Understanding Kloma And Its Different Meanings With Contexts

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Introduction

Kloma is explained as an internal organ. It is told as one of the places of Kapha. In this article, I have tried to compile all the explanations pertaining to Kloma. 

Kloma is one of the controversial topics in Ayurveda. It is an organ belonging to kapha group of organs (organs in which kapha is predominantly present).

Kloma in Abdomen

Version 1 – Kloma in the abdominal cavity

Kloma as a Kapha organ

Kloma is a Kapha organ (or tissue) –
Kloma is one of the seats of kapha predominance. Since Kapha represents the water body in the body, kloma can be thought of being one of the water controlling organs in the body which either indicates water loss or water imbalance in the body. It is one of the roots of udakavaha srotas – channels of the body carrying  water from place to place.

Kapha-Kloma-Water link

Kapha is water body – ‘Kena Jalena Phalati’ is the definition of kapha, which means ‘that which gets nourished by water is called kapha’. This shows that kapha and water, as long as the composition of the body is concerned are entities representing each other. Water in proper qualities and quantities enrich Kapha or water body in our physical body.

Kapha operates through ambukarma i.e. water like action. This shows that the Kapha and its entire family functions on the lines of water like action. Thus Kapha is the water body.

7/10 elements (5 dhatus and 2 malas) have been mentioned as Kapha sthanas, which sums up to 70%, almost similar to the water quantity of the body.

Water rich tissues

Water rich tissues (water depots, water storage or back-up zones)

The water rich tissues (or kapha predominant tissues) in the body are as below mentioned –

• Rasa – lymph, chyle, nutritional essence formed after digestion of food in the stomach which on reaching the heart is put into circulation
• Mamsa – muscle tissue
• Meda – fat tissue
• Majja – bone marrow
• Shukra – reproductive tissue
• Pureesha – feces and
• Mutra – urine

Thus the water rich tissues comprises of 5 tissues and 2 excreta.

Kapha Operating System

Kapha Operating System (KOS) comprises of an integrated closed network of all the organs which predominantly consist of kapha i.e. uras (chest chest organs i.e. lungs, heart, pericardial fluid, pleural fluid), kantha (throat), shira (head, cerebrospinal fluid), kloma (?? explained below), parva (small joints of hands and feet, inter-phalangeal joints), amashaya (stomach, duodenum), rasa (chyle, lymph, circulating nutritional juice), meda (fat tissue), ghrana (nose) and jihwa (tongue).

All these organs should work in an integrated way to maintain that 70% of water balance, neither going beyond nor lesser than that.

Therefore KOS is a closed network of assigned organs and tissues which correlate and coordinate with each other to have the water body in balance so as to provide a buffer from the heating action of pitta and drying action of vata.

The mentioned organs are spread out in the head, neck, thorax and abdomen, indicating that kapha is present all over the body. When one member in this system is disturbed, it sends the signals to the other organs and tissues. They may be mutually influenced by each other’s damage also.

Kloma is one of the members of the KOS in the body which perceives the loss of water and signals it to the body for compensation. Water loss or imbalance may alternatively damage kloma and we may get its signals from talu. Similarly the deficiency of water imbalance in KOS may be reflected in the form of dryness of talu and kloma. This it probably does by alerting the other water sub-bodies located in uras, kantha etc through signals. Therefore when there is water deficiency, each of these may be activated.

Kapha controlling stations (main offices) –
Kapha activities are monitored from 5 major centers involving the KOS. They are –
uras or chest (avalambaka),
Kantha – throat
shira or head (tarpaka), jihwa or tongue (bodhaka),
amashaya or stomach (kledaka) and
sandhi or joints (shleshaka). The deficiency symptoms of water imbalance will be depicted in these regions also.

Udaka and Udakavaha Srotas location

Where do we find udaka?
Udaka means water. It is synonymous with jala. It is one among the panchamahabhutas or five elements of the nature. It is represented in the body in the form of kapha. This udaka is present in the entire body, including the water content in the cells and outside cells, in cavities and in between the membranes around the viscera (peritoneal, pleural, pericardial and cerebro-spinal fluids).

Where do we have Udakavaha Srotas?
Water is present in every corner of the body. Therefore Udakavaha srotas too should be present all over the body. They convey and transport water to all parts of the body.

What may srotas denote?

• Generally srotas denotes or explains the ‘transporting system (channels of transport, discharge, flow) of various tissues, water, nutrition and building blocks of the body’
• Manufacturing centers and distributing centers
• Site of attachment (origin or insertion)
• Areas of spread

Udakavaha Srotas Mula

Mula means roots.
Mula in the context of Udaka Vaha Srotas means –

• ‘Signal system or alarming system’ of maintenance and imbalance of KOS or water body (both kloma and talu)
• Water regulating centers in the brain (hypothalamus) and thirst sensors (palate) i.e. talu + absorption and water distribution centres in the abdomen (highlighted ahead) i.e. kloma , here, one gets damaged (kloma) and one indicates the deficiency (talu)

Deficiency of water or imbalance in the entire KOS and tissues predominant in kapha (water) will reflect as thirst or want of water. They would express want of water through two alarm stations i.e. Talu and Kloma.

Organs involved

What organs or tissues fall into the territory of Kloma?
Many organs have been discussed as representing kloma. The below mentioned structures are considered as Kloma according to various opinions –

• Lung (right)
• Gall bladder
• Mesentery
• Stomach and duodenum
• Trachea
• Pharynx
• Adrenal Gland
• Lymphatic system, nodes and ducts
• Mediastinum

From different perspectives everything seems to be correct. But one among the kapha sthanas mentioned above (KOS) should be Kloma.  We cannot jump into unanimous decision about this so called controversial concept.

Further explanation

Getting more clarity to the concept of Kloma –
उदक वहे द्वे, तयोः मूलं तालु क्लोम च।
तत्र विद्धस्य पिपासा सध्यो मरणं च।(सु.श.9/12)

Sadhyo marana or immediate death is one of the symptoms of ‘damage to udakavaha srotas’ given by Sushruta. This might not occur just by fluid or water imbalance occurring in the body for a shorter time, because by instinct we all know to satisfy the need for water which gets manifested in the form of thirst or trishna. Sadhyo Marana may be a consequence of thirst or trishna which is of chronic nature or is associated with some serious pathology or is a part of a chronic stubborn, complicated disease with bad prognosis.

Sadhyo marana also reflects severe or complete dehydration in which even substitution or replacement of fluid also might not resuscitate the patient back to life. This may be in cases of shock especially due to severe hemorrhage and fluid loss.

Holding this, we need to see which among the above mentioned organs fit into the concept of Kloma.

When we go to a related concept ‘Sadhyo Pranahara Marma’ i.e. vital organs or structures which take away the life immediately after getting injured, we do not find any organ listed out as Kloma falling into the concept of Sadhyo Pranahara Marma. But Nabhi (navel) and Hridaya (heart) are two structures which are Sadhyo Pranahara Marmas.

Hridaya is not Kloma. Nabhi is also not kloma.
Seeing the location of Kloma explained in Ayurvedic texts, Kloma is some structure which is located in abdomen, located below and left of hridaya or heart, which when injured causes severe thirst and immediate death in spite of not being a marma.

But it can be close to a marma i.e. Hridaya Marma and Nabhi Marma. Therefore, we can see that Kloma is located in between Hridaya and Nabhi.

Correlation with organs

Probable correlation of Kloma with organs which fit into the possible explanation of Kloma
So it makes sense in considering the below mentioned structures as kloma –

Pancreas – though often compared to Agnyashaya, mainly produces insulin (anabolic hormone) and somatostatin (inhibitory hormone) which has kapha like actions, pancreatic juice also buffers the acidity of chyme (kapha like action or anti-pitta action). Deficiency of insulin will lead to excessive sugar in the blood stream and consequent manifestation of thirst suggesting kapha kshaya or udaka kshaya. Most part of Pancreas is located below and to the left of heart. Though Pancreas can produce many painful conditions, it is said to be the least commonly injured organs in the abdominal trauma.

Mesentery – Kloma can be considered as mesentery. The fluid (water or nutrition) is transported from intestines via mesentery only. Mesenteric ischemia leads to fluid imbalance and consequently causes trishna or thirst which is the key symptom of udakavaha srotas injury or contamination. In 2017, scientists accepted mesentery as one full fledged organ, though the functions of mesentery are to be specified yet. Apart from this, acharya Vagbhata has mentioned kloma as koshtanga or visceral organ located in the abdominal cavity, which correlates to mesentery (Dr Hebbar). Mesentery seems to be one good inclusion for considering Kloma.

Small Intestine – The early (initial length) of coils of jejunum and duodenum absorb major quantity of water. Since Small Intestine, mainly jejunum or half of jejunum match with the location of Kloma explained in Ayurvedic texts, it can be considered as Kloma.

Gall bladder – but we do not have many evidences for it taking part in water regulation or balance. It is also not prone for more injuries, even if injured may not cause immediate death.

Suprarenal Gland – Aldosterone secreted by suprarenal gland promotes water retention by kidneys and regulates the water balance. But it is a paired gland.

For me, – ‘Kloma would be a small circle which comprises of coils of upper intestine (jejunum and duodenum, though duodenum singly can be considered as grahani) with mesentery and lymph nodes with (?) or without pancreas’

Kloma in chest cavity

Version 2 – Kloma in the chest cavity
If we interpret ‘Sushruta’s concept’ things become clear in another way.
(हृदयस्य) तस्याधो वामतः प्लीहा फुफुसश्च दक्षिणतो यकृत् क्लोम च।(सु.शा.४/३०)

(Note: The same reference can be taken to explain the version 1 given above)

We split Sushruta’s explanation i.e. ‘Tasya adho vaamatah pleeha phuphusaha cha, dakshinato yakrit kloma cha’ as –
‘Hridayasya adho vaamatah’ i.e. below the heart and to the left, we have pleeha or spleen (adho i.e. below in the left) and to the left of the heart above (vaamataha i.e. by the left side to the heart) we have phuphusa i.e. left lung.

Therefore Sushruta has not considered right lung as Phuphusa.
Corresponding to this explanation – ‘Hridayasya dakshinato (adho) yakrit, dakshinato (upari) klomaha’ i.e. below the heart and to the right (corresponding to pleeha) we have Yakrit i.e. liver and to its right (corresponding to phuphusa or left lung) we have kloma.

According to this concept, ‘Kloma is right lung and is located in the chest or thoracic cavity’

Teeka (commentary) on Ashtanga Hridaya chapter 12, verse 3, also gives an explanation that states ‘Hrid dakshinato mamsa granthihi kloma’ for kloma which means a big mass (cyst) made up of muscle (like tissue) located to the right of the heart is called Kloma. This also justifies the presence of Kloma in the chest, adjacent to the heart and that it is right lung.
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