It consist of leukocytes movement from intravascular lumen to the site of i

Inflammation (Introduction) :

Inflammation in simple words may be defined as a fundamental protective response.

There are mainly 4 cardinal signs of inflammation given by Celsius

W- Warmth( Latin- Calor)

E- Erythema (Latin-rubor)

E- Edema (Latin – Tumor)

P- Pain( Latin-dolor)

Note- Fifth sign was given by Virchow- Loss of function ( Latin-function laesa)

Events that take place in Inflammation-

a)Vasoconstriction- It is the earliest and transient change in acute inflammation

b)Vasodilation

c)Increase in vascular permeability- Hallmark of acute inflammation, It affects venules mostly

d)Stasis- Increase vascular dilatation and fluid loss will increase viscosity and RBC concentration to develop stasis.

Cellular Events

It consist of leukocytes movement from intravascular lumen to the site of inflammation

It has following steps,

1)Margination- In this the leukocytes are the periphery of blood vessels and transiently adhered to endothelium.

2)Rolling- It means movement of leukocytes with intermittent attachment and detachment of receptors with endothelium.

3)Adhesion- It means firm adhesion of the leukocytes to the endothelial cells.

4)Pavementing- Endothelial lining covered by leukocytes.

5)Diapedesis- Occurs mainly in post capillary venules except in lungs where it occurs at capillaries. Transmigration of leukocytes through endothelial gap

6)Chemotaxis- Unidirectional movement of leukocytes towards chemotactic stimuli.

7)Phagocytosis- Cells are monocytes, neutrophils, macrophages, eosinophils consist of recognition and attachment ,engulfment, killing and degradation of microbes.

Inflammatory Mediators

–Cellular ( present within cells)

–Plasma (synthesized by liver and secreted in plasma).

Cellular Mediators–

Histamine– Synthesized from histidine amino acids.Mast cells are the richest source.

Function:-

Mainly vasodilation ( induce vasoconstriction of large arteries).
Increase vascular permeability.
Increase smooth muscle contraction.

Serotonin

Platelets are the richest source.

Increase vascular permeability.

Bronchoconstriction.

Lysosomal Enzymes

Present in lysosomes of neutrophil and monocytes.

Neuropeptides

They are secreted by sensory nerves and leukocytes.

Actions are

Pain signal transmission.
Blood pressure regulation.

Newly Synthesized Cellular Mediators

Mainly formed during process of inflammation.

They are

Nitric oxide (NO)– Synthesized from arginine amino acids by enzyme nitric oxide synthase.

Function

Vasodilation
Platelet anti- aggregators

Cytokines

Soluble polypeptides

Secreted by hematopoietic and non hematopoietic cells.

Secreted by hematopoietic and non hematopoietic cells.
Involved in inflammation, immunological reactions and would healing.

Chemokines

Stimulate leukocytes movement
Family of small proteins.

Platelet Activating Factor

Phospholipid derived Mediator
Most potent inflammatory mediators

Actions are

Platelet aggregation
Vasoconstriction
Transmits signals between cells.
At low concentrations it induces vasodilation and increase vascular permeability.

Arachidonic Acid Metabolites

It is a 20 carbon polyunsaturated fatty acid derieved from essential fatty acid linoleic acid.

Morphologic patterns of Acute Inflammation

They are of following types,

Serous Inflammation – When fluid exudate resembles serum or is watery.
Fibrinous Inflammation- Fibrin content of the fluid exudate is high.
Purulent Inflammation- Formation of creamy pus as seen in infection with pyogenic bacteria.
Hemorrhagic Inflammation- It involves vascular damage.
Mucoid Inflammation – when surface inflammation of epithelium produces increased secretion of mucus.

Chronic Inflammation

It consists of 3 features,

Mononuclear Inflammatory cells infiltration
Tissue destruction
Wound Healing

Wound Healing and Repair

It consists of 3 processes (3R)

R- Resolution (Ideal outcome of healing seen in acute Inflammatory response to minor injuries).
R- Regeneration
R- Repair by scar tissue formation

In Ayurveda we may compare Inflammation to shotha

Types of shoth (Acc To Charak)

Nija
Aaguntaj

According to Doshas,

Vataj

Pittaj

Kaphaj

According to Sushruta it is classified into,

Ekanga shoth- Vataj,Pittaj, Kaphaj, Raktaj, sannipataj, aganiya.

Sarvang shoth- Vataj, Pittaj, Kaphaj and Vishjanya.

Causes of Nija Shoth

Eating curd,polluted food , eating highly warm ,sour food,not following the rule of Dietic compabilities
Doing excessive horse or elephant riding
Improper treatment
Arsha(piles)
Keeping body untidy and doing proper shodhana of the body
Shwasa(Pulmonary diseases),Kasa(cough),Atisara(Diarrhoea),Anaemia etc are also some of its causes.

Causes of Aaguntuja shoth

Wounding of skin by fire ,weapon ,poison etc due to which skin becomes polluted.

Samprapti

Polluted vata affects the outer sira( veins)
Due to which Kapha,Rakta and Pitta also becomes polluted.
Polluted kapha,Rakta,Pitta hinders the path of Vata
Vata gets deviated from path
Due to which shoth develops.

Treatment

Primary Treatment,

Aamaj shoth- treatment (Langhan- Pachan).
Vataj shoth- Niruhan.
Vataj-Pittaj- Tikta dravya sidha ghrita.
Upper body part shoth- Vaman
Kaphaj shoth- char,katu,ushna( warm ) dravya should be used .Substances like Urine ,Aasavs,Takra are also used to get relief in shoth.

Things that should be avoided in shoth

Sleeping in noon.
Use of Alcohol.
Curd.
Meat of animals having high fat content.
Dry and heavy food which is hard to digest and not suitable for health

According to Sushruta things that should be avoided:-

Sour ,salty food should be avoided,curd, jaggery, animal fat ,oil,ghee and unhealthy and food hard to digest should be avoided.

Ayurvedic medicines used in Shotha

Aadrak Ghrita
Abhya Ghrita
Dashmool Haritiki
Mahatikta Ghrita
Kalyanak Ghrita

According to Charak other instructions and Yog

One should leave food and water and should consume warm milk for one week to one month
One should drink cow milk + cow urine
One should drink Buffalo milk+ Buffalo urine

Other medicines