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

IngredientsBotanical NameMethod of usingIndications
HaritakiTerminalia chebulaThe decoction prepared with these ingredients should be served freshEdema all over the body    
PunarnavaBoerhavia diffusa
TurmericCurcuma longa
Roots of Long pepperPiper longum
ChitrakaPlumbago zeylanica
CastorRicinus communis
MustaCyperus rotundus
CuminCuminum cyminum
MustaCyperus rotundus
DevadaruCedrus deodara
Long pepperPiper longum

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

IngredientsBotanical NameMethod of usingIndications
PunarnavaBoerhavia diffusaThe decoction prepared with these ingredients should be administered with sugar1. Anasarca 2. Fever 3. Dyspnea 4. Cough 5. Colic 6. Complicated anemia  
NeemAzadirachta indica
PatolaTrichosanthes dioica
GingerZingiber officinale
KatukiPicrorhiza kurrooa
GuduchiTinospora cordifolia
DaruharidraBerberis aristata
HaritakiTerminalia chebula  

4. Dashamuladi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 61

IngredientsBotanical NameMethod of usingIndications
DashamoolaTen rootsThe decoction prepared with these ingredients should be taken with honey and purified Guggulu i.e. Commiphora mukul for 6 days1. Fever 2. Abscess 3. Anasarca  
GuduchiTinospora cordifolia
HaritakiTerminalia chebula
DevadaruCedrus deodara
PunarnavaBoerhavia diffusa
DrumstickMoringa oleifera
GingerZingiber officinale

5. Chukkuchundadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 76

IngredientsBotanical NameMethod of usingIndications
GingerZingiber officinaleThe decoction prepared with these ingredients should be served fresh1. Constipation 2. Swelling
BhunimbaAndrographis paniculata
ApamargaAchyranthes aspera
YavasaAlhagi camelorum
Punarnava mulaRoots of Boerhavia diffusa

6. Pathya Punarnavadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 79

IngredientsBotanical NameMethod of usingIndications
HaritakiTerminalia chebulaThe decoction prepared with these ingredients should be served fresh1. It should be given early in the morning to cure anasarca. Chukkuchundadi Kashayam shall be given in the evening. These two form ideal combination to treat swelling.
PunarnavaBoerhavia diffusa
Long pepperPiper longum
Roots of Long pepperPiper longum
PrisniparniUraria picta
GingerZingiber officinale
HriveraPavonia odorata
CuminCuminum cyminum
DevadaruCedrus deodara
Katu tumbiLagenaria siceraria

7. Guduchi Triphaladi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 93

IngredientsBotanical NameMethod of usingIndications
GuduchiTinospora cordifoliaThe decoction prepared with these ingredients should be served fresh with Commiphora mukul for one month1. It cures skin afflictions, ulcers and anasarca
TriphalaFruits of – Terminalia chebula Terminalia bellirica Emblica officinalis
DarviBerberis aristata

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)

2 thoughts on “Shotha: Causes, Types, Treatment, Medicines”

    • Immature – will have lot of pain, redness and inflammation. Fever may be associated.
      Mature – lesser pain, more heaviness, pus formation, softening of the swollen area.

      Reply

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