Changes

In such a condition it is to be corrected by eating ''mashayusha'' (soup of black beans) and ''kulmasha'' (half cooked grains); and by taking honey or ''sura''. ''Kulmasha'' is also interpreted as a sour gruel (prepared by the spontaneous fermentation of fruit-juices or boiled rice). However, according to Chakrapani this is half cooked grain (barley etc.), which is popularly known as ''ghughuni''.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.18. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 713.</ref>,<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya. Verse 13-14.In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3738.</ref>. This is known as ''ghughari'' in Gujarat and western Madhya Pradesh. This is more suitable interpretation. This is considered to be well nourishing food article. (verse 18)

In such a condition it is to be corrected by eating ''mashayusha'' (soup of black beans) and ''kulmasha'' (half cooked grains); and by taking honey or ''sura''. ''Kulmasha'' is also interpreted as a sour gruel (prepared by the spontaneous fermentation of fruit-juices or boiled rice). However, according to Chakrapani this is half cooked grain (barley etc.), which is popularly known as ''ghughuni''.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.18. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 713.</ref>,<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya. Verse 13-14.In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3738.</ref>. This is known as ''ghughari'' in Gujarat and western Madhya Pradesh. This is more suitable interpretation. This is considered to be well nourishing food article. (verse 18)

Faulty application of ''bastis'' may cause a complication in the form of atisāra. ''Atisāra'' is a clinical condition of colon characterized by excessive and frequent defecation with altered consistency of stool. In short it may be interpreted as diarrhea. In next verse different forms of atisāra and their management are described. In this verse the condition is characterized by sāma stool (stool containing āma- undigested material), which smells like a decomposing body (putrid smell) and is associated with abdominal pain. Āma is a substance produced due to weak agni resulting in incomplete transformation of substance. In the present context, due to weak jatharāgni the transformation of food in to digested absorbable substances is incomplete resulting in to production of some intermediate substances.<ref>Vāgbhata; Aṣtāṅga Hṛdaya, chapter 13/25; edited by Bhiṣagācārya Hariśāstrī Parādakara Vaidya; Chaukhambha Orientalia, Varanasi; Reprint 10th edition, 2014; P 216.</ref>,<ref>Śrī Mādhavakara; Mādhavanidāna, volume 1, chapter 25 (madhukośa tīkā of vijayarakṣita and śrī kaṅṭhadatta on 5th verse); edited with madhudhārā hindi commentary by Brakmanand Tripathi; Chaukhamba Surabharati Prakashan, Varanasi, 2012; P 573-574.</ref> These substances are known as āma. Because of its adherent quality it is supposed to be a pathogenic substance.In this condition a decoction of ''mustā, ativiṣā, kuṣṭha, nata, dāru'' and ''vacā'' is recommended. These medicines help in ''pāchana'' (termination) of āma.

Faulty application of ''bastis'' may cause a complication in the form of atisāra. ''Atisāra'' is a clinical condition of colon characterized by excessive and frequent defecation with altered consistency of stool. In short it may be interpreted as diarrhea. In next verse different forms of atisāra and their management are described. In this verse the condition is characterized by sāma stool (stool containing āma- undigested material), which smells like a decomposing body (putrid smell) and is associated with abdominal pain. Āma is a substance produced due to weak agni resulting in incomplete transformation of substance. In the present context, due to weak jatharāgni the transformation of food in to digested absorbable substances is incomplete resulting in to production of some intermediate substances.<ref>Vagbhata. Sutra Sthana, Cha.13 Doshopakramaniya Adhyaya verse 25. In: Bhiṣagācārya Hariśāstrī Parādakara Vaidya, Editors. Ashtanga Hridayam. 1oth ed. Varanasi: Chaukhambha Orientalia;2000.p.4.2014; P 216.</ref> ,<ref>Vijayarakshita and Srikanthadata, Madavakara chapter 25,Amavata nidana  Verse 5, In: Brakmanand Tripathi Editor, Madhava Nidana ? ed. Varanasi: Chaukhamba Surabharati Prakashan,2012; P 573-574.</ref>These substances are known as āma. Because of its adherent quality it is supposed to be a pathogenic substance.In this condition a decoction of ''mustā, ativiṣā, kuṣṭha, nata, dāru'' and ''vacā'' is recommended. These medicines help in ''pāchana'' (termination) of āma.

This chapter describes six types of ''atisāra'' based on the pathogens being excreted in excess. This verse explains the remedy for one of them in which patient passes stool with significant undigested material. This undigested material causes putrid smell after decomposition. Decomposition also produces some toxic substances, which cause abdominal pain and loss of appetite. The recipe described here is not useful in atisāra produced as complication of basti but also in āmātisāra of any origin. (verse 19)

This chapter describes six types of ''atisāra'' based on the pathogens being excreted in excess. This verse explains the remedy for one of them in which patient passes stool with significant undigested material. This undigested material causes putrid smell after decomposition. Decomposition also produces some toxic substances, which cause abdominal pain and loss of appetite. The recipe described here is not useful in atisāra produced as complication of basti but also in āmātisāra of any origin. (verse 19)

#Atisāra (diarrhea) in which stool is pakva and containing kapha.

#Atisāra (diarrhea) in which stool is pakva and containing kapha.

For the management of these conditions bastis prepared with the svavargīya medicines (group of medicines acting against particular pathologies) are given.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā, siddhisthāna, chapter 8/20 (Cakrapāṇi commentary); edited by Yadavji trikamji acharya; Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714.</ref> For example the vargas (classified groups) described in Ṣaḍvirecanaśatāśrīya chapter (chapter 4th) of sūtrasthāna of Carakasaṁhitā. So, the recommended group of medicines for last five conditions of pathology is  purīṣasaṁgrahaṇīya [Ca.Sū.4/8/31], vātaghna, śoṇitasthāpana [Ca.Sū.4/8/46], pittaghna  and kaphaghna vargas  respectively.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā, siddhisthāna, chapter 4/8; edited by Yadavji trikamji acharya; Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 33 & 34.</ref>. Purīṣasaṁgrahaṇīya group consists of priyaṅgu (Callicarpa macrophylla R.Br.), ananta (Hemidesmus indicusR.Br.), Seed of  mango, kaṭvaṅga (Ailanthus excelsa Roxb.), lodhra (Symplocos racemosa Roxb.), mocharasa (secretion of Salmalia malabarica Scott&Endl.), samṅgā (Mimosa pudica Linn.), dhātakī (Woodfordia fruticosa Kurz.), padmā (Clerodendrum serratum Linn.) and padmakesara (Stamen of Nelumbo nucifera Gaertn.). shoṇitasthāpana group consists of honey, madhuka (Glycyrrhiza glabra Linn.), saffron, mocarasa (secretion of Salmalia malabarica Scott &Endl.), broken earthen vessel, lodhra (Symplocos racemosa Roxb.), gairika (red ochre), priyaṅgu (Callicarpa macrophylla  R.Br.), sharkarā(sugar) and lājā (puffed rice).<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā, siddhisthāna, chapter 4/8; edited by Yadavji trikamji acharya; Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 33 & 34.</ref>The form of basti is not described here. However, this may be decided according to disease condition and patient’s tolerance. (verse 20)

For the management of these conditions bastis prepared with the svavargīya medicines (group of medicines acting against particular pathologies) are given.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.20. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714.</ref> For example the vargas (classified groups) described in Ṣaḍvirecanaśatāśrīya chapter (chapter 4th) of sūtrasthāna of Carakasaṁhitā. So, the recommended group of medicines for last five conditions of pathology is  purīṣasaṁgrahaṇīya [Cha.Sa.[[Sutra Sthana]] 4/8/31], vātaghna, śoṇitasthāpana [Cha.Sa.[[Sutra Sthana]] 4/8/46], pittaghna  and kaphaghna vargas  respectively.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.4 Snehavyapat Siddhi ver.8. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714. P 33 & 34.</ref>.Purīṣasaṁgrahaṇīya group consists of priyaṅgu (Callicarpa macrophylla R.Br.), ananta (Hemidesmus indicusR.Br.), Seed of  mango, kaṭvaṅga (Ailanthus excelsa Roxb.), lodhra (Symplocos racemosa Roxb.), mocharasa (secretion of Salmalia malabarica Scott&Endl.), samṅgā (Mimosa pudica Linn.), dhātakī (Woodfordia fruticosa Kurz.), padmā (Clerodendrum serratum Linn.) and padmakesara (Stamen of Nelumbo nucifera Gaertn.). shoṇitasthāpana group consists of honey, madhuka (Glycyrrhiza glabra Linn.), saffron, mocarasa (secretion of Salmalia malabarica Scott &Endl.), broken earthen vessel, lodhra (Symplocos racemosa Roxb.), gairika (red ochre), priyaṅgu (Callicarpa macrophylla  R.Br.), sharkarā(sugar) and lājā (puffed rice).<ref>Chakrapani, Charak. Sidhi Sthana, Cha.4 Snehavyapat Siddhi ver.8. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714. P 33 & 34.</ref>The form of basti is not described here. However, this may be decided according to disease condition and patient’s tolerance. (verse 20)

In this version of [[Charak Samhita]] thirty six variants are cited, but another version ‘kēvalaiḥ saha ceṭ triṁśadvidyāt sōpadravānapi’ mentions only thirty.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā (only samskrita), 5th part, siddhisthāna,  chapter 8; edited by Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Rastriya Samskrita Samsthana, New Delhi, 2002; P 3739.</ref> Gaṅgādhara also explains thirty forms in the following manner.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā (only samskrita), 5th part, siddhisthāna,  chapter 8 (Commentary of Gaṅgādhara on 17); edited by Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Rastriya Samskrita Samsthana, New Delhi, 2002; P 3739.</ref>

In this version of [[Charak Samhita]] thirty six variants are cited, but another version ‘kēvalaiḥ saha ceṭ triṁśadvidyāt sōpadravānapi’ mentions only thirty.<ref>Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya . In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3739.</ref> Gaṅgādhara also explains thirty forms in the following manner.<ref>Gangadhara, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya.Verse 17 In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3739.</ref>

The six basic forms of atisāra are:  

The six basic forms of atisāra are:  

Nine ''upadrava'' as cited above.

Nine ''upadrava'' as cited above.

The upadravas in present version of chapter are ten. Gaṅgādhara has taken description of nine upadravas from another version.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā (only samskrita), 5th part, siddhisthāna, chapter 8/17 ; edited by Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Rastriya Samskrita Samsthana, New Delhi, 2002; P 3739.,</ref> But upadravas cannot be counted among types of a disease. Hence the thirtysix variants would be in following manner.

The upadravas in present version of chapter are ten. Gaṅgādhara has taken description of nine upadravas from another version.<ref>Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya. In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3739.</ref> But upadravas cannot be counted among types of a disease. Hence the thirtysix variants would be in following manner.

The six basic forms of atisāra are as mentioned above.

The six basic forms of atisāra are as mentioned above.

#kapha-pitta.

#kapha-pitta.

Moreover [[Charak Samhita]] describes types of atisāra in its chapter 19th of [[Sutra Sthana]] and 19th chapter of [[Chikitsa Sthana]] differently. <ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā, Sūtrasthāna, chapter 19/4/3; edited by Yadavji trikamji acharya; Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 110.</ref>,<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā, Cikitsāsthāna, chapter 19; edited by Yadavji trikamji acharya; Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 547-549.</ref> The context of the topic atisāra in present chapter is absolutely different. Here it is described first as a complication of basti, which eloborted further in the chapter. In earlier sections atisāra was described as a primary disease manifested because of its own physical and mental etiological factors. (verse 21-22)

Moreover [[Charak Samhita]] describes types of atisāra in its chapter 19th of [[Sutra Sthana]] and 19th chapter of [[Chikitsa Sthana]] differently. <ref> Charak. Sutra Sthana, Cha.19 Ashtodariya Adhyaya ver.4/3. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 110.</ref>,<ref> Charak. Chiktsa Sthana, Cha.19 Atisara Chikitsitam Adhyaya. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 547-549.</ref> The context of the topic atisāra in present chapter is absolutely different. Here it is described first as a complication of basti, which eloborted further in the chapter. In earlier sections atisāra was described as a primary disease manifested because of its own physical and mental etiological factors. (verse 21-22)

Basic principle of treatment of every condition associated with āma is āmapāchana (termination of āma by promoting function of agni). For this purpose mustā, ativiṣā, kuṣṭha, nata, dāru and vacā (which are mentioned in 19th verse) are to be given. This combination may be given in form of powder or as decoction. This recipe is useful in āmātisāra every origin. (verse 23)

Basic principle of treatment of every condition associated with āma is āmapāchana (termination of āma by promoting function of agni). For this purpose mustā, ativiṣā, kuṣṭha, nata, dāru and vacā (which are mentioned in 19th verse) are to be given. This combination may be given in form of powder or as decoction. This recipe is useful in āmātisāra every origin. (verse 23)

For vātaghna medicines to be used in vata associated atisara, Cakrapāṇi recommends daśhamula, while Gaṅgādhara considers bṛhat pañchamūla (see the commentary on 5th verse). For grāhī purpose the medicines of purīṣasaṁgrahaṇīya varga [Ca.Sū.4/8/31] are to be used.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā, Sūtrasthāna, chapter 4/8; edited by Yadavji trikamji acharya; Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 33 & 34.</ref>

For vātaghna medicines to be used in vata associated atisara, Cakrapāṇi recommends daśhamula, while Gaṅgādhara considers bṛhat pañchamūla (see the commentary on 5th verse). For grāhī purpose the medicines of purīṣasaṁgrahaṇīya varga [Cha.Sa.[[Sutra Sthana]].4/8/31] are to be used.<ref>Charak. Chiktsa Sthana, Cha.19 Atisara Chikitsitam Adhyaya. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 33 & 34.</ref>

Next condition in which atisāra is associated with dominance of vāta, snēhabasti supplemented with sweet, sourand salty substances is recommended. Being opposite to the properties of vāta, the substances in this basti antagonizes the vāta principle. (verse 24)

Next condition in which atisāra is associated with dominance of vāta, snēhabasti supplemented with sweet, sourand salty substances is recommended. Being opposite to the properties of vāta, the substances in this basti antagonizes the vāta principle. (verse 24)

The basti used in pittātisārais useful in raktātisāra also. Applying this principle, this type of basti may be used in a disease entity known as ulcerative colitis. (verse 25)

The basti used in pittātisārais useful in raktātisāra also. Applying this principle, this type of basti may be used in a disease entity known as ulcerative colitis. (verse 25)

These verses number 26-27 describe management plan for the saṁsargaja atisāras (in which two morbid components are associated and have mutual vitiation). Cakrapāṇi in his commentary decides the main and secondary role of the involved components on the basis of vibhakti (noun case) of the words. 7thvibhakti signifies the main role while 3rd expresses secondary role of the factors.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā, siddhisthāna, chapter 8/26-31 (Cakrapāṇi commentary); edited by Yadavji trikamji acharya; Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714.</ref>

These verses number 26-27 describe management plan for the saṁsargaja atisāras (in which two morbid components are associated and have mutual vitiation). Cakrapāṇi in his commentary decides the main and secondary role of the involved components on the basis of vibhakti (noun case) of the words. 7th vibhakti signifies the main role while 3rd expresses secondary role of the factors.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.26-31. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714.</ref>

In the 26th verse the possible combination are-

In the 26th verse the possible combination are-

In 1st condition the recommended basti is with trikaṭu, astringent and bitter substances while in 2nd condition with trikaṭu, astringent and salty medicines.

In 1st condition the recommended basti is with trikaṭu, astringent and bitter substances while in 2nd condition with trikaṭu, astringent and salty medicines.

In a pāthabheda (another version) of 29th verse<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā (only samskrita), 5th part, siddhisthāna, chapter 8 (verse 23 in this version); edited by Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Rastriya Samskrita Samsthana, New Delhi, 2002; P 3741.</ref>, rakta is also included. With this inclusion the the possible combination are-

In a pāthabheda (another version) of 29th verse<ref>Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya.Verse 23 In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3741.</ref>, [[rakta]]is also included. With this inclusion the the possible combination are-

#śakṛt (stool) is associated with vāta  (stool is primary and vāta is secondary)

#śakṛt (stool) is associated with vāta  (stool is primary and vāta is secondary)

Pitta is main with vāta as secondary. sweet, sour and bitter(verse 32-33)

Pitta is main with vāta as secondary. sweet, sour and bitter(verse 32-33)

There are six components involved in the pathogenesis of atisāra. In earlier verses the combinations of two components are described. The combinations of three, four or five are also possible. Gaṅgādhara in his Jalpakalpataru commentary mentions the possibility of combination of all six also.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā (only samskrita), 5th part, siddhisthāna,  chapter 8 (Commentary of Gaṅgādhara on 28); edited by Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Rastriya Samskrita Samsthana, New Delhi, 2002; P 3742-43.</ref> This appears logical, as when five may combine six together may also be possible.  

There are six components involved in the pathogenesis of atisāra. In earlier verses the combinations of two components are described. The combinations of three, four or five are also possible. Gaṅgādhara in his Jalpakalpataru commentary mentions the possibility of combination of all six also.<ref>Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya. In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3742-43.</ref> This appears logical, as when five may combine six together may also be possible.  

According to Gaṅgādhara, the following combinations may happen viz. ten clinical forms due to combinations of three, six forms due to combinations of four, three forms due to combinations of five and one form with all six. In this way twenty forms are possible. These combinations are as below.

According to Gaṅgādhara, the following combinations may happen viz. ten clinical forms due to combinations of three, six forms due to combinations of four, three forms due to combinations of five and one form with all six. In this way twenty forms are possible. These combinations are as below.

This medicated ghṛta is processed with plants having staṁbhana action. Therefore, it is useful in all types of atisāra. Being a nourishing preparation, it is useful in compensating the loss of the essential body substances. A basti may also be given with this preparation and should be retained as much as possible. This type of basti may be useful in inflammatory bowel diseases. (verse 36-37)

This medicated ghṛta is processed with plants having staṁbhana action. Therefore, it is useful in all types of atisāra. Being a nourishing preparation, it is useful in compensating the loss of the essential body substances. A basti may also be given with this preparation and should be retained as much as possible. This type of basti may be useful in inflammatory bowel diseases. (verse 36-37)

The remedies for atisāra continue in these verses 38-39. These verses describe recipe of medicated gruels useful in management of this disease. First the decoction is prepared according to the recipe of ṣaḍaṅgapānīya.<ref>Agniveśa, Caraka, Dṛḍhabala; Caraka saṁhitā, Cikitsāsthāna, chapter 3/145 (Cakrapāṇi commentary on it); edited by Yadavji trikamji acharya; Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 410.</ref>,<ref>Agnihotri Avadhabihari; Bhaiṣajyakalpanā Vijñāna; Chaukhamba orientalia publication, 6th edition, 2006, P 146-147.</ref>

The remedies for atisāra continue in these verses 38-39. These verses describe recipe of medicated gruels useful in management of this disease. First the decoction is prepared according to the recipe of ṣaḍaṅgapānīya.<ref>Chakrapani, Charak. Chikitsa Sthana, Cha.3 Jwara Chikitsitam ver.145 In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714.P 410.</ref>,<ref>Agnihotri Avadhabihari; Bhaiṣajyakalpanā Vijñāna; Chaukhamba orientalia publication, 6th edition, 2006, P 146-147.</ref>

For this purpose one part of the course powder of all plants is boiled with 64 parts of water. When water is reduced to half, this is to be taken to cook yavāgū. There are three varieties of yavāgū-maṇḍa, peyā and vilepī. These three are gradually thicker in consistency and may be chosen according to strength of a patient and his agni. (verse 38-39)

For this purpose one part of the course powder of all plants is boiled with 64 parts of water. When water is reduced to half, this is to be taken to cook yavāgū. There are three varieties of yavāgū-maṇḍa, peyā and vilepī. These three are gradually thicker in consistency and may be chosen according to strength of a patient and his agni. (verse 38-39)