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Udara Chikitsa (view source)

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Now we shall expound ~~upon~~ the ~~management~~ of generalized enlargement of abdomen. Thus said Lord Atreya [1-2]

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Now we shall expound the chapter "Udara chikitsa" (Management of generalized enlargement of abdomen). Thus said Lord Atreya [1-2]

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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]

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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]

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

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

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Sage Agnivesha addressing Punarvasu, said “Oh Lord!” it is observed that the patient of ''udara'' suffers from dryness of the mouth, emaciation of body, distension of abdomen and flanks, impaired digestion, loss of physical strength, inability to consume food, inability to perform any physical activities and depression; such patients sooner or later die due to the illness in the absence of treatment just like an orphan. I wish to hear the proper description of this disease from my teacher Lord Punarvasu in regards to its etiology, the number, the premonitory symptoms, clinical presentation and treatment [5-7]

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Sage Agnivesha addressing Punarvasu, said “Oh Lord!” it is observed that the patient of ''udara'' suffers from dryness of the mouth, emaciation of body, distension of abdomen and flanks, impaired digestion, loss of physical strength, inability to consume food, inability to perform any physical activities and depression; such patients sooner or later die due to the illness in the absence of treatment just like an orphan. I wish to hear the proper description of this disease from my teacher Lord Punarvasu in regards to its etiology, the number, the premonitory symptoms, clinical presentation and treatment. [5-7]

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Enthused by the student’s questioning, Lord Punarvasu spoke about the beneficial topics for the well being of human [8]

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Enthused by the student’s questioning, Lord Punarvasu spoke about the beneficial topics for the well being of human. [8]

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==== Pathogenesis of ''udara roga'' ====

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=== Pathogenesis of ''udara roga'' ===

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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]

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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]

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

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=== 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]

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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]

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==== Premonitary symptoms ====

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=== 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]

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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]

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

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=== 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]

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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]

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

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

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Distension and gurgling sound in the abdomen, edema of hands and feet, impaired digestion, smooth shiny cheeks and emaciation are the common symptoms of ''udara roga'' [21]

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Distension and gurgling sound in the abdomen, edema of hands and feet, impaired digestion, smooth shiny cheeks and emaciation are the common symptoms of ''udara roga''. [21]

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==== Classification of ''udara roga'' ====

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=== Classification 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].

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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].

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

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=== 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]

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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]

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

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

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Etiological factors of ''pittodara'' are excessive consumption of foods having pungent taste ans sour taste, salty foods, foods having ''ushna'' (hot) and ''tikshna'' (sharply acting) properties, exposure the heat of fire place, exposure to sunshine, consumption of foods that cause burning sensation whilst getting digested, pre-digestion meals and indigestion [26]

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Etiological factors of ''pittodara'' are excessive consumption of foods having pungent taste ans sour taste, salty foods, foods having ''ushna'' (hot) and ''tikshna'' (sharply acting) properties, exposure the heat of fire place, exposure to sunshine, consumption of foods that cause burning sensation whilst getting digested, pre-digestion meals and indigestion. [26]

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==== Pathogenssis of ''pittodara'' ====

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=== Pathogenssis 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]

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

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

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The symptoms of ''pittodara'' are burning sensation, fever, excessive thirst, transient loss of consciousness, diarrhea, giddiness, abnormal pungent taste in mouth, abnormal green or yellowish discoloration of nails, conjunctiva, mouth, dermis, urine and feces, abdominal wall covered with bluish, yellowish, greenish or coppery stretch marks and distended veins, burning sensation of the abdominal wall, abdomen becoming warm, subjective symptoms of smoke emitting from the abdomen, subjective feeling of abdominal warmth as if fire in near place, abdominal sweating, moistening of the abdomen, abdomen appears soft on palpation and the illness rapidly progressing to ascites [28].

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The symptoms of ''pittodara'' are burning sensation, fever, excessive thirst, transient loss of consciousness, diarrhea, giddiness, abnormal pungent taste in mouth, abnormal green or yellowish discoloration of nails, conjunctiva, mouth, dermis, urine and feces, abdominal wall covered with bluish, yellowish, greenish or coppery stretch marks and distended veins, burning sensation of the abdominal wall, abdomen becoming warm, subjective symptoms of smoke emitting from the abdomen, subjective feeling of abdominal warmth as if fire in near place, abdominal sweating, moistening of the abdomen, abdomen appears soft on palpation and the illness rapidly progressing to ascites. [28]

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==== Etiology of ''kaphodara'' ====

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=== Etiology of ''kaphodara'' ===

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Indulgence in the factors such as lack of physical exercise, day sleep, excessive consumption of sweet, greasy and slimy foods, curds, milk, liquids and meat of wet land animals causes ''kaphodara'' [29].

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Indulgence in the factors such as lack of physical exercise, day sleep, excessive consumption of sweet, greasy and slimy foods, curds, milk, liquids and meat of wet land animals causes ''kaphodara''. [29]

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==== Pathogenesis of ''kaphodara'' ====

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=== Pathogenesis of ''kaphodara'' ===

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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].

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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]

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

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

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The etiological factors such as person with impaired ''agni'' (digestive power) indulging in unhealthy food habits and consuming foods that are inadequately cooked, taking food articles having mutually contradictory properties, eating foods that are heavy for digestion, consumption of food adulterated with dust, hair, feces, urine, bone and nails which is offered by a wicked lady and slow poisoning by the intake of ''dushivisha'' (chronic poisoning) cause ''sannipatodara'' [32].

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The etiological factors such as person with impaired ''agni'' (digestive power) indulging in unhealthy food habits and consuming foods that are inadequately cooked, taking food articles having mutually contradictory properties, eating foods that are heavy for digestion, consumption of food adulterated with dust, hair, feces, urine, bone and nails which is offered by a wicked lady and slow poisoning by the intake of ''dushivisha'' (chronic poisoning) cause ''sannipatodara''. [32]

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==== Pathogenesis of ''sannipatodara'' ====

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

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The ''plihodara'' is caused by activities like travelling excessively in vibrating vehicle, heavy exercises that involve violent jerky movements of the body and are done immediately after the meals, excessive sex, lifting heavy objects, indulging in heavy walking, excessive vomiting and emaciation due to chronic illness [35].

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==== ''Samprapti'' of ''plihodara'' ====

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=== ''Samprapti'' 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].

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

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

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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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==== Etiology of ''baddhodara'' ====

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=== Etiology of ''baddhodara'' ===

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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].

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

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=== 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].

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

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

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Symptoms of ''baddhagudodara'' are excessive thirst, burning sensation, fever, dryness of the mouth, dryness of the palate, tiredness in the thighs, cough, breathlessness, debility, lack of taste in mouth, indigestion, constipation, retention of the urine, abdominal distention, vomiting, sneezing, headache, chest pain, pain in the umbilical region and rectum, absence of gurgling sound in the abdomen, abdominal wall covered with pinkish and bluish stretch marks, visible veins, probably the stretch marks and visible veins occur above the umbilicus in the shape of cow tail, or else there may not be any stretch marks [41].

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==== Causes of ''chhidrodara'' ====

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=== Causes of ''chhidrodara'' ===

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Consumption of food contaminated with sand particles, straw, pieces of wood, bone and thorn, or else yawing with stretching of the body as well as excessive intake of food causes injury to intestine lead to ''chhidrodara'' [42].

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==== Pathogenesis of ''chhidrodara'' ====

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=== Pathogenesis of ''chhidrodara'' ===

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Contaminated food causes perforation of the intestines, which undergoes suppuration. Or else the suppuration of the intestines may happen due to yawing or excessive food which in turn leads to perforation. Perforation of the intestines further causes leaking out of the chyle from the intestines, which tends to move into the dependent parts of the abdomen filling the intestinal and rectal parts. Eventually the accumulation of the fluids in the lower abdomen manifests in ''chhidrodara'' [43].

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==== Symptoms of ''chhidrodara'' ====

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=== Symptoms of ''chhidrodara'' ===

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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].

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

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

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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].

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

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

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The symptoms of ''udakodara'' (''jalodara'') includes lack of interest to take food, excessive thirst, mucus discharge from anus, abdominal pain, breathlessness, cough, debility, abdomen with stretch marks and distended variegated veins, fluid thrill and dull percussion note identical to the one seen in leather bag filled with water [47].

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==== Consequences of not treating ''jalodara'' at early stage ====

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=== Consequences of not treating ''jalodara'' at early stage ===

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On appearance of the fluid the patient may suffer several complications that include vomiting, diarrhea, asthma, excessive thirst, breathlessness, cough, hiccough, debility, pain in the sides of the abdomen, tastelessness in mouth, hoarseness of voice and retention of urine and in this state it is incurable [48-49].

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==== Prognosis of ''udara roga'' ====

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=== Prognosis of ''udara roga'' ===

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The ''udara'' is difficult to cure from the very onset itself but if the patient is physically strong, in state of ''ajatodaka'' (initial phase of distension of abdomen with slight fluid accumulation) and the ''udara'' of recent onset can be managed only with energetic treatment [50-54].

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==== Symptoms of ''ajatodaka udara roga'' ====

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=== Symptoms of ''ajatodaka udara roga'' ===

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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].

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

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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].

−

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

+

=== 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].

−

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

+

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

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If the patient has ''udavarta'' (reversed course of ''vata'' in the abdomen), ''sphurana'' (fasciculation), ''akshepa'' (involuntary movements), pain in the joints, bone, sides of the abdomen, back and sacral region; then again after performing oleation and sudation ''asthapana basti'' (decoction enema) is given [63].

−

==== Role of ''anuvasana basti'' ====

+

=== Role of ''anuvasana basti'' ===

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If the patient has strong digestive power and suffers from obstructed bowel movement and flatus as well as with dryness of the body; then he should be treated by ''anuvasana basti'' (oily enema) [64]

−

==== ''Dashamula niruha basti'' ====

+

=== ''Dashamula niruha basti'' ===

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''Anuvasana basti'' (oily enema) should be given with ''eranda taila'' (castor oil) or ''tila taila'' (sesame oil) processed with sour and anti ''vata'' drugs [65].

−

==== Indications for palliative (''shamana'') treatment ====

+

=== Indications for palliative (''shamana'') treatment ===

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The patient who is debilitated, aged, children, having delicate constitution, minimal morbidity of ''dosha'' and dominant vitiation of ''vata'' and unfit for ''virechana karma'' (therapeutic purgation) should be treated by palliative (''shamana'') measures. ''Shamana'' treatment comprises use of medicated ghee, meat soup, rice, oil massage and milk. Such patients may also be given ''anuvasana basti'' (oily enema).[66-67]

−

==== Treatment of ''pittodara'' ====

+

=== Treatment of ''pittodara'' ===

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Oral treatment with milk, ''basti karma'' (medicated enema) and ''virechana'' (therapeutic purgation) should be repeated in ''pittodara''; by this patient is gradually stabilized and the illness gets cured [71].

−

==== Treatment of ''kaphodara'' ====

+

=== Treatment of ''kaphodara'' ===

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''Shamana'' (palliative) treatment is done in ''kaphodara'' by oral intake of ''gomutra'' (cow’s urine), ''arishta'' (fermented decoctions), drug powder, ''ayaskriti'' (medically processed iron) and sesame oil added with ''kshara'' (alkali obtained from ash of herbs) [73].

−

==== Treatment of ''sannipatodara'' ====

+

=== Treatment of ''sannipatodara'' ===

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If the patient presents with all the complications of ''udara'' then the physician should avoid treating such patients considering it as ''pratyakhyeya'' (near death) [74].

−

==== Predominant symptoms of ''dosha'' in ''plihodara'' (splenomegaly) ====

+

=== Predominant symptoms of ''dosha'' in ''plihodara'' (splenomegaly) ===

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Predominance of ''kapha'' is judged by the symptoms like heaviness, lack of taste in the mouth and hardness of the abdomen. Presence of symptoms indicative of morbidity of ''rakta'' as mentioned in [[Vidhishonitiya Adhyaya]] point towards the dominance of morbid ''rakta'' in the pathogenesis of ''plihodara''. Hence, ''plihodara'' should be treated according to the dominance of ''dosha'' involved [75-76].

−

==== Treatment of ''plihodara'' ====

+

=== Treatment of ''plihodara'' ===

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Thus is the description of principles of treatment of ''plihodara''; now listen to the medications [79]

−

==== ''Pippalyadi churna'' ====

+

=== ''Pippalyadi churna'' ===

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Take one part each of the fine sieved powder of ''pippali'' (Piper longum), ''nagara'' (Zingiber officinale), ''danti'' (Baliospermum montanum), ''chitraka'' (Plumbago zeylanica) and ''vidanga'' (Embelia ribes), and add it to two parts of ''abhaya'' (Terminalia chebula). It is to be orally given with warm water [79]

−

==== ''Vidangadi kshara'' ====

+

=== ''Vidangadi kshara'' ===

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Take powder of ''vidanga'' (Embelia ribes), ''chitraka'' (Plumbago zeylanica), ''shunthi'' (Zingiber officinale Rosc), ''saindhava'' (rock salt) and ''vacha'' (Acorus calamus) and fry with ghee in an earthen pan and administer orally. This is curative of ''gulma'' (abdominal lump) and ''plihodara'' [80]

−

==== ''Rohitakadi yoga'' ====

+

=== ''Rohitakadi yoga'' ===

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The course powder of stem of ''rohitaka'' (Tecomella undulate) is soaked in a decoction of ''abhaya'' (Terminalia chebula) or cow’s urine for seven days and given to the patient to drink. Once the medicine gets digested the patient is asked to have meat soup of dry land animals in meals. This regimen cures ''kamala'' (jaundice), ''gulma'' (abdominal lump), ''prameha'' (frequent turbid urination), ''arsha'' (mass per rectum), ''plihodara'', all types of ''udara roga'' and ''krimi'' (worm infestation) [81-82].

−

==== ''Rohitaka ghrita'' ====

+

=== ''Rohitaka ghrita'' ===

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Twenty five ''pala'' (1200g) of bark of ''rohitaka'' (Tecomella Undulate) and two ''prastha'' (1536g) of ''kola'' (jujube) are added in eight times water and boiled to get the decoction. Then the paste prepared from 48g each of fruit and root of ''pippali'' (Piper longum), ''chavya'' (Piper retrofractum), ''chitraka'' (Plumbago zeylanica), ''nagara'' (Zingiber officinale) and equal to this 240g of bark of ''rohitaka'' and to this mixture 768g of cow’s ghee is added and boiled to get the medicated ghee. Oral medication with this medicated ghee will immediately cure ''plihodara, gulma'' (abdominal lump), ''udara roga'', dyspnea, ''krimi'' (worm infestation), anemia and jaundice [83-85].

−

==== ''Agnikarma'' (cauterization) ====

+

=== ''Agnikarma'' (cauterization) ===

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The ''vata'' and ''kapha'' dominated ''plihodara'' should be treated by ''agnikarma'' (cauterization)[86].

−

==== Treatment of ''pitta'' dominated ''plihodara''(splenomegaly) ====

+

=== Treatment of ''pitta'' dominated ''plihodara''(splenomegaly) ===

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''Plihodara'' with dominance of ''pitta'' is treated by oral administration of ghee medicated with ''jivaniya'' herbs (''Jeevaka'' (Malaxis acuminta), ''rishbhaka'' (Microstylis muscifera), ''meda'' (Polygonatum verticillatum), ''mahameda'' (Polygonatum cirrhifolium), ''kakoli'' (Roscoea procera), ''kshirakakoli'' (Lilium polphyllum), ''riddhi'' (Habenaria edgeworthii), ''vriddhi'' (Habenaria intermedia), ''kshara'' ''basti'' (decoction enema consisting of alkali obtained from ash of herbs), ''raktavaseka'' (blood letting), ''shodhana'' (purification measures) and oral intake of milk. Patient is asked to take ''yusha'' (cereal soup) or meat soup processed with ''dipaniya'' (herbs augmenting the digestive power) drugs and light food. Since the etiology and symptomatology of ''plihodara'' (splenomegaly) and ''yakritodara'' (hepatomegaly) are same, so all the treatment mentioned for ''plihodara'' should be adopted in ''yakritodara'' [87-88].

−

==== Treatment of ''baddhagudodara'' ====

+

=== Treatment of ''baddhagudodara'' ===

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Patient suffering from ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) should be initially treated by 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). Food that induces laxation should be given. Strong purgation is also indicated in the ''baddhodara''. All measures that cure ''udavarta'' as well as morbidity of ''vata'' should be done in ''baddhodara'' [89-90].

−

==== Treatment of ''Chhidrodara'' ====

+

=== Treatment of ''Chhidrodara'' ===

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''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. The treatment should be avoided in patient of ''chhidrodara'' if he suffers from symptoms like excessive thirst, cough, fever, emaciation, impairment of ''agni'', reduced food intake, dyspnea, abdominal pain and week cognition [91-92]

−

==== Treatment of ''jalodara'' ====

+

=== Treatment of ''jalodara'' ===

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Accumulation of the ''dosha'' in the abdomen lowers digestive power (''agnimandya''), hence light foods that augments the digestion (''agni'') should be given to the patient [96].

−

==== Healthy diet for ''udara roga'' ====

+

=== Healthy diet for ''udara roga'' ===

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Food comprising ''rakta shali'' (Oryza sativa), ''yava'' (Hordeum vulgare), ''mudga'' (Phaseolus radiatus), meat soup of dry land animals, milk, cow’s urine, ''asava'' (fermented infusions), ''arishtha'' (fermented decoctions), honey, ''sidhu'' (alcoholic preparation from sugarcane juice) and ''sura'' (alcoholic preparation made by fermenting a mixture of water, flour of rice and jaggery). ''Yavagu'' (rise gruel) and ''odana'' (rice) should be given along with cereal soup, or meat soup that are prepared by adding mild sour tasting drugs, small amount of ghee, pungent tasting drugs and ''panchamula'' (''bilva'' (Aegle marmelos), ''agnimantha'' (Clerodendrum phlomidis), ''shyonaka'' (Oroxylum indicum), ''kashmari'' (Gmelina arborea) and ''patala'' (Stereospermum suaveolens)).[97-98]

−

====Do’s and Don’ts ====

+

===Do’s and Don’ts ===

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Patient of ''udara'' (enlargement of abdomen) should avoid meat of aquatic and wetland animals, leafy vegetables, ''pishtakrita'' (cake and pastries made of flour; dough of rice flour), ''tila'' (Sesamum indicum), exercise, prolonged walking, day sleep, traveling, ''ushna ahara'' (hot foods), salty and sour foods, ''vidahi'' foods (foods that cause burning sensation on consumption), foods that are heavy for digestion and water [99-100].

−

==== Therapeutic use of ''takra'' (buttermilk) in ''udara roga'' ====

+

=== Therapeutic use of ''takra'' (buttermilk) in ''udara roga'' ===

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Patient suffering from ''chidrodara'' (enlargement of abdomen due to perforation in gastro-intestinal tract) should drink buttermilk added with ''pippali'' (Piper longum) and honey. Further, in patient suffering from ''udara'' (enlargement of abdomen) having morbidity of ''vata'' and ''kapha'' and who develops heaviness in the abdomen, loss of taste in the mouth, ''agnimandya'' (impairment of gastric fire) and diarrhea; intake of ''takra'' (buttermilk) is beneficial and its effect is identical to the nectar [103-106].

−

==== Use of milk in ''udara roga'' ====

+

=== Use of milk in ''udara roga'' ===

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The patient of ''udara'' (enlargement of abdomen) if develops symptoms like edema, distension of abdomen, abdominal pain and transient loss of consciousness then camel’s milk should be given to drink. If the patient’s physique reduces after the ''shodhana'' (purification measures) then he should be given cow’s milk, goat’s milk or buffalo’s milk to drink.[107]

−

==== Application of paste on abdomen ====

+

=== Application of paste on abdomen ===

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The paste prepared from ''devadaru'' (Cedrus deodara), ''palasha'' (Butea monosperma), ''arka'' (Calotropis procera), ''hastipippali'' (Scindapsus officinalis), ''shigru'' (Moringa oleifera) and ''ashvagandha'' (Withania somnifera) added with cow’s urine should be applied on the abdomen as ''pradeha'' (paste) [108].

−

==== ''Parisheka'' in ''udara roga'' ====

+

=== ''Parisheka'' in ''udara roga'' ===

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From here onward, the medicated ghee will be discussed that are curative of ''udara'' (enlargement of abdomen) and indicated in patients who exhibit dryness of the body, who have dominance of morbid ''vata'' and also the patients who will undergo ''shodhana'' (purification measures) [111-112].

−

==== ''Panchakola ghrita'' ====

+

=== ''Panchakola ghrita'' ===

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Take powder of ''pippali'' (Piper longum Linn), ''pippali mula'' (Piper longum), ''chavya'' (Piper retrofractum), ''chitraka'' (Plumbago zeylanica), ''nagara'' (Zingiber officinale) and ''kshara'' (alkali obtained from ash of herbs) half ''pala'' (24g) of each in quantity. This is added with ''ardha-tula'' (2400g) decoction of ''dashamula'' (roots of 10 drugs) and two ''prastha'' (1536g) of cow’s ghee and processed to get the medicated ghee. This ghee when orally administered along with ''dadhi manda'' (watery portion of curds) cures all types of ''udara, shvayathu'' (''anasaraka'') ''vata vishtambha'' (obstructed ''vata'' in the abdomen), ''gulma'' (abdominal lump) and ''arshas'' (mass per rectum) [112-114].

−

==== ''Nagaraadi ghrita'' ====

+

=== ''Nagaraadi ghrita'' ===

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One ''prastha'' (768g) of powder of ''nagara'' (Zingiber officinale), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica) and ''amalaki'' (Emblica officinalis) is added with 1/2 ''adhaki'' (1536g) of cow’s ghee, 1/2 ''adhaki'' (1536g) of ''taila'' (oil extracted from seeds of Sesamum indicum) and 1 ''adhaki'' (3073g) of ''mastu'' (liquid separated from curd ). This combination is processed in to medicated ghee. Oral administration of this ghee is effective in all types of ''udara'' (enlargement of abdomen) as well as ''kapha vataja gulma'' (abdominal lump) [115].

−

==== ''Chitraka ghrita'' ====

+

=== ''Chitraka ghrita'' ===

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The powder prepared from each 1 ''pala'' (48g) of ''chitraka'' (Plumbago zeylanica) and ''kshara'' (alkali obtained from ash of herbs) is added with 1 ''prastha'' (768g) cow’s ghee, 2 ''prastha'' (1536 g) of cow’s urine and 4 ''prastha'' (3073g) of water. The combination is processed into medicated ghee and is orally administered in patients suffering from ''udara'' (enlargement of abdomen). [116]

−

==== ''Yavadi ghrita'' ====

+

=== ''Yavadi ghrita'' ===

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The powders of ''yava'' (Hordeum vulgare), ''kola'' (Zizypus jujuba) and ''kulattha'' (Vigna unquiculata) is added with decoction of ''brihat panchamula'' (roots of five big plants), ''sura'' (alcoholic preparation made by fermenting a mixture of water, flour of rice and jaggery) and ''sauviraka'' (alcoholic beverage prepared from dehusked barley either raw or cooked) and ghee. This combination is processed into medicated ghee and is orally given in patients suffering from ''udara roga'' [117].

−

==== ''Virechana'' ====

+

=== ''Virechana'' ===

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After the oral medication of this medicated ghee, once the patient regains the physical strength, morbid ''vata'' gets alleviated and ''dosha'' has been mobilized into the ''koshtha''; the patient is treated with ''virechana'' (therapeutic purgation) by administering purgatives mentioned in the [[Kalpa Sthana]]. [118-119]

−

==== ''Patoāldi churna'' ====

+

=== ''Patoāldi churna'' ===

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The powder is prepared from each one ''karsha'' (12g) each powder of root of ''patola'' (Trichosanthes dioica), ''rajani'' (Curcuma longa), ''vidanga'' (Embelia ribes.), barks of ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica) and ''amalaki'' (Emblica officinalis), two ''karsha'' (24g) of ''kampilla'' (Mallotus philippinensis), three ''karsha'' (36g) of ''nilini'' (Indigofera tinctoria) and four ''karsha'' (48g) of ''trivrita'' (Operculina turpethum). This powder is orally administered in a dose of one ''pala'' (48g) along with cow’s urine to induce purgation. After the purgation, the patient is advised to have light food consisting of meat soup of dry land animals. Or else, after the intake of ''manda'' (gruel water) and ''peya'' (liquid rice gruel), the patient is given milk processed with ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale) and ''maricha'' (Piper nigrum) for six days. The repeated administration of this regimen cures all the types of ''udara'' including the stage of ''jatodaka'' (enlargement of abdomen with fluid accumulation), jaundice, anemia and ''anasaraka''. This powder named as ''patoladi churna'' is well appreciated for the cure of ''udara'' (enlargement of abdomen) [119-123]

−

==== ''Gavakshyadi churna'' ====

+

=== ''Gavakshyadi churna'' ===

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Powder prepared from equal amounts of ''gavakshi'' (Citrullus colocynthis), ''shankhini'' (Clitoria terneata), ''danti'' (Baliospermum montanum), bark of ''tilvaka'' (Symplocos cochinchinensis/Jatropha curcas) and ''vacha'' (Acorus calamus) is orally administered with juice of grapes, cow’s urine, decoction of ''kola'' (Zizypus jujuba), decoction of ''karkandhu'' (Zizyphus sativa) and ''sidhu'' (alcoholic preparation from unboiled/boiled sugarcane juice) [124]

−

==== ''Narayana churna'' ====

+

=== ''Narayana churna'' ===

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Take one part each of ''yavani'' (Trachyspermum ammi), ''hapusha'' (Juniperus communis), ''dhanyaka'' (Coriandrum sativum), ''haritaki'' (Terminalia chebula Retz), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''upakunchika'' (Nigella sativa), ''kaavi'' (Apium leptophyllum), root of ''pippali'' (Piper longum), ''ajagandha'' (Withania somnifera), ''shati'' (Hedychium spicatum), ''vacha'' (Acorus calamus), ''shatahva'' (Anethum sowa), ''jiraka'' (Cuminum cyminum), ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale), ''maricha'' (Piper nigrum), ''svarnakshiri'' (Argemone mexicana), ''chitraka'' (Plumbago zeylanica), ''sarjakshara'' (Sodii carbonas impura), ''yava kshara'' (alkali from awns of barley), ''pushkaramula'' (Inula racemosa), ''kushtha'' (Saussurea lappa), rock salt (saindhava), ''sauvarchala lavana'' (Unaqua sodium chloride), ''vida lavana'' (ammonium salt; salt obtained from animal’s excreta-feces/ urine), ''samudra lavana'' (Sodi muris), ''audbida lavana'' (salt obtained from earth) and ''vidanga'' (Embelia ribes). To this, three parts of ''danti'' (Baliospermum montanum), two parts of ''trivrita'' (Operculina turpethum), two parts of ''vishala'' (Citrulus colocynthis) and four parts of ''satala'' (Euphorbia tirucalli) are added and powdered. This powder is known as ''narayana churna'' and is effective in curing horde of diseases. Quite similar to the Lord Vishnu killing the demon; this ''churna'' on consumption kills the diseases. Patient suffering from ''udara roga'' should take this powder with butter milk. The patients suffering from ''gulma'' (abdominal lump) should be prescribed with decoction of ''badara'' (Ziziphus zizyphus). In case of ''anaddha vata'' (obstructed ''vata'' in the abdomen) this ''narayana churna'' should be given with ''sura'' (alcoholic preparation made by fermenting a mixture of water, flour of rice, jaggery). ''Vata roga'' is treated by administering this powder with ''prasanna'' (supernatant clear portion of alcoholic preparation; upper portion of ''madya''). Constipation is treated by giving this ''churna'' with ''dadhi manda'' (watery portion of curds). ''Arsha'' (piles) is treated by administering this powder with juice of ''dadima'' (Punica granatum). ''Parikartka'' (cutting pain in the anal region) may be treated by giving this medicine with ''vrikshamla'' (Garcinia indica). This powder, if given with lukewarm water cures indigestion. Also this powder is orally administered with relevant ''anupana'' (liquid adjunct) after oral oleation measure and to induce ''virechana'' (therapeutic purgation) in patients suffering from diseases like bhagandara (fistula in ano), anaemia, dyspnea, cough, throat irritation, cardiac disease, ''grahanidosha'' (malabsorption), ''kushtha'' (obstinate skin diseases), impaired appetite, fever, venomous bite, toxic tubers, ''garavisha'' (mild poisoning) and ''kritrima visha'' (poisoning with synthesized poison)[125-132]

−

==== ''Hapushadya churna'' ====

+

=== ''Hapushadya churna'' ===

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Prepare fine powder from ''hapusha'' (Juniperus communis), ''svarnakshiri'' (Argemone mexicana), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''katurohini'' (Picrorhiza kurroa), ''nilini'' (Indigofera tinctoria), ''trayamana'' (Gentiana kurrhoa), ''satala'' (Euphorbia Tirucalli), ''trivrita'' (Operculina turpethum), ''vacha'' (Acorus calamus), rock salt, ''kala lavana'' (black salt) and ''pippali'' (Piper longum). This powder should be orally given with juice of ''dadima'' (Punica granatum), decoction of ''triphala'' (three fruits), meat soup, cow’s urine or warm water. This medication induces purgation, eliminates ''vata, pitta and kapha''; and is effective in curing diseases that include ''shvitra'' (leukoderma), ''kushtha'' (obstinate skin diseases), pain due to morbid ''vata, vishamagni'' (irregular digestion), ''anasaracha'', ''arshas'' (piles), anemia, jaundice and ''halimaka'' (chlorosis) [133-136]

−

==== ''Nilinyadi churna'' ====

+

=== ''Nilinyadi churna'' ===

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The ''nililnyadi churna'' is prepared from the powders of ''nilini'' (Indigofera tinctoria), ''nichula'' (Barringtonia acutangula), pippali (Piper longum), ''shunthi'' (Zingiber officinale), ''maricha'' (Piper nigrum), ''svarajika kshara'' (Sodii carbonas impura), ''yava kshara'' (alkali from awns of barley), ''sauvarchala lavana'' (unaqua sodium chloride), ''vida lavana'' (ammonium salt), ''audbhida lavana'' (salt obtained from earth), rock salt (''saindhava''), ''samudra lavana'' (Sodi muris) and ''chitraka'' (Plumbago zeylanica). This powder is orally administered with ghee and is curative of all types ''udara roga'' as well as ''gulma'' (abdominal lump) [137]

−

==== ''Snuhi kshira ghrita'' ====

+

=== ''Snuhi kshira ghrita'' ===

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Take one ''adhaka'' (3073g) of ''dadhi manda'' (liquid portion of curds), one ''pala'' (48g) paste of ''snuhi kshara'' (latex of Euphorbia neriifolia) and one ''prastha'' (768g) of ghee and process it into medicated ''ghrita''. Its oral administeration in a proper dose to patients suffering from ''udara roga'' with ''peya'' (liquid rice gruel), sweetened milk or sweet tasting meat soup cures ''udara roga'' [141].

−

==== Management following ''virechana'' ====

+

=== Management following ''virechana'' ===

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The patient suffering from ''anaha'' (distented abdomen) should be treated with ghee processed with paste of ''pilu'' (Salvadora persica). The medicated ghee prepared from ''nilini'' (Indigofera tinctoria) or ''mishraka ghrita'' which is curative of ''gulma'' (abdominal lump) may also be prescribed to cure ''udara roga'' [145]

−

==== ''Shamana'' (palliative) treatment ====

+

=== ''Shamana'' (palliative) treatment ===

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The camel’s milk and goat’s milk may be orally given for three months added with ''pippali'' (Piper longum), ''shunthi'' (Zingiber officinale) and ''maricha'' (Piper nigrum). One course of ''haritaki'' (Terminalia chebula Retz) consisting a thousand numbers may be administered along with milk diet. ''Shilajatu'' (asphaltum) may be administerd orally along with milk diet. Similarly, ''guggulu'' (Commiphora wightii) may be orally administered. Juice of ''ardraka'' (Zingiber officinale) or decoction of ''shringavera'' (Zingiber officinale) is given orally with equal amounts of milk. Alternatively one can take 10 parts of oil processed with one part of ''ardraka'' (Zingiber officinale Rosc) with milk. Oral administration of oil extracted from the seeds of ''danti'' (Baliospermum montanum) and ''dravanti'' (Jatropha glandulifera) along with ''mastu'' (liquid separated from curd ), ''yusha'' (soup) and ''mamsarasa'' (meat soup) is effective in ''dushyodara'' (enlargement of abdomen tending ascites), ''shula'' (abdominal pain), ''anaha'' (flatulence) as well as ''vibandha'' (constipation). The combination of ''sarala'' (Pinus roxburghii), ''madhushigru'' (Moringa oleifera) and oil extracted from seeds of ''mulaka'' (Raphanus sativus) should be given orally and for oil massage in patients suffering from abdominal pain due to vātodara. Patient of kaphodara having the habit of consuming alcohol and suffering from symptoms like abdominal rigidity, ''staimitya'' (subjective feeling as if the body is covered by wet cloth), abdominal heaviness, lack of taste, nausea and impaired digestion should be treated with ''arishta'' (fermented decoctions) or ''kshara'' (alkali obtained from ash of herbs) [150-156]

−

==== ''Pippalyadi lavana'' ====

+

=== ''Pippalyadi lavana'' ===

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With the due consideration of morbid ''dosha'', the physician should prescribe ''pippalyadi lavana'' for liquefying the ''kapha''. The ingredients of ''pippalyadi lavana'' are ''pippali'' (Piper longum), ''tilvaka'' (Symplocos cochinchinensis/Jatropha curcas), ''hingu'' (Ferula foetida), ''nagaraa'' (Zingiber officinale), ''hastipippali'' (Scindapsus officinalis), ''bhallataka'' (Semecarpus anacardium), fruits of ''shigru'' (Moringa oleifera), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''katukarohini'' (Picrorhiza kurroa Royle), ''devadaru'' (Cedrus deodara), ''haridra'' (Curcuma longa), ''daruharidra'' (Berberis aristata), ''sarala'' (Pinus roxburghii), ''ativisha'' (Aconitum heterophyllum), ''vacha'' (Acorus calamus), ''kushtha'' (Saussurea lappa), ''musta'' (Cyperus rotundus), ''sauvarchala lavana'' (unaqua sodium chloride), ''vida lavana'' (ammonium salt), ''audbida lavana'' (salt obtained from earth), rock salt (''saindhava'') and ''samudra lavana'' (Sodi muris). The course powder of these drugs is added with curd/yogurt, cow’s ghee, ''vasa'' (animal fat), ''majja'' (bone marrow) and ''taila'' (oil extracted from seeds of Sesamum indicum) and then is burnt to get the ''kshara'' (alkali obtained from ash of herbs). This ''kshara'' is orally administered after the meals in a dose of one ''karsha'' (12g). The ''anupana'' (adjunct) for it is any one of madirā (alcoholic beverage), dadhimanda (liquid portion of curds), warm water, arishta (fermented decoctions), surā (alcoholic preparation made by fermenting a mixture of water, flour of rice, jaggery) and ''asava'' (fermented infusions). This medication effectively cures ''hridroga'' (cardiac disease), ''anasaraka, gulma'' (abdominal lump), ''plihodara'' (splenomegaly), ''arshas'' (piles), ''udara roga, visuchika'' (illness characterized by vomiting and diarrhea), ''udavarta'' (reversed course of ''vata'' in the abdomen) and ''vatashtila'' (mass obliterating the urinary and rectal passage)[157-161].

−

==== ''Kshara vatika'' ====

+

=== ''Kshara vatika'' ===

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''Kshara'' is prepared by burning goat’s dung processed with cow’s urine and it is added with 1 karsha (12g) each of root of ''pippali'' (Piper longum), ''sauvarchala lavana'' (unaqua sodium chloride), ''vida lavana'' (ammonium salt), ''audbida lavana'' (salt obtained from earth), ''saindhava'' (Sodi chloriduium), ''samudra lavana'' (Sodi muris), ''pippali'' (Piper longum), ''chitraka'' (Plumbago zeylanica), ''shunthi'' (Zingiber officinale), ''haritaki'' (Terminalia chebula), ''vibhitaki'' (Terminalia belerica), ''amalaki'' (Emblica officinalis), ''trivrita'' (Operculina turpethum), ''vacha'' (Acorus calamus), ''sarjikashara'' (Sodii carbonas impura), ''yava kshara'' (alkali from awns of barley), ''satala'' (Euphorbia Tirucalli), ''danti'' (Baliospermum montanum), ''svarnakshiri'' (Argemone mexicana ) and ''vishanika'' (Euphorbia fusiformis). This formulation is rolled into a pill of the size one ''kola'' (6g). This is orally administered in a dose of one ''kola'' (6g) with ''sauvira'' (alcoholic beverage prepared from dehusked barley either raw or cooked) and is effective in ''shvayathu'' (''anasaraka''), ''avipaka'' (indigestion) and advanced stage of ''udara roga'' [162-164].

−

==== ''Yavagu'' for treatment of ''udara roga'' ====

+

=== ''Yavagu'' for treatment of ''udara roga'' ===

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The rice that grows in 60 days is processed with cow’s urine and is used for the preparation of ''yavagu'' (rice gruel) added with milk. Patient is allowed to consume stomach full of this ''yavagu'' followed along with ample intake of sugar cane juice. This will cure the ''udara roga'' and the morbid ''vata, pitta'' as well ''kapha'' and help in regaining their natural abode [165-66].

−

==== Treatment of constipation ====

+

=== Treatment of constipation ===

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The knowledgeable physician should give the patients the food prepared with adding leaves of ''shankhini'' (Clitoria terneata), ''snuhi'' (Euphorbia neriifolia), ''trivrita'' (Operculina turpethum), ''danti'' (Baliospermum montanum) and ''chirabilva'' (Holoptelea integrifolia). This will soften the fecal matter and helps in emptying the bowels. If some amount of ''dosha'' is left unexpeled, then the patient is allowed to drink milk added with cow’s urine [167-168]

−

==== Treatment of ''parshva shula'' ====

+

=== Treatment of ''parshva shula'' ===

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Patient of ''udara'' if develops ''parshvashula'' (pain in the sides), ''upastambha'' (paresis and ''paresthesia'' of lower limbs due to entrapment of ''vata''), ''hridgraha'' (congestion in cardiac region) due to morbidity of ''vata'', it should be treated by oral administration of ''taila'' (oil extracted from seeds of Sesamum indicum), added with ''bilva kshāra'' (alkali obtained from ash of Aegle marmelos) [169].

−

==== ''Kshara taila'' ====

+

=== ''Kshara taila'' ===

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Oil is prepared successively with each of the ''kshara'' of ''agnimantha'' (Clerodendrum phlomidis), ''shyonaka'' (Oroxylum indicum), ''palasha'' (Butea monosperma), stalk of ''tila'' (Sesamum indicum), ''bala'' (Sida cordifolia), ''kadali'' (Musa paradisiaca) and ''apamarga'' (Achyranthes aspera). This is orally given to cure the ''udara roga''. This medicated oil also relieves cardiac arrest (''hridgraha'') caused by morbid ''vata'' in patient of ''udara'' [170-172]

−

==== ''Eranda taila'' in ''avarana'' ====

+

=== ''Eranda taila'' in ''avarana'' ===

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If morbid ''vata'' causes intestinal stasis and abdominal distension then it should be treated by administration of ''niruha'' (decoction enema) consisting of strong medicines such as ''kshara'' (alkali obtained from ash of herbs) and cow’s urine [172-75].

−

==== Use of ''venum'' in the treatment of ''sannipatodara'' ====

+

=== Use of ''venum'' in the treatment of ''sannipatodara'' ===

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Alternatively the angry serpent is made to release the venom while biting the fruit. Patient is allowed to consume this venomous fruit after proper analysis by the physician. This treatment immediately liquefies the infiltrating displaced morbid ''dosha'' by virtue of its ''pramathi'' (clearing the channels adhered with ''dosha'') property and eliminates from the body. Once the ''dosha'' is cleared from the body by the action of venom patient is treated with cold water ''parishechana'' (pouring of medicated liquids on body parts). Depending upon the physical strength, the patient is allowed to drink milk or yavāgu (rice gruel). The food prepared from leafy vegetables that include ''trivrita'' (Operculina turpethum), ''mandukaparni'' (Centella asiatica), ''yava'' (Hordeum vulgare), ''vastuka'' (Chenopodium murale) and ''kalashaka'' (Corchorus capsularis) processed with juice of same leafy vegetables should be given to the patient but without adding ''amla'' (sour), ''lavana'' (salty) and ''sneha'' (unctuous substance). This food may be served with or without steaming and during this food rice is avoided. This regimen should be continued for one month. During this course if the patient is thirsty then the juice extracted from these leafy vegetables should be given to the patient. By this method once in one month all the morbid ''dosha'' is cleared from the body and the patient is advised to drink milk to improve the physical strength [175-184]

−

==== Surgical measures ====

+

=== Surgical measures ===

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Surgical intervention should be done by an expert surgeon. A proper incision is made on the left side of the abdomen about fpur figure (7.8cm) below the umbilicus by an efficient surgeon. From this incision intestinal loops are drawn out and carefully looked for foreign substances causing ''chidrodara'' or ''baddhodara''. Ghee is applied on the affected loop of the intestines. Then the foreign substances like hair and others are then removed from the intestinal loop. Any torsion or intussusception of the loops of intestines if present is opened. By the surgical procedure if large rend happens in the intestines then edges of rend is anchored by making the small ants to bite and hold the edges together. Once the ants properly anchor the opposing edges of rend, the body of the ants is separated and thrown. Intestinal loops are then properly inserted into the abdomen and the incised area is sutured. Then wound management is done [184-188].

−

==== Surgical Intervention in ''jalodara'' ====

+

=== Surgical Intervention in ''jalodara'' ===

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In all conditions of ''udara'' with accumulation of fluid, the fluid should be aspirated by inserting a cannula into the abdomen just below the umbilicus on the left side. While aspirating, compress the abdomen and after the aspiration the abdomen is tightly wrapped with a cloth. This wrapping should also be done in cases where reduction of the abdomen is achieved by other methods like ''niruha basti'' (decoction enema) and ''virechana'' (therapeutic purgation). After the removal of the fluid patient is treated with ''langhana'' (reducing regimen) and is given ''peya'' (liquid rice gruel) with little or no addition of ''sneha'' (dietary fat) and salt. After this the patient is kept on only milk diet for six months. For another three months patient is allowed to take ''peya'' (liquid rice gruel) along with milk. Following this for another three months the patients is given rice prepared with shyāmaka (Echinochloa frumentacea) or ''koradusha'' (Paspalum scorbiculatum) added with milk. This light diet should be without salt altogether. By managing the patient in this manner for one year one can get cured of ''jalodara'' [189-192]

−

==== Importance of milk diet ====

+

=== Importance of milk diet ===

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To prevent the perpetuation of morbid ''dosha'' and to regain the physical strength, milk should be included in all prescriptions for the patients suffering from ''udara''. The physique of the patients of ''udara'' which is reduced due to medications is best recuperated by milk diet, and milk is regarded as best remedy identical to the nectar for gods in all patients suffering from depletion of all ''dhatu'' [193-194]

−

==== Summary of the chapter ====

+

=== Summary of the chapter ===

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== Vidhi Vimarsha (Applied Inferences ) ==

−

==== 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>.

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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 name="ref9" /> 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>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> [9-11].

−

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

+

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

The clinical condition of peritonitis is comparable to the ''udara roga'' in general. Clinically this is categorized into primary or secondary, acute or chronic and localized or diffuse. These are comparable to the ''doshaja udara'' that includes ''vataja, pittaja, kaphaja'' and ''sannipataja udara roga''. Splenomegaly and hepatomegaly refers to plihodara and ''yakritodara'' respectively. Intestinal obstruction is said by the ''baddhagudodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''chhidrodara'' (abdominal enlargement due to intestinal perforation) refers to the intestinal perforation. [22]

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Again, based on the etiology ''udara roga'' is further segregated into ''nija'' (endogenous) and ''agantuja'' (exogenous) type. Among the different types of ''udara roga''; the types of ''udara'' caused due to erroneous food and habits and mediated through morbidity of ''dosha'' and ''dushya'' is considered as ''nija'' type of ''udara''. ''Plihodara'' (enlargement of the spleen) and ''jalodara'' (enlargement of abdomen due to collection of fluid) are segregated as ''nija udara'' in the list of ''dushya'' dominant ''udara''. All the four types of ''dosha'' dominant ''udara'' fall under the category of ''nija udara'' (distension of abdomen due to endogenous causes). Contrary to this the ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction) and ''chidrodara'' (abdominal enlargement due to intestinal perforation) caused by injury of intestines due to external factors are regarded as ''agantu udara'' (distension of abdomen caused due to exogenous causes)<ref name="ref9" />[22].

−

==== ''Vatodara'' ====

+

=== ''Vatodara'' ===

Initial morbidity of ''vata'' caused by aggravated ''kapha'' during the pathogenesis of ''vatodara'' indicates that the morbidity of ''kapha'' is secondary. Thus, this secondary morbidity of ''kapha'' distinguishes the ''vatodara'' and ''kaphodara''<ref name="ref12" /> [23-24].

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Since the lower part of the abdomen is the normal location of ''vata'', distention of the abdomen initially occur in its lower parts.<ref name="ref12" /> Blackish and reddish discoloration of nails, conjunctiva, mouth and dermis is pathognomonic of morbid ''vata''<ref name="ref12" />. [25]

−

==== ''Pittodara'' ====

+

=== ''Pittodara'' ===

In this pathogenesis, the morbidity of ''pitta'' is most predominant than that of ''vata'' and ''kapha''. It is worth mentioning here that suppression of the ''agni'' in this context implies the suppression of ''dhatvagni''<ref name="ref12" /> [27].

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The primary peritonitis caused by pyogenic gram positive bacteria like streptococci, and pneumococci matches with the symptom of ''pittaja udara''. Acute presentation of the illness with rapid progression into prominently exudative ascites justifies the contention of ''pittodara''. Microbiology study of ascitic fluid will reveal pathogens and will clinch the diagnosis<ref name="ref21" />[28]

−

==== ''Kaphodara'' ====

+

=== ''Kaphodara'' ===

Peritoneal tuberculosis is comparable to ''kaphodara''. Chronic perpetuation of the illness with the co-morbidity of the respiratory illness justifies the same. Infection of peritoneum with Mycobacterium tuberculosis also causes peritonitis. Fever, anorexia, weakness, malaise, and weight loss are the initial constitutional manifestations. Abdominal distention then develops either because of partial intestinal obstruction or ascites. Doughy abdomen is regarded as most classic sign of tubercular peritonitis. In most of the cases it is possible to detect the primary focus of infection in the lungs. Abdominal tenderness associates the abdominal pain. Analysis of ascitic fluid confirms exudative ascites.<ref name="ref21" />[31]

−

==== ''Sannipatodara'' ====

+

=== ''Sannipatodara'' ===

''Dushyodara'' is another name of ''sannipatodara''. This is not the ninth type of ''udara'' and the total number of ''udara'' remains eight<ref>Sushruta, sushruta samhita with nabandha sangraha commentary by dhallahana, edited by yadavaji trikamji , nirnaya sagar press, 1915, p 711, pg no 236</ref>.

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Intra-abdominal malignancy spreading into the peritoneum causes malignant ascites. Usually it is the endometrial, colonic, gastric and pancreatic carcinoma, which may progress into peritoneal carcinomatosis. Even extra gastro intestinal malignancies like carcinoma of the breast, melanoma and lung carcinoma can cause peritoneal spread. Characteristically ascites happens in this condition in the absence of portal hypertension, tuberculosis, or right heart failure. Diagnostic paracentesis is confirmatory in this condition. More to add, the development of malignant ascites is always indicator of poor prognosis. This peritoneal carcinomatosis presenting with plethora of symptoms that matches with the symptoms pathognomonic of morbid ''vata, pitta'' and ''kapha dosha'', and its prognosis substantiates the consideration of ''sannipatodara'' in such cases<ref name="ref21" />[33-34].

−

==== ''Plihodara'' and ''Yakritodara'' ====

+

=== ''Plihodara'' and ''Yakritodara'' ===

The etiology, pathology and treatment of ''plihodara'' and ''yakritodara'' are identical. Thus, for the descriptive purposes these two conditions are collectively called as ''Yakrita-plihodara''.

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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].

−

==== ''Baddhagudodara'' ====

+

=== ''Baddhagudodara'' ===

Acute or chronic intestinal obstruction due to variety of causes is comparable to ''baddhodara'' (enlargement of abdomen due to gastrointestinal obstruction). Sudden development of intestinal obstruction in an otherwise healthy person may be due to strangulation, paralytic ileus, and intussusception. Even the simple of malignant stricture of the colon, diverticulitis and pressure by a tumor can cause obstruction. Impaction of masses of roundworms, too much cellulose like orange peel, hair balls and other foreign substances can also cause intestinal obstruction.

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Clinical presentations include absolute constipation, no passing of the flatus. This is true even after repeated enemata. Abdominal pain initially referred to umbilicus. Eventually the abdominal pain turns into colicky in nature due to strong peristalsis trying to overcome the obstruction. Tenderness is little. Since the beginning the patient will have projectile vomiting. Vomitus consists of food particles initially and then bile follows and finally stercoraceous with fecal odor. Abdominal distention is noticed, more in the flanks in colonic obstruction and will be seen in the central abdomen if, the obstruction is in the intestines. Peristalsis may be visible. Gradually the patient develops the constitutional symptoms like prostration, thready rapid pulse. Urine is diminished. Obstruction located in proximal intestines may cause tetany [39-41].

−

==== ''Kshatodara'' ====

+

=== ''Kshatodara'' ===

The word ''kshatodara'' is formed by the component terms ''kshata'' and ''udara''. The Sanskrit term ''kshata'' refers to the perforation caused by substances like sand particles. ''Kshatodara'' is caused by perforation of the intestines due entangling of the foreign substances that are consumed along with the food. Thus, the distension of the abdomen caused by the perforation of the intestines is termed as ''kshatodara''<ref>Raja radha kanta deva, Shabdakalpadruma, part 2 chaukhambha Sanskrit siries, varanasi 3rd edition 1967, P555; Pg no 226</ref>.

−

==== ''Parisravi udara'' ====

+

=== ''Parisravi udara'' ===

''Parisravi'' and ''udara'' are the component terms of ''parisraavi udara''. ''Parisraavi'' is again formed by the verb ''sraai'' with the addition of the prefix ''pari''. The prefix ''pari'' gives the meaning of extensive from all the sides. The verb ''sraavi'' refers to the secretion. Thus the term ''parisraavi'' refers to the pathology of morbid flow or extensive secretion from all sides.

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Pathologically this illness is characterized by intestinal contents oozing into the abdomen and the abdominal contents in turn oozing into the rectum. Hence the illness is called as ''parisraavi udara''<ref>Raja radha kanta deva, Shabdakalpadruma, part 5 chaukhambha Sanskrit siries, varanasi 3rd edition 1967, P555; Pg no 466</ref>.

−

==== ''Chhidrodara'' ====

+

=== ''Chhidrodara'' ===

The component terms ''chhidra'' and ''udara'' together forms ''chhidrodara''. '''Chhidra''' refers to perforation and ''udara'' refers to distension of the abdomen. Thus, the illness characterized by the perforation of the intestines is known as ''chhidrodara''<ref>Raja radha kanta deva, Shabdakalpadruma, part 2 chaukhambha Sanskrit siries, varanasi 3rd edition 1967, P937; Pg no 482 </ref>[42-43].

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Paralytic ileus supervenes in the pathology of peritonitis. Ileus is characterized by diminishing of the bowel sounds. Percussion note becomes tympanitic. Further as the disease advances the tachycardia progressively worsens and temperature gradually falls indicating impending peritoneal shock from bacterial toxemia and septicemia. Investigation may reveal leukocytosis. Free air under the diaphragm may be seen in an upright chest radiograph if a ruptured viscus is the cause.<ref>Tadataka Yamada, textbook of gastroenterology, 5th edition, volume 1, part 2, 2009 Blackwell Publishing. ISBN: pages 3413, chapter 100 2509</ref>

−

==== ''Jalodara'' ====

+

=== ''Jalodara'' ===

''Udaka'' in Sanskrit translates as fluid and ''udara'' refers to the distension of the abdomen, put together the term ''udakodara'' means distension of the abdomen due to accumulation of the fluid. According to Sanskrit literature, the word ''dakodara'' is formed by the removal of initial letter u from the word ''udakodara''. Thus, formed word ''dakodara'' also give the same meaning of ''udakodara''.<ref name="ref34">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 2825</ref>

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Further as the fluid accumulates, the patient develops the complete symptoms of ascites that include horse shoe dullness, shifting dullness and fluid thrill. This stage of peritonitis is considered as ''jatodakavastha'' of ''udara''<ref name="ref21" /> [48-49].

−

===== Current Clinical Management =====

+

==== Current Clinical Management ====

{| class="wikitable"

|-

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| ''-''

|}

−

~~=== Glossary ===~~

−

~~#ajātodaka (अजातोदक): initial phase of generalized enlargement of abdomen without fluid accumulation~~

−

~~#baddhagudodara (बद्धगुदोदर): Generalized enlargement of abdomen due to gastrointestinal obstruction~~

−

#Brihat Pañcamūla (बृहत पञ्चमूल): Five big plants whose roots are used viz. Bilva (Aegle marmelos Corr), agnimantha (Clerodendrum phlomidis Linn. f), shyonāka (Oroxylum indicum Vent), kāshmari (Gmelina arborea) and pātalā (Stereospermum suaveolens)

−

~~#chhidrodara (छिद्रोदर): Generalized abdominal enlargement due to intestinal perforation~~

−

~~#dadhi manda (दधिमण्ड): watery portion of curds~~

−

#dashamula (दशमूल): ten plants whose roots are used as medicine viz. Bilva (Aegle marmelos Corr), agnimantha (Clerodendrum phlomidis Linn. f), shyonāka (Oroxylum indicum Vent), kāshmari (Gmelina arborea), pātalā (Stereospermum suaveolens), shālaparni (Desmodium #gangeticum DC), Prishniiparni (Uraria picta Desv), brihati (Solanum indicum Linn), kantakāri (Solanum surattense Burm. f) and #gokshura (Tribulus terrestris Linn)

−

~~#jalodara (जलोदर): ascites~~

−

~~#kshatodara (क्षतोदर): Generalized abdominal enlargement due to intestinal perforation~~

−

~~#Pañcamūla (पञ्चमूल): five roots~~

−

~~#plihodara (प्लीहोदर): splenomegaly~~

−

~~#Prasannā (प्रसन्ना): supernatant clear portion of alcoholic preparation; upper portion of Madya~~

−

~~#Sidhu (सीधु): alcoholic preparation from un-boiled/boiled sugarcane juice~~

−

~~#Surā (सुरा): Alcoholic preparation made by fermenting a mixture of water, flour of rice and jaggery~~

−

~~#udakodara (उदकोदर): ascites.~~

−

~~#yakritodara (यकृतोदर): hepatomegaly~~

=== References ===

Agnivesha

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