“Role of laja manda in the management of Atisara (diarrhea) from Ayurvedic and modern perspective.”

like atisara (diarrhea), chhardi (vomiting), jvara (fever). The purpose of present study is to understand the role of laja manda in the management of atisara (diarrhea) from both ayurvedic and modern perspective.


INTRODUCTION:-
Ayurveda is holistic science which has emphasized more on maintenance of health and prevention of disease rather than treating the disease 1 . Health of the person can be maintained by following dincharya and rutucharya described in Ayurveda. Appropriate ahara plays an important role in sustaining and attaining good health 2 . Ahara is main pillar of a body so called as mahabhaisajy 3 .
Pathya Kalpana is one of the unique concepts in Ayurveda one can alter the properties of dravya with the help of kalpana. 'Pathya kalpana' comprises of the ways of preparations which will maintain the "patha" i.e. channels or systems of body healthy and will also be comfortable to mind 4 . The things opposite to these are considered as 'Apathya".
Acharya Sharangdhara explains about some pathya kalpana like manda, peya, vilepi, yavagu etc 5 . These kalpana are generally used in different diseases according to state of disease and capacity to digest the food in that disease. It also helps to maintain proper agni so as to digest food properly and give needed nutrition to tissues of body. Selection of proper pathya kalpana has significant role for changing the action of a dravya. Pathya kalpana includes selection and preparation of the food according to personalized need.
In pathya kalpana food is processed with the help of aushadhi dravyas (aushadhi siddha ahar). As pathya kalpana is the combination of medicines as well as food, it is not only useful in treating the disease but it also becomes palatable and pleasing. Hence pathya kalpana are easily digestible, quickly absorbable, fast acting and give adequate amount of energy to body.
Atisara (diarrhea) is most commonly encountered disease in clinical practice. 'Ati' means excess and 'saranam' is gati or flow.
Therefore atisara is a condition where watery stools are passed in excess, several times a day, through guda. Most important factor in the pathogenesis of atisara is mandagni. Due to consumption of etiological factors apa dhatu (watery elements) is increased which leads to agnimandya and ajeerana. Vimargagam apdhatu gets mixed with the stool, causes downward movement in annavahasrotas by vata leading to increase in dravata of pureesha in pakwasaya manifesting as atisara 6 .
Laja manda is one of the famous and routinely used Pathya kalpana i.e. dietary medicine in diseases like atisara, chhardi, jvara,etc. Laja manda is prepared by adding laja to Water in the ratio of 1:14 and cooked on low flame till lajas get cooked 7 . Laja Manda is Laghu,dipan gunatmaka and aap mahabhuta pradhana hence it is easy to digest, ignites the digestive fire and also helps to replenish the drava dhatu like rasa without deranging digestion. Thus, the purpose of present study is to understand the role of laja manda in the management of atisara by ayurvedic and modern perspective.

AIM AND OBJECTIVES:-
To understand the role of laja manda in the management of atisara (diarrhea) by Ayurvedic perspective and from modern point of view.
To study the standard operating procedure of laja manda thoroughly. E-ISSN: 2320-7329

MATERIALS AND METHODS:-
Literary references from ayurvedic classics and modern medical text along with journals were collected and analytically reviewed to evaluate role of laja manda in atisara management by ayurvedic and modern point of view.

Standard operating procedure of laja manda:
Standard operating procedure of manda kalpana by Sharangdhar Samhita has to be taken into consideration. Genuine species of laja should be taken. Laja is prepared by parching the rice in sand bath 8 . The husks open out and the rice swells into light body. Here, sanskara concept of Ayurveda should be taken into consideration. Sanskara means processing, which would result in the transformation of the gunas (inherent qualities) of the substance 9 . Due to agni sanskara, guru (hard to digest) and pittala (vitiating pitta) vrihi (rice) transforms into laja which is laghu (easy to digest) and pittahara (pacifies pitta).
Laja manda is prepared by using laja and water in 1:14 proportion. The laja is cooked in said proportion of water on low flame till lajas get cooked and filtrate obtained. i.e. water content of the prepared formulation is collected as manda (watery portion of rice gruel) 10 .
The major step in this recipe is cooking i.e. agni sanskara which make the recipe laghu (easy to digest). In atisara the digestive capacity is low, so such laghu recipe is preferred in Ayurveda. According to modern science, water after boiling gets disinfected which is useful in diarrhea having infective pathology.

Pathogenesis of atisara:-
Over-indulgence in foods which are very heavy(hard to digest), very fatty, very dry, very hot, very watery, very hard, very cold; which contains incompatibles, taken in large quantities very frequently; which are not cooked, and taken at unusual times; excess or improper usage of therapies like oleation etc., poisons, fear, grief, drinking of polluted water, excess of alcoholic drinks, changes in accustomed habits and seasonal features, over-indulgence in water sports, suppression of natural urges of the body, and infestation by worms(intestinal parasites) are the etiological factors for atisara 13 .
These can be categorised under five broad headings as viz. aharaja, viharaja, manasika, agantuja nidanas and atisara due to some other diseases. These may act as viprakrusta nidana (Distant causes) or sannikrishta nidana (immediate causes) or both. Due to consumption of etiological factors apa dhatu (watery elements) is increased in excess quantity which brings forth diminution of strength of agni, gets mixed with the feces, causes downward movement in annavahasrotas by vata leading to passage of excess watery stool is known as atisara.

Management of atisara by Ayurvedic view:
There are two different protocols in the management of atisara according to sam and niram avastha. In amavastha, agni is so diminished that it is unable to digest any kind of food. Hence in such condition, langhan i.e. fasting is indicated. In niram avastha or pakvavastha, the dietary medicines like yavagu, manda etc are indicated chronologically according to strength of digestive fire as per Sushruta 14 .

Matra (Dose):
The matra of manda kalpana is not clearly mentioned in Ayurvedic text. Since laja manda is food based dietary medicine, the dose of it should be according to capacity of digestive fire according to Charaka 15 .

Time of Administration: According to
Charaka, manda kalpana is 'pranadharana' 16 i.e. it acts on pran vayu So time of administration should be muhurmuhu i.e. frequently.

Synergetic action:
The action of laja manda is increased by adding drugs like pippali, nagara (Sunthi) 17 etc.

Role of laja manda in the management of atisara:
The main event in the pathogenesis of atisara is diminution of strength of agni. The basic treatment in atisara is to increase the strength of diminished digestive fire i.e. jatharagni dipana. In such condition, laghu, dipana (to evoke digestive fire), pachana (to ignite digestive fire) dravyas are indicated.
Laja manda (scum of parched paddy) relieves thirst, diarrhea, improves appetite, agreeable, beneficial in fainting and heartburn. It is especially beneficial for women, children and weak persons. It helps to correct agnimandya in atisara as it is called 'agni janana' (evokes digestive fire). It also gives adequate amount of energy as well as it is good appetizer. Laja manda also does the vatanulomana i.e. it corrects the movement of perturbed vata 18 .Yog Ratnakara has also mentioned laja manda, as one of the pathya ahaar in atisara 19 . It also helps to relieve associated symptoms like trishna (thirst), daurbalya (weakness), bhrama (fainting) in atisara. In atisara although the excessively increased apa dhatu is being excreted out of the body in large amount, still trishna is significant symptom which needs attention according to Vagbhata 20 . In samavastha one cannot advice water intake to patient and if this thirst is not satisfied it may result into death.
Here laja manda plays an important role. Laja manda though being apa mahabhut pradhana yet due to its laghu, dipana guna plays a dual role of satisfying the trishna and yet not deranging strength of agni. Laja manda is laghu gunatmaka hence easy to digest, dipangunatmak which ignites the agni. Being easily digestible it helps to replenish the drava dhatus and thus does 'tarpan karma'.

Management of dehydration in diarrhea:
Fluid and electrolyte replacement are of central importance to all forms of acute diarrhea. Fluid replacement alone may suffice for mild cases. Oral solution should be administered promptly with severe diarrhea to limit dehydration, which is the major cause of death. Massive diarrhea with watery stools results in marked depletion of sodium, potassium and bicarbonate ions.

Role of Oral Rehydration Therapy (ORT):
It has been demonstrated that sodium and water absorption by the small bowel is very much enhanced by the addition of glucose to oral fluid. Dehydration can therefore be successfully treated with oral fluids containing glucose, once the initial hypovolemia is corrected by 2-4 liters of IV fluid replacement. Moderate dehydration and acidosis due to diarrhea can be corrected in 3-6 hours by oral therapy alone. One teaspoonful given to a child every minute can provide 200-300 ml per hour. Adults can take 750-1000 ml. per hour for several hours until signs of dehydration disappear and abundant pale urine is produced. Proper institution of ORT would avoid shock from continuing dehydration cholera and other diarrheas.

Role of laja manda in diarrhea management as Oral Rehydration Solution (ORS):
E-ISSN: 2320-7329 The correct concentration of Na+ and glucose in the ORS is critical for optimal effect and safety. The ORS administrated can't greatly exceed plasma in osmolality without the risk of increased diarrhea and hypernatremia. Fortunately, nature has provided foods containing starches which have low osmolality in solution. Several studies have now shown that cereal (rice) based solutions are equally effective in reducing volume losses and may also shorten the duration of illness. Physiologically, cereal based ORS are identical to their glucose based counterparts. The dominant component in the cereal is starch. Starch is a large polymer of glucose that, on exposure to amylase in the intestine is digested into smaller polymers that are then split by maltase into glucose molecules with which to transfer sodium ions from lumen into the blood, while generating less luminal osmotic "back drag" that would the direct ingestion of an equivalent amount of glucose. The cereal proteins also provide small peptides and amino acids which also facilitate the absorption of additional sodium ions.

Tab. 2. Composition of Laja manda 22
The traditionally used laja manda is also the cereal (rice) based solution. Since it is prepared from laja i.e. parched paddy. So it is also good source of starch, proteins and minerals. Hence the above actions of cereal based ORS can be effectively achieved by laja manda. Laja manda is less expensive. No expert is needed to prepare and to administrate it. So from the above discussion it can be concluded that laja manda would be ideal ORS in correcting dehydration in diarrhea.

CONCLUSION:
 Agni sanskara has very important role in preparation of laja manda which make it laghu.(easily digestable)  Laja manda is laghu gunatmaka hence easy to digest, dipana gunatmaka which ignites the digestive fire.
 Laja manda is apa mahabhuta pradhana dietary medicine helps to replenish the drava dhatu like rasa without deranging digestion.
 Laja manda also helps to relieve associated symptoms like trishna, daurbalya, chhardi, bhrama etc.  Laja manda is cereal based solution so it is good source of starch protein and minerals which replenish the electrolyte loss in diarrhea.
 Laja manda would be the ideal oral rehydration solution in correcting dehydration in diarrhea.