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Atisara Chikitsa (view source)

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=== Sanskrit Text, Transliteration and English Translation ===

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अथातोऽतीसारचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātō'tīsāracikitsitaṁ vyākhyāsyāmaḥ||1||

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We shall now illustrate the chapter on the management of ''atisara'' (diarrhea). Thus, said lord Atreya [1-2]

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</div></div>

==== Query by Agnivesha ====

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भगवन्तंखल्वात्रेयंकृताह्निकंहुताग्निहोत्रमासीनमृषिगणपरिवृतमुत्तरेहिमवतःपार्श्वेविनयादुपेत्याभिवाद्यचाग्निवेशउवाच-

भगवन्! अतीसारस्यप्रागुत्पत्तिनिमित्तलक्षणोपशमनानिप्रजानुग्रहार्थमाख्यातुमर्हसीति ||३||

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bhagavantaṁ khalvātrēyaṁ kr̥tāhnikaṁ hutāgnihōtramāsīnamr̥ṣigaṇaparivr̥tamuttarē himavataḥ pārśvēvinayādupētyābhivādya cāgnivēśa uvāca

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bhagavantaM khalvAtreyaM kRutAhnikaM hutAgnihotramAsInamRuShigaNaparivRutamuttare himavataHpArshve vinayAdupetyAbhivAdya cAgnivesha uvAca-

bhagavan! atIsArasyaprAgutpattinimittalakShaNopashamanAni prajAnugrahArthamAkhyAtumarhasIti||3||

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</div></div>

On one occasion, when Lord Atreya was sitting on the northern slope of the Himalayas surrounded by the sages after completing his daily worship and oblations to the fire, Agnivesha approached him, offered his humble salutations to him, and requested him to expound the origin, etiology, signs and symptoms, and treatment of ''atisara'' (diarrhea) for the well-being of humanity [3]

==== Historical origins of ''atisara'' ====

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अथभगवान्पुनर्वसुरात्रेयस्तदग्निवेशवचनमनुनिशम्योवाच- श्रूयतामग्निवेश! सर्वमेतदखिलेनव्याख्यायमानम् | <br />

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अतश्चप्रत्यवरकालंपृषध्रेणदीर्घसत्रेणयजतापशूनामलाभाद्गवामालम्भःप्रवर्तितः | <br />

तंदृष्ट्वाप्रव्यथिताभूतगणाः, तेषांचोपयोगादुपाकृतानांगवांगौरवादौष्ण्यादसात्म्यत्वादशस्तोपयोगाच्चोपहताग्नीनामुपहतमनसां[१]चातीसारःपूर्वमुत्पन्नःपृषध्रयज्ञे ||४|| <br />

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atha bhagavān punarvasurātrēyastadagnivēśavacanamanuniśamyōvāca- śrūyatāmagnivēśa!sarvamētadakhilēna vyākhyāyamānam| <br />

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atashca pratyavarakAlaM pRuShadhreNa dIrghasatreNa yajatA pashUnAmalAbhAdgavAmAlambhaHpravartitaH| <br />

taM dRuShTvA pravyathitA bhUtagaNAH, teShAM copayogAdupAkRutAnAM gavAMgauravAdauShNyAdasAtmyatvAdashastopayogAccopahatAgnInAmupahatamanasAM [1] cAtIsAraHpUrvamutpannaH pRuShadhrayaj~je||4|| <br />

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</div></div>

After consideration of the above submission of Agnivesha, Lord Punarvasu said, “O Agnivesha, listen to me. I shall give a detailed response to your question.

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==== ''Vataja atisara'' ====

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अथावरकालंवातलस्यवातातपव्यायामात्रनिषेविणोरूक्षाल्पप्रमिताशिनस्तीक्ष्णमद्यव्यवायनित्यस्योदावर्तयतश्चवेगान्वायुःप्रकोपमापद्यते, पक्ताचोपहन्यते; सवायुःकुपितोऽग्नावुपहतेमूत्रस्वेदौपुरीषाशयमुपहृत्य, ताभ्यांपुरीषंद्रवीकृत्य, अतीसारायप्रकल्पते | <br />

तस्यरूपाणि- विज्जलमामंविप्लुतमवसादिरूक्षंद्रवंसशूलमामगन्धमीषच्छब्दमशब्दंवाविबद्धमूत्रवातमतिसार्यतेपुरीषं, वायुश्चान्तःकोष्ठेसशब्दशूलस्तिर्यक्चरतिविबद्धइत्यामातिसारोवातात् | <br />

पक्वंवाविबद्धमल्पाल्पंसशब्दंसशूलफेनपिच्छापरिकर्तिकंहृष्टरोमाविनिःश्वसञ्शुष्कमुखःकट्यूरुत्रिकजानुपृष्ठपार्श्वशूलीभ्रष्टगुदोमुहुर्मुहुर्विग्रथितमुपवेश्यतेपुरीषंवातात्; तमाहुरनुग्रथितमित्येके, वातानुग्रथितवर्चस्त्वात् ||५||<br />

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athāvarakālaṁ vātalasya vātātapavyāyāmātimātraniṣēviṇōrūkṣālpapramitāśinastīkṣṇamadyavyavāyanityasyōdāvartayataśca vēgān vāyuḥ prakōpamāpadyatē, paktācōpahanyatē; sa vāyuḥ kupitō'gnāvupahatē mūtrasvēdau purīṣāśayamupahr̥tya, tābhyāṁ purīṣaṁdravīkr̥tya, atīsārāya prakalpatē| <br />

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tasya rUpANi- vijjalamAmaM viplutamavasAdi rUkShaM dravaMsashUlamAmagandhamIShacchabdamashabdaM vA vibaddhamUtravAtamatisAryate purIShaM,vAyushcAntaHkoShThe sashabdashUlastiryak carati vibaddha ityAmAtisAro vAtAt| <br />

pakvaM vA vibaddhamalpAlpaM sashabdaM sashUlaphenapicchAparikartikaM hRuShTaromA viniHshvasa~jshuShkamukhaH kaTyUrutrikajAnupRuShThapArshvashUlI bhraShTagudomuhurmuhurvigrathitamupaveshyate purIShaM vAtAt; tamAhuranugrathitamityeke,vAtAnugrathitavarcastvAt||5|| <br />

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</div></div>

*''Vata'' dominant ''atisara'' occurs if a person with ''vata'' dominant constitution indulges in following: Exposure to strong wind, excess sunlight, and physical exercise;

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==== ''Pittaja atisara'' ====

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पित्तलस्यपुनरम्ललवणकटुकक्षारोष्णतीक्ष्णातिमात्रनिषेविणःप्रतताग्निसूर्यसन्तापोष्णमारुतोपहतगात्रस्यक्रोधेर्ष्याबहुलस्यपित्तंप्रकोपमापद्यते | <br />

तत्प्रकुपितंद्रवत्वादूष्माणमुपहत्यपुरीषाशयविसृतमौष्ण्याद्द्रवत्वात्सरत्वाच्चभित्त्वापुरीषमतिसारायप्रकल्पते | <br />

तस्यरूपाणि- हारिद्रंहरितंनीलंकृष्णंरक्तपित्तोपहितमतिदुर्गन्धमतिसार्यते[१]पुरीषं, तृष्णादाह स्वेद मूर्च्छाशूलब्रध्नसन्तापपाकपरीतइतिपित्तातिसारः ||६|| <br />

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pittalasya punaramlalavaṇakaṭukakṣārōṣṇatīkṣṇātimātraniṣēviṇaḥpratatāgnisūryasantāpōṣṇamārutōpahatagātrasya krōdhērṣyābahulasya pittaṁ prakōpamāpadyatē| <br />

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tasya rUpANi- hAridraM haritaM nIlaM

kRuShNaM raktapittopahitamatidurgandhamatisAryate [1] purIShaM,tRuShNAdAhasvedamUrcchAshUlabradhnasantApapAkaparIta iti pittAtisAraH||6|| <br />

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</div></div>

A person of ''pittaja'' constitution, by indulging in the following etiological factors, gets afflicted by ''pittaja atisara'':

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==== ''Kaphaja atisara'' ====

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श्लेष्मलस्यतुगुरुमधुरशीतस्निग्धोपसेविनःसम्पूरकस्याचिन्तयतोदिवास्वप्नपरस्यालसस्यश्लेष्माप्रकोपमापद्यते | <br />

सस्वभावाद्गुरुमधुरशीतस्निग्धःस्रस्तोऽग्निमुपहत्य सौम्यस्वभावात्पुरीषाशयमुपहत्यो पक्लेद्यपुरीषमतिसारायकल्पते | <br />

तस्यरूपाणि- स्निग्धंश्वेतंपिच्छिलंतन्तुमदामंगुरुदुर्गन्धंश्लेष्मोपहितमनुबद्धशूलमल्पाल्पमभीक्ष्णमतिसार्यतेसप्रवाहिकं, गुरूदरगुदबस्तिवङ्क्षणदेशःकृतेऽप्यकृतसञ्ज्ञःसलोमहर्षःसोत्क्लेशोनिद्रालस्यपरीतःसदनोऽन्नद्वेषीचेतिश्लेष्मातिसारः ||७||

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ślēṣmalasya tu gurumadhuraśītasnigdhōpasēvinaḥ sampūrakasyācintayatō divāsvapnaparasyālasasyaślēṣmā prakōpamāpadyatē| <br />

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sa svabhAvAd gurumadhurashItasnigdhaH srasto~agnimupahatya saumyasvabhAvAtpurIShAshayamupahatyopakledya purIShamatisArAya kalpate| <br />

tasya rUpANi- snigdhaM shvetaM picchilaM tantumadAmaM guru durgandhaMshleShmopahitamanubaddhashUlamalpAlpamabhIkShNamatisAryate sapravAhikaM,gurUdaragudabastiva~gkShaNadeshaH kRute~apyakRutasa~jj~jaH salomaharShaH sotkleshonidrAlasyaparItaH sadano~annadveShI ceti shleShmAtisAraH||7|| <br />

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</div></div>

A person of ''kaphaja'' type of constitution indulging in the following factors experiences the manifestation of ''kaphaja atisara'':

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==== ''Sannipataja atisara'' ====

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अतिशीतस्निग्धरूक्षोष्णगुरुखरकठिनविषमविरुद्धासात्म्यभोजनादभोजनात्कालातीतभोजनाद्यत्किञ्चिदभ्यवहरणात्प्रदुष्टमद्यपानीयपानादतिमद्यपानादसंशोधनात्प्रतिकर्मणांविषमगमनादनुपचाराज्ज्वलनादित्यपवनसलिलातिसेवनादस्वप्ना- दतिस्वप्नाद्वेगविधारणादृतुविपर्ययादयथाबलमारम्भाद्भयशोकचित्तोद्वेगातियोगात्कृमिशोषज्वरार्शोविकारातिकर्षणाद्वाव्यापन्नाग्नेस्त्रयोदोषाःप्रकुपिताभूयएवाग्निमुपहत्यपक्वाशयमनुप्रविश्यातीसारंसर्वदोषलिङ्गंजनयन्ति ||८||

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atiśītasnigdharūkṣōṣṇagurukharakaṭhinaviṣamaviruddhāsātmyabhōjanādabhōjanāt kālātītabhōjanādyatkiñcidabhyavaharaṇāt praduṣṭamadyapānīyapānādatimadyapānādasaṁśōdhanāt pratikarmaṇāṁviṣamagamanādanupacārājjvalanādityapavanasalilātisēvanādasvapnā-datisvapnādvēgavidhāraṇādr̥tuviparyayādayathābalamārambhādbhayaśōkacittōdvēgātiyōgātkr̥miśōṣajvarārśōvikārātikarṣaṇādvā vyāpannāgnēstrayō dōṣāḥ prakupitā bhūya ēvāgnimupahatyapakvāśayamanupraviśyātīsāraṁ sarvadōṣaliṅgaṁ janayanti||8||

atishItasnigdharUkShoShNagurukharakaThinaviShamaviruddhAsAtmyabhojanAdabhojanAtkAlAtItabhojanAd yatki~jcidabhyavaharaNAtpraduShTamadyapAnIyapAnAdatimadyapAnAdasaMshodhanAt pratikarmaNAMviShamagamanAdanupacArAjjvalanAdityapavanasalilAtisevanAdasvapnA-datisvapnAdvegavidhAraNAdRutuviparyayAdayathAbalamArambhAdbhayashokacittodvegAtiyogAtkRumishoShajvarArshovikArAtikarShaNAdvA vyApannAgnestrayo doShAH prakupitA bhUyaevAgnimupahatya pakvAshayamanupravishyAtIsAraM sarvadoShali~ggaM janayanti||8||

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</div></div>

The causative factors of ''sannipataja atisara'' (diarrhea caused by the simultaneous vitiation of all the three ''doshas'') are as follows:

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==== Signs and symptoms of ''sannipataja atisara'' ====

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अपिचशोणितादीन्धातूनतिप्रकृष्टं[१]दूषयन्तोधातुदोषस्वभावकृतानतीसारवर्णानुपदर्शयन्ति | <br />

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तृष्णादाहज्वरभ्रमतमकहिक्काश्वासानुबन्धमतिवेदनमवेदनंवास्रस्तपक्वगुदंपतितगुदवलिंमुक्तनालमतिक्षीणबलमांसशोणितं

सर्वपर्वास्थिशूलिनमरोचकारतिप्रलापसम्मोहपरीतंसहसोपरतविकारमतिसारिणमचिकित्स्यंविद्यात्; इतिसन्निपातातिसारः ||९||

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api ca śōṇitādīn dhātūnatiprakr̥ṣṭaṁ [1] dūṣayantō dhātudōṣasvabhāvakr̥tānatīsāravarṇānupadarśayanti| <br />

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tatra shoNitAdiShu dhAtuShvatipraduShTeShu hAridraharitanIlamA~jjiShThamAMsadhAvanasannikAshaMraktaM kRuShNaM shvetaM varAhabhedaHsadRushamanubaddhavedanamavedanaM vAsamAsavyatyAsAdupaveshyate shakRud grathitamAmaM sakRut, sakRudapipakvamanatikShINamAMsashoNitabalo mandAgnirvihatamukharasashca; tAdRushamAturaMkRucchrasAdhyaM vidyAt| <br />

ebhirvarNairatisAryamANaM sopadravamAturamasAdhyo~ayamiti pratyAcakShIta; tadyathA-pakvashoNitAbhaM [2] yakRutkhaNDopamaM medomAMsodakasannikAshaMdadhighRutamajjatailavasAkShIravesavArAbhamatinIlamatiraktamatikRuShNamudakamivAcchaMpunarmecakAbhamatisnigdhaM haritanIlakaShAyavarNaM karburamAvilaM picchilaM tantumadAmaMcandrakopagatamatikuNapapUtipUyagandhyAmAmamatsyagandhi makShikAkAntaM [3]kuthitabahudhAtusrAvamalpapurIShamapurIShaM vA~atisAryamANaMtRuShNAdAhajvarabhramatamakahikkAshvAsAnubandhamativedanamavedanaM vA srastapakvagudaMpatitagudavaliM muktanAlamatikShINabalamAMsashoNitaMsarvaparvAsthishUlinamarocakAratipralApasammohaparItaM sahasoparatavikAramatisAriNamacikitsyaMvidyAt; iti sannipAtAtisAraH||9||

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</div></div>

The three aggravated ''doshas'' cause excessive vitiation of ''dhatus'' (tissue elements, e.g., ''rakta'' (blood)), resulting in the appearance of different colors (in the stool). The nature of these colors depends upon the nature of the vitiated ''dhatus'' and ''doshas''.

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==== Guidelines for starting treatment ====

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तमसाध्यतामसम्प्राप्तंचिकित्सेद्यथाप्रधानोपक्रमेणहेतूपशयदोषविशेषपरीक्षयाचेति ||१०||

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tamasādhyatāmasamprāptaṁ cikitsēd yathāpradhānōpakramēṇa hētūpaśayadōṣaviśēṣaparīkṣayācēti||10||

tamasAdhyatAmasamprAptaM cikitsed yathApradhAnopakrameNa hetUpashayadoShavisheShaparIkShayAceti||10||

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</div></div>

The patient who has not yet reached the stage of absolute incurability should be properly treated after the examination of causative factors, ''upashaya'' (pacifying factors) and nature of the aggravation of specific ''dosha''. In this condition, the most aggravated ''dosha'' should be treated in the beginning followed by the treatment of the other less aggravated ''doshas''. [10]

==== Exogenous (psychological) diarrhea ====

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आगन्तूद्वावतीसारौमानसौभयशोकजौ | <br />

तत्तयोर्लक्षणंवायोर्यदतीसारलक्षणम् ||११||<br />

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āgantū dvāvatīsārau mānasau bhayaśōkajau| <br />

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AgantU dvAvatIsArau mAnasau bhayashokajau| <br />

tattayorlakShaNaM vAyoryadatIsAralakShaNam||11||<br />

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</div></div>

The exogenous type of ''atisara'' (diarrhea) is of mental origin and is of two types. One of these is caused by fear and the other is caused by grief. Their signs and symptoms are similar to those of the ''vatika'' type of ''atisara''. Thus ''atisara'' or diarrhea is of two types, viz., ''nija'' or endogenous (like ''vataja, pittaja, kaphaja'' and ''sannipataja atisara'' and ''agantuja/manasa'' or exogenous [11]

==== Management of exogenous (psychological) diarrhea ====

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मारुतोभयशोकाभ्यांशीघ्रंहिपरिकुप्यति | <br />

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इत्युक्ताःषडतीसाराः, साध्यानांसाधनंत्वतः | <br />

प्रवक्ष्याम्यनुपूर्वेणयथावत्तन्निबोधत ||१३||<br />

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mārutō bhayaśōkābhyāṁ śīghraṁ hi parikupyati| <br />

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ityuktAH ShaDatIsArAH, sAdhyAnAM sAdhanaM tvataH| <br />

pravakShyAmyanupUrveNa yathAvattannibodhata||13|| <br />

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</div></div>

The following therapies help to cure ''agantuja/manasa'' or exogenous:

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==== Principles of treatment ====

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दोषाःसन्निचितायस्यविदग्धाहारमूर्च्छिताः | <br />

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प्रमथ्यांमध्यदोषाणांदद्याद्दीपनपाचनीम् | <br />

लङ्घनंचाल्पदोषाणांप्रशस्तमतिसारिणाम् ||१९||<br />

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dōṣāḥ sannicitā yasya vidagdhāhāramūrcchitāḥ| <br />

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pramathyAM madhyadoShANAM dadyAddIpanapAcanIm| <br />

la~gghanaM cAlpadoShANAM prashastamatisAriNAm||19|| <br />

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</div></div>

The following principles of treatment are used in management of ''atisara'':

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==== Recipes of ''pramathya'' ====

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पिप्पलीनागरंधान्यंभूतीकमभयावचा | <br />

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वचाप्रतिविषाभ्यांवामुस्तपर्पटकेनवा | <br />

ह्रीवेरशृङ्गवेराभ्यांपक्वंवापाययेज्जलम् ||२२||<br />

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pippalī nāgaraṁ dhānyaṁ bhūtīkamabhayā vacā| <br />

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vacAprativiShAbhyAM vA mustaparpaTakena vA| <br />

hrIverashRu~ggaverAbhyAM pakvaM vA pAyayejjalam||22||<br />

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</div></div>

Three recipes of ''pramathya'' which are useful in the treatment of diarrhea are as follow:

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==== Diet and drinks for ''atisara'' patient ====

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युक्तेऽन्नकालेक्षुत्क्षामंलघून्यन्नानिभोजयेत् | <br />

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यवागूभिर्विलेपीभिःखडैर्यूषैरसौदनैः | <br />

दीपनग्राहिसंयुक्तैःक्रमश्चस्यादतःपरम् ||२५||<br />

+

yuktē'nnakālē kṣutkṣāmaṁ laghūnyannāni bhōjayēt| <br />

Line 456: Line 497:

yavAgUbhirvilepIbhiH khaDairyUShai rasaudanaiH| <br />

dIpanagrAhisaMyuktaiH kramashca syAdataH param||25|| <br />

+

</div></div>

*At appropriate meal time, if the patient feels hungry, light food should be given to eat. It enhances the appetite and stimulates agni and as a result the strength is promoted immediately.

Line 463: Line 505:

==== Treatment of ''vataja atisara'' ====

+

शालपर्णींपृश्निपर्णींबृहतींकण्टकारिकाम् | <br />

Line 475: Line 518:

वातश्लेष्महरोह्येषगणोदीपनपाचनः | <br />

ग्राहीबल्योरोचनश्चतस्माच्छस्तोऽतिसारिणाम् ||२९||<br />

+

śālaparṇīṁ pr̥śniparṇīṁ br̥hatīṁ kaṇṭakārikām| <br />

Line 499: Line 543:

vAtashleShmaharo hyeSha gaNo dIpanapAcanaH| <br />

grAhI balyo rocanashca tasmAcchasto~atisAriNAm||29|| <br />

+

</div></div>

The following drugs are useful for the cure of ''vataja atisara'' (diarrhea):

Line 505: Line 550:

==== Management of diarrhea associated with pain ====

+

आमेपरिणतेयस्तुविबद्धमतिसार्यते | <br />

Line 517: Line 563:

लोणिकायाःसपाठायाःशुष्कशाकेनवापुनः | <br />

दधिदाडिमसिद्धेनबहुस्नेहेनभोजयेत् ||३३||<br />

+

āmē pariṇatē yastu vibaddhamatisāryatē| <br />

Line 541: Line 588:

loNikAyAH sapAThAyAH shuShkashAkena vA punaH| <br />

dadhidADimasiddhena bahusnehena bhojayet||33|| <br />

+

</div></div>

After the maturity of ''ama'' (product of indigestion), if the patient experiences loose motions along with scybalous feces associated with colic pain and mucus very frequently in small quantities, and if there is griping pain, then he should be given food along with the soup of ''mulaka, badara, upodikā, kshirini, yavāni, vāstuka, suvarchala, chanchu'' (''nadika''), leaves of ''avalguja, shati, karkaruka, jivanti, chirbhata'' (karkati), ''lonika, patha'' or ''shushka-shaka'' (''kasamarda'' according to Chakrapani). These soups should be cooked along with curd (yogurt) and ''dadima'', and added with ghee in copious quantities [30-33]

==== Treatment of ''pravahika'' (dysentery) ====

+

कल्कःस्याद्बालबिल्वानांतिलकल्कश्चतत्समः | <br />

दध्नःसरोऽम्लस्नेहाद्यःखडोहन्यात्प्रवाहिकाम् ||३४|| <br />

+

kalkaḥ syādbālabilvānāṁ tilakalkaśca tatsamaḥ| <br />

Line 554: Line 604:

kalkaH syAdbAlabilvAnAM tilakalkashca tatsamaH| <br />

dadhnaH saro~amlasnehAdyaH khaDo hanyAt pravAhikAm||34|| <br />

+

</div></div>

The following ''khada'' (a sour appetizer) cures ''pravahika'' (dysentery):

Line 560: Line 611:

==== Treatment of ''varcha-kshaya'' (scanty formation of stool) ====

+

यवानांमुद्गमाषाणांशालीनांचतिलस्यच | <br />

Line 581: Line 633:

ओदनं[१]रक्तशालीनांतेनाद्यात्प्रपिबेच्चतत् | <br />

तथावर्चःक्षयकृतैर्व्याधिभिर्विप्रमुच्यते ||४१||<br />

+

yavānāṁ mudgamāṣāṇāṁ śālīnāṁ ca tilasya ca| <br />

Line 623: Line 676:

odanaM [1] raktashAlInAM tenAdyAt prapibecca tat| <br />

tathA varcaHkShayakRutairvyAdhibhirvipramucyate||41||<br />

+

</div></div>

If there is ''varcha-kshaya'' (scanty stool), then the patient should be given the following recipes:

Line 631: Line 685:

==== Treatment of prolapse of rectum ====

+

गुदनिःसरणेशूलेपानमम्लस्यसर्पिषः | <br />

प्रशस्यतेनिरामाणामथवाऽप्यनुवासनम् ||४२|| <br />

+

gudaniḥsaraṇē śūlē pānamamlasya sarpiṣaḥ| <br />

Line 640: Line 696:

gudaniHsaraNe shUle pAnamamlasya sarpiShaH| <br />

prashasyate nirAmANAmathavA~apyanuvAsanam||42|| <br />

+

</div></div>

If there is prolapse of rectum and colic pain, and if the diarrhea is free from ''ama'', then the patient should be given medicated ghee prepared with sour drugs or ''anuvasana'' (unctuous enema). [42]

==== ''Changeri ghritam'' ====

+

चाङ्गेरीकोलदध्यम्लनागरक्षारसंयुतम् | <br />

घृतमुत्क्वथितंपेयंगुदभ्रंशरुजापहम् ||४३|| <br />

इतिचाङ्गेरीघृतम् | <br />

+

cāṅgērīkōladadhyamlanāgarakṣārasaṁyutam| <br />

Line 656: Line 715:

ghRutamutkvathitaM peyaM gudabhraMsharujApaham||43|| <br />

iti cA~ggerIghRutam| <br />

+

</div></div>

Ghee should be cooked with the juice of ''changeri'', decoction of ''kola'' and sour curd, and the paste of ''nagara'' and ''kshara'' (alkali preparation). Intake of this medicated ghee cures ailments caused by prolapse of rectum. Thus, ends the description of ''changeri-ghrita'' [43].

==== ''Chavyadi ghritam'' ====

+

सचव्यपिप्पलीमूलंसव्योषविडदाडिमम् |<br />

Line 665: Line 726:

इतिगुदभ्रंशेचव्यादिघृतम् | <br />

+

sacavyapippalīmūlaṁ savyōṣaviḍadāḍimam| <br />

Line 675: Line 737:

iti gudabhraMshe cavyAdighRutam| <br />

+

</div></div>

Ghee should be cooked with the sour ingredients (juice of ''changeri'', decoction of ''kola'' and sour curd), and the pastes of ''chavya'', ''pippali-mula, shunthi, pippali, maricha, vida'' and ''dadima''. Intake of this medicated ghee should be done along with ''dhanya, ajaji'' and ''chitraka'' in appropriate quantities (for curing prolapse of rectum)

Line 681: Line 744:

==== ''Anuvasana basti'' in prolapse of rectum ====

+

दशमूलोपसिद्धंवासबिल्वमनुवासनम् | <br />

Line 686: Line 750:

इतिगुदभ्रंशेऽनुवासनम् <br />

+

daśamūlōpasiddhaṁ vā sabilvamanuvāsanam| <br />

Line 696: Line 761:

iti gudabhraMshe~anuvAsanam| <br />

+

</div></div>

For the cure of prolapse rectum, ''anuvasana basti'' (oil-based enema therapy) should be administered with the following recipes:

Line 705: Line 771:

==== Management of strangulated prolapsed rectum ====

+

स्तब्धभ्रष्टगुदेपूर्वंस्नेहस्वेदौप्रयोजयेत् | <br />

सुस्विन्नंतंमृदूभूतंपिचुनासम्प्रवेशयेत् ||४६||<br />

+

stabdhabhraṣṭagudē pūrvaṁ snēhasvēdau prayōjayēt| <br />

Line 714: Line 782:

stabdhabhraShTagude pUrvaM snehasvedau prayojayet| <br />

susvinnaM taM mRudUbhUtaM picunA sampraveshayet||46|| <br />

+

</div></div>

If the prolapsed rectum becomes stiff or strangulated, and does not go inside of its own, then oil should be applied over it and fomentation should be given. Thereafter, when the prolapsed rectum is well fomented and has become soft, then with the help of a cotton pad (or pad made of thick cloth) it should be pushed inside and restored to its original place [46].

==== Use of medicated milk ====

+

विबद्धवातवर्चास्तुबहुशूलप्रवाहिकः | <br />

Line 727: Line 797:

एवंक्षीरप्रयोगेणरक्तंपिच्छाचशाम्यति | <br />

शूलंप्रवाहिकाचैवविबन्धश्चोपशाम्यति ||४९||<br />

+

vibaddhavātavarcāstu bahuśūlapravāhikaḥ| <br />

Line 745: Line 816:

evaM kShIraprayogeNa raktaM picchA ca shAmyati| <br />

shUlaM pravAhikA caiva vibandhashcopashAmyati||49|| <br />

+

</div></div>

If the movement of flatus and stool is blocked(constipated), if the patient suffers from various kinds of pain, if the patient passes blood and mucus, and if the patient is thirsty, then adequate quantity of milk should be administered. Such a patient should be given ''yamaka'' (ghee and oil mixed together), and thereafter, lukewarm milk collected directly from the udder (''dharoshna'').

Line 751: Line 823:

==== Treatment of ''pittaja atisara'' ====

+

पित्तातिसारंपुनर्निदानोपशयाकृतिभिरामान्वयमुपलभ्ययथाबलंलङ्घनपाचनाभ्यामुपाचरेत् | <br />

Line 757: Line 830:

मुद्गमसूरहरेणुमकुष्ठकाढकीयूषैर्वालावकपिञ्जलशशहरिणैणकालपुच्छकरसैरीषदम्लैरनम्लैर्वाक्रमशोऽग्निंसन्धुक्षयेत् | <br />

अनुबन्धेत्वस्यदीपनीयपाचनीयोपशमनीयसङ्ग्रहणीयान्योगान्सम्प्रयोजयेदिति ||५०|| <br />

+

pittātisāraṁ punarnidānōpaśayākr̥tibhirāmānvayamupalabhya yathābalaṁlaṅghanapācanābhyāmupācarēt| <br />

Line 769: Line 843:

mudgamasUrahareNumakuShThakADhakIyUShairvAlAvakapi~jjalashashahariNaiNakAlapucchakarasairIShadamlairanamlairvA kramasho~agniM sandhukShayet|<br />

anubandhe tvasya dIpanIyapAcanIyopashamanIyasa~ggrahaNIyAn yogAn samprayojayediti||50|| <br />

+

</div></div>

For the cure of ''pittaja atisara'', the following therapy should be administered:

Line 778: Line 853:

==== Recipes for ''pittaja atisara'' ====

+

सक्षौद्रातिविषंपिष्ट्वावत्सकस्यफलत्वचम् | <br />

Line 796: Line 872:

जीर्णोषधानांशस्यन्तेयथायोगंप्रकल्पितैः | <br />

रसैःसाङ्ग्राहिकैर्युक्ताःपुराणारक्तशालयः ||५६||<br />

+

sakṣaudrātiviṣaṁ piṣṭvā vatsakasya phalatvacam| <br />

Line 832: Line 909:

jIrNoShadhAnAM shasyante yathAyogaM prakalpitaiH| <br />

rasaiH sA~ggrAhikairyuktAH purANA raktashAlayaH||56|| <br />

+

</div></div>

The following recipes are useful in curing ''pittaja atisara'':

Line 844: Line 922:

==== Administration of milk ====

+

पित्तातिसारोदीपाग्नेःक्षिप्रंसमुपशाम्यति | <br />

Line 862: Line 941:

शतपुष्पावरीभ्यांचपयसामधुकेनच | <br />

तैलपादंघृतंसिद्धंसबिल्वमनुवासनम् ||६२||<br />

+

pittātisārō dīpāgnēḥ kṣipraṁ samupaśāmyati| <br />

Line 898: Line 978:

shatapuShpAvarIbhyAM ca payasA madhukena ca| <br />

tailapAdaM ghRutaM siddhaM sabilvamanuvAsanam||62||<br />

+

</div></div>

*Goat-milk administered to a patient having strong power of digestion cures ''pittaja atisara'' and promotes strength as well as complexion.

Line 910: Line 991:

==== ''Piccha basti'' (slimy medicated enema) ====

+

कृतानुवासनस्यास्यकृतसंसर्जनस्यच | <br />

Line 928: Line 1,010:

पित्तातिसारज्वरशोथगुल्मजीर्णातिसारग्रहणीप्रदोषान् | <br />

जयत्ययंशीघ्रमतिप्रवृद्धान्विरेचनास्थापनयोश्चबस्तिः[२] ||६८||<br />

+

kr̥tānuvāsanasyāsya kr̥tasaṁsarjanasya ca| <br />

Line 964: Line 1,047:

pittAtisArajvarashothagulmajIrNAtisAragrahaNIpradoShAn| <br />

jayatyayaM shIghramatipravRuddhAn virecanAsthApanayoshca bastiH [2] ||68|| <br />

+

</div></div>

If diarrhea persists in spite of the administration of ''anuvasana basti'' and observing the ''samsarjana-krama'' (gradual administration of lighter to heavier food) then ''piccha basti'' (mucilaginous type of medicated enema) should be given.

Line 970: Line 1,054:

==== ''Raktatisara'' (bloody diarrhoea) ====

+

पित्तातिसारीयस्त्वेतांक्रियांमुक्त्वानिषेवते |<br />

Line 976: Line 1,061:

कुर्याद्रक्तातिसारंतुरक्तमाशुप्रदूषयेत् | <br />

तृष्णांशूलंविदाहंचगुदपाकंचदारुणम् ||७०||<br />

+

pittātisārī yastvētāṁ kriyāṁ muktvā niṣēvatē| <br />

Line 988: Line 1,074:

kuryAdraktAtisAraM tu raktamAshu pradUShayet| <br />

tRuShNAM shUlaM vidAhaM ca gudapAkaM ca dAruNam||70||<br />

+

</div></div>

If a ''pittaja atisara'' patient does not follow the therapeutic measures and resorts to such foods and drinks which cause aggravation of ''pitta'', then the excessively provoked ''pitta'' causes ''raktatisara'' and instantaneous vitiation of ''rakta'' (blood). This leads to serious complications like morbid thirst, colic pain, burning sensation and suppuration of the anus. It can also manifest itself directly on account of excessive aggravation of ''pitta'' and vitiation of blood [69-70]

==== Treatment of ''raktatisara'' ====

+

तत्रच्छागंपयःशस्तंशीतंसमधुशर्करम् | <br />

Line 1,010: Line 1,098:

दुर्बलंपाययित्वावातस्यैवोपरिभोजयेत् | <br />

प्राग्भक्तंनवनीतंवादद्यात्समधुशर्करम् ||७६||<br />

+

tatra cchāgaṁ payaḥ śastaṁ śītaṁ samadhuśarkaram| <br />

Line 1,046: Line 1,135:

durbalaM pAyayitvA vA tasyaivopari bhojayet| <br />

prAgbhaktaM navanItaM vA dadyAt samadhusharkaram||76|| <br />

+

</div></div>

For the treatment of ''raktatisara'', the following therapy should be administered:

Line 1,057: Line 1,147:

==== Measures to alleviate bleeding in ''raktatisara'' ====

+

प्राश्यक्षीरोत्थितंसर्पिःकपिञ्जलरसाशनः | <br />

Line 1,066: Line 1,157:

घृतंयवागूमण्डेनकुटजस्यफलैःशृतम् | <br />

पेयंतस्यानुपातव्यापेयारक्तोपशान्तये ||७९||<br />

+

prāśya kṣīrōtthitaṁ sarpiḥ kapiñjalarasāśanaḥ| <br />

Line 1,084: Line 1,176:

ghRutaM yavAgUmaNDena kuTajasya phalaiH shRutam| <br />

peyaM tasyAnu pAtavyA peyA raktopashAntaye||79|| <br />

+

</div></div>

*After taking ghee collected from the cream of milk along with milk, the patient should take the meat soup of ''kapinjala''. During this therapy, he should take milk in adequate quantity. It cures ''raktatisara'' in three days.

Line 1,090: Line 1,183:

==== Treatment of ''sannipataja atisara'' ====

+

त्वक्चदारुहरिद्रायाःकुटजस्यफलानिच | <br />

Line 1,096: Line 1,190:

षड्भिरेतैर्घृतंसिद्धंपेयामण्डावचारितम् | <br />

अतीसारंजयेच्छीघ्रंत्रिदोषमपिदारुणम् ||८१||<br />

+

tvak ca dāruharidrāyāḥ kuṭajasya phalāni ca| <br />

Line 1,108: Line 1,203:

ShaDbhiretairghRutaM siddhaM peyAmaNDAvacAritam| <br />

atIsAraM jayecchIghraM tridoShamapi dAruNam||81|| <br />

+

</div></div>

Ghee should be cooked by adding the six drugs, viz., the bark of ''daru-haridra'', fruits of ''kutaja, pippali, shringavera, draksa'' and ''katukarohini''. Intake of ''peya'' (thin gruel) and ''manda'' (very thin gruel) along with this medicated ghee cures a serious type of diarrhea even if caused by ''sannipata'' (simultaneous aggravation of all the three ''doshas'').[80-81]

==== Hemostatic recipes ====

+

कृष्णमृन्मधुकंशङ्खंरुधिरंतण्डुलोदकम् | <br />

Line 1,127: Line 1,224:

पीत्वासशर्कराक्षौद्रंचन्दनंतण्डुलाम्भसा | <br />

दाहतृष्णाप्रमेहेभ्योरक्तस्रावाच्चमुच्यते ||८६||<br />

+

kr̥ṣṇamr̥nmadhukaṁ śaṅkhaṁ rudhiraṁ taṇḍulōdakam| <br />

Line 1,157: Line 1,255:

pItvA sasharkarAkShaudraM candanaM taNDulAmbhasA| <br />

dAhatRuShNApramehebhyo raktasrAvAcca mucyate||86|| <br />

+

</div></div>

*Intake of ''krishnamrita'' (black earth), ''madhuka, shankha, rudhira'' (blood or ''kesara'') and rice-water, mixed with honey controls bleeding instantaneously.

Line 1,165: Line 1,264:

==== Treatment of anal suppuration ====

+

गुदोबहुभिरुत्थानैर्यस्यपित्तेनपच्यते | <br />

Line 1,185: Line 1,285:

कार्पाससङ्गृहीतेनसेचयेद्गुदवङ्क्षणम् |९३| <br />

+

gudō bahubhirutthānairyasya pittēna pacyatē| <br />

Line 1,225: Line 1,326:

kArpAsasa~ggRuhItena secayedgudava~gkShaNam|93| <br />

+

</div></div>

Aggravated ''pitta'' suppurates the anus due to frequent evacuation of stool. The anus of such a patient should be sprinkled and applied with the following recipes which stops bleeding and pacifies suppuration and pain.

Line 1,234: Line 1,336:

==== ''Pichcha-basti'' (mucilaginous enema) for dysentery ====

+

अल्पाल्पंबहुशोरक्तंसशूलमुपवेश्यते ||९३|| <br />

Line 1,244: Line 1,347:

तस्मादभीक्ष्णशस्तेषांगुदेस्नेहंप्रयोजयेत् |९६| <br />

+

alpālpaṁ bahuśō raktaṁ saśūlamupavēśyatē||93|| <br />

Line 1,264: Line 1,368:

tasmAdabhIkShNashasteShAM gude snehaM prayojayet|96| <br />

+

</div></div>

When the movement of the aggravated ''vata'' (flatus) gets obstructed or moves with difficulty or seizing of ''vata'' inside the abdomen, then the patient voids blood frequently in small quantities which is associated with pain. ''Piccha-basti'' should be administered to such patients. This type of patient may also be managed by ''anuvasana basti'' given with medicated ghee prepared with ''prapaundarika''. Because of chronic diarrhea, the anus of the patient generally becomes weak. Therefore cotton soaked in medicated ghee should be inserted into the anus frequently or ''anuvasana basti'' with medicated ghee is given [93-95½ ].

==== Medicated enema and recipes of linctus ====

+

पवनोऽतिप्रवृत्तोहिस्वेस्थानेलभतेऽधिकम् ||९६|| <br />

Line 1,284: Line 1,390:

अधोवायदिवाऽप्यूर्ध्वंयस्यरक्तंप्रवर्तते |१०१| <br />

+

pavanō'tipravr̥ttō hi svē sthānē labhatē'dhikam||96|| <br />

Line 1,316: Line 1,423:

adho vA yadi vA~apyUrdhvaM yasya raktaM pravartate|101| <br />

+

</div></div>

*The aggravated vata becomes stronger in its own site in ''atisara'' patients. For the pacification of aggravated ''vata'' associated with ''pitta'' (which takes place in bloody diarrhea), ''basti'' (both the ''anuvasana'' and ''niruha'' types) is the best therapy.

Line 1,322: Line 1,430:

==== Suppuration of anal sphincters ====

+

यस्त्वेवंदुर्बलोमोहात्पित्तलान्येवसेवते ||१०१|| <br />

दारुणंसवलीपाकंप्राप्यशीघ्रंविपद्यते |१०२|<br />

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yastvēvaṁ durbalō mōhāt pittalānyēva sēvatē||101|| <br />

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dAruNaM sa valIpAkaM prApya shIghraM vipadyate|102| <br />

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</div></div>

A patient who has become weak because of ''raktatisara'', if indulges in ''pitta''-aggravating ingredients out of ignorance, then the anal sphincters gets suppurated. This is a serious condition leading to instantaneous death [101½].

==== Treatment of ''kaphaja atisara'' ====

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श्लेष्मातिसारेप्रथमंहितंलङ्घनपाचनम् ||१०२|| <br />

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कट्फलंमधुयुक्तंवामुच्यतेजठरामयात् |११३| <br />

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ślēṣmātisārē prathamaṁ hitaṁ laṅghanapācanam||102|| <br />

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kaTphalaM madhuyuktaM vA mucyate jaTharAmayAt|113| <br />

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</div></div>

For the cure of ''kaphaja atisara'', following therapy and recipes should be administered:

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==== Management of complications of ''atisara'' ====

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कणांमधुयुतांपीत्वातक्रंपीत्वासचित्रकम् ||११३|| <br />

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पूर्वोक्तमम्लसर्पिर्वाषट्पलंवायथाबलम् | <br />

पुराणंवाघृतंदद्याद्यवागूमण्डमिश्रितम् ||११६||<br />

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kaṇāṁ madhuyutāṁ pītvā takraṁ pītvā sacitrakam||113|| <br />

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pUrvoktamamlasarpirvA ShaTpalaM vA yathAbalam| <br />

purANaM vA ghRutaM dadyAdyavAgUmaNDamishritam||116|| <br />

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</div></div>

*If the movement of ''vata'' (flatus) is obstructed resulting in colic pain and dysentery, then the patient should be given tender fruits of ''bilva'', jaggery, oil, ''pippali'' and ''shunthi''.

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==== ''Piccha-basti'' and ''anuvasana-basti'' ====

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वातश्लेष्मविबन्धेवाकफेवाऽतिस्रवत्यपि | <br />

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वचान्तैरथवाकल्कैस्तैलंपक्त्वाऽनुवासयेत् | <br />

बहुशःकफवातार्तस्तथासलभतेसुखम् ||१२०||<br />

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vātaślēṣmavibandhē vā kaphē vā'tisravatyapi| <br />

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vacAntairathavA kalkaistailaM paktvA~anuvAsayet| <br />

bahushaH kaphavAtArtastathA sa labhate sukham||120|| <br />

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</div></div>

For the cure of ''kaphaja'' and ''vataja''-predominant ''atisara'', the following therapy and recipes should be administered:

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==== Need for immediate control of ''vata'' ====

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स्वेस्थानेमारुतोऽवश्यंवर्धतेकफसङ्क्षये | <br />

सवृद्धःसहसाहन्यात्तस्मात्तंत्वरयाजयेत् ||१२१||<br />

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svē sthānē mārutō'vaśyaṁ vardhatē kaphasaṅkṣayē| <br />

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sve sthAne mAruto~avashyaM vardhate kaphasa~gkShaye| <br />

sa vRuddhaH sahasA hanyAttasmAttaM tvarayA jayet||121|| <br />

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</div></div>

When ''kapha'' gets reduced because of the above mentioned therapeutic measures, the ''vata'' undoubtedly gets aggravated in its own location (colon). This aggravated ''vata'' may cause instantaneous death and hence should be controlled without delay [121]

==== Principle of treatment of ''sannipataja atisara'' ====

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वातस्यानुजयेत्पित्तं, पित्तस्यानुजयेत्कफम् | <br />

त्रयाणांवाजयेत्पूर्वंयोभवेद्बलवत्तमः ||१२२||<br />

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vātasyānu jayēt pittaṁ, pittasyānu jayēt kapham| <br />

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vAtasyAnu jayet pittaM, pittasyAnu jayet kapham| <br />

trayANAM vA jayet pUrvaM yo bhavedbalavattamaH||122|| <br />

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</div></div>

For the cure of ''sannipataja atisara,'' following therapy and recipes should be administered:

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==== Summary ====

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तत्रश्लोकः-

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प्रागुत्पत्तिनिमित्तानिलक्षणंसाध्यतानच | <br />

क्रियाचावस्थिकीसिद्धानिर्दिष्टाह्यतिसारिणाम् ||१२३||<br />

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tatra ślōkaḥ-

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prAgutpattinimittAni lakShaNaM sAdhyatA na ca| <br />

kriyA cAvasthikI siddhA nirdiShTA hyatisAriNAm||123||<br />

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</div></div>

In this chapter, the following topics in respect of the patient suffering from ''atisara'' (diarrhea) are described:

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*Curability and incurability of ''atisara''

*Effective treatment for different stages of ''atisara'' [123].

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इत्यग्निवेशकृतेतन्त्रेचरकप्रतिसंस्कृतेचिकित्सास्थानेऽतिसारचिकित्सितंनामैकोनविंशोऽध्यायः ||१९||

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ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē'tisāracikitsitaṁ nāmaikōnaviṁśō'dhyāyaḥ||19||

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</div></div>

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]

Agnivesha

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Atisara Chikitsa (view source)

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