Grahani is the seat of Agni and it is so called because of holding up the food. The term Grahani Dosha implies the malfunctioning of Agni. Improper digestion of ingested food causes Grahani Dosha. If left untreated it finally leads to Grahani Roga. Muhurbadha and Muhurdrava Mala Pravrutti is the main Lakshana and associated with symptoms like Udarashoola, Arochaka, Sharirika Balakshaya, Asthi Parvashoola, Avipaka etc. As Agnimandya is the main cause, the first line of treatment is to correct the Dusti of Agni. Shuntyadi Churna and Mustakadi Churna have the qualities of Deepana, Pachana, Grahi, etc. and can be used in Sarvagrahani Chikitsa. This study is undertaken to clinically analyze the independent effect of Shuntyadi Churna and Mustakadi Churna in Grahani Roga. The study shows that both Shuntyadi Churna and Mustakadi Churna are effective in relieving the symptoms of Grahani Roga

Dr. K. G. Muddapur

Dr. Uma A. Patil

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

   ISSN: 2456-3110                                                    ORIGINAL ARTICLE July-Aug 2018  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2018 | Vol. 3 | Issue 4 9  A comparative clinical study to evaluate the efficacy of Shuntyadi Churna & Mustakadi Churna in the management of Grahani Roga w.s.r. to Irritable Bowel Syndrome  Dr. K. G. Muddapur,1 Dr. Uma A. Patil2 1Post Graduate Scholar, 2Associate Professor, Department of Kayachikitsa, BLDEA’s AVS Ayurveda Mahavidyalaya, Vijayapur, Karnataka, India.                   INTRODUCTION Ayurveda attributes its prime importance to maintain health in healthy individuals and alleviation of diseases in ailing populace.[1] In Ayurveda, Grahani Dosha is one among the Mahagadas. In modern science, Grahani Dosha is included into digestive disorders. Due to modern life style, disorders are increasing day by  day. Due  to  irregular  consumption  of  food, junk  Address for correspondence:  Dr. K. G. Muddapur Post Graduate Scholar, Department of Kayachikitsa,  BLDEA’s AVS Ayurveda Mahavidyalaya, Vijayapur, Karnataka, India. E-mail: preeti.sonar1990@gmail.com  Submission Date : 13/07/2018 Accepted Date: 19/08/2018 Access this article online Quick Response Code Website: www.jaims.in  DOI: 10.21760/jaims.v3i4.13277 food and untimely habit gastro-intestinal problems are most common in society.  The organ Grahani is the seat of Jatharagni (digestive fire) both are interrelated. It’s supported and nourished by the strength of Agni. Normally, it receives the ingested food, which is retained by restraining the downward movement (Grahanati). After digestion it releases the food through sides of lumen to next Ashaya i.e. Pakwashaya. In abnormal conditions due to weakness of Agni, it gets vitiated and releases food in indigested form. When Agni is not proper the food will not get digested properly and this undigested food gets fermentation and acts like poison in the body. It’s called Ama. Ama Utpatti leads to Grahani Dosha.[2] Agnimandhya is important factor in the Samprapti of the disease Grahani Dosha. This disturbs the normal flora of GI tract and weakens the muscles and acid fluid configuration of GI tract. So Prasad Bhaga of food is not formed properly so nourishment of whole body does not occur. Because of this the people may suffer from gastro intestinal A B S T R A C T  Grahani is the seat of Agni and it is so called because of holding up the food. The term Grahani Dosha implies the malfunctioning of Agni. Improper digestion of ingested food causes Grahani Dosha. If left untreated it finally leads to Grahani Roga. Muhurbadha and Muhurdrava Mala Pravrutti is the main Lakshana and associated with symptoms like Udarashoola, Arochaka, Sharirika Balakshaya, Asthi Parvashoola, Avipaka etc. As Agnimandya is the main cause, the first line of treatment is to correct the Dusti of Agni. Shuntyadi Churna and Mustakadi Churna have the qualities of Deepana, Pachana, Grahi, etc. and can be used in Sarvagrahani Chikitsa. This study is undertaken to clinically analyze the independent effect of Shuntyadi Churna and Mustakadi Churna in Grahani Roga. The study shows that both Shuntyadi Churna and Mustakadi Churna are effective in relieving the symptoms of Grahani Roga.  Key words: Agni, Grahani, Shuntyadi Churna, Mustakadi Churna, Irritable Bowel Syndrome. Dr. K. G. Muddapur et.al. Evaluation of the effect of  Shuntyadi Churna & Mustakadi Churna in Grahani Roga ISSN: 2456-3110                                                    ORIGINAL ARTICLE July-Aug 2018  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2018 | Vol. 3 | Issue 4 10  disorders like indigestion loss of appetite, irregular bowel movements, ulcers etc.[3] These factors affecting people will not only disturb the growth and development of physical health of it but its activities, social behavior, immunity and concentration power too. If above mentioned problems remained untreated or unnoticed, they may turn in to its related complications. According to modern science, this disease can be understood under the context of Irritable bowel syndrome characterized by abdominal pain and altered bowel habits with no particular structural pathology of the gastrointestinal tract. This syndrome is most frequent in women between the age of 20-40 years.[4] About 15% of the general population has symptoms that justify a diagnosis of IBS; in western series, female patients predominate, in South Asia and in India, most reporting patients are young men.[5] So it should be mainly treated for Agnivardhana by drugs with Deepana (which enhances digestive power) and Pachana (digestive) qualities. Ayurveda considers that the dysfunction of Agni is responsible for undigested food which is responsible for various functional and structural defects in the gastro-intestinal tract. According to modern science, this disease can be understood under the context of Irritable Bowel Syndrome characterized by abdominal pain and altered bowel habits with no particular structural pathology of the gastro-intestinal tract.  Grahani is the seat of Agni and it is so called because of holding up the food. The term Grahani Dosha implies the malfunctioning of Agni. The main pathology lies in the Dusti of Agni due to change of modern lifestyle, taking improper, junk and unwholesome food the Agni gets vitiated. In Grahani Roga, due to Dushita Jatharagni the food gets undigested. Undigested food forms a vitiated material called Ama, which is responsible for producing various disorders.  In Ayurveda, Acharya Charaka has given a vivid description about Grahani Roga. Acharya Sushruta and Vagbhata, also has thrown a very good light on Grahani Roga. Grahani is considered under Ashta Maharoga - and very difficult to treat. OBJECTIVES OF THE STUDY A comparative clinical study to evaluate the efficacy of Shuntyadi Churna and Mustakadi Churna in the management of Grahani Roga w.s.r. to irritable bowel syndrome. MATERIALS AND METHODS Study design: It is a randomized clinical study design where a minimum of 30 patients fulfilling the inclusion criteria were included in the study. Sample size: Minimum of 30 patients fulfilling inclusion criteria were selected and registered for the study. Diagnostic Criteria Patients with classical signs and symptoms of Grahani Dosha are taken for the study.  Muhurbadda Muhurdrava Mala Pravrutti  Arochaka (loss of taste)  Sharirika Balaksahya (weakness)  Asthi and Parva Vedana (bone pain)  Alasya (fatigue)  Tamaka (dizziness)  Atisara (diarrohea) Inclusion Criteria  Patients within the age group of 17-60 years.  Patients were selected randomly irrespective of their caste, religion and sex. Exclusion Criteria  Patient with associated systemic disorders like tuberculosis, malignancy and other complications.  Patients suffering from acute diarrhea, ulcerative colitis, gastric and peptic ulcers, intestinal obstruction.  Pregnant and lactating women. Dr. K. G. Muddapur et.al. Evaluation of the effect of  Shuntyadi Churna & Mustakadi Churna in Grahani Roga ISSN: 2456-3110                                                    ORIGINAL ARTICLE July-Aug 2018  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2018 | Vol. 3 | Issue 4 11  Posology Group A:  Sample size : 15 patients   Procedure : Shuntyadi Churna 3 gm BID 30 minutes before food with Jala.   Duration : 30 days Group B:  Sample size : 15 patients   Procedure : Mustakadi Churna 3 gm BID 30 minutes before food with Madhu.  Duration : 30 days Assessment Criteria A case proforma was prepared for the assessment of signs and symptoms by grading them. The obtained data was tested for statistical significance. OBSERVATION AND RESULTS Effect of therapy in Group A In Group A therapy, there was 78.79% improvement in the symptom of Muhurbaddha / Muhurdrava Mala Pravriti (p<0.001). Marked improvement was noted in Alasya (90.00%, p<0.01), Atopa (88.89%, p<0.001), Arochaka (85.71%, p<0.01), Udara Shoola (81.48%, p<0.001), Sense of incomplete evacuation (70.97%, p<0.001) and Sharirika Balakshaya (70.00%, p<0.001).  There was complete resolution in the symptoms of Atisara (100.00%, p<0.1) and Shleshma Mala Pravriti (100.00%, p<0.1). Amongst all symptoms, least improvement was noted in Swaroopa of Mala (58.75%, p<0.01) and Asthiparva Shoola (52.38%, p<0.001). Effect of therapy in Group B In Group B therapy, there was 74.29% (p<0.001) improvement in the symptom of Muhurbaddha / Muhurdrava Mala Pravriti. Significant improvement was noted in Arochaka (83.33%, p<0.001), Atisara (80.00%, p<0.05), Sense of incomplete evacuation (75.86%, p<0.001), Atopa (73.08%, p<0.001), Alasya (71.43%, p<0.02) and Udarashoola (62.96%, p<0.001).  There was complete resolution in the symptom of Shleshma Mala Pravriti (100.00%, p<0.1). Amongst all symptoms, least improvement was noted in the symptoms of Swaroopa of Mala (53.10%, p<0.02), Sharirikbalakshaya (47.62%, p<0.01) and Asthiparva Shoola (36.36%, p<0.01). DISCUSSION In the present study a total 32 subjects of Grahani Roga were selected from OPD and registered for the treatment. Out of which 30 patients completed the full duration of treatment, while 2 patients were drop outs. It was observed from the study that maximum subjects of Grahani Roga, 15 (50.00%), presented in the third decade of life (Age group: 21-30 years) followed by 8 (26.67%) subjects in fourth decade of life (Age group: 31-40 years). In the third and fourth decade of life people have busier and stressed life span, so they usually indulge in unwholesome regimen e.g. Adhyashana, Vishamashana, Ratrijagarana, Diwasvapana etc. This leads to inequilibrium of Tridosha mainly Shamana Vayu, Pachaka Pitta and Kledaka Kapha. Anxiety and stress badly affects function of Agni so that function of Grahani gets disturbed and they produce Grahani Roga.  The present study suggests that females (60%) are more prone to Grahani Roga than males (40%). Out of 30 subjects, 18 females were registered and 12 males were registered for this study. This may be due to more family stress and burden of household chores, untimely meals, etc. Hence they are more prone to gastrointestinal disorders like Grahani Roga. Among enrolled subjects 63.33% were married and 33.33% were unmarried which suggests that disease is more prominent in married people. Although there is no relation between the Grahani Roga and Marital status but due to increased stress and hurry-burry life they are more prone to be affected with this disease. Among enrolled subjects, it was observed that 40.00 % subjects were housewives and 26.67% were students, 20% service class, 10% business man and 3.33% belonged to labour class. Today’s stressful and hectic life styles play a role in development of Dr. K. G. Muddapur et.al. Evaluation of the effect of  Shuntyadi Churna & Mustakadi Churna in Grahani Roga ISSN: 2456-3110                                                    ORIGINAL ARTICLE July-Aug 2018  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2018 | Vol. 3 | Issue 4 12  Grahani. Sedentary life style produce Mandagni, whereas hectic lifestyle produce Vishamagni. Both states of Agni are responsible for Grahani Roga. In the present study, it was observed that 46.67% subjects were vegetarian and 53.33% belonged to Non-vegetarian group which suggests that the disease is some what more prominent in non-vegetarian group.  The Non-vegetarian diet contains Ati-guru, Ati-snigdha etc. elements in high concentrations compared to vegetarian food, which as per the Grahani Nidana are the factors responsible for Grahani Dosha. This study shows 43.33% subjects were taking timely meals as compared to 56.67% who were taking untimely meals. Vishamasana is one of the main reasons for development of Grahani Roga. Suppressing the hunger (Vegavarodha) may lead to vitiation of Agni which is directly proportional to Grahani. In the present study, Muhurbaddha / Muhurdrava Mala Pravrutti, sense of incomplete evacuation, Udara Shoola and Atopa were chief complaints in 100% subjects, while Asthiparvashoola was found in 90%, Sharirika Balakshaya in 86.67%, Arochaka in 66.67%, Lohagandhi Tiktaamlaudgara in 56.67%, Alasya in 46.67% patients, Atisara in 23.33%, Shleshmamala Pravrutti in 33.33% subjects. Tamaka Shwasa was not found in any of the subject. These all are the cardinal symptoms of Grahani Roga. Faulty dietary habit, mental disturbance and sleeping pattern etc. are the etiological factors, due to these factors there is vitiation of Tridosha and by these Agni is vitiated which leads to vitiation of Grahani that results in symptoms of Grahani Roga. Effect of therapy in Individual group In group A therapy, there was 78.79% improvement in the symptom of Muhurbaddha / Muhurdrava Mala Pravrutti. Marked improvement was noted in Alasya (90.00%), Atopa (88.89%), Arochaka (85.71%), Udarashola (81.48%), Sense of incomplete evacuation (70.97%) and Sharirika Balakshaya (70.00%). There was complete resolution in the symptoms of Atisara (100.00%), Shleshma Mala Pravrutti (100.00%) and Swaroopa of Mala (58.75%), Amongst all symptoms, least improvement was noted in Asthiparva Shoola (52.38%). In group B therapy, there was 74.29% improvement in the symptom of Muhurbaddha / Muhurdrava Mala Pravrutti. Significant improvement was noted in Arochaka (83.33%), Atisara (80.00%), Sense of incomplete evacuation (75.86%), Atopa (73.08%), Alasya (71.43%) and Udarashoola (62.96%). Swaroopa of Mala (53.10%). There was complete resolution in the symptom of Shleshma Mala Pravrutti (100.00%). Amongst all symptoms, least improvement was noted in the symptoms of Sharirika Balakshaya (47.62%) and Asthiparva Shoola (36.36%). CONCLUSION The vitiation of Agni (Mandagni) is the Pradhanakarana for Grahani. The other Nidanas such as Adhyashana, Vishamasana are Nimitta Karanas. Persons habituated to continuous intake of either of the three Rasa, two Rasa, or even one Rasa are more prone to diseases, which is evidently shown in present study of Grahani Roga. Shuntyadi Churna and Mustakadi Churna contains drugs that act through Deepana and Pachana Prakriya. Shuntyadi Churna and Mustakadi Churna demonstrated beneficial effects in Grahani Chikitsa. REFERENCES 1. Charaka Samhita of Agnivesha with Ayurveda dipika commentary; Vaidya Harish Chandra Kushavaha,  Chaukhambha Orientalia Varanasi: Vol 1: 495 2. Tripathi Brahmanand. Charaka Samhitha.Reprinted, Varanasi: Chaukhambha Surabharati Prakashan; 2007. Vol2 p560. 3. Agnivesha, Charaka Samhita, Acharya Vidyadhar Shukla and Prof. Ravi Dutt Tripathi: Chaukhambha Sanskrit Pratisthan, Delhi, vol2 p.369. 4. Davidsons Principals and Practice of Medicine, Christofer Edwards, 17th edition pg no.471. 5. API textbook of medicine, Yash Pal Munjal;Jaypee Brothers Medical Publishers 9th edition, 2012 pg no.820. Dr. K. G. Muddapur et.al. Evaluation of the effect of  Shuntyadi Churna & Mustakadi Churna in Grahani Roga ISSN: 2456-3110                                                    ORIGINAL ARTICLE July-Aug 2018  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2018 | Vol. 3 | Issue 4 13  6. Yogaratnakara, Pandit Sadashiva Shastri: Jaya Krishna Das Haridas Gupta: 219 7. Bhava Prakasha of Shri Bhava Mishra: Pandit Brahma Shankara Misra: Chaukambha Sanskrit Bhavan, Varanasi: 38       ******************************* How to cite this article: Dr. K. G. Muddapur, Dr. Uma A. Patil. A comparative clinical study to evaluate the efficacy of Shuntyadi Churna & Mustakadi Churna in the management of Grahani Roga w.s.r. to Irritable Bowel Syndrome. J Ayurveda Integr Med Sci 2018;4:9-13. http://dx.doi.org/10.21760/jaims.v3i4.13277  Source of Support: Nil, Conflict of Interest: None declared. 

A comparative clinical study to evaluate the efficacy of Shuntyadi Churna & Mustakadi Churna in the management of Grahani Roga w.s.r. to Irritable Bowel Syndrome

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A comparative clinical study to evaluate the efficacy of Shuntyadi Churna & Mustakadi Churna in the management of Grahani Roga w.s.r. to Irritable Bowel Syndrome

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