A Conceptual Study of Grahani Roga (Irritable Bowel Syndrome) and its...

[Full title: A Conceptual Study of Grahani Roga (Irritable Bowel Syndrome) and its Management Through Dietary Modification]

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[Find the meaning and references behind the names: Singh, Bharat, Sahu, Kumar, Long, Colon, Meena, Rashmi, Preeti, Sunita]

Review Article This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 5 (2),99-104, February, 2022 ISSN: 2581-785 X; https://irjay.com/ DOI: https://doi.org/10.47223/IRJAY.2022.5217 A Conceptual Study of Grahani Roga (Irritable Bowel Syndrome) and its Management Through Dietary Modification Sunita Rawat 1 , Ranweer Singh 2 , Preeti Sahu 3 , Bharat Kumar Padhar 4 , Rashmi Mutha, 5 HML Meena 6 1-Medical officer, Government of Rajasthan 2,3- P.G Scholar, Department of Kayachikitsa, National institute of Ayurveda, Deemed to be University ( De-novo ), Jaipur 4,5- Assistant professor, Department of Kayachikitsa, National institute of Ayurveda, Deemed to be University ( Denovo ), Jaipur 6- Associate professor, Department of Kayachikitsa, National institute of Ayurveda, Deemed to be University ( De-novo ), Jaipur INTRODUCTION Irritable bowel syndrome (IBS) is a broad term that refers to a number of disorders that produce pain in the gastrointestinal tract and cause significant morbidity in the general population. IBS is also known by a variety of names, including colitis, mucous colitis, spastic colon, and spastic bowel. In the absence of any organic aetiology, it is a functional bowel illness characterized by chronic stomach pain, discomfort, bloating, and changes in bowel patterns 1 Without any other medical symptoms, IBS can start after an illness (post-infectious, IBS-PI), a stressful life event, or the onset of maturity 2 15-20% of the Indian population suffers from IBS. It strikes women more frequently than males, and it strikes around half of the Article Info Article history: Received on: 12-12-2021 Accepted on: 07-02-2022 Available online: 28-02-2022 Corresponding author- Sunita Rawat, Medical officer, Government of Rajasthan. Email-drsunitarawat 67@gmail.com ABSTRACT: Irritable bowel syndrome (IBS) is one of the most frequent yet poorly understood disorders encountered in clinical practise. The symptoms of this illness are long-term, sometimes severe, and frequently do not respond well to treatment, leading in a lower quality of life. More than 40% of new referrals to gastroenterology outpatient clinics are due to IBS. The diagnosis is made using the Rome IV criteria. The aetiology and pathophysiology of this disease are unknown. It can be managed in Ayurveda using the notion of Grahani . The basic Samprapthi is found at the Grahani and Pakwasaya levels, as a result of Agnidushti. IBS has Tridoshaja symptoms with Vata predominance. As a result, medicines that contain Deepana, Pachana, Anulomana , or Grahi qualities are ideal. Because psychological issues are involved, Satwavajaya Chikitsa (psychotherapy) is beneficial. Because it is chronic and relapsing, dietary and lifestyle changes, as well as exercises and relaxation techniques, can help with management. The current article summarises the ayurvedic position on Grahani roga and how to treat it with Ayurvedic principles and a dietary pattern. Keywords- Ayurveda, Grahani, Dietary modification

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[Find the meaning and references behind the names: Guna, Anna, Fast, Main, Guru, Mala, Rasa, Ama, Rupa]

Sunita et al . “A Conceptual Study of Grahani Roga (Irritable Bowel Syndrome) and its Management Through Dietary Modification” : 2022; 5 (2):99-104 100 population before the age of 35 3 Psychological factors like as stress, anxiety, and others have a significant influence in the development of IBS 4 Because Ayurveda is built wholly on various underlying principles, there is no single condition in Ayurveda that can be precisely linked to IBS. There is a change or irregularity in nutrition and diet times in the fast-food age, as well as a sedentary lifestyle 5 In addition to food and lifestyle modifications, emotional stress is a continuous companion. All of this wreaks havoc on the digestive system, resulting in one of many disorders, the most common of which are digestion and absorption issues 6 Ama Dosha is caused by a functionally weak Agni, i.e. Mandagni , which causes poor digestion of ingested food. The Ama Dosha is the root of almost all ailments. It plays a crucial role in the development of Grahani Roga. Grahani Dosha is a frequent problem that primarily affects those who live in unsanitary environments and are nutritionally deficient 7 The main causes of Grahani Dosha are an unhealthy lifestyle, junk food consumption, stress, insufficient sleep, and the avoidance of Sadvritta . Pathologically, sickness begins with poor food digestion, which further vitiates Agni and Doshas, resulting in the production of ama, which causes constipation and diarrhea symptoms 8,9 Kashaya Rasa, Ushna Veerya , Madhura Vipaka, and Ruksha Guna are drugs that serve to balance Vata and Pitta Dosha, hence potentiating Agni and improving digestion 10 Grahani Dosha symptoms are relieved by drugs that bulk up the faeces, hydrate the body, and provide nutritional advantages 11,12 This article discussed the Grahani Dosha in general and how Ayurveda manages it through dietary changes. AIMS & OBJECTIVE 1. To describe the etiology and classification of Grahani Roga ( irritable bowel syndrome) 2. To discuss the management of Grahni ( ( irritable bowel syndrome) through Dietary modification MATERIAL & METHOD Information about Grahni (irritable bowel syndrome) was gathered from Ayurvedic texts such as Bahatriye, Laghutrye, and a modern medicine text book. The accessible Ayurvedic Samhita commentaries have also been referred to obtain important information. Medical publications, both index and non-index, have also been cited to collect information on relevant topics. Review of Literature. Ayurveda review of Grahani Roga The " Grahani Roga " is the most common gastrointestinal disorder. The fundamental cause of all diseases is the hypofunction of Agni, i.e. Mandagni. The Grahani becomes damaged as a result of Dusti or Vitiation of Pachakagni and Samana Vayu due to numerous etiological reasons of Grahani Roga . According to Acharya Charaka, a functionally weak Agni, or Mandagni, produces inappropriate digestion of ingested food, which moves either in Urdhva or Adhomarga 13 If it moves in Adhomarga, it causes Grahani Gada. Patients with Atisara who eat an unbalanced diet during the Agnimandya stage may develop Grahani Roga , according to Acharya Sushruta.14 Etiological Factors : 15 1 Abhojanat, Ajeernabhojanat, Attibhojanaat, Visamasanat, Asatmya Guru, Ruksa and Sandusta Bhojanat etc. 2 Vyadhikarshanat and Vegavidharana 3 Stress, anxiety and grief 4 In disciplinary life style and bad food habits 5 Unhygienic environmental condition 6 Nutritional insufficiency 7 Contagious predominance 8 Improper functioning of digestive fire 9 Diseased condition which weakened Agni 10 Virudha-ahara (Incompatible diet) Purvarupa - Aalasya (inaction), Trishna (excessive thirst), Anna Vidaha (burning sensation), Chirapaka (delayed digestion), Kayagaurava (heaviness in the body) 16 Rupa - Ati Srushta mala pravritti, vibbadha mala pravritti (Occasional hard and soft stool) Arochaka, Vairashya (altered in tongue), praseka (nausea), Tamaka, Shunapadkara, Asthiparvaruka, chhardana (vomiting), Jwara (fever), Lohanugandhi Udgara. 17 Samprapati Of Grahani Dosha 18 (Flow Chart 1) Contemporary View of Irritable bowel Syndrome IBS is a debilitating and chronic functional gastrointestinal illness that affects 9% to 23% of the world's population (World Gastroenterology Organization, 2009) 19 The definition of IBS has changed over the last 20 years, partly due to expert opinion and research that have revealed symptoms that distinguish those with IBS from those with organic disease, as well as factor analyses that have identified identifiable symptom clusters. IBS is most commonly associated with abdominal pain or discomfort that is eased by faeces or with a change in stool frequency

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[Find the meaning and references behind the names: Low, Red, Kala, Good, Sama]

Sunita et al . “A Conceptual Study of Grahani Roga (Irritable Bowel Syndrome) and its Management Through Dietary Modification” : 2022; 5 (2):99-104 101 (either an increase or reduction) or a change in stool appearance at the time of beginning (to either loose or hard). The absence of red flag (alarm) symptoms such gastrointestinal bleeding, weight loss, fever, anaemia, or an abdominal mass support IBS rather than structural disease 20 Treatment aims to improve quality of life as well as relieve or significantly improve core symptoms. Patient education, as well as dietary and lifestyle changes, are part of the first treatment for mild to moderate IBS. Interaction between the clinician and the patient is critical for establishing patterns of daily bowel habits and symptom flare-ups, as well as monitoring the symptom response to therapy. Many IBS patients experience symptom flare-ups as a result of dietary changes, and keeping track of symptoms and their links to specific foods, such as a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) diet, can help 21 Legumes (beans) and cruciferous vegetables including broccoli, Brussels sprouts, cabbage, and cauliflower are gas-producing foods. Many foods that contain poorly absorbed carbohydrates, which ferment in the bowel and cause bloating and gas, are excluded from low FODMAPS diets. FODMAPScontaining foods include dairy products, a variety of fruits (including apples, cherries, mangoes, pears, and melons), and grains (including barley, rye, and wheat). IBS sufferers may benefit from short trials of gluten and lactose avoidance. 21 Dietary fiber's roles in IBS are debatable. Ispaghula, oats, and psyllium are soluble fibres that may help with general IBS symptoms. Insoluble fibres like bran may help with constipation, but they also exacerbate other IBS symptoms like bloating. Encourage patients to drink more water while gradually increasing their dietary fiber intake to minimize bloating and gas 23 According to Ayurveda Management of Grahani Roga 24 1 The first is Dosha Shodhana, in which vitiated Doshas are expelled from the body. Acharyas recommend this method because when Doshas are expelled from the body, the sickness is not only treated, but the chances of recurrence are also eliminated. 2 Various Deepana- Pachana medications are detailed in the classics for this condition, followed by a light diet regimen and eventually the patient being switched to a regular diet. The sutra used by different Acharyas to treat 'Grahani Roga' is similar to Ajirna or Atisara. As a result, much thought must be given to the treatment of these disorders, as well as the rationale behind them. To begin with, Acharyas have said unequivocally that medications are of little help in Awasthas influenced by Amadosha, such as Ajirna , because the digestive power is incapable of digesting both food and medicines. 3 Only Apatarpana, which comes in three varieties and should be provided by a physician after a thorough examination and investigation of the patients, can heal diseases caused by Amadosha. 4 The three types of Apatarpana are Langhan, Langhan- Pachana and Shodhana or Avasechanam . Indications of these are: Alpa ama dosha langhanam, Madhya amadosha langhan pachanam, Prabhoota amadosha avasechanam . In all the diseases 5 Nidana Parivarjanam , is given due importance along with Laghu Aahar i.e. easily digestible food. The treatment of Grahani Roga should proceed on the full recognition of Agnidusti . Grahani Roga , represents the Dushti and Dosha of Annavaha Srotas , with the obvious implication that, in either case, there is the manifestation of Amadosa and Sama . Dietary modification 1 Dietary changes that promote good eating habits improve Agni and reduce the risk of Grahani. 2 Meal should be consumed at regular intervals. 3 Junk foods, allergic foods and food difficult to digest should be avoided. 4 Ayurveda recommends a balanced diet as part of Sansarjana Krama , as well as a regular food plan based on the Prakriti of the individual. As a result, Grahani's patient was advised to follow the Sansarjana Krama eating pattern. 5 Abhojanat, Ajeernabhojanat, Attibhojanaat, Visamasanat, Asatmya , and Sandusta Bhojanat should all be avoided. Preparation and consumption of unhygienic food articles. 6 Virudha-ahara must be avoided; means one should consume diet as per his/her internal constitution by following concept of Desha and Kala. 7 Diets which promote digestive enzyme; restore normal flora and maintain nutritional sufficiency Ahara Dravyas Recommended for Grahani Patients 25 (Table 1) DISCUSSION Grahani is an Annavaha srotas sickness linked to Agni and a particular way of life 26 Agni and pitta have similar characteristics. Sushrut acharya considers Pittadhara Kala , which is located halfway between Amashaya and Pakwashaya, to be Grahani 27 He termed Grahani the seat

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[Find the meaning and references behind the names: Nepal, Sharma, Gupta, Saman, Nil, Prakashan, Asha]

Sunita et al . “A Conceptual Study of Grahani Roga (Irritable Bowel Syndrome) and its Management Through Dietary Modification” : 2022; 5 (2):99-104 102 of pachaka pitta and the site of agni because of its ability to retain ( grahant ) the downward passage of food. It is placed above the nabhi and is maintained and nourished by agni's strength. Because Grahani and Agni have a reciprocal and interdependent relationship, adharadheya bhava exists. Grahani roga is a tridoshatmaka digestive illness caused by vitiation of the pachaka pitta, saman vayu, apana vayu , and kledaka kapha doshas . The functional relationship between regular vata and agni is significantly disrupted. Ayurvedic medicine's Grahani roga may be linked to IBS to some extent 29 Pittadhara kala is considered by Sushrut acharya to be Grahani , the seat of pachaka pitta , which accepts and retains dietary ingredients. Because vitiation in medha (psychological function) contributes to Grahani roga , it may be argued that vitiation in medha (psychological function) contributes to Grahani roga . Psychological factors may play a role in the development of IBS. Ingestible meal indigestion is the result. Ayurveda revealed a very effective drug and process that provides a lasting cure while also boosting health and avoiding dietary changes. CONCLUSION For Grahani patients, the 28 Ahara Dravyas of various classes can be recommended. Also, with good nutrition planning, precautions must be taken to avoid Grahani . It is obvious that if a person consumes food without following the proper process, he will quickly succumb to ailments such as irritable bowel syndrome, which is caused by Grahani vitiation as a result of his uncontrolled behaviors. With the support of Ayurvedic diet principles, we can restore regular bowel habits, enhance patients' overall nutritional status, and lessen the problems of irritable bowel syndrome. Acknowledgements:- Nil Conflict of Interest – None Source of Finance & Support - Nil REFERENCES 1 Dorland WA. 28 th ed. Philadelphia: Elsevier publication; 1997. Dorland's illustrated medical dictionary. [Google Scholar] 2 Available from: http://www.bhj.org/journal/special_issue_tb/D PII_13.htm . 3 Availablefrom: http://www.digestive.niddk.nih.gov/d diseases/pubs/ibs 4 Masand PS, Keuthen NJ, Gupta S, Virk S, Yu-Siao B, Kaplan D. Prevalence of irritable bowel syndrome in obsessive-compulsive disorder. CNS Spectr. 2006;11:21–5 5 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/P MC 3968698/ 6 Availablefrom: https://niimh.nic.in/ebooks/esushruta /index.php 7 Shastri AD; Sushrut Samhita; Sutrasthana, chapter 15, verse no.47; Chaukhambha Sanskrit Sansthan; Varanasi; 2011. 8 Sastri L. Vridda Jeevaka- Kashyapa Samhita (Vriddajeevaka Tantra) by -Sharma Hemaraj Pandit (Nepal Rajguru) revised by Vatsya with Sanskrit introduction and Vidyothini Hindi Commentary, Varanasi: Chaukhamba Sanskrit Sansthan.,1994. 9 Shashtri RL, Harita Samhita Edited with Asha Hindi Commentary, Varanasi: Prachya Prakashan., 1985. 10 Shastri K; Charak Samhita; Chikitsa Sthanam, chapter 15, verse no 51-52; Chaukhambha Bharati Academy; Varanasi; 2011. 11 Shastri K; Sushrut Samhita; Sutrasthana, chapter 15, verse no.48; Chaukhambha Sanskrit Sansthan; Varanasi; 2011. 12 Acharya YT, Charaka Samhita with Ayurveda Dipika Commentary of Chakrapanidatta, (Chikitsa Sthana 15, Verse 12) Varanasi; Chaukhambha Prakashan.2009. 13 Shastri K, Charak Samhita; Chikitsa Sthanam, chapter 15, verse no 51; Chaukhambha Bharati Academy; Varanasi; 2011. 14 Shastri AD; Sushrut Samhita; Uttaratantra, chapter 40, verse no.167; Chaukhambha Sanskrit Sansthan; Varanasi; 2011. 15 Shastri AD ,Sushrut Samhita; Sutrasthana, chapter 15, verse no.48; Chaukhambha Sanskrit Sansthan; Varanasi; 2011. 16 Shastri AD, Charak Samhita Chikitsasthan Chapter 15 Shalok 55 Chaukhambha Sanskrit Sansthan, Chikitsasthan Varanasi edition 2004.pp.388 17 Shastri AD, Charak Samhita Chikitsasthan Chapter 15 Shalok 55 Chaukhambha Sanskrit Sansthan Varanasi edition 2004.pp.388 18 Shastri AD Charak Samhita Chikitsasthan Chapter 15 Shloka 44 Chaukhambha Sanskrit Sansthan, Varanasi edition 2004 .pp. 386

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[Find the meaning and references behind the names: Camilleri, Chu, Ayu, Jain, Vazquez, Yang]

Sunita et al . “A Conceptual Study of Grahani Roga (Irritable Bowel Syndrome) and its Management Through Dietary Modification” : 2022; 5 (2):99-104 103 19 World Gastroenterology Organization. Irritable bowel syndrome: a global perspective. World Gastroenterology Organisation Global Guideline 2009. 20 Hammer J, Eslick GD, Howell SC, Altiparmak E, Talley NJ. Diagnostic yield of alarm features in irritable bowel syndrome and functional dyspepsia. Gut. 2004; 53 :666–672. 21 Yang J, Deng Y, Chu H, et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome Clin Gastroenterol Hepatol. 2013;11(3):262-268.e 1. doi: 10.1016/j.cgh.2012.11.034 22 Vazquez-Roque MI, Camilleri M, Smyrk T, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function Gastroenterology. 2013;144(5):903-911.e 3. doi: 10.1053/j.gastro.2013.01.049 23 Moayyedi P, Quigley EM, Lacy BE, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1367-74.doi: 10.1038/ajg.2014.195 24 Shastri K; Charak Samhita; Chikitsa Sthanam, chapter 15, verse no 85; Chaukhambha Bharati Academy; Varanasi; 2011. 25 Bhardwaj K et al: A Review Article On Diet In Grahani Roga. International Ayurvedic Medical Journal {online} 2020 {cited December, 2020} Available from: http://www.iamj.in/posts/images/upload/5395_5398.p df 26 Bhurke A, Bhurke L. GRAHANIROGA VIS-À-VIS IRRITABLE BOWEL SYNDROME: A REVIEW. International Journal of Innovation Science. 2016; 2(2). 27 Jain A et al: An Anatomical Study Of Pittadhara Kala - A Review Article. International Ayurvedic Medical Journal {online} 2020 28 Sorathiya A. P., Vyas, S. N., & Bhat, P. S. (2010). A clinical study on the role of ama in relation to Grahani Roga and its management by Kalingadi Ghanavati and Tryushnadi Ghrita. Ayu , 31 (4), 451–455. https://doi.org/10.4103/0974-8520.82041 How to cite this article: Rawat S, Singh R, Sahoo P, Padhar BK, Mutha R, Meena HML “ A Conceptual Study Of Grahani Roga (Irritable Bowel Syndrome) And Its Management Through Dietary Modification” IRJAY.[online]2022;5(2);99-104. Available from: https://irjay.com DOI: https://doi.org/10.47223/IRJAY.2022.5217

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[Find the meaning and references behind the names: Sara, Honey, Green]

Sunita et al . “A Conceptual Study of Grahani Roga (Irritable Bowel Syndrome) and its Management Through Dietary Modification” : 2022; 5 (2):99-104 104 Flow Chart 1 SAMPRAPATI OF GRAHANI DOSHA 18 NIDANA SEVANA DOSHA PRAKOPA AGNI DUSHTI APACHANA AMAVISHA SHUKTAPAKA AMOTPATTI GRAHANI DUSHTI GRAHANI ROGA VATAJA PITTAJA KAPHAJA SANNIPATAJA Table 1 Ahara Dravyas Recommended for Grahani Patients 25 English Name] Sanskrit Name Rasa Veerya Vipaka Guna Rice Shashtika Madhura Sheeta (cold in potency) Madhura Laghu, Snigdha (unctuous) Green Gram Mudga Madhura Sheeta Katu Laghu, Ruksha (creates dryness), Grahee Horse Gram Kullatha Kashaya Ushna (hot in potency) Katu Laghu, Sara (mild laxative ) Goat Curd Chag Dadhi Amla (sour) Ushna Amla Laghu,Grahee, Deepana Butter Butter Navneeta Madhura Sheeta Madhura Grahee, Snigdha, Agnikrit (stimulates Agni) Cow Ghee Gavyaghrit Madhura Sheeta Madhura Guru (difficult to digest), Rochana (enhances taste perception), Honey Makshika Madhura Kashaya Sheeta Madhura Laghu, Ruksha, Grahee, Deepana Bengal Quince Bilva Katu Kashaya, Tikta Ushna Katu Laghu, Snigdha, Grahee, Deepana, Pomegranate Dadima Kashaya Madhura Amla Anushna Madhura /Amla Laghu, Snigdha, Grahee Banana Kadalee Madhura Sheeta Madhura Guru,Vishtambhee (restraining)

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