Atisara

What is Diarrhea? Diarrhoea is the passage of three/ more loose/ liquid stools per day/more frequently than normal for an individual. From the clinical point of view, diarrhea means increased stool water, and this increases stool frequency and the passage of liquid stool. Diarrhea in Ayurveda According to Ayurveda, Diarrhoea is commonly known as Atisara. It occurs due to intake of causing factors which results in agnimandya mainly jathragni due to which ama dosha (Kapha) increases and vata prakopa occurs due to which strotodushti in poorishvaha and udakavaha occurs and increase of more loose or liquid stools comes out. Types of Atisara - According to Acharya Charak Vataja  Pittaja Kaphaja Sannipataja Aagantuka  Diarrhea Symptoms Loose/watery stool Abdominal cramps Fever Abdominal pain Blood/ mucus in the stool Abdominal bloating Nausea Frequent bowel movements  Diarrhea Causes Food intolerance/lactose intolerance Food allergy Contaminated water Adverse reaction to a medication Viral/ bacterial infection Intestinal disease Parasitic infection Gallbladder/stomach surgery Childhood cause - Rotavirus Bacterial infection - salmonella/E.coli Food poisoning Stress/indigestion due to mal-absorption Acc. To Ayurveda- ajirnashana, adhyashana, ati-drava, ati ruksha ahara, dushita anna, etc. Prevention of Diarrhoea Safe drinking water Improved sanitation Hand washes with antiseptic soap/solutions Good personal hygiene/food hygiene Health education about the spread of infections Vaccinations Use of ORS (Oral Rehydration Solution) Nutrient-rich foods in case of malnutrition Consult a doctor in case of persistent diarrhea When to See Your Doctor for Diarrhoea Disease? When diarrhea persists beyond a few days and the body starts dehydrating with severe abdominal/ rectal pain/bloody/black stools/weight loss/fever above 102 degrees F, then you should consult the doctor immediately. Diagnosis of Diarrhoea Physical examination of the abdomen Some general questions for the diagnosis will ask by the doctor like current medications/past medical history/family history/travel history/any other medical conditions Signs of dehydration Tests for diarrhoea include-CBC/liver function test/tests for malabsorption/ ESR/C-reactive protein/antibodies test/stool tests Colonoscopy X-Ray/CT- scan- to rule out structural abnormalities associated Diarrhoea Prevention Tips Drink clear liquids - water/broth/fruit juice Stay hydrated Replenishing water loss is important Avoid milk, it can make diarrhea worsen Intake of ORS ( Oral Rehydration Solution)/Electrolytes fluid  Consume (Sugar+salt+water ) BRAT diet -( banana/ rice/applesauce/toast) can be taken Avoid junk foods/alcoholic beverages Chamomile tea Avoid strenuous exercises What to avoid in Diarrhea? Heavy/hard/cold/hot/spicy and oily foods Avoid milk Fatty/fried foods Raw fruits and vegetables Spicy foods Beans/cabbage Caffeinated drinks Alcoholic beverages Avoid junk foods Avoid strenuous exercises Excessive workouts High-fat foods Greasy foods/spicy foods Artificial sweeteners/high levels of fructose foods What to eat in Diarrhea? Vilepi ( rice gruel), laaja manda, rice washed water ( avoid contamination with pesticides) Rice+curd/rice + buttermilk Masoor/ aadhaki yoosha Coconut water frequent drinking Deepana and laghu guna diets Pectin rich foods such as fruit Electrolytes food- miso-soup, sports drinks Cooked/ soft vegetables Taking probiotics Chamomile tea BRAT( banana/rice/applesauce/toast) diet Drink plenty of fluids to avoid dehydration Question & Answer Q.1 How much serious is Diarrhoea disease in children? Ans. Diarrhoeal disease is the second leading cause of death in children under 5 years, also kills around 525000 children under five. Globally, there are nearly 1.7 billion cases of childhood diarrhoeal disease every year according to data collected. Q.2 What are the different types of Diarrhoea? Ans. Different types of Diarrhoea include - 1) On the basis of duration:- Acute Diarrhoea, Chronic Diarrhoea. 2) On the basis of clinical presentation:- Acute watery diarrhea, Acute Bloody Diarrhoea. 3) On the basis of Physiology:- secretory diarrhea, osmotic diarrhea, exudative diarrhea, motility related, inflammatory diarrhea. Q.3 How does Diarrhea cause dehydration? Ans. Body intakes water and salt through drinks/food/fluid. Normally, it loses water and salt through stools/urine/sweat/breathing. When the bowel is healthy, water and salt pass from the bowel into the blood and when diarrhea occurs, the bowel doesn’t work normally. As a result of this, less water and salt pass into the blood, and more pass from the blood into the bowel. Thus, the amount of water and salt passed in the stools is greater than the normal.  Larger than normal loss of water and salt from the body results in dehydration. It usually occurs when the output of water and salt is greater than the input. Repeated vomiting, which often accompanies diarrhea can also contribute to dehydration. Q.4 Why is Diarrhea dangerous? Ans. Mainly due to diarrhea two main dangers, death and malnutrition occur. Death from acute diarrhea is most often caused by loss of a large amount of water and salt from the body, loss is called dehydration. Severe diarrhea with complications is most common in people with malnutrition and can also cause malnutrition and can make existing malnutrition worse because nutrients are continuously lost from the body and nutrients repair damaged tissue rather than for growth. Q.5 Why Diarrhoea has become a major cause of death in many countries? Ans. Diarrhea is a leading cause of death during complex emergencies and natural disasters. Displacement of populations into temporary, overcrowded shelters is often associated with polluted water sources, inadequate sanitation, poor hygiene practices, contaminated food, and malnutrition - all of which affect the spread and severity of diarrhea. At the same time, the lack of adequate health services and transport reduces the appropriate treatment of diarrhea cases which also considered a major issue in public health. Q.6 What is the importance of Oral Rehydration Solution (ORS) in children? Ans. A solution of oral rehydration solution salts (ORS) is a simple, inexpensive, and life-saving remedy that prevents dehydration among children with diarrhea. In a healthy child, the small intestines absorb water and electrolytes from the digestive tract so that these nutrient-rich fluids may be transported to other parts of the body through the bloodstream. In a sick child, diarrhea-causing pathogens damage the intestines- causing an excessive amount of water and electrolytes to be secreted rather than being absorbed. When the ORS solution reaches the small intestines, then the sodium (Na) and glucose in the mixture are transported together across the lining of the intestines, sodium, which is now in higher concentrations in the intestines, promotes water absorption back into the body from the gut. Q.7 What are the causing factors for Diarrhoea ( Atisara ) according to Ayurveda in general? Ans. By intake of too cold/unctuous/rough/heavy/coarse/hard things, irregular meals/intake of incompatible and unsuitable things/fasting/delayed meals/drinking defective wine and water/overdrinking/avoiding evacuation/irregular application/mismanagement of remedial measure/excessive exposure to fire, sun, wind & water, sleep/oversleep/suppression of urges/seasonal perversions, excessive fear/grief/mental agitation/, intestinal worms, phthisis, fever, piles, in a person having deranged agni all the three doshas get vitiated and damaged the agni and further reach the colon and cause atisara (=diarrhoea) with symptoms of all the doshas. Q.8 How Diarrhoea occurs according to Ayurveda? Ans. According to Ayurveda, Diarrhoea is commonly known as Atisara. It occurs due to intake of causing factors which results in agnimandya mainly jathragni due to which ama dosha (kapha) increases and vata prakopa occurs due to which strotodushti in poorishvaha and udakavaha occurs and increase of more loose or liquid stools comes out. Q.9 What is Traveler’s Diarrhoea? Ans. It is a digestive tract disorder that commonly causes loose stools and abdominal cramps. Mainly caused by eating contaminated food and water while travelling to different places. Common signs and symptoms include abrupt onset of passage of three/more stools in a day, urgency for defecation, cramps, nausea/vomiting/ fever can occur. Q.10 How Ayurveda treatment helps in managing Diarrhoea? Ans. Mainly Ayurveda principle works on the principle of Chikitsa sutra which includes proper treatment of ama dosha/ langhana/uses of stambhak aushadh/ (deepana-pachana dravya) use &treatment according to bhedanusara lakshana, & use of various ayurvedic formulations in shamana chikitsa helps in managing Diarrhoea acc. To Ayurveda. References 1. Longmore, Wilkinson, Davidson, Foulkes, Mafi, Oxford Handbook of Clinical Medicine 8th Edition 2. Kayachikitsa Volume-2 by Prof. Ajay Kumar Sharma (2017) 3. Charak Samhita, Chikitsa Sthana-ch-19 4. Madhava Nidana, Ch-3 5. Sushruta Samhita Uttaratantra, Ch-3 6. Ashtanga Hridaya, Nidana Sthana, Ch-8 7. Ashtanga Hridyaya, Chikitsa Sthana, Ch-9 8. J.Alastair Innes, Davidson’s Essential of Medicine 2nd edition  9. K Sembulingam, P Sembulingam, Essentials of Medical Physiology 6th Edition