PAPER 2 ROGANIDANA LAQ

1. Agnimandya - Ajeerna, Anaha, Adhmana, Atopa

2. Shoola
3. Atisara and Pravahika
4. Grahani
5. Shotha
6. Shwasa
7. Kasa
8. Jwara
9. Pandu
10. Sthoulya karshya

1.AGNIMANDYA

1.AGNIMANDYA
AS

Agnimandya Ajeerna, Anaha, Adhmana, Atopa

1. Define Anaha
N

2. Enlist types of Anaha

3. Describe Adhmana and Atopa
O

DEFINE ANAHA
TE

आनाहो वातमूत्रपुरीषादि निरोधः IS.S.Su. 26/10 (Dalhana)

Obstruction of urine and faeces or obstruction of flatus, urine, faeces etc. is known as
S

Ānāha, Vibandha, Viştambha and Malarodhajana are the synonyms of Ānāha.

आनाह उदरपूरणलक्षणः स च वातोत्कटदोषैर्जनितः ।।Ādd.Śa. Prā. 7/49

The fullness of the abdomen due to aggravation of Vata is called Ānāha.

The disease which produces the features of Udarapurana (fullness of the abdomen) due to
aggravation of Vata is called Ānāha.

आनाहाध्मानभेदः ॥ Kā.Śa.Pra. 7/49

Ācārya Kāśirāma described that the disease Anāha is a type of Adhmana (distension of
abdomen).

आनाहो बद्धोदरताः । A.H.Ni. 6/146 (Hemādri)

आनाहो जङ्गराध्मानम् । A.H.Ni. 28/8 (Arundatta)

Obstruction in the abdomen or distension of abdomen is known as Ānāha.

Reference: Sushruta Uttara Tantra, Chapter 56

Definition:

Anaha is a condition caused by the gradual accumulation of undigested food (Ama) or feces
in the gastrointestinal tract due to the obstruction of their normal elimination. It is primarily
due to the aggravation and disorientation of Vata Dosha.

Pathogenesis (Nidana):

Gradual accumulation of Ama or Shakrut (feces).

Aggravation of Vata Dosha obstructs normal digestive and eliminatory functions.

Clinical Features (Roopa):

A. Amaja Anaha (Due to Ama):

AS

तृष्णा (Trishna): Excessive thirst.

प्रतिश्याय (Pratishyaya): Rhinitis or nasal congestion.
शिरोविधान (Shiro Vidaha): Headache or irritation in the head region.
शूल (Shula): Abdominal colic or pain.
N

गुरुत्व (Gurutva): Heaviness in the abdomen.

हृत्स्तम्भ (Hrt Stambha): Stiffness in the chest or cardiac region.
उद्गारविघातनं (Udgara Vighatana): Difficulty or obstruction in belching.
O

B. Purishaja Anaha (Due to Feces):

TE

कटि-स्तम्भ (Kati Stambha): Stiffness in the pelvic region.

पृष्ठ-स्तम्भ (Prishta Stambha): Stiffness in the back.
पुरीष-स्तम्भ (Purisha Stambha): Constipation.
S

मूत्र-स्तम्भ (Mutra Stambha): Obstruction of urine or urinary retention.

शूल (Shula): Abdominal pain.
मूर्च्छा (Murcha): Fainting or loss of consciousness.
शकृ तश्च छर्दि (Shakrtascha Chardi): Fecal vomiting.
श्वास (Shvasa): Breathlessness or dyspnea.
अलसक लक्षण (Alasaka Lakshana): Symptoms of Alasaka (severe indigestion).

TYPES OF ANAНА

Anaha is of 2 types based on what has been obstructed

1. AMAJA ANAHA.
2. PURISHA ANAHA.

Amaja anaha
Anaha caused due to the accumulation of ama in the stomach,it is also called as
amashayaja / amashayagata anaha since the disease has its origin in the stomach

Purisha anaha

Anaha caused due to accumulation and obstruction of feces in the intestines and colon, it is
also called as pakvashayaja/ pakvashayagata anaha since the disease has its in
pakvashaya.

DESCRIBE ADHAMANA AND ATOPA.

Aadhmana is not a disease it is a prime symptom found in various diseases mainly of
annnavaha srotas.
Distension of abdomen and typical rumble of intestine are primary features of this
condition.

Ādhmāna
AS

1. Nirukti (Etymology) and Definition:

उदर वायोरतीव संचय अनिलपूरणम्। (A.Sa.K.)

N

Fullness of the abdomen with Vāta due to its excessive accumulation is called Ādhmāna.

वायुना कु पितेन नाभेरधः सशुलमापूरः आध्मानः। (A.Sa.Su. 5/8)

O

Pain and filling of Vāta below the umbilicus, caused by its aggravation, is termed
TE

Ādhmāna.

अनिलश्च रूद्धमार्गतया आध्मान करोतीति। (C.S.Si. 7/22 – Cakrapāṇi)

Vāta obstructed in its normal pathways results in Ādhmāna.

S

उदरस्याध्मानम् वायुना परिपूरणम्। (A.Sa.K.)

Distension of the abdomen caused by Vāta is called Ādhmāna.

आध्मान वातेनोदरपूरणम्। (A.H.Su. 11/13 – Hemādri)

Fullness of the abdomen due to Vāta is Ādhmāna.

2. Types of Ādhmāna:

A. Ādhmāna (Distension):

साटोपमत्युग्ररुजमाध्मातमुदरं। (S.S.Ni. 1/88)

Distension of the abdomen associated with sound (flatulence) and severe pain.
आध्मानमिति जानीया‌द्घोरं वातनिरोधजम्। (S.S.Ni. 1/88)

This condition is caused by suppression or obstruction of Vāta.

B. Pratyādhmāna (Secondary Distension):

तदेवामाशयोत्थितम्। (S.S.Ni. 1/89)

When the distension arises from the Āmāśaya (stomach/upper abdomen).

प्रत्याध्मानं विजानीयात् कफव्याकु लितानिलम्। (S.S.Ni. 1/89)

This type of distension is caused by the combined aggravation of Kapha and Vāta.

विमुक्तपार्श्वहृदयं भृशम्। (S.S.Ni. 1/88)

In Pratyādhmāna, the flanks (Pārśva) and heart region (Hṛdaya) remain unaffected.

Pathogenesis (Nidāna):
AS

Aggravation of Vāta Dosha due to improper diet, lifestyle, or suppression of natural

urges.
Obstruction of Vāta in its normal pathways leads to distension and pain.

4. Clinical Features (Rūpa)

N

1. Distension of the abdomen.

O

2. Severe pain in the abdominal region.

3. Sound (flatulence) due to trapped gas.
TE

4. May be associated with Kapha symptoms in Pratyādhmāna.

साटोपं अति उग्ररुजं आध्मातं उदरं भृशम्। आध्मानं इति जानीयाद्धोरं वातनिरोधजम् ॥ सुश्रुत निदान स्थान १/८८
S

Acharya sushruta in the 88th verse of the first chapter of sushruta nidana sthana
defines as
The disease in which pain in the abdomen with clear movements of the intestines is
noted by the patient is called as Aadhmana.
In this disease severe pain is felt in the abdomen.
When the condition limits itself only upto Amashaya it is termed as Pratyadhamana.
Adhamana is a condition caused by forcibly controlling/obstructing the fart reflex.
This eventually causes distension of abdomen along with severe pain and sounds in the
abdomen.
The swelling of abdomen is in the form of an air filled bag or water filled pot.
Here 'udara' indicates abdomen.
But to be specific it has to be considered as a colon (Madhukosha commentary).
Therefore adhmana begins and gets located in he colon / large intestine which is also
the chief seat of vata and is caused by aggravated vata therein
In other words the obstruction of vata in the major parts of the intestines i.e. colon and
small intestines other than the stomach
 And the mentioned symptoms manifested there in is called adhmana.

Āṭopa
1. Nirukti (Etymology) and Definition:

आटोपः गुडगुडाशब्दः। (C.S.Ci. 14/21 – Cakrapāṇi)

Āṭopa is the movement of Vāta in the abdomen, producing gurgling or bubbling sounds.

आटोपः कु क्षौ शब्दवद्वातभ्रमणम्। (C.S.In. 5/12-13 – Cakrapāṇi)

Movement of Vāta in the abdomen accompanied by sounds is called Āṭopa.

आटोपः गुडगुडाशब्दविशेषो वातजन्य। (C.S.Ni. 8/6-7 – Cakrapāṇi)

Gurgling noise in the abdomen caused by Vāta is termed Āṭopa.

2. Types of Āṭopa and Related Definitions:

AS

A. Distension of Abdomen (Udara Adhmāna):

आटोपः आध्मानम्। (S.S.Ci. 8/8; S.S.Ni. 2/8 – Dalhaṇa)

N

Āṭopa is associated with abdominal distension.

O

आटोप उदरस्याध्मानं। (S.S.Su. 46/474 – Dalhaṇa)

Distension of the abdomen is termed as Āṭopa.

TE

आटोप उदरपूरः। (S.S.Utt. 42/8 – Dalhaṇa)

Fullness or bloating of the abdomen is Āṭopa.

S

B. Movement and Noise:

आटोपः सञ्चलनं। (S.S.Ni. 1/88 – Gaya)

Movement of Vāta in the abdomen causes gurgling sounds.

आटोपश्चलचलमिति। (M.Ni. 22/28 – Madhu)

Gurgling or clicking movements in the abdomen describe Āṭopa.

C. Pain and Irritation:

आटोपः क्षोभः। (A.H.Su. 28/8 – Aruṇdatta)

Irritation or trembling in the abdomen is known as Āṭopa.

आटोपः रुजापूर्वकक्षोभः। (S.S.Ni. 9/20 – Dalhaṇa)

Irritating pain in the abdomen is a feature of Āṭopa.

आटोपः सतोदो वातसंक्षोभः। (S.S.Su. 26/10 – Dalhaṇa)

Movement of Vāta in the abdomen, associated with pricking pain, is Āṭopa.

आटोपो रुजापूर्वक उदरक्षोभः। (S.S.Su. 21/32 – Dalhaṇa)

Abnormal movement of Vāta with pain in the abdomen defines Āṭopa.

3. Pathogenesis (Nidāna):

Āṭopa occurs due to the abnormal movement or obstruction of Vāta Dosha in the
gastrointestinal tract.
It may be associated with pain, irritation, bloating, or gurgling sounds.

4. Clinical Features (Rūpa):

AS

1. Gurgling sounds (गुडगुडाशब्द) in the abdomen caused by Vāta.

2. Distension of the abdomen (आध्मान).
3. Pain in the abdomen, sometimes pricking (सतोद).
4. Irritation or trembling (क्षोभ) in the abdomen.
N

5. Abnormal movements of Vāta leading to fullness or bloating.

O

32.4.SHOOLA
TE

REFERENCES

1. SUSHRUTA SAMHITA,UTTARA TANTRA,42 ADHYAYA

S

2. MADHAVA NIDANA , 26 ADHAYAYA

3. HARITA SAMHITA, 3 ADHAYA 7
4. ASTANGA SANGRAHA ,NIDANA STAHANA 11 ADHYAYA
5. SIDDHANTA NIDANA
6. KASHYAPA SAMHITA ,KHILA STHANA 18

DEFINE SHOOLA
Colic type of pain in the abdomen is identified as Sula.
Stabbing pain in general and colic pain in particular.

NIRUKTI

शूल रुजायाम् । शुलति लोक रोगः ॥ Sabdakalpdruma शूलति लोकानिति शूलरोगे || śabdakalpdruma

The term Sula means pain or misery and it is called as disease of mankind.
DEFINTIONS

शूलं निखानितमिवासुखं येन तु वेत्त्यसौ ।S.S. Utt. 42/67

Discomfort likes that of as ifbeing pricked by pin or spike is known as Sula

शूलं निखानितमिव कीलकं निखनितमिवेत्यर्थः ।S.S.Utt. 42/67 (Dalhaņa)

Discomfort likes that of as ifbeing pricked by pin or spike is known as Sula

शूलसम्भवत्वादस्य शूलमिति सज्ज्ञा, शूलनिखातवद् वेदना जकत्वाच्च । M.Ni. 26/1 (Madhu)

The word Sula refers to spike-a weapon

The discomfort or pain felt which is similar to being pierced by spike or being digging in
or thrust off is called SHOOLA
pain in the abdomen resembling shankha spotana i.e blasting pain in the temples
Severe excruciating pain as if being pierced by a spear or nail is known as Sula.
Pain as if pierced by a spear associated with excruciating pain and difficulty in
AS

breathing is known as Sula.

Äcarya Indu described that the Gulma is Sula by name.

C01 ENLIST SHOOLA BHEDA

दोषैः पृथक् समस्तामद्वन्द्वैः शूलो अष्टधा भवेत् । सर्वेष्वेतेषु शूलेषु प्रायेण पवनः प्रभुः || १ || MA.NI.26.1
N

There are eight types of shula; one from each dosha,

O

One from the combination of all the three,

TE

One each from the combination of two doshas

Eighth from ama.
However, the vata is the predominant causative dosha in all the types. 1
S

THEY ARE

1. Vatika Shoola - caused by vitiated Vata

2. Pittaja or Paittika Shula caused by vitiated Pitta
3. Shlaishmika or Kaphaja Shoola - caused by vitiated Kapha
4. Sannipataja Shula - caused by all 3 vitiated doshas
5. Vata-Pittaja Shula - caused by vitiation of Vata and Pitta
6. Vata-Kaphaja Shula - caused by vitiation of Vata and Kapha
7. Pitta-Kaphaja Shoola - caused by vitiation of Pitta and Kapha
8. Amaja Shula - caused by Ama or improperly formed (immature) essence of nutrition /
digestion (intermediate products of digestion)

Parinama Shoola and Annadrava Shoola are special types of shula and its variants.
They have not been included under the 8 types of shool because of the unique way of
their presentation.
 Both these type of shoolas closely resemble with peptic ulcers and have a strong
relationship with the food intake.
Parinama Shula - closely resembles duodenal ulcers
Annadrava Shula - closely resembles gastric ulcer

C01 C05 DESCRIBE AND DIFFERENTIATE PARINAMA SHOOLA AND ANNADRAVA SHOOLA

PARINAMA SHOOLA (PEPTIC ULCERS)

स्वैर्निदानैः प्रकु पितो वायुः सन्निहितस्तदा || १५ || कफ-पित्ते समावृत्य शूलकरी भवेद् बली । भुक्ते जीर्यति यच्छू लं तदेव परिणामजं ||
१६ || तस्य लक्षणमप्येतत् समासेनाभिधीयते।-MA.NI.26.15-16

If the vayu is provoked and is associated with kapha and pitta, the shoola generated is
very strong.
The Shoola that subsides after intake of food is called parinama shoola.

The symptoms of this Shoola are —

· Distension
AS

· Gurgling noise in the intestines

· Blockage to the movement of faeces and urine
· Restlessness
· Severe suffering due to Vata.
N

By use of fatty and warm eatables, the pain is reduced. 15-16

ANNADRAVA SHOOLA (GASTRIC ULCERS)

O

Annadrava Sula is characterised by continuous severe pain and not subsiding either by
TE

digestion or after digestion or after taking food or in empty stomach.

It does not get relieved by any kind of measures.
Some people say patient gets relief after vomiting accumulated Pitta.
S

DIFFERENTIATE PARINAMA SHOOLA AND ANNADRAVA SHOOLA

SL PARINAMA SHOOLA ANNADRAVA SHOOLA

1 It is characterised by pain just after the It is characterised by continuous severe

digestion of food. pain and not subsiding either by digestion or
after digestion or after taking food or in
empty stomach

2 Vataja Parinama Sula gets relieved by It does not get relieved by any kind of
fatty & warm foods. measures.
Pittaja Parinama Sula get relieved some people say patient gets relief
after taking cold food & cold measures after vomiting accumulated Pitta.
Kaphaja Parināma Sula gets relieved
by pungent & bitter foods

3 It is classified into Vataja Parinama Sula, No classification mentioned

Pittaja Parinama Sula, Kaphaja Parinama
Sula, Dvandvaja Parinama Sula & Tridosaja
AS

Parinama Sula

33.5.ATISARA AND PRAVAHIKA

N

1. Describe pratyatma lakshana of Atisara

O

2. Describe hetu and samprapti of Atisara

3. Enlist bheda of Atisara
TE

4. Describe purvaroopa of Atisara

5. Enlist and describe upadrava of Atisara
6. Describe sadhya asadhyata of Atisara
7. Describe nivrutta Atisara lakshana or vigata Atisara lakshana
S

8. Describe samprapti of Pravahika

9. Enlist bheda of Pravahika
10. Describe samanya and vishishta lakshana of Pravahika
11. Differentiate between Atisara and Pravahika
12. Differentiate Doshaja Atisara
13. Explain Bhayaja atisara, Shokaja atisara and Raktaja atisara lakshana

ATISARA COMPARED WITH DIARRHEA

PRAVAHIKA CAN BE COMPARED WITH DYSSENTRY

DESCRIBE PRATYATMA LAKSHANA OF ATISARA

Clinical features: Roopa

1. Frequent pasnig of watery loose fecal material.

2. Uncontrolled defeacation with pain around the umbillicus.
 3. Exhaustion and fatigue
4. Dysponea
5. Roughness of skin
6. Pain in chest
7. Loss of tolerance to sound.

DESCRIBE HETU AND SAMPRAPTI OF ATISARA

गुर्वतिस्निग्धरुक्षोष्णद्रवस्थूलाति शीतलैः । विरुद्धाध्यशन जीर्णैर्विषमैश्चापि भोजनैः || १ || स्नेहाध्यैरतियुक्तै श्च मिथ्या

युक्तै र्विषैर्भयैः । शोकादुष्टाम्बु मध्यातिपानैः सात्म्यर्तु पर्ययैः || २ ||जलाभिरमणैर्वेगविघातैः कृ मिदोषतः । नृणां भवत्यतीसारो
लक्षणं तस्य वक्ष्यते || ३ ||-ΜΑ.ΝΙ.3/1-3

The following etiological factors are responsible for the causation of ATISARA ARE

Over indulgence in eatables that are hard to digest,

Very fatty; Very dry; Very hot; Very watery; Very hard; Very cold;
Intake of food items that contain incompatibles;
Meals taken in large quantities and very frequently;
AS

Intake of meals that are not cooked and foods taken at unusual times.
Moreover, excess or improper usage of therapies like application of oil on the body and
the like, poisons, fear, grief, drinking of polluted water,
Excess of alcoholic drinks, changes in accustomed habits and seasonal features, Over
indulgence in water sports, suppression of natural urges of the body and infestation by
N

worms are also the factors that produce diarrhoea. 1-3

O

SAMPRAPTI OF ATISARA

संशम्यापां धातुरन्तः कृ शानुं वर्चीमिश्रो मारुतेन प्रणुन्नः । वृद्धोऽतीवाधः सरत्येष यस्माद् व्याधिं घोरं तं त्यतीसारमाहुः ॥ ५ ॥-
TE

SU.SAM.UTTT.40.5

Due to consumption of above etiological factors Apa Dhātus (body fluids) are enhanced in
excess and brings diminution of strength of Agni, gets mixed with stool, causes downward
S

movement in Annavaha srotas by Väta leading to development of excess watery stool is

known as Atisāra.

Nidāna Sevana (Consumption of Etiological factors)

↓
Aggravation of Pitttādi doşās and Apa Dhātus
↓
Diminution of Agni
↓
Development of Ama inside the gastro intestinaltract
↓
Agitated doşās mixed with stool
↓
causes downward movement in Annavaha srotas by Vata
 ↓
Atisāra (Excess watery stool)

C01.ENLIST BHEDA OF ATISARA

Atisara or diarrhea is of two types,

1. Nija: endogenous
2. Aguntuja : exogenous

Nija includes

Vataja Atisara
Pittaja Atisara
Kaphaja Atisara
Sannipataja Atisara
Agantuja/manasa includes
AS

Bhayaja Atisara
Shokaja Atisara

.......... षड्विधं तं वदन्ति ||एकै कशः सर्वशश्चापि दोषैः शोके नान्यः षष्ट आमेन चोक्तः || ४ ||-ΜΑ.ΝΙ.3/4
N

Six types Atisara according to madhava nidana.

One from each of the three doshas.
O

one from the combination of the three doshas together, the fifth one from grief and the
sixth from the aama or undigested food. 4
TE

According to Sushruta samhita Atisara is classified into six types

1. Vataja Atisara
S

2. Pittaja Atisara
3. Kaphaja Atisara
4. Sannipaika Atisara
5. Shokaja Atisara
6. Aamaja Atisara

According to Charaka Samhita Atisara is classified into six types

1. Vataja Atisara
2. Pittaja Atisara
3. Kaphaja Atisara
4. Sannipaika Atisara
5. Aagantu Atisara- Shokaja Atisara and Bhayaja Atisara

C01.DESCRIBE PURVAROOPA OF ATISARA.

हन्नाभिपायूदरकु क्षितोद-गात्रावसादानिलसन्निरोधाः । विट्सङ्गः आध्मानमथाविपाको भविष्यतस्तस्य पुरःसराणि ॥ ८ ॥

Premonitory Symptoms -- SUS.SAM.40/8

Piercing pain in the regions of the heart, umbilicus, rectum, abdomen and in the Kuksi
(sides of the abdomen),
A sense of numbness in the limbs
Stoppage or supression of flatus and of stool,
Distension of the abdomen, and
Indigestion 8.

C01.ENLIST AND DESCRIBE UPADRAVA OF ATISARA

....शोथं शूलं ज्वरं तृष्णां श्वासं कासमरोचकम् । छर्दि मूर्च्छा च हिक्कां च दृष्ट्वातिऽसारीणं त्यजेत् ।।-M.Ni. Atisara
Chapter-3/20

If the complications of the ailment produce edema, colic pain, morbid thirst, fever, anorexia,
vomiting as well as hiccups, the given case of atisara should be avoided by a wise physician
AS

as the symptom is incurable indeed

The complications are

1. Edema.
2. Pain in abdomen.
N

3. Fever.
4. Thirst.
O

5. Dyspnoea.
6. Cough.
TE

7. Insipid mouth.
8. Vomiting.
9. Stupor.
10. Hiccup.
S

11. Delirium.
12. Pain in loin.
13. Severe restlessness.
14. Incoherent speech

C01.DESCRIBE SADHYA ASADHYATA OF ATISARA

सर्पिर्मेदोवेसवाराम्बुतैलमज्जा क्षीरं क्षौद्ररूपं स्रवेद् यत् । मञ्जिष्ठाभं मस्तुलुङ्गोपमं वा विस्त्रं शीतं प्रेतगन्ध्यञ्जनाभम् ॥ १८ ॥
राजीमद् वा चन्द्रकैः सन्ततं वा पूयप्रख्यं कर्दमाभं तथोष्णम् । हन्यादेतद् यत् प्रतीपं भवेच्च क्षीणं हन्युश्चोपसर्गाः प्रभूताः ॥ १९
॥ असंवृतगुदं क्षीणं दुरा (ध्मात) त्मानमुपद्रुतम् । गुदे पक्के गतोष्माणमतीसारकिणं त्यजेत् ॥ २० ॥SUS.SAM.UTT.40

Stool resembling ghee, fat, water of meat soup, oil, bone marrow, milk, honey, Mañjistä
or Mastulunga, putrid smell, cold, cadaveric smell, appears like Añjana (Sauvirāñjana),
has separating lines, glistening particles, resembling like pus or slush and hot
These features greatly enhanced and acting as complications and kill the weak persons.
 The patient whose anal orifice does not close at all, who is emaciated, having severe
flatulence, inflammation in the anus, and coldish touch should be rejected.

C01.DESCRIBE NIVRUTTA ATISARA LAKSHANA OR VIGATA ATISARA

LAKSHANA

यस्योच्चारं विना मूत्रं सम्यग् वायुश्च गच्छति । दीप्ताग्नेर्लघुकोष्ठस्य स्थितस्तस्योदरामयः ॥ १५४ ॥-

SUS.SAM.UTT.40/162

Proper elimination of urine, flatus and stool, enhancement of digestive fire and feeling
of lightness in gastro-intestinal tract indicates that patient is recovered from Atisara.

PRAVAHIKA

वायुः प्रवृद्धो निचितं बलासं नुदत्यधस्तादहिताशनस्य | प्रवाहमाणस्य मुहुर्मलाक्तं प्रवाहिकां तां प्रवदन्ति तज्ज्ञाः ||१३८||-
SUS.SAM.UTT.40/138

BALASA: MUCOUS
AS

One who consumes unwholesome foods & drinks leading to aggravation of Vata and
pushes the Kapha downwards again & again as a result Kapha comes out along with
stool is known as Pravähikā.

DESCRIBE SAMPRAPTI OF PRAVAHIKA

N

प्रवाहिका वातकृ ता सशूला पित्तात् सदाहा सकफा कफाच्च । सशोणिता शोणितसम्भवा तु ताः स्नेहरूक्षप्रभवा मतास्तु ||
O

१३९|| तासामतीसारवदादिशेच्च लिङ् ङ्ग क्रमं चामविपक्वतां च । १४० ।SUS.SAM.UTT.40/139-140

The ATISARA IS WITH

TE

Sula (pain) in the Vataja type of the disease,

Burning sensation in the Pittaja

S

Mucus in the Kaphaja

Blood (blood-streaked mucus) in the Raktaja (blood origined type).

CLASSIFICATION OF PRAVAHIKA

reference SUS.SAM.UTT.40/139-140

1. Vataja
2. Pittaja
3. Kaphaja
4. Raktaja

C01.DESCRIBE SAMANYA AND VISHISHTA LAKSHANA OF PRAVAHIKA

SAMANYA LAKSHANA
प्रवाहिका वातकृ ता सशूला पित्तात् सदाहा सकफा कफाच्च । सशोणिता शोणितसम्भवा तु ताः स्नेहरूक्षप्रभवा मतास्तु ||
१३९|| तासामतीसारवदादिशेच्च लिङ्ग क्रमं चामविपक्वतां च । १४० ।

1. Pain around the umbilicus.

2. Strenuous effort to pass the stool.
3. Fecal material mainly consists of mucous.
4. Frequent. unsatisfactory episodes of defecation.
5. Pain in calf muscles.

VISHISHTA LAKSHANA

Vataja Pravahika

1. Strenuous and painful defecation.

2. Fecal material is of mucoid nature.

Pittaja Pravahika
AS

1. Thirst.
2. Sensation of burning while passing the motions.
3. Motions are yellowish and mucoid in nature.

Kaphaja Pravahika
N

1. Stool is very sticky and mucoid.

2. A lot of mucus is expelled while defecation.
O

Raktaja Pravahika
TE

1. Easy fatigability.
2. Morions are mucoid with blood stains.

Sannipatika Pravahika
S

1. This is very chronic type of Pravahika with sticky stool and pain in the abdomen as the
main symptoms.
2. Additional effort to defecate is always required and still there is unsatisfactory feeling
on passing the stool

EXPLAIN BHAYAJA ATISARA, SHOKAJA ATISARA AND RAKTAJA ATISARA LAKSHANA

आगन्तू द्वावतिसारौ मानसौ भयशोकजौ। तत्तयोर्लक्षणं वायोर्यदतीसारलक्षणम् ।। मारुतो भयशोकाभ्यां शीघ्रं हि परिकु प्यति
।-CHA.CHI.9/11

The cause responsible for the production of this type of Atisara is external. Main two sub
types are described as;

1. Bhayaja Atisara
2. Shokaja Atisara:
Bhayaja Atisara

This type of Atisara forms due to getting struck or shocked for any reason. The features are:

1. Paleness of the body.

2. Meek (quite) and depressed mental status.
3. Delusions.
4. Tremor
5. Foamy, loose motions.
6. Fever.
7. Dryness of the mouth and soft palate

Shokaja Atisara

This type of Atisara develops due to sudden grief and mental shock on hearing very sad
news e.g. bereavement over the loss of family member.

Raktaja Atisara
AS

पित्तातिसारी यो मर्त्यः पित्तलान्यतिषेवते । पित्तं प्रदुष्टं तस्याशु रक्तातीसारमावहेत् ॥ ज्वरं शूलं तृषां दाहं गुदपाकञ्च दारुणम्
-SUS.SAM.UTT.40/116-117

1. One who is suffering from Pittaja Atisāra and does not follow the treatment of Atisāra
N

and indulges foods & drinks which cause further aggravation of Pitta upto great extent
as a result Rakta gets vitiated and manifest Raktātisāra.
O

2. It is very difficult for management because it manifest serious condition and patient
suffers from thirst, colic pain, burning sensation & inflammation of the ano-rectal region.
3. Raktātisāra may manifest as a complication of Pittätisära and it may also manifest
TE

independently without Pittätisära if person adopts Pitta provocative etiological factors

in excess

DIFFERENTIATE BETWEEN ATISARA AND PRAVAHIKA

S
 S
TE
O
N
AS
 AS
N
O
TE

6.GHRAHANI

24.SHOTHA AND STHOULYA KARSHYA

S

1. Describe hetu of Shotha

2. Enlist bheda of Shotha
3. Describe vidhi samprapti of shotha
4. Describe purvaroopa, vishishta lakshana, samprapti and sadhya asadhyata of Nija shotha
5. Differentiate Doshaja shotha

Synonyms

1. Shotha
2. Shopha
3. shvayathu

Hetu of Shotha
NIJA SVAYATHU HETU C.S.Ci. 12/5-6
 शुद्ध्यामयाभक्तकृ शाबलानां
Consumption of food that is unwholesome or inadequate in nutrition leading to emaciation
and debilitation.
क्षाराम्लतीक्ष्णोष्णगुरूपसेवा
Consumption of foods that are Kṣāra (alkaline), Āmla (sour), Tīkṣhṇa (sharp), Uṣṇa (hot), and
Guru (heavy) which aggravate the doshas
दध्याममृच्छाकविरोधिदुष्टगरोपसृष्टान्ननिषेवणं च
Consumption of curd (Dadhi), uncooked foods, and poisonous or antagonistic foods, which
increase Vāta and Pitta, causing injury to the digestive system
अर्शांस्यचेष्टा न च देहशुद्धिर्मर्मोपघातो विषमा प्रसूतिः
Lack of exercise, not undergoing biopurification therapies (Panchakarma) at the appropriate
time, injury to vital organs (particularly around the anal region), difficult labor, and improper
postnatal care. This results in improper circulation and the formation of hemorrhoids.
मिथ्योपचारः प्रतिकर्मणां च निजस्य हेतुः श्वयथोः प्रदिष्टः
Incorrect or improper treatments or mismanagement of biopurification therapies can
further lead to the formation of svayathu

AGANTUJA SVAYATHU HETU

AS

बाह्यास्त्वचो दूषयिताऽभिघातः काष्ठाश्मशस्त्राग्निविषा- यसाद्यैः आगन्तु हेतुः । C.S.Ci. 12/7

1. बाह्यास्त्वचो दूषयिता (Bāhyāstvaco dūṣayitā):

External affliction of the skin due to trauma or injury is a primary cause of Āgantuja
Svayathu.
N

2. अभिघातः
Refers to any form of external trauma or impact. This can involve physical injury, pressure,
or shock to the skin, resulting in painful swelling.
O

3. काष्ठाश्मशस्त्राग्निविषा- यसाद्यैः
Refers to external agents like:
TE

i. Kāṣṭha (wooden pieces): Injury caused by sharp wooden objects.

ii. Āśma (stones): Injuries from stones or rocks.
iii. Śastra (sharp instruments): Injuries from knives, needles, or other sharp tools.
iv. Agni (fire): Burns or scalds caused by exposure to fire.
S

v. Viṣa (poison): Envenomation or poisoning from external sources, such as bites or stings,
which can lead to swelling or infection.
vi. Yasādyaiḥ (iron-made articles etc.): Injuries caused by iron or metal objects.

Enlist bheda of Shotha

Śvayathu (swelling or inflammation) is classified in various ways based on dosha dominance,
etiology, and location.

1. Based on Dosha Dominance:

a. Vātaja Śvayathu
b. Pittaja Śvayathu
c. Kaphaja Śvayathu
d. Vatapittaja Śvayathu
e. Pittakaphaja Śvayathu
f. Vatakaphaja Śvayathu
g. Sannipātaja Śvayathu
 h. Abhighātaja Śvayathu (Caused by external trauma or injury, leading to swelling at the site of
impact.)
i. Vishaja Śvayathu (Caused by poisonous substances or toxic exposure)
2. Based on the Location of the Swelling:
a. Sarva Swelling that affects the whole body or widespread areas.
b. Ardhagatraja Swelling that affects half of the body or one side of the body.
c. Avayavaja Swelling that affects only one part, limb, or organ of the body.
3. Based on Exogenous or Endogenous Origin:
a. Exogenous Śvayathu (due to external factors like trauma, poison, etc.)
b. Endogenous Śvayathu (due to internal factors like doshic imbalances).
4. Based on the Number of Affected Areas:
a. Ekāngaja Swelling affecting one part of the body.
b. Sarvaja Swelling that is present throughout the entire body.

Describe vidhi samprapti of shotha

1. Vātaja Śvayathu (वातज श्वयथु)

Features: अरुणः कृ ष्णः तनुत्वक्परुषः अनवस्थितः (reddish/blackish, thin, rough, unstable).

AS

Symptoms: प्रसुप्ति (numbness), हर्ष (horripilation), तोद वेदना (pricking pain).

प्रसुप्तिहर्षार्तियुतोऽनिचलस्तनुत्वक्परुषोऽरुणोऽसितः मित्ततः। प्रशाम्यति प्रोन्नमति प्रपीडितो दिवाबली च श्वयथुः समीरणात्॥ (C.S.Ci.

12/12)
N

2. Pittaja Śvayathu (पित्तज श्वयथु)

Features : पीतः सरक्तः मृदुः शीघ्रानुसारि (yellowish/reddish, soft, spreads quickly).

O

Symptoms: भ्रम (giddiness), ज्वर (fever), दाह (burning sensation), पाक (inflammation).

मृदुः सगन्धोऽसितपीतरागवान् भ्रमज्वरस्वेदतृषामदान्वितः। य उष्यतेऽस्पर्शसहोऽक्षिरागकृ त् स पित्तशोथो भृशदाहपाकवान्॥ (C.S.Ci.

TE

12/13)

3. Kaphaja Śvayathu (कफज श्वयथु)

S

Features: पाण्डुः शुक्लः स्निग्धः कठिनः स्थिरः (pale/white, unctuous, hard, stable).
Symptoms: कण्डु (itching), रोचक (anorexia), निद्रा (excess sleep), vomiting.

गुरुः स्थिरः पाण्डुररोचकान्वितः प्रसेकनिद्रावमिवह्निमान्द्यकृ त। स कृ च्छ्रजन्मप्रशमो निपीडितो न चोन्नमेद्रात्रिबली कफात्मकः॥

(C.S.Ci. 12/14)

4. Sannipātaja Śvayathu (सन्निपातज श्वयथु)

Features: सर्ववर्णवेदनः (mixed symptoms of all three Doṣās).

सन्निपातश्वयथुः सर्ववर्णवेदनः॥ (S.S.Ci. 23/5)

5. Viṣaja Śvayathu (विषज श्वयथु)

Features: मृदुः क्षिप्रोत्थानः दाहपाकयुक्तः (soft, quickly arising, associated with burning and ulceration).
Etiology: विषदोष (due to poison, polluted water, contact with toxins).
विषनिमित्तस्तु गरोपयोगाद् दुष्टतोयसेवनात् प्रकु थितोदकावगाहनात्।…स तु मृदुः क्षिप्रोत्थानोऽवलम्बी चलोऽचलो वा दाहपाकरागप्रायश्च
भवति॥ (S.S.Ci. 23/5)

6. Dvidoṣaja and Tridoṣaja Śvayathu (द्विदोषज एवं त्रिदोषज श्वयथु)

Features: व्यामिश्रलक्षणः (symptoms of two or all three Doṣās).

नदानाकृ तिसंसर्गाच्छ्वयथुः सर्वाकृ तिः। सन्निपाताच्छोथो स्याद्विदोषजः व्यामिश्रलक्षणः॥ (C.S.Su. 18/10)

7. Abhighātaja Śvayathu (अभिघातज श्वयथु)

Features: भृशोष्मा लोहिताभासः (severe burning, reddish appearance).

Etiology: चोट (injury), विष (toxins), irritating substances.

अभिघातेन शस्त्रादिच्छेदभेदक्षतादिभिः। हिमानिलोदध्यनिलैर्भल्लातकपिकच्छु जैः…भृशोष्मा लोहिताभासः प्रायशः पित्तलक्षणः॥

(M.Ni. 36/11-12)

8. Avayavasthita Śvayathu (अवयवस्थित श्वयथु)

Features: Localized oedema based on Doṣa location:

AS

Urdhva Śarīra (Upper body): Dosas in stomach.

Madhya Śarīra (Middle body): Dosas in Pakvāśaya.
Adho Śarīra (Lower body): Dosas in rectum.
Sarvadeha (Entire body): Circulating Dosas.
N

दोषाः श्वयथुमूर्ध्वं हि कु र्वन्त्यामाशयस्थिताः। पक्वाशयस्था मध्ये तु वर्चः स्थानगतास्तत्वधः। कृ त्स्न्नदेहमनुप्राप्ताः कु र्युः सर्वसरं तथा॥
(S.S.Ci. 12/6-7)
O

SAMPRAPTI
TE

The Samprapti (pathogenesis) of Śvayathu (oedema) as described in Charaka Samhita can be

elaborated using the words from the given śloka (C.S. Chi. 12/8-9):

1. Nidāna Sevana (etiological factors):

S

Due to improper ahāra-vihāra and other causative factors, the vāta gets aggravated.
2. Vāta reaches external channels (Bāhyāḥ sirāḥ prāpya vāyuḥ):
a. Aggravated vāta enters the external channels.
3. Vitiation of Kapha, Rakta, and Pitta (Kaphāsṛkpittāni saṃdūṣayati):
a. Vāta then vitiates kapha, rakta, and pitta.
4. Obstruction in Srotas (Baddhamārgaḥ):
a. The combination of vitiated doṣas obstructs the srotas (passages).
5. Spreads to nearby areas (Visarpa):
a. This obstruction and doṣa accumulation spread to nearby regions.
6. Formation of Śvayathu (Utseḍhaliṅ gaṃ śvayathuṃ karoṭi):
a. As a result, śvayathu manifests with the characteristic feature of utseḍha (protuberance).
7. Localized or generalized involvement (Uraḥsthita…Sarvāṅ gaḥ):
When vāta along with other doṣas is in the chest region (uraḥsthita), swelling occurs in the
upper body (ūrdhvabhāga).
When it affects the pakvāśaya (seat of vāta), swelling occurs in the lower body (adho bhāga).
When located in the middle region, swelling appears in the middle body (madhyabhāga).
If generalized (sarvāṅ ga), swelling involves the whole body.