Shotha: Causes, Types, Treatment, Medicines

Article by Dr Raghuram Y.S. MD (Ay)
Shotha, As per Ayurveda is swelling or inflammation. It is also known as Shopha or Shvayathu. It is a wide term covering local swellings to inflammation of internal organs such as bronchitis, pancreatitis etc.  

Shotha samprapti

How Does Shotha occur?
The vitiated Vata dosha displaces the vitiated (morbid) rakta (blood), pitta and kapha and pushes them into the channels of circulation. The Vayu is further obstructed by these morbid elements and causes accumulation of pitta, kapha and rakta in between twak (skin) and mamsa (muscle). Then occurs swelling at the region of accumulation and is called Shotha.

This explanation also covers the pathogenesis of bursitis. The presence of pitta and rakta in between the skin and muscle (bursa here) is responsible for development of inflammation and the presence of kapha is responsible for fluid accumulation.

Types

Shotha is of 9 types
Vataja shotha – caused by vitiated vata
Pittaja shotha – caused by vitiated pitta
Kaphaja shotha – caused by vitiated kapha
Vata-pittaja shotha – caused by dual vitiation of vata and pitta
Pitta-kaphaja shotha – caused by dual vitiation of pitta and kapha
Kapha-vataja shota – caused by dual vitiation of kapha and vata
Traidoshaja shotha – caused by simultaneous vitiation of vata, pitta and kapha, all the 3 doshas
Abhighataja – caused due to trauma
Vishaja – caused due to contact with poisons and other chemicals

Among these, Abhighataja shotha can be closely compared to olecranon bursitis or Student’s elbow, though we cannot exclude pittaja, kaphaja, pitta-kaphaja and sannipataja shotha from the variants which can be compared.

Causes

Causes of Shotha –
Consumption of or exposure to the below said factors by people who have been debilitated or lost their strength because of undergoing shuddhi (cleansing treatments), suffering from jwara and pandu (fever and anaemia) etc diseases, fasting (upavasa) or consuming incompatible foods –

• Kshara – excessive alkalis
• Amla – sour foods
• Teekshna – intense or strong foods
• Ushna – hot foods
• Guru – heavy to digest foods
• Dadhi – curds
• Ama – unprocessed foods
• Mrit – mud
• Shaka – green vegetables, leafy vegetables
• Viruddha ahara – mutually incompatible foods,
• Dushta anna – contaminated foods
• Visha upasrushta anna – poisoned foods

Even if the above said are consumed in excess by anyone, they may lead to one or the other type of shotha in the body.

In terms of Student’s elbow, abhighata (trauma or injury) when associated with the above said causes might causes olecranon bursitis. These factors can be considered as triggering factors instead of causative factors.

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.

Shotha Chikitsa

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.

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

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)

Shophahara Kashaya From Sahasrayogam

a. Pathya Punarnavadi Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 48a

b. Gokshuradi Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 48b

2. Rasnaerandadi Kashayam (Vatahara Kashayam)

Ref – Sahasrayogam, Kashaya Prakaranam, 59f

3. Punarnavadi Kashayam (Panduhara Kashayam)

Ref – Sahasrayogam, Kashaya Prakaranam, 46a

4. Dashamuladi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 61

5. Chukkuchundadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 76

6. Pathya Punarnavadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 79

7. Guduchi Triphaladi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 93

Other Yogas From Sahasra Yoga Text Book

Sophahara Kashaya
Koushikokta Rasnadi Kwatha
Panduhara Kashaya
Tiktaka Ghrita
Mahatiktaka Ghrita
Sukumara Ghrita
Kusmanda Ghrita
Khandasama Choorna
Trikatwadi choorna
Hapushadi choorna
Hutabhungadi Choorna
Ayorajo Nagaradi Choorna
Krishna Rajanyadi Choorna
Triphaladi Talam
Kalyana Kshara
Dantyarishta
Duralabharishta
Punarnavasava
Usirasava
Lohasava
Patrangasava
Kumaryasava
Danti Haritakyavaleha
Punarnavadi Lehya
Dasamoola Haritaki Lehya
Gudardraka
Trivrit Kulambu
Kaisora Guggulu
Amruta Guggulu
Mandoora Vataka
Chanda Bhaskara Rasa
Neelakantha Rasa
Marichadi Gutika
Antrakutara Rasa
Panalviraladi Bhasma Ganji
Aviltoladi Bhasma Ganji
Swasari Taila
Karaskara Ghrita

External medicines

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
Click to Consult Dr Raghuram Y.S. MD (Ayu)

Pathya – Apathya

Wholesome diet and habits

Old rice, barley, horse gram, green gram, meat of Iguana lizard, Porcupine, peacock, partridge, cock, animals living in dry land forests, gallinaceous birds, tortoise, sheatfish, old ghee, butter milk, alcohol, honey, fermented decoction, nispava variety of pea, bitter gourd, red variety of drumstick, tender radish, red hogweed plant, carrot, Indian gooseberry, radish etc.

According to Yogaratnakara

Old barley & rice cooked in dashamoola decoction, foods which are slightly sour, pungent & unctuous etc.

Unwholesome diet and habits

Meat of domestic animals, meat of animals living in marshy lands, salt, dry vegetables, fresh rice, alcohol prepared from molasses, pastry, curd with cream, spring water, alcohol, sour substances, hog’s flesh, excessive food intake, heavy to digest food, unwholesome food, burning sensation causing food, night sleep etc.

According to Yogaratnakara

Dishes prepared with flour, hot substances, salt, alcohol, day sleeping, intake of meat of animals other than which live in desert like lands, milk, jaggery, oil, heavy to digest substances etc.

Classical signs of inflammation

The 5 classical signs of inflammation is explained by Master Vagbhata, in the context of Vata dosha being blocked by Rakta Dhat (blood tissue).
Raktavrita Vata

रक्तावृते सदाहार्तिस्त्वङ्मांसान्तरजा भृशम् ॥ ३३ ॥
भवेच्च रागी श्वयथुर्जायन्ते मण्डलानि च |
raktāvṛte sadāhārtis tvaṅmāṃsāntarajā bhṛśam || 33 ||
bhavecca rāgī śvayathurjāyante maṇḍalāni ca |
AH Nidanasthana 16/33b-34a

Daha – burning sensation, increase of temperature – Calor
Arti – pain – Dolor
Ragi – reddish discoloration – Rubor
Shvayatu – swelling
lack of functioning of that organ.