Changes

Depending on etiological factors diseases are grossly divided in to two categories:

Depending on etiological factors diseases are grossly divided in to two categories:

 

*The first category is of ''nija'' (endogenous) diseases which are caused by endogenous factors i.e. the whole disease process starts within the body, although the provocation or aggravating factors may come from outside but the complete phenomenon of pathogenesis occurs inside body in a systematic way. According to Ayurvedic concepts, full-fledged involvement of ''vata, pitta'' and ''kapha dosha'' is present here.  

*The first category is of ''nija'' (endogenous) diseases which are caused by endogenous factors i.e. the whole disease process starts within the body, although the provocation or aggravating factors may come from outside but the complete phenomenon of pathogenesis occurs inside body in a systematic way. According to Ayurvedic concepts, full-fledged involvement of ''vata, pitta'' and ''kapha dosha'' is present here.  

*The second type of swelling is known as ''agantuja'' (exogenous) in which the etiological factors are extraneous, which could be physical or environmental. Many times they circumvent the routine disease courses and cause diseases in a very short course of time. Conventional involvement of ''doshas'' take place later on i.e. after manifestation of disease.  

*The second type of swelling is known as ''agantuja'' (exogenous) in which the etiological factors are extraneous, which could be physical or environmental. Many times they circumvent the routine disease courses and cause diseases in a very short course of time. Conventional involvement of ''doshas'' take place later on i.e. after manifestation of disease.  

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]

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 ====

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

==== 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]

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 ===