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Line 1: + + + + + + + + + + + + + − The term ‘purisha’ means fecal matter or stool. It denotes the waste product or undigested residue remaining after the nutrient fraction of the food has been separated and absorbed. The feces (purisha) are important for normal physiological functions of [[vayu]] and [[agni]]. (SAT-B.459). Stool examination is an important test for assessment of status of digestion and overall health. This article deals with physiological, pathological, diagnostic and therapeutic aspects of stool. + − + + + + + + + + + + + + + + + + + + + + − The Sanskrit word ‘purisha’ is derived from root “pru” by adding the suffix “ishan” that means crumbling or loose earth, excremental dirt, rubbish, the solid mass which fills up (the intestine) etc. It is also known by synonyms like shakrut, varcha/varchaska, vishtha and vit in Sanskrit literature. + + + − === Fundamental composition and properties=== + + + + + + Line 20:
Line 59: − + + − ===Formation===+ + + − When the food material from the stomach (amashaya) reaches the large intestine (pakwashaya), it is dried up by the heat of [[pitta]] and absorbing property (ruksha guna) of vata to form lumps. [Cha. Sa. [[Chikitsa Sthana]] 15/11] Defecation is regulated by [[vata]] [[dosha]].The physiology of stool formation and defecation in described as follows.+ − + − + − ===Quantity=== + + − + − + − ===Functions=== − + + + − ===Channels carrying feces (purishavaha srotas) ===+ + − + + + + − ===Purishadhara kala (layer forming stools) ===+ + + + − Kala means the layer in body observed in sagittal section. The layer holding fecal matter(purishadhara kala) is present inside large intestine (pakwashaya) separates the waste products from the digested food.It covers the alimentary tract, liver and intestine especially in the caecum (unduka).[Su. Sa. Sharira Sthana 4/16-17]This layer performs functions of absorption of nutrients and elimination of harmful substances through stools. + − ===Diagnostic perspectives === + + − + + Line 62:
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Line 299: − + − + + + + − *The faecal transplant, the transfer of faces or portions of the faecal matter from one organism into the gastrointestinal tract of another, is rapidly gaining attention as a treatment for human gut infections. Now a days, it is used as a general research tool for gain-of-function experiments in animal models. + − − − − *Recently, a research study has developed and validated a toilet paper–based fecal occult blood test for the use as a point-of-care test for the rapid (in 60 seconds) and easy testing of fecal occult blood which can be a promising tool for screening of colorectal cancer in public health domain. + + − + + + + + + − + + + + +
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|title=Purisha
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|keywords=Purisha,fecal matter in ayurveda,Purisha Meaning,Mala,Aharamala,Ayurveda, Indian system of medicine,charak samhita
|description=The term ‘purisha’ means fecal matter or stool. It denotes the waste product or undigested residue remaining after the nutrient fraction of the food has been separated and absorbed.
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
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<p style="text-align:justify;">The term ‘purisha’ means fecal matter or stool. It denotes the waste product or undigested residue remaining after the nutrient fraction of the food has been separated and absorbed. The feces (purisha) are important for normal physiological functions of [[vayu]] and [[agni]]. (SAT-B.459).<ref>Available from http://namstp.ayush.gov.in/#/sat</ref> Stool examination is an important test for assessment of status of digestion and overall health. This article deals with physiological, pathological, diagnostic and therapeutic aspects of stool.
</p>
{{Infobox
|title = Contributors
== Meaning and synonyms ==
|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Mala]] /[[Purisha]]
|label2 = Authors
|data2 = Anagha S., Deole Y.S.
|label3 = Reviewer and Editor
|data3 = Basisht G.
|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar
|label5 = Correspondence email
|data5 = carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of first publication:
|data7 = January 8, 2021
|label8 = DOI
|data8 = [https://doi.org/10.47468/CSNE.2021.e01.s09.038 10.47468/CSNE.2021.e01.s09.038]
}}
== Meaning and synonyms ==
<div style="text-align:justify;">
The Sanskrit word ‘purisha’ is derived from root “pru” by adding the suffix “ishan” that means crumbling or loose earth, excremental dirt, rubbish, the solid mass which fills up (the intestine) etc.<ref>Jha Srujan. Amarkosha online application.</ref> It is also known by synonyms like shakrut, varcha/varchaska, vishtha and vit in Sanskrit literature.
</div>
==Fundamental composition and properties==
<div style="text-align:justify;">
The fecal matter has predominance of [[prithvi mahabhuta ]]. Its consistency depends upon the presence of [[jala mahabhuta]] in it.
The fecal matter has predominance of [[prithvi mahabhuta ]]. Its consistency depends upon the presence of [[jala mahabhuta]] in it.
*fat- 2–15%
*fat- 2–15%
*Other constituents- calcium and iron phosphates, intestinal secretions, small amounts of dried epithelial cells, and mucus.
*Other constituents- calcium and iron phosphates, intestinal secretions, small amounts of dried epithelial cells, and mucus.<ref>Rose C, Parker A, Jefferson B, Cartmell E. The Characterization of Feces and Urine: A Review of the Literature to Inform Advanced Treatment Technology. Crit Rev Environ Sci Technol. 2015;45(17):1827-Vale</ref>
</div>
==Formation==
<div style="text-align:justify;">
When the food material from the stomach (amashaya) reaches the large intestine (pakwashaya), it is dried up by the heat of [[pitta]] and absorbing property (ruksha guna) of vata to form lumps. [Cha. Sa. [[Chikitsa Sthana]] 15/11] Defecation is regulated by [[vata]] [[dosha]].
The physiology of stool formation and defecation in described as follows.
Feces formation takes place in the large intestine.It carries out functions like absorbing water and electrolytes, forming and propelling feces toward the rectum for elimination. Most nutrients and up to 90% of the water are absorbed by the small intestine from the indigestible material.The ascending colon absorbs remaining water and other key nutrients from it to form solidified stool.The feces are stored in descending colon and are emptied into the rectum.The sigmoid colon contracts to increase the pressure inside the colon, causing the stool to move into the rectum. The rectum holds the feces awaiting elimination by defecation.
Feces formation takes place in the large intestine.It carries out functions like absorbing water and electrolytes, forming and propelling feces toward the rectum for elimination. Most nutrients and up to 90% of the water are absorbed by the small intestine from the indigestible material.The ascending colon absorbs remaining water and other key nutrients from it to form solidified stool.The feces are stored in descending colon and are emptied into the rectum.The sigmoid colon contracts to increase the pressure inside the colon, causing the stool to move into the rectum. The rectum holds the feces awaiting elimination by defecation.<ref>Azzouz LL, Sharma S. Physiology, Large Intestine. [Updated 2020 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507857/</ref>
</div>
==Quantity==
<div style="text-align:justify;">
The total quantity of purisha is seven anjali (personified measurement unit).[Cha. Sa. [[Sharira Sthana]] 7/15]
The total quantity of purisha is seven anjali (personified measurement unit).[Cha. Sa. [[Sharira Sthana]] 7/15]
On average humans eliminate 128 g of fresh feces per person per day.
On average humans eliminate 128 g of fresh feces per person per day.<ref>Available from https://en.wikipedia.org/wiki/Human_feces cited on 24/12/2020</ref>
</div>
Purisha is a fundamental component of body.It supports the functions of [[vayu]] and [[agni]] in body.[Su. Sa. Sutra Sthana 15/5],[A. S.Sutra Sthana 19/4]It carries the solid waste products of metabolism and helps in preservation of health. It also helps to maintain the microbial flora of intestine.
==Functions==
<div style="text-align:justify;">
Purisha is a fundamental component of body.It supports the functions of [[vayu]] and [[agni]] in body.[Su. Sa. Sutra Sthana 15/5],[A. S.Sutra Sthana 19/4]
It carries the solid waste products of metabolism and helps in preservation of health. It also helps to maintain the microbial flora of intestine.
</div>
The channels carrying feces, are originated from the colon and anorectal region.[Cha.Sa. Vimana Sthana 5/8] [Su. Sa. Sharira Sthana 9/12] The large intestine and rectum form, store and carry fecal matter.
==Channels carrying feces (purishavaha srotas)==
<div style="text-align:justify;">
The channels carrying feces, are originated from the colon and anorectal region.[Cha.Sa.[[Vimana Sthana]] 5/8] [Su. Sa. Sharira Sthana 9/12] The large intestine and rectum form, store and carry fecal matter.
</div>
==Purishadhara kala (layer forming stools)==
<div style="text-align:justify;">
Kala means the layer in body observed in sagittal section. The layer holding fecal matter(purishadhara kala) is present inside large intestine (pakwashaya) separates the waste products from the digested food.It covers the alimentary tract, liver and intestine especially in the caecum (unduka).[Su. Sa. Sharira Sthana 4/16-17] This layer performs functions of absorption of nutrients and elimination of harmful substances through stools.
</div>
==Diagnostic perspectives==
===Causes of vitiation===
===Causes of vitiation===
<div style="text-align:justify;">
The channels carrying feces are afflicted due to suppression of urge of defecation, over eating, eating during indigestion, especially in persons with poor digestive capacity and who are emaciated. [Cha.Sa.[[ Vimana Sthana ]] 5/21]
The channels carrying feces are afflicted due to suppression of urge of defecation, over eating, eating during indigestion, especially in persons with poor digestive capacity and who are emaciated. [Cha.Sa.[[ Vimana Sthana ]] 5/21]
</div>
==Abnormal states==
===Abnormal states===
<div style="text-align:justify;">
The increase or decrease in quality and/or quantity of fecal matter can lead to various abnormal conditions. The states can be assessed by following clinical features.
The increase or decrease in quality and/or quantity of fecal matter can lead to various abnormal conditions. The states can be assessed by following clinical features.
{| class="wikitable"
{| class="wikitable"
|Intestinal gas /flatus moving upward along with sound ||--
|Intestinal gas /flatus moving upward along with sound ||--
|-
|-
|Frequent movement of gas in alimentary canal especially at epigastric region|| -
|Frequent movement of gas in alimentary canal especially at epigastric region|| --
|}
|}
* *[Cha Sa. [[Sutra Sthana]] 17/70], [Su. Sa. Sutra Sthana 15/11]
* *[Cha Sa. [[Sutra Sthana]] 17/70], [Su. Sa. Sutra Sthana 15/11]
'''Clinical features of vitiation of channels carrying fecal matter'''
'''Clinical features of vitiation of channels carrying fecal matter'''
Difficulty in evacuating bowels, scanty stools, passage with sound and pain, loose motions, or irritable/irregular bowels are observed due to affliction of channels carrying fecal matter.[ Cha. Sa. [[Vimana Sthana]] 5/8].Abdominal distension, excessive foul smell of feces, hardness of bowel or presentations like paralytic ileus are also seen.[ Su. Sa. Sharira Sthana 9/12]
Difficulty in evacuating bowels, scanty stools, passage with sound and pain, loose motions, or irritable/irregular bowels are observed due to affliction of channels carrying fecal matter.[ Cha. Sa. [[Vimana Sthana]] 5/8].
Abdominal distension, excessive foul smell of feces, hardness of bowel or presentations like paralytic ileus are also seen.[Su. Sa. Sharira Sthana 9/12]
Clinical features of suppression of urge of defecation:
Clinical features of suppression of urge of defecation:
*distension of abdomen [Cha. Sa. [[Sutra Sthana ]] 7/8]
*distension of abdomen [Cha. Sa. [[Sutra Sthana ]] 7/8]
</div>
== Stool examination(purisha pareeksha)==
== Stool examination(purisha pareeksha)==
<div style="text-align:justify;">
Examination of feces is included in the eight fold clinical diagnostic methods (ashtavidha pareeksha) mentioned in Ayurveda. [Ref?? Sha.Sa. and Y.R.] It is done in various medical conditions.
Examination of feces is included in the eight fold clinical diagnostic methods (ashtavidha pareeksha) mentioned in Ayurveda. [ Sha.Sa. Y.R. malapariksha 1] It is done in various medical conditions.
'''Visual Examination:'''
'''Visual Examination:'''
The Bristol stool scale is a diagnostic medical tool designed to classify the form of human feces . It is used in both clinical as well as experimental fields.
The Bristol stool scale is a diagnostic medical tool designed to classify the form of human feces . It is used in both clinical as well as experimental fields.
'''The seven categories in Bristol Stool Scale.'''
'''The seven categories in Bristol Stool Scale.''' <ref>Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017;6(11):99. Published 2017 Oct 26. doi:10.3390/jcm6110099</ref>
{| class="wikitable"
{| class="wikitable"
|-
|-
'''Occult Blood Test'''
'''Occult Blood Test'''
This test checks for hidden (occult) blood in the feces which is not visible to naked eyes. It detects the subtle blood loss in the gastrointestinal tract, anywhere from the mouth to the colon. It is used in the diagnosis of various conditions starting from peptic ulcer to malignancy like colorectal cancer.
This test checks for hidden (occult) blood in the feces which is not visible to naked eyes. It detects the subtle blood loss in the gastrointestinal tract, anywhere from the mouth to the colon. It is used in the diagnosis of various conditions starting from peptic ulcer to malignancy like colorectal cancer.<ref>Arasaradnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018;67(8):1380-1399. doi:10.1136/gutjnl-2017-315909</ref>
'''Microbiological test'''
'''Microbiological test'''
It is used as diagnostic test to detect the excess fat in the feces (steatorrhea) indicating fat malabsorption conditions. The dietary fat (primarily triglycerides) is digested by enzymes such as pancreatic lipase in the duodenum, and absorbed in the jejenum of the small intestine.The free fatty acids enter circulation for metabolism and storage.Human feces normally contains very little undigested fat.
It is used as diagnostic test to detect the excess fat in the feces (steatorrhea) indicating fat malabsorption conditions. The dietary fat (primarily triglycerides) is digested by enzymes such as pancreatic lipase in the duodenum, and absorbed in the jejenum of the small intestine.The free fatty acids enter circulation for metabolism and storage.Human feces normally contains very little undigested fat.
Steatorrhea is observed in following conditions:
Steatorrhea is observed in following conditions:<ref>Available from https://en.wikipedia.org/wiki/Fecal_fat_test accessed on 29/12/2020</ref>
*Disorders of exocrine pancreatic function, such as chronic pancreatitis, cystic fibrosis and Shwachman–Diamond syndrome (these are characterized by deficiency of pancreatic digestive enzymes)
*Disorders of exocrine pancreatic function, such as chronic pancreatitis, cystic fibrosis and Shwachman–Diamond syndrome (these are characterized by deficiency of pancreatic digestive enzymes)
!Dosha predominance !! Characteristics of stool*
!Dosha predominance !! Characteristics of stool*
|-
|-
|Vata ||Hard, dry, broken, frothy, dry and smoky color
|[[Vata]] ||Hard, dry, broken, frothy, dry and smoky color
|-
|-
|Pitta||Yellowish in color
|[[Pitta]]||Yellowish in color
|-
|-
|Kapha ||Whitish in color
|[[Kapha]] ||Whitish in color
|-
|-
|Vata-kapha||Brownish in color
|Vata-kapha||Brownish in color
===Bad prognostic features of stool===
===Bad prognostic features of stool===
Excessively blackish/whitish/yellowish/ reddish coloration of feces, excessively hot nature (causing burning sensation in anus), excessively foul-smelling or with a mixture of different colors is indicative of bad prognosis of a disease or imminent death of the person. [Y. R. mala pariksha / 7, 10] These features are indicative of grave underlying pathologies like gastrointestinal bleeding.
Excessively blackish/whitish/yellowish/ reddish coloration of feces, excessively hot nature (causing burning sensation in anus), excessively foul-smelling or with a mixture of different colors is indicative of bad prognosis of a disease or imminent death of the person. [Y. R. mala pariksha / 7, 10]
These features are indicative of grave underlying pathologies like gastrointestinal bleeding.
===Role of feces in etiopathogenesis and clinical features of diseases===
===Role of feces in etiopathogenesis and clinical features of diseases===
*Loose motions, stool associated with blood and mucus are features of anemia and diseases due to blood deficiency (pandu) caused by habitual consumption of clay [Cha.Sa.[[Chikitsa Sthana]] 16/30].
*Loose motions, stool associated with blood and mucus are features of anemia and diseases due to blood deficiency (pandu) caused by habitual consumption of clay [Cha.Sa.[[Chikitsa Sthana]] 16/30].
*The following table shows characteristic features of faecal matter in different types of fever (jwara) [Cha. Sa. [[Niana Sthana ]] 1/21-27], abdominal lumps(gulma) [Cha.Sa.[[Nidana Sthana ]] 3/7-11] and diseases of digestion and metabolism (grahani) [Cha. Sa. [[ Chikitsa Sthana]] 15/64, 66,70].
*The following table shows characteristic features of faecal matter in different types of fever (jwara) [Cha.Sa.[[Nidana Sthana]] 1/21-27], abdominal lumps(gulma) [Cha.Sa.[[Nidana Sthana ]] 3/7-11] and diseases of digestion and metabolism (grahani) [Cha. Sa. [[ Chikitsa Sthana]] 15/64, 66,70].
{| class="wikitable"
{| class="wikitable"
!Dosha dominance!!Character of fecal matter in fever(jwara)/ abdominal lump(gulma) !! Characteristic features of stool in diseases of digestion and metabolism (grahani) *
!Dosha dominance!!Character of fecal matter in fever(jwara)/ abdominal lump(gulma) !! Characteristic features of stool in diseases of digestion and metabolism (grahani) *
|-
|-
|Vata dosha ||Dark, blackish or reddish discoloration of stool and reduced tendency to evacuation of stool.|| Painful defecation, takes more time for elimination, feces are watery, dry, small sized associated with flatus and undigested food. Frequency of defecation is increased.
|[[Vata dosha]] ||Dark, blackish or reddish discoloration of stool and reduced tendency to evacuation of stool.|| Painful defecation, takes more time for elimination, feces are watery, dry, small sized associated with flatus and undigested food. Frequency of defecation is increased.
|-
|-
|Pitta dosha || Green or yellow coloration of stool.|| The stools have undigested food particles with either bluish-yellowish tinge or yellow in color; loose/watery.
|[[Pitta dosha]] || Green or yellow coloration of stool.|| The stools have undigested food particles with either bluish-yellowish tinge or yellow in color; loose/watery.
|-
|-
|Kapha dosha||Whitish coloration of stool.||Stools are mixed with undigested items and mucous; heavy (sink in water).
|[[Kapha dosha]]||Whitish coloration of stool.||Stools are mixed with undigested items and mucous; heavy (sink in water).
|}
|}
The character of stool is considered as an important parameter in assessment of the therapeutic oleation before therapeutic emesis (vamana) and purgation (virechana). The dietary fat consumption (in the form of ghee, oil, muscle fat and marrow) is increased for therapeutic purpose. The same is reflected in the consistency and fat content of stools.
The character of stool is considered as an important parameter in assessment of the therapeutic oleation before therapeutic emesis (vamana) and purgation (virechana). The dietary fat consumption (in the form of ghee, oil, muscle fat and marrow) is increased for therapeutic purpose. The same is reflected in the consistency and fat content of stools.
a)Hard and dry feces are signs of inadequate oleation
a) Hard and dry feces are signs of inadequate oleation
b)Lubricated, soft and not well formed faeces indicate proper oleation.
b) Lubricated, soft and not well formed faeces indicate proper oleation.
c)Improperly formed and loose faeces indicate excess oleation. [Cha.Sa.[[Sutra Sthana]] 13/57-59]
c) Improperly formed and loose faeces indicate excess oleation. [Cha.Sa.[[Sutra Sthana]] 13/57-59]
</div>
==Management of disorders related to fecal matter==
==Management of disorders related to fecal matter==
===Management of increased state ===
===Management of increased state ===
<div style="text-align:justify;">
*Judicious application of cleansing therapies (shodhana) or medicines to facilitate the natural expulsion is indicated.[Su. Sa. Sutra Sthana 15/17]
*Judicious application of cleansing therapies (shodhana) or medicines to facilitate the natural expulsion is indicated.[Su. Sa. Sutra Sthana 15/17]
'''Diet promoting the formation of feces (in case of scanty stool):'''
'''Diet promoting the formation of feces (in case of scanty stool):'''
*Barley (yava) [Cha. Sa. [[Sutra Sthana ]]25/40]
*Barley (yava) [Cha.Sa.[[Sutra Sthana]]25/40]
*A type of soup prepared of cereals and pulses (dhanya-yusha)made of barley(yava), green gram(mudga), black gram(masha), and shali type of rice, sesame seeds, Ziziphus jujuba Lamk (kola) and tender fruits of Aegle marmelos (bilva), sizzled with ghee and oil taken together with curd and the extract of pomegranate(dadima). One should take boiled shali rice along with this soup.
*A type of soup prepared of cereals and pulses (dhanya-yusha)made of barley(yava), green gram(mudga), black gram(masha), and shali type of rice, sesame seeds, Ziziphus jujuba Lamk (kola) and tender fruits of Aegle marmelos (bilva), sizzled with ghee and oil taken together with curd and the extract of pomegranate(dadima). One should take boiled shali rice along with this soup.
*Meat soup
*Meat soup
*The red variety of shali rice boiled by adding ghee and sour ingredients. [Cha.Sa.[[Chkitsa Sthana ]] 19/35-41]
*The red variety of shali rice boiled by adding ghee and sour ingredients. [Cha.Sa.[[Chikitsa Sthana ]] 19/35-41]
'''Role of tastes (rasa):'''
'''Role of tastes (rasa):'''
Excessive consumption of bitter taste (tikta rasa) food items leads to decrease of fecal matter. Excessive consumption of astringent food items (kashaya rasa) lead to constipation. [Cha. Sa. [[Sutra Sthana]] 26/43]
Excessive consumption of bitter taste (tikta rasa) food items leads to decrease of fecal matter. Excessive consumption of astringent food items (kashaya rasa) lead to constipation. [Cha.Sa.[[Sutra Sthana]]26/43]
</div>
==Current researches==
==Current researches==
<div style="text-align:justify;">
*The faecal transplant, the transfer of faces or portions of the faecal matter from one organism into the gastrointestinal tract of another, is rapidly gaining attention as a treatment for human gut infections. Now a days, it is used as a general research tool for gain-of-function experiments in animal models.<ref>Bojanova DP, Bordenstein SR. Fecal Transplants: What Is Being Transferred?. PLoS Biol. 2016;14(7):e1002503. Published 2016 Jul 12. doi:10.1371/journal.pbio.1002503.</ref>
*It is evident through some animal models that the gut micro biome has the functional capacity to induce or relieve metabolic syndrome. Faecal Microbiota Transplantation (FMT) is an emerging therapy with abundant potential in the field of management of obesity and metabolic syndrome.<ref>Zhang Z, Mocanu V, Cai C, et al. Impact of Fecal Microbiota Transplantation on Obesity and Metabolic Syndrome-A Systematic Review. Nutrients. 2019;11(10):2291. Published 2019 Sep 25. doi:10.3390/nu11102291</ref>
*It is evident through some animal models that the gut micro biome has the functional capacity to induce or relieve metabolic syndrome. Faecal Microbiota Transplantation (FMT) is an emerging therapy with abundant potential in the field of management of obesity and metabolic syndrome.
*Recently, a research study has developed and validated a toilet paper–based fecal occult blood test for the use as a point-of-care test for the rapid (in 60 seconds) and easy testing of fecal occult blood which can be a promising tool for screening of colorectal cancer in public health domain.<ref>Wang HY, Lin TW, Chiu SY, et al. Novel Toilet Paper-Based Point-Of-Care Test for the Rapid Detection of Fecal Occult Blood: Instrument Validation Study. J Med Internet Res. 2020;22(8):e20261. Published 2020 Aug 7. doi:10.2196/20261.</ref>
</div>
==Related theses works==
==Related theses works==
<div style="text-align:justify;">
1.Inya Lingu(2012): Study on Aetiopathogenesis of Vibandha in Geriatric persons and Role of Vaishvanara Churna in its Samprapti Vighatana, Department of Roganidana and Vikruti Vigyana, IPGT &RA, Jamnagar.
1.Inya Lingu(2012): Study on Aetiopathogenesis of Vibandha in Geriatric persons and Role of Vaishvanara Churna in its Samprapti Vighatana, Department of Roganidana and Vikruti Vigyana, IPGT &RA, Jamnagar.
2.Ramanand Tiwari(2012) : Clinical Evaluation of Bilvadi Leha in the Management of Irritable Bowel Syndrome (IBS), Department of Roganidana and Vikruti Vigyana, IPGT &RA, Jamnagar.
2.Ramanand Tiwari(2012) : Clinical Evaluation of Bilvadi Leha in the Management of Irritable Bowel Syndrome (IBS), Department of Roganidana and Vikruti Vigyana, IPGT &RA, Jamnagar.
</div>
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==References==
==References:==
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