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दाहशूलार्तिसङ्क्षोभस्वप्ननाशारतिज्वरैः। विदह्यमानं जानीयाद्गुल्मं तमुपनाहयेत् ॥४१॥
[Symptoms of suppurating (vidahamana) gulma] The gulma with symptoms of burning sensation, much pain, very much irritation and discomfort, loss of sleep and fever indicates that it is about to suppurate. In this condition upanaha (poultice) is indicated.
english translation
विदाहलक्षणे गुल्मे बहिस्तुङ्गे समुन्नते। श्यावे सरक्तपर्यन्ते संस्पर्शे बस्तिसन्निभे ॥४२॥
[Symptoms of suppurated gulma] If gulma protrudes pointing toward outside and skin over the lesion becomes stiff and numb and its color changes to dusky with red margins.
english translation
निपीडितोन्नते स्तब्धे सुप्ते [४] तत्पार्श्वपीडनात्। तत्रैव पिण्डिते शूले सम्पक्वं गुल्ममादिशेत् ॥४३॥
On palpation, the lump resembles as bladder filled with water, pitting on pressure, but on pressing from side the mass becomes tense with mild pain, otherwise it feels compressed mass with acute pain; all these signs and symptoms indicate that the gulma has suppurated
english translation
तत्र धान्वन्तरीयाणामधिकारः क्रियाविधौ। वैद्यानां कृतयोग्यानां व्यधशोधनरोपणे ॥४४॥
The suppurated gulma requires surgical intervention such as incision, cleansing and healing therefore it should be treated by a surgeon
english translation
अन्तर्भागस्य चाप्येतत् पच्यमानस्य लक्षणम्। हृत्क्रोडशूनताऽन्तःस्थे [५] बहिःस्थे पार्श्वनिर्गतिः ॥४५॥
The above mentioned symptoms also occur in suppurating (pachyamana) internal gulma. Only difference is that in the internal gulma there is swelling in cardiac region of the abdomen while exterior gulma protrudes towards sides of abdomen
english translation