- Preface: The entire discourse of atisaar as narrated by Lord Punarvasu Atreya to Agnivesha as follows:
In initial age, though the animals were sacrificeble in yagnyas(sacrificial rites), they were actually not sacrificed but after the sacrifice performed by Daksha when sacrificial rites were performed by the son’s of Manu such as Narishyan, Naabhag etc. the animals began to be sacrificed with their(animals) own permission. Still later Prushadhra started sacrificing bulls when other animals were not available for this long term sacrificial rite. On seeing this creatures became shocked and when in this afflicted mental state and consequent loss of agni they ingested the killed bulls, it caused diarrhoea due to heaviness, hotness, unsuitability and use of inauspicious thing. Thus atisaar(diarrhoea) originated initially in the sacrificial rite of Prushadhra.
- Types of Atisaar: Total 6 types.
1) Vatika Atisaar/diarrhoea
Aetiology along with pathogenesis: A person of vatika constitution is exposed excessively to wind, sun and physical exercise; takes rough, little or deficient food; indulges in sharp things, wine and sex and holds up the urges, vayu gets vitiated and agni is diminished. In this state the vitiated vayu carrying urine and sweat (fluids) to the colon liquefies the stool and thus causes diarrhoea.
Sign and symptoms: In this stool if Ama(undigested) is passed as slimy, spreading, precipitating, rough, liquid, painful, with fishy odour, slight or no sound, and retention of urine and flatus. The retained vayu moves within the belly here and there with sound and pain-this is Amatisara caused by Vata. In case of Pakva(digested)stool, it is constipated, passed in little quantity with sound, pain, froth, slim and cutting pain in anus, horripilation, increased respiration, dryness of mouth, pain in waist, thigh, sacral region, knee, back and sides, anal prolapse and now and then as scabulous. Some say it is “anugrathita”(scabulous) because of stool being knotted by Vata.
2) Pittaj Atisaar
Aetiology along with pathogenesis: when a person of pittal constitution takes sour, salty, pungent, alkaline, hot and irritant things excessively, is afflicted by constant exposure to fire, scorching sun and hot winds and psychologically stressed with anger and envy, his pitta gets vitiated. This extinguishes the agni due to fluidity and then reaching the colon breaks the stool due to hotness, fluidity and laxativeness and thus causes diarrhoea.
Sign and symptoms: in this the patient passes stool as yellow, green, blue, blak, associated with rakta-pitta and exceedingly foetid. Patient is associated with thirst, burning sensation, sweating, fainting, colic pain, inflammation and suppuration in anus.
3) Kaphaj Atisaar
Aetiology along with pathogenesis: when a person of shleshmal constitution takes heavy, sweet, cold and unctuous things excessively, oversaturates himself, is free from mental work, indulges in day sleep and is idle his kapha gets vitiated. Kapha being heavy, sweet, cold and unctuous in nature while moving down extinguishes the agni and further due to watery nature affects the colon with excessive fluid and thus causes diarrhoea.
Sign and Symptoms: In this patient passes stool as unctuous, white, slimy, thread, ama(undigested), heavy, foetid, mixed with mucous, with frequent colic pain, in little quantity and with tenesmus. He feels heaviness in abdomen, anus, pelvis and groin, has motions without knowledge and has horrilpilation, nausea, oversleep, idleness, lassitude and aversion to food.
4) Tridoshaj Atisaar/Sannipatatisaar
Aetiology along with pathogenesis: by intake of too cold, unctuous, rough, hot, heavy, coarse and hard things, irregular meals; intake of incompatible and unsuitable things, fasting, delayed meals, taking whatsoever, drinking defective wine and water, over-drinking, avoiding evacuation, irregular application and mismanagement of remedial measure, excessive exposure to fire, sun, wind and water, want to sleep or oversleep, suppression of urges, seasonal perversions, exertion not in consonance of strength, excessive fear, grief and mental agitation, or due to excessive emaciation in diseases like intestinal worms, pthisis, fever and piles in a person having deranged agni all the three doshas get vitiated and damaging the agni further reach the colon and cause diarrhoea with symptoms of all the doshas.
Sign and Symptoms: Besides by affecting the dhatus(blood etc.) deeply they exhibit varios colours in stool caused by the nature of dhatus and doshas. When the dhatus(blood etc.) are affected too much, the patient passes stool as yellow, green, blue red like manjishtha and meat-water, black, white like lard, painful or painless, all these combined together or separately, sometimes ama(undigested) and scabulous while sometimes digested, with not too much loss of flesh, blood or strength, having poor digestion and loss of normal taste in mouth. Such patient should be known as curable with difficulty.
2 types of diarrhoea caused by fear and anxiety are psychic and exogenous. Their symptoms are the same as those of vatika diarrhoea. Vayu gets vitiated quickly by fear and anxiety. Hence they are treated with vata-alleviating measures and psycho-therapeutic ones like-producing exhilaration and consolation.
That having stool with the following colours and other complications should be rejected as in curable such as like cooked blood, liver pieces, fat, meat-water, curd, ghee, marrow, oil, muscle-fat, milk and veshavara(a spicy preparation), exceedingly blue, red and black; clear like water, collyrium-like, too unctuous; green, blue and ochre-coloured, variegated, turbid, slimy, thread, ama(undigested) with moony lustre, foetid. Putrid and of cadaverous odour, having odour of uncooked fish, attacked by flies, containing profuse discharge of necrosed tissues, passing little or no stool associated with thirst, burning sensation, fever, giddiness, feeling of darkness, hiccup and dyspnoea, with excessive or no pain, prolapse and suppuration of anus, rectal folds having fallen down, open anal passage, too much wasting of strength, muscles and blood, pain in all the joints and bones, afflicted with anorexia, restlessness, delirium and fainting, sudden relief of symptoms-such patient of diarrhoea should be taken as incurable.
- Treatment principle of Atisaar/diarrhoea:
- In the case where doshas accumulated due to mixing up with the undigested food are responsible for diarrhoea, they should be eliminated.
- Further astringent measures should not be applied in the very beginning in case of amatisara(diarrhoea with indigestion)
न तु संग्रहणं देयं पूर्वं आमातिसारिणे...च. चि. १९/१५
because the doshas(pathogenic materials) held up before handproduce a number of disorders such as Dandakaalasak(a type of disease which stiffens the body), tympanitis, grahani disorder, piles, oedema, anemia, slpeenimegaly, kushtha, gulma, udarrog and fever.
- Hence one should ignore the excited and self-impelled motions or if there be any difficulty he should administer haritaki to induce it further. By this when the impurity is eliminated, the abdominal disorder is relieved, body recovers lightness and agni improves.
- The patient having moderate dosh should be given decoction to improve appetite and digestion. In case of those having little dosha, lightening is advisable.
- After vata, pitta and after pitta, kapha should be controlled or whicheve be strongest of the three should be overcome first.
- Treatment of various types of Atisaar/diarrhoea-
Vataj-amatisaar(diarrhoea with indigestion)-
- Decoctions/medicated water for amatisaar-decoctions prepared from pippali, shunthi, dhanyak, bilva, shunthi, musta etc.
- In case of hunger- light food in meal time, managed with buttermilk, sour-gruel, saturating drinks etc. Thereafter he should be given gruel, paste gruel, soups, rice with meat-soup added with appetisers and astringents.
- Various soups prepared from appetiser, digestive, astringent drugs like bilva, sunthi, patha, vacha, jirak, pippali, yavani, chitrak, sour pomegranate, hingu, rock salt etc.
- In case ama is digested but still the patient suffers from diarrhoea passing stool with retention, mucus and tenesmus in small quantity but frequently, the patient should be fed with the soup of radish, badara, veggetables, pomegranates, plenty of fat.
- In case of excessive elimination of stool leading to dryness of mouth(dehydration), the patient should fed on shali rice with the soup of cereals, tender fruit of bilva added with curd and pomegranate fruit. Various meat soups also help in such condition.
Niram Vata-atisaar treatment-
- When the patient if free from ama and suffers from prolapse of rectum with pain, he should take sour ghrut like changeri ghrut or unctuous enema.
- If the rectum is stiffened and prolapsed, at first, at first, it should be uncted and fomented and when it is fomented well and softened, it should be put inside with a tampon.
- If the patient has retention of flatus and faeces, excessive pain and tenesmus, passes blood and mucus and suffers from thirst, he requires ample saturation with milk. Warm milk can be boiled with castor root or tender fruit of bilva. This helps to subside above sign and symptoms.
Pittaj-amatisaar(diarrhoea with indigestion)-
- Patient should be managed with lighteneing and digestive measures according to strength.
- In case of thirst, he should be managed with water boiled with musta, parpatak, ushira, sariva etc.
- After lightening, at the time of food, he should be given gruel, scum etc. or saturating drink etc. gradually according to suitability cooked with the decoction of bala, atibala, prishniparni, bruhati shatavari and gokshur etc.
- Agni should be stimulated gradually by giving soup of green gram, lentils, harenu, adhaki or meat- soup slightly or not soured. If diarrhoea continues appetising, digestive, pacificatory and astringent formulations should be administered.
- Seeds and bark of kutaja, kirattikta, daruharidra, chandan, mrunal, utpala, mocharas, lodhra, lotus and water lilly are some drugs that can be taken with rice water and honey.
Niram Pitta-atisaar treatment-
- In patients having good appetite and digestion, use of goat’s milk improves strength and complexion.
- If the patient is strong and with good digestion but has plenty of impurity(fecal accumulation) then he should be cured with milk.
- If pain recurs unctuous enema should be administered quickly. If diarrhoea is still there, then Piccha basti(slimy enema) should be applied. Shalmali is used for this purpose. This enema acting as evacuative as well as sustaining, overcomes quickly.
- The patient of pittaj diarrhoea who avoiding all these measures indulges in the intake of pitta-vitiating food and drinks, his pitta aggravates severly and by affecting blood quickly produces Raktaatisaar(bloody diarrhoea) along with thirst, pain, burning and inflammation in anorectum.
- In such case goat’s milk cooked and added with honey and sugar should be used in food, drink and anal washing. The patient should be fed on boiled red shali rice with the above milk or the meat-soup etc.
- In case the anus gets inflamed by pitta due to frequent motions, one should sprinkle it with very cold decoction of patola, madhuka or panchvalkal or cow’s milk etc.
Kaphaj-amatisaar(diarrhoea with indigestion)-
- At first, lightening and digestion are desired and drugs which stimulate agni, alleviate ama and diarrhoea should be prescribed.
- Even on lightening and following the dietic regimen, the kaphaj diarrhoea is not controlled, it should be treated with biva-karkati(dried pieces of bilva fruit), musta, haritaki, shunthi, vacha, vidanga, ativisha, patha, pippali, pippalimool, chitrak, maricha, patha, kutaja, ativisha etc.These can be consumed with buttermilk and adding some uncting substance and salt.
- Suffering from pain, tenesmus and obstruction to flatus should take tender biva fruits, jiggery, tila oil, pippali, shunthi
- Food should be taken with dashmool decoction, other vata-alleviating formulations and vegetable and meat-soup
Niram Kapha-atisaar treatment-
- In case of excessive diarrhoea due to kapha or dysentery with pain, one should administer Piccha basti.
- On diminution of kapaha, vayu positively aggravates in its own place and thus suddenly kills the patient. Hence it should be controlled quickly.