Changes

==== Etiopathogenesis ====

==== Etiopathogenesis ====

Impairment of ''jatharagni'' leads to morbidity of all the three ''dosha''. ''Mala'' in the present context refers to morbid ''vata'', ''pitta'' and ''kapha'', the metabolic bi-products formed during ''dhatu'' metabolism i.e. during tissue formation as well as the wastes like excreta1. Impairment of ''agni'' leads to excess formation of metabolic bi products (''mala'') and less formation of quality products. This leads to accumulation of the waste at micro-cellular circulation, which causes multiple diseases. More specifically, this accumulation of wastes at various visceral organs like liver, spleen etc. leads to distension of abdomen2.  

Impairment of ''jatharagni'' leads to morbidity of all the three ''dosha''. ''Mala'' in the present context refers to morbid ''vata'', ''pitta'' and ''kapha'', the metabolic bi-products formed during ''dhatu'' metabolism i.e. during tissue formation as well as the wastes like excreta<ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with Ayurveda Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 491</ref>. Impairment of ''agni'' leads to excess formation of metabolic bi products (''mala'') and less formation of quality products. This leads to accumulation of the waste at micro-cellular circulation, which causes multiple diseases. More specifically, this accumulation of wastes at various visceral organs like liver, spleen etc. leads to distension of abdomen<ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with jalpakalpataru commentary by gangadhara, 3rd part, kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta, ed., 1st Edition, Culcutta, C.K.Sen and company ltd, Pp3828, Pg no 2815</ref>.  

''Malina ahara'' meaning unhealthy food refers to all food articles that cause morbidity of ''dosha'' in the body when consumed3. ''Malina ahara'' also includes unclean vegetable and other food articles4.

''Malina ahara'' meaning unhealthy food refers to all food articles that cause morbidity of ''dosha'' in the body when consumed<ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with Ayurveda Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 491</ref>. ''Malina ahara'' also includes unclean vegetable and other food articles<ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with jalpakalpataru commentary by gangadhara, 3rd part, kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta, ed., 1st Edition, Culcutta, C.K.Sen and company ltd, Pp3828, Pg no 2815</ref>.

Excessive dryness of the body in the absence of counteracting the same by proper measures leads to the ''udara roga''5. The disease ''ama'' causing ''udara'' refers to the chronic perpetuation ''ama'' leads to ''udara roga''5.  

Excessive dryness of the body in the absence of counteracting the same by proper measures leads to the ''udara roga''. The disease ''ama'' causing ''udara'' refers to the chronic perpetuation ''ama'' leads to ''udara roga''<ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with Ayurveda Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 491</ref>.  

''Āma'' as a cause of ''udara'' also refers to the consumption of uncooked foods6.  

''Āma'' as a cause of ''udara'' also refers to the consumption of uncooked foods<ref>Sushrut,  Sushruta samhita, with nibandha sangraha commentary of dhallahan & Nyayachandrika commentary of of gayadasa, yadavji trikamji , nirnaya sagar press, 1915, P713, Pgno 236</ref>.  

Severe suffering of diseases like ''pliha'' here refers to the suffering due to non availability of proper treatment predisposes to ''udara roga''7.  

Severe suffering of diseases like ''pliha'' here refers to the suffering due to non availability of proper treatment predisposes to ''udara roga''. Morbidity of ''srotas'' refers to the ''mutravaha'' and ''purishavaha srotas'' and others that lead to the manifestation of ''udara roga''<ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with      Ayurveda Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 492</ref>

Morbidity of ''srotas'' refers to the ''mutravaha'' and ''purishavaha srotas'' and others that lead to the manifestation of ''udara roga''7.

Traveling and other physical activities immediately after the meals are referred as irritation after the meals and are the cause of ''udara roga''.

Traveling and other physical activities immediately after the meals are referred as irritation after the meals and are the cause of ''udara roga''6.

Listing of sinful acts as etiology indicates the serious unrighteousness as the potent etiology of ''udara roga'' [12-13].

Listing of sinful acts as etiology indicates the serious unrighteousness as the potent etiology of ''udara roga''5 [12-13].

All the foods that are greasy, heavy for digestion or light for digestion and dry causes ''vidaha'' (burning sensation in the abdomen during the digestion of foods) or else the patient develops ''vidaghdajirna''<ref>Vagbhata. Astanga hridayam elaborated by Vagbhata, with joint commentaries Ayurveda Rasayana by Hemadri and Sarvangasundara by Arunadatta, Pt. Harisadashiva Shastri Paradakara Ed., 2010 Edition, Varanasi, Chaukhambha Sanskrit Sansthan, Pp 956, Pg 513.</ref> (intermediate state of digestion that caused burning)[12-15] .

The pathogenesis mentioned earlier in the text is of all types of ''udara roga''. The pathogenesis described here is that of the four types of ''udara'' caused by ''morbid dosha'' viz ''vatodara, pittodara, kaphodara'' and ''sannipatodara''<ref>Sushrut,  Sushruta samhita, with nibandha sangraha commentary of dhallahan & Nyayachandrika commentary of of gayadasa, yadavji trikamji , nirnaya sagar press, 1915, P713, Pgno 236</ref> [20].

 

The pathogenesis mentioned earlier in the text is of all types of ''udara roga''. The pathogenesis described here is that of the four types of ''udara'' caused by ''morbid dosha'' viz ''vatodara, pittodara, kaphodara'' and ''sannipatodara''9 [20].

Two tier impairment of ''jatharagni'' is mentioned as the cause of ''udara roga''. In a patient with impaired ''jatharagni'' (digestive juices), consumption of unhealthy foods further impairs the functioning of ''jatharagni''. This indicates extreme impairment of ''jatharagni'' is involved in the pathogenesis of ''udara roga''.

Two tier impairment of ''jatharagni'' is mentioned as the cause of ''udara roga''. In a patient with impaired ''jatharagni'' (digestive juices), consumption of unhealthy foods further impairs the functioning of ''jatharagni''. This indicates extreme impairment of ''jatharagni'' is involved in the pathogenesis of ''udara roga''.

Impairment of ''agni'' is the initial state that causes indigestion and morbidity of ''dosha''. Morbid ''dosha'' in turn further impairs the functioning of ''agni'' thus forming a vicious cycle.

Impairment of ''agni'' is the initial state that causes indigestion and morbidity of ''dosha''. Morbid ''dosha'' in turn further impairs the functioning of ''agni'' thus forming a vicious cycle.

Morbid ''dosha'' formed by the indigestion afflicts the ''srotas''. Constriction and dilatation are the two varieties of pathology of ''srotas''. Dilatation leads to excessive circulation and constriction leads to decreased circulation. In the pathology of ''udara, srotas'' are obliterated due to morbid ''dosha''. This obliteration at ''swedavaha srotas'' leads to impairment of sweating. The fluid within the ''sweda-vaha-srotas'' is deviated to ''udaka-vaha-srotas'' thereby adding to the body fluids 10-11.

Morbid ''dosha'' formed by the indigestion afflicts the ''srotas''. Constriction and dilatation are the two varieties of pathology of ''srotas''. Dilatation leads to excessive circulation and constriction leads to decreased circulation. In the pathology of ''udara, srotas'' are obliterated due to morbid ''dosha''. This obliteration at ''swedavaha srotas'' leads to impairment of sweating. The fluid within the ''sweda-vaha-srotas'' is deviated to ''udaka-vaha-srotas'' thereby adding to the body fluids. <ref>Sushrut,  Sushruta samhita, with nibandha sangraha commentary of Dhallahan & Nyayachandrika commentary of of gayadasa, yadavji trikamji , nirnaya sagar press, 1915, P713, Pgno 236</ref> <ref>Vriddhavagbhata. Astanga Sangraha, elaborated by Vriddha Vaghbata, with commentary Sasilekha by Indu, Dr Shivaprasad Sharma ed., 2006 Edition, Varanasi, Chowkhamba Sanskrit Sansthan, Pp965, Pg 385</ref>

''Udakavaha srotas'' that are coursing upwards and downwards are also being obliterated by the morbid ''dosha''. The body fluid increased in the ''srotas'' is then deviated to the abdomen between the ''tvacha'' (skin) and ''mamsa'' (visceral tissues) causing ''udara roga'' 12.   

''Udakavaha srotas'' that are coursing upwards and downwards are also being obliterated by the morbid ''dosha''. The body fluid increased in the ''srotas'' is then deviated to the abdomen between the ''tvacha'' (skin) and ''mamsa'' (visceral tissues) causing ''udara roga'' <ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with Ayurveda Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 492</ref>  

The divergence of fluids is not restricted to ''sweda-vaha-srotas'' and ''udaka-vaha srotas'', rather ''rasa-vaha srotas'' is also obstructed. ''Rasa dhatu'' is another source of fluid in the body. This fluid is also deviated to the space between the ''kala'' (mucus membrane) and visceral tissues in the abdomen. Thus, the fluid from the ''udaka-vaha srotas, sweda-vaha-srotas, rasa-vaha srotas'' and ''annavaha srotas'' deviates into the abdominal cavity 13.

The divergence of fluids is not restricted to ''sweda-vaha-srotas'' and ''udaka-vaha srotas'', rather ''rasa-vaha srotas'' is also obstructed. ''Rasa dhatu'' is another source of fluid in the body. This fluid is also deviated to the space between the ''kala'' (mucus membrane) and visceral tissues in the abdomen. Thus, the fluid from the ''udaka-vaha srotas, sweda-vaha-srotas, rasa-vaha srotas'' and ''annavaha srotas'' deviates into the abdominal cavity <ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with Jalpakalpataru commentary by gangadhara, 3rd part, kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta, ed., 1st Edition, Culcutta, C.K.Sen and company ltd, Pp3828, Pg no 2815</ref>

Fluid is diverged from the ''koshtha'' into the space between the ''kala'' (mucus membrane) and visceral tissues in the abdomen. In the present context, the word ''koshtha'' refers to the intestines wherein digestion as well as separation of nutrient from the waste and assimilation of nutrients takes place. To be clearer the chyle formed in the intestines is diverted to the abdominal space between the ''kala'' (mucus membrane) and visceral tissue. The accumulation of the fluid in the abdominal space is due to the diversion of fluids from the intestines, ''rasa, udaka''(fluid) as well as ''sweda'' (sweat)13.

Fluid is diverged from the ''koshtha'' into the space between the ''kala'' (mucus membrane) and visceral tissues in the abdomen. In the present context, the word ''koshtha'' refers to the intestines wherein digestion as well as separation of nutrient from the waste and assimilation of nutrients takes place. To be clearer the chyle formed in the intestines is diverted to the abdominal space between the ''kala'' (mucus membrane) and visceral tissue. The accumulation of the fluid in the abdominal space is due to the diversion of fluids from the intestines, ''rasa, udaka''(fluid) as well as ''sweda'' (sweat).

Diversion of fluids from the ''sweda-vaha, udaka-vaha,'' and ''rasa-vaha srotas'' is mobilized by the morbid ''vata''. In this pathology, the ''prana vata'' acts in the upper part of the trunk whereas the ''apana vata'' acts at the lower part of the trunk.

Diversion of fluids from the ''sweda-vaha, udaka-vaha,'' and ''rasa-vaha srotas'' is mobilized by the morbid ''vata''. In this pathology, the ''prana vata'' acts in the upper part of the trunk whereas the ''apana vata'' acts at the lower part of the trunk.

Since the fluid is diverted, the other body parts exhibit emaciation. Contrary to this the abdomen shows distention as the diverted fluid accumulates in the abdomen13.

Since the fluid is diverted, the other body parts exhibit emaciation. Contrary to this the abdomen shows distention as the diverted fluid accumulates in the abdomen.

No visible ''srotas'' is involved in the diversion of fluids into the abdomen. Rather it is from the minute pores present in the intestine, fluid oozes into the abdominal space between the ''kala'' and visceral tissues. This can be best understood by the allegory of oozing of the water stored in the new earthen pot through the invisible minute pores14. Thus, in ''udara'', the distension of abdomen is due to the accumulation of the fluids within the space between the ''kala'' and visceral tissues in the abdomen15 [9-11].

No visible ''srotas'' is involved in the diversion of fluids into the abdomen. Rather it is from the minute pores present in the intestine, fluid oozes into the abdominal space between the ''kala'' and visceral tissues. This can be best understood by the allegory of oozing of the water stored in the new earthen pot through the invisible minute pores<ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with Jalpakalpataru commentary by gangadhara, 3rd part, kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta, ed., 1st Edition, Culcutta, C.K.Sen and company ltd, Pp3828, Pg no 2815</ref>. Thus, in ''udara'', the distension of abdomen is due to the accumulation of the fluids within the space between the ''kala'' and visceral tissues in the abdomen<ref>Agnivesha. Charaka Samhita, elaborated by Charaka & Dridabala with Jalpakalpataru commentary by gangadhara, 3rd part, kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta, ed., 1st Edition, Culcutta, C.K.Sen and company ltd, Pp3828, Pg no 2816</ref> [9-11].

==== Types of ''udara roga'' ====

==== Types of ''udara roga'' ====