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

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

== Meaning and synonyms ==

== Meaning and synonyms ==

 

The Sanskrit word ‘purisha’ is derived from root “pru” by adding the suffix “ishan” that means crumbling or loose earth, excremental dirt, rubbish, the solid mass which fills up (the intestine) etc.<ref>Jha Srujan. Amarkosha online application.</ref>  It is also known by synonyms like shakrut, varcha/varchaska, vishtha and vit in Sanskrit literature.  

The Sanskrit word ‘purisha’ is derived from root “pru” by adding the suffix “ishan” that means crumbling or loose earth, excremental dirt, rubbish, the solid mass which fills up (the intestine) etc.<ref>Jha Srujan. Amarkosha online application.</ref>  It is also known by synonyms like shakrut, varcha/varchaska, vishtha and vit in Sanskrit literature.  

 

=== Fundamental composition and properties===

=== Fundamental composition and properties===

 

The fecal matter has predominance of [[prithvi mahabhuta ]]. Its consistency depends upon the presence of [[jala mahabhuta]] in it.

The fecal matter has predominance of [[prithvi mahabhuta ]]. Its consistency depends upon the presence of [[jala mahabhuta]] in it.

*Other constituents- calcium and iron phosphates, intestinal secretions, small amounts of dried epithelial cells, and mucus.<ref>Rose C, Parker A, Jefferson B, Cartmell E. The Characterization of Feces and Urine: A Review of the Literature to Inform Advanced Treatment Technology. Crit Rev Environ Sci Technol. 2015;45(17):1827-Vale</ref>  

*Other constituents- calcium and iron phosphates, intestinal secretions, small amounts of dried epithelial cells, and mucus.<ref>Rose C, Parker A, Jefferson B, Cartmell E. The Characterization of Feces and Urine: A Review of the Literature to Inform Advanced Treatment Technology. Crit Rev Environ Sci Technol. 2015;45(17):1827-Vale</ref>  

 

===Formation===

===Formation===

 

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

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

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

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

===Quantity===

===Quantity===

 

The total quantity of purisha is seven anjali (personified measurement unit).[Cha. Sa. [[Sharira Sthana]] 7/15]

The total quantity of purisha is seven anjali (personified measurement unit).[Cha. Sa. [[Sharira Sthana]] 7/15]

On average humans eliminate 128 g of fresh feces per person per day.<ref>Available from https://en.wikipedia.org/wiki/Human_feces cited on 24/12/2020</ref>

On average humans eliminate 128 g of fresh feces per person per day.<ref>Available from https://en.wikipedia.org/wiki/Human_feces cited on 24/12/2020</ref>

 

===Functions===

===Functions===

 

Purisha is a fundamental component of body.It supports the functions of [[vayu]] and [[agni]] in body.[Su. Sa. Sutra Sthana 15/5],[A. S.Sutra Sthana 19/4]

Purisha is a fundamental component of body.It supports the functions of [[vayu]] and [[agni]] in body.[Su. Sa. Sutra Sthana 15/5],[A. S.Sutra Sthana 19/4]

It carries the solid waste products of metabolism and helps in preservation of health. It also helps to maintain the microbial flora of intestine.

It carries the solid waste products of metabolism and helps in preservation of health. It also helps to maintain the microbial flora of intestine.

 

===Channels carrying feces (purishavaha srotas) ===

===Channels carrying feces (purishavaha srotas) ===

 

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

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

 

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

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

 

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

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

 

===Diagnostic perspectives ===

===Diagnostic perspectives ===

===Causes of vitiation===

===Causes of vitiation===

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

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

 

==Abnormal states==

==Abnormal states==

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

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

{| class="wikitable"

{| class="wikitable"

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

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

 

== Stool examination(purisha pareeksha)==

== Stool examination(purisha pareeksha)==

 

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

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

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

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

 

==Management of disorders related to fecal matter==

==Management of disorders related to fecal matter==

===Management of increased state ===

===Management of increased state ===

 

*Judicious application of cleansing therapies (shodhana) or medicines to facilitate the natural expulsion is indicated.[Su. Sa. Sutra Sthana 15/17]

*Judicious application of cleansing therapies (shodhana) or medicines to facilitate the natural expulsion is indicated.[Su. Sa. Sutra Sthana 15/17]

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

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

 

==Current researches==

==Current researches==

 

*The faecal transplant, the transfer of faces or portions of the faecal matter from one organism into the gastrointestinal tract of another, is rapidly gaining attention as a treatment for human gut infections. Now a days, it is used as a general research tool for gain-of-function experiments in animal models.<ref>Bojanova DP, Bordenstein SR. Fecal Transplants: What Is Being Transferred?. PLoS Biol. 2016;14(7):e1002503. Published 2016 Jul 12. doi:10.1371/journal.pbio.1002503.</ref>  

*The faecal transplant, the transfer of faces or portions of the faecal matter from one organism into the gastrointestinal tract of another, is rapidly gaining attention as a treatment for human gut infections. Now a days, it is used as a general research tool for gain-of-function experiments in animal models.<ref>Bojanova DP, Bordenstein SR. Fecal Transplants: What Is Being Transferred?. PLoS Biol. 2016;14(7):e1002503. Published 2016 Jul 12. doi:10.1371/journal.pbio.1002503.</ref>  

*Recently, a research study has developed and validated a toilet paper–based fecal occult blood test for the use as a point-of-care test for the rapid (in 60 seconds) and easy testing of fecal occult blood which can be a promising tool for screening of colorectal cancer in public health domain.<ref>Wang HY, Lin TW, Chiu SY, et al. Novel Toilet Paper-Based Point-Of-Care Test for the Rapid Detection of Fecal Occult Blood: Instrument Validation Study. J Med Internet Res. 2020;22(8):e20261. Published 2020 Aug 7. doi:10.2196/20261.</ref>

*Recently, a research study has developed and validated a toilet paper–based fecal occult blood test for the use as a point-of-care test for the rapid (in 60 seconds) and easy testing of fecal occult blood which can be a promising tool for screening of colorectal cancer in public health domain.<ref>Wang HY, Lin TW, Chiu SY, et al. Novel Toilet Paper-Based Point-Of-Care Test for the Rapid Detection of Fecal Occult Blood: Instrument Validation Study. J Med Internet Res. 2020;22(8):e20261. Published 2020 Aug 7. doi:10.2196/20261.</ref>

 

==Related theses works==

==Related theses works==

 

1.Inya Lingu(2012): Study on Aetiopathogenesis of Vibandha in Geriatric persons and Role of Vaishvanara Churna in its Samprapti Vighatana, Department of Roganidana and Vikruti Vigyana, IPGT &RA, Jamnagar.

1.Inya Lingu(2012): Study on Aetiopathogenesis of Vibandha in Geriatric persons and Role of Vaishvanara Churna in its Samprapti Vighatana, Department of Roganidana and Vikruti Vigyana, IPGT &RA, Jamnagar.

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

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

 

==References:==

==References:==