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Line 1,611: − Importance of agni in context of atisara:+ − त्रयो विकाराः प्रायेण ये परस्परहेतवः| − अर्शांसि चातिसारश्च ग्रहणीदोष एव च||२४४|| − एषामग्निबले हीने वृद्धिर्वृद्धे परिक्षयः| − तस्मादग्निबलं रक्ष्यमेषु त्रिषु विशेषतः||२४५|| − -Caraka chikitsā 14/244-245 − The three diseases viz. hemorrhoids, diarrhoea and Grahaṇí (digestive disorders) are interdependent in as much as one of them can cause the other. They get aggravated if there is reduction in the power of digestion and when the power of digestion is increased, they get cured. Therefore, agni should be specifically protected for these three ailments. Atisara manifests due to abnormal purishava srotas. − Therapeutic use of milk in atisara: − 1. When movement of flatus and stool is arrested, acute colic pain, patient voids blood and mucous- profuse quantity of milk should be given. − 2. In pittaja atisara-goat milk-for promotion of strength and complexion. − 3. In pittaja atisara, when dosha are excessively aggravated then cow’s milk should be given for laxation. − Milk is an emulsion or colloid of butter fat globules within a water-based fluid that contains dissolved carbohydrates and protein aggregates with minerals. Because it is produced as a food source for the young, all of its contents provide benefits for its growth. The principal requirements are energy (lipids, lactose, and protein), biosynthesis of non-essential amino acids supplied by proteins (essential amino acids and amino groups), essential fatty acids, vitamins and inorganic elements, and water. − Milk composition analysis, per 100 grams − Constituents Unit Cow+ − Goat − Sheep − Buffalo − Water g 87.8 88.9 83.0 81.1 − Protein g 3.2 3.1 5.4 4.5 − Fat g 3.9 3.5 6.0 8.0 − ----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 − Carbohydrate (i.e the sugar form of Lactose) − g 4.8 4.4 5.1 4.9 − Cholesterol mg 14 10 11 8 − Calcium mg 120 100 170 195 − Energy kcal 66 60 95 110 − kJ 275 253 396 463 − − The disease atisara may be correlated to diarrhoea. − − Diarrhoea − 1. Gastroenterologists define diarrhoea as the passage of more than 200 g of stool daily, and measurement of stool volume is helpful in confirming this. − 2. The most severe symptom in many patients is urgency of defecation, and faecal incontinence is a common event in acute and chronic diarrhoeal illnesses. − Acute diarrhoea − 1. This is extremely common and usually due to faecaloral transmission of bacteria, their toxins, viruses or parasites. − 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. A variety of drugs, including antibiotics, cytotoxic drugs, PPIs and NSAIDs, may be responsible for acute diarrhoea. − Chronic or relapsing diarrhoea − 1. The most common cause is irritable bowel syndrome, which can present with increased frequency of defecation and loose, watery or pellety stools. − 2. Diarrhoea rarely occurs at night and is most severe before and after breakfast. − 3. At other times the patient is constipated and there are other characteristic symptoms of irritable bowel syndrome. − 4. The stool often contains mucus but never blood, and 24-hour stool volume is less than 200 g. − 5. Chronic diarrhoea can be categorised as disease of the colon or small bowel, or malabsorption − 6. Clinical presentation, examination of the stool, routine blood tests and imaging reveal diagnosis in many cases. − 7. A series of negative investigations usually implies irritable bowel syndrome but some patients clearly have organic disease and need more extensive investigations. − Differential diagnosis: − Colonic Malabsorption Small bowel − Clinical features Blood and mucus Steatorrhoea Large-volume,watery stool − in stool − Cramping Undigested food Abdominal bloating − lower abdominal in the stool Cramping mid- − pain Weight loss and abdominal pain − nutritional − disturbances − Some causes Inflammatory bowel Pancreatic VIPoma(endocrine tumor) disease − Neoplasia Chronic pancreatitis Drug-induced − Ischaemia Cancer of pancreas NSAIDs − Irritable bowel Cystic fibrosis Aminosalicylates − syndrome − Enteropathy Selective serotonin − Coeliac disease re-uptake − Lymphoma inhibitors (SSRIs) − − Tropical sprue − Lymphangiectasia − Investigations Colonoscopy with Ultrasound, CT and Stool volume − biopsies MRCP − Small bowel biopsy Gut hormone profile − Barium follow- Barium follow-through − through − − Acute diarrhoea and vomiting − 1. Acute diarrhoea, sometimes with vomiting, is the predominant symptom in infectious gastroenteritis − 2. Acute diarrhoea may also be a symptom of other infectious and non-infectious diseases − 3. Stress, whether psychological or physical, can also produce loose stools. − Causes of infectious gastroenteritis − Toxin in food: < 6 hours incubation − • Bacillus cereus • Clostridium spp. − • Staph. aureus enterotoxin − Bacterial: 12-72 hours incubation − • Vibrio cholerae • Salmonella − • Enterotoxigenic E. Coli • Shigella − • Campylobacter − • Shiga toxin-producing E. coli • Clostridium difficile − − • Enteroinvasive E. coli − Viral: short incubation − • Rotavirus • Norovirus − Protozoal: long incubation − • Giardiasis • Amoebic dysentery − • Cryptosporidium − • Isosporiasis i − • Microsporidiosis − − Differential diagnosis of acute diarrhoea and vomiting − Infectious causes − • Gastroenteritis • Pelvic inflammatory disease − • C. difficile infection − • Acute diverticulitis • Meningococcaemia − • Sepsis − • Pneumonia (especially atypical disease) − • Malaria − Non-infectious causes − Gastrointestinal − • Inflammatory bowel • Overflow from constipation − disease • Bowel malignancy − Metabolic − • Diabetic ketoacidosis • Uraemia − • Neuroendocrine tumours − • Thyrotoxicosis releasing (e.g.) VIP or 5-HT − Drugs and toxins − • NSAIDs • Heavy metals − • Cytotoxic agents • Ciguatera fish poisoning − • Antibiotics − • Proton pump inhibitors • Scombrotoxic fish poisoning − • Dinoflagellates • Plant toxins − 1. The World Health Organization (WHO) estimates that there are more than 1000 million cases of acute diarrhoea annually in developing countries, with 3-4 million deaths, most often in infants and young children. − 2. In developed countries diarrhoea remains an important problem and the elderly are most vulnerable − 3. The majority of episodes are due to infections spread by the faecal-oral route and transmitted either on fomites, on contaminated hands, or in food or water. − 4. Measures such as the provision of clean drinking water, appropriate disposal of human and animal sewage, and simple principles of food hygiene all limit gastroenteritis. − Clinical features − 1. The history should include questioning about foods ingested, the duration and frequency of diarrhoea, the presence of blood or steatorrhoea, abdominal pain and tenesmus, and whether family or community members have been affected. − 2. Fever and bloody diarrhoea suggest an invasive, colitic, dysenteric process. − 3. Incubation periods of less than 18 hours suggest toxin-mediated food poisoning − 4. Incubation period longer than 5 days suggests diarrhoea caused by protozoa or helminths. − The clinical features of food-borne gastroenteritis depend on the pathogenic mechanisms involved. − 5. Some organisms (Bacillus cereus, Staph. aureus and Vibrio cholerae) elute exotoxins, which exert their major effects on the stomach and small bowel, and produce vomiting ; and/or so-called ‘secretory’ diarrhoea, which is watery ; diarrhoea without blood or faecal leucocytes. − • In general, the time from ingestion to the onset of symptoms is short and, other than dehydration, little systemic upset occurs. − 6. Other organisms, such as Shigella spp., Campylobacter spp. and enterohaemorrhagic E. coli (EHEC), may directly invade the mucosa of the small bowel or produce cytotoxins that cause mucosal ulceration, typically affecting the terminal small bowel and colon. − The incubation period is longer and more systemic upset occurs, with prolonged bloody diarrhoea. − 7. Salmonella spp. are capable of invading enterocytes, and of causing both a secretory response and invasive disease with systemic features. − • This is seen with Salmonella typhi and S. paratyphi (enteric fever), and, in the immunocompromised host, with non-typhoidal Salmonella spp. − Physical examination − 1. Examination includes assessment of the degree of dehydration − • Skin turgor − • Pulse and blood pressure measurement. − • The urine output and ongoing stool losses should be monitored. − − Investigations − 1. Examination of Stool − A. Inspection of stool for blood − B. Microscopy -- leucocytes, and ova, cysts and parasites( if the history indicates former tropical residence or travel). − C. Stool culture should be performed, if possible. − Blood − 2. FBC − 3. Serum electrolytes indicate the degree of inflammation and dehydration. − 4. In a malarious area, a blood film for malaria parasites should be obtained. − 5. Blood and urine cultures and a chest X-ray may identify alternative sites of infection, particularly if the clinical examination is suggestive of a syndrome other than gastroenteritis. − − Foods associated with infectious illness including gastroenteritis − Raw seafood − • Norovirus • Hepatitis A − • Vibrio spp. − Raw eggs − • Salmonella spp. − Undercooked meat or poultry − • Salmonella spp. • EHEC − • Campylobacterspp. • C. pertringens − Unpasteurised milk or juice − • Salmonella spp. • EHEC − • Campylobacterspp. • V, enterocolitica − Unpasfeurised soft cheeses − • Salmonella spp. • Y. enterocolitica − • Campylobacferspp. • L. Monocytogenes − • ETEC − Home-made canned goods − • botulinum − Raw hot dogs, pate − • L. Monocytogenes − − Management − Treatment: − Infectious Diarrhea or Bacterial Food Poisoning − Empirical regimens for the treatment of traveler's diarrhea are − 1. Clinical Syndrome − Watery diarrhea (no blood in stool, no fever), 1 or 2 unformed stools per day without distressing enteric symptoms − Treatment - Oral fluids (oral rehydration solution, Pedialyte, Lytren, or flavored mineral water) and saltine crackers − 2. Watery diarrhea (no blood in stool, no fever), 1 or 2 unformed stools per day with distressing enteric symptoms − Treatment - Bismuth subsalicylate (for adults): 30 mL or 2 tablets (262 mg/tablet) every 30 min for 8 doses; or loperamideb: 4 mg initially followed by 2 mg after passage of each unformed stool, not to exceed 8 tablets (16 mg) per day (prescription dose) or 4 caplets (8 mg) per day (over-the-counter dose); drugs can be taken for 2 days − 3. Watery diarrhea (no blood in stool, no distressing abdominal pain, no fever), >2 unformed stools per day − Treatment- Antibacterial drugc plus (for adults) loperamideb (see dose above) − 4. Dysentery (passage of bloody stools) or fever (>37.8°C) − Treatment- Antibacterial drug − 5. Vomiting, minimal diarrhea − Treatment- Bismuth subsalicylate (for adults; see dose above) − 6. Diarrhea in infants (<2 years old) − Treatment- 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 − − Current clinical management in Ayurveda practice: − Principles of treatment: Deepana, Grahi, Pachana, buttermilk − Main drugs: Kutaja, Ahiphena, Bhanga, Bhallataka, Bilva − Type Formulation Dose Time Anupana − Vata and kapha dominant Jatiphaladi –bhallataka guti 60-120 mg Before meals two times Buttermilk − Pitta and kapha dominant Kutaja kalpa 60 -120 mg Before meals two times Rice water with buttermilk − Raktaja Shatavaryadi kwatha 25 to 40 ml Empty stomach -- − Pravahika (dysentery) 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 − Chronic Dhanya panchaka churna 10-25 grams Between meals Bilvavaleha − Shatpala ghee 10-20 ml Before meals Buttermilk or hot water − Bilwadi tailam 10-20 grams Before meals Buttermilk − − Research areas: Line 1,871:
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→Vidhi Vimarsha
=== ''Vidhi Vimarsha'' ===
=== ''Vidhi Vimarsha'' ===
Work in Progress
=== Research areas ===
Though there are many anti-diarheal and ant-dysentery medicines are available in conventional systems of medicine, the immediate stoppage of diarrhea 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.
Though there are many anti-diarheal and ant-dysentery medicines are available in conventional systems of medicine, the immediate stoppage of diarrhea 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.
Effect of ayurveda medicines in chronic diarrhea and psycho somatic disease like irritable bowel syndrome needs further evaluation.
Effect of ayurveda medicines in chronic diarrhea and psycho somatic disease like irritable bowel syndrome needs further evaluation.
Yamaka (यमक): mixture of two unctuous substances e.g. mixture of ghee and oil
Yamaka (यमक): mixture of two unctuous substances e.g. mixture of ghee and oil
Yavāgū (यवागू): thick gruel
Yavāgū (यवागू): thick gruel
Further reading:
=== Further reading ===
1. Charaka 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
1. Charaka 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
2. Valiathan, M.S. (2009): Legacy of Charaka, Sushruta, Vagbhata, Orient Longman, Chennai.
2. Valiathan, M.S. (2009): Legacy of Charaka, Sushruta, Vagbhata, Orient Longman, Chennai.