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→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]
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 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 conventional medicine many mechanisms have been described to explain edema. Among these, increased capillary hydrostatic pressure, decreased plasma oncotic pressure, increased capillary permeability, sodium and water retention, and lymphatic obstruction4 are important. Above mechanisms can be studied in context of vataja, paittika and kaphaja types of shotha. [6]
Differential diagnosis of types of swelling:
Differential diagnosis of types of swelling:
Character/dosha vata dominance pitta dominance kapha dominance
Character/dosha vata dominance pitta dominance kapha dominance
Time of increase & decrease Increases in day, reduces at night -- Increases at night, reduces in day
Time of increase & decrease Increases in day, reduces at night -- Increases at night, reduces in day
Pacifying Hot and unctuous massage -- --
Pacifying Hot and unctuous massage -- --
Types of shotha, location:
Types of shotha, location:
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:
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 ===
1. Charaka samhita ; Nidana sthana - 1/10
1. Charaka samhita ; Nidana sthana - 1/10
2. Charak samhita ; chikitsa sthanam –16/30
2. Charak samhita ; chikitsa sthanam –16/30