E-ISSN:2456-3110

Case Report

Grahani

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

Role of Arrow Root Gruel in the management of Inflammatory Bowel Disease (Grahani) - A Case Report

S Ashraf A.1*, N Rao P.2, Kumar E S M.3, ur Rahman F.4
DOI:

1* Anisha S Ashraf, Post Graduate Scholar, Department of Shalya Tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda & Hospital, Hassan, Karnataka, India.

2 Prasanna N Rao, Principal and Professor, Department of Shalya Tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda & Hospital, Hassan, Karnataka, India.

3 Mahesh Kumar E S, Associate Professor and HOD, Department of Shalya Tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda & Hospital, Hassan, Karnataka, India.

4 Fassi ur Rahman, Ayurvedic Surgeon, Hennali Clinic, 9th cross, K R Puram, Hassan, Karnataka, India.

Background: Inflammatory bowel disease (IBD) commonly describes two conditions namely Crohn’s disease and Ulcerative Colitis. Grahani, which is affecting Annavaha Srotas and Purishavaha Srotas, is a disease of great clinical relevance in modern era because of its direct link with improper food habits and stressful lifestyle. Based on the symptoms and investigation reports of the patient, the condition can be considered as Crohn’s disease which can be correlated to Grahani. Crohn’s disease is an idiopathic inflammatory bowel disease involving inflammation of any part of the digestive tract. Signs and symptoms include abdominal pain, diarrhoea, weight loss and fever. A case of 27 years old female, presented with loose stools associated with mucous discharge and bleeding per rectum since 1 year, vomiting and urgency to pass stools immediately after taking food since 2 months has been taken for study. Methods: Arrow root gruel was given internally 4 times a day. Results: Result of the current case study is based on the frequency of stool evacuation. Conclusion: Arrow root gruel helped in increasing the stool consistency, size and in reducing the frequency of stool evacuation.

Keywords: Grahani, Crohn’s disease, Arrow root gruel, IBD

Corresponding Author How to Cite this Article To Browse
Anisha S Ashraf, Post Graduate Scholar, Department of Shalya Tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda & Hospital, Hassan, Karnataka, India.
Email: 		Anisha S Ashraf, Prasanna N Rao, Mahesh Kumar E S, Fassi ur Rahman, Role of Arrow Root Gruel in the management of Inflammatory Bowel Disease (Grahani) - A Case Report. J Ayu Int Med Sci. 2022;7(1):367-370.
Available From
https://jaims.in/jaims/article/view/1674

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-25 2022-01-27 2022-02-03 2022-02-10 2022-02-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Anisha S Ashraf, Prasanna N Rao, Mahesh Kumar E S, Fassi ur Rahmanand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)367
Ashraf A. et al: Role of Arrow Root Gruel in management of Inflammatory Bowel Disease

Introduction

Crohn’s disease/ Regional ileitis is a granulomatous transmural inflammatory condition of the small intestine commonly terminal ileum.[1]

Often inflammation can affect colon, jejunum, stomach, duodenum and oesophagus. It is of unknown etiology, but familial and infective nature is taken into consideration.[2]

It is slightly more common in adolescent and young adults especially females.[3]

According to Ayurveda, the dysfunction of Agni is responsible for indigestion which in turn causes various functional and structural anomalies in the gastro-intestinal tract.[4]

Acharyas mentioned the signs and symptoms of Grahani Roga in classics can be somehow related with IBD. In Grahani Roga, the digestions of food do not occur properly due to Agnimandya. From this phenomenon a vitiated material called “Ama’’ (undigested food) forms which is responsible for producing various disorders. Ama disturbs the normal flora of GI tract, disturbs the normal physiology of entrails and acid fluid configuration of GI tract. Ultimately the end product of food will not form appropriately and nourishment of body does not occur.

The Lakshanas of Grahani include Atisrushta Vibaddha Drava Mala Pravritti (hard or watery stools with increased frequency), Krusha (lean), Trishna (thirst), Asthi Parva Ruk (pain in the bones and small joints), Chardi (vomiting), Jwara (fever), Arochaka (anorexia), etc.[5]

In present era, number of patients suffering from the complaints related to G.I.T are increasing. These complaints vary from loss of appetite to chronic abdominal pain, irregular bowel habit, chronic flatulence, diarrhoea, weight loss, lethargy, occasional bleeding per rectum. Malfunctioning of Agni is the important factors which play a significant role in most of the digestive disorders and Vata Dosha along with significant contribution of mind in the physiological function of digestive system.

Case Report

27 years old female complaints of

  • Loose stools associated with mucous discharge and bleeding per rectum since 1 year
  • Vomiting and urgency to pass stools immediately after taking food since 2 months.
  • Associated with generalized weakness, loss of weight since 1 year (20 kg reduced within 1 year), intermittent fever and burning sensation over chest region.

History of Present Illness

Patient was healthy 2½ years back. She was diagnosed to have haemorrhoids and uunderwent hemorrhoidectomy 2 years back. After 1 month of surgery, patient had bleeding per rectum during defecation and ignored it thinking it was due to the surgical wound.

Gradually developed increased stool frequency and consistency was mucous mixed watery stools. For this she consulted a doctor and underwent USG abdomen & pelvis which revealed right gross hydronephrosis with ballooning of renal pelvis and renal parenchymal thinning.  Renogram was done for the same which revealed enlarged right kidney with impaired function and PUJ obstruction was noted. She underwent right nephrectomy. After Nephrectomy, bleeding per rectum increased.

She had increased frequency of loose stools immediately after consuming food for which she consulted a Gastroenterologist and colonoscopy was advised and was prescribed with medications (details not available). As there was no improvement from these complaints she consulted Shalya Samanya OPD and was admitted in SDM College of Ayurveda and Hospital, Hassan.

History of Past Illness

No H/O Diabetes, hypertension, thyroid disorder or any other medical disease.

Treatment History

H/O Hemorrhoidectomy - 2 years back

H/O Nephrectomy (Right) - 9 months back

Personal History

Weight - 30.3 kg

Height - 152 cms

BMI - 13.1

Appetite - Altered

Bowel - Loose stools (15-20 times /day since 2 months)


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)368
Ashraf A. et al: Role of Arrow Root Gruel in management of Inflammatory Bowel Disease

Micturition - Regular

Sleep - Disturbed

Menstrual History

Age of Menarche - 12 years

Cycle length & Frequency - 5/28

Interval - Regular

Examination of the Patient

General examination

General appearance: Ill look

Nutritional status: Poorly nourished

Consciousness: Conscious

Pallor: Present

Icterus: Absent

Cyanosis: Absent

Clubbing: Absent

Oedema: Absent

Lymphadenopathy: Absent

Vitals

BP: 110/80 mm of Hg

Temperature: Afebrile, 98.20 F

Pulse: 88bpm

Respiratory Rate: 16 cycles/min

Systemic examination

CNS: Intact, Conscious, well oriented to time, place and person.

CVS: S1, S2, M0

RS: equal air entry to B/L lung fields, NBVS +

P/A: Soft, no organomegaly

Tenderness present in Right iliac & hypogastric region

Investigations

Blood Investigations Dated on: 12/01/2021

Haemoglobin: 8.8gm%

Total Count: 4500cells/cmm

ESR: 48mm/hr

Blood urea: 15 mg/dl

Serum Creatinine: 0.7mg/dl

HIV & HbsAg: Negative

Serum electrolytes

Sodium - 134.4mg/dl

Potassium - 4.3 mg/dl

Chloride - 99.8 mg/dl

LFT

Total Bilirubin - 0.9 mg/dl

Direct bilirubin - 0.5 mg/dl

Indirect bilirubin - 0.4 mg/dl

Total protein - 4.7 mg/dl

Albumin - 2.6 mg/dl

USG Abdomen & Pelvis

Non visualized right kidney (post nerphrectomy status - Right)

Chest X Ray PA View : WNL

Stool Microscopic examination

Stool - ova & cyst

OVA - Not seen

CYST - Not seen

Bacteria - many bacilli seen

Others - few pus cells are seen

Colonoscopy dated on 10/01/2020


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)369
Ashraf A. et al: Role of Arrow Root Gruel in management of Inflammatory Bowel Disease

Histopathological examination

Diagnosis: Crohn’s disease (A2 L2 B1 P+) / Sannipathika Grahani

Treatment Given: Arrow root gruel 4 times a day

Result

  • Bowel frequency was reduced to 5 - 7 times from 15 -20 times.
  • Got symptomatic relief from mucous mixed watery consistency of stools.
  • General condition of the patient was satisfactory.

Discussion

Arrowroot has high starch content and it helps in increasing stool consistency and size. In turn, this reduces the frequency of evacuations and helps to rehydrate.

Arrow roots’ resistant starch content stimulates immune system and it is a potential source of prebiotics that feeds the gut bacteria.[6]

Beneficial gut bacteria may boost immune system as they produce multiple vitamins and absorb key minerals which are required for proper functioning of immune system.

Conclusion

Arrowroot gruel helped in increasing the stool consistency, size and in reducing the frequency of stool evacuation. In turn helped for rehydration and in improving immune system. Thus, it can be concluded that Arrow root gruel internally is more

effective in treating Crohn’s disease/ Grahani by reducing the frequency of evacuation.

Reference

  1. Shenoy KR, Shenoy A. Manipal Manual of Surgery. 4th New Delhi: CBS Publishers & Distributors, Pvt Ltd; 2020, P.686
  2. Bhat MS, SRB’S Manual of surgery, 5th New Delhi : Jaypee Brothers medical publishers; 2016 pg. 866
  3. Sandler RS, Golden AL. Epidemiology of Crohn’s disease. J Clin Gastroenterol [Internet]. 1986;8(2):160–5. Available from: http://dx.doi.org/ 10.1097/00004836-198604000-00011
  4. Shastri SN. Charaka Samhita Chikitsasthana 15/5.Chaukhambha Bharti Academy Varanasi. Reprint ed. 2011.P-128
  5. Acharya YT (Editor). Charaka Samhitha of Agnivesha. Varanasi, Choukambha Prakashana: Reprint Edition 2016, p. 517
  6. Lang A, BSc, MBA. Arrowroot: Nutrition, benefits, and uses [Internet]. Healthline. 2019 [cited 2022 Jan 29]. Available from: https://www.healthline.com /nutrition/what-is-arrowroot

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