Udara Chikitsa

Udara Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 13
Preceding Chapter	Svayatu Chikitsa
Succeeding Chapter	Arsha Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 13, Chapter on Treatment of Generalized Enlargement of Abdomen)

Abstract

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

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

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

Introduction

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

Sanskrit text, Transliteration and English Translation

अथात उदरचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athāta Udara cikitsitaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAta udaracikitsitaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

We shall now elucidate the treatment of generalized enlargement of abdomen. Thus said Lord Atreya [1-2]

सिद्धविद्याधराकीर्णे कैलासे नन्दनोपमे| तप्यमानं तपस्तीव्रं साक्षाद्धर्ममिव स्थितम्||३||

आयुर्वेदविदां श्रेष्ठं भिषग्विद्याप्रवर्तकम्| पुनर्वसुं जितात्मानमग्निवेशोऽब्रवीद्वचः||४||

siddhavidyādharākīrṇē kailāsē nandanōpamē| tapyamānaṁ tapastīvraṁ sākṣāddharmamiva sthitam||3||

āyurvēdavidāṁ śrēṣṭhaṁ bhiṣagvidyāpravartakam| punarvasuṁ jitātmānamagnivēśō'bravīdvacaḥ||4||

siddhavidyAdharAkIrNe kailAse nandanopame| tapyamAnaM tapastIvraM sAkShAddharmamiva sthitam||3||

AyurvedavidAM shreShThaM bhiShagvidyApravartakam| 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]

Description of patient of udara roga

भगवन्नुदरैर्दुःखैर्दृश्यन्ते ह्यर्दिता नराः| शुष्कवक्त्राः कृशैर्गात्रैराध्मातोदरकुक्षयः||५||

प्रनष्टाग्निबलाहाराः सर्वचेष्टास्वनीश्वराः| दीनाः प्रतिक्रियाभावाज्जहतोऽसूननाथवत्||६||

तेषामायतनं सङ्ख्यां प्राग्रूपाकृतिभेषजम्| यथावच्छ्रोतुमिच्छामि गुरुणा सम्यगीरितम्||७||

bhagavannUdara irduḥkhairdr̥śyantē hyarditā narāḥ| śuṣkavaktrāḥ kr̥śairgātrairādhmātōdarakukṣayaḥ||5||

pranaṣṭāgnibalāhārāḥ sarvacēṣṭāsvanīśvarāḥ| dīnāḥ pratikriyābhāvājjahatō'sūnanāthavat||6||

tēṣāmāyatanaṁ saṅkhyāṁ prāgrūpākr̥tibhēṣajam| yathāvacchrōtumicchāmi guruṇā samyagīritam||7||

bhagavannudarairduHkhairdRushyante hyarditA narAH| shuShkavaktrAH kRushairgAtrairAdhmAtodarakukShayaH||5||

pranaShTAgnibalAhArAH sarvaceShTAsvanIshvarAH| dInAH pratikriyAbhAvAjjahato~asUnanAthavat||6||

teShAmAyatanaM sa~gkhyAM prAgrUpAkRutibheShajam| yathAvacchrotumicchAmi guruNA samyagIritam||7||

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]

सर्वभूतहितायर्षिः शिष्येणैवं प्रचोदितः| सर्वभूतहितं वाक्यं व्याहर्तुमुपचक्रमे||८||

sarvabhūtahitāyarṣiḥ śiṣyēṇaivaṁ pracōditaḥ| sarvabhūtahitaṁ vākyaṁ vyāhartumupacakramē||8||

sarvabhUtahitAyarShiH shiShyeNaivaM pracoditaH| sarvabhUtahitaM vAkyaM vyAhartumupacakrame||8||

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

Pathogenesis of udara roga

अग्निदोषान्मनुष्याणां रोगसङ्घाः पृथग्विधाः| मलवृद्ध्या प्रवर्तन्ते विशेषेणोदराणि तु||९||

मन्देऽग्नौ मलिनैर्भुक्तैरपाकाद्दोषसञ्चयः| प्राणाग्न्यपानान् सन्दूष्य मार्गान्रुद्ध्वाऽधरोत्तरान्||१०||

त्वङ्मांसान्तरमागम्य कुक्षिमाध्मापयन् भृशम्| जनयत्युदरं तस्य हेतुं शृणु सलक्षणम् ||११||

agnidōṣānmanuṣyāṇāṁ rōgasaṅghāḥ pr̥thagvidhāḥ| malavr̥ddhyā pravartantē viśēṣēṇōdarāṇi tu||9||

mandē'gnau malinairbhuktairapākāddōṣasañcayaḥ| prāṇāgnyapānān sandūṣya mārgānruddhvā'dharōttarān||10||

tvaṅmāṁsāntaramāgamya kukṣimādhmāpayan bhr̥śam| janayatyUdara ṁ tasya hētuṁ śr̥ṇu salakṣaṇam||11||

agnidoShAnmanuShyANAM rogasa~gghAH pRuthagvidhAH| malavRuddhyA pravartante visheSheNodarANi tu||9||

mande~agnau malinairbhuktairapAkAddoShasa~jcayaH| prANAgnyapAnAn sandUShya mArgAnruddhvA~adharottarAn||10||

tva~gmAMsAntaramAgamya kukShimAdhmApayan bhRusham| janayatyudaraM tasya hetuM shRuNu salakShaNam||11||

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]

Etiology of udara roga

अत्युष्णलवणक्षारविदाह्यम्लगराशनात्| मिथ्यासंसर्जनाद्रूक्षविरुद्धाशुचिभोजनात्||१२||

प्लीहार्शोग्रहणीदोषकर्शनात् कर्मविभ्रमात्| क्लिष्टानामप्रतीकाराद्रौक्ष्याद्वेगविधारणात्||१३||

स्रोतसां दूषणादामात् सङ्क्षोभादतिपूरणात्| अर्शोबालशकृद्रोधादन्त्रस्फुटनभेदनात्||१४||

अतिसञ्चितदोषाणां पापं कर्म च कुर्वताम्| उदराण्युपजायन्ते मन्दाग्नीनां विशेषतः||१५||

atyuṣṇalavaṇakṣāravidāhyamlagarāśanāt| mithyāsaṁsarjanādrūkṣaviruddhāśucibhōjanāt||12||

plīhārśōgrahaṇīdōṣakarśanāt karmavibhramāt| kliṣṭānāmapratīkārādraukṣyādvēgavidhāraṇāt||13||

srōtasāṁ dūṣaṇādāmāt saṅkṣōbhādatipūraṇāt| arśōbālaśakr̥drōdhādantrasphuṭanabhēdanāt||14||

atisañcitadōṣāṇāṁ pāpaṁ karma ca kurvatām| udarāṇyupajāyantē mandāgnīnāṁ viśēṣataḥ||15||

atyuShNalavaNakShAravidAhyamlagarAshanAt| mithyAsaMsarjanAdrUkShaviruddhAshucibhojanAt||12||

plIhArshograhaNIdoShakarshanAt karmavibhramAt| kliShTAnAmapratIkArAdraukShyAdvegavidhAraNAt||13||

srotasAM dUShaNAdAmAt sa~gkShobhAdatipUraNAt| arshobAlashakRudrodhAdantrasphuTanabhedanAt||14||

atisa~jcitadoShANAM pApaM karma ca kurvatAm| udarANyupajAyante mandAgnInAM visheShataH||15||

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]

Premonitary symptoms

क्षुन्नाशः स्वाद्वतिस्निग्धगुर्वन्नं पच्यते चिरात्| भुक्तं विदह्यते सर्वं जीर्णाजीर्णं न वेत्ति च||१६||

सहते नातिसौहित्यमीषच्छोफश्च पादयोः| शश्वद्बलक्षयोऽल्पेऽपि व्यायामे श्वासमृच्छति||१७||

वृद्धिः पुरीषनिचयो रूक्षोदावर्तहेतुका| बस्तिसन्धौ रुगाध्मानं वर्धते पाट्यतेऽपि च||१८||

आतन्यते च जठरमपि लघ्वल्पभोजनात्| राजीजन्म वलीनाश इति लिङ्गं भविष्यताम्||१९||

kṣunnāśaḥ svādvatisnigdhagurvannaṁ pacyatē cirāt| bhuktaṁ vidahyatē sarvaṁ jīrṇājīrṇaṁ na vētti ca||16||

sahatē nātisauhityamīṣacchōphaśca pādayōḥ| śaśvadbalakṣayō'lpē'pi vyāyāmē śvāsamr̥cchati||17||

vr̥ddhiḥ purīṣanicayō rūkṣōdāvartahētukā| bastisandhau rugādhmānaṁ vardhatē pāṭyatē'pi ca||18||

ātanyatē ca jaṭharamapi laghvalpabhōjanāt| rājījanma valīnāśa iti liṅgaṁ bhaviṣyatām||19||

kShunnAshaH svAdvatisnigdhagurvannaM pacyate cirAt| bhuktaM vidahyate sarvaM jIrNAjIrNaM na vetti ca||16||

sahate nAtisauhityamIShacchophashca pAdayoH| shashvadbalakShayo~alpe~api vyAyAme shvAsamRucchati||17||

vRuddhiH purIShanicayo [1] rUkShodAvartahetukA| bastisandhau rugAdhmAnaM vardhate pATyate~api ca||18||

Atanyate ca jaTharamapi [2] laghvalpabhojanAt| rAjIjanma valInAsha iti li~ggaM bhaviShyatAm||19||

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]

General pathogenesis of udara roga

रुद्ध्वा स्वेदाम्बुवाहीनि दोषाः स्रोतांसि सञ्चिताः| प्राणाग्न्यपानान् सन्दूष्य जनयन्त्युदरं नृणाम्||२०||

ruddhvā svēdāmbuvāhīni dōṣāḥ srōtāṁsi sañcitāḥ| prāṇāgnyapānān sandūṣya janayantyUdaraṁ nr̥ṇām||20||

ruddhvA svedAmbuvAhIni doShAH srotAMsi sa~jcitAH| prANAgnyapAnAn sandUShya janayantyudaraM nRuNAm||20||

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]

General Symptoms of udara roga

कुक्षेराध्मानमाटोपः शोफः पादकरस्य च| मन्दोऽग्निः श्लक्ष्णगण्डत्वं कार्श्यं चोदरलक्षणम्||२१||

kukṣērādhmānamāṭōpaḥ śōphaḥ pādakarasya ca| mandō'gniḥ ślakṣṇagaṇḍatvaṁ kārśyaṁ cōdaralakṣaṇam||21||

kukSherAdhmAnamATopaH shophaH pAdakarasya ca| mando~agniH shlakShNagaNDatvaM kArshyaM codaralakShaNam||21||

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]

Classification of udara roga

पृथग्दोषैः समस्तैश्च प्लीहबद्धक्षतोदकैः| सम्भवन्त्युदराण्यष्टौ तेषां लिङ्गं पृथक् शृणु||२२||

pr̥thagdōṣaiḥ samastaiśca plīhabaddhakṣatōdakaiḥ| sambhavantyudarāṇyaṣṭau tēṣāṁ liṅgaṁ pr̥thak śr̥ṇu||22||

pRuthagdoShaiH samastaishca plIhabaddhakShatodakaiH| sambhavantyudarANyaShTau teShAM li~ggaM pRuthak shRuNu||22||

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].

Etiology of vatodara

रूक्षाल्पभोजनायासवेगोदावर्तकर्शनैः|

rūkṣālpabhōjanāyāsavēgōdāvartakarśanaiḥ|

rUkShAlpabhojanAyAsavegodAvartakarshanaiH|

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]

Pathogenesis of vatodara

वायुः प्रकुपितः कुक्षिहृद्बस्तिगुदमार्गगः||२३||

हत्वाऽग्निं कफमुद्धूय तेन रूद्धगतिस्ततः| आचिनोत्युदरं जन्तोस्त्वङ्मांसान्तरमाश्रितः||२४||

vāyuḥ prakupitaḥ kukṣihr̥dbastigudamārgagaḥ||23||

hatvā'gniṁ kaphamuddhūya tēna rūddhagatistataḥ| ācinōtyUdara ṁ jantōstvaṅmāṁsāntaramāśritaḥ||24||

vAyuH prakupitaH kukShihRudbastigudamArgagaH||23||

hatvA~agniM kaphamuddhUya tena rUddhagatistataH| AcinotyudaraM jantostva~gmAMsAntaramAshritaH||24||

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]

Symptoms of vatodara

तस्य रूपाणि- कुक्षिपाणिपादवृषणश्वयथुः, उदरविपाटनम्, अनियतौ च वृद्धिह्रासौ,कुक्षिपार्श्वशूलोदावर्ताङ्गमर्दपर्वभेदशुष्ककासकार्श्यदौर्बल्यारोचकाविपाकाः, अधोगुरुत्वं, वातवर्चोमूत्रसङ्गः, श्यावारुणत्वं चनखनयनवदनत्वङ्मूत्रवर्चसाम्, अपि चोदरं तन्वसितराजीसिरासन्ततम्, आहतमाध्मातदृतिशब्दवद्भवति,वायुश्चोर्ध्वमधस्तिर्यक् च सशूलशब्दश्चरति, एतद्वातोदरमिति विद्यात्||२५||

tasya rūpāṇi-kukṣipāṇipādavr̥ṣaṇaśvayathuḥ, Udara vipāṭanam, aniyatau ca vr̥ddhihrāsau,kukṣipārśvaśūlōdāvartāṅgamardaparvabhēdaśuṣkakāsakārśyadaurbalyārōcakāvipākāḥ, adhōgurutvaṁ,vātavarcōmūtrasaṅgaḥ, śyāvāruṇatvaṁ ca nakhanayanavadanatvaṅmūtravarcasām, api cōdaraṁtanvasitarājīsirāsantatam, āhatamādhmātadr̥tiśabdavadbhavati, vāyuścōrdhvamadhastiryak casaśūlaśabdaścarati, ētadvātōdaramiti vidyāt||25||

tasya rUpANi- kukShipANipAdavRuShaNashvayathuH, udaravipATanam, aniyatau ca vRuddhihrAsau,kukShipArshvashUlodAvartA~ggamardaparvabhedashuShkakAsakArshyadaurbalyArocakAvipAkAH,adhogurutvaM, vAtavarcomUtrasa~ggaH, shyAvAruNatvaM ca nakhanayanavadanatva~gmUtravarcasAm,api codaraM tanvasitarAjIsirAsantatam, AhatamAdhmAtadRutishabdavadbhavati,vAyushcordhvamadhastiryak ca sashUlashabdashcarati, etadvAtodaramiti vidyAt||25||

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]

Etiology of pittodara

कट्वम्ललवणात्युष्णतीक्ष्णाग्न्यातपसेवनैः| विदाह्यध्यशनाजीर्णैश्चाशु पित्तं समाचितम्||२६||

kaṭvamlalavaṇātyuṣṇatīkṣṇāgnyātapasēvanaiḥ| vidāhyadhyaśanājīrṇaiścāśu pittaṁ samācitam||26||

kaTvamlalavaNAtyuShNatIkShNAgnyAtapasevanaiH| vidAhyadhyashanAjIrNaishcAshu pittaM samAcitam||26||

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]

Pathogenssis of pittodara

प्राप्यानिलकफौ रुद्ध्वा मार्गमुन्मार्गमास्थितम्| निहन्त्यामाशये वह्निं जनयत्युदरं ततः||२७||

prāpyānilakaphau ruddhvā mārgamunmārgamāsthitam| nihantyāmāśayē vahniṁ janayatyUdaraṁ tataḥ||27||

prApyAnilakaphau ruddhvA mArgamunmArgamAsthitam| nihantyAmAshaye vahniM janayatyudaraM tataH||27||

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]

Symptoms of pittodara

तस्य रूपाणि- दाहज्वरतृष्णामूर्च्छातीसारभ्रमाः, कटुकास्यत्वं, हरितहारिद्रत्वं [१] च नखनयनवदनत्वङ्मूत्रवर्चसाम्, अपि चोदरंनीलपीतहारिद्रहरितताम्रराजीसिरावनद्धं, दह्यते, दूयते, धूप्यते, ऊष्मायते, स्विद्यते, क्लिद्य, मृदुस्पर्शं क्षिप्रपाकं चभवति; एतत् पित्तोदरमिति विद्यात्||२८||

tasya rūpāṇi- dāhajvaratr̥ṣṇāmūrcchātīsārabhramāḥ, kaṭukāsyatvaṁ, haritahāridratvaṁ [1] canakhanayanavadanatvaṅmūtravarcasām, api cōdaraṁ nīlapītahāridraharitatāmrarājīsirāvanaddhaṁ,dahyatē, dūyatē, dhūpyatē, ūṣmāyatē, svidyatē, klidyatē, mr̥dusparśaṁ kṣiprapākaṁ ca bhavati; ētatpittōdaramiti vidyāt||28||

tasya rUpANi- dAhajvaratRuShNAmUrcchAtIsArabhramAH, kaTukAsyatvaM, haritahAridratvaM [1] canakhanayanavadanatva~gmUtravarcasAm, api codaraM nIlapItahAridraharitatAmrarAjIsirAvanaddhaM,dahyate, dUyate, dhUpyate, UShmAyate, svidyate, klidyate, mRudusparshaM kShiprapAkaM ca bhavati;etat pittodaramiti vidyAt||28||

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].

Etiology of kaphodara

अव्यायामदिवास्वप्नस्वाद्वतिस्निग्धपिच्छिलैः| दधिदुग्धौदकानूपमांसैश्चाप्यतिसेवितैः||२९||

avyāyāmadivāsvapnasvādvatisnigdhapicchilaiḥ| dadhidugdhaudakānūpamāṁsaiścāpyatisēvitaiḥ||29||

avyAyAmadivAsvapnasvAdvatisnigdhapicchilaiH| dadhidugdhaudakAnUpamAMsaishcApyatisevitaiH||29||

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].

Pathogenesis of kaphodara

क्रुद्धेन श्लेष्मणा स्रोतःस्वावृतेष्वावृतोऽनिलः| तमेव पीडयन् कुर्यादुदरं बहिरन्त्रगः [१] ||३०||

kruddhēna ślēṣmaṇā srōtaḥsvāvr̥tēṣvāvr̥tō'nilaḥ| tamēva pīḍayan kuryādUdaraṁ bahirantragaḥ [1] ||30||

kruddhena shleShmaNA srotaHsvAvRuteShvAvRuto~anilaH| tameva pIDayan kuryAdudaraM bahirantragaH [1] ||30||

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

Symptoms of kaphodara

तस्य रूपाणि- गौरवारोचकाविपाकाङ्गमर्दाः, सुप्तिः, पाणिपादमुष्कोरुशोफः, उत्क्लेशनिद्राकासश्वासाः, शुक्लत्वं चनखनयनवदनत्वङ्मूत्रवर्चसाम्; अपि चोदरं शुक्लराजीसिरासन्ततं, गुरु, स्तिमितं, स्थिरं, कठिनं च भवति;एतच्छ्लेष्मोदरमिति विद्यात्||३१||

tasya rūpāṇi-gauravārōcakāvipākāṅgamardāḥ, suptiḥ, pāṇipādamuṣkōruśōphaḥ, utklēśanidrākāsaśvāsāḥ,śuklatvaṁ ca nakhanayanavadanatvaṅmūtravarcasām; api cōdaraṁ śuklarājīsirāsantataṁ, guru, stimitaṁ,sthiraṁ, kaṭhinaṁ ca bhavati; ētacchlēṣmōdaramiti vidyāt||31||

tasya rUpANi- gauravArocakAvipAkA~ggamardAH, suptiH, pANipAdamuShkorushophaH,utkleshanidrAkAsashvAsAH, shuklatvaM ca nakhanayanavadanatva~gmUtravarcasAm; api codaraMshuklarAjIsirAsantataM, guru, stimitaM, sthiraM, kaThinaM ca bhavati; etacchleShmodaramiti vidyAt||31||

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].

Etiology of sannipatodara

दुर्बलाग्नेरपथ्यामविरोधिगुरुभोजनैः| स्त्रीदत्तैश्च रजोरोमविण्मूत्रास्थिनखादिभिः||३२||

विषैश्च मन्दैर्वाताद्याः कुपिताः सञ्चयं त्रयः|

durbalāgnērapathyāmavirōdhigurubhōjanaiḥ| strīdattaiśca rajōrōmaviṇmūtrāsthinakhādibhiḥ||32||

viṣaiśca mandairvātādyāḥ kupitāḥ sañcayaṁ trayaḥ|

durbalAgnerapathyAmavirodhigurubhojanaiH| strIdattaishca rajoromaviNmUtrAsthinakhAdibhiH||32||

viShaishca mandairvAtAdyAH kupitAH sa~jcayaM trayaH|

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].

Pathogenesis of sannipatodara

शनैः कोष्ठे प्रकुर्वन्तो जनयन्त्युदरं नृणाम्||३३||

śanaiḥ kōṣṭhē prakurvantō janayantyUdaraṁ nr̥ṇām||33||

shanaiH koShThe prakurvanto janayantyudaraM nRuNAm||33||

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

Symptoms of sannipatodara

तस्य रूपाणि-सर्वेषामेव दोषाणां समस्तानि लिङ्गान्युपलभ्यन्ते, वर्णाश्च सर्वे नखादिषु, उदरमपि नानावर्णराजीसिरासन्ततंभवति; एतत् सन्निपातोदरमिति विद्यात्||३४||

tasya rūpāṇi- sarvēṣāmēva dōṣāṇāṁ samastāni liṅgānyupalabhyantē, varṇāśca sarvē nakhādiṣu,Udara mapi nānāvarṇarājīsirāsantataṁ bhavati; ētat sannipātōdaramiti vidyāt||34||

tasya rUpANi- sarveShAmeva doShANAM samastAni li~ggAnyupalabhyante, varNAshca sarve nakhAdiShu,udaramapi nAnAvarNarAjIsirAsantataM bhavati; etat sannipAtodaramiti vidyAt||34||

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].

Etiology of plihodara

अशितस्यातिसङ्क्षोभाद्यानयानातिचेष्टितैः| अतिव्यवायभाराध्ववमनव्याधिकर्शनैः||३५||

aśitasyātisaṅkṣōbhādyānayānāticēṣṭitaiḥ| ativyavāyabhārādhvavamanavyādhikarśanaiḥ||35||

ashitasyAtisa~gkShobhAdyAnayAnAticeShTitaiH| ativyavAyabhArAdhvavamanavyAdhikarshanaiH||35||

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].

Samprapti of plihodara

वामपार्श्वाश्रितः प्लीहा च्युतः स्थानात् प्रवर्धते| शोणितं वा रसादिभ्यो विवृद्धं तं विवर्धयेत्||३६||

vāmapārśvāśritaḥ plīhā cyutaḥ sthānāt pravardhatē| śōṇitaṁ vā rasādibhyō vivr̥ddhaṁ taṁ vivardhayēt||36||

vAmapArshvAshritaH plIhA cyutaH sthAnAt pravardhate| shoNitaM vA rasAdibhyo vivRuddhaM taM vivardhayet||36||

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

Symptoms of plihodara and yakritodara

तस्य प्लीहा कठिनोऽष्ठीलेवादौ वर्धमानः कच्छपसंस्थान उपलभ्यते; स चोपेक्षितः क्रमेण कुक्षिं जठरमग्न्यधिष्ठानं चपरिक्षिपन्नुदरमभिनिर्वर्तयति||३७||

तस्य रूपाणि-

दौर्बल्यारोचकाविपाकवर्चोमूत्रग्रहतमःप्रवेशपिपासाङ्गमर्दच्छर्दिमूर्च्छाङ्गसाद-कासश्वासमृदुज्वरानाहाग्निनाशकार्श्यास्यवैरस्यपर्वभेदकोष्ठवातशूलानि, अपि चोदरमरुणवर्णं विवर्णं वानीलहरितहारिद्रराजिमद्भवति; एवमेव यकृदपि दक्षिणपार्श्वस्थं कुर्यात्, तुल्यहेतुलिङ्गौषधत्वात्तस्य प्लीहजठर एवावरोधइति; एतत् प्लीहोदरमिति विद्यात्||३८||

tasya plīhā kaṭhinō'ṣṭhīlēvādau vardhamānaḥ kacchapasaṁsthāna upalabhyatē; sa cōpēkṣitaḥ kramēṇakukṣiṁ jaṭharamagnyadhiṣṭhānaṁ ca parikṣipannUdara mabhinirvartayati||37||

tasya rūpāṇi-

daurbalyārōcakāvipākavarcōmūtragrahatamaḥpravēśapipāsāṅgamardacchardimūrcchāṅgasādakāsaśvāsamr̥dujvarānāhāgnināśakārśyāsyavairasyaparvabhēdakōṣṭhavātaśūlāni, apicōdaramaruṇavarṇaṁ vivarṇaṁ vā nīlaharitahāridrarājimadbhavati; ēvamēva yakr̥dapidakṣiṇapārśvasthaṁ kuryāt, tulyahētuliṅgauṣadhatvāttasya plīhajaṭhara ēvāvarōdha it;ētat plīhōdaramitividyāt||38||

tasya plIhA kaThino~aShThIlevAdau [1] vardhamAnaH kacchapasaMsthAna upalabhyate; sa copekShitaHkrameNa kukShiM jaTharamagnyadhiShThAnaM ca parikShipannudaramabhinirvartayati||37||

tasya rUpANi-

daurbalyArocakAvipAkavarcomUtragrahatamaHpraveshapipAsA~ggamardacchardimUrcchA~ggasAda-kAsashvAsamRudujvarAnAhAgninAshakArshyAsyavairasyaparvabhedakoShThavAtashUlAni, apicodaramaruNavarNaM vivarNaM vA nIlaharitahAridrarAjimadbhavati; evameva yakRudapidakShiNapArshvasthaM kuryAt, tulyahetuli~ggauShadhatvAttasya plIhajaThara evAvarodha iti; etatplIhodaramiti vidyAt||38||

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

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

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

Etiology of baddhodara

पक्ष्मबालैः सहान्नेन भुक्तैर्बद्धायने गुदे| उदावर्तैस्तथाऽर्शोभिरन्त्रसम्मूर्च्छनेन वा||३९||

pakṣmabālaiḥ sahānnēna bhuktairbaddhāyanē gudē| udāvartaistathā'rśōbhirantrasammūrcchanēna vā||39||

pakShmabAlaiH sahAnnena bhuktairbaddhAyane gude| udAvartaistathA~arshobhirantrasammUrcchanena vA||39||

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

Pathogenesis of baddhagudodara

अपानो मार्गसंरोधाद्धत्वाऽग्निं कुपितोऽनिलः| वर्चःपित्तकफान् रुद्ध्वा जनयत्युदरं ततः||४०||

apānō mārgasaṁrōdhāddhatvā'gniṁ kupitō'nilaḥ| varcaḥpittakaphān ruddhvā janayatyUdara ṁ tataḥ||40||

apAno mArgasaMrodhAddhatvA~agniM kupito~anilaH| varcaHpittakaphAn ruddhvA janayatyudaraM tataH||40||

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

Symptoms of baddhagudodara

तस्य रूपाणि-

तृष्णादाहज्वरमुखतालुशोषोरुसादकासश्वासदौर्बल्यारोचकाविपाक-वर्चोमूत्रसङ्गाध्मानच्छर्दिक्षवथुशिरोहृन्नाभिगुदशूलानि, अपि चोदरं मूढवातं स्थिरमरुणं नीलराजि सिरावनद्धराजिकं वा प्रायोनाभ्युपरि गोपुच्छवदभिनिर्वर्तत इति; एतद्बद्धगुदोदरमिति विद्यात्||४१||

tasya rūpāṇi-

tr̥ṣṇādāhajvaramukhatāluśōṣōrusādakāsaśvāsadaurbalyārōcakāvipāka-varcōmūtrasaṅgādhmānacchardikṣavathuśirōhr̥nnābhigudaśūlāni, api cōdaraṁ mūḍhavātaṁsthiramaruṇaṁ nīlarāji sirāvanaddharājikaṁ vā prāyō nābhyupari gōpucchavadabhinirvartata iti;ētadbaddhagudōdaramiti vidyāt||41||

tasya rUpANi-

tRuShNAdAhajvaramukhatAlushoShorusAdakAsashvAsadaurbalyArocakAvipAka-varcomUtrasa~ggAdhmAnacchardikShavathushirohRunnAbhigudashUlAni, api codaraM mUDhavAtaMsthiramaruNaM nIlarAji sirAvanaddharAjikaM vA prAyo nAbhyupari gopucchavadabhinirvartata iti;etadbaddhagudodaramiti vidyAt||41||

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].

Causes of chhidrodara

शर्करातृणकाष्ठास्थिकण्टकैरन्नसंयुतैः| भिद्येतान्त्रं यदा भुक्तैर्जृम्भयाऽत्यशनेन वा||४२||

śarkarātr̥ṇakāṣṭhāsthikaṇṭakairannasaṁyutaiḥ| bhidyētāntraṁ yadā bhuktairjr̥mbhayā'tyaśanēna vā||42||

sharkarAtRuNakAShThAsthikaNTakairannasaMyutaiH| bhidyetAntraM yadA bhuktairjRumbhayA~atyashanena vA||42||

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].

Pathogenesis of chhidrodara

पाकं गच्छेद्रसस्तेभ्यश्छिद्रेभ्यः प्रस्रवद्बहिः| पूरयन् गुदमन्त्रं च जनयत्युदरं ततः||४३||

pākaṁ gacchēdrasastēbhyaśchidrēbhyaḥ prasravadbahiḥ| pūrayan gudamantraṁ ca janayatyUdara ṁ tataḥ||43||

pAkaM gacchedrasastebhyashchidrebhyaH prasravadbahiH| pUrayan gudamantraM ca janayatyudaraM tataH||43||

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].

Symptoms of chhidrodara

तस्य रूपाणि-तदधो नाभ्याः प्रायोऽभिवर्धमानमुदकोदरं भवति, यथाबलं च दोषाणां रूपाणि दर्शयति, अपि चातुरः सलोहितनीलपीतपिच्छिलकुणपगन्ध्यामवर्च उपवेशते, हिक्काश्वासकासतृष्णाप्रमेहारोचकाविपाकदौर्बल्यपरीतश्च भवति;एतच्छिद्रोदरमिति विद्यात्||४४||

tasya rūpāṇi- tadadhō nābhyāḥ prāyō'bhivardhamānamudakōdaraṁ bhavati, yathābalaṁ ca dōṣāṇāṁrūpāṇi darśayati, api cāturaḥ salōhitanīlapītapicchilakuṇapagandhyāmavarca upavēśatē,hikkāśvāsakāsatr̥ṣṇāpramēhārōcakāvipākadaurbalyaparītaśca bhavati; ētacchidrōdaramiti vidyāt||44||

tasya rUpANi- tadadho nAbhyAH prAyo~abhivardhamAnamudakodaraM bhavati, yathAbalaM cadoShANAM rUpANi darshayati, api cAturaH salohitanIlapItapicchilakuNapagandhyAmavarca upaveshate,hikkAshvAsakAsatRuShNApramehArocakAvipAkadaurbalyaparItashca bhavati; etacchidrodaramitividyAt||44||

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

Etiopathogenesis of jalodara

स्नेहपीतस्य मन्दाग्नेः क्षीणस्यातिकृशस्य वा| अत्यम्बुपानान्नष्टेऽग्नौ मारुतः क्लोम्नि संस्थितः||४५||

स्रोतःसु रुद्धमार्गेषु कफश्चोदकमूर्च्छितः| वर्धयेतां तदेवाम्बु स्वस्थानादुदराय तौ||४६||

snēhapītasya mandāgnēḥ kṣīṇasyātikr̥śasya vā| atyambupānānnaṣṭē'gnau mārutaḥ klōmni saṁsthitaḥ||45||

srōtaḥsu ruddhamārgēṣu kaphaścōdakamūrcchitaḥ| vardhayētāṁ tadēvāmbu svasthānādudarāya tau||46||

snehapItasya mandAgneH kShINasyAtikRushasya vA| atyambupAnAnnaShTe~agnau mArutaH klomni saMsthitaH||45||

srotaHsu ruddhamArgeShu kaphashcodakamUrcchitaH| vardhayetAM tadevAmbu svasthAnAdudarAya tau||46||

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

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].

Symptoms of udakodara

तस्य रूपाणि-

अनन्नकाङ्क्षापिपासागुदस्रावशूलश्वासकासदौर्बल्यानि, अपि चोदरंनानावर्णराजिसिरासन्ततमुदकपूर्णदृतिक्षोभसंस्पर्शं भवति, एतदुदकोदरमिति विद्यात्||४७||

tasya rūpāṇi-

anannakāṅkṣāpipāsāgudasrāvaśūlaśvāsakāsadaurbalyāni, api cōdaraṁnānāvarṇarājisirāsantatamudakapūrṇadr̥tikṣōbhasaṁsparśaṁ bhavati, ētadudakōdaramiti vidyāt||47||

tasya rUpANi-

anannakA~gkShApipAsAgudasrAvashUlashvAsakAsadaurbalyAni, api codaraMnAnAvarNarAjisirAsantatamudakapUrNadRutikShobhasaMsparshaM bhavati, etadudakodaramitividyAt||47||

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].

Consequences of not treating jalodara at early stage

तत्र अचिरोत्पन्नमनुपद्रवमनुदकमप्राप्तमुदरं त्वरमाणश्चिकित्सेत्; उपेक्षितानां ह्येषां दोषाः स्वस्थानादपवृत्तापरिपाकाद्द्रवीभूताः सन्धीन् स्रोतांसि चोपक्लेदयन्ति, स्वेदश्च बाह्येषु स्रोतःसुप्रतिहतगतिस्तिर्यगवतिष्ठमानस्तदेवोदकमाप्याययति; तत्र पिच्छोत्पत्तौ मण्डलमुदरं गुरु स्तिमितमाकोठितमशब्दंमृदुस्पर्शमपगतराजीकमाक्रान्तं नाभ्यामेवोपसर्पति| ततोऽनन्तरमुदकप्रादुर्भावः|

तस्य रूपाणि-

कुक्षेरतिमात्रवृद्धिः, सिरान्तर्धानगमनम्, उदकपूर्णदृतिसङ्क्षोभसंस्पर्शत्वं च||४८||

तदाऽऽतुरमुपद्रवाः स्पृशन्तिछर्द्यतीसारतमकतृष्णाश्वासकासहिक्कादौर्बल्यपार्श्वशूलारुचिस्वरभेदमूत्रसङ्गादयः;तथाविधमचिकित्स्यं विद्यादिति||४९||

tatra acirōtpannamanupadravamanudakamaprāptamUdara ṁ tvaramāṇaścikitsēt; upēkṣitānāṁ hyēṣāṁdōṣāḥ svasthānādapavr̥ttā paripākāddravībhūtāḥ sandhīn srōtāṁsi cōpaklēdayanti, svēdaśca bāhyēṣusrōtaḥsu pratihatagatistiryagavatiṣṭhamānastadēvōdakamāpyāyayati; tatra picchōtpattaumaṇḍalamUdara ṁ guru stimitamākōṭhitamaśabdaṁ mr̥dusparśamapagatarājīkamākrāntaṁnābhyāmēvōpasarpati| tatō'nantaramudakaprādurbhāvaḥ|

tasya rūpāṇi

kukṣēratimātravr̥ddhiḥ, sirāntardhānagamanam, udakapūrṇadr̥tisaṅkṣōbhasaṁsparśatvaṁca||48||

tadāturamupadravāḥ spr̥śantichardyatīsāratamakatr̥ṣṇāśvāsakāsahikkādaurbalyapārśvaśūlārucisvarabhēdamūtrasaṅgādayaḥ;tathāvidhamacikitsyaṁ vidyāditi||49||

tatra acirotpannamanupadravamanudakamaprAptamudaraM tvaramANashcikitset; upekShitAnAM hyeShAMdoShAH svasthAnAdapavRuttA paripAkAddravIbhUtAH sandhIn srotAMsi copakledayanti, svedashcabAhyeShu srotaHsu pratihatagatistiryagavatiShThamAnastadevodakamApyAyayati; tatra picchotpattaumaNDalamudaraM guru stimitamAkoThitamashabdaM mRudusparshamapagatarAjIkamAkrAntaMnAbhyAmevopasarpati| tato~anantaramudakaprAdurbhAvaH|

tasya rUpANi-

kukSheratimAtravRuddhiH, sirAntardhAnagamanam,udakapUrNadRutisa~gkShobhasaMsparshatvaM ca||48||

tadA~a~aturamupadravAH spRushanti-

chardyatIsAratamakatRuShNAshvAsakAsahikkAdaurbalyapArshvashUlArucisvarabhedamUtrasa~ggAdayaH;tathAvidhamacikitsyaM vidyAditi||49||

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

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

This is followed by appearance of fluid in the abdomen. The symptoms include huge distension of abdomen, disappearance of the distended veins, distended abdomen producing dull note on percussion and cystic on palpation identical to the one seen in leather bag filled with water.

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].

Prognosis of udara roga

भवन्ति चात्र-

वातात्पित्तात्कफात् प्लीह्नः सन्निपातात्तथोदकात्| परं परं कृच्छ्रतरमुदरं भिषगादिशेत्||५०||

पक्षाद्बद्धगुदं तूर्ध्वं सर्वं जातोदकं तथा| प्रायो भवत्यभावाय च्छिद्रान्त्रं चोदरं नृणाम्||५१||

शूनाक्षं कुटिलोपस्थमुपक्लिन्नतनुत्वचम्| बलशोणितमांसाग्निपरिक्षीणं च वर्जयेत्||५२||

श्वयथुः सर्वमर्मोत्थः श्वासो हिक्काऽरुचिः सतृट्| मूर्च्छा च्छर्दिरतीसारो निहन्त्युदरिणं नरम्||५३||

जन्मनैवोदरं सर्वं प्रायः कृच्छ्रतमं मतम्| बलिनस्तदजाताम्बु यत्नसाध्यं नवोत्थितम्||५४||

bhavanti cātra-

vātātpittātkaphāt plīhnaḥ sannipātāttathōdakāt| paraṁ paraṁ kr̥cchrataramUdara ṁ bhiṣagādiśēt||50||

pakṣādbaddhagudaṁ tūrdhvaṁ sarvaṁ jātōdakaṁ tathā| prāyō bhavatyabhāvāya cchidrāntraṁ cōdaraṁ nr̥ṇām||51||

śūnākṣaṁ kuṭilōpasthamupaklinnatanutvacam| balaśōṇitamāṁsāgniparikṣīṇaṁ ca varjayēt||52||

śvayathuḥ sarvamarmōtthaḥ śvāsō hikkā'ruciḥ satr̥ṭ| mūrcchā cchardiratīsārō nihantyudariṇaṁ naram||53||

janmanaivōdaraṁ sarvaṁ prāyaḥ kr̥cchratamaṁ matam| balinastadajātāmbu yatnasādhyaṁ navōtthitam||54||

bhavanti cAtra-

vAtAtpittAtkaphAt plIhnaH sannipAtAttathodakAt| paraM paraM kRucchrataramudaraM bhiShagAdishet||50||

pakShAdbaddhagudaM tUrdhvaM sarvaM jAtodakaM tathA| prAyo bhavatyabhAvAya cchidrAntraM codaraM nRuNAm||51||

shUnAkShaM kuTilopasthamupaklinnatanutvacam| balashoNitamAMsAgniparikShINaM ca varjayet||52||

shvayathuH sarvamarmotthaH shvAso hikkA~aruciH satRuT| mUrcchA cchardiratIsAro nihantyudariNaM naram||53||

janmanaivodaraM sarvaM prAyaH kRucchratamaM matam| balinastadajAtAmbu yatnasAdhyaM navotthitam||54||

Among the list of vatodara, pittodara, kaphodara, plihodara, sannipatodara and jalodara (ascites); the later ones are more and more difficult to cure. After a fortnight the baddhodara (enlargement of abdomen due to gastrointestinal obstruction) and udara that presents with accumulation of fluid are incurable. Mostly chhidrodara (enlargement of abdomen due to intestinal perforation) is fatal. The treatment should be avoided in patients of udara presenting with peri-orbital edema, distorted genitalia, moistening and thinning of the skin, severe reduction in the physical strength, severe depletion in the blood, severe wasting of the body flesh and severe impairment in the agni.

The development of symptoms like edema involving all vital parts, breathlessness, hiccough, tastelessness in the mouth, transient loss of consciousness, vomiting and diarrhea kills the patients of udara roga.

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].

Symptoms of ajatodaka udara roga

अजातशोथमरुणं सशब्दं नातिभारिकम्| सदा गुडगुडायच्च सिराजालगवाक्षितम्||५५||

नाभिं विष्टभ्य पायौ तु वेगं कृत्वा प्रणश्यति| हृन्नाभिवङ्क्षणकटीगुदप्रत्येकशूलिनः||५६||

कर्कशं सृजतो वातं नातिमन्दे च पावके| लोलस्याविरसे चास्ये मूत्रेऽल्पे संहते विषि||५७||

अजातोदकमित्येतैर्लिङ्गैर्विज्ञाय तत्त्वतः| उपाक्रमेद्भिषग्दोषबलकालविशेषवित्||५८||

ajātaśōthamaruṇaṁ saśabdaṁ nātibhārikam| sadā guḍaguḍāyacca sirājālagavākṣitam||55||

nābhiṁ viṣṭabhya pāyau tu vēgaṁ kr̥tvā praṇaśyati| hr̥nnābhivaṅkṣaṇakaṭīgudapratyēkaśūlinaḥ||56||

karkaśaṁ sr̥jatō vātaṁ nātimandē ca pāvakē| lōlasyāvirasē cāsyē mūtrē'lpē saṁhatē viṣi||57||

ajātōdakamityētairliṅgairvijñāya tattVātaḥ| upākramēdbhiṣagdōṣabalakālaviśēṣavit||58||

ajAtashothamaruNaM [1] sashabdaM nAtibhArikam| sadA guDaguDAyacca [2] sirAjAlagavAkShitam||55||

nAbhiM viShTabhya pAyau [3] tu vegaM kRutvA praNashyati| hRunnAbhiva~gkShaNakaTIgudapratyekashUlinaH||56||

karkashaM sRujato vAtaM nAtimande ca pAvake| lolasyAvirase [4] cAsye mUtre~alpe saMhate viShi||57||

ajAtodakamityetairli~ggairvij~jAya tattvataH| upAkramedbhiShagdoShabalakAlavisheShavit||58||

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

Treatment of vatodara

वातोदरं बलमतः पूर्वं स्नेहैरुपाचरेत्| स्निग्धाय स्वेदिताङ्गाय दद्यात् स्नेहविरेचनम्||५९||

हृते दोषे परिम्लानं वेष्टयेद्वाससोदरम्| तथाऽस्यानवकाशत्वाद्वायुर्नाध्मापयेत् पुनः||६०||

vātōdaraṁ balamataḥ pūrvaṁ snēhairupācarēt| snigdhāya svēditāṅgāya dadyāt snēhavirēcanam||59||

hr̥tē dōṣē parimlānaṁ vēṣṭayēdvāsasōdaram| tathā'syānavakāśatvādvāyurnādhmāpayēt punaḥ||60||

vAtodaraM balamataH pUrvaM snehairupAcaret| snigdhAya sveditA~ggAya dadyAt snehavirecanam||59||

hRute doShe parimlAnaM veShTayedvAsasodaram| tathA~asyAnavakAshatvAdvAyurnAdhmApayet punaH||60||

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

Post virechana regimen

दोषातिमात्रोपचयात् स्रोतोमार्गनिरोधनात्| सम्भवत्युदरं तस्मान्नित्यमेव विरेचयेत्||६१||

शुद्धं संसृज्य च क्षीरं बलार्थं पाययेत्तु तम्| प्रागुत्क्लेशान्निवर्त्यं च बले लब्धे क्रमात् पयः||६२||

यूषै रसैर्वा मन्दाम्ललवणैरेधितानलम्|

dōṣātimātrōpacayāt srōtōmārganirōdhanāt| sambhavatyUdaraṁ tasmānnityamēva virēcayēt||61||

śuddhaṁ saṁsr̥jya ca kṣīraṁ balārthaṁ pāyayēttu tam| prāgutklēśānnivartyaṁ ca balē labdhē kramāt payaḥ||62||

yūṣai rasairvā mandāmlalavaṇairēdhitānalam|

doShAtimAtropacayAt srotomArganirodhanAt| sambhavatyudaraM tasmAnnityameva virecayet||61||

shuddhaM saMsRujya ca kShIraM balArthaM pAyayettu tam| prAgutkleshAnnivartyaM ca bale labdhe kramAt payaH||62||

yUShai rasairvA mandAmlalavaNairedhitAnalam|

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

सोदावर्तं पुनः स्निग्धं स्विन्नमास्थापयेन्नरम्||६३||

स्फुरणाक्षेपसन्ध्यस्थिपार्श्वपृष्ठत्रिकार्तिषु|

sōdāvartaṁ punaḥ snigdhaṁ svinnamāsthāpayēnnaram||63||

sphuraṇākṣēpasandhyasthipārśvapr̥ṣṭhatrikārtiṣu|

sodAvartaM punaH snigdhaM svinnamAsthApayennaram||63||

sphuraNAkShepasandhyasthipArshvapRuShThatrikArtiShu|

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

दीप्ताग्निं बद्धविड्वातं रूक्षमप्यनुवासयेत्||६४||

dīptāgniṁ baddhaviḍvātaṁ rūkṣamapyanuvāsayēt||64||

dIptAgniM baddhaviDvAtaM rUkShamapyanuvAsayet||64||

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

तीक्ष्णाधोभागयुक्तोऽस्य निरूहो दाशमूलिकः|

tīkṣṇādhōbhāgayuktō'sya nirūhō dāśamūlikaḥ|

tIkShNAdhobhAgayukto~asya nirUho dAshamUlikaH|

Niruha basti (decoction enema) prepared with dashamula (bilva (Aegle marmelos Corr), agnimantha (Clerodendrum phlomidis Linn. f), shyonaka (Oroxylum indicum Vent), kashmari (Gmelina arborea), patala (Stereospermum suaveolens), shalaparni (Desmodium gangeticum DC), prishniparni (Uraria picta Desv), brihati (Solanum indicum Linn), kantakari (Solanum surattense Burm. f) and gokshura (Tribulus terrestris Linn)) added with potent purgatives should be given to the patients.[65]

वातघ्नाम्लशृतैरण्डतिलतैलानुवासनम्||६५||

vātaghnāmlaśr̥tairaṇḍatilatailānuvāsanam||65||

vAtaghnAmlashRutairaNDatilatailAnuvAsanam||65||

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

अविरेच्यं तु यं विद्याद्दुर्बलं स्थविरं शिशुम्| सुकुमारं प्रकृत्याऽल्पदोषं वाऽथोल्बणानिलम्||६६||

तं भिषक् शमनैः सर्पिर्यूषमांसरसौदनैः| बस्त्यभ्यङ्गानुवासैश्च क्षीरैश्चोपाचरेद्बुधः||६७||

avirēcyaṁ tu yaṁ vidyāddurbalaṁ sthaviraṁ śiśum| sukumāraṁ prakr̥tyā'lpadōṣaṁ vā'thōlbaṇānilam||66||

taṁ bhiṣak śamanaiḥ sarpiryūṣamāṁsarasaudanaiḥ| bastyabhyaṅgānuvāsaiśca kṣīraiścōpācarēdbudhaḥ||67||

avirecyaM tu yaM vidyAddurbalaM sthaviraM shishum| sukumAraM prakRutyA~alpadoShaM vA~atholbaNAnilam||66||

taM bhiShak shamanaiH sarpiryUShamAMsarasaudanaiH| bastyabhya~ggAnuvAsaishca kShIraishcopAcaredbudhaH||67||

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

पित्तोदरे तु बलिनं पूर्वमेव विरेचयेत्|

pittōdarē tu balinaṁ pūrvamēva virēcayēt|

pittodare tu balinaM pUrvameva virecayet|

Physically strong patients suffering from pittodara should be treated by virechana karma (therapeutic purgation) at the outset [68].

दुर्बलं त्वनुवास्यादौ शोधयेत् क्षीरबस्तिना||६८||

सञ्जातबलकायाग्निं पुनः स्निग्धं विरेचयेत्|

durbalaṁ tvanuvāsyādau śōdhayēt kṣīrabastinā||68||

sañjātabalakāyāgniṁ punaḥ snigdhaṁ virēcayēt|

durbalaM tvanuvAsyAdau shodhayet kShIrabastinA||68||

sa~jjAtabalakAyAgniM punaH snigdhaM virecayet|

If the patient of pittodara is physically weak then he should be treated by purification by adapting kshirabasti (decoction enema consisting of milk as predominant ingredient). By this treatment when the patient regains physical strength, and improved digestive power, once again the patient should be treated by virechana (therapeutic purgation) [68-69]

पयसा सत्रिवृत्कल्केनोरुबूकशृतेन वा||६९||

सातलात्रायमाणाभ्यां शृतेनारग्वधेन वा| सकफे वा समूत्रेण सवाते तिक्तसर्पिषा||७०||

payasā satrivr̥tkalkēnōrubūkaśr̥tēna vā||69||

sātalātrāyamāṇābhyāṁ śr̥tēnāragvadhēna vā| sakaphē vā samūtrēṇa savātē tiktasarpiṣā||70||

payasA satrivRutkalkenorubUkashRutena vA||69||

sAtalAtrAyamANAbhyAM shRutenAragvadhena vA| sakaphe vA samUtreNa savAte tiktasarpiShA||70||

Virechana be performed by administering paste of trivrita (Operculina turpethum) with milk; decoction of urubuka (Ricinus communis), decoction of satala (Euphorbia Tirucalli) and trayamana (Gentiana kurrhoa) or decoction of aragvadha (Cassia fistula). Again, if the dominance of kapha is present then in the above preparation cow’s urine may be added. If the dominance of vata is present, then in the above medicines for virechana (therapeutic purgation) medicated ghee prepared with bitter herbs should be given [69-70]

पुनः क्षीरप्रयोगं च बस्तिकर्म विरेचनम्| क्रमेण ध्रुवमातिष्ठन् युक्तः पित्तोदरं जयेत्||७१||

punaḥ kṣīraprayōgaṁ ca bastikarma virēcanam| kramēṇa dhruvamātiṣṭhan yuktaḥ pittōdaraṁ jayēt||71||

punaH kShIraprayogaM ca bastikarma virecanam| krameNa dhruvamAtiShThan yuktaH pittodaraM jayet||71||

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

स्निग्धं स्विन्नं विशुद्धं तु कफोदरिणमातुरम्| संसर्जयेत् कटुक्षारयुक्तैरन्नैः कफापहैः||७२|| snigdhaṁ svinnaṁ viśuddhaṁ tu kaphōdariṇamāturam| saṁsarjayēt kaṭukṣārayuktairannaiḥ kaphāpahaiḥ||72|| snigdhaM svinnaM vishuddhaM tu kaphodariNamAturam| saMsarjayet kaTukShArayuktairannaiH kaphApahaiH||72||

In patients suffering from kaphodara, shodhana (eliminative therapy) is done after preparing with oleation and sudation. In samsarjana krama (gradual diet schedule) pungent, kshāra and anti kapha diet is prescribed [72].

गोमूत्रारिष्टपानैश्च चूर्णायस्कृतिभिस्तथा| सक्षारैस्तैलपानैश्च शमयेत्तु कफोदरम्||७३|| gōmūtrāriṣṭapānaiśca cūrṇāyaskr̥tibhistathā| sakṣāraistailapānaiśca śamayēttu kaphōdaram||73|| gomUtrAriShTapAnaishca cUrNAyaskRutibhistathA| sakShAraistailapAnaishca shamayettu kaphodaram||73|| 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 kshāra (alkali obtained from ash of herbs) [73]. Treatment of sannipātodara: सन्निपातोदरे सर्वा यथोक्ताः कारयेत् क्रियाः| सोपद्रवं तु निर्वृत्तं प्रत्याख्येयं विजानता|७४| sannipātōdarē sarvā yathōktāḥ kārayēt kriyāḥ| sōpadravaṁ tu nirvr̥ttaṁ pratyākhyēyaṁ vijānatā|74| sannipAtodare sarvA yathoktAH kArayet kriyAH| sopadravaM tu nirvRuttaM pratyAkhyeyaM vijAnatA|74| Sannipatodara should be treated by the combination of treatment mentioned for doshaja udara depending upon the requirement [74]. If the patient presents with all the complications of udara then the physician should avoid treating such patients considering it as pratyakhyeya (near to death)-[74]. Predominent symptoms of dosha in plihodara (splenomegaly): उदावर्तरुजानाहैर्दाहमोहतृषाज्वरैः| गौरवारुचिकाठिन्यैश्चानिलादीन् यथाक्रमम्||७५|| लिङ्गैः प्लीह्न्यधिकान् [१] दृष्ट्वा रक्तं चापि स्वलक्षणैः| चिकित्सां सम्प्रकुर्वीत यथादोषं यथाबलम्||७६|| udāvartarujānāhairdāhamōhatr̥ṣājvaraiḥ| gauravārucikāṭhinyaiścānilādīn yathākramam||75|| liṅgaiḥ plīhnyadhikān [1] dr̥ṣṭvā raktaṁ cāpi svalakṣaṇaiḥ| cikitsāṁ samprakurvīta yathādōṣaṁ yathābalam||76|| udAvartarujAnAhairdAhamohatRuShAjvaraiH| gauravArucikAThinyaishcAnilAdIn yathAkramam||75|| li~ggaiH plIhnyadhikAn [1] dRuShTvA raktaM cApi svalakShaNaiH| cikitsAM samprakurvIta yathAdoShaM yathAbalam||76||

Association of symptoms like udāvarta (anti peristalsis), abdominal pain and flatulence indicate dominance of vāta in the plihodara. Symptoms like burning sensation, delirious state, excessive thirst and fever suggests dominance of pitta. 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 chapter 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: स्नेहं स्वेदं विरेकं च निरूहमनुवासनम्| समीक्ष्य कारयेद्बाहौ वामे वा व्यधयेत् सिराम्||७७|| snēhaṁ svēdaṁ virēkaṁ ca nirūhamanuvāsanam| samīkṣya kārayēdbāhau vāmē vā vyadhayēt sirām||77|| snehaM svedaM virekaM ca nirUhamanuvAsanam| samIkShya kArayedbAhau vAme vA vyadhayet sirAm||77||

With the due analysis of the pathogenesis, plihodara should be treated by measures like oral medication of sneha (medicated unctuous substance), sudation, virechana (therapeutic purgation), niruha (decoction enema) and anuvasana basti (oil enema) and raktamokshana (blood-letting) by sectioning the vein located in the left arm [77]. षट्पलं पाययेत् सर्पिः पिप्पलीर्वा प्रयोजयेत्| सगुडामभयां वाऽपि क्षारारिष्टगणांस्तथा||७८|| ṣaṭpalaṁ pāyayēt sarpiḥ pippalīrvā prayōjayēt| saguḍāmabhayāṁ vā'pi kṣārāriṣṭagaṇāṁstathā||78|| ShaTpalaM pAyayet sarpiH pippalIrvA prayojayet| saguDAmabhayAM vA~api kShArAriShTagaNAMstathA||78|| Patient of plihodara is treated by oral medication of shatpala ghrita, pippali (Piper longum), combination of molasses and haritaki (Emblica officinalis), kshāra (alkali obtained from ash of herbs) or arishta (fermented decoctions)[78]. एष क्रियाक्रमः प्रोक्तो योगान् संशमनाञ्छृणु| ēṣa kriyākramaḥ prōktō yōgān saṁśamanāñchr̥ṇu| eSha kriyAkramaH prokto yogAn saMshamanA~jchRuNu|

Thus is the description of principles of treatment of plihodara; now listen to the medications [79]. Pippalyadi churna: पिप्पली नागरं दन्ती चित्रकं द्विगुणाभयम्||७९|| विडङ्गांशयुतं चूर्णमेतदुष्णाम्बुना पिबेत्| pippalī nāgaraṁ dantī citrakaṁ dviguṇābhayam||79|| viḍaṅgāṁśayutaṁ cūrṇamētaduṣṇāmbunā pibēt| pippalI nAgaraM dantI citrakaM dviguNAbhayam||79|| viDa~ggAMshayutaM cUrNametaduShNAmbunA pibet|

Take one part each of the fine sieved powder of pippali (Piper longum), nāgara (Zingiber officinale), danti (Baliospermum montanum), chitraka (Plumbago zeylanica) and vidanga (Embelia ribes), and add it to 2 parts of abhayā (Terminalia chebula). It is to be orally given with warm water [79]. Vidangadi kshāra: विडङ्गं चित्रकं शुण्ठीं सघृतां सैन्धवं वचाम्||८०|| दग्ध्वा कपाले पयसा गुल्मप्लीहापहं पिबेत्| viḍaṅgaṁ citrakaṁ śuṇṭhīṁ saghr̥tāṁ saindhavaṁ vacām||80|| dagdhvā kapālē payasā gulmaplīhāpahaṁ pibēt| viDa~ggaM citrakaM shuNThIM saghRutAM saindhavaM vacAm||80|| dagdhvA kapAle payasA gulmaplIhApahaM pibet|

Take powder of vidanga (Embelia ribes), chitraka (Plumbago zeylanica), shunthi (Zingiber officinale Rosc), saindhava (rock salt) and vachā (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: रोहीतकलतानां तु काण्डकानभयाजले||८१|| मूत्रे वा सुनुयात्तच्च सप्तरात्रस्थितं पिबेत्| कामलागुल्ममेहार्शःप्लीहसर्वोदरक्रिमीन्||८२|| स हन्याज्जाङ्गलरसैर्जीर्णे स्याच्चात्र भोजनम्| rōhītakalatānāṁ tu kāṇḍakānabhayājalē||81|| mūtrē vā sunuyāttacca saptarātrasthitaṁ pibēt| kāmalāgulmamēhārśaḥplīhasarvōdarakrimīn||82|| sa hanyājjāṅgalarasairjīrṇē syāccātra bhōjanam| rohItakalatAnAM tu kANDakAnabhayAjale||81|| mUtre vA sunuyAttacca saptarAtrasthitaM pibet| kAmalAgulmamehArshaHplIhasarvodarakrimIn||82|| sa hanyAjjA~ggalarasairjIrNe syAccAtra bhojanam| The course powder of stem of rohitaka (Tecomella undulate) is soaked in decoction of abhaya (Terminalia chebula) or cow’s urine for 7 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 kāmalā (jaundice), gulma (abdominal lump), prameha (frequent turbid urination), arshas (mass per rectum), plihodara, all types of udara roga and krimi (worm infestation) [81-82]. Rohitaka ghrita: रोहीतकत्वचः कृत्वा पलानां पञ्चविंशतिम्||८३|| कोलद्विप्रस्थसंयुक्तं कषायमुपकल्पयेत्| पलिकैः पञ्चकोलैस्तु तैः सर्वैश्चापि तुल्यया||८४|| रोहीतकत्वचा पिष्टैर्घृतप्रस्थं विपाचयेत्| प्लीहाभिवृद्धिं शमयत्येतदाशु प्रयोजितम्||८५|| तथा गुल्मोदरश्वासक्रिमिपाण्डुत्वकामलाः| rōhītakatvacaḥ kr̥tvā palānāṁ pañcaviṁśatim||83|| kōladviprasthasaṁyuktaṁ kaṣāyamupakalpayēt| palikaiḥ pañcakōlaistu taiḥ sarvaiścāpi tulyayā||84|| rōhītakatvacā piṣṭairghr̥taprasthaṁ vipācayēt| plīhābhivr̥ddhiṁ śamayatyētadāśu prayōjitam||85|| tathā gulmōdaraśvāsakrimipāṇḍutvakāmalāḥ| rohItakatvacaH kRutvA palAnAM pa~jcaviMshatim||83|| koladviprasthasaMyuktaM kaShAyamupakalpayet| palikaiH pa~jcakolaistu taiH sarvaishcApi tulyayA||74|| rohItakatvacA piShTairghRutaprasthaM vipAcayet| plIhAbhivRuddhiM shamayatyetadAshu prayojitam||85|| tathA gulmodarashvAsakrimipANDutvakAmalAH|

Twenty five pala (1200g) of bark of rohitaka (Tecomella Undulate) and 2 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), nāgara (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), anaemia and jaundice [83-85]. Agnikarma (cauterization): अग्निकर्म च कुर्वीत भिषग्वातकफोल्बणे||८६|| agnikarma ca kurvīta bhiṣagvātakaphōlbaṇē||86|| agnikarma ca kurvIta bhiShagvAtakapholbaNe||86||

The vāta and kapha dominated plihodara should be treated by agnikarma (cauterization)-[86]. Treatment of pitta dominated plihodara(splenomegaly): पैत्तिके जीवनीयानि सर्पींषि क्षीरबस्तयः| रक्तावसेकः संशुद्धिः क्षीरपानं च शस्यते||८७|| यूषैर्मांसरसैश्चापि दीपनीयसमायुतैः| यकृति प्लीहवत् सर्वं तुल्यत्वाद्भेषजं मतम्||८८|| लघून्यन्नानि संसृज्य दद्यात् प्लीहोदरे भिषक्| paittikē jīvanīyāni sarpīṁṣi kṣīrabastayaḥ| raktāvasēkaḥ saṁśuddhiḥ kṣīrapānaṁ ca śasyatē||87|| yūṣairmāṁsarasaiścāpi dīpanīyasamāyutaiḥ| yakr̥ti plīhavat sarvaṁ tulyatvādbhēṣajaṁ matam||88|| laghūnyannāni saṁsr̥jya dadyāt plīhōdarē bhiṣak| paittike jIvanIyAni sarpIMShi kShIrabastayaH| raktAvasekaH saMshuddhiH kShIrapAnaM ca shasyate||87|| yUShairmAMsarasaishcApi dIpanIyasamAyutaiH| yakRuti plIhavat sarvaM tulyatvAdbheShajaM matam||88|| laghUnyannAni saMsRujya dadyAt plIhodare bhiShak|

Plihodara with dominance of pitta is treated by oral administration of ghee medicated with jivaniya herbs [Jeevaka (Malaxis acuminta), rishbhaka (Microstylis muscifera), medā (Polygonatum verticillatum), mahāmeda (Polygonatum cirrhifolium), kākoli (Roscoea procera), kshirakākoli (Lilium polphyllum), riddhi (Habenaria edgeworthii), vriddhi (Habenaria intermedia), kshāra basti (decoction enema consisting of alkali obtained from ash of herbs), raktāvaseka (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: स्विन्नाय बद्धोदरिणे मूत्रतीक्ष्णौषधान्वितम्||८९|| सतैललवणं दद्यान्निरूहं सानुवासनम्| परिस्रंसीनि चान्नानि तीक्ष्णं चैव विरेचनम्||९०|| उदावर्तहरं कर्म कार्यं वातघ्नमेव च| svinnāya baddhōdariṇē mūtratīkṣṇauṣadhānvitam||89|| satailalavaṇaṁ dadyānnirūhaṁ sānuvāsanam| parisraṁsīni cānnāni tīkṣṇaṁ caiva virēcanam||90|| udāvartaharaṁ karma kāryaṁ vātaghnamēva ca| svinnAya baddhodariNe mUtratIkShNauShadhAnvitam||89|| satailalavaNaM dadyAnnirUhaM sAnuvAsanam| parisraMsIni cAnnAni tIkShNaM caiva virecanam||90|| udAvartaharaM karma kAryaM vAtaghnameva ca|

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 udāvarta as well as morbidity of vāta should be done in baddhodara [89-90]. Treatment of Chhidrodara: छिद्रोदरमृते स्वेदाच्छ्लेष्मोदरवदाचरेत्||९१|| जातं जातं जलं स्राव्यमेवं तद्यापयेद्भिषक्| तृष्णाकासज्वरार्तं तु क्षीणमांसाग्निभोजनम्||९२|| वर्जयेच्छ्वासिनं तद्वच्छूलिनं दुर्बलेन्द्रियम्| chidrōdaramr̥tē svēdācchlēṣmōdaravadācarēt||91|| jātaṁ jātaṁ jalaṁ srāvyamēvaṁ tadyāpayēdbhiṣak| tr̥ṣṇākāsajvarārtaṁ tu kṣīṇamāṁsāgnibhōjanam||92|| varjayēcchvāsinaṁ tadvacchūlinaṁ durbalēndriyam| chidrodaramRute svedAcchleShmodaravadAcaret||91|| jAtaM jAtaM jalaM srAvyamevaM tadyApayedbhiShak| tRuShNAkAsajvarArtaM tu kShINamAMsAgnibhojanam||92|| varjayecchvAsinaM tadvacchUlinaM durbalendriyam|

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 chidrodara if he suffers from symptoms like excessive thirst, cough, fever, emaciation, Impairement of agni, reduced food intake, dyspnoea, abdominal pain and week cognition [91-92]. Treatment of jalodara: अपां दोषहराण्यादौ प्रदद्यादुदकोदरे||९३|| मूत्रयुक्तानि तीक्ष्णानि विविधक्षारवन्ति च| दीपनीयैः कफघ्नैश्च तमाहारैरुपाचरेत्||९४|| द्रवेभ्यश्चोदकादिभ्यो नियच्छेदनुपूर्वशः| apāṁ dōṣaharāṇyādau pradadyādudakōdarē||93|| mūtrayuktāni tīkṣṇāni vividhakṣāravanti ca| dīpanīyaiḥ kaphaghnaiśca tamāhārairupācarēt||94|| dravēbhyaścōdakādibhyō niyacchēdanupūrvaśaḥ| apAM doShaharANyAdau pradadyAdudakodare||93|| mUtrayuktAni tIkShNAni vividhakShAravanti ca| dIpanIyaiH kaphaghnaishca tamAhArairupAcaret||94|| dravebhyashcodakAdibhyo niyacchedanupUrvashaH| Initially all measure to eliminate the effect of fluid should be done in the treatment of jalodara (enlargement of abdomen due to collection of fluid). Oral administration of different strong kshāra (alkali obtained from ash of herbs) added with cow’s urine should be done. Foods that alleviate kapha and augments digestion should be given to the patient. Patient should gradually reduce the intake of fluids [93-94].

सर्वमेवोदरं प्रायो दोषसङ्घातजं मतम्||९५|| तस्मात्त्रिदोषशमनीं क्रियां सर्वत्र कारयेत्| sarvamēvōdaraṁ prāyō dōṣasaṅghātajaṁ matam||95|| tasmāttridōṣaśamanīṁ kriyāṁ sarvatra kārayēt| sarvamevodaraM prAyo doShasa~gghAtajaM matam||95|| tasmAttridoShashamanIM kriyAM sarvatra kArayet|

All types of udara (enlargement of abdomen) are mostly due to tri discordance of dosha, hence treatment that alleviate all three dosha should be adapted in all types of udara [95]. दोषैः कुक्षौ हि सम्पूर्णे वह्निर्मन्दत्वमृच्छति||९६|| तस्माद्भोज्यानि भोज्यानि दीपनानि लघूनि च| dōṣaiḥ kukṣau hi sampūrṇē vahnirmandatvamr̥cchati||96|| tasmādbhōjyāni bhōjyāni dīpanāni laghūni ca| doShaiH kukShau hi sampUrNe vahnirmandatvamRucchati||96|| tasmAdbhojyAni bhojyAni dIpanAni laghUni ca|

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: रक्तशालीन् यवान्मुद्गाञ्जाङ्गलांश्च मृगद्विजान्||९७|| पयोमूत्रासवारिष्टान्मधुसीधुं तथा सुराम्| यवागूमोदनं वाऽपि यूषैरद्याद्रसैरपि||९८|| मन्दाम्लस्नेहकटुभिः पञ्चमूलोपसाधितैः| raktaśālīn yavānmudgāñjāṅgalāṁśca mr̥gadvijān||97|| payōmūtrāsavāriṣṭānmadhusīdhuṁ tathā surām| yavāgūmōdanaṁ vā'pi yūṣairadyādrasairapi||98|| mandāmlasnēhakaṭubhiḥ pañcamūlōpasādhitaiḥ| raktashAlIn yavAnmudgA~jjA~ggalAMshca mRugadvijAn||97|| payomUtrAsavAriShTAnmadhusIdhuM tathA surAm| yavAgUmodanaM vA~api yUShairadyAdrasairapi||98|| mandAmlasnehakaTubhiH pa~jcamUlopasAdhitaiH| Food comprising rakta shāli (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 surā (alcoholic preparation made by fermenting a mixture of water, flour of rice and jaggery). yavāgu (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), shyonāka (Oroxylum indicum), kāshmari (Gmelina arborea) and pātalā (Stereospermum suaveolens)] -.[97-98]. Do’s and Don’ts : औदकानूपजं मांसं शाकं पिष्टकृतं तिलान्||९९|| व्यायामाध्वदिवास्वप्नं यानयानं च वर्जयेत्| तथोष्णलवणाम्लानि विदाहीनि गुरूणि च||१००|| नाद्यादन्नानि जठरी तोयपानं च वर्जयेत्| audakānūpajaṁ māṁsaṁ śākaṁ piṣṭakr̥taṁ tilān||99|| vyāyāmādhvadivāsvapnaṁ yānayānaṁ ca varjayēt| tathōṣṇalavaṇāmlāni vidāhīni gurūṇi ca||100|| nādyādannāni jaṭharī tōyapānaṁ ca varjayēt| audakAnUpajaM mAMsaM shAkaM piShTakRutaM tilAn||99|| vyAyAmAdhvadivAsvapnaM yAnayAnaM ca varjayet| tathoShNalavaNAmlAni vidAhIni gurUNi ca||100|| nAdyAdannAni jaTharI toyapAnaM ca varjayet|

Patient of udara (enlargement of abdomen) should avoid meat of acquatic and wetland animals, leafy vegitables, pishtakrita (cake and pastries made of flour; dough of rice flour), tila (Sesamum indicum), exercise, prolonged walking, day sleep, travelling, 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: नातिसान्द्रं हितं पाने स्वादु तक्रमपेलवम्||१०१|| त्र्यूषणक्षारलवणैर्युक्तं तु निचयोदरी| वातोदरी पिबेत्तक्रं पिप्पलीलवणान्वितम्||१०२|| शर्करामधुकोपेतं स्वादु पित्तोदरी पिबेत्| यवानीसैन्धवाजाजीव्योषयुक्तं कफोदरी||१०३|| पिबेन्मधुयुतं तक्रं कवोष्णं नातिपेलवम्| मधुतैलवचाशुण्ठीशताह्वाकुष्ठसैन्धवैः||१०४|| युक्तं प्लीहोदरी जातं सव्योषं तूदकोदरी| बद्धोदरी तु हपुषायवान्यजाजिसैन्धवैः ||१०५|| पिबेच्छिद्रोदरी तक्रं पिप्पलीक्षौद्रसंयुतम्| गौरवारोचकार्तानां समन्दाग्न्यतिसारिणाम्||१०६|| तक्रं वातकफार्तानाममृतत्वाय कल्पते| nātisāndraṁ hitaṁ pānē svādu takramapēlavam||101|| tryūṣaṇakṣāralavaṇairyuktaṁ tu nicayōdarī| vātōdarī pibēttakraṁ pippalīlavaṇānvitam||102|| śarkarāmadhukōpētaṁ svādu pittōdarī pibēt| yavānīsaindhavājājīvyōṣayuktaṁ kaphōdarī||103|| pibēnmadhuyutaṁ takraṁ kavōṣṇaṁ nātipēlavam| madhutailavacāśuṇṭhīśatāhvākuṣṭhasaindhavaiḥ||104|| yuktaṁ plīhōdarī jātaṁ savyōṣaṁ tūdakōdarī| baddhōdarī tu hapuṣāyavānyajājisaindhavaiḥ ||105|| pibēcchidrōdarī takraṁ pippalīkṣaudrasaṁyutam| gauravārōcakārtānāṁ samandāgnyatisāriṇām||106|| takraṁ vātakaphārtānāmamr̥tatvāya kalpatē| nAtisAndraM hitaM pAne svAdu takramapelavam||101|| tryUShaNakShAralavaNairyuktaM tu nicayodarI| vAtodarI pibettakraM pippalIlavaNAnvitam||102|| sharkarAmadhukopetaM [1] svAdu pittodarI pibet| yavAnIsaindhavAjAjIvyoShayuktaM kaphodarI||103|| pibenmadhuyutaM takraM kavoShNaM [2] nAtipelavam| madhutailavacAshuNThIshatAhvAkuShThasaindhavaiH||104|| yuktaM plIhodarI jAtaM savyoShaM tUdakodarI| baddhodarI tu hapuShAyavAnyajAjisaindhavaiH [3] ||105|| pibecchidrodarI takraM pippalIkShaudrasaMyutam| gauravArocakArtAnAM samandAgnyatisAriNAm||106|| takraM vAtakaphArtAnAmamRutatvAya kalpate|

Patient of sannipātodara (abdominal enlargement due to morbidity of all three dosha) should drink butter milk which is neither excessively thick, nor fatty, and while drinking it should be added with triushana [combination of three pungents that include pippali (Piper longum), shunthi (Zingiber officinale) and maricha (Piper nigrum)], kshāira (alkali obtained from ash of herbs) and rock salt. Patient suffering from vātodara should drink buttermilk added with pippali (Piper longum) and rock salt. Patient suffering from pittodara should drink buttermilk added with sugar and yastimadhu (Glycyrrhiza glabra). Patient suffering from kaphodara should drink luke warm buttermilk which is devoid of fat and added with yavāni (Trachyspermum ammi), rock salt, ajāji (Cuminum cyminum), pippali (Piper longum), shunthi (Zingiber officinale), maricha (Piper nigrum) and honey. Patient suffering from plihodara should take buttermilk added with honey, oil, vachā (Acorus calamus), shunthi (Zingiber officinale), shatahvā (Anethum sowa), kushtha (Saussurea lappa) and rock salt. Patient of jalodara (enlargement of abdomen due to collection of fluid) should take butter milk added with pippali (Piper longum), shunthi (Zingiber officinale) and maricha (Piper nigrum). Patient suffering from baddhodara (enlargement of abdomen due to gastrointestinal obstruction) should take buttermilk added with hāpusha (Juniperus communis), yavāni (Trachyspermum ammi), ajāji (Cuminum cyminum) and rock salt. 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 vāta 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: शोफानाहार्तितृण्मूर्च्छापीडिते कारभं पयः||१०७|| शुद्धानां क्षामदेहानां गव्यं छागं समाहिषम्| śōphānāhārtitr̥ṇmūrcchāpīḍitē kārabhaṁ payaḥ||107|| śuddhānāṁ kṣāmadēhānāṁ gavyaṁ chāgaṁ samāhiṣam| shophAnAhArtitRuNmUrcchApIDite kArabhaM payaH||107|| shuddhAnAM kShAmadehAnAM gavyaM chAgaM samAhiSham|

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: देवदारुपलाशार्कहस्तिपिप्पलिशिग्रुकैः||१०८|| साश्वगन्धैः सगोमूत्रैः प्रदिह्यादुदरं समैः| dēvadārupalāśārkahastiPippaliśigrukaiḥ||108|| sāśvagandhaiḥ sagōmūtraiḥ pradihyādUdaraṁ samaiḥ| devadArupalAshArkahastipippalishigrukaiH||108|| sAshvagandhaiH sagomUtraiH pradihyAdudaraM samaiH|

The paste prepared from devadāru (Cedrus deodara), palāsha (Butea monosperma), arka (Calotropis procera), hastipippali (Scindapsus officinalis), shigru (Moringa oleifera) and ashvagandhā (Withania somnifera) added with cow’s urine should be applied on the abdomen as pradeha (paste) [108]. Parisheka in udara roga: वृश्चिकालीं वचां कुष्ठं पञ्चमूलीं पुनर्नवाम्||१०९|| भूतीकं [४] नागरं धान्यं जले पक्त्वाऽवसेचयेत्| पलाशं कत्तृणं रास्नां तद्वत् पक्त्वाऽवसेचयेत्||११०|| मूत्राण्यष्टावुदरिणां सेके पाने च योजयेत्| vr̥ścikālīṁ vacāṁ kuṣṭhaṁ pañcamūlīṁ punarnavām||109|| bhūtīkaṁ nāgaraṁ dhānyaṁ jalē paktvā'vasēcayēt| palāśaṁ kattr̥ṇaṁ rāsnāṁ tadvat paktvā'vasēcayēt||110|| mūtrāṇyaṣṭāvudariṇāṁ sēkē pānē ca yōjayēt| vRushcikAlIM vacAM kuShThaM pa~jcamUlIM punarnavAm||109|| bhUtIkaM [4] nAgaraM dhAnyaM jale paktvA~avasecayet| palAshaM kattRuNaM rAsnAM tadvat paktvA~avasecayet||110|| mUtrANyaShTAvudariNAM seke pAne ca yojayet|

Abdomen should be treated with parisheka (pouring medicated liquids on body parts) by using decoction prepared from vrishchikāli (Tragia involucrata), vachā (Acorus calamus), kushtha (Saussurea lappa), bilva (Aegle marmelos), agnimantha (Clerodendrum phlomidis), shyonāka (Oroxylum indicum), kāshmari (Gmelina arborea), pātalā (Stereospermum suaveolens), punarnavā (Boerhaavia diffusa), bhutika (Cymbopogon jvarancusha), nāgara (Zingiber officinale) and dhānyaka (Coriandrum sativum). In the same way the decoction prepared from palāsha (Butea monosperma), kattruna (Cymbopogon citratus) and rāsna (Pluchea lanceolata) may be used for parisheka (pouring medicated liquids on body parts). In general the eight types of urine (urine of human being, cow, goat, sheep, camel and buffalo) may be used in the form of drink or parisheka (pouring medicated liquids on body parts) in patients suffering from udara (enlargement of abdomen tending ascites) [109-110]. रूक्षाणां बहुवातानां तथा संशोधनार्थिनाम्||१११|| दीपनीयानि सर्पींषि जठरघ्नानि चक्ष्महे|११२| rūkṣāṇāṁ bahuvātānāṁ tathā saṁśōdhanārthinām||111|| dīpanīyāni sarpīṁṣi jaṭharaghnāni cakṣmahē| rUkShANAM bahuvAtAnAM tathA saMshodhanArthinAm||111|| dIpanIyAni sarpIMShi jaTharaghnAni cakShmahe|

From here onwards, 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 vāta and also the patients who will undergo shodhana (purification measures) [111-112]. Panchakola ghrita: पिप्पलीपिप्पलीमूलचव्यचित्रकनागरैः||११२|| सक्षारैरर्धपलिकैर्द्विप्रस्थं सर्पिषः पचेत्| कल्कैर्द्विपञ्चमूलस्य तुलार्धस्वरसेन च||११३|| दधिमण्डाढकोपेतं तत् सर्पिर्जठरापहम्| श्वयथुं वातविष्टम्भं गुल्मार्शांसि च नाशयेत्||११४|| pippalīpippalīmūlacavyacitrakanāgaraiḥ||112|| sakṣārairardhapalikairdviprasthaṁ sarpiṣaḥ pacēt| kalkairdvipañcamūlasya tulārdhasvarasēna ca||113|| dadhimaṇḍāḍhakōpētaṁ tat sarpirjaṭharāpaham| śvayathuṁ vātaviṣṭambhaṁ gulmārśāṁsi ca nāśayēt||114|| pippalIpippalImUlacavyacitrakanAgaraiH||112|| sakShArairardhapalikairdviprasthaM sarpiShaH pacet| kalkairdvipa~jcamUlasya tulArdhasvarasena ca||113|| dadhimaNDADhakopetaM tat sarpirjaTharApaham| shvayathuM vAtaviShTambhaM gulmArshAMsi ca nAshayet||114|| Take powder of pippali (Piper longum Linn), pippali mula (Piper longum), chavya (Piper retrofractum), chitraka (Plumbago zeylanica), nāgara (Zingiber officinale) and kshāra (alkali obtained from ash of herbs) half pala (24g) of each in quantity. This is added with ardha-tulā (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) vāta vishtambha (obstructed vāta in the abdomen), gulma (abdominal lump) and arshas (mass per rectum) [112-114]. Nāgaraadi ghrita: नागरत्रिफलाप्रस्थं घृततैलात्तथाऽऽढकम्| मस्तुनः साधयित्वैतत् पिबेत् सर्वोदरापहम्||११५|| कफमारुतसम्भूते गुल्मे चैतत् प्रशस्यते| nāgaratriphalāprasthaṁ ghr̥tatailāttathāḍhakam| mastunaḥ sādhayitvaitat pibēt sarvōdarāpaham||115|| kaphamārutasambhūtē gulmē caitat praśasyatē| nAgaratriphalAprasthaM ghRutatailAttathA~a~aDhakam| mastunaH sAdhayitvaitat pibet sarvodarApaham||115|| kaphamArutasambhUte gulme caitat prashasyate|

One prastha (768g) of powder of nāgara (Zingiber officinale), haritaki (Terminalia chebula), vibhitaki (Terminalia belerica) and amalaki (Emblica officinalis) is aaded 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 vātaja gulma (abdominal lump) [115]. Chitraka ghrita: चतुर्गुणे जले मूत्रे द्विगुणे चित्रकात् पले||११६|| कल्के सिद्धं घृतप्रस्थं सक्षारं जठरी पिबेत्| caturguṇē jalē mūtrē dviguṇē citrakāt palē||116|| kalkē siddhaṁ ghr̥taprasthaṁ sakṣāraṁ jaṭharī pibēt| caturguNe jale mUtre dviguNe citrakAt pale||116|| kalke siddhaM ghRutaprasthaM sakShAraM jaTharI pibet| The powder prepared from each 1 pala (48g) of chitraka (Plumbago zeylanica) and kshāra (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] Yavādi ghrita: यवकोलकुलत्थानां पञ्चमूलरसेन च||११७|| सुरासौवीरकाभ्यां च सिद्धं वाऽपि पिबेद्घृतम्| yavakōlakulatthānāṁ pañcamūlarasēna ca||117|| surāsauvīrakābhyāṁ ca siddhaṁ vā'pi pibēdghr̥tam| yavakolakulatthAnAM pa~jcamUlarasena ca||117|| surAsauvIrakAbhyAM ca siddhaM vA~api pibedghRutam|

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: एभिः स्निग्धाय सञ्जाते बले शान्ते च मारुते||११८|| स्रस्ते दोषाशये दद्यात् कल्पदिष्टं विरेचनम्|११९| ēbhiḥ snigdhāya sañjātē balē śāntē ca mārutē||118|| srastē dōṣāśayē dadyāt kalpadiṣṭaṁ virēcanam|119| ebhiH snigdhAya sa~jjAte bale shAnte ca mArute||118|| sraste doShAshaye dadyAt kalpadiShTaM virecanam|119|

After the oral medication of this medicated ghee, once the patient regains the physical strength, morbid vāta gets alleviated and dosha has been mobilized into the koshtha; the patient is treated with virechana (therapeutic purgation) by administering purgatives mentioned in the Kalpasthana [118-119]. Patoāldi churna: पटोलमूलं रजनीं विडङ्गं त्रिफलात्वचम्||११९|| कम्पिल्लकं नीलिनीं च त्रिवृतां चेति चूर्णयेत्| षडाद्यान् कार्षिकानन्त्यांस्त्रींश्च द्वित्रिचतुर्गुणान्||१२०|| कृत्वा चूर्णमतो मुष्टिं गवां मूत्रेण ना पिबेत्| विरिक्तो मृदु भुञ्जीत भोजनं जाङ्गलै रसैः||१२१|| मण्डं पेयां च पीत्वा ना सव्योषं षडहं पयः| शृतं पिबेत्ततश्चूर्णं पिबेदेवं पुनः पुनः||१२२|| हन्ति सर्वोदराण्येतच्चूर्णं जातोदकान्यपि| कामलां पाण्डुरोगं च श्वयथुं चापकर्षति||१२३|| पटोलाद्यमिदं चूर्णमुदरेषु प्रपूजितम्| paṭōlamūlaṁ rajanīṁ viḍaṅgaṁ triphalātvacam||119|| kampillakaṁ nīlinīṁ ca trivr̥tāṁ cēti cūrṇayēt| ṣaḍādyān kārṣikānantyāṁstrīṁśca dvitricaturguṇān||120|| kr̥tvā cūrṇamatō muṣṭiṁ gavāṁ mūtrēṇa nā pibēt| viriktō mr̥du bhuñjīta bhōjanaṁ jāṅgalai rasaiḥ||121|| maṇḍaṁ pēyāṁ ca pītvā nā savyōṣaṁ ṣaḍahaṁ payaḥ| śr̥taṁ pibēttataścūrṇaṁ pibēdēvaṁ punaḥ punaḥ||122|| hanti sarvōdarāṇyētaccūrṇaṁ jātōdakānyapi| kāmalāṁ pāṇḍurōgaṁ ca śvayathuṁ cāpakarṣati||123|| paṭōlādyamidaṁ cūrṇamudarēṣu prapūjitam| paTolamUlaM rajanIM viDa~ggaM triphalAtvacam||119|| kampillakaM nIlinIM ca trivRutAM ceti cUrNayet| ShaDAdyAn kArShikAnantyAMstrIMshca dvitricaturguNAn||120|| kRutvA cUrNamato muShTiM gavAM mUtreNa nA pibet| virikto mRudu bhu~jjIta bhojanaM jA~ggalai rasaiH||121|| maNDaM peyAM ca pItvA nA savyoShaM ShaDahaM payaH| shRutaM pibettatashcUrNaM pibedevaM punaH punaH||122|| hanti sarvodarANyetaccUrNaM jAtodakAnyapi| kAmalAM pANDurogaM ca shvayathuM cApakarShati||123|| paTolAdyamidaM cUrNamudareShu prapUjitam|

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), 2 karsha (24g) of kampilla (Mallotus philippinensis), 3 karsha (36g) of nilini (Indigofera tinctoria) and 4 karsha (48g) of trivrit (Operculina turpethum). This powder is orally administered in a dose of 1 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 jātodaka (enlargement of abdomen with fluid accumulation), jaundice, anaemia and anasaraka. This powder named as patoladi churna is well appreciated for the cure of udara (enlargement of abdomen) [119-123]. Gavākshyādi churna: गवाक्षीं शङ्खिनीं दन्तीं तिल्वकस्य त्वचं वचाम्||१२४|| पिबेद्द्राक्षाम्बुगोमूत्रकोलकर्कन्धुसीधुभिः| gavākṣīṁ śaṅkhinīṁ dantīṁ tilvakasya tvacaṁ vacām||124|| pibēddrākṣāmbugōmūtrakōlakarkandhusīdhubhiḥ| gavAkShIM sha~gkhinIM dantIM tilvakasya tvacaM vacAm||124|| pibeddrAkShAmbugomUtrakolakarkandhusIdhubhiH| Powder prepared from equal amounts of gavākshi (Citrullus colocynthis), shankhini (Clitoria terneata), danti (Baliospermum montanum), bark of tilvaka (Symplocos cochinchinensis/Jatropha curcas) and vachā (Acorus calamus) is orally administerd 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]. Nārāyana churna: यवानी हपुषा धान्यं त्रिफला चोपकुञ्चिका||१२५|| कारवी पिप्पलीमूलमजगन्धा शटी वचा| शताह्वा जीरकं व्योषं स्वर्णक्षीरी सचित्रका||१२६|| द्वौ क्षारौ पौष्करं मूलं कुष्ठं लवणपञ्चकम्| विडङ्गं च समांशानि दन्त्या भागत्रयं तथा||१२७|| त्रिवृद्विशाले द्विगुणे सातला स्याच्चतुर्गुणा| एतन्नारायणं नाम चूर्णं रोगगणापहम्||१२८|| नैनत् प्राप्यातिवर्तन्ते रोगा विष्णुमिवासुराः| तक्रेणोदरिभिः पेयं गुल्मिभिर्बदराम्बुना||१२९|| आनद्धवाते सुरया वातरोगे प्रसन्नया| दधिमण्डेन विट्सङ्गे दाडिमाम्बुभिरर्शसैः||१३०|| परिकर्ते सवृक्षाम्लमुष्णाम्बुभिरजीर्णके| भगन्दरे पाण्डुरोगे श्वासे कासे गलग्रहे||१३१|| हृद्रोगे ग्रहणीदोषे कुष्ठे मन्देऽनले ज्वरे| दंष्ट्राविषे मूलविषे सगरे कृत्रिमे विषे||१३२|| यथार्हं स्निग्धकोष्ठेन पेयमेतद्विरेचनमिति नारायणचूर्णम् yavānī hapuṣā dhānyaṁ triphalā cōpakuñcikā||125|| kāravī pippalīmūlamajagandhā śaṭī vacā| śatāhvā jīrakaṁ vyōṣaṁ svarṇakṣīrī sacitrakā||126|| dvau kṣārau pauṣkaraṁ mūlaṁ kuṣṭhaṁ lavaṇapañcakam| viḍaṅgaṁ ca samāṁśāni dantyā bhāgatrayaṁ tathā||127|| trivr̥dviśālē dviguṇē sātalā syāccaturguṇā| ētannārāyaṇaṁ nāma cūrṇaṁ rōgagaṇāpaham||128|| nainat prāpyātivartantē rōgā viṣṇumivāsurāḥ| takrēṇōdaribhiḥ pēyaṁ gulmibhirbadarāmbunā||129|| ānaddhavātē surayā vātarōgē prasannayā| dadhimaṇḍēna viṭsaṅgē dāḍimāmbubhirarśasaiḥ||130|| parikartē savr̥kṣāmlamuṣṇāmbubhirajīrṇakē| bhagandarē pāṇḍurōgē śvāsē kāsē galagrahē||131|| hr̥drōgē grahaṇīdōṣē kuṣṭhē mandē'nalē jvarē| daṁṣṭrāviṣē mūlaviṣē sagarē kr̥trimē viṣē||132|| yathārhaṁ snigdhakōṣṭhēna pēyamētadvirēcanamiti nārāyaṇacūrṇam yavAnI hapuShA dhAnyaM triphalA copaku~jcikA||125|| kAravI pippalImUlamajagandhA shaTI vacA| shatAhvA jIrakaM vyoShaM svarNakShIrI sacitrakA||126|| dvau kShArau pauShkaraM mUlaM kuShThaM lavaNapa~jcakam| viDa~ggaM ca samAMshAni dantyA bhAgatrayaM tathA||127|| trivRudvishAle dviguNe sAtalA syAccaturguNA| etannArAyaNaM nAma cUrNaM rogagaNApaham||128|| nainat prApyAtivartante rogA viShNumivAsurAH| takreNodaribhiH peyaM gulmibhirbadarAmbunA||129|| AnaddhavAte surayA vAtaroge prasannayA| dadhimaNDena viTsa~gge dADimAmbubhirarshasaiH||130|| parikarte savRukShAmlamuShNAmbubhirajIrNake| bhagandare pANDuroge shvAse kAse galagrahe||131|| hRudroge grahaNIdoShe kuShThe mande~anale jvare| daMShTrAviShe mUlaviShe sagare kRutrime viShe||132|| yathArhaM snigdhakoShThena peyametadvirecanamiti nArAyaNacUrNam

Take one part each of yavāni (Trachyspermum ammi), hāpusha (Juniperus communis), dhānyaka (Coriandrum sativum), haritaki (Terminalia chebula Retz), vibhitaki (Terminalia belerica), amalaki (Emblica officinalis), upakunchika (Nigella sativa), kāavi (Apium leptophyllum), root of pippali (Piper longum), ajagandhā (Withania somnifera), shati (Hedychium spicatum), vacha (Acorus calamus), shatahvā (Anethum sowa), jiraka (Cuminum cyminum), pippali (Piper longum), shunthi (Zingiber officinale), maricha (Piper nigrum), svarnakshiri (Argemone mexicana), chitraka (Plumbago zeylanica), sarjakshāra (Sodii carbonas impura), yava kshāra (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 3 parts of danti (Baliospermum montanum), 2 parts of trivrit (Operculina turpethum), 2 parts of vishālā (Citrulus colocynthis) and 4 parts of sātala (Euphorbia tirucalli) are added and powdered. This powder is known as nārayana 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 vāta (obstructed vāta in the abdomen) this nārayana churna should be given with surā (alcoholic preparation made by fermenting a mixture of water, flour of rice, jaggery). vāta roga is treated by administering this powder with prasannā (supernatant clear portion of alcoholic preparation; upper portion of madya). Constipation is treated by giving this churna with dadhi manda (watery portion of curds). arshas (mass per rectum) is treated by administering this powder with juice of dādima (Punica granatum). Parikartkā (cutting pain in the anal region) may be treated by giving this medicine with vrikshāmla (Garcinia indica). This powder, if given with lukewarm water cures indigestion. Also this powder is orally administerd with relevant anupāna (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], Hapushādya churna: हपुषां काञ्चनक्षीरीं त्रिफलां कटुरोहिणीम्||१३३|| नीलिनीं त्रायमाणां च सातलां त्रिवृतां वचाम्| सैन्धवं काललवणं पिप्पलीं चेति चूर्णयेत्||१३४|| दाडिमत्रिफलामांसरसमूत्रसुखोदकैः| पेयोऽयं सर्वगुल्मेषु प्लीह्नि सर्वोदरेषु च||१३५|| श्वित्रे कुष्ठे सरुजके सवाते विषमाग्निषु| शोथार्शःपाण्डुरोगेषु कामलायां हलीमके||१३६|| वातं पित्तं कफं चाशु विरेकात् सम्प्रसाधयेतिति हपुषाद्यं चूर्ण hapuṣāṁ kāñcanakṣīrīṁ triphalāṁ kaṭurōhiṇīm||133|| nīlinīṁ trāyamāṇāṁ ca sātalāṁ trivr̥tāṁ vacām| saindhavaṁ kālalavaṇaṁ pippalīṁ cēti cūrṇayēt||134|| dāḍimatriphalāmāṁsarasamūtrasukhōdakaiḥ| pēyō'yaṁ sarvagulmēṣu plīhni sarvōdarēṣu ca||135|| śvitrē kuṣṭhē sarujakē savātē viṣamāgniṣu| śōthārśaḥpāṇḍurōgēṣu kāmalāyāṁ halīmakē||136|| vātaṁ pittaṁ kaphaṁ cāśu virēkāt samprasādhayētiti hapuṣādyaṁ cūrṇam hapuShAM kA~jcanakShIrIM triphalAM kaTurohiNIm||133|| nIlinIM trAyamANAM ca sAtalAM trivRutAM vacAm| saindhavaM kAlalavaNaM pippalIM ceti cUrNayet||134|| dADimatriphalAmAMsarasamUtrasukhodakaiH| peyo~ayaM sarvagulmeShu plIhni sarvodareShu ca||135|| shvitre kuShThe sarujake savAte viShamAgniShu| shothArshaHpANDurogeShu kAmalAyAM halImake||136|| vAtaM pittaM kaphaM cAshu virekAt samprasAdhayetiti hapuShAdyaM cUrNam

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), trāyamānā (Gentiana kurrhoa), sātalā (Euphorbia Tirucalli), trivrit (Operculina turpethum), vacha (Acorus calamus), rock salt, kāla lavana (black salt) and pippali (Piper longum). This powder should be orally given with juice of dādima (Punica granatum), decoction of triphalā (three fruits), meat soup, cow’s urine or warm water. This medication induces purgation, eliminates vāta, pitta and kapha; and is effective in curing diseases that include shvitra (leukoderma), kushtha (obstinate skin diseases), pain due to morbid vāta, Vishamāgni (irregular digestion), anasaraca, arshas (mass per rectum), anaemia, jaundice and halimaka (chlorosis)-[133-136]. Nilinyādi churna: नींलिनीं निचुलं व्योषं द्वौ क्षारौ लवणानि च||१३७|| चित्रकं च पिबेच्चूर्णं सर्पिषोदरगुल्मनुतिति नीलिन्याद्यं चूर्णम्|| nīlinīṁ niculaṁ vyōṣaṁ dvaukṣārau lavaṇāni ca||137|| citrakaṁ ca pibēccūrṇaṁ sarpiṣōdaragulmanutiti nīlinyādyaṁ cūrṇam nIlinIM niculaM vyoShaMdvau kShArau lavaNAni ca||137|| citrakaM ca pibeccUrNaM sarpiShodaragulmanutiti nIlinyAdyaM cUrNam

The Nililnyadi churna is prepared from the powders of nilini (Indigofera tinctoria), nichula (Barringtonia acutangula), pippali (Piper longum), shunthi (Zingiber officinale), maricha (Piper nigrum), svarajikā kshāra (Sodii carbonas impura), yava kshāra (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 kshāra ghrita: क्षीरद्रोणं सुधाक्षीरप्रस्थार्धसहितं दधि||१३८|| जातं विमथ्य तद्युक्त्या त्रिवृत्सिद्धं पिबेद्घृतम्| तथा सिद्धं घृतप्रस्थं पयस्यष्टगुणे पिबेत्||१३९|| स्नुक्क्षीरपलकल्केन त्रिवृताषट्पलेन च| गुल्मानां गरदोषाणामुदराणां च शान्तये||१४०|| इति स्नुहीक्षीरघृतम् kṣīradrōṇaṁ sudhākṣīraprasthārdhasahitaṁ dadhi||138|| jātaṁ vimathya tadyuktyā trivr̥tsiddhaṁ pibēdghr̥tam| tathā siddhaṁ ghr̥taprasthaṁ payasyaṣṭaguṇē pibēt||139|| snukkṣīrapalakalkēna trivr̥tāṣaṭpalēna ca| gulmānāṁ garadōṣāṇāmudarāṇāṁ ca śāntayē||140|| iti snuhīkṣīraghr̥tam kShIradroNaM sudhAkShIraprasthArdhasahitaM dadhi||138|| jAtaM vimathya tadyuktyA trivRutsiddhaM pibedghRutam| tathA siddhaM ghRutaprasthaM payasyaShTaguNe pibet||139|| snukkShIrapalakalkena trivRutAShaTpalena ca| gulmAnAM garadoShANAmudarANAM ca shAntaye||140|| iti snuhIkShIraghRutam

Curd is prepared from the mixture of 1 drona (12228g) of milk and half prastha (384g) of snuhikshira (latex of Euphorbia neriifolia). This curd is churned properly to extract the butter. Thus obtained butter is boiled to get the ghee. Further this ghee is processed with trivrit (Operculina turpethum) to get the snuhi kshara ghrita. Alternatively one can take 1 prastha (768g) of cow’s ghee, mixed with 8 prastha (6144g) of milk; and to this paste prepared from 1 pala (48g) of snuhikshira (latex of Euphorbia neriifolia) and 8 pala (384g) of trivrit (Operculina turpethum) is added. This is then processed to get the medicated ghee. This snuhi kshara ghrita is effective in alleviating the gulma (abdominal lump), garadosha (poison synthesized by combination of non toxic substances) and all types of udara. Thus is described snuhi kshara ghrita [138-140].

दधिमण्डाढके सिद्धात् स्नुक्क्षीरपलकल्कितात्| घृतप्रस्थात् पिबेन्मात्रां तद्वज्जठरशान्तये||१४१|| एषां चानु पिबेत् पेयां पयो वा स्वादु वा रसम्| dadhimaṇḍāḍhakē siddhāt snukkṣīrapalakalkitāt| ghr̥taprasthāt pibēnmātrāṁ tadvajjaṭharaśāntayē||141|| ēṣāṁ cānu pibēt pēyāṁ payō vā svādu vā rasam| dadhimaNDADhake siddhAt snukkShIrapalakalkitAt| ghRutaprasthAt pibenmAtrAM tadvajjaTharashAntaye||141|| eShAM cAnu pibet peyAM payo vA svAdu vA rasam|

Take 1 adhaka (3073g) of dadhi manda (liquid portion of curds), 1 pala (48g) paste of Snuhikshira (latex of Euphorbia neriifolia) and 1 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: घृते जीर्णे विरिक्तस्तु कोष्णं नागरकैः शृतम्||१४२|| पिबेदम्बु ततः पेयां यूषं कौलत्थकं ततः| पिबेद्रूक्षस्त्र्यहं त्वेवं भूयो [१] वा प्रतिभोजितः||१४३|| पुनः पुनः पिबेत् सर्पिरानुपूर्व्या तयैव च| घृतान्येतानि सिद्धानि विदध्यात् कुशलो भिषक्||१४४|| गुल्मानां गरदोषाणामुदराणां च शान्तये| ghr̥tē jīrṇē viriktastu kōṣṇaṁ nāgarakaiḥ śr̥tam||142|| pibēdambu tataḥ pēyāṁ yūṣaṁ kaulatthakaṁ tataḥ| pibēdrūkṣastryahaṁ tvēvaṁ bhūyō [1] vā pratibhōjitaḥ||143|| punaḥ punaḥ pibēt sarpirānupūrvyā tayaiva ca| ghr̥tānyētāni siddhāni vidadhyāt kuśalō bhiṣak||144|| gulmānāṁ garadōṣāṇāmudarāṇāṁ ca śāntayē| ghRute jIrNe viriktastu koShNaM nAgarakaiH shRutam||142|| pibedambu tataH peyAM yUShaM kaulatthakaM tataH| pibedrUkShastryahaM tvevaM bhUyo [1] vA pratibhojitaH||143|| punaH punaH pibet sarpirAnupUrvyA tayaiva ca| ghRutAnyetAni siddhAni vidadhyAt kushalo bhiShak||144|| gulmAnAM garadoShANAmudarANAM ca shAntaye|

Virechana karma (therapeutic purgation) should be undertaken after the digestion of the oraly administrated medicated ghee. After the virechana, the patient is advised to take decoction of nāgaraa (Zingiber officinale). Then the patient is given peya (liquid rice gruel) and yusha (cereal soup) prepared of kulattha (Vigna unquiculata). If the patient suffers from the state of dryness in his body then he should be given rice with milk for three days. On regaining the physical strength the patient should be repeatedly and alternatively treated with medicated ghee and nourishing diet. In this way gulma (abdominal lump), garavisha (poison synthesized by combination of nontoxic substances) and udara (enlargement of abdomen tending ascites) should be treated [142-144].

पीलुकल्कोपसिद्धं वा घृतमानाहभेदनम्||१४५|| गुल्मघ्नं नीलिनीसर्पिः स्नेहं वा मिश्रकं पिबेत्| pīlukalkōpasiddhaṁ vā ghr̥tamānāhabhēdanam||145|| gulmaghnaṁ nīlinīsarpiḥ snēhaṁ vā miśrakaṁ pibēt| pIlukalkopasiddhaM vA ghRutamAnAhabhedanam||145|| gulmaghnaM nIlinIsarpiH snehaM vA mishrakaM pibet|

The patient suffering from anāha (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: क्रमान्निर्हृतदोषाणां जाङ्गलप्रतिभोजिनाम् ||१४६|| दोषशेषनिवृत्त्यर्थं योगान् वक्ष्याम्यतः परम्| kramānnirhr̥tadōṣāṇāṁ jāṅgalapratibhōjinām ||146|| dōṣaśēṣanivr̥ttyarthaṁ yōgān vakṣyāmyataḥ param| kramAnnirhRutadoShANAM jA~ggalapratibhojinAm [2] ||146|| doShasheShanivRuttyarthaM yogAn vakShyAmyataH param| After the methodical elimination of dosha followed by proper nutrition by the intake of meat soup of dry land animals; the patient should be treated with oral medications to alleviate the remaining dosha. Such medications are discussed here onwards [146].

चित्रकामरदारुभ्यां कल्कं क्षीरेण ना पिबेत्||१४७|| मासं युक्तस्तथा हस्तिपिप्पली विश्वभेषजम्| citrakāmaradārubhyāṁ kalkaṁ kṣīrēṇa nā pibēt||147|| māsaṁ yuktastathā hastipippalī viśvabhēṣajam| citrakAmaradArubhyAM kalkaM kShIreNa nA pibet||147|| mAsaM yuktastathA hastipippalI vishvabheShajam| The fine powder of chitraka (Plumbago zeylanica) and devadāru (Cedrus deodara) should be orally given with milk for one month. Or else the powder of hastipippali and shunthi (Zingiber officinale) should be given orally with milk for one month [147].

विडङ्गं चित्रकं दन्ती चव्यं व्योषं च तैः पयः||१४८|| कल्कैः कोलसमैः पीत्वा प्रवृद्धमुदरं जयेत्| viḍaṅgaṁ citrakaṁ dantī cavyaṁ vyōṣaṁ ca taiḥ payaḥ||148|| kalkaiḥ kōlasamaiḥ pītvā pravr̥ddhamUdara ṁ jayēt| viDa~ggaM citrakaM dantI cavyaM vyoShaM ca taiH payaH||148|| kalkaiH kolasamaiH pItvA pravRuddhamudaraM jayet|

Take one kola (12g) each of vidanga (Embelia ribes), chitraka (Plumbago zeylanica), danti (Baliospermum montanum), chavya (Piper retrofractum), pippali (Piper longum), shunthi (Zingiber officinale) and maricha (Piper nigrum) and powder. This powder is added with milk and processed. The patient should take this medicated milk to cure of udara roga [148]. पिबेत् कषायं त्रिफलादन्तीरोहितकैः शृतम्||१४९|| व्योषक्षारयुतं जीर्णे रसैरद्यात्तु जाङ्गलैः| pibēt kaṣāyaṁ triphalādantīrōhitakaiḥ śr̥tam||149|| vyōṣakṣārayutaṁ jīrṇē rasairadyāttu jāṅgalaiḥ| pibet kaShAyaM triphalAdantIrohitakaiH shRutam||149|| vyoShakShArayutaM jIrNe rasairadyAttu jA~ggalaiH|

Decoction is prepared from drugs taken in equal amounts that includes haritaki (Terminalia chebula), vibhitaki (Terminalia belerica), amalaki (Emblica officinalis), danti (Baliospermum montanum) and rohitaka (Tecomella Undulate). This is added with powder of pippali (Piper longum), shunthi (Zingiber officinale), maricha (Piper nigrum) and kshāra (alkali obtained from ash of herbs). Patient is asked to take this medicine, and on its digestion meat soup of dry land animals is given [149]. मांसं वा भोजनं भोज्यं सुधाक्षीरघृतान्वितम्||१५०|| क्षीरानुपानां गोमूत्रेणाभयां वा प्रयोजयेत्| सप्ताहं माहिषं मूत्रं क्षीरं चानन्नभुक् पिबेत्||१५१|| मासमौष्ट्रं पयश्छागं त्रीन्मासान् व्योषसंयुतम्| हरीतकीसहस्रं वा क्षीराशी वा शिलाजतु||१५२|| शिलाजतुविधानेन गुग्गुलुं वा प्रयोजयेत्| शृङ्गवेरार्द्रकरसः पाने क्षीरसमो हितः||१५३|| तैलं रसेन तेनैव सिद्धं दशगुणेन वा| दन्तीद्रवन्तीफलजं तैलं दूष्योदरे हितम्||१५४|| शूलानाहविबन्धेषु मस्तुयूषरसादिभिः| सरलामधुशिग्रूणां बीजेभ्यो मूलकस्य च||१५५|| तैलान्यभ्यङ्गपानार्थं शूलघ्नान्यनिलोदरे| स्तैमित्यारुचिहृल्लासे मन्देऽग्नौ मद्यपाय च||१५६|| अरिष्टान् दापयेत् क्षारान् कफस्त्यानस्थिरोदरे|

māṁsaṁ vā bhōjanaṁ bhōjyaṁ sudhākṣīraghr̥tānvitam||150|| kṣīrānupānāṁ gōmūtrēṇābhayāṁ vā prayōjayēt| saptāhaṁ māhiṣaṁ mūtraṁ kṣīraṁ cānannabhuk pibēt||151|| māsamauṣṭraṁ payaśchāgaṁ trīnmāsān vyōṣasaṁyutam| harītakīsahasraṁ vā kṣīrāśī vā śilājatu||152|| śilājatuvidhānēna gugguluṁ vā prayōjayēt| śr̥ṅgavērārdrakarasaḥ pānē kṣīrasamō hitaḥ||153|| tailaṁ rasēna tēnaiva siddhaṁ daśaguṇēna vā| dantīdravantīphalajaṁ tailaṁ dūṣyōdarē hitam||154|| śūlānāhavibandhēṣu mastuyūṣarasādibhiḥ| saralāmadhuśigrūṇāṁ bījēbhyō mūlakasya ca||155|| tailānyabhyaṅgapānārthaṁ śūlaghnānyanilōdarē| staimityārucihr̥llāsē mandē'gnau madyapāya ca||156|| ariṣṭān dāpayēt kṣārān kaphastyānasthirōdarē| mAMsaM vA bhojanaM bhojyaM sudhAkShIraghRutAnvitam||150|| kShIrAnupAnAM gomUtreNAbhayAM vA prayojayet| saptAhaM mAhiShaM mUtraM kShIraM cAnannabhuk pibet||151|| mAsamauShTraM payashchAgaM trInmAsAn vyoShasaMyutam| harItakIsahasraM vA kShIrAshI vA shilAjatu||152|| shilAjatuvidhAnena gugguluM vA prayojayet| shRu~ggaverArdrakarasaH pAne kShIrasamo hitaH||153|| tailaM rasena tenaiva siddhaM dashaguNena vA| dantIdravantIphalajaM tailaM dUShyodare hitam||154|| shUlAnAhavibandheShu mastuyUSharasAdibhiH| saralAmadhushigrUNAM bIjebhyo mUlakasya ca||155|| tailAnyabhya~ggapAnArthaM shUlaghnAnyanilodare| staimityArucihRullAse mande~agnau madyapAya ca||156|| ariShTAn dApayet kShArAn kaphastyAnasthirodare|

Or the patient is given medicated ghee prepared with snuhikshira (latex of Euphorbia neriifolia) along with meat in food. The combination of abhayā (Terminalia chebula) and cow’s urine may be orally administered with milk. Patient may be treated with buffalo urine for one week along with milk as food avoiding rice. The camel’s milk and goat’s milk may be orally given for 3 months added with pippali (Piper longum), shunthi (Zingiber officinale) and maricha (Piper nigrum). One course of haritaki (Terminalia chebula Retz) consisting 1000 numbers may be administered along with milk diet. Shilājatu (asphaltum) may be administerd orally along with milk diet. Similaraly 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 1 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), anāha (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 kshāra (alkali obtained from ash of herbs)-[150-156]. Pippalyādi lavana: श्लेष्मणो विलयार्थं तु दोषं वीक्ष्य भिषग्वरः||१५७|| पिप्पलीं तिल्वकं हिङ्गु नागरं हस्तिपिप्पलीम्| भल्लातकं शिग्रुफलं त्रिफलां कटुरोहिणीम्||१५८|| देवदारु हरिद्रे द्वे सरलातिविषे वचाम् | कुष्ठं मुस्तं तथा पञ्च लवणानि प्रकल्प्य च||१५९|| दधिसर्पिर्वसामज्जतैलयुक्तानि दाहयेत्| अन्नादूर्ध्वमतः क्षाराद्बिडालकपदं पिबेत्||१६०|| मदिरादधिमण्डोष्णजलारिष्टसुरासवैः| हृद्रोगं श्वयथुं गुल्मं प्लीहार्शोजठराणि च||१६१|| विसूचिकामुदावर्तं वाताष्ठीलां च नाशयेत्| ślēṣmaṇō vilayārthaṁ tu dōṣaṁ vīkṣya bhiṣagvaraḥ||157|| pippalīṁ tilvakaṁ [3] hiṅgu nāgaraṁ hastipippalīm| bhallātakaṁ śigruphalaṁ triphalāṁ kaṭurōhiṇīm||158|| dēvadāru haridrē dvē saralātiviṣē vacām [4] | kuṣṭhaṁ mustaṁ tathā pañca lavaṇāni prakalpya ca||159|| dadhisarpirvasāmajjatailayuktāni dāhayēt| annādūrdhvamataḥ kṣārādbiḍālakapadaṁ pibēt||160|| madirādadhimaṇḍōṣṇajalāriṣṭasurāsavaiḥ| hr̥drōgaṁ śvayathuṁ gulmaṁ plīhārśōjaṭharāṇi ca||161|| visūcikāmudāvartaṁ vātāṣṭhīlāṁ ca nāśayēt| shleShmaNo vilayArthaM tu doShaM vIkShya bhiShagvaraH||157|| pippalIM tilvakaM [3] hi~ggu nAgaraM hastipippalIm| bhallAtakaM shigruphalaM triphalAM kaTurohiNIm||158|| devadAru haridre dve saralAtiviShe vacAm [4] | kuShThaM mustaM tathA pa~jca lavaNAni prakalpya ca||159|| dadhisarpirvasAmajjatailayuktAni dAhayet| annAdUrdhvamataH kShArAdbiDAlakapadaM pibet||160|| madirAdadhimaNDoShNajalAriShTasurAsavaiH| hRudrogaM shvayathuM gulmaM plIhArshojaTharANi ca||161|| visUcikAmudAvartaM vAtAShThIlAM ca nAshayet| With the due consideration of morbid dosha, the physician should prescribe pippalyādi lavana for liquefying the kapha. The ingredients of pippalyadi lavana are pippali (Piper longum), tilvaka (Symplocos cochinchinensis/Jatropha curcas), hingu (Ferula foetida), nāgaraa (Zingiber officinale), hastipippali (Scindapsus officinalis), bhallātaka (Semecarpus anacardium), fruits of Shigru (Moringa oleifera), haritaki (Terminalia chebula), vibhitaki (Terminalia belerica), amalaki (Emblica officinalis), katukarohini (Picrorhiza kurroa Royle), devādaru (Cedrus deodara), haridrā (Curcuma longa), dāruharidrā (Berberis aristata), sarala (Pinus roxburghii), ativishā (Aconitum heterophyllum), vacha (Acorus calamus), kushtha (Saussurea lappa), mustā (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/yogrut, cow’s ghee, vasā (animal fat), majjā (bone marrow) and taila (oil extracted from seeds of Sesamum indicum) and then is burnt to get the kshāra (alkali obtained from ash of herbs). This kshāra is orally administered after the meals in a dose of 1 karsha (12g). The anupāna (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 hrudroga (cardiac disease), anasaraka, gulma (abdominal lump), plihodara (splenomegaly), arshas (mass per rectum), udara roga, visuchika (illness characterized by vomiting and diarrhea), udāvarta (reversed course of vāta in the abdomen) and vātāshtila (mass obliterating the urinary and rectal passage)-[157-161]. Kshara vatikā: क्षारं चाजकरीषाणां स्रुतं मूत्रैर्विपाचयेत्||१६२|| कार्षिकं पिप्पलीमूलं पञ्चैव लवणानि च| पिप्पलीं चित्रकं शुण्ठीं त्रिफलां त्रिवृतां वचाम्||१६३|| द्वौ क्षारौ सातलां दन्तीं स्वर्णक्षीरीं विषाणिकाम्| कोलप्रमाणां वटिकां पिबेत् सौवीरसंयुताम्||१६४|| श्वयथावविपाके च प्रवृद्धे च दकोदरे| kṣāraṁ cājakarīṣāṇāṁ srutaṁ mūtrairvipācayēt||162|| kārṣikaṁ pippalīmūlaṁ pañcaiva lavaṇāni ca| pippalīṁ citrakaṁ śuṇṭhīṁ triphalāṁ trivr̥tāṁ vacām||163|| dvau kṣārau sātalāṁ dantīṁ svarṇakṣīrīṁ viṣāṇikām| kōlapramāṇāṁ vaṭikāṁ pibēt sauvīrasaṁyutām||164|| śvayathāvavipākē ca pravr̥ddhē ca dakōdarē| kShAraM cAjakarIShANAM srutaM mUtrairvipAcayet||162|| kArShikaM pippalImUlaM pa~jcaiva lavaNAni ca| pippalIM citrakaM shuNThIM triphalAM trivRutAM vacAm||163|| dvau kShArau sAtalAM dantIM svarNakShIrIM viShANikAm| kolapramANAM vaTikAM pibet sauvIrasaMyutAm||164|| shvayathAvavipAke ca pravRuddhe ca dakodare|

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), trivrit (Operculina turpethum), vacha (Acorus calamus), sarjikāshāra (Sodii carbonas impura), yava kshāra (alkali from awns of barley), sātalā (Euphorbia Tirucalli), danti (Baliospermum montanum), svarnakshiri (Argemone mexicana ) and vishānika (Euphorbia fusiformis). This formulation is rolled into a pill of the size 1 kola (6g). This is orally administered in a dose of 1 kola (6g) with sauvira (alcoholic beverage prepared from dehusked barley either raw or cooked) and is effective in shvayathu (anasaraka), avipāka (indigestion) and advanced stage of udara roga [162-164]. Yavāgu Curative of udara roga: भावितानां गवां मूत्रे षष्टिकानां तु तण्डुलैः||१६५|| यवागूं पयसा सिद्धां प्रकामं भोजयेन्नरम्| पिबेदिक्षुरसं चानु जठराणां निवृत्तये||१६६|| स्वं स्वं स्थानं व्रजन्त्येवं तथा पित्तकफानिलाः| bhāvitānāṁ gavāṁ mūtrē ṣaṣṭikānāṁ tu taṇḍulaiḥ||165|| yavāgūṁ payasā siddhāṁ prakāmaṁ bhōjayēnnaram| pibēdikṣurasaṁ cānu jaṭharāṇāṁ nivr̥ttayē||166|| svaṁ svaṁ sthānaṁ vrajantyēvaṁ tathā pittakaphānilāḥ| bhAvitAnAM gavAM mUtre ShaShTikAnAM tu taNDulaiH||165|| yavAgUM payasA siddhAM prakAmaM bhojayennaram| pibedikShurasaM cAnu jaTharANAM nivRuttaye||166|| svaM svaM sthAnaM vrajantyevaM tathA pittakaphAnilAH| The rice that grows in 60 days is processed with cow’s urine and is used for the preparation of yavāgu (rice gruel) added with milk. Patient is allowed to consume stomach full of this yavāgu followed along with ample intake of sugar cane juice. This will cure the udara roga and the morbid vāta, pitta as well kapha and help in regaining their natural abode [165-66]. Treatment of constipation: शङ्खिनीस्नुक्त्रिवृद्दन्तीचिरबिल्वादिपल्लवैः||१६७|| शाकं गाढपुरीषाय प्राग्भक्तं दापयेद्भिषक् | ततोऽस्मै शिथिलीभूतवर्चोदोषाय शास्त्रवित्||१६८|| दद्यान्मूत्रयुतं क्षीरं दोषशेषहरं शिवम्| śaṅkhinīsnuktrivr̥ddantīcirabilvādipallavaiḥ||167|| śākaṁ gāḍhapurīṣāya prāgbhaktaṁ dāpayēdbhiṣak | tatō'smai śithilībhūtavarcōdōṣāya śāstravit||168|| dadyānmūtrayutaṁ kṣīraṁ dōṣaśēṣaharaṁ śivam| sha~gkhinIsnuktrivRuddantIcirabilvAdipallavaiH||167|| shAkaM gADhapurIShAya prAgbhaktaM dApayedbhiShak [5] | tato~asmai shithilIbhUtavarcodoShAya shAstravit||168|| dadyAnmUtrayutaM kShIraM [6] doShasheShaharaM shivam| The knowledgeable physician should give the patients the food prepared with adding leaves of shankhini (Clitoria terneata), snuhi (Euphorbia neriifolia), trivrit (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 unexpelled, then the patient is allowed to drink milk added with cow’s urine (167-168). Treatment of pārshva shula: पार्श्वशूलमुपस्तम्भं हृद्ग्रहं चापि मारुतः||१६९|| जनयेद्यस्य तं तैलं बिल्वक्षारेण पाययेत्| pārśvaśūlamupastambhaṁ hr̥dgrahaṁ cāpi mārutaḥ||169|| janayēdyasya taṁ tailaṁ bilvakṣārēṇa pāyayēt| pArshvashUlamupastambhaM hRudgrahaM cApi mArutaH||169||

janayedyasya taM tailaM bilvakShAreNa pAyayet| 

Patient of udara if develops pārshvashula (pain in the sides), upastambha (paresis and paresthesia of lower limbs due to entrapment of vāta), hridgraha (congestion in cardiac region) due to morbidity of vāta, 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: तथाऽग्निमन्थस्योनाकपलाशतिलनालजैः||१७०|| बलाकदल्यपामार्गक्षारैः प्रत्येकशः स्रुतैः| तैलं पक्त्वा भिषग्दद्यादुदराणां प्रशान्तये||१७१|| निवर्तते चोदरिणां हृद्ग्रहश्चानिलोद्भवः|१७२| tathā'gnimanthasyōnākapalāśatilanālajaiḥ||170|| balākadalyapāmārgakṣāraiḥ pratyēkaśaḥ srutaiḥ| tailaṁ paktvā bhiṣagdadyādudarāṇāṁ praśāntayē||171|| nivartatē cōdariṇāṁ hr̥dgrahaścānilōdbhavaḥ|172| tathA~agnimanthasyonAkapalAshatilanAlajaiH||170|| balAkadalyapAmArgakShAraiH pratyekashaH srutaiH| tailaM paktvA bhiShagdadyAdudarANAM prashAntaye||171|| nivartate codariNAM hRudgrahashcAnilodbhavaH|172| Oil is prepared successively with each of the kshāra of agnimantha (Clerodendrum phlomidis), shyonāka (Oroxylum indicum), palāsha (Butea monosperma), stalk of tila (Sesamum indicum), balā (Sida cordifolia), kadali (Musa paradisiaca) and apāmārga (Achyranthes aspera). This is orally given to cure the udara roga. This medicated oil also relieves cardiac arrest (hridgraha) caused by morbid vāta in patient of udara [170-172]. Eranda taila in avarana: कफे वातेन पित्तेन ताभ्यां वाऽप्यावृतेऽनिले||१७२|| बलिनः स्वौषधयुतं तैलमेरण्डजं हितम्| सुविरिक्तो नरो यस्तु पुनराध्मापितो भवेत्||१७३|| सुस्निग्धैरम्ललवणैर्निरूहैस्तमुपाचरेत्| सोपस्तम्भोऽपि वा वायुराध्मापयति यं नरम्||१७४|| तीक्ष्णैः सक्षारगोमूत्रैर्बस्तिभिस्तमुपाचरेत्|१७५| kaphē vātēna pittēna tābhyāṁ vā'pyāvr̥tē'nilē||172|| balinaḥ svauṣadhayutaṁ tailamēraṇḍajaṁ hitam| suviriktō narō yastu punarādhmāpitō bhavēt||173|| susnigdhairamlalavaṇairnirūhaistamupācarēt| sōpastambhō'pi vā vāyurādhmāpayati yaṁ naram||174|| tīkṣṇaiḥ sakṣāragōmūtrairbastibhistamupācarēt|175| kaphe vAtena pittena tAbhyAM vA~apyAvRute~anile||172|| balinaH svauShadhayutaM tailameraNDajaM hitam| suvirikto naro yastu punarAdhmApito bhavet||173|| susnigdhairamlalavaNairnirUhaistamupAcaret| sopastambho~api vA vAyurAdhmApayati yaM naram||174|| tIkShNaiH sakShAragomUtrairbastibhistamupAcaret|175|

In condition where kapha is afflicted with morbid vāta and pitta or where vāta is overlaid by kapha and pitta, it should be treated by oral medication of eranda taila (oil of Ricinus communis) processed with relevant herbs that cure the morbid dosha. After the proper elimination of the morbid dosha, if the abdominal distension recurs then it should be treated by niruha basti (decoction enema) consisting adequate amount of sneha (dietary fat), sour tasting drugs and saindhava lavana (Sodi chloriduium). If morbid vāta causes intestinal stasis and abdominal distension then it should be treated by administration of niruha (decoction enema) consisting of strong medicines such as kshāra (alkali obtained from ash of herbs) and cow’s urine [172-75]. Use of venum in the treatment of sannipātodara: क्रियातिवृत्ते जठरे त्रिदोषे चाप्रशाम्यति||१७५|| ज्ञातीन् ससुहृदो दारान् ब्राह्मणान्नृपतीन् गुरून्| अनुज्ञाप्य भिषक् कर्म विदध्यात् संशयं ब्रुवन्||१७६|| अक्रियायां ध्रुवो मृत्युः क्रियायां संशयो भवेत्| एवमाख्याय तस्येदमनुज्ञातः सुहृद्गणैः||१७७|| पानभोजनसंयुक्तं विषमस्मै प्रयोजयेत्| यस्मिन् वा कुपितः सर्पो विसृजेद्धि फले विषम्||१७८|| भोजयेत्तदुदरिणं प्रविचार्य भिषग्वरः| तेनास्य दोषसङ्घातः स्थिरो लीनो विमार्गगः||१७९|| विषेणाशुप्रमाथित्वादाशु भिन्नः प्रवर्तते| विषेण हृतदोषं तं शीताम्बुपरिषेचितम्||१८०|| पाययेत भिषग्दुग्धं यवागूं वा यथाबलम्| त्रिवृन्मण्डूकपर्ण्योश्च शाकं सयववास्तुकम्||१८१|| भक्षयेत् कालशाकं वा स्वरसोदकसाधितम् | निरम्ललवणस्नेहं स्विन्नास्विन्नमनन्नभुक्||१८२|| मासमेकं ततश्चैव तृषितः स्वरसं पिबेत्| एवं विनिर्हृते दोषे शाकैर्मासात् परं ततः||१८३|| दुर्बलाय प्रयुञ्जीत प्राणभृत् कारभं पयः|१८४| kriyātivr̥ttē jaṭharē tridōṣē cāpraśāmyati||175|| jñātīn sasuhr̥dō dārān brāhmaṇānnr̥patīn gurūn| anujñāpya bhiṣak karma vidadhyāt saṁśayaṁ bruvan||176|| akriyāyāṁ dhruvō mr̥tyuḥ kriyāyāṁ saṁśayō bhavēt| ēvamākhyāya tasyēdamanujñātaḥ suhr̥dgaṇaiḥ||177|| pānabhōjanasaṁyuktaṁ viṣamasmai prayōjayēt| yasmin vā kupitaḥ sarpō visr̥jēddhi phalē viṣam||178|| bhōjayēttadudariṇaṁ pravicārya bhiṣagvaraḥ| tēnāsya dōṣasaṅghātaḥ sthirō līnō vimārgagaḥ||179|| viṣēṇāśupramāthitvādāśu bhinnaḥ pravartatē| viṣēṇa hr̥tadōṣaṁ taṁ śītāmbupariṣēcitam||180|| pāyayēta bhiṣagdugdhaṁ yavāgūṁ vā yathābalam| trivr̥nmaṇḍūkaparṇyōśca śākaṁ sayavavāstukam||181|| bhakṣayēt kālaśākaṁ vā svarasōdakasādhitam | niramlalavaṇasnēhaṁ svinnāsvinnamanannabhuk||182|| māsamēkaṁ tataścaiva tr̥ṣitaḥ svarasaṁ pibēt| ēvaṁ vinirhr̥tē dōṣē śākairmāsāt paraṁ tataḥ||183|| durbalāya prayuñjīta prāṇabhr̥t kārabhaṁ payaḥ|184| kriyAtivRutte jaThare tridoShe cAprashAmyati||175|| j~jAtIn sasuhRudo dArAn brAhmaNAnnRupatIn gurUn| anuj~jApya bhiShak karma vidadhyAt saMshayaM bruvan||176|| akriyAyAM dhruvo mRutyuH kriyAyAM saMshayo bhavet| evamAkhyAya tasyedamanuj~jAtaH suhRudgaNaiH||177|| pAnabhojanasaMyuktaM viShamasmai prayojayet| yasmin vA kupitaH sarpo visRujeddhi phale viSham||178|| bhojayettadudariNaM pravicArya bhiShagvaraH| tenAsya doShasa~gghAtaH sthiro lIno vimArgagaH||179|| viSheNAshupramAthitvAdAshu bhinnaH pravartate| viSheNa hRutadoShaM taM shItAmbupariShecitam||180|| pAyayeta bhiShagdugdhaM yavAgUM vA yathAbalam| trivRunmaNDUkaparNyoshca shAkaM sayavavAstukam||181|| bhakShayet kAlashAkaM vA svarasodakasAdhitam [2] | niramlalavaNasnehaM svinnAsvinnamanannabhuk||182|| mAsamekaM tatashcaiva tRuShitaH svarasaM pibet| evaM vinirhRute doShe shAkairmAsAt paraM tataH||183|| durbalAya prayu~jjIta prANabhRut kArabhaM payaH|184|

If patient suffering from udara does not respond to usual treatment due to morbidity of three dosha, then the physician should inform the critical state to the relative of the patient and start treating with venom of cobra after obtaining consent from the patients friends, spouse, brahmins, king as well as teacher. The physician should win the confidence of these people after clearly stating that the patient will not survive if the treatment with venom is not made, and patient may survive if this treatment is done. After obtaining the consent, the physician should mix the venom in food and drink and administer it to the patient. 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 pramāthi (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 trivrit (Operculina turpethum) mandukaparni (Centella asiatica), yava (Hordeum vulgare), vāstuka (Chenopodium murale) and kālashāka (Corchorus capsularis) processed with juice of same leafy vegitables 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: इदं तु शल्यहर्तॄणां कर्म स्याद्दृष्टकर्मणाम्||१८४|| वामं कुक्षिं मापयित्वा नाभ्यधश्चतुरङ्गुलम्| मात्रायुक्तेन शस्त्रेण पाटयेन्मतिमान् भिषक्||१८५|| विपाट्यान्त्रं ततः पश्चाद्वीक्ष्य बद्धक्षतान्त्रयोः| सर्पिषाऽभ्यज्य केशादीनवमृज्य विमोक्षयेत्||१८६|| मूर्च्छनाद्यच्च सम्मूढमन्त्रं तच्च विमोक्षयेत्| छिद्राण्यन्त्रस्य तु स्थूलैर्दंशयित्वा पिपीलिकैः||१८७|| बहुशः सङ्गृहीतानि ज्ञात्वा च्छित्वा पिपीलिकान्| प्रतियोगैः [२] प्रवेश्यान्त्रं प्रेयैः [३] सीव्येद्व्रणं ततः||१८८|| idaṁ tu śalyahartr̥̄ṇāṁ karma syāddr̥ṣṭakarmaṇām||184|| vāmaṁ kukṣiṁ māpayitvā nābhyadhaścaturaṅgulam| mātrāyuktēna śastrēṇa pāṭayēnmatimān bhiṣak||185|| vipāṭyāntraṁ tataḥ paścādvīkṣya baddhakṣatāntrayōḥ| sarpiṣā'bhyajya kēśādīnavamr̥jya vimōkṣayēt||186|| mūrcchanādyacca sammūḍhamantraṁ tacca vimōkṣayēt| chidrāṇyantrasya tu sthūlairdaṁśayitvā pipīlikaiḥ||187|| bahuśaḥ saṅgr̥hītāni jñātvā cchitvā pipīlikān| pratiyōgaiḥ [2] pravēśyāntraṁ prēyaiḥ [3] sīvyēdvraṇaṁ tataḥ||188|| idaM tu shalyahartRUNAM karma syAddRuShTakarmaNAm||184|| vAmaM kukShiM mApayitvA nAbhyadhashcatura~ggulam| mAtrAyuktena shastreNa pATayenmatimAn bhiShak||185|| vipATyAntraM tataH pashcAdvIkShya baddhakShatAntrayoH| sarpiShA~abhyajya keshAdInavamRujya vimokShayet||186|| mUrcchanAdyacca sammUDhamantraM tacca vimokShayet| chidrANyantrasya tu sthUlairdaMshayitvA pipIlikaiH||187|| bahushaH sa~ggRuhItAni j~jAtvA cchitvA pipIlikAn| pratiyogaiH [2] praveshyAntraM preyaiH [3] sIvyedvraNaM tataH||188||

Surgical intervention should be done by an expert surgeon. A proper incision is made on the left side of the abdomen about 4 fingure (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 Intervension in jalodara: तथा जातोदकं सर्वमुदरं व्यधयेद्भिषक्| वामपार्श्वे त्वधो नाभेर्नाडीं दत्त्वा च गालयेत्||१८९|| विस्राव्य च विमृद्यैतद्वेष्टयेद्वाससोदरम्| तथा बस्तिविरेकाद्यैर्म्लानं सर्वं च वेष्टयेत्||१९०|| निःस्रुते लङ्घितः पेयामस्नेहलवणां पिबेत्| अतः परं तु षण्मासान् क्षीरवृत्तिर्भवेन्नरः||१९१|| त्रीन् मासान् पयसा पेयां पिबेत्त्रींश्चापि भोजयेत्| श्यामाकं कोरदूषं वा क्षीरेणालवणं लघु||१९२|| नरः संवत्सरेणैवं जयेत् प्राप्तं जलोदरम्| tathā jātōdakaṁ sarvamUdaraṁ vyadhayēdbhiṣak| vāmapārśvē tvadhō nābhērnāḍīṁ dattvā ca gālayēt||189|| visrāvya ca vimr̥dyaitadvēṣṭayēdvāsasōdaram| tathā bastivirēkādyairmlānaṁ sarvaṁ ca vēṣṭayēt||190|| niḥsrutē laṅghitaḥ pēyāmasnēhalavaṇāṁ pibēt| ataḥ paraṁ tu ṣaṇmāsān kṣīravr̥ttirbhavēnnaraḥ||191|| trīn māsān payasā pēyāṁ pibēttrīṁścāpi bhōjayēt| śyāmākaṁ kōradūṣaṁ vā kṣīrēṇālavaṇaṁ laghu||192|| naraḥ saṁvatsarēṇaivaṁ jayēt prāptaṁ jalōdaram| tathA jAtodakaM sarvamudaraM vyadhayedbhiShak| vAmapArshve [1] tvadho nAbhernADIM dattvA ca gAlayet||189|| visrAvya ca vimRudyaitadveShTayedvAsasodaram| tathA bastivirekAdyairmlAnaM sarvaM ca veShTayet||190|| niHsrute la~gghitaH peyAmasnehalavaNAM pibet| ataH paraM tu ShaNmAsAn kShIravRuttirbhavennaraH||191|| trIn mAsAn payasA peyAM pibettrIMshcApi bhojayet| shyAmAkaM [2] koradUShaM vA kShIreNAlavaNaM laghu||192|| naraH saMvatsareNaivaM jayet prAptaM jalodaram|

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: प्रयोगाणां च सर्वेषामनु क्षीरं प्रयोजयेत्||१९३|| दोषानुबन्धरक्षार्थं बलस्थैर्यार्थमेव च| प्रयोगापचिताङ्गानां हितं ह्युदरिणां पयः| सर्वधातुक्षयार्तानां देवानाममृतं यथा||१९४|| prayōgāṇāṁ ca sarvēṣāmanu kṣīraṁ prayōjayēt||193|| dōṣānubandharakṣārthaṁ balasthairyārthamēva ca| prayōgāpacitāṅgānāṁ hitaṁ hyudariṇāṁ payaḥ| sarvadhātukṣayārtānāṁ dēvānāmamr̥taṁ yathā||194|| prayogANAM ca sarveShAmanu kShIraM prayojayet||193|| doShAnubandharakShArthaM balasthairyArthameva ca| prayogApacitA~ggAnAM hitaM hyudariNAM payaH| sarvadhAtukShayArtAnAM devAnAmamRutaM yathA||194||

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 dhātu [193-194]. Summary of the chapter: तत्र श्लोकौ- हेतुं प्राग्रूपमष्टानां लिङ्गं व्याससमासतः| उपद्रवान् गरीयस्त्वं साध्यासाध्यत्वमेव च||१९५|| जाताजाताम्बुलिङ्गानि चिकित्सां चोक्तवानृषिः| समासव्यासनिर्देशैरुदराणां चिकित्सिते||१९६|| tatra ślōkau- hētuṁ prāgrūpamaṣṭānāṁ liṅgaṁ vyāsasamāsataḥ| upadravān garīyastvaṁ sādhyāsādhyatvamēva ca||195|| jātājātāmbuliṅgāni cikitsāṁ cōktavānr̥ṣiḥ| samāsavyāsanirdēśairudarāṇāṁ cikitsitē||196|| tatra shlokau- hetuM prAgrUpamaShTAnAM li~ggaM vyAsasamAsataH| upadravAn garIyastvaM sAdhyAsAdhyatvameva ca||195|| jAtAjAtAmbuli~ggAni cikitsAM coktavAnRuShiH| samAsavyAsanirdeshairudarANAM cikitsite||196||

Thus the etiology, premonitory symptoms, general and individual symptoms of eight types of udara, complications of udara, seriousness of the illness, prognosis, symptoms of stages of udara as non accumulation and accumulation of fluid, and the specific as well as general treatment of udara roga are described by the sage Punarvasu in this chapter of Chikitsa [195-196].

Tattva Vimarsha

• Abnormalities of jatharagni (digestive power) leads to the morbid accumulation of the mala (dosha and excreta- waste) and in turn tend to cause multiple diseases and particularly udara roga. • Affliction of prana vata, agni as well as apana vata are main culprits leading to accumulation of morbid dosha. This in turn obliterates the channels of sweda (sweat) and udaka (body fluid) tending upwards and downwards. • The causes of gross enlargement of abdomen include consumption of foods that lead to vitiation of pitta like hot, salty, kshara (alkali), that cause burning sensation, sour, ruksha (dry), slow poisons, erroneous dietary management following purification treatments, viruddha ahara (combination of foods having mutually contradictory properties), unhealthy foods, emaciation due to splenic enlargement, 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. • Apart from accumulation of morbid dosha in abdomen, splenomegaly, gastrointestinal obstruction, intestinal perforation, collection of fluid are the other causes of udara • Liver and spleen are affected by morbid dosha leading to enlargement in size and udara. • The pathogenic factors in vata dominant udara are located at kukshi (lower abdomen), hridaya (heart), basti (bladder and urinary system), guda (ano-rectal canal). • The pathogenic factors in pitta dominant udara are located at amashaya (stomach and upper GI tract). • The pathogenic factors in kapha dominant udara are located at bahirantra (outer side of intestine i.e. peritoneal cavity). • Collection of ascitic fluid is due to affliction of kapha dosha and udaka. (body fluids). • Treatment protocol for vatodara includes administration of unctuous medications, abhyanga (unctuous massage), sweda (sudation), sneha virechana (purgation with unctuous purgatives) and pattabandhana (tight bandage on abdomen). • In order to prevent recurrence, udara should be treated by regular virechana (frequent therapeutic purgation). After purgation, milk is advised to improve the physical strength and to relieve the strain of purgation. • Asthapana (decoction enema) and anuvasana (unctuous enema) is advised to remove obstruction. • Physically strong patients suffering from pittodara should be treated by virechana karma (therapeutic purgation) first. Physically weak patients should be treated by purification by adapting kshirabasti (decoction enema consisting of milk as predominant ingredient). After they regain physical strength and digestive power improves, the patient should be treated with virechana (therapeutic purgation). • In patients suffering from kaphodara, shodhana (eliminative therapy) is done after preparing with oleation and sudation. In samsarjana krama (gradual diet schedule) pungent, kshara and anti kapha diet is prescribed. • Plihodara should be treated by measures like oral medication of sneha (medicated unctuous substance), sudation, virechana (therapeutic purgation), niruha (decoction enema) and anuvasana basti (oil enema) and raktamokshana (blood-letting) by sectioning the vein located in the left arm. The vata and kapha dominated plihodara should be treated by agnikarma (cauterization). • The treatment of baddhodara (enlargement of abdomen due to gastrointestinal obstruction) includes 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). • 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. • All types of udara (enlargement of abdomen) are mostly due to tri discordance of dosha, hence treatment that alleviates all three dosha should be adapted in all types of udara.

Vidhi Vimarsha

Etiopathogenesis: Impairment of jatharāgni leads to morbidity of all the three dosha. Mala in the present context refers to morbid vāta, pitta and kapha, the metabolic bi-products formed during dhātu metabolism i.e. during tissue formation as well as the wastes like excreta1. Impairment of agni leads to excess formation of metabolic bi products (mala) and less formation of quality products. This leads to accumulation of the waste at micro-cellular circulation, which causes multiple diseases. More specifically, this accumulation of wastes at various visceral organs like liver, spleen etc. leads to distension of abdomen2. Malina ahāra meaning unhealthy food refers to all food articles that cause morbidity of dosha in the body when consumed3. Malina ahāra also includes unclean vegetable and other food articles4. Excessive dryness of the body in the absence of counteracting the same by proper measures leads to the udara roga5. The disease ama causing udara refers to the chronic perpetuation ama leads to udara roga5. Āma as a cause of udara also refers to the consumption of uncooked foods6. Severe suffering of diseases like pliha here refers to the suffering due to non availability of proper treatment predisposes to udara roga7. Morbidity of srotas refers to the mutravaha and purishavaha srotas and others that lead to the manifestation of udara roga7. Travelling and other physical activities immediately after the meals are referred as irritation after the meals and are the cause of udara roga6. Listing of sinful acts as etiology indicates the serious unrighteousness as the potent etiology of udara roga5 [12-13]. All the foods that are greasy, heavy for digestion or light for digestion and dry causes vidāha (burning sensation in the abdomen during the digestion of foods) or else the patient develops vidaghdājirna8 (intermediate state of digestion that caused burning)[12-15] . The pathogenesis mentioned earlier in the text is of all types of udara roga. The pathogenesis described here is that of the four types of udara caused by morbid dosha viz vātodara, pittodara, kaphodara and sannipātodara9 [20].

Two tier impairment of jatharāgni is mentioned as the cause of udara roga. In a patient with impaired jatharagni (digestive juices), consumption of unhealthy foods further impairs the functioning of jatharāgni. This indicates extreme impairment of jatharagni is involved in the pathogenesis of udara roga. Impairment of agni is the initial state that causes indigestion and morbidity of dosha. Morbid dosha in turn further impairs the functioning of agni thus forming a vicious cycle. Morbid dosha formed by the indigestion afflicts the srotas. Constriction and dilatation are the two varieties of pathology of srotas. Dilatation leads to excessive circulation and constriction leads to decreased circulation. In the pathology of udara, srotas are obliterated due to morbid dosha. This obliteration at swedavaha srotas leads to impairment of sweating. The fluid within the sweda-vaha-srotas is deviated to udaka-vaha-srotas thereby adding to the body fluids 10-11. 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 māmsa [visceral tissues] causing udara roga 12. The divergence of fluids is not restricted to sweda-vaha-srotas and udaka-vaha srotas, rather rasa-vaha srotas is also obstructed. Rasa dhātu is another source of fluid in the body. This fluid is also deviated to the space between the kalā (mucus membrane) and visceral tissues in the abdomen. Thus, the fluid from the udaka-vaha srotas, sweda-vaha-srotas, rasa-vaha srotas and annavaha srotas deviates into the abdominal cavity 13. Fluid is diverged from the koshtha into the space between the kalā (mucus membrane) and visceral tissues in the abdomen. In the present context, the word koshtha refers to the intestines wherein digestion as well as separation of nutrient from the waste and assimilation of nutrients takes place. To be clearer the chyle formed in the intestines is diverted to the abdominal space between the kalā (mucus membrane) and visceral tissue. The accumulation of the fluid in the abdominal space is due to the diversion of fluids from the intestines, rasa, udaka(fluid) as well as sweda (sweat)13. Diversion of fluids from the sweda-vaha, udaka-vaha, and rasa-vaha srotas is mobilized by the morbid vāta. In this pathology, the prāna vāta acts in the upper part of the trunk whereas the apāna vāta acts at the lower part of the trunk. Since the fluid is diverted, the other body parts exhibit emaciation. Contrary to this the abdomen shows distention as the diverted fluid accumulates in the abdomen13. 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 kalā and visceral tissues. This can be best understood by the allegory of oozing of the water stored in the new earthen pot through the invisible minute pores14. Thus, in udara, the distension of abdomen is due to the accumulation of the fluids within the space between the kalā and visceral tissues in the abdomen15 [9-11]. 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 vataj, 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] Peritonitis caused without an apparent source of contamination of peritoneal cavity is regarded as primary peritonitis. The spontaneous peritonitis caused due to hematogenous spread of bacterial infection into the peritoneum causing inflammation. Chronic liver disease is the most common cause of such infection. This can even happen without any underlying disease. 80 % of the patients present with fever. Acute onset of abdominal pain is characteristic and malaise, fatigue, or encephalopathy is the other co morbidity16. The primary peritonitis caused by gram negative bacteria matches with the symptom of vataj udara. Sub acute manifestation with non pyogenic exudation causing ascites points towards the diagnosis of vātodara. Microbiology study of ascitic fluid will reveal pathogens like Escherichia coli and enterococci16 [25].

Image 01: Patient suffering from udara roga 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) 17 [22]. Vātodara: Initial morbidity of vāta caused by aggravated kapha during the pathogenesis of vātodara indicates that the morbidity of kapha is secondary. Thus, this secondary morbidity of kapha distinguishes the vātodara and kaphodara18 [23-24]. Since the lower part of the abdomen is the normal location of vāta, distention of the abdomen initially occur in its lower parts19. Blackish and reddish discoloration of nails, conjunctiva, mouth and dermis is pathognomonic of morbid vāta19. [25] Pittodara: In this pathogenesis, the morbidity of pitta is most predominant than that of vāta and kapha. It is worth mentioning here that suppression of the agni in this context implies the suppression of dhātvāgni20 [27]. 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 diagnosis21.[28]

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 ascites22.[31] Sannipātodara: Dushyodara is another name of sannipātodara. This is not the ninth type of udara and the total number of udara remains eight23. Literally the term dushya refers to the pathology of affliction. Since the illness occurs due to the affliction of rakta; it is termed as dushyodara. Or else, the mutual affliction of dosha is characteristic of sannipātodara hence is termed as dushyodara24. Wicked ladies with an intention of subjugating male partners or winning love, likely to offer food mixed with poison treated substances like menstrual blood, body dirt, hair, excreta, urine bone and nails. Person unaware of the mischief of ladies likely to consume the adulterated food offered by them and suffer from sannipātodara. Even enemies may practice adulterating the food with poison treated substances. Unknowingly, consuming such food also leads to the sannipātodara25. Probably the slow poisoning is attempted by the enemies. The poisons having reduced potency due to the act of environmental factors is known as dushivisha. The enemies may contaminate the food with such dushivisha. Person consuming such contaminated food suffers from sannipātodara26 [32]. 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 vāta, pitta and kapha dosha, and its prognosis substantiates the consideration of sannipātodara in such cases27 [33-34]. Plihodara & Yakritodara: The etiology, pathology and treatment of plihodara and yakritodara are identical. Thus, for the descriptive purposes these two conditions are collectively called as Yakrit-plihodara. Among the above said list of etiological factors; variety of dietary factors like sweet and greasy foods that cause affliction of rakta dhātu is the cause of achyuta plihavriddhi. All the other etiological factors are of chyuta plihavriddhi28 [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 vataj, pittaja, kaphaja and sannipataja29. 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 dhātu 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 plihodara29 [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 dhātu 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 agni30 [37-38]. 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. Rare cause of gastro intestinal obstruction is by the bezoars. The concretions of the foreign materials that are retained in the gastrointestinal tract for long is termed as bezoar. This can happen in all locations from esophagus to anus. The ingestion of fruits and vegetable consisting of indigestible fibers leading concretion of the same in gastro intestinal tract is known as phytobezoar. It is observed that consumption of food articles like apples, grapes, oranges, cherries, raisins, bran, oats, cabbage, potato peels, peanuts, and celery can cause phytobezoar. Also the phytobezoar formed from the excessive consumption of persimmons (Diospyros kaki) is known as diospyrobezoar and is a subtype of phytobezoar. More to add items such as plastic, paper, string, or styrofoam are also known to cause bezoars. The swallowed hair in the gastrointestinal tract can form concretions and is termed as trichobezoar. Medicines getting solidified with the gastrointestinal lumen are known by the name pharmacobezoar. The risk of formation of bezoar is increased with inadequate mastication, missing teeth, or poorly fitting dentures. These remain asymptomatic until they cause obstruction of the gastrointestinal tract. 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: 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 kshatodara31. Parisrāavi udara : Parisrāvi and udara are the component terms of parisrāvi udara. Parisrāvi is again formed by the verb sraāi with the addition of the prefix pari. The prefix pari gives the meaning of extensive from all the sides. The verb srāvi refers to the secretion. Thus the term parisrāvi refers to the pathology of morbid flow or extensive secretion from all sides. 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 parisrāvi udara 32. Chhidrodara: The component terms chidra 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 chhidrodara33 [42-43]. The foreign substances consumed with the food may traverse along the length of intestines without hurting it. At times these foreign substances may traverse across the length and hurt the intestines leading to perforation. Thus, if the foreign substances traverse along the length of the intestines without hurting, then the patient do not suffer from the chidrodara34. Foreign substances consumed along with food causes perforation of the intestines. Even consumption of excessive food and yawing with excessive stretching of the body may lead to perforation34. The intestines contain liquid chyle consisting of both nutrients and waste. This liquid leaks out of the intestines through the rent caused by the perforation into the space between the abdominal skin and flesh. Note that, fluids also leak into the abdomen in doshaja udara but not through the rent, but by the method of diffusion34. 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 out34. The accumulation of the chyle within the abdomen that does not diffuse into the rectum causes jalodara. This jalodara of chidrodara 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 chidrodara and is due to the leakage of fluids form the perforated intestines35. 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 umbilicus36. The etiopathogenesis of chidrodara matches with that of secondary peritonitis. Perforation with in any part of gastrointestinal tract leading to spillage of luminal contents into the peritoneal cavity causes peritonitis and is referred as secondary peritonitis. Perforation can happen in conditions like appendicitis, diverticulitis, peptic ulcer, and trauma. More to add hollow organs are more susceptible to athletic injury when they are full of waste & food products leading to peritonitis. The common pathogens causing such peritonitis include Escherichia coli, Streptococcus faecalis, Pseudomonas aeruginosa, Klebsiella mirabilis, Bacteroides fragilis, Clostridium species, and anaerobic streptococci. Also, aseptic peritonitis is possible if sterile bile, digestive juice leak into the peritoneal cavity. In this condition infection is possible later during the course of the illness. Sudden development of abdominal pain is the initial and typical of any acute diffuse peritonitis. Characteristically it is the constant pain. Pain may be diffuse or referred to the umbilicus. At times the pain may happen at sites corresponding to the site of perforation. Patients usually lie motionless with knees drawn up which prevents stretching of nerve fibers in the peritoneal cavity. Activities like coughing and sneezing that increases the pressure within the peritoneal cavity increases pain. During the coarse, the peritonitis may subside or localize, and accordingly the abdominal pain may show partial remission. On palpation, abdominal tenderness, voluntary guarding and involuntary abdominal rigidity, and rebound tenderness can be appreciated. Abdominal rigidity is typical and is referred as board like rigidity. This rigidity may be absent in elderly and immune-compromised patients. Hypovolemia (dry mucous membranes, tachycardia, hypotension), nausea fever and vomiting may co exist this initial phase of illness.

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 cause37 [43-44]. 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 udakodara38.

Image 02: Sira janma in udara

Water intoxication and edema are the two distinct clinical implications of over hydration. Excessive intake of plain water without adequate solutes causes abnormal increase in extracellular fluid with deficient sodium. This in turn causes movement of fluid into the cell to maintain the salt balance. Thus, resulting in cellular edema which in turn causes the clinical manifestation of water intoxication and it is a fatal condition. Contrary to this over hydration with adequate intake of sodium leads to increase in the fluid within the interstitial compartment due to excess of isotonic volume excess. The water does not diffuse into the cells as the solutes hold the water in the interstitial fluid compartment. Thus this will result in the edema. This edema is due to over hydration and is comparable to jalodara. Over hydration is observed in different clinical situations. As fluid supplementation is recommended in patients suffering from gastro enteritis, an excess of fluid intake may lead to over hydration. Identical to this, excessive fluid intake after any of the purification procedure may have similar sequel. Psychogenic polydipsia characterized by compulsive water drinking may sometimes lead to over hydration. This is also true in mentally challenged children. Individuals are likely to take large amount of fluids following long bouts of intensive exercise and will have the similar consequences of over hydration. Marathon runners are susceptible to excessive fluid intake while running and may prove incriminatory. Any physical activity leading to profuse sweating like working in extreme heat or humidity; may be followed by intake of excessive fluid to replace the loss. These situations with excessive fluid supplementation with adequate addition of salt and other solutes lead to edema39. Edema due to isotonic volume excess is characterized by weight gain, dependent edema, pitting edema, engorged neck vein, ascites, pericardial effusion, pleural effusion, increased blood pressure and congestive cardiac failure. [47]

Image03: Raji janma in udara

Image 04: Parivritta nābhi in udara

Image 05: Kutilopastha in udara

All types of udara are characterized by distension of the abdomen. Accumulation of the fluid in the abdomen is the common pathology in these conditions. But in the initial phases the collection of the fluid in the abdomen is due to the diffusion of chyle. This chyle is little as the impairment of agni is less severe. Also the little accumulation of the fluid is not detected clinically. In this state, in the absence of immediate effective treatment; morbid dosha tend to obliterate the external body channels that maintain the homeostasis of fluid in the body. The chyle is more liquefied. And more and more fluid is poured into the abdomen causing huge accumulation of the fluid in the abdomen. At this stage, accumulation of the fluid is clinically detected. Accordingly, the udara roga is distinguished into three stages. Identification of these stages is important and immediate energetic treatment should be planned lest all udara finally land in jalodara. Condition of ajātodaka, picchā and jātodaka are the three stages of udara . The course of primary as well as secondary peritonitis exhibits a typical progression. Initially the peritoneum gets inflamed and is characterized by abdominal pain and associated symptoms. This inflammation of the peritoneum is supervened by paralytic ileus. This paralytic ileus is responsible for the diminishing bowel sounds, gaseous distention of the abdomen and tympanic percussion note. This stage of peritonitis is the ajātodakavasthā of udara. As the inflammation continues gradually the fluid starts accumulating. The features of gaseous distension are going to be masked by the fluid accumulation. This phase of peritonitis is indicative of picchāvasthā of udara. 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 jātodakāvasthā of udara40 [48-49]. Current management:

Type Medicine Dose Time Anupana Vata dominant Dashamula kwatha 20-40 ml Apana kala (before meals) two times Water Surya kshara 800-1200 mg Morning Water Pitta dominant Suvarna shekhara 50-100 mg Apana kala Water Apamarga kshara 800-1200 mg Morning Water Kapha dominant Aarogyavardhini 250-500 mg Morning Milk Vajra kshara 800-1200 mg Morning Honey Yakrutodara-Plihodara Tamra kalpa 200-800 mg Morning Honey Gomutra 50-100 ml Morning Honey Tridoshaja Suvarna vasanta 200-400 mg Apana kala Honey Kumari asava 10-20 ml Apana kala Water Bhallatakasava 5-10 ml Samana kala Water Chhidrodara Surgery -- -- --

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 (दाशमूल): 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): ascitrs 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

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Charaka Samhita, elaborated by Charaka & Dridabala with jalpakalpataru commentary by gangadhara, 3rd part, kaviraja shri narendranathasen gupta; kaviraja shri balayichandrasen gupta, ed., 1st Edition, Culcutta , C.K.Sen and company ltd, Pp3828, Pg no 2825 39. C. Guyton, M.D; John E. Hall, Ph.D.Textbook of Medical Physiology ISBN 0-7216-0240-1E L; International Edition ISBN 0-8089-2317-X; eleventh edition pages1116, page 302 40. Anthony S. Fauci, et al Editor. Harrison’s princnciples of internal medicine. 17th edition. New York. McGraw-Hills. 2008. p 2739.Pg no 1912