Changes

''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]].

''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.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.

''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.

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]

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'' / Fundamental Principles===

*''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''.  

*''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''.  

*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''.

*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'' ===

=== ''Vidhi Vimarsha'' / Applied Inferences===

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.

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.

#Observing body purification treatments as per ''prakriti'' and season

#Observing body purification treatments as per ''prakriti'' and season

===== 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''

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

==== 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

#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  

#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

#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

*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.

*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.  

*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.

*More researches are needed to study effect of [[Ayurveda]] medicines in chronic diarrhea and psycho somatic disease like irritable bowel syndrome.

=== Glossary ===

=== Glossary ===