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Udara Chikitsa (view source)

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

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The diseases presenting with cardinal symptom of generalized enlargement of abdomen is regarded as ''udara roga''. Emaciation, loss of appetite, pedal edema, inability to perform any physical activity are its other characteristic features. Extreme impairment of ''agni'' (digestion and metabolism) is the basic pathology of ''udara roga'' in general, which is regarded as one among the ''mahagada'' (major illness). It is classified into eight types viz. four types of ''~~doshaja~~ udara roga'' (''~~vataja~~, ~~pittaja~~, ~~kaphaja~~'' and ''sannipataja''), ''plihodara'' (splenomegaly), ''kshatodara/chhidrodara'' (abdominal enlargement due to intestinal perforation), ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''jalodara/udakodara'' (ascites). ''Yakritodara'' (hepatomegaly) is also a distinct type of ''udara roga'' but incorporated in the ''plihodara'' since the etiology and treatment of these two conditions are similar.

+

The diseases presenting with cardinal symptom of generalized enlargement of abdomen is regarded as ''udara roga''. Emaciation, loss of appetite, pedal edema, inability to perform any physical activity are its other characteristic features. Extreme impairment of ''agni'' (digestion and metabolism) is the basic pathology of ''udara roga'' in general, which is regarded as one among the ''mahagada'' (major illness). It is classified into eight types viz. four types of ''[[dosha]]ja udara roga'' (''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' and ''sannipataja''), ''plihodara'' (splenomegaly), ''kshatodara/chhidrodara'' (abdominal enlargement due to intestinal perforation), ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''jalodara/udakodara'' (ascites). ''Yakritodara'' (hepatomegaly) is also a distinct type of ''udara roga'' but incorporated in the ''plihodara'' since the etiology and treatment of these two conditions are similar.

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Each type of ''udara roga'' has distinct etiology, pathology and symptomatology. ''~~Vataja~~, ~~pittaja~~, ~~kaphaja~~'' and ''sannipataja udara roga'' are comparable to the primary peritonitis based on the similarity of the symptoms. ''Plihodara'' (enlargement of the spleen) can be compared by the description of splenomegaly for different reasons. Symptoms of ''yakritodara'' resembles with that of hepatomegaly of varied pathology. Intestinal obstruction for different reasons causes ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction). Intestinal perforation is explained under the name of ''chhidrodara/kshatodara'' (abdominal enlargement due to intestinal perforation). ''Udara roga'' in general develops in three distinct stages. Conditions of ''ajatodaka'' is initial phase of generalized enlargement of abdomen without fluid accumulation, ''pichcha'' is generalized enlargement of abdominal distention due to liquefying state of ''dosha'' and ''jatodaka'' is generalized enlargement of abdomen with fluid accumulation. All the types of ''udara roga'' end up in ''jalodara'' (enlargement of abdomen due to collection of fluid) in the terminal phases. Among the different types of ''udara roga'', the later one in the list is more difficult to cure than its previous one. Presence of complication in ''udara roga'' is indicative of incurability. ''Virechana'' (therapeutic purgation), ''niruha basti'' (decoction enema), ''anuvasana basti'' (unctuous enema), intake of milk and buttermilk and surgical interventions (tapping) form the crux of treatment of ''udara roga''.

+

Each type of ''udara roga'' has distinct etiology, pathology and symptomatology. ''[[Vata]]ja, [[pitta]ja, [[kapha]]ja'' and ''sannipataja udara roga'' are comparable to the primary peritonitis based on the similarity of the symptoms. ''Plihodara'' (enlargement of the spleen) can be compared by the description of splenomegaly for different reasons. Symptoms of ''yakritodara'' resembles with that of hepatomegaly of varied pathology. Intestinal obstruction for different reasons causes ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction). Intestinal perforation is explained under the name of ''chhidrodara/kshatodara'' (abdominal enlargement due to intestinal perforation). ''Udara roga'' in general develops in three distinct stages. Conditions of ''ajatodaka'' is initial phase of generalized enlargement of abdomen without fluid accumulation, ''pichcha'' is generalized enlargement of abdominal distention due to liquefying state of ''[[dosha]]'' and ''jatodaka'' is generalized enlargement of abdomen with fluid accumulation. All the types of ''udara roga'' end up in ''jalodara'' (enlargement of abdomen due to collection of fluid) in the terminal phases. Among the different types of ''udara roga'', the later one in the list is more difficult to cure than its previous one. Presence of complication in ''udara roga'' is indicative of incurability. ''[[Virechana]]'' (therapeutic purgation), ''niruha [[basti]]'' (decoction enema), ''anuvasana [[basti]]'' (unctuous enema), intake of milk and buttermilk and surgical interventions (tapping) form the crux of treatment of ''udara roga''.

'''Keywords''': ''Udara roga, vatodara, pittodara, kaphodara, sannipatodara, plihodara, yakritodara, baddhodara, chidrodara, kshatodara, jalodara,'' intestinal perforation, splenomegaly, hepatomegaly, intestinal obstruction, ascites, ''ajatodakavastha, picchavastha, jatodakavastha, virechana,'' tapping </div>

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== Introduction ==

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Generalized enlargement of the abdomen is ''udara roga'' and due to similarity of this symptom i.e. bulging (''utsedha''), this chapter follows the chapter on ''shvayathu'' (edema). Out of eight types of ''udara roga'' viz. ''~~vataja~~, ~~pittaja~~, ~~kaphaja~~'' and ''sannipataja'' are regarded as ''dosha'' dominant ''udara roga''. In contrast to this ''plihodara'' (splenomegaly), ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction), ''kshatodara'' (abdominal enlargement due to intestinal perforation) and ''jalodara'' (enlargement of abdomen due to collection of fluid) are regarded as ''dushya'' dominant ''udara roga''. Again, ''baddhodara'' and ''chhidrodara'' are considered as ''agantuja'' (exogenous disease) and the remaining six types of ''udara roga'' are enlisted as ''nija'' (endogenous disease). Vitiation of morbid ''dosha'' obstructing the channels in the abdomen and leading to fluid accumulation are the predominant features of pathogenesis of ''udara roga''. Various purification treatments including therapeutic purgation, enema and surgical intervention to remove excess fluid are described in the chapter. The medications to pacify morbid ''dosha'' with strict dietary guidelines are treatment measures of ''udara roga''.

+

Generalized enlargement of the abdomen is ''udara roga'' and due to similarity of this symptom i.e. bulging (''utsedha''), this chapter follows the chapter on ''shvayathu'' (edema). Out of eight types of ''udara roga'' viz. ''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' and ''sannipataja'' are regarded as ''dosha'' dominant ''udara roga''. In contrast to this ''plihodara'' (splenomegaly), ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction), ''kshatodara'' (abdominal enlargement due to intestinal perforation) and ''jalodara'' (enlargement of abdomen due to collection of fluid) are regarded as ''[[dushya]]'' dominant ''udara roga''. Again, ''baddhodara'' and ''chhidrodara'' are considered as ''agantuja'' (exogenous disease) and the remaining six types of ''udara roga'' are enlisted as ''nija'' (endogenous disease). Vitiation of morbid ''[[dosha]]'' obstructing the channels in the abdomen and leading to fluid accumulation are the predominant features of pathogenesis of ''udara roga''. Various purification treatments including therapeutic purgation, enema and surgical intervention to remove excess fluid are described in the chapter. The medications to pacify morbid ''[[dosha]]'' with strict dietary guidelines are treatment measures of ''udara roga''.

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== Sanskrit text, Transliteration and English Translation ==

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Abnormalities of ''jatharagni'' (digestive power) leads to the morbid accumulation of the ''mala'' (''dosha'' and bodily wastes) and in turn tend to cause multiple diseases and particularly ''udara roga''. In the state of impaired ''jatharagni'' consumption of unhealthy foods further leads to indigestion and eventually causes accumulation of morbid substances. Thus formed morbidity afflicts the functioning of ''prana vata, agni'' as well as ''apana vata'' which in turn obliterates the channels tending upwards and downwards. Due to this obliteration of channels, finally the morbid ''dosha'' tend to divulge and penetrate the space between the skin and flesh and gets accumulated there. This accumulation leads severe distention of the abdomen and causes serious disease ''udara roga''. Hereafter etiology and clinical symptoms of the same have been narrated. [9-11] </div>

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Abnormalities of ''jatharagni'' (digestive power) leads to the morbid accumulation of the ''[[mala]]'' (''[[dosha]]'' and bodily wastes) and in turn tend to cause multiple diseases and particularly ''udara roga''. In the state of impaired ''jatharagni'' consumption of unhealthy foods further leads to indigestion and eventually causes accumulation of morbid substances. Thus formed morbidity afflicts the functioning of ''prana vata, agni'' as well as ''apana vata'' which in turn obliterates the channels tending upwards and downwards. Due to this obliteration of channels, finally the morbid ''[[dosha]]'' tend to divulge and penetrate the space between the skin and flesh and gets accumulated there. This accumulation leads severe distention of the abdomen and causes serious disease ''udara roga''. Hereafter etiology and clinical symptoms of the same have been narrated. [9-11] </div>

=== Etiology of ''udara roga'' ===

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Consumption of foods that are excessively hot in property, excessive consumption of salty foods, excessive intake of foods containing solutions of ''kshara'' (alkali obtained from ash of herbs), excessive intake of foods that cause burning sensation on digestion, excessive consumption of foods that are sour in taste, consumption of ''garavisha'' (intentional application of poison or poison synthesized by combination of nontoxic substances), erroneous dietary management following ''shodhana'' treatment, excessive consumption of foods having ''ruksha'' (dry) property, intake of ''viruddha ahara'' (combination of foods having mutually contradictory properties), consumption of unhealthy foods, emaciation due to splenic enlargement, emaciation due to ''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, these causes will lead to development of ''udara roga'' and among these more particularly the impairment of ''jatharagni''. [12-15] </div>

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Consumption of foods that are excessively hot in property, excessive consumption of salty foods, excessive intake of foods containing solutions of ''kshara'' (alkali obtained from ash of herbs), excessive intake of foods that cause burning sensation on digestion, excessive consumption of foods that are sour in taste, consumption of ''garavisha'' (intentional application of poison or poison synthesized by combination of nontoxic substances), erroneous dietary management following ''[[shodhana]]'' treatment, excessive consumption of foods having ''ruksha'' (dry) property, intake of ''viruddha ahara'' (combination of foods having mutually contradictory properties), consumption of unhealthy foods, emaciation due to splenic enlargement, emaciation due to ''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, these causes will lead to development of ''udara roga'' and among these more particularly the impairment of ''jatharagni''. [12-15] </div>

=== Premonitary symptoms ===

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Loss of appetite, delayed digestion of foods that are sweet, greasy and heavy for digestion, food consumed causing burning sensation, inability to appreciate the digestion and indigestion of the food, intolerance to over eating, slight edema in the feet, constant reduction in the physical strength, breathlessness even on slight exertion, abdominal distension due to accumulation of fecal matter resulting due to dryness or ''udavarta'' (abnormal upward course of ''vata''), abdominal pain, fullness of the abdomen, distension of the abdomen or bursting type of abdominal pain at the site where bladder meets the surrounding, distension of the stomach even after small meals, appearance of distended veins and loss of normal skin folds are the premonitory symptoms of ''udara roga''. [16-19] </div>

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Loss of appetite, delayed digestion of foods that are sweet, greasy and heavy for digestion, food consumed causing burning sensation, inability to appreciate the digestion and indigestion of the food, intolerance to over eating, slight edema in the feet, constant reduction in the physical strength, breathlessness even on slight exertion, abdominal distension due to accumulation of fecal matter resulting due to dryness or ''udavarta'' (abnormal upward course of ''[[vata]]''), abdominal pain, fullness of the abdomen, distension of the abdomen or bursting type of abdominal pain at the site where bladder meets the surrounding, distension of the stomach even after small meals, appearance of distended veins and loss of normal skin folds are the premonitory symptoms of ''udara roga''. [16-19] </div>

=== General pathogenesis of ''udara roga'' ===

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Morbid ''dosha'' by obstructing the channels of ''sweda'' (sweat) and ''udaka'' (body fluid) and afflicting the ''prana vata, agni'' and ''apana vata'' causes ''udara roga''. [20] </div>

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Morbid ''[[dosha]]'' by obstructing the channels of ''sweda'' (sweat) and ''udaka'' (body fluid) and afflicting the ''prana vata, agni'' and ''apana vata'' causes ''udara roga''. [20] </div>

=== General Symptoms of ''udara roga'' ===

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Three types of ''udara'' caused by each morbid ''dosha'', one type of ''udara'' caused by morbidity of all three ''dosha, plihodara'' (splenomegaly), ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction), ''kshatodara'' (abdominal enlargement due to intestinal perforation) and ''udakodara'' (enlargement of abdomen due to collection of fluid) are the eight types of ''udara''. Listen to the characteristic symptoms each of these types of ''udara roga''. [22]. </div>

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Three types of ''udara'' caused by each morbid ''[[dosha]]'', one type of ''udara'' caused by morbidity of all three ''[[dosha]], plihodara'' (splenomegaly), ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction), ''kshatodara'' (abdominal enlargement due to intestinal perforation) and ''udakodara'' (enlargement of abdomen due to collection of fluid) are the eight types of ''udara''. Listen to the characteristic symptoms each of these types of ''udara roga''. [22]. </div>

=== Etiology of ''vatodara'' ===

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Among the etiological factors of ''udara roga'' is intake of dry food articles, consumption of inadequate amount of food, exertion, suppression of naturally manifesting urges, abnormal upward course of ''vata'' and weight reducing activities like walking or lifting weight causes ''vatodara''. [23]

+

Among the etiological factors of ''udara roga'' is intake of dry food articles, consumption of inadequate amount of food, exertion, suppression of naturally manifesting urges, abnormal upward course of ''[[vata]]'' and weight reducing activities like walking or lifting weight causes ''vatodara''. [23]

</div>

=== Pathogenesis of ''vatodara'' ===

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Due to the etiological factors ''vata'' gets aggravated which assumes abnormal course and reaches the ''kukshi'' (lower abdomen), ''hridaya'' (chest), ''basti'' (pelvis) and ''gudamarga'' (rectum). Again the morbid ''vata'' further impairs the ''agni'' (digestive enzymes) and draws out the ''kapha''. Thus morbid ''kapha'' in turn obstructs the morbid ''vata''. Eventually the obstructed ''vata'' gets diverged in to the space between the skin and visceral tissues in the abdomen leading to distension of the abdomen and ''udara roga''. [23-24]

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Due to the etiological factors ''[vata]]'' gets aggravated which assumes abnormal course and reaches the ''kukshi'' (lower abdomen), ''hridaya'' (chest), ''basti'' (pelvis) and ''gudamarga'' (rectum). Again the morbid ''[[vata]]'' further impairs the ''agni'' (digestive enzymes) and draws out the ''[[kapha]]''. Thus morbid ''[[kapha]]'' in turn obstructs the morbid ''[[vata]]''. Eventually the obstructed ''[[vata]]'' gets diverged in to the space between the skin and visceral tissues in the abdomen leading to distension of the abdomen and ''udara roga''. [23-24]

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=== Symptoms of ''vatodara'' ===

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The symptoms of ''vatodara'' include distension of abdomen, edema of the hands, legs and scrotum, splitting type of pain in abdomen, undue increase and decrease of abdominal distension, abdominal pain, pain in the sides of the abdomen, abnormal upward course of ''vata'' within abdomen, body ache, pain in phalangeal joints, dry cough, emaciation, debility, lack of taste in mouth, indigestion, heaviness in the lower abdomen, obstructed flatus, constipation, retention of the urine, brown or reddish black discoloration of the nails, brown or reddish black discoloration of the conjunctiva, buccal mucosa, dermis, urine and fecal matter; abdominal wall possessing thin, blackish stretch lines and vessels, tympanic note on percussion similar to the sound produced on tapping air filled leather bag or bladder and upward, downward and lateral painful movement of ''vata'' with gurgling sound within the abdomen. [25]

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The symptoms of ''vatodara'' include distension of abdomen, edema of the hands, legs and scrotum, splitting type of pain in abdomen, undue increase and decrease of abdominal distension, abdominal pain, pain in the sides of the abdomen, abnormal upward course of ''[[vata]]'' within abdomen, body ache, pain in phalangeal joints, dry cough, emaciation, debility, lack of taste in mouth, indigestion, heaviness in the lower abdomen, obstructed flatus, constipation, retention of the urine, brown or reddish black discoloration of the nails, brown or reddish black discoloration of the conjunctiva, buccal mucosa, dermis, urine and fecal matter; abdominal wall possessing thin, blackish stretch lines and vessels, tympanic note on percussion similar to the sound produced on tapping air filled leather bag or bladder and upward, downward and lateral painful movement of ''[[vata]]'' with gurgling sound within the abdomen. [25]

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=== Etiology of ''pittodara'' ===

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Due to the etiological factors pitta gets aggravated, which assumes abnormal upward course and obstructs the ''vata'' and ''kapha''. Further the morbid ''pitta'' by suppressing the ''agni'' situated in stomach causes ''pittodara''. [27]

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Due to the etiological factors [[pitta]] gets aggravated, which assumes abnormal upward course and obstructs the ''[[vata]]'' and ''[[kapha]]''. Further the morbid ''[[pitta]]'' by suppressing the ''agni'' situated in stomach causes ''pittodara''. [27]

</div>

=== Symptoms of ''pittodara'' ===

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The etiological factors lead to the morbidity of ''kapha'' which obstructs the body channels that include obliteration of the passage of ''vata''. Thus obstructed ''vata'' expels the morbid ''kapha'' out of the intestines causing distension of the abdomen. [30]

+

The etiological factors lead to the morbidity of ''[[kapha]]'' which obstructs the body channels that include obliteration of the passage of ''[[vata]]''. Thus obstructed ''[[vata]]'' expels the morbid ''[[kapha]]'' out of the intestines causing distension of the abdomen. [30]

</div>

=== Symptoms of ''kaphodara'' ===

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The symptoms of ''kaphodara'' are heaviness of the body, lack of taste in the mouth, indigestion, body ache, numbness, edema of the hands, feet, scrotum and thighs, nausea due to morbid ''dosha'' located in the chest, sleepiness, cough, dyspnea, whitish discoloration of nails, conjunctiva, mouth, skin, urine and feces, abdominal wall covered with whitish stretch marks, whitish distended veins, subjective feeling of heaviness and stillness of the abdomen, unwavering abdomen with hardness of the abdomen. [31]

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The symptoms of ''kaphodara'' are heaviness of the body, lack of taste in the mouth, indigestion, body ache, numbness, edema of the hands, feet, scrotum and thighs, nausea due to morbid ''[[dosha]]'' located in the chest, sleepiness, cough, dyspnea, whitish discoloration of nails, conjunctiva, mouth, skin, urine and feces, abdominal wall covered with whitish stretch marks, whitish distended veins, subjective feeling of heaviness and stillness of the abdomen, unwavering abdomen with hardness of the abdomen. [31]

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=== Etiology of ''sannipatodara'' ===

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Exposure to the etiological factors lead to morbidity of all three ''dosha'', which gradually accumulates in the abdomen causing ''sannipatodara''. [33]

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Exposure to the etiological factors lead to morbidity of all three ''[[dosha]]'', which gradually accumulates in the abdomen causing ''sannipatodara''. [33]

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=== Symptoms of ''sannipatodara'' ===

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The symptoms of ''sannipatodara'' are manifestation of symptoms pathognomonic of all three ''dosha'', variegated abnormal coloration of nails and other body parts pathognomonic of all three ''dosha'' and appearance of stretch marks and veins having variegated color pathognomonic of morbidity of all three ''dosha''. This illness is regarded as ''sannipatodara''. [34]

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The symptoms of ''sannipatodara'' are manifestation of symptoms pathognomonic of all three ''[[dosha]]'', variegated abnormal coloration of nails and other body parts pathognomonic of all three ''[[dosha]]'' and appearance of stretch marks and veins having variegated color pathognomonic of morbidity of all three ''[[dosha]]''. This illness is regarded as ''sannipatodara''. [34]

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=== Etiology of ''plihodara'' ===

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Afflicted by the jerky movements of the body etc, the spleen located in the left side(flank or left hypochondriac region) enlarges and descends to cause enlargement of the abdomen; or else, a variety of dietary factors leading to increment and morbidity of ''rasa, rakta'' etc. which in turn causes enlargement of the spleen. Enlarged spleen distends the abdomen causing ''plihodara'' [36].

+

Afflicted by the jerky movements of the body etc, the spleen located in the left side(flank or left hypochondriac region) enlarges and descends to cause enlargement of the abdomen; or else, a variety of dietary factors leading to increment and morbidity of ''[[rasa]], [[rakta]]'' etc. which in turn causes enlargement of the spleen. Enlarged spleen distends the abdomen causing ''plihodara'' [36].

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=== Symptoms of ''plihodara'' and ''yakritodara'' ===

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Patient suffers from progressive enlargement of the spleen. Initially the enlarged spleen is palpable as a hard mass identical to the oval metal ball used by blacksmiths. The surface of the spleen appears smooth similar to the dorsum of the tortoise. If left untreated the enlarging spleen encroach the whole abdomen including the abode of ''agni'' [37].

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The symptoms of ''plihodara'' include debility, lack of taste in mouth, indigestion, constipation, retention of urine, darkness in front of the eyes, excessive thirst, body ache, vomiting, transient loss of consciousness, tiredness in the body parts, cough, dyspnea, mild fever, flatulence, loss of appetite, emaciation, abnormal taste in the mouth, pain in joint of the digits, abdominal pain due to morbid ''vata'', abnormal pinkish coloration of the abdomen, discoloration of the abdominal wall and the abdominal wall shows bluish greenish yellowish linear stretch marks.

+

The symptoms of ''plihodara'' include debility, lack of taste in mouth, indigestion, constipation, retention of urine, darkness in front of the eyes, excessive thirst, body ache, vomiting, transient loss of consciousness, tiredness in the body parts, cough, dyspnea, mild fever, flatulence, loss of appetite, emaciation, abnormal taste in the mouth, pain in joint of the digits, abdominal pain due to morbid ''[[vata]]'', abnormal pinkish coloration of the abdomen, discoloration of the abdominal wall and the abdominal wall shows bluish greenish yellowish linear stretch marks.

In the similar manner the enlarged liver located at right flank(hypochondriac) region causes distention of the abdomen. As the etiology symptoms and treatment of enlarged liver is identical to the ''plihodara, yakritodara'' is included in the ''plihodara''. This is regarded as ''plihodara'' [38].

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''Baddhodara'' is caused by the obliteration of the passage of stools due to consumption of the food admixed with feathers of birds or human hair, ''udavarta'' (reversed course of ''vata'' in abdomen), due to ''arshas'' (ano-rectal mass lesion) and intussusception of the intestines [39].

+

''Baddhodara'' is caused by the obliteration of the passage of stools due to consumption of the food admixed with feathers of birds or human hair, ''udavarta'' (reversed course of ''[[vata]]'' in abdomen), due to ''arshas'' (ano-rectal mass lesion) and intussusception of the intestines [39].

</div>

=== Pathogenesis of ''baddhagudodara'' ===

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Obliteration of the passage of colon leads to morbidity of ''apana vata'' which in turn impairs the functioning of the agni as well as obstructs the excretion of stools and obliterates the movement of ''pitta'' and ''kapha''. Eventually the patient suffers from the ''baddhagudodara'' [40].

+

Obliteration of the passage of colon leads to morbidity of ''apana vata'' which in turn impairs the functioning of the agni as well as obstructs the excretion of stools and obliterates the movement of ''[[pitta]]'' and ''[[kapha]]''. Eventually the patient suffers from the ''baddhagudodara'' [40].

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=== Symptoms of ''baddhagudodara'' ===

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The symptoms include distension of the abdomen mostly below the umbilicus due to accumulation of the fluids. Patient may suffer from a variety of symptoms according to the degree of morbidity of each ''dosha''. Patient excretes reddish, bluish, yellowish, mucous mixed with foul smelling and unformed stools. Patient suffers from hiccough, cough, breathlessness, thirst, altered state of consciousness, tastelessness in mouth, indigestion and debility. These are indicative of ''chhidrodara'' [44].

+

The symptoms include distension of the abdomen mostly below the umbilicus due to accumulation of the fluids. Patient may suffer from a variety of symptoms according to the degree of morbidity of each ''[[dosha]]''. Patient excretes reddish, bluish, yellowish, mucous mixed with foul smelling and unformed stools. Patient suffers from hiccough, cough, breathlessness, thirst, altered state of consciousness, tastelessness in mouth, indigestion and debility. These are indicative of ''chhidrodara'' [44].

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=== Etiopathogenesis of ''jalodara'' ===

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Excessive consumption of water on occasions like oral medication with medicated ghee, impaired state of ''agni'', debility and emaciation causes destruction of digestive power and vitiation of ''vata'' situated at ''kloma''. [45].

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Excessive consumption of water on occasions like oral medication with medicated ghee, impaired state of ''agni'', debility and emaciation causes destruction of digestive power and vitiation of ''[[vata]]'' situated at ''kloma''. [45].

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These vitiated factors obliterate ''udaka-vaha-srotas''. Thus obliterated ''kapha'' mixed water further increases the fluid contents which by disloging from its site and accumulating in abdomen produce ''jalodara'' [46].

+

These vitiated factors obliterate ''udaka-vaha-srotas''. Thus obliterated ''[[kapha]]'' mixed water further increases the fluid contents which by disloging from its site and accumulating in abdomen produce ''jalodara'' [46].

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=== Symptoms of ''udakodara'' ===

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''Udara roga'' of recent origin having no complications and without signs of fluid accumulation should be immediately treated. If left untreated, the morbid ''dosha'' gets displaced and liquefied, moistens the joints as well as body channels, obstructs the external channels and thus mobilizes the fluid into the abdomen.

+

''Udara roga'' of recent origin having no complications and without signs of fluid accumulation should be immediately treated. If left untreated, the morbid ''[[dosha]]'' gets displaced and liquefied, moistens the joints as well as body channels, obstructs the external channels and thus mobilizes the fluid into the abdomen.

The accumulated fluid in the abdomen thus become turbid and leads to the symptoms like globular distension of the abdomen, subjective feeling of heaviness in the abdomen, still abdomen with absence of gurgling sound, dull note on percussion, soft abdomen on palpation, disappearance of stretch marks and distended veins spreading around the umbilicus.

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State of ''ajatodaka'' (initial phase of distension of abdomen without fluid accumulation) of the ''udara'' is presents with symptoms such as pink coloration of distended abdomen, increased gurgling sound, comparatively less heaviness of the abdomen, persistent gurgling sound, abdomen covered with network of distended veins, the flatus frequently generates urges to pass with distention of the umbilical region and then fades away with of farting, pain in the cardiac region, umbilical region, groin, sacral region and anal part, passing of flatus with loud sound, less severe impairment of digestion, tastelessness in the mouth, reduced urination and constipation. This state of ''ajatodaka'' should be treated with the due consideration of degree of morbidity of ''dosha'' as well as time [55-58].

+

State of ''ajatodaka'' (initial phase of distension of abdomen without fluid accumulation) of the ''udara'' is presents with symptoms such as pink coloration of distended abdomen, increased gurgling sound, comparatively less heaviness of the abdomen, persistent gurgling sound, abdomen covered with network of distended veins, the flatus frequently generates urges to pass with distention of the umbilical region and then fades away with of farting, pain in the cardiac region, umbilical region, groin, sacral region and anal part, passing of flatus with loud sound, less severe impairment of digestion, tastelessness in the mouth, reduced urination and constipation. This state of ''ajatodaka'' should be treated with the due consideration of degree of morbidity of ''[[dosha]]'' as well as time [55-58].

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=== Treatment of ''vatodara'' ===

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Patient of ''vatodara'' who is physically strong should be initially treated with unctuous medications. Then after the ''snehana'' is completed, ''abhyanga'' (unctuous massage) and ''sweda'' (sudation) is done. Then the ''sneha virechana'' (purgation with unctuous purgatives) should be given. After elimination of ''dosha'' with ''shodhana'' (purification procedure) the abdomen should be tightly bandaged so that no space is left in the abdomen for the morbid ''vata'' to cause distension of the abdomen again [59-60].

+

Patient of ''vatodara'' who is physically strong should be initially treated with unctuous medications. Then after the ''[[snehana]]'' is completed, ''abhyanga'' (unctuous massage) and ''sweda'' (sudation) is done. Then the ''sneha [[virechana]]'' (purgation with unctuous purgatives) should be given. After elimination of ''[[dosha]]'' with ''[[shodhana]]'' (purification procedure) the abdomen should be tightly bandaged so that no space is left in the abdomen for the morbid ''[[vata]]'' to cause distension of the abdomen again [59-60].

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=== Post ''virechana'' regimen ===

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=== Post ''[[virechana]]'' regimen ===

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''Udara'' is caused due to the obliteration of the body channels leading to accumulation of morbid ''dosha''. Hence ''udara'' should be treated by regular ''virechana'' (therapeutic purgation). After the purgation, with an intention to improve the physical strength and to relieve the strain of purgation, the patient should be given milk. Gradually as the patient regains strength by the intake of milk, his functioning of the ''agni'' should be improved by giving ''yusha'' (cereal soup) or meat soup added with little salt [61-62].

+

''Udara'' is caused due to the obliteration of the body channels leading to accumulation of morbid ''[[dosha]]''. Hence ''udara'' should be treated by regular ''[[virechana]]'' (therapeutic purgation). After the purgation, with an intention to improve the physical strength and to relieve the strain of purgation, the patient should be given milk. Gradually as the patient regains strength by the intake of milk, his functioning of the ''agni'' should be improved by giving ''yusha'' (cereal soup) or meat soup added with little salt [61-62].

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=== Role of ''asthapana basti'' ===

+

=== Role of ''asthapana [[basti]]'' ===

Eganeesh

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