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==([[Chikitsa Sthana]] Chapter 19, Chapter on the Management of diarrhea and associated disorders)==
==[[Chikitsa Sthana]] Chapter 19, Chapter on the Management of ''Atisara'' (diarrhea and associated disorders)==
=== Abstract ===
=== Abstract ===
The chapter on [[Atisara Chikitsa]] (management of diarrhea) traces the historical origin of the disorder since the Vedic period and attributes it to eating of heavy and hot foods specially meat products. There are six types of diarrhea, three of which are caused by single ''dosha'' (''vataja, pittaja'' and ''kaphaja'') while a fourth is caused by the combination of all the three ''doshas''. The fifth and sixth types are caused due to psychological factors such as fear and grief. Some of these variants could be further classified based on their constituents, e.g., ''vataja atisara'' (diarrhea caused due to ''vata dosha'') is further divided into ''amaja'' and ''niramaja atisara'' (with or without mucoid substances diarrhea) and it has been emphasized not to stop the lose motions in initial or ''ama'' stage.
The chapter on [[Atisara Chikitsa]] (management of diarrhea) traces the historical origin of the disorder since the Vedic period and attributes it to eating of heavy and hot foods specially meat products. There are six types of diarrhea, three of which are caused by single ''dosha'' (''vataja, pittaja'' and ''kaphaja'') while a fourth is caused by the combination of all the three ''doshas''. The fifth and sixth types are caused due to psychological factors such as fear and grief. Some of these variants could be further classified based on their constituents, e.g., ''vataja atisara'' (diarrhea caused due to ''vata dosha'') is further divided into ''ama'' and ''nirama atisara'' (with or without mucoid substances diarrhea) and it has been emphasized not to stop the lose motions in initial or ''ama'' stage.
The etiology, pathology, signs and symptoms of each of these six types of diarrhea, along with their prognosis have been detailed here.The principles of treatment and complications associated with diarrhea, such as bleeding, suppuration, ulceration and prolapsed anus are also described along with various measures to tackle the problems effectively.
The etiology, pathology, signs and symptoms of each of these six types of diarrhea, along with their prognosis have been detailed here.The principles of treatment and complications associated with diarrhea, such as bleeding, suppuration, ulceration and prolapsed anus are also described along with various measures to tackle the problems effectively.
''Sangrahi'' (astringent or anti-diarrheals) therapies are not advisable in the initial stage of the disease because of presence of ''ama'' inside the body. Instead, mild laxative should be given to eliminate the accumulated ''doshas''. Diarrhea should be allowed to continue and should not be stopped by constipating or bowel binding drugs. The patients shall be managed with light to digest, nutritive and liquid diet regimen which enhances power of ''agni'' as well as it helps to stop diarrhea.
''Sangrahi'' (astringent or anti-diarrheals) therapies are not advisable in the initial stage of the disease because of presence of ''ama'' inside the body. Instead, mild laxative should be given to eliminate the accumulated ''doshas''. Diarrhea should be allowed to continue and should not be stopped by constipating or bowel binding drugs. The patients shall be managed with light to digest, nutritive and liquid diet regimen which enhances power of ''agni'' as well as it helps to stop diarrhea.
'''Keywords''': ''atisara, diarrhea, amaja, niramaja, sangrahi'' treatment, ''pichcha basti''.
'''Keywords''': ''atisara, diarrhea, ama, nirama, sangrahi'' treatment, ''pichcha basti''.
=== Introduction ===
=== Introduction ===
''Grahani'' and ''atisara'' - both manifest due to the vitiation of ''agni'' and share common features of impairment of digestion resulting in indigestion and loose motions. Therefore, this chapter should logically precede or succeed the chapter on ''grahani''. But it is described three chapters after that on ''grahani''. The reason for this unusual sequencing of these topics is that since ''pandu'' is a common symptom and sequelae of the malabsorption syndrome (''grahani''), the chapter on ''pandu'' follows ''grahani''. Now, dyspnea (''shwasa'') is a major symptom of ''pandu,'' and thus, follows the chapter on ''pandu''. Similarly, chapter on ''kasa'' (cough) follows ''shwasa'' because of their relationship. That explains the sequencing of ''grahani'' and ''atisara'' in [[Charaka Samhita]].
''Grahani'' and ''atisara'' - both manifest due to the vitiation of ''agni'' and share common features of impairment of digestion resulting in indigestion and loose motions. Therefore, this chapter should logically precede or succeed the chapter on ''grahani''. But it is described three chapters after that on ''grahani''. The reason for this unusual sequencing of these topics is that since ''pandu'' is a common symptom and sequelae of the malabsorption syndrome (''grahani''), the chapter on ''pandu'' follows ''grahani''. Now, dyspnea (''shwasa'') is a major symptom of ''pandu,'' and thus, follows the chapter on ''pandu''. Similarly, chapter on ''kasa'' (cough) follows ''shwasa'' because of their relationship. That explains the sequencing of ''grahani'' and ''atisara'' in [[Charak Samhita]].
Ayurveda considers ''atisara'' as a defense mechanism of the body to eject out any toxic material from it. Therefore, it is recommended that in ''amaja'' (or initial) state loose motions should not be checked. After evacuation of toxins from the body, fasting and digestive drugs are prescribed as a cure for milder forms of diarrhea. However, for other types of diarrhea, various preparations, diet and ''basti'' are advised. ''Picchabasti'' (mucilegue type of medicated enema) is prescribed particularly if blood accompanies the stool. Appropriate treatments for ulcer, suppuration of anus and prolapse of anus are dealt with, since these accompany the more complex forms of diarrhea.
Ayurveda considers ''atisara'' as a defense mechanism of the body to eject out any toxic material from it. Therefore, it is recommended that in ''amaja'' (or initial) state loose motions should not be checked. After evacuation of toxins from the body, fasting and digestive drugs are prescribed as a cure for milder forms of diarrhea. However, for other types of diarrhea, various preparations, diet and ''basti'' are advised. ''Picchabasti'' (mucilegue type of medicated enema) is prescribed particularly if blood accompanies the stool. Appropriate treatments for ulcer, suppuration of anus and prolapse of anus are dealt with, since these accompany the more complex forms of diarrhea.
''Atisara'' leads to the depletion of water and beneficial salts, causing dehydration in the body. This provokes ''vata'', and therefore requires taking special care of ''vata'', particularly if, the ''atisara'' is caused by all the three ''doshas''. Hydration of the body by means of oral administration of milk, buttermilk and various liquid preparations is advised. Goat’s milk is very useful in bloody diarrhea.
''Atisara'' leads to the depletion of water and beneficial salts, causing dehydration in the body. This provokes ''vata'', and therefore requires taking special care of ''vata'', particularly if, the ''atisara'' is caused by all the three ''doshas''. Hydration of the body by means of oral administration of milk, buttermilk and various liquid preparations is advised. Goat’s milk is very useful in bloody diarrhea.The treatment of cholera and other dehydrating diarrheal diseases was revolutionized by the promotion of oral rehydration solution (ORS), the efficacy of which depends on the fact that glucose-facilitated absorption of sodium and water in the small intestine remains intact in the presence of cholera toxin. Where indicated, appropriate antimicrobial agents can shorten the duration of illness from 3–4 days to 24–36 h, hence it should be started depending on the course of illness. Adequate prophylaxis measures should be taken to prevent the infectious diarrhoea.
=== Sanskrit Text, Transliteration and English Translation ===
=== Sanskrit Text, Transliteration and English Translation ===
अपिचशोणितादीन्धातूनतिप्रकृष्टं[१]दूषयन्तोधातुदोषस्वभावकृतानतीसारवर्णानुपदर्शयन्ति |
अपिचशोणितादीन्धातूनतिप्रकृष्टं[१]दूषयन्तोधातुदोषस्वभावकृतानतीसारवर्णानुपदर्शयन्ति |
तत्रशोणितादिषुधातुष्वतिप्रदुष्टेषुहारिद्रहरितनीलमाञ्जिष्ठमांसधावनसन्निकाशंरक्तंकृष्णंश्वेतंवराहभेदःसदृशमनुबद्धवेदनमवेदनंवासमासव्यत्यासादुपवेश्यतेशकृद्ग्रथितमामंसकृत्, सकृदपिपक्वमनतिक्षीणमांसशोणितबलोमन्दाग्निर्विहतमुखरसश्च; तादृशमातुरंकृच्छ्रसाध्यंविद्यात् |
तत्रशोणितादिषुधातुष्वतिप्रदुष्टेषुहारिद्रहरितनीलमाञ्जिष्ठमांसधावनसन्निकाशंरक्तंकृष्णंश्वेतंवराहभेदःसदृशमनुबद्धवेदनमवेदनंवासमासव्यत्यासादुपवेश्यतेशकृद्ग्रथितमामंसकृत्, सकृदपिपक्वमनतिक्षीणमांसशोणितबलोमन्दाग्निर्विहतमुखरसश्च; तादृशमातुरंकृच्छ्रसाध्यंविद्यात् |
एभिर्वर्णैरतिसार्यमाणंसोपद्रवमातुरमसाध्योऽयमितिप्रत्याचक्षीत; तद्यथा- पक्वशोणिताभं[२]यकृत्खण्डोपमंमेदोमांसोदकसन्निकाशंदधिघृतमज्जतैलवसाक्षीरवेसवाराभमतिनीलमतिरक्तमतिकृष्णमुदकमिवाच्छंपुनर्मेचकाभमतिस्निग्धंहरितनीलकषायवर्णंकर्बुरमाविलंपिच्छिलंतन्तुमदामंचन्द्रकोपगतमतिकुणपपूतिपूयगन्ध्यामाममत्स्यगन्धिमक्षिकाकान्तं[३]कुथितबहुधातुस्रावमल्पपुरीषमपुरीषंवाऽतिसार्यमाणंतृष्णादाहज्वरभ्रमतमकहिक्काश्वासानुबन्धमतिवेदनमवेदनंवास्रस्तपक्वगुदंपतितगुदवलिंमुक्तनालमतिक्षीणबलमांसशोणितंसर्वपर्वास्थिशूलिनमरोचकारतिप्रलापसम्मोहपरीतंसहसोपरतविकारमतिसारिणमचिकित्स्यंविद्यात्; इतिसन्निपातातिसारः ||९||
एभिर्वर्णैरतिसार्यमाणंसोपद्रवमातुरमसाध्योऽयमितिप्रत्याचक्षीत; तद्यथा- पक्वशोणिताभं[२]यकृत्खण्डोपमंमेदोमांसोदकसन्निकाशंदधिघृतमज्जतैलवसाक्षीरवेसवाराभमतिनीलमतिरक्तमतिकृष्णमुदकमिवाच्छंपुनर्मेचकाभमतिस्निग्धं
हरितनीलकषायवर्णंकर्बुरमाविलंपिच्छिलंतन्तुमदामंचन्द्रकोपगतमतिकुणपपूतिपूयगन्ध्यामाममत्स्यगन्धिमक्षिकाकान्तं[३]कुथितबहुधातुस्रावमल्पपुरीषमपुरीषंवाऽतिसार्यमाणं
तृष्णादाहज्वरभ्रमतमकहिक्काश्वासानुबन्धमतिवेदनमवेदनंवास्रस्तपक्वगुदंपतितगुदवलिंमुक्तनालमतिक्षीणबलमांसशोणितं
सर्वपर्वास्थिशूलिनमरोचकारतिप्रलापसम्मोहपरीतंसहसोपरतविकारमतिसारिणमचिकित्स्यंविद्यात्; इतिसन्निपातातिसारः ||९||
api ca śōṇitādīn dhātūnatiprakr̥ṣṭaṁ [1] dūṣayantō dhātudōṣasvabhāvakr̥tānatīsāravarṇānupadarśayanti|
api ca śōṇitādīn dhātūnatiprakr̥ṣṭaṁ [1] dūṣayantō dhātudōṣasvabhāvakr̥tānatīsāravarṇānupadarśayanti|
tatra śōṇitādiṣu dhātuṣvatipraduṣṭēṣu hāridraharitanīlamāñjiṣṭhamāṁsadhāvanasannikāśaṁ raktaṁkr̥ṣṇaṁ śvētaṁ varāhabhēdaḥsadr̥śamanubaddhavēdanamavēdanaṁ vā samāsavyatyāsādupavēśyatēśakr̥d grathitamāmaṁ sakr̥t, sakr̥dapi pakvamanatikṣīṇamāṁsaśōṇitabalō mandāgnirvihatamukharasaśca;tādr̥śamāturaṁ kr̥cchrasādhyaṁ vidyāt|
tatra śōṇitādiṣu dhātuṣvatipraduṣṭēṣu hāridraharitanīlamāñjiṣṭhamāṁsadhāvanasannikāśaṁ raktaṁkr̥ṣṇaṁ śvētaṁ varāhabhēdaḥsadr̥śamanubaddhavēdanamavēdanaṁ vā samāsavyatyāsādupavēśyatēśakr̥d grathitamāmaṁ sakr̥t, sakr̥dapi
pakvamanatikṣīṇamāṁsaśōṇitabalō mandāgnirvihatamukharasaśca;tādr̥śamāturaṁ kr̥cchrasādhyaṁ vidyāt|
ēbhirvarṇairatisāryamāṇaṁ sōpadravamāturamasādhyō'yamiti pratyācakṣīta; tadyathā- pakvaśōṇitābhaṁ[2] yakr̥tkhaṇḍōpamaṁ mēdōmāṁsōdakasannikāśaṁdadhighr̥tamajjatailavasākṣīravēsavārābhamatinīlamatiraktamatikr̥ṣṇamudakamivācchaṁpunarmēcakābhamatisnigdhaṁ haritanīlakaṣāyavarṇaṁ karburamāvilaṁ picchilaṁ tantumadāmaṁcandrakōpagatamatikuṇapapūtipūyagandhyāmāmamatsyagandhi makṣikākāntaṁ [3]kuthitabahudhātusrāvamalpapurīṣamapurīṣaṁ vā'tisāryamāṇaṁtr̥ṣṇādāhajvarabhramatamakahikkāśvāsānubandhamativēdanamavēdanaṁ vā srastapakvagudaṁpatitagudavaliṁ muktanālamatikṣīṇabalamāṁsaśōṇitaṁsarvaparvāsthiśūlinamarōcakāratipralāpasammōhaparītaṁ sahasōparatavikāramatisāriṇamacikitsyaṁvidyāt; iti sannipātātisāraḥ||9||
ēbhirvarṇairatisāryamāṇaṁ sōpadravamāturamasādhyō'yamiti pratyācakṣīta; tadyathā- pakvaśōṇitābhaṁ[2] yakr̥tkhaṇḍōpamaṁ mēdōmāṁsōdakasannikāśaṁdadhighr̥tamajjatailavasākṣīravēsavārābhamatinīlamatiraktamatikr̥ṣṇamudakamivācchaṁpunarmēcakābhamatisnigdhaṁ haritanīlakaṣāyavarṇaṁ karburamāvilaṁ picchilaṁ tantumadāmaṁcandrakōpagatamatikuṇapapūtipūyagandhyāmāmamatsyagandhi makṣikākāntaṁ [3]kuthitabahudhātusrāvamalpapurīṣamapurīṣaṁ vā'tisāryamāṇaṁtr̥ṣṇādāhajvarabhramatamakahikkāśvāsānubandhamativēdanamavēdanaṁ vā srastapakvagudaṁpatitagudavaliṁ muktanālamatikṣīṇabalamāṁsaśōṇitaṁsarvaparvāsthiśūlinamarōcakāratipralāpasammōhaparītaṁ sahasōparatavikāramatisāriṇamacikitsyaṁvidyāt; iti sannipātātisāraḥ||9||
Such a patient should be rejected for the treatment (as it is incurable). [9]
Such a patient should be rejected for the treatment (as it is incurable). [9]
==== Principles of treatment ====
==== Guidelines for starting treatment ====
तमसाध्यतामसम्प्राप्तंचिकित्सेद्यथाप्रधानोपक्रमेणहेतूपशयदोषविशेषपरीक्षयाचेति ||१०||
तमसाध्यतामसम्प्राप्तंचिकित्सेद्यथाप्रधानोपक्रमेणहेतूपशयदोषविशेषपरीक्षयाचेति ||१०||
Three recipes of ''pramathya'' which are useful in the treatment of diarrhea are as follow:
Three recipes of ''pramathya'' which are useful in the treatment of diarrhea are as follow:
*Decoction of pippali, nāgara, dhānyaka, bhutika, abhayā and vachā for vataja atisara
*Decoction of ''pippali, nagara, dhanyaka, bhutika, abhaya'' and ''vacha'' for ''vataja atisara''
*Decoction of hrivera, bhadra-mustā, bilva, nāgara and dhānyaka for pittaja atisara)
*Decoction of ''hrivera, bhadra-musta, bilva, nagara'' and ''dhanyaka'' for ''pittaja atisara'')
*Decoction of prasniparni, svadamstrā, samanga and kantakarika for kaphaja atisara
*Decoction of ''prashniparni, svadamstra, samanga'' and ''kantakarika'' for ''kaphaja atisara''
*Decoction of vachā and prativisha for vataja atisara
*Decoction of ''vacha'' and ''prativisha'' for ''vataja atisara''
*Decoction of Mustā and parpataka for pittaja atisara
*Decoction of ''musta'' and ''parpataka'' for ''pittaja atisara''
*Decoction of hrivera and sringavera for kaphaja atisara
*Decoction of ''hrivera'' and ''sringavera'' for ''kaphaja atisara''
[Note: Decoction should be prepared as per the procedure described for ''sandanga-paniya'' in C.S.Ci.3-145.] [20-22]
[Note: Decoction should be prepared as per the procedure described for ''sandanga-paniya'' in C.S.Ci.3-145.] [20-22]
==== Diet and drinks for ''atisara'' patient ====
==== Diet and drinks for ''atisara'' patient ====
*Depending upon the wholesomeness (''satmya'') of the patient, light food along with buttermilk or ''kanji'' (a sour drink), ''yavagu'' (thick gruel), ''tarpana'' (roasted flour of serials mixed with water), or alcoholic drink or honey should be given. Then gradually ''yavagu'' (thick gruel), ''vilepi'' (a sticky gruel), ''khanda'' (a sour appetiser), ''yusha'' (vegetable soup) and boiled rice mixed with meat soup which are prepared by adding digestive, stimulants and astringent (constipative) drugs should be given.
*Depending upon the wholesomeness (''satmya'') of the patient, light food along with buttermilk or ''kanji'' (a sour drink), ''yavagu'' (thick gruel), ''tarpana'' (roasted flour of serials mixed with water), or alcoholic drink or honey should be given. Then gradually ''yavagu'' (thick gruel), ''vilepi'' (a sticky gruel), ''khanda'' (a sour appetiser), ''yusha'' (vegetable soup) and boiled rice mixed with meat soup which are prepared by adding digestive, stimulants and astringent (constipative) drugs should be given.
Ingredients which are ''dipana'' (digestive stimulant) and ''grahi'' (constipating) are described in [[Charaka Samhita]] [[Sutra Sthana]] 4: 9 should be administered [23-25]
Ingredients which are ''dipana'' (digestive stimulant) and ''grahi'' (constipating) are described in [[Charak Samhita]] [[Sutra Sthana]] 4: 9 should be administered [23-25]
==== Treatment of ''vataja atisara'' ====
==== Treatment of ''vataja atisara'' ====
If there is prolapse of rectum and colic pain, and if the diarrhea is free from ''ama'', then the patient should be given medicated ghee prepared with sour drugs or ''anuvasana'' (unctuous enema). [42]
If there is prolapse of rectum and colic pain, and if the diarrhea is free from ''ama'', then the patient should be given medicated ghee prepared with sour drugs or ''anuvasana'' (unctuous enema). [42]
==== ''Changerighritam'' ====
==== ''Changeri ghritam'' ====
चाङ्गेरीकोलदध्यम्लनागरक्षारसंयुतम् |
चाङ्गेरीकोलदध्यम्लनागरक्षारसंयुतम् |
Ghee should be cooked with the juice of ''changeri'', decoction of ''kola'' and sour curd, and the paste of ''nagara'' and ''kshara'' (alkali preparation). Intake of this medicated ghee cures ailments caused by prolapse of rectum. Thus, ends the description of ''changeri-ghrita'' [43].
Ghee should be cooked with the juice of ''changeri'', decoction of ''kola'' and sour curd, and the paste of ''nagara'' and ''kshara'' (alkali preparation). Intake of this medicated ghee cures ailments caused by prolapse of rectum. Thus, ends the description of ''changeri-ghrita'' [43].
==== ''Chavyadighritam'' ====
==== ''Chavyadi ghritam'' ====
सचव्यपिप्पलीमूलंसव्योषविडदाडिमम् |
सचव्यपिप्पलीमूलंसव्योषविडदाडिमम् |
पवनोऽतिप्रवृत्तोहिस्वेस्थानेलभतेऽधिकम् ||९६||
पवनोऽतिप्रवृत्तोहिस्वेस्थानेलभतेऽधिकम् ||९६||
बलंतस्यसपित्तस्यजयार्थेबस्तिरुत्तमः |
बलंतस्यसपित्तस्यजयार्थेबस्तिरुत्तमः |
रक्तंविट्सहितंपूर्वंपश्चाद्वायोऽतिसार्यते ||९७||
रक्तंविट्सहितंपूर्वंपश्चाद्वायोऽतिसार्यते ||९७||
शतावरीघृतंतस्यलेहार्थमुपकल्पयेत् |
शतावरीघृतंतस्यलेहार्थमुपकल्पयेत् |
शर्करार्धांशिकंलीढंनवनीतंनवोद्धृतम् ||९८||
शर्करार्धांशिकंलीढंनवनीतंनवोद्धृतम् ||९८||
क्षौद्रपादंजयेच्छीघ्रंतंविकारंहिताशिनः |
क्षौद्रपादंजयेच्छीघ्रंतंविकारंहिताशिनः |
न्यग्रोधोदुम्बराश्वत्थशुङ्गानापोथ्यवासयेत् ||९९||
न्यग्रोधोदुम्बराश्वत्थशुङ्गानापोथ्यवासयेत् ||९९||
अहोरात्रंजलेतप्तेघृतंतेनाम्भसापचेत् |
अहोरात्रंजलेतप्तेघृतंतेनाम्भसापचेत् |
तदर्धशर्करायुक्तंलिह्यात्सक्षौद्रपादिकम् ||१००||
तदर्धशर्करायुक्तंलिह्यात्सक्षौद्रपादिकम् ||१००||
अधोवायदिवाऽप्यूर्ध्वंयस्यरक्तंप्रवर्तते |१०१|
अधोवायदिवाऽप्यूर्ध्वंयस्यरक्तंप्रवर्तते |१०१|
pavanō'tipravr̥ttō hi svē sthānē labhatē'dhikam||96||
pavanō'tipravr̥ttō hi svē sthānē labhatē'dhikam||96||
balaṁ tasya sapittasya jayārthē bastiruttamaḥ|
balaṁ tasya sapittasya jayārthē bastiruttamaḥ|
raktaṁ viṭsahitaṁ pūrvaṁ paścādvā yō'tisāryatē||97||
raktaṁ viṭsahitaṁ pūrvaṁ paścādvā yō'tisāryatē||97||
śatāvarīghr̥taṁ tasya lēhārthamupakalpayēt|
śatāvarīghr̥taṁ tasya lēhārthamupakalpayēt|
śarkarārdhāṁśikaṁ līḍhaṁ navanītaṁ navōddhr̥tam||98||
śarkarārdhāṁśikaṁ līḍhaṁ navanītaṁ navōddhr̥tam||98||
kṣaudrapādaṁ jayēcchīghraṁ taṁ vikāraṁ hitāśinaḥ|
kṣaudrapādaṁ jayēcchīghraṁ taṁ vikāraṁ hitāśinaḥ|
nyagrōdhōdumbarāśvatthaśuṅgānāpōthya vāsayēt||99||
nyagrōdhōdumbarāśvatthaśuṅgānāpōthya vāsayēt||99||
ahōrātraṁ jalē taptē ghr̥taṁ tēnāmbhasā pacēt|
ahōrātraṁ jalē taptē ghr̥taṁ tēnāmbhasā pacēt|
tadardhaśarkarāyuktaṁ lihyāt sakṣaudrapādikam||100||
tadardhaśarkarāyuktaṁ lihyāt sakṣaudrapādikam||100||
adhō vā yadi vā'pyūrdhvaṁ yasya raktaṁ pravartatē|101|
adhō vā yadi vā'pyūrdhvaṁ yasya raktaṁ pravartatē|101|
pavano~atipravRutto hi sve sthAne labhate~adhikam||96||
pavano~atipravRutto hi sve sthAne labhate~adhikam||96||
balaM tasya sapittasya jayArthe bastiruttamaH|
balaM tasya sapittasya jayArthe bastiruttamaH|
raktaM viTsahitaM pUrvaM pashcAdvA yo~atisAryate||97||
raktaM viTsahitaM pUrvaM pashcAdvA yo~atisAryate||97||
shatAvarIghRutaM tasya lehArthamupakalpayet|
shatAvarIghRutaM tasya lehArthamupakalpayet|
sharkarArdhAMshikaM lIDhaM navanItaM navoddhRutam||98||
sharkarArdhAMshikaM lIDhaM navanItaM navoddhRutam||98||
kShaudrapAdaM jayecchIghraM taM vikAraM hitAshinaH|
kShaudrapAdaM jayecchIghraM taM vikAraM hitAshinaH|
nyagrodhodumbarAshvatthashu~ggAnApothya vAsayet||99||
nyagrodhodumbarAshvatthashu~ggAnApothya vAsayet||99||
ahorAtraM jale tapte ghRutaM tenAmbhasA pacet|
ahorAtraM jale tapte ghRutaM tenAmbhasA pacet|
tadardhasharkarAyuktaM lihyAt sakShaudrapAdikam||100||
tadardhasharkarAyuktaM lihyAt sakShaudrapAdikam||100||
adho vA yadi vA~apyUrdhvaM yasya raktaM pravartate|101|
adho vA yadi vA~apyUrdhvaM yasya raktaM pravartate|101|
*The aggravated vata becomes stronger in its own site in ''atisara'' patients. For the pacification of aggravated ''vata'' associated with ''pitta'' (which takes place in bloody diarrhea), ''basti'' (both the ''anuvasana'' and ''niruha'' types) is the best therapy.
*If bleeding takes place before evacuating the stool or after evacuation of stool (i.e., a case of ''raktatisara''), then ''shatavari-ghrita'' (C.S Ci 30: 64-69) in the form of linctus should be given.
*Intake of freshly collected butter along with half the quantity of sugar and one fourth quantity of honey cures the above mentioned ailments. While taking this potion, the patient should take wholesome food. Adventitious roots of ''nyagrodha, udumbara'' and ''ashvattha'' should be crushed and kept soaked in hot water for twenty four hours. Ghee should be cooked along with this water. This medicated ghee should be added with half the quantity of sugar and one fourth in quantity of honey, and taken in the form of linctus. It cures ''raktatisara'', associated with bleeding either before or after the passing of stool [96-100½]
==== Suppuration of anal sphincters ====
==== Suppuration of anal sphincters ====
यस्त्वेवंदुर्बलोमोहात्पित्तलान्येवसेवते ||१०१||
यस्त्वेवंदुर्बलोमोहात्पित्तलान्येवसेवते ||१०१||
दारुणंसवलीपाकंप्राप्यशीघ्रंविपद्यते |१०२|
दारुणंसवलीपाकंप्राप्यशीघ्रंविपद्यते |१०२|
yastvēvaṁ durbalō mōhāt pittalānyēva sēvatē||101||
yastvēvaṁ durbalō mōhāt pittalānyēva sēvatē||101||
dāruṇaṁ sa valīpākaṁ prāpya śīghraṁ vipadyatē|102|
dāruṇaṁ sa valīpākaṁ prāpya śīghraṁ vipadyatē|102|
yastvevaM durbalo mohAt pittalAnyeva sevate||101||
yastvevaM durbalo mohAt pittalAnyeva sevate||101||
dAruNaM sa valIpAkaM prApya shIghraM vipadyate|102|
dAruNaM sa valIpAkaM prApya shIghraM vipadyate|102|
A patient who has become weak because of raktatisara, if indulges in pitta-aggravating ingredients out of ignorance, then the anal sphincters gets suppurated. This is a serious condition leading to instantaneous death [101½].
Treatment of kaphaja atisara:
A patient who has become weak because of ''raktatisara'', if indulges in ''pitta''-aggravating ingredients out of ignorance, then the anal sphincters gets suppurated. This is a serious condition leading to instantaneous death [101½].
श्लेष्मातिसारेप्रथमंहितंलङ्घनपाचनम् ||१०२||
==== Treatment of ''kaphaja atisara'' ====
श्लेष्मातिसारेप्रथमंहितंलङ्घनपाचनम् ||१०२||
योज्यश्चामातिसारघ्नोयथोक्तोदीपनोगणः |
योज्यश्चामातिसारघ्नोयथोक्तोदीपनोगणः |
लङ्घितस्यानुपूर्व्यांचकृतायांननिवर्तते ||१०३||
लङ्घितस्यानुपूर्व्यांचकृतायांननिवर्तते ||१०३||
कफजोयद्यतीसारःकफघ्नैस्तमुपाचरेत् |
कफजोयद्यतीसारःकफघ्नैस्तमुपाचरेत् |
बिल्वंकर्कटिकामुस्तमभयाविश्वभेषजम् ||१०४||
बिल्वंकर्कटिकामुस्तमभयाविश्वभेषजम् ||१०४||
वचाविडङ्गंभूतीकंधान्यकंदेवदारुच |
वचाविडङ्गंभूतीकंधान्यकंदेवदारुच |
कुष्ठंसातिविषापाठाचव्यंकटुकरोहिणी ||१०५||
कुष्ठंसातिविषापाठाचव्यंकटुकरोहिणी ||१०५||
पिप्पलीपिप्पलीमूलंचित्रकंहस्तिपिप्पली |
पिप्पलीपिप्पलीमूलंचित्रकंहस्तिपिप्पली |
योगाञ्छ्लोकार्धविहितांश्चतुरस्तान्प्रयोजयेत् ||१०६||
योगाञ्छ्लोकार्धविहितांश्चतुरस्तान्प्रयोजयेत् ||१०६||
शृताञ्छ्लेष्मातिसारेषुकायाग्निबलवर्धनान् |
शृताञ्छ्लेष्मातिसारेषुकायाग्निबलवर्धनान् |
अजाजीमसितांपाठांनागरंमरिचानिच ||१०७||
अजाजीमसितांपाठांनागरंमरिचानिच ||१०७||
धातकीद्विगुणंदद्यान्मातुलुङ्गरसाप्लुतम् |
धातकीद्विगुणंदद्यान्मातुलुङ्गरसाप्लुतम् |
रसाञ्जनंसातिविषंकुटजस्यफलानिच ||१०८||
रसाञ्जनंसातिविषंकुटजस्यफलानिच ||१०८||
धातकीद्विगुणंदद्यात्पातुंसक्षौद्रनागरम् |
धातकीद्विगुणंदद्यात्पातुंसक्षौद्रनागरम् |
धातकीनागरंबिल्वंलोध्रंपद्मस्यकेशरम् ||१०९||
धातकीनागरंबिल्वंलोध्रंपद्मस्यकेशरम् ||१०९||
जम्बूत्वङ्नागरंधान्यंपाठामोचरसोबला |
जम्बूत्वङ्नागरंधान्यंपाठामोचरसोबला |
समङ्गाधातकीबिल्वमध्यंजम्ब्वाम्रयोस्त्वचः ||११०||
समङ्गाधातकीबिल्वमध्यंजम्ब्वाम्रयोस्त्वचः ||११०||
कपित्थानिविडङ्गानिनागरंमरिचानिच |
कपित्थानिविडङ्गानिनागरंमरिचानिच |
चाङ्गेरीकोलतक्राम्लांश्चतुरस्तान्कफोत्तरे ||१११||
चाङ्गेरीकोलतक्राम्लांश्चतुरस्तान्कफोत्तरे ||१११||
श्लोकार्धविहितान्दद्यात्सस्नेहलवणान्खडान् |
श्लोकार्धविहितान्दद्यात्सस्नेहलवणान्खडान् |
कपित्थमध्यंलीढ्वातुसव्योषक्षौद्रशर्करम् ||११२||
कपित्थमध्यंलीढ्वातुसव्योषक्षौद्रशर्करम् ||११२||
कट्फलंमधुयुक्तंवामुच्यतेजठरामयात् |११३|
कट्फलंमधुयुक्तंवामुच्यतेजठरामयात् |११३|
ślēṣmātisārē prathamaṁ hitaṁ laṅghanapācanam||102||
ślēṣmātisārē prathamaṁ hitaṁ laṅghanapācanam||102||
yōjyaścāmātisāraghnō yathōktō dīpanō gaṇaḥ|
yōjyaścāmātisāraghnō yathōktō dīpanō gaṇaḥ|
laṅghitasyānupūrvyāṁ ca kr̥tāyāṁ na nivartatē||103||
laṅghitasyānupūrvyāṁ ca kr̥tāyāṁ na nivartatē||103||
kaphajō yadyatīsāraḥ kaphaghnaistamupācarēt
kaphajō yadyatīsāraḥ kaphaghnaistamupācarēt
bilvaṁ karkaṭikā mustamabhayā viśvabhēṣajam||104||
bilvaṁ karkaṭikā mustamabhayā viśvabhēṣajam||104||
vacā viḍaṅgaṁ bhūtīkaṁ dhānyakaṁ dēvadāru ca|
vacā viḍaṅgaṁ bhūtīkaṁ dhānyakaṁ dēvadāru ca|
kuṣṭhaṁ sātiviṣā pāṭhā cavyaṁ kaṭukarōhiṇī||105||
kuṣṭhaṁ sātiviṣā pāṭhā cavyaṁ kaṭukarōhiṇī||105||
pippalī pippalīmūlaṁ citrakaṁ hastipippalī|
pippalī pippalīmūlaṁ citrakaṁ hastipippalī|
yōgāñchlōkārdhavihitāṁścaturastān prayōjayēt||106||
yōgāñchlōkārdhavihitāṁścaturastān prayōjayēt||106||
śr̥tāñchlēṣmātisārēṣu kāyāgnibalavardhanān|
śr̥tāñchlēṣmātisārēṣu kāyāgnibalavardhanān|
ajājīmasitāṁ pāṭhāṁ nāgaraṁ maricāni ca||107||
ajājīmasitāṁ pāṭhāṁ nāgaraṁ maricāni ca||107||
dhātakīdviguṇaṁ dadyānmātuluṅgarasāplutam|
dhātakīdviguṇaṁ dadyānmātuluṅgarasāplutam|
rasāñjanaṁ sātiviṣaṁ kuṭajasya phalāni ca||108||
rasāñjanaṁ sātiviṣaṁ kuṭajasya phalāni ca||108||
dhātakīdviguṇaṁ dadyāt pātuṁ sakṣaudranāgaram|
dhātakīdviguṇaṁ dadyāt pātuṁ sakṣaudranāgaram|
dhātakī nāgaraṁ bilvaṁ lōdhraṁ padmasya kēśaram||109||
dhātakī nāgaraṁ bilvaṁ lōdhraṁ padmasya kēśaram||109||
jambūtvaṅnāgaraṁ dhānyaṁ pāṭhā mōcarasō balā|
jambūtvaṅnāgaraṁ dhānyaṁ pāṭhā mōcarasō balā|
samaṅgā dhātakī bilvamadhyaṁ jambvāmrayōstvacaḥ||110||
samaṅgā dhātakī bilvamadhyaṁ jambvāmrayōstvacaḥ||110||
kapitthāni viḍaṅgāni nāgaraṁ maricāni ca|
kapitthāni viḍaṅgāni nāgaraṁ maricāni ca|
cāṅgērīkōlatakrāmlāṁścaturastān kaphōttarē||111||
cāṅgērīkōlatakrāmlāṁścaturastān kaphōttarē||111||
ślōkārdhavihitān dadyāt sasnēhalavaṇān khaḍān|
ślōkārdhavihitān dadyāt sasnēhalavaṇān khaḍān|
kapitthamadhyaṁ līḍhvā tu savyōṣakṣaudraśarkaram||112||
kapitthamadhyaṁ līḍhvā tu savyōṣakṣaudraśarkaram||112||
kaṭphalaṁ madhuyuktaṁ vā mucyatē jaṭharāmayāt|113|
kaṭphalaṁ madhuyuktaṁ vā mucyatē jaṭharāmayāt|113|
shleShmAtisAre prathamaM hitaM la~gghanapAcanam||102||
shleShmAtisAre prathamaM hitaM la~gghanapAcanam||102||
yojyashcAmAtisAraghno yathokto dIpano gaNaH|
yojyashcAmAtisAraghno yathokto dIpano gaNaH|
la~gghitasyAnupUrvyAM ca kRutAyAM na nivartate||103||
la~gghitasyAnupUrvyAM ca kRutAyAM na nivartate||103||
kaphajo yadyatIsAraH kaphaghnaistamupAcaret|104|
kaphajo yadyatIsAraH kaphaghnaistamupAcaret|104|
bilvaM karkaTikA mustamabhayA vishvabheShajam||104||
bilvaM karkaTikA mustamabhayA vishvabheShajam||104||
vacA viDa~ggaM bhUtIkaM dhAnyakaM devadAru ca|
vacA viDa~ggaM bhUtIkaM dhAnyakaM devadAru ca|
kuShThaM sAtiviShA pAThA cavyaM kaTukarohiNI||105||
kuShThaM sAtiviShA pAThA cavyaM kaTukarohiNI||105||
pippalI pippalImUlaM citrakaM hastipippalI|
pippalI pippalImUlaM citrakaM hastipippalI|
yogA~jchlokArdhavihitAMshcaturastAn prayojayet||106||
yogA~jchlokArdhavihitAMshcaturastAn prayojayet||106||
shRutA~jchleShmAtisAreShu kAyAgnibalavardhanAn|
shRutA~jchleShmAtisAreShu kAyAgnibalavardhanAn|
ajAjImasitAM pAThAM nAgaraM maricAni ca||107||
ajAjImasitAM pAThAM nAgaraM maricAni ca||107||
dhAtakIdviguNaM dadyAnmAtulu~ggarasAplutam|
dhAtakIdviguNaM dadyAnmAtulu~ggarasAplutam|
rasA~jjanaM sAtiviShaM kuTajasya phalAni ca||108||
rasA~jjanaM sAtiviShaM kuTajasya phalAni ca||108||
dhAtakIdviguNaM dadyAt pAtuM sakShaudranAgaram|
dhAtakIdviguNaM dadyAt pAtuM sakShaudranAgaram|
dhAtakI nAgaraM bilvaM lodhraM padmasya kesharam||109||
dhAtakI nAgaraM bilvaM lodhraM padmasya kesharam||109||
jambUtva~gnAgaraM dhAnyaM pAThA mocaraso balA|
jambUtva~gnAgaraM dhAnyaM pAThA mocaraso balA|
sama~ggA dhAtakI bilvamadhyaM jambvAmrayostvacaH||110||
sama~ggA dhAtakI bilvamadhyaM jambvAmrayostvacaH||110||
kapitthAni viDa~ggAni nAgaraM maricAni ca|
kapitthAni viDa~ggAni nAgaraM maricAni ca|
cA~ggerIkolatakrAmlAMshcaturastAn kaphottare||111||
cA~ggerIkolatakrAmlAMshcaturastAn kaphottare||111||
shlokArdhavihitAn dadyAt sasnehalavaNAn khaDAn|
shlokArdhavihitAn dadyAt sasnehalavaNAn khaDAn|
kapitthamadhyaM lIDhvA tu savyoShakShaudrasharkaram||112||
kapitthamadhyaM lIDhvA tu savyoShakShaudrasharkaram||112||
kaTphalaM madhuyuktaM vA mucyate jaTharAmayAt|113|
kaTphalaM madhuyuktaM vA mucyate jaTharAmayAt|113|
==== Management of complications of atisara ====
For the cure of ''kaphaja atisara'', following therapy and recipes should be administered:
*Fasting (''langhana'') and carminative (''pachana'') therapies should be administered in the beginning.
*The group of drugs which stimulates the power of digestion (''dipana-gana'') which is prescribed for the treatment of ''ama-atisara'' should be given.
*If the ''kaphaja atisara'' persists even after the administration of the above mentioned measures, then the patient should be given ''kapha'' alleviating therapies.
*The following four decoctions cure ''kaphaja atisara'' as well as promotes ''kayagni'' (power of digestion and metabolism)
**Decoction of ''bilva, karkatika, musta, abhaya'' and ''vishva-bheshaja''(''shunthi'')
**Decoction of ''vacha, vidanga, bhutika, dhanyaka'' and ''devadaru''
**Decoction of ''kushtha, ativisha, pātha, chavya'' and ''katukarohini''
**Decoction of ''pippali, pippali-mula, chitraka'' and ''gajapippali''
*Administration of the recipe containing one part each of black variety of ''ajaji, pachana, nagara'' and ''maricha'' and two parts of ''dhataki'' along with profuse quantity of lime juice.
*One part each of ''rasanjana, ativisha'' and fruits of ''kutaja'', and two parts of ''dhataki'' should be added with honey and ginger. This potion should be given to drink.
*For the treatment of ''kaphaja atisara'', the following four recipes should be given in the form of ''khada'' (a type of sour drink which stimulates the power of digestion). ''Dhataki, nagara, bilva, lodhra'' and ''padmakesara''; bark of ''jambu, nagara, dhanya, patha, mocha-rasa'' and ''bala''; ''samanga, dhataki,'' pulp of ''bilva'' and the bark of ''jambu'' and ''amra''; and ''kapittha, vidanga, nagara'' and ''maricha''.
The above mentioned recipes should be added with the sour juice of ''changeri'' and ''kola'' and butter-milk and given to the patient after adding ghee and salt.
*Intake of the pulp of ''kapittha'' along with ''shunthi, pippali, maricha,'' honey and sugar, or ''katphala'' along with honey cures diseases of digestive system (''jathara'').
*Intake of ''pippali'' along with honey, or butter-milk added with the powder of ''chitraka'' or the powder of the tender fruits of ''bilva'' cures diseases of digestive system [102-112½].
==== Management of complications of ''atisara'' ====
कणांमधुयुतांपीत्वातक्रंपीत्वासचित्रकम् ||११३||
कणांमधुयुतांपीत्वातक्रंपीत्वासचित्रकम् ||११३||
जग्ध्वावाबालबिल्वानिमुच्यतेजठरामयात् |
जग्ध्वावाबालबिल्वानिमुच्यतेजठरामयात् |
बालबिल्वंगुडंतैलंपिप्पलींविश्वभेषजम् |
बालबिल्वंगुडंतैलंपिप्पलींविश्वभेषजम् |
लिह्याद्वातेप्रतिहतेसशूलःसप्रवाहिकः ||११४||
लिह्याद्वातेप्रतिहतेसशूलःसप्रवाहिकः ||११४||
भोज्यंमूलकषायेणवातघ्नैश्चोपसेवनैः |
भोज्यंमूलकषायेणवातघ्नैश्चोपसेवनैः |
वातातिसारविहितैर्यूषैर्मांसरसैःखडैः ||११५||
वातातिसारविहितैर्यूषैर्मांसरसैःखडैः ||११५||
पूर्वोक्तमम्लसर्पिर्वाषट्पलंवायथाबलम् |
पूर्वोक्तमम्लसर्पिर्वाषट्पलंवायथाबलम् |
पुराणंवाघृतंदद्याद्यवागूमण्डमिश्रितम् ||११६||
पुराणंवाघृतंदद्याद्यवागूमण्डमिश्रितम् ||११६||
kaṇāṁ madhuyutāṁ pītvā takraṁ pītvā sacitrakam||113||
kaṇāṁ madhuyutāṁ pītvā takraṁ pītvā sacitrakam||113||
jagdhvā vā bālabilvāni mucyatē jaṭharāmayāt|
jagdhvā vā bālabilvāni mucyatē jaṭharāmayāt|
bālabilvaṁ guḍaṁ tailaṁ pippalīṁ viśvabhēṣajam|
bālabilvaṁ guḍaṁ tailaṁ pippalīṁ viśvabhēṣajam|
lihyādvātē pratihatē saśūlaḥ sapravāhikaḥ||114||
lihyādvātē pratihatē saśūlaḥ sapravāhikaḥ||114||
bhōjyaṁ mūlakaṣāyēṇa vātaghnaiścōpasēvanaiḥ|
bhōjyaṁ mūlakaṣāyēṇa vātaghnaiścōpasēvanaiḥ|
vātātisāravihitairyūṣairmāṁsarasaiḥ khaḍaiḥ||115||
vātātisāravihitairyūṣairmāṁsarasaiḥ khaḍaiḥ||115||
pūrvōktamamlasarpirvā ṣaṭpalaṁ vā yathābalam|
pūrvōktamamlasarpirvā ṣaṭpalaṁ vā yathābalam|
purāṇaṁ vā ghr̥taṁ dadyādyavāgūmaṇḍamiśritam||116||
purāṇaṁ vā ghr̥taṁ dadyādyavāgūmaṇḍamiśritam||116||
kaNAM madhuyutAM pItvA takraM pItvA sacitrakam||113||
kaNAM madhuyutAM pItvA takraM pItvA sacitrakam||113||
jagdhvA vA bAlabilvAni mucyate jaTharAmayAt|
jagdhvA vA bAlabilvAni mucyate jaTharAmayAt|
bAlabilvaM guDaM tailaM pippalIM vishvabheShajam|
bAlabilvaM guDaM tailaM pippalIM vishvabheShajam|
lihyAdvAte pratihate sashUlaH sapravAhikaH||114||
lihyAdvAte pratihate sashUlaH sapravAhikaH||114||
bhojyaM mUlakaShAyeNa vAtaghnaishcopasevanaiH|
bhojyaM mUlakaShAyeNa vAtaghnaishcopasevanaiH|
vAtAtisAravihitairyUShairmAMsarasaiH khaDaiH||115||
vAtAtisAravihitairyUShairmAMsarasaiH khaDaiH||115||
pUrvoktamamlasarpirvA ShaTpalaM vA yathAbalam|
pUrvoktamamlasarpirvA ShaTpalaM vA yathAbalam|
purANaM vA ghRutaM dadyAdyavAgUmaNDamishritam||116||
purANaM vA ghRutaM dadyAdyavAgUmaNDamishritam||116||
==== Picchā-basti and anuvāsana-basti ====
*If the movement of ''vata'' (flatus) is obstructed resulting in colic pain and dysentery, then the patient should be given tender fruits of ''bilva'', jaggery, oil, ''pippali'' and ''shunthi''.
*Diet prepared with ''vata'' alleviating ingredients along with the vegetable soup, meat soup and ''khada'' (a type of sour drink) described under ''vataja atisara'' should be given.
*Sour medicated ghee like ''changeri ghrita'' or ''shatpala ghrita'' (C.S. Chi. 5: 147-148 or (ten years) old ghee mixed with ''yavagu'' (thick gruel) and ''manda'' (thin gruel) should be given [113-116].
==== ''Piccha-basti'' and ''anuvasana-basti'' ====
वातश्लेष्मविबन्धेवाकफेवाऽतिस्रवत्यपि |
वातश्लेष्मविबन्धेवाकफेवाऽतिस्रवत्यपि |
शूलेप्रवाहिकायांवापिच्छाबस्तिंप्रयोजयेत् ||११७||
शूलेप्रवाहिकायांवापिच्छाबस्तिंप्रयोजयेत् ||११७||
पिप्पलीबिल्वकुष्ठानांशताह्वावचयोरपि |
पिप्पलीबिल्वकुष्ठानांशताह्वावचयोरपि |
कल्कैःसलवणैर्युक्तंपूर्वोक्तंसन्निधापयेत् ||११८||
कल्कैःसलवणैर्युक्तंपूर्वोक्तंसन्निधापयेत् ||११८||
प्रत्यागतेसुखंस्नातंकृताहारंदिनात्यये |
प्रत्यागतेसुखंस्नातंकृताहारंदिनात्यये |
बिल्वतैलेनमतिमान्सुखोष्णेनानुवासयेत् ||११९||
बिल्वतैलेनमतिमान्सुखोष्णेनानुवासयेत् ||११९||
वचान्तैरथवाकल्कैस्तैलंपक्त्वाऽनुवासयेत् |
वचान्तैरथवाकल्कैस्तैलंपक्त्वाऽनुवासयेत् |
बहुशःकफवातार्तस्तथासलभतेसुखम् ||१२०||
बहुशःकफवातार्तस्तथासलभतेसुखम् ||१२०||
vātaślēṣmavibandhē vā kaphē vā'tisravatyapi|
vātaślēṣmavibandhē vā kaphē vā'tisravatyapi|
śūlē pravāhikāyāṁ vā picchābastiṁ prayōjayēt||117||
śūlē pravāhikāyāṁ vā picchābastiṁ prayōjayēt||117||
pippalībilvakuṣṭhānāṁ śatāhvāvacayōrapi|
pippalībilvakuṣṭhānāṁ śatāhvāvacayōrapi|
kalkaiḥ salavaṇairyuktaṁ pūrvōktaṁ sannidhāpayēt||118||
kalkaiḥ salavaṇairyuktaṁ pūrvōktaṁ sannidhāpayēt||118||
pratyāgatē sukhaṁ snātaṁ kr̥tāhāraṁ dinātyayē|
pratyāgatē sukhaṁ snātaṁ kr̥tāhāraṁ dinātyayē|
bilvatailēna matimānsukhōṣṇēnānuvāsayēt||119||
bilvatailēna matimānsukhōṣṇēnānuvāsayēt||119||
vacāntairathavā kalkaistailaṁ paktvā'nuvāsayēt|
vacāntairathavā kalkaistailaṁ paktvā'nuvāsayēt|
bahuśaḥ kaphavātārtastathā sa labhatē sukham||120||
bahuśaḥ kaphavātārtastathā sa labhatē sukham||120||
vAtashleShmavibandhe vA kaphe vA~atisravatyapi|
vAtashleShmavibandhe vA kaphe vA~atisravatyapi|
shUle pravAhikAyAM vA picchAbastiM prayojayet||117||
shUle pravAhikAyAM vA picchAbastiM prayojayet||117||
pippalIbilvakuShThAnAM shatAhvAvacayorapi|
pippalIbilvakuShThAnAM shatAhvAvacayorapi|
kalkaiH salavaNairyuktaM pUrvoktaM sannidhApayet||118||
kalkaiH salavaNairyuktaM pUrvoktaM sannidhApayet||118||
pratyAgate sukhaM snAtaM kRutAhAraM dinAtyaye|
pratyAgate sukhaM snAtaM kRutAhAraM dinAtyaye|
bilvatailena matimAnsukhoShNenAnuvAsayet||119||
bilvatailena matimAnsukhoShNenAnuvAsayet||119||
vacAntairathavA kalkaistailaM paktvA~anuvAsayet|
vacAntairathavA kalkaistailaM paktvA~anuvAsayet|
bahushaH kaphavAtArtastathA sa labhate sukham||120||
bahushaH kaphavAtArtastathA sa labhate sukham||120||
For the cure of kaphaja and vataja-predominant atisara, the following therapy and recipes should be administered:
For the cure of ''kaphaja'' and ''vataja''-predominant ''atisara'', the following therapy and recipes should be administered:
*If ''vata'' and ''kapha'' are obstructed in the ''mahasrotas'', if there is excessive evacuation of ''kapha'' (mucus) and if there is colic pain as well as dysentery, then ''piccha-basti'' (mucilaginous enema) should be administered.
*''Piccha-basti'' should be prepared of the paste of ''pippali, bilva, kustha, shatahva'' and ''vacha'' by adding salt.
*Patient feels comfortable after the ingredients of ''pichcha-basti'' come out of the rectum and then patient should be advised to take bath followed by intake of food. ''Anuvasana basti'' with lukewarm oil of ''bilva'' (C.S.Si 4: 4-7) should be given in the afternoon.The ''anuvasana basti'' can also be given frequently with the oil cooked with the paste of ''pippali, bilva, kushtha, shatahva'' and ''vacha'' [117-120].
==== Need for immediate control of vata ====
==== Need for immediate control of ''vata'' ====
स्वेस्थानेमारुतोऽवश्यंवर्धतेकफसङ्क्षये |
स्वेस्थानेमारुतोऽवश्यंवर्धतेकफसङ्क्षये |
सवृद्धःसहसाहन्यात्तस्मात्तंत्वरयाजयेत् ||१२१||
सवृद्धःसहसाहन्यात्तस्मात्तंत्वरयाजयेत् ||१२१||
svē sthānē mārutō'vaśyaṁ vardhatē kaphasaṅkṣayē|
svē sthānē mārutō'vaśyaṁ vardhatē kaphasaṅkṣayē|
sa vr̥ddhaḥ sahasā hanyāttasmāttaṁ tvarayā jayēt||121||
sa vr̥ddhaḥ sahasā hanyāttasmāttaṁ tvarayā jayēt||121||
sve sthAne mAruto~avashyaM vardhate kaphasa~gkShaye|
sve sthAne mAruto~avashyaM vardhate kaphasa~gkShaye|
sa vRuddhaH sahasA hanyAttasmAttaM tvarayA jayet||121||
sa vRuddhaH sahasA hanyAttasmAttaM tvarayA jayet||121||
When kapha gets reduced because of the above mentioned therapeutic measures, the vata undoubtedly gets aggravated in its own location (colon). This aggravated vata may cause instantaneous death and hence should be controlled without delay (121).
When ''kapha'' gets reduced because of the above mentioned therapeutic measures, the ''vata'' undoubtedly gets aggravated in its own location (colon). This aggravated ''vata'' may cause instantaneous death and hence should be controlled without delay [121]
==== Principle of treatment of sannipātaja atisara ====
==== Principle of treatment of ''sannipataja atisara'' ====
वातस्यानुजयेत्पित्तं, पित्तस्यानुजयेत्कफम् |
वातस्यानुजयेत्पित्तं, पित्तस्यानुजयेत्कफम् |
त्रयाणांवाजयेत्पूर्वंयोभवेद्बलवत्तमः ||१२२||
त्रयाणांवाजयेत्पूर्वंयोभवेद्बलवत्तमः ||१२२||
vātasyānu jayēt pittaṁ, pittasyānu jayēt kapham|
vātasyānu jayēt pittaṁ, pittasyānu jayēt kapham|
trayāṇāṁ vā jayēt pūrvaṁ yō bhavēdbalavattamaḥ||122||
trayāṇāṁ vā jayēt pūrvaṁ yō bhavēdbalavattamaḥ||122||
vAtasyAnu jayet pittaM, pittasyAnu jayet kapham|
vAtasyAnu jayet pittaM, pittasyAnu jayet kapham|
trayANAM vA jayet pUrvaM yo bhavedbalavattamaH||122||
trayANAM vA jayet pUrvaM yo bhavedbalavattamaH||122||
For the cure of sannipātaja atisara, following therapy and recipes should be administered:
For the cure of ''sannipataja atisara,'' following therapy and recipes should be administered:
*The aggravated ''vata'' should be pacified first followed by the alleviation of the aggravated ''pitta'' followed by alleviation of ''kapha''.
*Alternatively, the most aggravated one should be controlled first followed by the treatment of the remaining two ''dosha'' [122].
==== Summary ====
==== Summary ====
तत्रश्लोकः-
तत्रश्लोकः-
प्रागुत्पत्तिनिमित्तानिलक्षणंसाध्यतानच |
प्रागुत्पत्तिनिमित्तानिलक्षणंसाध्यतानच |
क्रियाचावस्थिकीसिद्धानिर्दिष्टाह्यतिसारिणाम् ||१२३||
क्रियाचावस्थिकीसिद्धानिर्दिष्टाह्यतिसारिणाम् ||१२३||
tatra ślōkaḥ-
tatra ślōkaḥ-
prāgutpattinimittāni lakṣaṇaṁ sādhyatā na ca|
prāgutpattinimittāni lakṣaṇaṁ sādhyatā na ca|
kriyā cāvasthikī siddhā nirdiṣṭā hyatisāriṇām||123||
kriyā cāvasthikī siddhā nirdiṣṭā hyatisāriṇām||123||
tatra shlokaH-
tatra shlokaH-
prAgutpattinimittAni lakShaNaM sAdhyatA na ca|
prAgutpattinimittAni lakShaNaM sAdhyatA na ca|
kriyA cAvasthikI siddhA nirdiShTA hyatisAriNAm||123||
kriyA cAvasthikI siddhA nirdiShTA hyatisAriNAm||123||
In this chapter, the following topics in respect of the patient suffering from atisara (diarrhoea) are described:
In this chapter, the following topics in respect of the patient suffering from ''atisara'' (diarrhea) are described:
*Historical origin of ''atisara''
*Etiology of different types of ''atisara''
*Signs and symptoms of ''atisara''
*Curability and incurability of ''atisara''
*Effective treatment for different stages of ''atisara'' [123].
इत्यग्निवेशकृतेतन्त्रेचरकप्रतिसंस्कृतेचिकित्सास्थानेऽतिसारचिकित्सितंनामैकोनविंशोऽध्यायः ||१९||
इत्यग्निवेशकृतेतन्त्रेचरकप्रतिसंस्कृतेचिकित्सास्थानेऽतिसारचिकित्सितंनामैकोनविंशोऽध्यायः ||१९||
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē'tisāracikitsitaṁ nāmaikōnaviṁśō'dhyāyaḥ||19||
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē'tisāracikitsitaṁ nāmaikōnaviṁśō'dhyāyaḥ||19||
Thus, ends the nineteenth chapter of Cikitsa-sthana (section on the treatment of diseases) dealing with the treatment of atisara (diarrhoea) in the work of Agnivesha as redacted by Charaka (19).
Thus, ends the nineteenth chapter of [[Chikitsa Sthana]] (section on the treatment of diseases) dealing with the treatment of ''atisara'' (diarrhea) in the work of Agnivesha as redacted by Charak [19]
=== ''Tattva Vimarsha'' ===
=== ''Tattva Vimarsha'' ===
*''Atisara'' is caused by intake of heavy to digest, excessively hot and food that is incompatible to the body, impairment of ''agni'' and mind. The body reacts to expel out the incompatible material out of gut in the form of ''atisara''.
*There are five categories of etio-pathological factors for ''atisara'':
#Reduced ''agni'',
#Vitiated ''vata'' and its sub types ''samana'' and ''apana''.
#Vitiated body fluids.
#Vitiated ''purishavaha srotas'' (lower gastro-intestinal tract) and organs of excretion.
#Fear and grief (mental).
*Interaction of ''prakriti'' (basic constitution) and the diet and lifestyle of similar properties (as that of ''dosha prakriti'') makes the person susceptible for ''atisara''.
*The exogenous factors like consumption of intoxicating beverages, exposure to '''krimi''' (bacteria and parasites), other diseases like ''shosha, jwara, arsha'' influence all the above factors and three ''dosha'' to cause ''sannipatik atisara'' (diarrhea) which includes bloody diarrhea.
*If spicy, hot, dry food in large quantity is ingested when ''agni'' is low, undigested food becomes waste product and ''samana vata'' sends it to excretory channels where ''apana vayu'' increases the motility of ''purishavaha srotas'' to excretes these large waste products, frequently.
*To fill this vacuum created by expulsion of wastes, the body fluids shift to the gut and get expelled out as ''atisara''/diarrhea causing dehydration.Thus after involvement of ''purishavaha srotasa'' ( lower GIT), ''udakavaha srotasa'' (body fluids) is also predominantly involved in pathogenesis of ''atisara''.
*Fear and grief are two important mental factors leading to ''atisara''. The presentation and treatment of this ''atisara'' is similar to ''vata'' dominant ''atisara''. The fear shall be treated with ''harshana''(exhilaration) treatment and grief shall be treated with ''ashwasana'' (consolation) therapy.
*The endogenous ''atisara'' shall be treated after proper assessment of dominant ''dosha'', causative factors and pacifying factors,
*At the initial stage of ''atisara'' when undigested food is being expelled, ''stambhan'' (anti diarrheal treatment) is strictly contraindicated. If ''stambhana'' is given, it leads to various complications. Mild laxatives like ''haritaki'' shall be administered for evacuating the ''mala'' (accumulated undigested wastes). ''Deepana'' and ''pachana'' (stimulation of ''agni'' for digestion and metabolism) should be given with light nutritive liquid foods. After restoration of ''agni, stambhan'' is given and care should taken to keep ''vata'' balanced.
*In case of prolapse of rectum, medicated ghee processed with sour herbs or ''anuvasana'' (unctuous enema) is prescribed.
*Various states of ''atisara'' like that mixed with mucous, blood, associated with colic pain shall be treated with ''pichcha basti'' (mucilaginous enema).
*When ''kapha'' gets reduced because of the above mentioned therapeutic measures, the ''vata'' is aggravated in its own location (colon). This aggravated ''vata'' must be immediately treated as it may cause instantaneous death.
*In case of ''sannipataja atisara'', at first the aggravated ''vata'' shall be pacified followed by ''pitta'' and ''kapha''. Alternatively, the most aggravated one should be controlled first followed by the treatment of the remaining two ''dosha''.
=== ''Vidhi Vimarsha'' ===
The disease ''atisara'' resembles the clinical condition of diarrhea and is defined as the passage of frequent, liquid stools (usually of more than 200 g of stool) daily. In the most severe instances of ''atisara'', incontinence is a commonly observed symptom. Diarrhea, among adults, could broadly be categorized as sudden onset(acute), or chronic diarrhea that could last for 14 days or more.
==== Acute (sudden onset) diarrhea ====
This is most common variant and in over 90% of cases is infectious, caused due to ingestion of contaminated food or water. Other causes may include drug induced especially antibiotics, diverticulitis, ischemia, radiation enterocholitis, food allergies or initial presentation of various gastrointestinal diseases.
==== Chronic (or relapsing) diarrhea <ref>Patient Education: Chronic Diarrhea among adults, UptoDate
(https://www.uptodate.com/contents/chronic-diarrhea-in-adults-beyond-the-basics?topicRef=4021&source=see_link)
</ref> ====
Defined as loose stools (occurring three or more times a day) that last for weeks. A most common variant is the Irritable Bowel Syndrome (IBS). Chronic diarrhea could be a symptom of an inflammatory bowel disease like Crohn's Disease, ulcerative colitis, malabsorption syndrome, metabolic or endocrine disorders, food allergies, laxative abuse, neoplasm, or reaction to certain medications.
Careful assessment of the patient's medical history, physical examination, CBC, electrolytes, stool and urine examination are initial tests advised to help assess the underlying causes. Further specialised investigations may be needed depending upon the condition of patient.
==== Pathophysiological factors of endogenous diarrhea ====
*Dosha: Vata dominant three dosha
*Dhatu (vitiated factors): Udaka (body fluid), Rasa dhatu
*Mala kriya affected: Purisha (defecation)
*Status of agni: Manda (poor)
*Origin of disease: Pakwashaya (large intestine)
*Sites of vitiation: large intestine
*Sites of clinical presentation: rectum and anus
*Srotasa involved: Purishavaha srotasa and udakavaha srotasa
*Type of samprapti: atipravritti (excess discharge)
==== Management protocol of endogenous diarrhea ====
===== Assessment of strength of patient =====
Excess dehydration in case of diarrhea can lead to serious complications. Hence the strength of the patient should be assessed first for severity of dehydration. This helps to design treatment protocol. Vital parameters including pulse rate, its volume, blood pressure, heart rate shall be examined.
===== Subjective and objective parameters =====
Frequency of bowel more than three times a day with stool weight less than 200 grams with more watery content are considered as diarrhea. The quantity is less in ''vata'' dominance, medium in ''pitta'' dominance and more in ''kapha'' dominant. Frequency is more in ''vata'' dominance, medium in ''pitta'' dominance and less in ''kapha'' dominance. The consistency of stool also differs according to ''dosha'' dominance as described in the text. ''Purisha pariksha'' (stool examination) is researched further in view of frequency, consistency, smell, its specific gravity in water to determine the ''ama'' and ''nirama'' status of ''purisha''.
[[File:Atisara.png]]
==== Prevention of ''atisara'' ====
===== ''Atisara'' can be prevented by following measures =====
#Avoiding causative factors
#Strengthening ''agni'' (digestive processes) by following dietary rules
#Observing body purification treatments as per ''prakriti'' and season
===== Current clinical management in Ayurveda practice =====
*'''Principles of treatment''': ''deepana, grahi, pachana,'' buttermilk
*'''Main drugs''': ''kutaja, ahiphena, bhanga, bhallataka, bilva''
{| class="wikitable"
|-
! scope="col"| Type
! scope="col"| Formulation
! scope="col"| Dose
! scope="col"| Time
! scope="col"| ''Anupana''
|-
| rowspan="2"|''Vata'' and ''kapha'' dominant
| ''Jatiphaladi–bhallataka guti''
| 60-120 mg
| Before meals, two times
| Buttermilk
|-
| ''Sanjivani vati''
| 60-250 mg
| Before meals
| Buttermilk
|-
|''Pitta'' and ''kapha'' dominant
| ''Kutaja kalpa''
| 60-120 mg
| Before meals, two times
| Ricewater with Buttermilk
|-
|''Raktaja''
| ''Shatavaryadi kwatha''
| 25-40 ml
| Empty stomach
| ''-''
|-
|rowspan = "3"|''Pravahika''(dysentry)
| ''Isabgola'' seeds (cold effusion with sugar)
| 5-10 ml
| Morning and night, two times
| ''-''
|-
| ''Ahiphena kalpa''
| 125-250 mg
| Morning and night, two times
| ''kutajavaleha''
|-
| ''Kutaja parpati''
| 250-1000 mg
| Empty stomach
| Honey
|-
|rowspan = "3"|Chronic
| ''Dhanya panchaka churna''
| 10-25 mg
| Between meals
| ''Bilvavaleha''
|-
| ''Shatpala ghee''
| 10-25 ml
| Before meals
| Buttermilk or hot water
|-
| ''Bilwadi tailam''
| 10-25 grams
| Before meals
| Buttermilk
|}
===== Researches on ''atisara'' and medicines =====
A combination of ''musta'' (cyperus rotundus), ''ativisha'' (aconitum heterophyllum), ''kutaja'' (holarrhena antidysenterica), ''chitraka'' (plumbago zeylanica) and ''bilva'' (Aegle marmelos) was found effective in management of ''atisara''.<ref>Sridhar B.N., Gopakumar K., Jaya N. Mustadi yoga-A new preparation for treatment of atisara. Aryavaidyan,10(4).May-July 1997;222-225. </ref>
=== ''Vidhi Vimarsha'' ===
''Kutaja'' is widely used and first preferred drug in management of ''atisara''. It is mainly indicated in conditions of vitiated ''kapha-pitta'' and as a ''sangrahi'' (styptic) and ''shoshana'' (absorbent)(Charak sutra 25/40). In an in-vitro study, sterile double dilution aqueous extract of ''kutaja'' was found effective to inhibit growth of E. coli, staphylococcus aureus, salmonella Typhi.<ref>Shrivastava Niraj, Saxena Varsha. Antibacterial activity of Kutaja(Holarrhena antidysenterica Linn.) in childhood diarrhea:-In vitro study. The Pharma Innovation Journal 2015;4(4):97-99 .</ref> Thus ''kutaja'' can be used for all purpose in management of ''atisara''.
Nitin Salve and Debendranath Mishra studied the botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhea.<ref>Nitin Salve, Debendranath Mishra. Botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhoea. Anc Sci Life.2016 Apr-Jun:35(4):195-200 </ref>
The conditions like ulcerative colitis, irritable bowel syndrome, acute diarrhea are considered under the umbrella of ''atisara''.
In a study on 43 patients of ulcerative colitis, Patel M.V.et.al observed 80% reduction in signs and symptoms of ulcerative colitis by Ayurvedic treatment. The treatment included ''udumbara kwatha'' combination of ''lodhra, musta, nagakeshara,mukta panchamrita rasa, kutaja ghana vati'' and ''udumbara kwatha basti''. It also highlighted disease modifying effect and reduction in use of steroidal drugs in the patients. <ref>Patel M.V.,Patel K.B., Gupta S.N. Effects of Ayurvedic treatment on forty three patients of ulcerative colitis. AYU,Oct-Dec 2010,31(4), 478-481.</ref>
A study found that a combination of ''nagarmotha'' (Cyperus rotundus L.), ''indrayava'' (Holarrhena antidysenterica (L.) Wall.), ''nagakeshara'' (Mesua ferrea L.), ''madhuyashti'' (Glycyrrhiza glabra L.), and ''amalaki'' (Emblica officinalis Gaertn.) powders, along with ''dadimashtaka choorna, shankha bhasma, mustarista'' and ''dhanyapanchaka kvatha'' showed significant response in case of ''pravahika'' (irritable bowel syndrome). <ref>Pooja BA, Bhatted S. Ayurvedic management of Pravahika – A case report. Ayu 2015;36:410-2. </ref>
In another study, ''bilwadileha'' showed significant relief in management of irritable bowel syndrome. <ref>Tiwari R, Pandya DH, Baghel MS. Clinical evaluation of Bilvadileha in the management of irritable bowel syndrome. AYU [serial online] 2013 [cited 2018 Jun 12];34:368-72. Available from: http://www.ayujournal.org/text.asp?2013/34/4/368/127717</ref>
In a study, ''vatasakadi'' syrup was observed 70 % effective in treatment of ''atisara'' in children as compared to ''bala-chaturbhadra'' syrup.<ref>Shah Kiran. A Comparative Study of Vatsakadi Syrup & Balachaturbhadra Syrup in Management Balatisara with reference to Diarrhea, Int. J. Ayu. Alt. Med., 2014; 2(1):28-33.</ref>
==== Management of exogenous diarrhea/''atisara'' ====
#Diarrhea due to mental factors: These patients need counseling along with therapeutic management of diarrhea as discussed above.
#Infectious diarrhea or bacterial food poisoning: The practitioner/physician should proceed with the treatment of the disease with information obtained from the history, stool examination, and evaluation of dehydration severity.
#Watery diarrhea usually indicates a defect in water absorption. However, there are other categories of watery diarrhea caused due to the dysregulation of intestinal function, endocrine dysfunction (including hypothyroidism), tumors (by obstructing bowel). Another category of watery diarrhea is idiopathic secretory diarrhea. These categories largely are termed chronic inflammatory diarrhea. Based on the result of examining the patient’s history thoroughly, the physician should prescribe a course of treatment as well as dietary regimen.<ref>Schiller Lawrence, Sellin Joseph, Pardi Darrell, Chronic Diarrhea:Diagnosis and Management, Clinical Gastroenterology and Hepatology, 2017, 15:182-193</ref>
#Fatty diarrhea, like watery diarrhea, indicates poor absorption of fat and other nutrients
#Dysentery (passage of bloody stools) or fever (>37.8°C) should be treated with antibacterial drugs
#Vomiting, minimal diarrhea should be treated with Bismuth subsalicylate.
#Diarrhea in infants (<2 years old) should be treated with fluids and electrolytes (oral rehydration solution, pedialyte, lytren); continue feeding, especially with breast milk; seek medical attention for moderate dehydration, fever lasting >24 h, bloody stools, or diarrhea lasting more than several days.
'''Note'''
Loperamide should not be used by patients with fever or dysentery because its use may prolong diarrhea in patients with infection due to Shigella or other invasive organisms.
==== Important guidelines and precautions for diarrhea management ====
The World Health Organization , beginning 2002, recommended a “reduced osmolarity/reduced-salt” Oral Rehydration Solution (ORS) to adequately rehydrate the patient, which is key to treating any case of diarrhea.<ref>WHO Press Release, 8 May 2002, http://www.who.int/mediacentre/news/releases/release35/en/</ref> The Centers for Disease Control and Prevention (CDC) considers rehydration as “the cornerstone of treatment of cholera”.<ref>https://www.cdc.gov/cholera/treatment/rehydration-therapy.html</ref> CDC also recommends other treatment alternatives, based on recent studies in Bangladesh and other areas affected by cholera, such as zinc treatment.<ref>https://www.cdc.gov/cholera/treatment/zinc-treatment.html</ref> Severe cases need to take a recourse of antibiotics, though there are instances of resistance to tetracycline and other antimicrobial agents .<ref> https://www.cdc.gov/cholera/treatment/antibiotic-treatment.html</ref>
----Saturated fatty acids g 2.4 2.3 3.8 4.2
----Monounsaturated fatty acids g 1.1 0.8 1.5 1.7
----Polyunsaturated fatty acids g 0.1 0.1 0.3 0.2
==== List of research on review of ''atisara'' ====
#Uikey R, Kar AC. A review on Purisha Pariksha in Ayurveda. AYU [serial online] 2015 [cited 2018 Jun 12];36:125-9. Available from: http://www.ayujournal.org/text.asp?2015/36/2/125/175536
#Patil Dhiraj, Babel Sadhana, Chitte Sanjay. Atisaar (Diarrhea): A Review based on Ayurveda and modern perspective. WJPMR, 2017,3(7), 227-229 available from http://www.wjpmr.com/ downloaded on 12/06/2018
#S Durgalakshmi, Pious Uthara Anu, Ajantha. An Overview on Nidana Panchaka of Atisara (Diarrhea). IAMJ: Volume 3(8); August. 2015 available from http://www.iamj.in/current_issue/images/upload/2419_2425.pdf downloaded on 12/06/2018
2. Infective diarrhoea is usually short-lived and patients who present with a history of diarrhoea lasting more than 10 days rarely have an infective cause.
3. At other times the patient is constipated and there are other characteristic symptoms of irritable bowel syndrome.
==== Research Areas ====
*Though there are many anti-diarrheal and ant-dysentery medicines are available in conventional systems of medicine, the immediate stoppage of diarrhoea may lead to complications as mentioned in the text. Therefore a survey study is needed to examine the prevalence of such complications caused by stoppage of diarrhea.
*The rehydrating effect of ''pramathya'' (decoctions), ''peya'' (liquid gruel), sour processing media like ''dadima, changeri,'' buttermilk used in the treatment of ''atisara'' need to be investigated further.
*More researches are needed to study effect of Ayurveda medicines in chronic diarrhea and psycho somatic disease like irritable bowel syndrome.
The clinical features of food-borne gastroenteritis depend on the pathogenic mechanisms involved.
=== Glossary ===
#Ādikālē (आदिकाले): At the commencement of ancient time (Satya-yuga)
#Anuvāsana Basti (अनुवासनबस्तिः): oily medicated enema
#Asthāpana Basti (स्थापनबस्तिः): medicated enema with decoction
#Atīsāracikitsitaṁ (अतीसारचिकित्सितं): treatment of diarrhoea
#Candrakōpagatam (चन्द्रकोपगतम): coloured patches circular in shape like moon
#Dadhighr̥tamajjatailavasākṣīravēsavārābham (दधिघृतमज्जतैलवसाक्षीरवेसवाराभम): looks like curd, ghee, bone-marrow, oil, muscle fat, milk and minced meat
#Gauravādauṣṇyādasātmyatvāda (गौरवादौष्ण्यादसात्म्यत्वाद): due to heavy, hot & unwholesome
#Grahnipradosa (ग्रहणीप्रदोषान्): grahani, sprue syndrome
#Gudapākaṁ (गुदपाकं): suppuration of the anus
#Gulma (गुल्म): localized growth in abdomen
#Hāridra (हारिद्र): yellow colour like turmeric
#Harita (हरित): green
#Hutāgnihōtram (हुताग्निहोत्रम): oblations to the fire
#Jāṅgalānāṁ (जाङ्गलानां): wild animals
#Karburam (कर्बुरम): stool of variegated in colour
#Kr̥tāhnikaṁ (कृताह्निकं): completion of daily worship
#Kuṇapgandhyama (कुणपगन्ध्यम): smell like that of a dead body
#Lakṣaṇa (लक्षण): signs and symptoms
#Laṅghita (लङ्घित): undergone lighening therapy
#Makṣikākāntaṁ (मक्षिकाकान्तं): stool attracts flies in excess
#Māṁsadhāvanasannikāśaṁ (मांसधावनसन्निकाशं): appears like washing of meat
#Maṇḍā (मण्डा): liquid portion of cooked rice
#Māñjiṣṭha (माञ्जिष्ठ): reddish colour like of mnjistha
#Matsyagandhi (मत्स्यगन्धि): smell like that raw fish
#Mēcakābha (र्मेचकाभ): like tar coloured
#Mēdōmāṁsōdakasannikāśaṁ (मेदोमांसोदकसन्निकाशं): like washing of fat or flesh
#Muktanāla (मुक्तनाल): paralysed anus sphictor
#Musti (मुष्टि): handful, fist
#Nīla (नील): blue
#Nimitta (निमित्त): cause
#Niryūha (निर्यूह): decoction
#Pañcavalkama (पञ्चवल्कम): bark of five plants viz. Nyagrodha, Udumbara, Ashvattha, Pārasa and plaksha
#Patitagudavaliṁ (पतितगुदवलिं): prolapsed anal sphincters
#Picchā-basti (पिच्छाबस्ति) medicated enema with mucilaginous drugs
#Prāgutpatti (प्रागुत्पत्ति): origin
#Prajānugrahārtham (प्रजानुग्रहार्थम): for wellbeing of humanity.
#Pratyavarakālaṁ (प्रत्यवरकालं): age following performance of sacrifice by Daksa Prajapati
#Pravāhikaḥ-(प्रवाहिकः): passing stool with spasmatic pain
#Pūtipūyagandhyam (पूतिपूयगन्ध्यम): putrid smell or smell like undigested food
#Samsarjanakrama (संसर्जन): gradual bringing from lighter to normal food after purification therapy
#Srastapakvagudaṁ (स्रस्तपक्वगुदं): prolapsed and inflamed of the anus
#Tarpaṇā (तर्पणा): roasted flour of cereals added with water
#Upahatāgnī (उपहताग्नी): loss of the power of digestion
#Upahatamanasāṁ (उपहतमनसां): afflicted mental equilibrium
#Upaśamana (उपशमन): treatment
#Varāhabhēdaḥsadr̥śa (वराहभेदःसदृश): white yellowish colour like of pig-fat
#Vibaddha (विबद्ध): blocked
#Yakr̥tkhaṇḍōpamaṁ (यकृत्खण्डोपमं): like piece of liver
#Yamaka (यमक): mixture of two unctuous substances e.g. mixture of ghee and oil
#Yavāgū (यवागू): thick gruel
=== Further reading ===
#Charak Samhita (700 BC) with English Translation and Critical exposition (Volume IV). Sharma R.K. and Dash B., Chaukhambha Sanskrit Series Office, Varanasi.pages-202-242
#Valiathan, M.S. (2009): Legacy of Charak, Sushruta, Vagbhata, Orient Longman, Chennai.
#Sushruta. Sushruta Samhita. Volume III, Uttarasthana, translated by Prof. K.R. Srikatha Murthy, Varanasi, Chaukhambha Orientalia; 2005.p.223-250.
#Parameswarappa’s ĀyurvedÍya Vikriti Vijñāna and Roga Vijñāna by Dr. P.S. Byadgi. Volume II, pages-431-446
#Davidson’s Principles of practice of medicine, 21th Ed. (2007) Ed. by Nicholas A. Boon., Nicki R. College, Brain R. Walker, Pub. Churchill Livingstone Elsevier, London Elsevier. Pages-302-304
#Harrison’s principles of internal medicine 17th Ed. (2008) Ed. by Fauci Kasper D.L., A.S., Longo D.L., Braunwal Eugene, Hauser S.J., Jameson J.L.. Joseph Loscalzo., Pub. MacGraw-Hill USA, Chapter 128. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning
#Harrison’s principles of internal medicine 17th Ed. (2008) Ed. by Fauci Kasper D.L., A.S., Longo D.L., Braunwal Eugene, Hauser S.J., Jameson J.L.. Joseph Loscalzo., Pub. MacGraw-Hill USA, Vol.-2, Chapter 338.
=== Reference ===
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