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INTRODUCTION

“Roga Sarvapi Mandagni Suturaudarani Tu”. Functionally weak agni that is mandagni causes improper digestion of ingested food which leads to Udara roga. Udara roga denotes the generalized distension or enlargement of abdomen of varied etiology. It is one among the Ashtamahagada. From the orgin of the illness it is difficult to manage. Agni dosha and mala vriddhi causes vitiation of Prana, agni & Apana and obstruction of the upward and downward channels of circulation. The vitiated doshas get lodged between skin and muscle tissue and causes extensive distension of the abdomen resulting in Udara roga.[1] The cardinal features are Kukshi adhmana (enlargement of abdomen), Karapada shopha (oedema in the limbs), Mandagni/ Atyanta Nastagni , Krushagatra(emaciation).[2]

According to Ayurveda agnimandya is mentioned as basic etiological factor for development of udara roga. Intake of excessive hot, saline, sour drinks, improper Samsarjana krama after Panchakarma therapy, improper vamana and virechana, arsha, grahani and pleehadosha, presence of ama, ulcerations and perforations are the main causes described in our classics. Low and delayed digestion, burning sensation, inability to determine between digestion and indigestion, disappearance of abdominal folds with prominent network of veins over abdomen occurs initially are some of the prodromal features of Udara roga. It has been described of eight types of medical and surgical udararogas in Ayurveda.

Vatodara (Accumulation of flatus), Pittodara (Hepatic causes), Kaphodara (Renal causes), Sannipatodara (exudative causes), Pleehodara/Yakritodara (enlargement of spleen and liver), Baddhagudodara (Intestinal obstruction), Kshatodara (Intestinal perforation) and Jalodara,[3] (Ascitis-Fluid in peritoneal cavity). Progressive stages of Jalodara are described namely Ajatodaka, Piccha and Jatodaka. Among eight types of udara roga Baddhagudodara and Kshatodara/Chidrodara are the surgical conditions while other types can be treated with difficulty by medicines.

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UDARA SAMPRAPTI

Nidana sevana + mandagani & ajjerna -> dosha dusthi-> swedavaha & udakvaha shrota avrodha-> pranavayu,apana vayu & agni dusti-> dust vayu duara upasneha bhanti rasa ka udarguha me shravana-> udarguha me anna rasa sanchaya & udar vriddhi-> udar roga

Agnidosha – defective digestion strength and

Mala Vruddhi – increase in waste products / morbid matter – These two are the reasons for diseases like Udara (abdominal diseases including ascites).

If there is suppression of Agni (power of digestion and metabolism), and if the person takes Polluted food, this leads to indigestion as a result of which Doshas get accumulated.

This causes vitiation of Prana (a variety of VataDosha), Agni (digestive enzymes) and Apana (another variety of Vata, related to expulsion of faeces, flatus, urine etc) and obstruction to the upward and downward channels of circulation.

Thereafter, the vitiated Doshas get lodged between the skin and the muscle tissue and cause extensive distension of lower part of abdomen.

This gives rise to Udara (obstinate abdominal diseases including Ascites). Now, hear the causative factors, signs and symptoms of this ailment [9-11]

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UDARA NIDANA – CAUSES

1. Intake of excessively hot, saline, Alkaline, Vidahi (which causes burning sensation), sour and poisonous food and drinks (Garavisha)

2. MithyaSamsarjana – Improper Samsarjanakrama( diet, drinks and other regimens given to the patient after the administration of Pancha karma therapy)

3. Rooksha, Viruddha, AshuchiBhojana – Intake of dry, mutually contradictory and unclean food

4. PleehaArshaGrahaniDoshaKarshana – Emaciation as a consequence of diseases, like Pliha (Splenic disorders), Arsas (piles) and GrahaniDosha (sprue syndrome)

5. Improper administration of Pancha Karma therapy, namely emesis, purgation etc.

6. Negligence of treatment of diseases, like PlihaRoga (splenic disorder) and the consequential unctuousness in the body.

7. Karma Vibhramaat – Suppression of the manifested natural urges

8. Vitiation of the channels of circulation

9. Continued presence of Ama (product of improper digestion and metabolism) in the body

10. Intake of irritating food and drinks

11. Over nourishment

12. Obstruction by piles, hair and hard stool masses

13. Ulceration and perforation of intestines

14. Excessive accumulation of vitiated Doshas and

15. Indulgences in serious sinful acts.

Because of the above mentioned factors, different varieties of Udara are manifested, especially in those having Mandagni (low digestion strength) [12-15]

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UDARAPOORVAROOPA: PREMONITORY SIGNS AND SYMPTOMS

1. KhsutNasha – Low digestion strength

2. Belated digestion of food, which is sweet, excessively unctuous and heavy

3. Vidaha (burning of indigestion) of all the food and drinks taken by the patient

4. Inability to determine between the digestion and indigestion of the food

5. Inability to tolerate a little excess of food

6. Slight swelling in the legs

7. Constant loss of strength

8. Shortness of breath even with slight exercise

9. Excessive accumulation of stool because of unctuousness and Udavarta (bloating, upward movement of the wind in the abdomen)

10. Pain and Adhmana (distension) in the Basti- Sandhi (lower part of abdomen)

11. Even if the patient takes food in small quantity, the size of his abdomen considerably increases. The patient experience bursting pain and the abdomen becomes considerably distended.

12. RajiJanma – Appearance of network of veins and

13. Vali nasha – Disappearance of folds in the abdomen and creases due to swelling [16-19]

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UDARASAMANALAKSHANA – GENERAL SYMPTOMS:

Kuksheadhmana – Distension in the side of the abdomen,

Aatopa – gurgling sound

Padashopha – oedema in the leg and hands,

Suppression of the power of digestion,

Slakshnagandatva – smoothness of the chin and

Karshya – emaciation [21]

1. adhyamana(tympanitis)

2. hasthapada sotha(odema in hands & feets)

3. agnimandhya(indigestion)

4. gand pradesha me chiknapan)

5. weakness

6. defficult to walk

7. sadana(looseness of body)

8. vata & purisha avarodha(obstruction of flatus 7 stool)

9. daha(burning sensation0

10. trishna(excessive thirst)

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SAMPRAPTI GHATAKA-

DOSHA- tridosha

DUSHYA- anna rasa

ADHISTHANA- udar

SHROTAS- annavaha,udak,purisha,rasa,rakta,sveda

SVABHAVA-daruna

SADHYAASADHYATA- kriccha sadhya