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Understanding Udararoga w.s.r to Jalodara vis-à-vis Ascites

By Dr. Amritha. E. Pady2nd year PG scholar

Dept., of PG studies in KayachikitsaSKAMCH&RC, Bangalore.

Guided by Dr. MuralidharaHOD & Professor in the department of PG studies in KayachikitsaSKAMCH&RC

The Great Pacific Garbage Patch• Giant collection of fishing nets, plastic containers and other discarded

items called a ‘ticking time bomb’ as large items crumble into micro plastics

Contents• Introduction• Udara• Nidana Panchaka of udara• Bheda & Lakshana• Critical analysis of Samprapti of Jalodhara• Upadrava • Sadyasadhyata • Chikitsa sutra of jalodhara• Ascites• Etiology and pathology• Evaluation of ascitic patient• Investigation-complication-prognosis• Discussion• Conclusion 5

• Udara roga is one among the astamahagada.

• Because of Utseda Sadharmya it is considered as a type of Shotha.

• उदरोत्सेद साधर्म्या�ा�द् उदरम्• The diseases that are manifested in the abdominal cavity causing the

distension of the abdomen –udara roga.

• In this condition Agni plays a major role in the manifestation of disease where

the aprakrutha ahara paka mala, and all malaswaroopa is accumulating in the

udara leads to this ghora vyadhi where mandagni,malinabhojana and mala

sanchaya are considered as main nidanas.

Introduction

• Ayurveda emphasizing on being healthy gives the detailed description

about the initiation of the diseases step by step.

• If one pays special attention to the changes happening inside and out

side of the body, any one can be healthy and its easy to get healed

early stages.

8

(vachaspati)

Diseases which manifests in udara is termed as Udara.

UDARA

9

Udara nidana

Ch.chi 13/12

10

Aharaja-Nidana

Ashuchi/Malina

GaraVishayukta Ati

ushna

Ahitaashana

Atiamla

Athikshara

Rooksha

11

Viharaja-Nidana

Paapakarma

Mithya samsarjana

Karma vibhramaath

Klishtaa na prathikarath

Athiroukshyat

h

Vegavidharanath

Atisankshobha ahara/vihara

12

Pleeha arsho grahaniDosha

karshanath

Baala shakruth

rodha antrasphutana

bhedanath

13

Poorvaroopa

14

Shakrut-atipravruthi/apravruthi

Kshutnaasha

Jeerna aparijnana

BalavarnanashaRaajijanamam

ValinaashaRuk Basthisandhi

visteernatha-laghu/alpa/abhojanerapi

Kinchit paadaGata

shopha

Shashwat balakshaya

Alpe apivyayaame

shwasa mruchati

15

Samanya roopa

||As.hru.ni 12/4||

16

Adhmanam,Dourbalya

Gamane ashakthi,Shopha Daha

Durbalagni,Vatapureesha sanga, Trushna

17

• Due to nidanas• Due to other

vyadhi• Ajeernaadi

Su durbala

agni

• Causing tridosha prakopa.• Arambhaka

dosha dushti in rasa,sweda

ambuvaha srotas

Chirath mala

sanchaya

• Leading to Prana Agni Apana sandushti

Adha urdhwa marga rodha

Samprapthi

Dhatwagnipaka not happening properly so utpathi of malaswaroopa of all dhatu getting increased.

Nidana sevana

18

Through upasneha

vat Annasara repeatedly oozes out through

anuthama srotas

Koshtaat annasaaro nisruthya

Because of dushta anila preritha takes

these dushta annasara in

between twacha and mamsa of

udara

Into udara

pradesha

• Vi• vardhaman

o jataram• Udara

Causing shanai: samunn

atha

19

•When the person indulging more on vishesha nidanas

the vyadhi will attain its bhedavastha.

20

UDARA

Vathodara

Pithodara

Kaphodara

Sannipataja/dooshya

udaraPleehodara

/yakrutaudara

Badhodara

Kshatodara

Jalodara

Udara bheda

21

Vatodara lakshanas

Aniyato cha vridhi

hraasa,

Kukshi-parshwa shula,

Udavartha

Angamarda

Parvabheda

Shushka kasa

Karshya

dourbalya

Arochaka

Avipaka

Adhoguruthwa,

Vatavarcha mootra

sanga,

Urdhwadha tiryak

sashoola shabda

on Pareeksha

Aadmadamdruti shabda

Kukshi-pani- pada- vrushana-

shwayathu

Shyava/arunatwa of

nakha-nayana-vadana-twak-mootra-varcha

Tanu asita raaji sira

23

Pithodara lakshanas

Daha Jwara

TrushnaKatukasyatwam

MoorchaAtisaraBhrama

Kshiprapaakam

DahyateDhooyateDhoopyadte Ushmayate SwidyateKlidhyate

On pareeksha

Harita-haaridratwa-nakha-nayana-vadana-twak-mootra-varcha

Mrudusparsha

Neela-peetha-haridra-harita-tamra raji sira

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Kaphodara lakshanas

Gourava arochaka avipaka

AngamardaSupti

Utklesha, nidra-kasa-shwasa Guru

Sthimita

On pareeksha

Pani-pada-mushka-uru-

shopha

Shukla-nakha-nayana-vadana-twak-mootra-

varcha

Shuklaraji sira vyaptam

Sthira Katina udara

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Durbala agni, apathyanna, virodhibhojana, gurubhojana

All tridosha lingasheeghrapaakam

Sthreedatha bhojana- raja,roma,vit,mootra,asthi nakhadi Samprasakta moorcha

Garadooshivisha, dushtambu, Shosha-kanta,taalu,mukha

Sannipathodara/dooshyodara

On pareeksha-Nanavarna raji sira vyaptam, Sarva varna-nakhadi

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Athisankshobha ashana, yana,

aticheshtitabhara adhwa vamana, vyadhikarshana

Pleeha chyuti/pleeha

vrudhi

Kachapasamsthanavath

udara-

Pleehodara/yakrudodara

RasaRakta dushti

and vrudhi due to vata prakopa

Pleeha becomes Katina and

ashteelavath

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Sa upakshita

Kramena kukshim jataram agnyadhishtanam

Parikshipan udaram abhinivarthayate-

vamaparshwa vrudhi-pleehodara-

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Yakrudodara- Dakshina parshwavrudhi

Tulya hetu linga oushada of pleehodara

On pareeksha- pleeha/yakrut will be sparshagamya kachapasamsthanavath ,katina and ashteelavath

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Dourbalya Arochaka Avipaka,

Varchamootragraha, Mrudu jwara

Anaaha, Agninasha,Atipandu

Karshya, Asyavairasya, Parvabheda,

Koshta vata shoola, Neela –harita-haridra-

raji

Tamapravesha, Pipaasa, Angamarda,

Chardi, Moorcha, Angasaada

Kasa Shwasa

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Badhodara/badhagudodaraPakshma- baala- ashma sahanna,

udavartha, arsha, other gudanirodhaka hetu

Antra samurchana-Badhayane

gude

• Apana marga samrodhatwath

Agnim kupito anila

Varcha pitha kapho

rudhwa

Badhagudodara

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Trushna, daha, Jwara

Mukha-taalu-shoshaKasa-shwasa dourbalyaArochakaavipaka

Varcha-mootra sangaAdhmana

Chardi –with vitgandhi Shira-hrudaya-nabhi-

guda-shoolaMoodavatam

On pareeksha -Shwayathu

SthiramAruna-neela raji-over

nabhi upariGopuchavath

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Sharkara, Truna,kaashta,asthi,

kantaka anna samyuthai:

Bhidyet antram

• During bhukta/jrumbhaya/atyashanena

Paka of rasa which oozed out from the

antra

Poorayan gudam antram

Janayati udaram

Chidrodara

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Yathabalam cha doshanam roopani

darshayati( udakodara roopam darshayathi)Varcha with-Ama-

salohita-saneela-sapeeta- pichila-kunapagandhi

Hikka shwasaKaasa

Trushnaprameha,

ArochakaAvipaka

dourbalya

36

• There are various nidanas and samprapti that will lead to specific udaras. ie, ashtaudara• Here the question arises how this different types of udara leading to

jalodara??• If proper intervention is not done to each udara, kalantharena by

paripaaka, all udara will transform to jalodara where the manifestation of jalodara as a paratantra vyadhi.

Su.ni.7/25

Critical analysis of samprapthi of jalodara

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UdakodaraPichotpathi Anudakaprapthi

Neglecting this avastha of udara (ajadodaka) leads

to…………

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Sashabda, sirajaalagavakshitam

SadagudugudayashchaNabhi vishtambhya

Alpa mootra pravruthi

Ishat shothaarunabhasa

Shoola-hrut,nabhi,vankshana,

kati,guda,Karkashe srujato vatamNa ati mande paavake

Na asya vairasya

Ajaatodaka avastha

Vayo tu vegam krutwa

pranashyati

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• swasthanaatapavruta• pari pakaat

Dosha

• Srothaamsi upakledayati

• Sveda-bahyasrothoprathihata

Dravi bhoothat

Accumulates

pichodaka in udara-(foam)

Avatishta in tiryak

gata marga

If neglecting Ajatodaka avastha

Pichotpathi

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Udara looks like mandalakruthi

Guru,sthimita

Akotitha ashabdam

Mrudusparsha

Apagata raajeekam aakrantam nabhyaame

upasarpathi

Neglect this stage leads to jalodara

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Triggers vata- acts on klomni-ambuvahasrothoavarodha by

kapha + udaka sammoorchana

Vardhayetham thadevaambu

swasthanaat udaraaya tu

Jalodaravastha

43

Udakapurna druthi sankshobha, samsparsha

Nanavarna raji siraKuksherathimatra

vrudhi

AnannakankshaShwasa kasa

dourbalya

Gudasrava

Jalodara lakshanas

44

Later stages if neglected

Sarva marmotha shwayathu

Shoonaaksha

Kutila upastha

Bala-shonita-mamsa-agni-pariksheenamUpaklinna

tanu twacha

Shwasa-hikka-

aruchi-trut

Moorcha-chardi-atisaara

45

Jalodhara as swatantravyadhi

46

Snehapeetasya mandagne

Atyambu panaat nashtaagne

Ksheenasya atikrushasya va Triggers vata- acts on

klomni-Ambuvaha srotho avarodha by kapha + udaka sammoorchana

Vardhayetham thadevaambu swasthanaat

udaraaya tu

Nidana and samprapthi

Jalodara lakshana

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Understanding Kapha + Udaka Sammorchana

• Due to above nidanas tridosha prakopa happens- vata accumulates in

udakavaha srotho moola sthana causes obstruction of the udakavaha srothas

leading to udaka and kapha moorchana

• Kapha will become abadhavastha and asthiratwa

• Vidagdata of kapha- gets lavana rasa.

• Udaka vrudhi happens.

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• Dosha -Tridosha –prana agni apana• Dooshya - rasa,udaka, sveda• Agni -Jataragni, dhatvagni• Ama - Jataragnimandhyajanya dhathwagnimandhyajanya• Srothas - rasavaha, swedavaha, ambuvaha• Sanchara - siras • Srotho dushti prakara – sanga, vimargagamana• Udbava sthana -amashayodbhava• Vyaktha sthana - Udara- twak mamsantara• Adhishtana - udara • Marga - Abhyanthara, baahya

Samprapti ghataka

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Lakshana Dosha involvementGamane ashakti, dourbalya, Vata vrudhi -prana dushtiShotha, udaka vrudhi Kapha- dravya vrudhiVatapurisha sanga Apana dushtiPaka pitha-ushna guna vrudhiDaha pitha-ushna guna vrudhiShushkavaktrata Ambuvaha srotodushti- kshayaKarshya Vata- rooksha guna vrudhi

• Kapha-sthira kshaya-guru vrudhi -pichila guna vrudhi- lavana rasa- vidagda kapha• Pitha- ushna- teekshna guna vrudhi• Vatha karma kshaya and rooksha guna vrudhi

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Samanya samprapthi Lakshana • Udbhava- koshta • Kshunnasha

• Agnimaandya kruta-jeernajeerna aparinjana• Bhuktam vidahyate• Sahate na athisouhityam

• Sanchara - siras • Upasnehavat – yatha anubhi:bahirsrothobhi bahisravad drushyate.

• Ashraya- udara -twak mamsanthara

• Srothodushti- rasa, sweda, ambuvaha

• Dosha – Tridosha • Dushya- sweda, ambu, rasa

Dominated with- • prana-apana-samana• Pachakapitha• Kledaka kapha• Kapha abadhata

Samprapthi lakshana sambanda and amshamsha kalpana

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Jalodaraupadrava

Chardi Tamaka shwasa

Atisara

Trushna

Kasa

HikkaDourbalya

Parshwashoola

Aruchi

Swarabheda

Mootrasanga

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Sadhyasadhyata

53

Param param Kruchrutharam

JALODARAVathodara

Pithodara

Kaphodara

Pleehodara Sannipatha

udara

Badhodara

Chidrodara

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• Ajatodaka avasta which is achirotpanna, anupadrava, anudakaprapti are

sadhya.

• Jalodara with upadrava – Asadhya

• If person is balavaan, jatambu navothitam- yatnasadhyam

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Chikitsa sutra of jalodara

||cha.chi 13/93||

अपां दोषहराण्�ादौ प्रदद्यादुदकोदरे||९३|| मूत्र�ुक्तानि" तीक्ष्णानि" नि'नि'धक्षार'न्ति*त च| दीप"ी�ैः कफघ्"ैश्च तमाहारैरुपाचरेत्||९४|| द्र'ेभ्�श्चोदकादिदभ्�ो नि"�चे्छद"ुपू'�शः|

(Ca.Chi.13/93-94)

दोषानितमात्रोपच�ात् स्रोतोमार्ग�नि"रोध"ात्| सम्भ'त्�ुदरं तस्मान्नि>त्�मे' नि'रेच�ेत|्|६१||

(Ch. Chi. 17/61)

• उदराणां मलाड्यत्'ाद्वहुश: शोध"ं् निहतम् ||(Ca.Chi.13/93-94)

• उदी��ते भृशतरं मार्ग�रोधाद्वहज्जलम्| �था तथाऽनि"लस्तस्� मार्गJ नि"त्�ं नि'शोध�ेत|्|

(Ch. Chi. 17/122)

• Nityameva udaranaam samprapthi praapnothi = Nityameva virechanaath.

• GOAL- Apaam dosha haranam, Srothoshodhanam

• Removing of accumulated fluids without harming the bala of Rogi.

• दुर्ब�लोऽनिप महादोषो नि'रेच्�ो र्बहुशोऽल्पशः| मृदुभिभभOषजैदQषा ह*�ुः हे्य"मनि"र्हृ�ताः|| (Ch. Kal. 12/69)• Restoring the Agni by expelling “BAHU DOSHA” stoka stoka nirharanam and

preventing further accumulation

• Correcting prana-agni- apana by inducing vatanulomana.

• Once apana starts moving its prakruta marga all other vata comes into

normalcy.

• Removal of apaam dosha by mootrayukta teekshna ksharadi oushadhis

• The abadha- asthira kapha samoorcha with udaka gets broken by rooksha

teekshna ushna gunas of mootra and enhances the agni.

• With the combination of hareetaki which does vatanulomana, deepanam

pachanam further supports for samprapti vighatana.

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• Takra prayoga- Swadu takra+sa vyosha• Ksheeraprayoga- chaga paya, karabha paya, gavya paya• Ksheeranupaanam for gomutraprayoga7 days mahisha mootra followed by ksheera- no anna1 month-oushtra paya3 month- chaga payaAlong with vyosha• Mootraprayoga- for seka paana• Gomutrahareetaki- for the shesha dosha nirharanaartham• Nagaraadi ghrutha• Patolaadi choorna peya• Katuki churna.

60

• Udara vyadha in jathodaka- tapping

• As pashchat karma –

Udara veshtana

Peya without sneha and lavana

For 6 months ksheeravruthi- 3 months ksheerapana

3 months ksheeraanna and paana

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Pathya ApathyaRaktashaali Odaka anoopaja mamsa/shaakaYava PishtakruthaMudga TilaanJangalarasa Vyayama, adhwaPaya DivaswapnaMootra Yaana yaana-ashwadiArishtaAsava

Ushna/amla/lavana/vidahi/guru/abhishyandi- bhojana

Madhu, seedhu ,sura Toyapaanam Alpa – amla/sneha/katu+ panchamoola sadhitaYavagu/odana/yusha.

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•Askites a Greek word which means ‘bag’ or ‘sac’.

• Accumulation of fluid within the peritoneal cavity.

• Small amounts of fluid will be asymptomatic.

• Increase in amount of fluid cause abdominal distention and

discomfort, anorexia, nausea, heartburn, flank pain and respiratory

distress.

Ascites

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Etiological factors

Prehepatic

Hepatic

Post hepatic

• Portal vein thrombosis• splenic vein thrombosis• Massive spleenomegaly

• Cirrhosis• Alcoholic hepatitis• Massive hepatic metastasis• Hepatic sinusoidal obstruction

• Budd-chiari syndrome• Inferior venacaval webs

64

• HypoproteineamiasNephrotic syndromeMalnutritionProtein losing enteropathy• Hepatic venous occlusion Buddchiari syndrome Venous occlusive diseasePerforationPancreatitisMeig’s syndromeOvarian torsion, rupture

65

Pathogenesis of ascites

• According to Starling’s hypothesis the exchange of fluids between the blood and tissue spaces is controlled by the balance between two factors;1. Capillary blood pressure 2. Osmotic pressure of plasma proteins (plasma colloid osmotic pressure/oncotic pressure)

Capillary blood pressure & Plasma colloid osmotic pressure Ascites

66

Theories behind the pathology

Under fill theory

Overfill theory

Vasodilatation theory

67

HYPOVOLAEMIA Kidney feels Body is under filled & require more salt and water

Stimulates JG cell to release RENIN angiotensinogen anginsioten-I ACE lung capillaries convert Angiotensin II Releases aldosterone from the zona glomerulosaIncrease the reabsorption of sodium and water & excretion of potassium

from the DCT ASCITES

Underfill theory

68

Overfill theory

Peripheral arterial vasodialation theory• When a portal pressure increases above a critical threshold, nitric oxide levels increase leading to vasodilatation

• As the state of vasodilatation worsens plasma levels of vasoconstrictor, sodium retentive hormones increase and renal function deteriorates ASCITES

• The combination of portal hypertension and circulating hypervolemia results in over flow from the congested portal system to the peritoneal cavity, to produce ascites

69

Portal hypertension

Splanchic arterial system vasodialation

Increased portal inflow

Increase splanchic pressure Arterial under filling

Activation of renin-angiotensis-aldosteroneIncrease in fluid

accumulation and extracellularfluid

volume Sodium retention

Formation of ascites

Pathogenesis of ascites with portal hypertension

Increase splanchic lymph

70

Evaluation of an ascitic patient

71

• Age child : Tuberculous ascites and nephrosisMiddle age : cirrhosis of liverOld age : malignancy

• SexFemale : Meig’s syndrome, pelvic tumors and infection, ovarian tumors

• Order of Development of AscitesCardiac causes : Leg oedema precedes ascites .Kidney causes : Puffiness of face precedes ascites .Cirrhosis of liver : Ascites is the first feature .

HISTORY

72

• Severe anaemia : Ascites of haematologic origin .• Periorbital oedema , puffiness of face and oedema associated with

ascites : acute nephritis , nephrotic synd.• Associated jaundice : Cirrhosis of liver .• Enlarged lymph nodes : Suggestive of TB , leukaemia , malignancy ,

and lymphomas .• Dyspnoea , orthopnoea , and oedema : congestive cardiac failure .

General examinations

73

Abdominal Examination• InspectionAbdomen is distended .Umbilicus is everted and slit transversely(laughing umbilicus) The distance between umbilicus and xiphi sternum is more

than the distance between umbilicus and pubic symphysis .Flanks are full. Nearly 1500 mL of fluid is required to make

the flanks full .Veins are dilated over the abdomen . Scrotal oedema indicates nephrotic syndrome

Examination of veins over the abdomenVein obstructed Site of engorged veins Direction of flow of blood

Portal vein obstruction Veins around the umbilicus and upper abdominal wall

• Veins above umbilicus- below upwards .

• Veins below umbilicus- from above downwards

• Caput medusa

Hepatic vein obstruction Lower thorax and upper abdomen

From above downwards

Inferior vena cava obstruction

Lower third of abdominal wall and flanks

From below upwards

75

• Shifting dullness is an important sign of free fluid in the peritoneal cavity . It requires nearly 500 mL of fluid to elicit this sign .• Fluid thrill is present in tense ascites .• If the fluid is small in amount nearly 120 mL , it will be demonstrated

by puddle sign

• Ausculation • It is not of much significance in ascites stage.

Percussion

76

Fluid wave / thrill

Bulging flanks

Puddle sign.

Flank dullness or horse-shoe

dullness

Shifting dullness

FIVE CLASSICAL PHYSICAL SIGN

GRADING OF ASCITES GRADE SEVERITY SIGNS

1 Mild Puddle sign +USG abdomen+

2 Moderate Shifting dullness+

No fluid thrill

3 Severe Fluid thrill+Resp. embarrassment+

• INVESTIGATION• X-Ray• CT• USG After the diagnosis of ascites is made, its cause should be determined

by laboratory analysis.

Ascitic fluid study (diagnostic paracentesis)

Strawcoloured / Transparent

Bloody fluid Opaque / milky Dark -brown Black colour

• Normal

• Cirrhosis

• TB

• Malignancies

• Trauma

• TB peritonitis

• Pancreatitis

• Perforation

• Traumatic tap

• Chylous ascites

• Billiary ascites

• Pancreatic ascites.

Colour / appearance of ascitic fluid

80

Determination of -•Total protein•Albumin content•Glucose•Blood cell count with differential•Gram’s and acid fast stains•Cytology •Amylase•LDH•Triglycerides•Culture for tuberculosis

Evaluation through SAAG- SAAG= serum albumin – ascitic fluid albumin

• Value >1.1g/dl- ascites due to portal hypertension• Value<1.1g/dl- ascites due to infectious or other malignant condition.

82

Transudate – (protein<25g/l) Exudate(protein>25g/l)

Low plasma protein concentrations• Malnutrition• Nephrotic syndrome• Protein losing enteropathyHigh central venous pressure• Congestive cardiac failurePortal hypertension• Portal vein thrombosis• Cirrhosis

• Tuberculous peritonitis• Peritoneal malignancy• Budd Chiari syndrome• Pancreatic ascites• Chylous ascites• Meig’s syndrome

Evaluation of ascitic fluid

Complications of ascites

1. Spontaneous bacterial peritonitis ( SBP)-

Characterized by the spontaneous infection of ascitic fluid in the absence of an

intra-abdominal source of infection

2. Hepatic renal syndrome

• GOAL-To achieve ascites-free status -To maintain it thereafterINDICATION FOR HOSPITALIZATION1. If there is no response to outpatient management for 4-6 weeks.2. Tense (grade III) ascites with respiratory embarrassment.3. Spontaneous bacterial peritonitis4. Refractory ascites

Management of ascites

85

Dietary sodium restriction <2gm/day• Usually put on spirolactone 100-200mg/day as a single doseFrusemide may be added at 40-80mg/day- particularly patients with peripheral oedemaIn refractive ascites-• Large volume paracentesis+ albumin infusion• Dietary sodium restriction+ diuretics• If ascites re accumulation- go with TIPS, consider liver transplantation,

large volume paracentesis with albumin if needed.

Prognosis of ascites

• Despite the recent advances in the treatment of ascites, the prognosis is always

grave after ascites.

• The presence of hepatocellular failure, evidenced by jaundice and

encephalopathy is a very bad prognostic factor .

87

• अग्निU"दोषा*म"ुष्�ाणांरोर्गसङ्घाःपृथग्निU'धाः| मल'ृद्ध्या प्र'त�*ते नि'शेषेणोदराभिण तु||९|| • While mentioning the nidanas, Acharyas have given very much importance to

agnidosha plays main role in causing udara vyadhi like “snehapeetasya

mandagne”

• The explanation given 300 decades back about the appearance of Udara rogi

suggests multiorgan disorders explained under one chapter.

Discussion

• The understanding of jalodara is in paralance with modern science i.e.,

manifestation of jala in udara pradesha is termed as jalodhara & the

accumulation of fluid in peritoneal cavity is termed as ascites.

• The clinical examination and treatment for jalodara such as anguli thadana

(percussion of abdomen), udakapoorna drutisparsha (fluid thrill),

akotitamashabdam (dullness), sirajaala gavakshitam (engorged veins),

udara vyadhana (tapping of abdomen) are seem to be adopted by modern

science which holds good even today also.

• The chikitsa sutra is based on dosha dushya amshamsha vikalpana which

when employed at appropriate time or stage gives us better approach in

managing udara in comparison to other streams.

• Understanding udara as a vyadhi, lakshana, asadhya lakshana, upadrava of

some other vyadhi gives a Vaidya more specificity while approaching the

patient.

• The investigative approach of ascites will help us to evaluate the use of

oushada and prognosis of the patient.

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• Rightly diagnosed is half cured so thorough examination of the patient is very

much essential for the diagnosis and management of udara roga.

• Jalodara which explained in our classics is very much similar to Ascites.

• The pathology of ascites in modern is based on certain hypothesis which is still

being debated.

• The samprapthi of jalodara is more specific in our classics which takes place

through upasneha nyaaya.

• Among all udaras- badhodara, chidrodara leading to jalodara needs Shastra

chikitsa.

Conclusion

ThankYou

Let our life flow smoothly, naturally without any obstruction