WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Desai et al. World Journal of Pharmacy and Pharmaceutical Sciences

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Volume 7, Issue 6, 1487-1494 Case Study ISSN 2278 – 4357

AYURVEDIC MANAGEMENT OF GRAHANI (IBS): A CASE STUDY

Kshitija Desai1*, Prashant Baghel2, Parshuram Dongre3, Priti Pusam4

*1
PG Scholar, Dept. of Rasashastra and Bhaishajyakalpna, Govt. Ayurved College,
Osmanabad, Maharashtra, India.
2
PG Scholar, Dept. of Kriya Sharir, Govt. Ayurved College, Osmanabad, Maharashtra, India
3
Professor and HOD, Dept. of Kayachikitsa, Govt. Ayurved College, Osmanabad,
Maharashtra, India.
4
PG Scholar, Dept. of Rasashastra & Bhaishajyakalpna, Govt. Ayurved College, Osmanabad,
Maharashtra, India.

Article Received on ABSTRACT

17 April 2018,
Revised on 07 May 2018,
Accepted on 28 May 2018
DOI: 10.20959/wjpps20186-11837
*Corresponding Author
Kshitija Desai
PG Scholar, Dept. of
Rasashastra and
Bhaishajyakalpna, Govt.
Ayurved College,
Osmanabad, Maharashtra,
India.
In present era Grahani Roga is common GIT disorder affecting the
normal life style of approx. Every individual at one time in their life
suffered from symptoms like abdominal pain, altered bowel habits,
nausea, rectal mucus, feeling of incomplete defecation, In modern
science above symptoms correlated with IBS (Irritable Bowel
Syndrome). In this case an effort was made to treat a 27 years old male
patient having symptoms Muhurbaddha Muhurshithil (altered bowel
habit), Apakwa Malapravritti (Stool with mucus), Udarshool
(abdominal pain) with Pichhabasti (medicated enema), Shirodhara
(pouring oil on head) and oral medications. At the end of 60 days of
treatment patient got significant improvement in symptoms.

KEY WORDS: Grahani, IBS (Irritable Bowel Syndrome), Pichhabasti, Oral medication.

INTRODUCTION
Approximately 20% of general population fulfills diagnostic criteria for Irritable Bowel
Syndrome (IBS). IBS encompasses a wide range of symptoms and a single cause is unlikely.
It is generally believed that most patients develop symptoms in response to psychosocial
factors, altered gastro intestinal motility, altered visceral sensation or luminal factors.[1]
As per Acharya Sushrta Grahani is the 6th Pittadhara Kala situated between Amashaya
(Stomach) and Pakwashaya.[2] Acharya Charaka mentioned it is the part which situated

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Desai et al. World Journal of Pharmacy and Pharmaceutical Sciences

above Nabhi (Umbelicus), it supported and nourished by strength of Agni (digestive power).
Grahani (organ) digest the food and releases into the next Ashaya i.e. Pakvashaya.[3] Because
of impairment of Agni it releases food in undigested form. Grahani disease is due to the
unhealthy and improper food habits, like constant intake of such food especially in person
with disturbed digestion and cause the disease Grahani. Thus it produces symptoms as
Atisrushta Atibadha Mala (loose/constipeted), Trushna (Thirst), Arochaka (tastelessness),
Asyavairasya (Alered oral taste), Prasek (excessive salivation), Shoon Padakara (edema over
hands and feets), Asthiparva Ruk (pain at phalangeal joint and bone), Chardan (vomiting),
Jwara (fever), and Louhagandhi Amlaudgara (iron pungent odor burps).[4]

Clinicaly IBS shows symptoms like altered abdominal habit, abdominal pain and bloating,
feeling of incomplete defecation, passage of mucus. In Ayurveda exact correlation cannot be
found of IBS but according to signs and symptoms and pathology of disease we can consider
this clinical entity as Grahani Dushti.

In present study through the case was diagnosed as Grahani (IBS), patient had GIT
symptoms and general symptoms related to Grahani. Hence the patient was administered
with Deepan, Pachan, Grahi oral medication with a course of Pichhabasti, Shirodhara.

MATERIAL AND METHODS

Case Presentation
A 26 years old male patient was registered from OPD with registration no. 13233,
Department of Kayachikitsa, Government Ayurveda Hospital, Osmanabad. The patient had
many complaints related to IBS which include Muhurbadha muhurshithil malaprvritti
(altered bowel habit), Udarshool (abdominal pain), Apakvamalapravritti (stool with mucus),
Aruchi (anorexia), Udaragourava(heaviness in abdomen), Alasya(fatigue),
Ajeerna(indigestion) for the last 6 months. As IBS correlated with Grahani Roga, drugs
suppressing Pitta and having Deepan, Pachan properties were prescribed- Panchamruta
Parpati 500mg, Naga Bhasma 60mg, Shankha Bhasma 250mg BD with Takra (butter milk)
and Sutshekhar Rasa 250mg BD. Pichhabasti (medicated enema) of Mochrasa Sidhha
Ksheer (milk), Anuvasan Basti of Jatyadi Tail (medicated oil) and Vasa Ghrita (Ghee
prepared by Adhatoda vasica) for 15 days and Shirodhara (pouring of oil on head) with
Vacha Taila (Oil preparation of Acorus calamus) for 7 days.

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Desai et al. World Journal of Pharmacy and Pharmaceutical Sciences

History of Present illness

Patient states that he was quite well 6 months back. Since then he has been suffering from
abdominal pain, altered bowel habits, sometimes passage stool with mucous, anorexia,
heaviness in abdomen, indigestion and fatigue. Patient had the complaint of Chronic Diarrhea
6 months back. Doctor diagnosed as IBS and started treatment. Patient underwent treatment
but could not get relief completely.

Past history of Patient

The patient used antacid and antispasmodic drug unevenly. His family history revealed that
there was no such complaint ever.

General Examination
VITALS
Pulse: 80/min CVS: S1 S2 Normal
BP: 110/70 mmHg CNS: Conscious, Oriented
Temp: Afebrile RS: AEBE, Clear
RR: 20/min P/A: Resonance ++, Mild Tenderness

Built: Lean
Weight: 45 kg
Height: 6 feet

Blood Investigation
Hb%: 11.7 g/dL
ESR: 40mm
BSL(R):120mg/dl
Sr.Creatinine: 0.85mg/dl
HBsAg: Non Reactive
Urine: Pus cells + (5-6)

Samprapti Ghatakas
Dosha: Samanavata, Apanavata, Pachakpitta
Dushya: Annarasa, Rasadhatu
Agni: Jatharagni
Ama: Jatharagnimandyajanya

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Srotas: Annavaha
Srotodushti: Atipravritti
Adhishthan: Grahani
Rogamarga: Abhyantara

Table No.1: Showing Grading for clinical features.

AT %
Clinical Features Grading BT th th th
15 day 30 day 60 day Relief
Passing normal
consistency 0
stool(1time/day)
Passing stool irregular(1-
1
2times/day)without pain
Passing stool irregular(2-
2
Muhurbaddhamuhurshithil mala 3times/day)with pain
(Altered bowel habit) Passing stool irregular &
just after meal(3- 3 4 2 1 0 100%
4times/day)with pain
Passing stool irregular &
just after
4
meal(>4times/day) with
pain
No complaint 0
Rarely complaint once in
1
a week
Distention of abdomen
after taking meal up to 1 2
hour
Distention of Abdomen
Distention of abdomen
after taking meal up to 1- 3 4 1 1 1 80%
3 hours
Distention of abdomen
after taking meal up to 6 4
hours
Taking normal diet with
0
interest
No interest in taking
Aruchi 1
normal diet
(anorexia) 0
Food has taken forcefully 2 2 0 0 100%
Not taken a food even
3
forcefully
No weakness 0
Weakness but performs
Balakshya 1
day to day activies
(Weakness)
Weakness & difficulty in 3 1 0 0 100%
2
performing day to day

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 Desai et al. World Journal of Pharmacy and Pharmaceutical Sciences

activities
Cannot able to get up
3
from bed
Normal thirst 0
Mild thirst , take water
1
frequently
Trushna
Thirst increases 2
(Thirst)
Excessive thirst, never 3 1 0 0 100%
satisfied after taking a 3
good amount of water
Enthusiastic 0
Alasya Occasionally 1
(laziness) Often 2
3 1 1 1 75%
Persistent 3
No complaint 0
Mild Salivation 1
Moderate salivation with
Praseka 2
nausea occasionally/day
(excessive salivation)
Excessive salivation with 2 1 0 0 100%
nausea & with often 3
vomiting
No exhaustion 0
Exhaustion with
1
Klama moderate work
(Exhaution) Exhaustion with mild
2 2 1 1 1 75%
work
Exhaustion without effort 3
No complaint 0
Occasionally 1
Tiktamlodgara 1-3days/week 2
(iron pungent odor burps) 3-5days/week 3
5-7days/week 4 5 2 1 1 83%
All the 7 days 5
No complaint 0
Occasionally 1
Antrakunjan
2-3 times/day before
(gurgling sound in abdomen) 2
passing stool 3 1 0 0 100%
Persistent 3
No visible mucous in
0
stool
Visible mucous stickled
1
to the stool
Passing mucus in stool
Passage of mucous with
2 2 0 0 0 100%
frequent stool
Passage of large amount
3
of mucous in stool

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Table No.2: Showing Oral Medication.

Formulation Dose Duration Anupana
Panchamruta Parpati 500mg+
Shankha bhasma 250mg + BD 30 days Takra
Naga Bhasma 60mg
Sutashekhar Rasa 250mg BD 30 days Water

Table No. 3: Showing Panchakarma procedure.

Panchakarma
Sr.No. Method Duration
Procedure
Mocharasa sidhha
1 Pichhabasti (P) Ksheerpaka -250ml + 12 Basti in 15 days
Vasa Ghrita - 30ml
Jatyadi Tail - 30ml +
2 Anuvasana Basti (A) 3 Basti in 15 days
Vasa Ghrita – 30ml
3 Shirodhara Vacha Tail – 500ml 7 days

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
P P P A P P P A P P P A P P P

OBSERVATIONS AND RESULTS

The follow up was made on 15th day, 30th day and 60th day. During this period patient did not
developed any other complaints. After 60th day blood investigations are carried out it shows
following results i.e. ESR- 10mm, Hb %- 12.5 gm%, Urine Pus cell – Nil. Patient reported
gradual improvement in altered bowel habits, stool with mucus, pain in abdomen, anorexia,
indigestion, heaviness in abdomen. After treatment patient got significant relief and he gained
weight up to 49 kg. (before treatment wt. 45kg)

FOLLOWUP AFTER TREATMENT

After discharging from the hospital patient is advised to continue with Kutaj Ghana Vati 1
TDS and Kutajarishta 10ml BD with water.

DISCUSSION
In this study Pichhabasti was given for the treatment of Grahani (IBS) made from
Mocharasa i.e. Shalmaliniryasa (resinous extract of Bombax cieba tree) by Ksheerapaka
Vidhi(Milk Preparation).Acharya Bhavprakash has mentioned the properties of
Mocharasa(resinous extract) as Hima (cool in potency), Grahi (astringent), Pitta
Raktadahanut (rectifies the vitiation of blood, Pitta Dosha, and decreases symptoms of
burning), Pravahikaghna (corrects pathogenesis occurring in Pravahika disease). It contains
Tannin as principle component along with Gallic acid. It is astringent in property which when

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Desai et al. World Journal of Pharmacy and Pharmaceutical Sciences

coming in contact with intestinal ulcered inflamed mucosa resist the chemical and mechanical
injury decreasing local irritation.[5] The healing property enhanced with Anuvasnbasti of
Jatyadi Tail (medicated oil) and Vasa Ghrita (Ghee preparation of Adhatoda vasica).

Shirodhara with Vacha Taila was advised for 1st seven days. Vacha (Acorus calamus) drug
is described under Shirovirechana (cleansing nasal therapy) Gana and Sanghyasthapan
(Restores Consciousness). As per Bhavaprakasha Vacha acts as Medhhya (Brain tonic) and
Vibandhahara (Carminative) because it has Tikta Katu Rasa, Laghu Tikshna Guna.[6] People
with IBS may be more sensitive to emotional troubles, stress and anxiety may make the mind
more aware of spasm in the colon so in present study we gave treatment of Shirodhara for
relieves the anxiety and stress with Vacha Taila(Oil preparation of Acorus calamus).

Panchamruta Parpati described under the Grahaniroga Chikitsaadhyay in

Bhaishajyaratnavali.

According to Ayurveda properties of Panchamruta Parpati includes Deepan (stimulation of

Agni), Pachan (digestive), Grahi (carminative), Laghu (decreases Ama).[7] Ushna Guna and
Deepan properties increases appetite, Grahi property improves absorption of nutritive
material. Takra (butter milk) is best Anupan mentioned in Grahani Chikita. In present case
report, Panchamruta Parpati with Takra as Anupan has been shows significant relief in
symptoms of Grahani Roga (IBS).

Acharya Sadananda Sharma has described properties of Shankha Bhasma in Ras Tarangini.
It is indicated in GIT disorders like Grahani Roga (IBS), Atisara (diarrhea), Amlapitta
(Hyperacidity) and it shows Balya, Grahi (carminative) effects.[8]

Naga Bhasma and Sutshekhar Rasa acts as Grahi and shows Deepan, Pachan properties.

CONCLUSION
In present case study Pichhabasti, Shirodhara, Panchamruta Parpati, Shankha Bhasma,
Naga Bhasma and Sutshekhar Rasa shows significant effect. The overall effect of therapies
showed 91.8% improvement in symptoms. There is no any adverse reaction found with these
drugs. These oral medication and Panchakarma procedures are effective in managing the
symptoms of Grahani(IBS).

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REFERENCES
1. Nicholas A.Boon, Christopher Haslett, Edwin R. Chilvers, John A.A. Hunter, Davidson’s
Principles and Practice of Medicine 18th Edition, Chapter, 9: 668.
2. Ambikadatta Shastri, Hindi commentary, Sushruta Samhita (Uttar Tantra), Atisar Pratised
Adhyay, Choukhamba Sanskrit Sansthan Varanasi; 2012 p.306.
3. Anna Moreshwar Kunte, Krishnashastri Navre, Ashtanghridayam (Sutra Sthana),
Choukhamba Prakashan Varanasi; 2010 p.193.
4. Vidyadhara Shukla, Ravidatta Tripathi, Charak Samhita Vol.II (Chikitsa Sthana),
Grahanichikitsa Adhyay, Choukhamba Sanskrit Pratishthan, Delhi; 2012 p.369.
5. Dongare Parshuram, Baghel Prashant. Integrated Study of Mode of Action of Mocharasa
Basti In Grahani Vyadhi with Special Reference to Inflammatory Bowel Disease.
AYUSHDHARA, 2016; 3[5]: 850-852.
6. Krushnachandra Chunekar, Edited by Gangasahay Pandey, Bhavprakash Nighantu,
Choukhamba Bharati Acadamy, Varanasi; 2015 p.43.
7. Govindas Sen, Hindi commentary by Ambikadatta Shastri, Bhaishajyaratnavali, Grahani
Roga Chikitsa Adhyay, Choukhamba Prakashan, Varanasi; 2016 p.278.
8. Sadananda Sharma, Edited by Pandit Kashinath Shastri, Rastarangini, Motilal
Banarasidas, Delhi; 2014 p.288.

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