Ashtanga Hridayam Chikitsa sthanam Chapter 14: Gulma Chikitsitam Adhyaya (Treatments of abdominal tumors)  

The 14th chapter of Cikitsasthanam of Ashtanga Hridayam is named as Gulma Cikitsitam Adhyayah. This chapter deals with the explanation of ‘treatment of abdominal tumors.’

The topics covered in this chapter include –

–      Vataja Gulma Cikitsa
–      Hingvadi Ghrta
–      Hapusadi Ghrta
–      Dadhika Ghrta
–      Tryshandhya Ghrta
–      Lasunadya Ghrta
–      Satpala Ghrta
–      Remedies for kapha association in Vata Gulma
–      Hingvadi Curnam
–      Vaisvanara Curnam
–      Hingvastaka Curnam
–      Sardula Curnam
–      Naraca Curnam
–      Putikadi Yoga
–      Hingutriguna Taila
–      Matulungadi Yoga
–      Shuntyadi Curna
–      Measures to be taken in Vatagulma associated with kapha and pitta
–      Lasuna Ksheerapaka
–      Use of taila, prasanna etc.
–      Chitrakadi Kvatha
–      Pushkaradi Kvatha
–      Vatyahvadi Kvatha
–      Use of Shilajatu and Brihat Pancamula
–      Use of Vatya
–      Use of Yavaka and Kulmasa
–      Nilini Ghrta
–      Diet for patients of Vataja Gulma
–      Pittaja Gulma Cikitsa
–      Pittaja Gulma Cikitsa – Trayamana Ghrta
–      Pittaja Gulma Cikitsa – Abhyanga, lepa, Sparsha
–      Pittaja Gulma Cikitsa – Raktamoksana (bloodletting)
–      Pittaja Gulma Cikitsa – Chinnamula Gulma
–      Pittaja Gulma Cikitsa – Use of meat soup and providing assurance
–      Pittaja Gulma Cikitsa – Use of treatment of Pittaja Vidradi
–      Pittaja Gulma Cikitsa – ideal food and drinks
–      Kaphaja Gulma Cikitsa
–      Bhallataka Ghrta
–      Importance of snehana and svedana
–      Sastra Cikitsa – surgical treatment
–      Kaphaja Gulma Cikitsa – Tiladi lepa and svedana
–      Kaphaja Gulma Cikitsa – for dislodged gulma
–      Misraka Sneha
–      Nilini sarpi and Sukumara Ghrta
–      Danti Haritaki
–      Use of Trivrt soaked in sap of Sudha
–      Use of Kushtadi yoga and Guggulu
–      Use of enemas described in kalpa and siddhi sthana
–      Treating deep rooted and large gulmas
–      Area of using ksara in kapha gulma
–      Ksaragada
–      Ksara – its importance in gulma
–      Use of Asava and Arista
–      Pathya anna pana – suitable foods and drinks
–      Agnikarma Cikitsa – thermal cautery
–      Rakta Gulma Cikitsa

Pledge by the author (s)

अथातो गुल्मचिकित्सितं व्याख्यास्याम: व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘treatment of abdominal tumors’. Thus say (pledge) Atreya and other sages.

Vataja Gulma Chikitsa

गुल्मं बद्धशकृद्वातं वातिकं तीव्रवेदनम् ।
रूक्षशीतोद्भवं तैलैः साधयेद्वातरोगिकैः ॥ १ ॥
पानान्नान्वासनाभ्यङ्गैः स्निग्धस्य स्वेदमाचरेत् ।
आनाहवेदनास्तम्भविबन्धेषु विशेषतः ॥ २ ॥
स्रोतसां मार्दवं कृत्वा जित्वा मारुतमुल्बणम् ।
भित्त्वा विबन्धं स्निग्धस्य स्वेदो गुल्ममपोहति ॥ ३ ॥
Vatika Gulma (tumour arising from vata)which manifests with the obstruction of faeces and flatus, severe pain arising from dryness and cold should be treated with medicated oils mentioned in the treatment of vataroga (chapter 21); by drinking (of fats) and consuming food (mixed with fats), lubricating enema and oil massage, person should be made to undergo oleation followed by sudation (fomentation) especially when there is distention, pain, loss of movement and constipation. By softening the channel, by mitigating the greatly increased vata, and by removing the obstruction, sudation therapy (fomentation etc.) cures the abdominal tumor of the person who has been administered oleation therapy.

Vataja Gulma Chikitsa based on site

स्नेहपानं हितं गुल्मे विशेषेण ऊर्ध्वनाभिजे ।
पक्वाशय गते वस्ति: उभयं जठर आश्रये ॥ ४ ॥ Drinking of fat is beneficialespecially for the tumor situated above the umbilicus; enema therapy for the tumor situated in the pakvasaya (large intestine); both (fat drinking and enema) and when it is localized in the jathara (stomach and small intestine).

Vataja Gulma Chikitsa

दीप्तेऽग्नौ वातिके गुल्मे विबन्धेऽनिलवर्चसोः ।
बृंहणान्यन्नपानानि स्निग्धोष्णानि प्रदापयेत् ॥ ५ ॥
पुनः पुनः स्नेहपानं निरूहाः सानुवासनाः ।
प्रयोज्या वातजे गुल्मे कफपित्तानुरक्षिणः ॥ ६ ॥
In gulma of vata origin, when the digestive fire is augmented, but when there is obstruction of and flatus and feces, foods and drinks which are nutritious, fatty and hot should be administered; Drinking of fats, decoction enema along with oil enema should be administered again and again in gulma of vata origin, while protecting (not causing aggravation) of kapha and pitta.

Vataja Gulma Chikitsa

वस्तिकर्म परं विद्याद्गुल्मघ्नं तद्धि मारुतम् ।
स्वस्थाने प्रथमं जित्वा सद्यो गुल्ममपोहति ॥ ७ ॥ तस्मादभीक्ष्णशो गुल्मा निरूहैः सानुवासनैः ।
प्रयुज्यमानैः शाम्यन्ति वातपित्तकफात्मकाः ॥ ८ ॥
Basti karma (enema therapy) is the best to destroy (cure) Gulma. It overcomes vata in its own seat (pakvasaya- large intestine) first and so cures the tumor immediately. Hence abdominal tumor arising from vata, pitta and kapha will subside by repeated administration of decoction enema and oil enema (alternatively).

Vataja Gulma Chikitsa: Hingvadi Ghrta

हिङ्गुसौवर्चलव्योषविडदाडिमदीप्यकैः ।
पुष्कराजाजीधान्याम्लवेतसक्षारचित्रकैः ॥ ९ ॥
शठीवचाजगन्धैलासुरसैर्दधिसंयुतैः ।
शूलानाहहरं सर्पिः साधयेद्वातगुल्मिनाम् ॥ १० ॥
Medicated ghee prepared with hiṅgu – Ferula narthex, sauvarcala – black salt, vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, viḍa – vida salt, dāḍima – Punica granatum, dīpyakaiḥ – Cuminum cyminum / Trachyspermum ammi, puṣkara – Inula racemosa, ajājī – Cuminum cyminum, dhānya – Coriandrum sativum, amlavetasa – Garcinia pedunculata, kṣāra – alkali of Hordeum vulgare, citraka – Plumbago zeylanica, śaṭhī – Curcuma zedoaria, vacā – Acorus calamus, ajagandha – Cleome gynandra, elā – Elettaria cardamomum, surasa – Ocimum sanctum and curds/yogurt. This ghee cures colic and distention of the abdomen in patients of vata gulma.

Hapushadi Ghrita

हपुषोषणपृथ्वीकापञ्चकोलकदीप्यकैः ।
साजाजीसैन्धवैर्दध्ना दुग्धेन च रसेन च ॥ ११ ॥ दाडिमान् मूलकात् कोलात् पचेत्सर्पिर्निहन्ति तत् ।
वातगुल्मोदरानाहपार्श्वहृत्कोष्ठवेदनाः ॥ १२ ॥ योन्यर्शोग्रहणीदोषकासश्वासारुचिज्वरान् ।
Medicated ghee prepared withhapuṣa – Juniperus communis, ūṣaṇa – Piper nigrum, pṛthvīkā – Elettaria cardamomum / Nigella indica, pañcakolaka – Piper longum, root of Piper longum, Piper retrofractum, Plumbago zeylanica and Zingiber officinale, dīpyaka – Trachyspermum ammi / Cuminum cyminum, ajājī – Cuminum cyminum, saindhava – rock salt, curds, milk, juices of dāḍima – Punica granatum, mūlaka – Raphanus sativus, kola – and Ziziphus jujube. This recipe cures vata gulma, enlargement of the abdomen, abdominal distention pain in the flanks, region of the heart and abdomen, diseases of the vagina, haemorrhoids, duodenal disorders, cough, dysponea, anorexia and fever.

Dadhika Ghrita

दशमूलं बलां कालां सुषवीं द्वौ पुनर्नवौ ॥ १३ ॥
पौष्करैरण्डरास्नाश्वगन्धाभार्ग्यमृताशठीः ।
पचेद्गन्धपलाशं च द्रोणेऽपां द्विपलोन्मितम् ॥ १४ ॥
यवैः कोलैः कुलत्थैश्च माषैश्च प्रास्थिकैः सह ।
क्वाथेऽस्मिन् दधिपात्रे च घृतप्रस्थं विपाचयेत् ॥ १५ ॥
स्वरसैर्दाडिमाम्रातमातुलुङ्गोद्भवैर्युतम् । ।
तथा तुषाम्बुधान्याम्लशुक्तैः श्लक्ष्णैश्च कल्कितैः ॥ १६ ॥
भार्गीतुम्बुरुषड्ग्रन्थाग्रन्थिरास्नाग्निधान्यकैः ।
यवानकयवान्यम्लवेतसासितजीरकैः ॥ १७ ॥
अजाजीहिङ्गुहपुषाकारवीवृषकोषकैः ।
निकुम्भकुम्भमूर्वेभपिप्पलीवेल्लदाडिमैः ॥ १८ ॥
श्वदंष्ट्रात्रपुसैर्वारुबीजहिंस्राश्मभेदकैः ।
मिशिद्विक्षारसुरसशारिवानीलिनीफलैः ॥ १९ ॥
त्रिकटुत्रिपटूपेतैर्दाधिकं तद्व्यपोहति ।
रोगान् आशुतरान् पूर्वान् कष्टानपि च शीलितम् ॥ २० ॥
अपस्मारगदोन्मादमूत्राघातानिलामयान् ।
Two pala (96 grams) each of daśamūlaṃ – roots of ten herbs, balā – Sida cordifolia, kālāṃ – Indigofera tinctoria, suṣavī – type of Cuminum cyminum, dvau punarnavau – two punarnava (Boerhavia diffusa), pauṣkara – Inula racemosa, eraṇḍa – Ricinus communis, rāsnā – Pluchea lanceolata, aśvagandhā – Withania somnifera, bhārgī – Clerodendrum serratum, amṛtā – Tinospora cordifolia, Curcuma zeodaria, gandhapalāśaṃ – and Paederia foetida, prāsthika – along with one prastha (768 grams) each of yava – Hordeum vulgare, kola – Ziziphus mauritiana, kulattha – Dolichos biflorus, māṣa – and Vigna mungo are boiled in one drone (12 litres 228 ml) of water and decoction reduced to a quarter). To this decoction are added, one patra (adhaka – 3 Kg 72 grams) of curds and one prastha (768 grams) of ghrta (ghee), juices of dāḍima – Punica granatum, āmrāta – Spondias pinnata and mātuluṅga: – Citrus medica, water in which barely husk is soaked, fermented water in which grains have been soaked and fermented rice-wash – each equal in quantity of ghee, nice paste of bhārgī – Clerodendrum serratum, tumburu – Zanthoxylum alatum, ṣaḍgranthā – Acorus calamus, granthi – knots of roots of Piper longum, rāsnā – Pluchea lanceolata, agni – Plumbago zeylanica, dhānyakaiḥ – Coriandrum sativum, yavānaka – type of Trachyspermum ammi, yavāni – Apium graveolens, amlavetasa – Garcinia pedunculata, asitajīraka – Carum carvi, ajājī – Cuminum cyminum, hiṅgu – Ferula narthex, hapuṣā – Juniperus communis, kāravī – Carum roxburghianum, vṛṣaka – Adhatoda vasica, uṣakaiḥ – alkaline sand, nikumbha – Baliospermum montanum, kumbha – Careya arborea, mūrvā – Marsdenia tenacissima, ibhapippalī – Scindapsus officinalis, vella – Piper nigrum, dāḍima – Punica granatum, śvadaṃṣṭrā – Tribulus terrestris, trapusa – seeds of Cucumis sativus, ervārubīja – and seeds of Cucumis melo, hiṃsrā – Capparis spinosa, aśmabhedaka – Bergenia ligulata, miśi – Foeniculum vulgare, dvikṣāra – the two alkali, surasa – Ocimum sanctum, śārivā – Hemidesmus indicus and fruits of nīlinī – Indigofera tinctoria, trikaṭu – Piper longum, Piper nigrum and Zingiber officinale, and three types of salt and ghee are cooked. This dadhika ghrta cures the diseases quickly, that are enumerated earlier, however difficult they are, if used habitually, so also epilepsy, insanity, retention of urine and diseases caused by Vata.

Trayushanadya Ghrita

त्र्यूषणत्रिफलाधान्यचविकावेल्लचित्रकैः ॥ २१ ॥ कल्कीकृतैर्घृतं पक्वं सक्षीरं वातगुल्मनुत् ।
Medicated ghee prepared withtryūṣaṇa – Piper longum, Piper nigrum and Zingiber officinale, triphalā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, dhānya – Coriandrum sativum, cavikā – Piper retrofractum, vella – Piper nigrum, citraka – and Plumbago zeylanica used for both decoction and paste and added with milk and cooked, cures gulma (abdominal tumour) of vata origin.

Lashunadya Ghrita

तुलां लशुनकन्दानां पृथक्पञ्चपलांशकम् ॥ २२ ॥
पञ्चमूलं महच्चाम्बुभारार्धे तद्विपाचयेत् ।
पादशेषं तदर्धेन दाडिमस्वरसं सुराम् ॥ २३ ॥
धान्याम्लं दधि चादाय पिष्टांश्चार्धपलांशकान् ।
त्र्यूषणत्रिफलाहिङ्गुयवानीचव्यदीप्यकान् ॥ २४ ॥
साम्लवेतससिन्धूत्थदेवदारून् पचेद्घृतात् ।
तैः प्रस्थं तत्परं सर्ववातगुल्मविकारजित् ॥ २५ ॥ One tula (4.8 Kg) ofcloves of laśuna – Allium sativumfive pala (240 grams) each of -the herbs of mahatpancamula (Aegle marmelos, Clerodendrum phlomidis, Oroxylum indicum, Stereospermum suaveolens and Gmelina arborea)are cooked inhalf-bhara of water – 48 litersand decoction reduced to one- fourth;equal quantities of juice of fruit of dāḍima – Punica granatum, beer, fermented water in which corns have been washedand curds, all together forming half the quantity of the decoction, paste of half pala (24 grams) each of tryūṣaṇa – Piper longum, Piper nigrum and Zingiber officinale, triphalā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, hiṅgu – Ferula narthex, yavānī – Trachyspermum ammi, cavya – Piper retrofractum, dīpyaka – Cuminum cyminum, amlavetasa – Garcinia pedunculata, sindhūttha – rock salt, devadārūn – and Cedrus deodara, and one prastha (768 grams) of ghee are added and cooked. This (recipe) is best to relieve all the abnormalities arising from vata gulma.

Shatpala Ghrita

षट्पलं वा पिबेत्सर्पिर्यदुक्तं राजयक्ष्मणि ।
प्रसन्नया वा क्षीरार्थः सुरया दाडिमेन वा ॥ २६ ॥
घृते मारुतगुल्मघ्नः कार्यो दध्नः सरेण वा ।
Shatpala ghrita, mentioned in the treatment of rajaksma (chapter 5/22-23) prepared by using either prasanna (scum of varuni), sura, juice of dāḍima – Punica granatum or whey of curds in place of milk can also be consumed along with ghee. This cures arising from Vata.

Remedies for kapha association in Vata Gulma

वातगुल्मे कफो वृद्धो हत्वाऽग्निमरुचिं यदि ॥ २७ ॥
हृल्लासं गौरवं तन्द्रां जनयेदुल्लिखेत्तु तम् ।
शूलानाहविबन्धेषु ज्ञात्वा सस्नेहमाशयम् ॥ २८ ॥
निर्यूहचूर्णवटकाः प्रयोज्या घृतभेषजैः ।
कोलदाडिमघर्माम्बुतक्रमद्याम्लकाञ्जिकै: ॥ २९ ॥
मण्डेन वा पिबेत्प्रातश्चूर्णान्यन्नस्य वा पुरः ।
चूर्णानि मातुलुङ्गस्य भावितान्यसकृद्रसे ॥ ३० ॥
कुर्वीत कार्मुकतरान् वटकान् कफवातयोः ॥ ३१अब् ॥
During course of vatagulma, with kapha increase, Kapha destroys the digestive fire causing tastelessness (anorexia), nausea, heaviness of the body and stupor. It (Kapha) should be expelled out by vamana-emesis therapy. With the presence of pain, distention of the abdomen and constipation considering these to be due to (increased) unctuousness of the abdominal viscera; decoction, powder or pills made from the herbs mentioned in the formula of medicated ghee should be administered. Powders (of herbs) should be consumed along with kola – Ziziphus jujube, dāḍima – Punica granatum, warm water, butter milk, alcohol, sour gruel, or scum of gruel. Either in the morning or just before partaking food. Powders (of herbs) soaked and macerated many times in the juice of Citrus medica, should be rolled into pills of efficient action (in appropriate dose) and used in gulma arising from kapha and vata.

Hinguvachadi Churnam

हिङ्गुवचाविजयापशुगन्धादाडिमदीप्यकधान्यकपाठाः ॥ ३१ ॥
पुष्करमूलशठीहपुषाग्निक्षारयुगत्रिपटुत्रिकटूनि ॥ ३१॥ साजाजिचव्यं सहतिन्तिडीकं सवेतसाम्लं विनिहन्ति चूर्णं ।
हृत्पार्श्ववस्तित्रिकयोनिपायुशूलानि वाय्वामकफोद्भवानि ॥ ३२ ॥ कृच्छ्रान् गुल्मान् वातविण्मूत्रसङ्गं कण्ठे बन्धं हृद्ग्रहं पाण्डुरोगम् ।
अन्नाश्रद्धाप्लीहदुर्नामहिध्मावर्ध्माध्मानश्वासकासाग्निसादान् ॥ ३३ ॥ Nice powder is prepared with equal quantities each ofhiṅgu – Ferula narthex, vacā – Acorus calamus, vijayā – Cannabis sativa, paśugandhā – Withania somnifera, dāḍima – Punica granatum, dīpyaka – Cuminum cyminum, dhānyaka – Coriandrum sativum, pāṭhāḥ – Cissampelos pareira, puṣkaramūla – Inula racemosa, śaṭhī – Curcuma zedoaria, hapuṣā – Juniperus communis, agni – Plumbago zeylanica, kṣārayuga – the two alkali, three kinds of salts, trikaṭu – Piper longum, Piper nigrum and Zingiber officinale, ajāji – Cuminum cyminum, cavyaṃ – Piper retrofractum, saha tintiḍīkaṃ – Rhus parviflora, vetasāmla – and Garcinia pedunculata. This cures pain of the region of the heart, flanks, urinary bladder, upper back, vagina and rectum arising from aggravation of vata, ama, and kapha, abdominal tumor which are difficult to treat, obstruction of flatus, faeces and urine, obstruction in the throat, catching pain of the heart, anemia, non-relishing of food, disease of the spleen, hemorrhoids, hiccup, enlargement of the scrotum, flatulence, dyspepsia, cough and diminution of digestive fire.

Vaishvanara Churnam

लवणयवानीदीप्यककणनागरमुत्तरोत्तरं वृद्धम् ।
सर्वसमांशहरीतकी चूर्णं वैश्वानरः साक्षात् ॥ ३४ ॥
lavaṇa – Rock salt, yavānī – Trachyspermum ammi, dīpyaka – Cuminum cyminum, kaṇa – Piper longum, nāgaraṃ – Zingiber officinale, each succeeding one increasing in quantity (by one part) and powder of Terminalia chebula equal to the total quantity of other herbs are made into nice powder. This curna is vaisvanara (God of fire) actually.

Hingvastaka Churnam

त्रिकटुकमजमोदा सैन्धवं जीरके द्वे |समधरणधृतानामष्टमो हिङ्गुभागः | प्रथमकवलभोज्यः सर्पिषा सम्प्रयुक्तो |जनयति जठराग्निं वातगुल्मं निहन्ति ॥ ३५ ॥ Nice powder of equal quantities oftrikaṭukaṃ – Piper longum, Piper nigrum and Zingiber officinale, ajamodā – Apium graveolens, saindhavaṃ – rock salt and the two jiraka (Cuminum cyminum and Carum carvi) and hiṅgu – Ferula narthex, one eighth part, consumed withthe first morsel of food, added with ghee, generates the gastric fire (digestive activity) and cures vatagulma (abdominal tumor of vata origin.

Shardula Churnam

हिङ्गूग्राविडशुण्ठ्यजाजिविजयावाट्याभिधानामयैश्चूर्णः
कुम्भनिकुम्भमूलसहितैर्भागोत्तरं वर्धितैः |
पीतः कोष्णजलेन कोष्ठजरुजो गुल्मोदरादीनयं
शार्दूलः प्रसभं प्रमथ्य हरति व्याधीन् मृगौघानिव ॥ ३६ ॥
Powder prepared with hiṅga – Ferula narthex, ugrā – Acorus calamus, viḍa – vida salt, śuṇṭhī – Zingiber officinale, ajāji – Cuminum cyminum, vijayā – Cannabis sativa, vāṭya – Sida cordifolia, roots of kumbha – Careya arborea nikumbha – and Baliospermum montanum each succeeding one increased by one part. This should be consumed along with warm water. It curespain of the abdominal viscera, abdominal tumor, enlargement of the abdomen and other diseases just as a lion attack and kills fiercely, the herd of animals.

Naracha Churnam

सिन्धूत्थपथ्याकणदीप्यकानां चूर्णानि तोयैः पिबतां कवोष्णैः |
प्रयाति नाशं कफवातजन्मा नाराचनिर्भिन्न इवामयौघः ॥ ३७द् ॥
Nice powder prepared from (equal quantities of) sindhūttha – rock salt, pathyā – Terminalia chebula, kaṇa – Piper longum, dīpyaka – and Cuminum cyminum consumed with lukewarm water, destroys the whole group of diseases arising from kapha and vata, just like an arrow (kills the enemies).

Putikadi Yoga

पूतीकपत्रगजचिर्भटचव्यवह्नि व्योषं च संस्तरचितं लवणोपधानम् |
दग्ध्वा विचूर्ण्य दधिमस्तुयुतं प्रयोज्यं गुल्मोदरश्वयथुपाण्डुगुदोद्भवेषु ॥ ३८द् ॥
pūtīka patra – Leaves of putika Holoptelea integrifolia, gaja cirbhaṭa – Cucumis momordica, cavya – Piper retrofractum, vahni – Plumbago zeylanica, vyoṣaṃ ca – Piper longum, Piper nigrum and Zingiber officinale, are placed on the ground like a heap and saindhava is spread over it. The heap is set on fire, the ash obtained is powdered nicely. This is to be administered mixed with supernatant liquid of curds in abdominal tumors, enlargement of the abdomen, dropsy, anaemia and hemorrhoids.

Hingutriguna Taila

हिङ्गुत्रिगुणं सैन्धवमस्मात्त्रिगुणं च तैलमेरण्डम् ॥ ३९अब् ॥
तत्त्रिगुणलशुनरसं गुल्मोदरवर्ध्मशूलघ्नम् ।
hiṅgu – Ferula narthex – one part, triguṇaṃ saindhavaṃ – rock salt – three parts, Oil of eraṇḍam – Ricinus communis three parts of it (of rock salt) juice of laśuna – juice of Allium sativum three parts of it (of oil of Ricinus communis) all are cooked together. This oil cures abdominal tumor, enlargement of the abdomen, enlargement of scrotum and colic.

Matulungadi Yoga

मातुलुङ्गरसो हिङ्गु दाडिमं विडसैन्धवम् ॥ ४० ॥
सुरामण्डेन पातव्यं वातगुल्मरुजापहम् ।
Juice of mātuluṅga – Citrus medica, hiṅgu – Ferula narthex, dāḍimaṃ – Punica granatum, viḍa – Vida salt, saindhavam – Rock salt, pātavyaṃ – consumed along with scum of beer relieves the pain of vata gulma.

Shuntyadi Churna

शुण्ठ्याः कर्षं गुडस्य द्वौ धौतात्कृष्णतिलात्पलम् ॥ ४१ ॥ खादन्नेकत्र सञ्चूर्ण्य कोष्णक्षीरानुपो जयेत् ।
वातहृद्रोगगुल्मार्शोयोनिशूलशकृद्ग्रहान् ॥ ४२ ॥ 12 Grams ofśuṇṭhi – Zingiber officinale, two karsa (24 grams) of jaggery and one pala (48 grams) of Sesamum indicum washed well – washed well are powdered together and consumed, followed by drinking warm milk. By this the person gets relieved of heart diseases of vata origin, abdominal tumor, hemorrhoids, vaginal pain and constipation.

Measures to be taken in Vata gulma associated with kapha and pitta

पिबेदेरण्डतैलं तु वातगुल्मी प्रसन्नया ।
श्लेष्मण्यनुबले वायौ पित्ते तु पयसा सह ॥ ४३ ॥ The patient of vata gulmawhen having kapha as the secondary dosha should drinkoil of Ricinus communis mixed withscum of varuni wineand when Vata Gulma is associated with pitta (is the secondary dosha) she should consume oil of Ricinus communis mixed with milk.

Measures to be taken in Vata gulma associated with pitta

विवृद्धं यदि वा पित्तं सन्तापं वातगुल्मिनः ।
कुर्याद्विरेचनीयोऽसौ सस्नेहैरानुलोमिकैः ॥ ४४ ॥
तापानुवृत्तावेवं च रक्तं तस्यावसेचयेत् ।
In the patient of vatagulma, when pitta getting greatly increased produces santapa (exhaustion due to increase of body temperature or feeling of burning sensation). He should be administered purgative therapy with fats, and laxative herbs. If the exhaustion / burning sensation persists, bloodletting should be done.

Lashuna Ksheerapaka

साधयेच्छुद्धशुष्कस्य लशुनस्य चतुःपलम् ॥ ४५ ॥
क्षीरोदकेऽष्टगुणिते क्षीरशेषं च पाचयेत् ।
वातगुल्ममुदावर्तं गृध्रसीं विषमज्वरम् ॥ ४६ ॥
हृद्रोगं विद्रधिं शोषं साधयत्याशु तत्पयः ।
Four pala (192 grams) of well dried laśuna – Allium sativum is boiled in eight times its quantity of milk and water, each separately, boiled and reduced to the quantity of milk and consumed. This milk quickly cures abdominal tumor of vata origin, upward movement of vata, sciatica, remittent fever, heart disease, abscess and consumption.

Use of taila, prasanna etc.

तैलं प्रसन्ना गोमूत्रमारनालं यवाग्रजः ॥ ४७ ॥
गुल्मं जठरमानाहं पीतमेकत्र साधयेत् ।
Scum of wine, cow urine, rice wash, ash of yavagra (yavaksara), all mixed together and consumed cures abdominal tumor, enlargement of the abdomen and distention.

Chitrakadi Kvatha

चित्रकग्रन्थिकैरण्डशुण्ठीक्वाथः परं हितः ॥ ४८ ॥
शूलानाहविबन्धेषु सहिङ्गुविडसैन्धवैः ।
Decoction of citraka – Plumbago zeylanica, granthika – Piper longum, eraṇḍa – Ricinus communis, śuṇṭhī – and Zingiber officinale, mixed with hiṅgu – Ferula narthex; viḍa – vida salt, saindhava – and rock salt is best for abdominal colic pain, distention of the abdomen and constipation.

Pushkaradi Kvatha

पुष्करैरण्डयोर्मूलं यवधन्वयवासकम् ॥ ४९ ॥
जलेन क्वथितं पीतं कोष्ठदाहरुजापहम् ।
Decoction of roots of puṣkara – Inula racemosa, eraṇḍa – Ricinus communis, yava – Hordeum vulgare and dhanvayavāsakam – Alhagi camelorum, boiled in water and consumed relieves the burning sensation and pain in the alimentary tract.

Vatyahvadi Kvatha

वाट्याह्वैरण्डदर्भाणां मूलं दारु महौषधम् ॥ ५० ॥
पीतं निःक्वाथ्य तोयेन कोष्ठपृष्ठांसशूलजित् ।
Roots of vāṭyāhva – Sida cordifolia, eraṇḍa – Ricinus communis and darbhā – Desmostachya bipinnata, dāru – Berberis aristata, and mahauṣadham – Zingiber officinale, made into a decoction and consumed with water relieves pain of the alimentary tract, cures pain in the back and scapular region.

Use of Shilajatu and Brihat Panchamula

शिलाजं पयसानल्पपञ्चमूलशृतेन वा ॥ ५१ ॥
वातगुल्मी पिबेत्
The patient of vatagulma – the patient of vatagulma should consume Asphaltum either with milk or with decoction of herbs of analpa (Brihat) pancamula (Aegle marmelos, Clerodendrum phlomidis, Oroxylum indicum, Gmelina arborea and Stereospermum suaveolens).

Use of Vatya

… वाट्यमुदावर्ते तु भोजयेत् ।
स्निग्धं पैप्पलिकैर्यूषैर्मूलकानां रसेन वा ॥ ५२ ॥
When udavarta (upward movement of vata inside the abdomen) is present, the patient should eat fried Hordeum vulgare mixed with fat, with either the soup processed with paippalikai: – Piper longum or juice of mūlakā – Raphanus sativus.

Use of Yavaka and Kulmasha

बद्धविण्मारुतोऽश्नीयात्क्षीरेणोष्णेन यावकम् ।
कुल्माषान् वा बहुस्नेहान् भक्षयेल्लवणोत्तरान् ॥ ५३ ॥
Ppatient of vata gluma. who has obstruction of feces and flatus should partake yāvakam – Hordeum vulgare along with warm milk or kulmasa (pulses baked in steam) added with more of fat (ghee or oil), consumed by adding with salt.

Neelini Ghrita

नीलिनीत्रिवृतादन्तीपथ्याकम्पिल्लकैः सह ।
समलाय घृतं देयं सविडक्षारनागरम् ॥ ५४ ॥
नीलिनीं त्रिफलां रास्नां बलां कटुकरोहिणीम् ।
पचेद्विडङ्गं व्याघ्रीं च पालिकानि जलाढके ॥ ५५ ॥
रसेऽष्टभागशेषे तु घृतप्रस्थं विपाचयेत् ।
दध्नः प्रस्थेन संयोज्य सुधाक्षीरपलेन च ॥ ५६ ॥
ततो घृतपलं दद्याद्यवागूमण्डमिश्रितम् ।
जीर्णे सम्यग्विरिक्तं च भोजयेद्रसभोजनम् ॥ ५७ ॥
गुल्मकुष्ठोदरव्यङ्गशोफपाण्ड्वामयज्वरान् ।
श्वित्रं प्लीहानमुन्मादं हन्त्येतन्नीलिनीघृतम् ॥ ५८ ॥
When the malas (doshas) are accumulated, ghee prepared with nīlinī – Indigofera tinctoria, trivṛt – Operculina turpethum, dantī – Baliospermum montanum, pathyā – Terminalia chebula and kampillaka – Mallotus philippensis should be given mixed with powder of vida salt, alkali of Hordeum vulgare and Zingiber officinale, one pala (48 grams) each of nīlinī – Indigofera tinctoria, triphalā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, rāsnā – Pluchea lanceolata, balā – Sida cordifolia, kaṭukarohiṇī – Picrorhiza kurroa, viḍaṅga – Embelia ribes, and vyāghrīṃ – Solanum xanthocarpum are boiled in one adhaka (3 litres 72 ml) of water and decoction reduced to one-eight part. One prastha (768 grams) of ghee and one prastha (768 ml) of curds, should be added to it. One pala (48 ml) of milky sap of Euphorbia neriifolia is added and medicated ghee is prepared. One pala (48 grams) of this ghee should be given with Yavagu mixed with manda (scum of gruel). After the medicine is digested properly the person should be given purgation. He should take meals along with juice soup of meat. This nilinighrtam cures abdominal tumor, skin diseases, enlargement of the abdomen, dark patches on the face, dropsy, anaemia, fever, leucoderma, disease of the spleen and schizophrenia.

Diet for patients of Vataja Gulma

कुक्कुटाश्च मयूराश्च तित्तिरिक्रौञ्चवर्तकाः ।
शालयो मदिरा सर्पिर्वातगुल्मचिकित्सितम् ॥ ५९ ॥
मितमुष्णं द्रवं स्निग्धं भोजनं वातगुल्मिनाम् ।
समण्डा वारुणी पानं तप्तं वा धान्यकैर्जलम् ॥ ६० ॥
Meat of fowl, peacock, partridge, heron and quail different kinds of rice, wine, and ghee are to be made use in the treatment of vatagulma. The food should be limited in quantity, hot, liquid, moist, mixed with fat, along with supernatant liquid of Varuni (a type of wine), or water boiled with dhānyaka – Coriandrum sativum are ideal to drink for patient of vatagulma.

Pittaja Gulma Chikitsa

स्निग्धोष्णेनोदिते गुल्मे पैत्तिके स्रंसनं हितम् ।
द्राक्षाभयागुडरसं कम्पिल्लं वा मधुद्रुतम् ॥ ६१ ॥
In abdominal tumor arising from pitta, caused due to indulgence in more of fats and hot things, mild purgation is beneficial. Juice of drākṣā – Vitis vinifera, abhayā – Terminalia chebula, and jaggery or of kampillaṃ – Mallotus philippensis mixed with honey (is good to take).

Pittaja Gulma Chikitsa

कल्पोक्तं रक्तपित्तोक्तं गुल्मे रूक्षोष्णजे पुनः ।
परं संशमनं सर्पिस्तिक्तं वासाघृतं शृतम् ॥ ६२ ॥
तृणाख्यपञ्चकक्वाथे जीवनीयगणेन वा ।
शृतं तेनैव वा क्षीरं न्यग्रोधादिगणेन वा ॥ ६३ ॥
Recipes (of sramsana – laxative therapy) described in either kalpasthana (chapter 2) or in the treatment of raktapitta (chapter 2/10 of cikitsasthana) are suitable for sramsana (laxative therapy). In pitta gulma caused by indulgence in dry and hot things, samshamana (therapy to mitigate the doshas) is best. Tiktakaghrta (chapter 19 of cikitsasthana), vasaghrta (chapter 2 of cikitsa sthana) should be consumed either with decoction of herbs of trnapancamula or decoction of Jeevaniya gana or milk boiled with same herbs or herbs of nyagrodhadi gana (chapter 15 of sutrasthana) are suitable (for samsamana, therapy).

Pittaja Gulma Cikitsa

तत्रापि स्रंसनं युञ्ज्याच्छीघ्रमात्ययिके भिषक् ।
वैरेचनिकसिद्धेन सर्पिषा पयसा&पि वा ॥ ६४ ॥
Even here, when there is emergency, the physician should immediately administer laxative therapy, either with ghee or milk processed with purgative herbs.

Pittaja Gulma Chikitsa

रसेनामलकेक्षूणां घृतप्रस्थं विपाचयेत् ।
पथ्यापादं पिबेत्सर्पिस्तत्सिद्धं पित्तगुल्मनुत् ॥ ६५ ॥
पिबेद्वा तैल्वकं सर्पिर्यच्चोक्तं पित्तविद्रधौ ।
One prastha (768 grams) of ghee should be cooked with juice of āmalaka – Emblica officinalis and ikṣū – Saccharum officinalis and one fourth part of Terminali chebula. This medicated ghee when consumed cures pitta Gulma. Tailvaka ghrita (chapter 21 of cikitsasthana) or that mentioned in the treatment of pitta vidradhi (chapter 13 of cikitsthana) should be consumed.

Pittaja Gulma Chikitsa

द्राक्षां पयस्यां मधुकं चन्दनं पद्मकं मधु ॥ ६६ ॥
पिबेत्तण्डुलतोयेन पित्तगुल्मोपशान्तये ।
drākṣā – Vitis vinifera, payasyāṃ – Ipomoea digitata, madhukaṃ – Glycyrrhiza glabra, candanaṃ – Santalum album, padmakaṃ – Prunus cerasoides honey should be consumed along with rice-wash for the cure of pitta gulma.

Pittaja Gulma Chikitsa: Trayamana Ghrita

द्विपलं त्रायमाणाया जलद्विप्रस्थसाधितम् ॥ ६७ ॥ अष्टभागस्थितं पूतं कोष्णं क्षीरसमं पिबेत् ।
पिबेदुपरि तस्योष्णं क्षीरमेव यथाबलम् ॥ ६८ ॥ तेन निर्हृतदोषस्य गुल्मः शाम्यति पैत्तिकः ।
Two pala (96 grams) oftrāyamāṇa – Gentiana kurroo is boiled in two prastha (1536 ml) of water, decoction reduced to one-eight the quantity, filtered and consumed hot, mixed with equal quantity of milk. This is followed by drinking hot milk onlyaccording to his strength. By this, the doshas get expelled and pitta gulma subsides.

Pittaja Gulma Chikitsa: Abhyanga, lepa, sparsha

दाहेऽभ्यङ्गो घृतैः शीतैः साज्यैर्लेपो हिमौषधैः ॥ ६९ ॥
स्पर्शः सरोरुहां पत्रै: पात्रैश्च प्रचलज्जलैः ।
If burning sensation is found, the body of the patient should be anointed with cold ghee or body should be smeared with ghee processed with herbs of cold potency, or touched (covered) with leaves of lotus plant or with vessels through which water is moving.

Pittaja Gulma Chikitsa: Raktamoksana (bloodletting)

विदाहपूर्वरूपेषु शूले वह्नेश्च मार्दवे ॥ ७० ॥
बहुशोऽपहरेद्रक्तं पित्तगुल्मे विशेषतः ।
In gulma associated with heart-burn, pain in the abdomen and weak digestion during the prodromal stage itself, blood-letting should be done many times especially so in pitta gulma.

Pittaja Gulma Chikitsa: Chinnamula Gulma

छिन्नमूला विदह्यन्ते न गुल्मा यान्ति च क्षयम् ॥ ७१ ॥
रक्तं हि व्यम्लतां याति तच्च नास्ति न चास्ति रुक् ।
When the gulma is removed from its root it does not undergo suppuration, in fact undergoes decrease. (Due to this), the vitiated blood becomes free from acidic nature (loses its acidic nature) and when it is not present (acidic blood), the pain also doesn’t exist.

Pittaja Gulma Chikitsa: Use of meat soup and providing assurance

हृतदोषं परिम्लानं जाङ्गलैस्तर्पितं रसैः ॥ ७२ ॥
समाश्वस्तं सशेषार्तिं सर्पिरभ्यासयेत् पुनः ।
The patient who has been relieved of the doshas, and who has become very weak, should be nourished with juice (soup) of meat of animals of desert-like regions, consoled to bear the remaining troubles and to get habituated to the use of (medicated) ghee for their relief.

Pittaja Gulma Chikitsa: Use of treatment of Pittaja Vidradi

रक्तपित्तातिवृद्धत्वात् क्रियामनुपलभ्य वा ॥ ७३ ॥
गुल्मे पाकोन्मुखे सर्वा पित्तविद्रधिवत् क्रिया ।
Either by great increase of rakta and pitta or by not getting proper treatment, pitta gulma progresses towards paka (suppression / ulceration). Then all the treatments prescribed for abscess arising from pitta should be adopted.

Pittaja Gulma Chikitsa: Ideal food and drinks

शालिर्गव्याजपयसी पटोली जाङ्गलं घृतम् ॥ ७४ ॥
धात्री परूषकं द्राक्षा खर्जूरं दाडिमं सिता ।
भोज्यं पानेऽम्बु बलया बृहत्याद्यैश्च साधितम् ॥ ७५ ॥
śāli: – Oryza sativa, cow’s milk goat’s milk patoli ghee prepared from milk of animals of desert-like regions,  dhātrī – Emblica officinalis, parūṣakaṃ – Grewia asiatica, drākṣā – Vitis vinifera, kharjūraṃ – Phoenix dactylifera, dāḍimaṃ – Punica granatum and sugar should be used as food. Water boiled either with Sida cordifolia or herbs commencing with Solanum indicum (Bruhatyadi Gana) is used for drinking.

Kaphaja Gulma Chikitsa

श्लेष्मजे वामयेत् पूर्वमवम्यमुपवासयेत् ।
तिक्तोष्णकटुसंसर्ग्या वह्निं सन्धुक्षयेत् ततः ॥ ७६ ॥
हिङ्ग्वादिभिश्च द्विगुणक्षारहिङ्ग्वम्लवेतसैः ।
In slesmaja gulma (abdominal tumor arising from kapha) the patient should be made to vomit (by administering vamana therapy) in the beginning itself. Those who are unfit for emesis should be made to fast. The digestive fire should be increased by the use of foods processed with herbs having bitter, hot and pungent properties and by the use of hingvadi curna etc. (described earlier in the treatment of vata gulma) or with those having alkali, double in quantity of hiṅgu – Ferula narthex and amlavetasa – Garcinia pedunculata.

Kaphaja Gulma Chikitsa

निगूढं यदि वोन्नद्धं स्तिमितं कठिनं स्थिरम् ॥ ७७ ॥
आनाहादियुतं गुल्मं संस्वेद्य विनयेदनु ।
घृतं सक्षारकटुकं पातव्यं कफगुल्मिनाम् ॥ ७८ ॥
Kaphagulma which is either concealed (deep seated) or bulging up but found to be immovable, hard and static, gulma associated with distention of the abdomen etc. should be given fomentation and mitigated. The patient is made to drink ghee processed with alkalies and pungent herbs.

Kaphaja Gulma Chikitsa

सव्योषक्षारलवणं सहिङ्गुविडदाडिमम् ।
कफगुल्मं जयत्याशु दशमूलशृतं घृतम् ॥ ७९ ॥
Medicated ghee prepared with decoction of daśamūla – group of ten roots, vyoṣa – along with Piper longum, Piper nigrum and Zingiber officinale, alkali, salt, hiṅgu – Ferula narthex, vida salt, and dāḍimam – Punica granatum cures kapha gulma quickly.

Bhallataka Ghrita

भल्लातकानां द्विपलं पञ्चमूलं पलोन्मितम् ।
अल्पं तोयाढके साध्यं पादशेषेण तेन च ॥ ८० ॥
तुल्यं घृतं तुल्यपयो विपचेदक्षसम्मितैः ।
विडङ्गहिङ्गुसिन्धूत्थयावशूकशठीविडैः ॥ ८१ ॥
सद्वीपिरास्नायष्ट्याह्वषड्ग्रन्थाकणनागरैः ।
Two pala (96 grams) of bhallātakānāṃ – Semecarpus anacardium, one pala (48 grams) of alpaṃ pañcamūlaṃ – alpa (hrasva) pancamula (Desmodium gangeticum, Uraria picta, Tribulus terrestris, Solanum indicum and Solanum xanthocarpum), are boiled in one adhaka (3 litres 72 ml) of water and decoction reduced to a quarter. To this are added ghee and milk, each equal in quantity and paste of one aksa (12 grams) each of viḍaṅga – Embelia ribes, hiṅgu – Ferula narthex, sindhūttha – rock salt, yāvaśūka – Hordeum vulgare, śaṭhī – Curcuma zedoaria vida salt, dvīpi – Plumbago zeylanica, rāsnā – Pluchea lanceolata, yaṣṭyāhva – Glycyrrhiza glabra, ṣaḍgranthā – Acorus calamus, kaṇa – Piper longum and nāgaraiḥ – Zingiber officinale and medicated ghee prepared. This bhallataka ghrita is best in curing kapha gulma, diseases of the spleen, anemia, dyspnoea, disease of the duodenum and cough.

Importance of Snehana and Svedana

ततोऽस्य गुल्मे देहे च समस्ते स्वेदमाचरेत् ॥ ८३ ॥
सर्वत्र गुल्मे प्रथमं स्नेहस्वेदोपपादिते ।
या क्रिया क्रियते याति सा सिद्धिं न विरूक्षिते ॥ ८४ ॥
Next, the tumor in him (caused by kapha) as well as the entire body should be given sveda (sudation/ fomentation). In all the varieties of abdominal tumors, that treatment which has been commenced with sneha (oleation) and sveda (sudation) therapies succeeds and not which has had viruksana (drying therapy).

Shastra Chikitsa: Surgical treatment

स्निग्धस्विन्नशरीरस्य गुल्मे शैथिल्यमागते ।
यथोक्तां घटिकां न्यस्येद्गृहीतेऽपनयेच्च ताम् ॥ ८५ ॥
वस्त्रान्तरं ततः कृत्वा भिन्द्याद्गुल्मं प्रमाणवित् ।
विमार्गाजपदादर्शैर्यथालाभं प्रपीडयेत् ॥ ८६ ॥
प्रमृज्याद्गुल्ममेवैकं न त्वन्त्रहृदयं स्पृशेत् ।
The person whose body has been given oleation and sudation therapies, and the tumor having attained looseness, a pot (cupping vessel) should be placed over it and be held tight over it and after it has held tight, it should be removed. Next, holding the tumor covered with cloth, it should be (excised), determining the size of the cut, pressing it either with vimarga, ajapada (both are instruments used by cobblers) or arso yantra (rectal speculum) whichever is available, all the time kneading only the tumor with the finger and not touching the intestines or the heart.

Kaphaja Gulma Cikitsa: Tiladi lepa and svedana

तिलैरण्डातसीबीजसर्षपैः परिलिप्य च ॥ ८७ ॥
श्लेष्मगुल्ममयःपात्रैः सुखोष्णैः स्वेदयेत् ततः ।
The tumor of kapha origin should be covered with the paste of tila – Sesamum indicum, eraṇḍa – seeds of Ricinus communis, atasībīja – seeds of Linum usitatissimum, and sarṣapa – Brassica nigra and given comfortable (lukewarm) fomentation with an iron vessel.

Kaphaja Gulma Cikitsa: For dislodged gulma

एवं च विसृतं स्थानात्कफगुल्मं विरेचनैः ॥ ८८ ॥
सस्नेहैर्वस्तिभिश्चैनं शोधयेद्दाशमूलिकैः ।
After the kapha gulma has been dislodged from its place by these methods, the patient should be purified with purgatives, containing fats and enemas with decoction of dasamula (chapter 4 of kalpasthana).

Mishraka Sneha

पिप्पल्यामलकद्राक्षाश्यामाद्यैः पालिकैः पचेत् ॥ ८९ ॥
एरण्डतैलहविषोः प्रस्थौ पयसि षड्गुणे ।
सिद्धोऽयं मिश्रकः स्नेहो गुल्मिनां स्रंसनं हितम् ॥ ९० ॥
वृद्धिविद्रधिशूलेषु वातव्याधिषु चामृतम् ।
One pala (48 grams) each of pippalī – Piper longum, āmalaka – Emblica officinalis, drākṣā – Vitis vinifera and śyāmādyaiḥ – Ipomoea petaloides, 0one prastha (768 grams) each of castor oil and ghee – all are boiled in milk, six times their quantity. This preparation known as mishraka sneha is suitable as a sramsana (laxative) for patients of abdominal tumor. It is like nectar for patients of scrotal enlargement, abscesses, abdominal pain and diseases caused by vata.

Nilini sarpi and Sukumara ghrita

पिबेद्वा नीलिनीसर्पिर्मात्रया द्विपलीनया ॥ ९१ ॥
तथैव सुकुमाराख्यं घृतान्यौदरिकाणि वा ।
Either nilini sarpis (vide verse 55-58), sukumara ghrta (chapter 13/14) or ghrta yogas (medicated ghee recipes) described in the treatment of udara (chapter 15) may be consumed in doses of two pala (96 grams) each.

Danti Haritaki

द्रोणेऽम्भसः पचेद्दन्त्याः पलानां पञ्चविंशतिम् ॥ ९२ ॥
चित्रकस्य तथा पथ्यास्तावतीस्तद्रसे स्रुते ।
द्विप्रस्थे साधयेत् पूते क्षिपेद्दन्तीसमं गुडम् ॥ ९३ ॥
तैलात्पलानि चत्वारि त्रिवृतायश्च चूर्णतः ।
कणाकर्षौ तथा शुण्ठ्याः सिद्धे लेहे तु शीतले ॥ ९४ ॥
मधु तैलसमं दद्याच्चतुर्जाताच्चतुर्थिकाम् ।
अतो हरीतकीमेकां सावलेहपलामदन् ॥ ९५ ॥
सुखं विरिच्यते स्निग्धो दोषप्रस्थमनामयः ।
गुल्महृद्रोगदुर्नामशोफानाहगरोदरान् ॥ ९६ ॥
कुष्ठोत्क्लेशारुचिप्लीहग्रहणीविषमज्वरान् ।
घ्नन्ति दन्तीहरीतक्यः पाण्डुतां च सकामलाम् ॥ ९७ ॥
Twenty five pala (1.2 Kg) each of danti – Baliospermum montanum, citraka – Plumbago zeylanica and pathyā – Terminalia chebula are boiled in one drona (12 Litres 228 ml) of water and decoction is reduced to a quarter and filtered. To this are added, jaggery equal in quantity to that of Baliospermum montanum; four pala (192 grams) each of taila and powder of Operculina turpethum; two karsa (24 grams) of kaṇā – Piper longum and śuṇṭhi – Zingiber officinale and cooked to form a leha (confection). After it cools, honey and oil equal in quantity are added, along with four pala (192 grams) of caturjāta – Cinnamomum zeylanicum, Cinnamomum tamala, Elettaria cardamomum and Mesua ferrea are added. One haritaki, along with one pala (48 grams) in quantity of confection should be consumed. The person subjected to oleation, purges out easily, one prastha (thirteen and half pala in the context of virecana therapy) without any discomfort. This Danti hariki leha, cures abdominal tumor, heart disease, haemorrhodis, dropsy, distention of abdomen, homicidal poisoning, enlargement of the abdomen, skin diseases, nausea, anorexia, disease of the spleen and duodenum, remittent fever, anaemia and jaundice.

Use of Trivrit soaked in sap of Sudha

सुधाक्षीरद्रवं चूर्णं त्रिवृतायाः सुभावितम् ।
कार्षिकं मधुसर्पिर्भ्यां लीढ्वा साधु विरिच्यते ॥ ९८ ॥
Powder of trivṛt – Operculina turpethum soaked and macerated in the milky sap of Euphorbia neriifolia, consumed in the dose of 12 grams, mixed with honey and ghee, produces purgation easily.

Use of Kushtadi yoga and Guggulu

कुष्ठ श्यामात्रिवृत् दन्ती विजया क्षार गुग्गुलून् ।
गोमूत्रेण पिबेदेकं तेन गुग्गुलुमेव वा ॥ ९९ ॥
Powder of kuṣṭha – Saussurea lappa, śyāmā – Ipomoea turpethum, trivṛt – Operculina turpethum, dantī – Baliospermum montanum, vijayā – Cannabis sativus, kṣāra – alkali of yava – Hordeum vulgare and guggulu – Commiphora mukul or guggulu – Commiphora mukul alone eva vā pibet – can be consumed mixed with cows urine (to produce purgation).

Use of enemas described in kalpa and siddhi sthana
निरूहान् कल्पसिद्ध्युक्तान् योजयेद्गुल्मनाशनान्।
Decoction enema recipes described in kalpa-siddhisthana (chapter 4) which cure abdominal tumor may be administered.

Treating deep rooted and large gulmas

कृतमूलं महावास्तुं कठिनं स्तिमितं गुरुम् ॥ १०० ॥
गूढमांसं जयेद्गुल्मं क्षारारिष्टाग्निकर्मभिः ।
एकान्तरं द्व्यन्तरं वा विश्रमय्याथवा त्र्यहम् ॥ १०१ ॥
शरीरदोषबलयोर्वर्धनक्षपणोद्यतः ।
The tumor which is deep rooted, occupying a large area, hard, static (immovable), heavy, and concealed within muscle tissue should be treated with use of caustic alkali fermented decoction and branding by fire with intervals of one, two or three days of rest, concentrating on balance of increase and decrease of strength of the body and the doshas.

Area of using kshara in kapha gulma

अर्शोऽश्मरीग्रहण्युक्ताः क्षारा योज्याः कफोल्बणे ॥ १०२ ॥
Caustic alkali recipes described in the treatment of haemorrhodis (chapter 8), renal calculus (chapter 11) and duodenal disease (chapter 10) should be administered when kapha is greatly increased.

Ksharagada

देवदारुत्रिवृद्दन्तीकटुकापञ्चकोलकम् ।
स्वर्जिकायावशूकाख्यौ श्रेष्ठापाठोपकुञ्चिकाः ॥ १०३ ॥
कुष्ठं सर्पसुगन्धां च द्व्यक्षांशं पटुपञ्चकम् ।
पालिकं चूर्णितं तैलवसादधिघृताप्लुतम् ॥ १०४ ॥
घटस्यान्तः पचेत्पक्वमग्निवर्णे घटे च तम् ।
क्षारं गृहीत्वा क्षीराज्यतक्रमद्यादिभिः पिबेत् ॥ १०५ ॥
गुल्मोदावर्तवर्ध्मार्शोजठरग्रहणीकृमीन् ।
अपस्मारगरोन्मादयोनिशुक्रामयाश्मरीः ॥ १०६ ॥
क्षारागदोऽयं शमयेद्विषं चाखुभुजङ्गजम् ।
One pala (48 grams) each of devadāru – Cedrus deodara, trivṛt – Operculina turpethum, dantī – Baliospermum montanum, kaṭukā – Picrorhiza kurroo, pañcakolakam – pancakola (Piper longum, roots of Piper longum, Piper retrofractum, Plumbago zeylanica and Zingiber officinale), svarjikaksara (sodium carbonate), yāvaśūkākhyau – alkali of Hordeum vulgare, śreṣṭhā – Leptadenia reticulata / Butea monosperma, pāṭhā – Cissampelos pareira, upakuñcikāḥ – Nigella sativa, kuṣṭhaṃ – Saussurea lappa and sarpasugandhāṃ – Rauwolfia serpentina, two aksa (24 grams) of five types of salt are powdered and soaked in a mixture of oil, muscle fat, curds and ghee in a pot. It is cooked till the pot becomes red-hot like the color of fire. After it cools, the ksara (caustic alkali) is taken out and consumed mixed with milk, ghee, buttermilk, wine etc. This Ksaragada cures abdominal tumor, udavarta (upward movement of vata inside the abdomen), scrotal enlargement, hemorrhoids, enlargement of the abdomen, duodenal disorders, intestinal worms, the abdomen, duodenal disorders, intestinal worms, epilepsy, homicidal poisoning, insanity, diseases of the vaginal tract and semen, renal calculus, and poison of rat (bite) and snake (bite).

Kshara: Its importance in gulma

श्लेष्माणं मधुरं स्निग्धं रसक्षीरघृताशिनः ॥ १०७ ॥
छित्त्वा भित्त्वाऽऽशयात्क्षारः क्षारत्वात्क्षारयत्यधः ।
Alkali by its ksaratva (property of penetrating deep into the tissues), pulls out the kapha which is sweet and unctuous by cutting and breaking (the hard masses) which are inside the internal organs and bring it down, in person who consumes meat soup, milk and ghee only as food.

Use of Asava and Arista

मन्देऽग्नावरुचौ सात्म्यैर्मद्यैः सस्नेहमश्नताम् ॥ १०८ ॥
योजयेदासवारिष्टान् निगदान् मार्गशुद्धये ।
When there is weakness of digestive fire, and loss of taste / appetite, the person should be asked to consume food mixed with fats and wine accustomed to him. Then after, fermented infusion and fermented decoction which are unspoilt should be given for cleaning the channels.

Pathya anna pana: Suitable foods and drinks

शालयः षष्टिका जीर्णाः कुलत्था जाङ्गलं पलम् ॥ १०९ ॥
चिरिबिल्वाग्नितर्कारीयवानीवरुणाङ्कुराः ।
शिग्रुस्तरुणबिल्वानि बालं शुष्कं च मूलकम् ॥ ११० ॥
बीजपूरकहिङ्ग्वम्लवेतसक्षारदाडिमम् ।
व्योषं तक्रं घृतं तैलं भक्तं पानं तु वारुणी ॥ १११ ॥
धान्याम्लं मस्तु तक्रं च यवानीविडचूर्णितम् ।
पञ्चमूलशृतं वारि जीर्णं मार्द्वीकमेव वा ॥ ११२ ॥
पिप्पलीपिप्पलीमूलचित्रकाजाजीसैन्धवैः ।
सुरा गुल्मं जयत्याशु जगलश्च विमिश्रितः ॥ ११३ ॥

Different kinds of śāli – Sali (Oryza sativa), paddy grown in a span of sixty days, which are old, kulatthā – Dolichos biflorus meat of animals of desert-like regions, tender sportus of ciribilva – Holoptelea integrifolia, agni – Plumbago zeylanica, tarkārī – Clerodendrum phlomidis, yavānī – Trachyspermum ammi, varuṇa – and Crataeva nurvula, śigru: – Moringa oleifera, tender fruit of bilva – Aegle marmelos, tender and dried, mūlakam – Raphanus sativus, bījapūraka – Citrus limon, hiṅgu – Ferula narthex, amlavetasa – Garcinia pedunculata, kṣāra – alkali of yava – Hordeum vulgare, dāḍimam – Punica granatum, vyoṣaṃ – Piper longum, Piper nigrum and Zingiber officinale, buttermilk, ghee, oil, bhaktaṃ – for food and varuni (type of wine) for drinking, sour gruel, supernatant layer of curds and buttermilk added with powder of Trachyspermum ammi and bida (vida salt), water boiled with group of five roots – group of five roots and old mardvika (wine prepared from grapes) as drinks are best situated. Beer / wine or jagala (and residue of beer) added with powder of pippalī – Piper longum, pippalīmūla – roots of Piper longum, citraka – Plumbago zeylanica, ajājī – Cuminum cyminum, rock salt cures abdominal tumor quickly.

Agnikarma Chikitsa: Thermal cautery

वमनैर्लङ्घनैः स्वेदैः सर्पिःपानैर्विरेचनैः ।
वस्तिक्षारासवारिष्टगुटिकापथ्यभोजनैः ॥ ११४ ॥
श्लैष्मिको बद्धमूलत्वाद्यदि गुल्मो न शाम्यति ।
तस्य दाहं हृते रक्ते कुर्यादन्ते शरादिभिः ॥ ११५ ॥
Even after administration of therapies such as emesis, fasting, sudation, drinking ghee, purgation, enema, alkali, asava, arista and pills and partaking healthy (suitable) foods, abdominal tumor of kapha origin does not subside because of being situated deep inside, the blood should be let out and as a last resort the tumor should be burnt (branded with fire) using iron arrow etc.

Agnikarma Chikitsa: Thermal cautery

अथ गुल्मं सपर्यन्तं वाससान्तरितं भिषक् ।
नाभिवस्त्यन्त्रहृदयं रोमराजीं च वर्जयन् ॥ ११६ ॥
नातिगाढं परिमृशेच्छरेण ज्वलता ऽथवा ।
लोहेनारणिकोत्थेन दारुणा तैन्दुकेन वा ॥ ११७ ॥
ततोऽग्निवेगे शमिते शीतैर्व्रण इव क्रिया ।
Then the physician should cover the tumor all around with a cloth, touched either with a red hot arrow or iron (rod), faggot of agnimantha – Clerodendrum phlomidis or wood of Diospyros malabarica; not very deep, avoiding the areas of the umblicius, urinary baldder, instestines, heart and streak of hair, after the severity of the burn subsides the wound should be treated with cold services.

Agnikarma Chikitsa: Thermal cautery

आमान्वये तु पेयाद्यैः सन्धुक्ष्याग्निं विलङ्घिते ॥ ११८ ॥
स्वं स्वं कुर्यात्क्रमं मिश्रं मिश्रदोषे च कालवित् ।
When there is combination of doshas and the doshas are in the ama (unripe) state, the digestive fire should be augmented by drinking of peya etc. (thin gruels). The person made to become thin and then treatment is planned, appropriate to the combined doshas done, taking note of the kala (time, season stage of the tumor etc.)

Rakta Gulma Chikitsa

गतप्रसवकालायै नार्यै गुल्मेऽस्रसम्भवे ॥ ११९ ॥
स्निग्धस्विन्नशरीरायै दद्यात्स्नेहविरेचनम् ।
In case of gulma (tumor) arising from blood in woman, after the lapse of the period of delivery (ten months), oleation and sudation should be administered followed next with purgartive therapy using fatty recipes.

Rakta Gulma Chikitsa

तिलक्वाथे घृतगुडव्योषभार्गीरजोऽन्वितः ॥ १२० ॥
पानं रक्तभवे गुल्मे नष्टे पुष्पे च योषितः ।
भार्गीकृष्णाकरञ्जत्वग्ग्रन्थिकामरदारुजम् ॥ १२१ ॥
चूर्णं तिलानां क्वाथेन पीतं गुल्मरुजापहम् ।
पलाशक्षारपात्रे द्वे द्वे पात्रे तैलसर्पिषोः ॥ १२२ ॥
गुल्मशैथिल्यजननीं पक्त्वा मात्रां प्रयोजयेत् ।
न प्रभिद्येत यद्येवं दद्याद्योनिविरेचनम् ॥ १२३ ॥
Decoction of Sesamum indicum mixed with ghee, jaggery, powder of vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, and bhārgī – Clerodendrum serratum should be consumed by the woman having rakta gulma and who has cessation of menstruation. Powder of bhārgī – Clerodendrum serratum, kṛṣṇā – Piper longum, karañjatvak – bark of Pongamia pinnata, granthikā – knots of roots of Piper longum, amaradārujam – Cedrus deodara consumed along with decoction of Sesamum indicum, cures the pain of the tumor. Two patra (two adhaka – 6 Kg 146 grams) of alkali of palāśa – Butea monosperma two patra (two adhaka – 6 Kg 146 grams) of oil and ghee sarpiṣoḥ – oil and ghee should be cooked and administered in suitable doses to produce looseness of the tumor. If by these treatments it does not break up, then vaginal purgation must be administered.

Rakta Gulma Chikitsa

क्षारेण युक्तं पललं सुधाक्षीरेण वा ततः ।
ताभ्यां वा भावितान् दद्याद्योनौ कटुकमत्स्यकान् ॥ १२४ ॥
वराहमत्स्यपित्ताभ्यां नक्तकान् वा सुभावितान् ।
किण्वं वा सगुडक्षारं दद्याद्योनौ विशुद्धये ॥ १२५ ॥
रक्तपित्तहरं क्षारं लेहयेन् मधुसर्पिषा ।
लशुनं मदिरां तीक्ष्णां मत्स्यांश्चास्यै प्रयोजयेत् ॥ १२६ ॥
वस्तिं सक्षीरगोमूत्रं सक्षारं दाशमूलिकम् ।
Paste of fried powder of palalaṃ – Sesamum indicum, added with alkalies or with sudhā kṣīra – milky sap of Euphorbia neriifolia or katuka fish processed with both alkali and milky sap of Euphorbia neriifolia should be placed inside the vagina, or katuka fish soaked in the bile of boar or fish or a wick soaked in the same (should be placed in the vagina) or yeast soaked in jaggery and alkali may be kept, in the vagina to purify it; – to purify it; ksara yoga (alkali) recipes – ksara yoga (alkali) recipes which cure raktapitta (bleeding diseases) should be licked mixed with honey and ghee. laśuna – Allium sativum, strong madira (wine) and fish should be consumed. Dasamulaka basti (chapter 4 of kalpasiddhi sthana) mixed with cow milk, cow urine and ksara (alkali) should be administered as enema.

Rakta Gulma Chikitsa

अवर्तमाने रुधिरे हितं गुल्मप्रभेदनम् ॥ १२७ ॥
यमकाभ्यक्तदेहायाः प्रवृत्ते समुपेक्षणम् ।
रसौदनस्तथाऽऽहारः पानं च तरुणी सुरा ॥ १२८ ॥
If there is no bleeding it is beneficial to cut open the tumor. If there is bleeding, the woman should be anointed with yamaka sneha (mixture of two fats) to the body, the bleeding should be neglected. For food, she is given boiled rice along with soup of meat and freshly prepared beer to drink.

Rakta Gulma Chikitsa

रुधिरेऽतिप्रवृत्ते तु रक्तपित्तहराः क्रियाः ।
कार्या वातरुगार्तायाः सर्वा वातहराः पुनः ॥ १२९||
आनाहादावुदावर्तबलासघ्न्यो यथायथम् ॥ १२९ऊअब् ॥
If the bleeding is profuse, treatment, which cures raktapitta (bleeding disease) should be administered. If there is pain produced by vata, all treatments which mitigate vata when there is distention of the abdomen etc. Treatment of vata moving in upward movement and mitigation of kapha should be done, as and how found appropriate.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने गुल्मचिकित्सितं नाम चतुर्दशोऽध्याय: ॥ १४ ॥
Thus ends the chapter-gulmacikistsiaa the foourteenth in cikitsita sthana of asthangahrdayasamhita composed by Srimadvagbhata, son of Sri Vaidyapati Simhagupta