Dysentery: Causes, Symptoms, Ayurvedic Treatment, Medicines

Article by Dr Raghuram Y.S. MD (Ay)
Dysentery is an inflammatory condition of gastrointestinal tract, especially colon. It is caused by various types of infection of intestines. The infection may be caused by bacteria, viruses, parasitic worms or protozoa. Dysentery presents with diarrhoea along with blood. Fever, abdominal pain and tenesmus, may be associated with bloody diarrhoea. Dysentery can be considered as a type of gastro-enteritis.

Definition

Thus, defining Dysentery –
‘Dysentery is an inflammatory condition of the intestine caused due to infection of colon and presents mainly with bloody diarrhoea’
‘Dysentery is a condition presenting with diarrhoea with visible blood’ (U.S. Centres for Disease Control and Prevention i.e. CDS)

Symptoms

General symptoms of dysentery –

• Bloody diarrhoea – loose motions mixed with phlegm (mucus), pus and blood. In extreme cases the patient may pass around 1 litre of fluid per hour. The diarrhoea is often foul smelling.
• Frequency – the person may feel to evacuate the bowel repeatedly
• Tenesmus – a feeling of incomplete evacuation at defecation or straining on defecation
• Abdominal pain – ranging from mild to moderate to very severe (depending on the type of infection)
• Rectal pain
• Fever
• Nausea – feel to vomit
• Shock
• Delirium
• Rapid weight loss
• Vague and generalized muscle pains (due to loss of water and electrolytes)
• Temporary lactose intolerance

In bacillary dysentery which is the most common type of dysentery presents with mild stomach pains, frequent stools or diarrhoea. The duration of symptoms ranges from 3-7 days. Frequent urge to defecate, large quantity of liquid faeces and presence of mucus, blood and or pus in the diarrhoea depends on the type of infection (pathogen involved).
Secondary infection – Rarely the amoebic parasites (amoebic dysentery) will pass through the blood stream and spread beyond the intestines. In these cases it may seriously infect other organs such as the brain, lungs and the liver.
Read related: 37 Ayurveda Home Remedies For Diarrhea And Dysentery

What to do when you already have dysentery?

• Fast for a day or two. It gives a rest to the stomach and gut, helps in regularizing the metabolism, cures infection and inflammation and helps to flush off the toxins. Ayurveda too recommends this in many acute disorders especially digestive and gut related diseases. It is called as Langhana (lightening therapy) or Upavasa (fasting). Make sure to have plenty of water and other fluids also to keep yourself hydrated. You can take fluids like tea and sports drink (helps replenish salts and minerals.
• Avoid sugar and refined flour products, alcohol, strong tea and coffee
• Include yoghurt, steamed rice, skimmed milk, fresh ripe fruits like banana, boiled potatoes, boiled rice, cooked carrots etc in your diet
• Avoid fried, stale, spicy, greasy, canned, refrigerated foods and junk foods
• Bed rest is essential
• Use hot water bag over the abdomen to get relieved from pain

Modern perspective

More about Dysentery, Modern perspective –
Mechanism –
Dysentery results from viral, bacterial or parasitic infestations. When we consume contaminated food or water, or have oral contact with contaminated objects or hand etc, the pathogens enter our body through mouth. Later they reach large intestine.

The pathogens then damage the intestinal lining. This leads to inflammation and consequent inflammatory immune response. Some microorganisms like Shigella secrete substances called cytotoxins which kill and damage intestinal tissue. Viruses directly attack intestinal cells and causes cell death.
This response leads to a chain of events like:

• Rise in temperature
• Painful spasms of the intestinal muscles (cramps)
• Swelling due to water leaking from the intestinal capillaries (oedema)
• Tissue damage by body’s immune cells and chemicals (cytokines) which are released to fight the infection
• This leads to impaired nutrient absorption, excessive water and mineral loss through the stools (failure of mechanism of fluid absorption in the intestine)
• Entry of pathogenic organisms into the bloodstream

Types of Dysentery

Amoebic dysentery –

• It is caused by an infection caused by entamoeba histolytica
• When the amoebae inside the bowel of an infected person are ready to leave the body, they group together and form a shell that surrounds and protects them
• This group of amoebae is now known as cyst
• The cyst is passed out of the body in the faeces
• These cysts can survive outside the body
• The infected faeces contaminates the surroundings such as nearby food and water
• If another person eats or drinks the food or water contaminated with faeces containing cyst he also will get infected with amoebae.
• After entering the person’s body through the mouth, the cyst travels down the stomach
• The amoebae inside the cyst are protected from the stomach’s digestive acid
• From the stomach, the cyst travels down to the intestines. Here it breaks open and releases the amoebae, causing infection.
• The amoebae can burrow into the walls of the intestines and cause small abscesses (pus pockets) and ulcers (painful sores)
• The cycle once again begins

Proper treatment of the underlying infection of amoebic dysentery is important. Insufficiently treated amoebiasis can lie dormant for years. They subsequently lead to severe, potentially fatal complications.
Amoebic dysentery is common in tropical areas and in regions where human faeces are used as fertilizers

Bacillary dysentery –
It is caused by shigellosis, an infection by bacteria of the genus Shigella. It is also called Marlow syndrome.
Entero-invasive Escherichia coli (E. Coli) may also cause a dysentery syndrome.

Read related: Atisar types and treatment as per Charaka

Diagnosis

Diagnosis of dysentery:
A clinical diagnosis is done based on history of illness and brief examination. Doctor would prefer to start the treatment even before a confirmation from the laboratory analysis is obtained.

Physical examination of the patient includes finding dryness of mouth, skin and lips due to dehydration and lower abdominal tenderness on abdominal palpation

Stool and blood tests – are done to identify the causative organism. Blood tests also help in measuring the abnormalities in the levels of essential minerals and salts.

Differential diagnosis

Differential diagnosis for dysentery:
Amoebiasis (Amoebic dysentery) – caused by Entamoeba histolytica, most cases are asymptomatic. Anyhow dysentery and invasive extraintestinal disease comprising of one or more of Liver abscess, pleura-pulmonary disease, peritonitis, pericarditis, brain abscess and genitourinary disease occur. Colitis, toxic megacolon, amoeboma, perianal ulceration are other common symptoms.

Diarrhoea – is a condition of having at least 3 loose or liquid bowel movements each day, often lasting for a few days and resulting in dehydration due to fluid loss. Signs of dehydration often begin with loss of normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, fast heart rate, loss of skin colour etc. Most common cause is an infection of intestines due to either a virus, bacteria or parasite, a condition known as gastroenteritis.

Bacterial gastroenteritis – generally occurs due to infection of stomach and intestines. It has many causes. It ranges from mild to severe, and typically manifests with symptoms of vomiting, diarrhoea and abdominal discomfort. It is usually self limited but improper management of an acute infection can lead to a protracted course of the disease.

Viral Gastroenteritis – ranges from a self-limited watery diarrhoea illness (usually less than 1 week) associated with symptoms of nausea, vomiting, anorexia, malaise or fever to severe dehydration resulting in hospitalization or even death.

Campylobacter infections – most commonly caused by Campylobacter jejuni, presents with diarrhoea, systemic illnesses, bloody diarrhoea or dysentery syndrome

Cholera – intestinal infection caused by Vibrio cholera , presents with profuse secretory diarrhoea. It may many times be asymptomatic or mild, severe cholera can cause dehydration and death within hours of onset.

Clostridium difficile colitis – results from a disturbance of normal bacterial flora of the colon, colonization of C. difficile and release of toxins. This leads to mucosal inflammation and damage. Antibiotic therapy alters the colon flora. This infection (CDI) occurs mainly in hospitalized people. Symptoms include mild to moderate watery diarrhoea (rarely bloody), anorexia, malaise and cramping abdomen pain.

Crohn’s Disease – is an idiopathic, chronic inflammatory process that can affect any part of the gastrointestinal tract from mouth to anus. People typically experience periods of symptomatic relapse and remission. Characteristic symptoms are pain abdomen and diarrhoea. Other symptoms and signs include rectal bleeding, fever, weight loss, anorexia, nausea, vomiting, malnutrition, fatigue, bone loss etc

Ulcerative Colitis – It is one of the 2 major types of ‘Inflammatory Bowel Disease’ (IBD) along with Crohn disease. It characteristically involves only large bowel. Predominant complaints include rectal bleeding, frequent stools, mucous discharge from the rectum, tenesmus, lower abdominal pain, purulent rectal discharges, severe diarrhoea, cramps, fever, abdominal distension etc

Celiac disease – is an autoimmune disorder affecting primarily the small intestine that occurs in people who are genetically predisposed. Classic symptoms include gastrointestinal problems such as chronic diarrhoea, abdominal distension, mal-absorption, loss of appetite and among children ‘failure to grow normally’. This often begins between 6 months and 2 years of age.

Irritable Bowel Syndrome – is one of the common causes of diarrhoea, presents with abdominal discomfort relieved by defecation and unusual stool pattern (diarrhoea or constipation) for at least 3 days a week over the previous 3 months.

Colon cancer – presents with iron deficiency anaemia, rectal bleeding, abdominal pain, change in bowel habits, intestinal obstruction (or perforation), weight loss, fatigue, abdominal tenderness, hepatomegaly, ascites etc

Cryptosporidiosis – caused by infection with apicomplexan protozoans of the genus Cryptosporidium, mainly Cryptosporidium hominis and C. paryum. It mainly affects childrenit is recognized as a cause of prolonged and persistent diarrhoea in children and of severe prolonged diarrhoea in persons with AIDS

Escherichia Coli infections – is causative of many infective disorders including diarrhoea and traveller’s diarrhoea

Salmonellosis – the genus Salmonella belonging to the family Entero-bacteriaceae are potentially enteric pathogens and a leading cause of bacterial food-borne illness. Among many diseases, these bacilli also cause entero-colitis (inflammation of small and large intestine) leading to diarrhoea.

Read related: Prevention And Lifestyle Tips For Dysentery and Diarrhoea

Treatment

Treatment for dysentery:
Oral rehydration therapy or intravenous fluid replacement – for maintaining body fluids
In availability of laboratory services – no antimicrobial therapy should be started until the microscopy and culture studies have identified specific infection
In non-availability of laboratory services – a combination of amoebicidal drug (to kill the parasite) and an antibiotic (to treat any associated bacterial infection) shall be administered.
Severe cases – antibiotics are useful
If necessary, a doctor may have to reserve antibiotics for those at highest risk of death, including young children, people over 50 years of age and anyone suffering from dehydration or malnutrition
Amoebic dysentery is often treated with 2 antimicrobial drugs such as metronidazole and paromomycin or iodoquinol etc

Prognosis

Most cases of dysentery will subside within 10 days of effective treatment; full recovery in most patients can be seen within 2-4 weeks after beginning proper treatment.
If it is left untreated, the prognosis varies with immunity of the person and severity of the disease.
Extreme dehydration can delay recovery and significantly raise the risk of serious complications

Epidemiology

Shigella is estimated to have caused the death of 34,000 children under the age of 5 years in 2013
Amoebiasis infects over 50 million people each year, of whom at least 50,000 die

Ayurvedic perspective

Dysentery, Ayurvedic perspective
Many conditions explained in Ayurveda can be compared to Dysentery among which Pravahika is the closest disease in terms of presentation

Pravahika

Pravahika is generally explained in the context of explaining atisara (diarrhoea). Therefore the clinical picture is similar to atisara. Modern view also supports this view (diarrhoea is a predominant presentation of dysentery).

The root word Pravahana in Pravahika means ‘to strain’. This word denotes tenesmus which is a common feature of dysentery.
vAyuH pravRddho nicitaM balAsaM nudati adhastAd ahita azanasya|
pravahato alpaM bahuzo malAktaM pravAhikAM tAM pravadanti tajJAH||(su.u.40)

In a person who consumes ahita ahara (incompatible or unwholesome food and drinks), the kapha gets exacerbated and collected in the abdominal viscera, mainly in the stomach and intestines. When the vitiated Vayu pulls this accumulated kapha (phlegm or mucus) in a downward direction and tries to eliminate it, the stools (mixed with mucus) get excreted in a small or large quantity. The excretion of stools (faeces) and mucus takes place with difficulty and the person is compelled to strain or force the stools out. In this attempt, he will feel pain in the abdomen and rectum. There will be a general sense of incomplete evacuation of bowel.  This condition is called Pravahika.

In this – the consumption of incompatible foods, tenesmus (feeling of incomplete evacuation and straining at defecation) and faeces mixed with mucus are the points which are similar to the symptoms present in dysentery.

Types

Types of Pravahika –
Pravahika is of 4 types. They are as mentioned below:
Vataja Pravahika (caused due to predominant vitiation of Vata) – mainly presents with shula or severe pain in the abdomen
Paaittika Pravahika (caused due to vitiation of Pitta) – mainly presents with daha or burning sensation
during defecation
Kaphaja Pravahika (caused due to excess Kapha) – mainly presents with shleshma or excessive excretion of phlegm or mucus along with stools
Raktaja Pravahika (caused due to vitiation of rakta or blood) – mainly presents with rakta or bleeding along with faeces

All the symptoms of the above said types of pravahika along with main symptoms of pravahika will fulfil the comparison criteria with respect to dysentery
Raktaja Pravahika ultimately fulfils the definition of dysentery given in modern texts ‘bloody diarrhoea’

Differential diagnosis

Differential diagnosis, other conditions explained in Ayurveda which can be compared to dysentery –

Raktaja Atisara –
Raktaja=caused by blood, Atisara=diarrhoea, Raktaja Atisara = Diarrhoea caused by vitiated or morbid blood, presents with blood mixed diarrhoea
Raktatisara is an extended version of Pittatisara. Neglected or inadequately treated pittatisara leads to raktatisara.

Since Rakta atisara is caused by neglected Pitta atisara, the causes of Pitta atisara are generally considered to be the causes of Rakta atisara also. They are as below mentioned –
Excessive consumption of amla (sour), lavana (salt), spicy (teekshna), pungent (katu), alkaline (kshaara), hot (ushna) and irritative (corrosive) foods
Excessive exposure to atapa (heat of sun), agni (fire), hot air (breeze)
High end emotions like krodha (anger), irshya (jealousy) etc

Symptoms –

• Rakta yukta atisara – Excessive bloody diarrhoea
• Daha – Severe thirst
• Shula – abdominal pain
• Daruna guda paka – severe and complicated anal suppuration
• Haridra (colour of turmeric), peeta (yellow), harita (green), neela (blue), krushna (brownish black or grey), rakta (bloody) coloured loose stools
• Durgandha yukta mala – watery stools with foul smell
• Sweda – excessive sweating
• Murcha – fainting or giddiness

Note that the symptoms point towards the inflammatory process going on in the colon and loss of blood, different colours of stools and foul smell reflect infection. This explanation fits into raktatisara being compared to dysentery.

Kaphaja atisara –
Kaphaja Atisara is a type of atisara (diarrhoea) which is caused by vitiated kapha
Symptoms –

• Appearance of faeces – Loose and unformed (watery stools which is Snigdha (oily), sheeta (cold), pichchila (sticky), tantumad (streaks of phlegm or mucus membrane), ama (indigested material), guru (heavy), durgandha (foul smelling), shleshma upahitam (mixed with lot of mucus)
• Shula – pain abdomen
• Alpam alpam – small quantities of faeces
• Abheekshnam malam – frequency of defecation (many times)
• Sa pravahikam – with tenesmus (straining at defecation, feeling of incomplete evacuation)

Even in Kaphaja Atisara the symptoms like mucus mixed loose stools (diarrhoea) along with frequency, foul smell and tenesmus point towards its similarity with dysentery

Sannipataja Atisara –
Atisara or diarrhoea caused due to vitiation of all the 3 doshas is called Sannipataja Atisara. Since dysentery is caused by infection, there is a chance that all the 3 doshas are vitiated at some point and make the clinical picture of the disease complicated.

Symptoms –

• Various colours and presentations of diarrhoea like – haridra (turmeric colour), peeta (yellow), hareeta (green), neela (blue), mamsa dhavana (meat wash), rakta (blood red or blood mixed), krushna (black), shweta (white), varaha meda sadrusha (similar to fat of the pig), etc
• Vedana – loose watery stools of various colours as said above will be associated with pain (may be devoid of pain also)
• Grathita mala – pellet like stools
• Amayukta – mixed with indigested food
• Pakwa mala – sometimes formed stools are also eliminated

This atisara when associated with the above said complications, loss of flesh, blood and strength, indigestion and abnormal tastes in the mouth is said to be difficult to treat
This Sannipataja atisara points out towards the complications of dysentery like elimination of flesh, blood, mucus in the faeces along with manifestation of many colours in the watery stools. The causes and symptoms point out this type of atisara towards complicated dysentery.

Read related: Traditional Ayurvedic Diet Recipes For Dysentery And Diarrhoea

Amatisara –
Here basically the atisara or diarrhoea is caused by ama or indigested material (Ama is the improperly processed food essence in circulation having a tendency to cause blocks in the channels and damage the tissues and organs).

Symptoms –
Nana varna atisara – loose, watery stools having various colours
Shula – pain abdomen

Kaphaja Grahani –
Grahani is a disease of gastrointestinal tract wherein there is abnormal behaviour of the digestion process of small intestine especially duodenum. In this there is excretion of unformed, foul smelling stools and sometimes altered by formed stools along with severe pain in the abdomen. The main symptoms of any type of Grahani are –

Ruja – pain abdomen
Muhur baddha muhur drava mala pravritti – constipation altered with loose stools
Pooti mala – foul smelling stools

Sushruta explains that Grahani disease is an extension of untreated or improperly treated, mismanaged or neglected atisara (diarrhoea). This happens when the person who already has diarrhoea or is in the process of recovering would consume incompatible and unwholesome foods breeching all restrictions.

In the causes of Grahani Sushruta has enlisted Ahitashana and Charaka has mentioned sandushta bhojana (both meaning incompatible and unwholesome foods)

Grahani is a disorder which covers many pathological conditions of the modern day including irritable bowel syndrome (IBS), inflammatory bowel disease, sprue syndrome, chronic amoebiasis (steatorrhoea) etc

Kaphaja Grahani resembles amoebic dysentery

Symptoms –

• Dukha pachana – difficult or delayed digestion
• Hrillasa – nausea
• Chardi – vomiting
• Arochaka – tastelessness, anorexia
• Asya upadeha – coating on the tongue
• Madhurya – feeling of sweetness in the mouth
• Kasa – cough
• Shteevana – excessive expectoration
• Peenasa – running nose
• Hridayam manyate – feeling as if the heart is filled with liquid
• Styaanam udaram – lazy abdomen
• Stimitam – feel as if the belly is covered with wet cloth
• Guru – heaviness
• Dushta udgara – foul belchings
• Madhura udgara – sweet belchings
• Sadanam – lethargy
• Aalasya – laziness
• Dourbalya – weakness
• Nature of stools – Bhinna (unformed and watery, loose), ama (associated with indigested food), shleshma (mixed with mucus), guru (heavy)

Other conditions resembling Dysentery –
Vataja Grahani – In this pradushta bhojana (contaminated food) is said to be one of the causative factors as in dysentery. Nature of stools is said to be watery, thin, associated with ama, sounds and froath. It is associated with frequency of defecation, urgency, difficulty in defecation (tenesmus) etc symptoms alike in dysentery

Ajeerna – Ajeerna means indigestion. Pravahanam (tenesmus, repeated defecation and feel of incomplete evacuation) is one of the symptoms mentioned by Charaka.

Krimi Roga – Krimi is a word which envelopes all the microorganisms including bacteria, virus and fungi. Among the causes for krimi, viruddha bhojana (incompatible foods) is enlisted. Atisara or diarrhoea is one of the symptoms of krimi manifestation (sanjata krimi lakshana – Sushruta Uttara 58). Vidbheda (diarrhoea) is mentioned by Vagbhata as one of the symptoms of Purishaja Krimi (bacteria or microbes having their origin from contaminated stools or faeces). This probably points towards the knowledge of cysts passing through the stools by ancient Ayurveda teachers.

Ayurvedic treatment

Treatment principles and medicines for dysentery, Ayurveda perspective –
Ayurveda treatment of dysentery shall be done on the lines of:

• Pravahika Chikitsa
• Atisara Chikitsa (Ama atisara, Kaphaja Atisara, Rakta Atisara, Sannipataja Atisara)
• Grahani Roga Chikitsa (Kaphaja grahani)
• Ajeerna Chikitsa
• Krimi Roga Chikitsa

The treatments and medicines which I have enlisted in the upcoming portion of the blog will be a compilation of the treatments of all the above said conditions.

We should remember that for all the above said conditions, the causes are (in correlation to dysentery) – infection (krimi), agnimandhya and ajirna (low metabolism and indigestion) and inflammation of colon (high pitta in the colon).

The treatment principles of dysentery would be –

• To rectify the digestion and metabolism process and destroy ama by administration of deepana and pachana aushadhas
• Langhana (lightening therapies and medicines)
• To destroy the krimi (krimighna chikitsa)
• To check loose stools, to check the loss of water, electrolytes, blood and mucus (stambhana)
• To flush off the toxins and infection (ama, krimi, vishahara)
• Panchakarma measures, mainly Virechana (therapeutic purgation and enemas) after the active phase of infection and inflammation has subsided and after the passage of fluids and blood in the motion have been checked effectively
• Diet and lifestyle changes (Pathya Apathya vinishchaya)

Deepana, Pachana

Deepana Pachana Chikitsa, measures to cure ajeerna –
Deepana medicines are those which kindle the agni, i.e. the metabolic fire and act like appetizers. They rectify and enhance the metabolic process which had gone weak.

Pachana medicines are those which help in digesting ama (digestants) and removing them from the cells. Ama is a metabolic toxin. It is an intermediate product (bi-product) of digestion which by all means is harmful due to its harmful nature. Ama is the improperly processed or immature essence of digestion in circulation. Due to its sticky nature, ama tends to block the channels of the body and deprive the cells and organs of nutrition leading to cell and organ damage which in turn is the causative factor of all the diseases.

Indigestion and formation of systemic and cellular ama is a common feature of the gut related disorders, especially in diarrhoea, dysentery, IBS and sprue syndromes.

In dysentery lot of ama and ama visha are formed following infection and inflammation. In this condition stambhana (anti-diarrhoeal medicines should not be given. According to Ayurveda, in this stage of dysentery considered as sama avastha (stage of the disease associated with ama) the loose motions should not be controlled. In fact the ama should be digested and the agni rectified by the administration of deepana and pachana medicines.

Most of the medicines of deepana and pachana category will acto on the virtue of one or more of the katu (pungent), tikta (biter) or kashaya (astringent) tastes, ushna guna or veerya (hot nature or potency) and katu vipaka (post digestion effect). Many medicines act on the virtue of prabhava (disease modifying effect). All these taste and qualities mentioned above are best in destroying and eradicating krimis (pathogens, bacteria).

Deepana and pachana medicines help improve the digestion, destroys ama, expel krimis and thus reduce the gut inflammation and irritability. Thus, indirectly these medicines will be acting as anti-diarrhoeal medicines.

These are also the medicines which will cure ajeerna (indigestion)

The best drugs used for Deepana are –

• Pippali – Piper longum
• Pippalimula – Root of Piper longum
• Chavya – Piper retrofractum
• Chitraka – Plumbago zeylanica
• Shunti – Zingiber officinale
• Amlavetasa – Garcinia pedunculata
• Maricha – Piper nigrum
• Ajamoda – Trachyspermum ammi
• Bhallataka – Semecarpus anacardium
• Hingu – Ferula foetida
• Madhya – alcoholic or fermented products (medicated)
• Lavana –salt
• Ativisha – Aconitum heterophyllum
• Kiratatikta – Swertia chirata
• Hingu – Ferula foetida
• Triphala – fruits of Terminalia chebula, Terminalia bellirica and Emblica officinalis
• Mishreya – Bishop’s weed
• Shatapushpa – Anethum sowa
• Jeeraka – Cumin seeds
• Krishna Jeeraka – Black caraway
• Takra – buttermilk
• Pippalyadi group of herbs
• Bilwadi group of herbs
• Guduchyadi group of herbs
• Amalakyadi group of herbs

The first 5 herbs are called Panchakola

Ama-pachana – The best medicines which can get rid of ama are –

• Dhanyaka – Coriander
• Musta – Cyperus rotundus
• Pippalimula – Roots of Piper longum
• Maricha – Piper nigrum
• Shunti – Zingiber officinale
• Lavanga – Syzygium aramaticum
• Shaileya – Permelliya perforate
• Mulaka – Raphenus sativus
• Erandakarkati – Carica papaya
• Nagakeshara – Mesua ferrea
• Haridra – Turmeric
• Daruharidra – Berberis aristata
• Haritaki – Terminalia chebula
• Amalaki – Emblica officinalis
• Bibhitaki – Terminalia bellirica
• Kushta – Saussurea lappa
• Vacha – Acorus calamus
• Patha – Cissampelos pareira, Cyclea peltata
• Katuki – Picrorrhiza kurroa
• Ativisha – Aconitum heterophyllum
• Ela – Cardamom
• Bhallataka – Semecarpus anacardium
• Chitraka – Plumbago zeylanica
• Kiratatikta – Swertia chirata
• Trayamana – Gentiana kurroo
• Patola – Trichosanthes dioica
• Chandana – Santalum album
• Murva – Marsdenia tenacissima
• Guduchi – Tinospora cordifolia
• Parijata – Nyctanthes arbortristis
• Karavellaka – Bitter gourd
• Shigru – Drumstick
• Shana – Crotalaria juncea
• Tila – Sesame
• Sarshapa – Mustard
• Atasi – Flax
• Tikta skanda – bitter group of herbs
• Pippalyadi gana – herbs belonging to Pippalyadi group
• Dashamula – 10 roots
• Haridradi – Herbs belonging to Haridradi group
• Vachadi – Herbs of Vachadi group

Useful formulations for Deepana-Pachana (they also will control and cure the dysentery in the earlier stages) –

• Decoction of Vacha (Acorus calamus) and Ativisha (Aconitum heterophyllum)
• Decoction of Musta (Cyperus rotundus) and Parpataka (Fumaria indica)
• Decoction of shunti (ginger), ativisha (Aconitum heterophyllum), Musta (Cyperus rotundus),
• Paste of Shunti, ativisha and musta mixed in hot water
• Powder of Haritaki (Terminalia chebula) mixed in hot water
• Powder of shunti (ginger) mixed in hot water

Langhana

Langhana means lightening therapies. These are the therapies which induce lightness of the body and establish health.

Langhana helps the body to recover from the blocks and damages caused by ama. Langhana also destroys the morbidity by serving the purposes of deepana and pachana. Read more about Langhana

To destroy Krimi

Decoction of Dadima twak (bark of pomegranate tree) mixed with Tila taila (sesame oil)

Khadiradi kwatha – Decoction of Khadira (Acacia catechu), kutaja (Holarrhena antidysenterica), nimbi twak (neem bark), Vacha (Acorus calamus), shunti (ginger), pippali (long pepper), maricha (black pepper), amalaki (Indian gooseberry), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica) and Trivrit (Operculina turpethum) mixed with urine of cow (gomutra)

Nimbadi churna – Powder of Nimba twak (bark of neem), vatsaka twak (bark of Holarrhena antidysenterica), Vidanga (Embelia ribes), Saindhava Lavana (rock salt) and Hingu (purified asafoetida) taken with honey

Vidanga rasa, churna – decoction of Embelia ribes

Nimbi patra rasa – juice of tender leaves of neem with honey

Palasha beeja churna – powder of seeds of Butea monosperma with honey

Nimba twak churna (powder of bark of Neem plant) and Hingu (powder of asafoetida) mixed with honey

Powder of Nimba twak (powder of neem plant), ajamoda (celery seeds), vidanga (Embelia ribes), Palasha beeja (seeds of Butea monosperma), HIngu (asafoetida powder) and Guda (jaggery)

• Krimi mudgara rasa
• Krimi kutara rasa
• Krimighna vati
• Krimi ghatini vati
• Vidangarishta
• Vidanga churna

Stambhana chikitsa

Stambhana Chikitsa (anti-diarrhoeal medicines) –
Stambhana Chikitsa is done to check loose stools, to check the loss of water, electrolytes, blood and mucus
This can (should) be done only after the deepana and pachana have been carried out effectively and in the absence of ama.
In this portion I would put forth the compilation of effective formulations and treatments which are explained in atisara, pravahika and grahani.

Deepana and Sangrahi Gana (group of medicines which act as appetizers, metabolizers and anti-diarrhoeal) –

• Shalaparni – Desmodium gangeticum
• Prishniparni – Uraria picta
• Brihati – Solanum indicum
• Kantakari – Solanum xanthocarpum
• Gokshura – Tribulus terrestris
• Bala – Sida cordifolia
• Bilwa – Aegle marmelos
• Patha – Cissampelos pareira
• Shunti – Zingiber officinale
• Dhanyaka – Coriandrum sativum
• Shatee – Tephrosea purpurea
• Palasha – Butea monosperma
• Hapusha – Juniperus communis
• Vacha – Acorus calamus
• Jeeraka – Cuminum cymini
• Pippali – Piper longum
• Yavani – Trachyspermum ammi
• Pippali moola – root of Piper longum
• Chitraka – Plumbago zeylanica
• Hasti pippali – Scindapsus officinalis
• Vrikshamla – Garcinia indica
• Daadima – Punica granatum
• Hingu – asafoetida
• Saindhava Lavana – rock salt
• Vida lavana – Vida salt

The above said medicines should be used to process the food. They destroy morbid vata, kapha and ama. They can be skilfully used individually or in combinations. They are multi-purpose in nature i.e. deepana (appetizer), pachana (digestant), sangrahi (anti-diarrhoeal), balya (strength promoters), rochaka (enhances taste)

Ayurvedic formulations

Useful classical formulations for dysentery –

• Ativishadi yoga (pitta atisara) – paste of ativisha (Aconitum heterophyllum), indrayava (seeds of Holarrhena antidysenterica) and the bark of the same plant made in honey should be given along with tandulodaka (rice wash)
• Kiratadi churna – powder of Kiratatikta (Swertia chirayata), Musta (Cyperus rotundus), Vatsaka (seeds of Holarrhena antidysenterica) and Rasanjana (extract of Berberis aristata) mixed in honey and made into a paste is administered with Tandulodaka (rice wash)
• Bilwadi kwatha – decoction of Bilwa (Aegle marmelos), Karkatasringi (Pistacia chinensis), Musta (Cyperus roundus), Haritaki (Terminalia chebula) and Shunti (Ginger) – Kaphaja Atisara
• Vachadi Kwatha – Decoction of Vacha (Acorus calamus), Vidanga (Embelia ribes), Ajamoda (carom seeds), Dhanyaka (coriander seeds) and Devadaru (Cedrus deodara) – in Kaphaja atisara
• Pippali churna (powder of Long pepper) mixed in honey followed by buttermilk mixed with powder of Chitraka (Plumbago zeylanica) or bilwa majja (pulp of raw bael fruit) – Kaphaja atisara
• Decoction of Ativisha (Aconitum heterophyllum), shunti (ginger), Pippali (long pepper) and maricha (black pepper) mixed with saindhava lavana (rock salt, yavakshara (alkali of barley plant) and hingu i.e asafoetida which has been fried in ghee – Pitta and Kaphaja Grahani
• Ativishadi churna (powder of the above mentioned herbs) mixed in hot water – Pittaja and Kaphaja Grahani
• Powder of Kutaja twak (bark of Holarrhena antidysenterica) and Ativisha (Aconitum heterophyllum) taken with honey wards off bleeding dysentery
• Juices of Jambu (Eugenia jambolana, Jamun fruit), Amra (mango) and Amalaki (Indian gooseberry) mixed with honey, ghee and milk – Raktatisara (bloody diarrhoea)
• Bala bilwa majja (pulp of tender or unripe bael fruit), guda (jaggery), tila taila (sesame oil), pippali (long pepper) and shunti (ginger) – paste of all these relieves tenesmus and dysentery
• Paste of Pippali (long pepper) or Maricha (black pepper) mixed in milk
• Aja dugdha (goat milk) mixed with honey and sugar is wholesome in Rakta atisara
• Paste of Shatavari (Asparagus racemosus) mixed in milk, followed by diet rich in only milk (Rakta atisara)
• Ghee processed with seeds of Holarrhena antidysenterica with Yavagu (Rakta atisara)
• Paste of Tila (sesame seeds) and sugar mixed in 1:4 ratio should be administered with goats milk (raktatisara)
• Powder of chandana (sandal) mixed in honey should be consumed with Tandulodaka (rice water)

Panchakarma treatments

Panchakarma options in dysentery –
Panchakarma doesn’t have a great role in the treatment of Dysentery, especially in its earlier stages. Earlier stages of dysentery have to be managed with simple formulations which enhance metabolism and digestion process, get rid of ama and krimi (metabolic toxins and pathogens) and check bleeding and fluid loss. Proper diet and lifestyle changes need to be planned.

Panchakarma procedures will be beneficial in the later part of the disease, chronic stages of dysentery and in stubborn disease with complications. Among the Panchakarma, Virechana (therapeutic purgation) and Niruha Vasti (decoction enema) will be highly beneficial to flush out the ama, krimi and other toxins and establish health of the colon and stomach. Anuvasana (oil or ghee enema) will be handy in strengthening the colon and intestines and providing long standing immunity against the disease.

Pichcha Vasti is the ultimate choice among the Vasti’s to treat chronic and stubborn dysentery and diarrhoeas.

Pichcha Vasti  for dysentery:
This type of Vasti is prepared using Pichcha dravyas (medicines having slimy nature). The intention is to stop the loss of pichcha (slimy substance of the body which holds the integrity of our body) and jeeva shonita (fresh blood) by checking them through their coagulant or anti-diarrhoeal property (stambhana). This can be included into the category of grahi or sangrahi vasti.

Laghu Ahara

Laghu Ahara (light diet) in dysentery –
The lightest food format comes in the forms of:
Yavagu – is a liquid preparation in the form of thin gruel wherein rice (1part) is processed in 6 times water. It is seen that the final preparation has more of liquid than solid.

Vilepi – is a liquid preparation in the form of thin gruel wherein rice (1part) is processed in 4 times water. It is seen that the final preparation is of a semisolid nature. Apart from being nutritious and tasty, it is known to destroy ama by its root and kindle the belly fire.

Peya – is a liquid preparation in the form of thin gruel wherein rice (1part) is processed in 14 times water. It is seen that the final preparation has a small quantity of solid portion left over.

Manda – is a liquid preparation in the form of thin gruel wherein rice (1part) is processed in 14 times water. It is seen that the entire solid content is filtered out from the final preparation such that only liquid remains.

Yusha – is a liquid preparation in the form of thin gruel wherein dal i.e. grams mainly green gram (1part) is processed in 18 times water and its extract is filtered out.

Wholesome food and activities

Pathya for dysentery (wholesome food and activities) –

• Langhana – fasting
• Vamana – therapeutic vomiting
• Nidraa – sleep
• Purana shali – old rice
• Shashtika shali – paddy grown in 60 days
• Vilepi – type of gruel
• Laja manda – thin gruel prepared using parched rice or puffed rice
• Masura rasa – juice or decoction of red lentils
• Ena and Harina rasa – meat soup of deer
• Kshudra matsya – all types of small fishes
• Taila – sesame oil
• Chaga ghrita – ghee prepared from the milk of goat
• Chaga ksheera – goat milk
• Chaga takra – buttermilk prepared from goats milk
• Chaga dadhi – curds prepared from goat’s milk
• Go ksheera – milk of cow
• Go dadhi – curds made out of cow’s milk
• Go-aja-navaneeta – butter extracted from buttermilk prepared from the milk of goat and cow
• Nava rambha pushpa phala – unripe flower and fruit of plantain and dishes prepared from them
• Kshoudra – honey
• Jambu phala – Jamun fruit
• Maha ardraka – large sized ginger available in forests
• Shunti – ginger
• Kapitta – Feronia limonia
• Bilwa – Bael fruit
• Dadima – Pomegranate
• Changeri – Oxalis corniculata
• Vijaya (Bhang) – Marijuana
• Manjishta – Rubia cordifolia
• Jatiphala – Myristica fragrans (Nutmeg)
• Jeeraka – Cumin seeds
• Ahiphena – opium
• Dhanyaka – coriander
• Maha nimba – Ailantus malabarica
• Kashaya rasa – astringent taste
• Deepana annapana – all the foods and drinks which act as deepana (digestion promoters)
• Laghu annapana – all foods and drinks which are easy to digest

Unwholesome food and activities

Apathya for dysentery (unwholesome food and lifestyle) –

• Swedana – fomentation or sweat inducing treatments
• Anjana – collyrium (medicinal applications to the eyes)
• Rakta mokshana – bloodletting
• Jala paana – drinking water
• Snaana – bath
• Vyavaaya – sexual intercourse
• Jagarana – awakening late nights
• Dhumrapana – smoking
• Nasyam – nasal medication
• Abhyanjana – massage
• Sakala vega dharanam – forcibly withholding the natural reflexes
• Ruksha ashana – dry foods
• Asaatmya ashana – unwholesome foods
• Viruddha ashana – mutually incompatible foods
• Godhuma – wheat
• Masha – black gram
• Yava – barley
• Kakamachi – Solanum nigrum (Makoy)
• Puga – betel nut
• Kushmanda – ash gourd
• Tumbi – cucumber
• Badara – jujube fruit
• Guru annapanam – heavy to digest foods and drinks
• Tambula – betel leaves
• Ikshu – sugarcane
• Guda – jaggery
• Madhya – alcohol
• Draksha – raisins
• Amlavetasa – Garcinia pedunculata
• Lashuna – garlic
• Dushta ambu – contaminated water
• Mastu – supernatant water of curds
• Kanji – fermented liquids
• Narikela – coconut
• Snehakarma – oleation in the form of medicated ghee or oil (oral)
• Akhila patra shaka – all types of leafy vegetables
• Ksheeram – milk
• Saaraka – laxatives
• Lavana – excessive use of salts
• Amla – excessive use of sour foods
• Avagahana – tub bath
• Vyayama – excessive exercise
• Agni – exposure to heat

Ayurvedic medicines

Classical formulations for Dysentery –
Churnas (powders):

• Laghu Gangadhara Churna
• Vriddha Gangadhara Churna
• Pushyanuga churna
• Dadimashtaka Churna
• Kapittadi churna (kaphaja atisara)
• Balachaturbhadra churna
• Rajanyadi churna
• Bhaskaralavana churna
• Hingwadi churna
• Hingwashtaka churna
• Bhunimbadi kwatha

Vati and rasa (tablets and herbo-mineral preparations):

• Chitrakadi Vati
• Lashunadi vati
• Agnikumara rasa
• Muktapanchamrita rasa
• Navajivana rasa
• Rasa karpura
• Shankodara rasa
• Mruta sanjeevani rasa
• Chandraprabha vati
• Kutaja Ghana vati
• Kanaka sundara vati
• Shankha vati
• Agasti sutaraja rasa
• Karpura rasa
• Kumara kalyana rasa
• Sutasekara rasa
• Punarnavadi mandura

Parpati preparations –

• Suvarna rasaparpati
• Grahani kapata rasa
• Rasa parpati
• Panchamrita parpati
• Lauha parpati

Bhasmas:

• Kapardika bhasma
• Loha bhasma
• Naga bhasma
• Shanka bhasma
• Yashada bhasma
• Vaikranta bhasma

Asavas and Arishtas (Fermented herbal liquids):

• Kutajarishta
• Takrarishta
• Jeerakarishta
• Mustarishta
• Mruta sanjeevani sura
• Pippalyadyasava
• Rohitakarishta
• Dashamularishta
• Devadarvarishta

Ghrita (medicated ghee):

• Changeri ghrita (kaphaja atisara)
• Purana ghrita (kaphaja atisara)
• Shatavari ghrita (raktatisara)
• Tiktaka ghrita
• Shunthi Ghrita

Avaleha (confections):

• Dadimavaleha
• Kutajadi avaleha
• Dadimashtaka leham
• Kalyanaka Avaleha

Proprietary medicines for dysentery –

• Tab Amoebica (Baidyanath company)
• Cap Amoebrid (Bal Vedics)
• Cap and Syrup Bactefar (Ayulabs)
• Bilagyl granules (Sandu)
• Cap Mobic (Trio)
• Syrup Colicarmin (BAN)
• Tab Diarex (Himalaya)
• Tab Diasyn (J & J)
• Dysentrol (Dhanwantri)
• Syrup Dysnorm (Bajaj)
• Syrup and Tab Entostal (Solumiks)
• Cap Imidin (IMIS)
• Tab Intokam (Anuja)
• Tab Koshta-Sanjivini (Pavaman)
• Tab Kutajadi (Pavaman)
• Cap Mayo (Kumar)
• Cap and syrup Mebarid (Phyto pharma)
• Tab Berb-Enterone (Sandu)

Medicinal formulations for Atisara from Sahasra yoga text book

Atisarahara kashaya
Kaphapittatisarahara peya
Raktatisarahara peya
Patha karanjadi ghrita
Laghu gangadhara choorna
Pushyanuga choorna
Vishawajamodadi choorna
Nimbadi choorna
Kapitthashtaka choorna
Dadimashtaka choorna
Modakadi choorna
Jeerakadyarishta
Kutajarishta
Mustakarishta
Kutajavaleha
Charngeri rasayana
Kutajadyavaleha
Lavangadyam modakam
Setubandha matra
Paccha Endiyadi Gutika
Jatikkadi Gutika
Sankhapani Rasa
Ananda Rasa
Kanaka sundara Rasa
Ashtakshari Gutika
Mudgadi kashaya
Muviladi kanni Kashaya
Charngeryadi Morkanni
Suradarvadi Kashaya
Bilwambudadi Kashaya
Punkin Toladi Ghrita
Amragandhadi Ghrita

Medicinal formulations for Pravahika From Sahasra Yoga Text Book
Laghu Gangadhara Choorna
Vriddha Gangadhara Choorna
Nagaradi Choorna
Mustakarishta
Kutajadyavaleha
Suradarvadi Kashaya

Clinical experience

My experience –
In my 19 years of clinical experience, I have never felt it difficult to solve the mystery of dysentery, diarrhoea or in fact any gut related disorders, thanks to effective Ayurvedic medicines and treatments. Generally I have found that people deal with dysentery or diarrhoea by simple home remedies which have been traditionally followed in the Indian homes, the Indian kitchen being a small pharmacy by itself. Many useful herbs like ginger, turmeric, cumin seeds, asafoetida, pepper etc are a part of kitchen.

Educated people who do not wish to risk with self treatment, would definitely give a call, so did I have from my patients. Since there are many options of prescriptions I never felt it an issue to handle diarrhoea or dysentery effectively. I have successfully used many of the above said formulations and have found good success.

Many times simple formulations which can be managed at home with kitchen recipes and light diet (manda, peya, yusha etc explained above) have taken cause of dysentery in a couple of days. I have insisted patients not to neglect dysentery and to undergo Virechana after 2-3 weeks after the symptoms have come down. This has helped patients having susceptible gut (having frequent colon upsets) to get rid of the problem permanently. This also helps in flushing out the toxins, micro-organisms and ama and preventing relapses. I have never forgotten to put my patients on Rasayana (immune-modulators) for at least 2-3 months after the symptoms have totally gone and after any relapse has not been seen.

Just before finishing –
Before concluding the article I would like to declare that Ayurveda is highly successful in handling cases of dysentery, including the most complicated and carrier stages also, to eradicate the cysts permanently. Ayurvedic medicines are comprehensive packages of goodness. They not only have disease modifying and eradicating property but also will work towards sustaining the strength of the patient and in resuscitating the energy and immunity. The medicines by themselves are formulated in such a skilful manner that they de-root the disease from its base and also prevent recurrences. I have seen Langhana (fasting) and laghu ahara (light diets explained above) itself to be highly effective, just like oral rehydration or intravenous hydration of the patient, or even more!! Langhana, Laghu Ahara, Aushadha (medicines) and Pathya (wholesome diet) are the keys for successful treatment of dysentery.
Click to Consult Dr Raghuram Y.S. MD (Ayu)