Journal of Ayurveda and Integrated Medical Sciences

Balatisara meaning Atisara in Bala or childhood diarrhoea.^[1] It is one of the commonest & serious disease during childhood. These liquid stools are usually passed more than three times a day. However, diarrhoea is the recent change in consistency and character of stool is most important rather than number of stool passed. A child suffers from an average 10 to 15 episodes of diarrhoea in the first five year of life, out of these three to five episodes occurs during very infancy. i.e., 1^st year of age.^[2] In the tropical belt 15 to 40% of all deaths among children below 5 years are due to diarrhoea. Diarrhoea has its main impact on infants and young children in the poor section of the developing countries. Existence of mal-nutrition makes the child much vulnerable to suffer from diarrhoea. Diarrhoea has also been shown to have significant effect on nutrition. According to a conservative estimate, almost 500 million children suffer from acute diarrhoea annually, of them 5 million die every year. In India alone, nearly 1.5 million children die due to acute diarrhoea every year.^[3] The seriousness of the disease owes to the commonest complication i.e., dehydration which the most fatal one. A child may lose almost and much water and electrolytes from the body during an episode of diarrhoea as in an adult, since the length and surface area of intestinal mucosa of a child from where the diarrhoeal fluids are secreted are fairly large.

A 9 -year-old thin built male patient visited the outpatient department for the complaints of Atisara like Dravamalavega (diarrohea lasting for more than 2 weeks), Vivarnata (moderate), Udara Shoola (continuous moderate pain), Trishna (moderate-drinks poorly), Kshudhahani (appetite decreased), Daurbalya (weakness), Nidralpata (reduced sleep) for more than two weeks. A history of the present illness revealed that the patient was apparently normal before one weeks. He had episodic passing watery loose stools for 4 to 5 times per day. The problem increased day by day, and the patient suffered from fever and severe abdominal pain, then consulted with family physician and was on some antibiotic medicine which relieved the condition for a time being. After two days he feels pain in abdomen, with frequent watery stool

As mentioned in Ayurvedic text, Dosha Dushti in this patient is Pittapradhan Tridoshdushti, as there is Amlodgar, Urodaha, Trushna Lakshnas were present. Due to increased Drava, Sara and Ushna Guna of Pitta leads to Agninash and Purishbheda. This leads to Pittaja Atisara. So, the Samprapti in this patient was postulated as follows:

Ati Ushna, Tiksha, Lavan, Katu Ahara Sevan → Tridosh Dushti (Pitta Dushti Adhik) → Drava, Sara and Ushna Guna of Pitta increased) Apa Dhatu is increased in excess → Downward movement in Purishashay by Vata → Leading to development of excess watery stool → Atisara

Most of the patients were suffering from Mandagni, which clearly indicate that Agnimandya is the prior stage of almost all the diseases. Here in case of Atisara also Mandagni leads to Ama formation which further leads to Atisara. Dravamala Pravrutti was nothing but the cardinal signs of the Atisara. Udarshool was present in the patient followed by Aruchi. Jivha Pariksha and Jalnimajan Pariksha were very important tools of Ayurveda to decide Sama or Nirama Avastha.

Bilvadileha^[4]

Bilva due to its Kashaya Tikta Rasa, Katu Vipaka and Laghu Guna act as Agnideepan and also Aamapachak. Kashaya Rasa and Ushna Virya help in reducing the colonic motility. Sangrahi property of Bilva is very useful to treat the increased frequency of defecation and the consistency of the stool. In Bilvadileha in addition to Bilva, Prakshepa Dravyas like Dhanyaka, Jeeraka, Ela, Keshara, Twaka, Trikatu, Musta, have properties like Deepan, Pachana, Kaphghna, Vedanasthapaka, Rasayana. Thus, due to different properties of its ingredients, Bilvadileha has property like Tridoshahar, Deepan, Pachana, Aamnashaka, Grahi, Vibandhahar and Vatanuloman which checks the Samprapti and pacify the symptoms of Atisara.