Gulma- Abdominal Tumor: Symptoms, Diagnosis, and Ayurvedic Treatment

Gulma is a medical condition characterized by the presence of a lump between the cardiac region and the pelvic region.

The primary cause of all types of gulma is the imbalance of vata, and the disease cannot manifest without vata involvement. The term gulma refers to a cluster of creepers in a condensed form, similar to how vata remains compact and forms a solid lump in this condition.

Gulma is primarily identified by the presence of pain, making it a vedanapradhana vyadhi, and this pain serves as the main diagnostic factor.

Types of gulma

There are five different types of gulma, namely vatagulma, pittagulma, shleshmagulma, nicayagulma, and shonitagulma.

The variation in the number of gulma types mentioned in Nidana and Chikitsa Sthana is attributed to the principles of Prakriti Sama Samaveta and Vikriti Vishama Samaveta. In Nidana Sthana, three Prakriti Sama Samaveta Dwandwaja Gulma are not mentioned because their causes and treatment can be determined based on the individual humours involved in the pathogenesis. However, in Chikitsa Sthana, the other three Vikriti Vishama Samaveta Dwandwaja Gulma are counted separately as their causes, signs & symptoms, and treatment cannot be assumed solely based on the individual humours.

Gulma purvarupa

The occurrence of gulma in the near future can be indicated by the presence of several features such as excessive belching (udgarabahulya), constipation (pureesha bandha), dislike towards food (trupti), inability to work (akshamatva), increased intestinal motility (antravikujana), borborygmus (atopa), flatulence (adhmana), indigestion (apaktishakti), and disturbed metabolism (agnivaishamya).

Gulma samanya rupa

All types of gulma exhibit the following features: Aruchi (anorexia), krchra vinmutravata (difficulty in passing faeces, urine and flatus), antravikujana (sounds in the intestine), anaha (flatulence), and urdhwavata (over belching).

Specific symptoms of individual Gulma

Vata	Pitta	kaphaj
Sthana-Sansthana-Ruja vikalpa, Vid-Vara Sanga, Gala-Vaktra Shosha, Shyava-Arunatvan, Sheeta Jvara, Hrit-Kukshi-Parsh- va-Amsa-Shiro rujam, aggravates by digestion of food, relieved by eating food.	Jvara, Trishna, anga Raktata, severe shula during digestion, sweda, vrinavat vidaha, saprsh asaha.	Staimitya, sheeta jvara, gourava, sada, hrillasa, kasa, aruci, shaityam, alpa ruja, kathina-Unnata vriddhi

Line of Treatment

Vataja Gulma

Snehapana– Rukshajanya, Vyayamajanya, severe painful, obstructed Mala and Vata, present above the Nabhi. (Ca. Ci.5/ 21, 24)
Basti– Pakvashaya Gata. (Ca.Ci.5/24)
Snehapana and Basti-Gulma present in Jathara. (Ca. Ci.5/24 )
Repeated Snehana, Niruha, Anuvasana in Vatagulma, protecting the Kapha and Pitta at the same time. (Ca. Ci.5/26)
Vamana Prayoga- Agnimandya, Aruci, Hrillasa, Gourava, Tandra due to Kapha Vriddhi. (Ca.Ci.5/29)
Virecana Prayoga- In Vatagulma, if Pitta increased and causing Santapa, then Virecana with Sansneha Anulomana Dravya. (Ca. Ci.5/31)
Varti, Gutika, Churna Prayoga– In Gulma associated with Anaha, Udarashoola, Vibandha (Ca. Ci.5/30)
Raktamokshana- If by abovesaid treatments, the Vata, etc, are not pacified, then Raktamokshana should be done (Ca. Ci.5/ 32).

Pittaja Gulma

Virechana – Snigdha and Ushna Karanajanya; Ghritapana-Ruksha and Ushna Karanajanya. (Ca.Ci. 5/33)
Niruha Basti (Satikta Ksheera Basti)– Pakvashayagata Pitta Gulma. (Ci. 34)
Raktamokshana– Pitta Gulma ass. with Trishna, Jvara.

Kaphaja Gulma

Langhana– Avamya, Alpagni, Upanaha, Shastra, Shodhana.
(Ca, Ci.5/49) 2. Vamana-Mandagni, Vamana Yogya, Mandavedana, Gurukoshtha, Stimita Koshtha and Utklesha. (Ca, Ci.5/50)
Virechana– By seeing the displacement of Gulma from its site by Kshara Katu Yukta Ghritapana, then Virecana should be given. (Ca, Ci.5/53)
Svedana and Vilayana- Associated with Anaha, Vibandha, having Kathina, Kaphaja, Gulma.
Churna, Asava, Arishta Prayoga in Mandagni.
Kshara Prayoga– After assessing the Bala and Dosha Pramana, Kshara should be given with intervals of 1 or 2 or 3 days. (Ca, Ci.5/59)

Treatment Plan of Gulma

Panchakarma

Snehapana-Sukumara Ghrita
Svedana
Virechana – Gandharvahastadi Taila
Niruha– Dashamula
Anuvasana Basti – Sukumara Ghrita

Shamana Chikitsha

Classical Ayurvedic Formulations for Vataja Gulma:

kalanala Rasa [BR]-500mg TID
Shulavajrini vati [BR]-500mg TID
Kravyada rasa [BR]-500mg TID
Agnikumara rasa [BR]-250mg TID
Kankayana vati [BR]-500mg TID
Kalyana kshara [BR]-250-500mg TID
Hingvadi Churna or Gutika [CCi]-3gm TID with Ghee before meal
Shatyadi Churna [CD]-3-6gm TID with Ghee before meal
Sukumara ghrita (SY)-10 ml BD with warm water
Higusauvarchaladi ghrita [CCi]-10 ml BD with warm water
Pippalyadi ghrita [CCi]-10 ml BD with warm water Tailapanchaka [CCi]-10 ml BD with warm water

Classical Ayurvedic Formulations for Pittaja Gulma

Sutashekara rasa [BR]-250mg TID
Pravalapanchamrita rasa [BR]-250mg TID
Shakha vati [BR]-250mg TID
Shulavajrini rasa [BR]-250mg TID
Panchanana rasa [BR]-250mg TID
Rohinyadi ghrita [CCi]-10 ml BD with warm water
Vasadi ghrita [CCi]-10 ml BD with warm water
Avipattikara churna [BR]-3-6gm BD with warm milk

Classical Ayurvedic Formulations for Kaphaja gulma

Vadavanala rasa [BR]-250mg-500mg TID before meal
Kravyada rasa [BR]-250mg-500mg TID before meal
Agnikumara rasa [BR]-250mg-500mg TID before meal BR]
Gulmakuthara rasa -250mg-500mg TID before meal
Shulavajrini rasa [BR]-250mg-500mg TID before meal
Lashuna vati [CCi]-250mg-500mg TID before meal
Vajra kshara [BR]-250mg-500mg TID before meal
Bhallakadya ghrita [CCi] -10 ml BD with warm water
Rasonadya ghrita [CCi]-10 ml BD with warm water
Dashamula ghrita [CCi]-10 ml BD with warm water
Kshirashatpala ghrita [CCi]-10 ml BD with warm water
Mishraka sneha [CCi]-10 ml BD with warm water
Dantiharitaki leha [CCi]-1 tsf BD with warm water
Kumaryasava [BR]-15ml BD with water after meal

Prescription for Gulma:

Prescription for Vataja Gulma

Si No	Name of medicine and dose	Kala	Anupana
	Lashunadi Vati-500mg	Apana kala; 3 times	Nimbu panaka
	Gumakalanala rasa-250mg	Apana kala; 3 times	Ushna jala
	Hingvashtaka churna-3gm Varatika bhasma-250mg	Apana kala; 3 times	Ghrita
	Pippalyadi ghrita-20ml	Morning and evening	Ushna jala

Prescription for Pittaja Gulma

Si No	Name of medicine and dose	Kala	Anupana
1	Pravala panchamrita-500mg	Samudga; 4 times	Milk+Sugar
2	Shatavari Mandura-500mg	Apana kala; 2 times	Ushna jala
3	Vasa Ghrita-20 ml	Morning and evening	Ushna jala

Prescription for Kaphaj Gulma

Si no	Name of medicine and dose	Kala	Anupana
1	Bhallataka taila-5-10drops	Apana kala: 2 times	milk
2	Shulavajrini rasa-250-500mg	Apana kala; 3 times	Kumaryasava
3	Arogyavardhini rasa	Apana kala; 2 times	Kumaryasava

Prescription for Raktaja Gulma

Si No	Name of medicine and dose	Kala	Anupana
1	Lauha parpati-250mg Bola parpati-250mg Shuddha Gairika-50mg Pravala bhasma-250mg Mayaphala churna-2gm	Apana kala; 2 times	milk
2	Shatavari-trinapanchamula kvatha-20ml	Antarbhakta; 3 times	Milk+ Honey

Diet and Lifestyle:

Same as Agnimandya.

Wholesome diet and habits

1. Purana shali (old rice)
2. Kulattha (horse gram)
3. Jangala mamsa (desert animals)
4. Kooshmanada (ash gourd)
5. Amalaki (goose berry)
6. Dadima (pomegranate)
7. Eranda taila (castor oil)
8. Ardraka (ginger)
9. Jiraka (cumin seeds)
10. Hingu (asa foetida)
11. Deepana (easily digestible, carminative food) etc.

According to Yogaratnakara

Red rice that is a year old, sugar candies, horse gram soup, soup made from the meat of animals that live in desert regions, goat or cow milk, raisins, falsa fruit, buttermilk, castor oil, garlic, tender radish, pattura vegetable, Mexican tea, drumstick, citron fruit, chebulic myrobalan, and items that aid in the valley of vata dosha.

Unwholesome food and habits

1. Guru ahara (heavy food)
2. Viruddha Ahara (incompatible food)
3. Vishama Ahara (improper food)
4. Shushka shaka (dry vegetable)
5. Shushka mamsa (dried meat)
6. Kanda moola (tubers and roots)
7. Matsya (fish)
8. Vegadharana (suppression of the urges) etc.

According to yogaratnakara

Pulses, barley, sweet potatoes, dried meat, radish, fish, and sweet fruits; stifling the urges to urinate, poop, and take deep breaths after exercising; emesis; and drink an excessive amount of water, among other things.

It is extremely difficult to link the condition known as a gaseous tumor (Gulma) to any specific disease category in the contemporary medical system. This is frequently observed as a characteristic of numerous acute and long-term medical disorders. However, it is frequently observed in patients who consume an unhealthy diet and take several medications or types of food at once. Therefore, caution should be used when combining medications with food and liquids.

Yoga Therapy: