Changes

=== 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.  

*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'' ====

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē'tisāracikitsitaṁ nāmaikōnaviṁśō'dhyāyaḥ||19||  

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē'tisāracikitsitaṁ nāmaikōnaviṁśō'dhyāyaḥ||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 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'' ===

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''.

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]]

[[File:Atisara.png]]

*'''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''

===== Researches on ''atisara'' and medicines =====

===== 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>  

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>  

    

    

''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.<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''.   

''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>  

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>  

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

#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.

#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.   

#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

#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

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

==== 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.<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>

==== List of research on review of ''atisara'' ====

==== List of research on review of ''atisara'' ====

=== Further reading ===

=== Further reading ===

   

   

#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

#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 Charaka, Sushruta, Vagbhata, Orient Longman, Chennai.

#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.

#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

#Parameswarappa’s ĀyurvedÍya Vikriti Vijñāna and Roga Vijñāna by Dr. P.S. Byadgi. Volume II, pages-431-446

#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, 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.

#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.

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