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    Irritable Bowel Syndrome (IBS)

    तृष्णारोचकवैरस्यप्रसेकतमकान्वित:।।
    शूनपादकरः सास्थिपर्वरुक छर्दन॑ ज्वरः।
    लोहामगन्धिस्तिक्ताम्ल उद्गारश्चास्य जायते।।

    A Complete Guide to Irritable Bowel Syndrome (IBS)

    Introduction

    Today in our daily routine, stress has become inescapable. Stress substantially changed the food habits of people with an increase in consumption of junk, spicy food, alcoholic beverages, vegetable oil, etc. Stress along with lifestyle modifications are responsible for various types of diseases in our body like hypertension, IBS, depression, ulcers, obesity, etc. Among all these diseases IBS is the most common condition that is found throughout the world but one of the least well-understood. 60% of people throughout the world suffering from IBS have psychological disorders i.e anxiety, depression, etc. Dietary changes are also one of the main causes of IBS. As per Ayurveda, IBS is correlated with Grahani but some researchers suggested that IBS cannot be correlated with Grahani because Grahani is Ana Vaha Srotas Vyadhi while IBS has clinical features similar to Purisha Vaha Srotas Vyadhi. Therefore here, the correlation of IBS with Grahani and also with Pakvashya Gata Vata, Udavarta, and Vataja Atisara is also mentioned. In this article, you can better understand the IBS from a modern as well as an Ayurveda perspective. Here Ayurvedic treatment along with Yoga procedures and their mechanism of action is also mentioned. Pathya and Apathya i.e Dietary guidelines along with Behavioral guidelines are also well mentioned so that you can better understand and treat the disease.

    Facts About IBS

    • In the London medical gazette, in 1949, Dr. Cumming, described IBS.
    • IFFGD, 1997 designated April as an awareness month for IBS.
    • 19th April is celebrated as world IBS awareness day.
    • IBS affects people of all ages, even children are affected by these diseases.
    • 5- 10% of people worldwide are suffering from IBS.
    • 60- 65% of people suffering from IBS are women.
    • IBS is an unpredictable disease Your symptoms like diarrhea can alternate with constipation.
    • The most frequent feature of IBS is pain; Four out of five people have pain as the frequent symptom of IBS.
    • As per the severity index reported by the community, 20.3% of cases of IBS are severe,48. 3% are moderate and 31.4% are mild.
    • Low-FODMAP diet is very beneficial for IBS.

    Ayurvedic Reference of IBS - As Per Classical Literature

    Cause of IBS

    Ayurvedic point of view

     

    • Sushruta Samhita Uttara Tantra. 40/ 166- 167

    दुष्यति ग्रहणी जन्तोरग्निसादनहेतुभिः।। 

    अतिसारे निवृत्ते अपि मन्दाग्नेरहिताशिनः। 

    भूयः सन्दूषितो वह्निग्रहणीमभिदूषयेत।। 

     

    • Ashtanga Hridya Nidana Sthana. 8/ 15- 16

    अतिसारेषु यो नाति यत्नवान्‌ ग्रहणी गदः।। 

    ततस्य स्यादग्निविध्वंसकरैरन्यस्य सेवितैः।

     

    Diseases of Grahani manifest due to improper functions of Agni, After the cure of Atisara or who is suffering from mild digestive fire, if they consume an unwholesome dietetic regimen leading to further vitiation of Agni along with Grahani.

     

    Asatmya Bhojam (Intake of unwholesome food), Vegadharana (Suppression of urges), Virudh Ahara (Incompatible food), Guru Ahara (Intake of heavy food), Ati Maithun (Over-indulgence in sexual activity), Ati Bhojan (Excessive food intake), Mithya Yog of Panchkarma (Procedure of Panchkarma done incorrectly), Abhojnat (Excessive fasting) all these causes lead to IBS.

     

    Modern point of view:

     

    The causes of irritable bowel syndrome are incompletely understood in modern science, but biological, social, psychological, and luminal factors (like diet and gut microbiota) are believed to play an important role.

     

    Psychological and behavioral factors

     

    The study revealed that approximately 50% of patients with IBS have psychiatric illnesses like depression, anxiety, neurosis, etc. These psychiatric illnesses alter gastrointestinal motility and visceral perception. So, these factors may contribute to IBS.

     

    Physiological factors

     

    IBS is a state of immune activation, not detectable by tests or low-grade gut inflammation. In IBS mucosal mast cell increases that sensitize enteric neurons. So, it was evidenced that irritable bowel syndrome is a 5- HT (Serotonergic) disorder. 

     

    Excessive release and relative deficiency of 5- HT results in D-IBS AND C- IBS respectively.

     

    Some other factors that result in IBS are as follows:

     

    • Unhygienic environmental condition
    • Bacterial infection
    • Visceral hypersensitivity
    • Changes in gut microbes 
    • Food sensitivities
    • Low-grade inflammation
    • Contagious predominance
    • Certain psychological disorders like stress, depression, anxiety, etc
    • Excessive use of antibiotics
    • Bad lifestyle and food habits

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    Evaluation of Prakriti in IBS Patient

    A recent study revealed that: Vata predominant patients had developed IBS-C, and Pitta predominant patients had developed IBS-D. 

     

    (Reference: Shirolkar SG, Tripathi RK, Rege NN. Evaluation of Prakriti and quality-of-life in patients with irritable bowel syndrome. Anc Sci Life. 2015 Apr-Jun; 34 (4): 210- 5. doi: 10. 4103/ 0257- 7941. 160865. PMID: 26283806; PMCID: PMC4535069.)

    Types of IBS

    Ayurvedic point of view:

     

    As per classical texts of Ayurveda Grahani is of four types.

     

    • Sushruta Samhita Uttara Tantra. 40/ 171

    एकशः सर्वशश्चैव दोषेरत्यर्थमुच्छिवतै: । 

    सा दुष्टा बहुशो भुक्तमाममेव विमुंञ्चति।।

     

    • Charaka Samhita Chikitsa Sthana. 15/ 58

    वातात्‌ पित्तात्‌ कफाच्च स्वात्तद्रोगस्त्रि्य एव च। 

    हेतुं लिड्गं चिकित्सां च श्रृणु तस्य पृथक्‌ पृथक।।

     

    Mainly four types of Grahani are as mentioned:

     

    • Vataja 
    • Pittaja
    • Kaphaja
    • Sannipataja

     

    But according to Charaka Samhita Chikitsa Sthana. 15/ 71 and as per Charaka Samhita Chikitsa Sthana. 15/ 38- 41 the word Grahani Dosha includes the following diseases:

     

    • Ajirna
    • Mandagni
    • Tikshna Agni
    • Vishama Agni
    • Agnimandya
    • Grahani Roga

     

    Few other types of Grahani as mentioned by different authors are as follows:

     

    • Sangrahni Grahani
    • Ghati Yantra Grahani
    • Kashtaja Grahani
    • Nirmukha Grahani
    • Raja Grahani

     

    Modern point of view

     

    Irritable bowel syndrome with constipation (C- IBS): In C- IBS, the stool passes with strain, and fewer abnormal movements occur overall. C- IBS is the most common type of IBS. In this type approximately 25% of stool is loose and the left stool is lumpy and hard.

     

    Irritable bowel syndrome with diarrhea (D- IBS): In D- IBS, the stool is a mixture of hard and loose stool i.e approximately a quarter of stool is loose and the left stool is hard and lumpy. In this type, the patient feels frequent urges and abdominal pain. The common symptom is this type of IBS is excessive gas.

     

    Irritable bowel syndrome with mixed bowel habits (IBS- M) or irritable bowel syndrome with alternating diarrhea and constipation (IBS- A): In this type, stool may occur in any form i.e it may be hard or loose, watery. stool may be loose, watery, or hard. Both types of stool may occur alternatively or the patient may pass mixed stool in equal quantity.

     

    Post-diverticulitis IBS: Post-diverticulitis IBS is a complication of diverticulitis in which symptoms like nausea, vomiting, abdominal pain, fever along constipation may be experienced.

     

    Post-infectious IBS: The IBS that occurs after a gastrointestinal infection. The most common sign of this type of IBS is diarrhea. Vomiting may occur in a few cases of post-infectious IBS.

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    Prodromal Features (Purva Rupa of Grahani)

    Ayurvedic point of view

     

    • Charaka Samhita Chikitsa Sthana, 15/ 55

    पूर्वरूपं  तु तस्येदं  तृष्णा आलस्यं बलक्षयः। 

    विदाहो  अन्नस्य  पाकश्च चिरात कायस्य गौरवम्।। 

     

    • Sushruta Samhita Uttara Tantra. 40/ 173

    तस्य उत्प्तौ विदाहो अन्ने सदनालस्यतृद्क्लमाः। 

    बलक्षयो अरुचि: कास: कर्ण क्ष्वेडो आंत्र कूजनम्‌।।

    Premonitory Signs and Symptoms of Grahani are as follows:

    Charaka Samhita:

     

    • Trishna (thirst)
    • Aalasya (laziness)
    • Bala Kshaya (diminution of strength)
    • Vidaho Anasya (burning sensation during digestion of food)
    • Pakya Chirrat (delayed digestion)
    • Kayastha Gourvam (General malaise)

    Sushruta Samhita:

     

    • Bala Kshya (exhaustion)
    • Aruchi (Anorexia)
    • Kasa (cough)
    • Karna Shveda (ringing inside the ears)
    • Antara Kunjam (gurgling noise in the abdomen)

    Pathophysiology (Samprapati) of IBS

    Ayurvedic point of view

     

    • Charaka Samhita Uttara Tantra. 40/ 171- 172

    सा दुष्टा बहुशो भुक्तमाममेव विमुञ्चति पक्वं वा। 

    Due to etiological factors, both Agni and Grahani become disturbed leading to the development of Grahani Roga. 

     

    • Charaka Samhita Chikitsa Sthana. 15/ 51- 52

    दुर्बलो विदहत्यनं तद्यात्यूध्वमधो अपि वा।। 

    अधस्तु पक्व आमं वा प्रवृत्त ग्रहणीगदः। 

    उच्यते सर्वमेवान प्रायो हास्य विदाह्यते।। 

    Impaired Agni burns the food incompletely which goes either upward or downwards when it moves downwards either in the ripe or unripe condition known as Grahani Gada.

     

    • Charaka Samhita Chikitsa Sthana. 15/ 57

    दुर्बलाग्निबला दुष्टा त्वाममेव विमुञ्चति।        

    Such patients suffer from sour eructation, burning sensation, thirst along with difficulty in digestion.

     

    Samprapti Ghataka (Component of manifestation of diseases)

     

    Dosha Pitta Pradhana Trishoja 
    • Vata- Samana Vata
    • Pitta- Pachaka Pitta
    • Kapha- Kledaka Kapha
    DushyaDhatu- Rasa

    Sharirika Mala- Mutra, Pureesha

    Dhatu Mala- Kapha, Pitta

    AgniJathara Agni
    Agni DushtiManda Agni
    Ama Agni Janya
    StrotasAnavaha
    StrotodustiSanga, Vimarg Gamana, Ati Pravritti
    AdhisthanaGrahani
    Udbhava SthanaGrahani
    Vyakta SthanaGrahani
    Sanchaar SthanaMaha Strotas, Ana Vaha Srotas
    SvabhavaChirakari
    PrabhavaMaha Roga, Sudustra (difficult to treat)
    Roga MargaAbhyantara
    Roga BhedaVtaaja, Pittaja, Kaphaja, Sannipataja

    Common Symptoms of IBS (Samanya Lakshana)

    Ayurvedic point of view

     

    • Charaka Samhita Chikitsa Sthana. 15/ 53- 54

    अतिसृष्ट॑ विबद्ध॑ वा द्रव तदुपदिश्यते। 

    तृष्णारोचकवैरस्यप्रसेकतमकान्वित:।। 

    शूनपादकरः सास्थिपर्वरुक छर्दन॑ ज्वरः। 

    लोहामगन्धिस्तिक्ताम्ल उद्गारश्चास्य जायते।। 

     

    • Sushruta Samhita Uttara Tantra. 40/ 174- 175

    अथ जाते भवेज्जन्तुः शूनपादकरः कृशः। 

    पर्वरुग्लौल्यतृट्छर्दिज्वरारोचकदाहवान्।। 

    उद्विग्र तिक्त अम्ल लोह धूम आम  गंधिक।   

    प्रसेकमुखवैरस्यतमकारुचिपीडितः

     

    The common symptoms of Grahani are as follows:

     

    • Ati srishtam (Patient pass frequent watery stool)
    • Vivadham (constipated)
    • Trishna (excessive thirst)
    • Aruchi (anorexia)
    • Vairsya (distaste in mouth)
    • Praseka (Excessive salivation)
    • Tam (feeling of darkness)
    • Shun Paad Kara (Oedema on feet and hands)
    • Asthi Parva Ruka (pain in bones and joints)
    • Chardan (vomiting)
    • Jwara (fever)
    • Loham Gandhi (eructation have metallic smell)
    • Ama Gandhi (Ama or smoke smell)
    • Tikt, Amla Udgaar (sour, bitter, vinegar eructations)
    • Krisha (emaciation)
    • Lollya (greediness)
    • Dahavaan (burning sensation inside)
    • Tamaka (breathlessness)

     

    Modern point of view

     

    • Change in form of stool – Stool may be loose and watery or hard or a mixture of both.
    • Change in frequency of stool
    • Recurrent abdominal pain
    • Abdominal pain that improves with defecation
    • Steatorrhea
    • Difficulty in sleeping
    • Bloating 
    • Cramping
    • Weight loss
    • Fatigue 
    • Early satiety
    • Intermittent dyspepsia
    • Non-cardiac chest pain
    • Rheumatologic symptoms
    • Fibromyalgia
    • Genito- urinary symptoms
    • Backache
    • Headache
    • Chronic fatigue syndrome

    Diagnosis of IBS

    Diagnosis of IBS is made by Rome III Criteria.

     

    The Main presentation of IBS is recurrent abdominal discomfort. On basis of that diagnosis is made:

     

    Recurrent abdominal pain for at least three days per month in the last three months, associated with two or more of the following symptoms: 

     

    • Onset associated with the change in frequency of stool
    • Onset is associated with the change in form of stool.
    • Improvement in abdominal pain with defecation.

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    Correlation of Different Types of IBS

    IBS is correlated with different types of disease as per the symptoms involved.

     

    Few researchers suggested that IBS is Purisha Vaha Srotas Vyadhi and types of IBS are co- related with Pakvashya Gata Vata, Udavarta, Vataja Atisara, Grahani due to similarity in clinical features.

     

    Pureesha Vaha Strotas Gata Vyadhi Lakshana (C. S. Vi. 5/ 8)

     

    Purisavaha srotas (channels carrying feces) have their roots in Pakyasaya and Stu Laguda (rectum). Symptoms of their morbidity are these- such as “Kricchen Alp Shabdh Sha Drava Ati Grathit Ati Bahu Mala” i.e  passing feces with difficulty, in small quantity, with sound and pain, too liquid, too sabulous and in large quantity indicate morbidity of the Purisha Vaha Srotas.

    IBS Co-Relation with the Different Disease by Considering it Purisha Vaha Srotas Vyadhi

    IBS- C: 

     

    IBS- C is correlated with Pakvashya Gata Vata, Udavarta.

     

    Clinical features in Pakvashya Gata Vata are Antra Kunjan (gurgling sound in intestine), Trika Shula (pain in the sacral region), excessive formation of gas, Krricha Mutra Pureesha (Retention of stool and urine), flatus, Shool (colic pain), Aatopa (meteorism), Aanaha (hardness of bowel) and constipation. (C. S. Chi. 27/ 28, 29)

     

    Clinical features in Udavarta are Flatulence, griping pain, indigestion, pricking pain, nausea, and obstruction in the evacuation of stool. Frequent pain in the heart, pelvis, regions of the urinary bladder, inflammation of the urinary bladder.

     

    IBS- D: 

     

    IBS- D is co-related with Vata Atisara.

     

    Clinical features: In Vataja Atisara two types of stool are present Amaja or Pakva. 

     

    • In Vatika Ama Atisara stool is mixed with mucus or slimy.
    • In Vataja Pakwa Atisara stool is pellet-shaped hard.
    • During the evacuation of stool, colic pain is present. 
    • Pain in the sacral and lumbar region (Trika Shula).
    • Dryness of mouth 
    • Pain in knees and thigh

     

    IBS- mixed: 

     

    Mixed IBS is correlated with Vatika Grahani.

     

    Clinical features seen in Vatika Grahani like Difficulty in passing stool, the stool is often mixed with Ama (undigested food), dyspepsia, mental depression, abnormal sounds in the ear, etc.

    Correlation of Different Types of Grahani with Different Types of IBS

    Vataja Grahani 

     

    Co- relation of Vataja GrahaniVataja Grahani is co- related with irritable bowel syndrome with constipation (C- IBS)/ Constipation predominant IBS

     

    Nidana (Etiological factors):

     

    Charaka Samhita Chikitsa Sthana, 15/ 59

    कटु तिक्त कषाय अतिरूक्षशीतलभोजनै: 

    प्रमितानशनात्यध्ववेगानिग्रह मैथुनैः।। 

     

    Excessive consumption of pungent, bitter, astringent, excessively unctuous & cold food substances, less intake of food, fasting too much, traveling on foot, suppression of natural urges, and excessive sexual intercourse.

     

    Samprapti (Pathophysiology):

    Charaka Samhita Chikitsa Sthana, 15/ 60

    करोति  कुपितो मन्दमग्निं संछाद्य  मारुतः। 

     

    Due to etiological factors Vata gets aggravated and surrounds Agni as a result Agni becomes sluggish and manifests Vataja Grahani.

     

    Lakshana (symptoms):

    Charaka Samhita Chikitsa Sthana, 15/ 60- 64

    तस्यानं पच्यते दुःखं शुक्तपाकं खरंगता।।  

    कण्ठास्यशोष: क्षु तृष्णा  तिमिरं कर्णयो: स्वनः। 

    पार्श्व उरु वंक्षण ग्रीवारुजो अभीक्षण विसूचिका।। 

    हत्पीडा कार्श्यदौर्बल्य॑ वैरस्य॑ परिकर्तिका। 

    गृद्धि: सर्वरसानां मनसः  सदन॑ तथा।। 

    जीणें जीर्यति चाध्मानं भुकते स्वास्थ्यमुपैति च। 

    वातगुल्महद्रोगप्लीहा शंकी मानव:।। 

    चिराददुःखं द्रव्म शुष्क॑ तन्वामं  शब्दफेनवत् 

    पुन: पुन: सृजेद वर्च: कासश्वासार्दितो अनिलात्।।

     

    Food digested with difficulty, hyperacidity, roughness in body, dryness of throat & mouth, hunger, thirst, blurred vision, tinnitus, frequent pain in sides of the chest, thighs, pelvic region, and neck, Visuchika, pain in the cardiac region, emaciation, weakness, distaste in mouth, cutting pain in the abdomen, desire to take all taste food items, lassitude, flatulence after & during the process of digestion, temporary relief after taking food, patient suspects as if he is suffering from Vata Gulma, Hridya Roga or Pliha Roga. Patients pass stool frequently with difficulty, which is liquid mixed with -hard stool, thin, Ama associated with sound & frothiness. The patient also suffers from cough & dyspnea.

     

    Chikitsa (Treatment of Vataja Grahani)

     

    Charaka Samhita Chikitsa Sthana. 15- 73- 76

    ग्रहणीमाश्रितं दोष॑ विदग्धाहार मूर्छितं।  

    सविष्टम्भप्रसेकार्तिविदाहारुचिगौरवैः।। 

    आम लिंगान्वितं दृष्टवा सुखोष्णेनाम्बुनोद्धरेत्‌। 

    फलानां वा कषायेण पिप्पलीसर्षपैस्तथा।। 

    लीन॑ पक्वाशयस्थ॑ वा आप्याम स्त्राव्य॑ सदीपनै: ।

    शरीरानुगते सामे रसे लड्नपाचनम्‌।। 

    विशुद्धामायशंयायास्मै पंञ्चकोलादिभि: श्रृतम्‌। 

    दद्यात्‌ पेयादि लघ्वन्न॑ पुनर्योगांश्च दीपनान्‌।।

     

    When the dosa located in Grahani is vitiated by food, which is undigested (vidagdha, i.e., partly digested and partly undigested) manifest symptoms and signs namely vistambha (constipation), praseka (salivation), pain, burning sensation, anorexia, and heaviness.

     

    • Ama stage of Grahani roga should be administered emetic therapy with the help of lukewarm water. Alternatively, the decoction of Madana Phala mixed with pippali and sarsapa should be used for emetic therapy.
    • If the ama moves downwards and remains adhered to the colon, then the patient should be given purgation therapy by such drugs which enhance digestion.
    • If the dosa in its āma (undigested) stage is converted into rasa (chyle) and pervades entire parts of the body, then the patient should be made to fast and be given drugs conducive to Pacana (metabolic transformation) of the undigested material, e.g., yavagu (thick gruel).
    • After the amasaya is purified by the elimination of ama (undigested material) by the administration of appropriate purgation and fasting therapies, the patient should be given peya (thin gruel) prepared of the decoction of pañcakola (pippali, pippali- mula, chavya, citraka, and Nagara), etc. He may also be given light food and such other ingredients as stimulants of digestion.

     

    Some formulations of Vataja Grahani: 

     

    • Chitrakadi Gutika (C. S. Chi. 15/ 96- 97)
    • Das Mulyadi Ghritam (C. S. Chi. 15/ 82- 86)
    • Trisushanadya Ghritam (C. S. Chi. 15/ 87)
    • Amladi Churna Chitrakadi Gutika (C. S. Chi. 15/ 112- 115)
    • Panchmuladya Ghrita, Taila and Churna (C. S. Chi. 15/ 93)

     

    Pathya for Vataja Grahani: C. S. Chi. 15/ 115- 116

     

    • Soup of the meat of kravyada (meat-eating) types of birds and animals prepared by adding drugs, which stimulate the power of digestion should be made sour by adding Dadima and buttermilk and administered as food to the patient suffering from Vataja grahani.
    • He should be given buttermilk, aranala (a sour drink), alcoholic drinks, and arista (a type of alcoholic drink) as drinks.
    • Soup of panakola (pippali, pippali mula, cavya, citraka and nagara).
    • Soup of the meat of Pakshi and Pashu (birds and animals) inhabiting arid land prepared by sizzling (with ghee etc.)

     

    Pittaja Grahani 

     

    Correlation of Pittaja GrahaniPittaja Grahani is correlated with Irritable bowel syndrome with Diarrhea (D- IBS)/ Diarrhea predominant IBS

     

    Nidana (Etiological factors):

    Charaka Samhita Chikitsa Sthana, 15/ 65

    कद्बजीर्ण विदाहाम्ल क्षाराद:  पित्तमुल्बणम्‌ ।

     

    Intake of pungent, uncooked food; eating during indigestion, food substances that induce burning, sour, alkaline food, etc.

     

    Samprapti (Pathophysiology):

    Charaka Samhita Chikitsa Sthana, 15/ 65

    अग्निमाप्लावयद्धन्ति जलंतप्तमिवानलम्‌।। 

     

    Due to etiological factors, Pitta gets aggravated and extinguishes Agni, like hot water causes the extinction of physical fire.

     

    Lakshana (symptoms):

    Charaka Samhita Chikitsa Sthana, 15/ 66

    सो अजीर्णनीलपीताभंपीताभः सार्यतेद्रवम्‌ । 

    पूत्यम्लो उदगार हत्कण्ठदाहारुचितृडर्दित: ।।

     

    Patient passes stool, which is watery, undigested, either bluish-yellow or yellow, fetid and sour eructation, burning sensation in the cardiac region & throat, anorexia & thirst.

     

    Chikitsa (treatment of Pittaja Grahani)

     

    Therapeutic interventions for Pittaja Grahani are as follows:

     

    Charaka Samhita Chikitsa Sthana 15/ 196- 198

     

    • Snehana (oleation therapy)
    • Swedana (sudation therapy)
    • Shodhana (purification)
    • Langhana (fasting therapy)
    • Deepana (stimulation of digestive fire)
    • Sura (alcohol)
    • Takra Yoga (formulation contains buttermilk)
    • Asava (type of alcoholic preparation)
    • Lavana (recipe containing salt)

     

    Some formulations of Pittaja Grahani: 

     

    • Chandanadya Ghrita (C. S. Chi. 15/ 125- 128)
    • Bhunimbadi Churna (C. S. Chi. 15/ 132- 133)
    • Nagaradi Churna (C. S. Chi. 15/ 129- 131)
    • Kiratadya Churna (C. S. Chi. 15/ 137- 140)
    • Tiktaka Ghrita (C. S. Chi. 15/ 125- 129)

     

    Pathya for Pittaja Grahani- C. S. Chi. 15/ 123- 124

     

    • The patient should be given a diet that does not cause Vidaha (burning sensation) and which is light and added with the powder of bitter ingredients.
    • The patient should be given the soup of the meat of animals inhabiting an arid zone, and the soup of vegetable products like mudga, and khada (a sour drink). These food preparations should be added with sour dadima, ghee, and drugs which cause stimulation of digestion, and are constipated (grahi). 
    • The power of digestion of the patient should be stimulated by the administration of the powder of bitter drugs or medicated ghee (Tikta- satpalaka ghrta and Maha- tiktaka-ghrta) prepared by adding such bitter drugs.

     

    Kaphaja Grahani 

     

    Co- relation of Kaphaja Grahani- Kaphaja Grahani is co- related with irritable bowel syndrome with Dysentery/ Dysentery predominant IBS

     

    Nidana (Etiological factors):

    Charaka Samhita Chikitsa Sthana, 15/ 67

    गुर्वतिस्निग्धशीतादिभोजनादति भोजनात्‌। 

     

    Excess consumption of food, which is heavy, too unctuous, cold, etc.; overeating and sleeping immediately after meals.

     

    Samprapti (Pathophysiology):

    Charaka Samhita Chikitsa Sthana, 15/ 67

    भुक्तमात्रस्य च स्वपाद्धन्त्यग्निं कुपितः कफ: ।। 

     

    Due to etiological factors Kapha gets aggravated and extinguishes Agni & manifests Kaphaja Grahani Roga.

     

    Lakshana (symptoms):

    Charaka Samhita Chikitsa Sthana, 15/ 68- 70

    तस्यानन॑ पच्यते दुःखं. हल्लास छर्दि आरोचका: ।   

    आस्योप देहमाधुर्यकासष्ठीवन पीनसाः।। 

    हृदय मन्यते स्त्यानमुदरं स्तिमितं गुर। 

    दुष्टो मधुर उदगार: सदनं स्त्रीष्वहर्षणम्‌।। 

    भिन्‍नामश्लेष्मसंसृष्टगुरु वर्च:प्रवर्तनम्‌। 

    अकृशस्यापि दौर्बल्यमालस्य॑ च कफात्मके।।

     

    Digestion of food with difficulty, nausea, vomiting, anorexia, sliminess and swedishness in mouth, cough, spitting sputum, rhinitis, feeling of sluggishness in cardiac region, the patient feels his abdomen is still & heavy, sweetish eructation having foul smell, general debility, lack of desire towards women, the patient passes stool which is split into pieces, mixed with Ama & Mucus and heavy; without emaciation, the patient feels weak & lassitude.

     

    Chikitsa (treatment of Kaphaja Grahani)

     

    Therapeutic intervention for Kaphaja Grahani are as follows:

     

    ग्रहण्यां श्लेष्म दुष्टायांवमितस्य यथाविधि। 

    कटुवम्ललवणक्षारैस्तिक्तै श्च अग्निम  विवर्धयेत्‌।।

     

    • Vamana (emetic) therapy is indicated for Kaphaja Grahani as a line of treatment.  (C. S. Chi. 15/ 141)
    • The pungent, sour, saline, alkaline, and bitter drug should be administered for the enhancement of the function of Agni. (C. S. Chi. 15/ 141)
    • Palashadi decoction and gruel are useful in Kaphaja Grahani. (C. S. Chi. 15/ 144)

     

    Some formulations of Kaphaja Grahani: 

     

    • Madhva Arishta (C. S. Chi. 15/ 156- 159)
    • Pippalyadi Churna (C. S. Chi. 15/ 168- 169)
    • Madhuka Asava (C. S. Chi. 15/ 146- 149)
    • Durlabha Asava (C. S. Chi. 15/ 152- 155)

     

    Pathya for Kaphaja Grahani- C. S. Chi. 15/ 144

     

    Ingredients of food that are light for digestion along with the soup of dried radish or Kulattha mixed with pungent. sour, alkaline, and saline drugs.

     

    Sannipataja Grahani 

     

    Co- relation of Sannipataja GrahaniSannipataja Grahani is co- related with complex/ mixed irritable bowel syndrome

     

    Nidana (Etiological factors), Samprapti (Pathophysiology), Lakshana (symptoms):

     

    Charaka Samhita Chikitsa Sthana 15/ 62

    पृथक वातादि निर्दिष्ट हेतु लिंग समागमे।……त्रिदोष निर्दिशे ||

    Ashtanga Hridya Nidana Sthana. 8

    सर्वाजे सर्व संकर: । 

     

    If a person adopts etiological factors, which are capable of aggravating all three Doshas simultaneously leading to suppression of Agni and manifest signs & symptoms of all the Dosas is known as Sannipataja Grahani Roga. It shows mixed symptoms of Vataja, Pittaja, and Kaphaja Grahani.

     

    Chikitsa (treatment of Sannipatika Grahani)

     

    Therapeutic intervention for Sannipatika Grahani are as follows:

     

    त्रिदोषेविधिविद्द्य: पंञ्च कर्माणि कारयेत्‌।। 

    घृतक्षारासवारिष्टान्‌ दद्याच्चाग्निविवर्धनान्‌। 

    क्रिया या  चानिलादीनांनिर्दिष्टाग्रहणींप्रति।। 

    व्यत्यासात्तांसमस्तां वा कुर्याद्योषविशेषधित्‌।

     

    • Grahani Roga (sprue syndrome) caused by the simultaneous vitiation of all three dosas (tridosaja) should be treated by the physician with the appropriate administration of Pancha-karma (five specialized elimination therapies).
    • The patient should be given medicated ghee, alkalies, Asavas (medicated wine), and aristas (medicated wine of another type) which stimulate the power of digestion (gastric fire).
    • For the patient suffering from different types of Grahani, various therapeutic measures for the alleviation of Vata, etc., are described. These should be administered by the physician either separately or jointly after ascertaining the nature of the dosa involved in the causation of this ailment.

     

    Sangrehani Grahani and Ghati Yantra Grahani

     

    Co- relation of Sangrehani Grahani and Ghati Yantra Grahani: Sangrehani Grahani is co- related with accrual irritable bowel syndrome and Ghati Yantra Grahani is co- related with tympanites predominant IBS

     

    अन्त्रकूजनमालस्यं दौर्बल्यं सदन तथा। 

    द्रव शीत घन स्निग्ध॑ सकटीवेदनं शकृत।। 

    आमं बहु सपैच्छिल्यिं सशब्द॑ मन्दवेदनम्‌। 

    पक्षान्मासाद शाहाद्वा नित्य वा अप्यथ मुच्चति।।

    दिवा प्रकोपो भवति रात्रौ शान्तिं ब्रजेच्च या। 

    दुर्विज्ञया दुश्चिकित्स्य चिरकालानुबन्धिनी।। 

    सा भवेदामवातेन संग्रहग्रहणी मता। 

     

    Nidana (Etiological factors), Samprapti (Pathophysiology), Lakshana (symptoms):

     

    Sangrahagrahani is caused by Ama and Vata and its manifest signs and symptoms are as follows- Intestinal gurgling, lassitude, debility, general malaise, passes stool, which is liquid, cold, solid, unctuous, associated with pain in the low back, patient voids stool with excessive Ama, sliminess, sound associated with mild pain. This disease repeats once in 15 days, 30 days, 10 days, or once a day. The disease aggravates during the daytime and pacifies at nighttime.Sangrahni is very difficult to diagnose & its management is also very difficult. The patient suffers from this entity for a longer period.

     

    Ghati Yantra Grahani

     

    Madhava Nidana. 4

    स्वपतः पार्श्वो  शूलं गलज्जलघटीध्वनि: 

    तं  वदन्ति घटीयन्त्रमसाध्यं ग्रहणीगदम।।

     

    Ghatiyantra grahani is characterized by excessive sleeping, pain in the sides of the chest, and produces a sound like that of water pouring out of the pot while defecating and it is incurable.

     

    Sadhya- Asadhyta of Grahani (prognosis of Grahani)

     

    Madhava Nidana. 4/ 18- 20

    दोष॑ सामं निराम॑ विद्यादन्नातिसारवत्।। 

    लिङ्गेरसाध्यो ग्रहणीविकारो यैस्तैरतीसारगदो सिध्येत। 

    वृद्धस्य नून॑ ग्रहणीविकारो हत्वा तनुं नैव निवर्तते च।।

    बालके ग्रहणी साध्या यूनि कृच्छा समीरिता। 

    बृद्धे त्वसाध्या विज्ञेया मत धन्वन्तरेरिदम ।।

     

    The digested and undigested state of this disease is to be known as Atisara, Prognosis is like that of Atisara. If an old person is affected by Grahani roga, it will not leave him even after death. Grahani Roga in children is curable, it is difficult for management in the young and it is incurable in the old, according to Dhanvantari.

     

    Updrava (Complication) of Grahani 

     

    • Kasa (cough)
    • Kusth (skin disorder)
    • Shotha (edema)
    • Aruchi (anorexia)
    • Jwara (fever)
    • Arsha (piles)
    • Parkartika (fissures)
    • Bhagandara (fistula)
    • Avipaka (indigestion)
    • Pandu (anemia)

    Management of IBS - As Per Modern Medical System:

    • Reassurance is given to the patient after a confirmed diagnosis of IBS. If the system resolves that well but if the system persists then treatment is done on the basis of type of IBS.
    • If the patient is suffering from IBS- D, the patient is advised to avoid legumes, and excessive dairy fibers and advised to take a low-FODMAP diet or gluten-free diet. If symptoms are not resolved then Antidiarrheal drugs like loperamide (2-8 grams daily), Codeine phosphate (30- 90mg daily), and Cholestyramine (1 sachet daily) is advised. If symptoms persist then Amitriptyline or imipramine (10- 25mg) at night and rifaximin 600 mg daily for 2 weeks are advised. If the symptom persists, then Duloxetine 30- 60 mg at night along with relaxation therapy and hypnotherapy are advised.
    • If the patient is suffering from IBS- C, the patient is put on a high roughage diet. If symptoms do not subside, then Isabgol (psyllium) or lactulose is given. If symptoms persist, then Prucalopride or linaclotide is given. If the symptom persists, then Duloxetine 30- 60 mg at night along with relaxation therapy and hypnotherapy are advised.
    • If the patient is suffering from pain and bloating, then a low-FODMAP diet along with a gluten-free diet is given to the patient. Patients are advised to exclude wheat and dairy products. If symptoms persist then Mebeverine, peppermint oil, hyoscine, probiotics, Rifaximin 600 mg daily for 2 weeks and Amitriptyline or imipramine 10- 25 mg at night are advised. If the symptom persists, then Duloxetine 30- 60 mg at night along with relaxation therapy and hypnotherapy are advised.

    Herbs Used for Grahani (IBS) and their Classical Indication and Method of Using for Grahani (IBS):

    Herbs that can be used for Grahani are as follows:

     

    • Ankota
    • Ativisha
    • Yuthika
    • Yavani
    • Udumbara
    • Trivrita
    • Trikatu
    • Palasha
    • Trayamana
    • Sarja Rasa 
    • Sunthi
    • Panchkola
    • Masura
    • Murva
    • Madhuka
    • Kiratatikta
    • Kharjura
    • Kadali
    • Ikshu
    • Haritaki
    • Durlabha
    • Draksha
    • Dasamula
    • Chitraka
    • Changeri
    • Chandana
    • Brihati
    • Bilva 
    • Bhanga
    • Arjuna

    Classical indication and method of using different herbs for Grahani

     

    Ankota (Alangium salvifolium):

     

    • The powder is prepared with root bark of Ankota 3 parts and Ativisha 1 part. It is taken with rice water. It alleviated all abdominal disorders. (Vanga Sena. 167)

     

    Ativisha (Aconitum heterophyllum):

     

    • Ativisa Avaleha containing ativisa along with bilva, mocarasa, lodhra, dhataki-puspa, and mango-seed, checks for severe diarrhea. (B. P. Ci. 2/ 148)
    • Liquid gruel processed with ativisa, sours, and sunthi is efficacious is Amaatisara. (C. S. Su. 2/ 22)
    • In grahani-roga, a decoction of ativisa, sunthi, and musta is given to digest ama. (C. S. Chi. 15/ 98)
    • Ankota 3 parts and ativisa 1 part mixed is taken with water. It checks all abdominal disorders. (BS. grahani. 167)

     

    Yuthika (Jasminum auriculatum): 

     

    • Yuthika is one of the ingredients in Kiratadya Churna. (C. S. Chi. 15/ 135)

     

    Yavani (Trachyspermum ammi): 

     

    • Takra Arishta (C. S. Chi. 15/ 121)

     

    Udumbara (Ficus glomerata): 

     

    • The patient of Grahani should eat tender fruits of Udumbara steamed and then mixed with curd. (Siddha Bhaishjya Mannimala. 4/ 180)

     

    Trivrita (Operculina turpethum): 

     

    • Trivrit, Pippali, Haritaki 2, 4, 5 parts respectively mixed with equal quantities of Jaggery should be made into pills. It relieves constipation and the disorder caused thereby like IBS- C. (Vrinda Madhava. 28/ 6)
    • Trivrit root is considered as the best purgative. (C. S. Ka. 7/ 3)

     

    Trikatu (Sauth, Marich, Pippali/ Vyosh):

     

    • Triushna Ghrita (C. S. Chi. 15/ 87)
    • Hingvastak Churna. (A. H. Chi. 14/ 35)

     

    Palasha (Butea monosperma): 

     

    • Decoction of Palasha fruit (seeds) mixed with milk should be given followed by the intake of warm milk according to strength. This impurity is eliminated and diarrhea is checked. Therefore, it can be used in IBS- D. (C. S. Chi. 19/ 59- 6, a. h. Chi. 9/ 68)

     

    Trayamana (Gentiana Kurroo): 

     

    • Trayamana like Palasha should be used in diarrhea to expel impurity. (C. S. Chi. 19/ 60, A. H. Chi. 9/ 69)

     

    Sarja Rasa (Oleo- resin of Vateria indica): 

     

    • Sarja Rasa mixed with less quantity of jaggery should be taken. (Bhava Parkasha Chikitsa. 4/ 58)

     

    Shunthi (Zingiber officinalis): dry ginger

     

    Specific indication for Grahani: 

     

    • Nagaradya Churna. (C. S. Chi. 15. 129- 31)
    • Decoction or paste of Sunthi, ativisa, and musta digests ama, similarly acts haritaki or Sunthi with hot water. (C. S. Chi. 15. 98, A. H. Chi. 10. 8, V. M. 4. 12)
    • Sunthi-ghrta I, II (V. M. 4.  36-37)
    • Sunthi taken with buttermilk checks diarrhea, promotes digestive power and alleviates grahani, piles, Udara, edema, and poisoning. (Gada Nigreha. 2. 3. 66)
    • The paste of Sunthi and bilva taken with lentil soup alleviates grahani- roga. Similarly, acts that of brihati with buttermilk. (Sarangdhara Samhita. 2. 5. 28)

     

    Shunthi indications that are helpful in IBS- D

     

    • One should take water processed with Vacha and ativisa, musta and parpata, and hribera and sunthi for improving appetite and digestion. (C. S. Ci. 19. 22)
    • In Atisara (diarrhea) caused by Kapha and associated with ama (toxins), the paste of Zinziber officinalis (Sunthi) alone should be taken with water. (Kalyana Karaka. 9. 94)
    • One who defecates frequently with or without a stool or with tenesmus should take sunthi with Jaggery mixed with curd, oil, ghee, and milk. (A. H. Ci. 9. 17)
    • Powder of Sunthi smeared with ghee is wrapped within eranda leaves and cooked in putapaka (closed heating) on a mild fire. The Churna (powder) is then taken out and mixed with an Sama Matra Sharkara (equal quantity of sugar). It is taken in the morning and thus pacifies all sorts of pain due to amatisara. (Sharangdhara Samhita. 2. 1. 38- 39)
    • Fried and unfried sunthi mixed and pounded with eranda juice alleviates pain due to amatisara and stimulates digestion and appetite. (B. P. Ci. 2. 22)
    • Sunthi uses for symptoms associated with IBS like Loss of appetite and indigestion
    • Yavaksara and powdered sunthi taken together with ghee in the morning promotes appetite. Same effect is produced by Sunthi alone taken with Skoshan Jala (warm water). (Chakra Dutta. 6. 3)
    • In the case of ama, indigestion, piles, and constipation one should regularly use sunthi or pippali or haritaki or dadima mixed with jaggery. (V. M. 6. 13)
    • If a person otherwise strongly feels some doubt of indigestion at the time of the meal, he should take haritaki mixed with Sunthi before taking food. (V. M. 6. 24)
    • Sunthi along with haritaki, Sharkara (jaggery) or Lavana (salt) are wholesome in case of loss of appetite. (B. P. Ci. 6. 34)
    • Decoction of Sunthi boiled in water 1/2 adhaka (1.28 liters) remaining to one half stimulates digestive fire quickly and there is no need for other drugs for this purpose, (Vaidya Masnorma. 6/ 35)
    • Decoction of Sunthi 40 ml. mixed with honey alleviates anorexia, loss of appetite, respiratory and abdominal disorders, and all defects of water and promotes health and luster. (B. P. Chi. 1/ 831)

     

    Panchkola (Pippali, Pippali Mula, Chavya, Chitraka , Sunthi): 

     

    • The patient should take a proper dosage of ghee mixed with five stimulating drugs. By this Samana Vayu gets pacified and seated in the channel. (C. S. Chi. 15/ 203)
    • In Grahani Roga, soup of Panchkola and radish mixed with Maricha is prescribed in the diet.

     

    Masura (Lens culinaris):

     

    • Masura- Ghrita I, II (V. M. 4/ 21- 22)
    • Paste of Shunthi and Bilva fruit taken with Masura Soup alleviates the disorder of Grahani. Similarly acts like that of Brihati with buttermilk. (Sharangdhara Samhita. 2. 5. 28)

     

    Murva (Marsdenia tenacissima): 

     

    • Murva is one of the components of Ksara that strengthens Grahani. (C. S. Chi. 15/ 179)

     

    Maricha (Piper nigrum):

     

    • Marichadya Ghrita. (C. S. Chi. 15/ 108- 110)
    • Intake of fine powder of Pippali or Maricha checks even chronic dysentery. (A. H. Chi. 9/ 40)
    • One who takes the power of Maricha mixed with Chitraka and Sauvarchala with buttermilk becomes free from Grahani Roga besides Udara, splenomegaly, deficient digestion, gulma, and piles. (Sharangdhara Samhita. 2. 6. 53)

     

    Madhuka (Madhuca indica):

     

    • Madhuka Asava I, II. (C. S. Chi. 15/ 146- 150)

     

    KirataTikta (Swertia Chirata):

     

    • Kiratadya Churna (C. S. Chi. 15/ 137- 140)
    • Bhunimbadi Churna (C. S. Chi. 15/ 132- 133)

     

    Kharjura (Phoenix dactylifera):

     

    • The fermented juice of Draksha, sugarcane, and Kharjura should be used. (C. S. Chi. 15/ 15)

     

    Ikshu (Saccharum officinarum): 

     

    • One should take fermented juice of Draksha, Kharjura, and Ikshu. (C. S. Chi. 15/ 151)

     

    Kadali (Musa paradisiaca): 

     

    • The unripe fruit of Kadali is steamed a little and made into bread. It is taken with curd devoid of the fatty layer to overcome Grahani Roga.

     

    Haritaki (Terminalia chebula): 

     

    • The bark of the Haritaki tree taken with buttermilk alleviates Grahani Roga associated with Ama and blood. (Vanga Sena. Grehani. 168)

     

    Dhan Vyasa (Fagonia cretica):

     

    • Durlabha Asava. (C. S. Chi. 15/ 152- 155)

     

    Draksha (Vitis vinifera):

     

    • Likewise, the fermented juice of Draksha, ikshu, and Kharjura should be taken. (C. S. Chi. 15/ 151)

     

    Dashmula (group of 10 drugs):

     

    • Dashmuladya Ghrita. (C. S. Chi. 15/ 82- 86)

     

    Chandana (Santalum album):

     

    • Chandanadya Ghrita. (C. S. Chi. 125- 128)

     

    Changeri (Oxalis corniculata):

     

    • Ghrita cooked with the paste of Pippalyadi group, Changeri juice, and four times curd is useful. (S. S. U. 40/ 181)

     

    Chitraka (Plumbago zeylanica):

     

    • Chitrakadi Gutika (C. S. Chi. 15/ 96, 97)
    • Chitraka Ghrita (Chakra Dutta. 4/ 43)

     

    Brihati (Solanum indicum):

     

    • Brihati with buttermilk overcomes Grehani disorder. (Sharangdhara Samhita. 2. 5. 28)

     

    Bhanga (Cannabis sativa):

     

    • Bhanga and jatiphal in equal parts mixed with Indrayava in double quantity are made into linctus. It checks all types of diarrhea. It is beneficial in IBS- D.  
    • Bhanga mixed with latex of Udumbara is made into pills and used to treat diarrhea. (Siddha Bhaishjya Mannimala. 4/ 166)
    • Arka distilled from Bhanga and Yavani promotes digestive fire. (Siddha Bhaishjya Manni Mala. 4/ 264)

     

    Bilva (Aegle marmelos)

     

    • One gets rid of abdominal disorder (diarrhea) after taking pippali with honey or buttermilk with citraka or tender fruits of bilva. (C. S. Ci. 19. 113)
    • In case of diarrhea with blood, tender fruits of bilva mixed with liquid jaggery, honey and oil should be taken. It checks the disease immediately. (S. S. U. 40. 119)
    • The dietary preparation (khada) made of tender bilva fruits, an equal quantity of sesamum paste, a supernatant layer of curd, and added with sour and ghee checks dysentery. (C. S. Ci. 19/ 34)
    • Fruit-pulp of bilva and madhuka mixed with sugar and honey and taken with rice-water checks diarrhea caused by pitta and rakta. (S. S. U. 40. 127)
    • Badara fruits are steamed with bilva fruits and when cooled are taken with jaggery and oil to check for diarrhea. (S. S. U. 40. 133)
    • Intake of bilva with jaggery checks diarrhea with blood, removes pain due to ama and constipation and alleviates disorders of bowels: (V. M. 3. 40, Vaidya Jeevana. .2. 15, BP. 2. 57)
    • Tender fruits of bilva, jaggery, oil, pippali, and sunthi- all these together should be taken in the condition of obstructed Vata, pain, and tenesmus. (VM. 3. 66)
    • Decoction of bilva and Amra (seed) mixed with honey and sugar checks vomiting and diarrhea. (VM.3.30)
    • Paste of the tender fruit of bilva mixed with sunthi powder and jaggery alleviates severe grahani roga if the patient is kept on a diet of buttermilk. (V. M. 4. 10)
    • One should take steamed tender fruits of bilva with honey followed by intake of buttermilk added with citraka (powder). (Vanga Sena. grahani. 169)

     

    Arjuna (Terminalia arjuna):

     

    • The alkali of Kesaraja and arjuna taken with curd water in the morning alleviates grahani disorder associated with ama. (Vanga Sena. Grahani. 189)

    Few Classical Formulations with Ingredients for Grahani

    Bhaishjya Ratnavalli, 3- 26- 27

    Citrakaadi Gutika

    Ingredients: Citraka, the root of pippali, both types of ksara (alkalis), five varieties of lavana (salts), vyosa, hingu, ajamoda, cavya, and juice of Matulunga or dadima.

    Dose and Anupana: 125 mg, along with lukewarm water.

     

    Bhaishjya Ratnavalli, 8/ 118- 124

    Ingredients: Talispattra, cavya, Marica, dried ginger, pippali mula, pippali, nagakesara, smaller cardamom, cinnamon, cassia, along with the old raw sugar.

    Dose and Anupana: 125 mg. with liquor, yusha, or milk

     

    Salaparnyadi Kvatha

    Bhaishjya Ratnavalli, 8/ 8

    Ingredients: Salaparni, roots of bald the fruit pulp of bilva, coriander and dried ginger.

    Dose and Anupana: 50 ml. with water

     

    Punarnavadi Kasaya 

    Bhaishjya Ratnavalli, 8/ 9

    Ingredients: Roots of punarnava, black pepper, the roots of Sarapunkha, the dried ginger root of citraka, Harada, the bark of Karanja and dried bilva fruit.

    Dose and Anupana: Take this decoction in doses of 50 ml

     

    Yamanikadi Kvatha

    Bhaishjya Ratnavalli, 8/ 10

    Ingredients: Caraway (vamant), dried ginger, coriander, ativisa, mustaka, the root of Bala, dried pulp of the bilva fruit, salaparni, and prishniparni.

    Dose and Anupana: 50 ml. with water.

     

    Caturbhadra Kvatha 

    Bhaishjya Ratnavalli, 8/ 12

    Ingredients: Guduci, ativisa, sunthi, and musta.

    Dose and Anupana: 50 ml. with water.

     

    Tiktadi Kasaya

    Bhaishjya Ratnavalli, 8/ 13

    Ingredients: Pathya, rasanjana, Sunthi, katuki, indrayava, musta, kutaja and purified ativisa.

    Dose and Anupana: 50 ml. with water.

     

    Rasnadi Curnam 

    Bhaishjya Ratnavalli, 8/ 17- 18

    Ingredients: Rasna, Harada, karcura, dried ginger, Marica, pippali, svarjiksara, yavakshara, all five types of salt, pippali mula, pieces of jambira lemon, and juice of jambira lemon.

    Dose and Anupana: 2 gm. to 5 gm. along with warm water.

     

    Dasamula Guda

    Bhaishjya Ratnavalli, 8/ 136- 143

    Ingredients: Dasamula herbs, raw sugar, juice of ginger, pippali, pippali mula, Marica, dried ginger, asafoetida fried in ghritam, purified bhallataka, vayavidanga, ajamoda, svarjiksara, yavakshara, the root of citraka, cavya and all of the five types of salts.

    Dose and Anupana: 9 gm. along with cold water during morning hours.

     

    Nagaradya Churna

    Bhaishjya Ratnavalli, 8/ 29- 31

    Ingredients: Nagara, ativisa, musta, dhataki, rasanjana, bark and fruit of vatsaka, bilva, pathã, katuka Rohini.

    Dose and Anupana: 2 gm. along with honey and tandulambu (rice-washing).

     

    Pathadya Churna

    Bhaishjya Ratnavalli, 8/ 33- 4

    Ingredients: Patha, bilva, anala, vosa, jambu, dadima, dhataki, katuka, ativisa, musta, darvi, bhunimba, vatsaka and powder of kutaja bark.

    Dose and Anupana: 2 gm. to 4 gm. along with the rice-washing (tandulodaka) and honey.

     

    Sunthyadi Kvatha 

    Bhaishjya Ratnavalli, 8/ 6

    Ingredients: Dried ginger (sunthi), mustaka, ativisha, and guduci.

    Dose and Anupana: 50 ml. with water

     

    Mundyadi Gutika

    Bhaishjya Ratnavalli, 8/ 127- 130

    Ingredients: Mundi, Shatavari, musta, vanari, dugdhika, guduci, yasti, rock salt, ghrta-fried vijayã, cow milk, and honey.

    Dose and Anupana: 12 gm. along with honey.

     

    Dhanykadi Kvatha

    Bhaishjya Ratnavalli, 8/ 7

    Ingredients: Coriander (dhanyaha), ativisa, netrubala, caraway, mustaka, Bala, dried ginger, salaparni, prishniparni, and dried fruit pulp of bilva.

    Dose and Anupana: 50 ml. with water

    Talisadi Gutika and Churna (BR. 8/118-124)

     

    Vartaku Gutika 

    Bhaishjya Ratnavalli, 8/ 125- 126

    Ingredients: Stem of snuhi, salt (rock salt, suvarchala, and Vida varieties), vartaku (aubergine), arka, citraka, and juice of vartaku fruits or leaves.

    Dose and Anupana: 125 mg. taken after meals.

     

    Kankatavaleha 

    Bhaishjya Ratnavalli, 8/ 131- 135

    Ingredients: Kancata, talamuli, water, sugar, powder of manjistha or varahakranta, flowers of dhataki, patha, seed- pulp of bilva fruit, musta, pepper, indrayava, ativisa, yavaksara, sauvcarala salt, rasanjana, mocarasa, and honey.

    Dose and Anupana: 5 gm, to 12 gm. with water

    Rasa Aushadhi (Metallic Preparation) Used in Grahani

    • Rasa Parpati
    • Swarna Parpati
    • Loha Parpati
    • Grahani Kapat Rasa
    • Vijaya Parpati
    • Panchamrit Parpati

    Yoga Therapy

    Different Yoga modules that can be used as remedial therapy to better manage the symptoms of IBS are as follows:

     

    • Regulation of Manipura Chakra
    • Bhastrika Pranayama
    • Pavana Mukta Asana
    •  Uddiyana Bandha
    • Yoga module that particular focus on the abdominal region and helps to relieve IBS
    •  Balancing of Pancha Kosha by Yoga therapy
    • Apana Mudra
    • Apana Vayu Mudra
    • Tadagi Mudra
    • Pashinee Mudra

     

    For more information regarding Yoga therapy for IBS, click here.

    Pathya and Apathya (Do’s and Don’ts)

    • Eat roughage (fibers)
    • Gluten-free diet
    • Follow a low FODMAP diet
    • Elimination diet

     

    For more information about Pathya (Do’s) and Apathya (Don’ts) regarding IBS, click here.

    Recent Research on IBS and Grahani

    • Sorathiya AP, Vyas SN, Bhat PS. A clinical study on the role of ama with Grahani Roga and its management by Kalingadi Ghanavati and Tryushnadi Ghrita. Ayu. 2010 Oct; 31(4): 451- 5. doi: 10. 4103/ 0974- 8520. 82041. PMID: 22048538; PMCID: PMC3202250.
    • Patel RV, Kori VK, Patel KS. A clinical study of Devadarvyadi-Vati on Grahani Dosha in children. Ayu. 2011 Apr; 32 (2): 187- 91. doi: 10. 4103/ 0974- 8520. 92568. PMID: 22408300; PMCID: PMC 3296338.
    • Wange M; From the proceedings of Insight Ayurveda 2013, Coimbatore. 24th and 25th May 2013. PA03. 22. Importance of Agni Chikitsa in the management of Grahani Disease w.s.r to Lavanabhaskara Churna. Anc Sci Life. 2013 Jan; 32(Suppl 2): S91. doi: 10. 4103/ 0257- 7941.123920. PMCID: PMC 4147567.
    • Mukta, Rao MV, Arora J. Efficacy of Samsarjanakrama in a patient with Agnimandya due to vyadhi Sankar: A case study. J Ayurveda Integr Med. 2021 Jan-Mar; 12 (1): 182- 186. doi: 10. 1016/ j. jaim. 2021. 01. 004. Epub 2021 Feb 27. PMID: 33648827; PMCID: PMC 8039330.
    • Tiwari R, Pandya DH, Baghel MS. Clinical evaluation of Bilvadileha in the management of irritable bowel syndrome. Ayu. 2013 Oct; 34 (4): 368- 72. doi: 10. 4103/ 0974- 8520.127717. PMID: 24696573; PMCID: PMC 3968698.
    • Shirolkar SG, Tripathi RK, Rege NN. Evaluation of prakṛti and quality-of-life in patients with irritable bowel syndrome. Anc Sci Life. 2015 Apr-Jun; 34 (4): 210- 5. doi: 10. 4103/ 0257- 7941.160865. PMID: 26283806; PMCID: PMC 4535069.
    • Jeitler M, Wottke T, Schumann D, Puerto Valencia LM, Michalsen A, Steckhan N, Mittwede M, Stapelfeldt E, Koppold-Liebscher D, Cramer H, Wischnewsky M, Murthy V, Kessler CS. Ayurvedic vs. Conventional Nutritional Therapy Including Low-FODMAP Diet for Patients with Irritable Bowel Syndrome- A Randomized Controlled Trial. Front Med (Lausanne). 2021 Sep 6; 8: 622029. doi: 10. 3389/ fmed. 2021. 622029. PMID: 34552937; PMCID: PMC8450363.
    • Rahimi R, Abdollahi M. Herbal medicines for the management of irritable bowel syndrome: a comprehensive review. World J Gastroenterol. 2012 Feb 21; 18 (7): 589- 600. doi: 10. 3748/ wjg. v18. i7. 589. PMID: 22363129; PMCID: PMC 3281215.
    • Chakraborty, Swagata & Das, Aparajita. (2021). MANAGEMENT OF GRAHANI ROGA IN AYURVEDA: A CASE STUDY. World Journal of Pharmaceutical Research. 9. 953. 10. 20959/ wjpr 202015- 19220.
    • Dwivedi, Deepika & Mishra, Pramod & Srivastava, Anupam & Pandey, Ajai. (2017). EFFECT OF SHADDHARAN CHURNA IN IRRITABLE BOWEL SYNDROME (IBS): A CASE STUDY. World Journal of Pharmaceutical Research. 6. 645- 653. 10. 20959/ wjpr 201712- 9606.
    • Pulikkottil, Anil Joy. (2010). Ayurvedic Treatment for IBS (irritable bowel syndrome).
    • Tiwari, Ramanand & Pandya, Darshna & Baghel, Madhav. (2013). Clinical evaluation of Bilvadileha in the management of irritable bowel syndrome. Ayu. 34. 368- 72. 10. 4103/ 0974- 8520.127717.
    • Singh, Renu & Panda, Punendu & Bhurke, Laxman & Singh, Harbans & Sharma, Surendra & Kumari, Krishna & Sharma, Omraj & Rao, Meda & Tomar, Rinku & Chaudhary, Shweta & Khanduri, Shruti & Bhuyan, G.C. & Yadav, Babita & Dua, Pradeep & Rana, Rakesh & Singhal, Richa & Kumar, Adarsh. (2017). Clinical Safety of Selected Ayurvedic Formulations in Management of Irritable Bowel Syndrome. Journal of Research in Ayurvedic Sciences. 1. 136- 141. 10. 5005/ jp- journals-10064- 0015.
    • Rawat, Sunita & Singh, Ranweer & Sahu, Preeti & Padhar, Bharat & Mutha, Rashmi & Meena, HML. (2022). A Conceptual Study of Grahani Roga (irritable bowel syndrome) and its Management Through Dietary Modification. International Research Journal of Ayurveda & Yoga. 05. 99- 104. 10. 47223/ IRJAY. 2022. 5217.
    • Nirmal, Hanumant & Meena, Ram & Kumar, Jitender & Dharmarajan, Prasanth & Bhatted, Santoshkumar. (2019). International Journal of Ayurveda and Pharma Research Case Study MANAGEMENT OF IRRITABLE BOWEL SYNDROME THROUGH AYURVEDA: A CASE STUDY.
    • Pulikkottil, Anil Joy & Pulikkottil, Anil. (2012). AYURVEDIC TREATMENT FOR IBS (irritable bowel syndrome).
    • Chang FY. Irritable bowel syndrome: the evolution of multi-dimensional looking and multidisciplinary treatments. World J Gastroenterol. 2014 Mar 14; 20 (10): 2499- 514. doi: 10. 3748/ wjg. v20. i10. 2499. PMID: 24627587; PMCID: PMC 3949260.
    • Bahrami HR, Hamedi S, Salari R, Noras M. Herbal Medicines for the Management of Irritable Bowel Syndrome: A Systematic Review. Electron Physician. 2016 Aug 25; 8 (8): 2719- 2725. doi: 10. 19082/ 2719. PMID: 27757180; PMCID: PMC 5053451.
    • Jun H, Ko SJ, Kim K, Kim J, Park JW. An Overview of Systematic Reviews of Herbal Medicine for Irritable Bowel Syndrome. Front Pharmacol. 2022 May 18; 13: 894122. doi: 10. 3389/ fphar. 2022. 894122. PMID: 35662700; PMCID: PMC 9158123.
    • Peckham EJ, Cooper K, Roberts ER, Agrawal A, Brabyn S, Tew G. Homeopathy for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2019 Sep 4; 9 (9): CD009710. doi: 10. 1002/ 14651858. CD009710. pub3. PMID: 31483486; PMCID: PMC 6724562.

    References

    • Tripathi Brahmanand and Pandey G.S, Charaka Samhita of Agnivesa with Charaka Chandrika Hindi Commentory, 6th Ed.,Varanasi:  Chaukhamba  SurbharatiPrakashan., (Vol-1), 1999.
    • Tripathi Brahmanand and Pandey G.S, Charaka Samhita of Agnivesa with Charaka Chandrika Hindi Commentory, 6th Ed., Varanasi:  Chaukhamba  SurbharatiPrakashan., (Vol-II), 1999.
    • Shastri K.  Ambikadatta, Sushruta Samhita of Maharsi Sushrut edited with Ayurveda Tattva Sandipika Hindi   Commentary, 13th Ed., Varanasi:  Chaukhamba Sanskrit Bhawan.,(Vol-1), 2000.
    • Shastri K.  Ambikadatta, Sushruta Samhita of Maharsi Sushrut edited with Ayurveda Tattva Sandipika Hindi   Commentary, 13th Ed., Varanasi:  Chaukhamba Sanskrit  Bhawan.,(Vol-II), 2000.
    • Vagbhatta Astanga Hridaya, Nidana sthana, edited by Y. Upadhaya, Chaukambha Prakashan, Varanasi, 2012.
    • Textbook of pathology by Harsh Mohan: seventh edition.
    • Brahmanant Tripati, Madhava Nidana Chukambha surabharati prakashan,Edition, 2012.
    • Shri Shashtri. S, Madava Nidanam of Madavakara  with  Madhukosha  Sanskrit Commentary, Chaukhamba Sanskrit Sansthan,Varanasi:, 2003
    • Dr. P. S. Byadgi, Dr. A. K. Pandey. A textbook of Kaya Chikitsa, reprint 2017, Chaukambha publication, Vol. II.
    • Dr. Nisha Kumari, A textbook for Roga Nidana and Vikruthi Vigyana, First edition 2017, Chaukambha Orientalia, Vol. II.
    • Dr. P. S. Byadgi, Ayurvediya Vikriti Vijana, and Roga Vijanana, reprint 2016, Chaukambha publication, Vol. II.
    • Sandhya A Kamath, S. N. S., Milland Y Nadkar, Edition 11, Vol. II, Published by the Association of physicians of India.
    • Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014 Jun 14; 20 (22): 6759- 73. doi: 10. 3748/ wjg. v20. i22. 6759. PMID: 24944467; PMCID: PMC 4051916.

    Article Written By: Dr. Sahil Gupta (B.A.M.S., M.H.A.)

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