Wednesday, May 4, 2016

Shoth (inflammation or swelling) … and its management with #Ayurveda……

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Next topic for discussion:  Shoth (inflammation or swelling) … and its management with #Ayurveda……

Dr. Prerak Shah: Can we discuss abt shoth? Types? Samprapti? Correlation with modern concept? Conditions where shoth can be a symptom? Thnx
Dr. Meghdoot Satvekar: Edema is explained as Shotha or Shopha in Ayurveda. We come across the edema conditions in different local areas such as face, feet etc or throughout the body or half of the body. Even though it usually appears as a symptom, in so many diseases related to vital organs like kidney, liver, heart, lungs, brain, uterus etc,
Onset of Shotha – oedema
Due to the causative factors, the Vata Dosha, , rakta [blood], Pitta and Kapha are vitiated and they are lodged in the veins which circulate in the body and extremities. Due to defect in the circulation, the muscle and twak (skin) are also badly affected and ultimately hard and elevated oedema is resulted.General features of Shotha Heaviness of the body,Disorientation,Oedema over any of the body surface,Warmth,Debility in the veins
Dr Dipak Shirude: Making of list of diseases showing shoth is good idea !!Which kind of jwara consists shoth ?
Whole body shoth and certain organ related shoth i.e. saarvdehik and ekdeshaj Clinically we see saarvdehik in --Anaemia,Hypothyroid,Renal disturbances (CRF),Gynaecological problems,Menopausal syndromeNon specific i.e. shoth rog itself.
Ekdeshaj commonly in --Heart diseases,Sometimes renal problems,Varicosity in veins,Deep venous thrombosis,Rheumatoid or rheumatic conditions,Internal or external injuries,Allergy or poisoning
These are general conditions and they are mentioned without bookish references.Please add to the list.Someone, especially students or new practitioners may make compilation of shoth from brihat trayee. It requires extreme desire only. It also takes very less time. Someone start and give inputs. If anyone did it already, please shade light on it.
Vd. Dhruti Kagrana: Causes factors for Shotha (oedema) :Improper evacuation of doshas from the body by Panchakarma procedures like like  Vamana (emesis), Virechana(purgation) etc-Due to fever,Due to anemia,Long term fasting,Improper diet,Excess intake of alkaline or acidic food,Warm ,spicy,and heavy food intake,Intake of curd , lussy ,vitiated food etc,Incompatible food,Food poisoning,Sedentary life etc
Wholesome diet and habits for oedema- Purana shali [old rice],Yava [barley],Kulattha [horse gram], Mudga [green gram],Tamr chooda rasa [chicken soup],Koorma [ flesh of tortoise],Purana ghrita [old ghee ],Takra [butter milk],Madhu [honey],Shigru [drumstick],Rasona [garlic],Bala moolaka [tender raddish],Amalaki [goose berry] etc
Unwholesome diet and habits for oedema- Lavana [salty diet],Shushka shaka [dry vegetables],Navanna[newer grains],Madhya [alcohol],Amla rasa [sour substances],Shimbi dhanya [pulses],Guru ahara [heavy food],Vidahi ahara [spicy food],Adhwa [long walk],Shrama [exhaustion],Dadhi [curd] etc
Dr. Meghdoot Satvekar: List of diseases where oedema is symptom. physical inactivity ,standing / sitting for a long time ,surgery ,heat / burns ,hormonal imbalance ,diabetes ,excessive salt intake malnutrition ,kidney damage ,heart failure ,chronic lung diseases ,liver damage,allergies ,thyroid disease ,brain tumour ,head injury ,blood clot / varicose vain ,infection / inflammation
Dr. Bhadresh Naik: Filariasis,Traumatic injury, Infection, Osteomyelitis, Fracture, Strain and sprain of muscle
Dr. J. T. Contractor:  Vd Satvekar has narrated in right way the detailed cause of the problem
Dr. Binni Shah: Anemia,Arthritis,Vascular debility,Pulmonary disease, Malnutrition. Basically swelling is a reactionary condition to any abnormality in the can be local swelling or anasarca
Dr. Bhadresh Naik: Low potassium,Low b 12,Excessive sodium,Dehydration Are causes of edema
Dr. Meghdoot Satvekar: Anaemia & oedema - In patients with oedema caused by chronic severe anaemia there is retention of salt and water, reduction of renal blood flow and glomerular filtration rate, and neurohormonal activation similar to that seen in patients with oedema caused by myocardial disease. However, unlike patients with myocardial disease, patients with anaemia have a high cardiac output and a low systemic vascular resistance and blood pressure. It is suggested that the low concentration of haemoglobin in patients with anaemia causes a reduced inhibition of basal endothelium-derived relaxing factor activity and leads to generalised vasodilatation. The consequent low blood pressure may be the stimulus for neurohormonal activation and salt and water retention.
Vd. Dhruti Nirav Bhatt: Some time drug reaction is also caused Sarvang shoth, Amavastha,Shoth in  Pre menstruation condition and Pre Menopause stage due to hormonal changes
Dr. Bhadresh Naik: Many times we don't consider vataj-Pitaj-Coughj shoth  .Line of treatment change according to dosh
Vd. Dhruti Nirav Bhatt: Dashmoolkwath,Punarnavastak kwath, Dipanpachan treatment, diet and treatment  according to cause
Vd. Javed Ghumara: Before few days one pt female 44 yr came with sarvdehik shoth since 2 years..she was known case of hypothyrodism and take allopathy medicine regular since 2 yr...her tsh also in normal range....when I took history I found that lady is having aamajirn...with many nidana like diwaswap dadhi intake regular adhyasan excessive water intake....first i stop all that nidana than i advice her for mild langhan with sunthi dhyanyak sidha jala and give her only ajamodadi choorna...within 7 days her shoth disaapear here nidan is important not medicine...that's y aacharyas write.Nidanparivarjanm adau vijaniyat tatantarm aaushadham
Vd. Dhruti Nirav Bhatt: Even I have seen that patient with  Constipation relief by laxative aushadh and Sunthi castoroil kwath
Dr. Satyendra Sharma: Inflammation is a none specific protective immune system response to cell injury or irritation that is characterized by capillary enlargement. Almost every aspect of our industrialized life style stimulates our immune system to become  chronically overactive. This over activity results a chronic release of molecules that cause infamation.Several factors are responsible for inflammation such as genetic factor,diabetes,smoking, HTN,lack of exercise,depression, hypothyroidism, obesity,stress,elevated lipids,elevated homocystein ,inadequate intake of fruits and veg  consumption, inadequate omega3 levels,elevated C-reactive protein,pollution, excessive alcohol consumption etc.Inflammation is the root cause of entire degenerative disease as heart disease, diabetes, cancer,arthrites etc. Solutions-consume natural anti inflammatory like omega3,antioxidant ,adequate exercise and sound sleep, Avoid processed food,alcohol and sedentary habits.Ayurved management-equall amount of punarva powder,giloa and kutki powder ,one spoon twice in a day.Regular use of haldi and pomegranate is effective,
Dr. Meghdoot Satvekar: Punarnava mandur is a traditional Ayurvedic formulation which is prescribed in conditions like Anemia, Jaundice, pedal edema or generalized edema, Swelling and fluid accumulation, fluid retention in feet. It is also a best herbal remedy for ascites, Disorders associated with Liver and Spleen, Skin diseases, Kidney diseases, fluid retention due to kidney failure or liver failure.Punarnava mandur tablets work as natural diuretic. They clear away the accumulated fluid quickly without causing side effects.Punarnava mandur tablets are classical ayurvedic tablets for many health conditions. It is an excellent herbal remedy to improve blood count, improve blood quality, remove toxins from the blood, help in decreasing urea/creatinine, cholesterol and other toxins. These are natural diuretic tablets. Punarnava Mandur helps in ascits, renal failure, liver failure, fluid accumulation, swelling, puffy eyes, glaucoma, anemia, fatty liver and many other problems related with accumulation of fluid in the body tissues.
Vd. Kinshuk Hirpara: Edema and swelling is the same thing. Edema is the scientific term while swelling is the lay term. Edema or swelling is a consequence of acute inflammation. Acute inflammation is a physiological reaction of the body to injury. Injurious agents damage the tissues. They trigger the release of histamine from mast cells, blood vessel lining cells, and platelets. There is an initial reflex contraction of the capillary bed to limit entry of injurious agents into the blood stream. Histamine and serotonin released from mast cells, capillary endothelial cells[1], and platelets relax the capillaries and increase the permeability of capillaries. These cells contain a pre-formed amount of these vasoactive substances ready to be released at a moment’s notice. This marks the onset of fluid exudation. Histamine is the key inflammatory mediator released during the immediate phase of acute inflammatory reaction. During the latent phase, other more potent inflammatory mediators like serotonin, leukocyte proteins, bradykinins, Kallikreins, arachidonic acid derivatives, leukotrienes, and acute phase proteins further increase capillary permeability and platelet activation. Therefore, a large amount of water andelectrolytes leak into the inflamed tissues. When the water moves out, the hydrostatic pressure inside the capillaries goes down. Therefore, osmotic pressures inside and outside the capillaries equalize. This will be the end of water movement if it is only water that moves through the capillary walls. In acute inflammation, it is not the case. Through enlarged gaps in the blood vessel wall lining, proteins leak out. These proteins draw water out into the tissues. This is called hydrophilic interactions. Protein breakdown due to tissue damage increases this water movement further. At the venous end of the capillary bed, water does not enter the circulation because water gets held by in the tissue by electrolytes and proteins. Therefore, the amount of fluid exiting the arterial end of the capillaries is larger than the amount of water that enters the venous end of the capillaries. Thus swelling occurs. Causes of pitting oedema
Pitting-dependent oedema.This is oedema of the ankle if mobile, sacral when bed-bound
Immobility: Increased fluid pressure from venous stasis,Varicose veins.,Obesity:
Increased fluid pressure from sodium and water retention; should not to be confused with non-pitting lymphoedema.Cardiac:Increased fluid pressure: right heart failure, constrictive pericarditis.Drugs:Increased fluid pressure from sodium and water retention: calcium antagonists, non-steroidal anti-inflammatory drugs (NSAIDs), prolonged steroid therapy, insulin.Hepatic:
Decreased oncotic pressure due to hypoalbuminaemia. Also increased capillary permeability from systemic venous hypertension.
Renal:Decreased oncotic pressure from protein loss, and increased fluid pressure from sodium and water retention: acute nephritic syndrome, nephrotic syndrome.
Gastrointestinal:Decreased oncotic pressure: starvation, malnutrition, malabsorption, protein-losing enteropathy (eg, Crohn's disease, ulcerative colitis, tumours of stomach and colon, coeliac disease and other intestinal allergies).
Obstructive sleep apnoea:Increased capillary hydrostatic pressure due to pulmonary hypertension.
Pregnancy:Increased fluid pressure both from sodium and water retention and venous stasis from pelvic obstruction.
High-altitude illness:Oedema of face, hands and ankles may occur. Cerebral and pulmonary oedema, however, are usually of greater concern if disease progresses.
Idiopathic oedema:Associated with cyclical high lymph volume overload, or dynamic insufficiency: usually in a woman aged 20-40 years.
Variable and not related to menstrual periods.
Diagnosis is based on the exclusion of other causes of oedema.
Post-thrombotic syndrome:Late complication of deep vein thrombosis (DVT) which occurs in up to two thirds of patients.
May present with pain, oedema, hyperpigmentation, and even skin ulceration.
May result from remaining venous obstructions, from reflux, or both.
Rate of reflux is highest during the 6-12 months after an acute DVT.
It may be temporary and self-limiting or not resolve and persist at variable severity. Best drug of choice cow urine therapy For shotha
Shri Minoo parabia: I would like to know about Glaucoma, Ascites and Pluresy, some dangerous adpects of fluid accumulation at unusual places.
Vd. Kinshuk Hirpara: Fluid retention any where we can consider as shotha. As per my knowledge. Fresh cow urine has magical results in ascites as well. No water should be given only cow urine and milk alternate every 2-3 hrs.. Milk of female camel should be given.   Narsinh vati can be given reference Vaidya zanduji. In fluid retention
Dr. Prerak Shah: Cow urine is more considers as Tikshna virechaniya (bhedana)
Dr. Bhadresh Naik: Pleurisy most common cause tb Infection-Lvf-Ascies-Liver disease-Lvf-Portal hypertension-Carcinoma-Obstructive jaundice- Glucoma-Obstruction in lacrimal gland-Vegavrodh of ashru(crying)
Vd. Kinshuk Hirpara: Oedema in Pregnancy - we can not give cow urine and aloe vera or narsinhvati. Safest drug is decoction of gokhru and punarnava equal parts. Once a day.
Shri Minoo parabia: Yes with gokhru and punarnava yav- barley watet is an innocent regimen
I have found the combination of Singapuri loban (Styrax benzoin) and Mamro Badam Almond very useful in ascites. Bapaji used to recommend Katuki Picrorrhiza kurroa.One Jain Maharaja saheb recommended Opuntia swaras with gram flour, as bread-Roti......and yes strict diet of only milk or buttermilk.
Dr. Bhadresh Naik: Shoth I all ready mention etiology and causes Dosh vigatan play a roll to treat
We must find out the cause Randomly you prescribe medicine Vataj shoth,Discoloration of skin Hard,Dryness ofskin,Pittaj,Heat in touch Redness,Possible to pus Increase by massage, Cough
Sign of skin coper colour,No pitting on pressure,Slow progesive
Dr. J. T. Contractor: Coriander leave juice or decoction helps reduce edema in most general cases
Dr. Bhadresh Naik: Please consartaing on each dosh vikruti shoth and give lineof treatment is more beneficial
Dr. Rahul: For pedal oedema Pitting or non - Pitting following combination has shows considerable results in 5-7 days... Along wid dietary restrictions Arogyavardhini,Chandraprabha ,Gomutra haritki Dash-mool kwath + Punarnavadi kwath.For pleurisy Punarnavadi guggul ,Carwin capsules ,Swasosol forte .Along with Dash-mool kwath shows considerable improvement
Dr. Devesh Kumar: Is same treatment of pedal odema can b given to hypertensive pt ??
Dr. Bhadresh Naik: Like coughj shoth Dipan,Pachan,Cough nasak medicine,Udvartan,Nityanand ras,Gomutra haritaki,Tricutu churna,Agnikumars,Goxuradi gugulu,Bhallatak,Kafketuras,Punarva gugulu,Shothari mandur,Shothari loh,Nidan parivargan In pleurisy Please rule out causes other wise it's create serious complications.  Frist try to change samprapti Doshvighan,Nidan parivarjan
Dr. Rahul: For hypertensive patients with no other complications except diabetes
The same combination may be used.  You may also add Punarnava mandoor to the combination depending upon the patient.
Dr Jayesh Patel: Kans haritaki also very useful in shoth
Vd Tushar Trivedi MD: @ dr. Jayesh. Which pharmacy make kansa haritaki ?
Dr Jayesh Patel:  self prepared
Dr. Binni Shah: Sir, shoth relation between doshsthana and bodypart is really great observation and interesting thought by Dr Jaydeep.
Vd. Sachin Kadlag: 
No.    Location of dosha                   location of shotha
  1        Urasthita                                  Urdhwa  ( upper region of body )
 2.     Vayu sthana sthita                 adhopradeshi  ( lower region of body)
3.      Madhyagata                          madhya (middle region of body)
4.       Sarvagata                              sarvanga  ( whole body)
5. Kwachitastha                          kwachita  pradeshi ( some part of body)
Reference   Charak chikitsa    12/9
Dr. Nayan Gajera: in arthritic condition, agnikarma is helpful to reduced edema or swelling
Vd. Krutika Suhas Chaudhary: Kleda variddhi...un shotha so i think milk is not useful in all conditions.... According to dosha regimen should be decided...Yes cow milk may b used . But instead of dat mudgayush...etc..or sidhha yavagu will work nicely... Also in vranaj shoth..jalaukavacharan has very nice result. Its successfully applied on shoth of pidika...bhagandar and in janu shoth as well as cellulitis.... In pune i have seen application of jalauka to reduce pain and oedema...
Dr. Sujata Vaidya: Punarnavasav is habit forming??
Urvi parikh: Actually sotha is a very broad term in use n as far as possible v sud not limit it only of swelling.See d ::nidana:: cha.chi.12/6
Nij sotha : sudhya amaya abhaktya Krushanam abalanam....In all these condition rather then swelling it can be hypertrophy or atrophy related changes.
Aagantuj sotha : baahyaa tu twacho dushaitva...Has all allergic or traumatic causes on skin. Chakrapani says
Bahya iti agambhira... That means if d skin is infested or infected very deep then sotha is not said, so it is different than swelling.
::Samprapti ::
Baahyaa sira (vasodilation or vasoconstriction or vasoconsolidation) praapya yada...
Kapha (allergic response) asruk (blood born infection or infestation) pitani (metabolic change related inflammatory response) (dosha)
(Dushya) vata (nervous irritation or cell mediated atopsy or autoimmunity)
Te badha marga.... (Aavrut marga chakrapani) (vasoconstriction in auto repsonse to vasodilation)
Sa tada visarpa ( fast)
Utsedha ling ( inflammation or hypertrophy )
::Chikitsa sutra::
Nidana dosha ( so it is very important to find are d inflammatory changes due to kapha/askruk/pitta... Without that just giving diuretics wud not suffice)
Ritu viparya (this is very important n not said by charak very time)
The ongoing season sud b considered bfr treating
Upacharet bal dosha kat vit....
Bal (sud understand patient immunological condition)
Vd. Meeta Parekh: Sunthi+Castor oil with warm water daily gives good results in shoth.
USA Dinesh Pandya: यो मध्यदेशे श्वयथुः कष्टः सर्वगश्च यः |
अर्धाङ्गे रिष्टभूतः स्याद्यश्चोर्ध्वं परिसर्पति ||१७||
श्वासः पिपासा छर्दिश्च दौर्बल्यं ज्वर एव |
यस्य चान्ने रुचिर्नास्ति श्वयथुं तं विवर्जयेत् ||१८||
अनन्योपद्रवकृतः शोथः पादसमुत्थितः |
पुरुषं हन्ति नारीं मुखजो गुह्यजो द्वयम् |
नवोऽनुपद्रवः शोथः साध्योऽसाध्यः पुरेरितः ||१९||
विवर्जयेत् कुक्ष्युदराश्रितं तथा गले मर्मणि संश्रितं |
स्थूलः खरश्चापि भवेद्विवर्ज्यो यश्चापि बालस्थविराबलानाम् ||२०
Dr. Arvind Shahane: If shoth on liver or splin with tenderness You will go for raktmokshan from cubital vein from same site Very good results I show…….Raktmokshan for liver from rt cubital .For spleen Lt cubital vein
---------------------------- end of comments from group 1 -----------------------------
LVG Shriram Gandhi: Punarnava (satodi) is  widely use in inflamatin.
IPR Chhayaben: Haldi + salt  mix,  make paste n heat.. Luke warm.. N apply on the swelling area..
Dr. Jyoti Ashok: Dashamoola is best shothahara
Vd Daxa Patel: Gugglu kalpna is best for all types of inflammation
Vd. Rahul Marwah: Jaggery + ginger juice very effective in kaphaj and vataj shooth. Known as gud adrak yog in the samhitas
Australia Vd. Neerja Ahuja: Castor oil topically or internally
Exi kir: Sir, Shoth (swelling) happens on different parts of body. It happens inside body also.
Dr. Bhavesh Modh: बाह्यः सिराः प्राप्य यदा कफासृकपित्तानि संदूषयतीह वायुः
तैर्बध्धमार्ग तदा विसर्पन् उत्सेधलिग्ड़ं श्वयथुं करोति ।।
चरक चिकित्सा 12
 कृमिज ह्रदरोग मे ही  केवल शोथ बताया गया है
* उदररोग शोथ का ही एक प्रकार there are two types of शोथ
1. निज (? pathogens, related to दोषाः धातुः  imbalances  )
2. आगन्तु (accidental )
Again निज शोथ have two causes
1. दौर्बल्य कारक - Heart disease
2. अभिष्यंद कारक  ( ? Infection
Liver or Renal disease
One more thing
When we try to understand  निज शोथ  considerate उदररोग as well & in आगन्तु शोथ  considerate व्रणशोथ = traumatic injury.

 उध्वगामी नरं पादाभ्याम् अधोगामी मुखात्स्त्रीयम्
उभयं बस्तिसंजात शोथो हन्ति संशय  ।। सुश्रुत

श्वयथुर्मध्यदेशे यः कष्टः सर्वगश्च यः ।। चरक
Pedal edema  in male , Facial edema in female  are कष्ट साध्य = very difficult to treat. & sushrut says बस्तिसंजात( = related to urinary system ) शोथ ,असाध्य  = incurable
As well as महर्षि  चरक,  श्वयथु मध्य देशे = abdominal swelling  (probably occur in liver or renal disease. ) incurable.
Dr. Ravindra Upadhyay: shoth 3 types, vataj, pittaj, kafaj,  vataj will respond to Dashmoolghan tab, dashmoolkwatha, guduchighan tab, guduchi. powder, with lukewarm water. thrice a day, in pittaj shoth, there will be localised warmth, redness, pain with. burning sensation, will respond to, combination of musta, parpat, ushir, chandan, and shunthi, to be taken by mouth with coconut warter or audumbar jal, phondaghat pharma, from. mumbai,  helps quite a lot, in kafaj shoth gudardrak yog is ideal, avoid drinking water after that.
Vd. Pankaj Chhayani: There are more than one classification of swelling (shoth) in Ayurveda...
Pathogenesis:-Kapha, Rakta(asruk) and pitta enter the external vessels and afflict vata located there.  As a result of these, the passage (channel of circulation ) gets obstructed which spreads to the near by areas, thereby causing oedema characterized by swelling...
function of vyana vayu at peripheral tissue:-providing nutrients/water into tissue and draining of water and proteins into lymph...
When vitiated kapha and pitta come at external vessels ,vata is vitiated and normal function of vata is disturbed..due to dysfunctional vata ,fluid accumulate and cause oedema(pitting)..
1⃣ Vataj type of swelling:-
प्रशाम्यति प्रोन्नमति प्रपिडितो=non pitting oedema (when pressed, the swelling disappears but it appears again after the pressure is withdrawn).
दिवाबली= greater intensity during the day time(at the end of day).. This type is seen in oedema due to cardiac problem where swelling is more at the end of day due to gravitational force..
2⃣ Pittaja type of swelling:-
रागवान= redness
उष्यते=feeling of warmness
दाह=burning sensation
स्पशँरुग= tenderness
These all symptoms are seen in modern inflammation.
4 cardinal symptoms/signs (redness, swelling, warm,fever)of inflammation are seen in pittaj type of swelling..
3⃣Kaphaja type of  swelling:-
रात्री बली= greater in intensity during night(early morning). Swelling over face is commonly seen in cases of renal pathology..
निपिडितो चोन्नमेद(pitting oedema)= when pressed and if the pressure is released, the pit doesn't get filled up, i.e. the swelling  doesn't come to its original shape again..
वमन= vomiting , this is commonly seen in pt of CKD.
Dr. Bhavesh Modh: Edema is explained as शोथ or शोफ in Ayurveda. We come across the edema conditions in different local areas such as face, feet etc or throughout the body or half of the body. Even though it usually appears as a symptom, in so many diseases related to vital organs like kidney, liver, heart, lungs, brain, uterus etc.
*Onset of शोथ / श्वयथु edema
Due to the causative factors, the Vata Dosha, , rakta [blood], Pitta and Kapha are vitiated and they are lodged in the veins which circulate in the body and extremities. Due to defect in the circulation, the मांसधातु (muscle) and त्वक(skin) are also badly affected and ultimately hard and elevated oedema is resulted.
*Ayurvedic Treatment for edema 
According to the doshic dominance, dosha pacifying measures are undertaken. In case of severe mal digestion, fasting (लंघन) and digestive medicines (पाचन) are advised. All measures are undertaken to reduce the swelling by application, tub bath and oral medication.

*Single drug एकल औषध recommended in शोथ (edema)श्वयथु
1⃣Ginger – Shunthi- Zingiber officinale
2⃣Castor root – Eranda- Ricinus communis Linn.
3⃣Punarnava- Boerhavia diffusa Linn.
4⃣Tribulus – Gokshura- Tibulus terrestris Linn.
5⃣Guggulu- Commiphora mukul (Hook. Ex. Stocks.) Engl.
6⃣Aragwadha- Cassia fistula Linn.
7⃣Cumin seeds – Jeeraka- Cuminum cyminum Linn.
8⃣Turmeric – Haridra- Curcuma longa Linn.
9⃣Shilajit -Asphaltum punjabinum
10.Devadaru- Cedrus deodara (Roxb.) Loud.
11.Haritaki- Terminalia chebula Retz.
12.Shallaki- Boswellia serrata Roxb.

🔹Ayurvedic medicines for edema management:
1. Shunthyadi kashaya
2. Punarnavasava
3. Gomutra mandoora
4. Kamsahareetaki
5. Dashamoola hareetaki
6. Vasakasava
7. Gokshradi guggulu
8. Shothari Rasa

🔹Simple home remedies for edema
Regular consumption of a mixture of one pinch of turmeric along with half a teaspoon of ginger along with honey relieves edema.
The herbs – one teaspoon of Punarnava, ginger and turmeric are taken in a vessel. Added with two cups of water, boiled and reduced to half a cup filtered. This in a dose of 20 ml, two times a day before food along with a small piece of jaggery is useful to relieve edema.
Erandamoola, Gokshura and Jeeraka are taken in equal quantity and a decoction is prepared .This is capable of pacifying edema.
🔹Wholesome diet and habits for edema
शाली [old rice]
यव [barley]
कुलत्थ [horse gram]
मुंग [green gram
घृत [old ghee ]
तक्र[butter milk]
शहद  [honey]
साहिजन સરગવો [drumstick]
लहसून  [garlic]
बाल मूलक [tender raddish]
आंवला [goose berry] etc
🔹Unwholesome diet and habits for edema
लवण [salty diet]
सुकवणी  (गुजराती) [dry vegetables]
नवीन धान्य [newer grains]
शराब अत्यधिक  [alcohol]
अम्ल रस fermented  [sour substances]
शिंबी धान्य  [pulses]
गुरू आहार  [heavy food]
विदाही आहार  [spicy food]
पंथ [long walk]
श्रम [exhaustion]
दही[curd] etc
Colombia Enrique Jorge Galindo Bogota: Any treatment of periodontal abscesses when it produces inflamation?
Dr. Bhavesh Modh: Oil Pulling – An ancient Ayurvedic healing tradition, oil pulling has been used for many years to remove toxins from the body. I use organic coconut oil to do  oil pulling because it has anti-bacterial and immune boosting properties. Take 1 tablespoon of coconut oil and swish it around your mouth, through your teeth and gums for 10-30 minutes. Do not swallow it! After at least 10 minutes spit it out and rinse your mouth out.
Raw Garlic – took a clove of garlic and mashed it a little so the juice would come out and stuck it right between gum and lip. This helps to kill the infection and also eases the pain and boosts the immune system.
An abscess (any where ) is a localised collection of pus. In Ayurveda, it is termed as ‘Vidhradhi’.
त्वग्रक्तमांसमेदांसि प्रदूश्यास्थिसमाश्रिताः |
दोषा: शोफं शनैर्घोरं जनयन्त्युच्छ्रिता भृशम् ||
महामूलं रुजावन्तं वृतं चाप्यथवायतम् |
तमाहुर्विद्धधिं धीरा…|| (Ref : Su. Ni. Ch. 9/4-5)
According to Sushruta (School of Ayurvedic Surgery), when Vata, Pitta and Kapha doshas getting aggravated, it vitiates the skin, blood, muscle, fat and bone tissues and becoming localised at some place and produce a troublesome swelling which is bulging up rapidly, deep rooted, painful, round or wide, such type of swelling is known  as ‘Vidhradhi’.
🔹According to Ayurveda, in the very beginning stage of an abscess, always try to subside the swelling.
One should apply the ‘Ayurvedic herbal paste’ having anti inflammatory properties on the affected area, e.g. Dashang lepa, Doshagna lepa etc.
🔹Advice patient to take Ayurvedic medicines having anti inflammatory properties, e.g. Triphala Kwath, Varunaadi Kwath, Punarnavaadi Kwath, Shigru Kwath, Tab. Shilajit, Tab. Pathyadi ghanvati, Tab. Dashang guggulu, Tab. Yograj guggulu etc.
By using these above appropriate measure, if the swelling is not getting subsided and become larger and larger, then go for the next step, and try to ripe the swelling fast.
🔹For achieving it, apply the ‘Ayurvedic herbal paste’ which can ripe, mild squeeze and burst the swelling, e.g. Lepa ghuti lepa, Apamarg kshara lepa, Yav kshara lepa etc.
👉Incision and drainage of the abscess would the last treatment choice.
 Vd. Karuna Mantri: Shoth-- hrudaya vikrutijanya- vrukka vikrutijanya - pandurog janya
Useful medicines in Ayurved
1. Shothari Loh
Loh bhasma + trikatu + yavakshar sampraman.
Anupan - dugdha.
2. Punarnavashtak kashaya with mandurbhasma and kadu churna
3. Shoth har churna - shubhra churna 8gm + mandurbhasma 1gm
( 250mg twice a day with gaumutra ark )
Shothrog pathya
1. Less Cereals diet (shimbivarg)
2. Rogi ko dugdhahar & madhur + aaml raspradhan falahar par rakhe
3. Udar shuddhi karte rahe
-Gaumutra basti or glycerine enema can be given
4. Tivra mutral aushadhi na de.
Dr Jaydeep: Very interesting aspect of Shotha- oedema appearance over different body parts on the basis of dosha-  given by renowned vd c.p.shukla sir that ...
Kaphaja Shotha- is related with kidney mal function so it generally appears on upper body e.g. face dominantly as its kapha area of body.
Pittaja Shotha- is related with liver malfunction and so appears on Central body part e.g.abdomen which is pitta body part
And vataja sotha is related with heart disease and so appears in vataja body area e.g. over  lower extrimities dominantly .
Dr. Ekta Patel (g): Punarnava is mutravirechniy
Deepak Tamboli: What r the reasons for inflammation on intestine?how it can be cured?
Dr. Ekta Patel (g): Useful in shoth.  So ayurved also believe in mutravirechniy in shoth
Vd. Amit Mahajan: Here r we treating shotha or shofa with mutravirechniya drugs like punarnava? Inflammation or oedema? Similarly diseases like jalodara or plihodara are also included in this category?Then y separate chapters r given in Charak Samhita for शवयथु & उदर रोग
Vd. Pankaj Chhayani: Leech therapy is useful in Ekang shoth(local swelling) where lymphatic blockage(or  other ) is cause...
Dr. Sheetal Sumra: Shoth due to aama..  In this we can use ruskh Sweden is useful
Vd. Pulkit D. Patel: kshara is the best result in shoths......
Dr. Renu Agarwal: Pedal edema in male and facial edema in female is difficult to treat according to ayurveda
Vd. Vidhi Joshi: Shoth name derived from " shuthi" it means to eliminate smthng or to prevent smthng according to use of it. Its also known as " vishwabhejak " whch means vishwa - all abt & bhejak - medicine so it means " shoth is medicine 4 all kind of disease whn it vl taken with diff ANUPAN . Bcz main action of shoth is on digestive fire so its control GIT
Common way to take shoth in seasonal days 4 even healthy ppl is shoth water whch prevents yr body 4m seasonal disorders / allergy specially monsoon
Shoth is very useful in case of sinusitis,  odema, insomnia, severe backache after menopause,  epitaxis,  haematuria....Widely I used shoth bcz its cover " vata/ pitta / kapha"
Dr Premsukh: Edema causes and investigation are important for proper diagnosis: Rule out the involvement of kidney, Heart and blood are important.
Dr. Nikhil Baxi: avarodhjanya/kaphaj shotha i generally use Gomutra Haritaki & Punarnavashrak kadha (sharangdhara samhita). Haritaki is not only dipan pachan but rechak also. udar chi - nityam yeva virechyet - milk is rechak & pittashamak hence useful.
Dr Premsukh: Hypoproteinmia and Anemia are also having Sotha so always think broadly when chronic patients are there
Dr. Nikhil Baxi: this topic is very vast - we can discuss shotha acc to causetive factor & organ wise, nija -agantuj shotha. agantuj shotha & anaemia - Tapyadi loha/punarnava mandur helps a lot.
Vd. Gurumahantesh: Modern management like diuretics should not be applied here as some practice giving mutrajanana dravyas to combat shotha. My opinion
Prashaant: Urtica/Kettle tea can be used in case of oedema. It helps when having swollen feet.
Dr. Ravi Dewan: Punarnavadi Mandur should be multi purpose drug in shoth due to any pathology. Specifically when related to kidneys, liver or due to anaemia.
Vd. Hardik bhatt, Idar: Thyroid , kidney disease , heart disease , anemia , insect bite, any injury , 'Sam' condition are most common causes of Shoth, And we have to treat with according to dosh as
Usa Kalindi Narayan: I really enjoy reading new information regarding Ayurveda. I only know Allopathy & Yoga practices.  So Pardon  for not being active in sharing. Thanks for the knowledge all of you share. Kalindi
Dr.Yogesh Gorakhnath Patil: 1) Cow urine + haritaki   2) punarnva + gokshur + pippali
Dr. Piyush Pampaniya: So thts y Gamutra haritaki is indicated in shoth for rukshniy(Drying)  but nt
Vd. Amarish Pandya: Gud Adrak prayog is very good for different types of Shotha. One clinical study was conducted at IPGT& RA , Jamnagar which exhibited promising results. Very simple yet effective treatment.
Usa Kalindi Narayan: As  we are discussing Shoth, inflamation, one of the symptoms,  which is the cause and one of the effect is pain.   we should try using pranayamas, kapalabhati and bhastrica. Also, I just heard on TV that one of the busiest emergency room  in Usa is using the Music therapy to eleviate the pain, instead of Opiates. They do not give even first dose of Opiates in ER. So with the help of ayurveda, music therapy, meditation and different pranayamas, we can do wonders. I hope this can make sense!
Dr Sandeep Madaan: Please comment if chronic inflammation is also shoth? Can it be anywhere in amlapitta also describe as chronic inflammation in the body and is not just gastritis?
--------------------------------end of comments from group 2 --------------------------
Vd. Pooja Hirpara: Regular consumption of a mixture of one pinch of turmeric along with half a teaspoon of ginger along with honey relieves edema.
Nigeria Mr. M. Gopikrishna: Moringa leaves with domestic calcium hydroxide paste applied is known to reduce swelling
Dr. Lokesh Raturi: Dashmool and punarnava kasayam is good in shoth. Turmeric with milk is also helpful
Vd. Vijayananda: Inflammation is a serious issue when in relation to cardiovascular disease. Clearly the Pitta-related heart condition.
Dr. Shriniwas Gujjarwar: About - Shotha.Sarvanga (all over body) and Ekanga  (Sthanik or local).Then Sthanik / Ekanga / regional or local-
Three stages-
Amavastha  (unriped ) inflammation.
Pachyamanavastha (digestive inflammatory stage)
Pakwavastha  (riped, puss formation inflammatory stage or abscess condition).
Dr. Dhaval Dholakiya: Shoth--- cause: nija and agantuja. Basic vikrit dhatu--- rasa. Pitting oedema--- avgadhe no unnati( kaphaja), non pitting related with generally vata dosha……..Mainly effective drugs according to condition of the disease, patient, srotasa. Like in amavata pippali, in hrud roga and renal conditions gokshura and punarnava,  in respiratory and associated cardiad conditions. Dashmoola, in vatavyadhi aerandmoola,  in generalized anasarca prabhut anulomana by goumutra, goumutra haritaki, haritaki,  or guda adraka.
Dr.Sandeep Saluja: Any correlate of autoimmune diseases?Which Ayurvedic drugs are helpful in these conditions which obviously involve inflammation
Dr. Shriniwas Gujjarwar: Shotha or shopha term is for
Generalised swelling all over body.In vrikka vikar (kidney diseases ) , udara (acitis) Yakruta vikar (liver diseases ) and in Pandu  (anamia ) etc.
Dr. Anup Torane: In short shoth is nothing but increases kleda in certain area of body or organ of body lyk liver cirrhosis corelate with yakrit shoth.According to panchbhoutik concept shoth is increase Aapya (jaliy) gun in body.
Treatment of any shoth According to modern is mutravirechniy n according to ayurveda is malavirechniy
Dr. Muanpuii: Due to the causative factors, the Vata Dosha, , rakta [blood], Pitta and Kapha are vitiated and they are lodged in the veins which circulate in the body and extremities. Due to defect in the circulation, the mamsa (muscle) and twak (skin) are also badly affected and ultimately hard and elevated oedema is resulted.
Dr. Anup Torane: Rason n bhallatak is d best medicine treating  shoth
Dr. Chetan Mehta: Punarnava & gourmet & haridra also Goxur
Dr. Prerak Shah: @Dr. Anup: very good observation. If shoth is according to ayurveda malavirechniy, then why we all prescribe more diuretics for the treatment of shoth? Out thinking process is more influenced by modern thinking.
Dr. Mrugeshkumar Patel: Vatik shoth snehpan  niruhbasti,paitik shoth milk & dhrut pan ,kafaja shoth ruxan kriya takra asav arist aapavu punarnavadi,gomutra haritaki,gud adrark ,silajit vardhama prayog..dasang lep.  Gauo mutra haritaki is the best.. Charak....
Dr. Prerak Shah: What about vatik, paittik or kaphaj shoth? Can we give the same treatment?
Dr. Shriniwas Gujjarwar: Yes sir.Gomutra  (cow urine) and Gomutra preparations are very effective in shotha due to kidney or liver.
Main drug is :Gomutra Haritaki.  No according to samprapti ,  Dosha dominance and symptoms line of treatment will  differ. .
Dr. Anup Torane: Vajedi basti hav excellent result in vrikka shoth
Dr. Shriniwas Gujjarwar: Vajedi means I think intestines of goat ?
Dr. Ashish Mule: Cow urine panchgavya is great elixir, proper diet, pleasing to heart, giver of mental and physical strength, enhances longevity. It balances bile, mucous and airs. Remover of heart diseases and effect of poison.
Dr. Muanpuii: 1. Shunthyadi kashaya 2. Punarnavasava 3. Gomutra mandoora 4. Kamsahareetaki 5. Dashamoola hareetaki 6. Vasakasava 7. Gokshradi guggulu 8. Shothari Rasa
Dr. Lokesh Raturi: Dear all as per Ayurveda causative factor can be on body and mind level but treatment can be on three levels- body,mind and soul. All inflammatory conditions anti inflammatory, diuretics, vatanuloman,amapachan and immune modulator along with liver and kidney tonic herbs is helpful. In my practice I always use One approach to balance present Dosha and another according to the symptoms along with pranayama and meditation.As I was mostly in Europe for 14 years so I was using single herbs like Haritaki, Punarnava,Gokshur,Turmeric and Dashmool. Marma therapy also plays important role in healing.
Vd. sandeep Ahirkar: Shotha types
1)nija shotha (vatadi doshjanya)
2)agantujh shoth (marmoghat ,vishajanya)
Nija shotha types
1)ekang (localized oedema)
2)ardhang (half body)
3)sarwang ( whole body oedema)
Samprapti of shoth (oedema)
Vitiated vaat by entering in bahya siras (external channels) vitiated Kapha ,rakta and pita .These vitiated Kapha,rakta,and pita obstruc  the pathway of Vata .this obstructed vayu going in invesre direction due to that symptoms like utsedh (swelling) happens it's called as shotha (oedema)
 Vd. sandeep Ahirkar: 🔹Charak used  सुंठी,मरीच & पीप्पली in most of कफज चिकित्सा योगाः  Reduce inflammation , pain & avoid infection with the help of दीपन - पाचन
🔹 Morden science  gives diuretics in treatment of edema even मर्मोपधात  (head injury or chest injury )in this conditions vitiated vayu get obstrted by rakta or kapha so that to reliving obstruction ushna tishna katurasa yukta medicines are used
🔹I think  charak also used गौमूत्र,  पानिय क्षार & पुर्ननवा not diuretics  in many yoga but main thing is that these drugs used in obstruction pathology
----------------------------- end of comments from group 3 ----------------------------
Dr. Bhadresh Naik: Two type- External-Internal. Pleurisy most common cause tb Infection,Lvf,Ascies,Liver disease,Portal hypertension,Carcinoma,Obstructive jaundice, GlucomaObstruction in lacrimal gland,Vegavrodh of ashru(crying) Shoth I all ready mention etiology and causes Dosh vigatan play a roll to treat.We must find out the cause .Randomly you prescribe medicine
Vataj shoth- Discoloration of skin-Hard,Dryness ofskin
Pittaj-Hoat in touch ,Redness,Possible to pus,Increase by massage
Kaphj- Sinng of skin coper colour,No pitting on pressure,Slow progesive
 Please consartaing on each dosh vikruti shoth and give lineof treatment is more beneficial
Like coughj shoth-Dipan,Pachan,Cough nasak medicine,Udvartan,Nityanand ras,Gomutra haritaki,Tricutu churna,Agnikumars,Goxuradi gugulu,Bhallatak,Kafketuras,Punarva gugulu,Shothari mandur,Shothari loh and Nidan parivargan
Frist try to change samprapti Doshvighan-Nidan parivarjan
Vd Tushar Trivedi MD: Sometimes it becomes difficult to treat knee swelling especially in OA though all possible treatment done...
Dr. Anup Torane:  vajedi basti means preparation of aja bruhdantra 50gm in small pices+ 150 ml water+ cooked in cooker for 1 whistle. Then 100 ml preparation give basti
Dr. Bhadresh Naik: Vd joshi from puna used in renal failure
Dr. Shriniwas Gujjarwar: In Osteoarthritis swelling can be tried with following management -
Sthanik Swedan,Dashanga lepa or kanaka lepa. Raktamokshan ,Agnikarma
Vd Tushar Trivedi MD: Raktamokshana with either jalauka or cupping provides short term relief, then shoth reappears ...
Dr. Shriniwas Gujjarwar: Try with Agnikarma with Suvarna shalaka. Pain and swelling will  get relieve very fast .I am doing 10-15 Agnikarma with Suvarna shalaka for pain management
Dr. Bhadresh Naik: OA-It's depends upon stage Grade 1and 2 benifited with medicine ……….. in grade 3and 4 difficult to treat. External and internal snehan
Valuka swed, Physiotherapy, Agnnikarma, Sallaki, Shinad gugulu, Rasna guglu, Laxadi gugulu, Precaution, Posture, Splint
Vd Tushar Trivedi MD: Patients of knee OA without swelling improve very fast with Basti treatment whereas with swelling takes long time for recovery.
Deepak Tamboli: Bhadreshji as I heard too much doses of guggulu crates heat in the body. If it is true will it appropriate to give 3 guggulu at a time? Pls clarify
Dr. Bhadresh Naik: Rakta moxan help in infected oa Infusion,Swelid of pitta origin,Agnikarma excellent instant pain reliever,Even increase flexibility of joint More than100 tryle study I have done
Dr. Ravindra Upadhyay: The Anubhoot yog suggested by Late Vd. Labhshankar Thaker, the. Phant of  Parijat leaves has been found useful, effective in O A. Apart from reduction of wt in obese pt, the mobilisation of the knee jt, strengthening of hamstring muscles does help quite a lot. Of the O A is found in zmiddle aged moderately built, person, Aampachan helps quite a lot. O A in oldage without obessity, responds well. by giving Shunghi with. Shatavari. The combination can  be given with siddha Dugdha, ie processed milk. The old age needs nourishments to various Dhatu, which is very well can be taken care of.
Dr. J. T. Contractor: Wintergreen oil( salicylic acid ) gentle massaged after hot water fomentation on knee joint may be pain relieving I
Dr. Bhadresh Naik: I have suggests nama of medicine According to patients y prescribe Heat word is unnecessary
Dr. Ravindra Upadhyay: Use of. Flaxseed has been already tried by the old vaidyas from maharashtra and has been found very much fruitful. pt could easily overcome TKR.
Dr. Bhadresh Naik: Parijat,Nirgundi,Sigru I prescribe in any joints disorder Especially in sciatica

Germany Helga Fuchs: Oedema due V or K. K (watery) is seen if you give pressure on area and there is a deep mark. V nothing much. My experience s are not much, and without any special medicin, only commmon herbs. For both types one point is a need. Increase movement. Vata no strong movement, K little stronger, but not that Patient get thired. If P is not aggreavated, both can have SOFT sweda. Massage not deeply in V.  K soft Udhvartana. Lokal sweda is nice. But not so successful. Food as Prakruti. If clients follow this plan most get stronger and swelling is gone. Organs can work better and the pranas flow in right direction. Hot spices but no Chili for V. With bitter herbs I am careful, they are good. Given strenght but very adstringend. Amapachana substances for K. In both conditions people are thired. V need more rast, but it is not easy for him. In clinical state people have to follow this roules, to come back in normal life and to stay healthy.2:14
Dr. Bhadresh Naik: Sunthi-Digestive,Increase hunger,V balance,Ampachan,K reducer,Vatanuloman.Majority disease related to amvat so very effective along with luke worm and castor oil
 Dr. Ravindra Upadhyay: As Dr Vidhi has very rightly.and timely pointed out, the use of Shunthi, jaggery, and pure Ghee does help in O A, but because of. Samata.
Germany Helga Fuchs: Yes, in Rheuma. Dry heat is good. If nature get wet and cold most problems arise in Rheuma patients. But all this people need help for agni.
Vd. Dhruti Kagrana: Charaka  samhita
Treatment of shotha in its different stages:
अथामजं लङ्घन पाचन क्रमै र्विशोधनैरुल्बण दोषमादितः|
शिरोगतं शीर्ष विरेचनैरधो विरेचनैरूर्ध्वहरैस्तथोर्ध्वजम्||१७||
उपाचरेत् स्नेहभवं विरूक्षणैः प्रकल्पयेत् स्नेहविधिं रूक्षजे|
विबद्ध विट्केऽनिलजे निरूहणं घृतं तु पित्तानिलजे सतिक्तकम्||१८||
पयश्च मूर्च्छारति दाह तर्षिते विशोधनीये तु समूत्रमिष्यते|
कफोत्थितं क्षार कटूष्ण संयुतैः समूत्र तक्रासव युक्ति भिर्जयेत्||१९||

If Shvayathu is caused by Ama, then the patient is Langhana-fasting therapy
Pachana therapy – to get rid of ama, to improve digestion strength
Shodhana – elimination Panchakarma therapies to alleviate the predominant, Dosha involved.
If Sotha is located in the head,
Seersha Virechana (therapies, like inhalation, nasal drops, meant for the elimination of the Doshas from the head) is administered.
If located in the lower body part,
Virechana – Purgation therapy is given, and
located in the upper part of the body,
Vamana – emetic therapy is administered.

If Shotham is caused by improper administration of the Snehakarma – oleation therapy, then drugs having dryness qualities are administered.
If Svayathu is caused by excessive intake of dry foods and drinks, then Sneha – oleation therapy is given.
If there is constipation and if Svayathu is caused by Vata, then Niruha (decoction enema) is administered.
If Svayathu is caused by the simultaneous aggravation of Pitta and Vata, then Tikta ghrita is administered.
If the patient is suffering from fainting (Murcha), Arati (dislike for everything), burning sensation and morbid thirst, then he is given milk.
If, however, such a patient is to be given elimination therapy, then a suitable recipe along with cow’s urine is used.
If Shwayathu is caused by Kapha, then Takrasava mixed with cow’s urine and added with Kshara, pungent and hot drugs, is administered. [17-19]
Dr. Meghdoot Satvekar: Drugs  for shotha/ oedema
Punarnavasava, Kumariasava,Dashmoola kwatha,Prisniparanyadi kashaya,Navyasa choorna,Punarnavadi choorna,Sunthi ghrita,Punarnavadi ghrita,Chitraka ghrita,Punarnava mandoor,Gokshuradi guggulu
Dr. Ravindra Upadhyay: simple guduchi powder, guduchighan tab, dashamoolghan tab, very useful in traumatic, kafaj, pittaj, even vataj. the shoth of trauma is very well treated by cryshed powder of roasted cumin seeds, processed in milk, when applied locally, does help quite a lot.
 Dr. Meghdoot Satvekar: Punarnava – Boerhavia diffusa is one of the very important anti inflammatory medicinal herbs. It is well known for its diuretic and swelling reducing activities.above combination of punarnava are given as per patients symptoms
Dr. Ravindra Upadhyay: I agree, poonarnava, is useful  when Agni dushti is there, noemal functions of liver, gallbladder, urinary bladder, kidney, is pathognomonic, otherwise dashamool, nirgundi, doorva, are useful.
Dr. Shriniwas Gujjarwar: Raktamokshan  (blood letting ) for Shotha (local Cellulitis).. relived pain and swelling very fast and started knee joint movement immediately after raktamokshan
Baroda Dr. Jwalant:  If patient of shotha and kidney is sunthi is contraindicated and if shotha with hypertension punarnava is contraindicated.
Bunty Gandhi: For Aam Pachan Ajmodadi Choorna , Vaishwanara Choorna having shonth is quite good.
Baroda Dr. Jwalant: Also when patients come to you for treatment first please check which drugs he or she has taken for oedema or other complain?  Because it may be a side effects of some drugs and having oedema we have to rule out first.Also when patient came investigate complitly and check which major organ - heart, lung, lever or kidney is involved.
Vd. Hardik bhatt, Idar: Dashang lepa and doshghna Lep are also advisable for Shoth
Baroda Dr. Jwalant: Some patients have dependent oedema due to standing or sitting for long time. When they sleep give advise to put some wooden or brick under their bed to give some height and put their legs at this side.
Dr Jayesh Patel: Sir why punarnava is contraindicated in shoth with hypertension??
Bunty Gandhi: Yup that would be helpful to know
Vd. Pankaj Chhayani: shothaghni is synonym of punarnava..we use successfully in shoth...Pls let's know if there is specific reason behind not to use punarnava in shoth...Its beneficial in cases of cardiac originated oedema...
Dr. Anup Torane: What about garbhini shoth?
Dr. Bhavesh Modh: पाटला अग्निमंथ श्योनाक बिल्व काशमर्य कंटकारी बृहती शालपर्णी पृश्निपर्णी गोक्षुरका इति दशेमानि श्वयथुहराणि भवन्ति ।। .सू.4
In view of Morden science,      During pregnancy, the body produces approximately 50% more blood and body fluids to meet the needs of the developing baby. Swelling is a normal part of pregnancy ( but beware  about swelling in pre eclampsia stage or varicose  ) that is caused by this additional blood and fluid.
Edema in pregnancy  is extra retention of fluid is needed to soften the body, which enables it to expand as the baby develops.
😳Extra fluid also helps prepare the pelvic joints and tissues to open for delivery.
😳The extra fluids account for approximately 25% of the weight women gain during pregnancy.
Preventing the swelling of feet during pregnancy.
🔹 Take two cups of water and add a teaspoonful of palm sugar ( This has been used to during puberty, pregnancy, delivery, menopause and for overcoming menstrual problems, anemia, calcium deficiency and to prevent diabetes. This is believed in Tamil Nadu to prevent miscarriage and to strengthen uterus. )
(also  can use देशी गोळ = Jaggery ) in it. Add two teaspoons of fennel seeds to it. Boil this mixture, till the volume reduces to half; i.e. only one cupful of water is left. Drink this mixture thrice in a day. It will help protect the feet from getting swollen.

🔹Add a few tablespoons of coriander (धान्यक)in two cups of water. Boil this mixture till it reduces to half its quantity, i.e. to one cup. Drink this coriander decoction thrice in a day. It will prevent from swelling of feet during pregnancy.
🔹The most important thing to prevent feet from swelling up during pregnancy is to keep them exercised often. Pregnant women tend to reduce their normal activities in the fear that it would harm the fetus. But in fact, the opposite is true. Walking for half an hour per day is ideal.
The feet moving about. This is a very sure way of preventing the accumulation of fluids in the feet.
Canada Nitin Shah: If there is an inflammation in the joints Boswelia serreta along with ginger and turmeric.  If there is an oedema than punarnanva, gokshura
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Compilaiton courtesy : Vd. Kinshuk Hirpara, Ahmedabad

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