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Line 32: − === Introduction ===+ Line 39:
Line 39: − === Sanskrit text, Transliteration and English Translation ===+ Line 56:
Line 56: − + − ==== Three types of ''shotha'' ====+ Line 71:
Line 71: − ==== Causes of exogenous swelling ====+ Line 88:
Line 88: − ==== Diagnosis and treatment of exogenous swelling ====+ Line 101:
Line 101: − ==== General causes of endogenous swellings ====+ Line 122:
Line 122: − ==== Specific causes of swelling due to ''dosha'' dominance ==== + − ===== Swelling due to ''vata'' dominance =====+ Line 138:
Line 138: − ===== Swelling due to ''pitta'' dominance =====+ Line 152:
Line 152: − ===== Swelling due to ''kapha'' dominance =====+ Line 166:
Line 166: − ===== Different types due to involvement of more than one ''dosha'' =====+ Line 181:
Line 181: − ==== Various types of ''shotha'' and cardinal sign ====+ Line 194:
Line 194: − ==== Brief description of specific features ====+ Line 265:
Line 265: − ===== Specific features of ''vataja, pittaja'' and ''kaphaja'' swellings =====+ Line 276:
Line 276: − ==== Prognosis ====+ Line 301:
Line 301: − ==== Complications of ''shotha'' ====+ Line 317:
Line 317: − ==== Different types of swelling at specific sites ====+ − ===== ''Upajivhika'' =====+ Line 334:
Line 334: − ===== ''Galashundika'' =====+ Line 350:
Line 350: − ===== ''Galaganda'' =====+ Line 366:
Line 366: − ===== ''Galagraha'' =====+ Line 382:
Line 382: − ===== ''Visarpa'' =====+ Line 398:
Line 398: − ===== ''Pidika'' =====+ Line 414:
Line 414: − ===== ''Tilaka-pipplava-vyanga-neelika'' =====+ Line 430:
Line 430: − ===== ''Shankhaka'' =====+ Line 446:
Line 446: − ===== ''Karnamulika shotha'' (swelling at base of ears) =====+ Line 462:
Line 462: − ===== ''Pliha'' (splenomegaly) =====+ Line 478:
Line 478: − ===== ''Gulma'' (abdominal lumps) =====+ Line 494:
Line 494: − ===== ''Vriddhi'' (scrotum enlargement) =====+ Line 510:
Line 510: − ===== Udara (abdominal diseases) =====+ Line 526:
Line 526: − ===== ''Anaha'' (obstruction in abdomen) =====+ Line 542:
Line 542: − ===== Tumors =====+ Line 558:
Line 558: − ===== ''Rohini'' (diphtheria) =====+ Line 594:
Line 594: − ==== Prognosis of diseases ====+ Line 648:
Line 648: − ==== Criteria for classification of diseases ====+ Line 673:
Line 673: − ==== Identification of new diseases ====+ Line 716:
Line 716: − ==== Discussion on ''dosha'' ====+ Line 732:
Line 732: − ===== Functions of normal ''vata dosha'' =====+ Line 748:
Line 748: − ===== Functions of normal ''pitta dosha'' =====+ Line 764:
Line 764: − ===== Functions of normal ''kapha dosha'' =====+ Line 780:
Line 780: − ===== Diagnosis of abnormal state of ''dosha'' =====+ Line 810:
Line 810: − ==== Summary ====+ Line 841:
Line 841: − + Line 859:
Line 859: − + − ==== Classification of ''shotha'' (swelling/ distension) ====+ Line 870:
Line 870: − ==== Etiology of swelling ====+ Line 879:
Line 879: − ==== '''Table 1:Differential diagnosis of types of swelling''' ====+ Line 921:
Line 921: − ==== Types of ''shotha'' and their location/site ====+ − ==== Distribution of ''shotha'' and prognosis ====+ − ==== Complications ====+ Line 936:
Line 936: − ==== Various locations of ''shotha'' ====+ Line 944:
Line 944: − ==== ''Dosha'' and disease ====+ Line 957:
Line 957: − === Related Chapter ===+ − === References ===+
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== Introduction ==
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In the previous chapter, diseases of vital organs like head, heart, and the urinary system, signs of ''dhatu kshaya'' (depletion of ''dhatu'') and ''pidika'' (papules) with signs of swellings were described. This chapter deals with the etiology and symptomatology of endogenous and exogenous as well as local and generalized swellings and distensions. The name of the chapter denotes three types of swellings but later in the text, these swellings are classified into various types based upon several etiopathological factors and location. This chapter is important from the standpoint of diagnostics as it describes the main causes of all diseases that can be endogenous (innate origin) and exogenous (external agents). Some of the causative factors that can trigger non-infectious and infectious inflammations include traumatic injuries, contact with poisonous plants, animals, insect bites, animal bites, frost bite, and burns. The body’s reaction to invading micro-organisms, in terms of vitiation of ''dosha'', can be observed and appropriate course of action can be planned.
In the previous chapter, diseases of vital organs like head, heart, and the urinary system, signs of ''dhatu kshaya'' (depletion of ''dhatu'') and ''pidika'' (papules) with signs of swellings were described. This chapter deals with the etiology and symptomatology of endogenous and exogenous as well as local and generalized swellings and distensions. The name of the chapter denotes three types of swellings but later in the text, these swellings are classified into various types based upon several etiopathological factors and location. This chapter is important from the standpoint of diagnostics as it describes the main causes of all diseases that can be endogenous (innate origin) and exogenous (external agents). Some of the causative factors that can trigger non-infectious and infectious inflammations include traumatic injuries, contact with poisonous plants, animals, insect bites, animal bites, frost bite, and burns. The body’s reaction to invading micro-organisms, in terms of vitiation of ''dosha'', can be observed and appropriate course of action can be planned.
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== Sanskrit text, Transliteration and English Translation ==
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Now we will expound the chapter on three types of ''shotha'' i.e. swellings. Thus, said Lord Atreya. [1-2]
Now I will explain the chapter on 'Three types of swellings and other conditions'. Thus, said Lord Atreya. [1-2]
=== Three types of ''shotha'' ===
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There are three types of ''shothas'' (swelling) i.e. ''vataja, pittaja'' and ''kaphaja''. Further, they can be classified into two i.e. ''nija'' (endogenous) and ''agantuja'' (exogenous). [3]
There are three types of ''shothas'' (swelling) i.e. ''vataja, pittaja'' and ''kaphaja''. Further, they can be classified into two i.e. ''nija'' (endogenous) and ''agantuja'' (exogenous). [3]
=== Causes of exogenous swelling ===
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=== Diagnosis and treatment of exogenous swelling ===
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Exogenous swellings can be primarily identified by characteristic signs of injury and localization. After some time, they become similar to endogenous swellings (due to vitiation of ''dosha''). They are treated by bandage, ''mantra'' (holy chants), antidotes, local application of medicines, fomentation, cooling measures etc. [5]
Exogenous swellings can be primarily identified by characteristic signs of injury and localization. After some time, they become similar to endogenous swellings (due to vitiation of ''dosha''). They are treated by bandage, ''mantra'' (holy chants), antidotes, local application of medicines, fomentation, cooling measures etc. [5]
=== General causes of endogenous swellings ===
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=== Specific causes of swelling due to ''dosha'' dominance ===
==== Swelling due to ''vata'' dominance ====
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''Vata'' gets vitiated due to excess intake of ''sheeta'' (cold things), ''ruksha'' (rough or low calorie), ''laghu'' (very light), ''vishada'' (non-slimy substance) diets, ''shrama'' (excessive exertion), ''upavasa'' (excessive fasting), ''ati-karshan'' (emaciation), and ''kshapana'' (wasting). This vitiated ''vata'' gets into and stays within ''twak'' (skin), ''mamsa'' (muscle tissue), along with ''rakta'' (blood) and produces ''shotha'', i.e., swelling. This swelling increases as well as subsides quickly, black or reddish in color, fleeting, pulsating, with coarse skin, rough and broken hair. The person feels different types of pain sensation like ''chhidyati'' (excision), ''bhidyati'' (incision), ''suchibhiriva'' (piercing by needles/pricking), crawling of ants, irritation (as if pasted with mustard) and a feeling of contraction or expansion. These are some of the traits of swelling caused by ''vata''. [1]
''Vata'' gets vitiated due to excess intake of ''sheeta'' (cold things), ''ruksha'' (rough or low calorie), ''laghu'' (very light), ''vishada'' (non-slimy substance) diets, ''shrama'' (excessive exertion), ''upavasa'' (excessive fasting), ''ati-karshan'' (emaciation), and ''kshapana'' (wasting). This vitiated ''vata'' gets into and stays within ''twak'' (skin), ''mamsa'' (muscle tissue), along with ''rakta'' (blood) and produces ''shotha'', i.e., swelling. This swelling increases as well as subsides quickly, black or reddish in color, fleeting, pulsating, with coarse skin, rough and broken hair. The person feels different types of pain sensation like ''chhidyati'' (excision), ''bhidyati'' (incision), ''suchibhiriva'' (piercing by needles/pricking), crawling of ants, irritation (as if pasted with mustard) and a feeling of contraction or expansion. These are some of the traits of swelling caused by ''vata''. [1]
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==== Swelling due to ''pitta'' dominance ====
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''Pitta'' is vitiated due to excessive intake of hot, irritant, pungent, alkaline, salt, sour food, taking food when ailing from indigestion, or due to excessive exposure to heat and sunlight. This gets into the skin, muscle tissue, or blood and produces swelling. It also increases and subsides quickly. The affected part becomes blackish, yellow, bluish, copper-tinged, hot, or soft with brown and coppery hair. It gives a burning sensation of various forms and could be hot, sweaty, and moist. The affected region could be tender to touch and very sensitive to heat. These are the traits of swelling due to ''pitta dosha''. [2]
''Pitta'' is vitiated due to excessive intake of hot, irritant, pungent, alkaline, salt, sour food, taking food when ailing from indigestion, or due to excessive exposure to heat and sunlight. This gets into the skin, muscle tissue, or blood and produces swelling. It also increases and subsides quickly. The affected part becomes blackish, yellow, bluish, copper-tinged, hot, or soft with brown and coppery hair. It gives a burning sensation of various forms and could be hot, sweaty, and moist. The affected region could be tender to touch and very sensitive to heat. These are the traits of swelling due to ''pitta dosha''. [2]
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==== Swelling due to ''kapha'' dominance ====
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''Kapha'' is vitiated due to excessive use of heavy to digest, sweet, cold and unctuous food, excessive sleep, sedentary life, etc. Vitiated ''kapha'' inhabits the skin, muscle tissues, and blood, causing swelling. A ''kapha''-induced swelling grows slowly and subsides with difficulty. Affected part becomes pale, whitish, heavy, unctuous, smooth, stable, thick, with white hair, tolerant of touch and heat This is the swelling caused due to ''kapha''.
''Kapha'' is vitiated due to excessive use of heavy to digest, sweet, cold and unctuous food, excessive sleep, sedentary life, etc. Vitiated ''kapha'' inhabits the skin, muscle tissues, and blood, causing swelling. A ''kapha''-induced swelling grows slowly and subsides with difficulty. Affected part becomes pale, whitish, heavy, unctuous, smooth, stable, thick, with white hair, tolerant of touch and heat This is the swelling caused due to ''kapha''.
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==== Different types due to involvement of more than one ''dosha'' ====
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=== Various types of ''shotha'' and cardinal sign ===
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On the basis of causative factors and classifications from different views, swelling may be of two, three, four, seven or eight types Again, there is only one type with common sign of ‘swelling’. [8]
On the basis of causative factors and classifications from different views, swelling may be of two, three, four, seven or eight types Again, there is only one type with common sign of ‘swelling’. [8]
=== Brief description of specific features ===
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==== Specific features of ''vataja, pittaja'' and ''kaphaja'' swellings ====
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In the case of ''vataja'' swelling, affected body parts are swollen, and there is a feeling of numbness, pain, the swelling rebounds immediately after releasing pressure (pitting edema). It is reddish in color and subsides during night, by application of unctuous and hot massage. [9-10]
In the case of ''vataja'' swelling, affected body parts are swollen, and there is a feeling of numbness, pain, the swelling rebounds immediately after releasing pressure (pitting edema). It is reddish in color and subsides during night, by application of unctuous and hot massage. [9-10]
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=== Prognosis ===
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A swelling that starts from the feet and spreads all over the body and which starts from the face in women can only be cured with difficulty. In men or women, swellings that emanate from the genitalia, as well as all complicated variants of edema are mostly difficult to cure. [16-17]
A swelling that starts from the feet and spreads all over the body and which starts from the face in women can only be cured with difficulty. In men or women, swellings that emanate from the genitalia, as well as all complicated variants of edema are mostly difficult to cure. [16-17]
=== Complications of ''shotha'' ===
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Vomiting, breathlessness, anorexia, excessive thirst, pyrexia, diarrhea and weakness - these are seven complications of ''shotha''. [18]
Vomiting, breathlessness, anorexia, excessive thirst, pyrexia, diarrhea and weakness - these are seven complications of ''shotha''. [18]
=== Different types of swelling at specific sites ===
==== ''Upajivhika'' ====
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When the vitiated ''kapha'' emanates or begins from the root of the tongue and causes swelling suddenly, is called ''upajivhika'' (ranula or hypertrophied solitary lingual papilla). [19]
When the vitiated ''kapha'' emanates or begins from the root of the tongue and causes swelling suddenly, is called ''upajivhika'' (ranula or hypertrophied solitary lingual papilla). [19]
==== ''Galashundika'' ====
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The vitiated ''kapha'' inhabits at uvula and produces swelling suddenly, that is called ''Galashundika''(uvulitis). [20]
The vitiated ''kapha'' inhabits at uvula and produces swelling suddenly, that is called ''Galashundika''(uvulitis). [20]
==== ''Galaganda'' ====
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A swelling that is caused when a vitiated ''kapha'' affects the throat from the outside, and gradually produces swelling , is called ''galaganda'' (goitre). [21]
A swelling that is caused when a vitiated ''kapha'' affects the throat from the outside, and gradually produces swelling , is called ''galaganda'' (goitre). [21]
==== ''Galagraha'' ====
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When the vitiated ''kapha'', firmly located inside the throat causes swelling suddenly, it causes ''galagraha'' (pharyingitis). [22]
When the vitiated ''kapha'', firmly located inside the throat causes swelling suddenly, it causes ''galagraha'' (pharyingitis). [22]
==== ''Visarpa'' ====
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When a vitiated ''pitta'' (with ''rakta'', or blood) spreads through the skin, it causes swelling with redness.Such a swelling is called ''visarpa'' i.e. erysipelas. [23]
When a vitiated ''pitta'' (with ''rakta'', or blood) spreads through the skin, it causes swelling with redness.Such a swelling is called ''visarpa'' i.e. erysipelas. [23]
==== ''Pidika'' ====
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When the vitiated ''pitta'' is located within the skin and ''rakta'', swelling and redness appears causing ''pidika'' i.e. boils or pustules. [24]
When the vitiated ''pitta'' is located within the skin and ''rakta'', swelling and redness appears causing ''pidika'' i.e. boils or pustules. [24]
==== ''Tilaka-pipplava-vyanga-neelika'' ====
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When the vitiated ''pitta'' goes into ''rakta'' and gets absorbed in it (i.e., within the blood), it causes ''tilaka'' (moles), ''piplu'' (port-wine marks), ''vyanga'' (blemish/spots), or ''nilika'' (blue-black moles). [25]
When the vitiated ''pitta'' goes into ''rakta'' and gets absorbed in it (i.e., within the blood), it causes ''tilaka'' (moles), ''piplu'' (port-wine marks), ''vyanga'' (blemish/spots), or ''nilika'' (blue-black moles). [25]
==== ''Shankhaka'' ====
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When a vitiated ''pitta'' inhabits the temporal regions of the head, severe and fatal swellings known as ''shankhaka'' (saggital sinus thrombosis/ intracranial growth/ temporal arteritis) are caused. [26]
When a vitiated ''pitta'' inhabits the temporal regions of the head, severe and fatal swellings known as ''shankhaka'' (saggital sinus thrombosis/ intracranial growth/ temporal arteritis) are caused. [26]
==== ''Karnamulika shotha'' (swelling at base of ears) ====
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When the vitiated ''pitta'' is located at the base of ears, a severe, incurable and fatal swelling arises at the terminal stage of the fever. [27]
When the vitiated ''pitta'' is located at the base of ears, a severe, incurable and fatal swelling arises at the terminal stage of the fever. [27]
==== ''Pliha'' (splenomegaly) ====
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When the vitiated ''vata'' inhabits and elevates the spleen, it causes a gradual prickly pain in the sides, causing ''pliha vriddhi'' i.e. splenomegaly. [28]
When the vitiated ''vata'' inhabits and elevates the spleen, it causes a gradual prickly pain in the sides, causing ''pliha vriddhi'' i.e. splenomegaly. [28]
==== ''Gulma'' (abdominal lumps) ====
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When the vitiated ''vata'' inhabits in the abdominal region causing swelling and pain, it causes ''gulma''. [29]
When the vitiated ''vata'' inhabits in the abdominal region causing swelling and pain, it causes ''gulma''. [29]
==== ''Vriddhi'' (scrotum enlargement) ====
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When the vitiated ''vata'' moves from the groins to testicles causing swelling and pain, it causes ''vriddhi'' i.e. testicular swellings. [30]
When the vitiated ''vata'' moves from the groins to testicles causing swelling and pain, it causes ''vriddhi'' i.e. testicular swellings. [30]
==== Udara (abdominal diseases) ====
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When the vitiated ''vata'' located between the skin and muscles produces swelling in the abdomen, it is known as ''udara roga'' i.e. diseases of abdominal cavity. [31]
When the vitiated ''vata'' located between the skin and muscles produces swelling in the abdomen, it is known as ''udara roga'' i.e. diseases of abdominal cavity. [31]
==== ''Anaha'' (obstruction in abdomen) ====
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When the vitiated ''vata'' is stuck in the belly and moves neither upwards nor downwards (neither passed through flatus nor through belching), it causes ''anaha'' (obstruction in abdomen). [32]
When the vitiated ''vata'' is stuck in the belly and moves neither upwards nor downwards (neither passed through flatus nor through belching), it causes ''anaha'' (obstruction in abdomen). [32]
==== Tumors ====
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Various diseases with names and features such as ''adhimamsa'' (fleshy growth or extra growth of muscles), and ''arbuda'' (tumors) are included in the family of shotha due to the common appearance of swelling. [33]
Various diseases with names and features such as ''adhimamsa'' (fleshy growth or extra growth of muscles), and ''arbuda'' (tumors) are included in the family of shotha due to the common appearance of swelling. [33]
==== ''Rohini'' (diphtheria) ====
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=== Prognosis of diseases ===
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=== Criteria for classification of diseases ===
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There are several diseases classified on the basis of type of pain, appearance (color), etiology, site, symptoms and name. Their systematic classification has been attempted in the form of some gross disease families or classes. However, in other cases general principle may be followed. [42]
There are several diseases classified on the basis of type of pain, appearance (color), etiology, site, symptoms and name. Their systematic classification has been attempted in the form of some gross disease families or classes. However, in other cases general principle may be followed. [42]
=== Identification of new diseases ===
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One should not be ashamed of one’s inability to name a disease, since all disorders cannot be given standard names. There are innumerable diseases because the same vitiated ''dosha'' causes various disorders according to variations in etiology and location. Hence one should initiate any treatment after acquiring complete knowledge of the nature of the disease as well as its pathogenesis, location and etiological factors. The one who initiates the treatment after knowing all these things, rationally and according to prescribed procedure, does not get confused in actions. [44-47]
One should not be ashamed of one’s inability to name a disease, since all disorders cannot be given standard names. There are innumerable diseases because the same vitiated ''dosha'' causes various disorders according to variations in etiology and location. Hence one should initiate any treatment after acquiring complete knowledge of the nature of the disease as well as its pathogenesis, location and etiological factors. The one who initiates the treatment after knowing all these things, rationally and according to prescribed procedure, does not get confused in actions. [44-47]
=== Discussion on ''dosha'' ===
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''Vata, pitta'' and ''kapha'' - these three ''doshas'' are always present in the body of all living beings. The learned should know about their normal or abnormal states. [48]
''Vata, pitta'' and ''kapha'' - these three ''doshas'' are always present in the body of all living beings. The learned should know about their normal or abnormal states. [48]
==== Functions of normal ''vata dosha'' ====
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Enthusiasm, inspiration, expiration, movements, normal processing of dhatu (body tissues), and normal elimination of excreta are the normal functions of ''vayu'' (''vata)''. [49]
Enthusiasm, inspiration, expiration, movements, normal processing of dhatu (body tissues), and normal elimination of excreta are the normal functions of ''vayu'' (''vata)''. [49]
==== Functions of normal ''pitta dosha'' ====
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Vision, digestion, (production of) heat, hunger, thirst, softness in body, luster, serenity and intelligence are the normal functions of ''pitta''. [50]
Vision, digestion, (production of) heat, hunger, thirst, softness in body, luster, serenity and intelligence are the normal functions of ''pitta''. [50]
==== Functions of normal ''kapha dosha'' ====
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Unctuousness, binding, firmness/stability, heaviness, virility, strength, forbearance, restraint and absence of greed are the properties of ''kapha''. [51]
Unctuousness, binding, firmness/stability, heaviness, virility, strength, forbearance, restraint and absence of greed are the properties of ''kapha''. [51]
==== Diagnosis of abnormal state of ''dosha'' ====
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Conversely, any aggravation in ''dosha'' is indicated by an increase in their normal functions. Thus normalcy, decrease and aggravation of ''dosha'' are examined. [53]
Conversely, any aggravation in ''dosha'' is indicated by an increase in their normal functions. Thus normalcy, decrease and aggravation of ''dosha'' are examined. [53]
=== Summary ===
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Types, causes, symptoms and prognoses of swelling, of various diseases, types of diseases, definitions of the three doshas, normal functions and symptoms of decrease and aggravation of doshas - all these have been explained in this chapter on three types of swellings by Punarvasu , who is free from tamas and rajas qualities, doshas, greed, conceit, pride and ambition.[54-56]
Types, causes, symptoms and prognoses of swelling, of various diseases, types of diseases, definitions of the three doshas, normal functions and symptoms of decrease and aggravation of doshas - all these have been explained in this chapter on three types of swellings by Punarvasu , who is free from tamas and rajas qualities, doshas, greed, conceit, pride and ambition.[54-56]
=== ''Tattva Vimarsha'' /Fundamental Principles ===
== Tattva Vimarsha (Fundamental Principles) ==
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*''Shotha'' (swelling) is associated with ''tridosha'' and occurs due to endogenous and exogenous factors.
*''Shotha'' (swelling) is associated with ''tridosha'' and occurs due to endogenous and exogenous factors.
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=== ''Vidhi Vimarsha'' / Applied Inferences ===
== Vidhi Vimarsha (Applied Inferences) ==
=== Classification of ''shotha'' (swelling/ distension) ===
Depending on etiological factors diseases are grossly divided in to two categories:
Depending on etiological factors diseases are grossly divided in to two categories:
In addition to the types of swellings mentioned by Charak, Sushruta has added ''rakta''based swellings as a separate type. [Su. Su. 17/4]. Sushruta has also emphasized on ''vishaja'' (caused due to poisons) as another type while mentioning treatment. [Su. Chi. 23/3]. Vagbhata has differentiated types based on causes of injuries (''abhighataja'') and contact with poisons (''vishaja''). Further he has mentioned two types of ''shotha'' on the basis of distribution in body i.e. ''sarvanga'' (generalized) and ''ekanga'' (localized). According to its manifestation he has described three categories i.e. ''prathu'' (diffused spread), ''unnata'' (elevated) and ''grathita'' (nodular) [A.H. Ni. 13/22, 23]. On the basis of prognosis, Madhava has divided ''shotha'' into three i.e. ''urdhvagata'' (in upper part of body), ''madhyagata'' (in the middle part) and ''adhogata'' (in the lower part) [Ma.ni.-36/17]. These types are of clinical importance since they help understand the origin of the swelling and the pre-dominant ''dosha'' involved in it. [3]
In addition to the types of swellings mentioned by Charak, Sushruta has added ''rakta''based swellings as a separate type. [Su. Su. 17/4]. Sushruta has also emphasized on ''vishaja'' (caused due to poisons) as another type while mentioning treatment. [Su. Chi. 23/3]. Vagbhata has differentiated types based on causes of injuries (''abhighataja'') and contact with poisons (''vishaja''). Further he has mentioned two types of ''shotha'' on the basis of distribution in body i.e. ''sarvanga'' (generalized) and ''ekanga'' (localized). According to its manifestation he has described three categories i.e. ''prathu'' (diffused spread), ''unnata'' (elevated) and ''grathita'' (nodular) [A.H. Ni. 13/22, 23]. On the basis of prognosis, Madhava has divided ''shotha'' into three i.e. ''urdhvagata'' (in upper part of body), ''madhyagata'' (in the middle part) and ''adhogata'' (in the lower part) [Ma.ni.-36/17]. These types are of clinical importance since they help understand the origin of the swelling and the pre-dominant ''dosha'' involved in it. [3]
=== Etiology of swelling ===
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]
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=== '''Table 1:Differential diagnosis of types of swelling''' ===
{| class="wikitable"
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=== Types of ''shotha'' and their location/site ===
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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 vessels<ref> Manual of practical medicine by R. Alagappan; chapter-3(page-159), 3rd edition.</ref>. 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 vessels<ref> Manual of practical medicine by R. Alagappan; chapter-3(page-159), 3rd edition.</ref>. 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 diseases<ref> Manual of practical medicine by R. Alagappan, chapter-7 page-369-371, 3rd edition.</ref>. 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 diseases<ref> Manual of practical medicine by R. Alagappan, chapter-7 page-369-371, 3rd edition.</ref>. 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 ===
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 ===
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)<ref>Manual of practical medicine by R. Alagappan, chapter-3 page-159, 3rd edition. </ref>. 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)<ref>Manual of practical medicine by R. Alagappan, chapter-3 page-159, 3rd edition. </ref>. 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'' ===
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.
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.
''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 ''Karnamoola 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 diphtheriae <ref>Textbook of microbiology – Orient Longman, chapter-26 page-23, 4th edition. </ref>. 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 ''Karnamoola 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 diphtheriae <ref>Textbook of microbiology – Orient Longman, chapter-26 page-23, 4th edition. </ref>. 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]
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]
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== Related Chapter ==
* [[Shvayathu Chikitsa]]
* [[Shvayathu Chikitsa]]
== References ==
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