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|title=Prasrita Yogiyam Siddhi
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|keywords=atisara, basti, doshanulomana, grahi, karsha, karmanaviplutanam, niruha, pachana, Panchakarma, prasrita, prastha, snehabasti, vyapat, enema in delicate persons, complication of Panchakarma,Ayurveda, Indian system of medicine, charak samhita. 
|description=Siddhi Sthana Chapter 8. Standardized therapeutic enema formulations in a dose of ''Prasrita'' Unit
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<big>'''[[Siddhi Sthana]] Chapter 8. Standardized therapeutic enema formulations in a dose of ''Prasrita'' Unit'''</big>
{{Infobox
|title =  Prasrita Yogiyam Siddhi
|label1 = Section/Chapter
|data1 = [[Siddhi Sthana]] Chapter 8
|label2 = Preceding Chapter
|data2 = [[Bastivyapat Siddhi]]
|label4 = Succeeding Chapter
|data4 = [[Trimarmiya Siddhi]]
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]]
|label6 = Translator and commentator
|data6 = Gupta S.N.
|label7 = Reviewer 
|data7  = Panse A.
|label8 = Editors
|data8  = Thakar A. B., Mangalasseri P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication 
|data9 =  2020
|label10 = Publisher 
|data10 =  [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI 
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s08.009 10.47468/CSNE.2020.e01.s08.009]
}}
<big>''' Abstract </big>'''
<p style="text-align:justify;">This chapter describes recipes of ''prasritayogiya bastis'' (enema formulation in which ingredients are measured in unit of ''prasrita''). ''Prasrita'' is a measurement, which is approximately equal to 100 millilitre.  Nine types of ''[[basti]]'' therapies for various clinical conditions including ''prameha'' (urinary disorders including diabetes), ''abhishyanda'' (oozing), ''kushtha'' (skin diseases), ''krimi'' (worm infestation), ''mutrakrichchra'' (dysuria) and alike are described. ''Atisara'', a clinical condition characterized by frequent defecation with altered composition and consistency of stool is described in detail. ''Atisara'' has various forms depending upon involvement of six morbid components in the pathogenesis viz. ''ama'' (stool with undigested material), ''shakrita'' (stool only), ''[[vata]]'' (with dominant flatulence), ''asrik'' (stool with blood), ''[[pitta]]'' and ''[[kapha]]''. Different recipes of ''[[basti]]'', oral medicaments and food preparations are described to treat these ''atisara'' conditions. These remedies are practically quite useful in several modern diseases like ulcerative colitis and irritable bowel syndrome.
<br/>
'''Keywords''':  ''atisara, [[basti]], doshanulomana, grahi, karsha, karmanaviplutanam, niruha, [[pachana]],'' [[Panchakarma]], ''prasrita, prastha,  snehabasti, vyapat,'' enema in delicate persons, complication of [[Panchakarma]].
</p>


== Introduction ==
<div style="text-align:justify;">
There are two main types of ''[[basti]]'' according to the composition and the action. ''Anuvasana basti'' is composed of unctuous substance and it is to be retained for minimum nine hours. ''Asthapana basti'' contains mainly decoction with least oil and is evacuated after few minutes. ''[[Basti]]'' is administered through ano-rectal route and acting through the ''pakvashaya'' (colon). It is useful in several diseases particularly [[vata]] disorders having roots in ''pakvashaya''. It is claimed to be half a treatment or even a complete treatment by ancient practitioners<ref>Charak. Siddhi Sthana, Cha.1 Kalpana Siddhi Adhyaya verse 38-40. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi:Munshiram Manoharlal publishers pvt. Ltd; 1981; P 683-684.</ref>. It is not only a procedure of ''[[shodhana]]'' but also providing a recto-colonic route of drug administration. 

Previous chapter ([[Bastivyapat Siddhi]]) deals with the ''vyapat'' (complications) arising due to faulty application of ''[[basti]]s''. Present chapter begins with the treatment of those patients who developed complications as a result of faulty application of therapies (''karmana viplutanam'') and for the tender persons who are not able to tolerate strong measures. For this purpose, chapter describes mild form of ''niruha bastis''. The ingredients of these ''[[basti]]s'' are measured in the unit of ''prasrita''. Therefore the name of the chapter is [[Prasrita Yogiyam Siddhi]]. The unit ''prasrita'' is equal to two ''palas'', which is approximately equal to 100 milliliter (1 ''pala''= approx. 50 ml).<ref>Chakrapani, Charak. Siddhi Sthana, Cha.8 Bastivyapad Siddhi ver.04. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed.New Delhi:Munshiram Manoharlal publishers pvt. Ltd; 1981; P 713</ref><ref>Agnihotri Avadhabihari; Bhaiṣajyakalpanā Vijñāna; Chaukhamba orientalia publication, 6th edition, 2006, P 7-20</ref>

== Sanskrit text, Transliteration and English Translation ==
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अथातः प्रासृतयोगीयां सिद्धिं व्याख्यास्यामः||१|| 

इति ह स्माह भगवानात्रेयः||२||
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Athātaḥ prāsṛtayōgīyāṁ siddhiṁ vyākhyāsyāmaḥ ||1|| 

iti ha smāha bhagavānātrēyaḥ ||2||

athAtaH prAsRutayogIyAM siddhiM vyAkhyAsyAmaH||1|| 

iti ha smAha bhagavAnAtreyaH||2||
</div></div>

Now we shall expound the chapter "Prasrita Yogiyam Siddhi" (Standardized therapeutic enema formulations in a dose of ''Prasrita'' Unit). Thus said Lord Atreya. [1-2]

Note: The chapter describes the formulations having ingredients measured in the unit ''prasrita''(approximately equal to 100 millilitre).

=== Objective of ''prasrita basti'' ===
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अथेमान् सुकुमाराणां निरूहान् स्नेहनान् मृदून्| 

कर्मणा विप्लुतानां च वक्ष्यामि प्रसृतैः पृथक्||३|| 
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athēmān sukumārāṇāṁ nirūhān snēhanān  mṛdūn| 

karmaṇā viplutānāṁ ca vakṣyāmi prasṛtaiḥ pṛthak||3||

athemAn sukumArANAM nirUhAn snehanAn mRudUn| 

karmaNA viplutAnAM ca vakShyAmi prasRutaiH pRuthak||3||
</div></div>

Now, I (Atreya) shall explain oleaginous and mild form of ''niruha [[basti]]s'', for the tender persons and the patients suffered from complications as a result of therapies. Composition of those will be in the unit of ''prasrita''. [3]

=== ''Pancha prasritiki Basti''-I ===
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क्षीराद्द्वौ प्रसृतौ कार्यौ मधुतैलघृतात्त्रयः| 

खजेन मथितो बस्तिर्वातघ्नो बलवर्णकृत्||४|| 
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kṣīrāddvau prasṛtau kāryau madhutailaghṛtāttrayaḥ| 

khajēna mathitō bastirvātaghno balavarṇakṛt||4|| 

kShIrAddvau prasRutau kAryau madhutailaghRutAttrayaH| 

khajena mathito bastirvAtaghno balavarNakRut||4|| 
</div></div>

Two ''prasritas'' of milk and three ''prasritas'' of ''madhu'' (honey), ''taila'' (sesame oil) and ''ghrita'' (clarified butter) are taken together and churned with a churning stick. This ''[[basti]]'' eliminates ''[[vata]]'', and promotes strength as well as complexion. [4]

=== ''Ashta-prasritiki basti'' ===
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एकैकः प्रसृतस्तैलप्रसन्नाक्षौद्रसर्पिषाम्| 

बिल्वादिमूलक्वाथाद्द्वौ कौलत्थाद्द्वौ स वातनुत्||५|| 
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ēkaikaḥ prasṛtastailaprasannākṣaudrasarpiṣām| 

bilvādimūlakvāthāddvau kaulatthāddvau sa vātanut||5|| 

ekaikaH prasRutastailaprasannAkShaudrasarpiShAm| 

bilvAdimUlakvAthAddvau kaulatthAddvau sa vAtanut||5|| 
</div></div>

''[[Basti]]'', composed of one ''prasrita'' each of ''taila'' (sesame oil), ''prasanna''(supernatant part of ''sura''- a type of alcoholic preparation), ''kshaudra'' (honey) and ''ghrita'' (clarified butter) and two ''prasritas'' each of the decoctions of roots of ''bilvadi'' (a group of plants that begins with ''bilva''-Aegle marmelos Carr.) as well as two ''prasritas'' of ''kulattha'' (Phaseolus biflorus Linn.), antagonizes ''[[vata]]''. [5]

=== ''Nava--prasritiki basti'' ===
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पञ्चमूलरसात् पञ्च द्वौ तैलात् क्षौद्रसर्पिषोः| 

एकैकः प्रसृतो बस्तिः स्नेहनीयोऽनिलापहः||६||
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pañcamūlarasāt pañca dvau tailāt kṣaudrasarpiṣoḥ|
 
ēkaikaḥ prasṛto bastiḥ snēhanīyō'nilāpahaḥ||6||

pa~jcamUlarasAt pa~jca dvau tailAt kShaudrasarpiShoH| 

ekaikaH prasRuto bastiH snehanIyo~anilApahaH||6||
</div></div>

''[[Basti]]'' prepared with five ''prasritas'' of the decoction of ''panchamula'' (''bilva, shyonaka, gambhari, patala'' and ''agnimantha''), two ''prasritas'' of ''taila'' (sesame oil) and one ''prasrita'' each of ''kshaudra'' (honey) as well as ''sarpi'' (''ghrita''), oleates (the body) and expels ''[[vata]]''. [6]

=== ''Chatu-prasritiki basti''-I ===
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सैन्धवार्धाक्ष एकैकः क्षौद्रतैलपयोघृतात्| 

प्रसृतो  हपुषाकर्षो निरूहः शुक्रकृत् परम्||७||
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saindhavārdhākṣa ēkaikaḥ kṣaudratailapayōghṛtāt| 

prasṛtō  hapuṣākarṣō nirūhaḥ śukrakṛt param||7||

saindhavArdhAkSha ekaikaH kShaudratailapayoghRutAt| 

prasRuto  hapuShAkarSho nirUhaH shukrakRut param||7||
</div></div>

''Niruha basti'', prepared with half ''aksha'' (about 6 grams) of ''saindhava'' (rock salt) one ''prasrita'' each of honey, sesame oil, milk, and ''ghrita'', and one ''karsha'' (about 12 grams) of ''hapusha'' (Juniperus communis Linn.), is an excellent promoter of ''shukra''. [7]

=== ''Panchatikta niruha basti'' ===
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पटोलनिम्बभूनिम्बरास्नासप्तच्छदाम्भसः| 

चत्वारः प्रसृता एको घृतात् सर्षपकल्कितः||८|| 

निरूहः पञ्चतिक्तोऽयं मेहाभिष्यन्दकुष्ठनुत्  |९|
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paṭōlanimbabhūnimbarāsnāsaptacchadāmbhasaḥ| 

catvāraḥ prasṛtā ēkō ghṛtāt sarṣapakalkitaḥ||8|| 

nirūhaḥ pañcatiktō'yaṁ mēhābhiṣyandakuṣṭhanut  |9|

paTolanimbabhUnimbarAsnAsaptacchadAmbhasaH| 

catvAraH prasRutA eko ghRutAt sarShapakalkitaH||8|| 

nirUhaH pa~jcatikto~ayaM mehAbhiShyandakuShThanut |9|
</div></div>

A ''[[basti]]'' prepared by mixing four ''prasritas'' of decoction of ''patola'' (Trichosanthes dioica Roxb.), ''nimba'' (Azadirachta indica A.Juss.), ''bhunimba'' (Andrographis paniculata Nees.), ''rasna'' (Pluchea lanceolata Oliver &Hiern.), ''saptacchada'' (Alstonia scholaris R.Br.); one ''prasrita'' of ''ghrita'', mixed with a ''kalka'' (paste) of ''sarshapa'' (Brassica campestris Linn.) is known as ''panchatikta niruha'' and is acting against ''prameha, abhishyanda'' and ''kushtha''. [8-8½]

'''Note''': The quantity of ''kalka'' of ''sarshapa'' is not mentioned in the above recipe. According to commentary of Chakrapani on this verse, it may be decided.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.8-9. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 713.</ref>
In the ''niruha basti'' with an amount of twelve ''prasritas'', the amount of ''kalka'' is usually two ''palas'' (about 100 gms).  In present recipe, the amount is five ''prasritas'' and therefore the amount of ''kalka'' of ''sarshapa'' would be about 40 gms. This principle is applicable in latter recipes also where the amount of ''kalka'' is not mentioned.

=== ''Shat-prasritika basti'' ===
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विडङ्गत्रिफलाशिग्रुफलमुस्ताखुपर्णिजात्||९|| 

कषायात् प्रसृताः पञ्च तैलादेको विमथ्य तान्| 

विडङ्गपिप्पलीकल्को निरूहः क्रिमिनाशनः||१०||
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viḍaṅgatriphalāśigruphalamustākhuparṇijāt||9||
 
kaṣāyāt  prasṛtāḥ pañca tailādēkō vimathya tān| 

viḍaṅgapippalīkalkō nirūhaḥ krimināśanaḥ||10||

viDa~ggatriphalAshigruphalamustAkhuparNijAt||9|| 

kaShAyAt  prasRutAH pa~jca tailAdeko vimathya tAn|
 
viDa~ggapippalIkalko nirUhaH kriminAshanaH||10||
</div></div>

Five ''prasritas'' of decoction of ''vidanga'' (Embelia ribes Burm.), ''triphala'' (a combination of three fruits viz. Emblica officinalis Gaertn, terminalia chebula Retz. and terminalia belerica Roxb.), ''shigru'' (Moringa oleifera Linn.), ''madanaphala'' (Randia dumetorum Lam.), ''musta'' (Cyperus rotundus Linn.) and ''akhuparni'' (Merremia emarginata Burm.) and one ''prasrita'' of ''tila taila'' (sesame oil) churned together with a paste of ''vidanga'' (Embelia ribes Burm.) and ''pippali'' (Piper longum Linn.) is ''kriminashana niruha'' (''niruha'' acting against parasites) [9-10]

=== ''Sapta-prasritika basti'' ===
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पयस्येक्षुस्थिरारास्नाविदारीक्षौद्रसर्पिषाम्| 

एकैकः प्रसृतो बस्तिः कृष्णाकल्को वृषत्वकृत्||११|| 
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payasyēkṣusthirārāsnāvidārīkṣaudrasarpiṣām| 

ēkaikaḥ prasṛtō bastiḥ kṛṣṇākalkō vṛṣatvakṛt||11|| 

payasyekShusthirArAsnAvidArIkShaudrasarpiShAm| 

ekaikaH prasRuto bastiH kRuShNAkalko vRuShatvakRut||11|| 
</div></div>

''[[Basti]]'' prepared with decoction of one ''prasrita'' of each of ''payasya'' (Fritillaria roylei Hook.), ''ikshu'' (Saccharum officinarum Linn.), ''sthira'' (Desmodium gangeticum DC.), ''rasna'' (Pluchea lanceolata Oliver & Hiern.) and ''vidari'' (Pueraria tuberosa DC.); one ''prasrita'' each of honey and ''ghrita'', and paste of ''pippali'' (Piper longum Linn.) is ''vrishya'' (enhancing libido and sexual vigour). [11]

=== ''Chatu-prasritika basti''-II ===
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चत्वारस्तैलगोमूत्रदधिमण्डाम्लकाञ्जिकात्| 

प्रसृताः सर्षपैः कल्कैर्विट्सङ्गानाहभेदनः ||१२||
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catvārastailagōmūtradadhimaṇḍāmlakāñjikāt 

prasṛtāḥ sarṣapaiḥ kalkairviṭsaṅgānāhabhēdanaḥ  ||12||

catvArastailagomUtradadhimaNDAmlakA~jjikAt| 

prasRutAH sarShapaiH kalkairviTsa~ggAnAhabhedanaH ||12||
</div></div>

''[[Basti]]'' prepared with a total of four ''prasritas'' of ''tila taila'' (sesame oil), cow’s urine, ''dadhimanda'' (whey) and ''amlakanji'' (fermented sour gruel) mixed with a paste of ''sarshapa'' (Brassica campestris Linn.) relieves the stagnation of stool and constipation. [12]

=== ''Pancha-prasritika basti''-II ===
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श्वदंष्ट्राश्मभिदेरण्डरसात्तैलात् सुरासवात्| 

प्रसृताः पञ्च यष्ट्याह्वकौन्तीमागधिकासिताः||१३|| 

कल्कः स्यान्मूत्रकृच्छ्रे तु सानाहे बस्तिरुत्तमः| 

एते सलवणाः कोष्णा निरूहाः प्रसृतैर्नव||१४||
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śvadaṁṣṭrāśmabhidēraṇḍarasāttailāt surāsavāt| 

prasṛtāḥ pañca yaṣṭyāhvakauntīmāgadhikāsitāḥ||13||
 
kalkaḥ  syānmūtrakṛcchrē tu sānāhē bastiruttamaḥ| 

ētē salavaṇāḥ kōṣṇā nirūhāḥ prasṛtairnava||14||

shvadaMShTrAshmabhideraNDarasAttailAt surAsavAt| 

prasRutAH pa~jca yaShTyAhvakauntImAgadhikAsitAH||13|| 

kalkaH syAnmUtrakRucchre tu sAnAhe bastiruttamaH| 

ete salavaNAH koShNA nirUhAH prasRutairnava||14||
</div></div>

''[[Basti]]'' prepared with five ''prasritas'' decoction of ''shvadamshtra'' (Tribulus terrestris Linn.), ''ashmabhida'' (Bergenia ligulata Wall.), ''eranda'' (Ricinus communis Linn.) together, ''taila'' and ''surasava'' (an alcoholic preparation) added with paste of ''yashti'' (Glycyrrhiza glabra Linn.), ''kaunti'' (Piper aurantiacum Wall.), ''magadhika'' (Piper longum Linn.) and ''sitah'' (sugar candy) is useful in ''mutrakricchra'' (a condition characterized by difficult and painful micturition) and ''anaha'' (constipation). These nine ''prasrita bastis'' are given with salt and moderately warm. [13-14]

=== Treatment of stagnated ''[[basti]]'' ===
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मृदुबस्तिजडीभूते तीक्ष्णोऽन्यो बस्तिरिष्यते| 

तीक्ष्णैर्विकर्षिते स्वादु प्रत्यास्थापनमिष्यते ||१५||
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mṛdubastijaḍībhūtē tīkṣṇō'nyō bastiriṣyatē| 

tīkṣṇairvikarṣitē svādu pratyāsthāpanamiṣyatē [1] ||15||

mRudubastijaDIbhUte tIkShNo~anyo bastiriShyate| 

tIkShNairvikarShite svAdu pratyAsthApanamiShyate  ||15||
</div></div>

If a ''mridubasti'' (mild acting ''[[basti]]'') gets stagnated, that needs another ''teekshna basti'' (strong and sharp acting ''[[basti]]''). One, who is emaciated because of strong ''[[basti]]s'', requires ''asthapana [[basti]]'' prepared with ''madhura'' (sweet) substances. [15]

=== Treatment of ''guda-daha'' (burning sensation in anus) ===
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वातोपसृष्टस्योष्णैः स्युर्गुददाहादयो यदि| 

द्राक्षाम्बुना त्रिवृत्कल्कं दद्याद्दोषानुलोमनम्||१६|| 

तद्धि पित्तशकृद्वातान् हृत्वा दाहादिकाञ्जयेत्| 

शुद्धश्चापि पिबेच्छीतां यवागूं शर्करायुताम्||१७||
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vātōpasṛṣṭasyōṣṇaiḥ syurgudadāhādayō  yadi| 

drākṣāmbunā trivṛtkalkaṁ dadyāddōṣānulōmanam||16|| 

taddhi pittaśakṛdvātān hṛtvā dāhādikāñjayēt| 

śuddhaścāpi pibēcchītāṁ yavāgūṁ śarkarāyutām||17||

vAtopasRuShTasyoShNaiH syurgudadAhAdayoyadi| 

drAkShAmbunA trivRutkalkaM dadyAddoShAnulomanam||16|| 

taddhi pittashakRudvAtAn hRutvA dAhAdikA~jjayet| 

shuddhashcApi pibecchItAM yavAgUM sharkarAyutAm||17||
</div></div>

If a patient with ''[[vata]]'' disorder suffers from anorectal burning (and other similar ''[[pitta]]''-related symptoms) due to (administration of) hot ''[[basti]]s'', a mixture of ''drakshambu'' (grape juice or decoction of raisins) and ''trivritkalka'' (paste of Operculina turpethum Linn.), which is ''doshanulshmana'' (bringing the movement of ''[[dosha]]'' in right direction) is given. This relieves burning sensation and similar conditions by expelling the ''[[pitta]]'', stool and ''[[vata]]''. After the body is cleansed, the patient has to take cold ''yavagu'' added with sugar. [16-17]

=== Treatment of ''mala kshaya'' (depletion of stool) ===
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अथवाऽतिविरिक्तः स्यात् क्षीणविट्कः स भक्षयेत्|
 
माषयूषेण कुल्माषान् पिबेन्मध्वथवा  सुराम्||१८||
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athavā'tiviriktaḥ syāt kṣīṇaviṭkaḥ sa bhakṣayēt 

māṣayūṣēṇa kulmāṣān pibēnmadhvathavā  surām||18||

athavA~ativiriktaH syAt kShINaviTkaH sa bhakShayet| 

mAShayUSheNa kulmAShAn pibenmadhvathavA surAm||18||
</div></div>

On the other hand, if a patient has excessive purgation and suffers from depletion of stool (and other essential body components e.g. fluids), he or she has to take ''kulmasha'' (half cooked grains) with ''mashayoosha'' (soup of Phaseolus mungo Linn.), or ''sura'' (an alcoholic preparation) or honey. [18]

=== Treatment of ''amaja shula'' (abdominal pain due to improper digestion) ===
<div class="mw-collapsible mw-collapsed">

सामं चेत् कुणपं शूलैरुपविशेदरोचकी| 

स घनातिविषाकुष्ठनतदारुवचाः पिबेत्||१९||
<div class="mw-collapsible-content">

sāmaṁ cēt kuṇapaṁ śūlairupaviśēdarōcakī| 

sa ghanātiviṣākuṣṭhanatadāruvacāḥ pibēt||19||

sAmaM cet kuNapaM shUlairupavishedarocakI| 

sa ghanAtiviShAkuShThanatadAruvacAH pibet||19|| 
</div></div>

(A decoction of) ''musta'' (Cyperus rotundus Linn.), ''ativisha'' (Aconitum heterophyllum wall.), ''kushtha'' (Saussurea lappa C.B.Clarke.), ''nata'' (Valeriana wallichii DC.), ''daru'' (Cedrus deodara Roxb.) and ''vacha'' (Acorus calamus Linn.) is recommended to a patient with loss of appetite, passing ''sama'' stool (i.e., stool containing ''ama'') smelling like a dead (decomposing) body and with abdominal pain. [19]

=== Treatment of ''atisara'' (diarrhea) ===
<div class="mw-collapsible mw-collapsed">

शकृद्वातमसृक् पित्तं कफं वा योऽतिसार्यते| 

पक्वं , तत्र स्ववर्गीयैर्बस्तिः श्रेष्ठं भिषग्जितम्||२०||
<div class="mw-collapsible-content">

śakṛdvātamasṛk pittaṁ kaphaṁ vā yō'tisāryatē| 

pakvaṁ , tatra svavargīyairbastiḥ śrēṣṭhaṁ bhiṣagjitam||20||

shakRudvAtamasRuk pittaM kaphaM vA yo~atisAryate| 

pakvaM , tatra svavargIyairbastiH shreShThaM bhiShagjitam||20||
</div></div>

When a patient has ''pakva atisara'' (without undigested material) passing ''shakrita'' (stool), ''[[vata]], asrika'' (blood), ''[[pitta]]'' or ''[[kapha]]'', then ''[[basti]]'' prepared with a specific group of medicines acting against each of these pathologies is best measure. [20]

=== Six types of ''atisara'' and its common complications ===
<div class="mw-collapsible mw-collapsed">

षण्णामेषां द्विसंसर्गात् त्रिंशद्भेदा भवन्ति तु| 

केवलैः सह षट्त्रिंशद्विद्यात् सोपद्रवानपि||२१||

शूलप्रवाहिकाध्मानपरिकर्त्यरुचिज्वरान्| 

तृष्णोष्णदाहमूर्च्छादींश्चैषां विद्यादुपद्रवान्||२२||
<div class="mw-collapsible-content">

ṣaṇṇāmēṣāṁ dvisaṁsargāt triṁśadbhēdā bhavanti tu| 

kēvalaiḥ saha ṣaṭtriṁśadvidyāt sōpadravānapi||21||

śūlapravāhikādhmānaparikartyarucijvarān| 

tṛṣṇōṣṇadāhamūrcchādīṁścaiṣāṁ vidyādupadravān||22||

ShaNNAmeShAM dvisaMsargAt triMshadbhedA bhavanti tu| 

kevalaiH saha ShaTtriMshadvidyAt sopadravAnapi||21||

shUlapravAhikAdhmAnaparikartyarucijvarAn| 

tRuShNoShNadAhamUrcchAdIMshcaiShAM vidyAdupadravAn||22||
</div></div>

These six types of ''atisara'' may have thirty variants as a result of mutual combination of two morbid factors. Together with basic six, they constitute thirty six types, which manifest along with their complications. ''Shoola'' (abdominal pain), ''pravahika'' (dysentery), ''adhmana'' (abdominal distension) ''parikarti'' (anal pain), ''aruchi'' (distaste for food), ''[[jwara]]'' (fever), ''tṛishna'' (thirst), ''ushnatva'' (feeling of heat), ''daha'' (burning sensation) and ''murccha''(syncope) are its complications (''upadrava''). [21-22]

=== Treatment of ''ama-atisara'' ( diarrhea with improper digestion) ===
<div class="mw-collapsible mw-collapsed">

तत्रामेऽन्तरपानं स्यात् व्योषाम्ललवणैर्युतम्| 

पाचनं शस्यते बस्तिरामे हि प्रतिषिध्यते||२३||
<div class="mw-collapsible-content">

tatrāmē'ntarapānaṁ syāt vyōṣāmlalavaṇairyutam| 

ṁ śasyatē bastirāmē hi pratiṣidhyatē||23||

tatrAme~antarapAnaM  syAt vyoShAmlalavaNairyutam| 

pAcanaM shasyate bastirAme hi pratiShidhyate||23||
</div></div>

In case of ''amatisara'', a drink having ''[[pachana]]'' action added with ''trikatu'' (a group of three pungent drugs viz. rhizome of Zingiber officinalis Roxb.; fruits of Piper nigrum Linn. and Piper longum Linn.), ''amla'' (sour) and ''lavana'' (salty) substances is recommended. ''[[Basti]]s'' are contraindicated in ''ama'' condition. [23]

=== Treatment of ''shakrita-atisara'' and ''[[vata]] atisara''( diarrhea with excess stools and ''[[vata]]'') ===
<div class="mw-collapsible mw-collapsed">

वातघ्नैर्ग्राहिवर्गीयैर्बस्तिः शकृति शस्यते |

स्वाद्वम्ललवणैः शस्तः स्नेहबस्तिः समीरणे||२४||
<div class="mw-collapsible-content">

vātaghnairgrāhivargīyairbastiḥ śakṛti śasyatē

svādvamlalavaṇaiḥ śastaḥ snēhabastiḥ samīraṇē||24||

vAtaghnairgrAhivargIyairbastiH shakRuti shasyate

svAdvamlalavaNaiH shastaH snehabastiH samIraNe||24|| 
</div></div>

In ''shakritatisara'' (''atisara'' in which only stool is passed), ''[[basti]]'' with ''vataghna'' and ''grahi'' category of medicines is recommended. In ''[[vata]]'' related ''atisara, sneha [[basti]]'' with ''svadu'' (sweet), ''amla'' (sour) and ''lavana'' (salty) substances is acclaimed. [24]

=== Treatment of ''[[rakta]] atisara, [[pitta]] atisara'' and ''[[kapha]] atisara'' (diarrhea with blood, ''[[pitta]]'' and ''[[kapha]]'') ===
<div class="mw-collapsible mw-collapsed">

रक्ते रक्तेन, पित्ते तु कषायस्वादुतिक्तकैः| 

सार्यमाणे कफे बस्तिः कषायकटुतिक्तकैः||२५||
<div class="mw-collapsible-content">

raktē raktēna, pittē tu kaṣāyasvādutiktakaiḥ| 

sāryamāṇē kaphē bastiḥ kaṣāyakaṭutiktakaiḥ||25||

rakte raktena, pitte tu kaShAyasvAdutiktakaiH| 

sAryamANe kaphe bastiH kaShAyakaTutiktakaiH||25||
</div></div>

In ''[[rakta]] atisara'' (diarrhea with blood) ''[[basti]]'' with blood, in ''[[pitta]] atisara [[basti]]'' with ''kashaya'' (astringent), ''madhura'' (sweet) and ''tikta'' (bitter) substances and in ''[[kapha]] atisara'' with ''kashaya'' (astringent), ''katu'' (pungent) and ''tikta'' (bitter) substances is to be administered. [25]

=== Treatment of ''atisara'' (diarrhea) mixed with ''shakrita-ama'' and ''[[vata]]'' ===
<div class="mw-collapsible mw-collapsed">

शकृता वायुना वाऽऽमे तेन वर्चस्यथानिले| 

संसृष्टेऽन्तरपानं स्याद् व्योषाम्ललवणैर्युतम्||२६|| 
<div class="mw-collapsible-content">

śakṛtā vāyunā vā”me tena varcasyathānilē| 

saṁsṛṣṭē'ntarapānaṁ syād vyōṣāmlalavaṇairyutam||26|| 

shakRutA vAyunA vA~a~ame tena varcasyathAnile| 

saMsRuShTe~antarapAnaM syAd vyoShAmlalavaNairyutam||26|| 
</div></div>

In the conditions where ''ama'' is associated with ''shakrita'' (stool) or ''[[vata]]'', or ''shakrita'' (stool) or ''[[vata]]'' is associated with ''ama'' a drink, prepared with ''vyosha'' (a group of three pungent drugs, commonly known as ''trikatu'', viz. rhizome of Zingiber officinalis Roxb.; fruits of Piper nigrum Linn. and Piper longum Linn.), sour and salty substances, is recommended. [26]

=== Treatment of ''atisara'' (diarrhea) mixed with ''[[pitta]]-[[rakta]]'' and ''ama'' ===
<div class="mw-collapsible mw-collapsed">

पित्तेनामेऽसृजा वाऽपि तयोरामेन वा पुनः| 

संसृष्टयोर्भवेत् पानं सव्योषस्वादुतिक्तकम्||२७||
<div class="mw-collapsible-content">

pittēnāmē'sṛjā vā'pi tayōrāmēna vā punaḥ| 

saṁsṛṣṭayōrbhavēt pānaṁ savyōṣasvādutiktakam||27||
 
pittenAme~asRujA vA~api tayorAmena vA punaH| 

saMsRuShTayorbhavet pAnaM savyoShasvAdutiktakam||27||
</div></div>

If there is association of ''ama'' with ''[[pitta]]'' or ''[[rakta]]'' or of both separately with ''ama'' then a drink with ''trikaṭu'', sweet and bitter substances is indicated. [27]

=== Treatment of ''atisara'' (diarrhea)mixed with ''[[kapha]]-ama'' ===
<div class="mw-collapsible mw-collapsed">

तथाऽऽमे कफसंसृष्टे  कषायव्योषतिक्तकम्| 

आमेन तु कफे व्योषकषायलवणैर्युतम्||२८|| 
<div class="mw-collapsible-content">

tathā''mē kaphasaṁsṛṣṭē kaṣāyavyōṣatiktakam| 

āmēna tu kaphē vyōṣakaṣāyalavaṇairyutam||28|| 

tathA~a~ame kaphasaMsRuShTe kaShAyavyoShatiktakam|
 
Amena tu kaphe vyoShakaShAyalavaNairyutam||28|| 
</div></div>

If ''ama'' is associated with ''[[kapha]]'', a ''[[basti]]'' containing ''kashaya'' (astringent), ''trikatu'' and bitter substances and when ''[[kapha]]'' is associated with ''ama'', a ''[[basti]]'' containing ''trikatu, kashaya'' (astringent) and salty substances is recommended. [28]

=== Treatment of ''atisara'' (diarrhea) mixed with ''[[pitta]]-[[vata]]-shakrita'' ===
<div class="mw-collapsible mw-collapsed">

वातेन विशि पित्ते वा विट्पित्ताभ्यां  तथाऽनिले| 

मधुराम्लकषायः स्यात् संसृष्टे बस्तिरुत्तमः||२९||
<div class="mw-collapsible-content">

vātēna viśi pittē vā viṭpittābhyāṁ  tathā'nilē| 

madhurāmlakaṣāyaḥ syāt saṁsṛṣṭē bastiruttamaḥ||29||

vAtena vishi pitte vA viTpittAbhyAM  tathA~anile| 

madhurAmlakaShAyaH syAt saMsRuShTe bastiruttamaH||29||
</div></div>

When stool or ''[[pitta]]'' is associated with ''[[vata]]'' or ''[[vata]]'' is associated with stool and ''[[pitta]]'', a ''[[basti]]'' with sweet, sour and astringent substances, is excellent. [29]

=== Treatment of ''atisara'' (diarrhea) mixed with ''[[pitta]]-[[rakta]]-shakrita'' ===
<div class="mw-collapsible mw-collapsed">

शकृच्छोणितयोः पित्तशकृतो रक्तपित्तयोः| 

बस्तिरन्योन्यसंसर्गे कषायस्वादुतिक्तकः||३०|| 
<div class="mw-collapsible-content">

śakṛcchōṇitayōḥ pittaśakṛtō raktapittayōḥ| 

bastiranyōnyasaṁsargē kaṣāyasvādutiktakaḥ||30||

shakRucchoNitayoH pittashakRuto raktapittayoH| 

bastiranyonyasaMsarge kaShAyasvAdutiktakaH||30|| 
</div></div>

In case of morbid mutual associations of ''[[pitta]]'' with stool and ''[[rakta]]'', as well as stool with ''[[rakta]]'' and ''[[pitta]], [[basti]]'' with astringent, sweet and bitter ingredients. [30]

=== Treatment of ''atisara'' (diarrhea) mixed with ''[[kapha]]-[[rakta]]-[[pitta]]-shakrita'' ===
<div class="mw-collapsible mw-collapsed">

कफेन विशि पित्ते वा कफे विट्पित्तशोणितैः| 

व्योषतिक्तकषायः स्यात् संसृष्टे बस्तिरुत्तमः||३१|| 
<div class="mw-collapsible-content">

kaphēna viśi pittē vā kaphē viṭpittaśōṇitaiḥ| 

vyōṣatiktakaṣāyaḥ syāt saṁsṛṣṭē bastiruttamaḥ||31||

kaphena vishi pitte vA kaphe viTpittashoNitaiH| 

vyoShatiktakaShAyaH syAt saMsRuShTe bastiruttamaH||31||
</div></div>

In case of similar associations of ''[[kapha]]'' with stool or ''[[pitta]]''; or of stool or ''[[pitta]]'' or ''[[rakta]]'' with ''[[kapha]]'', a ''[[basti]]'' with ''trikatu'', bitter and ''kashaya'' ingredients is to be recommended. [31]

=== Treatment of ''atisara'' (diarrhea) mixed with ''[[vata]]-[[kapha]]-shakrita'' and ''[[rakta]]-[[kapha]]'' ===
<div class="mw-collapsible mw-collapsed">

स्याद्बस्तिर्व्योषतिक्ताम्लः संसृष्टे वायुना कफे| 

मधुरव्योषतिक्तस्तु रक्ते कफविमूर्च्छिते||३२|| 
<div class="mw-collapsible-content">

syādbastirvyōṣatiktāmlaḥ saṁsṛṣṭē vāyunā kaphē| 

madhuravyōṣatiktastu raktē kaphavimūrcchitē||32|| 

syAdbastirvyoShatiktAmlaH saMsRuShTe vAyunA kaphe| 

madhuravyoShatiktastu rakte kaphavimUrcchite||32||
</div></div>

In ''atisara'' where ''[[kapha]]'' is associated with ''[[vata]], [[basti]]'' with ''trikatu'', bitter and sour ingredients, and if ''[[rakta]]'' is associated with ''[[kapha]]'' then with sweet, ''trikatu'' and bitter is recommended. [32]

=== Treatment of ''atisara'' (diarrhea) mixed with ''[[kapha]]- [[vata]] -shakrita'' and ''[[vata]]-[[pitta]]'' ===
<div class="mw-collapsible mw-collapsed">

मारुते कफसंसृष्टे व्योषाम्ललवणो भवेत्| 

बस्तिर्वातेन पित्ते  तु कार्यः स्वाद्वम्लतिक्तकः||३३||
<div class="mw-collapsible-content">

mārutē kaphasaṁsṛṣṭē vyōṣāmlalavaṇō bhavēt| 

bastirvātēna pittē  tu kāryaḥ svādvamlatiktakaḥ||33||

mArute kaphasaMsRuShTe vyoShAmlalavaNo bhavet| 

bastirvAtena pitte [2] tu kAryaH svAdvamlatiktakaH||33||
</div></div>

If ''[[vata]]'' is accompanied by ''[[kapha]]'', a ''[[basti]]'' with ''trikatu'', sour and salty ingredients; and when ''[[pitta]]'' is associated with ''[[vata]], [[basti]]'' with sweet, sour and bitter substances is to be administered. [33]

=== Treatment for conditions due to ''samsarga'' (combination of ''[[dosha]]'') ===
<div class="mw-collapsible mw-collapsed">

त्रिचतुःपञ्चसंसर्गानेवमेव विकल्पयेत्| 

युक्तिश्चैषातिसारोक्ता सर्वरोगेष्वपि स्मृता||३४||
<div class="mw-collapsible-content">

tricatuḥpañcasaṁsargānēvamēva vikalpayēt| 

yuktiścaiṣātisārōktā sarvarōgēṣvapi smṛtā||34||

tricatuHpa~jcasaMsargAnevameva vikalpayet| 

yuktishcaiShAtisAroktA sarvarogeShvapi smRutA||34||
</div></div>
 
Similarly a plan may be designed in cases of morbid combinations of three, four or five components. This planning for ''atisara'' is applicable in all disease conditions. [34]
<div class="mw-collapsible mw-collapsed">
 
युगपत् षड्रसं षण्णां संसर्गे पाचनं भवेत् | 

निरामाणां तु पञ्चानां बस्तिः षाड्रसिको मतः||३५||
<div class="mw-collapsible-content">

yugapat ṣaḍrasaṁ ṣaṇṇāṁ saṁsargē pācanaṁ bhavēt [1] | 

nirāmāṇāṁ tu pañcānāṁ bastiḥ ṣāḍrasikō mataḥ||35|| 

yugapat ShaDrasaM ShaNNAM saMsarge pAcanaM bhavet [1] | 

nirAmANAM tu pa~jcAnAM bastiH ShADrasiko mataH||35||
</div></div>

In ''atisara'', if all six pathological components are simultaneously involved, a ''[[pachana]]'' (causing or promoting digestion or transformation) medicine containing the drugs of all six tastes is useful, while in ''nirama'' (without ''ama'') condition, where other five are involved a ''[[basti]]'' consisting of all six ''rasas'' (tastes) is indicated. [35]

=== ''Sarvatisara nashaka ghrita'' (medicated ghee for treatment of all types of diarrhea) ===
<div class="mw-collapsible mw-collapsed">

उदुम्बरशलाटूनि जम्ब्वाम्रोदुम्बरत्वचः| 

शङ्खं सर्जरसं लाक्षां कर्दमं च पलांशिकम्||३६|| 

पिष्ट्वा तैः सर्पिषः प्रस्थं क्षीरद्विगुणितं पचेत्| 

अतीसारेषु सर्वेषु पेयमेतद्यथाबलम्||३७|| 
<div class="mw-collapsible-content">

udumbarani jambvāmrōdumbaratvacaḥ| 

śaṅkhaṁ sarjarasaṁ lākṣāṁ kardamaṁ ca palāṁśikam||36|| 

piṣṭvā taiḥ sarpiṣaḥ prasthaṁ kṣīradviguṇitaṁ pacēt|
 
atīsārēṣu sarvēṣu pēyamētadyathābalam||37||

udumbarashalATUni jambvAmrodumbaratvacaH| 

sha~gkhaM sarjarasaM lAkShAM kardamaM ca palAMshikam||36|| 

piShTvA taiH sarpiShaH prasthaM kShIradviguNitaM pacet| 

atIsAreShu sarveShu peyametadyathAbalam||37||
</div></div>
 
A freshly prepared paste of ''udumbarashalaatu'' (unripe fruits of Ficus glomerata Roxb.), bark of ''jaambu'' (Syzygium cumini Skeels.), ''amra''  (Mangifera indica Linn.) and ''udumbara'' (Ficus glomerata Roxb.); ''sankha'' (conch shell), ''sarjarasa'' (resin of Vateria indica Linn.), ''laaksha'' (resinous secretion of Laccifera lacca Kerr.) and ''kardama'' (a type of rice), each one ''pala'' (about 50 grams) is to be cooked with one ''prastha'' (about 800 ml.) of ''ghrita'', and two ''prastha'' of milk. This (thus prepared ''ghrita'') is to be taken in all types of ''atisara'' according to ''bala'' (strength of the patient as well as disease). [36-37]

=== ''Sarvatisara nashaka yavagu'' (medicated gruel for treatment of all types of diarrhea) ===
<div class="mw-collapsible mw-collapsed">

कच्छुराधातकीबिल्वसमङ्गारक्तशालिभिः| 

मसूराश्वत्थशुङ्गैश्च यवागूः स्याज्जले शृतैः||३८|| 

बालोदुम्बरकट्वङ्गसमङ्गाप्लक्षपल्लवैः  | 

मसूरधातकीपुष्पबलाभिश्च तथा भवेत्||३९|| 
<div class="mw-collapsible-content">

kacchurādhātakībilvasamaṅgāraktaśālibhiḥ| 

masūrāśvatthaśuṅgaiśca yavāgūḥ syājjalē śṛtaiḥ||38||
 
bālōdumbarakaṭvaṅgasamaṅgāplakṣapallavaiḥ  | 

masūradhātakīpuṣpabalābhiśca tathā bhavēt||39||

kacchurAdhAtakIbilvasama~ggAraktashAlibhiH| 

masUrAshvatthashu~ggaishca yavAgUH syAjjale shRutaiH||38|| 

bAlodumbarakaTva~ggasama~ggAplakShapallavaiH  | 

masUradhAtakIpuShpabalAbhishca tathA bhavet||39||
</div></div>

A ''yavagu'' (gruel) prepared by cooking ''raktashali'' (a variety of rice brownish in color) and ''masura''  (Lens culinaris Medic.)) in a decoction of ''kacchura'' (Mucuna pruriens Baker. ), ''dhataki'' (Woodfordia fruticosa Kurz.), ''bilva'' (Aegle marmelos Carr.), ''samanga'' (Mimosa pudica Linn.) and ''ashvatthashunga'' (leaf bud of Ficus religiosa Linn.) is beneficial in ''atisara''.
 
Similar preparation can be made with unripe fruit of ''udumbara'', leaves of ''kathvanga'' (Ailanthus excelsa Roxb.) and ''samanga'' as well as ''plaksha'' (Ficus lacor Buch.), ''masura'' (Lens culinaris Medic.) and ''dhataki'' flowers. [38-39]

=== Treatment of all types of diarrhea ===
<div class="mw-collapsible mw-collapsed">

स्थिरादीनां बलादीनामिक्ष्वादीनामथापि वा| 

क्वाथेषु समसूराणां यवाग्वः स्युः पृथक् पृथक्||४०|| 

कच्छुरामूलशाल्यादितण्डुलैरुपसाधिताः| 

दधितक्रारनालाम्लक्षीरेष्विक्षुरसेऽपि वा||४१|| 

शीताः सशर्कराक्षौद्राः सर्वातिसारनाशनाः| 

ससर्पिर्मरिचाजाज्यो मधुरा लवणाः शिवाः||४२||
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sthirādīnāṁ balādīnāmikṣvādīnāmathāpi vā| 

kvāthēṣu samasūrāṇāṁ yavāgvaḥ syuḥ pṛthak pṛthak||40|| 

kacchurāmūlaśālyāditaṇḍulairupasādhitāḥ| 

dadhitakrāranālāmlakṣīrēṣvikṣurasē'pi vā||41|| 

śītāḥ saśarkarākṣaudrāḥ sarvātisāranāśanāḥ| 

sasarpirmaricājājyō madhurā lavaṇāḥ śivāḥ||42|| 

sthirAdInAM balAdInAmikShvAdInAmathApi vA| 

kvAtheShu samasUrANAM yavAgvaH syuH pRuthak pRuthak||40|| 

kacchurAmUlashAlyAditaNDulairupasAdhitAH| 

dadhitakrAranAlAmlakShIreShvikShurase~api vA||41|| 

shItAH sasharkarAkShaudrAH sarvAtisAranAshanAH| 

sasarpirmaricAjAjyo madhurA lavaNAH shivAH||42||
</div></div>

Different ''yavagus'' can be prepared by combining ''masura'' (Lens culinaris Medic.) with the decoctions of ''sthiradi, baladi'' and ''ikshvadi'' (groups of plants). [40]

Roots of ''kacchura'' (Mucuna pruriens Baker.) and rice of ''shali'' and other varieties cooked with ''dadhi'' (yogurt), ''takra'' (churned yogurt), ''aranala'' (sour fermented supernatant of cooked rice), ''ksheera'' (milk) or ''ikshurasa'' (sugarcane juice), and after being cooled added with sugar and honey, is able to treat all types of ''atisara''. The above-mentioned gruels are promising (anti-diarreal) when added with ''ghrita'', pepper and cumin (Cuminum cyminum Linn.), sweet substances and rock salt. [41-42]

=== Treatment principles ===
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भवन्ति चात्र श्लोकाः-
 
स्निग्धाम्ललवणमधुरं पानं बस्तिश्च मारुते कोष्णः| 

शीतं तिक्तकषायं मधुरं पित्ते च रक्ते च||४३|| 

तिक्तोष्णकषायकटुश्लेष्मणि सङ्ग्राहि वातनुच्छकृति| 

पाचनमामे पानं पिच्छासृग्बस्तयो रक्ते||४४|| 

अतिसारं प्रत्युक्तं मिश्रं द्वन्द्वादियोगजेष्वपि च| 

तत्रोद्रेकविशेषाद्दोषेषूपक्रमः कार्यः||४५||
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bhavanti cātra ślōkāḥ- 

snigdhāmlalavaṇamadhuraṁ pānaṁ bastiśca mārutē kōṣṇaḥ| 

śītaṁ tiktakaṣāyaṁ madhuraṁ pittē ca raktē ca||43|| 

tiktōṣṇakaṣāyakaṭuślēṣmaṇi saṅgrāhi vātanucchakṛti| 

pācanamāmē pānaṁ picchāsṛgbastayō raktē||44|| 

atisāraṁ pratyuktaṁ miśraṁ dvandvādiyōgajēṣvapi [1] ca| 

tatrōdrēkaviśēṣāddōṣēṣūpakramaḥ kāryaḥ||45|| 

bhavanti cAtra shlokAH- 

snigdhAmlalavaNamadhuraM pAnaM bastishca mArute koShNaH| 

shItaM tiktakaShAyaM madhuraM pitte ca rakte ca||43|| 

tiktoShNakaShAyakaTushleShmaNi sa~ggrAhi vAtanucchakRuti| 

pAcanamAme pAnaM picchAsRugbastayo rakte||44|| 

atisAraM pratyuktaM mishraM dvandvAdiyogajeShvapi  ca| 

tatrodrekavisheShAddoSheShUpakramaH kAryaH||45||
</div></div>

Here the ''shlokas'' (verses) remain-

(Besides the above some more treatment-principles useful in ''atisaras'' are given below as per the factors involved)

#''[[Vata]]: snigdha'' (unctuous) ''amla'' (sour) ''lavana'' (salty) and ''madhura'' (sweet) liquids orally and warm ''[[basti]]s'' with same substances. 
#''[[Pitta]]'' and ''[[rakta]]'': cold bitter astringent and sweet substances.
#''[[Kapha]]'': bitter, hot, astringent and pungent substances.
#''Shakrita'' (stool): ''sangrahi'' (checks ''atisara'' through improving the digestion) and ''vataghna'' (measures)
#''Ama: [[pachana]]'' (measures digesting ''ama'')
#''[[Rakta]]: picchabasti'' and ''raktabasti''  
#''Atisara'' may also be in combination of two or more factors. In those conditions treatment is to be planned according to dominance of the ''[[dosha]]s'' (and the factors involved). [43-45]

=== Summary ===
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तत्र श्लोकः- 

प्रासृतिकाः सव्यापत्क्रिया निरूहास्तथाऽतिसारहिताः| 

रसकल्पघृतयवाग्वश्चोक्ता  गुरुणा प्रसृतसिद्धौ||४६||
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tatra ślōkaḥ- 

prāsṛtikāḥ savyāpatkriyā nirūhāstathā'tisārahitāḥ| 

rasakalpaghṛtayavāgvaścōktā [1] guruṇā prasṛtasiddhau||46|| 

tatra shlokaH- 

prAsRutikAH savyApatkriyA nirUhAstathA~atisArahitAH| 

rasakalpaghRutayavAgvashcoktA [1] guruNA prasRutasiddhau||46||
</div></div>

In this chapter of [[Prasrita Yogiyam Siddhi]] management of the complications, ''prasritika niruhas'', and the ''[[basti]]s,'' decoctions, ''ghrita'', gruels useful in the management of ''atisaras'' are presented by the teacher. [46]
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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते 

दृढबलसम्पूरिते सिद्धिस्थाने प्रासृतयोगीयसिद्धिर्नामाष्टमोऽध्यायः ||८||
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ityagnivēśakṛtē tantrē carakapratisaṁskṛtē'prāptē 

dṛḍhabalasampūritē siddhisthānē prāsṛtayōgīyasiddhirnāmāṣṭamō'dhyāyaḥ [1] ||8|| 

ityagniveshakRute tantre carakapratisaMskRute~aprApte 

dRuDhabalasampUrite siddhisthAne prAsRutayogIyasiddhirnAmAShTamo~adhyAyaH [1] ||8||
</div></div>

Thus in the treatise (originally) prepared by Agnivesha, edited by Charak and supplemented the lost parts by Dridhabala, in [[Siddhi Sthana]], the eighth chapter entitled [[Prasrita Yogiyam Siddhi]] is concluded.

== Tattva Vimarsha (Fundamental Principles) ==

*A milder form of ''[[basti]]'' can get stagnated inside leading to complications of not eliminating ''[[dosha]]s''. This may result into ''ayoga'' or ''heenayoga'' (insufficient action). On the contrary if a ''[[basti]]'' is stronger it may cause an ''atiyoga'' (action in excess) causing excessive evacuation of ''[[dosha]]'' along with body constituents.
*Faulty application of ''[[basti]]s'' may cause a complication in the form of ''atisara'' (diarrhea).
*''Atisara'' (diarrhea) may be either acute with undigested material associated with ''ama'' or chronic without much undigested material/ ''pakwa''.
*''Pakwa'' type of ''atisara'' is again of five types as with ''shakrita'' (fecal matter), with ''[[vata]]'' (flatus), with ''asrika'' (blood), with ''[[pitta]]'' and with ''[[kapha]]''. 
*Basic principle of treatment of every condition associated with ''ama'' is ''amapachana''. Decoction / powder of ''musta, ativisha, kushtha, nata, daru'' and ''vacha'' are ideal for ''amapachana''. This recipe is useful in ''amatisara''. 
*To manage ''pakvatisara'', medicines of two categories viz. ''vataghna'' (anti-''vata'') and ''grahi'' (anti-diarrheal by promoting digestion and absorption) are used. 
*''Picchabasti'' and ''raktabasti'' are treatments for diarrhea with blood.These can be considered as ''[[stambhana]]'' (stop bleeding) and ''vishesha [[brimhana]]'' (enhance internal strength). 
*The treatment principles of various types of ''atisara'' due to complications of ''[[basti]]'' therapy:
**''[[Vata]]'': ''snigdha'' (unctuous), ''amla'' (sour), ''lavana'' (salty) and ''madhura'' (sweet) liquids orally and warm ''[[basti]]s'' with same substances. 
**''[[Pitta]]'' and ''[[rakta]]'': cold bitter astringent and sweet substances.
**''[[Kapha]]'': bitter, hot, astringent and pungent substances.
**''Shakrita'' (stool): ''sangrahi'' (checks ''atisara'' through improving the digestion) and ''vataghna'' (measures)
**''Ama: [[pachana]]'' (measures digesting ''ama'')
**''[[Rakta]]: picchabasti'' and ''raktabasti''.

== Vidhi Vimarsha (Applied Inferences ) ==

The unit ''prasrita'', according to [[Charak Samhita]] is an amount of two ''palas'' which is approximately equal to 100 milliliter (1''pala''=50ml).<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.4. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 713.</ref>,<ref>Agnihotri Avadhabihari; Bhaiṣajyakalpanā Vijñāna; Chaukhamba orientalia publication, 6th edition, 2006, P 7-20.</ref> (verse 1-2)[[Charak Samhita]] is written in the form of dialogue between the teacher (Atreya) and his disciples (mainly Agnivesha). Mild form of ''[[shodhana]]'' measures are for those subjects who are not suitable for strong measures and for the patients who suffered with the complications of the measures described in previous chapters. ''[[Vamana]]'' and ''[[virechana]]'' are major procedures for ''[[shodhana]]''. However, these are contraindicated for the tender persons. Tender persons may not tolerate even ''[[basti]]''. Therefore, mild forms of ''[[basti]]s'' are described for them. Similarly, the measures to treat the complications developed due to the faulty application of the procedures especially the ''[[basti]]''. 

Some translators interpreted the phrase ''karmana viplutanama'' as ‘exhausted of hard work’.<ref> Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.3. In: Dash Bhagavan & Sharma R K, Editor. Charak Samhita.2nd ed. Varanasi: Chowkhamba Sanskrit Series, 2005; P 310</ref>
However, the meaning of this phrase can be taken as ‘complicated by the consequences of the therapies’, which seems to be more appropriate in this context. The complications may be natural consequences of the therapies or may be due to faulty application. (verse 3)

The recipe in verse 4 is composed of total five ''prasritas'' (2 ''prasritas'' of milk, 1 ''prasrita'' each of honey, sesame oil and ''ghrita''), therefore this ''[[basti]]'' is named by Gangadhara as ''panchaprasrtika basti''.<ref>Gangadhara, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya . In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3735.</ref> This ''[[basti]]'' is useful for eliminating ''[[vata]]'' as well as promoting the strength and the complexion. 

''[[Vata]]'' eliminating measures usually promotes quality of ''[[dhatu]]s'' and ''upadhatus'' (structural components of the body). This eventually results in promotion of the body strength and the complexion. Word ''bala'' also denotes the immune function; hence this may also be interpreted as promoting immune activity. In ancient time to mix a ''[[basti]]'' material, churning stick was used. In modern time an electric blender is an ideal alternative. With a blender the mixture is better homogenized than a manual churning stick.

Chakrapani considered ''bilvadi'' group in his [[Ayurveda]] ''deepika'' commentary as ''dashamula''.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.5. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 713.</ref> This group consists of roots of ten plants viz. ''bilva'' (Aegle marmelos Carr.), ''shyonaka'' (Oroxylum indicumVent.),''gambhari'' (Gmelina arborea Roxb.), ''patala'' (Stereospermum suaveolensDC.),''agnimantha'' (Premna integrifolia Roxb.), ''shalaparni'' (Desmodium gangeticumDC.), ''prishniparni'' (Uraria picta Desr.) ''brihati'' (Solanum indicum Linn.), ''kantakari'' (Solanum suranttense Burm.) and ''gokshura'' (Tribulus terrestris Linn.).  

While Gangadhara in his ''Jalpakalpataru'' commentary mentions this as ''panchamula'' –the roots of a group of five plants viz. ''bilva,shyonaka, gambhari, patala'' and ''agnimantha.''<ref>Gangadhara, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya.Verse 5 In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3735.</ref>Since next verse (5th) describes a recipe with ''panchamula'', in this verse considering ''bilvadi'' as ''dashamula'' is more logical and practical. This ''[[basti]]'' consists a total of eight ''prasritas'' (one ''prasrita'' each of ''taila, prasanna, madhu'' and ''ghrita'' and two ''prasritas'' each of ''bilvadi'' decoction and ''kulattha'' decoction). Therefore, Gangadhara names this as ''ashtaprasritika [[basti]]''.<ref>Gangadhara, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya . In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3735.</ref>

The ''[[basti]]'' in verse six, consists of total nine ''prasritas'' i.e. ''panchamula'' decoction- five ''prasritas'', sesame oil - two ''prasritas'', honey- one ''prasrita, ghrita''- one ''prasrita''. Therefore, Gangadhara names this as ''navaprasritika [[basti]]''.<ref>Gangadhara, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya . In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3736.</ref> (verses 4-6)

''Aksha'' and ''karsha'' are the units of same amount, which is equal to about twelve grams. Hence the amount of rock salt in this [[basti]] would be about 6 grams. ''[[Shukra]]'' is one of the seven ''[[dhatu]]s'' (structural components). ''[[Shukra]]'' is not a single entity. It comprises male reproductive cells and substances including the androgenic hormones responsible for manhood in a man. This ''[[basti]]'' promotes quality and quantity of all these entities in the body.

The usual contents of a ''niruha [[basti]]'' are salt, honey, oil'', kalka'' and decoction (or a liquid). These are to be mixed by churning in the sequence as mentioned above. Here the mixing may be in this sequence- ''saindhava'', honey, oil, ''ghrita, hapusha'' (fruits of Juniperus communis Linn.)and milk.(verse 7)

''[[Basti]]'' is usually contraindicated in ''kushtha''<ref>Charak. Sidhi Sthana, Cha.2 Panchakamiya Siddhi ver.14. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 688.</ref>. However, Sushruta Samhita recommends ''niruhabastis'' in this condition.<ref>Sushruta. Chikitsa Sthana, Cha.35  Netrabastipramana pravibhaga Chikitsitam Adhyaya verse 22. In: Jadavaji Trikamji Aacharya and Narayana Ram Acharya, Editors. Sushruta Samhita. 4th ed. Varanasi: Chaukhambha Orientalia;1980, P 527.</ref> Practically ''niruha [[basti]]'', with bitter substances e.g. ''panchatikta niruha'', is useful in ''kushtha''.

The quantity of ''kalka'' of ''sarshapa'' is not mentioned in the above recipe. According to commentary of Chakrapani on this verse, it may be decided. <ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.8-9. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 713.</ref> In the ''niruha bastis'' with an amount of twelve ''prasritas'', the amount of ''kalka'' is usually two ''palas'' (about 100gms). In present recipe, the amount is five ''prasritas'' and therefore the amount of ''kalka'' of ''sarshapa'' would be about 40 gms. This principle is applicable in latter recipes also where the amount of ''kalka'' is not mentioned. 

This ''[[basti]]'' contains ''vidanga'' (Embelia ribes Burm.) which is the best among ''krimighna''(anti-parasitic) [Cha. Sa. [[Sutra Sthana]] 25/40] substances. Therefore, it has a ''kriminashana'' effect. (verse 9-10)

Gangadhara in his ''Jalpakalpataru'' commentary considers ''payasyas ksheerakakoli'', which is Fritillaria roylei Hook. Some scholars consider ''payasyaas vidari'', but at present, ''vidari'' recipies already include one ingredient therefore to consider it ''ksheerakakoli'' is appropriate.

In the recipes of verse 11-12, the amount of paste is not mentioned. This may be calculated as stated in earlier verse 8th -9th. (verse 11-12)

In above verses from 4 to 14, nine recipes of ''prasrita bastis'' are described. Here a special and practical instruction is given that even if salt is not mentioned in any of the recipes, rock salt is to be added and these ''[[basti]]s'' are always given with a moderate warm temperature.

While preparing the ''[[basti]]s'', rock salt is to be added. The amount is to be calculated according to the principle described in the 7th verse i.e. about 6 gms. After preparing the ''[[basti]]'', to keep it warm until it is administered, a hot water bath may be used. (verse 13-14)

In the verse 15-16, two opposite possibilities are described.  It may be milder than normal or it may be stronger than a normal. A mild ''[[basti]]'' is unable not only to eliminate ''[[dosha]]s'', but it itself is not ableto come out. This is ''ayoga'' or ''heenayoga'' (insufficient action). In such a case a ''[[basti]]'' is to be repeated with a stronger recipe. Contrary to this, if a ''[[basti]]'' is stronger it may cause an ''atiyoga'' (action in excess) causing evacuation of colonic contents more than required and eventually loss of essential substances.

A soft acting ''[[basti]]'' is not able to eliminate the ''[[dosha]]s'' and may get stagnated and cause disturbance. To eliminate it, a strong and sharp acting ''[[basti]]'' is recommended. If strong ''[[basti]]s'' have caused emaciation, dehydration or weakness, the ''[[basti]]s'' with ''madhura'' (sweet) substances are useful because ''madhura'' substances are nourishing in action. (verses 15-16)

In ''[[vata]]''-related disorders, ''[[basti]]'' material with physically and pharmacologically hot property is preferred. It may cause ''[[pitta]]'' aggravation resulting in burning sensation and other such ''[[pitta]]''-related symptoms. In such a condition, grape juice or decoction of raisins added with a ''kalka'' (paste) of ''trivrita'' (Operculina turpethum Linn.) is given. In case of unavailability of ''kalka'', its powder can be used. This cures the burning sensation and other ''[[pitta]]''-related symptoms with its anti-''[[pitta]]'' action and expulsion of stool, ''[[pitta]]'' and ''[[vata]]''. ''Yavagu'' with sugar is given for nourishing purpose after this laxation. (verses 16-17)

If the purgation is in excess, it may cause significant loss of stool along with essential substances (e.g.water and electrolytes). This requires immediate attention to prevent the harm due to depletion of essential body components.

In such a condition it is to be corrected by eating ''mashayusha'' (soup of black beans) and ''kulmasha'' (half cooked grains); and by taking honey or ''sura''. ''Kulmasha'' is also interpreted as a sour gruel (prepared by the spontaneous fermentation of fruit-juices or boiled rice). However, according to Chakrapani this is half cooked grain (barley etc.), which is popularly known as ''ghughuni''.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.18. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 713.</ref>,<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya. Verse 13-14.In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3738.</ref>. This is known as ''ghughari'' in Gujarat and western Madhya Pradesh. This is more suitable interpretation. This is considered to be well nourishing food article. (verse 18)

Faulty application of ''[[basti]]s'' may cause a complication in the form of atisāra. ''Atisāra'' is a clinical condition of colon characterized by excessive and frequent defecation with altered consistency of stool. In short it may be interpreted as diarrhea. In next verse different forms of atisāra and their management are described. In this verse the condition is characterized by sāma stool (stool containing āma- undigested material), which smells like a decomposing body (putrid smell) and is associated with abdominal pain. Āma is a substance produced due to weak agni resulting in incomplete transformation of substance. In the present context, due to weak jatharāgni the transformation of food in to digested absorbable substances is incomplete resulting in to production of some intermediate substances.<ref>Vagbhata. Sutra Sthana, Cha.13 Doshopakramaniya Adhyaya verse 25. In: Bhiṣagācārya Hariśāstrī Parādakara Vaidya, Editors. Ashtanga Hridayam. 1oth ed. Varanasi: Chaukhambha Orientalia;2000.p.4.2014; P 216.</ref> ,<ref>Vijayarakshita and Srikanthadata, Madavakara chapter 25,Amavata nidana  Verse 5, In: Brakmanand Tripathi Editor, Madhava Nidana ? ed. Varanasi: Chaukhamba Surabharati Prakashan,2012; P 573-574.</ref>These substances are known as āma. Because of its adherent quality it is supposed to be a pathogenic substance.In this condition a decoction of ''mustā, ativiṣā, kuṣṭha, nata, dāru'' and ''vacā'' is recommended. These medicines help in ''[[pachana]]'' (termination) of āma.

This chapter describes six types of ''atisāra'' based on the pathogens being excreted in excess. This verse explains the remedy for one of them in which patient passes stool with significant undigested material. This undigested material causes putrid smell after decomposition. Decomposition also produces some toxic substances, which cause abdominal pain and loss of appetite. The recipe described here is not useful in atisāra produced as complication of [[basti]] but also in āmātisāra of any origin. (verse 19)

This verse number 20 describes other five types of atisāra. In this way, six types of atisāras those are depicted in above verses are as follow.

#''Atisara'' (diarrhea) in which stool contains ''ama'' (undigested material)  
#Atisāra (diarrhea) in which stool is pakva i.e.free from āma (undigested material) 
#Atisāra (diarrhea) in which stool is pakva and containing [[vata]] i.e. significant flatulence.
#Atisāra (diarrhea) in which stool is pakva and containing asṛk (blood).
#Atisāra (diarrhea) in which stool is pakva and containing [[pitta]].
#Atisāra (diarrhea) in which stool is pakva and containing [[kapha]].

For the management of these conditions [[basti]]s prepared with the svavargīya medicines (group of medicines acting against particular pathologies) are given.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.20. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714.</ref> For example the vargas (classified groups) described in Ṣaḍvirecanaśatāśrīya chapter (chapter 4th) of sūtrasthāna of Carakasaṁhitā. So, the recommended group of medicines for last five conditions of pathology is  purīṣasaṁgrahaṇīya [Cha.Sa.[[Sutra Sthana]] 4/8/31], vātaghna, śoṇitasthāpana [Cha.Sa.[[Sutra Sthana]] 4/8/46], pittaghna  and kaphaghna vargas  respectively.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.4 Snehavyapat Siddhi ver.8. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714. P 33 & 34.</ref>.Purīṣasaṁgrahaṇīya group consists of priyaṅgu (Callicarpa macrophylla R.Br.), ananta (Hemidesmus indicusR.Br.), Seed of  mango, kaṭvaṅga (Ailanthus excelsa Roxb.), lodhra (Symplocos racemosa Roxb.), mocharasa (secretion of Salmalia malabarica Scott&Endl.), samṅgā (Mimosa pudica Linn.), dhātakī (Woodfordia fruticosa Kurz.), padmā (Clerodendrum serratum Linn.) and padmakesara (Stamen of Nelumbo nucifera Gaertn.). shoṇitasthāpana group consists of honey, madhuka (Glycyrrhiza glabra Linn.), saffron, mocarasa (secretion of Salmalia malabarica Scott &Endl.), broken earthen vessel, lodhra (Symplocos racemosa Roxb.), gairika (red ochre), priyaṅgu (Callicarpa macrophylla  R.Br.), sharkarā(sugar) and lājā (puffed rice).<ref>Chakrapani, Charak. Sidhi Sthana, Cha.4 Snehavyapat Siddhi ver.8. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714. P 33 & 34.</ref>The form of [[basti]] is not described here. However, this may be decided according to disease condition and patient’s tolerance. (verse 20)

In this version of [[Charak Samhita]] thirty six variants are cited, but another version ‘kēvalaiḥ saha ceṭ triṁśadvidyāt sōpadravānapi’ mentions only thirty.<ref>Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya . In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3739.</ref> Gaṅgādhara also explains thirty forms in the following manner.<ref>Gangadhara, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya.Verse 17 In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3739.</ref>

The six basic forms of atisāra are: 
#āmātisāra (diarrhea with undigested material) 
#śakṛdatisāra (frequent stool only) 
#vātātisāra (that with significant flatulence) 
#asṛkātisāra (that with blood)
#pittātisāra (that with [[pitta]]) and 
#kaphātisāra (that with [[kapha]]).

Due to saṁsarga (mutual combinations of two) a total of fifteen variants occur, viz.
#āma-śakṛd, āma-[[vata]], āma-asṛk, āma-[[pitta]], āma-[[kapha]],
#śakṛd-[[vata]], śakṛd-asṛk, śakṛd-[[pitta]], śakṛd-[[kapha]],
#vāta-asṛk, [[vata]]-[[pitta]], [[vata]]-[[kapha]],
#asṛk-[[pitta]], asṛk-[[kapha]], and
#[[pitta]]-[[kapha]].

Nine ''upadrava'' as cited above.

The upadravas in present version of chapter are ten. Gaṅgādhara has taken description of nine upadravas from another version.<ref>Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya. In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3739.</ref> But upadravas cannot be counted among types of a disease. Hence the thirtysix variants would be in following manner.

The six basic forms of atisāra are as mentioned above.

Due to saṁsarga (mutual combinations of two) a total of thirty variants occur, viz. fifteen samsargas as mentioned above and other fifteen are as below:
#śakṛd- āma, [[vata]]-āma, asṛk-āma, [[pitta]]-āma, [[kapha]]-āma,
#[[vata]]-śakṛd, asṛk-śakṛd, [[pitta]]-śakṛd, [[kapha]]-śakṛd,
#asṛk-[[vata]], [[pitta]]-[[vata]], [[kapha]]-[[vata]],
#[[pitta]]-asṛk, [[kapha]]-asṛk, and
#[[kapha]]-[[pitta]].

Moreover [[Charak Samhita]] describes types of atisāra in its chapter 19th of [[Sutra Sthana]] and 19th chapter of [[Chikitsa Sthana]] differently. <ref> Charak. Sutra Sthana, Cha.19 Ashtodariya Adhyaya ver.4/3. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 110.</ref>,<ref> Charak. Chiktsa Sthana, Cha.19 Atisara Chikitsitam Adhyaya. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 547-549.</ref> The context of the topic atisāra in present chapter is absolutely different. Here it is described first as a complication of [[basti]], which eloborted further in the chapter. In earlier sections atisāra was described as a primary disease manifested because of its own physical and mental etiological factors. (verse 21-22)

Basic principle of treatment of every condition associated with āma is āmapāchana (termination of āma by promoting function of agni). For this purpose mustā, ativiṣā, kuṣṭha, nata, dāru and vacā (which are mentioned in 19th verse) are to be given. This combination may be given in form of powder or as decoction. This recipe is useful in āmātisāra every origin. (verse 23)

For vātaghna medicines to be used in [[vata]] associated atisara, Cakrapāṇi recommends daśhamula, while Gaṅgādhara considers bṛhat pañchamūla (see the commentary on 5th verse). For grāhī purpose the medicines of purīṣasaṁgrahaṇīya varga [Cha.Sa.[[Sutra Sthana]].4/8/31] are to be used.<ref>Charak. Chiktsa Sthana, Cha.19 Atisara Chikitsitam Adhyaya. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 33 & 34.</ref>

Next condition in which atisāra is associated with dominance of [[vata]], snēha [[basti]] supplemented with sweet, sour and salty substances is recommended. Being opposite to the properties of [[vata]], the substances in this [[basti]] antagonizes the [[vata]] principle. (verse 24)

Now the management of other conditions - raktātisāra, pittātisāra and kaphātisāra is explained.  In raktātisāra, a [[basti]] with blood of animals e.g. goat, is given. This not only stops the bleeding but also supplements the substances to produce blood, which is lost due to colonic bleeding. [[Pitta]] pacifying remedies also helpful in this condition and therefore the remedies useful in pittātisāra can also be given in raktātisāra. Substances with astringent, sweet and bitter tastes have [[pitta]]-antagonizing action and hence the [[basti]] consists of such substances are helpful in management of pittātisāra. Substances with astringent, pungent and bitter tastes have [[kapha]]-antagonizing action; therefore, a [[basti]] with such medicines is beneficial in kaphātisāra.

The [[basti]] used in pittātisāra is useful in raktātisāra also. Applying this principle, this type of [[basti]] may be used in a disease entity known as ulcerative colitis. (verse 25)

These verses number 26-27 describe management plan for the saṁsargaja atisāras (in which two morbid components are associated and have mutual vitiation). Cakrapāṇi in his commentary decides the main and secondary role of the involved components on the basis of vibhakti (noun case) of the words. 7th vibhakti signifies the main role while 3rd expresses secondary role of the factors.<ref>Chakrapani, Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Siddhi ver.26-31. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714.</ref>

In the 26th verse the possible combination are-
#āma is associated with śakṛt i.e.stool (āma is primary and stool is secondary)
#āma is associated with [[vata]] (āma is primary and [[vata]] is secondary)
#śakṛt (stool) is associated with āma (stool is primary āma is secondary)
#[[vata]] is associated with āma  ([[vata]] is primary and āma is secondary)

In the 27th verse the possible combination are-
#āma is associated with [[pitta]]  (āma is primary and [[pitta]] is secondary)
#āma is associated with [[rakta]] (āma is primary and [[rakta]] is secondary)
#[[pitta]] is associated with āma  ([[pitta]] is primary and āma is secondary)
#[[rakta]] is associated with āma ([[rakta]] is primary and āma is secondary)

In these conditions in mentioned in 26th verse, a drink prepared with trikaṭu, sour and salty substances is recommended. While the conditions mentioned in 27th verse, are manageable with adrink, prepared with trikaṭu, sweet and bitter substances are useful. (verse 26-27)

The description of saṁsargaja atisāras continues in these verses 28-29. In the 28th verse, the possible combination are-

#āma is associated with [[kapha]] (āma is primary and [[kapha]] is secondary)
#[[kapha]] is associated with āma ([[kapha]] is primary and āma is secondary)

In 1st condition the recommended [[basti]] is with trikaṭu, astringent and bitter substances while in 2nd condition with trikaṭu, astringent and salty medicines.

In a pāthabheda (another version) of 29th verse<ref>Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya.Verse 23 In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3741.</ref>, [[rakta]]is also included. With this inclusion the possible combination are-

#śakṛt (stool) is associated with [[vāta]]  (stool is primary and [[vata]] is secondary)
#[[pitta]] is associated with [[vāta]]  ([[pitta]] is primary and [[vata]] is secondary)
#[[rakta]] is associated with [[vāta]]  ([[pitta]] is primary and āma is  secondary) 
#[[vata]]  is associated withstool([[vata]] is primary and stool is secondary)
#[[vata]]  is associated with [[pitta]] ([[vata]] is primary and [[pitta]] is secondary)
#[[vata]]  is associated with [[rakta]] ([[vata]] is primary and [[rakta]] is secondary)

In these pathological conditions a [[basti]] with sweet, sour and astringent materials is acclaimed. (verse 28-29)

The management of saṁsargaja atisāras further continues in these verses. In the 30th verse the possible combination are-
#[[rakta]] is associated with śakṛt i.e. stool([[rakta]] is primary and stool is secondary)
#[[rakta]] is associated with [[pitta]] ([[rakta]] is primary and [[pitta]] is secondary)
#śakṛt (stool) is associated with [[pitta]] (stool is primary and [[pitta]] is secondary) 
#śakṛt stool is associated with [[rakta]] (stool is primary and [[rakta]] is secondary)
#[[pitta]] is associated with [[rakta]] ([[pitta]] is primary and [[rakta]] is secondary)
#[[pitta]]  is associated with śakṛt stool ([[pitta]] is primary and stool is secondary)

In the 31st verse the possible combination are-
#stool is associated with [[kapha]] (stool is primary and [[kapha]] is secondary)
#[[pitta]] is associated with [[kapha]] ([[pitta]] is primary and [[kapha]] is secondary)
#[[kapha]] is associated with stool ([[kapha]] is primary andstool is secondary) 
#[[kapha]] is associated with [[pitta]] ([[kapha]] is primary and [[pitta]] is secondary)
#[[kapha]] is associated with [[rakta]] ([[kapha]] is primary and [[rakta]] issecondary)

The conditions mentioned in 30th verse are managed by administration of [[basti]] prepared with astringent, sweet and bitter ingredients. While the pathologies in 31stverse, are manageable by a [[basti]] with trikaṭu, bitter and astringent ingredients. (verse 30-31)

In these verses 32-33, four more combinations of pathology are described with their management. In 32nd verse the [[kapha]] is main factor with [[vata]] as secondary and [[rakta]] as main with [[kapha]] as secondary while in 33rd verse [[vata]] is main factor with [[kapha]] as secondary and [[pitta]] as main with [[vata]] as secondary.

Type of atisāra according to involvement of factors.	Reccommended material for [[basti]]
[[Kapha]] is main factor with [[vata]] as secondary	trikaṭu, bitter and sour ingredients
[[Rakta]] as main with [[kapha]] as secondary	sweet,trikaṭu and bitter 
[[Vata]] is main factor with [[kapha]] as secondary	trikaṭu,sour and salty
[[Pitta]] is main with [[vata]] as secondary.	sweet, sour and bitter(verse 32-33)

There are six components involved in the pathogenesis of atisāra. In earlier verses the combinations of two components are described. The combinations of three, four or five are also possible. Gaṅgādhara in his Jalpakalpataru commentary mentions the possibility of combination of all six also.<ref>Charak. Sidhi Sthana, Cha.8 Prasrita Yogiyam Sidhi Adhyaya. In: Kaviraj shree Narendranath sen Gupta, and kaviraj shree Balaichandra sen Gupta, Editors. Charak Samhita.? ed. New Delhi;Rastriya Samskrita Samsthana, 2002; P 3742-43.</ref> This appears logical, as when five may combine six together may also be possible. 

According to Gaṅgādhara, the following combinations may happen viz. ten clinical forms due to combinations of three, six forms due to combinations of four, three forms due to combinations of five and one form with all six. In this way twenty forms are possible. These combinations are as below.

Combinations of three	Combinations of four	Combinations of five	Combination of six
āmaviḍvātaja
āmaviḍasṛja
āmaviḍpittaja
āmaviḍkaphaja
viḍvātāsṛja
viḍvātapittaja
viḍvātakaphaja
vātāsṛkpittaja
vātāsṛkkaphaja
asṛkpittakaphaja	
āmaviḍvātāsṛja
āmaviḍvātapittaja
āmaviḍvātakaphaja
viḍvātāsṛkpittaja
viḍvātāsṛkkaphaja
vātāsṛkpittakaphaja	
āmaviḍvātāsṛkpittaja
āmaviḍvātāsṛkkaphaja
viḍvātāsṛkpitta kaphaja
āmaviḍvātāsṛkpittakaphaja(verse 34) 

If case of association of āma, [[basti]]s are contraindicated. This is a general rule. In such condition the āmapācana (preparation to terminate āma)is given. However, in nirāma condition (without association of āma), [[basti]]s are recommended. (verse 35)

In these verses 36-37, two new units of measurement are described i.e. pala and prastha. After calculating these amounts in modern units of metric system, pala is around 50 gms or 50 ml while prastha around 800 ml. Though, in previous verses the management of different types of atisāras, has been described. In coherence of the topic, more remedies for atisāra are described in present verses.

This medicated ghṛta is processed with plants having [[stambhana]] action. Therefore, it is useful in all types of atisāra. Being a nourishing preparation, it is useful in compensating the loss of the essential body substances. A [[basti]] may also be given with this preparation and should be retained as much as possible. This type of [[basti]] may be useful in inflammatory bowel diseases. (verse 36-37)

The remedies for atisāra continue in these verses 38-39. These verses describe recipe of medicated gruels useful in management of this disease. First the decoction is prepared according to the recipe of ṣaḍaṅgapānīya.<ref>Chakrapani, Charak. Chikitsa Sthana, Cha.3 Jwara Chikitsitam ver.145 In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.4th ed. New Delhi: Munshiram Manoharlal publishers pvt. Ltd; 4th edition 1981; P 714.P 410.</ref>,<ref>Agnihotri Avadhabihari; Bhaiṣajyakalpanā Vijñāna; Chaukhamba orientalia publication, 6th edition, 2006, P 146-147.</ref>

For this purpose one part of the course powder of all plants is boiled with 64 parts of water. When water is reduced to half, this is to be taken to cook yavāgū. There are three varieties of yavāgū-maṇḍa, peyā and vilepī. These three are gradually thicker in consistency and may be chosen according to strength of a patient and his agni. (verse 38-39)

Gaṅgādhara considers Sthirādi group of plants as Svalpapañcamūla consists of śālaparṇī (Desmodium gangeticum DC.), pṛśniparṇī (Uraria picta Desr.) bṛhatī (Solanum indicum Linn.) kaṇṭakārī (Solanum suranttense Burm.) and gokṣura (Tribulus terrestris Linn.). About balādi group there is no clarification by any commentator however the plants Sida cordifolia Linn., abutilon indicum Linn., Sida rhombifolia Linn. and Grewia hirsute Vahl. may be taken for this purpose. Ikṣvādi is considered by Cakrapāṇi as roots of Saccharum officinarum Linn., Desmostachya bipinnata Stapf., Saccharum spontaneum Linn. and roots of rice.
There is another version of verse 42, which mentions last line as ‘sasarpirlavaṇā yojyā madhurā lavaṇāpi vā’ which means that this preparation can be used with ghṛta and rock salt in sweet or salty form.

Above verses give some more recipes for medicated yavāgūs those are helpful in management of atisāra. (verse 40-42)
In these verses some additional and useful remedies for management of various types of atisāra are given. It is to be recalled that in this chapter, authors have considered six factors responsible in pathogenesis and manifestation of atisāra viz. āma [[vata]], [[pitta]], [[kapha]], [[rakta]] and sakṛt (stool). The treatments are to be considered as per the factors involved. (verse 43-45)
The chapter describes various clinical forms of atisara according to the components involved in the pathogenesis. The therapeutics for these various forms of atisāra is described in a planned manner. Ayurvedic management is not merely medicaments but it recommends the food preparations those are helpful in restoring the normalcy of the body components of the patient. Thus the chapter is significantly useful for clinical practice of [[basti]] therapies and the treatment of disease atisāra, which includes several modern diseases such as ulcerative colitis, Crohn’s dieases and irritable bowel syndrome. (verse 46)
The [[basti]] formulations mentioned in this chapter are used widely in today’s clinical practice. However, though atisara (diarrhea) is explained in detail as complication of improperly administered [[basti]], in todays clinical practice, this complication is observed rarely.
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