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Grahani (irritable bowel syndrome): Cure & care by Ayurveda
Dr. Imlikumba, Health Naturally Clinic, Mercy Building: Kevijau colony, Dimapur: Nagaland, +919483328411,  :  Dec/03/2017 04:58:PM
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IBS is primarily a disorder of motility of the entire digestive tract causing abdominal pain, bloating, diarrhoea and constipation. In this disorder the digestive tract is especially sensitive to a host of stimuli, stress, diet, drugs, hormones or minor irritants. Classical Ayurveda mentions the clinical condition Grahani-roga, wherein the symptoms of major varieties of IBS can be accommodated. Physiologically Grahani is defined as the seat of Agni and is so named because of holding up the food for successive stages of digestion. When Grahani is deranged / disturbed due to weak Agni or due to the malfunctioning of the local controlling factor broadly termed Apana vayu, it releases the ingested material frequently even in unripe condition. With varying degree of the involvement of Agni and Samana vayu clinical symptoms also vary among diarrhea, constipation, abdominal pain, bloating headache and fatigue
In most of clinical condition, IBS is found to be aggravated by a variety of exogenous and endogenous factors. 
Triggers for IBS can range from gas or pressure on intestine to certain food, medication or emotions. Changes in life style and reasonable amount of stress have proven role in most of the intestinal pathologies.
Causes for IBS as per ayurveda: Abhojan (Excessive fasting Fasting), Ajeerna Bhojana (Eating before the digestion of previously taken food. Having food during indigestion.), Ati Bhojana (Excessive food intake), Vishama Bhojana (Improper food),Asatmya Bhojana (Unwholesome food), Guru Bhojana (Heavy food intake), Sheeta Bhojana(Cold food intake),  Rooksha Ahara (Dry and junk food), Dushta Bhojana (Polluted food), Vegadharana (Suppression of urges), Vireka Vibhrama, Improper Virechana (purgation) treatment, Sneha vibhrama (Improper oleation therapy), Swapna viparyaya (Improper sleep, staying awake at night and sleeping during day), Shoka (Grief), Krodha (Anger), Bhaya (Fear), Vyadhi Karshana (Suffering due to chronic illness, leading to lowered digestion strength), Deasha Vaishamya (Migration/Travel), Kala Vaishamya (Change in the season).
Types of grahani acc. to ayurveda: Ayurveda explains signs and symptoms of IBS based on Dosha dominance:
• Vataja Grahani: Abdominal pain, increased frequency of stool, altered bowel habit, distention of the abdomen, flatus, head ache, debility, chest pain etc.
• Pittaja Grahani: Burning of the chest, belching, head ache etc.
• Kaphaja Grahani: Stool with mucus, sensation of incomplete evacuation of the bowel, nausea, vomiting, flatus, heaviness of abdomen.
• Sannipatic Grahani: All the three Doshas are involved.
Mixed features of all the doshas, lack of concentration, severe debility. This stage is also called as Samgrahani. In this condition,all all features of IBS like gurgling sound in the abdomen, fatigue, bowel with flatus or mucus, tenesmus (constant urge to pass stools), intermittent episodes, increased frequency of bowel in the day time are found.
Clinical features of grahani ACC to ayurveda:
• Praseka (Nausea, excessive salivation.)
• Aruchi (Tastelessness, anorexia.)
• Annasya chirat paka (Delayed digestion.)
• Vidaha (Burning sensation.)
• Chardi(Vomiting.)
• Adhmana (Bloating, distention of abdomen.)
• Asya Vairasya (Altered taste in tongue.)
• Trisha (Excessive thirst.)
• Klama (Fatigue.)
• Bhrama (Giddiness.)
• Antra koojana (Gurgling sound in the stomach.)
• Muhurbaddha and Muhurdrava Pravritti (Occasional hard and soft stools.)
Types of IBS ACC. to modern medical science: IBS is classified as:
• IBS D – where diarrhea is the pridominant symptom.
• IBS C – with constipation.
• IBS A – alternating diarrhea and constipation.
Clinical features of ibs acc. to modern medical science:- 
• Abdominal pain: - pain is felt in left/ right iliac fossa or hypogastrium. The pain may be continuous, colicky, diffused or localized. Rarely the pain may be severe. Abdominal pain is generally relieved by defecation and provoked by food. Pain is usually associated with constipation.
• Painless intermittent diarrhoea: - it is characterize by passage of several loose watery stool when constipated, stools are hard, pellet like accompanied by mucus. 
• Bloating of abdomen.
• Alternate constipation and diarrhoea.
• Nausea, anorexia, tiredness, tenderness of abdomen. 
The Rome criteria have been shown to be both sensitive and specific for the diagnosis of IBS and can be used in clinical practice. At least three months in the preceding 12 months of abdominal pain or discomfort that has two of the following three features:
• Relieved with defecation .
• Associated with a change in frequency of stool
• Associated with change in form of stool.
Routine examination:
• Patient above fifty should have a screening colonoscopy. 
• Patient below 40 with strong family history of colorectal cancer should also undergo a colonoscopy.
•  Small bowel or colonic mucosal biopsies may be indicated in patient with loose watery stool. 
• Other routine examination is CBC, Blood chemistry, ESR & TSH.
Principal of treatment: Treatment can be taken as the treatment of Grahiniroga. Langhana, Dipana and Pachana drugs are given in the initial stage. It can be controlled by managing diet, lifestyle and stress. The treatment plan under the following domains 
• Agnidipana (Carminative property), Pachana(Digestive), Sangrahi Laghu – lightness.: astachurna, hinguvachadi churna, dipakyadichurna Ajirna, atisara, sula: mustakaranjadi kashay, vilwadi gulika, dadimaastak churna kalaskadikwatha. 
• Vatanulomana: kaidaryadi kashay, patupancakadi gulika, bhuktanjari gulika Amlodagara, daha: mahatiktak kashay, trantyadi kashay.
• Manonukulat (intestinal restorative, which increases absorption capacity of intestines) : Other medicines found effective are indukanta ghrita, vidaryadi ghrita, mahatiktakaghrita. 
Chronic IBS patient may develop the symptoms of depression. In such condition, physician should take care to relieve depression. Kalyanakakashay. Kalyanaka ghrita , sarasvatarista . Manasmitravatak can be given stress relieving factors like yoga, meditation, are useful. 
Herbs useful in grahani (IBS): Pomegranate, Kutaja (Holarrhena antidysenterica), Musta (Cyperus rotundus), Dhataki (Woodfordia fruticosa), Patha (Cissampelos pareira), Lodhra (Symplocos racemosa), Pushkaramoola (Inula racemosa), Chavya (Piper chaba), Daruharidra (Berberis aristata), Shalmali (Shalmalia malabarica), Lajjalu (Mimosa pudica)
Home remedies for grahani (IBS):
• Cumin seeds and tender leaves of Guava are taken and made into fine paste.20 gram of this is taken along with buttermilk twice daily. It helps to reduce the frequency of episodes of bowel habit.
• The fruit cover (epicarp) of Pomegranate is rubbed well with lemon juice and fine paste is made. This is taken twice daily along with warm water. This restores the capacity of small intestine.
Wholesome diet and habits in grahani (IBS):
• Regular intake of buttermilk, Cumin seeds, Pomegranate
Warm water, Easy-to-digest foods, Moderate exercise, Proper sleep, In many fiber rich diet is very useful to relieve symptoms.
Unwholesome diet and habits in Grahani (IBS):
• Dadhi(Curd), Madya (Alcohol), Shukta (Acidic beverages), Jagarana(Night awakening), Vegadharana(Suppression of the urges), Aniyata asana(Improper posture), Upavasa (Fasting for longer period), Sodas, junk foods, regular hotel foods, Foods that cause excess gas production and bloating such as potato, egg plant, cabbage, broccoli, cauliflower
The patient is asked to prepare a list of foods that trigger an IBS attack and is asked to avoid them.
Mental aspects to IBS: Usually IBS is related with Psychaitric aspects. A patient with IBS usually suffers from anxiety or depression. In such a case, along with efforts to restore digestive health with the above said remedies and medicines, treatment to depression /anxiety should also be given.
Hence treatments like:
• Shirodhara treatment (pouring medicated liquid over forehead in a stream), 
• Pranayama: Regular Pranayama,  is very useful.
• Lifestyle adjustments such as – sleeping and waking up at regular intervals, moderate exercise, Yoga, stress management techniques are very useful.
Conclusion:  IBS continues to be a major health hazard affecting the productive age group worldwide. Ayurveda has the strong theoretical backup in the genesis of IBS. In Ayurveda IBS can be considered as Grahani. The treatment module may be modified according to the predominant symptoms. Patient should be advised to follow appropriate food regimen for the utmost care of health. Together with it psychic factor are involved so appropriate counseling has to done. Health indeed is the real wealth. When you are in the pink of health, instead of wasting the gift with alcohol, smoking, irregular sleep and diet habits, inculcate discipline in your routine with right food choices, Yoga, Pranayama etc. These will help you to keep diseases like IBS at bay.
NOTE: Ayurvedic medicines and treatments should be taken under Qualified Ayurvedic Doctor/Physician. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician.

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