Understanding IBS

Editor’s Note

Dear Readers,

Grahaniroga, the commonest clinical manifestation of gastrointestinal pathology, is emerging as a lifestyle disorder and is encountered frequently in day-to-day practice. Patients generally approach the Ayurvedic system for the therapy only when get exhausted from the incomplete treatments and unwanted complications from conventional medicine, by when the disease condition almost gets intractable. Ayurvedic texts explain Grahani as a Gastro-Intestinal Disorder caused due to the impairment of the Jatharagni (Digestive fire). Irritable bowel syndrome (IBS) has clinical resemblance with that of Grahani, like alternate constipation and diarrhea (Muhurbaddha / Muhurdrava), mucus mixed stools (Sasleshma Mala Pravrtti), etc. In this newsletter, we will see in detail the causes, pathogenesis, symptoms, and Ayurvedic approach to the management of IBS.

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Understanding IBS

Ayurveda works magically even in deadly diseases of this era. Often called Spastic Colitis, Irritable Bowel Syndrome is a disorder of the small and large intestines causing chronic intermittent constipation or diarrhea often associated with varying degrees of abdominal pain. The origin of this condition is not well understood in the West and is very difficult to treat.

Through ayurvedic eyes, the practitioner of Ayurveda comes to understand the nature of their patient multi-dimensionally. Upon doing so, each patient with irritable bowel syndrome will present with a wide variety of imbalances on all three levels. This condition appears to occur most prevalently in those individuals with a Vata Prakriti or vikruti. The severity of the condition is somewhat proportionate to the state of Ojas. When ojas are low, the condition is more severe. As each person is unique, so too will each presentation be unique. There are however many commonalities and from these, the practitioner can come to understand the nature of the disease and develop a plan for managing it. IBS is not a life-threatening condition; however, for those patients with the more severe disease it does have a relatively large impact on quality of life, is leading to the need for medical treatment and work absenteeism with consequent economic costs. Incidence

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder with worldwide prevalence rates ranging from 9–23%. The age distribution is very broad, but 40% of the patients are aged between 35 and 50 years. Symptoms begin before the age of 35 in 50% of patients. Only between 30-70% of “patients” suffering from IBS symptoms are “consulters” with symptoms experienced severe enough as to trigger a physician visit. Significant proportions – 35% to 40% – of individuals who report IBS in the community are male. Approximately 60% to 65% of individuals who report IBS in the community are female.

Grahani roga – IBS: A Clinical Correlation

The pathogenesis of IBS will be confirmed by observing the etiological factors, symptoms, Upashaya (Relieving factors) & complications of the IBS.

Etiological factors

• Pertaining to Ahara – Unwholesome food (Heavy, Coarse food) – Irregular eating

• Pertaining to Vihara – Suppression of natural urges

• Desha-Kala Vaishamya

• Mental Stress (in 70 to 90% of Patients) – Both anxiety & depression can impact the perception of symptoms.

It has rightly been said by Vagbhata that all the ailments of the body, especially diseases of the alimentary tract arise due to the malfunction of Agni. IBS is also one such disease that occurs due to the ingestion of an unwholesome diet causing disturbances in Agni. Psychological factors like the Kama (Lust), Krodha (Anger), Shoka (Grief), etc. lead to Agni dusti (improper function of digestive fire, collectively it is called Grahani Dosha). A careful review of the clinical picture of various GIT diseases, described in Ayurveda reveals that some of the disorders definitely have some clinical symptoms which are also observed in the patients of IBS e.g. Vataja & Kaphaja Atisara, Sangraha Grahani, Pravahika, Pakvashaya gata Vata. But if we take a look into the pathogenesis of all these diseases, there is a stage of Grahani Dosha. So we may consider IBS as Grahani Dosha.

Life is the complex union of Sattva, Atma, and Sharira. Thus, mind, body, and soul influence each other. Charaka has greatly emphasized the need for a healthy mind for the maintenance of good physical health

A description like Achara Rasayana and Sadvritta are available in the literature to illustrate the psychosomatic approach for the prevention and treatment of a disease.

Irritable Bowel Syndrome (IBS) is one of the most common conditions encountered in clinical practice but one of the least well understood. Irritable bowel syndrome is common with a wide variety of presentations having gastrointestinal motility disorder that places a substantial burden on patients and society. Symptoms of this disorder are chronic, sometimes severe, and often respond poorly to treatment with traditional approaches, resulting in reduced quality of life. Because structural, physical, or biochemical markers cannot be used to identify either disorder, diagnosis is symptom-based. In the absence of alarming features suggestive of organic disease or secondary causes of symptoms, these disorders can be positively and confidently diagnosed. Until, recently, many physicians did not consider IBS to be a disease at all; they viewed it as nothing more than a somatic manifestation of psychological stress. Stress shows no discrimination on the basis of either age, sex or occupation it strikes everyone, and unfortunately more & more young people buckle down under it. IBS according to Ayurveda can be considered as a disorder where there is a derangement of Vata in Pakvashaya (intestine) especially of Apana Vayu leading to Symptoms of pain in the abdomen & altered bowel habits. Mandagni (Decreased Digestive fire) leads to Vitiation of Doshas. The emotions like Krodha (anger), Shoka (grief), Bhaya (fear), etc. cause vitiation of Vata. Thus, disturbance in mental health directly affects the gastrointestinal tract

Ayurvedic Approach to the management of IBS

Many formulations are explained in classical texts having their efficacy on gastrointestinal disorders. The line of treatment of Grahani mentioned in Ayurveda texts is the same as Atisara (Diarrhea) and Ajirna (Indigestion) that is the use of Grahi (Bowel binding), Dipana (Appetizing), and Pachana (Digestive) herbs and foods. Also, Piccha Basti is explained as one of the treatment methods in Atisara. Piccha Basti cures excess bowel movements and duodenal disorders. Medhya Rasayana group of drugs described in ancient literature is the molecular nutrients for the brain and claimed to relieve mental fatigue, anxiety, and stress at the psychological and neuroendocrine levels. Since IBS is a psychosomatic disorder, Medhya Rasayana added to the principal therapy proves effective in all cases of IBS.

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