ATISARA

MYHOLOGICAL ORIGIN OF ATISARA:

At the commencement of satya yuga,the sacrificial animals were
released soon after the recitation of the sacrificial mantras,these animals
were not actually killed during the course of yajna In the age following the
performance of the yajna,by daksha prajapathi,the sons of manu started
assassinating these sacrificial animals during the performance of the
yajna,thinking that in the sastras it was so ordained or being pressed by
themselves and they will directly attain the heaven.It become quite
impossible to get other animals in the required number, prishadhra who was
performing yajna,starded sacrificing even bulls and cows.After observing
this living creatures were bewildered.The meat of the sacrificial bulls and
cows proved to be too heavy,too hot and too harmful.Persons partaking that
meat starting suffering from the loss of the power of digestion and loss of
mental equilibrium.Thus atisara originating from the yajna performed by
prishadhra

NIDANA

Intake of heavy,very fatty or very dry,very hot or very cold meals and
excessively liquidity or excessively solid food.It is also caused by the intake
of incompatible articles of diet,by eating before the previous meal has been
digested or during indigestion and by the intake of an unbalanced diet.
Exessive use or improper use of oleation therapies
etc..,poisons,fear,grief,excessive drinking of wine,actions opposite to the
beneficial rules of diet etc.., and to proper seasonal regimen,excessive
playing in water,suppression of natural physiological evacuatory urges and
worm infestions may also result in atisara.
 SAMPRAPTHI:

Increased fluids of the body subdue the internal digestive fire,mix with the
faeces and being propelled down by vayu flow out excessively called
atisara.
BHEDHA:

Vataja,pittaja,kaphaja,sannipataja,amaja,sokhaja

Vataja,pittaja,kaphaja,sannipataja,bhayaja,sokhaja-6 types.
Charaka mentioned vataja,pittaja,kaphaja, sannipataja,bhayaja and
sokhaja as the types of atisara and mentioned that bhayaja and sokhaja as
agantuja atisara.
PURVARUPA:

Pain in the heart,umbilicus,anal,abdominal and the flanks

region,bodyache,obstruction of the passage by vata ,constipation,
flatulence,indigestion.

RUPA:
Vataja atisara:[AMA]
1.The stool is slimy and mixed with mucus.
2.The stool floats on water.
3.The stool when placed over the earth gets soaked.
4.The stool is rough and liquid.
5.Voiding of stool is associated with colic pain.
6.The stool smells like undigested food.
7.Voiding of the stool is associated with less o sound or no sound at all.
8.It is associated with non voiding of flatus and urine.
9.The aggrevated vayu moves in the koshta obliquely along with gurgling
sound,while causing colic pain.
Vataja atisara:[PAKWA]

1.Patients voids hard stool in small quantities.

2.Voiding of stool is associated with sound in small quantities.
3.The stool is frothy and slimy.
4.The patient suffers from griping pain,horripation, groaning,dryness of the
mouth,pain in the lumbar region,thighs,sacral region,knees,back,sides of
chest, prolapse of the rectum.
5.He voids grathitha stool frequently.
According to some physicians,this atisara is called
“ANUGRATHITHA-ATISARA”because of the voiding of grathita varchas.

The patient of vatika atisara suffers from griping pain,oligiuria,intestinal

gurgling,loss of tone in the anorectal region and a feeling of tiredness in the
waist,thigh and calf regions,passes blackish,frothy, fatless,faeces frequently
and insmall quantities.
Madhavakara also followed susrutha but induced pain and noise while
expelling the faeces.
Pittaja atisara:

1.The patient voids frequent loose motions which are either

yellow,green,blue or black in colour.
2.The stool is mixed with blood and bile, it is excessively foul smelling.
3.The patient suffers from morbid thirst,burning sensation,
excessive sweating,fainting,colic pain and hot sensation.
4.Suppuration of the anus.

Foul smelling,hot and meat washings like loose feces which come out in
spouts, the patient sweats all over the body and feels an excessively sharp
sense. The stools may be yellowish,bluish or bloody. He also suffers from
thirst,attacks of fainting,burning sensation,stppuration and fever.
Kaphaja atisara:

1.The patient voids stool which is unctuous white slimy,

fibrous,mixed with mucous as well as undigested food particles,
heavy,foul smelling and mixed with phlegm.
2.The patient suffers from continous colic pain.
3.He stool in small quantities frequently
4.The voiding of stool is associated with griping pain.
5.The patient suffers from heaviness in the abdomen, in the region of
urinary bladder and in pelvic region.
6.The patient feels the urge for passing another bout of stool even
evacuation.
7.He suffers from horriplation,nausea,excessive sleep dislike for food.

Drowsiness,excessive sleep,a feeling of heaviness in the body,nausea

and depression. Even after defecation the patient feels desire to pass stool
again. His feces are white in colour,viscid,mixed with mucous. The patient
suffers from an eversion to food. He pass stools with out producing any
sound but associated with horripilation.
Tridoshaja atisara:

1.The patient voids stool having yellow,green,blue, reddish

,pink,red,black,white and yellowish in colour.
2.The patient suffers from continous pain or he may be free from any pain
3.Sometimes,te patient may void scybalous stool, sometimes it may be mixed
with mucous and sometimes,the stool may be free from mucous.
4.There is diminution of muscle tissue,blood and strength.
5.The power of digestion of the patient is suppressed
6.There is impairment of the taste in the mouth of the patient.

Drowsiness,confusion,leathergy and dryness of the mouth.He passes

feces of the mouth.He passes feces of various colours complains of
thirst,exhibits signs and symptoms of vitiation of all the doshas,it is difficult
to cure incurable in children and old patient.
Sokhaja and bhayaja:

Agantuja atisara is of mental origin and is of 2 types-sokhaja and

bhayaja. Their signs and symptoms are similar to these of vatika type of
atisara.
According susruta,the patient due to sokha takes small quantities of
meals,his bashapa vega effects the digestion process in the koshta and
agitates the blood. Thereafter,this blood,looking is like kakananthi is passed
by the patient with difficulty from the lower passage mixed with stool or
without stool with or without any odour,this is krichra sadhya.
Amatisara:

The feces mixed with the doshas sink when dropped in water,have a very
foul odour and gets scattered,this is called ama.
Pakwatisara:

In pakwatisara features opposite to amatisara are seen particularly that of

lightness,indicates pakwatisara.
Raktatisara:
 If the patient suffering from the paittika atisara does not follow the
regimen for the pittatisara and resorts to such foods and drinks which cause
aggrevation of pitta,then the exceedingly aggrevated pitta causes
raktatisara and instantaneous vitiation of rakta. This leads to complications
like thirst, coic pain,burning sensation and suppuration of anus.

SADYASADYATWA
Asadya lakshanas:
1.The patient voids stool having the colour of digested blood,piece of liver,
washing of fat or flesh,curd,ghee,bone marrow,oil,muscle fat,milk,vesavara.
2.The colour of the stool is excessively blue,red,black,transparent like water
or tar coloured.
3.The stool is excessively greesy.
4.The colour of the stool is a mixture of the green,blue,brown.
5.The stool is variegated in colour,dirty,slimy,fibrous,mixed with mucous
and spotted with candraka.
6.The stool has exceedingly bad smell like that of a dead body or it is
exceedingly putid in smell or the stool bears the smell of undigested
products or it is like raw fish.
7.The stool attracts fliesin excess.
8.The stool contains sloughs and tissues elements in excess.
9.The stool contains less or no fecal mater.
10.Patient continuously suffers from morbid thirst,burning sensation,fever
giddiness,fainting,hiccup,asthma,excessive pain or no pain.
11.There is prolapse and inflammation anal canal or anal spinctures come
out of their sites or the whole of the rectum comes out.
12.There is excessive loss of strength,muscle tissue and blood.
13.There is pain in all the joints and bones.
14.The patient suffers from excessive form of anorexia,dislike for
everything,delirium and unconsiousness.

According to astanga hridaya:

Atisara:1)sama
2)nirama
SAMA:Feces is heavy,sinks in water,foul smelling,gurgling sounds,stasis of
undigested food in the stomach,pain in abdomen.
NIRAMA::opposite to the ama avastha.

Feces containing more kapha also sinks in the water even though it is
pakwa.
Atisara:1)sarsa(with blood)
2)nirasra(with out blood)

Bhayaja and sokhaja atisara:

These are caused by the effliction of the mind,by the increase of vata
and pitta the feces become liquid and produces atisara. Elimination is quick
warm,floating and have of the symptoms caused by vitation of vata and
pitta.
These are the signs and symptoms of bhayaja and sokhaja atisara.

CHIKITSA
Chikitsa sutra:

When the atisara is caused by the accumulated doshas impelled by

vidagdha ahara,the patient should be given laxative to eliminate the doshas.
It is not desirable to give sangrahi dravyas to the patient suffering from
amatisara initially.

Atisara is born especially born by from the amasaya destroying the

digestive fire,hence langhana is ideal at the commencement even in that
atisara arising from vata.
 At the in amatisara sangrahana should be not done. Untimely
administration of sangrahana leads to complications.
In mildly vitiated doshas langhana is the best treatment.

Foods processed with grahi,dipana and pachana dravyas should be

given.
-Ankota along with honey and rice water cures atisara
-Masuradi ghrita containing masura,bilwa,ghrita is useful in curing atisara.

Chitraka,pippali mula,vacha and katukarohini should be taken with

dhanyamla,warm water or with wine water.

Vataja atisara:

Pramathya prepared with pippali,nagara,dhanya,bhutika,abhaya,

vacha useful in vataja atisara.

Decoction of vacha and ativisha are useful in vataja atisara.

Medicated oil or ghrita prepared with bilwa,pippalimula,dadima is

useful in vataja and kaphaja atisara.
 Persons suffering from atisara should first be given langhana therapy,
then substances beginning with yavagu etc.., given in their respective order

Equal parts of trailokya vijaya,jatiphala added with kalingaka

equal to both all are made into fine powder are licked,cures all types of
atisara

Pittaja atisara:

The fruit and bark of vatsaka should be added with ativisha and
honey along with rice water.

Powder of kiratatikta,musta,vatsaka and rasanjana.

Powder of bilwa,daruharidra,twak,hribera,duraharidra.

Juice obtained from the leaves of mild variety of babula or that of the
bark of syonaka or kutaja alleviates all types of atisara.

The well ripened dadima fruit is incenerated and its juice is added
with honey administrated to alleviate all types of atisara.
-kashaya of saliparni,bala,bilwa,dhanyaka,sunthi cures atisara
 Vacha,ativisha,musta,bija of kutaja prepared kashaya is best for vataja
atisara.

Importance of milk in pittaja atisara:

Administration of goat milk to the patient having strong digestive power

cures pittaja atisara and promotes strength as well as complexion.
-virechana with milk is useful
-kashaya prepared with palasa phala along with milk.
Anuvasana vasti:
Ghrita cooked by adding ¼ th of tila,kashaya of satapushpa,satavari,
madhuka and bilwa.
Piccha basthi:
If atisara persists even after the administration of anuvasana vasti and
the administration of samsarjana karma, then piccha basti should be
administrated.
Ardra vrinta of salmali should be covered with green kusa and tied. This
bundle should then be smeared with mud of black soil and placed over cow
dung fire. After the mud is dried up and stalks of salmali are removed. These
stalks should then be triturated in khalwa yantra. One mushti of the paste
should be mixed with one prastha of boiled milk and then filtered. In this
milk,oil and ghee and the paste of madhuka should be added in adequate
quantities. This recipe should be used as piccha vasti after the patient is
massaged with oil. After the ingredients of vasti comes out of the rectum,the
patient should take bath and take the food along with either milk or jangala
mamsa rasa.
Piccha vasti cures pittaja atisara,grahani and the acute complications of
anuvasana vasti.
SUSRUTHA MENTIONED FOLLOWING YOGAS FOR PITTAJA
ATISARA:
1)Mustaka,kutaja beeja,bhunimba,rasanjana.
2)Patha,mustaka,haridra,daruharidra,pippali,kutaja phala.
3)Mrintaka,candana,rodhra,nagara,blue lotus.

Phanitha,kutaja beeja added with drugs of vatskadi and ambastadi gana

with makshika cures all types of atisara.
-sadanga paniya is useful in pittaja atisara when the patient is suffering
with thirst.

Kaphaja atisara:

- Administration of the yoga containing one part of the black variety of ajaji,
patha,nagara and maricha and two parts of dhataki,along with profuse
quantity of lime juice cures kaphaja atisara
- Pippali,pippalimula,citraka.
- One part each of rasanjana,ativisha and kutaja phala and 2 parts of
dhataki should be added with honey and ginger.
- Kapittha,vidanga,nagara,maricha should be added with juice of cangeri,
kola and takra after adding with ghrita and lavana.
- Kapitha along with honey.
- Pippali along with honey and citraka churna.

Langhana is the best therapy firstly in the treatment of kaphaja atisara.

- Kapittha churna.
- Dadimastaka churna.
- Bilwa taila for anuvasana vasthi.
- Patha,chitraka,vastaka,granthi,tikta,sunthi,abhaya are useful in kaphaja
atisara either in the kashaya or churna.
Amatisara:

Fasting is ideal even during purva rupa,at all the langhana,ingestion of

light foods with more of liquids is best.

Harithaki,daru,vacha,musta,nagara,ativisha prepared kashaya should be

given in amatisara.

Harithaki,ativisha,hingu,souvarchala,vacha,saindhava are made into

paste and take with warm water.

- Dardara(cinnabar),vatsanabha,maricha,tankana,kana are made inro

churna in equal quantities is called “ANANDABHAIRAVI RAS”.

Susrutha mentioned following yogas for amatisara.

- Panchalavana,pippali,vidanga,harithaki.
- Chitraka,simspa,patha,sarangesta,pancha lavana.
- One aksha of each of paste of hasthi danti,pippali.
- Vacha and stem of guduchi.

Raktatisara:
 Goat milk, when cooled with honey and sugar for drink along with food
and for washing anus.
- Salidhanya boiled with ajakshira.
- Takra along with honey and sugar should be given before meals.
- Ghee along kapinjala rasa cures raktatisara in 3 days.

Satavari mixed with milk or ghee boiled with paste of satavari cures the
rakta atisara.
- Krishna tila taken with 4 parts of sugar along with aja ksheera cures rakta
srava immediately.
- Paste of priyangu with tandulambu stops bleeding immediately.

Pulp of bilwa,madhuka along with honey and sugar taken with

tandulodaka cures pittaraktaja atisara.

Bilwa along with guda cures raktatisara.

Badarimula kalka along with tila kalka taken with madhu and kshara
cures rakta atisara.

Pakwatisara:
 Lodhra,dhataki,bilwa,musta,amrasthi and kalingaka should be powdered
nicely and consumed with mahisha takra.
-Gangadhara churna
-Vriddha gangadhara churna
-Kutaja avaleha.
SODHANA IN RAKTATISARA:
-Anuvasana vasthi with satavari ghrita.
-Piccha basti with prapondarika.

Atisara with pain:

In atisara associated with pain harithaki should be given as mridu

virechana.

The patient who passes loose stool repeatedly in small quantities with
pain,virechana with haritaki and pippali kalka along with luke warm water
should be given.

Ghrita processed with curd,kanji,vyosha,ajaji,chitraka along with cavya

and pippalimula with dadima is beneficial for the patient suffering with pain
in atisara.
Sannipataja atisara:
If atisara is caused by sannipataja, then in the beginning the aggrevated
vayu should be alleviated followed by the pitta and kapha. Alternatively of
the 3 doshas, the most aggrevated one should treated first.

Decoction of pancha valkala or sugarcane juice and milk or ghee of goat

or cow mixed with sugar and honey is done prakshalana on anal region in
gudpaka.
- The powder of dhataki and lodhra taken in equal quantities may be used
for dusting over the guda paka.
Susrutha mentioned piccha basti in case of gudapaka associated with
sula.

Guda bhramsa:

Anuvasana vasthi should be given with:

1)Dasamula siddha vasa
2)Bilwa cooked with vasa.
3)Sati,satahva,bilwa cooked in fat.
4)Vasa cooked with fat
5)Citraka cooked with fat should be given.
When rectum becomes stiff and strangulated and does not goes inside of
its own should be applied with oil and sweda karma to be done and with the
help of cotton plug,guda is pushed,placed and resorted in original place
after the rectum becomes soft.
-Cangeri ghrita and chavyadi ghrita are also mentioned in case of guda
bhramsa.
BHAVAPRAKASHA MENTIONED:
Guda bhramsa:Rectum should be anointed with fats and pushed inside with
mridu swedana.
Guda nissarana:Use of changri ghrita.

Varcha kshaya:
-Charaka mentioned raktasali siddha ghrita with amla dravyas should be
given to the patient in varcha kshaya.
-Dhanya yusha made of mudga,yava,masha,Sali,tila,kola,bilwa pravala
along with yamaka,dadhi and dadima should be given to the patient.

The decoction of masha,yava,kola,ama in yamaka should be

processed with dadhi,dadima given for meals which is beneficial to the
patient who suffers with varcha kshaya.
Susrutha mentioned different types of putapaka like tittira putapaka,
lodhradi putapaka,vatapraroha putapaka for the different types of atisara.

Sokhaja and bhayaja atisara:

Because of the fear and grief, vayu gets aggrevated instantaneously.

Therefore,for the treatment of these two varieties of atisara,vayu alleviating
drugs and therapies should be administrated. The patient suffering from
atisara caused by fear should be exhilarated and the patient suffering from
atisara caused by sokha should be consoled for their cure.
 PRAVAHIKA
Nidana and samprapthi:

In persons who take unwholesome diet,excessively aggrevated vayu

propels by the accumulated vayu propels by the accumulated mucous mixed
with feces down repeatedly with a lot of griping called pravahika.

Rupa:
Vataja pravahika—elimination of feces with pain.
Pittaja pravahika---elimination of feces with burning sensation.
Kaphaja pravahika---elimination feces mixed with kapha.
Raktaja pravahika----mixed with blood and more moisture.

Chikitsa:

Khada should prepared by adding the paste of tender fruits of bilwa,

equal quantity of paste of tila,sour curd,profuse quantity of ghee, this cures
pravahika when take internally.
Susrutha mentioned asthapana vasthi prepared with dasamula and milk
and followed anuvasana vasthi with dasamula and milk for pravahika
chikitsa.
 Powder of pippali or maricha consumed cures pravahika though
persisting for longtime.

JWARA ATISARA:

Kashaya of nagara,bilwa,guduchi,musta and vatsaka is digestion

and cures atisara associated with jwara.

Powder of utpala,dadima twak,padmakesara consumed along with

rice wash water cures jwara atisara.

ANUPANA

Yogaratnakara mentioned kutaja as the best anupana for atisara.