E-ISSN:2456-3110

Case Report

Grahani Roga

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 10 OCTOBER
Publisherwww.maharshicharaka.in

A case study of Ayurvedic treatment of Grahani Roga

Mallick P1*, Das R2, Acharya B3
DOI:10.21760/jaims.9.10.42

1* Pragayapriyadarshini Mallick, Professor and Hod, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

2 Rupanjali Das, Post Graduate Scholar, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

3 Bharatilata Acharya, Lecturer, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

Grahani is an important part of the Mahasrotas (gastrointestinal tract). Grahani and Agni (digestive fire) have an Adhara Adheya Sambandha (mutual relationship). Jathar Agni (digestive fire) governs the process of digestion, supported by the Tridoshas (three bio-humors). Due to a chronic imbalance of the Pachaka Pitta (digestive fire), Saman Vayu (the air entity that aids digestion), and Kledaka Kapha (the type of phlegm involved in digestion), a weak digestive fire (MandAgni) can lead to the release of food in its undigested form (Ama Utpatti), resulting in Grahani Roga. Any individual if suffering from symptoms like alternate passing of hard & loose bowel habits, abdominal pain, passing of foul smelling stool, mucus in faecal matter can be diagnosed as Grahani Roga. In modern science, above symptoms can be correlated with IBS (Irritable Bowel Syndrome). In IBS the wall of the intestine becomes sensitive to even mild stimulus which causes excess abdominal cramps & hence the bowel movement alters along with indigestion. In India, IBS affects about 15% of adult population. This paper discusses the pathogenesis of Grahani Roga, a condition linked to impaired digestive function, and presents various treatment modalities, including herbs, Yoga, and lifestyle modifications.

Keywords: Grahani, Irritable Bowel Syndrome, IBS, Duodenal disorder, Case Report

Corresponding Author How to Cite this Article To Browse
Pragayapriyadarshini Mallick, Professor and Hod, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.
Email: 		Mallick P, Das R, Acharya B, A case study of Ayurvedic treatment of Grahani Roga. J Ayu Int Med Sci. 2024;9(10):256-260.
Available From
https://jaims.in/jaims/article/view/3899

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-09-07 2024-09-17 2024-09-27 2024-10-07 2024-10-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.65

© 2024by Mallick P, Das R, Acharya Band 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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Rupanjali D et al. A case study of Ayurvedic treatment of Grahani Roga

Introduction

Grahani is a disease which affects large population globally especially in developing countries due to improper food habits, unhyiegenic environment along with stressful lifestyle having nutritional deficiency. The faulty lifestyle, consumption of junk food, stress, inadequate sleep and avoidance of Sadvritta are the major reasons of Grahani Dosha. Irritable bowel syndrome (IBS) is characterised by recurrent abdominal pain in association with abnormal defecation in the absence of a structural abnormality of the gut. Grahani is the seat of Agni (digestive fire), it retains the Ahara (until it gets fully digested) and then passes it into Pakwashya (intestine). Grahani is one of the important parts of Mahasrotas (GI tract) and according to Acharya Sushruta 6th Pittadhara Kala situated between Amashaya and Pakwashaya is called Grahani. The pathogenesis of Grahani Roga revolves around Agnidosha associated with impaired function of digestive fire. Grahani being the seat of Agni (digestive fire) is situated above Nabhi (umbilicus) region, it withholds the food for certain time inside the Amashaya (stomach) to facilitate digestion.

The strength of Grahani is from Agni itself and strength of Agni from Grahani. When Agni undergoes vitiation, Grahani also gets vitiated and produces diseases. It is the disorder of digestive system having involvement of Pachaka Pitta, Samana Vayu, Kledaka Kapha produces symptoms likee Muhurbaddha Muhurdravam (alternate passing of hard & loose bowel habits), Sarujam Ama-Apakwa Puti Malapravritti (painful foul-smelling defaecation in form of Ama-Pakwa Avastha), Bahusho Bimunchati (defaecation in large quantity), Vairasya (tastelessness), Suktapaka (acid eructation), Trishna (excessive thirst), Daurbalya (weakness), Manasa Sadanam (depression) etc. Due to malabsorption and lack of nutrition, various complications due to predominance of Vata become manifested like Swasa, Kasa, Gulma, Hridroga, Pliharoga, Parikartika. Prevalence In India the female to male ratio is 1:3 and common age group is 20-40 years. Symptoms are vague and these include abnormal bowel habits ranging from constipation to diarrhoea (often alternating irregularly), pellet like stools, increased gastrocolic reflex, vague abdominal pain. Around 20% of subjects complain of weight loss.

Clinically IBS shows symptoms like altered bowel habit i.e. constipation, diarrhoea or mixed type, abdominal pain and bloating, indigestion, heart burn, feeling of incomplete defecation, passage of mucus in stool etc. The line of treatment followed was both Shodhana and Shamana. Drugs having Kasaya Rasa, Usna Veerya, Madhura Vipaka & Ruksha Guna help to pacifies Vata & Pitta Dosha therefore potentiates Agni which improves process of digestion.

Drugs which gives bulk to the stool, hydrate body and possess nutritional benefits also relieve symptoms of Grahani Dosha. This article described general consideration of Grahani Dosha and its management by Ayurveda and conduction of disciplinary life style. The present case study demonstrates the critical contribution of Ayurveda to the effective treatment of Grahani (IBD).

Etiological Factors

  • Abhojanat, Ajeernabhojanat, Attibhojanaat, Visamasanat, Asatmya Guru, Ruksa and Sandusta Bhojanat
  • Vyadhikarshanat and Vegavidharana
  • Stress, anxiety and grief
  • In disciplinary life style and bad food habits
  • Unhygienic environmental condition
  • Nutritional insufficiency
  • Contagious predominance
  • Improper functioning of digestive fire
  • Diseased condition which weakened Agni
  • Virudha-Ahara
  • Avoidance of concept of Desha and Kala during consumption of food stuffs.
  • Excessive use of antibiotics.

Case Report

The present case involves a 34-year-old female patient who presented to the Outpatient Department (OPD) with chief complaints of pain in the right upper region of the abdomen, accompanied by acidity, anorexia, constipation, and altered bowel habits for the past six months. The pain is described as pricking in nature, aggravated by consuming heavy and spicy foods, and relieved by the intake of cold beverages.


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The patient has experienced weight loss over the last two months (6 kg), despite maintaining a regular mixed diet. She frequently consumes spicy and non-vegetarian foods at irregular intervals. Additionally, she has been suffering from stress and anxiety for the past year.

History of Present Illness

Patient states that she was quite well 10 months back except Agnimandya. Gradually, patient had developed symptoms like Muhurbaddha Muhurdravam (alternate constipation and diarrhoea), Sarujam Ama-Apakwa Puti Malapravritti (painful foul-smelling defaecation for the past six months in form of Ama-Pakwa Avastha), Bahusho Bimunchati (defaecation in large quantity), Vairasya (tastelessness), Suktapaka (acid eructation), Trishna (excessive thirst), Daurbalya (weakness), Manasa Sadanam (depression) & Anidra (insomnia).

Patient was clinically diagnosed IBS (type M) after 2 months and took treatment from different allopathic hospitals but treatment only provides relief only during medication time period i.e., temporarily.

All symptoms were gradually increased due to further consumption of spicy, junk diet and ultimately patient appeared with severely emaciated. That state led the patient to get admitted in the hospital.

Past History

Patient used to take antacids, proton-pump inhibitors, antibiotics unevenly.

General and Systemic Examination

Body built - Thin
Height - 4ft 9 inch
Weight - 53 kg.
BP - 114/70mmHg
PR - 68/min.
RR - 18/min
Temp. - 98.4°F
Pallor - Mild
Icterus - Absent
Bowel - Irregular [(Alternative episodes of Diarrhoea - 5-6 times per day, 2-3 times per night), along with constipation for 1-2 days]
Urine output - Normal.

No abnormality detected in other Cardiovascular system, Nervous system, Respiratory system.

Investigation

Haematological report revealed that Haemoglobin - 10 g/dL, ESR - 45mm/hr, TC, DC and other haematological parameters were within normal limits. Serological study revealed that FBS - 88 mg/dL, PPBS - 128mg/dL, LFT & RFT were normal.

Urine for R/E & M/E showed normal study. Routine examination of stool showed Pus cells - 6-8/hpf, RBC - 4-6/hpf & plenty vegetable cells present in the stool sample.

Ashtavidha Pareeksha

  • Nadi (pulse) - 80/min (V-P Predominant)
  • Mala (stool) - Vibandha
  • Mutra (urine) - Samyak
  • Jeevha (tongue) - Saam
  • Shabda (speech) - Spashta
  • Sparsha - Anushna Sheeta
  • Druka (eyes) - No pallor, no icterus
  • Akruti - Krusha

Treatment Plan

The treatment was carried out in two phases. In 1st phase Piccha Basti was given after proper Abhyanga & Swedana and Shamana Aushadhi were given for 20 consecutive days and in 2nd phase only Shamana Aushadhi was given for next 40 days. Ushnodaka & Takra were administered as Pathya.

Sodhana Chikitsa

1. Sarvanga Snehana with Dashmoola Taila (whole body massage)
2. Puti Swedana (wood chamber steam)
3. Picha Basti (160 mL) (medicated enema): Quath 100 mL (Arjuna (Terminalia arjuna), Ashwatha (Ficus religiosa), Udumbara (Ficus racemosa), Kutaj (Holarrhena antidysenterica), Shalmalli (Salmalia malabarica), Yastimadhu (Glycyrrhiza glabra), Water and Milk), Honey 20 mL, Saindhava Lavana 10 gm, Yastimadhu Taila 30 mL (Glycyrrhiza glabra oil), Yastimadhu Kalka (Glycyrrhiza glabra paste).

Shamana Chikitsa

1. Stop IBS (250 mg) 2 tab BD After meal.
2. Chitrakadi Vati + Mahashankha Vati 500mg (2 pills) + 500mg (2 pills) Ushnodaka twice a day after meal.


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3. Brahmi Vati 250mg (2 pills) Madhu twice a day (morning & evening).
4. Nasya with Goghrita 2 drops in each nostril daily.
5. Shivakshar Pachana Churna 3gm with Ushnodaka twice a day before meal.
6. Panchaamruta Parpati (125 mg) (Anupana Takra) 2 tab. two times/day After meal.

Dietary materials recommended for Grahani Roga are as follows

Diets which promote digestive enzyme; restore normal flora and maintain nutritional sufficiency should be adopted such as; fibers, fruit, vegetables, grains and curd. Yavagu, Panchkola soup, Takrarista, Jangalmansa, Vegetable soups - Light diet and Soup of dried raddish, carrot.

Therapeutic Outcome

During the first follow-up, the frequency of bowel movements was reduced to 2-3 times per day. In the second and third follow-ups, there was marked relief in all her symptoms. The patient experienced an adequate appetite and reported no fatigue or weakness, as her food intake and digestion were normal.

Discussion

After clinical examination and investigations, the patient was diagnosed with Inflammatory Bowel Disease (IBD) by a gastroenterologist. The patient had a personal history of Adhyashana (eating before the previous food is digested), Vishamashana (eating food without following a specific schedule), Ratrijagaranam (late-night awakening), Diwasvapana (daytime sleeping), emotional stress, and anxiety. Therefore, the aim of treatment was to enhance Agni, by releasing the obstruction by ama in Srotas. The treatment was started with Sarvanga Udwartana, which helps liquefy Kapha, Ama, Baddha mala and enhances absorption and increases nutrition to all tissues.

As a result, patients are prescribed medications with Deepana-Pachana (appetiser or digestive-promoting) and Mana Prasadak (brain tonic) properties. Piccha Basti (medicated enema) is named for its Picchila (slimy) property, which provides an ulcer-healing effect. Moreover, it is Agnideepaka (promotes digestion) and Sangrahi. Nasya with Goghrita which enhances Smriti, Buddhi, Agni, Shukra, Oja etc.

can correct Jatharagni as well as mitigates aggravated Vata Dosha. Oral medications like Chitakadi Vati & Mahashankha Vati both has properties like Deepana, Pachana, Grahi, Shulaghna, Vata-Kapha Shamana etc. and with the help of these properties, these drugs act as excellent medication in GI tract diseases. Brahmi Vati (with Madhu Anupana) is also a very good drug to prevent anxiety & stress, induce sleep & alleviate Vata. Panchamrita Parpati possesses Agnideepana (boosting digestive fire) properties.

The Parpati Kalpa itself has Deepan (promoting digestion) and Grahi (holding) properties due to the effects of the formulation. This formulation predominantly acts on Agni (digestive fire), performing both Amapachana (digesting toxins) and Agni Deepana (promoting digestion).[12] Takra (buttermilk) is recommended twice a day as Anupana of Panchamrita Parpati, as it is specifically advised for Grahani Roga due to its Deepana-Pachana (promoting digestion), Grahi (holding), Stambhak (retentive), Jantughna (treating worms), Baladayaka (strength-giving), and Laghavatva (lightness) properties. Tablet Stop IBS contains Kutaj, Bramhi, Bilwa, and Shunthi. Shunthi and Bilva have gastroprotective effects and anti-diarrhoeal activity, while Kutaja has anti-diarrheal properties.

Behaviour and daily routine modification

Behavioural factors such as stress, worry, fear, and sleeplessness can exacerbate Grahani symptoms. Excessive stress triggers central nervous system defence mechanisms, leading to neuroendocrine and behavioural responses. Sleep regulation involves complex processes, including the Hypothalamic-pituitary-adrenal (HPA) axis, circadian rhythms, and immune system components like Interleukin (IL)-1β. Stress-related insomnia can become chronic due to a cycle involving the HPA axis, necessitating a deeper understanding for effective treatment. Patients are advised to maintain balance and avoid an unruly lifestyle.

Conclusion

Grahani is a digestive fire disease affecting Annavaha Srotas and life style patterns, causing abdominal pain, bloating, and disturbed bowel habits. Ayurveda offers various formulations and therapeutic modalities for management.


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Tridoshatmaka disease of digestive fire occurs due to the vitiation of Agni; Jatharagni, Saman Vayu, Pachak Pitta and Kledaka Kapha. The present case study illustrates the significant efficacy of Ayurveda therapies in treating Grahani (IBD). The patient stopped taking allopathic medications, and Ayurveda proved to be a safe therapeutic choice with no side-effects. Given the results observed in the present case, future large-scale clinical trials are needed to confirm the efficacy of Ayurvedic methods for Grahani. Such holistic Ayurveda solutions are a promising option for individuals seeking effective disease management while minimising the risks associated with conventional treatments.

References

1. Chakraborty S, Das A. Management of Grahani Roga in Ayurveda: A Case Study. World Journal of Pharmaceutical Research. 2021;9(15):953-61. Doi: 10.20959/ wjpr202015-19220.
2. Tiwari R, Pandya DH, Baghel MS. Clinical evaluation of Bilvadileha in the management of Irritable Bowel Syndrome. Ayu. 2013;34(4):368-72. Doi: 10.4103/ 0974-8520.127717. PMID: 24696573; PMCID: PMC3968698.
3. Choudhary K, Gupta N, Mangal G. Therapeutic impact of Deepana-Pachana (appetizer-digestives) in panchakarma: An overview. IRJAY. 2021;4(1):252-58. Available from: https://doi.org/10.47223/IRJAY. 2021.4108.
4. Acharya YT., editor. Sushruta Samhita of Sushruta with Nibandhasangraha commentary of Dalhanacharya, Uttaratantra, Chapter 40, Verse 167, Varanasi: Chaukhambha Sanskrit Sansthan, 2012.
5. Vagbhata; Ashtanga Hridaya; Sarvanga Sundari Teeka of Arunadatta; Ayurveda Rasayana of Hemadri; Edited by Bhishagacharya Harishastry Paradakara Vaidya: Sutrasthana, Chapter 12, Verse 8; Publishers Chowkhambha Orientalia; 10th edition, 2012; 193..
6. Kaviraj Govind Das Sen. Bhaisajya Ratnavali, edited by Mishra S, Grahanidoshavikara: Chapter 8, Verse 190-192. Chaukhamba Surbharati Prakashan, Varanasi, (Reprint ed.), 2013; 151.
7. McGraw-Hill; Harrison’s Principle of Internal Medicine, Vol-2; 16th edition; Medical publishing division, 1779.

8. Vagbhata; Ashtanga Hridaya; Sarvanga Sundari Teeka of Arunadatta; Ayurveda Rasayana of Hemadri; Edited by Bhishagacharya Harishastry Paradakara Vaidya: Chikitsasthana, Chapter 27, Verse 2-4; Publishers Chowkhambha Orientalia; 10th edition, 2012.
9. Krishna CM, Bandari S, Sangu PK, Prasad PG, Narayana A, Prasanna KT. A prospective study on Parpati Kalpana w.s.r to Panchamrut Parpati. International Journal of Ayurvedic Medicine. 2010;1(3):118-28. Doi: 10.47552/ijam.v1i3.46.
10. Ayurveda Sara Sangraha, published by Shri Baidyanath Ayurveda Bhavan Limited, Naini, Allahabad, edition-2015, p.531.
11. Vaidya Yadavji Trikamji Acharya, Charak Samhita on Ayurved Dipika commentary by Agnivesh, published by Chowkhamba Krishnadas Academy, Varanasi, edition- reprint 2015, Chikitsa Sthana, Chapte-15, shloka-75, p.518.
12. Ayurveda Sara Sangraha, published by Shri Baidyanath Ayurveda Bhavan Limited, Naini, Allahabad, edition-2015, p.526.


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