Prasrita Yogiyam Siddhi

Siddhi Sthana Chapter 8. Standardized therapeutic enema formulations in a dose of Prasrita Unit

Prasrita Yogiyam Siddhi

Section/Chapter	Siddhi Sthana Chapter 8
Preceding Chapter	Bastivyapat Siddhi
Succeeding Chapter	Trimarmiya Siddhi
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana
Translator and commentator	Gupta S.N.
Reviewer	Panse A.
Editors	Thakar A. B., Mangalasseri P., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s08.009

Abstract

This chapter describes recipes of prasritayogiya bastis (enema formulation in which ingredients are measured in unit of prasrita). Prasrita is a measurement, which is approximately equal to 100 millilitre. Nine types of basti therapies for various clinical conditions including prameha (urinary disorders including diabetes), abhishyanda (oozing), kushtha (skin diseases), krimi (worm infestation), mutrakrichchra (dysuria) and alike are described. Atisara, a clinical condition characterized by frequent defecation with altered composition and consistency of stool is described in detail. Atisara has various forms depending upon involvement of six morbid components in the pathogenesis viz. ama (stool with undigested material), shakrita (stool only), vata (with dominant flatulence), asrik (stool with blood), pitta and kapha. Different recipes of basti, oral medicaments and food preparations are described to treat these atisara conditions. These remedies are practically quite useful in several modern diseases like ulcerative colitis and irritable bowel syndrome.
Keywords: atisara, basti, doshanulomana, grahi, karsha, karmanaviplutanam, niruha, pachana, Panchakarma, prasrita, prastha, snehabasti, vyapat, enema in delicate persons, complication of Panchakarma.

Introduction

There are two main types of basti according to the composition and the action. Anuvasana basti is composed of unctuous substance and it is to be retained for minimum nine hours. Asthapana basti contains mainly decoction with least oil and is evacuated after few minutes. Basti is administered through ano-rectal route and acting through the pakvashaya (colon). It is useful in several diseases particularly vata disorders having roots in pakvashaya. It is claimed to be half a treatment or even a complete treatment by ancient practitioners. It is not only a procedure of shodhana but also providing a recto-colonic route of drug administration.

Previous chapter (Bastivyapat Siddhi) deals with the vyapat (complications) arising due to faulty application of bastis. Present chapter begins with the treatment of those patients who developed complications as a result of faulty application of therapies (karmana viplutanam) and for the tender persons who are not able to tolerate strong measures. For this purpose, chapter describes mild form of niruha bastis. The ingredients of these bastis are measured in the unit of prasrita. Therefore the name of the chapter is Prasrita Yogiyam Siddhi. The unit prasrita is equal to two palas, which is approximately equal to 100 milliliter (1 pala= approx. 50 ml).

Sanskrit text, Transliteration and English Translation

अथातः प्रासृतयोगीयां सिद्धिं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

Athātaḥ prāsṛtayōgīyāṁ siddhiṁ vyākhyāsyāmaḥ ||1||

iti ha smāha bhagavānātrēyaḥ ||2||

athAtaH prAsRutayogIyAM siddhiM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Prasrita Yogiyam Siddhi" (Standardized therapeutic enema formulations in a dose of Prasrita Unit). Thus said Lord Atreya. [1-2]

Note: The chapter describes the formulations having ingredients measured in the unit prasrita(approximately equal to 100 millilitre).

Objective of prasrita basti

अथेमान् सुकुमाराणां निरूहान् स्नेहनान् मृदून्|

कर्मणा विप्लुतानां च वक्ष्यामि प्रसृतैः पृथक्||३||

athēmān sukumārāṇāṁ nirūhān snēhanān mṛdūn|

karmaṇā viplutānāṁ ca vakṣyāmi prasṛtaiḥ pṛthak||3||

athemAn sukumArANAM nirUhAn snehanAn mRudUn|

karmaNA viplutAnAM ca vakShyAmi prasRutaiH pRuthak||3||

Now, I (Atreya) shall explain oleaginous and mild form of niruha bastis, for the tender persons and the patients suffered from complications as a result of therapies. Composition of those will be in the unit of prasrita. [3]

Pancha prasritiki Basti-I

क्षीराद्द्वौ प्रसृतौ कार्यौ मधुतैलघृतात्त्रयः|

खजेन मथितो बस्तिर्वातघ्नो बलवर्णकृत्||४||

kṣīrāddvau prasṛtau kāryau madhutailaghṛtāttrayaḥ|

khajēna mathitō bastirvātaghno balavarṇakṛt||4||

kShIrAddvau prasRutau kAryau madhutailaghRutAttrayaH|

khajena mathito bastirvAtaghno balavarNakRut||4||

Two prasritas of milk and three prasritas of madhu (honey), taila (sesame oil) and ghrita (clarified butter) are taken together and churned with a churning stick. This basti eliminates vata, and promotes strength as well as complexion. [4]

Ashta-prasritiki basti

एकैकः प्रसृतस्तैलप्रसन्नाक्षौद्रसर्पिषाम्|

बिल्वादिमूलक्वाथाद्द्वौ कौलत्थाद्द्वौ स वातनुत्||५||

ēkaikaḥ prasṛtastailaprasannākṣaudrasarpiṣām|

bilvādimūlakvāthāddvau kaulatthāddvau sa vātanut||5||

ekaikaH prasRutastailaprasannAkShaudrasarpiShAm|

bilvAdimUlakvAthAddvau kaulatthAddvau sa vAtanut||5||

Basti, composed of one prasrita each of taila (sesame oil), prasanna(supernatant part of sura- a type of alcoholic preparation), kshaudra (honey) and ghrita (clarified butter) and two prasritas each of the decoctions of roots of bilvadi (a group of plants that begins with bilva-Aegle marmelos Carr.) as well as two prasritas of kulattha (Phaseolus biflorus Linn.), antagonizes vata. [5]

Nava--prasritiki basti

पञ्चमूलरसात् पञ्च द्वौ तैलात् क्षौद्रसर्पिषोः|

एकैकः प्रसृतो बस्तिः स्नेहनीयोऽनिलापहः||६||

pañcamūlarasāt pañca dvau tailāt kṣaudrasarpiṣoḥ|

ēkaikaḥ prasṛto bastiḥ snēhanīyō'nilāpahaḥ||6||

pa~jcamUlarasAt pa~jca dvau tailAt kShaudrasarpiShoH|

ekaikaH prasRuto bastiH snehanIyo~anilApahaH||6||

Basti prepared with five prasritas of the decoction of panchamula (bilva, shyonaka, gambhari, patala and agnimantha), two prasritas of taila (sesame oil) and one prasrita each of kshaudra (honey) as well as sarpi (ghrita), oleates (the body) and expels vata. [6]

Chatu-prasritiki basti-I

सैन्धवार्धाक्ष एकैकः क्षौद्रतैलपयोघृतात्|

प्रसृतो हपुषाकर्षो निरूहः शुक्रकृत् परम्||७||

saindhavārdhākṣa ēkaikaḥ kṣaudratailapayōghṛtāt|

prasṛtō hapuṣākarṣō nirūhaḥ śukrakṛt param||7||

saindhavArdhAkSha ekaikaH kShaudratailapayoghRutAt|

prasRuto hapuShAkarSho nirUhaH shukrakRut param||7||

Niruha basti, prepared with half aksha (about 6 grams) of saindhava (rock salt) one prasrita each of honey, sesame oil, milk, and ghrita, and one karsha (about 12 grams) of hapusha (Juniperus communis Linn.), is an excellent promoter of shukra. [7]

Panchatikta niruha basti

पटोलनिम्बभूनिम्बरास्नासप्तच्छदाम्भसः|

चत्वारः प्रसृता एको घृतात् सर्षपकल्कितः||८||

निरूहः पञ्चतिक्तोऽयं मेहाभिष्यन्दकुष्ठनुत् |९|

paṭōlanimbabhūnimbarāsnāsaptacchadāmbhasaḥ|

catvāraḥ prasṛtā ēkō ghṛtāt sarṣapakalkitaḥ||8||

nirūhaḥ pañcatiktō'yaṁ mēhābhiṣyandakuṣṭhanut |9|

paTolanimbabhUnimbarAsnAsaptacchadAmbhasaH|

catvAraH prasRutA eko ghRutAt sarShapakalkitaH||8||

nirUhaH pa~jcatikto~ayaM mehAbhiShyandakuShThanut |9|

A basti prepared by mixing four prasritas of decoction of patola (Trichosanthes dioica Roxb.), nimba (Azadirachta indica A.Juss.), bhunimba (Andrographis paniculata Nees.), rasna (Pluchea lanceolata Oliver &Hiern.), saptacchada (Alstonia scholaris R.Br.); one prasrita of ghrita, mixed with a kalka (paste) of sarshapa (Brassica campestris Linn.) is known as panchatikta niruha and is acting against prameha, abhishyanda and kushtha. [8-8½]

Note: The quantity of kalka of sarshapa is not mentioned in the above recipe. According to commentary of Chakrapani on this verse, it may be decided. In the niruha basti with an amount of twelve prasritas, the amount of kalka is usually two palas (about 100 gms). In present recipe, the amount is five prasritas and therefore the amount of kalka of sarshapa would be about 40 gms. This principle is applicable in latter recipes also where the amount of kalka is not mentioned.

Shat-prasritika basti

विडङ्गत्रिफलाशिग्रुफलमुस्ताखुपर्णिजात्||९||

कषायात् प्रसृताः पञ्च तैलादेको विमथ्य तान्|

विडङ्गपिप्पलीकल्को निरूहः क्रिमिनाशनः||१०||

viḍaṅgatriphalāśigruphalamustākhuparṇijāt||9||

kaṣāyāt prasṛtāḥ pañca tailādēkō vimathya tān|

viḍaṅgapippalīkalkō nirūhaḥ krimināśanaḥ||10||

viDa~ggatriphalAshigruphalamustAkhuparNijAt||9||

kaShAyAt prasRutAH pa~jca tailAdeko vimathya tAn|

viDa~ggapippalIkalko nirUhaH kriminAshanaH||10||

Five prasritas of decoction of vidanga (Embelia ribes Burm.), triphala (a combination of three fruits viz. Emblica officinalis Gaertn, terminalia chebula Retz. and terminalia belerica Roxb.), shigru (Moringa oleifera Linn.), madanaphala (Randia dumetorum Lam.), musta (Cyperus rotundus Linn.) and akhuparni (Merremia emarginata Burm.) and one prasrita of tila taila (sesame oil) churned together with a paste of vidanga (Embelia ribes Burm.) and pippali (Piper longum Linn.) is kriminashana niruha (niruha acting against parasites) [9-10]

Sapta-prasritika basti

पयस्येक्षुस्थिरारास्नाविदारीक्षौद्रसर्पिषाम्|

एकैकः प्रसृतो बस्तिः कृष्णाकल्को वृषत्वकृत्||११||

payasyēkṣusthirārāsnāvidārīkṣaudrasarpiṣām|

ēkaikaḥ prasṛtō bastiḥ kṛṣṇākalkō vṛṣatvakṛt||11||

payasyekShusthirArAsnAvidArIkShaudrasarpiShAm|

ekaikaH prasRuto bastiH kRuShNAkalko vRuShatvakRut||11||

Basti prepared with decoction of one prasrita of each of payasya (Fritillaria roylei Hook.), ikshu (Saccharum officinarum Linn.), sthira (Desmodium gangeticum DC.), rasna (Pluchea lanceolata Oliver & Hiern.) and vidari (Pueraria tuberosa DC.); one prasrita each of honey and ghrita, and paste of pippali (Piper longum Linn.) is vrishya (enhancing libido and sexual vigour). [11]

Chatu-prasritika basti-II

चत्वारस्तैलगोमूत्रदधिमण्डाम्लकाञ्जिकात्|

प्रसृताः सर्षपैः कल्कैर्विट्सङ्गानाहभेदनः ||१२||

catvārastailagōmūtradadhimaṇḍāmlakāñjikāt

prasṛtāḥ sarṣapaiḥ kalkairviṭsaṅgānāhabhēdanaḥ ||12||

catvArastailagomUtradadhimaNDAmlakA~jjikAt|

prasRutAH sarShapaiH kalkairviTsa~ggAnAhabhedanaH ||12||

Basti prepared with a total of four prasritas of tila taila (sesame oil), cow’s urine, dadhimanda (whey) and amlakanji (fermented sour gruel) mixed with a paste of sarshapa (Brassica campestris Linn.) relieves the stagnation of stool and constipation. [12]

Pancha-prasritika basti-II

श्वदंष्ट्राश्मभिदेरण्डरसात्तैलात् सुरासवात्|

प्रसृताः पञ्च यष्ट्याह्वकौन्तीमागधिकासिताः||१३||

कल्कः स्यान्मूत्रकृच्छ्रे तु सानाहे बस्तिरुत्तमः|

एते सलवणाः कोष्णा निरूहाः प्रसृतैर्नव||१४||

śvadaṁṣṭrāśmabhidēraṇḍarasāttailāt surāsavāt|

prasṛtāḥ pañca yaṣṭyāhvakauntīmāgadhikāsitāḥ||13||

kalkaḥ syānmūtrakṛcchrē tu sānāhē bastiruttamaḥ|

ētē salavaṇāḥ kōṣṇā nirūhāḥ prasṛtairnava||14||

shvadaMShTrAshmabhideraNDarasAttailAt surAsavAt|

prasRutAH pa~jca yaShTyAhvakauntImAgadhikAsitAH||13||

kalkaH syAnmUtrakRucchre tu sAnAhe bastiruttamaH|

ete salavaNAH koShNA nirUhAH prasRutairnava||14||

Basti prepared with five prasritas decoction of shvadamshtra (Tribulus terrestris Linn.), ashmabhida (Bergenia ligulata Wall.), eranda (Ricinus communis Linn.) together, taila and surasava (an alcoholic preparation) added with paste of yashti (Glycyrrhiza glabra Linn.), kaunti (Piper aurantiacum Wall.), magadhika (Piper longum Linn.) and sitah (sugar candy) is useful in mutrakricchra (a condition characterized by difficult and painful micturition) and anaha (constipation). These nine prasrita bastis are given with salt and moderately warm. [13-14]

Treatment of stagnated basti

मृदुबस्तिजडीभूते तीक्ष्णोऽन्यो बस्तिरिष्यते|

तीक्ष्णैर्विकर्षिते स्वादु प्रत्यास्थापनमिष्यते ||१५||

mṛdubastijaḍībhūtē tīkṣṇō'nyō bastiriṣyatē|

tīkṣṇairvikarṣitē svādu pratyāsthāpanamiṣyatē [1] ||15||

mRudubastijaDIbhUte tIkShNo~anyo bastiriShyate|

tIkShNairvikarShite svAdu pratyAsthApanamiShyate ||15||

If a mridubasti (mild acting basti) gets stagnated, that needs another teekshna basti (strong and sharp acting basti). One, who is emaciated because of strong bastis, requires asthapana basti prepared with madhura (sweet) substances. [15]

Treatment of guda-daha (burning sensation in anus)

वातोपसृष्टस्योष्णैः स्युर्गुददाहादयो यदि|

द्राक्षाम्बुना त्रिवृत्कल्कं दद्याद्दोषानुलोमनम्||१६||

तद्धि पित्तशकृद्वातान् हृत्वा दाहादिकाञ्जयेत्|

शुद्धश्चापि पिबेच्छीतां यवागूं शर्करायुताम्||१७||

vātōpasṛṣṭasyōṣṇaiḥ syurgudadāhādayō yadi|

drākṣāmbunā trivṛtkalkaṁ dadyāddōṣānulōmanam||16||

taddhi pittaśakṛdvātān hṛtvā dāhādikāñjayēt|

śuddhaścāpi pibēcchītāṁ yavāgūṁ śarkarāyutām||17||

vAtopasRuShTasyoShNaiH syurgudadAhAdayoyadi|

drAkShAmbunA trivRutkalkaM dadyAddoShAnulomanam||16||

taddhi pittashakRudvAtAn hRutvA dAhAdikA~jjayet|

shuddhashcApi pibecchItAM yavAgUM sharkarAyutAm||17||

If a patient with vata disorder suffers from anorectal burning (and other similar pitta-related symptoms) due to (administration of) hot bastis, a mixture of drakshambu (grape juice or decoction of raisins) and trivritkalka (paste of Operculina turpethum Linn.), which is doshanulshmana (bringing the movement of dosha in right direction) is given. This relieves burning sensation and similar conditions by expelling the pitta, stool and vata. After the body is cleansed, the patient has to take cold yavagu added with sugar. [16-17]

Treatment of mala kshaya (depletion of stool)

अथवाऽतिविरिक्तः स्यात् क्षीणविट्कः स भक्षयेत्|

माषयूषेण कुल्माषान् पिबेन्मध्वथवा सुराम्||१८||

athavā'tiviriktaḥ syāt kṣīṇaviṭkaḥ sa bhakṣayēt

māṣayūṣēṇa kulmāṣān pibēnmadhvathavā surām||18||

athavA~ativiriktaH syAt kShINaviTkaH sa bhakShayet|

mAShayUSheNa kulmAShAn pibenmadhvathavA surAm||18||

On the other hand, if a patient has excessive purgation and suffers from depletion of stool (and other essential body components e.g. fluids), he or she has to take kulmasha (half cooked grains) with mashayoosha (soup of Phaseolus mungo Linn.), or sura (an alcoholic preparation) or honey. [18]

Treatment of amaja shula (abdominal pain due to improper digestion)

सामं चेत् कुणपं शूलैरुपविशेदरोचकी|

स घनातिविषाकुष्ठनतदारुवचाः पिबेत्||१९||

sāmaṁ cēt kuṇapaṁ śūlairupaviśēdarōcakī|

sa ghanātiviṣākuṣṭhanatadāruvacāḥ pibēt||19||

sAmaM cet kuNapaM shUlairupavishedarocakI|

sa ghanAtiviShAkuShThanatadAruvacAH pibet||19||

(A decoction of) musta (Cyperus rotundus Linn.), ativisha (Aconitum heterophyllum wall.), kushtha (Saussurea lappa C.B.Clarke.), nata (Valeriana wallichii DC.), daru (Cedrus deodara Roxb.) and vacha (Acorus calamus Linn.) is recommended to a patient with loss of appetite, passing sama stool (i.e., stool containing ama) smelling like a dead (decomposing) body and with abdominal pain. [19]

Treatment of atisara (diarrhea)

शकृद्वातमसृक् पित्तं कफं वा योऽतिसार्यते|

पक्वं , तत्र स्ववर्गीयैर्बस्तिः श्रेष्ठं भिषग्जितम्||२०||

śakṛdvātamasṛk pittaṁ kaphaṁ vā yō'tisāryatē|

pakvaṁ , tatra svavargīyairbastiḥ śrēṣṭhaṁ bhiṣagjitam||20||

shakRudvAtamasRuk pittaM kaphaM vA yo~atisAryate|

pakvaM , tatra svavargIyairbastiH shreShThaM bhiShagjitam||20||

When a patient has pakva atisara (without undigested material) passing shakrita (stool), vata, asrika (blood), pitta or kapha, then basti prepared with a specific group of medicines acting against each of these pathologies is best measure. [20]

Six types of atisara and its common complications

षण्णामेषां द्विसंसर्गात् त्रिंशद्भेदा भवन्ति तु|

केवलैः सह षट्त्रिंशद्विद्यात् सोपद्रवानपि||२१||

शूलप्रवाहिकाध्मानपरिकर्त्यरुचिज्वरान्|

तृष्णोष्णदाहमूर्च्छादींश्चैषां विद्यादुपद्रवान्||२२||

ṣaṇṇāmēṣāṁ dvisaṁsargāt triṁśadbhēdā bhavanti tu|

kēvalaiḥ saha ṣaṭtriṁśadvidyāt sōpadravānapi||21||

śūlapravāhikādhmānaparikartyarucijvarān|

tṛṣṇōṣṇadāhamūrcchādīṁścaiṣāṁ vidyādupadravān||22||

ShaNNAmeShAM dvisaMsargAt triMshadbhedA bhavanti tu|

kevalaiH saha ShaTtriMshadvidyAt sopadravAnapi||21||

shUlapravAhikAdhmAnaparikartyarucijvarAn|

tRuShNoShNadAhamUrcchAdIMshcaiShAM vidyAdupadravAn||22||

These six types of atisara may have thirty variants as a result of mutual combination of two morbid factors. Together with basic six, they constitute thirty six types, which manifest along with their complications. Shoola (abdominal pain), pravahika (dysentery), adhmana (abdominal distension) parikarti (anal pain), aruchi (distaste for food), jwara (fever), tṛishna (thirst), ushnatva (feeling of heat), daha (burning sensation) and murccha(syncope) are its complications (upadrava). [21-22]

Treatment of ama-atisara ( diarrhea with improper digestion)

तत्रामेऽन्तरपानं स्यात् व्योषाम्ललवणैर्युतम्|

पाचनं शस्यते बस्तिरामे हि प्रतिषिध्यते||२३||

tatrāmē'ntarapānaṁ syāt vyōṣāmlalavaṇairyutam|

ṁ śasyatē bastirāmē hi pratiṣidhyatē||23||

tatrAme~antarapAnaM syAt vyoShAmlalavaNairyutam|

pAcanaM shasyate bastirAme hi pratiShidhyate||23||

In case of amatisara, a drink having pachana action added with trikatu (a group of three pungent drugs viz. rhizome of Zingiber officinalis Roxb.; fruits of Piper nigrum Linn. and Piper longum Linn.), amla (sour) and lavana (salty) substances is recommended. Bastis are contraindicated in ama condition. [23]

Treatment of shakrita-atisara and vata atisara( diarrhea with excess stools and vata)

वातघ्नैर्ग्राहिवर्गीयैर्बस्तिः शकृति शस्यते |

स्वाद्वम्ललवणैः शस्तः स्नेहबस्तिः समीरणे||२४||

vātaghnairgrāhivargīyairbastiḥ śakṛti śasyatē

svādvamlalavaṇaiḥ śastaḥ snēhabastiḥ samīraṇē||24||

vAtaghnairgrAhivargIyairbastiH shakRuti shasyate

svAdvamlalavaNaiH shastaH snehabastiH samIraNe||24||

In shakritatisara (atisara in which only stool is passed), basti with vataghna and grahi category of medicines is recommended. In vata related atisara, sneha basti with svadu (sweet), amla (sour) and lavana (salty) substances is acclaimed. [24]

Treatment of rakta atisara, pitta atisara and kapha atisara (diarrhea with blood, pitta and kapha)

रक्ते रक्तेन, पित्ते तु कषायस्वादुतिक्तकैः|

सार्यमाणे कफे बस्तिः कषायकटुतिक्तकैः||२५||

raktē raktēna, pittē tu kaṣāyasvādutiktakaiḥ|

sāryamāṇē kaphē bastiḥ kaṣāyakaṭutiktakaiḥ||25||

rakte raktena, pitte tu kaShAyasvAdutiktakaiH|

sAryamANe kaphe bastiH kaShAyakaTutiktakaiH||25||

In rakta atisara (diarrhea with blood) basti with blood, in pitta atisara basti with kashaya (astringent), madhura (sweet) and tikta (bitter) substances and in kapha atisara with kashaya (astringent), katu (pungent) and tikta (bitter) substances is to be administered. [25]

Treatment of atisara (diarrhea) mixed with shakrita-ama and vata

शकृता वायुना वाऽऽमे तेन वर्चस्यथानिले|

संसृष्टेऽन्तरपानं स्याद् व्योषाम्ललवणैर्युतम्||२६||

śakṛtā vāyunā vā”me tena varcasyathānilē|

saṁsṛṣṭē'ntarapānaṁ syād vyōṣāmlalavaṇairyutam||26||

shakRutA vAyunA vA~a~ame tena varcasyathAnile|

saMsRuShTe~antarapAnaM syAd vyoShAmlalavaNairyutam||26||

In the conditions where ama is associated with shakrita (stool) or vata, or shakrita (stool) or vata is associated with ama a drink, prepared with vyosha (a group of three pungent drugs, commonly known as trikatu, viz. rhizome of Zingiber officinalis Roxb.; fruits of Piper nigrum Linn. and Piper longum Linn.), sour and salty substances, is recommended. [26]

Treatment of atisara (diarrhea) mixed with pitta-rakta and ama

पित्तेनामेऽसृजा वाऽपि तयोरामेन वा पुनः|

संसृष्टयोर्भवेत् पानं सव्योषस्वादुतिक्तकम्||२७||

pittēnāmē'sṛjā vā'pi tayōrāmēna vā punaḥ|

saṁsṛṣṭayōrbhavēt pānaṁ savyōṣasvādutiktakam||27||

pittenAme~asRujA vA~api tayorAmena vA punaH|

saMsRuShTayorbhavet pAnaM savyoShasvAdutiktakam||27||

If there is association of ama with pitta or rakta or of both separately with ama then a drink with trikaṭu, sweet and bitter substances is indicated. [27]

Treatment of atisara (diarrhea)mixed with kapha-ama

तथाऽऽमे कफसंसृष्टे कषायव्योषतिक्तकम्|

आमेन तु कफे व्योषकषायलवणैर्युतम्||२८||

tathāmē kaphasaṁsṛṣṭē kaṣāyavyōṣatiktakam|

āmēna tu kaphē vyōṣakaṣāyalavaṇairyutam||28||

tathA~a~ame kaphasaMsRuShTe kaShAyavyoShatiktakam|

Amena tu kaphe vyoShakaShAyalavaNairyutam||28||

If ama is associated with kapha, a basti containing kashaya (astringent), trikatu and bitter substances and when kapha is associated with ama, a basti containing trikatu, kashaya (astringent) and salty substances is recommended. [28]

Treatment of atisara (diarrhea) mixed with pitta-vata-shakrita

वातेन विशि पित्ते वा विट्पित्ताभ्यां तथाऽनिले|

मधुराम्लकषायः स्यात् संसृष्टे बस्तिरुत्तमः||२९||

vātēna viśi pittē vā viṭpittābhyāṁ tathā'nilē|

madhurāmlakaṣāyaḥ syāt saṁsṛṣṭē bastiruttamaḥ||29||

vAtena vishi pitte vA viTpittAbhyAM tathA~anile|

madhurAmlakaShAyaH syAt saMsRuShTe bastiruttamaH||29||

When stool or pitta is associated with vata or vata is associated with stool and pitta, a basti with sweet, sour and astringent substances, is excellent. [29]

Treatment of atisara (diarrhea) mixed with pitta-rakta-shakrita

शकृच्छोणितयोः पित्तशकृतो रक्तपित्तयोः|

बस्तिरन्योन्यसंसर्गे कषायस्वादुतिक्तकः||३०||

śakṛcchōṇitayōḥ pittaśakṛtō raktapittayōḥ|

bastiranyōnyasaṁsargē kaṣāyasvādutiktakaḥ||30||

shakRucchoNitayoH pittashakRuto raktapittayoH|

bastiranyonyasaMsarge kaShAyasvAdutiktakaH||30||

In case of morbid mutual associations of pitta with stool and rakta, as well as stool with rakta and pitta, basti with astringent, sweet and bitter ingredients. [30]

Treatment of atisara (diarrhea) mixed with kapa-rakta-pitta-shakrita

कफेन विशि पित्ते वा कफे विट्पित्तशोणितैः|

व्योषतिक्तकषायः स्यात् संसृष्टे बस्तिरुत्तमः||३१||

kaphēna viśi pittē vā kaphē viṭpittaśōṇitaiḥ|

vyōṣatiktakaṣāyaḥ syāt saṁsṛṣṭē bastiruttamaḥ||31||

kaphena vishi pitte vA kaphe viTpittashoNitaiH|

vyoShatiktakaShAyaH syAt saMsRuShTe bastiruttamaH||31||

In case of similar associations of kapha with stool or pitta; or of stool or pitta or rakta with kapha, a basti with trikatu, bitter and kashaya ingredients is to be recommended. [31]

Treatment of atisara (diarrhea) mixed with vata-kapha-shakrita and rakta-kapha

स्याद्बस्तिर्व्योषतिक्ताम्लः संसृष्टे वायुना कफे|

मधुरव्योषतिक्तस्तु रक्ते कफविमूर्च्छिते||३२||

syādbastirvyōṣatiktāmlaḥ saṁsṛṣṭē vāyunā kaphē|

madhuravyōṣatiktastu raktē kaphavimūrcchitē||32||

syAdbastirvyoShatiktAmlaH saMsRuShTe vAyunA kaphe|

madhuravyoShatiktastu rakte kaphavimUrcchite||32||

In atisara where kapha is associated with vata, basti with trikatu, bitter and sour ingredients, and if rakta is associated with kapha then with sweet, trikatu and bitter is recommended. [32]

Treatment of atisara (diarrhea) mixed with kapha- vata -shakrita and vata-pitta

मारुते कफसंसृष्टे व्योषाम्ललवणो भवेत्|

बस्तिर्वातेन पित्ते तु कार्यः स्वाद्वम्लतिक्तकः||३३||

mārutē kaphasaṁsṛṣṭē vyōṣāmlalavaṇō bhavēt|

bastirvātēna pittē tu kāryaḥ svādvamlatiktakaḥ||33||

mArute kaphasaMsRuShTe vyoShAmlalavaNo bhavet|

bastirvAtena pitte [2] tu kAryaH svAdvamlatiktakaH||33||

If vata is accompanied by kapha, a basti with trikatu, sour and salty ingredients; and when pitta is associated with vata, basti with sweet, sour and bitter substances is to be administered. [33]

Treatment for conditions due to samsarga (combination of dosha)

त्रिचतुःपञ्चसंसर्गानेवमेव विकल्पयेत्|

युक्तिश्चैषातिसारोक्ता सर्वरोगेष्वपि स्मृता||३४||

tricatuḥpañcasaṁsargānēvamēva vikalpayēt|

yuktiścaiṣātisārōktā sarvarōgēṣvapi smṛtā||34||

tricatuHpa~jcasaMsargAnevameva vikalpayet|

yuktishcaiShAtisAroktA sarvarogeShvapi smRutA||34||

Similarly a plan may be designed in cases of morbid combinations of three, four or five components. This planning for atisara is applicable in all disease conditions. [34]

युगपत् षड्रसं षण्णां संसर्गे पाचनं भवेत् |

निरामाणां तु पञ्चानां बस्तिः षाड्रसिको मतः||३५||

yugapat ṣaḍrasaṁ ṣaṇṇāṁ saṁsargē pācanaṁ bhavēt [1] |

nirāmāṇāṁ tu pañcānāṁ bastiḥ ṣāḍrasikō mataḥ||35||

yugapat ShaDrasaM ShaNNAM saMsarge pAcanaM bhavet [1] |

nirAmANAM tu pa~jcAnAM bastiH ShADrasiko mataH||35||

In atisara, if all six pathological components are simultaneously involved, a pachana (causing or promoting digestion or transformation) medicine containing the drugs of all six tastes is useful, while in nirama (without ama) condition, where other five are involved a basti consisting of all six rasas (tastes) is indicated. [35]

Sarvatisara nashaka ghrita (medicated ghee for treatment of all types of diarrhea)

उदुम्बरशलाटूनि जम्ब्वाम्रोदुम्बरत्वचः|

शङ्खं सर्जरसं लाक्षां कर्दमं च पलांशिकम्||३६||

पिष्ट्वा तैः सर्पिषः प्रस्थं क्षीरद्विगुणितं पचेत्|

अतीसारेषु सर्वेषु पेयमेतद्यथाबलम्||३७||

udumbarani jambvāmrōdumbaratvacaḥ|

śaṅkhaṁ sarjarasaṁ lākṣāṁ kardamaṁ ca palāṁśikam||36||

piṣṭvā taiḥ sarpiṣaḥ prasthaṁ kṣīradviguṇitaṁ pacēt|

atīsārēṣu sarvēṣu pēyamētadyathābalam||37||

udumbarashalATUni jambvAmrodumbaratvacaH|

sha~gkhaM sarjarasaM lAkShAM kardamaM ca palAMshikam||36||

piShTvA taiH sarpiShaH prasthaM kShIradviguNitaM pacet|

atIsAreShu sarveShu peyametadyathAbalam||37||

A freshly prepared paste of udumbarashalaatu (unripe fruits of Ficus glomerata Roxb.), bark of jaambu (Syzygium cumini Skeels.), amra (Mangifera indica Linn.) and udumbara (Ficus glomerata Roxb.); sankha (conch shell), sarjarasa (resin of Vateria indica Linn.), laaksha (resinous secretion of Laccifera lacca Kerr.) and kardama (a type of rice), each one pala (about 50 grams) is to be cooked with one prastha (about 800 ml.) of ghrita, and two prastha of milk. This (thus prepared ghrita) is to be taken in all types of atisara according to bala (strength of the patient as well as disease). [36-37]

Sarvatisara nashaka yavagu (medicated gruel for treatment of all types of diarrhea)

कच्छुराधातकीबिल्वसमङ्गारक्तशालिभिः|

मसूराश्वत्थशुङ्गैश्च यवागूः स्याज्जले शृतैः||३८||

बालोदुम्बरकट्वङ्गसमङ्गाप्लक्षपल्लवैः |

मसूरधातकीपुष्पबलाभिश्च तथा भवेत्||३९||

kacchurādhātakībilvasamaṅgāraktaśālibhiḥ|

masūrāśvatthaśuṅgaiśca yavāgūḥ syājjalē śṛtaiḥ||38||

bālōdumbarakaṭvaṅgasamaṅgāplakṣapallavaiḥ |

masūradhātakīpuṣpabalābhiśca tathā bhavēt||39||

kacchurAdhAtakIbilvasama~ggAraktashAlibhiH|

masUrAshvatthashu~ggaishca yavAgUH syAjjale shRutaiH||38||

bAlodumbarakaTva~ggasama~ggAplakShapallavaiH |

masUradhAtakIpuShpabalAbhishca tathA bhavet||39||

A yavagu (gruel) prepared by cooking raktashali (a variety of rice brownish in color) and masura (Lens culinaris Medic.)) in a decoction of kacchura (Mucuna pruriens Baker. ), dhataki (Woodfordia fruticosa Kurz.), bilva (Aegle marmelos Carr.), samanga (Mimosa pudica Linn.) and ashvatthashunga (leaf bud of Ficus religiosa Linn.) is beneficial in atisara.

Similar preparation can be made with unripe fruit of udumbara, leaves of kathvanga (Ailanthus excelsa Roxb.) and samanga as well as plaksha (Ficus lacor Buch.), masura (Lens culinaris Medic.) and dhataki flowers. [38-39]

Treatment of all types of diarrhea

स्थिरादीनां बलादीनामिक्ष्वादीनामथापि वा|

क्वाथेषु समसूराणां यवाग्वः स्युः पृथक् पृथक्||४०||

कच्छुरामूलशाल्यादितण्डुलैरुपसाधिताः|

दधितक्रारनालाम्लक्षीरेष्विक्षुरसेऽपि वा||४१||

शीताः सशर्कराक्षौद्राः सर्वातिसारनाशनाः|

ससर्पिर्मरिचाजाज्यो मधुरा लवणाः शिवाः||४२||

sthirādīnāṁ balādīnāmikṣvādīnāmathāpi vā|

kvāthēṣu samasūrāṇāṁ yavāgvaḥ syuḥ pṛthak pṛthak||40||

kacchurāmūlaśālyāditaṇḍulairupasādhitāḥ|

dadhitakrāranālāmlakṣīrēṣvikṣurasē'pi vā||41||

śītāḥ saśarkarākṣaudrāḥ sarvātisāranāśanāḥ|

sasarpirmaricājājyō madhurā lavaṇāḥ śivāḥ||42||

sthirAdInAM balAdInAmikShvAdInAmathApi vA|

kvAtheShu samasUrANAM yavAgvaH syuH pRuthak pRuthak||40||

kacchurAmUlashAlyAditaNDulairupasAdhitAH|

dadhitakrAranAlAmlakShIreShvikShurase~api vA||41||

shItAH sasharkarAkShaudrAH sarvAtisAranAshanAH|

sasarpirmaricAjAjyo madhurA lavaNAH shivAH||42||

Different yavagus can be prepared by combining masura (Lens culinaris Medic.) with the decoctions of sthiradi, baladi and ikshvadi (groups of plants). [40]

Roots of kacchura (Mucuna pruriens Baker.) and rice of shali and other varieties cooked with dadhi (yogurt), takra (churned yogurt), aranala (sour fermented supernatant of cooked rice), ksheera (milk) or ikshurasa (sugarcane juice), and after being cooled added with sugar and honey, is able to treat all types of atisara. The above-mentioned gruels are promising (anti-diarreal) when added with ghrita, pepper and cumin (Cuminum cyminum Linn.), sweet substances and rock salt. [41-42]

Treatment principles

भवन्ति चात्र श्लोकाः-

स्निग्धाम्ललवणमधुरं पानं बस्तिश्च मारुते कोष्णः|

शीतं तिक्तकषायं मधुरं पित्ते च रक्ते च||४३||

तिक्तोष्णकषायकटुश्लेष्मणि सङ्ग्राहि वातनुच्छकृति|

पाचनमामे पानं पिच्छासृग्बस्तयो रक्ते||४४||

अतिसारं प्रत्युक्तं मिश्रं द्वन्द्वादियोगजेष्वपि च|

तत्रोद्रेकविशेषाद्दोषेषूपक्रमः कार्यः||४५||

bhavanti cātra ślōkāḥ-

snigdhāmlalavaṇamadhuraṁ pānaṁ bastiśca mārutē kōṣṇaḥ|

śītaṁ tiktakaṣāyaṁ madhuraṁ pittē ca raktē ca||43||

tiktōṣṇakaṣāyakaṭuślēṣmaṇi saṅgrāhi vātanucchakṛti|

pācanamāmē pānaṁ picchāsṛgbastayō raktē||44||

atisāraṁ pratyuktaṁ miśraṁ dvandvādiyōgajēṣvapi [1] ca|

tatrōdrēkaviśēṣāddōṣēṣūpakramaḥ kāryaḥ||45||

bhavanti cAtra shlokAH-

snigdhAmlalavaNamadhuraM pAnaM bastishca mArute koShNaH|

shItaM tiktakaShAyaM madhuraM pitte ca rakte ca||43||

tiktoShNakaShAyakaTushleShmaNi sa~ggrAhi vAtanucchakRuti|

pAcanamAme pAnaM picchAsRugbastayo rakte||44||

atisAraM pratyuktaM mishraM dvandvAdiyogajeShvapi ca|

tatrodrekavisheShAddoSheShUpakramaH kAryaH||45||

Here the shlokas (verses) remain-

(Besides the above some more treatment-principles useful in atisaras are given below as per the factors involved)

1. Vata: snigdha (unctuous) amla (sour) lavana (salty) and madhura (sweet) liquids orally and warm bastis with same substances.
2. Pitta and rakta: cold bitter astringent and sweet substances.
3. Kapha: bitter, hot, astringent and pungent substances.
4. Shakrita (stool): sangrahi (checks atisara through improving the digestion) and vataghna (measures)
5. Ama: pachana (measures digesting ama)
6. Rakta: picchabasti and raktabasti
7. Atisara may also be in combination of two or more factors. In those conditions treatment is to be planned according to dominance of the doshas (and the factors involved). [43-45]

Summary

तत्र श्लोकः-

प्रासृतिकाः सव्यापत्क्रिया निरूहास्तथाऽतिसारहिताः|

रसकल्पघृतयवाग्वश्चोक्ता गुरुणा प्रसृतसिद्धौ||४६||

tatra ślōkaḥ-

prāsṛtikāḥ savyāpatkriyā nirūhāstathā'tisārahitāḥ|

rasakalpaghṛtayavāgvaścōktā [1] guruṇā prasṛtasiddhau||46||

tatra shlokaH-

prAsRutikAH savyApatkriyA nirUhAstathA~atisArahitAH|

rasakalpaghRutayavAgvashcoktA [1] guruNA prasRutasiddhau||46||

In this chapter of Prasrita Yogiyam Siddhi management of the complications, prasritika niruhas, and the bastis, decoctions, ghrita, gruels useful in the management of atisaras are presented by the teacher. [46]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते

दृढबलसम्पूरिते सिद्धिस्थाने प्रासृतयोगीयसिद्धिर्नामाष्टमोऽध्यायः ||८||

ityagnivēśakṛtē tantrē carakapratisaṁskṛtē'prāptē

dṛḍhabalasampūritē siddhisthānē prāsṛtayōgīyasiddhirnāmāṣṭamō'dhyāyaḥ [1] ||8||

ityagniveshakRute tantre carakapratisaMskRute~aprApte

dRuDhabalasampUrite siddhisthAne prAsRutayogIyasiddhirnAmAShTamo~adhyAyaH [1] ||8||

Thus in the treatise (originally) prepared by Agnivesha, edited by Charak and supplemented the lost parts by Dridhabala, in Siddhi Sthana, the eighth chapter entitled Prasrita Yogiyam Siddhi is concluded.

Tattva Vimarsha (Fundamental Principles)

• A milder form of basti can get stagnated inside leading to complications of not eliminating doshas. This may result into ayoga or heenayoga (insufficient action). On the contrary if a basti is stronger it may cause an atiyoga (action in excess) causing excessive evacuation of dosha along with body constituents.
• Faulty application of bastis may cause a complication in the form of atisara (diarrhea).
• Atisara (diarrhea) may be either acute with undigested material associated with ama or chronic without much undigested material/ pakwa.
• Pakwa type of atisara is again of five types as with shakrita (fecal matter), with vata (flatus), with asrika (blood), with pitta and with kapha.
• Basic principle of treatment of every condition associated with ama is amapachana. Decoction / powder of musta, ativisha, kushtha, nata, daru and vacha are ideal for amapachana. This recipe is useful in amatisara.
• To manage pakvatisara, medicines of two categories viz. vataghna (anti-vata) and grahi (anti-diarrheal by promoting digestion and absorption) are used.
• Picchabasti and raktabasti are treatments for diarrhea with blood.These can be considered as stambhana (stop bleeding) and vishesha brimhana (enhance internal strength).
• The treatment principles of various types of atisara due to complications of basti therapy:
  • Vata: snigdha (unctuous), amla (sour), lavana (salty) and madhura (sweet) liquids orally and warm bastis with same substances.
  • Pitta and rakta: cold bitter astringent and sweet substances.
  • Kapha: bitter, hot, astringent and pungent substances.
  • Shakrita (stool): sangrahi (checks atisara through improving the digestion) and vataghna (measures)
  • Ama: pachana (measures digesting ama)
  • Rakta: picchabasti and raktabasti.

Vidhi Vimarsha (Applied Inferences )

The unit prasrita, according to Charak Samhita is an amount of two palas which is approximately equal to 100 milliliter (1pala=50ml)., (verse 1-2)Charak Samhita is written in the form of dialogue between the teacher (Atreya) and his disciples (mainly Agnivesha). Mild form of shodhana measures are for those subjects who are not suitable for strong measures and for the patients who suffered with the complications of the measures described in previous chapters. Vamana and virechana are major procedures for shodhana. However, these are contraindicated for the tender persons. Tender persons may not tolerate even basti. Therefore, mild forms of bastis are described for them. Similarly, the measures to treat the complications developed due to the faulty application of the procedures especially the basti.

Some translators interpreted the phrase karmana viplutanama as ‘exhausted of hard work’. However, the meaning of this phrase can be taken as ‘complicated by the consequences of the therapies’, which seems to be more appropriate in this context. The complications may be natural consequences of the therapies or may be due to faulty application. (verse 3)

The recipe in verse 4 is composed of total five prasritas (2 prasritas of milk, 1 prasrita each of honey, sesame oil and ghrita), therefore this basti is named by Gangadhara as panchaprasrtika basti. This basti is useful for eliminating vata as well as promoting the strength and the complexion.

Vata eliminating measures usually promotes quality of dhatus and upadhatus (structural components of the body). This eventually results in promotion of the body strength and the complexion. Word bala also denotes the immune function; hence this may also be interpreted as promoting immune activity. In ancient time to mix a basti material, churning stick was used. In modern time an electric blender is an ideal alternative. With a blender the mixture is better homogenized than a manual churning stick.

Chakrapani considered bilvadi group in his Ayurveda deepika commentary as dashamula. This group consists of roots of ten plants viz. bilva (Aegle marmelos Carr.), shyonaka (Oroxylum indicumVent.),gambhari (Gmelina arborea Roxb.), patala (Stereospermum suaveolensDC.),agnimantha (Premna integrifolia Roxb.), shalaparni (Desmodium gangeticumDC.), prishniparni (Uraria picta Desr.) brihati (Solanum indicum Linn.), kantakari (Solanum suranttense Burm.) and gokshura (Tribulus terrestris Linn.).

While Gangadhara in his Jalpakalpataru commentary mentions this as panchamula –the roots of a group of five plants viz. bilva,shyonaka, gambhari, patala and agnimantha.Since next verse (5th) describes a recipe with panchamula, in this verse considering bilvadi as dashamula is more logical and practical. This basti consists a total of eight prasritas (one prasrita each of taila, prasanna, madhu and ghrita and two prasritas each of bilvadi decoction and kulattha decoction). Therefore, Gangadhara names this as ashtaprasritika basti.

The basti in verse six, consists of total nine prasritas i.e. panchamula decoction- five prasritas, sesame oil - two prasritas, honey- one prasrita, ghrita- one prasrita. Therefore, Gangadhara names this as navaprasritika basti. (verses 4-6)

Aksha and karsha are the units of same amount, which is equal to about twelve grams. Hence the amount of rock salt in this basti would be about 6 grams. Shukra is one of the seven dhatus (structural components). Shukra is not a single entity. It comprises male reproductive cells and substances including the androgenic hormones responsible for manhood in a man. This basti promotes quality and quantity of all these entities in the body.

The usual contents of a niruha basti are salt, honey, oil, kalka and decoction (or a liquid). These are to be mixed by churning in the sequence as mentioned above. Here the mixing may be in this sequence- saindhava, honey, oil, ghrita, hapusha (fruits of Juniperus communis Linn.)and milk.(verse 7)

Basti is usually contraindicated in kushtha. However, Sushruta Samhita recommends niruhabastis in this condition. Practically niruha basti, with bitter substances e.g. panchatikta niruha, is useful in kushtha.

The quantity of kalka of sarshapa is not mentioned in the above recipe. According to commentary of Chakrapani on this verse, it may be decided. In the niruha bastis with an amount of twelve prasritas, the amount of kalka is usually two palas (about 100gms). In present recipe, the amount is five prasritas and therefore the amount of kalka of sarshapa would be about 40 gms. This principle is applicable in latter recipes also where the amount of kalka is not mentioned.

This basti contains vidanga (Embelia ribes Burm.) which is the best among krimighna(anti-parasitic) [Cha. Sa. Sutra Sthana 25/40] substances. Therefore, it has a kriminashana effect. (verse 9-10)

Gangadhara in his Jalpakalpataru commentary considers payasyas ksheerakakoli, which is Fritillaria roylei Hook. Some scholars consider payasyaas vidari, but at present, vidari recipies already include one ingredient therefore to consider it ksheerakakoli is appropriate.

In the recipes of verse 11-12, the amount of paste is not mentioned. This may be calculated as stated in earlier verse 8th -9th. (verse 11-12)

In above verses from 4 to 14, nine recipes of prasrita bastis are described. Here a special and practical instruction is given that even if salt is not mentioned in any of the recipes, rock salt is to be added and these bastis are always given with a moderate warm temperature.

While preparing the bastis, rock salt is to be added. The amount is to be calculated according to the principle described in the 7th verse i.e. about 6 gms. After preparing the basti, to keep it warm until it is administered, a hot water bath may be used. (verse 13-14)

In the verse 15-16, two opposite possibilities are described. It may be milder than normal or it may be stronger than a normal. A mild basti is unable not only to eliminate doshas, but it itself is not ableto come out. This is ayoga or heenayoga (insufficient action). In such a case a basti is to be repeated with a stronger recipe. Contrary to this, if a basti is stronger it may cause an atiyoga (action in excess) causing evacuation of colonic contents more than required and eventually loss of essential substances.

A soft acting basti is not able to eliminate the doshas and may get stagnated and cause disturbance. To eliminate it, a strong and sharp acting basti is recommended. If strong bastis have caused emaciation, dehydration or weakness, the bastis with madhura (sweet) substances are useful because madhura substances are nourishing in action. (verses 15-16)

In vata-related disorders, basti material with physically and pharmacologically hot property is preferred. It may cause pitta aggravation resulting in burning sensation and other such pitta-related symptoms. In such a condition, grape juice or decoction of raisins added with a kalka (paste) of trivrita (Operculina turpethum Linn.) is given. In case of unavailability of kalka, its powder can be used. This cures the burning sensation and other pitta-related symptoms with its anti-pitta action and expulsion of stool, pitta and vata. Yavagu with sugar is given for nourishing purpose after this laxation. (verses 16-17)

If the purgation is in excess, it may cause significant loss of stool along with essential substances (e.g.water and electrolytes). This requires immediate attention to prevent the harm due to depletion of essential body components.

In such a condition it is to be corrected by eating mashayusha (soup of black beans) and kulmasha (half cooked grains); and by taking honey or sura. Kulmasha is also interpreted as a sour gruel (prepared by the spontaneous fermentation of fruit-juices or boiled rice). However, according to Chakrapani this is half cooked grain (barley etc.), which is popularly known as ghughuni.,. This is known as ghughari in Gujarat and western Madhya Pradesh. This is more suitable interpretation. This is considered to be well nourishing food article. (verse 18)

Faulty application of bastis may cause a complication in the form of atisāra. Atisāra is a clinical condition of colon characterized by excessive and frequent defecation with altered consistency of stool. In short it may be interpreted as diarrhea. In next verse different forms of atisāra and their management are described. In this verse the condition is characterized by sāma stool (stool containing āma- undigested material), which smells like a decomposing body (putrid smell) and is associated with abdominal pain. Āma is a substance produced due to weak agni resulting in incomplete transformation of substance. In the present context, due to weak jatharāgni the transformation of food in to digested absorbable substances is incomplete resulting in to production of some intermediate substances. ,These substances are known as āma. Because of its adherent quality it is supposed to be a pathogenic substance.In this condition a decoction of mustā, ativiṣā, kuṣṭha, nata, dāru and vacā is recommended. These medicines help in pachana (termination) of āma.

This chapter describes six types of atisāra based on the pathogens being excreted in excess. This verse explains the remedy for one of them in which patient passes stool with significant undigested material. This undigested material causes putrid smell after decomposition. Decomposition also produces some toxic substances, which cause abdominal pain and loss of appetite. The recipe described here is not useful in atisāra produced as complication of basti but also in āmātisāra of any origin. (verse 19)

This verse number 20 describes other five types of atisāra. In this way, six types of atisāras those are depicted in above verses are as follow.

1. Atisara (diarrhea) in which stool contains ama (undigested material)
2. Atisāra (diarrhea) in which stool is pakva i.e.free from āma (undigested material)
3. Atisāra (diarrhea) in which stool is pakva and containing vata i.e. significant flatulence.
4. Atisāra (diarrhea) in which stool is pakva and containing asṛk (blood).
5. Atisāra (diarrhea) in which stool is pakva and containing pitta.
6. Atisāra (diarrhea) in which stool is pakva and containing kapha.

For the management of these conditions bastis prepared with the svavargīya medicines (group of medicines acting against particular pathologies) are given. For example the vargas (classified groups) described in Ṣaḍvirecanaśatāśrīya chapter (chapter 4th) of sūtrasthāna of Carakasaṁhitā. So, the recommended group of medicines for last five conditions of pathology is purīṣasaṁgrahaṇīya [Cha.Sa.Sutra Sthana 4/8/31], vātaghna, śoṇitasthāpana [Cha.Sa.Sutra Sthana 4/8/46], pittaghna and kaphaghna vargas respectively..Purīṣasaṁgrahaṇīya group consists of priyaṅgu (Callicarpa macrophylla R.Br.), ananta (Hemidesmus indicusR.Br.), Seed of mango, kaṭvaṅga (Ailanthus excelsa Roxb.), lodhra (Symplocos racemosa Roxb.), mocharasa (secretion of Salmalia malabarica Scott&Endl.), samṅgā (Mimosa pudica Linn.), dhātakī (Woodfordia fruticosa Kurz.), padmā (Clerodendrum serratum Linn.) and padmakesara (Stamen of Nelumbo nucifera Gaertn.). shoṇitasthāpana group consists of honey, madhuka (Glycyrrhiza glabra Linn.), saffron, mocarasa (secretion of Salmalia malabarica Scott &Endl.), broken earthen vessel, lodhra (Symplocos racemosa Roxb.), gairika (red ochre), priyaṅgu (Callicarpa macrophylla R.Br.), sharkarā(sugar) and lājā (puffed rice).The form of basti is not described here. However, this may be decided according to disease condition and patient’s tolerance. (verse 20)

In this version of Charak Samhita thirty six variants are cited, but another version ‘kēvalaiḥ saha ceṭ triṁśadvidyāt sōpadravānapi’ mentions only thirty. Gaṅgādhara also explains thirty forms in the following manner.

The six basic forms of atisāra are:

1. āmātisāra (diarrhea with undigested material)
2. śakṛdatisāra (frequent stool only)
3. vātātisāra (that with significant flatulence)
4. asṛkātisāra (that with blood)
5. pittātisāra (that with pitta) and
6. kaphātisāra (that with kapha).

Due to saṁsarga (mutual combinations of two) a total of fifteen variants occur, viz.

1. āma-śakṛd, āma-vata, āma-asṛk, āma-pitta, āma-kapha,
2. śakṛd-vata, śakṛd-asṛk, śakṛd-pitta, śakṛd-kapha,
3. vāta-asṛk, vata-pitta, vata-kapha,
4. asṛk-pitta, asṛk-kapha, and
5. pitta-kapha.

Nine upadrava as cited above.

The upadravas in present version of chapter are ten. Gaṅgādhara has taken description of nine upadravas from another version. But upadravas cannot be counted among types of a disease. Hence the thirtysix variants would be in following manner.

The six basic forms of atisāra are as mentioned above.

Due to saṁsarga (mutual combinations of two) a total of thirty variants occur, viz. fifteen samsargas as mentioned above and other fifteen are as below:

1. śakṛd- āma, vata-āma, asṛk-āma, pitta-āma, kapha-āma,
2. vata-śakṛd, asṛk-śakṛd, pitta-śakṛd, kapha-śakṛd,
3. asṛk-vata, pitta-vata, kapha-vata,
4. pitta-asṛk, kapha-asṛk, and
5. kapha-pitta.

Moreover Charak Samhita describes types of atisāra in its chapter 19th of Sutra Sthana and 19th chapter of Chikitsa Sthana differently. , The context of the topic atisāra in present chapter is absolutely different. Here it is described first as a complication of basti, which eloborted further in the chapter. In earlier sections atisāra was described as a primary disease manifested because of its own physical and mental etiological factors. (verse 21-22)

Basic principle of treatment of every condition associated with āma is āmapāchana (termination of āma by promoting function of agni). For this purpose mustā, ativiṣā, kuṣṭha, nata, dāru and vacā (which are mentioned in 19th verse) are to be given. This combination may be given in form of powder or as decoction. This recipe is useful in āmātisāra every origin. (verse 23)

For vātaghna medicines to be used in vata associated atisara, Cakrapāṇi recommends daśhamula, while Gaṅgādhara considers bṛhat pañchamūla (see the commentary on 5th verse). For grāhī purpose the medicines of purīṣasaṁgrahaṇīya varga [Cha.Sa.Sutra Sthana.4/8/31] are to be used.

Next condition in which atisāra is associated with dominance of vata, snēha basti supplemented with sweet, sour and salty substances is recommended. Being opposite to the properties of vata, the substances in this basti antagonizes the vata principle. (verse 24)

Now the management of other conditions - raktātisāra, pittātisāra and kaphātisāra is explained. In raktātisāra, a basti with blood of animals e.g. goat, is given. This not only stops the bleeding but also supplements the substances to produce blood, which is lost due to colonic bleeding. Pitta pacifying remedies also helpful in this condition and therefore the remedies useful in pittātisāra can also be given in raktātisāra. Substances with astringent, sweet and bitter tastes have pitta-antagonizing action and hence the basti consists of such substances are helpful in management of pittātisāra. Substances with astringent, pungent and bitter tastes have kapha-antagonizing action; therefore, a basti with such medicines is beneficial in kaphātisāra.

The basti used in pittātisāra is useful in raktātisāra also. Applying this principle, this type of basti may be used in a disease entity known as ulcerative colitis. (verse 25)

These verses number 26-27 describe management plan for the saṁsargaja atisāras (in which two morbid components are associated and have mutual vitiation). Cakrapāṇi in his commentary decides the main and secondary role of the involved components on the basis of vibhakti (noun case) of the words. 7th vibhakti signifies the main role while 3rd expresses secondary role of the factors.

In the 26th verse the possible combination are-

1. āma is associated with śakṛt i.e.stool (āma is primary and stool is secondary)
2. āma is associated with vata (āma is primary and vata is secondary)
3. śakṛt (stool) is associated with āma (stool is primary āma is secondary)
4. vata is associated with āma (vata is primary and āma is secondary)

In the 27th verse the possible combination are-

1. āma is associated with pitta (āma is primary and pitta is secondary)
2. āma is associated with rakta (āma is primary and rakta is secondary)
3. pitta is associated with āma (pitta is primary and āma is secondary)
4. rakta is associated with āma (rakta is primary and āma is secondary)

In these conditions in mentioned in 26th verse, a drink prepared with trikaṭu, sour and salty substances is recommended. While the conditions mentioned in 27th verse, are manageable with adrink, prepared with trikaṭu, sweet and bitter substances are useful. (verse 26-27)

The description of saṁsargaja atisāras continues in these verses 28-29. In the 28th verse, the possible combination are-

1. āma is associated with kapha (āma is primary and kapha is secondary)
2. kapha is associated with āma (kapha is primary and āma is secondary)

In 1st condition the recommended basti is with trikaṭu, astringent and bitter substances while in 2nd condition with trikaṭu, astringent and salty medicines.

In a pāthabheda (another version) of 29th verse, raktais also included. With this inclusion the possible combination are-

1. śakṛt (stool) is associated with vāta (stool is primary and vata is secondary)
2. pitta is associated with vāta (pitta is primary and vata is secondary)
3. rakta is associated with vāta (pitta is primary and āma is secondary)
4. vata is associated withstool(vata is primary and stool is secondary)
5. vata is associated with pitta (vata is primary and pitta is secondary)
6. vata is associated with rakta (vata is primary and rakta is secondary)

In these pathological conditions a basti with sweet, sour and astringent materials is acclaimed. (verse 28-29)

The management of saṁsargaja atisāras further continues in these verses. In the 30th verse the possible combination are-

1. rakta is associated with śakṛt i.e. stool(rakta is primary and stool is secondary)
2. rakta is associated with pitta (rakta is primary and pitta is secondary)
3. śakṛt (stool) is associated with pitta (stool is primary and pitta is secondary)
4. śakṛt stool is associated with rakta (stool is primary and rakta is secondary)
5. pitta is associated with rakta (pitta is primary and rakta is secondary)
6. pitta is associated with śakṛt stool (pitta is primary and stool is secondary)

In the 31st verse the possible combination are-

1. stool is associated with kapha (stool is primary and kapha is secondary)
2. pitta is associated with kapha (pitta is primary and kapha is secondary)
3. kapha is associated with stool (kapha is primary andstool is secondary)
4. kapha is associated with pitta (kapha is primary and pitta is secondary)
5. kapha is associated with rakta (kapha is primary and rakta issecondary)

The conditions mentioned in 30th verse are managed by administration of basti prepared with astringent, sweet and bitter ingredients. While the pathologies in 31stverse, are manageable by a basti with trikaṭu, bitter and astringent ingredients. (verse 30-31)

In these verses 32-33, four more combinations of pathology are described with their management. In 32nd verse the kapha is main factor with vata as secondary and rakta as main with kapha as secondary while in 33rd verse vata is main factor with kapha as secondary and pitta as main with vata as secondary.

Type of atisāra according to involvement of factors. Reccommended material for basti Kapha is main factor with vata as secondary trikaṭu, bitter and sour ingredients Rakta as main with kapha as secondary sweet,trikaṭu and bitter Vata is main factor with kapha as secondary trikaṭu,sour and salty Pitta is main with vata as secondary. sweet, sour and bitter(verse 32-33)

There are six components involved in the pathogenesis of atisāra. In earlier verses the combinations of two components are described. The combinations of three, four or five are also possible. Gaṅgādhara in his Jalpakalpataru commentary mentions the possibility of combination of all six also. This appears logical, as when five may combine six together may also be possible.

According to Gaṅgādhara, the following combinations may happen viz. ten clinical forms due to combinations of three, six forms due to combinations of four, three forms due to combinations of five and one form with all six. In this way twenty forms are possible. These combinations are as below.

Combinations of three Combinations of four Combinations of five Combination of six āmaviḍvātaja āmaviḍasṛja āmaviḍpittaja āmaviḍkaphaja viḍvātāsṛja viḍvātapittaja viḍvātakaphaja vātāsṛkpittaja vātāsṛkkaphaja asṛkpittakaphaja āmaviḍvātāsṛja āmaviḍvātapittaja āmaviḍvātakaphaja viḍvātāsṛkpittaja viḍvātāsṛkkaphaja vātāsṛkpittakaphaja āmaviḍvātāsṛkpittaja āmaviḍvātāsṛkkaphaja viḍvātāsṛkpitta kaphaja āmaviḍvātāsṛkpittakaphaja(verse 34)

If case of association of āma, bastis are contraindicated. This is a general rule. In such condition the āmapācana (preparation to terminate āma)is given. However, in nirāma condition (without association of āma), bastis are recommended. (verse 35)

In these verses 36-37, two new units of measurement are described i.e. pala and prastha. After calculating these amounts in modern units of metric system, pala is around 50 gms or 50 ml while prastha around 800 ml. Though, in previous verses the management of different types of atisāras, has been described. In coherence of the topic, more remedies for atisāra are described in present verses.

This medicated ghṛta is processed with plants having stambhana action. Therefore, it is useful in all types of atisāra. Being a nourishing preparation, it is useful in compensating the loss of the essential body substances. A basti may also be given with this preparation and should be retained as much as possible. This type of basti may be useful in inflammatory bowel diseases. (verse 36-37)

The remedies for atisāra continue in these verses 38-39. These verses describe recipe of medicated gruels useful in management of this disease. First the decoction is prepared according to the recipe of ṣaḍaṅgapānīya.,

For this purpose one part of the course powder of all plants is boiled with 64 parts of water. When water is reduced to half, this is to be taken to cook yavāgū. There are three varieties of yavāgū-maṇḍa, peyā and vilepī. These three are gradually thicker in consistency and may be chosen according to strength of a patient and his agni. (verse 38-39)

Gaṅgādhara considers Sthirādi group of plants as Svalpapañcamūla consists of śālaparṇī (Desmodium gangeticum DC.), pṛśniparṇī (Uraria picta Desr.) bṛhatī (Solanum indicum Linn.) kaṇṭakārī (Solanum suranttense Burm.) and gokṣura (Tribulus terrestris Linn.). About balādi group there is no clarification by any commentator however the plants Sida cordifolia Linn., abutilon indicum Linn., Sida rhombifolia Linn. and Grewia hirsute Vahl. may be taken for this purpose. Ikṣvādi is considered by Cakrapāṇi as roots of Saccharum officinarum Linn., Desmostachya bipinnata Stapf., Saccharum spontaneum Linn. and roots of rice. There is another version of verse 42, which mentions last line as ‘sasarpirlavaṇā yojyā madhurā lavaṇāpi vā’ which means that this preparation can be used with ghṛta and rock salt in sweet or salty form.

Above verses give some more recipes for medicated yavāgūs those are helpful in management of atisāra. (verse 40-42) In these verses some additional and useful remedies for management of various types of atisāra are given. It is to be recalled that in this chapter, authors have considered six factors responsible in pathogenesis and manifestation of atisāra viz. āma vata, pitta, kapha, rakta and sakṛt (stool). The treatments are to be considered as per the factors involved. (verse 43-45) The chapter describes various clinical forms of atisara according to the components involved in the pathogenesis. The therapeutics for these various forms of atisāra is described in a planned manner. Ayurvedic management is not merely medicaments but it recommends the food preparations those are helpful in restoring the normalcy of the body components of the patient. Thus the chapter is significantly useful for clinical practice of basti therapies and the treatment of disease atisāra, which includes several modern diseases such as ulcerative colitis, Crohn’s dieases and irritable bowel syndrome. (verse 46) The basti formulations mentioned in this chapter are used widely in today’s clinical practice. However, though atisara (diarrhea) is explained in detail as complication of improperly administered basti, in todays clinical practice, this complication is observed rarely.

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