Changes

===== Current clinical management in Ayurveda practice =====

===== Current clinical management in Ayurveda practice =====

*'''Principles of treatment''': deepana, grahi, pachana, buttermilk  

*'''Principles of treatment''': ''deepana, grahi, pachana,'' buttermilk  

*'''Main drugs''': kutaja, ahiphena, bhanga, bhallataka, bilva

*'''Main drugs''': ''kutaja, ahiphena, bhanga, bhallataka, bilva''

Vata and kapha dominant Jatiphaladi –bhallataka guti 60-120 mg Before meals two times Buttermilk

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''.

Pitta and kapha dominant Kutaja kalpa 60 -120 mg Before meals two times Rice water with buttermilk

''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)(Charaka 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.  Thus ''kutaja'' can be used for all purpose in management of ''atisara''. 

Pravahika (dysentery) Isabgola seeds cold effusion with sugar 5-10 ml Morning and night two times --

Chronic Dhanya panchaka churna 10-25 grams Between meals Bilvavaleha

Shatpala ghee 10-20 ml Before meals Buttermilk or hot water

Nitin Salve and Debendranath Mishra studied the botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhea.  

Nitin Salve and Debendranath Mishra studied the botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhoea.  

The conditions like ulcerative colitis, irritable bowel syndrome, acute diarrhoea are considered under the umbrella of atisara.

The conditions like ulcerative colitis, irritable bowel syndrome, acute diarrhea are considered under the umbrella of ''atisara''.

In a study, vatasakadi syrup was observed 70 % effective in treatment of atisara in children as compared to bala-chaturbhdra syrup.  

Management of exogenous diarrhoea/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. 

1. Diarrhea due to mental factors: These patients need counseling along with therapeutic management of diarrhea as discussed above.

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). 

2. 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.

3. 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.   

4. Fatty diarrhea, like watery diarrhea, indicates poor absorption of fat and other nutrients

 

5. Dysentery (passage of bloody stools) or fever (>37.8°C) should be treated with antibacterial drugs

6. Vomiting, minimal diarrhea should be treated with Bismuth subsalicylate.  

 

7. 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  

 

#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.   

#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.

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

==== 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 . The Centers for Disease Control and Prevention (CDC) considers rehydration as “the cornerstone of treatment of cholera”. CDC also recommends other treatment alternatives, based on recent studies in Bangladesh and other areas affected by cholera, such as zinc treatment . Severe cases need to take a recourse of antibiotics, though there are instances of resistance to tetracycline and other antimicrobial agents .

 

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 . The Centers for Disease Control and Prevention (CDC) considers rehydration as “the cornerstone of treatment of cholera”. CDC also recommends other treatment alternatives, based on recent studies in Bangladesh and other areas affected by cholera, such as zinc treatment. Severe cases need to take a recourse of antibiotics, though there are instances of resistance to tetracycline and other antimicrobial agents .

=== Research areas ===

=== Research areas ===