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Chapter 50 – Shitapitta, Udarda, Kotha Nidanam

The 50th chapter of Madhava Nidana is Shitapitta, Udarda, Kotha nidanam which deals with Skin rashes, Erythema, Allergy and the like.

Etiopathogenesis —

 शीतमारुतसंस्पर्शात् प्रदुष्टौ कफमारुतौ |
पित्तेन सह संभूय बहिरन्तर्विसर्पतः || १ || 

śītamārutasansparśāt praduṣṭau kaphamārutau |
pittēna saha sambhūya bahirantarvisarpataḥ || 1 ||

Shitapitta is caused by contact with a very cold breeze. This vitiates the kapha and vata and increases them. Subsequently, along with pitta, the kapha and Vata begin to travel externally in the skin and internally through the blood and other tissues. 1

Prodromal Features —

पिपासारुचि – हृल्लास – देहसादाङ्गगौरवम् |
रक्तलोचनता तेषां पूर्वरूपस्य लक्षणम् || २ ||

 pipāsāruci – hr̥llāsa – dēhasādāṅgagauravam |
raktalōcanatā tēṣāṁ pūrvarūpasya lakṣaṇam || 2 ||

The Prodromal features are:

  • Feeling of thirst
  • Loss of appetite,
  • Oppression in the chest,
  • Debility,
  • Heaviness in the body and
  • Redness of the eyes.
Udarda —

वरतिदष्ट संस्थानः शोथः संजायते बहिः |
सकण्डूस्तोदबहुलश्च्छर्दि – ज्वर – विदाहवान् || ३ ||
उदर्दमिति तं विध्याच्छीतपित्तमथापरे |
वाताधिकं शीतपित्तमुदर्दस्तु कफाधिकः || ४ ||

varatidaṣṭa sansthānaḥ śōthaḥ sañjāyatē bahiḥ |
sakaṇḍūstōdabahulaścchardi – jvara – vidāhavān || 3 ||
udardamiti taṁ vidhyācchītapittamathāparē |
vātādhikaṁ śītapittamudardastu kaphādhikaḥ || 4 ||

Sometimes, there appear swellings on external parts of the body creating pain that matches the one produced by a wasp bite. These swellings generate itching sensation and a feeling of pricking of pins and needles. Moreover, there also appear vomiting, fever and heartburn. This condition has been identified as the disease Udarda. Other diagnose it as Shitapitta. However, it may be noted that the shitapitta has a predominance of Vata, whereas udarda has a predominance of kapha.

That kaphaja disorder  is called Udarda that is characterised by the raised, reddish, itching, and circular patches. 3-4

सोत्सङ्गैश्च सरागैश्च कण्डूमद्भिश्च मण्डलैः |
शैशिरः कफजो व्याधिरुदर्द इति कीर्तितः || ५ ||

sōtsaṅgaiśca sarāgaiśca kaṇḍūmadbhiśca maṇḍalaiḥ |
śaiśiraḥ kaphajō vyādhirudarda iti kīrtitaḥ || 5 ||

Udarda is identified through elevated, reddish, highly irritating, and round patches caused by kapha during winter (Shishira). 5

Features of Kotha —

असंयग्वमनोदीर्णपित्त – श्लेष्मान्ननिग्रहैः |
मण्डलानि सकण्डूनि रागवन्ति बहूनि च |
उत्कोठ सानुबन्धश्च कोठ इत्यभिधीयते || ६ || 

asanyagvamanōdīrṇapitta – ślēṣmānnanigrahaiḥ |
maṇḍalāni sakaṇḍūni rāgavanti bahūni ca |
utkōṭha sānubandhaśca kōṭha ityabhidhīyatē || 6 ||

Features of Kotha include the following:

  • Incomplete emesis
  • Suppression of the movement of pitta, kapha as well as the stomached eatables (anna) lead on appearance of innumerable rashes, red in complexion, highly itching.
  • The patches appear on the skin repeatedly. 6

 इति श्रीमाधवकरविरचिते माधवनिदाने शीतपित्तोदर्द – कोठनिदानं समाप्तम् || ५० || 

iti śrīmādhavakaraviracitē mādhavanidānē śītapittōdarda – kōṭhanidānaṁ samāptam || 50 ||

Thus concludes the chapter on Shitapitta and the like ailments.