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Padma Priya N et.al., Role of Picchavasthi in the management of Grahani w.s.r Irritable Bowel Syndrome

Role of Picchavasthi in the Management of Grahani w.s.r Irritable Bowel Syndrome

Case Report

Padma Priya1*, Praveen Kumar Madikonda2, Johar B3

1. PG Scholar, 2. Associate Professor, 3. H.O.D,

P.G Department of Panchakarma, Dr. B.R.K.R.Govt. Ayurvedic Medical College, Hyderabad, Telangana State

Abstract
‘Grahani’ is chronic disease of A nnavaha srotas related to A gni. Ayurveda considers it as a Tridoshaja
vyadhi, which occurs due to the depletion of jataragni by samana Vayu, pachaka pitta and kledaka kapha. It is
characterised by indigestion, altered stool consistency and disturbed bowel habits. The symptoms of Grahani
resemble those of Irritable Bowel Syndrome. It is a very common digestive disorder which is affecting nearly 10 to
20% of the population around the world. Young women are affected more often than men. Scientific research has
linked it to stress and anxiety but as yet the exact cause of the disease is unknown. Treatment in contemporary
system gives symptomatic relief and sometimes result in side effects also. The present study is an observational
study using Piccha vasthi which was prepared as per the reference given in Susruta Samhita Chikista Stana with
slight modification. Ingredients include Shalmali kanta chooran, Krishna tila pisti, Gritha, Madhu, Dugdha used
for piccha vasthi in a quantity of 160 ml given continuously for 14 days. It gave good symptomatic relief to the
patient and noticed no recurrence even after a year.
Keywords: Grahani, Piccha vasthi, Ir r itable Bowel Syndr ome.

Introduction Aims and Objectives

‘Grahani’ is a chronic disease of A nnavaha 1) To verify the efficacy of the simpler version of
srotas related to Agni. Ayurveda considers it as a Piccha Vasthi in the patient of IBS.
Tridoshaja vyadhi, which occurs due to the depletion of 2) To administer Piccha V asthi in a yapana vasthi
jataragni by samana Vayu, pachaka pitta and kledaka pattern.
kapha, it is characterised by indigestion, altered stool
consistency and disturbed bowel habits. (1) Materials and Methods
The symptoms of Grahani resemble those of The present study is an observational study.
Irritable Bowel Syndrome (IBS). It is functional bowel Patient was administered with Piccha V ashti for a
disorder characterized by abdominal pain or discomfort period of 14 days in yapana V asthi pattern based on
and altered bowel habits in the absence of detectable therapy guidelines on Piccha V asthi by Acharya Susruta
structural abnormalities. No clear diagnostic markers (3) with slight modification.
exist for IBS; thus, the diagnosis of the disorder is
based on clinical presentation. Pathophysiology of Irritable Bowel Syndrome
IBS is one of the most common conditions The pathogenesis of IBS is poorly understood,
encountered in clinical practice but one of the least well although roles of abnormal gut motor and sensory
understood. Throughout the world, about 10-20% of activity, central neural dysfunction, psychological
adults and adolescents have symptoms consistent with disturbances, stress, and luminal factors have been
IBS, and most studies show a female predominance. proposed. (4)
IBS symptoms tends to come and go over time and Patients with diarrhea as a predominant symptom
often overlap with other functional disorders such as exhibit clusters of rapid jejunal contraction waves, rapid
fibromyalgia, headache, backache and genitourinary intestinal transit and an increased number of fast and
symptoms. Severity of symptoms varies and can propagated colonic contraction.
significantly impair quality of life, resulting in high Those who are predominantly constipated have
health care costs. (2) Treatment in contemporary decreased orocaecal transit and a reduced number of
system gives symptomatic relief and sometimes result high-amplitude, propagated colonic contraction waves
in side effects also. Thus, it gave big scope to but there is no consistent evidence of abnormal motility.
alternative system of medicine to find effective therapy IBS is associated with increased sensitivity to
to treat IBS. intestinal distension induced by inflation of balloons in
the ileum, colon and rectum, a consequence of altered
*Corresponding Author: CNS processing of visceral sensation. This is more
Padma Priya N, common in diarrhoea predominant IBS. Between 7 and
PG Scholar, Department of Panchakarma, 32% of patients develop IBS following an episode of
Dr. BRKR Government Ayurvedic Medical College, gastroenteritis and others may be intolerant of specific
Erragadda, Hyderabad. Telangana State dietary components, particularly lactose and wheat.
Email: sunkararao18@gmail.com Abnormalities of gut microflora leading to increased

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ISSN: 0976-5921
International Journal of Ayurvedic Medicine, 2019, 10(4), 338-341
fermentation and gas production and minimal for skin), Stanya (increases breast milk), V rano Hitham
inflammation have also been postulated. Some patients (heals ulcers), Dantya (strengthens teeth), A lpa Mutra
have subtle, histologically undetectable mucosal Krudh (reduces the quantity of urine), Grahi
inflammation, possibly leading to activation of (absorbent), V atagno (pacifies vata), A gnimatipradha
inflammatory cells and release of cytokines, nitric oxide (promotes digestive power and intellect).(11)
and histamine. These may trigger abnormal
secretomotor function and sensitise enteric sensory Gritha (Ghee):
nerve endings. (5) Rasa: Madhura; Virya: Sheeta; VIpaka: Madhura
Its properties are A gni deepana (promotes
Pathogenesis of Grahani Roga digestive fire), Alpabhishyandi (it causes very minimal
The main cause of Grahani is agni dushti which or no obstruction to the channels), Cakshushya
brings indigestion, the resulted semi digested food (beneficial for vision), Medya (increases memory
moves upward and downward in the gastrointestinal power), Pittanila haram (pacifies vata and pitta), Kanthi
tract. The condition of downward movement of vardhaka (increases brightness), Ojovardhakam
indigested food is called Grahani roga. The predominant (increases immunity), Lavanya V ardhakam (Increases
symptom is passing of stool in large quantity either in lusture), A yurvardakam (increases life span) and
solid or liquid form associated with thirst, excessive Swarsmrithikaram (promotes voice and memory
salivation, anorexia, vomiting, fever, oedema in legs power). (12)
and hands and pain in bones and phalanges etc. (6)
4) Dugdha (Milk):
Line of Management of Grahani Roga Rasa: Madhura; Virya: Sheeta; Vipaka: Madhura
SNEHA, SWEDA, PANCHAKARMA, LANGANA, Its properties are V ata Pitta haram (pacifies vata
DEEPANA, LAVANA & KSHARA PRAYOGA, and Pitta), Saram (mobile in nature), Sadha Sukrakaram
MADVARISHTA SURA & ASAVA PRAYOGA, (Promotes semen instantaneously), Sheetalam (cool in
TAKRA PRAYOGA AND DIPANA SARPIS. (7) nature), Satmyam sarva Shareeranam (suitable to all
persons). Jeevaniyam (life promoter). Brhimanam
PICCHA VASTHI: (nutritious), V ajikaram (aphrodisiac), V aya Stapanam
It is one of the popular therapeutic modalities (life stabilizer), Sandhikaram (heals up fractures),
practiced in Ayurveda. Two varieties of Piccha vasthi Rasayam (Tissue vitalizer), Dosha Dhatu Mala
were mentioned by Charka in chikista stana while Srotasaam kinchith kledakaram (It enhances mild
dealing with the management of A rsas (8) and A tisara moisture to Dosha, Dhatu, Mala and Srotas). (13)
(9) with some slight variation. But A charya Susruta,
while mentioning management for the complications of 5) Madhu (Honey):
virechana karma, has brought a very simple version of Rasa: Madhura; Anurasa: Kashaya; Virya:
piccha vasthi with few ingredients. In present study, Sheeta; Vipaka: Madhura
patient was administered with piccha vasthi with slight It has properties like Grahi(absorbent) V ilekanam
modification from that propounded by A charya Susruta (depletor of body fats) Deepanam (appetizer)
as detailed below. Vranashodanaropanam (clears and heals ulcers) etc. It
is helpful in treating skin diseases, cough, hemorrhoids,
Table 1: Drug Schedule and Dosage: urinary tract disorders, worm infestations, diarrhoea and
Madhu 30 gms constipation. Its Y ogavahi property helps in speeding up
the vasthi action (14).
Go Gritha 30 gms
Kalka – Krishna tila Pishti 20 gms Case Report
Kwatha-Mocha rasa(10gms) siddha 80 ml A 46-year-old male patient came to Panchakarma
Kheera paka (320 ml of milk) OPD of Dr. B.R.K.R.Govt. Ayurvedic College and
Total 160 ml Hospital (OP regd. No.21867) with complaints of
passing watery stools containing semi digested food and
mucous, 10-12 times a day for the last four years. He
Properties of the drugs used in Piccha vasthi also complained of indigestion, abdominal bloating,
Shalmali Niryasa: (Gum of Silk Cotton Tree) severe pain abdomen before and while passing stools
Rasa: Kashaya; Virya: Sheeta; Vipaka: Madhura which was relieved after passing stools. Earlier, he was
Shalmali Niryasa is Hima (cool in Potency), treated in contemporary system of medicine with Anti-
Grahi (absorbent), Snigdha (demulcent), Vrishya diarrheal, anti- amoebic, anti-cholinergic and anti-
(aphrodisiac) and cures dysentery, diarrhoea, retained depressants for many months with minimal
undigested food, burning sensation and diseases of improvement. On his first consultation, he was advised
Kapha, Pitta and Rakta. (10) ayurvedic oral medications like Bilvadi Gutika,
Dadimashataka Chooran and Mustarishta for a period of
Krishna Tila Pishti: (Black sesamum seeds) one month which resulted in symptomatic relief only.
Rasa: Madhura, tikta, kashaya,; Virya: Ushna; Therefore, Piccha vasthi was planned which resulted in
Vipaka: katu significant improvement in a very short span of time that
Tila cures Kapha, Pitta diseases. It is Balya (acts sustained for more than a year as detailed below.
as general tonic), Keshya (hair tonic), Twachya (good
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Padma Priya N et.al., Role of Picchavasthi in the management of Grahani w.s.r Irritable Bowel Syndrome
Treatment Protocol Figure 1 : Showing the Assessment of symptoms of
Procedure IBS Before and After Therapy
Purva Karma: Performed Sthanika abyangana with
tila taila and Nadi sweda before administration of
vasthi.

Pradana Karma: Patient was made to lie in left lateral

position for administration of vasthi. Light diet
advised 2 hours before administration of vasthi.

Paschat Karma: Lifting the legs, patting to the buttocks

and anti-clock wise massage to the abdomen done.
Dietetic and behavioral regimen explained. (15)

Duration of Treatment: Continuously for 14 days in

yapana vasthi Schedule.

Assessment Criteria: Impr ovement of the Patient Discussion

was assessed on the basis of relief in the subjective Grahani Roga is a chronic disease of Annavaha
parameters. All the subjective parameters were srotas which occur in organ Grahani due to vitiation of
scored and assessed before and after treatment. agni. Acharya Vagbhata included it in Ashtamaha
Gadhas which are hard to diagnose and difficult to
Table 2: Gradation of Subjective Parameters treat. (16) Grahani roga is the prime disease of
Sl.no Signs and Symptoms Gradation gastrointestinal tract which is most often found in
1 Bowel Frequency clinical practice. It disturbs daily routine of individuals.
1or 2 times in a day 0 Vasthi karma is the most important among
3 to 4 times in a day 1 Panchakarmas due to its multiple benefits. It is the best
5 to 7 times in a day 2
procedure for vata disorders. It is also effective in
correcting the morbid pitta, kapha and rakta (17).
8 to 10 times in a day 3
Acharya Charaka considered Vasthi karma as artha
More than 10 times in a day 4 chikista for all diseases (18) while some other authors
2 Mucus in stool consider it as the complete remedy for all the ailments.
No mucus in stool 0 Various types of vasthi karma are mentioned in classics
Mucus present occasionally in 1 based on their action and one of them is Piccha vasthi. It
stool (not daily) is named because of its picchila property which means
Mucus present in initial stools 2 sticky or lubricant in nature. Because of this property, it
only forms a protective layer over the intestinal mucosa to
Mucus present in more than 6 3 avoid friction and reduction in intestinal irritation. In the
stools per day present study Susruta version of piccha vasthi was
Mucus present in every stool 4 performed on a patient with IBS. The ingredients used
3 Abdominal Bloating in piccha vasti were Shalmali niryasa, Krishna tila
No Bloating 0 pista, Gritha, Madhu and Dugdha. Many of them have
Minimal Bloating 1 similar properties like Madura rasa, Sheeta veerya and
Moderate Bloating relieved 2 Madura paka. By virtue of these properties, it acts as
after passing stool pitta shamaka, shota hara, vrana ropana, rakta stambaka
Mild Bloating present even 3 etc. These are helpful in controlling Grahani roga. The
after passing stool whole combination of above mentioned ingredients was
Bloating present before and 4 administered in the form of Y apana vasthi in a quantity
after passing stools of 160 ml each day for a period of 14 days. The result
was very significant in terms of complete remission of
Table 3: Assessment of symptoms of IBS Before symptoms which was assessed in terms of improvement
and After Therapy: observed in gradation scores of bowel frequency,
mucous in stool and abdominal bloating.
Sl. Signs and Before After
N Symptoms treatment treatment
o (Subjective Conclusion
Parameters) Piccha vasthi was prepared from easily available
1 Bowel Frequency 4 0 herbs and after administration, it gave good
symptomatic relief to the patient and there was no
2 Mucus in stool 2 0 recurrence even after one year. Hence, in view of the
3 Abdominal 3 0 above and the complications attached to contemporary
Bloating system, the piccha vasthi is definitely a better option to
treat Grahani w.s.r to IBS.

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