gulma is a disease of Ayurveda and it is very controversial topic.

1. Critical study on Gulma and it’s
surgical aspects in Ayurveda
Dr. Alok Kumar
M.S.(Ay.), Ph.D. Scholar
P.G. Department Of Shalya Tantra, N.I.A.
Jaipur

2. Gulma
• Meaning
• The word meaning of gulma is Lata i.e shrub
or bush, another meaning is pindakara as per
the chakrapani.

3. Nirukti of gulma
• गुपितानिलमूलत्वाद्गूढमूलोदयादपि
गुल्मवद्वा पवशालत्वाद्गुल्म इत्यभिधीयते
निबन्धसङ्ग्रह व्याख्या (डल्हण कृ त)
• अथ गुल्मनिरुक्तिमाह-
• गुपििानिलमूलत्वादित्यादि
• गुपििानिलमूलत्वाि्
• आकु लीकृ िवायुमूलत्वाि्,
• एिेि सववगुल्मािाां वायुुः कारणम्| गूढमूलोियादिनि गूढमूलाुः
कन्िाियुः,िेषाममवोियािुत्ित्ेुः; अन्ये िु गूढमूलो गुप्िकारण उियो यस्य
• स िथा िस्माि्, मूलस्य वायोगूवढत्वमावृित्वमुच्यिे
ित्रकोिद्वैपवध्याि्; िथा -च “वायोर्ाविुक्षयाि्कोिो मागवस्यावरणेि
च”-इनि|

4. • The ways of understanding & concept of
gulma according to our acharyas are
different. The analogy, keen observation
and the way of understand of the concept
of gulma according to different acharyas
concept helps a lot in our clinical
practice.

5. According to acharya Charaka
• The word meaning of gulma is pindakara (round and hard mass)
while explaining the vataja, pittaja, kaphaja, sannipataja, raktaja
gulma lakshanas is unique as that of root meaning of gulma i.e
pindakara - nodules or mass.
• So for the better understanding of cahrakokta gulma is tumours,
the terms "mass" and "nodule" is often used synonymously with
"tumor". Generally speaking, however, the term "tumor" is used
generically, without reference to the physical size of the lesion.
• Tumor is not synonymous with cancer. While cancer is by
definition malignant, a tumor can be benign, pre-malignant
or malignant or can represent a lesion without any cancerous
potential what so ever.

6. According to shushrutha acharya
हृद्बस्त्योरन्तरे ग्रनन्थिःसञ्चारी यनि वाऽचलिः |
चयापचयवान् वृत्तिः स गुल्म इनत कीनतितिः ||
• while explaining the lakshanas of vataja pittaja kaphaja,
sannipatja, raktaja gulma they mention amurtha lakshanas.
• So, For the better understanding we concluded that
shushrutokta gulma is Gastritis, in kannada we call it as Batti
roga, in the batti roga or Gastritis around the umbilical region
we can palpate as a round mass like structure, it is an pulsatile
and moving around the abdomen and also other lakshanas like
cathing & spasmodic pain in heart, parshwa (back of the
chest), around the umbilicus, etc.

7. • Ayurvedic scholars define it as the abdominal
lump which is caused due to aggravation and
encapsulation of Vata Dosha (kupita Anila
moodhatwat) which does not give clue about
its site of origin (Goodha Gulmodaya) which
spreads widely like the shrubs (Gulmavat
vishalatwaat). It is usually known as gaseous
tumor of abdomen.

8. Gulma – Causative factors:
1. Excess intake of Vata aggravating foods
(dry, light, rough, spicy)
2. Constipation or improper bowel habit
3. Suppression of natural urges
4. Pressure exerted by external causes like
injury, hit, compression etc
5. Excess food intake
6. Grief / stress
7. Improperly carried Panchakarma treatment

9. Gulma – Origin of the disease:
The causative factors lead to severe aggravation of
Vatadosha at the level of abdomen. This further
vitiates Pitta and Kapha in the localized area and
obstruct the passage of the channels. Due to the
blockage of the morbid factor, they are stagnated and
localized in abdominal organs like intestines, liver.
According to the site and Dosha involvement, the
features are exhibited. Usually, the condition is
manifested in epigastrium, umbilicus, pelvic cavity
and in lumbar/iliac regions.

10. Types
1. Vataja
2. Pittaja
3. Kaphaia
4. Tridoshic
5. Raktaja (in female, refers to uterine fibroids)

11. Stages of Gulma:
1. Immature (recent onset) tumors:
Tumors are heavy, hard, situated beneath the
muscles, without change or color and fixed firmly.
2. Maturing tumours:
The Tumors are burning, painful, causing agony,
loss of sleep, irritation, and fever.
3. Matured (suppurated) gaseous tumors:
The tumors are burning, bluish red in color,
palpable like bladder and severe painful in nature.

12. Specific features of gulma:
1.Vatik Gulma:
Obstruction of flatus, dryness of the throat and
mouth, shivering, fever, pain in heart and
abdominal sides, shoulder and head, aggravates
on empty stomach and relieved on ingestion of
food; the condition is worsened by dry-
astringent-bitter and pungent substances.
• 2. Pittaja gulma:
In the condition, fever, thirst, redness of the face,
pain, sweating, burning and tenderness are
complained by the patients.
• 3. Kaphajagulma:
This produces inertia, shivering, fever, body ache,
nausea, cough, tastelessness, heaviness, and hard
elevated non inflammatory masses.

13. • 4. Dwidoshaja and sannipataja:
According to the dosha involvement mixed features
are observed.
• 5. Raktaja gulma:
Menstruating women indulging in fasting or using
excess of dry food, facing the fearsome events,
suppressing the natural urges, subjecting to therapies
which arrest the free outgoing of blood and vomiting,
suffering from uterine dysfunction etc, cause the
vitiation of menstrual blood. This, in turn lead to the
occurrence of Raktaja gulma (fibroid).
Here, pulsating tumor, gradually taking the shape of
the round mass, with pain and producing the features
or pregnancy (like amenorrhoea, pigmented nipples,
morning sickness etc).
Acharya Ksharapani stated that Raktaj gulma may
found in men also.
Often this produces this pain and burning sensation
with the features of Pittaja Gulma.
Raktaj gulma is easly treatable after 10 months as per
Acharya charak.

14. Treatments
• Vataj
वातगुल्मार्दितंस्निग्धंयुक्तंनिेहपवरेचिैः|
उिाचरेद्यथाकालंनिरूहैःसािुवासिैः ||१६Su.U
• Pittaj
पित्तगुल्मार्दितंस्निग्धंकाकोल्यार्दघृृतेितु |
पवररक्तं मधुरयोगनििरूहैःसमुिाचरेत् ||17Su.U
• Kaphaj
श्लेष्मगुल्मार्दितंस्निग्धंपिप्िल्यार्दघृृतेितु
|तीक्ष्णपविररक्तंतद्रूिनििरूहैःसमुिाचरेत् ||18Su.U

15. Treatment : Surgical Aspects
• Raktamokshana
• सशूले सोन्ितेऽनिन्दे दाहिाकरुगस्न्वते ||52||
• गुल्मे रक्तं जलौकोभिैःभसरामोक्षेण वा हरेत ् |53| Su.U
• Shashtra karma in pakva gulam by Acharya charak.
• Acharya Baghbhatta also discribes a type of
raktamokshan technique in kaphaj gulam known as
Ghati yantra, A type of cupping therapy.
• He describe the procedure as a hot pot of soil placed
on gulma site , after saome time whem gulma come
inside the pot then , gulma is dissolved by hands or
some instruments like Vimarga, Ajpad, Adarsh.
• For the bhedan of gulma Acharya Sushruta advised
some medicated varti made from different preprations.

16. Abdominal lump
• Abdominal aortic aneurysm
• Bladder distention
• Cholecystitis (an inflammation of the gallbladder)
• Colon cancer
• Crohn's disease
• Bowel obstruction
• Diverticulitis
• Gallbladder tumor
• Hydronephrosis (fluid-filled kidney)
• Kidney cancer (including renal cell carcinoma)
• Liver cancer
• Hepatomegaly (Liver enlargement)
• Neuroblastoma
• Ovarian cyst
• Pancreatic abscess
• Pancreatic pseudocyst
• Splenomegaly (Spleen enlargement)
• Stomach cancer
• Uterine leiomyoma (fibroids)
• Volvulus (twisted piece of the gastrointestinal tract)
• Uretero-pelvic junction obstruction

17. Migratory abdominal lump
• Torsion of the Wandering Spleen, Seen as a Migratory Abdominal
Mass A case report published in in RSNA Radiology April 1977
• Volume 123, Issue 1
• DOI: http://dx.doi.org/10.1148/123.1.36
• Abstract: Torsion of the wandering spleen is an unusual cause of an
acute abdomen, rarely diagnosed preoperatively. The authors
describe a case which was suspected prior to surgery and
confirmed by radionuclide imaging. Radiographic findings include
an extrinsic mass on barium-enema examination and absence of
the splenic shadow in the left upper quadrant.
• Wandering spleen (or Pelvic spleen) is a rare medical disease
caused by the loss or weakening of the ligaments that help to hold
the spleen stationary

18. Abdominal tuberculosis
• Indian J Med Res 120, October 2004, pp 305-
31
• Ileocaecal tuberculosis
• Patients complain of colicky abdominal pain, borborygmi and
vomiting. Abdominal examination may reveal no abnormality
or a doughy feel. A well defined, firm, usually mobile mass is
often palpable in the right lower quadrant of the abdomen.
Associated lymphadenitis is responsible for the presence of
one or more lumps which are mobile if mesenteric nodes are
involved and fixed if para-aortic or illiac group of nodes are
enlarged.

19. Ind. J. Tub. 2000, 47, 101
ISOLATED TUBERCULOUS MESENTERIC ABSCESS -A CASE REPORT
D. Vijaya1, T.K. Lakshmi Kanth1*, S.I.S. Khadri1*, H.C. Suresh Chandru3* and A.
Malini4
• Local examination revealed a firm mobile mass measuring 7x5 cms with defined
margin in the right iliac and lu.nbar regions.
• Sputum and urine were negative for acid fast bacilli. Mantoux test was positive.
Clinical diagnosis of appendicular a
• Laparotomy showed a spherical 8 cm isolated mass medial to the caecum, in the
root of mesentry. All other organs were normal. There was no mesenteric
lymphadenitis. Pus aspirated from the abscess cavity was sent to the Microbiology
bscess/ileocaecal tuberculosis was made.
• mesenteric cold abscess might be secondary to symptomless pulmonary
tuberculosis which probably spread to the mesentery after swallowing sputum. This
report emphasizes the diverse clinical features of abdominal tuberculosis and the
need for a high index of suspicion for the proper management of such cases.

20. 1230 Proc. roy. Soc. Med. Volume 62
December 1969
• Clinical Features and Surgical Management of
Ileocecal Tuberculosis

21. Uterine fibroid
• Signs and symptoms
• Fibroids, particularly when small, may be entirely asymptomatic. Symptoms depend on the
location and size of the fibroid. Important symptoms include abnormal uterine bleeding,
heavy or painful periods, abdominal discomfort or bloating, painful defecation, back ache,
urinary frequency or retention, and in some cases, infertility. There may also be pain during
intercourse, depending on the location of the fibroid. During pregnancy they may also be the
cause of miscarriage, bleeding, premature labor, or interference with the position of the fetus
• Location and classification
• a=subserosal fibroids
• b=intramural fibroids
• c=submucosal fibroid
• d=pedunculated submucosal fibroid
• e=fibroid in statu nascendi
• f=intraligamental fibroid

22. Treatments
• Most fibroids do not require treatment unless they are causing
symptoms. After menopause fibroids shrink and it is unusual for
them to cause problems. In those who have symptoms uterine artery
embolization and surgical options have similar outcomes with
respect to satisfaction.
Symptomatic uterine fibroids can be treated by:
 medication to control symptoms
 medication aimed at shrinking tumors
 ultrasound fibroid destruction
 myomectomy or radio frequency ablation
 hysterectomy
 uterine artery embolization

23. Conclusion
• It is very difficult to correlate the gulma with a single entity in
modern context.
• Gulma has various presentation.
• There is no definite etiology.
• Various condition having suppurated or nonsuppurated
abdominal mass with or without association of other sign/
symptoms may include in gulma.
• Medicinal management was preferred by acharyas.
• Raktamokshan is the common procedure advocated by most of
the acharyas.