PRAVAHIKA (DYSENTRY)

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.
 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.
 TYPES OF DYSENTERY
• AMOEBIC DYSENTERY-It is caused by an infection caused by
entamoeba histolytica.

• 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.
 MANAGEMENT OF 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
 Diagnosis of dysentery:

• 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.
 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, anyone suffering from
dehydration or malnutrition
• Amoebic dysentery is often treated with 2 antimicrobial drugs such as
metronidazole and paromomycin or iodoquinol etc
 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’.
• 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.
CAUSES OF PRAVAHIKA
 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
 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 AND PACHANA

• Deepana and pachana medicines help improve the digestion, destroys ama,
expel krimis and thus reduce the gut inflammation and irritability.
• 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.
• 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,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
• 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 pachan.
• 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) can be used.
 Stambhana Chikitsa
• 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.
• Shalaparni – Desmodium gangeticum,Prishniparni – Uraria
picta,Brihati – Solanum indicum,Kantakari – Solanum
xanthocarpum,Gokshura – Tribulus terrestris, Patha –
Cissampelos pareira,Shunti – Zingiber officinale,Bala – Sida
cordifolia,Bilwa – Aegle marmelos.
• 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).
 PICHCHA VASTI

• 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.
 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).
 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
• 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
• 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).