767 Thesis-0812 PDF

ISSN 2320-5407 International Journal of Advanced Research (2016)
Journal homepage: http://www.journalijar.com INTERNATIONAL JOURNAL

OF ADVANCED RESEARCH
“A Clinical Study to Evaluate the Efficacy of Vasti karma in

Management of Grahani Roga”
Thesis submitted for partial fulfillment of the requirement for the degree of
M.D. (Ay.) PANCHAKARMA

By
DR. SUNEETA SINGH
Dr. Ashok Kumar Sharma Dr. Uttam Kumar Sharma

M.D. (Ay.) M.O. M.D.(Ay.) Ph.D.
Ex.Reader cum Principal, Professor,
S.R.T.Ayurvedic College & Hospital Karjara(Gaya)
P.G. Department of Panchakarma, Rishikul Govt. Post Graduate Ayurvedic

College and Hospital Haridwar, Uttarakhand- 249401
Affiliated to
H.N.B. Garhwal University (Central University)
Srinagar (Garhwal) INDIA
Enrollment No. G 11772555 August 2013
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Index
 ACKNOWLEDGEMENT
 ABBREVIATION
 INTRODUCTION 8-12
 CONCEPTUAL STUDY 14-82
 Anatomical & physiological aspect of Grahni
 Disease Review of Grahani –
o Ayurvedic review
o Modern review
 Vasti Review
 DRUG REVIEW 83-95
 CLINICAL STUDY 96-156
 Material and Method
 Observation and Results
 DISCUSSION 157-170
 SUMMARY & CONCLUSION 171-175
 BIBLIOGRAPHY
 APPENDIX
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ACKNOWLEDGEMENT
At the time of Completion of thesis work I express my salutation to the almighty Maa
Durge for blessing me and helping to achieve such a distinguished stage of my life.
I express my reverential and heartily gratitude to my mother, whose blessings helped me
a lot in every phase of my life. I express my profound sense of love to my father, brothers and
sisters, whose inspiration and love are the prime source of progress and success throughout my
life. Nothing can ever absolve me of my indebtedness to the sacrifices of my parents.
It is great pleasure for me to express my gratitude with profound respect to my respected
Supervisor Dr. Uttam Kumar Sharma, Professor for his compassionate, extensive guidance,
valuable suggestions, co-operation, constant encouragement, benevolent and keen interest
throughout the study.
I express my gratitude to my co-guide Dr. Ashok Kumar Sharma whose helpful guidance,
suggestions, firm remarks and untiring affords throughout the preparation of his dissertation are
beyond the capacity of my words to reciprocate with thankfulness.
I extend my gratefulness to my Head of Department Dr. K. K. Sharma for his suggestions
and support. I am thankful to Dr. Alok Kumar Srivastava for his kind support & valuable
suggestions.
I am highly grateful to Dr. A.K. Tripathi, Principal and Dr. P.K. Bhardwaj, Ex. Principal
Rishikul State Ay. P.G.College & Hospital, for providing all the facilities to make this study
successful.
I pay my heartily thanks to Dr. Deshraj and Dr. D.K. Goel from Department of Kaya
Chikitsa for their kind support. It is privilege to convey my regards to my teachers Dr. Sanjay
Singh, Dr. Kirti Verma and Dr. Usha Sharma for their loving admonition and caring support.
I am very lucky to have freinds like Dr. Reema, Dr. Kalpana, Dr. Parul Goel, Dr. Seema,
Dr. Neelam, Dr. Deepa, Dr. Yadvendra & Dr. Shailendra Dagar who all
have contributed in various aspects and made my study a memorable one.
My sincere thanks to my seniors Dr. Rajan Yadav, Dr Pawan & Dr. Anil and juniors Dr.
Bhawana, Dr. Narender, Dr. Namita, Dr. Shikha, Dr. Bharati, Dr.Krishna Kant, & Dr. Amit and
my colleagues Dr. Neeraj, Dr. Chetan, Dr. Piyush. I am thankful to Dr. Anshuma, Dr. Jyoti, Dr.
Rajesh, Dr. Ajay, Dr. Niranjan, Dr. Pradeep , Dr. Amit, & Dr. Sarvesh for their direct or indirect
support.
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I would further like to extend my thanks to therapists Mrs Deepa,Mrs Beena, Mrs
Kusum, Mr. Avinash & Mr.Nitin for their kind support.
I also extend my vote to all the staff of Department of Panchakarma and hospital staff of
Rishikul for their help and co-operation provided during study time.
It is next to impossible to express my profound love and gratitude to all my family
members and in-laws .Their lovable support and encouragement were initiating sources which
directed me towards the progress and success in each step of my life. I would further like to
extend my thanks to my brother in law Mr. Ghanshyam for their kind support.
I would like to thank and remember my nearest and heartiest elder brother Shri
P.K.Singh(Judge) who always remained with me with his faithful backing, relentless
encouragement and cheerful attitude which made every moment happier.
Not a single alphabet can express my deep feelings towards my best friend and husband
Dr. Pradeep Kumar, who has always been with me in my ups and downs and is just like a
shining star in the sky that guides me in the dark. He is the person who gave me all time
encouragement making me aware of my aims and capacities, without which it was impossible for
me to reach at this stage of life.
Last but not least I would further like to extend my thanks to all friends, relatives and well
wishers who directly or indirectly helped me throughout my thesis work.
Suneeta Singh
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ABBREVIATIONS
A. H. - Astanga Hridaya
A. H. Ni. - Astanga Hridaya Nidanasthana
A. H. Su. - Astanga Hridaya Sutrasthana
A. H. U. - Astanga Hridaya Uttartantra
A. Sm. - Astanga Samgraha
A. Sm. Su. - Astanga Samgraha Sutrasthana
A. Sm. U. - Astanga Samgraha Uttartantra
B. R. - Bhaishajya Ratnavali
Bh. Pr. - Bhava Prakasha
Ch. Chi. - Charaka Samhita Chikitsasthana
Ch. Sha. - Charaka Samhita Sharirasthana
Ch. Sid. - Charaka Samhita Siddhisthana
Ch. Su. - Charaka Samhita Sutrasthana
Ch. Vi. - Charaka Samhita Vimanasthana
Ha. Sm. - Harita Samhita
Su. Kal. - Sushruta Samhita Kalpasthana
Su. Sha. - Sushruta Samhita Sharirasthana
Su. Su. - Sushruta Samhita Sutrasthana
Su. U. - Sushruta Samhita Uttaratantra
Y. R. - Yoga Ratnakara
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Introduction
Nobody can go back and start a new beginning, but anyone

can start today and make a new ending.
(Maria Robinson)
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INTRODUCTION
In modern era the life style disorders are increasing day by day. Due to vitiated and irregular
consumption of food, gastro-intestinal problems are most common in society. Ayurveda
considers that the dysfunction of Agni is responsible for undigested food which is responsible for
various functional and structural defects in the gastro-intestinal tract. By taking a look on the
sign and symptom of Grahani, somehow it resembles to I.B.S, colitis, Crohn‘s disease etc.
In Grahani Roga, due to Dushit jathragni the digestions of food do not occur properly.
Undigested food forms a vitiated material called “Ama‖, which is responsible for producing
various disorders. This disturbs the normal flora of GI tract and weakens the muscles and acid
fluid configuration of GI tract. So Prasad bhaga of food is not form properly so nourishment of
whole body does not occur.
In today‘s practice, one can come across good number of patients suffering from the complaints
related to G.I.T. These complaints vary from loss of appetite to chronic abdominal pain, irregular
bowel habit, incomplete evacuation, chronic flatulence, Constipation, diarrheas and Failure to
thrive etc. These factors affecting peoples will not only disturb the growth & development of
physical health of it but its activities, social behavior, immunity & concentration power too. If
above mentioned problems are remain untreated or unnoticed, they may turn in to its related
complications, According to the survey conducted by UN almost 500 million people in this
world are suffering from G.I. disorders. According to the available evidence the condition is
even worst in India.
A lot of research works have covered the diseases of Annavaha srotas like that of Pravahika,
Chardi, Krimi, Atisara etc.; but no consideration was given to the aspect of such problems in a
chronic stage or such complaints with nature of reoccurrence. This has very high percentage of
patients visiting O.P.D. now days. So, considering all the above mentioned factors, it is thought
to be the need of an hour to work in this regard. For this what has to be done, is to go back to the
basics. Concentrating on the basic principles, few scattered references and physiology of
digestion, a concept can be formulated covering all above points under heading of Grahani Roga.
This is accepted and well supported by classics too.
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In Ayurveda, Acharya Charaka has given a vivid description about Grahani Roga which is
described later in relevant contexts. Acharya Sushruta and Vagbhata, also has thrown a very
good light on Grahani Roga. Grahani is considered under Ashta Maharoga- very difficult to
treat.
In Grahani Roga, although Rogadhisthan is Grahani but dysfunction occurs in whole G.I. tract.
In Grahani Roga, due to vitiated Samana Vayu, Kledaka Kapha and Dushit jathragni the
digestion of food not occur properly, so form undigested materials, which occur like toxins for
whole body. These materials also distorted the normal flora of GI tract. So we need such a
therapy which provides not only purificatory effect but therapeutic and healing process also, for
treatment of Grahani Roga. Vasti karma is indicated in the management of Grahani. It helps in
improving the function of gut and also heals it. Disorders like I.B.S. colitis, Crohn‘s disease
somehow resemble the symptoms of Grahani. So keeping this view in mind the work has been
taken to evaluate the effect of Vasti karma in respect of the treatment of Grahani Roga. In
Ayurveda, there are much mare curative and preventive measures, by which one can get rid of
itself and its hazardous effect. Vasti Karma is the one of these Ayurvedic measures.
In Ayurveda chikitsa, the role of Panchakarma and especially Vasti is having very important
place in the treatment of many disorders.
तस्माििकित्साधधिमित ब्रुवितत सवाां िचकित्सामिि विस्तमिे (Ch.sidh.1/39).
Vasti has multidimensional utility; it can fulfil the purpose of elimination, palliation,
nourishment and rejuvenation. Vasti fulfil all the purposes which are wanted in Grahani Roga,
but previously very few works on Vasti karma (most commonly pichcha vasti) have been done in
management of Grahani Roga, so there is need to do more research in respect of Panchakarma
therapy in different directions. No work has been done to evaluate the efficacy of Vasti Karma
(Vidangadi Taila Dhanyapanchak Kwatha Vasti) in management of this disease.
These are the reasons that, we have chosen the entire way of Ayurvedic treatment in the present
study regarding Grahani Roga.
The previous works done on Vasti Chikitsa in Grahani Raga:
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1. A study of role of Vasti chikitsa in Vatika Grahani. Ediriveera ERHS, 1993, Banaras Hindu
University, Varanasi.
2. Studies on Vataja Grahani & its management with Pichchha-Vasti. Gudadhe Sonal, 2000.
3. A Clinical evaluation of Abhayadi choorna with Sanshodhana karma (Sneh-Vasti) in cases

of Grahani Roga. Singh V.K., 2002,
4. Clinical Study on Grahani Roga w.s.r. to its management with Panchamrit parpati and
Vasti. Patil Rajendra 2003
AIM AND OBJECTIVES:
 To evaluate the effect of Vasti karma in management of Grahani Roga.

 To study Grahani Roga with reference to I.B.S. and other disorders from Ayurveda and
Modern System of medicine.
MATERIALS AND METHOD-
For present study 30 cases of Grahani Roga, after a detailed preliminary screening, are selected
for present work. The patients are administered with Yoga Vasti prepared with Dhanyapanchak
kwath as Nirooh Vasti & Vidangadi tail as Anuvasana Vasti, so that we can contribute a safe and
effective ayurvedic management for Grahani Roga.
The patients are selected randomly from O.P.D. of Rishikul Govt. P.G. Ayurvedic College &
Hospital, Haridwar (U.K.). A 32 days complete course of Vasti karma is consist 8 days Vasti
karma and after 16 days interval the next course of 8 days of Vasti is performed–
Day 1 to 8 - Vasti
Day 9 to 24 - Parihaar kaal
Day 25 to 32 – Vasti
The follow ups and assessment of the patients are done on 30days and 60 days after the complete
Vasti karma.
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DESIGN OF THE STUDY: To study in detail and for the purpose of convenience the plan of
study was divided into following sections:
1. The first part – (Conceptual study)-:
Various Ayurvedic and Modern textbooks, journals, previous and ongoing research works
related with the subject are thoroughly screened analyzed, summarized and referred for this part.
Conceptual study is mainly divided into following parts.
(1) Anatomical and Physiological review of Grahani

(2) Disease Review of Grahani Roga
 Ayurvedic Review
 Modern Review
(3) Vasti Review
The study deals with the historical glimpse. It is obvious that ―Grahani‖ is well described in
Ayurvedic text .Any description regarding Grahani in various Ayurvedic literatures is mentioned
here in this part. List of previous works on Grahani Roga is also presented in it. The study deals
with the literary aspect of Grahani Roga from Ayurvedic point of view as well as modern point
of view.
3. The Second part – (Drug Review)-: Drug review deals with detail description of ingredients
of the trail drugs. The details of the drugs are mentioned with their properties and
pharmacodynamics.
4. The Third part – (Clinical Study)-: Clinical study deals with need and plan of study, bio
statistical reports, clinical observations and results.
i. Patients suffering from Grahani Roga were selected from OPD of Rishikul Ay. Hospital
of Haridwar.
ii. Drugs used for clinical trial as Yoga Vasti – Dhanyapanchak kwath & Vidangadi tail.
iii. A special research Proforma was designed for the present study.
iv. A suitable scoring pattern was adopted for the assessment of clinical trial
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5. The Fourth part – (Discussion)-: In this part an illustrative attempt has been made to point out
hidden facts in conceptual and clinical contrive.
6. The Fifth part – (Summary & Conclusion)-: This last chapter summarizes the extensive
profile of this work and provides conclusions which are presented at the end of study. Lastly this
thesis is adjunct with shloka, bibliography and research proforma.
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Conceptual study
“The worth of a book is to be measured by what you

can carry away from it.”
(James Bryce)
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CONCEPTUAL STUDY
ANATOMICAL & PHYSIOLOGICAL ASPECT OF GRAHANI

Etymology of the term Grahani
The derivation of the term Grahani has been from the Dhatu Graha which has different
meanings like,
xzg& bfr xzg.ks] xzkg;fr] xzgh;rs

vknkus
xzkg;fr] xzgfr
miknkus
vkdzers
शब्दिल्िद्रुम ¼ f}fr;ks Òkx% ½
The verb Grahane, Gruhnati, Gruhnite, or Grahayati and Grahati, all these verbs, which have
formed from the above cited, GRAHA in general, means ‗to catch‘ or ‗to get‘ or ‗to hold‘. The
verbs like Adane and Upadane have also the same meaning like, giving a base to a particular
thing. In all, it seems to denote the action of holding something firmly or mitigating the strength
of a particular subject. The verb Grhnati in the other form Grahini is attributed to Akramate i.e.
‗to invade upon‘. Pointing towards the invasion of this diseased condition on the Agni
Adhisthana (Base of Jatharagni) Grahani or it can be understood that Grahani invades upon
Amashaya for the process of digestion.
DEFINITION OF GRAHANI:
Almost all the Ayurvedic classics have described the organ - Grahani. It is unanimously
considered as an organ of digestion. According to Acharya Charaka : (Ch. Chi. 15/56-57) 1
Grahani is a site of Agni and is situated above Nabhi. It is not only a site of Agni but is also
supported and strengthened by it (i.e. Jatharagni). It receives the ingested food, which is retained
by it (i.e. Grahan), till the process of digestion, and after digestion it releases the food through
the sides of lumen to next Ashaya i.e. Pakwashaya. In abnormal conditions, when it gets vitiated
because of Mandagni, it releases the food in undigested form.
Acharya Charaka has defined Grahani as an organ of Mahasrotas which receives the consumed
food. And due to this function of the organ, it has been named as Grahani. Commenting on the
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functions of Grahani mentioned by Acharya Charaka, Chakrapani refers it as Grahanat iti

Dharanat. It means Grahani not only receives the food but it holds the food too.
In the opinion of Acharya Sushruta, the sixth Kalaa, described as Pitta Dhara-Kalaa is situated
between Amashaya and Pakwashaya, and it is stated to be Grahani. (Su. U. 40/169) 2
Acharya Vagbhata has supported both these opinions of Charaka and Sushruta and defined
Grahani as the organ of Mahasrotas, which receives the food and further he supported Acharya
Sushruta‘s opinion by saying that, Grahani is the site for Pittadharakala. 3
Here Acharya Vagbhata has denoted specificity about the organ Grahani. This is a very specific
description of the Grahani, Here Grahani is compared with an Argala and it is described as the
Argala (wooden bolt) of Bhuktamarga. 4
In Vaidyaka Shabdasindhu, Grahani is defined as Agnivaha Dhamanis.
In Madhukosha, the organ Grahani is defined as Agnyadhisthana Nadi.
In Sharangdhara Purva Khanda, the organ Grahani is defined as Pittadharakala or

Agnidharakala which lies in between other organs like Amashaya and Pakwashaya.
ANATOMICAL ASPECT OF GRAHANI:
Grahani is an important organ situated in the Mahasrotas (i.e. alimentary canal or

gastrointestinal tract) and it receives and holds the ingested food. Almost all the ancient
Acharyas have described the location of Grahani differently. Acharya Charaka states that
Grahani is situated above umbilicus, whereas according to Acharya Sushruta, it is situated
between Pakwashaya and Amashaya and is termed as Pitta Dhara Kalaa (Su. U.
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40/169).
A clear and precise anatomical description for the most of parts of the Mahasrotas, in which
Grahani is also mentioned, has been furnished in Charaka Samhita and described by Vaidyaka
Sabda Sindhu as Annapaka-Nadi. It is called as Annapaka-Nadi because it is concerned with the
digestion of food. It is composed of Kalaa and Peshi its upper part is known as Mukha and the
lower part as Guda. The part of Nadi, which extends from Kantha above and the Amashaya
below, is known as Anna-nadi (oesophagus). It is placed at the back of Shwasa-nalika. This tube
is composed of two layers, the outer layer is of longitudinal - Mamsa Kalaa and the inner one of
circular Mamsa Kalaa and is having Shleshma Sravi-Kalaa (mucous membrane) At its lower
portion it pierces through Mahaprachira and joins the Jathara. Mahaprachira is a thick sheet of
Mamsapeshi and Snayu which separates the Uras and Udara, with its convexity towards the
chest and concavity towards abdomen. Under its concavity lie the Yakrita, the right side Jathara
and Pleeha on the left side. Jathara / Urdhva Amashaya is a big bulge of Mahasrotas, forming
base line for stasis of food; Saguha Avayava (hollow organ).
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It is placed on the left side of the upper abdomen and extends towards the centre and also
downwards. Behind it, is Pleeha and in between these two, lies the Taila Vartika. At both ends
of this organ (Jathara), there is a ring of Sushira Snayu (circular ligaments), which by its action
can close the passage, hence called Argala or Mudrika (sphincter). The upper Mudrika is
designated as Hardika-dwara Mudrika (cardiac sphincter) as it is nearer to heart and the lower
Mudrika is called the Grahani-dwara Mudrika (pyloric sphincter) which marks the beginning of
Grahani. Grahani is the continuation of Urdhwa Amashaya (stomach), extending about 25 cm. It
is also the first part of Kshudrantra (small intestine).
The Mudrika at its beginning being the powerful one, which holds the food about 2½ to 3hrs, to
remain in the Urdhawa Amashaya (hence the name Grahani) and latter allows it to pass slowly. The
two separate Nalikas one from Yakrit Pittashaya and another from Taila Vartika open inside the
Grahani, so as to discharge Pittas produced by them (hence the name Pitta Dhara-kalaa for
Grahani) to be mixed with food. Grahani is very important organ of Annavaha-srotas as Ahara
Paka is greatly dependent upon its function.
Adho-Amashaya (Pachyamanashaya) is the further continuation of tube and is about 6.5 meters
long, lying in loops and coils in the centre of abdomen and held in position by the Vapa
(omentum) to Urdhwa Amashaya, it is thin, but has the same structural pattern of three layers.
The inner most layer i.e. Sleshmasravika Kalaa is arranged horizontally in folds of quick
succession. This layer has innumerable Sukhsma Srotansi called the Rasayanis (lacteals and villi)
by which Ahara Rasa is absorbed. Unduka is the place of junction of Kshudrantra with
Brihadantra. Here also there is Mudrika made of Sushira Snayu. About 5 cm below this junction,
a small tail like or worm like projection is seen arising from Brihadantra and is called Unduka
Puchcha or Antra Puchcha.
After this structure Pakwashaya or Brihadantra starts which encircles the whole of Udara.
Pakwashaya terminates finally in to Uttara Guda (rectum) and Adhara Guda (anus), last
terminal of Mahasrotas which opens to the exterior (Bahirmukha). Here also a Sushira-Snayu
Mudrika (sphincter) functions as Argala, controlling the passage of Purisha. Yakrit is a solid
organ outside Mahasrotas, located in Dakhsina Anuparshwa Pradesha (right hyprochondrium),
and underneath this is the Pittashaya. Both Yakrit and Pittashaya are connected with Mahasrotas
by a common tube (common bile duct which opens in to the Grahani (duodenum). Tail- Vartika
resembling big wick soaked in oil, being made up of Medodhatu. It is located outside
Mahasrotas in the Vama Anuparshwa Pradesha (left hypochondrium) in between the Urdhva
Amashaya and Pleeha. It is connected to Grahani by its own Nalika known as pancreatic duct.
According to Acharya Sushruta, Grahani is situated between Pakwashaya and Amashaya and is
termed as Pittadhara Kalaa. Pittadhara Kalaa is so called because this "Kalaa" bears Pitta
(Agni i.e. digestive enzymes). The media between Dosha, Dhatu and Mala is described as the
Kalaa. Still there is difference of opinion regarding Kalaa. It is also described as membrane
which separates the ‗Dhatus‘ and 'Ashayas' and is named as Pittadhara Kalaa and is considered
as Grahani by ancient Acharyas. (Dwarkanth C. 1967).
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Acharya Sushruta says, the integrity of Grahani depends upon Agni and later is located in the
former. Any impairment of Agni, involves the integrity of Grahani and vice versa. (Su. U.
40/170).5
Charka has used the term Koshta while explaining the process of digestion. He has said that the
food ingested is propelled in to the Kostha by Pranavayu (Ch. Ch. 15/6).6
The various definitions and description regarding Grahani are cryptive and brief i.e. they are not
descriptive. This has led to considerable controversies regarding the actual location of the
structure described as Grahani and functions performed by it. Hence it is essential to have a
careful analysis of four distinct views presently offered by the persons in the field of Ayurveda.
The views are summarized as follows:
Grahani is
1. Duodenum
2. Whole of small intestine with its mucous membrane
3. Extending from pylorus to ileocaecal junction, including two sphincters.
1. Duodenum as Grahani:
According to Charak Samhita, Grahani is seat of Agni and is situated above Nabhi. Author in
Vaidyaka Shabda Sindhu has clearly mentioned that the first part of the intestine, which is seat
of Agni, is Grahani. It is part of intestine extending from pylorus and ending with jejunum where
the main digestive secretions i.e. bile from liver and gall bladder and pancreatic juice from
pancreas mix together to give nearly all properties of Pachaka Pitta, hence it should be
considered the main seat of Agni (Pachaka Pitta).
In fact, the process of digestion initiates in the stomach, but the food is not completely digested
there. It can be said that Amashaya provides the food in such a form that it becomes easy to
complete the digestion in intestine. This is supported by Acharya Charaka also. (Ch. Chi.
15/10)7. The location of Grahani stated by Charaka is also in favor of duodenum. No doubt that
the functions described to Grahani are more are less, performed throughout the small intestine,
but the operative and controlling role played by the duodenum is of main importance.
2. Small Intestine with Mucous Membrane as Grahani:
In Ayurvedic classics, the functions of Grahani are described as, retaining, digestion and
separation of Sara and Kitta out of digested food. These functions have similarity with functions
of small intestine describe in modern science. This supports the concept of the interpretation of
Grahani as small intestine. Pachaka Pitta (Agni) or digestive secretions are also located between
submucous coat and inner mucosa of small intestine.
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3. Grahani as Pylorus to Ileocaecal Junction:
This concept is about the corresponding location of Grahani. Urdhwa Amashaya (stomach) is the
organ, which extends from cardiac sphincter of stomach to the pyloric sphincter, and the Adho-
Amashaya is a region which extends from pyloric antrum to ileocaecal valve, from where
Pakwashaya starts. Ayurvedic Acharyas have strongly recommended that Grahani lies between
Amashaya and Pakwashaya, in the view of observed fact.
 Pyloric sphincter helps in retaining the food in the stomach as temporary storage allowing
good time for the digestive enzymes to act and the production of acidified chyme.
 The duodenum exercises a regulating control over the secretion of some of important
digestive juices. Secretions from the gall bladder and pancreas are released into the
duodenum through a common structure, the hepato-pancreatic ampulla and the opening
into the duodenum is guarded by the hepato-pancreatic sphincter (of Oddi). The
remaining part of the Grahani, corresponding to jejunum and ileum, are lined with
Pittadhara Kala, which furnishes the essential components of Jatharagni, responsible for
the completion of Anupaka, which later forms the essential aspect of Jatharagni Vyapara.
In the small intestine the digestion of all the nutrition is completed. Carbohydrates are
broken down to monosaccharides. Proteins are broken down to amino acids. Fats are
broken down to fatty acids and glycerol.
In addition, the formation of Sara (Ahara Rasa) and separation of Sara from Kitta i.e.
indigestible residue of food also takes place in this area. The Sara bhaga fraction is retained in
this region for the duration of the time required for its Soshana (absorption), while Kitta fraction
is propelled downwards into Pakwashaya, under the influence of Samana Vayu. Thus, the entire
small intestine commencing from the antrum of the pylorus including pyloric sphincter and
extending up to the ileocaecal sphincter represent a total entity known as Grahani.
PHYSIOLOGICAL ASPECT OF GRAHANI:
The food, after being swallowed, moves down the Anna nalika, passes through the Hardika-
dwara Mudrika and reaches the Jathara or Urdhwa Amashaya. Movement of the food through
this tube downwards is brought about by Prana Vayu; whereas movement of gas or air from the
Jathara upwards is known as Udgara is attributed to Udana Vayu.
The food which has reached the Jathara is retained there for 2 to 3 hrs. Here quantity of
Kledaka Kapha (mucin) and Pachaka Pitta (hydrochloric acid) increase considerably Kledaka
Kapha in the beginning and Pachaka Pitta afterwards. Kledaka Kapha (mucin) breaks down the
food material in to finer particles (Bhinna-sanghata), soaks it thoroughly and imparts the
necessary fluid consistency (Klinnata) so that Pachaka Pitta can penetrate into every particle of
food and bring about Paka. This phase of predominance of Kapha is called Madhura-avastha
Paka and is the first phase of Ahara Paka.
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After this, the fraction of Pachaka Pitta which has increased by this time initiates the second
phase known as Amla-avastha Paka or Shukta Paka. The Pitta enters into the finer particles of
food and brings about Paka in both its aspects - Parinamana (physical change) and Pravritti
(chemical change). When Amla-bhava has reached its maximum, Grahani-dwara Mudrika
(pyloric sphincter) opens allowing food to pass slowly into Grahani. Actions of two Mudrika
and contraction of Jathara helps in increased production of Kledaka Kapha and Pachaka Pitta is
stimulated by Samana Vayu.
 Bhinna-sanghata of food is by Kledaka Kapha.

 Udgara or belching i.e. movement of gas or air upwards is by Udana Vayu.
 Paka is by Pachaka Pitta.
 Sandhukshana of Agni by Samana Vayu.
When the food passes slowly through Grahani, two fractions of Pitta one from Yakrita and
Pittashaya (i.e. bile from liver and gall bladder) and another from Taila Vartika (pancreatic
Juice) get mixed with it. The process of Paka continues further as the food passes in to the
Kshudrantra or Adho-Amashaya. The food, which is thick liquid now, is slowly moved
throughout the length of Kshudrantra. This part of Antra also gives out its own Pachaka Pitta
(intestinal juice) to be mixed with food. The movement of food is always in forward direction
(Purassarana), a small segment of the intestine contracting and pushing the contents forwards
(peristaltic movements). By the time the food comes the second half of Ksudrantra,the process
of Paka will have been almost completed, Sara bhaga and Kitta bhaga separated.
The Sukshma Srotansi (Villi) present in the Sleshma Sravikalaa (mucous membrane) begin to
absorb the nutrient portion (Rasa Shoshana) while some amount of water and the residue of food
are left over, which slowly moves through the Unduka Mudrika (caecum) Argala to the
Pakwashaya. Much of the water and nutrient portion of food having been absorbed already, the
material that comes to Pakwashaya mainly consists of Kitta of Ahara and degraded Pitta. This
material here undergoes third Avastha-paka the Katu bhava. The Pitta, now of a degraded
nature, helps for the easy movement of material (Sarattwa) imparts yellow color (Mala Ranjana)
and bad smell (Durgandha) to the contents.
This bulky material is slowly moved throughout the three portions of the Pakwashaya i.e.
ascending, transverse and descending colon, and is allowed to stay in the Uttara-Guda for some
hours and latter expelled as Purisha some quantity of gas called as Adho-Vata is also produced
during the course of digestion and is expelled along with Purisha or even separately. This act is
facilitated by Apana Vayu.
IMPORTANT FACTS ABOUT GRAHANI:
After going through the definition, etymology and anatomy and physiology of the Grahani, it
seems that there are few important facts regarding Grahani, which are very important in
understanding the concept of Grahani Roga.
20
Agni Adhisthana
Pittadhara Kala
Argala
Main Functions of Grahani
1. Agni Adhisthana:
Grahani and Agni are said to have Adhar Adheya Sambandha. Proper functioning of one element
will ultimately boost the proper functioning of other and further combined effect of these two
will produce all the needed Bhavas for the body.
Supporting the above mentioned concept of Adhara Adheya Sambandha, Acharya Charaka has
quoted that Grahani makes process of digestion convenient and it gives strength to the functions
of Agni too. (Ch.Chi.15/56)8.
So, it has been concluded, that Bala of Grahani is the Bala of Agni and Vise a versa. So any
defect or pathology in the functions of any one of these two, will lead to diseased condition.
(A.Hr.Sa.3/53) 9
2. Pittadharakala Adhisthana:
Acharya Sushruta and Vagbhata have mentioned Pittadharakala and which is said to be situated
at Grahani. Further it is commented that it does the function of digestion.10
In Ayurvedic text, Pitta and Agni both of these factors have been considered as same entities, at
least in the context of process of digestion. Of course with some specificity, It is said that Pitta,
like of all the other Sharirika Bhavas, is made up of Panchamahabhuta. In the process of
digestion it leaves its Dravatwa due to the influence of dominant Tejas Guna. Now it is
considered as an Agni and further it takes a major part to digest the food.
Out of these five types of Pitta dosha the Pitta situated at the site of Pittadharakala or Grahani
is specifically named as Pachaka Pitta. It is considered as the most important of all these Pitta,
as it is said that this Pachaka Pitta not only plays a vital role in the process of digestion. 11
It can be said that, Pitta or Agni is situated at the site of Grahani. This transforming ability of
Pitta or Agni can perform their proper function because of the Adhara provided by the Grahani.
Acharya Sushruta has defined Kalaa as Dhatwashayantara Maryada, means Kalaa is the
structure which intervenes between Dhatu and Ashaya. From available description of this
structure, it is seen that Kalaa resembles in some respects, the semi permeable membrane and in
other respects the mucosal lining of hollow visceral organs. In the present context the description
of Pittadhara Kalaa would appear to refer to the lining membrane and in special to the lining
membrane of gastrointestinal tract extending from pyloric region up to ileocaecal region, in fact,
21
the lining or mucosal membrane (including submucosa) of small intestines. In addition, it not
only serves the purpose of a covering membrane but also -
(a) As a system of glands which provides necessary digestive enzymes
(b) As a surface on which various kinds of digestive reaction takes place
(c) As a surface from which absorption of the digested Ahara-Rasa take place.
Argala 12
The organ Grahani is specifically, denoted as, Argala. On the opinion of Astanga Hridaya,
Acharya Arundatta has commented for described Argala as, Argala is the thing, which is used to
close or to block or to obstruct the way. It can be understood by a very common example, which
everyone has experienced in daily routine. By the help of which the doors of a cupboard is closed
and opened, is termed as an Argala in olden days or in many part of the country today also, A
wooden bolt is used to close the doors or way of the house. This bolt is known as an Argala.
Acharya Arundatta explains the whole process. The consumed food travels through, mouth then
to Kanthnadi, and then it travels further down and enters in to the Kostha i.e. Annavaha srotas
and here due to the obstruction produced by Argala i.e. Grahani that consumed food is
obstructed for the process of digestion. In other words at this place of Argala, food is obstructed
and so this part is also said to receive the food and so termed as Grahani or Annadhisthana.
MAIN FUNCTIONS OF GRAHANI:
From the above description, it seems that Grahani (duodenum including small intestine)
performs the following functions –
 To receives to food
 To hold the food
 To help in the process in digestion.
 To provide adequate time to digest the food.
 To provide beneficial factors like Ayu, Varna, Bala, Swasthya etc.
These functions can be discussed one by one, but generally, Grahani‘s main functions remain
confined to the process of digestion.
1. To receive food: Grahani being situated between Amashaya and Pakwashaya. The
ingested food travels from mouth to Kantha and Annanalika and finally received by Amashaya
(Jathara) by closing Grahani-dwara Mudrika. In this way Grahani receives the food.
2. To hold the food: As it is described that; Grahani obstructs the food in between Amashaya
and Pakwashaya. Here it holds the food for the further digestive functions.
22
3. To help in the process of digestion: It is already mentioned that, Grahani is termed as Agni
Adhisthana or Pittadharakala Adhisthana. Pitta or Agni is the main entities in the process of
digestion. It can be concluded that Grahani, helps in the process of digestion.
4. To provide adequate time for digestion: For any process, time is required to complete it.
Grahani has the main digestive factors as well as the consumed food, which is received and
remained at Grahani. It plays an important role of providing enough time to that digestive
powers to work on the consume food for the proper digestion.
5. To leave digestive food further: This is peculiar function of Grahani. It expels out the well
digested food further into the Pakwashaya. It holds the food till the food reaches this stage. As
food reaches this stage, it is sending in to Pakwashaya for further transformation.13
6. To provide beneficial factors : Agni is located in the Grahani, plays very important role in
the process of digestion, similarly proper digestion produces number of essential factors which
are beneficial for the body in maintaining of Swasthya. So it is well established fact that Ayu,
Varna, Bala, Swasthya, Upachaya, Prabha, Dhatu, Oja etc. depends on Agni which is located in
Grahani.
DOSHAS CONFINED TO ORAGAN - GRAHANI:
After understanding the concept of Grahani in Ayurvedic science, next point which should be
considered is Doshas concerned to Grahani Roga. It is said that Doshas are everywhere in the
body but on the basis of the particular functions that they produce, the Doshas are named
accordingly; Samana Vayu, Pachaka Pitta and Kledaka Kapha are the Doshas, which are
confined to the organ Grahani. Their role in the proper functioning of Grahani is to be
considered.
1. Kledaka Kapha14
Kledaka Kapha is one of the five types of Kapha dosha. Out of these five types, Kledaka Kapha
is related to Grahani. It is described to be associated with Amashaya. The peculiar function of
Kledaka Kapha is mentioned as Annasamghatasya Kledanatwat that means Kledaka Kapha get
mixed with the consumed food when the food reaches Amashaya and it acts on the Samghata or
the consistency of the food.
2. Pachaka Pitta 15
Pachaka Pitta is one of the five types of Pitta dosha. Out of these five types, Pachaka Pitta is
related to Grahani. It is described to be situated in between Amashaya and Pakwashaya.
Physiologically in the process of digestion it plays a major role; it is made up of
Panchamahabhuta. In digestion process it leaves Dravatwa due to influence of dominant Teja
factor, Now (Pachaka Pitta) is named as Agni and with the help of other factors like Vayu and
23
Kleda, it not only digests the food but it also differentiates the digested food between Sara and
Kitta bhaga and it also gives strength to other types of Pitta dosha too.
3. Samana Vayu 16
Samana Vayu is one of the five types of Vata dosha. Out of these five types of Vata dosha,
Samana Vayu, is concerned with Grahani. It specifically described as Agnisamipastha its
specific place is quoted as Graha.
As Samana Vayu is situated around Agni, It‘s the nature of vayu to give strength to the Agni and
here same function is carried out by Samana Vayu and ultimately by doing this it takes part in the
actual process of digestion. In Amashaya, Kledana of the samghata of food is done by Kledaka
Kapha, this Samghata is further disassociated by Samana Vayu by virtue of which, each and every
particle of the food is exposed to the Pitta or Agni and digestion and transformation of that
individual atom of food is made possible.
Further, after the process of digestion is over, Samana Vayu carries out the function of expelling the
waste form of digested food to next the Ashayas. As already described this function i.e. expelling the
well digested further into the Pakwashaya is mentioned under function of Grahani too. So, it can be
considered that because of Samana Vayu only, Grahani carries out this function.
Samana Vayu is very much similar to the functions performed by the intrinsic nerves of stomach
and intestines. Modern researches show that there are numerous nerves present in the walls of
stomach, intestine and esophagus.
These nerves connect gastrointestinal tract anatomically and functionally with the brain and
spinal cord. Muscular layer of GIT consists of two layers of smooth (involuntary) muscle.
Muscle fibers of outer layer are arranged longitudinally, and those of inner layer are arranged in
circular manner. Between these two muscle layers are blood vessels, lymph vessels and nerve
plexus of sympathetic and parasympathetic nerves called myenteric or Auerbach's plexus.
These nerve plexus make up a diffuse mesh work of nerve tissue and serve as a decentralized or
peripheral brain by which intestinal movements are controlled. Contraction and relaxation of
muscle layers occurs in waves which push the contents of tract onwards.
This type of contraction of smooth muscle is called peristalsis. The submucosa of tract also has
nerve plexus called submucosal or Meissner's plexus consisting of sympathetic and
parasympathetic nerves. Myenteric or Auerbach's nerve plexus and Meissner's nerve plexus
exerts a regulating effect on gastrointestinal peristalsis, which is of utmost importance in the
process of digestion, in the same way, as the description of the influence exerted by Samana
Vayu on the process of digestion.
The above description provide an explanation of the function of Samana vayu viz. Anna-pachana
or enabling the digestion of food, Anna-vivechana or separation of the nutrient fraction from the
24
residual fraction, which is still to be digested or if undigested, the expulsion or Munchana of this
fraction to the subsequent segment of the intestine. Where by churning movements followed by
the peristaltic waves, the process of digestion is continued without interruption, until final
digested residue is passed down in a semisolid state into Pakwashaya.
CONCEPT OF PACHANA:
The Pitta or Agni which digests the food is called Pachaka Pitta, which is located between
Amashaya and Pakwashaya and works there. Though its constitution is Panchabhautik but still it
is predominantly Teja in quality. As a result of its Teja prominent quality, it gives up its liquid
nature and performs the function of digestion, transformation, and combustion etc., which gives
it to be named as Anala or fire (As. Hr. Su. 12/11) 17. After digesting the food, it converts the
same into Sara and Kitta. This Pitta though keeping itself confined to its area, oblige other Pitta
by sending its moieties to them.
Pachana in Grahani:
By the term ―Jatharagni paka‖ means the digestion of food under the influence of Jatharagni.
The Prana Vayu, whose function is to ingest food, draws it into stomach. There it is mixed with
digestive juices, broken up and on being mixed with unctuous substance, becomes softened.
Then the Jatharagni being agitated and carried by Samana Vayu digest the ingested food of
appropriate quality, taken in required quantity and in right time (Ch. Chi. 15/7) 18.
Ahara Dravya are Panchabhautik and digestion of different types of food stuffs
(Panchbhutatmak) takes place in the organ - Jathara with the help of Pachaka Pitta at different
intervals and it is completed in the small intestine (Ch. Chi. 15/57). The changes taking place in
Ahara Dravyas in different organs is termed as Awastha-paka. It takes place in three stages i.e.
Madhura, Amla and Katu (Ch. Chi. 15/9-10) 19, 20. After Jatharagni paka, the food undergoes
complete change which is called Vipaka (As. Hr. Su 9/20)21.
Vagbhata in Astanga Sangraha (As.Sa. Sa. 5/78-79) and in Astanga Hridaya (As. Hr. Sa. 3/59-
60) has clearly described the steps leading to Bhutagni- paka and according to him, the
separation of Sara and Kitta takes place after the completion of Bhutagni paka. According to
Charaka, the formation of Sara and separation of Kitta occurs at the end of Jatharagni-paka and
Dhatvagni-paka.
Then the food reached in Pakwashaya and dehydrated by the Vata and Agni is converted into
formed feces. These being pungent in taste, lead to increase in Vayu. The Avastha-paka gives an
idea of the form of food received by Grahani, Which is partially digested. In this stage, food is
digested in the presence of Pachaka Pitta which is liquid in consistency; but due to
predominance of Agni Mahabhuta, Pachaka Pitta loses the quality of liquidity and acts as fire
and digests the food. At the final, substances after Jatharagni-paka are converted in Vishishta-
paka i.e. Vipaka which depends upon the Rasa of Dravya ingested.
25
1. Avastha Paka:
Ingested Ahara Dravya undergoes through different stages of digestion in Kostha is called
Avastha-paka. Charaka has described two terms, i.e. Prapaka and Vipaka. Prapaka is defined as
Prathama Paka (Ch.Chi.15/9) 19 i.e. first outcome of Paka or chemical action. Vipaka has been
defined as the outcome of Jatharagni on the Ahara which has been already subjected to
Prathama Paka (As. Hr. Su. 9/20) 21. This Vipaka is judged from the Rasa assumed as the end
product of gastrointestinal digestion viz. Madhura, Amla and Katu. Digression into the nature of
Dravyas becomes necessary in view of the description of the products which present the final
outcome of Jatharagni-paka in terms of Rasa.
The main point to be noted here is the fact that change in Rasa is directly correlated with the
change in composition of Dravyas, brought under the influence of Jatharagni. Thus Ahara-paka
in the Kostha may be stated to proceed in the order as Madhura, Amla and Katu Bhavas
respectively.
(I) Madhuravastha Paka:
As soon the food enters the mouth, it comes in contact with Bodhaka Kapha, which leads to the
perception of taste. The property of Bodhaka Kapha, which is mainly fluid, is to dissolve food
substances, otherwise the sensation of taste cannot be judged or felt. The outcome of action of
Bodhaka Kapha on food, which is essentially Madhura in taste is seems to be continued and
completed in Urdhva-amashaya. In this stage, the insoluble Madhura portion of food (starch)
become sufficiently soluble and mixed up with Kledaka Kapha present in the Urdhva-amashaya.
The fraction of Ahara Dravya which is meant to undergo Amla Bhava, remains in this stage up to
mixing with Kledaka Kapha and further Kledaka Kapha makes the food particles Klinna. Thus it
is seen that all Ahara Dravyas, of all kinds attain Madhura Bhava as soon as they reach the
Adho-amashaya.
(II) Amlavastha Paka:
This is the second stage of Avastha Paka. This is brought about by the secretion of AcchaPitta in
Adho-amashaya (duodenum). This stage is not related to anything to do with the digestion of the
substances which possess Madhura rasa. In this sage food stuffs remains partially digested i.e.
the digestion is still incomplete. Charaka has stated this stage as Vidagdha- avastha (Ch. Chi.
15/10) 20. Chakrapani interpreted this term as Pakva-Apakvam or Kinchid Pakvam, Kinchid
Apakvam.
The Ahara in this stage is not fit for absorption and utilization for Bhutagni paka and Dhatvagni
paka. The Ahara which has now attained Amla Bhava is propelled into next lower portion of the
Mahasrotas where Accha Pitta is stated to be secreted.
The term ―Accha‖ has been interpreted by Chakrapani Dutta and Gangadhar Sen as "Aghana"
and "Swachha" - means thin and clear respectively (Chakrapani and Gangadhar on Ch. Chi.
15/10). Accha Pitta would, therefore, represent a total concept of Pachaka Pitta or Jatharagni.
26
(III) Katuavastha Paka:
When food reaches Pakwashaya, it gets dried by the heat of Jatharagni and is rendered in the
form of lumps. In this stage, Ahara assumes Katubhava and formation of Vayu takes place (Ch.
Chi. 15/11).
Chakrapani Dutta commented on the above verse clearly as "Paripindita-Pakwashaya" means

the change of material present in Pakwashaya to form the lumps, in the process of formation of
Mala (Ch. Chi. 15/11 commented by Chakrapani).
2. Nishta Paka (Vipaka):
There is no clear cut definition of this phenomenon as mentioned by Charaka and Sushruta. But
detailed description can be found. By the word ―Vipaka‖ itself explains that it is different from
other type of Pakas. i.e. Vishishta Paka Vipaka Vagbhata in Astanga Hridaya has explained as
the Rasa which goes to another Rasa after the end of Jatharagni paka is Vipaka (AsHr.Su. 9/20)
21
. Charaka has described Vipaka as Vipaka Karmanisthaya i.e. Vipaka is the completion of
action (Ch. Su. 26/66) 22. The difference between Avastha paka and Nishta-paka has been
described by Hemadri, another commentator of the same treatise.
The description given by him is the three Avastha-paka come to an end before the complete
action of Jatharagni, where as Vipaka is formed after the completion of Jatharagni paka.
According to Chakrapani-Dutta, Guna which produced at Nishta Kaala (particular time) after the
coherence of Jatharagni into the food, is Vipaka. (Chakrapani on Ch. Su. 26/28)
27
THE DIGESTIVE SYSTEM:
The digestive system is a collective name used to describe the alimentary canal with some
accessory organs and a variety of digestive process which takes place at different levels in the
canal to prepare food eaten in the diet for absorption. Alimentary canal begins at the mouth,
passes through the thorax, abdomen and pelvis and finally ends at the anus.
The complex digestive process gradually breaks down the food eaten until they are in a suitable
form for absorption. Chemical substances or enzymes which effect these changes are secreted
into the canal, by specialized glands, some of which are in the walls of the canal and some are
outside the canal, but with ducts leading into it. After absorption, nutrients are used to synthesize
body constituents; they provide raw materials for the manufacturing of new cells, hormones and
energy needed for these and other processes and for the disposal of waste materials. The
activities of the digestive system can be grouped under five headings.
1. Ingestion: This is the process of taking food into the alimentary canal.
2. Propulsion: This moves the content along the alimentary tract.
3. Digestion: This consists of:
28
 Mechanical breakdown of food e.g. mastication (chewing)
Chemical digestion of food by enzymes present in secretion produced by glands and accessory
organs of digestive system.
4. Absorption: This is a process by which digested food substance pass through the walls of
alimentary canal and nutrient fraction is taken into blood and lymph capillaries for circulation
around the body.
5. Elimination: Food substances, which have been eaten, but cannot be digested and absorbed,
are excreted by the bowel as feces.
SMALL INTESTINE
The small intestine is a narrow tube, continuous with the stomach at pyloric sphincter and leads
in to large intestine at ileocaecal valve. It is approximately about 5 meters long and lies in the
abdominal cavity, surrounded by large intestines. In the small intestine, the chemical digestion of
food is completed and most of the absorption of nutrients takes place. The small intestine
comprises three main parts and continuous with each other.
1. Duodenum: It follows the stomach at pyloric sphincter and is about 25 cm long, C-shaped
structure which curves around the head of pancreas. Secretions from gall bladder and pancreas
are released into the duodenum, through a common structure, the hepato-pancreatic ampulla, and
the opening into duodenum is guarded by the hepato-pancreatic sphincter, commonly known as
sphincter of Oddi.
2. Jejunum: The jejunum is the middle part of small intestine and is about 2 meters long. Its wall
is thicker and more vascular than that of ileum.
3. Ileum: The ileum or terminal section forms the lower part of small intestine. It is about 3
meters long and ends at the ileocaecal valve, which controls the flow of material from the ileum
to the caecum, the first part of large intestine, and prevents regurgitation.
STRUCTURES OF THE SMALL INTESTINE:
The walls of the small intestine are composed of four layers of tissue as described earlier in the
layer of stomach with some modifications of the peritoneum and mucosa. The description is as
follows:
1. PERITONEUM:
A double layer of peritoneum called mesentery attaches the jejunum and ileum to posterior
abdominal wall. The large blood vessels and nerves lie on the posterior abdominal wall and
branches to the small intestine pass between the two layers of mesentery.
2. MUCOSA (MUCOUS MEMBRANE LINING):
29
The surface area of the small intestine mucosa is greatly increased by permanent circular folds;
villi and microvilli. The permanent circular folds, unlike the rugae of the stomach, are not
smoothed out when the small intestine is distended. They promote mixing of chyme as it passes
along these circular folds are known as plicae circulars. The villi are tiny finger like projections
of the mucosal layer into intestinal lumen, about 5 to 1 mm long. Their walls consist of columnar
epithelial cells or enterocytes, with tiny microvilli on their free border. The goblet cells that
secrete mucous are interspersed between the enterocytes. These epithelial cells enclose a network
of blood and lymph capillaries. The lymph capillaries are called lacteals because absorbed fat,
gives the lymph milky appearance. Absorption of nutrients takes place in the enterocytes before
entering the blood and lymph capillaries.
The intestinal glands are simple tubular glands situated below the surface between the villi. The
cells of the gland migrate upwards to form the walls of villi replacing those at the tips, as they
are rubbed off by the intestinal contents. The entire epithelium is replaced every 3 to 5 days.
During migration the cells from digestive enzyme that lodged in the microvilli, and together with
intestinal juice, complete the chemical digestion of carbohydrates, protein and fats.
Numerous lymph nodes are found in the mucosa at regular intervals throughout the length of the
small intestine. The smaller ones one known as solitary lymphatic follicles, and about 20 to 30
larger lymph nodes situated towards the distal end of the ileum are called aggregated lymphatic
follicles (Payer‘s patches). The lymphatic tissues, packed with defensive cells, are strategically
placed to neutralize ingested antigens.
FUNCTIONS OF SMALL INTESTINE:
The functions are:
 Onward movement of its contents, which is produced by peristalsis

 Secretion of intestinal juice
 Completion of chemical digestion of carbohydrates, protein and fats in the enterocytes of
villi
 Protection against infection by microbes that have survived the antimicrobial action of
hydrochloric acid in the stomach, by the solitary lymph follicles and aggregated lymph
follicles (Payer‘s patches)
 Secretion of hormone - cholecystokinin (CCK) and secretin.
 Absorption of nutrients.
Intestinal Juice or Succus entericus: About 1500 ml of intestinal juice is secreted daily by glands
of small intestine. If consists of
Water
Mucous
30
Mineral salts
Enzyme: enterokinase (enteropeptidase)
The pH of intestinal juice is usually between 7.8 and 8.0; it helps in raising the pH of intestinal
contents to between 6.5 and 7.5. Most of digestive enzymes in the small intestine are contained
in the enterocytes in the walls of villi. Digestion of carbohydrate, protein and fat is completed by
direct contact between these nutrients and the microvilli and within the enterocytes. Enterokinase
activates pancreatic peptidases such as trypsin which convert some polypeptides to amino acids
and some to smaller peptides.
The final stage of break down to amino acids of all peptides occurs inside the enterocytes. Lipase
completes the digestion of emulsified fats to fatty acids and glycerol partly in the intestine and
partly in the enterocytes. Sucrase, maltase and lactase complete the digestion of carbohydrates
converting disaccharides such as sucrose, maltose and lactose to monosaccharides inside the
enterocytes.
PANCREAS
The pancreas is a pale grey gland weighing about 60 gm. It is about 12-15 cm long and is
situated in the epigastria and left hypo gastric region. It consists of a broad head, a body and tail.
Head lies in the C-shaped curve of duodenum. The pancreas is both exocrine and endocrine
gland, the exocrine part of pancreas produce pancreatic juice containing enzymes that digest
carbohydrates, proteins and fats. The endocrine part of pancreas has specialized cells called islets
of Langerhans. The islets have no ducts so hormones diffuse directly into the blood. Islets of
Langerhans secrete hormones - insulin and glucagon, which are principally concerned with
control of blood glucose level.
Pancreatic Juice: Pancreatic juice secreted from the exocrine part of pancreas enters the
duodenum at hepato-pancreatic ampulla and consists of:
Water
Mineral salts
Enzymes
* Amylase
* Lipase
Inactive enzyme precursors
* Trypsinogen
31
* Chymotrypsinogen
* Procarboxypeptidase
Pancreatic juice is alkaline (pH 8), because it contains significant quantities of bicarbonate ions,
which are alkaline in nature. When acid contents of stomach enters duodenum they are mixed
with pancreatic juice and bile, and pH is raised between 6 to 8. This is the pH at which
pancreatic enzymes - amylase and lipase act most effectively.
LIVER
Liver is the largest gland in the body, weighing up to 1.5 to 2.3 kg. It is situated in the upper part
of abdominal cavity and occupies greater part of the right hypochondria, part of epigastrium and
extending in the left hypochondriac region. The liver has four lobes. The most obvious are the
right - large and the smaller wedge shaped - left lobe. The other two, the caudate and quadrate
lobes, are areas on posterior surface. The lobes of liver are made up of tiny lobules and are
hexagonal in outline and are formed by cubical shaped cells called hepatocytes, arranged in pairs
of columns radiating from a central vein.
Between the two pairs of columns of cells there are sinusoids (blood vessels with incomplete
walls) containing a mixture of blood from branches of the portal vein and hepatic artery. This
arrangement allows the arterial blood and portal venous blood to mix and come in close contact
with liver cells. Amongst the cells lining the sinusoids are hepatic macrophages (Kupffer cells)
whose function is to digest and destroy any foreign particle present in the blood flowing through
the liver.
One of the important function of liver is to secrete bile; the bile canaliculi run between the
columns of liver cells, means each column of hepatocytes has a blood sinusoid on one side and
bile canaliculi on the other. The canaliculi join up to form larger bile canals and finally they form
right and left hepatic ducts which drain the bile from liver
Bile:
Secretion of Bile: Bile is secreted by the liver, it contains no enzymes. The hepatocytes
synthesize the constituents of the bile from the mixed arterial and venous blood in the sinusoids.
These include bile salts, bile pigments, and cholesterol.
Composition and Functions of Bile:
About 500 ml of bile is secreted by the liver cells daily. Bile consists of
Water
Mineral salts
Mucous
32
Bile pigments mainly bilirubin
Bile salts, which are derived from bile acids i.e. colicacid and chenodoxycholic acid
The bile acids (colicacid and chenodoxycholic acid) are synthesized by hepatocytes from
cholesterol, conjugated (combined) either with glycerin or taurine, then secreted in to bile as
sodium or potassium salts. In the intestine they emulsify fats and help in fat digestion. In the
terminal ileum most of bile salts are reabsorbed and return to the liver through the portal vein.
Bilirubin is one of the products of haemolysis of erythrocytes by hepatic macrophages (Kupffer
cells) in the liver and other macrophages in the spleen and bone marrow. In its original form
bilirubin is insoluble in water and is carried in the blood bound to albumin.
In the hepatocytes it is conjugated with glucuronic acid and becomes water soluble before being
excreted in bile. Bacteria in the intestine change the form of bilirubin and most is excreted as
stercobilinogen in the feces. A small amount is reabsorbed and excreted in urine as urobilinogen.
GALL BLADDER
The gall bladder is a pear shaped sac attached to the posterior surface of liver. It has a fundus, a
body and neck which is continuous with the cystic duct. It acts as reservoir for bile, the right and
left hepatic ducts join to form common hepatic duct just outside the portal fissure. The hepatic
duct passes downwards about 3 cm where it is joined at an acute angle by cystic duct from the
gall bladder. The cystic and hepatic ducts together from the common bile duct which passes
downward behind the head of pancreas to be joined to main pancreatic duct at hepato-pancreatic
ampulla.
The opening of combined duct into the duodenum is controlled by hepato-pancreatic sphincter
(sphincter of Oddi). As the bile is secreted by the liver, it contains no enzymes and thus has no
chemical action on food. Its salts mainly, sodium glycocholate and sodium taurocholate, reduce
the surface tension of large fat droplets and break them into many small ones in the small
intestine. This process is called emulsification of fat. The small fat droplets present larger surface
area to lipases. This increases lipase action on fats.
LARGE INTESTINE (COLON), RECTUM AND ANAL CANAL:
Large Intestine: This is about 1.5 meters long, beginning at the caecum in the right iliac fossa
and terminate at the rectum and anal canal deep in the pelvis. Its lumen is large than that of small
intestine. It forms an arch round the coiled up small intestine. For descriptive purpose the colon
is divided in to the caecum, ascending colon, transverse colon, descending colon, sigmoid colon,
rectum and anal canal.
Caecum: This is the first part of colon. It is a dilated region which has a blind end inferiorly and
is continuous with the ascending colon superiorly. Just below the junction of the two, the
ileocaecal valve opens from the ileum. The vermiform appendix is a fine tube, closed at one end,
33
which leads from the caecum, is usually 13 cm long and has the same structure as the walls of
the colon, but contains more lymphoid tissue.
Ascending Colon: This passes upward from the caecum to the level of the liver where it curves
to the left at hepatic flexor to become transverse colon.
Transverse Colon: This is a loop of colon which extends across the abdominal cavity in front of
duodenum and the stomach to the area of spleen, where if forms the splenic flexor and curves
acutely downwards to become the descending colon.
Descending Colon: This passes down the left side of the abdominal cavity then curve towards
the midline. After it enters the true pelvis it is known as the sigmoid colon.
The Sigmoid Colon: This part describes an S-shaped curve in the pelvis and then continues
downwards to b1ecome the rectum.
Rectum: This is a slightly dilated section of the colon which is about 13 cm long. It leads from
the sigmoid colon and terminates in the anal canal.
Anal Canal: This is a short passage about 3.8 cm long in the adults and leads from the rectum to
the exterior. Two sphincter muscles control the anus, the internal sphincter, consisting of smooth
muscle fibers, is under the control of the autonomic nervous system and the external sphincter,
formed by skeletal muscle, is under voluntary control.
FUNCTIONS OF LARGE INTESTINE, RECTUM AND ANAL CANAL:
1. Absorption:
The contents of ileum which pass through the ileocaecal valve into caecum are fluid, even
though some water has been absorbed in the small intestine. In the large intestine, absorption of
water continues until the familiar semisolid consistency of feces is achieved. Mineral, salts,
vitamins and some drug are also absorbed in to the blood capillaries from large intestine.
2. Microbial Activity:
The large intestine is heavily colonized by certain types of bacteria, which synthesise Vit. K and
folic acid. They include Escherichia coli, Enterobacter aerogens, Streptococcus faecalis and
Clostridium perfringens. These microbes are commensals in humans. They may become
pathogenic, if transferred to other parts of body. e.g. Escherichia coli may cause cystitis if it
gains entry to urinary bladder. Gases in the bowel consist of some of constituents of air, mainly
nitrogen swallowed with food and drink and as a feature of some anxiety states. Hydrogen,
carbon dioxide and methane are produced by bacterial fermentation of unabsorbed nutrients
especially carbohydrates. Gases pass out of the bowel as flatus.
3. Mass Movement:
34
The large intestine does not exhibit peristaltic movement as it is seen in other parts of the
digestive tract. Only at fairly long intervals (about twice an hour) wave of mass movements takes
place.
4. Defecation:
Usually rectum is empty, but when a mass movement forces the contents of sigmoid colon into
rectum, the nerve endings in its wall are stretched. In the infant defecation occurs by reflex
(involuntary) action. However, some time in the second or third year of life, the ability to
override the defecation reflex is developed. In practical term this acquired voluntary control,
means that the brain can inhibit reflex until such time, as it is convenient to defecate. The
external anal sphincter is under conscious control through pudendal nerve.
Thus defecation involves voluntary contraction of muscles of rectum and relaxation of the
internal anal sphincter. Contraction of abdominal muscles and lowering of diaphragm increases
the abdominal pressure (Valsalva's manoeuver) and so assist the process of defecation. When
defecation is voluntarily postponed the feeling of fullness and need to defecate tends to fade until
the next mass movement occurs and reflex is initiated again. Repeated suppression of reflex may
lead to constipation.
Constituents of Feces:
The feces consist of semisolid brown mass. The brown color is due to the presence of stercobilin.
Even though, absorption of water taken place in the large intestine, water still makes up 60-70%
of the weight of feces. The remainder consists of
Fiber (indigestible cellular plant and animal material)
Dead and live microbes
Epithelial cells from walls of tract
Fatty acids
Mucous secreted by the epithelial lining of the large intestine.
Mucus helps to lubricate the feces and adequate amount of roughage in the diet ensures that the
contents of the colon are sufficiently bulky to stimulate defecation.
AYURVEDIC REVIEW OF GRAHANI ROGA

The "Grahani Roga" is the leading disorder of the gastrointestinal tract. As the hypo function of
Agni i.e. Mandagni is the root cause of all the disease. Due to various etiological factors of
35
Grahani Roga, the Grahani becomes impaired as a result of Dusti or Vitiation of Pacakaagni and
Samana Vayu.
Acharya Charaka has mentioned that- Functionally weak Agni i.e. Mandagni causes improper
digestion of ingested food, which moves either in Urdhva or Adho-marga; when it goes in Adho-
marga, then it leads to Grahani Gada. (Ch.Chi. 15/51) 1
Acharya Sushruta (in Uttara-sthana-40/168) 2 has mentioned that, patients of Atisara, during the
stage of Agnimandya, if indulge in injudicious diet, may lead to Grahani Roga.
Similarly Acharya Chakrapani, while commenting on Grahani Chikitsa has clearly mentioned
that Grahani is Ashraya and Agni is Ashrita. The Upachara for Grahani Roga is same as that of
Agni. (Chakrapani, Ch. Chi.15/7).
Aetiological Factors:
The pathogenesis of Grahani Roga revolves around Agnidosha. The relationship between Agni
and Grahani that stand both in physiological and pathological states is comparable to the
relationship that exists between structure and function. Any involvement of Grahani - like hyper,
hypo and perverse functions may result in a corresponding disturbance of Agni. But especially
mandagni predisposes Grahani Roga. Thus etiological factor of Agnidushti are the causes of
Grahani Roga. So Agnidushti is the main cause of Grahani Roga (Ch. Chi. 15/57) 3, (Ch. Chi.
14/245) 4.
NIDANA:
The true etiological factors, which are stated to bring about Agnidusti are (Ch. Chi. 15/42-43) 5,
(Su. Su. 46/508) 6.
1. Ahara :
1. Abhojana
2. Samashana, Vishamashana and Viruddhashana
3. Atibhojana
4. Indigestion due to
(a) Asatmya-Bhojana
(b) Atiguru-bhojana
(c) Sheeta-Bhojana
(d) Atiruksha-Bhojana
(e) Sandushta-Bhojana
2. Vishesha : Vyapada of
(a) Virechana
(b) Vamana
(c) Snehana
3. Emaciation or wasting brought about by other disease
4. Viruddha or Incompatibility of -
36
(a) Desha
(b) Kala
(c) Ritu
5. Vega-Vidharana
6. Mental, Psychological and Emotional instabilities like
(a) Irshya
(b) Bhaya
(c) Krodha
(d) Lobha
(e) Shoka
Similarly the aetiological factors responsible for production of Amadosha mentioned by Acharya
Charaka in Vimana 2/8-9 are also responsible for causing Grahani Roga.
PURVA RUPA OF GRAHANI ROGA:
It is doubtful if, in Grahani Roga, which is a long drawn condition, information relating to Purva
Rupa can be obtained from the patient.
The Purva Rupa of Grahani Roga can be tabulated as below:
(Ch.Chi. 15/54 7, Su. U. 40/173 8, A. H. Ni. 8/19-20 9)
Lakshanas. Ch. Su. A.H. M.N. A.S. Y.R. Dalh.

Trishna + + + + + + +
Alasya + + - + - + +
Bala kshaya + + - + - + +
Anna vidaha + - - + - + +
Chira paka + - + + + + -
Kaya guarava + - - + - + -
Vidaha - + - - - - +
Sadana - + + - + - +
Klama - + + - + - +
Aruchi - + + - + - -
Karna kshveda - + + - + - +
Aantra kunjana - + + - + - -
Angasada - - - - - - +
Pipasa - - - - - - +
Kasa - + - - - - -
Chhardi - - + - + - -
37
Bhrama - - + - + - -
Anutsaha - - - - - - +
Amlaka - - + - + - -
Praseka - - + - + - -
Vaktra vairasya - - + - + - -
RUPA OF GRAHANI ROGA:

According to various Acharyas, the signs & symptoms of Grahani Roga can be tabulated as
below,
Samanya Lakshana:
Symptoms Charaka 10 Sushruta 11 Vagbhata 12
Muhurbaddha-Muhurdrava - - +
Mala Pravriti
Ati Srushta Mala Pravriti + - -
Vibbadha Mala Pravriti + - -
Trishna + + -
Arochaka + + -
Vairashaya + + -
Praseka + + -
Tamaka + + -
Shuna Padakara + + +
Chardana + + -
Jwara + + -
Lohanugandhi Udgara + + -
Daha - + -
Karshya - + +
Loulya - + -
Dhumaka - - +
Murchha - - +
Shiroruka - - +
Vistambha - - +
Vishishta Lakshana:
Vataja Grahani:
Symptoms Charak 13 Sushrut 14 Vagbhat 15
38
Jirne jiryati cha adhmanam + - +

Bhukte Swasthyam + - +
Chirat srijet varcha + - +
Sadukh malapravriti + - +
Chirat Drava, Shushka + - +
Malapravriti
Ama Yukta, Sashabda, + - +
Saphena Malapravriti
Punah punaha srijet varcha + - +
Annam Pachate Dukham + - -
Shukta Paka + - -
Kharangata + - -
Kanth Ashya Shosha + - -
Kshudha + - +
Trishna + - +
Timira + - +
Karnayo Swanaha + - +
Parshva Ruja + + +
Uru,Vankshana,Griva Ruja + - +
Visuchika + - +
Hrida Pida + - -
Karshya + - -
Daurbalya + - -
Muka Vairashya + - -
Guda, Hrida Roga, Arsha + + +
Pandu Pliha Shanki
Mastishka Shoola - + -
Udara Shoola - + -
Kasa, Shwasa + + +
Pittaja Grahani:
Ajirna + - -
Nil Pitabha Mala + - +
Puti(Durgandhi), Amlodgara + - +
Hrida Kantha Daha/ Daha + + +
Aruchi + - +
Trishna + - +
Shoola + - +
39

Ajirna + - -
Nil Pitabha Mala + - +
Puti(Durgandhi), Amlodgara + - +
Hrida Kantha Daha/ Daha + + +
Aruchi + - +
Trishna + - +
Shoola + - +
Kaphaja Grahani:

Annam Pachate Dukham + - +
Bhinna, Ama Yukta Mala + - +
Shleshma Bhuyishta Mala + - +
Hrillasa/ Chhardi + - +
Arochaka + - +
Asyopadeha + - +
Sarvasharirguruta - + -
Asya Madhurya + - -
Madhura Udgara + - +
Peenasa, Kasa, Sthivana + - +
Udara Staimitya + - +
Sadana + - +
Akrushsyapi daurbalya + - +
Alasya + - +
Classification of Grahani Roga:
Types Ch.Sm. Su. Sm. A.H. M. N. Sh. Sm.

Vataj + + + + +
Pittaj + + + + +
Kaphaj + + + + +
Sannipatik + + + + +
Sangraha - - - + -
Ghatiyantra - - - + -
Amaja - - - - +
40
Sannipatik Grahani:
Nidana – Tridosha Prakopaka
Lakshana - The mixed symptoms of Vataja, Pittaja and Kaphaja types.
Sangraha Grahani:
In M. N. 4th chapter this condition of Tridosha Grahani is described. He explains the signs and
symptoms as below:
1. Antrakunjan
2. Alasya
3. Daurbalya
4. Sadan
5. Drava, Sheeta, Ghana (Sometimes), Snigdha, Malapravriti along with kativedana.
6. Ama, Bahu, Picchila, Sashabda, Malapravritti in large quantity associated with mild pain.
7. This condition aggravates in daytime and subsides at night
8. This is a chronic condition and difficult to cure
Ghatiyantra Grahani:
Symptoms
1. Pain in flanks while lying down
2. Gargling sound similar to the sound of filling a pot with water.
3. This condition is incurable
Sama and Niram Lakshana of Grahani-
This is considered to be similar to that of Atisara.
Sama laksana of Purisha –
Durgandhi
Picchilla
Sink in water.
Nirama laksana of Purisa –
Laghu
Floats on water
SAMPRAPTI OF GRAHANI ROGA
Agnidushti is the main cause of Grahani Roga. In this disease, due to Nidan sevan primarily
Jatharagni is especially vitiated. Because of Agnidushti, ingested food is not properly digested
and results in Apachana and Ama formation, the food attains Shuktapaka. At this stage, Doshas
(i.e. Kledaka Kapha, Pachaka Pitta and Samana Vayu) sheltered in the organ - Grahani gets
vitiated and mixed with Vidagadha ahara. The Shuktapaka stage leads to Annavisha. If the
41
proper care is not taken, then later it may spread in the whole body through rasa, and mixes with
Doshas, Dushya or Dhatus, this leads to Grahani Roga. (Ch. Chi. 15/44) 20
In Context of pathogenesis of Grahani Roga Acharya Sushruta stated that: Grahani Roga occurs
as a sequel of disease Atisara. A person who has been relieved of Atisara, but is still having
mandagni, if he takes injudicious food it leads to vitiation of Agni and then damages the organ
Grahani. This condition is calling Grahani Roga (Su.U.40/166) 21.
The Samprapti according to different classics is like –
In the beginning, Agnidushti occurs in mild form. Because of Agnidushti ingested food is not
properly digested and results in Apachana and Ama formation. Thus, the food attains Shuktata.
At this stage, dosha i.e. Kledaka Kapha, Pachaka Pitta, and Samana Vayu sheltered in the organ
Grahani gets vitiated. During this stage of indigestion and Shuktapaka the following symptoms
viz. Vistambha, Praseka, Arti, Vidaha, Aruchi and Gaurava are produced. (Ch.Chi. 15/73)22.
The Shuktapaka stage leads to Annavisha formation. Here indigested food undergoes
fermentative changes. Now in this condition food attains such a form that it becomes able to
produce so many ailments like poison does. Annavisha while, remaining in the Grahani and
spread in the whole body through Rasadi dhatus produces symptoms, Viz. Abdominal
distension, headache, fainting and giddiness, stiffness of back and lumber region, yawning,
malaise, morbid thirst, fever, vomiting, tenesmus, anorexia and indigestion of food. This is a
serious condition (Ch. Chi. 15/45-56). It is named as Grahani Roga.
For the manifestation of Grahani Roga, the vitiation of following basic component of body is
involved-:
1. DOSHA 2.DHATU 3.SROTAS 4.AGNI
1. DOSHAS- In pathogenesis of Grahani Roga all the three dosha are involved-:
(a)- SAMANA VATA- As Samana Vayu is situated around Agni, it gives strength to Agni by its
Sandhukshana Karma and similarly further dissociate the Samghata of food, by virtue of which
each and every particle of food is exposed to Pachaka Pitta and thus the proper digestion and
transformation of food is made possible. The movement of food is always forward in direction,
small segment of intestine contracting and pushing the contents forward. The Sara Bhaga and
Kitta Bhaga separated. Sukshma Srotamsi present in the Shlehsma-Sravi Kalaa begin to absorb
the nutrient fraction (Rasa Shoshana), while some amount of water and the residue of food are
left over, which slowly move through Unduka Mudrika (caecum) to the Pakwashaya. This whole
function is carried out by Samana Vayu.
(b)- PACHAK PITTA- Pachaka Pitta (digestive enzymes) to act on the food.
42
(c)- KALEDAKA KAPHA- Kledaka Kapha helps in mixing the consumed food and help in
Samghata Bhedana Kriya, which provide maximum surface area for Pachaka Pitta to act on
every particle of food.
2-DHATU- Rasa
3-SROTAS- Annavaha Srotas, Purishavaha Srotas, Rasavaha Srotas these three Srotas are
related with digestion, absorption and excretion. So, it can be said that in 'Grahani Roga' above
mentioned functions are hampered.
4-AGNI- Jatharagni
Schematic representation of Grahani Roga Samprapti
NIDANA SEVANA
↓
DOSHA PRAKOPA
↓
AGNI DUSTI
↓
APACHANA (Indigestion)
↓
AMOTPATTI
↓
SHUKTA PAKA
↓
AMAVISHA
(Localized at GIT level-Generalized in whole Body)
↓
GRAHANI DOSHA
↓ with Bowel → Kukshigata Rogas
with Dhatu → Dhatugata Rogas
GRAHANI DUSHTI
↓
GRAHANI ROGA
VATAJA PITTAJA KAPHAJA SANNIPATAJA
Samprapti Ghataka of Grahani Roga
Samprapti Ghataka of Grahani Roga can be summarized under the following headings:
43
1. NIDANA : Aharaja, Viharaja, Manasika Karanas
2. DOSHA : Kaledaka Kapha, Pachaka Pitta, Samana Vayu
3. DUSHYA: Rasa (Ahara Rasa)
4. AGNI: Jatharagni-Mandya
5. AMA: Amavisha formation at GIT level
6. SROTAS: Annavaha, Rasavaha, Purishavaha Srotas
7. SAROTODUSTI TYPE : Sanga, Vimarga-gamana, Atipravriti
8. UDBHAVASTHANA: Amashaya
9. ROGAMARGA: Madhyama and Bahya Roga Marga
10. VYADHISWABHAVA: Chirakari
11. ADHISTHANA: Grahani
While formulating schematic representation of Grahani Roga Samprapti due consideration is

given to following three factors,
• Grahani is the organ of Mahasrotas.
• Pittadhara Kalaa occupies the organ Grahani and produces Pachaka Pitta (Jatharagni)
• Doshas like Samana Vayu, Kledaka Kapha and Pachaka Pitta are associated with Grahani
organ.
Thus, the whole Samprapti can be understood in two ways,
First due to various etiological factors, functions of organ - Grahani becomes disturbed, which is
followed by Agnidushti, which result in vitiation of Grahani Ashrita doshas and ultimately
whole process turns into Grahani dosha and then those vitiated doshas travel through whole
body with Rasadi dushyas, finally it leads to Grahani Roga.
Second, after stimulation by various etiological factors, there is vitiation of Jatharagni i.e.
Agnidushti occurs first, which is the direct cause of vitiation of Grahani Ashrita dosha, followed
by disturb function of Grahani, it leads to Grahani dosha, and then there is structural changes in
Grahani organ which ultimately turns into disease - Grahani Roga. Also Acharya Charaka has
used the term Dushta Grahani (Duodenum including small intestine is damaged) which indicate
towards the Grahani Roga.
Specific Pathogenesis on the basis of Dosha predominance:
44
Acharya Charaka has mentioned Vata, Pitta, Sleshma and Sannipatik Grahani.
1. Vatik Grahani : When the pt. indulges in the etiological factors of

Vatik Grahani, it leads to provocation of Vata which in turn effects the Agni and make it weak
leading to Vatik Grahani Roga. Food is digested with difficulty and pain occurs. (Ch. Chi. 15/59)
13
2. Pittaj Grahani: The Pitta by its aetiological factors, submerges the Agni, impairs its action just
as hot water extinguishes the fire, leading to the production of Pittaja Grahani (Ch. Chi. 15/65)
16
3. Shleshmaj Grahani: The Kapha dosha get vitiated by its aetiological factors and impairs the
Agni. The food is not digested easily. (Ch. Chi. 15/67) 23
Prognosis of Grahani Roga:

The disease Grahani is Krichchha Sadhya Vyadhi.
According to Acharya Madhava, 20 the Asadhya Lakshanas of Grahani are similar to Asadhya
Lakshanas of Atisara viz. Shoola, Pipasa, etc. He also opines that, in Balyavastha, Grahani is
considered as Sadhya, in Yuva and Vriddha Avastha it is stated to be Krichchha Sadhya and
Asadhya respectively.
Upadrava of Grahani Roga:

Acharya Harita described six complication of Grahani Roga-
• Pliha Yakrita Vriddhi
• Kandu
• Mala Bandha
• Asthila
• Krimi
• Udara Roga
PRINCIPLES OF TREATMENT OF GRAHANI ROGA

(Ch. Chi.15/75) 24
There is general line of treatment described in the classics for almost all the disease. First there is
Shodhana of Doshas, in which vitiated Doshas are eliminated out of the body. This modality is
always preferred by Acharyas because, if Doshas are thrown out of body, disease not only gets
cured but the chances of recurrence also become nil.
If the physician is confirmed that Doshas are confined to Kostha or Annavaha Srotas, then they
should be eliminated from nearest possible root, i.e. if they are related to Amashaya then by oral
route with Vamana Karma and if related to Pakwashaya then by Virechana Karma. In this
45
disease, various Deepana- Pachana drugs are described in the classics, followed by light diet
regimen and then shifting the patient on regular diet.
Other References of Grahani Roga Chikitsa 25

After screening all Chikitsa sutras of 'Grahani Roga', one thing is found to be very common and
that is about the sutra which is quoted by various Acharyas to treat 'Grahani Roga' just like
Ajirna or Atisara. So, due consideration has to be given to the treatment of these diseases
followed by possible rationality behind them.
Ajirna :
Ajirna is a disease described by almost all the text and it is characterized by disturbed digestion.
Its types and symptomatology are very elaborately mentioned in the classics. Here concentration
has to be paid to the treatment aspect only.
First of all, Acharyas have clearly mentioned that in such Awasthas like Ajirna which are
influenced by the Amadosha, medicines are of less use as the digestive power is not able to
digest either food or medicines too.
Diseases caused by Amdosha are cured only by Apatarpana, which is of three types and which
should be administered by a Physician after a thorough examination and investigation of the
patients. The three type of Apatarpana are Langhan,Langhan-Pachan and Shodhan or
Avasechanam.
Indications of these are,

ऄल्ि अमदोष लंघनम्
मध्य अमदोष लंघनिाचनम्
प्रभूत अमदोष शोधन/ ऄवसेचन
After the primary management, the principle of the treatment described as above (A.S.Su.11/43)
26
.
Atisara :
This is another disease, Acharyas have advocated following while treating Grahani Roga. Atisara
is again a disease in which digestive power of an individual is decreased and this too, is a disease
confined to Annavaha srotas and pathogenesis wise it related to Amadosha. Concentrating on the
treatment aspect of diseases, Atisara again, as it is a Amadoshaj vyadhi, first line of treatment
described by almost all Acharyas is Apatarpan .
This Langhan may of Shaman type likes Upavasa or Pachana etc. It has to be decided by the
Physician by examining the awastha of Atisara. For example in Vataja Atisara due to
amadoshtwa – Upavasadi langhan is indicated. While for Kapha and Pitta dosha or for
46
aggravated symptom confined to a particular Ashaya like Amashaya or Pakwashaya, Shodhana

like Vamana or Sramsana can be applied accordingly.
Atisara (Prabuta - Bhuishtha Dosha Awastha)
All the Amadoshajanya Vyadhies have classified for their treatment on the basis of Bahu
doshata, Madhya doshata and Alpa doshata. Atisara too, is not an exception to this, there is a
special description of Prabhuta doshas, that means Doshas after their vitiation and aggravation
in excess quantity, start to go out of the body from nearest possible root. Regarding the treatment
of these Awasthas, all most all text has advocated not to use any kind of Stambhana medicine.
On the other hand to remove such Bhuistha doshas, Anuloman aushadhi, like Haritaki is
indicated.
After looking on the general principles of treatment of Ajirna and Atisara, Concentration has to
be paid, over the similarities between the approaches of the treatment in these three diseases.
The probable points can be enlisted as below:-
1. All the three mentioned diseases, Atisara, Ajirna and Grahani Roga are confined to Annavaha
srotas.
2. All the three conditions have Agnimandyata or Agni vikruti, as a common factor.
3. All the three diseases have a strong relation with Ama or Amanubandhata.
4. All the three conditions manifest as improper digestion of food.
5. All the three diseases have, Prabhuta doshawastha, sometimes Vibbadha doshawastha may
also be encountered.
6. In All the three conditions consumption of Angi vikritikara hetus can be traced out.
So, because of all these reasons the General principle of treatment for all the above
mentioned conditions is same as,
1. Shodhana is indicated in all the three diseases.
2. It is advised to remove the doshas from the nearest root, from where they are accumulated.
3. Treatment principles of Ama are common for all the above conditions.
4. In Lina or Prabhuta dosha or Dhatugat awastha, Shodhana is indicated in all the three
conditions.
5. In Madhya dosha or Alpa dosha, pachana of doshas is advocated.
6. In all the conditions, after Ashaya shudhi, number of recipes for Agni deepana is mentioned.
7. In all the diseases Nidana Parivarjanam, is given due importance along with Laghu 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.
The main line of treatment should, therefore, aim at:

(a) Dosa Pratyaneeka Chikitsa in Grahani Roga and breaking up of the vicious circle
phenomenon by Deepana and Pachana therapeutics, and
47
(b) Vyadhipratyaneeka Chikitsa in Grahani Roga by properly conceived medicines (Deepana

and Pacana) Aharas, Swedana, Shodhana therapies, where there are indications for them.
DIETETIC REGIMEN:
Oleation, Sudation, Purification and lightening therapies, articles that are gastric stimulants,
various kinds of Churnas, salts, alkalis, honey Arishta, Sura, Asava, various kinds of butter milk
courses, and digestive stimulant ghee should be resorted to, by the patient suffering from
Grahani. (Ch.Chi. 15/196) 27
Importance of Takra in Management of Grahani Roga:
The authors of the three main classics have laid emphasis on the administration of Takra or
Takrasadhita kashaya as the main diet and medicine. Explaining the advantage of Takra over
other articles of diet, in Grahani-dosha and Grahani Roga, Vagbhata says, ―Takra is the best diet
for patients suffering from Grahani-dosha and Grahani Roga‖. As Takra is Laghu in Guna,
process Deepana properties and attains Madhurapaka, it does not provoke an increase of Pitta,
because of its Kashaya-rasa, Ushna Virya, Vikasi and Ruksha Gunas, it is also useful in Kapha;
as freshly churned Takra is sweet, slightly sour and sufficiently thick, it will not produce Daha in
the Kostha and it is also Vatahara.(A. H. Chi. 10/415)28.
The advantage of Takra is that, it contains less fat and is easily digestible.
Charaka has also suggested the use of Takra and Takrarista in the routine treatment of
Grahani.(Ch.Chi. 15/117-119)29
Classics have also advocated the use of different kinds of Panas, Takras, Suras and Asavas in
the management of Grahani Roga (A. S. Chi. 12/4), (A. H. Chi. 10/3)30.
Somatic treatment
- Shodhana : Vasti chikitsa

- Shamana : Deepana, Pachana, Grahi, Tridosha Shamak and Medhya drugs
PATHYA APATHYA-
Nutritious, easily digestible and Sattvika diet has always been recommended. Over eating and
consumption of Rajasika -Tamasika diet should be avoided.
1. PATHYA AHARA:
Annavarga – Sashtti Shali, Jirna Shali, Masoora, Tuvari, Mudga Yusha, Lajamanda, Vilepi etc.
Shakavarga – Changeri, Rambha Pushpa, Kamalakanda
Phalavarga – Rambha, Jambu, Kapittha, Dadima
Dugdhavarga – Aja or Gavya Dugdha, Takra, Ghrita
Tailavarga – Tila Taila
PATHYA VIHARA: Nidra, Vishrama, Activities making mind happy
2. APATHYA AHARA: Atishita Jala, Dushta Jala, Guru, Snigdha, Drava, Atiruksha, & Saraka
substances, Viruddha Bhojana, Rasona, Patra Shaka etc.
APATHYA VIHARA: Vegavidharana, Chinta, Shoka, Bhaya, Krodha, etc.
48
MODERN REVIEW OF GRAHANI ROGA
In the present study a concept of Grahani Roga is constructed with the consideration of symptoms like:
Udara-Shoola, Aruchi, Atop, Udara Gaurava, Vibandha or Abaddha-mala Pravritti, Bhojanottara Mala-
Pravritti etc. as chief complaints. In modern medical science, no disease or condition is exactly similar to
Grahani Roga. Following symptoms found in different gastro-intestinal disorders can be taken as study
point of view of Grahani Roga-
 Chronic abdominal pain
 Reduced appetite or loss of appetite
 Abdominal distension
 Flatulence
 Belching
 Eructation / Salivation
 Nausea / Vomiting
 Indigestion (Mal digestion)
 Chronic altered loose motion/ constipation
 Stools with mucous and foul smell
 Frequency of loose stool just after meal etc.
Following conditions and diseases may be considered in context of Grahani Roga:

 Irritable Bowel Syndrome
 Mal absorption syndrome
 Coeliac disease
 Tropical sprue
 Irritable Bowel Disease- Crohn‘s Disease
-Ulcerative Colitis
 Parasitic Colitis- Amoebiasis
-Giardiasis
IRRITABLE BOWEL DISEASE
IBS is characterized by abdominal pain and altered bowel habit, including diarrhoea, constipation, or
alternating diarrhoea and constipation. Symptoms are typically intermittent but may be continuous and
should be present for at least 3 months.
AETIOLOGY-
It is not clear why patients develop IBS. IBS is often considered ‗functional‘ disorder because no
structural, biochemical or infectious aetiology has been found. It is generally believed that most
49
patients develop symptoms in response to psychological factors, Altered Gastrointestinal

motility, abnormal visceral perception, Food sensitivity.
1. Psychological Factors: More than half of patients with IBS can relate the start of symptoms
to a stressful event like depression, anxiety, hysteria and somatisation in their life. Symptoms
tend to become worse during times of stress or anxiety. The colon is connected to the brain
through nerves of the autonomic nervous system. These nerves become more active during times
of stress, and can cause the intestines to squeeze or contract more. People with IBS may have a
colon that is over-responsive to these nerves. Over activity of the nerves or muscles of the gut
may be responsible for altered gastrointestinal motility.
2. Altered Gastrointestinal motility-Slow motility can lead to constipation and fast motility can
lead to diarrhoea. Spasms, or sudden strong muscle contractions that come and go, can cause
abdominal pain.
3. Abnormal visceral perception- IBS is associated with increased sensitivity to intestinal

distension induced by inflation of balloons in the ileum, colon and rectum. Patients with IBS
have a lower pain threshold to stretching of the bowel caused by gas or stool compared with
people who do not have IBS. The brain may process pain signals from the bowel differently in
people with IBS.
4. Food sensitivity - Certain foods and beverages can cause symptoms, such as foods rich in
carbohydrates, spicy or fatty foods, coffee, and alcohol. However, people with food sensitivity
typically do not have clinical signs of food allergy. For instance, chocolate, milk and alcohol
might cause constipation or diarrhoea. Carbonated beverages and some fruits and vegetables may
lead to bloating and discomfort in some people with IBS.
SIGNS AND SYMPTOMS-

The signs and symptoms of irritable bowel syndrome can vary widely from person to person and
often resemble those of other diseases. Among the most common are:
 Abdominal pain or cramping

 A bloated feeling
 Gas (flatulence)
 Diarrhoea or constipation — sometimes even alternating bouts of constipation and
diarrhoea
 Mucus in the stool
Abdominal pain, fullness, gas, and bloating that have been present for at least 3 months are the
main symptoms of IBS. The pain and other symptoms will often:
50
 Occur after meals

 On and off
 Be reduced or go away after a bowel movement
Altered bowel habits in IBS may have the following characteristics:
 Constipation variably results in complaints of hard stools, painful or infrequent

defecation, and intractability to laxatives
 Diarrhoea usually is described as small volumes of loose stool, with evacuation preceded
by urgency or frequent defecation
Additional symptoms consistent with irritable bowel syndrome are as follows:

 Loss of appetite
 Dyspepsia,
 heartburn
 Nausea, vomiting
 Urinary frequency and urgency have been noted
 Stress-related symptoms
COMPLICATIONS
IBS isn't associated with any serious conditions, such as colon cancer. But, diarrhoea and
constipation, both signs of irritable bowel syndrome, can aggravate or even cause haemorrhoids.
The impact of IBS on overall quality of life may be its most significant complication. IBS might
limit ability to:
 With IBS, the difficulty of coping with symptoms away from home may cause one to
avoid social engagements.
 The physical discomfort of IBS may make sexual activity unappealing or even painful.
 These effects of IBS may cause a feeling that one does not living life to the fullest,
leading to discouragement or even depression.
MANAGEMENT
Though there is no cure for IBS, the symptoms can be treated with a combination of the
following:
 changes in eating, diet, and nutrition

 medications
 probiotics
 Reassurance
51
1-Eating, Diet, and Nutrition- Large meals can cause cramping and diarrhoea, so eating smaller
meals more often, or eating smaller portions, may help in reducing IBS symptoms. Eating meals
that are low in fat and high in carbohydrates, such as pasta, rice, whole-grain breads and cereals,
fruits, and vegetables, may help. Certain foods and drinks may cause IBS symptoms in some
people, such as foods high in fat, milk products, alcohol or caffeine, drinks with large amounts of
artificial sweeteners, which are substances used in place of sugar, foods that may cause gas, such
as beans and cabbage. People with IBS may avoid these foods. Dietary fibre may lessen
constipation in people with IBS.
2-Medications
 Fibre supplements
 Laxatives
 Antidiarrheals. Loperamide
 Antispasmodics. Hyoscine, Cimetropium, and Pinaverium
 Antidepressants. Tricyclic antidepressants (TCAs) and selective serotonin reuptake
inhibitors (SSRIs) in low doses can help relieve IBS symptoms including abdominal pain.
 Lubiprostone (Amitiza). It improves symptoms of abdominal pain or discomfort, stool
consistency, straining, and constipation severity.
3-Probiotics-SpecificallyBifidobacteria and certain probiotic combinations, improve symptoms

of IBS when taken in large enough amounts.
4-Reassurance and stress reduction
Grahani Vis-à-vis IBS

Symptoms of IBS have similarities with the symptoms of Grahani, like alternate constipation and
diarrhoea (Muhurbaddha muhurdrava), mucus mixed stools (shleshmika malapravriti), etc.
MALABSORPTION SYNDROME (MAS)

Malabsorption syndromes (disorders) are conditions that cause insufficient assimilation of
ingested nutrients as a result of either mal digestion or mal absorption.
AETIOLOGY
Mucosal causes: It is due to small bowel resection or condition in which damage the small
intestinal epithelium. Intestinal hurry due to gastrectomy or Gastrojejunostomy .This
considerably reduces the surface area available for absorption.
Intraluminal causes
1. Deficiency of bile
2. Pancreatic insufficiency
PATHOPHYSIOLOGY
Malabsorption constitutes the pathological interference with the normal physiological sequence
52
of digestion, absorption and transport of nutrients. Intestinal malabsorption can be due to:
 Mucosal damage
 Congenital or acquired reduction in absorptive surface
 Defects of specific hydrolysis
 Defects of ion transport
 Pancreatic insufficiency
 Impaired enterohepatic circulation
Protein mal absorption usually occurs along with fat and carbohydrate malabsorption. It is
characterized by intestinal inflammation and mucosal damage. Protein losing enteropathy occurs
when there is protein as predominant nutrient is not absorbed as in intestinal lymphangiectasia or
from increased venous pressure in the intestine or to the right sided heart failure.
Similarly carbohydrate malabsorption is common and occurs with ingestion of poorly absorbed
sugars like sorbitol or disorders of mucosa or defects of intraluminal phase of digestion (exocrine
pancreatic insufficiency).
The digestion and absorption of fat are complex process, requiring 3 stages: 1.Intraluminal
digestion 2. Mucosal absorption 3.Proper intestinal transportation. There are various disorders
affecting these stages that can cause fat malabsorption. Patients with malabsorption are liable to
develop deficiency of fat soluble vitamins. Primary and secondary alteration of bowel mucosa
may also result in deficiency of water soluble vitamins.
CLINICAL FEATURS OF MAS:

The clinical manifestations of mal absorption syndrome vary according to underlying cause.
However some common symptoms are: Chronic diarrhoea : Commonest mode of presentation is
bulky highly offensive stools, sometimes watery stools, Abdominal distension, Abdominal pain,
Anorexia, Weight loss, Undigested food in stool, Malaise, Muscle cramps, Failure to thrive,
Lethargy, Oedema, Clubbing of fingers, depigmentation of skin and hairs, Hemorrhagic
diathesis, Eczema, Follicular hyperkeratosis, Stomatitis, Recurrent respiratory infections.
COMPLICATIONS
 Children will have stunted growth.
 Infertility
 Anaemia may occur.
 Rickets, osteoporosis or osteomalacia may occur.
MANAGEMENT-- Management depends upon the cause.

 Add nutrients which are not absorbed.
 Pancreatic insufficiency requires the oral administration of enzymes with food.
 Blockage of the flow of bile requires surgery.
 Where bile salts are not reabsorbed, it may be necessary to give resins to bind them
53
 Nutrient replacement to correct deficiencies includes folic acid, vitamin B-12, and iron.
Grahani Vis-à-vis Malabsorption Syndrome

The presence of hydrochloric acid, in the stomach, is inimical to a large number of bacteria.
Many of them are destroyed by salivary secretion and hydrochloric acid, and some of them
which survive may enter into the intestine. In a hypothetical case where, there is a deficient
gastro-secretion, especially HCl, protein digestion in the stomach may not only be disturbed, but
the starch content of food may undergo fermentative changes(Shuktatva) yielding lactic acid,
butyric acid, acetic acid and the protein may undergo putrefactive changes, resulting in the
production of foul odour.
Since gastric emptying of the ingested food is dependent to a large extent, on the acidification of
the chyme, which in turn stimulates the pyloric sphincter to open to allow the material to pass
into duodenum?
A deficit of acid secretion may lead to the retention of the food for a longer duration in the
stomach than what is normal. The lack of acidity in the material that is propelled into the
duodenum may result in either scanty production or non secretion of the hormones of this area.
As a result, pancreas may not produce required quantity and quality of pancreatic juice and gall
bladder may not discharge the bile properly contained in it. Thus the pH of the duodenum will be
disturbed.
The overall outcome of these sequences may result in the disturbance of protein, carbohydrate
and fat. This explanation of possible pathogenesis of Malabsorption Syndrome is explained by
Prof. S. C. Dhyani to co-relate it with Samprapti of Grahani as explained by Charaka.
COELIAC DISEASE
Coeliac disease (CD) is a chronic immune-mediated disorder that develops in genetically

susceptible persons when gluten, a major protein found in wheat, barley, and rye is ingested in
the diet. Also called non-tropical sprue, or gluten-sensitive enteropathy, CD is primarily an
enteropathy characterized by inflammation of the small bowel mucosa and atrophy of the villi,
resulting in nutrient malabsorption, wasting, and diarrhoea.
AETIOLOGY- The major genetic association of celiac disease is with genes whose complex
locus lies in chromosome-6. The celiac disease is an immunologically mediated small intestine
enteropathy. The mucosal lesion suggest both cell mediated and humoral immunological over
stimulation. There is strong genetic influence on the susceptibility to Coeliac disease and is
suggested by occurrence of multiple cases in families.
54
PATHOPHYSIOLOGY-
Celiac disease is a multifactorial and a multisystem disorder involving a genetic predisposition,
environmental exposure of the small bowel mucosa to gluten, and an immunologic response to
gluten.
1. Genetic: The majority (>90%) of people with CD possess the HLA DQ2 haplotype, and 5%
to 10% possess the DQ8 haplotype, conferring a negative predictive value greater than 98%.
These haplotypes are encoded within the HLA class II region of the major histocompatibility
complex on chromosome 6p.
2.Environmental: Risk for developing CD is increased with the introduction of gluten in the diet
of infants before the age of 4 months. Grains that activate the disease contain proteins that can
form gluten (prolamins: glutenins and gliadins) and include wheat, barley, and rye.
3. Immunologic: Exposure of the upper small bowel mucosa to gluten in susceptible people
precipitates an immune mediated reaction that involves both the innate and the adaptive immune
responses. Tissue trans-glutaminase, an enzyme present in the lamina propria of the small bowel,
deamidates glutamine residues in gluten to form glutamic acid. Glutamic acid is a negatively
charged molecule that is recognized by the antigen-precipitating cells that express the HLA
DQ2/DQ8 receptors for T lymphocytes. T lymphocytes become activated and they begin to
divide rapidly and secrete several immunomodulators such as immunoglobulins, cytokines,
interferons, tumor necrosis factor, and interleukin 15 and 17 that cause damage to the enterocytes
and result in villous atrophy.
CLINICAL FEATURES
The clinical features of Coeliac disease depend upon the severity and extent of the small intestine
pathology. The common features include:
_ Chronic diarrhoea
_ Abdominal distension
_ Abdominal pain
_ Muscle wasting
_ Anorexia
_ Irritability
Clinical history reveals that patient starts passing bulky, greasy and foul smelling stool; The
mucosa of small intestine is damaged and altered, and hence release of secretin and CCK-P2 are
decreased. Pancreatic enzyme secretin is markedly decreased, this leads to indigestion, and
damaged mucosa leads to malabsorption.
Other physical signs include:
_ Peripheral oedema
55
_ Clubbing of fingers
_ Smooth tongue
COMPLICATION- 1. Malignancy related to CD includes enteropathy-associated intestinal

lymphoma or enteropathy-associated T-cell lymphoma and various carcinomas
2. Ulcerative jejunoileitis
MANAGEMENT-
 Withdrawing gluten from the diet for life. It entails eliminating wheat, barley, and rye.
This allows healing of the small bowel mucosa and restitution of normal nutritional
status.
 Lactose-containing products can worsen gastrointestinal symptoms and should be
avoided initially until restitution of a normal mucosa.
 Deficiencies of vitamins D and B12, folic acid, calcium, and iron and other nutritional
deficiencies should be replaced as necessary.
 Complications of CD should be managed appropriately, and increased vigilance in
recognizing and managing lymphomas and cancers is very important in these patients.
TROPICAL SPRUE
Tropical sprue is a chronic disorder commonly found in the tropical regions, marked with
abnormal flattening of the villi and inflammation of the lining of the small intestine. It is
characterized by abnormalities of the small intestine structure and function, which become
progressively more severe. It eventually leads to the development of the disease and
manifestations of nutritional deficiencies.
AETIOLOGY
The exact causative factor of tropical sprue is unknown. The epidemiological pattern suggests its
infectious type, but not a single bacterium has been isolated, the condition often begins after an
acute diarrhoeal illness. It has been suggested that it is caused by bacterial, viral, amoebal, or
parasitic infection. Folic acid deficiency has also been suggested as possible causes. Small bowel
bacterial overgrowth with the bacteria such as: Klebsiella, Escherichia coli, Enterobacter.
PATHOPHYSIOLOGY
The exact role of microbial agents in the initiation and propagation of the disease is poorly
understood. One theory is that an acute intestinal infection leads to jejunal and ileal mucosa
injury; then intestinal bacterial overgrowth and increased plasma enteroglucagon results in
56
retardation of small-intestinal transit. Central to this process is folate deficiency, which probably
contributes to further mucosal injury.
The upper small intestine is predominantly affected; however, because it is a progressive and
contiguous disease, the distal small intestine up to the terminal ileum may be involved.
Pathological changes are rarely demonstrated in the stomach and colon. Coliform bacteria, such
as Klebsiella, Escherichia coli, Enterobacter species are isolated and are the usual organisms
associated with tropical sprue.
CLINICAL FEATURS
Tropical sprue is a syndrome characterized by acute or chronic diarrhoea, weight loss, and
malabsorption of nutrients. It starts as an acute episode of watery diarrhoea accompanied by
malaise, fever and weakness. The diarrhoea does not subside in the usual time. Individual
develops abdominal cramps, excessive flatus, anorexia, and weakness.
Common signs of malnutrition may include night blindness, glossitis, stomatitis, cheilosis,
hyper-pigmentation and oedema. Muscle wasting is marked and abdomen is often distended.
Megaloblastic anaemia is the result of folate and Vit. B12 deficiency.
MANAGEMENT
1 - Antibiotics - tetracycline or Sulfamethoxazole/ Trimethoprim for 3 to 6 months, as well as
supplementation of vitamins B12 and folic acid.
2 - Replacement of nutrients (eg. folic acid, vitamin B-12, iron), deficient fluid, and sometimes
blood.
3 -The fluid, electrolyte and acid-base disturbances should be corrected.
4 -Unlike Coeliac disease, dietary restrictions are not necessary.
Grahani Vis-à-vis Tropical sprue

Prof. S. C. Dhyani opines, the Samprapti is borne by factual evidence furnished by modern
medicine. In case of Grahani Roga diagnosed by modern medicine as ―Tropical-sprue‖, there is
usually the atrophy of the small intestine microvilli, so as to render it almost diaphanous. The
main changes are thinning and atrophy of the mucous membrane of the absorptive and secretary
epithelium with some shrinkage of some of microvilli. These changes have been essentially
degenerative and aplastic.
The signs and symptoms of tropical sprue will draw attention to the fact that in this condition,
deficiency of some of the essential factors of Pitta, viz. Castles factor (Amashayastha Ranjaka
Pitta of Vagbhatta) and deficiency of folic acid (Yakritastha Ranjaka Pitta of Sushruta) among
others, are more prominent. One of the important contributory factors is a previous
gastrointestinal disease amounting to Grahani Roga.
It may be stated that, in Grahani Roga changes occur in the structure of Grahani (Duodenum
including small intestine).
57
INFLAMMATORY BOWEL DISEASE (IBD)
Inflammatory Bowel disease (IBD) is a general term for a group of chronic inflammatory
disorders of unknown cause involving the gastro-intestinal tract. It may be divided into two
major groups:-
1. Ulcerative colitis.
2. Crohn's disease
1. Ulcerative Colitis: An inflammatory disease of unknown origin characterized clinically by

recurrent attacks of bloody diarrhoea and pathologically by a diffuse inflammation of the colonic
mucosa.
Clinical features:
1). Acute: Can be mild, moderate or severe passage of frequent, small volume, loose stools with
fresh blood and mucous.
 Cramping abdominal pain
 Tenesmus with fever
 Tachycardia
2) Chronic
 Diarrhoea
 Passage of blood and mucous with faeces
 Tenderness over colon
 Malaise
 Anorexia
 Malabsorption
 Weight loss
2. Crohn's Disease:
It is non-specific granulomatous inflammation of single or multiple areas of the intestine.
Clinical Features:
 Fever
 Weight loss
 Malabsorption
 Abdominal mass
 Recurrent abdominal pain and diarrhoea
The term "'inflammatory bowel disease" (IBD) is commonly used to include two idiopathic
bowel diseases having many similarities‖ but the conditions usually have distinctive
morphological appearance.
These two conditions are.
58
1. Crohn's disease or regional enteritis is an idiopathic chronic ulcerative IBD, characterised by

transmural, non-caseating granulomatous inflammation, affecting most commonly the segment
of terminal ileum and/or colon, though any part of the gastro intestinal tract may be involved.
2. Ulcerative colitis is an idiopathic from of acute and chronic ulcer inflammatory colitis
affecting chiefly the mucosa and subsmucosa of the rectum, and descending colon, though
sometimes it may involve the entire length of large bowel.
The main difference between Crohn's disease and UC is the location and nature of the
inflammatory changes. Crohn's can affect any part of the gastrointestinal tract, from mouth to
anus (skip lesions), although a majority of the cases start in the terminal ileum. Ulcerative colitis,
in contrast, is restricted to the colon and the rectum ulcerative colitis is restricted to the mucosa
(epithelial lining of the gut), while Crohn's disease affects the whole bowel wall ("transmural
lesions").
ETIOPATHOGENESIS: The exact aetiology of IBD remains unknown. Therefore, IBD is

called an idiopathic disease.
Aetiology is Unknown. Possible factors are:

1. Genetic and environmental factors
2. Immunological factor
3. Infection
4. Psychological factors
An unknown factor/agent (or a combination of factors) triggers the body‘s immune system to
produce an inflammatory reaction in the intestinal tract that continues without control. As a
result of the inflammatory reaction, the intestinal wall is damaged leading to bloody diarrhoea
and abdominal pain.
Symptoms in Crohn's disease vs. ulcerative colitis

Symptoms may range from mild to severe and generally depend upon the part of the intestinal
tract involved. They include the following:
Abdominal cramps and pain
Bloody diarrhoea
Severe urgency to have a bowel movement
Fever
Loss of appetite
Weight loss
Anaemia (due to blood loss)
No. Features Crohn’s disease Ulcerative colitis

,
1 Defecation Often porridge-like Often mucus-like
sometimes steatorrhea and with blood
2 Tenesmus Less common More common
3 Fever Common Indicates severe disease
4 Fistulae Common Seldom
59
5 Weight loss Often More seldom
COMPLICATIONS
 Profuse bleeding from the ulcers
 Perforation (rupture) of the bowel
 Strictures and obstruction
 Fistulae and perianal disease
 Malignancy: colon cancer
MANAGEMENT
I. Medical
Diet and nutrition:
(i) Avoid high fibre diet in presence of diarrhoea / dysentery
(ii) Diet should be nutritious
(iii) Supplemental fat soluble vitamins, medium chain triglycerides and parenteral Vit B12.
(iv) In severe inflammation
(a) Nothing by mouth
(b) Total parenteral nutrition
Drugs : (a) Sulfasalazine
(b) Corticosteroids
(c) Immunosupressants
(d) Antidiarrhoeals
(e) Metronidazole
(f) Bile acid binding resins and medium chained triglycerides.
(g) Antibiotics,
Depending on specific condition, Psychotherapy
II. Surgery -removal of affected part
Bowel resection, strictureplastycolostomy or ileostomy
In chronic stage both these conditions have many symptoms similar to Grahani Roga. These are
also responsible for mal absorption. Inflammatory Bowel Disease also includes parasitic colitis:
PARASITIC COLITIS:
Amoebiasis or amoebic dysentery and Giardiasis are the most common conditions among
parasitic infections. Even though both result in diarrhoea as a main symptom, they can be
considered in Grahani.
60
AMOEBIASIS
Amoebiasis is a common intestinal protozoal infestation, which may also cause systemic
manifestations; in majority of cases the infestation is asymptomatic. It is more common in
regions with poor standards of personal and food hygiene, and inadequate sanitation.
Infection is transmitted by ingestion of food or water contaminated with fecal material
containing cysts of Entamoeba.
PATHOGENESIS
Following ingestion, cysts open in the intestine to produce eight trophozoites. Trophozoites
colonise the mucosa of large intestine and may cause tissue invasion and destruction in the form
of ulcer with local inflammatory response.
FEATURES OF AMOEBIC DYSENTARY
 Number of stools per day 6 to 8
 Amount Relatively copious
 Odour Offensive
 Colour Dark red
 Nature Blood and mucous mixed with stools
 Reaction Acid
 Consistency Not adherent to the container
COMPLICATIONS:
Entamoeba histolytica may reach liver through portal circulation and may produce similar lytic
lesion, the so called amoebic liver abscess. Abscess may be sterile, containing viscid, chocolate,
non-pyogenic material. Amoebic involvement of peritoneum, pericardium, pleura, lungs, brain,
and genitourinary system occurs rarely.
GIARDIASIS
Giardiasis known as beaver fever is a parasitic disease caused by the flagellate protozoan
Giardia lamblia. The giardia organism inhabits the digestive tract of a wide variety of domestic
and wild animal species, as well as humans. Giardiasis is passed via the fecal-oral route.
PATHOPHYSIOLOGY- Giardia are flagellated protozoans, which cause decreased action of

brush-border enzymes, morphological changes to the microvillous, and apoptosis of small
intestinal epithelial cells.
The attachment of trophozoites, of which Giardia lamblia causes villus flattening and inhibition
of disaccharides activities. The alteration of the villi leads to an inability for nutrient and water
absorption from the intestine. This results in diarrhoea, one of the predominant symptoms.
61
On an immunological level, activated host T-lymphocytes attack endothelial cells that have been
injured in order to remove the cell. This occurs after the disruption of the tight junctions between
endothelial cells that make up the brush border. The result is heavily increased intestinal
permeability.
Giardia protects its own growth by reducing the formation of nitric oxide by consuming all local
arginine which is the necessary substrate for the production of nitric oxide. Arginine starvation is
known to be a cause of programmed cell death and local removal is a strong apoptotic agent.
SIGNS AND SYMPTOMS-
Symptoms include loss of appetite, diarrhoea, hematuria (blood in urine), loose or watery stool,
stomach cramps, upset stomach, projectile vomiting (uncommon), bloating, excessive gas, and
burping (often sulphurous). Symptoms typically begin one to two weeks after infection and may
wane and reappear cyclically. Disease manifestations of Giardiasis range from asymptomatic
carriage to fulminate diarrhoea and malabsorption. Symptoms may develop suddenly or
gradually in persons with acute giardiasis, symptoms develop after incubation - period that lasts
for at least 5 to 6 days and usually 1 to 3 weeks. Prominent early symptoms include diarrhoea,
abdominal pain, bloating, belching, flatus, nausea and vomiting. Individuals with chronic
giardiasis may present with or without having experienced an antacid acute symptomatic
episode.
Diarrhoea is not necessarily prominent, but increased flatus, loose stools, and weight loss occur.
Symptoms may be continual or episodic and can persist for years. Symptoms tend to be
intermittent yet recurring and gradually debilitating, in contrast with the acute disabling
symptoms associated with many enteric bacterial infections. However, the disease can be severe
resulting in malabsorption, weight loss, growth retardation, dehydration, and in rare cases- death.
MANAGEMENT
 Treatment is not always necessary as the infection usually resolves by itself.

 Standard treatment for amoebiasis & giardiasis consists of antibiotic therapy. Usually
metronidazole, albendazole, and tinidazole are used.
 Appropriate fluid and electrolyte management is critical, particularly in patients with
large-volume diarrheal losses.
 Severely dehydrated or malnourished patients should be admitted for further care.
In this chapter some of the disease entities pertaining to gastrointestinal tract which are
comparable with Grahani are briefly discussed as per the modern view. None of these can be
correlated singly with Grahani Roga. Their signs and symptoms are seen in Grahani in its various
stages, say Grahani dosha or Grahani Roga or in its different varieties like Vataja Grahani etc.
Considering these facts, in the present study none of these diseases are specifically taken but
62
consideration was done purely on Ayurvedic basis depending on the Grahani Lakshanas
observed in the patient.
VASTI REVIEW
Vasti is the most important Karma among Panchakarma due to its multiple effects. Pitta and
Kapha is dependent on Vata as it governs their functions. Vasti is not only best for Vata
disorders it also equally effective in correcting the morbid Pitta, Kapha and Rakta. Charaka has
considered, Vasti therapy as half of the treatment of all the diseases, while some authors consider
it as the complete remedy for all the ailments.
Among all the therapeutic procedures, Vasti is superior because Vamana and Virechana can
produce only vomiting and purgation respectively but Vasti has got multidimensional therapeutic
goal like Bhrimhana, Shodhana, Shamana, Rasayana,Vajikarana etc. therapeutic effects can be
achieved by Vasti.
In modern medicine, enema is mainly given to remove the feces from the large intestine. While
in Ayurveda, Vasti is given as a route of administration of the drugs for multiple actions, which
acts locally on large intestine as well as systematically on the whole body.
Definition:
It is defined in two ways i.e. one indicates the whole of the Karma and the other indicates just the
instrument used for it.
(1) Charaka defined Vasti on the basis of the Karma similar to that of Vamana and Virechana i.e.
―The Karma where in the drugs administered through anal canal reaches upto Nabhi Pradesha,
Kati, Parsva, Kukshi (Anatomical Landmarks on the abdomen), churns the accumulated Dosha
and Purisha (Morbid humors and fecal matters), spreads the unctuousness all over the body and
easily comes out along with the churned Purisha and Dosha, is called as Vasti.‖ This denotes the
Nirooh and Anuvasana Vasti only, as they eliminate the accumulated Dosha and Purisha.1
(2) The other Acharya has described Vasti in general on the basis of the instrument used. i.e.
―The procedure in which, either Vasti is used for the administration of the drugs OR the drugs
administered first reaches to the Vasti.‖ 2
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Historical Aspects of Vasti
Charaka Samhita:
Charaka has described Vasti elaborately and out of the twelve chapters of Siddhi Sthana, 8
chapters are contributed to Vasti In addition scattered references regarding Vasti are available in
various chapters of this Samhita. First two chapters of Siddhisthana, deals with properties of
Vasti Samyakayoga, Ayoga Lakshanas, indications and contraindications of Vasti.
Sushruta Samhita:
In Sushruta Samhita, four chapters have been devoted completely for the description of the Vasti
in Chikitsa Sthana. Other numerous references of Vasti are also available in this Samhita.
Ashtanga Sangraha:
28th chapter of Sutra Sthana has been devoted to Vasti only. In addition four chapters of Kalpa
Sthana also deal with Vasti.
Ashtanga Hridaya:
In this text, 19th chapter of Sutrasthana-Vasti Vidhi and 4th and 5th chapter of Kalpasthana
named as Vasti Kalpa and Vasti Vyapada Siddhi explain the every aspect of Vasti.
Kashyapa Samhita:
In Kashyapa Samhita, Vasti has been explained in detail in Siddhisthana and Khilasthana.
Classification of Vasti:
In Ayurveda, many varieties of Vasti have been mentioned in different contexts which can be
classified under the following headings:
(A) On the basis of fixed schedule: In this type of group three Vasti are mentioned: 3
1. Karma Vasti:
In this schedule 30 Vasti are being administered out of which there are 18 Anuvasana and 12
Nirooh. Initially one Anuvasana is administered then 12 Nirooh and 12 Anuvasana are given
alternately and in the last 5 Anuvasana should be given. Every day one Vasti can be given.3
2. Kala Vasti:
Charaka mentioned that it includes half number of Vasti to that of Karma Vasti. But Chakrapani
opined that it includes 16 Vasti. According to Vagbhata it includes 15 Vasti. He reduced one
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Anuvasana in this schedule. On first day 1 Anuvasana can be given then Afterwards 6
Anuvasana and 6 Nirooh given alternatively and at last 3 Anuvasana are administered.3
3. Yoga Vasti:
………………ततश्च योगः । (Ch.Sid.1/47)
Charaka mentioned that it includes half number of Vasti to that of Kala Vasti. It includes 8 Vasti
out of which 5 Anuvasana and 3 Nirooh.3 On the first day 1 Anuvasana then 3 Nirooh and 3
Anuvasana alternatively and at last 1 Anuvasana should be given. This Vasti schedule is called
Yoga Vasti. It is used in the patients having Kapha Sansarga along with Vata vitiation.
(B) On the Basis of Adhisthana:
It depends upon the part of the body used for the administration of Vasti.
Ashtanga Hridaya:
In this text, 19th chapter of Sutrasthana-Vasti Vidhi and 4th and 5th chapter of Kalpasthana
named as Vasti Kalpa and Vasti Vyapada Siddhi explain the every aspect of Vasti.
Kashyapa Samhita:
In Kashyapa Samhita, Vasti has been explained in detail in Siddhisthana and Khilasthana.
Classification of Vasti:
In Ayurveda, many varieties of Vasti have been mentioned in different contexts which can be
classified under the following headings:
(A) On the basis of fixed schedule: In this type of group three Vasti are mentioned: 3
1. Karma Vasti:
In this schedule 30 Vasti are being administered out of which there are 18 Anuvasana and 12
Nirooh. Initially one Anuvasana is administered then 12 Nirooh and 12 Anuvasana are given
alternately and in the last 5 Anuvasana should be given. Every day one Vasti can be given.3
2. Kala Vasti:
Charaka mentioned that it includes half number of Vasti to that of Karma Vasti. But Chakrapani
opined that it includes 16 Vasti. According to Vagbhata it includes 15 Vasti. He reduced one
Anuvasana in this schedule. On first day 1 Anuvasana can be given then Afterwards 6
Anuvasana and 6 Nirooh given alternatively and at last 3 Anuvasana are administered.3
3. Yoga Vasti:
65
………………ततश्च योगः । (Ch.Sid.1/47)
Charaka mentioned that it includes half number of Vasti to that of Kala Vasti. It includes 8 Vasti
out of which 5 Anuvasana and 3 Nirooh.3 On the first day 1 Anuvasana then 3 Nirooh and 3
Anuvasana alternatively and at last 1 Anuvasana should be given. This Vasti schedule is called
Yoga Vasti. It is used in the patients having Kapha Sansarga along with Vata vitiation.
(B) On the Basis of Adhisthana:
It depends upon the part of the body used for the administration of Vasti.
Internal Application:
A- Pakvashayagata Vasti
B- Uttara Vasti 1. Garbhashayagata Vasti 2. Mutrashayagata Vasti
External Application:
1- Vranagata Vasti 2- Kati Vasti
3- Shiro Vasti 4- Netra Vasti
(C) On the nature of Vasti drugs:
Depending up on the nature of Vasti drugs i.e. Kashaya and Sneha the Vasti is mainly sub-
classified as Nirooh and Anuvasana Vasti.
a) Nirooh Vasti (Evacuative or Un-unctuous Enema):
The Vasti which eliminates the vitiated Dosha thus provides strength to the body, is called
Nirooh Vasti19. Its other important synonym is Asthapana.
वयः स्थािनादायुः स्थािनाद्वा अस्थािनम् । (Su.Chi.35/18)
It stabilizes the young age and provides longevity (Ayu Sthapana), so it is called as Asthapana
Vasti.
In Nirooh Vasti, Kashaya (decoction) is the dominant content along with Sneha, Kalka, Madhu
and Saindhava, but depending upon drugs used for preparations of Vasti. It may be classified as
follows:
1. Madhutailaika Vasti 2. Yuktaratha Vasti
3. Yapana Vasti 4. Siddha Vasti
b) Anuvasana Vasti (Unctuous Enema):
66
In this type of Vasti only Sneha is used.
ऄनुवासन्निि न दुष्यत्यनुकदवसं वा दीयत आत्यनुवासनः । (Su.Chi.35/18)
The Sneha given in the Vasti does not harm even if it is retained for one day, therefore it is called
Anuvasana Vasti
According to the quantity of oil used in the Vasti, it is subdivide as follows:
Sneha Vasti : 1/4th of the quantity of Nirooh i.e. 6 Pala (298ml)
Anuvasana Vasti : The quantity of Sneha is half of the Sneha Vasti i.e. 3 Pala (148ml).
Matra Vasti : In Matra Vasti, minimum quantity of Sneha is given i.e.½ of Anuvasana Vasti (1½
Pala or 72ml).
Pharmacological Classification:
(A) According to effects after administration
1. Shodhana Vasti
2. Lekhana Vasti
3. Brimhana Vasti
(B) According to Dose:
1 Dvadasha Prasritaki Vasti 4 Chatuha Prasritaki Vasti
2 Ekadasha Prasritaki Vasti 5 Ekaika Prasritaki Vasti
3 Nava Prasritaki Vasti 6Pancha Prasritaki Vasti
(C) Miscellaneous Classification:
1 Rakta Vasti 4 Vaitarana Vasti
2 Kshara Vasti 5 Mutra Vasti
3 Mamsa Vasti 6 Kshira Vasti
(D) On the basis of Nature of the Vasti Dravya:
1 Mridu Vasti 3 Tikshna Vasti
2 Madhyama Vasti
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(E) On the Basis of Special Purpose with Special Indications:
1 Madhutailika Vasti 5 Pichchha Vasti
2 Siddha Vasti 6 Pichchhila Vasti
3 Yuktaratha Vasti 7 Vaitarana Vasti
4 Yapana Vasti
(F) On the Basis of Chief action:
1 Snehana Vasti 7 Rasayana Vasti.
2 Brinhana Vasti 8 Vajikarana Vasti
3 Shamana Vasti 9 Bala-varnakrita Vasti
4 Lekhana Vasti 10 Chakshushya Vasti
5 Shodhana Vasti 11 Dipana Vasti
6 Sangrahika Vasti
(G) On the Basis of Specific indication indications:
1 Pramehahara Vasti 7 Abhishyandahara Vasti
2 Visarpahara Vasti 8 Krimihara Vasti
3 RaktaPittahara Vasti 9 Dahaghna Vasti
4 Kusthahara Vasti 10 Mutrakrichchhahara Vasti
5 Vataraktahara Vasti 11 Parikartikahara Vasti
6 Gulmahara Vasti
Approximately 216 kinds of Vasti formulations are mentioned by Charaka in various chapters of
Siddhisthana
1
Action of Vasti:
Acharya Charaka has defined the Vasti as the procedure in which the drug prepared administered
through the anus reaches up to the Nabhi Pradesha (umbilical region), Kati (lumber region),
Parshva and Kukshi (flanks), churns the accumulated Dosha and Purisha (stool), spreads the
unctuousness (potency of the drugs) all over the body and easily comes out along with the
churned Purisha and Doshas..
68
1. Systemic Action of Vasti:4
The Virya of Vasti administered through the Vasti into the Pakwashaya reaches the whole body
through the channels (Srotasa), as the active principles in the water when poured at the root of
the tree reaches the whole plant.
2. Eliminative or Purificative Action of Vasti:5
Vasti administered into Pakwashaya draws the Dosha/Mala (morbid matter) from all over the
body from the foot to the head by the virtue of its Virya (potency), just as the sun situated in the
sky draws the moisture from the earth by its heat.
3. Action of Vasti on Vayu:
Vayu is considered to be the main controller of the body. Now if Vayu alone or in combination
with other Dosha get vitiated, then Vasti by the way of evacuation or elimination normalizes the
path of Vayu along with Pitta, Kapha and fecal matter.
Effect of Vasti:
 It cleanses all the systems and makes a clear passage up to micro channel level.
 It acts on various disorders because of the selection of the drug according to disease.
 Palliative.
 Vasti can be administered at any age and at any stage of disorder after proper
examination. It can also be given in normal persons too.
(a) Promotive Aspects:6
 Sustains Age.
 Provides better life, improves strength, digestive Power, voice and complexion.
 Perform all functions.
 Provides firmness.
 Corpulence.
 Lightness in systems because of removal of morbid matter from all over the body.
 Restores normalcy.
(b) Curative Aspect:
 Relieves Stiffness.
 Relieves contractions and adhesions.
 Effective in discoloration and fracture condition. Effective in those conditions where
Vata aggravated in Shakha/extremities.
 Relieves pain.
 Effective in disorders of GI tract.
69
 Effective in diseases of Shakha and Kostha.

 Effective in the diseases of vital parts, upper extremities and Localized or General part.
 Beneficial to debilitated and weak persons.
 Arrest premature old age and the graying of hair.
(c) Preventive Aspects: Effective to cleanse various systems of the body from time to time
seasonal application.
(d) Rejuvinative Aspect:
 Increases the quantity and quality of sperm.

 Effective to restore the normal functions of blood and other Dhatu.
 It provides strength by increasing muscle power.
 Beneficial as aphrodisiac.
(e) Effect on Brain and Psychology:
 Improves intellectual power.

 Provides clarity of mind.
 Improves clarity of sense organs.
 Induces sound sleep.
 Lightness.
 Exhilaration.
 Pleases the mind.
(f) Effective at any Age and in any Season:
 Vasti is non antagonistic to healthy, diseased and old persons.

 Applicable in all seasons.
 Vasti can be administered in child and older person too because it is free from
complications.
Anuvasana Vasti:-
Purvakarma:-
In Anuvasana Vasti only Sneha is given which should always be Pakva and luke warm at the
time of administration. As the maximum dose of Anuvasana Vasti is approximately 280 ml
therefore metal enema syringes available in the market may be used, but conventional Vasti
Yantra should be preferred.
70
Indications for Anuvasana Vasti 7
Anuvasana is indicated in patients who are already indicated for Nirooh, but special mention has
been given to certain conditions like Rooksha, Kevala Vata Roga and Atyagni where Anuvasana
is more beneficial.
Contraindications of Anuvasana Vasti 8
Anuvasana Vasti given in Anasthapya, Abhuktabhakta leads to upward movement of Sneha.

Anuvasana Vasti given in Navajwara, Kamala & Prameha leads to Udara Roga; Arsha leads to
Adhmana; Arochaka leads to more Anannabhilasha Mandagni & Durbala leads to increase in
the condition; Pleehodara & Kaphodara leads to more Dosha Vardhana Urustambha,
Garapeeta, Kaphabhishyanda, Gurukoshta, Shleepada, Galaganda, Apachi, Krimikoshta,
Kushta, Sthaulya, Peenasa, Krushna, Varchobheda Pratishyaya Pandu Vishapeeta.
The body of the patient should be prepared with suitable Abhyanga and Swedana. Then patient is
advised to have his prescribed meal (1/4 or ¾ then routine) and asked to take a short walk.
Having passed stool and urine he is laid on a bed, which is not very high, and the head must be at
lower level. No pillows are used. The patient should be on his left side drawing up the right leg
and straightening the left leg.
Pradhana Karma:-
The Sneha prescribed for Anuvasana is to be taken in the Vasti-putaka and tied well placing the
Vasti Netra in position. The trapped air in Vasti-yantra is expelled by gently pressing the Vasti-
putaka. Then the anal region and the Netra should be smeared with oil. Gently probe the anal
orifice with the index finger of the left hand and introduce the Vasti Netra through it into the
rectum up to first Karnika. Keeping in the same position, press the Vasti-putaka with right hand
with adequate force. Remove carefully the Vasti-netra when a little quantity of Sneha remaining
inside the Vastiputaka.
Pashchata Karma:-
The patient is kept lying on his back as long as it would take to count up to hundred. The patient
should be gently struck three times on each of the soles and over the buttocks. The lower limb
should be raised thrice. If patient gets the urge for defecation one can attend. But in the
conditions in which Sneha passes immediately, another Anuvasana Vasti can be given. After
passing the motion with Sneha in proper time the patient is allowed to take light food if he feels
hungry.
The ideal time for coming out of Vasti Sneha is 3 Yama i.e. 9 hours, but it may be retained for 24
hours if it is not disturbing the patient.9
Complications of Sneha Vasti:-
71
Six types of complications may arise in Sneha Vasti, which are due to: -
i Vata avrita Sneha iv Atibhukta (Annavruta Sneha)
ii Pitta avrita Sneha v Pureesha avrita Sneha
iii Kapha avrita Sneha iv Abhukta -Pranita Sneha
NIROOH VASTI:
Purvakarma:-
Indications for Nirooh Vasti 10
Sarvangaroga, Rajakshaya, Ekangaroga, Vishamagni, Kukshiroga, Spikshoola, Vatasanga,

Janushoola, Mutrasanga, Janghashoola, Malasanga, Urushoola, Shukrasanga, Gulphashoola,
Balakshaya, Parshnishoola, Mamsakshaya, Prapadashoola, Doshakshaya, Yonishoola,
Shukrakshaya, Bahushoola, Aadhmana, Angulishoola, Angasupti, , Sthanashoola, Krimikoshta,
Dantashoola, Udavarta, Nakhashoola, Sudhatisara, Parvasthishoola, Parvabheda, Shopha,
Abhitapa, Sthmaba, PleehaDosha, Aantrakoojana, Gulma, Parikartika, Shoola,
MaharogoktaVatavyadhi, Hridroga, Jwara, Bhagandara, Timira, Unmad, Pratishaya, Jwara,
Adhimantha, Bradhna, Ardita, Shirashoola, Pakshaghata, Karnaroga, Ashmari, Hritshoola,
Upadamsha, Parshwashoola, Vatarakta, Prushtashoola, Arshas, Katishoola, Stanyakshaya,
Vepana, Manyagraha, Aakshepa, Hanugraha, Angagaurava, Ashmari, Atilaghava.
Moodhagarbha AmlaPitta, Hridroga, Asrugdhara AmlaPitta, Hridroga, Asrugdhara and
Vishamanajwara
Contraindication for Nirooh Vasti 11
The Nirooh Vasti has been contraindicated in the following conditions, which are described
along with the reasons for their contraindications:
 If Nirooh Vasti is given in Ajeerna, Atisnigdha & PeetaSneha, it may lead to

Dushyodara, Moorchha, and Shotha.
 If Nirooh Vasti is given in Utklishta Dosha & Alpagni, it may lead to Tivra Aruchi.
 Nirooh Vasti given in Yana-klanta, Atidurbala, Kshudhaarta leads to Shaeerashosha &
Pranaparodha. Trishnaarta, Sharmaarta leads to Kruchraswasa.
 If Nirooh Vasti is given in Atikrisha, Bhuktabhakta & Pitodaka it may lead to more
Karshya and Utklesha of Dosha.
 If Nirooh Vasti is given in Vamita & Virikta, more Rookshata will occur.
72
 If Nirooh Vasti is given in Krita Nasyakarma it may lead to Manovibhrama and

Srotonirodha.
 Nirooh Vasti, given in Krudha & Bheeta causes Vastidravya to move up.
 Nirooh Vasti given in Mata & Murchita leads to Sangnanasha and Hrudayopaghata.
 Nirooh Vasti given in Prasakta-chhardi causes Vasti Dravya to moves up because of the
existing Urdhvagati of Vata.
 Nirooh Vasti given in Prasaktanishteeva, Svasaprasakta, Kasaprasakta, Hikkaprasakta,
Baddhagudodara, Chhidrodara, Dakodara & Adhmana leads to death by causing severe
distension of abdomen
 Nirooh Vasti given in Alasaka, Visoochika, AsmaDosha, Amatisara causes Teevra
Amavastha of the body.
 Nirooh Vasti given in Madhumeha & Prameha leads to Vyadhi Vardhakam Kushtha,
Arshas, Pandu, Bhrama, Arochaka, Unmad, Shokagrastha, Sthaulya, Kandhashosha,
Garbhini, Bala, Vruddha, Alpavarcha, Gudashodha, Amaprajatha Shopha were also
mentioned.
Vasti – Ingredients:
Significance of different ingredients in the Vasti Dravya :
The importance of each of the ingredient for the preparation of Nirooh Vasti. Dravya in general
can be explained as follows:
1) Madhu (Honey):
It is considered as the Best among the vehicles, as it contains various substances in it, which
denotes its drug (potency of the drug) Carrying Capacity.
Owing to its Sukshma Guna it reaches up to the micro channels, in turn carries the drug (potency
of) the drug at the molecular level through the micro channels. Further it is Tridoshahara; hence
it is always wholesome and can be used in all the conditions.
Charaka says that Vasti Dravya containing excess of honey when administered to the person
makes him extremely virile and Vasti Dravya with honey do not lead to over action or under
action.
2) Saindhava Lavana:
Lavana in general are having the properties like Vishyandi, Sukshma, Tikshna, Ushna and
Vataghna and promotes the evacuation of bladder and rectum.
Owing to the Sukshma property it helps the drug (potency of the drug) to reach in the micro
channels, Saindhava mixed with Madhu is capable of liquefying the viscid Kapha and breaking
73
it into minute particles for their easy elimination. Similarly it may liquefy the morbid Dosha
Sanghata and break it into smaller particles by virtue of its Ushna and Tikshna property
respectively and thus helps their elimination. Apart from this, Saindhava destroys the Pichcchila,
Bahula and Kashaya properties of Madhu and makes close union with it to form a homogeneous
mixture. Absence or less quantity of Saindhava is responsible for Ayoga and excess quantity
produces Daha and Atisara.
3) Sneha:
It includes Ghrita, Taila, Vasa, Majja and each one is having its specific properties accordingly
it produces beneficial effects. Sneha in general is Vatahara, Mridukara (Produces softness in the
channels and tissues, in turn helps for easy elimination of waste substances) and destroys the
compact Mala and removes the obstruction in the channels produced by the Mala i.e Malanam
Vinihanti Sangam.
Owing to the Snigdha Guna, it produces unctuousness in the body in turn helps for easy
elimination and by Sukshma Guna it helps the drug (potency of the drug) to reach into the micro
channels. Apart from these functions, it protects the mucous membrane from the untoward effect
of irritating drugs in the Vasti Dravya.
Thus these three substances viz. Madhu, Saindhava and Sneha helps to form a homogeneous
mixture of the Vasti Dravya and after administration they helps to reach the drug (potency of the
drug) through the micro channels at the cellular level and to eliminate the waste substances from
the body.
4) Kalka Dravya:
It serves the function of Utkleshana or Doshaharana or Samshamana depending upon the

contents, the contents are selected accordingly. It gives required thickness to the Vasti material.
Less quantity or absence of Kalka makes the Vasti Dravya thin which comes out immediately
after administration. Excess quantity of the Kalka makes the Vasti Dravya thick and difficult for
administration and may not come out within the expected time.
5) Kwatha:
It is the Drava Dravya, usually the Kashaya is used, but as per the need Kshira, Gomutra,
Amlakanji, Prasanna, Mamsarasa etc. are also used in place of Kashaya or for the preparation of
Kwatha itself.
The drugs used for the preparation of Kalka and Kwatha are selected on the basis of Dosha,
Dushya and Srotas involved in the pathogenesis of the disease; hence they are the main
constituents of the Vasti Dravya.
74
6) Avapa Dravya:
They are used sometimes in order to make the Vasti either Tikshna or Mridu and to affect the
particular Dosha.
Dose of drugs: Vagbhatta advised, in the following proportion for the Vasti Dravya12 :
Sneha –One fourth of kwath dravya
Kalka – One eighth of kwath dravya
Makshika – yathayogya or as Sneha dravya
Lavana – yathayogya or half karsha
Physician must consider factor mentioned by Acharya Vagbhatta, because practical aspect of
factor mentioned by Acharya Vagbhatta considering very applicable in present time.
Preparation of the Vasti:
It plays significant role in getting the expected results. Mixing of the ingredients of the Vasti
should be in this way. First of all the ingredients are to be taken in the required quantity by
measuring them.
The ingredients should be mixed by triturating in the order of Madhu, Saindhava, Sneha, Kalka,
Kwatha and then Avapa Dravya one by one gradually until it becomes a homogeneous mixture.13
Then it should be churned further to make it more fine and homogeneous, heated in water bath to
make it Sukhoshna i.e. nearer to the normal body temperature.
I. Pradhana Karma
It includes advice to the patient, Vasti Pranidhana, Vasti Pratyagamana and observing the
Samyaka yoga, Ayoga and Atiyoga Lakshana.
Vasti Pranidhana :
Vasti is to be administered when the patient is having the symptoms of Jirnahara and is not very
hungry. After performing Abhyanga and Nadi Sweda, the patient is asked to lie down in the left
lateral position on the Vasti table. Then patient is asked to keep his left hand below the head as a
pillow, to extend the left leg completely and to flex the right leg at the knee joint, keeping on the
left leg by flexing the hip joint. Then Sukhoshna Sneha is to be applied in the anal region and on
the Vasti Netra, remove the cotton piece and the air bubble if any and keep the thumb on the
Netra while introducing it. Then introduce the Vasti Netra gradually in the parallel direction to
that of the vertebral column up to ¼ part of the Netra until the nearer Karnika fixes over the
anus. Then hold the Vasti Putaka in the left hand and keep the right hand on the Putaka.
75
After this press it gradually with the constant pressure, neither too fast nor too slow, without
tremoring the hand. By asking the patient to breath in, push the Vasti Dravya into the rectum till
a little quantity remains in the Putaka otherwise Vayu enters into the Pakwashaya, and then
withdraw the Netra gradually. Then the patient is asked to lie down in the supine position. After
this the patient is asked to lie in a comfortable position with a pillow below the hips till he gets
the urge for defecation and when he/she gets the urge ask him/her to sit in Utkatasana and pass
the urge. After administration of Vasti Dravya, a keen observation should be done so as to
evaluate the proper function of Vasti.
Vasti Pratyagamana:
One muhurta (48 min) is the maximum period of time in which the Pratyagamana of Vasti
should occur. If it does not occur then it causes untoward consequences like Vata Pratilomata,
Vistabdhata, Shula, Arati, Jwara and even death.
Hence if it does not come out within the stipulated time period certain measures are to be
undertaken for the Vasti Pratyagamana like administration of the Tikshna Vasti, Phalavarti,
Swedana over the pelvic region, Utrasana (Showing fear) and administration of Virechana
Aushadhi. Until the Pratyagaman takes place, the physician should observe the patient.
However, Kashyapa opines that Yapana Vasti owing to its Mridu nature retains for longer time
and Tikshna Vasti comes out in 100 matra periods, hence Atitikshna Vasti should not be
administered.
YOGA – AYOGA - ATIYOGA LAKSHANA
Samyaka Yoga Lakshana14:
Prasrista Vitakata, Prasrista Mutrata, Prasrista Vata, Kramena – Mala , Pitta, Kapha & Vayu
Visarjana, Laghuta, Ruchi, Agnidipti, Ashaya Laghuta, Rogoprashamana, Prakritisthitata, Bala
Vriddhi.
Ayoga Lakshana15:
Shiro – Hrit – Guda – Vasti – Medhra Vedana, Shotha, Pratishyaya, Parikartika, Hrillasa,
Vatasanga, Mutrasanga, Swasakrichchhrata, Alpa Vega, Alpa Vasti Pratyagamana, Alpa Mala –
Anila Pratyagamana, Aruchi, Gaurava. In Ayoga, measures for Vasti Pratyagamana should be
undertaken.
Atiyoga Lakshana16:
These Lakshanas are similar to that of Virechana Atiyoga i.e. Angasupti, Angamarda, Klama,
Kampa, Nidra, Daurbalya, Tamapravesha, Unmada, Hikka. In Atiyoga, Grahi, Dipana, Pachana
Aushadhi is to be administered and according to symptoms it is to be managed.
II. Paschata Karma :
76
If Samyaka Niruhita Lakshanas are not observed, then again Vasti may be administered
preferably after administering an Anuvasana Vasti and further 3rd or 4th Nirooh Vasti may be
administered on next day till getting the Samyaka Nirudhita Lakshana.
Vasti Vyapada17 :
These Vyapadas can be rectified by taking precautions and proper care. But certain other
Vyapadas that occurs are of serious nature should be effectively Managed. They are as follows:
1] Ayoga: Due to less quantity of Vasti Dravya, rock salt, add oil leads to heaviness in abdomen,
obstruction of flatus stool and urine, burning sensation, inflammation at anal region, itching,
anorexia, etc.
2] Atiyoga: Administration of Tikshna Vasti to Mridu Kostha person leads to Atiyoga and
symptoms are similar to Vamana Virechana Atiyoga.
3] Klama: Conduction of Mridu Vasti in Ama state, Pitta and Kapha gets vitiated and block the
channels, which lead to dyspepsia. Thereafter Vata also become vitiated and causes fatigue,
syncope, colic, chest pain, heaviness.
4] Adhmana: Due to low potency drugs to strong person, dry bodies and costive bowel, the drugs
are not able to expel vitiated Dosha ,and Vata gets vitiated leading to Adhmana causing pain in
Vasti and Hridaya, severe burning sensation, pain in testicles and groin.
5] Hikka: Hiccup results in administering Tikshna Vasti to weak person and Mridu Kostha with
excessive expulsion of Dosha.
6] Hrit Prapti: Vasti Dravya reaches the cardiac region by entering into deeper levels due to
complete squeezing or improper handling of Vastiputaka and causes pain in chest and the
surroundings.
7] Urdhwagamana: Suppression of urges before or after Vast karma and squeezing Vastiputaka
with high pressure leads to the upward movement.
8] Pravahika: Administration of less potent and insufficient quantity of Vastidravya to the person
suffering from intensive vitiated Dosha leads to Pravahika.
9] Shiroarti: Includes symptoms of headache, earache, deafness, tinnitus and coryza, eye
disorders due to administration of less potent Sheeta Virya Dravyas with insufficient quantity to
weak persons.
10] Angarti: Administration of Tikshna Vasti without conducting pre-operative procedures like
Abhyanga and Sweda leads to Angarti with upward movement of Vata and twisting and pricking
pain in the body.
77
11] Parikartika: Ruksha and Tikshna Vasti in excessive quantity to the person having
Mridukoshta and in conduction of less vitiated Dosha leads to the excessive expulsion of Dosha
causing Parikartika.
12] Parisrava: Administration of Tikshna and Ushna Vasti to the person suffering from Pitta
Roga / RaktaPitta leads to Parisrava and causes burning sensation, erosion and cutting.
MODE OF ACTION OF VASTI:-
1. Ayurvedic view: Probable mode of action of Vasti:
In Ayurvedic classics, Acharyas have tried to explain actions of Vasti with suitable analogies-
मूले िनिषक्तो िह यथा द्रुमः स्यान्नीलच्छ्दः िोमलिल्ल्वाग्र्यः ।

(As.H.Su. 19/47)
As tree irrigated in its root level Attains nourishment for whole tree, In the same way, Vasti
drugs given through Guda {Rich of blood vessels, lymphatic & nerves} Nourishes all the limbs
& organs of the body. By the above mentioned reference, a collation of information about Guda
Sharira (structure of Anus), its relations, its physiology etc. gives compendious information
about it. Guda (Anus) is one of the Pranayatana, where all twelve Prana dwell predominantly.
Guda (Anus) is a Mamsa Marma of Sadyapranahara type. Being a Marma it has roots of all four
types of Sira embedded in it viz. Vatavaha, Pittavaha, Kaphavaha and Shonitavaha. Due to its
Sadyapranahara nature, Guda (Anus) is highly sensitive. Even a mild stimulation to it, say, by
Vasti drugs and procedure may sensitize the whole body by vigorous action of Vayu through all
the Siras present in the body.
This physiology confirms immediate and all pervasive action of Vasti drugs even though the
Vasti lies in Pakvashaya.
Relations of Guda (Anus):
Apana Vayu - Anus is the seat of Apana Vayu
Prana Vayu - Being Sadyapranahara Marma
Vyana Vayu - Vyana is all-pervasive
Samana Vayu - It moves all over the Kostha.
Pachaka Pitta - Helps in digestion
Sira, Snayu, Sandhi, Asthi - As it is a Marma and Mamsa Sannipata
Kala - Maladhara, Asthidhara and Majjadhara.
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Dhatu - Rasa, Rakta, Mamsa, Meda, Majja & Shukra.
From the above-sited relevance, it may be said that, Vasti influences whole body. However, it
acts mainly on the structures related to Guda (Anus). If Apana is controlled in its own abode
other four Vayus can be bridled automatically. Vagbhata illustrated the whole phenomenon as
follows-
The Virya (potency) of collective Vasti drug is first taken up by Apana Vayu, i.e. it acts or
influences the Gunas of Apana Vayu with which it comes in contact first. Consequently the
Samana Vayu is also affected followed by Vyana, Prana and Udana. By the Gunas of Vasti
Dravya, the vitiated Vayu regain their normal state and supports the body. They also bring
vitiated Pitta and Kapha in their normal state, and the five types of Vayu nourish their respective
Sharira-Bhuta Guna.
Vasti drugs in Pakwashaya acts on whole body in a same way that of sun, which though placed
in the sky, causes evaporation of water on the earth.18A The Virya(potency) of Dravya are
propagated by the Vyana in Tiryaka or lateral direction, by the Apana in downward direction and
in upward direction by Prana, just as water pipes carry water to the different parts of the field
similarly the ―Harini‖ (Channels) carry the Gunas of the Vasti Dravya to every part the body,
hence a Vasti which is appropriate will with the help of Vata, Pitta and Kapha through the Shira
will spread in all body and cures even the most difficult disease. Pakwashaya is the place where
Poshakamsha (nutritive substences) originates and supplies the nutrition to all Vayus. As Vasti is
introduced in its Udbhavasthana, it has capacity to control all the five Vayu. However it acts
more on Samana and Apana because it has direct contact with their places.
Charaka clearly mentioned that in normal conditions Sneha of Anuvasana is digested within
three days. As the Sneha is difficult to digest than Kwatha so it may be inferred that the drugs in
the Vasti, other than Sneha, are digested sooner than Sneha. Chakrapani explored it further and
explained, Sneha impregnated to Pakwashaya is digested by the Agni located there which gets
exudates to the exterior. Further he stated that Agni is located above the colon, hence the Sneha
adhered to the wall of the colon does not come in direct contact with Agni. Even then fractions of
Jatharagni that come in contact with the Sneha perform this work of digestion.
2. Pharmacokinetics of Vasti Dravya- Modern aspect:
(I) Saindhava:
1] The cells of the intestinal mucosal membrane are so easily permeable for sodium chloride that
hypotonic / isotonic solution are absorbed almost as rapidly as pure water.
2] The presence of Na+ (Saindhava) in Vasti Dravya may play important role for the absorption
of the drug with the help of Na+ channels; the most commonly used channel for the absorption
of the substances.
79
3] The concentrated dose of salt causes irritant action on the bowel producing peristalsis.
(II) Honey (Madhu):
Glucose molecules of Honey have better permeability to get absorbed and enter the circulation.
Along with salts honey makes homogenous solution having properties to get penetrated easily.
(III) Taila (oily substance):
Oil mainly helps to protect the intestinal mucosa from the irritating substances. It helps for easy
elimination of Vasti Dravya. Volatile substances are rapidly absorbed from aqueous or oil
solutions. Oil enema or oil present in the enema preparation can also get absorbed.
(IV) Kalka (Paste):
This is one of the ingredients mainly according to the disease. Kalka gives thickness to the Vasti
Dravya. The drugs containing volatile properties which cannot be used for the decoction can be
used in the form of Kalka.
(V) Kwatha (Decoction):
This is the main content of Vasti Dravya. The drugs used for decoction are mainly according to
the disease and the stage of the disease. The drugs which are soluble in water can be used in this
way. Water base is always essential for the absorption of the drugs from the intestine. The Kwath
gives essential quantity to the Vasti Dravya for administration.
3. Absorption and Influence of Vasti:
Vasti is not merely the enema, one which exerts local cleansing effect; rather it is a highly
complex, sophisticated and systemic therapy having wider range of therapeutic actions and
indication. It exerts its action by endcolonic (action inside the colon), encolonic(action on tissues
of colon) and diacolonic (for systemic action) ways.
A) Absorption:
Vasti may be absorbed by: diffusion, filtration, osmosis or by adsorption depending upon
substance used in it.
a) Drug absorption
1. The rectum has rich blood & lymph supply.
2. Vasti drugs get absorbed via two routes:
80
1) Drug absorbed by upper haemorrhoidal vein goes into portal circulation. 2) Drug absorbed by
middle and inferior haemorrhoidal veins is always absorbed without reacting with digestive
enzymes and acids.
b) Electrolyte absorption-
The ions like sodium (Na+), calcium (Ca) and potassium are absorbed and are essential for the
generation of action potential, which is the main functional unit of Nervous system. Here are the
mechanisms how they absorb from intestinal mucosa.
1. Sodium (Na+) ions are absorbed by Diffusion & Active Transport.
2. Chloride (Cl-) ions penetrates via Passive diffusion and facilitated by sodium absorption
3. Calcium (Ca) ions can be absorbed via Active Transport
c) Fat absorption-
1. In Anuvasana Vasti
 The Fat given by Vasti stimulates Cholecystokinin enzyme which stimulates Gall bladder
to secrete the bile.
 Bile contains bile salts, 20-50 molecules of bile salt aggregate to form ‗micelles‘ which
have the ability to dissolve in water.
 The central part of micelles is fat soluble, so fatty acids & mono-glycerides dissolve in
the center of micelle.
 When they come in contact with the surface of epithelial cells, fatty acids & mono-
glycerides diffuses into the cell leaving the micelles behind.
 In this way the absorption of fat takes place in Anuvasana Vasti.
2. In Asthapana Vasti-
 While preparing the Asthapana Vasti Sneha is added into Madhu & Saindhava.
 By continuous Mardana of Sneha it gets emulsified in small particles.
 The small particles are covered by a layer of honey & rock salt and which is water
soluble just like a micelles of bile salts which can be absorbed through the epithelial layer
of intestine.
B) Influence on Bacterial Flora
a) Vasti influences the normal bacterial flora thus it increases the endogenous synthesis of
Vitamin B12, Vitamin K etc. Vasti makes the whole metabolism normal.
b) Production of Thiamine with the help of bacteria, which is necessary for nerve
conduction and which is produced in large intestine, may be controlled by Vasti.
81
C) Influence through ENS (Enteric Nervous System):
a) ENS (Enteric Nervous System) is Substantial group of neurons
b) It is capable of Autonomous reflex without influence of central nervous system.
c) More than 500 million neurons present in the ENS (Enteric Nervous System) so it‘s
called ―second brain‖.
d) There are so many similarities between CNS-ENS regarding cellular structure,

neuropeptide secretion and specific functions. And recent studies have shown that there is
great influence of CNS and ENS (Enteric Nervous System) on each other.
In this way, Vasti may produce Neuromuscular remodelling, pain modulation by influencing
ENS (Enteric Nervous System) and thereby CNS (Central Nervous System).
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Drug review
God sleeps in the minerals, awakens in plants,

walks in animals, and thinks in man.
(Arthur Young)
83
DRUG REVIEW
The Vasti karma was observed on the patients of Grahani Roga in present study. The schedule of
Vasti karma was adopted as Yoga Vasti.
The Vidangadi Taila (Ch.Sid.4/18)1 was used in Anuvasana Vasti and the Contents of
Dhanyapanchak Kwatha (Chakradutta- 3/21)2 were taken in preparation of Nirooh Vasti.
VIDANGADI TAILA
Vidangadi Taila has been selected for present study. Yavakut of Kwatha dravya is taken in same
quantity and added water 8 times of total amount of Kwatha dravya, prepared its decoction with
¼ reduction of water, and then added Tila Taila in Chaturthansha Pramana of Kwatha and Kalka
in Chaturthansha Pramana of Taila. Taila is prepared on slow fire.
This Vidangadi Taila is indicated for the treatment of Grahani Roga, Agni- vishmata, Malavikriti
and all three Dosha Prokopa. It is used as Pana, Abhyanga and Vasti method.
The Latin name, Family and Gana of the ingredients of Vidangadi Taila are as given below:-
84
DRUG BOTANIC FAMILY PAR PROPERTIES DOSHAGHN

AL NAME T RASA GUNA VIRY VIPA KARMA ATA
USE A KA
D
VIDAN Embelia Myrsinace Phala Katu, Laghu, Ushna Katu Krimighna KAPHAVA
G ribs ae Kasaya Ruksha, Dipana, TA
Tikshna Pachana
Anulomana,
Rasayna
dravya,
ERAND Ricinus Euphorbia Mool, Madhur Snigdh, Ushna Madh Amashodhana, KAPHAVA
communis ceae a Tiksna ura Dipana, TA
Sukshma Bhedana
PATOL Trichosanth Cucurbitac Patra Tikta Laghu, Ushna Katu Dipana, VATA,
A es dioca eae Singdha Rochana PITTA,
KAPHA
GUDUC Tinospora Menisper Kanda Tikta, Laghu, Ushna Madh Rasayan, VATA,
HI cordifolia maceae Kashay Snigdha ura Dipan, Balya, PITTA,
a Samgrahi KAPHA
HARIT Terminalia Combertac Phala Pancha Laghu, Ushna Madh Vedanasthapan VATA,
AKI Chebula eae rasa Ruksha ura a, PITTA,
(Lavan Vranashodhan KAPHA
a a,
Varjita) Vranaropana,
, Dipana,
Kashay Pachana,
apradha Krimighna,
na Anulomana,
VIBHIT Terminalia Combretac Phala Kashay Ruksha, Ushna Madh Anulomana, VATA,
AKI Bellirica eae a Laghu ura Bhedaniya, PITTA,
Shothahara KAPHA
AMALA Emblica Euphorbia Phala Panchar Guru, Sheet Madh Dahaprashama VATA,
KI Officinalis ceae as Ruksha, a ura na, Rechana, PITTA,
(Lavan Dipana, KAPHA
a Anulomana,
Varjita)
Amla
Pradha
na
JATI Jasninum Oleaceae Patra, Tikta, Laghu, Ushna Katu Anulomana VATA,
officinale Kashay Snigdha, PITTA,
a KAPHA
NIRGU Vitex Verbenace Patra, Katu, Laghu, Ushna Katu Amapachana, VATA
NDI negundo ae Tikta, Ruksha Shothahara, KAPHA
Kashay VedanaSthapa
a na, Jwaraghna
AKHUP Merremia Convolvul Panch Katu Laghu, Ushna Katu Dipana, KAPHAVA
85
ARNIK emarginata aceae ang Ruksha, Rechan, TA

A Tikshna Krimighna
NIMBA Azadiracta Meliaceae Kand Tikta, Laghu Sheet Katu Sangrhahi, KAPHA
indica tvak Kashay a Balaya, PITTA
a Agnivardaka,
PATHA Cissampelo Menisper Mula Tikta Laghu, Ushna Katu Dipana, VATA,
s mea Bhum Tikshna Pachana,Grahi PITTA,
Pareira ceae ik KAPHA
Kand
PIYAV Barberia Acanthace Bija, Tikta, Laghu Ushna Katu Vishaghna, KAPHAVA
ASA prionitis ae Shothahar, TA
Raktashodhak,
Vedanasthapan
AMALT Cassia Caesalpini Phala Madhur Guru, Sheet Madh Mriduvirechan KAPHA
ASA fistula aceae majja, a Snigdha, a ura a, Anulomana PITTA
Mridu
KARVI Thevetia Apocynac Mula Katu, Laghu, Ushna Katu Dipana, KAPHAVA
RKA neriifolia eae Tikta ruksha, Vidahi, TA
Tikshna Bhedana
MADA Randia Rubiaceae Phala Kashay Laghu, Ushna Katu Vatanulomana, KAPHA
N spinosa a, Ruksha, Lekhana PITTA
PHALA Madhur Vyavayi,
a, Vikasi
Tikta,
Katu
BILVA Aegle Rutaceae Mula, Kashay Laghu, Ushna Katu Dipana, KAPHAVA
marmelos Tvaka a, Ruksha Pachana,Grahi TA
, Tikta,
Phala Madhur
a
TRIVRI Operculum Convolvul Mula- Katu , Laghu, Ushna Katu Lekhan, KAPHA
TA terpathu aceae tvaka Tikta Ruksha, Sukhavirechan PITTA
Tikshna
PIPALI Piper Piperaceae Phala, Katu Laghu, Anusn Madh Dipana, VATA
longum Snigdha, a ura Shirovirechana KAPHA
Tikshna Sheet ,
a Raktashodhaka
,
RASNA Pluchea Composita Kanda Tikta Guru Ushna Katu Amapachan, KAPHAVA
lanceolata e Shoolaghna, TA
Vedanasthapan
BHUNI Andrograph Acanhthac Whol Tikta Laghu, Ushna Katu Dipana, KAPHA
MBA is eae e Ruksha Piitasraka PITTA
paniculata Plant Saraka
86
DEVDA Cedrus Pinaceae Kand Tikta Laghu, Ushna Katu Dipana, KAPHAVA
RU deodara sara Snigdha Pachana TA
SAPTA Alstonia Apocynac Tvaka Tikta, Laghu, Ushna Katu Dipana, KAPHA
PARNA scholaris eae Kashay Snigdha Anulomana, PITTA
a Yakridbalya
VACHA Acorus Araceae Mula Katu, Laghu Ushna Katu Shoolaghna, VATA
Calamus Tikta Tikshna Shakrita-Mutra KAPHA
Shodhana
Pramathi
proerty (of
Vacha) dilates
Srotomukha
(Ch.Chi.8/166)
.
USHIRA Vetiveria Graminae Mula Tikta, Ruksha, Sheet Katu Dipana,Pachan KP↓
zizanioidis Madhur Laghu a a,
a Trishnanigraha
na,Chardinigra
hana,Stambhan
a
DARU Berberis Berberidac Mula, Tikta, Laghu, Ushna Katu Dipana, grahi, KAPHAVA
HARID aristata eae Kashay Ruksha Shothahara TA
RA a Vedanasthapan
a
KUSTH Saussurea Composita Mula Katu, Laghu, Ushna Katu Dipana,Pachan KAPHAVA
A lappa e Tikta, Ruksha a,Anulomana, TA
Madhur Tikshna Shulaprashama
a na
INDRA Holarrhena Apocynac Bija Katu, Laghu, Sheet Katu Sangrahi, VATA,
YAVA antidysentri eae Tikta Ruksha a Dipana PITTA,
ca KAPHA
MANJIS Rubia Rubiaceae Mula Kashay Guru, Ushna Katu Krimighna, KAPHA
THA cordifolia a, Ruksha vishaghna, PITTA
Tikta, raktashodhaka,
HARID Curcuma Zingiberac Kanda Tikta, Laghu, Ushna Katu Raktavardhana VATA,
RA longa eae Katu Ruksha Raktaprasadha PITTA,
n Anulomana, KAPHA
Jwaraghna.
SHATA Foenieulum Umbellifer Phala, Madhur Laghu, Sheet Madh Dipana,Pachan VATA,
HVA vulgare ae a Katu, Snigdha a ura a,Anulomana, PITTA
Tikta Trishnanigraha
na,Chardinigra
hana
CHITRA Plumbago Plumbagin Mula Katu, Laghu, Ushna Katu Dipana,Pachan KAPHAVA
87
KA zeylenica aceae Tikta Ruksa, a, Lekhana, TA

Tiksna, Shothahara
Usna
KARCH Curcuma Zinziberac Kanda Katu, Laghu, Ushna Katu Dipana, KAPHAVA
URA zedoaria eae Tikta Tikshna Rochana, TA
Anulomana,
Yakridottejaka
CHORA Angelica Umbellifer Mula Katu, Laghu, Ushna Katu Dipana, KAPHAVA
KA glauca ae Tikta Tikshna Pachana, TA
Anulomana,
Rochana
PUSHK Inula Composita Mula Katu, Laghu, Ushna Katu Dipana,Pachan KAPHAVA
AR racemosa e Tikta Tikshna , Anulomana TA
MULA
Dashmula
Ingredients: Bilva Root (Aegle marmelos), Agnimantha Root (Premna integrifolia), Shyonaka
Root (Oroxylum indicum), Patala Root (Stereospermym suaveolens), Kashmari Root (Gmelina
arborea), bruhati Root (Solanum indicum), Kantakari Root (Solanum xanthocarpum), Shalaparni
Root (Desmodium gangeticum), Prushniparni Root (Uraria picta), Gokshura Root (Tribulus
terrestris).
Actions: Charaka has described Dashamula in Shothahara Mahakashaya. Dashamula mitigates

Doshas especially Vata (Sushruta). It is Shwasahara, Amapachana, and Jwarahara (Sushruta).
According to Bhavaprakasha, it is useful in Shotha, Shwasa, Kasa, Shiroruja, Tandra and
Parshvapida. Dashamula are used extensively in Vatavyadhi in different formulations and in
different forms like Churna, Kwatha, Asava etc.
Medicinal uses: Though Dashamula are useful in all Vata disorders, however, each drug in
Dashamula has its action on specific type of Vata, e.g. Kantakari and Brihati act on Udana Vatu,
Shalaparni and Prishniparni and Agnimantha act on Vyana Vayu. Bilva and Shyonaka has main
action on Samana Vayu and; and Gokshura pacifies Apana Vayu (Gokhale, 1962).
Tila Taila -
Latin name - Sesamum indicum
Family - Pedaliaceae
Part used - Taila
Rasapanchaka
88
Rasa - Madhura, kashaya, Tikta
Virya - Ushna
Vipaka - Madhura
Guna - Guru, Snigdha, Picchila, Laghu, Ruksha, Sukshma
Doshaghnata - Vata
Phytochemical profile: Sesamum oil is rich in oleic and linoleic acids, which together account of
85% of the total fatty acid. Myristic, palmitic stearic, arachidic, hexadechoneic, and lignoceric
acid is present in trace, sesamin, sesamolin and sterol are found in the oil.
Properties and uses: The sesamum oil is sweet with astringent as subsidiary taste, penetrating,
hot readily absorbed, aggravates Pitta and Kapha, constipating, antidiuretic, the best among the
Vata alleviating, strength promoting, beneficial for skin, and promotes intellect and appetite. It
destroys all diseases due to combination of drugs and processing (Ch. Su. 27/286-288) 3.
DHANYAPANCHAK KWATHA-
The Dhanyapanchak Kwatha consists of 5 drugs and mentioned in Chakradutta-Ch. 3/21.2
The Latin name, Family, Gana and Part used of the ingredients of Dhanyapanchak Nirooh Vasti
is given below:-
1) DHANYAKA:
Botanical Name : Coriandrum sativum
Family : Umbelliferae
Synonyms : Chhatra, Kustumburu, Vitunnaka
English Name : Coriander
Gana : Trishna Nigrahana, Shitaprashamana (Ch.) Guduchyadi (Su.)
Part used: Fruit, Oil, Leaves
Properties :
Rasa - Kashaya,Tikta, Katu
Guna - Snigdha, Laghu
Virya - Ushna
89
Vipaka - Madhura
Doshaghnata - Tridoshahara
Chemical :In fruit Moisture11.2%, Protein 14.11%, Fat 16.1%, Constituents Carbohydrate 2.6%,
Minerals 4.4%, Volatile oil 0.5%, it contain Coriandrol. Fatty oil is 19-21%. (Glossary of Indian
Medicinal Plants – 1992)
Action & uses: It is Deepana, Pachana, Mutral, Rochana & Grahi. Hence it is prescribed in
condition of Jvara, Trishna, Daha, Shvasa, Kasa, Arsha, Krimi etc.
2) SHUNTHI
Latin Name : Zingier officinale Rosc
Family : Zingiberaceae
Gana: Charaka : Truptighna, Dipaniya, Trishanigraha
Sushruta : Pipalyadi, Trikatu.
Classical Name: Shunthi, Vishva, Vishvabheshaja, Shringavera,
Mahaushadha, Nagara.
Sanskrit Name : Shunthi
Hindi Name : Shonth
English Name : Ginger, Dry Zingiber
Properties
Rasa : Katu
Guna : Laghu, Snigdh
Virya : Ushna
Vipaka : Madhura
Doshaghnata : Kapha-Vata Shamaka
Part used : Rhizome
Karma : Kapha-Vata shamaka, Shothahara, Dipana, Pachana, Anulomana, Shoolahara,

Srotorodhanivarana, AmaPachana.
90
Actions and Uses: - It is aromatic, carminative, stimulant to the gastrointestinal tract and
stomachic. It removes viscid matter, strengthens memory, removes obstruction in the vessels. It
is used is nervous diseases, Sannipata Jvara, Agnimandya, Ajeerna, Amavata , Grahani, Hikka,
Urustambha, etc.
Chemical Composition:- Camphene, Phellandrene, Zingiberine, Cineol and borneol, ginerol.

Gingerin is the active principle. Other resins and starch, K-Oxalate is also present. Zingiber
officinale contains 0.25 to 3% of a volatile oil possessing the aroma. The drug contains in
addition resin and about 56% of starch. The crude fibre varies from 1.7% to 9% with an average
of 4% the vitamins present in the green ginger are; Thiamine 0.06, riboflavin 0.03, niacin 0.06,
and vitamin C 6.0 mg/100 gm. The carotene present in 40mg/100g.
Shunthi is included under Deepanaiya Mahakashaya so by virtue of Deepana Pachana and

Rochan guna , it modulates the Agni especially at the Dhatu level of metabolism. By its
Trishnanigrahan property, it prevents voracious thirst.
3) NAGAR MOTHA
Latin name : Cyperus rotandus
Family : Cyperaceae
Gana
Charka : Triptighna, Trushanigrahana,Lekhaniya
Sushruta : Mustadi, Vachadi
Classical Name : Varid, Mustaka
Sanskrit Name : Mustak
Hindi Name : Motha
English Name : Nut grass
Part used: Rhizome
Properties:
Rasa: Tikta, Katu;
Vipaka: Katu;
Virya: Shita;
91
Guna: Laghu, Ruksha.
Actions: Dipana, Pachana, Vatakar, Kaphapittahara, Jwarahara. Acts on Rasa, Asthi, Majja
Dhatu, Amashaya and Basti. (Phadke, 1960)
Medicinal uses: Musta is the drug of choice among all Dipana and Pachana drugs (Ch. Su. 25).
Chemical Constituents: β – sitosterol, pinene, cineol, linolenic, linolic, oleic, myristic and stearic
acids, cyperotundone, α-rotunol, β-rotanol, cyperolone, cyperenone, aureusidin.
Pharmacological Activities: Tranquillizing, anti-inflammatory, anti-pyretic, oestrogenic,

antiemetic, smooth muscle relaxant, antimicrobial, diuretic.
4) BILWA :
Latin Name : Aegle marmelos
Family : Rutaceae
Gana:
Charaka : Sothahara, Arshoghna, Asthapanopaga, Anuvasanopaga.
Sushruta : Vrihat Panchamoola, Varunadi, Jambawastthadi.
Classical Name: Shriphala, Sadaphala, Shandily, Mahakapitha
Sanskrit Name : Bilwa
Hindi Name : Bael
English Name : Bael
Properties
Rasa : Kashaya, Tikta
Guna : Laghu, Ruksha
Virya : Ushna
Vipaka : Katu
Doshaghnata : Kapha-Vata Shamaka
Part used : Mool, Twak, Phala, Patra
92
Actions: Pacifies Vata and Kapha and aggravate Pitta. Its root is used in Vata Vyadhi (Sharma,
1988).
Chemical Constituents: Tannic acid, volatile oil etc. Most important active principle is
‗marmelosin‘.
Pharmacological Activities: Antibacterial (Bhatt et al. 1984), anti-inflammatory and wound

healing (Udupa et al. 1994).
5) SUGANDHABALA
Botanical Name : Valeriana wellichii DC.
Family : Valerianaceae
Parts used : Root
Synonyms : Tagara, Nata, Vakra, Nahush, Udeechya
Action and Uses : The plant is indicated in poisoning,epilepsy, colics and in eye diseases.Also
tridoshahara.
Properties :
Rasa : Katu, Tikta, Kashaya
Guna : Laghu, Snigdha
Virya : Ushna
Vipaka : Katu
Doshaghnata : Kapha, Vata Shamaka
Karma : Vednasthapaka, Akshepahara, Vranaropaka, Shulaprashama, Saraka, Kaphaghana and

Shwashara. Yakrit and Hridyottejaka, Vishaghna, and Balya.
Pharmacological activities : Analgesic, anti- convulsive, cardiac tonic.
Rasapanchaka of the Dhaanyapanchak
INGREDIENT RASA GUNA VIRYA VIPAKA PRABHAV KARM

A
DHANYAKA Katu Laghu,Snigdha Ushna Madhura Dipan,Pachan,Grahi VPK↓
BILVA Tikta Laghu,Ruksha Ushna Katu Dipan,Pachan,Grahi KV↓
NAGARMOTHA Katu Laghu,Ruksha Sheeta Katu Dipan,Pachan,Grahi KP↓
SUGANDHBALA Katu Laghu,Snigdha Ushna Katu Dipan,Pachan,Grahi KV↓
SHUNTHI Katu Laghu,Snigdha Ushna Madhura Dipan,Pachan,Grahi KV↓
93
SAINDHAVA LAVANA
Latin Name : Sodii Chloridum
Rasapanchaka
Rasa : Lavana, Madhura
Guna : Snigdha, Tikshna, Sukshma & Laghu
Veerya : Anushna Sheeta & Sheeta (B.P)
Vipaka : Madhura
Doshghnata : Tridoshahara
Phytochemical profile: It is a white transparent & cubic in shape, which contains NaCl, KCl,
Ca.So4, CaCl2, and MgCl2 & NaHCo3. The chloride content is 59.64 w/w & Sulphide content is
10.40 w/w. Its specific gravity is 2.17.
Properties and uses: Agni Deepaka, Pachaka, Ruchikaraka, Kapha Vilayana & Chedana, Vrisya,
Chakshusya, Hridya & Srustamutrapurisa. All the salts are Vishyandi, Sukshma, Tikshna, Ushna
and Vataghna in action. They promote evacuation of bladder and rectum (A.H.Su.6/143) 4
These all properties exist in Saindhava also. Besides, it is Madhura in trace, Vrishya and
eliminates all the three Doshas. It is Laghu and slight Ushna, doesn‘t cause Vidaha and is
Dipana. Because of its Vishyandi property it separates the particles and thus reduces the
compactness and density of Kapha.
On account of its Sukshma property it can go in the microchannels of body. Thus molecule of
other contents of Vasti if bounded with Saindhava may also reach up to the micro-channels. Here
Saindhava plays the role of a carrier, and helps to act the Vasti in deep level. Saindhava liquefies
and segregates the Kapha in the body (Ch.K.1/15)5. It also liquefies the accumulated morbid
matter there in by virtue of its Ushna property and breaks it up by its Tikshna property. As it
promotes the evacuation, the broken and liquefied matter is expelled out (Ch.Su.25/43) hence
Vasti doesn‘t retain inside and comes out after certain time.
MADHU:
Honey is Madhura and Kashaya in taste, Ruksha Shita Laghu in Guna and is Deepan, Varnya,
Savarnya, Lekhana, Hridya Vajikaran, Sandhankar, Shodhana, Ropana and Prasadan in action. It
has capacity to go through micro channels. Because of its Laghu Guna it eliminates Kapha. By
virtue of its Pichhila Guna and Madhura and Kashaya taste it eliminates Vata and Pitta. Thus it is
Tridosha Prashmana in nature (Su.Su. 45/132) 6.
94
According to charaka honey is provocative of Vata, Guru, Shita, curative of Rakta Pitta and
Kapha disorders (Ch. Su.27/245) 7.
As honey is composed of various substances it is the best of vehicles. (Ch. Su. 27/249) 8. Honey
is best Kapha-nashaka, and moderately Pitta-nashaka. It leads to Mansa and Meda Kshapana,
Rakta Prasadana, Rasa Pachana and Vrishya quality (Nanal, 1998).
Honey being the best vehicle and having capacity to go through micro channels, increases the
potency of Vasti drugs. This also carries the drug to molecular level. Vasti with honey do not
lead to over action or under action.
Chemical constituents: Laevulose 40 - 50 %, Dextrose 32 - 37 %, and sucrose 0.4 - 0.6%,

vitamin B, B2, B6, C and Nicotinic acid. The miner constituents of honey are Pestrine and Gums
0.7 %, Ash 0.182 - 1%, and Miscellaneous acid, Pollen grains, Beeswax pigments etc.0.1 - 7 %.
It also contains minerals like Potassium, Magnesium, Zinc, Calcium, Iron, and Copper etc.
Actions and Uses: Honey could lower blood sugar and improve renal hepatic and bone marrow
functions and lipid profile. It decreases Sr. Cholesterol, Sr. LDL, Sr. triglyceride and increase
S.HDL level.
PATHYA
The registered patients were advised to follow the Pathya regimen following were chosen –
Takra, Payas,Shuntthi,Saumf, Mudgayusha, Ushnajala
The patients were advised to include the above mentioned dietary articles in their normal routine,
after registration and up-to the day of investigations were completed i.e. before the
commencement of clinical trial. Later on, the same Pathya was advised to be followed
throughout the entire schedule of treatment.
Once, the Vasti procedure was started, they were advised to consume Ushnajala, Takra and
Yusha in sufficient quantities throughout the day. The Guna Karma of these Pathya articles have
been briefly presented here:-
a. Takra: Laghu, Kashaya, Amla, Dipana, Kaphavatahara, Aruchinashaka.
b. Kshira: Svadupaka, Snigdha, Ojasya, Dhatuvardhana, Vata-pittahara, Mutra-krcchrahara etc.
c. Mudga: Kashaya, Madhura, Rakta-pittahara.
d. Ushna Jala: Laghu, Ushna, Dipana, Pachana, Basti shodhana,Vata-kaphahara etc.
The Pathya dravya by virtue of their Kapha-vatahara, Dipana,Pachana and Vasti-shodhana

actions fortify the action of the drugs taken for the study.
95
Clinical study
“Observation more than books and experience

more than persons, are the prime educators.”
(Alcott, Amos Bronson)
96
CLINICAL STUDY
Research is a ‗creative work‘ of high order, different from the routine work and having a sense of
further development. Research in general requires a strict disciplinary and scientific code of
investigational approach to the problem which has to be followed rigidly and then only the
results could be authentic and reproducible. For achieving the reproducible results one has to
follow the strict unbiased observation without any sentimental attachment to any science. It is
accepted by all sciences that pratyaksha direct evidence is the most acceptable to all evidences.
A small step of research can become a boon to humanity. Hence the present work is a small step
in the field of medical science. In the research of medical science, clinical study is the most vital
part of it and evaluation of any therapeutics is incomplete unless and until they are tried
clinically.
AIMS AND OBJECTIVES
• To evaluate the effect of Vasti karma in management of Grahani Roga.
 To study Grahani Roga with reference to I.B.S.and other disorders from Ayurveda and
Modern System of medicine.
SELECTION OF PATIENTS: All the patients were selected from O.P.D. and I.P.D. of
Rishikul Govt. P.G. Ayurvedic College & Hospital, Haridwar (U.K.).
SAMPLING TECHNIQUE: The patients were selected irrespective of their sex, religion,
occupation etc. and simple random sampling technique was followed.
DIAGNOSTIC CRITERIA:
All the patients were diagnosed on basis of prepared Proforma incorporating all the sign and
symptoms of Grahani Roga according to ayurvedic and modern classics. The detailed
examination carried out on each patient to exclude other diseases properly.
INCLUSION CRITERIA:
 Age – 16 – 60 years.
 Clinical features suggesting Grahani Roga.
 Patients of conventional long term therapy with no satisfactory response.
97
EXCLUSION CRITERIA:
 Age < 16 years and > 60 years.
 Patients with major ailments like heart disease, diabetes mellitus, piles, blood mixed
stool, ascitis, etc.
 Patients having tuberculosis, malignancy or hepatic abscess.
 Patients with any surgery of GI tract.
INVESTIGATION:
Routine Haematological Hb%, TLC, DLC, ESR, Urine & Stool examination were carried out to
assess the general condition and exclusion of other pathogenesis of the patients.
DETAILS OF MATERIAL & MATHOD:
The method adopted in present study is randomized clinical study. The patients were
administered with Yoga Vasti prepared with Dhanyapanchak Kwatha as Nirooh Vasti and
Vidangadi Taila as Anuvasana Vasti. A 32 days complete course of Vasti karma was consist 8
days Vasti karma and after 16 days interval the next course of 8 days of Vasti was performed -
Day 1 to 8 - Vasti
Day 9 to 24 - Parihaar kaal
Day 25 to 32 - Vasti
YOGA VASTI:
In the present study, schedule of Yoga Vasti followed where on day first 1 Anuvasana was given
then Afterwards 3 Anuvasana and 3 Nirooh were given alternatively and at last 1 Anuvasana
Vasti were administered.
CONTENTS OF VASTI:
Nirooh Vasti-
Dhanyapanchak Kwatha- 400ml
Vidangadi Taila- 100ml
Madhu- 100 ml,
98
Dhanyapanchak Kalka – 30 gm
Saindhav- 15 gm
Total dose administered- approx. 645 ml
Anuvasana Vasti- Vidangadi tail
Dose administered- approx. 120ml
Step1: Preparation of Dhanyapanchak decoction.

• Decoction is the main part of the Vasti and is selected to serve the specific functions.
• To prepare decoction, approx.1.6 liters of water is taken and 100 gms of Dhanyapanchak
Yakut is added into it. Now it is allowed to get boiled up to ¼ of total e.g.400 ml. So
ultimately 400 ml decoction can be obtained.
• By making a Decoction preparation, all the qualities of crude drugs are transferred to
water by boiling process.
• Water is the source matter of nourishment i.e. Rasayoni. It promotes the nourishing effect
of the ingredients added to the Vasti and enhances the action of Vasti Dravyagata Rasa
(essence of Vasti). Water, by dint of its Avyakta rasa and Laghu Guna potentially
imbibes qualities of the drugs boiled with it and the preparation, thus, becomes more
effective and readily absorbable. Water possess qualities like Jivana(vital),
Tarpana(nourishing), Amritam etc. Amongst these, Amritam is the most important
quality. Dalhana opined it is said Amrit because it does not provoke any Dosha - it‘s
chemically inert.
• Due to Decoction formation, the substratum changes from solid to liquid. However,
qualities of the drugs remain same.
Step 2: Mixing of honey and rock salt.
• 15 gms of rock salt and 100 mg of honey are mixed together in mortar.
• Honey, is first of all poured and triturated well with rock salt. Rock salt disintegrates
Paichhilya (stickyness), Bahalatva (voluminous) and Kashayatva (astringent) property of
honey and potentiates its Sukshmasrotogami and Srotoshodhaka property.
• Absence or less quantity of rock salt is responsible for Ayoga where as in excess quantity
it produces burning and diarrhoea. Honey is extensively Yogavahi , Rasayana and
Tridoshahara.
99
100
• When Vasti is fortified with honey, they do not allow any Atiyoga or Ayoga.
Step 3: Oil is to be poured in the mortar.
• 100 ml of Vidangadi oil is poured in the mixture of honey and rock salt and triturated
well.
• The qualities of Sneha like Snigdha, Guru get mixed with above solution and form a
uniform mixture. It counterparts the some of initiating properties of honey and rock salt.
Step 4: - Kalka Dravyas (paste) are added.
• To prepare Kalka (paste) 30 gms of Dhanyapanchak powder is taken and adequate

amount of water is added into it and mixed vigorously to obtain paste like consistency.
Then it is added to the mixture and mixed well till the mixture become homogenous.
• It also gives required thickness to the Vasti material so that the Vasti may be retained in
Pakwashaya for appropriate time. Less quality or absence of Kalka makes Vasti too thin,
which cannot retain in the body for longer time. Excess quantity of Kalka makes Vasti
viscid, and difficult to administer. Thicker Vasti cannot return in the expected time.
Step 5: Decoction is added in the mixture.
• Decoction and mixture in the mortar are to be mixed and stirred well. This addition of
Decoction brings homogeneity in the Vasti.
• Vasti Dravya is made lukewarm by keeping it into hot water.
QUALITIES OF PREPARED VASTI DRAVYA:
(1) A prepared Vasti dravya should be homogenous.
(2) Vasti dravya should be kept at body temperature at the time of administration.
(3) No oil drops should be floating on the surface of Vasti dravya.
(4) Consistency of Vasti should be not so thick and not so liquid.
Method of Administration of Dhanyapanchak Vasti:
After passing the stool and urine the patients were subjected to local Abhyanga (with Bala Oil)
and Swedana (Nadi Sweda). Patients undergone preparatory procedure were given left lateral
position with their left leg held out stretched while the right leg flexed at knee and held near
abdomen. Movements at the time of Vasti were prohibited. Vasti Yantra was used for
101
administration of Vasti. Vasti Netra was lubricated with oil. Vasti Puttaka was filled with
required quantity of prepared drug and Vasti Netra was introduced into anus steadily and slowly.
Vasti Netra was removed after administration of Vasti and patients were advised to relax in
supine position. After sometimes, patients were advised to get up from the table and to take rest
in bed.
Method of Administration of Anuvasana Vasti:

Anuvasana Vasti was given with the help of Anuvasana Vasti Yantra. Patients were advised to
have take meal before coming for Anuvasana Vasti. After performing local Abhyanga, lubricated
catheter was inserted into anus slowly. Then the oil was pushed steadily by pressing the handle.
Catheter was removed after administration of Vasti and patients were advised to relax in supine
position. Then gentle pats were given on the soles and buttocks of the patients. After sometimes
patients were advised to get up from the table and to take rest on bed.
PARIHARA-
Pathya Ahar and Vihar should be observed for double the period as undertaken in the entire
course of Vasti therapy. The patients should avoid activities like Atyasana, Avasthana, speaking
loudly, sleeping during the day, excessive sexual activities, and use of cold water roaming in the
sun, cold wind and angry temperament. He should take beneficial food, considering the Kaala.
(Ch. Si. 1/54, 55) 9.
PATHYA VICHAR
• Nirooh: After the Vasti Dravyas have been adequately let out, the patient should be allowed to
rest and take bath with luke warm water. Milk,Yusha and Mansarasa should be given in
dominance of Pitta, Kapha and Vata respectively. (Ch.Si 3/70 & Su.Chi.38/12) 10. Light diet
should be taken with one third or half fraction of stomach remaining empty (Su.chi38/13) 11.
Acharya Vagbhatt opines that Doshas which gain momentum due to Nirooh and tend to produce
complications can be pacified by the use of warm water. (A.H.Su.19/51) 12
• Anuvasana: The day following Vasti, good food should be given in the afternoon and Yushadi
in the evening (Su.Chi.38/11-13). The patient should be given water incorporated with Dhanyaka
and Nagar. This aid in digestion, assimilation of Sneha, does Kapha chhedana and
Vatanulomana (Ch. Si. 4/43-44) 13.
102
CONSENT FORM-
The purpose of the study, nature of the study drugs, the procedures to be carried out and the
potential risks and benefits were explained to the patients in details. Thereafter their consent was
taken.
FOLLOW UP-
The follow ups and assessment of the patients were done on 30days and 60 days after the
complete Vasti karma.
CRITERIA FOR ASSESSMENT

Grading of parameters taken for assessment
1. Muhurbaddha / Muhurdrava Mal pravriti
0 - Passing of normal consistency stool.
1 - Passing stool (2-3 times /day) irregular, without pain.
2 - Passing stool (3-5 times / day) just after meals, irregular, with pain.
3 - Passing stool more than 5 times/day just after meals, irregular, with pain
2. Arochak:
0 - Normal appetite.
1 - Loss of appetite without eating habits.
2 - Oral intake altered without significant weight loss.
3 - Associated with significant weight loss.
3. Trishna :
0 - No thirst.
1 -Thirst satisfaction from taking normal limited water.
2 - Thirst satisfactions after taking more than normal limited water. frequency of taking
water is also increases.
3- No satisfaction after taking water, taking electrolytes.
4. Praseka :
0 - Normal salivation during meal.
1 - Morning or evening, one time without meal time.
2 - Morning and evening, both time without meal time.
3 - Everytime.
5. Shoonpaadkarah :
0 - No swelling.
1 - Only in lower limbs.
2 - Only in upper limbs.
3 - In all limbs.
6. Asthiparvaruk :
0 - No pain.
1 - Pain in major joints/bones in either one extremities.
2 - Pain in major joints/bones in either both extremities.
103
3 - Pain in all small & major joints/bones in all extremities.

7. Chhardan :
0 - No emesis
1 - 1- episode in 24 hours.
2 - 2-5 episodes in 24 hours.
3 - > 5 episodes in 24 hours
8. Udara Shoola (Abdominal pain or discomfort):
0 - No abdominal pain.
1 - Sometime/ rarely abdominal pain.
2 - Intermittent crampy lower abdominal pain which is relieved by passage of flatus or
stool.
3 - Continuous abdominal pain often over the right upper quadrant/ mid epigastria/
lower iliac region which is not relieved by passage of flatus or stool.
9. Shleshma mala pravriti (Presence of mucous in stool):

0 - No visible mucous in stool.
1 - Visible mucous stickled to the stool.
2 - Passage of mucous with frequent stool.
3 - Passage of large amount of mucous in stool.
10. Atopa (Gas / Flatulence):
0 - No abnormal gas/flatulence.
1 - Occasional abdominal distension.
2 - Frequently abdominal distention with increased flatulence & bleeding.
3 - Gargling/Rumbling sound present in abdomen.
11. Alasya:
0 – No laziness
1 – Laziness for hard physical work.
2 – Refuse to physical work.
3 – No desire even for routine activities.
Other-
─Jwar : Yes / No
─Lohaamagandhi-tiktaamla udgar : Yes / No
In this study an effort has been made to follow the guidelines laid down by Acharya Charaka for
assessment of results. Assessment of results on the basis of only cardinal symptoms will not give
the complete assessment of therapy. Acharya Charaka has advised assessment as the wise
physician should carefully investigate minute changes in excess, normalcy or diminution of the
morbid elements as well as the strength of body, Agni and mind.
104
OVERALL ASSESSMENT OF THERAPY

The overall assessment was calculated on the basis of average improvement in the percentage
relief of symptom score.
The total effect of Therapy was marked as follows:
Cured : 100% relief
Marked improvement : 75% relief to 99% relief
Moderate improvement : 50% up to 74% relief
Mild improvement : 25% up to 49% relief
No improvement : < 25% relief
STASTICAL ANALYSIS
The information gathered on the basis of observation made about various parameters, was
subjected to statistical analysis in term of Mean, Standard Deviation (SD) and Standard Error
(SE).
The data were analyzed by paired ‗t‘test, at p<0.05, p<0.01, and p<0.001. The obtained results
was interpreted as,
Non significant : p>0.05,
Significant : p<0.05,
Highly significant : p<0.01, P<0.001
Presentation of Data
The data collected and compiled from the multi dimensional clinical work was sorted out and
processed further by subjective criteria to varied statistical methods.
The effect of individual therapy was evaluated and is hereby presented in the following sections.
1. The first component incorporated the general observations as Age, Sex, and Religion etc.
2. The second part deals with the results of the therapy evaluated on the basis of
improvement in,
(a) Symptoms
(b) Total effect of therapy
OBSERVATION
In the present study total 38 patients of Grahani Roga were registered for the treatment. Out of
which 30 patients were completed. The full duration of treatment, 8 patients were left at different
stages of treatment.
105
Table 1
Age wise distribution of 30 patients
Age Number of patients %
16-20 2 6.67
21-30 6 20
31-40 4 13.33
41-50 14 46.67
51-60 4 13.33
In the present study, all patients were in the range of 16-60 years out of these 6.67% in the age
group of 12-20 years, 20% in the age group of 21-30years, 13.33% in the age group of 31-
40years, 46.67% in the age group of 41-50 group and 13.33% of patients belonged to age group
of 51-60 years.
Table 2
Age wise distribution of male patients
16-20 2 10.52
21-30 5 26.31
31-40 1 5.27
41-50 10 52.63
51-60 1 5.27
From above table this was observed that maximum number of male patients 52.63% belonging to
age group of 41-50 years. After that 26.31% belonged to age group of 21-30 years and minimum
5.27% belonged to each age group of 31-40 and 51-60 years.
106
Age Wise Status
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
% of patients
20.00%
15.00%
10.00%
5.00%
0.00%
16-20 yrs
21-30 yrs
31-40 yrs
41-50 yrs
51-60 yrs
Age Wise Status Of Male Patients

60.00%
50.00%
40.00%
30.00%
% of male patients
20.00%
10.00%
0.00%
16-20 yrs
21-30 yrs
31-40 yrs
41-50 yrs
51-60 yrs
107
Table 3
Age wise distribution of female patients

12-20 0 0
21-30 1 9.09
31-40 3 27.27
41-50 4 36.37
51-60 3 27.27
From above table it was observed that maximum number of female patients belonged to 36.37 %
age group of 41-50 years. Minimum number of patients was 0% in the age group of 12-20 years
and next minimum was 9.09 % in the age group of 21-30 years.
Table 4
Sex wise distribution of 30 patients
Sex Number of patients %

Male 19 63.33
Female 11 36.67
Maximum 63.33 % patients were male and 36.67 % patients were female.
108
Age Wise Status Of Female Patients
40
35
30
25
20
% of female patients
15
10
5
0
16-20 yrs
21-30 yrs
31-40 yrs
41-50 yrs
51-60 yrs
Sex Wise Status
Female
36.67%
Male
63.33%
109
Table 5
Religion wise distribution of 30 patients
Religion Number of patients %

Hindu 22 73.33
Muslim 8 26.67
It was observed that maximum number of patients (73.33%) were Hindu and 26.66 % were
Muslim. This is because the hospital is situated in Hindu population area. So there is no any
relation of distribution of disease with religion.
Table 6
Marital status wise distribution of 30 patients
Marital status Number of patients %

Married 24 80
Unmarried 5 16.67
Widow 1 3.33
Among registered cases 80% patients were married. This shows that disease is more prominent
in married patients and in older age group.
110
Relision Wise Status
Muslims
2%
Hindu
73.33%
Marital status of Patients

Widow
3.33%
Unmarried
16.67%
Married
80%
111
Table 7
Occupation wise distribution of 30 patients
Occupation Number of patients %
Student 2 6.67
House wife 11 36.66
Service 9 30
Business 3 10
Labour 5 16.67
From above table it was observed that 36.66 % patients were house wives and 30% were service
class, 10 % business man, 16.67 % were labour and 6.67 % were students.
Table -8
Education wise distribution of 30 patients –
Qualification Number of patients %
Illiterate 7 23.33
Primary school 5 16.67
High school 8 26.67
Graduate 8 26.67
Post graduate 2 6.67
Ph.D. 0 0
Amongst 30 patients, 23.33% patients were illiterate, 16.67% patients were primary educated,
26.67% of each high school and graduate educated, post graduate patients were only 6.67%.
112
Occupation Wise Status
Student
Labour 6.67%
16.67%
Business
10% House wife
33.33%
Service
33.33%
Education Wise Status

30.00%
25.00%
20.00%
15.00%
% of patients
10.00%
5.00%
0.00%
Illiterate Primary High Graduate Post Phd.
school school graduate
113
Table -9
Distribution of disease with Economic status –
Economic status Number of patients %

Higher class 2 6.67
Higher middle class 4 13.33
Middle class 14 46.67
Lower class 10 33.33
From above table it was observed that maximum number of patients (46.67%) belonged to
middle class family and next to this 33.33% patients belonged to lower class family. Minimum
6.67% patients belonged to higher class family. This shows disease is more prominent in middle
class and lower class family.
Table -10
Family history wise distribution of 30 patients –
Family history Number of patients %

Present 4 13.33
Absent 26 86.67
Only 13.33% patients showed family history which is insignificant in report of this disease.
114
Economic Status
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
% of patients
20.00%
15.00%
10.00%
5.00%
0.00%
Higher class Highermiddle Middle class Lower class
class
Family History Status
Present
13.33%
Absent
86.67%
115
Table -11
Chronicity wise distribution of 30 patients –
Chronicity of disease Number of patients %

Up to 6 months 1 3.33
6 months to 1 year 4 13.33
1 year to 11/2 year 13 43.33
11/2 year to 2 year 8 26.67
More than 2 year 4 13.33
From above table it was observed that maximum 43.33% of patients the duration of disease are 1
year to 11/2 year. Although in 13.33% the duration of disease is more than 2 yrs (2-10 yrs),
3.33% patients duration up to 6 months and 13.33 % patients the duration of disease up to 6
months to 1 years.
Table -12
Nature of diet wise distribution of 30 patients-
Nature of diet Number of patients %

Vegetarian 14 46.67
Non-vegetarian 16 53.33
From above table it was observed that 46.67% patients were vegetarian and 53.33% patients‘
belonged to mixed group this shows that the disease is somewhat more prominent in non-
vegetarian patients.
116
Chronicity Wise Status
45.00%
40.00%
35.00%
30.00%
25.00%
20.00% % of patients
15.00%
10.00%
5.00%
0.00%
up to 6 6 month to 1 yrs to 11/2 yrs to More than
months 1 yrs 11/2 yrs 2 yrs 2 yrs
Nature Of Diet
Vegetarian
Non-vegetarian 46.67%
53.33%
117
Table -13
Appetite wise distribution of 30 patients –
Appetite Number of patients %

Normal 10 33.33
Less 20 66.67
It was observed that 20 patients out 30 patients i.e.66.67% patients having less than normal
appetite. This shows disease is more prominent in patients having deprived appetite.
Table -14
Aggravating factor wise distribution of 30 patients –
Aggravating factor Number of patients %

Specific drugs 0 00
Specific Diet 12 40
Weather/Climate changes 0 00
Occupational stress 6 20
No aggravating factor 12 40
It was observed that diet and occupational stress were most common aggravating factors. 40%
patients were having no such aggravating factor. Diet was mainly aggravating factor because diet
was responsible in 40% of patients.
118
Appetite Wise Status
Normal
33.33%
Less
66.67%
Aggravating Factors Wise Status
40%
35%
30%
25%
20%
% of patients
15%
10%
5%
0%
Specific Specific diet Climate Occupation No effect
drug changes
119
Table -15
Meal time wise distribution of 30 patients –
Meal time Number of patients %

Timely 12 40
Untimely 18 60
This table shows 40 % patients were taking meal timely and 60 % patients were taking meal
untimely.
Table -16
Dietary habit wise distribution of 30 patients –
Dietary habit Number of patients %

Vishamasana 13 43.33
Samasana 4 13.33
Adhyasana 10 33.33
Viruddhasana 3 10
The above table shows that 43.33% patients were having Dietetic habit of Vishamasana while
33.33% Adhyasana, 13.33% Samasana and 10% patients were having habit of Viruddhasana.
120
Meal Time Wise Status
Untimely
60%
Timely
40%
Diatary Habit Wise Status
45
40
35
30
25
20
15 % of patients
10
5
0
121
Table -17
Excessive Supplementary food wise distribution of 30 patients
Supplementary food Number of patients %

Tea 21 70
Coffee 1 3.33
Milk 5 16.67
Cold drink 0 0
Tea & milk 4 13.33
Above table shows that 70 % patients were taking excessive tea, 13.33 % patients were taking
tea & milk, 16.67 % patients were taking milk and 3.33% taking coffee as food supplements.
Table –18
Addiction wise distribution of 30 patients –
Addictive Number of patients %

Tobacco 4 13.33
Smoking 1 3.33
Alcohol & Smoking 2 6.67
No addiction 23 76.67
Maximum numbers of 76.67 % patients were not taking any addiction, while 13.33 %patients
were taking tobacco, 6.67 % patients were taking Alcohol & Smoking and 3.33 % patients were
on smoking
122
Excessive Supplimentary Food Status
80%
70%
60%
50%
40% % of Patients
30%
20%
10%
0%
Tea Coffee Milk Cold drink Tea & Milk
Addiction Wise Status
80.00%
70.00%
60.00%
50.00%
40.00%
% of Patients
30.00%
20.00%
10.00%
0.00%
Tobacco Smoking Alcohol & No addiction
Smoking
123
Table –19
Exercise wise distribution of 30 patients –
Physical exercise Number of patients %

Regular 7 23.33
Irregular 8 26.67
No exercise 15 50
As shown in table 50% patients were doing exercise, 26.67 % patients were doing exercise
irregularly where as only 23.33% of the patients were doing regular exercise.
Table -20
Nature of Occupation wise distribution of 30 patients –
Occupation Number of patients %

Physical 22 73.33
Mental 8 26.67
The above table shows nature of Occupation of 73.33 % patients were of physical work while
26.67% patients having mental work.
124
Exercise Wise Status
Regular
23%
no exercise
50%
Irregular
27%
Nature Of Occupation Wise Staus
Mental
26.67%
Physical
73.33%
125
Table -21
Sleep wise distribution of 30 patients –
Sleep Number of patients %

Proper 8 26.67
Less 10 33.33
Excessive 2 6.67
Disturbed 10 33.33
33.33% patients were having less sleep, 33.33% patients were having disturbed sleep, 26.67 %
patients were having proper sleep and 6.67 % patients were having excessive sleep.
Table -22
Psychological condition wise distribution of 30 patients –
Psychological condition Number of patients %

Anxiety 16 53.33
Stress 8 26.67
Depression 2 6.67
Normal 4 13.33
As shown in table 6.67% patients were of depressed mood, 26.67 % patients were in stress,
53.33 % patients were having anxiety where as only 13.33 % of the patients were having normal
mood.
126
Sleep Wise Status
Disturb Proper
33.33% 26.67%
Excess
6.67%
Less
33.33%
Psychological Condition Wise Status

60.00%
50.00%
40.00%
30.00%
20.00% % of patints
10.00%
0.00%
127
Table –23
Sharir Prakriti wise distribution of 30 patients –
Sharir prakriti Number of patients %

Vata Kaphaja 10 33.33
Vata Pittaja 16 53.33
Kapha Pittaja 4 13.33
Maximum 53.33 % patients were Vata Pittaja prakriti, 33.33 % were Vata Kaphaja prakriti and
only 13.33 % patients were Kapha Pittaja prakriti.
Table -24
Manas Prakriti wise distribution of 30 patients –
Manas prakriti Number of patients %

Sattvik 1 3.33
Rajas 12 40
Tamas 17 56.67
From above table it was observed that maximum 56.67 % patients were of Tamas prakriti, 40 %
patients were of Rajas prakriti and only 3.33 % patients were of Sattvik prakriti.
128
Sharir Prakriti Status
60.00%
50.00%
40.00%
30.00% % of patients
20.00%
10.00%
0.00%
VK VP KP
Manas Prakriti Status
60
50
40
30 % of patients
20
10
0
Sattvik Tamas Rajas
129
Table –25
Sara wise distribution of 30 patients –
Sara Number of patients %

Pravara 1 3.33
Madhyam 21 70
Avara 8 26.67
This table shows that 26.67 % patients were of Avara sara, 3.33 % patients were of Pravara sara
and 70 % patients were of Madhyama sara.
Table-26
Samhanan wise distribution of 30 patients –
Samhanan Number of patients %

Pravara 8 26.67
Madhyam 16 53.33
Avara 6 20
Maximum 53.33 % of patients were of Madhyam samhanan 26.67% patients were of Pravara
samhanan and 20 % patients were of Avara samhanan.
130
Sara Wise Status

70
60
50
40
30
% of Patients
20
10
0
Pravara
Madhyam
Avara
Samhanan Wise Status
60.00%
50.00%
40.00%
30.00% % of Patients
20.00%
10.00%
0.00%
pravara madhyam avara
131
Table-27
Satva wise distribution of 30 patients –
Satva Number of patients %

Pravara 9 30
Madhyam 15 50
Avara 6 20
From above table it was observed that 50 % patients were of Madhyam satva 30 % patients were
of Pravara satva and 20 % patients were of Avara satva.
Table-28
Satmya wise distribution of 30 patients –
Satmya Number of patients %

Pravara 0 00
Madhyam 22 73.33
Avara 7 26.67
Maximum 73.33% patients were having Madhyam satmya, 26.67 % patients were having Avara
satmya and no one patient was having Pravara satmya.
132
Satva Wise Status
50%
45%
40%
35%
30%
25% % of patients
20%
15%
10%
5%
0%
pravara Madhyam Avara
Satmya Wise Status

80
70
60
50
40
30 % of patients
20
10
0
Pravara
Madhyama
Avara
133
Table-29
Prominent Dosha wise distribution of 30 patients –
Prominent dosha Number of Patients %

Vata 16 53.33
Pitta 6 20
Kapha 8 26.67
Vata dosha was prominent in 53.33% patients, Pitta dosha was prominent in 20% patients and
Kapha dosha was prominent in 26.67% patients.
Table- 30
Vyayama Shakti wise distribution of 30 patients –
Vyayama shakti Number of patients %

Pravara 3 10
Madhyam 12 40
Avara 15 50
Maximum 50 % of patients were having Avara vyayama shakti, 40% patients were having
Madhyam vyayama shakti and 10 % patients were having Pravara vyayama shakti.
134
Prominant Dosha Status
60
50
40
30 % of Patients
20
10
0
Vata Pitta Kapha
Vyayama Shakti wise Status
Pravara
10%
Avara
50%
Madhyam
40%
135
Table-31
Ahara Shakti wise distribution of 30 patients –

A.
Abhyavaharana shakti Number of patients %

Pravara 0 0
Madhyam 6 20
Avara 24 80
Abhyavaharana shakti was observed as Avara in 80% subjects, Madhyam in 20% and none of
the subjects showed Pravara shakti.
B.
Jarana shakti Number of patients %

Pravara 0 00
Madhyam 4 13.33
Avara 26 86.67
Jarana shakti was observed as Avara in 86.67% subjects. Madhyam in 13.33% and none of the
subject showed Pravara shakti.
136
Abhyavaharana Shakti Status
80
70
60
50
40 % of Patients
30
20
10
0
Pravara Madhyam Avara
Jarana Shakti Status
90
80
70
60
50
% of Patients
40
30
20
10
0
Pravar Madhyam Avara
137
Table- 32
Agni wise distribution of 30 patients –
Agni Number of patients %
Mandagni 26 86.67
Vishamagni 4 13.33
Tikshanagni 0 0
Samagni 0 0
Highest number of patients i.e. 26 (86.67%) had Mandagni, 13.33% had

Vishamagni and no patient were reported with Tikshnagni or Samagni.
Table- 33
Mutra pravriti wise distributions of 30 patients-
Mutra pravriti No. of patients %
Varna Vishesha 0 0
Avishesha 30 100
Frequency Day 2-4times 8 26.66
5-7times 22 73.33
>7times 0 0
Night 1-2times 19 63.33
>2times 1 3.33
100% Patients were found normal colour of urine. Most of Patients i.e. 22 (73.33%) had
frequency of micturition 5 to 7 times/day. 26.66% of Patients had frequency of micturition 2 to 4
times / day. 63.33% Patients had frequency of micturition 1- 2 times / night, while 3.33% had
frequency of micturition > 2 times / night.
138
Agni Wise Status
90
80
70
60
50
% of Patients
40
30
20
10
0
Mandagni Vishamagni Tiksanagni Samagni
Mutra Pravritti Status

100
90
80
70
60
50
40 % of Patients
30
20
10
0
139
Table- 34
Mal Pravriti wise distribution of 30 patients
Mala Pravriti No. of patients %

Nature Muhurbaddha-drava 30 100
Mala
Durgandhita 23 76.66
Shleshmala 14 46.66
Colour Avishesh 30 100
Vishesh 0 0
Habit irregular 30 100
regular 0 0
Frequency 2 to 3 times 6 20
3 to 4 times 13 43.33
> 5 times 11 36.66
Muhur baddha-drava mala pravriti was found in all i.e. 100% of patients.
76.66% of patients had Durgandhita mala pravriti, while, Shleshmala mala pravriti was
observed in 46.66% of patients. All i.e. 100% of patients had normal colour of stool. 100% of
patients were having irregular bowel habit. 43.33% of patients, frequency of stool was observed
3 to 4 times in a day. In 20% of patients, it was observed 2 to 3 times in a day, while in 36.66%
of patients frequency of stool was observed more than 5 times in a day.
140
Mala Pravritti Status

100
90
80
70
60
50
40
% of Patients
30
20
10
Table- 35
Nidana (Etiological factors) reported by 30 patients-
Nidana No. of patients %
Katu 25 83.33
Atisnigdha 19 63.33
Amla 14 46.66
141
Guru Ahara 16 53.33
Vidahi Ahara 13 43.33
Sheeta Ahara 8 26.66
Ruksha Ahara 10 33.33
Vishamashan 13 43.33
Adhyashana 10 33.33
Viharaja
Divaswapna 16 53.33
Vega vidharana 11 36.66
Ratri jagarana 13 43.33
Ativyayama 8 26.66
Manasika
Chinta 22 73.33
Shoka 14 46.66
Krodha 13 43.33
Bhaya 6 20
Aharaja: According to Nidana of Grahani Roga, Katu ahara was observed in 83.33% of patients.
Atisnigdha ahara was found in 63.33% of patients. Amla & Guru ahara were observed in
46.66% & 53.33% of patients respectively. Sheeta ahara was found in 26.66% of patients.
Adhyashana was found in 33.33% of patients. Ruksha ahara was observed in 33.33% of patients.
Vishamashana was found in 40% of patients.
Viharaja: According to Viharaja Nidana, Divaswapna was found in 53.33% of patients, Ratri-
jagarana was observed in 43.33% of patients, Vega-vidharana was observed in 36.66% of
patients, and Ativyayam was found in 26.66% of patients.
Manasika: Chinta was found in 73.33% of patient, while Shoka was observed in 46.66% of
patients. Bhaya was found in 20% of patient, while Krodha was observed in 43.33% of patients.
142
Aharaja Nidan Wise status

90
80
70
60
50
40
30
% of Patients
20
10
0
Viharaja Nidan Status
60
50
40
30
% of Patients
20
10
0
Diva swapana Vega Ratri jagarana Ati Vyayama
vidharana
Mansika Nidan Status
80
60
40 % of Patients
20
0
Chinta Shoka Krodha Bhaya
143
Table no. -36
Stool Examination in 30 Patients –

Stool No. of patients %
vegetative cells 30 100
Pus cells 5 16.66
epithelial cell 19 63.33
Ova, Cyst 0 0
Stool examination wise, vegetative cells was present in all the patients, pus cells was present in
16.66% of patients, epithelial cell was present in 63.33% of patients and ova & cyst was not
found in any of patient.
Table no. - 37
Chief complaints wise distribution of 30 Patients –
Chief complaints No. of patients %

Muhurbaddha/Muhurdrava mala pravriti 30 100
Arochaka 27 90
Trishna 26 86.66
Praseka 21 70
Shoonpadkaraha 10 33.33
Asthiparvaruk 30 100
Chhardan 26 86.67
Udara Shoola 30 100
Shleshma mala pravriti 21 70
Atopa 30 100
Aalasya 27 90
Other complaints
Lohaamagandhi-tiktaamla Udgara 18 60
Jwara 10 33.33
In the present study, Muhur baddha/drava mala privriti was found as chief complaint in 100%
patients, while Arochaka were found in 90% patients, Trishna in 86.66% patients, and Praseka
in 70% patients, Shoonpadkaraha in 33.33% patients, Asthiparvaruk in all patients and
Chhardan in 86.66% patients. Udarshoola and atopa was observed in all patients, Alasya in 90%
patients, Shleshma malapravriti in 70% patients, Lohaamagandhi-tiktaamla Udgara in 60%
patients and in a few i.e. 33.33% patients Jwara was found.
144
Stool Examination Status

100
80
60
40
20 % of Patients
vegetative
pus cells
cells epithelial
cells ova, cyst
Chief Complaint Wise Status
100
90
80
70
60
50
40
30
20
10
0
% of Pts
145
EFFECT OF THERAPY
In the present study, 30 patients of Grahani Roga were registered for trial and were treated
completely. During the treatment patients were followed up after certain interval. The effect of
therapy on symptoms is being presented here in following tables.
Table- 38
Effect of Vasti Karma on sign and Symptoms –
S.N Symptoms Mean Grade Diff. %of relief

Score
BT AT
1 Muhurbaddha/Muhurdrava 68 17 51 75
mala pravriti
2 Arochaka 65 9 56 86.15
3 Trishna 41 0 41 100
4 Praseka 41 13 28 68.29
5 Shoonpadkarah 18 8 10 55.55
6 Asthiparvaruk 70 13 57 81.42
7 Chhardan 52 4 48 92.30
8 Udara Shoola 74 23 51 68.91
9 Shleshma mala pravriti 36 2 34 94.44
10 Atopa 75 13 62 82.66
11 Aalasya 64 12 52 81.25
Improvement in the symptom of Muhurbaddha / Muhurdrava mala pravriti was 75, Arochaka
was 86.15%, Trishna was 100%, and Praseka was 68.29%, Asthiparvaruk was 100%, Chhardan
was 92.30%, Udara-shoola was 68.91%, atopa was 82.66%, Alasya was 81.25% and Shleshma
mala-pravriti was in 94.44%.
146
Effect of Vasti Karma on Symptoms
80
70
60
50
40
30
20
10
Symptoms BT
Symptoms AT
147
Table –39
Effect of Vasti Karma on Sign and Symptoms of 30 patients
Symptoms Mean Diff. %of SD SE t P

Score relief +_ +_
BT AT
Muhurbaddha/ 2.26 0.56 1.7 75 0.59 0.10 15.62 < .001
Muhurdrava
mala pravriti
Arochaka 2.16 0.3 1.86 86.15 1.04 0.19 9.81 < .001
Trishna 1.36 0 1.36 100 0.71 0.13 10.41 < .001
Praseka 1.36 0.43 0.93 68.29 0.78 0.14 6.51 <.001
Shoonpadkarah 0.6 0.26 0.33 55.55 0.66 0.12 2.76 < .02
Asthiparvaruk 2.33 0.43 1.9 81.42 0.71 0.12 14.61 < .001
Chhardan 1.73 0.13 1.6 92.30 1.00 0.18 8.73 < .001
Udara Shool 2.46 0.76 1.7 68.91 0.70 0.12 13.25 < .001
Shleshma mala 1.2 0.06 1.13 94.44 0.93 0.17 6.62 < .001
pravriti
Atopa 2.5 0.43 2.06 82.66 0.69 0.12 16.36 < .001
Alasya 2.13 0.4 1.73 81.25 0.58 0.10 16.27 < .001
The result of Vidangadi Taila- Dhanyapanchak Kwath Vasti has been found highly significant in
all the symptoms except Shoonpadkarah.
148
Effect of Vasti on Symptoms

100%
90%
80%
70%
60%
50%
40%
30%
% of relief
20%
10%
0%
149
Table –40
Effect of Vasti Karma on Other symptoms of 30 patients
S.No. Other Symptoms BT AT

No. of pts. % No. of pts. %
1. Jwara 10 33.33 0 0
2. Lohaamagandhi-tiktaamla 18 60 3 10
Udgara
Before treatment Lohaamagandhi-tiktaamla udgaar present in 60% patients and Jwara present
in 33.33% patients. After treatment Jwara was not found in any patients and Lohaamagandhi-
tiktaamla Udgara was found only 10% patients.
Table-41
Effect of Vasti Karma on Hematological parameters
Parameters Mean
BT AT
Hb% 11.30 12.52
TLC 7660 6880
ESR 14.33 8.6
This table shows that hematological status (Hb, TLC, and ESR) was improved after treatment.
150
Effect of Vasti on other symptoms

60
40
20
BT
0
AT
Hb%
13
12 BT
11
10 AT
Hb%
TLC
8000
7500
7000 BT
6500 AT
6000
TLC
ESR
15
10
BT
5 AT
0
ESR
151
Table-42
Effect of Vasti Karma on Ahara shakti-
A. Abhyavaharana shakti
Abhyavaharana shakti No. of patients

BT AT
Pravara 0 25
Madhyam 6 4
Avara 24 1
Before treatment total 30 patients were having Madhyam and Avara (6+24) Abhyavaharana
shakti but after completion of treatment 25 patients acquired Pravara Abhyavaharan shakti.
B. Jarana shakti
Jarana shakti No. of patients

BT AT
Pravara 0 24
Madhyam 4 5
Avara 26 1
Before treatment total 30 patients were having Madhyam and Avara (4+26) Jarana shakti but
after completion of treatment 24 patients acquired Pravara Jarana shakti.
152
Abhyavaharana Shakti Status

25
20
15
10 BT
AT
5
Pravara
Madhyam
Avara
Jarana Shakti Status

30
25
20
15
BT
10
AT
5
Pravara
Madhyam
Avara
153
Table-43
Effect of Vasti Karma on Vyayama Shakti –
Vyayama shakti No. of patients
BT AT
Pravara 3 18
Madhyam 12 7
Avara 15 5
Before treatment total 30 patients were having Pravara, Madhyam and Avara (3+12+15)
vyayama shakti but after completion of treatment 18 patients acquired Pravara vyayama shakti, 7
patients were having Madhyam vyayama shakti and only 5 patients having remain Avara
vyayama shakti.
Table- 44
Effect of Vasti Karma on Agni-bala –
Agni-bala No. of patients
BT AT
Mandagni 21 0
Vishamagni 9 2
Samagni 0 28
Before treatment total 30 patients were having Mandagni and Vishamagni (21+9) Agni-bala but
after completion of treatment 28 patients acquired Samagni.
154
Effect of Vasti Karma on Vyayama Shakti

18
16
14
12
10
8
BT
6
4 AT
2
0
Pravara
Madhyam
Avara
Effect of Vasti Karma on Agni-Bala

30
25
20
15
BT
10
AT
5
Mandagni
Vishamagni
Samagni
155
OVERALL EFFECT OF THERAPY
Table: - 45
OVERALL EFFECT No. of Patients %

Marked Improvement 24 80
Moderate Improvement 6 20
Mild Improvement 0 0
No Improvement 0 0
Twenty four patients (80%) got marked relief and six patients (20%) got moderate relief. No
patient was listed under mild improvement or unchanged/ no Improvement category.
156
Discussion
“The larger the island of knowledge, the longer the

soreline of mistery.”
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DISCUSSION
This is the vital & mandatory part of every research work, which comprises the discussion of
important points from conceptual study as well as from clinical study based on the results
obtained. Discussion is nothing but the logical reasoning of observations based upon the figures
and facts. If all the points are discussed with proper reasoning than only they will helpful to
illustrate proper conclusions. It is a bridge, which connects the findings with conclusions. Only a
properly done discussion can fulfill the purpose of research work i.e. to draw some conclusions
from the findings and results. The clinical research which was carried out on a devastating entity
like Grahani Roga is needed to be discussed in the following terms.
Discussion of the present study consists following points-
1. CLINICAL STUDY
2. CONCEPTUAL STUDY OF DISEASE
3. PROBABLE MODE OF ACTION OF TRIAL DRUGS
CLINICAL STUDY:
In the present study total 38 patients of Grahani Roga were selected from OPD and registered for
the treatment. Out of which 30 patients completed the full duration of treatment, while 8 patients
were left at different stages of treatment and follow-up.
Age
It was observed from study that maximum patients of Grahani Roga 14(46.67%) found in the age
group of 41-50 years and minimum 2(6.67%) in 16-20 years of age group. From table 3 & 4, it is
clear that age group 41-50 is more prone to the disease in both sexes.
Maximum patients are from age group i.e. 41-50. In this age group people have more busy and
stressed life span, so they usually indulge in unwholesome regimen e.g. Adhyashana,
Vishamashana, Ratrijagarana, Diwasvapana etc. This leads to inequilibrium of Tridosha mainly
Samana Vayu, Pachaka Pitta, & Kledaka Kapha. Anxiety and stress badly affects function of
Agni so that function of Grahani gets disturbs and they produce Grahani Roga.
Sex:
From present study it may be concluded that males are more prone to Grahani Roga that females.
Out of 30 patients- 19 males were registered and 11 females were registered for this study.
This may be due to more stress and burden of work, travel and outside meals are common life
style in males, that why they are more affected to gastrointestinal disorders like Grahani Roga.
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Religion:
It was observed that maximum 73.33% are Hindu patients and 26.66 % are Muslim patients. This
is because the hospital is situated in Hindu population area.
Marital status:
80% patients are married. This shows that disease is more prominent in married patients and in
older age group in comparison to unmarried patients. Although there is no relation between the
Grahani Roga & Marital status but due to increased stress and hurry in life they are more
affected with this disease.
Occupation:
Among registered patients, 33% were house wives and 33% were service class. So the both
groups were equally affected. This study reveals that sedentary life style and hectic life style both
are equally responsible to produce Grahani Roga. Sedentary life style produce Mandagni when
as hectic life style produce Vishamagni. Both states of Agni are responsible for Grahani Roga.
Education:
In this study, 76.67 % patients are educated. This incidence is observed maximum in educated
people may be due to hurried and worried life, irregular diet habit etc.
Economic status:
It is observed that maximum number of patients 46.67% belongs to middle class family and next
to these 33.33% patients belongs to lower class family. Minimum 6.67 % patients belong to high
class family. This shows possibility of disease is more in middle class and lower class family.
Middle class people pay more attention to maintain their status in the society, which causes
mental stress and vitiation of Vata Dosha produces Vishamagni and later on Grahani Roga.
Family history:
It is observed that there is no any correlation with family history because family history is
present in only 13.33% of patient.
Chronicity of disease:
Maximum 43.33% patients had history of disease from one year to one and half year and 26.67%
of patients had history of disease up to one and half year to two year.
Maximum numbers of patients i.e. 70.00% were having chronicity of disease Grahani Roga from
1to 2 years. As patients initially do not care of mild symptoms of Grahani disease and keep them
on self medication once prescribed by physician just as digestive, appetizer etc. Due to these
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types of drugs temporary suppress the symptoms of disease, hence patient attend hospital lately.
This disease is more chronic in nature also due to its periodic type.
Nature of diet:
Patients taking non-vegetarian diet suffering somewhat more 53.33% than vegetarian patients
46.67%. This shows non vegetarian diet making patients more prone to this disease. This
observation reflects although the predominant diet of this region is vegetarian of the local
population but more patients who are suffering from Grahani Roga in this region are non
vegetarian.
Appetite:
Results are showing that 66.67% of Grahani Roga having deprived appetite. This shows it,
appetite has been decreased with this disease due to Ama deposition.
Aggravating factors:
Different aggravating factors drugs, diet, climate changes, occupation etc are taken into
consideration; results showing diet and occupation are most common aggravating factors. Diet is
main aggravating factor because it was responsible in 40% of patients.
Meal time:
Maximum 60 %patients are on irregular meal and 40 % on regular meal.
Dietetic Habit:
43.33% of patients of this clinical study are doing Vishamasana followed by 33.33% patients are
doing Adhyasana because both Vishamasana and Adhyasana type of dietetic habit produce Ama
in the body; finally it results into occurrence of disease.
Supplementary food:
This study shows 70 % patients are taking excessive tea, 13.33 % patients are taking excessive
tea & milk, and 16.67 % patients are taking milk and 3.33 % taking coffee as food supplements.
Maximum no. of patients i.e. 70% are taking tea as supplementary diet.
The secretion of digestive juice increases for digestion of tea in those persons who are
consuming excessive tea. This excessive secretion of digestive juice leads to damage of gastric
mucosa. In such persons, at the time of meal, secretion of digestive juice are inappropriate in
quantity, this leads to indigestion and later causes Grahani Roga.
Addiction:
76.67 % patients were not taking any addiction, while 13.33 % patients were taking tobacco,
6.67 % patients were taking alcohol & smoking and 3.33 % patients were on smoking. This
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statistical data shows maximum patients are not taking any addiction. The reason behind this
data may be that patients not given addiction history truly because of society factor. Although
they are taking addictives even they don‘t want to show in society.
Exercise:
The data shows that 50% patients were not doing any exercise. This may be due to today‘s busy
scheduled people have no time for exercise. It causes Ama production which hampers proper
digestion. 26.67 % patients were doing exercise irregularly where as only 23.33% of the patients
were doing regular exercise. It means peoples not doing any exercise are suffering more with
Grahani Roga in comparison to those doing exercise.
Nature of work:
Majority of patients i.e. 73.33 % were doing physical work, because of maximum patients were
labours and female.
Sleeping pattern:
Majority of patients i.e. 33.33% patients were having decreased sleep, 33.33% patients were
having disturbed sleep. Patients with some psychological problems get less or disturbed sleep.
This observation reflects the disease is related to psychological problems of the patient also.
Disturbed natural night sleep causes Divaswapna .This Divaswapna causes Agnimandya/Ajirna
which later causes Grahani Roga.
Psychological Status:
In the present study Majority of patients i.e. 53.33 % were having anxiety followed by 26.67%
were stressed and 6.67% patients were depressed where as only 13.33 % of the patients were
with normal mood. Emotional anxiety and stress leads to vitiation of Agni and it results into
Amavastha of Grahani Roga.
Sharir Prakriti & Manasa Prakriti:
In present clinical study, all patients were having Dwandaja Prakriti. Among them each of
53.33% had Vata-Pittaja followed by 33.33% Vata-Kaphaja Prakriti, while 13.33% patients had
Kaphaja-Pittaja Prakriti.
56.67 % of patients were having Raja dominant Prakriti followed by 40 % patients having Tama
dominant Prakriti. Generally People of Rajasika & Tamasika prakriti are less care taking
regarding their Ahara – Vihara. Due to this Mithya Ahara Vihara, Agni is vitiated and finally it
leads to Amavastha of the disease.
Sara, Samhanana, Pramana, Satva & Satmya:
The majority of patients were having Madhyama Sara (70%), Madhyama Samhanana (53.33%),
Madhyama Satva (50%). These observations show that the most of the patients were having
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Madhyama Bala. The data reflects the usual presentation of Sara, Samhanana, Satva and Satmya
of society.
Vyayama Shakti:
Before treatment maximum number of patients i.e.15 (50%) were showing Avara Vyayama
shakti, 12 (40%) patients were having Madhyam Vyayama shakti and 3 (10%) patients having
Pravara Vyayama shakti. Maximum patients i.e. 50% were showing Avara Vyayama shakti
before treatment due to disease but after therapy Vyayama shakti of patients improved due to
proper digestion, absorption and elimination of food, which increases immunity and strength of
body. After treatment maximum number of patients 18 (60%) were showing Pravara Vyayama
shakti.
Ahara Shakti
• Abhyavaharana Shakti & Jarana Shakti:

Before treatment 80 % patients were having Avara Abhyavaharana Shakti, 20% patients were
having Madhyam Abhyavaharana shakti and 86.67% patients were having Avara Jarana shakti.
This signifies the importance of Agni in the pathogenesis of Grahani Roga.
After treatment in maximum 25 (83.33%) patients improved to Pravara Abhyavaharana Shakti
and no one patient was showing Avara Abhyavaharana Shakti. After treatment in maximum 24
(80%) patients improved to Pravara Jarana Shakti and only 3.33% patients remain in Avara
Jarana Shakti.
After therapy Abhyavaharana Shakti and Jarana Shakti of patients improved due to Ama
Pachana and proper absorption and elimination of Sara and Kitta bhag from the body. It
eliminates the Srotorodha. The pachana of Ahara is improved, so Ahara Shakti of patients
improved after therapy.
Status of Agni:
In the present clinical study, highest number of patients i.e. 70% had Mandagni, followed by
30% of Vishamagni. This signifies the importance of Mandagni in the pathogenesis. Mandagni
results into vitiation of Dosha which leads to Ama formation. It plays a key role in Samprapti of
Grahani Roga. Therefore here drug was given having Deepana and Pachana properties.
After Treatment maximum 93.33% patients were showing Samagni. Nobody was showing
Mandagni. This is due to Deepana and Pachana drug administration and Ama pachana.
Mala Pravriti:
Muhurbaddha Muhurdrava Mala Pravriti was found in all i.e. 100% of patients. 76.66% of
patients had Durgandhita Mala Pravriti, Shleshmala Mala Pravriti was observed in 46.67% of
patients, 100% of patients were having irregular bowel habit. In 43.33% patients, frequency of
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stool was observed 3 to 4 times in a day. This observation shows, vitiation of Agni may cause
improper digestion and it may create irregular Mala Pravriti.
Mutra Pravriti:
In 96.66% patients, the colour of Mutra was Avishesha. 73.33% had to pass urine 5 to 7 times
/day. 63.33% patients had to pass urine 1 to 2 times / night. The data shows the general
information regarding Mutra. Nothing significant can be drawn from the data.
Etiological Factors:
Aharaja Nidana :
Katu Ahara was found in 83.33% patients. Atisnigdha Ahara was observed in 63.33% of
patients. Amla Ahara was found in 46.66% of patients. Guru Bhojana was observed in 53.33%
of patients. Vidahi Bhojana was observed in 43.33% of patients. Sheeta Ahara was observed in
26.66% patients. Ruksha Ahara was found in 33.33% patients. Vishamasana was found in
43.33% of patients and Adhyashana was found in 33.33% patients. Maximum patients were
having faulty Dietetic habits. This is responsible for vitiation of Dosha which leads to Agni
Dushti and Formation of Ama, which leads to disease occurrence.
Viharaja Nidana:
Divaswapna was found in 53.33% patients. Vega-vidharana was observed in 36.67% of patients.
While Ratri-jagarana found in 43.33% patients. Ati-Vyayama was found in 26.66% of patients.
These all things are responsible for improper digestion and vitiation of Doshas, leading to
Amavastha and finally lead to Grahani Roga.
Manasika Nidana:
Chinta was found in 73.33% patient while Shoka was found in 46.66% of patients. Krodha was
found in 43.33% of patient while Bhaya was observed in 20% of patients. It may be due to
prolong ill health & different types of dietary restriction. This is responsible for improper
digestion which leads to Ajirna like condition as mentioned in Ayurvedic classics. These
psychological factors play a dominant role in the development of Agni dushti.
In all the cases, involvement of Annavaha, Purishavaha and Rasavaha Srotasa was observed.
These three Srotas are related with digestion, absorption and excretion. So, it can be said that in
'Grahani Roga' above mentioned functions are hampered. Hence it can be summarized that in
Grahani Roga the predominantly involved Srotasas are Rasavaha, Annavaha and Purishavaha
Srotasa.
Chief Complaints:
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In the present study, Muhurbaddha/ Muhurdrava mala privriti was found as chief complaint in
100% patients. While Arochaka was found in 90% patients, Trishna in 86.67%, Praseka in 70%,
Shoonpadkaraha in 33.33% and Asthiparvaruk in all patients.
Chhardan was found in 86.66% patients, Udara Shool in all patients, and Atopa in 68.18%
patients. Shleshma mala pravriti was found in 70% patients, Loha-amagandhi udgara in 60%
and jwara in 33.33% patients. Alasya was observed in 36.36% patients.
These all are the cardinal symptoms of Grahani Roga. Faulty dietetic habit, mental disturbance
and sleeping pattern etc. are the etiological factors, due to these factors there is vitiation of
Tridosha and by these Agni is vitiated which leads to vitiation of Grahani that results in
symptoms of Grahani Roga.
EFFECT OF THERAPY-
Total 30 patients were registered for this study. These were randomly selected. For the
assessment of results the symptoms which are in classics were adopted. For statistical analysis to
make these criteria more objective, an effort has been made to give scores to all subjective
criteria. Each symptom has been given score 03. Few symptoms have been given Present/Absent
scoring also.
Further all the scores of symptoms have been combined to assess the overall effect of therapy.
Assigning the score depending upon their severity did the assessments of signs & symptoms
regarding improvement.
♦Drug was found to be highly effective in relieving Muhurbaddha / Muhurdrava mala pravriti
by 75% which was statistically highly significant (p < 0.001).
♦ Arochaka was promptly relieved by 86.15% which was statistically highly significant
(p<0.001).
♦ Trishna was subsided by 100% which was statistically highly significant (p<0.001).
♦Praseka was relieved by 68.29% which was statistically highly significant (p< 0.001).
♦In 55.55% patients improvement in Shoonpadkarah was seen which was statistically significant
(p<0.05).
♦Asthiparvaruk was relieved in 81.42% patients which was statistically highly significant
(p<0.001).
♦The symptoms of Chhardan reduced by 92.30% which was statistically highly significant at
p<0.001.
♦Udarshoola was relieved by 68.91% and was statistically highly significant (p<0.001).
♦Atopa was subsided by 82.66% which was statistically highly significant at p<0.001.
♦Relief in Alasya was found in 81.25% patients which was statistically highly significant
(p<0.001).
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♦Shleshma mala pravriti was relieved by 94.44%, which was statistically highly significant at
p<0.001.
♦Jwara was subsided after treatment and Loha-amagandhi-tiktaamla Udgara was remaining
only 10% patients.
These observations clearly emphasis Deepana-Pachana effect of Vidangadi Taila
Dhanyapanchak Kwath Vasti and its efficacy.
TOTAL EFFECT OF THERAPY:

Twenty four patients (80%) were markedly improved and Six patients
(20%) were moderately improved. From this observation, it is seen that drug– Vidangadi Taila
Dhanyapanchak Kwatha Vasti was highly effective in treating Grahani Roga.
Discussion on effect on sign and symptoms-
As mentioned earlier all these above mentioned symptoms are caused mainly due to vitiation of
Pachaka Pitta, Samana-Vayu and Kledaka Kapha, Jatharagnimandya, Amarasa. Vidangadi tail-
Dhanyapanchak kwath Vasti provided better relief in almost all the symptoms because their
Dravyas have Katu-tikta rasa, Laghu-tikshna-sukshma guna, Deepana-pachana property and
Katu Vipaka reduces Kapha- Vata dushti, correct the Jatharagni, and digest the Ama. By this
normal physiology of digestion gets restored which in turns leads to proper formation of Sara
and Kitta bhaga and relief in above symptoms.
PROBABLE MODE OF ACTION OF VASTI

Mode of action. “Guda moolam hi shareeram………” Drug cross rectal mucosa. Upper rectal
mucosa→ Sup.hemorrhoidal vein→ Portal circulation. Lower rectal mucosa→ Middle &
Inf.hemorrhoidal vein→Systemic circulation.
Nirooh Vasti:- Hyper osmotic- facilitates absorption of endotoxins in the solution-

Detoxification. AnuvasanaVasti- Hypo osmotic- absorption in blood.
In Vasti dravya, First of all sodium ion in Saindhav actively absorb from colon. Removes excess
acidity, Generates hydro-electric energies in the cells & for nerve cells communication. It
stimulates ionic action potential. High concentration of sodium ion facilitates sugar influx.
Increase sodium ion in mucosal membrane generate osmotic gradient. Water follows this
osmotic gradient thus passive absorption of water take place. Free fatty acid is easily absorbed by
passive diffusion in the colon. Sugar absorbs quickly- instant energizer. Hygroscopic nature- It
speeds up the healing, growth of healing tissue, Antibacterial-acidic nature. Regular usage
increases WBC, good antioxidant also. Sneha gives potency to whole combination. It helps to
disintegrate Malas- increasing osmotic permeability of solution. Kalka maintains volume of fluid
and helps in spreading & cleaning. Water Electrolytes, some vitamins are also absorbed through
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the colon, Colon bacteria in normal condition, produces Vitamin B1, 2, B12 & K. Similarly some
of the Nutrients of Vasti can also be absorbed from the colon and reaches at the cellular level.
From above description, it can be understood that how Saindhav, Madhu, Sneha and Kwatha,
lipid and water soluble portion is absorbed from colon.
FOLLOW-UP STUDY:
Data shows the percentage-wise comparative data of follow-up study regarding signs and
symptoms of Grahani Roga in patients undergone treatment.
According to Ayurveda, the management protocol of any disease consists of three major
components i.e. Aushadha, Ahara and Vihara. Regarding the treatment of Grahani Roga, it is
evident that more emphasis is given to Ahara and Vihara than medicines except in some specific
conditions. The Pathya- Apathya always becomes a major part of treatment.
Since no treatment can be thought of in Ayurveda without proper observation of Pathya-Apathya.
The possible etiological factors like outside food, fast foods, ice creams, chocolates, pav-bhaji,
panipuri, wafers, low quality bakery items etc. were strictly avoided. They were advised to wash
hands properly before eating and after toilet, cleaning of nails, and not to wear dirty cloths, take
at least 20 minutes boiled water (some of the ova / cysts are not destroyed during chlorination of
water only 20 minutes boiling of water can destroy them) and proper care regarding food and
food habits.
The striking results were observed in the group clearly show that they have followed these
instructions sincerely. It is evident from the results that life style management and avoiding the
etiological factors have the major role to play in the management of Grahani Roga. The way the
treatment has worked is very simple. All the possible causative factors of Agnimandya were
effectively ruled out, along with this intake of boiled water, fresh and warm food, avoiding of
bakery items and outside food might have increased the digestive power. Various clinical and
observational studies conducted in modern medicines have also shown the same conclusion that
life style management has an upper hand in preventing the gastrointestinal disorders.
The scheduled Vasti karma was found to be definitely effective in the cases of Grahani. The
effect of Vasti karma obtained probably due to Vatanulomana property and balancing effect on
equilibrium of Tridosha and more probably due to Vasti ingredients having Deepana, pachana,
Grahi and Snehan effects. The overall activity may be improving the function of digestion and
absorption of food with correcting the peristaltic movement of intestine. The disease becomes
more difficult to cure in chronic form as described in classic.
CONCEPTUAL STUDY OF DISEASE:
The word Grahani peculiarly specific for organ of Mahasrotas considered as a main seat of
Agni. The meaning of that word means to hold or to provide a base for a particular thing.
Another meaning of the word Grahani is to invade upon. Grahani is described to be situated in
between Amashaya and Pakwashaya. So, it can be said that Grahani is an organ which invades
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upon Amashaya and by doing this; it holds or obstructs the food and provides base for Agni to
act on the consumed food.
Grahani is described as an Argala; this similarity clarifies the anatomical and functional aspect of
Grahani. An Argala is a sort of wooden bolt that is used to close the doors, in other words Argala
obstructs or blocks the way.
Likewise, Grahani too, in between Amashaya and Pakwashaya obstructs the way for consumed
food.
The location of Grahani is stated between Amashaya and Pakwashaya (Sushruta) and above
Nabhi (Charaka). The organ stomach can be considered as Amashaya which is primarily a
storage site and engaged in the process of digestion. The Adho-amashaya i.e. small intestine
(along with pyloric sphincter and ileocaecal sphincter) can be anatomically and physiologically
considered as Grahani. But the duodenum the most suitable part of intestine to be called as
Grahani.
Grahani is described as Agni Adhisthana or site of Pachaka Pitta and it is considered as the
primary site for digestion, But, this half truth in both the aspect, in view of digestion and in the
view of functions of Grahani too.
So, the whole process of digestion can understood in step wise manner, as follows,
♦Food is consumed and digestive process starts in mouth itself.
♦This transformed food in a different nature is then brought to Koshtha or Amashaya in
particular, through Kantha nadi mainly by Prana vayu.
♦When this food is reached in to the Amashaya. It is obstructed by Grahani and remained in
Amashaya itself and prevented from entering into Pakwashaya.
♦Here all the transforming and digestive process take place by Kledaka Kapha, Pachaka Pitta
and Samana Vayu.
♦As the food is well digested it is expelled out into Pakwashaya by Grahani.
♦Then as a part of digestive process, well digested food is differentiated into Sara and Kitta.
♦From the Sara part all the Dhatu are produced by further process of transformation.
♦While, Kitta part is further divided into Accha mutra and Ghana or Samhat Purisha.
♦It is said that, tongue is the mirror of digestive canal, further it can be added by saying that a
well formed stool is a mark of healthy digestive process.
In Samhita Granthas, Grahani Roga is discussed as an independent disease and is considered as
Maharoga. Grahani Roga is described in Charaka Samhita Chikitsa Sthanam chapter 15,
Astanga hridaya Nidan Sthanam Chapter 08 and Ashtang Hridaya Chikitsa Sthanam Chapter 10.
When the vitiated Doshas get confined only to the organ Grahani, then it should be called
Grahani Dosha. When the vitiated Doshas travels throughout the Rasadi dhatus i.e.
Sarvasharira- gatatva then it should be called as Grahani Roga.
It has been seen that Grahani and Agni are interdependent; therefore all the aetiological factors
of Agnidushti is the direct cause of Grahani Roga.
The etiological factors which are stated to cause Agnidushti are- Aharaja, Vishesha (Vyapada of
Virechana, Vamana and Snehana), Emaciation or wasting brought about by other
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disease,Virudha dosha, Kaala, Ritu, Vega vidharana, mental, psychological and emotional
instabilities.
Regarding the Purvarupa of the disease, In Ashtanga Hridaya the Purvarupa are described i.e.
‗Pragrupam Tasya Sadanam.‘ But, Acharya Arundatta has commented over it by saying that
these are the Rupas of Grahani Roga. While the immediate next Shloka of Ashtanga Hridaya
explains the clinical features of Grahani Roga which is accepted as a Rupa of Grahani Roga by
Arundatta too.
Pathogenesis of the disease is confined to Annavaha srotas, which is clear as Charaka has
described Pakwashayastha and Linawastha after describing the Grahani Roga, So the symptoms,
mentioned in Charaka which are manifested as Vistambha, Aruchi, Gaurava, Praseka, Arti, and
Udarashool etc. Coming on the point, course of the disease, etiological factors lead to vitiation
of Grahanistha Doshas or disturbance in the functions of Grahani manifested as Grahani Roga.
If the etiological factors and environment is remained persistent the pathology will not remain
confined to Amashaya, but it will lead to severity with Bhuyatah vikriti, Linatwa (distribution of
Doshas all over the body) and Bahudoshatwa manifesting as ―Grahani Roga‖ which is described
as Maharoga.
In the Samprapti of Grahani Roga, Acharya Charaka elaborated a cascade of events viz.
indulgence in Agni Vikritikara hetus →Dosha prakopa → Agni dushti → Apachana → Ama-
utpatti → Shukta paka → Anna visha or Ama visha → Grahani dosha →Grahani dushti →
GRAHANI ROGA.
The Shuktapaka stage leads to Annavisha formation. The Annavisha thus produced may remain
localized in the Grahani or it may spread in the body through Rasa with the help of Vyana-Vayu
and mixes with Dosha, Dushya or Dhatus. If Annavisha localizes, it causes affections at GIT
level; if it is mixed with Rasa, Rakta etc. Dhatus, it causes disease of those Dhatu i.e. Dhatu
dushti. This whole process of production of Grahani Roga can be considered in three pathways
viz.
1. Durbala Agni (Weakened digestive power)
2. Durbala Bala (Weak holding capacity of Grahani)
3. Dushta Grahani (Duodenum including small intestine is damaged)
Pathway up to Durbala Agni and Durbala Bala may be considered as Grahani Dosha and stage
of Dushta Grahani as Grahani Roga.
It is very well known that Grahani is Ashraya and Agni is Ashrita and due to various etiological
factors the functions of Grahani becomes impaired as a result of vitiation of Pachaka Pitta,
Samana-Vayu and Kledaka Kapha.
PROBABLE MODE OF ACTION OF TRIAL DRUGS

The main lacuna with the present available health practice (irrespective of the system) is that
emphasis is always given on curative aspect of disease but not to the preventive aspect. Ayurveda
is unique in its approach, where it clearly mentions its ultimate aim as nothing but to prevent the
disease, and maintain the health of healthy individual.
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Ayurvedic texts have infinite number of herbal combinations for successful treatment of Grahani
Roga. Vidangadi Taila and Dhanyapanchak Kwath was selected as trial drug for the present
study.
Pharmacological Analysis of Vasti-Drugs on Ayurvedic Parameters-
The pharmacology of the drugs used in therapy was analyzed on Ayurvedic Parameter. The
combination of rasa was predominantly Katu and Tikta. Laghu (85%), Ruksha (51.43%), and
Tikshna (37.14%) Guna was predominant in this composition. The composition was
predominant of Ushna veerya (82.35%) in comparision to opposite Veerya Sheeta (17.65%).
Vipaka was found Katu dominant (77.14%) followed by Madhura (22.86%). Doshaghnata of the
combination was assessed as Kapha-Vata Shamaka (50%), Kapha-Pitta Shamaka (23.53%), and
Tridosha Shamaka (26.47%).
The drugs in the combination are having appetizing, digestive, carminative, anti-spasmodic,
antibacterial, anti-amoebic, anti inflammatory, anti-helmintic, hepatoprotective, anti viral, anti-
Giardia, anti ulcerative, immunomodulator, purgative, laxative, anti-emetic, antidepressant,
prostaglandin inhibitory properties.
Probable Mode of the Action of Drugs:

Acharya Charaka states that, certain drugs act through Rasa; some through Veerya; some through
their Gunas; some through their Vipaka and some through their Prabhava.
• At the level of Dosha:
Because of its Laghu, Ruksha - Guna and Katu, Tikta - Rasa (dominant with Agni, Vayu and
Akasha Mahabhuta) it subsides the aggravated Kapha. While, by Ushna Veerya & Tikshna Guna
it counteracts Vata.
• At the level of Agni:
By virtue of its Tikshna Guna which is predominant with Agni, Vayu and Akasha Mahabhuta.
Ushna Veerya, Katu - Tikta Rasa it stimulates Jatharagni which turn by turn stimulates all other
Agnis.
• At the level of Srotasa:
Due to its Laghu, Ruksha, Tikshna Guna and Ushna Veerya it removes present Srotorodha as it
penetrates minutest Srotasa.
• At the level of Dhatu:
Due to Katu, Tikta Rasa, Katu Vipaka, Ushna Virya, Laghu, Ruksha, Tikshna Guna drug brings
down the increased Rasa Dhatu to normalcy and due to equilibrium of Rasa, Madhura Rasa and
Snigdha Guna nourish the Rasadi Dhatu.
In Grahani Roga, mainly there is vitiation of Agni, usually Mandagni is seen. This ultimately
results in Ama formation and also may lead to Suktapaka. Drugs of Vasti have properties like
Katu, Tikta Rasa, Katu Vipaka, Laghu, Ruksha, Tikshna, Snigdha Guna acts as Agni Dipaka and
also Amapachaka. Tikta Rasa and Laghu, Ruksha Guna helps in reducing the colonic motility
169
and thereby helps in Sashleshma mala pravriti. Due to these pharmacodynamics it has specific
action on Jatharagni and ultimately on the Grahani Roga. This characteristic combination of
Rasa, Guna, Veerya and Vipaka can be summarized as Deepana, Pachakaa, Ruchya, Shodhan,
Annasya Shoshanaha, Srotansi Vivrunoti, etc.
Maximum Drugs have an Ushna virya because of this feature it acts on Jathargni and Grahani
too. The feature of Ushna virya is very specific for the process of digestion.
So, because of predominantly Katu, Tikta rasa and Katu vipaka and Ushna virya the drug has an
action on Jhathargni and as, Agni and Grahani has Adheya – Adhar Sambandha, the drug acts on
Grahani too. With the same time, because of the specific action (Adhishthan gamatwa) of drugs,
it is supposed to act on Grahani too. So, the drug of Vasti regulates the Jatharagni and the
functions of Grahani and ultimately curing 'Grahani Roga'.
170
Summary
& Conclusion
Satisfaction does not come with achievement, but

with effort. Full effort is full victory.
(Gandhi Ji)
171
SUMMARY
Today there is tremendous increase in life style disorders because of a change in dietary and
living habits. This type of lifestyle and food habits affects the function of Grahani (site of Agni
or Pitta) by means of vitiation (Vishamagni) or suppression (Mandagni) of Agni. When proper
digestion of food does not take place in Grahani and this undigested food material passes through
it to further parts of intestine, then it disturbs further digestion, absorption and other functions of
small and large intestine. In Grahani Roga, although Rogadhisthan is Grahani but dysfunction
occurs in whole G.I. tract. Vasti karma is indicated in the management of Grahani. It helps in
improving the function of gut and also nourishes it.
The common symptoms of gastro-intestinal disorders include abdominal pain, bowel disturbance
i.e. diarrhoea, constipation, nausea, vomiting, abdominal pain, alteration in appetite, indigestion,
malabsorption and ultimately failure to thrive, are also the result of indigestion. These features
cannot be grouped under any particular heading.
In Ayurvedic Texts, conditions like Udara Shoola, Kshudha-Alpata, Aruchi, Adhmana, Hrillasa,
Avipaka, Vibaddha Mala Pravritti and Abaddha Mala Pravritti alternately etc. have been
described under the heading of Grahani Roga.
The present study entitled, ―A clinical study to evaluate the efficacy of Vasti karma in the
management of ―GRAHANI ROGA‖
Aim and Objective-
 To evaluate the effect of Vasti karma in management of Grahani Roga.

 To study Grahani Roga with reference to I.B.S. and other disorders from Ayurveda and
modern system of medicine.
Present thesis work comprises of four parts viz. conceptual Study, clinical study, discussion and
summary & conclusions.
Conceptual study: This chapter dealt with the concept of Grahani, anatomical and physiological
review of Grahani, review of Grahani Roga, and modern review of diseases related to Grahani
Roga, review of Grahani Roga in respect of modern literature.
Under the conceptual study various Ayurvedic and modern text books, journals, previous and
ongoing research works related to the subject are thoroughly screened, analysed and
summarized. Definitions of Grahani, etymology, anatomy and physiology of organ - Grahani,
172
Agni Adhisthana, Pittadhara Kalaa, Argala, main functions of Grahani, Doshas associated with
Grahani (i.e. Kledaka Kapha, Pachaka Pitta and Samana-Vayu), concept of Agni, concept of
Pachana, modern anatomy and physiology of digestive system along with physiology of
digestion are also described under this section.
In the modern medical science, no disease or condition is found exactly similar to Grahani Roga;
but the conditions which have very close similarity with the Grahani Roga, which are commonly
observed are malabsorption syndrome, celiac disease tropical sprue, irritable bowel syndrome,
worm infestations like Amoebiasis and Giardiasis are also explained in this section.
Drug Review- The drugs – Vidangadi Taila and Dhanyapanchak Kwatha having almost same
Ayurvedic properties, i.e. predominant Rasa is Katu and Tikta; predominant Guna is Laghu and
Ruksha. Most of the drugs of both formulas are having Ushna Veerya, predominantly Katu
Vipaka. The Doshghnata of drugs is Kapha-Vata Shamaka. So, because of predominantly Katu
Tikta rasa and Katu Vipaka and Ushna veerya the drug has an action on Jhathargni and as, Agni
and Grahani has Adheya –Adhar Sambandha and Paraspara Upakaraka bhava, the drug acts on
Grahani too
Both compound drugs having properties like digestive, carminative, antispasmodic, appetizer,
anti inflammatory, anthelmintic, hepato-protective, stomachic, antiviral, antibacterial, anti-
amoebic, antigiardial, haematinic properties, anti ulcerative, immunomodulator.
Clinical study: In this section plan of study with material and methods, criteria for selection,
criteria for assessment, observation in tabular form along with statistical analysis of result were
observed.
Clinical trial was carried out in 30 patients of 16-60 year of age group from O.P.D. and I.P.D. of
department of Panchakarma and Kayachikitsa, Rishikul state ayurvedic P.G. College and
hospital, Haridwar, having cardinal signs and symptoms of Grahani Roga. Routine
haematological & biochemical examination, Stool and urine investigations were done to rule out
any systemic disorder in all the registered patients. In all patients Vasti schedule (2 course of
Yoga Vasti with Parihar kaala). Pathyaapathya were also kept during complete course.
Observation- Majority of patients i.e. 66.67% were from 31-50 year of age. The disease was
found higher in males 63.33% as compared to females 36.67%. Majority of the patients were
Hindu 73.33%. Maximum of the patients i.e. 80% were married. 76.67% patients were educated.
Maximum of patients were housewives and service class, 46.67% were belonging to middle
class.
53.33% patients were observed as mixed diet, and 46.67% patients were having vegetarian.
Maximum of patients i.e. 60% were having regular diet pattern. In dietetic habit, Vishamashana
in 43.33% patients were observed. 83.33% patients were taking Katu Rasa. Maximum of patients
i.e. were having disturbed or less sleep. 100% patients were complaining unsatisfactory bowel.
173
73.33% patients were doing physical work. Maximum of patients i.e. 53.33% were having
anxious / tensive type of nature.
In 53.33% patients, Vata-Pittaja Prakriti was observed, While 33.33% of the patients had Vata-
Kahaja Prakriti. 56.67% patients were found as Tamas Pradhana Manasa Prakriti. Maximum
patients, i.e. 70% were observed as Madhyama Sara, Madhyama Samhanana was found in
53.33% of the cases, 50% patients were observed as Madhyama Satva. 73.33% of patients were
observed as Madhyama Satamya, 50% were having Avara Vyayama Shakti.
Abhyavarana Shakti was Avara in 73.33% of patients, 86.66% patients were having Avara
Jarana Shakti, and Mandagni was found in 86.67% of patients. In 43.33% patients, the frequency
3 to 4 times/day of bowel was observed. 70% patients were having 1-2 year chronicity.
According to Nidana, in Aharaja Nidana various Nidana were observed, i.e. Katu Ahara in
83.33% patients, Ati Snigdha in 63.33%, While Amla in 46.66%, Guru in 53.33%, Vidahi Ahara
in 43.33% patients. In Viharaja Nidana, Divaswapna was found in 53.33% of patients, Vega
Vidharana in 36.67% and Ratri Jagarana was found in 43.33% of patients. In Manasa Nidana,
Chinta and Shoka were found in 73.33% & in 46.67% patients respectably.
Regarding chief complain, Muhurbaddha/Muhurdrava Mala Pravriti was observed in 100%

patients, and other symptoms were found i.e. Arochak were found in 90% patients, Trishna in
86.66% patients, Praseka in 70% of patients, Asthiparvaruk in 100% patients, Chhardan in
86.67% patients, Lohaamagandhi-tiktaamla Udgara in 60% patients, and Alasya in 90% patients,
Udara Shoola (Abdominal pain or Discomfort) and Atopa (Gas / Flatulence) in 100% patients.
Effect of Therapy –
Patients who completed treatment have showed average percentage improvement obtained was
80%.In patients treated with therapy, highly significant were obtained in the symptoms of
Muhurbaddha-Muhurdrava Mala Pravriti(75%), Arochaka (86.15%), Trishna (100%), Praseka
(68.29)%, Asthiparvaruk (81.42)%, Chhardan in (92.30)%, Lohaamagandhi-tiktaamla Udgara ,
Udara Shoola (68.91%) and Atopa (82.66%)and Alasya (81.25%). In Agnibala, highly
significant results obtained with Abhyavaharana Shakti (48.86%), and Jarana Shakti (50.0%).
Highly significant result was obtained with Vyayama shakti (52.46%).
Overall effect of therapy:
After therapy administration, twenty four patients (80%) were marked improvement, six patients
(20%) were moderate improvement, and no any patient was unchanged or complete remission.
The Vasti karma was found to be definitely effective in the cases of Grahani. The effect of Vasti
karma obtained probably due to Vatanulomana property and balancing effect on equilibrium of
Tridosha and more probably due to Vasti ingredients having Deepana, Pachana, Grahi and
Snehan effects. The overall activity may be improving the function of digestion and absorption
174
of food with correcting the peristaltic movement of intestine. The disease becomes more difficult
to cure in chronic form as described in classic.
CONCLUSION
It can be concluded from the study that Vidangadi Taila and Dhanyapanchak Kwatha Vasti
found very effective in the management of Grahani Roga. No patient reported any adverse effect
of the treatment. The complete course of the treatment has improved the feeling of wellbeing and
health status of the patients.
175
Appendix
“The mystery of life is not a problem to be solved

but a reality to be experienced.”
(Art Van Der Leeuw)
176
Conceptual Study
1 ऄग्नतयिधष्ठानमन्नस्य ग्रहणाद् ग्रहणी मता ।
नाभेरुियधििबलेनोिष्टब्धोबृंिहता ॥
ऄिक्व धारयत्यन्नं िक्वं सृजित िार्श्धतः।
दुबधलाििबला दुष्टा त्वाममेव िवमुञ्चित ॥ (Ch.Chi.15/56-57)
2 षष्ठी िित्तधरा नाम या िला िररिीर्ततता ।

िक्वामाशयमध्यस्था ग्रहणी सा प्रिीर्ततता ॥ (Su.U.40/169)
3 षष्ठी िित्तधरा नाम िक्वामाशयमध्यस्था..................ततो। (A.S.Sha.5/52)
4 तदिधष्ठानमन्नस्य ग्रहणाद् ग्रहणी मता ।

सैव धतवततररमते िला िित्तधराह्वया ॥ (A.H.Sha.3/50)
……………भुक्तमागाधगधलैव सा । (A.H.Sha.3/51)
5 ग्रहण्या बलमििर्तह स चािि ग्रहणी िितः ।

तस्मात् सतदूिषते वह्नौ ग्रहणी सम्प्प्रदुष्यित ॥ (Su.U.40/170)
6 ऄन्नमादानिमाध तु प्राणः िोष्ठं प्रिषधित ।

तद्दवैर्तभन्नसतघातं स्नेहन
े मृदत
ु ां गतम् ॥ (Ch.Chi.15/6)
7 िरं तु िच्छयमानस्य िवदग्नधस्याम्प्लभावतः ।

अशयच्च्यवमानस्य िित्तमच्छछमुदीयधते ॥ (Ch.Chi.15/10)
8 नाभेरुियधििबलेनोिष्टब्धोिबृंिहता । (Ch.Chi.15/56)
9 ग्रहण्या बलमििर्तह स चािि ग्रहणीबलः ।

दूिषतेऽिावतो दुष्टा ग्रहणी रोगिाररणी ॥ (A.H.Sha.3/53)
10 षष्ठी िित्तधरा नाम िक्वामाशयमध्यस्था | (A.S.Sha.5/36)
177
11 …………. तत्रिक्वामाशयमध्यगम् ।
िञ्चभुतात्मित्वेऽिि यत्तैजसगुणोदयात् ॥
त्यक्तद्र्वत्वं िािाकदिमधणाऽनलशब्दतम् ।
िचत्यन्नं िवभजते सारकिट्टौ िृथि् तथा ॥ (A.H.Su.12/10-11)
12 तदिधष्ठानमन्नस्य ग्रहणाद् ग्रहणी मता ।सैव धतवततररमते िला िित्तधराह्वया ॥

अयुरारोग्नयवीयोजोभूतधात्वािििुष्टये। िस्थता िक्वाशयद्वारर भुक्तमागाधगधलैव सा
(A.H.Sha.3/51)
13 भुक्तमामाशये रुद्धध्वा सा िविाच्छय नयत्यधः।

बलवत्यबला त्वान्नामामेव िवमुञ्चित॥ (A.H.Sha.3/52)
14 ……………..यस्त्वामाशयसंिस्थतः ।
क्लेदिः सोऽन्नसंघातक्लेदनात् …………………. (A.H.Su.12/16)
15 यदामाशयिक्वाशयमध्यस्थं िञ्चभुतात्मित्वेऽिि तेजोगुणोदयात् क्षिितसोमगुणं ततश्च व्यक्तद्रवस्वभाव

सहिाररिारणैवाधयुक्लेदाकदिभरनुग्रहाद्दहनिाचनाकदकियया लब्धाििशब्दं िित्तमन्नं िचित सारकिट्टौ
िवभजित शेषािण च िित्तस्थानािन तत्रस्थमेवानुगृहणाित तत् िाचििमत्युच्छयते ।
(A.S.Su.20/5)
16 समानो-ऄििसमीिस्थः िोष्ठे चरित सवधतः ।

ऄन्नं ग्रहणाित िचित िववेचयित मुञ्चित ॥ (A.H.Su. 12/8)
17 त्यक्तद्रवत्वं िािाकदिमधणाऽनलशिब्दतम् ।
िचत्यन्नं िवभजते सारकिट्टौ िृथि् तथा ॥ (A.H.Su.12/11)
18 समानेनावधूतोऽििरुदयधः िवनोदृहः ।
िाले भुक्तं समं सम्प्यि् िचत्यायुर्तववृद्धये ॥ (Ch.Chi.15/7)
19 ऄन्नस्य भुक्तमात्रस्य षड्सस्य प्रिाितः ।

मधुराद्दात् िफोभावात् फे नभूतं ईदीयधते ॥ (Ch.Chi.15/9)
20 िरं तु िच्छयमानस्य िवदग्नधस्याम्प्लभावतः ।

अशयच्च्यवमानस्य िित्तमच्छछमुदीयधते ॥ (Ch.Chi.15/10)
21 जाठरे णाििना योगा|दुदिे त रसाततरम् ।

रसानां िररणामातते स िविाि आित स्मृतः ॥ (A.H.Su.9/20)
22 रसो िनिाते द्रव्याणां, िविािः िमधिनष्ठया ।

वीयां यावदधीवासािन्निातािोिलभ्यते ॥ (Ch.Su.26/66)
178
Disease Review
1 िवषमो धातुवैषम्प्यं िरोित िवषमं िचन् ।
तीक्ष्णो मतदेतधनोधातून् िवशोषयित िाविः॥
युक्तं भुक्तवतो युक्तो धातुसाम्प्यं समं िचन् ।
दुबधलो िवदहत्यन्नं त|kत्यूध्वधमधोऽिि वा ॥ (Ch.Chi.15/51-52)
2 ऄितसारे िनवृत्तेऽिि मतदािेरिहतािशनः ।

भूयः सतदूिषतो विह्नग्रधहणीमिभदूषयेत् ॥ (Su.U.40/167)
3 ऄिक्व धारयत्यन्नं िक्वं सृजित िार्श्धतः।

दुबधलाििबला दुष्टा त्वाममेव िवमुञ्चित ॥ (Ch.Chi.15/57)
4 त्र्यो िविाराः प्रायेण ये िरस्िर हेतवः ।

ऄशाांिस चाितसारश्च ग्रहणीदोष एव च ॥
एषामििबले हीने वृिद्धवृद्धे िररक्ष्यः ।
यस्मादििबलं रक्ष्यमेषु ित्रषु िवशेषतः ॥ (Ch.Chi.14/244-245)
5 ऄभोजनादजीणाधितभोजनािद्वषमाशनात् । ऄसात्म्प्यगुरुशीताितरुक्ष्सतदुष््भोजनात् ॥ ४२
िवरे ि वमन स्नेह िवभ्रमाव्द्यािधिषधणात्।देशिलातुधवैषम्प्याद्वेगानां च िवधारणात् ॥ ४३
(Ch.Chi.15/42-43)
6 ऄत्याम्प्बुिानािद्वषमाशना}k सतधरणात् स्वप्निवियधयाि ।

िालेऽिि सात्म्प्यं लघु चािि भुक्तमन्नं न िािं भजते नरस्य ।।
इष्याधभयिोधिररक्षतेन् लुब्धेनरुग्नदैतयिनिीिडतेन् ॥
प्र}s"k;qक्ते न च सेव्यमानमन्नं न सम्प्यि् िररणाममेित॥ (Su.Su.46/507-508)
7 िूवधरुिं तु तस्येदं तृष्णाऽऽलस्यं बलक्षयः ।
िवदाहोऽन्नस्य िािश्च िचरात् िायस्य गौरवम् ॥ (Ch.Chi15/55)
8 तस्योत्ित्तौ िवदाहोऽन्ने सदनालस्यतृटक्लमाः ।

बलक्षयोऽरुिचः िासः िणधक्ष्वडोऽतत्रिू जनम् ॥ (Su.U.40/173)
9 प्राग्रूिं तस्य सदनं िचरात्िचनमम्प्लिं ॥

प्रसेिो वक्त्रवैरस्यमरुिचस्तृट् क्लमोभ्रमः ।
अनद्धोदरता छर्दः िणधक्ष्वडोऽतत्रिू जनम् ॥ (A.H.Ni.8/19-20)
10 ऄितसृष्टं िवब¼a वा द्रवं तदुिकदश्यते । तृष्णारोचिवैरस्यप्रसेितमिाितवतः ॥

शूनिादिरःसािस्थिवधरुि् छदधनं ज्वरः।लोहामगितधिस्तक्ताम्प्ल ईद्गारश्चास्य जायते॥
(Ch.Chi15/53-54)
11 ऄथ जाते भवेज्जततुः शूनिादिरः िृ शः।
िवधरुग्नलौल्यतृ्छर्दज्वरारोचिदाहवान् ॥
ईfåरे च्छछु क्तितक्ताम्प्ललोहधूमागितधिम् ।
179
प्रसेिमुखवैरस्यतमिारुिचिीिडतः ॥ (Su.U.40/174-175)
12 सामातयं लक्षणं िाश्यां धूमिस्तमिो ज्वरः ।

मूच्छछाध िशरोरुिग्नवष्टम्प्भः र्श्यथुः िरिादयोः ॥ (A.H.Ni.8/21)
13 िटुितक्तिषाय……………………… िुनः िुनः सृजेत् वचधः िासर्श्ासार्दतोऽिनलात् |

(Ch.Chi15/59-62)
14 वाताच्छछू लािधिै ः…………………………….ित्रभ्याििलक्षणैः। (Su.U.40/176)
15 तत्रािनलात्तालुशोषिस्तिमरं …………………. िायुरुक्र्श्ासिासवान्।

(A.H.Ni.8/22-28)
16 ि्वजीणध िवदाह्यम्प्लक्षाराद्धैः……………… िूत्यम्प्लोद्गाहृत्िण्ठदाहरुिचतृऽर्दतः॥
(Ch.Chi.15/53-65)
17 िित्तेन् नीलिीताभं ………………………… िूत्यम्प्लोद्गाहृत्िण्ठदाहरुिचतृऽर्दतः ॥
(A.H.Ni.8/25)
18 तस्यान्नम िच्छयते दुःखं ……………………… दौबधल्यमालस्यं च िफात्मिे ॥
(Ch.Chi.15/68-70)
19 श्लेष्मणा िच्छयते दुःखमन्नं …………………….ऄिृ शस्याििदौबधल्यं ॥
(A.H.Ni.8/26-28)
20 दुष्यत्याििः, स दुष्टोऽन्नं न तत् िचित लघ्विि ।
ऄिच्छयमानं शुक्तत्वं यात्यन्नं िवषरुिताम् ॥ (Ch.Chi.15/44)
21 दुष्यित ग्रहणी जततोरििसादनहेतुिभः ॥ (Su.U.40/166)
22 ग्रहणीमािितं दोषं िवदग्नधाहारमूर्तच्छछतम् ।

सिवष्टम्प्भप्रसेिार्ततिवदाहारुिचगौरवैः ॥ (Ch.Chi.15/73)
23 गुवाधितिस्नग्नधशीताकदभोजनाितभोजनात् ।
भुक्तमात्रस्य च स्वप्नाद्धतत्यग्नि िु िितः िफः ॥ (Ch.Chi.15/67)
24 लीनं िक्वाशयस्थं वाऽप्यामं स्राव्यं सदीिनैः ।

शरीरानुगते सामे रसे y†निाचनम् ॥ (Ch.Ch.i15/75)
25 ग्रहणीमािितं दोषमजीणधवदुिचारे त् ।
ऄितसारोक्तिविधना तस्यामं िविाचयेत् ॥ (A.H.Chi.10/1)
26 अमदोषजानां िुनर्तविाराणामितिधणेनैवोिशमो भवित ।

तत्तु ित्रिवधम् – लंघन लंघनिाचनमवसेचनं च ॥
तत्र लंघनमल्िदोषाणाम् ……..।
लंघनिाचनाभ्यां मध्यदोषो ………….।
बहुदोषाणां िुनदोषावसेचनमेव िायधम् । (A.H.Su.11/43-46)
180
27 स्नेह्नं स्वेदनं शुिद्धलंघनं …………ग्रहणीरोिगिभः सेव्याः। (Ch.Chi15/196)
28 ग्रहणी दोषाणां तिं दीिनग्रािहलाघवात् ।

िथ्यं, मधुरिाकित्वान च िित्त प्रदूषणम् ॥
िषायोष्णिविािसत्वाद्रूक्ष्त्वाि िफे िहतम् ।
वाते स्वk}म्प्लसातद्रत्वात्स|Lिमिवदािह तत् ॥ (A.H.Chi.10/4-5)
29 तिं तु ग्रहणीदोषे …………………….. तिप्रयोगा ये जठराणां तथाऽशधसाम् ॥

(Ch.Chi 15/117-119)
30 n|kत्साितिवषा िेयमामे साम्प्लां सनागराम् ।
िानाऽतीसारिविहतं वारर तिं सुराकद च ।। (A.H.Chi.10/3)
Vasti Review
1 नािभप्रदेशं िरटिार्श्धिुग्नक्ष गत्वा शिृ द्दोषचयं िवलोड्य ।

सस्नेह्य िायं सिुरीष्दोषः सम्प्यि॒ सुखेनैित च यः स विस्त ॥
(Ch.Sid. 1/40-41)
2 बिस्तना दीयते बिस्त वा िूवधमतवेत्यतो बिस्त । (A.S.Su. 28/2)
3 ग्नत्रषतमताः िमधनु वस्तयो ………………………………… िञ्चैव िराकदमध्याः।

(Ch.Sid.1/47-48)
4 िक्वाश्याद्बिस्तवीयां खैदह
े मनुसिधित। वृक्षमूले िनिषक्तानामिां वीयधिमव द्रुमe~ ।।
(Su.Chi.35/25)
5 अिादतलमूधधस्थान दोषान् िक्वाशये िस्थतः।

वीयेण विस्तरादत्ते खस्योऽिो भूरसािनव ॥ (Ch.Sid.7/64)
6 बिस्तवधयःस्थािियतासुखायुबधलाििमेधास्वरवणधिृि
…………………… सवाधन् िविारान् शमयेिन्नरुहः ।। (Ch.Sid.1/27-28)
7 य एवानास्थाप्यास्त ……………….. प्रधानतमिमत्युक्तं मूले द्रुमप्रसेिवत् ।

(Ch.Sid.2/19)
8 य एवानास्थाप्यास्त …………………………… िश्लिदगलगण्डाििचकििमिोिष्ठिनः ॥

(Ch.Sid.2/17)
9 यस्येह यामाननुवतधते त्रीन् स्नेहो नरः स्यात् स िवशु¼nsहः ॥

(Ch.Sid.1/46)
10 शेषास्त्वास्थाप्याः,िवशेषस्तु सवाधÄõSिाÄõिु िक्ष …………………. वनस्िितमूलच्छछेदवत्॥

(Ch.Sid.2/16)
181
11 ऄनास्थाप्यास्तु- ऄजीण्यधितिस्नग्नध ………………………. तस्मादते नास्थाप्याः ॥

(Ch.Sid.2/14-15)
12 तत्र ग्नवशितमात्रािण ………………..यथायोग्नय च शेषािण िल्ियेत् ।

(A.S.Su.28/36)
13 मािक्षिं लवणं स्नेहं िल्िं क्वाथिमित क्र्मात्। अविेत िनरुहणामेष संयोजनेिविधः॥

(A.S.Su.28/42) (A.H.Su.19/45)
14 प्रसृिष््वतमूत्रसमीर.kRoa …………………………………..तत् स्यात् सुिनरुिललÄõe~ ॥

(Ch.Sid.1/41)
15 स्याद्रुd~fNरोह्र्दद्धगुदविस्तिलÄõs ………………. न सम्प्यि् च िनरुिहते स्युः॥

(Ch.Sid.1/42)
16 िलÄõa यदेवाितिवरे िचतस्य भवेत्तदेवाितिनरुिहतस्य ॥ (Ch.Sid.1/43)
17 नाितयोगौ क्लमाध्माने ……………………………………. िचकित्सां च िनबोधते ॥

(Ch.Sid.7/6)
18 वीयेण बिस्तरादत्ते दोषानािादमस्तिान्। िक्वाशयस्थोऽम्प्बरगो भूमेरिो रसािनव॥

(Su.Chi.35/27)
Drug Review
1 िवडङगैरण्डरजनीिटोलित्रफलामृता । जाितप्रवालिनगुधण्डीदशमूलाखुिर्तणिाः ॥
िनम्प्बिाठासहचरश्म्प्िाििरवीरिाः। एषां क्वथेन िविचेत्तैलमेिभश्च ििल्ितैः ॥
फलिबल्वित्रवृत्िृ ष्णारास्नाभुिनम्प्बदारुिभः ।सप्तिणधवचोशीरदावीिु ष्ठििलङ्गिै ः ॥
लतागौरीशताह्वाििशटीचोरििौष्िरै ः। तत िु ष्ठािन किमीन मेहानशाांिस ग्रहणीगदम्॥
क्लीवतां िवष्मािित्वं मलं दोषत्रयं तथा प्रयुक्तं प्रणुदत्याशु िानाभ्यङ्गानुवासनैः॥
(Ch.Sid. 4/18-22)
2 धातयिं नागरं मुस्तं बालिं िबल्वमेव च ।

अमशूलिवबतधघ्नं िाचनं विह्नदीिनम् ॥ (Chakradutta Chi 3/21)
3 िषायानुरसं स्वादु सुक्ष्ममुष्णं व्यवािय च ।

िित्तलं बद्धिवण्मूत्रं न च श्लेष्मािभवधधनम् ॥
वातघ्नेषूत्तमं बल्यं त्वच्छयं मेधाििवधधनम् ।
तैल संयोगसंस्िारात् सवधरोगािहं मतम् ॥ (Ch.Su.27/286-287)
4 िवष्यितद लवणं सवां सुक्ष्मं सृष्टमलं मृद ु ।
182
वातघ्नं िाकि तीक्ष्णोष्णं रोचनं िफिित्तनुत् ॥ (A.H.Su.6/143)
5 सवेषु तु मधुसैतधवं िफिवलयनच्छछेदाथां …………………… (Ch.K.1/15)
6 मधु तु मधुरं िषायानुरसं ………………… वातिित्तघ्नम्॥ (Su.U.45/132)
7 वातलं गुरु शीतं च रक्तिित्तिफािहम् । (Ch.Su.27/245)
8 नानाद्रव्यात्मित्वाि योगवािह िरं मधु । (Ch.Su.27/249)
9 ऄत्यासनस्थानवचांिस यानं स्वप्नं कदवा मैथुतवेगरोधान् ॥

शीतोिचारातिशोिरोषांस्त्यजेदिालािहतभोजनं च । (Ch.Sid.1/54-55)
10 िित्तश्लेष्मािनलािवष्टं क्षीरयूषरसैः िमात् । (Su.Chi.38/12)
11 ित्रभागहीनमधां वा हीनमात्रमथािि वा ।
यथाििदोषं मात्रेयं भोजनस्य िवधीयते ॥ (Su.Chi.38/13)
12 िविारा ये िनरुढस्य भवितत प्रचलैमधलैः ।
ते सुखोष्णाम्प्बुिसक्तस्य याितत भुक्तवतः शमम् ॥ (A.H.Su.19/51)
13 धातयनागरिसद्धं िह तोयं द|kf}चक्षणः ।

व्युिषताय िनशां िल्यमुष्णं वा िे वलं जलम् ॥
स्नेहजीणां जरयित श्लेष्माणां तििनित्त च।
मारुतस्यानुलोम्प्यं च िु याधदष्ु णोदिं नृणाम् ।। (Ch.Sid. 4/43-44)
183
CASE PROFORMA
DEPARTMENT OF PANCHKARMA
RISHIKUL STATE AYURVEDIC (P.G.) COLLEGE & HOSPITAL, HARIDWAR
“A CLINICAL STUDY TO EVALUATE THE EFFICACY OF VASTI

KARMA IN MANAGEMENT OF GRAHANI ROGA”
Scholar: Suneeta Singh Co-guide: Dr.Ashok Kumar Sharma
Guide: Prof. Dr. Uttam Kumar Sharma
IDENTIFICATION OF THE PATIENT
Name of Patient : Age & Sex :

Father’s Name: Religion:
Occupation:
Economical status: High/ High medium/Medium/Low
Education: Illiterate/Literate - Primary school /High school/GD/PG/Ph.D
Address:
Desha: Jangle/Anoop/Sadharana Marital Status: M/UM/W/D
184
OPD No.: IPD No.:
Date of Admission: Date of Discharge:
1. Chief complaints with duration Duration
Muhubaddha / Muhudrava Mal pravriti
Arochaka (Anorexia)
Trishna (Thirst)
Praseka (Salivation)
Shoonpaadkaraha (Swelling of limbs)
Asthiparvaruk (Pain in bone & joints)
Chhardan (Nausea/Vomiting)
Udara Shool(Abdominal pain or Discomfort)
Shleshma malapravriti
Atopa (Gas / Flatulence)
Alasya
Jwar (Hyperthermia)
Lohaamagandhi-tiktaamla Udgaar
2. History of present illness:

Time of Onset– Childhood/ Adult
Duration of disease ……………………………………………………………
Factors aggravating the disease / Chief complaints :
Drug Diet climate change Occupational
Treatment given so for : Ayurvedic medicne Modern medicine Mixed
185
3. History of past illness : Yes/ No

4. Family history: Present/Absent
5. Personal history:
5.1 Dietetics:
a) Appetite: Excessive Less Normal
b) Diet: i) Nature: veg. Mixed
ii) Pattern : Regular Irregular
Dietary Habit: Vishamasana/ Adhyasana/ viruddhasana/ Samsana
c)Supplementary: Tea Coffee Milk Cold drink
5.2 Addiction: Tobacco/ Alcohol/ Cigarette/ Bidi/ Drugs
5.3 Physical exercise: Regular/Irregular/No exercise
5.4 Occupation History:
a) Physical / Mental
b) Day / Night /Shifting c) Hours of work …………/ day
5.5 Sleep: Proper/Less/Excess/Disturb ……… hrs/day ……… hrs/night
5.6 Bowel :
Nature: Muhurbaddha/Muhurdrava Mala/ Durgandhita/ Shleshmala
Colour: Avishesh/ Vishesh
Habit: Regular/ Irregular
Frequency……………. Times/day
5.7 Micturation:
Colour: Avishesh/ Vishesh
186
Frequency……………. Times/day…………… Times/night
5.8 Psychological condition
Anxiety/ Stress/ Depression / Normal
5.9 Menstrual history: Regular/Irregular
5.10 Obstetric history:
6. Physical Examination
o Pulse ……………. ○Resp. rate………/min.
o B.P.…….............. mm of Hg ○Temperature ……...
o Height (in cm.) ○ Weight (in Kg.)
o Tounge ○Vertebral Column
o Pallor ○ Joints
o Jaundice ○ Oedema
o Lymphadenopathy ○ Skin, Hair,Nails
o Clubbing
7. Systemic Examination
7.1 Digestive System:
7.2 Respiratory System
7.3 CVS
7.4 CNS
8. Asthavidha Pariksha (Eightfold examination)

8.1 Nadi -
8.2 Mutra Pravrutti -
8.3 Mala Pravrutti -
8.4 Jihva – Sama/Nirama/any other symptoms
8.5 Sabda -
187
8.6 Sparsha – Sheeta/Ushna, Snigdha/Ruksha

8.7 Drikka –
8.8 Akruti –
9. Dashavidha Pariksha (Tenfold examination)

9.1 Prakuti
Dosha- V/P/K/VP/PK/KV/VPK
Manas – S/R/T/SR/RT/TS.
9.2 Vikruti
Dosha………………… Dushya …………………. Kala…………………….
9.3 Sara: Pravara/Madhya/Avara
9.4 Samhanan: Pravara/Madhya/Avara
9.5 Pramana: Sama / Vishama
9.6 Satva: Pravara/Madhya/Avara
9.7 Satmya: Pravara/Madhya/Avara Agnibala BT AT
9.8 Ahar Shakti: Abhayaharana Shakti
Abhayaharana Shakti: P/M/A Jarana Shakti
Jarana Shakti: P/M/A Vyayama Shakti
9.9 Vyayama Shakti: P/M/A Agni
9.10Agni: Samagni/Mandagni/Tikshani/Vishamagni
Nidaana Pariksha-
Aaharaj-Atisevana of Katu, Vidahi, Snigdha, Amla, Guru,Sheet, Ruksha,-aahara,
188
Vishamasana, Adhyashana
Viharaj- Vega vidharana, Diva Svapa, Ratri jagarana, Ati Vyayama,
Manasika- Krodha, Shoka, Chinta, Bhaya
Srotas Pariksha:
a) Rasavaha Srotas: Aruchi/ Agni mandhya/ Klama /Angamarda /Hrillasa/ Trishna /
Aalasya / Shrama / Asyavairasya / Hritshoola/ Angasada / Jrimbha/ Hritdrava / Nidra

/Utklesh
b) Annavaha Srotas: Arochaka / Avipaaka/ Aadhmaana/ Udara Shoola Sthivana/
Madhura Udgara / Hrit Kantha daaha/ Amla- Katu-Udgara / Kantha-asya shosha
f) Purishavaha Srotas: Muhu Baddha/ Drava Mal privriti/ Kukshishoola/ Aatopa/
Adhovata Ati Pravritti / Gaurava/ Sasabda malapravriti/ Adhovata Sanga/ Atisaara
g) Others.
For Assessment of Grahani roga according to prominent dosha :
S.No. Vaatik Paittik Kaphaj
1. Kharangata Pita mala Hrillas
2. Kantthasyashopha Saryate dravam mala Aasyopdeh madhurya
3. Karshya Amlo-udgaar Stthivam
189
4. Daurbalya Hrit-kantha daha Udarstimitam
5. Chiraad dukham,fenwat mala Akrishasyapi daurbalyam
6. Punah-2 srujet varchah Alasya
16. Progress chart:
S.No. Sign & Symptoms BT AT
1. Muhubaddha / Muhudrava Mal

pravriti
2. Arochaka
3. Trishna
4. Praseka
5. Shoonpaadkaraha
6. Asthiparvaruk
7. Chhardan
8. Udara Shool
9. Shleshma malapravriti
10. Atopa
11. Alasya
12. Jwar
13. Lohaamagandhi-tiktaamla Udgaar
Investigation:
190
 Routine investigation:
S.NO. INVESTIGATION BT AT
1. Hb%
2. TLC(/cmm)
3. DLC(%)
4. ESR (mm1sthr)
5. Urine<R&M
6. Stool<R&M
10. Diognosis.......................................................................................
10. Medical Management ………………………………………………..
11. Prognosis………………………………………………………………
12.Result ……………………………………………………………………
Signature of Guide Signature of Co-Guides
191
Patient’s Consent Form
I …………………………………………………………………………….exercising my free
power of choice, here give my consent to be included as a patient in the clinical study namely:-
“A CLINICAL STUDY TO EVALUATE THE EFFICACY OF VASTI KARMA IN

MANAGEMENT OF GRAHANI ROGA”
I have informed to my satisfaction by the attending research scholar for the purpose of
clinical trial and the nature of treatment and follow up including the laboratory investigations to
monitor and safe guard my body functions.
I have been given the opportunity to question Dr. Suneeta Singh of study and have
understood the advice and information given as a result. I understand that the in-charge of this
study may stop the study or stop my participation in the study at any time for any reason without
any consent. I am also aware of my right to leave the trial at any time during the course of trial
without having to give reasons for doing so.
I hereby give permission to the research scholar of the study to release information
regarding or obtained as a result of my participation in this study to government, semi-
government, private agencies and to allow them to inspect all my medical records.
Signature of Patient Date
192
Bibliography
“A book must be an ice-axe to break the seas frozen

inside our soul.”
(Franz Kafka)
193
BIBLIOGRAPHY
 Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya, Ed. A.M. Kunte,

Chaukhamba, (1982).
 Astanga Hridaya: Ed. A.M. Kunte, Chaukhamba, Varanasi, (1982).
 Astanga Samgraha: With Indu commentary, Ed. A.D. Athavle, Pune, (1980)
 Apate V.S.: Sanskrit English Disctionary, Motilal Banarasidas, Delhi.
 A.P. I. Text Book of Medicine: Fifteenthh edition.
 Amarkosha: By Amarsinh with commentary by Bhatoji Dixit, Ed. By Pandit
Satyambhama Panduranga, Nirnaya Sagar Press, Bombay (1944).
 Ayurveda Ka Vaijnanika Itihas: P.V. Sharma, Chaukhamba, Varanasi.
 Ayurvediya Pancakarma Vijnana: Vd. H.S. Kasture, (1993), Baidyanath Ayurveda
Bhavana Ltd., Nagpur.
 Ayurvediya Panchkarma Chikitsa –Mukundilala Dwivedi, Chaykhambha Sanskrit
Pratisthana,Delhi.
 Ayurvediya Rasa Sastra: Dr. Candrabhushana Jha, Chaukhamba Surbharati Prakashana,
Varanasi second edition, 1998.
 Ayurvediya Rasa Sastra: Dr. S.N. Mishra – Chaukhamba Orientalia, Varanasi, second
edition, 1990.
 Bhaisajya Ratnavali: With commentary by Shri Ambikadatta Shastri, Chaukhambha
(1984).
 Bhava Prakasa: With Hindi commentary by Bramhashankara Shastri, Chaukhamba,
Varanasi (1984).
 Bhela Samhita: Ed. V.S. Venkatsubramhanym Shastri and C. Raja Rajeshvara,
C.C.R.I.M.H., New Delhi (1977).
 B.K. Mahajana: Methods in Biostatistics, 6th ed. (1997).
 Charaka Samhita- Acharya Agnivesa. Comm by Kashinath Shastri and Gorakhnath
Chaturvedi. Chaukhambha Bharati Prakashan, Varanasi.
 Charaka Samhita, Comm. Chakrapanidatta Ed. R.K. Sharma, Bhagawandash,
Chowkhamba Sanskrita Series, Varanasi, 2001.
 Chakrapani – Chakradatta with Bhavarth Sandipani Comm. IV Edi. by Shashtri
Bramhshnakr, Chaukhambha, 1976, Varanasi.
 Cakradatta: By Cakrapani with Hindi commentary by J.P. Tripathi, Chukhamba,
Varanasi (1976).
 Chopra R.N.: Glossary of Indian Medicinal Plants (1958).
 Dalhana: Nibandha Samgraha Commentary on Susruta Samhita, Ed. Yadavaji Trikamji
Acharya, Chaukhamba, Varanasi (1980).
194
 Gangadhara: Jalpakalpatara commentary on Caraka Samhita Ed. Narendranath

Sengupta and Balai Chandra Sengupta, C.K. Sen. Company, Calcutta.
 Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut.
2007 Dec;56
 Gray’s Anatomy: Thirty fifth edition – 1973.
 Hemadri: Ayurveda Rasayana commentary on Astanga Hrdaya, Ed. A.M. Kunte, Pune
(1982).
 Hanauer, Stephen B.; William Sandborn (2001-03-01). American Journal of
Gastroenterology 96 (3): 635–43.
 Kirtikar K.R., Basu B.D.: Indian Medicinal Plants (1981).
 Madhava Nidana: Ed. Y.N. Upadhyaya, Chaukhamba, Varanasi (1985).
 The Merck Manual. Irritable Bowel Syndrome (IBS). Accessed August 16, 2012
 Marks DJ, Segal AW. (January 2008). "Innate immunity in inflammatory bowel disease:
a disease hypothesis". J Pathol.
 Micheal Swash: Huchison‘s Clinical methods, ELBS publication, 19th Ed. (1992).
 Moneir Williams: Samskrta English Dictionary, Motilal Banarasidas, Delhi.
 Mahadeva, U; Martin, JP; Patel, NK; Price, AB (July 2002). "Granulomatous
ulcerative colitis: a re-appraisal of the mucosal granuloma in the distinction of Crohn's
disease from ulcerative colitis". Histopathology
 Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, Koussoulas V, Barbatzas C,
Pimentel M (2012). "The Prevalence of Overgrowth by Aerobic Bacteria in the Small
Intestine by Small Bowel Culture: Relationship with Irritable Bowel Syndrome". Dig.
Dis. Sci. 57 (5): 1321–29.
 Pancakarma and Ayurvedic Massage: Prof. Dr. Avinash Lele – Published
byInternational Academy of Ayurveda – 1999.
 Prayogic Pancakarma Vijnana: Dr. P. Yadayya – Jaya Prakashana, Akola, 2000.
 Practice Clinical. Irritable bowel syndrome. Mayer EA. N Engl J Med. 2008 Apr
 Principals of Anatomy and Physiology: Gerand J. Tortora, Nicholas P. nagnostokas,
4th ed., 1984.
 Sabdakalpadruma: By Raja Radhakanta Dave, Chaukhamba, Varanasi (1967).
 Sharma P.V.: Dravya Guna Vigyan, 10th Ed. Chaukhamba, Varanasi.
 Sharma P.V.: Caraka Samhita Text with English translation, editor and translator Prof.
P.V. Sharma, Jaykrushna Ayurveda Granthmala (1997).
 Sushruta Samhita – Sushruta Samhita translated by Ambika Datt Sashtri, Chaukhambha
Orientallia Publication, Varanasi.
 Susruta Samhita: By Susrutacarya with commentary by Dalhana and Gayadasa Ed.Y.T.
Acarya, Choukhamba, Varanasi.
 Sarangadhara Samhita: With Dipika and Gudhartha Dipika commentary edited by
Prashuram Shastri, Vidya Sagar, Krishnadas Acadamy Varanasi (1985).
195
 Stark D, van Hal S, Marriott D, Ellis J, Harkness J (January 2007). "Irritable bowel
syndrome: a review on the role of intestinal protozoa and the importance of their
detection and diagnosis".
 "Tropical sprue: some early investigators favoured an infective cause, but was a
coccidian protozoan involved?". Gut 40 (3): 428–9. Cook GC (March 1997).
 Vacaspatyam: Complied by Taranath Tarka Vachaspati, Chaukhamba, Varanasi (1962).
 Vijaya Raksita: Madhukosa commentary on Madhava Nidana, Ed. Y.T. Acharya,
Chaukhamba Varanasi, 1984.
 Wolfe MS "Giardiasis". JAMA 233 (13): 1362–5.
 Yogaratnakara: Chaukhamba, Varanasi.
196

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ISSN 2320-5407 International Journal of Advanced Research (2016)

Journal homepage: http://www.journalijar.com INTERNATIONAL JOURNAL

“A Clinical Study to Evaluate the Efficacy of Vasti karma in

M.D. (Ay.) PANCHAKARMA

DR. SUNEETA SINGH

Dr. Ashok Kumar Sharma Dr. Uttam Kumar Sharma

P.G. Department of Panchakarma, Rishikul Govt. Post Graduate Ayurvedic

Enrollment No. G 11772555 August 2013

A. H. Ni. - Astanga Hridaya Nidanasthana

A. H. Su. - Astanga Hridaya Sutrasthana

A. H. U. - Astanga Hridaya Uttartantra

A. Sm. - Astanga Samgraha

A. Sm. Su. - Astanga Samgraha Sutrasthana

A. Sm. U. - Astanga Samgraha Uttartantra

Bh. Pr. - Bhava Prakasha

Ch. Chi. - Charaka Samhita Chikitsasthana

Ch. Sha. - Charaka Samhita Sharirasthana

Ch. Sid. - Charaka Samhita Siddhisthana

Ch. Su. - Charaka Samhita Sutrasthana

Ch. Vi. - Charaka Samhita Vimanasthana

Ha. Sm. - Harita Samhita

Su. Kal. - Sushruta Samhita Kalpasthana

Su. Sha. - Sushruta Samhita Sharirasthana

Su. Su. - Sushruta Samhita Sutrasthana

Su. U. - Sushruta Samhita Uttaratantra

Nobody can go back and start a new beginning, but anyone

तस्माििकित्साधधिमित ब्रुवितत सवाां िचकित्सामिि विस्तमिे (Ch.sidh.1/39).

The previous works done on Vasti Chikitsa in Grahani Raga:

3. A Clinical evaluation of Abhayadi choorna with Sanshodhana karma (Sneh-Vasti) in cases

Vasti. Patil Rajendra 2003

AIM AND OBJECTIVES:

 To evaluate the effect of Vasti karma in management of Grahani Roga.

MATERIALS AND METHOD-

Day 9 to 24 - Parihaar kaal

1. The first part – (Conceptual study)-:

(1) Anatomical and Physiological review of Grahani

“The worth of a book is to be measured by what you

ANATOMICAL & PHYSIOLOGICAL ASPECT OF GRAHANI

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functions of Grahani mentioned by Acharya Charaka, Chakrapani refers it as Grahanat iti

In Vaidyaka Shabdasindhu, Grahani is defined as Agnivaha Dhamanis.

In Madhukosha, the organ Grahani is defined as Agnyadhisthana Nadi.

In Sharangdhara Purva Khanda, the organ Grahani is defined as Pittadharakala or

ANATOMICAL ASPECT OF GRAHANI:

Grahani is an important organ situated in the Mahasrotas (i.e. alimentary canal or

The views are summarized as follows:

2. Whole of small intestine with its mucous membrane

3. Extending from pylorus to ileocaecal junction, including two sphincters.

2. Small Intestine with Mucous Membrane as Grahani:

3. Grahani as Pylorus to Ileocaecal Junction:

PHYSIOLOGICAL ASPECT OF GRAHANI:

 Bhinna-sanghata of food is by Kledaka Kapha.

IMPORTANT FACTS ABOUT GRAHANI:

Main Functions of Grahani

(a) As a system of glands which provides necessary digestive enzymes

(b) As a surface on which various kinds of digestive reaction takes place

MAIN FUNCTIONS OF GRAHANI:

DOSHAS CONFINED TO ORAGAN - GRAHANI:

(II) Amlavastha Paka: