Atisāra (diarrhea) according to Caraka

Atisāra Symptoms of Atisāra or Diarrhea are-passing excess of loose stools. It is said that diarrhea originated from the sacrifice performed by King Pṛṣadhra. Even The king first started sacrificing bulls and cows. Cows proved to be too heavy, too hot and too harmful. Therefore, it is said in brief that diarrhea is the main disease of bile and mucus. The pathogenesis, signs and symptoms of Atisāra are -unwholesome diet, vitiation of physical and mental doṣa, loss of agni etc.

There are six types of diarrhoea—

1. Vātaja,
2. Pittaja,
3. Kaphaja,
4. Sannipātaja,
5. Bhayaja and
6. Śokaja^[1].

Vātika types of atisāra are manifested in the following factors-exposure to the excessively strong wind, hot sun and physical exercise; indulgence in ununctuous food or less quantity of food or irregular meals or strong alcoholic drinks or excessive sexual intercourse; and suppression of natural urges. They cause the Vāyu to get aggravated and the power of digestion gets afflicted. When the loss of the power of digestion, the aggravated vāyu forcefully brings down the urine and sweat to the colon or purīṣāśaya and with the help of these liquified the stool, causing diarrhea thereby.

The two conditions of Vātajātisāra are Āmātisāra and Pakvātisāra. The following signs and symptoms of the vātika type of Atisāra are as follows: the stool is slimy and mixed with mucus (Āma); the stool floats on water; the stool when placed over the earth gets soaked; the stool is rough and liquid; voiding of stool is associated with colic pain; the stool smells like undigested food; voiding of the stool is associated with less of sound or no sound at all; it is associated with non-voiding of flatus and urine; the aggravated vāyu moves in the Koṣṭha obliquely along with gurgling sound, while causing colic pain.

In the Pakva stage of vātika type of Atisāra, the signs and symptoms manifested are as follows: the patient voids hard stool in small quantities; the voiding of stool is associated with sound and colic pain, the stool is frothy and slimy; the patient suffers from griping pain, horripilation, groaning, dryness of the mouth, pain in the lumber region, thighs, sacral region, knees, back and sides of the chest, and prolapse of the rectum, and he voids scybalous stool frequently.

The general treatment of Vātajātisāra has been said to be -do not try to stop diarrhoea when undigested food is being expelled; apply decoction to improve appetite and digestion; Harītakī can be administered to expel the doṣa. In prolapse of rectum used unctuous enema or cāṅgeri-ghṛta internally and replacement of rectum and placing of picu.

Paittikā types of atisāra are manifested in the following factors: excessive intake of sour, saline, pungent, alkaline, hot and sharp ingredients; Affliction of the body by excessive exposure to the heat of the strong fire, hot rays of the sun and hot wind, and excessively wrathful and jealous disposition. They cause the pitta to get aggravated and on account of its the liquidity suppresses the power of digestion, and having arrived at the colon, disintegrates the stool because of its heat, liquidity and mobility, causing diarrhoea thereby.

The signs and symptoms of paittikātisāra are as follows: the patient voids frequent loose motions which are either yellow, green, blue or black in colour; the stool is mixed with blood and bile, and it is excessively foul smelling, and the patient suffers from morbid thirst, burning sensation, excessive sweating, fainting, colic pain and hot sensation, and there is suppuration of the anus.

Treatment of Pittaja Atisāra includes light food to increase appetite and digestion if the patient is strong and has good digestion purgatives to expel the doṣa. In case of recurring pain unctuous enema is caused.

Bloody diarrhea is treated by intake of goat’s milk, honey, and sugar mixture; and use of Kuṭaja decoction and Śatāvarīghṛta orally; use of mixture of butter, honey, and sugar, and also, Picchā basti. When Pittajātisāra person continues to consume pitta food, which causes aggravation of pitta, then the exceedingly aggravated pitta causes Raktātisāra.

Kaphaja type of atisāra are manifested in the following factors: intake of heavy, sweet, cold and unctuous ingredients in excess; inactivity of the mind and indolence, and habitually sleeping during the day time. They cause the Kapha to get aggravated and it moves downwards and afflicts the power of digestion on account of its natural cooling property, and having arrived at the colon, it liquefies the stool, causing diarrhoea thereby.

The signs and symptoms of Kaphajātisāra are as follows: the patient voids stool which is unctuous, white, slimy, fibrous, mixed with mucus as well as undigested food particles, heavy, foul-smelling and mixed with phlegm; the patient suffers from nonstop colic pain; he voids stool frequently in small amounts; the voiding of stool is related with griping pain; the patient suffers from heaviness in the abdomen, in the region of urinary bladder, and in the urge for passing another spell of stool even after evacuation. He suffers from horripilation, nausea, excessive sleep, indolence, prostration and dislike for food.

Kaphajātisāra treatment includes lightening and digestive measures; eating tender, Bilva fruits; Kapittha fruit with trikaṭu, honey and sugar. Picchābasti is the best treatment of Pittaja and Kaphajātisāra.

Kṣārapāṇi has, however, specifically and separately described the signs and symptoms of both these stages āma and Pakva-of all the three types of atisāra. According to him, in the ama stage of vātika type of atisāra, the following signs and symptoms are manifested: the stool is associated with ama (mucus); the patient gets colic pain while voiding stool; the stool is frothy, thin and greyish black in colour; the voiding of stool is associated with noise; the stool is tool smelling and scybalous; and the patient voids stool in small quantities.

Symptoms of Sannipātajātisāra are: Cold, Soft, Rough, Warm, Hard and Solid consumption, Odd Eating, unwholesome food, Eating Unhealthy food, Eating contaminated food, eating less food, drinking contaminated alcohol and drinks, Overconsumption of alcohol, constipation, purgation of excessive consumption, excess consumption of Agni, Sun, air and water, insomnia, excess sleep, disorder of periods, exhaustion, excess of fear, grief and haemorrhoids, or worm infestation due to wormborne fever and haemorrhoids. They cause the three dosas to get aggravated, power of digestion gets vitiated having entered into Pakvāśaya, and this causes diarrhoea.

Two types of stranger diarrhoea are caused by mental fear and grief. The symptoms of these two types of diarrhea are similar to those of flatulence. Fear and grief soon engulf the Vāyu. In such a place, Vātahara treatment is necessary. Therefore, it is obligatory to reassure the patient.

The patient whose flesh is bloody and whose strength is very faint, whose taste of the mouth is lost, such a patient cannot be cured. Again, the patient's stool having the following colours, and if the patient has the following symptoms, he cannot be cured. For example, if the patient’s stool, decoction, blood, liver, etc. becomes very blue and bloody, the patient will be incurable. Various medicines have been prescribed for the treatment of diarrhoea.

For example, if you drink Cāṅgerīghṛta, it cures ailments caused by prolapse of rectum. This medicated ghee is prepared ghee which should be cooked with the juice of cāṅgerī, decoction of kula and sour curd, and the paste of Nāgara and kṣāra.

For example, Rasāñjanādi-cūrṇa can be taken with lemon juice to get rid of diarrhoea; Rasāñjanādicūrṇa, Kapitthādi-cūrṇa can be taken to get rid of diarrhea. On the other hand, if you take Pippalyādi cūrṇa the mucus and diarrhoea are destroyed. After vāta, pitta and the kapha should be managed or whichever doṣa is the strongest, should be managed first^[2].

Footnotes and references:

[1]:

pittalasya punaramlalavaṇakaṭukakṣāroṣṇatīkṣṇātimātraniṣeviṇaḥ pratatāgnisūryasaṃtāpoṣṇamārutopahatagātrasya krodherṣyābahulasya pittaṃ prakopamāpadyate | tat prakupitaṃ dravatvādū ṣmāṇmupahatya purīṣāśayavisṛtamauṣṇyād dravatvāt saratvācca bhittvā purīṣamatisārāya prakalpate | tasya rūpāṇi-hāridraṃ haritaṃ nīlaṃ kṛṣṇaṃ raktapittopahitamatidurgandhamatisāryate purīṣaṃ, tṛṣṇādāhasvedamūrcchāśūlabradhnasaṃtāpapākaparīta iti pittātisāraḥ || (C. Cikitsāsthāna–XIX.6); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 223.

[2]:

C. Cikitsāsthāna–XIX.4-122; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. IV, Varanasi, Chowkhamba Sanskrit Series Office, 2017, pp. 203-241.