Introduction

In Ayurveda, the concepts of Dosha, Dhatu, and Malas are integral to understanding the body’s physiological functions.  Although Malas are waste products, they play a crucial role in maintaining the body’s functions and overall health. If not adequately eliminated, Malas can lead to health issues. Malas are categorised into two primary types: Sharirika Mala (body wastes) and Dhatu Mala (metabolic wastes). Sharirika Mala is further divided into three forms: Mutra (urine), Purisha (stool), and Sweda (sweat). Dhatu Mala, on the other hand, is classified into seven types."Agni" refers to the digestive fire responsible for digestion and metabolism. After digestion, the nutrient-rich portion, Sarabhaga, is absorbed, and the remaining undigested part becomes solid, known as Purisha. Ayurveda emphasises the balance of Agni and the proper elimination of waste to maintain health. Disturbances in these processes lead to disease. "Agni Vikruti" refers to an imbalance or malfunction of this digestive fire, which can result in the improper formation of "Purish Mala" or waste products. When Agni is impaired, the formation of waste becomes abnormal, leading to the presence of substances such as undigested food particles, mucus, blood, pus, etc., in the feces, which are not typically found in healthy individuals. Any imbalance in Agni leads to an abnormal formation of Purish Mala.

Aim and Objectives:

To explore the Ayurvedic understanding of Purisha Mala (stool) and its significance in maintaining overall health, with a focus on its formation, elimination, and the role of Agni (digestive fire) in its proper functioning as described in classical Ayurvedic texts.

Objectives:

1. To analyse classical Ayurvedic texts to gather and interpret references related to Purisha Mala (stool) and its formation as a vital indicator of healthy digestion and overall bodily function.
2. To investigate the role of Agni (digestive fire) in the proper formation of Purisha Mala and how imbalances in Agni (Agni Vikruti) contribute to abnormal stool formation and related health issues.
3. To evaluate the importance of timely stool elimination, especially in relation to Dinacharya (daily regimen) practices, such as early morning evacuation, in promoting health and balancing the Doshas, particularly Vata.

Materials and methods – The study incorporates a review of work done and literature from classical texts as well as research papers.

Nirukti of Purisha–

The word purisha is derived from ?? – ????

Synonyms of Purisha [1]–

Purisha, Shamala, Varchaska, Duryam, Avaskar, Vit, Mala, Ucchar, Gutha etc.

Utpatti of Purisha Mala [2][3]-

The digestion of food occurs with the help of Jatharagni and Panchabhutagni. Once the food is digested, it is divided into two parts: Sara (the essential nutrients) and Kitta (the waste). The Kitta portion is further divided into two—Mutra (the liquid waste, or urine) and Purisha (the solid waste, or feces). According to Acharya Charaka, by the time the food reaches the Pakwashaya (large intestine), it becomes dry due to the influence of Agni. It takes on a solid form or Pindaswaroopa. This process also increases Vata Dosha due to the presence of Katu Rasa (pungent taste). The term "Paripindita Pakwasya" refers to the waste material that takes on a solid form, known as Purisha.

Purisha Pramana-[4]

The quantity of Purisha is said to be equivalent to seven Anjali, which is approximately 112 Tolas.

 Panchabhautika predominance of Purisha –

Agni and Vayu are predominant elements, along with Prithvi Mahabhuta. While Prithvi provides form and structure, the abundance of Agni and Vayu causes normal feces to float on water.

Saama and Niraama Parikshan of Purisha:[5]

a. Saama Purisha Lakshanas

• Guru – Heavy
• Bhrusha Durgandhit – Extremely foul-smelling
• Vishtambha – Constipation
• Udarshula – Abdominal pain
• Gaurava – Feeling of heaviness
• Tandra – Improper orientation or drowsiness

b. Niraama Purisha Lakshanas

• The characteristics of Niraama (pure) purisha are opposite to those of Saama purisha.

Jale Nimajjati or Tarati Pariksha for Identification of Saama and Niraama Purisha[6]

Stools associated with Aama tend to sink in water due to their heaviness. In contrast, stools that are free of Aama generally float unless they are excessively liquid, compact, cold, or affected by Kapha dosha. Therefore, it is crucial to determine whether the stools are associated with Aama before prescribing any treatment.

Symptoms of Purisha Vruddhi [7]

        When there is an increased quantity of feces, the resulting symptoms include abdominal fullness, gas movement in the intestines, heaviness, and pain.

Symptoms of Purisha Kshaya

A decrease in feces leads to gurgling noises in the intestines, accompanied by bloating. The Vayu becomes active within the intestines, creating noise as it attempts to move upward, resulting in pain or discomfort in the lower region of the heart.

Purisha Karya- [8]

Avashtambha, or Upasthambha, refers to the function of Purisha, which means "Shariradharan," or the support of the body. Properly formed Purisha is essential for providing strength to the body. Acharya Sushruta notes that Purisha has another vital function: it supports Vayu and Agni, contributing to their strength. Some Acharyas suggest that Purisha also performs the function of Prinana, though Acharya Dalhana does not accept this view. Despite being a waste product and lacking Sarabhaga or Satwabhaga, its role in Dehadharana Karma is recognised by all Acharyas.In the context of Rajayakshma, all Dhatus experience depletion, and during this condition, the patient's bodily functions rely heavily on their feces. Therefore, a physician must protect Purisha in patients suffering from Rajayakshma. Yogaratnakara also refers to Mala as Jivitam, emphasising the significance of Purisha Mala in maintaining a healthy human body.

Purishadhara Kala- [9]

The fifth Kala is referred to as Purishadhara, also known as Maladhara Kala. It is anatomically located in the Pakwashaya and Unduka regions. This Kala is responsible for dividing waste into two components: Purisha and Mutra. The upper side corresponds to the Yakruta, while the lower side pertains to the Guda. Therefore, the anatomical location of Purishadhara Kala encompasses the entire Koshtha (digestive tract), primarily affecting the central part of Koshtha, which includes the Amashaya and Pakwashaya. The Unduka region, where the separation of Rasa, Mutra, and Purisha occurs, is identified explicitly as Maladhara Kala.

Purishavaha Strotas – [10][11]

The roots of Purishvaha Strotas are identified as the Pakwashaya and Sthula Guda. Acharya emphasises the importance of understanding Utpattisthana (site of origin), Karyasthana (site of action), and Abhivyaktisthana (site of presentation of disease). This knowledge is crucial for the effective diagnosis and treatment of diseases, with Pakwashaya and Sthula Guda being universally recognised as the roots of Purishavaha Strotas across classical literature.

Review of Pakvashaya from Bruhattrayee-

In Bruhattrayee, the concept of Pakwashaya is presented with nuanced definitions and interpretations by different scholars. Here is a summary of the perspectives:

1. Charaka Samhita:

In Chikitsa Sthana (Ch. 5/7), Acharya Charaka refers to Pakwashaya as the organ located beneath the Pittashaya and Amashaya.

2. Sushruta Samhita:

In Sutra Sthana (Su. Su.21/6), Acharya Sushruta elaborates on the location of Pakwashaya as lying below the Nabhi(navel) and above the Shroni-Guda (pelvis)

3. Ashtanga Hridaya

According to Acharya Vagbhata, Pakwashaya refers to the site where digested food is stored or passes through. It specifically denotes the large intestine or colon. Pakwashaya is mentioned as an Ashaya out of seven Ashaya, and it is described as the principal site of Vata Dosha.

Review of Guda from Bruhattrayee

The Guda is considered one of the 15 Koshtangas (organs within the visceral cavity) in Ayurveda. He is identified as an essential seat of Prana (life force), thus included in the Dashapranayatana (ten vital seats of life). According to Acharya Charaka, the Guda is divided into two parts:

1. Uttar Guda – This is the upper part where Purisha (feces) is collected.

2. Adhara Guda – This is the lower part from which Purisha is expelled.

Formation of Guda:

The Guda is formed by the Prasad Bhaga (essence part) of Rakta and Kapha after digestion by Pitta, with the assistance of Vayu.

Guda Marma (Vital Point of Guda):

The Guda is classified as a Sadyopranahara Marma (vital point where immediate death may occur if injured) by Acharya Sushruta. While Acharya Sushruta considers it a Mamsa Marma (vital point related to muscle), Acharya Vagbhata categorises it under Dhamani Marma (vital point related to vessels).

Gudavali’s (Vali’s of Guda):

According to Acharya Sushruta, the Guda contains three transverse folds or rings known as Valis:

1. Pravahini – The proximal fold responsible for propelling the feces.
2. Visarjini – The middle fold, which facilitates defecation.
3. Samvarani – The distal fold, which helps in the closure of the anal canal.

These Valis are arranged spirally (Shankhavartanibha) and have the colour of the palate of an elephant (Gajatalu). They are spaced approximately 1.5 Angulas apart. Additionally, Acharya Vagbhata provides a further classification of these folds, naming the first proximal fold as Pravahini, the last distal one as Samvarani, and the middle one as Visarjini.

Gudaushtha:

The Gudaushtha is situated 1 Angula distal to the Samvarani Vali. The total length of the Guda, including the Gudaushtha, is said to be 4.5 Angulas.

This detailed anatomical description emphasises the importance of the Guda in digestion and waste elimination according to Ayurvedic teachings.

Other parts of Antra in relation to Purisha –

1. Purishashaya

In the context of pathogenesis of Atisaar (diarrhea), the Purishashaya refers to the area where fecal matter is stored before excretion. In the quote from the Charaka Samhita (Ch. Chi.19/5) and explained by Chakrapani, it is stated that the mala (waste) moves from the Pakwashaya (large intestine) to the Purishashaya (the rectal region), indicating that these two areas are connected and function together in the elimination of waste.

2. Unduka

This term, as defined by Dalhana in Sushruta Samhita (Su. Sha. 4/17), refers to a "pottalaka" or sac-like structure. Unduka may refer to a structure resembling a sac that plays a role in fecal retention or support in the lower gastrointestinal tract.

3. Dimbha

Acharya Vagbhata, in the Ashtanga Hridaya (A.H. Sha. 3/12), introduces the term Dimbha, which is unique to this text. Dimbha is considered part of the Koshtanga (internal organs of the abdominal cavity) and is said to provide support to fecal matter. This highlights its functional role in stabilising and assisting the movement or storage of waste material in the lower digestive system.

Purishavaha Strotas Dushti Karane – [12]

• Sandharanat – Suppression of the urge to Defecation
• Atyashanat – Consumption of excessive food
• Ajirnat – Indigestion
• Adhyashanat – Eating in quick succession
• Durbalagni – Poor or hampered digestive power
• Krusha – Emaciated one

These are the etiological factors for vitiation of Purishvaha Strotas.

Purishavaha Strotas Dushti Lakshane- [13]

When the Purishvaha Strotas are vitiated, stools may be evacuated with difficulty, resulting in small quantities or painful movements accompanied by a specific sound. The expelled stools may also be excessively loose or glandular and occur in large amounts.

1. Krucchrena (Difficulty in passing stools): This can manifest in two ways:

• Malaswaroop Vikruti (improper stool formation) – This involves hard or slimy stools. For instance, in cases of Pravahika, the stools become slimy
• due to Kapha, leading to difficulty in evacuation. In conditions like Vataja Grahani or Pakwashayagata Vata, the stools may become excessively dry because of the Ruksha Guna of Vayu, making hard, dry stools challenging to expel.
• Marga Vikruti – This includes obstruction in the anal canal, as seen in Arsha, or narrowing of the anal canal, such as in Sahaj Vikruti, which can occur post-operatively (Sanniruddha Guda).

2. Alpalpa (Frequent, slight discharge of feces): This condition is characterised by the formation of homogenous stools influenced by the Snigdha Guna of Kapha and the Drava Guna of Pitta. When these properties are depleted, and the Ruksha Guna of Vayu increases, it results in Alpalpa Malapravartan, as observed in Pravahika.

3. Sashabda (Stools passed with a particular sound): This phenomenon occurs due to the accumulation of vitiated Vayu in the Pakwashaya, producing distinctive sounds during defecation, as seen in Vataja Atisara and Vataja Grahani.

4. Sashula (Painful stool passage): Pain may arise from local anomalies, such as Vataja Arsha or Parikartika, where dry feces irritate hemorrhoids or the anal walls. In Vataja Atisara, the increased Chala Guna of Vayu can cause significant intestinal pain.

5. Atidrava (Liquefied stools): This condition arises when Abdhatu mixes with stools or when Pitta, increased by its Drava Guna, results in excessively loose stools, as seen in Atisara.

6. Atigrathita (Extremely hard stools): The formation of hard stools is attributed to various factors, including increased Ruksha Guna of Vayu, heightened Ushna Guna of Pitta, and depletion of the Drava and Snigdha Guna of Pitta, along with decreased Snigdha Guna of Kapha. Conditions such as Purishaja Udavarta, Vatanigrahaja Udavarta, and Vataja Pandu exemplify this.

7. Atibahu (Increased quantity of stool): Excessive production of Kitta Bhaga due to improper digestion contributes to an increased quantity of stools, as noted in Sangrahani.

Purishvaha Strotas Viddha Lakshane

In Sharirsthan 9/12,  Viddha Lakshana, given by Acharya Sushruta, is

• Anaha - Bloating
• Durgandhata – Foul smell
• Grathitantrata – Knotted stools in the intestines

Purisha Vega

In Ayurveda, Purisha Vega refers to the natural urge for defecation. It's classified among the 13 Adharaniya Vegas (bodily urges that should not be suppressed). Apana Vayu, a sub-type of Vata Dosha, responsible for the downward and outward movement in the body, governs the process of defecation. This process is coordinated under the influence of Prana Vayu.

The verse refers to “tannishkramane kriya preranam adigrahanena viddharanadiparigrahah" (Ashtangasangraha Sutrasthan 20/2), which suggests that the expulsion of stool requires the proper functioning and coordination of Vayu.

The normal frequency of Purisha Vega –

In healthy individuals, the frequency of Purisha Vega is two times a day.

Purisha Nishkramana Kriya According to Ayurveda

In Ayurveda, the process of Purisha Nishkramana Kriya begins with the digested food from the Grahani, which the Pakwashaya receives. Here, the Poshakbhavas, the products of digestion, are absorbed, leaving behind the Kitta portion in the Unduka. Within the Pakwashaya, the Ruksha Guna of Vayu facilitates the absorption of water content, transforming the remaining material into Purisha. This Ghana and Paripindita Purisha is then moved into the Uttarguda for storage. When the urge arises, the Purisha is pushed into the Adhara Guda and Gudaushtha, eventually being excreted through the Gudamukha. This entire process within the Pakwashaya and Guda is governed by the Apana Vayu, assisted by Prana and Samana Vayu.

Discussion

While Malas are considered waste products, their proper management and elimination are essential for maintaining the body's physiological balance and health. Ayurveda recognises this interconnectedness, emphasising that a healthy lifestyle and diet support the effective functioning of Malas, leading to overall well-being.

Understanding the Ayurvedic concepts like Purishadhara Kala, Purishvaha Strotas, and its Sharir(anatomy and physiology) helps in managing these dosha imbalances and promoting proper bowel function. For example, sluggish digestion and impaired elimination might indicate excess Kapha, while diarrhea suggests aggravated Pitta or Vata.  

If the urge for defecation is consistently suppressed, it can disturb Apana Vayu, resulting in constipation or other complications like abdominal discomfort, bloating, or even more severe digestive disorders. Therefore, Ayurveda strongly advises against suppressing this and other natural urges. According to Ayurveda, proper digestion (Agni) and the timely elimination of waste (Mala) are critical for maintaining health. Imbalances in these processes can lead to the accumulation of toxins, which is believed to be a root cause of various diseases.

Conclusion

In summary, Purisha Mala is more than just a waste product in Ayurveda; it is seen as a reflection of the body's internal balance, digestive efficiency, and overall health.

Regular and healthy bowel movements are crucial for maintaining physical, mental, and emotional harmony.