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Line 632: − • Shotha (swelling) is associated with tridosha and occurs due to endogenous and exogenous factors. + − • The exogenous factors cause swelling first and then vitiate dosha. This leads to exogenous swellings getting transformed into endogenous swellings. + − • Any treatment of swelling depends upon the causative factors and doshas associated with it. [5]+ − • Endogenous swelling can be caused by iatrogenic factors (e.g., poor administration of [[Panchakarma]]), complications arising from other diseases, consumption of improper food articles (e.g., allergic reactions to nuts or grains), not following proper ante-natal/post-natal regimen, etc. [6]+ − • Etiological factors specific to each dosha are involved in the pathogenesis of swelling.[7]+ − • The prognosis of swelling depends upon the involvement of dosha, the affected part and location of dosha accumulation. [16-41]+ − • There are innumerable diseases classified on the basis of type of pain, appearance (color), etiology, site, symptoms and name. [42]+ − • All the diseases cannot be named with standard nomenclature. [44]+ − • For knowing and treating a new disease that has not been described in the text, the underlying dosha, its location, etiological factors, and the movement of dosha should be well identified. Then pathogenesis should become evident and rational treatment can be started. [45-47] + − • Three doshas - vata, pitta and kapha - are always present in the body of living beings. The learned should know about their normal and vitiated states. [48]+ − • Enthusiasm, inspiration, expiration, movements, processing of dhatu (body tissues) and elimination of excreta are natural functions of of a normal vata.[49] + − • Vision, digestion, heat production, hunger, thirst, softness in body, luster, serenity and intelligence are the natural functions of a normal pitta. [50]+ − • Unctuousness, binding, firmness/stability, heaviness (maintaining volume/mass), virility, strength, forbearance, restraint and absence of greed are the natural functions of of a normal kapha. [51]+ − • The decrease (or increase) of these doshas in a body can be best diagnosed by a decrease (or increase) in the functions mentioned above. The alternate method to examine the status is to check functions of other (opposite) dosha. Thus the status of dosha can be investigated based on their representative functions only.[52]+ − + − + − + − + − + + + + + + + + + +
→Tattva Vimarsha
=== ''Tattva Vimarsha'' ===
=== ''Tattva Vimarsha'' ===
*''Shotha'' (swelling) is associated with ''tridosha'' and occurs due to endogenous and exogenous factors.
*The exogenous factors cause swelling first and then vitiate ''dosha''. This leads to exogenous swellings getting transformed into endogenous swellings.
*Any treatment of swelling depends upon the causative factors and ''doshas'' associated with it. [5]
*Endogenous swelling can be caused by iatrogenic factors (e.g., poor administration of [[Panchakarma]]), complications arising from other diseases, consumption of improper food articles (e.g., allergic reactions to nuts or grains), not following proper ante-natal/post-natal regimen, etc. [6]
*Etiological factors specific to each ''dosha'' are involved in the pathogenesis of swelling.[7]
*The prognosis of swelling depends upon the involvement of ''dosha'', the affected part and location of ''dosha'' accumulation. [16-41]
*There are innumerable diseases classified on the basis of type of pain, appearance (color), etiology, site, symptoms and name. [42]
*All the diseases cannot be named with standard nomenclature. [44]
*For knowing and treating a new disease that has not been described in the text, the underlying ''dosha'', its location, etiological factors, and the movement of ''dosha'' should be well identified. Then pathogenesis should become evident and rational treatment can be started. [45-47]
*Three ''doshas'' - ''vata, pitta'' and ''kapha'' - are always present in the body of living beings. The learned should know about their normal and vitiated states. [48]
*Enthusiasm, inspiration, expiration, movements, processing of ''dhatu'' (body tissues) and elimination of excreta are natural functions of of a normal ''vata''.[49]
*Vision, digestion, heat production, hunger, thirst, softness in body, luster, serenity and intelligence are the natural functions of a normal ''pitta''. [50]
*Unctuousness, binding, firmness/stability, heaviness (maintaining volume/mass), virility, strength, forbearance, restraint and absence of greed are the natural functions of of a normal ''kapha''. [51]
*The decrease (or increase) of these ''doshas'' in a body can be best diagnosed by a decrease (or increase) in the functions mentioned above. The alternate method to examine the status is to check functions of other (opposite) ''dosha''. Thus the status of ''dosha'' can be investigated based on their representative functions only.[52]
Vidhi Vimarsha:
Classification of shotha (swelling/ distension):
=== ''Vidhi Vimarsha'' ===
Depending on etiological factors diseases are grossly divided in to two categories. First one are 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 bypass routine disease courses and causes disease in very short course of time. Conventional involvement of doshas take place later on i.e. after manifestation of disease.
In addition to the types of swellings mentioned by Charaka, Sushruta has added rakta 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 ekang (localized). According to its manifestation he has described three categories i.e. prathu (diffused spread), unnat (elevated) and grathit (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]
==== Classification of ''shotha'' (swelling/ distension) ====
Etiology of swelling:
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 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 addition to the types of swellings mentioned by Charaka, 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]
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.