AYURVEDIC MANAGEMENT OF GRAHANI (IBS): A CASE STUDY

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1 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Desai et al. SJIF Impact Factor 7.4 Volume 7, Issue 6, Case Study ISSN AYURVEDIC MANAGEMENT OF GRAHANI (IBS): A CASE STUDY Kshitija Desai *, Prashant Baghel, Parshuram Dongre 3, Priti Pusam 4 * PG Scholar, Dept. of Rasashastra and Bhaishajyakalpna, Govt. Ayurved College, Osmanabad, Maharashtra, India. PG Scholar, Dept. of Kriya Sharir, Govt. Ayurved College, Osmanabad, Maharashtra, India 3 Professor and HOD, Dept. of Kayachikitsa, Govt. Ayurved College, Osmanabad, Maharashtra, India. 4 PG Scholar, Dept. of Rasashastra & Bhaishajyakalpna, Govt. Ayurved College, Osmanabad, Maharashtra, India. Article Received on 7 April 08, Revised on 07 May 08, Accepted on 8 May 08 DOI: /wjpps *Corresponding Author Kshitija Desai PG Scholar, Dept. of Rasashastra and Bhaishajyakalpna, Govt. Ayurved College, Osmanabad, Maharashtra, India. ABSTRACT In present era Grahani Roga is common GIT disorder affecting the normal life style of approx. Every individual at one time in their life suffered from symptoms like abdominal pain, altered bowel habits, nausea, rectal mucus, feeling of incomplete defecation, In modern science above symptoms correlated with IBS (Irritable Bowel Syndrome). In this case an effort was made to treat a 7 years old male patient having symptoms Muhurbaddha Muhurshithil (altered bowel habit), Apakwa Malapravritti (Stool with mucus), Udarshool (abdominal pain) with Pichhabasti (medicated enema), Shirodhara (pouring oil on head) and oral medications. At the end of 60 days of treatment patient got significant improvement in symptoms. KEY WORDS: Grahani, IBS (Irritable Bowel Syndrome), Pichhabasti, Oral medication. INTRODUCTION Approximately 0% of general population fulfills diagnostic criteria for Irritable Bowel Syndrome (IBS). IBS encompasses a wide range of symptoms and a single cause is unlikely. It is generally believed that most patients develop symptoms in response to psychosocial factors, altered gastro intestinal motility, altered visceral sensation or luminal factors. [] As per Acharya Sushrta Grahani is the 6 th Pittadhara Kala situated between Amashaya (Stomach) and Pakwashaya. [] Acharya Charaka mentioned it is the part which situated Vol 7, Issue 6,

2 above Nabhi (Umbelicus), it supported and nourished by strength of Agni (digestive power). Grahani (organ) digest the food and releases into the next Ashaya i.e. Pakvashaya. [3] Because of impairment of Agni it releases food in undigested form. Grahani disease is due to the unhealthy and improper food habits, like constant intake of such food especially in person with disturbed digestion and cause the disease Grahani. Thus it produces symptoms as Atisrushta Atibadha Mala (loose/constipeted), Trushna (Thirst), Arochaka (tastelessness), Asyavairasya (Alered oral taste), Prasek (excessive salivation), Shoon Padakara (edema over hands and feets), Asthiparva Ruk (pain at phalangeal joint and bone), Chardan (vomiting), Jwara (fever), and Louhagandhi Amlaudgara (iron pungent odor burps). [4] Clinicaly IBS shows symptoms like altered abdominal habit, abdominal pain and bloating, feeling of incomplete defecation, passage of mucus. In Ayurveda exact correlation cannot be found of IBS but according to signs and symptoms and pathology of disease we can consider this clinical entity as Grahani Dushti. In present study through the case was diagnosed as Grahani (IBS), patient had GIT symptoms and general symptoms related to Grahani. Hence the patient was administered with Deepan, Pachan, Grahi oral medication with a course of Pichhabasti, Shirodhara. MATERIAL AND METHODS Case Presentation A 6 years old male patient was registered from OPD with registration no. 333, Department of Kayachikitsa, Government Ayurveda Hospital, Osmanabad. The patient had many complaints related to IBS which include Muhurbadha muhurshithil malaprvritti (altered bowel habit), Udarshool (abdominal pain), Apakvamalapravritti (stool with mucus), Aruchi (anorexia), Udaragourava(heaviness in abdomen), Alasya(fatigue), Ajeerna(indigestion) for the last 6 months. As IBS correlated with Grahani Roga, drugs suppressing Pitta and having Deepan, Pachan properties were prescribed- Panchamruta Parpati 500mg, Naga Bhasma 60mg, Shankha Bhasma 50mg BD with Takra (butter milk) and Sutshekhar Rasa 50mg BD. Pichhabasti (medicated enema) of Mochrasa Sidhha Ksheer (milk), Anuvasan Basti of Jatyadi Tail (medicated oil) and Vasa Ghrita (Ghee prepared by Adhatoda vasica) for 5 days and Shirodhara (pouring of oil on head) with Vacha Taila (Oil preparation of Acorus calamus) for 7 days. Vol 7, Issue 6,

3 History of Present illness Patient states that he was quite well 6 months back. Since then he has been suffering from abdominal pain, altered bowel habits, sometimes passage stool with mucous, anorexia, heaviness in abdomen, indigestion and fatigue. Patient had the complaint of Chronic Diarrhea 6 months back. Doctor diagnosed as IBS and started treatment. Patient underwent treatment but could not get relief completely. Past history of Patient The patient used antacid and antispasmodic drug unevenly. His family history revealed that there was no such complaint ever. General Examination VITALS Pulse: 80/min BP: 0/70 mmhg Temp: Afebrile RR: 0/min CVS: S S Normal CNS: Conscious, Oriented RS: AEBE, Clear P/A: Resonance ++, Mild Tenderness Built: Lean Weight: 45 kg Height: 6 feet Blood Investigation Hb%:.7 g/dl ESR: 40mm BSL(R):0mg/dl Sr.Creatinine: 0.85mg/dl HBsAg: Non Reactive Urine: Pus cells + (5-6) Samprapti Ghatakas Dosha: Samanavata, Apanavata, Pachakpitta Dushya: Annarasa, Rasadhatu Agni: Jatharagni Ama: Jatharagnimandyajanya Vol 7, Issue 6,

4 Srotas: Annavaha Srotodushti: Atipravritti Adhishthan: Grahani Rogamarga: Abhyantara Table No.: Showing Grading for clinical features. Clinical Features Grading BT Muhurbaddhamuhurshithil mala (Altered bowel habit) Distention of Abdomen Aruchi (anorexia) Balakshya (Weakness) Passing normal consistency 0 stool(time/day) Passing stool irregular(- times/day)without pain Passing stool irregular(- 3times/day)with pain Passing stool irregular & just after meal(3-3 4times/day)with pain Passing stool irregular & just after 4 meal(>4times/day) with pain No complaint 0 Rarely complaint once in a week Distention of abdomen after taking meal up to hour Distention of abdomen after taking meal up to hours Distention of abdomen after taking meal up to 6 4 hours Taking normal diet with 0 interest No interest in taking normal diet Food has taken forcefully Not taken a food even 3 forcefully No weakness 0 Weakness but performs day to day activies Weakness & difficulty in performing day to day AT % 5 th day 30 th day 60 th day Relief % 4 80% % % Vol 7, Issue 6,

5 Trushna (Thirst) Alasya (laziness) Praseka (excessive salivation) Klama (Exhaution) Tiktamlodgara (iron pungent odor burps) Antrakunjan (gurgling sound in abdomen) Passing mucus in stool activities Cannot able to get up from bed 3 Normal thirst 0 Mild thirst, take water frequently Thirst increases Excessive thirst, never satisfied after taking a 3 good amount of water Enthusiastic 0 Occasionally Often Persistent 3 No complaint 0 Mild Salivation Moderate salivation with nausea occasionally/day Excessive salivation with nausea & with often 3 vomiting No exhaustion 0 Exhaustion with moderate work Exhaustion with mild work Exhaustion without effort 3 No complaint 0 Occasionally -3days/week 3-5days/week 3 5-7days/week 4 All the 7 days 5 No complaint 0 Occasionally -3 times/day before passing stool Persistent 3 No visible mucous in stool 0 Visible mucous stickled to the stool Passage of mucous with frequent stool Passage of large amount of mucous in stool % 3 75% % 75% 5 83% % % Vol 7, Issue 6,

6 Table No.: Showing Oral Medication. Formulation Dose Duration Anupana Panchamruta Parpati 500mg+ Shankha bhasma 50mg + BD 30 days Takra Naga Bhasma 60mg Sutashekhar Rasa 50mg BD 30 days Water Table No. 3: Showing Panchakarma procedure. Sr.No. Panchakarma Procedure Pichhabasti (P) Anuvasana Basti (A) Method Mocharasa sidhha Ksheerpaka -50ml + Vasa Ghrita - 30ml Jatyadi Tail - 30ml + Vasa Ghrita 30ml Duration Basti in 5 days 3 Basti in 5 days 3 Shirodhara Vacha Tail 500ml 7 days P P P A P P P A P P P A P P P OBSERVATIONS AND RESULTS The follow up was made on 5 th day, 30 th day and 60 th day. During this period patient did not developed any other complaints. After 60 th day blood investigations are carried out it shows following results i.e. ESR- 0mm, Hb %-.5 gm%, Urine Pus cell Nil. Patient reported gradual improvement in altered bowel habits, stool with mucus, pain in abdomen, anorexia, indigestion, heaviness in abdomen. After treatment patient got significant relief and he gained weight up to 49 kg. (before treatment wt. 45kg) FOLLOWUP AFTER TREATMENT After discharging from the hospital patient is advised to continue with Kutaj Ghana Vati TDS and Kutajarishta 0ml BD with water. DISCUSSION In this study Pichhabasti was given for the treatment of Grahani (IBS) made from Mocharasa i.e. Shalmaliniryasa (resinous extract of Bombax cieba tree) by Ksheerapaka Vidhi(Milk Preparation).Acharya Bhavprakash has mentioned the properties of Mocharasa(resinous extract) as Hima (cool in potency), Grahi (astringent), Pitta Raktadahanut (rectifies the vitiation of blood, Pitta Dosha, and decreases symptoms of burning), Pravahikaghna (corrects pathogenesis occurring in Pravahika disease). It contains Tannin as principle component along with Gallic acid. It is astringent in property which when Vol 7, Issue 6,

7 coming in contact with intestinal ulcered inflamed mucosa resist the chemical and mechanical injury decreasing local irritation. [5] The healing property enhanced with Anuvasnbasti of Jatyadi Tail (medicated oil) and Vasa Ghrita (Ghee preparation of Adhatoda vasica). Shirodhara with Vacha Taila was advised for st seven days. Vacha (Acorus calamus) drug is described under Shirovirechana (cleansing nasal therapy) Gana and Sanghyasthapan (Restores Consciousness). As per Bhavaprakasha Vacha acts as Medhhya (Brain tonic) and Vibandhahara (Carminative) because it has Tikta Katu Rasa, Laghu Tikshna Guna. [6] People with IBS may be more sensitive to emotional troubles, stress and anxiety may make the mind more aware of spasm in the colon so in present study we gave treatment of Shirodhara for relieves the anxiety and stress with Vacha Taila(Oil preparation of Acorus calamus). Panchamruta Parpati described under the Grahaniroga Chikitsaadhyay in Bhaishajyaratnavali. According to Ayurveda properties of Panchamruta Parpati includes Deepan (stimulation of Agni), Pachan (digestive), Grahi (carminative), Laghu (decreases Ama). [7] Ushna Guna and Deepan properties increases appetite, Grahi property improves absorption of nutritive material. Takra (butter milk) is best Anupan mentioned in Grahani Chikita. In present case report, Panchamruta Parpati with Takra as Anupan has been shows significant relief in symptoms of Grahani Roga (IBS). Acharya Sadananda Sharma has described properties of Shankha Bhasma in Ras Tarangini. It is indicated in GIT disorders like Grahani Roga (IBS), Atisara (diarrhea), Amlapitta (Hyperacidity) and it shows Balya, Grahi (carminative) effects. [8] Naga Bhasma and Sutshekhar Rasa acts as Grahi and shows Deepan, Pachan properties. CONCLUSION In present case study Pichhabasti, Shirodhara, Panchamruta Parpati, Shankha Bhasma, Naga Bhasma and Sutshekhar Rasa shows significant effect. The overall effect of therapies showed 9.8% improvement in symptoms. There is no any adverse reaction found with these drugs. These oral medication and Panchakarma procedures are effective in managing the symptoms of Grahani(IBS). Vol 7, Issue 6,

8 REFERENCES. Nicholas A.Boon, Christopher Haslett, Edwin R. Chilvers, John A.A. Hunter, Davidson s Principles and Practice of Medicine 8 th Edition, Chapter, 9: Ambikadatta Shastri, Hindi commentary, Sushruta Samhita (Uttar Tantra), Atisar Pratised Adhyay, Choukhamba Sanskrit Sansthan Varanasi; 0 p Anna Moreshwar Kunte, Krishnashastri Navre, Ashtanghridayam (Sutra Sthana), Choukhamba Prakashan Varanasi; 00 p Vidyadhara Shukla, Ravidatta Tripathi, Charak Samhita Vol.II (Chikitsa Sthana), Grahanichikitsa Adhyay, Choukhamba Sanskrit Pratishthan, Delhi; 0 p Dongare Parshuram, Baghel Prashant. Integrated Study of Mode of Action of Mocharasa Basti In Grahani Vyadhi with Special Reference to Inflammatory Bowel Disease. AYUSHDHARA, 06; 3[5]: Krushnachandra Chunekar, Edited by Gangasahay Pandey, Bhavprakash Nighantu, Choukhamba Bharati Acadamy, Varanasi; 05 p Govindas Sen, Hindi commentary by Ambikadatta Shastri, Bhaishajyaratnavali, Grahani Roga Chikitsa Adhyay, Choukhamba Prakashan, Varanasi; 06 p Sadananda Sharma, Edited by Pandit Kashinath Shastri, Rastarangini, Motilal Banarasidas, Delhi; 04 p Vol 7, Issue 6,