Now I shall discuss the features which distinguish a Gulma (internal tumour from a Vidradhi (internal abscess). It may be asked, how is it that Gulma, (internal tumour) though caused by, and involving the co-operation of the same deranged Doshas as an internal abscess, does nut suppurate, while the latter (Vidradhi) does run to suppuration? 22 - 23. The answer is that a Gulma (internal tumour, though caused by the same deranged Doshas as a Vidradhi (internal abscess), does not resort to any deranged organic matter, such as flesh, blood, etc., while, on the contrary, in a case of Vidradhi, the diseased flesh and blood of a locality are in themselves transformed into an abscess. An internal tumour (Gulma) is like a - water bubble floating and moving about within a cavity of the body etc. without any fixed root of its own. Hence, it is that a Gulma (internal tumour) does not suppurate at all. Suppuration sets in in an abscess only because it largely contains flesh and blood unlike a Gulma (internal tumour) which is not formed of any such organic matter, and depends only on the aggravated Doshas giving birth to it. Hence, a Gulma does not suppurate at all. 24.
* A Gulma according to Sus'ruta does not suppurate, but the term "Api" (also) contemplates instances in which a Gulma may suppurate as in the case where it has got its basis in the deranged flesh etc. of the locality. Charaka asserts that retarded digestion of the ingested food followed by digestionary acid reaction, colic pain, insomnia with lever and a non-relish for food and a sense of oppression, etc. are the symptoms which indicate that suppuration has set in a Gulma, and he advises that it (Gulma) should be treated with poultices, etc.
A case of an internal abscess suppurating about the heart, bladder or umbilicus as well as one of the Tridosha type (appearing in any part of the organism) should be given up as incurable. The abscess in which the marrow suppurates (generally) becomes fatal. The suppurating process in an internal abscess, which generally affects the underlying bone, is sometimes found to affect the marrow. The suppurated marrow, failing to find an outlet on account of the compactness of the local flesh and bone, produces a sort of burning sensation in the locality which consumes the body like a blazing fire. The disease confined to the bone, like a piercing dirt, torments the patient for a considerable length of time. An incision (made into the affected bone) is followed by the secretion of a fat-like, glossy, white, cold and thick pus. Men, learned in the knowledge of the Medicinal Sástras, designate such an abscess as an Asthigháta-Vidradhi (abscess of the bone) which involves all the three kinds of deranged Doshas, and is attended with various kinds of pain which mark them respectively. 25-26.
Thus ends the ninth Chapter of the Nidánasthánam in the Sus'ruta Samhitá which treats of the aetiology of abscess.