pravahika kc019 gdg

“The evaluation of efficacy of Nagaradi Churna in Pravahika with special reference

to Amoebic dysentery”

By Basavaraj G. swami

As partial fulfillment of post graduation degree

Ayurveda Vachaspati M.D. (Kayachikitsa) Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka

Guide Dr. Vangipuram Varadacharyulu

M.D. (Ayu) (Osm – Gold Medallist

Professor H.O.D. Kayachikitsa Postgraduate studies and research center, Kayachikitsa

Co-Guide

Dr. Shashidhar H. Doddamani, M.D. (Ayu)

Asst. Professor in Kayachikitsa

Postgraduate studies and research center, Kayachikitsa

D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE Gadag - 582 103

Post graduate studies and research center Department of Kayachikitsa

2000-2003

Ayurmitra

TAyComprehended

This is to certify that the contents of this thesis entitled “The evaluation of efficacy

of Nagaradi Churna in Pravahika with special reference to Amoebic dysentery” is has

been worked out by BASAVARAJ. G. SWAMI, under my supervision with close guidance.

Even though this disease, Pravahika has been mentioned in Ayurvedic texts, the

aetiology, pathogenesis etc., needs further evaluation and research. It is as developed and

explained by BASAVARAJ. G. SWAMI is unique and scientific and will definitely help in

elucidation of this disease in Ayurvedic and Modern scientific parlance and further planning

with the management.

This work is applied, scientific and an original contribution in the field of research in

Ayurveda.

I am fully satisfied with the work and recommend the dissertation to be put before the

M.D. (Ayurveda Vachaspathi) Kayachikitsa panel of Rajiv Gandhi University of Health

Sciences, Bangalore for adjudication.

GuideDr. V.Varadacharyulu

M.D.(K.C)(Osm), Professor & H.O.D

DEPT. KAYACHIKITSADGMAMC, PGS&RC, Gadag

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER DEPARTMENT OF KAYACHIKITSA

GADAG, 582 103

Certificate

This is to certify that BASAVARAJ. G. SWAMI has worked for his thesis on the topic

entitled “The evaluation of efficacy of Nagaradi Churna in Pravahika with special

reference to Amoebic dysentery”.

He has successfully done the work under the guidance Dr. V. Varadacharyulu, M.D.

(Ayu) (Osm), and Co-guidance of Dr. Shashidhar H. Doddamani, M.D (Ayu).

We here with forward this thesis for the evaluation and adjudication.

(Dr. G. B. Patil)

(Dr. V. Varada charyulu)

Certificate This is to certify that BASAVARAJ. G. SWAMI has worked for his thesis on the topic

entitled “The evaluation of efficacy of Nagaradi Churna in Pravahika with special

reference to Amoebic dysentery”.

Clinical trials are done under my supervision and guidance. This thesis makes a

distinct advance on scientific lines in the above subject and the findings are highly significant

at the statistical evaluation and have considerably contributed to the present knowledge of

the subject.

Co-Guide Dr. Sashidhar H. Doddamani,

M.D. (Ayu)

Asst. Professor in Kayachikitsa Postgraduate studies and research center

“The evaluation of Nagaradi Churna in Pravahika with special reference to Amoebic dysentery”.

Index Chapter-1

Introduction to Pravahika

1 to 6

Chapter-2

Conceptual study – includes Shareera, Nidana, and Chikitsa in detail

with respect to the disease in comparison to contemporary medicine.

7 to 77

Chapter-3

Drug review – Nagaradi churna composition is discussed with its

pharmacological and pharmaco-dynamics.

78 to 89

Chapter-4

Material and methods

90 to 97

Chapter-5

Observation and results

98 to 112

Chapter-6

Discussion and conclusion

113 to 123

Annexes

Summary

References

Bibliography

List of tables Pravahika Nidana 46

Correlative Aetiology of Pravahika and Amoebic dysentery 47

Signs and symptoms of Pravahika mentioned in various Ayurveda

texts

55

Samprapti ghatakas of Pravahika can be deduced as follows 58

Differences between the three Atisara, Pravahika and Grahani 66

Differences between amathisara and Pravahika. 67

Table-1 Depicting the frequency at the disease in the different Age

groups

99

Table –2 Depicting the Sex ratio of the study 100

Table–3 Depicting the frequency of the disease according to Religion 101

Table–4 Depicting the frequency of the disease according to economic

status

102

Table-5 Depicting the frequency of the disease according to Regional

Distribution

103

Table-6 Depicting the frequency of the disease According to

Occupation

104

Table-7 Depicting the frequency of the disease according to Diet 105

Table-8 Data related to presenting complaints 106

Table-9 Tests of significance - Statistical Data related to parameters 107

Table-10 Showing results 109

Difference of assessment criteria – Baseline to final 110

The assessment criteria - individual patients 111

List of graphs

Graph-1 Depicting the frequency at the disease in the different Age

groups

99

Graph –2 Depicting the Sex ratio of the study 100

Graph–3 Depicting the frequency of the disease according to Religion 101

Graph–4 Depicting the frequency of the disease according to

economic status

102

Graph-5 Depicting the frequency of the disease according to Regional

Distribution

103

Graph-6 Depicting the frequency of the disease According to

Occupation

104

Graph-7 Depicting the frequency of the disease according to Diet 105

Graph-8 Data related to presenting complaints 107

Graph-9 Showing results 112

Acknowledgement

I am deeply indebted to several people who have helped me during my study.

I acknowledge my sincere gratitude to my guide Dr. V. Varadacharyulu, H.O.D.

Post-Graduate studies and Research Center in Kayachikitsa, D.G.M.A.M.C, Gadag,

for his expert comments, critical analysis and affectionate encouragement,

throughout my study.

I am grateful to my Co-guide Dr. Shashidhar H. Doddamani, Asst. Professor, Post-

Graduate studies and Research Center in Kayachikitsa, D.G.M.A.M.C, Gadag for

inspiring me to take up this dissertation subject and supporting me with timely

guidance and encouragement

Words are poor substitutes for my immense feelings of gratitude to Dr. G. B. Patil, Principal, DGMAMC, Gadag. I thank him for his ever-inspiring encouragement,

facilities provided and personal interest in overall supervision of this study.

With a deep sense of gratitude, I thank my teacher Dr. K. Shiva Rama Prasad,

Reader/ Asst. Professor, Post-Graduate studies and Research Center in

Kayachikitsa, D.G.M.A.M.C, Gadag for his much-valued guidance, constant support

and encouragement throughout my study.

It is my prime duty to remember Late Sri Danappa Gurushiddhappa Melmalagi, founder chairman of this esteemed Ayurvedic institution, which made many

graduates to serve the ailing in and around Gadag district. I am taking with respect

the name of Mrs. Girijamma Melmalagi who became mother for many in this

institution.

I extend my immense gratitude to Dr. M.C. Patil, Dr. Raghavadra Shetter and Dr.

Kuber Shank, faculties of Post-Graduate studies and Research Center in

Kayachikitsa, D.G.M.A.M.C, Gadag.

I am very grateful to my parents late Sri Gangadhara Swami, Smt. Siddhalingamma

Bhoosanurmath and late Prof. S.A. Hiremath, S.A. College, Naregal for their

cooperation since my birth to study medicine.

I can never forget the encouragement of Late Dr. C M Sarangamath, learned

colleague friend and philosopher who inspired me to take-up postgraduate studies.

The cooperation of my wife Smt Vidya, my children Avinash, Anusha and Abhilasha

in the process of my post-graduation is unique.

I sincerely remember the co-operation and guidance extended to me by Dr. G.S.

Hiremath, Dr.S.B.Govindappanavar, Dr. V.M. Sajjan, Dr. C.S. Kudarikhannur, Dr. U.

V. Purad, Dr. Gireesh Danappagoudar and all the staff of D.G.M. Ayurvedic Medical

College, U.G and P.G. I thank all my P.G. colleagues and Heads of the Departments

of Dravyaguna, Rasashastra and Panchakarma for their timely support and co-

operation.

I genuinely remember the co-operation and support extended in the clinical trail by

R.M.O. Dr. S.D. Yarageri, Dr.N.S. Hadli, and hospital staff for their constant help and

co-operation.

I honestly remember the co-operation and support of Dr.G.S.Hadimani, Dr.

Shankaragouda, Dr. Srinivasa Reddy, Dr. A.P.Yasmin, Dr. C.S. Hanamanthagoudar

and all the scholars of DGMAMC – PG branches. I thank all my P.G. colleagues for

their constant help and co-operation.

I candidly thank Mr. P.M. Nandakumar, statistician, for the statistical analysis of the

results, librarian V.M. Mundinamani for his timely assistance and thank Shankar

Belawadi for his constant co-operation in my career.

With deep sense of gratitude I thank all the subjects who participated in this study.

(Basavaraj G. swami)

Pravahika – Introduction 1

Food, water and air in order of increasing priority are the main for survival of human

being. One way intake of these are not sufficient to withstand, but also the expulsion of the

excessive or the unwanted is to be pushed out, therefore the mechanism of formation of

fecal matter, urine and expiration of carbon dioxide have been developed in the body. The

quantity, quality of the above three play an important role in the life, thus it is clearly said in

the Samhitas as, That the life not only depends upon the food but also on the fecal matter

passed out with reference to Rajyakshma management. Out of many diseases in the

gastrointestinal tract, the important are Pravahika, Athisara, and Grahani.

The diagnosis of Grahani as per the present systems other than Ayurveda is difficult

but where as the other two which may manifest individually or as well as related with one to

another have been identified by the Acharyas centuries ago. It is still followed by the

physicians of all systems even today. Susruta and Madhavakara have first identified

Pravahika as distinctive disease and Charaka as a symptom in kaphaja athisara.

Pravahika the disease coined after the word pravahana or kunthana which is defined

as the sound made by a person when to strains down to pass the stools, seems to be the

appropriate definition, even though many have defined it as Atisara or Grahani associated

with pain. But the cardinal symptoms is that even after straining the person passes small

amount Mala or fecal matter associated with large quantity of Kapha or mucous or pus or

blood.

Basically unhygienic conditions are the causes of spread of the disease. It is

manifested via the oral cavity along with food and water. Urbanization where the sewage

and the drinking water supply are near gets inter-linked to cause the epidemics. The irony of

the same is that it does not manifest in the persons and may be sub clinical, but still they

can contaminate the others too. This is augmented by the habit of eating food and drinking

at places with poor hygiene, and the mechanical life of the city in particular supporting this


habit, and also drinking water at different places. The cause of not manifesting after invasion

could be the resistance of the person. And if the food taken is unwholesome or virudha in

quantity, quality and timing may help in the formation of Ama and reduce resistance of the

person thereby manifesting the Pravahika. Even though the line of treatment is with good

prognosis but the rate of recurrence is high. The number of fatalities is low with the help of

present drug therapy, but it was high earlier, especially during the wars where epidemics are

common.

The disease is the result of the vitiation of Samanavata, Kledakakapha and

Apanavata. Even though the above Doshas are vitiated to smaller extent the disease will not

manifest unless it is associated with the Ama, which is the result of the agnimandya. As a

result of the vitiation of the Kledakakapha and the Samanavata, or if the doshic vitiation is

severe and the involvement of the Pachakapitta/ Agni is not there then the disease will

manifest without the formation of the Ama also. Thus the disease may manifest with the

association of Ama or even without. This disease is the equivalent with the contemporary

disease dysentery is said to be due to the infection of Entemoeba histolitica or E. coli or

Bacteria. Susruta also affirmed krimi as the cause with out specifying the type or name.

Here we observe that in all cases of positive infestation the signs and symptoms may not be

seen. Probably in these cases of Pravahika, once the person takes more of virrudha ahara

or Ama kara ahara for the formation of Ama. Ama is the undigested food getting fermented

in the stomach. By which the resistance of the person will decrease thereby the sub clinical

signs and symptoms may become clinical.

Need and significance of the study:-

Generally using contemporary system management relives the signs and symptoms

in the patients, but the hard luck of the same is that the patients are prone for malignancy if


the systemic drugs are used indiscriminately. Especially in India the diagnosis is based

mostly on the signs and symptoms rather than by investigation.

Keeping in view the above points when we search for an alternative system for the

treatment of Pravahika. Ayurveda gives a good answer because of the herbal drugs being

with out side effects and the wholesome treatment of the disease. This not only takes out

the disease but also the resistance and immune capacity of patient is increased. So that the

recurrence rate may be low compared to the other groups of medicament usage.

Even though Ayurveda has advocated many a number of medicines for Pravahika,

the selection of Nagaradi churna has been undertaken based on the following points.

The Chakradatta has given a best combination of drugs, which are appropriate

having the krimighna effect over the Entamoeba Histalitica. E. Coli, and other various

bacteria. And also having the property of regulating the bowel habits, along with deepana,

pachana shoola hara raktha sthambaka and ropana gunas.

The pathology for the passage of blood and mucous is due to the inflammation of the

large intestine mucosa due to the exo-toxins of the bacteria and the irritation of the cysts of

Entamoeba hystolitica as explained by the contemporary medicine. Though Ayurveda could

not explain it for the lack of postmortem facilities to locate the krimi in the dead body the

signs and symptoms enunciated is exactly same and krimi has been pointed under the lime

light of Tridosha theory.

Objectives of the study: -

1) To study literary search on Pravahika vis-a-vis amoebic dysentery

2) To study the efficacy of Nagaradi Churna on Pravahika with reference to

subjective and objective parameters

3) To evaluate the efficacy of Nagaradi Churna in improving the clinical status of

Pravahika with special reference to E.Coli infection


Historical glimpses of Pravahika

The sage physicians of ancient India have recognised the disease Pravahika as a

problem of all ages and sex. To begin with an inquiry into the etymological begins of the

word Pravahika.

The word Pravahika it self is a combination of two identical units as 'pra' and 'vahik'.

Vahika is derived from the root 'vaha' with the suffix-nvul of kridanta. For the 'pra upasarga',

'vaha dhatu', nvul pratyaya and 'tap' are combining lead to an origin of the word Pravahika.

According to 'shabda stoma mahanidhi' pravahana indicates mala pravahana. Hence

more fecal matter when expelled out with tenesmus can be defined as Pravahika. Further

when there is urge for defecation but expulsion of stool is not much can be termed as

Pravahika.

Susruta suggested Pravahika, as it originates from the 'vadhri vilodane' or vaha

dhatu. Which means prayatna (initiation) for expulsion of fecal matter with tenesmus.

Kaviraja gananath sen has lucidly clarified that the word pravahana means 'kunthan'

(tenesmus) "pravahanam nama kunthanama" which means in a disease where there is

more kunthana, the said disease can be termed as Pravahika.

The word Pravahika is a term of female gender, which means "pravahyati malam

bahulam" or "pravahyati muhurmuhu sakapha malam pravar tayati iti Pravahika". In

Pravahika the vitiated Vata tries to excrete the Kapha which is accumulated due to intake of

ahita Ahara in the kosthas of the patient. The accumulated Kapha along with mala comes

out by pressing force from the anus in small quantity. This clinical condition is known as

Pravahika in Ayurveda1.

Charaka described the signs and symptoms of Pravahika2, however the remedial

skills are found noted in the Chikitsa chapter of Charaka Samhita3. In Susruta Samhita it is

described specifically under Atisara chapter and the treatment and symptoms are vividly


described4. Vagbhata accepted the views of Charaka. Most of other collections like

Parashara Samhita, Sharngadhar Samhita. Bhavaprakash, Madhvanidana and Bhaishajya

Ratnavali etc. enumerated the disease in detail paying it the status of a disease.

With the advent of scientific knowledge and thought, the medical science reached its

peak during 19th century and the disease Pravahika has a simulation with amoebic colitis.

The roman physician Galen (130-205 A.D.) also identified the disease and mentioned

infection of the liver and intestine.

Therefore keeping all the above points in view the combination of Nagaradi churna

has been under taken for the trial and also they are, supporting for the above properties.

The combination of Nagaradi churna5 is as follows:

Nagara Zingiber officinale

Ativisha Aconitum heterophylum

Mustaka Cyperus rotandis

Dhataki Woodflorida fruticosa

Rasanjan Berberis aristata (modified form)

Vatsaka Holarrhena antidysentrica

Twak phala Cinnomnmn zeylanicum

Bilwa Aegle marimelos

Pata Cissampelos pareira

Katuki Latilopicrorhiza kurroaroyle

Hypothesis: -

Nagaradi Churna in Pravahika with special reference to Amoebic dysentery is more

effective in controlling the condition and to eliminate the causative organism.


Materials and methods: -

30 cases with cardinal symptoms of Pravahika would be undertaken for the trial after

getting the stool examined from DGM Ayurvedic Medical College, Gadag. All the positive

cases would be considered for the trial as out patients, as the disease is not that acute

needing the admission to wards and requires close observation. The efficacy and the results

in detail has been recorded and discussed separately in the concerned chapters.


1 Charaka Chikitsa 19/7 2 Charaka Chikitsa 19/30 3 Charaka Chikitsa 19/34 4 Susruta Uttara 40/140-141 5 Sahasra Yoga Churna Prakarana – 83,84

Pravahika – Conceptual Study 7

Historical review

History of any subject starts either or around the birth of Christ as accepted by the

historians. Time being divided as pre Christ and post Christ that is the birth and death of

Christ from when an approximate chronological information is recorded and available. This

seems to be also effected the identification of various books and their time period. But while

not pointing the specific year or century. Indian philosophy in general and history in

particular searches itself in the Apourusheya vedas and the great grammarian’s work of

panini grammar being the earliest. So also Ayurveda which is accepted to have its roots

from this period even though many changes and editions have come across. Thus we start

our search from the Vedas. Regarding the present topic of Pravahika as a disease, we do

not see any references in Vedas 6. But an approximation of its coining could be assessed to

be in the 8th century BC, with reference to the Baudhika vangmaya where its mention and

discussion is clearly seen. Its reference in Ayurvedic texts should be definitely present since

it is seen in the contemporary literature of that time 7.

The line of treatment of both Grahani and Pravahika are similar, therefore basing on

this principle, it might have been though to be paryaya of Grahani. Such a discussion is

seen in garuda puraana.

It is believed according to some that Buddha had suffered from blood motions which

resulted in his nirvana and these bloody motions being different from Atisara, have been

identified as pakkanddika or praskhanddika, whose symptoms and signs are similar to that

of Pravahika. The characters mentioned in the above reference seem to be similar to that of

Pravahika. Mention of prakkandhika or praskhandhika in books of angutharanikaaya 8 and

dhighanikaaya 9, jathaka 10 etc.,. It is also seen in milindapahaana 11.

In another bauddhika literature, majjminikaaya 12 and jathak 13 mention of lohitha

pakkandhika is seen which is equivalent ot rakthaja Pravahika.


Here we even get references of the isolated causative factors for the said disease,

which is similar to that of Pravahika. Eating vitiated bath, a type of food preparation. In

milindapahaano, where in a short story mentions that eating pig meat causes it, due to the

inability of the pachakagni to digest it. Where as the treatment reference is seen in keshab

jathak. Where it says that due to anidhra results into ajeerna, and it causes theevra vedana

and pravahana with blood motions, when the treatment of the doctor failed, on an advise of

a friend dhahi, madhu, ghrita and guda was tried which gave good relief. In milindapahaano

also reference of rakthaja Pravahika is seen.

The characters or the signs and symptoms mentioned in the baudhika saahitya

which they have called as praskhandhika or Pravahika is similar to those mentioned in the

savil’s system of medicine under the heading of dysentery. That is the patient complaints of

frequency of motions with blood, mucus and perhaps with pus in stools. Associated with

tenesmus, and abdominal pain, must be known to be suffering from dysentery.

Thus from the above references keeping in view, the bauddhika period as around

800 B.C., and since we do not have authentic Ayurvedic texts of this period we assume that

without the availability I the prevailing medical system such references may not be positively

mentioned in other literature.

Charaka used the word Pravahika 14 and also uses the word pravaahana while

mentioning the kaphaja athisara lakshanas. Again in the siddhi sthaana 15 while describing

the upadravas in the series with other diseases Pravahika mention is seen. But he has not

given any definition of the word or the explanation of the same.

The definition and specificity of the disease is seen in Susruta 16 after explaining

Atisara, where even the lines of treatment and drugs have been mentioned. From then on all

the classics have given the description of the disease, like Vagbhata, Madhavakara,

Bhavaprakasha, Sarangadhara etc., but significant material is not to be seen. In the recent


literature too except for commenting upon the above classics and explaining the same in a

better way much work has not been done in this regard, and only improvises the thoughts of

the older classics.

After a wide gap we find that the so-called disease which is having similar signs and

symptoms of Pravahika is dysentery. As in Ayurvedic literature, even in the present medical

history, written information is only available in a proper way from 1700 to 1800 years A.D.,

and the earlier information is not clearly available. The start of the importance and the

prominence of this disease are associated with wars. The initial description of the disease is

as dysentery, later on we sees the development of the classification of the disease and later

on the development of these sub groups but still in general practice treatment is given for

dysentery in general.

The accountable history starts from 1752 when sir. John Pringle has given

description of dysentery from the army in Flanders. In 1788 John Hunter compared with the

signs and symptoms of the disease as seen by him in the Army in Jamica with those

mentioned by Sydenham and others in 1779-80 prevalent in London. In India the modern

literature of dysentery in a written form is from Amesley in 1828 in his book researches on

the diseases of India, where he reports of dysentery and abscess of liver as seen in Madras

presidency. Twinning in 1835 dealt fully with dysentery in his book clinical illustrations of the

more important diseases of Bengal. A concise paper on dysentery for the first time was

written Edmund Parkes in 1846. Kenneth Mackinnon reported remarks on dysentery and

hepatitis in India and fatal cases in 1848 in his treatise on the prevailing diseases of Bengal

and northwest provinces. While in London it was seen in Millbank prison by William Baly.

With relation to be time period of the year between august to November, in algeria was

mentioned by Haspel in 1847. In 1849 bleker recognised dysentery in batavia. Then on in

1860 james morehed in his diseases of Indians in Bombay. Woodward in medical and


surgical history of the war of the rebellion published in 1880 deals with diarrhea and

dysentery together, Fayer in 1881 has mentioned the treatment of the same with

Jpecacuanha in India

Dysentery which was assumed to have been caused by an organism living in the

human intestine, it was doubted whether these caused the disease or only associated with it

because its presence in normal cases and absence in the positive cases. Early break

through available for this problem by shiga in 1898 discovered bascillus dysenteriae and

other closely allied strains of coli. In 1859 at prague lambl has discovered living amoebae in

infantile diarrhea and demonstrated I other cases of diarrhoea and dysentery. In 1870 D.D.

gunningham and lewis have seen amoebae in cholera stools but have not given any

importance. Loesch at St. Petersburgh in 1875 found amoebae in stools and in the ulcers of

large intestines of a postmortem case. In 1876 and 1881 sonsino grassi, perroncito found

amoebae in-patients and Grassi and Leuckart also discovered in healthy people.

In 1890 Councilman and Lafleur of USA published a classical description of the

disease together with a fully review of earlier literature and was supported by Lutz in 1891

has identified amoebae in the case of dysentery. Lock at the same period reported findings

of amoebae in dysentery cases at Texas. Rogers in 1901 recorded occurrence of amoebic

dysentery in India. Schandium published his observations on the life history of the

pathogenic and saprophytic forms of amoeba.

All (Klebs in 1887, Chantemesse, and Widalin 1889, Grigorieff and Ogata in 1892)

opinioned that the dysentery was due to a single bacillus. Majjcora in 1892 suggested

bacillus Coli of exalted virulence to be the cause of dysentery and by Arand in 1894. Bacillus

pyocyaneus by calmette (1893) and Bertrand (1897), streptococci by Durham & Mott (1896)

Ciechanowski & Nowack (1898) were found. Other organisms found were bacillus coli, B.

Proteus vulgaris, B. subtilis and vucrococci shiga in 1898. Clearly established in Japan the


bacillus, and were seen in serum of the cases and was confirmed by Kruse in 1900 and

Flexner and in 1902 by Rogers in India thus they have established a difference of bacillary

dysentery and amoebic dysentery.

Thus what basically described on the basis of signs and symptoms as Pravahika

some where between 3rd century BC, and 3rd century AD in Ayurveda further probed and

what has been mentioned as causative factors are reestablished in the recent ages. These

are further classified on the basis of the organisms as bacillary and amoebic even though

Susruta and Vagbhata had doubted that some organisms to be one of the causes of the

disease, some centuries ago.

The history of dissecting a human body for the knowledge has started in the age of

Susruta it self but being ruru sishya parampara. Except the important points and those

required were written, where as the rest did the teacher only explain. Therefore the basic

points and detailed explanations of various organs have not been available. Secondly only

anatomy as individual subject was not considered but with relation to the physiology.

Coming to the anatomy with relation to Pravahika, we find in the texts mention of koshta and

its organs, which are related, with the process of digestion of food, excretion of excrete and

urine 17.

When we observe Charaka comments we see that the organs comprising of the

koshta are nabhi, Hridaya, kloma, yakruth, pleeha, vrukka, vasthi, malaashaya, pakwasaya,

Uttara and adho guda, kshudhrantra and sthoola anthras, vahanam totally 15 in number 18.

Susruta has explained the shape, size and mode of formation of these organs too 19.

He also classified these organs according to the functions and shapes of these organs as

classifying all the ashayas or those, which store and later on pass out the contents.

Therefore he has mentioned Amashaya and Pakwashaya in ashayas. Explaining the

anthras he has clearly given that the length of the same differs from Male and female in the


ratio of 31/2 to 3 vyamaanyanthraam. Where as guda is included in the orifices along with

the other openings.

DEFINITION AND SYNONYMS

The original word as seen in the earliest text of Ayurveda is Pravahika by Charaka

while giving the lakshanas of kaphaja Atisara 20. It was considered as part of Atisara but

later on it has gained its own importance never the less both are inter linked. The word

Pravahika is derived from ‘vaha’ dhatu succeeding the ‘pra’ upasarga and both related with

‘lyut’ prathyaya giving the word Pravahika 21. Kaikaseya is of opinion that it is masculine 22.

Where as raja radha kantha deva in the shabda kalpa druama 23 says that Pravahika is

feminine. Rravathi muhur muhur pravarthathe meaning passing very frequently and later

puts as Grahani Roga. Further mentions that it is a rakshasa and as the one which is

responsible for movement, it has also been given here itself the lakshans and treatment for

Pravahika at another place.

Shabda ratna karam is of opinion that it is Atisara Roga and the pravahana means

flowing or waves or pravruthi 24. According to vachaspathyam Pravahika is a disease 25 and

Amarakosha has defined it as Grahani 26, and further says that pravahikathaha is that which

is responsible to cause movement or gathi. Rajanighantu says that it is valluka 27.

Amarakosha mani prabha teeka has given two synonyms for Grahani. First one is

sangrahani and the other is Pravahika, which means Grahani ruk or Grahani ruja 28. Where

as in Namalinganusasana he mentions ruk as ruja and Pravahika and mentions rukh as ruja

and Pravahika. Pravahika, Grahani are synonyms of samgrahani, earlier it is said as

Grahani ruk here only Grahani is Pravahika.

Vaijayanithi nighantu opines that Pravahika and Grahani are similar to that of Atisara

29. Shabdasthoma mahanidhi says that the reference relates jala srotases and Pravahika is

related to movement of malam and is Grahani Roga 30. Shabdardha chandrika says it as


Atisara 31. Shabdartha parijatha says that Pravahika is ahisara vyadi 32. Vaidyakeeya

shabda sinduram mentions that Pravahika is Grahani Roga according to raja nighantu but

he says that it is Atisara bedha, and for the word pravahanam it means kunthaanam 33. The

word meaning of kunthanam means the sound, which is made when one effort downward to

increase the intra-abdominal pressures to pass the stool out.

Dalhana seems to give the meaning of pravahana as preryamanasya that is forcing

the faecal matter out without bothering the exact definition of the individual word. Pravahika

disease is defined as a problem in which the patient has to put effort to pass stools, which is

associated with Kapha, the quantity of the faecal matter passed is small, but the frequency

of the defecation is raised associated with abdominal pain 34.

Almost all the authors have mentioned Pravahika, at different places different words

equivalent to Pravahika are used. Following are the synonyms used by various Acharyas

apart from Pravahika.

1. Nihssarak: Sri gathou dhatu presided by Nis upasarga and confined with

lyut prathgyaya forming Nihssarak. This word is used because in Pravahika

only small amount of mala is passed. Sru dhatu denotes movement, Nis

upasarga denotes reduced or less that is relects on the small quantity of

Kapha or mala. Susruta and Hareetha have used this word 35.

2. Nihscarak: Nis upasarga followed by char means movement again with lyut

prathyaya is the way in which the word is formed. The meaning is explained

to similar to that of Nihssrak. This word was also used y Susruta and

Hareetha 36.

3. Visramsi: Sramsi sarpane dhatu preceded by vi upasrga forming visramsi

meaning excessive passage via guda. This is seen in the Ama avastha in

Pravahika. This word is used by bhoja alone.


4. Bimbisi: Ashtanga sangraha kara basing upon the bleeding given the word

for Pravahika as bimbisi. He alone has given the name, whose mala is red

being in association with raktha like bimbiraktha varna phala and further it is

said that this is due to vrana in bruhadantras and also ulcer in sleshma kala

of anthra. (could be the Pureesha dhara kala)

5. Praskhandika: Pra upasarga followed by skandhir gathi shoshanamo dhatu

and being combined with lyut prathyaya as above forms praskhandhika,

meaning large quantity of blood being passed. Some others have used the

word prakkhandhika.

6. Anthra granthi: Due to vrana or ulcer in the gastrointestinal tract or

bruhadanthras, the seepage is blocked and a swelling is seen like granthi.

This word is used by parashara.

7. Annagranthi: This is also similar to that of anthra granthi, the cause of

obstruction to the seepage in the capillaries is due to the blockage by small

particles of food and small granthis are formed like food particles in size.

Anatomical description

Apart from the above the anatomy of the anthras and amapakwasayaa, a detailed

information regarding some of these were explained as required, in the disease. For

example in case guda, the explanation is give in the Arshas relation it is described as the

end part of stoolantras, and is about 4 ½ inches in length and formed by the saramsa of

raktha and Kapha, digested by the Pitta with the involvement of Vata. Susruta has given a

place in Marmas and included in the mamsa Marma and says that any trauma may cause

instant death or sadyopranahara category 37. Charaka has explained that the guda

comprises of the Uttara and adho guda gananatha sen in prathyaksha sareera explains it as

having 3 parts.


1. Gudoshta (anus)

2. Guda nalika (anal canal)

3. Malasaya (rectum).

The last part of the rectum is lower 1 inch is also considered as guda.

Valis of guda:-

The valis of guda consists of 3 number and from above downwards it is pravahani,

Visargini and samvarni. These are lining involved indentures of a conch shell, situated one

above the other, coloured like the palate of the elephant 38. The circumferences of these are

4 inches 39. What is explained as the anal sphincter and the muscles of the rectum and anus

helping in the closure and opening of the anal orifices and helping in the expulsion of the

fecal matter, similarly there valis are thought to help in the above said manner.

PRAVAHINI

It is the first one from the above and is in the upper part of the guda and is about

11/2 inch above the second. Dalhana defines that the one which helps in the passage of

Mala. “pravaha yati iti pravahani”. Ghanekar says “Malasya peedanaath pradhnmaa

pravahani”. Vaghbhatta pravahani. As it presses the faecal matter down it is called as

pravahini.

VISARJINI

It is the second one between pravahani and amavarani and is about 1 ½ inch above

the 3rd. Dalhana says that which helps in the expulsion of faecal matter is vissargini,

“visrujateethi visaargini”. “guda visparaneni Mala visarjanat dwiteeya visargini” by ghanakar.

“thaasan antharaniadya visarjini” by Vagbhata, that which expands guda and helps in

passage of Mala.


SAMVARANI

The last vali and in 1 inch above the gudoshta 40. Balhana says that which helps the

closure of the guda. “samrunateethi samvarani” valistu samvarani name. Guda

samkoochanaakya peshi dweya, kruthi” Chakraa aakara valisthu samvarani name”

ghanekar. Vaghbhata “baahya samvarani”. The guda samkoochana is with the help of 2

peshis, which are round in shape and are called as samvarani, and is external.

Gudoshta :-

It is below the samvarani, and is the terminal part of the guda consisting about 1 ½

yava pramana 41. Bhoja says it is only about ½ anguls and outside there are hairs are

present. Dalhana explains vali as folds of twak. Ghanekar in his commentary has compared

these valis with Houston vales. Which are transverse folds of mucous membrane. Situated

in rectum but extend up to anal verge. Therefore not only the Houston valves, anal columns

and valves are considered as these valis, Ayurveda has based it explanation on the basis of

physiology than anatomy therefore pravahani and visargini could be the ampulla of rectum,

internal and external sphincter, whose functions can be considered as pravahani, visargini

and sambarani 42.

From the above references we find that the Uttara gudha consists of the rectum or

the malashaya as per ghananatha sen and adho gudha being the gudoshta and gudanalika.

With the help of the above organs, the ingested food is digested and the undigested

forms as kitta. From this water is separated and the solid forms as the Pureesha in the

pureeshavaha Srotas with its moola or controlling points being in the Pakwashaya and

guda, helps in the excretion of the pureesha. Both Susruta and Charaka have mentioned

this pureeshavaha Srotas 43.

The large intestine extends from the end of the ileum to the anus, and is about 1.5

meters long. Its caliber is largest at its commencement at the caecum, and gradually


diminishes as far as the rectum where there is a dilation of considerable size just above the

anal canal. It differs from small intestines by

1. Greater caliber,

2. Most of the part is fixed

3. Colon is puckered and saculated and the longitudinal fibers or teeniae coli are

shorter that the circular.

4. Little peritoneal covering with fatty projections termed appendices epiploicae

except over the colon vermiform appendix and rectum. The large intestine

describes an arch and encloses the convolutions of the small intestines.

Commences in right lumbar and hypochondriac region to below the liver, bends

to right (right colic flexure) to the left, and curving downward and forward as

convexity passes as transverse colon, to the left hypochondrium, then bends (left

colic flexure), and descends via the lumbar and iliac regions to pelvis, and forms

a loop called pelvic colon, and continues along lower part of posterior wall of

pelvis to the anus.

Caecum

The caecum, which is the commencement of the large intestine, lies in the right iliac

fossa. Its surface projection occupies the triangular area bounded by the right lateral plane,

the transtubercular plane and the fold of the groin. It is a large sac which has a blind lower

and but is continuous above with the ascending colon, and at the point where the one

passes into the other the ileum opens into the large intestine from the medial side. Its

average length is about 6cm. And its breadth about 7.5cm. It is situated in the right iliac

fossa above the katerak lateral half of the inguinal ligament; it rests on the iliacus and on the

psoas major, being separated from both muscles by their covering fasciae and the

peritoneum, and the caecal recess of the peritoneum which frequently contains the


vermiform appendix. In addition,the lateral cutaneous nerve of the thigh intervenes between

it and the iliacus. In front it is usually in contact with the anterior abdominal wall, but the

greater omentum, and it the caecum is empty, some coils of small intestine, may lie in front

of it. As a rule, it is entirely enveloped by peritoneum, but in about 5 percent of cases the

peritoneal covering is incomplete, the upper part of the posterior surface being in covered

and connected to the iliac fascia by areolartissue. The caedum enjoys a considerable

amount of movement, so that it may become herniated down the right inguinal canal, and it

has occasionally been found in an inguinal hernia on the left side.

The caecum varies in shape, but, according to treves, it may be classified under one

of four types. In early foetal life it is short, conical, and broad at the base, with its apex

turned upwards and medically towards the ileocolic junction. It then resembles the caecum

of the mangabey monkey. As the foetus grows, the caecum increases in length more than in

breadth, so that it forms a longer tube and lacks the broad base, but still has the same

inclination of the apex towards the ileocolic junction. This form is seen in the spider monkey.

As development goes on, the lower part of the tube ceases to grow and the upper part

becomes greatly increased, so that at birth the narrow vermiform appendix hangs from the

apex of a conical caecum. This is the infantile form ad as it persists throughout life in about

2 percent of subjects, it was regarded by treves as the first of his four types of human caeca.

The three taeniae coli start from the appendix and equidistant from each other. In the

second type, the conical caecum has become quadrate by the outgrowth of a saccule on

each side of the anterior taenia. These saccules are of equal size, and the appendix arises

from the depression between them, instead of from the apex of a cone. This type is found in

about 3 percent of subjects. The third type is the normal type for man. Here the two

saccules, which in the second type were uniform, have grown at unequal rates; the right with

greater rapidity than the left. In consequence of this an apparently new apex has been


formed by the downward growth of the right saccule, and the original apex, with the

appendix attached, is pushed over to the left towards the ileocolic junction. The three

taeniae still start from the base of the vermiform appendix, but they are now no longer

equidistant from each other, because the right saccule has grown between the anterior and

postero lateral taeniae, pushing then over to the left. This type occurs in about 90 percent of

subjects. The fourth type is merely an exaggregated condition of the third; the right saccule

is still larger, andat the same time the left saccule has become atrophied, so that the original

apex of the caecum, with the vermiform appendix, is close to the ileccolic junction, and the

anterior taenia courses medially to the same situation. This type is present in about 4

percent of subjects.

The ileocolic valve;-

The lower end of the ileum opens into the medial and posterior aspect of the large

intestine, at the point of junction of the caecum with the colon. The ileocolic orifice is

represented on the surface at the point of intersection of the right lateral and transtubercular

planes; about 2 cm. Below this point the vermiform appendix opens into the caecum. The

opening is provided with a valve consisting of two seqments or lips, which project into the

lumen of the large intestine. If the intestine has been inflated and dried the lips are of

semilunar shape. The upper lip, nearly horizontal in direction, is attached to the line of

junction of the ileum with the colon; the lower lip, the longer and more concave, is attached

to the line of junction of the ileum with the caecum. At the ends of the aperture the two

segments of the valve coalesce, and are continued as narrow membranous ridges for a

short distance, forming the frenula of the valve. The left or anterior end of the aperture is

rounded; the right or posterior is narrow and pointed. In the fresh condition, or in specimens,

which have been hardened in situ, the lips of the valve project as which folds into the lumen

of the caecum, and the opening may present the appearance of a slit or may be somewhat


oval in shape. The circular muscle coat of the terminal part of the ileum is thickened to form

a sphincter.

Each lip of the valve is formed by reduplication of the mucous membrane and of the

circular muscular fibers of the intestine, the longitudinal fibers and peritoneum being

continued uninterruptedly from the small to the large intestine.

The surfaces of the valve directed towards the ileum are covered with villi and

present the characteristic structure of the mucous membrane of the small intestine are

destitute of villi and marked with the orifices of the numerous tubular glands peculiar to the

mucous membrane of the large intestine. It was formerly maintained that this valve

prevented reflex from the caecum into the ileum, but in all probability it acts as a sphincter

round the end of the ileum and prevents the contents of the ileum from passing too quickly

into the caecum; the valve is kept in a condition of tonic contraction by impulses which reach

it through the sympathetic nerves. The taking of food into the stomach initiates contraction of

the ileum and the passage of ileal contents into the large intestine through the ileocolic

opening.

• The colon is divided into four parts:

• The ascending

• Transverse

• Descending and

• Pelvic

Ascending colon

The ascending colon, about 15 cm. Long, is smaller in caliber than the caecum. It

begins at the caecum, and ascends to the under surface of the right lobe of the liver, where

it is lodged in a shallow depression, termed the colic impression, here it bends abruptly

forwards and to the left, forming the right colic flexure. In surface projection it runs upwards


immediately to the right of the right lateral plane, from the tranbstubercular plane to midway

between the subcostal and transpyloric planes. It is covered with peritoneum on its front and

sides. Its posterior surface is connected by areolar tissue to the fascia over the iliacus.

Iliolumbarligament, ouadratus lumborum and the aponeurotic origin of the transversus

abdominis, and to the perirenal fascia in front of the lower and lateral part of the right kidney.

The lateral cutaneous nerve of the thigh, the fourth lumbar artery (as a rule) and,

sometimes, the ilio-inguinal and iliohypogastric nerves cross behind it. Sometimes, it is

completely invested with peritoneum, and it then possesses a distinct but narrow

mesocolon. It is in relation, in front, with the convolutions of the ileum, the right edge of the

greater omentum and the abdominal wall.

Right colic flexure

The right colic flexure comprises the terminal part of the ascending colon and the

commencement of the transverse colon. Which turns downwards, forwards and to the left.

Behind it is in relation with the lower and lateral part of the anterior surface of the right lobe

of the liver; anteromedially, to the second part of the duodenum and the fundus of the gall-

bladder. It is not covered by peritoneum on its posterior surface, asorenal fascis. The flexure

is not so acute as the left colic flexure.

Transverse colon

The transverse colon about 50 cm. Long begins at the right colic flexure, in the right

hypochondriac region, and passing across the abdomen into the left hypochondriac region,

curves sharply on itself, downwards and backwards, beneath the lower end of the spleen,

forming the left colic flexure. In its course across the abdomen it describes an arch, the

convavity of which is usually6 directed backwards and upwards; towards its splenic end

there is often an abrupt U-shaped curve which may descend lower than the main curve. Its

surface projection is drawn from a point, situated immediately lateral to the right lateral plane


and midway between the subcostal and transpyloric planes, to the umbilicus, above and

lateral to the intersection of the left lateral and transpyloric planes. The precise position

occupied by the transverse colon is difficult to define, for it not only shows variations from

individual to individual but its position varies in the same individual from time to time. Very

commonly it lies in the lower umbilical or upper hypogastric region, but it is often found at a

higher level, especially in formal in hardened subjects. It frequently descends in a V-shaped

manner, the apex of the V reaching well below the level of the ilia crests. The posterior

surface of its right extremity is devoid of peritoneum, and is attached areolar tissue to the

front of the second part of the duodenum and the head of the pancreas. Between the head

of the pancreas and the left colic flexure, the transverse colon is almost completely invested

by peritonum, and is connected to the the anterior border of the pancreas by the transverse

mesocolon. It is in relation, by its upper surface, with the liver and gall-bladder, the greater

curvature of the stomach, and the lateral end of the spleen; by its under surface, with the

small intestine; by its anterior surface with the posterior layers of the greater omentum, its

posterior surface is in relation with the second portion of the duodenum, the head of the

pancreas, the upper end of the mesentery, the duodenojejunal flexure and some of the coils

of the jejunum and ileum.

Left colic flexure

The left colic flexure is situated at the junction of the transverse and descending

parts of the colon in the left hypochondriac region, and is in relation with the lateral end of

the spleen and the tail of the pancreas, above, and with the anterior aspect of the left

kidney, medially the flexure is so acute that the end of the transverse colon usually lies in

contact with the front of the descending colon. The left colic flexure lies at a higher level

than, and on a plane posterior to, the right colic flexure and is attached to the diaphragm,


opposite the tenth and eleventh ribs, by a peritoneal fold, named the phrenicocolic ligament,

which lies below the lateral end of the spleen.

Descending colon

The descending colon about 25 cm. Long passes downwards through the left

hypochondriac and lumbar regions. At first it follows the lower part of the lateral border of

the left kidney and then, at the lower pole of that organ, it descends, in the angle between

psoas major and quadratus lumborum, to the crest of the ilium, it then curves downwards

and medially in front of the iliacus and psoas major, and ends in the pelvic colon at the inlet

of the true pelvis. In surface projection it passes downwards, just lateral to the left lateral

plane, from a point situated a little above and to the left of the intersection of the transpyloiric

and left lateral planes, as far as the fold of the groin. The peritoneum covers its anterior

surface and sides, while its posterior surface is connected by areolar tissue with the fascia

over the lower and lateral part of the left kidney, the aponeurotic origin of the transversus

abdominis, the quadratus lumborum, the iliacus and the psoas major. Numerous structures

cross behind it. They include; the subcostal vessels and nerve, the iliohypogastric and ilio-

inguinal nerves, the fourth lumbar artery (as a rule), the lateral femoral cutaneous, femoral

and genitofemoral nerves, the testicular (or ovarian) vessels and the external iliac artery, all

of the left side. The descending colon is smaller in calibre, more deeply placed, and more

frequently covered with peritoneum on its posterior surface, than the ascending colon.

Anteriorly it is related to coils of the jejunum, except in its lower part, which can be felt

through the anterior abdominal wall when, the abdominal muscles are relaxed.

Pelvic colon

The pelvic colon begins at the inlet of the true pelvis. Where it is continuous with the

descending colon, it forms a loop, which varies greatly in length, but averages about 40 cm.

And normally lies within the pelvis. The loop consists of three parts, the first part descends in


contact with the left pelvic wall, the second crosses the pelvic cavity, between the rectum

and bladder I the male, and the rectum and uterus in the female, and may come into contact

with the right pelvic wall, the third arches backwards and reaches the median plane at the

level of the third piece of the sacrum, where it bends downwards and ends in the rectum.

The pelvic colon is completely surrounded by peritonaum, which forms a mesenbtery,

termed the pelvic mesocolon; this diminishes in length from the centre towards the ends of

the loop, where it disappears so that the loop fixed at its junctions with the descending colon

and rectum, but enjoys a considerable range of movement in its central portion. Its relations

are therefore subject to considerable variation. Laterally, it is related to the external iliac

vessels, the obturator nerve, the ovary (in the female), the vas deferens (in the male) and

the lateral pelvic wall. Posteriorly it is related to the internal iliac vessels, the ureter, the

piriformis and the ascral plexus, all of the left side. In seriorly it rests on the bladder, in the

male, and on the uterus and bladder, I the female. Above and on its right side, it is in contact

with the terminal coil of the ileum.

Rectum

The rectum is continuous above with the pelvic colon, whilst below it ends I the anal

canal. From its origin at the level of the third sacral vertabra it passes downwards. Lying in

the sacrococcygeal curve, and extends for 2 or 3cm. In front of, and a little below the tip of

the coccyt. As far as the apear of the prostate. It then bends sharply backwards into the anal

canal. It therefore presents two anteroposterior flexures; an upper or sacral flexure with its

convexity backwards, and a lower or perineal flexure with its convexity forwards. Three

lateral curves arealso described, the upper one covex to the right, opposite the junction of

the third and forth sacral vertebra, a middle one convex to the left. Opposite the

sacrococcygeal articulation, and a lower convex to the right in front of the tip of the coccyx.


As a result of these lateral curves the rectum is not exactly in the median plane, except at its

upper and lower ends; the middle part bulges to the left.

The rectum is about 12 cm. Long. And its commencement its calibre is similar to that

of the pelvic colon, but near its termination it is dilated to form the rectal ampulle. It has no

sacculations comparable to those of the colon, but when the lower part of it is contracts its

mucous membrane is thrown into a number of folds, which are longitudinal in direction and

are effected by the distension of the gut. Besides these there are certain permanent

horizontal folds of a semi lunar shape. There are usually three of these horizontal folds. But

sometimes four or five and frequently only two, are present. One is situated near the

commencement of the rectum, on the right side; a second extends inwards from the left side

of the tube at a slightly lower level, a third, the largest and most constant, projects

backwards from the fore part of the rectum, opposite the fundus of the urinary bladder.

When a fourth is present, it is situated on the left and posterior wall near the lower end of the

tube. These folds are about 12 mm. In width and contain some of the circular fibers of the

gut. In the empty states of the intestines they overlap each other. Their use seems to be

“support the weight of faecal matter, and prevent its urging towards the anus, where its

presence always excites a sensation demanding its discharge”.

The peritoneum is related only to the upper two-thirds of the rectum, covering at first

its fronts and sides, but lower down its front only, from the latter it is reflected on to the

bladder in the male and the posterior vaginal wall in the female.

The level at which the peritoneum is reflected from the rectum to the viscus in front of

it is higher in the male than in the female. In the former the height of the recto-vesical pouch

is about 7.5 cm (i.e., the height to which an ordinary index finger can reach) from anus. In

the female the height of recto-uterine pouch is about 5.5 cm from the anal orifice. In the

male foetus the peritoneum extends downwards on the front of the rectum as far as the


apex of the prostate. The lower part of the rectum is surrounded by a dense tube of fascia,

which consists of a localized thickening, and compression of the extra-peritoneal tissue, this

facial tube is loosely attached to the rectal wall by areolar tissue, in order to allow of

distension of the viscus.

Anal canal

The anal canal begins at the level of the apex of the prostate, is directed downwards

and backwards through the pelvic floor, and ends at the anus. It forms an angle with the

lower part of the rectum, and is from 2 to 3 cm long. It has no peritoneal covering, but is

invested by the sphincter ani internus, supported by the levatores ani, and surrounded by

the sphincter ani externus. In the empty condition it presents the appearance of an

anterposterior longitudinal slit. Behind, it is in contact with a mass of musclular and fibrous

tissue, termed the anococcygeal body; in front it is seperated by the perineal body from the

membranous part of the urethra and the bulf of the penis in the male, and from the lower

end of the vegina in the female.

The upper half of the anal canal is lined by mucous membrane which presents from

six to ten vertical folds know as the anal columns. These columns are usually well marked in

the newborn child but are often ill defined in the adult. They are produced by in folding of the

mucous membrane and of some of the longitudinal muscular tissue, end each contains a

small artery and vein which are the terminus radicals of the superior rectal vessels. They are

separated from one another by furrows, and end below in small crescentic valve-like folds,

termed anal valves; these valves join together the lower ends of the anal columns, and each

forms the inner wall of a small pouch or anal sinus.

The lower half of the anal canal is lined with skin and exhibits a series of fold

extending upwards from the anus towards the anal columns. A white line indicates the

junction of the skin and mucous membrane, which is somewhat wavy owing to the


interlocking of the cutaneous and mucous folds. The part of the anal canal below the anal

valves is developed from the ectodermal proctodaeum while the part above them is from

entodermal cloaca. In correlation with this dual mode of development the following facts may

beenoted. In the lower half, the epithelium is of the startified squamous type, the skin is

supplied by cerebrospinal nerves (inferior haemorrhoidal nerve), the arterial blood supply is

from the inferior rectal artery, the venous drainage is by the inferior rectal vein, which passes

to the internal pudendal vein, and the lymphatics drain with those of the perinal skin into the

superficial inguinal lymph glands. In the uper half, the epithelium is simple columnar in type,

the mucous membrane is supplied by sympathetic nerves, the arterial blood supply is from

the superior rectal artery, the venous drainage is the superior rectal vein route, and the

lymphatics drain with those of the rectum. At the junctional zone portal and systemic venous

circulatios anastomose; and the vein passes between the internal and external sphincters.

The different types of nerve supply of the two parts of the anal canal connote a response to

different types of stimuli; the lower part is very sensitive and responds to stimuli like the skin

in general; and the upper part, like the gut is insensitive to stimulation apart from increase in

tension.

Anus or anal orifice

The anus or anal orifice is the lower aperture of the anal canal and is situated about

4 cms below and in front of the apex of the coccyx in the cleft between the buttocks. The

skin surrounding it is thrown into a series of folds which converge towards the orifice and are

continued upwards into the lower part of the anal canal. After puberty, hairs are developed

in this skin I the male only.

Guda has been divided into the uttara and the andhra by chraka on which the

chakrapani comments that the part of guda, which stores is the uttara and passes out via

the adhara. These two could be the rectum and the anus. Susruta in his reference says that


which passes the vayu (flatulence) and mala is the guda, probably it is the nearest to the

relation to the function of control of the movement of the feacal matter, similar to that of the

sphincters. This could be one of the reasons why it is also considered as one of the moolas

of the Pureesha vaha srotas.

Vegadharana, athyashana, ajeerna, agnimandya and the alpa Pureesha will vitiate

the Pureesha vaha srotas. The lakshanas manifested by the Pureesha vaha srotas after

vitiation are difficulty in passing stools, or stolls are passed in small quantities with pain and

sound or the stools are hard or watery, and the frequency of the passage may increase, or

associated with foul smell.

MICRO ANATOMY OF THE LARGE INTESTINE

The large intestine has four coats; serous, muscular, submucous and mucous. The

serous coat is peritoneum, which invests the different portions of the large intestine to a

variable extent. In the course of the colon the peritoneal coat is thrown into a number of

small pouches filled with fat called appendices epiploicaem more in transverse colon and

the pelvic colon and not present in the rectum.

The muscular coat consists of an external longitudinal and an internal circular layer

of unstriped muscular fibers. The longitudinal fibers form a continuous layer over the surface

of the large intestine, but in certain situations this layer is thickened to form conspicuous

longitudinal bands, taeniae coli and in the intervals between them the longitudinal coat is

lees than half the thickness of the circular conat. In the caecum and colong three taeniae

are present, ranging from 6 to 12 mm in width in different individuals. On is placed anteriorly

on the caecum, ascending, descending and pelvic colon but posteriorly on the transverse

mesocolon, the third is placed posterolaterally in the caecum, ascending and descending

colon and pelvic colon, but is situated on the anterosuperior surface of the transverse colon

at the site where the posterior layers of the greater omentum meet this part of the large


intestine. In the pelvic colon the longitudinal fibers become more scattered, and round the

rectum they spread out and form a layer which completely encircles this portion of the gut,

but is thicker on the anterior and posterior surfaces, so that an anterior and posterior broad

band is seen. At the rectal ampulla few strands of the anterior longitudial fibers pass

forwards to the perineal body to form the rectourethralis muscle. In addition, two fasciculi of

the plain muscles arise from the front of the second and third coccygeal vertebrae, and pass

downwards and forwards toblend with longitudinal muscular fibers on the posterior wall of

the anal canal. These are known as rectococcygeal muscles. The circular fibers form a thin

layer over the caecum and colon, being especially accumulated in the intervals between the

sacculi, in rectum they form a thick layer, and in the anal canal they become numerous, and

constitute the shinter ani internus. This sphincter ani internus surrounds the upper 2.5cms of

the anal canal below it is in contact with the subcutaneous part of the sphincter ani externus

and posteriorly and on each side it is covered by the pubo rectalis part of levator ani.

The submucous coat connects the muscular and mucous layers closely together.

The mucous membrane of caecum and colon is pale, smooth, and destitute of villi. And

raised into numerous crescentic folds, which correspond with intervals between sacculi,

those of rectum are thicker, darker and more vascular and more loosely connected with

muscular coat. The glands of large intestine are minute tubular prolongatios of mucous

membrane arranged perpendicularly

Vessels and nerves

The arteries which supply the part of the large intestine developed from the midgut

(caecum, appendix, ascending colon, right two thirds of transverse colon) are derived from

the colic branches of the superior mesenteric artery, those supplying the left part of the

transverse colon, descending colon, pelvic colon, rectum and upper half of the anal canal

(hind gut derivatives) are the inferior mesenteric artery (and its terminal branch, the superior


rectal) and the middle rectal artery. The rectum is supplied by the superior, rectal branch of

the inferior mesentric, and anal canal by the superior, middle and inferior rectal arteries. The

superior rectal artery is continuation of the inferior mesenteric artery.

The veins of the rectum commence in a plexus of vessels which surrounds the anal

canal. From the plexus about six vessels of considerable size are given off. These ascend

between the muscular and mucous coats running parallel to one another at about the middle

of the rectum they pierce the muscular coat, and by their union, form a single trunk the

superior rectal vein. This arrangement is termed the rectal plesux. It communicates with the

tributeries of the middle and inferior rectal veins, at its commencement, and thus a

communications is established between the systemic and portal circulations.

The nerve supply of the large intestine (exclusive of the lower half of the anal canal)

is derived from the sympathetic and parasymathetic systems. The caecum, appendix,

ascending colon and the right two thirds of the transverse colon all derivatives of the mid gut

have their sympathetic supply from the coeliac and superior mesenteric ganglia, and their

parasympathetic supply from the vagus, the left third of the transverse colon, descending

colon, pelvic colon, rectum and upper half of the anal canal derive their sympathetic supply

from lumbar part of the trunk and hypgastic plexus by means of the plexuses on the

branches of the inferior mescenteric artery. The parasympatheitic supply to this part of the

gut is derived from the pelvic splanchnic nerves. From these latter fibers pass to the pelvic

plexuxes to supply the rectum and upper half of the anal canal. Further branches from the

pelvic splanchnic nerves pass upon the posterior abdominal wall behind the peritoneum,

independently of inferior mesenteric artery, to be distributed directly to the left colic flexure

and descending colon 44.


Physiological description

Apart from this the whole koshta especially the gastrointestinal tract is covered by a

membrane called mucous membrane according to modern even though the nature of this

almost similar throughout, the functions differ at various places.

Pureeshadharakala

There by basing on the function Ayurveda pin points some places and called it

accordingly as Pureeshadharakala where the faecal matter is formed by the absorption of

the water content by the membrane present, there. This Pureeshadharakala is situated in

the Pakwashaya. The boundaries of this are below the yakruth, koshta that is Amashaya,

Pakwashaya madyastham, anthras and unduka 45.

In the kala sequence the pureeshadhara or the mala dhara kala is the fifth one. It is

situated in the sthoolanthras, but also extends into kshudranthras, yakruth, pleeha too. The

waste products of the digestion pass through the unduka and then on the differentiation

takes place by the kala into mootra, mala and vayu, this is the so-called maladhara kala 46.

The moola or the controlling points of the pureeshavahasrotas are two that is

pakwashaya and guda (anal sphincters and the nerves of sciatic plexus). The Pakwashaya

according to the later thoughts has been further divided into a) Undhuka or pureeshundk,

this seems to be a refference to the caecum 47, it is a bag like stricture which is 4 inches

long, therefore generally it is reffered as pottlak, by dalhana that which Susruta callas

unduka 48, Charaka has called it as pureeshadhara. The kshudhranthras, and the

sthoolanthras are joined by a valve or kapatika, this will allow the forward movement only,

and on the top of it is the unduka 49.

Pittadharakala

Coming to the Pittadharakala it is the 6th one in sequence and is situated in the

Amashaya and Pakwashaya and will digest 4 types of food taken by the person. Some


explain it is that which is situated between Amashaya and Pakwashaya and cover the part

of anthras called Grahani 50.

Pakwashaya

The digestion of the food is completed in the kshudhranthras, and the digested

material is absorbed via the rasa dhamanis and the rasayanees will distribute the same

throughout the body. The rest of the waste or the kitta part of the food is pushed in to the

sthoolantras. And the water content of the kitta is absorbed in the sthoolanthras, the kala of

the sthoolanthras will such the water, this process Charaka mentions as the action of Agni,

therefore the liquid kitta will solidify as the water content is absorbed. This is called as the

pureesha. The rasa of this Pureesha being katu, dushitha vayu will be produced in the

Pakwashaya. Therefore three products are produced in the sthoolanthras that is pureesha,

mootra, and the mala bhootha vayu 51.

Chakrapani on the above says that by the term paripindita Pakwashaya is the

change of form in the kitta to form solid or lumps of stools and vaayusyaat katu bhavathah is

during the above process of solidification pungent vayu is produced 52.

LARGE BOWEL MOTILITY:

Colon receives the mixed residues remaining after completion of intestinal digestion

and absorption that digested and undigested food residues and remains of the digestive

secretions including considerable quantities of water and fluids swallowed or secreted and

has escaped absorption in the small intestines, and are converted into faecal matter which is

later evacuated. The motor activities are divided into a) those that appear to designed

primarily to absorb and b) to propels the matter down.

Colon agitates itself to segmenting contraction as of small intestines, Haustral

contractions in which clonic walls roll back and forth, kneading movements in large


segments for contraction and relaxation, by alternate peristalsis and anti-peristalsis. Anti

peristalsis are rare in human colon.

ACT OF DEFECATION:

Due to mass movement of the intestines and the entry of the faeces into the rectum

causes a desire to defecate and when the intra luminal pressure of 20 to 25 cm of water in

rectum will generally create the desire to defecate, this desire could be induced by straining

to pass stools. The receptors of the rectal wall not only detect the increase in the pressure

variations (presso-receptors) but can also differentiate accurately whether the pressure

increase is due to gas, liquid or solid. The act of defecation is preceded usually by voluntary

effort consisting of assumption of appropriate posture, voluntary relaxation of the external

anal sphincter and the compression of the abdominal contents by means of straining. These

movements in turn probably give rise to stimuli which augment the visceral reflexes although

these originate in the distal ends of rectum with the result that, the reflexes cause a mass

contraction involving the entire colon and the internal anal sphincter relaxes. Therefore the

act of defecation is under control of involuntary as well as the voluntary to certain extent.

Reflex centers for defection are situated I the hypothalsmus, lower lumbar and upper sacral

segments of the spinal cord and in the ganglionic plexus of the gut.

SOURCE OF PUREESHA:

Apart from the one that is the undigested and unabsorbed food material, the second

source is the dhatu kitta, which is the resultant of dhatu paka of all the dhatus. The same is

in the modern too said as, the carbohydrates and protein are totally absorbed by the time

they reach the caecum along with fats, and those which are undigested as cellulose, and the

faeces is made up of the above and the bacterial secretions etc., this the ahara part of it,

where as regarding the dhatu kitta, it is seen in the experiments that even during stravations

stools are formed, and does not change in composition, in an isolated intestines after some


time formation of stools was seen and it constituted more of faecal fat, which is present even

if the fatty foods are not ingested. It differs from the dietary fat but resembles the blood lipids

having lecithin and coporosterol which is derived from the action of bacteria (reducing the

cholesterol and other substances like calcium, phosphate, magnesium and inorganic

materials), these are the products of the dhatu kitta, probably.

In Pravahika we observe that the kledhaka Kapha pachaka Pitta, samana Vata and

apana Vata are involved in the disease pathogenesis. When we observe their functions and

the sthaanas.

PUREESHA SWAROOPA:

A person passes about 100 to 150 grams of faecal matter per day constuting 25% of

dead and living micro organisms of the large intestines, 75% is water, small amount of fat, of

endo genous origin. Ash 15% calcium, phosphates, iron, magnesium. Ether soluble

substances – 15%, fats, fatty, acids, lecithin, cholic acid and coprosterol. Nitrogen 5%

derived from purine base, about 0.11 gms/day. Desquamated epithelial cells, bacteria,

mucus, undigested and unabsorbed food.

FUNCTIONS PUREESHA:

Pureesha will support deha or the body and also controls Agni and vayu, apart from

shukra on which the streangth of the body depends and the jeevana on mala. In rajyakshma

as the Agni is in manda state the food is undigested and is passed with mala, therefore the

quantity and the components of the mala has to be protected.

PUREESHA KSHAYA LAKSHANAS:

If the quantity of the mala visarjana is more than the patient suffers from shoola,

anthra koojana, shareera gurutwa and adhmana 53.


Kledakakapha:

It is situated in Amashaya and moistens the food, brought to it and disintegrates or

breaks and liquefies it, Susruta has qualified the Amashaya as the organ which is above the

pittasaya, according to Chakrapani, the part of Amashaya which is the seat of kledaka

Kapha is the urdwa Amashaya 54. The additional function is it acts as chandra for tejas of

pita that is it protects the Amashaya from being digested by the Pitta also located there,

here inthis not it is supported by the malaroopa Kapha of the dhatu parinama, which is result

of kittta paka of rasagni of rasadhatu and poured into Amashaya. Gastric mucous (mucin) is

like kledaka Kapha it is thick, viscous fluid, it is rich in mucoproteins, which is a glycoprotein,

particularly one in which the sugar component is chondropointen sulfuric or muco protein

sulphuric acid as seen in vitreous humour, synovial fluid etc., glycoproteins are not digested

by the enzymes of the gastric mucosa. The actions are 1) Buffer the strong acid 2) Inhibits

the action of pepsin and moistens the food and loosens the molecules especially of the

protein molecules. Similarly in Ayurveda too it is believed, that the gastric juice is secreted

by the cells throughout the lining of stomach and mucin by the gastric glands, which forms a

protective layer from pepsin. Much of the water of gastric mucous is reabsorbed and

becomes extra-cellular fluid.

Samanavata:

The digestion of the food and separation of the required part from waste are with the

help of Samanavata. Charaka states it is located near Agni, the word Agni denotes the

antharagni or the pachakagni or the Pachakapitta. The Pachakapitta is located in Amashaya

and Pakwashaya. Susruta says it is in between Amashaya and Pakwashaya ashtanga

sangraha says that it is near the Agni and moves in Amashaya and Pakwashaya and also in

the channels carrying doshas, malas, sukra, artawa and water. Ashtanga Hridaya says only

in the koshta as the range of movements. Charaka says it stimulates the pachakagni,


regulates the channels carrying sweda, Dosha, ambu. It helps the antargni to digest the food

taken in time and quantity and also helps in the seperation of saara and kitta. Ashtanga

sangraha and Hridaya are of the opinion that it receives and retains till digested and later

seperates the sara and the kitta 55.

Receive food, retain and digest either in Amashaya or Pakwashaya and makes

Separation of saara and kitta, absorption from Pakwashaya the acchabhaga from kitta.

Propulsion of kitta or food residue downs to pureeshadhara kala, and later out of the body.

Samanavata will stimulate production of Pitta in two regions. Gastric secretion, on ingestion

of a meal, gastric secretion is initiated prior to the food arriving into the stomach by the

afferent impulses arising in head via vegas nucleus, and efferent stimuli are sent to gastric

mucosa via vagi. The cephalic or initial stimulation is due to sight, smell or taste of food or

from the act of mastication. Stimulation of vegus causes the increase in the concentration of

the hydrochloric acid and pepsin. In gastric phase both neural and humoral control is seen.

Gastrin is released from the pyloric mucosa by local, mechanical and chemical stimulation

via cholineargic nervous mechanism comprising of meisser’s flexus and its local and central

connections. Stimuli of vagi facilitated the nervous mechanism involved in release of gastrin

and may release small amount even in absence of specific local stimuli. Neither of gastrin or

vegal will produce the maximal stimulation, but both simultaneously will produce abundant

secretion. Pancreatic secretion is also under both central nervous system and humoral.

Nervous is by sympathetic and parasympathetic division of autonomic nervous system. In

addition there is evidence that a local cholinergic mechanism, independent of vagal

innervation may play a role. Stimulation of vegas or parasympathetic innervation of

pancreas results to secretion of enzymes but not bicarbonate.

Secretion of brumer’s glands is increased on stimulation of vegas neural and

humoral mechanism of small intestines stimulation is poorly known. Local, chemical and


mechanical stimulation cn evoke secretion few are of that only parasympathetic will control

the axons of these cells lying in the central nervous system in mid brain, medula oblongata

and sacral region and are connected with ganglonic cells within or in close relation to

innervated organs. Vagal fibers to esophagus and stomach and small intestine synapses

with ganglion cells of the myenteric plexux of auerbach and submucous plexus of meissner.

Motor effect of Samanavata is due to intrinsic nerves of stomach and intestines,

gastero intestinal tract has abundant nerves from authonomic nerves, and contain within its

wall an elaborate plexus of interconnected ganglia of two plexus,

• Myenteric plexus of auerbach and

• Sub mucous plexus of meissner,

Those are considered as artificial but act as one unit. The entaric plexus should be

regarded as a separate division of autonomic nervous system and that said as enteric

nervous system. Parasympathetic fibers of G.I.T., smooth muscles from vegas does not end

in smooth muscles but synapse with cells of enteric plexus. These will increase or decrease

the excitability of reflex centres and not to initiate muscular activity directly. Sympathetic

supply from splanchnic nerves mostly vasomotor sypply, gastero intestinal tracthas its own

capability on the basis of local nervous mechanism and properties of smooth muscle, as the

rhythemic functions as gastric antral peristalsis and segmental contractions of small and

large intestines are dependent on smooth muscle, and the highly co-ordinated function as

forward peristalsis in small intestines and mass movement of colon etc., depend upon the

myenteric plexus. Both neurogenic and myogenic function are regulated by central nervous

system via autonomic nerves. Thus even if intrinsic nerves are severed the intestines can

carry its functions.

The rhythmic contraction is together to agitate the intestinal contents and facilitates

several processes, it ends to increase the degree of sub division of food particles with


mixing with digestive fluids and change the layers which are in contact with mucosa helping

in absorption, also the changes in pressure helps in absorption. Peristaltic and rhythmic

segmentation are super imposed and are independent. The peristaltic contraction manifest

as a rise of the tone level of the intestinal muscles, with out interruption to segmentation

contraction. This has the effect of narrowing the lumen of intestines at the point at which the

increase to tonus occur and it may obliterate it. As the waves of contraction and tones travel

down they sweep the contents forward to the distal end. The villi of the small intestines

increase the surface of absorption, the activity is for two types.

• Lashing and

• Rhythmic shortening and lengthening

The absorption depends upon its activity and are under the nervous control, they

increase in activity is due to spalanchnic but not the Vegas.

Apanavata:

According to Charaka the seat of Apanavata is the testis, urinary bladder, penis,

umbilicus, thighs, groin, rectum and the anthras, the definition is that the one which tends to

move downwards. Where as Susruta states that the Apanavata is situated in the

pakwadhana that is the receptacle of the fully digested food, and also the Pakwashaya,

there is no separate receptacle for the fully digested and the partly digested food, and the

digestion is completed in this region and the nutrients are absorbed simultaneously

therefore the pakwadhana is that region where the kitta bagha is left and later transformed

into Pureesha by pureeshadhara kala of koshta. It is interpreted by some as colon and

rectum. Vagbhata also says that Apanavata resides in the pakwadhana and moves via the

urinary bladder, hips, penis, testis, groin and thighs. Apanavata also denotes the lower most

ends and the Vata associated with this region 56.


All accept the same action that is

• Vegapravarthana that excretion of mala and mootra

• Ejection of semen

• Bring down menstrual blood

• Passage of the foetus during delivery that is it consists of action of defecation,

micturation erection of penis, and ejaculating, free menstrual flow and normal

delivery and cause premature delivery of the ill formed foetus.

Pachakapitta:

The digestion of the ingested food is the basic function of Pachakapitta. The

Ayurvedic scholars, stating that every disease is due to the vitiation of this Pachakapitta

emphasize the importance of the same. Chakrapani says that ‘ Antharagni Chikitsa is

Kayachikitsa it also controls the other pittas of the body, as they are originating from it. Their

waxing and waning depend upon the increase and decrease of the Pachakapitta. Agni is

synonymies as kayaagni, pachakagni, koshtagni antaragni and jatharagni etc., this

Pachakapitta is stated to be situated in the Amashaya and Pakwashaya together called as

the koshta, and here the food is digested. The interior of these asayas is covered by a

membrane or kala called as Pittadharakala which produces Pachakapitta. The part where

this Pittadharakala is situated is also called as Grahani as it stores the food till it is

completely digested 57.

Charaka quotes that the koshtagni leads all other factors with relation to digestion in

the body, the seat of which is grahani, which stores the undigested, digests and pushes into

the Pakwashaya. The life spans, vitality, health. Complexion, luster, heats, enthusiasm,

plumpness are dependent upon the dehagni and when this is extinguished the man dies,

when it is deranged, it causes illness 58.


Therefore the main stay of life is this antharagni and if it is functioning appropriately

then one will not fall ill. Where as Susruta says that by a dispensation which is unseen and

hidden a cause which cannot be perceived or explained in terms of known fact the

Pachakapitta or antharagni is responsible for the digestion of food and drinks.

Even though located in the Amashaya and Pakwashaya, by the inherent powers it

contributes and augments the actions of other pittas present else where in the performance

of metabolic functions of the body. The kala or membrane (mucous) situated in between the

Amashaya and Pakwashaya is the Pitta dhara kala and that part of the koshta is called as

grahani, it gives support to the Pachakapitta for the digestion of food y this part of the koshta

on its way to Pakvashaya 59.

Susruta further says that this Grahani and the Agni depend on the integrity of each

other. Where as Vagbhata in the sangraha states that this Pitta in between the Amashaya

and Pakwashaya consists of all the five bhootas, but the tejas and the soma guna is more

and less respectively and with help of Samanavata it digests the food, even in the Hridaya

the some points have been mentioned, and with reference to Pittadharakala Susruta was

followed 60.

Pravahika – Conceptual Study

41

Nidana of Pravahika

Any disease should have a sequence of pathogenesis that is the process in which

the disease causing factors should be triggered resulting in vitiation of these factors

functions and end in diseases with specific or general signs and symptoms. The triggering

causes should be present in all diseases. These factors will change from one disease to the

other and also will change from period to period in specific, but the basic factors will be the

same in one way or the other. With ensuing changes in the periods varying from decades to

centuries the virility of the causes undergo changes. Apart from the above the reaction or

the response of the human being is also changing to these causative factors for example he

is loosing the thresh hold of pain and the resistance to the changing climates and

atmospheres is decreasing when compared with those mentioned in the Samhita and

Nighantus.

Etiological factors for Pravahika and Atisara are similar as prescribed by all authors

considering both as a dual disease, diarrhea and dysentery which the Acharyas have

accepted and included, Pravahika and Atisara together some hundreds of years back

standing same till now. Having been the oldest one according to the availability of the cases


42

and information with much clarity Acharya Charaka could explain the factors for the

individual Doshic vitiation causing individual Doshic types of the disease. Where as the

others have given a general group of causative factors of which one or more may be

applicable for individual patients.

Susruta in the Uttara stana says that guru, snigha, ruksha, ushna, drava,

sthoola,sheetha padartha sevana samyogaviruddha, samskara viruddha, Ahara sevana

adyasana that is eating before the digestion of the earlier ingested food ajeerna, asathmya

bhojana, increased snehapana, bhaya, visha, shoka, dushtamboopaana, madyapana, rithu

asaathmya, moving in water, vegavarodhana, krimi and arshas 61.

Dalhana defines guru ahara as guru guna in matra that is quantity, guna and vipaka.

Here the quantity of laghu Ahara may be increased or small quantities of guru guna food.

For snehadyairathigukthashcha is explained as intake of excessive oils or sneha

padharthas. He details the cause of signs and symptoms are not to be found in some are

due the virulence of the krimi, which has infected the gastrointestinal tract 62.

Madhava kara in Nidana has referred to the above sloka and mentioned the same

etiological factors to cause Pravahika 64. And vijayarakshitha in his commentary of Athanka

darpana has clarified certain points and says that apart from the above said gurvaadi

factors, the basic cause is Ajeerna Ahara that is not fully cooked food, or ingesting food of

vidhagdha properties leading to Ajeerna and Ama formation. While speaking about the

dushtambupaan he says that, the water which is vitiated and is un-potable and madya or

alcohol if taken in excess will cause the disease. Next he also says that if one indulges in

prolonged stay either by swimming or by any other way or if the drinking water is polluted

with bathing or swimming or by any other methods is used. If mootra or Pureesha vegas are

stopped will lead to Pravahika.


43

Here we come across two different words used one is dushtambu or vyapanna jalam

by which we may say that the vitiation is due to the seasons like varsha, where the flowing

water gathers impurities that is where a large population’s water supply is contaminated.

Where as in the second one that paneeyath athi kreedhanath may have been used to

denote a particular place or localized drinking water being made un-potable due to using the

water source for bathing or swimming etc.,

It is said that excessive intake of madya and contaminated water will effect the

person, it could be possible that the Acharya was of opinion about the resistance of the

body, where in drinking once or twice of the contaminated water may not effect generally.

There by if it is persistent then one will definitely be affected by the disease.

Where as madhukosha akara says that guru means matra guru, swabhava guru that

is taking large quantities of food or even though the quantity is less the food is of guru gunas

like masha etc., explaining the word virudha he says that food with relation to samyog,

desha, kala, maatra, koshta, avastha, karma, samskara, Agni and saathmya. Paakavdhi

viruddha, pariharopachara viruddha, hruddhi virrudha and sampddhivirudha. He further

defines what is adhyasana and for vishamaasana he says that eating large quantities in

short period. With respect to Krimi he explains that the ingested Krimi bases in Pakwashaya

and vitiates the same along with the Dosha 65.

Vagbhata has given importance to the mamsa varga of the food classification and

says that eating sushka or ruksha mamsa or mamasa which is from lean animals, or

preparations of tila or germinating seeds, Krimi and Arshas. He also mentions drinking of

excessive fluids as one of the causes of Pravahika succeeding Atisara, here probably he

might have assumed that ruksha, sushka and mamsa of lean animals is associated with

Vata rakopa in the animals therefore eating such will cause vitiation of Vata I the body nd

cause Pravahika 66.


44

Where as Acharya Charaka has given an elaborate and detailed description of the

separate doshic Nidana for various types.

Vataja: If a person of Vata prakruthi enjoys excessive winds, heat, vyayama, foods which

are ruksha, takig smaller quantities of food, eating without schedule, intake of theekshana

madyas etc., enjoying excessive daily sexual life and avoiding urge of micturation and

daefication will vitiate Vata and cause Pravahika 67.

Pittaja: If a person with Pitta prakruthi ingests foods of lavana, amla and katu resas in large

quantities or ratios or taking kshaaras or ushna and theekshna dravyas taking large

quantities of food at a time, enjoying ushna or hot winds or indulging in jalousies and anger

will vitiate Pitta and cause pittaja Pravahika 68.

Kaphaja: Patient of Kapha prakruthi if takes large quantities of guru, madhura,sheeta

veerya, snigdha foods, or takes large quantities of liquid food, or if the total stomach is

stuffed with food sleeping during day, or not doing any vyayama or with out any other

diviersion of physical or psychological functions 69.

Sannipathaja: If a person takes foods which are snigdha ruksha, ushn, guru khatina,

sheethaveerya, vishama, pertaining to the time quality like viruddha Ahara or Ahara which is

asathmya to body, season and desha langhana, or taking food after regular time, takig

pathya and apathaya food together, drinking malformed madhya or increased madya pana,

if shodhana is not done or not done as prescribed by the proceedure. Bathing in sun or

enjoying winds or water for a prolonged time. Not sleeping during nights and sleeping during

daytime. Vega avarodha if done or if the seasons are not accordingly, or if the person is

debilitated with Krimi, shosha, jwara, arshas etc., then he may suffer from Pravahika where

in all the doshas may be vitiated together 70.

Gangadhara commenting on the above Charaka’s reference says that the possibility

of the Dosha that is similar to that of the prakruthi of the person easily gets vitiated and it will


45

be difficult to treat the same. And further to de-confuse us he says that in a particular

prakruthi patient other Dosha may also vitiate and cause their predominant diseases

depending upon the Ahara and vihara of the patient 71.

Chakrapani commenting upon the kaphaja type says that the increased quantity is

the sampoorakasys or athimathrashana. where as Gandhara is differing slightly and says

that it is kind of food taken that is if the fluids are excessive in the diet. The second one is

that of Gandhara seems to co-relate with Atisara where as Chakrapani’s may include both

Pravahika and Atisara 72.

At the present age human life has become conservative and mechanical, he now

gives importance to time and temporary comforts, thus the food habits have changed

considerably or in majority and also the habits of consuming have changed that is how he

prefers to take delicious things rather than seeing the combination of the food and the way it

is prepared, being mechanical he is forced to take food at places other than his house. Thus

this taking untimely foods and food at other than house is causing a deep cleavage in

between the actual healthy food habits and the present ones.

Secondly urbanization leads to movement of people from natives and thus

depending on others for food, apart from it villages are planned in sanitary and house

building, that is sanitary would be at one side of the village but with urbanization houses

going in all sides drainage becomes in the center and is causing a problem and as such the

contamination of the potable water is taking place causing disease spread in the form of

epidemics there fore leaving the food habits and the aganthuka karanas resulting in krimi,

the resent scientific world is around infections and infestations only, therefore they list the

causative factors as follows giving a small importance to the dietetic factors.


46

Pravahika Nidana Nidana CS SS V MN BP YR SN HS Aharaja Atiguru + + + + + + Atisnigdha + + + + + + Atiruksha + + + + + + Atiushna + + + + + + Atidrava + + + + Atisthoola + + + + Atisheeta + + + + + Viruddha + + + + Adhyasana + + + + Ajeerna + + + + Asatmya bhojana + + + + + Ati madyapana + + + + + Ahitashana + + + Ati madhura + + Ati ambupana + Vishamashana + Vibandha + Ati sushka + + Apakwa anna + Kadana and phala + Viharaja Jalatirmana + + + + Vegadharana + + + + + + Achinta + Diwaswapna + Alasya + Rutu viparyaya + + + + Vyapat janya Sneha atiyoga + + + + + Sneha mithya yoga + + + + Virechana vyapat + + Vasti ayoga + Snehadi Panchakarma + + + + Manasa hetu Shoka + + + + Bhaya + + + + Anya karana Dustambu + + + + Krimidosha + + + + + Dusta jeevanu + Visha + + + + Arshas +

CS=Charaka Samhita, SS= Susruta Samhita, V= Vagbhata, MN= Madhava Nidana, BP = Bhava Prakasha, YR= Yoga Ratnakara, SS= Sarngadhara Samhita, HS= Hareeta Samhita


47

Correlative Aetiology of Pravahika and Amoebic dysentery

Pravahika Amoebic dysentery

1. Ahitashana, atiruksha, atishushka ahara, viruddhashana

Nutritional imbalance with decreased protein

2. Asatmya bhojana Indiscriminate use of unaccustomed food

3. Atiushna, teekshna ahara Inflammation favors the ameba to become hematogenous

4. Sampurakasya adhyashana atisthula, astisnigdha, atiguru ahara achinta, divaswapna alasya

High blood cholesterol level increases the virulence and invasiveness of entamoeba histolytica

5. Vishamabhojana ajeerna Inadequate secretion of bile salts favors the colonization in lower intestinal tract because bile salts, acids offer resistance to the host

6. Atimadhura ahara Amoebiasis worsens with vit. C deficiency and high carbohydrate diet

7. Atimadyapana, atisheetala ahara atidrava sevana

Alcoholism and anti metabolites influence the outcome of infections

8. Apakwa anna,apakwa phala, kadamaphala visha, ritu viparyaya

Reduced immunity favors the infection

9. Vibandha, vegadharana,arshas Alteration in the colonic mucosa increases the susceptibility

10. Krimi Dosha Other intestinal infections may predispose the invasion

11. Dushtambupana dushta jeevanu sankramana jalatiramana

Direct relationship between the number of cysts ingested and development of the disease. Minimum of 1000 cysts are required to cause infection

12. Bhaya, shoka Stress factor in the host modifies the intestinal environment

13. Basti vyapath Spread of infection by direct rectal inoculation through colonic irrigation devices

14. Basti vyapath virechana vyapath sneha vyapath

Depletion of intestinal mucous diffuse inflammation and disruption of the epithelial barrier occur before the contact of the trophozoites with colonic mucosa


48

POORVA ROOPA OF PRAVAHIKA

This is a stage in the disease process, and results in the sub-clinical manifestation of

the disease where the Dosha dooshya sammurchana takes place, but due to the Prasara

State the vitiated doshas are weakened and in this stage cause prodromal symptoms only.

Here the resistance of the host will play equally role. If it is high the disease will not proceed

into the roopa or Manifestation State. Or if the physician diagnosis the disease and treats, it

will be sukha saadya. Charaka has not given any poorva roopa avastha for Pravahika or

atisara Susruta says that before the advent of Pravahika disease suchika veda in Hridaya

pradesha, nabhi, guda, udara and kukshi is dealt. Shaithilyam of the body, apaana vayu

sangha, constipation, aadhmana and indigestion are the poorva roopas of Pravahika 73.

Dalhana on the above reference of Susruta says that even though nabhi includes in

kukshi or udara, to give more prominence to nabhi it is mentioned again, and the thoda will

be more in nabhi region 74.

Madhavakara 75 in his Nidana and Bhavaprakasha 76 in his nighantu has referred to

the same lakshanas as said by Susruta.

Where as madhukosha kara on the above reference clarifies that while it is said that

thoda is felt by the patient, here two words are given that is udara and kukshi, here puruktha

Dosha is not applicable even though kukshi includes in the udara because it should be

interpreted as anthra and kukshi, with regards to anila sanuruddha he says that vayu or

flatus does not come out either from above or downwards. Further he says that this is all

during the Dosha and dooshya sammurchana state only and once the roopa state is

reached these characters will be submerged and includes Ajeerna as one of the purva

roopas 77. Vijaya rakshatha says that with the above lakshanas Pravahika or Atisara may

result in as the poorva roopa for both is it 78.


49

Vagbhata 79 in this regard says that thoda is seen in the Hrudaya, guda and koshta,

gaathra saada, constipation associated with ajeerna and adhmana are seen in the poorva

roopa. While comparing the two ideas of Susruta and Vagbhata we see that nabhi, udara,

kushi has been brought under the one word that is koshta. Indu in his Shashileka vyakyana

has also mentioned the above points 80.

LAKSHANA RUPAM OF PRAVAHIKA

Charaka has rightly said that few signs and symptoms of common in nature are

grouped under a disease add a name is coined for the same. At the same place he also

cautions that one should never totally depend upon the old coined diseases, but basing

upon the characters the patient should be treated as per those characters, because

physicians cannot give a name for all characters 81. Therefore basing upon the Dosha and

the Dooshyas and lakshanas seen in the patient the line of treatment or the principle of

medication should be planned.

Pravahika is as such based on the basic character or the cardinal symptoms or the

prathyaathamaneeyatha lakshanam that is pravahanam, that is the person has to use force

to evacuate the bowels at that period he has to force air down the gastrointestinal tract to

push the stools out. This effort is called as pravahana or kunthana and the disease

originates the word pravahana as Pravahika. Even after passing stool, the patient feels as if

the rectum is full and have to go to the toilet but will not pass any stools when he puts effort

to push the faecal matter out and succeeds in passing a small quantity of stools. Some

times he may pass large quantities, but all the same he has to push the faecal matter out

with effect or pravahana.

Depending upon the doshic involvement with the above prathyathma niyatha

lakshana, Pravahika is of 4 types viz.,


50

1) Vataja 2) Pittaja 3) Kaphaja 4) Rakthaja - as specified by the Sarangadhara, but

he has not given any lakshanas for the above said four.

According to Charaka vataja Pravahika comprises of two different sub groups that is

vataja Pravahika associated with Ama and not associated with Ama that is pakwa. With

regards to vataja Ama type he says that the mala is associated with excessive fluids or

vijjalam viplutham. It means associated with easily spreading character or easily sinks in

water or into the ground that is avasaadi, ruksh, drava, shoola, aama gandha or foul

smelling with loud or mild notice. And stopping the apaana Vata, mootra and the air or gas

in the abdomen to produce sound or admana. These are the characters of vataja Ama

Pravahika 82.

Gangadhara on the above references that vijjalam means picchilam or sticky or

micus, and for vipltham he says that it is the Dosha viplutham which is apakwam and the

vayu in the koshta is inside the koshta and causes pain as well as the shabdam and as it

moves in all directions causes vibhadham 83.

Where as Chakrapani says that when it is associated with Ama or undigested food.

And the spreading natures is attributed to viplutahm, avasadhitham means sinking into the

ground (bhooman patheetham leenambhavathi)

In vatja pakwa Pravahika vibhaddam or constip0ation is associated with passage of

small quantities of stools associated with pain, shabda, phena and parkarthika or pain in the

anal region. During daefecation, romaharsha is felt along with dryness of mouth and difficult

in breathing, kati, uru, thrika, janu peetha and parshwa shoola is observed. Gangadhara has

also given the same characters in his commentary. Chakrapani says that the mala is

associated with viggranthi that is granules like welling 84.

Susruta with regards to vataja Pravahika says that apart from the pain in udara,

mootrabhandana, Anthrakoojana, apaana Vata is not under control, shidhalatha of uru,


51

jangha etc., malam is passed in small quantities along with phena or foam which is black

and ruksha and associated with flatulence 85.

Dalhana on the above reference explains the lakshanas mentioned by sushrutha and

says that srasthaapanaha means prolapse of guda, samuka urugangha means shidilatha or

uru and jangha, saamlam means associated with sound and Vata or flatulence and syava

varna means arunam and that of red colour 86.

According to Vagbhata vatajapravhika is characterized by mala bhaddam, along with

frequent motions, watery but in small quantities, ruksha, phenile, the odour of the mala and

the consistency is of over burnt jaggery along with pain in anal orifice, parikarthika,

romaharsha and guda bhramsha is observed 87.

Madhavakara has condensed the above lakshanas and says that the mala is aruna

or red in colour, associated with foam, ruksha, aama and is passed in small quantities along

with pain and noise 88.

Bhavamishra 89 yogarathnakara 90 and shodhala 91 is his gada nighraha has reffered

to the same lakshanas for the vataja type. Madhukosha kara on the above reference of

madhava kara states that in vataja type arunabham and phenilam are the basic characters,

because these are due to the dosh and dooshya sammurchan where only it Vata is involved

are seen, along with shabdam and shoola which is due to movement of vitiated vayu all over

the udara or intestines, sarukh means associated with pain, and shakruth in the reference is

meant for pureesham or faecal matter 92.

Vijayarakshitha on the above reference in his athanka darpana vyakaya clarifies that

marutha means vayu, shakruth is pureesham, ruksha is without sheha, muhur muhur is

increased frequency, that is if the faecal matter is passed frequently in small quantities

which is red and without sneha is vataja type 93.


52

Charaka mentioned that the patient passes stools, which may be green, yellow, blue

or black associated with Rakta or Pitta and with severe foul smell is passed. And the patient

suffers from thrushna, daaha, swedana, moorcha udara shoola, and burning sensation in

guda along with inflammation 94.

Gangadhara has given all the same lakshanas and chakrapani says that

bradnogudha is present 95. Susruta says that apart from the above the malam is ushna or

warm, cither liquid or in the mamsa 96, and is associated with above characters. Jwara is

also present. This definition of mamsa thoya prakkyam is given by Dalhana as the faecal

liquid is similar to that of flesh cleaned water, and clarifies that the paka is for guda and the

deha includes gudha as well as the jattara 97.

Vagbhata too has given the same lakshanas of colour, foul smell, associated with

blood, moorcha, shoola guda paka etc., but he has not mentioned jwara and he has given

importance to thrushna 98.

Madhavakara 99 has referred to the lakshanas given by the Susruta and madhukosha

kara says that daha is for the whole body, where as paka is for gudam, along with above

characters and guda bradhno too is seen 100. Vijayarakshitta too in his commentary has

given lakshanas101. Bhavaprakasha 102 has given lakshanas as Vagbhata but uses a word

drutham, which means that the vega of motion cannot be controlled. Shodhala in

Gadanigraha and Yogaratnakara 103 have given the same reference where apart from the

above lakshanas say that the mala is rakthaja colour and does not mention the presence of

raktha along with mala.

The patient suffering from kaphaja type will pass mala which is white, snigdham,

picchilam, guru, durgandha associated with Kapha and shoola, and is sticky forming thread

like, udara, guda, vasthi and vankshana pradesha gurutha, and the patient has to put effort

to remove stools and feels like going for motion again along with the above, romaharsha,


53

uttkesha, nidra, aalasya, shareera avasaadam and Ama dwesha is seen. Gangadhara 104

has given the above lakshanas only, where as Chakrapani clarifies that kruthepyakruthi

sangna word clearly whose definition has given above apart from it, it also denotes

incontinence105.

Susruta describes kaphaja as association of thandra, nidra, gaurava, uthklesha,

anndwesha, sukla, saandra sleshma yuktha malam roma harsham and vegashanka is seen.

Dalhana explaining the above says that thandra is a variation of nidra, uthklesha and adhi

he says with glani yuktham, and vega shaka is srushta vittkaha or feeling like passing

motion even after passing, saandra means ghanam niswanam is without sound 106.

Vagbhata has given all the likashanas as said by charaka for the sleshma type.

Where as Madhavakara 107 has given only half the lakshans of Susruta, he has not

given importance to the characters felt by the patient that is thandra, nidra, gaurava,

uthklesha vega shanka and ashabdam, but only mentioned some of the lakshanas of

kaphajamalam, but has given an additional guna of sheetha to the malam and another one

is visram meaning Ama gandham. Vijaya rakshitha has given all the characters as

madhavakara.

Where as Bhavaprakasha mentions that mala is ghana baddham, alpa rupam and is

also sheetham. Like madhava kara yogarathnakara and shodala has given similar

lakshanas but the additional lakshana that is sheetha has been mentioned 108.

Susruta says that in rakthaja type jwara, udara shoola, thrushana, daaha, severe

inflammation of guda, and bleeding before or after the passing of stools is seen. Madhava

kara, Vagbhata and Bhavamishra along with Charaka have considered rakthaja in pittaja

itself. Where as Yogarathnakara says that in rakthaja the association of bleeding which may

be with any type, and basing upon the Dosha the lakshanas will be present. Even shodala

has accepted the above reference 109.


54

When we observe the above references we find that Charaka has subdivided vataja

type into two basing upon the association of Ama and with out Ama. While talking about

Agni we come across a reference where the vitiated Vata will some times digest and

sometimes will not digest the food, therefore two types of the vataja could be seen when

digested the Dosha is alone and when undigested the vitiated Dosha is associated with

Ama, here we are referring to the vishamagni. Where as with regards to Pitta even though

mandagni is not mentioned with relation with but if the quantity of food is high even then

pittaharam is seen causing Ama production, thus Charaka has given Ama and Pitta in the

treatment reference. Where as with regards to Kapha we see that Kapha will immediately

causes Agni mandyam.

All other Acharyas have totally changed the pattern and have only given the general

classification and later on basing upon the lakshanas of the mala they have mentioned Ama

and pakwa type of the disease. But in the clinical observation it is difficult to see cases,

which are of single doshic, nature, but we do definitely see cases of single predominant

disease with few signs and symptoms of the involvement of other doshas too. Basing upon

the quantity and quality of the lakshans or signs and symptoms the predominant Dosha is

arrived at. Therefore a table of the lakshanas in brief have been tabulated herewith.


55

Signs and symptoms of Pravahika mentioned in various Ayurveda texts

Signs and symptoms CS SS AS AH MN BS HS VM VS

1) Saphena pureesham + + + +

2) Parikartika +

3) Bahusha pravahanam + + + + + + + + +

4) Sashoola + + +

5) Alpalapa + + + + + + +

6) Nishpureesha + + + +

7) Maha ruja + +

8) Vibaddham + +

9) Mutra sanga + +

10) Mala sanga + + +

11) Sa Kapha + + +

12) Sa pichchila + + + +

13) Sa Ama mala +

14) Sweta Kapha +

15) Payu sopha +

16) Uru sada +

17) Jangha sodha +

18) Varcho kshaya + +

19) Vata vibadhdham + +

20) Sushkashyata +

21) Mutra kruchra +

22) Roma harsha +

23) Krishna varna Kapha +

24) Sa jwara +

25) Trushna +

26) Vasti sopha +

27) Sadaha + + +

28) Sa shonita + + +

29) Rakta varna Kapha +

30) Guda bhramsha + CS=Charaka Samhita, SS= Susruta Samhita, AS= Astanga Sangraha, AH= Astanga

Hrudaya, MN= Madhava Nidana, BS= Bhela Samhita, HS= Hareeta Samhita, VM= Vrunda Madhava, VS= Vanga sena


56

Amoebiasis is an infection of large intestines produced by Entamoeba histolytica. It is

and a symptomatic carrier stalls in most individual. But diseases ranging from chronic, mild

diarrhea to fulminate dysentery may occur. Among extra intestinal complications commonest

is hepatic abscess, which may rupture into peritoneum, pleura, and lung or into pericardium.

Entamoeba histolytica existis in 2 forms, motile trophozoite and cyst. The trophozoite

is the parasitic form and dwells in the lumen and or wall of colon as by binary fission, grows

best under anaerobic conditions and requires the presence of either bacteria or tissue

substrates to satisfy its nutrition from the intestines, with diarrhea trophozoites are passed

unchanged in the liquid stool, where they can be distinguished by the size. 10 to 20 µ in

diameter) directional motility, sharp demarcated clear ectop0loasm with slender finger like

pseudopodia and fine granular endoplasm. In dysentery the trophozoites are larger and

often contain ingested erythrocytes. In the absence of diarrhea the trophozoites usually

encyst before leaving the gut. The cysts are highly resistant to environmental changes are

responsible for transmission of disease.

Young cysts have single nucleus, a glycogen vacuole, and sausage shaped

chromatid bodies. As the cyst matures it absorbs its cytoplasmic vacuoles and becomes

quandrinucleate. The cysts of Entamoeba histolytiica can be distinguished from those of E.

coli by the presence of 1-4 nuclei with small centric karyosomes and 5 peripheral chromatin

and by their thick chromatid bodies with round cells.

Entamoeba histolytiica been classified into large and small races depending upon

whether they form cysts measuring more or less than 10 cm in diameter. Strains of the small

race however are not pathogenic for human beings and are now considered as a distinct

species Entamoeba hardmani.

Entamoeba histolytica like amoebas are organisms isolated from human that are

morphologically indistinguishable from true Entamoeba histolytica. However unlike


57

Entamoeba histolytica they are nonpathogenic grow at 20 and can multiply indefinitely in

hypotonic solution.

The causative organisms are of four types of shigella species, shigella dysenteriase,

shigella flexineri, shigella bodydii and shigella sonni various of the attack varies from mild

gastroenterition, producing slight diarrhoea to a fulminating toxic and at times fatal illness.

The mode of transmission is food by files, water contamination with faeces. Direct faecal

hand to mouth in children, carriere such as cooks or food handlers are occult source of

transmission.

The clinical features of bascillary dysentery are, colic pain in form of frequent apana

of gripping abdominal pain which starts gradually, rapidly increase in intensity and then

wane, increase and desire to defecate. Diarrhea at first could be four to five and the

frequency increasing with in a day or two, loose, yellowish brown to start with soon assume

typical dysenteric character, small or faecal matter, consisting of bloody gelatinous mucous

or muco-pus. Blood may vary from streaks or small lumps, to large clote. In severe cases

shreds of mucosa may be present. Tenesmus, that is passage of stools often associated

with straining and burning pain in rectum and anux. Tenderness of large bowel may be

present. The general symptoms of moderate pyrexia, headache, malaise, anorexia, dirty

tongue, as the disease advances thirst, emaciation, dry shallow skin, weakness, and

prostration 110.


58

In a nutshell, the Samprapti ghatakas of Pravahika can be deduced as follows

Samprapti ghatakas

Dosha Vatapradhana tridosha

Dushya Anna, rasa, rakta, pureesha

Agni Jataragni

Ama Jatharagni mandya janya Ama

Srotas Pureeshavaha,annavaha, rasavaha srotas

Dusti prakara Sanga and atipravrithi

Udhbavasthana Amapakwashaya

Sancharasthana Rasayanis

Adhisthana Pureeshavaha srotas

Vyaktasthana Guda

Rogamarga abhyantara

SAMPRAPTI

The pathway in which the disease is manifested is the Samprapti, which is defined

as samyakprapthi Samprapti. The basic cause for the specific disease when done by a

person this will in turn effects the normal function of the body disturbing the doshic balance

causing signs and symptoms. Here a word srotho avarodha, or srotho vaigunya has to be


59

defined because few others explain it as only obstruction in a channel. Few others explain it

as deviation from the normal process, that is it may not be a channel for example a

particular product production is if vitiated and if other product is resulted varying from the

normal one, even then it is said to be srotho avarodha or srotho vaigunya.

As explained by all schools of treatment that Pravahika and Atisara i.e., dysentery

and diarrhea are inter-related. The basic cause for both is Agnimandya resulted due to

vikruthi of Samanavata, Kledakakapha, Pachakapitta and the Pureeshavaha Srotas. Here in

Pravahika the Kledakakapha has importance as well as Samanavata initial and later on the

Apanavata.

In Pravahika due to the Nidana that is various types of foods, food combinations,

times and vitiated drinks, association of Krimi in ingested materials will cause Agnimandya

or vitiation of the digestive factors causing in digestion. Once indigestion results the

absorption of the foods is also effected, thereby the resistance of the person will decrease

and sub-clinical characters will surface. This could be one of the important factors in

Pravahika or dysentery because we seen that even though the stools are containing ova

and cysts but signs and symptoms are to be seen in many cases, but after some time or at

any time they may manifest.

The basic Dosha vitiated at first is Vata and later on the Kapha. This vitiated Vata will

forcefully evacuate the Kapha downwards and when the person uses stress to deficate

small amounts of faecal matter associated with relatively large amount of Kapha is passed

many times 111.

Dalhana says that balaasam is kapham and nichitham is sanchitam, mudhathi is

preranam, adhasthath is via the guda marga, malaktham is Kapha mixed with slight amount

of faecal matter. In other words he says that vitiated Kapha sanchitha or stagnated in the


60

pureesha vaha srotas is pushed down wards and out by the vitiated Vata. And the mala

passed consists of a large quantity of vikutha Kapha, on the above Susruta reference112.

Madhavakara has followed the same as Susruta regarding the Samprapti of

Pravahika. Madhukoshakara explains further that basic Srotas involved in this is the

pureesha vaha Srotas or we may consider anatomical as the sthollantras where the stools

are formed, here it is associated with the vitiated Kapha. Patient feels like defecating or

passing mala, but as he does not pass he has to use force which is the pravahana 113.

Aathankadarpana on the above aloka says the same as described by Dalhana

acharya, but further says that the main doshic involvement is Vata and Kapha but still the

Pitta and Rakta involvement is seen together. What ever be the case either rakthaja or

pittaja inevitably Vata and Kapha involvement will be present 114.

To explain how the vitiated Kapha lodges in the sthoolanthras, due to the Nidana

both Kapha in the Amashaya and the Vata related that is the kleedaka Kapha and the

Samanavata are vitiated. The Samanavata is vitiated causing mandagni or vishamagni

resulting in Ama formation, this may be fortified with combination of the Kledakakapha after

its vitiation. This vitiated Kledakakapha along with the food or alone may be pushed down

into the sthoolanthras, as Samanavata is responsible for digestion as well as the forward

movement of the food. Samanavata and the Apanavata may push this Kledakakapha in the

Amashaya into the sthoolanthras and later on down via the guda or anus.

When we observe the physiology of deification, we understand that the mala

accumulated in the sthoolanthara, will stimulate the Apanavata, whose function in to

regulate the passage of mala, mootra etc,. Here due to vitiation of the Kapha, which is

stagnated in the sthoolanthras, will effect the Apanavata, and the person feels like

defecating, but since there is only Kapha in the sthoolanthras, it will pass downwards. The

formation of mala in the sthoolanthras is a continuous process that is small quantities will be


61

collected shortly and this mala in association with the Kapha will be passed out when the

person puts pressure to defecate. But if the Vata is associated with Pitta or Rakta, the name

will be associated with male, sometimes if the Kapha and Rakta are together then the colour

of the total mass may changed be red.

Since the frequency of the defilation is increased, the anus is irritated, therefore guda

paka along with parikarthika is seen, especially if the Pitta and Rakta Dosha and Ama are

involved. Further this may lead to loss of control of anal sphincters.

Since agnimandya is one of the basic causes, and the vitiated Kapha in the anthras

with Vata will cause contraction of these anthras and the person suffers from spasmodic

pain.

The Srotas, which is involved, is the Pureeshavaha the membrane that is covering

this Srotas is the Pureesha dhara kala or the mala dhara kala, it separates the digested and

the undigested food. After the absorption of fluid contents, forming the mala, which is sent

out. This is the fifth kala in the sequence 115. It is believed to cover the whole koshta or the

shareera madhayama or the GIT. Some translate koshta as GIT with the accessory glands

and say that this also covers yakruth, puppusa, kloma etc. this kala might be the seat of

inflammation and ulceration as said by the modern people.

Postmortem was a rare this in Indian culture, thereby the physicians or the surgeons

have very rarely opened the dead body to see the exact cause and changes which have

taken place in the diseased. But in the later period, the search for the causative factors, and

the mode of disease progress and spread and the changes in the body organs have lead

the scholars for deep study and one of them is the postmortem study.

Dysentery is a disease where diarrhea characterized by the presence of blood and

pus in the motions along with mucus, tanesmus and straining to defecate. Pain and

tanesmus along with diarrhea are the result of acute inflammation of large intestines or the


62

sthoolanthras. Pus and blood are due to ulceration. Mucus could also be associated and in

large quantity in the chronic case. The ulceration in the large intestines are of two different

types depending upon the type of infection either bacillary or amoebic. In bacillary type the

bascilla remain localized but do not penetrate the tissues at first or will invade the blood

stream, they cause local necrosis and distant damage with the help of exo-toxins. When the

ulcer is resulted due to necrosis the bascilli may penetrate into the deeper parts of the wall.

Even though the basic seat is colon, lower ileum may also be effected. The toxins

will cause acute inflammation of the wall of the bowel. Part of the mucous membrane gives

off to form ulcers after it is necrosed and sloughs off. The surface containing an

inflammatory exudate formed of fibrin, plymorpho nuclear leucoulcer will not perforate

generally as the depth of the ulcer rarely reaches the serous coat and often ends in the

muscularis mucosa, these may coalesec to form Large ones and the mucous membrane in

between the ulcer may become papillomatous.

Where as in the amoeboid type the swallowed cysts will divide in the small intestines

and by the time they reach large intestines they multiply and once there they penetrate the

lumen of the glands and destroy the epithelium with the help of proteolytic enzymes and

penetrate deeper tissue. Generally these cysts merely enter portal vein and to lesser extent

to lympatics, without colonization, there is no lesion, therefore they colonize in the

submucosa causing dysentery they spread out and set up a colliguative necrosis with

protoolytic furments. The mucosa which is necrosed will plough off leaving ragged ulcers are

formed. The ulcers are deeply undermined edges, as sub-mucosa involved rather than

mucosa and the in between mucosa is healthy. In carrier the inactive form not other en-cyst

forms. As the amoeba in stools contains red blood corpuscles it would appear that they are

responsible for the lesions in carrier without symptoms. Microscopically the necrosis with

little or no inflammation in large number can be seen in bowel wall.


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Dushtambupaana, and Krimi as mentioned in the Nidana correlated as the specific

organisms as mentioned by the modern physicians, as there is no specific organisms

identified as specific causative factors of Pravahika.

Ayurveda and modern sciences observe that the signs and symptoms are similar,

and in the pathogenesis, since postmortem reports are not available in Ayurveda but seen in

modern where ulcers are seen. Apart from this both ways we find that the vitiated Kapha will

stimulate the Apanavata, and causes the feeling of deification and since mala is not properly

formed the Kapha is excreted along with small amounts of mala.

Similarly we find that the inflammatory exudates as well the mucus and the ulcers will

cause stimulation on the nerves of the gut in the form of stretch reflex and as well as pain,

thus the person feels like deification and when he tries to pass he will not pass any stools.

Therefore he requires stressing and by which the mucous pus and blood in the colon and

with any small quantities of faecal matter comes out. Since the nerves are stimulated he

frequently feels like passing motions. Therefore the frequency of the motions will increase

where as the quantity will be very less as accepted by both the schools of treatment.

DOSHA116

Vata: The pradhana Dosha that is involved in case of Pravahika is Vata. The ahitashana,

which is the prime cause of the same disease, is mentioned as atishayana vatala bhakshya

bhojana in Bhavaprakasha. The malapravrithi being impaired indicates the Apanavata dusti.

The Agnimandya present in the person indicates Samanavata dusti.

Pitta: When the patient is examined thoroughly, it is noticed that there will be vrana shotha

in Pureeshavaha srotas observed through sigmoido-scope or colono-scope. There is no

paka without Pitta, so the involvement of Pitta is evident. The Annavaha srotas being

involved in the pathogenesis the type of Pitta to get vitiated is Pachakapitta. Due to vikriti in


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Pachakapitta there is Agnimandya and Ama prior to the manifestation of the disease

Pravahika.

Kapha: Vitiation of Kapha is evident by saying nichitam balasam in case of Pravahika. The

Agnimandya causes Ama, which is similar to Kapha in its gunas. The Kapha karaka nidanas

as explained by Charaka provocative Kapha and cause the disease. Thus Kapha i.e.,

Kledakakapha is vitiated. The kshobha to the shleshmadharakala present in Pakvashaya

indicates the shleshaka Kapha vikriti in Pakvashaya.

DUSHYA

The first step of Samprapti is Agni dusti leading to production of Ama in case of

Pravahika. The apakwa annarasa formed because of Agnimandya indicates the involvement

of Rasa. When Ama gets mixed with Pureesha, that is also vitiated and it is evident by the

Pureesha nimajjana in jala. The kshobha i.e. ulceration in the deeper layers of

Pureeshavaha Srotas leads to the rupture of the vessels resulting in Rakta pravrithi through

gudamarga indicating the involvement of Rasa. Hence in Pravahika the dushyas are Rasa,

Rakta, and Pureesha. In case of ghora Pravahika, the udaka, mamsadharakala of

Pakwashaya also become vitiated.

AGNI

The Jatharagni mandya is seen which leads to Ama in case of Pravahika. The

shoshyamana vahni present in Pakwashaya is also impaired which leads to Atisara.

AMA

The Ama resulted by Jatharagni mandya causes srotorodha and leads to

manifestation of Pravahika.


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SROTAS

The pradhana Srotas that gets vitiated in case of Pravahika is Pureeshavaha Srotas.

In fulminate conditions the whole Annavaha Srotas gets involved along with the Udakavaha

Srotas.

DUSTI PRAKARA

In Pravahika, during process of disease evolution the sanga type of vikriti is seen

initially i.e., the Ama and Kapha obstruct the Vata marga. Due to this sanga, atipravrithi, of

mala through gudamarga is resulted.

UDBHAVA STHANA

Being a Vata pradhana Vyadhi the place of origin of the disease is Pakvashaya.

Impairment of Agni is a first manifestation in case of Pravahika indicating the involvement of

Amashaya.

SANCHARASTHANA

The vitiated Vata along with other Dosha moves through rasayanis.

ADHISTHANA

Adhistana means the abode of the disease. In Pravahika, Pureeshavaha Srotas is

the adhistana.

VYAKTA STHANA

The part where the disease is exhibited is called vyaktasthana. Guda is vyaktashtana

in Pravahika where muhurmuhu mala pravrithi is seen

ROGAMARGA

In Pravahika, abhyantara rogamarga ie., koshta is seen.

SAPEKSHA NIDANA

Even though Atisara and Pravahika are having similar Nidana Dosha,

dooshyassamurchana and treatment but the Samprapti of the two differ. Therefore the


66

acharyas have given two entities of the Pravahika disease, that is in association with Atisara

and as a separate entity. Even though Grahani also involved in the diseases of the koshta

with particular reference to the Nidana of Agnimandya and Ama formation but it differs from

Atisara and Pravahika. A tabular form is given below to denote the differences between the

three Atisara, Pravahika and Grahani.

Atisara Pravahika Grahani

Asukari Chirakari Chirakari

Teevra bali Manda bali Teevra bali

Pravahana and kunthana is

absent

Bahushopravahanam Alpa pravahanam

Large quantity mala

atisarana

Alpa mala nissaranam Muhurbaddha, muhurmala

nissaranam

Many dahtus are lost with

mala

Kapha nissaranam Later stages are noted dhatu

nissaranam

Udara shoola during

deification

Pain before deification

leading to straining

Occasionally udara shoola is

complained

Undigested food along with

mala

No undigested food is lost Both is lost with mala

Bleeding along with mala

with water lost

Bleeding along with water

and less mala

Bleeding is not observed

Water loss is high Water loss is high Water loss is less rarely

constipated

Independent disease Independent and along with

Atisara

After Atisara if mandagni is

seen


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A tabular form is given below to denote the differences between amathisara and

Pravahika.

Pravahika Amatisara

1) Many dhatus are passed with mala Only Kapha is passed with mala

2) Pain is observed during deification Pain is observed before deification

3) Quantity of mala is large Smaller amount of mala is passed

4) Undigested food is passed Undigested food is not passed

SADHYA ASADHYATHA

The disease once manifested will mainly have three ways of progress. If it is virulent

it will kill the patient, or if it is properly treated or if the resistance of the person is high it will

subside. Thirdly if the disease is mild or if the treatment is not properly done the disease

becomes chronic or it will be sub-clinical and whenever the conditions are favorable the

signs and symptoms will be seen. Apart from this as Ayurveda says, unless the Nidana is

not omitted or parivarjana is followed the occurrence of disease will be seen regularly.

Pravahika as it is a chronic disease that is unless the Nidana parivarjana is not strictly

followed its relapse is seen fequently. Basically it is not a dreadful disease, even though a

quite number of people may be effected ata time (epidemic), if treated properly mortality is

rare. The treatment should be continued till total saamyatha is achieved, then the aahara

and vihara should be strictly maintained especially with the dooshitha jala paana as it seems

to be the prominent cause now.

Aacharya Charaka says that if Pravahika and Atisara are tridoshaja and if the patient

passes stools which are like blood, the colour of liver, fats, or mamsajala sadrushya, curds,


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ghee, majja, oil, vasa milk, deep blue or red, black or watery or of many colours, very sticky,

green, neela, kashaya colours, or if it is thready, foul smelling, fishy smell and if the fly sit on

the stools.

If the quantity of the stool even though is less but is it is associated with dhatu

sravaas or if only water is passed, or if the patient suffers from thrishna, daaha, jwara,

brahma, thamakaswasa, hicca, swasa, etc., if the rectal prolapse is seen, if the anal orifice

or guda cannot be closed properly, or if the pain is fluctuating. If the mamsa, raktha and

strength is reduced. If associated with pain in bones and joints or arochaka, arathi,

pralapamoha etc., are seen then the treatment is not to be easily dealt, but with every

caution it should be treated 117.

Susruta says if the quality of the mala is similar to that of ghee, medas, vesavaara,

thaila, majja kshera, madhu in fluidity, or if the colour of the stool is similar to that of

manjishta qwatha, with aamagandha, cold or if it is foul smelling or it she stools are yellow or

blue, or peacock’s eye colour. Even after treatment is attempted it is not controllable or if the

patient is already weak due to other diseases or if associated with upadravas. Further he

says that if the motions are ever flowing and if the anal closure is weak or associated with

aadhmana or anal vrana is formed or if the body becomes cold 118.

Dalhana commenting on the above sloka has defined that veshavaram is the water

associated with mamsa, ghee like medas means the sneha which is similar to the fluid

present in the masthulungam (brain), foul smelling and the smell of decayed bodies is

vishram,. Anjanam represents souveeranjanam, and the colours are the streaks associated

with the stools. Chandrika means like mayurpincha, the upadravas are jwara, shopha,

shoola, thrishna, swasa, kasa arochaka, chardhi, hicca, moorchan if associated with

Pravahika or Atisara. Samrutha gudam is asankuchitha gudam that the anal orifice cannot


69

be closed. Ksheenam means balahaani, depressed, and loss of conciousness (ajithendriya).

As the stools passed are of ushna lakshana it causes guda paka 119.

Madhavakara in Nidana says that if the stools are similar to pakwa jamboo or

singdha or the colour of sliced liver, that is krishna lohitham. Or loose liquid like ghee, oil

vasa, majja veshavaara, curds, milk or water which has cleaned the mamsa, neelaruna or

krishna and ruksha like mardhitha anjana, snigdha or associated with many cololur for

example mayura pincha. If the quantity of the stools is very large, even though it is solid but

if the smell is feetoid (dead body). If the patient suffers from thrishna, daaha, swasa, hicca,

parshwa shoola, asthi shoola, moorcha arathi, moha, inflammed guda valli, rectal prolapse,

the loss of retraction of anus, weak, distended abdomen, shoola swasa, pipaasa, jwara. The

patient who is suffering from the diseases mentioned by Susruta should be treated 120.

Madhukoshakara explaining the above says that if the stools are black and sticky like

jambuphala or if the colour is blackish brown like liver or if it is watery. Krishnanajan

indicates the deep colour of krishna indicating the involvement of Pitta Dosha as the main

one, shigdha means drava dhatu associated with sneha. If the patient is unconscious,

(moorcha) or moha that is the loss of control on the indriyas, especially the Apanavata is not

controlled 121.

Vijayarakshitha on the above sloka has given almost same points, but also says that

inflammation or swelling of limbs, fingers, and joints along with anuria or mootra kshaya.

Further he is the first one to indicate the age factor saying that if signs and symptoms are

seen as upadravaas then in children and old it is asaadyam, and also even in adults if the

sarana of dhatus is seen 122. Cross-referred from Bhavaprakahsa. Bhavamishra has referred

to the same shika of Madhava Nidana and further clarifies that whose anal orifice cannot be

closed, and whose anus is inflamed due to vitiation of Pitta, but even then if the body is cold,

or if the patient is very old then the case will be asaadya 123.


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According to kalyaana kaarakam if associated with excessive sadness, or blood with

stools, along with shoola, sopha, thrishna, jwara, kasa, as upadravas and of heena swaram

is seen then it is asaadhyam 124.

From the above references we observe that if the quantity of the stool is very high in

number or in quantity and if associated with dhatus being lost in form of stools or excessive

blood loss, foul smelling due to severe infection causing putrifaction in the intestines, or after

the loss of drava dhatus if the snahamsha is lost. Or if the three doshas together are

affected. If the patient is suffering from the above mentioned diseases, or due to severe

motions and due to debility of the pelvic musculature causing prolapsed rectum, non closure

of the anal opening associated with inflammation of anus then the treatment is very difficult.

Even though if the signs and symptoms are not fully present but if the patient is young or old

or even if the patient is youth but if there is severe dhatu loss then the case is asaadyam.

In the above paragraph we observe that the sadhyaasadhyatha lakshans are mixed

together of both Pravahika and Atisara (diarrhea and dysentery). But if we segregate those

of Pravahika only we seen that even if the stools are hard but large or undigested or

associated with loss of dhatus especially Rakta, foul smelling, anal inflammation, and if

associated with three doshas together and severe vitiation of the three doshas. If the patient

is suffering from a long time then it will be kruchrasaadya.

CHIKITSA OF PRAVAHIKA

The aim of Ayurveda is “swasthasya swasthya rakshana and aturasya

roganivarana”. When a person fails to maintain the state of equilibrium i.e., swasthya, the

necessity of getting rid of the imbalance condition arises. The affected part of body should

be brought back to the normal state. The disease being caused by the morbid doshas they


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have to be palliated adopting various upakramas which is nothing but Chikitsa ie., kit

rogapanayane.

Pravahika is a pureeshavaha srotovyadhi. Acharya Charaka, in srotovimaniya

adhyaya explains pureeshavaha sroto dustikarana, laxana and also Chikitsa. He says, the

treatment of any disease of pureeshavaha Srotas is atisarikikiya. Naturally the Chikitsa of

Pravahika is that of Atisara. It is a fact that both in Atisara and Pravahika, colitis is a

condition amoebic dysentery in contemporary science is a variety of Pravahika, where in the

condition of colitis is also seen. Obviously, the treatment procedures and drugs mentioned

for treating Pravahika no doubt will be helpful in case of amebic dysentery.

In our classics the treatment of Atisara as well as Pravahika are explained in an

elaborated manner. All the authorities have accepted that the diseases above mentioned

have to be treated considering their avasthavishesha ie., amavastha of pakwasastha.

Charaka 125 differentiated the treatment in amavastha and pakwavastha in the

Atisara Chikitsa adhyaya of Charaka Samhita clearly mentioning the drugs separately in

each condition. Sushruta, bhaishajya ratnavali, Chikitsa sara sangraha, Chakrapani,

Madhava Nidana, Gadanigraha all have stated that amapakwa kramam hitwa natirare kriya

yatah 126.

Amatisara Chikitsa

If the laxanas like durgandha, atopa, vishtambha, arati, praseka, pureeshanimajjana

in jala, are present then it is considered as amatisara.

Upekshana and sampravartana

As the first step of treatment of amatisara, upekshana should be done because –

“natu sangrahanam deyam purvam amatisarine” 127 initially the sangrahana or stambhana

should not be done because the stambhana in this condition leads the Doshas to cause

many distresses like dandaka, alasaka, adhmana, Grahani, arshas, shotha, pandu, pleeha


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kustha, gulma, udara, jwara, etc caused by Ama dosha 128. That is why initially upekshana

has to be done for the malas being eliminated themselves.

The bahudoshas along with prabhoota Ama can cause various hazards if they are let

to stay inside the body. So these pravritha doshas should be neglected till their level comes

down in the body. If they are being expelled with difficulty, then their elimination should be

supported by givinghareetaki. This hareetaki prayoga 129 helps not only for the elimination of

the doshas but even brings the laghavata and Agni deepana in the body 130.

Langhana

Langhana is the treatment of choice in Amavastha. However Charaka 131 says –

“langhanamcha alpadoshanam prashantam atisarinam”. Susruta quotes “tatra adou

langhananam karyam atisareshu dehinam” 132. When upekshana of bahudoshas is

completed, that is when there is alpadosha, then langhana would be beneficial. Especially in

amatisara, amavatatisara, shleshmatisara and pittatisara, the authors advise the langhana.

Either upavasa or langhana with alpa ahara is advisable beneficial. If the patient is

pravarabalayukta then upavasa and if the patient is possessing alpabala and vataprakopa

alphahara rupi langhana to be carried out. Chikitsa tatwa deepikakara advises to consume

peyaki laghuanna that is peya, manda, vilepi etc., for the purpose of ahara during langhana.

The langhana brings the langhavata to the body. It aids in amapachana and agnideepana

hence reversing the fundamental process of pathogenesis langhanakarma at the state of

purvarupa cheeks the disease from attaining further stages. But it is clear by the version of

Charaka as quoted earlier that langhana is better if there is alpa Dosha. Even Vagbhata

opines that – alpa dosham punarupavasayet” 133.

That is why if there is a condition of bahudosha the necessity arises to adopt the

further upakramas


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Pachana

Though langhana helps even for amapachana in case of prabhoota Ama, the need

of supplimentation of amapachaka dravyas arises, Susruta says – ame cha langhanm

shastamadou pachanameva” 134.

In case of madhyama pramana doshas, pachana karma has to be carried out to

bring out the level of Ama in the body. For the purpose of amapachana, haridradigana

dravyas, vachadigana dravyas, musta, pippali, patha, guduchi, bhunimba, katurohini,

rasanjana etc. dravyas are helpful in the form of kwatha. If amapachana is carried out

sucessfully then srotorodha is removed hence the disease process is checked.

Deepana

Deepana is one, which does agnideepana not commencing with the action of

amapachana. The pravahikaroga being initiated by Agnimandya the Agni has to be

corrected to palliate the disease. Chikitsa tatwva deepikakara says - Shaliparni,

prashniparni, brihati, kantakari, haritaki, pippali, yavani, shati, chitraka etc drugs can be

administered for this purpose.

Stambhana or sangrahana

After complete amapachana and agnideepana, the amatisara attains pakwavastha.

Then it has to be treated in the lines of pakwatisara. The expulsion of the malas should be

stopped by stambhana karma. Susruta says – yada pakwo apyatisaro …hitam 135.

The stambhana should be carried out using the dravyas like kapittha shalmati, Vata,

karpasa, dadima, yuthika, kachura, shelu, shana and dadhi,

Sangrahana karma has to be done by nyagrodhadi ganadravya with madhu and

sharkara. Vagbhata says – the sangrahana has to be done after shodhana. Acharyas have

advised stambhana even in case of amatisara if the patient is possessing avarabala,

ksheenadhatu, atisruta, bahudosha. The pachanakarma in such a person proves fatal.


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Stambhana is also helpful in pittaja and raktaja Atisara. In a patient who has developed the

condition of dehydration and electrolyte imbalance stambhanakarma can save the patient

after which immediate re-hydration has to be restored.

Snehana in Atisara 136

If the person become emaciated by the langhanadi procedures then in niramavastha,

having shoola the ghritapana along with ksheera will be beneficial to alleviate the prakupita

Vata in Atisara, varaghna dravya siddha taila is advisable. The ghrita prepared out of

sangrahi dravyas is helpful in rakta pravrithi. Sthanika sneha to the gudapradesha proves

effective in case of gudadourbalya and Atisara of a chronic course.

Shodhana in case of Atisara/Pravahika

Shodhana is helpful to eliminate the excessive doshas from the body. Various

procedures of shodhana to be adopted in different conditions are as follows

Vamana 137

Though vamana karma is apathya for an Atisara rogi in certain conditions it is

advisible. In case of amatisara with shoola and adhmana and in atidrava and atipureesha

sarana, vamanakarma by pippali saindhava jala is carried out initially, then langana is

advised. After vamana, during samsarjana, laghubhojana, khadayusha, yavagu have to be

given here. Here vamana helps to expel the Ama thus simplifying the deepana pachana

karma. When the person possesses prabala Kapha exhibiting the symptoms like gourava,

jwara, daha, vibandha, even in pakwavastha vamanakarma acts effective when the excess

Kapha is eliminated out through it 138.

Vamanakarma has to be done using madana saindhava pippali kalka with

ushnajalapana. After vamana when person attains niramalaxanas during samsarjana karma,

sangrahaka aushadha has to be given.


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Virechana 139

Sushruta says – when a person is suffering from vibandha shoola and alpalpa mala

raktatisara with bahudosha and deeptagni then virechana by abhaya pippali kalka or abhaya

shunthi kalka or vidanga triphala, pippali kashaya should be administered.

The drugs like triphala act as Ama pravartaka and Dosha pravartaka. The vidanga, pippali,

shunthi act as catalysts to triphala and also they remove srotorodha and improve Agni. After

virechana the patient attains the Shareera laghavata, agnideepana, and Atisara shamana.

Basti 140

When atipravrithi of Vata makes the patient possess bala in Pitta. So in such

conditions to save his bala, basthi is the treatment of choice.

Niruha 141

In case of pakwavastha, bahudosha, vibandha, shoola, and mutrakrichra, the

niruhabasti has to be administered prepared out of ksheera, madhu, ghrita, with madhuka,

utpala. This brings down daha, jwara and also above said symptoms.

Anuvasana 142

In Atisara with shoola, bahusruta Dosha, gudabharamsha, pravahana, mutraghata,

katigraha etc. symptoms the anuvasana basti has to be given after niruha by ghrita or taila

prepared out of mahdura amla cravyas, or dashamoola or bilwa, shati shatahwa vacha,

chitraka etc., drugs. The taila prepared by madhura rasa dravya should be used for

anuvasana daily in a person having ruja.

When this procedure palliates Vata the Pravahika also subsides. That is why in

Pravahika, Vata has to be treated at the first place.

Doshanusara Chikitsa in Pravahika 143

The Dosha, which is prabala, has to be given attention at the first place. So the

doshanusara Chikitsa is effective to palliate the aggravated doshas.


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Vatatisara

In Atisara, Ama is priorly seen so even in vataja Atisara, in amavastha, langhana is

best. In shoola, anaha, praseka conditions initially vamana then deepana pachana are

advisible. If vibandha is present laghu virechana, in pichasrava, shoola, khada, in guda

bhramsha dashamoola siddha anuvasana prove beneficial.

Pittatisara

Langhana pachana, avoiding teekshana ushan ahara, in bahudosha sramsana, then

sangrahana by deepaneeya pachaneeya, sangrahi dravyas are advisible. Mamsarasa,

ajaksheera, godugdha, shatapushpadi anuvasana, and pichchabasti are very effective.

Raktatisara

Sangrahana should be done using nyagrodhadi guna dravyas. Pichchha basti,

ghritapana mamsarasa, shatavari, indrayava, priyangu chandana are best used. Chaga and

ksheera with madhu, sharkara should be used for pana, bhojana gudaprakshalana etc.

Kaphaja Atisara

Langhana pachana, kaphaghna dravya prayoga sangraha, pichchhabasti followed

by anuvasana are helpful.

Bhayaja and shoksaja Atisara

Harshana, ashwasana, vataharakriya are to be done

Sannipatatisara

There is a difference of opinion in treating sannipataja Atisara. Charaka says Vata

should be treated first, then Pitta and then Kapha. Otherwise the atibalavan Dosha should

be treated first 144.

On the contrary Susruta opines that in sannipataja or dwidoshaja Atisara, and jwara

at the first place the Pitta has to be treated Vata has to be taken care of in other

disorders145.


77

This opinion of Susruta seems to be more suitable because Atisara is

amapradoshaja Vyadhi resulted due to Agnimandya. Charaka”s opinion of treating Vata at

first step is better suitable in sansarga of Kapha and Vata in Atisara, because if pachana is

done in Kapha vataja Atisara there may be chances of kaphapakshayajanya Vata prakopa.

Recent commentators opine that treating Vata initially is better in acute cases while treating

Pitta is useful in jeerna Atisara 146.

Vagbhata opines in a different way that due to kaphakshaya in Atisara and

Pravahika, the Vata gets aggrevated further. So this Vata has to be controlled initially in

dwandwaja and sannipataja Atisara. So is the opnion of Susruta i.e., tasmat Pravahika roge

marutham shamayedbhishak 147.

Pravahika - Drug profile 78

The composition of the trail drug “Nagaradi Churna” 148 is as follows.











All the above herbs are collected from the local herb collector and made them dried

in the shade. Further it is powdered and filled in the capsules of 500mg. All the capsules are

packed and distributed to the selected patients.


Nagara Zingiber officinale, roscoe 149, 150, 151, 152

Sanskrit Shunti

Hindi Sonth

Kannada Shunti

English Dry zinger

Family Scitaminaceae

Synonyms Sunti, Nagara, Mahowshadha, Viswabheshaja, Sringavera

Description Rhizome, stout, tuberous with erects leafy stems 0.6 to 1.2-

meter height. Leaves narrow, flowers greenish. It is a well-

known plant

Parts used Scraped and dried rhizomes

Preparation of Shunti

(dried ginger):

The green is first sun- dried, cleaned and soaked in water.

The outer skin is scraped off and the scraped ginger washed

and again sun-dried. Both ginger and shunti are used as

condiment and also medicinally

Rasa Katu

Guna Laghu

Veerya Ushna

Vipaka Madhura

Pharmacological

properties

Prabhava Kaphavata shamaka

Constituents:

“Indian ginger contains an aromatic volatile oil,1 to 5 p.c. of light yellow colour having

a characteristic odour and containing camphene, phellandrene, zingiberine, cineol and

borneol; gingerol a yellow pungent body an oleo-resin-“gingerin” the active principle, other

resin and starch; K-oxalate. The essential oil and resin, to which ginger owes its pungent


flavor, occur just beneath the skin or epidermis. The pungent principles of ginger are not

found in the volatile oil. It has how ever, been isolated and been named gingerol, but its true

chemical nature has not yet been finally settled.”

Action:

It is aromatic, carminative, stimulant to the gastrointestinal tract, and stomachic, also

sialogogue and digestive. Externally, a local stimulant and rubrifacient.

Ativisha Aconitum heterophylum 153,154

Sanskrit Ativisha, sitashringi

Hindi Atis, ateicha

Kannada Athivisha,

English Indian atees

Family Ranuculaceae

Synonyms Shukla Kanda, Bhangura, Kashmari, Sishubhaishajya

Description Sub alpine and alpine zones, the himalayas from indus to

kumaon

Parts used Dried tuberous roots

Rasa Tikta,katu

Guna Laghu, rooksha

Veerya Ushana

Vipaka Katu

Pharmacological

properties

Prabhava Deepana, pachana, grahi chaddinigraha,

arshogna, vagikarana, vishamajwarahara

Constituents:

The non-crystalline (amorphous) intensely bitter alkaloid, atisine which is non-toxic;

aconitinic acid, tannic acid, pectous substance, abundant starch, fat, a mixture of oleic,


palmitic, stearic glyerides, vegetable mucilage, cane-sugar and ash 2 percent “chemical

assay of A. heterophyllum and A. lycoctunum varieties shows that the alkaloid content of the

so-called ferox form (A. dinorrhizum and A. balfourii combined) is double that of the

european variety of A. napellus official in the pharmacopoeia, and that of the Indian napellus

variety (A. chasmanthum) is ten times as much”. Biological assay of these roots shows that

the ether soluble alkaloid (psedo-aconitine)of the so-called ferox form is 5 times stronger

than aconitine obtained from the european variety of napellus (A. chasmanthum) and the

alkaloids obtained from the Indian variety of napellus (A. chasmanthum) are 0.7 times

weaker.

Action:

Roots are bitter, tonic, astringent, stomachic, antiperiodic and aphrodisiac.

Mustaka Cyperus rotandis 155,156

Sanskrit Mustaka, bhadra musta,

Hindi Korehi-jhar

Kannada Tangahullu

English Nut grass

Family Cyperaceae

Synonyms Mustaka, Musta, Varida

Description It is a plentiful species occurring throughout the plains of India,

especially South India.

Parts used Tuber or bulbous root

Rasa Tikta, katu, kashaya

Guna Laghu, rooksha

Veerya Seetha,

Pharmacological

properties

Vipaka Katu


Prabhava Pitta shamaka, sothahara, lakhana,

sthnya, tooshna nigraha, deepana,

pachana, grahi, raktaprasadakara,

mootrala, kaphagna, twakdoshahara,

jwaragna, vishagna,

Constituents:

Fat, sugar, gum, carbohydrates, essential oil, albuminous matter, strach, fibre and ash.

There are traces of an alkaloid.

Action:

Stimulant, tonic, demulcent, diuretic, anthelmintic, stomachic, carminative,

diaphoretic, astringent, emmenagogue and vermifuge.

Dhataki Woodflorida fruticosa 157,158

Sanskrit Dhataki, dhauri

Hindi Dhauta

Kannada Tamrapushpi

Family Lythraceae

Synonyms Dhataki, Dhatupushpa, Tamrapushpi, Kunjara, Subhiksha,

Bahupushpi, Vahnijwala,

Description It is a 15-30 feet growing tree with red colour flowers

Parts used Flower

Rasa Kashaya,

Guna Laghu, rooksha

Veerya Seetha

Pharmacological

properties

Vipaka Katu


Prabhava Pureesha sangrahani, mootravirajaneya,

sandhaniya, Pravahikahara

Constituents:

A bright red flower consists of 20% tannin.

Action:

It is useful in the disorders of mucous membrane, hemorrhoids and derangement of

liver. It is also considered as safe stimulant in pregnancy. The leaves are used in bilious

sickness and also used in headache.

Rasanjan Berberis aristata (modified form) 159,160

Sanskrit Daru haridra

Hindi Rasaut, Chitra, Dar-hald, Kashmal

English Indian ophthalmic barberry

Family Berberidaceae

Synonyms Peeta daru, Darvi

Description Berberry bushes grow on the Nilgiris and all over the

temperate Himalayas.

Parts used Extract, fruit, root-bark, stem and wood

Rasa Katu, Tikta, kashaya

Guna Rooksha, laghu

Veerya Ushna

Vipaka Katu

Pharmacological

properties

Prabhava Varnyam

Constituents:

Root and wood are rich in ayellow alkaloid “berberine” a bitter substance, which

disolves in acids and forms salts of the alkaloid: root consists of some more alkaloids.


Action:

Wood Bark is Tonic, stomachic, astringent, antiperiodic, diaphoretic, anti pyretic, and

alterative. Yakrut rogaharam, varnyam, rasayanam, used in liver and spleen enlargements,

jaundice, emmemagogue. Root is purgative and fruit is adish.

Vatsaka Holarrhena antidysentrica 161,162

Sanskrit Kutaja,

Hindi Karchi, kura

Kannada Korasigina-gida

English Tellicherry bark

Family Apocynaceae

Synonyms kalinga, vatsika, girimallika

Description This small tree is common in the forests of India, indigenous to

the tropical Himalayas.

Parts used Bark, seeds leaves

Rasa Tikta, kashaya

Guna Laghu, Rooksha

Veerya Sheeta

Vipaka Katu

Pharmacological

properties

Prabhava Kapha Pitta shamaka, vrana ropaka,

jwaraghna

Constituents:

Bark and seeds contain a non-oxygenated alkaloid- wrightine or conessine or

kurchisine and holarrhenine. Wrightine or conessine is a amorphous powder soluble in

water and alcohol and in dilute acids.


Action:

Bark is bitter, stomachic, astringent, powerful antidysenteric, febrifuge and

anthelmintic. Seeds which resemble oats, are very bitter, astringent, febriguge,

antidysenteric., anthelmintic, carminative and also antiperiodic in combination with other

antiperiodics like cocculus cordifolius. Arabic and persian writters consider the seeds to be

carminative, astrigent, lithontriptic, tonic and aphrodisiac. “The total alkaloids from the bark

can be given in large doses and without producing depressant, emetic, irritative or

cumulative effects. They are much less toxic than emetine. They produce a certain amount

of local reaction, pain and swelling which pass off in 24 to 48 hours.”

Twak phala Cinnamomum zeylanicum 163,164

Sanskrit twak

Hindi Dalchini

Kannada Dalchini

English Cinnamon

Family Lauraceae

Synonyms Utkata

Description Indigenous to ceylon province and in the region of negumbo in

the west. Southern India and growing in a wild state in the

western ghats.

Parts used Dried inner bark of the shoots from truncated stalks and

essential oil

Rasa Katu, Tikta, Madhura

Guna Laghu, Rooksha, Teekshna

Pharmacological

properties

Veerya Ushna


Vipaka Katu

Prabhava Sleshmahara, Garbhashaya sankochaka

Constituents:

Volatile oil cinnamic acid, resin, tannin, sugar, mannit, strach, mucilage, ash etc.

oleum cinnamomum is distilled from the cortex and consists chiefly of cinnamic aldehyde

oxidizing into resin and cinnamkic acid also cinnamyl acetate and hydro-carbon, and small

quantities of phellandrene, pinene, linalol, caryophyllene, cugenol etc., also exist. The british

pharmacopoeia limits the amount of aldehydes to 55 to 65 percent but a genuine oil may

contain as much as 75 percent.

Action:

Bark is carminative, antispasmodic, aromatic, stimulant, haemostatic, astringent,

antiseptic stomachic and germicide. Oil has no astringency it is a vascular and nervine

stimulant in large doses an irritant and narcotic poison. The volatile oils are aromatic.

Bilwa Aegle marimelos 165,166

Sanskrit Bilva

Hindi Bel, sriphal

Kannada Belapatre

English Bael fruit

Family Rutaceae

Synonyms Bilvam, sriphal


Description Found all over India, from sub-Himalayan forests, bengal

central and south India, and in burma. Two kinds of fruit are

available in the market a small and wild variety and a large

cultivated variety.

Parts used Fruit, root-bark, leaves, rind of the ripe fruit and flowers.

Rasa Kashaya, Tikta

Guna Laghu, Rooksha

Veerya Ushna

Vipaka katu

Pharmacological

properties

Prabhava Shodhahara, astapanopaga, arshaghna

Constituents:

The pulp contains mucilage, pectin, sugar tannin volatile oil, bitter principle, ash 2%

and a balsamic principle resembling balsam of peru. The wood-ash contains potassium and

sodium compounds, phosphates of lime and iron, calcium carbonate magnesium carbonate

silicia sand etc., fresh leaves yield in distillation a yellowish – green oil with a peculiar

aromatic odour marmelosin.

Action:

Ripe fruit is sweet, aromatic, cooling, alterative andnutritive. When taken fresh it

possesses laxative properties. Unripe fruit is astringent, digestive and stomachic, and a little

constipative. Pulp is stimulant, antipyretic and antiscorbutic. Fresh juice is biter and pungent.

Pata Cissampelos pareira 167,168

Sanskrit Patha

Hindi Harjori

Kannada Padvali


English Velvet-leaf

Family Menispermaceae

Synonyms Ambosthavanitikkika,

Description Tropical and sub-tropical India from sind and the punjab to

south India and ceylon.

Parts used Root, bark and leaves

Rasa Tikta

Guna Laghu, Teekshna

Veerya Ushna

Vipaka Katu

Pharmacological

properties

Prabhava Vishaghna, deepana, pachana,

raktashodhaka, kaphaghna, kustaghna,

jwaraghna, mutrakara

Constituents:

Cissampeline or pelosine ½ % in the root. Sepeerine, bebeerine, cissampeline.

Action:

Mild stomachic, bitter tonic, diuretic and antilithic. It is considered to exercise an

astringent and sedative action on the mucous membranes of the genito-urinary organs.

Katuki

Picrorhiza kurroaroyle 169,170 Sanskrit Katuka rohini

Hindi Katuki, Kuru

Kannada Balkadu

Family Scrophulariaceae

Synonyms Katuka, tikta, katurohini, kandaruha, matyashakala, chakrangi,


krushnabheda, shataparwa

Description Common on the north western himalayas

Parts used Dried rhizome

Rasa Tikta

Guna Rooksha, Laghu

Veerya Sheeta

Vipaka Katu

Pharmacological

properties

Prabhava Kaphaghna, Pramehahara, Stanya

shodhaka, Kustaghna, Shodhahara

Constituents:

Root consists of a glucoside called picrorrhizin, a fairly large percentage of soluble

bitter substance with an acid reaction. The drug also contains other substances such as

glucose, wax, cathartic acid etc. it yeald the following substances when subjected for

analysis.

Petroleum ether extract 1.49%

Sulfuric extract 3.45%

Absolute alcoholic extract 32.42%

Aqueous extract 8.46%

Action:

In small doses, it is a bitter stamachic and laxative and in large quantities a cathartic.

It is reputed as an antiperiodic and cholagogue.

Pravahika - Materials and Methods 90

MATERIAL AND METHODS

This clinical study was taken up with the proper understanding of classical

explanations, observations and management of the condition Pravahika. Among the causes

of Pravahika bhutopaghata (infection) of E. Coli has been given more emphasis and the

pathopysiology, clinical symptoms and the management of Amoebiosis disease are taken

into consideration.

MATERIALS

Source of data:

Subject for the clinical trail was selected from out patient department of post

graduation and research center of Sri D.G.M. Ayurvedic medical college and hospital,

Gadag.

Sample size –

30 patients


Trial Medicine:

The combination and proportion of “Nagaradi Churna” is –

Equal parts of the following

1. Nagara Zingiber officinale

2. Ativisha Aconitum heterophylum

3. Mustaka Cyperus rotandis

4. Dhataki Woodflorida fruticosa

5. Rasanjan Berberis aristata (modified form)

6. Vatsaka Holarrhena antidysentrica

7. Twak phala Cinnomnmn zeylanicum

8. Bilwa Aegle marimelos

9. Pata Cissampelos pareira

10. Katuki Latilopicrorhiza kurroaroyle

Criteria for selection of drugs

♦ Corner stone of management of Pravahika is reinstitution of Dosha by giving

“Nagaradi Churna”. Out of the ingredients Dhataki and Rasanjana are of

Krimihara in nature.

♦ As Pureeshavaha srotas disturbances are the root cause of this condition, the

drugs with krimihara and proven static properties that is Vatsaka, Bilwa, Pata and

Twak phala are taken.

♦ Nagara, Mustaka nad Katuki are taken for their ama pachaka properties, as there

is involvement of ‘Ama’ in the pathogenesis.

Criteria for quantity of drugs:

The standard therapeutic dose of each drug was taken into consideration and 500mg

capsule was made with equal parts of “Nagaradi Churna”.


Preparation of “Nagaradi Churna”:

As E. Coli infection is a grave condition of alimentary canal suceptable for easy

infection, care was taken to prepare the drug with good manufacturing practices (GMP). For

this purpose the drug was prepared at DGM Âyurvedic Medical College Pharmacy, Gadag.

Steps followed in the preparation of “Nagaradi Churna”

METHOD OF “Nagaradi Churna” CAPSULE PREPARATION

SR.

NO. INGREDIENTS QTY./CAP

1 Nagara 50 mg

2 Ativisha 50 mg

3 Mustaka 50 mg

4 Dhataki 50 mg

5 Rasanjana 50 mg

6 Vatsaka 50 mg

7 Twakphala 50 mg

8 Bilwa 50 mg

9 Patha 50 mg

10 Katuki 50 mg

Total 500 mg

Steps followed:

1. All herbal materials are cleaned. All the inputs including empty Gelatin Capsules

and packing materials are QA approved.

2. Ingredients are weighed as per required batch quantity


3. Herbal material are crushed to fine powder and triturated with the same materials

individually to fortify the medicine.

4. The bulk is dried, pulverized and passed through 80-mesh shifter to get granules

and mixed well.

5. It is sampled for QA check for moisture (Moisture NMT 5%).

6. After QA approval the total quantity of granules are filled equally in empty Gelatin

Capsule (Size ‘0”) as per batch size.

7. The process of Capsule filling conducted in dehumidified and air-conditioned

room. Weight variation is checked at an interval of ½ hrs (NMT 10 %)

8. After final compliance with QA parameters i.e. weight variation and moisture %,

the Capsules are packed in 60 ml HDPE containers, 60 Capsules per pack and

heat sealed with Aluminum circles.

Analytical test and standardization

This drug was coded as NC01 and sent to Pharmacy College, Gadag for analytical

test and drug standardization. Reports of said tests are given below.

ANALYTICAL REPORT

Report No: DGM/NC/2000-01

Name of the sample NC01

Batch No: NC/00

Date: 21/01/2000

Description Brown Colour capsule, filled with brown powder.

Water-soluble extractive: 28.22 %

Alcohol Soluble extractive: 7.670 %

Average Weight: 0.5539gm

Disintegration Time: 14 minutes


Objective of the study;

1) To study literary search on Pravahika vis-a-vis amoebic dysentery

2) To study the efficacy of Nagaradi Churna on Pravahika with reference to subjective and

objective parameters

3) To evaluate the efficacy of Nagaradi Churna in improving the clinical status of

Pravahika with special reference to E.Coli infection

Research design:

As this disease is a grave condition and of high inconvenience, a open clinical trial

was conducted. All the patients received the same medicine. Even though a total of 85

patients were screened during this period, 30 patients were taken for the study. A detailed

Proforma was prepared for case taking.

1. The patients are included in the study after obtaining the informed consent.

2. The identity of all the patients are kept confidentially.

Inclusion criteria

Patients complaining of -

1) frequent passing of stools i.e. muhurmuhu mala pravrutti

2) pravahana – tenesmus with association of sarakta or sakapha mala or both

i.e. stoos with blood and mucus

3) drava mala i.e. watery stools

4) udara shoola i.e. abdominal pain

5) daha i.e burning sensation

stools examination which reveals the presence of Entamoeba Histolitica

patients with in the age groups of 15 to 60 years

Patients irrespective of sex, religion and chronicity other than that of exclusion criteria

are included in the study.


Exclusion criteria

1) Patients with the upadravas of Pravahika and Atisara

2) Patients below the age of 10 years and above the age of 70 years

3) Patients having other systemic diseases are also excluded

Criteria for considering for dropouts

1. Inability to attend two successive follow-ups

2. Discontinuation of medication for more than three days

Criteria for withdrawals

1. Deterioration of condition, which needs hospitalization

2. Subsequent diagnosis of associated diseases

3. Indulgence in concomitant therapy

Duration : 21 days

Follow-up : 21 days

Posology:

Two capsules of 500mg each three times daily before food with water or buttermilk.

All the patients were asked to attend the OPD for weekly follow-up and medicine was

provided every week for 3 weeks. Patients were checked for dehydration and weight

changes periodically.

Special instruction/advice given to patients

1. To stop smoking, alcohol and other habits

2. Not to indulge in strenuous exercise

3. Not to take any other medication except the trial medication.

4. Not to indulge in sex

5. To take regulated food and not to have food out side the house.


CRITERIA FOR ASSESSMENT OF THE RESPONSE TO THE MEDICATION

Subjective parameters

1. Mala Pravahanam (Tenesmus defecation)

2. Nirvidya Pravahanam (Tenesmus or Tics)

3. Muhurmurmalaktam (Frequent defecation)

4. Alpaalpa Alpasamalam (Minimal stools defecation)

5. Saphena Malam (Frothy defecation)

6. Saruja Malam (Painful defecation)

7. Sapichha Malam (Mucous defecation)

8. Savibandha Malam (Constipated defecation)

Objective parameters - investigations

1. Routine hematological investigations – hemoglobin percentage, total count,

differential count and erythrocyte sedimentation rate are done.

2. Routine urine examination for the evidence of albumin, sugar and

microorganisms is done.

3. Stools examination specifically for occult blood and microorganisms is carried

out.

Assessment

For the assessment grades were fixed depending upon the condition. Overall

assessment is made taking into consideration both subjective and objective

parameters. They are –

Assessment criteria

1. Pravahika Progression score -28 (PPS-28)

2. Pravahika Associated Disease score - 36 (PADS-36)

3. Ayurvedic General Health index – 82 (AGHI-82)


4. Hb% (Haemoglobin %)

5. Erythrocyte sedimentation rate

6. Occult blood test

7. Ova & Cysts

Considering all the above parameters patients are graded in to four groups

depending upon the response to Nagaradi Churna. The over all score was considered as 7

based on the subjective and objective parameters. An exclusive assessment is made for the

Ayurvedic aspect. Out of 7 scores depending upon the scoring of individual patient the

grading was done as follows.

Grade Score range

Cured 6 & 7

Responded 3 to 5

Not responded 1 to 2

Pravahika - Observations and results 98

The following observations are made while studying the dissertation “The evaluation

of efficacy of Nagaradi Churna in Pravahika with special reference to Amoebic dysentery”.

Total patients of 56 are screened and out of them 30 patients are subjected to research as

they fall under inclusion criteria. A through investigations and interrogations are subjected

and felt to undertake each case individually. All are summarized to the parameters of

subjective and objective. Ultimate results are announced with reference to baseline data.

The tabulations and pictorial expressions of different categories are discussed as under.


Table –1 & Graph -1

Depicting the frequency at the disease in the different Age groups

Years in Range

Number of patients Percentage

21 to 25 6 20.00

26 to 30 8 26.67

31 to 35 4 13.33

36 to 40 6 20.00

41 to 45 3 10.00

46 to 50 3 10.00

Total 30 100

Out of 30 patients 8 (26.67%) patients were in the range of 26 to 30 years, 6 patients

(20.0%) patients were in the range of 21 to 25 and 36 to 40 age group and 4 patients

(13.3%) patients were in the range of 31 to 35 years. 3 patients (10%) falls under the 41 to

45 and 46 to 50 age groups. The graphical expression of table-1 is as follows in the graph –

1.

21 to 2520.00%

26 to 3026.67%31 to 35

13.33%

36 to 4020.00%

41 to 4510.00%

46 to 5010.00%


Table –2 & Graph -2

Depicting the Sex ratio of the study

Sex Number of patients Percentage

Male 20 66.67

Female 10 33.33

TOTAL 30 100

Out of the 30 patients 20 (66.67%) patients were male and 10 (33.33%) were female.

The graphical expression of table-2 is as follows in the graph – 2.

Male66.67%

Female33.33%


Table – 3 & Graph -3

Depicting the frequency of the disease according to Religion

Religion Number of patients Percentage

Hindu 29 96.67

Muslim 1 3.33

Christian 0 0

Others 0 0

Total 30 100

Out of 15 patients 29 (96.67%) belong to Hindu community and the rest 1 (3.33%)

are Muslims. It doesn’t mean actual but the area of the sample collection is with dominant

Hindu community. The graphical expression of table-3 is as follows in the graph – 3.

Hindu96.67%

Muslim3.33%

Christian0.00%

Others0.00%



Depicting the frequency of the disease according to economic status

Economic status Number of patients Percentage

Poor 12 40.00

Middle Class 16 53.33

Higher class 2 6.67

Aristocrat 0 0

Total 30 100

Out of 30 patients highest number i.e. 16 (53.33%) belong to middle class and 12

(40%) belong to poor class. Apart from these 2 patients (6.67%) is noted from higher class

also. The graphical expression of table-4 is as follows in the graph – 4.

Middle Class53.33%

Aristocrat 0.00% Poor

40.00%

Higher class6.67%



Depicting the frequency of the disease according to Regional Distribution

Regional Distribution

Number of patients Percentage

Urban 17 56.67

Sub-Urban 10 33.33

Rural 3 10

Total 30 100

Out of 30 patients 17 (56.67%) belong to urban area, 10 (33.33%) belong to sub-

urban area and the last 3 (10%) belong to rural area. The graphical expression of table-5 is

as follows in the graph – 5.

Urban56.67%

Sub-Urban33.33%

Rural10.00%



Depicting the frequency of the disease According to Occupation

Occupation Number of patients Percentage

Labour 10 33.33

Student 5 16.67

Service 2 6.67

House wife 9 30.00

Business 4 13.33

Total 30 100

Out of 30 patients 10 (33.33%) are laborers, 5 (16.67%) is student, 2 (6.67%) are in

service, 9 (30.0%) is housewife and 4 patients (13.33%) are of businessmen. The

distribution is studied with their diet habits. People with regular food habits and working with

any service are less prone to get the Pravahika. The graphical expression of table-6 is as

follows in the graph – 6.

10

5

2

9

4

0

1

2

3

4

5

6

7

8

9

10

Labour Student Service House wife Business



Depicting the frequency of the disease according to Diet

Diet Number of patients Percentage

Vegetarian 27 90

Mixed diet 3 10

Total 30 100

Out of 30 patients of Pravahika 27 (90%) patients belong to vegetarian diet group

and the rest of 3 (10%) patients are with mixed diet. The graphical expression of table-7 is

as follows in the graph-7.

Mixed diet10.00%

Vegetarian90.00%



Data related to presenting complaints

Complaint Number of patients

Percentage

Mala Pravahanam (Tenesmus defecation) 30 100

Nirvidya Pravahanam (Tenesmus or Tics) 25 83.33

Muhurmurmalaktam (Frequent defecation) 30 100

Alpaalpa Alpasamalam (Minimal stools defecation) 30 100

Saphena Malam (Frothy defecation) 7 23.33

Saruja Malam (Painful defecation) 12 40

Sapichha Malam (Mucous defecation) 28 93.32

Savibandha Malam (Constipated defecation) 14 46.66

Presenting complaints are scrutinized and it was found that Mala Pravahanam

(Tenesmus defecation), Muhurmurmalaktam (Frequent defecation) and Alpaalpa

Alpasamalam (Minimal stools defecation) are common amongst Pravahika patients reported

and the percentage is of 100. Apart form these complaints 28 patients (93.32%) found with

Sapichha Malam (Mucous defecation). 25 patients (83.33%) found with Nirvidya

Pravahanam (Tenesmus or Tics). 14 patients’ (46.66) complained with Savibandha Malam

(Constipated defecation), 12 patients (40%) with Saruja Malam (Painful defecation) and 7

(23.33%) patients complained Saphena Malam (Frothy defecation). The graphical

expression of table-9 is as follows in the graph – 9.


Graph – 8

Tests of significance

Table 9 Statistical Data related to parameters

Parameter Mean SD SE “t” Value “P” Value Remarks

AGHI-82 43.433 9.027 1.648 26.354 <0.001 HS

PPS-28 2.966 2.008 0.366 8.104 <0.001 HS

PADS-36 18.733 2.517 0.4597 40.75 <0.001 HS

Hemoglobin % 1.416 0.432 0.078 18.154 <0.001 HS

ESR 9.333 1.806 0.329 28.367 <0.001 HS

Occult Blood 0.766 0.43 0.078 9.82 <0.001 HS

Ova & Cyst 0.866 0.345 0.0631 13.724 <0.001 HS

HS = Highly Significant

30

25

30 30

7

12

28

14

0

5

10

15

20

25

30

Patients 30 25 30 30 7 12 28 14

Mala Prava

Nirvidya

Muhurmur

Alpaalpa

Saphena

Saruja

Sapichha

Savibandha


There is a much significance difference between baseline to final data of treatment

PADS-36, ESR, AGHI-82, (as P is less then 0.001). In all other parameters such as PPS-

28, hemoglobin percent, Occult blood test and Ova &cyst shows highly significance, as P is

less then 0.001.

For further discussion we used the “sign test” as “Non-parametric test”. There are no

ties in the data of AGHI-82, PPS-28, PADS-36 and ESR, for “n=30”. This is the value that

would expected if the baseline to after treatment readings came from populations having the

same median and we check with the table values using 5% “two sided test”, we find the

critical values as 9 and 21. Since n+ ≥ 21 (where n+ is the number of positive differences out

of n-pairs), we reject the hypothesis that there is a difference in the medians at 5% level.

One-sided tests are directly available from sign test table. (Bio-statistics by P.N.Arora and

P.K.Malhan, first edition – 1996, Published by Himalaya publication, Mumbai –4)

For n=30, the lower one-sided critical region for 2.5% is n+ ≤ 9, and upper critical

region is n+ ≥ 21. Finally we conclude that under the conditions of this experiment influencing

the changes in baseline and final treatment.

For a two-sided test at P=0.05, the critical values of correlation coefficient

(Spearman’s rank correlation coefficient) from the table for n=30 is ± 0.349. The calculated

values of correlation coefficient for Hemoglobin %, AGHI-82 and ESR respectively are

0.7056, 0.505 and 0.9294. Therefore the hypothesis of no association between baseline and

final treatment readings is rejected at 0.02 < P < 0.05. Hence there is a much perfectly

positive association between baseline and final treatments of ESR and hemoglobin %. And

AGHI-82 is moderately positively correlated.

For PPS-28 the calculated (Spearman’s rank correlation coefficient) correlation

coefficient is 0.206, which is positively correlated.


For Occult blood test and Ova & Cyst tests χ2 values are 21.04 and 24.03. The table

values of χ2 for 1 degrees of freedom, at 5% is 3.84, which yields the rejection of hypothesis

since P is less the 0.001, i.e. the test indicates the difference between the baseline and final

treatment are highly significant. (Elements of Health statistics, by N.S.N.Rao, 1989, Tara

book agency, Varanasi)

RESULTS:

Out of the specified result criteria if the parameter ova and cyst is not secure any

positive point even though the number of points high to say responded is not considered for.

Even though less points secured but ova and cyst are absent taken in to consideration of

cured. If the occult blood test is positive and ova is negative considered as responded. A

general pattern of scores declared in materials and methods above are summarized as

under –

If the scores are between 7 and 6 it is considered as CURED

If the scores are between 5 and 3 it is considered as RESPONDED

If the scores are between 2 and 0 it is considered as NOT RESPONDED

Table 10 & Graph 9

Table showing results “The evaluation of efficacy of Nagaradi Churna in Pravahika with special reference to Amoebic dysentery”

RESULT Number of patients Percentage

Cured 22 73.34

Responded 4 13.33

Not Responded 4 13.33

Total 30 100

Results are based upon the assessment criteria. The assessment criteria mentioned

in materials and methods are tabulated to individual patients. They are as follows -


Statistical tests of significance

Par

amet

er

Mea

n

Sta

ndar

d D

evia

tion

Sta

ndar

d E

rror

“t” V

alue

P –

Val

ue

Rem

arks

AGHI-82 43.433 9.027 1.648 26.354 <0.001 Highly Significant

PPS-28 2.966 2.008 0.366 8.104 <0.001 Highly Significant

PADS-36 18.733 2.517 0.4597 40.75 <0.001 Highly Significant

Hemoglobin % 1.416 0.432 0.078 18.154 <0.001 Highly Significant

ESR 9.333 1.806 0.329 28.367 <0.001 Highly Significant

Occult Blood Test

0.766 0.43 0.078 9.82 <0.001 Highly Significant

Ova & Cyst 0.866 0.345 0.0631 13.724 <0.001 Highly Significant




less then 0.001.

For further discussion we used the “sign test” as “Non-parametric test”. There are no

ties in the data of AGHI-82, PPS-28, PADS-36 and ESR, for “n=30”. This is the value that

would expected if the baseline to after treatment readings came from populations having the

same median and we check with the table values using 5% “two sided test”, we find the

critical values as 9 and 21. Since n+ ≥ 21 (where n+ is the number of positive differences out

of n-pairs), we reject the hypothesis that there is a difference in the medians at 5% level.


One-sided tests are directly available from sign test table. (Bio-statistics by P.N.Arora and

P.K.Malhan, first edition – 1996, Published by Himalaya publication, Mumbai –4)




For a two-sided test at P=0.05, the critical values of correlation coefficient

(Spearman’s rank correlation coefficient) from the table for n=30 is ± 0.349. The calculated

values of correlation coefficient for Hemoglobin %, AGHI-82 and ESR respectively are

0.7056, 0.505 and 0.9294. Therefore the hypothesis of no association between baseline and

final treatment readings is rejected at 0.02 < P < 0.05. Hence there is a much perfectly

positive association between baseline and final treatments of ESR and hemoglobin %. And

AGHI-82 is moderately positively correlated.

For PPS-28 the calculated (Spearman’s rank correlation coefficient) correlation

coefficient is 0.206, which is positively correlated.




treatment are highly significant. (Elements of Health statistics, by N.S.N.Rao, 1989, Tara

book agency, Varanasi)

Data related to the observations of Efficacy of Nagaradi Churna in Pravahika with

special reference to Amoebic dysentery and the assessments of the criteria of “The

evaluation of efficacy of Nagaradi Churna in Pravahika with special reference to Amoebic

dysentery” is placed in the anexure -


Graph 9

Graph depicting the results of the “The evaluation of efficacy of Nagaradi Churna in

Pravahika with special reference to Amoebic dysentery”

The result declared the table 11 and graph –10 specify “The efficacy of Nagaradi

Churna in Pravahika with special reference to Amoebic dysentery” as the best. The result is

as follows. The number of patients cured with the symptoms of Pravahika i.e. Amoebic

dysentery are 22 (73.33%) and responded are of 4 13.33%). Very small number of the

patients I.e. 4 (13.33%) were not responded to the management but they also improved with

the other parameters.

Cured73.33%

Not Responded

13.33%

Responded13.33%

Pravahika - Discussion and conclusion 113

Discussion and conclusion

Pravahika is a disease appearing independent disease and also as a

symptom for the Atisara 171. Some times it may appear as Avasta bheda of Atisara

172 or as Upadrava173. It may associate with Pureesha kshaya, which ultimately leads

to Guda bhramsha. This all happens because of Ama associations. Thus when it is

associated with Ama, saraktata and vibaddha varchas designated as “Bahusoola

Pravahika”174.

It can be said as the symptoms drawn from Ayurvedic classics about

Pravahika are correlated to that of amoebic dysentery of present day. The pratyatma

niyata lakshana of the Pravahika are explained as Saphena, Punah punah alpalpa

Kapha nissaranam.

The effect of Nagaradi Churna in Pravahika in the present context is

discussed under following headings.

1) Importance of diet in Pravahika

2) Effect of Nagaradi Churna on Samprapti ghataka viz.,

(a) Agni

(b) Ama

(c) Srotas

(d) Dosha (Dosha pratyaneka Chikitsa)

(e) Dooshya

3) Effect of Nagaradi Churna on abhyantara krimi


1) Importance of diet in Pravahika:

The disease develops initially from the gut Atisara as nidanarthakara Vyadhi.

The food materials that cause Atisara also are capable of producing Pravahika. Thus

the Nidana parivarjana 175 is prime most in the management of Pravahika. The foods,

which are increasing or vitiating Vata, are commonly capable of giving rise the

Pravahika. The food effect over Annavaha Srotas and Pureeshavaha Srotas is more

comparative with other Srotas. The direct effect of food before to pachana i.e. Ama

avasta and its genesis of Ama in Srotas are carried to the successive stage pakwa

avasta. Thus the entire pathology is based upon the input and it is stated from

Ayurvedic citations “Nidana parivarjana is the best”. 176

Here in this trail the patient was asked to avoid the out side foods and also

the contaminated or paryushita i.e. putrefied. Even the foods that are described from

the classics are also omitted from the daily routines. The diet is prescribed as

srotohitam and also which is good for the Pravahika.

2) Effect of Nagaradi Churna on Samprapti ghataka

The Samprapti ghatakas are discussed in detail as under.

(a) Agni:

Kaya means body and the management is its Agni i.e. internal

metabolic fire is Chikitsa. The management in Ayurveda is not just for the

pathological entity but also considers the body imbalances as three humors,

psyche health by rectifying rajas and tamas and spiritual health by including

the soul. The soulless body is like oil less engine and otherwise a dead

corpus. Thus Charaka said –

¯dd¦£dyí›¦dy e«d‚Sd£dy eŸdTa

¡df®d£Sd¦dd«dSdd 177


The whole living is dependent on Agni, which is not different from that

of Pitta, thus the Agni to rectify and protect is necessary. In this clinical trail

the Deepana Pachana dravyas added to fulfill the Agni Chikitsa. The

rectification is done from that of Nagara, Ativisha, Mustaka and Pata.

(b) Ama

The dravyas, which rectify Agni, are capable of nullifying the Ama,

which generates either at the time of digestion process embedded into the

tissues. The Ama as visha in the body capable of not only vitiates Dosha but

also to that of dhatwagnies. Nagara, Ativisha, Mustaka and Pata enrich the

jataragni. Pata is capable of constituting Ama in Amashaya as it is said as

vishaharam.

(c) Srotas

Pravahika is a disease develops from the pureeshavaha Srotas and

its development sites are Pakvashaya and Amashaya. Here dhataki acts as

Pureesha sangrahani i.e. segregating fecal material.

The Srotas is susceptible of inflammation because of invasion of

external origins such as Entamoeba histalitica. The inflammation is managed

through the Sothahara dravyas. Out of the combination Bilwa, Katuki and

Musta are the best Sothahara dravys. Occasionally it is possible to get

ulceration in the colon because of the invaded organism. At that time vatsaka

acts as Vrana ropaka.

Ativisha and Bilwa with their arshoghna properties makes the

intactness effect to the colon, where the elasticity is not lost because of the

frequent defecation in the Pravahika.

With the grahi action Musta also induces same action in the colon.


(d) Dosha

Dosha nullification is the basic management in the Ayurveda. The

tridosha are responsible for the manifestation of Pravahika. Apdhatu (Kapha)

kshaya, Agnimandya (Pitta) and active peristalsis (Vata) are the factors to

understand the disease in nutshell. The ingredients Twakphala, Nagara,

Pata, Vatsaka and Katuki are kaphaharam. Where as Vatsaka and Mustaka

are Pitta Shamaka and Nagara is Vata haram. Thus the Dosha balancing is

made out of the ingredients included in the yoga is justifiable. Apart from all

these the Dhataki and Vatsaka have Pravahika hara prabhava i.e. anti

dysenteric effect.

(e) Dooshya:

Apdhatu and rasa are the dushya in Pravahika. The water loss in the

Atisara is remarkable but here in Pravahika loss even though reported very

small but dusti of Agni and apdhatu makes the expulsion of the mucus form

Kapha. Thus the prakrutastu balam slesham is diminished in quantity and

also quality. The cumulative effect of the above said ingredients in the

Nagaradi Churna makes the Samprapti vighatana and there by normalizes

the dushyas which are responsible for the Ama development and induction of

Pravahika.

3) Effect of Nagaradi Churna on abhyantara krimi

The krimi concept is not new in Ayurveda. But while narrating kostagata krimi

microorganisms were not described. Thus the inventions of the microorganism in the

recent makes immense understanding of microbes. We have to search anti microbial

property drugs from the treasure of Ayurvedic herbs. Out of many from the selected

yoga we have Pata as kustaghna extends its effect as krimighna. Apart from this the


anti toxic effect is inducted by Mustaka as it is Vishaghna. It is further noted that the

hyper metabolic activity which makes the body temperature to elevate is pacified by

the Vatsaka as it is even Jwaraghna.

Recommendations for further study:

The following recommendations are made on the basis of the observations

made for further studies as well as to observe the limitations.

(a) Same yoga can be repeated by taking a large number of samples with

randomized control groups.

(b) The effect of Nagaradi Churna can be studied along with Shodhana

therapy.

(c) The effect of Nagaradi Churna can be studied on long duration to

avoid the reoccurrence of Pravahika.

Limitations of the study:

Sample size is small to generalize the result.

Samples are selected incidentally.

As chosen drug is a compound form it is difficult to specify the action

of any individual herb and or to cumulative mode of action.

Statistical tests of significance




less then 0.001.








treatment are highly significant.

Conclusion:

The following conclusions can be drawn on the basis of literature and observations

made in this study.

1. The Pravahika is the condition, which is almost, resembles the disease amoebic

dysentery.

2. Etiological factors for the Pravahika and Atisara are the same.

3. The etiology of Pravahika and amoebic dysentery are similar.

4. The Nagaradi Churna found effective in Pravahika.

5. It is effective in chronic cases of Pravahika and more effective in fresh reported

cases.

Pravahika – Summary 119

Summary

Out of many diseases in the gastrointestinal tract, the important are Pravahika,

Atisara, and Grahani.

Susruta and Madhavakara have first identified Pravahika as distinctive disease

and Charaka as a symptom in kaphaja Atisara.

Basically unhygienic conditions are the causes of spread of the disease.

It is manifested via the oral cavity along with food and water.

The disease is the result of the vitiation of Samanavata, Kledakakapha and

Apanavata.

Probably in these cases of Pravahika, once the person takes more of virrudha

ahara or Ama kara ahara for the formation of Ama.

To study literary search on Pravahika vis-a-vis amoebic dysentery

The objectives are - To study the efficacy of Nagaradi Churna on Pravahika with

reference to subjective and objective parameters and To evaluate the efficacy of

Nagaradi Churna in improving the clinical status of Pravahika with special

reference to E. Coli infection

The sage physicians of ancient India have recognized the disease Pravahika as

a problem of all ages and sex.

The word Pravahika it self is a combination of two identical units as 'pra' and

'vahik'. Susruta suggested Pravahika, as it originates from the 'vadhri vilodane' or


vaha dhatu. Which means prayatna (initiation) for expulsion of fecal matter with

tenesmus.

Kaviraja gananath sen has lucidly clarified that the word pravahana means

'kunthan' (tenesmus) "pravahanam nama kunthanama" which means in a

disease where there is more kunthana, the said disease can be termed as

Pravahika.

The word Pravahika is a term of female gender, which means "pravahyati malam

bahulam" or "pravahyati muhurmuhu sakapha malam pravar tayati iti Pravahika".

This clinical condition is known as Pravahika in Ayurveda.

Charaka described the signs and symptoms of Pravahika, however the remedial

skills are found noted in the Chikitsa chapter of Charaka Samhita.

Bhavaprakash, Madhvanidana and Bhaishajya Ratnavali etc. enumerated the

disease in detail paying it the status of a disease.

If mootra or Pureesha vegas are stopped will lead to Pravahika. Vega avarodha if

done or if the seasons are not accordingly, or if the person is debilitated with

krimi, shosha, jwara, arshas etc., then he may suffer from Pravahika where in all

the doshas may be vitiated together.

Susruta says that before the advent of Pravahika disease suchika veda in

Hridaya pradesha, nabhi, guda, udara and kukshi is dealt.

According to Charaka vataja Pravahika comprises of two different sub groups

that is vataja Pravahika associated with Ama and not associated with Ama that is

pakwa. In vatja pakwa Pravahika vibhaddam or constipation is associated with

passage of small quantities of stools associated with pain, shabda, phena and

parkarthika or pain in the anal region.


In Pravahika due to the Nidana that is various types of foods, food combinations,

times and vitiated drinks, association of krimi in ingested materials will cause

Agnimandya or vitiation of the digestive factors causing in digestion. The basic

Dosha vitiated at first is Vata and later on the Kapha.

The pradhana Dosha which is involved in case of Pravahika is Vata.

Due to vikriti in Pachakapitta there is Agnimandya and Ama prior to the

manifestation of the disease Pravahika.

Vitiation of Kapha is evident by saying nichitam balasam in case of Pravahika.

The Kapha karaka nidanas as explained by Charaka provocate the Kapha and

cause the disease. Thus Kapha i.e., Kledakakapha is vitiated.

The pradhana Srotas that gets vitiated in case of Pravahika is Pureeshavaha

Srotas.

In Pravahika, during process of disease evolution the sanga type of vikriti is seen

initially i.e., the Ama and Kapha obstruct the Vata marga. In Pravahika,

Pureeshavaha Srotas is the adhistana.

Guda is vyaktashtana in Pravahika where muhurmuhu mala pravrithi is seen

In Pravahika, abhyantara rogamarga i.e., koshta is seen.

If it is virulent it will kill the patient, or if it is properly treated or if the resistance of

the person is high it will subside.

Charaka says that if Pravahika and Atisara are tridoshaja.

Upadravas associated with Pravahika or Atisara are jwara, shopha, shoola,

thrishna, swasa, kasa arochaka, chardhi, hicca, moorchan.

Even though if the signs and symptoms are not fully present but if the patient is

young or old or even if the patient is youth but if there is severe dhatu loss then

the case is asaadyam.


Pravahika is a pureeshavaha srotovyadhi. Naturally the Chikitsa of Pravahika is

that of Atisara.

If the patient is pravarabalayukta then upavasa and if the patient is possessing

alpabala and vataprakopa alphahara rupi langhana to be carried out. If

amapachana is carried out successfully then srotorodha is removed hence the

disease process is checked.

Charaka says Vata should be treated first, then Pitta and then Kapha. Charaka”s

opinion of treating Vata at first step is better suitable in sansarga of Kapha and

Vata in Atisara, because if pachana is done in Kapha vataja Atisara there may be

chances of kaphapakshayajanya Vata prakopa.

30 cases with cardinal symptoms of Pravahika would be undertaken for the trial

after getting the stool examined from DGM Ayurvedic Medical College, Gadag.

The composition of the trail drug “Nagaradi Churna” 148 is as follows.












All the above herbs are collected from the local herb collector and made them

dried in the shade. Further it is powdered and filled in the capsules of 500mg. All

the capsules are packed and distributed to the selected patients.

Graph depicting the results of the

“The evaluation of efficacy of

Nagaradi Churna in Pravahika

with special reference to Amoebic dysentery”

The result declared the table 11 and graph –10 specify “The efficacy of

Nagaradi Churna in Pravahika with special reference to Amoebic dysentery” as the

best. The result is as follows. The number of patients cured with the symptoms of

Pravahika i.e. Amoebic dysentery are 22 (73.33%) and responded are of 4 13.33%).

Very small number of the patients I.e. 4 (13.33%) were not responded to the

management but they also improved with the other parameters.

Cured73.33%

Not Responded

13.33%

Responded13.33%

References:

1 Charaka Chikitsa 19/7 2 Charaka Chikitsa 19/30 3 Charaka Chikitsa 19/34 4 Susruta Uttara 40/140-141 5 Sahasra Yoga Churna Prakarana – 83,84 6 Vaidika Padanukramakosha Vedanga –3, Pravahika 1-1-37 7 Garuda Purana Purvakhanda 15 (Atisara 8-9) 8 Anguntharani Kaya X – 6-60 9 Dhiganikaya II -127

10 Jataka IV-328

11 Milinda Pahani IV-62

12 Majjinikaya XI, VI, II -19 13 Jataka II –22p, IV –346, VII-467

14 Charaka Chikitsa 19/10,37

15 Charaka Siddhi 8/22

16 Susruta Uttara 40/137

17 Susruta Shareera 5/8

18 Charaka Shareera 7/3


20 Charaka Chikitsa 19/10 21 Shabdha Kalpadruma part III pp 294

22 Kaikaseya pp81

23 Shabdha Kalpadruma part III pp 142

24 Shbdha Ratnakara

25 Vachaspatyam 6, pp275,4493

26 Amarakosha – Namalinganushasanam – 3-3-108 27 Rajanighantu

28 Amarakosha – Maniprabha teeka – 2-6-55 29 Vaijayanthi Nighantu pp183,257

30 Shabdhastoma Mahanidhi pp288

31 Shabdhardhachandrika

32 Shabdhardha Parijata 33 Vaidyaka Shabdha Sindhu

34 Susruta Uttara 40/137 Dalhana

35 Hareeta Samhita

36 Astanga Hrudaya Chikitsa 9/3


38 Susruta Nidana 2/5 39 Ibid 2/4

40 Ibid 2/6

41 Ibid 2/5

42 Dr. V.S patil and Deshpande et. al 1979

43 Charaka Vimana 5/8

44 Anatomy Gray’s pp 1382 45 Susruta Shareera 9/12

46 Ibid 4/16-17

47 Charaka Vimana 5/8

48 Susruta Shareera 9/12 Dalhana

49 Charaka Shareera 9/12 Chakrapani

50 Susruta Shareera 4/17 51 Charaka Chikitsa 15/11 52 Ibid 15/11 Chakrapani 53 Charaka sutra 17/72

54 Astanga Hrudaya sutra 12/16

55 Ibid 12/8

56 Charaka Chikitsa 28/10 57 Astanga Hrudaya sutra 12/10-12

58 Charaka Chikitsa 15/6

59 Susruta sutra 21/10


61 Susruta Uttara 40/3-5

62 Ibid, Dalhana 63 Madhava Nidana 3/1-3

64 Ibid, Vijayarakshita

65 Ibid, Atankadarpana

66 Astanga Hrudaya Nidana 9/1-3


68 Ibid, 19/7 69 Ibid, 19/9

70 Ibid, 19/11

71 Ibid, 19/5-11 Gangadhara

72 Ibid, Chakrapani


74 Ibid, Dalhana 75 Madhava Nidana 3/5

76 Bhava Prakasha Madhayma Khanda Atisaradhikara

77 Madhava Nidana 3/5, Madhukosha


79 Astanga Hrudaya Nidana 9/4

80 Ibid, Indu 81 Charaka sutra 19/7


83 Ibid, 19/6-1

84 Ibid, 19/6-2 Chakrapani


86 Ibid, Dalhana 87 Astanga Hrudaya Nidana 8/5-7

88 Madhava Nidana 3/6

89 Bhavaprakasha madhyamakhanda Atisara/113

90 Yogaratnakara madhyamakhanda Atisara/8

91 shodala Nighantu Atisara

92 Madhava Nidana 3/6, Madhukosha 93 Ibid, Vijayarakshita


95 Ibid, Gangadhara


97 Ibid, Dalhana

98 Astanga Hrudaya Nidana 8/8 99 Madhava Nidana 3/7

100 Ibid, Madhukosha


102 Bhava Prakasha Madhayma Khanda Atisaradhikara / 113

103 Yogaratnakara madhyamakhanda Atisara/8

104 Charaka Chikitsa 19/10 105 Ibid Gangadhara 106 Susruta Uttara 40/11, Dalhana

107 Madhava Nidana 3/7-2, Vijayarakshita

108 Bhava Prakasha Madhayma Khanda Atisaradhikara / 113


110 Textbook of Medical Parasitology, Panikar, pp16 111 Susruta Uttara 40/138

112 Ibid, Dalhana


114 Madhava Nidana 3/2, Vijayarakshita


116 Bhava Prakasha Madhayma Khanda Atisaradhikara / 116 117 Charaka Chikitsa 19/3

118 Susruta Uttara 40/19-21

119 Ibid, Dalhana

120 Madhava Nidana 3/14


122 Madhava Nidana 3/14, Vijayarakshita 123 Bhava Prakasha Madhayma Khanda Atisaradhikara /

124 Kalyanakarakam, Atisaradhikara




128 Ibid, 19/16 129 Ibid, 19/17

130 Ibid, 19/18

131 Ibid, 19/19


133 Astanga Sangraha Chikitsa 11/8

134 Susruta Uttara 40/34 135 Ibid, 40/69

136 Ibid, 40/26



139 Ibid, 40/33

140 Ibid, 40/107 Charaka Chikitsa 19/96 141 Susruta Uttara 40/151

142 Ibid, 40/152 Charaka Chikitsa 19/47,61,63,

143 Chikitsa tatwa, Papekar pp 84



146 Charaka Chikitsa 19/122, Vidyotini teeka vol 2 147 Susruta Uttara 40/153

148 Sahasra Yoga Churna Prakarana – 83,84

149 Indian materia medica pp 1308 – 1315, 150 Indian medicinal plants Vol IV pp 2435 –2438, 151 Dravyaguna Vijnana pp263, Susruta Samhita Sutra 46

152 Bhvaprakasha Haritakyadi varga, 153 Indian materia medica pp 19, 154 Dravyaguna Vijnana pp355

155 Indian materia medica pp 428 156 Dravyaguna Vijnana pp370

157 Indian materia medica pp 1295, 158 Dravyaguna Vijnana pp472 159 Indian materia medica pp 187, 160 Dravyaguna Vijnana pp537

161 Indian materia medica pp 634, 162 Dravyaguna Vijnana pp463

163 Indian materia medica pp 328, 164 Dravyaguna Vijnana pp250 165 Indian materia medica pp 45, 166 Dravyaguna Vijnana pp455

167 Indian materia medica pp 333, 168 Dravyaguna Vijnana pp627

169 Indian materia medica pp 953, 170 Dravyaguna Vijnana pp441 171 Charaka Chikitsa 19/ Chakrapani 172 Susruta Uttara 40/ Dalhana

173 A.H. Nidana 8

174 Charaka Chikitsa 19 175 Charaka Vimana 7/30 176 Charaka Vimana 7/29 177 Charaka Chikitsa 15

Bibliography

BIBLIOGRAPHY

• API Text book of Medicine.By G.S.Sainani 5th edition 1992

Published by Association of Physicians of India, Bombay.

• Astanga Hridaya with commentaries of Arunadatta and Hemadri

By Harisastry paradakar Vaidya1939

Published by Nirnaya sagar press Bombay.

• Astanga Samgraha of Vagbhata 1st edition 1996

By Prof K.R.Srikantha Murthy.

Published by Chowkhamba Orientalia, Varanasi.

• Basavaraajeeyam By Vaidya Basavaraju, 1959

Published by Konda Shankaraiah, vani press, Secundrabad.

• Bhavaprakasa By Sri Brahmasankara Misra. 4th edition 1984

Published by Chowkhamba Sanskrit Sansthan, Varanasi.

• Chakradatta By Priyavrat Sharma. 2nd edition 1998

Published by Chowkhamba Orientalia, Varanasi.

• Charaka Samhita Poorvardha 1st edition 1962,

by Vaidya Satyanaryana Shastri.

Published by Chowkhamba Vidya Bhavan. Varanasi.

• Charaka Samhita Uttarardha, 1st edition 1962

By Vaidya Satyanaryana Shastri.

Published by Chowkhamba Vidya Bhavan. Varanasi.

• Davidson’s Principles and Practice of medicine,

By John Maclod

1992, Published by Pitman press, Great Britain.

• Digestion and Metabolism in Ayurveda, By C. Dwarkanath,

Published by Baidyanath Publications, Calcutta.

• Dorland’s Pocket Medical Dictionary.

By Douglas M. Anderson. 24th edition 1989

Published by Oxford & IBH publishing Co. Pvt. Ltd. Bombay.

Bibliography

• Essentials of Basic Ayurveda Concepts.

By Prof Dr. V.V.S.Sastri. 1999

Published by Publication Division,

PGARC, DGM Ayurvedic Medical College, Gadag

• Gray’s Anatomy

by Henry Gray, 1973 Published by Longman group Ltd.

• Human Physiology By Dr C.C.Chatterjee, 11th edition 1992

Published by Medical Allide Agency. Calcutta.

• Indian Materia Medica by K.M.Nadkarni. Vol 1 - 2

2nd edition 1982Published by Popular Prakashan Bombay

• Indian Medicinal Plants

by Kirtikar & Basu, Vol 1 - 3 2nd edition 1975

• Introduction to Kayachiktsa,

By C. Dwarkanath,

Published by Chowkamba offest press, Varanasi.

• Kashyapa Samhita,

by Vridha Jeevaka,

1953 Published by Chowkhamba Vidya Bhavan. Varanasi

• Madhava Nidana with Madhukosha sanskrit vyakarna.

By Acharya Sri Narindranath shastri.

1st edition 1989Published by Motilal Banarasidas, Varnasi.

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By Vishwas R Gaitonde East West Books Pvt. Ltd

• Harrison’s Principles of Internal Medicine 14th edition

• Rajanighantu By Pandit Narahari.

2nd edition 1998 Published by Krishnadas Academy, Varansai.

• Review of medical Physiology

By Willam. F. Ganong, Published by Lange Medical publications

• Sushruta Samhita Poorvardha 8th edition

By Kaviraja Ambikadutta shastri.

Published by Chowkhamba Sanskrit Sansthan, Varanasi.

Bibliography

• Susruta Samhita Uttarardha 8th edition

By Kaviraja Ambikadutta shastri.

Published by Chowkhamba Sanskrit Sansthan, Varanasi

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By M. Ramasundar Rao, 2nd edition 1994

Published by M. Madhava, Metro Printers, Vijayawada.

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R K Sri Baidyanath Ayurveda Bhavan 1984.

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Academy,Varanasi1991.

• Shabda Stoma Mahanidhi,A sankrit Dictionary by Bhattacharya Taranat.The

sanskrit series office1967.Bhaishajya Ratnavali by Kaviraj Sri Ambikadatta

Shasthri Choukambha Sankrit Samsthan Varanasi

• Bio statistics by BK Mahajan Jaypee Brothers 1998

SPECIAL CASE SHEET FOR “PRAVAHIKA”

DEPARTMENT OF POSTGRADUATE STUDIES AND RESEARCH, (KAYACHIKITSA) SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG – 582103, KARNATAKA

1. Name of Patient Sl. No.

2. Father’s/Husband’s Name OPD No.

3. Age – years IPD No.

4. Sex – Bed No.

5. Religion Schedule initiation

Schedule completion

6. Occupation

7. Economical Status

8. Address

9. Selection

10. Result

Cured Responded Not responded Discontinued

Consent:

I Son/Daughter/wife of

exercise my free will, to participate in the said study. I have been informed to my

satisfaction, by the attending physician the purpose of the clinical evaluation and nature of

drug treatment. I am also aware of my right to quit at any time during the schedule.

Hindu Muslim Christian Other

Included Excluded

Labor Student Service House Wife

Poor Middle High Aristocrat

Tel:-

PIN

Guide:- Dr. V.Varadacharyulu. M. D. (Ayu.)

B.G.Swami M.D. Scholar Co – Guide: Dr. Shashidhar H. Doddamani M. D. (Ayu.)

Signature of Patient

1) Chief Complaints: -

S.No Complaints Duration Before After

1 Mala Pravahanam (Tenesmus defecation)

2 Nirvidya Pravahanam (Tenesmus or Tics)

3 Muhurmurmalaktam (Frequent defecation)

4 Alpaalpa Alpasamalam (Minimal stools defecation)

5 Saphena Malam (Frothy defecation)

6 Saruja Malam (Painful defecation)

7 Sapichha Malam (Mucous defecation)

8 Savibandha Malam (Constipated defecation)

2) Associated Complaints

S.No Associated Complaints Duration Before After

1 Adhmana (Distended abdomen)

2 Udara shoola (Abdominal Pain)

3 Shira soola (Headache)

4 Jwara (Fever)

5 Yakrit vedana (Pain in Liver)

6 Sheetapitta (Urticaria)

7 Udarda (Allergic Dermatitis)

8 Guda Bhramsha (Prolapsed Rectum)

9 Trishna (Polydipsia)

10 Sarakta Malam (Blood stained stools)

3) History of present illness:

Mode of onset

Aggravating factors 1) 2) 3) 4)

Relieving factors 1) 2) 3) 4)

Severity

Nature of disease

Gradual Sudden

Acute Sub-acute Chronic

Progressive Regressive Constant Intermittent

4) History of the Past Illness:

5) Previous treatment history:

6) Family History:

7) Personal History:

(a) Ahara:

(b) Jatharagni:

(c) Nidra:

(d) Vyasana:

(e) Artava Pravritti

8) Examination of Patient:

a) Astastana Pareeksha

1. Nadi

2. Shabda (Srotrendriyam)

3. Sparsha (Twacha)

4. Drik (Netra)

5. Akriti (General Gesture)

6. Pureesha Pravritti:

7. Mutra Pravritti:

8. Jihwa

Vegetarian Mixed food

Manda Teekshna Vishama Sama

Vidwibandha Dravavit pravahana Frequency

Frequency Day Night Mutra Daha

Smoking Alcohol Tobacco No Habits

Days Samanya Alpa Adhika Rajonivritti

V P K VP VK PK VPK

Prakrita Vikruta

Prakrita Kharasparsha sheeta Ushna

Prakrita Vikruta Vision

Nirlepa Upalepa

Sukha Alpa Ati Vaishamya

b) Vital Examination

a. Pulse b. Blood Pressure c. Temperature

d. Height e. Respiration f. Weight

c) Dashavidha Pareeksha

Prakruti V P K VP VK PK VPK

Sara Pravara Avara Madhyama

Samhanana Susamhita Asamhita Madhysamhita

Satmya Ekarasa Sarvarasa Ruksha Sneha

Satwa Pravara Avara Madhyama

Ahara Shakti Abhyavaharana Jarana

Vyayam Shakti Pravara Avara Madhyama

Vaya Bala Yavvana Vaardhakya

Desham (Bhumi) Jangala Anupa Sadharana

d) General Examination

Inspection Shiras Palpation Inspection Palpation Percussion

Urah

Auscultation Inspection Palpation Percussion

Udara

Auscultation Inspection Palpation Reflexes & Jerks

Shakha

Crepitation e) Special Examination (Pureeshavaha Srotas)

Aticharvana Atigradhita Atibahu

Krichramalam Alpaalpamalam Sashabdham

Sashoolam Kaphaupalepa Sarakta

Kandu Gurutwa Avaruddha

Pur

esha

vaha

S

rota

s

Krichravisarga Atipravrutti Apravrutti

/Min mm Hg °F

cms /min Kg

Apsu avasedana Durgandha Prustakati graha

Ghana/Bhrusha Pichchila Sadana S

ama

Pur

esha

Vichchinna Vistambham Shiroruk

Aruchi Tandra Suptata

Apakti Nisteva Stambha

Klama Hridayavisuddhi Anila mudhata

Alasya Gurudara Vyakulamutra

Am

a

Dos

ha

Balabhramsha Gowrava Malasanga 9) Laboratory investigations

1) Haematological examination

S.No Test Before After 1 Hb% (Haemoglobin %) 2 Erythrocyte sedimentation rate 3 Total RBC Count 4 Total WBC Count

Polymorphs Lymphocytes Eosionophils Basophils

5

Diff

eren

tial

coun

t

Monocytes 2) Stools examination

S.No Before After Amount Colour Odour Form Consistency

1 Physical examination

Abnormality 2 Chemical

examination Occult blood test

Cysts

3 Microscopic examination

Ova

3) Routine Urine examination S.No Test Before After 1 Sugar 2 Albumin 3 Microscopic

10) Assessment a) Ayurvedic assessment

S.No Condition Explanation

1 Hetu

2 Poorvarupa

3 Rupa

4 Upadrava

5 Aristalakshana

6 Sadhyaasadhyata

7 Rogamarga

8 Udbhavastana

9 Sancharastana

10 Adhistana

11 Vyaktastana

b) Assessment criteria

S.No Assessment criteria Before After

1 Pravahika Progression score -28 (PPS-28)

2 Pravahika Associated Disease score - 36 (PADS-36)

3 Ayurvedic General Health index – 82 (AGHI-82)

4 Hb% (Haemoglobin %)

5 Erythrocyte sedimentation rate

6 Occult blood test

7 Ova & Cysts

Investigator’s note: –

Signature of the scholar

Signature of the Co-Guide Signature of the Guide

Ayurvedic General Health index (AGHI-82) Dosha -9 0 = Sama, 1 = Vruddhi, 2 = Kshaya, 3 = Vigunya Agni - 4 0 = Sama, 1 = Vruddhi, 2 = Kshaya, 3 = Vigunya Dhatu - 21 0 = Sama, 1 = Vruddhi, 2 = Kshaya, 3 = Vigunya Mala – 9 0 = Sama, 1 = Vruddhi, 2 = Kshaya, 3 = Vigunya Atma – 3 Prasannata samanyasaktata, vishayasaktata, nirasaktata Indriya – 15 Prasannata samanyasaktata, vishayasaktata, nirasaktata Manas – 15 Prasannata samanyasaktata, vishayasaktata, nirasaktata Total -82

Pravahika Progression score -28 (PPS-28) Mala Pravahanam (Tenesmus defecation)

0 = Absence 1 = Mild 2 = Moderate 3 = Severe

Nirvidya Pravahanam (Tenesmus or Tics)


Muhurmurmalaktam (Frequent defecation)

0 = Absence 1 = Minimal Presence not related to food 2 = Minimal Presence related to food 3 = Moderate Presence not related to food 4 = Moderate Presence related to food 5 = Severe

Alpaalpa Alpasamalam (Minimal stools defecation)


Saphena Malam (Frothy defecation)


Saruja Malam (Painful defecation)

0 = Absence 1 = Dull pain – localized 2 = Dull pain – Generalized 3 = Colic Pain – localized 4 = Colic Pain – Generalized 5 = Spasmodic Pain

Sapichha Malam (Mucous defecation)


Savibandha Malam (Constipated defecation)


Pravahika Associated Disease score - 36 (PADS-36) Adhmana (Distended abd) 0 = Absence 1 = Mild 2 = Moderate 3 = Severe Udara shoola (Abdominal Pain)

0 = Absence 1 = Dull pain – localized 2 = Dull pain – Generalized 3 = Colic Pain – localized 4 = Colic Pain – Generalized 5 = Spasmodic Pain

Shira soola (Headache) 0 = Absence 1 = Dull pain – localized 2 = Dull pain – Generalized 3 = Moderate Pain – localized 4 = Moderate Pain – Generalized 5 = Severe Pain

Jwara (Fever) 0 = Normal 1 = Mild 2 = Moderate 3 = Severe Yakrit vedana (Pain in Liver) 0 = Absence 1 = Mild Pain 2 = Mild Pain & Palpable Liver

3 = Moderate Pain & Palpable Liver 4 = Severe Pain, Massive enlargement & tender Liver

Sheetapitta (Urticaria) 0 = Absence 1 = localized Urticaria 2 = Generalized Urticaria Udarda (Allergic Dermatitis) 0 = Absence 1 = localized Dermatitis

2 = localized Dermatitis with exude 3 = Generalized Dermatitis 4 = Generalized Dermatitis with exude

Guda Bhramsha (Prolapsed Rectum)

0 = Normal 1 = Prolapsed at deification only & normal restoration 2 = Prolapsed at deification & manual restoration 3 = Prolapsed & infected 4 = Prolapsed & infected with exude

Trishna (Polydipsia) 0 = Normal 1 = Mild 2 = Moderate 3 = Severe Sarakta Malam (Blood stained stools)

0 = Normal 1 = Mild 2 = Moderate 3 = Severe

pravahika kc019 gdg

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