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|title=Purisha

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|description=The term ‘purisha’ means fecal matter or stool. It denotes the waste product or undigested residue remaining after the nutrient fraction of the food has been separated and absorbed.

|description=The term ‘purisha’ means fecal matter or stool. It denotes the waste product or undigested residue remaining after the nutrient fraction of the food has been separated and absorbed.

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<p style="text-align:justify;">The term ‘purisha’ means fecal matter or stool. It denotes the waste product or undigested residue remaining after the nutrient fraction of the food has been separated and absorbed. The feces (purisha) are important for normal physiological functions of [[vayu]] and [[agni]]. (SAT-B.459).<ref>Available from  http://namstp.ayush.gov.in/#/sat</ref>  Stool examination is an important test for assessment of status of digestion and overall health. This article deals with physiological, pathological, diagnostic and therapeutic aspects of stool.  

The term ‘purisha’ means fecal matter or stool. It denotes the waste product or undigested residue remaining after the nutrient fraction of the food has been separated and absorbed. The feces (purisha) are important for normal physiological functions of [[vayu]] and [[agni]]. (SAT-B.459).<ref>Available from  http://namstp.ayush.gov.in/#/sat</ref>  Stool examination is an important test for assessment of status of digestion and overall health. This article deals with physiological, pathological, diagnostic and therapeutic aspects of stool.  

 

{{Infobox

{{Infobox

|data5 = carakasamhita@gmail.com

|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:

|label6 = Publisher

|data6 = January 8, 2021

|label7 = DOI

 

|data7 =  

|label7 = Date of first publication:

|data7 = January 8, 2021

 

|label8 = DOI

|data8 = [https://doi.org/10.47468/CSNE.2021.e01.s09.038 10.47468/CSNE.2021.e01.s09.038]

}}

}}

==Formation==

==Formation==

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When the food material from the stomach (amashaya) reaches the large intestine (pakwashaya), it is dried up by the heat of [[pitta]] and absorbing property (ruksha guna) of vata to form lumps. [Cha. Sa. [[Chikitsa Sthana]] 15/11] Defecation is regulated by [[vata]] [[dosha]].The physiology of stool formation and defecation in described as follows.

When the food material from the stomach (amashaya) reaches the large intestine (pakwashaya), it is dried up by the heat of [[pitta]] and absorbing property (ruksha guna) of vata to form lumps. [Cha. Sa. [[Chikitsa Sthana]] 15/11] Defecation is regulated by [[vata]] [[dosha]].

 

The physiology of stool formation and defecation in described as follows.

Feces formation takes place in the large intestine.It carries out functions like absorbing water and electrolytes, forming and propelling feces toward the rectum for elimination. Most nutrients and up to 90% of the water are absorbed by the small intestine from the indigestible material.The ascending colon absorbs remaining water and other key nutrients from it to form solidified stool.The feces are stored in descending colon and are emptied into the rectum.The sigmoid colon contracts to increase the pressure inside the colon, causing the stool to move into the rectum. The rectum holds the feces awaiting elimination by defecation.<ref>Azzouz LL, Sharma S. Physiology, Large Intestine. [Updated 2020 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507857/</ref>

Feces formation takes place in the large intestine.It carries out functions like absorbing water and electrolytes, forming and propelling feces toward the rectum for elimination. Most nutrients and up to 90% of the water are absorbed by the small intestine from the indigestible material.The ascending colon absorbs remaining water and other key nutrients from it to form solidified stool.The feces are stored in descending colon and are emptied into the rectum.The sigmoid colon contracts to increase the pressure inside the colon, causing the stool to move into the rectum. The rectum holds the feces awaiting elimination by defecation.<ref>Azzouz LL, Sharma S. Physiology, Large Intestine. [Updated 2020 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507857/</ref>

==Channels carrying feces (purishavaha srotas)==

==Channels carrying feces (purishavaha srotas)==

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The channels carrying feces, are originated from the colon and anorectal region.[Cha.Sa. Vimana Sthana 5/8] [Su. Sa. Sharira Sthana 9/12] The large intestine and rectum form, store and carry fecal matter.  

The channels carrying feces, are originated from the colon and anorectal region.[Cha.Sa.[[Vimana Sthana]] 5/8] [Su. Sa. Sharira Sthana 9/12] The large intestine and rectum form, store and carry fecal matter.  

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===Purishadhara kala (layer forming stools) ===

==Purishadhara kala (layer forming stools)==

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Kala means the layer in body observed in sagittal section. The layer holding fecal matter(purishadhara kala) is present inside large intestine (pakwashaya) separates the waste products from the digested food.It covers the alimentary tract, liver and intestine especially in the caecum (unduka).[Su. Sa. Sharira Sthana 4/16-17]This layer performs functions of absorption of nutrients and elimination of harmful substances through stools.  

Kala means the layer in body observed in sagittal section. The layer holding fecal matter(purishadhara kala) is present inside large intestine (pakwashaya) separates the waste products from the digested food.It covers the alimentary tract, liver and intestine especially in the caecum (unduka).[Su. Sa. Sharira Sthana 4/16-17] This layer performs functions of absorption of nutrients and elimination of harmful substances through stools.  

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===Diagnostic perspectives ===

 

==Diagnostic perspectives==

 

===Causes of vitiation===

===Causes of vitiation===

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The channels carrying feces are afflicted due to suppression of urge of defecation, over eating, eating during indigestion, especially in persons with poor digestive capacity and who are emaciated. [Cha.Sa.[[ Vimana Sthana ]] 5/21]

The channels carrying feces are afflicted due to suppression of urge of defecation, over eating, eating during indigestion, especially in persons with poor digestive capacity and who are emaciated. [Cha.Sa.[[ Vimana Sthana ]] 5/21]

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==Abnormal states==

 

===Abnormal states===

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The increase or decrease in quality and/or quantity of fecal matter can lead to various abnormal conditions. The states can be assessed by following clinical features.

The increase or decrease in quality and/or quantity of fecal matter can lead to various abnormal conditions. The states can be assessed by following clinical features.

|Intestinal gas /flatus moving upward along with sound ||--

|Intestinal gas /flatus moving upward along with sound ||--

|-

|-

|Frequent movement of gas in alimentary canal especially at epigastric region|| -

|Frequent movement of gas in alimentary canal especially at epigastric region|| --

|}

|}

* *[Cha Sa. [[Sutra Sthana]] 17/70], [Su. Sa. Sutra Sthana 15/11]

* *[Cha Sa. [[Sutra Sthana]] 17/70], [Su. Sa. Sutra Sthana 15/11]

'''Clinical features of vitiation of channels carrying fecal matter'''

'''Clinical features of vitiation of channels carrying fecal matter'''

Difficulty in evacuating bowels, scanty stools, passage with sound and pain, loose motions, or irritable/irregular bowels are observed due to affliction of channels carrying fecal matter.[ Cha. Sa. [[Vimana Sthana]] 5/8].Abdominal distension, excessive foul smell of feces, hardness of bowel or presentations like paralytic ileus are also seen.[ Su. Sa. Sharira Sthana 9/12]

Difficulty in evacuating bowels, scanty stools, passage with sound and pain, loose motions, or irritable/irregular bowels are observed due to affliction of channels carrying fecal matter.[ Cha. Sa. [[Vimana Sthana]] 5/8].

 

Abdominal distension, excessive foul smell of feces, hardness of bowel or presentations like paralytic ileus are also seen.[Su. Sa. Sharira Sthana 9/12]

Clinical features of suppression of urge of defecation:

Clinical features of suppression of urge of defecation:

*distension of abdomen [Cha. Sa. [[Sutra Sthana ]] 7/8]

*distension of abdomen [Cha. Sa. [[Sutra Sthana ]] 7/8]

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== Stool examination(purisha pareeksha)==

== Stool examination(purisha pareeksha)==

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Examination of feces is included in the eight fold clinical diagnostic methods (ashtavidha pareeksha) mentioned in Ayurveda. [ Sha.Sa.  Y.R. malapariksha 1]] It is done in various medical conditions.  

Examination of feces is included in the eight fold clinical diagnostic methods (ashtavidha pareeksha) mentioned in Ayurveda. [ Sha.Sa.  Y.R. malapariksha 1] It is done in various medical conditions.  

'''Visual Examination:'''  

'''Visual Examination:'''  

!Dosha predominance !! Characteristics of stool*

!Dosha predominance !! Characteristics of stool*

|-

|-

|Vata ||Hard, dry, broken, frothy, dry and smoky color

|[[Vata]] ||Hard, dry, broken, frothy, dry and smoky color

|-

|-

|Pitta||Yellowish in color

|[[Pitta]]||Yellowish in color

|-

|-

|Kapha ||Whitish in color

|[[Kapha]] ||Whitish in color

|-

|-

|Vata-kapha||Brownish in color

|Vata-kapha||Brownish in color

*Loose motions, stool associated with blood and mucus are features of anemia and diseases due to blood deficiency (pandu) caused by habitual consumption of clay [Cha.Sa.[[Chikitsa Sthana]] 16/30].

*Loose motions, stool associated with blood and mucus are features of anemia and diseases due to blood deficiency (pandu) caused by habitual consumption of clay [Cha.Sa.[[Chikitsa Sthana]] 16/30].

*The following table shows characteristic features of faecal matter in different types of fever (jwara) [Cha. Sa. [[Niana Sthana ]] 1/21-27],  abdominal lumps(gulma) [Cha.Sa.[[Nidana Sthana ]] 3/7-11] and diseases of digestion and metabolism (grahani) [Cha. Sa. [[ Chikitsa Sthana]] 15/64, 66,70].

*The following table shows characteristic features of faecal matter in different types of fever (jwara) [Cha.Sa.[[Nidana Sthana]] 1/21-27],  abdominal lumps(gulma) [Cha.Sa.[[Nidana Sthana ]] 3/7-11] and diseases of digestion and metabolism (grahani) [Cha. Sa. [[ Chikitsa Sthana]] 15/64, 66,70].

{| class="wikitable"

{| class="wikitable"

!Dosha dominance!!Character of fecal matter in fever(jwara)/ abdominal lump(gulma) !! Characteristic features of stool in diseases of digestion and metabolism (grahani) *

!Dosha dominance!!Character of fecal matter in fever(jwara)/ abdominal lump(gulma) !! Characteristic features of stool in diseases of digestion and metabolism (grahani) *

|-

|-

|Vata dosha ||Dark, blackish or reddish discoloration of stool and reduced tendency to evacuation of stool.|| Painful defecation, takes more time for elimination, feces are watery, dry, small sized associated with flatus and undigested food. Frequency of defecation is increased.  

|[[Vata dosha]] ||Dark, blackish or reddish discoloration of stool and reduced tendency to evacuation of stool.|| Painful defecation, takes more time for elimination, feces are watery, dry, small sized associated with flatus and undigested food. Frequency of defecation is increased.  

|-

|-

|Pitta dosha || Green or yellow coloration of stool.|| The stools have undigested food particles with either bluish-yellowish tinge or yellow in color; loose/watery.

|[[Pitta dosha]] || Green or yellow coloration of stool.|| The stools have undigested food particles with either bluish-yellowish tinge or yellow in color; loose/watery.

|-

|-

|Kapha dosha||Whitish coloration of stool.||Stools are mixed with undigested items and mucous; heavy (sink in water).

|[[Kapha dosha]]||Whitish coloration of stool.||Stools are mixed with undigested items and mucous; heavy (sink in water).

|}

|}

The character of stool is considered as an important parameter in assessment of the therapeutic oleation before therapeutic emesis (vamana) and purgation (virechana). The dietary fat consumption (in the form of ghee, oil, muscle fat and marrow) is increased for therapeutic purpose. The same is reflected in the consistency and fat content of stools.  

The character of stool is considered as an important parameter in assessment of the therapeutic oleation before therapeutic emesis (vamana) and purgation (virechana). The dietary fat consumption (in the form of ghee, oil, muscle fat and marrow) is increased for therapeutic purpose. The same is reflected in the consistency and fat content of stools.  

   

   

a)Hard and dry feces are signs of inadequate oleation

a) Hard and dry feces are signs of inadequate oleation

b)Lubricated, soft and not well formed faeces indicate proper oleation.  

b) Lubricated, soft and not well formed faeces indicate proper oleation.  

c)Improperly formed and loose faeces indicate excess oleation. [Cha.Sa.[[Sutra Sthana]] 13/57-59]

c) Improperly formed and loose faeces indicate excess oleation. [Cha.Sa.[[Sutra Sthana]] 13/57-59]

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==Management of disorders related to fecal matter==

==Management of disorders related to fecal matter==

===Management of increased state ===

===Management of increased state ===

'''Diet promoting the formation of feces (in case of scanty stool):'''

'''Diet promoting the formation of feces (in case of scanty stool):'''

*Barley (yava) [Cha. Sa. [[Sutra Sthana ]]25/40]  

*Barley (yava) [Cha.Sa.[[Sutra Sthana]]25/40]  

*A type of soup prepared of cereals and pulses (dhanya-yusha)made of barley(yava), green gram(mudga), black gram(masha), and shali type of rice, sesame seeds, Ziziphus jujuba Lamk (kola) and tender fruits of Aegle marmelos (bilva), sizzled with ghee and oil taken together with curd and the extract of pomegranate(dadima). One should take boiled shali rice along with this soup.

*A type of soup prepared of cereals and pulses (dhanya-yusha)made of barley(yava), green gram(mudga), black gram(masha), and shali type of rice, sesame seeds, Ziziphus jujuba Lamk (kola) and tender fruits of Aegle marmelos (bilva), sizzled with ghee and oil taken together with curd and the extract of pomegranate(dadima). One should take boiled shali rice along with this soup.

*Meat soup  

*Meat soup  

*The red variety of shali rice boiled by adding ghee and sour ingredients. [Cha.Sa.[[Chkitsa Sthana ]] 19/35-41]

*The red variety of shali rice boiled by adding ghee and sour ingredients. [Cha.Sa.[[Chikitsa Sthana ]] 19/35-41]

'''Role of tastes (rasa):'''

'''Role of tastes (rasa):'''

Excessive consumption of bitter taste (tikta rasa) food items leads to decrease of fecal matter. Excessive consumption of astringent food items (kashaya rasa) lead to constipation. [Cha. Sa. [[Sutra Sthana]] 26/43]

Excessive consumption of bitter taste (tikta rasa) food items leads to decrease of fecal matter. Excessive consumption of astringent food items (kashaya rasa) lead to constipation. [Cha.Sa.[[Sutra Sthana]]26/43]

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==Current researches==

==Current researches==

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2.Ramanand Tiwari(2012) : Clinical Evaluation of Bilvadi Leha in the Management of Irritable Bowel Syndrome (IBS), Department of Roganidana and Vikruti Vigyana, IPGT &RA, Jamnagar.

2.Ramanand Tiwari(2012) : Clinical Evaluation of Bilvadi Leha in the Management of Irritable Bowel Syndrome (IBS), Department of Roganidana and Vikruti Vigyana, IPGT &RA, Jamnagar.

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==References:==

 

 

==References==

 

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