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{{#seo:

|title=Atisara Chikitsa

|titlemode=append

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|keywords=atisara, diarrhea, ama, nirama, sangrahi treatment, pichcha basti

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|keywords=atisara, diarrhea, ama, nirama, sangrahi treatment, pichcha basti,Ayurveda, Indian system of medicine, charak samhita.

|description=Chikitsa Sthana Chapter 19. Management of Atisara (diarrhea and associated disorders)

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=charak samhita

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|type=article

}}

<big>'''[[Chikitsa Sthana]] Chapter 19. Management of Atisara (diarrhea and associated disorders)</big>'''

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~~<big>''' Abstract </big>'''~~

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The chapter on [[Atisara Chikitsa]] (management of diarrhea) traces the historical origin of the disorder since the Vedic period and attributes it to eating of heavy and hot foods specially meat products. There are six types of diarrhea, three of which are caused by single ''dosha'' (''vataja, pittaja'' and ''kaphaja'') while a fourth is caused by the combination of all the three ''doshas''. The fifth and sixth types are caused due to psychological factors such as fear and grief. Some of these variants could be further classified based on their constituents, e.g., ''vataja atisara'' (diarrhea caused due to ''vata dosha'') is further divided into ''ama'' and ''nirama atisara'' (with or without mucoid substances diarrhea) and it has been emphasized not to stop the lose motions in initial or ''ama'' stage.

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The etiology, pathology, signs and symptoms of each of these six types of diarrhea, along with their prognosis have been detailed here.The principles of treatment and complications associated with diarrhea, such as bleeding, suppuration, ulceration and prolapsed anus are also described along with various measures to tackle the problems effectively.

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''Sangrahi'' (astringent or anti-diarrheals) therapies are not advisable in the initial stage of the disease because of presence of ''ama'' inside the body. Instead, mild laxative should be given to eliminate the accumulated ''doshas''. Diarrhea should be allowed to continue and should not be stopped by constipating or bowel binding drugs. The patients shall be managed with light to digest, nutritive and liquid diet regimen which enhances power of ''agni'' as well as it helps to stop diarrhea.

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~~'''Keywords''': ''atisara, diarrhea, ama, nirama, sangrahi'' treatment, ''pichcha basti''.~~

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{{Infobox

|title = Atisara Chikitsa

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|label5 = Other Sections

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|data6 = Byadgi P.S., Dube N.

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|label7 = Reviewer

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|data7 = Prasad B.S.

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|label8 = Editors

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|data8 = Singh G., Goyal M., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.020 10.47468/CSNE.2020.e01.s06.020]

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}}

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~~|header3~~ =

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<big>''' Abstract </big>'''

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<p style='text-align:justify;'>The chapter on [[Atisara Chikitsa]] (management of diarrhea) traces the historical origin of the disorder since the Vedic period and attributes it to eating of heavy and hot foods specially meat products. There are six types of diarrhea, three of which are caused by single [[dosha]] ([[vata]]ja, [[pitta]]ja and [[kapha]]ja) while a fourth is caused by the combination of all the three [[dosha]]. The fifth and sixth types are caused due to psychological factors such as fear and grief. Some of these variants could be further classified based on their constituents, e.g., [[vata]]ja atisara (diarrhea caused due to [[vata]] [[dosha]]) is further divided into ''ama'' and ''nirama atisara'' (with or without mucoid substances diarrhea) and it has been emphasized not to stop the lose motions in initial or ''ama'' stage.

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<br/>

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The etiology, pathology, signs and symptoms of each of these six types of diarrhea, along with their prognosis have been detailed here.The principles of treatment and complications associated with diarrhea, such as bleeding, suppuration, ulceration and prolapsed anus are also described along with various measures to tackle the problems effectively.

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<br/>

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''Sangrahi'' (astringent or anti-diarrheals) therapies are not advisable in the initial stage of the disease because of presence of ''ama'' inside the body. Instead, mild laxative should be given to eliminate the accumulated [[dosha]]. Diarrhea should be allowed to continue and should not be stopped by constipating or bowel binding drugs. The patients shall be managed with light to digest, nutritive and liquid diet regimen which enhances the power of [[agni]] as well as it helps to stop diarrhea. </p>

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}}

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'''Keywords''': atisara, diarrhea, ama, nirama, sangrahi treatment, pichcha [[basti]].

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~~=== Introduction ===~~

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''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]].

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== Introduction ==

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''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]].

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[[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.

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[[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. Piccha[[basti]] (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.

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''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.

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''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 [[dosha]]. 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.

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</div>

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=== Sanskrit Text, Transliteration and English Translation ===

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== Sanskrit Text, Transliteration and English Translation ==

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iti ha smAha bhagavAnAtreyaH||2||

</div></div>

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We shall ~~now illustrate~~ the chapter ~~on the management~~ of ~~''atisara'' (~~diarrhea). Thus, said ~~lord~~ Atreya [1-2]

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Now we shall expound the chapter "Atisara chikitsa" (Management of diarrhea and associated disorders). Thus said Lord Atreya. [1-2]

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</div>

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==== Query by Agnivesha ====

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=== Query by Agnivesha ===

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bhagavan! atIsArasyaprAgutpattinimittalakShaNopashamanAni prajAnugrahArthamAkhyAtumarhasIti||3||

</div></div>

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On one occasion, when Lord Atreya was sitting on the northern slope of the Himalayas surrounded by the sages after completing his daily worship and oblations to the fire, Agnivesha approached him, offered his humble salutations to him, and requested him to expound the origin, etiology, signs and symptoms, and treatment of ''atisara'' (diarrhea) for the well-being of humanity [3]

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</div>

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==== Historical origins of ''atisara'' ====

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=== Historical origins of ''atisara'' ===

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taM dRuShTvA pravyathitA bhUtagaNAH, teShAM copayogAdupAkRutAnAM gavAMgauravAdauShNyAdasAtmyatvAdashastopayogAccopahatAgnInAmupahatamanasAM [1] cAtIsAraHpUrvamutpannaH pRuShadhrayaj~je||4|| <br />

</div></div>

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After consideration of the above submission of Agnivesha, Lord Punarvasu said, “O Agnivesha, listen to me. I shall give a detailed response to your question.

In the Vedic age/ancient times, sacrificial animals used to get released in the wild soon after the recitation of the sacrificial mantras, and these animals were not killed during the course of the sacrifice (''yajna''). However, in the subsequent periods following the reign of Daksha Prajapati, the sons of Manu named Narishyana, Nabhag, Ikshvaku, Nriga, and Sharyati, sacrifice of these animals became a part of the ''yajna'' (sacrificial ritual) at their instinctive acquiescence. After that, during the sacrifice over a long course of time performed by Prushadra (name of a king), as goats were not obtainable, even the sacred cows were also offered up for sacrifice. This deviation bewildered (or disturbed) all of humanity leading to grief. When the flesh of these sanctified cows were eaten, by the heavy, hot and incompatible to human nature properties of their flesh, as well as the use of what was not prescribed by the scriptures, the people started suffering from the loss of their ability to digest and losing their mental equilibrium, resulting in ''atisara'' (diarrhea). Thus, diarrhea originated from the ''yajna'' performed by Prushadhra [4]

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</div>

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===~~= ''Vataja~~ atisara~~'' =~~===

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=== [[Vata]]ja atisara===

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pakvaM vA vibaddhamalpAlpaM sashabdaM sashUlaphenapicchAparikartikaM hRuShTaromA viniHshvasa~jshuShkamukhaH kaTyUrutrikajAnupRuShThapArshvashUlI bhraShTagudomuhurmuhurvigrathitamupaveshyate purIShaM vAtAt; tamAhuranugrathitamityeke,vAtAnugrathitavarcastvAt||5|| <br />

</div></div>

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*''Vata'' dominant ''atisara'' occurs if a person with ''vata'' dominant constitution indulges in following: Exposure to strong wind, excess sunlight, and physical exercise;

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*[[Vata]] dominant ''atisara'' occurs if a person with [[vata]] dominant constitution indulges in following: Exposure to strong wind, excess sunlight, and physical exercise;

*Indulgence in dry and rough or less quantities of food (''pramitashana'') or irregular meals or strong alcoholic drinks or excessive sexual intercourse; and

*Suppression of natural urges.

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The above factors aggravate ''vata'', afflicting the power of digestion (or, reducing the ''agni''). With the depletion of ''agni'', the aggravated ''vata'' forces urine and sweat to the colon (''purishashaya''), liquefying the stool and manifesting ~~''vataja~~ atisara''.

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The above factors aggravate [[vata]], afflicting the power of digestion (or, reducing the [[agni]]). With the depletion of [[agni]], the aggravated [[vata]] forces urine and sweat to the colon (''purishashaya''), liquefying the stool and manifesting [[vata]]ja atisara.

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~~''Vataja~~ amaja atisara'' (early stages of ~~''vataja~~ atisara''):

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[[Vata]]ja amaja atisara (early stages of [[vata]]ja atisara):

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The early signs and symptoms of ~~''vataja~~ amaja atisara'' are as follows:

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The early signs and symptoms of [[vata]]ja amaja atisara are as follows:

*The stool is slimy and has mucus (''ama'');

*The stool floats on water;

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*The aggravated ''vata'' (flatus) moves in the ''koshtha'' (gastrointestinal tract) obliquely along with gurgling sound, causing colic pain.

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The above mentioned signs and symptoms pertain to the ''ama'' stage (primary or immature stage) of the ~~''vataja~~ atisara''.

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The above mentioned signs and symptoms pertain to the ''ama'' stage (primary or immature stage) of the [[vata]]ja atisara.

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~~''Vataja~~ niramaja atisara'' (advanced stage of ~~''vataja~~ atisara''):

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[[Vata]]ja niramaja atisara (advanced stage of [[vata]]ja atisara):

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In the ''pakva'' stage (advanced or mature stage) of ~~''vataja~~ atisara'', the signs and symptoms manifested are as follows:

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In the ''pakva'' stage (advanced or mature stage) of [[vata]]ja atisara, the signs and symptoms manifested are as follows:

*The patient evacuates hard stool in small quantities;

*The evacuation of stool is associated with sound and colic pain;

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According to some physicians, this type of diarrhea is also called ''anugrathita-atisara'' because of evacuation the scybalous stool. [5]

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</div>

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===~~= ''Pittaja~~ atisara~~'' =~~===

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===[[Pitta]]ja atisara===

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kRuShNaM raktapittopahitamatidurgandhamatisAryate [1] purIShaM,tRuShNAdAhasvedamUrcchAshUlabradhnasantApapAkaparIta iti pittAtisAraH||6|| <br />

</div></div>

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A person of ~~''pittaja''~~ constitution, by indulging in the following etiological factors, gets afflicted by ~~''pittaja~~ atisara'':

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A person of [[pitta]]ja constitution, by indulging in the following etiological factors, gets afflicted by [[pitta]]ja atisara:

*Excessive intake of sour, saline, pungent, alkaline (''kshara''), hot and sharp (''teekshna'') ingredients;

*Affliction of the body by excessive exposure to the heat of strong fire, hot rays of the sun and hot wind; and

*Excessive disposition to negative emotions such as anger, jealousy, etc.

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Due to the above mentioned factors, ''pitta'' gets aggravated, in turn suppressing the power of ''agni'' (digestion) on account of its liquidity and reaches the colon, disintegrates the stool because of its heat, liquidity and mobility leading to the manifestation of ~~''pittaja~~ atisara''.

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Due to the above mentioned factors, [[pitta]] gets aggravated, in turn suppressing the power of [[agni]] (digestion) on account of its liquidity and reaches the colon, disintegrates the stool because of its heat, liquidity and mobility leading to the manifestation of [[pitta]]ja atisara.

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The signs and symptoms of ~~''pittaja~~ atisara'' are as follows:

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The signs and symptoms of [[pitta]]ja atisara are as follows:

*The patient experiences frequent loose motions which are either yellow, green, blue or black in color;

*The stool is mixed with blood and bile, and is excessively foul smelling;

*The patient suffers from morbid thirst, burning sensation, excessive sweating, fainting, colic pain and hot sensation; and

*There is suppuration of the anus [6]

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</div>

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===~~= ''Kaphaja~~ atisara~~'' =~~===

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=== [[Kapha]]ja atisara===

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tasya rUpANi- snigdhaM shvetaM picchilaM tantumadAmaM guru durgandhaMshleShmopahitamanubaddhashUlamalpAlpamabhIkShNamatisAryate sapravAhikaM,gurUdaragudabastiva~gkShaNadeshaH kRute~apyakRutasa~jj~jaH salomaharShaH sotkleshonidrAlasyaparItaH sadano~annadveShI ceti shleShmAtisAraH||7|| <br />

</div></div>

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A person of ~~''kaphaja''~~ type of constitution indulging in the following factors experiences the manifestation of ~~''kaphaja~~ atisara'':

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A person of [[kapha]]ja type of constitution indulging in the following factors experiences the manifestation of [[kapha]]ja atisara:

*Consumption of heavy, sweet, cold and unctuous ingredients in excess;

*Inactivity of the mind and indolence; and

*Habitually sleeping during the day time.

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Because of the above mentioned factors, ''kapha'' gets aggravated. It moves downwards due to its nature (i.e heavy, sweet, cold and unctuous) and afflicts the ''agni'' (power of digestion) on account of its natural cooling property (which is contradictory to the heating effect of ''agni''). Thereafter, having arrived at the colon, it liquefies the stool to cause ~~''kaphaja~~ atisara''.

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Because of the above mentioned factors, [[kapha]] gets aggravated. It moves downwards due to its nature (i.e heavy, sweet, cold and unctuous) and afflicts the [[agni]] (power of digestion) on account of its natural cooling property (which is contradictory to the heating effect of [[agni]]). Thereafter, having arrived at the colon, it liquefies the stool to cause [[kapha]]ja atisara.

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The signs and symptoms of ~~''kaphaja~~ atisara'' (diarrhea) are as follows:

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The signs and symptoms of [[kapha]]ja atisara (diarrhea) are as follows:

*The stool is unctuous, white, slimy, fibrous, mixed with mucus as well as undigested food particles, heavy, foul-smelling and mixed with phlegm;

*The patient suffers from continuous, griping, colic pain

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*Suffers from horripilation, nausea, excessive sleep, indolence, prostration and dislike for food.

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These are the specific features of ~~''kaphaja~~ atisara''. [7]

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These are the specific features of [[kapha]]ja atisara. [7]

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</div>

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===~~= ''~~Sannipataja atisara~~'' =~~===

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=== Sannipataja atisara ===

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अतिशीतस्निग्धरूक्षोष्णगुरुखरकठिनविषमविरुद्धासात्म्यभोजनादभोजनात्कालातीतभोजनाद्यत्किञ्चिदभ्यवहरणात्प्रदुष्टमद्यपानीयपानादतिमद्यपानादसंशोधनात्प्रतिकर्मणांविषमगमनादनुपचाराज्ज्वलनादित्यपवनसलिलातिसेवनादस्वप्ना- दतिस्वप्नाद्वेगविधारणादृतुविपर्ययादयथाबलमारम्भाद्भयशोकचित्तोद्वेगातियोगात्कृमिशोषज्वरार्शोविकारातिकर्षणाद्वाव्यापन्नाग्नेस्त्रयोदोषाःप्रकुपिताभूयएवाग्निमुपहत्यपक्वाशयमनुप्रविश्यातीसारंसर्वदोषलिङ्गंजनयन्ति ||८||

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atishItasnigdharUkShoShNagurukharakaThinaviShamaviruddhAsAtmyabhojanAdabhojanAtkAlAtItabhojanAd yatki~jcidabhyavaharaNAtpraduShTamadyapAnIyapAnAdatimadyapAnAdasaMshodhanAt pratikarmaNAMviShamagamanAdanupacArAjjvalanAdityapavanasalilAtisevanAdasvapnA-datisvapnAdvegavidhAraNAdRutuviparyayAdayathAbalamArambhAdbhayashokacittodvegAtiyogAtkRumishoShajvarArshovikArAtikarShaNAdvA vyApannAgnestrayo doShAH prakupitA bhUyaevAgnimupahatya pakvAshayamanupravishyAtIsAraM sarvadoShali~ggaM janayanti||8||

</div></div>

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The causative factors of ''sannipataja atisara'' (diarrhea caused by the simultaneous vitiation of all the three ~~''doshas''~~) are as follows:

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The causative factors of ''sannipataja atisara'' (diarrhea caused by the simultaneous vitiation of all the three [[dosha]]) are as follows:

*Intake of excessively cold, unctuous, ununctuous, hot, heavy, coarse and hard ingredients;

*Intake of irregular meals, ingredients of food having mutually contradictory properties and unwholesome food;

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*Excessive emaciation due to worm-infection, consumption, fever and piles (bleeding).

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Because of the above mentioned causative factors, ''agni'' (power of digestion) gets vitiated as a result of which all the three ~~''doshas''~~ get aggravated. These aggravated ~~''doshas''~~ in turn further afflict the ''agni'', and having entered into ''pakvashaya'' (colon) cause ''sannipataja atisara''. [8]

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Because of the above mentioned causative factors, [[agni]] (power of digestion) gets vitiated as a result of which all the three [[dosha]] get aggravated. These aggravated [[dosha]] in turn further afflict the [[agni]], and having entered into ''pakvashaya'' (colon) cause ''sannipataja atisara''. [8]

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</div>

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==== Signs and symptoms of ''sannipataja atisara'' ====

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=== Signs and symptoms of ''sannipataja atisara'' ===

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ebhirvarNairatisAryamANaM sopadravamAturamasAdhyo~ayamiti pratyAcakShIta; tadyathA-pakvashoNitAbhaM [2] yakRutkhaNDopamaM medomAMsodakasannikAshaMdadhighRutamajjatailavasAkShIravesavArAbhamatinIlamatiraktamatikRuShNamudakamivAcchaMpunarmecakAbhamatisnigdhaM haritanIlakaShAyavarNaM karburamAvilaM picchilaM tantumadAmaMcandrakopagatamatikuNapapUtipUyagandhyAmAmamatsyagandhi makShikAkAntaM [3]kuthitabahudhAtusrAvamalpapurIShamapurIShaM vA~atisAryamANaMtRuShNAdAhajvarabhramatamakahikkAshvAsAnubandhamativedanamavedanaM vA srastapakvagudaMpatitagudavaliM muktanAlamatikShINabalamAMsashoNitaMsarvaparvAsthishUlinamarocakAratipralApasammohaparItaM sahasoparatavikAramatisAriNamacikitsyaMvidyAt; iti sannipAtAtisAraH||9||

</div></div>

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The three aggravated [[dosha]] cause excessive vitiation of [[dhatu]] (tissue elements, e.g., [[rakta]] (blood)), resulting in the appearance of different colors (in the stool). The nature of these colors depends upon the nature of the vitiated [[dhatu]] and [[dosha]].

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The three aggravated ''doshas'' cause excessive vitiation of ''dhatus'' (tissue elements, e.g., ''rakta'' (blood)), resulting in the appearance of different colors (in the stool). The nature of these colors depends upon the nature of the vitiated ''dhatus'' and ''doshas''.

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If the [[dhatu]] like [[rakta]]] are excessively vitiated then the following signs and symptoms are manifested:

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If the ~~''dhatus''~~ like ''rakta'' are excessively vitiated then the following signs and symptoms are manifested:

*The patient passes stool having yellow (like the color of turmeric), green, blue, reddish (like the color of ''manjistha''), pink (like the color of water in which meat is washed), red, black, white and yellowish (like the color of pig-fat) in color;

*The patient suffers from continuous pain or may be free from any pain (in the abdomen). The above mentioned signs and symptoms may be manifested in their entirety or only some of these may be manifested.

*Sometimes, the patient may pass scybalous stool, sometimes it may be mixed with mucus (''ama'') and sometimes, the stool may be free from mucus (''pakva'');

*There is depletion of the muscle tissue, blood and strength;

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*The power of digestion (''agni'') of the patient is suppressed; and

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*The power of digestion ([[agni]]) of the patient is suppressed; and

*There is impairment of the taste in the mouth of the patient.

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Such a patient should be rejected for the treatment (as it is incurable). [9]

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</div>

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==== Guidelines for starting treatment ====

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=== Guidelines for starting treatment ===

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tamasAdhyatAmasamprAptaM cikitsed yathApradhAnopakrameNa hetUpashayadoShavisheShaparIkShayAceti||10||

</div></div>

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The patient who has not yet reached the stage of absolute incurability should be properly treated after the examination of causative factors, ''upashaya'' (pacifying factors) and nature of the aggravation of specific [[dosha]]. In this condition, the most aggravated [[dosha]] should be treated in the beginning followed by the treatment of the other less aggravated [[dosha]]. [10]

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</div>

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The patient who has not yet reached the stage of absolute incurability should be properly treated after the examination of causative factors, ''upashaya'' (pacifying factors) and nature of the aggravation of specific ''dosha''. In this condition, the most aggravated ''dosha'' should be treated in the beginning followed by the treatment of the other less aggravated ''doshas''. [10]

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=== Exogenous (psychological) diarrhea ===

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==== Exogenous (psychological) diarrhea ====

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tattayorlakShaNaM vAyoryadatIsAralakShaNam||11||<br />

</div></div>

+

+

The exogenous type of ''atisara'' (diarrhea) is of mental origin and is of two types. One of these is caused by fear and the other is caused by grief. Their signs and symptoms are similar to those of the ''vatika'' type of ''atisara''. Thus ''atisara'' or diarrhea is of two types, viz., ''nija'' or endogenous (like [[vata]]ja, [[pitta]]ja, [[kapha]]ja and ''sannipataja atisara'' and ''agantuja/manasa'' or exogenous [11]

+

</div>

−

The exogenous type of ''atisara'' (diarrhea) is of mental origin and is of two types. One of these is caused by fear and the other is caused by grief. Their signs and symptoms are similar to those of the ''vatika'' type of ''atisara''. Thus ''atisara'' or diarrhea is of two types, viz., ''nija'' or endogenous (like ''vataja, pittaja, kaphaja'' and ''sannipataja atisara'' and ''agantuja/manasa'' or exogenous [11]

+

=== Management of exogenous (psychological) diarrhea ===

−

==== Management of exogenous (psychological) diarrhea ====

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pravakShyAmyanupUrveNa yathAvattannibodhata||13|| <br />

</div></div>

−

+

The following therapies help to cure ''agantuja/manasa'' or exogenous:

−

Both fear and grief causes aggravation of ''vata'' instantaneously. ''Vata'' alleviating drugs and therapies should be administered for the treatment of exogenous ''atisara''. The patient suffering from diarrhea caused by fear (''bhayaja'') should be exhilarated. The patient suffering from diarrhea caused by ''shoka'' (grief) should be consoled [12-13]

+

Both fear and grief causes aggravation of [[vata]] instantaneously. [[Vata]] alleviating drugs and therapies should be administered for the treatment of exogenous ''atisara''. The patient suffering from diarrhea caused by fear (''bhayaja'') should be exhilarated. The patient suffering from diarrhea caused by ''shoka'' (grief) should be consoled [12-13]

+

</div>

−

==== Principles of treatment ====

+

=== Principles of treatment ===

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la~gghanaM cAlpadoShANAM prashastamatisAriNAm||19|| <br />

</div></div>

−

+

The following principles of treatment are used in management of ''atisara'':

−

*When the diarrhea is caused by the accumulated (aggravated) ~~''doshas''~~ impelled by ''vidagdha'' (fermentation of undigested) food, the patient should be given laxative to eliminate the ''dosha''.

+

*When the diarrhea is caused by the accumulated (aggravated) [[dosha]] impelled by ''vidagdha'' (fermentation of undigested) food, the patient should be given laxative to eliminate the [[dosha]].

*In the initial state i.e. ''ama'' (primary or immature) of diarrhea, stopping or binding therapies are never indicated.

−

*Administration of such bowel-binding therapies in the initial stage obstructs the movement and elimination of the already aggravated ''dosha'' leading to complications like ''dandakalasaka'' (obstruction to intestinal peristalsis), ''adhmana'' (flatulence), ''grahani roga'' (digestive disorders like sprue syndrome), piles, fistula-in-ano, edema, anemia, splenic disorders, ''kushtha'' (obstinate skin diseases including leprosy), ''gulma'' (abdominal lumps), ''udara roga'' (obstinate abdominal diseases including ascites) and fever.

+

*Administration of such bowel-binding therapies in the initial stage obstructs the movement and elimination of the already aggravated [[dosha]] leading to complications like ''dandakalasaka'' (obstruction to intestinal peristalsis), ''adhmana'' (flatulence), ''grahani roga'' (digestive disorders like sprue syndrome), piles, fistula-in-ano, edema, anemia, splenic disorders, ''kushtha'' (obstinate skin diseases including leprosy), ''gulma'' (abdominal lumps), ''udara roga'' (obstinate abdominal diseases including ascites) and fever.

*Hence, the physician should ignore the downward movement of the detached (''utklishta'') morbid matter, which is moving downwards on its own.

*Diarrhea should be allowed to continue and should not be stopped by constipating medicines.

*If the diarrhea is associated with griping pain (difficulty in evacuating), then ''haritaki'' should be given as a mild laxative.

−

*Once the morbid matter is eliminated through downward movement then this abdominal disease (diarrhea) gets cured, the body becomes light and the power of ''agni'' becomes strong.

+

*Once the morbid matter is eliminated through downward movement then this abdominal disease (diarrhea) gets cured, the body becomes light and the power of [[agni]] becomes strong.

−

*Moderately aggravated ''dosha'' should be managed by ''pramathya'' (a type of decoction of drugs) which stimulates the power of digestion (''dipana'') and which is carminative (''pachana'') should be administered. Slightly aggravated ''dosha'' should be managed by ''langhana'' (fasting therapy) [14-19].

+

*Moderately aggravated [[dosha]] should be managed by ''pramathya'' (a type of decoction of drugs) which stimulates the power of digestion ([[dipana]]) and which is carminative ([[pachana]]) should be administered. Slightly aggravated [[dosha]] should be managed by [[langhana]] (fasting therapy) [14-19].

−

==== Recipes of ''pramathya'' ====

+

=== Recipes of ''pramathya'' ===

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Three recipes of ''pramathya'' which are useful in the treatment of diarrhea are as follow:

−

*Decoction of ''pippali, nagara, dhanyaka, bhutika, abhaya'' and ''vacha'' for ~~''vataja~~ atisara''

+

*Decoction of ''pippali, nagara, dhanyaka, bhutika, abhaya'' and ''vacha'' for [[vata]]ja atisara''

−

*Decoction of ''hrivera, bhadra-musta, bilva, nagara'' and ''dhanyaka'' for ~~''pittaja~~ atisara'')

+

*Decoction of ''hrivera, bhadra-musta, bilva, nagara'' and ''dhanyaka'' for [[pitta]]ja atisara'')

−

*Decoction of ''prashniparni, svadamstra, samanga'' and ''kantakarika'' for ~~''kaphaja~~ atisara''

+

*Decoction of ''prashniparni, svadamstra, samanga'' and ''kantakarika'' for [[kapha]]ja atisara''

−

*Decoction of ''vacha'' and ''prativisha'' for ~~''vataja~~ atisara''

+

*Decoction of ''vacha'' and ''prativisha'' for [[vata]]ja atisara''

−

*Decoction of ''musta'' and ''parpataka'' for ~~''pittaja~~ atisara''

+

*Decoction of ''musta'' and ''parpataka'' for [[pitta]]ja atisara''

−

*Decoction of ''hrivera'' and ''sringavera'' for ~~''kaphaja~~ atisara''

+

*Decoction of ''hrivera'' and ''sringavera'' for [[kapha]]ja atisara''

[Note: Decoction should be prepared as per the procedure described for ''sandanga-paniya'' in C.S.Ci.3-145.] [20-22]

−

==== Diet and drinks for ''atisara'' patient ====

+

=== Diet and drinks for ''atisara'' patient ===

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*At appropriate meal time, if the patient feels hungry, light food should be given to eat. It enhances the appetite and stimulates agni and as a result the strength is promoted immediately.

−

*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 [~~[Charak Samhita]]~~ [[Sutra Sthana]] 4: 9 should be administered [23-25]

+

Ingredients which are [[dipana]] (digestive stimulant) and ''grahi'' (constipating) are described in [Cha. Sa. [[Sutra Sthana]] 4/9 ] should be administered [23-25]

−

==== Treatment of ~~''vataja~~ atisara~~'' =~~===

+

=== Treatment of [[vata]]ja atisara ===

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</div></div>

−

The following drugs are useful for the cure of ~~''vataja~~ atisara'' (diarrhea):

+

The following drugs are useful for the cure of [[vata]]ja atisara(diarrhea):

*''Shalaparni, prashniparni, brhati, kantakarika, bala, svadamstra, bilva, patha, nagara, dhanyaka, shati, palasha, hapusha, vacha, jiraka, pippali, yavani, pippali-mula, chitraka, hastipippali, vrikshamla, sour pomegranate, hingu, vida'' and ''saindhava''-these ingredients should be appropriately used in processing food preparations.

−

*Drugs belonging to the ''vata'' and ''kapha'' alleviative group and those drugs which are ''dipana'' (digestive stimulant), ''pachana'' (carminative), ''grahi'' (constipating), ''balya'' (promoter of strength) and ''rochana'' (appetizer) should be prescribed. [26-29]

+

*Drugs belonging to the [[vata]] and [[kapha]]' alleviative group and those drugs which are [[dipana]] (digestive stimulant), [[pachana]] (carminative), ''grahi'' (constipating), ''balya'' (promoter of strength) and ''rochana'' (appetizer) should be prescribed. [26-29]

−

==== Management of diarrhea associated with pain ====

+

=== Management of diarrhea associated with pain ===

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After the maturity of ''ama'' (product of indigestion), if the patient experiences loose motions along with scybalous feces associated with colic pain and mucus very frequently in small quantities, and if there is griping pain, then he should be given food along with the soup of ''mulaka, badara, upodikā, kshirini, yavāni, vāstuka, suvarchala, chanchu'' (''nadika''), leaves of ''avalguja, shati, karkaruka, jivanti, chirbhata'' (karkati), ''lonika, patha'' or ''shushka-shaka'' (''kasamarda'' according to Chakrapani). These soups should be cooked along with curd (yogurt) and ''dadima'', and added with ghee in copious quantities [30-33]

−

==== Treatment of ''pravahika'' (dysentery) ====

+

=== Treatment of ''pravahika'' (dysentery) ===

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*It is prepared by adding the paste of tender fruits of ''bilva'', equal quantities of the paste of sesame, cream of sour curd and copious quantities of ghee [34].

−

==== Treatment of ''varcha-kshaya'' (scanty formation of stool) ====

+

=== Treatment of ''varcha-kshaya'' (scanty formation of stool) ===

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*The meat soup of the trunk of sheep should be added with its blood and sizzled by adding the extract of ''dadima, dhanya'', ghee and ''nagara''. This soup should be used for boiling red variety of ''shali'' rice. Intake of this cooked rice and drinking this soup make the patient free from the ailments caused by ''varcha-kshaya'' (scanty stool) [35-41]

−

==== Treatment of prolapse of rectum ====

+

=== Treatment of prolapse of rectum ===

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If there is prolapse of rectum and colic pain, and if the diarrhea is free from ''ama'', then the patient should be given medicated ghee prepared with sour drugs or ''anuvasana'' (unctuous enema). [42]

−

==== ''Changeri ghritam'' ====

+

=== ''Changeri ghritam'' ===

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Ghee should be cooked with the juice of ''changeri'', decoction of ''kola'' and sour curd, and the paste of ''nagara'' and ''kshara'' (alkali preparation). Intake of this medicated ghee cures ailments caused by prolapse of rectum. Thus, ends the description of ''changeri-ghrita'' [43].

−

==== ''Chavyadi ghritam'' ====

+

=== ''Chavyadi ghritam'' ===

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Thus, ends the description of ''chavyadi -ghrita'' for prolapsed rectum [44].

−

==== ''Anuvasana basti'' in prolapse of rectum ====

+

=== ''Anuvasana basti'' in prolapse of rectum ===

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</div></div>

−

For the cure of prolapse rectum, ''anuvasana basti'' (oil-based enema therapy) should be administered with the following recipes:

+

For the cure of prolapse rectum, anuvasana [[basti]] (oil-based enema therapy) should be administered with the following recipes:

*''Dashamoola'' cooked with fat;

*''Bilva'' cooked with fat:

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*Chitraka cooked with fat [45].

−

==== Management of strangulated prolapsed rectum ====

+

=== Management of strangulated prolapsed rectum ===

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If the prolapsed rectum becomes stiff or strangulated, and does not go inside of its own, then oil should be applied over it and fomentation should be given. Thereafter, when the prolapsed rectum is well fomented and has become soft, then with the help of a cotton pad (or pad made of thick cloth) it should be pushed inside and restored to its original place [46].

−

==== Use of medicated milk ====

+

=== Use of medicated milk ===

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Milk boiled with the root of castor or tender fruit of ''bilva'' may also be given in the above mentioned condition. By the intake of the recipes of medicated ghee mentioned above, bleeding and mucus discharge from the anus stops. These recipes also cure colic pain, dysentery and constipation [47-49]

−

==== Treatment of ~~''pittaja~~ atisara~~'' =~~===

+

=== Treatment of [[pitta]]ja atisara ===

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</div></div>

−

For the cure of ~~''pittaja~~ atisara'', the following therapy should be administered:

+

For the cure of [[pitta]]ja atisara, the following therapy should be administered:

−

*If ~~''pittaja~~ atisara'' (diarrhea) patient is also afflicted with ''ama'' which can be determined by causative factors, ''upachaya'' (habituation), and signs and symptoms, then the patient should be given ''langhana'' (fasting therapy) and ''pachana'' (carminative therapy) appropriate to the strength of the patient.

+

*If [[pitta]]ja atisara (diarrhea) patient is also afflicted with ''ama'' which can be determined by causative factors, ''upachaya'' (habituation), and signs and symptoms, then the patient should be given [[langhana]] (fasting therapy) and [[pachana]] (carminative therapy) appropriate to the strength of the patient.

*If the patient is thirsty, then the decoction of ''musta, parpataka, ushira, sariva, chandana, kiratatiktaka'' and ''udichya'' should be given to drink.

−

*After the proper fasting therapy, during meal time, the patient should be gradually given ''yavagu'' (thick gruel), ''manda'' (a type of thin gruel) and ''tarpana'' (roasted flour of cereals added with water) or decoction prepared (according to the procedure suggested for ''shadanga-paniya''(C.~~S. Chi~~. 3/ 145-146)) of ''bala, atibala, surpa-parni'' (''mudga-parni'' and ''mansa-parni''), ''shala-parni, prashni-parni, brahati, kantakari, shatavari'' and ''shvadanshtra''.

+

*After the proper fasting therapy, during meal time, the patient should be gradually given ''yavagu'' (thick gruel), ''manda'' (a type of thin gruel) and ''tarpana'' (roasted flour of cereals added with water) or decoction prepared (according to the procedure suggested for ''shadanga-paniya''[Cha.Sa. [[Chikitsa Sthana]] 3/ 145-146] of ''bala, atibala, surpa-parni'' (''mudga-parni'' and ''mansa-parni''), ''shala-parni, prashni-parni, brahati, kantakari, shatavari'' and ''shvadanshtra''.

−

*''Agni'' (power of digestion) should be stimulated gradually with the vegetable soup of ''mudga, masura, harenu, makustha'' and ''adhaki'' or with the soup of the meat of ''lava, kapinjala, shasha, harina, ena'' and ''kalapuchcha''. These vegetable soups and meat soups may or may not be sour.

−

*If the ''pittaja atisara'' persists even after the administration of the above mentioned measures, then the patient should be treated with recipes which are ''dipaniya'' (digestive stimulant), ''pachaniya'' (carminative), ''upashamaniya'' (dosha-alleviator) and ''sangrahaniya'' (constipating). [50]

−

==== Recipes for ~~''pittaja~~ atisara~~'' =~~===

+

*[[Agni]] (power of digestion) should be stimulated gradually with the vegetable soup of ''mudga, masura, harenu, makustha'' and ''adhaki'' or with the soup of the meat of ''lava, kapinjala, shasha, harina, ena'' and ''kalapuchcha''. These vegetable soups and meat soups may or may not be sour.

+

*If the [[pitta]]ja atisara persists even after the administration of the above mentioned measures, then the patient should be treated with recipes which are ''dipaniya'' (digestive stimulant), ''pachaniya'' (carminative), ''upashamaniya'' ([[dosha]]-alleviator) and ''sangrahaniya'' (constipating). [50]

+

=== Recipes for [[pitta]]ja atisara ===

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</div></div>

−

The following recipes are useful in curing ~~''pittaja~~ atisara'':

+

The following recipes are useful in curing [[pitta]]ja atisara:

*The fruit and bark of ''vatsaka'' should be added with ''ativisha'' and honey. It should be taken along with rice-water (''tandulodaka'').

The following recipes should be taken along with honey and rice-water (''tandulodaka'').

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*''Katphala, nagara, patha,'' seed-pulp of ''jambu'' and ''amra'', and ''duralabha''. Once the above mentioned recipes are digested, the patient should be given to eat red variety of rice harvested in earlier seasons, along with appropriately cooked meat-soup added with constipating drugs [51-56]

−

==== Administration of milk ====

+

=== Administration of milk ===

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</div></div>

−

*Goat-milk administered to a patient having strong power of digestion cures ~~''pittaja~~ atisara'' and promotes strength as well as complexion.

+

*Goat-milk administered to a patient having strong power of digestion cures [[pitta]]ja atisara and promotes strength as well as complexion.

−

*Due to excessive aggravation of ''dosha'', if the ~~''pittaja~~ atisara'' is not cured and if the patient has strong power of digestion and vitality, then laxative therapy with milk should be given.

+

*Due to excessive aggravation of [[dosha]], if the [[pitta]]ja atisara is not cured and if the patient has strong power of digestion and vitality, then laxative therapy with milk should be given.

*Decoction of the fruit of ''palasha'' along with milk should be given. Later, depending upon the strength of the patient, lukewarm milk should be given. This will restore bowel movement and control the ''atisara''. Decoction of ''trayamana'' along with milk should be given. Later, depending upon the strength of the patient lukewarm milk should be given. This will restore bowel movement and control the ''atisara''.

−

''Anuvasana basti'' (medicated untuous enema):

+

Anuvasana [[basti]] (medicated untuous enema):

−

*During the course of ''sansarjana-krama'' (gradual administration of light food) after purification therapy if the colic pain persists, then ''anuvasana basti'' therapy should be administered immediately because morbid matter is already eliminated.

+

*During the course of ''sansarjana-krama'' (gradual administration of light food) after purification therapy if the colic pain persists, then anuvasana [[basti]] therapy should be administered immediately because morbid matter is already eliminated.

−

''Satapushpadi'' ghee is advised for ''anuvasana basti'' [57-62].

+

''Satapushpadi'' ghee is advised for anuvasana [[basti]] [57-62].

−

===~~= ''~~Piccha basti'' (slimy medicated enema) ====

+

=== Piccha [[basti]] (slimy medicated enema) ===

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</div></div>

−

If diarrhea persists in spite of the administration of ''anuvasana basti'' and observing the ''samsarjana-krama'' (gradual administration of lighter to heavier food) then ''piccha basti'' (mucilaginous type of medicated enema) should be given.

+

If diarrhea persists in spite of the administration of anuvasana [[basti]] and observing the ''samsarjana-krama'' (gradual administration of lighter to heavier food) then piccha [[basti]] (mucilaginous type of medicated enema) should be given.

−

Green stalks of ''shalmali'' should be covered with green ''kusha'' and tied. This bundle is then smeared with the mud of black soil and placed over cow-dung fire. After the mud is dried up, the stalks of ''shalmali'' is removed. These stalks are then triturated in a pestle and mortar. One ''mushti'' (''pala'' or handful) of this paste should be mixed with one ''prastha'' of boiled milk and filtered. In this milk, oil, ghee and paste of ''madhuka'' is added in adequate quantity. This recipe is used for medicated enema to be given to the patient after massaging the body with oil. When the nasty material comes out, the patient should take bath and thereafter take food along with either milk or the meat soup of the wild animals. This ''piccha-basti'' (mucilaginous enema) cures ''paittika'' type of diarrhea, fever, edema, ''gulma'' (abdominal lumps), chronic diarrhea, ''grahani'' (digestive disorders) and the acute complications of purgation as well as of ''asthapana basti'' [63-68]

+

Green stalks of ''shalmali'' should be covered with green ''kusha'' and tied. This bundle is then smeared with the mud of black soil and placed over cow-dung fire. After the mud is dried up, the stalks of ''shalmali'' is removed. These stalks are then triturated in a pestle and mortar. One ''mushti'' (''pala'' or handful) of this paste should be mixed with one ''prastha'' of boiled milk and filtered. In this milk, oil, ghee and paste of ''madhuka'' are added in adequate quantity. This recipe is used for the medicated enema to be given to the patient after massaging the body with oil. When the nasty material comes out, the patient should take bath and thereafter take food along with either milk or the meat soup of the wild animals. This piccha-[[basti]] (mucilaginous enema) cures ''paittika'' type of diarrhea, fever, edema, ''gulma'' (abdominal lumps), chronic diarrhea, ''grahani'' (digestive disorders) and the acute complications of purgation as well as of asthapana [[basti]] [63-68]

−

==== ''Raktatisara'' (bloody diarrhoea) ====

+

=== ''Raktatisara'' (bloody diarrhoea) ===

Line 1,076: Line 1,098:

</div></div>

−

If a ~~''pittaja~~ atisara'' patient does not follow the therapeutic measures and resorts to such foods and drinks which cause aggravation of ''pitta'', then the excessively provoked ''pitta'' causes ''raktatisara'' and instantaneous vitiation of ''rakta'' (blood). This leads to serious complications like morbid thirst, colic pain, burning sensation and suppuration of the anus. It can also manifest itself directly on account of excessive aggravation of ''pitta'' and vitiation of blood [69-70]

+

If a [[pitta]]ja atisara patient does not follow the therapeutic measures and resorts to such foods and drinks which cause aggravation of [[pitta]], then the excessively provoked [[pitta]] causes ''raktatisara'' and instantaneous vitiation of [[rakta]] (blood). This leads to serious complications like morbid thirst, colic pain, burning sensation and suppuration of the anus. It can also manifest itself directly on account of excessive aggravation of [[pitta]] and vitiation of blood [69-70]

−

==== Treatment of ''raktatisara'' ====

+

=== Treatment of ''raktatisara'' ===

Line 1,146: Line 1,168:

*Butter along with honey and sugar may be given before meals [71-76].

−

==== Measures to alleviate bleeding in ''raktatisara'' ====

+

=== Measures to alleviate bleeding in ''raktatisara'' ===

Line 1,182: Line 1,204:

*Consumption of ghee cooked by adding the paste of fruits of ''kutaja'', along with the scum (upper part) of ''yavagu'', and followed by intake of ''peya'' (thin gruel) is advised [77-79].

−

==== Treatment of ''sannipataja atisara'' ====

+

=== Treatment of ''sannipataja atisara'' ===

Line 1,205: Line 1,227:

</div></div>

−

Ghee should be cooked by adding the six drugs, viz., the bark of ''daru-haridra'', fruits of ''kutaja, pippali, shringavera, draksa'' and ''katukarohini''. Intake of ''peya'' (thin gruel) and ''manda'' (very thin gruel) along with this medicated ghee cures a serious type of diarrhea even if caused by ''sannipata'' (simultaneous aggravation of all the three ~~''doshas''~~).[80-81]

+

Ghee should be cooked by adding the six drugs, viz., the bark of ''daru-haridra'', fruits of ''kutaja, pippali, shringavera, draksa'' and ''katukarohini''. Intake of ''peya'' (thin gruel) and ''manda'' (very thin gruel) along with this medicated ghee cures a serious type of diarrhea even if caused by ''sannipata'' (simultaneous aggravation of all the three [[dosha]]).[80-81]

−

==== Hemostatic recipes ====

+

=== Hemostatic recipes ===

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*The paste of ''priyangu'' should be added with rice-water (''tandulambu''). Intake of this, while taking the soup of the meat of animals inhabiting arid zone, in food, controls bleeding instantaneously.

*One part of the paste of the black variety of ''tila'' should be added with four parts of sugar. Intake of this potion along with the goat’s milk checks bleeding instantaneously.

−

*Intake of the decoction of the seeds of ''vatsaka'', while taking meat-soup as food, cures ~~''pittaja''~~ disorders of abdomen (''jathara'').

+

*Intake of the decoction of the seeds of ''vatsaka'', while taking meat-soup as food, cures [[pitta]]ja disorders of abdomen (''jathara'').

*Intake of ''chandana'' along with rice-water, mixed with sugar and honey cures burning sensation, morbid thirst, ''prameha'' and bleeding [82-86].

−

==== Treatment of anal suppuration ====

+

=== Treatment of anal suppuration ===

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</div></div>

−

Aggravated ''pitta'' suppurates the anus due to frequent evacuation of stool. The anus of such a patient should be sprinkled and applied with the following recipes which stops bleeding and pacifies suppuration and pain.

+

Aggravated [[pitta]] suppurates the anus due to frequent evacuation of stool. The anus of such a patient should be sprinkled and applied with the following recipes which stops bleeding and pacifies suppuration and pain.

*Exceedingly cold decoction of ''patola'' and ''madhuka''

*Decoction of ''pancha-valkala'' (barks of ''nyagrodha, udumbara, ashvattha, parisa'' and ''plaksha'') or sugar-cane juice. Milk or ghee of goat or cow mixed with sugar and honey. The paste of drugs mentioned above for washing (sprinkling over) the anus may be mixed with ghee and applied over the suppurated anus. The powder of the above mentioned drugs may also be used for ''pratisarana'' (dusting) over the suppurated anus.

*The powder of ''dhataki'' and ''lodhra'', taken in equal quantities, may be used for dusting over the suppurated anus.

*If there is excessive bleeding (from the anus), the cold decoction of the above mentioned drugs should be impregnated with ghee, and sprinkled over the anal region, pelvic region, lumbar region and thighs.

−

*Excessive bleeding should be controlled with a cotton pad soaked with ''chandanadya-taila'' (C.~~S Ci~~ 3-258) or ''satadhauta-ghrita'' (ghee washed with cold water for one hundred times), and the oil or ghee; squeeze this pad over the anal and pelvic regions [87-92 ½]

+

*Excessive bleeding should be controlled with a cotton pad soaked with ''chandanadya-taila''[Cha.Sa. [[Chikitsa Sthana]] 3-258] or ''satadhauta-ghrita'' (ghee washed with cold water for one hundred times), and the oil or ghee; squeeze this pad over the anal and pelvic regions [87-92 ½]

−

===~~= ''~~Pichcha-basti'' (mucilaginous enema) for dysentery ====

+

=== Pichcha-[[basti]](mucilaginous enema) for dysentery ===

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</div></div>

−

When the movement of the aggravated ''vata'' (flatus) gets obstructed or moves with difficulty or seizing of ''vata'' inside the abdomen, then the patient voids blood frequently in small quantities which is associated with pain. ''Piccha-basti'' should be administered to such patients. This type of patient may also be managed by ''anuvasana basti'' given with medicated ghee prepared with ''prapaundarika''. Because of chronic diarrhea, the anus of the patient generally becomes weak. Therefore cotton soaked in medicated ghee should be inserted into the anus frequently or ''anuvasana basti'' with medicated ghee is given [93-95½ ].

+

When the movement of the aggravated vata (flatus) gets obstructed or moves with difficulty or seizing of [[vata]] inside the abdomen, then the patient voids blood frequently in small quantities which is associated with pain. Piccha-[[basti]] should be administered to such patients. This type of patient may also be managed by anuvasana [[basti]] given with medicated ghee prepared with ''prapaundarika''. Because of chronic diarrhea, the anus of the patient generally becomes weak. Therefore cotton soaked in medicated ghee should be inserted into the anus frequently or anuvasana [[basti]] with medicated ghee is given [93-95½ ].

−

==== Medicated enema and recipes of linctus ====

+

=== Medicated enema and recipes of linctus ===

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</div></div>

−

*The aggravated vata becomes stronger in its own site in ''atisara'' patients. For the pacification of aggravated ''vata'' associated with ''pitta'' (which takes place in bloody diarrhea), ''basti'' (both the ''anuvasana'' and ''niruha'' types) is the best therapy.

+

*The aggravated vata becomes stronger in its own site in ''atisara'' patients. For the pacification of aggravated [[vata]] associated with [[pitta]] (which takes place in bloody diarrhea), [[basti]] (both the ''anuvasana'' and ''niruha'' types) is the best therapy.

−

*If bleeding takes place before evacuating the stool or after evacuation of stool (i.e., a case of ''raktatisara''), then ''shatavari-ghrita'' (C.~~S Ci~~ 30: 64-69) in the form of linctus should be given.

+

*If bleeding takes place before evacuating the stool or after evacuation of stool (i.e., a case of ''raktatisara''), then ''shatavari-ghrita'' [Cha.Sa. [[Chikitsa Sthana]] 30/64-69] in the form of linctus should be given.

*Intake of freshly collected butter along with half the quantity of sugar and one fourth quantity of honey cures the above mentioned ailments. While taking this potion, the patient should take wholesome food. Adventitious roots of ''nyagrodha, udumbara'' and ''ashvattha'' should be crushed and kept soaked in hot water for twenty four hours. Ghee should be cooked along with this water. This medicated ghee should be added with half the quantity of sugar and one fourth in quantity of honey, and taken in the form of linctus. It cures ''raktatisara'', associated with bleeding either before or after the passing of stool [96-100½]

−

==== Suppuration of anal sphincters ====

+

=== Suppuration of anal sphincters ===

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</div></div>

−

A patient who has become weak because of ''raktatisara'', if indulges in ''pitta''-aggravating ingredients out of ignorance, then the anal sphincters gets suppurated. This is a serious condition leading to instantaneous death [101½].

+

A patient who has become weak because of ''raktatisara'', if indulges in [[pitta]]-aggravating ingredients out of ignorance, then the anal sphincters gets suppurated. This is a serious condition leading to instantaneous death [101½].

−

==== Treatment of ~~''kaphaja~~ atisara~~'' =~~===

+

=== Treatment of [[kapha]]ja atisara ===

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</div></div>

−

For the cure of ~~''kaphaja~~ atisara'', following therapy and recipes should be administered:

+

For the cure of [[kapha]]ja atisara, following therapy and recipes should be administered:

−

*Fasting (''langhana'') and carminative (''pachana'') therapies should be administered in the beginning.

+

*Fasting ([[langhana]]) and carminative ([[pachana]]) therapies should be administered in the beginning.

−

*The group of drugs which stimulates the power of digestion (''dipana-gana'') which is prescribed for the treatment of ''ama-atisara'' should be given.

+

*The group of drugs which stimulates the power of digestion ([[dipana]]-gana) which is prescribed for the treatment of ''ama-atisara'' should be given.

−

*If the ~~''kaphaja~~ atisara'' persists even after the administration of the above mentioned measures, then the patient should be given ''kapha'' alleviating therapies.

+

*If the [[kapha]]ja atisara persists even after the administration of the above mentioned measures, then the patient should be given [[kapha]] alleviating therapies.

−

*The following four decoctions cure ~~''kaphaja~~ atisara'' as well as promotes ''kayagni'' (power of digestion and metabolism)

+

*The following four decoctions cure [[kapha]]ja atisara as well as promotes ''kayagni'' (power of digestion and metabolism)

**Decoction of ''bilva, karkatika, musta, abhaya'' and ''vishva-bheshaja''(''shunthi'')

**Decoction of ''vacha, vidanga, bhutika, dhanyaka'' and ''devadaru''

Line 1,567: Line 1,589:

*Administration of the recipe containing one part each of black variety of ''ajaji, pachana, nagara'' and ''maricha'' and two parts of ''dhataki'' along with profuse quantity of lime juice.

*One part each of ''rasanjana, ativisha'' and fruits of ''kutaja'', and two parts of ''dhataki'' should be added with honey and ginger. This potion should be given to drink.

−

*For the treatment of ~~''kaphaja~~ atisara'', the following four recipes should be given in the form of ''khada'' (a type of sour drink which stimulates the power of digestion). ''Dhataki, nagara, bilva, lodhra'' and ''padmakesara''; bark of ''jambu, nagara, dhanya, patha, mocha-rasa'' and ''bala''; ''samanga, dhataki,'' pulp of ''bilva'' and the bark of ''jambu'' and ''amra''; and ''kapittha, vidanga, nagara'' and ''maricha''.

+

*For the treatment of [[kapha]]ja atisara, the following four recipes should be given in the form of ''khada'' (a type of sour drink which stimulates the power of digestion). ''Dhataki, nagara, bilva, lodhra'' and ''padmakesara''; bark of ''jambu, nagara, dhanya, patha, mocha-rasa'' and ''bala''; ''samanga, dhataki,'' pulp of ''bilva'' and the bark of ''jambu'' and ''amra''; and ''kapittha, vidanga, nagara'' and ''maricha''.

The above mentioned recipes should be added with the sour juice of ''changeri'' and ''kola'' and butter-milk and given to the patient after adding ghee and salt.

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*Intake of ''pippali'' along with honey, or butter-milk added with the powder of ''chitraka'' or the powder of the tender fruits of ''bilva'' cures diseases of digestive system [102-112½].

−

==== Management of complications of ''atisara'' ====

+

=== Management of complications of ''atisara'' ===

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</div></div>

−

*If the movement of ''vata'' (flatus) is obstructed resulting in colic pain and dysentery, then the patient should be given tender fruits of ''bilva'', jaggery, oil, ''pippali'' and ''shunthi''.

+

*If the movement of vata (flatus) is obstructed resulting in colic pain and dysentery, then the patient should be given tender fruits of ''bilva'', jaggery, oil, ''pippali'' and ''shunthi''.

−

*Diet prepared with ''vata'' alleviating ingredients along with the vegetable soup, meat soup and ''khada'' (a type of sour drink) described under ~~''vataja~~ atisara'' should be given.

+

*Diet prepared with [[vata]] alleviating ingredients along with the vegetable soup, meat soup and ''khada'' (a type of sour drink) described under [[vata]]ja atisara should be given.

−

*Sour medicated ghee like ''changeri ghrita'' or ''shatpala ghrita'' ~~(C.S~~. ~~Chi~~. 5: 147-148 or (ten years) old ghee mixed with ''yavagu'' (thick gruel) and ''manda'' (thin gruel) should be given [113-116].

+

*Sour medicated ghee like ''changeri ghrita'' or ''shatpala ghrita'' [Cha.Sa. [[Chikitsa Sthana]] 5/ 147-148 ] or (ten years) old ghee mixed with ''yavagu'' (thick gruel) and ''manda'' (thin gruel) should be given [113-116].

−

===~~= ''~~Piccha-basti'' and ''anuvasana-basti~~'' =~~===

+

=== Piccha-[[basti]] and anuvasana-[[basti]] ===

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</div></div>

−

For the cure of ~~''kaphaja''~~ and ~~''vataja''~~-predominant ''atisara'', the following therapy and recipes should be administered:

+

For the cure of [[kapha]]ja and [[vata]]ja-predominant ''atisara'', the following therapy and recipes should be administered:

−

*If ''vata'' and ''kapha'' are obstructed in the ''mahasrotas'', if there is excessive evacuation of ''kapha'' (mucus) and if there is colic pain as well as dysentery, then ''piccha-basti'' (mucilaginous enema) should be administered.

+

*If [[vata]] and [[kapha]] are obstructed in the ''mahasrotas'', if there is excessive evacuation of [[kapha]] (mucus) and if there is colic pain as well as dysentery, then piccha-[[basti]] (mucilaginous enema) should be administered.

−

*''Piccha-basti'' should be prepared of the paste of ''pippali, bilva, kustha, shatahva'' and ''vacha'' by adding salt.

+

*Piccha-[[basti]] should be prepared of the paste of ''pippali, bilva, kustha, shatahva'' and ''vacha'' by adding salt.

−

*Patient feels comfortable after the ingredients of ''pichcha-basti'' come out of the rectum and then patient should be advised to take bath followed by intake of food. ''Anuvasana basti'' with lukewarm oil of ''bilva'' (C.S.Si 4: 4-7) should be given in the afternoon.The ''anuvasana basti'' can also be given frequently with the oil cooked with the paste of ''pippali, bilva, kushtha, shatahva'' and ''vacha'' [117-120].

+

*Patient feels comfortable after the ingredients of pichcha-[[basti]] come out of the rectum and then patient should be advised to take bath followed by intake of food. Anuvasana [[basti]] with lukewarm oil of ''bilva'' [Cha.Sa.[[Siddhi Sthana]] 4/ 4-7] should be given in the afternoon.The anuvasana [[basti]] can also be given frequently with the oil cooked with the paste of ''pippali, bilva, kushtha, shatahva'' and ''vacha'' [117-120].

−

==== Need for immediate control of ''vata~~'' =~~===

+

=== Need for immediate control of [[vata]] ===

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</div></div>

−

When ''kapha'' gets reduced because of the above mentioned therapeutic measures, the ''vata'' undoubtedly gets aggravated in its own location (colon). This aggravated ''vata'' may cause instantaneous death and hence should be controlled without delay [121]

+

When [[kapha]] gets reduced because of the above mentioned therapeutic measures, the [[vata]] undoubtedly gets aggravated in its own location (colon). This aggravated [[vata]] may cause instantaneous death and hence should be controlled without delay [121]

−

==== Principle of treatment of ''sannipataja atisara'' ====

+

=== Principle of treatment of ''sannipataja atisara'' ===

Line 1,696: Line 1,718:

For the cure of ''sannipataja atisara,'' following therapy and recipes should be administered:

−

*The aggravated ''vata'' should be pacified first followed by the alleviation of the aggravated ''pitta'' followed by alleviation of ''kapha''.

+

*The aggravated [[vata]] should be pacified first followed by the alleviation of the aggravated [[pitta]] followed by alleviation of [[kapha]].

−

*Alternatively, the most aggravated one should be controlled first followed by the treatment of the remaining two ''dosha'' [122].

+

*Alternatively, the most aggravated one should be controlled first followed by the treatment of the remaining two [[dosha]] [122].

−

==== Summary ====

+

=== Summary ===

Line 1,735: Line 1,757:

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~~'' /~~ Fundamental Principles===

+

== 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''.

*There are five categories of etio-pathological factors for ''atisara'':

−

#Reduced ''agni'',

+

#Reduced [[agni]],

−

#Vitiated ''vata'' and its sub types ''samana'' and ''apana''.

+

#Vitiated [[vata]] and its sub types ''samana'' and ''apana''.

#Vitiated body fluids.

#Vitiated ''purishavaha srotas'' (lower gastro-intestinal tract) and organs of excretion.

#Fear and grief (mental).

−

*Interaction of ~~''prakriti''~~ (basic constitution) and the diet and lifestyle of similar properties (as that of ''dosha ~~prakriti''~~) makes the person susceptible for ''atisara''.

+

*Interaction of [[Prakriti]] (basic constitution) and the diet and lifestyle of similar properties (as that of [[dosha]] [[Prakriti]]) makes the person susceptible for ''atisara''.

−

*The exogenous factors like consumption of intoxicating beverages, exposure to '''krimi''' (bacteria and parasites), other diseases like ''shosha, jwara, arsha'' influence all the above factors and three ''dosha'' to cause ''sannipatik atisara'' (diarrhea) which includes bloody diarrhea.

+

*The exogenous factors like consumption of intoxicating beverages, exposure to '''krimi''' (bacteria and parasites), other diseases like ''shosha, jwara, arsha'' influence all the above factors and three [[dosha]] to cause ''sannipatik atisara'' (diarrhea) which includes bloody diarrhea.

−

*If spicy, hot, dry food in large quantity is ingested when ''agni'' is low, undigested food becomes waste product and ''samana vata'' sends it to excretory channels where ''apana vayu'' increases the motility of ''purishavaha srotas'' to excretes these large waste products, frequently.

+

*If spicy, hot, dry food in large quantity is ingested when [[agni]] is low, undigested food becomes waste product and samana [[vata]] sends it to excretory channels where ''apana vayu'' increases the motility of ''purishavaha srotas'' to excretes these large waste products, frequently.

*To fill this vacuum created by expulsion of wastes, the body fluids shift to the gut and get expelled out as ''atisara''/diarrhea causing dehydration.Thus after involvement of ''purishavaha srotasa'' ( lower GIT), ''udakavaha srotasa'' (body fluids) is also predominantly involved in pathogenesis of ''atisara''.

−

*Fear and grief are two important mental factors leading to ''atisara''. The presentation and treatment of this ''atisara'' is similar to ''vata'' dominant ''atisara''. The fear shall be treated with ''harshana''(exhilaration) treatment and grief shall be treated with ''ashwasana'' (consolation) therapy.

+

*Fear and grief are two important mental factors leading to ''atisara''. The presentation and treatment of this ''atisara'' is similar to [[vata]] dominant ''atisara''. The fear shall be treated with ''harshana''(exhilaration) treatment and grief shall be treated with ''ashwasana'' (consolation) therapy.

−

*The endogenous ''atisara'' shall be treated after proper assessment of dominant ''dosha'', causative factors and pacifying factors,

+

*The endogenous ''atisara'' shall be treated after proper assessment of dominant [[dosha]], causative factors and pacifying factors,

−

*At the initial stage of ''atisara'' when undigested food is being expelled, ''stambhan'' (anti diarrheal treatment) is strictly contraindicated. If ''stambhana'' is given, it leads to various complications. Mild laxatives like ''haritaki'' shall be administered for evacuating the ''mala'' (accumulated undigested wastes). ''Deepana'' and ''pachana'' (stimulation of ''agni'' for digestion and metabolism) should be given with light nutritive liquid foods. After restoration of ''agni, ~~stambhan''~~ is given and care should taken to keep ''vata'' balanced.

+

*At the initial stage of ''atisara'' when undigested food is being expelled, ''stambhan'' (anti diarrheal treatment) is strictly contraindicated. If ''stambhana'' is given, it leads to various complications. Mild laxatives like ''haritaki'' shall be administered for evacuating the [[mala]] (accumulated undigested wastes). [[Deepana]] and [[pachana]] (stimulation of [[agni]] for digestion and metabolism) should be given with light nutritive liquid foods. After restoration of [[agni]], [[stambhana]] is given and care should taken to keep [[vata]] balanced.

*In case of prolapse of rectum, medicated ghee processed with sour herbs or ''anuvasana'' (unctuous enema) is prescribed.

−

*Various states of ''atisara'' like that mixed with mucous, blood, associated with colic pain shall be treated with ''pichcha basti'' (mucilaginous enema).

+

*Various states of ''atisara'' like that mixed with mucous, blood, associated with colic pain shall be treated with pichcha [[basti]] (mucilaginous enema).

−

*When ''kapha'' gets reduced because of the above mentioned therapeutic measures, the ''vata'' is aggravated in its own location (colon). This aggravated ''vata'' must be immediately treated as it may cause instantaneous death.

+

*When [[kapha]] gets reduced because of the above mentioned therapeutic measures, the [[vata]] is aggravated in its own location (colon). This aggravated [[vata]] must be immediately treated as it may cause instantaneous death.

−

*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~~'' /~~ Applied Inferences===

+

== 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.

−

==== Acute (sudden onset) diarrhea ====

+

=== Acute (sudden onset) diarrhea ===

This is most common variant and in over 90% of cases is infectious, caused due to ingestion of contaminated food or water. Other causes may include drug induced especially antibiotics, diverticulitis, ischemia, radiation enterocholitis, food allergies or initial presentation of various gastrointestinal diseases.

−

==== Chronic (or relapsing) diarrhea <ref>Patient Education: Chronic Diarrhea among adults, UptoDate

+

=== Chronic (or relapsing) diarrhea <ref>Patient Education: Chronic Diarrhea among adults, UptoDate

(https://www.uptodate.com/contents/chronic-diarrhea-in-adults-beyond-the-basics?topicRef=4021&source=see_link)

−

</ref> ====

+

</ref> ===

Defined as loose stools (occurring three or more times a day) that last for weeks. A most common variant is the Irritable Bowel Syndrome (IBS). Chronic diarrhea could be a symptom of an inflammatory bowel disease like Crohn's Disease, ulcerative colitis, malabsorption syndrome, metabolic or endocrine disorders, food allergies, laxative abuse, neoplasm, or reaction to certain medications.

Careful assessment of the patient's medical history, physical examination, CBC, electrolytes, stool and urine examination are initial tests advised to help assess the underlying causes. Further specialised investigations may be needed depending upon the condition of patient.

−

==== Pathophysiological factors of endogenous diarrhea ====

+

=== Pathophysiological factors of endogenous diarrhea ===

−

*Dosha: Vata dominant three dosha

+

* [[Dosha]]: [[Vata]] dominant three [[dosha]]

−

*Dhatu (vitiated factors): Udaka (body fluid), Rasa dhatu

+

* [[Dhatu]] (vitiated factors): Udaka (body fluid), [[Rasa dhatu]]

−

*Mala kriya affected: Purisha (defecation)

+

* [[Mala]] kriya affected: [[Purisha]] (defecation)

−

*Status of agni: Manda (poor)

+

* Status of [[agni]]: Manda (poor)

−

*Origin of disease: Pakwashaya (large intestine)

+

* Origin of disease: Pakwashaya (large intestine)

−

*Sites of vitiation: large intestine

+

* Sites of vitiation: large intestine

−

*Sites of clinical presentation: rectum and anus

+

* Sites of clinical presentation: rectum and anus

−

*Srotasa involved: Purishavaha srotasa and udakavaha srotasa

+

* Srotasa involved: Purishavaha srotasa and udakavaha srotasa

−

*Type of samprapti: atipravritti (excess discharge)

+

* Type of samprapti: atipravritti (excess discharge)

−

==== Management protocol of endogenous diarrhea ====

+

=== Management protocol of endogenous diarrhea ===

−

===== Assessment of strength of patient =====

+

==== Assessment of strength of patient ====

Excess dehydration in case of diarrhea can lead to serious complications. Hence the strength of the patient should be assessed first for severity of dehydration. This helps to design treatment protocol. Vital parameters including pulse rate, its volume, blood pressure, heart rate shall be examined.

−

===== Subjective and objective parameters =====

+

==== Subjective and objective parameters ====

−

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]]

−

==== Prevention of ''atisara'' ====

+

=== Prevention of ''atisara'' ===

−

===== ''Atisara'' can be prevented by following measures =====

+

==== ''Atisara'' can be prevented by following measures ====

#Avoiding causative factors

−

#Strengthening ''agni'' (digestive processes) by following dietary rules

+

#Strengthening [[agni]] (digestive processes) by following dietary rules

−

#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''

Line 1,812: Line 1,834:

! scope="col"| ''Anupana''

|-

−

| rowspan="2"|''Vata'' and ''kapha'' dominant

+

| rowspan="2"|[[Vata]] and [[kapha]] dominant

| ''Jatiphaladi–bhallataka guti''

| 60-120 mg

Line 1,823: Line 1,845:

| Buttermilk

|-

−

|''Pitta'' and ''kapha'' dominant

+

|[[Pitta]] and [[kapha]] dominant

| ''Kutaja kalpa''

| 60-120 mg

Line 1,829: Line 1,851:

| Ricewater with Buttermilk

|-

−

|~~''Raktaja''~~

+

|[[Rakta]]ja

| ''Shatavaryadi kwatha''

| 25-40 ml

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|}

−

===== 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>

−

''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''.

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''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>

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

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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. <ref>Patel M.V.,Patel K.B., Gupta S.N. Effects of Ayurvedic treatment on forty three patients of ulcerative colitis. AYU,Oct-Dec 2010,31(4), 478-481.</ref>

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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. <ref>Patel M.V.,Patel K.B., Gupta S.N. Effects of Ayurvedic treatment on forty three patients of ulcerative colitis. AYU,Oct-Dec 2010,31(4), 478-481.</ref>

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). <ref>Pooja BA, Bhatted S. Ayurvedic management of Pravahika – A case report. Ayu 2015;36:410-2. </ref>

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In a study, ''vatasakadi'' syrup was observed 70 % effective in treatment of ''atisara'' in children as compared to ''bala-chaturbhadra'' syrup.<ref>Shah Kiran. A Comparative Study of Vatsakadi Syrup & Balachaturbhadra Syrup in Management Balatisara with reference to Diarrhea, Int. J. Ayu. Alt. Med., 2014; 2(1):28-33.</ref>

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==== Management of exogenous diarrhea/''atisara'' ====

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=== Management of exogenous diarrhea/''atisara'' ===

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

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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.

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==== Important guidelines and precautions for diarrhea management ====

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=== 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.<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>

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

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=== 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

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#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

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==== Research Areas ====

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=== Research Areas ===

*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.

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

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~~=== Glossary ===~~

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~~#Ādikālē (आदिकाले): At the commencement of ancient time (Satya-yuga)~~

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~~#Anuvāsana Basti (अनुवासनबस्तिः): oily medicated enema~~

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~~#Asthāpana Basti (स्थापनबस्तिः): medicated enema with decoction~~

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~~#Atīsāracikitsitaṁ (अतीसारचिकित्सितं): treatment of diarrhoea~~

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~~#Candrakōpagatam (चन्द्रकोपगतम): coloured patches circular in shape like moon~~

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#Dadhighr̥tamajjatailavasākṣīravēsavārābham (दधिघृतमज्जतैलवसाक्षीरवेसवाराभम): looks like curd, ghee, bone-marrow, oil, muscle fat, milk and minced meat

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~~#Gauravādauṣṇyādasātmyatvāda (गौरवादौष्ण्यादसात्म्यत्वाद): due to heavy, hot & unwholesome~~

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~~#Grahnipradosa (ग्रहणीप्रदोषान्): grahani, sprue syndrome~~

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~~#Gudapākaṁ (गुदपाकं): suppuration of the anus~~

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~~#Gulma (गुल्म): localized growth in abdomen~~

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~~#Hāridra (हारिद्र): yellow colour like turmeric~~

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~~#Harita (हरित): green~~

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~~#Hutāgnihōtram (हुताग्निहोत्रम): oblations to the fire~~

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~~#Jāṅgalānāṁ (जाङ्गलानां): wild animals~~

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~~#Karburam (कर्बुरम): stool of variegated in colour~~

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~~#Kr̥tāhnikaṁ (कृताह्निकं): completion of daily worship~~

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~~#Kuṇapgandhyama (कुणपगन्ध्यम): smell like that of a dead body~~

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~~#Lakṣaṇa (लक्षण): signs and symptoms~~

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~~#Laṅghita (लङ्घित): undergone lighening therapy~~

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~~#Makṣikākāntaṁ (मक्षिकाकान्तं): stool attracts flies in excess~~

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~~#Māṁsadhāvanasannikāśaṁ (मांसधावनसन्निकाशं): appears like washing of meat~~

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~~#Maṇḍā (मण्डा): liquid portion of cooked rice~~

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~~#Māñjiṣṭha (माञ्जिष्ठ): reddish colour like of mnjistha~~

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~~#Matsyagandhi (मत्स्यगन्धि): smell like that raw fish~~

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~~#Mēcakābha (र्मेचकाभ): like tar coloured~~

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~~#Mēdōmāṁsōdakasannikāśaṁ (मेदोमांसोदकसन्निकाशं): like washing of fat or flesh~~

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~~#Muktanāla (मुक्तनाल): paralysed anus sphictor~~

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~~#Musti (मुष्टि): handful, fist~~

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~~#Nīla (नील): blue~~

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~~#Nimitta (निमित्त): cause~~

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~~#Niryūha (निर्यूह): decoction~~

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~~#Pañcavalkama (पञ्चवल्कम): bark of five plants viz. Nyagrodha, Udumbara, Ashvattha, Pārasa and plaksha~~

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~~#Patitagudavaliṁ (पतितगुदवलिं): prolapsed anal sphincters~~

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~~#Picchā-basti (पिच्छाबस्ति) medicated enema with mucilaginous drugs~~

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~~#Prāgutpatti (प्रागुत्पत्ति): origin~~

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~~#Prajānugrahārtham (प्रजानुग्रहार्थम): for wellbeing of humanity.~~

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~~#Pratyavarakālaṁ (प्रत्यवरकालं): age following performance of sacrifice by Daksa Prajapati~~

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~~#Pravāhikaḥ-(प्रवाहिकः): passing stool with spasmatic pain~~

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~~#Pūtipūyagandhyam (पूतिपूयगन्ध्यम): putrid smell or smell like undigested food~~

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~~#Samsarjanakrama (संसर्जन): gradual bringing from lighter to normal food after purification therapy~~

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~~#Srastapakvagudaṁ (स्रस्तपक्वगुदं): prolapsed and inflamed of the anus~~

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~~#Tarpaṇā (तर्पणा): roasted flour of cereals added with water~~

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~~#Upahatāgnī (उपहताग्नी): loss of the power of digestion~~

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~~#Upahatamanasāṁ (उपहतमनसां): afflicted mental equilibrium~~

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~~#Upaśamana (उपशमन): treatment~~

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~~#Varāhabhēdaḥsadr̥śa (वराहभेदःसदृश): white yellowish colour like of pig-fat~~

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~~#Vibaddha (विबद्ध): blocked~~

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~~#Yakr̥tkhaṇḍōpamaṁ (यकृत्खण्डोपमं): like piece of liver~~

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~~#Yamaka (यमक): mixture of two unctuous substances e.g. mixture of ghee and oil~~

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~~#Yavāgū (यवागू): thick gruel~~

=== Further reading ===

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#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.

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