Changes

|title=Atisara Chikitsa

|title=Atisara Chikitsa

|titlemode=append

|titlemode=append

|keywords=atisara, diarrhea, ama, nirama, sangrahi treatment, pichcha basti

|keywords=atisara, diarrhea, ama, nirama, sangrahi treatment, pichcha basti,Ayurveda, Indian system of medicine, charak samhita.

|description=Chikitsa Sthana Chapter 19. Management of Atisara (diarrhea and associated disorders)

|description=Chikitsa Sthana Chapter 19. Management of Atisara (diarrhea and associated disorders)

}}

}}

<big>'''[[Chikitsa Sthana]] Chapter 19. Management of Atisara (diarrhea and associated disorders)</big>'''

<big>'''[[Chikitsa Sthana]] Chapter 19. Management of Atisara (diarrhea and associated disorders)</big>'''

{{Infobox

{{Infobox

|title = Atisara Chikitsa

|title = Atisara Chikitsa

|label5 = Other Sections

|label5 = Other Sections

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

 

== Introduction ==

== Introduction ==

 

''Grahani'' and ''atisara'' - both manifest due to the vitiation of ''agni'' and share common features of impairment of digestion resulting in indigestion and loose motions. Therefore, this chapter should logically precede or succeed the chapter on ''grahani''. But it is described three chapters after that on ''grahani''. The reason for this unusual sequencing of these topics is that since ''pandu'' is a common symptom and sequelae of the malabsorption syndrome (''grahani''), the chapter on ''pandu'' follows ''grahani''. Now, dyspnea (''shwasa'') is a major symptom of ''pandu,'' and thus, follows the chapter on ''pandu''. Similarly, chapter on ''kasa'' (cough) follows  ''shwasa'' because of their relationship. That explains the sequencing of ''grahani'' and ''atisara'' in [[Charak Samhita]].

''Grahani'' and ''atisara'' - both manifest due to the vitiation of ''agni'' and share common features of impairment of digestion resulting in indigestion and loose motions. Therefore, this chapter should logically precede or succeed the chapter on ''grahani''. But it is described three chapters after that on ''grahani''. The reason for this unusual sequencing of these topics is that since ''pandu'' is a common symptom and sequelae of the malabsorption syndrome (''grahani''), the chapter on ''pandu'' follows ''grahani''. Now, dyspnea (''shwasa'') is a major symptom of ''pandu,'' and thus, follows the chapter on ''pandu''. Similarly, chapter on ''kasa'' (cough) follows  ''shwasa'' because of their relationship. That explains the sequencing of ''grahani'' and ''atisara'' in [[Charak Samhita]].

''Atisara'' leads to the depletion of water and beneficial salts, causing dehydration in the body. This provokes ''vata'', and therefore requires taking special care of ''vata'', particularly if, the ''atisara'' is caused by all the three ''doshas''. Hydration of the body by means of oral administration of milk, buttermilk and various liquid preparations is advised. Goat’s milk is very useful in bloody diarrhea.The treatment of cholera and other dehydrating diarrheal diseases was revolutionized by the promotion of oral rehydration solution (ORS), the efficacy of which depends on the fact that glucose-facilitated absorption of sodium and water in the small intestine remains intact in the presence of cholera toxin. Where indicated, appropriate antimicrobial agents can shorten the duration of illness from 3–4 days to 24–36 h, hence it should be started depending on the course of illness.  Adequate prophylaxis measures should be taken to prevent the infectious diarrhoea.

''Atisara'' leads to the depletion of water and beneficial salts, causing dehydration in the body. This provokes ''vata'', and therefore requires taking special care of ''vata'', particularly if, the ''atisara'' is caused by all the three ''doshas''. Hydration of the body by means of oral administration of milk, buttermilk and various liquid preparations is advised. Goat’s milk is very useful in bloody diarrhea.The treatment of cholera and other dehydrating diarrheal diseases was revolutionized by the promotion of oral rehydration solution (ORS), the efficacy of which depends on the fact that glucose-facilitated absorption of sodium and water in the small intestine remains intact in the presence of cholera toxin. Where indicated, appropriate antimicrobial agents can shorten the duration of illness from 3–4 days to 24–36 h, hence it should be started depending on the course of illness.  Adequate prophylaxis measures should be taken to prevent the infectious diarrhoea.

 

== Sanskrit Text, Transliteration and English Translation ==

== Sanskrit Text, Transliteration and English Translation ==

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

iti ha smAha bhagavAnAtreyaH||2||  

iti ha smAha bhagavAnAtreyaH||2||  

</div></div>

</div></div>

 

Now we shall expound the chapter "Atisara chikitsa" (Management of diarrhea and associated disorders). Thus said Lord Atreya. [1-2]

Now we shall expound the chapter "Atisara chikitsa" (Management of diarrhea and associated disorders). Thus said Lord Atreya. [1-2]

 

=== Query by Agnivesha ===

=== Query by Agnivesha ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

bhagavan! atIsArasyaprAgutpattinimittalakShaNopashamanAni prajAnugrahArthamAkhyAtumarhasIti||3||  

bhagavan! atIsArasyaprAgutpattinimittalakShaNopashamanAni prajAnugrahArthamAkhyAtumarhasIti||3||  

</div></div>

</div></div>

 

On one occasion, when Lord Atreya was sitting on the northern slope of the Himalayas surrounded by the sages after completing his daily worship and oblations to the fire, Agnivesha approached him, offered his humble salutations to him, and requested him to expound the origin, etiology, signs and symptoms, and treatment of ''atisara'' (diarrhea) for the well-being of humanity [3]

On one occasion, when Lord Atreya was sitting on the northern slope of the Himalayas surrounded by the sages after completing his daily worship and oblations to the fire, Agnivesha approached him, offered his humble salutations to him, and requested him to expound the origin, etiology, signs and symptoms, and treatment of ''atisara'' (diarrhea) for the well-being of humanity [3]

 

=== Historical origins of ''atisara'' ===

=== Historical origins of ''atisara'' ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

taM dRuShTvA pravyathitA bhUtagaNAH, teShAM copayogAdupAkRutAnAM gavAMgauravAdauShNyAdasAtmyatvAdashastopayogAccopahatAgnInAmupahatamanasAM [1] cAtIsAraHpUrvamutpannaH pRuShadhrayaj~je||4|| <br />

taM dRuShTvA pravyathitA bhUtagaNAH, teShAM copayogAdupAkRutAnAM gavAMgauravAdauShNyAdasAtmyatvAdashastopayogAccopahatAgnInAmupahatamanasAM [1] cAtIsAraHpUrvamutpannaH pRuShadhrayaj~je||4|| <br />

</div></div>

</div></div>

 

After consideration of the above submission of Agnivesha, Lord Punarvasu said, “O Agnivesha, listen to me. I shall give a detailed response to your question.   

After consideration of the above submission of Agnivesha, Lord Punarvasu said, “O Agnivesha, listen to me. I shall give a detailed response to your question.   

In the Vedic age/ancient times, sacrificial animals used to get released in the wild soon after the recitation of the sacrificial mantras, and these animals were not killed during the course of the sacrifice (''yajna''). However, in the subsequent periods following the reign of Daksha Prajapati, the sons of Manu named Narishyana, Nabhag, Ikshvaku, Nriga, and Sharyati, sacrifice of these animals became a part of the ''yajna'' (sacrificial ritual) at their instinctive acquiescence. After that, during the sacrifice over a long course of time performed by Prushadra (name of a king), as goats were not obtainable, even the sacred cows were also offered up for sacrifice. This deviation bewildered (or disturbed) all of humanity leading to grief. When the flesh of these sanctified cows were eaten, by the heavy, hot and incompatible to human nature properties of their flesh, as well as the use of what was not prescribed by the scriptures, the people started suffering from the loss of their ability to digest and losing their mental equilibrium, resulting in  ''atisara'' (diarrhea). Thus, diarrhea originated from the ''yajna'' performed by Prushadhra [4]  

In the Vedic age/ancient times, sacrificial animals used to get released in the wild soon after the recitation of the sacrificial mantras, and these animals were not killed during the course of the sacrifice (''yajna''). However, in the subsequent periods following the reign of Daksha Prajapati, the sons of Manu named Narishyana, Nabhag, Ikshvaku, Nriga, and Sharyati, sacrifice of these animals became a part of the ''yajna'' (sacrificial ritual) at their instinctive acquiescence. After that, during the sacrifice over a long course of time performed by Prushadra (name of a king), as goats were not obtainable, even the sacred cows were also offered up for sacrifice. This deviation bewildered (or disturbed) all of humanity leading to grief. When the flesh of these sanctified cows were eaten, by the heavy, hot and incompatible to human nature properties of their flesh, as well as the use of what was not prescribed by the scriptures, the people started suffering from the loss of their ability to digest and losing their mental equilibrium, resulting in  ''atisara'' (diarrhea). Thus, diarrhea originated from the ''yajna'' performed by Prushadhra [4]  

 

=== ''Vataja atisara'' ===

=== ''Vataja atisara'' ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

pakvaM vA vibaddhamalpAlpaM sashabdaM sashUlaphenapicchAparikartikaM hRuShTaromA viniHshvasa~jshuShkamukhaH kaTyUrutrikajAnupRuShThapArshvashUlI bhraShTagudomuhurmuhurvigrathitamupaveshyate purIShaM vAtAt; tamAhuranugrathitamityeke,vAtAnugrathitavarcastvAt||5|| <br />

pakvaM vA vibaddhamalpAlpaM sashabdaM sashUlaphenapicchAparikartikaM hRuShTaromA viniHshvasa~jshuShkamukhaH kaTyUrutrikajAnupRuShThapArshvashUlI bhraShTagudomuhurmuhurvigrathitamupaveshyate purIShaM vAtAt; tamAhuranugrathitamityeke,vAtAnugrathitavarcastvAt||5|| <br />

</div></div>

</div></div>

 

*''Vata'' dominant ''atisara'' occurs if a person with ''vata'' dominant constitution indulges in following: Exposure to strong wind, excess sunlight, and physical exercise;

*''Vata'' dominant ''atisara'' occurs if a person with ''vata'' dominant constitution indulges in following: Exposure to strong wind, excess sunlight, and physical exercise;

*Indulgence in dry and rough or less quantities of food (''pramitashana'') or irregular meals  or strong alcoholic drinks or excessive sexual intercourse; and

*Indulgence in dry and rough or less quantities of food (''pramitashana'') or irregular meals  or strong alcoholic drinks or excessive sexual intercourse; and

According to some physicians, this type of diarrhea is also called ''anugrathita-atisara'' because of evacuation the scybalous stool. [5]  

According to some physicians, this type of diarrhea is also called ''anugrathita-atisara'' because of evacuation the scybalous stool. [5]  

 

=== ''Pittaja atisara'' ===

=== ''Pittaja atisara'' ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

kRuShNaM raktapittopahitamatidurgandhamatisAryate [1] purIShaM,tRuShNAdAhasvedamUrcchAshUlabradhnasantApapAkaparIta iti pittAtisAraH||6|| <br />

kRuShNaM raktapittopahitamatidurgandhamatisAryate [1] purIShaM,tRuShNAdAhasvedamUrcchAshUlabradhnasantApapAkaparIta iti pittAtisAraH||6|| <br />

</div></div>

</div></div>

 

A person of ''pittaja'' constitution, by indulging in the following etiological factors, gets afflicted by ''pittaja atisara'':

A person of ''pittaja'' constitution, by indulging in the following etiological factors, gets afflicted by ''pittaja atisara'':

*Excessive intake of sour, saline, pungent, alkaline (''kshara''), hot and sharp (''teekshna'') ingredients;

*Excessive intake of sour, saline, pungent, alkaline (''kshara''), hot and sharp (''teekshna'') ingredients;

*The patient suffers from morbid thirst, burning sensation, excessive sweating, fainting, colic pain and hot sensation; and

*The patient suffers from morbid thirst, burning sensation, excessive sweating, fainting, colic pain and hot sensation; and

*There is suppuration of the anus [6]

*There is suppuration of the anus [6]

 

=== ''Kaphaja atisara'' ===

=== ''Kaphaja atisara'' ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

tasya rUpANi- snigdhaM shvetaM picchilaM tantumadAmaM guru durgandhaMshleShmopahitamanubaddhashUlamalpAlpamabhIkShNamatisAryate sapravAhikaM,gurUdaragudabastiva~gkShaNadeshaH kRute~apyakRutasa~jj~jaH salomaharShaH sotkleshonidrAlasyaparItaH sadano~annadveShI ceti shleShmAtisAraH||7|| <br />

tasya rUpANi- snigdhaM shvetaM picchilaM tantumadAmaM guru durgandhaMshleShmopahitamanubaddhashUlamalpAlpamabhIkShNamatisAryate sapravAhikaM,gurUdaragudabastiva~gkShaNadeshaH kRute~apyakRutasa~jj~jaH salomaharShaH sotkleshonidrAlasyaparItaH sadano~annadveShI ceti shleShmAtisAraH||7|| <br />

</div></div>

</div></div>

 

A person of ''kaphaja'' type of constitution indulging in the following factors experiences the manifestation of ''kaphaja atisara'':

A person of ''kaphaja'' type of constitution indulging in the following factors experiences the manifestation of ''kaphaja atisara'':

*Consumption of heavy, sweet, cold and unctuous ingredients in excess;

*Consumption of heavy, sweet, cold and unctuous ingredients in excess;

These are the specific features of ''kaphaja atisara''. [7]

These are the specific features of ''kaphaja atisara''. [7]

 

=== ''Sannipataja atisara'' ===

=== ''Sannipataja atisara'' ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

अतिशीतस्निग्धरूक्षोष्णगुरुखरकठिनविषमविरुद्धासात्म्यभोजनादभोजनात्कालातीतभोजनाद्यत्किञ्चिदभ्यवहरणात्प्रदुष्टमद्यपानीयपानादतिमद्यपानादसंशोधनात्प्रतिकर्मणांविषमगमनादनुपचाराज्ज्वलनादित्यपवनसलिलातिसेवनादस्वप्ना- दतिस्वप्नाद्वेगविधारणादृतुविपर्ययादयथाबलमारम्भाद्भयशोकचित्तोद्वेगातियोगात्कृमिशोषज्वरार्शोविकारातिकर्षणाद्वाव्यापन्नाग्नेस्त्रयोदोषाःप्रकुपिताभूयएवाग्निमुपहत्यपक्वाशयमनुप्रविश्यातीसारंसर्वदोषलिङ्गंजनयन्ति ||८||  

अतिशीतस्निग्धरूक्षोष्णगुरुखरकठिनविषमविरुद्धासात्म्यभोजनादभोजनात्कालातीतभोजनाद्यत्किञ्चिदभ्यवहरणात्प्रदुष्टमद्यपानीयपानादतिमद्यपानादसंशोधनात्प्रतिकर्मणांविषमगमनादनुपचाराज्ज्वलनादित्यपवनसलिलातिसेवनादस्वप्ना- दतिस्वप्नाद्वेगविधारणादृतुविपर्ययादयथाबलमारम्भाद्भयशोकचित्तोद्वेगातियोगात्कृमिशोषज्वरार्शोविकारातिकर्षणाद्वाव्यापन्नाग्नेस्त्रयोदोषाःप्रकुपिताभूयएवाग्निमुपहत्यपक्वाशयमनुप्रविश्यातीसारंसर्वदोषलिङ्गंजनयन्ति ||८||  

<div class="mw-collapsible-content">

<div class="mw-collapsible-content">

atishItasnigdharUkShoShNagurukharakaThinaviShamaviruddhAsAtmyabhojanAdabhojanAtkAlAtItabhojanAd yatki~jcidabhyavaharaNAtpraduShTamadyapAnIyapAnAdatimadyapAnAdasaMshodhanAt pratikarmaNAMviShamagamanAdanupacArAjjvalanAdityapavanasalilAtisevanAdasvapnA-datisvapnAdvegavidhAraNAdRutuviparyayAdayathAbalamArambhAdbhayashokacittodvegAtiyogAtkRumishoShajvarArshovikArAtikarShaNAdvA vyApannAgnestrayo doShAH prakupitA bhUyaevAgnimupahatya pakvAshayamanupravishyAtIsAraM sarvadoShali~ggaM janayanti||8||  

atishItasnigdharUkShoShNagurukharakaThinaviShamaviruddhAsAtmyabhojanAdabhojanAtkAlAtItabhojanAd yatki~jcidabhyavaharaNAtpraduShTamadyapAnIyapAnAdatimadyapAnAdasaMshodhanAt pratikarmaNAMviShamagamanAdanupacArAjjvalanAdityapavanasalilAtisevanAdasvapnA-datisvapnAdvegavidhAraNAdRutuviparyayAdayathAbalamArambhAdbhayashokacittodvegAtiyogAtkRumishoShajvarArshovikArAtikarShaNAdvA vyApannAgnestrayo doShAH prakupitA bhUyaevAgnimupahatya pakvAshayamanupravishyAtIsAraM sarvadoShali~ggaM janayanti||8||  

</div></div>

</div></div>

 

The causative factors of ''sannipataja atisara'' (diarrhea caused by the simultaneous vitiation of all the three ''doshas'') are as follows:  

The causative factors of ''sannipataja atisara'' (diarrhea caused by the simultaneous vitiation of all the three ''doshas'') are as follows:  

*Intake of excessively cold, unctuous, ununctuous, hot, heavy, coarse and hard ingredients;

*Intake of excessively cold, unctuous, ununctuous, hot, heavy, coarse and hard ingredients;

Because of the above mentioned causative factors, ''agni'' (power of digestion) gets vitiated as a result of which all the three ''doshas'' get aggravated. These aggravated ''doshas'' in turn further afflict the ''agni'', and having entered into ''pakvashaya'' (colon) cause ''sannipataja atisara''. [8]

Because of the above mentioned causative factors, ''agni'' (power of digestion) gets vitiated as a result of which all the three ''doshas'' get aggravated. These aggravated ''doshas'' in turn further afflict the ''agni'', and having entered into ''pakvashaya'' (colon) cause ''sannipataja atisara''. [8]

 

=== Signs and symptoms of ''sannipataja atisara'' ===

=== Signs and symptoms of ''sannipataja atisara'' ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

ebhirvarNairatisAryamANaM sopadravamAturamasAdhyo~ayamiti pratyAcakShIta; tadyathA-pakvashoNitAbhaM [2] yakRutkhaNDopamaM medomAMsodakasannikAshaMdadhighRutamajjatailavasAkShIravesavArAbhamatinIlamatiraktamatikRuShNamudakamivAcchaMpunarmecakAbhamatisnigdhaM haritanIlakaShAyavarNaM karburamAvilaM picchilaM tantumadAmaMcandrakopagatamatikuNapapUtipUyagandhyAmAmamatsyagandhi makShikAkAntaM [3]kuthitabahudhAtusrAvamalpapurIShamapurIShaM vA~atisAryamANaMtRuShNAdAhajvarabhramatamakahikkAshvAsAnubandhamativedanamavedanaM vA srastapakvagudaMpatitagudavaliM muktanAlamatikShINabalamAMsashoNitaMsarvaparvAsthishUlinamarocakAratipralApasammohaparItaM sahasoparatavikAramatisAriNamacikitsyaMvidyAt; iti sannipAtAtisAraH||9||  

ebhirvarNairatisAryamANaM sopadravamAturamasAdhyo~ayamiti pratyAcakShIta; tadyathA-pakvashoNitAbhaM [2] yakRutkhaNDopamaM medomAMsodakasannikAshaMdadhighRutamajjatailavasAkShIravesavArAbhamatinIlamatiraktamatikRuShNamudakamivAcchaMpunarmecakAbhamatisnigdhaM haritanIlakaShAyavarNaM karburamAvilaM picchilaM tantumadAmaMcandrakopagatamatikuNapapUtipUyagandhyAmAmamatsyagandhi makShikAkAntaM [3]kuthitabahudhAtusrAvamalpapurIShamapurIShaM vA~atisAryamANaMtRuShNAdAhajvarabhramatamakahikkAshvAsAnubandhamativedanamavedanaM vA srastapakvagudaMpatitagudavaliM muktanAlamatikShINabalamAMsashoNitaMsarvaparvAsthishUlinamarocakAratipralApasammohaparItaM sahasoparatavikAramatisAriNamacikitsyaMvidyAt; iti sannipAtAtisAraH||9||  

</div></div>

</div></div>

 

The three aggravated ''doshas'' cause excessive vitiation of ''dhatus'' (tissue elements, e.g., ''rakta'' (blood)), resulting in the appearance of different colors (in the stool). The nature of these colors depends upon the nature of the vitiated ''dhatus'' and ''doshas''.  

The three aggravated ''doshas'' cause excessive vitiation of ''dhatus'' (tissue elements, e.g., ''rakta'' (blood)), resulting in the appearance of different colors (in the stool). The nature of these colors depends upon the nature of the vitiated ''dhatus'' and ''doshas''.  

   

   

Such a patient should be rejected for the treatment (as it is incurable). [9]

Such a patient should be rejected for the treatment (as it is incurable). [9]

 

=== Guidelines for starting treatment ===

=== Guidelines for starting treatment ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

tamasAdhyatAmasamprAptaM cikitsed yathApradhAnopakrameNa hetUpashayadoShavisheShaparIkShayAceti||10||  

tamasAdhyatAmasamprAptaM cikitsed yathApradhAnopakrameNa hetUpashayadoShavisheShaparIkShayAceti||10||  

</div></div>

</div></div>

 

The patient who has not yet reached the stage of absolute incurability should be properly treated after the examination of causative factors, ''upashaya'' (pacifying factors) and nature of the aggravation of specific ''dosha''. In this condition, the most aggravated ''dosha'' should be treated in the beginning followed by the treatment of the other less aggravated ''doshas''. [10]

The patient who has not yet reached the stage of absolute incurability should be properly treated after the examination of causative factors, ''upashaya'' (pacifying factors) and nature of the aggravation of specific ''dosha''. In this condition, the most aggravated ''dosha'' should be treated in the beginning followed by the treatment of the other less aggravated ''doshas''. [10]

 

=== Exogenous (psychological) diarrhea ===

=== Exogenous (psychological) diarrhea ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

tattayorlakShaNaM vAyoryadatIsAralakShaNam||11||<br />

tattayorlakShaNaM vAyoryadatIsAralakShaNam||11||<br />

</div></div>

</div></div>

 

The exogenous type of ''atisara'' (diarrhea) is of mental origin and is of two types. One of these is caused by fear and the other is caused by grief. Their signs and symptoms are similar to those of the ''vatika'' type of ''atisara''. Thus ''atisara'' or diarrhea is of two types, viz., ''nija'' or endogenous (like ''vataja, pittaja, kaphaja'' and ''sannipataja atisara'' and ''agantuja/manasa'' or exogenous [11]

The exogenous type of ''atisara'' (diarrhea) is of mental origin and is of two types. One of these is caused by fear and the other is caused by grief. Their signs and symptoms are similar to those of the ''vatika'' type of ''atisara''. Thus ''atisara'' or diarrhea is of two types, viz., ''nija'' or endogenous (like ''vataja, pittaja, kaphaja'' and ''sannipataja atisara'' and ''agantuja/manasa'' or exogenous [11]

 

=== Management of exogenous (psychological) diarrhea ===

=== Management of exogenous (psychological) diarrhea ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

pravakShyAmyanupUrveNa yathAvattannibodhata||13|| <br />

pravakShyAmyanupUrveNa yathAvattannibodhata||13|| <br />

</div></div>

</div></div>

 

The following therapies help to cure ''agantuja/manasa'' or exogenous:

The following therapies help to cure ''agantuja/manasa'' or exogenous:

Both fear and grief causes aggravation of ''vata'' instantaneously. ''Vata'' alleviating drugs and therapies should be administered for the treatment of exogenous ''atisara''. The patient suffering from diarrhea caused by fear (''bhayaja'') should be exhilarated.  The patient suffering from diarrhea caused by ''shoka'' (grief) should be consoled [12-13]  

Both fear and grief causes aggravation of ''vata'' instantaneously. ''Vata'' alleviating drugs and therapies should be administered for the treatment of exogenous ''atisara''. The patient suffering from diarrhea caused by fear (''bhayaja'') should be exhilarated.  The patient suffering from diarrhea caused by ''shoka'' (grief) should be consoled [12-13]  

 

=== Principles of treatment ===

=== Principles of treatment ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

la~gghanaM cAlpadoShANAM prashastamatisAriNAm||19|| <br />

la~gghanaM cAlpadoShANAM prashastamatisAriNAm||19|| <br />

</div></div>

</div></div>

 

The following principles of treatment are used in management of ''atisara'':

The following principles of treatment are used in management of ''atisara'':

*Depending upon the wholesomeness (''satmya'') of the patient, light food along with buttermilk or ''kanji'' (a sour drink), ''yavagu'' (thick gruel), ''tarpana'' (roasted flour of serials mixed with water), or alcoholic drink or honey should be given. Then gradually ''yavagu'' (thick gruel), ''vilepi'' (a sticky gruel), ''khanda'' (a sour appetiser), ''yusha'' (vegetable soup) and boiled rice mixed with meat soup which are prepared by adding digestive, stimulants and astringent (constipative) drugs should be given.  

*Depending upon the wholesomeness (''satmya'') of the patient, light food along with buttermilk or ''kanji'' (a sour drink), ''yavagu'' (thick gruel), ''tarpana'' (roasted flour of serials mixed with water), or alcoholic drink or honey should be given. Then gradually ''yavagu'' (thick gruel), ''vilepi'' (a sticky gruel), ''khanda'' (a sour appetiser), ''yusha'' (vegetable soup) and boiled rice mixed with meat soup which are prepared by adding digestive, stimulants and astringent (constipative) drugs should be given.  

Ingredients which are ''dipana'' (digestive stimulant) and ''grahi'' (constipating) are described in [[Charak Samhita]] [[Sutra Sthana]] 4: 9 should be administered [23-25]

Ingredients which are ''dipana'' (digestive stimulant) and ''grahi'' (constipating) are described in [Cha. Sa. [[Sutra Sthana]] 4/9 ] should be administered [23-25]

=== Treatment of ''vataja atisara'' ===

=== Treatment of ''vataja atisara'' ===

*If ''pittaja atisara'' (diarrhea) patient is also afflicted with ''ama'' which can be determined by causative factors, ''upachaya'' (habituation), and signs and symptoms, then the patient should be given ''langhana'' (fasting therapy) and ''pachana'' (carminative therapy) appropriate to the strength of the patient.

*If ''pittaja atisara'' (diarrhea) patient is also afflicted with ''ama'' which can be determined by causative factors, ''upachaya'' (habituation), and signs and symptoms, then the patient should be given ''langhana'' (fasting therapy) and ''pachana'' (carminative therapy) appropriate to the strength of the patient.

*If the patient is thirsty, then the decoction of ''musta, parpataka, ushira, sariva, chandana, kiratatiktaka'' and ''udichya'' should be given to drink.  

*If the patient is thirsty, then the decoction of ''musta, parpataka, ushira, sariva, chandana, kiratatiktaka'' and ''udichya'' should be given to drink.  

*After the proper fasting therapy, during meal time, the patient should be gradually given ''yavagu'' (thick gruel), ''manda'' (a type of thin gruel) and ''tarpana'' (roasted flour of cereals added with water) or decoction prepared (according to the procedure suggested for ''shadanga-paniya''(C.S. Chi. 3/ 145-146)) of ''bala, atibala, surpa-parni'' (''mudga-parni'' and ''mansa-parni''), ''shala-parni, prashni-parni, brahati, kantakari, shatavari'' and ''shvadanshtra''.

*After the proper fasting therapy, during meal time, the patient should be gradually given ''yavagu'' (thick gruel), ''manda'' (a type of thin gruel) and ''tarpana'' (roasted flour of cereals added with water) or decoction prepared (according to the procedure suggested for ''shadanga-paniya''[Cha.Sa. [[Chikitsa Sthana]] 3/ 145-146] of ''bala, atibala, surpa-parni'' (''mudga-parni'' and ''mansa-parni''), ''shala-parni, prashni-parni, brahati, kantakari, shatavari'' and ''shvadanshtra''.

 

*''Agni'' (power of digestion) should be stimulated gradually with the vegetable soup of ''mudga, masura, harenu, makustha'' and ''adhaki'' or with the soup of the meat of ''lava, kapinjala, shasha, harina, ena'' and ''kalapuchcha''. These vegetable soups and meat soups may or may not be sour.  

*''Agni'' (power of digestion) should be stimulated gradually with the vegetable soup of ''mudga, masura, harenu, makustha'' and ''adhaki'' or with the soup of the meat of ''lava, kapinjala, shasha, harina, ena'' and ''kalapuchcha''. These vegetable soups and meat soups may or may not be sour.  

*If the ''pittaja atisara'' persists even after the administration of the above mentioned measures, then the patient should be treated with recipes which are ''dipaniya'' (digestive stimulant), ''pachaniya'' (carminative), ''upashamaniya'' (dosha-alleviator) and ''sangrahaniya'' (constipating). [50]

*If the ''pittaja atisara'' persists even after the administration of the above mentioned measures, then the patient should be treated with recipes which are ''dipaniya'' (digestive stimulant), ''pachaniya'' (carminative), ''upashamaniya'' (dosha-alleviator) and ''sangrahaniya'' (constipating). [50]

*The powder of ''dhataki'' and ''lodhra'', taken in equal quantities, may be used for dusting over the suppurated anus.

*The powder of ''dhataki'' and ''lodhra'', taken in equal quantities, may be used for dusting over the suppurated anus.

*If there is excessive bleeding (from the anus), the cold decoction of the above mentioned drugs should be impregnated with ghee, and sprinkled over the anal region, pelvic region, lumbar region and thighs.  

*If there is excessive bleeding (from the anus), the cold decoction of the above mentioned drugs should be impregnated with ghee, and sprinkled over the anal region, pelvic region, lumbar region and thighs.  

*Excessive bleeding should be controlled with a cotton pad soaked with ''chandanadya-taila'' (C.S Ci 3-258) or ''satadhauta-ghrita'' (ghee washed with cold water for one hundred times), and the oil or ghee; squeeze this pad over the anal and pelvic regions [87-92 ½]

*Excessive bleeding should be controlled with a cotton pad soaked with ''chandanadya-taila''[Cha.Sa. [[Chikitsa Sthana]] 3-258] or ''satadhauta-ghrita'' (ghee washed with cold water for one hundred times), and the oil or ghee; squeeze this pad over the anal and pelvic regions [87-92 ½]

=== ''Pichcha-basti'' (mucilaginous enema) for dysentery ===

=== ''Pichcha-basti'' (mucilaginous enema) for dysentery ===

*The aggravated vata becomes stronger in its own site in ''atisara'' patients. For the pacification of aggravated ''vata'' associated with ''pitta'' (which takes place in bloody diarrhea), ''basti'' (both the ''anuvasana'' and ''niruha'' types) is the best therapy.

*The aggravated vata becomes stronger in its own site in ''atisara'' patients. For the pacification of aggravated ''vata'' associated with ''pitta'' (which takes place in bloody diarrhea), ''basti'' (both the ''anuvasana'' and ''niruha'' types) is the best therapy.

*If bleeding takes place before evacuating the stool or after evacuation of stool (i.e., a case of ''raktatisara''), then ''shatavari-ghrita'' (C.S Ci 30: 64-69) in the form of linctus should be given.

*If bleeding takes place before evacuating the stool or after evacuation of stool (i.e., a case of ''raktatisara''), then ''shatavari-ghrita'' [Cha.Sa. [[Chikitsa Sthana]] 30/64-69] in the form of linctus should be given.

*Intake of freshly collected butter along with half the quantity of sugar and one fourth quantity of honey cures the above mentioned ailments. While taking this potion, the patient should take wholesome food. Adventitious roots of ''nyagrodha, udumbara'' and ''ashvattha'' should be crushed and kept soaked in hot water for twenty four hours. Ghee should be cooked along with this water. This medicated ghee should be added with half the quantity of sugar and one fourth in quantity of honey, and taken in the form of linctus. It cures ''raktatisara'', associated with bleeding either before or after the passing of stool [96-100½]

*Intake of freshly collected butter along with half the quantity of sugar and one fourth quantity of honey cures the above mentioned ailments. While taking this potion, the patient should take wholesome food. Adventitious roots of ''nyagrodha, udumbara'' and ''ashvattha'' should be crushed and kept soaked in hot water for twenty four hours. Ghee should be cooked along with this water. This medicated ghee should be added with half the quantity of sugar and one fourth in quantity of honey, and taken in the form of linctus. It cures ''raktatisara'', associated with bleeding either before or after the passing of stool [96-100½]

*If the movement of ''vata'' (flatus) is obstructed resulting in colic pain and dysentery, then the patient should be given tender fruits of ''bilva'', jaggery, oil, ''pippali'' and ''shunthi''.

*If the movement of ''vata'' (flatus) is obstructed resulting in colic pain and dysentery, then the patient should be given tender fruits of ''bilva'', jaggery, oil, ''pippali'' and ''shunthi''.

*Diet prepared with ''vata'' alleviating ingredients along with the vegetable soup, meat soup and ''khada'' (a type of sour drink) described under ''vataja atisara'' should be given.  

*Diet prepared with ''vata'' alleviating ingredients along with the vegetable soup, meat soup and ''khada'' (a type of sour drink) described under ''vataja atisara'' should be given.  

*Sour medicated ghee like ''changeri ghrita'' or ''shatpala ghrita'' (C.S. Chi. 5: 147-148 or (ten years) old ghee mixed with ''yavagu'' (thick gruel) and ''manda'' (thin gruel) should be given [113-116].

*Sour medicated ghee like ''changeri ghrita'' or ''shatpala ghrita'' [Cha.Sa. [[Chikitsa Sthana]] 5/ 147-148 ] or (ten years) old ghee mixed with ''yavagu'' (thick gruel) and ''manda'' (thin gruel) should be given [113-116].

=== ''Piccha-basti'' and ''anuvasana-basti'' ===

=== ''Piccha-basti'' and ''anuvasana-basti'' ===

*If ''vata'' and ''kapha'' are obstructed in the ''mahasrotas'', if there is excessive evacuation of ''kapha'' (mucus) and if there is colic pain as well as dysentery, then ''piccha-basti'' (mucilaginous enema) should be administered.  

*If ''vata'' and ''kapha'' are obstructed in the ''mahasrotas'', if there is excessive evacuation of ''kapha'' (mucus) and if there is colic pain as well as dysentery, then ''piccha-basti'' (mucilaginous enema) should be administered.  

*''Piccha-basti'' should be prepared of the paste of ''pippali, bilva, kustha, shatahva'' and ''vacha'' by adding salt.

*''Piccha-basti'' should be prepared of the paste of ''pippali, bilva, kustha, shatahva'' and ''vacha'' by adding salt.

*Patient feels comfortable after the ingredients of ''pichcha-basti'' come out of the rectum and then patient should be advised to take bath followed by intake of food. ''Anuvasana basti'' with lukewarm oil of ''bilva'' (C.S.Si 4: 4-7) should be given in the afternoon.The ''anuvasana basti'' can also be given frequently with the oil cooked with the paste of ''pippali, bilva, kushtha, shatahva'' and ''vacha'' [117-120].

*Patient feels comfortable after the ingredients of ''pichcha-basti'' come out of the rectum and then patient should be advised to take bath followed by intake of food. ''Anuvasana basti'' with lukewarm oil of ''bilva'' [Cha.Sa.[[Siddhi Sthana]] 4/ 4-7] should be given in the afternoon.The ''anuvasana basti'' can also be given frequently with the oil cooked with the paste of ''pippali, bilva, kushtha, shatahva'' and ''vacha'' [117-120].

=== Need for immediate control of ''vata'' ===

=== Need for immediate control of ''vata'' ===

#Harrison’s principles of internal medicine 17th Ed. (2008) Ed. by  Fauci Kasper D.L., A.S., Longo D.L., Braunwal Eugene, Hauser S.J., Jameson J.L.. Joseph Loscalzo., Pub. MacGraw-Hill USA, Chapter 128. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning  

#Harrison’s principles of internal medicine 17th Ed. (2008) Ed. by  Fauci Kasper D.L., A.S., Longo D.L., Braunwal Eugene, Hauser S.J., Jameson J.L.. Joseph Loscalzo., Pub. MacGraw-Hill USA, Chapter 128. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning  

#Harrison’s principles of internal medicine 17th Ed. (2008) Ed. by  Fauci Kasper D.L., A.S., Longo D.L., Braunwal Eugene, Hauser S.J., Jameson J.L.. Joseph Loscalzo., Pub. MacGraw-Hill USA, Vol.-2, Chapter 338.

#Harrison’s principles of internal medicine 17th Ed. (2008) Ed. by  Fauci Kasper D.L., A.S., Longo D.L., Braunwal Eugene, Hauser S.J., Jameson J.L.. Joseph Loscalzo., Pub. MacGraw-Hill USA, Vol.-2, Chapter 338.

== References ==

== References ==