A Critical Analysis of Samuthana Vishesha In The Etiological Diagnosis of Sheetapitta, Udarda, And Kota

Introduction

Sheetapitta, Udarda, and Kota are common allergic skin conditions that continue to challenge contemporary healthcare due to their recurrent nature and the limited long-term relief provided by conventional treatments. By exploring their etiological factors through the principles of Ayurveda, a deeper understanding of their root causes can be achieved, thereby paving the way for holistic and sustainable therapeutic approaches. In Ayurveda, Samuthana Vishesha refers to the specific etiological factors responsible for a disease’s onset, while Tridoshas—Vata, Pitta, and Kapha—are the fundamental energies governing the body’s physiological processes. Nidanas are the causative factors that lead to illness.

Methodology

This review examines descriptions from authoritative Ayurvedic texts such as Charaka Samhita and Sushruta Samhita, along with commentaries by Chakrapanidatta and Dalhana, to elucidate the etiological factors of these conditions. Samuthana vishesha refers to the specific Nidanas responsible for particular Vyadhis. This review focuses on understanding these underlying causes, or Nidanas, of Sheetapitta, Udarda, and Kota, through the lens of Ayurvedic classifications and their impact on the skin. Samuthana vishesha, or Nidana, is defined as the fundamental cause that initiates the process of illness. After analyzing the Nidana, one can directly materialize the treatment, which begins with nidana parivarjana (removal of the causative factors).

Even though Vyadhis are classified in many varieties, every Vyadhi ultimately falls under the understanding of Trividha Rogas—Aadhyatmika, Aadidaivika, and Adibhoutika. Therefore, the Samuthana vishesha of Sheetapittadi rogas is critically analyzed under these categories. Based on the specificity in Nidanas, these Vyadhis have been further classified into seven subtypes [1].

Classification and Correlative Terms

The classification of Sheetapitta, Udarda, and Kota is based on various Nidanas (causative factors). These are:

Aadhyatmika Vikaras

Aadibalapravrutta Vyadhi signifies defects inherent in either Shukra (male reproductive element) or Shonita (female reproductive element) that form the primary factors for the disease manifestation. Diseases like Kushta, Prameha, and Arsas are some examples of this category [3]. Ashtanga Sangrahakara refers to these diseases as Sahaja or those arising during birth. The pathology occurs during fertilization in the form of an Upatapta Bija (defective seed), which results in abnormalities in Bija (chromosomes) and Bija Bhaga (genes). The tissues or organs derived from these defective seeds get deformed. In the case of Sheetapitta, Udarda, and Kota, atopic individuals who have a genetic susceptibility to these conditions are prone to these diseases.

Janmabalapravrutta Vyadhi manifests in a child due to improper Ahara (diet) and Vihara (lifestyle) followed by the mother during conception and pregnancy[4]. Acharya Charaka describes this scenario with the analogy of a tree standing in a river and being affected by the forceful movement of water, wood, and stones during the rainy season. Similarly, the foetus in the mother gets affected by vitiated Doshas[5]. Garbha (the fetus) is formed out of the amalgamation of Matruja, Pitruja, Atmaja, Satmyaja, Satvaja, and Rasaja bhavas. The optimal presence of these factors defines the suitability for a new life and is referred to as Satmya for the Garbha[6]. If the mother resorts to regimens that are causative factors for various diseases, the offspring will also predominantly suffer from the same diseases[7], including Sheetapitta, Udarda, and Kota. Twak (skin) is a Matruja avayava (maternal organ), and the X-chromosome of both the ovum and sperm plays a role in the formation of organs derived from the mother. Hence, any mutation in these chromosomes during the gestational period can vitiate the skin of the foetus and compromise its quality. Modern dermatological research has also identified genetic markers associated with allergic skin conditions, such as mutations in the filaggrin gene, which may predispose individuals to atopic dermatitis—similar to the genetic influences described in Ayurvedic texts for conditions like Sheetapitta.

Doshabalapravrutta Vyadhi

This category of diseases results from the derangement of any one of the Doshas (humours) due to improper dietary habits and lifestyle [8]. It is further subdivided into Amashayasamuttha and Pakvashayasamuttha, which are classified into Sharirika (bodily) and Manasika (mental) categories.

The Nidanas responsible for doshic imbalance are classified into Bahya (external) and Abhyantara (internal) Nidanas. The external factors include excessive intake of Lavana (salt), Katu rasa (pungent taste), Aranala [9] (fermented foods), and others, while internal factors include Tridosha (all three Doshas) acting as Utpadaka (producing) and Vyanjaka (manifesting) hetus. The detailed list of these Nidanas is provided in Table 1.

 Table 1: Nidana for Sheetapitta, Udarda, and Kota

Role of Tridoshas

Pitta governs digestion, metabolism, and skin health. An imbalance in Pitta often manifests as inflammatory or allergic skin conditions. Vata controls movement and the nervous system, playing a role in the dryness and scaling often seen in skin disorders. Kapha regulates moisture and structure, and its imbalance can contribute to sluggish skin, leading to conditions such as eczema or hives.

The basic viewpoint of Ayurveda is the Loka-purusha satmya sidhanta, which suggests that the cycle of six seasons follows a specific pattern of doshic distribution that plays a vital role in disease manifestation as well as in the preservation of health. Seasonal variations of Doshas contribute to the aggravation (Prakopa) or pacification (Prashama) of specific Doshas in particular seasons.

In Sheetapitta, Udarda, and Kota, Pitta dosha plays a primary role as the Utpadaka hetu (causative factor) [11], while Vata and Kapha act as Vyanjaka hetus (manifesting factors). Pitta undergoes Chaya (accumulation), Prakopa (aggravation), and Prashama (pacification) in the various seasons. Pitta vitiation can occur in two forms—qualitative (Gunatmaka) or quantitative (Pramanatmaka) increase. Pitta prakopa is often a result of improper diet and activities during specific seasons, leading to various skin conditions, including Sheetapitta, Udarda, and Kota.

Vata and Kapha doshas also play significant roles in the initiation and manifestation of these conditions. Vata dosha, in particular, helps in triggering the manifestation of these skin disorders.

Adibhoutika Hetu

This category of Vyadhis arises due to Sanghatabalapravrutta Nidanas, such as Shastrakrita (injury from weapons or instruments) and Vyalakruta (insect bites or infestations) [12]. These are generally Agantuja (external) disorders that may not directly be recognized as Nidanas for Sheetapitta, Udarda, and Kota but can act as Vyanjaka hetus (manifesting factors) in clinical settings.

Adidaivika Hetu

This category includes diseases caused by the anger of Devas (gods) or curses, and those inflicted through supernatural means, such as Abhichara karmas (malicious rituals) or Mantras (incantations)[13].Krimi samsarga (worm infestation) is identified as a Nidana for Sheetapitta, Udarda, and Kota in some classical texts.

Swabhavabala Pravritta

This refers to diseases that manifest naturally, and they are categorized as Kalakrita (seasonal) and Akaala krita (out of season) [14]. While no specific Nidanas were found for Sheetapitta, Udarda, and Kota in this category, the manifestation of these conditions is often influenced by the natural imbalance of Doshas.

Discussion

The intricate understanding of Sheetapittadi Vikaras in Ayurveda arises from its holistic framework of disease causation and progression. These allergic skin conditions, which are recurrent and challenging to treat, highlight the need for a thorough analysis of Samuthana Vishesha (specific etiological factors). Ayurveda categorizes diseases under Trividha Rogas, emphasizing the multifaceted origins of these conditions. Recent dermatological studies support the multifactorial nature of conditions like eczema, psoriasis, and urticaria, which share many commonalities with Sheetapitta, Udarda, and Kota. Genetic predisposition, environmental factors, and immune system dysfunctions are widely recognized as contributing factors in these conditions. These findings align with Ayurvedic principles that emphasize the interconnectedness of genetic, environmental, and lifestyle factors in disease manifestation. For instance, the concept of Dosha imbalances in Ayurveda parallels the understanding of metabolic and immunological dysregulations in modern dermatology. Acharya Charaka emphasizes the interplay of Nidanas (causative factors) and the Tridoshas in disease manifestation, particularly focusing on lifestyle and dietary causes. In contrast, Acharya Sushruta stresses the genetic factors (Beejadosha) in the etiology of these conditions, suggesting a need for an integrative understanding of Sheetapitta, Udarda, and Kota.

Table 2: Categorization of nidana (Causative factors) for Sheetapitta, udarda and Kota

Conclusion

Ayurveda has a sharply defined understanding of Sheetapitta, Udarda, and Kota nidana with its strong foundation to analyze the disease process through the lens of Samuthana Vishesha and Tridosha framework. By identifying the root causes at genetic, developmental, doshic, and environmental levels, Ayurveda emphasizes the interconnectedness of internal and external factors in disease manifestation. The classification of Aadhyatmika, Aadidaivika, and Aadibhoutika not only underscores the holistic nature of Ayurveda but also highlights the critical role of personalized treatment protocols beginning with Nidana parivarjana (elimination of causative factors). The exploration of etiological factors and their classification into Utpadaka Hetu, Vyanjaka Hetu, and others enriches the understanding of disease progression and provides a robust foundation for therapeutic interventions. In conclusion, integrating Ayurvedic principles with modern clinical methodologies offers a comprehensive and sustainable approach to managing recurrent allergic skin conditions, bridging traditional knowledge with contemporary medical practices.

Acknowledgements & Ethical Compliance:: This study is a literature review and does not involve any human or animal subjects. All sources are publicly available and properly cited.

Financial Support & Sponsership: Nil

Conflicts of Interest: Nil

References:

1. Suśrutasaṁhitā, Sutrasthana, Vyadhisamudhesiyamadhyayam, 24/4. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 09/09/2024).
2. Suśrutasaṁhitā, Sutrasthana, Vyadhisamudhesiyamadhyayam, 24/4. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 09/09/2024).
3. Suśrutasaṁhitā, Sutrasthana, Vyadhisamudhesiyam Adhyayam, 24/5. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 09/09/2024).
4. Carakasaṁhitā, Shāreerasthana, Atulyagotreeyamshareeram, 2/30. Available from: http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 09/09/2024).
5. Carakasaṁhitā, Sutrasthana, Mahatigarbhavakranthishareeram, 4/4. Available from: http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 09/09/2024).
6. Carakasaṁhitā, Sutrasthana, Khuddikagarbhavakranthishareeram, 3/11. Available from: http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 09/09/2024).
7. Carakasaṁhitā, Sutrasthana, Jatisootreeyashareeram, 8/21. Available from: http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 09/09/2024).
8. Suśrutasaṁhitā, Sutrasthana, Vyadhisamudhesiyamdhyayam, 24/5. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 09/09/2024).
9. Dash VB & Kashyap VL. Materiamedica of Ayurveda. Concept Publishing Company, New Delhi; 1980. pp. 187-203.
10. Dash VB & Kashyap VL. Materiamedica of Ayurveda. Concept Publishing Company, New Delhi; 1980. pp. 187-203.
11. Madhavanidana, Sheetapittodardakototkotaanidanam, 50/1. Available from: https://niimh.nic.in/ebooks/madhavanidana/ (Accessed on 09/09/2024).
12. Suśrutasaṁhitā, Sutrasthana, Vyadhisamudhesiyamadhyayam, 24/6. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 09/09/2024).
13. Suśrutasaṁhitā, Sutrasthana, Vyadhisamudhesiyamadhyayam, 24/7. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 09/09/2024).
14. Suśrutasaṁhitā, Sutrasthana, Vyadhisamudhesiyamadhyayam, 24/7. Available from: http://niimh.nic.in/ebooks/esushruta/ (Accessed on 09/09/2024).