Changes

{{Infobox

{{Infobox

|title =  Trishothiya Adhyaya

|title =  Trishothiya Adhyaya

|data2 = ''Roga Chatushka''

|data2 = ''Roga Chatushka''

|label3 = Preceding Chapter

|label3 = Preceding Chapter

|data3 = [[Kiyanta Shiraseeya]]

|data3 = [[Kiyanta Shiraseeya Adhyaya]]

|label4 = Succeeding Chapter

|label4 = Succeeding Chapter

|data4 = [[Ashtodariya]]

|data4 = [[Ashtodariya Adhyaya]]

|label5 = Other Sections

|label5 = Other Sections

}}

}}

=== Introduction ===

=== Introduction ===

iti ha smAha bhagavAnAtreyaH||2||

iti ha smAha bhagavAnAtreyaH||2||

Now we will discuss the chapter on three types of ''shotha'' i.e. swellings. Thus, said Lord Atreya. [1-2]

Now we will expound the chapter on three types of ''shotha'' i.e. swellings. Thus, said Lord Atreya. [1-2]

==== Three types of ''shotha'' ====

==== Three types of ''shotha'' ====

निजाः पुनः स्नेहस्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावत्प्रयोगान्मिथ्यासंसर्जनाद्वाछर्द्यलसकविसूचिकाश्वासकासातिसारशोषपाण्डुरोगोदरज्वरप्रदरभगन्दरार्शोविकारातिकर्शनैर्वा कुष्ठकण्डूपिडकादिभिर्वाछर्दिक्षवथूद्गारशुक्रवातमूत्रपुरीषवेगधारणैर्वा कर्मरोगोपवासाध्वकर्शितस्य वासहसाऽतिगुर्वम्ललवणपिष्टान्नफलशाकरागदधिहरितकमद्यमन्दकविरूढनवशूकशमीधान्यानूपौदक-पिशितोपयोगान्मृत्पङ्कलोष्टभक्षणाल्लवणातिभक्षणाद्गर्भसम्पीडनादामगर्भप्रपतनात् प्रजातानां चमिथ्योपचारादुदीर्णदोषत्वाच्च शोफाः प्रादुर्भवन्ति; इत्युक्तः सामान्यो हेतुः||६||  

निजाः पुनः स्नेहस्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावत्प्रयोगान्मिथ्यासंसर्जनाद्वाछर्द्यलसकविसूचिकाश्वासकासातिसारशोषपाण्डुरोगोदरज्वरप्रदरभगन्दरार्शोविकारातिकर्शनैर्वा कुष्ठकण्डूपिडकादिभिर्वाछर्दिक्षवथूद्गारशुक्रवातमूत्रपुरीषवेगधारणैर्वा कर्मरोगोपवासाध्वकर्शितस्य वासहसाऽतिगुर्वम्ललवणपिष्टान्नफलशाकरागदधिहरितकमद्यमन्दकविरूढनवशूकशमीधान्यानूपौदक-पिशितोपयोगान्मृत्पङ्कलोष्टभक्षणाल्लवणातिभक्षणाद्गर्भसम्पीडनादामगर्भप्रपतनात् प्रजातानां चमिथ्योपचारादुदीर्णदोषत्वाच्च शोफाः प्रादुर्भवन्ति; इत्युक्तः सामान्यो हेतुः||६||  

nijāḥ punaḥ snēhasvēdavamanavirēcanāsthāpanānuvāsanaśirōvirēcanānāmayathāvatprayōgānmithyāsaṁsarjanādvāchardyalasakavisūcikāśvāsakāsātisāraśōṣapāṇḍurōgōdarajvarapradarabhagandarārśōvikārātikarśanairvā

nijāḥ punaḥ snēhasvēdavamanavirēcanāsthāpanānuvāsanaśirōvirēcanānāmayathāvatprayōgānmithyāsaṁsarjanādvāchardyalasakavisūcikāśvāsakāsātisāraśōṣapāṇḍurōgōdarajvarapr<br>adarabhagandarārśōvikārātikarśanairvā

kuṣṭhakaṇḍūpiḍakādibhirvā chardikṣavathūdgāraśukravātamūtrapurīṣavēgadhāraṇairvā karmarōgōpavāsādhvakarśitasya vāsahasā'tigurvamlalavaṇapiṣṭānnaphalaśākarāgadadhiharitakamadyamandakavirūḍhanavaśūkaśamīdhānyānūpaudaka-piśitōpayōgānmr̥tpaṅkalōṣṭabhakṣaṇāllavaṇātibhakṣaṇādgarbhasampīḍanādāmagarbhaprapatanāt prajātānāṁ camithyōpacārādudīrṇadōṣatvācca śōphāḥ prādurbhavanti; ityuktaḥ sāmānyō hētuḥ||6||  

kuṣṭhakaṇḍūpiḍakādibhirvā chardikṣavathūdgāraśukravātamūtrapurīṣavēgadhāraṇairvā karmarōgōpavāsādhvakarśitasya vāsahasā'tigurvamlalavaṇapiṣṭānnaphalaśākarāgadadhiharitakamadyamandakavirūḍhanavaśūkaśamīdhānyānūpaudaka-piśitōpayōgānmr̥tpaṅkalōṣṭabhakṣaṇāllavaṇātibhakṣaṇādgarbhasampīḍanādāmagarbhaprapatanāt prajātānāṁ camithyōpacārādudīrṇadōṣatvācca śōphāḥ prādurbhavanti; ityuktaḥ sāmānyō hētuḥ||6||  

nijAH punaH snehasvedavamanavirecanAsthApanAnuvAsanashirovirecanAnAmayathAvatprayogAnmithyAsaMsarjanAdvAchardyalasakavisUcikAshvAsakAsAtisArashoShapANDurogodarajvarapradarabhagandarArshovikArAtikarshanairvA kuShThakaNDUpiDakAdibhirvAchardikShavathUdgArashukravAtamUtrapurIShavegadhAraNairvA karmarogopavAsAdhvakarshitasya vAsahasA~atigurvamlalavaNapiShTAnnaphalashAkarAgadadhiharitakamadyamandakavirUDhanavashUkashamIdhAnyAnUpaudaka-pishitopayogAnmRutpa~gkaloShTabhakShaNAllavaNAtibhakShaNAdgarbhasampIDanAdAmagarbhaprapatanAt prajAtAnAM ca mithyopacArAdudIrNadoShatvAccashophAH prAdurbhavanti; ityuktaH sAmAnyo hetuH||6||

nijAH punaH snehasvedavamanavirecanAsthApanAnuvAsanashirovirecanAnAmayathAvatprayogAnmithyAsaMsarjanAdvAchardyalasakavisUcikAshvAsakAsAtisArashoShapANDurogo<br>darajvarapradarabhagandarArshovikArAtikarshanairvA kuShThakaNDUpiDakAdibhirvAchardikShavathUdgArashukravAtamUtrapurIShavegadhAraNairvA karmarogopavAsAdhvakarshitasya vAsahasA~atigurvamlalavaNapiShTAnnaphalashAkarAgadadhiharitakamadyamandakavirUDhanavashUkashamIdhAnyAnUpaudaka-pishitopayogAnmRutpa~gkaloShTabhakShaNAllavaNAtibhakShaNAdgarbhasampIDanAdAmagarbhaprapatanAt prajAtAnAM ca mithyopacArAdudIrNadoShatvAccashophAH prAdurbhavanti; ityuktaH sAmAnyo hetuH||6||

''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:

sarvAkRutiH sannipAtAcchotho vyAmishrahetujaH||15||

sarvAkRutiH sannipAtAcchotho vyAmishrahetujaH||15||

===== Specific features of ''vataja, paittika'' and ''kaphaja'' swellings =====

===== Specific features of ''vataja, pittaja'' and ''kaphaja'' swellings =====

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

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

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 ''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]

shanaiH paritudan [7] pArshvaM plIhA tasyAbhivardhate||28||  

shanaiH paritudan [7] pArshvaM plIhA tasyAbhivardhate||28||  

When the vitiated ''vata'' inhabits and elevates the spleen, it causes a gradual prickly pain in the sides, causing ''vliha 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) =====

sAdhyAshcaivApyasAdhyAshca vyAdhayo dvividhAH smRutAH|  

sAdhyAshcaivApyasAdhyAshca vyAdhayo dvividhAH smRutAH|  

mRududAruNabhedena te bhavanti caturvidhAH||41||  

mRududAruNabhedena te bhavanti caturvidhAH||41||  

 

There are certain curable diseases that become fatal if improperly managed or not given adequate treatment. There are other curable diseases that are mild and get alleviated certainly with or without effort. There are incurable diseases, considered “palliable”, in which appropriate treatment enables the patient to move along. And finally, there are other incurable diseases that do not respond to any treatment. At times, ignorant physicians treat these enthusiastically. However, the wise should not treat them. Thus, diseases are primarily of two types: curable and incurable, and depending upon their severity and responsiveness to drugs, are further categorized into two sub-categories within each of these types. [37-41]

There are certain curable diseases that become fatal if improperly managed or not given adequate treatment. There are other curable diseases that are mild and get alleviated certainly with or without effort. There are incurable diseases, considered “palliable”, in which appropriate treatment enables the patient to move along. And finally, there are other incurable diseases that do not respond to any treatment. At times, ignorant physicians treat these enthusiastically. However, the wise should not treat them. Thus, diseases are primarily of two types: curable and incurable, and depending upon their severity and responsiveness to drugs, are further categorized into two sub-categories within each of these types. [37-41]

==== Criteria for classification of diseases ====

==== Criteria for classification of diseases ====

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 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]

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' /Fundamental Principles ===

 

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

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

*The exogenous factors cause swelling first and then vitiate ''dosha''. This leads to exogenous swellings getting transformed into endogenous swellings.  

*The exogenous factors cause swelling first and then vitiate ''dosha''. This leads to exogenous swellings getting transformed into endogenous swellings.  

*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 ''doshas'' - ''vata, pitta'' and ''kapha'' - are always present in the body of living beings. The learned should know about their normal and vitiated states. [48]

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

*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 a 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 of a 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 ''doshas'' in a body can be best diagnosed by a decrease (or increase) in the functions mentioned above. The alternate method to examine the status is to check functions of other (opposite) ''dosha''. Thus the status of ''dosha'' can be investigated based on their representative functions only.[52]

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' / Applied Inferences ===

==== Classification of ''shotha'' (swelling/ distension) ====

==== Classification of ''shotha'' (swelling/ distension) ====

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

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

 

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

*The 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 ''doshas'' take place later on i.e. after manifestation of disease.  

In addition to the types of swellings mentioned by Charaka, Sushruta has added ''rakta''based swellings as a separate type. [Su. Su. 17/4]. Sushruta has also emphasized on ''vishaja'' (caused due to poisons) as another type while mentioning treatment. [Su. Chi. 23/3]. Vagbhata has differentiated types based on causes of injuries (''abhighataja'') and contact with poisons (''vishaja'').  Further he has mentioned two types of ''shotha'' on the basis of distribution in body i.e. ''sarvanga'' (generalized) and ''ekanga'' (localized). According to its manifestation he has described three categories i.e. ''prathu'' (diffused spread), ''unnata'' (elevated) and ''grathita'' (nodular) [A.H. Ni. 13/22, 23]. On the basis of prognosis, Madhava has divided ''shotha'' into three i.e. ''urdhvagata'' (in upper part of body), ''madhyagata'' (in the middle part) and ''adhogata'' (in the lower part) [Ma.ni.-36/17]. These types are of clinical importance since they help understand the origin of the swelling and the pre-dominant ''dosha'' involved in it. [3]

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]

==== 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 2. Excessive use of salt will result in sodium retention and edema 3. 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'' (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 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 obstruction4 are important. Above mechanisms can be studied in context of ''vataja, paittika'' and ''kaphaja'' types of ''shotha''. [6]

In conventional medicine many mechanisms have been described to explain edema. Among these, increased capillary hydrostatic pressure, decreased plasma oncotic pressure, increased capillary permeability, sodium and water retention, and lymphatic obstruction<ref>  Pathology by Harsh mohan; chapter-5 page (64-70), 3rd edition.</ref> are important. Above mechanisms can be studied in context of ''vataja, paittika'' and ''kaphaja'' types of ''shotha''. [6]

==== Differential diagnosis of types of swelling ====

==== '''Table 1:Differential diagnosis of types of swelling''' ====

{| class="wikitable"  

{| class="wikitable"  

! Character''/dosha'' !! ''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 ====

 

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 vessels5. 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 ''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.  

Kaphaja shotha, on the other hand, could be due to hypoproteinaemia in liver diseases or due to proteinuria in renal diseases6. 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]

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]

==== Distribution of ''shotha'' and prognosis ====

==== Distribution of ''shotha'' and prognosis ====

Improper treatment or care of any existing edema-causing disease can lead to upadravas, or complications caused due to obstruction caused by accumulated fluid in the interstitial spaces leading to improper circulation. This hampers the normal movement of vata leading to various complications.  

Improper treatment or care of any existing edema-causing disease can lead to upadravas, or complications caused due to obstruction caused by accumulated fluid in the interstitial spaces leading to improper circulation. This hampers the normal movement of vata leading to various complications.  

If we consider modern etiopathogenesis of edema, then it is clear that all the complications described here are consequences of either edema or its associated disease. For example, hypertension is an etiological factor for heart and renal failure which are common causes of edema. Sometimes, pulmonary edema develops due to many reasons resulting in dyspnea. Anorexia may be due to hepatic pathology itself or may be due to congestion (as in the case of congestive heart failure)7. Excessive thirst may be due to induced or spontaneous diuresis leading to dehydration. Pyrexia, diarrhea and weakness can develop because of associated infections or other systemic ailments. [18]

If we consider modern etiopathogenesis of edema, then it is clear that all the complications described here are consequences of either edema or its associated disease. For example, hypertension is an etiological factor for heart and renal failure which are common causes of edema. Sometimes, pulmonary edema develops due to many reasons resulting in dyspnea. Anorexia may be due to hepatic pathology itself or may be due to congestion (as in the case of congestive heart failure)<ref>Manual of practical medicine by R. Alagappan, chapter-3 page-159, 3rd edition. </ref>. Excessive thirst may be due to induced or spontaneous diuresis leading to dehydration. Pyrexia, diarrhea and weakness can develop because of associated infections or other systemic ailments. [18]

==== 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 [https://en.wikipedia.org/wiki/Ayurveda 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.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.  

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.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).

''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 [https://en.wikipedia.org/wiki/Ayurveda 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 8. 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 ====

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.Su. 11/5-7]. [53]

=== References ===

=== References ===

 

#[[Charaka Samhita]] [[Nidana Sthana]] - 1/10

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#[[Charaka Samhita]] [[Chikitsa Sthana]] –16/30

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#Pathology by Harsh mohan; chapter-5 page (66-67), 3rd edition

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#Pathology by Harsh mohan; chapter-5 page (64-70), 3rd edition.

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#Manual of practical medicine by R. Alagappan; chapter-3(page-159), 3rd edition.

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#Manual of practical medicine by R. Alagappan, chapter-7 page-369-371, 3rd edition.

#Manual of practical medicine by R. Alagappan, chapter-3 page-159, 3rd edition.

#Textbook of microbiology – Orient Longman, chapter-26 page-23, 4th edition.