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=== Introduction ===
=== Introduction ===
''Grahani'' and ''atisara'' - both manifest due to the vitiation of ''agni'' and share common features of impairment of digestion resulting in indigestion and loose motions. Therefore, this chapter should logically precede or succeed the chapter on ''grahani''. But it is described three chapters after that on ''grahani''. The reason for this unusual sequencing of these topics is that since ''pandu'' is a common symptom and sequelae of the malabsorption syndrome (''grahani''), the chapter on ''pandu'' follows ''grahani''. Now, dyspnea (''shwasa'') is a major symptom of ''pandu,'' and thus, follows the chapter on ''pandu''. Similarly, chapter on ''kasa'' (cough) follows ''shwasa'' because of their relationship. That explains the sequencing of ''grahani'' and ''atisara'' in [[Charaka Samhita]].
''Grahani'' and ''atisara'' - both manifest due to the vitiation of ''agni'' and share common features of impairment of digestion resulting in indigestion and loose motions. Therefore, this chapter should logically precede or succeed the chapter on ''grahani''. But it is described three chapters after that on ''grahani''. The reason for this unusual sequencing of these topics is that since ''pandu'' is a common symptom and sequelae of the malabsorption syndrome (''grahani''), the chapter on ''pandu'' follows ''grahani''. Now, dyspnea (''shwasa'') is a major symptom of ''pandu,'' and thus, follows the chapter on ''pandu''. Similarly, chapter on ''kasa'' (cough) follows ''shwasa'' because of their relationship. That explains the sequencing of ''grahani'' and ''atisara'' in [[Charak Samhita]].
Ayurveda considers ''atisara'' as a defense mechanism of the body to eject out any toxic material from it. Therefore, it is recommended that in ''amaja'' (or initial) state loose motions should not be checked. After evacuation of toxins from the body, fasting and digestive drugs are prescribed as a cure for milder forms of diarrhea. However, for other types of diarrhea, various preparations, diet and ''basti'' are advised. ''Picchabasti'' (mucilegue type of medicated enema) is prescribed particularly if blood accompanies the stool. Appropriate treatments for ulcer, suppuration of anus and prolapse of anus are dealt with, since these accompany the more complex forms of diarrhea.
Ayurveda considers ''atisara'' as a defense mechanism of the body to eject out any toxic material from it. Therefore, it is recommended that in ''amaja'' (or initial) state loose motions should not be checked. After evacuation of toxins from the body, fasting and digestive drugs are prescribed as a cure for milder forms of diarrhea. However, for other types of diarrhea, various preparations, diet and ''basti'' are advised. ''Picchabasti'' (mucilegue type of medicated enema) is prescribed particularly if blood accompanies the stool. Appropriate treatments for ulcer, suppuration of anus and prolapse of anus are dealt with, since these accompany the more complex forms of diarrhea.
*Depending upon the wholesomeness (''satmya'') of the patient, light food along with buttermilk or ''kanji'' (a sour drink), ''yavagu'' (thick gruel), ''tarpana'' (roasted flour of serials mixed with water), or alcoholic drink or honey should be given. Then gradually ''yavagu'' (thick gruel), ''vilepi'' (a sticky gruel), ''khanda'' (a sour appetiser), ''yusha'' (vegetable soup) and boiled rice mixed with meat soup which are prepared by adding digestive, stimulants and astringent (constipative) drugs should be given.
*Depending upon the wholesomeness (''satmya'') of the patient, light food along with buttermilk or ''kanji'' (a sour drink), ''yavagu'' (thick gruel), ''tarpana'' (roasted flour of serials mixed with water), or alcoholic drink or honey should be given. Then gradually ''yavagu'' (thick gruel), ''vilepi'' (a sticky gruel), ''khanda'' (a sour appetiser), ''yusha'' (vegetable soup) and boiled rice mixed with meat soup which are prepared by adding digestive, stimulants and astringent (constipative) drugs should be given.
Ingredients which are ''dipana'' (digestive stimulant) and ''grahi'' (constipating) are described in [[Charaka Samhita]] [[Sutra Sthana]] 4: 9 should be administered [23-25]
Ingredients which are ''dipana'' (digestive stimulant) and ''grahi'' (constipating) are described in [[Charak Samhita]] [[Sutra Sthana]] 4: 9 should be administered [23-25]
==== Treatment of ''vataja atisara'' ====
==== Treatment of ''vataja atisara'' ====
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē'tisāracikitsitaṁ nāmaikōnaviṁśō'dhyāyaḥ||19||
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē'tisāracikitsitaṁ nāmaikōnaviṁśō'dhyāyaḥ||19||
Thus, ends the nineteenth chapter of [[Chikitsa Sthana]] (section on the treatment of diseases) dealing with the treatment of ''atisara'' (diarrhea) in the work of Agnivesha as redacted by Charaka [19]
Thus, ends the nineteenth chapter of [[Chikitsa Sthana]] (section on the treatment of diseases) dealing with the treatment of ''atisara'' (diarrhea) in the work of Agnivesha as redacted by Charak [19]
=== ''Tattva Vimarsha'' ===
=== ''Tattva Vimarsha'' ===
A combination of ''musta'' (cyperus rotundus), ''ativisha'' (aconitum heterophyllum), ''kutaja'' (holarrhena antidysenterica), ''chitraka'' (plumbago zeylanica) and ''bilva'' (Aegle marmelos) was found effective in management of ''atisara''.<ref>Sridhar B.N., Gopakumar K., Jaya N. Mustadi yoga-A new preparation for treatment of atisara. Aryavaidyan,10(4).May-July 1997;222-225. </ref>
A combination of ''musta'' (cyperus rotundus), ''ativisha'' (aconitum heterophyllum), ''kutaja'' (holarrhena antidysenterica), ''chitraka'' (plumbago zeylanica) and ''bilva'' (Aegle marmelos) was found effective in management of ''atisara''.<ref>Sridhar B.N., Gopakumar K., Jaya N. Mustadi yoga-A new preparation for treatment of atisara. Aryavaidyan,10(4).May-July 1997;222-225. </ref>
''Kutaja'' is widely used and first preferred drug in management of ''atisara''. It is mainly indicated in conditions of vitiated ''kapha-pitta'' and as a ''sangrahi'' (styptic) and ''shoshana'' (absorbent)(Charaka sutra 25/40). In an in-vitro study, sterile double dilution aqueous extract of ''kutaja'' was found effective to inhibit growth of E. coli, staphylococcus aureus, salmonella Typhi.<ref>Shrivastava Niraj, Saxena Varsha. Antibacterial activity of Kutaja(Holarrhena antidysenterica Linn.) in childhood diarrhea:-In vitro study. The Pharma Innovation Journal 2015;4(4):97-99 .</ref> Thus ''kutaja'' can be used for all purpose in management of ''atisara''.
''Kutaja'' is widely used and first preferred drug in management of ''atisara''. It is mainly indicated in conditions of vitiated ''kapha-pitta'' and as a ''sangrahi'' (styptic) and ''shoshana'' (absorbent)(Charak sutra 25/40). In an in-vitro study, sterile double dilution aqueous extract of ''kutaja'' was found effective to inhibit growth of E. coli, staphylococcus aureus, salmonella Typhi.<ref>Shrivastava Niraj, Saxena Varsha. Antibacterial activity of Kutaja(Holarrhena antidysenterica Linn.) in childhood diarrhea:-In vitro study. The Pharma Innovation Journal 2015;4(4):97-99 .</ref> Thus ''kutaja'' can be used for all purpose in management of ''atisara''.
Nitin Salve and Debendranath Mishra studied the botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhea.<ref>Nitin Salve, Debendranath Mishra. Botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhoea. Anc Sci Life.2016 Apr-Jun:35(4):195-200 </ref>
Nitin Salve and Debendranath Mishra studied the botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhea.<ref>Nitin Salve, Debendranath Mishra. Botanical identification of plants described in text Madhava chikitsa for the treatment of diarrhoea. Anc Sci Life.2016 Apr-Jun:35(4):195-200 </ref>
=== Further reading ===
=== Further reading ===
#Charaka Samhita (700 BC) with English Translation and Critical exposition (Volume IV). Sharma R.K. and Dash B., Chaukhambha Sanskrit Series Office, Varanasi.pages-202-242
#Charak Samhita (700 BC) with English Translation and Critical exposition (Volume IV). Sharma R.K. and Dash B., Chaukhambha Sanskrit Series Office, Varanasi.pages-202-242
#Valiathan, M.S. (2009): Legacy of Charaka, Sushruta, Vagbhata, Orient Longman, Chennai.
#Valiathan, M.S. (2009): Legacy of Charak, Sushruta, Vagbhata, Orient Longman, Chennai.
#Sushruta. Sushruta Samhita. Volume III, Uttarasthana, translated by Prof. K.R. Srikatha Murthy, Varanasi, Chaukhambha Orientalia; 2005.p.223-250.
#Sushruta. Sushruta Samhita. Volume III, Uttarasthana, translated by Prof. K.R. Srikatha Murthy, Varanasi, Chaukhambha Orientalia; 2005.p.223-250.
#Parameswarappa’s ĀyurvedÍya Vikriti Vijñāna and Roga Vijñāna by Dr. P.S. Byadgi. Volume II, pages-431-446
#Parameswarappa’s ĀyurvedÍya Vikriti Vijñāna and Roga Vijñāna by Dr. P.S. Byadgi. Volume II, pages-431-446