Dr. Bakhtyar AsharafiMD 2nd Year

P.G. Deptt. Of kaumarbhrityaR.G.G.P.G. Ayurvedic College Paprola

“Rogaa: sarvepimandaagnou”

The disease in which the grahani gets vitiated and there is impairement of agni is called as grahaniroga.Grahani is the specialised part of the mahasrotsa . Acc. To acharaya sushruta , the 6th

pittdhara kala situated between amasya and pakwasya is called grahani while acharya charakahad mention it as the part being situated above the nabhi,as it is the site of agni and does grahana of anna and it is supported and nourished by the strength of Agni. Hence Agni is to be corrected in all stages of Grahani Roga.

The eating habits, physical activities ,rest and sleeping pattern are the principal factors that influence health and overall wellbeing of a child. An irregular eating pattern implies the intake of meals at different intervals of time, avoiding imp. meals & frequently indulging in fat rich fast food or junk meals causes many problems and one of them is ‘grahani roga’ that has become a global issue and more common in this modernized era.

The disease , although is not life threatening , but causes a great distress to the children and also to their parents.

The most common time of onset of IBD is during the preadolescence/adolescence era and young adulthood. A bimodal distribution has been shown with an early onset at 10–20 yr of age and a 2nd, smaller peak at 50–80 yr of age. 25% of patients present before 20 yr of age. Nonetheless, IBD may begin as early as the 1st yr of life, and an increased incidence among young children has been observed over the past decade.The risk of IBD in family members of an affected individual has been reported in the range of 7–30%; a child whose parents both have IBD has a >35% chance of acquiring the disorder.

Textual reference

Kashyapa Sanhita sutra sthana 25

Charaka Sanhita Chikitsa sthana 15

Sushruta Sanhita Uttartantra

Ashtang Sangrah

Ashtamg Hriday

Nidana

Samanya(general)

Ahara Vyapada Emaciation ViruddhaVega

Vidharana

Vishishtha(specific)

Aaharaj nidan

Emaciated by other disease

Vyapad

Viruddha

( Incompatibility of)

Desha(Country)

Kala (Climate)

Ritu(Season)

Suppression of natural urges (Vega Vidharana)

Samprapti Ghataka of Grahani Dosha• Nidana : Aharaja, Viharaja, Manasika Karanas

• Dosha : Kledaka Kapha, Pachaka Pitta, Saman Vayu

• Dushya : Rasa (Ahara Rasa)

• Agni : Jatharagni-Mandya

• Ama : Amavisha formation at GIT level

• Srotas : Annavaha Srotas, Purishavaha Srotas,Rasavaha Srotas

• Strotodusti : Sanga, Vimarga-gamana, Atipravriti

• Udbhavasthana : Amashaya

• Rogamarga : Madhyama and Bahya Roga Marga

• Vyadhiswabhava : Chirakari

• Adhisthana : Grahani

Nidan sewana

Vitiation of Jatharagni

Vitiation of Grahanistha

doshas

Disturbed functions of

Grahani

GRAHANI DOSHA

Vitiation of JatharVitiati

on of Grahanistha

doshasagni

Vitiation of Jatharagni

Disturbed functions of

Grahani

SAMPRAPTI OF GRAHANI DOSHA IN CHILDREN

Children have

Aniyata-Agni

AparipakwaDhatu

SarvannaAnupasevana

Klesha-Asahishnuta

SAMPRAPTI OF GRAHANI DOSHA IN CHILDREN

Vishamashana, Anashana,

Adhayashana (Aharaja)

Ritu Kala, DeshaVipryaya

Bhaya, Krodha, Udvegaetc

(vhiharaja, mansika)

AGANIDUSHTI

(Manda, Vishama, Tikshana

APACHANA(Indigestion)

AMOTPATTI

SHUKTAPAKA

AMAVISHA

(Localized at GIT level - Generalize

whole body)

GRAHANI DOSHA

Purva Roopa (Premonitory symptoms) of Grahani Dosha:

DIFFERENTIAL DIAGNOSIS

Grahani Atisara Pravahika Visuchika Amatisara

Chirkari Ashukari Ashukari

No Pravahan No Pravahan Pravahan

No blood in stool

Blood may be found in stool

Blood is found in stool

Occ. blood in stool

Amamalapravruti(sometimes)

Amamalapravruti(sometimes)

Amamalapravruti(Always)

Ama may be present in stool

Apakwa amamala pravruti

Karshya & Balakshay

Not much Karshya & Balakshay

If frequency incresesBalakshay

Not much

DIFFERENTIAL DIAGNOSIS

Sr.no.

Grahani dosha Grahni Roga

1 Vikritti is limited to Grahani inparticular.

Vikritti is not limited to a particularAasaya but it is found to bedistributed to other AashayaorSrotasa.

2 The Doshas are in the form ofaccumulation in Ashaya Grahani.

The Dosha are distributed all over thebody.

3 Preliminary stage, Sthanika-dushti,localized pathology.

More advanced stage, deep rootedpathology, it is described asMahagada

Prognosis of Grahani Dosha:

As a general rule the disease Grahani is Krichchha SadhyaVyadhi.According to Acharya Madhava,26 the Asadhya Lakshanas ofGrahani are similar to Asadhya Lakshanas of Atisara viz. Shoola,Pipasa, etc.He also opines that, in Balyavastha, Grahani is considered asSadhya Thus, it can be said that the Dhatus in Balyavastha are inVivardhamana stage, so the structural deformity in the Grahanican be overcome in this particular Vaya Avastha easily. It is alsoevident from the fact that after removal of wheat and rye flourfrom the diet in gluten enteropathy frequently results in anespecially miraculous cure within weeks in children.

UPADRAVA OF GRAHANI DOSHA:

Acharya Harita described six complication of GrahaniRoga viz. 28

• Pliha Yakrita Vriddhi (hepto spleno megaly)• Kandu (Itching)• Mala Bandha (Constipation)• Asthila• Krimi• Udara Roga

In modern science treatment is being done according to the symptoms. If diarrhea predominates then anti diarrheal drugs and if constipation predominates then lactulose along with roughage diet , if abdominal pain predominates then antispasmodic drugs are effective .

In ayurvedaTreatment principals of grahani roga

nidanparivarjana i.e. removal of cause maintenance of dhatus i.e.Dhatusamya

Grahani associated with ama dosha: when the patient having complaint of constipation , excessive salivation , pain in abdomen, heart burn , heaviness then he should be treated with vaman.vamana should be done either lukewarm water , decoction of madanphala and powder of piper and mustard.

Pakavasyasth upchara : the patient should be treated with virechana .the medicine having agni deepana propeties should be added in the virechanayoga.

When apkva ahar rasa is present in all over the body the langhana and paachana medicine should be given.

After the purification of amashaya peya preapared with deepana and paachana dravyas should be given to the patients.

Snehana ,svedana and shoshana , langhna deepana paachana and sangrahni drugs should be given as per the condition of the patients.

PRINCIPLE OF GRAHANI DOSHA CHIKITSA :Acharya Vagbhatta suggested that, all the treatmentmodalities of Ajeerna should be implemented in themanagement of Grahani Ashrita Dosha. He also opines that,Sama and Nirama Avastha should be taken into account asper Atisara Chikitsa.In the management of Grahani Dosha, the fact that along with Agni Mandhya, the Pachana Shakti and PrachushanaShakti of Grahani is deranged. Due to this the ingested diet undergoes Putikriya, and has actions similar to visha, which produces symptomatology of Ama. For this particular stage, Shodhana Chikitsa is preferred, considering the two staged of diseases viz.

‘Amalinganvitam’ and ‘Shariranugate Same’.

Special Use of Takra in Grahani Dosha:The authors of Ayurvedic classics have laid emphasis on the administration of Takra or Takra Siddha Kashaya as the main diet and medicine. Explaining the advantages of Takra over other articles of diet in Grahani Dosha Vagbhata says"Takra is the best diet for patients suffering from Grahani Dosha".As the Takra is Laghu in Guna, possesses Deepana properties and attains Madhura Paka, it does not provoke and increase Pitta; because of Kashaya Rasa, Ushna Veerya, Vikasi and RukshaGunas it is useful in Kapha; as freshly churned Takra is sweet, slightly sour, it will not produce Daha in the Kostha and it is alsoVatahara. The advantage of Takra is that it contains less fat and is easily digestible.Acharya Charaka has also suggested the use of Takra and Takrarishta in the routine treatment of Grahani.Classics have also advocated the use of different kinds of Panas, Takras, Suras and Asavas in the management of Grahani Dosha.

MODERN ASPECT OF DISEASE GRAHANI DOSHAIn the present study a concept of grahani dosha is constructed with the consideration of symptoms like,muhurbaddhamuhurdrava mala pravritti,durgandhita mala pravritti,udara-shoola,kshudhalpata,adhmana,hrillasa etc.as chief complaints. In modern medical science, no disease or condition is exactly similar to grahani dosha, but symptoms like;

• Chronic abdominal pain • Stools with mucous and foul smell• Loss of appetite • Abdominal distension• Failure to thrive. etc.• Flatulence• Belching• Eructation / Salivation• Nausea / Vomiting• Indigestion (Maldigestion)• Chronic loose motion• Constipation• Frequency of loose stool just after meal

Grahani

Irritable bowel disease

Coeliac disease

Tropical sprue

Malabsorptionsyndrome /

Failure to thrive.