Charaka Gulma Nidana: 3rd Chapter

The 3rd chapter of Charaka Samhitha Nidana Sthana is called Gulma Nidana. It deals with causes, pathology,types, symptoms of Gulma, as per ayurveda. अथातो गुल्म निदानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athāto gulma nidānaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||
We shall now explore the chapter on the Diagnosis of Gulma. Thus said Lord Atreya [1-2]

Types of Gulma

इह खलु पञ्च गुल्मा भवन्ति; तद्यथा- वातगुल्मः, पित्तगुल्मः, श्लेष्मगुल्मो, निचयगुल्मः, शोणितगुल्म इति||३||
iha khalu pañca gulmā bhavanti; tadyathā- vātagulmaḥ, pittagulmaḥ, śleṣmagulmo, nicayagulmaḥ, śoṇitagulma iti||3||
There are 5 types of Gulma viz
Vata gulma
Pitta gulma
Slesma/Kapha gulma
Nichaya Gulma – Gulma due to the simultaneous vitiation of all the 3 Doshas and
Shonita gulma – Gulma due to the affliction of blood [3]

Means to understand specific features of Gulma:
एवंवादिनं भगवन्तमात्रेयमग्निवेश उवाच- कथमिह भगवन् पञ्चानां गुल्मानां विशेषमभिजानीमहे; नह्य विशेषविद्रोगाणामौषधविदपि भिषक् प्रशमनसमर्थो भवतीति||४||
तमुवाच भगवानात्रेयः- समुत्थान पूर्वरूप लिङ्ग वेदनोपशय विशेषेभ्यो विशेष विज्ञानं गुल्मानां भवत्यन्येषां च रोगाणामग्निवेश! तत्तु खलु गुल्मेषूच्यमानं निबोध||५||
evaṃvādinaṃ bhagavantamātreyamagniveśa uvāca- kathamiha bhagavan pañcānāṃ gulmānāṃ viśeṣamabhijānīmahe; nahya viśeṣavidrogāṇāmauṣadhavidapi bhiṣak praśamanasamartho bhavatīti||4||
tamuvāca bhagavānātreyaḥ- samutthāna pūrvarūpa liṅga vedanopaśayaviśeṣebhyo viśeṣavijñānaṃ gulmānāṃ bhavatyanyeṣāṃ ca rogāṇāmagniveśa! tattu khalu gulmeṣūcyamānaṃ nibodha||5||

Agnivesha asked Lord Atreya, “How to understand the specific features of these 5 types of Gulma? Without this knowledge such patients cannot be successfully treated by a physician even though he is well versed in the selection of drugs”.
Lord Atreya versed in the specific features of Gulma as of others diseases can be ascertained from
Nidana (etiology)
Purvarupa (premonitory symptoms)
Linga (symptomatology)
Vedana (various types of pain) and
Upashaya (exploratory therapy)
The following are the characteristic feature of different types of Gulma. [4-5]

Vataja Gulma

Vataja Gulma Nidana
यदा पुरुषो वातलो विशेषेण ज्वर वमन विरेचनातीसाराणामन्यतमेन कर्शनेन कर्शितो वातलमाहारमाहरति, शीतं वा विशेषेणातिमात्रम् , अस्नेह पूर्वे वा वमन विरेचने पिबति, अनुदीर्णां वा छर्दिमुदीरयति, उदीर्णान् वात मूत्र पुरीष वेगान्निरुणद्धि, अत्यशितो वा पिबति नवोदकमतिमात्रम्, अतिसङ्क्षोभिणा वा यानेन याति, अतिव्यवाय व्यायाम मद्य शोकरुचिर्वा, अभिघातमृच्छति वा, विषमासन शयन स्थान चङ्क्रमणसेवी वा भवति, अन्यद्वा किञ्चिदेवंविधं विषममतिमात्रं व्यायामजातमारभते, तस्यापचाराद्वातः प्रकोपमापद्यते||६||
yadā puruṣo vātalo viśeṣeṇa jvara vamana virecanātīsārāṇāmanyatamena karśanena karśito vātalamāhāramāharati, śītaṃ vā viśeṣeṇātimātram, asneha pūrve vā vamana virecane pibati, anudīrṇāṃ vā chardimudīrayati, udīrṇān vāta mūtra purīṣa vegānniruṇaddhi, atyaśito vā pibati navodakamatimātram, atisaṅkṣobhiṇā vā yānena yāti, ativyavāya vyāyāma madya śokarucirvā, abhighātamṛcchati vā, viṣamāsana śayana sthāna caṅkramaṇasevī vā bhavati, anyadvā kiñcidevaṃvidhaṃ viṣamamatimātraṃ vyāyāmajātamārabhate, tasyāpacārādvātaḥ prakopamāpadyate||6||

यदा पुरुषो वातलो विशेषेण ज्वर वमन विरेचनातीसाराणामन्यतमेन कर्शनेन कर्शितो वातलमाहारमाहरति, शीतं वा विशेषेणातिमात्रम् , अस्नेह पूर्वे वा वमन विरेचने पिबति, अनुदीर्णां वा छर्दिमुदीरयति, उदीर्णान् वात मूत्र पुरीष वेगान्निरुणद्धि, अत्यशितो वा पिबति नवोदकमतिमात्रम्, अतिसङ्क्षोभिणा वा यानेन याति, अतिव्यवाय व्यायाम मद्य शोकरुचिर्वा, अभिघातमृच्छति वा, विषमासन शयन स्थान चङ्क्रमणसेवी वा भवति, अन्यद्वा किञ्चिदेवंविधं विषममतिमात्रं व्यायामजातमारभते, तस्यापचाराद्वातः प्रकोपमापद्यते||६||
yadā puruṣo vātalo viśeṣeṇa jvara vamana virecanātīsārāṇāmanyatamena karśanena karśito vātalamāhāramāharati, śītaṃ vā viśeṣeṇātimātram, asneha pūrve vā vamana virecane pibati, anudīrṇāṃ vā chardimudīrayati, udīrṇān vāta mūtra purīṣa vegānniruṇaddhi, atyaśito vā pibati navodakamatimātram, atisaṅkṣobhiṇā vā yānena yāti, ativyavāya vyāyāma madya śokarucirvā, abhighātamṛcchati vā, viṣamāsana śayana sthāna caṅkramaṇasevī vā bhavati, anyadvā kiñcidevaṃvidhaṃ viṣamamatimātraṃ vyāyāmajātamārabhate, tasyāpacārādvātaḥ prakopamāpadyate||6||

Factors aggravating Vata in Gulma:
In the body of an individual who is of Vatika type of constitution and who is exceeding emaciated due to Jvara (fever), Vamana (emesis), Virechana (purgation) or Atisara(diarrhea).
Vatala aahara sevana – Intake of Vata aggravating food
śītaṃ vā viśeṣeṇātimātram – Adoption of regimens which are exceedingly cold
Asneha pūrve vā vamana virecane pibati – Administration of emetic or purgation therapy without oleation
Anudīrṇāṃ vā chardimudīrayati – Vomiting without manifested urge
Udīrṇān vāta mūtra purīṣa vegānniruṇaddhi – Suppression of the manifested urge for passing flatus, urine and stool
Atyaśito vā pibati navodakamatimātram – Intake of fresh water in excess specially after heavy food
Atisaṅkṣobhiṇā vā yānena yāti – Travel in exceedingly jolting vehicles
Ativyavāya vyāyāma madya śokarucirvā – Excessive indulgence in sexual act, physical exercise, drink and anxiety
Abhighātamṛcchati vā – Assault
Viṣamāsana śayana sthāna caṅkramaṇasevī vā bhavati – Sitting, sleeping, standing or moving in irregular posture and
Anyadvā kiñcidevaṃvidhaṃ viṣamamatimātraṃ vyāyāmajātamārabhate – Indulgence in physical excursive of this a sort in irregular posture [6]

Vataja Gulma Samprapti, Lakshana, Chikitsa: 
स प्रकुपितो वायुर्महास्रोतोऽनुप्रविश्य रौक्ष्यात् कठिनीभूतमाप्लुत्य पिण्डितोऽवस्थानं करोति हृदि बस्तौ पार्श्वयोर्नाभ्यां वा; स शूलमुपजनयति ग्रन्थींश्चानेकविधान्, पिण्डितश्चावतिष्ठते, स पिण्डितत्वाद् ‘गुल्म’ इत्यभिधीयते; स मुहुराधमति , मुहुरल्पत्वमापद्यते; अनियत विपुलाणुवेदनश्च भवति चलत्वाद्वायोः, मुहुः पिपीलिका सम्प्रचार इवाङ्गेषु, तोद भेद स्फुरणायाम सङ्कोच सुप्ति हर्ष प्रलयोदय बहुलः; तदातुरः सूच्येव शङ्कुनेव चाभिसंविद्धमात्मानं मन्यते, अपि च दिवसान्ते ज्वर्यते , शुष्यति चास्यास्यम्, उच्छ्वासश्चोपरुध्यते, हृष्यन्ति चास्य रोमाणि वेदनायाः प्रादुर्भावे; प्लीहाटोपान्त्रकूजनाविपाकोदावर्ताङ्गमर्द मन्याशिरः शङ्ख शूल ब्रध्नरोगाश्चैनमुपद्रवन्ति; कृष्णारुण परुष त्वङ्नख नयन वदन मूत्र पुरीषश्च भवति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत इति वातगुल्मः||७||
sa prakupito vāyurmahāsroto’nupraviśya raukṣyāt kaṭhinībhūtamāplutya piṇḍito’vasthānaṃ karoti hṛdi bastau pārśvayornābhyāṃ vā; sa śūlamupajanayati granthīṃścānekavidhān, piṇḍitaścāvatiṣṭhate, sa piṇḍitatvād ‘gulma’ ityabhidhīyate; sa muhurādhamati , muhuralpatvamāpadyate; aniyata vipulāṇuvedanaśca bhavati calatvādvāyoḥ, muhuḥ pipīlikā sampracāra ivāṅgeṣu, toda bheda sphuraṇāyāma saṅkoca supti harṣa pralayodaya bahulaḥ; tadāturaḥ sūcyeva śaṅkuneva cābhisaṃviddhamātmānaṃ manyate, api ca divasānte jvaryate , śuṣyati cāsyāsyam, ucchvāsaścoparudhyate, hṛṣyanti cāsya romāṇi vedanāyāḥ prādurbhāve; plīhāṭopāntrakūjanā vipākodāvartāṅgamarda manyāśiraḥ śaṅkha śūla bradhnarogāścainamupadravanti; kṛṣṇāruṇa paruṣa tvaṅnakha nayana vadana mūtra purīṣaśca bhavati, nidānoktāni cāsya nopaśerate, viparītāni copaśerata iti vātagulmaḥ||7||

Pathogenesis, Symptoms and exploratory therapy of Vataja Gulma:
Vata, thus aggravated, enters the alimentary tract (Maha srotas) which latter has become hard round due to ununctusness, then spreads and gets localized in heart, bladder sides of the chest or umbilical region.

It produces colic pain and various types of nodules and remains in a round form. It is because of this round shape that the disease is known as ‘Gulma’. This round mass at times increases and at times gets decreases. Because of the instability (Chalatva) of Vata there is irregularly acute and mild pain.

Often there is a
pipīlikā sampracāra ivāṅgeṣu – feeling as if ants are crawling on the limbs.

There is frequent disappearance and appearance of piercing, breaking and throbbing types of patient feels as if he is pierced with a needle or a nail.
api ca divasānte jvaryate -There is fever during the afternoon.

There is
śuṣyati cāsyāsyam – dryness of mouth
ucchvāsaścoparudhyate – obstruction to respiration and
hṛṣyanti cāsya romāṇi vedanāyāḥ prādurbhāve – horrification during the onset of pain.
Complications of these types of Gulma are
Plīhāṭopāntrakūjanā – affliction of spleen
Avipaka – metorism
Udavarta – intestinal gurgling
Avipaka – loss of the power of digestion
Anga marda – malaise
manyāśiraḥ śaṅkha śūla bradhnarogāścainamupadravanti – pain in head, sternomastoid and temporal region, and swelling in the inguinal lymph glands
kṛṣṇāruṇa paruṣa tvaṅnakha nayana vadana mūtra purīṣaśca bhavati – blackness, reddishness and roughness in the skin, nails, eyes, faces, urine and stool.
Etiological factors enumerated above aggravated the condition whereas things having opposite qualities give relief to the patient. This is about the Vatika type of Gulma. [7]

Pittaja Gulma

Pittaja Gulma Nidana, Samprapti, Lakshana: 
तैरेव तु कर्शनैः कर्शितस्याम्ल लवण कटुक क्षारोष्ण तीक्ष्ण शुक्त व्यापन्न मद्य हरितकफलाम्लानां विदाहिनां च शाकधान्यमांसादीनामुपयोगादजीर्णाध्यशनाद्रौक्ष्यानुगते चामाशये वमनमतिवेलं सन्धारणं वातातपौ चातिसेवमानस्य पित्तं सह मारुतेन प्रकोपमापद्यते||८||
तत् प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति, य उक्ता वातगुल्मे; पित्तं त्वेनं विदहति कुक्षौ हृद्युरसि कण्ठे च; स विदह्यमानः स धूममिवोद्गारमुद्गिरत्यम्लान्वितं, गुल्मावकाशश्चास्य दह्यते दूयते धूप्यते ऊष्मायते स्विद्यति क्लिद्यति शिथिल इव स्पर्शासहोऽल्परोमाञ्चश्च भवति; ज्वर भ्रम दवथु पिपासा गलतालुमुखशोष प्रमोह विड्भेदाश्चैनमुपद्रवन्ति; हरित हारिद्र त्वङ्नख नयन वदन मूत्र पुरीषश्च भवति; निदानोक्तानि चास्य नोपशेरते, विपरीतान्युपशेरत इति पित्तगुल्मः||९||
taireva tu karśanaiḥ karśitasyāmla lavaṇa kaṭuka kṣāroṣṇa tīkṣṇa śukta vyāpanna madya haritakaphalāmlānāṃ vidāhināṃ ca śākadhānyamāṃsādīnāmupayogādajīrṇādhyaśanādraukṣyānugate cāmāśaye vamanamativelaṃ sandhāraṇaṃ vātātapau cātisevamānasya pittaṃ saha mārutena prakopamāpadyate||8||
tat prakupitaṃ māruta āmāśayaikadeśe saṃvartya tāneva vedanāprakārānupajanayati, ya uktā vātagulme; pittaṃ tvenaṃ vidahati kukṣau hṛdyurasi kaṇṭhe ca; sa vidahyamānaḥ sa dhūmamivodgāramudgiratyamlānvitaṃ, gulmāvakāśaścāsya dahyate dūyate dhūpyate ūṣmāyate svidyati klidyati śithila iva sparśāsaho’lparomāñcaśca bhavati; jvara bhrama davathu pipāsā galatālumukhaśoṣa pramoha viḍbhedāścainamupadravanti; harita hāridra tvaṅnakha nayana vadana mūtra purīṣaśca bhavati; nidānoktāni cāsya nopaśerate, viparītānyupaśerata iti pittagulmaḥ||9||

Factors aggravating Pitta in Gulma – Pathogenesis and Symptoms:
The following factors aggravate Pitta along with Vata in an individual emaciated due either to fever, emesis, purgation and diarrhea.
karśitasyāmla lavaṇa kaṭuka kṣāroṣṇa tīkṣṇa śukta vyāpanna madya haritakaphalāmlānāṃ vidāhināṃ ca śākadhānyamāṃsādīnāmupayogād – Intake of food articles which cause burning sensation like Amla(sour), Lavana (saline), Katu (pungent) Ksara(alkaline), Ushna(hot), Tikshna(sharp) and fermented diet, deteriorated wine, salads, sour fruits, vegetables, corns and flesh.
Ajīrṇādhyaśanādraukṣyānugate – Frequent meals even before the previous food are digested
Amashaye vamanamativelaṃ – Administration of emesis therapy when the stomach is dry
Sandharanam – Suppression of manifested urges for a long time and
Vātātapau cātisevamānasya – Excessive exposure to wind and the sun.
This aggravated Vata gets localized in a part of Amashaya (stomach including small intestine) and produces such pains as are described to manifest in Vata gulma (in Para 7 above).
There is pittaṃ tvenaṃ vidahati kukṣau hṛdyurasi kaṇṭhe ca – Burning sensation in the pelvic region, heart region, chest and throat due to vitiated Pitta.
sa vidahyamānaḥ sa dhūmamivodgāramudgiratyamlānvitaṃ – Due to this burning sensation there is eructation of sour taste and there is a feeling as if smoke is coming out through it.
In the region of Gulma there is
Dahyate – burning sensation
Duyate – pain
Dhupyate – feeling of fumigation
Ushmayate – heat
Svidyati iva bhavati – sweating
Klidyati – softening
śithila – looseness
Sparśāsaho’lparomāñcaśca – tenderness and slight horrification.
Complications of this type of Gulma are
Jvara – fever
Bhrama – giddiness
Davathu – throbbing pain
Pipāsā – thirst
Gala tālu mukha śoṣa – dryness of throat, palate and mouth
Pramoha – unconsciousness and
Vidbheda – diarrhea
Harita hāridra tvaṅnakha nayana vadana mūtra purīṣaśca bhavati – There is green stickiness and yellowness of the skin, nails, eyes, face, urine and stool.
Etiological factors enumerated above aggravate the condition whereas things having opposite qualities give relief to the patient. This is about Paittika type of Gulma. [8-9]

Kaphaja Gulma

Kaphaja Gulma Nidana, Samprapti, Lakshana: 
तैरेव तु कर्शनैः कर्शितस्यात्यशनादतिस्निग्ध गुरु मधुर शीताशनात् पिष्टेक्षुक्षीर तिल माष गुड विकृति सेवनान्मन्दक मद्यातिपानाद्धरितकातिप्रणनयादानूपौदक ग्राम्य मांसातिभक्षणात् सन्धारणादबुभुक्षस्य चातिप्रगाढमुदपानात् सङ्क्षोभणाद्वा शरीरस्य श्लेष्मा सह मारुतेन प्रकोपमापद्यते||१०||
तं प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति य उक्ता वातगुल्मे; श्लेष्मा त्वस्य शीत ज्वरारोचकाविपाकाङ्गमर्द हर्ष हृद्रोग च्छर्दि निद्रालस्य स्तैमित्य गौरव शिरोभितापानुपजनयति, अपि च गुल्मस्य स्थैर्य गौरव काठिन्यावगाढ सुप्तताः, तथा कास श्वास प्रतिश्यायान् राजयक्ष्माणं चातिप्रवृद्धः, श्वैत्यं त्वङ्नख नयन वदन मूत्र पुरीषेषूपजनयति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत इति श्लेष्म गुल्मः||११||
taireva tu karśanaiḥ karśitasyātyaśanād atisnigdha guru madhura śītāśanāt piṣṭekṣukṣīra tila māṣa guḍa vikṛti sevanānmandaka madyātipānādd haritakātipraṇanayādānūpaudaka grāmya māṃsātibhakṣaṇāt sandhāraṇādabubhukṣasya cātipragāḍhamudapānāt saṅkṣobhaṇādvā śarīrasya śleṣmā saha mārutena prakopamāpadyate||10||
taṃ prakupitaṃ māruta āmāśayaikadeśe saṃvartya tāneva vedanāprakārānupajanayati ya uktā vātagulme; śleṣmā tvasya śīta jvarārocakāvipākāṅgamarda harṣa hṛdroga cchardi nidrālasya staimitya gaurava śirobhitāpānupajanayati, api ca gulmasya sthairya gaurava kāṭhinyāvagāḍha suptatāḥ, tathā kāsa śvāsa pratiśyāyān rājayakṣmāṇaṃ cātipravṛddhaḥ, śvaityaṃ tvaṅ nakha nayana vadana mūtra purīṣeṣūpajanayati, nidānoktāni cāsya nopaśerate, viparītāni copaśerata iti śleṣma gulmaḥ||11||

Factors aggravating Kapha-Pathogenesis and symptoms of Kapha:
The following factors aggravate Kapha along with Vata in an individual emaciated (due to the Jwara(fever), Vamana(emesis), Virechana (purgation) and Atisara (diarrhoea).]
Ati snigdha guru madhura shita aahara – Intake of excessively unctuous, heavy, sweet and cold food
Piṣṭekṣukṣīra tila māṣa guḍa vikṛti sevanā – Intake of pastry, preparations of sugar cane juice, milk, tila (sesamum induicum Linn) Masha (Phaseolus rediatus Linn) and Sugar Candy.
Mandaka madya atipana – Intake of immature curd and wine in excess
Haritakātipraṇanayādānūpaudaka grāmya māṃsātibhakṣaṇāt – Intake of Haritaka (salads), the flesh of marshy, aquatic and domestic animals in excess
Sandharana – Suppression of the manifested natural urges
Bubhukṣasya cātipragāḍhamudapānāt – Intake of large quantity of water in the absence of appetite and
Saṅkṣobhaṇādvā śarīrasya – Physical assault.
This aggravated Vata gets localized in a part of Amashaya (stomach including small in instance) and produces such pains as are described to appear in Vatika gulma (in para 7 above).

The Vitiated Kapha produces
śleṣmā tvasya śīta tam jvara – fever beginning with cold
Arochaka – anorexia
Avipaka – indigestion
Anga marda – malaise
Harsha – horrification
Hrdroga – heart disease
Chardi – emesis
Ati nidra – excessive sleep
Aalasya – Laziness
Staimitya – timidity
Gaurava – heaviness and
Shiro abhitapa – pain in the head.
The gulma remains stable (fixed), heavy, hard, deep seated and there is a feeling of numbness, when aggravated in excess, there is
Kasa – cough
Shvasa – dyspnoea
Pratishyaya – coryza and
Raja Yakshma – tuberculosis
śvaityaṃ tvaṅnakha nayana vadana mūtra purīṣeṣūpajanayati – Skin, nails, eyes, face, urine and stool-all become white.
Etiological factors enumerated above aggravated the condition whereas things having opposite qualities give relief to the patient. This is about the Slaismika/Kaphaja type of Gulma. [10-11]

Asadhya Gulma

त्रिदोष हेतु लिङ्ग सन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति कुशलाः|
स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचय गुल्मः||१२||
tridoṣa hetu liṅga sannipāte tu sānnipātikaṃ gulmamupadiśanti kuśalāḥ|
sa vipratiṣiddhopakramatvādasādhyo nicayagulmaḥ||12||

Incurable Gulma:
Sannipatika type of Gulma is caused by the etiological factors responsible for the vitiation of all the 3 Doshas and it shares the symptoms of all the 3 types of Gulma, viz,
Vatika
Paittika and
Slaismika / Kaphaja
This type of Gulma is incurable because of the mutual contradiction involved in its treatment. [12]

Rakta gulma

शोणित गुल्मस्तु खलु स्त्रिया एव भवति न पुरुषस्य, गर्भ कोष्ठार्तवागमनवैशेष्यात्|
पारतन्त्र्यादवैशारद्यात् सततमुपचारानुरोधाद्वा वेगानुदीर्णानुपरुन्धत्या आमगर्भे वाऽप्यचिरपतितेऽथवाऽप्यचिरप्रजाताया ऋतौ वा वातप्रकोपणान्यासेवमानायाः क्षिप्रं वातः प्रकोपमापद्यते||१३||
स प्रकुपितो योनि मुखमनुप्रविश्यार्तवमुपरुणद्धि, मासि मासि तदार्तवमुपरुध्यमानं कुक्षिमभिवर्धयति|
तस्याः शूल कासातीसार च्छर्द्यरोचकाविपाकाङ्गमर्द निद्रालस्य स्तैमित्य कफप्रसेकाः समुपजायन्ते, स्तनयोश्च स्तन्यम्, ओष्ठयोः स्तनमण्डलयोश्च कार्ष्ण्यम्, अत्यर्थं ग्लानिश्चक्षुषोः, मूर्च्छा, हृल्लासः, दोहदः, श्वयथुश्च पादयोः, ईषच्चोद्गमो रोमराज्याः, योन्याश्चाटालत्वम्, अपि च योन्या दौर्गन्ध्यमास्रावश्चोपजायते, केवलश्चास्या गुल्मः पिण्डित एव स्पन्दते, तामगर्भां गर्भिणीमित्याहुर्मूढाः||१४||
śoṇita gulmastu khalu striyā eva bhavati na puruṣasya, garbha koṣṭhārtavāgamanavaiśeṣyāt|
pāratantryādavaiśāradyāt satatamupacārānurodhādvā vegānudīrṇānuparundhatyā āmagarbhe vā’pyacirapatite’thavā’pyaciraprajātāyā ṛtau vā vātaprakopaṇānyāsevamānāyāḥ kṣipraṃ vātaḥ prakopamāpadyate||13||
sa prakupito yoni mukhamanupraviśyārtavamuparuṇaddhi, māsi māsi tadārtavamuparudhyamānaṃ kukṣimabhivardhayati|
tasyāḥ śūla kāsātīsāra cchardyarocakāvipākāṅgamarda nidrālasya staimitya kaphaprasekāḥ samupajāyante, stanayośca stanyam, oṣṭhayoḥ stanamaṇḍalayośca kārṣṇyam, atyarthaṃ glāniścakṣuṣoḥ, mūrcchā, hṛllāsaḥ, dohadaḥ, śvayathuśca pādayoḥ, īṣaccodgamo romarājyāḥ, yonyāścāṭālatvam, api ca yonyā daurgandhyamāsrāvaścopajāyate, kevalaścāsyā gulmaḥ piṇḍita eva spandate, tāmagarbhāṃ garbhiṇīmityāhurmūḍhāḥ||14||

Raktaja gulma:
The Gulma due to the vitiation of blood occurs not in males but in females because of their characteristic feature to pass menstrual blood through the uterus.
Vata in them gets immediately aggravated because of the following:-

Suppression of natural urges due to their sub-ordinate position in the family, ignorance and disposition to the service of others.
sa prakupito yoni mukhamanupraviśyārtavamuparuṇaddhi – Instant abortion or
Intake of Vata aggravating things immediately after delivery or burning menstrual period.
The aggravated Vata enters into the cervix of the uterus and obstructs the menstrual blood.
māsi māsi tadārtavamuparudhyamānaṃ kukṣimabhivardhayati – Such obstruction of the menstrual- blood- flow goes on every month and as a result of this there is distention of the lower abdomen.

There is
Shula – colic pain
Kasa – cough
Atīsāra – diarrhea
Chardi – vomiting
Arochaka – anorexia
Avipaka – indigestion
Anga marda – malaise
Ati nidra – excessive sleep
Aalasya – laziness
staimitya – timidity and
Kapha prasekāḥ – excessive salivation
There is
atyarthaṃ glāniścakṣuṣoḥ – excessive strain on eyes
Mūrcchā – fainting
Hṛllāsaḥ – Nausea
Dohadaḥ – longings for specific objects
śvayathuśca pādayoḥ – swelling in feet
īṣaccodgamo romarājyāḥ – appearance of small hairs in small quantity
Yonyāścāṭālatvam – dilatation of the vaginal orifice and
api ca yonyā daurgandhyamāsrāvaścopajāyate – foul smelling discharge from the uterus
Kevalaścāsyā gulmaḥ piṇḍita eva spandate – There is pulsation in the entire mass of Gulma which is round is shape. Tāmagarbhāṃ garbhiṇīmityāhurmūḍhāḥ -The ignorant considers such a patient as a case of pregnancy even though there is actually no pregnancy. [13-14]

Purvaroopa

Gulma Purvaroopa: 
एषां तु खलु पञ्चानां गुल्मानां प्रागभिनिर्वृत्तेरिमानि पूर्वरूपाणि भवन्ति; तद्यथा- अनन्नाभिलषणम्, अरोचकाविपाकौ, अग्निवैषम्यं, विदाहो भुक्तस्य, पाककाले चायुक्त्या छर्द्युद्गारौ, वात मूत्र पुरीष वेगानां चाप्रादुर्भावः, प्रादुर्भूतानां चाप्रवृत्तिरीषदागमनं वा, वात शूलाटोपान्त्रकूजनापरिहर्षणातिवृत्तपुरीषताः, अबुभुक्षा, दौर्बल्यं, सौहित्यस्य चासहत्वमिति||१५||
eṣāṃ tu khalu pañcānāṃ gulmānāṃ prāgabhinirvṛtterimāni pūrvarūpāṇi bhavanti; tadyathā- anannābhilaṣaṇam, arocakāvipākau, agnivaiṣamyaṃ, vidāho bhuktasya, pākakāle cāyuktyā chardyudgārau, vātamūtrapurīṣavegānāṃ cāprādurbhāvaḥ, prādurbhūtānāṃ cāpravṛttirīṣadāgamanaṃ vā, vāta śūlāṭopāntrakūjanāpariharṣaṇātivṛttapurīṣatāḥ, abubhukṣā, daurbalyaṃ, sauhityasya cāsahatvamiti||15||

Premonitory symptoms of Gulma:
Anannābhilaṣaṇam – loss of desire to take food
Arochaka – anorexia
Avipaka – indigestion
Agnivaiṣamyaṃ – irregularity in the power of digestion
vidāho bhuktasya – incomplete digestion of food
Pākakāle cāyuktyā chardyudgārau – vomiting ,eructation during the process of digestion without any specific cause,
Vātamūtrapurīṣavegānāṃ cāprādurbhāvaḥ, prādurbhūtānāṃ cāpravṛttirīṣadāgamanaṃ vā – non- manifestation of the urges for flatus, urination and defecation, even if such urges are manifested there is no excretion or excretion only in small quantity
Shula – colic pain due to Vata
Aatopa – meteroism
Aantra kujana – intestinal gurgling
Pari harsha – horripilation
Ativrtta purishtah – misperistalsis
Abubhukṣā – loss of appetite
Daurbalyam – weakness and
Sauhityasya cāsahatvamiti – intolerance to heavy food. [15]

Chikitsa Sutra

Gulma Chikitsa Sutra: 
सर्वेष्वपि खल्वेतेषु गुल्मेषु न कश्चिद्वातादृते सम्भवति गुल्मः|
तेषां सान्निपातिकमसाध्यं ज्ञात्वा नैवोपक्रमेत, एकदोषजे तु यथास्वमारम्भं प्रणयेत्, संसृष्टांस्तु साधारणेन कर्मणोपचरेत्|
यच्चान्यदप्यविरुद्धं मन्येत तदप्यवचारयेद्विभज्य गुरु लाघवमुपद्रवाणां, गुरूनुपद्रवांस्त्वरमाणश्चिकित्सेज्जघन्यमितरान्|
त्वरमाणस्तु विशेषमनुपलभमानो गुल्मेष्वात्ययिके कर्मणि वातचिकित्सितं प्रणयेत्, स्नेहस्वेदौ वातहरौ स्नेहोपसंहितं च मृदु विरेचनं बस्तींश्च; अम्ललवणमधुरांश्च रसान् युक्त्याऽवचारयेत्|
मारुते ह्युपशान्ते स्वल्पेनापि प्रयत्नेन शक्योऽन्योऽपि दोषो नियन्तुं गुल्मेष्विति||१६||
भवति चात्र- गुल्मिनामनिलशान्तिरुपायैः सर्वशो विधिवदाचरितव्या|
मारुते ह्यवजितेऽन्यमुदीर्णं दोषमल्पमपि कर्म निहन्यात्||१७||
sarveṣvapi khalveteṣu gulmeṣu na kaścidvātādṛte sambhavati gulmaḥ|
teṣāṃ sānnipātikamasādhyaṃ jñātvā naivopakrameta, ekadoṣaje tu yathāsvamārambhaṃ praṇayet, saṃsṛṣṭāṃstu sādhāraṇena karmaṇopacaret|
yaccānyadapyaviruddhaṃ manyeta tadapyavacārayedvibhajya guru lāghavamupadravāṇāṃ, gurūnupadravāṃstvaramāṇaścikitsejjaghanyamitarān|
tvaramāṇastu viśeṣamanupalabhamāno gulmeṣvātyayike karmaṇi vātacikitsitaṃ praṇayet, snehasvedau vātaharau snehopasaṃhitaṃ ca mṛdu virecanaṃ bastīṃśca; amlalavaṇamadhurāṃśca rasān yuktyā’vacārayet|
mārute hyupaśānte svalpenāpi prayatnena śakyo’nyo’pi doṣo niyantuṃ gulmeṣviti||16||
bhavati cātra- gulmināmanilaśāntirupāyaiḥ sarvaśo vidhivadācaritavyā|
mārute hyavajite’nyamudīrṇaṃ doṣamalpamapi karma nihanyāt||17||

Principle of treatment of Gulma: 
Vitiated Vata is an invariable causative factor for all the types of Gulma. Of them the Sannipatika type caused by the vitiation of all Doshas should not be treated as it is incurable.
Gulma caused by only one of these 3 Doshas is treated according to the vitiated. The types of Gulma caused by the simultaneous vitiation of 2 these Doshas is treated by adapting the general line of treatment.
Therapies which are not mutually contradictory are to be adopted for the treatment of complications, of course, according to their seriousness or lightness. The serious complications are attempted immediately whereas the other ones can be treated even after some time.
Should it be considered necessary to treat the patient suffering from Gulma immediately, the therapy may begin with the treatment of vata even if no specific symptom indicative of the type of Gulma is discernible.
For this purpose, the physician should carefully administer oleation and fomentation therapies, mild including drugs having sour, saline, and sweet tastes. If Vata is alleviates, other pertaining to Gulma can be brought to their normal state with slight effort.

Thus it is said:-
For a patient suffering from Gulma, such of the therapies as would alleviate Vata is administered carefully. Once the Vata is alleviates, other aggravated Doshas would get subsidized even with slight effort. [16-17]

तत्र श्लोकः- सङ्ख्या निमित्तं रूपाणि पूर्वरूपमथापि च|
दिष्टं निदाने गुल्मानामेकदेशश्च कर्मणाम्||१८||
tatra ślokaḥ- saṅkhyā nimittaṃ rūpāṇi pūrvarūpamathāpi ca|
diṣṭaṃ nidāne gulmānāmekadeśaśca karmaṇām||18||

Conclusion

To sum up: The number, etiology, symptomatology, premonitory symptoms and the line of treatment in brief are described in this chapter on the “Diagnosis of Gulma’’ [18]

इत्यग्निवेशकृते तन्त्रे चरक प्रतिसंस्कृते निदानस्थाने गुल्म निदानं नाम तृतीयोऽध्यायः||३||
ityagniveśakṛte tantre caraka pratisaṃskṛte nidānasthāne gulma nidānaṃ nāma tṛtīyo’dhyāyaḥ||3||
Thus ends the third chapter on the “Gulma Nidana” of the section on the “Diagnosis of diseases” of Agnivesha’s work as redacted by Charaka.

Read related:
Gulma- Abdominal Tumor- A Unique Disease In Ayurveda
Charaka – Gulma Chikitsa – 5th Chapter
Chapter edited by Dr Malini Bhat.