उदर

Reference:
Ch.Chi.13, A.H.Ni.12, Su.Ni.7

Introduction
The disease is called as उदर because there is distension of उदर (Abdomen).

Svaroopa
Distended abdomen is the cardinal sign of the disease (Aadhmaata Udara and Kukshi). It is a sort of edema and therefore Chakrapaan`i says that it has been described after शोथ.

उदर is a serious type of disease (Ghora Krichchhratama). Patient looks as if he is dead; it reveals the serious condition of the disease.

Nirukti
Udara Utsedha Saamaanyaat Udaram | M. N. 35 Madhukos`ha

Synonyms
Jat`hara

Hetu
The basic factor in manifestation of उदर is Agni Dosha. In context of उदर, Agni Dosha refers to Agni Maandya (lowered digestive capacity); which lead to the aggravation of Dosha and Mala (Mala Vriddhi Malaah Vaataadayah Pureeshaadayah Cha – Chakrapaan`i). This increased quantity of Mala leads to उदर.

In such a condition of lowered digestive capacity, a person eats dirty food; Dosha get accumulated due to indigestion.

There is vitiation of Praan`a Vaayu, Apaana Vaayu and digestive power (Agni). There is obstruction of upward and downward channel (Praan`avaha and Pureeshavaha Srotas). This results in to the distention of abdomen and flanks which is a cardinal sign of उदर.

Different types of उदर are caused by the following factors:

1. Intake of excessive hot, salty, alkaline (Kshaara), Vidaahee (which causes burning sensation), sour, poisonous food.
2. Improper Samsarjana Krama.
3. Intake of dry (Rooksha), Viruddha and unclean food.
4. Emaciation due to the diseases like Pleehaa (Splenomegaly), अर्श (Piles), ग्रहणी.
5. Improper administration of पंचकर्म.
6. Negligence in treatment of the diseases like Pleehaa and consequential non unctuousness in the body.
7. Suppression of natural urges.
8. Vitiation of channels for circulation.
9. Due to presence of Aama (Product of improper indigestion).
10. Due to irritation.
11. Intake of food in excess amount.
12. Obstruction in digestive system by piles, hairs and hard stools.
13. Due to ulceration in intestines.
14. Excessive accumulation of the Dosha.
15. Indulgence in sinful acts.

Because of these factors, different types of उदर are manifested in those persons having lowered digestive capacity (Mandaagni).

Sampraapti

1. Accumulated Dosha obstruct the channels carrying sweat (Sveda), body fluid (Ambu).
2. They vitiate Praan`a, Apaana and Agni.
3. Dosha gets settled in the joint of skin and muscular tissue on abdomen.
4. They distend abdomen manifesting उदर.

Sus`hruta describes mode of manifestation of उदर according to Upasnehana Nyaaya.

1. As water percolates out off the new clay pot through its minute porous channels, Annasaara (digestive product of the food) percolates out off the Kosht`ha ग्रहणी (Intestines).
2. This percolated Annasaara gets provoked by Vaayu which distends abdomen by causing swelling in the skin.
3. This distention goes on increasing which leads to the Jat`hara (उदर).

Signs and symptoms of उदर
It presents itself with the symptoms resembling गुल्म. But still it is different form गुल्म. Actually, before complete manifestation of उदर, the picture of disease resembles to गुल्म.

Cardinal signs

1. Kukhsi Aadhmaapana – Distention of flanks
2. Aat`opa flatulence in the abdomen
3. Paada and Hasta S`hopha oedema in the legs and hands
4. S`hlakshn`a Gan`d`atva smoothness of cheeks
5. Kaars`hya emaciation

Other signs: presentation of a patient who is suffering from उदर is like this:

1. S`hushka Vaktra dryness in mouth
2. Kris`ha Gaatra emaciation of the body parts
3. Aadhmaata Udara distended abdomen
4. Aadhmaata Kukshi distended flanks
5. Pranasht`a Agni loss of digestive power / capacity
6. Pranasht`a Bala loss of physical strength
7. Pranasht`a Aahaara loss of food intake
8. Sarva Chesht`aasu Anees`hvara a person does not able to carry out the locomotory functions
9. Deena patient becomes depressed

Types of उदर

Charaka	Sus`hruta
Vaataja	Vaataja
Pittaja	Pittaja
Kaphaja	Kaphaja
Saannipaatika	Saannipaatika
Pleehodara	Pleehodara
Baddhodara	Baddhagudodara
Kshatodara	Aagantu Udara
Udakodara	Dakodara

Vaataja Udara
Vaayu gets aggravated due to dry food and less quantity of food, exertion, suppression of natural urges, उदावर्त (upward movement of the Vaayu) and emaciation. This aggravated Vaayu moves through Kukshi, Hridaya, Basti and Guda suppressing digestive capacity (Agni Hanana). It stimulates Kapha (Kapham Uddhooya), therefore movements of Vaayu gets arrested between skin and muscular tissue of the abdomen which causes swelling of the abdomen.

Pittaja Udara
Pitta gets immediately accumulated due to Pitta aggravating factors. Having reached to the locations of Vaayu and Kapha, it obstructs their channels. It moves upward and suppresses the Agni in the stomach as a result of which उदर gets manifested.

Kaphaja Udara
Kapha gets aggravated due to Kapha aggravating factors. This aggravated Kapha obstructs the channels of the circulation; as a result of which Vaayu gets obstructed located in the exterior of the intestines (Bahih Antragah). This Vaayu exercises pressure on Kapha as a result of which उदर is manifested.

Sannipaata Udara
All the three Dosha get aggravated due to their aggravating causes such as

1. Administering unwholesome ingredients of food like hair, stool, urine, bones, nails or excretory secretions etc.
2. Slow poisoning (Dooshee Visha)
3. When a person having weak digestive capacity indulges in unwholesome, uncooked, Viruddha and heavy food.

These three Dosha get accumulated gradually in the Kosht`ha (digestive system) also Rakta gets vitiated. as a result of which उदर gets manifested.

This type of उदर gets aggravated due to cold air, in cloudy weather. Patient faints down, becomes pale, emaciates, and becomes thirsty. This is serious condition.

Pleehaa Udara

1. Person who is indulged in excessive exertion, traveling, excessive movements, excessive sexual act, carrying heavy load, walking, and emesis after eating,
2. Pleehaa (Spleen), which is situated in the left side of the abdomen gets displaced and enlarged. It Spleen can get enlarged (without displacement) due to the increase in the quantity of blood.
3. Increase in blood is possible due to increase in the antecedent Dhaatu like Rasa and increase in the descendent Dhaatu like Maamsa etc.
4. The enlarged Pleehaa resembles to the Asht`heelaa rounded, stony hard swelling (like back of tortoise).
5. It goes on increasing and if at all it remains untreated, it puts the pressure on the flanks, stomach (Jat`hara) and site of Agni manifesting उदर.
6. The same event may take place with respect to Yakrit (Liver).
   Pleehaa Roga has similar Sampraapti that of Pleehodara and has signs and symptoms as Pleehaa Vriddhi and Paars`hva Toda.

If liver gets enlarged then it is called as Yakritodara. It is counted in Pleehodara itself.

Sampraapti Suggested by Sus`hruta

When a person indulges in Vidaahee and Abhishyandee food, Rakta and Kapha gets highly vitiated.
They enlarge Pleehaa and the Agni gets lowered.
Patient has mild temperature (Manda Jvara), emaciated and highly paled (AtiPaan`d`u).

Baddha Gudodara

1. Vaayu gets aggravated as a result of obstruction in the passage of the Guda because of following:
           Intake of foreign bodies (as small hairs with food)
           उदावर्त (Upward movement of Vaayu)
           Upalepa (coating of intestines due to stickiness in the food etc)
           Piles (Ars`ha),
           Antra Sammoorchchaanaa (intussusceptions or intrusion of the intestine in to its lumen)
           Obstruction to the passage of Apaana Vaayu.
2. This aggravated Vaayu lowers down the digestive capacity (Agnim Hatvaa).
3. It obstructs movements of faces, Pitta and Kapha.
4. Abdominal swelling caused by the obstruction in the intestines gets manifested that is termed as Baddha Gudodara.
5. This results in distention of the region between Hridaya and Naabhi.

Kshata Udara

1. The intestines get perforated because of the following reasons:
   Piercing of the intestines because of foreign bodies like (sand, grass, pieces of wood, bone or nails etc)
   Any jerks as sudden deep yawing etc.
   Intake of food in large quantity
2. The wound in the intestine thus caused gets suppurated and from this wound the Rasa comes of the intestines.
3. The rectum and the intestines get filled with this juice as a result of which Kshata उदर (Acute abdominal swelling due to intestinal perforation) is manifested.

Difference between Udakodara and Kshata Udara.
It may present similar to Udakodara; but in comparison with Udakodara, manifestation of Kshata उदर is quicker than Udakodara.

Parisraavee Udara / Kshataantra

1. Any foreign body (S`halya) engulfed with food cuts down the intestines.
2. Secretions through this wound gets accumulated below the level of umbilicus.
3. The fluid gets passed through the anus.
4. Therefore, there is distention of the abdomen below umbilical level with pain and burning sensation (Vidahyate).

Udakodara

1. Causes of Udakodara include अग्निमांद्य potentiating factors,also following causes are prominent:
   When emaciated, weakened person or whose digestive capacity is hampered, consumes Sneha (oily substances) that leads to complete loss of digestive capacity.
   When a person drinks cold water after consumption of Sneha, Anuvaasana Basti, amana (Emesis), Virechana (Purgation), Niruha Basti.
   Factors, which block channels by Sneha.
2. As a result of this Vaayu located in Kloman gets mixed with Kapha and Udaka.
3. They obstruct the channels resulting in the increase of Udaka (body fluid).
4. The vitiated Vaayu and Kapha from their locations assist in increasing this water as a result of which Udakodara is caused.

Physician should treat this condition immediately before any complication gets appeared and before fluid gets accumulated in the abdomen. If it is not treated, then the vitiated Dosha get displaced and become liquefied due to Paripaaka (Maturation). They produce stickiness in the Sandhi and channels (Srotas). Sweat is diverted from the external channels in to the side ways (Tiryag Gati) which adds to the quantity of fluid accumulated in the abdomen.

Clinical presentation of Udakodara:
The appearance of this sticky liquid (Pichchhaa) makes the abdomen round (Man`d`alam), heavy (Guru) and numb (Stimita). The abdomen becomes dull in percussion (Aakot`hita S`habdam) and soft to touch (Mridu Spars`ham). Thereafter, the veins on the abdomen disappear. During this period, the umbilical region is primarily afflicted and from there the disease spreads in the remaining parts of the abdomen. The abdomen looks like a bag of leather full of water with averted umbilicus.

Relation between Dosha and Lakshan`a

Vaataja Lakshan`a	Pittaja Lakshan`a	Kaphaja Lakshan`a
उदावर्त	Moha	Gaurava
Rujaa	Trid`	Aruchi
आनाह	Dahana	Kaat`hinya
	ज्वर

Upadrava of उदर

1. छर्दि
2. Ateesaara
3. तृष्णा
4. श्वास
5. कास
6. हिक्का
7. Daurbalya
8. Paars`hva S`hoola
9. Aruchi
10. स्वरभेद
11. Mootra Sanga

	उदर	Vaataja	Pittaja	Kaphaja	Saannipaatika	Pleehodara	Baddhodara	Kshatodara(Chhidraantra)	Udakodara
रोगमार्ग	Aabhyantara
Vyaadhiclassification	Rasapradoshaja Vikaara (As there is Paan`d`utva in उदर)Raktapradoshaja Vikaara (Pleehodara)
Svabhaava	Daarun`aGhora (Bhayaanaka)Mahaavyaadhi
Avayava	उदरKukshiTvak-Maamsa AntaraKosht`ha	Kukshi,HridayaBasti Guda	Aamaas`haya		Kosht`ha	Pleehaa	Antra Guda (Guda Nirodha)Hridaya and Naabhi Madhya	GudaAntraAdho Naabhi	Kloma
Saadhya	Balavaan Rugn`a Ajaatodaka AvasthaaNava
Krichchhra	All उदर are generally Krichchhrasaadhya	Krichchhrasaadhya	Krichchhrasaadhya	Krichchhrasaadhya	Krichchhrasaadhya	KrichchhrasaadhyaS`hastra Saadhya	S`hastra Saadhya	S`hastra Saadhya	Krichchhrasaadhya
Asaadhya	S`hoona Aksha Kut`ila Upastha Upaklinna TanuUpaklinna TvachaaKsheen`a BalaKsheen`a MaamsaKsheen`a AgniSarva Marmottha S`hothaS`hvaasa YuktaHikkaa YuktaAruchi YuktaTrit` YuktaMoorchchhaa YuktaChhardi YuktaAteesaara Yukta Dakodara Upadrava Yukta Paars`hva BhangaAnna VidvesheeS`hotha Peed`ita Ateesaara Peed`itaViriktam api Pooryamaan`a	Krichchhrasaadhya	Krichchhrasaadhya	Krichchhrasaadhya	Krichchhrasaadhya	KrichchhrasaadhyaKaalaprakarshaad Asaadhya	After 15 days AsaadhyaKaalaprakarshaad Asaadhya	AsaadhyaAsaadhya Kaalaprakarshaad AsaadhyaAfter 15 days	Jaatodakaavasthaa Asaadhya
Vyaadhi Vyavachchheda	गुल्म					Asht`heelaaPleehaa RogaPleehaa Vriddhi		Udakodara
Dosha	Tridoshaja Mala (Dosha) वृद्धिPraan`a Dusht`iApaana Dusht`iDosha SanchayaAti Sanchita Dosha Vriddha DoshaAnila Veganunnah (Vaata Prakopa)	Vaata PrakopaVaayu Ruddha Gati	Pitta SamaachitaPitta Unmaargee	S`hleshmaa KriddhaAavrita Vaayu	Kupita Tridosha	Kapha GayadaasaPitta GayadaasaAti Pradusht`a Kapha	Vaata Prakopa Apaana Maarga RodhaPitta RodhaKapha Rodha		Vaata PrakopaKapha Prakopa
Dosha_Gun`a		ChalaKharaLaghuRookshaS`heetaSookshma	AmlaDravaKat`uLaghuLavan`aSaraTeekshn`aUshn`a	GuruMandaS`heetaS`hlakshn`aSnigdhaSthira
Dhaatu					Rakta Kupita	S`hon`ita VriddhiAti Pradusht`a Rakta
Mala	Mala VriddhiPureesha Nichaya						Pureesha RodhaMala (Pureesha) SanchayaMala Sanga		Sveda RodhaSveda Rodha
Srotas	Praan`avaha SrotasPraan`avaha Srotas RodhaPureeshavaha SrotasRodha Annavaha Srotas Dooshan`aSvedavaha SrotasSvedavaha Srotas Rodha (Baahyatah) Ambuvaha Srotas Rodha Udakavaha Rasava Srotas Dusht`i & Rodha GayadaasaSvedavaha Srotas Dusht`i & Rodha GayadaasaAmbuvaha Srotas Dusht`i & Rodha Gayadaasa								UdakavahaUdakavaha Srotas Rodha
Agni	Pranasht`aManda Agni Dosha Maandya Chakrapaan`iAgni Dusht`iSudurbalaagni (Atyanta Nasht`a Agni)	Agni Hanana	Vahnim Hanti		Durbala Agni	Manda Agni	Agni Hanana		Nasht`a AgniManda Agni

Last updated on February 12th, 2021 at 11:13 am