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{{#seo:

|title=Shvayathu Chikitsa

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|keywords=Shvayathu, shotha, shopha, edema, swelling, langhana, amapachana, shodhana, Ayurveda, charak samhita, Indian system of medicine.

|description=Chikitsa Sthana Chapter 12. Management of Shvayathu (Various types of Swellings)

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

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

|image_alt=charak samhita

|type=article

}}

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<big>'''[[Chikitsa Sthana]] Chapter 12. Management of Shvayathu (Various types of Swellings) </big>'''

{{Infobox

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|label7 = Reviewer

|data7 = Singh G.

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|label8 = ~~Editor~~

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|label8 = Editors

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|data8 = Singh G., Goyal M.

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|data8 = Singh G., Goyal M., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

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|label9 = ~~Date~~ of publication

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|label9 = Year of publication

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|data9 = ~~December 17, 2018~~

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|data9 = 2020

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|label10 = ~~DOI~~

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|label10 = Publisher

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|data10 =

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|~~header3~~ =

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.013 10.47468/CSNE.2020.e01.s06.013]

}}

<big>'''Abstract</big>'''

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

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<p style="text-align:justify;">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 ''[[dosha]]s'' 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.

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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.

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<br/>

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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.

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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.

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<br/>

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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.

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<br/>

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'''Keywords''': ''Shvayathu, shotha, shopha,'' edema, swelling, ''langhana, ~~amapachana~~, shodhana''. </~~div~~>

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'''Keywords''': ''Shvayathu, shotha, shopha,'' edema, swelling, ''[[langhana]], ama[[pachana]], [[shodhana]]''. </p>

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== Introduction ==

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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''.

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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.

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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 ==

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</div></div>

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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.

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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.

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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]

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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 ===

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</div></div>

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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.

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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.

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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.

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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.

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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]

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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 ===

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</div></div>

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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]

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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 ===

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Heaviness, movability, bulging, heat, thinning of the vessels, horripilation and discoloration of the affected skin are the general signs and symptoms of edema [11]

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=== Symptoms of ''~~vataja~~'' dominant edema/swelling ===

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=== Symptoms of ''[[vata]]ja'' dominant edema/swelling ===

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</div></div>

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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]

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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]

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=== Symptoms of ''pitta'' dominant swelling (inflammation) ===

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=== Symptoms of ''[[pitta]]'' dominant swelling (inflammation) ===

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</div></div>

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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]

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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]

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=== Symptoms of ''kapha''-dominant edema ===

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=== Symptoms of ''[[kapha]]''-dominant edema ===

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</div></div>

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''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]

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''[[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 ===

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</div></div>

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The swelling of a patient who is neither emaciated nor weak; that involved single ''dosha'' or is of recent origin is easily curable.

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The swelling of a patient who is neither emaciated nor weak; that involved single ''[[dosha]]'' or is of recent origin is easily curable.

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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]

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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 ===

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</div></div>

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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:

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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 ''[[dosha]]ja'' swelling are as follows:

*If it involves head then ''shiro-virechana'' is prescribed;

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*If it involves lower parts of the body then ''virechana'' (therapeutic purgation) is prescribed;

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*If it involves lower parts of the body then ''[[virechana]]'' (therapeutic purgation) is prescribed;

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*If it involves upper parts of the body then ''vamana'' (therapeutic emesis)is prescribed;

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*If it involves upper parts of the body then ''[[vamana]]'' (therapeutic emesis)is prescribed;

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*If it is caused by unctuous then ''rukshana'' (drying) therapy is done;

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*If it is caused by unctuous then ''[[rukshana]]'' (drying) therapy is done;

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*If it is caused by un-unctuous (''ruksha'') then unctuous (''snehana'') therapy is done;

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*If it is caused by un-unctuous (''ruksha'') then unctuous (''[[snehana]]'') therapy is done;

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*If ''vata'' swelling is associated with constipation then it should be treated with ''niruha basti'';

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*If ''[[vata]]'' swelling is associated with constipation then it should be treated with ''niruha [[basti]]'';

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*If it is caused by ''vata-pitta'' then it should be treated with ghee prepared with bitter drugs;

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*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;

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*If the patient is suffering from swelling where ''shodhana'' is required then milk mixed with cow’s urine should be given.

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*If the patient is suffering from swelling where ''[[shodhana]]'' is required then milk mixed with cow’s urine should be given.

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*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]

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*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 ===

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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]

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=== ''Vyoshadi churna'' for ''kapha'' swelling/edema ===

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=== ''Vyoshadi churna'' for ''[[kapha]]'' swelling/edema ===

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</div></div>

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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]

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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 ===

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</div></div>

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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]

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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]

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=== Remedy for ''vata'' edema/swelling ===

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=== Remedy for ''[[vata]]'' edema/swelling ===

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</div></div>

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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]

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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]

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=== Remedy for ''vata-pitta'' swelling/edema ===

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=== Remedy for ''[[vata]]-[[pitta]]'' swelling/edema ===

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</div></div>

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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]

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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 ===

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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''.

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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]

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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'' ===

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</div></div>

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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]

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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]

=== ''Punarnavadi arishta'' ===

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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.

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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, ~~oja~~ and vitality. Thus ''punarnavadi arishta'' is described [34-38]

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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'' ===

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</div></div>

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Use of any one of the following powder preparations cures chronic edema caused by all the three ''dosha'':

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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

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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.

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The one month course cures ''gulma, udararoga,'' piles, edema, polyuria, dyspnea, coryza, cough, ''alasaka,'' indigestion, jaundice, consumption, mental disorders and kapha disorders [47-48]

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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'' ===

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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.

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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]

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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'' ===

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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''.

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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 ''~~vāta~~'' disorders of urine and semen. Thus ''kaṁsaharītakī'' is described [50-52]

+

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 ===

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</div></div>

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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, ''~~vāta~~-gulma'', polyuria and stimulates digestion and metabolism (''agni'').

+

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]

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</div></div>

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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, ''~~vāta~~ gulma'', edema, heart disease and low digestion.

+

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).

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</div></div>

−

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]

+

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'' ===

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</div></div>

−

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 ''~~vāta~~'' 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]

+

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 ===

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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 ===

+

=== External application in ''[[pitta]]'' dominance ===

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</div></div>

−

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]

+

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 ===

+

=== External application in ''[[kapha]]'' dominance ===

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</div></div>

−

In ''kapha'' dominant edema, application of paste of long pepper, sand, old oil-cake, bark of drum-stick and linseed is advised.

+

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).

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</div></div>

−

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]

+

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) ===

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</div></div>

−

All the three dosha, provoked by indulging in their etiological factors produce severe inflammation of head.

+

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]

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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 a''dhijihvikā'' (sub lingual glossitis) [77]

+

Swelling due to ''[[kapha]]'' occurring on the upper part of tongue is called ''upajihvikā'' (acute superficial glossitis) and which occurs sublingual part is called a''dhijihvikā'' (sub lingual glossitis) [77]

=== ''Upakusha'' (gingivitis) and ''danta-vidradhi'' (dental abscess) ===

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</div></div>

−

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]

+

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 ===

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</div></div>

−

In all the above mentioned conditions blood-letting, purgation, ''nasya, dhuma'' (medicated smoking therapy) and intake of old ghee is beneficial.

+

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]

+

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 ===

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</div></div>

−

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]

+

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'' ===

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</div></div>

−

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]

+

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)===

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</div></div>

−

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 ''~~vāta~~'' 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]

+

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) ===

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</div></div>

−

Multiple eruptions occurring on the trunk due to ''pitta'' and ''vata'' where usually Hindu holy thread is worn, is known as ''kakṣā''.

+

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]

+

Other such types of eruptions (''pidikā'') whether big, medium or small are also due to ''[[pitta]]'' [91]

=== ''Romantika'' (measles) ===

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</div></div>

−

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]

+

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 ===

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</div></div>

−

Due to ''vata'' or other ''dosha'', the intestine frequently enters into scrotum and comes out and this condition is known as bradhna (hernia).

+

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).

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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.

+

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]

+

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 ===

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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]

+

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 ===

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</div></div>

−

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]

+

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 ===

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</div></div>

−

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''.

+

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]

+

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]

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</div></div>

−

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]

+

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 ===

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</div></div>

−

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''.

+

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]

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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]

+

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]

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== 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.

+

*''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.

+

*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''.

+

*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.

+

*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 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 ''[[dosha]]ja'' 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 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 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 unctuous then ''[[rukshana]]'' (drying) therapy is done;

−

**If it is caused by un-unctuous (''ruksha'') then unctuous (''snehana'') 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 ''[[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 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 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.

+

**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).

+

**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 ) ==

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=== 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.

+

''[[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.

+

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 ~~(Ashtangahridaya~~ Nidana 13/~~33)~~. Yellowish coloration indicates involvement of liver. Inflammatory swelling is related to ''~~pittaja~~ shotha'' .

+

''[[Pitta]] sopha'' begins from middle parts of the body and then spreads to the other parts and has yellow-reddish color<ref>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. </ref>. Yellowish coloration indicates involvement of liver. Inflammatory swelling is related to ''[[pitta]]ja 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 ~~(Ashtangahridaya~~ Nidana 13/35-36). 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).

+

''[[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 <ref>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.</ref>. This indicates that hard non-pitting edema of elephantiasis may also be included under it. Other symptom mentioned for ''[[kapha]]ja 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 ([[Sutra Sthana]] chapter 18/18). Sushruta mentions two additional complications viz. cough and hiccups (Sushruta Chikitsa 23/8-9~~)(15)~~

+

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.<ref>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.</ref>(15)

−

~~Sushruta classify general edema in five types viz~~., ~~''vata, pitta, kapha, sannipata'' and ''vishaja'' (~~Sushruta ~~Chikitsa 23~~/3) 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'' (Sushruta Sutra 17:3).~~

−

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 ~~(Ashtangahridaya~~ Nidana 13/21-42).

+

Sushruta classify general edema in five types viz., ''[[vata]], [[pitta]], [[kapha]], sannipata'' and ''vishaja''<ref>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.</ref> 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'' <ref>Sushruta. Sutra Sthana, Cha.17 Amapkweshaneeya Adhyaya verse 3 In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>

+

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.<ref>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. </ref>.

−

Madhava Nidana followed Ashtangahridaya and describes nine types of ''shotha'' and does not describe localized ''shotha'' in this chapter on ''shotha'' (~~Madhava Nidana ''shothadhikara''~~).

+

Madhava Nidana followed Ashtangahridaya and describes nine types of ''shotha'' and does not describe localized ''shotha'' in this chapter on ''shotha'' <ref>Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--</ref>.

''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 (Sushruta Nidana 11/13-14). 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).

+

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 <ref>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.</ref>. 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).

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=== ''Shat-kriya-kala'' of ''shotha'' ===

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#''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.

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#''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.

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#''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.

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#''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.

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#''Prasara'' (Spreading): In the stage of ''prasara'' the ''dosha'' leaves their normal site and starts circulating all over the body.

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#''Prasara'' (Spreading): In the stage of ''prasara'' the ''[[dosha]]'' leaves their normal site and starts circulating all over the body.

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#''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.

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#''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.

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#''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 ([[Sutra Sthana]] 18:18).

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#''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'' ===

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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.

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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.

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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.

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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''.

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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''.

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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''.

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Swelling which is soft, tender on touch, associated with change to yellow color, fever etc is ''pitta 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.

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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) ===

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[[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.

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[[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.

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''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.

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''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.

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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.

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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.

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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''.

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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.

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! scope="col"| ''Anupana''

|-

−

| ''Vata'' dominant

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| ''[[Vata]]'' dominant

| ''Harina shringa'' mixture

| 60-120 mg

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| Honey + ''Dashamularishta'' + ''Punarnavasa''

|-

−

| ''Pitta'' dominant

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| ''[[Pitta]]'' dominant

| ''Aarogya'' Mixture

| 120-250 mg

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| Milk + ''saravadyasava'' + ''punarnavasava'' + ''vasakasava'

|-

−

| rowspan = "3"|''Kapha'' dominant

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| rowspan = "3"|''[[Kapha]]'' dominant

| ''Gomutra Haritaki''

| 1-3 grams

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| Honey

|}

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~~=== Further reading ===~~

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~~#Charak. Sutra Sthana, Cha.18 Trishothiya Adhyaya. In: Jadavaji Trikamji Aacharya, Editors. Charak Samhita.1st ed. Varanasi: Krishnadas Academy;2000. p.1-24.~~

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~~#Charak. Chikitsa Sthana, Cha.12 Shvayathu Chikitsa. In: Jadavaji Trikamji Aacharya, Editors. Charak Samhita.1st ed. Varanasi: Krishnadas Academy;2000. p.1-24.~~

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~~#Sushruta. Sutra Sthana, Cha.17 Amapkveshaneeya Adhyaya. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1-10.~~

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~~#Sushruta. Chikitsa Sthana, Cha.23 Sophachikitsitam. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1-10.~~

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~~#Arunadatta, Vagbhata.In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.~~

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~~#Madhava: Madhava Nidana; Śothadhikara. Published by Chaukhamba Samskrit series office, Varanasi,~~

=== Related Chapter ===

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* [[Trishothiya Adhyaya]]

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