Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Similarities between Shitapitta, Udarda and Kotha
1. Shitapitta, Udarda and Kotha have been explained in the same chapter. This indicates that these three are ‘almost identical conditions’. But we would get a doubt so as to why they have different names. This is because there are small differences amongst these three conditions in spite of all the three having almost similar manifestations.
2. All three conditions are Tridoshaja – caused by aggravation of all the three doshas.
3. All the three conditions lead to twak dushti i.e. contamination of skin, just like in Kushta (skin disease, leprosy). This is the reason (points 2 and 3) the chapter covering shitapitta, udarda and kotha (Madhava Nidana Chapter 50) is explained immediately after Kushta Nidana (Madhava Nidana Chapter 49).
4. All three conditions not only affect the skin but also spread inwards into the deeper tissues. So, shitapitta, udarda and kotha are not just skin diseases but are also systemic manifestations. We can put it this way – shitapitta, udarda and kotha might look like skin conditions on the outlook but will gradually encroach to affect and involve the other tissues also (might become a systemic disease affecting multiple tissues in later time or when the disease is not treated quickly once they manifest on the skin).
5. All the three conditions are caused by excessive exposure to the cold breeze.
6. The premonitory symptoms of all the three conditions is the same.
7. Treatment for all the three conditions is the same.
Differences between Shitapitta, Udarda and Kotha
1. Dosha relation – In spite of being caused by all the three doshas –
Shitapitta is vata predominant condition.
Udarda is kapha predominant condition.
Kotha is predominantly caused by aggravated kapha and pitta.
2. Different symptoms for shitapitta have not been enumerated. Symptoms of Udarda have been mentioned. Shitapitta is said to have similar symptoms as those of udarda. Both are said to be almost identical conditions with exception of dosha predominance (as explained above).
3. Udarda is said to predominantly occur in Shishira Rtu i.e. late winter season. This is a season known for kapha accumulation. Similar seasonal link has not been mentioned with other conditions i.e. shitapitta and kotha. Shitapitta and Udarda are identical conditions but Udarda is said to occur in late winter. This means to tell that Udarda probably does not occur in other seasons and also that Shitapitta does not occur in late winter and can occur in other seasons, mainly Grishma (summer season – wherein accumulation of vata takes place) and Varsha Rtu (rainy season, monsoon – wherein aggravation of vata occurs).
4. Kotha occurs due to erroneous (inadequate, improper) administration of emesis therapy or withholding pitta, kapha and food which are about to be expelled or withholding urge for vomiting. Therefore it can occur in any season (unrelated to seasonal changes). Shitapitta and Udarda are not caused by wrongly administered emesis therapy or withholding pitta, kapha, food or urge for vomiting. Vasantha Rtu (spring season) is ideal for administering emesis therapy. This is also a season for kapha aggravation. By inference we can link Vasanta Rtu to Kotha. The other causes mentioned as causal for Kotha indicate that this condition can occur at any time, in any season.
5. Kotha has a subtype called Utkotha while other conditions (shitapitta and udarda) do not have such variants.
6. Kotha is characterized by ‘Niranubandhatva’ i.e. it quickly manifests and quickly disappears i.e. short lived (Utkotha occurs repeatedly and runs a chronic course). Niranubandhatva is not explained in terms of Shitapitta and Udarda. This means that Shitapitta and Udarda occur as chronic and long standing conditions if not treated properly and promptly while Kotha is a temporary and short lived condition. But if Kotha is not treated properly it can transform into Utkotha and run a longer course. In this condition, like shitapitta and udarda, kotha too spreads to the deeper tissues. Else Kotha is superficial and temporary skin manifestation.
7. Symptoms of Shitapitta and Udarda are alike but those of kotha are entirely different.
| Udarda Symptoms | Shitapitta Symptoms | Kotha Symptoms |
| Kapha predominance + Swelling or elevated patches (rashes) manifesting on the exterior (skin), the lesion appearing as if stung by a wasp Itching Excessive pricking pain Vomiting Fever Burning sensation Alternatively – raised red colored patches depressed at the center and elevated at the ends, associated with itching Appears in late winter | Vata predominance + Same symptoms as enlisted under Udarda, no specific seasonal relation or exacerbation as in udarda | Inadequate or improper (erroneous) administration of emesis therapy Forcibly withholding the urges of pitta, kapha and anna (food) i.e. preventing them from getting expelled even when they are ready to get expelled |
