अथातोऽतीसारग्रहणीदोषनिदानं व्याख्यास्यामः । ह स्माहुरात्रेयादयो महर्षयः । इति
We shall now expound the chapter Atisara, grahanidosa nidanam-diagnosis of diarrhoea and disorders of the duodenum; thus said Atreya and other great sages.
Atisara bheda – types of diarrhoea
दोषैर्व्यस्तैः समस्तैश्च भयाच्छोकाच्च षड्विधः। अतीसारः
Atisara (diarrhoea ) is or six types; viz from each dosa seperately, from all of them together, one each from fear and grief. 1.
Nidana-samprapti – causes and pathogenesis of diarrhoea
स सुतरां जायतेऽत्यम्बुपानतः ॥ १॥
कृशशुष्कामिषासात्म्यतिलपिष्टविरूढकैः । मद्यरूक्षातिमात्रान्नैरर्शोभिः स्नेहविभ्रमात् ॥ २ ॥
कृमिभ्यो वेगरोधाच्च तद्विधैः कुपितोऽनिलः । विस्त्रंसयत्यधोऽब्धातुं हत्वा तेनैव चानलम् ॥ ३ ॥
व्यापद्यानुशकृत्कोष्ठं पुरीषं द्रवतां नयन् । प्रकल्पतेऽतिसाराय
It chiefly arises from drinking large quantity of water, eating meat which is emaciated and dry, uaccustomed foods, puddings, of tila ( sesame seeds), sprouted grains, excess of wine, foods which are dry (non-fatty) and in large quantity; from arsas (piles), improper oleation therapy, worms (intestinal parasites), suppression of urges and such others.
Anila (vata) getting aggravated, makes the ap dhatu (watery tissues) to move downwards; destroying the anala (digestive fire), invades the kostha ( alimentary tract), makes the faeces watery and produces atisara ( diarrhoea). 1b-4b.
Purva rupa – premonitory symptoms
लक्षणं तस्य तोदो हृद्गुदकोष्ठेषु गात्रसादो मलग्रहः । आध्मानमविपाकश्च भाविनः ॥ ४ ॥
Its premonitory symptoms are pricking pain in the region of the heart, rectum and alimentary tract; weakness of the body, constipation, flatulence and indigestion. 4b-5b.
Vataja atisara Rupa – clinical features
तत्र वातेन विड्जलम् ॥ ५ ॥
अल्पाल्पं शब्दशूलाढ्यं विबद्धमुपवेश्यते । रूक्षं सफेनमच्छं च ग्रथितं वा मुहुर्मुहुः ॥ ६॥
तथा दग्धगुडाभासं सपिच्छापरिकर्तिकम् । शुष्कास्यो भ्रष्टपायुश्च हृष्टरोमा विनिष्टनन् ॥ ७ ॥
In diarrhoea caused by vata, the faeces is watery, very less in quantity, expelled out with noise, severe pain and difficulty; it may be dry, mixed with froth, thin or scabelous and expelled often; or it may resemble over-burnt jaggery and mixed with slimy material; the person has dryness of the mouth, prolapse of the rectum, horripilations and straining at stools. 5b-7.
Pittaja Atisara
पित्तेन पीतमसितं हारिद्रं शाद्वलप्रभम् । सरक्तमतिदुर्गन्धं तृणमूर्च्छास्वेददाहवान् ॥ ८ ॥
सशूलं पायुसन्तापपाकवान्
In that caused by pitta, the faeces is yellow, black, termuric like (deep yellow) or algae like ( green); mixed with blood and foul smelling, the person has thirst, fainting, perspiration, burning sensation; elimination is accompained with pain, burning sensation and ulceration of the rectum.
Kaphaja Atisara
श्लेष्मणा घनम् । पिच्छिलं तन्तुमच्छ्रेतं स्निग्धमामं कफान्वितम् ॥ ९ ॥
अभीक्ष्णं गुरु दुर्गन्धं विबद्धमनुबद्धरुक् । सप्रवाहिकम् ॥ १० ॥
निद्रालुरलसोऽन्नद्विडल्पाल्पं सरोमहर्षः सोत्क्लेशो गुरुबस्तिगुदोदरः । कृतेऽप्यकृतसंज्ञश्च
In that due to slesma ( kapha) the faeces is solid, slimy, thready, white, fatty, uncooked, mixed with kapha (mucus), frequent, heavy foulsmelling, accompanied with difficulty of elimination and followed by pain; the person is always sleepy, lazy, dislikes food, has slight ( mild ) straining at stools (or tenesmus) always; horripilation, nausea, feeling of heavyness of the urinary bladder, rectum and abdomen and feeling of non-elimination ( of faeces) though actually eliminated.
Tridosaja
सर्वात्मा सर्वलक्षणः ॥ ११ ॥ That caused by all the dosas will have all the features ( simultaneously). 11b.
Bhayaja and sokaja Atisara
भयेन क्षोभिते चित्ते सपित्तो द्रावयेच्छकृत् । वायुस्ततोऽतिसार्येत क्षिप्रमुष्णं द्रवं प्लवम् ॥ १२ ॥ वातपित्तस्त्रमं लिङ्गैराहुः तद्वच्च शोकतः ।
The mind getting disordered by fear, makes for increase of pitta and vayu (vata) which cause the faeces to become liquid, and produce diarrhoea. Elimination is quick, faeces is warm, fluid and floating (on water); the person having symptoms caused by vata and pitta; that ( diarrhoea) caused by greif is also similar. 12-13a.
अतीसारः समासेन द्विधा सामो निरामकः ॥ १३ ॥
सासृड्निरस्त्रः तत्राद्ये गौरवादप्सु मज्जति । शकृद्दुर्गन्धमाटोपविष्टम्भार्तिप्रसेकिनः ॥ १४॥
विपरीतो निरामस्तु कफात्पक्वोऽपि मज्जति ।
In breif, diarrhoea is of two kinds viz, sama (associated with ama) and nirama (unassociated with ama) and sasra mixed with blood and nirasra not mixed with blood. In the first (sama) the faeces is heavy and so sinks in water, has foul smell, accompanied with intestinal gurgling, stasis of undigested food in the stomach, pain in the abdomen and more salivation; nirama (which is not having ama) has opposite features; feaces containing more of kapha also sinks though it is ripe. 13b-15a.
Grahani dosha nidanam – diagnosis of duodenal disorders
अतीसारेषु यो नातियत्नवान् ग्रहणीगदः ॥ १५ ॥
तस्य स्यादग्निविध्वंसकरैरन्यस्य सेवितैः ।
The patient of diarrhoea who does not try much (to get cured of it) becomes affected by disorders of grahani (duodenumj); so also even others who indulge in things (food and activities) which destroy the agni (digestive activity). 15b-16a.
सामं शकृन्निरामं वा जीर्णे येनातिसार्यते ॥ १६ ॥
सोऽतिसारोऽतिसरणादाशुकारी स्वभावतः । सामं सान्नमजीर्णेऽन्ने जीर्णे पक्कं तु नैव वा ॥ १७ ॥
अकस्माद्वा मुहुर्बद्धमकस्माच्छिथिलं मुहुः । चिरकृद्ग्रहणीदोषः सञ्चयाच्चोपवेशयेत् ॥ १८ ॥
Too many elimination of faeces with or without admixture of ama, after the digestion of food is atisara (diarrhoea) which by nature, is going to cause death soon; whereas in grahani dosa (disorder of duodenum) the faeces is mixed with ama and food, eliminated either when the food is undigested, during digestion or after it; or there may be no eliminations (of faeces) at all; the faeces is sometimes eliminated, solid and some other times loose (liquid) without any other reason; elimination occurs only after accumilation (in the large intestine); this disease causing death after a long time.
Grahnidosha bheda (types)
स चतुर्धा पृथग्दोषैः सन्निपाताच्च जायते ।
It is of four kinds; (one) from each dosa seperately and from all of them together. 19a.
Purvarupa – premonitory symptoms of grahni
प्राग्रूपं तस्य सदनं चिरात्पचनमम्लकः ॥ १९ ॥ प्रसेको वक्त्रवैरस्यमरुचिस्तृट् क्लमो भ्रमः । आनद्धोदरता छर्दिः कर्णक्ष्वेडोऽन्त्रकूजनम् ॥ २० ॥
Its premonitory symptoms are-weakness, digestion after a longtime, sourness (increased acidity ) , salivation, bad taste in the mouth, loss of taste / appetite, thirst, exhaustion, dizziness, distenion of the abdomen vomitting, noise in the ears and intestinal gurgling. 19b-20.
Rupa – clinical features of duodenal disorders
सामान्य लक्षणं कार्यं धूमकस्तमको ज्वरः । मूर्च्छा शिरोरुग्विष्टम्भः श्वयथुः करपादयोः ॥ २१ ॥
Its general symptom are emaciation, feeling of hot fumes coming out from the mouth, tamaka ( dyspnoea), fever, fainting, headache, stasis of undigested food in the stomach and swelling of the hands and feet. 21.
Vataja Grahani
तत्रानिलात्तालुशोषस्तिमिरं कर्णयोः स्वनः । पार्श्वोरुवड्ङ्क्षणग्रीवारुजाऽभीक्ष्णं विसूचिका ॥ २२ ॥
रसेषु गृद्धिः सर्वेषु क्षुत्तृष्णा परिकर्त्तिका | जीर्णे जीर्यति चाध्मानं भुक्ते स्वास्थ्यं समश्रुते ॥ २३ ॥
वातहृद्रोगगुल्मार्श: प्लीहपाण्डुत्वशङ्कितः। चिराद्दुःखं द्रवं शुष्कं तन्वामं शब्दफेनवत् ॥ २४ ॥
पुनः पुनः सृजेद्वर्च: पायुरुक्श्वासकासवान् ।
In that caused by anila (vata), there is dryness of the palate, tamaka, ( dyspnoea), noise in the ears; constant pain in the flanks, thighs, groins and neck, visucika (vomitting and diarrhoea simultaneously ) , desire for ( things of) all the tastes, increased hunger and thirst, cutting pain in the rectum, flatulence after digestion, feels comfortable by taking food; leads to suspicion of disease of the heart, abdominal tumor, piles, disease of the spleen and anaemia-all of vata origin; patient eliminates faeces after long intervals, with difficulty; faeces is liquid, dry (non-unctuous), thin, uncooked, frothy, associated with pain, and increased frequently, accompanied with pain in the rectum, dyspnoea and cough. 22-25a.
Pittaja Grahani
पित्तेन नीलपीताभं पीताभः सृजति द्रवम् ॥ २५ ॥ पूत्यम्लोद्गारहृत्कण्ठदाहरुचितृडर्दितः ।
In that caused by pitta, the faeces is bluish-yellow or yellow, and liquid; the person has bad smelling, sour belchings, burning sensation in the region of the heart and throat, loss of taste / appetite and thirst. 25b-26a.
Kaphaja Grahani
श्लेष्मणा पच्यते दुःखमन्नं छर्दिररोचकः ॥ २६ ॥
आस्योपदेहनिष्ठीवकासहल्लासपीनसाः हृदयं मन्यते स्त्यानमुदरं स्तिमितं गुरु ॥२७॥
उद्गारो दुष्टमधुरः सदनं स्त्रीष्वहर्षणम् । भिन्नामश्लेष्मसंसृष्टगुरुवर्चः अकृशस्यापि दौर्बल्यम् प्रवर्तनम् ॥ २८ ॥
In that caused by slesma ( kapha) , the food is digested with difficulty, there is vomitting, loss of taste / appetite, coating of the mouth, expectoration, cough, nausea, nasal catarrh, the person feels his throat as solid (heavy) and abdomen as static ( movementless ) and heavy; impure belchings (with bad smell) and sweet; debility, lack of desire for women ( sex ), elimination of faeces which is broken, uncooked, mixed with mucus, and heavy or large in quantity, and feeling of weakness even though not emaciated. 26b-29a.
Tridosaja Grahani
सर्वजे सर्वसङ्करः । विभागेऽङ्गस्य ये चोक्ता विषमाद्यास्त्रयोऽग्नयः ॥ २९ ॥ तेऽपि स्युर्ग्रहणीदोषाः समस्तु स्वास्थ्यकारणम् ।
In that due to all dosas, all the symptoms are present. Even visamagni and other kinds of agnis (kinds of digestive activities) described in angavibhaga (chapter 3 of Sarirasthana) are also grahani dosa ( disorders of the duodenum); the samagni (normal digestive agency) only is the cause for health. 29b-30a.
वातव्याध्यश्मरीकुष्ठमेहोदरभगन्दराः ।। ३० ॥ Vatavyadhi (nervous diseases), asmari ( urinary calculus), kustha (leprosy ), meha (diabetes ), udara (enlargement of the abdomen), bhagandara (fistula-in-ano), arsas (piles, haemorrhoids) and grahani (duodenal disease) these eight Maharogas (great diseses) are difficult to treat. 30.
अशसि ग्रहणीत्यष्टौ महारोगाः सुदुस्तराः ॥
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने अतीसारग्रहणीदोषनिदानं
नामाष्टमोऽध्यायः ॥ ८ ॥
Thus ends the chapter Atisara-grahani nidana-the eighth in of Astanga hrdaya samhita, composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
