Introduction

Paad Shoth or swelling of the feet, is a clinical manifestation that can range from mild puffiness to severe pitting edema. It is not a disease in itself but a symptom of an underlying pathology, commonly linked to systemic disorders involving the liver, kidneys, heart, or lymphatic system. In clinical practice, elevated liver enzymes SGPT (ALT) and SGOT (AST) are significant indicators of hepatocellular injury, pointing toward conditions such as viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), or drug-induced hepatotoxicity.^[10,13]

Hepatic dysfunction compromises the synthesis of plasma proteins like albumin, leading to a reduction in plasma oncotic pressure and subsequent fluid extravasation into interstitial spaces^[1], particularly in the lower extremities due to gravity. Additionally, liver dysfunction can impair portal circulation, causing portal hypertension, which further contributes to fluid accumulation in the form of ascites and peripheral edema. Renal sodium retention due to secondary hyperaldosteronism in chronic liver disease also exacerbates the problem.^[2]

Ayurvedic perspective, Paad Shoth is mainly caused by an imbalance in the Kapha dosha, which is responsible for maintaining the body's structure and regulating fluid balance.^[3,4,5] When the liver is involved, Pitta dosha also plays a significant role, as it governs metabolic functions and is primarily located in the liver. The disease process typically begins with Agnimandya (weakened digestive fire), which leads to the accumulation of Ama (toxic, undigested substances).

This Ama obstructs the Srotas (bodily channels), especially the Udakavaha Srotas (involved in water transport) and Rasavaha Srotas (responsible for circulating plasma). As a result, fluid distribution becomes impaired. When Rasa Dhatu (plasma tissue) is affected due to poor digestion or an unhealthy lifestyle, it can give rise to Shotha^[6] (inflammation or swelling)

Clinical findings and diagnosis

The patient presented with the chief complaint of bilateral lower limb swelling, which he described as gradual in onset and progressive over the past four years.

Ashtavidha Pariksha^[7]

Naadi (Pulse): Vata Pradhana Nadi, regular

Mutra (Urine): Quantity: 900-1100 ml/day, Frequency: Normal, Color: Normal, Odor:Normal

Mala (Stool): Consistency: Hard, Color: Yellow, Frequency: Irregular (needing medication)

Jihva (Tongue): coated, Color: Normal

Shabda (Speech): Normal

Sparsha (Touch): Dry skin

Drik (Vision): Normal vision

Akriti (Body Built): Normal

Dashavidha Pariksha^[3]

Prakriti (Constitution)

Sharirika (Physical): Pittakaphaja
Manasika (Mental): Rajasika

Vikriti (Disease State)

Dosha: Kapha, Pitta

Dushya (Tissue elements affected): Rasa (Plasma), Rakta (Blood), Sira (Vessels)

Adhisthana (Seat of the disease): Pad (lower leg)

Srotodushti (Channel impairment): Vimargagamana (detour)

Saara (Essence): Madhyama (Average)

Samhanana (Physique): Madhyama (Average)

Pramana (Metabolism): Madhyama (Average)

Satmya (Dietary preferences): Sarva Rasa (Can tolerate all tastes)

Satva (Mental state): Prabal (strong mental strength)

Ahara Shakti (Digestive power): Madhyama (Average)

Vyayama Shakti (Physical strength): Prabal (strong physical strength)

Vaya (Age): Vivardhamana (17-30years)

Interventions^[8,9]

The treatment plan focused on balancing Pitta, Kapha and Yakrit Vikara.

After Treatment

Before Treatment

After Treatment

Liv 52 DS, a proprietary herbal formulation, is widely researched for its efficacy in improving liver function. It stabilizes hepatic cell membranes, enhances antioxidant defence, and promotes hepatocyte regeneration.^[14] In the observed clinical response, a notable reduction in pedal edema and a gradual normalization of liver enzymes indicate the efficacy of this integrative herbal regimen. No adverse effects were noted, supporting the safety profile of the selected drugs when used under supervision. Thus, this multidrug Ayurvedic approach shows promising results in managing Paad Shoth secondary to liver dysfunction, validating the ancient principle of Samprapti Vighatana (breaking the pathogenesis) through multi-targeted therapy.^[8,14]

Conclusion

This case highlights the efficacy of Ayurvedic therapeutic approaches in the management of Paad Shoth (pedal edema) associated with underlying liver dysfunction. The integration of detoxification therapies (Shodhana) and herbal formulations (Shamana) provided symptomatic relief and addressed the root cause of the condition in accordance with Ayurvedic principles. Central to the treatment was the correction of Doshic imbalance, particularly of Kapha and Pitta, enhancement of Agni (digestive/metabolic fire), and elimination of Ama (toxic waste). The use of Shothahara and Yakrituttejaka herbs such as Punarnava, Kutki and Aarogyavrdhni Vati played a pivotal role in reducing inflammation, supporting liver function, and promoting fluid drainage. Additionally, dietary modifications, lifestyle regulation, and individualized herbal interventions contributed to the overall improvement. This holistic approach reinforces the significance of Ayurveda in managing complex systemic conditions and emphasizes the need for treating not just the symptoms, but the underlying imbalances for long-term health restoration.

References