E-ISSN:2456-3110

Review Article

Sheetpitta

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 3 April
Publisherwww.maharshicharaka.in

Literary review of Sapeksha Nidana of Sheetpitta, Udarda and Kotha

Sharma P.1*, Gandharve S.2, Sood R.3
DOI:

1* Puneet Sharma, Assistant Professor, Department of Samhita and Siddhant, Shiva Ayurvedic Medical College and Hospital, Himachal Pradesh, India.

2 Satish Gandharve, Reader, Department of Samhita and Siddhant, Shiva Ayurvedic Medical College and Hospital, Himachal Pradesh, India.

3 Rajesh Sood, Professor, Department of Samhita and Siddhant, Shiva Ayurvedic Medical College and Hospital, Himachal Pradesh, India.

Ayurveda is the oldest system of medicine which comprises detailed study of diseases and their treatment in a unique way. The differential diagnosis of a disease is needed today as diseases which present with similar clinical pictures create confusion in their treatment. Sheetpitta, Udarda and Kotha are characterized by itchy wheal formation; however, these diseases can be differentiated on the basis of Dosha involvement and treatment available in classical texts.

Keywords: Sheetpitta, Udarda, Kotha, Ayurveda

Corresponding Author How to Cite this Article To Browse
Puneet Sharma, Assistant Professor, Department of Samhita and Siddhant, Shiva Ayurvedic Medical College and Hospital, , Himachal Pradesh, India.
Email: 		Puneet Sharma, Satish Gandharve, Rajesh Sood, Literary review of Sapeksha Nidana of Sheetpitta, Udarda and Kotha. J Ayu Int Med Sci. 2022;7(3):140-149.
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https://jaims.in/jaims/article/view/1792

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-02-23 2022-02-25 2022-03-04 2022-03-11 2022-03-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Puneet Sharma, Satish Gandharve, Rajesh Soodand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Sharma P et al: Literary review of Sapeksha Nidana of Sheetpitta, Udarda and Kotha

Introduction

Sapeksh Nidana of Roga (differential diagnosis of diseases) is important for the management of diseases. In parlance of Sheetpitta, Udarda and Kotha have the same presentation but have different dominance of Doshas.  Sheetpitta, Udarda and Kotha are the same as these three ailments have similar presentations with characterized Shotha. Still Acharyas have used different nomenclature for these three diseases. Critical analysis of these three nomenclatures is needed for differentially categorizing on the basis of etiology, symptoms and management which would be helpful  for detailed understanding. The present study has been planned to do Sapeksh Nidana i.e., differential diagnosis of these identical but having different nomenclatures in classical texts. These three diseases are characterized by wheal formation on the body which are transient in nature. Various formulations have been given in texts.

Aim and Objectives

To scrutinize the classical texts to find out the significant aetiological factor and establish in relation to Sapeksh Nidana of Sheetapitta, Udarda and Kotha.

Plan of Study

The available literature has been scrutinized for the differential diagnosis of Sheetpitta, Udarda and Kotha.

Conceptual Study

Conceptual study denotes understanding and framing an idea about the subject to be dealt. It deals with everything right from the past to the present which is related to the subject and which provides a clear picture of the same.

The conceptual study has been classified into

a. Description of Sheetpitta, Udarda and Kotha.
b. Differential diagnosis of Sheetpitta, Udarda and Kotha
General description about Sheetpitta, Udarda and Kotha

1. Sheetpitta: The old dictionaries like Shabdhakalpdruma, Vachaspatyam and Amarkosha has not included word Sheetpitta.

But it comprises of two words i.e., Sheeta and Pitta which indicated that there is mainly vitiation of Vata and Pitta Dosha in manifestation of Sheetpitta.

Acharaya Madhava and Bhavprakash have defined Sheetpitta as Shotha caused by Sarti-dansh along with Kandu, Toda, Jvara, Chhardi and Vidaah.[1] Some Acharayas consider Udarda and Sheetpitta as the same disease. Acharya Madhav has clearly indicated that Sheetpitta and Udarda has vata and kapha aggravation respectively.[2]

There is no description of Sheetpitta in Brihatrayi samhita and their commentaries.

Lakshana of Sheetpitta: (Madhavnidana 50\3)

a. Vartidasht Sansthan Shotha (Inflammation like insect bite)
b. Kandu (itching)
c. Todda bahulya (excessive pain like pricking)
d. Chhardi (nausea or vomiting)
e. Jvara (fever)
f. Vidaah (burning sensation)

2. Udarda

Acharaya Madhav has defined Udarda a disease having predominance of Kapha dosha and aggravated in Shishsir Ritu with symptoms as Raag, Kandu, Utsang and Mandal.[3]

Acharya Charaka has quoted Udarda in Purvarupa of Unmada[4] and in Rupa of Kapahja Jvara[5]by Acharya Vagbhata. Acharya Chakrapani has specified the meaning of Udarda having Spandan or Ruja in Urah Pradesh.[6]

Acharya Vagbhata has quoted Udarda as symptom of Kaphaja jvara.[7] Acharaya Arundutta while commenting on Udarda has denoted it like Shotha which is the outcome of Sheet and Paniya Sansparsh especially in Shishsir Ritu.[8]

Lakshana of Udarda: (Madhhavnidana 50\5)

a. Utsang (elevated localised leisons)
b. Raag (erythema)
c. Kandu (itching)
d. Mandal (circumscribed leisons)
e. Aggravation in Shishsir Ritu

3. Kotha: Acharya Madhava has explained Kotha as a manifestation dominated with Pitta and Kapha resulting as the complication of malpractice of Vaman Karma which has intensive Raga (erythematic), Kandu (itching) and Mandal (wheals).[9]


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Acharya Chakrapani has defined Kotha as Shotha like Varti Dansht with Kandu and Lohit-Varan. Acharya Chakrapani has added symptom Kshanik-Utpaad-Vinash in Kotha.[10]

Acharaya Charaka has quoted kotha in different references:


  • Chhardi Nigrahaja Gada.[11]
  • Pitta Nanatmaj Vikara.[12]
  • Rakt Pradoshaj Vikara.[13]
  • Santarpan Janya Vyadhi.[14]
  • Lakshana of Pittaj-Jvara.[15]
  • Lakshana of Manifestation Bahya Malaj-Krimi.[16]
  • Lakshana of Sannipataj Jvara.[17]
  • Lakshana of Punaravartak Jvara.[18]
  • Lakshana of Dushi Visha.[19]
  • Lakshana of poisoned Abhayang, Utsadana, clothes and ornaments etc. [20]

Acharaya Arundatta has defined Kotha as Mandalakar and Nirmukhi Pitika and Acharya Hemadri has defined Raktkotha as Rakt-Varan Mandal on the body.[21]

B. Sapeksha Nidana of Sheetpitta, Udarda and Kotha as described in classical texts.

Features Sheetpitta Udarda Kotha
Dosha Vatadhik Kaphadhik Udeern Pitta Sleshma
Aakriti (Morphology) Varti Dasht Sansthan Sotha Utsang and Mandal Mandal and Varti Dasht Sankash
Raag (Erythema) Raag Raag Raag and Lohita Varan
Kaal (Time factor) Not specified Not specified Kshanik Utpaad Vinash
Toda (Prickly pain) Todda bahulya Absent Absent
Vidaah (Burning sensation) Present Absent Absent
Ang-Pradesh (Body part involved) Not specified Uras Not specified
Chhardi (nausea or vomitting) Present Absent Absent
Jvara (fever) Present - -
Nidana (Etiological factors) Sheet Marut Sansparsha in any season Sheet-Marut Sansparsha In shishir ritu only a.        Santarpan b.        Chhardi Nigrahen c.        Bahya Krimi d.        Dushi Vish
As Lakshan of Vyadhi   In Kaphaj Jvara In Sannipataj Jvara

Apparently Sheetpitta, Udarda and Kotha seems to be similar, but as per the description available in our classical texts, these can be differentiated on the basis of

Dosha

Acharya Madhav has described Doshas in these three disease as:[22]

Sheetpitta - Vatadhikya

Udarda - Kaphadhikya

Kotha - Udeern-Pitta-Sleshma

Aakriti

Sheetpitta - The lesions of Sheetpitta appears like Varti Dasht Sansthan Shotha.[23]                

Udarda - The lesions of Udarda are centrally depressed and elevated in periphery.[24]

Kotha    - Acharya Chakrapani has described Kotha as Shotha which looks like Vartidansht[25]. Acharya Arundutta has described Kotha as Mandlakar Pitika without opening.[26]

Raga: Acharya Madhav has described Raga as symptom in Sheetpitta, Udarda and Kotha. Kotha has additional feature of intense Raga[27] and Lohit Varana.[28]

Kaal: Acharya Chakrapani has quoted Kshanik-Utpad-Vinash[29] in reference of Kotha.

Acharya Madhav has named Utkoth as Kotha which is Anubandh in nature. In Madhukosha, Acharya has explained Anubandh in Utkotha as recurrence of Kotha again and again.[30]

Todda: Todda as symptom is described in Sheetpitta only since it occurs because of vitiated Vaat Dosha.[31]

Vidaah: Vidaha is present only in Sheetpitta.[32]

Ang Pradesh: Acharya Chakrapani has specified Udarda as the ailment suffering Uras Pradesh.[33] No such specification is given about Sheetpitta and Kotha.

Jvara and Chhardi: Sheetpitta - Jvara and Chhardi found as symptoms in Sheetpitta.[34]

Udarda - Udarda is symptom of Kaphaj Jvara.[35]

Kotha - Kotha is one of symptom in Sannipataj Jvara.[36]


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Nidana: Sheetpitta and Udarda are caused by Sheet Maruta Sansparsha. Acharya Madhav has added aggravation of Udarda in Shishir Ritu.[37]

Nidana of Kotha is as follows:

  • Chhardi Nigrahaja Gada[38]
  • Santarpan[39]
  • Bahya Malaj Krimi[40]
  • Dushi Visha[41]

Differentiation of Sheetpitta, Udarda and Kotha on the basis of management (Chikitsa)

In Chakradutta, Acharaya has given various formulations for Sheetpitta, Udarda and Kotha.[42]

Udarda

  • Abhyang with Sarshap Taila and Swedan with Ushanambu is[43] Abhyang with Sarsap Taila is Vaat Nashak. Sarsap Taila is Ushna and does not increase Kapha Dosha.[44]
  • Vaman with Patola and Arishta causes Kapha Nashan as Vaman Karma helps in normalizing vitiated Kapha Dosha in [44]
SN Contents Rasa Guna Virya Vipaka
1. Patol[45] Tikta Laghu, Ruksha Ushna Katu
2. Arisht (Nimb)[46] Tikta, Kashaya Laghu Sheeta Katu

Patol and Arisht both have Kaphanashak Guna, Rasa and Vipaka. Patol has Ushana Virya. Thus, both helps in normalizing vitiated Kapha Dosha.

Virechan with Triphala, Gugglu (Pura) and Pippali (Krishna).[47] According to Acharya Susruta, Triphala is Kaph-Pitta Ghani.[48]

Drug Rasa Guna Virya Vipaka
Guggul[49] Tikta, Katu   Laghu,Ruksha,Tikshna,Vishad,Suksham,Sara,Sugandhi Ushna Katu
Pippali[50] Katu Laghu, Sanigdha and tikshana Anushna Sheeta Katu

Tikshana, Ushna, Ruksha Guna of Gugglu are Kaphashamak. Rasa, Virya and Vipaka are also Kaphanashak.

Rasa and Vipaka of Pippali are Kaphanashak. Laghu and Tikshana guna are also against Kapha Dosha.

Virechan with Triphala and Gugglu helps in Udarda by treating vitiated Kapha Dosha.

Virechan with Triphala and Madhu help in treating Udarda by their Kaphashamak effect.[51] Triphala has Kapho-Pittashamak Guna and Madhu is Ruksha and Laghu which help in normalizing Kapaha Dosha.[52]

Navkarshik Kwatha is also advised in Udarda.[53] According to Acharya Sharagdhar, it's Rogadhikar is Vaatrakta.

SN Contents Rasa Guna Veerya Vipaka
1. Haritaki[54] Kashaya, Madhur,Amla, Katu, Tikta Laghu, Ruksha Ushna Madhur
2. Vibhitaki[55] Kashaya Ruksha, Laghu Ushna Madhur
3. Amlaki[56] Amla, Madhur, Katu, Tikta, Kashaya Guru, Ruksha, Sheeta Sheeta Madhur
4. Nimb[57] Tikta, Kashaya Laghu Sheeta Katu
5. Manjistha[58] Tikta,Kashaya,Madhur Guru, Ruksha Ushna Katu
6. Vacha[59] Katu, Tikta Laghu, Tikshna Ushna Katu
7. Katukrohini[60] Tikta Laghu, Ruksha Sheeta Katu
8. Vatsadni (Guduchi)[61] Tikta, Kashaya Guru, Sanigdha Ushna Madhur
9. Daruharidra[62] Tikta, Kashaya Laghu,Ruksha Ushna Katu

Predominant Rasa in Navkarshik Kwatha is Tikta and Kashaya which are Kaphashamak.

Most of the contents have Laghu and Ruksha Guna. Six contents have Ushna Veerya. Five contents have Katu Vipaka. Overall effect of Navkarshik Kwatha is Kaphashamak.

Amritadi Kwatha[63]

SN Contents Rasa Guna Veerya Vipaka
1. Amrita[64] Tikt, Kashaya Guru, Snigdha Ushna Madhur
2. Vasa[65] Tikta, Kashaya Ruksha, Laghu Sheeta Katu
3. Patol[66] Tikta Laghu, Ruksha Ushna Katu
4. Mustak[67] Katu, Tikta, Kashaya Laghu, Ruksha Sheeta Katu
5. Saptparn[68] Tikta, Kashaya Laghu, Snigdha Ushna Katu
6. Khadir[69] Tikta, Kashaya Laghu, Ruksha Sheeta Katu
7. Asit vetra[70] Katu Laghu Sheeta Katu
8. Nimb[71] Tikta, Kashaya Laghu Sheeta Katu
9. Haridra[72] Tikta, Katu Ruksha, Laghu Ushna Katu
10. Daruharidra[73] Tikta, Kashaya Laghu,Ruksha Ushna Katu

Contents of Amritaadi Kwatha have Katu, Tikta and Kashaya Rasa which are Kaphshamak. Laghu and Ruksha Gunas are predominant in Amritaadi Kwatha. Katu Vipaka is present in all contents except Guduchi. Hence overall effect of Amritaadi Kwatha is Kaphashamak.

Guda and Dipyika (Yawani) with Pathyaahar helps in managing Udarda in a week.[74]

Drug Rasa Guna Veerya Vipaka
Yawani[75] Katu, Tikta Laghu, Ruksha, Tikshna Ushna Katu

Rasa, Guna, Veerya and Vipaka of Yawani are Kaphashamak.


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Sheetpita: Use of Sarshap, Haridra, Kustha, Prapunnag and Tilla with Katu Taila is beneficial in Sheetpitta.[76]

SN Content Rasa Guna Veerya Vipaka
1. Sarshap[77] Katu, Tikta Sanigdha Ushna Katu
2. Haridr[78] Katu, Tikta Ruksha, Laghu Ushna Katu
3. Kustha[79] Tikta, Madhur, Katu Laghu Ruksha, Tikshna Ushna Katu
4. Prapunnag[80] Katu Laghu, Ruksha Ushna Katu
5. Tilla[81] Madur Guru, Sanigdha Ushna Madhur

All the contents here possess Ushna Veerya. Sarshap and Tilla have Sanigdha Guna, which helps in Shaman of Vata Dosha which is predominant in Sheetpitta.

Lepa of Durva and Nisha (Haridra) helps in managing Sheetpitta.[82]

SN Contents Rasa Guna Veerya Vipaka
1. Durva[83] Kashaya, Madhur Laghu Sheeta Madhur
2. Nisha[84] Katu, Tikta Ruksha, Laghu Ushna Katu

Ushna veerya of Nisha and Madhur Vipaka of Durva are antagonists to Vata Dosha and thus help in Shaman of Vata Dosha.

According to Acharya Vagbhat Abhyang helps in Shaman of Vata Dosha .[85]

Abhyang of Yavakshar, Saindhav Lavana along with Sarsap Taila helps in managing Sheetpitta.[86]

Yavakshar is Vata Kapha Nashak.[87] Saindhav Lavana is Swadu, Sanigdha and Tridoshshamak (Bhavpraksah Nighantu).[88]

Yashtimadhvaadi Kwatha[89]

SN Content Rasa Guna Veerya Vipaka
1. Yashtimadhu[90] Madhur Guru Snigdha Sheeta Madhur
2. Madhuk[91] Madhur Laghu, Snigdhapichhil Sheeta Madhur
3. Rasna[92] Katu Laghu, TikshnaRuksha Ushna Katu
4. Chandan[93] Tikta,Madhur Laghu, Ruksha Sheeta Katu
5. Raktchandan[94] Tikta,Madhur Guru, Ruksha Sheeta Katu
6. Nirgundi[95] Katu,Tikta Laghu, Ruksha Ushna Katu
7. Pippali[96] Katu Laghu, SnigdhaTikshna Anushna Sheeta Madhur

Contents of Yashtimadhvaadi Kwatha possess Madhur Rasa, Sanigdha Guna and Madhur Vipaka, which indicates it has Vatashamak  properties.

Kotha: Management of Kotha is explained identical in Chakradutta as for Kustha, Amalpitta and Udarda. Mahatikta Ghrita and Raktmokshana has been advised in Kotha. Kotha has predominance

of Pitta and Kapha Dosha. Raktmokshana has been advised in management of Kotha only.[97]

Kustha - Tridosha Nashak Chikitsa.

Udarda - Kapha Nashak Chikitsa.

Amalpitta - Pitta Nashak Chikitsa.

Hence it is evident that Kotha requires Pitta and Kapha Nashak Chikitsa. Panchkarma as advised in Kustha are also beneficial here.

On the basis of Nidana, Lakshana and Chikitsa regarding Sheetpitta, Udarda and Kotha which are available in classical texts, It can be summarised that there is a significance of aetiological factors, symptoms and management to differentiate Sheetpitta,Udarda and Kotha, which are discussed earlier in detail. These diseases manifest with either Varti Dast Sansthan or Utsang, so these look alike, but on the basis of other symptoms these can be differentiated respectively. Similarly on the basis of predisposing factors Kotha appears to be different and it has a variety of Nidana. Sheetpitta and udarda have the same Nidana, still Acharya Madhav has specified involvement of different dosha in them. Chikitsa Yoga which are advised separately for Sheetpita, Udarda and Kotha are Dosha Shamak according to Dosha involved in Vyadhi.

Discussion

The purpose of discussion is to interpret and describe the significance of findings in the light of what was already known. Discussion based on Shastras about any conceptual or clinical study is always fruitful.

Our classics have given three terms Sheetpitta, Udarda and Kotha as diseases characterized by formation of Mandal or Vartidasht Sansthan Sotha. Although these three nomenclature appear the same, still there are some different characters which are helpful in their Sapeksh Nidana. On critical analysis based on descriptions available in Classics, these three nomenclature can be classified. Sheetpitta and Udarda have been given as synonyms by Acharya Madhav but specified different dosha involvement. Kotha has been given as a separate disease in the end of chapter as it has totally different causes like Asamyak Vaman and Annah Nigrahan. Brihtrayee has given these nomenclatures in various references. Since Sheetpitta, Udarda and Kotha have different


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involvement of doshas and some other criterias, these nomenclatures can be summed up as three overlapping variants presenting with Varti Dasht Sansthan or Mandal formation.

Conclusion

On the basis of present study following conclusions can be drawn. Sapeksh Nidana of three nomenclatures Sheetpitta , Udarda and Kotha can be done on the basis of Dosha involvement, specific features and management.

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63. Sharma P. Arshoghanadi Varga, Chapter 6, Dravyaguna Vigyan, Part 2. Chaukhamba Bharti Academy, Varanasi. 2018, p537.

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98. Sharma P. Udarda, Kotha and Sheetpitta Chikitsa Adhyaya, Chapter 51, Verse 8, Cakradutta. Chaukhamba Orientalia, Varanasi. 2013, p410-411.


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