EDITORIALEDITORIAL

April 2011

SHOTHA VISHESHANK

It's very common that some of the items consumed regularly by us are the main cause for “disturbing our

health”.Vata – Pitta – Kapha, the Shareer

D o s h a s t h a t a r e responsible for the perfect functioning of the body mechanism get vitiated due to i m p r o p e r d i e t , improper behavior and improper thoughts. No

wonder then that it gives rise to many unwanted and undesired diseases. The Ayurvedic fraternity of course is well aware of this. Shotha is one of such unwanted diseases. Any swelling external or internal - anywhere in the body - is described as 'Shvayathu', 'Shotha' or 'Shopha' by the Seers.Many a times, Shothavastha seen in patients is a symptom of a disease. In such cases the main disease is treated and Shotha - the symptom present there - regresses. In some cases, Shotha is the disease caused by specific factors and the presence of Sthanasanshray in the body. Here the cause of Shotha needs to be treated. Shotha may be Nija i.e. arising due to the causative factors present inside the body or Aagantuja i. e. arising due to external factors or any other diseases. Treatment is imperative and has to be modified according to Samprapti. I thank you for suggesting specific topics for past as well as coming Arogya Mand i r Pa t r i ka . Th is 'Sho tha Visheshank' issue is also brought out keeping in view the wishes of many of our erudite and esteemed patrons. I hope this issue too will not fail your expectations.

Yours Truly,

Vd. Shailesh Nadkarni

Vishaya Pravesh

Shotha

If one goes through various Ayurvediya Trayi we find Shotha being discussed at Samhita and Grantha, it's clear that length. Charakacharya has also Shotha can be a 'Swatantra Vyadhi' or mentioned 'Shotha' in the list of 'Paratantra Vyadhi' in an individual. Santarpanajanya Vyadhi in Sutra Sthan Shotha as Paratantra Vyadhi is 23 and has also enumerated in the list of described in the form of 'Anya Vyadhi 'Amla Lavan Rasa Atisevanjanya Vyadhi' Lakshana' or 'Anya Vyadhi Upadrava'. in Sutra Sthan 26. For example Shotha arising in Shleepad In this Ayurved Patrika, we will discuss is 'Lakshan Swaroop' and in Vrukka 'Shotha' as Swatantra Vyadhi in detail Vikruti as 'Upadrav Swaroop'. and Paratantra Shotha in brief. Charakacharya has also described Ekdesheeya Shotha in Trishothiya Definition: Adhyay. Though they are Ekdesheeya GlmesOeb mebnleb MeesHebâ leceeng: efveÛeÙeeole: ~ cee.efve.S h o t h a , C h a r a k a c h a r y a h a s differentiated them by names as they

According to Ayurved Samhita Grantha, appear at different sites due to their any swelling (Utsedh) Ashraybhed, Doshabhed and so on. For caused by all the three e.g. Karnamoola Shotha, Udar etc.vitiated Vatadi Dosha is The Vranashopha described in Charak known as Shotha. Samhita and Sushrut Samhita can be In Modern science, considered as a kind of Shotha seen Oedema is defined as prior to the formation of wound due to abnormal and excessive the causes similar to that of Shotha accumulation of fluid in the interstitial Vyadhi i. e. Nija or Aagantuja. The line of tissue spaces and serous cavities. treatment is initially the same, but at Any t rans ien t en la rgement o r later stages changes. It will be protuberance in the body affecting its discussed in brief here as the original normal structure can be included identification of Avastha, i. e. Aam, in Shotha. It may or may not affect the Pachyaman and Pakva is essential to normal functions of the parts affected by hone down to the exact line of treatment. Shotha.In the Bruhad Trayi as well as Laghu

In the last edition of Arogya Mandir Patrika, 'Yakrut Pleeha Vikar Visheshank', we have discussed various ailments caused due to the alteration in the normal functioning of Liver and Spleen and their treatment including the Vyadhi 'Udar'. Udar Vyadhi is described as 'Ekadesheeya Shotha' in Trishothiy Adhyay of Charak Samhita, Sutrasthan. Udar Vyadhi can be considered as a best example of Ekdesheeya Shotha, though it can be taken as a Swatantra Vyadhi due to its Swatantra Samprapti etc. Udar Vyadhi, if not treated properly & in time, can lead to Sarvadehik Shotha. Charakacharya, has perhaps for this reason, described Shotha Chikitsa after Udara Chikitsa in the Chikitsa Sthan of Charaka samhita. In this Arogya Mandir Patrika, we are discussing various types of Shotha like Udar in brief, as well as about Shotha Vyadhi with scientific and practical approach. In this modern era, the changed food habits and sedentary life style have invited a number of miserable and disabling disorders. Symptomatic approach of modern medicine has worsened the condition. Here arises the need of perfect diagnosis, understanding the pathogenesis and designing the line of treatment accordingly for the cure from disease and not just symptomatic relief. Our science gives great importance to Nidana, - the causative factors - in the development of disease, as it is the Nidan Parivarjan i. e. avoidance of the causative factors, the first step in the Ayurvediy principles of treatment.

Vyadhi Marga2

Introduction of Affected Srotas

Charakacharya has categorized this disorder in Shakhanusari as well as Koshthanusari Vyadhi to indicate that it follows both the paths of pathogenesis, Bahya as well as Aabhyantar. It is necessary to understand the Rogamarga, so as to know the Sadhya Asadhyatva, i. e. the prognosis of the disease. It is also useful in deciding the line of treatment. For example, Bahyamarganusari Shotha may just require Shamana whereas Koshthanusari needs Dosha Sanshodhana from nearest outlet of the body.As mentioned in the Samprapti Sootra of Shotha, Dosha and Dooshya of this Vyadhi circulate through the Bahih Sira and stay in Twak as well as Mansa Dhatu. It can be deduced that they affect the Rasavaha and Raktavaha Srotas and as per the site of 'Kha Vaigunya', they give rise to Sthanik (localized ) or Sarvadehik (generalized) Shotha. Harita describes Rasavaha Srotodushti whereas Maharshi Kashyapa has included it in Medovaha Srotas in the Samprapti of Shotha. Kashyapacharya has also opined that Shotha is difficult to treat as it involves Uttarottar Dhatu from Rasa to Meda.

Arogyavardhani:

Effective in Shotha caused due to Yakrut-Pleeha Vikar, Udar, Hruday Vikar, Pandu being Deepak, Pachak, MalashodhakHelps to clear the obstruction from Srotas

and restores function of Yakrut

Dose - 2 to 4 tablets 2-3 times a day with Kumari Asava No: 1 or lukewarm water

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NIJA /Aahara

Sour, Salty, Hot, Spicy, Fermented food items, Curd, Beverages, Sprouted, New grains, Sea food, Mud, Dirt, Roasted mud, Food poisoning caused by Viruddha anna and Dushit Anna, Fasting

Vihara Brisk walk after meal, Control of the natural urges, Improper post natal care, Sedentary life style, Suffering from chronic diseases, Intercourse in condition of Ajeerna

Others Improper methods of Panchakarma, Snehan, Swedan, Sansarjan Krama, Abortion, Pressure exerted by Foetus, Marmaghata

AAGANTUJA /Abhigat

Trauma or Injury like cuts, tear, perforation etc. due to fall or weaponsExternal pressure exerted by any object

Visha Direct or indirect contact with poisonous object or organisms. e.g. air, sweat, touch, bites etc., contact with snow, heat

Causative Factors:One finds great commonality in the Hetus of Shotha described by various Granthakaras. Charakacharya has described common factors, i. e. Samanya Hetu in Chikitsa Sthan whereas Vishesh Hetu according to the predominance of Dosha – Dushya in Sutra Sthan. As the disease is known to be Tridoshajanya, factors vitiating all the three are naturally found mentioned in list of Samanya Hetu given below. As is found in most cases, the factors affecting bodily substances first and then gradually landing in Shotha, are grouped under the heading Nija; where as external factors directly giving rise to Shotha are grouped under Aagantuja Hetu.A noteworthy part is that, Charakacharya has included 'Marmaghata' in the list of Nija Hetu. It clearly indicates that any functional vikruti in the vital organs of the body like Kidneys, Brain, Heart, which are 'Marma', themselves can give rise to Shotha. Charakacharya, in Snehaadhyaya while describing Sneha Vyapad as well as in Visha Chikitsa Adhyaya while listing the symptoms of the third Visha Vega, has mentioned Shotha as a symptom.The Hetus can be classifieds in many ways, e.g.

Vyadhi Marga and Srotas

Punarnavadi Guggul:

Effective in Shotha associated with Vrukka VikrutiUseful in Samavastha being Shothaghna,

Kledaghna, Lekhan & Medohar Can also be used in Santarpanjanya

Vyadhi like Sthoulya and Mootravaha Srotas VikarDose - 2 to 4 tablets 2-3 times a day with

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Srotas Rasavaha Raktavaha Mansavaha Medavaha

Origin Hrudaya, Dasha Dhamanya.

Yakrut, Pleeha Snayu, Twak Vrukka, Vapavahana

Causes Guru, Sheeta, Atisnigdha, Atimatra Ahar, Atichinta

Vidahi, Snigdha, Ushna, Drava Aahara, Atapasevan, Analasevan

Abhishyandi, Sthoola, Guru Anna, Bhojanottar Divaswap

Avyayama, Divaswap, Medyaahara, Ati Varuni Sevana

3vessels, excitation of the Erector pilli muscles of the skin, Shotha Poorvaroopa:

G<cee leLee mÙeeod oJeLeg: efmejeCeeceeÙeece FlÙesJe Ûe hetJe&®heced ~ discoloration of body.

Ûe.met.18 These Poorvaroopa and Roopa may be localized or

Feeling of heat or burning sensation along with stretching generalized depending upon the site and spread of the sensation or the tension in the capillaries or vessels is disease Shotha.mentioned as Poorvaroopa of Shotha Vyadhi.

Shotha Roopa (Vishesh Lakshan):Shotha Roopa (Samanya Lakshan): The Vishesh Lakshanas in addition to Samanya Lakshan meieewjJeb mÙeeoveJeefmLelelJeb meeslmesOecet<ceeLe efmejeleveglJeced ~help the physician to hone down to the type of the Doshaj meueescen<ee&ÁefJeJeCe&lee Ûe meeceevÙeefueÁb ÕeÙeLees Øeefo°ced ~~ Ûe.met.18predominance in a given case. Though, the disease is

known to be 'Tridhoshajanya', it can be classified as Samanya Lakshan of Shotha includes Heaviness, asymmetrical distribution, swelling, local heat/ raised temperature, delicacy of follows:

Types according to Dosha, Dushya and Shotha Roopa

Types:1) According to the causesa. Nija – The Shotha that gets developed due to the causative agents like Aahar, Vihar etc, vitiating the Sharir Dosha first and then giving rise to the Utsedh, is known as Nija. Nija Shotha can be classified as follows as per the predominance of Dosha. 1. Ekadoshaja – Vataj, Pittaj, Kaphaj, 32. Dwidoshaja – Vatapittaj, Pittakaphaj, Vatakaphaj, 3 3. Sannipatika – Tridoshaj, 1b. Aagantuja – The Shotha that gets developed due to external factors, directly giving rise to Utsedh is known as Aagantuj. Dosha gets vitiated later on.

1. Abhighataja – caused due to Trauma. It includes Vranashopha2. Vishajanya – caused due to contact with poisonous substances like Bhallatak.

2) According to the locationa. Ekanga: Shotha vyadhi that is

restricted to a part of body or single body organ is known as Ekanga Shotha. All Ekadeshiya Shotha described by Charak Acharya can be included under this heading. Eg. Upajivhika, Galashundi, Galaganda, Galagraha, Visarpa, Shankhak, Rohini, Karnamoolak, Udara, Gulma, Pleeha, Vruddhi, etcModern science has described it as Localized Oedema or Swelling.b. Sarvanga: Shotha when gets developed all over the body is considered as Sarvanga Shotha. Modern science has described it as Generalized or Systemic Oedema or Swelling. Depending upon its location in the body, i. e. upper, middle and lower part of the body, it can be also classified as is described in Sushrut Samhita as well as in Madhav Nidana.

Types Signs & Symptoms

Nija

VATAJA

Chala, Twak - Parush, Redness, Blackish discoloration, Animitta - Harsha, Vedana, Prasupti and Shaman, Prapeedane Unnaman, Divabalee (More prominent during day time)

Tanu,

PITTAJA /RAKTAJA

Mrudu, Sagandha, Blackish, yellowish discoloration, Bhrama, Jwar, Sweda, Trushna, Mada, Osha, Daah, Sparshasahatva, Netra Araktata, Paka

KAPHAJA

Guru, Sthira, Pale swelling, Arochak, Prasek, Nidra, Chchardi, Agnimandya, Kruchchha Janma Prasham (Slowly develops, progresses and subsides), Nipeedato na unnamed (Doesn't come up when pressed with a finger), Ratribalee (More prominent during night hours)

DWANDWAJA Combination of two Doshas

SANNIPATIK Combination of three Doshas

Aagantuja

ABHIGHATAJAVisarpavan (Spreading), Bhrushoshna (Very hot), Lohitabhas(Erythema)

VISHAJA

Mrudu (Soft), Chala (swelling with changing position), Avalambi (Hanging with a pedicle), Sheeghrotpatti (Rapid onset), Daah (Burning sensation), Ruja (Pain)

Lakshan & Types of Shotha

4This information or classification can be of use for deciding 2. Generalized (Anasarca or Dropsy)the line of treatment as well as to know the prognosis. a. Urdhva, for e. g. Akshikoota Shoth or peri orbital oedema Localized or Organs specific:found in Pandu Vyadhi as a Poorvaroopa. 1. Corneal oedema b. Madhya, for e. g. abdominal distention as found in Udar 2. Periorbital oedemaVyadhi. 3. Cutaneous oedemac. Adha, for e. g. Paada Shotha or swelling over lower limbs 4. Lymphedemaas found in Sleepada Vyadhi. 5. Hydrops fetalis

6. Pulmonary oedema3) According to the appearance 7. Acute high altitude pulmonary Shotha can also be classified as of following types based on oedemaits external appearance as described 8. Cerebral oedemain Ashtanga Hrudaya. a. Pruthu: when Shotha has Generalized: comparatively less of protuberance, it 1. Renal oedemais known as Pruthu - in Nephrotic Syndrom

- in Glomerulo Nephritisb. Unnata: when the Shotha is in the - in Acute tubular injuryform of protuberance, its considered as Unnata 2. Cardiac oedema

- Decreased cardiac outputc. Grathita: when Shotha is hard to touch, it is considered as - Transudation (Back pressure hypothesis)Grathita - Chronic hypoxia (Forward pressure

hypothesis)

According to the content of the accumulated fluid, it is also 4) According to the Pathogenesis classified as,

a. Swatantra: Shotha is considered a Swatantra Vyadhi 1. Transudate: A fluid that passes through a membrane when it arises due to none other but its own causative factors which filters out much of the protein and cellular elements to and gets resolved using its own specific treatment. It may be yield a watery solution. It occurs due to increased pressure in Nija or Aagantuja. e. g. local swelling aroused at neck as in the veins. e.g. in Congestive Cardiac Failure - CCFGalaganda in case of Nija or the one caused due to trauma or contact with Visha Dravya like Bhallatak in case of 2. Exudates: A fluid rich in proteins and cellular elements Aagantuja. that oozes out of blood vessels due to inflammation and is

deposited in nearby tissues (e.g. in abscess)b. Paratantra: Shotha is considered as Paratantra Vyadhi, if it is caused due to some other Vyadhi and gets resolved As per Modern science, oedema is one of the cardinal when that particular Vyadhi is treated. This can be in the form symptoms of inflammation - of Lakshan of other Vyadhi or the Upadrava of Vyadhi as Tumor (Swelling/ Oedema) - Rubor (Redness)follows: Calor (Temperature ) - Dolor (Pain)

I. Anya Vyadhi Lakshan Swaroopa: Shotha is found as a Lakshan of Vyadhis such as Vrukkavikar, Hrudrog, Yakrut Pleeha Vikar, Krumi, Kushtha etc. e. g. Shotha in case of Vrukkavikar is due to impaired function of Mootra to carry out Kleda from body.

II. Anya Vyadhi Upadrava Swaroopa: in following Vyadhi, Shotha is found as Upadrava of that particular Vyadhi. i. e. if not treated well, they may lead to Shotha Vyadhi. Chhardi, Alasaka, Visuchika, Atisar, Udar, Shwas, Kasa, Shosha, Kshataksheen, Jwar, Pandu, Arsha, Bhagandar, Pradar.

5) Types according to Modern scienceModern science has classified it in following manner, depending upon the site of the disease.1. Localized in organs or limbs

Kumari Aasava No.1:

Kumari along with Tamra & Loha Bhasma, effective in Yakrut Vikar & related problemsHelps to clear obstruction from the Srotas within the YakrutaHelps in proper secretion of PittaHelps to maintain proper flow of Pitta in GrahaniUseful in Shotha caused due to Yakrut-Pleeha Vikar, Pandu and KamalaUseful in Udar being Deepak, Pachak, Yakrutottejak, Shothaghna and Mootral

Dose - 2 to 4 tsp (10 - 20 ml) 2-3 times a day with equal quantity of lukewarm water

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Types of Shotha

5Vranashopha has been described by Sushrutacharya as There are three types of Vranashopha well as Charakacharya. according to the stages involved during its

progress. As these stages form criteria for Deeceb efJeheÛÙeceeveb me mecÙekedâ hekeäJeÃe Ùees efYe<ekedâ ~ the line of treatment, it is important to

know them in brief.peeveerÙeeled me YeJesled JewÅe: Mes<eemlejkeâjJe=òeÙe: ~~ meg.met. 17/11

The causative factors include Nija and Aagantuja Hetu It is said that the one who has got the knowledge of all the similar to that of Shotha. But Vranashotha is a stage prior to three stages of Vranashopha is eligible for the designation

'Vaidya', and rest are just comparable to thieves. Vrana Utpatti.

In Madhukosha Teeka, Shotha is said to be different than Vranashopha as Vranashopha has 8 Vrana Vastu - Twak, Sira, Mans, Asthi, Sandhi, Snayu, Marma and Koshtha same as Vrana where as Shotha is restricted upto Twak and Mansa Dhatu.

Charakacharya in Chikitsa Sthan Adhyay 25 has described Shothaghna Chikitsa as the first treatment in 36 Vranopakrama. Also, Raktamokshana is very important line of treatment in Aam and Pachyaman Avastha of Vranashotha as well as in Kathin Vranashotha.

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le=leerÙeb Gheveenb Ûe ÛelegLeea heešveer ef›eâÙeeced ~~

hebÛeceb MeesOeveb kegâÙee&led <e‰b jesheCeefce<Ùeles ~

Sles ›eâcee ›eCemÙe Gòeâe mehleceb Jewke=âleehenced ~~

megßegle met$emLeeve 17/22-23

Sushrutacharya in Sootra Sthan 17 has mentioned 7 types of treatment as given above in the table and in Chikitsa Sthan Adhyay 1, first eleven types of treatments (from Aalepa till Virechana) out of 60 Vranopakrama are for Vranashopha.

Stage Sign & Symptoms Treatment

Aam Mandoshmata(Mild rise in local temp), Twaksavarnata (Same skin color), Sheet (Cold), Sthairya ( Stable), Alpa Shophata (Mild swelling), Manda Vedana (Mild pain)

Vimlapan (Applying pressure by rubbing with fingers), Avasechan (includes Raktamokshan, Snehan, Vaman, Virechan)

Pachyaman Twak Vaivarnya (Skin discoloration), Shotha Vruddhi (Enlarged swelling), Jwar (Fever), Daha (Burning sensation), Trushna (Thirst), Aruchi(Tastelessness), Sthana Asana Shayanen Na Shanti (No relief by rest), Toda, Chhedan, Bhedanadi Vedana (Pain and Different sensations like Pricking, Tearing, Cutting, Throbbing etc.)

Upanaha (with Atasi, Yava Kalka etc)

Pakva Vedana, Upadrava Shanti (Relief from pain and complications), Pandu (Shweta Varnata), Alpa Shotha (Mild swelling), Vali (Wrinkles), Twak Pariputan (Cracks on the skin), Kandu (Itching), Muhurmuhur Toda (Intermittent mild pricking sensation), Puya Sancharan (Movement of accumulated pus)

Paatan (Incision), Shodhan with Triphala Kwath, Ropan with Nyagrodhadi Kwath, Chandanadi Lepa, Vaikrutapaha (Pandukarma, Krushnakarma, Savarnikarana, Romasanjanana)

Punarnavasava:

Shothaghna, Mootral, Mootraranjak, Kledahar, Hrudya Asava, prepared form Punarnava, the one which has ability to rejuvenate Effective in Sthanik as well as Sarvadehik ShothaEffective in Shotha due to diseases of Vrukka, Yakrut-Pleeha, Hruday etc.Useful in Pandu associated with Yakrut Vikar

Dose - 2 to 4 tsp (10 - 20 ml) 2-3 times a day with equal quantity of lukewarm water

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Lohasava:

Asava containing Loha Bhasma Useful in Shotha associated withRaktalpata developed from Yakrut-PleehaVikar being Deepak, RaktaprasadakExtremely beneficial in condition ofShotha associated with Shwasa,HrudravataAlso useful in Yakrut-Pleeha Vruddhi, Agnimandya, Jeerna Jwar, Rajah Dushti, Pandu, Gulma, Shwas, Kasa, Udar

Dose - 2 to 4 tsp (10 - 20 ml) 2-3 times a day with equal quantity of lukewarm water

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Vranashopha

66

Punarnava Mandoora:

Useful in Shotha caused due to Pandu, Yakrut-Pleeha Vikar, Udar being Shothaghna, Raktavardhak, Mootral, AgnideeapakEffective in Jeernavastha of Udara with symptoms like Krushata, Agnimandya, AjeernaDose - 1 to 2 tablets 2-3 times a day with

Punarnavasava, Kumari Asava No. 1 or lukewarm water

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Samprapti (Pathogenesis):While explaining the Samanya Samprapti of Shotha Vyadhi, Charakacharya in Chikitsa Sthan Adhyay 12 says,

yee¢ee: efmeje: ØeehÙe Ùeoe keâHeâeme=kedâefheòeeefve mebot leern JeeÙeg: ~lewye&æceeie&: me leoe efJemehe&lÙeglmesOeefueÁb ÕeÙeLegb keâjesefle ~~ Ûe.efÛe. 12

efheòejòeâkeâHeâevJeeÙegog&°es og°eved yeefn: efmeje: ~veerlJee ®æieeflemlewefn& kegâÙee&led lJekedâceebmemebßeÙeced ~~GlmesOeb mebnleb MeesHebâ leceengefveÛeÙeeole: ~ De.ù.efve.13Vishesh Samprapti of Vatajadi Bhed of Shotha Vyadhi is explained in Charak Samhita Sutra Sthan, Adhyay 18 Dosha : Tridosha, Vatapradhan (Vyana)Dushya : Rasa, Rakta, Mansa, MedaSrotas : Rasavaha, Raktavaha,

Mansavaha, MedavahaAgni : Rasadhatvagni mandya,

Jalamahabhutagni mandyaUdbhava sthana : Bahya siraVyakti Sthana : Twak, MansaAdhishthana : Ekanga, SarvangaVyadhimarga : Bahya, Abhyantar

<eÙe

Vitiated Pitta, Rakta, Kapha

Vitiated Vata

Utseda Sanhata Shotha

Accumulation of Dosha in Twak, Mansa (Sthansanshray)

Vinmarga Gamana of Vata

Sangapradhana Strotodushti

Obstruction inNormal path of Vata

Accumulation in the Bahi Sira

Nidansevan

Shotha as Garbhopadrava and as Sutika Roga:It is one of the 'Garbhopadrava' discussed by Kashyap Aacharya.

It is also one of the Sutika Roga caused due to improper Sutikacharya Palan.Upadrava of Shotha: Shotha, if left untreated, may give rise to following disorders: Chhardi, Shwas, Aruchi, Trushna, Atisar, Jwar, Daurbalya (Charak) and additionally Hikka, Kasa as per Sushrut.The manifestation of Upadrava depends on the extent of the Dosha Dushti as well as the site of the Sthanasanshray. Asadhya Shotha: In case of Females, Shotha starting from head and spreading towards lower limbsIn case of Males, Shotha starting from lower limbs and spreading towards headIn case of both sexes, Shotha over Genitalia Presence of all the UpadravaWhole body involved with appearance of capillaries on it, with secretions Arishta in Shotha: The special feature of Charak Samhita is Indriyasthan where Arishta Lakshanas have been elaborately described. In Adhaya 6 & 10, Charakacharya has described the Arishta Lakshan associated with Shotha as follows which certainly leads to the death of the patient. (Sadyo Marana)Vataja type with Atisara and TrushnaShotha over extremities, trunk and genitalia

It is often found during pregnancy.

Why does the Shotha appear in different areas though the Samprapti factor remains common?

Ùeoe Øekegâefhelee: oes<ee: Mejerjs heefjOeeJeleeced ~ Ùe$e meÁ KeJewiegCÙe JÙeeefOe $eeshepeeÙeles ~~ meg.met.

‘Kha Vaigunya' or Srotas Vaigunya being the most important stage during the progress of the disease, it can b e u n d e r s t o o d t h a t a f t e r D o s h a D u s h y a Sammoorchhana, when these vitiated Doshadi circulate through body, they get stuck at some places.

In case of Aagantuja Shotha, these are the sites of the

Trauma or Poisonous contact and in case of Nija Shotha,

these locations are nothing but the part of body with

impaired anatomy or physiological functions being

vulnerable or favorable for the stay of Doshadi. Here

comes the stage of 'Sthana Sanshraya'. Thus, Vyakti and

Bhed appear at the same site.

mle

7As number of diseases described in our Samhita Grantha have a similarity in the Lakshan Shotha, they can be distinguished from each other as follows. Though the cardinal symptom Swelling remains the same, the pattern may differ.

Differential Diagnosis

Chandraprabha:

Helps to remove excessive Kleda through

MootraEffective in Shotha caused due to Vrukka

Vikar, Mootravaha Srotas Vikar being

Rasayana, Balya, Shamak, Mootral,

AshmariharaDose - 1 to 2 tablets 2-3 times a day with

lukewarm water

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Vyadhivyavachhed

Gokshuradi Guggul:

Moot ra l , Va taha r, Sho thaghna , Vedanahar

Effective in Shotha associated with Vrukka VikrutiRemoves excessive accumulation of Jaleeya Ansha from the bodyHelps to increase urinary output in turn reduces Shotha

Dose - 1 to 2 tablets 2-3 times a day with

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Chikitsa: efveoeveoes<eleg&efJeheÙe&Ùe›eâcew®heeÛejsled leb yeueoes<ekeâeueefJeled ~ Ûe.efÛe. 12MemleceguuesKeveb le$e efJejskeâes jòeâcees#eCeced ~JÙeeÙeece§eesheJeeme§e Oetcee§e mJesoveeefve Ûe ~®#eewõ§eeYeÙeeØeeMe: ØeeÙees ®#eeVemesJeveced ~ÛetCe&Øeosne Ùes Ûeesòeâe keâC[gkeâes"efJeveeMevee: ~~ Ûe.met. 23Before treating the patient as per 'Nidana,' 'Dosha' and 'Rhutu' Viparyaya, Bala, Dosha and Kala need to be examined properly.Nidana Viparyaya: Aahara, Vihara and Aushadhi with opposite Guna of causative factorsDosha Viparyaya: Aahara, Vihara and Aushadhi with opposite Guna of Pradhana DoshaRhutu Viparyaya: Aahara, Vihara and Aushadhi with opposite Guna of the Rhutu

Disease Site Signs & Symptoms Diagnostic Tests Treatment

Shotha Local orSystemic(Twak, Mansa)

Localized or Generalized Swelling, Pitting, Non- pitting oedema

Measurements of girth of part affected, CBC, Renal & Cardiac profile

Punarnavasava, Punarnavadi Kwath, Guggul, Mandura, Gudardraka

Sthoulya Sites of Fat deposition like Omentum (Meda)

Obesity, weight gain Raised BMI, Weight,Lipid profile, Thyroid profile

Arogyavardhani, Vadavagni Loha, Vidangadi Loha

Udar Abdominal cavity(Twak, Mansa)

Abdominal distention Dull sound on percussion, Abd. girth, USG, CT Abd.

Ichchhabhedi Rasa, Jalodarari Rasa

Shleepada Lower extremities(Twak, Mansa, Meda)

Hard Swelling over foot/ leg, Non pitting oedema

Blood & Serological test for Filarial organism

Nityananda Rasa, Shleepadari Loha

Vranashopha Vranavastu (8) Swelling prior to the wound formation, Ushnasparsha

USG Upanah

Karnamoola Shotha

Karnamoola Swelling, erythema, pain External appearance Asadhya

Vidradhi Intra peritoneal or extra peritoneal(Twak, Rakta, Mansa, Meda, Asthi)

Slow onset, Large swelling, Throbbing pain due to Putrification

USG, CT Scan Kajjali, Varunadi Ghruta

Visarpa Along the nerve distribution, (Twak, Mansa, Rakta)

Severe pain, Burning sensation and tenderness

Serum test for Herpes zoster

Dashanga Lepa, Karanjadi Taila

Type of Shotha Treatment Aama janya - Langhan

Vruddha dosha janya - Sanshodhan

Shirogata - Nasya

Adhoga - Virechan

Urdhwaj - Vaman

Snigdhajanya - Rookshan

Rukshyajanya - Snehan

Vataja with Vibandha - Niruha

Vata Pittaja - Tikta Ghruta

Moorchha, Arati, Daha, Trushna - Dugdha with Mootra

Kaphaja - Kshara, Katu, Ushna, Takra with Mootra, Asava

81. Nidanaparivarjana: The Hetu responsible for the Vyadhi 3. If Sthanika: In case of Sthanika Shotha, following Utpatti must be avoided as the first line of treatment as well measures can be administered to Pacify the vitiated Dosha. as for prevention. In addition to that, above line of treatment can also be 2. If Sarvadehika: In case of Sarvadehika Shotha, following followed depending upon the extent of the disease .are the measures to be taken care of. a. Langhana: Fasting or Laghu Bhojan Shamana: Snehan, Swedan, Upanaha b. Pachana: Preparations like Gudardrak can be used for Dhooma,Lepa,Pradeha Paachan Raktamokshana, Agnikarma (Bh. R.)c. Vyayam: Being a type of Apatarpan, it helps to reduce kleda Pathya: Purana Yava shali, Dashamula Kwatha siddha d. Shodhana: Panchakarma Chikitsa can help to remove anna, Katu, Snigdha Bhojana the Dosha out of the Body from the nearest outlet Apathya: Pishtanna, Ushna, Lavana, Madya, Mruttika, Vaman,Teekshna Virechan, Aasthapan, Raktamokshan, Aanupa, Audaka Mansa, Dugdha, Guda, Taila, Gurvanna, Nasya Divaswapa.

Eka Dravya Chikitsa:

Following Dravya are known to effectively reduce Shotha even when used single. Their Guna and Karma can be summarized as follows.

Punarnava: Katu Tikta Rasatmak, Katu Vipakatmak, Ushna Veeryatmak, Laghu, Ruksha

Gokshur: Madhur Rasa, Madhur Vipaka, Sheet Veeryatmak, Guru, Snigdha

Shunthi: Katu Rasa, Madhur Vipaka, Ushna Veeryatmak, Guru, Ruksha, Teekshna

Kuchala: Tikta, Katu Rasa, Katu Vipaka, Ushna Veeryatmak, Laghu, Ruksha, Teekshna

Punarnava acts at the site of obstruction and it let the 'Kleda' go out of body by relieving the obstruction, whereas, Gokshur acts at the level of formation of Mootra and flushes it out by excessive production of Kleda.

Shotha

Punarnava Gokshur

Agnideepan Kaphavrudhi

Kleda pachan Kleda Vrudhi

Strotorodh Nashan Mootra Vrudhi

Mutra, sweda, mala, Vat utsarjan

Mootra VirechanBasti Shodhan

Shothahar Shothahar

Is it not necessary to think?

Now a days, Diuretics like Lasix or Herbs like Punarnava or responsible for Shotha. This should always be kept in mind Gokshur are used in order to flush out excessive body fluid while planning the diet of the patient for prevention as well through urine so as to reduce the Oedema. But is it not as cure. It is always observed that due to Gravitational necessary to think about the etiopathology of the disease force; Shotha is located at the sites of dangling parts like and accordingly the Sampraptibhanga of that disease? 'Paedal oedema' in case of ambulatory patients and 'Sacral Fluid restriction may help to stop further complications, but oedema' in case of bed ridden patients. does it reverse the pathogenesis already set into motion ? Why can't we all approach it with simple and authentic Are we the Ayurvedic physicians really taking Agni factor in Ayurvedic diagnostic tools instead of making it get lost in a account, while treating any disease? bunch of papers of investigations like Renal profile, Thyroid

profile, Cardiac profile, etc? Are they all really needed to Is it really logical to drink plenty of water early in the morning reach the diagnosis in each case? Though the documented when Jatharagni is not yet activated to act perfectly? Isn't it proof is the necessity of the times, is it not our duty to a weird thought of Atyambu sevana for flushing out body preserve the purity of our Science and to see that it does not toxins as if it's a toilet drainage system? Is the concept of get lost in the process of the so-called Modern approach? 'Shodhan' not the key factor to seriously work upon in such

situations?Is Haemodialysis really the last choice for the patients in chronic conditions? Sadhya Asadhya Lakshans mentioned in our Samhitas are rarely taken into account. People with curable conditions die due to negligence, whereas those with poor prognosis can survive with extreme care. So, one should always try to give all the comforts to the sufferer.Is it not necessary to correct the life style and our food habits in order to prevent such conditions? As described in all the texts, 'Amla' and 'Lavana' Rasa are the factors

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