ATISARA (DIARROHEA) Treatment Protocol by Ayush
INTRODUCTION
Atisara is an acute gastrointestinal disorder characterized with increased frequency of stools with loose motions.1 This could be correlated with various diarrhoeal conditions.
Case definition:
Excessive passage of watery stools associated with discomfort in abdomen, cardiac, umbilical & anal region, and malaise.
Types:
Considering the cause, there are main types named as Vataja, Pittaja, Kaphaja, Sannipataja, Amaja, Bhayaja / Shokaja. Depending upon the stage, classics have classified Atisara as Sama or Nirama.
Table 14.1: Types of Atisara with their characteristics
Types |
Symptoms |
Aamatisara |
Unformed stool with excessive mucus with foul odour, usually associated with features of Ama like flatulence, heaviness in abdomen or body, loss of appetite, lethargy. |
Pakvatisara |
Stool which is contrasting to characteristics and symptoms of Amatisara. |
Vataja |
Patient frequently passes small quantity of liquid stool with flatus or froth, with discomfort or pain in abdomen, anus, thigh or sacral region, associated with horripilation, increased respiration, dryness of mouth, weakness |
Pittaja |
Patient passes stool with yellow, green, black tinge which may contain blood with exceedingly foetid smell. Associated features may include increased thirst, burning sensation, sweating, fainting, colic pain, inflammation and suppuration in anus |
Kaphaja |
Patient passes stool as unctuous, white, slimy, foetid smell mixed with mucus, with frequent colic pain, or tenesmus. Associated complains may include heaviness in abdomen, anus, pelvis and groin, horripilation, nausea, lassitude and aversion to food. |
Sannipataja |
Mixed symptoms of Tridoshaja (incurable) |
Bhayaja and Shokaja |
The presentation of this variety is similar as Vataja Atisara. But in addition to it, psychological factors can be traced in the induction of loose stool |
Differential Diagnosis:
- Grahani
- Pravahika
- Vishoochika
- Krimiroga
- Ajeerna
Line of treatment
- Nidana Parivarjana should be the first line of treatment.
- Shodhana Chikitsa – Nil
- Shamana Chikitsa- Langhana, Pachana, Deepana, Grahi, Stambhana
- External applications - Nil
- Rasayana Chikitsa for Grahani
- Treatment according to Doshik involvement
- General line of treatment prescribed for Purishavaha Srotas
LEVEL 1: AT SOLO AYUVEDIC PHYSICIAN’S CLINIC / PHC
Clinical Diagnosis: On the basis of history and clinical presentation.
Investigations: Routine stool examination
Treatment: In the initial stage of Amatisara, it is not necessary to use Stambhana drugs. Pachana and Deepana should be advised.
Table 14.2: Medicines at level 1 for Atisar
Drugs |
Dosage form |
Dose |
Time of administration |
Duration |
Anupana |
Shunthi Churna |
Churna |
2-3 gm |
3-4 times |
1-2 days |
Takra |
Sanjivani Vati2 |
Vati |
1-2 Vati |
Before food 2-3 times a day |
Till symptom subsides |
Plain water |
Bilwadi Gutika3 |
Vati |
1-2 Vati |
Before food 2-3 times a day |
Till symptom subsides |
Plain water |
Ativisha Churna4 |
Churna |
125-250 mg |
Before food 2-3 times a day |
Till symptom subsides |
Plain water |
Bilwamoola Churna5 |
Churna |
1-2 gm |
Before food 2-3 times a day |
Till symptom subsides |
Plain water |
Musta Churna6 |
Churna |
3-6 gm |
After meal / thrice a day |
Till symptom subsides |
Plain water |
Dadima Phala Twak Churna |
Churna |
3-6 gm |
After meal / thrice a day |
Till symptom subsides |
Plain water |
Dadimashtaka Churna7 |
Churna |
3-6 gm |
After meal / thrice a day |
Till symptom subsides |
Water / fresh butter milk |
Kutaja Churna8 |
Churna |
3-6 gm |
After meal / thrice a day |
Till symptom subsides |
Water / fresh butter milk |
Balachaturbhadra Churna9 |
Churna |
3-6 gm |
After meal / thrice a day |
Till symptom subsides |
Honey / water |
Kutajaghan Vati |
Vati |
1-2 Vati |
After meal / thrice a day |
Till symptom subsides |
Plain water |
Kutajarishta10 |
Arista |
10-20 ml |
After meal / thrice a day |
Till symptom subsides |
Equal amount water |
Pathya - Apathya (Diet and life style education):
Do’s -
- Ahara: Laja Manda, Peya, Vilepi, Khichadi, Shritasheeta Jala, Takra
- Vihara: Rest
Don’ts -
- Ahara: Heavy Food, sweets and cold items, milk and milk products except buttermilk
- Vihara: Overeating, daytime sleep, night wakening, physical & mental stress
Referral criteria:
- Cases not responding to above therapy
LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES
Clinical diagnosis: Same as level 1 for a fresh case reporting directly.
Investigations:
- Serum electrolytes
- RFT
Treatment: In addition to the management mentioned in Level 1, few of the following drugs may be added
Table 14.3: Medicines at level 2 for Atisara
Drugs |
Dosage form |
Dose |
Time of administration |
Duration |
Anupana |
||||
Bruhat Gangadhara11 |
Churna |
500 mg-2 gm |
After meal / thrice daily |
Till symptom subsides |
Water / fresh butter milk |
||||
Hingvastaka Churna12 |
Churna |
2-3 gm |
After meal / thrice daily |
Till symptom subsides |
With water |
||||
Mustakaranjadi Kashaya13 |
Kwatha |
12-24 ml |
6 am & 6 pm in empty stomach |
Till symptom subsides |
- |
||||
Anandabhairava Rasa14 |
Churna |
250-500 mg |
After meal / thrice daily |
Till symptom subsides |
Water |
||||
Shankha Vati15 |
Vati |
1-2 Vati |
After meal / thrice daily |
Till symptom subsides |
Water |
||||
Kutaja Avaleha16 |
Granules |
5-10 gm |
Before meal / twice daily |
Till symptom subsides |
- |
||||
Karpoorasava17 |
Asava |
5-10 drops |
Before meal / twice daily |
Till symptom |
|||||
Pathya - Apathya (Diet and life style education): Same as Level 1
Referral criteria: Cases not responding to above therapy.
LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL LEVEL OR DISTRICT
HOSPITAL / INTEGRATED AYURVEDIC HOSPITALS
Clinical Diagnosis: As mentioned above
Investigation:
- Stool culture
- Rapid rotavirus antigen test in stool
- Antigen tests for Giardia, Cryptosporidium and E. histolytica
- USG abdomen, colonoscopy
Treatment: In addition to the management mentioned in Level 1 & 2, some of the following can be advised.
Table 14.4: Medicines at level 3 for Atisara
Drugs |
Dosage form |
Dose |
Time of administration |
Duration |
Anupana |
||||
Panchamruta Parpati Kalpa |
Churna |
125-250 mg This may be increased gradually upto 750 mg. |
Before meal / once a day |
10 days |
Madhu, Ghrita Bhrushta Jeeraka Churna |
||||
Karpura Rasa |
Vati |
1-2 Vati |
Thrice a day |
Till symptom subsides |
Water |
||||
Picchha Basti: Shalmali, Lodhra, Vatankura and Yastimadhu Kalka mixed with ghee, milk, honey |
Emulsion |
400 ml |
Once a day |
Till symptom subsides |
|||||
Pathya - Apathya (Diet and life style education): Same as Level 1 and 2.
REFERENCES
- Acharya Sushruta, Sushruta Samhita with Dalhana Commentary - Nibandhasangraha, and Gayadas Acharya commentary - Nyayachandrika Panjika on Nidanasthana, Uttartantra 40/6, edited By Vd. Jadavaji Trikamji Acharya & Narayana Ram Acharya, Chaukhamba Surbharti Prakashana, Varanasi, 2008.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, PART “A” FORMULATIONS, Govt. of India, 2000. pg. 549.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, PART “A” FORMULATIONS, Govt. of India, 2000. pg. 523.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “B” FORMULARY OF SINGLE DRUGS, 2000, pg. 139.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “B” FORMULARY OF SINGLE DRUGS, 2000, pg. 196.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “B” FORMULARY OF SINGLE DRUGS, 2000, pg. 678.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “B” FORMULARY OF SINGLE DRUGS, 2000, pg. 243.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “B” FORMULARY OF SINGLE DRUGS, 2000, pg. 576.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 337.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 36.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 338.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 353.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 193.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 663.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 545.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 118.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A” FORMULATIONS. 2000, pg. 54.