1

1. ATISARA
 Mythological Origin of Diarrhea:
1. In Satya Yuga, the sacrificial animals were actually released
soon after the recitation of the sacrificed mantras, & these
were not actually killed during the course of the sacrifice.
2. However, in the age following the performance of the
sacrifice by Daksa prajapate, the sons of Manu, like
Narisyan, nabhaga, Iksvaku , Nrga & saryate started actually
assassinating these sacrificial animals during the
performance of yajna.
3. Subsequently, it became quite impossible to get other
animals in the required number, & Prsadhra who was
performing sacrifice, started sacrificing even bulls & cows.
4. After observing this, the living creatures were bewildered.
5. The meat of the sacrificed bells & cows proved to be too
heavy, too hot & too harmful.
6. Persons partaking that meat started suffering from

a. Loss of power of digestion

b. Loss of mental equilibrium

7. Thus, atisara originate

Reference:
CHARAKA SAMHITHA
Chikitsa sthana 19th chapter
4th shloka
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 Types:
Acc, to charaka

1. Vata

2. Pitta

3. Kapha

4. Sannipatika

5. Agantuja

a. Bhayaja

b. Shokaja

 Vataja Atisara:
Etiology:

वातलस्य वातातपव्यायामाततमात्रतिषेतवणो रूक्षाल्प |

प्रतमतातििस्तीक्ष्णमद्यव्यवायतित्यस्योदावततयतश्च वेगाि् ||

(च.तच 19/5)

1. Exposure to the excessively strong wind, hot Sun &

physical exercise.

2. Indulgence in unctuous food (or) less quantity of food

(or) irregular meals (or) strong alcoholic drinks (or)
excessive sexual intercourse.

3. Suppression of natural urges.

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Samprapti:

वायुुः प्रकोपमापद्यते पक्ता चोपहन्यन्ते स वायुुः कु तपतोऽग्नावुपद्यते

मूत्रस्वेदौ पुरीषाियमुपहृत्य ताभयाां पुरीषां द्रवीकृ त्य अतीसाराय

प्रकल्पते ।

(च.तच 19/5)

Because of above Nidana

Vayu gets aggravated & Agni afflicted

After loss of agni, aggravated vayu forcefully

Brings down the urine and sweat to the colon

It liquefies the stool

Diarrhea
Signs & symptoms:
तस्य रूपातण तवज्जलमामां तवप्लुतमवसादद रूक्षां द्रवां
सिूलमामगन्धमीषच्छब्दमिब्दां वा तवबद्धमूत्रवातमततसायतते
पुरीषां वायुश्चान्तुःकोष्ठे सिब्दिूलतस्तयतक् चरतत तवबद्ध
इत्यामाततसारो वातात् । पक्वां वा तवबद्धमल्पाल्पां सिब्दां
सिूलफे ितपच्छापररकर्ततकां हृष्टरोमा तवतिुःश्वसञ् िुष्कमुखुः
कट्यूरुतत्रकजािुपृष्ठपाश्वतिल ू ी भ्रष्टगुदो मुहुमुतहुर्वतग्रतितमुपवेश्यते
पुरीषां वातात् तमाहुरिुग्रतिततमत्येके वातािुग्रतितवचतस्त्वात् |

(च.चच 19/5)
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Ama stage:

 Stool is slimy & mixed with mucus.

 Stool floats on water.

 Stool when placed over the earth gets soaked.

 Stool is rough & liquid.

 Voiding stool is associated with colic pain.

 Stool smells like undigested food.

 Voiding of the stool is associated with lens of sound (or)

no sound at all.

 Associated with non -voiding of flatus & urine.

 Aggravated vayu moves in the kostha obliquely along

with gurgling sound, while causing Colic pain.

Above signs & symptoms pertain to Ama stage.

Nirama stage: (pakva ståge)

 Patient voids hard stool in small quantities.

 Voiding of stool is associated with sound & Colic pain.

Stool is frothy and slimy.

 Patient suffers from griping pain, Homipilation groaning,

dryness of mouth pain in the lumbar region, thighs, sacral
region, knees, back & sides of the chest, prolapse of the
rectum.

 Voids scybalous stool frequently.

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 This type of diarrhea is also called Anugrathila-atisara

because of voiding scybalous stool.

 Paittika Atisara:
Etiology:

तपत्तलस्य पुिरम्ललवणकटुकक्षारोष्णतीक्ष्णाततमात्रतिषेतवणुः

प्रततातग्नसूयतसांतापोष्णमारुतोपहतगात्रस्य क्रोधेष्यातबहुलस्य तपत्तां

प्रकोपमापद्यते । (च.तच19/6)

 Excessive intake of sour, Saline, pungent, ksara, hot,

sharp ingredients.

 Affliction of the body by excessive exposure to the heat

of strong fire, hot rays of sun, hot wind.

 Excessively wrathful & jealous deposition.

Samprapti:

तत्प्रकु तपतां द्रवत्वादूष्माणमुपहत्य पुरीषाियतवसृतमौष््याद्

द्रवत्वात् सरत्वाच्च तित्त्वा पुरीषमततसाराय प्रकल्पते । (च.चच

19/6)
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Due to above nidana

Pitta gets aggravated, suppresses agni

Arrived at the colon

Disintegrates the stool because of its heat liquidity & mobility

Paittika atisara

Signs & Symptoms:

तस्य रूपातण हाररद्रां हररतां िीलां कृ ष्णां

रक्ततपत्तोपतहतमततदुगतन्धमततसायतते पुरीषां
तृष्णादाहस्वेदमूच्छातिलू ब्रध्नसांतापपाकपरीत इतत तपत्ताततसारुः॥
(च.चच 19/6)

 Patient voids frequent loose motions which are either

yellow, green, blue / black, in color.

 Stool is mixed with blood, bile & it is excessively foul

smelling.

 Morbid thirst, Burning sensation, excessive sweating,

fainting, colic pain, hot sensation.

 There is suppuration of the anus.

 kaphaja Atisara:
Etiology:

श्लेष्मलस्य तु गुरुमधुरिीततिग्धोपसेतविुः सांपूरकस्यातचन्तयतो

ददवास्वप्नपरस्यालसस्य श्लेष्मा प्रकोपमाद्यते | (च.चच19/7)

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 Intake of heavy, sweet, cold & unctuous ingredients in

excess.
 Inactivity of the mind & indolence.
 Habitually sleeping during the day time

Samprapti:
स स्विावाद् गुरुमधुरिीततिग्धुः स्रस्तोऽतग्नमुपहत्य

सौम्यस्विावात् पुरीषाियमुपहत्योपक्लेद्य पुरीषमततसाराय

कल्पते । (च.चच 19/9)

Due to above nidana

Kapha gets aggravated

By nature kapha is heavy, sweet, cold, and unctuous

Move downwards & afflicts agni

After arrived at the colon, it liquefies the stool

Kaphaja atisara.
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Signs & symptoms:

तस्य रूपातण तिग्धां श्वेतां तपतच्छलां तन्तुमदामां गुरु दुगतन्धां

श्लेष्मोपतहतमिुबद्धिूलमल्पाल्पमिीक्ष्णमततसायतते सप्रवातहकां ||

(च.चच 19/7)

 Voids stool which is unctuous, white, slimy, fibrous

mixed with mucus as well as undigested food particles,
heavy foul- smelling & mixed with phlegm.

 Continuous colic pain.

 Voids stool frequently in small quantities.

 Gripping pain.

गुरूदरगुदबतस्तवांक्षणदेिुः कृ तेऽप्यकृ तसांज्ञुःसलोमहषतुः सोत्क्लेिो

तिद्रालस्यपरीतुः सदिोऽन्नद्वेषी चेतत श्लेष्माततसारुः |

(च.चच19/7)

 Suffers from heaviness in the abdomen, in the region of

urinary bladder & in pelvic region

 Patient feels the urge for passing another bout of stool

even after evacuation.

 Homipilation, Nausea, excessive sleep, indolence,

prostration & dislike of food.
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Sannipatika atisara :

Etiology:
अततिीततिग्धरूक्षोष्णगुरुखरकरिितवषमतवरुद्धासात्म्यिोजिात्
कालातीतिोजिाद् यतत्कां तचदभयवहरणात्
प्रदुष्टमद्यपािीयपािादततमद्यपािादसांिोधिात् प्रततकमतणाां
तवषमगमिादिुपचाराज्ज्वलिाददत्यपविसतललातत-
सेविादस्वप्नादततस्वप्नाद्वेगतवधारणादृतुतवपयतयादयिाबलमारम्िा
द्भयिो-कतचत्तोद्वेगाततयोगात्
कृ तमिोषज्वरािोतवकाराततकषतणाद्वा व्यापन्नाग्नेस्त्रयो दोषाुः
प्रकु तपता िूय एवातग्नमुपहत्य पक्काियमिुप्रतवश्यातीसारां
सवतदोषतलङ्गां जियतन्त |

( च.चच 9/8)

 Intake of excessively cold, unctuous, hot, heavy, Coase

& hard ingredients.

 Intake of irregular meals, ingredients of food having

mutually contradiction properties & unwholesome food,
avoiding intake of food.

 Intake of food long after schedules time.

 Intake of food without caring for its wholesomeness.

 Drinking of alcohol, other drinks - polluted

 Drinking of alcohol in excess

 Not restoring to elimination therapies.

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Samprapti:

Due to above nidana

Agni get vitiated, 3 doses aggravated

Afflict agni & enter into pakvasaya

Cause atisara

Signs & symptoms :

1. हाररद्रहररतिीलमातिष्ठमाांसधाविसतन्नकािां रक्तां कृ ष्णां श्वेतां

वराहमेदुःसदृिमिुबद्धवेदिमवेदिां |

(च.चच19/9)
 Patient voids stool having yellow, green, blue, reddish
pink, red, black, and white, yellowish.
 Suffers from continuous pain, can free from any pain.
2. ग्रतितमामां सकृ त् सकृ दतप पक्कमिततक्षीणमाांसिोतणतबलो
मन्दातग्नर्वतहतमुखरसश्च तादृिमातुरां कृ च्रसाध्यां तवद्यात् ।

(च.चच.19/9)
 Void scybalous stool, sometimes it mixed with mucus &
sometimes free from mucus.
 Diminution of muscle tissue blood, strength.
 The power of digestion of the patient is suppressed.
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 Impairment of the taste of mouth.

Such a patient is difficult to cure

COMPLICATIONS:
 Patient becomes incurable asadya shows following
complications
 पक्विोतणतािां यकृ तख्डोपमां मेदोमाांसोदकसतन्नकािां

दतधघृतमज्जतैलवसाक्षीरवेसवारािमततिीलमततरक्तमततकृ ष्णमुद

क|

(च.चच 19/9)

 Patient voids stool having color of digested blood piece

of liver, washing of fat /flesh, curd, ghee, bone marrow,
oil, muscle fat, milk, vesavara.
 Patent – voids stool - blue, red, black, transparent like
water/tan coloured.

Such patient should be rejected.

LINE OF TREATMENT:

दोषा सतन्नतचता यस्य तवदग्धाहारमूर्च्छतताुः

अतीसाराय कल्पन्ते िूयस्ताि् सांप्रवततयेत् ||

ि तु सांग्रहणां देयां पूवतमामाततसाररणे
तवबध्यमािाुः प्राग्दोषा जियन्त्यामयाि् बन्ि् ||
द्डकालसकाध्मािग्रह्यिोगदाांस्तिा
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िोिपाड्वामयप्लीहकु ष्ठगुल्मोदरज्वराि् ||
तस्मादुपेक्षेतोतत्क्लष्टाि् वततमािाि् स्वयां मलाि्
कृ च्रां वा वहताां दद्यादियाां सांप्रवर्ततिीम् ||
तया प्रवातहते दोषे प्रिाम्यत्युदरामयुः
जायते देहलघुता जिरातग्नश्च वधतते ||
प्रमथयाां मध्यदोषाणाां दद्याद्दीपिपाचिीम्
लङ्घिां चाल्पदोषाणाां प्रिस्तमततसाररणाम्||

(च.चच19/14-19)

 When the diarrhea is caused by the accumulated dosas

impelled by vidagdha food, the patient should be given
laxative to eliminate these dosas.
 It is not desirable to give bowel-binding therapies to
such patients in the beginning in the ama stage of
diarrhea.
 Administiation of such bowel binding therapies obstructs
the movement & elimination of the already aggravated
dosas which gives rise to several diseases like
dandakalasaka , adhmana , grahani, piles, fistula-in-ano,
oedema , anemia splenic disorders, kuslha , gulma, udara
& fever.
 Therefore physician should ignore the downward
movement of the already detached Morbid matter which
is moving downwards of its own.
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 If the diarrhea is associated with griping pain then

haritaki should be given as mild laxative.
 When the morbid matter is eliminated through
downward movement, then this abdominal disease gets
cured the body becomes light & the abdominal agni
becomes strong.
 If the dosas - moderately aggravated, then pramathya
which stimulates the power of digestion & which is
pacana should be administered.
 If the dosas are only slightly aggravated & causing
diarrhea, then langhana useful

Agantuja Atisara:
आगन्तू द्वावतीसारौ मािसौ ियिोकजौ
तत्तयोलतक्षणां वायोयतदतीसारलक्षणम् ||

(च.चच 19/11)

Agantuja is of two types:

 Bhayaja
 Shokaja

Their signs & symptoms are similar to vatika type of

atisara.
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Management of Agautuja Atisara:

मारुतो ियिोकाभयाां िीघ्रां तह पररकु प्यतत
तयोुः दक्रया वातहरी हषतणाश्वासिाति च ||
इत्युक्ताुः षडतीसाराुः साध्यािाां साधिां त्वतुः
प्रवक्ष्याम्यिुपूवेण यिावत्ततन्नबोधत ||

(च.चच19/12-13)

 Because of fear & Grief, vaya gets aggravated

instantaneously treatment of 2 varieties of diarrhea, vayu
alleviating drugs & therapies should administered.
 The patient suffering from diarrhea caused by fear
should be exhilarated patient suffering from diarrhea
caused by soka – consoled for this cure.

Chikitsa: according to charaka chikitsa 19/26-122

1. Vataja Atisara:

 Salaparni, brhati , kantakauka, bala, Svadamstra bilva,

patha , nagara , dhanyaka , sati, palasa, hapusa vaca,
Jiraka, pippali, Yavani, pippali-mula, Citraka, hasti-
pippati, vrikshamla, saindhara – used in processing food
prepations .
Dipana, pacana, Graha, Balyan, Rechana drugs.
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2. Pittaja atisara:

Atisara with ama - Langhana, pacana.

 Thirsty - give decoction of musta, parpatala, usira, sovia,

Candana kirata tikta , udicya.
 After fasting, meal should be Yavage, Manda, tarpana
prepared with niryuha for sandaga paniya.
 Stimulate agni with Mudga, masua, harenuka, adhaki,
makustha (or) soup of lava kapinjala, sasa, harina, ena,
kalapuccha. Should be slightly sour or not to be sour.
 Even if pittaja atisara persists even after administration
of above measures, then gives Dipaniya, Pachaniya,
Upasamaniya, Sanghahaniya recipes.

Anurasana vasti: Satapushpadi ghee (च.तच 19/61-62)

Samarjana krama.

Piccha-Basti

If diarrhea persists even after administration of

anuvasana basti & Samsarjana karma then piccha- basti
should be given.

3. kaphaja Atisara

 Fasting pacana therapies in the beginning.

 dipana gana for ama atisara.
 If kaphaja atisara persists even after above measures,
then give kapha alleviating therapies.
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 Bilwadi kashaya, vacadi kashaya, kustadi kwatham,

pippaladi kashayam – cure kaphaja atisara & also
promotes kayagni.
 To cure kaphaja – vataja predominant Atisara picha vasti
evam Anuvasana vasti should administer.

4. Rakta atisara:

 Goat’s milk is very useful  with honey & sugar for

drink, along with food, & for washing anal region.
 Goats milk along with boiled ice of red salt variety.
 Butter along with honey & sugar.

5.Sannipataja Atisara Cikitsa:

 Aggravated vata pacified first followed by pitta and then

kapha.
 Most aggravated dosa should treat first & them
remaining dosas
yogas:
1. Nagaradi kwatha (B.R 7/16)
2. Dhanya pancaka (B.R7/19)
3. Pathadi Kwatha (B.R7/17)
4. Vatsakadi kwatha (B.R7/26)
5. Brhat saliparnyadi (B.R 7/21)
6. Yamanyadi kwatha (B.R 7/28)
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7. Tryusanadi churnam (B.R 7/33)

8. Sunthyadi Churnam (B.R 7/35)
9. Vacadi kwatha (B.R 7/39)
10. Cavyadi kwatha (B.R7 7/46)
11. Bilvadi kwatha (B.R 7/41)
12. Hingvadi churnam (B.R 7/48)
13. Citrakadi kwatha (B.R 7/56)
14. Pancamulibaladi kwatha (B.R 7/59-60)
15. Narayana churnam (B.R 7/103-106)
16. Karpura Ras (B.R 7/164-165)
17. Sadanga ghritam (B.R 7169-170)
18. Kutajadyavalehyam(B.P)
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2.Pravahika

वायुुः प्रवृद्धो तितचतां बलासां िुदत्यधस्तादतहताििस्य |

प्रवाहमाणस्य मुहुमतलाक्तां प्रवातहकाां ताां प्रवदतन्त तज्ज्ञाुः ||

सु.उ 40/138.
If aggravated vayu, in a person indulged in unwholesome diet,
propels down the accumulated kapha mixed with little faeces
frequently with marked tenesmus, it is known as pravahika.

It is a type of diarrhea,

Types according to Susrutha;

1. Vataja
2. Pittaja
3. Кaрaја
4. Raktaja

Lakshanas:

प्रवातहका वातकृ ता सिूला तपत्तात् सदाहा सकफा कफाच्च

सिोतणता िोतणतसांिवा तु ताुः िेहरूक्षप्रिवा मतास्तु ||
तासामतीसारवदाददिेच्च तलङ्गां क्रमां चामतवपक्वताां च

(सु.उ 40/139).
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 vatika dysentry : painful,

Paittäka dysentry: Burning sensation

kaphaja dysentry : mucus.

Raktaja: Blood

 These originate from excessive use of snigdha & Ruksha

substances,

Chikitsa:

According to charaka

कल्कुः स्याद्वालतबल्वािाां ततलकल्कश्च तत्समुः

दध्नुः सरोऽम्लिेहाढ्युः खडो हन्यात् प्रवातहकाम् ||

(च.चच 19/34)

Khada cures pravahika. It is prepared by adding the paste of

tender fruits of bilva, equal quantity of the paste of tila, cream of
sour curd & profuse of ghee.

Chikitsa according to susrutha:

ि िातन्तमायातत तवलङ्घिैयात योगैरुदीणात यदद पाचिैवात

ताां क्षीरमेवािु िृतां तिहतन्त तैलां ततलाुः तपतच्छलबस्तयश्च ||

(सु.उ 40/140)
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 Aggravated dysentery which does not subside by fasting (or)

digestive formulation is controlled soon by boiled milk, oil,
sesamum & slimy enemas.

2. आद्रै: कु िैुः सांपररवेतष्टताति वृन्तान्यिाद्राततण तह िाल्मलीिाम्

पक्वाति सम्यक् पुटपाकयोगेिापोथय तेभयो रसमाददीत
क्षीरां िृतां तैलहतवर्वततमश्रां कल्के ि यष्टीमधुकस्य वाऽतप

बतस्तां तवदध्यातद्भषगप्रमत्तुः प्रवातहकामूत्रपुरीषसङ्गे ||

(सु.उ40/141-142)

 Fresh petioles of salmali wrapped in fresh kura grans are

cooked by the method of putapaka & juice is extracted
therefrom. With this juice, boiled milk, oil ghee, paste of
yastimadhu – all mixed together should be used as enema
carefully by the physician in dysentery & retention of urine &
faces.

3. In case of pain & tenesmus

तद्वपञ्चमूलीक्वतितेि िूले प्रवाहमाणस्य समातक्षके ण |

क्षीरे ण चास्िापिमग्र्यमुक्तां तैलेि युञ्ज्यादिुवासिां च ||
(सु.उ 40/143)
 Non-unctuous enema applied with decoction of dasamula
Application of same enema with milk cooked with
dasamula & mixed with honey is regarded as excellent
one.
 21

 Unctuous enema –applied with oil cooked with milk

processed with dasamula.

4. In case of severe pain & dysuria.

महारुजे मूत्रकृ च्रे तिषग् बतस्तां प्रदापयेत्
पयोमधुघृतोतन्मश्रां मधुकोत्पलसातधतम् ||
स बतस्तुः िमयेत्तस्य रक्तां दाहमिो ज्वरम्
[सु.उ40/150]

 Enema with decoction of madhuka & utpala mixed with milk,

honey & ghee. This checks blood, burning sensation & fever.

यिा यिा सतैलुः स्याद्वातिातन्तस्तिा तिा

प्रिान्ते मारुते चातप िातन्तां यातत प्रवातहका ||
तस्मात् प्रवातहकारोगे मारुतां िमयेतद्भषक्
(सु.उ 40/152-153)

 Vata gets pacified in the same order if unctuous enema is

given leads to subsidence of dysentery. Physician should
pacify vote in case of dysentery.

6. पािाजमोदाकु टजोत्पलां च िु्िी समा मागतधकाश्च तपष्टाुः

िुखाम्बुपीताुः िमयतन्त रोगां मेध्या्डतसद्धां सघृतां पयो वा ||

(S.Utt40/154]
 22

 Powder of patha, ajamodaka, kutaja, utpala, sunthi, pippali

taken in equal quantity taken with warm water alleviates
the disease (or) milk cooked with goat's testicles & mixed
with ghee & oil & then use - cures dysentery.
YOGAS:
1.Bilwadyavalehyam (B.P)
2.Dhatakyadyavalehyam(B.P)
 23

3.Purishaja krimi Roga

krimi Roga Hetu and Samprapti :

अजीणातध्यििासात्म्यतवरुद्धमतलिाििैुः
अव्यायामददवास्वप्नगुवततततिग्धिीतलैुः ३
माषतपष्टान्नतवदलतबसिालूकसेरुकै ुः
पणतिाकसुरािुक्तदतधक्षीरगुडेक्षुतिुः ४
पललािूपतपतिततप्याकपृिक
ु ाददतिुः
स्वाद्वम्लद्र वपािैश्च श्लेष्मा तपत्तां च कु प्यतत ५
कृ मीि् बहुतवधाकाराि् करोतत तवतवधाश्रयाि्
आमपक्वािये तेषाां कफतवड्जन्मिाां पुिुः
धमन्याां रक्तजािाां च प्रसवुः प्रायिुः स्मृतुः ६
(सु.उ 54/3-6)

Due to indigestion, eating during indigestion, faking

unsuitable incompatible & duty food, lack of physical
exercise day sleep intake of heavy, too unctuous, cold items,
black gram, edibles of rice flour, pulses, stem & roof of lotus,
kaseruka, leafy vegetables, wine, vinegar Curd, milk, jaggery,
sugarcane, paste of sesamum, meat of marshy animals, oil
cake flattened rice etc, and also sweet & sour drinks kapha &
pitta get aggravated & gives rise to worms of various shapes
& in various locations. Generally those arising from Kapha &
 24

faeces are located in amashaya & pakvasaya while those

originating from blood one found in blood vessels.

Bheda:

According to charaka,

तवितततवधाुः दक्रमयुः पूवतमुदद्दष्टा िािातवधेि प्रतविागेिान्यत्र सहजेभयुः ते

पुिुः प्रकृ तततिर्वतिज्यमािाश्चतुर्वतधा िवतन्त तद्यिा -पुरीषजाुः श्लेष्मजाुः
िोतणतजा मलजाश्चेतत ९
(च.चि 7/9)

There are 20 types. On the basis of their source, they are divided
into 4 groups.

1. purisaja
2. Slesmaja
3. Sonithaja
4. Malaja

1. Parasites of External excreta (malaja) [c.vi 7/10]

 yuka, pippilika

2. Parasites of shonithaja: [c.vi 7/11]

 kesada
 Lomada
 Lomadvipa
 Saurasa
 25

 Audumbara
 Jantumatrn

3. Parasites of purisha [c.vi 7/12]

 kakeruka
 Makeruka
 leliha
 Sasulaka
 Sausurada

4.Parasites of sleshma [c.vi7/13 ]

 Antrada
 Udarada
 Hrdayacara
 Darbhapushpa
 Saugandhika
 Managuda
 Curu.
Bheda according to Susrutha
तवांिते कृ तमजातीिाां तत्रतवधुः सांिवुः स्मृतुः
पुरीषकफरक्ताति तासाां वक्ष्यातम तवस्तरम् ७
(सु.उ 54/7)
Of twenty types - 3 originating sources
 26

a. Faeces
b. kapha
c. Blood.

1. Raktaja krimi:

के िरोमिखादाश्च दन्तादाुः दकदक्किास्तिा

कु ष्ठजाुः सपरीसपात ज्ञेयाुः िोतणतसांिवाुः १५
(सु.उ54/15)

 kesada

Romadha

Nakhada

dantada

kikkisa

kusthaja

 parisarpa

2. Purishaja krimi:

अजवा तवजवाुः दकप्यातश्चप्या ग्डू पदास्तिा

चूरवो तद्वमुखाश्चैव ज्ञेयाुः सप्त पुरीषजाुः ८
(सु.उ 54/8)

Ajava

Vijara
 27

kipya

 Cipya

gandupada

 Curu

dvimukha

3. Sleshmaja krimi:

दितपुष्पा महापुष्पाुः प्रलूिातश्चतपटास्तिा

तपपीतलका दारुणाश्च कफकोपसमुद्भवाुः १२
(सु.उ 54/12)

Darbhapusha

 Mahapushpa

Paraluna

cipita

pipilika

daruna,

4.Purishaja krimi:

पुरीषजास्तुल्यसमुत्िािाुः श्लेष्मजैुः तेषाां स्िािां पक्वाियुः ते

प्रवधतमािास्त्वधो तवसपततन्त यस्य पुिरामाियातिमुखाुः स्युयतदन्तरां तदन्तरां
तस्योद्गारतिुःश्वासाुः पुरीषगतन्धिुः स्युुः सांस्िािवणततविेषास्तु
सूक्ष्मवृत्तपरीणाहाुः श्वेता दीघात ऊणाांिुसांकािाुः के तचत् के तचत् पुिुः
 28

स्िूलवृत्तपरीणाहाुः श्याविीलहररतपीताुः तेषाां िामाति कके रुकाुः

मके रुकाुः लेतलहाुः सिूलकाुः सौसुरादाश्चेतत प्रिावुः पुरीषिेदुः काश्यां
पारुष्यां लोमहषाततितिवतततिां च त एव चास्य गुदमुखां पररतुदन्तुः क्डू ां
चोपजियन्तो गुदमुखां पयातसते त एव जातहषात गुदतिष्क्रमणमततवेल
कु वततन्त इत्येष श्लेष्मजािाां पुरीषजािाां च दक्रमीणाां समुत्िािाददतविेषुः
(च .चि 7/13)

Cause: Same as for phlegm born parasites.

Habitat: pakvasaya (or) colon, excessively grow - more

downwards, when they move towards amasaya eructation &
breath is fecal odor.

Form & color: minute, cylindrical, long appear like fibers of

wool, white in color, thick, cylindrical.

Colors: gray, blue, green, yellow.

Names: kakeruka, Makeruka, Leliha Sasulaka, Sausurada.

Effects: Diarrhea, Emaciation, dryness, horripilation, inhibit oral

region cause irritation Itching there, when excited they
frequently come out of the anus.

साध्यासाध्यता:

Purishaja & kaphaja -- visible.

Remaining varieties -- invisible.

 29

 Chikitsa:
तत्र सवतदक्रमीणामपकषतणमेवाददतुः कायां ततुः प्रकृ तततवघातुः
अिन्तरां तिदािोक्तािाां िावािामिुपसेवितमतत १४
(च. चि 7/14)

All parasites should first of all be extracted, thereafter, factors

responsible for the production of these parasites, with-, phlegm
etc, and should be counteracted.

Third principle of their treatment - factors which cause such

parasites should be avoided.

Extraction procedure:

तत्रापकषतणां हस्तेिातिगृह्य तवमृश्योपकरणवताऽपियिमिुपकरणेि वा

स्िािगतािाां तु दक्रमीणाां िेषजेिापकषतणां न्यायतुः तच्चतुर्वतधां तद्यिा

तिरोतवरेचिां वमिां तवरे चिम् आस्िापिां च इत्यपकषतणतवतधुः|

(च.चि 7/15)

Paying due consideration to all aspects parasites may be

extracted by hand with (or) without the help of instruments.

 Parasites residing inside the body can be extracted by the

administration of appropriate therapies which au of our type’s
viz. Srovirecana, vomiting, purgation & asthapana type of
enema.
 30

Preparatory treatment:

अिैिां दक्रतमकोष्ठमातुरमग्रे षड्रात्रां सप्तरात्रां वा िेहस्वेदाभयामुपपाद्य श्वोिूते

एिां सांिोधिां पायतयताऽस्मीतत
क्षीरगुडदतधततलमत्स्यािूपमाांसतपष्टान्नपरमान्नकु सुम्ििेहसांप्रयुक्तैिोज्यैुः
सायां प्रातश्चोपपादयेत् समुदीरणािां दक्रमीणाां कोष्ठातिसरणािां च तिषक्
अि व्युष्टायाां रात्रयाां सुखोतषतां सुप्रजीणतिक्तां च
तवज्ञायास्िापिवमितवरे चिैस्तदहरे वोपपादयेदप ु पादिीयश्चेत् स्यात् सवाति्
परीक्ष्यतविेषाि् परीक्ष्य सम्यक् १६
(च.चि 7/16)

 The patient affected with parasites in his body should be

given oleation & fomentation therapies for 6 to 7 nights.
 Next day during morning & evening meals he should be
given food consisting of milk, sugar candy, curd, tila, fish,
and meat of animals inhabiting marshy land, pastry, and oil of
kusumbo. To arouse parasites & impelling them to migrate to
the alimentary tract.
 If the patient passes the night comfortably and the food taken
by him in the previous day is fully digested, he should be
given asthapana, emesis & purgation therapis - all on the
same day, provided the patients after proper examination, is
found fit for all these therapies.

Exlininalim therapy asthapana. (च.चि7/17)

1. Mulakadi asthapana basti

2. Arkadi asthapana basti.
 31

 Pathya:
सुरसाददां तु सवेषु सवतिैवोपयोजयेत् ३८
प्रव्यक्तततक्तकटुकां िोजिां च तहतां िवेत्
कु लत्िक्षारसांसृष्टां क्षारपािां च पूतजतम् ३९
क्षीरातण माांसाति घृताति चैव दधीति िाकाति च पणतवतन्त
समासतोऽम्लान्मधुराि् तहमाांश्च कृ मीि् तजघाांसुुः पररवजतयेत्तु ४०
(सु.उ 54/38-40)

 Surasadi gana: all varieties of krimi.

 Katu, tikta ahara . Yavakshara with kulattha.
 Avoid use of milk, meat, ghee, curd, leafy vegetable which
are sour sweet & cold substance.
 Asthapana vasti, virecane, sirovirecana, Smoke treatment.

 Apathya :

Avoidable meals are

 Avoid meals & medicines that cause vomiting.

 Fish & milk together – avoid.
 Avoid day sleep.
 Avoid kalka based meals.
 Urada, Curd, meat, milk, meat, sweet items Prohibited.
 32

Efficacy of Shunthi Kalpa in the Management of Atisara:

Aim:

To study the efficacy of Shunthi Kalpain the management

of Atisara.

OBJECTIVES

1.To study the etiopathology and prognosis of Atisara.

2.To study the standardization of ingredients of

ShunthiKalpa.

3.To Study the mode of action of Shunthi Kalpa.

MATERIALS AND METHODS

1. Patients: Total 100 patients of Atisarafrom OPD and IPD

unit of Dr. M. N. Agashe hospital, Satara.

2. Drug:For the present study Shunthi Kalpawas used for the

management of Atisara.

The details of the formulation and method of preparation are

as follows.
 33

Table 1: Details of Shunthi Kalpa

Sr. Drug Latin name Part used Quantity

1 Shunthi Zingiber officinalis Kanda (rhizome) 1 parts

2 Go ghrita Cow ghee As it is 1parts

3 Seeta Sugar As it is 1 part

Method of Preparation of Shunthi Kalpa:

1.Adraka khanda shodhana-The well grown Adrakakhanda by

making pieces, washed with simple water and made clean
by removing clay and other impurities.

2.Preparation of Shunthifrom Adraka khanda–the Twakawas

removed with knife after cleaning Adrakakhanda. This Twak-
viraheet Adraka khandasare poured in a iron pan containing
milk and boiled. After boiling Adraka khandaswere removed
from pan and kept in dishes in sunlight for drying. The
time required for complete drying process was 5 days.

3.Choornikarana-the Shunthiwas taken in Khalwayantraafter

making small pieces. With the help of Peshanakait was
crushed and made in the powder form. With the help of
four folded muslin cloth, fine Vastragala choornawas obtained.

4.Bharjana sanskar-Fine Vastragala choornawas taken in

iron pan, kept on gas stove and Bharjanasanskarwas done
 34

by adding little amount of Go-ghrita. It was added in such

amount that the Shunthichoornadoes not get burned.For
Bharjana sanskarmandagniwas given and it was completed
when we felt the smell of shunthi and slight change in colour.

5.Sharkara mishrana –Ghrita bharjit shunthi choornawas kept

in pan and allowed to cool. Same quantity of sugar in powder
form was added and mixed well. Finally a homogenous
mixture is obtained and it is the Shunthi Kalpa.

Inclusion criteria
1.Patients having classical signs and symptoms of
Atisara described in Ayurvedic classics without any bar of
caste, sex and religion.

2.Patients having age between 10 -60 years.

3.The patients having moderate degree of dehydration. It

has been mainly assessed on the basis of clinical
parameters. Systolic blood pressure minimum 90mm of Hg
was decided as the main criteria for moderate dehydration.

Exclusion criteria

1.Patients with severe degree of dehydration.

2.Patients having age less than 10years and more than 60
years.
3.Loose motions with Melaena.
4.Known case of poisoning taken orally, like
insecticides, pesticides etc.
 35

5.Patients having severe cardiac, renal, hepatic disease,

Malignancy, AIDS etc.
6.Pregnant and lactating women.Groups of management All the
selected patients were allocated to single group treated by
Shunthi Kalpa. Hence, it was a single arm open clinical trial.

The details of drug administration are as follows:

 Drug : Shunthi kalpa

 Form of drug : Choorna
 Dose: 2 grams T.d.s .
 Anupana :Shruta sheeta jala
 Sevana kalaNirannakala(Empty stomach) :8.00 a.m.,
3.00p.m. and 10.00 p.m.
 Duration6 days
 Follow up :Every week and whenever needed Diet As per
Pathyakara Ahara mentioned in Ayurvedic classics
 Vihara Bed rest

Criteria for diagnosis

1.Dravamalapravritti(increased frequency of loose motions)

2.Udarshula(Pain in abdomen)

3.Agnimandya(decreased appetite)

4.Daurbalya(fatigue)

5.Aruchi(Anorexia)

6.Patients having Pichchila,Durgandhita and Sakapha

malapravrutti.
 36

Scoring and Gradation Pattern

1.Loose motions

Symptom Score

Normal defecation 0

1-3 loose motions per day 1

4-6 loose motions per day 2

More than 7loose motions per 3

day

2.Udarashula

Symptom Score No

abdominal pain 0

Mild abdominal pain 1

Moderate abdominal pain 2

Severe abdominal pain 3

OBSERVATIONS AND RESULTS

 Among the total number of patients 36% patients were

from the age group of 10 to 20 years.
 37

 68% patients were female and 98% patients were of

Hindu religion. Occupation wise 44% patients were
housewives, 56% patients were from poor family. The
number of patients living in urban area was 60%.
 According to Prakriti 36% patients were of Vata Kapha
and Vata Pitta Prakriti each. Madhyama Koshtha was found
in 68% patients.
 Among the causative factors Shakahar was present in 52%
patients followed by Mamsaharin 24% patients.
 Dushita Jala Sevan was found as a cause in 16% patients
whereas Madyapana was found in 8% patients.
 Tongue examination revealed that 100% patients were
having ‘Sama Jivha’.
 In case of Dosha predominance, Vatanubandha and
Kaphanubandha was foundin 40% patients each whereas
20% patients were having Pittanubandha. The
Jalanimajjana Parikshawas found positive in 96%
patients.
 In stool examination most of the patients showed the
presence of starch mucous, pus cell and cyst of E.H. In
results most of the patients showed the improvement in
appetite within first 3 days.
 Among the chief symptoms Dravamalapravrittiwas found in
100% of patients. Udarshulawas maximum present in
98% patients followed by Agnimandyain 96% patients
 38

each. Next to it 86% patients were having

Daurbalyaand Aruchiwas present in 84% patients.
 In results Dravamalapravritiiwas relieved by 96.36%
whereas 94.44% improvement was seen in Udarshula.
88.85% relief was observed in Agnimandya. Daurbalya and
Aruchi showed 83.73% and 78.66% relief respectively.
 All the parameters showed highly significant
results. Complete relief was observed in 92% patients
whereas 8% patients showed no relief. 24% patients
showed the relief within 24 hrs,56% patients within 48%
hrs and 12% patients showed relief within 72
hrs from the commencement of the treatment.

Table 3: Effect of Shunthi Kalpaon Atisara

Symptoms N Mean

B.T A.T

Dravamalapravritii 100 2.523 0.462 96.36

Udarashula 98 2.769 94.44

Agniman 94 2.892 0.462 88.8

Daurbalya 86 2.227 0.385 83.73

Aruchi 84 2.312 0.632 78.66

 39

Probable mode of action:

 Shunthi is the chief constituent of the remedy which

acts as Amapachak and Agnideepak due to its Katu Rasa,
Ushna Veerya and Laghu Guna.
 It also does the function of Vatanulomana due to
Madhura Vipaka. Shunthi is told as Grahi which is again due
to its Ushna Veerya and Katu Rasa.
 It also works as Shulaprashaman due to UshnaVeerya.
Hence, after taking the Shunthi Kalpa, the Ama condition
of the patients was mitigated due to Amapachak activity of
Shunthi; along with this the Agni was also increased.
 Shunthi Kalpa due to Grahi nature absorbed the excessive
liquid in Purisha and corrected its pathology.
 Shunthi possesses Ruksha Guna which may act as
Vataprakopaka hence Ghrita was added in Shunthi Kalpa to
minimize the Rukshata of the Shunthi.
 Further sometimes Shunthi may cause burning sensation
due to Katu Rasa hence Sharkara was added to minimize
the Katuka of Shunthi. So, together Shunthi Kalpa worked as
an excellent remedy in the patients suffering from Amatisara
 40

CONCLUSION:
 The incidence of disease is seen more in the age group
10-20 years. Females were more affected by the disease.
 The occurrence of the disease was highest in lower
socio economic class. The symptoms Dravamalapravritti,
Udarshoola, Aruchietc. indicate the Amavasthaof the
disease. Sama Jivhawas observed in all the patients.
 Jala Nimajjana Parikshawas also positive in almost all
the patients. Shunthi Kalpashowed highly significant
results in Dravamalapravritti, Udarshula, Agnimandya,
Daurbalyaand Aruchi. Hence it could be concluded that
Shunthi Kalpais a very effective remedy for Atisaraespecially
in Amavastha.
 41

DIARRHOEA

Diarrhea, is the condition of having at least three loose or

liquid bowel movements each day. There is an increase in
FREQUENCY, LIQUIDITY AND VOLUME of stools.
In pseudo-diarrhea there is an increased frequency but
with normal volume. Seen due to local inflammation of
rectum. Patient passes small but frequent stools.

SIGNS AND SYMPTOMS:

• Loose and watery stools

• Stomach pain
• Abdominal cramps
 42

• Thirst
• Weight loss
• Fever
• Malaise
• Other signs of dehydration. (Like increased thirst, dry
mouth, headache, confusion, dizziness, palpitation, fainting,
inability to sweat, oliguria).

TYPES:
1. Acute diarrhea-Less than two weeks.
2. Persistent diarrhea-2-4 weeks.
3. Chronic diarrhea-More than four weeks.

ACUTE DIARRHOEA:
It is of two type’s infectious and non-infectious diarrhea.

A. Infectious diarrhea: It is of two types toxin induced and

inflammation of Bowel wall.
1. Toxin induced-No inflammation, no RBC or WBC in stools.
Causes: Staphylococcus aureus

Bacillus cereus

Vibrio cholera

E.coli

Helminthes
Cryptosporidium.
 43

2. Inflammation of Bowel wall - May have WBC and RBC in

stools,

Causes: Rota virus

Norwalk virus

Salmonella

Campylobacter

Vibrio parahemolyticus

Shigella
Entamoeba histolytica.

B.Non-infectious:

1. Drugs-antibiotics, laxatives, NSAIDs, antacids, anti-

Histamines.
2. Toxins-Arsenic, amanita, organophosphates.
3. Ischemic colitis
4. Diverticulitis.

DIAGNOSIS OF ACUTE DIARRHOEA:

1. Stool examination - ova (helminthes), cyst (E.histolytica),
WBC (infectious), RBC (severe invasion), antigen (rota
virus).
2. USG Abdomen-reveals bunch of helminthes.
3. Serology-Antigens seen in blood (E.histolytica).
 44

CHRONIC DIARRHOEA
-More than four week’s duration

-90% non-infectious and 10% infectious

-Classified according to mechanism of diarrhea as:

1. Secretory
2. Osmotic
3. Exudative
4. Inflammatory
5. Dysmotility

1. Secretory diarrhea:

- Due to derangement of fluid and electrolyte transport across.

- Either failure to reabsorb or hypersecretion into lumen (Na+,
K+, water).
- Watery stools and painless diarrhea.
- Persists with fasting (independent of oral intake).
Causes: Infections like chronic shigella (destroys mucosal
cells)

- Chronic alcohol (damages enterocytes)

- Intestinal resection (after surgery, decreased area for
reabsorption of Na and K)
- Stimulant laxatives like Senna, castor oil (irritates mucosa
and causes hypersecretion)
- Addisons disease (aldosterone deficiency)
- Hormonal like VIPoma, Zollingen-Ellison Syndrome,
Calcitonin, prostaglandins and histamines.
 45

2. Osmotic diarrhea
- Due to presence of osmotically active agent in lumen which
draws water leading to diarrhea.
- Due to water drawn into lumen, distention of abdomen and
painful diarrhea.
- Stops with fasting
Causes:-

- Osmotic laxatives like Magnesium sulphate, aliuminium

containing (cause severe irritation).
3.exudative diarrhea:
-Occurs with presence of blood and pus in stools
-Occurs with inflammatory bowel diseases such as crohns
disease or ulcerative colitis and severe infections like
E.Coli or other forms of food poisoning.
4.Inflammatory diarrhea:
-Exudation of leukocytes
-Increased secretions due to prostaglandins.
-Increased motility due to cytokines (IL-2)released from
inflammatory cells.

Causes:-IBD
-Eosinophilic gasteroenteritis (deposition of eosinophils in
sub mucosa)
-Chronic GVHD(graft-versus host disease)
-chronic radiation.
 46

5. Dysmotility diarrhea:
- Due to rapid transit time or intestinal motility.
- Due to nerves (Auto immune neuropathies as in DM).
- Due to hormones (hyperthyroidism).

DIAGNOSIS OF CHRONIC DIARRHEA

- Hormonal assay (serum gastrin levels, calcitonin).
- Stool pH (acidic if lactose is present in stools, alkaline due
to laxatives like MgSO4).
- 72hr stool fat quantitive test, blood sugar, TFT.

MANAGEMENT

1. Rehydration
- Oral hydration is sufficient in most cases.
- 1.V fluids
- A. Normal saline may be preferred when BP is low and
low perfusion.
- B. Ringer lactate when potassium levels are low,
2. Anti-motility
- Given when there is no fever, non RBC diarrhea,
moderate to severe diarrhea.

-Eg: loperamide, Bismuth subsalicylates.

 47

3. Antibiotics

- While antibiotics are beneficial in certain types of acute

diarrhea, they are usually not used except in specific
situations. There are concerns that antibiotics may
increase the risk of hemolytic uremic syndrome in
people infected with Escherichia coli. In resource-poor
countries, treatment with antibiotics may be beneficial.
However, some bacteria are developing antibiotic
resistance, particularly Shigella. Antibiotics can also
cause diarrhea, and antibiotic-associated diarrhea is the
most common adverse effect of treatment with general
antibiotics.
4. Bile acid sequestrates

- Such as cholestyramine can be effective in chronic

diarrhea due to bile acid malabsorption.
5. Probiotics

Probiotics reduce the duration of symptoms by one day and

reduced the chances of symptoms lasting longer than
four days by 60%. The probiotic lactobacillus can help
prevent antibiotic-associated diarrhea in adults but
possibly not in children.
 48

ASCARIASIS
A common round worm disease.

INTRODUCTION:
 Ascaris lumbricoides is the largest nematode parasitizing
the human intestine.
 It is an intestinal worm found in small intestine.
 More ecommon in children than in adult
 As many as 500 to 5000 adult worms may inhibit a single
host.

GEOGRAPHIC DISTRIBUTION:

 The most common human helminthic infection.

 Worldwide distribution
 Highest prevalence in tropical and subtropical regions and
areas with inadequate sanitation.
 49

MORPHOLOGY:

 It is a elongated ,cylindrical and tapering at both

ends.
 Sexes are separate.
 The female is longer than male 20-35 cm long ,4-6mm in
diameter.
 Male is smaller being 15-30 cm long 2-4 mm in diameter.
 The posterior end of male is curved having penial setae
near thee end.

 Mouth parts:
o Opens at anterior end
o Surrounded by 3 finely toothed lips.
o Lips are one dorsal and 2 ventrolateral
o Lips bear sensory structures called labial papillae.
 50

INFECTION TO MAN:
 It occurs when the person swallows the infective eggs of
ascaris with contaminated food and water.

LIFE CYCLE OF ASCARIS:

 Adult ascaris live in the lumen of the small intestine.

 A female may produce approximately 250,000 eggs per
day which are passed with the faeces.
 51

 Unfertilized eggs may be ingested but are not

affective.fertile eggs embryonate and become infective
after 18 days to several weeks.
 After infective eggs are swallowed the larvae hatch invade
the intestinal mucosa.
 Carried via the portal then systemic circulation to the lungs
larvae mature further in the lungs(10 to 14 days) penetrate
the alveolar walls ,ascend the bronchial tree to the throat
and are swallowed.
 Upon reaching the small intestine they develop into adult
worms. Between 2 and 3 months are required fron
ingestion of the infected eggs to oviposition by the adult
female.
 Adult worms can live 1 to 2 years.

SYMPTOMS OF ASCARIASIS:
 No symptoms
 Stage 1: worm larvae in the bowels attaches to the bowel
walls.
 Stage2: worm larvae migrate into the lungs.
o Fever and breathing difficulty.
 Stage3: worms enter the small intestine and mature into
worms and remain there to feed.
 52

Abdominal Symptoms:

Abdominal discomfort

 intestinal blockage may be partial or complete.

 Severe abdominal pain

 Vomiting
 Restlessness
 Disturbed sleep
 Worm in stool.
 Worm in vomit.

CLINICAL FEATURES:
 Larva migration in lungs cause transient,intermittent
eosinophilic pneumonitis with irriatating non productive
cough and substernal burning discomfort.
 Heavy infections can cause abdominal pain,small bowel
obstruction, perforation,intussusceptions or volvulus.
 A large worm can enter and occlude biliary tree-biliary
colic,cholicystitis,cholangitis,pancreatitis or rarely
intrahepatic abscesses.
 53

 Single worm may cause symptoms due to migration into

aberrant sites.
 Migration of worms into oesophagus and expulsion by
vomiting.

INVESTIGATIONS:
 Examination of stool for eggs.
 Passage of round worms in stool,vomitus,expulsion
through the nose.
 Plain X-Ray abdomen-masses of worms in gas filled
loops of bowel in the intestine obstruction.contrast
studies of GIT may reveal the worms.
 USG of abdomen and ERCP may reveal the hepato
biliary worm infestation.
MANAGEMENT:
 Albendazole 4oomg once
 Mebendazole 100mg bid for three days
 Pyrental pamoate 11 mg/kg to a maximum of1 gm
once. Safe in pregnancy and other drugs are
contraindicated.
 Surgical intervention is needed for obstruction of
bowel or biliary tract.
 54

PREVENTION:
 Keeping good sanitation conditions.
 Pollution of soil with human faeces should be avoided.
 Vegetable should be thoroughly washed in a mild solution
of potassium permanganate and properly cooked before
use.
 Finger nails should be regularly cut to avoid the collection
of dirt and egs below them.
 Hands should be properly washed with some antiseptic
soap before touching edibles or eating.
55
 56

DYSENTERY
According to WHO:

Dysentery is bloody diarrhea i.e., any diarrhoeal episode in

which the loose or watery stools contain visible red blood.

Bacterial cytotoxins,in contrast, destroy intestinal mucosal

cells and produce the syndrome of dysentery with bloody
stools.

CAUSES:

It is often caused by shigella species or entamoeba

histolytica.

Chemical irritation of the intestines.

Invasion :

Dysentery may result not only from the production of

cytokinins but also from bacterial invasion amd destruction
of intestinal mucosal cells.

Infections due to shigella and E.coli are characterized by the

organisms invasion of mucosal epithelial
cells,intraepithelial multiplication and subsequent spread to
adjacent cells.

SYMPTOMS:
 Bloody diarrhea
 Abdominal pain
 57

 Fever
 Tenesmus
 Abdominal bloating
 Flatulence.

 Types of dysentery:

1.AMOEBIC DYSENTERY

2.BACILLARY DYSENTERY.

1.AMOEBIC DYSENTERY:

 Also called amoebiasis

 It is an infection with intestinal protozoan entamoeba
histolytica.
 Geographical distribution:
 Present worldwide,but most prevalent in tropical and
subtropical areas under conditions of crowding,poor
sanitation,and poor nutrition.
 HOST:Humans
 Transmission:
- Through ingestion of cysts from faecally contaminated
food/water,
- person to person spread
- by flies etc.,
 58

LIFECYCLE:

It consists of two stages: CYSTS and TROPHOZOITES.

1.Cysts measure 10 to 15micrometre in diameter and contain 4

nuclei.

Excystation of ingested cyst occur in the lumen of small intestine-

nuclear division followed by cytoplasmic division.

Each cyst gives rise to 8 trophozoites.

2.Tropozoites measure 10 to 50 micrometre and contain single

nucleus with a central karyosome.
 59

They reside in caecum and large intestine.

Re-encystation of the trophozoites occur in the colon and excretion

of cysts in the faeces.

Pathology:

1.The tropozoites invade the colonic epitheliumcausing amoebic

colitis.

2.Amoebic ulcers are flask shaped and are usually located in

ileocaecal region due to stasis of stool there and next
common site is sigmoido-rectal region.

3.In severe cases entire colon is affected with multiple ulcerations.

4.Ocassionally agranumatous tissue forms a mass called

amoeboma in above regions.

5.E.histolytica tropozoites can invade all tissue of the body-

intestinal mucosa,liver,pleura,lungs,brain and skin.

CLINICAL FEATURES:

1.Incubation period is 2 to 4 weeks.

2.90% of the infected person are carriers without symptoms.

3.Mild abdominal pain and diarrhea with periods of remission and

recurrence may last for weeks.

4.fever is uncommon,microscopic haematochezia is common.

 60

5.Tenderness on palpation of abdomen and right

hypochondrium-tender hepatomegaly.

6.In severe form: it presents with vomiting

fever

abdominal pain

hepatic enlargement

frequent dysentery (10-20 stools/day)

7.In chronic form: it presents with chronic diarrhea,

Weight loss

Amoebic appendicitis

Granulomatous lesions resulting

In amoebomas

INVESTIGATIONS:

1.Stool examination :for haematophagus EH tropozoites is

diagnostic

Different species of entamoeba cysts look alike

And differentiation is not possible.

EH cyst contain 4 nuclei whereas E.coli cyst

Contains 8 nuclei.
 61

2.Serological tests like ELISA,IFA(indirect fluorescence

antibody) and IHA(indirect haemagglutination) testa are positive
in 90% of cases.

3. Species-specific PCR is very useful but expensive.

4.Trophozoites from chocolate coloured aspirate-especially last

few

Drops from the abscess wall.

5.X-ray chest reveals raised dome of right diaphragm.

6.USG,CT and MRI scans detect the abscess.

TREATMENT:

1.Luminal amoebicides

-Diloxanide furoate-500mg PO tid for 10 days

-Diiodohydroxyquin-650mg PO tid for 21 days

-Paromomycin-10mg/kg PO tid for 7 days.

2.Tissue amoebicides

-for all tissues:*metronidazole :400mg PO tid for 10 days

*tinidazole : 2gm PO daily for 3 days+one

luminal agent.
 62

*Emetine or dehydroemetine-1mg /kg.sc/IM for

10days.

-for liver only: *chloroquine:300 mg base first 2 days and

then 150mg base for 19 days.

*tetracycline: 250mg qid PO for 10days.

2.BACILLARY DYSENTERY:
o Also called shigellosis.
o Caused by: non motile gram negative genus shigella.
Groups: 4 serophytes and 47 serotypes.
o Transmission: through faeco oral route, contaminated
water and food,flies.
o Incubation period: 1 to 3 days.
 63

PATHOGENESIS:

Bacteria
Intestine

Penetrate mucus normal bacterial flora IgA

Multiply in epithelia cell Prevent attaching

and proper lamina

inflammation vessel endotoxin

contraction
endogenous pyrogen fever
superficial mucosal necrosis and ulcer

diarrhea mixed with blood and pus,

abdominal pain.

CLINICAL FEATURES:
1.fever
2.headache
3.malaise
4.abdominal cramps
 64

5.vomiting
6.bloody mucoid stools
7.tenesmus
8.abdominal tenderness
INVESTIGATIONS:
1.Stool examination
2. and laboratory culture for shigella bacillus.
3.DNA probes, PCR,
ELISA methods useful for diagnosis.
COMPLICATIONS:
1.Toxic megacolon
2.HUS(hemolyticuremic syndrome)
3.Dehydration
4.Circulatory failure
5.Convulsions
6.Rectal prolapsed

DIFFERENTIAL DIAGNOSIS:
1.Include diarrheal diseases caused by
E.coli,salmonella,campylobacter, entamoeba
histolytica,ulcerative colitis.
*Isolation and identification of shigella from stool
culture confirms the diagnosis.
 65

TREATMENT:

1.Ciprofloxacin 500mgbid or

Norfloxacin 400mg bid for 5 days.

2.ceftriazone or azithromycin

3.Third generation cephalosporins: cefotaxime,cefixime

4.fluid and electrolyte replacement

5.Do not use anti motility drugs

6.Shigella infections in immunocompromised patients

Should treated for 7-0 days.

7.Oral rehydration eith ORS solution.

8.Second line of drugs:-*ceftriazone IM

*axithromycin PO once a day.

 66

DIFFERENTIAL DIAGNOSIS BETWEEN

AMOEBIC DYSENTERY AND BACILLARY
DYSENTERY:

Feature Amoebic dysentery Bacillary dysentery

No.of stools 6-8 motions per day More than 10per day
per day
Amount Relatively copious Small quantity
Odour Offensive Odourless.
Colour Dark red Bright red
nature Blood and mucous Blood and
mixed with faeces mucus(with minimal
faecal matter)
Reaction Acid Alkaline
Consistency Not adherent to the Adherent to the
container container
Microscopic
examination:
a)RBC Discrete
b)Pus cells Scanty Numerous

c)Macrophages Very few Numerous

d)Eosinophils Present Absent
e)parasite Trophozoites of Nil
E.histolytica
 67

BIBLIOGRAPHY

1.CHARAKA SAMHITHA: SUTRA STHANA

VIMANA STHANA
CHIKITSA STHANA
2.SUSRUTHA STHANA:SUTRA STHANA.
UTTARATANTRA
3. BHAISHAJYA RATNAVALI
4. BHAVAPRAKASHA
5.R Alagappan manual of practical medicine 6 th edition.
6,HARRISONS principles of internal medicine 19 th edition.
7.https://www.slideshare.net/mobile/soumyaranjamparida/ascari
asis- 51337134.
8. https://ijapr.in/index.php/ijapr/article/view/313/327