Ayurvedic Treatment For Pedal Edema: Principles, Panchakarma, Limitations

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Swelling caused by different causes and having different presentations are covered in the topic ‘Shotha’ in Ayurveda. Most of the causes of pedal edema (foot swelling), leg swelling and ankle swelling explained in modern medicine fall under the ‘Shotha’ category. Treatment of foot, leg and ankle swelling caused due to different causes may be treated on the lines of ‘Shotha Chikitsa’ i.e. principles of treatment of shotha. Shotha also covers all sorts of swelling i.e. edema, inflammatory edema, non-inflammatory edema and traumatic swelling. It also includes swelling occurring within and outside the body. 

Swelling of foot (pedal edema), leg and ankle can be termed as ‘Pada Shotha’. Shwayathu and Shopha are synonyms of Shotha.
Read related: Lifestyle Tips, Yoga And Home Remedies For Pedal Edema

Ayurvedic treatment

Treatment approach of Pada SHotha or Pada Shopha, Ayurvedic perspective
Pada Shotha or Pedal edema shall be treated on the lines of treatment of the below said conditions –

Shotha Chikitsa

Foot swelling should be treated on lines of treatment of Shotha, because shotha or swelling of foot, ankle and leg is the predominant symptom of this condition, immaterial of the cause. Thus all types of swelling in foot can be treated according to Shota Chikitsa.
Related reading – Shotha: Causes, Types, Treatment, Medicines

Hridroga Chikitsa

Since many heart related conditions lead to foot swelling or manifest foot swelling as one of their symptoms, pedal edema including swelling of leg and ankle should be treated on the lines of Hrid Roga or heart diseases. Treatment principles and medicines mentioned in Hrid Roga not only cure heart diseases but also reduce the swelling.

Heart related pathological conditions like Congestive Heart Failure (CHF), Hypertensive Heart Disease, Ischemic Cardiomyopathy (IC), Myocarditis, Endocarditis, Mitral Valve Stenosis, Pericarditis, Heart Failure – all these conditions have foot and ankle swelling as one of the symptoms. If these primary conditions are addressed, the symptoms including pedal edema too get reduced. All these conditions can be treated on the lines of Hridroga Chikitsa.
Read related: Pedal Edema: Feet Swelling Causes, Differential Diagnosis, Symptoms

Shwasa Roga Chikitsa

Lung conditions or respiratory disorders like Emphysema, Chronic Bronchitis and Cor-Pulmonale can cause foot, ankle and leg edema. These conditions (swelling of foot, pedal edema, associated with respiratory disorders) can be treated on the lines of Shwasa Chikitsa.
Shwasa = Dyspnoea, breathlessness, shortness of breath
Related Reading – Shwasa Roga Chikitsa: Ayurvedic Treatment, Medicines

Pranavaha Sroto Dushti Chikitsa

Pranavaha Sroto Dushti Chikitsa
Pranavaha Srotas are those channels in the body which carry the prana or vital life force or oxygen to every corner of the body. Pranavaha Srotas has its roots in Hridaya (heart) and rasa vahini dhamanis (channels or ducts or arteries carrying the nutrients). Oxygen and nutrients to all the cells are supplied through circulation which is monitored by the heart and blood vessels, i.e. arteries. We have already learnt that heart ailments lead to pedal edema.

Any obstruction in the pranavaha srotas or damage or morbidity related to the same also includes the heart. Therefore when foot and ankle edema appears as a result of Pranavaha Srotas vitiation, we should address the issue by treating it on the lines of prana vaha sroto dushti chikitsa. Hrid Roga Chikitsa and Pranavaha Sroto Dushti Chikitsa can be blended or used interchangeably.
Related Reading – Pranavaha Srotas: Channels Carrying Vital Life Element – Oxygen

Pandu Roga Chikitsa

Pandu Roga Chikitsa
Liver Cirrhosis, Liver disorders and anemia are the causes of pedal edema. In this context the case should be handled on the lines of Pandu Roga Chikitsa. Liver Cirrhosis can be handled on the lines of Vataja Pandu Chikitsa, Liver disorders and anemia should be handled on the lines of Pandu Chikitsa seeing the predominance of doshas.
Related Reading – Pandu Roga: Causes, Pathophysiology, Symptoms, Treatment

Udara, Jalodara Chikitsa

Udara, Jalodara Chikitsa
Abdominal disorders, especially ascites often cause pedal edema, including swelling of ankle and legs. The swelling associated with these conditions should be treated on the lines of Udara Chikitsa (treatment of abdominal disorders) and Jalodara Chikitsa (treatment of ascites or fluid accumulation in the abdominal cavity).
Related Reading – Ayurvedic Treatment Plan And Medicines For Ascites (Jalodara)

Sthoulya Chikitsa

Sthoulya Chikitsa / Medo Roga Chikitsa
Sthoulya means obesity. Medo Roga means errors of fat metabolism and related diseases. Both these conditions lead to the manifestation of foot swelling along with other set of symptoms. If pedal edema is associated with obesity or weight increase, it should be treated on the lines of Sthoulya or Medo Roga Chikitsa or Medo Vaha Sroto Dushti Chikitsa (treatment of diseases caused due to contamination of channels related to fat metabolism).
Related Reading – Effective Obesity Treatment, Remedies And Ayurveda Tips

Sira Granthi Chikitsa

Sira Granthi Chikitsa
Varicose veins and other conditions including blockage in the veins can be correlated to Sira Granthi type of pathology explained in Ayurveda. Varicose veins are one of the causes for foot, ankle and leg swelling, pedal edema. If varicose veins are causing the foot swelling, it should be treated on the lines of treatment of Sira Granthi or according to Arsha Chikitsa (treatment of piles).
Related Reading – Varicose Veins – Ayurvedic Treatment, Herbs, Home Remedies

Vatarakta Chikitsa

Vata Rakta Chikitsa
Vata Rakta Chikitsa can be thought of when the leg and foot swelling is due to pathologies in blood vessels like Peripheral Vascular Diseases, Deep Vein Thrombosis (DVT), Varicose Veins etc and also in swelling related to joint disorders like gout and rheumatoid arthritis. All these diseases fall in the category of Vata Rakta or Vata Shonita. Swelling due to sprains and strains and injuries can also be treated on the lines of Vatarakta or Bhagna (fracture or dislocation) chikitsa.
Related Reading – Vatarakta: Causes, Pathogenesis, Types, Treatment

Sandhigata Vata Chikitsa

Sandhi Gata Vata Chikitsa
If the swelling in the foot is due to the degeneration of joints and bones and if osteoarthritis is a cause, the condition shall be treated on the lines of Sandhigata Vata or SandhiVata Chikitsa

Amavata Chikitsa

Amavata Chikitsa
Amavata is a term often given to correlate Rheumatoid Arthritis or inflammatory arthritis. If the foot, ankle and leg swelling is caused due to inflammatory process or as a resultant of Rheumatoid Arthritis, it shall be treated on the lines of Amavata Chikitsa.
Amavata: Causes, Pathology, Treatment, Panchakarma, Medicines

Mutravaha Sroto Dushti Chikitsa

Mutra Vaha Sroto Dushti, Mutraghata, Mutrakrichra, Prameha Chikitsa
Kidney failure, Chronic Kidney Disease, Obstructive uropathy, Glomerulonephritis and Acute Nephritis which are the causes of pedal edema fall in the category of Mutra Vaha Sroto Dushti (contamination of channels or ducts carrying urine) according to Ayurveda. The foot swelling caused due to kidney conditions shall be treated on the lines of treatment of Mutra Vaha Sroto Dushti. These conditions can also be treated on the lines of Mutraghata (obstruction of urine) and Mutrakrichra (difficulty in urination) and Prameha Chikitsa (urinary disorders, diabetes).
Read related: Prameha: Ayurvedic Approach To Urinary Disorders

Treatment of other causes

Treatment of other causes of Foot and Ankle Swelling
Apart from the above said conditions, there are many other causes in the form of systemic, lifestyle and endocrine related problems which can cause foot, ankle and leg swelling. All those conditions shall be treated on the lines of Shotha Chikitsa in accordance with the predominant vitiated dosha.

Swelling of foot caused by Hypothyroidism and Lymphedema can be treated on the lines of Kaphaja Shotha, Galaganda and Granthi Chikitsa.

Panchakarma treatment

Role of Panchakarma in the management of pedal edema and leg swelling
Vamana (therapeutic emesis) and Virechana (therapeutic purgation) are the treatment of choices in pedal edema and leg swelling as far as Panchakarma options are concerned.

Vamana is preferred in the swellings wherein there is fluid accumulation and in conditions of non-inflammatory edema. Virechana is helpful in inflammatory swellings. Both Vamana and Virechana are not only helpful in clearing the accumulated fluid and exudates from the region of swelling but are also disease modifying. They are not only targeted towards the swelling but also to address the primary disease which is causing pedal edema. The choice should be done according to the treatment context of the particular disease which is responsible for pedal edema.

Limitations

Limitations of Ayurveda in dealing with Pedal edema
Ayurveda has a wide spectrum of formulations and treatments to combat any type of swelling including foot, ankle and leg swelling, be it inflammatory, non-inflammatory or traumatic. The key lay in accurate diagnosis of the condition which is causing that swelling. Once the culprit dosha or disease is tracked down, it is easy to deal with it. We have already discussed various perspectives of differentially seeing the leg and foot swelling in an Ayurvedic way in the above passages. The treatment protocol and medicines provided in the related contexts should be religiously followed along with lifestyle changes and diet restrictions.

Clinical experience

My experience in treating foot and ankle swelling
I have always relied on the doshic theory and accurate diagnosis of the condition causing the foot swelling. Very rarely a patient comes with predominant symptom or complaint as ‘foot swelling’. Generally foot swelling is a part of some other disease unless it has local causes like trauma (injury) or conditions like arthritis or cellulitis. When Swelling is a part of a systemic disease, I have always tried to treat the main disease and get rid of the foot swelling. Most of the times, the treatment principles of Shotha Chikitsa have yielded good results immaterial of the cause and primary disease causing it. Shotha chikitsa has not only helped to relieve swelling but also has addressed the major disease. Therefore it is vice versa, though not at all times. Shotha Chikitsa is the key for addressing many types of foot swelling.

I have taken to the local treatments like abhyanga and swedana, lepa (application of medicinal pastes), upanaha (poultice), dhara (stream pouring of medicated liquids on the afflicted area) etc when the swelling is associated with conditions like arthritis, injury, sprain and soft tissue injuries.

One good thing is that many people who come to the clinic with different diagnosed conditions (not essentially coming for pedal edema) and also have pedal edema can be handled with the disease modifying measures of that particular disease or condition in question through Ayurvedic measures. Example, a patient of diagnosed anemia coming to the clinic with pedal edema as one of the symptoms shall be effectively dealt with by administration of treatment and formulations pertaining to Pandu Roga Chikitsa or Shotha Chikitsa.

Just Before Conclusion –
Foot, ankle and leg edema is often a symptom of a major disease. The diagnosis of the main disease forms the key for treating that edema. Local edemas related with arthritis, injury and soft tissue injury can be dealt with effective local measures. Though Shotha Chikitsa helps in addressing most of these swellings, I have given different perspectives and dimensions of handling the foot swelling while addressing the primary disorder causing it in this article, also keeping in view the modern way of differential diagnosis and blending it with Ayurvedic concepts.
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