum indicum and
1 Pala of Guda – Jaggery is made to a paste and taken along with hot milk.

This potion cures
Vata-Gulma
Udavarta – upward movement of wind) and
Yoni shoola – Pain in female genital organs [91 ½- 92]

Administration of Castor oil

पिबेदेरण्डजं तैलं वारुणी मण्डमिश्रितम्||९२||
तदेव तैलं पयसा वातगुल्मी पिबेन्नरः|
श्लेष्मण्यनुबले पूर्वं हितं पित्तानुगे परम्||९३||

pibederaṇḍajaṃ tailaṃ vāruṇī maṇḍamiśritam||92||
tadeva tailaṃ payasā vātagulmī pibennaraḥ|
śleṣmaṇyanubale pūrvaṃ hitaṃ pittānuge param||93||

Erandataila – Castor oil is taken by a patient suffering from Vataja Gulma after mixing it with the Manda (upper portion) of Varuni (a type of alcoholic preparation) or milk.

It is taken with Manda of Varuni, if kapha is secondarily aggravated along with Vata Dosha.
It is taken with milk if Pitta is secondarily aggravated. [92-93]

Lashuna Ksheerapaka

साधयेच्छुद्धशुष्कस्य लशुनस्य चतुष्पलम्|
क्षीरोदकेऽष्टगुणिते क्षीरशेषं च ना पिबेत्||९४||
वातगुल्ममुदावर्तं गृध्रसीं विषमज्वरम्|
हृद्रोगं विद्रधिं शोथं साधयत्याशु तत्पयः||९५||
इति लशुनक्षीरम्|

sādhayecchuddhaśuṣkasya laśunasya catuṣpalam|
kṣīrodake’ṣṭaguṇite kṣīraśeṣaṃ ca nā pibet||94||
vāta gulmamudāvartaṃ gṛdhrasīṃ viṣamajvaram|
hṛdrogaṃ vidradhiṃ śothaṃ sādhayatyāśu tatpayaḥ||95||
iti laśunakṣīram|

4 Palas of Dehusked and dried Lasuna is boiled by adding 8 times of milk and water and reduced to the quantity of milk.
This medicated milk immediately cures
Vata- Gulma,
Udavarta – upward movement of wind
Gridhrasi – sciatica
Vishama Jvara – Recurrent fever
Hrid rogam – heart disease,
Vidradhi – Abscess and
Shotha – edema. [94-95]
Learn how to prepare Lashuna Ksheerapaka

Taila panchaka

तैलं प्रसन्ना गोमूत्रमारनालं यवाग्रजम्|
गुल्मं जठरमानाहं पीतमेकत्र साधयेत्||९६||
इति तैलपञ्चकम् |
tailaṃ prasannā gomūtramāranālaṃ yavāgrajam|
gulmaṃ jaṭharamānāhaṃ pītamekatra sādhayet||96||
iti tailapañcakam |

Taila (sesame oil), Prasanna (a type of alcoholic drink), cow’s urine, aranala (a type of sour drink) and YavaKshara is taken together for the cure of Gulma Jathara and Anaha (abdominal bloating) [96]

Administration of Shilajat

पञ्चमूलीकषायेण सक्षारेण शिलाजतु|
पिबेत्तस्य प्रयोगेण वातगुल्मात् प्रमुच्यते||९७||
इति शिलाजतुप्रयोगः|

pañcamūlīkaṣāyeṇa sakṣāreṇa śilājatu|
pibettasya prayogeṇa vātagulmāt pramucyate||97||
iti śilājatuprayogaḥ|

Intake of Shilajatu along with the decoction of Panchamoola added with Kshara (alkali preparation) Yava – Barley – Hordeum vulgare Kshara cures Vataja Gulma. [97]

Administration of boiled barley

वाट्यं पिप्पलीयूषेण मूलकानां रसेन वा|
भुक्त्वा स्निग्धमुदावर्ताद्वातगुल्माद्विमुच्यते||९८||
vāṭyaṃ pippalīyūṣeṇa mūlakānāṃ rasena vā|
bhuktvā snigdhamudāvartādvātagulmādvimucyate||98||

Intake of Vatya (boiled barley) along with the soup of Pippali – Long pepper fruit – Piper longum or the juice of Mulaka – Radish – Raphanus sativus by adding Sneha (ghee) cures Udavarta (upward movement of Vata) and Vata-Gulma [98]

Swedana therapy

Swedana – Sweating Therapy:
शूलानाह विबन्धार्तं स्वेदयेद्वातगुल्मिनम्|
स्वेदैः स्वेद विधावुक्तैर्नाडीप्रस्तर सङ्करैः||९९||
śūlānāha vibandhārtaṃ svedayedvātagulminam|
svedaiḥ sveda vidhāvuktairnāḍīprastara saṅkaraiḥ||99||
If the patient of Vata- Gulma has symptoms like-
Shula – colic pain,
Anaha – abdominal distension and
Vibandha – constipation, then he is given fomentation therapy with the help of Nadi, Prastara or Sankara type of fomentation as described in Sutra 14[99]

Enema therapy

Basti – Enema Therapy:
बस्तिकर्म परं विद्याद्गुल्मघ्नं तद्धि मारुतम्|
स्वे स्थाने प्रथमं जित्वा सद्यो गुल्ममपोहति||१००||
तस्मादभीक्ष्णशो गुल्मा निरूहैः सानुवासनैः|
प्रयुज्यमानैः शाम्यन्ति वातपित्तकफात्मकाः||१०१||
गुल्मघ्ना विविधा दिष्टाः सिद्धाः सिद्धिषु बस्तयः|१०२|

bastikarma paraṃ vidyādgulmaghnaṃ taddhi mārutam|
sve sthāne prathamaṃ jitvā sadyo gulmamapohati||100||
tasmādabhīkṣṇaśo gulmā nirūhaiḥ sānuvāsanaiḥ|
prayujyamānaiḥ śāmyanti vātapittakaphātmakāḥ||101||
gulmaghnā vividhā diṣṭāḥ siddhāḥ siddhiṣu bastayaḥ|102|

Medicated enema is the best therapy for curing Gulma.
In the beginning, it overcomes Gulma. Therefore, Niruha and Anuvasana types of medicated enema is administered frequently for the cure.over Dosage or taking this medicine for longer period than prescribed may cause Vatika, Paittika and Kaphaja type of Gulma.
Different effective recipes of medicated enema for successful treatment of this disease are described in Siddhi section of this work. [100-101]

Herbal Oils and Ghee

गुल्मघ्नानि च तैलानि वक्ष्यन्ते वातरोगिके||१०२||
तानि मारुतजे गुल्मे पानाभ्यङ्गानुवासनैः|
प्रयुक्तान्याशु सिध्यन्ति तैलं ह्यनिलजित्परम् ||१०३||

gulmaghnāni ca tailāni vakṣyante vātarogike||102||
tāni mārutaje gulme pānābhyaṅgānuvāsanaiḥ|
prayuktānyāśu sidhyanti tailaṃ hyanilajitparam ||103||

Recipes of medicated oils in the chapter dealing with the treatment of Vata-Roga (Chikitsa 28) should be useful for Pana (oral intake), massage and Anuvasana type of medicated enema by a patient suffering from Vataja Gulma. Medicated oil is the best for overcoming Vata. Therefore, these recipes cure Gulma instantaneously.

Ghee for Purification of Body:
नीलिनीचूर्णसंयुक्तं पूर्वोक्तं घृतमेव|
समलाय प्रदातव्यं शोधनं वातगुल्मिने||१०४|||
nīlinīcūrṇasaṃyuktaṃ pūrvoktaṃ ghṛtameva|
samalāya pradātavyaṃ śodhanaṃ vātagulmine||104||

Recipes of medicated ghee described earlier in the chapter is administered along with the powder of Neelini – Indigofera tinctorea to the patient suffering from Vata Gulma for the elimination (Shodhana) of excreta (Mala) from his body.[102- 104]

Nilinyadya Ghrita

नीलिनी त्रिवृता दन्ती पथ्या कम्पिल्लकैः सह|
शोधनार्थं घृतं देयं सबिडक्षार नागरम्||१०५||
nīlinī trivṛtā dantī pathyā kampillakaiḥ saha|
śodhanārthaṃ ghṛtaṃ deyaṃ sabiḍakṣāra nāgaram||105||

For purification (elimination of waste products from the body), ghee is administered along with
Nilini – Indigofera tinctoria
Trivrit – Operculina turpethum
Danti – Baliospermum montanum,
Pathya – Chebulic Myrobalan fruit rind – Terminalia chebula and
Kampillaka – Mallotus phillippinensis
By adding Bida a (type of salt), Kshara (Alkalies) and Nagara (ginger) [105]

Neelinyadi Ghrita 2

नीलिनीं त्रिफलां रास्नां बलां कटुकरोहिणीम्|
पचेद्विडङ्गं व्याघ्रीं च पलिकानि जलाढके||१०६||
तेन पादावशेषेण घृतप्रस्थं विपाचयेत्|
दध्नः प्रस्थेन संयोज्य सुधाक्षीरपलेन च||१०७||
ततो घृतपलं दद्याद्यवागूमण्डमिश्रितम्|
जीर्णे सम्यग्विरिक्तं च भोजयेद्रसभोजनम्||१०८||
गुल्मकुष्ठोदरव्यङ्गशोफपाण्ड्वामयज्वरान्|
श्वित्रं प्लीहानमुन्मादं घृतमेतद्व्यपोहति||१०९||
इति नीलिन्याद्यं घृतम्|

nīlinī trivṛtā dantī pathyā kampillakaiḥ saha|
śodhanārthaṃ ghṛtaṃ deyaṃ sabiḍakṣāra nāgaram||105||
nīlinīṃ triphalāṃ rāsnāṃ balāṃ kaṭukarohiṇīm|
pacedviḍaṅgaṃ vyāghrīṃ ca palikāni jalāḍhake||106||
tena pādāvaśeṣeṇa ghṛtaprasthaṃ vipācayet|
dadhnaḥ prasthena saṃyojya sudhākṣīrapalena ca||107||
tato ghṛtapalaṃ dadyādyavāgūmaṇḍamiśritam|
jīrṇe samyagviriktaṃ ca bhojayedrasabhojanam||108||
gulma kuṣṭhodara vyaṅga śopha pāṇḍvāmayajvarān|
śvitraṃ plīhānamunmādaṃ ghṛtametadvyapohati||109||
iti nīlinyādyaṃ ghṛtam|

Neelinyadi Ghrita – 2
1 Pala of each of
Nilini – Indigofera tinctoria
Triphala – Amla, harad, Baheda
Rasna – Pluchea lanceolata / Vanda roxburghi,
Bala – Country mallow (root) – Sida cordifolia,
Katuka Rohini – Kutki – Picrorhiza kurroa
Vidanga – False black pepper – Embelia ribes and
Vyaghri – Kantakari
is boiled in 1 Adhaka of water till 1/4th remains.
This is boiled by adding 1 prastha of Ghee, 1 Prastha of curd and 1 Pala of the milky- latex of Sudha (Snuhi).
1 Pala of this medicated ghee is administered to the patient by mixing it with Yavagu (thick gruel) or Manda (a type of thin gruel).
When the recipe is digested and when he is properly purged, he is given food in the form of meat soup.
This medicated ghee cures
Gulma,
Kushta – Obstinate abdominal diseases including leprosy
Udara – obstinate abdominal diseases including ascites
Vyanga – dark spots on the face
Shotha – edema
Pandu – anemia,
Jwara – fever
Leucoderma,
Splenic disorders and
Insanity [106-109]

Diet for Vata Gulma

कुक्कुटाश्च मयूराश्च तित्तिरिक्रौञ्चवर्तकाः|
शालयो मदिरा सर्पिर्वातगुल्मभिषग्जितम्||११०||
हितमुष्णं द्रवं स्निग्धं भोजनं वातगुल्मिनाम्|
समण्डवारुणीपानं पक्वं वा धान्यकैर्जलम्||१११||
मन्देऽग्नौ वर्धते गुल्मो दीप्ते चाग्नौ प्रशाम्यति|
तस्मान्ना नातिसौहित्यं कुर्यान्नातिविलङ्घनम्||११२||
सर्वत्र गुल्मे प्रथमं स्नेहस्वेदोपपादिते|
या क्रिया क्रियते सिद्धिं सा याति न विरूक्षिते||११३||

kukkuṭāśca mayūrāśca tittirikrauñcavartakāḥ|
śālayo madirā sarpirvātagulmabhiṣagjitam||110||
hitamuṣṇaṃ dravaṃ snigdhaṃ bhojanaṃ vātagulminām|
samaṇḍavāruṇīpānaṃ pakvaṃ vā dhānyakairjalam||111||
mande’gnau vardhate gulmo dīpte cāgnau praśāmyati|
tasmānnā nātisauhityaṃ kuryānnātivilaṅghanam||112||
sarvatra gulme prathamaṃ snehasvedopapādite|
yā kriyā kriyate siddhiṃ sā yāti na virūkṣite||113||

Meat of cook, peacock, Tittiri, Kraunca and Vartaka, Different types of Shali Rice, Madira (alcoholic drink) and ghee, these are to be used in the treatment of Vata- Gulma. Hot, liquid ad unctuous food and drinks like Varunu(a type of alcoholic drink) along with its Manda (upper portion or water boiled by adding Dhanyaka – Coriander – Coriandrum sativum are useful for a patient suffering from Vata- Gulma.
If there is suppression of the power of digestion then Gulma gets aggravated, and if the power of digestion then Gulma gets aggravated, and if the power of digestion is stimulated then Gulma gets alleviated. Therefore, the patient should not eat in excess nor should he fast in excess. [110-112]

Pittaja Gulma Ayurvedic medicines

Medicines for Pittaja Gulma Chikitsa:

Trayamanadi Ghurta

जले दशगुणे साध्यं त्रायमाणाचतुष्पलम्|
पञ्चभागस्थितं पूतं कल्कैः संयोज्य कार्षिकैः||११८||
रोहिणी कटुका मुस्ता त्रायमाणा दुरालभा|
कल्कैस्तामलकीवीरा जीवन्ती चन्दनोत्पलैः||११९||
रसस्यामलकानां च क्षीरस्य च घृतस्य च|
पलानि पृथगष्टाष्टौ दत्त्वा सम्यग्विपाचयेत्||१२०||
पित्तरक्तभवं गुल्मं वीसर्पं पैत्तिकं ज्वरम्|
हृद्रोगं कामलां कुष्ठं हन्यादेतद्घृतोत्तमम्||१२१||
इति त्रायमाणाद्यं घृतम्|

jale daśaguṇe sādhyaṃ trāyamāṇācatuṣpalam|
pañcabhāgasthitaṃ pūtaṃ kalkaiḥ saṃyojya kārṣikaiḥ||118||
rohiṇī kaṭukā mustā trāyamāṇā durālabhā|
kalkaistāmalakīvīrā jīvantī candanotpalaiḥ||119||
rasasyāmalakānāṃ ca kṣīrasya ca ghṛtasya ca|
palāni pṛthagaṣṭāṣṭau dattvā samyagvipācayet||120||
pittaraktabhavaṃ gulmaṃ vīsarpaṃ paittikaṃ jvaram|
hṛdrogaṃ kāmalāṃ kuṣṭhaṃ hanyādetadghṛtottamam||121||
iti trāyamāṇādyaṃ ghṛtam|

Trayamanadya Ghurta:
4 Palas of Trayamana – Gentiana kurroo is boiled with 10 times of water and reduced to 1/5th.
To this decoction, the paste of 1 Karsha – 12 g each of
Katurohini – Kutki
Musta – Nut grass (root) – Cyperus rotundus,
Trayamana – Gentiana kurroa
Duralabha – Alhagi camelorum
Tamalaki – Phyllanthus niruri
Veera
Jivanti – Leptadenia reticulata,
Chandana – Santalum album and
Utpala – Nymphaea stellata and
8 Palas each of the juice of Amalaka,
Milk and
Ghee is added and cooked properly.
This excellent recipe of medicated ghee cures:
Gulma caused by Pitta and Raktha
Visarpa – erysipelas
Paittika types of fever
Hrdroga – Heart disease
Kamala – Jaundice and
Kushta – skin diseases [118-121]

Amalakadi Ghrta

रसेनामलकेक्षूणां घृतपादं विपाचयेत्|
पथ्यापदं पिबेत्सर्पिस्तत्सिद्धं पित्तगुल्मनुत्||१२२||
इत्यामलकाद्यं घृतम्|
rasenāmalakekṣūṇāṃ ghṛtapādaṃ vipācayet|
pathyāpadaṃ pibetsarpistatsiddhaṃ pittagulmanut||122||
ityāmalakādyaṃ ghṛtam|

To the juice of Amla and Ikshu, 1/4th ghee in quantity is added and cooked. During cooking, the 1/4th paste of Pathya – Chebulic Myrobalan fruit rind – Terminalia chebula in quantity is added. Intake of this medicated ghee cures Paittika Gulma. [122]

Drakshadya Ghrita

द्राक्षां मधूकं खर्जूरं विदारीं सशतावरीम्|
परूषकाणि त्रिफलां साधयेत्पलसम्मितम्||१२३||
जलाढके पादशेषे रसमामलकस्य च|
घृतमिक्षुरसं क्षीरमभयाकल्कपादिकम्||१२४||
साधयेत्तद्घृतं सिद्धं शर्कराक्षौद्रपादिकम्|
प्रयोगात् पित्तगुल्मघ्नं सर्वपित्तविकारनुत्||१२५||
इति द्राक्षाद्यं घृतम् |

Drakshadi Ghrita:
drākṣāṃ madhūkaṃ kharjūraṃ vidārīṃ saśatāvarīm|
parūṣakāṇi triphalāṃ sādhayetpalasammitam||123||
jalāḍhake pādaśeṣe rasamāmalakasya ca|
ghṛtamikṣurasaṃ kṣīramabhayākalkapādikam||124||
sādhayettadghṛtaṃ siddhaṃ śarkarākṣaudrapādikam|
prayogāt pitta gulmaghnaṃ sarva pittavikāranut||125||
iti drākṣādyaṃ ghṛtam|

1 Pala each of Draksha – Raisin – Vitis vinifera,
Madhuka –Madhuca longifolia
Vidari – Ipomoea paniculata / Pueraria tuberosa,
Shatavari – Asparagus racemosus
Parushaka – Falsa Fruit – Grewia asiatica and
Triphala is boiled with 1 Adhaka of water and reduced to fourth.
To this, juice of Amalaku, ghee, sugar cane juice, milk and 1/4th in quantity of the paste of Abhaya – Terminalia chebula is added.
After it is cooked, 1/4th in quantity of sugar and honey is added.
This recipes cures Paittika Gulma and other diseases caused by Pitta [123-125]

Vasa Ghrutha

वृषं समूलमापोथ्य पचेदष्टगुणे जले|
शेषेऽष्टभागे तस्यैव पुष्पकल्कं प्रदापयेत्||१२६||
तेन सिद्धं घृतं शीतं सक्षौद्रं पित्तगुल्मनुत्|
रक्तपित्त ज्वर श्वास कास हृद्रोग नाशनम्||१२७||
इति वासाघृतम्|

vṛṣaṃ samūlamāpothya pacedaṣṭaguṇe jale|
śeṣe’ṣṭabhāge tasyaiva puṣpakalkaṃ pradāpayet||126||
tena siddhaṃ ghṛtaṃ śītaṃ sakṣaudraṃ pittagulmanut|
raktapitta jvara śvāsa kāsa hṛdroga nāśanam||127||
iti vāsāghṛtam|

Vasa Ghrutha:
Vasa – Adhathoda vasica along with its root is crushed and boiled in 8 times of water till 1/8th remains. To this the paste of the flower of Vata and ghee is added and it is cooked. After it is cooled, honey is added and given to the patient.
This ghee cures:
Pitta-gulma
Rakta Pitta – a disease characterised by bleeding from different parts of the body,
Jvara – fever
Shwasa – Asthma
Kasa – coughing and
Hrd roga – cardiac ailments [126-127]

Trayamana Ksheera Yoga

द्विपलं त्रायमाणाया जल द्वि प्रस्थ साधितम्|
अष्टभाग स्थितं पूतं कोष्णं क्षीरसमं पिबेत्||१२८||
पिबेदुपरि तस्योष्णं क्षीरमेव यथाबलम्|
तेन निर्हृतदोषस्य गुल्मः शाम्यति पैत्तिकः||१२९||

Dvi palaṃ trāyamāṇāyā jala dvi prastha sādhitam|
aṣṭa bhāga sthitaṃ pūtaṃ koṣṇaṃ kṣīrasamaṃ pibet||128||
pibedupari tasyoṣṇaṃ kṣīrameva yathābalam|
tena nirhṛtadoṣasya gulmaḥ śāmyati paittikaḥ||129||

2 Palas of Trayamana is to be boiled in 2 Prasthas of water and reduced to 1/8th.
When lukewarm, this decoction is to be mixed with equal quantity of milk and given to the patient. Thereafter, the patient is asked to take more milk depending upon his power of digestion.
This eliminates morbid Doshas, and thus, cures Paittika type of Gulma [128-129]

Recipes for purgation

द्राक्षाभयारसं गुल्मे पैत्तिके सगुडं पिबेत्|
लिह्यात्कम्पिल्लकं वाऽपि विरेकार्थं मधु द्रवम्||१३०||

drākṣābhayārasaṃ gulme paittike saguḍaṃ pibet|
lihyātkampillakaṃ vā’pi virekārthaṃ madhu dravam||130||

For purgation, the patient suffering from Paittika Gulma should take the juice or decoction of Draksha – Raisin – Vitis vinifera and Abhaya – Terminalia chebula mixed with jaggery.
He may also take Kampillaka in the form of linctus by mixing it with honey. [130]

Massage therapy

दाह प्रशमनोऽभ्यङ्गः सर्पिषा पित्तगुल्मिनाम्|
चन्दनाद्येन तैलेन तैलेन मधुकस्य वा||१३१||

dāha praśamano’bhyaṅgaḥ sarpiṣā pittagulminām|
candanādyena tailena tailena madhukasya vā||131||

Burning sensation in a patient of pittaja Gulma can be alleviated by using ghee or Chandanadya Taila – Sesame (Sesamum indicum) or Madhuka– Licorice – Glycyrrhiza glabra Taila for massage [131]

Medicated Enema

ये च पित्तज्वरहराः सतिक्ताः क्षीरबस्तयः|
हितास्ते पित्तगुल्मिभ्यो वक्ष्यन्ते ये च सिद्धिषु||१३२||
ye ca pittajvaraharāḥ satiktāḥ kṣīrabastayaḥ|
hitāste pittagulmibhyo vakṣyante ye ca siddhiṣu||132||

Recipes of Ksira- basti (medicated enema made of milk and other drugs)prepared by boiling milk with bitter drugs, which alleviate Pitta- Jwara, are also useful for Pitta- Gulma. Such recipes are also described in Siddhi Sthana. [132]

Diet and drinks

Diet and Drinks for Pitta- Gulma
शालयो जाङ्गलं मांसं गव्याजे पयसी घृतम्|
खर्जूरामलकं द्राक्षां दाडिमं सपरूषकम्||१३३||
आहारार्थं प्रयोक्तव्यं पानार्थं सलिलं शृतम्|
बला विदारीगन्धाद्यैः पित्तगुल्म चिकित्सितम्||१३४||
śālayo jāṅgalaṃ māṃsaṃ gavyāje payasī ghṛtam|
kharjūrāmalakaṃ drākṣāṃ dāḍimaṃ saparūṣakam||133||
āhārārthaṃ prayoktavyaṃ pānārthaṃ salilaṃ śṛtam|
balā vidārīgandhādyaiḥ pittagulma cikitsitam||134||

Different types of Shali rice, meat of animals inhabiting arid land, cow milk, goat milk, ghee Kharjura – Dates – Phoenix dactylifera , amalaka, draksha, Dadima – Pomegranate – Punica granatum and Parusaka these is given as diet to the patient suffering from Pitta Gulma. To such patients, water boiled with Bala – Country mallow (root) – Sida cordifolia, Vidarigandha etc, is given for drinking [134]

Stimulation of Digestive power

आमान्वये पित्तगुल्मे सामे वा कफवातिके|
यवागूभिः खडैर्यूषैः सन्धुक्ष्योऽग्निर्विलङ्घिते||१३५||
āmānvaye pittagulme sāme vā kaphavātike|
yavāgūbhiḥ khaḍairyūṣaiḥ sandhukṣyo’gnirvilaṅghite||135||

After administration of fasting therapy in Pittaja Gulma, Vataja Gulma or Kaphaja Gulma, when these are associated with Ama, the patient is given Yavagu (gruel), Khada and Yusha (soup) for stimulating his powder of digestion. [135]

Importance of Agni

शमप्रकोपौ दोषाणां सर्वेषामग्निसंश्रितौ|
तस्मादग्निं सदा रक्षेन्निदानानि च वर्जयेत्||१३६||

śamaprakopau doṣāṇāṃ sarveṣāmagnisaṃśritau|
tasmādagniṃ sadā rakṣennidānāni ca varjayet||136||

Alleviation and aggravation of all Doshas is dependent upon Agni (power of digestion and metabolism). Therefore, it is always necessary to maintain Agni and to avoid factors responsible for the vitiation of Agni. [136]

Kaphaja Gulma Ayurvedic medicines

Medicine and treatment for Kaphaja gulma:

Surgical Management

वमनं वमनार्हाय प्रदद्यात् कफगुल्मिने|
स्निग्धस्विन्नशरीराय गुल्मे शैथिल्यमागते||१३७||
परिवेष्ट्य प्रदीप्तांस्तु बल्वजानथवा कुशान्|
भिषक्कुम्भे समावाप्य गुल्मं घटमुखे न्यसेत्||१३८||
सङ्गृहीतो यदा गुल्मस्तदा घटमथोद्धरेत्|
वस्त्रान्तरं ततः कृत्वा भिन्द्याद्गुल्मं प्रमाणवित्||१३९||
विमार्गाजपदादर्शैर्यथालाभं प्रपीडयेत्|
मृद्नीयाद्गुल्ममेवैकं न त्वन्त्रहृदयं स्पृशेत्||१४०||
तिलैरण्डातसीबीजसर्षपैः परिलिप्य च|
श्लेष्मगुल्ममयःपात्रैः सुखोष्णैः स्वेदयेद्भिषक्||१४१||

vamanaṃ vamanārhāya pradadyāt kaphagulmine|
snigdhasvinnaśarīrāya gulme śaithilyamāgate||137||
pariveṣṭya pradīptāṃstu balvajānathavā kuśān|
bhiṣakkumbhe samāvāpya gulmaṃ ghaṭamukhe nyaset||138||
saṅgṛhīto yadā gulmastadā ghaṭamathoddharet|
vastrāntaraṃ tataḥ kṛtvā bhindyādgulmaṃ pramāṇavit||139||
vimārgājapadādarśairyathālābhaṃ prapīḍayet|
mṛdnīyādgulmamevaikaṃ na tvantrahṛdayaṃ spṛśet||140||
tilairaṇḍātasībījasarṣapaiḥ parilipya ca|
śleṣmagulmamayaḥpātraiḥ sukhoṣṇaiḥ svedayedbhiṣak||141||

The patient of Kapha Gulma is administered Snehana and Swedana, thereafter, Vamana therapy is administered if needed.
After the mass of Gulma has become soft by the administration of these therapies, at the brim, it is covered with a piece of cloth and made to enter the mouth of a jar containing ignited Balvaja or Kusha.

When because of the negative pressure created inside the jar, the mouth of the jar becomes strongly adhered to brim of the mass of Gulma, the jar is pulled. Then though another piece of cloth, the mass of Gulma is tied at its Root (peduncle) and punctured by a physician well versed in this technique. Thereafter, with the help of implements like Vimarga, Ajapada and Adarsha, what ever is available, the mass of Gulma is squeezed.
Thereafter with the paste of Tila – Sesamum indicum, Eranda – Castor, seeds of Atasi – Linseed – Linum usitatissimum and sarshapa and fomented with the help of an iron pan made tolerably warm. [137-141]

Dashamuli Ghrita

सव्योष क्षार लवणं दशमूलीशृतं घृतम्|
कफगुल्मं जयत्याशु सहिङ्गुबिडदाडिमम्||१४२||
इति दशमूलीघृतम्|
savyoṣa kṣāra lavaṇaṃ daśamūlīśṛtaṃ ghṛtam|
kaphagulmaṃ jayatyāśu sahiṅgubiḍadāḍimam||142||
iti daśamūlīghṛtam|

Ghee boiled with the decoction of Dasha- Mula along with the paste of Vyosa, ksara (Alkali) Lavana (rock Salt), Hingu, bida and Dadima cures Kapha- Gulma immediately. [142]

Bhallatakadya Ghrta

भल्लातकानां द्विपलं पञ्चमूलं पलोन्मितम्|
साध्यं विदारीगन्धाद्यमापोथ्य सलिलाढके||१४३||
पादशेषे रसे तस्मिन् पिप्पलीं नागरं वचाम्|
विडङ्गं सैन्धवं हिङ्गु यावशूकं बिडं शटीम्||१४४||
चित्रकं मधुकं रास्नां पिष्ट्वा कर्षसमं भिषक्|
प्रस्थं च पयसो दत्त्वा घृतप्रस्थं विपाचयेत्||१४५||
एतद्भल्लातकघृतं कफगुल्महरं परम्|
प्लीह पाण्ड्वामय श्वास ग्रहणी रोग कासनुत्||१४६||
इति भल्लातकाद्यं घृतम्|
bhallātakānāṃ dvipalaṃ pañcamūlaṃ palonmitam|
sādhyaṃ vidārīgandhādyamāpothya salilāḍhake||143||
pādaśeṣe rase tasmin pippalīṃ nāgaraṃ vacām|
viḍaṅgaṃ saindhavaṃ hiṅgu yāvaśūkaṃ biḍaṃ śaṭīm||144||
citrakaṃ madhukaṃ rāsnāṃ piṣṭvā karṣasamaṃ bhiṣak|
prasthaṃ ca payaso dattvā ghṛtaprasthaṃ vipācayet||145||
etadbhallātakaghṛtaṃ kaphagulmaharaṃ param|
plīha pāṇḍvāmaya śvāsa grahaṇī roga kāsanut||146||
iti bhallātakādyaṃ ghṛtam|

2 Palas of Bhallataka – Purified Semecarpus anacardium and 1 Pala of each of the drugs belonging to Kusdra Pancha- Mula group is boiled in 1 Adhaka of water till 1/4th remains.
To this decoction the paste of 1 Karsa of each of
Pippali – Long pepper fruit – Piper longum
Nagara – Ginger Rhizome – Zingiber officinalis
Vacha – Acorus calamus
Vidanga – False black pepper – Embelia ribes
Saindhava Lavana – Black salt
Hingu – Asafoetida
Yavakshara – Alkali of Barley
Bida salt
Shati – Hedyium spicatum
Chitraka – Plumbago zeylanica
Madhuka – Licorice – Glycyrrhiza glabra and
Rasna – Pluchea lanceolata / Vanda roxburghi
1 Prastha of milk and
1 Prastha of Ghee is added and cooked
This is called Bhallatak Ghrta.
It is an excellent recipe for the cure of Kapha Gulma.
It also cures
Pliha – Splenic disorders
Pandu – anaemia
Shwasa – asthma
Grahani – sprue syndrome and
Kasa – cough [143-146]

Ksheera shatpala Ghruta

पिप्पली पिप्पलीमूल चव्य चित्रक नागरैः|
पलिकैः सयवक्षारैर्घृतप्रस्थं विपाचयेत्||१४७||
क्षीरप्रस्थं च तत् सर्पिहन्ति गुल्मं कफात्मकम्|
ग्रहणी पाण्डुरोगघ्नं प्लीह कास ज्वरापहम्||१४८||
इति क्षीरषट्पलकं घृतम्|

pippalī pippalīmūla cavya citraka nāgaraiḥ|
palikaiḥ sayavakṣārairghṛtaprasthaṃ vipācayet||147||
kṣīraprasthaṃ ca tat sarpihanti gulmaṃ kaphātmakam|
grahaṇī pāṇḍurogaghnaṃ plīha kāsa jvarāpaham||148||
iti kṣīraṣaṭpalakaṃ ghṛtam|

1 Prastha of ghee is boiled with 1 Prastha of milk and the paste of 1 Pala of each of
Pippali – Long pepper fruit – Piper longum,
Pippalimula
Chavya
Chitraka – Plumbago zeylanica
Nagara – Ginger
and
YavaKshara – Alkali
It cures
Kapha- Gulma
Grahani – sprue syndrome
Pandu – anaemia
Pliha – splenic disorders
Kasa – cough and
Jwara – fever [147-148]

Mishraka Sneha

त्रिवृतां त्रिफलां दन्तीं दशमूलं पलोन्मितम्|
जले चतुर्गुणे पक्त्वा चतुर्भागस्थितं रसम्||१४९||
सर्पिरेरण्डजं तैलं क्षीरं चैकत्र साधयेत्|
स सिद्धो मिश्रकस्नेहः सक्षौद्रः कफगुल्मनुत्||१५०||
कफवातविबन्धेषु कुष्ठप्लीहोदरेषु च|
प्रयोज्यो मिश्रकः स्नेहो योनिशूलेषु चाधिकम्||१५१||
इति मिश्रकः स्नेहः|

trivṛtāṃ triphalāṃ dantīṃ daśamūlaṃ palonmitam|
jale caturguṇe paktvā caturbhāgasthitaṃ rasam||149||
sarpireraṇḍajaṃ tailaṃ kṣīraṃ caikatra sādhayet|
sa siddho miśrakasnehaḥ sakṣaudraḥ kaphagulmanut||150||
kaphavāta vibandheṣu kuṣṭha plīhodareṣu ca|
prayojyo miśrakaḥ sneho yoniśūleṣu cādhikam||151||
iti miśrakaḥ snehaḥ|

1 Pala of each of Trivrt, Triphala, Danti – Baliospermum montanum and Dashamoola is boiled with 4 times of water till 1/4th remains.
To this decoction, ghee, castor oil and milk are added and cooked.
This Misraka Sneha (mixture of ghee and oil) is administrating red long with honey.
It cures
Kapha- gulma
Constipation caused by Kapha and Vata,
Kustha – obstinate skin diseases including leprosy and
Pliha – splenic disorders.
This is used specially for the cure of Yoni- sula (pain in the female genital tract). [149-151]

Purgation Therapy

यदुक्तं वातगुल्मघ्नं स्रंसनं नीलिनीघृतम्|
द्विगुणं तद्विरेकार्थं प्रयोज्यं कफगुल्मिनाम्||१५२||
सुधाक्षीरद्रवे चूर्णं त्रिवृतायाः सुभावितम्|
कार्षिकं मधुसर्पिभ्यां लीढ्वा साधु विरिच्यते||१५३||

yaduktaṃ vātagulmaghnaṃ sraṃsanaṃ nīlinīghṛtam|
dviguṇaṃ tadvirekārthaṃ prayojyaṃ kaphagulminām||152||
sudhā kṣīradrave cūrṇaṃ trivṛtāyāḥ subhāvitam|
kārṣikaṃ madhu sarpibhyāṃ līḍhvā sādhu viricyate||153||

The recipe of Nilini Ghrta which is prescribed for Sramsana (mild purgation) in the treatment of Vata –Gulma (wide verses 106-109) can also be used in double dose (2 Palas) for purgation in the treatment of Kapha- Gulma.
1 Karsa of the powder of Trivrt well impregnated with the milky latex of Sudha is given to this patient by mixing with honey and ghee for proper purgation. [152-153]

Danti Haritaki

जलद्रोणे विपक्तव्या विंशतिः पञ्च चाभयाः|
दन्त्याः पलानि तावन्ति चित्रकस्य तथैव च||१५४||
अष्टभागावशेषं तु रसं पूतमधिक्षिपेत्|
दन्तीसमं गुडं पूतं क्षिपेत्तत्राभयाश्च ताः||१५५||
तैलार्धकुडवं चैव त्रिवृतायाश्चतुष्पलम्|
चूर्णितं पलमेकं तु पिप्पलीविश्वभेषजम्||१५६||
तत् साध्यं लेहवच्छीते तस्मिंस्तैलसमं मधु|
क्षिपेच्चूर्णपलं चैकं त्वगेलापत्रकेशरात्||१५७||
ततो लेहपलं लीढ्वा जग्ध्वा चैकां हरीतकीम्|
सुखं विरिच्यते स्निग्धो दोषप्रस्थमनामयम्||१५८||
गुल्मं श्वयथुमर्शांसि पाण्डुरोगमरोचकम्|
हृद्रोगं ग्रहणीदोषं कामलां विषमज्वरम्||१५९||
कुष्ठं प्लीहानमानाहमेषा हन्युपसेविता|
निरत्ययः क्रमश्चास्या द्रवो मांसरसौदनः||१६०||
इति दन्तीहरीतकी|

jaladroṇe vipaktavyā viṃśatiḥ pañca cābhayāḥ|
dantyāḥ palāni tāvanti citrakasya tathaiva ca||154||
aṣṭabhāgāvaśeṣaṃ tu rasaṃ pūtamadhikṣipet|
dantīsamaṃ guḍaṃ pūtaṃ kṣipettatrābhayāśca tāḥ||155||
tailārdhakuḍavaṃ caiva trivṛtāyāścatuṣpalam|
cūrṇitaṃ palamekaṃ tu pippalīviśvabheṣajam||156||
tat sādhyaṃ lehavacchīte tasmiṃstailasamaṃ madhu|
kṣipeccūrṇapalaṃ caikaṃ tvagelāpatrakeśarāt||157||
tato lehapalaṃ līḍhvā jagdhvā caikāṃ harītakīm|
sukhaṃ viricyate snigdho doṣaprasthamanāmayam||158||
gulmaṃ śvayathumarśāṃsi pāṇḍurogamarocakam|
hṛdrogaṃ grahaṇīdoṣaṃ kāmalāṃ viṣamajvaram||159||
kuṣṭhaṃ plīhānamānāhameṣā hanyupasevitā|
niratyayaḥ kramaścāsyā dravo māṃsarasaudanaḥ||160||
iti dantīharītakī|

In 1 Drona of water 25 fruits of Haritaki – Chebulic Myrobalan fruit rind – Terminalia chebula and 25 Palas of each Danti – Baliospermum montanum and Chitraka and boiled till 1/8th remains.
In this decoction, 25 fruits of Haritaki (boiled earlier), ½ Kudava of oil, 4 Palas of Trivrit and 1 Pala of the lines suggested for the powder of Tvak, Ela, Patra – Cinnamomum tamala Nees and Eberum. And Kesara is added.
The patient is given 1 Pala of this linctus along with 1 fruit of Haritaki (added to this recipe). This, when administered to an oleated patient, causes painless purgation.
It eliminates 1 Prastha of waste- product from the body without any difficulty.
It cures
Gulma
Svayathu – edema
Arshas: piles
Pandu: anaemia
Aruchi: anorexia
Hrd roga: heart diseases
Grahani: sprue syndrome
Kamala: Jaundice
Visama Jvara – irregular fever
Kushta – obstinate skin diseases including leprosy
Pliha – splenic disorders and
Anaha – abdominal distension
After the administration of this recipe, the patient is given liquid food including meat soup and rice which constitute the safe regimen. [154-160]

Other recipes

Other Recipes and Therapies for Kaphaja Gulma:
Effective recipes of Niruha basti(decoction enema) for the successful treatment of Kapha- Gulma will be described in the Siddhi section. Similarly, effective recipes of Arista (a type of alcoholic preparation) for the effective treatment of this ailment will be described in chapters dealing with the treatment of spore syndrome (Cikitsa 15) and piles (Cikitsa 14).
Powders and pills described in this chapter for the treatment of Kapha-Gulma provide Ksara (alkalies), Hingu – Asafoetida and Amala- Vetasae taken in double the prescribed quantity.
Recipes of Alkalies (Ksharas) prescribed for the treatment of sprue syndrome (in Cikitsa 15) is also effective and safe for the treatment of Kapha- Gulma. At the end Daha (cauterisation) therapy is useful in this condition. [161-163]

Diet and drinks

Diet and Drinks for Kaphaja gulma
प्रपुराणानि धान्यानि जाङ्गला मृगपक्षिणः|
कौलत्थो मुद्गयूषश्च पिप्पल्या नागरस्य च||१६४||
शुष्कमूलकयूषश्च बिल्वस्य वरुणस्य च|
चिरबिल्वाङ्कुराणां च यवान्याश्चित्रकस्य च||१६५||
बीजपूरक हिङ्ग्वम्लवेतस क्षार दाडिमैः|
तक्रेण तैलसर्पिर्भ्यां व्यञ्जनान्युपकल्पयेत्||१६६||
पञ्चमूलीशृतं तोयं पुराणं वारुणीरसम्|
कफगुल्मी पिबेत्काले जीर्णं माध्वीकमेव वा||१६७||
prapurāṇāni dhānyāni jāṅgalā mṛgapakṣiṇaḥ|
kaulattho mudgayūṣaśca pippalyā nāgarasya ca||164||
śuṣkamūlakayūṣaśca bilvasya varuṇasya ca|
cirabilvāṅkurāṇāṃ ca yavānyāścitrakasya ca||165||
bījapūraka hiṅgvamlavetasa kṣāra dāḍimaiḥ|
takreṇa tailasarpirbhyāṃ vyañjanānyupakalpayet||166||
pañcamūlīśṛtaṃ toyaṃ purāṇaṃ vāruṇīrasam|
kaphagulmī pibetkāle jīrṇaṃ mādhvīkameva vā||167||

Diet and drinks useful for a patient suffering from Kapha- Gulma:
1) Old corns and cereals, meat of animals inhabiting arid land and birds, and soups of Kulattha and Mudga
2) Vegetable dishes prepared of Pippali, Nagara, Soup of dried Radish, Bilva, Varuna, tender( leaves) of Cirabilva, Yavani and Chitraka prepared by adding Beejapuraka, Hingu, Amlavestasa, Ksara, Dadima, Butter- milk , oil and Ghee;
3) Water boiled with Panca- Mula and
4) Old Varuni (a type of alcoholic drink) is taken by the patient at the appropriate time. After the digestion of food Madhvika (another type of alcoholic drink) is taken. [164-167]

Digestive Stimulants

यवानीचूर्णितं तक्रं बिडेन लवणीकृतम्|
पिबेत् सन्दीपनं वातकफमूत्रानुलोमनम् ||१६८||
yavānīcūrṇitaṃ takraṃ biḍena lavaṇīkṛtam|
pibet sandīpanaṃ vātakaphamūtrānulomanam ||168||

Butter- milk sprinkled with the powder of Yavani and made saline by adding Lavana (rock- salt) is given to the patient to drink. This potion stimulates the power of digestion and helps in the downward movement of Vata, Kapha and urine. [168]

Incurability and Complications

सञ्चितः क्रमशो गुल्मो महावास्तुपरिग्रहः|
कृतमूलः सिरानद्धो यदा कूर्म इवोन्नतः||१६९||
दौर्बल्यारुचिहृल्लासकासवम्यरतिज्वरैः |
तृष्णातन्द्राप्रतिश्यायैर्युज्यते न स सिध्यति||१७०||
गृहीत्वा सज्वरश्वासं वम्यतीसारपीडितम्|
हृन्नाभिहस्तपादेषु शोफः कर्षति गुल्मिनम्||१७१||

sañcitaḥ kramaśo gulmo mahāvāstuparigrahaḥ|
kṛtamūlaḥ sirānaddho yadā kūrma ivonnataḥ||169||
daurbalyārucihṛllāsakāsavamyaratijvaraiḥ |
tṛṣṇātandrāpratiśyāyairyujyate na sa sidhyati||170||
gṛhītvā sajvaraśvāsaṃ vamyatīsārapīḍitam|
hṛnnābhihastapādeṣu śophaḥ karṣati gulminam||171||

When Gulma, gradually accumulated, surrounds a large area, deep-rooted, when it is engrossed with veins, when it is elevated like a tortoise and when it is associated with weakness, anorexia, Nausea, Cough, vomiting, Arati (Disliking for every thing), fever, morbid thirst, drowsiness as well as coryza, it becomes incurable.
Oedema in cardiac region, umbilical region and upper as well as lower limbs in a patient of Gulma who is afflicted with fever, dyspnoea, vomiting and diarrhoea drag him towards death.

Management of Raktaja Gulma

रौधिरस्य तु गुल्मस्य गर्भकाल व्यतिक्रमे|
स्निग्ध स्विन्नशरीरायै दद्यात् स्नेह विरेचनम्||१७२||
पलाश क्षारपात्रे द्वे द्वे पात्रे तैलसर्पिषोः|
गुल्म शैथिल्य जननीं पक्त्वा मात्रां प्रयोजयेत्||१७३||
प्रभिद्येत न यद्येवं दद्याद्योनिविशोधनम् |
क्षारेण युक्तं पललं सुधाक्षीरेण वा पुनः||१७४||
आभ्यां वा भावितान् दद्याद्योनौ कटुकमत्स्यकान्|
वराहमत्स्यपित्ताभ्यां लक्तकान् वा सुभावितान्||१७५||
अधोहरैश्चोर्ध्वहरैर्भावितान् वा समाक्षिकैः|
किण्वं वा सगुडक्षारं दद्याद्योनिविशोधनम्||१७६||
रक्तपित्तहरं क्षारं लेहयेन्मधुसर्पिषा|
लशुनं मदिरां तीक्ष्णां मत्स्यांश्चास्यै प्रदापयेत्||१७७||
बस्तिं सक्षीरगोमूत्रं सक्षारं दाशमूलिकम्|
अदृश्यमाने रुधिरे दद्याद्गुल्मप्रभेदनम्||१७८||
प्रवर्तमाने रुधिरे दद्यान्मांसरसौदनम्|
घृततैलेन चाभ्यङ्गं पानार्थं तरुणीं सुराम्||१७९||
रुधिरेऽतिप्रवृत्ते तु रक्तपित्तहरीः क्रियाः|
कार्या वातरुगार्तायाः सर्वा वातहरीः पुनः||१८०||
घृततैलावसेकांश्च तित्तिरींश्चरणायुधान्|
सुरां समण्डां पूर्वं च पानमम्लस्य सर्पिषः||१८१||
प्रयोजयेदुत्तरं वा जीवनीयेन सर्पिषा|
अतिप्रवृत्ते रुधिरे सतिक्तेनानुवासनम्||१८२||

raudhirasya tu gulmasya garbhakāla vyatikrame|
snigdha svinnaśarīrāyai dadyāt sneha virecanam||172||
palāśa kṣārapātre dve dve pātre tailasarpiṣoḥ|
gulma śaithilya jananīṃ paktvā mātrāṃ prayojayet||173||
prabhidyeta na yadyevaṃ dadyādyoniviśodhanam|
kṣāreṇa yuktaṃ palalaṃ sudhākṣīreṇa vā punaḥ||174||
ābhyāṃ vā bhāvitān dadyādyonau kaṭukamatsyakān|
varāhamatsyapittābhyāṃ laktakān vā subhāvitān||175||
adhoharaiścordhvaharairbhāvitān vā samākṣikaiḥ|
kiṇvaṃ vā saguḍakṣāraṃ dadyādyoniviśodhanam||176||
raktapittaharaṃ kṣāraṃ lehayenmadhusarpiṣā|
laśunaṃ madirāṃ tīkṣṇāṃ matsyāṃścāsyai pradāpayet||177||
bastiṃ sakṣīragomūtraṃ sakṣāraṃ dāśamūlikam|
adṛśyamāne rudhire dadyādgulmaprabhedanam||178||
pravartamāne rudhire dadyānmāṃsarasaudanam|
ghṛtatailena cābhyaṅgaṃ pānārthaṃ taruṇīṃ surām||179||
rudhire’tipravṛtte tu raktapittaharīḥ kriyāḥ|
kāryā vātarugārtāyāḥ sarvā vātaharīḥ punaḥ||180||
ghṛta tailāvasekāṃśca tittirīṃścaraṇāyudhān|
surāṃ samaṇḍāṃ pūrvaṃ ca pānamamlasya sarpiṣaḥ||181||
prayojayeduttaraṃ vā jīvanīyena sarpiṣā|
atipravṛtte rudhire satiktenānuvāsanam||182||

The patient suffering from Rakta- Gulma, after 10th month, is given oleation and fomentation therapies followed by Sneha Virechana (purgation therapy with unctuous ingredients).
Two Patras of Palasha-Ksara (Alkali preparation of Palasa tree) and two Patras of oil and ghee is boiled together and administered to the patient in appropriate dose for with a view to suffering the Gulma. If the mass of Gulma does not break by the administration of this recipe, 1 of the following recipes is inserted into the vagina for the cleansing of Yoni (female genital tract)
1) Oil cake mixed with alkalies
2) Oil cake mixed with the milky latex of Sudha
3) Katuka- Maaatsya ( small fish called Saphari which is pungent in taste) impregnated with alkalies and milky later of Sudha
4) A peace of cloth well pergnated with the bile of Varaha or Matsya
5) A peace of cloth well impregnated with the drugs which cause vomiting or purgation and smeared with honey; and
6) Kinva (Yeast which is used for fermentation, Asavas and Aristas) mixed with Jaggery and Alkalies
If inspite of it, bleeding does not occur, then for breaking the Rakta Gulma,the patient may be given alkalies prescribed for the treatment of Raktha-Pitta ( A disease characterised by bleeding from different parts of the body) along with honey and ghee in the form of a linctus. She is given Lasuna, sharp type of Madira (variety of alcoholic drink) and fish. She may also be given medicated enema prepared without the decoction of Dasa-Mula mixed with milk, Cow’s urine and Alkalies.
After the occurrence of bleeding, the patient is given rice mixed with meat soup to it.
Ghee and oil is used for massage of her body, and for drinking; she is given freshly prepared Sura (a type of Alcoholic drink).
If there is excessive bleeding, then therapies prescribed for excessive pain is given, then she is given all therapies Avaseka (sprinkling of water), Tittiri, Charanayudha (cock), Sura alongwith its Manda (upper portion of the fermented liquid) and ghee prepared with sour drugs as food, drinks and regimens.
Ghee boiled with drugs belonging to Jivaniya group is used for Uttara Basti (douching the vaginal tract). If there is excessive bleeding then anuvasana type of medicated enema is administered by boiling with bitter – drugs [172-182]

Summary

तत्र श्लोकाः-
स्नेहः स्वेदः सर्पिर्बस्तिश्चूर्णानि बृंहणं गुडिकाः|
वमनविरेकौ मोक्षः क्षतजस्य च वातगुल्मवताम्||१८३||
सर्पिः सतिक्तसिद्धं क्षीरं प्रस्रंसनं निरूहाश्च|
रक्तस्य चावसेचनमाश्वासनसंशमनयोगाः||१८४||
उपनाहनं सशस्त्रं पक्वस्याभ्यन्तरप्रभिन्नस्य|
संशोधनसंशमने पित्तप्रभवस्य गुल्मस्य||१८५||
स्नेहः स्वेदो भेदो लङ्घनमुल्लेखनं विरेकश्च|
सर्पिर्बस्तिर्गुटिकाश्चूर्णमरिष्टाश्च सक्षाराः||१८६||
गुल्मस्यान्ते दाहः कफजस्याग्रेऽपनीतरक्तस्य|
गुल्मस्य रौधिरस्य क्रियाक्रमः स्त्रीभवस्योक्तः||१८७||
पथ्यान्नपानसेवा हेतूनां वर्जनं यथास्वं च|
नित्यं चाग्निसमाधिः स्निग्धस्य च सर्वकर्माणि||१८८||
हेतुर्लिङ्गं सिद्धिः क्रियाक्रमः साध्यता न योगाश्च|
गुल्मचिकित्सितसङ्ग्रह एतावान् व्याहृतोऽग्निवेशस्य||१८९||

tatra ślokāḥ-
snehaḥ svedaḥ sarpirbastiścūrṇāni bṛṃhaṇaṃ guḍikāḥ|
vamanavirekau mokṣaḥ kṣatajasya ca vātagulmavatām||183||
sarpiḥ satiktasiddhaṃ kṣīraṃ prasraṃsanaṃ nirūhāśca|
raktasya cāvasecanamāśvāsanasaṃśamanayogāḥ||184||
upanāhanaṃ saśastraṃ pakvasyābhyantaraprabhinnasya|
saṃśodhanasaṃśamane pittaprabhavasya gulmasya||185||
snehaḥ svedo bhedo laṅghanamullekhanaṃ virekaśca|
sarpirbastirguṭikāścūrṇamariṣṭāśca sakṣārāḥ||186||
gulmasyānte dāhaḥ kaphajasyāgre’panītaraktasya|
gulmasya raudhirasya kriyākramaḥ strībhavasyoktaḥ||187||
pathyānnapānasevā hetūnāṃ varjanaṃ yathāsvaṃ ca|
nityaṃ cāgnisamādhiḥ snigdhasya ca sarvakarmāṇi||188||
heturliṅgaṃ siddhiḥ kriyākramaḥ sādhyatā na yogāśca|
gulma cikitsita saṅgraha etāvān vyāhṛto’gniveśasya||189||

Agnivesa has described the following topics in this chapter dealing with the treatment of Gulma-
1) Oleation and formenation therapies, recipes of Ghee enema, powder, nourishing pills, emetic, purgation and oleation therapies for the treatment of Vata- Gulma
2) Medicated ghee prepared by boiling it with bitter drugs, milk, laxatives, recipes for Niruha type of medicated enema, blood- letting, Ashvasana (consolation), recipes for alleviation, application of hot ointment, surgical management of suppurated and internally ruptured ailment, elimination and alleviation therapies for the treatment of Paittika Gulma;
3) Oleation, fomentation, puncturing, fasting, emetic and purgation therapies, recipes for medicated ghee, medicated enema, pills, powders, aristas ( type of alcoholic drink), Alkalies, cauterization as the terminal therapy after blood- letting for the treatment of Kapha- Gulma
4) Management of Raktaja Gulma occurring in women and
5) Use of wholesome food and drinks, prevention of the very productive grounds of various types liable to bring about morbid conditions, need for regularly maintaining the powder of digestion and metabolism (Agni), need for oleation therapy before all types of treatment, etiology, signs and symptoms, management, line of treatment, curability and incurability and recipes in respect of different types of Gulma.
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते चिकित्सितस्थाने
गुल्मचिकित्सितं नाम पञ्चमोऽध्यायः||५||

ityagniveśakṛte tantre carakapratisaṃskṛte cikitsitasthāne
gulma cikitsitaṃ nāma pañcamo’dhyāyaḥ||5||

Thus, ends the fifth chapter dealing with the treatment of Gulma in the section of Chikitsa sthana of the work by Agnivesha and redacted by Charaka.