HTML Full Text

Introduction

Edema is defined as an abnormal accumulation of fluid in the interstitial spaces. Bilateral pedal edema is commonly seen in systemic conditions like heart failure, chronic kidney disease, liver cirrhosis, and uncontrolled hypertension. Modern management includes diuretics and control of underlying disease. In Ayurveda, such swelling is described under the term Shotha, these are swellings which may have foreign (agantuja) or endogenous (nija) etiological causes. Three doshas are involved in all swelling forms, but the dosha's dominance determines the nomenclature, which may be generalized (Sarvanga Shotha) or localized (Ekanga Shotha)[1]. According to Sushruta Acharaya, in Kaphaja shotha to determine its Pakva-Apakva Avastha (ripe-unripe stage), diseases caused by Kapha dosha or sometimes due to inflammation caused by trauma, being settled in deep dhatus, when complete symptoms of inflammation are not visible, the vaidya makes the mistake of considering the ripe inflammation to be unripe. Where there is colour of the skin, cold edema, stability, less pain and hardness like stone in the inflammation, it should be considered as Pakva Avastha[2]. Generally causes include vitiation of Tridosha, obstruction of Srotas, and impaired circulation of Rasa and Rakta Dhatu. In hypertensive patients, Vyana Vayu dushti with Raktavaha and Udakavaha Srotas dushti plays a role. This paper presents a case study of a hypertensive patient with bilateral pedal edema, managed with Ayurvedic interventions.

Case Report

Patient Information

Age/Gender: 61-year-old male Occupation: Salesmen Presenting Complaints: Ubhay Pada Shotha (Swelling in both legs) (non-pitting type), Pada Gauravta (heaviness), Pada Kriya kashtata (difficulty in prolonged standing and walking) – since 1 year.
History: Known case of hypertension for 10 years, on regular allopathic medication (Tab Amlodipine 5 mg + Telmisartan 40mg OD).
No history of: Diabetes, renal disease, or liver disease.

Clinical Examination

General: Normal physique, pulse 84/min, BP 150/92 mmHg.Local:

- Bilateral pedal edema (Grade II, Non-pitting).

 - Mild tenderness, heaviness reported.
Systemic Examination: Normal cardiac and respiratory findings.

Examination (Ayurvedic Assessment)

Nidana: Aharaja (excess salt, heavy diet), Viharaja (sedentary lifestyle)

Lakshana: Shotha (non-pitting edema), Gaurava (heaviness)

Dosha: Predominantly Kapha–Vata

Dushya: Rasa, Rakta, Meda Srotas involved: Rasavaha, Raktavaha, Medovaha Srotorodha hetu: Hypertension-related vascular changes

Diagnosis

Modern: Bilateral pedal edema in a hypertensive patient.

Ayurvedic: Vata-Kaphaja Shotha (Sarvanga Shotha of lower limb predominance).

Discussion

Bilateral pedal edema in hypertensive patients is primarily a consequence of vascular congestion, increased hydrostatic pressure, and chronic fluid retention, which often complicates the management of long-standing hypertension. In Ayurvedic terms, this condition is interpreted as a manifestation of Vata-Kapha Dosha imbalance, resulting in Shotha (edema). Vata governs movement and fluid circulation, while Kapha contributes to fluid accumulation and tissue stagnation, explaining the pathophysiology of edema in this framework.

The treatment regimen focused on Dosha balancing, Dhatu correction, and metabolic normalization using classical Ayurvedic herbs and formulations:

• Punarnava (Boerhavia diffusa): Exhibits Mutrala (diuretic), Shothahara (anti-edema), and Lekhana (scraping/clearing) properties, which facilitate removal of excess extracellular fluid. Its efficacy in reducing edema has been supported by previous pharmacological studies demonstrating enhanced renal excretion and anti-inflammatory effects.
• Gokshura (Tribulus terrestris): With Mutrala and Balya properties, it supports the urinary system, promoting diuresis, which is crucial for mobilizing and eliminating retained fluids in hypertensive edema.
• Arogyavardhini Vati: Acts as Agni Deepaka (digestive/metabolic stimulant), Rakta Shuddhi (blood purifier), and metabolic corrector, addressing underlying Rasa and Rakta Dhatu imbalances, which may contribute to fluid retention.
• Gandharva Haritaki: Provides mild Anulomana, regulating bowel function and ensuring proper excretion and metabolism, further supporting fluid homeostasis.

The combination therapy resulted in a marked reduction in pedal edema, alleviation of heaviness, and improved quality of life. The integrative approach aligns with Ayurvedic principles of holistic care, targeting the root causes of edema rather than only symptomatic relief. Moreover, previous studies validate the diuretic and Shothahara activity of Punarnava, reinforcing its role in managing edema.

Conclusion

The present case demonstrates that Ayurvedic management, employing a combination of Punarnava Mandur, Punarnavadi Kashaya, Gokshuradi Guggulu, Arogyavardhini Vati, and Gandharva Haritaki Churna, can provide effective symptomatic relief in bilateral pedal edema associated with hypertension. Each of these interventions contributes through complementary mechanisms: diuresis, Shothahara (anti-edema) action, metabolic correction, and Dosha balance, addressing both the underlying pathophysiology and the symptoms of edema. The patient experienced a marked reduction in swelling, alleviation of heaviness, and improved ambulation, reflecting not only symptomatic improvement but also enhancement in quality of life.