Ashtanga Hridayam Nidanasthanam Chapter 8:  Atisara Grahanidosha Nidanam Adhyaya (Diagnosis of diarrhea and duodenal disorders)

The 8th chapter of Nidanasthanam of Ashtanga Hridayam is named as Atisara Grahani Dosa Nidanam Adhyayah. This chapter deals with the explanation of ‘diagnosis of diarrhea and duodenal disorders’.

The topics covered in this chapter include –

–       Atisara Bheda – kinds of diarrhea
–       Nidana-Samprapti – causes and pathogenesis
–       Purvarupa – premonitory symptoms
–       Rupa – clinical features of diarrhea
–       Vataja, pittaja, kaphaja, tridoshaja, bhayaja and shokaja atisara
symptoms
–       Sama and Nirama atisara
–       Grahani Dosha Nidanam – diagnosis of duodenal disorders
–       Grahani Dosha bheda – kinds of duodenal disorders
–       Purvarupa – premonitory symptoms of diarrhea
–       Rupa – clinical features of diarrhea
–       Vataja, pittaja, kaphaja, tridoshaja grahani symptoms
–       Ashta maharogas – eight great diseases

Pledge by the author(s)

अथातोऽतीसार ग्रहणीदोषनिदानं व्याख्यास्याम ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘diagnosis of diarrhea and duodenal disorders’. Thus say (pledge) Atreya and other sages.

Atisara Bheda (kinds of diarrhea)

दोषै: व्यस्तैः समस्तैश्च भयात् शोकात् च षड्विधः ।
अतीसारः
Atisara (diarrhea) is of six kinds; viz. from each Dosha separately, from all of them together, one each from fear and grief.

Nidana Samprapti (causes and pathogenesis)

सुतरां जायतेऽत्यम्बुपानतः ॥ १ ॥
कृशशुष्कामिषासात्म्यतिलपिष्टविरूढकैः ।
मद्यरूक्षातिमात्रान्नैरर्शोभिः स्नेहविभ्रमात् ॥ २ ॥
कृमिभ्यो वेगरोधाच्च तद्विधैः कुपितोऽनिलः ।
विस्रंसयत्यधोऽब्धातुं हत्वा तेनैव चानलम् ॥ ३ ॥
व्यापद्यानुशकृत् कोष्ठं पुरीषं द्रवतां नयन् ।
प्रकल्पतेऽतिसाराय
It chiefly arises from drinking large quantity of water, eating meat which is emaciated and dry, unaccustomed foods, puddings, of Tila – Sesamum indicum (sesame seeds), sprouted grains, excess of wine, foods which are dry (non-fatty) and in large quantity; from Arsas (piles), improper oleation therapy, worms (intestinal parasites), suppression of urges and such others. Anila (Vata) getting aggravated, makes the Apdhatu (watery tissues) to move downwards; destroying the Anala (digestive fire), invades the Kostha (alimentary tract), makes the faeces watery and produces atisara (diarrhea).

Purvarupa (premonitory symptoms)

लक्षणं तस्य भाविनः ॥ ४ ॥
तोदो हृद्गुदकोष्ठेषु गात्रसादो मलग्रहः ।
आध्मानमविपाकश्च
Its premonitory symptoms are pricking pain in the region of the heart, rectum and alimentary tract; weakness of the body, constipation, flatulence and indigestion.

Rupa (clinical features)

Vataja Atisara

तत्र वातेन विड्जलम् ॥ ५ ॥
अल्पाल्पं शब्दशूलाढ्यं विबद्धमुपवेश्यते।
रूक्षं सफेनमच्छं च ग्रथितं वा मुहुर्मुहुः ॥ ६ ॥
तथा दग्धगुडाभासं सपिच्छापरिकर्तिकम् ।
शुष्कास्यो भ्रष्टपायुश्च हृष्टरोमा विनिष्टनन् ॥ ७ ॥
In diarrhea caused by Vata, the faeces is watery, very less in quantity, expelled out with noise, severe pain and difficulty; it may be dry, mixed with froth, thin or scabelous and expelled often; or it may resemble over-burnt jaggery and mixed with slimy material; cutting pain in the anal region, the person has dryness of the mouth, prolapsed of the rectum, horripilation and straining at stools.

Pittaja Atisara

पित्तेन पीतमसितं हारिद्रं शाद्वलप्रभम् ।
सरक्तमतिदुर्गन्धं तृण्मूर्छास्वेददाहवान् ॥ ८ ॥
सशूलं पायुसन्तापपाकवाञ्
In that caused by Pitta, the faeces is yellow, black, turmeric like (deep yellow) or algae like (green); mixed with blood and foul smelling, the person has thirst, fainting, perspiration, burning sensation; elimination is accompanied with pain, burning sensation and ulceration of the rectum.

Kaphaja Atisara

छ्लेष्मणा घनम् ।
पिच्छिलं तन्तुमच्छ्वेतं स्निग्धमामं कफान्वितम् ॥ ९ ॥
अभीक्ष्णं गुरु दुर्गन्धं विबद्धं अनुबद्धरुक् ।
निद्रालुरलसोऽन्नद्विड् अल्पाल्पं सप्रवाहिकम् ॥ १० ॥
सरोमहर्षं सोत्क्लेशो गुरुवस्तिगुदोदरः ।
In that due to Slesma (Kapha) the faeces is solid, slimy, thready, white, fatty, uncooked, mixed with Kapha (mucus), frequent, heavy foul-smelling, accompanied with difficulty of elimination and followed by pain; the person is always sleepy, lazy, dislikes food, has slight (mild) straining at stools (or tenesmus) always; horripilation, nausea, feeling of heaviness of the urinary bladder, rectum and abdomen and feeling of non-elimination (of feaces) though actually eliminated.

Tridoshaja Atisara

सर्वात्मा सर्वलक्षणः॥११॥
That caused by all the Doshas will have all the features (simultaneously).

Bhayaja and Shokaja Atisara

भयेन क्षोभिते चित्ते सपित्तो द्रावयेच्छकृत् ।
वायुस्ततोऽतिसार्येत क्षिप्रमुष्णं द्रवं प्लवम् ॥ १२ ॥
वातपित्तसमं लिङ्गैराहुस्तद्वच्च शोकतः ।
The mind getting disordered by fear, makes for increase of Pitta and Vayu (Vata) which cause the faeces to become liquid, and produce diarrhea. Elimination is quick, faeces is warm, fluid and floating (on water); the person having symptoms caused by Vata and Pitta; that (diarrhea) caused by grief is also similar.

Sama and Nirama types of Atisara

अतीसारः समासेन द्विधा सामो निरामकः ॥ १३ ॥
सासृङ् निरस्रस्तत्राद्ये गौरवादप्सु मज्जति ।
शकृद्दुर्गन्धमाटोपविष्टम्भार्तिप्रसेकिनः ॥ १४ ॥
विपरीतो निरामस्तु कफात्पक्वोऽपि मज्जति ।
In brief, diarrhea is of two kinds viz, Sama (associated with Ama) and Nirama (unassociated with Ama) and Sasra mixed with blood and Nirasra not mixed with blood. In the first (Sama) the faeces is heavy and so sinks in water, has foul smell, accompanied with intestinal gurgling, stasis of undigested food in the stomach, pain in the abdomen and more salivation; Nirama (which is not having Ama) has opposite features; feces containing more of Kapha also sink though it is ripe.

Grahani Dosha Nidanam (diagnosis of duodenal disorders)

अतीसारेषु यो नातियत्नवान् ग्रहणीगदः ॥ १५ ॥
तस्य स्यादग्निविध्वंसकरैरन्यस्य सेवितैः ।
The patient of diarrhea who does not try much (to get cured of it) becomes affected by disorders of Grahani (duodenum); so also even others who indulge in things (food and activities) which destroy the Agni (digestive activity).

Grahani Dosha Nidanam (diagnosis of duodenal disorders)

सामं शकृन्निरामं वा जीर्णे येनातिसार्यते ॥ १६ ॥
सोऽतीसारोऽतिसरणादाशुकारी स्वभावतः ।
सामं सान्नमजीर्णेऽन्ने जीर्णे पक्वं तु नैव वा ॥ १७ ॥
अकस्माद्वा मुहुर्बद्धमकस्माच्छिथिलं मुहुः ।
चिरकृद्ग्रहणीदोषः सञ्चयाच्चोपवेशयेत् ॥ १८ ॥
Too many elimination of feces with or without admixture of Ama, after the digestion of food is Atisara (diarrhea) which by nature, is going to cause death soon; whereas in Grahani Dosha (disorder of duodenum) the faeces is mixed with Ama and food, eliminated either when the food is undigested, during digestion or after digestion; or there may be no eliminations (of faeces) at all; the faeces is sometimes eliminated solid and some other times loose (liquid) without any other reason; elimination occurs only after accumulation (in the large intestine); this disease causing death after a long time.

Grahani Dosha Bheda (kinds of duodenal disorders)

स चतुर्धा पृथग्दोषैः सन्निपाताच्च जायते ।
It is of four kinds; (one) from each Dosha separately and from all of them together.

Purvarupa (premonitory symptoms)

प्राग्रूपं तस्य सदनं चिरात्पचनमम्लकः ॥ १९ ॥
प्रसेको वक्त्रवैरस्यमरुचिस्तृट् क्लमो भ्रमः ।
आनद्धोदरता छर्दिः कर्णक्ष्वेडोऽन्त्रकूजनम् ॥ २० ॥
Its premonitory symptoms are-weakness, digestion after a long time, sourness (increased acidity), salivation, bad taste in the mouth, loss of taste/appetite, thirst, exhaustion, dizziness, distension of the abdomen, vomiting, noise in the ears and intestinal gurgling

Rupa (clinical features)

सामान्यं लक्षणं कार्श्यं धूमकस्तमको ज्वरः ।
मूर्छा शिरोरुग्विष्टम्भः श्वयथुः करपादयोः ॥ २१ ॥
Its general symptoms are emaciation, feeling of hot fumes coming out from the mouth Tamaka (dyspnoea), fever, fainting, headache, stasis of undigested food in the stomach and swelling of the hands and feet.

Vataja Grahani

तत्रानिलात्तालुशोषस्तिमिरं कर्णयोः स्वनः ।
पार्श्वोरुवङ्क्षणग्रीवारुजाभीक्ष्णं विषूचिका ॥ २२ ॥
रसेषु गृद्धिः सर्वेषु क्षुत्तृष्णा परिकर्तिका ।
जीर्णे जीर्यति चाध्मानं भुक्ते स्वास्थ्यं समश्नुते ॥ २३ ॥
वातहृद्रोगगुल्मार्शःप्लीहपाण्डुत्वशङ्कितः ।
चिराद्दुःखं द्रवं शुष्कं तन्वामं शब्दफेनवत् ॥ २४ ॥
पुनः पुनः सृजेद्वर्चः पायुरुक्श्वासकासवान् ।
In that caused by Anila (Vata), there is dryness of the palate, feeling of blindness, noise in the ears; constant pain in the flanks, thighs, groins and neck, Visucika (vomiting and diarrhea simultaneously), desire for (things of all the tastes, increased hunger and thirst, cutting pain in the rectum, flatulence after and during digestion, feels comfortable by taking food; leads to suspicion of disease of the heart, abdominal tumor, piles, disease of the spleen and anemia – all of Vata origin; patient eliminates faeces alter long intervals, with difficulty; faeces is liquid, dry (non-unctuous), thin, uncooked, frothy, and increased frequency, accompanied with pain in the rectum, dyspnea and cough.

Pittaja Grahani

पित्तेन नीलपीताभं पीताभः सृजति द्रवम् ॥ २५ ॥
पूत्यम्लोद्गारहृत्कण्ठदाहारुचितृडर्दितः ।
In that caused by Pitta, the feces is bluish-yellow or yellow, and liquid; the person has bad smelling, sour belching, burning sensation in the region of the heart and throat, loss of taste/appetite and thirst.

Kaphaja Grahani

श्लेष्मणा पच्यते दुःखमन्नं छर्दिररोचकः ॥ २६ ॥
आस्योपदेहनिष्ठीवकासहृल्लासपीनसाः ।
हृदयं मन्यते स्त्यानमुदरं स्तिमितं गुरु ॥ २७ ॥
उद्गारो दुष्टमधुरः सदनं स्त्रीष्वहर्षणम् ।
भिन्नामश्लेष्मसंसृष्टगुरुवर्चःप्रवर्तनम् ॥ २८ ॥
अकृशस्यापि दौर्बल्यं
In that caused by Slesma (Kapha), the food is digested with difficulty, there is vomiting, loss of taste/appetite, coating of the mouth, expectoration, cough, nausea, nasal catarrh, the person feels his throat / heart as solid (heavy) and abdomen as static (movement less), damp and heavy; impure belching (with bad smell) and sweet; debility, lack of desire for women (sex), elimination of faeces which is broken, uncooked, mixed with mucus, and heavy or large in quantity, and feeling of weakness even though not emaciated.

Tridoshaja Grahani

सर्वजे सर्वसङ्करः ।
विभागेऽङ्गस्य ये चोक्ता विषमाद्यास्त्रयोऽग्नयः ॥ २९ ॥
तेऽपि स्युर्ग्रहणीदोषाः समस्तु स्वास्थ्यकारणम् ॥ ३०अब् ॥
In that due to all the Doshas, all the symptoms are present. Even Visamagni and other kinds of Agnis (kinds of digestive activities) described in Angavibhava (chapter 3 of Sarirasthana) are also Grahani Dosha (disorders of the duodenum); the Samagni (normal digestive agency) only is the cause for health.

Ashta Maharogas: Eight great diseases

वातव्याध्यश्मरीकुष्ठमेहोदरभगन्दराः ॥ ३०- ॥
अर्शांसि ग्रहणीत्यष्टौ महारोगाः सुदुस्तराः ॥ ३०- ॥
Vatavyadhi (nervous disease), Ashmari (urinary calculus), Kustha (leprosy), Meha (diabetes) udara (enlargement of the abdomen), Bhagandara (fistula-in-ano), Arshas (piles, haemorrhoids) and Grahani (duodenal disease) these eight Maharogas (great diseases) are difficult to treat.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थानेऽतीसारग्रहणिदोषनिदानं नामाष्टमोऽध्याय: ।।१॥
Thus ends the chapter Atisara-Grahani Nidana – the eighth in Nidanasthana of AstangaHrdaya Samhita, composed by Srimad Vagbhata, son of Sri VaidyapatiSimhagupta.