fitnessblog

AIAPGET Points

–        वायोर्निरोधोविषमाग्निताच – Vayornirodhata and Vishamagnita are the special features of Vataja Gulma. (Su.Ut.42/10)

–        Ghrta used for snehana in Pittaja Gulma – KAKOLYADI GHRTA (Su.Ut.42/17)

–        Acharya Sushruta has indicated Kakolyadi Ghrta specifically for Snehana in which condition? (KAKOLYADI GHRTA – PITTAJA GULMA – Su.Ut.42/17)

–        Ghrta used for snehana in Kaphaja Gulma – PIPPALYADI GHRTA (Su.Ut.42/18)

–        In RAKTA GULMA, Ghrta prepared with PALASHA KSHARA TOYA should be used for Snehana. PIPPALYADI GHRTA is used for Uttara Basti.

–        Ghrtas for Pittaja and Rakta Gulma – Trnapanchamula Siddha Ghrta, Nyagrodhadi Gana Siddha Ghrta, Utpaladi Gana Siddha Ghrta (Su.Ut.42/36)

–        KSHARALEHA – indicated in GULMA treatment by Sushruta should be taken with dadhi, sura, ghrta, dhanyamla, ushna toya or kulattha rasa (Su.Ut.42/42-44)

–        Acharya Sushruta has described SHULA in the chapter of GULMA (Su.Ut.42)

For More AIAPGET Points from this chapter and also for content and preparation, please join our SARATHI Program.

The 42nd chapter of Uttaratantra of Sushruta Samhita is named as Gulma Pratiṣedha Adhyaya. This chapter deals with the Treatment of Abdominal Tumours.  

अथातो गुल्मप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Gulma pratiședha – treatment of abdominal tumours; as revealed by the venerable Dhañvantari.

Notes – Sūla (pain in the abdomen) is also included in this chapter itself.

यथोक्तैः कोपनैर्दोषाः कुपिताः कोष्ठमागताः |
जनयन्ति नृणां गुल्मं स पञ्चविध उच्यते ||३||

Doshas get aggravated by various causes which have been mentioned previously. These aggravated doshas reach the kostha – alimentary tract (gut) and produce Gulma (abdominal tumours).

Gulma is of five kinds.

Nirukti- definition

हृद्बस्त्योरन्तरे ग्रन्थिः सञ्चारी यदि वाऽचलः |
चयापचयवान् वृत्तः स गुल्म इति कीर्तितः ||४||

Any mass is described as Gulma when it has the below mentioned features –

–        the mass is present in between heart and urinary bladder,

–        it is either moving or stationary,

–        it undergoes increase and decrease (sometimes increases and sometimes decreases) and

–        is round in shape

पञ्चगुल्माश्रयानॄणांपार्श्वेहृन्नाभिबस्तयः।
गुपितानिलमूलत्वाद्गूढमूलोदयादपि ||५||
गुल्मवद्वा विशालत्वाद्गुल्म इत्यभिधीयते |६|
Gulma means shrub.

The disease is called as Gulma due to the below mentioned reasons –

–        the root (chief) cause of this disease is aggravated vata,

–        it arises from deep inside (inside the abdomen) and

–        is broad like a gulma – shrub

Below mentioned are the five seats of gulma –

–        2 – flanks,

–        1 – heart i.e. region of the heart,

–        1 – navel region and

–        1 – urinary bladder (region of urinary bladder)

स यस्मादात्मनि चयं गच्छत्यप्स्विव बुद्बुदः ||६||
अन्तः सरति यस्माच्च न पाकमुपयात्यतः |७|

Gulma does not undergo ripening (suppuration) due to the below mentioned reasons –

–        it increases in size on its own, just like a bubble in the water and

–        moves inside the alimentary tract

Vidha – kinds

स व्यस्तैर्जायते दोषैः समस्तैरपि चोच्छ्रितैः ||७||
पुरुषाणां तथा स्त्रीणां ज्ञेयो रक्तेन चापरः |८|

Gulma is of five kinds –

–        produced by each dosha separately – 3 types i.e. vataja, pittaja and kaphaja and,

–        by all the three doshas together – sannipataja (all these four types are produced both in men and women) and

–        one more produced by rakta (blood) – only in women

Pūrvarūpa- premonitory symptoms

सदनं मदन्ता वह्नेराटोपोऽन्त्रविकूजनम् ||८||
विण्मूत्रानिलसङ्गश्च सौहित्यासहता तथा |
द्वेषोऽन्ने वायुरूर्ध्वं च पूर्वरूपेषु गुल्मिनाम् ||९||

Below mentioned are the purvarupa – premonitory symptoms of gulma –

–        debility,

–        weak digestive fire,

–        tympanitis with noise inside the abdomen,

–        intestinal gurgling,

–        non-elimination of faeces, urine and flatus,

–        intolerance to comforts,

–        aversion to food and

–        upward movement of air (belching)

Rupa- clinical features

हृत्कुक्षिशूलं मुखकण्ठशोषो वायोर्निरोधो विषमाग्निता च |
ते ते विकाराः पवनात्मकाश्च भवन्ति गुल्मेऽनिलसम्भवे तु ||१०||

Symptoms of Vataja Gulma – abdominal tumour caused by aggravated vata –

–        pain in the region of the heart and epigastrium region,

–        dryness of mouth and throat,

–        obstruction of flatus,

–        erratic behavior of digestive fire influenced by vata (visamagni) and

–        other symptoms of vata aggravation

स्वेदज्वराहारविदाहदाहास्तृष्णाऽङ्गरागः कटुवक्त्रता च |
पित्तस्य लिङ्गान्यखिलानि यानि पित्तात्मके तानि भवन्ति गुल्मे ||११||

Symptoms of Pittaja Gulma – abdominal tumour caused by aggravated pitta –

–        excessive sweating,

–        fever,

–        burning sensation on taking food,

–        feeling of burning sensation inside the body,

–        thirst,

–        skin becomes red in colour,

–        bitterness in the mouth and

–        all symptoms of aggravation of pitta

स्तैमित्यमन्नेऽरुचिरङ्गसादश्छर्दिः प्रसेको मधुरास्यता च |
कफस्य लिङ्गानि च यानि तानि भवन्ति गुल्मे कफसम्भवे तु ||१२||

Symptoms of Kaphaja Gulma – abdominal tumour caused by aggravated kapha –

–        inactivity (feeling as if the body is covered by wet cloth / skin),

–        dislike for food,

–        weakness of the body,

–        vomiting,

–        excessive salivation,

–        sweetness in the mouth and

–        symptoms of aggravation of kapha

सर्वात्मकः सर्वविकारयुक्तः सोऽसाध्य उक्तः क्षतजं प्रवक्ष्ये |१३|

Symptoms of Kaphaja Gulma – abdominal tumour produced by all three doshas together –

–        symptoms of all the three doshas are present and

–        this type is said to be incurable

 

Kşataja or raktajagulma – uterine tumor

नवप्रसूताऽहितभोजना या या चामगर्भं विसृजेदृतौ वा ||१३||
वायुर्हि तस्याः परिगृह्य रक्तं करोति गुल्मं सरुजं सदाहम् |
पैत्तस्य लिङ्गेन समानलिङ्गं विशेषणं चाप्यपरं निबोध ||१४||
न स्पन्दते नोदरमेति वृद्धिं भवन्ति लिङ्गानि च गर्भिणीनाम् |
तं गर्भकालातिगमे चिकित्स्यमसृग्भवं गुल्ममुशन्ति तज्ज्ञाः ||१५||

Ksataja / Raktaja gulma –

Now, Ksataja or Raktaja Gulma shall be described by me.

Vata gets aggravated in the below mentioned women – 

–        woman who has delivered recently indulging in unsuitable foods or

–        woman in her menstrual period indulging in unsuitable foods or

–        woman who has delivered premature foetus i.e. has undergone abortion or miscarriage

This aggravated vata vitiates the blood (menstrual blood) and produces abdominal tumour. This tumour is associated with pain, burning sensation and symptoms similar to those of aggravation of pitta.

The special features of Raktaja Gulma are –

–        it does not make movements in parts, as of the foetus,

–        abdomen does not enlarge,

–        manifestation of other symptoms of pregnancy (pregnant woman) and

–        it should be treated after the expiry of the usual time of delivery (according to the specialists)

Gulmacikitsa- treatment of abdominal tumour

वातगुल्मार्दितं स्निग्धं युक्तं स्नेहविरेचनैः |
उपाचरेद्यथाकालं निरूहैः सानुवासनैः ||१६||

Treatment of Vataja Gulma –

–        the patient should be administered oleation, followed by

–        purgation with fatty / unctuous purgation,

–        decoction enema and

–        oil enema – all of these should be administered at appropriate times.

पित्तगुल्मार्दितं स्निग्धं काकोल्यादिघृतेन तु |
विरिक्तं मधुरैर्योगैर्निरूहैः समुपाचरेत् ||१७||

Treatment of Pittaja Gulma –

–        oleation therapy should be given with Kakolyadi Ghrta and

–        purgation with herbs predominantly having sweet taste and

–        decoction enema prepared with herbs having sweet taste

श्लेष्मगुल्मार्दितं स्निग्धं पिप्पल्यादिघृतेन तु |
तीक्ष्णैर्विरिक्तं तद्रूपैर्निरूहैः समुपाचरेत् ||१८||

Treatment of Kaphaja Gulma –

–        firstly oleation should be given with Pippalyadi Ghrta followed by

–        administration of strong purgatives and

–        strong decoction enemas

सन्निपातोत्थिते गुल्मे त्रिदोषघ्नो विधिर्हितः |१९|

Treatment principles of Sannipataja / Tridoshaja Gulma – In this condition, treatments which mitigate all the three doshas should be given.

पित्तवद्रक्तगुल्मिन्या नार्याः कार्यः क्रियाविधिः ||१९||
विशेषमपरं चास्याः शृणु रक्तविभेदनम् |
पलाशक्षारतोयेन सिद्धं सर्पिः प्रयोजयेत् ||२०||
दद्यादुत्तरबस्तिं च पिप्पल्यादिघृतेन तु |
उष्णैर्वा भेदयेद्भिन्ने विधिरासृग्दरो हितः ||२१||

Treatment of Raktaja Gulma – This condition manifesting in only women should be treated on similar lines of treating pittaja gulma. Now, other treatments which break the tumour shall be explained, listen to the same.

Medicated ghee should be prepared with the solution of Palasa Ksara. This should be given for drinking.

Uttara Basti should be given using Pippalyadi Ghrta.

The tumour can also be broken by administering herbs having hot potency.

Once the tumour is broken by the above mentioned methods, treatment methods advocated for treatment of Asrgdhara – menorrhagia should be administered.

Anuvāsana (oil enema) 

आनूपौदकमज्जानो वसा तैलं घृतं दधि |
विपक्वमेकतः शस्तं वातगुल्मेऽनुवासनम् ||२२||

In Vata Gulma, oil enema should be administered with bone marrow and muscle fat of animals living in marshy lands and water along with oil, ghee and curds boiled and processed together so as to obtain medicated fat.

जाङ्गलैकशफानां तु वसा सर्पिश्च पैत्तिके |
तैलं जाङ्गलमज्जान एवं गुल्मे कफोत्थिते ||२३||

In Pittaja Gulma, oil enema prepared by boiling and processing together the below mentioned ingredients together is ideal –

–        muscle-fat of animals living in arid regions and of un-split hoof and

–        ghee

In Kaphaja Gulma, it is ideal to give oil enemas prepared by boiling together oil and bone marrow of animals living in arid regions.

Ghrta yoga for vātagulma

धात्रीफलानां स्वरसे षडङ्गं विपचेद्घृतम् |
शर्करासैन्धवोपेतं तद्धितं वातगुल्मिने ||२४||

Ghee for consumption – Ghee cooked with the below mentioned ingredients should be consumed –

–        dhatri phala and

–        vidanga added with

–        sarkara and

–        saindhava lavana

This ghee is beneficial for patients having vataja gulma.

Citrakādi ghrta

चित्रकव्योषसिन्धूत्थपृथ्वीकाचव्यदाडिमैः |
दीप्यकग्रन्थिकाजाजीहपुषाधान्यकैः समैः ||२५||
दध्यारनालबदरमूलकस्वरसैर्घृतम् |
तत्पिबेद्वातगुल्माग्निदौर्बल्याटोपशूलनुत् ||२६||

Decoction should be prepared with equal quantity of the below mentioned ingredients –

–        Citraka,

–        Vyosa,

–        Sindhuttha,

–        Prthvika,

–        Cavya,

–        Dadima,

–        Dipyaka,

–        Granthika,

–        Rajani,

–        Hapusa and

–        Dhanyaka

Ghee should be cooked with this decoction along with Dadhi, Aranala, juice of Badara and Mulaka, all cooked well.

When consumed, this ghee would cure the below mentioned conditions –

–        vataja gulma,

–        weakness of digestive fire,

–        tympanitis or sounds in the abdomen and

–        abdominal pain

Hingvādi ghṛta

हिङ्गुसौवर्चलाजाजीविडदाडिमदीप्यकैः |
पुष्करव्योषधान्याम्लवेतसक्षारचित्रकैः ||२७||
शटीवचाजगन्धैलासुरसैश्च विपाचितम् |
शूलानाहहरं सर्पिर्दध्ना चानिलगुल्मिनाम् ||२८||

Ghee should be prepared with the below mentioned ingredients added with curds –

–        hingu,

–        sauvarcala,

–        ajaji,

–        bida,

–        dadima,

–        dipyaka,

–        puskara,

–        vyosa,

–        dhanyamla,

–        vetasaksara and

–        citraka,

–        sati,

–        vaca,

–        ajagandha,

–        ela and

–        surasa

Benefits – This medicated ghee cures abdominal pain, flatulence and gulma of vata origin.

Dādhika ghrta

विडदाडिमसिन्धूत्थहुतभुग्व्योषजीरकैः |
हिङ्गुसौवर्चलक्षाररुग्वृक्षाम्लाम्लवेतसैः ||२९||
बीजपूररसोपेतं सर्पिर्दधिचतुर्गुणम् |
साधितं दाधिकं नाम गुल्महृत् प्लीहशूलजित् ||३०||

Decoction should be prepared with the below mentioned ingredients –

–        Bida,

–        Dadima,

–        Sindhuttha

–        Hutabhuk – Citraka,

–        Vyosa,

–        Jiraka,

–        Hingu,

–        Sauvarcala,

–        Ksara – Yava Ksara,

–        Kustha,

–        Vrksamla,

–        Tintidika and

–        Amlavetasa

While decoction is being prepared with the above-mentioned ingredients, one part of juice of bijapura and ghee and four parts of curds are added and all are cooked and medicated ghee is prepared. This is known as Dadhika Ghrta.

Benefits – Dadhika Ghrta cures gulma, spleen diseases and abdominal pain.

Rasonādi ghṛta

रसोनस्वरसे सर्पिः पञ्चमूलरसान्वितम् |
सुरारनालदध्यम्लमूलकस्वरसैः सह ||३१||
व्योषदाडिमवृक्षाम्लयवानीचव्यसैन्धवैः |
हिङ्ग्वम्लवेतसाजाजीदीप्यकैश्च समांशिकैः ||३२||
सिद्धं गुल्मग्रहण्यर्शःश्वासोन्मादक्षयज्वरान् |
कासापस्मारमन्दाग्निप्लीहशूलानिलाञ्जयेत् ||३३||

Ghee should be prepared with the below mentioned ingredients –

–        fresh juice of rasona,

–        decoction of mahat / brhat pancamula,

–        sura – beer,

–        aranala – rice wash / sour or fermented medicated liquid,

–        sour curd,

–        juice of mulaka and

–        powder of equal quantities of vyosa, dadima, vrksamla, yavani, cavya, saindhava, hingu, amlavetasa, ajaji and dipyaka

Benefits – When consumed, this ghee cures gulma, duodenal diseases, piles, dyspnoea, insanity, consumption, fevers, cough, epilepsy, dyspepsia, diseases of spleen, colic and vata disorders.

दधि सौवीरकं सर्पिः क्वाथौ मुद्गकुलत्थजौ |
पञ्चाढकानि विपचेदावाप्य द्विपलान्यथ ||३४||
सौवर्चलं सर्जिकां च देवदार्वथ सैन्धवम् |
वातगुल्मापहं सर्पिरेतद्दीपनमेव च ||३५||

Medicated ghee is prepared by cooking all the below mentioned ingredients together –

–        One adhaka (2.50 kg) each of – curd, sauviraka (fermented gruel) and ghee

–        five adhaka (12.80 kg) of – decoction of mudga and kulattha (together) and

–        two pala (80 gm) each of – sauvarcala, sarjika ksara, devadaru and saindhava lavana

Benefits – This ghee cures Vataja Gulma and also augments digestive fire.

Pitta and raktagulma hara ghṛta

तृणमूलकषाये तु जीवनीयैः पचेद्घृतम् |
न्यग्रोधादिगणे वाऽपि गणे वाऽप्युत्पलादिके ||३६||
रक्तपित्तोत्थितं घ्नन्ति घृतान्येतान्यसंशयम् |३७|

Medicated ghee should be prepared with decoction of Trna Pancamula, added with paste of Jivaniya Gana group of herbs.

Medicated ghee also can be prepared with the herbs belonging to Nyagrodhadi Gana group or Utpaladi Gana.

When consumed, the above said ghee (both) cures gulma – abdominal tumour produced by rakta and pitta, without any doubt.

Kaphagulmahara ghrta – āragvadhādi ghrta

आरग्वधादौ विपचेद्दीपनीययुतं घृतम् ||३७||
क्षारवर्गे पचेच्चान्यत् पचेन्मूत्रगणेऽपरम् |
घ्नन्ति गुल्मं कफोद्भूतं घृतान्येतान्यसंशयम् ||३८||

Below mentioned ghee preparations (recipes) would cure kaphaja gulma without any doubt –

–        with decoction of Aragvadhadi Gana group of herbs along with paste of Dipaniya group of herbs (Pippalyadi Gana) or

–        ghee prepared with herbs belonging to Ksara Varga / Ksara Gana herbs or

–        ghee prepared with Mutra Gana (group of urines)

यथादोषोच्छ्रयं चापि चिकित्सेत्सान्निपातिकम् |
चूर्णं हिङ्ग्वादिकं वाऽपि घृतं वा प्लीहनाशनम् ||३९||
पिबेद्गुल्मापहं काले सर्पिस्तैल्वकमेव वा |४०|

Treatment of Sannipataja or Tridoshaja Gulma (that caused by all three doshas) should be done in accordance with the dosha aggravated.

Below mentioned recipes can also be consumed –

–        Hingvadi Curna Vataka – explained in Cikitsa Sthana, chapter 5,

–        Ghrta which cures Pliha – spleen enlargement – Satpala Ghrta explained in Cikitsa Sthana, chapter 14

KsaraIeha

तिलेक्षुरकपालाशसार्षपं यावनालजम् ||४०||
भस्म मूलकजं चापि गोजाविखरहस्तिनाम् |
मूत्रेण महिषीणां च पालिकैश्चावचूर्णितैः ||४१||
कुष्ठसैन्धवयष्ट्याह्वनागरकृमिघातिभिः |
साजमोदैश्च दशभिः सामुद्राच्च पलैर्युतम् ||४२||
अयःपात्रेऽग्निनाऽल्पेन पक्त्वा लेह्य(ह)मथोद्धरेत् |
तस्य मात्रां पिबेद्दध्ना सुरया सर्पिषाऽपि वा ||४३||
धान्याम्लेनोष्णतोयेन कौलत्थेन रसेन वा |
गुल्मान् वातविकारांश्च क्षारोऽयं हन्त्यसंशयम् ||४४||

Below mentioned ingredients are taken –

–        One pala (40 gm) each of – Ash of Tila, Iksuraka, Palasa, Sarsapa, Yavanala and Mulaka

–        Four parts (all put together) of urine of cow, goat, sheep, donkey, elephant and buffalo,

–        One pala (40 gm) each of powder or – Kustha, Saindhava, Yasti, Nagara, Krimighati (Vidanga) and Ajamoda

–        Ten pala (400 gm) of Samudra Lavana

The ash of Tila etc is dissolved in the urine of cows etc. The powder of Kustha etc. and Samudra Lavana in the mentioned quantities are added to it.

All these are put together in an iron vessel and cooked on a mild fire and confection is prepared.

This preparation is known as Ksaraleha. It should be consumed in a suitable dose along with curd, beer, ghee, dhanyamla, warm water or soup of kulattha.

Benefits – When consumed, this confection cures abdominal tumours and diseases produced by aggravated vata, without any doubt.

स्वर्जिकाकुष्ठसहितः क्षारः केतकिजोऽपि वा |
तैलेन शमयेत् पीतो गुल्मं पवनसम्भवम् ||४५||
पीतं सुखाम्बुना वाऽपि स्वर्जिकाकुष्ठसैन्धवम् |४६|

When Svarjika, Kustha,and  ash of Ketaki are boiled and processed in oil and consumed, it cures Gulma of Vata origin.

Vataja Gulma is also cured by consumption of powder of Svarjika and Kustha with comfortably warm water.

Vrścīvādyarişta

वृश्चीव(र)मुरुबूकं च वर्षाभूर्बृहतीद्वयम् ||४६||
चित्रकं च जलद्रोणे पक्त्वा पादावशेषितम् |
मागधीचित्रकक्षौद्रलिप्ते कुम्भे निधापयेत् ||४७||
मधुनः प्रस्थमावाप्य पथ्याचूर्णार्धसंयुतम् |
बुसोषितं दशाहं तु जीर्णभक्तः पिबेन्नरः ||४८||
अरिष्टोऽयं जयेद्गुल्ममविपाकमरोचकम् |४९|

Below mentioned are boiled in one drona (10.24 kg) of water and decoction is reduced to one fourth –

–        Vrsciva,

–        Urubuka,

–        Varsabhu,

–        two kinds of Brhati and

–        Citraka,

The decoction is now filled in a pot whose inside has been smeared with paste of Pippali, Citraka and honey. To this, one prastha (640 gm) of honey and half prastha (320 gm) of Pathya are added.

The pot is now sealed and kept concealed in a heap of husk for a time period of ten days. After ten days, it is removed. This arista – fermented decoction should be consumed after digestion of food.

Benefits – This recipe cures abdominal tumour, indigestion and anorexia.

पाठानिकुम्भरजनीत्रिकटुत्रिफलाग्निकम् ||४९||
लवणं वृक्षबीजं च तुल्यं स्यादनवो गुडः |
पथ्याभिर्वा युतं चूर्णं गवां मूत्रयुतं पचेत् ||५०||
गुटिकास्तद्घनीभूतं कृत्वा खादेदभुक्तवान् |
गुल्मप्लीहाग्निसादांस्ता नाशयेयुरशेषतः ||५१||
हृद्रोगं ग्रहणीदोषं पाण्डुरोगं च दारुणम् |५२|
Powder of equal quantity of the below mentioned ingredients should be prepared –

–        Patha,

–        Nikumbha,

–        Rajani,

–        Trikatu,

–        Triphala,

–        Agnika,

–        Saindhava Lavana and

–        Vrksa Bija – Indrayava

This powder is consumed mixed with old jaggery / treacle.

Alternatively, this powder should be cooked in cow’s urine and made into pills. These pills are consumed before eating meals.

Benefits – This recipe cures abdominal tumour, enlargement of spleen, sluggish digestion, heart disease, duodenal disorders and severe anaemia completely.

सशूले सोन्नतेऽस्पन्दे दाहपाकरुगन्विते ||५२||
गुल्मे रक्तं जलौकोभिः सिरामोक्षेण वा हरेत् |५३|

Bloodletting using leeches or by venepuncture should be done in tumours when –

–        the tumour is painful,

–        bulged out,

–        not moving,

–        associated with burning sensation, suppuration and pain

सुखोष्णा जाङ्गलरसाः सुस्निग्धा व्यक्तसैन्धवाः ||५३||
कटुत्रिकसमायुक्ता हिताः पाने तु गुल्मिनाम् |
पेया वातहरैः सिद्धाः कौलत्था संस्कृता रसाः ||५४||
खलाः सपञ्चमूलाश्च गुल्मिनां भोजने हिताः |५५|

Beneficial drink for patients of gulma – Soup of meat of animals living in arid lands should be prepared and served comfortably warm after adding fats, more quantity of saindhava lavana and Katutrika, for drinking.

Below mentioned are also beneficial as foods for patients of gulma –

–        peya (thin gruel) – prepared with vata mitigating herbs or

–        soup of kulattha processed with spices, salt etc.

–        khala – buttermilk cooked and prepared with Pancamula herbs

बद्धवर्चोनिलानां तु सार्द्रकं क्षीरमिष्यते ||५५||

Milk boiled with Ardraka – wet ginger is desirable for patients of gulma having obstruction of faeces and flatus.

कुम्भीपिण्डेष्टकास्वेदान् कारयेत् कुशलो भिषक् |५६|

Below mentioned kinds of sveda – sudation, as explained in Cikitsa Sthana, chapter 32, can be administered by a skilled physician –

–        Kumbhi Sveda,

–        Pinda Sveda or

–        Ishtika Sveda

गुल्मिनः सर्व एवोक्ता दुर्विरेच्यतमा भृशम् ||५६||
अतश्चैतांस्तु सुस्विन्नान् स्रंसनेनोपपादयेत् |५७|

Since patients of all kinds of gulma are very difficult for virecana – purgation (virechana does not happen easily in the patients suffering from gulma), they should be very well given with ‘sudation therapy’ first and then purgation should be administered.

विम्लापनाभ्यञ्जनानि तथैव दहनानि च ||५७||
उपनाहाश्च कर्तव्याः सुखोष्णाः साल्वणादयः |
उदरोक्तानि सर्पींषि मूत्रवर्तिक्रियास्तथा ||५८||
लवणानि च योज्यानि यान्युक्तान्यनिलामये |५९|

Below mentioned treatments are beneficial –

–        Vimlapana (kneading), Abhyanga (massage, anointing), Dahana (branding), Upanaha (poultice) like Salvana Upanaha etc. – all these should be used comfortably warm

–        Medicated ghee described in Chikitsa Sthana, Chapter 14 (Udara Cikitsa),

–        Use of Mutravarti  described in Chikitsa Sthana, Chapter 14,

–        Patra Lavana and Kalyanaka Lavana – described in treatment of Vata Roga (Chikitsa Sthana, chapter 4)

वातवर्चोनिरोधे तु सामुद्रार्द्रकसर्षपैः ||५९||
कृत्वा पायौ विधातव्या वर्तयो मरिचोत्तराः |६०|

Wicks (suppositories) should be prepared from the below mentioned –

–        Samudra Lavana,

–        Ardraka,

–        Sarsapa and

–        Marica – more quantity

This should be kept in the rectum. It helps in treating obstruction of flatus and faeces.

दन्तीचित्रकमूलेषु तथा वातहरेषु च ||६०||
कुर्यादरिष्टान् सर्वांश्च श्लोकस्थाने यथेरितान् |६१|
स्वादेद्वाऽप्यङ्कुरान् भृष्टान् पूतीकनृपवृक्षयोः ||६१||

Below mentioned Arista prepared as described in Sutra Sthana are useful in this condition –

–        using Danti, Citrakamula and Vata mitigating herbs or

–        with tender leaves of Putika and Nrpavrksa (Vatsaka)

ऊर्ध्ववातं मनुष्यं च गुल्मिनं न निरूहयेत् |६२|

Decoction enema should not be administered in persons suffering from udavarta and gulma.

पिबेत्त्रिवृन्नागरं वा सगुडां वा हरीतकीम् ||६२||
गुग्गुलुं त्रिवृतां दन्तीं द्रवन्तीं सैन्धवं वचाम् |
मूत्रमद्यपयोद्राक्षारसैर्वीक्ष्य बलाबलम् ||६३||
एवं पीलूनि भृष्टानि पिबेत् सलवणानि तु |६४|

After considering the strength of the patient, the below mentioned formulations may be given along with cows urine, wine, milk or juice of draksa –

–        Trivrt and Nagara or

–        Haritaki and Guda or

–        Guggulu, Trivrt, Danti, Dravanti, Saindhava and Vaca

Similarly, leaves of Pilu fried and added with salts should be given.

पिप्पलीपिप्पलीमूलचव्यचित्रकसैन्धवैः ||६४||
युक्ता हन्ति सुरा गुल्मं शीघ्रं काले प्रयोजिता |६५|

The recipe consisting of the below mentioned ingredients should be administered –

–        Pippali,

–        Pippalimula,

–        Cavya,

–        Citraka and

–        Saindhava

It should be given at a suitable time, mixed with sura (beer). It is effective in curing Gulma.

बद्धविण्मारुतो गुल्मी भुञ्जीत पयसा यवान् ||६५||
कुल्माषान् वा बहुस्नेहान् भक्षयेल्लवणोत्तरान् |६६|

If the patient of gulma has obstruction of faeces and flatus, he should consume the below mentioned foods –

–        food prepared with yava along with milk or

–        kulmasa i.e. cooked pulses added with more quantity of fats and salt

अथास्योपद्रवः शूलः [९] कथञ्चिदुपजायते ||६६||
शूलं निखानितमिवासुखं येन तु वेत्त्यसौ |६७|

Sula – which means pain or discomfort wherein a person experiences needles being driven into the body, sometimes develops as a complication in gulma.

तत्र विण्मूत्रसंरोधः कृच्छ्रोच्छ्वासः स्थिराङ्गता ||६७||
तृष्णा दाहो भ्रमोऽन्नस्य विदग्धपरिवृद्धिता |
रोमहर्षोऽरुचिश्छर्दिर्भुक्तवृद्धिर्जडाङ्गता ||६८||
वाय्वादिभिर्यथासङ्ख्यं मिश्रैर्वा… |६९|

In gulma, the below mentioned symptoms are produced by vata and other doshas aggravated either separately or combined together –

–        obstruction to faeces and urine,

–        dyspnoea,

–        rigidity of the body,

–        thirst,

–        feeling of burning sensation,

–        giddiness,

–        pain increasing during digestion of food,

–        horripilations,

–        anorexia,

–        vomiting,

–        increase of pain immediately after taking the food,

–        inactivity of the body parts

…वीक्ष्य योजयेत् |
पथ्यात्रिलवणं क्षारं हिङ्गुतुम्बुरुपौष्करम् ||६९||
यवानीं च हरिद्रां च विडङ्गान्यम्लवेतसम् |
विदारीत्रिफलाऽभीरुशृङ्गाटीगुडशर्कराः ||७०||
काश्मरीफलयष्ट्याह्वपरूषकहिमानि च |
षड्ग्रन्थातिविषादारुपथ्यामरिचवृक्षजान् ||७१||
कृष्णामूलकचव्यं च नागरक्षारचित्रकान् |
उष्णाम्लकाञ्जिकक्षीरतोयैः श्लोकसमापनान् ||७२||
यथाक्रमं विमिश्रांश्च द्वन्द्वे सर्वांश्च सर्वजे |७३|

Treatments should be planned after determining the nature of doshas. Below mentioned formulations may be used –

1. Pathyā, the three lavanās, ksara (yavaksāra), hiñgu, tumburu,

puskaramūla, yavānī, haridrā, vidanga and amlavetasa.

2. Vidārī, triphalā, abhiru, Śrāgāta, guda, sarkara, kāsmariphala,

yastyahvā, parūsaka, and hima (candana).

3. Sadgrañthā, ativisā, dāru, pathyā, marica, vrkşaja (indrayava),

krsnamūla (pippallīmūla), cavya, nāgara, yavakşāra and citraka.

They can be taken with –

–        warm sour gruel – for vata aggravation,

–        warm milk – for pitta aggravation and

–        warm water – for kapha aggravation

They may also be mixed suitably and administered to combat combinations of two or three doshas.

तथैव सेकावगाहप्रदेहाभ्यङ्गभोजनम् ||७३||
शिशिरोदकपूर्णानां भाजनानां च धारणम् |
वमनोन्मर्दनस्वेदलङ्घनक्षपणक्रियाः ||७४||
स्नेहादिश्च क्रमः सर्वो विशेषेणोपदिश्यते |७५|

Similarly, the below mentioned therapies are also indicated as and when needed –

–        seka – pouring medicated liquids on the body,

–        avagaha – tub bath,

–        pradeha – warm poultice,

–        abhyanga – oil massage / anointing the body with medicated oils,

–        bhojana – suitable foods,

–        shishira udaka purna bhanjananam dharanam – keeping vessels filled with cold water on the abdomen,

–        vamana – emesis,

–        unmardana – kneading,

–        svedana – sudation,

–        langhana – fasting,

–        kshapana – methods and measures adopted to thin the body,

–        snehana – oleation and

–        other therapies

वल्लूरं मूलकं मत्स्यान् शुष्कशाकानि वैदलम् ||७५||
न खादेदालुकं गुल्मी मधुराणि फलानि च |७६|

Below mentioned things should not be consumed by patients of gulma –

–        dried meat,

–        radish,

–        fish,

–        dry vegetables,

–        pulses,

–        aluka – tubers / potato and

–        sweet fruits

Gulmarahita sula – abdominal pain without tumour

विना गुल्मेन यच्छूलं गुल्मस्थानेषु जायते ||७६||
निदानं तस्य वक्ष्यामि रूपं च सचिकित्सितम् |७७|
Nidāna – causes-

After this, causes, signs and symptoms and treatments of that kind of sula – abdominal pain (colic) which appears in places of gulma (places indicated for manifestation of gulma) but occurs without gulma.

Śūla – abdominal pain

वातमूत्रपुरीषाणां निग्रहादतिभोजनात् ||७७||
अजीर्णाध्यशनायासविरुद्धान्नोपसेवनात् |
पानीयपानात् क्षुत्काले विरूढानां च सेवनात् ||७८||
पिष्टान्नशुष्कमांसानामुपयोगात्तथैव च |
एवंविधानां द्रव्याणामन्येषां चोपसेवनात् ||७९||
वायुः प्रकुपितः कोष्ठे शूलं सञ्जनयेद्भृशम् |
निरुच्छ्वासी भवेत्तेन वेदनापीडितो नरः ||८०||

Below mentioned are the causes of Sula –

–        suppression of urges of flatus, urine and faeces,

–        overeating of foods,

–        indigestion,

–        taking food often (many times),

–        excessive exertion,

–        intake of incompatible foods,

–        drinking lot of water and other beverages at the time of hunger,

–        eating pulses, powdery foods and dry meats and such other foods

Vata would get aggravated due to the above mentioned causes and causes severe pain in the abdomen. When this happens, the person becomes breathless, being troubled greatly by pain.

शङ्कुस्फोटनवत्तस्य यस्मात्तीव्राश्च वेदनाः |
शूलासक्तस्य लक्ष्यन्ते तस्माच्छूलमिहोच्यते ||८१||

A condition wherein severe pain is experienced by the person similar to a nail being driven into the body, it is called as Sula.

Lakşana – symptoms

निराहारस्य यस्यैव तीव्रं शूलमुदीर्यते |
प्रस्तब्धगात्रो भवति कृच्छ्रेणोच्छ्वसितीव च ||८२||
वातमूत्रपुरीषाणि कृच्छ्रेण कुरुते नरः |
एतैर्लिङ्गैर्विजानीयाच्छूलं वातसमुद्भवम् ||८३||

Symptoms of abdominal pain produced by vata –

–        severe pain develops when the person has not taken any foods i.e. on empty stomach,

–        the body of the patient becomes very rigid without movements,

–        he breathes with difficulty and

–        eliminates flatus, urine and faeces with difficulty

तृष्णा दाहो मदो मूर्च्छा तीव्रं शूलं तथैव च |
शीताभिकामो भवति शीतेनैव प्रशाम्यति ||८४||
एतैर्लिङ्गैर्विजानीयाच्छूलं पित्तसमुद्भवम् |८५|

Symptoms of abdominal pain produced by pitta –

–        thirst,

–        burning sensation,

–        toxicity,

–        fainting,

–        severe pain,

–        person desires for cold comforts and

–        pain subsides by cold comforts itself

शूलेनोत्पीड्यमानस्य हृल्लास उपजायते ||८५||
अतीव पूर्णकोष्ठत्वं तथैव गुरुगात्रता |
एतच्छ्लेष्मसमुत्थस्य शूलस्योक्तं निदर्शनम् ||८६||
सर्वाणि दृष्ट्वा रूपाणि निर्दिशेत्सान्निपातिकम् |
सन्निपातसमुत्थानमसाध्यं तं विनिर्दिशेत् ||८७||
शूलानां लक्षणं प्रोक्तं चिकित्सां तु निबोध मे |

Symptoms of abdominal pain produced by kapha –

–        nausea occurring consequent to pain,

–        fullness of abdomen experienced in great proportions and

–        feeling of heaviness of the body

Symptoms of abdominal pain caused by tridosha – If all the symptoms i.e. symptoms of all the doshas are present it should be understood as caused by sannipata doshas i.e. caused due to simultaneous aggravation of all three doshas. This condition is described as being incurable.

Thus, features of sula i.e. colics were described. Now listen to the treatment of the same.

Śūla cikitsa – treatment of pain in the abdomen

आशुकारी हि पवनस्तस्मात्तं त्वरया जयेत् ||८८||
तस्य शूलाभिपन्नस्य स्वेद एव सुखावहः |
पायसैः कृशरापिण्डैः स्निग्धैर्वा पिशितैर्हितः ||८९||

Vata should be controlled quickly because it is very quick in action. Sudation / fomentation alone brings good relief for the persons afflicted by abdominal pain. Payasa – milk pudding or Krsara pinda – bolus of cooked rice should be used for administering sudation.

त्रिवृच्छाकेन वा स्निग्धमुष्णं भुञ्जीत भोजनम् |
चिरबिल्वाङ्कुरान् वापि तैलभृष्टांस्तु भक्षयेत् ||९०||
वैहङ्गांश्च रसान् स्निग्धान् जाङ्गलान् शूलपीडितः |
यथालाभं निषेवेत मांसानि बिलशायिनाम् ||९१||

Patients with abdominal pain should consume any one of the below mentioned foods as available –

–        warm foods added with leaves of Trivrt and fats or

–        tender leaves of Cirabilva fried in oil or

–        soup of meat of birds living in arid regions or

–        meat of animals living in burrows

सुरा सौवीरकं चुक्रं मस्तूदश्वित्तथा दधि |
सकाललवणं पेयं शूले वातसमुद्भवे ||९२||
कुलत्थयूषो युक्ताम्लो लावकीयूषसंस्कृतः |
ससैन्धवः समरिचो वातशूलविनाशनः ||९३||

Recipes for pain produced by vata – Sura, sauviraka, cukra, mastu, udasvit or dadhi should be consumed after adding kala lavana to it.

Below mentioned foods also cure vataja sula i.e. pain caused by aggravated vata –

–        soup of kulattha added with suitable sour substances or

–        soup of lava bird processed with spices etc. and added with saindhava lavana and marica

विडङ्गशिग्रुकम्पिल्लपथ्याश्यामाम्लवेतसान् |
सुरसामश्वमूत्रीं च सौवर्चलयुतान् पिबेत् ||९४||
मद्येन वातजं शूलं क्षिप्रमेव प्रशाम्यति |९५|

Decoction of the below mentioned herbs should be prepared –

–        Vidanga,

–        Hingu,

–        Kampilla,

–        Pathya,

–        Syama,

–        Amlavetasa,

–        Surasa and

–        Asvamutri – Sallaki

Sauvarcala is added to this decoction. Now the decoction should be consumed along with wine. This recipe would quickly cure vataja sula.

पृथ्वीकाजाजिचविकायवानीव्योषचित्रकाः ||९५||
पिप्पल्यः पिप्पलीमूलं सैन्धवं चेति चूर्णयेत् |
तानि चूर्णानि पयसा पिबेत् काम्बलिकेन वा ||९६||
मध्वासवेन चुक्रेण सुरासौवीरकेण वा |
अथवै(चै)तानि चूर्णानि मातुलुङ्गरसेन वा ||९७||
तथा बदरयूषेण भावितानि पुनः पुनः |
तानि हिङ्गुप्रगाढानि सह शर्करया पिबेत् ||९८||
सह दाडिमसारेण वर्तिः कार्या भिषग्जिता |
सा वर्तिर्वातिकं शूलं क्षिप्रमेव व्यपोहति ||९९||
गुडतैलेन वा लीढा पीता मद्येन वा पुनः |१००|

Powder of the below mentioned should be made –

–        Prthvika,

–        Ajaji,

–        Cavika,

–        Yavani,

–        Vyosa,

–        Citraka,

–        Pippali,

–        Pippalimula and

–        Saindhava Lavana

This should be consumed along with either water, kambalika (water of curds, made sour), madhvasava, cukra, sura, sauviraka or juice of matulunga.

Alternatively, this powder should be soaked often in the soup of badara. Then, it should be mixed with more Hingu and consumed with sugar.

This powder may be mixed with Dadima Sara i.e. juice of pomegranate fruits and made into wicks (pills or dragees). These wicks will cure Vataja Sula quickly, when consumed.

They may also be consumed with jaggery, oil or wine.

बुभुक्षाप्रभवे शूले लघु सन्तर्पणं हितम् ||१००||
उष्णैः क्षीरैर्यवागूभिः स्निग्धैर्मांसरसैस्तथा |१०१|

Light and easily digestible santarpana (nourishing) foods should be given along with warm milk, thick gruel or meat soup added with fats, if the pain develops when the person is hungry.

वातशूले समुत्पन्ने रूक्षं स्निग्धेन भोजयेत् ||१०१||
सुसंस्कृताः प्रदेयाः स्युर्घृतपूरा विशेषतः |
वारुणीं च पिबेज्जन्तुस्तथा सम्पद्यते सुखी ||१०२||
एतद्वातसमुत्थस्य शूलस्योक्तं चिकित्सितम् |१०३|

Unctuous foods, especially ghrtapura – puri fried in ghee which is well processed should be given to the patient when vataja sula occurs (commences) and if the patient is dry. He should also drink varuni – scum of wine. By this, he would find comfort.

Thus, the treatment of Vataja Sula has been described. 

Pittasula cikitsă

अथ पित्तसमुत्थस्य क्रियां वक्ष्याम्यतः परम् ||१०३||
स सुखं छर्दयित्वा तु पीत्वा शीतोदकं नरः |
शीतलानि च सेवेत सर्वाण्युष्णानि वर्जयेत् ||१०४||

Now, the treatment of pain produced by pitta shall be described by me.

By administering emetics, the patient should be made to vomit comfortably. Then, the patient should drink cold water. He should also use all cold things only and avoid all hot things.

मणिराजतताम्राणि भाजनानि च सर्वशः |
वारिपूर्णानि तान्यस्य शूलस्योपरि निक्षिपेत् ||१०५||

Cold water should be filled in the vessels made of gems, silver or copper. These vessels shall be placed on the site of pain.

गुडः शालिर्यवाः क्षीरं सर्पिःपानं विरेचनम् |
जाङ्गलानि च मांसानि भेषजं पित्तशूलिनाम् ||१०६||
रसान् सेवेत पित्तघ्नान् पित्तलानि विवर्जयेत् |
पालाशं धान्वनं वाऽपि पिबेद्यूषं सशर्करम् ||१०७||

Below mentioned are the treatments for patients suffering from pain caused due to pitta –

–        jaggery,

–        sali rice,

–        yava – barley,

–        milk,

–        drinking ghee,

–        purgative therapy,

–        consuming meat of animals living in arid lands

–        pitta mitigating meat soups,

–        avoiding pitta aggravating things / causes

–        soup of meat of palasa (carnivorous animals according to Acharya Dalhana) or dhanvana (animals living in arid lands) added with sugar

परुषकाणि मृद्वीकाखर्जूरोदकजान्यपि |
तत् पिबेच्छर्करायुक्तं पित्तशूलनिवारणम् ||१०८||

Parusaka, Mrdvika and Kharjura should be squeezed in water. Sugar is added to this water and consumed. It cures abdominal pain produced by pitta.

Kaphajasula cikitsa

अशने भुक्तमात्रे तु प्रकोपः श्लैष्मिकस्य च |
वमनं कारयेत्तत्र पिप्पलीवारिणा भिषक् ||१०९||

Kapha gets aggravated immediately after taking meals. This aggravated kapha gives rise to pain. In this condition, the patient should be given water boiled with pippali to drink and made to vomit.

रूक्षः स्वेदः प्रयोज्यः स्यादन्याश्चोष्णाः क्रिया हिताः |
पिप्पली शृङ्गवेरं च श्लेष्मशूले भिषग्जितम् ||११०||

Dry sudation should be administered. Similarly, all other hot therapies are beneficial. For pain caused by aggravated kapha, pippali and srngavera are the best medicines.

पाठां वचां त्रिकटुकं तथा कटुकरोहिणीम् |
चित्रकस्य च निर्यूहे [१] पिबेद्यूषं सहार्जकम् ||१११||

Decoction prepared with Patha, Vaca, Trikatu, Katukarohini and Citraka should be given for drinking. Alternatively, Yusa i.e. soup of pulses should be given for drinking after mixing arjaka in it.

Erandadi quatha

एरण्डफलमूलानि मूलं गोक्षुरकस्य च |
शालपर्णीं पृश्निपर्णीं बृहतीं कण्टकारिकाम् ||११२||
दद्याच्छृगालविन्नां च सहदेवां तथैव च |
महासहां क्षुद्रसहां मूलमिक्षुरकस्य च ||११३||
एतत् सम्भृत्य सम्भारं जलद्रोणे विपाचयेत् |
चतुर्भागावशेषं तु यवक्षारयुतं पिबेत् ||११४||
वातिकं पैत्तिकं वाऽपि श्लैष्मिकं सान्निपातिकम् |
प्रसह्य नाशयेच्छूलं छिन्नाभ्रमिव मारुतः ||११५||

Below mentioned are boiled in one drona (10.24 kg) of water and reduced to one-fourth so as to prepare its decoction –

–        Fruits and roots of Eranda,

–        Roots of Goksura,

–        Salaparni,

–        Prsniparni,

–        Brhati,

–        Kantakarika,

–        Srgalavinna,

–        Sahadevi,

–        Mahasaha,

–        Ksudrasaha and

–        Roots of Iksuraka

This decoction should be consumed by adding Yava Ksara to it.

Benefits – Just like the wind disperses the clouds, this recipe definitely cures abdominal pain produced by vata, pitta and kapha and sannipata.

पिप्पली स्वर्जिकाक्षारो यवाश्चित्रक एव च |
सेव्यं चैतत् समानीय भस्म कुर्याद्विचक्षणः ||११६||
तदुष्णवारिणा पीतं श्लेष्मशूले भिषग्जितम् |११७|
Equal quantities of the below mentioned are burnt so as to obtain their ash –

–        Pippali,

–        Svarjika Ksara,

–        Yava Ksara and

–        Citraka

This should be consumed mixed in warm water. It is the best medicine for relieving pain caused by aggravated kapha.

Pārśvaśūla – pain of the flanks

रुणद्धि मारुतं श्लेष्मा कुक्षिपार्श्वव्यवस्थितः ||११७||
स संरुद्धः करोत्याशु साध्मानं गुड्गुडायनम् |
सूचीभिरिव निस्तोदं कृच्छ्रोच्छ्वासी तदा नरः ||११८||
नान्नं वाञ्छति नो निद्रामुपैत्यर्तिनिपीडितः |
पार्श्वशूलः स विज्ञेयः कफानिलसमुद्भवः ||११९||

Vata located in Kuksi (abdomen – epigastrium) and Parsva (flanks – sides of the abdomen) is obstructed by Kapha. This obstructed vata gives rise to pain associated with flatulence and gurgling noise.

Other symptoms –

–        pain – as though pricked by needles,

–        dyspnoea,

–        lack of desire for food,

–        loss of sleep due to pain

This condition is known as Parsva Sula – pain in the flanks. It is jointly produced by kapha and vata.

तत्र पुष्करमूलानि हिङ्गु सौवर्चलं विडम् |
सैन्धवं तुम्बुरुं पथ्यां चूर्णं कृत्वा तु पाययेत् ||१२०||
पार्श्वहृद्बस्तिशूलेषु यवक्वाथेन संयुतम् |
सर्पिः प्लीहोदरोक्तं वा घृतं वा हिङ्गुसंयुतम् ||१२१||
बीजपूरकसारं वा पयसा सह साधितम् |
एरण्डतैलमथवा मद्यमस्तुपयोरसैः ||१२२||
भोजयेच्चापि पयसा जाङ्गलेन रसेन वा |१२३|

Nice powder of the below mentioned is prepared –

–        Puskaramula,

–        Hingu,

–        Sauvarcala,

–        Bida,

–        Saindhava,

–        Tumburu and

–        Pathya

This powder should be consumed with the decoction of Yava. It cures pain in the flanks, heart and urinary bladder.

Below mentioned recipes too may be consumed –

–        Satpala Ghrta – medicated ghee mentioned in the context of treatment of Plihodara – enlargement of spleen or

–        ghee mixed with hingu – asafoetida,

–        seeds of bijapuraka fruit cooked in milk or

–        eranda taila mixed with wine, whey, milk or meat soup

Food can be taken along with milk or soup of meat of animals living in arid lands.

Kukşisüla – pain in the epigastrium

प्रकुप्यति यदा कुक्षौ वह्निमाक्रम्य मारुतः ||१२३||
तदाऽस्य भोजनं भुक्तं सोपस्तम्भं न पच्यते |
उच्छ्वसित्यामशकृता शूलेनाहन्यते मुहुः ||१२४||
नैवासने न शयने तिष्ठन् वा लभते सुखम् |
कुक्षिशूल इति ख्यातो वातादामसमुद्भवः ||१२५||

The food which has been consumed would stay in the stomach for a long duration without getting digested when aggravated vata vitiates the agni. When this happens, the person would suffer from the below mentioned symptoms –

–        difficulty in breathing,

–        elimination of unripe (unformed) faeces,

–        frequent pain and

–        no comfort in sitting, lying or standing

This condition is known as Kuksi Sula (epigastric pain or pain around the pit of the stomach). It is caused by vata and ama.

वमनं कारयेत्तत्र लङ्घयेद्वा यथाबलम् |
संसर्गपाचनं कुर्यादम्लैर्दीपनसंयुतैः ||१२६||

In this condition, the patient should be administered vomiting therapy and depending on his strength, he should be made to fast. Following this, the regimen of liquid foods (peya, vilepi etc) processed with sour and digestive herbs shall be administered.

नागरं दीप्यकं चव्यं हिङ्गु सौवर्चलं विडम् |
मातुलुङ्गस्य बीजानि तथा श्यामोरुबूकयोः ||१२७||
बृहत्याः कण्टकार्याश्च क्वाथं शूलहरं पिबेत् |१२८|

Decoction of the below mentioned ingredients cures abdominal pain –

–        Nagara,

–        Dipyaka,

–        Cavya,

–        Hingu,

–        Sauvarcala,

–        Bida,

–        Seeds of Matulunga,

–        Syama (Vrddhadaru),

–        Urubaka,

–        Brhati and

–        Kantakari

वचा सौवर्चलं हिङ्गु कुष्ठं सातिविषाऽभया ||१२८||
कुटजस्य च बीजानि सद्यःशूलहराणि तु |
विरेचने प्रयुञ्जीत ज्ञात्वा दोषबलाबलम् ||१२९||

Decoction of the below mentioned ingredients cures pain immediately, when consumed –

–        Vaca,

–        Sauvarcala,

–        Hingu,

–        Kustha,

–        Ativisa,

–        Abhaya and

–        Kutaja Bija

Considering the strength and condition of doshas, purgative therapy should be administered.

स्नेहबस्तीन्निरूहांश्च कुर्याद्दोषनिबर्हणान् |
उपनाहाः स्नेहसेका धान्याम्लपरिषेचनम् ||१३०||
अवगाहाश्च शस्यन्ते यच्चान्यदपि तद्धितम् |१३१|
Unctuous enemas and decoction enemas which would mitigate the doshas may also be administered.

Below mentioned treatments should also be given as and when required –

–        application of warm poultices,

–        anointment of oil,

–        sudation – pouring of warm medicinal liquids on the body,

–        pouring of dhanyamla on the body,

–        tub bath or

–        any other therapy which is beneficial

Hrtsula- pain in the region of the heart

कफपित्तावरुद्धस्तु मारुतो रसमूर्च्छितः ||१३१||
हृदिस्थः कुरुते शूलमुच्छ्वासारोधकं परम् |
स हृच्छूल इति ख्यातो रसमारुतसम्भवः ||१३२||

Kapha and pitta present in the chest cause obstruction of vata. This obstructed vata combines with rasa present in the heart. Doing so, the vata gives rise to pain which causes obstruction to breathing. This is called Hrt Sula. This condition is produced by rasa and vata.

तत्रापि कर्माभिहितं यदुक्तं हृद्विकारिणाम् |१३३|

In this condition, the treatments prescribed for diseases of the heart should be done.

Bastisula – pain in the region of urinary bladder

संरोधात् कुपितो वायुर्बस्तिमावृत्य तिष्ठति ||१३३||
बस्तिवङ्क्षणनाभीषु ततः शूलोऽस्य जायते |
विण्मूत्रवातसंरोधी बस्तिशूलः स मारुतात् ||१३४||

Vata gets aggravated by suppression of urges (of urine, faeces and flatus). This aggravated vata resides in the area that gives rise to pain in the urinary bladder, groins and umbilicus. This causes obstruction of faeces, urine and flatus. This condition is called Basti Sula and is caused by aggravated vata.

Mūtrasüla

नाभ्यां वङ्क्षणपार्श्वेषु कुक्षौ मेढ्रान्त्रमर्दकः |
मूत्रमावृत्य गृह्णाति मूत्रशूलः स मारुतात् ||१३५||

Aggravated Vata gets localized in the areas of umbilicus, groin, flanks, pit of the abdomen, penis and intestines. Getting localized in the mentioned regions, the aggravated vata causes obstruction of elimination of urine and produces pain. This condition is called Mutra Sula, and is caused by vata.

Vitśūla

वायुः प्रकुपितो यस्य रूक्षाहारस्य देहिनः |
मलं रुणद्धि कोष्ठस्थं मन्दीकृत्य तु पावकम् ||१३६||
शूलं सञ्जनयंस्तीव्रं स्रोतांस्यावृत्य तस्य हि |
दक्षिणं यदि वा वामं कुक्षिमादाय जायते ||१३७||
सर्वत्र वर्धते क्षिप्रं भ्रमन्नथ [सघोषवान् |
पिपासा वर्धते तीव्रा भ्रमो मूर्च्छ च जायते ||१३८||
उच्चारितो मूत्रितश्च न शान्तिमधिगच्छति |
विट्शूलमेतज्जानीयाद्भिषक् परमदारुणम् ||१३९||

Vata obstructs the faeces in the alimentary tract of persons who indulge in ingestion of dry (non-unctuous, non-fatty) foods and causes weakness of digestive fire. It also invades the alimentary tract and gives rise to severe pain either in the right or left part of the abdomen. The pain also spreads to all other parts moving about. The pain is associated with noise (in the abdomen), great increase in thirst, giddiness and fainting.

The pain does not subside even after elimination of faeces or urine. This condition should be understood and diagnosed as Vit Sula – pain in the abdomen caused due to the obstruction of faeces, by the physician. This is a very dreadful condition.

क्षिप्रं दोषहरं कार्यं भिषजा साधु जानता |
स्वेदनं शमनं चैव निरूहाः स्नेहबस्तयः ||१४०||
पूर्वोद्दिष्टान् पाययेत योगान् कोष्ठविशोधनान् |
उदावर्तहराश्चास्य क्रियाः सर्वाः सुखावहाः ||१४१||

In this condition, the physician should quickly administer –

–        therapies which mitigate the doshas,

–        sudation,

–        palliative medicines,

–        decoction enemas and

–        unctuous / oil enemas

Medicines which purify the alimentary tract which have been mentioned earlier and also the therapies used for mitigating Udavarta will also be beneficial in this condition and has to be administered.

Annadoşhaja sula- pain due to indigestion

अतिमात्रं यदा भुक्तं पावके मृदुतां गते |
स्थिरीभूतं तु तत्कोष्ठे वायुरावृत्य तिष्ठति ||१४२||
अविपाकगतं ह्यन्नं शूलं तीव्रं करोत्यति |
मूर्च्छाऽऽध्मानं विदाहश्च हृदुत्क्लेशो विलम्बिका ||१४३||
विरिच्यते छर्दयति कम्पतेऽथ विमुह्यति |
अविपाकाद्भवेच्छूलस्त्वन्नदोषसमुद्भवः ||१४४||

When more quantity of food is taken, the digestive fire becomes weak. When this happens, the food stays for long periods of time inside (the stomach and intestines) and will cause aggravation of vata. This vata along with undigested food together will produce severe pain. This pain is accompanied by fainting, flatulence, heart-burn, nausea, vilambika – a type of severe indigestion, excessive purgation, vomiting, shaking of body parts and unconsciousness.

This is known as Annadoshaja Sula. It arises from improper digestion of food.

वमनं लङ्घनं स्वेदः पाचनं फलवर्तयः |
क्षाराश्चूर्णानि गुटिकाः शस्यन्ते शूलनाशनाः ||१४५||

For this, the below mentioned treatments are best suited –

–        emesis,

–        fasting,

–        sudation,

–        digestive medicines,

–        rectal wicks,

–        use of alkalis, powders and pills which relieve pain

गुल्नावस्थाः क्रियाः कार्या यथावत्सर्व शूलिनाम्।।

Treatments advocated for Gulma should also be adopted as found suitable in patients of all kinds of sula – abdominal pains.

इति श्रीसुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे गुल्मप्रतिषेधो नाम (चतुर्थोऽध्यायः, आदित) द्विचत्वारिंशोऽध्यायः।।४२।।

Thus ends the forty second chapter by name Gulma Pratisedha in Uttara Sthana of Susruta Samhita.