Introduction

According to Ayurveda  Irritable bowel syndrome  is the similar condition  explained in the name of grahani or samgrahani. The name is given so because grahana(retaining) is the function of grahani organ (small intestine) as this  function is significantly altered and bowel loses its control to retain for stipulated period of time according to ones requirement of absorption this condition is called grahani.

Allopathic concept

IBS  is a condition of  combination of abdominal discomfort or pain and altered bowel habits: either altered frequency (diarrhea or constipation) or altered stool form (thin, hard, or soft and liquid). There is no clear picture  what IBs or what causes IBS. But it is a medical condition with collection of symptoms  that has been ongoing for at least six months. As per treatment is concerned nearly all people with IBS  can get help but no single treatment  works for everyone.  Some of the medicines like antispasmodic, antidiarrhoel drugs, laxatives  and antidepressants  can be advised  depending upon the cause. All these can give  the temporary relief but also have some side effects.

AYURVEDA CONCEPT

The food we ingest is broken down in to the constituents that nourish the tissues and supports our everyday functions. When the digestive fire – Agni, which burns within our stomach, is affected by incorrect lifestyle and eating habits this ultimately affects the digestive process causing food to be either partially digested or over digested leading to the formation of Ama- toxins. Not only does incorrect digestive fire give rise to toxins but it weakens the function behind the digestive process itself.

All the three doshas ie. vata, pita and kahpa  play a role in the digestive process.  Pachaka pitta as the essence behind the digestive fire Jathara Agni is responsible for the transformation of solid food into smaller particles as it passes into the small intestine. The partially digested food particles are further broken down by the continued presence of Jathara Agni in the small intestine into components which will be absorbed across the wall of the small intestine. Kledaka kapha functions as the protective mucosa layer lining the stomach protecting stomach tissue from the hydrochloric acid and pepsin which are nothing more than aspects of Jathara Agni. Kledaka Kapha is also responsible for moisture in the GI tract, and in the stomach mucus excreted by the mucosa cells mixes with the food substance forming chyme enabling the food to flow as liquid from the stomach to the small intestine. The movement of food particles  across the intestinal wall and the movement of the chime throughout the small intestinal tract are done with the help of  Samana Vayu. Apana Vayu whose seat is the colon is responsible for the elimination of the waste material that passes from the small intestine into the colon. Vyana vayu is responsible for the movement of nutrients to the peripheral tissue via the flow of lymph – rasa and blood – rakta.

Hence digestion is ruled by Jathara Agni but supported by the three doshas. As each doshas supports digestion an imbalance of any one of the doshas will affect the role of that dosha in the digestive process and ultimately affect the function of the other doshas in digestion.

When the digestive system is affected by one or more of the doshas leading to incomplete digestion, diseases arise in the Annavaha srota – GI Tract. Grahani is due to chronic imbalance of the one or more of the doshas affecting Jathara Agni leading to weakness in the duodenum. According to Ayurveda the function of the duodenum is not only to digest the food but to “hold” on to the food until it is digested, it then releases the food allowing it to pass into the colon where it is excreted under the influence of Apana Vayu. Due to weak digestive fire – Agni, the duodenum becomes weakened and its function is inhibited, it will then either release its contents early than normal into the colon with the food being “uncooked” or it will retain its contents for longer periods releasing the food into the colon that is “overcooked.” Due to this factor one of the main symptom of  grahani ( IBS)  is alternating loose bowel motions with constipation.

 Causes

Eating habits are the the primary cause of grahani which are  directly affect Jathara Agni leading to a weakness in the small intestine. Aggravation of any one of the three doshas can be responsible for the alteration of digestion and it will depend on the aggravating factors that lead to the manifestation of disease. The causative factors that lead to the alteration of normal digestive fire known as Sama Agni are those same factors that cause the three types of deranged Agni.   Vishama Agni (due to aggravated Vata) , Tikshna Agni (due to aggravated Pitta), and Manda Agni (due to aggravated Kapha).  Untreated chronic diarrhoea which is itself caused by doshas affecting the process of digestion is also a cause of Grahani.

• The exact cause of irritable bowel syndrome (IBS) is unknown and may be due to multiple factors.

• Too fast or slow movements of the colon and small intestines.
• Hypersensitivity to pain from a full bowel or gas
• Gastroenteritis  may trigger IBS symptoms
• Anxiety  or depression are observed in many people with IBS
• Reproductive hormones or neurotransmitters may be off-balance in people with IBS.
• Small intestinal bacterial overgrowth

TYPES

According to  Ayurveda the different types of  grahani  (IBS) are following (based on the predominance  of vitiated  dosha.)

1. vataja
2. pittaja
3. kaphaja
4. sannipathaja

PREMONITORY SYMPTOMS

There will be pre-signs and symptoms indicating the development of the disease. One may experience slower digestion of food, hyperacidity, bad taste in the mouth, anorexia, increased thirst, gastric reflux, tinnitus and the noise of gurgling in the abdomen. One may also fee

l lightheaded and notice a decrease in energy levels as Rasa dhatu is not properly nourished due to inadequate absorption of nutrients across the intestinal wall and inferior quality of nutrient due to improper digestion. As the disease progresses one may lose weight, experience dyspnoea, notice the retention of food in the stomach and start to experience fainting, headache and oedema in the extremities.

SYMPTOMS

The following are the symptoms  usually  seen in a person suffering from grahani  caused by vata aggrevation – Dryness of the palate, noise in the ears – tinnitus, cough, dyspnoea all caused by Prana vayu aggravation. Aggrevated Apana vayu  leads to constipation, increased frequency of motion, flatulence, passing gas on passing bowel, frothy loose stools, painful bowel motions due to intestinal cramps, dry feces, and pain in the rectum. Samana vayu  causes loose bowel motions due to increased peristalsis in the small intestine. Aggrevation  of Vyana vayu   leads to cardiac pain,   pain in the sides of the abdomen, thighs, groin and neck. The individual craves all types of food and feels satisfied when they have eaten.

IBS caused by Pitta  aggrevation  produces  discoloration of the faeces ( bluish or yellow colour due to ranjaka pitta variation), the body odor of the individual is fetid, aggravation of  Pachaka pitta causes hyperacidity resulting in heart burn and sour belching, also affecting the quality of stool so that it is liquid in consistency. Loss of thirst  and  anorexia are also present.

In grahani caused by aggrevation  of  kapha – increase in  Kledaka kapha  causes  Manda Agni which leads to heaviness in the stomach,  nausea and vomiting, retention of undigested food in the stomach leading to fermentation and burping with bad smell and loss of appetite. Avalambaka kapha that is aggravated causes cough with mucus.  Aggravation of Bodhaka kapha causing excess salivation and mucus in the mouth and loss of taste due to saturation. Excessive Kledaka kapha passes into the colon and is passed in the stools that are broken and may be considerable in quantity. Due to excessive kapha in the body one may feel lethargic and weak yet does not appear by physical observation to be showing signs of tissue weakness.

When Grahani is  caused by  combination of two or three doshas  it may present the following symptoms.

• diarrheaor constipation
• Constipation alternating with diarrhea.
• Symptoms of IBStend to worsen with stress.
• increased gas
• abdominal swelling or bloating
• cramping pain after eating certain foods
• nausea
• mucous or foamy stool
• relieve in the symptoms  by bowel movements
• symptoms of menstrual periods gets aggrevated in women with IBS
• Unexplained weight loss.

We  at Apthasree

For any disease dosha imbalance  is the main cause.  We at Apthasree mainly  aim at balancing  the physical  and mental doshas.  First we have to do the mental and physical detoxification.  For de-toxification panchakarma therapies like snehapana, virechana, vamana, vasthi, thakradara, tailadara  etc.  can be done  depending upon the predominant  vitiated dosha.  Once the detoxification is done  it is very important to maintain the balance  in doshas.  The balance can be  maintained by following proper diet, routines and internal  medication.

The following  diet can be adviced in case of IBS  which helps  to maintain the doshas.

• Eat smaller, more frequent meals; Instead of 3 meals, try 5 or 6 regularly scheduled small meals.
• Eat at regular times.To regulate bowel  function  try to maintain proper timings of food each day.
• Slow down; don’t rush through meals.
• Avoid meals that over-stimulate everyone’sgut, like large meals or high fat foods. Like black gram, soya bean, coconut, chicken, chilly, prawns , mango, pine apple, cashew , papaya, fig, jack fruit.
• Try to drink plenty of fluids every day. Water is best.
• Take care with dairy products.If you’re lactose intolerant, try substituting yogurt for milk.
• If you are constipated, try to make sure you have breakfast, as this is the meal that is most likely to stimulate the colon and give you a bowel movement.
• If you think a certain food is a problem, try cutting it out of your dietThe foods most likely to cause problems are: Insoluble (cereal) fiber, Coffee/caffeine, Chocolate, Nuts
• Fiber rich items like whole grains, fruits, vegetables and beans helps to reduce constipation, it can also make gas and cramping worse. So  the amount of finer in your diet should be increased slowly  over a period of weeks.

Along  with food the following activities can help in getting relief from symptoms and maintaining balance.

• quit smoking
• Regular exercises-  helps to relieve depression and stress  and also stimulates normal contractions of your intestines, and can help you feel better about yourself
• To Avoid  gas and stimulation of intestinal intake of  Alcohol and beverages that contain caffeine and carbonated drinks should be avoided.
• Use stress management and relaxation techniques.

Conclusion

Treatment of the grahani (IBS) is mainly treating the vitiated  dosha or doshas; however treatment will be focused ultimately on correcting Agni and strengthening the small intestine. As IBS  is  not a disease  but a group of symptoms seen together  due to imbalance  mental and physical doshas  the ultimate  remedy is only through  ayurveda  by which both detoxification of doshas  and maintaining the balance of doshas and  correcting the agni can be done.