Ashtanga Hridayam Nidanasthanam Chapter 11:  Vidradhi Vriddhi Gulma Nidanam Adhyaya (Diagnosis of abscess, hernia and abdominal tumors)

The 11^th chapter of Nidanasthanam of Ashtanga Hridayam is named as Vidradhi Vrddhi Gulma Nidanam Adhyayah. This chapter deals with the explanation of ‘diagnosis of abscess, hernia and abdominal tumors’.

The topics covered in this chapter include –

• Vidradhi Nidana and Samprapti (causes and pathogenesis of abscess)
• Rupa (clinical features)
• Rakta Vidradhi Rupa (clinical features of abscess caused by blood)
• Kshataja Vidradhi Rupa (clinical features of abscess caused by trauma)
• Signs of abscess as per its location
• Expulsion of abscess contents in relation to their location with respect to umbilicus
• Sadhyasadhyata (prognosis)
• Sthana Vidradhi (Breast Abscess)
• Vriddhi Nidana (diagnosis of enlargement of scrotum)
• Mutraja Vrddhi (hydrocele)
• Antraja Vrddhi (hernia)
• Gulma Nidana (diagnosis of abdominal tumors)
• Vataja, Pittaja, Kaphaja and Raktaja Gulma
• Difference between Gulma and Vidradhi
• Gulma located outside and inside the alimentary tract
• Anaha (bloating)
• Asthila and Pratyathila
• Tuni and Prathituni
• Gulma Purvarupa (premonitory symptoms of tumors)

Pledge by the author(s)

अथातो विद्रधिवृद्धिगुल्मनिदानं 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 ‘diagnosis of abscess, hernia and abdominal tumors’. Thus say (pledge) atreya and other sages.

Vidradhi Nidana and Samprapti (causes and pathogenesis of abscess)

भुक्तैः पर्युषितात्युष्णरूक्षशुष्कविदाहिभिः ।
जिह्मशय्याविचेष्टाभिस्तैस्तैश्चासृक्प्रदूषणैः ॥ १ ॥
दुष्टत्वङ्मांसमेदोऽस्थिस्नाय्वसृक्कण्डराश्रयः ।
यः शोफो बहिरन्तर्वा महामूलो महारुजः ॥ २ ॥
वृत्तः स्यादायतो यो वा स्मृतः षोढा स विद्रधिः ।
दोषैः पृथक्समुदितैः शोणितेन क्षतेन च ॥ ३ ॥
By indulgence in foods which are stale (kept overnight), very hot, dry foods (without moisture and fat), those causing burning sensation during digestion; lying on uneven bed, improper movement of the body parts those (foods and activities) which cause vitiation of blood; the Doshas getting aggravated cause vitiation of the skin, muscle, fat, bone, ligaments, blood and tendons and produce a swelling arising from them either outside or inside (the body) situated deep inside accompanied with severe pain; being either round or wide, this is known as Vidradhi (abscess); it is of six kinds; from each Dosha separately, from the combination of all, from blood and from trauma.

Rupa (clinical features)

बाह्योऽत्र तत्र तत्राङ्गे दारुणो ग्रथितोन्नतः ।
आन्तरो दारुणतरो गम्भीरो गुल्मवद्घनः ॥ ४ ॥
वल्मीकवत्समुच्छ्रायी शीघ्रघात्यग्निशस्त्रवत् ।
नाभिबस्तियकृत्प्लीहक्लोमहृत्कुक्षिवङ्क्षणे ॥ ५ ॥
स्याद्वृक्कयोरपाने च
The external one, occurs here and there (anywhere on the body) difficult to bear, hard and elevated; the internal one is more difficult to bear, deep seated, hard like a tumor, heavy, growing upwards like an anthill, causes quick death like the fire or weapon, manifests on (near) the umbilicus, urinary bladder, liver, spleen, kloma (pancreas ) heart, abdomen (epigastrium), groins, kidneys and rectum.

Rupa (clinical features)

Vataja Vidradhi: Clinical features

वातात्तत्रातितीव्ररुक् ।
श्यावारुणश्चिरोत्थानपाको विषमसंस्थितिः ॥ ६ ॥
व्यधच्छेदभ्रमानाहस्पन्दसर्पणशब्दवान् ।
That arising from Vata has very severe pain, brownish red in color, takes long time to grow and suppurate; of irregular placement (uneven shape), has pains such as puncturing, excising, rotating pain, flatulent (as if filled with air) throbbing; spreads to other parts and produces sound.

Pittaja Vidradhi: Clinical features

रक्तताम्रासितः पित्तात्तृण्मोहज्वरदाहवान् ॥ ७ ॥
क्षिप्रोत्थानप्रपाकश्च
That caused by Pitta, is red, coppery or black in color ; produces thirst, delusion, fever and burning sensation, quick to grow and suppurate.

Kaphaja and Sannipataja Vidradhi: Clinical features

पाण्डुः कण्डूयुतः कफात् ।
सोत्क्लेशशीतकस्तम्भजृम्भारोचकगौरवः ॥ ८ ॥
चिरोत्थानविपाकश्च सङ्कीर्णः सन्निपाततः ।
That caused by Kapha is white, itching (irritating), accompanied with nausea, cold, stiffness of the body, excess yawning, loss of taste and feeling of heaviness of the body; slow in growth and suppuration. All the symptoms are present together, in that caused by all the Doshas.

Determination of internal / external vidradhi

सामर्थ्याच्चात्र विभजेद्बाह्याभ्यन्तरलक्षणम् ॥ ९ ॥
Determination whether it is external or internalshould be made on ability (severity) and relation with organs etc. (of the symptoms)

Rakta Vidradhi Rupa (Clinical features of abscess caused by blood)

कृष्णस्फोटावृतः श्यावस्तीव्रदाहरुजाज्वरः ।
पित्तलिङ्गोऽसृजा बाह्यः स्त्रीणामेव तथान्तरः ॥ १० ॥
That caused by blood is surrounded by black eruptions, brown in color, accompanied with severe burning sensation, pain and fever other symptoms of Pitta aggravation are seen in external Vidradhi. Internal Vidradhi is seen only in women (implying that it arises in the uterus).

Kshataja Vidradhi Rupa (Clinical features of abscess caused by trauma)

शस्त्राद्यैरभिघातेन क्षते वापथ्यकारिणः ।
क्षतोष्मा वायुविक्षिप्तः सरक्तं पित्तमीरयन् ॥ ११ ॥
पित्तासृग्लक्षणं कुर्याद्विद्रधिं भूर्युपद्रवम् ।
Vayu (Vata) getting aggravated by assault by weapons, etc. by unsuitable foods etc. and by displacing the heat at the site of trauma, leads to the aggravation of Pitta and Rakta (blood) and gives rise to an abscess, presenting symptoms of Pitta and Rakta, producing severe complications, secondary diseases.

Signs of abscess as per its location

तेषूपद्रवभेदश्च स्मृतोऽधिष्ठानभेदतः ॥ १२ ॥
नाभ्यां हिध्मा भवेद्बस्तौ मूत्रं कृच्छ्रेण पूति च ।
श्वासो यकृति रोधस्तु प्लीह्न्युच्छ्वासस्य तृट् पुनः ॥ १३ ॥
गलग्रहश्च क्लोम्नि स्यात्सर्वाङ्गप्रग्रहो हृदि ।
प्रमोहस्तमकः कासो हृदये घट्टनं व्यथा ॥ १४ ॥
कुक्षिपार्श्वान्तरांसार्तिः कुक्षावाटोपजन्म च ।
सक्थ्नोर्ग्रहो वङ्क्षणयोर्वृक्कयोः कटिपृष्ठयोः ॥ १५ ॥
पार्श्वयोश्च व्यथा पायौ पवनस्य निरोधनम् ।
These complications depends upon the site (of the abscess etc) such as; hiccup if the abscess is near the umbilicus; difficult and foul smelling urine if the abscess is in the bladder; yspnoea, if in the liver; obstruction to expiration, if in the spleen; thirst and obstruction of the throat if in the Kloma (pancreas) catching pain (or rigidity) all over the body, profound delusion, darkness (unconsciousness), difficulty in breathing , friction and pain in the heart manifest if the abscess is in the heart; pain in the abdomen (upper region), flanks and shoulders, gurgling noise in the epigastrium appear if it is in the epigasrtium; stiffness of the thighs, if it is in the groins; catching pain in the waist and back, pain in the flanks if it is in the kidneys; obstruction of flatus if it is in the rectum.

Expulsion of abscess contents in relation to their location with respect to umbilicus

आमपक्वविदग्धत्वं तेषां शोफवदादिशेत् ॥ १६ ॥
नाभेरूर्ध्वं मुखात्पक्वाः प्रस्रवन्त्यधरे गुदात् ।
गुदास्यान्नाभिजो विद्याद्दोषं क्लेदाच्च विद्रधौ ॥ १७ ॥
यथास्वं व्रणवत्
The unripe, Ripening and Ripened Stages are similar to those of sopha (inflammatory edema). After ripening, the abscesses localized above the umbilicus expel their contents (pus, blood etc) through the mouth, those localized below the umbilicus, though the rectum.Those localized in the umbilicus expel their contents through both rectum and mouth. The features of the doshas and of the exudates in abscesses should be understood as similar to those of an ulcer (organic ulcer and not traumatic wound).

Sadhyasadhyata (prognosis)

तत्र विवर्ज्यः सन्निपातजः ।
पक्वो हृन्नाभिबस्तिस्थो भिन्नोऽन्तर्बहिरेव वा ॥ १८ ॥
पक्वश्चान्तः स्रवन् वक्त्रात् क्षीणस्योपद्रवाऽन्वितः ।
Those produced by all the doshas together; those located in the heart, umbilicus and urinary bladder, which have burst after ripening either inside or outside; those which have ripened / burst inside and have expelled their contents through their opening; those arising in debilitated persons, those having complications/ secondary diseases should be rejected.

Sthana Vidradhi (Breast Abscess)

एवमेव स्तनसिरा विवृताः प्राप्य योषिताम् ॥ १९ ॥
सूतानां गर्भिणीनां वा सम्भवेच्छ्वयथुर्घनः ।
स्तने सदुग्धेऽदुग्धे वा बाह्यविद्रधिलक्षणः ॥ २० ॥
नाडीनां सूक्ष्मवक्त्रत्वात् कन्यानां न स जायते ।
In the same way (the doshas) invading the open channels of the breasts in women, in women in post partum period or or pregnant produce a hard swelling in the breasts. Having the features of an external abscess; when the breasts are either having milk or not; this is Stana Vidradhi (breast abscess), it does not happen in virgins (girls who have not menstruated) because the mouths of the breast channels are minute. Thus ends the diagnosis of Vidradhi (abscess).

Vriddhi Nidana (Diagnosis of enlargement of scrotum)

क्रुद्धो रुद्धगतिर्वायुः शोफशूलकरश्चरन् ॥ २१ ॥
मुष्कौ वङ्क्षणतः प्राप्य फलकोशाभिवाहिनीः ।
प्रपीड्य धमनीर्वृद्धिं करोति फलकोशयोः ॥ २२ ॥
दोषास्रमेदोमूत्रान्त्रैः स वृद्धिः सप्तधा गदः ।
मूत्रान्त्रजावप्यनिलाद्धेतुभेदस्तु केवलम् ॥ २३ ॥
Vata getting aggravated from obstruction of its movements, begins to move from the groins to the scrotum, producing swelling and pain, on reaching the vessels of the scrotum followed by pulling down of the dhamani (blood vessels) going into vessels inside the scrotum causes Vrddhi (enlargement) of the scrotum vriddhi is of seven kinds-viz from each of the dosha separately , by blood, by fat, by urine and by the intestines; those by urine and intestine are (actually) caused by vata itself but are designated differently (to denote the organs involved).

Rupa (Clinical features)

वातपूर्णदृतिस्पर्शो रूक्षो वातादहेतुरुक् ।
पक्वोदुम्बरसङ्काशः पित्ताद्दाहोष्मपाकवान् ॥ २४ ॥
कफाच्छीतो गुरुः स्निग्धः कण्डूमान् कठिनोऽल्परुक् ।
कृष्णस्फोटावृतः पित्तवृद्धिलिङ्गश्च रक्ततः ॥ २५ ॥
कफवन्मेदसा वृद्धिर्मृदुस्तालफलोपमः ।
In that (swelling of the scrotum) caused by vata, the (scrotum) resembles a leather bag filled with air for touch, is dry and painful without any other reason in that caused by pitta ( the scrotum) resembles a ripe fruits of udumbara (brownish red in color and small) and has burning sensation, heat and suppuration; in Vruddhi caused by kapha (the scrotum) is cold, heavy, unctuous, itching, hard and with slight pain; in Vruddhi caused by blood, scrotum is studded with black eruptions (boils) and has the symptoms of increase of pitta; in that caused by fat the swelling of scrotum is soft and resembles a ripe fruit of tala – Borassus flabellifer (blakish- blue) in color and big in size and has symptoms of kapha swelling.

Mutraja Vrddhi (Hydrocele)

मूत्रधारणशीलस्य मूत्रजः स तु गच्छतः ॥ २६ ॥
अम्भोभिः पूर्णदृतिवत्क्षोभं याति सरुङ्मृदुः ।
मूत्रकृच्छ्रमधस्ताच्च वलयं फलकोशयोः ॥ २७ ॥
Vrddhi (scrotal enlargement) caused by urine happens in persons who suppress the urge of urine habitually, the scrotum resembles a leather bag filled with water,
producing irritation; is painful and soft, accompanied with difficult urination and creating round rings underneath the scrotum.

Antraja Vrddhi (Hernia)

वातकोपिभिराहारैः शीततोयावगाहनैः ।
धारणेरणभाराध्वविषमाङ्गप्रवर्तनैः ॥ २८ ॥
क्षोभणैः क्षुभितोऽन्यैश्च क्षुद्रान्त्रावयवं यदा ।
पवनो विगुणीकृत्य स्वनिवेशादधो नयेत् ॥ २९ ॥
कुर्याद्वङ्क्षणसन्धिस्थो ग्रन्थ्याभं श्वयथुं तदा |
उपेक्ष्यमाणस्य च मुष्कवृद्धिमाध्मानरुक्स्तम्भवतीं स वायुः |
प्रपीडितोऽन्तः स्वनवान् प्रयाति प्रध्मापयन्नेति पुनश्च मुक्तः ॥ ३० ॥
By indulgence in foods which cause increase of vata, immersing the body in cold water, suppression or premature initiation of the urges of the body, carrying heavy loads, walking long distance, improper movements of the body and such other acts, vata getting increased, when pulls down the vitiated small intestine from its place, then produces a tumor like swelling in the joining place of groin (inguinal hernia). By neglecting it, vata produces enlargement of the scrotum accompanied swelling (of the groin and of the scrotum), pain and stiffness, if pressed by the hand, it (intestine) goes inside (the abdomen)

accompanied with a sound and comes down again (into the scrotum) when released. This antravrddhi i.e. scrotal hernia is incurable It possesses symptoms similar to scrotal enlargement caused by vata,
Thus ends the diagnosis of vrddhi (scrotal enlargement).

Notes: The term ’vrddhi’ in its common use, earns an increase more than the usual. It may after to number, qualities etc, of substances.

 Increase in the size of the scrotum is named as vrddhi’ based on this meaning only, but term has somehow gained a technical sense, to stand for scrotal enlargement. Vrddhi is also called as Bradhna in mutraja vrddhi it is not urine that collects in the scrotum but it is a fluid secreted by the layers of the scrotum itself (hydrocele). Antraja vrddhi includes both inguinal and scrotal hernia. Hernia occurs at the umbilicus also especially in weak children (hiatus hernia)

अथ गुल्मनिदानम् ॥

Gulma Nidana (Diagnosis of abdominal tumors)

रूक्षकृष्णारुणसिरातन्तुजालगवाक्षितः ।
गुल्मोऽष्टधा पृथग्दोषैः संसृष्टैर्निचयं गतैः ॥ ३२ ॥
आर्तवस्य च दोषेण नारीणां जायतेऽष्टमः ।
Covered with network of dry blackish red threads of veins spread all over Gulma (tumors inside the abdomen) is of eight kinds viz, from each dosha separately, by the combination of any two of them, by the combination of all of them,the eighth in women only, due to disorders of artava (menstrual blood).

Gulma Nidana (Causes of abdominal tumors)

ज्वरच्छर्द्यतिसाराद्यैर्वमनाद्यैश्च कर्मभिः ॥ ३३ ॥
कर्शितो वातलान्यत्ति शीतं वाऽम्बु बुभुक्षितः ।
यः पिबत्यनु चान्नानि लङ्घनप्लवनादिकम् ॥ ३४ ॥
सेवते देहसङ्क्षोभिच्छर्दिं वा समुदीरयेत् ।
अनुदीर्णामुदीर्णान्वा वातादीन्न विमुञ्चति ॥ ३५ ॥
स्नेहस्वेदावनभ्यस्य शोधनं वा निषेवते ।
शुद्धो वाशु विदाहीनि भजते स्यन्दनानि वा ॥ ३६ ॥
वातोल्बणास्तस्य मलाः पृथक् क्रुद्धा द्विशोऽथवा ।
सर्वे वा रक्तयुक्ता वा महास्रोतोऽनुशायिनः ॥ ३७ ॥
ऊर्ध्वाधोमार्गमावृत्य कुर्वते शूलपूर्वकम् ।
स्पर्शोपलभ्यं गुल्माख्यमुत्प्लुतं ग्रन्थिरूपिणम् ॥ ३८ ॥
Person who has become weak by fever, vomiting, diarrhea etc. (other such debilitating diseases) or by therapies like emesis etc, when person eats foods which cause increase of vata, or drinks cold water when hungry or indulge in jumping, swimming, and such other strenuous activities immediately after food; or initiates the urge of vomiting which has not started or suppresses the urges of flatus etc. which are manifest; who resorts to purifactory therapies (emesis, purgation etc) without oleation and sudation therapies or soon after Panchakarma treatment, the person begins to consume foods that cause burning sensation or that causes more secretions (moisture), immediately after purification therapies (without following the diet schedule prescribed). By these causes, the malas (doshas) with the predominance of vata, undergo increases either separately, in combination of any two or all the three Doshas together or get vitiated along with blood, invade the alimentary tract, spread in both upward and downward paths, and give rise to a palpable, elevated hard nodular mass, preceded by pain in the abdomen; this is known as Gulma – Abdominal tumor.

Rupa (Clinical features)

Vataja Gulma: Gulma of vata origin

कर्शनात् कफविट्पित्तैर्मार्गस्यावरणेन वा ।
वायुः कृताश्रयः कोष्ठे रौक्ष्यात्काठिन्यमागतः ॥ ३९ ॥
स्वतन्त्रः स्वाश्रये दुष्टः परतन्त्रः पराश्रये ।
पिण्डितत्वादमूर्तोऽपि मूर्तत्वमिव संश्रितः ॥ ४० ॥
गुल्म इत्युच्यते बस्तिनाभिहृत्पार्श्वसंश्रयः ।
वातान्मन्याशिरःशूलं ज्वरप्लीहान्त्रकूजनम् ॥ ४१ ॥
व्यधः सूच्येव विट्सङ्गः कृच्छ्रादुच्छ्वसनं मुहुः ।
स्तम्भो गात्रे मुखे शोषः कार्श्यं विषमवह्निता ॥ ४२ ॥
रूक्षकृष्णत्वगादित्वं चलत्वादनिलस्य च ।
अनिरूपितसंस्थानस्थानवृद्धिक्षयव्यथः ॥ ४३ ॥
पिपीलिकाव्याप्त इव गुल्मः स्फुरति तुद्यते ।
Either by weakness (due to loss or depletion of tissues) or by obstruction of its passage by kapha, vit (faeces) or pitta, vata gets aggravated, localized in the alimentary tract, due to dryness, becomes hard If the mass develops in its own (of vata) seat, i.e. pakvasaya- large intestine, then the disease is primary / independent and if it develops in the seat of the other Doshas (pitta and kapha) then the disease is secondary / dependent. Though the mass is not having any shape, still it is considered to have a shape because of aggregation at one place and forming a bolus / elevation. (aggregated at one place) forming an elevation. Hence it is called gulma (tumor); it occupies the region of the urinary bladder, umbilicus, heart and the flanks. Due to Vata Dosha. The gulma is associated with pain in the sides of the neck, headache, fever enlargement of spleen gurgling sound in the intestines, pain as though being pricked by needles, constipation, frequent difficulty in breathing, rigidity of the body, dryness of the mouth, emaciation, irregular digestion,because of unsteadiness of Vata, there will be dryness and black discoloration of skin etc. (nails, eyes, urine, faeces). The tumor mass is undefined in shape, place, increase or decrease (in size) and nature of pain, there is feeling as though (the tumor) is being swarmed by ants; throbbing and cutting pain

Pitta Gulma: Gulma of pitta origin

पित्ताद्दाहोऽम्लको मूर्छाविड्भेदस्वेदतृड्ज्वराः ॥ ४४ ॥
हारिद्रत्वं त्वगाद्येषु गुल्मश्च स्पर्शनासहः ।
दूयते दीप्यते सोष्मा स्वस्थानं दहतीव च ॥ ४५ ॥
In gulma of pitta origin, there is (increased) burning sensation, sourness (acidity), episodes of unconsciousness, Diarrhea, Sweating, thirst, fever, yellow discoloration of skin etc; the tumour area will be tender has burning sensation, hotness and increased temperature as though burning its own site.

Kaphaja Gulma: Gulma of kapha origin

कफात्स्तैमित्यमरुचिः सदनं शिशिरज्वरः ।
पीनसालस्यहृल्लासकासशुक्लत्वगादिताः ॥ ४६ ॥
गुल्मोऽवगाढः कठिनो गुरुः सुप्तः स्थिरोऽल्परुक् ।
In gulma of kapha origin, there is stiffness, anorexia, weakness, fever associated with coldness, nasal catarrh, lassitude, nausea, cough, white discoloration of skin, paleness etc; the tumor is deep seated, hard, heavy, numb, lack of sensationstatic, stable and slightly painful.

Characteristics of doshaja gulma

स्वदोषस्थानधामानः स्वे स्वे काले च रुक्कराः ॥ ४७ ॥
प्राय:
Tumors arising from each dosha are found to develop generally in their own seats and produce pain at their on specific times

Characteristics of doshaja gulma

त्रयस्तु द्वन्द्वोत्था गुल्माः संसृष्टलक्षणाः ।
सर्वजस्तीव्ररुग्दाहः शीघ्रपाकी घनोन्नतः ॥ ४८ ॥
सोऽसाध्यो
The three kinds of gulma arising from the combination of two doshas, have mixed symptoms; Gulma arising from the combination of all the doshas has severe pain, burning sensation suppurates soon, hard and greatly elevated, this is incurable.

Rakta Gulma

रक्तगुल्मस्तु स्त्रिया एव प्रजायते ।
ऋतौ वा नवसूता वा यदि वा योनिरोगिणी ॥ ४९ ॥
सेवते वातलानि स्त्री क्रुद्धस्तस्याः समीरणः ।
निरुणद्ध्यार्तवं योन्यां प्रतिमासमवस्थितम् ॥ ५० ॥
कुक्षिं करोति तद्गर्भलिङ्गमाविष्करोति च ।
हृल्लासदौर्हृदस्तन्यदर्शनक्षामतादिकम् ॥ ५१ ॥
क्रमेण वायुसंसर्गात्पित्तयोनितया च तत् ।
शोणितं कुरुते तस्या वातपित्तोत्थगुल्मजान् ॥ ५२ ॥
रुक्स्तम्भदाहातीसारतृड्ज्वरादीनुपद्रवान् ।
गर्भाशये च सुतरां शूलं दुष्टासृगाश्रये ॥ ५३ ॥
योन्याश्च स्रावदौर्गन्ध्यतोदस्पन्दनवेदनाः ।
न चाङ्गैर्गर्भवद्गुल्मः स्फुरत्यपि तु शूलवान् ॥ ५४ ॥
पिण्डीभूतः स एवास्याः कदाचित्स्पन्दते चिरात्
न चास्या वर्धते कुक्षिर्गुल्म एव तु वर्धते ॥ ५५ ॥
Rakta Gulma – Abdominal tumor arising from blood occurs only in women. Women who during their menstrual period, or soon after delivery or who are having gynecological disorders, indulge in foods and activities which aggravate vata, in them Vata dosha gets aggravated, obstructs the artava (menstrual blood) coming out every month, within the yoni (uterus) and produces signs and symptoms of pregnancy inside the abdomen, such as nausea, longings that are common during pregnancy, appearance of breast milk, emaciation etc., gradually the rakta (blood tissue) due to association of Vata, and of pitta in the uterus, causes complications of vata-pittaja Gulma such as pain, stiffness, burning sensation, diarrhea, thirst, fever etc. severe pain in the uterus by accumulation of vitiated blood, per vaginalexudation, foul smell, tearing and pulsating pain in the vagina. The tumor moves inside the uterus like a foetus, without its parts (head , arms and legs), such movements being painful, because it is a gathered mass; it sometimes pulsates slowly, there is no growth of the abdomen (steadily as in pregnancy). But there is growth only of the tumor.

Notes: Rakta gulma is compared to different kinds of tumor and cysts developing in the uterus, ovaries or fallopian tubes.

Difference between Gulma and Vidradhi

स्वदोषसंश्रयो गुल्मः सर्वो भवति तेन सः ।
पाकं चिरेण भजते नैव वा विद्रधिः पुनः ॥ ५६ ॥
पच्यते शीघ्रमत्यर्थं दुष्टरक्ताश्रयत्वतः ।  
अतः शीघ्रविदाहित्वाद्विद्रधिः सोऽभिधीयते ॥ ५७ ॥
Gulma (tumors) have only the causative dosha as their base and supporting material and all gulmas are formed by these doshas, so they undergo suppuration after a long time, or not at all; whereas Vidhradhi (abscesses) undergoes suppuration quickly. Because their base (supporting material) is the highly vitiated blood. Because of their quickly suppuration, they are called as Vidradhi.

Gulma located outside and inside the alimentary tract

गुल्मेऽन्तराश्रये बस्तिकुक्षिहृत्प्लीहवेदनाः ।
अग्निवर्णबलभ्रंशो वेगानां चाप्रवर्तनम् ॥ ५८ ॥
अतो विपर्ययो बाह्ये कोष्ठाङ्गेषु तु नातिरुक् ।
वैवर्ण्यमवकाशस्य बहिरुन्नतताधिकम् ॥ ५९ ॥
Gulma (tumors) situated inside (the alimentary tract), produce pain in the regions of the urinary bladder, upper abdomen (epigastric region), heart and spleen; weak digestion strength, loss of color, complexion and strength, non appearance of the urges (non elimination of urine, feces, flatus etc); Gulma situated outside (the alimentary tract) and in the abdominal organs, produce opposite symptoms such as absence of severe pain, discoloration, greater outward growth, occupying wider space. Thus ends Gulma nidana.

Anaha (Bloating)

साटोपमत्युग्ररुजमाध्मानमुदरे भृशम् ।
ऊर्ध्वाधोवातरोधेन तमानाहं प्रचक्षते ॥ ६० ॥
Severe pain in the abdomen accompanied with gurgling noise, and profound enlargement of the abdomen, due to obstruction of the upward and downward movement of vata, it is seen as Anaha – bloating (flatulence).

Asthila and Pratyathila

घनोऽष्ठीलोपमो ग्रन्थिरष्ठीलोर्ध्वं समुन्नतः ।
आनाहलिङ्गस्तिर्यक् तु प्रत्यष्ठीला तदाकृतिः ॥ ६१ ॥
A hard tumor resembling a cobblers stone, elevated upwards, presenting symptoms of anaha is known as Asthila;if elevated sideward in same shape it is pratyasthila.

Tuni and Prathituni

पक्वाशयाद्गुदोपस्थं वायुस्तीव्ररुजः प्रयान् ।
तूणी प्रतूणी तु भवेत्स एवातो विपर्यये ॥ ६२ ॥
Vata produces severe pain, travelling from pakvasaya (large instance) to the Guda (rectum) and upastha (penis ) is known as Tuni; travelling in the revere direction (from rectum and penis) pain travelling to the large intestine is known as pratituni.

Gulma Purvarupa (Premonitory symptoms of tumors)

उद्गारबाहुल्यपुरीषबन्धतृप्त्यक्षमत्वान्त्रविकूजनानि ।
आटोपमाध्मानमपक्तिशक्तिमासन्नगुल्मस्य वदन्ति चिह्नम् ॥ ६३ ॥
Excessive belching, obstructions to elimination of feces, constipation, pathological feeling of contentment, intolerance, intestinal gurgling, movement of gas inside the intestines, flatulence, and poor digestion capacity are the premonitory symptoms of gulma (abdominal tumor).

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थाने विद्रधिवृद्धिगुल्मनिदानं नामैकादशोऽध्याय: । ।।११॥
Thus ends the chapter Vidradhi – abscess-vrddhi-gulma nidana the eleventh in Nidanasthana of astangahrdaya samhita composed by srimad Vaghata, son of Sri Vaidyapati Simhaguta.