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→Prognosis of udara roga
balinastadajAtAmbu yatnasAdhyaM navotthitam||54||
balinastadajAtAmbu yatnasAdhyaM navotthitam||54||
Among the list of ''vatodara, pittodara, kaphodara, plihodara, sannipatodara'' and ''jalodara'' (ascites); the later ones are more and more difficult to cure. After a fortnight the ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) and udara that presents with accumulation of fluid are incurable. Mostly chhidrodara (enlargement of abdomen due to intestinal perforation) is fatal. The treatment should be avoided in patients of udara presenting with periorbital edema, distorted genitalia, moistening and thinning of the skin, severe reduction in the physical strength, severe depletion in the blood, severe wasting of the body flesh and severe impairement in the agni.
Among the list of ''vatodara, pittodara, kaphodara, plihodara, sannipatodara'' and ''jalodara'' (ascites); the later ones are more and more difficult to cure. After a fortnight the ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''udara'' that presents with accumulation of fluid are incurable. Mostly ''chhidrodara'' (enlargement of abdomen due to intestinal perforation) is fatal. The treatment should be avoided in patients of ''udara'' presenting with peri-orbital edema, distorted genitalia, moistening and thinning of the skin, severe reduction in the physical strength, severe depletion in the blood, severe wasting of the body flesh and severe impairment in the ''agni''.
The development of symptoms like edema involving all vital parts, breathlessness, hiccough, tastelessness in the mouth, transient loss of consciousness, vomiting and diarrhea kills the patients of udara roga.
The development of symptoms like edema involving all vital parts, breathlessness, hiccough, tastelessness in the mouth, transient loss of consciousness, vomiting and diarrhea kills the patients of ''udara roga''.
The udara is difficult to cure from the very onset itself but if the patient is physically strong, in state of ajatodaka (initial phase of distension of abdomen with slight fluid accumulation) and the udara of recent onset can be managed only with energetic treatment [50-54].
The ''udara'' is difficult to cure from the very onset itself but if the patient is physically strong, in state of ''ajatodaka'' (initial phase of distension of abdomen with slight fluid accumulation) and the ''udara'' of recent onset can be managed only with energetic treatment [50-54].
==== Symptoms of ''ajatodaka udara roga'' ====
अजातशोथमरुणं सशब्दं नातिभारिकम्|
अजातशोथमरुणं सशब्दं नातिभारिकम्|
सदा गुडगुडायच्च सिराजालगवाक्षितम्||५५||
सदा गुडगुडायच्च सिराजालगवाक्षितम्||५५||
नाभिं विष्टभ्य पायौ तु वेगं कृत्वा प्रणश्यति|
नाभिं विष्टभ्य पायौ तु वेगं कृत्वा प्रणश्यति|
हृन्नाभिवङ्क्षणकटीगुदप्रत्येकशूलिनः||५६||
हृन्नाभिवङ्क्षणकटीगुदप्रत्येकशूलिनः||५६||
कर्कशं सृजतो वातं नातिमन्दे च पावके|
कर्कशं सृजतो वातं नातिमन्दे च पावके|
लोलस्याविरसे चास्ये मूत्रेऽल्पे संहते विषि||५७||
लोलस्याविरसे चास्ये मूत्रेऽल्पे संहते विषि||५७||
अजातोदकमित्येतैर्लिङ्गैर्विज्ञाय तत्त्वतः|
अजातोदकमित्येतैर्लिङ्गैर्विज्ञाय तत्त्वतः|
उपाक्रमेद्भिषग्दोषबलकालविशेषवित्||५८||
उपाक्रमेद्भिषग्दोषबलकालविशेषवित्||५८||
ajātaśōthamaruṇaṁ saśabdaṁ nātibhārikam|
ajātaśōthamaruṇaṁ saśabdaṁ nātibhārikam|
sadā guḍaguḍāyacca sirājālagavākṣitam||55||
sadā guḍaguḍāyacca sirājālagavākṣitam||55||
nābhiṁ viṣṭabhya pāyau tu vēgaṁ kr̥tvā praṇaśyati|
nābhiṁ viṣṭabhya pāyau tu vēgaṁ kr̥tvā praṇaśyati|
hr̥nnābhivaṅkṣaṇakaṭīgudapratyēkaśūlinaḥ||56||
hr̥nnābhivaṅkṣaṇakaṭīgudapratyēkaśūlinaḥ||56||
karkaśaṁ sr̥jatō vātaṁ nātimandē ca pāvakē|
karkaśaṁ sr̥jatō vātaṁ nātimandē ca pāvakē|
lōlasyāvirasē cāsyē mūtrē'lpē saṁhatē viṣi||57||
lōlasyāvirasē cāsyē mūtrē'lpē saṁhatē viṣi||57||
ajātōdakamityētairliṅgairvijñāya tattVātaḥ|
ajātōdakamityētairliṅgairvijñāya tattVātaḥ|
upākramēdbhiṣagdōṣabalakālaviśēṣavit||58||
upākramēdbhiṣagdōṣabalakālaviśēṣavit||58||
ajAtashothamaruNaM [1] sashabdaM nAtibhArikam|
ajAtashothamaruNaM [1] sashabdaM nAtibhArikam|
sadA guDaguDAyacca [2] sirAjAlagavAkShitam||55||
sadA guDaguDAyacca [2] sirAjAlagavAkShitam||55||
nAbhiM viShTabhya pAyau [3] tu vegaM kRutvA praNashyati|
nAbhiM viShTabhya pAyau [3] tu vegaM kRutvA praNashyati|
hRunnAbhiva~gkShaNakaTIgudapratyekashUlinaH||56||
hRunnAbhiva~gkShaNakaTIgudapratyekashUlinaH||56||
karkashaM sRujato vAtaM nAtimande ca pAvake|
karkashaM sRujato vAtaM nAtimande ca pAvake|
lolasyAvirase [4] cAsye mUtre~alpe saMhate viShi||57||
lolasyAvirase [4] cAsye mUtre~alpe saMhate viShi||57||
ajAtodakamityetairli~ggairvij~jAya tattvataH|
ajAtodakamityetairli~ggairvij~jAya tattvataH|
upAkramedbhiShagdoShabalakAlavisheShavit||58||
upAkramedbhiShagdoShabalakAlavisheShavit||58||
State of ajatodaka (initial phase of distension of abdomen without fluid accumulation) of the Udara is presents with symptoms such as pink coloration of distended abdomen, increased gurgling sound, comparatively less heaviness of the abdomen, persistent gurgling sound, abdomen covered with network of distended veins, the flatus frequently generates urges to pass with distention of the umbilical region and then fades away with of farting, pain in the cardiac region, umbilical region, groin, sacral region and anal part, passing of flatus with loud sound, less severe impairment of digestion, tastelessness in the mouth, reduced urination and constipation. This state of ajatodaka should be treated with the due consideration of degree of morbidity of dosha as well as time [55-58].
Treatment of vātodara:
State of ''ajatodaka'' (initial phase of distension of abdomen without fluid accumulation) of the ''udara'' is presents with symptoms such as pink coloration of distended abdomen, increased gurgling sound, comparatively less heaviness of the abdomen, persistent gurgling sound, abdomen covered with network of distended veins, the flatus frequently generates urges to pass with distention of the umbilical region and then fades away with of farting, pain in the cardiac region, umbilical region, groin, sacral region and anal part, passing of flatus with loud sound, less severe impairment of digestion, tastelessness in the mouth, reduced urination and constipation. This state of ''ajatodaka'' should be treated with the due consideration of degree of morbidity of ''dosha'' as well as time [55-58].
==== Treatment of ''vatodara'' ====
वातोदरं बलमतः पूर्वं स्नेहैरुपाचरेत्|
वातोदरं बलमतः पूर्वं स्नेहैरुपाचरेत्|
स्निग्धाय स्वेदिताङ्गाय दद्यात् स्नेहविरेचनम्||५९||
स्निग्धाय स्वेदिताङ्गाय दद्यात् स्नेहविरेचनम्||५९||
हृते दोषे परिम्लानं वेष्टयेद्वाससोदरम्|
हृते दोषे परिम्लानं वेष्टयेद्वाससोदरम्|
तथाऽस्यानवकाशत्वाद्वायुर्नाध्मापयेत् पुनः||६०||
तथाऽस्यानवकाशत्वाद्वायुर्नाध्मापयेत् पुनः||६०||
vātōdaraṁ balamataḥ pūrvaṁ snēhairupācarēt|
vātōdaraṁ balamataḥ pūrvaṁ snēhairupācarēt|
snigdhāya svēditāṅgāya dadyāt snēhavirēcanam||59||
snigdhāya svēditāṅgāya dadyāt snēhavirēcanam||59||
hr̥tē dōṣē parimlānaṁ vēṣṭayēdvāsasōdaram|
hr̥tē dōṣē parimlānaṁ vēṣṭayēdvāsasōdaram|
tathā'syānavakāśatvādvāyurnādhmāpayēt punaḥ||60||
tathā'syānavakāśatvādvāyurnādhmāpayēt punaḥ||60||
vAtodaraM balamataH pUrvaM snehairupAcaret|
vAtodaraM balamataH pUrvaM snehairupAcaret|
snigdhAya sveditA~ggAya dadyAt snehavirecanam||59||
snigdhAya sveditA~ggAya dadyAt snehavirecanam||59||
hRute doShe parimlAnaM veShTayedvAsasodaram|
hRute doShe parimlAnaM veShTayedvAsasodaram|
tathA~asyAnavakAshatvAdvAyurnAdhmApayet punaH||60||
tathA~asyAnavakAshatvAdvAyurnAdhmApayet punaH||60||
Patient of vātodara who is physically strong should be initially treated with unctuous medications. Then after the snehana is completed, abhyanga (unctuous massage) and sweda (sudation) is done. Then the sneha virechana (purgation with unctuous purgatives) should be given. After elimination of dosha with shodhana (purification procedure) the abdomen should be tightly bandaged so that no space is left in the abdomen for the morbid vāta to cause distension of the abdomen again [59-60].
Patient of ''vatodara'' who is physically strong should be initially treated with unctuous medications. Then after the ''snehana'' is completed, ''abhyanga'' (unctuous massage) and ''sweda'' (sudation) is done. Then the ''sneha virechana'' (purgation with unctuous purgatives) should be given. After elimination of ''dosha'' with ''shodhana'' (purification procedure) the abdomen should be tightly bandaged so that no space is left in the abdomen for the morbid ''vata'' to cause distension of the abdomen again [59-60].
Post virechana regimen:
==== Post ''virechana'' regimen ====
दोषातिमात्रोपचयात् स्रोतोमार्गनिरोधनात्|
दोषातिमात्रोपचयात् स्रोतोमार्गनिरोधनात्|
सम्भवत्युदरं तस्मान्नित्यमेव विरेचयेत्||६१||
सम्भवत्युदरं तस्मान्नित्यमेव विरेचयेत्||६१||
शुद्धं संसृज्य च क्षीरं बलार्थं पाययेत्तु तम्|
शुद्धं संसृज्य च क्षीरं बलार्थं पाययेत्तु तम्|
प्रागुत्क्लेशान्निवर्त्यं च बले लब्धे क्रमात् पयः||६२||
प्रागुत्क्लेशान्निवर्त्यं च बले लब्धे क्रमात् पयः||६२||
यूषै रसैर्वा मन्दाम्ललवणैरेधितानलम्|
यूषै रसैर्वा मन्दाम्ललवणैरेधितानलम्|
dōṣātimātrōpacayāt srōtōmārganirōdhanāt|
dōṣātimātrōpacayāt srōtōmārganirōdhanāt|
sambhavatyUdaraṁ tasmānnityamēva virēcayēt||61||
sambhavatyUdaraṁ tasmānnityamēva virēcayēt||61||
śuddhaṁ saṁsr̥jya ca kṣīraṁ balārthaṁ pāyayēttu tam|
śuddhaṁ saṁsr̥jya ca kṣīraṁ balārthaṁ pāyayēttu tam|
prāgutklēśānnivartyaṁ ca balē labdhē kramāt payaḥ||62||
prāgutklēśānnivartyaṁ ca balē labdhē kramāt payaḥ||62||
yūṣai rasairvā mandāmlalavaṇairēdhitānalam|
yūṣai rasairvā mandāmlalavaṇairēdhitānalam|
doShAtimAtropacayAt srotomArganirodhanAt|
doShAtimAtropacayAt srotomArganirodhanAt|
sambhavatyudaraM tasmAnnityameva virecayet||61||
sambhavatyudaraM tasmAnnityameva virecayet||61||
shuddhaM saMsRujya ca kShIraM balArthaM pAyayettu tam|
shuddhaM saMsRujya ca kShIraM balArthaM pAyayettu tam|
prAgutkleshAnnivartyaM ca bale labdhe kramAt payaH||62||
prAgutkleshAnnivartyaM ca bale labdhe kramAt payaH||62||
yUShai rasairvA mandAmlalavaNairedhitAnalam|
yUShai rasairvA mandAmlalavaNairedhitAnalam|
''Udara'' is caused due to the obliteration of the body channels leading to accumulation of morbid ''dosha''. Hence ''udara'' should be treated by regular ''virechana'' (therapeutic purgation). After the purgation, with an intention to improve the physical strength and to relieve the strain of purgation, the patient should be given milk. Gradually as the patient regains strength by the intake of milk, his functioning of the ''agni'' should be improved by giving ''yusha'' (cereal soup) or meat soup added with little salt [61-62].
==== Role of ''asthapana basti'' ====
सोदावर्तं पुनः स्निग्धं स्विन्नमास्थापयेन्नरम्||६३||
सोदावर्तं पुनः स्निग्धं स्विन्नमास्थापयेन्नरम्||६३||
स्फुरणाक्षेपसन्ध्यस्थिपार्श्वपृष्ठत्रिकार्तिषु|
स्फुरणाक्षेपसन्ध्यस्थिपार्श्वपृष्ठत्रिकार्तिषु|
sōdāvartaṁ punaḥ snigdhaṁ svinnamāsthāpayēnnaram||63||
sōdāvartaṁ punaḥ snigdhaṁ svinnamāsthāpayēnnaram||63||
sphuraṇākṣēpasandhyasthipārśvapr̥ṣṭhatrikārtiṣu|
sphuraṇākṣēpasandhyasthipārśvapr̥ṣṭhatrikārtiṣu|
sodAvartaM punaH snigdhaM svinnamAsthApayennaram||63||
sodAvartaM punaH snigdhaM svinnamAsthApayennaram||63||
sphuraNAkShepasandhyasthipArshvapRuShThatrikArtiShu|
sphuraNAkShepasandhyasthipArshvapRuShThatrikArtiShu|
If the patient has udāvarta (reversed course of vāta in the abdomen), sphurana (fasciculation), akshepa (involuntary movements), pain in the joints, bone, sides of the abdomen, back and sacral region; then again after performing oleation and sudation asthāpana basti (decoction enema) is given [63].
If the patient has ''udavarta'' (reversed course of ''vata'' in the abdomen), ''sphurana'' (fasciculation), ''akshepa'' (involuntary movements), pain in the joints, bone, sides of the abdomen, back and sacral region; then again after performing oleation and sudation ''asthapana basti'' (decoction enema) is given [63].
Role of anuvāsana basti:
==== Role of ''anuvasana basti'' ====
दीप्ताग्निं बद्धविड्वातं रूक्षमप्यनुवासयेत्||६४||
दीप्ताग्निं बद्धविड्वातं रूक्षमप्यनुवासयेत्||६४||
dīptāgniṁ baddhaviḍvātaṁ rūkṣamapyanuvāsayēt||64||
dīptāgniṁ baddhaviḍvātaṁ rūkṣamapyanuvāsayēt||64||
dIptAgniM baddhaviDvAtaM rUkShamapyanuvAsayet||64||
dIptAgniM baddhaviDvAtaM rUkShamapyanuvAsayet||64||
If the patient has strong digestive power and suffers from obstructed bowel movement and flatus as well as with dryness of the body; then he should be treated by ''anuvasana basti'' (oily enema) [64]
==== ''Dashamula niruha basti'' ====
तीक्ष्णाधोभागयुक्तोऽस्य निरूहो दाशमूलिकः|
तीक्ष्णाधोभागयुक्तोऽस्य निरूहो दाशमूलिकः|
tīkṣṇādhōbhāgayuktō'sya nirūhō dāśamūlikaḥ|
tīkṣṇādhōbhāgayuktō'sya nirūhō dāśamūlikaḥ|
tIkShNAdhobhAgayukto~asya nirUho dAshamUlikaH|
tIkShNAdhobhAgayukto~asya nirUho dAshamUlikaH|
Niruha basti (decoction enema) prepared with dashamula [bilva (Aegle marmelos Corr), agnimantha (Clerodendrum phlomidis Linn. f), shyonāka (Oroxylum indicum Vent), kāshmari (Gmelina arborea), pātalā (Stereospermum suaveolens), shālaparni (Desmodium gangeticum DC), prishniparni (Uraria picta Desv), brihati (Solanum indicum Linn), kantakāri (Solanum surattense Burm. f) and gokshura (Tribulus terrestris Linn)] added with potent purgatives should be given to the patients.[65]
''Niruha basti'' (decoction enema) prepared with ''dashamula'' (''bilva'' (Aegle marmelos Corr), ''agnimantha'' (Clerodendrum phlomidis Linn. f), ''shyonaka'' (Oroxylum indicum Vent), ''kashmari'' (Gmelina arborea), ''patala'' (Stereospermum suaveolens), ''shalaparni'' (Desmodium gangeticum DC), ''prishniparni'' (Uraria picta Desv), ''brihati'' (Solanum indicum Linn), ''kantakari'' (Solanum surattense Burm. f) and g''okshura'' (Tribulus terrestris Linn)) added with potent purgatives should be given to the patients.[65]
वातघ्नाम्लशृतैरण्डतिलतैलानुवासनम्||६५||
वातघ्नाम्लशृतैरण्डतिलतैलानुवासनम्||६५||
vātaghnāmlaśr̥tairaṇḍatilatailānuvāsanam||65||
vātaghnāmlaśr̥tairaṇḍatilatailānuvāsanam||65||
vAtaghnAmlashRutairaNDatilatailAnuvAsanam||65||
vAtaghnAmlashRutairaNDatilatailAnuvAsanam||65||
Anuvasana basti (oily enema) should be given with eranda taila (castor oil) or Tila taila (sesame oil) processed with sour and anti vāta drugs [65].
''Anuvasana basti'' (oily enema) should be given with ''eranda taila'' (castor oil) or ''tila taila'' (sesame oil) processed with sour and anti ''vata'' drugs [65].
Indications for palliative (shamana) treatment:
==== Indications for palliative (''shamana'') treatment ====
अविरेच्यं तु यं विद्याद्दुर्बलं स्थविरं शिशुम्|
अविरेच्यं तु यं विद्याद्दुर्बलं स्थविरं शिशुम्|
सुकुमारं प्रकृत्याऽल्पदोषं वाऽथोल्बणानिलम्||६६||
सुकुमारं प्रकृत्याऽल्पदोषं वाऽथोल्बणानिलम्||६६||
तं भिषक् शमनैः सर्पिर्यूषमांसरसौदनैः|
तं भिषक् शमनैः सर्पिर्यूषमांसरसौदनैः|
बस्त्यभ्यङ्गानुवासैश्च क्षीरैश्चोपाचरेद्बुधः||६७||
बस्त्यभ्यङ्गानुवासैश्च क्षीरैश्चोपाचरेद्बुधः||६७||
avirēcyaṁ tu yaṁ vidyāddurbalaṁ sthaviraṁ śiśum|
avirēcyaṁ tu yaṁ vidyāddurbalaṁ sthaviraṁ śiśum|
sukumāraṁ prakr̥tyā'lpadōṣaṁ vā'thōlbaṇānilam||66||
sukumāraṁ prakr̥tyā'lpadōṣaṁ vā'thōlbaṇānilam||66||
taṁ bhiṣak śamanaiḥ sarpiryūṣamāṁsarasaudanaiḥ|
taṁ bhiṣak śamanaiḥ sarpiryūṣamāṁsarasaudanaiḥ|
bastyabhyaṅgānuvāsaiśca kṣīraiścōpācarēdbudhaḥ||67||
bastyabhyaṅgānuvāsaiśca kṣīraiścōpācarēdbudhaḥ||67||
avirecyaM tu yaM vidyAddurbalaM sthaviraM shishum|
avirecyaM tu yaM vidyAddurbalaM sthaviraM shishum|
sukumAraM prakRutyA~alpadoShaM vA~atholbaNAnilam||66||
sukumAraM prakRutyA~alpadoShaM vA~atholbaNAnilam||66||
taM bhiShak shamanaiH sarpiryUShamAMsarasaudanaiH|
taM bhiShak shamanaiH sarpiryUShamAMsarasaudanaiH|
bastyabhya~ggAnuvAsaishca kShIraishcopAcaredbudhaH||67||
bastyabhya~ggAnuvAsaishca kShIraishcopAcaredbudhaH||67||
The patient who is debilitated, aged, children, having delicate constitution, minimal morbidity of dosha and dominant vitiation of vāta and unfit for virechana karma (therapeutic purgation) should be treated by palliative (shamana) measures. Shamana treatment comprises use of medicated ghee, meat soup, rice, oil massage and milk. Such patients may also be given anuvāsana basti (oily enema).[66-67].
The patient who is debilitated, aged, children, having delicate constitution, minimal morbidity of dosha and dominant vitiation of vāta and unfit for virechana karma (therapeutic purgation) should be treated by palliative (shamana) measures. Shamana treatment comprises use of medicated ghee, meat soup, rice, oil massage and milk. Such patients may also be given anuvāsana basti (oily enema).[66-67].
Treatment of pittodara:
Treatment of pittodara: