Changes

*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 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.Sa.Sutra Sthana 17/4]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> Sushruta has also emphasized on ''vishaja'' (caused due to poisons) as another type while mentioning treatment. [Su.Sa.Chikitsa Sthana 23/3]<ref name=Susruta/> 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. Nidana Sthana 13/22-23]<ref name=Hridaya>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref> 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 ===

=== 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 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 [Cha.Sa.Chikitsa Sthana 16/27-30]. Excessive use of salt will result in sodium retention and edema<ref> Pathology by Harsh mohan; chapter-5 page (66-67), 3rd edition </ref>. 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''. [Cha.Sa.[[Chikitsa Sthana]] 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.Sa.Chikitsa Sthana 23/4]<ref name=Susruta/> 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. Nidana Sthana 13/26]<ref name=Hridaya/> 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. [Cha.Sa.[[Chikitsa Sthana]] 16/27-30] Excessive use of salt will result in sodium retention and edema<ref> Pathology by Harsh mohan; chapter-5 page (66-67), 3rd edition </ref>. 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 obstruction<ref>  Pathology by Harsh mohan; chapter-5 page (64-70), 3rd edition.</ref> 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 obstruction<ref>  Pathology by Harsh mohan; chapter-5 page (64-70), 3rd edition.</ref> are important. Above mechanisms can be studied in context of ''vataja, paittika'' and ''kaphaja'' types of ''shotha''. [6]

=== 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.Sa.Chikitsa Sthana 23/6]<ref name=Susruta/> 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.Sa.Chikitsa Sthana 23/7-8]<ref name=Susruta/> 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 ===

=== 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.  

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.Sa.Nidana Sthana 13/43]<ref name=Susruta/> Similarly ''vyanga'' (pigmentation) as painless, fine, black color circles. [Su.Sa.Nidana Sthana 13/45-46]<ref name=Susruta/> Same manifestation over the face or other body parts is called ''nilika''. [Su.Sa.Nidana Sthana 13/46]<ref name=Susruta/> 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.Sa.Uttara Tantra 25/16-18]<ref name=Susruta/> 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''. [Cha.Sa.[[chikitsa Sthana]] 3/287] ''Pliha vriddhi'' (splenomegaly) has been described as ''plīhodara''. [Cha.Sa.[[Chikitsa SThana]] 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.[Cha.Sa.[[Chikitsa Sthana]] 5] & [Cha.Sa.[[Nidana Sthana]] 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).

Two causes of ''aanaha'' are: impaired peristalsis of the stomach and that of the large bowel. [Su.Sa.Uttara Tantra 57/20-22]<ref name=Susruta/> ''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.Nidana Sthana 11/21-31]<ref name=Hridaya/> 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.Sa.Nidana Sthana 16/47-50]<ref name=Susruta/>

''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]

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]   

    

    

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.Nidana Sthana 11/1]<ref name=Hridaya/> [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 [Cha.Sa.[[Sutra Sthana]] 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.Sutra Sthana 11/5-7]<ref name=Hridaya/> [53]

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