Charaka – Shotha Chikitsa 12th Chapter

12th Chapter of Charaka Samhita Chikitsa Sthana – Shvayathu chikitsa deals with symptoms and treatment of different types of inflammation. The term Shotha, Sotha, Shoth are used as synonyms of Shvayathu.

Now we shall expound the chapter on the treatment of Svayatu (oedema).
Thus said Lord Atreya. [1-2]

Agnivesha’s query

Agnivesha enquired from the great sage Atreya, the excellent physician and the one respected by the gods and Siddhas (those who have attained special spiritual powers) about complete description of etiology, signs and symptoms and treatment. [3]

Lord Atreya, the original source of science of medicine, appropriately explained to Agivesha the Etiology etc. of the diseases which is classified into 3 categories, namely Vataja, Pittaja and Kaphaja, and also classified differently as exogenous (Agantuja), endogenous (Agantuja), Ekangaja ( located in only one limb) and Sarvaja (swelling all over the body). [4]

Nija shotha causes

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;
Marma upaghata – 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

Agantuja Shotha Nidana – 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]

Types of Nija and Agantuja Shotha (endogenous)

The endogenous and exogenous oedema are of 3 types, viz,
Sarva Gatra – oedema pervading the whole body,
Ardha Gatra – oedema pervading the half of the body, and
Avayava Ashraya – oedema afflicting only one limb of the body. [7 ½]

Shotha samprapti: Pathogenesis

Because of the above-mentioned factors, Kapha, Asrik( blood) and Pitta enter the external vessels (Bahya Sira) and afflict Vata Dosha. 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
Urdhva Svayathu: If the afflictions take place in the chest, then oedema occurs in the upper part of the body
Adhah Svayathu: 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
Sarvaanga Shotha: 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) [9]

Shotha Purvaroopa

Premonitory signs and symptoms of Sotha Roga
Ushma – Hyper pyrexia, increased temperature
Davathu – burning sensation and
Siranam Ayama – 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. [10]

Shotha Samanya lakshana

The general signs and symptoms of Svayathu:
Sa gauravam – Heaviness
Anavasthitatvam – instability,
Utsedha – swelling
Ushma – rise in temperature,
Sira tanutvam – thinning of vessels,
Loma harsha – horripilation and
Anga vivarnata – discoloration of the skin over the limbs [11]

Vataja Shotha Lakshana

Signs and Symptoms of Vatika Svayathu:
Chala – The nature of the oedema changes very often
Tanu Twak – The skin over the odematous part becomes thin,
Parusha – rough to touch
Aruna, Asita – red or black in colour;
Prasupti – numbness,
Harsha – tingling sensation, horripilation
Arti – Pain
The oedema gets subsided without any reason
When pressed, the swelling disappears but it appears again after the pressure is withdrawn and
Diva Bali – The swelling is more during day time. [12]

Pittaj Shotha Lakshana

Signs and Symptoms of Paittiks Svayathu:
Mrudu – swelling is soft to touch and
Sagandha – emits odour
Asita Peeta Raagavaan – black, yellow or red in colour
Bhrama, Jwara, Sweda, Trushna, Mada – associated with giddiness, fever, sweating, thirst and intoxication
Ushyate – local rise of temperature
Sparsha Ruk – local tenderness
Akshiragakrut – Eyes of the patient become red and
Brhusha Daha pakavan – Excess and  burning sensation and suppuration in the affected part. [13]

Kaphaja Shoth Lakshan

Signs and Symptoms of Kaphaja Svayathu:
Guru – heaviness in the affected limb/ local area
Sthira – oedema remains stable and confined to one area
Pandu, Arochaka – patient suffers from anaemia and anorexia,
Praseka – to excessive salivation,
Nidra – excessive sleep,
Vami – vomiting and
Vahnimandya – suppression of the power of digestion
This type of oedema takes a long time to appear and its cure also takes a long time
Upon pressing and releasing the pressure, the pit doesn’t get filled up immediately and
Ratribali – the condition gets aggravated at night. [14]

Sadhya Asadhyata

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

Sadhyata –
Good prognosis – curability:
Aheena mamsa – if there is no muscle wasting in the patient,
Eka Doshaja – if only one Dosha is involved
Nava – oedema of recent origin
Balasthasya – if the patient has good strength then the condition is curable. [16 ½]

Chikitsa Sutra

Shotha Chikitsa Sutra: Line of Treatment:
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]

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,
Seersha Virechana (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 Tiktaka Ghrita 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]

Apathya

Unwholesome diet and regimen:
The Svayathu patient should avoid:
Gramya, Abja, Anupa – Meat of domesticated, aquatic and marsh place animals
Abala – meat that do not promote strength
Shushka shaka: Dried vegetables
Navanna – newly harvested grains
Gauda – Preparations of jaggery,
Pishtanna – pastries, starchy foods
Dadhi – curd,
Tila – sesame, slimy food and drinks, sour alcoholic preparations,
Dhana (germinated barley after frying) and dried meat;
Wrong food combinations
Heavy, unwholesome and Vidahi (which cause burning sensation) food and drink
Sleep during day time and
Sexual intercourse

Kaphaja shotha treatment

Treatment of kaphaja Type of Svayathu (Oedema):
Trikatu ( Ginger, black pepper and long pepper),
Trivrt –Operculina turpethum and
Katukarohini – Picrorhiza kurroa
mixed with the powder of Ayoraja – iron is taken along with the
decoction Triphala (haritaki, Vibhitaki, Amalaki) which cures Svayathu caused by Kapha.
Similarly, intake of Haritaki along with Cow’s urine cures Kaphaja type of oedema. [21]

Treatment of all the 3 types of Svayatu:
In all 3 varieties of oedema, viz., Vataja, Pittaja and Kaphaja Svayathu, the Patient is given the paste of
Haritaki – Terminalia chebula
Nagara – Zingiber officinale and
Devadaru – Cedrus deodara along with luke- warm water alternatively.
The patient is given the paste of
Haritaki – Terminalia chebula
Nagara – Zingiber officinale
Devadaru – Cedrus deodara and
Punarnava – Boerhavia diffusa along with cow’s urine
After taking these recipes, the patient should take bath, and after the recipe is digested, he should take food (cereals) along with milk. [22]

Treatment of Vataja Shotha

Punarnava – Boerhavia diffusa
Nagara – Ginger
Musta – Cyperus rotundus
paste of the above, in the dose of 12 grams (Aksha) each, is processed with 1 Prastha (768 ml) of milk, added with
Mayuraka
Magadhika – Long pepper fruit
Pippalimoola – Long pepper root
Nagara – ginger

Treatment of Vata- Pittaja Svayathu:
1/2 Pala (24 g) of the paste of
Danti – Baliospermum montanum
Trivrut – Operculina turpethum
Trikatu (Ginger, pepper and long pepper fruit) and
Chitraka – Leadword – Plumbago zeylanica is boiled in 2 Prasthas (768 X 2 ml) of milk and reduced to half.
Intake of this liquid is indicated in Vata Paittika type of Svayathu [24]

Recipes:

The patient of oedema should take milk boiled the following recipes.
• Decoction of Sunthi – Zingiber officinale and Pitadaru (Deva Daru or Daru Haridra
• Shyama (Trivrit), castor and black pepper fruit, cinnamon, Devadaru (Cedrus deodara) Varsabhu (Punarnava) and ginger and Danti – Baliospermum montanum [25]

Camel milk:

The patient should avoid taking food (cereals) and water, but take only camel milk either for a week or for a month [depending upon the strength of the patient and the stage of the disease].
He may also take cow’s milk added with cow’s urine or buffalo milk added with cow’s urine. The patient can take either cow’s milk or urine alone during this period. [26]

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 – Zingiber officinale [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]

Gandiradyarista

2 Prasthas (768 X 2 ) of
Gandira – Coleus Forskohlii / Cayratia carnosa
Chitraka – leadwort – Plumbago zeylanica
Vyosa ( Ginger, pepper and long pepper),
Vidanga – Embelia ribes
Brhati – Solanum indicum and
Kantakari – Yellow berried nightshade (whole plant) – Solanum xanthcarpum is added with
2 Dronas of Kurchika and cooked over cow dung fuel till 1/3rd remains.
After it is well cooked and cooled, 2 Dronas (2 X12.288 ml) of Prakruta Mastu – Supernatent liquid of curds and
100 Palas of Sitopala (Crystal sugar) is added and be kept in an earthen jar, the inside wall of which is smeared with the powder of Chitraka – Plumbago zeylanica and Pippali – Long pepper fruit – Piper longum.
This Jar is hung from the roof with help of net of ropes for 10 days and thereafter, used in medicine.
It is indicated in –
Shopha – oedema
Bhagandara – Fistula in ano
Arsha – Piles
Krumi – intestinal parasites
Kustha – obstinate skin diseases and
Meha – urinary disorders
Vaivarnya – discoloration of the skin
Karsya – emaciation and
Hikka – Hiccup caused by vayu [29-31]

Astasatarishta

100 Palas of each of
Kashmarya – Gmelina arborea
Dhatri – Indian gooseberry fruit – Emblica officinalis Gaertn. ,
Maricha – Piper nigrum
Abhaya – haritaki
Aksha – Vibhitaki
Fruits of Draksha – Vitis vinfera and
Pippali – Long pepper fruit – Piper longum is made to a coarse powder.
To this, old jaggery and 2 Droni of water is added and kept in a jar, the inside wall of which is smeared with honey.
In summer season, this Jar is kept sealed for 1 week and in winter for 2 weeks [to facilitate fermentation].
Intake of this cures different types of oedema and constipation caused by Kapha and Vayu.
This is called “Astasata Arista”. It promotes the powder of digestion. [32-33]

Punarnavadyarishtam

3 Palas of each
Sveta Punarnava – Spreading Hogweed – Boerhavia diffusa
Rakta Punarnava – Spreading Hogweed – Boerhavia diffusa
Bala – Country mallow (root) – Sida cordifolia
Atibala – Abutilon indicum
Patha – Cyclea peltata
Danti – Baliospermum montanum
Guduchi – Tinospora cordifolia
Chitraka – Plumbago zeylanica and
Nidigdhika – Brinjal Eggplant – Solanum melongena [is made to coarse powder, boiled with 4 Dronas of water] is reduced to 1 Drona.
To this decoction, 2 Tulas of old jaggery is added.
After it is cooled, 2 Prasthas of honey is added.
The recipe is then be kept in a jar, the inside a heap of barley for over 1 month.
After fermentation, the liquid is strained out, and to this, 1/2 Pala of each of the powder of
Patra – Cinnamomum tamala
Tvak – cinnamon
Ela – Cardamom – Elettaria cardamom
Maricha – Piper nigrum
Hrivera – Pavonia odorata and
Aguru – Aquallria agallocha is added.
This liquid is kept in a jar smeared with honey and ghee till it becomes aromatic
This is given to the patient after the digestion of the food, in a suitable dose depending upon the seriousness of the disease.
It immediately cures
Hrud roga – heart disease
Pandu – anaemia
Serious type of oedema
Pliha – splenic enlargement
Jwara – fever
Aruchi – anorexia
Meha – obstinate urinary disorders
Gulma – tumour
Bhagandara – Fistula- in- ano
The six varieties of Jathara Rogas (obstinate abdominal disease)
Kasa – cough
Svasa – Asthma
Grahani – sprue syndrome
Kushta – obstinate skin diseases,
Kandu – itching
Aggravation of vayu in the limbs
Constipation
Hikka – hiccup
Kilasa – a type of leucoderma and
Halimaka – a serious type of Jaundice
It endows the patient with complexion, strength, longevity, Ojas (essence of all the 7 Dhatus and Tejas (Lustre).
The patient while using this recipe should take food along with meat soup. [34-38]

Triphaladyarishta [Phalatrikadyarista]

1 Kudava (192 g) of each of the powder of
Triphala (Haritaki – Terminalia chebula, Bibhitaki – Terminalia bellericaand Amalaki – Phyllanthus emblica)
Dipyaka – Yavani
Chitraka – Plumbago zeylanica
Pippali – Piper longum
Lauha Bhasma – Iron calx and
Vidanga – Embelia ribes is added with
2 Kudavas of honey and Tula of old Jaggery [to this, 2 Dronas of water is added and fixed well] .This is kept in a jar smeared with ghee [and sealed]. This jar is kept in a heap of barley for month.
Intake of this recipe cures all the diseases described in Punarnavadyarishta – (see above)
Arishtas (fermented liquids containing self-generated alcohol) prescribed for the treatment of piles and Pandu – (anaemia)  are also useful in the treatment of Svayathu [39-40]

Krushnadi Churna

The powder of
Krushna – Long pepper – Pipr longum
Patha – Cyclea peltata
Gaja pippali –
Nidigdhika – Brinjal Egg plant – Solanum melongena
Chitraka – Plumbago zeylanica
Nagara – Zingiber officinale
Pippali mula – Piper nigrum
Haridra – Curcuma longa
Ajaji – Cumin and
Musta – Cyperus rotundus is taken along with luke- warm.
Cures: Oedema caused by the vitiation of all the 3 Doshas jointly and chronic oedema.
Similar therapeutic effect is obtained by taking the paste of
Bhunimba – Andrographis paniculata and
Shunthi – Zingiber officinale along with the decoction of
Triphala (Haritaki – Terminalia chebula, Bibhitaki – Terminalia bellerica and Amalaki – Phyllanthus emblica) or
By louha Bhasma and the powder of
Sunthi – Zingiber officinale
Pippali – Piper nigrum and
Yavaksara along with
Triphala decoction [41-42]

Kshara Gutika

1 Pala (48 g) of each of
Yava kshara
Svarji Ksara
sauvarcala – Black salt
Saindhava,
Vida and
Audbhida type of Salt
Lauha Bhasma
Sunthi – Zingiber officinale
Pippali – Piper longum
Marica – Piper nigrum
Haritaki – Terminalia chebula
Bibhitaki – Terminalia bellerica
Amalaki – Phyllanthus emblica
Pippali mula – Piper longum
Dehusked fruits of Vidanga – Embelia ribes
Musta – Cyperus rotundus
Ajamoda – Trachyspermum ammi
Devadaru – Cedrus deodara
Bilva – Aegle marmelos
Kalingaka – Holarrhena antidysenterica
Chitraka mula – Plumbago zeylanica
Patha – Cyclea peltata
Yastimadhu – Gylcrrhiza glabra and
Ativisa – Aconitum heterophyllum and
1 Karsha of Hingu is dried and made to fine powders.

These powders is added to Ksaratoya (alkaline water) prepared from ashes. 1 Drona of these ashes of 1 Drona of Mulaka [For this purpose Mulaka is dried and burnt to ashes]

1 Drona of these ashes is boiled by adding 8 times of water and reduced to 1/4th. This is then being strained through a cloth for 21 times.
The water, thus obtained, is to be added to the powders of Yava – Barley (Hordeum vulgare) Kshara etc

The recipe is thereafter boiled till it becomes condensed but does not get burnt. From this semi-solid paste pills of 1 Tola is prepared and dried.
Intake of these pills according to the prescribed procedure, cures
Plihodara – splenic enlargement
Svitra – Leucoderma
Halimaka – a serious type of Jaundice
Arsha – piles
Pandu – anaemia,
Aruchi – anorexia,
Kshya – consumption
Shotha – oedema,
Visucika – chronic Diarrhoea
Gulma – tumour
Poisoning
Asmari – urinary stone
Asthma – cough and
Kushta –obtained skin diseases including leprosy [43-46]

Gudardaka Yoga

Jaggery and green ginger taken in equal quantities is given to a patient in a dose of 1/2 Pala on the first day.
On subsequent days, both of the Jaggery and ginger taken together is increased by 1/2 Pala till it reaches the dose of 5 Palas on the 10th day.
In this dose the recipe is given to the patient for 1 month.
After the digestion of this recipe, the patient is give milk, vegetable soup and meat soup to consume.
It cures
Gulma – tumour
Udara – obstinate abdominal diseases including ascites
Arshas – piles
Shotha – oedema
Prameha – obstinate urinary disorders including diabetes
Svasa – Asthma
Pinasa – chronic cold
Alasaka – a type of digestive disorder
Vipaka – indigestion
Kamala – Jaundice
Sosha – consumption
Mano vikara – psychic disorders
Kasa – cough and
Other diseases caused by Kapha Dosha [47-48]

Ginger and Shilajit

Use of Ginger Juice
Similarly, the juice of ginger [mixed with jaggery] is given to the patient [by gradually increasing dose as described above] for the treatment of the above diseases.
After the liquid is digested, the patient should take food along with milk. [49 ½]

Similarly, the juice of ginger [mixed with jaggery] is given to the patient [by gradually increasing dose as described above] for the treatment of the above diseases.
After the liquid is digested, the patient should take food along with milk. [49 ½]

Use of Shilajatu:
Intake of Silajatu along with the decoction of Triphala effectively cures oedema caused by the vitiation of all the 3 Doshas. [49 ½]

Kamsa Haritaki

In 1 Kamsa of the decoction of
Dvipanchamula or
Dashamula (Bilva – Aegle marmelos, Syonaka, Gambhari – Gmelina arborea, Patali – Stereospermum suaveolens, Ganikarika – Clerodendrum phlomidis, Shalaparni – Desmodium gangeticum, Prsniparni, Brhati – Solanum indicum, Kantakari – Solanum xanthocarpum and Goksura – Tribulus terristris)
100 Palas of jaggery is cooked till linctus is formed.

To this, 4 Palas of the powder of
Trikatu (Ginger, pepper, long pepper) and
2 Palas of the powder of Trisugandhi (Tvak – Cinnamon, ela – cardamom and and Patra – Cinnamomum tamala) is added when it is luke- warm.

After it is cooled down, 1/2 Prastha of honey [in actual practice, 1 Prastha is added according to the general rule of Paribhasa] and 2 Palas of yavaksara is added.
The patient should take 1 fruit of Abhaya (Haritaki) and 1 Shukti of the linctus.

This cures aggravated form of
Shotha – oedema
Svasa – Asthma
Jwara – fever
Aruchi – anorexia
Prameha – obstinate urinary disorders including diabetes
Plihodara – enlargement of spleen
Udara – obstinate abdominal diseases caused by the simultaneous vitiation of all the 3 Doshas
Pandu – anaemia
Karshya – emaciation
Amavata – rheumatism
Raktapitta – an ailment characterised by bleeding from different parts of the body
Amlapitta – hyperacidity
Vaivarnya – discolouration of the skin and the
Diseases of urine, Vayu as well as semen [50-52]

Patolamuladi Kasaya

1 Karsa of each
Patolamula – Tricosanthes dioca
Devadaru – Cedrus deodara
Danti – Baliospermum montanum
Trdyanti
Pippali – Piper nigrum
Abhaya – Terminalia chebula
Visala
Madhuyasti – Licorice
Tiktaka rohini – Picrorhiza kurroa
Chandana – Santalum album
Nichula and
Darvi – Berberis aristata is made to a decoction.
This decoction is added with 1 Kudava of Ghee and given to the patient.

It is indicated in-
Visarpa – Erysipelas
Daha – Burning sensation
Jwara – fever caused by the simultaneous vitiations of an the 3 Doshas,
Trsna – morbid thirst
Poisoning and
Halimaka – A serious type of Jaundice [53-54]

Chitrakadi Ghrita

2 Prasthas of ghee is cooked by adding the paste of
Chitraka – Plumbago zeylanica
Dhanya – Coriander
Yavani – Carum copticum
Ajaji – cumin
Sauvarcala – Sochal salt
Tryusana (Trikatu – Pepper, long pepper and ginger)
Vetasamla
Fruit of
Bilva – Aegle marmelos
Dadima – Punica granatum
Yavakshara
Pippali mula – Piper nigrum and
Chavya – Piper chaba 1 Aksha (12 gram) each
And 2 Adhakas of water
It cures
Arsha – Piles,
Gulma – Tumour
Shotha – Oedema and
Mutra krchrra – Dysuria
It stimulates the power of digestion. [55-56]

Chitrakadi Ghrita:
Ghee boiled with 8 times of water and the Alkali preparation of Chitraka – Plumbago zeylanica [as paste] can also be given to the patient suffering from oedema.
Alternatively, he is given “Kalyanaka Ghrta’ (Chikitsa 9: 33-42) or Pancha Gavya (144-150) or ‘Tiktaka Ghrta’ (Cikitsa 7: 140- 143) [57]

Chitraka Ghrutam:
An earthen jar is smeared with the paste of Chitraka—Plumbago zeylanica
In this Jar, milk is kept and made to curd.
This curd is churned and ghee is prepared out of the butter which comes out.
This ghee is cooked with the paste of Chitraka mula and butter milk (which is already prepared during the process of curing).
This medicated Ghee is an excellent recipe for curing
Svayathu – oedema
Arshas – piles
Atisara – diarrhoea
Gulma – tumour caused by Vayu and
Prameha – obstinate urinary disorders including diabetes
It promotes the powder of digestion.
Food ingredients are taken along with butter milk and the above mentioned ghee.
Yavagu (thick Gruel) prepared by adding this medicated ghee is administered to the patient suffering from oedema. [58-59]

Yavagu, Yusha, Vegetables

Yavagu (Thick Gruel):
Yavagu (thick Gruel) is prepared by adding 1 Kola of each
Jivanti – Leptadenia reticulata
Ajaji – cumin seeds
Shati – Hedychium spicatum
Puskara mula – Inula racemosa
Karavi – Black cumin
Chitraka – Plumbago zeylanica
Rind of Bilva – Aegle marmelos and
Yava Ksara.
To this, small quantity of Vrksamla is added and it is sizzled with ghee and oil.
This medicated gruel cures
Arsha – piles,
Atisara – diarrhoea,
Gulma – tumour caused by Vayu,
Shyavathu – Oedema,
Hrud roga – heart diseases and
Manda agni -suppression of the power of digestion
Yavagu prepared by adding Pancha Kola (Pippali – Piper longum, Pippalimula, Chavya – Piper retrofractum, Chitraka – Plumbago zeylanica and Nagara – Zingiber officinale), in the above mentioned manner has also the above mentioned properties. [60-61]

Yusha:
The soup of Kulattha – Horse gram along with Pippali –Piper longum or the soup of Mudga along with Trikatu (Sunthi—Zingiber officinale, Pippali – Piper longum and Marica – Piper nigrum) and Yava is useful for the patient suffering from oedema.

Similarly, the meat soup of Vishkiras (group of Gallinacious birds) and Jangala group of animals dwelling in dry land forests) and other animals, like Kurma (Tortoise), Godha (Iguana) Sikhi(Peacock) and Sallaki (Pangoline) in wholesome for the patient suffering from oedema. [62]

Vegetables and Cereals:
For those who are desirous of taking vegetables, Suvarcala or Suvarcika (Suryavarta) Grnjanaka (a type of vegetable similar to garlic) or Sobhanjana, Patola – Tricosanthes dioica, Vayasi (Kakamachi – Solanum nigrum), Mulaka – Raphanus sativus, Vetra and Nimba – Azadirachta indica are useful.
Rice prepared of old Shali (a Variety of Paddy which is prepared after harvesting for more than 1 year) or barley is very useful for such patients. [63]

External therapies

External Therapies for Vatika Oedema:
In the above mentioned verses, recipes for internal use are prescribed. Now recipes for external use will be appropriately discussed.

If oedema is caused by the aggravation of Vayu, then the patient is given
Oleation
Pradeha – application of thick ointments
Parisechana – sprinkling of mentioned liquids and
Fermentation therapies
Oil is cooked with
Shaileya
Mustha – Cyperus rotundus
Aguru – Aquallaria agallocha
Devadaru—Cedrus deodara
Kaunti
Tvak – Cinnamon
Padmaka
Ela – Elattaria cardamom
Ambu
Palasa—Butea monosperma
Priyangu – Callicarpa macrophylla
Thauneyaka
Hema
Mamsi – Jatamansi
Talisapatra – Taxus baccata
Plava
Patra – Cinnamon leaf
Dhanya – Coriander
Srivestaka
Dhyanaka
Pippali – Piper longum
Sprukka and
Nakha, whichever is readily available.
This medicated oil is used for oedema caused by Vayu.
The fine paste of the above mentioned drugs can also be used as ointment (Pradeha) externally.
The patient should take fermentations therapy in a bath tub filled with water boiled by adding Vasa – Adhatoda vasica, aksa, Karanja – Pongamia pinnata, Shigru – Moringa oleifera, Kasmarya, Patra, and Arjaka. Thereafter, he should take bath with water which is made warm by exposing to the rays of the sun.
At the end, he is smeared with the ointment of aromatic drugs. [64-67]

External Therapies for Paittika Oedema
Vetasa – Amla vetasa
Bark of Ksiri vrukshas (Nyagrodha—Ficus bengalensis, Udumbara –Ficus racemosa, Asvattha – Ficus religiosa, Parusaka, and Plaksa)
Manjistha – Rubia cordifolia
Mrunala – lotus stalk
Chandana – Santalum album
Padmaka and
Balaka- Hrivera –
these drugs is made to a paste and applied over the body of the patient suffering from Paittika type of oedema.
Oil is cooked with the paste and the decoction of the above mentioned drugs and used for massage.

Having applied the above mentioned medicated oil, the patient should take bath with water which is boiled by adding Chandana – Santalum album; abhaya, Ushira – Vetiveria zizanoides and Padmaka and which is further heated through its exposure to the rays of the sun.

The decoction of Ksirivrksas (Nyagrodha – Ficus bengalensis, Udumbara – Ficus racemosa, Asvattha – Ficus religiosa, Parisa – and Plaksa) and milk added with water are useful for the bath of the patient suffering from Paittika type of oedema after bath he should apply sandal- wood paste over his body. [68-69]

External Therapies for Kaphaja Shotha:
Paste of these ingredients is applied to relive oedema caused by Kapha:
Pippali – Piper longum
Sand – Sikata
Pinyaka – old oil cake,
Bark of Sigru – Moringa oliefera and
Atasi – Linum usitaissimum
For this purpose, the body of the patient is sprinkled with the decoction of Kulattha and Sunthi as well as cow’s urine.
After taking bath, the patient is anointed with the paste of chandana – Santalum album and Aguru – Aquallaria agallocha [70]

External Therapies for All Types of Oedema in General:
The  pulp of Bibhitaka – Terminalia bellerica is made to a paste and applied externally. This cures burning sensation and pain in all types of oedema.
If this patient of oedema is suffering from pimples associated with burning sensation, etc then the paste of Madhuyasti – Glycyrrhiza glabra, Musta – Cyperus rotundus, leaves of Kapittha and Chandana – Santalum album is applied.
Rasna – Pluchea lanceolata
Vasa – Adhatoda vasica
Arka – Calotropis procera
Triphala (Haritaki – Terminalia chebula, Bibhitaki – Terminalia bellerica and Amalaki – Phyllanthus emblica),
Arjaka
Vyaghranakha (Nakhi)
Durva – Cynodon dactylon
Suvarchala – Black salt
Tiktaka rohini
Kakamachi
Brihati – Solanum indicum
Kushta – Sausserea lappa
Punarnava – Boerhavia diffusa
Chitraka – Plumbago zeylanica and
Nagara – Zingiber officinale the powder of these drugs is made to a paste by triturating with cow’s urine and used for unction (Unmardana), which cures [all types of] oedema.
In this condition, sprinkling with the juice or decoction of Mulaka – Raphanus sativus is useful. [71-73]

Localised Oedema

Sometimes oedema is localised in a particular part or organ of the body. Depending upon their locations, tissue elements involved shape and nomenclatures, these are of innumerable types. By way of example, some of these are being described here. [74]

Sirah Shotha (cellulitis / swelling of the head):
All the 3 Doshas get aggravated by their respective causative factors and caused oedema in the head which is of very serious nature. [75]

Kantha Saluka (Quinsy):
Sometimes oedema occurs inside the throat.
In shape, it is like ‘saluka’ (rhizome of lotus) because of this the patient gets sternous breathing. It obstructs inspiration. [75/ ½]

Bidalika (Ludwig’s Angina)
Bidalika is characterised by oedema in the joint between the neck and the face, chin and throat.
The swelling is associated with Daha-burning sensation and Raga-redness.
It causes serious impairment of respiration and excruciating pain.
If it surrounds the neck, then the patient succumbs to this disease. [76]

Talu Vidradhi (Palatal Abscess):
Talu Vidradhi is characterised by an abscess associated with Daha-burning sensation, Raga- redness and Talu pakva – suppuration in the throat.
It is caused by the aggravation of the 3 Doshas. [½ 77]

Upajihvika and Adhijihvika:
Upajihvika – acute superficial glossitis is located in the exterior of the tongue and Adhijihvika (sub- lingual abscess) which is caused by Kapha afflicts the lower part of the tongue. [77 ½]

Upakusha (Gingivitis):
Because of the aggravation Rakta and Pitta, there is inflammation in gum muscles which is called Upakusa (Gingivitis) [78 1/2]

Danta vidradhi (Dental Abscess)
Inflammation in the muscles surrounding the teeth is called Danta Vidradhi (dental abscess)
It is caused by the accumulation of aggravated Kapha and blood in that locality. [78 ½]

Galaganda (Goitre) and Gandamala (Cervical adenitis):
If there is a single swelling in the ride of the throat. It is called Galaganda (Goitre) and if there is a chain of swellings, then it is called Gandamala (cervical adenitis).
These their treatment Sira Vyadha (Venesection), Kaya Vireka (elimination of the Doshas, Rhinitis), Partva Sula ( pain in the rides of the chest), bronchitis, fever and vomiting then they are incurable.
For their treatment Sira Vyadha (Venesection), Kaya Vireka (Elimination of the Doshas from the head), Dhuma (therapeutic smoking), intake of old ghee and fasting therapy is administered.
If the swelling occurs inside the mouth, then Pragharsana (rubbing) and Kavalagraha (keeping the paste of drugs in the mouth for a specific period) is administered. [79- 80]

Granthi (Hard Tumour)

Granthi (hard Tumour) occurs in a particular part of the body because of vitiated Vayu, etc it is associated with the signs and symptoms of the concerned aggravated Dosha.
If surrounded by vessels, it pulsates.
Granthi in muscles tissue is large in size.
If it is of Medas (fat tissue), then it is free from pain and it is unctuous as well as mobile
First of all, the body of the patient is purified [by the administration of elimination therapies].
Tumour is then fomented with the help of a stone, wood, thumb or a rod.
The physician should dissolve (Vilayana) the tumour if it is not suppurated.
After suppuration, it is excised and removed along with the help of a stone, wood, thumb or a rod.
The physician should dissolve (Vilayana) the tumour if it is not suppurated.
After suppuration, it is excised and removed along with its covering capsule with the help of a sharp instrument.
Thereafter, the stump of the tumour is cauterised. Then the resultant ulcer is treated on the lines suggested for the treatment of urinary Vrana (Ulcer).
If it is not cauterised, and if even a little amount of the tumour tissue remains there, it is likely to grow again gradually even to large size.

Therefore, an expert surgeon should, keeping in view the anatomy of the locality excise it from all sides without any residual tissue left.
If any residual tissue is left, then it is likely to cause suppuration, which may spread from this ulcer to the nearby tissues, if such a complication arises, the physician, with proper consideration should apply medicines described earlier and prevent such a spread of suppuration right in the beginning by careful administration of the appropriate therapies.
Thereafter, by the application of appropriate therapies, the skilful should make effort quickly heat the ulcer.
If the tumour is located in Pelvic region, abdomen, throat or in any vital organ, if it is large in size and rough to touch and if it occurs in children, persons of Over-dosage or taking this medicine for longer period than prescribed may cause age and in persons with a weak physique, then treatment of such tumour should not be attempted. [81-86]

Granthi – tumour, fibroid, Arbuda:
Since in Granthi (hard tumours) and Arbuda (ordinary tumour), Shape, Doshas and dusyas (vitiation of tissue elements), therefore, the skilful physician should treat cases Arbuda (Ordinary tumour) according to the line of treatment suggested for Granthi ( hard tumour). [87]

Alaji:
Copper coloured and painful eruptions associated with discharge from their mouth are called Alaji. [88 ½]

Charma nakhantara Sotha (Whitlow)
The oedema appearing to the joint of the skin and the nail without any ulcer is caused by the vitiation of Mamsa (Muscle tissue) and blood.
It gets serious and becomes quickly suppurated. [88 ½]

Read related: Whitlow – Ayurvedic treatment and remedies

Vidarika (Inguinal and Axillary Lymphadenitis)
The elongated swelling in the inguinal and axillary regions which is associated with fever, which is painless [some scholars interpret “Nirarti” as having pain], which is hard to touch and which is expansive, is called Vidarika. This condition is caused by the vitiation of both Kapha and Vayu. [89 ¾]

Treatment:
For the treatment of above mentioned ailment (Alaji etc) therapies according to the Doshas involved, is administered.
The patient is given blood- letting therapy by venesection, etc. Upanaha type of fomentation is given with the help of drugs, tied to a bolus (Pindika).
After suppuration, these ailments are treated like an ordinary Vrana (Ulcer). [89 ½ – ½ 90]

Visphotaka – Boils
In postural eruptions (Sphota) eruptions appear all over the body.
These eruptions are red in colour and the patient suffers from fever and morbid thirst. [90 ½]

Kaksha (herpes Zoster):
In Kaksa, large number of eruption appear on the line where the Yajnopavita (Sacred thread of Hindus) is worn [i.e the line connecting the lateral part of the left shoulder with the bottom of the right side chest and then round the back up to the top of the shoulder).
These eruptions are caused by Pitta and Vayu
Some other miscellaneous varieties of eruptions of big, small and medium size also appear on the body. These are all caused by Pitta. [91]

Romantika:
Romantika is caused by aggravated Pitta and Kapha, but is characterised by the Pidaka – appearance of small eruptions all over the body and association with
Jwara-fever
Daha – burning sensation
Aruchi – anorexia and
Praseka – excessive salivation [92]

Masurika:
Masurika is caused by aggravated Pitta and Kapha, but Visarpa – herpes( erysipelas)- vide Chikitsa 21st chapter and has been prescribed for the treatment of Kustha (skin diseases including leprosy) are useful for the treatment of the above mentioned diseases, namely Visphota, Kaksha, Romantika , Masurika. [93]

Bradhna (Hernia and Scrotal Tumour)

Bradhna is a swelling in the inguinal and scrotal regions caused by aggravated Vayu, Pitta and Kapha.
These are characterised by the signs and symptoms of aggravated Doshas.
Antravrdhi is characterised by frequent entry of the intestines from abdomen into the scrotum and their exit [through the inguinal canal].
Medoja Vrddhi: is characterised by the swelling is caused by fat, and then it is unctuous and hard to touch
For their treatment, purgation therapy, massage, Niruha (a type of medicated enema) and Lepa (external application of drugs in a paste form) should be administered. If the swelling suppurated, then it should be treated like any other ulcer.
Mutra Vrddhi and Bradhna caused by Kapha is incised, cleansed of morbid material and sutured. If these are suppurated, then treatment on the lines of ordinary ulcers should be sutured. [94-95]

Bhagandara (Fistula in ano)

Causes: Because of injury caused by parasites or small pieces of bone, Vyavaya-excessive sexual intercourse, Pravhana-excessive straining for passing stool, Utkata ashva -use of hard seat and riding on horse back abscess appears in the sides of the anal orifice which is exceedingly painful. When abscess gets suppurated and bursts, the condition is known as Bhagandara (fistula- in –ano)

For its treatment, purgation therapy is administered and probing as well as incision is performed.
When the tract cleansed, it is cauterised with the help of hot oil.
Thereafter with alkaline preparations), the tract is cut open. Then, this is treated like an ordinary ulcer. [96-97]

Read related: Fistula – Ayurvedic treamtne, remedies and tips

Shleepada [Elephantiasis]:
shleepada (elephantiasis) is caused because of the vitiation of muscle tissue by Kapha and Rakta (blood).
It causes swelling in calf groin and Pindi (lower part of the leg), and the swelling begins from Prapada (front portion of the leg), all vessel are suitable for the treatment of this ailment.
Application of mustard paste over the swelling part it very useful [98]

Read related: Ayurvedic treatment possibiliies for elephantiasis

Jalakagardabha:
Nidana: Mildly aggravated Doshas with the predominance of Pitta causes serious Doshas with the predominance of Pitta cause serious type of swelling with mild suppuration of blood. This condition is associated with fever and morbid thirst. It spreads from one place to the other. This condition is called ‘Jalakagardabha”.

Treatment: Langhanam – fasting, Rakta mokshana -blood- letting, application of unctuous ointment, elimination of the Doshas from the body (by emesis, purgation, etc) is performed.
Amalaki in different forms is administered to such a patient and cooling ointment should be variably be applied for the treatment of ‘Jalakagardabha’. [99-100]

Management of Miscellaneous types of swelling:
Similar other varieties of swelling is examined with reference to their signs and symptoms of the concerned aggravated Doshas and appropriate therapies including Alepana (external application of ointment), Chedana (excision), Bhedana (Puncturing) and Dahana( Cauterisation) is administered to cure them. [101]

Agantuja Shotha – Exogenous Swelling:
Generally (external) injury aggravated Vayu along with vitiated blood which in turn causes localised swelling with red colour.
Therapies indicated for the treatment of Visarpa – herpes (vide Cikitsa 21) and those helpful in the alleviation of aggravated Vayu and Vitiated blood is administered.
If the swelling is caused by the contact with [poisonous substance, then appropriate anti- toxic therapies is administered. [102]

Summary

In this chapter the following topics are discussed:
1. The 3 varieties of oedema, depending upon the aggravation of 3 Doshas
2. The varieties of oedema extending all over the body, half of the body or specific parts of the body
3. The two varieties of oedema, viz endogenous and exogenous
4. The signs and symptoms of oedema and
5. The treatment of different varieties of oedema [103]

Thus, ends the 12th Chapter dealing with the treatment of oedema (Svayathu), in the section on therapeutics of Agnivesha’s work as redacted by Charaka, restored by Drudhabala.