Musta in the Management of Atisara

Introduction

The disease atisara looks very simple but it is a global problem. In 2016, diarrhoea came out as the eighth most prominent cause of mortality, accounting for more than 1·6 million deaths.¹ In 2017, almost 1.6 million people died from diarrheal diseases globally.² Atisara is characterized by loose watery stools and mithya ahara vihara i.e. incorrect diet and lifestyle is the nidana (prime cause) directed to atisara. Vata pradhana tridosha is implicated in samanya samprapti of atisara. According to the classics of Ayurveda, it is well managed and musta either alone or with others has been found useful for almost all types of atisara. So the role of musta in the treatment of all types of atisara is analyzed in this article.

Samprapti:³

The usual nidana being mithya ahara and vihara (faulty Diet and lifestyle) leads to agnimandya (diminished digestive capacity) which in turn causes indigestion and vitiates gastrointestinal tract and hinders the absorption from the intestine leading to loose stools (Fig 1) (Table 1).

Types: Six types of atisara described by the Acharyas are: Vataja, pittaja, kaphaja, tridoshaja, bhayaja, and shokaja. Acharya Sushruta explains amaja instead of bhayaja. Acharya Charaka explicates two stages in vataja atisara as ama and pakwaatisara. Diagnosis of atisara is based on the lakshana as follows:⁴

Management of atisara:

Diarrhoea usually occurs when fluid cannot be absorbed from the contents of the bowel or when extra fluid is secreted into bowel causing watery faeces.⁵ So, improvement in the intestinal absorption and halting of fluid secretion is the main line of treatment. Ayurveda emphasizes the same and explains when to use drugs for the improvement of intestinal absorption and halt intestinal secretion. Management of atisara involves the evaluation of ama and pakwaavastha along with doshakopana. In amaavastha, the drugs which are ama, dosha, and mala pachaka are advised. In pakwaavastha, stambhana dravya is advised (Figure 2).

Musta is one such drug that can be used in both the conditions (ama and pakwa) of atisara.

Musta, Cyperus rotundus Linn belonging to the Cyperaceae family is a glabrous; stolon elongate, slender, 10–20 cm long and has hard ovoid tunicate black fragrant tubers of 0.8–2.5 cm diameter; root fibers are clothed with flexuous hair.⁶ Musta is eaten by varaha (Pigs) as it helps in digesting any type of food. Musta is attributed to the following properties(Table 2):⁷

Prayoga: It is highly recommended in amatisara, pakwatisara, grahani, aruchi, and trishna-like gastrointestinal disorders.

Mode of action of musta in atisara:

Amatisara: It is characterized by mandagni, amadosha, and mala. Musta digests ama due to tikta and kashaya rasa and resolves ajirnata. Musta subsides abdominal pain observed in amatisara. Hence, musta works effectively in amatisara.

1. Musta churna is given with vacha (Acorus calamus), ativisha (Aconitum heterophyllum), abhaya (Terminalia chebula), bhadradaru (Cedrus deodara), and nagakeshara (Mesua ferrea).⁸ 

2. Musta kshira: Twenty musta are pounded and boiled in 8 times of milk and water (3 times more than milk) till water evaporates. It reduces shula and cures amatisara. ⁹

3. Equal parts of churna of musta, patolapatra (Trichosanthes dioica), ajamoda, bilva (Aegle marmelos), vacha (Acorus calamus), pippali (Piper longum), shunthi (Zingiber officinale), kushtha (Saussurea lappa), vidanga (Embelia ribes) is given in 2–4 masha matra (2–4gms) with koshna jala (lukewarm water) for 2–3 times.¹⁰

4. One part milk, twenty (pala) musta, and three parts of water are mixed, boiled, and reduced to the quantity of milk to cure painful amatisara. ¹¹

Samapittatisara: It involves sama pitta and musta in amapachaka and pittashamaka (tikta, kashaya rasa, and shitavirya) to resolve samapittatisara.

1. Churna or kwatha of musta with kutajaphala (Hoerrhena antidysentrica) and tvak (Cinnamomum zeylanicum), shunthi (Zingiber officinale) and vacha (Acorus calamus) is advised.¹²

2. Churna or kwatha of musta with kutajabija (Indrayava), bhunimba (Andrographis paniculata), and rasanjana is also administered.¹³

Pakwatisara: Stambhana and agnidipana are the treatment modalities and musta halts mala by reducing intestinal secretion.The ruksha, laghuguna, kashayarasa, and shitavirya of musta helps in malastambhana.

1. Churna or kwatha of musta, dhatakipushpa (Woodfordia fruticosa), manjishtha (Rubia cordifolia), and lodhra (Symplocos racemosa) is given with madhu and tandulodaka.¹⁴

2. Musta kwatha with madhu is also advised.¹⁵

3. Yavagu prepared with bilva (Aegle marmelos), musta, akshibhaishajya (Rodhra-Symplocos racemosa), dhatakipushpa (Woodfordia fruticosa), and Nagara (Zingiber officinale) can also cure pakwatisara. ¹⁶

Sashonita pakwatisara: Rakta and malastambhana are the line of treatment in case of blood in loose stools. Shitavirya, kashaya madhura rasa of musta acts as pittahara, raktashodhaka to stop bleeding and loose stool.

1. Equal quantities of musta, vidari (Pueraria tuberosa), raktachandana (Pterocarpus santalinus), bharangi (Clerodendrum serratum), sharkara (sugar), and padmakeshara (Nelumbo nucifera) made into churna and 2–4 masha are given with madhu (honey) and tandulodaka. ¹⁷

Pittaja atisara: Musta being tikta rasa and shita in virya, subsides kupita pitta, reduces morbid thirst, burning sensation, excessive sweating, fainting, colic pain, and hot sensation and suppuration of the anus found in pittajaatisara.

1. Kwatha prepared from musta with hrivera (Pavonia odorata), bilva (Aegle marmelos), nagara (Zingiber officinale), and dhanyaka (Coriandrum sativum) is given.¹⁸

2. Kashaya of musta with madhu (honey) is also advised.¹⁹

Kaphaja atisara: Agnidipana, amapachana, and aruchihara chikitsa is required. Musta is having laghu, ruksha guna, tikta, kashaya rasa so relieves snigda (unctuous), swetha (whitish), pichila (slimy). Tantumat (contain fibrinous shreds and undigested matter), Guru (heavy), durgandha (offensive) loose and constant, sleshomapahita (gets mixed with the lump of mucus).

1. Kwatha prepared of musta, bilva (Aegle marmelos), karkatika, pranada, shunthi (Zingiber officinale), vacha (Acorus calamaus), vidanga (Embelia ribes), bhutika, dhanyaka (Coriandrum sativum), and maradaru is given.²⁰

2. Kwatha of musta, abhaya (Terminalia chebula), shunthi (Zingiber officinale), and balabilwa (Aegle marmelos) is also recommended.²¹

Trishna in atisara: Trishna or polydipsia is a frequently seen symptom after the loss of fluid in stool, if not supplemented with fluids, body may suffer from dehydration. So, Acharyas have explained the administration of medicated water for diarrhoea. Musta is trishnanigrahaka and prevents water loss by improving water absorption in the intestine.

1. Jala prepared from musta, vacha (Acorus calamus), hribera (Pavonia odorata), parpata (Fumaria parviflora), prativisha (Aconitum heterophyllum), and shunthi (Zingiber officinale) is given.²²

Madhyadosha atisara: Here the dosha involved will not be so severe and can be controlled with simple formulations.

1. Pramathya of jala, musta, bilwapeshika (Aegle marmelos), shunthi (Zingiber officinale), and dhanyaka (Coriandrum sativum) can cure atisara. ²³

2. Kwatha of musta, pippali (Piper longum), indrayava (Hoerrhena antidysentrica), patha (Cyclea peltata), and tejovati (Zanthoxyllum alatum) is beneficial.²⁴

Alpadosha atisara: It is the initial stage of atisara.

1. Jala boiled in musta and parpata (Fumaria parviflora) is beneficial.²⁵

Discussion

From the above review, it is evident that musta acts effectively in both the stages and different types of atisara (diarrhoea). Samanya samprapti of atisara involves agnimandya (diminished digestive capacity), ajirnata (indigestion), and diminished intestinal absorption. Musta corrects digestion, increases intestinal absorption, and stops loose stool. It is apparent from the classics that musta prevents fluid loss and hence dehydration. Additionally, it along with other drugs can be used to prepare oral rehydration solution.

Tikta and kashaya rasa of musta helps its amapachaka property and makes it potent in amatisara. In the same way, grahiguna of musta improves intestinal absorption and stops loose stool so best indicated in pakwatisara.

Conclusion

The literature review suggests that all the Brihatrayis mentioned musta as the best drug of choice in ama as well as pakwa atisara. So any type of atisara can be managed with musta alone or in combination with other dravyas.

Author Contribution

Dr. Subhas V Bagade and Dr. Sarojini D Byadigi contributed equally to this work.

Conflicts of Interest

None