Charak Samhita - Sutrasthana - Chapter 18 (Trishothiya Adhyaya)
Carbuncle-like swellings were mentioned in the chapter before this one. More information on the causes of exogenous and endogenous distensions/swellings, symptoms of dominant dosha swellings, their places in the body, and the concepts of therapy are provided in this chapter. Also described are the standards for classifying a condition and the protocols for making a new diagnosis. In this chapter, the dosha's specific typical functions are discussed. If these processes are disrupted, they can be correctly deduced to be early clinical symptoms of a body change. These are employed in the early diagnosis of diseases or in the forecasting of potential illnesses. So today we will discuss the Charaka Samhita Sutra sthana chapter eighteenth Trishothiya adhyaya in detail.
Symptoms of dhatu depletion (Dhatu kshaya) and papules (Pidika) with indicators of swellings were detailed in the preceding chapter in relation to disorders of critical organs such the heart, urinary system and head. The symptomatology and aetiology of local and widespread distensions, and swellings and both endogenous and external, are covered in this chapter. The chapter's name refers to three different forms of swellings, however in the remainder of the content, these swellings are divided into several categories depending on their etiopathological causes and geographic distribution. Since it discusses the primary causes of all illnesses, both exogenous (Caused by outside factors) and endogenous (Of innate origin), this chapter is crucial from the perspective of diagnosis. Traumatic injuries, exposure to poisonous animals, plants, animal bites, bug bites, burns and frostbite are a few of the etiologic elements that can cause both non-infectious and infectious inflammations. By observing the body's response to invading microbes in the context of dosha vitiation, a suitable course of treatment can be chosen.
Three Different Kinds Of Shotha
Shotha (Swelling) comes in three different forms: Vataja, Pittaja, and Kaphaja. Additionally, they can be divided into two groups: endogenous (Nija) and exogenous (Agantuja).
The Aetiology Of Exogenous Swelling
The exogenous swellings are caused by incision, breaking, excision, injury, grinding, stroking, hinderance, binding, piercing, heating, twisting, pressing, or by contact of the juice of flowers and fruits of bhallataka (Semecarpus anacardium), kapikacchu (Mucuna pruriens) and insects, poisonous creepers, shrubs and leaves or by crawling, sweating, and urination of insects on body parts, or attacking of poisonous animals with teeth, nails, horns and fangs or exposure to oceanic wind, poisonous wind, fire or snowfall.
Exogenous Swelling Evaluation And Treatment
Exogenous swellings can be primarily identified by characteristic signs of injury and localization. They eventually start to resemble endogenous swellings (Because of dosha vitiation). Bandages, antidotes, mantra (Holy chants), fomentation, local drug application, cooling techniques, etc. are used to treat them.
Causes Of Endogenous Swellings
One of these factors may be the cause of endogenous swelling:-
- Iatrogenic Factors- Improper application of therapeutic purgation, therapeutic emesis, unctuous enema, head evacuation, non-unctuous enema, and improper dietary regimen after the purification therapy.
- Other Disease's Complications- It occur due to complication of vomiting (chhardi), cholera (visuchika), obstructive and delayed digestive process (alasaka), cough (kasa), dyspnea (shwasa), diarrhoea (atisara), anaemia (pandu roga), tuberculosis or phthisis (shosha), abdominal diseases (udara roga), pyrexia (jwara), fistula in ano (bhagandara), excessive vaginal discharge (pradara), skin disorders, piles, worm infestation, excessive emaciation, boils (pidika), etc.
- Lifestyle- It can occur due to inhibition of natural urges such as sneezing, ejaculation, vomiting, flatus, excessive weakness, belching, defecation, micturition caused due to therapeutic cleansing procedures, fasting, excessive walking and chronic diseases.
- Dietary Factors- Excessive consumption of foods that are too salty, sour, heavy, preparations of maida/pastry/rice flour, vegetables, fruits, curd, wine, pickle or raga preparations, unfermented curd, green salads, new cereals and corn, sprouted, intake of meat of aquatic or marshy animals like some fish, eating earthen pots or bricks pieces or clay, consume excess salt which lead to occur swelling.
- Antenatal and Postnatal Factors- Doshas get worsened and create shotha as a result of high pressure on the uterus during pregnancy, abortion, premature birth, and incorrect compliance with the puerperal schedule.
Specific Dosha Dominance-Related Causes Of Edema
Vata Dominance-Related Swelling
Vata is vitiated by rough, non slimy, cold, light substance, fasting, exertion, wasting and excessive emaciation etc. overcoming the skin, blood, muscle etc. produces swelling. This is quickly arising and subsiding. The part affected becomes blackish or reddish or has normal complexion, pulsating, moving, with hair and skin coarse, broken, and rough. The person feels that part as if incised, excised, pressed, pierced with needles, crawled over by ants, has irritating sensation as if pasted with mustard, sensation of expands or contracts. This is the character of vata Shotha.
Pitta Dominance-Related Swelling
Pitta vitiated with excessive intake of sharp, salt, hot, pungent, sour, alkaline food and eating during indigestion, and heating with the sun and fire, overcomes the skin, blood and muscle and thus produces swelling. It quickly arises and subsides. The part affected has yellow, blue, black and coppery tinge, soft, hot and with coppery and brown hairs. It has burning sensations of various natures, is hot, moist, perspiring and likes the contact of hot things. Thus is the character of pitta Shotha.
Kapha Dominance-Related Swelling
Kapha is vitiated by excessive use of sweet, unctuous, cold and heavy food, over sleep and lack of exercise etc., overcomes the skin, muscle, blood etc. and thus produces swelling. It arises and subsides with difficulty. The part affected is smooth, pale, thick, unctuous, stable, with white hair tips and tolerant of heat and touch. This is the character of kapha sotha.
Dwidoshaja And Sannipatika Related Swelling
By combination of respective causes and symptoms dwidoshaja that is produced by two dosha combined together swellings occur which are three in number. Likewise, by combination of respective causes and symptoms of all the three doshas sannipatika swelling arises which is only one. Thus swelling is of seven types.
Various Kinds Of Swelling And Cardinal Sign
Swelling can be classified into two, three, four, seven, or eight different categories based on the circumstances that cause it and different points of view. But basically, swelling is one having protuberance in common.
Detailed Explanation Of Certain Characteristics
Particular Characteristics Of Vata-Dominant Swellings
In vatika swelling, the body parts have swelling, they seem as numbed, are painful and after pressure regain the usual position. The swelling which is reddish subsides at night and also by unctuous and hot massage is of vatika type.
Particular Characteristics Of Pitta-Dominant Swellings
In Paitika swelling, the patient suffers from fever and thirst, the part has burning pain, smell, moisture and perspiration. It starts with the middle of the body, the patient has yellow skin, face and eyes, thin skin and diarrhoea.
Particular Characteristics Of Kapha-Dominant Swellings
Immobile, pale, itching, cold swelling that lacks resiliency after pressure is of kaphaja type. These swellings exude a slimy liquid rather than bleeding when cut with the sharp object or kusha grass. When there is the combination of symptoms and causes of two doshas, it is dwidoshaja. The sannipataja has the combination of symptoms and causes of all the three doshas.
The swelling which starts from feet and spreads throughout the body is hardly curable and also the one which in women begins with the face. In women or men, if the swelling arises from the genitals, it is mostly difficult to be cured and also the one having complications.
Dyspnea, diarrhoea, debility, vomiting, anorexia, fever and thirst-these seven are the complications of swelling.
Various Forms Of Swelling At Particular Locations
The quickly emerging swelling caused by kapha, vitiated and located at the tongue root produces upajihvika.
The similar swelling caused by kapha, vitiated and located in uvula produces galashundika.
When the vitiated kapha, firmly located within the throat, causes swelling quickly, it produces galagraha (Pharyngitis).
When aggravated pitta along with rakta (Blood) spreads in skin it causes swelling with redness which produces visarpa (Erysipelas).
The aggravated pitta is located in skin and blood, redness and swelling appear which causes pidika (Boils).
The aggravated pitta goes to rakta and dries up there, it produces tilaka (Moles), piplu (Port-wine marks), vyanga (Blemish/spots) and nilika (Blue-black moles).
The aggravated pitta is located in temporal regions, severe swelling known as shankhaka is produced.
Karnamulika Shotha (Swelling At The Roots Of The Ears)
At the end of fever, pitta gets aggravated and is located at the roots of the ears, a fatal and severe swelling arises.
The aggravated vata elevates the spleen producing mild pain in sides, the spleen enlarges.
Gulma (Abdominal lumps)
The aggravated vata is located in the regions of gulma (Abdominal area) causing pain and swelling, it produces gulma.
Vriddhi (Scrotum Enlargement)
The aggravated vata travels from the groins to testicles and develops pain and swelling, it produces vriddhi.
Udara (Abdominal Diseases)
The aggravated vata is located beneath the muscles and skin producing abdominal swelling, it causes udara.
Anaha (Obstruction In Abdomen)
The aggravated vata stays localized in the belly and moves neither downwards nor upwards, it causes anaha.
In the context of swelling, there are other swellings like arbuda (tumours), extra growth of muscles (adhimamsa) etc. which have specific names and forms.
All the three doha get aggravated simultaneously and get located at the root of the tongue, they produce swelling, various kinds of pain and intense burning sensation, this quickly fatal disease is called as rohini. If this condition is present and neglected, an individual could pass away in three days. However, if a skilled doctor is consulted quickly, one can nearly rapidly recover.
Prognosis Of Diseases
Certain treatable illnesses can become deadly if they are not adequately managed or treated. Other mild disorders that can be cured can be treated either with or without any effort. There are "palliable" diseases that are assumed to be incurable, yet with the right care, the patient can make progress. Additionally, certain diseases are incurable and have no therapy options. Sometimes, ignorant doctors handle these with enthusiasm. The wise, however, should not handle them. Therefore, there are two main groups for diseases: those that can be cured and those that cannot. Within both of these categories, there are two more categories based on the severity of the condition and how well it responds to treatment.
Categorization Standards For Diseases
Different diseases can be categorised according to their name, site, aetiology, symptoms, look (Colour), and severity of pain. It has been attempted to systematically classify them using various groups or families of gross diseases. The general approach, however, might be used in various circumstances.
Identification Of New Diseases
Since not all ailments can have standardised names, one shouldn't feel embarrassed about being unable to name a sickness. The reason is that the same aggravated dosha can induce a variety of ailments depending on differences in origin and location, there are countless diseases. Therefore, one should begin any treatment only after having learned everything about the disease's nature, along with its pathophysiology, the site, and etiological variables. The person who starts the treatment after learning all of this, logically, and in accordance with the recommended approach, does not behave in a confused manner.
Discussion On Dosha
All living things have vata, pitta, and kapha as eternally present in their bodies. The educated ought to be aware of their abnormal or normal states.
Normal Functions Of Vata Dosha
Inspiration, movements, expiration, normal removal of excreta, normal processing or functioning of body tissues (Dhatus) and enthusiasm-this is the normal function of vata.
Normal Functions Of Pitta Dosha
Digestion, hunger, heat, softness in body, vision, thirst, cheerfulness, intellect and lustre-this is the normal function of pitta.
Normal Functions Of Kapha Dosha
Binding, heaviness, strength, unctuousness, firmness, virility, forbearance, absence of greed and restraint-this is the normal function of kapha.
Assessment Of An Improper Dosha State
The diminution of vata, pitta and kapha is known by deficiency in normal function or increase in opposite actions. The aggravation of doshas is known invariably by the increase in their normal functions. Thus, normalcy, diminution and aggravation of doshas are examined.
Causes, types, prognosis and symptoms of swelling, the precedent swellings in various diseases, types of diseases, three important points, normal functions and symptoms of diminution and aggravation of doshas-all this has been explained in this chapter on trishothiya adhyaya by Punarvasu who is free from rajas and tamas doshas, conceit, greed, ambition, and pride.