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|title=Trishothiya Adhyaya

|title=Trishothiya Adhyaya

|titlemode=append

|titlemode=append

|keywords=Swellings, endogenous causes, exogenous causes, shotha, nija-agantuja, generalized edema, localized edema, charak samhita, ayurveda

|keywords=Swellings, endogenous causes, exogenous causes, shotha, nija-agantuja, generalized edema, localized edema, Ayurveda, Indian system of medicine, charak samhita.

|description=Sutra Sthana Chapter 18.Three Types of Swellings and other conditions

|description=Sutra Sthana Chapter 18.Three Types of Swellings and other conditions

|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|type=article

|type=article

<big>'''Sutra Sthana Chapter 18.Three Types of Swellings and other conditions '''</big>

<big>'''Sutra Sthana Chapter 18.Three Types of Swellings and other conditions '''</big>

{{Infobox

{{Infobox

|label5 = Other Sections

|label5 = Other Sections

|data5 = [[Nidana Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|data5 = [[Nidana Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

}}

}}

== Introduction ==

== Introduction ==

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In the previous chapter, diseases of vital organs like head, heart, and the urinary system, signs of ''dhatu kshaya'' (depletion of ''dhatu'') and ''pidika'' (papules) with signs of swellings were described. This chapter deals with the etiology and symptomatology of endogenous and exogenous as well as local and generalized swellings and distensions. The name of the chapter denotes three types of swellings but later in the text, these swellings are classified into various types based upon several etiopathological factors and location. This chapter is important from the standpoint of diagnostics as it describes the main causes of all diseases that can be endogenous (innate origin) and exogenous (external agents). Some of the causative factors that can trigger non-infectious and infectious inflammations include traumatic injuries, contact with poisonous plants, animals, insect bites, animal bites, frost bite, and burns. The body’s reaction to invading micro-organisms, in terms of vitiation of ''dosha'', can be observed and appropriate course of action can be planned.  

In the previous chapter, diseases of vital organs like head, heart, and the urinary system, signs of [[dhatu]] kshaya (depletion of [[dhatu]]) and ''pidika'' (papules) with signs of swellings were described. This chapter deals with the etiology and symptomatology of endogenous and exogenous as well as local and generalized swellings and distensions. The name of the chapter denotes three types of swellings but later in the text, these swellings are classified into various types based upon several etiopathological factors and location. This chapter is important from the standpoint of diagnostics as it describes the main causes of all diseases that can be endogenous (innate origin) and exogenous (external agents). Some of the causative factors that can trigger non-infectious and infectious inflammations include traumatic injuries, contact with poisonous plants, animals, insect bites, animal bites, frost bite, and burns. The body’s reaction to invading micro-organisms, in terms of vitiation of [[dosha]], can be observed and appropriate course of action can be planned.  

Inflammation is an important pathology that includes tumor (swelling) as a cardinal sign. Further, classifications of ''shotha'' (swelling/distension) based on cause, predominance of ''dosha'', and prognosis as per site of swelling are explained. Principles of identification of new diseases are also elucidated. The normal functions of ''dosha'' and their importance in disease conditions is emphasized. Thus, the chapter is fundamental in knowing disease.

Inflammation is an important pathology that includes tumor (swelling) as a cardinal sign. Further, classifications of ''shotha'' (swelling/distension) based on cause, predominance of [[dosha]], and prognosis as per site of swelling are explained. Principles of identification of new diseases are also elucidated. The normal functions of [[dosha]] and their importance in disease conditions is emphasized. Thus, the chapter is fundamental in knowing disease.

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There are three types of ''shothas'' (swelling) i.e. ''vataja, pittaja'' and ''kaphaja''. Further, they can be classified into two i.e. ''nija'' (endogenous) and ''agantuja'' (exogenous). [3]

There are three types of ''shothas'' (swelling) i.e. [[vata]]ja, [[pitta]]ja and [[kapha]]ja. Further, they can be classified into two i.e. ''nija'' (endogenous) and ''agantuja'' (exogenous). [3]

=== Causes of exogenous swelling ===

=== Causes of exogenous swelling ===

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Exogenous swellings can be primarily identified by characteristic signs of injury and localization. After some time, they become similar to endogenous swellings (due to vitiation of ''dosha''). They are treated by bandage, ''mantra'' (holy chants), antidotes, local application of medicines, fomentation, cooling measures etc. [5]

Exogenous swellings can be primarily identified by characteristic signs of injury and localization. After some time, they become similar to endogenous swellings (due to vitiation of [[dosha]]). They are treated by bandage, ''mantra'' (holy chants), antidotes, local application of medicines, fomentation, cooling measures etc. [5]

=== General causes of endogenous swellings ===

=== General causes of endogenous swellings ===

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''Nija shotha'' i.e. endogenous swelling could be caused due to any of the following factors:

Nija shotha i.e. endogenous swelling could be caused due to any of the following factors:

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#'''Iatrogenic factors''': Improper administration of ''snehana'' (oleation), ''swedana'' (sudation), ''vamana'' (therapeutic emesis), ''virechana'' (therapeutic purgation), ''asthapana basti'' (non-unctuous enema), ''anuvasana basti'' (unctuous enema), ''shirovirechana'' (nasal errhines) and/or ''samsarjana krama'' (dietetic regimen after purification therapy).  

#'''Iatrogenic factors''': Improper administration of [[snehana]](oleation), [[swedana]](sudation), [[vamana]](therapeutic emesis), [[virechana]](therapeutic purgation), asthapana [[basti]] (non-unctuous enema), anuvasana [[basti]](unctuous enema), shirovirechana(nasal errhines) and/or samsarjana krama(dietetic regimen after purification therapy).  

#'''Complication of other diseases''': It can also result as complication of ''chhardi'' (vomiting), ''alasaka'' (delayed and obstructive digestive process), ''visuchika'' (cholera), ''shwasa'' (dyspnoea), ''kasa'' (cough), ''atisara'' (diarrhea), ''shosha'' (tuberculosis or pthysis ), ''pandu roga'' (anemia), ''udara roga'' (abdominal diseases including ascitis), ''jwara'' (pyrexia), ''pradara'' (excessive vaginal discharge), ''bhagandara'' (fistula-in-ano), ''arsha'' (piles) excessive emaciation, skin disorders, worm infestation, ''pidika'' (boils) etc.

#'''Complication of other diseases''': It can also result as complication of ''chhardi'' (vomiting), ''alasaka'' (delayed and obstructive digestive process), ''visuchika'' (cholera), ''shwasa'' (dyspnoea), ''kasa'' (cough), ''atisara'' (diarrhea), ''shosha'' (tuberculosis or pthysis ), ''pandu roga'' (anemia), ''udara roga'' (abdominal diseases including ascitis), ''jwara'' (pyrexia), ''pradara'' (excessive vaginal discharge), ''bhagandara'' (fistula-in-ano), ''arsha'' (piles) excessive emaciation, skin disorders, worm infestation, ''pidika'' (boils) etc.

#'''Lifestyle''': It may be due to suppression of natural urges like vomiting, sneezing, belching, ejaculation, flatus, micturition, defecation, excessive weakness caused by therapeutic purification procedures, chronic diseases, fasting, and excessive walking.  

#'''Lifestyle''': It may be due to suppression of natural urges like vomiting, sneezing, belching, ejaculation, flatus, micturition, defecation, excessive weakness caused by therapeutic purification procedures, chronic diseases, fasting, and excessive walking.  

=== Specific causes of swelling due to ''dosha'' dominance ===  

=== Specific causes of swelling due to ''dosha'' dominance ===  

==== Swelling due to ''vata'' dominance ====

==== Swelling due to [[vata]] dominance ====

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''Vata'' gets vitiated due to excess intake of ''sheeta'' (cold things), ''ruksha'' (rough or low calorie), ''laghu'' (very light), ''vishada'' (non-slimy substance) diets, ''shrama'' (excessive exertion), ''upavasa'' (excessive fasting), ''ati-karshan'' (emaciation), and ''kshapana'' (wasting). This vitiated ''vata'' gets into and stays within ''twak'' (skin), ''mamsa'' (muscle tissue), along with ''rakta'' (blood) and produces ''shotha'', i.e., swelling. This swelling increases as well as subsides quickly, black or reddish in color, fleeting, pulsating, with coarse skin, rough and broken hair. The person feels different types of pain sensation like ''chhidyati'' (excision), ''bhidyati'' (incision), ''suchibhiriva'' (piercing by needles/pricking), crawling of ants, irritation (as if pasted with mustard) and a feeling of contraction or expansion. These are some of the traits of swelling caused by ''vata''. [1]

[[Vata]] gets vitiated due to excess intake of ''sheeta'' (cold things), ''ruksha'' (rough or low calorie), ''laghu'' (very light), ''vishada'' (non-slimy substance) diets, ''shrama'' (excessive exertion), ''upavasa'' (excessive fasting), ''ati-karshan'' (emaciation), and ''kshapana'' (wasting). This vitiated [[vata]] gets into and stays within ''twak'' (skin), [[mamsa dhatu]](muscle tissue), along with [[rakta dhatu]] (blood) and produces shotha, i.e., swelling. This swelling increases as well as subsides quickly, black or reddish in color, fleeting, pulsating, with coarse skin, rough and broken hair. The person feels different types of pain sensation like ''chhidyati'' (excision), ''bhidyati'' (incision), ''suchibhiriva'' (piercing by needles/pricking), crawling of ants, irritation (as if pasted with mustard) and a feeling of contraction or expansion. These are some of the traits of swelling caused by [[vata]]. [1]

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==== Swelling due to ''pitta'' dominance ====

==== Swelling due to [[pitta]] dominance ====

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''Pitta'' is vitiated due to excessive intake of hot, irritant, pungent, alkaline, salt, sour food, taking food when ailing from indigestion, or due to excessive exposure to heat and sunlight. This gets into the skin, muscle tissue, or blood and produces swelling. It also increases and subsides quickly. The affected part becomes blackish, yellow, bluish, copper-tinged, hot, or soft with brown and coppery hair. It gives a burning sensation of various forms and could be hot, sweaty, and moist. The affected region could be tender to touch and very sensitive to heat. These are the traits of swelling due to ''pitta dosha''. [2]

[[Pitta]] is vitiated due to excessive intake of hot, irritant, pungent, alkaline, salt, sour food, taking food when ailing from indigestion, or due to excessive exposure to heat and sunlight. This gets into the skin, muscle tissue, or blood and produces swelling. It also increases and subsides quickly. The affected part becomes blackish, yellow, bluish, copper-tinged, hot, or soft with brown and coppery hair. It gives a burning sensation of various forms and could be hot, sweaty, and moist. The affected region could be tender to touch and very sensitive to heat. These are the traits of swelling due to [[pitta]] [[dosha]]. [2]

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==== Swelling due to ''kapha'' dominance ====

==== Swelling due to [[kapha]] dominance ====

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''Kapha'' is vitiated due to excessive use of heavy to digest, sweet, cold and unctuous food, excessive sleep, sedentary life, etc. Vitiated ''kapha'' inhabits the skin, muscle tissues, and blood, causing swelling. A ''kapha''-induced swelling grows slowly and subsides with difficulty. Affected part becomes pale, whitish, heavy, unctuous, smooth, stable, thick, with white hair, tolerant of touch and heat  This is the swelling caused due to ''kapha''.

[[Kapha]] is vitiated due to excessive use of heavy to digest, sweet, cold and unctuous food, excessive sleep, sedentary life, etc. Vitiated [[kapha]] inhabits the skin, muscle tissues, and blood, causing swelling. A [[kapha]]-induced swelling grows slowly and subsides with difficulty. Affected part becomes pale, whitish, heavy, unctuous, smooth, stable, thick, with white hair, tolerant of touch and heat  This is the swelling caused due to [[kapha]].

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==== Different types due to involvement of more than one ''dosha'' ====

==== Different types due to involvement of more than one [[dosha]]====

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Through the combination of the causes and symptoms of two ''doshas'' (''dwidoshaja''), three types of swelling occur. Similarly, a ''sannipatika shotha'' is caused by the combination of respective causes and symptoms of all three ''doshas''. Thus swelling is of seven types. [7]

Through the combination of the causes and symptoms of two [[dosha]] (''dwidoshaja''), three types of swelling occur. Similarly, a sannipatika shotha is caused by the combination of respective causes and symptoms of all three [[dosha]]. Thus swelling is of seven types. [7]

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==== Specific features of vata dominant swellings ====

==== Specific features of [[vata]] dominant swellings ====

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In the case of ''vataja'' swelling, affected body parts are swollen, and there is a feeling of numbness, pain, the swelling rebounds immediately after releasing pressure (pitting edema). It is reddish in color and subsides during night, by application of unctuous and hot massage. [9-10]

In the case of [[vata]]ja swelling, affected body parts are swollen, and there is a feeling of numbness, pain, the swelling rebounds immediately after releasing pressure (pitting edema). It is reddish in color and subsides during night, by application of unctuous and hot massage. [9-10]

==== Specific features of pitta dominant swellings ====

==== Specific features of [[pitta]] dominant swellings ====

In the case of ''paittika'' or ''pittaja'' swelling, the patient suffers from excessive thirst and fever, and in the affected parts there is a sensation of burning, sweating, moisture and foul smell. Patients have yellow eyes, face and skin, thin skin, diarrhea and the ailment emanates from the middle of the body (abdomen and trunk). [11-12]

In the case of paittika or [[pitta]]ja swelling, the patient suffers from excessive thirst and fever, and in the affected parts there is a sensation of burning, sweating, moisture and foul smell. Patients have yellow eyes, face and skin, thin skin, diarrhea and the ailment emanates from the middle of the body (abdomen and trunk). [11-12]

==== Specific features of kapha dominant swellings ====

==== Specific features of [[kapha]] dominant swellings ====

In ''kaphaja'' swelling, the patient has cold, immobile, itchy, and pale swelling that does not rebound after pressure (solid edema). These swellings do not bleed on cutting with a sharp weapon or ''kusha'' grass but instead ooze a slimy discharge. [13-14]

In [[kapha]]ja swelling, the patient has cold, immobile, itchy, and pale swelling that does not rebound after pressure (solid edema). These swellings do not bleed on cutting with a sharp weapon or ''kusha'' grass but instead ooze a slimy discharge. [13-14]

As mentioned earlier, there is a combination of causes and symptoms of two ''doshas'', called ''dwidoshaja''. A ''sannipataja'' swelling, on the other hand, combines the causes and symptoms of all the three ''doshas''. [15]

As mentioned earlier, there is a combination of causes and symptoms of two [[dosha]], called ''dwi[[dosha]]ja''. A ''sannipataja'' swelling, on the other hand, combines the causes and symptoms of all the three [[dosha]]. [15]

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When the vitiated ''kapha'' emanates or begins from the root of the tongue and causes swelling suddenly, is called ''upajivhika'' (ranula or hypertrophied solitary lingual papilla). [19]

When the vitiated [[kapha]] emanates or begins from the root of the tongue and causes swelling suddenly, is called ''upajivhika'' (ranula or hypertrophied solitary lingual papilla). [19]

==== ''Galashundika'' ====

==== ''Galashundika'' ====

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The vitiated ''kapha'' inhabits at uvula and produces swelling suddenly, that is called ''Galashundika''(uvulitis). [20]

The vitiated [[kapha]] inhabits at uvula and produces swelling suddenly, that is called ''Galashundika''(uvulitis). [20]

==== ''Galaganda'' ====

==== ''Galaganda'' ====

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A swelling that is caused when a vitiated ''kapha'' affects the throat from the outside, and gradually produces swelling , is called ''galaganda'' (goitre). [21]

A swelling that is caused when a vitiated [[kapha]] affects the throat from the outside, and gradually produces swelling , is called ''galaganda'' (goitre). [21]

==== ''Galagraha'' ====

==== ''Galagraha'' ====

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When the vitiated ''kapha'', firmly located inside the throat causes swelling suddenly, it causes ''galagraha'' (pharyingitis). [22]

When the vitiated [[kapha]], firmly located inside the throat causes swelling suddenly, it causes ''galagraha'' (pharyingitis). [22]

==== ''Visarpa'' ====

==== ''Visarpa'' ====

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When a vitiated ''pitta'' (with ''rakta'', or blood) spreads through the skin, it causes swelling with redness.Such a swelling is called ''visarpa'' i.e. erysipelas. [23]

When a vitiated [[pitta]] (with [[rakta]], or blood) spreads through the skin, it causes swelling with redness.Such a swelling is called ''visarpa'' i.e. erysipelas. [23]

==== ''Pidika'' ====

==== ''Pidika'' ====

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When the vitiated ''pitta'' is located within the skin and ''rakta'', swelling and redness appears causing ''pidika'' i.e. boils or pustules. [24]

When the vitiated [[pitta]] is located within the skin and [[rakta]], swelling and redness appears causing ''pidika'' i.e. boils or pustules. [24]

==== ''Tilaka-pipplava-vyanga-neelika'' ====

==== ''Tilaka-pipplava-vyanga-neelika'' ====

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When the vitiated ''pitta'' goes into ''rakta'' and gets absorbed in it (i.e., within the blood), it causes ''tilaka'' (moles), ''piplu'' (port-wine marks), ''vyanga'' (blemish/spots), or ''nilika'' (blue-black moles). [25]  

When the vitiated [[pitta]] goes into [[rakta]] and gets absorbed in it (i.e., within the blood), it causes ''tilaka'' (moles), ''piplu'' (port-wine marks), ''vyanga'' (blemish/spots), or ''nilika'' (blue-black moles). [25]

 

==== ''Shankhaka'' ====

==== [[Shankhaka]] ====

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When a vitiated ''pitta'' inhabits the temporal regions of the head, severe and fatal swellings known as ''shankhaka'' (saggital sinus thrombosis/ intracranial growth/ temporal arteritis) are caused. [26]

When a vitiated [[pitta]] inhabits the temporal regions of the head, severe and fatal swellings known as [[shankhaka]] (saggital sinus thrombosis/ intracranial growth/ temporal arteritis) are caused. [26]

==== ''Karnamulika shotha'' (swelling at base of ears) ====

==== ''Karnamulika shotha'' (swelling at base of ears) ====

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When the vitiated ''pitta'' is located at the base of ears, a severe, incurable and fatal swelling arises at the terminal stage of the fever. [27]

When the vitiated [[pitta]] is located at the base of ears, a severe, incurable and fatal swelling arises at the terminal stage of the fever. [27]

==== ''Pliha'' (splenomegaly) ====

==== ''Pliha'' (splenomegaly) ====

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When the vitiated ''vata'' inhabits and elevates the spleen, it causes a gradual prickly pain in the sides, causing ''pliha vriddhi'' i.e. splenomegaly. [28]

When the vitiated [[vata]] inhabits and elevates the spleen, it causes a gradual prickly pain in the sides, causing ''pliha vriddhi'' i.e. splenomegaly. [28]

==== ''Gulma'' (abdominal lumps) ====

==== ''Gulma'' (abdominal lumps) ====

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When the vitiated ''vata'' inhabits in the abdominal region causing swelling and pain, it causes ''gulma''. [29]

When the vitiated [[vata]] inhabits in the abdominal region causing swelling and pain, it causes ''gulma''. [29]

==== ''Vriddhi'' (scrotum enlargement) ====

==== ''Vriddhi'' (scrotum enlargement) ====

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When the vitiated ''vata'' moves from the groins to testicles causing swelling and pain, it causes ''vriddhi'' i.e. testicular swellings. [30]

When the vitiated [[vata]] moves from the groins to testicles causing swelling and pain, it causes ''vriddhi'' i.e. testicular swellings. [30]

==== Udara (abdominal diseases) ====

==== Udara (abdominal diseases) ====

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When the vitiated ''vata'' located between the skin and muscles produces swelling in the abdomen, it is known as ''udara roga'' i.e. diseases of abdominal cavity. [31]

When the vitiated [[vata]] located between the skin and muscles produces swelling in the abdomen, it is known as ''udara roga'' i.e. diseases of abdominal cavity. [31]

==== ''Anaha'' (obstruction in abdomen) ====

==== ''Anaha'' (obstruction in abdomen) ====

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When the vitiated ''vata'' is stuck in the belly and moves neither upwards nor downwards (neither passed through flatus nor through belching), it causes ''anaha'' (obstruction in abdomen). [32]

When the vitiated [[vata]] is stuck in the belly and moves neither upwards nor downwards (neither passed through flatus nor through belching), it causes ''anaha'' (obstruction in abdomen). [32]

==== Tumors ====

==== Tumors ====

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''Vata, pitta'' and ''kapha'' - these three ''doshas'' are always present in the body of all living beings. The learned should know about their normal or abnormal states. [48]  

[[Vata]], [[pitta]] and [[kapha]]- these three [[dosha]] are always present in the body of all living beings. The learned should know about their normal or abnormal states. [48]  

==== Functions of normal ''vata dosha'' ====

==== Functions of normal [[vata]] [[dosha]] ====

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उत्साहोच्छ्वासनिः श्वासचेष्टा धातुगतिः समा|  

उत्साहोच्छ्वासनिः श्वासचेष्टा धातुगतिः समा|  

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Enthusiasm, inspiration, expiration, movements, normal processing of dhatu (body tissues), and normal elimination of excreta are the normal functions of ''vayu'' (''vata)''. [49]

Enthusiasm, inspiration, expiration, movements, normal processing of [[dhatu]] (body tissues), and normal elimination of excreta are the normal functions of vayu([[vata]]). [49]

==== Functions of normal ''pitta dosha'' ====

==== Functions of normal [[pitta]] [[dosha]]====

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Vision, digestion, (production of) heat, hunger, thirst, softness in body, luster, serenity and intelligence are the normal functions of ''pitta''. [50]

Vision, digestion, (production of) heat, hunger, thirst, softness in body, luster, serenity and intelligence are the normal functions of [[pitta]]. [50]

==== Functions of normal ''kapha dosha'' ====

==== Functions of normal [[kapha]] [[dosha]]====

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स्नेहो बन्धः स्थिरत्वं च गौरवं वृषता बलम्|  

स्नेहो बन्धः स्थिरत्वं च गौरवं वृषता बलम्|  

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Unctuousness, binding, firmness/stability, heaviness, virility, strength, forbearance, restraint and absence of greed are the properties of ''kapha''. [51]

Unctuousness, binding, firmness/stability, heaviness, virility, strength, forbearance, restraint and absence of greed are the properties of [[kapha]]. [51]

==== Diagnosis of abnormal state of ''dosha'' ====

==== Diagnosis of abnormal state of [[dosha]]====

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Any decrease in ''vata, pitta'' and ''kapha'' is thus indicated by a decrease in their natural functions or increase in functions of opposite ''dosha''. (this is indicated by the properties associated with any of these ''doshas'', for example, reduced unctuousness indicates a decrease in ''kapha'', etc). [52]

Any decrease in [[vata]], [[pitta]] and [[kapha]] is thus indicated by a decrease in their natural functions or increase in functions of opposite [[dosha]]. (this is indicated by the properties associated with any of these [[dosha]], for example, reduced unctuousness indicates a decrease in [[kapha]], etc). [52]

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Conversely, any aggravation in ''dosha'' is indicated by an increase in their normal functions. Thus normalcy, decrease and aggravation of ''dosha'' are examined. [53]

Conversely, any aggravation in [[dosha]] is indicated by an increase in their normal functions. Thus normalcy, decrease and aggravation of [[dosha]] are examined. [53]

=== Summary ===

=== Summary ===

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Types, causes, symptoms and prognoses of swelling, of various diseases, types of diseases, definitions of the three doshas, normal functions and symptoms of decrease and aggravation of doshas - all these have been explained in this chapter on three types of swellings by Punarvasu , who is free from tamas  and rajas qualities, doshas, greed, conceit, pride and ambition.[54-56]

Types, causes, symptoms and prognoses of swelling, of various diseases, types of diseases, definitions of the three [[dosha]], normal functions and symptoms of decrease and aggravation of [[dosha]]- all these have been explained in this chapter on three types of swellings by Punarvasu , who is free from tamas  and rajas qualities, [[dosha]], greed, conceit, pride and ambition.[54-56]

== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

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*''Shotha'' (swelling) is associated with ''tridosha'' and occurs due to endogenous and exogenous factors.  

*''Shotha'' (swelling) is associated with tri[[dosha]] 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.  

*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]

*Any treatment of swelling depends upon the causative factors and [[dosha]] 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]

*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]

*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]

*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]

*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]

*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]  

*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]

*Three [[dosha]] - [[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 normal ''vata''.[49]   

*Enthusiasm, inspiration, expiration, movements, processing of [[dhatu]](body tissues) and elimination of excreta are natural functions of normal [[vata]].[49]   

*Vision, digestion, heat production, hunger, thirst, softness in body, luster, serenity and intelligence are the natural functions of normal ''pitta''. [50]

*Vision, digestion, heat production, hunger, thirst, softness in body, luster, serenity and intelligence are the natural functions of normal [[pitta]]. [50]

*Unctuousness, binding, firmness/stability, heaviness (maintaining volume/mass), virility, strength, forbearance, restraint and absence of greed are the natural functions of normal ''kapha''. [51]

*Unctuousness, binding, firmness/stability, heaviness (maintaining volume/mass), virility, strength, forbearance, restraint and absence of greed are the natural functions of 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]

*The decrease (or increase) of these [[dosha]] 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]

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

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

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

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

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

*The second type of swelling is known as ''agantuja'' (exogenous) in which the etiological factors are extraneous, which could be physical or environmental. Many times they circumvent the routine disease courses and cause diseases in a very short course of time. Conventional involvement of [[dosha]] 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 <ref> Charak samhita ; chikitsa sthanam –16/30 </ref>. 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 [[vata]]ja, [[pitta]]ja and [[kapha]]ja types of shotha. [6]

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{| class="wikitable"  

{| class="wikitable"  

! Character/criterion'''' !! ''Vata'' dominance !! ''Pitta'' dominance !! ''Kapha'' dominance

! Character/criterion'''' !! [[Vata]] dominance !! [[Pitta]] dominance !! [[Kapha]] dominance

|-

|-

! rowspan="1" style="text-align: left;" | Duration  

! rowspan="1" style="text-align: left;" | Duration  

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

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

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<div style="text-align:justify;">

The appearance of ''vātaja shotha'' can be correlated with the increased hydrostatic pressure mechanism of edema. The features are similar to edema caused by cardiac diseases where congestion is a major cause of increased hydrostatic pressure in vessels<ref>  Manual of practical medicine by R. Alagappan; chapter-3(page-159), 3rd edition.</ref>. Through the day, due to gravity, water goes down the body and gets retained in lower limbs causing edema in the evening hours. During night (i.e., at rest), the retained water redistributes and the edema subsides. Edema of cardiac origin is pitting in type, similar to vataja shotha.  

The appearance of [[vata]]ja shotha can be correlated with the increased hydrostatic pressure mechanism of edema. The features are similar to edema caused by cardiac diseases where congestion is a major cause of increased hydrostatic pressure in vessels<ref>  Manual of practical medicine by R. Alagappan; chapter-3(page-159), 3rd edition.</ref>. Through the day, due to gravity, water goes down the body and gets retained in lower limbs causing edema in the evening hours. During night (i.e., at rest), the retained water redistributes and the edema subsides. Edema of cardiac origin is pitting in type, similar to [[vata]]ja shotha.  

Kaphaja shotha, on the other hand, could be due to hypoproteinaemia in liver diseases or due to proteinuria in renal diseases<ref>  Manual of practical medicine by R. Alagappan, chapter-7 page-369-371, 3rd edition.</ref>. In renal edema, swelling is typically facial and manifests early in the morning.  Sometimes these swellings are too hard, as found in cases of malignancies or tumors. The swellings of paittika/pittaja type are mostly inflammatory in nature.  [9-15]

[[Kapha]]ja shotha, on the other hand, could be due to hypoproteinaemia in liver diseases or due to proteinuria in renal diseases<ref>  Manual of practical medicine by R. Alagappan, chapter-7 page-369-371, 3rd edition.</ref>. In renal edema, swelling is typically facial and manifests early in the morning.  Sometimes these swellings are too hard, as found in cases of malignancies or tumors. The swellings of paittika/[[pitta]]ja type are mostly inflammatory in nature.  [9-15]

=== 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. [[Dosha]] 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. [[vata]]ja, [[pitta]]ja, [[kapha]]ja, [[rakta]]ja, 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. [[vata]]ja, [[pitta]]ja, [[kapha]]ja, [[rakta]]ja'' 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]

=== ''Dosha'' and disease ===

=== [[Dosha]] and disease ===

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'', [[vata]] 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 [[dosha]], 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 [[dosha]], along with body tissues ([[dhatu]]), and secretions ([[mala]]). In all circumstances, [[dosha]], [[dhatu]] and [[mala]] 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 [[dosha]] 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 [[guna]] of [[dosha]] 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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* [[Shvayathu Chikitsa]]

* [[Shvayathu Chikitsa]]

== References ==

== References ==