A 46 years old male was suffering from inadequate bowel evacuation for many years. He was passing mucus mixed stool almost 10 times a day for the last 18 years. He also suffered from less appetite, fatty liver, raised PSA, SGOT & SGPT levels and frequent urination. Renowned gastroenterologists performed different investigations to diagnose his disease and he was diagnosed as having IBS. Allopathic medicines gave symptomatic relief that too only for a very short period of time after which all the symptoms recurred.After thorough examination he was diagnosed with having Grahani Roga (Pitta type) and he was administered Panchakarma treatment and internal Ayurveda herbal health supplements.Incidence Irritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder with worldwide prevalence rates ranging from 9–23%. The age distribution is very broad, but 40% of the patients are aged between 35 and 50 years. Symptoms begin before the age of 35 in 50% of patients. Only between 30-70% of “patients” suffering from IBS symptoms are “consulters” with symptoms experienced severe enough to trigger a physician visit. Significant proportions – 35% to 40% – of individuals who report IBS in the community are male. Approximately 60% to 65% of individuals who report IBS in the community are female. Grahani roga – IBS: A Clinical CorrelationThe pathogenesis of IBS will be confirmed by observing the etiological factors, symptoms, Upashaya (Relieving factors) & complications of the IBS.Etiological factorsPertaining to Ahara • Unwholesome food (Heavy, Coarse food)• Irregular eatingPertaining to Vihara• Suppression of natural urges• Desha-Kala Vaishamya (Environmental and Seasonal variations)• Mental Stress (in 70 to 90% of Patients)• Both anxiety & depression can impact on the perception of symptoms.It has rightly been said by Vagbhata that all the ailments of the body, especially diseases of alimentary tract arise due to the malfunction of Agni. IBS is also one such disease which occurs due to the ingestion of unwholesome diet causing disturbances in Agni. Psychological factors like Kama (Lust), Krodha (Anger), Shoka (Grief) etc. leads to Agni dusti (improper function of digestive fire, collectively it is called Grahani Dosha). A careful review of the clinical picture of various GIT diseases, described in Ayurveda reveals that some of the disorders definitely have some clinical symptoms which are also observed in the patients of IBS e.g. Vataja & Kaphaja Atisara, Sangraha Grahani, Pravahika, Pakvashaya gata Vata. But if we take a look into the pathogenesis of all these diseases, there is a stage of Grahani Dosha. So we may consider IBS as Grahani Dosha. Life is the complex union of Sattva, Atma, and Sharira. Thus, mind, body and soul influence each other. Charaka has greatly emphasized the need for a healthy mind for the maintenance of good physical health. Descriptions like Acharaya Rasayana and Sadvritta are available in the literature to illustrate the psychosomatic approach for prevention and treatment of a disease. Irritable Bowel Syndrome (IBS) is one of the most common conditions encountered in clinical practice but one of the least well understood. Irritable bowel syndrome is common with a wide variety of presentations having gastrointestinal motility disorder that place a substantial burden on patients and society. Symptoms of this disorder are chronic, sometimes severe, and often respond poorly to treatment with traditional approaches, resulting in reduced quality of life. Because structural, physical, or biochemical markers cannot be used to identify either disorder, diagnosis is symptom-based. In the absence of alarming features suggestive of organic disease or secondary causes of symptoms, these disorders can be positively and confidently diagnosed. Until, recently, many physicians did not consider IBS to be a disease at all; they viewed it as nothing more than a somatic manifestation of psychological stress. Stress shows no discrimination on the basis of either age, sex or occupation it strikes everyone and unfortunately more & more young people buckle down under it. IBS according to Ayurveda can be considered as a disorder where there is a derangement of Vata in Pakvashaya (intestine) especially of Apana Vayu leading to Symptoms of pain in abdomen & altered bowel habits. Mandagni (Decreased Digestive fire) leads to Vitiation of Doshas. The emotions like Krodha (anger), Shoka (grief), Bhaya (fear) etc. cause vitiation of Vata. Thus, disturbance in mental health directly affects the gastrointestinal tract.Many formulations are explained in classical texts having its efficacy on gastrointestinal disorder. The line of treatment of Grahani mentioned in Ayurveda texts is same as Atisara (Diarrhea) and Ajirna (Indigestion), that is the use of Grahi (Bowel binding), Dipana (Appetizing)) and Pachana (Digestive) herbs and foods. Also Piccha basti is explained as one of the treatment methods in Atisara. Piccha basti cures excess bowel movements and duodenal disorders. Medhya rasayana group of drugs described in ancient literature is the molecular nutrients for the brain, and is claimed to relieve mental fatigue, anxiety, and stress at psychological and neuroendocrine levels. Since IBS is a psychosomatic disorder, Medhya Rasayana added to the principal therapy proves effective in all cases of IBS.There is remarkable improvement visibly in IBS cases with Ayurvedic treatments. One case study is discussed below.IBS in the WorldGrahani Roga or IBS, the commonest clinical manifestation of gastro-intestinal pathology, is emerging as a lifestyle disorder and is encountered frequently in day to day practice. Patients generally approach the Ayurvedic system for the therapy only when they get exhausted from the incomplete treatments and unwanted complications from conventional medicine, by when the disease condition almost gets intractable. Ayurvedic texts explain Grahani as a Gastrointestinal Disorder caused due to the impairment of the Jatharagni (Digestive fire). Irritable bowel syndrome (IBS) has clinical resemblance with that of Grahani, like alternate constipation and diarrhea (Muhurbaddha / Muhurdrava), mucus mixed stools (Sasleshma Mala Pravrtti), etc.
Ayurvedic Remedy for Irritable Bowel Syndrome:
Treatment schedule during Panchakarma
Vatsakadi ghan vati–1 gm daily after food (2 tablets of 250 gm each, two times daily)
Herbal compound powder consisting of Musta, Anartwak, Mocharas, Bilwa, Vidanga, Methika, Sunti, Shankha, Indrayava, Guduchi – 9 gm daily after food (4.5 gm two times daily)
Laghusutasekar vati – 1 gm daily after food (2 tablets of 250 gm each two times daily)
Picchabasti freshly prepared with Milk, Water, Pippali, Kutaja, Shatavari and Mocharas was administered daily for 8 days (under Yoga basti schedule).
Vatsakadi ghan vati helps in digestion of ama (metabolic toxins) and increases the Jatharagni (Digestive fire). It has indrayava beej (vatsaka), Maricha, Ajamoda and fried Hingu as the ingredients which have the functions of anti-diarrhoeal, pain reducing and antispasmodic properties; whereas panchakola, sunti helps in digestion of ama. Customized herbal compound powder with many ingredients like Musta, Bilwa, etc improves Agni (Digestive fire), also increases the absorption capacity of the small intestine.
Since there is derangement of Samana Vata and Apana Vata in IBS, Basti is the main treatment for the homoeostasis of Vata in the body and Piccha Basti helps similarly and also checks increased bowel movements and mucus in bowels.
Simple modifications in his diet and lifestyle were also implemented during his treatment period like restricting intake of milk, tea and coffee, bakery products, junk foods, processed foods, spicy and oily foods, yeast containing products and food added with preservatives. He was advised to take herbal tea, timely and regular meals which were freshly prepared and light to digest, to be physically active throughout the day and avoid day sleep.
Follow up Ayurveda herbal health supplements after Panchakarma for 3 months –
Vatsakadi ghan vati – 1 gm daily after food (2 tablets of 250 gm each two times daily)
Herbal compound powder consisting of Musta, Anartwak, Mocharas, Bilwa, Vidanga, Methika, Sunti, Shankha, Indrayava, Guduchi – 9 gm daily after food (4.5 gm two times daily)
Chandraprabha vati – 1 gm daily after food (2 tablets of 250 gm each two times daily)
Mansyadi ghan vati – 1 gm daily after food (2 tablets of 250 gm each two times daily)
Review after treatment
After 8 days of Panchakarma treatments and after follow up with internal medicines for 3 months, there was marked improvement in his health. His bowels were well formed and devoid of mucus. And the frequency of bowel movements reduced from 10 to only 3 a day. His SGOT, SGPT and PSA levels came to normalcy. His appetite became normal. Ojo Vriddhi Lakshana (signs of increase of Ojas. ie. the essence of life) was also noted in the form of growth of new hairs on bald scalp, after 3 months of treatment.
Understanding IBS
Ayurveda works magically even in deadly diseases of this era. Often called Spastic Colitis, Irritable Bowel Syndrome is disorder of the small and large intestines causing chronic intermittent constipation or diarrhea often associated with varying degrees of abdominal pain. This origin of this condition is not well understood in the West and is very difficult to treat. Through Ayurvedic eyes, the practitioner of Ayurveda comes to understand the nature of their patient multi dimensionally. Upon doing so, each patient with irritable bowel syndrome will present with a wide variety of imbalances on all three levels.
This condition appears to occur most prevalently in those individuals with a Vata prakruti or vikruti. The severity of the condition is somewhat proportionate to the state of Ojas. When ojas is low, the condition is more severe. As each person is unique, so too will each presentation be unique. There are however many commonalities and from these, the practitioner can come to understand the nature of the disease and develop a plan for managing it.
IBS is not a life-threatening condition; however, for those patients with more severe disease it does have a relatively large impact on quality of life, leading to need for medical treatment and work absenteeism with consequent economic costs.
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