SHLEEPADA - NIDANA, SAMPRAPTI, BHEDA AND FEATURES

SHLEEPADA - NIDANA, SAMPRAPTI, BHEDA AND FEATURES

Shleepada is a Vata-Kaphaja Nanatmaja Vyadhi characterized by gradual swelling of the lower limbs resembling the condition of Elephantiasis in modern science. It is a chronic, progressive, and disfiguring condition and is commonly associated with filarial infection in modern pathology.

NIDANA (CAUSES)

According to Ayurvedic classics, Shleepada is primarily caused due to Krimi (parasites), Apathyasevana, and Dushita Vata-Kapha. The causes are:

• Krimikarana (parasitic infestation)

• Abhishyandi ahara sevana (consumption of heavy, unctuous food)

• Guru-snigdha ahara

• Avyayama (lack of exercise)

• Vihara dosha (wrong lifestyle)

• Atimaithuna (excessive sexual indulgence)

• Diwaswapna (day sleep)

• Ajirna (indigestion)

• Prachura annapana sevana (overeating and excessive drinking)

• Krimidosha (internal or external parasites)

स्निग्धगुरुपीतेनाभिष्यन्दिभिर्जनं तथा।
श्लेष्मवातकृतं रोगं कृमिभिश्चोपपीडितम्॥
(Charaka Samhita, Chikitsa Sthana 17/97)

SAMPRAPTI (PATHOGENESIS)

• Due to the above-mentioned Nidanas, Kapha and Vata doshas get aggravated.

• Krimis (microparasites or macroparasites) invade the Rasa and Rakta dhatus, leading to obstruction in the srotas (microchannels).

• Due to Margavarana (obstruction) and Vata prakopa, there is an abnormal accumulation of Kapha and fluid in Shakha pradesha (lower limbs).

• The swelling becomes chronic, firm, cold and painless in early stages, gradually becoming painful with deformity.

श्लेष्मणा चोदितो वातः कृमिभिश्चोपपीडितः।
चिरं पादे स्थितः श्लीपदं सञ्जनयेद्गदं॥
(Ashtanga Hridaya, Nidana Sthana 12/1)

BHEDA (TYPES OF SHLEEPADA)
According to classical texts, Shleepada is mainly of the following types:

• VATAJA SHLEEPADA

  • Dry swelling, blackish discoloration

  • Severe pain and cracking of skin

  • Reduced flexibility of joints

  • Associated with emaciation and deformity

• KAPHAJA SHLEEPADA

  • Cold, heavy, pale and soft swelling

  • Mild pain or no pain

  • Discharge of thick, white fluid

  • Laziness, heaviness in the limb

• VATA-KAPHAJA SHLEEPADA

  • Mixed symptoms of both vata and kapha

  • Moderate swelling with occasional pain

  • Chronic and progressive in nature

• KRIIMIJANYA SHLEEPADA

  • Caused specifically due to Krimi

  • Associated with pus discharge and foul smell

  • Ulceration and deformity may be present

श्लीपदं त्रिविधं प्रोक्तं वातकफकृमिसम्भवम्।
तत्र लक्षणविभ्रष्टं त्रिविधं समुपचर्यते॥
(Ashtanga Hridaya, Nidana Sthana 12/2)

LAKSHANA (FEATURES OF SHLEEPADA)

• Gradual swelling of the foot and leg (usually one-sided)

• The skin becomes thickened and coarse like an elephant’s skin

• Swelling is cold, heavy and hard in nature

• Discoloration: Blackish or dark skin tone

• Loss of mobility, pain in some types

• In chronic cases, ulceration and foul smell may appear

• Deformity of foot and leg

• Veins may be prominent, and nodular swelling seen

• It resembles the foot of an elephant, hence the name Shleepada

श्लीपदं कुरुते शोथं पादयोः स्थिरमन्दकम्।
गौरवं चास्थिरं स्फीतं शीतं सन्दुःखनाशनम्॥
(Ashtanga Hridaya, Nidana Sthana 12/3)

MODERN CORRELATION

Shleepada is commonly correlated with Lymphatic Filariasis (Elephantiasis) caused by nematode parasites such as:

• Wuchereria bancrofti

• Brugia malayi

• Brugia timori

ETIOLOGY (Modern)

• Infection by mosquito-borne filarial parasites

• Transmitted by Culex or Anopheles mosquitoes

• Microfilariae invade the lymphatic system, causing obstruction and lymphedema

PATHOGENESIS (Modern)

• Chronic inflammation of lymphatics due to repeated infection

• Lymphatic obstruction → accumulation of lymph → lymphedema

• Progressive fibrosis → elephantiasis

• Secondary bacterial infections may worsen the condition

CLINICAL FEATURES (Modern)

• Swelling of the limbs, usually lower limb, unilateral

• Thickening of the skin

• Non-pitting edema

• Recurrent fevers (acute filarial lymphangitis)

• Secondary infections, abscesses, ulcers

• Disfigurement and disability in advanced stages