The Compendium of Caraka 2.3

English (machine translation) 2.3

Language: English

2.3.1

Now we shall explain the etiology of abdominal swellings (gulma).

2.3.3

Here, indeed, there are five abdominal swellings (gulma); they are as follows: wind gulma, bile gulma, phlegm gulma, gulma from accumulation [of all three doshas], and blood gulma.

To the venerable Ātreya speaking thus, Agniveśa said: 'How, O venerable one, do we distinguish among the five gulmas here? For a physician, even if knowledgeable about remedies, is not capable of alleviating diseases if he does not know their distinguishing features.'

2.3.5

The venerable Ātreya said to him: 'O Agniveśa, the distinguishing knowledge of gulmas as well as of other diseases arises from the specific differences in their etiology, premonitory symptoms, signs, pains, and therapeutic suitability. Listen to that as it is declared regarding gulmas.

2.3.6

When a person of wind constitution, emaciated especially by any one manifestation among fever, vomiting, purgation, or diarrhea, takes wind-increasing food, or especially cold [food] in excessive quantity; or drinks emetics or purgatives without prior unction; or induces unprovoked vomiting, or suppresses the provoked urges of flatus, urine, and feces; or, having overeaten, drinks freshly drawn water in excessive quantity; or travels by an excessively jarring vehicle; or is fond of excessive sexual intercourse, exercise, wine, and grief; or sustains trauma; or is accustomed to improper sitting, lying, standing, and walking; or undertakes any other such improper and excessive form of physical exertion—from his improper conduct, the wind becomes provoked.

2.3.7

That provoked wind, having entered the great channel (mahāsrotas), having enveloped [the part] that has become hardened through dryness, becomes massed into a ball and establishes a seat in the heart, in the urinary bladder, in the flanks, or in the navel; it produces colic and diverse kinds of nodular lumps, and remains massed into a ball; because it is massed into a ball (piṇḍita), it is called "gulma"; it swells at one moment and subsides at another moment; its pain is indefinite, broad, or minute because of the instability of wind; it frequently feels as if ants are crawling over the limbs; it abounds in the sudden onset and disappearance of pricking, bursting, throbbing, stretching, constriction, numbness, horripilation, and fainting; the patient afflicted with it considers himself pierced as if with needles or stakes; moreover, at the end of the day he develops fever, his mouth becomes dry, his breathing is obstructed, and his body hair stands on end when the pain manifests; splenomegaly, abdominal distension with rumbling, intestinal gurgling, indigestion, upward movement of wind, body aches, stiffness of the neck, and pain in the head, temples, and groin afflict him; his skin, nails, eyes, face, urine, and feces become blackish-red and rough; things declared as its etiology do not suit him, and opposite things do suit him—thus is wind gulma.

2.3.8

However, in one emaciated by those very same reducing factors, through the use of sour, salty, pungent, alkaline, hot, sharp, spoiled vinegar, wine, green vegetables, sour fruits, and burning foods such as greens, grains, meats, and the like; through eating before the previous meal is digested and overeating; and in one whose stomach has become dry, through excessively untimely vomiting, through suppression [of urges], and through excessive exposure to wind and sun—the bile becomes provoked along with the wind.

2.3.9

That provoked wind, having gathered the bile in a portion of the stomach, produces those very varieties of pain that were described in wind gulma; but the bile burns him in the abdomen, in the heart, in the chest, and in the throat; being burnt, he belches a smoky-like eructation accompanied by sourness; the site of his gulma burns, aches, fumes, feels heated, perspires, becomes moist, feels relaxed, becomes intolerant to touch, and has slight horripilation; fever, dizziness, burning sensation, thirst, dryness of the throat, palate, and mouth, bewilderment, and loose stools afflict him; his skin, nails, eyes, face, urine, and feces become green or yellow; things declared as its etiology do not suit him, and opposite things do suit him—thus is bile gulma.

2.3.10

However, in one emaciated by those very same reducing factors, through overeating; through eating foods that are excessively unctuous, heavy, sweet, and cold; through consuming flour products, sugarcane, milk, sesame, black gram, and molasses preparations; through excessive drinking of immature wine; through excessive consumption of fresh greens; through excessive eating of meat from marshland, aquatic, and domesticated animals; through suppression [of urges]; through excessive drinking of water when not hungry; or through violent agitation of the body—the phlegm becomes provoked along with the wind.

2.3.11

That provoked wind, having gathered the phlegm in a portion of the stomach, produces those very varieties of pain that were described in wind gulma; but the phlegm produces in him cold fever, anorexia, indigestion, body aches, horripilation, heart disease, vomiting, sleepiness, laziness, rigidity, heaviness, and burning headache; furthermore, stability, heaviness, hardness, deep-seatedness, and numbness of the gulma; likewise, when excessively increased, it produces cough, dyspnea, coryza, and consumption (rājayakṣmā); it produces whiteness in the skin, nails, eyes, face, urine, and feces; things declared as its etiology do not suit him, and opposite things do suit him—thus is phlegm gulma.

2.3.12

However, upon the combination of the causes and signs of all three doshas, the experts designate it as a gulma born of all three doshas (sānnipātika).

2.3.12_1

That gulma from accumulation [of all three doshas] (nicayagulma) is incurable because its treatments are mutually contradictory.

2.3.13

Blood gulma, however, occurs only in a woman, not in a man, on account of the distinction of the womb and the flow of menstrual blood.

2.3.13_1

In a woman who, out of dependence, lack of confidence, or constant deference to etiquette, suppresses provoked urges; or who, when an immature fetus has recently miscarried, or when she has recently given birth, or during menstruation, indulges in wind-provoking factors, the wind quickly becomes provoked.

2.3.14

That provoked wind, entering the mouth of the vagina, obstructs the menstrual blood; that menstrual blood, being obstructed month after month, enlarges the abdomen.

2.3.14_1

In her, colic, cough, diarrhea, vomiting, anorexia, indigestion, body aches, sleepiness, laziness, rigidity, and excessive salivation of phlegm arise; milk appears in the breasts; blackness of the lips and the areolas of the breasts; extreme fatigue of the eyes, fainting, nausea, pregnancy cravings, swelling of the feet, slight emergence of the abdominal line of hair, widening of the vaginal orifice, and also foul odor and discharge from the vagina arise; and her gulma throbs only as a solid mass; fools declare her, who is not pregnant, to be pregnant.'

2.3.15

Prior to the manifest appearance of these five gulmas, these premonitory symptoms arise; namely: lack of desire for food, anorexia and indigestion, irregularity of the digestive fire, burning of what has been eaten, untimely vomiting and eructation at the time of digestion, non-appearance of the urges of wind, urine, and feces, and non-passage or slight passage of those that have appeared, wind colic, abdominal distension, rumbling in the intestines, lack of erection, retention of feces, lack of hunger, debility, and intolerance of satiety.

2.3.16

In all these gulmas, indeed, no gulma arises without wind.

2.3.16_1

Among them, knowing one born of all three doshas to be incurable, he should not undertake its treatment at all; but in one born of a single dosha, he should apply the procedure specific to it, and he should treat those born of combined doshas with a combined measure.

2.3.16_2

Whatever else he considers unopposed [to the treatment], that too he should administer, distinguishing the gravity and lightness of the complications; acting with urgency, he should treat the severe complications, and the others subsequently.

2.3.16_3

If acting with urgency and not discerning any particular [dosha], he should apply the treatment for wind in emergencies involving gulmas: unction and sudation which remove wind, mild purgation combined with unctuous substances, and enemata; and he should administer sour, salty, and sweet tastes with proper method.

Commentaries (1)

Jalpakalpataru — Gaṅgādhara Kaviratna 1860, Sanskrit

Linked texts (1)

Carakasaṃhitā — Agniveśa (Āyurveda) & Caraka, Sanskrit