E-ISSN:2456-3110

Review Article

Nidanapanchaka

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 6 June
Publisherwww.maharshicharaka.in

Nidanapanchaka of Grahani Roga along with Lifestyle modification

M. Joshi V.1*, Prashant A.2
DOI: http://dx.doi.org/10.21760/jaims.8.6.10

1* Vibha M. Joshi, Post Graduate Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.

2 A.S. Prashant, HOD and Principal, Department of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.

A healthy body creates a healthy mind. A healthy gut molds a healthy body. This establishes the relation of gut with that of the brain. Ayurveda emphasized the relation with gut and brain dating back to the centuries. Grahani Roga is one of the leading disorders of Annavaha Srotas. The main site of Agni is Grahani i.e., “Sasthi Pittadhara Kala” i.e., the part of the intestine between Amashaya and Pakwashaya. Grahani springs from Dhatu “Graha” which suggests “to catch”, “to hold” or “to get”. Normally it retains the undigested food and releases the digested food through the sides of its lumen. Any disturbance in Agni leads to an improper digestion of food which moves either in Urdhva or Adho Marga and when it goes in Adho Marga then it leads to Grahani Roga. So, it should be mainly treated with Deepana (which enhance digestive power) and Pachana (digestive) drugs for Agnivardhana. In modern science it can be correlated with Irritable bowel syndrome (IBS) which is characterized by a group of symptoms that can significantly undermine the quality of life of the patient. It is a functional gastrointestinal disorder characterized by a group of symptoms accompanied together that include abdominal pain and changes in the consistency of bowel movement.

Keywords: Nidanapanchaka, Grahani Roga, Lifestyle modification, Irritable bowel syndrome, IBS

Corresponding Author How to Cite this Article To Browse
Vibha M. Joshi, Post Graduate Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.
Email: 		Vibha M. Joshi, A.S. Prashant, Nidanapanchaka of Grahani Roga along with Lifestyle modification. J Ayu Int Med Sci. 2023;8(6):62-68.
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https://jaims.in/jaims/article/view/2537

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-29 2023-05-02 2023-05-09 2023-05-16 2023-05-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2023by Vibha M. Joshi, A.S. Prashantand 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].

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Joshi V et al: Nidanapanchaka of Grahani Roga along with Lifestyle modification

Introduction

In Ayurvedic classic, the basic approach to the concept of health is essentially psychosomatic in nature which was related to the state of equilibrium of physio biochemical factors namely Dosha, Dhatu, Mala and Agni and a state of well being of mental and spiritual forces. Today is the era of science, in which everyone is busy to get luxurious lifestyle. Polluted air and water lead to many diseases of Annavaha Srotas. The faulty lifestyle leads to interruption of Dinacharya (daily regimen) and Rutucharya (seasonal regimen), described in Ayurveda and also affect social and mental status of person. If the man avoids following the rules of taking food and continuously takes Virudha Ahara, Jatharagni gets vitiated and vitiated Jatharagni is the cause of all disease. Ayurveda considered that the dysfunction of Agni is responsible for undigested food which is responsible for various functional and structural defects in gastro intestinal tract. Grahani Roga is one of the major illness of Gastrointestinal tract, included in Ashta Mahagada by Acharya Vagbhata. The sign and symptom of Grahani Roga is similar to Irritable Bowel Syndrome (IBS) described in modern science.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain in association with abnormal defecation in the absence of a structural abnormality of the gut. About 10-15% of the population are affected at some time but only 10% of these consult their doctors because of symptoms. Young women are affected 2-3 times more often than men. Most patients alternate between episodes of diarrhea and constipation, but it is useful to classify patients as having predominantly constipation or predominantly diarrhea.[18]

Etymology of Grahani: The word Grahani is derived from Dhatu “Graha” which means “to catch”, “to hold” or “to get”.

Grahani is the specialized part of the Mahasrotas (Gastro intestinal system).

Physio-Anatomical view of Grahani

Anatomically, Grahani is said to be situated above the Nabhi[1] and between the Amashaya (stomach) and Pakwashaya[2] (large intestine). It is the site of Agni.

Physiologically, it holds the indigested food for the duration of its digestion before the Kitta or undigested food residue is propelled into the Pakwashaya. Thus, Grahana, Dharana, Pachana and Shoshana become the main function of Grahani.

Agni in Grahani Roga: The Grahani Roga is mainly caused by Agnidushti. Mandagni is also cause of all diseases – “Rogaha Sarve Api Mandagnou”.[3] Jatharagni and Grahani have Ashraya-Ashrita type of relationship. The organ Grahani is Ashraya and Agni is Ashrita. The impairment of Grahani will impair the functional aspect of Agni and vice versa.

Nidana of Grahani Roga

  • Aharaja - Abhojana (excessive fasting), Atibhojana (excessive food intake), Vishamabhojana (improper food), Asatmya Bhojana (unwholesome food) etc.
  • Vyapad of Vamana, Virechana, Snehana. (Adverse effect of therapeutic measures).
  • Vega Vidharana (Suppression of natural urges).
  • Virudha or incompatibility of Desha, Kala and Rutu.
  • Shoka (Grief), Krodha (Anger), Bhaya4 (Fear).[4]

Vishishta Nidana

SN Vataja Grahani Pittaja Grahani Kaphaja Grahani
1. Katu, Tikta, Kashaya Rasa Katu, Amla Rasa Yukta Ahara Guru, Atisnigdha, Sheeta Bhojana
2. Atiruksha, Dooshita Bhojana Ajeerna Atibhojana
3. Pramitashana Vidahi Anna Bhukta Matra Swapna
4. Anashana Kshara (alkaline food)  
5. Veganigraha - -
6. Atimaithuna - -

Purvaroopa

SN Purvaroopa Charaka Sushruta Vagbhata
1. Trushna (thirst) + + +
2. Alasyam + + -
3. Balakshaya (loss of strength) + + -
4. Annasyavidaha + + -
5. Chirapaka (delayed digestion) + - +
6. Kayasya Gouravam (heaviness of body) + - +
7. Saada (lassitude) - + +
8. Klama (exhaustion) - + +
9. Aruchi (aversion of food) - + +
10. Kasa (cough) - + -
11. Karnakshweda (ringing in ear) - + +
12. Antrakujanam (rumbling sound in the intestine) - + +
13. Praseka (salivation) - - +
14. Vaktravairasya - - +
15. Bhrama - - +
16. Chardi - - +
17. Amlapaka - - +

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Roopa

  • Ati Srushta Mala Pravrutti, Vibadha Mala Pravrutti (Occasional hard and loose stool)
  • Arochaka
  • Asyavairasya
  • Praseka (nausea)
  • Tamaka
  • Shunapada-Kara
  • Asthiparva Ruk
  • Chardana (vomiting)
  • Jwara
  • Lohanugandhi Udgara[5]

Vishishta Roopa

1. Vataja Grahani

  • Specific character - Flatulence after and during digestion.
  • Generalized symptoms - Roughness in body, dryness of throat and mouth, hunger, thirst, blurred vision, tinnitus, Pain in chest, thigh, pelvic region, neck region, emaciation, weakness, Parikartika, cough, dyspnoea.
  • Abdominal symptoms - Food digest with difficulty, Suktapaka, visuchika.
  • Character of Stool - Passes stool with difficulty, liquid mixed with hard stool, frothy, undigested repeatedly.

2. Pittaja Grahani

  • Specific character - Fetid and sour eructation
  • Generalized symptoms - Roughness in body, dryness of throat, mouth.
  • Hunger, thirst, blurred vision, tinnitus, pain in chest, thigh, pelvic region, neck region, weakness, Parikartika, cough, dyspnoea
  • Character of stool - Watery, undigested, yellowish stool.

3. Kaphaja Grahani

  • Specific character - Heaviness and stiffness of abdomen
  • Generalized symptoms - Nausea, vomiting, anorexia, sweetness of mouth, cough, rhinitis, eructation having foul smell, lack of desire towards women, weakness and lassitude.
  • Character of stool - Stool not well formed but broken into pieces, mixed with Ama and mucous and heavy.

4. Sannipataja Grahani - Mixed Lakshana of Vataja, Pittaja, Kaphaja Grahani.

5. Sangrahani -

  • Specific character - Disease aggravates during day time and pacifies in night time, disease repeats once in 15 days, 30 days, 10 days or once in a day.
  • Generalised symptoms - Lassitude, debility, general malaise, low backache.
  • Abdominal symptoms - Intestinal gurgling.
  • Character of stool - Watery, cold, solid, sliminess, unctuous with Ama, frothy and passed with sound.

6. Ghatiyantra Grahani -

  • Specific character - Produces sound while passing stool like pouring water out of a pot.
  • Generalised symptoms - Excessive sleep, pain in side of chest.

7. Raja Grahani - It is seen in people living sedentary life style.

8. Kshataja Grahani - It is due to injury to Grahani after relieving from Atisara and Pravahika.

9. Nirmukh Grahani - Pain present during defecation and stool mixed with intestinal mucous membrane is passed.

Samprapti[6]

Nidana Sevana

↓

Dosha Prakopa

↓

Agni Dushti

↓

Apachana

↓

Amotpatti

↓

Shukta Paka

↓


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Amavisha

↓

Grahani Dosha

↓

Grahani Dushti

↓

Grahani Roga

↓

Vataja, Pittaja, Kaphaja, Sannipataja

Samprapti Ghataka

Dosha - Tridosha

Dushya - Anna, Rasa

Srotas - Annavaha, Purishavaha

Adhishthan - Pittadharakala, Grahani

Srotodusti Prakara - Atipravarti

Agni - Manda

Sadhya-Asadhyata- Kruchrasadhya

Purisha Pariksha

It is the objective method which was used to detect the presence of Ama in stool in ancient time. In Saamaj Purisha it sinks in water. If Purisha is free from Aam it floats on water.

Sadhyasadhyata of Grahani Dosha[7]

According to Acharya Madhava, the Asadhya Lakshanas of Grahani Roga are similar to Asadhya Lakshanas of Atisara viz. Shoola, Pipasa etc. He also opines that, in Balyavastha, Grahani Roga is considered as Sadhya, in Yuva and Vriddha Avastha it is stated to be Kruchra Sadhya and Asadhya respectively.

Principle of Grahani Roga Chikitsa[8]

“Nidanparivarjanam”[9] i.e. removal of cause. Acharya Sushruta mentioned Nidana Parivarjana as the first line of treatment of all diseases. Acharya Vagbhata suggested that all the treatment modalities of Ajeerna should be implemented in the management of Grahani Ashrita Dosha.[10] He also opines that, Sama and Nirama Avastha should be taken into account as per Atisara Chikitsa.

In the management of Grahani Roga the fact that along with Agnimandya, the Pachana Shakti of Grahani is deranged. Due to this the indigested food undergoes Putikriya, and has action similar to Visha, which produces symptomatology of Ama. For this particular stage, Shodhana Chikitsa is preferred.

Chikitsa

  • Grahani Roga associated with Ama Dosha - when the patient having complaint of constipation, excessive salivation, pain in abdomen, heart burn, heaviness then he should be treated with Vamana should be done either with lukewarm water or with decoction of Madanaphala and powder of piper and mustard.
  • Pakawasyasth Upachara - the patient should be treated with Virechana. The medicine having Agni Deepana properties should be added in Virechana Yoga.
  • When Apakva Ahara Rasa is present in all over the body the Langhana and Pachana medicine should be given.
  • After the purification of Amashaya, Peya prepared with Deepana and Pachana Dravyas should be given to the patient.
  • Snehana, Svedana, and Shoshana, Langhana, Deepana, Pachana and Sangrahani drugs should be given as per the condition of the patient.

Life Style Modification in Grahani Roga

Dietary modification

  • Dietary changes that promote good eating habits improve Agni and reduce the risk of Grahani roga.
  • Meal should be consumed at regular intervals.
  • Junk foods, allergic foods and food difficult to digest should be avoided.
  • Ayurveda recommends a balanced diet as part of Samsarjana Krama, as well as
  • a regular food plan based on the Prakruti of the individual.
  • Abhojanat, Ajeernabhojanat, Atibhojanaat, Vishamashanat, Asatmya, and Sandushta Bhojanat should all be avoided.
  • Virudha-Ahara must be avoided; means one should consume diet as per his/her internal constitution by following concept of Desha and

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  • Diets which promote digestive enzyme; restore normal flora and maintain Nutritional sufficiency should be adopted such as; fibers, fruit, vegetables, grains and curd.
  • Yavagu, Panchakola soup
  • Takrarishta, Jangala Mamsa
  • Vegetable soups
  • Light diet and Soup of dried radish

Importance of Takra in Grahani Roga

Takra is the best diet for patients suffering from Grahani Roga. As Takra is Laghu in Guna, possesses Deepana properties and attains Madhura Paka, it does not provoke and increase Pitta; because of Kashaya Rasa, Ushna Virya, Vikasi and Ruksha Gunas, it is also useful in Kapha; as freshly churned Takra is sweet, slightly sour and sufficiently thick, it will not produce Daha in the Kostha and it is also Vatahara.[11]

Charaka has also suggested the use of Takra and Takrarishta in the routine treatment of Grahani Roga.[12,13]

Behavior modification

  • Behavioral factors such as fear, grief, stress and sleeplessness may also lead to symptoms of Grahani Roga. Therefore, one should avoid stress, fear and grief to disrupt condition of depression which may affect Agni.
  • One should remain positive and enthusiastic to maintain normal metabolic functioning.
  • Habits of too much thinking/Chintana should be avoided which may affect process of digestion since, during thinking process blood circulation remains associated mainly with brain instead of intestine.
  • One should always think that the food which he/she going to consume will offer good effect.
  • Be happy and associated with mental empowerment activities.
  • One should consume diet by following rules of Swasthavrutta in proper manner so as to achieve maximum beneficial effect of consumed food.[14-16]

Daily regimen modification/Exercise and Yoga

  • Indisciplinary life style need to be avoided.
  • Day time sleeping and late night awakening should be avoided.
  • One should follow daily regimen with fix timing of each and every activities including fix daily routine of exercise, breakfast, meal and sleep.
  • Regular exercise to strengthen body & Agni.
  • Meditation to calm down stress.
  • Yoga and Pranayama also offers beneficial effect to increase stress resistance.
  • Ayurveda mentioned some defined regimen such as; Ritucharya and Dinacharya to get beneficial results of daily regimen.
  • Dhyan and Shodhana procedure after some fix interval also offers beneficial effect in Grahani Roga.[14-17]

Role of Asana in Grahani Roga

  • Bhujangasana: Bhujangasana heats the body and improves digestion.
  • Mayurasana: Mayurasana removes undigested material in stomach.
  • Paschimottanasana: Paschimottanasana boosts gastric fire.
  • Matsyendrasana: Matsyendrasana stimulates Jatharagni.
  • Sarvangasana: Sarvangasana pacifies Kapha & Pitta, also relieves indigestion.

Discussion

“Rogasarveapimandagnau” i.e., all the diseases are due to Mandagni. Agni and Pitta are similar in qualities. Sushrutacharya considers Pittadhara Kala as Grahani, which is located between Amashaya and Pakwashaya. He has mentioned Grahani as seat of Pachaka Pitta, site of Agni is called so, because of its power of retain (Grahanat) the downward movement of food, it is located above the Nabhi, and is supported and nourished by the strength of Agni.

The relation between Grahani and Agni is reciprocal and interdependent, thus Adharadheya Bhava is present. Grahani Roga is Tridoshatmaka disorder of digestive system occurs due to vitiation of Pachaka Pitta, Samana Vayu, Apanavayu, Kledakakapha. The functional dependency between normal Vata and Agni is altered to a significant level. Ayurveda described very useful medicine and procedure which is permanent cure with promoting health and without any altering aliment.



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Conclusion

Ayurveda possesses ability to control Tridosha imbalances using various herbs and natural medicines. The disorders related to digestion of food and its absorption is becoming more common than the past due to our faulty food habits. Grahani Roga is one of them and can be cured using basic principles. Drugs relieve disease symptoms along with Yoga and meditation. Vatanulomana and Agnideepana Aharas along with Deepana and Pachana drugs will be helpful.

Reference

1. Charak Samhita by Pandit K. Shastri Published by Chaukhambha Sanskrit Sansthan Varanasi, edition 2004 Chikitsasthana chapter 15 Shloka 56 page 388.

2. Sushruta Samhita by Kaviraj Ambika Dutta Shastri Published by Chaukhamba Sanskrit Sansthan Varanasi, edition reprint 2012 Uttaratantra chapter 40 Shloka 169 page 306.

3. Astanga Hridaya by Brahmananda Tripathi Published by Chaukhambha Sanskrit pratisthan Delhi, edition 2012 Nidansthana chapter12 Shloka 1 page 512.

4. Charak Samhita by Pandit K. Shastri Published by Chaukhamabha Sanskrit Sansthana, Varanasi, edition 2004, Chikitsasthana Chapter 15 Shloka 42-43 page 386.

5. Charak Samhita by Pandit K. Shastri published by Chaukhambha Sanskrit Sansthan, Varanasi edition 2004 Chikitsasthana Chapter 15 Shloka 53-54 page 388.

6. Charak Samhita by Pandit K. Shastri published by Chaukhambha Sanskrit Sansthan, Varanasi edition 2004 Chikitsasthana Chapter 15 Shloka 44 page 386.

7. Madhava Nidana by Brahamananda Tripathi, published by Chaukhamba Surbharati Prakashan Varanasi edition 2012, chapter 4 Shloka 19-20 page 235.

8. Charak samhita by Pandit K. Shastri published by Chaukhamba Sanskrit Sansthan, Varanasi edition 2004 Chikitsasthana Chapter 15 Shloka 75 page 391.

9. Astanga Hridaya by Brahmananda Tripathi Published by Chaukhambha Sanskrit pratisthan Delhi, edition 2012 Nidansthana chapter 12 Shloka 1 page 512.

10. Astanga Hridaya by Brahmananda Tripathi Published by Chaukhamba Sanskrit pratisthan Delhi, edition 2012 Chikitsasthana chapter 10 Shloka 1 page 395.

11. Astanga Hridaya by Brahmananda Tripathi Published by Chaukhamba sanskrit pratisthan Delhi, edition 2012 Chikitsasthana Chapter 10 Shloka 4-5 page 696.

12. Charak Samhita by Pandit K. Shastri Published by Chaukhambha Sanskrit Sansthan, Varanasi, edition 2004 Chikitsasthana Chapter 15 Shloka 117-119 page 397.

13. Charak Samhita by Pandit K. Shastri Published by Chaukhambha Sanskrit Sansthan, Varanasi, edition 2004 Chikitsasthana Chapter 15 Shloka 120-121 page 397.

14. Charaka Samhita with Ayurveda Dipika Commentary of Chakrapanidatta, Vaidya Yadavaji Trikamji, Chikitsa Sthana 15, Verse 12, Varanasi; Chaukhambha Prakashan; p. 513.

15. Susruta Samhita of Maharishi Sushruta, Kaviraja Ambikadutta Shastri, Part –II (Uttaratantra 40, Verse 167). Varanasi; Chaukhamba Sanskriti Sansthan; 2008. p. 237.

16. Susruta Samhita of Maharishi Sushruta, Kaviraja Ambikadutta Shastri, Part –II (Uttaratantra 40, Verse 167). Varanasi; Chaukhamba Sanskriti Sansthan; 2008. p. 237.

17. Susruta Samhita of Maharishi Sushruta, Kaviraja Ambikadutta Shastri, Part –II (Uttaratantra 40, Verse 172). Varanasi; Chaukhamba Sanskriti Sansthan; 2008. p. 239.

18. Davidson’s principles and practice of medicine 22 edition by Ian D. Penman page 907.


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