Vamana karma or induced vomiting is recommended for atisara conditions involving ama or all three doshas. Virechana karma or purgation therapy using herbs like triphala is suggested when stool is scanty or hard. Niruha basti followed by anuvasana basti can be given when doshas are aggravated and constipation is present. Medications involving pachana or digestive herbs are prescribed depending on the dosha involvement and symptoms. Panchakarma therapies aim to eliminate aggravated doshas and ama from the body to treat atisara.

1. ROLE OF PANCHAKARMA IN
ATISARA

2. DEFINITION
 अतिसरणमिीसार ( Ch. Ni. 1/9; Ayu dee vyakyana )
“अति” means excessively and “सरण” means to flow, so
we can say , Atisara is the condition were there will be
excessive flow of malas through the Adhobhaga.
 सोऽतिसारोऽतिसरणादाशुकारी स्वभाविः ( A.H.Ni. 8/16)
A disease in which Atisarana or excessive flow is seen
is called Atisara.
Here Acharya add’s the point that the disease is of
आशुकारी in nature.

3. Acc to सु. उ. िं. अ. ४०/१ -३
 Aharas which are guru, atisnigdha, ruksha, usna,
drava, stula, atisheeta.
 Intake of incompatible foods, eating before the
digestion of previous meal.
 Due to improper snehanadi karmas.
 Due to factors like fear, grief, excess intake of
madya and unhygienic water.
 Indulging in activites related with water like
swimming, diving, etc.
 Due to mutradi vega dharana,
 Due to krimi infestation
अतिसारतिदािम्

4. अतिसारसम्प्राप्तः
संशम्यापान्धािुरतनं प्रवृद्धः शक
ृ प्िश्रो वायुिाऽधः
प्रणुन्नः |
सरत्यिीवातिसारं िमाहुर्व्ाातधं घोरं षड्तवधं िं
वदप्ि |
एक
ै कशः सवाशश्चातप दोषैः शोक
े िान्यः षष्ठ आमेि
चोक्तः (४)
(सु. उ. िं. अ. ४०)
• गुर्वतितिग्धतद Nidana
• Jala amsha dhatus gets predominantly
increased
• Thus it decreases the power of Agni in
Amashaya.
• It then gets mixed with the feaces and increases
in quantity.
• Gets involved with vata dosha
• and finally flows out excessively through the
Adho marga. This is called atisara

5. अतिसार भेदा
1. Six types :
 Ekadoshaja, Tridoshaja, Sokaja and Bhayaja by Astanga Hridaya.
 Ekadoshaja, Tridoshaja, Sokaja and Amaja by Susruta Samhita.
 Ekadoshaja, Tridoshaja, Rakhtatisara and Agandujatisara by Charaka
Samhita. Here Acharya has added भय & शोका as Agantu karanas.
 A point to be noted is that Dalhana Acharya told raktatisara as an
avastavishesha of pittatisara..
“इदािींतपत्तािीसारस्यैवावस्थातवशेषं रक्तािीसारमाह” डल्हण commentry

6. अतिसारपूवारूपम्
 हृन्नातभपायूदरक
ु तििोदगात्रावसादातिलसतन्नरोधाः |
तवट्सङ्ग आध्मािमथातवपाका भतवष्यिस्तस्य
पुरःसरातण ||५||
(सु. उ. िं. अ. ४०) |
• There will be immense pain over हृदयं, nabi,
payu, udara, kukshi.
• There will be sannirodha of vayu, constipation,
blotting, indigestion, etc

7. वािातिसारलिण
म्
 Pain of abdomen, waist, thigh, and calves.
 Non elimination of urine with intestinal
gurgling.
 The person expels faeces often mixed
with froth and of small quantity.
 It will be of black colour , dry and often
associated with gas.
तपत्तातिसारलिण
म्
 Faeces will be having a foul odour, severe
burning sensation on voiding.
 It takes severe force to come out and
resembles red in colour.
 The stools will be intermittent followed by
severe sweating by the patient.
 It will be of either yellow, bluish or even red in
colour.
 After explusion the patient might feel severe
thirst, ulceration , fever or even may faint.

8. श्लेष्मातिसारलिणम्
 The patient suffers from tandra, nidra,
heaviness of the body, nausea and debility.
 Even after elimination of feaces in large
quantity, he again gets the urge for
defecation.
 The stool will be pale in colour, thick in
consistency mixed with kapha dosha.
 Elimination of feaces happens without any
sound .
 The patient will have an aversion towards
food and often happens to have
horripulations.
तत्रदोषजातिसारलिणम्
 Here all the 3 doshas are involved.
 Here patient will suffer from moha, sada,
debility, dryness of mouth.
 Elimination of feaces having multiple
colours.
 Exhibits symptoms of above 3 types of
lakshanas.
 This type of atisara is difficult to treat and is
incurable in bala and vruddha.

9. आमातिसारलिण
म्
 Here atisara develops due to the
involvement of ama dosha.
 Doshas get severly aggravated.
 Sthana is the amasaya
 Here faeces will be having multiple colours .
 The patient will be running for defectaion
multiple times and voiding occurs with
much difficulty.
 It is difficult to cure.
BHAYAJATISARA
 Due to bhaya, vata dosha along with pitta
gets vitiated.
 After getting vitiated, it does the द्रवि of the
शक
ृ द् .
 It gets eliminated easily,which is a little
froathy and usna in nature.

10. शोकातिसारलिणम्
 In persons affected with different kinds of grief,
due to alpasana and Basposhmata, it does the
nasha of agni
 This gets mixed with rakta, then along with or
without purisha, it moves downwards and gets
eliminated with great difficulty.
 The blood will be of काकणिीप्रकाशम् ( color of
gunja seed) having either bad smell or without
it.
 Acc to Susuruta Acharya, this is a dushchikitsya
vyadi
 Acharya Vagbhatta says that sokaja atisara
exhibit the same properties as that of bhayaja
atisara.
िैस्तैभाावैः शोचिोऽल्पाशिस्य बाष्पोष्मा वै
वतिमातवश्य जिोः |
कोष्ठं गत्वा िोभयेत्तस्य रक्तं िच्चाधस्ताि्
काकणिीप्रकाशम् ||९||
तिगाच्छेद्वै तवड्तवतमश्रं ह्यतवड्वा तिगान्धं वा
गन्धवद्वाऽतिसारः |
शोकोत्पन्नो दुतश्चतकत्स्योऽतिमात्रं रोगो वैद्ैः कष्ट एष
प्रतदष्टः ||१०||
(सु. उ. िं. अ. ४०) |

11. TREATMENT OF ATISARA
ित्रादौ लङ्घिं कायामतिसारेषु देतहिाम् |
ििः पाचिसंयुक्तो यवाग्वातदक्रमो तहिः ||२५||
अथवा वामतयत्वाऽऽमे शूलाध्माितिपीतडिम् |
तपप्पलीसैन्धवाम्भोतभलाङ्घिाद्ैरुपापाचरेि् ||२६|
 First of all the treatment of atisara should be
done only after assessing the ama or pakwa
avasta of the mala.
1) Ama mala :
संसृष्टमेतभदोषैस्तु न्यस्तमप्स्स्ववसीदति |
पुरीषं भृशदुगाप्न्ध तवप्च्छन्नं चामसञ्ज्ञकम् ||
2) Pakwa mala:
एिान्येव िु तलङ्गाति तवपरीिाति यस्य िु |
लाघवं च मिुष्यस्य िस्य पक्व
ं तवतितदाशेि् ||
 At first Fasting should be done followed by
intake of pachana yavagu.
 If Ama is present then we should go for
shodhana karma.

12. PANCHAKARMA IN ATISARA

13. 1) VAMANA KARMA
If Ama is seen in an atisara patient along with soola and
admana, the he / she should be given Vamana karma by
administering kashaya of pippali and saindhava.
After this he can be administered to other therapies like
langhana, swedana, and usnaodaka pana.
After vomiting has stopped he should be given laghu
annawhich is predominantly drava in nature.
If a person eliminates feaces in excess watery form and in large
quantity then he should be given VAMANA first followed by
laghana and administration of pachana drugs.
Vagbhata Acharya says that vamana can be given for pittadi
dushida atisara but not for kevala vata condition

14. Vamana is also indicated when there is a feeling of heaviness of
body associated with preominace of kapha dosha.
When patient suffers from fever, burning sensation and
constipation, due to predominace of vata, then treatment
should be like that of adhoga rakhtapitta which in vamana.
After vamana , one should be given food which are more
dravata in nature . Ex : Kadayusha, yavagu processed with
pippalyadi gana choorna.
If after vamana, still ama dosha persists, the patient should be
made to drink kashaya of either haridradi gana or vachadi gana.

15. 2) VIRECHANA KARMA
If a person eliminates small quantity of faeces associated with
constipation and abdominal pain, then he should be
administered with Virechana karma by giving Abhaya and
pippali with usnodaka.
Acc to charaka samhita :
पैतत्तको यद्िीसारः पयसा िं तवरेचयेि्||
पलाशफलतियूाहं पयसा सह पाययेि्|
ििोऽिुपाययेि् कोष्णं िीरमेव यथाबलम्
In Astanga hridaya :
तवबद्धं दोषबहुलो दीतातनयोऽतिसायािे|
क
ृ ष्णातवडङ्गतत्रफलाकषायैस्तं तवरेचयेि्||१५||
पेयां युञ्जयातद्वररक्तस्य वािघ्नैदीपिैः क
ृ िाम्

16. If the mala is Bhadda, Bahudosha,
deeptagni and eliminates often, then
he should be administerd with
Virechana.
For virechana he should be
administered with kashaya of vidanga,
triphala and Krishna.
Or
By the administration of milk mixed
with eranda tailam.
After virechana karma , he should be
given yavagu prepared with vata hara
drugs

17. 3) NIRUHA BASTI
When doshas are pakwa and in bahu dosha avasta, followed by
constipation, then to eliminate the doshas niruha basti is given
using mutrashodana dravyas and strictly it should be followed
by Anuvasana basti.

18. 4) Anuvasana BASTI
Acharya susruta says that A.B should be administered immediately after
the administration of Niruha Basti.
प्रवाहणे गुदभ्रंशे मूत्राघािे कतटग्रहे |
मधुराम्ैः शृिं िैलं सतपावााऽप्यिुवासिम्
Acharya advises to administer AB fro pts suffering from paittika
gudapaka. ( if Vata is predominant, then taila processed with dadimanda,
sura and vilva shud be used.)
When the pt is eliminating faeces in small quantity and more of blood
along with vayu vibhanda, then Piccha Basti shud be administered.
If in raktatisara condition, if pain is an associated symptom, then
picchabasti is indicated.

19. MEDICATIONS
 Acharya susruta says that ksheera is said to be like amutha
for a patient suffering from atisara.
 If he is suffering from chronic atisara, then ksheera has to be
given mixed with 3 parts of jala.
 While discussing about sannipata atisara chikitsa, Acharya
says that if atisara is pakwa, of long time, having diff colours
and having no pain, then putapaka should be given with
drugs explained there.
 If the condition is niramma, with pain abdomen, and the
patient is emaciated by langana, then gritam should be
administered mixed with yavakshara, only after considering
the agni of the patient.

20. TREATMENT IN OPD
 If ama is not present.
 Kudajarishta + kudajagana vati
 Karpooradi arka
 Gangadara vati ( stambana; Y.R)
 If ama is present.
 Mustarishtam and dadimashtaka choorna(
mixed with honey)
 Ayamodaka arka
 Karpooradi arka