Shvayathu Chikitsa
Chikitsa Sthana Chapter 12. Management of Shvayathu (Various types of Swellings)
| Section/Chapter | Chikitsa Sthana Chapter 12 |
|---|---|
| Preceding Chapter | Kshatakshina Chikitsa |
| Succeeding Chapter | Udara Chikitsa |
| Other Sections | Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana |
| Translator and commentator | Goyal M. |
| Reviewer | Singh G. |
| Editors | Singh G., Goyal M., Deole Y.S., Basisht G. |
| Year of publication | 2020 |
| Publisher | Charak Samhita Research, Training and Skill Development Centre |
| DOI | 10.47468/CSNE.2020.e01.s06.013 |
Abstract
This chapter deals with the treatment of various types of swellings like generalized edema and local eruptions including pustules, nodules and tumors. The etiological factors for these swellings can be endogenous (nija) or exogenous (agantuja). In all types of swellings, three doshas are involved but it is named according to the dominance of the dosha. After describing general symptoms and signs of the swelling, specific symptoms and signs of vata, pitta and kapha as well as of incurable and curable swellings are explained.
Line of treatment depends upon type of swelling as well as involved parts of the body; wholesome and unwholesome diet and lifestyle for the benefit of the patient is explained. Detailed treatments along with drug preparations, internal and external therapeutic measures are discussed according to vata, pitta and kapha types of swelling.
Local swellings occurring in the various parts of the body in the form of papules, pustules, nodules, tumors etc are described in the last part of the chapter. It includes shaluka (quinsy), Bidalika (Ludwig’s angina), Taluvidradhi (palatal abscess), Upajihivika (superficial glossitis), Upakusha (gingivitis) and Danta-Vidradhi (dental abscess) which occurs in buccal cavity and generally included in Śālākya specialty. Galaganda is goiter and gandamala and granthi are mainly related with various types of swellings of lymph nodes. Arbuda (tumor), alaji (inflammation of eye), akshata (whitlow), vidarika (lymphadenitis), visphotaka (eruption), kaksha (herpes zoster), romantika (measles), masurika (chickenpox), bradhna (hernia), bhagandara (fistula-in-ano), shleepada (elephantiasis), jalakagardabha (acute sprading inflammation), abhighataja (traumatic) and vishaja (poisonous) swellings along with their medical treatment and wherever necessary surgical measures are also described. Difference and similarity between granthi and arbuda are also mentioned.
Keywords: Shvayathu, shotha, shopha, edema, swelling, langhana, amapachana, shodhana.
Introduction
This chapter on Shvayathu Chikitsa (treatment of swelling) follows the chapter on kshata-kshina because in both the diseases vital organs are involved. Charaka defines shvayathu as bulging (utsedha) from the skin and this chapter mainly deals with the management of various types of general swellings and local swellings such as pidika (papules and pustules), nodules (including gandhamala), large swellings like galaganda (goiter), tumor etc are also described.
Chapter 18th of Sutra Sthana deals with diagnostic aspects of swelling under the name of trishothiya. Therein the word shopha is frequently used for shotha. Thus, the words shvayathu, shotha and shopha are used as synonyms and all denote edema or swelling. For inflammatory swelling Sushruta has used the word vrana-shotha.
In the Sutra Sthana, Charaka classified shotha in many ways but in this chapter which is mainly on the treatment, only those classifications are given which are important from treatment point of view, such as three types according to dosha viz, vata, pitta and kapha; two types viz. nija (endogenous) and agantuja (exogenous) as well as ekanga (local) and sarvanga (generalized ) types.
Sanskrit text, Transliteration and English Translation
Now we shall expound the chapter "Shvayathu chikitsa" (Management of different types of swelling). Thus said Lord Atreya. [1-2]
भिषग्वरिष्ठं सुरसिद्धजुष्टं मुनीन्द्रमत्र्यात्मजमग्निवेशः|
महागदस्य श्वयथोर्यथावत् प्रकोपरूपप्रशमानपृच्छत्||३||
Agnivesha approached the best physician and great sage, the son of Atri sitting midst of gods and saints and requested him to elaborate on the etiology, signs and symptoms and treatment of the major disease- shvayathu [3]
तस्मै जगादागदवेदसिन्धुप्रवर्तनाद्रिप्रवरोऽत्रिजस्तान्|
वातादिभेदात्त्रिविधस्य सम्यङ्निजानिजैकाङ्गजसर्वजस्य||४||
Sage Atreya who is like Himalaya from which flows out the Indus of the science of healing, fully expounded the subject of swellings of three types based on tridosha, nija and agantuja based on etiology and ekanga and sarvanga type according to location [4]
Causative factors of nija (endogenous) swelling/edema
शुद्ध्यामयाभक्तकृशाबलानां क्षाराम्लतीक्ष्णोष्णगुरूपसेवा|
दध्याममृच्छाकविरोधिदुष्टगरोपसृष्टान्ननिषेवणं च||५||
अर्शांस्यचेष्टा न च देहशुद्धिर्मर्मोपघातो विषमा प्रसूतिः|
मिथ्योपचारः प्रतिकर्मणां च निजस्य हेतुः श्वयथोः प्रदिष्टः||६||
Excessive use of kshara (alkali) or food articles having sour, sharply acting, hot and heavy properties by an emaciated or weak person due to excessive shodhana, fasting or disease.
Excessive intake of curd, raw food articles, soil, leafy vegetables, mutually contradictory food articles (virodhi), spoiled or mixed with toxic substance (such as pesticide), or a person suffering from piles, having sedentary life style, nonperforming of shodhana therapy even if indicated, injury to vital organs (marma), abnormal delivery, due to improper treatment and as complication of improper purification treatment [5-6]
Causative factors of agantuka (exogenous) swelling
बाह्यास्त्वचो दूषयिताऽभिघातः काष्ठाश्मशस्त्राग्निविषायसाद्यैः [१] |
आगन्तुहेतुःत्रिविधो निजश्च सर्वार्धगात्रावयवाश्रितत्वात्||७||
External causative factors of swelling are trauma to skin with wood, stone, weapon, fire, poison etc.
Endogenous swelling is of three types i.e. of whole body, half body or limited to one part or organ [7]
Pathogenesis of swelling
बाह्याः सिराः प्राप्य यदा कफासृक्पित्तानि सन्दूषयतीह वायुः|
तैर्बद्धमार्गः स तदा विसर्पन्नुत्सेधलिङ्गं श्वयथुं करोति||८||
उरःस्थितैरूर्ध्वमधस्तु [१] वायोः स्थानस्थितैर्मध्यगतैस्तु मध्ये|
सर्वाङ्गगः सर्वगतैः क्वचित्स्थैर्दोषैः क्वचित् स्याच्छ्वयथुस्तदाख्यः||९||
Morbid vata is obstructed by vitiated kapha, rakta and pitta aggravated at the site of peripheral superficial vessels. This vitiated vata (due to obstruction) spreads to the various places causing swelling as its cardinal symptom.
If the vata lodges in the chest, then it causes edema of upper parts of the body; if it lodges in its own place i.e. lower parts then it causes edema of lower parts and if it lodges in middle then it causes edema of middle parts.
If vata spreads in the entire body then it causes edema all over the body but if it lodges in one place then it causes local swelling of that part or organ. These swellings are named after the particular region that it affects [8-9]
Prodromal symptoms of edema
ऊष्मा तथा स्याद्दवथुः सिराणामायाम इत्येव च पूर्वरूपम्|
Rise in temperature, burning sensation as if burnt by fire and dilation of the vessels are the prodromal symptoms of swelling [9½]
Tridoshaja nature of all swellings
सर्वस्त्रिदोषोऽधिकदोषलिङ्गैस्तच्छब्दमभ्येति भिषग्जितं च||१०||
All types of swelling are produced by involvement of all the three dosha but they are named based on the predominance of that particular dosha. The line of treatment is also according to the dominant dosha [10]
General symptoms of swelling
सगौरवं स्यादनवस्थितत्वं सोत्सेधमुष्माऽथ सिरातनुत्वम्|
सलोमहर्षाऽङ्गविवर्णता च सामान्यलिङ्गं श्वयथोः प्रदिष्टम्||११||
Heaviness, movability, bulging, heat, thinning of the vessels, horripilation and discoloration of the affected skin are the general signs and symptoms of edema [11]
Symptoms of vataja dominant edema/swelling
चलस्तनुत्वक्परुषोऽरुणोऽसितः प्रसुप्तिहर्षार्तियुतोऽनिमित्ततः|
प्रशाम्यति प्रोन्नमति प्रपीडितो दिवाबली च श्वयथुः समीरणात्||१२||
Skin of the effected part in vata dominant swelling becomes thin and rough and dry (parusha), dusky-brown colored with horripilation and feeling of numbness and discomfort. The swelling is moveable and pitting on pressure but it attains normal position immediately, increases during the day time and often subsides without appreciable reason [12]
Symptoms of pitta dominant swelling (inflammation)
मृदुः सगन्धोऽसितपीतरागवान् भ्रमज्वरस्वेदतृषामदान्वितः|
य उष्यते स्पर्शरुगक्षिरागकृत् [१] स पित्तशोथो भृशदाहपाकवान्||१३||
The pitta-dominant swelling is soft, painful to touch, with specific odor and blackish, yellow or red colored skin and has tendency of turning to abscess. It is accompanied with excessive burning sensation, fever, perspiration, giddiness, thirst, redness in eyes and intoxication [13]
Symptoms of kapha-dominant edema
गुरुः स्थिरः पाण्डुररोचकान्वितः प्रसेकनिद्रावमिवह्निमान्द्यकृत्|
स कृच्छ्रजन्मप्रशमो निपीडितो न चोन्नमेद्रात्रिबली कफात्मकः||१४||
Kapha-dominant swelling is heavy and firm/immovable. It is associated with anemia, anorexia, low digestion, water-brash, vomiting and sleepiness. It appears and disappears very slowly and on pressing it takes long time to attain its normal position and increases at the night time [14]
Symptoms of bad prognostic of edema
कृशस्य रोगैरबलस्य यो भवेदुपद्रवैर्वा वमिपूर्वकैर्युतः|
स हन्ति मर्मानुगतोऽथ राजिमान् परिस्रवेद्धीनबलस्य सर्वगः||१५||
The edema/swelling of the patient, whose body is emaciated and weakened by a disease or is debilitated, or having complications or associated with vomiting, involving vital organs or whole body or spread with prominent vessels or in which profuse discharge oozes out, leads to death [15]
Symptoms of easily curable swelling
अहीनमांसस्य य एकदोषजो नवो बलस्थस्य सुखः स साधने|
निदानदोषर्तुविपर्ययक्रमैरुपाचरेत्तं बलदोषकालवित्||१६||
The swelling of a patient who is neither emaciated nor weak; that involved single dosha or is of recent origin is easily curable. The physician expert in the knowledge of strength, dosha and proper time of treatment should treat the curable patients by prescribing such measures which are opposite to cause, dosha and season [16]
Principles of treatment of edema/swelling
अथामजं लङ्घनपाचनक्रमैर्विशोधनैरुल्बणदोषमादितः|
शिरोगतं शीर्षविरेचनैरधो [४] विरेचनैरूर्ध्वहरैस्तथोर्ध्वजम्||१७||
उपाचरेत् स्नेहभवं विरूक्षणैः प्रकल्पयेत् स्नेहविधिं च रूक्षजे|
विबद्धविट्केऽनिलजे निरूहणं घृतं तु पित्तानिलजे सतिक्तकम्||१८||
पयश्च मूर्च्छारतिदाहतर्षिते विशोधनीये तु समूत्रमिष्यते|
कफोत्थितं क्षारकटूष्णसंयुतैः समूत्रतक्रासवयुक्तिभिर्जयेत्||१९||
If swelling is associated with ama it should be managed first by prescribing lightening therapy (langhana) and digestive drugs and only then shodhana therapy should be undertaken according to dominant dosha. General lines of treatment of doshaja swelling are as follows:
- If it involves head then shiro-virechana is prescribed;
- If it involves lower parts of the body then virechana (therapeutic purgation) is prescribed;
- If it involves upper parts of the body then vamana (therapeutic emesis)is prescribed;
- If it is caused by unctuous then rukshana (drying) therapy is done;
- If it is caused by un-unctuous (ruksha) then unctuous (snehana) therapy is done;
- If vata swelling is associated with constipation then it should be treated with niruha basti;
- If it is caused by vata-pitta then it should be treated with ghee prepared with bitter drugs;
- If the patient is suffering from associated symptoms such as fainting, pain, burning sensation and thirst then it should be treated with intake of milk;
- If the patient is suffering from swelling where shodhana is required then milk mixed with cow’s urine should be given.
- If the patient is suffering from kapha swelling then kshara or pungent and hot articles mixed in cow’s urine or buttermilk or asava are given [17-19]
Apathya (unwholesome) for swelling/edema
ग्राम्याब्जानूपं पिशितमबलं शुष्कशाकं नवान्नं
गौडं पिष्टान्नं दधि तिलकृतं [५] विज्जलं [६] मद्यमम्लम्|
धाना वल्लूरं समशनमथो गुर्वसात्म्यं विदाहि
स्वप्नं चारात्रौ श्वयथुगदवान् वर्जयेन्मैथुनं च||२०||
Meat of domestic, aquatic and wet-land animals or weak animals; dry vegetables, fresh grains, molasses, fine flour products, curd, products of sesame, slimy and sour food articles, wine, roasted barley, dried meat, samashana (taking of mixture of wholesome and unwholesome food), taking of unwholesome, heavy and irritant diet articles, day sleep and sexual acts should be avoided by the patient of edema/swelling [20]
Vyoshadi churna for kapha swelling/edema
व्योषं त्रिवृत्तिक्तकरोहिणी च सायोरजस्का त्रिफलारसेन|
पीतं कफोत्थं शमयेत्तु शोफं गव्येन मूत्रेण हरीतकी च||२१||
Mixture of powders of trikatu, trivrit, katuka and lauha-bhasma taken with juice of triphala; or haritaki powder taken by mixing with cow’s urine relieves kapha edema/swelling [21]
Remedy for tridoshaja edema
हरीतकीनागरदेवदारु सुखाम्बुयुक्तं सपुनर्नवं वा|
सर्वं पिबेत्त्रिष्वपि मूत्रयुक्तं स्नातश्च जीर्णे पयसाऽन्नमद्यात्||२२||
Mixture of haritaki, dried ginger and devadaru taken with lukewarm water, or punarnava mixed with all the above drugs taken with cow‘s urine relieves swelling produced by all the three dosha. On digestion of the drug and after taking bath, the patient should take food with milk [22]
Remedy for vata edema/swelling
पुनर्नवानागरमुस्तकल्कान् प्रस्थेन धीरः पयसाऽक्षमात्रान्|
मयूरकं मागधिकां समूलां सनागरां वा प्रपिबेत् सवाते||२३||
The 500 ml of milk prepared with paste of 10 gm each punarnava, dried ginger and mustaka; or milk prepared with mayuraka, pippalimula and dried ginger taken orally relieves swelling due to vata [23]
Remedy for vata-pitta swelling/edema
दन्तीत्रिवृत्त्र्यूषणचित्रकैर्वा पयः शृतं दोषहरं पिबेन्ना|
द्विप्रस्थमात्रं तु पलार्धिकैस्तैरर्धावशिष्टं पवने सपित्ते||२४||
One liter of milk prepared with 20 gm each of danti, trivrit, trikatu and chitraka added with one liter of water reduced to half, taken orally relieves edema caused by combination of vata and pitta [24]
General remedies for edema
सशुण्ठिपीतद्रुरसं प्रयोज्यं श्यामोरुबूकोषणसाधितं वा|
त्वग्दारुवर्षाभुमहौषधैर्वा गुडूचिकानागरदन्तिभिर्वा||२५||
Milk prepared with dry ginger and daruharidra or prepared with shyama, castor root and black pepper, or prepared with cinnamon, devadaru, punarnava and dry ginger; or prepared with guduchi, dry ginger and danti; taken orally relieves edema [25]
सप्ताहमौष्ट्रं त्वथवाऽपि मासं पयः पिबेद्भोजनवारिवर्जी|
गव्यं समूत्रं महिषीपयो वा क्षीराशनो मूत्रमथो गवां वा||२६||
The patient by avoiding all other food and drinks if remains only on camel’s milk for a week or month or similarly remains on cow’s milk mixed with equal quantity of cow’s urine or on buffalo’s milk mixed with an equal quantity of cow’s urine or other milk with cow’s urine, then edema is cured [26]
तक्रं पिबेद्वा गुरुभिन्नवर्चाः सव्योषसौवर्चलमाक्षिकं च|
गुडाभयां वा गुडनागरं वा सदोषभिन्नामविबद्धवर्चाः||२७||
Patient of edema if passes heavy (with mucous) and loose stools may drink butter milk mixed with trikatu, sauvarchala-salt and honey; or if the stool is morbid, loose, with ama or hard stool, then jaggery and haritaki or jaggery with dry ginger are given [27]
विड्वातसङ्गे पयसा रसैर्वा प्राग्भक्तमद्यादुरुबूकतैलम् [७] |
स्रोतोविबन्धेऽग्निरुचिप्रणाशे मद्यान्यरिष्टांश्च पिबेत् सुजातान्||२८||
If there is retention of feces and flatus, the patient may be given castor oil with milk or with meat-soup before meal; and if there is occlusion of channels or loss of digestion power and appetite, then the patient may be given simple or medicated wines [28]
Gandeeradyarishta
गण्डीरभल्लातकचित्रकांश्च व्योषं विडङ्गं बृहतीद्वयं च|
द्विप्रस्थिकं गोमयपावकेन द्रोणे पचेत् कूर्चिकमस्तुनस्तु [८] ||२९||
त्रिभागशेषं च सुपूतशीतं द्रोणेन तत् प्राकृतमस्तुना च|
सितोपलायाश्च शतेन युक्तं लिप्ते घटे चित्रकपिप्पलीनाम्||३०||
वैहायसे स्थापितमादशाहात् प्रयोजयंस्तद्विनिहन्ति शोफान्|
भगन्दरार्शःक्रिमिकुष्ठमेहान् वैवर्ण्यकार्श्यानिलहिक्कनं च||३१||
इति गण्डीराद्यरिष्टः
Take 1.280 Kg of gandeera, bhallataka, chitraka, trikatu, vidnaga, kantakari and brihati and add 1.024 Kg of kurchika-mastu (prepared by adding hot water in curd) and boil on cow-dung fire till one-third remains and then filter. On cooling add to it 1.024 Kg natural-mastu (prepared by adding water in curd), 4 kg of sugar-candy and put in a pitcher lined with paste of chitraka and pippali and leave this pot at a high-open place for 10 days for fermentation to prepare arishta.
Oral administration of gandeeradyarishtha cures edema, fistula-in-ano, piles, helminthiasis, kushtha(obstinate skin diseases), polyuria, discoloration, emaciation and hiccup due to vata. Thus gandeeradyarishtha is described [29-31]
Ashtashato arishta
काश्मर्यधात्रीमरिचाभयाक्षद्राक्षाफलानां [९] च सपिप्पलीनाम्|
शतं शतं जीर्णगुडात्तुलां [१०] च सङ्क्षुद्य कुम्भे मधुना प्रलिप्ते||३२||
सप्ताहमुष्णे द्विगुणं तु शीते स्थितं जलद्रोणयुतं पिबेन्ना|
शोफान् विबन्धान् कफवातजांश्च निहन्त्यरिष्टोऽष्टशतोऽग्निकृच्च||३३||
इत्यष्टशतोऽरिष्टः
Take 100 pala each of kashmarya, amalaki, black pepper, haritaki, vibhitaki, pippali and grapes, add to it 100 pala of old jaggery and two drona of water, then put the mixture in a vessel lined with honey for 7 days in summer or for 14 days in winter for fermentation. Thus fermented asava is known as ashtashato-arishtha. Its oral administration cures edema and constipation due to kapha and vata and stimulates digestion and metabolism (agni). Thus ashthato-arishta is described [32-33]
पुनर्नवे द्वे च बले सपाठे दन्तीं [११] गुडूचीमथ चित्रकं च|
निदिग्धिकां च त्रिपलानि पक्त्वा द्रोणावशेषे सलिले ततस्तम्||३४||
पूत्वा रसं द्वे च गुडात् पुराणात्तुले मधुप्रस्थयुतं सुशीतम्|
मासं निदध्याद्घृतभाजनस्थं पल्ले यवानां परतस्तु मासात्||३५||
चूर्णीकृतैरर्धपलांशिकैस्तं पत्रत्वगेलामरिचाम्बुलोहैः [१२] |
गन्धान्वितं क्षौद्रघृतप्रदिग्धे जीर्णे पिबेद् व्याधिबलं समीक्ष्य||३६||
हृत्पाण्डुरोगं श्वयथुं प्रवृद्धं प्लीहज्वरारोचकमेहगुल्मान्|
भगन्दरं षड्जठराणि कासं श्वासं ग्रहण्यामयकुष्ठकण्डूः||३७||
शाखानिलं बद्धपुरीषतां च हिक्कां किलासं च हलीमकं च|
क्षिप्रं जयेद्वर्णबलायुरोजस्तेजोन्वितो मांसरसान्नभोजी||३८||
इति पुनर्नवाद्यरिष्टः
Make a decoction of 120 gm each of two types of punarnavā, balā, pāṭhā, dantī, guḍūchī, chitraka, kantakāri and triphalā by adding water (about 4.1 liters) and reducing it to 1.024 liter. Add to this decoction 8 kg of jaggery and 640 gm of honey and keep it in a vessel lined with ghee and place it in a heap of barley for a month. Thereafter to make it fragrant, add 20 gm powders each of tejapatra, cinnamon, cardamom, black pepper, couscous and iron bhasma and store in a pot lined with honey and ghee. It is to be taken after the digestion of the meal in a dose according to the strength of the disease. In diet, food with meat soup may be given.
It provides quick cure in heart disease, anemia, severe edema, splenic disorders, fever, anorexia, polyuria, gulma, fistula-in-ano, six types of udararoga, cough, dyspnea, assimilation disorders (grahani), dermatosis (kushtha), pruritis, vata disorders of limbs, constipation, hiccup, leukoderma and halimaka (greenish coloration of skin). It also improves complexion, strength, ojas and vitality. Thus punarnavadi arishta is described [34-38]
Triphaladyarishta
फलत्रिकं दीप्यकचित्रकौ च सपिप्पलीलोहरजो विडङ्गम्|
चूर्णीकृतं कौडविकं द्विरंशं क्षौद्रं पुराणस्य तुलां गुडस्य||३९||
मासं निदध्याद्घृतभाजनस्थं यवेषु तानेव निहन्ति रोगान्|
ये चार्शसां पाण्डुविकारिणां च प्रोक्ता हिताः शोफिषु तेऽप्यरिष्टाः||४०||
इति त्रिफलाद्यरिष्टः
Make decoction from the coarse powder of 160 gm each of triphala, ajawan, chitraka, pippali, iron bhasma and vidanga. To this decoction add 320 ml of honey and 4 kg of jaggery and put it in a vessel lined with ghee and place in a heap of barley for a month. Its oral administration cures all the diseases mentioned above. Thus triphaladyarishtha is described.
The asava and arishtha mentioned for the treatment of piles and anemia are also beneficial for relieving the edema [39-40]
Powder preparations for edema
कृष्णा सपाठा गजपिप्पली च निदिग्धिका चित्रकनागरे च|
सपिप्पलीमूलरजन्यजाजीमुस्तं च चूर्णं सुखतोयपीतम्||४१||
हन्यात्त्रिदोषं चिरजं च शोफं कल्कश्च भूनिम्बमहौषधस्य|
अयोरजस्त्र्यूषणयावशूकचूर्णं च पीतं त्रिफलारसेन||४२||
Use of any one of the following powder preparations cures chronic edema caused by all the three dosha:
The mixture of the powders of pippali, pippalimula, pāthā, gajapippali, cumin, kantakāri, chitraka, dried ginger, turmeric, cumin and mustaka taken with lukewarm water, or paste of bhumyāmalaki and dried ginger taken with lukewarm water or bhasma of iron, trikatu and yavakshara taken with decoction of triphala [41-42]
Ksharagudika
क्षारद्वयं स्याल्लवणानि चत्वार्ययोरजो व्योषफलत्रिके च|
सपिप्पलीमूलविडङ्गसारं मुस्ताजमोदामरदारुबिल्वम्||४३||
कलिङ्गकाश्चित्रकमूलपाठे यष्ट्याह्वयं सातिविषं पलांशम्|
सहिङ्गुकर्षं त्वणुशुष्कचूर्णं द्रोणं तथा मूलकशुण्ठकानाम्||४४||
स्याद्भस्मनस्तत् सलिलेन साध्यमालोड्य यावद्घनमप्रदग्धम्|
स्त्यानं ततः कोलसमां तु मात्रां कृत्वा सुशुष्कां विधिनोपयुञ्ज्यात्||४५||
प्लीहोदरश्वित्रहलीमकार्शःपाण्ड्वामयारोचकशोषशोफान्|
विसूचिकागुल्मगराश्मरीश्च सश्वासकासाः प्रणुदेत् सकुष्ठाः||४६||
इति क्षारगुडिका
Take 40 gm fine powder each of svarajjikā and yava-kshara, four varieties of salt, iron bhasma, trikatu, triphala, pippalimula, pealed seeds of vidanga, mustaka, ajamodā, devadāru, bilva, indrayava, root of chitraka, pāthā, ativishā and liquorice; 10 gm of asafetida and 1.024 Kg of dried radish and dried ginger. Add water to it and heat the mixture till it becomes thick taking care that it should not seared and from it make pills of 5 gm each and dry them.
Properly administered pills cure splenomegaly, leukoderma, halimaka (greenish coloration of the skin), piles, anemia, anorexia, emaciation, edema, gastroenteritis, gulma, synthetic poisoning, lithiasis, dyspnea, cough and dermatosis. Thus ksharagudika is described [43-46]
Course of gud-adraka
प्रयोजयेदार्द्रकनागरं वा तुल्यं गुडेनार्धपलाभिवृद्ध्या|
मात्रा परं पञ्चपलानि मासं जीर्णे पयो यूषरसाश्च भक्तम्||४७||
गुल्मोदरार्शःश्वयथुप्रमेहाञ् श्वासप्रतिश्यालसकाविपाकान्|
सकामलाशोषमनोविकारान् कासं कफं चैव जयेत् प्रयोगः||४८||
Mix equal quantity of jaggery and ginger and take it in 20 gm dose initially and then increase its dose by 20 gm daily till the dose becomes 200 gm per day. Then this dose is to be continued for the remaining days of the month. During this treatment, on digestion of the drug, rice gruel and milk or meat soup should be given to eat.
The one month course cures gulma, udararoga, piles, edema, polyuria, dyspnea, coryza, cough, alasaka, indigestion, jaundice, consumption, mental disorders and kapha disorders [47-48]
Course of shilajatu
रसस्तथैवार्द्रकनागरस्य पेयोऽथ जीर्णे पयसाऽन्नमद्यात्|
जत्वश्मजं [१३] च त्रिफलारसेन हन्यात्त्रिदोषं श्वयथुं प्रसह्य||४९||
इति शिलाजतुप्रयोगः
Similarly juice of ginger may be taken with shilajatu for one month in the doses and manner mentioned above. On getting the hunger food should be taken with milk.
A month’s course of shilājatu with juice of triphalā will completely cure the edema/swelling caused by all the three dosha. Thus course of shilājatu is described [49]
Kamsa haritaki
द्विपञ्चमूलस्य पचेत् कषाये कंसेऽभयानां च शतं गुडस्य|
लेहे सुसिद्धेऽथ विनीय चूर्णं व्योषं त्रिसौगन्ध्यमुषास्थिते च||५०||
प्रस्थार्धमात्रं मधुनः सुशीते किञ्चिच्च चूर्णादपि यावशूकात्|
एकाभयां प्राश्य ततश्च लेहाच्छुक्तिं निहन्ति श्वयथुं प्रवृद्धम्||५१||
श्वासज्वरारोचकमेहगुल्मप्लीहत्रिदोषोदरपाण्डुरोगान्|
कार्श्यामवातावसृगम्लपित्तवैवर्ण्यमूत्रानिलशुक्रदोषान्||५२||
इति कंसहरीतकी
Make 2.56 liter decoction of dashamula and add to it haritaki 100 in number and 4.0 kg of jaggery and powder of trikatu and trijata (three aromatics- leaves and bark of cinnamon and cardamom). Leave it overnight and next morning on cooling adds 320 gm of honey and little quantity of yavakshara.
Take it in the dose of 10 gm along with one haritaki. It will cure severe edema and also dyspnea, fever, anorexia, polyuria, gulma, splenic-disorders, sannipātika-udararoga, anemia, emaciation, rheumatoid arthritis, bleeding disorders, hyperchlorhydria, discoloration of skin and vata disorders of urine and semen. Thus kaṁsaharītakī is described [50-52]
Patoladi kashaya
पटोलमूलामरदारुदन्तीत्रायन्तिपिप्पल्यभयाविशालाः|
यष्ट्याह्वयं तिक्तकरोहिणी च सचन्दना स्यान्निचुलानि दार्वी||५३||
कर्षोन्मितैस्तैः क्वथितः कषायो घृतेन पेयः कुडवेन युक्तः|
वीसर्पदाहज्वरसन्निपाततृष्णाविषाणि श्वयथुं च हन्ति||५४||
Make decoction of 10 gm each of roots of patola, devadāru, danti, trāyamānā, pippali, haritaki, indrāyana, liquorices, sandal wood, katukā, dāruhridrā and samudraphala. This decoction should be taken with 160 gm of ghee. It cures visarpa (erysipelas), burning sensation, fever, sannipāta thirst, poisoning and edema [53-54]
Chitraka ghrita
सचित्रकं [१४] धान्ययवान्यजाजीसौवर्चलं त्र्यूषणवेतसाम्लम्|
बिल्वात् फलं दाडिमयावशूकौ सपिप्पलीमूलमथापि चव्यम्||५५||
पिष्ट्वाऽक्षमात्राणि जलाढकेन पक्त्वा घृतप्रस्थमथ प्रयुञ्ज्यात्|
अर्शांसि गुल्मं श्वयथुं कृच्छ्रं निहन्ति वह्निं च करोति दीप्तम्||५६||
Make paste of 10 gm each of chitraka, coriander, ajawan, cumin, sauvarchala-salt, trikatu, amlavetasa, bilva, pomegranate, yavakṣāra, pippalimula and chavya; add to it 640 gm of ghee and 2.56 liter of water. Prepare ghrita as per sneha pāka method.
Oral administration of chitraka ghee cures edema/swelling even if it is difficult to cure as well as piles and gulma and stimulate the digestion and metabolism (agni). [55-56]
पिबेद्घृतं वाऽष्टगुणाम्बुसिद्धं सचित्रकक्षारमुदारवीर्यम्|
कल्याणकं वाऽपि सपञ्चगव्यं तिक्तं महद्वाऽप्यथ तिक्तकं वा||५७||
Prepare a ghrita with eight times of water with paste of chitraka and yavakshara. It has great potency. The patient may also take the kalyānaka ghrita or panchagavya ghrita or mahātikta ghrita or tikta ghrita [57]
क्षीरं घटे चित्रककल्कलिप्ते दध्यागतं साधु विमथ्य तेन|
तज्जं घृतं चित्रकमूलगर्भं तक्रेण सिद्धं श्वयथुघ्नमग्र्यम्||५८||
अर्शोऽतिसारानिलगुल्ममेहांश्चैतन्निहन्त्यग्निबलप्रदं [१५] च|
तक्रेण चाद्यात् सघृतेन तेन भोज्यानि सिद्धामथवा यवागूम्||५९||
इति चित्रकघृतम्
Put milk in a pot coated with paste of chitraka and curdle it. Churn this curd well to get butter which is heated to ghee. Add to the ghee all the buttermilk (which contains mixed chitraka also) from the pot and prepare the medicated ghrita. It is best to cure edema. It also provides relief in piles, diarrhea, vata-gulma, polyuria and stimulates digestion and metabolism (agni).
During the treatment the diet should be taken with buttermilk prepared as above with chitraka along with ghee prepared from the above butter or gruels prepared with this butter milk and ghee. Thus chitraka ghrita is described [58-59]
Yavagu preparations
जीवन्त्यजाजीशटिपुष्कराह्वैः सकारवीचित्रकबिल्वमध्यैः|
सयावशूकैर्बदरप्रमाणैर्वृक्षाम्लयुक्ता घृततैलभृष्टा||६०||
अर्शोऽतिसारानिलगुल्मशोफहृद्रोगमन्दाग्निहिता यवागूः|
या पञ्चकोलैर्विधिनैव [१६] तेन सिद्धा भवेत् सा च समा तयैव||६१||
Take 5 gm each of jivanti, cumin, saṭi, pushkarmula, karvi (celery), chitraka, bilva and yavakashara, make a medicated gruel (yavāgu) and then fry it in ghee and oil. This gruel taken by adding vrikshamla cures piles, diarrhea, vata gulma, edema, heart disease and low digestion.
The medicated yavāgu (gruel) similarly prepared with panchakola also gives the same relief as mentioned above (60-61).
Pathya (wholesome food) for shotha
कुलत्थयूषश्च सपिप्पलीको मौद्गश्च सत्र्यूषणयावशूकः|
रसस्तथा विष्किरजाङ्गलानां सकूर्मगोधाशिखिशल्लकानाम्||६२||
सुवर्चला गृञ्जनकं पटोलं सवायसीमूलकवेत्रनिम्बम्|
शाकार्थिनां शाकमिति प्रशस्तं भोज्ये पुराणश्च यवः सशालिः||६३||
Followings diet articles are wholesome for the patient of edema/swelling:
- Soup of kulattha mixed with long piper
- Soup of munga mixed with trikatu and yavakshara
- Meat soup of gallinaceous and wild creatures,
- Meat soup of tortoise, iguana, peacock and pangolin,
- Vegetables such as heliotrope, turnip, makoya (wild snake gourd), radish, vetra, neem and patola
- Old shali rice and old barley [62-63]
External applications
आभ्यन्तरं भेषजमुक्तमेतद्बर्हिर्हितं यच्छृणु तद्यथावत्|
स्नेहान् प्रदेहान् परिषेचनानि स्वेदांश्च वातप्रबलस्य कुर्यात्||६४||
Thus internal preparations have been described. Now external preparations beneficial for the patient of swelling will be described. Snehana, swedana, smearing with pastes and effusions should be done in a patient having dominance of vata swelling [64]
Shaileyadi taila
शैलेयकुष्ठागुरुदारुकौन्तीत्वक्पद्मकैलाम्बुपलाशमुस्तैः|
प्रियङ्गुथौणेयकहेममांसीतालीशपत्रप्लवपत्रधान्यैः||६५||
श्रीवेष्टकध्यामकपिप्पलीभिः स्पृक्कानखैश्चैव यथोपलाभम्|
वातान्वितेऽभ्यङ्गमुशन्ति तैलं सिद्धं सुपिष्टैरपि च प्रदेहम्||६६||
Take kuṣṭha, aguru, devadāru, kaunti, cinnamon, padmaka, cardamom, sugandhabālā, palāśa, mustaka, priyangu, thauneyaka, nāgakeśara, jatāmāmsi, tālisapatra, plava, tejapatra, coriander, sriveshtaka, dhyāmaka, piper longum, sprikkā and nakha. Make paste of all or as much as drugs available and prepare medicated oil from it. In vata edema, do massage with this oil. Alternatively make paste of the entire drugs and apply on the body of the patient as smear [65-66]
Medicated water for bath
जलैश्च वासार्ककरञ्जशिग्रुकाश्मर्यपत्रार्जकजैश्च सिद्धैः|
स्विन्नो मृदूष्णै रवितप्ततोयैः स्नातश्च गन्धैरनुलेपनीयः||६७||
Add leaves of vāsā, arka, karanja, sigru, kashmarya and holy basil in hot water and take sudation with this tolerably hot water. Then the patient should take bath with water heated in sun and apply aromatics on the body [67]
External application in pitta dominance
सवेतसाः क्षीरवतां द्रुमाणां त्वचः समञ्जिष्ठलतामृणालाः|
सचन्दनाः पद्मकवालकौ च पैत्ते प्रदेहस्तु सतैलपाकः||६८||
आक्तस्य तेनाम्बु रविप्रतप्तं सचन्दनं साभयपद्मकं च|
स्नाने हितं क्षीरवतां कषायः क्षीरोदकं चन्दनलेपनं च||६९||
Prepare medicated oil from vetasa, manjiṣhthā, mrināla, sandal, padmaka and khasha and bark of latex-exuding plants. Apply this oil on the body to relieve pitta swelling. Thereafter, bathing with medicated water prepared with sandal, khaśa and padmaka and heated by sun rays or with water prepared with latex-exuding plants or water mixed with milk is beneficial. Smearing with paste of sandalwood is also beneficial [68-69]
External application in kapha dominance
कफे तु कृष्णासिकतापुराणपिण्याकशिग्रुत्वगुमाप्रलेपः|
कुलत्थशुण्ठीजलमूत्रसेकश्चण्डागुरुभ्यामनुलेपनं च||७०||
In kapha dominant edema, application of paste of long pepper, sand, old oil-cake, bark of drum-stick and linseed is advised. Effusion with decoction of kulattha (hoarse gram), dry ginger and cow’s urine followed by anointing of the body with paste of sandal and aguru is also beneficial (70).
External application in burning sensation
बिभीतकानां फलमध्यलेपः सर्वेषु दाहार्तिहरः प्रदिष्टः|
यष्ट्याह्वमुस्तैः सकपित्थपत्रैः सचन्दनैस्तत्पिडकासु लेपः||७१||
In all types of swelling, smearing with paste of fruit of vibhitaka is recommended to cure burning sensation and discomfort. The topical application of paste of leaves of kapittha (wood apple), sandal, liquorices and mustaka provides relief in papules [71]
रास्नावृषार्कत्रिफलाविडङ्गं शिग्रुत्वचो मूषिकपर्णिका च|
निम्बार्जकौ व्याघ्रनखः सदूर्वा सुवर्चला तिक्तकरोहिणी च||७२||
सकाकमाची बृहती सकुष्ठा पुनर्नवा चित्रकनागरे च|
उन्मर्दनं शोफिषु मूत्रपिष्टं शस्तस्तथा मूलकतोयसेकः||७३||
Take rāsnā, vāsā, arka, triphalā, vidanga, bark of sigru, mushakaparni, neem, holy basin, nails of vyāghra (shell), durvā, sunflower, katukā, kākamāchi, brihati, kuṣtha, punarnavā, chitraka and dry ginger and make paste with cow’s urine. Unmardana type of massage with it is beneficial for swelling. Also effusion done with water boiled with above drugs is beneficial [72-73]
Various types of local swellings
शोफास्तु गात्रावयवाश्रिता ये ते स्थानदूष्याकृतिनामभेदात्|
अनेकसङ्ख्याः कतिचिच्च तेषां निदर्शनार्थं गदतो निबोध||७४||
The swelling occurring in one limb or organ is of many types owing to their different classifications based on involved site, duṣhya, shape and name. Listen to the descriptions of some of them being given as illustration [74]
Shira Shopha (cellulitis of head) and Salūka (quinsy)
दोषास्त्रयः स्वैः कुपिता निदानैः कुर्वन्ति शोफं शिरसः सुघोरम्|
अन्तर्गले घुर्घुरिकान्वितं च शालूकमुच्छ्वासनिरोधकारि||७५||
All the three dosha, provoked by indulging in their etiological factors produce severe inflammation of head. When it affects inside of the throat, it produces sālūka, which is accompanied with stertorous breathing and obstruction to expiration [75]
Bidalika (Ludwig’s angina)
गलस्य सन्धौ चिबुके गले च सदाहरागः श्वसनासु चोग्रः|
शोफो भृशार्तिस्तु बिडालिका स्याद्धन्याद्गले चेद्वलयीकृता सा||७६||
Acute swelling at the junction of throat behind the chin i.e. in trachea with redness and burning sensation in throat and causes obstruction to breathing with very much discomfort is known as biḍālikā. It kills the patient if folds are formed in throat [76]
Talu-vidradhi (palatal abscess), upajihvika (superficial glossitis) and adhijihvikā (sub-lingual glossitis)
स्यात्तालुविद्रध्यपि दाहरागपाकान्वितस्तालुनि सा त्रिदोषात्|
जिह्वोपरिष्टादुपजिह्विका स्यात् कफादधस्तादधिजिह्विका च||७७||
Abscess in palate caused by tridosha with burning sensation, redness and pus formation is known as tālu-vidradhi.
Swelling due to kapha occurring on the upper part of tongue is called upajihvikā (acute superficial glossitis) and which occurs sublingual part is called adhijihvikā (sub lingual glossitis) [77]
Upakusha (gingivitis) and danta-vidradhi (dental abscess)
यो दन्तमांसेषु तु रक्तपित्तात् पाको भवेत् सोपकुशः प्रदिष्टः|
स्याद्दन्तविद्रध्यपि दन्तमांसे शोफः कफाच्छोणितसञ्चयोत्थः||७८||
Provoked rakta and pitta causes suppuration of the gums and it is called upakusha. Accumulation of kapha and rakta produces elevated swelling in gums and it is known as danta-vidradhi [78]
Galaganḍa (goiter),gandamala (cervical adenitis) and its management
गलस्य पार्श्वे गलगण्ड एकः स्याद्गण्डमाला बहुभिस्तु गण्डैः|
साध्याः स्मृताः पीनसपार्श्वशूलकासज्वरच्छर्दियुतास्त्वसाध्याः||७९||
Single glandular swelling on the (middle) of neck is called galagaṇḍa (goiter) but if there are many nodular swellings making a chain like appearance, is known as gandamālā. Generally they are curable but if accompanied with coryza, pain in side of the chest, cough, fever and vomiting then they are incurable [79]
तेषां सिराकायशिरोविरेका धूमः पुराणस्य घृतस्य पानम्|
स्याल्लङ्घनं वक्त्रभवेषु चापि प्रघर्षणं स्यात् कवलग्रहश्च||८०||
In all the above mentioned conditions blood-letting, purgation, nasya, dhuma (medicated smoking therapy) and intake of old ghee is beneficial.
For the conditions specially affecting mouth, the line of treatment is langhana and rubbing with medicated powders and mouth washes (kavala) are beneficial [80]
Granthi (nodule) and its management
अङ्गैकदेशेष्वनिलादिभिः स्यात् स्वरूपधारी स्फुरणः सिराभिः|
ग्रन्थिर्महान्मांसभवस्त्वनर्तिर्मेदोभवः स्निग्धतमश्चलश्च||८१||
Swelling occurring in one organ or region due to vata or other dosha may be diagnosed on the basis of their characteristic symptoms. The swelling occurring in vessels are pulsating in nature. The nodular swelling occurring in muscles is large in size. Swelling of the adipose tissues is excessively unctuous and movable [81]
Surgical management of granthi
संशोधिते स्वेदितमश्मकाष्ठैः साङ्गुष्ठदण्डैर्विलयेदपक्वम्|
विपाट्य चोद्धृत्य भिषक् सकोशं शस्त्रेण दग्ध्वा व्रणवच्चिकित्सेत्||८२||
If the tumor is non-suppurative then after purification therapy, local sudation of the swelling should be done. Then the physician should try to dissolve the swelling by rubbing with stone or wooden apparatus or with manipulation of thumb or of a rod. Then it should be cut open and take out the tumor with its capsule. Then it should be cauterized and treatment of regular wound should be adopted [82]
अदग्ध ईषत् परिशेषितश्च प्रयाति भूयोऽपि शनैर्विवृद्धिम्|
तस्मादशेषः कुशलैः समन्ताच्छेद्यो भवेद्वीक्ष्य शरीरदेशान्||८३||
शेषे कृते पाकवशेन शीर्यात्ततः क्षतोत्थः प्रसरेद्विसर्पः|
उपद्रवं तं प्रविचार्य तज्ज्ञस्तैर्भेषजैः पूर्वतरैर्यथोक्तैः||८४||
निवारयेदादित एव यत्नाद्विधानवित् स्वस्वविधिं विधाय|
ततः क्रमेणास्य यथाविधानं व्रणं व्रणज्ञस्त्वरया चिकित्सेत्||८५||
If the tumor is not properly cauterized or if some of its part is left out then it starts gradually increasing again. In that case it should be removed completely by opening from all sides by the skillful surgeon keeping in view the regional anatomy. If some portion is still left then it may suppurate and slough and may lead to complication of visarpa (erysipelas). The surgeon considering it as the severe complication first should try to treat it with great care by appropriate remedies described earlier. Therefore the wound specialist should quickly treat it in the prescribed manner following the appropriate line of treatment [83-85]
विवर्जयेत् कुक्ष्युदराश्रितं च तथा गले मर्मणि संश्रितं च|
स्थूलः खरश्चापि भवेद्विवर्ज्यो यश्चापि बालस्थविराबलानाम्||८६||
The tumors occurring in flanks, abdomen, in the throat and in vital organs are incurable. Similarly tumors of big size and indurated which occurs in children, aged and weak are also incurable [86]
Differential diagnosis of arbuda (tumor)
ग्रन्थ्यर्बुदानां च यतोऽविशेषः प्रदेशहेत्वाकृतिदोषदूष्यैः|
ततश्चिकित्सेद्भिषगर्बुदानि विधानविद्ग्रन्थिचिकित्सितेन||८७||
There is no much difference in nodules and tumors with regards to site, causative factors, shape, dosha morbidity and dushya (susceptible tissues). Therefore, tumor specialist should treat the tumor on the line of nodules described above [87]
Alaji and akshata (whitlow)
ताम्रा सशूला पिडका भवेद्या सा चालजी नाम परिस्रुताग्रा|
शोफोऽक्षतश्चर्मनखान्तरे स्यान्मांसास्रदूषी भृशशीघ्रपाकः||८८||
Appearing of copper colored papules with acute pain from which pus oozes out is known as alajī. The severe inflammation occurring by vitiating flesh and blood in the skin adjoining nail which suppurates quickly is known as akṣata [88]
Vidarika (lymphadenitis) and its management
ज्वरान्विता वङ्क्षणकक्षजा या वर्तिर्निरर्तिः कठिनायता च|
विदारिका सा कफमारुताभ्यां तेषां यथादोषमुपक्रमः स्यात्||८९||
विस्रावणं पिण्डिकयोपनाहः पक्वेषु चैव व्रणवच्चिकित्सा|
Painless cylindrical and hard swelling in the groin or axillary region accompanied with fever is known as vidārikā. It occurs due to vitiation of kapha and vata and should be managed according to the treatment of these dosha, which include bloodletting, pinda sweda, upanāha and on suppuration it should be treated on the line of abscess [89]
Visphotaka (eruption)
विस्फोटकाः सर्वशरीरगास्तु स्फोटाः [२७] सरागज्वरतर्षयुक्ताः||९०||
Red colored eruptions occurring all over the body along with fever and thirst are known as visphōṭaka (90).
Kaksha (herpes zoster)
यज्ञोपवीतप्रतिमाः प्रभूताः पित्तानिलाभ्यां जनितास्तु कक्षाः [२८] |
याश्चापराः स्युः पिडकाः प्रकीर्णाः स्थूलाणुमध्या अपि पित्तजास्ताः||९१||
Multiple eruptions occurring on the trunk due to pitta and vata where usually Hindu holy thread is worn, is known as kakṣā.
Other such types of eruptions (pidikā) whether big, medium or small are also due to pitta [91]
Romantika (measles)
क्षुद्रप्रमाणाः पिडकाः शरीरे सर्वाङ्गगाः सज्वरदाहतृष्णाः|
कण्डूयुताः सारुचिसप्रसेका रोमान्तिकाः पित्तकफात् प्रदिष्टाः||९२||
Small sized eruption all over the body due to pitta and kapha along with fever, burning sensation, thirst, itching, anorexia and salivation are known as romāntikā (measles) [92]
Masurika (chickenpox) and its management
याः सर्वगात्रेषु मसूरमात्रा मसूरिकाः पित्तकफात् प्रदिष्टाः|
वीसर्पशान्त्यै विहिता क्रिया या तां तेषु कुष्ठे च हितां विदध्यात्||९३||
Eruptions similar to size and shape of lentil (masura) occurring all over the body due to pitta and kapha is known as masurikā; the treatment described for visarpa should is also adopted for it. For visphotaka etc., treatment described for kuṣtha should be adopted [93]
Bradhna (hernia) and its management
ब्रध्नोऽनिलाद्यैर्वृषणे स्वलिङ्गैरन्त्रं निरेति प्रविशेन्मुहुश्च|
मूत्रेण पूर्णं मृदु मेदसा चेत् स्निग्धं च विद्यात् कठिनं च शोथम्||९४||
विरेचनाभ्यङ्गनिरूहलेपाः पक्वेषु चैव व्रणवच्चिकित्सा|
स्यान्मूत्रसेकः कफजं विपाट्य विशोध्य सीव्येद्व्रणवच्च पक्वम्||९५||
Due to vata or other dosha, the intestine frequently enters into scrotum and comes out and this condition is known as bradhna (hernia).
If liquid (mutra) accumulates in scrotum then the swelling is soft (hydrocele).
If fat accumulates in scrotum it is hard and unctuous.
Its treatment is virechana karma, oil massage, niruha basti and smearing of paste. If it suppurates then treatment of ulcer (vrana) should be adopted.
If there is oozing of liquid (mutra) and the swelling is due to kapha, then it should be open up, cleaned and sutured as per line of treatment of ulcer [94-95]
Bhagandara (fistula-in-ano) and its management
क्रिम्यस्थिसूक्ष्मक्षणनव्यवायप्रवाहणान्युत्कटकाश्वपृष्ठैः |
गुदस्य पार्श्वे पिडका भृशार्तिः पक्वप्रभिन्ना तु भगन्दरः स्यात्||९६||
विरेचनं चैषणपाटनं च विशुद्धमार्गस्य च तैलदाहः|
स्यात् क्षारसूत्रेण सुपाचितेन छिन्नस्य चास्य व्रणवच्चिकित्सा||९७||
On the lateral side of anus, a very painful pustule (pidika) occurs which suppurates and opens up; it is known as bhagandara (fistula-in-ano). It is caused by infection (krimi), injury with pointed object like bone leading to minute erosion, excessive sex, straining at defecation and friction due to sitting on hard seat of a horse or moving object.
Its treatment is virechana, probing, cutting and after cleansing cauterization with hot oil. If surgery is contraindicated then kshara-sutra should be applied and during and after cutting the track, routine line of management of ulcer is adopted [96-97]
Shlipada (elephantiasis) and its management
जङ्घासु पिण्डीप्रपदोपरिष्टात् [३५] स्याच्छ्लीपदं मांसकफास्रदोषात्|
सिराकफघ्नश्च विधिः समग्रस्तत्रेष्यते सर्षपलेपनं च||९८||
The provoked kapha and rakta by involving flesh causes edema which begins from the upper part of the foot and spreads up to calf-muscle or shank; it is known as shlipada (elephantiasis). Its treatment is vene-section and local application of paste of mustard-seed as well as all other anti-kapha treatment [98]
Jalakagardabha and its management
मन्दास्तु पित्तप्रबलाः प्रदुष्टा दोषाः सुतीव्रं तनुरक्तपाकम्|
कुर्वन्ति शोथं ज्वरतर्षयुक्तं विसर्पणं जालकगर्दभाख्यम्||९९||
विलङ्घनं रक्तविमोक्षणं च विरूक्षणं कायविशोधनं च|
धात्रीप्रयोगाञ् शिशिरान् प्रदेहान् कुर्यात् सदा जालकगर्दभस्य||१००||
Mildly provoked dosha with dominance of pitta causes very acute inflammation which slightly bleeds and suppurates, has a tendency of quick spreading and is accompanied by fever and thirst is known as jalakagardabha.
Its treatment is langhana (lightening therapy), blood-letting, un-unctuous therapy, virechana, use of amalaki and application of paste of drugs having cold potency [99-100]
एवंविधांश्चाप्यपरान् परीक्ष्य शोथप्रकाराननिलादिलिङ्गैः|
शान्तिं नयेद्दोषहरैर्यथास्वमालेपनच्छेदनभेददाहैः||१०१||
Other types of inflammatory swellings may be diagnosed on the basis of the characteristic symptoms of the involved vata and other dosha. It may also be managed by prescribing the treatment of involved dosha as well as by application of paste, incision and excision [101]
General guidelines of management
प्रायोऽभिघातादनिलः सरक्तः शोथं सरागं प्रकरोति तत्र|
वीसर्पनुन्मारुतरक्तनुच्च कार्यं विषघ्नं विषजे च कर्म||१०२||
Generally external trauma causes reddish swelling due to provocation of vata and rakta. It should be treated with drugs used for the treatment of visarpa and provoked vata and rakta.
If the swelling is caused by poisonous substances then it should be treated with anti-poison measures [102]
Summary
तत्र श्लोकः-
त्रिविधस्य दोषभेदात् सर्वार्धावयवगात्रभेदाच्च|
श्वयथोर्द्विविधस्य तथा लिङ्गानि चिकित्सितं चोक्तम्||१०३||
Re-capitulatory verses-
Three types of swelling as per involvement of dosha; classification of swelling according to involvement whole or half body or one part; exogenous and endogenous swelling; their symptoms and treatment have been described [103]
इत्यग्निवेशकृते तन्त्रेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने श्वयथुचिकित्सितं नाम द्वादशोऽध्यायः||१२||
Thus 12th chapter named Shvayathu Chikitsa in Chikitsa Sthana of treatise compiled by Agnivesha, revised by Charaka and unavailable part restored by Dridhabala is completed (12).
Tattva Vimarsha (Fundamental Principles)
- Shotha is caused by dietary causes like excessive use of kshara (alkali) or food articles having sour, sharply acting, hot and heavy properties by an emaciated or weak person due to excessive shodhana, fasting or disease; excessive intake of curd, raw food articles, soil, leafy vegetables, mutually contradictory food articles (virodhi), spoiled or mixed with toxic substance (such as pesticide), or a person suffering from piles, having sedentary life style, nonperforming of shodhana therapy even if indicated, injury to vital organs (marma), abnormal delivery, due to improper treatment and as complication of improper purification treatment.
- Exogenous causes include trauma or injuries of various types and have acute pathogenesis.
- The pathogenesis of nija shotha includes obstruction of morbid vāta by vitiated kapha, rakta and pitta at the site of peripheral superficial vessels. This vitiated vata (due to obstruction) spreads to the various places causing swelling as its cardinal symptom.
- Rise in temperature, burning sensation as if burnt by fire and dilation of the vessels are the prodromal symptoms of swelling.
- All types of swelling are produced by involvement of all the three dosha but they are named based on the predominance of that particular dosha. The line of treatment is also according to the dominant dosha.
- The swelling in a patient who is neither emaciated nor weak; that involved single dosha or is of recent origin is easily curable.
- If swelling is associated with ama it should be managed first by prescribing lightening therapy (langhana) and digestive drugs. Only after that shodhana therapy should be undertaken according to dominant dosha. General lines of treatment of doshaja swelling are as follows:
- If it involves head then shiro-virechana is prescribed;
- If it involves lower parts of the body then virechana (therapeutic purgation) is prescribed;
- If it involves upper parts of the body then vamana (therapeutic emesis)is prescribed;
- If it is caused by unctuous then rukshana (drying) therapy is done;
- If it is caused by un-unctuous (ruksha) then unctuous (snehana) therapy is done;
- If vata swelling is associated with constipation then it should be treated with niruha basti;
- If it is caused by vata-pitta then it should be treated with ghee prepared with bitter drugs;
- If the patient is suffering from associated symptoms such as fainting, pain, burning sensation and thirst then it should be treated with intake of milk;
- If the patient is suffering from swelling where shodhana is required then milk mixed with cow’s urine should be given;
- If the patient is suffering from kapha swelling then kshara or pungent and hot articles mixed in cow’s urine or buttermilk or asava are given.
- Generally external trauma causes reddish swelling due to provocation of vata and rakta. It should be treated with drugs used for the treatment of visarpa and provoked vata and rakta. If the swelling is caused by poisonous substances then it should be treated with anti-poison measures (102).
Vidhi Vimarsha (Applied Inferences )
Derivation of term
The word Shvayathu is derived from root Tuoshchi-Gati-Vriddhyoh. Tuo is converted to Shvi indicating to increase (Vriddhi) and by adding Athuc Pratyaya the word Shvayathu is derived which literally means increased (3).
Pathogenesis
In pathogenesis of shotha there is involvement of superficial veins (Bahya shira). Involvement of circulatory or lymphatic system is must in producing the shotha.
Types of shotha
Vata shotha is shifting in nature, pitting on pressure and increases in the day time and may vanish without visible cause. Further vata causes edema of the lower part of the body i. e feet and legs. All these characteristics of vata shotha are indicative cardiac edema.
In day time due to various activities and fatigue vata gets increased leading to increase in the edema. From modern point of view, cardiac edema increases in the evening which is vata kala due to the day activities. Vata shotha is pitting on pressure but on removing the pressure it immediately takes its original shape.
Pitta sopha begins from middle parts of the body and then spreads to the other parts and has yellow-reddish color[1]. Yellowish coloration indicates involvement of liver. Inflammatory swelling is related to pittaja shotha .
Kapha Shotha slightly pits on pressure but takes long time to attain its original position after removing the pressure and increases at night. It develops slowly and also takes long time to subside. Kapha shotha occurs in upper part of the body and the treatment of edema occurring on the upper part is vamana i.e. of kapha. On this basis it can be said that which mainly includes face. Renal edema occurs on the face in the morning (noticed on awakening though increased in the night). Other important sign is it is hard and the serous discharge comes out on scratching the skin [2]. This indicates that hard non-pitting edema of elephantiasis may also be included under it. Other symptom mentioned for kaphaja shotha that the patient like warm touch indicates towards edema found in hypothyroidism (14).
Complications
Complications of shotha are vomiting, dyspnea, anorexia, thirst, fever, loose motions and weakness (Cha. Sa. Sutra Sthana chapter 18/18]. Sushruta mentions two additional complications viz. cough and hiccups.[3](15)
Sushruta classify general edema in five types viz., vata, pitta, kapha, sannipata and vishaja[4] but does not consider local swelling as the part of shopha because while defining swelling it is clearly mentioned that which occurs in the large part under the skin and flesh etc but is other than nodules (granthi), abscess (vidradhi), alaji etc is known as shopha [5]
Ashtangahridaya describes shopha in the chapter on panduroga (anemia) because it is a main complication of anemia. Nine types of shopha described therein are three single dosha type, three samsarga types, one tridoshaja and one each due to trauma and poison. In addition three new types of shopha viz. prithu (extensive), unnata (elevated) and grathita (compact) are also mentioned.[6].
Madhava Nidana followed Ashtangahridaya and describes nine types of shotha and does not describe localized shotha in this chapter on shotha [7].
Charaka considers bulging (utsedha) from the skin as shvayathu therefore local swellings such as pidika (papules and pustules), nodules (including gandhamala), galagandha (goiter), tumor etc are also described in this chapter. The probable modern equivalents are given in the bracket while describing these conditions in the text (74-100).
Sushruta defines arbuda as a round and immovable growth produced by vitiated dosha by afflicting mamsa with mild pain but having deep roots and located in extensive area at the expense of tissue and causes swelling of the mamsa extensively. This arbuda (tumor) grows slowly and does not suppurate [8]. But Charaka being a clinician does not consider much difference in the management of arbuda and granthi as their site, causative factors, shape, dosha morbidity and dushya (susceptible tissues) are about the same. However, it is clearly mentioned that arbuda should be managed by the expert surgeon only (87).
Line of treatment, various procedures and preparations mentioned in this chapter for the management of various types of swellings are easy to administer and practical so should be practiced (16-73).
Shat-kriya-kala of shotha
- Sanchaya (Accumulation): This is the first stage of the disease where due to indulgence into the causative factors accumulation of concerned dosha occurs. During this stage increase in the normal functions of the dosha is noticed.
- Prakopa (Provocation): If the accumulated dosha are not properly taken care then they may go to the next stage of provocation. During this stage the prakopa symptoms of the involved dosha appear.
- Prasara (Spreading): In the stage of prasara the dosha leaves their normal site and starts circulating all over the body.
- Sthana-Smashrya (Localization): The circulating dosha interacts with such tissues which have some problem in their channels which may be anatomical, physiological or pathological. This phenomenon is dosha-dushya-samurchchana. This localization of dosha leads to beginning of the pathogenesis of the disease and during this stage prodromal symptoms (purva-rupa) of the disease are produced. The prodromal symptoms of edema are heat, burning sensation and dilation of the vessels.
- Vyakti (Manifestation): If the disease is not managed at the stage of localization then the disease manifest with its specific symptoms. The symptoms of various types of edema are mentioned in the verses from 11 to 16 of this chapter. All or few symptoms mentioned for the disease may appear but if all the symptoms appear then the disease may become incurable and if few then it is easily curable. Moderate appearance of the symptom indicates its moderate prognosis.
- Bheda (Complications): If the disease is not properly treated even after it is fully manifestation then the complications may appear and the disease becomes difficult to cure or incurable. The seven complications of edema are vomiting, thirst, anorexia, dyspnea, fever, diarrhea and weakness [ Cha. Sa. Sutra Sthana 18/18].
Differential Diagnosis of shotha
Ayurveda is a clinical science, therefore the classifications are also planned so that the disease can systematically be diagnosed on the basis of the symptoms. Shotha is a good example for it.
Shotha has been defined as any abnormal elevation from the skin. First question to be asked to the patient whether there is any history of trauma, biting etc and if yes, then it is an agantuja shotha. If there is a history of contact or taking poisonous substance then it is vishaja.
Hereafter it is to be confirmed that whether the swelling is localized or all over the body. If shotha is localized in single organ or site then it can be diagnosed on the basis of nature of the lesion such as papules, pustules, nodules, tumor etc. It is further diagnosed on the basis of shape, site etc. For example gandhamala is garland like and galagandha is scrotum like swelling in neck. Romantika has minute papules while masurika has lentil like papules and so on. Associated general features such as fever, thirst etc also helps in differential diagnosis.
If shotha is generalized swelling then the point of its beginning is important e.g. pitta shopha starts from middle part of the abdomen, vata from the lower parts and kapha from upper parts of the body. The consideration of other characteristic features mentioned above will help in reaching the final diagnosis.
For example moving, pitting on pressure, increasing in the day time and sometime subsides without appreciable cause etc help in reaching the diagnosis for vata shopha.
Swelling which is firm, slight pitting on pressure, increases in the night, takes long time to subside and is associated with low digestion, vomiting, anemia indicates towards kapha shotha.
Swelling which is soft, tender on touch, associated with change to yellow color, fever etc is pitta shotha.
Similarly causative factors can also be sorted out by asking whether it relates to food articles (curd, unripe fruits, spoiled, leafy vegetables) or its properties (excessive use of kshara, sour, sharp, hot and heavy food articles), diet habit (fasting), sedentary life style, emaciation or weakness due to a disease or excessive shodhana, contact to poisonous substances etc.
Chikitsa Sutra (Principles of treatment)
Ayurveda gives very importance to ama. Therefore, if ama is associated with swelling then first it should be managed by prescribing lightening therapy (langhana) and digestive drugs. After getting the nirama symptoms, shodhana therapy can be done according to dominant dosha. It is the general rule for all types of swellings.
Shiro-virechana is the choice of therapy for dosha situated in head. Therefore if the swelling involves the head then first nasya should be done.
Chest and the upper parts are the main sites of kapha and for its removal, vamana therapy is best. Therefore if swelling is situated in upper parts or begins from upper parts and then spreads to other parts or it is kapha type then first of all vamana (emesis) therapy is prescribed. Kshara or pungent and hot articles mixed in cow’s urine or buttermilk or asava are indicated after vamana therapy. If vamana therapy is not possible in the patient suffering from kapha swelling then these drugs may be given directly.
Generally basti is not preferred for the treatment of swelling, but if vata swelling is associated with constipation then it should be treated with niruha basti. Otherwise virechana is indicated for the swelling of lower part as well as of vata. The local swellings with symptom of inflammation may be treated by following the general line of treatment as mentioned above and other measures mentioned while describing their treatment in this chapter. If it belongs to shalya or shalakya type specialties, then let it be treated by the experts of the specialty.
Clinical practices
| Type | Formulations | Dosage | Time | Anupana |
|---|---|---|---|---|
| Vata dominant | Harina shringa mixture | 60-120 mg | In between two meals | Honey + Dashamularishta + Punarnavasa |
| Pitta dominant | Aarogya Mixture | 120-250 mg | In between two meals | Milk + saravadyasava + punarnavasava + vasakasava' |
| Kapha dominant | Gomutra Haritaki | 1-3 grams | In between two meals | Cow urine, honey |
| Punarnava mandura | 250-500 mg | In between two meals | Punarnavasava | |
| Gudadraka Yoga | 120-250 mg | In between two meals | Honey |
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References
- ↑ Vagbhata. Nidana Sthana, Cha.13 Pandurogasophavisarpa Nidana Adhyaya verse 33. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
- ↑ Vagbhata. Nidana Sthana, Cha.13 Pandurogasophavisarpa Nidana Adhyaya verse 35-36. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
- ↑ Sushruta. Chikitsa Sthana, Cha.23 Sopha Chikisitam Adhyaya verse 8-9. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
- ↑ Sushruta. Chikitsa Sthana, Cha.23 Sopha Chikisitam Adhyaya verse 3. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
- ↑ Sushruta. Sutra Sthana, Cha.17 Amapkweshaneeya Adhyaya verse 3 In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
- ↑ Vagbhata. Nidana Sthana, Cha.13 Pandurogasophavisarpa Nidana Adhyaya verse 21-42. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.
- ↑ Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--
- ↑ Sushruta. Nidana Sthana, Cha.11 Grandhiapachiarbudagalaganda Nidana Adhyaya verse 13-14 In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.