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Digestive Health

IBS: Ayurvedic Treatment, Home Remedies, Lifestyle Tips

“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.

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

IngredientsBotanical NameMethod of usingIndications
PutikaranjaHoloptelea integrifoliaThe decoction prepared with these ingredients should be served fresh1. Enhances digestive capacity 2. Cures irritable bowel syndrome & sprue
BilwaAegle marmelos
ChavyaPiper retrofractum
ChitrakaPlumbago zeylanica
Pippali mulaRoots of Piper longum
PunarnavaBoerhavia diffusa
HaritakiTerminalia chebula
GingerZingiber officinale

Read – Pippali – Long Pepper Fruit Uses, Dose, Side Effects

b. Pathyadi Kashayam

IngredientsBotanical NameMethod of usingIndications
HaritakiTerminalia chebulaThe decoction prepared with these ingredients should be served fresh1. Cures all types of intestinal disorders 2. Cures sprue, irritable bowel syndrome
TrikatuPiper longum Piper nigrum Zingiber officinale
PunarnavaBoerhavia diffusa
MustaCyperus rotundus
TurmericCurcuma longa
Karanja dwayaPongamia pinnata and Holoptelea integrifolia
BhangaCannabis sativa
PathaCissampelos pareira
BilwaAegle marmelos
AtivishaAconitum hererophyllum
ShyonakaOroxylum indicum
VachaAcorus calamus
ChitrakaPlumbago zeylanica
ChavyaPiper retrofractum
YavaniTrachyspermum ammi
SarapunkhaTephrosia purpurea

2. Nagara Pippalyadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 49

IngredientsBotanical NameMethod of usingIndications
GingerZingiber officinaleThe decoction prepared with these ingredients should be served fresh with rock salt and powder of cumin seeds1. Kindles digestive fire 2. Cures irritable bowel syndrome and sprue
Pippali mulaRoots of Piper longum
DevadaruCedrus deodara
CoriandrumCoriandrum sativum
Bilwa mulaRoots of Aegle marmelos
PippaliPiper longum

3. Dhanya Bilwadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 50

IngredientsBotanical NameMethod of usingIndications
CoriandrumCoriandrum sativumThe decoction prepared with these ingredients should be served fresh1. Cures intestinal disorders caused by vitiated vata, associated with flatulence and gripping pain in abdomen
BilwaAegle marmelos
BalaSida cordifolia
GingerZingiber officinale
ShalaparniDesmodium 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

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  • Really helpful & clears doubts that usually comes in mind. Thanx alot for Ur article.

    • The above medicines along with bitter principle herbs like Neem, Giloy, Patola etc are useful. The herbs should have anti microbial properties.

      • It may take around 2 weeks to show improvements and around 2 - 3 months time to show marked improvements.

  • What is antra koojana. What is the cause of gurgling sounds in the stomach. I have that a lot. I am vata. Thanks

    • The movement of food and fluid through the gut is a coordinated forceful process. The strong muscle contractions are constantly churning food and pushing it through the gut. Although the normal sounds (borborygmi) are expected after eating a meal, there are times when certain foods and drinks can contribute to louder and excessive sounds yet there is no bowel disease or disorder. One of the major contributors in this regard is carbonated beverages. The increased gas within the bowels contributes further to the gurgling sounds than would be expected.

      Similarly, eating too fast or swallowing air while eating and drinking may also increase gas within the bowels. Some foods are said to be “gassy” because it releases larger amounts of gas when digested in the gut. These gassy foods are known to increase belching and flatulence but the gas within the bowels also causes excessive gurgling and bubbling sounds. Some foods may not be as well tolerated by certain people and the presence of these foods within the bowels may alter normal bowel activity to the extent that more prominent bowel sounds are audible.

    • Please read here - easyayurveda.com/2015/10/30/carpal-tunnel-syndrome/

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