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Atisara Chikitsa (view source)

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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]

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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 [[vata]]ja, [[pitta]]ja, [[kapha]]ja and ''sannipataja atisara'' and ''agantuja/manasa'' or exogenous [11]

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

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

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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]

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=== Principles of treatment ===

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

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*When the diarrhea is caused by the accumulated (aggravated) ~~''doshas''~~ impelled by ''vidagdha'' (fermentation of undigested) food, the patient should be given laxative to eliminate the ''dosha''.

+

*When the diarrhea is caused by the accumulated (aggravated) [[dosha]] impelled by ''vidagdha'' (fermentation of undigested) food, the patient should be given laxative to eliminate the [[dosha]].

*In the initial state i.e. ''ama'' (primary or immature) of diarrhea, stopping or binding therapies are never indicated.

−

*Administration of such bowel-binding therapies in the initial stage obstructs the movement and elimination of the already aggravated ''dosha'' leading to complications like ''dandakalasaka'' (obstruction to intestinal peristalsis), ''adhmana'' (flatulence), ''grahani roga'' (digestive disorders like sprue syndrome), piles, fistula-in-ano, edema, anemia, splenic disorders, ''kushtha'' (obstinate skin diseases including leprosy), ''gulma'' (abdominal lumps), ''udara roga'' (obstinate abdominal diseases including ascites) and fever.

+

*Administration of such bowel-binding therapies in the initial stage obstructs the movement and elimination of the already aggravated [[dosha]] leading to complications like ''dandakalasaka'' (obstruction to intestinal peristalsis), ''adhmana'' (flatulence), ''grahani roga'' (digestive disorders like sprue syndrome), piles, fistula-in-ano, edema, anemia, splenic disorders, ''kushtha'' (obstinate skin diseases including leprosy), ''gulma'' (abdominal lumps), ''udara roga'' (obstinate abdominal diseases including ascites) and fever.

*Hence, the physician should ignore the downward movement of the detached (''utklishta'') morbid matter, which is moving downwards on its own.

*Diarrhea should be allowed to continue and should not be stopped by constipating medicines.

*If the diarrhea is associated with griping pain (difficulty in evacuating), then ''haritaki'' should be given as a mild laxative.

−

*Once the morbid matter is eliminated through downward movement then this abdominal disease (diarrhea) gets cured, the body becomes light and the power of ''agni'' becomes strong.

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*Once the morbid matter is eliminated through downward movement then this abdominal disease (diarrhea) gets cured, the body becomes light and the power of [[agni]] becomes strong.

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*Moderately aggravated ''dosha'' should be managed by ''pramathya'' (a type of decoction of drugs) which stimulates the power of digestion (''dipana'') and which is carminative (''pachana'') should be administered. Slightly aggravated ''dosha'' should be managed by ''langhana'' (fasting therapy) [14-19].

+

*Moderately aggravated [[dosha]] should be managed by ''pramathya'' (a type of decoction of drugs) which stimulates the power of digestion ([[dipana]]) and which is carminative ([[pachana]]) should be administered. Slightly aggravated [[dosha]] should be managed by [[langhana]] (fasting therapy) [14-19].

=== Recipes of ''pramathya'' ===

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Three recipes of ''pramathya'' which are useful in the treatment of diarrhea are as follow:

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*Decoction of ''pippali, nagara, dhanyaka, bhutika, abhaya'' and ''vacha'' for ~~''vataja~~ atisara''

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*Decoction of ''pippali, nagara, dhanyaka, bhutika, abhaya'' and ''vacha'' for [[vata]]ja atisara''

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*Decoction of ''hrivera, bhadra-musta, bilva, nagara'' and ''dhanyaka'' for ~~''pittaja~~ atisara'')

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*Decoction of ''hrivera, bhadra-musta, bilva, nagara'' and ''dhanyaka'' for [[pitta]]ja atisara'')

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*Decoction of ''prashniparni, svadamstra, samanga'' and ''kantakarika'' for ~~''kaphaja~~ atisara''

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*Decoction of ''prashniparni, svadamstra, samanga'' and ''kantakarika'' for [[kapha]]ja atisara''

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*Decoction of ''vacha'' and ''prativisha'' for ~~''vataja~~ atisara''

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*Decoction of ''vacha'' and ''prativisha'' for [[vata]]ja atisara''

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*Decoction of ''musta'' and ''parpataka'' for ~~''pittaja~~ atisara''

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*Decoction of ''musta'' and ''parpataka'' for [[pitta]]ja atisara''

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*Decoction of ''hrivera'' and ''sringavera'' for ~~''kaphaja~~ atisara''

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*Decoction of ''hrivera'' and ''sringavera'' for [[kapha]]ja atisara''

[Note: Decoction should be prepared as per the procedure described for ''sandanga-paniya'' in C.S.Ci.3-145.] [20-22]

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*At appropriate meal time, if the patient feels hungry, light food should be given to eat. It enhances the appetite and stimulates agni and as a result the strength is promoted immediately.

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*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.

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*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.

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

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

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

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=== Treatment of [[vata]]ja atisara ===

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The following drugs are useful for the cure of ~~''vataja~~ atisara'' (diarrhea):

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The following drugs are useful for the cure of [[vata]]ja atisara(diarrhea):

*''Shalaparni, prashniparni, brhati, kantakarika, bala, svadamstra, bilva, patha, nagara, dhanyaka, shati, palasha, hapusha, vacha, jiraka, pippali, yavani, pippali-mula, chitraka, hastipippali, vrikshamla, sour pomegranate, hingu, vida'' and ''saindhava''-these ingredients should be appropriately used in processing food preparations.

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*Drugs belonging to the ''vata'' and ''kapha'' alleviative group and those drugs which are ''dipana'' (digestive stimulant), ''pachana'' (carminative), ''grahi'' (constipating), ''balya'' (promoter of strength) and ''rochana'' (appetizer) should be prescribed. [26-29]

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*Drugs belonging to the [[vata]] and [[kapha]]' alleviative group and those drugs which are [[dipana]] (digestive stimulant), [[pachana]] (carminative), ''grahi'' (constipating), ''balya'' (promoter of strength) and ''rochana'' (appetizer) should be prescribed. [26-29]

=== Management of diarrhea associated with pain ===

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For the cure of prolapse rectum, ''anuvasana basti'' (oil-based enema therapy) should be administered with the following recipes:

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For the cure of prolapse rectum, anuvasana [[basti]] (oil-based enema therapy) should be administered with the following recipes:

*''Dashamoola'' cooked with fat;

*''Bilva'' cooked with fat:

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Milk boiled with the root of castor or tender fruit of ''bilva'' may also be given in the above mentioned condition. By the intake of the recipes of medicated ghee mentioned above, bleeding and mucus discharge from the anus stops. These recipes also cure colic pain, dysentery and constipation [47-49]

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=== Treatment of ~~''pittaja~~ atisara'' ===

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=== Treatment of [[pitta]]ja atisara ===

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For the cure of ~~''pittaja~~ atisara'', the following therapy should be administered:

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For the cure of [[pitta]]ja atisara, the following therapy should be administered:

−

*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 [[pitta]]ja 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.

*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''.

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*''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 [[pitta]]ja 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]

−

=== Recipes for ~~''pittaja~~ atisara'' ===

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=== Recipes for [[pitta]]ja atisara ===

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The following recipes are useful in curing ~~''pittaja~~ atisara'':

+

The following recipes are useful in curing [[pitta]]ja atisara:

*The fruit and bark of ''vatsaka'' should be added with ''ativisha'' and honey. It should be taken along with rice-water (''tandulodaka'').

The following recipes should be taken along with honey and rice-water (''tandulodaka'').

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*Goat-milk administered to a patient having strong power of digestion cures ~~''pittaja~~ atisara'' and promotes strength as well as complexion.

+

*Goat-milk administered to a patient having strong power of digestion cures [[pitta]]ja atisara and promotes strength as well as complexion.

−

*Due to excessive aggravation of ''dosha'', if the ~~''pittaja~~ atisara'' is not cured and if the patient has strong power of digestion and vitality, then laxative therapy with milk should be given.

+

*Due to excessive aggravation of [[dosha]], if the [[pitta]]ja atisara is not cured and if the patient has strong power of digestion and vitality, then laxative therapy with milk should be given.

*Decoction of the fruit of ''palasha'' along with milk should be given. Later, depending upon the strength of the patient, lukewarm milk should be given. This will restore bowel movement and control the ''atisara''. Decoction of ''trayamana'' along with milk should be given. Later, depending upon the strength of the patient lukewarm milk should be given. This will restore bowel movement and control the ''atisara''.

−

''Anuvasana basti'' (medicated untuous enema):

+

Anuvasana [[basti]] (medicated untuous enema):

−

*During the course of ''sansarjana-krama'' (gradual administration of light food) after purification therapy if the colic pain persists, then ''anuvasana basti'' therapy should be administered immediately because morbid matter is already eliminated.

+

*During the course of ''sansarjana-krama'' (gradual administration of light food) after purification therapy if the colic pain persists, then anuvasana [[basti]] therapy should be administered immediately because morbid matter is already eliminated.

−

''Satapushpadi'' ghee is advised for ''anuvasana basti'' [57-62].

+

''Satapushpadi'' ghee is advised for anuvasana [[basti]] [57-62].

−

=== ''Piccha basti'' (slimy medicated enema) ===

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=== Piccha [[basti]] (slimy medicated enema) ===

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If diarrhea persists in spite of the administration of ''anuvasana basti'' and observing the ''samsarjana-krama'' (gradual administration of lighter to heavier food) then ''piccha basti'' (mucilaginous type of medicated enema) should be given.

+

If diarrhea persists in spite of the administration of anuvasana [[basti]] and observing the ''samsarjana-krama'' (gradual administration of lighter to heavier food) then piccha [[basti]] (mucilaginous type of medicated enema) should be given.

−

Green stalks of ''shalmali'' should be covered with green ''kusha'' and tied. This bundle is then smeared with the mud of black soil and placed over cow-dung fire. After the mud is dried up, the stalks of ''shalmali'' is removed. These stalks are then triturated in a pestle and mortar. One ''mushti'' (''pala'' or handful) of this paste should be mixed with one ''prastha'' of boiled milk and filtered. In this milk, oil, ghee and paste of ''madhuka'' is added in adequate quantity. This recipe is used for medicated enema to be given to the patient after massaging the body with oil. When the nasty material comes out, the patient should take bath and thereafter take food along with either milk or the meat soup of the wild animals. This ''piccha-basti'' (mucilaginous enema) cures ''paittika'' type of diarrhea, fever, edema, ''gulma'' (abdominal lumps), chronic diarrhea, ''grahani'' (digestive disorders) and the acute complications of purgation as well as of ''asthapana basti'' [63-68]

+

Green stalks of ''shalmali'' should be covered with green ''kusha'' and tied. This bundle is then smeared with the mud of black soil and placed over cow-dung fire. After the mud is dried up, the stalks of ''shalmali'' is removed. These stalks are then triturated in a pestle and mortar. One ''mushti'' (''pala'' or handful) of this paste should be mixed with one ''prastha'' of boiled milk and filtered. In this milk, oil, ghee and paste of ''madhuka'' are added in adequate quantity. This recipe is used for the medicated enema to be given to the patient after massaging the body with oil. When the nasty material comes out, the patient should take bath and thereafter take food along with either milk or the meat soup of the wild animals. This piccha-[[basti]] (mucilaginous enema) cures ''paittika'' type of diarrhea, fever, edema, ''gulma'' (abdominal lumps), chronic diarrhea, ''grahani'' (digestive disorders) and the acute complications of purgation as well as of asthapana [[basti]] [63-68]

=== ''Raktatisara'' (bloody diarrhoea) ===

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If a ~~''pittaja~~ atisara'' patient does not follow the therapeutic measures and resorts to such foods and drinks which cause aggravation of ''pitta'', then the excessively provoked ''pitta'' causes ''raktatisara'' and instantaneous vitiation of ''rakta'' (blood). This leads to serious complications like morbid thirst, colic pain, burning sensation and suppuration of the anus. It can also manifest itself directly on account of excessive aggravation of ''pitta'' and vitiation of blood [69-70]

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If a [[pitta]]ja atisara patient does not follow the therapeutic measures and resorts to such foods and drinks which cause aggravation of [[pitta]], then the excessively provoked [[pitta]] causes ''raktatisara'' and instantaneous vitiation of [[rakta]] (blood). This leads to serious complications like morbid thirst, colic pain, burning sensation and suppuration of the anus. It can also manifest itself directly on account of excessive aggravation of [[pitta]] and vitiation of blood [69-70]

=== Treatment of ''raktatisara'' ===

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Ghee should be cooked by adding the six drugs, viz., the bark of ''daru-haridra'', fruits of ''kutaja, pippali, shringavera, draksa'' and ''katukarohini''. Intake of ''peya'' (thin gruel) and ''manda'' (very thin gruel) along with this medicated ghee cures a serious type of diarrhea even if caused by ''sannipata'' (simultaneous aggravation of all the three ~~''doshas''~~).[80-81]

+

Ghee should be cooked by adding the six drugs, viz., the bark of ''daru-haridra'', fruits of ''kutaja, pippali, shringavera, draksa'' and ''katukarohini''. Intake of ''peya'' (thin gruel) and ''manda'' (very thin gruel) along with this medicated ghee cures a serious type of diarrhea even if caused by ''sannipata'' (simultaneous aggravation of all the three [[dosha]]).[80-81]

=== Hemostatic recipes ===

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*The paste of ''priyangu'' should be added with rice-water (''tandulambu''). Intake of this, while taking the soup of the meat of animals inhabiting arid zone, in food, controls bleeding instantaneously.

*One part of the paste of the black variety of ''tila'' should be added with four parts of sugar. Intake of this potion along with the goat’s milk checks bleeding instantaneously.

−

*Intake of the decoction of the seeds of ''vatsaka'', while taking meat-soup as food, cures ~~''pittaja''~~ disorders of abdomen (''jathara'').

+

*Intake of the decoction of the seeds of ''vatsaka'', while taking meat-soup as food, cures [[pitta]]ja disorders of abdomen (''jathara'').

*Intake of ''chandana'' along with rice-water, mixed with sugar and honey cures burning sensation, morbid thirst, ''prameha'' and bleeding [82-86].

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Aggravated ''pitta'' suppurates the anus due to frequent evacuation of stool. The anus of such a patient should be sprinkled and applied with the following recipes which stops bleeding and pacifies suppuration and pain.

+

Aggravated [[pitta]] suppurates the anus due to frequent evacuation of stool. The anus of such a patient should be sprinkled and applied with the following recipes which stops bleeding and pacifies suppuration and pain.

*Exceedingly cold decoction of ''patola'' and ''madhuka''

*Decoction of ''pancha-valkala'' (barks of ''nyagrodha, udumbara, ashvattha, parisa'' and ''plaksha'') or sugar-cane juice. Milk or ghee of goat or cow mixed with sugar and honey. The paste of drugs mentioned above for washing (sprinkling over) the anus may be mixed with ghee and applied over the suppurated anus. The powder of the above mentioned drugs may also be used for ''pratisarana'' (dusting) over the suppurated anus.

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*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 ===

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−

When the movement of the aggravated ''vata'' (flatus) gets obstructed or moves with difficulty or seizing of ''vata'' inside the abdomen, then the patient voids blood frequently in small quantities which is associated with pain. ''Piccha-basti'' should be administered to such patients. This type of patient may also be managed by ''anuvasana basti'' given with medicated ghee prepared with ''prapaundarika''. Because of chronic diarrhea, the anus of the patient generally becomes weak. Therefore cotton soaked in medicated ghee should be inserted into the anus frequently or ''anuvasana basti'' with medicated ghee is given [93-95½ ].

+

When the movement of the aggravated vata (flatus) gets obstructed or moves with difficulty or seizing of [[vata]] inside the abdomen, then the patient voids blood frequently in small quantities which is associated with pain. Piccha-[[basti]] should be administered to such patients. This type of patient may also be managed by anuvasana [[basti]] given with medicated ghee prepared with ''prapaundarika''. Because of chronic diarrhea, the anus of the patient generally becomes weak. Therefore cotton soaked in medicated ghee should be inserted into the anus frequently or anuvasana [[basti]] with medicated ghee is given [93-95½ ].

=== Medicated enema and recipes of linctus ===

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−

*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'' [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]

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−

A patient who has become weak because of ''raktatisara'', if indulges in ''pitta''-aggravating ingredients out of ignorance, then the anal sphincters gets suppurated. This is a serious condition leading to instantaneous death [101½].

+

A patient who has become weak because of ''raktatisara'', if indulges in [[pitta]]-aggravating ingredients out of ignorance, then the anal sphincters gets suppurated. This is a serious condition leading to instantaneous death [101½].

−

=== Treatment of ~~''kaphaja~~ atisara'' ===

+

=== Treatment of [[kapha]]ja atisara ===

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</div></div>

−

For the cure of ~~''kaphaja~~ atisara'', following therapy and recipes should be administered:

+

For the cure of [[kapha]]ja atisara, following therapy and recipes should be administered:

−

*Fasting (''langhana'') and carminative (''pachana'') therapies should be administered in the beginning.

+

*Fasting ([[langhana]]) and carminative ([[pachana]]) therapies should be administered in the beginning.

−

*The group of drugs which stimulates the power of digestion (''dipana-gana'') which is prescribed for the treatment of ''ama-atisara'' should be given.

+

*The group of drugs which stimulates the power of digestion ([[dipana]]-gana) which is prescribed for the treatment of ''ama-atisara'' should be given.

−

*If the ~~''kaphaja~~ atisara'' persists even after the administration of the above mentioned measures, then the patient should be given ''kapha'' alleviating therapies.

+

*If the [[kapha]]ja atisara persists even after the administration of the above mentioned measures, then the patient should be given [[kapha]] alleviating therapies.

−

*The following four decoctions cure ~~''kaphaja~~ atisara'' as well as promotes ''kayagni'' (power of digestion and metabolism)

+

*The following four decoctions cure [[kapha]]ja atisara as well as promotes ''kayagni'' (power of digestion and metabolism)

**Decoction of ''bilva, karkatika, musta, abhaya'' and ''vishva-bheshaja''(''shunthi'')

**Decoction of ''vacha, vidanga, bhutika, dhanyaka'' and ''devadaru''

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*Administration of the recipe containing one part each of black variety of ''ajaji, pachana, nagara'' and ''maricha'' and two parts of ''dhataki'' along with profuse quantity of lime juice.

*One part each of ''rasanjana, ativisha'' and fruits of ''kutaja'', and two parts of ''dhataki'' should be added with honey and ginger. This potion should be given to drink.

−

*For the treatment of ~~''kaphaja~~ atisara'', the following four recipes should be given in the form of ''khada'' (a type of sour drink which stimulates the power of digestion). ''Dhataki, nagara, bilva, lodhra'' and ''padmakesara''; bark of ''jambu, nagara, dhanya, patha, mocha-rasa'' and ''bala''; ''samanga, dhataki,'' pulp of ''bilva'' and the bark of ''jambu'' and ''amra''; and ''kapittha, vidanga, nagara'' and ''maricha''.

+

*For the treatment of [[kapha]]ja atisara, the following four recipes should be given in the form of ''khada'' (a type of sour drink which stimulates the power of digestion). ''Dhataki, nagara, bilva, lodhra'' and ''padmakesara''; bark of ''jambu, nagara, dhanya, patha, mocha-rasa'' and ''bala''; ''samanga, dhataki,'' pulp of ''bilva'' and the bark of ''jambu'' and ''amra''; and ''kapittha, vidanga, nagara'' and ''maricha''.

The above mentioned recipes should be added with the sour juice of ''changeri'' and ''kola'' and butter-milk and given to the patient after adding ghee and salt.

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</div></div>

−

*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 [[vata]]ja atisara should be given.

*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]] ===

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</div></div>

−

For the cure of ~~''kaphaja''~~ and ~~''vataja''~~-predominant ''atisara'', the following therapy and recipes should be administered:

+

For the cure of [[kapha]]ja and [[vata]]ja-predominant ''atisara'', the following therapy and recipes 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.

+

*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'' [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].

+

*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]] ===

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</div></div>

−

When ''kapha'' gets reduced because of the above mentioned therapeutic measures, the ''vata'' undoubtedly gets aggravated in its own location (colon). This aggravated ''vata'' may cause instantaneous death and hence should be controlled without delay [121]

+

When [[kapha]] gets reduced because of the above mentioned therapeutic measures, the [[vata]] undoubtedly gets aggravated in its own location (colon). This aggravated [[vata]] may cause instantaneous death and hence should be controlled without delay [121]

=== Principle of treatment of ''sannipataja atisara'' ===

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For the cure of ''sannipataja atisara,'' following therapy and recipes should be administered:

−

*The aggravated ''vata'' should be pacified first followed by the alleviation of the aggravated ''pitta'' followed by alleviation of ''kapha''.

+

*The aggravated [[vata]] should be pacified first followed by the alleviation of the aggravated [[pitta]] followed by alleviation of [[kapha]].

−

*Alternatively, the most aggravated one should be controlled first followed by the treatment of the remaining two ''dosha'' [122].

+

*Alternatively, the most aggravated one should be controlled first followed by the treatment of the remaining two [[dosha]] [122].

=== Summary ===

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== Tattva Vimarsha (Fundamental Principles) ==

−

*''Atisara'' is caused by intake of heavy to digest, excessively hot and food that is incompatible to the body, impairment of ''agni'' and mind. The body reacts to expel out the incompatible material out of gut in the form of ''atisara''.

+

*''Atisara'' is caused by intake of heavy to digest, excessively hot and food that is incompatible to the body, impairment of [[agni]] and mind. The body reacts to expel out the incompatible material out of gut in the form of ''atisara''.

*There are five categories of etio-pathological factors for ''atisara'':

−

#Reduced ''agni'',

+

#Reduced [[agni]],

−

#Vitiated ''vata'' and its sub types ''samana'' and ''apana''.

+

#Vitiated [[vata]] and its sub types ''samana'' and ''apana''.

#Vitiated body fluids.

#Vitiated ''purishavaha srotas'' (lower gastro-intestinal tract) and organs of excretion.

#Fear and grief (mental).

−

*Interaction of ~~''prakriti''~~ (basic constitution) and the diet and lifestyle of similar properties (as that of ''dosha ~~prakriti''~~) makes the person susceptible for ''atisara''.

+

*Interaction of [[Prakriti]] (basic constitution) and the diet and lifestyle of similar properties (as that of [[dosha]] [[Prakriti]]) makes the person susceptible for ''atisara''.

−

*The exogenous factors like consumption of intoxicating beverages, exposure to '''krimi''' (bacteria and parasites), other diseases like ''shosha, jwara, arsha'' influence all the above factors and three ''dosha'' to cause ''sannipatik atisara'' (diarrhea) which includes bloody diarrhea.

+

*The exogenous factors like consumption of intoxicating beverages, exposure to '''krimi''' (bacteria and parasites), other diseases like ''shosha, jwara, arsha'' influence all the above factors and three [[dosha]] to cause ''sannipatik atisara'' (diarrhea) which includes bloody diarrhea.

−

*If spicy, hot, dry food in large quantity is ingested when ''agni'' is low, undigested food becomes waste product and ''samana vata'' sends it to excretory channels where ''apana vayu'' increases the motility of ''purishavaha srotas'' to excretes these large waste products, frequently.

+

*If spicy, hot, dry food in large quantity is ingested when [[agni]] is low, undigested food becomes waste product and samana [[vata]] sends it to excretory channels where ''apana vayu'' increases the motility of ''purishavaha srotas'' to excretes these large waste products, frequently.

*To fill this vacuum created by expulsion of wastes, the body fluids shift to the gut and get expelled out as ''atisara''/diarrhea causing dehydration.Thus after involvement of ''purishavaha srotasa'' ( lower GIT), ''udakavaha srotasa'' (body fluids) is also predominantly involved in pathogenesis of ''atisara''.

−

*Fear and grief are two important mental factors leading to ''atisara''. The presentation and treatment of this ''atisara'' is similar to ''vata'' dominant ''atisara''. The fear shall be treated with ''harshana''(exhilaration) treatment and grief shall be treated with ''ashwasana'' (consolation) therapy.

+

*Fear and grief are two important mental factors leading to ''atisara''. The presentation and treatment of this ''atisara'' is similar to [[vata]] dominant ''atisara''. The fear shall be treated with ''harshana''(exhilaration) treatment and grief shall be treated with ''ashwasana'' (consolation) therapy.

−

*The endogenous ''atisara'' shall be treated after proper assessment of dominant ''dosha'', causative factors and pacifying factors,

+

*The endogenous ''atisara'' shall be treated after proper assessment of dominant [[dosha]], causative factors and pacifying factors,

−

*At the initial stage of ''atisara'' when undigested food is being expelled, ''stambhan'' (anti diarrheal treatment) is strictly contraindicated. If ''stambhana'' is given, it leads to various complications. Mild laxatives like ''haritaki'' shall be administered for evacuating the ''mala'' (accumulated undigested wastes). ''Deepana'' and ''pachana'' (stimulation of ''agni'' for digestion and metabolism) should be given with light nutritive liquid foods. After restoration of ''agni, ~~stambhan''~~ is given and care should taken to keep ''vata'' balanced.

+

*At the initial stage of ''atisara'' when undigested food is being expelled, ''stambhan'' (anti diarrheal treatment) is strictly contraindicated. If ''stambhana'' is given, it leads to various complications. Mild laxatives like ''haritaki'' shall be administered for evacuating the [[mala]] (accumulated undigested wastes). [[Deepana]] and [[pachana]] (stimulation of [[agni]] for digestion and metabolism) should be given with light nutritive liquid foods. After restoration of [[agni]], [[stambhana]] is given and care should taken to keep [[vata]] balanced.

*In case of prolapse of rectum, medicated ghee processed with sour herbs or ''anuvasana'' (unctuous enema) is prescribed.

−

*Various states of ''atisara'' like that mixed with mucous, blood, associated with colic pain shall be treated with ''pichcha basti'' (mucilaginous enema).

+

*Various states of ''atisara'' like that mixed with mucous, blood, associated with colic pain shall be treated with pichcha [[basti]] (mucilaginous enema).

−

*When ''kapha'' gets reduced because of the above mentioned therapeutic measures, the ''vata'' is aggravated in its own location (colon). This aggravated ''vata'' must be immediately treated as it may cause instantaneous death.

+

*When [[kapha]] gets reduced because of the above mentioned therapeutic measures, the [[vata]] is aggravated in its own location (colon). This aggravated [[vata]] must be immediately treated as it may cause instantaneous death.

−

*In case of ''sannipataja atisara'', at first the aggravated ''vata'' shall be pacified followed by ''pitta'' and ''kapha''. Alternatively, the most aggravated one should be controlled first followed by the treatment of the remaining two ''dosha''.

+

*In case of ''sannipataja atisara'', at first the aggravated [[vata]] shall be pacified followed by [[pitta]] and [[kapha]]. Alternatively, the most aggravated one should be controlled first followed by the treatment of the remaining two [[dosha]].

== Vidhi Vimarsha (Applied Inferences ) ==

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=== Pathophysiological factors of endogenous diarrhea ===

−

*Dosha: Vata dominant three dosha

+

* [[Dosha]]: [[Vata]] dominant three [[dosha]]

−

*Dhatu (vitiated factors): Udaka (body fluid), Rasa dhatu

+

* [[Dhatu]] (vitiated factors): Udaka (body fluid), [[Rasa dhatu]]

−

*Mala kriya affected: Purisha (defecation)

+

* [[Mala]] kriya affected: [[Purisha]] (defecation)

−

*Status of agni: Manda (poor)

+

* Status of [[agni]]: Manda (poor)

−

*Origin of disease: Pakwashaya (large intestine)

+

* Origin of disease: Pakwashaya (large intestine)

−

*Sites of vitiation: large intestine

+

* Sites of vitiation: large intestine

−

*Sites of clinical presentation: rectum and anus

+

* Sites of clinical presentation: rectum and anus

−

*Srotasa involved: Purishavaha srotasa and udakavaha srotasa

+

* Srotasa involved: Purishavaha srotasa and udakavaha srotasa

−

*Type of samprapti: atipravritti (excess discharge)

+

* Type of samprapti: atipravritti (excess discharge)

=== Management protocol of endogenous diarrhea ===

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==== Subjective and objective parameters ====

−

Frequency of bowel more than three times a day with stool weight less than 200 grams with more watery content are considered as diarrhea. The quantity is less in ''vata'' dominance, medium in ''pitta'' dominance and more in ''kapha'' dominant. Frequency is more in ''vata'' dominance, medium in ''pitta'' dominance and less in ''kapha'' dominance. The consistency of stool also differs according to ''dosha'' dominance as described in the text. ''Purisha pariksha'' (stool examination) is researched further in view of frequency, consistency, smell, its specific gravity in water to determine the ''ama'' and ''nirama'' status of ''purisha''.

+

Frequency of bowel more than three times a day with stool weight less than 200 grams with more watery content are considered as diarrhea. The quantity is less in [[vata]] dominance, medium in [[pitta]] dominance and more in [[kapha]] dominant. Frequency is more in [[vata]] dominance, medium in [[pitta]] dominance and less in [[kapha]] dominance. The consistency of stool also differs according to [[dosha]] dominance as described in the text.[[Purisha]] pariksha (stool examination) is researched further in view of frequency, consistency, smell, its specific gravity in water to determine the ''ama'' and ''nirama'' status of [[purisha]].

[[File:Atisara.png]]

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==== ''Atisara'' can be prevented by following measures ====

#Avoiding causative factors

−

#Strengthening ''agni'' (digestive processes) by following dietary rules

+

#Strengthening [[agni]] (digestive processes) by following dietary rules

−

#Observing body purification treatments as per ~~''prakriti''~~ and season

+

#Observing body purification treatments as per [[Prakriti]] and season

==== Current clinical management in [[Ayurveda]] practice ====

−

*'''Principles of treatment''': ''deepana, grahi, pachana,'' buttermilk

+

*'''Principles of treatment''': [[deepana]], grahi, [[pachana]], buttermilk

*'''Main drugs''': ''kutaja, ahiphena, bhanga, bhallataka, bilva''

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! scope="col"| ''Anupana''

|-

−

| rowspan="2"|''Vata'' and ''kapha'' dominant

+

| rowspan="2"|[[Vata]] and [[kapha]] dominant

| ''Jatiphaladi–bhallataka guti''

| 60-120 mg

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| Buttermilk

|-

−

|''Pitta'' and ''kapha'' dominant

+

|[[Pitta]] and [[kapha]] dominant

| ''Kutaja kalpa''

| 60-120 mg

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| Ricewater with Buttermilk

|-

−

|~~''Raktaja''~~

+

|[[Rakta]]ja

| ''Shatavaryadi kwatha''

| 25-40 ml

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A combination of ''musta'' (cyperus rotundus), ''ativisha'' (aconitum heterophyllum), ''kutaja'' (holarrhena antidysenterica), ''chitraka'' (plumbago zeylanica) and ''bilva'' (Aegle marmelos) was found effective in management of ''atisara''.<ref>Sridhar B.N., Gopakumar K., Jaya N. Mustadi yoga-A new preparation for treatment of atisara. Aryavaidyan,10(4).May-July 1997;222-225. </ref>

−

''Kutaja'' is widely used and first preferred drug in management of ''atisara''. It is mainly indicated in conditions of vitiated ''kapha-pitta'' and as a ''sangrahi'' (styptic) and ''shoshana'' (absorbent)(Charak sutra 25/40). In an in-vitro study, sterile double dilution aqueous extract of ''kutaja'' was found effective to inhibit growth of E. coli, staphylococcus aureus, salmonella Typhi.<ref>Shrivastava Niraj, Saxena Varsha. Antibacterial activity of Kutaja(Holarrhena antidysenterica Linn.) in childhood diarrhea:-In vitro study. The Pharma Innovation Journal 2015;4(4):97-99 .</ref> Thus ''kutaja'' can be used for all purpose in management of ''atisara''.

+

''Kutaja'' is widely used and first preferred drug in management of ''atisara''. It is mainly indicated in conditions of vitiated [[kapha]]-[[pitta]] and as a ''sangrahi'' (styptic) and ''shoshana'' (absorbent)(Charak sutra 25/40). In an in-vitro study, sterile double dilution aqueous extract of ''kutaja'' was found effective to inhibit growth of E. coli, staphylococcus aureus, salmonella Typhi.<ref>Shrivastava Niraj, Saxena Varsha. Antibacterial activity of Kutaja(Holarrhena antidysenterica Linn.) in childhood diarrhea:-In vitro study. The Pharma Innovation Journal 2015;4(4):97-99 .</ref> Thus ''kutaja'' can be used for all purpose in management of ''atisara''.

Nitin Salve and Debendranath Mishra studied the botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhea.<ref>Nitin Salve, Debendranath Mishra. Botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhoea. Anc Sci Life.2016 Apr-Jun:35(4):195-200 </ref>

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The conditions like ulcerative colitis, irritable bowel syndrome, acute diarrhea are considered under the umbrella of ''atisara''.

−

In a study on 43 patients of ulcerative colitis, Patel M.V.et.al observed 80% reduction in signs and symptoms of ulcerative colitis by Ayurvedic treatment. The treatment included ''udumbara kwatha'' combination of ''lodhra, musta, nagakeshara,mukta panchamrita rasa, kutaja ghana vati'' and ''udumbara kwatha basti''. It also highlighted disease modifying effect and reduction in use of steroidal drugs in the patients. <ref>Patel M.V.,Patel K.B., Gupta S.N. Effects of Ayurvedic treatment on forty three patients of ulcerative colitis. AYU,Oct-Dec 2010,31(4), 478-481.</ref>

+

In a study on 43 patients of ulcerative colitis, Patel M.V.et.al observed 80% reduction in signs and symptoms of ulcerative colitis by Ayurvedic treatment. The treatment included ''udumbara kwatha'' combination of ''lodhra, musta, nagakeshara,mukta panchamrita rasa, kutaja ghana vati'' and udumbara kwatha [[basti]]. It also highlighted disease modifying effect and reduction in use of steroidal drugs in the patients. <ref>Patel M.V.,Patel K.B., Gupta S.N. Effects of Ayurvedic treatment on forty three patients of ulcerative colitis. AYU,Oct-Dec 2010,31(4), 478-481.</ref>

A study found that a combination of ''nagarmotha'' (Cyperus rotundus L.), ''indrayava'' (Holarrhena antidysenterica (L.) Wall.), ''nagakeshara'' (Mesua ferrea L.), ''madhuyashti'' (Glycyrrhiza glabra L.), and ''amalaki'' (Emblica officinalis Gaertn.) powders, along with ''dadimashtaka choorna, shankha bhasma, mustarista'' and ''dhanyapanchaka kvatha'' showed significant response in case of ''pravahika'' (irritable bowel syndrome). <ref>Pooja BA, Bhatted S. Ayurvedic management of Pravahika – A case report. Ayu 2015;36:410-2. </ref>

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#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.

</div>

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