classified into 3 categories, namely Vataja, Pittaja and Kaphaja

Types of Nija and AgantujaShotha (endogenous)

The endogenous and exogenous oedema are of 3 types, viz,

SarvaGatra – oedema pervading the whole body,

ArdhaGatra – oedema pervading the half of the body, and

AvayavaAshraya – oedema afflicting only one limb of the body.

1

NIDANA

Nija Shotha Nidana – Causes of Endogenous Variety:

Following are the causative factors of endogenous type of oedema:

Intake of Kshara (Alkaline preparation),

Amla (sour food and drinks),

Teekshna (strong, piercing food articles)

Guru (heavy food) by a person who has become emaciated and weak because of Shuddhi (Panchakarma therapies)

Intake of Dadhi (curd), uncooked food, Mrut (Mud), Shaka (leafy vegetable),

Virodhi Anna (wrong food combinations),

Dushta Anna (Polluted food and water)

food afflicted with Gara (artificially prepared poison);

Afflictions with piles and lack of exercise;

Not administering Panchakarma purification therapies in appropriate times;

Marmaupaghata – Afflictions of vital organs because of endogenous diseases

(such as kidney disorders, heart disorders etc)

Irregular delivery, abortion and miscarriages and

Inappropriate administration of Panchakarma elimination therapies and improper

care of the patient after the administration of these therapies [5-6]

Agantuj shoth causes

AgantujaShothaNidana – Etiology of Exogenous Oedema

Affliction of skin by the impact of wood, stone, weapon, fire, poison and iron

gives rise to exogenous type of oedema. [7 ½]

2

PURVA ROOPA

Ushma – Hyper pyrexia, increased temperature

Davathu – burning sensation and

SiranamAyama – dilatation of the vessels of the locality (10 ½)

Though all the 3 Doshas are involved in the manifestation of

all the types of Shotha, it is on the basis of the predominance of

the respective Doshas that

Vatika,

Pattika and

Slaismika (Kaphaja) varieties are determined and therapies are

prescribed accordingly.

3

SYMPTOMS

Shotha Samanya lakshana

The general signs and symptoms of Svayathu:

Sa gauravam – Heaviness

Anavasthitatvam – instability,

Utsedha – swelling

Ushma – rise in temperature,

Siratanutvam – thinning of vessels,

Loma harsha – horripilation and

Angavivarnata – discoloration of the skin over the limbs [11]

Vataja Shotha

Pain is the dominant feature. It usually affects joints.

The swelling will be movable, with thin (transparent) skin overlying it,

rough and coarse in nature (touch), have aruna varna (yellowish red colour)

or asita (blackish colour), associated with sushupti (numbness),

harsha (horripulation), gets pacified on its own without any reason

(at times) and reappears again, on pressing and releasing, it quickly

rises to the surface. The swelling will be predominant in the day time.

Pittaja Shotha

the swelling will be smooth and soft, emits some odour, has blackish or yellowish

discolouration, associated with jwara (fever), bhrama (giddiness), sweda (sweating),

trusha (thirst), mada (intoxication), daha (burning sensation), sparsha asahtva (tenderness)

and paka (suppuration). All these point towards stages of inflammation.

Kaphaja shotha

the swelling will be hard and heavy, pale in colour, associated with aruchi (anorexia), nidra (sleep), vamana (vomiting), mandagni (low digestion), doesn’t pit on pressure and increases in night time.

Pitta Kaphaja Shotha

will have the symptoms of both pitta and kapha in mixed proportions.

Abhighataja shotha

happens due to abhighata (trauma), cheda (being cut by weapons), bheda (splitting of tissues), kshata (injury), contact of hima anila (cold breeze), abdhi anila (wind coming from ocean or sea), contact with bhallataka (Semecarpus anacardium, marking nut) or kapikachchu (Mucuna pruriens) etc. the swelling will be hot in touch, red in colour and will have similar symptoms as those of pittaja shotha.

4

Sadhyaasadhyata-

Bad prognosis

The patient of Svayathu succumbs to death because of the following:

If oedema occurs in a person who is emaciated and afflicted by other diseases

Vami – If the patient of oedema develops complications, like vomiting, etc

Marmanugata – If the oedema has afflicted the vital organs of the body

Rajiman – If stripes appears over the oedematous part

Parisrava – If there is exudation of fluid from this oedematous part

HeenabalasyaSarvanuga – If there is general oedema allover the body (anasarca) in a weak patient [15]

Good prognosis – curability:

Aheenamamsa – if there is no muscle wasting in the patient,

EkaDoshaja – if only one Dosha is involved

Nava – oedema of recent origin

Balasthasya – if the patient has good strength then the condition is curable.

5

SAMPRAPTI

Because of the above-mentioned factors, Kapha, Asrik( blood) and Pitta enter the external vessels (BahyaSira) and afflict VataDosha. As a result, the channel of circulation gets obstructed which spreads to the nearby areas, leading to Shotha. Shotha/ Shvayatu is characterised by swelling. [8]

Pathogenesis

UrdhvaSvayathu: If the afflictions take place in the chest, then oedema occurs in the upper part of the body

AdhahSvayathu: If these afflictions take place in the colon or pelvic region, which is the location of Vata, then oedema occurs in the lower part of the body.

Madhya shvayathu: If these afflictions take place in the middle of the body, ie between the chest and the pelvic region, then oedema occurs in the middle of the body, and

SarvaangaShotha: If these afflictions take place in the whole body, then swelling occurs in the entire body.

If however, these afflictions are located in any particular viscera, such as throat and palate, then oedema takes place in that locality and it is named after the viscera where it occurs (e.g Gala Shotha)

6

CHIKITSA SUTRA

The physician, after ascertaining –

Bala – strength of the patient,

Dosha – Doshas involved

Kala – time, season, stage of disease, should treat the ailment by administering therapies, contradicting the etiological factors, Doshas and season. [16]

Shotha chikitsa (general principles of treatment of shotha) –

The treatment of shotha antagonistic to the causes and causative dosha should be planned.

When the shotha is ama (unripened), langhana (fasting) and pachana (ripening medicines) should be given.

When the shotha is matured, it should be subjected to Shodhana, Vamana (therapeutic emesis) and Virechana (therapeutic purgation) are the best options to expel the morbid doshas.

7

TREATMENT OF SHOTHA IN ITS DIFFERENT STAGES:

If Shvayathu is caused by Ama, then the patient is given

Langhana – fasting therapy

Pachana therapy – to get rid of ama, to improve digestion strength

Shodhana – elimination Panchakarma therapies to alleviate the predominant, Dosha involved.

Shotha of head

If Sotha is located in the head,

SeershaVirechana (therapies, like inhalation, nasal drops, meant for the elimination of the Doshas from the head) is administered.

If located in the lower body part,

Virechana – Purgation therapy is given, and

If located in the upper part of the body,

Vamana – emetic therapy is administered.

If Shotham is caused by improper administration of the Snehakarma – oleation therapy, then drugs having dryness qualities are administered.

If Svayathu is caused by excessive intake of dry foods and drinks, then Sneha – oleation therapy is given.

If there is constipation and if Svayathu is caused by Vata, then Niruha (decoction enema) is administered.

If Svayathu is caused by the simultaneous aggravation of Pitta and Vata, then TiktakaGhrita is administered.

If the patient is suffering from fainting (Murcha), Arati (dislike for everything), burning sensation and morbid thirst, then he is given milk.

If, however, such a patient is to be given elimination therapy, then a suitable recipe along with cow’s urine is used.

If Shwayathu is caused by Kapha, then Takrasava mixed with cow’s urine and added with Kshara, pungent and hot drugs, is administered. [17-19]

8

TREATMENT OF SHOTHA ASSOCIATED WITH DIARRHOEA AND CONSTIPATION:

If the patient of oedema suffers from diarrhoea, then he should take butter- milk along with Trikatu (Ginger, pepper, Long pepper), black salt and honey.

If he is suffering from constipation or passage of Ama including Doshas with the stool, then he should be given jaggery and Haritaki or Jaggery added with Nagara – Zingiberofficinale [27]

Svayathu with Constipation etc:

If the patient of oedema suffers from constipation and bloating, he is given castor oil along with milk or meat soup. This recipe is given before taking food.

If there is obstruction to the channels of circulation, if there is suppression of digestion strength with anorexia, then the oedema patient is given well fermented Madyas (a variety of alcoholic preparation containing self- generated alcohol) [28]

9

CHIKTSA ACCORDING DOSHA DUSTI

In vata predominant shotha (pain is predominant in varicocele) –

• Trivrit Churna (powder of Operculina turpethum) should be taken for 15 days

• Eranda taila (castor oil) – should be taken in presence of constipation

• Shali, ksheera, mamsarasa – In diet, cooked rice with milk and meat soup should be taken

• Swedana – fomentation with vata alleviating medicines

• Mardana – massage and tapping with vata mitigating oils

• Vatahara sinchana, lepana – sprinkling and application of medicines having vata alleviating property

• Shuntyadi kwatha – decoction prepared with shunti (ginger), punarnava (boerhavia diffusa), erandamula (root of castor plant), and panchamula (greater 5 roots)

• Niruha vasti – herbal decoction enemas

In pitta predominant shotha (pitta associated with vata) –

• Tikta ghritas (ghee processed with bitter medicines) and

• Virechana (purgation) should be administered

• Only milk diet

• Trivritadi kwatha – decoction of Trivriti (Operculina turpethum), Guduchi (Tinospora cordifolia), Haritaki (Terminalis chebula), Bibhitaki (Terminalia bellirica) and Amalaki (Emblica officinalis)

• Triphala churna – Powder of equal quantities of Haritaki (Terminalis chebula), Bibhitaki (Terminalia bellirica) and Amalaki (Emblica officinalis) mixed in Gomutra (urine of cow)

• Patoladi kwatha – decoction of Patola (pointed gourd), Haritaki (Terminalis chebula), Bibhitaki (Terminalia bellirica), Amalaki (Emblica officinalis), Nimba twak (bark of neem) and Daruharidra (Berberis aristata) mixed with Shuddha Guggulu (purified Commiphora mukul)

In kapha predominant shotha –

• Gomutra (urine of cow) and takra (buttermilk) mixed with kshara (alkalis), katu (pungent medicines) and ushna (medicines or herbs having hot property) should be given.

• Vamana is an ideal choice in high kapha morbidity.

• Punarnavadi kwatha – decoction of Punarnava (Boerhavia diffusa), Shunti (ginger), Trivrit (Operculina turpethum), Guduchi (Tinospora cordifolia), Aragwadha (Cassia fistula), Haritaki (Terminalia chebula), Devadaru (Cedrus deodara) mixed with gomutra (urine of cow)

• Punarnavadi Kalka – Paste of the above said herbs mixed in gomutra

• Punarnavadi leham – confection prepared using decoction of Punarnava (Boerhavia diffusa), Guduchi (Tinospora cordifolia), Daruharidra (Berberis aristata), Dashamula (10 roots), Ardraka rasa (ginger juice), purana guda (old jaggery), and powders of shunti (ginger), maricha (pepper), pippali (long pepper), teja patra (bay leaves), ela (cardamom) and twak (cinnamon) mixed with honey

10

AYURVEDIC FORMULATIONS

CLASSICAL FORMULATIONS FROM TREATISES:

Ardraka rasa – ginger juice should be taken orally and once it gets digested rice should be taken with milk

Shilajit – should be taken with decoction of Triphala

Bilwa swaras – Juice of bilwa (Aegle marmelos) mixed with powder of maricha (black pepper)

Bhunimba kalka – paste of Bhunimba (Andrographis paniculata) and shunti (ginger) should be consumed followed by decoction of punarnava (Boerhavia diffusa)

Triphala kwatha – decoction of Haritaki (Terminalis chebula), Bibhitaki (Terminalia bellirica) and Amalaki (Emblica officinalis) mixed with mahisha sarpi (ghee of buffalo)

Gudadi churna – powder of guda (jaggery), pippali (long pepper) and shunti (ginger)

Guda ardraka – equal quantity of guda (jaggery) and ardraka (ginger)

Guda shunti – equal quantity of guda (jaggery) and shunti (ginger)

Guda haritaki – equal quantity of guda (jaggery) and haritaki (Terminalia chebula)

Guda pippali – equal quantity of guda (jaggery) and pippali (long pepper)

EXTERNAL MEDICINES (IN ABHIGHATAJA SHOTHA AND OTHER TYPES OF SHOTHA)

Tila lepa – paste of paste of tila (sesame) made with butter

Tila lepa – paste of paste of tila (sesame) made withmilk

Yashtyadi lepa – paste of yashtimadhu (liquorice), dugdha (milk) and tila (sesame) mixed with navaneeta (butter)

Punarnavadi lepa – paste of punarnava (Boerhavia diffusa), devadaru (Cedrus deodara), shunti (ginger), sarshapa (white mustard) and shigru twak (bark of drumstick tree) made with kanji (sour fermented herbal drink)

Darvadi lepa – paste of devadaru (Cedrus deodara), guggulu (Commiphora mukul) and shunti (ginger) made in gomutra (cow urine)

Bibhitaki lepa – seeds of Bibhitaki (Terminalia bellirica) should be applied

Gandiradyarista

Astasatarishta

Punarnavadyarishtam

Triphaladyarishta [Phalatrikadyarista]

KrushnadiChurna

KsharaGutika

Gudardaka Yoga

PatolamuladiKasaya

ChitrakadiGhrita

A. AAM PACHAK AUSHADHI-(5-7DAYS)

B. ABHYANTER SNEHAPANA-

Chitrak ghrita or triphala ghrita (krur kosti-80-90ml/madhya kosti-50-60ml/hina kosti-20-30ml)

Samyak sneha lakshan then

C. 1 din svedana

D. VAMANA

E. SANSAMAN KARMA

F. 9TH-10TH-11TH DAY abhyanter snehapana badhi matra me

G. 12th-14th day rest

H. If no responce then also use tikshna basti

TIKSHNA BASTI

Varunadi kvatha 50mg + trin panchmula kvatha 50gm -> make 300ml kvatha

Add 50ml gomutra + 50ml madhu + 10gm saindhav

(anuvasan is not nessasory)

SPECIAL CONDITION

A. SIRA PRADESHA

- Sirovorechana

- Dhamapan/avapidan(shigru,vacha,vidanga & anu taila)

B. ADHO PRADESHA - Virechana

C. UDHARVA PRADESHA - Vamana

D. ATI SNEHA - Rukshan

E. RUKSHATA SE - Snigdha chikitsa

F. VATIK/VIBANDHA - Niruha basti

G. VATA-PITTA - Tikta dravya se siddha ghrita

H. KAPHAJA - Kshar, katu, ushna, gomutra, ashav/arista

PATHYA-

- Shunthi,yava, mungayush, sahajan, makoya, muli, nimba, purana Sali, protin anna, takra, madhu, harad, karela

- Upavasa, svedana, vishram

APATHYA-

- Jala,lavana, amla, anupa mamsa, guda, dadhi, tila, madhya, samsana, guru, vidahi, ghrita, taila, ksheera

- Divasvapna, maithuna, vegavrodha

MUTRA VIRECHAK AUSHADHI-

- Punarnava, gokshura, trinpanchmula, sveta parpati

MALA VIRECHAKA AUSHADHI-

- Haritaki, kutki, danti

HRIDAYA-SWASA ROGA(PRANA) JANYA SOTHA-

- Kansh haritaki

- Dasamula haritaki

- Hridayanav rasa

- Punarnava mandura

- Arjunarista

- Swasakasa chintamani rasa

- Shringa bhasma

YAKRUTA ROGA(AGNI) JANYA SOTHA-

- Yakruta palihari loha

- Punarnava mandura

- Arogyavardhani vati

- Phalatrikadi kvatha

VRIKKA VIKARA(APANA) JANYA SOTHA

- Suddha shilajatu

- Punarnava mandura

- Sothari loha

- Varunadi loha

- Gokshuradi gugglu

- Sveta parpati

- Chandanadi vati

RASODHI/BHASMA/PISTI-(120-250MG WITH MADHU/TRIPHALA KVATHA)

- Punernava mandura-(punarnava,nishotha,mandura)

- Sothari loha-(trikatu,yavakshar,loha)

- Sothakalanal rasa-(chitrak,jatiphala,kajjali)

- Triushnadi loha-(trikatu,loha)

- Sotha sardula rasa-(panchlavan,rasasindura)

- Hridayanav rasa-(triphala,kakmachi,tamra)

- Varunadi loha-(varun,abhrak,loha)

- Sveta parpati-(sora,subhra,narsar)

- Agnimukha loha-(trivrita,chitrak,shilajatu)

VATI-(250-500MG WITH USHNA JALA)

- Takra vati-(kajjali,vatsanabh,tamra,mandura)

- Dugdha vati-(vatsanabh,ahiphena,loha,abhrak)

- Arigyavardhani vati-(kajjali,loha,abhrak,tamra,kutki)

- Prabhakar vati-(svarnmakshik,shilajatu,arjuna)

- Saptavinshati gugglu-(trikatu,triphala,indrayava)

- Gokshuradi gugglu-(trikatu,triphala,gokshura)

- Punarnavadi gugglu-(punarnava,devdaru,haritaki)

CURNA-(3-6GM WITH TRIPHALA KVATHA/TAKRA/USHNODAKA)

- Punarnava curna-(punarnava,devdaru,haritaki)

- Sothari curna-(mulak,apamarga,trikatu)

- Triphala curna-(haritaki,bhibitaki,amlaki)

- Krishnadi curna-(pippali,patha,chitrakmula)

KAVATH/ASAV/ARISHTA-(20-40ML WITH SAMABHAG WATER)

- Punarnavaasthak kvatha-(punarnava,nimba,patol)

- Phalatrikadi kvatha-(triphala,daruharidra,indrayanmula)

- Dasamula kvatha-(gokshura,prishnaparni,patala,kantakari)

- Punarnavasava-(triphala,trikatu,gokshura,punarnava)

- Punarnavadhyarista-(punarnava,bala,patha)

- Gandiradhyarista-(gandira,bhallataka,chitrak)

- Abhayarista-(haritaki,amlaki,indrayana)

GHRITA(20-30ML WITH USHNODAKA)

- Shunthi ghrita-(shunthi,dasamula)

- Punarnavdhya ghrita-(punarnava,chirayata,bhanga)

- Chitrak ghrita-(chitrakmula,ghrita)

- Shushka muladhya taila-(sushka mulak,punarnava,devdaru)

AVLEHA-(20-30 GM WITH DUGDHA)

- Kansh haritaki(dasamula haritaki)-(punarnava,devdaru,amrita)

- Gudadraka-(guda,adraka)