अथातस्त्रिशोथीयमध्यायं व्याख्यास्यामः ॥ १ ॥ इति ह स्माह भगवानात्रेयः ॥ २ ॥
We shall now expound the chapter on “The three types of Swelling.”
Thus, said Lord Atreya. [ 1-2 ]
In the seventeenth chapter, abscesses have been fully explained. The abscesses are nothing but a form of swelling. So swellig in general is being described in this chapter.
Classification of swelling
त्रयः शोथा भवन्ति वातपित्तश्लेष्मनिमित्ताः, ते पुनर्द्विविधा निजागन्तु भेदेन ॥ ३ ॥
Swellings are of three types viz.; vatika, paittika and lasimika. They are again of two types-endogenous and exogenous. 
There are two types of classification of swellings-(1) the one based on the vitiation of respective doshas responsible for the swelling; (2) the other related to whether the swelling has been caused by internal or external factors. According to the former classification, the swelling of the three types viz., vatika, paittika and slaismika. According to the latter classification swellings are of two types viz., endogenous and exogenous. This chapter is however, named after the former type of classification because the main factor responsible for swellings is the vitiation of any of the three doshas.
Aetiology of exogenous swellings
तत्रागन्तवच्छेदन भेदनक्षणनभञ्जनपिच्छनोत्पेषणप्रहारवधबन्धनवेष्टनव्यधनपीइनादिभिर्वा भल्लातकपुष्पफलरसात्मगुप्ताशूकक्रिमिशूकाहितपत्रलतागुल्मसंस्पर्शनैर्वा स्वेदनपरिसर्पणावमूत्रणैर्वा विषिणां सविषप्राणिदंष्ट्रा दन्तविषाणनखनिपातैर्वा सागरविषवातहिमदहनसंस्पर्शनैर्वा शोथाः समुपजायन्ते ॥ ४ ॥
The exogenous type of swelling is caused by excision, incision, comminution, fracture, exposure to excessive pressure, grinding, assault, grievous hurt, trying by rope act., twisting by a snake, etc., piercing, comperssion, contact of the fruit and flower of bhallataka ( Semecarpus anacardium Linn. ), atmagupta ( Mucuna prurita Hook ), bristles of poisonous insects, harmful leaves, creepers and shrubs, sweat, crawling or urine of poisonous creatures, injury by fangs, teeth, horns, nails, etc. of poisonous animals and coming in contact with the sea, poisonous, snow wind and fire. [ 4 ]
Exogenous and endogenous swellings
ते पुनर्यथास्वं हेतुव्यञ्जनैरादावुपलभ्यन्ते निजव्यञ्जनैकदेशविपरीतैः; बन्धमन्त्रागदप्रलेपप्रताप निर्वापणादिभिश्चोपक्रमैरुपक्रम्यमाणाः प्रशान्तिमापद्यन्ते ॥५॥
The exogenous swellings are diagnosed by the characteristic etiology, signs and symptoms. Even though, ultimately the exogenous swelling may share the characteristic signs and symptoms of endogenous swellings, the difference lies in the priority or posteriority of certain features common to both types of swellings. The endogenous swelling starts with the vitiation of doshas and then brings about pain. The exogenous swelling, on the other hand, starts with pain and then bring about the vitiation of doshas. Such swellings are cured when treated with such therapies as bandages including talisman, incantations, administration of medicines, application of ointments, fomentation and cold sponging. 
Aetiology of endogenous swellings
निजाः पुनः स्नेहस्वेदव मनविरेचनास्थापनानुवासन शिरोविरेचनाना मयथावत्प्रयोगान्मिथ्यासंसर्जनाद्वा छर्घलसकविसूचिकाश्वासकासातिसारशोषपाण्डुरोगोदरज्वरप्रदरभगन्दराशविकारातिकर्शनैर्वा कुष्ठकंण्डूपिडकादिभिर्वा छर्दिक्षवथूद्वारशुक्रवातमूत्रपुरीषवेगधारणैर्वा कर्मरोगोपवासाध्वकर्शितस्य वा सहसाऽतिगुर्वम्ललवणपिष्टान्न फलशाकरागद धिहरितकमद्यमन्दकविरूढनव शूकशमीधान्यानूपौदकपिशितोपयोगान्मृत्पङ्कलोष्टभक्षणाल्लवणातिर्भक्षणाद्गर्भसंपीडनादामगर्भप्रपतनात् प्रजातानां च मिथ्योपचारादुदीर्णदोषत्वाच्च शोफाः प्रादुर्भवन्ति; इत्युक्तः सामान्यो हेतुः ॥ ६ ॥
Endogenous swellings are caused by improper administration of oleation, fomentation, emesis, purgation, asthapana and anuvasana types of enema, elimination of doshas from the head, adoption of improper post-therapeutic dietetic programme, excessive emaciation due to vomiting, intestinal torpor, choleric diarrhoea, dyspnoea, coughing, diarrhoea, consumption, anemia, abdominal diseases, fever menorrhagia, fistula-in-ano and piles,obstinate skin diseases including leprosy, pruritus, abscess, suppression of natural urges relating to vomiting, sneezing, eructation, the discharge of semen, flatus, urine and stool; sudden intake of exceedingly heavy, sour, and salty food, pestry, fruit pickles, salad, alcohal, immature curd, germinated and fresh corn with or without bristles, meat of marshy or aquatic animals by an individual when he is emaciated due to the administration of five elimination therapies, diseases, fasting or walking for long distance; intake of earth, mud, clod of earth, excessive intake of salt, pressure on gravid uterus, abortion, adoption of improper regimen after delivery and excitation of doshas. These are the etiological factors in general. 
Clinical features of different types of swellings
अयं त्वत्र विशेषः शीतरूक्षलघुविशदश्रमोपवासातिकर्शनक्षपणादिभिर्वायुः प्रकुपितस्त्वयांसशोणितादीन्यभिभूय शोफं जनयति; स क्षिप्रोस्थानप्रशमो भवति, श्यामारुणवर्णः प्रकृतिवर्णो वा, चलः स्पन्दनः खरपरुषभिन्नत्वग्रोमा छिद्यत इव भिद्यत इव पीड्यत इव सूचीभिरिव तुद्यते पिपिलिकाभिरिव संसृप्यते सर्वप कल्कावलिप्त इव चिमिचिमायते संकुच्यत आयम्यत इवेति वातशोथः ( १ );
उष्णतीक्ष्णकटुकक्षारलवणाम्लजीर्णभोजनैरग्न्यातपप्रतापैश्च पित्तं प्रकुपितं त्वयांसशोणितान्यभिभूय शोथं जनयति; स क्षिप्रोत्थानप्रशमो भवति, कृष्णपीतनील ताम्रावभास उष्णो मृदुः कपिलताम्ररोमा उष्यते दूयते धूप्यते ऊष्मा यते स्विद्यते क्लिद्यते न च स्पर्शमुष्णं च सुषूयत इति पित्तशोथः ( २ );
गुरुमधुरशीतस्निग्धैरतिस्वमाव्यायामदिभिश्च लेष्मा प्रकुपितस्त्वयांसशोणितादीन्यभिभूय शोथं जनयति; स कृच्छ्रोत्थानप्रशमो भवति, पाण्डुश्वेतावभासो गुरुः स्निग्धः लक्ष्णः स्थिरः स्त्यानः शुक्लाभरोमा स्पर्शोष्णसहश्चेति श्लेष्मशोथः ( ३ );
यथास्वकारणाकृतिसंसर्गाद्विदोषजास्त्रयः शोथा भवन्ति; यथास्वकारणाकृतिसन्निपातात् सान्निपातिक एक; एवं सप्तविधो भेदः ॥ ७ ॥
प्रकृतिभिस्ताभिस्ताभिर्भिद्यमानो द्विविधस्त्रिविधश्चतुर्विधः सप्तविधोऽष्टविधश्च उपलभ्यते, पुनश्चैक एवोत्सेधसामान्यात् ॥ ८ ॥
The following are the special features
By the intake of cold, ununctuous light and non-slimy food; exertion, fasting, excessive emaciation and elimination, the vata gets aggravated and affficts the tvak ( skin ), mainsa ( flesh ) rakta, etc., and causes swellings. The swellings thus caused appear and disappear abruptly. They are either of blue or reddish colour or of the natural colour of the organ affected; they are mobile and they throb. The skin and hair over the swellings are rough, hard and broken; the resultant pain resemble, cutting, splitting, pressing, pinching by needles, carwling by ants, ete. There is tingling sensation as if covered with mustard paste. They contract and expand. These are the vatika types of swellings.
By the intake of hot, pungent, bitter, alkaline, saline, sour and heavy food and exposure to heat of fire and sun, the pitta gets aggravated and affects the tvak (skin), mamsa (flesh) and rakta (blood) and thus swelling caused. It appears and disappears abruptly, it is black, yellow, blue and coppery in colour; it is hot and soft in touch; the hair over the swelling becomes light-gray and coppery; there is a feeling of hot sensation, pain, emission of smoke, high temperature, steaming and sloughing. It does not stand hot touch. This is paittika type of swelling.
Due to the intake of heavy, sweet, cold and unctuous diet, excessive sleep, lack of exercise, etc., the kapha gets aggravated and it effects the skin, muscles, blood, etc. to cause slaismika type of swellings. Suce swellings take a long time to manifest themselves and cure. They are of apparently pale white colour, heavy unctuous, smooth, immobile, compact and having white hair in the border. They stand pressure and heat.
According to the etiology, signs and symptoms, there are three more types of swellings due to the combined morbidity of two doshas (viz., vatapaittika, vataslaismika and pittaslaismika). There is only one sannipatika type of swelling arising out of the combined morbidity and it manifests the signs and symptoms of all the three doshas. Thus, there are seven varieties of swellings caused by the vitiation of doshas.
There are characteristic differences amongst the various types of swellings. They are of two types ( exogenous and endo genous), three types (vatika, paittika and slaismika), four types (vatika, paittika, and slaismika, types of endogenous variety and the exogenous variety ), seven types (vatika, paittika, slaismika, vatapaittika, vataslaismika, slesma-paittika and sannipatika) and eight types (seven types of endogenous and one type of exogen. ous). But on an ultimate analysis, fotha is only of one type having the swelling as a characteristic sign in common. [7-81
भवन्ति चात्रशूयन्ते यस्य गात्राणि स्वपन्तीव रुजन्ति च । पीडितान्युन्नमन्त्याशु वातशोथं तमादिशेत् ॥ ९ ॥ यश्चाप्यरुणवर्णाभः शोथो नक्तं प्रणश्यति । स्नेहोष्णमर्दनाभ्यां च प्रणश्येत् स च वातिकः ।। १० ।। यः पिपासाज्वरार्तस्य दूयतेऽथ विदह्यते । स्विद्यति क्लिद्यते गन्धीस पैत्तः श्वयथुः स्मृतः ॥ ११ ॥ . ● यः पीतनेत्रवक्त्रत्वक् पूर्व मध्यात् प्रशूयते । तनुत्वक् चातिसारी च पित्तशोथः च उच्यते ॥ १२ ॥ शीतः सक्तगतिर्यस्तु कण्डूमान् पाण्डुरेव च । निपीडितो नोन्नमति श्वयथुः स कफात्मकः ॥ १३ ॥ यस्य शस्त्रकुशच्छिन्नाच्छोणितं न प्रवर्तते । कृच्छ्रेण पिच्छा स्रवति स चापि कफसंभवः ।। १४ ।। निदानाकृतिसंसर्गाच्छ्रयथुः स्याद्विदोषजः । सर्वाकृतिः सन्निपाताच्छोथो व्यामिश्रहेतुजः ॥ १५ ॥
Thus it is said :
The vatika type of sotha is characterised by swelling, numbness and pain in the limbs and it regains its normal position immediately after it is pressed (and the pressure is withdrawn). The swelling which is reddish in colour, which disappears during the night and gets cured by the application of unctuous and hot massage is also of vatika type.
In the paittika type of swelling, the patient feels thirsty and feverish; there is pain and burning sensation in the swelling; there is sweating; sloughing and foul smell; the eyes, face and skin of the patient become yellow and the swelling starts from middle part of the body; the skin becomes thin and there is diarrhoea.
The slaismika type of swelling is cold in touch, it does not spread, it causes itching; it is pale in colour; and it pits on pressure. Moreover, the slaismika type of swelling does not bleed even if it is cut with a weapon or sharp edged grass; there is oozing after a long time.
The swellings due to the combination of two doshas may be diagnosed on the basis of the combined etiology, signs and symptoms. Similarly, the sannipatika type of swelling can also be diagnosed from the combination of etiological factors. [ 9-15]
Prognosis of Sotha roga
यस्तु पादाभिनिर्वृत्तः शोथः सर्वाङ्गगो भवेत् ।
जन्तोः सच सुकष्टः स्यात् प्रसृतः स्त्रीमुखाच्च यः ॥ १६ ॥ . यश्चापि गुह्यप्रभवः स्त्रिया वा पुरुषस्य वा । स च कष्टतमो ज्ञेयो यस्य च स्युरुपद्रवाः ॥ १७ ॥ In the case of male patients, if the swelling starts from the feet and spreads all over the body, and in the case of female patients if it starts from the mouth and spreads, it is difficult to cure. In both male and female patients, if the swelling starts from the perenium and is associated with complications, it is exceedingly difficult to cure. [ 16-17]
The lower part of the male is lighter than the upper part. So if the swelling occurs in the lower part and it is not cured while limited to that part only, it would be too difficult to cure it when it spreads to the upper part of the body which is heavier in weight. As to the females, the lower part is heavier than the upper part; so if swelling occurs in her face and then spreads to the lower part of the body which is heavier in weight, it will be equally difficult to cure it cf. Susruta: Sutra 46; 132.
Complications of Sotha roga
छर्दिः श्वासोऽरुचिस्तृष्णा ज्वरोऽतीसार एव च । सप्तकोऽयं सदौर्बल्यः शोफोपद्रवसंग्रहः । १८ ।।
The seven complications of sotharoga ( swelling) are, vomiting, dyspnoea, anorexia, thirst, fever, diarrhoea and general weakness. [ 18 ]
Localised inflammatory Lesions
यस्य आशु लेष्मा प्रकुपितो जिह्वामूलेऽवतिष्ठते । संजनयेच्छोथं जायतेऽस्योपजिह्निका ॥ १९ ॥ श्लेष्मा प्रकुपितः काकले व्यवतिष्ठते । आयु संजनयेच्छोकं करोति गलशुण्डिकाम् ॥ २० ॥ लेष्मा प्रकुपितो गलबाह्येऽवतिष्ठते । शनैः संजनयेच्छोफं यस्य यस्य गलगण्डोऽस्य जायते ॥ २१ ॥ यस्य लेष्मा प्रकुपितस्तिष्ठत्यन्तर्गले स्थिरः । आशु संजनयेच्छोफं जायतेऽस्य यस्य पित्तं प्रकुपितं सरक्तं त्वचि शोफं सरागं जनयेद्विसर्पस्तस्य गलग्रहः ॥ २२ ॥ सर्पति । जायते ॥ २३ ॥ यस्य पित्तं प्रकुपितं त्वचि रक्तेऽवतिष्ठते । शोथं सरागं जनयेत् पिड़का तस्य जायते ॥ २४ ॥ यस्य पित्तं प्रकुपितं भ्वयथुः शङ्खको नाम यस्य पित्तं प्रकुपितं ज्वरान्ते दुर्जयोऽन्ताय यस्य प्रकुपितं पित्तं शोगितं प्राप्य शुष्यति । तिलका पिप्लवो व्यङ्गा नीलिका तस्य जायते ॥ २५ ॥ शङ्खयोरवतिष्ठते । दारुणस्तस्य जायते ॥ २६ ॥ कर्णमूलेऽवतिष्ठते । शोथस्तस्योपजायते ॥ २७ ॥ वातः प्लीहानमुद्धय कुपितो यस्य तिष्ठति । शनैः परितुदन पार्श्व प्लीहा तस्याभिवर्धते ॥ २८ ॥ प्रकुपितो गुल्मस्थानेऽवतिष्ठते । गुल्मस्तस्योपजायते ॥ २९ ॥ शोफशूलकरश्चरन् । वृद्धिस्तस्योपजायते ॥ ३० ॥ प्रकुपितस्त्वड्यांसान्तरमाश्रितः । यस्य वातः तिष्ठति । जायते ॥ ३२ ॥ निर्देशयाः शोथं संजनयेत् कुक्षावुदरं तस्य जायते ॥ ३१ ॥ यस्य वातः प्रकुपितः कुक्षिमाश्रित्य नाधो व्रजति नाप्यूर्ध्वमानाहस्तस्य रोगाचोत्सेधसामान्यदधिमांसाबुदादयः विशिष्टा नामरूपाभ्यां वातपित्तकफा यस्य युगपत् जिह्वामूलेऽवतिष्ठन्ते विदहन्तः जनयन्ति भृशं शोथं वेदनाश्च तं शीघ्रकारिणं रोगं रोहिणीति त्रिरात्रं परमं तस्य जन्तोर्भवति कुशलेन त्वनुक्रान्तः क्षिप्रं संपद्यते यस्य वायुः शोफं सशूलं जनयन् यस्य वायुः प्रकुपितः वडणावृषणौ याति शोथसंग्रहे ॥ ३३ ॥ कुपिता स्त्रयः । समुच्छ्रिताः ॥ ३४ ॥ पृथग्विधाः । विनिर्दिशेत् ॥ ३५ ॥ जीवितम् । सुखी ॥ ३६ ॥
The aggravated kapha is located at the root of the tongue, it causes instantaneous swelling which is known as upajihvika.
When the aggravated kapha is located in the root of the palate, it causes instaneous swelling; this is known as galasundika.
If the aggravated kapha is located outside the throat it causes swelling by and by. This is known as galaganda.
When the aggravated pitta together with rakta spreads within the skin, it causes red swelling which is known as visarpa.
When the aggravated pitta is located in the tvak (skin) and rakta, this will also cause red swelling which in known as pidaka (abscess ).
When the aggravated pitta gets dried up in combination with rakta, this causes skin diseases like tilaka ( black moles), piplu (port wine mark ), vyanga (red moles) and nilika (blue moles).
When aggravated in both the temples, the pitta causes a serious type of swelling there known as fankhaka. When the aggravated pitta localises in the root of the ears specially after fever, it causes a swelling which is difficult to cure and may lead to death.
When the aggravated vata disturbs the spleen and causes pain in the sides of abdomen by and by, it leads to the enlargement of the spleen.
When the aggravated vata is localised in the abdomen this causes swelling together with pain there resulting in the formation of gulma (tumour) there.
When the aggravated vata moves from the sides of the lower abdomen to testicles and there by causes swelling and pain there, it is known as Vruddhi.
When the aggravated vata is muscles, it causes swelling in the udararoga. localised within the skin and abdomen.
When the aggravated vata is localised in the abdomen but does neither move downwards nor upwards, this is known as anaha ( constipation).
Besides such swellings as adhimamsa, arbuda, etc., though having distinctive features of their own both by their name and form, they are all to be included under fotha because swelling is the common feature.
When vata, pitta and kapha-all the three doshas in morbid condition, are simultaneously aggravated and they are localised in the root of the tongue causing burning sensation and swelling, this results in swelling all the more and causes various types of pain. This acute disease is known as rohini. The patient suffering from this disease can hardly survive for three nights. If however, he is quickly treated by a skilled physician, he can be cured. [ 19-36 ]
The doshas leading to the disease “galaganda have their effect a little slowly; those causing galagraha, etc. on the other hand are quick to show their effect.
Even though, the factors leading to the causation of visarpa and pidaka are the same, the doshas in the case of visarpa spread from one place to another while those in the case of pidaku, are localised and static in nature.
If the swelling occurs at the root of the ears during the time of remission of the fever, it is very difficult to cure. It can, however, be cured when adequate precaution is taken and properly treated. Even the slightest carelessness may lead to death. As it has been stated elsewhere, if swelling occurs at the root of the ears during the remission of Sannipata type of fever, patients hardly survive.
Diseases like gulma, etc., will be explained in greater details; they are mentioned here in brief according as they have swelling in common with other diseases described here.
Even though rohini type of swelling can cause death of a patient in three nights, the patient can recover if timely action on his treatment is taken. It also depends upon the nature of the disease itself that the patient survives or dies. There are diseases which by nature cause instantaneous death; there are others which can even automatically be cured-cf. Chikitsa 3:55.
Prognosis of diseases in general
सन्ति ह्येवंविधा रोगाः साध्या दारुणसंमताः । ये हन्युरनुपक्रान्ता मिथ्याचारेण वा पुनः ॥ ३७ ॥ साध्याश्चाप्यपरे सन्ति व्याधयो मृदुसंमताः । यत्वायत्तकृतं येषु कर्म सिध्यत्यसंशयम् ॥ ३८ ॥ असाध्याश्चापरे सन्ति ब्याधयो याप्यसंज्ञिताः । सुसाध्वपि कृतं येषु कर्म यात्राकरं भवेत् ॥ ३९ ॥ सन्ति चाप्यपरे रोगा येषु कर्म न सिध्यति । अपि यत्नकृतं बालैर्न तान् विद्वानुपाचरेत् ॥ ४० ॥ साध्याश्चैवाप्यसाध्याश्च व्याधयो द्विविधाः स्मृताः । मृदुदारुणभेदेन ते भवन्ति चतुर्विधाः ॥ ४२ ॥ .
There are diseases of serious type which even though curable with difficulties can cause death if not properly treated or treated wrongly. There are other diseases of mild nature which are definitely cured by treatment with or without any special care. There is another category of palliable diseases which are not curable but even the most effective treatment will only enable the patient to stand the disease. There are other diseases where no treatment can succeed. Only ignorant physicians will attempt to treat such cases; wise physicians will not.
Diseases are of two types-curable and incurable. Each of them is again of two types, viz., mild or serious. Thus, taken together, there are four types of diseases. [ 37-41]
Even the incurable diseases may be mild or serious according as they are palliable or fatal or they are capable of causing death after some time or instantaneously respectively.
Innumerability of diseases
त एवापरिसंख्येया भिद्यमाना भवन्ति हि । रुजावर्णसमुत्थानसंस्थाननामभिः ॥ ४२ ॥
व्यवस्थाकरणं तेषां यथास्थूलेषु संग्रहः । प्रकृतिसामान्यं विकारेषूपदिश्यते ॥ ४३ ॥ तथा
In fact diseases are of innumerable varieties depending upon their distinctive features like pain, colour ( signs ), etiology, site of origin and manifestation ( like abdomen, rasadhatu, etc., ), symptoms ( like gulma or tumour, etc. ), and nomenclature ( like rajayaksma, sosa, etc. ) Only important diseases have, however, been enumerated (in Sutra 19 ). Other diseases are classified similarly according to the ation. [ 42-43 ] factors involved in their manifest
Factors responsible for the vitiation of doshas have also to be taken into account while treating the disease, e.g.. each of the conditions of vata vitiated due to the intake of coarse food, vigil during night, etc. is to be differently treated.
Correct approach to the diagnosis and treatment of diseases
विकारनामाकुशलो न जिह्वीयात् कदाचन । न हि सर्वविकाराणां नामतोऽस्ति ध्रुवा स्थितिः ॥ ४४ ॥ स एव कुपितो दोषः समुत्थानविशेषतः । स्थानांन्तरगतश्चैव ‘जनयत्यामयान् बहून् ॥ ४५ ॥ च । बुद्ध्वा कर्म समाचरेत् ॥ ४६ ॥ भिषक् । मुह्यति ॥ ४७ ॥ तस्माद्विकारप्रकृतीरधिष्ठानान्तराणि समुत्थानविशेषांश्च यो ह्येतन्त्रितयं ज्ञात्वा कर्माण्यारभते ज्ञानपूर्व यथान्यायं स कर्मसु न
If a physician is not able to name a particular disease, should not feel ashamed on that account because it is not always possible to name all types of diseases in definite terms. When aggravated, one and the same dosha may cause manifold diseases depending upon the various etiological factors and the sites manifestation.
So a physician should try to comprehend the nature of the disease ( dosha ), the site of its manifestation and etiological factors and should then initiate the treatment, A physician who so initiates the treatment after having full knowledge of the therapeutic properties of these three aspects and paying due regard to scriptural instructions would never fail in his attempt to cure the disease. [ 44-47 ]
It is the thorough knowedge of etiological factors rather than the names of diseases which counts for the purpose of their treatment. The acquaintance with the names of diseases is important for the purpose of description only. So a physician is required to be well acquainted inter alia with the sites of manifestation. Even if located in one place, the doshas are likely to cause various diseases. For example, vata located in the neck may cause kanthadhvamsa ( irritation of the throat ), coughing, hoarseness of voice and anorexia.
Relation of doshas with body
नित्याः प्राणभृतां देहे वातपित्तकफास्त्रयः ।
प्रकृतिस्था वा तान् वुभुत्सेत पण्डितः ॥ ४८ ॥ The three doshas, viz. vata, pitta and kapha are already present in the body of all creatures. A physician should try to know whether they are in normal or morbid condition. [ 48]
Functions of normal Vata, Pitta and Kapha
समो उत्साहोच्छ्रासनिःश्वासचेष्टा धातुगतिः समा । मोक्षो गतिमतां वायोः कर्माविकारजम् ॥ ४९ ॥ दर्शनं पक्तिरूष्मा च क्षुत्तृष्णा देहमार्दवम् । प्रभा प्रसादो मेधा च पित्तकर्माविकारजम् ॥ ५० ॥ स्नेहो वन्धः स्थिरत्वं च गौरवं वृषता बलम् । धृतिरलोभश्च कफकर्माविकारजम् ॥ ५१ ॥ क्षमा
When vata is in its normal state, it reflects itself in the form of enthusiasm, inspiration, expiration, movements, normal metabolic transformation of tissues and proper elimination of excreta.
The actions of pitta in its normal state are good vision, good digestion, normal temperature, normal hunger, thirst, bodily softness, lustre, happiness and intelligence.
Effects of kapha in its normal state are unctuousness, cohesion, steadiness, heaviness, virility, strength, forbearance, patience and greedlessness. [ 49-51]
Functions of abnormal doshas
वाते पित्ते कफे चैव क्षीणे लक्षणमुच्यते । कर्मणः प्राकृताद्धानिर्वृद्धिर्वाऽपि विरोधिनाम् ॥ ५२ ॥
The diminution of vata, pitta, and kapha is indicated by the decrease in their respective normal actions or increase in their respective opposite actions. 
When vata, pitta or kapha is deficient, this is indicated by the corresponding deficiency in its respective action. For example, when vata is deficient, then comes the corresponding deficiency in the enthusiasm of the persons affected. Sometimes, even an increase in the respective opposite actions is indicative of the deficiency in the doshas. For example, in the event of the deficiency of vata, there is aggravation of grief that stands iu juxtaposition with morale which latter represents the normal action of vata. Similarly, non-vision and indigestion are aggravated in the event of the deficiency of pitta; roughness of the skin is aggravated in the case of the deficiency in kapha.
Deficiency in the normal action of doshas does not necessarily lead to the aggravation of opposite action. If the enthusiasm goes down, it does not mean that grief would necessarily be in excess or if there is decrease in greedlessness, it does not necessarily follows that there will be slight aggravation of greediness.
Or there are the two ways in which the deficiency of doshas reflect itself-the one is negative and the other is positive. The negative aspect is indicated by the decrease in the respective normal actions of the doshas and the positive one by an increase in the actions of opposite qualities.
Some hold the view that in the event of deficiency in one dosha, the dosha of opposite qualities gets aggravated.. That is to say, in the event of the deficiency in kapha, pitta would get.jaggravated and vice-versa. But this is not correct. The aggravation or deficiency of one dosha does not necessarily cause deficiency or aggravation of the other doshas respectively. If it were so, the kapha would always get diminished in the event of the aggravation of pitta. As stated earlier, the doshas are not in juxtaposition, with each other. In fact, the main symptom of the deficiency in a given dosha is the decrease in its respective action cf. Sutra 17: 62.
दोष प्रकृतिवैशेष्यं नियतं दोषाणां प्रकृतिनिर्वृद्धिश्चैवं वृद्धिलक्षणम् । परीक्ष्यते ॥ ५३ ॥
The aggravation of doshas is invariably indicated by something in excess of their respective normal action. Thus, one can examine the normal condition, deficiency or aggravation of doshas as the case may be. [ 35 ]
If there is an increase in the normal indicate that the given dosha is aggravated. action of a dosha, this would For example, the aggravation of kapha would reflect itself in excessive unctuousness, coolness and sweetness.
तत्र लोकाःसंख्यां निमित्तं रूपाणि शोथानां साध्यतां न च । तेषां तेषां विकाराणां शोथांस्तांस्तांश्च पूर्वजान् ॥ ५४ ॥ विधिभेदं विकाराणां त्रिविधं बोध्य संग्रहम् । प्राकृतं कर्म दोषाणां लक्षणं हानिवृद्धिषु ।। ५५ ।। वीतमोहरजोदोषलोभमानमदस्पृहः व्याख्यातवांत्रिशोथीये रोगाध्याये पुनर्वसुः ॥ ५६ ॥
To sum up :
Lord Punarvasu who is free from attachment, rajas, greed, ego, pride and desire, has explained in this chapter on “The Three Types of Swellings” the following : types, etiology, signs and symptoms, curability or otherwise of swellings, the swellings that appear as premonitory signs of various diseases, different types of diseases, the important points which are to be kept in view during treatment, the normal functions of doshas and signs and symptoms of diminished or aggravated doshas, [ 54-56] Swelling might be curable or incurable. For example, the swelling of the vatika type is cured by unctuous and hot massage. Conversely swellings spreading from the leg are said to be incurable.
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते लोकस्थाने त्रिशोथीयो नामाष्टादशोऽध्यायः ॥ १८ ॥
Thus ends the eighteenth chapter on “The Three Types of Swelling” of the Sutra section of Agnivesa’s work as redacted by Charaka.