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Udara Chikitsa (view source)

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<big>'''Abstract </big>'''

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The diseases presenting with cardinal symptom of generalized enlargement of abdomen is regarded as ''udara roga''. Emaciation, loss of appetite, pedal edema, inability to perform any physical activity are its other characteristic features. Extreme impairment of ''agni'' (digestion and metabolism) is the basic pathology of ''udara roga'' in general, which is regarded as one among the ''mahagada'' (major illness). It is classified into eight types viz. four types of ''doshaja udara roga'' (''vataja, pittaja, kaphaja'' and ''sannipataja''), ''plihodara'' (splenomegaly), ''kshatodara/chhidrodara'' (abdominal enlargement due to intestinal perforation), ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''jalodara/udakodara'' (ascites). ''Yakritodara'' (hepatomegaly) is also a distinct type of ''udara roga'' but incorporated in the ''plihodara'' since the etiology and treatment of these two conditions are similar.

Each type of ''udara roga'' has distinct etiology, pathology and symptomatology. ''Vataja, pittaja, kaphaja'' and ''sannipataja udara roga'' are comparable to the primary peritonitis based on the similarity of the symptoms. ''Plihodara'' (enlargement of the spleen) can be compared by the description of splenomegaly for different reasons. Symptoms of ''yakritodara'' resembles with that of hepatomegaly of varied pathology. Intestinal obstruction for different reasons causes ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction). Intestinal perforation is explained under the name of ''chhidrodara/kshatodara'' (abdominal enlargement due to intestinal perforation). ''Udara roga'' in general develops in three distinct stages. Conditions of ''ajatodaka'' is initial phase of generalized enlargement of abdomen without fluid accumulation, ''pichcha'' is generalized enlargement of abdominal distention due to liquefying state of ''dosha'' and ''jatodaka'' is generalized enlargement of abdomen with fluid accumulation. All the types of ''udara roga'' end up in ''jalodara'' (enlargement of abdomen due to collection of fluid) in the terminal phases. Among the different types of ''udara roga'', the later one in the list is more difficult to cure than its previous one. Presence of complication in ''udara roga'' is indicative of incurability. ''Virechana'' (therapeutic purgation), ''niruha basti'' (decoction enema), ''anuvasana basti'' (unctuous enema), intake of milk and buttermilk and surgical interventions (tapping) form the crux of treatment of ''udara roga''.

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'''Keywords''': ''Udara roga, vatodara, pittodara, kaphodara, sannipatodara, plihodara, yakritodara, baddhodara, chidrodara, kshatodara, jalodara,'' intestinal perforation, splenomegaly, hepatomegaly, intestinal obstruction, ascites, ''ajatodakavastha, picchavastha, jatodakavastha, virechana,'' tapping

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'''Keywords''': ''Udara roga, vatodara, pittodara, kaphodara, sannipatodara, plihodara, yakritodara, baddhodara, chidrodara, kshatodara, jalodara,'' intestinal perforation, splenomegaly, hepatomegaly, intestinal obstruction, ascites, ''ajatodakavastha, picchavastha, jatodakavastha, virechana,'' tapping </div>

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== Introduction ==

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Generalized enlargement of the abdomen is ''udara roga'' and due to similarity of this symptom i.e. bulging (''utsedha''), this chapter follows the chapter on ''shvayathu'' (edema). Out of eight types of ''udara roga'' viz. ''vataja, pittaja, kaphaja'' and ''sannipataja'' are regarded as ''dosha'' dominant ''udara roga''. In contrast to this ''plihodara'' (splenomegaly), ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction), ''kshatodara'' (abdominal enlargement due to intestinal perforation) and ''jalodara'' (enlargement of abdomen due to collection of fluid) are regarded as ''dushya'' dominant ''udara roga''. Again, ''baddhodara'' and ''chhidrodara'' are considered as ''agantuja'' (exogenous disease) and the remaining six types of ''udara roga'' are enlisted as ''nija'' (endogenous disease). Vitiation of morbid ''dosha'' obstructing the channels in the abdomen and leading to fluid accumulation are the predominant features of pathogenesis of ''udara roga''. Various purification treatments including therapeutic purgation, enema and surgical intervention to remove excess fluid are described in the chapter. The medications to pacify morbid ''dosha'' with strict dietary guidelines are treatment measures of ''udara roga''.

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== Sanskrit text, Transliteration and English Translation ==

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iti ha smAha bhagavAnAtreyaH||2||

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Now we shall expound the chapter "Udara chikitsa" (Management of generalized enlargement of abdomen). Thus said Lord Atreya [1-2]

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punarvasuM jitAtmAnamagnivesho~abravIdvacaH||4|| <br />

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Sage Punarvasu was residing in Mount Kailasa (which is similar to ''Nandana Vana'') and was accompanied with ''Siddha'' (a group of highly skilled individuals possessing eight supernatural faculties) and ''Vidhyadara'' (the possessor of knowledge of science/super human personality is termed ''Vidyadhara''). In Mount Kailasa, Sage Punarvasu was seated like very embodiment of ''dharma'' (righteousness) and was engaged in practicing austerity. Sage Punarvasu is the foremost among those who are proficient in the knowledge of [[Ayurveda]] and involved in promulgating the science of medicine. Agnivesha spoke addressing to such self controlled great sage Punarvasu. [3-4]

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=== Description of patient of ''udara roga'' ===

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yathAvacchrotumicchAmi guruNA samyagIritam||7|| <br />

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Sage Agnivesha addressing Punarvasu, said “Oh Lord!” it is observed that the patient of ''udara'' suffers from dryness of the mouth, emaciation of body, distension of abdomen and flanks, impaired digestion, loss of physical strength, inability to consume food, inability to perform any physical activities and depression; such patients sooner or later die due to the illness in the absence of treatment just like an orphan. I wish to hear the proper description of this disease from my teacher Lord Punarvasu in regards to its etiology, the number, the premonitory symptoms, clinical presentation and treatment. [5-7]

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Sage Agnivesha addressing Punarvasu, said “Oh Lord!” it is observed that the patient of ''udara'' suffers from dryness of the mouth, emaciation of body, distension of abdomen and flanks, impaired digestion, loss of physical strength, inability to consume food, inability to perform any physical activities and depression; such patients sooner or later die due to the illness in the absence of treatment just like an orphan. I wish to hear the proper description of this disease from my teacher Lord Punarvasu in regards to its etiology, the number, the premonitory symptoms, clinical presentation and treatment. [5-7] </div>

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sarvabhUtahitaM vAkyaM vyAhartumupacakrame||8||<br />

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Enthused by the student’s questioning, Lord Punarvasu spoke about the beneficial topics for the well being of human. [8]

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=== Pathogenesis of ''udara roga'' ===

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janayatyudaraM tasya hetuM shRuNu salakShaNam||11||<br />

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Abnormalities of ''jatharagni'' (digestive power) leads to the morbid accumulation of the ''mala'' (''dosha'' and bodily wastes) and in turn tend to cause multiple diseases and particularly ''udara roga''. In the state of impaired ''jatharagni'' consumption of unhealthy foods further leads to indigestion and eventually causes accumulation of morbid substances. Thus formed morbidity afflicts the functioning of ''prana vata, agni'' as well as ''apana vata'' which in turn obliterates the channels tending upwards and downwards. Due to this obliteration of channels, finally the morbid ''dosha'' tend to divulge and penetrate the space between the skin and flesh and gets accumulated there. This accumulation leads severe distention of the abdomen and causes serious disease ''udara roga''. Hereafter etiology and clinical symptoms of the same have been narrated. [9-11]

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Abnormalities of ''jatharagni'' (digestive power) leads to the morbid accumulation of the ''mala'' (''dosha'' and bodily wastes) and in turn tend to cause multiple diseases and particularly ''udara roga''. In the state of impaired ''jatharagni'' consumption of unhealthy foods further leads to indigestion and eventually causes accumulation of morbid substances. Thus formed morbidity afflicts the functioning of ''prana vata, agni'' as well as ''apana vata'' which in turn obliterates the channels tending upwards and downwards. Due to this obliteration of channels, finally the morbid ''dosha'' tend to divulge and penetrate the space between the skin and flesh and gets accumulated there. This accumulation leads severe distention of the abdomen and causes serious disease ''udara roga''. Hereafter etiology and clinical symptoms of the same have been narrated. [9-11] </div>

=== Etiology of ''udara roga'' ===

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udarANyupajAyante mandAgnInAM visheShataH||15||<br />

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Consumption of foods that are excessively hot in property, excessive consumption of salty foods, excessive intake of foods containing solutions of ''kshara'' (alkali obtained from ash of herbs), excessive intake of foods that cause burning sensation on digestion, excessive consumption of foods that are sour in taste, consumption of ''garavisha'' (intentional application of poison or poison synthesized by combination of nontoxic substances), erroneous dietary management following ''shodhana'' treatment, excessive consumption of foods having ''ruksha'' (dry) property, intake of ''viruddha ahara'' (combination of foods having mutually contradictory properties), consumption of unhealthy foods, emaciation due to splenic enlargement, emaciation due to ''arshas'' (mass per rectum), emaciation due to ''grahani roga'' (malabsorption), improper administration of [[Panchakarma]], ignorance of persistent illness without treatment, dryness of the body, withholding the naturally manifesting urges, morbidity of body channels, illness of ''ama'' (undigested food), psychological irritation, excessive consumption of foods, obstruction of the ano-rectal canal by the ''arshas'' (mass per rectum), impaction of hair within the lumen of the intestines, impaction of hardened stools within the intestines, perforation or rupture of intestines, excessive accumulation of morbidity, indulging in sinful activities, these causes will lead to development of ''udara roga'' and among these more particularly the impairment of ''jatharagni''. [12-15]

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Consumption of foods that are excessively hot in property, excessive consumption of salty foods, excessive intake of foods containing solutions of ''kshara'' (alkali obtained from ash of herbs), excessive intake of foods that cause burning sensation on digestion, excessive consumption of foods that are sour in taste, consumption of ''garavisha'' (intentional application of poison or poison synthesized by combination of nontoxic substances), erroneous dietary management following ''shodhana'' treatment, excessive consumption of foods having ''ruksha'' (dry) property, intake of ''viruddha ahara'' (combination of foods having mutually contradictory properties), consumption of unhealthy foods, emaciation due to splenic enlargement, emaciation due to ''arshas'' (mass per rectum), emaciation due to ''grahani roga'' (malabsorption), improper administration of [[Panchakarma]], ignorance of persistent illness without treatment, dryness of the body, withholding the naturally manifesting urges, morbidity of body channels, illness of ''ama'' (undigested food), psychological irritation, excessive consumption of foods, obstruction of the ano-rectal canal by the ''arshas'' (mass per rectum), impaction of hair within the lumen of the intestines, impaction of hardened stools within the intestines, perforation or rupture of intestines, excessive accumulation of morbidity, indulging in sinful activities, these causes will lead to development of ''udara roga'' and among these more particularly the impairment of ''jatharagni''. [12-15] </div>

=== Premonitary symptoms ===

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rAjIjanma valInAsha iti li~ggaM bhaviShyatAm||19||<br />

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Loss of appetite, delayed digestion of foods that are sweet, greasy and heavy for digestion, food consumed causing burning sensation, inability to appreciate the digestion and indigestion of the food, intolerance to over eating, slight edema in the feet, constant reduction in the physical strength, breathlessness even on slight exertion, abdominal distension due to accumulation of fecal matter resulting due to dryness or ''udavarta'' (abnormal upward course of ''vata''), abdominal pain, fullness of the abdomen, distension of the abdomen or bursting type of abdominal pain at the site where bladder meets the surrounding, distension of the stomach even after small meals, appearance of distended veins and loss of normal skin folds are the premonitory symptoms of ''udara roga''. [16-19]

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Loss of appetite, delayed digestion of foods that are sweet, greasy and heavy for digestion, food consumed causing burning sensation, inability to appreciate the digestion and indigestion of the food, intolerance to over eating, slight edema in the feet, constant reduction in the physical strength, breathlessness even on slight exertion, abdominal distension due to accumulation of fecal matter resulting due to dryness or ''udavarta'' (abnormal upward course of ''vata''), abdominal pain, fullness of the abdomen, distension of the abdomen or bursting type of abdominal pain at the site where bladder meets the surrounding, distension of the stomach even after small meals, appearance of distended veins and loss of normal skin folds are the premonitory symptoms of ''udara roga''. [16-19] </div>

=== General pathogenesis of ''udara roga'' ===

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prANAgnyapAnAn sandUShya janayantyudaraM nRuNAm||20||<br />

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Morbid ''dosha'' by obstructing the channels of ''sweda'' (sweat) and ''udaka'' (body fluid) and afflicting the ''prana vata, agni'' and ''apana vata'' causes ''udara roga''. [20]

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Morbid ''dosha'' by obstructing the channels of ''sweda'' (sweat) and ''udaka'' (body fluid) and afflicting the ''prana vata, agni'' and ''apana vata'' causes ''udara roga''. [20] </div>

=== General Symptoms of ''udara roga'' ===

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mando~agniH shlakShNagaNDatvaM kArshyaM codaralakShaNam||21|| <br />

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Distension and gurgling sound in the abdomen, edema of hands and feet, impaired digestion, smooth shiny cheeks and emaciation are the common symptoms of ''udara roga''. [21]

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Distension and gurgling sound in the abdomen, edema of hands and feet, impaired digestion, smooth shiny cheeks and emaciation are the common symptoms of ''udara roga''. [21] </div>

=== Classification of ''udara roga'' ===

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sambhavantyudarANyaShTau teShAM li~ggaM pRuthak shRuNu||22||<br />

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Three types of ''udara'' caused by each morbid ''dosha'', one type of ''udara'' caused by morbidity of all three ''dosha, plihodara'' (splenomegaly), ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction), ''kshatodara'' (abdominal enlargement due to intestinal perforation) and ''udakodara'' (enlargement of abdomen due to collection of fluid) are the eight types of ''udara''. Listen to the characteristic symptoms each of these types of ''udara roga''. [22].

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Three types of ''udara'' caused by each morbid ''dosha'', one type of ''udara'' caused by morbidity of all three ''dosha, plihodara'' (splenomegaly), ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction), ''kshatodara'' (abdominal enlargement due to intestinal perforation) and ''udakodara'' (enlargement of abdomen due to collection of fluid) are the eight types of ''udara''. Listen to the characteristic symptoms each of these types of ''udara roga''. [22]. </div>

=== Etiology of ''vatodara'' ===

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rUkShAlpabhojanAyAsavegodAvartakarshanaiH|

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Among the etiological factors of ''udara roga'' is intake of dry food articles, consumption of inadequate amount of food, exertion, suppression of naturally manifesting urges, abnormal upward course of ''vata'' and weight reducing activities like walking or lifting weight causes ''vatodara''. [23]

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=== Pathogenesis of ''vatodara'' ===

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AcinotyudaraM jantostva~gmAMsAntaramAshritaH||24|| <br />

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Due to the etiological factors ''vata'' gets aggravated which assumes abnormal course and reaches the ''kukshi'' (lower abdomen), ''hridaya'' (chest), ''basti'' (pelvis) and ''gudamarga'' (rectum). Again the morbid ''vata'' further impairs the ''agni'' (digestive enzymes) and draws out the ''kapha''. Thus morbid ''kapha'' in turn obstructs the morbid ''vata''. Eventually the obstructed ''vata'' gets diverged in to the space between the skin and visceral tissues in the abdomen leading to distension of the abdomen and ''udara roga''. [23-24]

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=== Symptoms of ''vatodara'' ===

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tasya rUpANi- kukShipANipAdavRuShaNashvayathuH, udaravipATanam, aniyatau ca vRuddhihrAsau,kukShipArshvashUlodAvartA~ggamardaparvabhedashuShkakAsakArshyadaurbalyArocakAvipAkAH,adhogurutvaM, vAtavarcomUtrasa~ggaH, shyAvAruNatvaM ca nakhanayanavadanatva~gmUtravarcasAm,api codaraM tanvasitarAjIsirAsantatam, AhatamAdhmAtadRutishabdavadbhavati,vAyushcordhvamadhastiryak ca sashUlashabdashcarati, etadvAtodaramiti vidyAt||25||

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The symptoms of ''vatodara'' include distension of abdomen, edema of the hands, legs and scrotum, splitting type of pain in abdomen, undue increase and decrease of abdominal distension, abdominal pain, pain in the sides of the abdomen, abnormal upward course of ''vata'' within abdomen, body ache, pain in phalangeal joints, dry cough, emaciation, debility, lack of taste in mouth, indigestion, heaviness in the lower abdomen, obstructed flatus, constipation, retention of the urine, brown or reddish black discoloration of the nails, brown or reddish black discoloration of the conjunctiva, buccal mucosa, dermis, urine and fecal matter; abdominal wall possessing thin, blackish stretch lines and vessels, tympanic note on percussion similar to the sound produced on tapping air filled leather bag or bladder and upward, downward and lateral painful movement of ''vata'' with gurgling sound within the abdomen. [25]

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=== Etiology of ''pittodara'' ===

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vidAhyadhyashanAjIrNaishcAshu pittaM samAcitam||26|| <br />

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Etiological factors of ''pittodara'' are excessive consumption of foods having pungent taste ans sour taste, salty foods, foods having ''ushna'' (hot) and ''tikshna'' (sharply acting) properties, exposure the heat of fire place, exposure to sunshine, consumption of foods that cause burning sensation whilst getting digested, pre-digestion meals and indigestion. [26]

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=== Pathogenssis of ''pittodara'' ===

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nihantyAmAshaye vahniM janayatyudaraM tataH||27|| <br />

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Due to the etiological factors pitta gets aggravated, which assumes abnormal upward course and obstructs the ''vata'' and ''kapha''. Further the morbid ''pitta'' by suppressing the ''agni'' situated in stomach causes ''pittodara''. [27]

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=== Symptoms of ''pittodara'' ===

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tasya rUpANi- dAhajvaratRuShNAmUrcchAtIsArabhramAH, kaTukAsyatvaM, haritahAridratvaM [1] canakhanayanavadanatva~gmUtravarcasAm, api codaraM nIlapItahAridraharitatAmrarAjIsirAvanaddhaM,dahyate, dUyate, dhUpyate, UShmAyate, svidyate, klidyate, mRudusparshaM kShiprapAkaM ca bhavati;etat pittodaramiti vidyAt||28||

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The symptoms of ''pittodara'' are burning sensation, fever, excessive thirst, transient loss of consciousness, diarrhea, giddiness, abnormal pungent taste in mouth, abnormal green or yellowish discoloration of nails, conjunctiva, mouth, dermis, urine and feces, abdominal wall covered with bluish, yellowish, greenish or coppery stretch marks and distended veins, burning sensation of the abdominal wall, abdomen becoming warm, subjective symptoms of smoke emitting from the abdomen, subjective feeling of abdominal warmth as if fire in near place, abdominal sweating, moistening of the abdomen, abdomen appears soft on palpation and the illness rapidly progressing to ascites. [28]

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=== Etiology of ''kaphodara'' ===

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dadhidugdhaudakAnUpamAMsaishcApyatisevitaiH||29|| <br />

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Indulgence in the factors such as lack of physical exercise, day sleep, excessive consumption of sweet, greasy and slimy foods, curds, milk, liquids and meat of wet land animals causes ''kaphodara''. [29]

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=== Pathogenesis of ''kaphodara'' ===

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tameva pIDayan kuryAdudaraM bahirantragaH [1] ||30||<br />

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The etiological factors lead to the morbidity of ''kapha'' which obstructs the body channels that include obliteration of the passage of ''vata''. Thus obstructed ''vata'' expels the morbid ''kapha'' out of the intestines causing distension of the abdomen. [30]

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=== Symptoms of ''kaphodara'' ===

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tasya rUpANi- gauravArocakAvipAkA~ggamardAH, suptiH, pANipAdamuShkorushophaH,utkleshanidrAkAsashvAsAH, shuklatvaM ca nakhanayanavadanatva~gmUtravarcasAm; api codaraMshuklarAjIsirAsantataM, guru, stimitaM, sthiraM, kaThinaM ca bhavati; etacchleShmodaramiti vidyAt||31||

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The symptoms of ''kaphodara'' are heaviness of the body, lack of taste in the mouth, indigestion, body ache, numbness, edema of the hands, feet, scrotum and thighs, nausea due to morbid ''dosha'' located in the chest, sleepiness, cough, dyspnea, whitish discoloration of nails, conjunctiva, mouth, skin, urine and feces, abdominal wall covered with whitish stretch marks, whitish distended veins, subjective feeling of heaviness and stillness of the abdomen, unwavering abdomen with hardness of the abdomen. [31]

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=== Etiology of ''sannipatodara'' ===

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viShaishca mandairvAtAdyAH kupitAH sa~jcayaM trayaH|

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The etiological factors such as person with impaired ''agni'' (digestive power) indulging in unhealthy food habits and consuming foods that are inadequately cooked, taking food articles having mutually contradictory properties, eating foods that are heavy for digestion, consumption of food adulterated with dust, hair, feces, urine, bone and nails which is offered by a wicked lady and slow poisoning by the intake of ''dushivisha'' (chronic poisoning) cause ''sannipatodara''. [32]

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=== Pathogenesis of ''sannipatodara'' ===

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shanaiH koShThe prakurvanto janayantyudaraM nRuNAm||33||

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Exposure to the etiological factors lead to morbidity of all three ''dosha'', which gradually accumulates in the abdomen causing ''sannipatodara''. [33]

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=== Symptoms of ''sannipatodara'' ===

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tasya rUpANi- sarveShAmeva doShANAM samastAni li~ggAnyupalabhyante, varNAshca sarve nakhAdiShu,udaramapi nAnAvarNarAjIsirAsantataM bhavati; etat sannipAtodaramiti vidyAt||34||

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The symptoms of ''sannipatodara'' are manifestation of symptoms pathognomonic of all three ''dosha'', variegated abnormal coloration of nails and other body parts pathognomonic of all three ''dosha'' and appearance of stretch marks and veins having variegated color pathognomonic of morbidity of all three ''dosha''. This illness is regarded as ''sannipatodara''. [34]

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=== Etiology of ''plihodara'' ===

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ativyavAyabhArAdhvavamanavyAdhikarshanaiH||35|| <br />

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The ''plihodara'' is caused by activities like travelling excessively in vibrating vehicle, heavy exercises that involve violent jerky movements of the body and are done immediately after the meals, excessive sex, lifting heavy objects, indulging in heavy walking, excessive vomiting and emaciation due to chronic illness [35].

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=== ''Samprapti'' of ''plihodara'' ===

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shoNitaM vA rasAdibhyo vivRuddhaM taM vivardhayet||36|| <br />

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Afflicted by the jerky movements of the body etc, the spleen located in the left side(flank or left hypochondriac region) enlarges and descends to cause enlargement of the abdomen; or else, a variety of dietary factors leading to increment and morbidity of ''rasa, rakta'' etc. which in turn causes enlargement of the spleen. Enlarged spleen distends the abdomen causing ''plihodara'' [36].

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=== Symptoms of ''plihodara'' and ''yakritodara'' ===

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daurbalyArocakAvipAkavarcomUtragrahatamaHpraveshapipAsA~ggamardacchardimUrcchA~ggasAda-kAsashvAsamRudujvarAnAhAgninAshakArshyAsyavairasyaparvabhedakoShThavAtashUlAni, apicodaramaruNavarNaM vivarNaM vA nIlaharitahAridrarAjimadbhavati; evameva yakRudapidakShiNapArshvasthaM kuryAt, tulyahetuli~ggauShadhatvAttasya plIhajaThara evAvarodha iti; etatplIhodaramiti vidyAt||38||

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Patient suffers from progressive enlargement of the spleen. Initially the enlarged spleen is palpable as a hard mass identical to the oval metal ball used by blacksmiths. The surface of the spleen appears smooth similar to the dorsum of the tortoise. If left untreated the enlarging spleen encroach the whole abdomen including the abode of ''agni'' [37].

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In the similar manner the enlarged liver located at right flank(hypochondriac) region causes distention of the abdomen. As the etiology symptoms and treatment of enlarged liver is identical to the ''plihodara, yakritodara'' is included in the ''plihodara''. This is regarded as ''plihodara'' [38].

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=== Etiology of ''baddhodara'' ===

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udAvartaistathA~arshobhirantrasammUrcchanena vA||39|| <br />

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''Baddhodara'' is caused by the obliteration of the passage of stools due to consumption of the food admixed with feathers of birds or human hair, ''udavarta'' (reversed course of ''vata'' in abdomen), due to ''arshas'' (ano-rectal mass lesion) and intussusception of the intestines [39].

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=== Pathogenesis of ''baddhagudodara'' ===

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varcaHpittakaphAn ruddhvA janayatyudaraM tataH||40|| <br />

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Obliteration of the passage of colon leads to morbidity of ''apana vata'' which in turn impairs the functioning of the agni as well as obstructs the excretion of stools and obliterates the movement of ''pitta'' and ''kapha''. Eventually the patient suffers from the ''baddhagudodara'' [40].

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=== Symptoms of ''baddhagudodara'' ===

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tRuShNAdAhajvaramukhatAlushoShorusAdakAsashvAsadaurbalyArocakAvipAka-varcomUtrasa~ggAdhmAnacchardikShavathushirohRunnAbhigudashUlAni, api codaraM mUDhavAtaMsthiramaruNaM nIlarAji sirAvanaddharAjikaM vA prAyo nAbhyupari gopucchavadabhinirvartata iti;etadbaddhagudodaramiti vidyAt||41||

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Symptoms of ''baddhagudodara'' are excessive thirst, burning sensation, fever, dryness of the mouth, dryness of the palate, tiredness in the thighs, cough, breathlessness, debility, lack of taste in mouth, indigestion, constipation, retention of the urine, abdominal distention, vomiting, sneezing, headache, chest pain, pain in the umbilical region and rectum, absence of gurgling sound in the abdomen, abdominal wall covered with pinkish and bluish stretch marks, visible veins, probably the stretch marks and visible veins occur above the umbilicus in the shape of cow tail, or else there may not be any stretch marks [41].

−

+

</div>

=== Causes of ''chhidrodara'' ===

Line 606: Line 607:

bhidyetAntraM yadA bhuktairjRumbhayA~atyashanena vA||42|| <br />

</div></div>

−

+

Consumption of food contaminated with sand particles, straw, pieces of wood, bone and thorn, or else yawing with stretching of the body as well as excessive intake of food causes injury to intestine lead to ''chhidrodara'' [42].

−

+

</div>

=== Pathogenesis of ''chhidrodara'' ===

Line 622: Line 623:

pUrayan gudamantraM ca janayatyudaraM tataH||43|| <br />

</div></div>

−

+

Contaminated food causes perforation of the intestines, which undergoes suppuration. Or else the suppuration of the intestines may happen due to yawing or excessive food which in turn leads to perforation. Perforation of the intestines further causes leaking out of the chyle from the intestines, which tends to move into the dependent parts of the abdomen filling the intestinal and rectal parts. Eventually the accumulation of the fluids in the lower abdomen manifests in ''chhidrodara'' [43].

−

+

</div>

=== Symptoms of ''chhidrodara'' ===

Line 635: Line 636:

tasya rUpANi- tadadho nAbhyAH prAyo~abhivardhamAnamudakodaraM bhavati, yathAbalaM cadoShANAM rUpANi darshayati, api cAturaH salohitanIlapItapicchilakuNapagandhyAmavarca upaveshate,hikkAshvAsakAsatRuShNApramehArocakAvipAkadaurbalyaparItashca bhavati; etacchidrodaramitividyAt||44||

</div></div>

−

+

The symptoms include distension of the abdomen mostly below the umbilicus due to accumulation of the fluids. Patient may suffer from a variety of symptoms according to the degree of morbidity of each ''dosha''. Patient excretes reddish, bluish, yellowish, mucous mixed with foul smelling and unformed stools. Patient suffers from hiccough, cough, breathlessness, thirst, altered state of consciousness, tastelessness in mouth, indigestion and debility. These are indicative of ''chhidrodara'' [44].

−

+

</div>

=== Etiopathogenesis of ''jalodara'' ===

Line 660: Line 661:

vardhayetAM tadevAmbu svasthAnAdudarAya tau||46|| <br />

</div></div>

−

+

Excessive consumption of water on occasions like oral medication with medicated ghee, impaired state of ''agni'', debility and emaciation causes destruction of digestive power and vitiation of ''vata'' situated at ''kloma''. [45].

These vitiated factors obliterate ''udaka-vaha-srotas''. Thus obliterated ''kapha'' mixed water further increases the fluid contents which by disloging from its site and accumulating in abdomen produce ''jalodara'' [46].

−

+

</div>

=== Symptoms of ''udakodara'' ===

Line 681: Line 682:

anannakA~gkShApipAsAgudasrAvashUlashvAsakAsadaurbalyAni, api codaraMnAnAvarNarAjisirAsantatamudakapUrNadRutikShobhasaMsparshaM bhavati, etadudakodaramitividyAt||47||

</div></div>

−

+

The symptoms of ''udakodara'' (''jalodara'') includes lack of interest to take food, excessive thirst, mucus discharge from anus, abdominal pain, breathlessness, cough, debility, abdomen with stretch marks and distended variegated veins, fluid thrill and dull percussion note identical to the one seen in leather bag filled with water [47].

−

+

</div>

=== Consequences of not treating ''jalodara'' at early stage ===

Line 715: Line 716:

chardyatIsAratamakatRuShNAshvAsakAsahikkAdaurbalyapArshvashUlArucisvarabhedamUtrasa~ggAdayaH;tathAvidhamacikitsyaM vidyAditi||49||

</div></div>

−

+

''Udara roga'' of recent origin having no complications and without signs of fluid accumulation should be immediately treated. If left untreated, the morbid ''dosha'' gets displaced and liquefied, moistens the joints as well as body channels, obstructs the external channels and thus mobilizes the fluid into the abdomen.

Line 723: Line 724:

On appearance of the fluid the patient may suffer several complications that include vomiting, diarrhea, asthma, excessive thirst, breathlessness, cough, hiccough, debility, pain in the sides of the abdomen, tastelessness in mouth, hoarseness of voice and retention of urine and in this state it is incurable [48-49].

−

+

</div>

=== Prognosis of ''udara roga'' ===

Line 779: Line 780:

balinastadajAtAmbu yatnasAdhyaM navotthitam||54||<br />

</div></div>

−

+

Among the list of ''vatodara, pittodara, kaphodara, plihodara, sannipatodara'' and ''jalodara'' (ascites); the later ones are more and more difficult to cure. After a fortnight the ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''udara'' that presents with accumulation of fluid are incurable. Mostly ''chhidrodara'' (enlargement of abdomen due to intestinal perforation) is fatal. The treatment should be avoided in patients of ''udara'' presenting with peri-orbital edema, distorted genitalia, moistening and thinning of the skin, severe reduction in the physical strength, severe depletion in the blood, severe wasting of the body flesh and severe impairment in the ''agni''.

Line 785: Line 786:

The ''udara'' is difficult to cure from the very onset itself but if the patient is physically strong, in state of ''ajatodaka'' (initial phase of distension of abdomen with slight fluid accumulation) and the ''udara'' of recent onset can be managed only with energetic treatment [50-54].

−

+

</div>

=== Symptoms of ''ajatodaka udara roga'' ===

Line 826: Line 827:

upAkramedbhiShagdoShabalakAlavisheShavit||58||<br />

</div></div>

−

+

State of ''ajatodaka'' (initial phase of distension of abdomen without fluid accumulation) of the ''udara'' is presents with symptoms such as pink coloration of distended abdomen, increased gurgling sound, comparatively less heaviness of the abdomen, persistent gurgling sound, abdomen covered with network of distended veins, the flatus frequently generates urges to pass with distention of the umbilical region and then fades away with of farting, pain in the cardiac region, umbilical region, groin, sacral region and anal part, passing of flatus with loud sound, less severe impairment of digestion, tastelessness in the mouth, reduced urination and constipation. This state of ''ajatodaka'' should be treated with the due consideration of degree of morbidity of ''dosha'' as well as time [55-58].

−

+

</div>

=== Treatment of ''vatodara'' ===

Line 851: Line 852:

tathA~asyAnavakAshatvAdvAyurnAdhmApayet punaH||60|| <br />

</div></div>

−

+

Patient of ''vatodara'' who is physically strong should be initially treated with unctuous medications. Then after the ''snehana'' is completed, ''abhyanga'' (unctuous massage) and ''sweda'' (sudation) is done. Then the ''sneha virechana'' (purgation with unctuous purgatives) should be given. After elimination of ''dosha'' with ''shodhana'' (purification procedure) the abdomen should be tightly bandaged so that no space is left in the abdomen for the morbid ''vata'' to cause distension of the abdomen again [59-60].

−

+

</div>

=== Post ''virechana'' regimen ===

Line 882: Line 883:

yUShai rasairvA mandAmlalavaNairedhitAnalam|

</div></div>

−

+

''Udara'' is caused due to the obliteration of the body channels leading to accumulation of morbid ''dosha''. Hence ''udara'' should be treated by regular ''virechana'' (therapeutic purgation). After the purgation, with an intention to improve the physical strength and to relieve the strain of purgation, the patient should be given milk. Gradually as the patient regains strength by the intake of milk, his functioning of the ''agni'' should be improved by giving ''yusha'' (cereal soup) or meat soup added with little salt [61-62].

−

+

</div>

=== Role of ''asthapana basti'' ===

Line 901: Line 902:

sphuraNAkShepasandhyasthipArshvapRuShThatrikArtiShu|

</div></div>

−

+

If the patient has ''udavarta'' (reversed course of ''vata'' in the abdomen), ''sphurana'' (fasciculation), ''akshepa'' (involuntary movements), pain in the joints, bone, sides of the abdomen, back and sacral region; then again after performing oleation and sudation ''asthapana basti'' (decoction enema) is given [63].

−

+

</div>

=== Role of ''anuvasana basti'' ===

Line 914: Line 915:

dIptAgniM baddhaviDvAtaM rUkShamapyanuvAsayet||64||

</div></div>

−

+

If the patient has strong digestive power and suffers from obstructed bowel movement and flatus as well as with dryness of the body; then he should be treated by ''anuvasana basti'' (oily enema) [64]

−

+

</div>

=== ''Dashamula niruha basti'' ===

Line 927: Line 928:

tIkShNAdhobhAgayukto~asya nirUho dAshamUlikaH|

</div></div>

−

+

''Niruha basti'' (decoction enema) prepared with ''dashamula'' (''bilva'' (Aegle marmelos Corr), ''agnimantha'' (Clerodendrum phlomidis Linn. f), ''shyonaka'' (Oroxylum indicum Vent), ''kashmari'' (Gmelina arborea), ''patala'' (Stereospermum suaveolens), ''shalaparni'' (Desmodium gangeticum DC), ''prishniparni'' (Uraria picta Desv), ''brihati'' (Solanum indicum Linn), ''kantakari'' (Solanum surattense Burm. f) and g''okshura'' (Tribulus terrestris Linn)) added with potent purgatives should be given to the patients.[65]

+

</div>

Line 938: Line 940:

vAtaghnAmlashRutairaNDatilatailAnuvAsanam||65||

</div></div>

−

+

''Anuvasana basti'' (oily enema) should be given with ''eranda taila'' (castor oil) or ''tila taila'' (sesame oil) processed with sour and anti ''vata'' drugs [65].

−

+

</div>

=== Indications for palliative (''shamana'') treatment ===

Line 963: Line 965:

bastyabhya~ggAnuvAsaishca kShIraishcopAcaredbudhaH||67||<br />

</div></div>

−

+

The patient who is debilitated, aged, children, having delicate constitution, minimal morbidity of ''dosha'' and dominant vitiation of ''vata'' and unfit for ''virechana karma'' (therapeutic purgation) should be treated by palliative (''shamana'') measures. ''Shamana'' treatment comprises use of medicated ghee, meat soup, rice, oil massage and milk. Such patients may also be given ''anuvasana basti'' (oily enema).[66-67]

−

+

</div>

=== Treatment of ''pittodara'' ===

Line 976: Line 978:

pittodare tu balinaM pUrvameva virecayet|

</div></div>

−

+

Physically strong patients suffering from ''pittodara'' should be treated by ''virechana karma'' (therapeutic purgation) at the outset [68].

+

</div>

Line 993: Line 996:

sa~jjAtabalakAyAgniM punaH snigdhaM virecayet|

</div></div>

−

+

If the patient of ''pittodara'' is physically weak then he should be treated by purification by adapting ''kshirabasti'' (decoction enema consisting of milk as predominant ingredient). By this treatment when the patient regains physical strength, and improved digestive power, once again the patient should be treated by ''virechana'' (therapeutic purgation) [68-69]

+

</div>

Line 1,013: Line 1,017:

sakaphe vA samUtreNa savAte tiktasarpiShA||70|| <br />

</div></div>

−

+

''Virechana'' be performed by administering paste of ''trivrita'' (Operculina turpethum) with milk; decoction of ''urubuka'' (Ricinus communis), decoction of ''satala'' (Euphorbia Tirucalli) and ''trayamana'' (Gentiana kurrhoa) or decoction of ''aragvadha'' (Cassia fistula). Again, if the dominance of ''kapha'' is present then in the above preparation cow’s urine may be added. If the dominance of ''vata'' is present, then in the above medicines for ''virechana'' (therapeutic purgation) medicated ghee prepared with bitter herbs should be given [69-70]

+

</div>

Line 1,027: Line 1,032:

krameNa dhruvamAtiShThan yuktaH pittodaraM jayet||71||<br />

</div></div>

−

+

Oral treatment with milk, ''basti karma'' (medicated enema) and ''virechana'' (therapeutic purgation) should be repeated in ''pittodara''; by this patient is gradually stabilized and the illness gets cured [71].

−

+

</div>

=== Treatment of ''kaphodara'' ===

Line 1,043: Line 1,048:

saMsarjayet kaTukShArayuktairannaiH kaphApahaiH||72||<br />

</div></div>

−

+

In patients suffering from ''kaphodara, shodhana'' (eliminative therapy) is done after preparing with oleation and sudation. In ''samsarjana krama'' (gradual diet schedule) pungent, ''kshara'' and ''anti-kapha'' diet is prescribed [72].

+

</div>

Line 1,057: Line 1,063:

sakShAraistailapAnaishca shamayettu kaphodaram||73||<br />

</div></div>

−

+

''Shamana'' (palliative) treatment is done in ''kaphodara'' by oral intake of ''gomutra'' (cow’s urine), ''arishta'' (fermented decoctions), drug powder, ''ayaskriti'' (medically processed iron) and sesame oil added with ''kshara'' (alkali obtained from ash of herbs) [73].

−

+

</div>

=== Treatment of ''sannipatodara'' ===

Line 1,073: Line 1,079:

sopadravaM tu nirvRuttaM pratyAkhyeyaM vijAnatA|74|<br />

</div></div>

−

+

''Sannipatodara'' should be treated by the combination of treatment mentioned for ''doshaja udara'' depending upon the requirement [74].

If the patient presents with all the complications of ''udara'' then the physician should avoid treating such patients considering it as ''pratyakhyeya'' (near death) [74].

−

+

</div>

=== Predominant symptoms of ''dosha'' in ''plihodara'' (splenomegaly) ===

Line 1,100: Line 1,106:

cikitsAM samprakurvIta yathAdoShaM yathAbalam||76|| <br />

</div></div>

−

+

Association of symptoms like ''udavarta'' (anti peristalsis), abdominal pain and flatulence indicate dominance of ''vata'' in the ''plihodara''. Symptoms like burning sensation, delirious state, excessive thirst and fever suggests dominance of ''pitta''.

Predominance of ''kapha'' is judged by the symptoms like heaviness, lack of taste in the mouth and hardness of the abdomen. Presence of symptoms indicative of morbidity of ''rakta'' as mentioned in [[Vidhishonitiya Adhyaya]] point towards the dominance of morbid ''rakta'' in the pathogenesis of ''plihodara''. Hence, ''plihodara'' should be treated according to the dominance of ''dosha'' involved [75-76].

−

+

</div>

=== Treatment of ''plihodara'' ===

Line 1,118: Line 1,124:

samIkShya kArayedbAhau vAme vA vyadhayet sirAm||77|| <br />

</div></div>

−

+

With the due analysis of the pathogenesis, ''plihodara'' should be treated by measures like oral medication of ''sneha'' (medicated unctuous substance), sudation, ''virechana'' (therapeutic purgation), ''niruha'' (decoction enema) and ''anuvasana basti'' (oil enema) and ''raktamokshana'' (blood-letting) by sectioning the vein located in the left arm [77].

+

</div>

Line 1,132: Line 1,139:

saguDAmabhayAM vA~api kShArAriShTagaNAMstathA||78|| <br />

</div></div>

−

+

Patient of plihodara is treated by oral medication of ''shatpala ghrita, pippali'' (Piper longum), combination of molasses and ''haritaki'' (Emblica officinalis), ''kshara'' (alkali obtained from ash of herbs) or ''arishta'' (fermented decoctions)[78]

+

</div>

Line 1,143: Line 1,151:

eSha kriyAkramaH prokto yogAn saMshamanA~jchRuNu|

</div></div>

−

+

Thus is the description of principles of treatment of ''plihodara''; now listen to the medications [79]

−

+

</div>

=== ''Pippalyadi churna'' ===

Line 1,162: Line 1,170:

viDa~ggAMshayutaM cUrNametaduShNAmbunA pibet|

</div></div>

−

+

Take one part each of the fine sieved powder of ''pippali'' (Piper longum), ''nagara'' (Zingiber officinale), ''danti'' (Baliospermum montanum), ''chitraka'' (Plumbago zeylanica) and ''vidanga'' (Embelia ribes), and add it to two parts of ''abhaya'' (Terminalia chebula). It is to be orally given with warm water [79]

−

+

</div>

=== ''Vidangadi kshara'' ===

Line 1,181: Line 1,189:

dagdhvA kapAle payasA gulmaplIhApahaM pibet|

</div></div>

−

+

Take powder of ''vidanga'' (Embelia ribes), ''chitraka'' (Plumbago zeylanica), ''shunthi'' (Zingiber officinale Rosc), ''saindhava'' (rock salt) and ''vacha'' (Acorus calamus) and fry with ghee in an earthen pan and administer orally. This is curative of ''gulma'' (abdominal lump) and ''plihodara'' [80]

−

+

</div>

=== ''Rohitakadi yoga'' ===

Line 1,209: Line 1,217:

sa hanyAjjA~ggalarasairjIrNe syAccAtra bhojanam|

</div></div>

−

+

The course powder of stem of ''rohitaka'' (Tecomella undulate) is soaked in a decoction of ''abhaya'' (Terminalia chebula) or cow’s urine for seven days and given to the patient to drink. Once the medicine gets digested the patient is asked to have meat soup of dry land animals in meals. This regimen cures ''kamala'' (jaundice), ''gulma'' (abdominal lump), ''prameha'' (frequent turbid urination), ''arsha'' (mass per rectum), ''plihodara'', all types of ''udara roga'' and ''krimi'' (worm infestation) [81-82].

−

+

</div>

=== ''Rohitaka ghrita'' ===

Line 1,246: Line 1,254:

tathA gulmodarashvAsakrimipANDutvakAmalAH|

</div></div>

−

+

Twenty five ''pala'' (1200g) of bark of ''rohitaka'' (Tecomella Undulate) and two ''prastha'' (1536g) of ''kola'' (jujube) are added in eight times water and boiled to get the decoction. Then the paste prepared from 48g each of fruit and root of ''pippali'' (Piper longum), ''chavya'' (Piper retrofractum), ''chitraka'' (Plumbago zeylanica), ''nagara'' (Zingiber officinale) and equal to this 240g of bark of ''rohitaka'' and to this mixture 768g of cow’s ghee is added and boiled to get the medicated ghee. Oral medication with this medicated ghee will immediately cure ''plihodara, gulma'' (abdominal lump), ''udara roga'', dyspnea, ''krimi'' (worm infestation), anemia and jaundice [83-85].

−

+

</div>

=== ''Agnikarma'' (cauterization) ===

Line 1,259: Line 1,267:

agnikarma ca kurvIta bhiShagvAtakapholbaNe||86||

</div></div>

−

+

The ''vata'' and ''kapha'' dominated ''plihodara'' should be treated by ''agnikarma'' (cauterization)[86].

−

+

</div>

=== Treatment of ''pitta'' dominated ''plihodara''(splenomegaly) ===

Line 1,290: Line 1,298:

laghUnyannAni saMsRujya dadyAt plIhodare bhiShak|

</div></div>

−

+

''Plihodara'' with dominance of ''pitta'' is treated by oral administration of ghee medicated with ''jivaniya'' herbs (''Jeevaka'' (Malaxis acuminta), ''rishbhaka'' (Microstylis muscifera), ''meda'' (Polygonatum verticillatum), ''mahameda'' (Polygonatum cirrhifolium), ''kakoli'' (Roscoea procera), ''kshirakakoli'' (Lilium polphyllum), ''riddhi'' (Habenaria edgeworthii), ''vriddhi'' (Habenaria intermedia), ''kshara'' ''basti'' (decoction enema consisting of alkali obtained from ash of herbs), ''raktavaseka'' (blood letting), ''shodhana'' (purification measures) and oral intake of milk. Patient is asked to take ''yusha'' (cereal soup) or meat soup processed with ''dipaniya'' (herbs augmenting the digestive power) drugs and light food. Since the etiology and symptomatology of ''plihodara'' (splenomegaly) and ''yakritodara'' (hepatomegaly) are same, so all the treatment mentioned for ''plihodara'' should be adopted in ''yakritodara'' [87-88].

−

+

</div>

=== Treatment of ''baddhagudodara'' ===

Line 1,317: Line 1,325:

udAvartaharaM karma kAryaM vAtaghnameva ca|

</div></div>

−

+

Patient suffering from ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) should be initially treated by sudation followed by ''niruha basti'' (decoction enema) consisting of potent medicines, cow’s urine, ''saindhava'' (rock salt) and oil. After ''niruha basti'' (decoction enema), oil processed with same drugs should be given in the form of ''anuvasana basti'' (unctuous enema). Food that induces laxation should be given. Strong purgation is also indicated in the ''baddhodara''. All measures that cure ''udavarta'' as well as morbidity of ''vata'' should be done in ''baddhodara'' [89-90].

−

+

</div>

=== Treatment of ''Chhidrodara'' ===

Line 1,345: Line 1,353:

varjayecchvAsinaM tadvacchUlinaM durbalendriyam|

</div></div>

−

+

''Chhidrodara'' (enlargement of abdomen due to intestinal perforation) is treated by all measures of ''kaphodara'' except sudation. The patient should be maintained by repeated aspiration of the abdominal fluid as and when it gets collected. The treatment should be avoided in patient of ''chhidrodara'' if he suffers from symptoms like excessive thirst, cough, fever, emaciation, impairment of ''agni'', reduced food intake, dyspnea, abdominal pain and week cognition [91-92]

−

+

</div>

=== Treatment of ''jalodara'' ===

Line 1,376: Line 1,384:

dravebhyashcodakAdibhyo niyacchedanupUrvashaH|

</div></div>

−

+

Initially all measure to eliminate the effect of fluid should be done in the treatment of ''jalodara'' (enlargement of abdomen due to collection of fluid). Oral administration of different strong ''kshara'' (alkali obtained from ash of herbs) added with cow’s urine should be done. Foods that alleviate ''kapha'' and augments digestion should be given to the patient. Patient should gradually reduce the intake of fluids [93-94].

+

</div>

Line 1,393: Line 1,402:

tasmAttridoShashamanIM kriyAM sarvatra kArayet|

</div></div>

−

+

All types of ''udara'' (enlargement of abdomen) are mostly due to the imbalance of all the three ''doshas'', hence treatment that alleviate all three ''dosha'' should be adapted in all types of udara [95].

+

</div>

Line 1,410: Line 1,420:

tasmAdbhojyAni bhojyAni dIpanAni laghUni ca|

</div></div>

−

+

Accumulation of the ''dosha'' in the abdomen lowers digestive power (''agnimandya''), hence light foods that augments the digestion (''agni'') should be given to the patient [96].

−

+

</div>

=== Healthy diet for ''udara roga'' ===

Line 1,438: Line 1,448:

mandAmlasnehakaTubhiH pa~jcamUlopasAdhitaiH|

</div></div>

−

+

Food comprising ''rakta shali'' (Oryza sativa), ''yava'' (Hordeum vulgare), ''mudga'' (Phaseolus radiatus), meat soup of dry land animals, milk, cow’s urine, ''asava'' (fermented infusions), ''arishtha'' (fermented decoctions), honey, ''sidhu'' (alcoholic preparation from sugarcane juice) and ''sura'' (alcoholic preparation made by fermenting a mixture of water, flour of rice and jaggery). ''Yavagu'' (rise gruel) and ''odana'' (rice) should be given along with cereal soup, or meat soup that are prepared by adding mild sour tasting drugs, small amount of ghee, pungent tasting drugs and ''panchamula'' (''bilva'' (Aegle marmelos), ''agnimantha'' (Clerodendrum phlomidis), ''shyonaka'' (Oroxylum indicum), ''kashmari'' (Gmelina arborea) and ''patala'' (Stereospermum suaveolens)).[97-98]

−

+

</div>

===Do’s and Don’ts ===

Line 1,466: Line 1,476:

nAdyAdannAni jaTharI toyapAnaM ca varjayet|

</div></div>

−

+

Patient of ''udara'' (enlargement of abdomen) should avoid meat of aquatic and wetland animals, leafy vegetables, ''pishtakrita'' (cake and pastries made of flour; dough of rice flour), ''tila'' (Sesamum indicum), exercise, prolonged walking, day sleep, traveling, ''ushna ahara'' (hot foods), salty and sour foods, ''vidahi'' foods (foods that cause burning sensation on consumption), foods that are heavy for digestion and water [99-100].

−

+

</div>

=== Therapeutic use of ''takra'' (buttermilk) in ''udara roga'' ===

Line 1,530: Line 1,540:

takraM vAtakaphArtAnAmamRutatvAya kalpate|

</div></div>

−

+

Patient of ''sannipatodara'' (abdominal enlargement due to morbidity of all three ''dosha'') should drink butter milk which is neither excessively thick, nor fatty, and while drinking it should be added with ''triushana'' (combination of three pungent elements that include ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale) and ''maricha'' (Piper nigrum)], ''kshaira'' (alkali obtained from ash of herbs) and rock salt.

Line 1,544: Line 1,554:

Patient suffering from ''chidrodara'' (enlargement of abdomen due to perforation in gastro-intestinal tract) should drink buttermilk added with ''pippali'' (Piper longum) and honey. Further, in patient suffering from ''udara'' (enlargement of abdomen) having morbidity of ''vata'' and ''kapha'' and who develops heaviness in the abdomen, loss of taste in the mouth, ''agnimandya'' (impairment of gastric fire) and diarrhea; intake of ''takra'' (buttermilk) is beneficial and its effect is identical to the nectar [103-106].

−

+

</div>

=== Use of milk in ''udara roga'' ===

Line 1,561: Line 1,571:

shuddhAnAM kShAmadehAnAM gavyaM chAgaM samAhiSham|

</div></div>

−

+

The patient of ''udara'' (enlargement of abdomen) if develops symptoms like edema, distension of abdomen, abdominal pain and transient loss of consciousness then camel’s milk should be given to drink. If the patient’s physique reduces after the ''shodhana'' (purification measures) then he should be given cow’s milk, goat’s milk or buffalo’s milk to drink.[107]

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+

</div>

=== Application of paste on abdomen ===

Line 1,580: Line 1,590:

sAshvagandhaiH sagomUtraiH pradihyAdudaraM samaiH|

</div></div>

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+

The paste prepared from ''devadaru'' (Cedrus deodara), ''palasha'' (Butea monosperma), ''arka'' (Calotropis procera), ''hastipippali'' (Scindapsus officinalis), ''shigru'' (Moringa oleifera) and ''ashvagandha'' (Withania somnifera) added with cow’s urine should be applied on the abdomen as ''pradeha'' (paste) [108].

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+

</div>

=== ''Parisheka'' in ''udara roga'' ===

Line 1,611: Line 1,621:

mUtrANyaShTAvudariNAM seke pAne ca yojayet|

</div></div>

−

+

Abdomen should be treated with ''parisheka'' (pouring medicated liquids on body parts) by using decoction prepared from ''vrishchikali'' (Tragia involucrata), ''vacha'' (Acorus calamus), ''kushtha'' (Saussurea lappa), ''bilva'' (Aegle marmelos), ''agnimantha'' (Clerodendrum phlomidis), ''shyonaka'' (Oroxylum indicum), ''kashmari'' (Gmelina arborea), ''patala'' (Stereospermum suaveolens), ''punarnava'' (Boerhaavia diffusa), ''bhutika'' (Cymbopogon jvarancusha), ''nagara'' (Zingiber officinale) and ''dhanyaka'' (Coriandrum sativum). In the same way the decoction prepared from ''palasha'' (Butea monosperma), ''kattruna'' (Cymbopogon citratus) and ''rasna'' (Pluchea lanceolata) may be used for ''parisheka'' (pouring medicated liquids on body parts). In general the eight types of urine (urine of human being, cow, goat, sheep, camel and buffalo) may be used in the form of drink or ''parisheka'' (pouring medicated liquids on body parts) in patients suffering from ''udara'' (enlargement of abdomen tending ascites) [109-110].

+

</div>

Line 1,628: Line 1,639:

dIpanIyAni sarpIMShi jaTharaghnAni cakShmahe|

</div></div>

−

+

From here onward, the medicated ghee will be discussed that are curative of ''udara'' (enlargement of abdomen) and indicated in patients who exhibit dryness of the body, who have dominance of morbid ''vata'' and also the patients who will undergo ''shodhana'' (purification measures) [111-112].

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</div>

=== ''Panchakola ghrita'' ===

Line 1,665: Line 1,676:

shvayathuM vAtaviShTambhaM gulmArshAMsi ca nAshayet||114||

</div></div>

−

+

Take powder of ''pippali'' (Piper longum Linn), ''pippali mula'' (Piper longum), ''chavya'' (Piper retrofractum), ''chitraka'' (Plumbago zeylanica), ''nagara'' (Zingiber officinale) and ''kshara'' (alkali obtained from ash of herbs) half ''pala'' (24g) of each in quantity. This is added with ''ardha-tula'' (2400g) decoction of ''dashamula'' (roots of 10 drugs) and two ''prastha'' (1536g) of cow’s ghee and processed to get the medicated ghee. This ghee when orally administered along with ''dadhi manda'' (watery portion of curds) cures all types of ''udara, shvayathu'' (''anasaraka'') ''vata vishtambha'' (obstructed ''vata'' in the abdomen), ''gulma'' (abdominal lump) and ''arshas'' (mass per rectum) [112-114].

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</div>

=== ''Nagaraadi ghrita'' ===

Line 1,687: Line 1,698:

kaphamArutasambhUte gulme caitat prashasyate|

</div></div>

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+

One ''prastha'' (768g) of powder of ''nagara'' (Zingiber officinale), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica) and ''amalaki'' (Emblica officinalis) is added with 1/2 ''adhaki'' (1536g) of cow’s ghee, 1/2 ''adhaki'' (1536g) of ''taila'' (oil extracted from seeds of Sesamum indicum) and 1 ''adhaki'' (3073g) of ''mastu'' (liquid separated from curd ). This combination is processed in to medicated ghee. Oral administration of this ghee is effective in all types of ''udara'' (enlargement of abdomen) as well as ''kapha vataja gulma'' (abdominal lump) [115].

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</div>

=== ''Chitraka ghrita'' ===

Line 1,706: Line 1,717:

kalke siddhaM ghRutaprasthaM sakShAraM jaTharI pibet|

</div></div>

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+

The powder prepared from each 1 ''pala'' (48g) of ''chitraka'' (Plumbago zeylanica) and ''kshara'' (alkali obtained from ash of herbs) is added with 1 ''prastha'' (768g) cow’s ghee, 2 ''prastha'' (1536 g) of cow’s urine and 4 ''prastha'' (3073g) of water. The combination is processed into medicated ghee and is orally administered in patients suffering from ''udara'' (enlargement of abdomen). [116]

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</div>

=== ''Yavadi ghrita'' ===

Line 1,725: Line 1,736:

surAsauvIrakAbhyAM ca siddhaM vA~api pibedghRutam|

</div></div>

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+

The powders of ''yava'' (Hordeum vulgare), ''kola'' (Zizypus jujuba) and ''kulattha'' (Vigna unquiculata) is added with decoction of ''brihat panchamula'' (roots of five big plants), ''sura'' (alcoholic preparation made by fermenting a mixture of water, flour of rice and jaggery) and ''sauviraka'' (alcoholic beverage prepared from dehusked barley either raw or cooked) and ghee. This combination is processed into medicated ghee and is orally given in patients suffering from ''udara roga'' [117].

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</div>

=== ''Virechana'' ===

Line 1,744: Line 1,755:

sraste doShAshaye dadyAt kalpadiShTaM virecanam|119|

</div></div>

−

+

After the oral medication of this medicated ghee, once the patient regains the physical strength, morbid ''vata'' gets alleviated and ''dosha'' has been mobilized into the ''koshtha''; the patient is treated with ''virechana'' (therapeutic purgation) by administering purgatives mentioned in the [[Kalpa Sthana]]. [118-119]

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</div>

=== ''Patoāldi churna'' ===

Line 1,799: Line 1,810:

paTolAdyamidaM cUrNamudareShu prapUjitam|

</div></div>

−

+

The powder is prepared from each one ''karsha'' (12g) each powder of root of ''patola'' (Trichosanthes dioica), ''rajani'' (Curcuma longa), ''vidanga'' (Embelia ribes.), barks of ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica) and ''amalaki'' (Emblica officinalis), two ''karsha'' (24g) of ''kampilla'' (Mallotus philippinensis), three ''karsha'' (36g) of ''nilini'' (Indigofera tinctoria) and four ''karsha'' (48g) of ''trivrita'' (Operculina turpethum). This powder is orally administered in a dose of one ''pala'' (48g) along with cow’s urine to induce purgation. After the purgation, the patient is advised to have light food consisting of meat soup of dry land animals. Or else, after the intake of ''manda'' (gruel water) and ''peya'' (liquid rice gruel), the patient is given milk processed with ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale) and ''maricha'' (Piper nigrum) for six days. The repeated administration of this regimen cures all the types of ''udara'' including the stage of ''jatodaka'' (enlargement of abdomen with fluid accumulation), jaundice, anemia and ''anasaraka''. This powder named as ''patoladi churna'' is well appreciated for the cure of ''udara'' (enlargement of abdomen) [119-123]

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+

</div>

=== ''Gavakshyadi churna'' ===

Line 1,818: Line 1,829:

pibeddrAkShAmbugomUtrakolakarkandhusIdhubhiH|

</div></div>

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+

Powder prepared from equal amounts of ''gavakshi'' (Citrullus colocynthis), ''shankhini'' (Clitoria terneata), ''danti'' (Baliospermum montanum), bark of ''tilvaka'' (Symplocos cochinchinensis/Jatropha curcas) and ''vacha'' (Acorus calamus) is orally administered with juice of grapes, cow’s urine, decoction of ''kola'' (Zizypus jujuba), decoction of ''karkandhu'' (Zizyphus sativa) and ''sidhu'' (alcoholic preparation from unboiled/boiled sugarcane juice) [124]

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</div>

=== ''Narayana churna'' ===

Line 1,900: Line 1,911:

yathArhaM snigdhakoShThena peyametadvirecanamiti nArAyaNacUrNam

</div></div>

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+

Take one part each of ''yavani'' (Trachyspermum ammi), ''hapusha'' (Juniperus communis), ''dhanyaka'' (Coriandrum sativum), ''haritaki'' (Terminalia chebula Retz), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''upakunchika'' (Nigella sativa), ''kaavi'' (Apium leptophyllum), root of ''pippali'' (Piper longum), ''ajagandha'' (Withania somnifera), ''shati'' (Hedychium spicatum), ''vacha'' (Acorus calamus), ''shatahva'' (Anethum sowa), ''jiraka'' (Cuminum cyminum), ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale), ''maricha'' (Piper nigrum), ''svarnakshiri'' (Argemone mexicana), ''chitraka'' (Plumbago zeylanica), ''sarjakshara'' (Sodii carbonas impura), ''yava kshara'' (alkali from awns of barley), ''pushkaramula'' (Inula racemosa), ''kushtha'' (Saussurea lappa), rock salt (saindhava), ''sauvarchala lavana'' (Unaqua sodium chloride), ''vida lavana'' (ammonium salt; salt obtained from animal’s excreta-feces/ urine), ''samudra lavana'' (Sodi muris), ''audbida lavana'' (salt obtained from earth) and ''vidanga'' (Embelia ribes). To this, three parts of ''danti'' (Baliospermum montanum), two parts of ''trivrita'' (Operculina turpethum), two parts of ''vishala'' (Citrulus colocynthis) and four parts of ''satala'' (Euphorbia tirucalli) are added and powdered. This powder is known as ''narayana churna'' and is effective in curing horde of diseases. Quite similar to the Lord Vishnu killing the demon; this ''churna'' on consumption kills the diseases. Patient suffering from ''udara roga'' should take this powder with butter milk. The patients suffering from ''gulma'' (abdominal lump) should be prescribed with decoction of ''badara'' (Ziziphus zizyphus). In case of ''anaddha vata'' (obstructed ''vata'' in the abdomen) this ''narayana churna'' should be given with ''sura'' (alcoholic preparation made by fermenting a mixture of water, flour of rice, jaggery). ''Vata roga'' is treated by administering this powder with ''prasanna'' (supernatant clear portion of alcoholic preparation; upper portion of ''madya''). Constipation is treated by giving this ''churna'' with ''dadhi manda'' (watery portion of curds). ''Arsha'' (piles) is treated by administering this powder with juice of ''dadima'' (Punica granatum). ''Parikartka'' (cutting pain in the anal region) may be treated by giving this medicine with ''vrikshamla'' (Garcinia indica). This powder, if given with lukewarm water cures indigestion. Also this powder is orally administered with relevant ''anupana'' (liquid adjunct) after oral oleation measure and to induce ''virechana'' (therapeutic purgation) in patients suffering from diseases like bhagandara (fistula in ano), anaemia, dyspnea, cough, throat irritation, cardiac disease, ''grahanidosha'' (malabsorption), ''kushtha'' (obstinate skin diseases), impaired appetite, fever, venomous bite, toxic tubers, ''garavisha'' (mild poisoning) and ''kritrima visha'' (poisoning with synthesized poison)[125-132]

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+

</div>

=== ''Hapushadya churna'' ===

Line 1,949: Line 1,960:

hapuShAdyaM cUrNam <br />

</div></div>

−

+

Prepare fine powder from ''hapusha'' (Juniperus communis), ''svarnakshiri'' (Argemone mexicana), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''katurohini'' (Picrorhiza kurroa), ''nilini'' (Indigofera tinctoria), ''trayamana'' (Gentiana kurrhoa), ''satala'' (Euphorbia Tirucalli), ''trivrita'' (Operculina turpethum), ''vacha'' (Acorus calamus), rock salt, ''kala lavana'' (black salt) and ''pippali'' (Piper longum). This powder should be orally given with juice of ''dadima'' (Punica granatum), decoction of ''triphala'' (three fruits), meat soup, cow’s urine or warm water. This medication induces purgation, eliminates ''vata, pitta and kapha''; and is effective in curing diseases that include ''shvitra'' (leukoderma), ''kushtha'' (obstinate skin diseases), pain due to morbid ''vata, vishamagni'' (irregular digestion), ''anasaracha'', ''arshas'' (piles), anemia, jaundice and ''halimaka'' (chlorosis) [133-136]

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</div>

=== ''Nilinyadi churna'' ===

Line 1,968: Line 1,979:

citrakaM ca pibeccUrNaM sarpiShodaragulmanutiti nIlinyAdyaM cUrNam

</div></div>

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+

The ''nililnyadi churna'' is prepared from the powders of ''nilini'' (Indigofera tinctoria), ''nichula'' (Barringtonia acutangula), pippali (Piper longum), ''shunthi'' (Zingiber officinale), ''maricha'' (Piper nigrum), ''svarajika kshara'' (Sodii carbonas impura), ''yava kshara'' (alkali from awns of barley), ''sauvarchala lavana'' (unaqua sodium chloride), ''vida lavana'' (ammonium salt), ''audbhida lavana'' (salt obtained from earth), rock salt (''saindhava''), ''samudra lavana'' (Sodi muris) and ''chitraka'' (Plumbago zeylanica). This powder is orally administered with ghee and is curative of all types ''udara roga'' as well as ''gulma'' (abdominal lump) [137]

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</div>

=== ''Snuhi kshira ghrita'' ===

Line 2,005: Line 2,016:

iti snuhIkShIraghRutam

</div></div>

−

+

Curd is prepared from the mixture of one ''drona'' (12228g) of milk and half ''prastha'' (384g) of ''snuhi kshira'' (latex of Euphorbia neriifolia). This curd is churned properly to extract the butter. Thus obtained butter is boiled to get the ghee. Further this ghee is processed with ''trivrita'' (Operculina turpethum) to get the ''snuhi kshira ghrita''. Alternatively one can take one ''prastha'' (768g) of cow’s ghee, mixed with eight ''prastha'' (6144g) of milk; and to this paste prepared from one ''pala'' (48g) of ''snuhi kshira'' (latex of Euphorbia neriifolia) and eight ''pala'' (384g) of ''trivrita'' (Operculina turpethum) is added. This is then processed to get the medicated ghee. This ''snuhi kshira ghrita'' is effective in alleviating the ''gulma'' (abdominal lump), ''garadosha'' (poison synthesized by combination of non toxic substances) and all types of ''udara''. Thus is described ''snuhi kshira ghrita'' [138-140].

+

</div>

Line 2,025: Line 2,037:

eShAM cAnu pibet peyAM payo vA svAdu vA rasam|

</div></div>

−

+

Take one ''adhaka'' (3073g) of ''dadhi manda'' (liquid portion of curds), one ''pala'' (48g) paste of ''snuhi kshara'' (latex of Euphorbia neriifolia) and one ''prastha'' (768g) of ghee and process it into medicated ''ghrita''. Its oral administeration in a proper dose to patients suffering from ''udara roga'' with ''peya'' (liquid rice gruel), sweetened milk or sweet tasting meat soup cures ''udara roga'' [141].

−

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</div>

=== Management following ''virechana'' ===

Line 2,061: Line 2,073:

gulmAnAM garadoShANAmudarANAM ca shAntaye|

</div></div>

−

+

''Virechana karma'' (therapeutic purgation) should be undertaken after the digestion of the orally administrated medicated ghee. After the ''virechana'', the patient is advised to take decoction of ''nagaraa'' (Zingiber officinale). Then the patient is given ''peya'' (liquid rice gruel) and ''yusha'' (cereal soup) prepared of ''kulattha'' (Vigna unquiculata). If the patient suffers from the state of dryness in his body then he should be given rice with milk for three days. On regaining the physical strength the patient should be repeatedly and alternatively treated with medicated ghee and nourishing diet. In this way ''gulma'' (abdominal lump), ''garavisha'' (poison synthesized by combination of nontoxic substances) and ''udara'' (enlargement of abdomen tending ascites) should be treated [142-144].

+

</div>

Line 2,078: Line 2,091:

gulmaghnaM nIlinIsarpiH snehaM vA mishrakaM pibet|

</div></div>

−

+

The patient suffering from ''anaha'' (distented abdomen) should be treated with ghee processed with paste of ''pilu'' (Salvadora persica). The medicated ghee prepared from ''nilini'' (Indigofera tinctoria) or ''mishraka ghrita'' which is curative of ''gulma'' (abdominal lump) may also be prescribed to cure ''udara roga'' [145]

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</div>

=== ''Shamana'' (palliative) treatment ===

Line 2,097: Line 2,110:

doShasheShanivRuttyarthaM yogAn vakShyAmyataH param|

</div></div>

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+

After the methodical elimination of ''dosha'' followed by proper nutrition by the intake of meat soup of dry land animals; the patient should be treated with oral medications to alleviate the remaining ''dosha''. Such medications are discussed here onwards [146]

+

</div>

Line 2,114: Line 2,128:

mAsaM yuktastathA hastipippalI vishvabheShajam|

</div></div>

−

+

−

The fine powder of ''chitraka'' (Plumbago zeylanica) and ''devadaru'' (Cedrus deodara) should be orally given with milk for one month. Or else the powder of ''hastipippali'' and ''shunthi'' (Zingiber officinale) should be given orally with milk for one month [147].

+

The fine powder of ''chitraka'' (Plumbago zeylanica) and ''devadaru'' (Cedrus deodara) should be orally given with milk for one month. Or else the powder of ''hastipippali'' and ''shunthi'' (Zingiber officinale) should be given orally with milk for one month [147]. </div>

Line 2,131: Line 2,145:

kalkaiH kolasamaiH pItvA pravRuddhamudaraM jayet|

</div></div>

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−

Take one ''kola'' (12g) each of ''vidanga'' (Embelia ribes), ''chitraka'' (Plumbago zeylanica), ''danti'' (Baliospermum montanum), ''chavya'' (Piper retrofractum), ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale) and ''maricha'' (Piper nigrum) and powder. This powder is added with milk and processed. The patient should take this medicated milk to cure of ''udara roga'' [148]

+

Take one ''kola'' (12g) each of ''vidanga'' (Embelia ribes), ''chitraka'' (Plumbago zeylanica), ''danti'' (Baliospermum montanum), ''chavya'' (Piper retrofractum), ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale) and ''maricha'' (Piper nigrum) and powder. This powder is added with milk and processed. The patient should take this medicated milk to cure of ''udara roga'' [148] </div>

Line 2,148: Line 2,162:

vyoShakShArayutaM jIrNe rasairadyAttu jA~ggalaiH|

</div></div>

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−

Decoction is prepared from drugs taken in equal amounts that includes ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''danti'' (Baliospermum montanum) and ''rohitaka'' (Tecomella Undulate). This is added with powder of ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale), ''maricha'' (Piper nigrum) and ''kshara'' (alkali obtained from ash of herbs). Patient is asked to take this medicine, and on its digestion meat soup of dry land animals is given [149].

+

Decoction is prepared from drugs taken in equal amounts that includes ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''danti'' (Baliospermum montanum) and ''rohitaka'' (Tecomella Undulate). This is added with powder of ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale), ''maricha'' (Piper nigrum) and ''kshara'' (alkali obtained from ash of herbs). Patient is asked to take this medicine, and on its digestion meat soup of dry land animals is given [149]. </div>

Line 2,219: Line 2,233:

ariShTAn dApayet kShArAn kaphastyAnasthirodare|

</div></div>

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+

Or the patient is given medicated ghee prepared with snuhikshira (latex of Euphorbia neriifolia) along with meat in food. The combination of ''abhaya'' (Terminalia chebula) and cow’s urine may be orally administered with milk. Patient may be treated with buffalo urine for one week along with milk as food avoiding rice.

−

The camel’s milk and goat’s milk may be orally given for three months added with ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale) and ''maricha'' (Piper nigrum). One course of ''haritaki'' (Terminalia chebula Retz) consisting a thousand numbers may be administered along with milk diet. ''Shilajatu'' (asphaltum) may be administerd orally along with milk diet. Similarly, ''guggulu'' (Commiphora wightii) may be orally administered. Juice of ''ardraka'' (Zingiber officinale) or decoction of ''shringavera'' (Zingiber officinale) is given orally with equal amounts of milk. Alternatively one can take 10 parts of oil processed with one part of ''ardraka'' (Zingiber officinale Rosc) with milk. Oral administration of oil extracted from the seeds of ''danti'' (Baliospermum montanum) and ''dravanti'' (Jatropha glandulifera) along with ''mastu'' (liquid separated from curd ), ''yusha'' (soup) and ''mamsarasa'' (meat soup) is effective in ''dushyodara'' (enlargement of abdomen tending ascites), ''shula'' (abdominal pain), ''anaha'' (flatulence) as well as ''vibandha'' (constipation). The combination of ''sarala'' (Pinus roxburghii), ''madhushigru'' (Moringa oleifera) and oil extracted from seeds of ''mulaka'' (Raphanus sativus) should be given orally and for oil massage in patients suffering from abdominal pain due to vātodara. Patient of kaphodara having the habit of consuming alcohol and suffering from symptoms like abdominal rigidity, ''staimitya'' (subjective feeling as if the body is covered by wet cloth), abdominal heaviness, lack of taste, nausea and impaired digestion should be treated with ''arishta'' (fermented decoctions) or ''kshara'' (alkali obtained from ash of herbs) [150-156]

+

The camel’s milk and goat’s milk may be orally given for three months added with ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale) and ''maricha'' (Piper nigrum). One course of ''haritaki'' (Terminalia chebula Retz) consisting a thousand numbers may be administered along with milk diet. ''Shilajatu'' (asphaltum) may be administerd orally along with milk diet. Similarly, ''guggulu'' (Commiphora wightii) may be orally administered. Juice of ''ardraka'' (Zingiber officinale) or decoction of ''shringavera'' (Zingiber officinale) is given orally with equal amounts of milk. Alternatively one can take 10 parts of oil processed with one part of ''ardraka'' (Zingiber officinale Rosc) with milk. Oral administration of oil extracted from the seeds of ''danti'' (Baliospermum montanum) and ''dravanti'' (Jatropha glandulifera) along with ''mastu'' (liquid separated from curd ), ''yusha'' (soup) and ''mamsarasa'' (meat soup) is effective in ''dushyodara'' (enlargement of abdomen tending ascites), ''shula'' (abdominal pain), ''anaha'' (flatulence) as well as ''vibandha'' (constipation). The combination of ''sarala'' (Pinus roxburghii), ''madhushigru'' (Moringa oleifera) and oil extracted from seeds of ''mulaka'' (Raphanus sativus) should be given orally and for oil massage in patients suffering from abdominal pain due to vātodara. Patient of kaphodara having the habit of consuming alcohol and suffering from symptoms like abdominal rigidity, ''staimitya'' (subjective feeling as if the body is covered by wet cloth), abdominal heaviness, lack of taste, nausea and impaired digestion should be treated with ''arishta'' (fermented decoctions) or ''kshara'' (alkali obtained from ash of herbs) [150-156] </div>

=== ''Pippalyadi lavana'' ===

Line 2,276: Line 2,290:

visUcikAmudAvartaM vAtAShThIlAM ca nAshayet|

</div></div>

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With the due consideration of morbid ''dosha'', the physician should prescribe ''pippalyadi lavana'' for liquefying the ''kapha''. The ingredients of ''pippalyadi lavana'' are ''pippali'' (Piper longum), ''tilvaka'' (Symplocos cochinchinensis/Jatropha curcas), ''hingu'' (Ferula foetida), ''nagaraa'' (Zingiber officinale), ''hastipippali'' (Scindapsus officinalis), ''bhallataka'' (Semecarpus anacardium), fruits of ''shigru'' (Moringa oleifera), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''katukarohini'' (Picrorhiza kurroa Royle), ''devadaru'' (Cedrus deodara), ''haridra'' (Curcuma longa), ''daruharidra'' (Berberis aristata), ''sarala'' (Pinus roxburghii), ''ativisha'' (Aconitum heterophyllum), ''vacha'' (Acorus calamus), ''kushtha'' (Saussurea lappa), ''musta'' (Cyperus rotundus), ''sauvarchala lavana'' (unaqua sodium chloride), ''vida lavana'' (ammonium salt), ''audbida lavana'' (salt obtained from earth), rock salt (''saindhava'') and ''samudra lavana'' (Sodi muris). The course powder of these drugs is added with curd/yogurt, cow’s ghee, ''vasa'' (animal fat), ''majja'' (bone marrow) and ''taila'' (oil extracted from seeds of Sesamum indicum) and then is burnt to get the ''kshara'' (alkali obtained from ash of herbs). This ''kshara'' is orally administered after the meals in a dose of one ''karsha'' (12g). The ''anupana'' (adjunct) for it is any one of madirā (alcoholic beverage), dadhimanda (liquid portion of curds), warm water, arishta (fermented decoctions), surā (alcoholic preparation made by fermenting a mixture of water, flour of rice, jaggery) and ''asava'' (fermented infusions). This medication effectively cures ''hridroga'' (cardiac disease), ''anasaraka, gulma'' (abdominal lump), ''plihodara'' (splenomegaly), ''arshas'' (piles), ''udara roga, visuchika'' (illness characterized by vomiting and diarrhea), ''udavarta'' (reversed course of ''vata'' in the abdomen) and ''vatashtila'' (mass obliterating the urinary and rectal passage)[157-161].

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With the due consideration of morbid ''dosha'', the physician should prescribe ''pippalyadi lavana'' for liquefying the ''kapha''. The ingredients of ''pippalyadi lavana'' are ''pippali'' (Piper longum), ''tilvaka'' (Symplocos cochinchinensis/Jatropha curcas), ''hingu'' (Ferula foetida), ''nagaraa'' (Zingiber officinale), ''hastipippali'' (Scindapsus officinalis), ''bhallataka'' (Semecarpus anacardium), fruits of ''shigru'' (Moringa oleifera), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''katukarohini'' (Picrorhiza kurroa Royle), ''devadaru'' (Cedrus deodara), ''haridra'' (Curcuma longa), ''daruharidra'' (Berberis aristata), ''sarala'' (Pinus roxburghii), ''ativisha'' (Aconitum heterophyllum), ''vacha'' (Acorus calamus), ''kushtha'' (Saussurea lappa), ''musta'' (Cyperus rotundus), ''sauvarchala lavana'' (unaqua sodium chloride), ''vida lavana'' (ammonium salt), ''audbida lavana'' (salt obtained from earth), rock salt (''saindhava'') and ''samudra lavana'' (Sodi muris). The course powder of these drugs is added with curd/yogurt, cow’s ghee, ''vasa'' (animal fat), ''majja'' (bone marrow) and ''taila'' (oil extracted from seeds of Sesamum indicum) and then is burnt to get the ''kshara'' (alkali obtained from ash of herbs). This ''kshara'' is orally administered after the meals in a dose of one ''karsha'' (12g). The ''anupana'' (adjunct) for it is any one of madirā (alcoholic beverage), dadhimanda (liquid portion of curds), warm water, arishta (fermented decoctions), surā (alcoholic preparation made by fermenting a mixture of water, flour of rice, jaggery) and ''asava'' (fermented infusions). This medication effectively cures ''hridroga'' (cardiac disease), ''anasaraka, gulma'' (abdominal lump), ''plihodara'' (splenomegaly), ''arshas'' (piles), ''udara roga, visuchika'' (illness characterized by vomiting and diarrhea), ''udavarta'' (reversed course of ''vata'' in the abdomen) and ''vatashtila'' (mass obliterating the urinary and rectal passage)[157-161]. </div>

=== ''Kshara vatika'' ===

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shvayathAvavipAke ca pravRuddhe ca dakodare|

</div></div>

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''Kshara'' is prepared by burning goat’s dung processed with cow’s urine and it is added with 1 karsha (12g) each of root of ''pippali'' (Piper longum), ''sauvarchala lavana'' (unaqua sodium chloride), ''vida lavana'' (ammonium salt), ''audbida lavana'' (salt obtained from earth), ''saindhava'' (Sodi chloriduium), ''samudra lavana'' (Sodi muris), ''pippali'' (Piper longum), ''chitraka'' (Plumbago zeylanica), ''shunthi'' (Zingiber officinale), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''trivrita'' (Operculina turpethum), ''vacha'' (Acorus calamus), ''sarjikashara'' (Sodii carbonas impura), ''yava kshara'' (alkali from awns of barley), ''satala'' (Euphorbia Tirucalli), ''danti'' (Baliospermum montanum), ''svarnakshiri'' (Argemone mexicana ) and ''vishanika'' (Euphorbia fusiformis). This formulation is rolled into a pill of the size one ''kola'' (6g). This is orally administered in a dose of one ''kola'' (6g) with ''sauvira'' (alcoholic beverage prepared from dehusked barley either raw or cooked) and is effective in ''shvayathu'' (''anasaraka''), ''avipaka'' (indigestion) and advanced stage of ''udara roga'' [162-164].

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</div>

=== ''Yavagu'' for treatment of ''udara roga'' ===

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svaM svaM sthAnaM vrajantyevaM tathA pittakaphAnilAH|

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The rice that grows in 60 days is processed with cow’s urine and is used for the preparation of ''yavagu'' (rice gruel) added with milk. Patient is allowed to consume stomach full of this ''yavagu'' followed along with ample intake of sugar cane juice. This will cure the ''udara roga'' and the morbid ''vata, pitta'' as well ''kapha'' and help in regaining their natural abode [165-66].

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</div>

=== Treatment of constipation ===

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dadyAnmUtrayutaM kShIraM [6] doShasheShaharaM shivam| <br />

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The knowledgeable physician should give the patients the food prepared with adding leaves of ''shankhini'' (Clitoria terneata), ''snuhi'' (Euphorbia neriifolia), ''trivrita'' (Operculina turpethum), ''danti'' (Baliospermum montanum) and ''chirabilva'' (Holoptelea integrifolia). This will soften the fecal matter and helps in emptying the bowels. If some amount of ''dosha'' is left unexpeled, then the patient is allowed to drink milk added with cow’s urine [167-168]

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</div>

=== Treatment of ''parshva shula'' ===

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janayedyasya taM tailaM bilvakShAreNa pAyayet|

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Patient of ''udara'' if develops ''parshvashula'' (pain in the sides), ''upastambha'' (paresis and ''paresthesia'' of lower limbs due to entrapment of ''vata''), ''hridgraha'' (congestion in cardiac region) due to morbidity of ''vata'', it should be treated by oral administration of ''taila'' (oil extracted from seeds of Sesamum indicum), added with ''bilva kshāra'' (alkali obtained from ash of Aegle marmelos) [169].

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</div>

=== ''Kshara taila'' ===

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nivartate codariNAM hRudgrahashcAnilodbhavaH|172|

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Oil is prepared successively with each of the ''kshara'' of ''agnimantha'' (Clerodendrum phlomidis), ''shyonaka'' (Oroxylum indicum), ''palasha'' (Butea monosperma), stalk of ''tila'' (Sesamum indicum), ''bala'' (Sida cordifolia), ''kadali'' (Musa paradisiaca) and ''apamarga'' (Achyranthes aspera). This is orally given to cure the ''udara roga''. This medicated oil also relieves cardiac arrest (''hridgraha'') caused by morbid ''vata'' in patient of ''udara'' [170-172]

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</div>

=== ''Eranda taila'' in ''avarana'' ===

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tIkShNaiH sakShAragomUtrairbastibhistamupAcaret|175|

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In condition where ''kapha'' is afflicted with morbid ''vata'' and ''pitta'' or where ''vata'' is overlaid by ''kapha'' and ''pitta'', it should be treated by oral medication of ''eranda taila'' (oil of Ricinus communis) processed with relevant herbs that cure the morbid ''dosha''.

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If morbid ''vata'' causes intestinal stasis and abdominal distension then it should be treated by administration of ''niruha'' (decoction enema) consisting of strong medicines such as ''kshara'' (alkali obtained from ash of herbs) and cow’s urine [172-75].

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</div>

=== Use of ''venum'' in the treatment of ''sannipatodara'' ===

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durbalAya prayu~jjIta prANabhRut kArabhaM payaH|184| <br />

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If patient suffering from ''udara'' does not respond to usual treatment due to morbidity of three ''dosha'', then the physician should inform the critical state to the relative of the patient and start treating with venom of cobra after obtaining consent from the patients friends, spouse, brahmins, king as well as teacher. The physician should win the confidence of these people after clearly stating that the patient will not survive if the treatment with venom is not made, and patient may survive if this treatment is done. After obtaining the consent, the physician should mix the venom in food and drink and administer it to the patient.

Alternatively the angry serpent is made to release the venom while biting the fruit. Patient is allowed to consume this venomous fruit after proper analysis by the physician. This treatment immediately liquefies the infiltrating displaced morbid ''dosha'' by virtue of its ''pramathi'' (clearing the channels adhered with ''dosha'') property and eliminates from the body. Once the ''dosha'' is cleared from the body by the action of venom patient is treated with cold water ''parishechana'' (pouring of medicated liquids on body parts). Depending upon the physical strength, the patient is allowed to drink milk or yavāgu (rice gruel). The food prepared from leafy vegetables that include ''trivrita'' (Operculina turpethum), ''mandukaparni'' (Centella asiatica), ''yava'' (Hordeum vulgare), ''vastuka'' (Chenopodium murale) and ''kalashaka'' (Corchorus capsularis) processed with juice of same leafy vegetables should be given to the patient but without adding ''amla'' (sour), ''lavana'' (salty) and ''sneha'' (unctuous substance). This food may be served with or without steaming and during this food rice is avoided. This regimen should be continued for one month. During this course if the patient is thirsty then the juice extracted from these leafy vegetables should be given to the patient. By this method once in one month all the morbid ''dosha'' is cleared from the body and the patient is advised to drink milk to improve the physical strength [175-184]

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</div>

=== Surgical measures ===

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pratiyogaiH [2] praveshyAntraM preyaiH [3] sIvyedvraNaM tataH||188||<br />

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Surgical intervention should be done by an expert surgeon. A proper incision is made on the left side of the abdomen about fpur figure (7.8cm) below the umbilicus by an efficient surgeon. From this incision intestinal loops are drawn out and carefully looked for foreign substances causing ''chidrodara'' or ''baddhodara''. Ghee is applied on the affected loop of the intestines. Then the foreign substances like hair and others are then removed from the intestinal loop. Any torsion or intussusception of the loops of intestines if present is opened. By the surgical procedure if large rend happens in the intestines then edges of rend is anchored by making the small ants to bite and hold the edges together. Once the ants properly anchor the opposing edges of rend, the body of the ants is separated and thrown. Intestinal loops are then properly inserted into the abdomen and the incised area is sutured. Then wound management is done [184-188].

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</div>

=== Surgical Intervention in ''jalodara'' ===

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naraH saMvatsareNaivaM jayet prAptaM jalodaram| <br />

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In all conditions of ''udara'' with accumulation of fluid, the fluid should be aspirated by inserting a cannula into the abdomen just below the umbilicus on the left side. While aspirating, compress the abdomen and after the aspiration the abdomen is tightly wrapped with a cloth. This wrapping should also be done in cases where reduction of the abdomen is achieved by other methods like ''niruha basti'' (decoction enema) and ''virechana'' (therapeutic purgation). After the removal of the fluid patient is treated with ''langhana'' (reducing regimen) and is given ''peya'' (liquid rice gruel) with little or no addition of ''sneha'' (dietary fat) and salt. After this the patient is kept on only milk diet for six months. For another three months patient is allowed to take ''peya'' (liquid rice gruel) along with milk. Following this for another three months the patients is given rice prepared with shyāmaka (Echinochloa frumentacea) or ''koradusha'' (Paspalum scorbiculatum) added with milk. This light diet should be without salt altogether. By managing the patient in this manner for one year one can get cured of ''jalodara'' [189-192]

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</div>

=== Importance of milk diet ===

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sarvadhAtukShayArtAnAM devAnAmamRutaM yathA||194||<br />

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To prevent the perpetuation of morbid ''dosha'' and to regain the physical strength, milk should be included in all prescriptions for the patients suffering from ''udara''. The physique of the patients of ''udara'' which is reduced due to medications is best recuperated by milk diet, and milk is regarded as best remedy identical to the nectar for gods in all patients suffering from depletion of all ''dhatu'' [193-194]

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</div>

=== Summary of the chapter ===

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samAsavyAsanirdeshairudarANAM cikitsite||196||<br />

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Thus the etiology, premonitory symptoms, general and individual symptoms of eight types of ''udara'', complications of ''udara'', seriousness of the illness, prognosis, symptoms of stages of ''udara'' as non accumulation and accumulation of fluid, and the specific as well as general treatment of ''udara roga'' are described by the sage Punarvasu in this chapter of [[Chikitsa Sthana]] [195-196].

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== References ==

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