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|title=Udara Chikitsa

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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, Ayurveda, charak samhita, Indian system of medicine.

|description=Chikitsa Sthana Chapter 13. Management of Udara (Generalized enlargement of Abdomen)

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|image=http://www.carakasamhitaonline.com~~/mediawiki-1.32.1~~/resources/assets/ogimgs.jpg

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<big>'''[[Chikitsa Sthana]] Chapter 13. Management of Udara (Generalized enlargement of Abdomen)</big>'''

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

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~~<div style="text-align:justify;">~~

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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.

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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 </div>

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{{Infobox

|title = Udara Chikitsa

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|label5 = Other Sections

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

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|label6 = Translator and commentator

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|data6 = Acharya G.S.

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|label7 = Reviewer

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|data7 = Goyal M.

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|label8 = Editors

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|data8 = Singh G., Goyal M., Deole Y.S., Basisht G.

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.014 10.47468/CSNE.2020.e01.s06.014]

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}}

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~~|header3~~ =

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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 ''[[dosha]]ja udara roga'' (''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' 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.

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Each type of ''udara roga'' has distinct etiology, pathology and symptomatology. ''[[Vata]]ja, [[pitta]]ja, [[kapha]]ja'' 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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}}

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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>

== 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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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. ''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' 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''.

</div>

== Sanskrit text, Transliteration and English Translation ==

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</div></div>

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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>

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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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</div></div>

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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>

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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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</div></div>

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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>

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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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</div></div>

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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>

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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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</div></div>

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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>

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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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</div></div>

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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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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]

</div>

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

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</div></div>

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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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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]

</div>

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

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</div></div>

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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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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]

</div>

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

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</div></div>

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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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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]

</div>

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

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</div></div>

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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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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]

</div>

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

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</div></div>

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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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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]

</div>

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

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</div></div>

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

</div>

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

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</div></div>

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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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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]

</div>

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

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</div></div>

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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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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].

</div>

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

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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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The symptoms of ''plihodara'' include debility, lack of taste in mouth, indigestion, constipation, retention of urine, darkness in front of the eyes, excessive thirst, body ache, vomiting, transient loss of consciousness, tiredness in the body parts, cough, dyspnea, mild fever, flatulence, loss of appetite, emaciation, abnormal taste in the mouth, pain in joint of the digits, abdominal pain due to morbid ''vata'', abnormal pinkish coloration of the abdomen, discoloration of the abdominal wall and the abdominal wall shows bluish greenish yellowish linear stretch marks.

+

The symptoms of ''plihodara'' include debility, lack of taste in mouth, indigestion, constipation, retention of urine, darkness in front of the eyes, excessive thirst, body ache, vomiting, transient loss of consciousness, tiredness in the body parts, cough, dyspnea, mild fever, flatulence, loss of appetite, emaciation, abnormal taste in the mouth, pain in joint of the digits, abdominal pain due to morbid ''[[vata]]'', abnormal pinkish coloration of the abdomen, discoloration of the abdominal wall and the abdominal wall shows bluish greenish yellowish linear stretch marks.

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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</div></div>

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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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''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].

</div>

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

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</div></div>

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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].

+

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].

</div>

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

Line 640: Line 647:

</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].

+

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 665: Line 672:

</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].

+

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].

+

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'' ===

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</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.

+

''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.

The accumulated fluid in the abdomen thus become turbid and leads to the symptoms like globular distension of the abdomen, subjective feeling of heaviness in the abdomen, still abdomen with absence of gurgling sound, dull note on percussion, soft abdomen on palpation, disappearance of stretch marks and distended veins spreading around the umbilicus.

Line 831: Line 838:

</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].

+

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'' ===

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</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].

+

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 ===

+

=== Post ''[[virechana]]'' regimen ===

Line 887: Line 894:

</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].

+

''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'' ===

+

=== Role of ''asthapana [[basti]]'' ===

Line 906: Line 913:

</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].

+

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'' ===

+

=== Role of ''anuvasana [[basti\\'' ===

Line 919: Line 926:

</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]

+

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'' ===

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</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].

+

''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 ===

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</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]

+

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'' ===

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</div></div>

−

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

+

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

</div>

Line 1,000: Line 1,007:

</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]

+

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 1,021: Line 1,028:

</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]

+

''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 1,036: Line 1,043:

</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].

+

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 1,052: Line 1,059:

</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].

+

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 1,087: Line 1,094:

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) ===

+

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

Line 1,110: Line 1,117:

</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''.

+

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].

+

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 1,128: Line 1,135:

</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].

+

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 1,271: Line 1,278:

</div></div>

−

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

+

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

</div>

−

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

+

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

Line 1,302: Line 1,309:

</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].

+

''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 1,329: Line 1,336:

</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].

+

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 1,388: Line 1,395:

</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].

+

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 1,424: Line 1,431:

</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].

+

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'' ===

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</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]

+

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 1,544: Line 1,552:

</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.

+

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.

Patient suffering from ''vatodara'' should drink buttermilk added with ''pippali'' (Piper longum) and rock salt.

Line 1,556: Line 1,564:

Patient suffering from ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) should take buttermilk added with ''hapusha'' (Juniperus communis), ''yavani'' (Trachyspermum ammi), ''ajaji'' (Cuminum cyminum) and rock salt.

−

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].

+

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 1,575: Line 1,583:

</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]

+

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]

</div>

=== Application of paste on abdomen ===

Line 1,643: Line 1,651:

</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].

+

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].

</div>

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

Line 1,680: Line 1,688:

</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].

+

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].

</div>

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

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</div></div>

−

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].

+

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]] [[vata]]ja gulma'' (abdominal lump) [115].

</div>

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

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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].

</div>

−

=== ''Virechana'' ===

+

=== ''[[Virechana]]'' ===

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</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]

+

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]

</div>

=== ''Patoāldi churna'' ===

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</div></div>

−

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]

+

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]

</div>

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

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</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]

+

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]

</div>

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

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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].

</div>

−

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

+

=== Management following ''[[virechana]]'' ===

Line 2,077: Line 2,085:

</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].

+

''[[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 2,114: Line 2,122:

</div></div>

−

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]

+

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>

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</div></div>

−

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>

+

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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</div></div>

−

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].

+

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].

</div>

=== Treatment of constipation ===

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</div></div>

−

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]

+

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]

</div>

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

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</div></div>

−

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].

+

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].

</div>

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

Line 2,434: Line 2,442:

</div></div>

−

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]

+

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]

</div>

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

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</div></div>

−

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''.

+

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]]''.

−

After the proper elimination of the morbid ''dosha'', if the abdominal distension recurs then it should be treated by ''niruha basti'' (decoction enema) consisting adequate amount of ''sneha'' (dietary fat), sour tasting drugs and ''saindhava lavana'' (Sodi chloriduium).

+

After the proper elimination of the morbid ''[[dosha]]'', if the abdominal distension recurs then it should be treated by ''niruha [[basti]]'' (decoction enema) consisting adequate amount of ''sneha'' (dietary fat), sour tasting drugs and ''saindhava lavana'' (Sodi chloriduium).

−

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].

+

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].

</div>

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

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</div></div>

−

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.

+

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]

+

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]

</div>

=== Surgical measures ===

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</div></div>

−

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]

+

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]

</div>

=== Importance of milk diet ===

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</div></div>

−

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]

+

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]

</div>

=== Summary of the chapter ===

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== Tattva Vimarsha (Fundamental Principles) ==

−

*Abnormalities of ''jatharagni'' (digestive power) leads to the morbid accumulation of the ''mala'' (''dosha'' and excreta- waste) and in turn tend to cause multiple diseases and particularly ''udara roga''.

+

*Abnormalities of ''jatharagni'' (digestive power) leads to the morbid accumulation of the ''[[mala]]'' (''[[dosha]]'' and excreta- waste) and in turn tend to cause multiple diseases and particularly ''udara roga''.

−

*Affliction of ''prana vata, agni'' as well as ''apana vata'' are main culprits leading to accumulation of morbid ''dosha''. This in turn obliterates the channels of ''sweda'' (sweat) and ''udaka'' (body fluid) tending upwards and downwards.

+

*Affliction of ''prana vata, agni'' as well as ''apana vata'' are main culprits leading to accumulation of morbid ''[[dosha]]''. This in turn obliterates the channels of ''sweda'' (sweat) and ''udaka'' (body fluid) tending upwards and downwards.

−

*The causes of gross enlargement of abdomen include consumption of foods that lead to vitiation of ''pitta'' like hot, salty, ''kshara'' (alkali), that cause burning sensation, sour, ''ruksha'' (dry), slow poisons, erroneous dietary management following purification treatments, ''viruddha ahara'' (combination of foods having mutually contradictory properties), unhealthy foods, emaciation due to splenic enlargement, ''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'' (rectal mass, or piles), 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.

+

*The causes of gross enlargement of abdomen include consumption of foods that lead to vitiation of ''[[pitta]]'' like hot, salty, ''kshara'' (alkali), that cause burning sensation, sour, ''ruksha'' (dry), slow poisons, erroneous dietary management following purification treatments, ''viruddha ahara'' (combination of foods having mutually contradictory properties), unhealthy foods, emaciation due to splenic enlargement, ''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'' (rectal mass, or piles), 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.

−

*Apart from accumulation of morbid ''dosha'' in abdomen, splenomegaly, gastrointestinal obstruction, intestinal perforation, collection of fluid are the other causes of ''udara''.

+

*Apart from accumulation of morbid ''[[dosha]]'' in abdomen, splenomegaly, gastrointestinal obstruction, intestinal perforation, collection of fluid are the other causes of ''udara''.

−

*Liver and spleen are affected by morbid ''dosha'' leading to enlargement in size and ''udara''.

+

*Liver and spleen are affected by morbid ''[[dosha]]'' leading to enlargement in size and ''udara''.

−

*The pathogenic factors in ''vata'' dominant ''udara'' are located at ''kukshi'' (lower abdomen), ''hridaya'' (heart), ''basti'' (bladder and urinary system), ''guda'' (ano-rectal canal).

+

*The pathogenic factors in ''[[vata]]'' dominant ''udara'' are located at ''kukshi'' (lower abdomen), ''hridaya'' (heart), ''basti'' (bladder and urinary system), ''guda'' (ano-rectal canal).

−

*The pathogenic factors in ''pitta'' dominant ''udara'' are located at ''amashaya'' (stomach and upper GI tract).

+

*The pathogenic factors in ''[[pitta]]'' dominant ''udara'' are located at ''amashaya'' (stomach and upper GI tract).

−

*The pathogenic factors in ''kapha'' dominant ''udara'' are located at ''bahirantra'' (outer side of intestine i.e. peritoneal cavity).

+

*The pathogenic factors in ''[[kapha]]'' dominant ''udara'' are located at ''bahirantra'' (outer side of intestine i.e. peritoneal cavity).

−

*Collection of ascitic fluid is due to affliction of ''kapha dosha'' and ''udaka''. (body fluids).

+

*Collection of ascitic fluid is due to affliction of ''[[kapha dosha]]'' and ''udaka''. (body fluids).

−

*Treatment protocol for ''vatodara'' includes administration of unctuous medications, ''abhyanga'' (unctuous massage), ''sweda'' (sudation), ''sneha virechana'' (purgation with unctuous purgatives)and ''pattabandhana'' (tight bandage on abdomen).

+

*Treatment protocol for ''vatodara'' includes administration of unctuous medications, ''abhyanga'' (unctuous massage), ''sweda'' (sudation), ''sneha [[virechana]]'' (purgation with unctuous purgatives)and ''pattabandhana'' (tight bandage on abdomen).

−

*In order to prevent recurrence, ''udara'' should be treated by regular ''virechana'' (frequent therapeutic purgation). After purgation, milk is advised to improve the physical strength and to relieve the strain of purgation.

+

*In order to prevent recurrence, ''udara'' should be treated by regular ''[[virechana]]'' (frequent therapeutic purgation). After purgation, milk is advised to improve the physical strength and to relieve the strain of purgation.

*''Asthapana'' (decoction enema) and ''anuvasana'' (unctuous enema) is advised to remove obstruction.

−

*Physically strong patients suffering from ''pittodara'' should be treated by ''virechana karma'' (therapeutic purgation) first. *Physically weak patients should be treated by purification by adapting ''kshirabasti'' (decoction enema consisting of milk as predominant ingredient). After they regain physical strength and digestive power improves, the patient should be treated with ''virechana'' (therapeutic purgation).

+

*Physically strong patients suffering from ''pittodara'' should be treated by ''[[virechana]] karma'' (therapeutic purgation) first. *Physically weak patients should be treated by purification by adapting ''kshirabasti'' (decoction enema consisting of milk as predominant ingredient). After they regain physical strength and digestive power improves, the patient should be treated with ''[[virechana]]'' (therapeutic purgation).

−

*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.

+

*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.

−

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

+

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

−

*The treatment of ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) includes 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).

+

*The treatment of ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) includes 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).

*''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.

−

*All types of ''udara'' (enlargement of abdomen) are mostly due to tri-discordance of ''dosha'', hence treatment that alleviates all three ''dosha'' should be adapted in all types of ''udara''.

+

*All types of ''udara'' (enlargement of abdomen) are mostly due to tri-discordance of ''[[dosha]]'', hence treatment that alleviates all three ''[[dosha]]'' should be adapted in all types of ''udara''.

== Vidhi Vimarsha (Applied Inferences ) ==

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=== Etiopathogenesis ===

−

Impairment of ''jatharagni'' leads to morbidity of all the three ''dosha''. ''Mala'' in the present context refers to morbid ''vata'', ''pitta'' and ''kapha'', the metabolic bi-products formed during ''dhatu'' metabolism i.e. during tissue formation as well as the wastes like excreta<ref name="ref1">~~Agnivesha. Charak Samhita~~, ~~elaborated by~~ Charak ~~& Dridabala with [[Ayurveda]] Deepika commentary by Chakrapani Datta, Vaidya~~ Jadavaji Trikamji ed.~~, 2009 Edition,~~ Varanasi, Chaukhambha Orientalia~~, Pp~~ 738, ~~Pg no~~ 491</ref>. Impairment of ''agni'' leads to excess formation of metabolic bi products (''mala'') and less formation of quality products. This leads to accumulation of the waste at micro-cellular circulation, which causes multiple diseases. More specifically, this accumulation of wastes at various visceral organs like liver, spleen etc. leads to distension of abdomen<ref name="ref13">~~Agnivesha. [[Charak Samhita]]~~, ~~elaborated by~~ Charak ~~& Dridabala with jalpakalpataru commentary by gangadhara, 3rd part, kaviraja~~ shri ~~narendranathasen gupta~~; kaviraja shri ~~balayichandrasen gupta~~, ed.~~, 1st Edition, Culcutta,~~ C.K.Sen and company ltd, ~~Pp3828, Pg no~~ 2815</ref>.

+

Impairment of ''jatharagni'' leads to morbidity of all the three ''[[dosha]]''. ''[[Mala]]'' in the present context refers to morbid ''[[vata]]'', ''[[pitta]]'' and ''[[kapha]]'', the metabolic bi-products formed during ''[[dhatu]]'' metabolism i.e. during tissue formation as well as the wastes like excreta<ref name="ref1">Chakrapani, Charak. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita. 1st ed. Varanasi: Chaukhambha Orientalia;2009.p.738,491</ref>. Impairment of ''agni'' leads to excess formation of metabolic bi products (''[[mala]]'') and less formation of quality products. This leads to accumulation of the waste at micro-cellular circulation, which causes multiple diseases. More specifically, this accumulation of wastes at various visceral organs like liver, spleen etc. leads to distension of abdomen<ref name="ref13">Gangadhara, Charak. In: Kaviraja shri Narendranathasen Gupta; kaviraja shri Balayichandrasen Gupta, Editor. Charak Samhita. 1st ed. Calcutta: C.K.Sen and company ltd;??.p.3828,2815.</ref>.

−

''Malina ahara'' meaning unhealthy food refers to all food articles that cause morbidity of ''dosha'' in the body when consumed<ref name="ref1" />. ''Malina ahara'' also includes unclean vegetable and other food articles<ref name="ref13" />

+

''Malina ahara'' meaning unhealthy food refers to all food articles that cause morbidity of ''[[dosha]]'' in the body when consumed<ref name="ref1" />. ''Malina ahara'' also includes unclean vegetable and other food articles<ref name="ref13" />

−

Excessive dryness of the body in the absence of counteracting the same by proper measures leads to the ''udara roga''. The disease ''ama'' causing ''udara'' refers to the chronic perpetuation ''ama'' leads to ''udara roga''.<ref name="ref12">~~Agnivesha. Charak Samhita~~, ~~elaborated by~~ Charak ~~& Dridabala with [[Ayurveda]] Deepika commentary by Chakrapani Datta, Vaidya~~ Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 492</ref>

+

Excessive dryness of the body in the absence of counteracting the same by proper measures leads to the ''udara roga''. The disease ''ama'' causing ''udara'' refers to the chronic perpetuation ''ama'' leads to ''udara roga''.<ref name="ref12">Chakrapani, Charak. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita, 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 492</ref>

''Ama'' as a cause of ''udara'' also refers to the consumption of uncooked foods.<ref name="ref13" />

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Listing of sinful acts as etiology indicates the serious unrighteousness as the potent etiology of ''udara roga''<ref name="ref12" /> [12-13].

−

All the foods that are greasy, heavy for digestion or light for digestion and dry causes ''vidaha'' (burning sensation in the abdomen during the digestion of foods) or else the patient develops ''vidaghdajirna''(intermediate state of digestion that caused burning)<ref>~~Agnivesha. [[Charak Samhita]]~~, ~~elaborated by~~ Charak ~~& Dridabala with Jalpakalpataru commentary by gangadhara, 3rd part, kaviraja~~ shri narendranathasen gupta; kaviraja shri balayichandrasen gupta~~, ed.~~, 1st Edition, Culcutta, C.K.Sen and company ltd, ~~Pp3828~~, Pg no 2816</ref>[12-15] .

+

All the foods that are greasy, heavy for digestion or light for digestion and dry causes ''vidaha'' (burning sensation in the abdomen during the digestion of foods) or else the patient develops ''vidaghdajirna''(intermediate state of digestion that caused burning)<ref>Gangadhara, Charak. .In:Kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta,1st Edition, Culcutta, C.K.Sen and company ltd,??? Pp 3828, Pg no 2816</ref>[12-15] .

−

The pathogenesis mentioned earlier in the text is of all types of ''udara roga''. The pathogenesis described here is that of the four types of ''udara'' caused by ''morbid dosha'' viz ''vatodara, pittodara, kaphodara'' and ''sannipatodara''<ref name="ref12" />[20].

+

The pathogenesis mentioned earlier in the text is of all types of ''udara roga''. The pathogenesis described here is that of the four types of ''udara'' caused by ''morbid [[dosha]]'' viz ''vatodara, pittodara, kaphodara'' and ''sannipatodara''<ref name="ref12" />[20].

Two tier impairment of ''jatharagni'' is mentioned as the cause of ''udara roga''. In a patient with impaired ''jatharagni'' (digestive juices), consumption of unhealthy foods further impairs the functioning of ''jatharagni''. This indicates extreme impairment of ''jatharagni'' is involved in the pathogenesis of ''udara roga''.

−

Impairment of ''agni'' is the initial state that causes indigestion and morbidity of ''dosha''. Morbid ''dosha'' in turn further impairs the functioning of ''agni'' thus forming a vicious cycle.

+

Impairment of ''agni'' is the initial state that causes indigestion and morbidity of ''[[dosha]]''. Morbid ''[[dosha]]'' in turn further impairs the functioning of ''agni'' thus forming a vicious cycle.

−

Morbid ''dosha'' formed by the indigestion afflicts the ''srotas''. Constriction and dilatation are the two varieties of pathology of ''srotas''. Dilatation leads to excessive circulation and constriction leads to decreased circulation. In the pathology of ''udara, srotas'' are obliterated due to morbid ''dosha''. This obliteration at ''swedavaha srotas'' leads to impairment of sweating. The fluid within the ''sweda-vaha-srotas'' is deviated to ''udaka-vaha-srotas'' thereby adding to the body fluids.<ref name="ref9" /> <ref name="ref12" />

+

Morbid ''[[dosha]]'' formed by the indigestion afflicts the ''srotas''. Constriction and dilatation are the two varieties of pathology of ''srotas''. Dilatation leads to excessive circulation and constriction leads to decreased circulation. In the pathology of ''udara, srotas'' are obliterated due to morbid ''[[dosha]]''. This obliteration at ''swedavaha srotas'' leads to impairment of sweating. The fluid within the ''sweda-vaha-srotas'' is deviated to ''udaka-vaha-srotas'' thereby adding to the body fluids.<ref name="ref9" /> <ref name="ref12" />

−

''Udakavaha srotas'' that are coursing upwards and downwards are also being obliterated by the morbid ''dosha''. The body fluid increased in the ''srotas'' is then deviated to the abdomen between the ''tvacha'' (skin) and ''mamsa'' (visceral tissues) causing ''udara roga'' <ref>Vagbhata. Astanga hridayam elaborated by Vagbhata, with joint commentaries [[Ayurveda]] Rasayana by Hemadri and Sarvangasundara by Arunadatta, Pt. Harisadashiva Shastri Paradakara Ed., 2010 Edition, Varanasi, Chaukhambha Sanskrit Sansthan, Pp 956, Pg 513.</ref>

+

''Udakavaha srotas'' that are coursing upwards and downwards are also being obliterated by the morbid ''[[dosha]]''. The body fluid increased in the ''srotas'' is then deviated to the abdomen between the ''tvacha'' (skin) and ''[[mamsa]]'' (visceral tissues) causing ''udara roga'' <ref>Vagbhata. Astanga hridayam elaborated by Vagbhata, with joint commentaries [[Ayurveda]] Rasayana by Hemadri and Sarvangasundara by Arunadatta, Pt. Harisadashiva Shastri Paradakara Ed., 2010 Edition, Varanasi, Chaukhambha Sanskrit Sansthan, Pp 956, Pg 513.</ref>

−

The divergence of fluids is not restricted to ''sweda-vaha-srotas'' and ''udaka-vaha srotas'', rather ''rasa-vaha srotas'' is also obstructed. ''Rasa dhatu'' is another source of fluid in the body. This fluid is also deviated to the space between the ''kala'' (mucus membrane) and visceral tissues in the abdomen. Thus, the fluid from the ''udaka-vaha srotas, sweda-vaha-srotas, rasa-vaha srotas'' and ''annavaha srotas'' deviates into the abdominal cavity <ref name="ref9">~~Sushrut~~, Sushruta samhita~~, with nibandha sangraha commentary of dhallahan & Nyayachandrika commentary of of gayadasa,~~ yadavji trikamji , nirnaya sagar press, 1915, P713, Pgno 236</ref>

+

The divergence of fluids is not restricted to ''sweda-vaha-srotas'' and ''udaka-vaha srotas'', rather ''[[rasa]]-vaha srotas'' is also obstructed. ''[[Rasa dhatu]]'' is another source of fluid in the body. This fluid is also deviated to the space between the ''kala'' (mucus membrane) and visceral tissues in the abdomen. Thus, the fluid from the ''udaka-vaha srotas, sweda-vaha-srotas, [[rasa]]-vaha srotas'' and ''annavaha srotas'' deviates into the abdominal cavity <ref name="ref9">Dalhana,Gayadasa,Sushruta, Sushruta samhita In:yadavji trikamji, Editors,Mumbai:nirnaya sagar press,1915, P713, Pgno 236</ref>

−

Fluid is diverged from the ''koshtha'' into the space between the ''kala'' (mucus membrane) and visceral tissues in the abdomen. In the present context, the word ''koshtha'' refers to the intestines wherein digestion as well as separation of nutrient from the waste and assimilation of nutrients takes place. To be clearer the chyle formed in the intestines is diverted to the abdominal space between the ''kala'' (mucus membrane) and visceral tissue. The accumulation of the fluid in the abdominal space is due to the diversion of fluids from the intestines, ''rasa, udaka''(fluid) as well as ''sweda'' (sweat)<ref name="ref9" />.

+

Fluid is diverged from the ''koshtha'' into the space between the ''kala'' (mucus membrane) and visceral tissues in the abdomen. In the present context, the word ''koshtha'' refers to the intestines wherein digestion as well as separation of nutrient from the waste and assimilation of nutrients takes place. To be clearer the chyle formed in the intestines is diverted to the abdominal space between the ''kala'' (mucus membrane) and visceral tissue. The accumulation of the fluid in the abdominal space is due to the diversion of fluids from the intestines, ''[[rasa]], udaka''(fluid) as well as ''sweda'' (sweat)<ref name="ref9" />.

−

Diversion of fluids from the ''sweda-vaha, udaka-vaha,'' and ''rasa-vaha srotas'' is mobilized by the morbid ''vata''. In this pathology, the ''prana vata'' acts in the upper part of the trunk whereas the ''apana vata'' acts at the lower part of the trunk.

+

Diversion of fluids from the ''sweda-vaha, udaka-vaha,'' and ''[[rasa]]-vaha srotas'' is mobilized by the morbid ''[[vata]]''. In this pathology, the ''prana vata'' acts in the upper part of the trunk whereas the ''apana vata'' acts at the lower part of the trunk.

Since the fluid is diverted, the other body parts exhibit emaciation. Contrary to this the abdomen shows distention as the diverted fluid accumulates in the abdomen<ref name="ref9" />.

−

No visible ''srotas'' is involved in the diversion of fluids into the abdomen. Rather it is from the minute pores present in the intestine, fluid oozes into the abdominal space between the ''kala'' and visceral tissues. This can be best understood by the allegory of oozing of the water stored in the new earthen pot through the invisible minute pores.<ref name="ref9" /> Thus, in ''udara'', the distension of abdomen is due to the accumulation of the fluids within the space between the ''kala'' and visceral tissues in the abdomen<ref>Vriddhavagbhata. Astanga Sangraha, ~~elaborated by Vriddha Vaghbata, with commentary Sasilekha~~ by ~~Indu,~~ Dr Shivaprasad Sharma ~~ed., 2006 Edition~~, Varanasi, Chowkhamba Sanskrit Sansthan, ~~Pp965~~, Pg 385</ref> [9-11].

+

No visible ''srotas'' is involved in the diversion of fluids into the abdomen. Rather it is from the minute pores present in the intestine, fluid oozes into the abdominal space between the ''kala'' and visceral tissues. This can be best understood by the allegory of oozing of the water stored in the new earthen pot through the invisible minute pores.<ref name="ref9" /> Thus, in ''udara'', the distension of abdomen is due to the accumulation of the fluids within the space between the ''kala'' and visceral tissues in the abdomen<ref> Indu,Vriddhavagbhata. Astanga Sangraha, translated by Dr Shivaprasad Sharma , Varanasi, Chowkhamba Sanskrit Sansthan,2006 , Pp 965, Pg 385</ref> [9-11].

=== Types of ''udara roga'' ===

−

The clinical condition of peritonitis is comparable to the ''udara roga'' in general. Clinically this is categorized into primary or secondary, acute or chronic and localized or diffuse. These are comparable to the ''doshaja udara'' that includes ''~~vataja~~, ~~pittaja~~, ~~kaphaja~~'' and ''sannipataja udara roga''. Splenomegaly and hepatomegaly refers to plihodara and ''yakritodara'' respectively. Intestinal obstruction is said by the ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''chhidrodara'' (abdominal enlargement due to intestinal perforation) refers to the intestinal perforation. [22]

+

The clinical condition of peritonitis is comparable to the ''udara roga'' in general. Clinically this is categorized into primary or secondary, acute or chronic and localized or diffuse. These are comparable to the ''doshaja udara'' that includes ''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' and ''sannipataja udara roga''. Splenomegaly and hepatomegaly refers to plihodara and ''yakritodara'' respectively. Intestinal obstruction is said by the ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''chhidrodara'' (abdominal enlargement due to intestinal perforation) refers to the intestinal perforation. [22]

−

Peritonitis caused without an apparent source of contamination of peritoneal cavity is regarded as primary peritonitis. The spontaneous peritonitis caused due to hematogenous spread of bacterial infection into the peritoneum causing inflammation. Chronic liver disease is the most common cause of such infection. This can even happen without any underlying disease. 80% of the patients present with fever. Acute onset of abdominal pain is characteristic and malaise, fatigue, or encephalopathy is the other co-morbidity.<ref name="ref21">Anthony S. Fauci, et al Editor. Harrison’s principles of internal medicine. 17th edition. New York. McGraw-Hills. 2008. p 2739.Pg no 1912</ref> The primary peritonitis caused by gram negative bacteria matches with the symptom of ''~~vataja~~ udara''. Sub acute manifestation with non pyogenic exudation causing ascites points towards the diagnosis of ''vatodara''. Microbiology study of ascitic fluid will reveal pathogens like Escherichia coli and enterococci<ref name="ref21" />[25].

+

Peritonitis caused without an apparent source of contamination of peritoneal cavity is regarded as primary peritonitis. The spontaneous peritonitis caused due to hematogenous spread of bacterial infection into the peritoneum causing inflammation. Chronic liver disease is the most common cause of such infection. This can even happen without any underlying disease. 80% of the patients present with fever. Acute onset of abdominal pain is characteristic and malaise, fatigue, or encephalopathy is the other co-morbidity.<ref name="ref21">Anthony S. Fauci, et al Editor. Harrison’s principles of internal medicine. 17th edition. New York. McGraw-Hills. 2008. p 2739.Pg no 1912</ref> The primary peritonitis caused by gram negative bacteria matches with the symptom of ''[[vata]]ja udara''. Sub acute manifestation with non pyogenic exudation causing ascites points towards the diagnosis of ''vatodara''. Microbiology study of ascitic fluid will reveal pathogens like Escherichia coli and enterococci<ref name="ref21" />[25].

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Again, based on the etiology ''udara roga'' is further segregated into ''nija'' (endogenous) and ''agantuja'' (exogenous) type. Among the different types of ''udara roga''; the types of ''udara'' caused due to erroneous food and habits and mediated through morbidity of ''dosha'' and ''dushya'' is considered as ''nija'' type of ''udara''. ''Plihodara'' (enlargement of the spleen) and ''jalodara'' (enlargement of abdomen due to collection of fluid) are segregated as ''nija udara'' in the list of ''dushya'' dominant ''udara''. All the four types of ''dosha'' dominant ''udara'' fall under the category of ''nija udara'' (distension of abdomen due to endogenous causes). Contrary to this the ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''chidrodara'' (abdominal enlargement due to intestinal perforation) caused by injury of intestines due to external factors are regarded as ''agantu udara'' (distension of abdomen caused due to exogenous causes)<ref name="ref9" />[22].

+

Again, based on the etiology ''udara roga'' is further segregated into ''nija'' (endogenous) and ''agantuja'' (exogenous) type. Among the different types of ''udara roga''; the types of ''udara'' caused due to erroneous food and habits and mediated through morbidity of ''[[dosha]]'' and ''[[dushya]]'' is considered as ''nija'' type of ''udara''. ''Plihodara'' (enlargement of the spleen) and ''jalodara'' (enlargement of abdomen due to collection of fluid) are segregated as ''nija udara'' in the list of ''[[dushya]]'' dominant ''udara''. All the four types of ''[[dosha]]'' dominant ''udara'' fall under the category of ''nija udara'' (distension of abdomen due to endogenous causes). Contrary to this the ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''chidrodara'' (abdominal enlargement due to intestinal perforation) caused by injury of intestines due to external factors are regarded as ''agantu udara'' (distension of abdomen caused due to exogenous causes)<ref name="ref9" />[22].

=== ''Vatodara'' ===

−

Initial morbidity of ''vata'' caused by aggravated ''kapha'' during the pathogenesis of ''vatodara'' indicates that the morbidity of ''kapha'' is secondary. Thus, this secondary morbidity of ''kapha'' distinguishes the ''vatodara'' and ''kaphodara''<ref name="ref12" /> [23-24].

+

Initial morbidity of ''[[vata]]'' caused by aggravated ''[[kapha]]'' during the pathogenesis of ''vatodara'' indicates that the morbidity of ''[[kapha]]'' is secondary. Thus, this secondary morbidity of ''[[kapha]]'' distinguishes the ''vatodara'' and ''kaphodara''<ref name="ref12" /> [23-24].

−

Since the lower part of the abdomen is the normal location of ''vata'', distention of the abdomen initially occur in its lower parts.<ref name="ref12" /> Blackish and reddish discoloration of nails, conjunctiva, mouth and dermis is pathognomonic of morbid ''vata''<ref name="ref12" />. [25]

+

Since the lower part of the abdomen is the normal location of ''[[vata]]'', distention of the abdomen initially occur in its lower parts.<ref name="ref12" /> Blackish and reddish discoloration of nails, conjunctiva, mouth and dermis is pathognomonic of morbid ''[[vata]]''<ref name="ref12" />. [25]

=== ''Pittodara'' ===

−

In this pathogenesis, the morbidity of ''pitta'' is most predominant than that of ''vata'' and ''kapha''. It is worth mentioning here that suppression of the ''agni'' in this context implies the suppression of ''dhatvagni''<ref name="ref12" /> [27].

+

In this pathogenesis, the morbidity of ''[[pitta]]'' is most predominant than that of ''[[vata]]'' and ''[[kapha]]''. It is worth mentioning here that suppression of the ''agni'' in this context implies the suppression of ''dhatvagni''<ref name="ref12" /> [27].

−

The primary peritonitis caused by pyogenic gram positive bacteria like streptococci, and pneumococci matches with the symptom of ''~~pittaja~~ udara''. Acute presentation of the illness with rapid progression into prominently exudative ascites justifies the contention of ''pittodara''. Microbiology study of ascitic fluid will reveal pathogens and will clinch the diagnosis<ref name="ref21" />[28]

+

The primary peritonitis caused by pyogenic gram positive bacteria like streptococci, and pneumococci matches with the symptom of ''[[pitta]]ja udara''. Acute presentation of the illness with rapid progression into prominently exudative ascites justifies the contention of ''pittodara''. Microbiology study of ascitic fluid will reveal pathogens and will clinch the diagnosis<ref name="ref21" />[28]

=== ''Kaphodara'' ===

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=== ''Sannipatodara'' ===

−

''Dushyodara'' is another name of ''sannipatodara''. This is not the ninth type of ''udara'' and the total number of ''udara'' remains eight<ref>Sushruta, ~~sushruta samhita with nabandha sangraha commentary by dhallahana, edited by yadavaji trikamji , nirnaya~~ sagar press, 1915, p 711, pg no 236</ref>.

+

''Dushyodara'' is another name of ''sannipatodara''. This is not the ninth type of ''udara'' and the total number of ''udara'' remains eight<ref>Dalhana, Sushruta. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita.? ed.Mumbai:Nirnaya sagar press, 1915, p 711, pg no 236</ref>.

−

Literally the term ''dushya'' refers to the pathology of affliction. Since the illness occurs due to the affliction of ''rakta''; it is termed as ''dushyodara''. Or else, the mutual affliction of ''dosha'' is characteristic of ''sannipatodara'' hence is termed as ''dushyodara''<ref>~~Madhavakara~~, ~~Madhavanidham with Madhukosha Sanskrit comantary of Vijayarakshitha and~~ Shrikantadutta, ~~edited~~ by vaidya yadavaji trikamji, Pandurang jawaji, ~~nirnayasagar~~ press, Page no. 495 with page 269</ref>.

+

Literally the term ''dushya'' refers to the pathology of affliction. Since the illness occurs due to the affliction of ''[[rakta]]''; it is termed as ''dushyodara''. Or else, the mutual affliction of ''[[dosha]]'' is characteristic of ''sannipatodara'' hence is termed as ''dushyodara''<ref> Vijayarakshitha,Shrikantadutta,Madhavakara, Madhavanidana translated by vaidya yadavaji trikamji, Pandurang jawaji, Mumbai: Nirnayasagar press, Page no. 495 with page 269</ref>.

−

Wicked ladies with an intention of subjugating male partners or winning love, likely to offer food mixed with poison treated substances like menstrual blood, body dirt, hair, excreta, urine bone and nails. Person unaware of the mischief of ladies likely to consume the adulterated food offered by them and suffer from ''sannipatodara''. Even enemies may practice adulterating the food with poison treated substances. Unknowingly, consuming such food also leads to the ''sannipatodara''<ref>~~Agnivesha. Charak Samhita~~, ~~elaborated by Charak & Dridabala with Jalpakalpataru commentary by gangadhara~~, 3rd part~~, kaviraja~~ shri narendra natha sengupta; kaviraja shri balayichandra sengupta, ed., 1st Edition, Culcutta, C.K.Sen and company ltd, Pp3828, Pg no. 2820</ref>.

+

Wicked ladies with an intention of subjugating male partners or winning love, likely to offer food mixed with poison treated substances like menstrual blood, body dirt, hair, excreta, urine bone and nails. Person unaware of the mischief of ladies likely to consume the adulterated food offered by them and suffer from ''sannipatodara''. Even enemies may practice adulterating the food with poison treated substances. Unknowingly, consuming such food also leads to the ''sannipatodara''<ref> Gangadhara, Charaka,3rd part In: Kaviraja shri narendra natha sengupta; kaviraja shri balayichandra sengupta, ed., 1st Edition, Culcutta, C.K.Sen and company ltd, Pp3828, Pg no. 2820</ref>.

Probably the slow poisoning is attempted by the enemies. The poisons having reduced potency due to the act of environmental factors is known as ''dushivisha''. The enemies may contaminate the food with such ''dushivisha''. Person consuming such contaminated food suffers from ''sannipatodara''<ref name="ref12" /> [32].

−

Intra-abdominal malignancy spreading into the peritoneum causes malignant ascites. Usually it is the endometrial, colonic, gastric and pancreatic carcinoma, which may progress into peritoneal carcinomatosis. Even extra gastro intestinal malignancies like carcinoma of the breast, melanoma and lung carcinoma can cause peritoneal spread. Characteristically ascites happens in this condition in the absence of portal hypertension, tuberculosis, or right heart failure. Diagnostic paracentesis is confirmatory in this condition. More to add, the development of malignant ascites is always indicator of poor prognosis. This peritoneal carcinomatosis presenting with plethora of symptoms that matches with the symptoms pathognomonic of morbid ''vata, pitta'' and ''kapha dosha'', and its prognosis substantiates the consideration of ''sannipatodara'' in such cases<ref name="ref21" />[33-34].

+

Intra-abdominal malignancy spreading into the peritoneum causes malignant ascites. Usually it is the endometrial, colonic, gastric and pancreatic carcinoma, which may progress into peritoneal carcinomatosis. Even extra gastro intestinal malignancies like carcinoma of the breast, melanoma and lung carcinoma can cause peritoneal spread. Characteristically ascites happens in this condition in the absence of portal hypertension, tuberculosis, or right heart failure. Diagnostic paracentesis is confirmatory in this condition. More to add, the development of malignant ascites is always indicator of poor prognosis. This peritoneal carcinomatosis presenting with plethora of symptoms that matches with the symptoms pathognomonic of morbid ''[[vata]], [[pitta]]'' and ''[[kapha]] [[dosha]]'', and its prognosis substantiates the consideration of ''sannipatodara'' in such cases<ref name="ref21" />[33-34].

=== ''Plihodara'' and ''Yakritodara'' ===

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The etiology, pathology and treatment of ''plihodara'' and ''yakritodara'' are identical. Thus, for the descriptive purposes these two conditions are collectively called as ''Yakrita-plihodara''.

−

Among the above said list of etiological factors; variety of dietary factors like sweet and greasy foods that cause affliction of ''rakta dhatu'' is the cause of ''achyuta plihavriddhi''. All the other etiological factors are of ''chyuta plihavriddhi'' <ref name="ref31" /> [35].

+

Among the above said list of etiological factors; variety of dietary factors like sweet and greasy foods that cause affliction of ''[[rakta dhatu]]'' is the cause of ''achyuta plihavriddhi''. All the other etiological factors are of ''chyuta plihavriddhi'' <ref name="ref31" /> [35].

+

The Sanskrit term ''chyuta'' refers to the act to descend and the ''vriddhi'' implies abdominal enlargement. Descent of the spleen is said to happen due to the violent jerk that happens during different physical activities. Descended spleen causes abdominal enlargement. Further this is of four types based on causative morbidity of ''[[dosha]]'' as ''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' and ''sannipataja''. <ref name="ref31"> Chakrapani, Charak. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.1st ed. Varanasi: Krishnadas Academy;2009.p.4.Pp 738, Pg no 493</ref>

−

The Sanskrit term ''chyuta'' refers to the act to descend and the ''vriddhi'' implies abdominal enlargement. Descent of the spleen is said to happen due to the violent jerk that happens during different physical activities. Descended spleen causes abdominal enlargement. Further this is of four types based on causative morbidity of ''dosha'' as ''vataja, pittaja, kaphaja'' and ''sannipataja''. <ref name="ref31">Agnivesha. Charak Samhita, elaborated by Charak & Dridabala with [[Ayurveda]] Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 493</ref>In Sanskrit, the word ''Achyuta'' refers to lack of downward displacement. ''Vriddhi'' refers to the abdominal enlargement. Put together, the word ''achyuta plihavriddhi'' refers to the abdominal enlargement due to splenic causes without its descending. The morbidity of the ''rakta dhatu'' causes enlargement of the spleen which in turn is responsible for the abdominal distension. Thus, the ''chyuta'' and ''achyuta'' type of ''plihodara'' together forms five types of ''plihodara''<ref name="ref31" /> [36].

+

In Sanskrit, the word ''Achyuta'' refers to lack of downward displacement. ''Vriddhi'' refers to the abdominal enlargement. Put together, the word ''achyuta plihavriddhi'' refers to the abdominal enlargement due to splenic causes without its descending. The morbidity of the ''[[rakta dhatu]]'' causes enlargement of the spleen which in turn is responsible for the abdominal distension. Thus, the ''chyuta'' and ''achyuta'' type of ''plihodara'' together forms five types of ''plihodara''<ref name="ref31" /> [36].

−

Febrile illness of mild degree is the symptom of ''plihodara''. Habitual consumption of food habits that cause burning sensation leads to the morbidity of ''rakta'' as well as ''pitta dosha''. Morbid ''pitta dosha'' and ''rakta dhatu'' cause mild fever. Further loss of appetite is a clinical symptom of ''plihodara''. Habitual consumption of ''abhishyandi'' foods causes morbidity of ''kapha'' which in turn is responsible for the impairment of ''agni''<ref name="ref9" /> [37-38].

+

Febrile illness of mild degree is the symptom of ''plihodara''. Habitual consumption of food habits that cause burning sensation leads to the morbidity of ''[[rakta]]'' as well as ''[[pitta dosha]]''. Morbid ''[[pitta dosha]]'' and ''[[rakta dhatu]]'' cause mild fever. Further loss of appetite is a clinical symptom of ''plihodara''. Habitual consumption of ''abhishyandi'' foods causes morbidity of ''[[kapha]]'' which in turn is responsible for the impairment of ''agni''<ref name="ref9" /> [37-38].

=== ''Baddhagudodara'' ===

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The foreign substances consumed with the food may traverse along the length of intestines without hurting it. At times these foreign substances may traverse across the length and hurt the intestines leading to perforation. Thus, if the foreign substances traverse along the length of the intestines without hurting, then the patient do not suffer from ''chhidrodara''.<ref name="ref9" />

−

Foreign substances consumed along with food causes perforation of the intestines. Even consumption of excessive food and yawing with excessive stretching of the body may lead to perforation.<ref name="ref9" /> The intestines contain liquid chyle consisting of both nutrients and waste. This liquid leaks out of the intestines through the rent caused by the perforation into the space between the abdominal skin and flesh. Note that, fluids also leak into the abdomen in ''~~doshaja~~ udara'' but not through the rent, but by the method of diffusion.<ref name="ref9" />

+

Foreign substances consumed along with food causes perforation of the intestines. Even consumption of excessive food and yawing with excessive stretching of the body may lead to perforation.<ref name="ref9" /> The intestines contain liquid chyle consisting of both nutrients and waste. This liquid leaks out of the intestines through the rent caused by the perforation into the space between the abdominal skin and flesh. Note that, fluids also leak into the abdomen in ''[[dosha]]ja udara'' but not through the rent, but by the method of diffusion.<ref name="ref9" />

The fluid leaked out of the intestines again re-enters into the rectum. Over filled fluid with the space between the skin and viscera may re-enter into the intestines through the end of perforation. Or else the fluid may seep into the rectum. Thus, the rectum gets filled with the undigested food consisting of nutrients and waste which is defecated out<ref name="ref9" />.

−

The accumulation of the chyle within the abdomen that does not diffuse into the rectum causes ''jalodara''. This ''jalodara'' of ''chhidrodara'' is different from the ''jalodara''. ''Jalodara'' as type of ''udara'' is caused by distinct causes as an independent disease and the fluid accumulates by the process of diffusion. ''Jalodara'' is a phase in ''chhidrodara'' and is due to the leakage of fluids form the perforated intestines.<ref>Vagbhata. ~~Astanga hridayam, elaborated by Vagbhata, with joint commentaries [[Ayurveda]] Rasayana by Hemadri and Sarvangasundara by Arunadatta,~~ Pt. Harisadashiva Shastri Paradakara Ed.~~, 2010 Edition~~, Varanasi, Chaukhambha Sanskrit Sansthan, Pp 956, Pg 516.</ref>

+

The accumulation of the chyle within the abdomen that does not diffuse into the rectum causes ''jalodara''. This ''jalodara'' of ''chhidrodara'' is different from the ''jalodara''. ''Jalodara'' as type of ''udara'' is caused by distinct causes as an independent disease and the fluid accumulates by the process of diffusion. ''Jalodara'' is a phase in ''chhidrodara'' and is due to the leakage of fluids form the perforated intestines.<ref>Arunadatta, Vagbhata. Sutra Sthana. In: Pt. Harisadashiva Shastri Paradakara Ed., Varanasi: Chaukhambha Sanskrit Sansthan,2010, Pp 956, Pg 516.</ref>

Since the fluid tends to occupy the dependent parts, the accumulation of the chyle in the abdomen causes distention of the lower part of the abdomen below the umbilicus.<ref name="ref31" />

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=== ''Jalodara'' ===

−

''Udaka'' in Sanskrit translates as fluid and ''udara'' refers to the distension of the abdomen, put together the term ''udakodara'' means distension of the abdomen due to accumulation of the fluid. According to Sanskrit literature, the word ''dakodara'' is formed by the removal of initial letter u from the word ''udakodara''. Thus, formed word ''dakodara'' also give the same meaning of ''udakodara''.<ref name="ref34">~~Agnivesha. Charak Samhita~~, ~~elaborated by~~ Charak ~~& Dridabala with jalpakalpataru commentary by gangadhara,~~ 3rd part, kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta, ed., 1st Edition, Culcutta , C.K.Sen and company ltd, Pp3828, Pg no 2825</ref>

+

''Udaka'' in Sanskrit translates as fluid and ''udara'' refers to the distension of the abdomen, put together the term ''udakodara'' means distension of the abdomen due to accumulation of the fluid. According to Sanskrit literature, the word ''dakodara'' is formed by the removal of initial letter u from the word ''udakodara''. Thus, formed word ''dakodara'' also give the same meaning of ''udakodara''.<ref name="ref34">Gangadhara, Charak. 3rd part, In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.1st ed. Varanasi:kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta, ed., 1st Edition, Culcutta , C.K.Sen and company ltd, Pp3828, Pg no 2825</ref>

'''Image 02: ''Sira janma'' in ''udara'''''

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[[File:Udara5.jpg|200px|thumb]]

−

All types of ''udara'' are characterized by distension of the abdomen. Accumulation of the fluid in the abdomen is the common pathology in these conditions. But in the initial phases the collection of the fluid in the abdomen is due to the diffusion of chyle. This chyle is little as the impairment of ''agni'' is less severe. Also the little accumulation of the fluid is not detected clinically. In this state, in the absence of immediate effective treatment; morbid ''dosha'' tend to obliterate the external body channels that maintain the homeostasis of fluid in the body. The chyle is more liquefied. And more and more fluid is poured into the abdomen causing huge accumulation of the fluid in the abdomen. At this stage, accumulation of the fluid is clinically detected. Accordingly, the ''udara roga'' is distinguished into three stages. Identification of these stages is important and immediate energetic treatment should be planned lest all ''udara'' finally land in ''jalodara''. Condition of ''ajatodaka, piccha'' and ''jatodaka'' are the three stages of ''udara'' .

+

All types of ''udara'' are characterized by distension of the abdomen. Accumulation of the fluid in the abdomen is the common pathology in these conditions. But in the initial phases the collection of the fluid in the abdomen is due to the diffusion of chyle. This chyle is little as the impairment of ''agni'' is less severe. Also the little accumulation of the fluid is not detected clinically. In this state, in the absence of immediate effective treatment; morbid ''[[dosha]]'' tend to obliterate the external body channels that maintain the homeostasis of fluid in the body. The chyle is more liquefied. And more and more fluid is poured into the abdomen causing huge accumulation of the fluid in the abdomen. At this stage, accumulation of the fluid is clinically detected. Accordingly, the ''udara roga'' is distinguished into three stages. Identification of these stages is important and immediate energetic treatment should be planned lest all ''udara'' finally land in ''jalodara''. Condition of ''ajatodaka, piccha'' and ''jatodaka'' are the three stages of ''udara'' .

The course of primary as well as secondary peritonitis exhibits a typical progression. Initially the peritoneum gets inflamed and is characterized by abdominal pain and associated symptoms. This inflammation of the peritoneum is supervened by paralytic ileus. This paralytic ileus is responsible for the diminishing bowel sounds, gaseous distention of the abdomen and tympanic percussion note. This stage of peritonitis is the ''ajatodakavastha'' of ''udara''.

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

|-

−

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

+

| rowspan="2"|''[[Vata]]'' dominant

| ''Dashamula kwatha''

| 20-40 ml

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| Water

|-

−

| rowspan="2"|''Pitta'' dominant

+

| rowspan="2"|''[[Pitta]]'' dominant

| ''Suvarna Shekhara''

| 50-100 mg

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| Water

|-

−

| rowspan="2"|''Kapha'' dominant

+

| rowspan="2"|''[[Kapha]]'' dominant

| ''Arogyavardhini''

| 250-500 mg

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| ''-''

|}

+

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