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→Tattva Vimarsha
Thus the etiology, premonitory symptoms, general and individual symptoms of eight types of udara, complications of udara, seriousness of the illness, prognosis, symptoms of stages of udara as non accumulation and accumulation of fluid, and the specific as well as general treatment of udara roga are described by the sage Punarvasu in this chapter of Chikitsa [195-196].
Thus the etiology, premonitory symptoms, general and individual symptoms of eight types of udara, complications of udara, seriousness of the illness, prognosis, symptoms of stages of udara as non accumulation and accumulation of fluid, and the specific as well as general treatment of udara roga are described by the sage Punarvasu in this chapter of Chikitsa [195-196].
=== Tattva Vimarsha ===
=== ''Tattva Vimarsha'' ===
*Abnormalities of jatharagni (digestive power) leads to the morbid accumulation of the mala (dosha and excreta- waste) and in turn tend to cause multiple diseases and particularly udara roga.
*Affliction of prana vata, agni as well as apana vata are main culprits leading to accumulation of morbid dosha. This in turn obliterates the channels of sweda (sweat) and udaka (body fluid) tending upwards and downwards.
*The causes of gross enlargement of abdomen include consumption of foods that lead to vitiation of pitta like hot, salty, kshara (alkali), that cause burning sensation, sour, ruksha (dry), slow poisons, erroneous dietary management following purification treatments, viruddha ahara (combination of foods having mutually contradictory properties), unhealthy foods, emaciation due to splenic enlargement, arshas (mass per rectum), emaciation due to grahani roga (malabsorption), improper administration of panchakarma, ignorance of persistent illness without treatment, dryness of the body, withholding the naturally manifesting urges, morbidity of body channels, illness of ama (undigested food), psychological irritation, excessive consumption of foods, obstruction of the ano-rectal canal by the arshas (mass per rectum), impaction of hair within the lumen of the intestines, impaction of hardened stools within the intestines, perforation or rupture of intestines, excessive accumulation of morbidity, indulging in sinful activities.
*Apart from accumulation of morbid dosha in abdomen, splenomegaly, gastrointestinal obstruction, intestinal perforation, collection of fluid are the other causes of udara
*Liver and spleen are affected by morbid dosha leading to enlargement in size and udara.
*The pathogenic factors in vata dominant udara are located at kukshi (lower abdomen), hridaya (heart), basti (bladder and urinary system), guda (ano-rectal canal).
*The pathogenic factors in pitta dominant udara are located at amashaya (stomach and upper GI tract).
*The pathogenic factors in kapha dominant udara are located at bahirantra (outer side of intestine i.e. peritoneal cavity).
*Collection of ascitic fluid is due to affliction of kapha dosha and udaka. (body fluids).
*Treatment protocol for vatodara includes administration of unctuous medications, abhyanga (unctuous massage), sweda (sudation), sneha virechana (purgation with unctuous purgatives) and pattabandhana (tight bandage on abdomen).
*In order to prevent recurrence, udara should be treated by regular virechana (frequent therapeutic purgation). After purgation, milk is advised to improve the physical strength and to relieve the strain of purgation.
*Asthapana (decoction enema) and anuvasana (unctuous enema) is advised to remove obstruction.
*Physically strong patients suffering from pittodara should be treated by virechana karma (therapeutic purgation) first. Physically weak patients should be treated by purification by adapting kshirabasti (decoction enema consisting of milk as predominant ingredient). After they regain physical strength and digestive power improves, the patient should be treated with virechana (therapeutic purgation).
*In patients suffering from kaphodara, shodhana (eliminative therapy) is done after preparing with oleation and sudation. In samsarjana krama (gradual diet schedule) pungent, kshara and anti kapha diet is prescribed.
*Plihodara should be treated by measures like oral medication of sneha (medicated unctuous substance), sudation, virechana (therapeutic purgation), niruha (decoction enema) and anuvasana basti (oil enema) and raktamokshana (blood-letting) by sectioning the vein located in the left arm. The vata and kapha dominated plihodara should be treated by agnikarma (cauterization).
*The treatment of baddhodara (enlargement of abdomen due to gastrointestinal obstruction) includes sudation followed by niruha basti (decoction enema) consisting of potent medicines, cow’s urine, saindhava (rock salt) and oil. After niruha basti (decoction enema), oil processed with same drugs should be given in the form of anuvasana basti (unctuous enema).
*Chhidrodara (enlargement of abdomen due to intestinal perforation) is treated by all measures of kaphodara except sudation. The patient should be maintained by repeated aspiration of the abdominal fluid as and when it gets collected.
*All types of udara (enlargement of abdomen) are mostly due to tri discordance of dosha, hence treatment that alleviates all three dosha should be adapted in all types of udara.
=== Vidhi Vimarsha ===
=== Vidhi Vimarsha ===