Changes

The exogenous factors produce sudden swellings most of the time while endogenous swellings mostly occur gradually. Any type of trauma, direct or indirect, will produce a swelling first.  Some plants contain allergens which may cause allergic reactions such as severe itching. Scorpion, wasp, honey bee, spider stings or their touch can cause inflammatory reaction including edema. Excessive cold air or prolonged contact with ice may cause frostbite like symptoms and swelling causes weakness of the affected organ resembling a paralytic disorder. [4]

The exogenous factors produce sudden swellings most of the time while endogenous swellings mostly occur gradually. Any type of trauma, direct or indirect, will produce a swelling first.  Some plants contain allergens which may cause allergic reactions such as severe itching. Scorpion, wasp, honey bee, spider stings or their touch can cause inflammatory reaction including edema. Excessive cold air or prolonged contact with ice may cause frostbite like symptoms and swelling causes weakness of the affected organ resembling a paralytic disorder. [4]

In chikitsa sthanam, few other causes, such as the people who never do any physical activity, neither they adopt internal purification e.g. vamana, virechana etc., nor they take external purification by means of bath; may develop shotha (Ca.chi. 12/6). Some other etiological factors e.g. intake of kata-sharkara i.e. burned sugar and lime, practice of sexual intercourse during indigestion or travelling by vehicles with jerky movements may also produce shotha [Su. Chi. 23/4]. Few other causes of nija shotha described are sleeping during the day and working at night, and intake of dry and domestic animal meat in diet [A.H. Ni. 13/26]. During bio-purification procedures there is a loss of some body contents. When procedures are optimally performed then only unwanted materials are lost, but if the procedures are improperly administered, then certain amount of necessary body contents may also get removed which may result in many diseases. Besides, some nutrients may not get absorbed or metabolized properly. Due to these reasons deficiency of proteins, iron and other nutrients may occur causing edema in the long term. Similar pathology is found in many chronic disorders due to malnutrition, few of which are mentioned here. Violation of dietary rules is responsible for many shotha disorders. Eating of clay and pieces of earthen pots may cause worm infestations, thereby causing anemia or malnutrition, and in due course of time will result in edema2. Excessive use of salt will result in sodium retention and edema3. Lastly, recurrent abortions, miscarriages, intra-uterine death, and ante-natal problems may cause anemia and hypo-proteinaemia resulting in edema.  

In [[Chikitsa Sthana]], few other causes, such as the people who never do any physical activity, neither they adopt internal purification e.g. ''vamana, virechana'' etc., nor they take external purification by means of bath; may develop ''shotha'' (Ca.chi. 12/6). Some other etiological factors e.g. intake of ''kata-sharkara'' i.e. burned sugar and lime, practice of sexual intercourse during indigestion or travelling by vehicles with jerky movements may also produce ''shotha'' [Su. Chi. 23/4]. Few other causes of ''nija shotha'' described are sleeping during the day and working at night, and intake of dry and domestic animal meat in diet [A.H. Ni. 13/26]. During bio-purification procedures there is a loss of some body contents. When procedures are optimally performed then only unwanted materials are lost, but if the procedures are improperly administered, then certain amount of necessary body contents may also get removed which may result in many diseases. Besides, some nutrients may not get absorbed or metabolized properly. Due to these reasons deficiency of proteins, iron and other nutrients may occur causing edema in the long term. Similar pathology is found in many chronic disorders due to malnutrition, few of which are mentioned here. Violation of dietary rules is responsible for many ''shotha'' disorders. Eating of clay and pieces of earthen pots may cause worm infestations, thereby causing anemia or malnutrition, and in due course of time will result in edema 2. Excessive use of salt will result in sodium retention and edema 3. Lastly, recurrent abortions, miscarriages, intra-uterine death, and ante-natal problems may cause anemia and hypo-proteinaemia resulting in edema.  

 

 

Character/dosha vata dominance pitta dominance kapha dominance

Character/dosha vata dominance pitta dominance kapha dominance

Duration Quick onset and regression Quick onset and regression Slow onset and difficult regression  

Duration Quick onset and regression Quick onset and regression Slow onset and difficult regression  

Pacifying Hot and unctuous massage -- --

Pacifying Hot and unctuous massage -- --

Types of shotha, location:

==== Types of ''shotha'' and their location/site ====

The appearance of vātaja shotha can be correlated with the increased hydrostatic pressure mechanism of edema. The features are similar to edema caused by cardiac diseases where congestion is a major cause of increased hydrostatic pressure in vessels5. Through the day, due to gravity, water goes down the body and gets retained in lower limbs causing edema in the evening hours. During night (i.e., at rest), the retained water redistributes and the edema subsides. Edema of cardiac origin is pitting in type, similar to vataja shotha.  

The appearance of ''vātaja shotha'' can be correlated with the increased hydrostatic pressure mechanism of edema. The features are similar to edema caused by cardiac diseases where congestion is a major cause of increased hydrostatic pressure in vessels5. Through the day, due to gravity, water goes down the body and gets retained in lower limbs causing edema in the evening hours. During night (i.e., at rest), the retained water redistributes and the edema subsides. Edema of cardiac origin is pitting in type, similar to vataja shotha.  

Kaphaja shotha, on the other hand, could be due to hypoproteinaemia in liver diseases or due to proteinuria in renal diseases6. In renal edema, swelling is typically facial and manifests early in the morning.  Sometimes these swellings are too hard, as found in cases of malignancies or tumors. The swellings of paittika/pittaja type are mostly inflammatory in nature.  [9-15]

Kaphaja shotha, on the other hand, could be due to hypoproteinaemia in liver diseases or due to proteinuria in renal diseases6. In renal edema, swelling is typically facial and manifests early in the morning.  Sometimes these swellings are too hard, as found in cases of malignancies or tumors. The swellings of paittika/pittaja type are mostly inflammatory in nature.  [9-15]

Distribution of shotha and prognosis:

 

==== Distribution of ''shotha'' and prognosis ====

 

kapha dosha are typically found in upper body parts, pitta in middle body parts and vata in lower body parts. Doshas situated in amashaya (stomach) cause shotha in the upper body, those situated in pakwashaya (large bowel) cause shotha in the middle body and those situated in malashaya (rectum) cause shotha in the lower body parts, whereas more than one dosha leads to shotha in the whole body [Su.chi.23/6]. Shotha in the middle body parts and generalized edema are difficult to cure. A shotha that has spread across half of the body is invariably fatal and a shotha that spreads upward from the lower parts (or from the top towards lower body parts) is incurable [Su.chi. 23/7-8]. Swellings of flanks, abdomen, throat and vital parts are incurable. Excessively bulky and rough swellings are also incurable. Swellings in children, old people and very weak patients are incurable (Ma.ni.-36/20). [16-17]

kapha dosha are typically found in upper body parts, pitta in middle body parts and vata in lower body parts. Doshas situated in amashaya (stomach) cause shotha in the upper body, those situated in pakwashaya (large bowel) cause shotha in the middle body and those situated in malashaya (rectum) cause shotha in the lower body parts, whereas more than one dosha leads to shotha in the whole body [Su.chi.23/6]. Shotha in the middle body parts and generalized edema are difficult to cure. A shotha that has spread across half of the body is invariably fatal and a shotha that spreads upward from the lower parts (or from the top towards lower body parts) is incurable [Su.chi. 23/7-8]. Swellings of flanks, abdomen, throat and vital parts are incurable. Excessively bulky and rough swellings are also incurable. Swellings in children, old people and very weak patients are incurable (Ma.ni.-36/20). [16-17]

Complications:

 

==== Complications ====

 

Improper treatment or care of any existing edema-causing disease can lead to upadravas, or complications caused due to obstruction caused by accumulated fluid in the interstitial spaces leading to improper circulation. This hampers the normal movement of vata leading to various complications.  

Improper treatment or care of any existing edema-causing disease can lead to upadravas, or complications caused due to obstruction caused by accumulated fluid in the interstitial spaces leading to improper circulation. This hampers the normal movement of vata leading to various complications.  

If we consider modern etiopathogenesis of edema, then it is clear that all the complications described here are consequences of either edema or its associated disease. For example, hypertension is an etiological factor for heart and renal failure which are common causes of edema. Sometimes, pulmonary edema develops due to many reasons resulting in dyspnea. Anorexia may be due to hepatic pathology itself or may be due to congestion (as in the case of congestive heart failure)7. Excessive thirst may be due to induced or spontaneous diuresis leading to dehydration. Pyrexia, diarrhea and weakness can develop because of associated infections or other systemic ailments. [18]

If we consider modern etiopathogenesis of edema, then it is clear that all the complications described here are consequences of either edema or its associated disease. For example, hypertension is an etiological factor for heart and renal failure which are common causes of edema. Sometimes, pulmonary edema develops due to many reasons resulting in dyspnea. Anorexia may be due to hepatic pathology itself or may be due to congestion (as in the case of congestive heart failure)7. Excessive thirst may be due to induced or spontaneous diuresis leading to dehydration. Pyrexia, diarrhea and weakness can develop because of associated infections or other systemic ailments. [18]

Various locations of shotha:

 

==== Various locations of ''shotha'' ====

 

Sushruta described galashundi as kanthashundi, a condition indicated by breathlessness, coughing and thirst. He mentioned the role of rakta along with kapha in causing the condition. (Su.ni.-16/41). Visarpa is a kind of inflammatory swelling mostly caused due to infection. In the context of kshudra rogas (curable diseases), tilaka (mole) is black in color, similar to size of sesame seed, painless and is flat (Su.ni.-13/43). Similarly vyanga (pigmentation) as painless, fine, black color circles (Su.ni.-13/45,46). Same manifestation over the face or other body parts is called nilika (Su.ni.-13/46). In addition to pitta, Sushruta has mentioned involvement of vata, kapha and rakta in the affliction of shankhaka roga (saggital sinus thrombosis/intracranial growth/temporal arteritis) (Su.ut.-25/16-18). In Madhava Nidanam it is described as a very severe and fatal condition that, by causing blockages in the head and throat, can kill the patient in three days [Ma.ni.-60/15].  Karnamoola shotha (swelling at base of ear/parotitis) has been described as a complication of sannipataja jwara (Ca.chi.-3/287). Pliha vriddhi (splenomegaly) has been described as plīhodara (Ca.chi.-13/35-38). Sushruta has described plihodara, due to intake of irritant and slimy food items, as a cause for aggravation of rakta and kapha. Gulma is a very special disease class described in Ayurveda, because it is neither mentioned independently in modern medicine nor it can be correlated with any disease. The problems or symptoms described in reference to gulma are practically found in clinical practice therefore it should be considered exclusively(Ca.chi.-5 & ch.ni.-3). In Aanaha (distension of abdomen), not only is the movement of vata hampered but the vitiated vata also dries the stool. Therefore, the patient of aanaha complains of constipation along with flatulence. Two causes of aanaha are: impaired peristalsis of the stomach and that of the large bowel (Su.utt.-57/20-22). Vriddhi roga (hydrocele and hernia) has been described to be of seven types i.e. vataja, pittaja, kaphaja, raktaja, medoja, mutraja and antraja. (A.H.Ni.-11/21-31). The antraja vriddhi may be correlated with swelling of the hernia and is said to be incurable. Sushruta has described five types of rohini (diptheria) i.e. vataja, pittaja, kaphaja, raktaja and sannipataja  (Su.ni.-16/47-50).

Sushruta described galashundi as kanthashundi, a condition indicated by breathlessness, coughing and thirst. He mentioned the role of rakta along with kapha in causing the condition. (Su.ni.-16/41). Visarpa is a kind of inflammatory swelling mostly caused due to infection. In the context of kshudra rogas (curable diseases), tilaka (mole) is black in color, similar to size of sesame seed, painless and is flat (Su.ni.-13/43). Similarly vyanga (pigmentation) as painless, fine, black color circles (Su.ni.-13/45,46). Same manifestation over the face or other body parts is called nilika (Su.ni.-13/46). In addition to pitta, Sushruta has mentioned involvement of vata, kapha and rakta in the affliction of shankhaka roga (saggital sinus thrombosis/intracranial growth/temporal arteritis) (Su.ut.-25/16-18). In Madhava Nidanam it is described as a very severe and fatal condition that, by causing blockages in the head and throat, can kill the patient in three days [Ma.ni.-60/15].  Karnamoola shotha (swelling at base of ear/parotitis) has been described as a complication of sannipataja jwara (Ca.chi.-3/287). Pliha vriddhi (splenomegaly) has been described as plīhodara (Ca.chi.-13/35-38). Sushruta has described plihodara, due to intake of irritant and slimy food items, as a cause for aggravation of rakta and kapha. Gulma is a very special disease class described in Ayurveda, because it is neither mentioned independently in modern medicine nor it can be correlated with any disease. The problems or symptoms described in reference to gulma are practically found in clinical practice therefore it should be considered exclusively(Ca.chi.-5 & ch.ni.-3). In Aanaha (distension of abdomen), not only is the movement of vata hampered but the vitiated vata also dries the stool. Therefore, the patient of aanaha complains of constipation along with flatulence. Two causes of aanaha are: impaired peristalsis of the stomach and that of the large bowel (Su.utt.-57/20-22). Vriddhi roga (hydrocele and hernia) has been described to be of seven types i.e. vataja, pittaja, kaphaja, raktaja, medoja, mutraja and antraja. (A.H.Ni.-11/21-31). The antraja vriddhi may be correlated with swelling of the hernia and is said to be incurable. Sushruta has described five types of rohini (diptheria) i.e. vataja, pittaja, kaphaja, raktaja and sannipataja  (Su.ni.-16/47-50).

Upajihvika, galashundika, galagraha, rohini, are basically infectious disorders affecting the mouth and throat area. Galaganda closely resembles goitre which is caused due to thyroid disorders. Visarpa and pidika are caused due to skin infections, whereas tilaka, piplu, vyanga and nilika are the problems present in skin due melanin pigment disorders. Pliha vridhi or spleenomegaly is condition where spleen gets enlarged due to many reasons such as infections, hematological disorders, malignancies etc. Gulma, udara roga, aanaha are diseases mainly located and related to gastrointestinal tract, having main features of fullness or protuberance. Eight udara rogas described in Ayurveda are actually diseases present as protuberances in abdomen. But all udara rogas are not directly related to the gastrointestinal tract e.g. plihodara (splenomegaly), yakradaludara (hepatomegaly), and jalodara (ascites). Still their manifestation is similar to shotha i.e. swellings. Swelling at the roots of ears, commonly known as Karnamool shotha (Parotitis), is mostly due to viral infections. Vriddhi roga is a kind of hernia, i.e., inguinal, femoral, umbilical or incision hernia with visible swelling. Adhimansa (increased muscles bulk) and arbuda(tumor) are swellings associated with extra or new growth that could be benign or malignant. Rohini can be closely correlated with diphtheria which is caused by a bacterial infection i.e. Corynibacterium diphtheriae8. It can affect many sites in the body but most commonly the throat where if not treated properly may cause death due to suffocation or asphyxia. [19-36]

Upajihvika, galashundika, galagraha, rohini, are basically infectious disorders affecting the mouth and throat area. Galaganda closely resembles goitre which is caused due to thyroid disorders. Visarpa and pidika are caused due to skin infections, whereas tilaka, piplu, vyanga and nilika are the problems present in skin due melanin pigment disorders. Pliha vridhi or spleenomegaly is condition where spleen gets enlarged due to many reasons such as infections, hematological disorders, malignancies etc. Gulma, udara roga, aanaha are diseases mainly located and related to gastrointestinal tract, having main features of fullness or protuberance. Eight udara rogas described in Ayurveda are actually diseases present as protuberances in abdomen. But all udara rogas are not directly related to the gastrointestinal tract e.g. plihodara (splenomegaly), yakradaludara (hepatomegaly), and jalodara (ascites). Still their manifestation is similar to shotha i.e. swellings. Swelling at the roots of ears, commonly known as Karnamool shotha (Parotitis), is mostly due to viral infections. Vriddhi roga is a kind of hernia, i.e., inguinal, femoral, umbilical or incision hernia with visible swelling. Adhimansa (increased muscles bulk) and arbuda(tumor) are swellings associated with extra or new growth that could be benign or malignant. Rohini can be closely correlated with diphtheria which is caused by a bacterial infection i.e. Corynibacterium diphtheriae8. It can affect many sites in the body but most commonly the throat where if not treated properly may cause death due to suffocation or asphyxia. [19-36]

Dosha and disease:

 

Over the years, as a result of changes in lifestyle, multiple etiological factors, and decreased body resistance, new diseases are appearing. Therefore, naming all the diseases is a problem that all branches of medical sciences face. In modern medicine where the cause of a disease is not very clear, symptom-based or descriptive diagnosis is given to various conditions, e.g.,  APD (Acid Peptic Diseases) is the term given to problems having symptoms of hyperacidity, pain in the abdomen, indigestion etc. Similarly, NUD (Non Ulcer Dyspepsia) term is applied to the symptoms of indigestion without pain. CAD (Coronary Artery Disease), CHD (Congenital Heart Disease), CVA (Cerebro- Vascular Accidents), COPD (Chronic Obstructive Pulmonary Disease), HE (Hepatic-encephalopaty), Renal parenchymal disease, Coagulopathies, Myopathies, Neuropathies, etc. are a few other examples of grouping various ailments by their symptoms. In a similar manner, certain Ayurvedic conditions have been grouped into Twak vikara (skin disorders), Udara vikara, Mutra vikara, Mano vikara, vāta vikara, pitta vikara, kapha vikara etc. and an appropriate course of treatment is administered after understanding the possible etiopathogenesis. [44-47]  

==== ''Dosha'' and disease ====

 

Over the years, as a result of changes in lifestyle, multiple etiological factors, and decreased body resistance, new diseases are appearing. Therefore, naming all the diseases is a problem that all branches of medical sciences face. In modern medicine where the cause of a disease is not very clear, symptom-based or descriptive diagnosis is given to various conditions, e.g.,  APD (Acid Peptic Diseases) is the term given to problems having symptoms of hyperacidity, pain in the abdomen, indigestion etc. Similarly, NUD (Non Ulcer Dyspepsia) term is applied to the symptoms of indigestion without pain. CAD (Coronary Artery Disease), CHD (Congenital Heart Disease), CVA (Cerebro- Vascular Accidents), COPD (Chronic Obstructive Pulmonary Disease), HE (Hepatic-encephalopaty), Renal parenchymal disease, Coagulopathies, Myopathies, Neuropathies, etc. are a few other examples of grouping various ailments by their symptoms. In a similar manner, certain Ayurvedic conditions have been grouped into Twak vikara (skin disorders), Udara vikara, Mutra vikara, Mano vikara, vāta vikara, pitta vikara, kapha vikara etc. and an appropriate course of treatment is administered after understanding the possible etiopathogenesis. [44-47]

If we analyze doshas, then we observe that all solid and watery contents of our body are made up of kapha. Most enzymes, digestive functions and all warmth in body can be attributed to pitta. And all types of micro or macro-movements in our bodies are performed by vata. Therefore, our body and the associated constituents and life-processes could be attributed to the three doshas, along with body tissues (dhatus), and secretions (mala). In all circumstances, doshas, dhatus and malas play an important role and are considered as roots of the body [A.H.Ni. 11/1]. [48]

If we analyze doshas, then we observe that all solid and watery contents of our body are made up of kapha. Most enzymes, digestive functions and all warmth in body can be attributed to pitta. And all types of micro or macro-movements in our bodies are performed by vata. Therefore, our body and the associated constituents and life-processes could be attributed to the three doshas, along with body tissues (dhatus), and secretions (mala). In all circumstances, doshas, dhatus and malas play an important role and are considered as roots of the body [A.H.Ni. 11/1]. [48]

vata, pitta and kapha are further sub-categorized into five types of each. They all have their specific sites in the body and specific functions applicable to those sites. (Sha.Pu.Kh. 5/27-35). Specific sites of these doshas are mentioned in (Ca.Su. 20/8). [49-51]

vata, pitta and kapha are further sub-categorized into five types of each. They all have their specific sites in the body and specific functions applicable to those sites. (Sha.Pu.Kh. 5/27-35). Specific sites of these doshas are mentioned in (Ca.Su. 20/8). [49-51]

Many functions and gunas of doshas are mostly interrelated (especially opposite to each other). For instance, vata and kapha properties are mostly opposite to pitta properties. Therefore, their functions increase or decrease in inverse relation to each other. [52]

Many functions and gunas of doshas are mostly interrelated (especially opposite to each other). For instance, vata and kapha properties are mostly opposite to pitta properties. Therefore, their functions increase or decrease in inverse relation to each other. [52]

Typical functions of aggravated dosha are described such as emaciation, blackening, willingness of warm things, tremors, flatulence, constipation, impaired body power, insomnia, incapability of grasping objects by sense organs, delirium, vertigo and lustlessness are functions or presentations of aggravated vata. Yellowish discoloration of stool, urine, nails and skin, reduction in appetite, thirst, burning and sleep are due to aggravated pitta, whereas anorexia, excessive salivation, laziness, heaviness, white discoloration of body, coldness and loss of muscle tone, increase in breathlessness, coughing and sleep are due to aggravated kapha [A.H.Su. 11/5-7]. [53]  

Typical functions of aggravated dosha are described such as emaciation, blackening, willingness of warm things, tremors, flatulence, constipation, impaired body power, insomnia, incapability of grasping objects by sense organs, delirium, vertigo and lustlessness are functions or presentations of aggravated vata. Yellowish discoloration of stool, urine, nails and skin, reduction in appetite, thirst, burning and sleep are due to aggravated pitta, whereas anorexia, excessive salivation, laziness, heaviness, white discoloration of body, coldness and loss of muscle tone, increase in breathlessness, coughing and sleep are due to aggravated kapha [A.H.Su. 11/5-7]. [53]

=== References ===

=== References ===