ATISARA GRAHANI DOSHA NIDANAM – Diagnosis of Diarrhoea and disease of the duodenum – Ashtanga Sangraha Nidanasthana Chapter 8
अथातोऽतीसारग्रहणीदोषनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
We will now expound the diagnosis of Atisara (diarrhoea) and Grahani dosha (disease of duodenum); thus said Atreya and other great sages. ( 1 )
Atisara samprapti – pathogenesis of diarrhoea
दोषैर्व्यस्तैः समस्तैश्च भयाच्छोकाच्च षड्विधः । अतीसारः स सुतरां जायते ऽत्यम्बुपानतः ॥२॥
कृशशुष्कामिषासात्म्यतिलपिष्टविरूढकः । मद्यरूक्षातिमात्रान्नैरर्शोभिः स्नेहविभ्रमात् ॥३॥
कृमिभ्यो वेगरोधाच्च तद्विधैः कुपितोऽनिलः । विस्स्रंसयत्यधोब्धातुं हत्वा तेनैव चानलम् ॥४॥
व्यापद्यानुशकृत् कोष्ठं पुरीषं द्रवतां नयन् । प्रकल्पतेऽतिसाराय – ॥५॥
Atisara (diarrhoea) is of six kinds-produced by each of the doshas seperately, by the combination of all the three, by fear and by grief.
It (diarrhoea) is especially produced by drinking large quantities of water, eating meat of emaciated animals and which is dry, foods which are unaccustomed, paste of sesamum, germinating grains, wines, foods which are dry, eating large quantity of foods, by presence of piles, by improper procedure of oleation therapy, presence of worms (intestinal parasites ), suppression of the urges and such other causes.
Anila (vata) undergoing increase, draws all the watery tissues (rasa, rakta, medas, majja, sukra, mutra, and sveda) into the alimentary tract, destroys (inactivites) the digestive activity, and makes the faeces watery and gives rise to Atisara (diarrhoea). (2-5)
लक्षणं तस्य भाविनः ।
तोदो हृद्गुदकोष्टेषु गात्रसादो मलग्रहः । आध्मानमविपाकश्च ॥६॥
Its prodromal symptoms are; pricking pain in the heart, rectum and alimentary tract, debility, obstruction of faeces, flatulence and indigestion. ( 6 )
Atisara Lakshana – clinical features
तत्र वातेन विजलम् ।अल्पाल्पं शब्दशूलाढ्यं विबद्धमुपवेश्यते । रूक्षं सफेनमच्छं च ग्रथितं वा मुहुर्मुहुः ॥७॥
तथा दग्धगुडाभासं सपिच्छापरिकर्तिकम् । शुष्कास्यो भ्रष्टपायुश्च हृष्टरोमा विनिष्टनन् ॥ ८ ॥
पित्तेन पीतमसितं हारिद्रं शाद्वलप्रभम् । सरक्तमतिदुर्गन्धं तृणमूर्च्छास्वेददाहवान् ॥९॥
सशूलः पायुसन्तापपाकवान्, श्लेष्मणा घनम् । पिच्छिलं तन्तुमच्छ्वेतं स्निग्धमामं कफान्वितम् ॥ १० ॥
अभीक्ष्णं गुरु दुर्गन्धं विबद्धमनुबद्धरुक् । निद्रालुरलसोऽन्नद्विडल्पाल्पं सप्रवाहिकम् ॥११॥
सरोमहर्ष: सोत्क्लेशो गुरुबस्तिगुदोदरः । कृतेऽप्यकृतसंज्ञश्च, सर्वात्मा सर्वलक्षणः ॥ १२॥
In that (diarrhoea) caused by vata the symptoms are the faeces is like dry liquid, small in quantity, is eliminated with great sound, and pain, it is obstructed, dry, mixed with froth, semisolid or hard, excreted very frequently, resembles burnt jaggery/ (treacle), mixed with slimy matter, associated with cutting pain in the rectum, dryress of the mouth, prolapse of the rectum, horripilations and straining at stools.
In that caused by pitta, the faeces is yellow, black, turmeric like (deep yellow) or like algae (green), mixed with blood, of very foul smell, associated with thirst, faintings, perspiration, burning sensation, pain in the abdomen, burning sensation and ulceration of the rectum.
In that caused by slesma (kapha) the faeces is solid, slimy, having thread, white, fatty uprocessed, heavy mixed with kapha ( mucus), eliminated constantly, heavy, foul smelling, obstructed, followed by pain, the person is sleepy, lazy and hates food, the feaces comes out in small quantity after straining, horripilations, naucea, feeling of heaviness of the (region of the) urinary bladder, rectum and abdomen, and a feeling of non-elimination of faeces even though eliminated. In that caused by the combination of all the doshas, all the symptoms are present. (7-12)
भयेन क्षोभिते चित्ते सपित्तो द्रावयेच्छकृत् । वायुस्ततोऽतिसार्येत क्षिप्रमुष्णं द्रवं प्लवम् ॥ १३ ॥
वातपित्तसमं लिङ्गैराहुस्तद्वच्च शोकतः । अतीसार: समासेन द्वेधा सामो निरामकः ॥१४॥
सासृनिरस्त्रस्तत्राद्ये गौरवादप्सु मज्जति । शकृदुर्गन्धमाटोपविष्टम्भार्तिप्रसेकिनः ॥१५॥
विपरीतो निरामस्तु कफात् पक्कोऽपि मज्जति ॥१६॥
When the mind is afflicted with fear, vata associating with pitta, liquifies the faeces, accompanied with symptoms of (increase of) vata and pitta; similar is the diarrhoea caused by grief.
In brief, atisara is of two kinds – Sama and Nirama. In the first kind (sama) the faeces may be with or without admixture of blood, sinks in water being heavy and is foul smelling; the patient will have gurglings (in the intestines), stasis of food for long periods in the abdomen, body aches and excess of salivation. In the Nirama type the symptoms are all opposite; in diarrhoea caused by kapha, the faeces sinks in water even though it is pakva (well cooked). (13-16)
Grahani roga- diagnosis of duodenal disease
असीसारेषु यो नातियत्नवान् ग्रहणीगदः । तस्य स्यादग्निविध्वंसकरैरन्यस्य सेवितैः ॥१७॥
The person who does not make all efforts to get cured of diarrhoea becomes affected, with Grahanigada ( disorder of the duodenum); even others who indulge in foods and activities which destroy the agni ( digestive activity) will also get it. (17)
सामं शकृन्निरामं वा जीर्णे येनातिसार्यते । सोऽतिसारो ऽतिसरणादाशुकारी स्वभावतः ॥१८॥
सामं सान्नमजीर्णेऽन्ने जीर्णे पक्कं तु नैव वा । अकस्माद्वा मुहुर्बद्धमकस्माच्छिथिलं मुहुः ॥ १९ ॥
चिरकृद्ग्रहणीदोषः सञ्चयाच्चोपवेशयेत् ॥ २०॥ सचतुर्धा पृथग्दोषैः सन्निपाताच्च जायते ।
Atisara (diarrhoea) is that disease in which the faeces is eliminated after the digestion of food, faeces, being either sama or nirama, it is so called because of elimination of large quantities of faeces often and is by nature quick in action. Whereas in Grahani dosha (disorder of the duodenum) the faeces is eliminated before digestion of food, mixed with food materials and in sama state, or after the digestion of food the faeces being pakva or there may by no elimination of faeces at all (every day), or the faeces may be sometime hard (solid) and sometimes loose (liquid) without any apparant reason; the disease is slow to manifest, appears whenever the doshas get increased. (18-20)
It is of four kinds; from each one of the doshas seperately and by the combination of all the them.
Grahani Purvarupa- premonitory symptoms
प्राग्रूपं तस्य सदनं चिरात् पचनमम्लकः ॥२१॥
प्रसेको वक्त्रवैरस्यमरुचिस्तृट् क्लमो भ्रमः । आनद्धोदरता छर्दिः कर्णवेडान्त्रकूजनम् ॥ २२ ॥
सामान्यलक्षणं कार्यं धूमकस्तमको ज्वरः । मूर्छा शिरोरुग्विष्टम्भः श्वयथुः करपादयोः ॥ २३ ॥
Its premonitory symptoms are debility, digestion of food after long time, sourness (increased acidity ), salivation, bad taste, loss of appetite, thirst, exhaustion without effort, giddiness, distention of the abdomen, vomiting, ringing in the ears, gurglings in the intestines, emaciation, feeling of hot fumes coming out of the mouth, dimness of vision (feeling of darkness or lack of knowledge) fever, fainting, headache, stasis of food, swelling of the hands and feet. (21-23)
Lakshana – clinical features
तत्रानिलात्तालुशोषस्तिमिरं कर्णयोः स्वनः । पार्श्वोरुवङ्क्षणग्रीवारुजाभीक्ष्णं विषूचिका ॥२४॥
रसेषु गृद्धिः सर्वेषु क्षुत्तृष्णा परिकर्तिका । जीर्णे जीर्यति चाध्मानं भुक्ते स्वास्थ्यं समश्नुते ॥२५॥
वातहृद्रोगगुल्मार्श: प्लीहपाण्डुत्वशङ्कितः । चिरादुःखं द्रवं शुष्कः तन्वामं शब्दफेनवत् ॥२६॥
पुनःपुनः सृजेद्वर्चः पायुरुक्श्वासकासवान् । पित्तेन नीलं पीताभं पीताभः सृजति द्रवम् ॥ २७ ॥
पूत्यम्लोद्गारहृत्कण्ठदाहारुचितृडर्दितः । श्रेष्मणा पच्यते दुःखमन्नं छर्दिररोचकः ॥ २८ ॥
आस्योपदेहनिष्ठीव कासहृल्लासपीनसाः । हृदयं मन्यते स्त्यानमुदरं स्तिमितं गुरु ॥ २९ ॥
उद्गारो दुष्टमधुरः सदंन स्त्रीष्वहर्षणम् । भिन्नामलेष्मसंसृष्टगुरुवर्चः प्रवर्तनम् ॥३०॥ अकृशस्यापि दौर्बल्यं सर्वजे सर्वसङ्करः ॥३१॥
Symptoms of vataja grahani are – dryness of the throat, dimness of vision, ringing in the ears, constant pain in the flanks, thighs, groins and back, vomiting and diarrhoea together, desire for all the taste, more of hunger and thirst, cutting pain in the rectum, distention of the abdomen after (or during) digestion of food, and its relief if food is taken, condition creates doubt of the presence of hrdroga (disease of the heart), gulma (abdominal tumor), arsa (piles), pliha (splenic enlargement), and panndutva (anaemia) of vata origin, the faeces is eliminated after long periods, with difficulty, liquid, dry (non -unctous), thin, ama (uncooked), painful and mixed with froth, frequently and accompanied with pain in the rectum, dyspnoea and cough.
In the pittaja grahani – the patient eliminates faeces is blue, yellowish and liquid, he apprearas yellowish, has belchings which are of foul smell and sour, causing burning sensation in the (region of) heart and throat, loss of appetite and thirst.
In the slesmaja (kaphaja) the food is digested with difficulty, vomiting, loss of appetite, taste, coating of the mouth, expectoration, cough, nausea, running in the nose, feeling of heaviness of the heart, the abdomen is stiff (without normal movement), and heavy, belchings are sweet in taste, debility, lack of desire of women (sexual activity) the faeces is semisolid, ama (inadequately processed) mixed with slesma (mucus), and heavy (sinking in water) and the patient is debilitated though not emaciated. In that caused by the combination of all the doshas, there will be presence of all the symptoms. (24-31)
सिराविभागे ये चोक्ता विषमाद्यास्त्रयोऽग्नयः । तेऽपि स्युर्ग्रहणीदोषाः समस्तु स्वास्थ्यकारणम् ॥३२॥
The visama and other three types of abnormal agnis (gastric fire) described in the sira vibhaga (chapter 6 of sharira sthana) will also be found in Grahanidosha (duodenal disorder), while the samagni (normal digestive activity) is the cause for health. (32) Maharogas- dreadful diseases
वातव्याध्यश्मरीकुष्ठमेहोदरभगन्दराः । अशसि ग्रहणीत्यष्टौ महारोगा: सुदुस्तराः ॥३३॥
Vatavyadhi (nervous disorders), asmari (urinary calculus), kustha (leprosy), meha (diabetes), udara (enlargement of the abdomen) bhagandara (fistula-in-one), arsas (piles, haemorrhoids), and grahani (duodenal disorders) – these eight are the Mahagadas (dreadful diseases) which are difficult to manage (cure). (33)
॥ इति अष्टमोऽध्यायः ॥ Thus ends the Eighth chapter.
