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tapyamAnaM tapastIvraM sAkShAddharmamiva sthitam||3||  

tapyamAnaM tapastIvraM sAkShAddharmamiva sthitam||3||  

AyurvedavidAM shreShThaM bhiShagvidyApravartakam|  

[[Ayurveda]]vidAM shreShThaM bhiShagvidyApravartakam|  

punarvasuM jitAtmAnamagnivesho~abravIdvacaH||4||  

punarvasuM jitAtmAnamagnivesho~abravIdvacaH||4||  

Sage Punarvasu was residing in Mount Kailasa (which is similar to ''Nandana Vana'') and was accompanied with ''Siddha'' (a group of highly skilled individuals possessing eight supernatural faculties) and ''Vidhyadara'' (the possessor of knowledge of science/super human personality is termed ''Vidyadhara''). In Mount Kailasa, Sage Punarvasu  was seated like very embodiment of ''dharma'' (righteousness) and was engaged in practicing austerity. Sage Punarvasu is the foremost among those who are proficient in the knowledge of Ayurveda and involved in promulgating the science of medicine. Agnivesha spoke addressing to such self controlled great sage Punarvasu [3-4]

Sage Punarvasu was residing in Mount Kailasa (which is similar to ''Nandana Vana'') and was accompanied with ''Siddha'' (a group of highly skilled individuals possessing eight supernatural faculties) and ''Vidhyadara'' (the possessor of knowledge of science/super human personality is termed ''Vidyadhara''). In Mount Kailasa, Sage Punarvasu  was seated like very embodiment of ''dharma'' (righteousness) and was engaged in practicing austerity. Sage Punarvasu is the foremost among those who are proficient in the knowledge of [[Ayurveda]] and involved in promulgating the science of medicine. Agnivesha spoke addressing to such self controlled great sage Punarvasu [3-4]

==== Description of patient of ''udara roga'' ====

==== Description of patient of ''udara roga'' ====

==== 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 excreta<ref name="ref1">Agnivesha. Charak Samhita, elaborated by Charak & 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 name="ref13">Agnivesha. [[Charak Samhita]], elaborated by Charak & 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>.  

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 name="ref1">Agnivesha. Charak Samhita, elaborated by Charak & 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 name="ref13">Agnivesha. [[Charak Samhita]], elaborated by Charak & 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 consumed<ref name="ref1" />. ''Malina ahara'' also includes unclean vegetable and other food articles<ref name="ref13" />

''Malina ahara'' meaning unhealthy food refers to all food articles that cause morbidity of ''dosha'' in the body when consumed<ref name="ref1" />. ''Malina ahara'' also includes unclean vegetable and other food articles<ref name="ref13" />

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 name="ref12">Agnivesha. Charak Samhita, elaborated by Charak & Dridabala with Ayurveda Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 492</ref>

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 name="ref12">Agnivesha. Charak Samhita, elaborated by Charak & Dridabala with [[Ayurveda]] Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 492</ref>

''Ama'' as a cause of ''udara'' also refers to the consumption of uncooked foods.<ref name="ref13" />

''Ama'' as a cause of ''udara'' also refers to the consumption of uncooked foods.<ref name="ref13" />

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 name="ref9" /> <ref name="ref12" />

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 name="ref9" /> <ref name="ref12" />

''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>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>   

''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>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>   

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 name="ref9">Sushrut,  Sushruta samhita, with nibandha sangraha commentary of dhallahan & Nyayachandrika commentary of of gayadasa, yadavji trikamji , nirnaya sagar press, 1915, P713, Pgno 236</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 <ref name="ref9">Sushrut,  Sushruta samhita, with nibandha sangraha commentary of dhallahan & Nyayachandrika commentary of of gayadasa, yadavji trikamji , nirnaya sagar press, 1915, P713, Pgno 236</ref>

Among the above said list of etiological factors; variety of dietary factors like sweet and greasy foods that cause affliction of ''rakta dhatu'' is the cause of ''achyuta plihavriddhi''. All the other etiological factors are of ''chyuta plihavriddhi'' <ref name="ref31" /> [35].

Among the above said list of etiological factors; variety of dietary factors like sweet and greasy foods that cause affliction of ''rakta dhatu'' is the cause of ''achyuta plihavriddhi''. All the other etiological factors are of ''chyuta plihavriddhi'' <ref name="ref31" /> [35].

The Sanskrit term ''chyuta'' refers to the act to descend and the ''vriddhi'' implies abdominal enlargement. Descent of the spleen is said to happen due to the violent jerk that happens during different physical activities. Descended spleen causes abdominal enlargement. Further this is of four types based on causative morbidity of ''dosha'' as ''vataja, pittaja, kaphaja'' and ''sannipataja''. <ref name="ref31">Agnivesha. Charak Samhita, elaborated by Charak & Dridabala with Ayurveda Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 493</ref>In Sanskrit, the word ''Achyuta'' refers to lack of downward displacement. ''Vriddhi'' refers to the abdominal enlargement. Put together, the word ''achyuta plihavriddhi'' refers to the abdominal enlargement due to splenic causes without its descending. The morbidity of the ''rakta dhatu'' causes enlargement of the spleen which in turn is responsible for the abdominal distension. Thus, the ''chyuta'' and ''achyuta'' type of ''plihodara'' together forms five types of ''plihodara''<ref name="ref31" /> [36].

The Sanskrit term ''chyuta'' refers to the act to descend and the ''vriddhi'' implies abdominal enlargement. Descent of the spleen is said to happen due to the violent jerk that happens during different physical activities. Descended spleen causes abdominal enlargement. Further this is of four types based on causative morbidity of ''dosha'' as ''vataja, pittaja, kaphaja'' and ''sannipataja''. <ref name="ref31">Agnivesha. Charak Samhita, elaborated by Charak & Dridabala with [[Ayurveda]] Deepika commentary by Chakrapani Datta, Vaidya Jadavaji Trikamji ed., 2009 Edition, Varanasi, Chaukhambha Orientalia, Pp 738, Pg no 493</ref>In Sanskrit, the word ''Achyuta'' refers to lack of downward displacement. ''Vriddhi'' refers to the abdominal enlargement. Put together, the word ''achyuta plihavriddhi'' refers to the abdominal enlargement due to splenic causes without its descending. The morbidity of the ''rakta dhatu'' causes enlargement of the spleen which in turn is responsible for the abdominal distension. Thus, the ''chyuta'' and ''achyuta'' type of ''plihodara'' together forms five types of ''plihodara''<ref name="ref31" /> [36].

Febrile illness of mild degree is the symptom of ''plihodara''. Habitual consumption of food habits that cause burning sensation leads to the morbidity of ''rakta'' as well as ''pitta dosha''. Morbid ''pitta dosha'' and ''rakta dhatu'' cause mild fever. Further loss of appetite is a clinical symptom of ''plihodara''. Habitual consumption of ''abhishyandi'' foods causes morbidity of ''kapha'' which in turn is responsible for the impairment of ''agni''<ref name="ref9" /> [37-38].

Febrile illness of mild degree is the symptom of ''plihodara''. Habitual consumption of food habits that cause burning sensation leads to the morbidity of ''rakta'' as well as ''pitta dosha''. Morbid ''pitta dosha'' and ''rakta dhatu'' cause mild fever. Further loss of appetite is a clinical symptom of ''plihodara''. Habitual consumption of ''abhishyandi'' foods causes morbidity of ''kapha'' which in turn is responsible for the impairment of ''agni''<ref name="ref9" /> [37-38].

The fluid leaked out of the intestines again re-enters into the rectum. Over filled fluid with the space between the skin and viscera may re-enter into the intestines through the end of perforation. Or else the fluid may seep into the rectum. Thus, the rectum gets filled with the undigested food consisting of nutrients and waste which is defecated out<ref name="ref9" />.

The fluid leaked out of the intestines again re-enters into the rectum. Over filled fluid with the space between the skin and viscera may re-enter into the intestines through the end of perforation. Or else the fluid may seep into the rectum. Thus, the rectum gets filled with the undigested food consisting of nutrients and waste which is defecated out<ref name="ref9" />.

The accumulation of the chyle within the abdomen that does not diffuse into the rectum causes ''jalodara''. This ''jalodara'' of ''chhidrodara'' is different from the ''jalodara''. ''Jalodara'' as type of ''udara'' is caused by distinct causes as an independent disease and the fluid accumulates by the process of diffusion. ''Jalodara'' is a phase in ''chhidrodara'' and is due to the leakage of fluids form the perforated intestines.<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 516.</ref>

The accumulation of the chyle within the abdomen that does not diffuse into the rectum causes ''jalodara''. This ''jalodara'' of ''chhidrodara'' is different from the ''jalodara''. ''Jalodara'' as type of ''udara'' is caused by distinct causes as an independent disease and the fluid accumulates by the process of diffusion. ''Jalodara'' is a phase in ''chhidrodara'' and is due to the leakage of fluids form the perforated intestines.<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 516.</ref>

Since the fluid tends to occupy the dependent parts, the accumulation of the chyle in the abdomen causes distention of the lower part of the abdomen below the umbilicus.<ref name="ref31" />

Since the fluid tends to occupy the dependent parts, the accumulation of the chyle in the abdomen causes distention of the lower part of the abdomen below the umbilicus.<ref name="ref31" />