“Doctor, whenever I get ready to go out, I’m getting the urge to defecate, whenever I finish breakfast, I get the urge”- these kinds of patient’s presentations are quite common in IBS. Irritable bowel syndrome (IBS) is a functional disorder of the small intestine characterized by the abdominal pain, discomfort followed with altered bowel habits – hard or soft bowels.
Usually, structural abnormalities cannot be detected in such instances. It is one among the commonly diagnosed functional disorder of the digestive system. Surely this will not kill the individuals; but the discomfort caused by this illness causes great distress to the patients and life becomes miserable with fatigue. Many people tend to lose weight over a period of time.
In modern medicine they denote the contribution of hereditary factors, enteric infections, inflammatory action of the small intestine, altered food habits etc in this disease. Stress, depression, anxiety etc do play important role in the causation of this disease.
In Ayurveda, a similar condition is explained in the name of Grahani or Sangrahani. The name is given so because according to Ayurveda, Grahana (Retaining ability) is the function of Grahani organ (Small intestine in general and Duodenum in particular). As this function is significantly altered and bowel loses its control to retain for stipulated time period, according to ones requirement of absorption, this condition is called Grahani.
Table of Contents
IBS – C – Constipation Remedies
IBS C is considered as Pitta dominant. This type of IBS clinically shows the presence of heartburn, thirst, feeling hot, irritable or angry, inflammation, sweating and fever, fluid, and foul smelling stools and eructation.
The diet should include:
• The use of Buttermilk (takra) is emphasized.
• Indigestible foods such as bread; cheese; and cold, hard, and raw foods should be avoided. Herbs like ginger, fennel, and cumin that stimulate enzyme secretions will improve digestion, absorption, and clear ama from the digestive tract.
• Prefered food items are Eat old rice, jawar, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, wood apple, Pomegranate, nutmeg, skimmed milk, buttermilk, hot water.
• Avoid foods items such as maize, barley, pigeon pea, pea, cow pea, black gram, gram, Soya bean, potato, sweet potato, onion, coconut, groundnut, chili, oily food, chicken, mango, pineapple, apple, watermelon, cashew, pumpkin gourd, papaya, fig, jack fruit
The following changes in lifestyle help to control IBS:
• Identify and remove food intolerances — Because grains are a common culprit, an elimination diet should be tried.
• Restore a healthy balance of bacteria in the gut -Use of buttermilk (takra) is emphasized.
• Mind–body therapy — Complete rest, adequate sleep is advisable and day sleep, awakening at night, tension, suppression of urges should be avoided.
The following herbs are used in this type of IBS for their respective benefits:
• Amalaki
• Coriander water cools pitta
• Musta (Cyperus rotundus) improves intestinal absorption and stops diarrhea.
• Aloe vera juice
• Guduchi (Tinospora cordifolia)
• Sweet, bitter, and astringent foods are best.
How to control IBS with Ayurvedic diet and lifestyle?
Causes
Causes for IBS as per Ayurveda – Grahani Hetu:
Ayurvedic classics point out following reasons for the manifestation of Grahani-
Abhojana – excessive fasting
Ajeerna bhojana – Eating before the digestion of previously taken food, Having food during indigestion.
Ati bhojana – excessive food intake
Vishama bhojana – Improper food
Asatmya bhojana – Unwholesome food
Guru bhojana – Heavy food intake
Sheeta bhojana – Cold food intake
Rooksha ahara – Dry and junk food
Dushta bhojana – polluted food intake
Vegadharana – suppression of natural urges (read more about it)
Vireka vibhrama – Improper Virechana (purgation) treatment
Sneha vibhrama (Improper oleation therapy)
Swapna viparyaya – Improper sleep, staying awake at night and sleeping during day
Shoka – Grief
Krodha – Anger
Bhaya – Fear
Vyadhi karshana – suffering due to chronic illness, leading to lowered digestion strength
Deasha vaishamya – Migration/Travel
Kala Vaishamya – Change in the season
Pathology
Pathology of Grahani (IBS):
Usually Irritable bowel syndrome is triggered by a stomach event – such as stomach infection, a bout of unhealthy meals, a stressful event, etc.
Due to the above said causative factors Vata is affected in intestines. (Specifically, Samana type of Vata is affected.) It hinders digestion and absorption strength of intestines.
Intestines fail to perform their normal functions of –
Anna grahana – receiving the food from stomach),
Pachana – digestion
Vivechana – Separation of nutritive matters and waste products,
Munchana – Pushing of remnants to its exterior-large intestine.
Thus the Grahani disease is caused.
Prodromal features
Prodromal features of Grahani(IBS):
Praseka – nausea, excessive salivation
Aruchi – tastelessness, anorexia
Annasya chirat paka – delayed digestion
Vidaha – burning sensation
Chardi – vomiting
Adhmana – bloating, distention of abdomen
Asya Vairasya – altered taste in tongue
Trisha – excessive thirst
Klama – fatigue
Bhrama – giddiness
Antra koojana – Gurgling sound in the stomach
Features
Cardinal feature of Grahani (IBS):
Muhurbaddha and muhurdrava pravritti – occasional hard and soft stools.
Features of Grahani(IBS):
Ayurveda explains signs and symptoms of IBS based on Dosha dominance:
Vataja Grahani
Abdominal pain, increased frequency of stool, altered bowel habit, distention of the abdomen, flatus, head ache, debility, chest pain etc
Pittaja Grahani
Burning of the chest, belching, head ache etc
Kaphaja Grahani
Stool with mucus, sensation of incomplete evacuation of the bowel, nausea, vomiting, flatus, heaviness of abdomen
Sannipatja Grahani
all the three Doshas are involved.
Mixed features of all the doshas, lack of concentration, severe debility. This stage is also called as Samgrahani.
In this condition,all features of IBS like gurgling sound in the abdomen, fatigue, bowel with flatus or mucus, tenesmus (constant urge to pass stools), intermittent episodes, increased frequency of bowel in the day time are found.
Modern classification
IBS is classified as –
IBS D – where diarrhoea is the predominant symptom
IBS C – with constipation
IBS A – alternating diarrhoea and constipation
Complications
Complications of Grahani(IBS) according to Ayurveda:
Jwara (fever)
Aruchi (anorexia)
Atisara (diarrhoea)
Kasa (cough)
Avipaka (indigestion)
Kushtha (shin diseases)
Pandu (anaemia)
Gulma (gaseous tumors)
Shoola (abdominal pain)
Shwayathu (oedema)
Arsha (haemorrhoids)
Bhrama (vertigo)
Parikartika (fissure in anus)
Bhagandara (fistula in ano).
Note: Charaka Samhita, Chikitsa sthana, 19th chapter explains Shokaja Atisara. It is a type of diarrhoea, due to stress and anxiety. It can be compared to IBS – D. He explains that such a type of Atisara should be treated with Vata balancing therapies and medicines.
Line of treatment
Line of treatment in IBS:
The medicines should have following qualities:
Deepana – carminative property,
Pachana – digestive,
Sangrahi – intestinal restorative, which increases absorption capacity of intestines
Laghu – lightness.
Herbs used
Herbs useful in Grahani (IBS):
Pomegranate
Kutaja- Holarrhena antidysenterica
Musta- Cyperus rotundus
Dhataki- Woodfordia fruticosa
Patha- Cissampelos pareira
Lodhra- Symplocos racemosa
Pushkaramoola-Inula racemosa
Chavya- Piper chaba
Daruharidra- Berberis aristata
Shalmali- Shalmalia malabarica
Lajjalu- Mimosa pudica
Ayurvedic medicines
Ayurvedic medicines for IBS:
Mustakarishtha – used to treat digestive complaints like diarrhoea, indigestion, etc.
Kutajarishta – used in the treatment of diarrhoea, dysentery, IBS etc.
Pippalyasavam – used for a variety of conditions. It is used in the treatment of anemia, piles, digestive complaints, sprue, liver complaints. It is also used as a medicine to put on weight.
Dantyarishta – used in the treatment of haemorrhoids, constipation, gastric, intestine and spleen related diseases.
Dadimadyavaleha – used in treating fever with diarrhoea, bleeding disorders, such as ulcerative colitis, abdominal colic.
Kutajavaleha – used in the treatment of piles,ulcerative colitis, diarrhoea, IBS, anaemia, bleeding disorders, gastritis, inflammatory conditions.
Sanjeevani vati – used in Ayurvedic treatment of dyspepsia, indigestion, gastro-enteritis etc.
Kamdudha Ras – used in treating gastritis and bleeding diseases
Jeerakarishtam –used post natal care, in the treatment of frequent passing of stools, diarrhoea, indigestion etc
Bilvadi gutika – used in Ayurvedic treatment of insect bites, rodent bites, gastro enteritis etc. It is widely used in South Indian Ayruvedic practice.
Chitrakadi vati – It improves digestion power.
Brihat gangadhara choorna – It is used in the Ayurvedic treatment for Diarrhoea and gastro intestinal conditions.
Pushyanuga choorna – used in the Ayurvedic treatment of Menorrhagia, Metrorrhagia, Leucorrhoea, Menstrual disorder, Excessive menstrual bleeding of various aetiology.
Jirakadi Modak – used in treatment of diseases of digestive tract.
Bilvarishtha
Bilvasava
Takrarishtha
Ayurvedic home remedies
Home remedies for Grahani (IBS):
1.Cumin seeds and tender leaves of Guava are taken and made into fine paste.20 gram of this is taken along with buttermilk twice daily.It helps to reduce the frequency of episodes of bowel habit.
2.The fruit cover (epicarp) of Pome granate is rubbed well with lemon juice and fine paste is made.This is taken twice daily along with warm water.This restores the capacity of small intestine.
Wholesome diet and habits
Wholesome diet and habits in Grahani (IBS):
Regular intake of buttermilk
Cumin seeds
Pomegranate
Warm water
Easy-to-digest foods
Moderate exercise
Proper sleep
In many, fibre rich diet is very useful to relieve symptoms.
According to Yogaratnakara:
Green gram
Rice which is harvested in sixty days
Pigeon pea
Honey
Milk, curd, ghee and butter of goat
Wood apple
Curd devoid of butter
Bael fruit
Banana – fruit&flower
Pomegranate
Scum of parched grain
Water caltrop
Small fishes
Meat of Black buck, Partridge, Quail, Rabbit and other carnivorous animals
Unwholesome diet and habits
Unwholesome diet and habits in Grahani (IBS):
Dadhi (Curd)
Madya (Alcohol)
Shukta (Acidic beverages)
Jagarana (Night awakening)
Vegadharana (Suppression of the urges)
Aniyata asana (Improper posture)
Upavasa (Fasting for longer period)
Sodas, junk foods, regular hotel foods.
Foods that cause excess gas production and bloating such as potato, egg plant, cabbage, broccoli, cauliflower
According to Yogaratnakara:
Foods which are unctuous, hard, heavy to digest
Foods that which cause ama (undigested metabolic waste)
The patient is asked to prepare a list of foods that trigger an IBS attack and is asked to avoid them.
Rasaushadhis
Grahani Kapata rasa
Rasa parpati
Loha parpati
Svarna Parpati
Vijaya Parpati
Panchamrit Parpati
Addition By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Effective Decoctions For Grahani From Sahasrayogam
1. Grahanihara Kashayam
Ref – Sahasrayogam, Kashaya Prakaranam, 37
a. Putikadi Kashayam
| Ingredients | Botanical Name | Method of using | Indications |
| Putikaranja | Holoptelea integrifolia | The decoction prepared with these ingredients should be served fresh | 1. Enhances digestive capacity 2. Cures irritable bowel syndrome & sprue |
| Bilwa | Aegle marmelos | ||
| Chavya | Piper retrofractum | ||
| Chitraka | Plumbago zeylanica | ||
| Pippali mula | Roots of Piper longum | ||
| Punarnava | Boerhavia diffusa | ||
| Haritaki | Terminalia chebula | ||
| Ginger | Zingiber officinale |
Read – Pippali – Long Pepper Fruit Uses, Dose, Side Effects
b. Pathyadi Kashayam
| Ingredients | Botanical Name | Method of using | Indications |
| Haritaki | Terminalia chebula | The decoction prepared with these ingredients should be served fresh | 1. Cures all types of intestinal disorders 2. Cures sprue, irritable bowel syndrome |
| Trikatu | Piper longum Piper nigrum Zingiber officinale | ||
| Punarnava | Boerhavia diffusa | ||
| Musta | Cyperus rotundus | ||
| Turmeric | Curcuma longa | ||
| Karanja dwaya | Pongamia pinnata and Holoptelea integrifolia | ||
| Bhanga | Cannabis sativa | ||
| Patha | Cissampelos pareira | ||
| Bilwa | Aegle marmelos | ||
| Ativisha | Aconitum hererophyllum | ||
| Shyonaka | Oroxylum indicum | ||
| Vacha | Acorus calamus | ||
| Chitraka | Plumbago zeylanica | ||
| Chavya | Piper retrofractum | ||
| Yavani | Trachyspermum ammi | ||
| Sarapunkha | Tephrosia purpurea |
2. Nagara Pippalyadi Kashayam
Ref – Sahasrayogam, Parishishta Prakaranam, 49
| Ingredients | Botanical Name | Method of using | Indications |
| Ginger | Zingiber officinale | The decoction prepared with these ingredients should be served fresh with rock salt and powder of cumin seeds | 1. Kindles digestive fire 2. Cures irritable bowel syndrome and sprue |
| Pippali mula | Roots of Piper longum | ||
| Devadaru | Cedrus deodara | ||
| Coriandrum | Coriandrum sativum | ||
| Bilwa mula | Roots of Aegle marmelos | ||
| Pippali | Piper longum |
3. Dhanya Bilwadi Kashayam
Ref – Sahasrayogam, Parishishta Prakaranam, 50
| Ingredients | Botanical Name | Method of using | Indications |
| Coriandrum | Coriandrum sativum | The decoction prepared with these ingredients should be served fresh | 1. Cures intestinal disorders caused by vitiated vata, associated with flatulence and gripping pain in abdomen |
| Bilwa | Aegle marmelos | ||
| Bala | Sida cordifolia | ||
| Ginger | Zingiber officinale | ||
| Shalaparni | Desmodium gangeticum |
Yogas from Sahasra yoga text book
Tiktaka Ghrita
Mahatiktaka Ghrita
Patha karanjadi Ghrita
Laghu Gangadhaa Choorna
Yavanyadi Choorna
Patoladi choorna
Kayampurandaradi Choorna
Nimbadi Choorna
Nagaradi Choorna
Kapitthashtaka Choorna
Dadimashtaka Choorna
Modakadi Choorna
Solari Choorna
Sudha Kandadi Kshara
Jeerakadyarishta
Dasamoolarishta
Kutajarishta
Mustakarishta
Dantyarishta
Devadarvyarishta
Pippalyasava
Lohasava
Agasthya Rasayana
Danti Hareetakyavaleha
Charngeri Rasayana
Kutajadyavaleha
Lavangadyam modakam
Setu bandha matra
Paccha Endiyadi Gutika
Sankhapani Rasa
Ananda Rasa
Kanakasundara Rasa
Ashtakshari Gutika
Punkin toladi Ghrita
Mental aspects to IBS
Usually IBS is related with psychaitric aspects. A patient with IBS usually suffers from anxiety or depression. In such a case, along with efforts to restore digestive health with the above said remedies and medicines, treatment to depression /anxiety should also be given.
Hence treatments like
Shirodhara treatment (pouring medicated liquid over forehead in a stream), Regular Pranayama, is very useful.
Pranayama (Learn how to do pranayama)
Lifestyle adjustments such as – sleeping and waking up at regular intervals, moderate exercise, Yoga, stress management techniques are very useful.
Health indeed is the real wealth. When you are in the pink of health, in stead of wasting the gift with alcohol, smoking, irregular sleep and diet habits, inculcate discipline in your routine with right food choices, Yoga, Pranayama etc. These will help you to keep diseases like IBS at bay.
Article by Dr MS Krishnamurthy and Dr Hebbar
