Introduction

INTRODUCTION

              The Grahani is the leading disorder of the digestive system. Due to various etiological factors of Grahani Roga, the Grahani becomes impaired as a result of Dusti or vitiation of Pachakagni and S              aman Vayu. [1] The logical outcome of the Grahani Dosha is the malabsorption of ingested food, resulting in the production of Pakwa Ama secondly the malabsorption of the products of digestion. The Vaisamya at Saman Vayu causes the hyper motility of gut resulting in frequent evacuation of the bowel, which one large and hard or liquid. Grahani and Agni are interdependent.[2] Functionally weak Agni i.e., Mandagni, causes improper digestion of ingested food, which leads to Ama Dosha. This Ama Dosha is a root cause of most of the diseases. It has pivotal importance in the pathogenesis of Grahani Roga. Grahani is considered under eight major diseases.[3] According to Acharya Charaka, Visamagni and Tikshanagni may cause Grahani Dosha but Grahani Roga is the consequence of only Mandagni. Chakrapanidutta has commented that Grahani Dosha. Grahani passes the food in the stage of Ama (Apakwaj) because of weak Agni and affection of Dosha. In an unusual situation, it releases the food in an undigested form only when it gets vitiated due to weakness of Agni.

               The main line of treatment is to correct the Agni Dushti by following Langhana and administering drugs which are Ama Pachan and Agni Deepan in action. The Stambhana measure has to be adopted according to the Roga and Rogi Bala to restore health. Hence the present study was conducted to evaluate the management of Grahani (IBS) with herbal medications.  The present drug formulation Marichyadi churna is taken from Chakradatta Grahani Chikitsa 28.[4] It contains Kalimirch, Shunthi, Kutajtwak, Jaggery are all in powdered form. All ingredients of these are having Deepan, Panchan, Tridoshahara, Amapachak, Sangrahi, Krimighna & Vishaghna properties and it is beneficial for Atisar, Pravahika and Grahani. Marichyadi Churna has been mentioned in the treatment of Grahani roga.

Objectives:                 

1. To study literature of Grahani Roga in details and its probable Ayurvedic correlations with Irritable Bowel Syndrome.
2. To find the efficacy of oral Marichyadi Churna Churna in the management of Grahani.

The patient attending the OPD & IPD irrespective of age and sex, from department of Kayachikitsa, Desh Bhagat Ayurvedic College & Hospital, Mandi Gobindgarh and from other referral hospital were selected for the study.

 

 

Inclusion Criteria:

1. Patients of all sexes and from various ethnic backgrounds were taken into consideration, as well as patients between the ages of 20 and 60.
2. Patients with Grahani syndrome and irritable bowel syndrome, as described in classical texts.
3. Willing to consent

 

Exclusion Criteria:

1. Patients under 20 and older than 60.
2. People suffering from various diseases include tuberculosis, malignancy, ulcerative colitis, and acute illnesses like cholera and gastroenteritis. intestinal obstructions, etc.
3. Women who are pregnant or lactating.

 

Diagnostic Criteria- Subjective criteria:

The patients having complaints of Grahani Roga, i.e. Muhurbaddha/Muhurdrava Mal Pravriti, Udara Shoola, Udara Gaurava, Apachana, Aruchi, Atopa, Vidaha, Aalasya, Vistambha, Praseka, Tamak Swasa, Pain in joint, Swelling, Trishna were selected for the study. For the purpose of perfect diagnosis and assessment an exceptional research Proforma was structured.

Objective criteria:

Routine Haematological, Biochemical and Routine-Microscopic, Urine & Stool examination were carried out to assess the general condition and exclusion of other pathogenesis of the patients.

Intervention:

Group A – 20 patients (Marichyadi churna – 5 gm TDS with warm water after meal)

Dose of drug: 5 gm TDS with warm water after meal

Duration of study: 30 days

Scheduled follow-up

1. 0 day – Enrolment Day
2. 15th   Day - 1st follow up
3. 30th Day - 2nd follow up
4. 45th Day – 3rd Follow up

Criteria for Assessment

1. The assessment was made before, during and after the treatment on scoring of cardinal signs and associated symptoms.
2. Scoring design was created according to severity of symptoms.
3. Result was analyzed statistically on the basis of improvement in subjective as well as objective criteria.
4. Relief in Ama Lakshanas of Grahani Roga.

Assessment of Total Effect:

The changes in clinical features of Grahani (Irritable Bowel Syndrome) were recorded before and after the treatment based on improvement in scoring Index.  The result was recorded as-

Marked relief                 - Above 75% improvement

Moderate relief             -             50% - 75% improvement

Mild relief                       -             25% - 50% improvement

No relief                          -             Below 25% improvement

OBSERVATIONS - Observations and results have been discussed here with logical interpretation on the basis of Ayurveda science as well as modern medical science. Findings observed in the present study are–

Demographic Data –

1. Age –47.5% patients belong to the age group between 20-30 years followed by 32.5% patients in 31-40 years, 12.5% in 41-50 years and 7.5% in 51-60 years
2. Gender -  55% was male while 45% patients were female.
3. Marital status - 85% was married while only 15% patients were unmarried. 
4. Religion –25% patients belong to the Hindu followed by 7.5% patients were of Muslim, 65% patient belong to Sikh and 2.5% patients were found from Christian community.
5. Occupation - 27.5% were doing sitting jobs (desk- work), 20% patients were labour, 17.5% patients were housewives and 35% were doing other types of jobs such as students, businessmen, farmers, army personnel etc.
6. Educational Status - 30% patients were taking education up to higher secondary education. 17.5% patients were primary educated, 17.5% patients were taking education up to Graduation level and 10% patients were post graduate. 25% patients were illiterate.
7. Economic Status - 42.5% were of poor class, 40% patients were of middle class, 12.5% patients of middle-higher class and 5% patients were of higher class.
8. Appetite - 45% had moderate appetite, 32.5% patients had poor appetite and 22.5% patients had good appetite.
9. Diet –45% patients were taking mixed type of diet and 55% patients were taking only vegetarian diet.
10. Dietary Type - Samashana was observed in 45% patients, Adhyashana in 20%, Vishamashana in 5% and Virudhashana was observed in 30% patients.
11. Addiction - 28% was addicted to tea/coffee.
12. Agni - 75% had Mandagni and 25% patients had Vishamagni.
13. Kostha - 65% had Mridu kostha, 27.5% patients had Madhyam kostha and 7.5% patients had Krura kostha.
14. Sleep Pattern - 75% patients had disturbed sleep and 25% had sound sleep.
15. Bowel Habit - 90% patients and 10% patients had regular bowel habit.
16. Nature of work -             17.5% patients were doing sedentary work; 27.5% patients were doing moderate type of work and 55% patients were doing strenuous work.
17. Built - 35% patients were having slim built; 45% patients were having normal built and 20% patients were obese.
18. Exercise - 70% were doing Avar exercise, 12.5% patients were doing Madhyam exercise and 17.5% patients were doing regular Pravara exercise.
19. Dominance Rasa - 60% were having Katu Rasa dominant in their routine diet, Madhura Rasa in 10% patients, Amla Rasa and Lavana Rasa in 12.5% patients each and Tikta Rasa in 5% patients.
20. Dominance Guna - 25% were having Ruksha guna dominant followed by Snigdha guna in 20% patients, Sheeta guna in 17.5% patients, Ushna guna in 15% patients, Laghu guna in 12.5% patients and Guru guna in 10% patients.
21. Chronicity of disease - 45% were suffering from Grahani Roga from more than one year, 15% patient from one month, 15% patients from upto 6 months and 25% patients were suffering from the disease from 6 to 12 months of duration.
22. Emotional Makeup - 35% had tensive nature, 20% patients had anxiety, 17.5% patients had depression, 17.5% had sentimental nature and 10% patients were normal.
23. Abhyavaharana Shakti - 45% were having Avar Abhyavaharana Shakti, 42.5% patients were Madhyam and 12.5% patients were having Pravara Abhyavaharana Shakti.
24. Jarana Shakti - 82.5% were having Avar Jarana Shakti and 17.5% patients were having Madhyama Jarana Shakti.
25. Doshaj Prakriti - 32.5% patients had Vatapittaj Prakriti, 27.5% patients had Vatakaphaj Prakriti and 40% patients had Pittakaphaj Prakriti.
26. Manas Prakriti - 65% patients were having Rajasika Prakriti and 35% patients were having Tamasika Prakriti.

Table no 3. Assessment of Overall Effects of Therapy of 20 patients of Grahani

Assessment	Score	Group A
		Number of Patients	Percentage
Complete Cure	100%	Nil	-
Marked Relief	>75% to <100%	Nil	-
Moderate Response	>50% to 75%	14	70%
Mild Improvement	>25% to 50%	06	30%
No Relief	Up to 25%	Nil	-

 

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Material and methods

Source of Data:

The clinical trial that was conducted on 20 patients who had the characteristic symptoms of Grahni Roga (Irritable Bowel Syndrome). The patient attending the OPD & IPD irrespective of age and sex, from department of Kayachikitsa, Desh Bhagat Ayurvedic College & Hospital, Mandi Gobindgarh and from other referral hospital were selected for the study.

 

Inclusion Criteria:

1. Patients of all sexes and from various ethnic backgrounds were taken into consideration, as well as patients between the ages of 20 and 60.
2. Patients with Grahani syndrome and irritable bowel syndrome, as described in classical texts.
3. Willing to consent

 

Exclusion Criteria:

1. Patients under 20 and older than 60.
2. People suffering from various diseases include tuberculosis, malignancy, ulcerative colitis, and acute illnesses like cholera and gastroenteritis. intestinal obstructions, etc.
3. Women who are pregnant or lactating.

 

Diagnostic Criteria- Subjective criteria:

The patients having complaints of Grahani Roga, i.e. Muhurbaddha/Muhurdrava Mal Pravriti, Udara Shoola, Udara Gaurava, Apachana, Aruchi, Atopa, Vidaha, Aalasya, Vistambha, Praseka, Tamak Swasa, Pain in joint, Swelling, Trishna were selected for the study. For the purpose of perfect diagnosis and assessment an exceptional research Proforma was structured.

Objective criteria:

Routine Haematological, Biochemical and Routine-Microscopic, Urine & Stool examination were carried out to assess the general condition and exclusion of other pathogenesis of the patients.

Intervention:

Group A – 20 patients (Marichyadi churna – 5 gm TDS with warm water after meal)

Dose of drug: 5 gm TDS with warm water after meal

Duration of study: 30 days

Scheduled follow-up

1. 0 day – Enrolment Day
2. 15th   Day - 1st follow up
3. 30th Day - 2nd follow up
4. 45th Day – 3rd Follow up

Criteria for Assessment

1. The assessment was made before, during and after the treatment on scoring of cardinal signs and associated symptoms.
2. Scoring design was created according to severity of symptoms.
3. Result was analyzed statistically on the basis of improvement in subjective as well as objective criteria.
4. Relief in Ama Lakshanas of Grahani Roga.

Assessment of Total Effect:

The changes in clinical features of Grahani (Irritable Bowel Syndrome) were recorded before and after the treatment based on improvement in scoring Index.  The result was recorded as-

Marked relief                 - Above 75% improvement

Moderate relief             -             50% - 75% improvement

Mild relief                       -             25% - 50% improvement

No relief                          -             Below 25% improvement

OBSERVATIONS - Observations and results have been discussed here with logical interpretation on the basis of Ayurveda science as well as modern medical science. Findings observed in the present study are–

Demographic Data –

1. Age –47.5% patients belong to the age group between 20-30 years followed by 32.5% patients in 31-40 years, 12.5% in 41-50 years and 7.5% in 51-60 years
2. Gender -  55% was male while 45% patients were female.
3. Marital status - 85% was married while only 15% patients were unmarried. 
4. Religion –25% patients belong to the Hindu followed by 7.5% patients were of Muslim, 65% patient belong to Sikh and 2.5% patients were found from Christian community.
5. Occupation - 27.5% were doing sitting jobs (desk- work), 20% patients were labour, 17.5% patients were housewives and 35% were doing other types of jobs such as students, businessmen, farmers, army personnel etc.
6. Educational Status - 30% patients were taking education up to higher secondary education. 17.5% patients were primary educated, 17.5% patients were taking education up to Graduation level and 10% patients were post graduate. 25% patients were illiterate.
7. Economic Status - 42.5% were of poor class, 40% patients were of middle class, 12.5% patients of middle-higher class and 5% patients were of higher class.
8. Appetite - 45% had moderate appetite, 32.5% patients had poor appetite and 22.5% patients had good appetite.
9. Diet –45% patients were taking mixed type of diet and 55% patients were taking only vegetarian diet.
10. Dietary Type - Samashana was observed in 45% patients, Adhyashana in 20%, Vishamashana in 5% and Virudhashana was observed in 30% patients.
11. Addiction - 28% was addicted to tea/coffee.
12. Agni - 75% had Mandagni and 25% patients had Vishamagni.
13. Kostha - 65% had Mridu kostha, 27.5% patients had Madhyam kostha and 7.5% patients had Krura kostha.
14. Sleep Pattern - 75% patients had disturbed sleep and 25% had sound sleep.
15. Bowel Habit - 90% patients and 10% patients had regular bowel habit.
16. Nature of work -             17.5% patients were doing sedentary work; 27.5% patients were doing moderate type of work and 55% patients were doing strenuous work.
17. Built - 35% patients were having slim built; 45% patients were having normal built and 20% patients were obese.
18. Exercise - 70% were doing Avar exercise, 12.5% patients were doing Madhyam exercise and 17.5% patients were doing regular Pravara exercise.
19. Dominance Rasa - 60% were having Katu Rasa dominant in their routine diet, Madhura Rasa in 10% patients, Amla Rasa and Lavana Rasa in 12.5% patients each and Tikta Rasa in 5% patients.
20. Dominance Guna - 25% were having Ruksha guna dominant followed by Snigdha guna in 20% patients, Sheeta guna in 17.5% patients, Ushna guna in 15% patients, Laghu guna in 12.5% patients and Guru guna in 10% patients.
21. Chronicity of disease - 45% were suffering from Grahani Roga from more than one year, 15% patient from one month, 15% patients from upto 6 months and 25% patients were suffering from the disease from 6 to 12 months of duration.
22. Emotional Makeup - 35% had tensive nature, 20% patients had anxiety, 17.5% patients had depression, 17.5% had sentimental nature and 10% patients were normal.
23. Abhyavaharana Shakti - 45% were having Avar Abhyavaharana Shakti, 42.5% patients were Madhyam and 12.5% patients were having Pravara Abhyavaharana Shakti.
24. Jarana Shakti - 82.5% were having Avar Jarana Shakti and 17.5% patients were having Madhyama Jarana Shakti.
25. Doshaj Prakriti - 32.5% patients had Vatapittaj Prakriti, 27.5% patients had Vatakaphaj Prakriti and 40% patients had Pittakaphaj Prakriti.
26. Manas Prakriti - 65% patients were having Rajasika Prakriti and 35% patients were having Tamasika Prakriti.

Table no 3. Assessment of Overall Effects of Therapy of 20 patients of Grahani

Assessment	Score	Group A
		Number of Patients	Percentage
Complete Cure	100%	Nil	-
Marked Relief	>75% to <100%	Nil	-
Moderate Response	>50% to 75%	14	70%
Mild Improvement	>25% to 50%	06	30%
No Relief	Up to 25%	Nil	-

 

Overall Effect of therapy –

Overall Effect of therapy – The efficacy of Marichyadi churna in Grahani Roga (IrritableBowel Syndrome) i.e. provided moderate response in 14 (70%) patients and 06 (30%) patients showed mild improvement after completion of treatment.

Discussion

Mode of Action of Marichyadi Churna – The present drug formulation Marichyadi churna is taken from Chakradatta Grahani Chikitsa 28. It contains mainly Kalimirch, Sunthi, Kutaj Twak, Jaggery all are in powdered form.[5] All ingredients of these are having Deepan, Panchan, Tridoshahara, Amapachak, Sangrahi, Krimighna & Vishaghna properties and it is beneficial for Atisar, Pravahika and Grahani. It acts as anti-diarrheal, anti-dysenteric, appetizer, astringents, carminative, digestive and stomachic. It reduces the frequency of bowel movements. It gives relief in intestinal spasms and pain. It controls diarrhea by preventing micro-organism and their toxic effects in the intestines. It supports intestinal flora and aids healthy digestion. Kutaj lowers the viral load on the liver. The anti-inflammatory and hepato-protective activity help in liver disorders.[6] Sunthi is unctuous, hot in potency and increases Pitta and decreases Kapha. It improves taste, light to digest, improves digestive strength, and helps to absorb excess moisture especially in intestine. [7] Marich is an excellent antiviral and antibacterial helps in treating liver infection. Jaggery is rich in minerals, iron & instant glucose. It is not only easily digestible but has various minerals & vitamins in right proportion, which is extremely useful for our body.[8] Carbohydrate which is prominently present in Sugar, needs Vitamin-B for their proper utilization by the body.

Conclusion

The clinical characteristics of vataja Grahani are the ones that most resemble those of irritable bowel syndrome among the several forms of Grahani. The medications chosen for the clinical study are having All the drugs chosen for the study are having Deepan, Pachan, Amapachaka, Sangrahi properties in nature. The drugs are easily available, cheaper and with no side and adverse effects. The drugs act as anti-diarrheal, anti-dysenteric, appetizer, astringents, carminative, digestive and stomachic. The medications are easily available, cheaper and with no side and adverse effect. It provided better relief in the amelioration of signs and symptoms of Grahani (Irritable Bowel syndrome). Also statistically significant results were found.