678632588-ATISARA-ppt best for ayurvedas

Atisara

1. ATISARA Dr.bhumika saxena 2 nd year pg scholar, dept. of pg studies in kayachikitsa , sscasrh , bangalore 1

2. CONTENTS Introduction Historical review Nirukti Definition Nidana Samprapti Samprapti ghataka Types Purva rupa Bhedanusara lakshana Sama-nirama mala pareeksha Atisara nivrutti lakshana Sadhya-asadhyata Upadrava Chikitsa Research articles Conclusion 2

3. INTRODUCTION Atisara is the most commonly encountered disease in all age groups during clinical practice. It is a major cause of morbidity and mortality in rural communities of socio-economically backward in developing countries. Atisara means excessive flow of watery stool through guda marga . Most important factor in the pathogenesis of Atisara is Mandagni . Mandagni is the root cause of Ama dosha and is the crucial factor for manifestation of most of the diseases including Atisara . It has become a common problem of the present era, due to irregular and unhealthy habits relating to Ahara and Vihara . 3

4. Historical review Mentioned in Charaka samhita Due to the sacrifice of cow. The gomamsa is guru, ushna , prakruti viruddha and Aprashasta , due to which its intake causes mandagni and manasika upaghata leading to Atisara roga . 4

5. NIRUKTI अति = in increased quantity सृ = सरण ( pravrutti ) अति + सृ + णिच् + अच् प्रत्यय अतिशयेन सारयति नानाविधद्रवधातून् मलान् वा इति अतिसारः | (ch.chi.19) 5

6. DEFINATION अतिसरणम् अतिसारः | ( dalhana ) अतीव सरत्यतिसारं गुदेन | ( sharangadhara ) The disease which is characterised by mala atisarana through guda marga is called as Atisara . 6

7. Nidana Samanya Nidana : According to Acharya Shushruta - गुर्वतिस्निग्धरूक्षोष्णद्रवस्थूलातिशीतलैः | विरुद्धाध्यशनाजीर्णैरसात्म्यैश्चापि भोजनैः ||३|| स्नेहाद्यैरतियुक्तैश्च मिथ्यायुक्तैर्विषाद्भयात् | शोकाद्दुष्टाम्बुमद्यातिपानात् सात्म्यर्तुपर्ययात् ||४|| जलातिरमणैर्वेगविघातैः कृमिदोषतः | नृणां भवत्यतीसारो लक्षणं तस्य वक्ष्यते ||५|| ( su.utt . 40/3-5) 7

8. Indulgence in foods which are- Guru Ati – snigdha - ruksha - ushna - drava - sthula , Ati sheeta . Viruddha adhyashana , Ajeerna , Asatmya bhojana Sneha sevana either in excess or in improper manner. Ingestion of poison, contaminated water Bhaya (Fear), shoka (sorrow) Excess alcohol intake Practicing opposite to satmya and ritu (season) Indulging too much in water sports Supressing natural urges ( vegadharana ) Infestations by worms 8

9. According to Acharya Vagbhata स सुतरां जायते ऽत्यम्बुपानतः ॥१॥ कृशशुष्कामिषासात्म्यतिलपिष्टविरूढकैः । मद्यरूक्षातिमात्रान्नै र र्शो भिः स्नेहविभ्रमात् ॥२॥ कृमिभ्यो वेगरोधाच्च ।  (A.H. ni . 8/2-3) 9

10. Vishesha Nidana : By Acharya Charaka Vataja atisara Pittaja atisara Kaphaja atisara Sannipataja atisara वातलस्य  वातातप व्यायामातिमात्र पित्तलस्य  पुनरम्ललवणकटुक श्लेष्मलस्य तु  गुरुमधुरशीतस्निग्धो पसेविनः  अतिशीतस्निग्धरूक्षोष्णगुरुखरकठिन रूक्षाल्पप्रमिताशिन क्षारोष्णतीक्ष्ण ati sevana सम्पूरकस्या विषमविरुद्धासात्म्यभोजनादभोजनात् कालातीतभोजनाद् तीक्ष्णमद्य प्रतताग्निसूर्यसन्तापोष्णमारुत अचिन्तयतो प्रदुष्टमद्यपानीयपानाद व्यवायनित्य क्रोधेर्ष्याबहुलस्य  दिवास्वप्नपरस्यालसस्य अतिमद्यपान Vega dharana संशोधनात् प्रतिकर्मणां  विषमगमनादनुपचारा ज्ज्वलनादित्यपवनसलिलातिसेवनाद स्वप्ना- दतिस्वप्ना द्वेगविधारणा , दृतुविपर्ययाद , थाबलमारम्भा द्भयशोकचित्तोद्वेगातियोगात् कृमि शोषज्वरार्शो , अतिकर्षणा 10

11. Samprapti 11

12. Samanya Samprapti संशम्यापान्धातुरन्तः कृशानुं वर्चोमिश्रो मारुतेन प्रणुन्नः | वृद्धोऽतीवाधः सरत्येष यस्माद्व्याधिं घोरं तं त्वतीसारमाहुः ||६|| ( Su. Utt . 40/6) 12

13. Vishesha samprapti Vataja Atisara : स वायुः कुपितोऽग्नावुपहते मूत्रस्वेदौ पुरीषाशयमुपहृत्य, ताभ्यां पुरीषं द्रवीकृत्य, अतीसाराय प्रकल्पते| ( Shloka . Ch.chi . 19/5) Nidana sevana Vata prakopa Jatharagni mandya मूत्रस्वेदौ पुरीषाशयमुपहृत्य  पुरीषं द्रवीकृत्य अतीसारा 13

14. Pittaja Atisara :  पित्तं प्रकोपमापद्यते| तत् प्रकुपितं द्रवत्वादूष्माणमुपहत्य पुरीषाशयविसृतमौष्ण्याद् द्रवत्वात् सरत्वाच्च भित्त्वा पुरीषमतिसाराय प्रकल्पते| ( ch.chi . 19/6) Nidana sevana Pitta prakopa Jataragni mandya (due to increased dravta of pitta) Purisha ashaya Ushna , drava & sara guna of pitta will do the Bhedana of purisha Atisara 14

15. Kaphaja Atisara :  श्लेष्मा प्रकोपमापद्यते| स स्वभावाद् गुरुमधुरशीतस्निग्धः स्रस्तोऽग्निमुपहत्य सौम्यस्वभावात् पुरीषाशयमुपहत्योपक्लेद्य पुरीषमतिसाराय कल्पते| ( ch.chi . 19/7) Nidana sevana Kapha prakopa Jataragni mandya (due to guru, madhur , sheeta , snighda guna of kapha ) Purisha ashaya (due to saumya guna ) Purisha into drava Atisara 15

16. Sanniptaja Atisara : स्त्रयो दोषाः प्रकुपिता भूय एवाग्निमुपहत्य पक्वाशयमनुप्रविश्यातीसारं  सर्वदोषलिङ्गं  जनयन्ति||८|| (ch.chi.19/8) 16

17. Samprapti ghataka Dosha - Vata Pradhana Tridosha Dushya - Udaka , Purisha Agni- Jataragni Agni Dushti - Mandagni Srotas - Purishavaha , Udakavaha , Annavaha Sroto Dushti Lakshana - Ati Pravrutti Udbhava Sthana - Pakwashaya Vyaktasthana - Pakwashaya / Guda Swabhava - Ashukari 17

18. Types s.no. Charaka Shushruta A.H 1. Vataja Vataja Vataja 2. Pittaja Pittaja Pittaja 3. Kaphaja Kaphaja Kaphaja 4. Sannipataja Sannipataja Sannipataja 5. Bhayaja Shokaja Bhayaja 6. Shokaja Aamaja Shokaja In Sushruta samhita , a/c to Kashiraja , there are no types of Atisara , it’s many kinds are only the different stages of the doshas and appears at various time in the patient. 18

19. 19

20. Purva rupa लक्षणं तस्य भाविनः॥४॥ तोदो हृद्गुदकोष्ठेषु गात्रसादो मलग्रहः। आध्मानमविपाकश्च  (A.H. ni.8/5) हृन्नाभिपायूदरकुक्षितोदगात्रावसादानिलसन्निरोधाः ||८|| विट्सङ्ग आध्मानमथाविपाको भविष्यतस्तस्य पुरःसराणि |९| ( su.utt . 40/8-9) Pricking pain in hridaya , nabhi , udara , kukshi Anga avasada Anila sannirodha Constipation Flatulence Indigestion 20

21. Bhedanusara lakshana Vataja Atisara : अरुणं फेनिलं रुक्षमल्पमल्पं मुहुर्मुहुः | शकृदामं सरुक् शब्दं मारुतेनातिसार्यते || (Ma. Ni 3/6) Aruna varna Phenila (frothy) Dry and less in quantity Passing Aama mala Frequently with pain and sound. तत्र वातेन विड्जलम्॥५॥ अल्पाल्पं शब्दशूलाढ्यं विबद्धमु पवेश्यते। रूक्षं सफेनमच्छं च ग्रथितं वा मुहुर्मुहुः॥६॥ तथा द ग्धगुडाभासं सपिच्छापरिकर्तिकम् । शुष्कास्यो भ्रष्टपायुश्च हृष्टरोमा विनिष्टनन्॥७॥  ( A.h. ni.8/6-7) 21

22. Pittaja Atisara : दुर्गन्ध्युष्णं वेगवन्मांसतोयप्रख्यं भिन्नं स्विन्नदेहोऽतितीक्ष्णम् ||१०|| पित्तात्  पीतं नीलमालोहितं  वा तृष्णामूर्च्छादाहपाकज्वरार्तः |११| ( su.utt . 40/10-11) पित्तेन पीतमसितं हारिद्रं शाद्वलप्रभम् । ( a.h. ni . 8/8) 22

23. Kaphaja Atisara : तन्द्रानिद्रागौरवोत्क्लेशसादी वेगाशङ्की सृष्टविट्कोऽपिभूयः ||११|| शुक्लं  सान्द्रं श्लेष्मणा श्लेष्मयुक्तं भक्तद्वेषी निःस्वनं हृष्टरोमा |१२| (su.utt.40/11-12) In Ashatanga hrudaya , foul smelling is also mentioned. तस्य रूपाणि- स्निग्धं श्वेतं पिच्छिलं तन्तुमदामं गुरु दुर्गन्धं श्लेष्मोपहितमनुबद्ध शूलमल्पाल्पमभीक्ष्णमतिसार्यते   सप्रवाहिकं ,  गुरूदरगुदबस्तिवङ्क्षणदेशः कृतेऽप्यकृतसञ्ज्ञः  सलोमहर्षः  सोत्क्लेशो निद्रालस्यपरीतः सदनोऽन्नद्वेषी चेति श्लेष्मातिसारः||७|| ( ch.chi . 19/7) 23

24. Sannipataja Atisara : तन्द्रायुक्तो मोहसादास्यशोषी वर्चः कुर्यान्नैकवर्णं तृषार्तः ||१२|| सर्वोद्भूते सर्वलिङ्गोपपत्तिः  || ( su.utt . 40/12-13) Tandra , moha , sada Shosha , trushna Eliminates faeces of many colours Appearance of specific symptoms of all doshas . Ma.ni. 3/8- stool appears like pig’s fat or flesh washed with water associated with other signs of doshaja atisara . 24

25. According to Acharya Charaka , when all the dushtita tridoshas does the dushti of raktadi dhatus , the following symptoms are produced- तत्र शोणितादिषु धातुष्वतिप्रदुष्टेषु  हारिद्रहरितनीलमाञ्जिष्ठमांसधावनसन्निकाशं   रक्तं कृष्णं श्वेतं   वराहभेदः सदृशम नुबद्धवेदनमवेदनं  वा  समासव्यत्यासादुपवेश्यते  शकृद्  ग्रथितमामं   सकृत्, सकृदपि पक्वम | ( ch.chi . 19/9) 25

26. Raktatisara पित्तातिसारी यस्त्वेतां क्रियां मुक्त्वा निषेवते| पित्तलान्यन्नपानानि तस्य पित्तं महाबलम्||६९|| कुर्याद्रक्तातिसारं तु रक्तमाशु प्रदूषयेत्| ( ch.chi . 19/69-70) 26

27. Symptoms of Raktatisara : तृष्णां शूलं विदाहं च  गुदपाकं  च दारुणम्||७०|| ( ch.chi . 19/70) सरक्तमतिदुर्गन्धं तृण्मूर्च्छास्वेददाहवान्॥८॥ सशूलं पायुसन्तापपाकवान्   | ( A.h. ni . 8/8) 27

28. Agantuja atisara आगन्तू द्वावतीसारौ मानसौ भयशोकजौ| ( ch.chi . 19/19) 28

29. Shokaja atisara तत्तयोर्लक्षणं वायोर्यदतीसारलक्षणम्||११|| ( ch.chi . 19/11) The symptoms are similar to that of Vatatisara . तैस्तैर्भावैः शोचतोऽल्पाशनस्य बाष्पावेगः पक्तिमाविध्यजन्तोः || कोष्ठं गत्वा क्षोभयत्यस्य रक्तं तच्चाधस्तात् काकणन्तीप्रकाशम् | वर्चोमिश्रं निःपुरीषं सगन्धं निर्गन्धं वा सार्यते तेन कृच्छ्रात् || शोकोत्पन्नो दुश्चिकित्स्योऽतिमात्रं रोगो वैद्यैः कष्ट एष प्रदिष्टः | (su.utt.40/13-15) In persons who are stricken by grief, intakes less quantity of food, holds the tears, vitiates the jataragni (causes क्षोभ ) and rakta . The rakta resembles bright red in colour ( काकणन्ती ) eliminates outs with or without faeces, either with bad odour or without odour with difficulty. This type of Atisara is said to be difficult to treat by the physicians. According to Ashtanga hrudaya , the symptoms are similar to that of the Vata and pitta. 29

30. Amatisara आमाजीर्णोपद्रुताः क्षोभयन्तः कोष्ठं दोषाः सम्प्रदुष्टाः सभक्तम् ||१५|| नानावर्णं नैकशः सारयन्ति कृच्छ्राज्जन्तोः षष्ठमेनं वदन्ति ||१६|| (su.utt.40/15-16) 30

31. Sama-nirama mala pareeksha संसृष्टमेभिर्दोषैस्तु न्यस्तमप्स्ववसीदति | पुरीषं भृशदुर्गन्धि विच्छिन्नं चामसञ्ज्ञकम्  ||१७|| (su.utt.40-17) Faeces vitiated by doshas , sinks when put on the water. Foul smelling, picchila (slimy) and broken faeces is considered as Ama . एतान्येव तु लिङ्गानि विपरीतानि यस्य तु | लाघवं च मनुष्यस्य तस्य पक्वं विनिर्दिशेत् ||१८|| (su.utt.40-18) Faeces having features opposite to those of Ama and the patient feels lightness in his body, then it has to understood as Pakwa ( Nirama ). 31

32. Atisara nivrutti lakshana यस्योच्चारं विना मूत्रं सम्यग्वायुश्च गच्छति | दीप्ताग्नेर्लघुकोष्ठस्य स्थितस्तस्योदरामयः || ( su.utt . 40/162) When elimination of urine happens independent of faeces When flatus is expelled properly without any trouble Kindling of jataragni Lightness of koshta 32

33. Sadhya-asadhyata Sukha Sadhya : Vataja , Pittaja , Kaphaja Atisara Kruccha Sadhya : नतिक्षीणमांसशोणितबलो मन्दाग्निर्विहतमुखरसश्च; तादृशमातुरं कृच्छ्रसाध्यं विद्यात्| ( ch.chi 19/9) In Sannipataja atisara , if the patient’s mamsa , rakta and bala (strength) is not reduced much, have manda jataragni and has lost the sense of taste is said to be kruccha sadhya . 33

34. Asadhya Atisara : According to Acharya Shushruta , सर्पिर्मेदोवेसवाराम्बुतैलमज्जाक्षीरक्षौद्ररूपं स्रवेद्यत् | मञ्जिष्ठाभं मस्तुलुङ्गोपमं वा विस्रं शीतं प्रेतगन्ध्यञ्जनाभम् ||१९|| राजीमद्वा चन्द्रकैः सन्ततं वा पूयप्रख्यं कर्दमाभं तथोष्णम् | हन्यादेतद्यत् प्रतीपं भवेच्च क्षीणं हन्युश्चोपसर्गाः प्रभूताः ||२०|| असंवृतगुदं क्षीणं दुराध्मातमुपद्रुतम् | गुदे पक्वे गतोष्माणमतीसारकिणं त्यजेत् ||२१|| (su.utt.40/19-21) Faeces resembling ghrita , fat, water of meat soup, oil, bone marrow, milk, honey, manjishta , mastulunga . Foul smelling and cold, smells like dead body. Appears like Anjana , have line with chandrika . Resembles pus, mud and is hot. The one who has Arishta lakshanas and with Upadravas , is said to be asadhya . The patient whose guda marga does not closes at all, who is emaciated, have severe flatulence, have ulcers in anus and who has become cold on touch (lost his body heat) are unsuitable for treatment. According to Acharya charaka , in the condition of guda paka , if the person still consumes pitta vartdhaka aahra , there will be paka in the guda valli and will lead to dead. 34

35. Upadrava श्वासशूलपिपासार्तं क्षीणं ज्वरनिपीडितम् | विशेषेण नरं वृद्धमतीसारो विनाशयेत् ||१९|| ( su . su.33/19) शोथं शूलं ज्वरं तृष्णां कासं श्वासमरोचकम् | छर्दि मूर्छां च हिक्कां च दृष्टवातीसारिणं त्यजेत् || (Ma.ni. 3/19) Shoola Shotha Pipasa Arochaka Kshardi Ksheena (weakness) Jwara Hikka Kasa Swasa 35

36. Chikitsa तमसाध्यतामसम्प्राप्तं चिकित्सेद् यथाप्रधानोपक्रमेण हेतूपशयदोषविशेषपरीक्षया चेति| ( ch.chi . 19/10) आमपक्वक्रमं हित्वा नातिसारे क्रिया यतः | अतः सर्वेऽतिसारास्तु ज्ञेयाः पक्वामलक्षणैः ||२४|| ( su.utt . 40/24) The treatment of all the Atisaras should be started only before assessing the Ama and Pakwa lakshanas . 36

37. Langhana in atisara तत्रादौ लङ्घनं कार्यमतिसारेषु देहिनाम् | ततः पाचनसंयुक्तो यवाग्वादिक्रमो हितः ||२५|| (su.utt.40/25) अतीसारो हि भूयिष्ठं भवत्यामाशयान्वयः। हत्वाऽग्निं वातजेऽप्यस्मात्प्राक् तस्मिंल्लङ्घनं हितम्॥१॥  ( A.h. chi.9/1) Langhana (according to Ashtanga hrudaya , even in vataja atisara ) Intake of yavagu etc made from pachani drugs. 37

38. Vamana in atisara शूलानाहप्रसेकार्तं वामयेदतिसारिणम्।  ( a.h. chi. 9/2) Vamana (vomiting) should be done in those patients of Atisara , who are suffering from pain in abdomen, flatuence and excess of salivation. अथवा वामयित्वाऽऽमे शूलाध्माननिपीडितम् | पिप्पलीसैन्धवा म्भोभिर्लङ्घनाद्यैरुपाचरेत् ||२६|| (su.utt.40/26) 38

39. Amatisara chikitsa न तु सङ्ग्रहणं देयं पूर्वमामातिसारिणे| विबध्यमानाः प्राग्दोषा जनयन्त्यामयान् बहून्||१५|| ( ch.chi . 19/15) Sangrahaka aushadha should not to be given initially in atisara as if the pravrudha gati of the doshas is stopped, it will lead to other diseases. दण्डकालसकाध्मानग्रहण्यर्शो गदांस्तथा| शोथपाण्ड्वाम य प्लीहकुष्ठगुल्मोदरज्वरान् ||१६|| ( ch.chi . 19/16) According to Acharya Charaka , If the dosha and malas are excreting out from the body by themselves, then they should not be stopped initially. ( ch.chi . 19/17) Haritaki prayoga - if the malas are excreting out with difficulty then, haritaki should be used. 39

40. Langhana Alpa dosha Deepana-Pachana with Pramathya Virechana ( shodhana ) Madhya dosha Bahu dosha 40

41. Pathya in amatisara युक्तेऽन्नकाले क्षुत्क्षामं लघ्वन्नप्रति भोजयेत्॥९॥ तथा स शीघ्रं प्राप्नोति रुचिमग्निबलं बलम्।  (a.h.chi.9/9) When the person feels weak by hunger, he should be given light food, in little quantity, at the proper time. That undergoes digestion quickly, and increases the ruchi and strengthens the jataragni and body. वचाप्रतिविषाभ्यां वा मुस्तापपर्टकेन वा॥ ह्नीबेरनागराभ्यां वा विपक्वं पाययेज्जलम्।  (a.h.chi.9/8) Water cooked with vacha and ativisha or musta and parpataka or with hribera and nagara should be used for drinking. तक्रेणावन्तिसोमेन यवाग्वा तर्पणेन वा॥१०॥ सुरया मधुना वाऽथ यथासात्म्यमुपाचरेत्।  (a.h.chi.9/10) 41

42. Pramathya : Pipalyadi pramathya ( pippali , shunti , abhaya , vacha etc ) Hriberadi pramathya ( hribera , nagaramotha , bilva , shunti , dhanyaka ) Prishniparnayadi pramathya ( prishni parni , gokshura etc ) Shaka prayoga : Moolaka , bakuchi , jeevanti , patha etc mixed with dadhi and dadima rasa should be taken with sneha . Use of Bala bilva ( unriped bilva fruit), dadima , dadhi , shunti , mamsarasa etc. 42

43. Pakwatisara chikitsa In this condition, stambhaka and sangrahi aushadhas can be used. Yavagu , vilepi , yusha . Mamsa rasa etc cooked with deepana and grahi aushadha . 43

44. वातातिसारे आवस्थिकी चिकित्सा Vibandha chikitsa - Ksheera pana - धारोष्ण क्षीर mixed with ghrita and taila . Eranda moola ksheera paka etc. 44

45. Pittatisara chikitsa पित्तातिसारं पुनर्निदानोपशयाकृतिभिरामान्वयमुपलभ्य यथाबलं लङ्घनपाचनाभ्यामुपाचरेत्| ( ch.chi . 19/50) Langhana Pachana If associated with trushna - Musta , parpataka , usheera , sariva , chandana , kiratatikta and sugandha bala siddha jala sevana . 45

46. Yogas : Ativiashadi yoga ( ativisha , vatsaka , ateesa in equal quantity mixed with madhu . After this tandulodaka pana ) Pittatisara nashaka yogas (6): Kirata tiktaka , musta , vatsaka , rasanjana Bilva , daru haridra , twak , hribera , durlabha Chandana , mrunala , nagara , lodhra , utpala Tila , mocha rasa, lodhra , samanga , utpala Utpala , dhataki pushpa , dhataki twak , shunti Kataphala , nagara , patha , jambu , amra asthi , durbhala . To be taken with madhu and then intake of tandulodaka . 46

47. Pathya in Pittatisara : Mamsa rasa cooked with sangrahi dravyas Purana rakta shali Aja ksheera Ksheera virechana in Pittatisara : When there is Agni teevrata , increased pitta dosha , balavana rogi and the atisara doesn’t stopped, then virechana with go dugdha , go dhugdha with palasha phala kwatha etc , should be given. Anuvasana basti – shatapushpadi anuvasana 47

48. Piccha basti कृतानुवासनस्यास्य कृतसंसर्जनस्य च| वर्तते यद्यतीसारः पिच्छाबस्तिरतः परम्||६३|| (ch.chi.19/63) When the atisara doesn’t stopped in a person suffering from pittatisara even after giving anuvasana basti and following samsarsajana krama , then in that condition Piccha basti has to be given. Ingredients of Piccha basti : Semal ( shalmali ), dugdha , taila , ghrita , madhuka kalka . Piccha basti is also helpful in the following conditions- पित्तातिसारज्वरशोथगुल्मजीर्णातिसारग्रहणीप्रदोषान्| 48

49. Guda bhramsha chikitsa Amla rasa siddha ghrita pana Amla rasa yukta anuvasana basti Changeri ghrita ( changeri , kola, dadhi , nagara , yavakshara ) Chavyadi ghrita Anuvasana basti with dashamoola kwatha or chitraka moola etc Picchu prayoga after doing snehana and mrudu swedana of guda . 49

50. Raktatisara chikitsa Ajadugdha prayoga - intaking aja dugdha with madhu and sharkara , with rakta shali and even using it for guda prakshalana . Mamsa rasa – paravat mamsa aja and mriga mamsa and rakta . Phala yusha - kashmarya phala Shatavari prayoga Navaneeta prayoga - with half the quantity of sharkara and 1/4 th of madhu . Yoga:- Nilotpaladi yoga Priyangukadi rakta sangrahaka yoga Rakta sangrahi yoga Darvayadi ghrita Guda prakshalana yoga ( madhuka , pancha valkala etc ) Guda pralepa Piccha basti Anuvasana basti 50

51. In case of Ati rakta srava - Application of ghrita on guda , vankshan , kati and uru pradesha . Sheeta prakshalana Applying cotton dipped with chandanadi taila and shata dhoota ghrita 51

52. Kaphatisara chikitsa श्लेष्मातिसारे प्रथमं हितं लङ्घनपाचनम्|| योज्यश्चामातिसारघ्नो यथोक्तो दीपनो गणः| (ch.chi.19/102-03) Langhana Pachana Use of deepana aushadha Kapha nashaka aushadha sevana 52

53. Yogas : Kwatha Bilva , karkataka , musta , abhaya , shunti Pippali , pippali moola , chitraka , gaja pippali etc Rasanjanadi yoga ( rasanjana , ativisha , kutaja ) Kapithadi yoga Pippalyadi yoga Bilva prayoga Changeri ghrita , shatapala ghrita Kapitthasthaka churna (AH) Dadimashtaka churna (AH) Piccha basti Anuvasana basti 53

54. Sannipataja atisara chikitsa वातस्यानु जयेत् पित्तं, पित्तस्यानु जयेत् कफम्| त्रयाणां वा जयेत् पूर्वं यो भवेद्बलवत्तमः||१२२|| ( ch.chi . 19/122) Or The dosha which is more more prakupita or balvana 54

55. Jwaratisara पित्तज्वरे पित्तभवोऽतिसारस्तथाऽतिसारे यदि वा ज्वरः स्यात् | दोषस्य दुष्यस्य समानभावाज्जवरातिसारः कथितो भिषगिमः || (B.R 6/1) Pitta dushti causes pittatisara and this dushita pitta can cause jwara also. The similarity in dosha-dushya , causes jwaratisara . CHIKITSA : अनुलोमनं ज्वरघ्नं ग्राहकमतिसारहभ्दवति | पृथगुक्तमौषधं तजज्वरातिसारे विरुद्धमन्योऽन्यम् || (Bh.pr. Madhyam khanda . 3/2) The treatment of jwaratisara has to be done separately, not to be combined. As the jwarahara medicines are Anulomana while Atisarahara medicines are Grahaka in nature which is contrary in nature. If the rogi is balwana , then langhana is the best treatment for jwaratisara followed by the intake of peya etc. ( Chakradutta . 2/1) 55

56. Agantuja atisara chikitsa मारुतो भयशोकाभ्यां शीघ्रं हि परिकुप्यति| तयोः क्रिया वातहरी हर्षणाश्वासनानि च||१२|| (ch.chi.19/12) Vatahari chikitsa Bhayaja atisara Shokaja atisara Aashvasana Harshana 56

57. Common drugs used in atisara Rasoushadi : Jatiphala rasa Purna chandrodaya rasa Parpati : Ramban parpati Panchamruta parpati Vati : Jatiphaladi vati Kutaja ghana vati Churna : Jatiphaladi churna Dadimashtaka churna Gangadhara churna Asava / Arishta : Kutajyarishta Ahifenasava Avaleha : Dadimavaleha Kutajadyavaleha Ativishavaleha Single drugs: Kutaja Mocha rasa Bilwa Dadima etc 57

58. Research articles EFFICACY OF SHUNTHI KALPA IN THE MANAGEMENT OF ATISARA ( S.C.MuthaAryangla Vaidyak Mahavidyalaya , Satara , Maharashtra) Total 100 patients of Atisara (age group= 10-60 years) Shunti kalpa . Shunti 1part Go ghrita 1 part Sugar 1 part Shunti kalpa in dosage of 2grams TID empty stomach (.00 a.m., 3.00p.m. and 10.00 p.m ) for 7 days. Results: Shunthi Kalpa showed highly significant results in Dravamalapravritti , Udarshula , Agnimandya , Daurbalya and Aruchi 58

59. Evaluation of Atisaraghna ( antidiarrhoeal ) effect Shami ( Prosopis spicigera Linn.) on albino rats- An experimental study ( Triveni.Y.Koujageri , Gadag , Karnataka ) Shami churna showed significant effect as anti diarrhoeal screened under experimental study using castor oil induced diarrhoea and intestine motility test experimental models. 59

60. EFFECT OF THE VACHADI YOGA BASED ON THE RELATIVE PREDOMINANCE OF DOSHIKA CHARACTERISTICS IN DIARRHEAL STOOL OF INFANTS (BHU) Vachadi Yoga:- equal quantity of raw form of Vacha , Musta , Ativisha , and Indrayava Drug administration- Syrup Vachadi Yoga was given 8 mg/kg/dose, twice in a day. Dose of Churna for one year old infant is 12 Ratti i.e.1500 mg (1 Ratti = 125 mg). The average weight of one-year infant is 10 kg, and then dose for one-year-old infant is 1500 mg or 150 mg/kg/day. Result- Vachadi yoga was found more significant in reducing the frequency of stool in all type of Doshika Atisara and has leading effect on the Vatapradhana Pitta and Pittapradhana Vata . 60

61. A Clinical Study of Nagaradi Yoga in Childhood Atisara ( Diarrhea ) Ajeet Singh Yadav1 , P.S. Upadhyay2 (BHU) Nagaradi Yoga is a herbal formulation which contains Nagar ( Zingiber officinale ), Ativisha (Aconitum heterophyllum ), Mustaka ( Cyperus rotundus ), Indrayava ( Holarrhena antidysenterica ) and Balaka ( Pavonia odorata ). a total number of 20 cases Test drug was given in dose 8-10 mg/kg/dose thrice in a day. Test drug was prepared in syrup form in concentration of 400 mg/5ml. Follow up on 1st day (after 8 hrs of treatment), 3 rd , 7 th and 14 th day. Result: - Signs and symptoms of Atisara ( diarrhea ) persist maximum up to 3 rd follow up, and on 3rd follow up significant improvement in clinical signs and symptoms were observed. 61

62. Assessment of effect of Kutaja ( Holarrhena antidysenterica , Wall) in different Doshika Atisara in Infants: A Clinical Study ( Kumari Vandana , Brij Mohan Singh, Ashok Kumar, Girish Singh.) 30 infants were selected, out which 28 completed. The trial drug Kutaja was given to infant in dose of 15mg/kg/dose, 8 hourly for two days. Infants were evaluated at 24 and 48 hours on follow ups. Result: Analysis of gathered data divulges that Kutaja has significant effect in reducing frequency, foul smell and mucus in stool. It also subsides pain in abdomen as well as improve the consistency of stool 62

63. Conclusion Atisara means excessive flow of watery fluid through Guda marga (anus). Mandagni is the most important factor in causation of Atisara . Faulty life style like Adhyashana , Vishamashana , and eating stale food etc. which affects the Agni leading to Ama formation and diseases like Atisara . If Atisara roga is not treated properly, agni gets further hampered and this leads to Grahani roga . Therefore drugs used for treatment should act directly or indirectly on Agni. Management should primarily aim at Nidana Parivarjana in Atisara by avoiding agnivaigunyakara hetus and apanavaigunyakara hetus . 63

64. Thank you 64

65. Differential diagnosis Atisara Pravahika Grahani dosha Ashukari Ashukari Chirakari Pravahana is absent (present in kaphatisara ) Pravahana is present Pravahana is absent More quantity of drava mala with increased frequency Less quantity of mala with increased frequency Muhur baddham-muhur dravam Karshayata is absent Karshayata is absent Karshayata is present 65

66. Shokatisara Raktatisara Raktapitta Nidana is shoka Nidana is pittavardhaka aahara sevana Nidana is pittavardhaka aahara sevana Rakta may come with mala Rakta will come with mala Rakta may or may not come with mala Rakta will come out from guda marga Rakta will come out from guda marga Rakta can come out from guda , mukha , nasa etc Treatment: Raktastambhana + manasika chikitsa ( harshana ) Treatment: Raktastambhana + pittashamaka Treatment: Raktastambhana + pittashamaka 66