Shitapitta, Udarda, Kotha: Introduction, causes, symptoms, diagnosis

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Shitapitta, Udarda and Kotha – explained in the same context

Shitapitta, Udarda and Kotha are three different conditions explained in a single chapter. This indicates that all these three conditions in spite of being different conditions, will also have some striking similarities in terms of etiological factors, symptoms, nature of presentation and treatment approach and principles.

Ref – Madhava Nidana, Uttarardha, Chapter 50

Etiological factors & pathogenesis of Sitapitta, Udarda and Kotha

Common Etiological Factors

शीतमारुतसंस्पर्शात्प्रदुष्टोकफमारुतौ।पित्तेनसहसंभूयबहिरन्तर्विसर्पतः।।१।।

Contact (regular and frequent) with very cold breeze is the single major etiological factor mentioned as causative factor for all these three interrelated conditions i.e. sitapitta, udarda and kotha.

 Specific etiological factor for Kotha and Utkotha

असम्यग्वमनोदीर्णपित्तश्लेष्मान्ननिग्रहैः।

Incomplete (inadequate or erroneous) administration of emesis therapy (i.e. improper administration of emesis to be specific and also other treatments) and suppression (obstruction) of the movement of pitta, kapha and anna (food) in the body is said to be a specific etiological factor for Kotha and its variant Utkotha.

Pathogenesis (for all three conditions)

Excessive and repeated exposure to cold breeze
↓
Aggravation of kapha and vata
↓
Gets association of pitta aggravated by its own factors
↓
All three doshas spread outward towards the skin and inwards towards rasa and other (seven) tissues and invade them and
↓
Will cause Shitapitta, Udarda (or) and Kotha

Premonitory Symptoms (of all the three conditions)

पिपासारुचिहल्लासदेहसादाङ्गगौरवम्।रक्तलोचनतातेषांपूर्वरूपस्यलक्षणम् ||२||

The premonitory symptoms of Shitapitta, Udarda and Kotha are –

• excessive thirst,
• loss of taste,
• nausea,
• debility in the body parts, and
• feeling of heaviness in the body and
• redness of the eyes

Symptoms of Udarda and Shitapitta

The symptoms of Shitapitta have not been specifically mentioned by the author. After enumerating the symptoms of Udarda it is said that the symptoms of Shitapitta are also similar to those of Udarda. But Shitapitta and Udarda are not synonyms. They have some differences in spite of being very similar conditions in terms of their signs and symptoms. The explanation is as given below.

वरीदासंस्थानःशोथःसञ्जायतेबहिः।सकण्डूस्तोदबहुलश्छर्दिज्वरविदाहवान्।।३।।
उदमितितंविद्याच्छीतपित्तमथापरे।वाताधिकंशीतपित्तमुदर्दस्तुकफाधिकः।।४।।

Symptoms of Udarda include swelling (or elevated patches or rashes) resembling the rashes produced by the sting of the wasp produced on the skin. This is associated with itching and severe pricking pain, vomiting, fever and burning sensation. This condition is called as Shitapitta by other experts. But there is slight difference in these two conditions. While Shitapitta is a Vata predominant condition, Udarda is a Kapha predominant condition. We need to remember that both these conditions (and Kotha) are caused by aggravation of all the three doshas, but are predominant in one or more doshas.

Other form (presentation) of Udarda

सोत्सङ्गैश्चसरागैश्चकण्डूमद्भिश्चमण्डलैः।शैशिरःकफजोव्याधिरुदर्दइतिकीर्तितः ||५||

Another explanation tells that a condition manifesting with elevated reddish patches, have severe itching, caused by vitiated kapha during sisira rtu (late winter) is also known as udarda.

Here we can see that a seasonal link has been given for udarda. We do not see such relation in shitapitta or udarda. Udarda mainly manifests in Shishira rtu i.e. late winter. Since Shitapitta is explained to be a condition similar to Udarda, it too can manifest in late winter but can also occur in other seasons.

Kotha: Causes and symptoms

असम्यग्वमनोदीर्णपित्तश्लेष्मान्ननिग्रहैः।
मण्डलानिसकण्डूनिरागवन्तिबहूनिच।
उत्कोठःसानुबन्धश्चकोठइत्यभिधीयते।।६।।

Kotha, like shitapita and udarda is a disease caused by tridosha aggravation and caused due to exposure to extreme cold breeze.

Apart from this we can find that Kotha has specific etiological factors and symptoms different from those of shitapitta and udarda (shitapitta and udarda have similar symptoms).

Specific etiological factors of Kotha

• incomplete (inadequate) or erroneous administration of emesis therapy and
• suppression (obstruction) of the movement of pitta, kapha and anna (food)

Symptoms of Kotha – appearance of innumerable rashes, red in colour and highly itching (is called as Kotha) are the main symptoms of kotha.

Utkotha – If the same condition (kotha) repeats (relapses) again and again, many times, it is called as Utkotha.