INTRODUCTION

 Shleepada is categorised under Krimi Vijnanam. ‘ स्लीपद

इति शीलावत पदं ' a pathological condition which means foot
will be turned hard like a stone

 . This condition mostly affects the Twak (skin). Rohini is the

sixth layer of Twak with thickness equivalent to Vrihi
Pramana (thickness of Rice) and is regarded as the seat
of Granthi, Apache, Arbudha, Shleepada and Galaganda

 Detailed review on Shleepada has been mentioned in

Bruhatrayee and in Laghutrayee. Water from Paariyaatra,
Vindya, Sahya ranges causes Shiroroga, Hridroga, Kushta
and Shleepada.

 Water from Mahendra Mountain produces Shleepada and

Udararoga whereas water of Himavat Mountain causes
Hridroga, Kshvathu, Shiroroga, Shleepada and Galaganda.

 Shleepada develops in cold climate and due to Dusta

Jala (contaminated Water) which causes vitiation of Vata,
Pitta, Kapha leading to Adhogamana of Prakupita Doshas

 .That gets localized in groin, thigh, foreleg, calves and

gradually reaches to the foot.
 It rise to Shopha associated with Arati (Pain), Jwara
(Pyrexia) and turns hard in consistency.

 Acharya Sushruta has mentioned that Shotha can occur

in Karna, Netra, Shishna, Oshtha and Nasa.

 Shleepada has been classified into three types as Vataja,

Pittaja and Kaphaja.This disease does not manifest without
the involvement of Kapha Dosha.

 If Shleepada persists for more than one year and it grows

bigger in size resembling to that of an ant hill and
exudates fluid associated with Kandu (itching) and Srava
(discharge) it is termed as Asadhya (incurable)

 Sleepada is Kapha Pradhana Tridoshaja Vyadhi which

manifests by vitiating Mamsa, Kapha and Rakta and it leads
to abnormal enlargement of different body parts.

 Dusta Jala is considered to be one of the prime causes of

Shleepada which manifests with the symptoms of fever,
painful swelling starting from groin and extending to the
feet.

 It is classified into three types as Vataja, Pittaja and Kaphaja.

 Some Acharyas opine that Shleepada manifests to the othe
body parts like hands, ears, eyes, penis, lips and nose.

 Ayurveda though provides therapeutic measures for disease,

it emphasis more on maintenance and promotion of health.
The present concept of Shleepada enunciated in Samhitas.

 In modern it is explained as filariasis it is a tropical parasitic

disease that effect lymph nodes and lymph vessels.

 Lymphatic filariasis is spread by infectious mosquitoes

 Their bites deposit a parasite that travels to lymph system.

 NIDANA

 Bhava Prakasha has commented that water from Sahya

Range (Example Godavari and Krishna River) may cause
Twak Vikaras and vitiates Vata and Kapha Dosha.

 Acharya vagbhatta opines that stagnated water from

Himalayas Vindya, Sahya, Mahendra Mountains mitigates
Doshas, bestows the strength, sexual vigour and vitiates
tridosha

 Acharya Bhela has mentioned it under Janapadodwamsa

Vyadhi where habitual intake of Matsyanna in Prachya
Pradesha (Bengal, Assam, Manipur, Nagaland, Mizoram,
Arunachal Pradesh) causes prevalence of Kapha Pitta
ailments like Galaganda and Shleepada.

 He mentioned Dadhi (Curd) as a cause of

Shleepada.Matsya (fish) possesses Snigdha, Guru Guna,
Madhura Rasa, Bahudoshakara and Vatahara properties.

 In Anupa Desha, due to heavy rainfall there will be

stagnation of water in large quantity.
 Nidana for Shleepada Anupa Desha always surrounds with
thick forest where the cold wind blows.

 The land is predominant with Kapha Dosha and Kapha

Predominant Vyadhi and water of Anupa AAbhishyandi
and Ahitam .

 It possesses Madhura Rasa, Snigdha, Guru and

Abhishyandi Guna.

 Sannikrushta Nidana Kaphaja - Ahara Vihara, Dusta Jala

Sevana

 Nidana - Sheeta Kala, Anupa Desha

 Vyabhichari Hetu - Sheeta Kala, Anupa Desha

 Pradhanika Hetu - Kaphakara Ahara, Dusta Jala sevana

 Utpadaka Hetu - In cold climate, due to Kaphakara Ahara

Vihara, Kapha Dosha Prakopa

 Vyanjaka Hetu - Accumulated Kapha manifests disorders

of Kapha
 Dosha Hetu Vata – Jala from Sahya range Pitta- Water
from Anupa DeshaKapha- Kaphavardhaka Ahara Vihara,
Justa Jala Sevana

 Vyadhi Hetu - Kaphakara Ahara Vihara, Dushita Jala

Sevana

 Ubhaya Hetu - Water from Anupa Desha, Kaphavardhaka

Ahara, Justa Jala Sevana

 Bahya Hetu - Kaphadosha Prakopaka Hetu (Dadhi, Matsya,

dushta jala )

 Abhyantara hetu - Tridosha

 Asatmendriyartha Samyoga –

 Prajnaya paradha - Ahdharma (Janapadhodhwamsa )

 Parinama - Sheetha kala

 Anbandha hetu – vata pitta dosha

 Anubandhaya hetu – kapha dosha

 LAKSHANAS

 Disease sleepada is characterized by fever , swelling starts

from ground and gradually extend to feet associated with
pain .

 Some say it manifests in order places like hands , ears ,

eyes , penies , lips and nose .

 On Nidana Sevana, when Dosha Dushya Sammurchana

occurs, the Lakshanas (symptoms) will get manifested.

 In Sleepada ‘Shila Vat Shopham’ (hardening like a stone)

can be taken as cardinal feature along with symptoms like
Jwara, pain in groin region .

 Shopha: Consumption of Mithya Ahara Vihara leads to

Tridosha Dushti.

 Kapha Dosha is predominant of Jala Mahabhuta And

Prithvi Mahabhuta.

 Due to Sneha Samana Guna of Kapha, Pitta also gets

vitiated. With an increase in Drava Guna of Pitta Occurs
Agni Mandhyata.
 Along with vitiated Vata, alteration in Guru and Sthira
Guna of Kapha causes Srotorodha with decrease In
metabolism, increase in body weight and thickened skin.

 With the increase in Guru and Picchila Guna in body Sira

Shaithilya takes place and thus the working mechanism of
Rasa Rakta Vikshepana gets slow down and it affects Rasa,
Rakta, Sira and Lasika.

 The blood gets too thick with low osmotic pressure as

compared to the cells.

 Thus it will move from higher concentration to lower

concentration. Hence, there occurs the accumulation of
fluid giving rise to ‘Shila Vat Shopha’.

 Arati: Arati is synonym of Vedana. Pain does not manifest

without the involvement of Vata.

 Due to Srotorodha, Gati of Vata gets obstructed with

alteration in Chala, Sukshma, Ruksha Guna of Vata.

 It causes increase in dryness of skin, discoloration and

thickened skin .

 Pain in association with Pitta and Kapha Dosha,

respectively the Dahayukta Vedana and Manda Vedana
 can be inferred due to alteration in Guna of the concerned
Dosha.

 Jwara: Intake of Excessive Shleshmala Ahara Vihara causes

Ama formation with an increase in Drava, Snigdha, Picchila
and kleda Guna of Kapha Dosha.

 Aapya Mahabhuta is predominant in Kapha Dosha; with an

increase in Kapha Dosha subsequently there occurs
alteration in Medo Dhatu in the body.

 Alongg with the obstruction of Medovaha Srotas,

Swedhavaha Srotas also gets obstructed as Sweda is Mala
of Medo Dhatu.

 It does not able to restore the body temperature and thus

causing Jwara

 Sleepada manifest due to consumption of food and habits

with aggravates kapha .

 In kaphaja prakruthi , excluding bigger in size , severe

itching associated symptoms should be rejected for
treatment.
 Hetu Sira sthaithilya Ama manifestation Srotho rodha
Dosha Tridosha Tridosha Vata
involved
Agni Mandha Agni Mandha Agni Vishama Agni
dushti Rasadhatvagnimandhya
Medhodhatvagnimandhy
a
Guna Drava,guru , Kledha , drava , snigha Sukshma ,
involved sthira , picchila picchila ruksha , chala
Karma Sarana Pachana Gati
affected
Srotho Sanga , Sanga vimargagamana Sanga
dushti vimargagamana vimargagamana
Lakshana Shopha Jwara Arati , rukshata
s

 Sleepada persist for more than one year growing bigger &
bigger resembling like any hill excluding fluids.
  SAMPRAPTHI
जडासु प्रण्डीप्रपदोपपरिष्टात ् स्याच्छलीपदं मांसकफारत्रदोषात ्

 Sixth Layer of skin named rohini equal to one grain of

paddy in thickness , is the seat of granthi , apachi ,
arbudha , sleepada , & galaganda Sleepada manifests by
vitiating mamsa , kapha , & raktha.

 It is characterized by swelling in the calf region , lower

extremities & swelling originates from the portion of the
leg .

 Excessively exacerbated vata , pitta , kapha move

downwards and get localised in the ground , thighs &
calves , gradually reach the foot in the due course of time
& gives rise to swelling is known as sleepada

 Samprapti mentions about the progression of disease. It

plays a significant role in deciding the treatment protocol
and Management of disease.

 Pradhana Samprapti: Kapha Pradhana Tridoshaja

 Vidhi Samprapti: Nija , Doshaja, Yapya, Shastra Kriya

Sadhya Vyadhi
 Vikalpa Samprapti:Kapha (Drava Guna, Snigdha Guna,
Sthira Guna), Vata (Ruksha Guna, Sukshma, Chala), Pitta
(Ushna Guna, Drava Guna)

 Samkhya Samprapti: Three Types, Seven types of

Shleepada

 Bala Samprapti: Roga Bala is more

 Kala Samprapti: All age groups (not specified)

Nidana sevana
|
Aggravation of kapha pradhana dosha
|
Vitiates mamsa and raktha
|
Moves downwards
|
Gets localised in groins , thighs , fore leg , calves and
gradually reach the foot
|
Swelling in the lower limbs
|
Sleepada
 SAMPRAPTHI GHATAKA

 Dosha Kapha Pradhana Tridosha

 Dushya Rasa, Rakta, Mamsa, Medas ,Lasika
 Srotas Rasavaha, Raktavaha, Mamsavaha, Medovaha
 Adhisthana Twak ,Vankshana,Uru, Jaanu, Jangha
 Srotodushti Sanga,Vimargagamana
 Swabhava Chirakari
 Agni Jatharagnijanya Mandhya, Dhatvagnijanya
Mandhya
 Ama Jatharagnijanya Ama, Dhatvagnijanya Ama
 Udbhava Sthana Amashaya
 Sanchara Sthana Sarva Sharira
 Vyakta Sthana Adhobhaga Shopha [36], Karna, Netra,
Shishna, Oshtha and Nasa Gata Shopha [
 Rogamarga Bahya
 Sadhyasadhyata

 If Shleepada persists for more than one year and it

grows bigger in size resembling to that of Ant hill and
exudates fluid it is Asadhya

 If Shleepada manifests with bigger size and exudates,

associated with itching is considered as Asadhya.
  BHEDHA
 Vataja Sleepada
 Pittaja Sleepada
 Kaphaja sleepada

Vataja Sleepada :

तत्र वताजं खरं कृष्णं परुषनिमि तानिलरूजं परिस्फुटतिच बहुशः

(S.Ni. 12/14)
Affected area becomes rough , blackish , coarse , has various
kinds of vataja pain piercing etc ..severe pain appearing without
any apparent cause , excessive crackness & fever .
Pittaja sleepada:

पितजं तु पीताव – भासमीषन्मदज्

ु वरादाहाप्रचयं च ( S.S. Ni .
12/14)
Affected area becomes yellowish, slightly soft , associated with
fever & burning sensation .
Kaphaja sleepada :

रलेष्मजं तु स्वेतं स्निग्धवभासं मन्दवेधनं भारिकं माहा ग्रन्थिकं

कण्टकैरुपचितं च। ( S.S. Ni.12/14 )Affected area becomes
whitish, appears unctouus has mild pain , heaviness , b
Dosha Vataja Pittaja Kaphaja
lakshana sleepada sleepada sleepada
Sushrutha Khara , Peeta Shwetha ,
krushna , avabhasa., snigdha ,
parusha ,animi Ishat mrudhu, mandhavedhana,
tta anila ruja jwara , dhaha bharikam ,mahag
ranthikam ,
kantaka
rupachitam
Madhava Krushna , Petta Snigdha
Bhava ruksha , sankhasam, Varnasweatga ,
prakasha sphutita , dhaha , jwara , pandu,
Yogaratnakara teevra mrudhu guru ,sthira
vedhana shotha .
animitta ruja ,
jwara

Vagbhatta Paripotayuta, Peeta Guru , snigdha ,

krishnam , Varna ,twak, mamsa
animittaja , dhaha , jwara ankurabhruhata
khara ,ruksha
 Sleepada is a tridoshaja vyadhi which is predominant of
kaha dosha . All varieties of sleepada is kapha because
without kapha heaviness and big size never manifests.

 UPASHAYA AND PATHTYA

 Langana (Fasting therapy)
 Alepanana (External application)
 Swedana (Fomentation)
 Rechana (Purgation therapy)
 Raktamokshana (Blood Letting)
 Kaphaghna Ushna Upchara[and Siraveda in Vataja
shleepada 4 Angul above Gulfa Sandhi (Ankle Joint), Pittaja
Angula below Gulfa Sandhi, Kaphaja 4 .Angula above
Shipra Marma in foot relieves Shleepada.
 Paneeya Kshara (Alkaline preparation) is also indicated.
 Intake of Shakhotak Valka Kwatha (decoction of Streblus
asper) along with Gomutra relieves Shleepada.

 Wholesome Diet consists of

 Yava Anna (Barley),

 Sarshapa Taila (Mustard Oil),

 Kurma Mamsa (flesh of Tortoise).

 Purana, Shashtika Shali (varieties of Rice),

 Yava,

 Kulatha (Macrotyloma uniflorum),

 Lashuna (Allium sativum),

 Patola (Trichosanthes Dioica),

 Shobhanjan (Moringa oleifera),

 Karvellaka (Momordica charantia),

 Upodika (Basella rubra),

 Punarnava Mula (Boerhavia Diffusa),

 Eranda Taila (Ricinus communis),

 Gomutra

 Katu Tikta Rasa Pradhana Dravya,

 Deepaniya Padartha

 ANUPASHAYA /AHPATHYA
 The following measures and edibles are considered to be
harmful for the sleepada patients :
Pishtaanna ,Dugdhavikriti , ( milk products), Guda
( jaggery), meat of animals and birds living in marshy land
, sweet juices, river water evolving from the mountains of
Mahendra , sahya and vindhya , oily products, heavy to
digest and abhisyandi products .

 CHIKITSA

 Vataja sleepada chikitsa :

स्नेहस्वेदोपपन्ने तु श्लीपदे ऽनिलजे भिषक् |

कृत्वा गल्
ु फोपरि सिरां विध्येत्तु चतरु ङ्गल
ु े ||५२||
समाप्यायितदे हं च बस्तिभिः समप
ु ाचरे त ् |
मासमेरण्डजं तैलं पिबेन्मत्र
ू ण े संयत
ु म ् ||५३||
पयसौदनमश्नीयान्नागरक्वथितेन च |
त्रैवत
ृ ं चोपयञ्
ु जीत शस्तो दाहस्तथाऽग्निना ||५४||

In sleepada ( filariasis ) produced by vata, the physician

should administer oleation and duration therapies first
situated four angula ( 8 cm ) above the gulpha should be
administered the patient should be asked to drink eranda
taila mixed with gomutra for one month , partake food
 along with milk bolied with nagara .Truvrt ghritha should
be used , burning ( cauterising ) by fire is also beneficial.

 Pittaja sleepada chikitsa:

गुल्फस्याधः सिरां विध्येच्छ्लीपदे पित्तसम्भवे |

पित्तघ्नीं च क्रियां कुर्यात ् पित्तार्बुदविसर्पवत ् ||५५|

In sleepada produced by pitta , venepuncture should be done

below the ankle and treatment s mitigating pitta should be
done similar be done similar to that of pittaja arbuda or pittaja
visarpa
 Kaphaja sleepada chikitsa:

सिरां सुविदितां विध्येदङ्गुष्ठे श्लैष्मिके भिषक् |

मधय
ु क्
ु तानि चाभीक्ष्णं कषायाणि पिबेन्नरः ||५६||
पिबेद्वाऽप्यभयाकल्कं मत्र
ू ण े ान्यतमेन च |
कटुकाममत
ृ ां शण्
ु ठीं विडङ्गं दारु चित्रकम ् ||५७||
हितं वा लेपने नित्यं भद्रदारु सचित्रकविडङ्गमरिचार्के षु
नागरे चित्रकेऽथवा ||५८|
भद्रदार्वेलुकाख्ये च सर्वेषु लवणेषु च |
 तैलं पक्वं पिबेद्वाऽपि यवान्नं च हितं सदा ||५९||
पिबेत ् सर्षपतैलं वा श्लीपदानां निवत्ृ तये |
पत
ू ीकरञ्जपत्राणां रसं वाऽपि यथाबलम ् ||६०||
अनेनैव विधानेन पुत्रञ्जीवकजं रसम ् |
प्रयुञ्जीत भिषक् प्राज्ञः कालसात्म्यविभागवित ् ||६१||
केवुकाकन्दनिर्यासं लवणं त्वथ पाकिमम ् |

 In sleepada caused by kapha , the physician should

punture the vein prominent in big toe,

 Patient should drink decoction of ( kapha mitigating)

drugs added with honey often or consume the paste of
abhaya mixed with urine cow or any other animal.

 It is beneficial to apply the paste of katuka, amrta,sunti ,

vidanga , daru and citraka , oil cooked with either vidanga
, maricha and arka or nagara cooked with vidanga
maricha and arka (Or)

 Nagara with citraka or bhadradaru and eluka added with

all salts , should be consumed daily and partake boiled
yava always or drink sarshapa taila or fresh juice of
putikaranha.
  According to strength in the same manner the wise and
his habituation .juice of tubers of kebuka , pakima lavana
( Bida lavana) added to the juices mentioned earlier
should be consumed as best medicine for sleepada.

 AYURVEDIC MEDICINES USED FOR SLEEPADA

 Maharasnadhi kwatham
 Nongadhi tailam
 Sleepadataka gutika
 Arogya vardhini vati
 Kaisora guggilu
 Triphala guggulu
 Chirabilwadhi kashyam
 Pipalyadhi choornam
 Nithyananda ras
 Sleepada gajakesari ras
 Karamba shokadhi tailam

 FILARIASIS
 Introduction :
Filariasis is a parasitic disease caused by an infection with
roundworms of the Filarioidea type. These are spread by
blood-feeding insects such as black flies and mosquitoes.
They belong to the group of diseases called helminthiases.
 These parasites exist in the wild in subtropical parts of
southern Asia, Africa, the South Pacific, and parts of South
America.

 One does not acquire them in temperate areas like Europe

or the United States.Eight known filarial worms have
humans as a definitive host.

 These are divided into three groups according to the part

of the body they affect:Lymphatic filariasis is caused by the
worms Wuchereria bancrofti, Brugia malayi, and Brugia
timori

 These worms occupy the lymphatic system, including the

lymph nodes; in chronic cases, these worms lead to the
syndrome of elephantiasis.

 Subcutaneous filariasis is caused by Loa loa (the

eyeworm), Mansonella streptocerca, and Onchocerca
volvulus.

 These worms occupy the layer just under the skin. L. loa
causes Loa loa filariasis, while O. volvulus causes river
blindness.
 Serous cavity filariasis is caused by the worms Mansonella
perstans and Mansonella ozzardi, which occupy the serous
cavity of the abdomen

 Dirofilaria immitis, the dog heartworm, rarely infects

humans.

 The adult worms, which usually stay in one tissue, release

early larval forms known as microfilariae into the person’s
blood

 These circulating microfilariae can be taken up during a

blood meal by an insect vector; in the vector, they develop
into infective larvae that can be spread to another person.

 Individuals infected by filarial worms may be described as

either “microfilaraemic” or “amicrofilaraemic”, depending
on whether microfilariae can be found in their peripheral
blood.

 Filariasis is diagnosed in microfilaraemic cases primarily

through direct observation of microfilariae in the
peripheral blood.

 Occult filariasis is diagnosed in amicrofilaraemic cases

based on clinical observations and, in some cases, by
finding a circulating antigen in the blood.
 Signs and symptoms :

 The most spectacular symptom of lymphatic filariasis is

elephantiasis – edema with thickening of the skin and
underlying tissues—which was the first disease discovered
to be transmitted by mosquito bites.

 Elephantiasis results when the parasites lodge in the

lymphatic system.

 Elephantiasis affects mainly the lower extremities, while

the ears, mucous membranes, and amputation stumps are
affected less frequently. However, different species of
filarial worms tend to affect different parts of the body.

 Wuchereria bancrofti can affect the legs, arms, vulva,

breasts, and scrotum (causing hydrocele formation), while
Brugia timori rarely affects the genitals.[citation needed]

 Those who develop the chronic stages of elephantiasis are

usually free from microfilariae (amicrofilaraemic), and
often have adverse immunological reactions to the
microfilariae, as well as the adult worms.
 The subcutaneous worms present with rashes, urticarial
papules, and arthritis, as well as hyper- and
hypopigmentation macules. Onchocerca volvulus
manifests itself in the eyes, causing “river blindness”

 Causes :

 Human filarial nematode worms have complicated life

cycles, which primarily consists of five stages. After the
male and female worms mate, the female gives birth to
live microfilariae by the thousands.

 The microfilariae are taken up by the vector insect

(intermediate host) during a blood meal. In the
intermediate host, the microfilariae molt and develop into
third-stage (infective) larvae. Upon taking another blood
meal, the vector insect, such as Culex pipiens, injects the
infectious larvae into the dermis layer of the skin

 . After about one year, the larvae molt through two more
stages, maturing into the adult worms.
 Diagnosis :

 Filariasis is usually diagnosed by identifying microfilariae

on Giemsa stained, thin and thick blood film smears, using
the “gold standard” known as the finger prick test.

 The finger prick test draws blood from the capillaries of

the finger tip; larger veins can be used for blood
extraction, but strict windows of the time of day must be
observed. Blood must be drawn at appropriate times,
which reflect the feeding activities of the vector insects.

 Examples are W. bancrofti, whose vector is a mosquito;

night is the preferred time for blood collection. Loa loa’s
vector is the deer fly; daytime collection is preferred.

 This method of diagnosis is only relevant to microfilariae

that use the blood as transport from the lungs to the skin.

 Some filarial worms, such as M. streptocerca and O.

volvulus, produce microfilariae that do not use the blood;
they reside in the skin only. For these worms, diagnosis
relies upon skin snips and can be carried out at any time.
  Treatment

 The recommended treatment for people outside the

United States is albendazole combined with ivermectin.

 A combination of diethylcarbamazine and albendazole is

also effective

 Side effects of the drugs include nausea, vomiting, and

headaches .All of these treatments are microfilaricides;
they have no effect on the adult worms. While the drugs
are critical for treatment of the individual, proper hygiene
is also required.

 There is good evidence that albendazole alone; or addition

of albendazole to diethylcarbamazine or ivermectin,
makes minimal difference in clearing microfilaria or adult
worms from blood circulation.

 Diethylcarbamazine-medicated salt is effective in

controlling lymphatic filariasis while maintaining its
coverage at 90% in the community for six months.