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The above mentioned five kinds of formulations should be consumed with comfortable warm water.

निवृत्तेष्वामशूलेषु यस्य न प्रगुणोऽनिलः |
स्तोकं स्तोकं रुजामच्च सशूलं योऽतिसार्यते ||५४||
सक्षारलवणैर्युक्तं मन्दाग्निः स पिबेद्घृतम् |
क्षीरनागरचाङ्गेरीकोलदध्यम्लसाधितम् ||५५||
सर्पिरच्छं पिबेद्वापि शूलातीसारशान्तये |
दध्ना तैलघृतं पक्वं सव्योषाजातिचित्रकैः ||५६||
सबिल्वपिप्पलीमूलदाडिमैर्वा रुगन्वितैः |
निखिलो विधिरुक्तोऽयं वातश्लेष्मोपशान्तये ||५७||

Ghee should be boiled and prepared with the below mentioned ingredients –

–        milk,

–        nagara,

–        cangeri,

–        kola and

–        dadhyamla

This ghee should be administered in the below mentioned conditions –

–        after the abdominal pain has subsided,

–        in persons in whom vata is not aggravated,

–        when faeces is expelled in small quantities and often, and

–        in presence of pain and poor digestive fire / power

Alternatively, plain ghee should be given for drinking.

These ghee would mitigate pain and diarrhoea.

Oil or ghee should be cooked with curd. It should be added with Vyosa, Ajaji, Citraka, Bilva, Pippalimula and Dadima. This should be administered to the patient suffering from pain.

The above said are the treatments beneficial for mitigating diarrhoea produced by vata-kapha i.e. combined aggravation of vata and kapha.

Pittätisära cikitsä

तीक्ष्णोष्णवर्ज्यमेनं तु विदध्यात्पित्तजे भिषक् |
यथोक्तमुपवासान्ते यवागूश्च प्रशस्यते ||५८||
बलयोरंशुमत्यां च श्वदंष्ट्रबृहतीषु च |
शतावर्यां च संसिद्धाः सुशीता मधुसंयुताः ||५९||
मुद्गादिषु च यूषाः स्युर्द्रव्यैरेतैः सुसंस्कृताः |६०|

Herbs having hot potency and penetrating qualities should not be prescribed by the physician while treating the diarrhoea produced by pitta. He should in fact advise the patient to do fasting and use of yavagu – thick gruels at the end.

The patient shall consume ghee boiled with the below mentioned herbs in a cold state, mixed with honey –

–        bala and amsumati,

–        svadamstra and brhati or

–        satavari

Alternatively, yusa – soup of mudga etc. processed with the same herbs mentioned above shall be consumed.

मृदुभिर्दीपनैस्तिक्तैर्द्रव्यैः स्यादामपाचनम् ||६०||
हरिद्रातिविषापाठावत्सबीजरसाञ्जनम् |
रसाञ्जनं हरिद्रे द्वे बीजानि कुटजस्य च ||६१||
पाठा गुडूची भूनिम्बस्तथैव कटुरोहिणी |
एतैः श्लोकार्धनिर्दिष्टैः क्वाथाः स्युः पित्तपाचनाः ||६२||

Ama would get digested when the herbs which augment hunger mildly and predominantly have a bitter taste are administered.

To digest ama associated with pitta, the decoctions of herbs mentioned in the below mentioned half verses may be used –

1.   Haridra, Ativisa, Patha, Vatsabija and Rasanjana,
2.   Rasanjana, two kinds of Haridra and Kutaja Bija,
3.   Patha, Guduci, Bhunimba and Katurohini

मुस्तं कुटजबीजानि भूनिम्बं सरसाञ्जनम् |
दार्वी दुरालभा बिल्वं वालकं रक्तचन्दनम् ||६३||
चन्दनं वालकं मुस्तं भूनिम्बं सदुरालभम् |
मृणालं चन्दनं रोध्रं नागरं नीलमुत्पलम् ||६४||
पाठा मुस्तं हरिद्रे द्वे पिप्पली कौटजं फलम् |
फलत्वचं वत्सकस्य शृङ्गवेरं घनं [१] वचा ||६५||
षडेतेऽभिहिता योगाः पित्तातीसारनाशनाः |६६|
Below mentioned six formulations in decoction form is beneficial in curing pittatisara – diarrhoea caused by aggravated pitta –

1. Mustā, kutajabija, bhūnimba and rasañjana
2. Dārvī, durālabhā, bilva, valaka and raktacandana
3. Cañidana, vālaka, mustā, bhūnimba and durālabhā
4. Mrnāla, candana, rodhra, nāgara and nilotpala
5. Pathā, mustā, the two haridra, pippali and kutajaphala
6. Bark of fruit of vatsaka, Sringavera, ghana and vacã

बिल्वशक्रयवाम्भोदबालकातिविषाकृतः |
कषायो हन्त्यतीसारं सामं पित्तसमुद्भवम् ||६६||
मधुकोत्पलबिल्वाब्दह्रीबेरोशीरनागरैः |
कृतः क्वाथो मधुयुतः पित्तातीसारनाशनः ||६७||

Decoction of the below mentioned herbs cures diarrhoea caused by pitta –

–        Bilva,

–        Sakrayava – Indrayava,

–        Amboda – Musta,

–        Valaka and

–        Ativisa

Decoction should be prepared with below mentioned herbs –

–        Madhuka,

–        Utpala,

–        Bilva,

–        Abda,

–        Hribera,

–        Usira and

–        Nagara

Honey should be added to this decoction. When consumed, it cures diarrhoea caused by pitta.

यदा पक्वोऽप्यतीसारः सरत्येव मुहुर्मुहुः |
ग्रहण्या मार्दवाज्जन्तोस्तत्र संस्तम्भनं हितम् ||६८||

Controlling the diarrhoea is beneficial when –

–        it has become ripe (pakva) after lapse of some days but,

–        the faeces often moves out due to the weakness of grahani (duodenum)

समङ्गा धातकीपुष्पं मञ्जिष्ठा लोध्रमुस्तकम् |
शाल्मलीवेष्टको रोध्रं वृक्षदाडिमयोस्त्वचौ ||६९||
आम्रास्थिमध्यं लोध्रं च बिल्वमध्यं प्रियङ्गवः |
मधुकं शृङ्गवेरं च दीर्घवृन्तत्वगेव च ||७०||
चत्वार एते योगाः स्युः पक्वातीसारनाशनाः |
उक्ता य उपयोज्यास्ते सक्षौद्रास्तण्डुलाम्बुना ||७१||

Powder of the herbs mentioned below in the half verses cure pakva atisara – ripe diarrhoea caused by pitta –

1. Samañgā, dhätakīpuṣpa, mañjistha, lodhra and mustaka.
2. Śālmalivestaka (gum of Śālmali tree), rodhra and bark of vrksa (kutaja) and dadima.
3. Kernel of seed of āmra, lodhra, pulp of bilva fruit and priyañgu
4. Madhuka, Srngavera and bark of dirghavrita (aralu),

These powders should be administered mixed with honey and rice wash.

मौस्तं कषायमेकं वा पेयं मधुसमायुतम् |
लोध्राम्बष्ठाप्रियङ्ग्वादीन् गणानेवं प्रयोजयेत् ||७२||

Alternatively, decoction of musta alone should be consumed by the patient, adding honey to the decoction.

Similarly, decoction of herbs belonging to the below mentioned groups may be used –

–        Lodhradi Gana,

–        Ambasthadi Gana and

–        Priyangvadi Gana

पद्मां समङ्गां मधुकं बिल्वजम्बूशलाटु च |
पिबेत्तण्डुलतोयेन सक्षौद्रमगदङ्करम् ||७३||

Powder of the below mentioned ingredients should be consumed along with rice-wash and honey –

–        Padma,

–        Samanga,

–        Madhuka,

–        Tender fruits of Bilva and

–        Jambu

This recipe cures Pittaja Atisara.

कच्छुरामूलकल्कं वाऽप्युदुम्बरफलोपमम् |
पयस्या चन्दनं पद्मा सितामुस्ताब्जकेशरम् ||७४||
पक्वातिसारं योगोऽयं जयेत्पीतः सशोणितम् |७५|

Alternatively, the below mentioned recipes should be used to cure Pakvatisara with bleeding –

1. Paste of root of Kaccura (Kankatika), equal to the size of Udumbara fruit – should be consumed with rice-wash added with honey,
2. Paste of the below mentioned ingredients should be consumed with rice-wash added with honey

–        Payasya,

–        Candana,

–        Padma,

–        Sita,

–        Musta,

–        Abja and

–        Kesara (Padma Kesara)

निरामरूपं शूलार्तं लङ्घनाद्यैश्च कर्षितम् ||७५||
नरं रूक्षमवेक्ष्याग्निं सक्षारं पाययेद्घृतम् |७६|

Ghee added with Yava Ksara should be administered after considering the digestive fire / power, to the person –

–        who has symptoms of absence of ama,

–        has abdominal pain,

–        is emaciated by fasting etc. therapies and

–        is dry (body is dry)

बलाबृहत्यंशुमतीकच्छुरामूलसाधितम् ||७६||
मधूक्षितं समधुकं पिबेच्छूलैरभिद्रुतः |७७|

Decoction of the below mentioned ingredients cures abdominal pain if the patient drinks it mixed with honey –

–        Bala,

–        Brhati,

–        Amsumati,

–        Kaccuramula and

–        Madhuka

Sannipata atisara cikitsä

दार्वीबिल्वकणाद्राक्षाकटुकेन्द्रयवैर्घृतम् ||७७||
साधितं हन्त्यतीसारं वातपित्तकफात्मकम् |
दध्ना चाम्लेन सम्पक्वं सव्योषाजाजिचित्रकम् ||७८||
सचव्यपिप्पलीमूलं दाडिमैर्वा रुगर्दितः |
पयो घृतं च मधु च पिबेच्छूलैरभिद्रुतः ||७९||
सिताजमोदकट्वङ्गमधुकैरवचूर्णितम् |८०|

Ghee boiled and prepared with the below mentioned herbs cures diarrhoea produced by all three doshas i.e. vata, pitta and kapha together –

–        Darvi,

–        Bilva,

–        Kana,

–        Draksa,

–        Katuka and

–        Indrayava

Alternatively, ghee boiled and prepared with sour curds along with Vyosa, Rajani, Citraka, Cavya, Pippalimula and Dadima may be consumed by the patient. This would cure the pain.

Also, mixture of the below mentioned should be consumed –

–        milk,

–        ghee,

–        honey or

–        sugar

Powder of Ajamoda, Katvanga and Madhuka should be added to this recipe while consuming. This recipe cures pain.

अवेदनं सुसम्पक्वं दीप्ताग्नेः सुचिरोत्थितम् ||८०||
नानावर्णमतीसारं पुटपाकैरुपाचरेत् |८१|

Putapaka (juice of medicinal herbs cooked inside burning coal) is ideal to be used in treating atisara in the below mentioned conditions –

–        diarrhoea not associated with pain,

–        is ripe i.e. has become old,

–        persisting for long time,

–        faeces of different colours eliminated, for long time and

–        the patient having keenness of digestive fire

त्वक्पिण्डं दीर्घवृन्तस्य पद्मकेसरसंयुतम् ||८१||
काश्मरीपद्मपत्रैश्चावेष्ट्य सूत्रेण सन्दृढम् |
मृदाऽवलिप्तं सुकृतमङ्गारेष्ववकूलयेत् ||८२||
स्विन्नमुद्धृत्य निष्पीड्य रसमादाय तं ततः |
शीतं मधुयुतं कृत्वा पाययेतोदरामये ||८३||
जीवन्तीमेषशृङ्ग्यादिष्वेवं द्रव्येषु साधयेत् |८४|

Balls are prepared from paste of Dirghavrita (Syonaka) bark added with filaments of lotus flower (Padmakesara). These balls are enveloped with leaves of Kasmari or Padma and fastened well with thread. Later, a coating of mud is given on this and the balls are dried slightly. The dried balls are put into a heap of burning coal and properly cooked. The balls are taken out once they are properly cooked. The layers are removed and the balls of medicinal herbs are squeezed so as to extract its juice. Once this juice is cooled, honey is added to it. The patient having abdominal diseases (diarrhoea here) should drink this juice.

Similarly, the juice obtained from Jivanti, Mesasrngi etc. extracted in the same (explained) method may also be used.

तित्तिरिं लुञ्चितं सम्यक् निष्कृष्टान्त्रं तु पूरयेत् ||८४||
न्यग्रोधादित्वचां कल्कैः पूर्ववच्चावकूलयेत् |
रसमादाय तस्याथ सुस्विन्नस्य समाक्षिकम् ||८५||
शर्करोपहितं शीतं पाययेतोदरामये |८६|

Feathers and intestines (beak and legs also) of a Tittiri bird are removed and the bird is filled with paste of bark of Nyagrodha etc. i.e. barks of Pancavalkala trees. This mass is enveloped with leaves and mud plaster as explained above. This is cooked inside a heap of burning coal following the putapaka method as explained earlier (above context). It is taken out once it is well cooked and its juice is extracted. This juice is mixed with honey and sugar. The patient suffering from abdomen diseases (diarrhoea here) should consume this juice. This recipe will cure the disease.

लोध्रचन्दनयष्ट्याह्वदार्वीपाठासितोत्पलान् ||८६||
तण्डुलोदकसम्पिष्टान् दीर्घवृन्तत्वगन्वितान् |
पूर्ववत् कूलितात्तस्माद्रसमादाय शीतलम् ||८७||
मध्वाक्तं पाययेच्चैतत् कफपित्तोदरामये |८८|

Ball is prepared by macerating Lodhra, Candana, Yastyahva, Darvipatha and Sitotpala in rice-wash. This ball is covered with bark of Dirghavrnta and cooked as described above. After the ball is cooked, it is removed, its layers are separated and the juice is extracted from the ball of herbs. This juice is mixed with honey. When administered, this recipe cures diarrhoea caused by combined vitiation of kapha and pitta.

एवं प्ररोहैः कुर्वीत वटादीनां विधानवत् ||८८||
पुटपाकान् यथायोगं जाङ्गलोपहितान् शुभान् |८९|

Similarly, juice of leaf buds of Vata etc. trees may be obtained and used and so also the juice of meat of birds living in arid regions.

बहुश्लेष्म सरक्तं च मन्दवातं चिरोत्थितम् ||८९||
कौटजं फाणितं वाऽपि हन्त्यतीसारमोजसा |
अम्बष्ठादिमधुयुतं पिप्पल्यादिसमन्वितम् ||९०||

Kutaja Phanita would cure atisara with its power (action) in the below mentioned conditions –

–        if there is more mucus in the faeces in atisara,

–        if faeces is mixed with blood,

–        if the function of vata is mild and

–        if the disease is persisting for a long time

Alternatively, Phanita of herbs belonging to Pippalyadi Gana group mixed with honey and administered will also cure that disease.

पृश्निपर्णीबलाबिल्ववालकोत्पलधान्यकैः |
सनागरैः पिबेत् पेयां साधितामुदरामयी ||९१||

Peya – thin gruel prepared with the below mentioned herbs may be consumed by the patient of atisara –

–        Prsniparni,

–        Bala,

–        Bilva,

–        Valaka,

–        Utpala,

–        Dhanyaka and

–        Nagara

अरलुत्वक् प्रियङ्गुं च मधुकं दाडिमाङ्कुरान् |
आवाप्य पिष्ट्वा दधनि यवागूं साधयेद्द्रवाम् ||९२||
एषा सर्वानतीसारान् हन्ति पक्वानसंशयम् |९३|

Below mentioned ingredients are macerated with curd –

–        Bark of Aralu,

–        Priyangu,

–        Madhuka and

–        Tender leaves of Dadima

From this, Yavagu – thick gruel is prepared.

When consumed, it cures all kinds of old (chronic / ripe) diarrhoeas without any doubt.

रसाञ्जनं सातिविषं त्वग्बीजं कौटजं तथा ||९३||
धातकी नागरं चैव पाययेत्तण्डुलाम्बुना |
सशूलं रक्तजं घ्नन्ति एते मधुसमायुताः ||९४||

Powder of the below mentioned ingredients should be prepared –

–        Rasanjana,

–        Ativisa,

–        Bark and seeds of Kutaja,

–        Dhataki and

–        Nagara

This should be consumed along with rice wash added with honey. It cures diarrhoea accompanied with pain and bleeding.

मधुकं बिल्वपेशी च शर्करामधुसंयुता |
अतीसारं निहन्युश्च शालिषष्टिकयोः कणाः ||९५||
तद्वल्लीढं मधुयुतं बदरीमूलमेव तु |९६|

For cure of diarrhoea, Madhuka and young fruit of Bilva should be given to the patient added with sugar and honey.

Similarly, flour of Sali and Sastika rice should be administered with sugar and honey.

Alternatively, paste of root of Badari should be consumed added with sugar and honey. This recipe too will cure diarrhoea.

बदर्यर्जुनजम्ब्वाम्रशल्लकीवेतसत्वचः ||९६||
शर्कराक्षौद्रसंयुक्ताः पीता घ्नन्त्युदरामयम् |९७|
एतैरेव यवागूंश्च षडान् यूषांश्च कारयेत् ||९७||
पानीयानि च तृष्णासु द्रव्येष्वेतेषु बुद्धिमान् |९८|
Paste of the below mentioned herbs should be mixed with sugar and honey –

–        Bark of Badari,

–        Arjuna,

–        Jambu,

–        Amra,

–        Sallaki and

–        Vetasa

When consumed, this recipe cures diarrhoea.

The same herbs can be used by an intelligent physician to prepare the below mentionend recipes –

–        Yavagu – thick gruel,

–        Sadava – sour fruit salad and

–        Yusa – soup and

–        Paniya – drinking water

These recipes also cure diarrhoea.

कृतं शाल्मलिवृन्तेषु कषायं हिमसञ्ज्ञितम् ||९८||
निशापर्युषितं पेयं सक्षौद्रं मधुकान्वितम् |९९|

Cold infusion (hima kashaya) of Salmali Vrnta should be prepared and kept overnight. This should be used next morning added with honey.

विबद्धवातविट् शूलपरीतः सप्रवाहिकः ||९९||
सरक्तपित्तश्च पयः पिबेत्तृष्णासमन्वितः |
यथाऽमृतं तथा क्षीरमतीसारेषु पूजितम् ||१००||
चिरोत्थितेषु तत् पेयमपां भागैस्त्रिभिः शृतम् |
दोषशेषं हरेत्तद्धि तस्मात्पथ्यतमं स्मृतम् ||१०१||

Milk should be consumed by the patient in the below mentioned conditions –

–        he who has obstruction of flatus and faeces,

–        abdominal pain,

–        straining while defecating,

–        raktapitta – bleedingn disorders and

–        thirst

Milk is similar to nectar in diarrhoeas.

Milk should be consumed with three parts of water in chronic diarrhoeas. Since the milk removes residue of doshas, it is considered as most suitable in atisara.

हितः स्नेहविरेको वा बस्तयः पिच्छिलाश्च ये |
पिच्छिलस्वरसे सिद्धं हितं च घृतमुच्यते ||१०२||

Below mentioned recipes are also beneficial –

–        Sneha Virechana – unctuous purgatives,

–        Picchila Basti – enema prepared with slimy substances, prepared from fresh juice of slimy substances and

–        Ghrta – Use of medicated ghee

शकृता यस्तु संसृष्टमतिसार्येत शोणितम् |
प्राक् पश्चाद्वा पुरीषस्य सरुक् सपरिकर्तिकः ||१०३||
क्षीरिशुङ्गाशृतं सर्पिः पिबेत् सक्षौद्रशर्करम् |१०४|

Ghee should be prepared with decoction of leaf buds of ksiri vrksa i.e. trees yielding milky sap. This ghee is mixed with honey and sugar and may be consumed when –

–        the blood is being eliminated either mixed with faeces or before or after elimination of faeces, accompanied with

–        pain in abdomen and

–        cutting pain in the anus / rectum

दार्वीत्वक्पिप्पलीशुण्ठीलाक्षाशक्रयवैर्घृतम् ||१०४||
संयुक्तं भद्ररोहिण्या पक्वं पेयादिमिश्रितम् |
त्रिदोषमप्यतीसारं पीतं हन्ति सुदारुणम् ||१०५||

Decoction should be prepared with –

–        Bark of Darvi,

–        Pippali,

–        Sunthi,

–        Laksa,

–        Sakrayava – Indrayava and

–        Bhadrarohini – Katukarohini

Ghee should be prepared with this decoction. When consumed along with peya (thin gruel) etc., this recipe cures even dreadful diarrhoea caused by all three doshas together.

गौरवे वमनं पथ्यं यस्य स्यात् प्रबलः कफः |
ज्वरे दाहे सविड्बन्धे मारुताद्रक्तपित्तवत् ||१०६||

Therapeutic emesis is ideal when the patient has a feeling of heaviness in the body due to predominance of kapha.

Atisara shall be treated on the lines of treating adhoga raktapitta i.e. bleeding from downward direction, when there is fever, burning sensation and constipation due to predominance of vata.

सम्पक्वे बहुदोषे च विबन्धे मूत्रशोधनैः |
कार्यमास्थापनं क्षिप्रं तथा [१] चैवानुवासनम् ||१०७||

Decoction enema prepared with herbs which purify urine should be quickly administered followed by oil enema, when the doshas are ripe and when the person has constipation.

प्रवाहणे गुदभ्रंशे मूत्राघाते कटिग्रहे |
मधुराम्लैः शृतं तैलं सर्पिर्वाऽप्यनुवासनम् ||१०८||

Oil or ghee boiled and prepared with herbs predominantly having sweet and sour tastes is the best one for anuvasana basti (unctuous enema) when –

–        there is straining,

–        prolapse of rectum,

–        retention of urine and

–        catching pain in the waist

गुदपाकस्तु पित्तेन यस्य स्यादहिताशिनः |
तस्य पित्तहराः सेकास्तत्सिद्धाश्चानुवासनाः ||१०९||
दधिमण्डसुराबिल्वसिद्धं तैलं समारुते |
भोजने च हितं क्षीरं कच्छुरामूलसाधितम् ||११०||

In persons who are indulged in unsuitable foods, pitta aggravation takes place and would cause gudapaka (suppuration of anus / rectum). In such conditions, below mentioned treatments are beneficial –

–        pouring liquids which mitigate pitta and

–        unctuous enema with oils prepared from pitta mitigating herbs,

When vata is predominant, oil prepared with whey (scum of curds), beer (sura) and bilva is ideal to be used. Likewise, milk boiled and prepared with roots of Kacchura used along with food is suitable.

अल्पाल्पं बहुशो रक्तं सरुग्य उपवेश्यते |
यदा वायुर्विबद्धश्च पिच्छाबस्तिस्तदा हितः ||१११||

Pichcha Basti i.e. slimy enemas are beneficial and hence administered when the person is eliminating small quantities of faeces and more blood accompanied with pain and retention of flatus.

प्रायेण गुददौर्बल्यं दीर्घकालातिसारिणाम् |
भवेत्तस्माद्धितं तेषां गुदे तैलावचारणम् ||११२||

Usually, when diarrhoea persists for a long time, weakness of the rectum / anus develops. Therefore it is beneficial to apply medicated oil into the anus.

कपित्थशाल्मलीफञ्जीवटकार्पासदाडिमाः |
यूथिका कच्छुरा शेलुः शणश्चुच्चूश्च दाधिकाः ||११३||
शालपर्णी पृश्निपर्णी बृहती कण्टकारिका |
बलाश्वदंष्ट्राबिल्वानि पाठानागरधान्यकम् ||११४||
एष आहारसंयोगे हितः सर्वातिसारिणाम् |
तिलकल्को हितश्चात्र मौद्गो मुद्गरसस्तथा ||११५|| 

Below mentioned herbs boiled and mixed with curds should be used along with food –

–        Kapittha,

–        Salmali,

–        Vata,

–        Karpasa,

–        Dadima,

–        Yuthika,

–        Kacchura,

–        Selu,

–        Sana and

–        Cunccu

Below mentioned herbs are beneficial for usage as adjuncts to food and to cure all kinds of diarrhoea –

–        Saliparni,

–        Prsniparni,

–        Brhati,

–        Kantakari,

–        Bala,

–        Svadamstra,

–        Bilva,

–        Patha,

–        Nagara and

–        Dhanyaka

Similarly, paste of tila – sesame or mudga – green gram taken with mudgarasa – soup of green gram is beneficial.

Raktātisāra – haemorrhagic diarrhoea

पित्तातिसारी यो मर्त्यः पित्तलान्यतिषेवते |
पित्तं प्रदुष्टं तस्याशु रक्तातीसारमावहेत् ||११६||
ज्वरं शूलं तृषां दाहं गुदपाकं च दारुणम् |११७|

Raktatisara (Rakta Atisara) means diarrhoea wherein blood is eliminated with loose stools i.e. diarrhoea with haemorrhage from rectum (anus). This is caused when a patient suffering from pitta type of diarrhoea gets indulged in foods which aggravate pitta. Due to this, the pitta gets excessively increased and causes bloody diarrhoea.

Raktatisara is associated with

–        fever,

–        pain in the abdomen,

–        thirst,

–        burning sensation and

–        severe suppuration of rectum / anus

यो रक्तं शकृतः पूर्वं पश्चाद्वा प्रतिसार्यते ||११७||
स पल्लवैर्वटादीनां ससर्पिः साधितं पयः |
पिबेत् सशर्कराक्षौद्रमथवाऽप्यभिमथ्य तत् ||११८||
नवनीतमथो लिह्यात्तक्रं चानुपिबेत्ततः |११९|

Below mentioned recipes should be consumed by the patient who eliminates blood either before or after defecation –

–        milk boiled with leaf buds of vata etc. herbs i.e. pancavalkala added with ghee,

–        lick butter prepared from milk which has been added with the above said (vata etc) leaf buds and churned with sugar and honey, this should be followed by drinking buttermilk

प्रियालशाल्मलीप्लक्षशल्लकीतिनिशत्वचः ||११९||
क्षीरे विमृदिताः पीताः सक्षौद्रा रक्तनाशनाः |१२०|

Below mentioned herbs should be mixed milk, churned well and consumed after adding honey to it –

–        Bark of Priyangu,

–        Salmali,

–        Plaksa,

–        Sallaki and

–        Tinisa

This recipe cures bleeding.

मधुकं शर्करां लोध्रं पयस्यामथ सारिवाम् ||१२०||
पिबेच्छागेन पयसा सक्षौद्रं रक्तनाशनम् |१२१|

Below mentioned should be boiled in goat’s milk –

–        Madhuka,

–        Sarkara,

–        Lodhra,

–        Payasa and

–        Sariva

Honey is added to this milk and mixed properly. When consumed, this recipe cures haemorrhage.

मञ्जिष्ठां सारिवां लोध्रं पद्मकं कुमुदोत्पलम् ||१२१||
पिबेत् पद्मां च दुग्धेन छागेनासृक्प्रशान्तये |१२२|

Below mentioned ingredients are boiled and processed in goat’s milk –

–        Manjistha,

–        Sariva,

–        Lodhra,

–        Padmaka,

–        Kumuda,

–        Utpala and

–        Padma

When this medicated milk is consumed, it stops bleeding.

शर्करोत्पललोध्राणि समङ्गा मधुकं तिलाः ||१२२||
तिलाः कृष्णाः सयष्ट्याह्वाः समङ्गा चोत्पलानि च |
तिला मोचरसो लोध्रं तथैव मधुकोत्पलम् ||१२३||
कच्छुरा तिलकल्कश्च योगाश्चत्वार एव च |
आजेन पयसा पेयाः सरक्ते मधुसंयुताः ||१२४||

The below mentioned four groups of herbs should be boiled in goat’s milk and consumed added with honey –

1.   Sarkara, urpala. lodhra, samanga, madhuka and tila.
2.   Krsnatila, yastyāhva, samanga and utpala
3.   Tila, mocarasa, lodhra, madhuka and utpala
4.   Kacchura and tila paste

These recipes cure bleeding.

द्रवे सरक्ते स्रवति बालबिल्वं सफाणितम् |
सक्षौद्रतैलं प्रागेव लिह्यादाशु हितं हि तत् ||१२५||

Phanita i.e. molasses should be consumed along with tender fruit of Bilva, honey and sesame oil. This is beneficial when liquid faeces is eliminated with blood and should be administered right at the beginning itself.

कोशकारं घृते भृष्टं लाजचूर्णं सिता मधु |
सशूलं रक्तपित्तोत्थं लीढं हन्त्युदरामयम् ||१२६||
बिल्वमध्यं समधुकं शर्कराक्षौद्रसंयुतम् |
तण्डुलाम्बुयुतो योगः पित्तरक्तोत्थितं जयेत् ||१२७||
योगान् साङ्ग्राहिकांश्चान्यान् पिबेत्सक्षौद्रशर्करान् |
न्यग्रोधादिषु कुर्याच्च पुटपाकान् यथेरितान् ||१२८||

Kosakara is a variety of sugarcane. It should be fried in ghee and added with powder of Laja, sugar and honey. When consumed, this recipe cures diarrhoea produced by rakta and pitta, associated with abdominal pain.

Pulp of Bilva fruit and Madhuka are mixed with sugar and honey. This mixture should be consumed with rice washed water. It cures diarrhoea caused by aggravation of pitta and rakta (blood).

Also, any other recipe (formulation) which binds the stools and causes constipation (of the fluids getting expelled) should be mixed with honey and sugar and consumed.

Nyagrodha etc. herbs should be cooked by Putapaka method. The juice extracted after cooking them should be consumed as previously described.

गुदपाके च ये उक्तास्तेऽत्रापि विधयः स्मृताः |
रुजायां चाप्रशाम्यन्त्यां पिच्छाबस्तिर्हितो भवेत् ||१२९||

In raktatisara i.e. haemorrhagic diarrhoea also, the treatments indicated for ulcers of the rectum / anus are beneficial. Pichcha Basti i.e. slimy enema shall be administered when the pain is not subsiding.

सक्तविड् दोषबहुलं दीप्ताग्निर्योऽतिसार्यते |
विडङ्गत्रिफलाकृष्णाकषायैस्तं विरेचयेत् ||१३०||
अथवैरण्डसिद्धेन पयसा केवलेन वा |
यवागूर्वितरेच्चास्य वातघ्नैर्दीपनैः कृताः ||१३१||

Purgation therapy should be administered in the below mentioned conditions –

–        if there is obstruction of faeces,

–        if there great increase of doshas,

–        if the digestive fire is keen and

–        if there is frequent elimination of faeces

For the purpose of purgation, decoction of Vidanga, Triphala and Krsna should be used. Alternatively, milk added and mixed with Eranda Taila should be used.

After this, the patient should be given Yavagu (thick gruel) prepared with herbs which mitigate vata and also those which kindle hunger.

दीप्ताग्निर्निष्पुरीषो यः सार्यते फेनिलं शकृत् |
स पिबेत् फाणितं शुण्ठीदधितैलपयोघृतम् ||१३२||
स्विन्नानि गुडतैलाभ्यां भक्षयेद्बदराणि च |
स्विन्नानि पिष्टवद्वाऽपि समं बिल्वशलाटुभिः ||१३३||
दध्नोपयुज्य कुल्माषान् श्वेतामनुपिबेत् सुराम् |१३४|

Phanita – molasses mixed with ginger, curds, oil and ghee should be consumed by persons having keen digestive fire and eliminates frothy stools which are devoid of faecal matter.

Boiled badara fruits should be consumed mixed with jaggery and sesame oil.

Alternatively, cooked tender bilva fruit (bilva salatu) may also be consumed.

One should consume Kulmasa i.e. boiled pulses with curds as long as possible. After this, he should drink Sveta Sura i.e. white beer.

शशमांसं सरुधिरं समङ्गां सघृतं दधि ||१३४||
खादेद्विपाच्य सेवेत मृद्वन्नं शकृतः क्षये |
संस्कृतो यमके माषयवकोलरसः शुभः ||१३५||
भोजनार्थं प्रदातव्यो दधिदाडिमसाधितः |१३६|
The patient should eat rabbit’s meat along with cooked blood after adding Samanga, ghee, curd and soft-boiled rice to it when he has decreased faeces.

Soup of Masa, Yava and Kola should be prepared. This soup should be processed with any two fats combined together (yamaka – ghee and oil). This should be used as food after adding curds and pomegranate.

विडं बिल्वशलाटूनि नागरं चाम्लपेषितम् ||१३६||
दध्नः सरश्च यमके भृष्टो वर्चःक्षये हितः |
सशूलं क्षीणवर्चा यो दीप्ताग्निरतिसार्यते |
स पिबेद्दीपनैर्युक्तं सर्पिः सङ्ग्राहकैः सह ||१३७||

Below mentioned ingredients are macerated with sour juice –

–        Bida Lavana,

–        Tender fruits of Bilva and

–        Nagara

This should be added with whey (dadhi sara – scum of curds) and later fried in a mixture of oil and ghee. This recipe is said to be beneficial for treating cases of decreased faeces.

Ghee boiled and processed with carminative (dipana) and constipating (grahi) herbs should be consumed by –

–        the person having diarrhoea associated with pain and

–        decreased faeces and having

–        good digestive fire / power

Pravāhikā – dysentery

वायुः प्रवृद्धो निचितं बलासं नुदत्यधस्तादहिताशनस्य |
प्रवाहमाणस्य मुहुर्मलाक्तं प्रवाहिकां तां प्रवदन्ति तज्ज्ञाः ||१३८||

Vata gets aggravated in persons indulged in regular consumption of unhealthy foods. This aggravated vata pushes kapha accumulated in the colon downwards again and again, after straining and mixed with faeces. The learned physicians call this condition as Pravahika.

प्रवाहिका वातकृता सशूला पित्तात् सदाहा सकफा कफाच्च |
सशोणिता शोणितसम्भवा तु ताः स्नेहरूक्षप्रभवा मतास्तु ||१३९||
तासामतीसारवदादिशेच्च लिङ्गं क्रमं चामविपक्वतां च |१४०|

Below mentioned are the main symptoms in Pravahika produced by specific doshas –

–        In vata type of pravahika – pain is predominantly present,

–        In pitta type of pravahika – there is burning sensation,

–        In kapha type of pravahika – faeces is eliminated mixed with kapha,

–        In rakta type of pravahika – faeces is mixed with blood

These types of Pravahika are produced by more unctuousness and dryness in the colon.

The signs and symptoms, methods of treatment and features of ama – unripe and pakva – ripe stages are similar to those of atisara – diarrhoea.

Pravahikā cikitsā – treatment of dysentery

न शान्तिमायाति विलङ्घनैर्या योगैरुदीर्णा यदि पाचनैर्वा ||१४०||
तां क्षीरमेवाशु शृतं निहन्ति तैलं तिलाः पिच्छिलबस्तयश्च |१४१|

Use of boiled milk, sesame oil and slimy enemas (piccha basti) would subside pravahika which –

–        does not subside by administration of therapies like vilanghana etc. i.e. fasting and other methods which cause lightness / thinness of the body or

–        gets increased by use of pacana – digestive medicines (which digest ama)

आर्द्रैः कुशैः सम्परिवेष्टितानि वृन्तान्यथार्द्राणि हि शाल्मलीनाम् ||१४१||
पक्वानि सम्यक् पुटपाकयोगेनापोथ्य तेभ्यो रसमाददीत |
क्षीरं शृतं तैलहविर्विमिश्रं कल्केन यष्टीमधुकस्य वाऽपि ||१४२||
बस्तिं विदध्याद्भिषगप्रमत्तः प्रवाहिकामूत्रपुरीषसङ्गे |१४३|

Moist stalks of Salmali fruits are selected. They are enveloped with moist blades of kusa grass. They are cooked by the putapaka method. Once they are cooked properly, their juice is extracted. This juice is mixed with cooked milk, oil, ghee and yastimadhu paste. All these are stirred well and administered by physicians as enema, slowly. It is administered in pravahika and obstruction of faeces and urine. 

द्विपञ्चमूलीक्वथितेन शूले प्रवाहमाणस्य समाक्षिकेण ||१४३||
क्षीरेण चास्थापनमग्र्यमुक्तं तैलेन युञ्ज्यादनुवासनं च |१४४|

Decoction enema prepared with decoction of mahat and laghu pancamula group of herbs, added with honey and milk is said to be the best enema recipe to be administered when pain is predominantly present in patients suffering from pravahika. Anuvasana Basti – oil enema prepared with the same herbs is also beneficial in the same condition.

वातघ्नवर्गे लवणेषु चैव तैलं च सिद्धं हितमन्नपाने ||१४४||
लोध्रं विडं बिल्वशलाटु चैव लिह्याच्च तैलेन कटुत्रिकाढ्यम् |१४५|

Along with foods and drinks, oil boiled and processed with herbs belonging to the vata mitigating group and all salts should be used.

Paste of Lodhra, Bida Lavana and tender fruit of Bilva should be prepared. This paste should be added with more Trikatu and should be licked.

दध्ना ससारेण समाक्षिकेण भुञ्जीत निश्चा(स्सा)रकपीडितस्तु ||१४५||
सुतप्तकुप्यक्वथितेन वाऽपि क्षीरेण शीतेन मधुप्लुतेन |
शूलार्दितो व्योषविदारिगन्धासिद्धेन दुग्धेन हिताय भोज्यः ||१४६||
वातघ्नसाङ्ग्राहिकदीपनीयैः कृतान् षडांश्चाप्युपभोजयेच्च [२] |
खादेच्च मत्स्यान् रसमाप्नुयाच्च वातघ्नसिद्धं सघृतं सतैलम् ||१४७||
एणाव्यजानां तु वटप्रवालैः सिद्धानि सार्धं पिशितानि खादेत् |
मेध्य(द्य)स्य सिद्धं त्वथ वाऽपि रक्तं बस्तस्य दध्ना घृततैलयुक्तम् ||१४८||
खादेत् प्रदेहैः शिखिलावजैर्वा भुञ्जीत यूषैर्दधिभिश्च मुख्यैः |
माषान् सुसिद्धान् घृतमण्डयुक्तान् खादेच्च दध्ना मरिचोपदंशान् ||१४९||

Food should be consumed along with one of the below mentioned by the person suffering from pravahika –

–        with scum of curds (whey) added with honey or

–        with milk boiled in a metallic vessel, cooled and added with honey

If there is pain, the person should take foods in below mentioned ways –

–        food should be taken with milk boiled with vyosa and herbs belonging to vidarigandhadi gana group, rasa (mamsarasa – meat soup) prepared with vata mitigating herbs and herbs causing constipation and increasing hunger

–        fish can be consumed or

–        meat soup boiled and prepared with vata mitigating herbs, added with ghee or oil should be taken or

–        meat of ena (deer), avi (sheep) or aja (goat) cooked with tender leaves of vata should be consumed or

–        meat of medhya (fat goat) or its blood cooked and added with ghee and oil may be consumed or

–        meat of peacock or lava birds and their soup may be consumed along with soup of pulses and curds or

–        masa – black gram cooked well, added with scum of ghee and marica should be consumed

महारुजे मूत्रकृच्छ्रे भिषग् बस्तिं प्रदापयेत् |
पयोमधुघृतोन्मिश्रं मधुकोत्पलसाधितम् ||१५०||
स बस्तिः शमयेत्तस्य रक्तं दाहमथो ज्वरम् |१५१|

The physician should administer decoction enema prepared with madhuka and utpala mixed with milk, honey and ghee when there is severe pain and dysuria. This enema mitigates bleeding, burning sensation and fever.

मधुरौषधसिद्धं च हितं तस्यानुवासनम् ||१५१||
रात्रावहनि वा नित्यं रुजार्तो यो भवेन्नरः |
यथा यथा सतैलः स्याद्वातशान्तिस्तथा तथा ||१५२||
प्रशान्ते मारुते चापि शान्तिं याति प्रवाहिका |
तस्मात् प्रवाहिकारोगे मारुतं शमयेद्भिषक् ||१५३||

When the person is suffering from pain, anuvasana basti i.e. oil enema prepared with herbs predominantly having sweet taste should be administered either during day or night time. Vata gets mitigated as and when oil enema is administered. When vata gets mitigated pravahika too will subside. Hence, the physician should always try to mitigate vata first while treating pravahika.

पाठाजमोदाकुटजोत्पलं [७] च शुण्ठी समा मागधिकाश्च पिष्टाः |
सुखाम्बुपीताः शमयन्ति रोगं मेध्याण्डसिद्धं सघृतं पयो वा ||१५४||

Paste of the below mentioned herbs is prepared –

–        Patha,

–        Ajamoda,

–        Kutaja,

–        Utpala,

–        Sunthi and

–        Magadhika

This paste is consumed with warm water. This recipe mitigates the diseases. Alternatively, testicles of goat cooked with ghee or milk also mitigates the disease.

शुण्ठीं घृतं सक्षवकं सतैलं विपाच्य लीढ्वाऽऽमयमाशु हन्यात् |
गजाशनाकुम्भिकदाडिमानां रसैः कृता तैलघृते सदध्नि ||१५५||
बिल्वान्विता पथ्यतमा यवागू र्धारोष्णदुग्धस्य तथा च पानम् |१५६|
लघूनि पथ्यान्यथ दीपनानि स्निग्धानि भोज्यान्युदरामयेषु ||१५६||

This disease is quickly cured when sunthi and ksavaka cooked in ghee and oil together is consumed.

Yavagu – thick gruel should be prepared with juice of Sallaki, Kumbhika, and Dadima. It should be added with oil, ghee, curds and bilva and consumed. Alternatively, milk fresh from the udder of the cow should be consumed.

हितायनित्यंवितरेद्विभज्ययोगांश्चतांस्तान्भिषगप्रमत्तः।।१५७।।

In treatment of pravahika – dysentery, foods which have the below mentioned properties should be used –

–        easily digestible,

–        healthy,

–        those increasing hunger and

–        unctuous

The physician should allow the patient to consume such foods every day in accordance to the factors like season, time of intake of food etc. without any hesitation.

तृष्णापनयनी लघ्वी दीपनी बस्तिशोधनी |
ज्वरे चैवातिसारे च यवागूः सर्वदा हिता ||१५८||

Yavagu is beneficial in both jvara – fevers and atisara – diarrhoea due to the below mentioned properties –

–        it mitigates thirst,

–        gets easily digested,

–        kindles hunger / digestive fire and

–        cleanses the urinary bladder (helps in easy urination)

रूक्षाज्जाते क्रिया स्निग्धा रूक्षा स्नेहनिमित्तजे |
भयजे सान्त्वनापूर्वा शोकजे शोकनाशिनी ||१५९||
विषार्शःकृमिसम्भूते हिता चोभयशर्मदा |
छर्दिमूर्च्छातृडाद्यांश्च साधयेदविरोधतः ||१६०||

Unctuous therapies should be administered in diarrhoea produced by excessive dryness. On the other hand, diarrhoea produced due to excessive unctuousness (unctuous therapies) should be treated with dry therapies.

In atisara caused by fevers, treatment should commence with pacifying words.

In diarrhoea caused by grief, treatments to ward off grief should be done.

In diarrhoea produced by poisons, piles and worms, treatment for both cause and effect (diseases caused by poisons etc) should be done.

Treatment for vomiting, fainting, thirst etc. should be done without interfering with the main diseases (treatments should not be contradictory).

समवाये तु दोषाणां पूर्वं पित्तमुपाचरेत् |
ज्वरे चैवातिसारे च सर्वत्रान्यत्र मारुतम् ||१६१||

When the doshas are intimately combined together in fevers and diarrhoea, pitta should be treated first. In other diseases, vata should be treated first.

Atisara nivṛtti lakṣaṇa- signs of cure of diarrhoea-

यस्योच्चारं विना मूत्रं सम्यग्वायुश्च गच्छति |
दीप्ताग्नेर्लघुकोष्ठस्य स्थितस्तस्योदरामयः ||१६२||

Disease of the abdomen i.e. diarrhoea should be considered as cured in the presence of the below mentioned signs (and symptoms) –

–        when urine is eliminated independent of faeces,

–        when there is proper elimination of flatus, without any trouble,

–        when the digestive fire is keen and

–        when the alimentary canal is light

Vyādhibheda – kinds of diseases

कर्मजा व्याधयः केचिद्दोषजाः सन्ति चापरे |
कर्मदोषोद्भवाश्चान्ये कर्मजास्तेष्वहेतुकाः ||१६३||
नश्यन्ति त्वक्रियाभिस्ते क्रियाभिः कर्मसङ्क्षये |
शाम्यन्ति दोषसम्भूता दोषसङ्क्षयहेतुभिः ||१६४||

Some diseases are Karmaja, some are Dosaja and some others are Karma-dosaja.

Karmaja vyadhi are those diseases which are produced by the effects of actions committed in previous lives. These diseases have no causes that can be apparently seen. These diseases disappear either without any treatment or with treatment only after the expiry of the effects of actions of previous lives.

Doshaja vyadhi are those diseases which are produced by aggravation of doshas in this life. These diseases subside (cured) by the causes (treatments) which mitigate the doshas.

Karma-Doshaja vyadhi are those diseases which are produced by combination of effects of previous lives as well as aggravation of doshas in this life.

तेषामल्पनिदाना ये प्रतिकष्टा भवन्ति च |
मृदवो बहुदोषा वा कर्मदोषोद्भवास्तु ते ||१६५||
कर्मदोषक्षयकृता तेषां सिद्धिर्विधीयते |१६६|

Among all the varieties of diseases, karmaja vyadhis – those diseases which have mild and less causes or no known causes are difficult to cure.

Similarly, the diseases which are mild and produced by powerful doshas are also difficult to cure.

Treatments are advocated for those diseases which are born from a combination of both karma and dosha. The diseases caused by karma and dosha together get cured only after the decrease of effects of karma and doshas.

Grahani roga – diseases of the duodenum-

दुष्यति ग्रहणी जन्तोरग्निसादनहेतुभिः ||१६६||
अतिसारे निवृत्तेऽपि मन्दाग्नेरहिताशिनः |
भूयः सन्दूषितो वह्निर्ग्रहणीमभिदूषयेत् ||१६७||
तस्मात्कार्यः परीहारस्त्वतीसारे विरिक्तवत् |
यावन्न प्रकृतिस्थः स्याद्दोषतः प्राणतस्तथा ||१६८||

Due to the causes which weaken the digestive fire (power), the organ grahani (duodenum) becomes disordered in living beings.

If the person indulges in improper foods, even after the cure of diarrhoea or in persons having poor digestive fire / power, the doshas greatly vitiate the digestive fire. At the same time, the doshas would also vitiate the grahani (duodenum). This is the reason that treatments in atisara should be done as advocated for the person who has had purgation, until the person becomes normal in respect of dosha and also strength.

Grahani – duodenum

षष्ठी पित्तधरा नाम या कला परिकीर्तिता |
पक्वामाशयमध्यस्था ग्रहणी सा प्रकीर्तिता ||१६९||
ग्रहण्या बलमग्निर्हि स चापि ग्रहणीं श्रितः |
तस्मात् सन्दूषिते वह्नौ ग्रहणी सम्प्रदुष्यति ||१७०||

Pittadhara Kala has been described as the sixth kala in sarira sthana section, chapter 4. This kala is situated between pakvasaya – intestines and amasaya – stomach. The same kala is known as Grahani – duodenum.

Agni – digestive fire is the strength of grahani and that agni resides in the grahani. Hence, when agni gets vitiated, grahani also becomes vitiated.

एकशः सर्वशश्चैव दोषैरत्यर्थमुच्छ्रितैः |
सा दुष्टा बहुशो भुक्तमाममेव विमुञ्चति ||१७१||
पक्वं वा सरुजं पूति मुहुर्बद्धं मुहुर्द्रवम् |
ग्रहणीरोगमाहुस्तमायुर्वेदविदो जनाः ||१७२||

Grahani becomes disordered by greatly aggravated doshas, either by individual doshas separately or by all doshas together. When grahani becomes greatly disordered, it releases the ingested food either in uncooked or cooked states. It is accompanied with pain in the abdomen. The grahani eliminates bad smelling faeces, sometimes constipated (faeces is hard, solid) and sometimes liquid and frequent (occurs more number of times). This disease is called Grahani Roga – duodenal diseases by persons who are learned and well versed in Ayurveda.

Pürvarüpa – premonitary symptoms

तस्योत्पत्तौ विदाहोऽन्ने सदनालस्यतृट्क्लमाः |
बलक्षयोऽरुचिः कासः कर्णक्ष्वेडोऽन्त्रकूजनम् ||१७३||

Below mentioned are the premonitory symptoms of Grahani Roga –

–        burning sensation due to the presence of food in the stomach,

–        general debility,

–        lassitude,

–        thirst,

–        exhaustion,

–        decrease of strength,

–        loss of taste,

–        cough,

–        ringing in the ears and

–        gurgling noise in the intestines

Rupa- clinical features

अथ जाते भवेज्जन्तुः शूनपादकरः कृशः |
पर्वरुग्लौल्यतृट्छर्दिज्वरारोचकदाहवान् ||१७४||
उद्गिरेच्छुक्ततिक्ताम्ललोहधूमामगन्धिकम् |
प्रसेकमुखवैरस्यतमकारुचिपीडितः ||१७५||

Below mentioned are the symptoms of manifested disease –

–        swelling in the arms and legs,

–        emaciation,

–        pain in the joints,

–        greediness – liking towards all tastes,

–        thirst,

–        vomiting,

–        fever,

–        loss of taste,

–        burning sensation inside the body,

–        vomiting material appears like vinegar, is bitter and sour, smells like iron and smoke,

–        excessive salivation,

–        bad taste in the mouth,

–        asthma – dyspnoea and

–        anorexia

वाताच्छूलाधिकैः पायुहृत्पार्श्वोदरमस्तकैः |
पित्तात् सदाहैर्गुरुभिः कफात्त्रिभ्यस्त्रिलक्षणैः ||१७६||
दोषवर्णैर्नखैस्तद्वद्विण्मूत्रनयनाननैः |
हृत्पाण्डूदरगुल्मार्शःप्लीहाशङ्खी च मानवः ||१७७||

Below mentioned are the symptoms of different doshas in the disease –

The colour of nails, faeces, urine, eyes and face will be in accordance with the predominant dosha involved in the pathogenesis (causative dosha). The person is likely to be suspected as suffering from heart disease, anaemia, enlargement of the abdomen, abdominal tumour, piles and diseases of the spleen.

Cikitsā – treatment

यथादोषोच्छ्रयं तस्य विशुद्धस्य यथाक्रमम् |
पेयादिं वितरेत् सम्यग्दीपनीयोपसम्भृतम् ||१७८||
ततः पाचनसङ्ग्राहिदीपनीयगणत्रयम् |
पिबेत् प्रातः सुरारिष्टस्नेहमूत्रसुखाम्बुभिः ||१७९||
तक्रेण वाऽथ तक्रं वा केवलं हितमुच्यते |
कृमिगुल्मोदरार्शोघ्नीः क्रियाश्चात्रावचारयेत् ||१८०||
चूर्णं हिङ्ग्वादिकं चात्र घृतं वा प्लीहनाशनम् |१८१|

Shodhana i.e. purificatory therapies should be administered in accordance with the aggravation of doshas. Peya and other liquid foods which are processed with herbs increasing hunger should be given. After this, powder prepared from pacana (digestive), grahi (constipating) and dipana (digestive) group of herbs should be administered along with sura (beer), arista (fermented decoctions), sneha (fats), mutra (urines), sukhambu (lukewarm water) or takra (buttermilk). Buttermilk is also beneficial to be consumed.

Treatments explained for the below mentioned conditions should also be adopted –

–        diseases caused by intestinal worms,

–        abdominal tumour,

–        enlargement of abdomen and

–        piles

Hingvadi Curna and medicated ghee which is indicated for enlargement of spleen should also be used in this context.

कल्केन मगधादेश्च चाङ्गेरीस्वरसेन च ||१८१||
चतुर्गुणेन दध्ना च घृतं सिद्धं हितं भवेत् |१८२|
सर्वथा दीपनं सर्वं ग्रहणीरोगिणां हितम् ||१८२||
ज्वरादीन विरोधाच्च साधयेत्स्वैश्चिकित्सितैः।।१८२।।

Medicated ghee should be prepared with the below mentioned ingredients and used –

–        paste of magadha – pippali,

–        fresh juice of cangeri,

–        dadhi – curds – four parts and

–        ghee – one part

Medicines which augment digestive fire (power) should always be used for patients suffering from grahani roga.

When complications like fever etc. arise, the treatment should be planned in such a way that they are not against the primary disease (grahani).

इति श्री सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गत कायचिकित्सातन्त्रेऽतिसारप्रतिषेधो नाम (द्वितीयोऽध्यायः, आदित) चत्वारिंशोऽध्यायः।।४०।।

Thus ends the fortieth chapter by name Atisara Cikitsa – in Uttara

Sthana of Suśruta Samhita.