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.
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.
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.
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.
According to Ayurveda the different types of grahani (IBS) are following (based on the predominance of vitiated dosha.)
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.
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.
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.
Along with food the following activities can help in getting relief from symptoms and maintaining balance.
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.