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Grahani Chikitsa (view source)

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|titlemode=append

|keywords=Digestion in Ayurveda, metabolism in Ayurveda, jatharagni, bhutagni, dhatvagni, grahani, grahanidosha, grahani roga, annavisha, atyagni, samashana, vishamashana, adhyashana

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|description=Chikitsa Sthana Chapter 15. Management of Grahani (~~Digestive Disorders~~)

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|description=Chikitsa Sthana Chapter 15. Management of Grahani (Diseases of digestion and metabolism)

}}

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<big>'''[[Chikitsa Sthana]] Chapter 15. Management of Grahani (~~Digestive Disorders~~) </big>'''

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<big>'''[[Chikitsa Sthana]] Chapter 15. Management of Grahani (Diseases of digestion and metabolism) </big>'''

<big>'''Abstract </big>'''

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[[Grahani Chikitsa]] consists of three parts. The first part explains the concept of normal digestion process. The second part describes the abnormal digestion and third part is about diseases caused by abnormality of digestive ~~fire~~ and its interaction with proximal intestine or ''grahani''. These disorders are called ''grahanidosha''.

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[[Grahani Chikitsa]] consists of three parts. The first part explains the concept of normal digestion process. The second part describes the abnormal digestion and third part is about diseases caused by abnormality of digestive factors and its interaction with proximal intestine or ''grahani''. These disorders are called ''grahanidosha''.

''Agni'' (digestive and metabolic agents), based on their specific functions of conversion of food into biological elements of the body are classified into thirteen types. First, the ''jatharagni'' is most important because it is the initiator of digestive process and it strengthens the digestive ability of other twelve ''agnis''. Five ''bhutagnis'' transform the ''panchmahabhauika'' components of ''ahara rasa'' created by ''jatharagni'' into different structures of the body. Seven ''dhatvagnis'' create seven tissues elements(''dhatu'').

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Secondly, ''pandu roga'' is due to ''alpata'' of ''raktaposhaka sara bhaga'' (Chakrapani Ca. Ci. 16/3-7) and, one of the main causes of this ''alpata'' is mal-digestion and mal-absorption which takes place in ''grahani''. It is well known fact, that various contributory factors for blood formation have their absorption in gastrointestinal tract such as folic acid, vitamin B12, iron, etc which if not absorbed causes anemia this is the reason why Charak has placed this chapter in between ''arsha'' and ''pandu roga''.

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===Sanskrit Text, Transliteration and English Translation===

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== Sanskrit Text, Transliteration and English Translation ==

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</div></div>

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Now we shall ~~describe~~ the chapter ~~on the management~~ of ~~''grahani dosha'', so~~ said ~~respectable~~ Atreya [1-2]

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Now we shall expound the chapter "Grahani Chikitsa" (Management of diseases of digestion and metabolism). Thus said Lord Atreya. [1-2]

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==== Importance of ''dehagni'' ====

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=== Importance of ''dehagni'' ===

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The food one consumes becomes capable of nourishing the body tissues and of promoting the ''ojas'' (vital essence), strength, complexion etc., only in the presence of normally functioning ''agni''. In the absence of normal digestion (and metabolism), the normal body tissues such as ''rasa'' cannot be formed nor nourished [5]

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==== Process of digestion-first phase ====

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=== Process of digestion-first phase ===

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The ingested food is carried to ''koshtha'' by ''prana vata''. The food disintegrates because of the liquids, and further it becomes soft because of the fatty substances. The ''samana vata'', that has an inherent ability to intensify the ''agni,'' intensifies the digestive enzymes and properly digests the food that one consumes timely and in an appropriate quantity, thus leading to longevity. This process of digestion by ''agni'' in the gut which leads to the formation of ''rasa'' and ''mala'' is comparable to the process of cooking of the raw rice kept in an earthen vessel containing water on a fire [6-8]

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==== Three states of digestion and provoking ''dosha'' ====

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=== Three states of digestion and provoking ''dosha'' ===

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When the ''pakva'' part (the non-absorbable remnant part after the absorption of the nutrients), reaches the ''pakvashaya'' (the colon), the drying effect of ''agni'' converts it into a solid mass. There also occurs the release of ''vata'' which is ''katu'' (pungent) state [9-11]

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==== Second phase of digestion by ''pancha-mahabhuta'' ====

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=== Second phase of digestion by ''pancha-mahabhuta'' ===

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Specific categories of entities in the body having specific attributes can be nourished by only those substances that belong to the same category having those same attributes. This means that ''parthiva'' entities in the body (one that is dominated by ''prithvi mahabhuta'' in its composition) can be nourished only by the ''parthiva'' substances in the food and so on. The same rule applies to the whole body [14]

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==== Third phase of digestion and metabolism at level of ''dhatu'' ====

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=== Third phase of digestion and metabolism at level of ''dhatu'' ===

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''Rakta'' is produced after ''rasa'' and then ''mamsa''. After ''mamsa'' the ''medas'' is formed and then ''asthi'' is produced. After ''asthi'' the ''majja'' is derived and then ''shukra'' is produced and finally fine ''shukra'' leads to ''garbha'' [16]

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==== ''Upadhatu'' (metabolic products) ====

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=== ''Upadhatu'' (metabolic products) ===

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''Stanya'' (breast milk) and the menstrual blood are derived after rasa. ''Kandara'' (tendon) and ''sira''(vein) are derived after ''rakta''. ''Vasa''(muscle fat) and the six layers of ''tvacha'' (skin) are derived after ''mamsa'' (muscle) and ''snayu''(ligament) are derived after ''medas'' (adipose tissue) [17]

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==== ''Mala'' formed at tissue level metabolism ====

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=== ''Mala'' formed at tissue level metabolism ===

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The feces and the urine are the ''kitta'' (non-nutrient portion/waste portion/byproduct) of ingested food. The ''kitta'' of ''rasa'' is ''mala-kapha'' (excretions). ''Mala-pitta'' (bile pigment) is the ''kitta'' of ''rakta''. ''Kha-mala'' (the wastes accumulated in the hollow structures of the body such as external ears and nostrils) are the ''kitta'' of ''mamsa''. ''Sweda'' (sweat) is the ''mala'' of ''medas''. ''Kesha'' (hairs on the head) and ''loma'' (body hair) are the ''mala'' of ''asthi''. The ''mala'' of ''majja'' is the oily excretion of the eye and the skin (sebum). Thus, the ''dhatus'' continuously undergo two kinds of transformation: ''prasada'' (nutrient portion) and ''kitta'' (non-nutrient portion). This entire sequence of transformation and metabolism of ''dhatu'' is thus inter dependent [18-19½]

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==== Modes of transformation ====

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=== Modes of transformation ===

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How is it that a rough ''asthi'' is formed out of smooth structures such as ''mamsa'' and ''meda''? How does the soft and fatty ''majja'' form out of rough structures such as ''asthi''? If at all ''shukra'', which is present everywhere in the body is formed out of ''majja'' that is located inside the ''asthi'', how does it come out as one cannot see pores on ''asthi''? [22-26]

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==== Formation of ''rasa'' and ''rakta'' ====

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=== Formation of ''rasa'' and ''rakta'' ===

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The nourishment fluid formed, known as ''rasa'', undergoes transformation by the ''ushma'' (heat) of ''pitta'' and gets converted into the red colored tissue known as ''rakta'' [27-28]

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==== Formation of ''mamsa dhatu'' ====

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=== Formation of ''mamsa dhatu'' ===

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Due to the action of heat along with the ''vata, ambu'' (water) and ''tejas,'' the ''rakta'' is converted into stable ''mamsa,'' after being acted upon by its own ''agni'' (''mamsadhatvagni'') [29]

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==== Formation of ''meda dhatu'' ====

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=== Formation of ''meda dhatu'' ===

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Because of the action of ''medo-dhatvagni'' on the excessively dominant ''snigdha'' attribute of aṃbu, the ''medo-dhatu'' is formed [29½]

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==== Formation of ''asthi dhatu'' ====

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=== Formation of ''asthi dhatu'' ===

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Because of the action of ''asthi dhātvagni'' on the aggregation of ''prithvi, agni'' and ''anila'', roughness is attained during the formation of the ''asthi'' [30]

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==== Formation of ''majja dhatu'' ====

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=== Formation of ''majja dhatu'' ===

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''Vata'' produces hollowness inside the ''asthi dhatu'', and after which, these hollow cavities get filled up by fatty tissue which is known as ''majja'' [31]

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==== Formation of ''shukra dhatu'' ====

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=== Formation of ''shukra dhatu'' ===

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The ''sneha'' (fatty) portion of ''majja'' produces shukra. The porosity in the ''asthi'' is produced because of the factors such as ''vata'' and ''akasha.'' ''Shukra'' comes out of ''asthi'' through these pores just as the water comes out of a new earthen vessel. Through the channels known as ''shukravaha srotamsi'', this ''shukra'' spreads all over the body. This ''shukra'' is discharged through the urethra (which is connected to the urinary bladder) because of several factors such as sexual excitation, reflex activities (''vega''), and mental determination (''samkalpa''). Just as the ghee moves out with ease when heated, the ''shukra'' too, is discharged due to the heat liberated during the sexual activity. This process of seminal discharge is comparable with the movement of water from a place of lower altitude to a place of higher altitude) [32-35]

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==== Continuous circulation of ''rasa'' all over the body ====

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=== Continuous circulation of ''rasa'' all over the body ===

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Because of being forcefully propelled (out of the heart) by the action of ''vyana vata'', the ''rasa dhatu'' spreads all over the body simultaneously, continuously and for the entire life [36]

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==== Significance of ''Kha-Vaigunya'' (abnormality in body system) in causing disease state ====

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=== Significance of ''Kha-Vaigunya'' (abnormality in body system) in causing disease state ===

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Thus ends the description of the physiological functions of ''bhutagni, dhatvagni'' and ''jatharagni'' [38]

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==== Significance of ''jatharagni'' ====

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=== Significance of ''jatharagni'' ===

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An individual should take utmost care to maintain the ''agni'' by providing fuel in the form of food and drinks which should be taken as per the rules mentioned, because life and strength of an individual depends on ''agni'' [40]

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==== Initiation of ''grahani dosha'' ====

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=== Initiation of ''grahani dosha'' ===

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If an individual indulges in food without following the rules and regulation of diet intake, then he quickly suffers from diseases caused by the vitiation of ''grahani'' because of his greedy habits. Such diseases are being described henceforth [41]

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==== Causes of vitiation of ''agni'' ====

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=== Causes of vitiation of ''agni'' ===

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This vitiated digestive agent forms an intermediate substance called ''ama'', which turns sour (''shukta'') during fermentation and finaly turns in poisonous substance (''amavisha'') [44]

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==== Signs and symptoms of ''ajirna''(indigestion) ====

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=== Signs and symptoms of ''ajirna''(indigestion) ===

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This poisonous substance (''amavisha'') manifests clinical features like flatulence, uncomfortable physical and mental miseries, headache, altered consciousness, giddiness, stiffness of back and lumbar region, yawning, body-ache, malaise, morbid thirst, fever, vomiting, tenesmus, anorexia and indigestion and it is similar to antigenic poison. [45-46]

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==== Associated disorders of ''annavisha'' ====

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=== Associated disorders of ''annavisha'' ===

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The ''annavisha'' when enters renal system, urine related disorders occur; similarly, ''kukshigata roga'' (ailments related to abdomen) have their origin when ''sakrita'' (feces) is involved. ''Rasadi pradoshaja vikara'' (tissue related ailments) occur when ''rasadi srotas'' are involved [47-49]

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==== Effects of ''Vishamagni'' (irregular ''agni'')and ''tikshanagni''( excessive ''agni'') ====

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=== Effects of ''Vishamagni'' (irregular ''agni'')and ''tikshanagni''( excessive ''agni'') ===

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The ''vishamagni'' (improper ''agni'') causes irregularity in digestion and therefore defective formation of ''dhatu'' takes place whereas, ''tikshanagni'' (excessive ''agni'') when associated with little quantity of fuel (in the form of food) causes depletion of ''dhatu'' (tissue elements) [50]

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==== ''Samagni'' ====

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=== ''Samagni'' ===

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If ''agni'' is ''sama'' i.e. in balanced condition and correct diet regimen (as explained in Ca. Su. 5 and Ca.Vi.1/21) are also followed then there is proper digestion of food which helps in maintaining proper balance within the ''dhatu'' [50½]

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==== ''Durbala'' (weak) ''agni'' ====

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=== ''Durbala'' (weak) ''agni'' ===

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''Durbala'' (weak) ''agni'' brings about partial digestion of food. These partially digested bio substances then enter in circulation, which may move either in upward or downward direction [51]

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==== ''Grahani gada''(diseases of ''grahani'') ====

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=== ''Grahani gada''(diseases of ''grahani'') ===

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In this condition the individual may pass stools in excessive quantity or frequency wherein stools may be loose, with thin consistency or in the form of pellet like stool/bound stool (''vibaddham'') and morbid thirst, anorexia, distaste, excessive watering of mouth, blackout, edema of legs and hands, pain in bones and finger joints, vomiting, fever, eructation having either metallic smell or undigested food and having bitter or sour taste are observed [52-54]

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==== Premonitory symptoms of ''Grahani gada'' ====

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=== Premonitory symptoms of ''Grahani gada'' ===

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Premonitory signs and symptoms are thirst, malaise, diminution of strength, burning sensation; delay in digestion and heaviness in body [55]

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==== Functions of ''grahani'' ====

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=== Functions of ''grahani'' ===

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''Grahani'' is seat of ''agni'' and it is so called since it holds/retains the food (for proper digestion and assimilation). It holds the food just above the umbilical region and it is supported and nourished by the ''agni''. ''Grahani'' with help of ''agni'' holds the undigested food and pushes forward digested food, but when ''agni'' becomes weak and vitiated due to ''vidagdha ahara murchita dosha'' (afflicted by improperly digested food) i.e ''sama dosha''(''dosha'' associated with ''ama'') it vitiates the ''grahani'' and releases food in the form of ''ama'' i.e. undigested form [56-57]

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==== Four types of ''grahani'' disease ====

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=== Four types of ''grahani'' disease ===

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''Grahani'' is classified into four types viz ''vataja, pittaja, kaphaja'' and ''sannipataja''. On the basis of the classification, etiological factors, symptoms and signs are being mentioned one by one [58]

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==== Causes of ''vataja grahani'' ====

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=== Causes of ''vataja grahani'' ===

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Excessive indulgence in diet having ''katu'' (pungent), ''tikta'' (bitter), ''kashaya'' (astringent) dominant food, which is dry in nature or having absorptive or emaciative qualities; cold, chilled or frozen items, eating quantitatively less amount of food, suppression of natural urges and excessive sexual intercourse contribute to aggravation of ''vata dosha'' which encompass the ''agni'' causing suppression of ''agni'' [59½]

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==== Symptoms of ''vataja grahani'' ====

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=== Symptoms of ''vataja grahani'' ===

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Stools are evacuated with difficulty and consume time. Feces are either watery, dry, small sized associated with flatus and undigested food. Frequency of stool is increased and patient may suffer from cough and breathing difficulty [60-64]

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==== Causes of ''pittaja grahani'' ====

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=== Causes of ''pittaja grahani'' ===

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''Katu'' (spicy), ''ajeerna'' (undigestable food), ''vidahi'' (food causing eructation), ''amla'' (sour), ''kshara'' (alkali) and other food items which aggravate ''pitta'' are causes for ''pittaja grahani''. The aggravated ''pitta'' hampers the function of ''agni'' similar to condition wherein hot water extinguishes fire [65]

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==== Symptoms of ''pittaja grahani'' ====

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=== Symptoms of ''pittaja grahani'' ===

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The stools have undigested food particles having either bluish-yellowish tinge or yellow in color and are loose/watery. The eructions have foul smell and sour taste, there is burning sensation in the cardiac region (retro-sternal) and throat, anorexia and thirst are the symptoms of ''pittaja grahani'' [66]

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==== Causes of ''kaphaja grahani'' ====

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=== Causes of ''kaphaja grahani'' ===

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Heavy to digest or excessively unctuous foods, frozen or chilled items or food having cold nature or food which has qualities similar to ''kapha'', excessive intake of food and sleeping just after the meals hamper the function of ''agni'' and simultaneously vitiates ''kapha'' [67]

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==== Symptoms of ''kaphaja grahani'' ====

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=== Symptoms of ''kaphaja grahani'' ===

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Four types of ''agni'' have been previously explained in [[Roganika Vimana]]. Except ''samagni'' other three types of ''agni'' contribute to the ''grahani dosha'' [71]

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==== ''Sannipataja grahani'' ====

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=== ''Sannipataja grahani'' ===

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''Sannipataja grahani'' occurs by simultaneous vitiation of ''vata, pitta'' and ''kapha''. In such conditions etiological factors, symptoms and signs are of all the three ''dosha'' appear. Hereafter treatment of ''grahanidosha'' is expounded [72]

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==== ''Vamana'' in ''grahanidosha'' ====

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=== ''Vamana'' in ''grahanidosha'' ===

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When the ''doshas'' are located in ''grahani'' and are associated with incomplete digested food then ''vishtambha'' (constipation), excessive salivation, bodyache, burning sensation, anorexia and heaviness is felt by patient which are symptoms of ''ama'' and in such a condition ''vamana'' (emetic therapy) with lukewarm water or with decoction of ''madanaphala'' (Randia spinosa), ''pippali'' (Piper longum) and ''sarshapa'' (Brassica campestris) should be administered [73-74]

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==== Treatment of ''leena dosha'' ====

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=== Treatment of ''leena dosha'' ===

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If the ''ama'' is in ''pakvashaya'' and in ''anutklishtha'' (stuck, not ready to come out) condition then ''stravana'' (increasing secretion) with ''deepana dravyas'' should be administered whereas if ama gets absorbed along with ''rasa dhatu'' and if it pervades throughout the body then ''langhana'' and ''pachana'' should be advised [75]

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==== ''Panchakoladi shritam and peya'' ====

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=== ''Panchakoladi shritam and peya'' ===

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In patients with ''vataja grahani'' after ascertaining that ''ama'' is digested, medicated ghee starting with very minimum quantity prepared from ''deepaneeya gana'' be administered [Ca.Su.4/9/6]- [77]

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==== ''Niruha basti'' ====

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=== ''Niruha basti'' ===

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As stimulation of ''agni'' is observed and still if patient finds difficulty in passing stool, urine and flatus then in such condition every two or three days ''niruha basti'' should be administered after proper ''snehana'' and ''swedana'' [78]

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==== ''Virechana'' ====

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=== ''Virechana'' ===

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After ''niruha'', the ''strasta dosha'' (''dosha'' ready to come out) should be cleaned with purgative drugs like ''eranda taila'' (castor oil) or ''tilvaka ghrita'' mixed with ''kshara'' (medicine with alkaline nature) [79]

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==== ''Anuvasana basti'' ====

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=== ''Anuvasana basti'' ===

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After appropriate administration of ''niruha, virechana'' and ''anuvasana'', light diet should be taken daily and ghee should be taken repeatedly [81]

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==== ''Dashamooladya ghrita''====

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=== ''Dashamooladya ghrita''===

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Boil the ''svarasa'' of two ''panchamoola'' (''brihat'' and ''laghu''), ''sarala'' ((''trivrita'') Operculina turpethum), ''devadaru'' (Cedrus deodara), ''nagara'' (Zingiber officinale), ''pippali'' (Piper longum), ''pippalimoola, chitraka'' (Plumbago zeylanica), ''gajapippali'' (Piper retofractum), ''sanabeeja'' (seeds of Crotalaria juncea), barley, ''kola, kulatta'' and ''susavi'' (Woodfordia fruticosa) with ''aranala, dadhimanda'' or ''sauviraka''. After one fourth reductions add one ''adhaka'' (3.073 kg) of ghee and ''svarjikakshara'' and ''yavashukakshara'' as per ''yukti pramana'' i.e. either in small quantity or at the time of ''ghrita siddhi lakshana'' alongwith ''saindhava'' (rock salt), ''audbhida'' (salts derived from plants), ''samudra'' (table salt), ''bidha'' (red granular salt), ''romaka, sauvarchala'' and ''pakya'' (''pakaja'') types of salt in two ''pala'' quantity each (96 gm each). After preparation, it may be administered up to one ''prasrita'' i.e. 96 gm. It increases ''agni'', strength and complexion and helps in alleviation of ''vata'' and thus digestion of food [82-86]

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==== ''Tryushanadya ghrita'' ====

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=== ''Tryushanadya ghrita'' ===

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Prepare paste of ''trikatu'' and ''triphala'' in quantity of one ''bilva'' and add one ''pala'' (48g) of jaggery and do ''sneha siddhi'' by adding eight ''palas'' (384 gm) of ghee. This medicated ''ghrita'' is indicated in ''mandagni'' i.e. low digestive power [87]

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==== ''Panchamooladya ghrita'' and ''choorna'' ====

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=== ''Panchamooladya ghrita'' and ''choorna'' ===

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In condition such as ''kapha avrite vata'' (''vata'' occluded by ''kapha''), ''sama kapha'' and ''vata'' aggravated due to ''kapha'' give the above ''choorna'' for digestion and to stimulate ''agni''. The medicine is known as ''panchamooladyam ghritam choornam'' [88-93]

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==== Examination of feces ====

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=== Examination of feces ===

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Patient should be evaluated for ''amadosha'' whether ''samata'' or ''niramta'' is present or not and then appropriately treated with ''pachana'' etc. treatment [95]

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==== ''Chitrakadya gutika'' ====

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=== ''Chitrakadya gutika'' ===

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''Chitraka, pippalimoola,'' two ''kshara'' (''yavakshara'' and ''sarjikshara''), salt, ''trikatu, hingu, ajamoda'' and ''chavya'' are mixed together and trichurated with either ''matulunga svarasa'' or ''dadima svarasa'' and tablets are prepared. This ''chitrakadya guthi'' is useful for digestion of ''ama'' and stimulation of the ''agni'' [96-97]

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==== Recipes for ''pachana'' of ''ama'' ====

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=== Recipes for ''pachana'' of ''ama'' ===

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''Kalinga, hingu, ativisha, vacha, sauvarchala'' and ''haritaki'' with warm water is useful in vomiting, ''arshogranthi'' (analpolyp with pellet stool) and pain in abdomen. Similarly, combination of ''haritaki, sauvarchala'' and ''ajaji'' along with maricha can be used for same condition [101-102]

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==== Recipe for ''pitta-kapha grahani'' ====

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=== Recipe for ''pitta-kapha grahani'' ===

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''Choorna'' of ''pippali, nagara, patha, sariva, brihatidvayam'' (''brihati, kantakari''), ''chitraka,'' seeds of ''kutaja'', five types of ''lavana'', along with ''yavakshara,'' curd, hot water and different types of fermented liquids such as ''kanji, sauviraka'' etc is taken for increasing the power of ''agni'' and to eliminate the ''vata'' in abdomen [106-107]

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==== ''Marichadya choorna'' ====

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=== ''Marichadya choorna'' ===

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Make powder of one ''prastha'' (768 gm) of four ''amla'' drugs, three ''pala'' (144 gm) of ''trikatu'', four ''pala'' (192 gm) of ''lavana'' (''saindhava'') and eight ''pala'' (384 gm) of sugar and mix together. It is to be taken with vegetable preparations such as soup cooked food and ''raga'' for cure of cough, indigestion, anorexia, dyspnea, heart disease, anemia and pain in abdomen [111]

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==== Five types of ''yavagu'' ====

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=== Five types of ''yavagu'' ===

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Make paste of ''chavya, tvak, pippalīmūla, dhātakī, trikatu, chitraka, kapittha, bilva, pāṭhā, sālmali, gajapippalī, slōdbhēda'' (''shilajeet'') and ''ajājī,'' each taken in quantity equal to ''badara'' (about 6 gm). Fry it in ghee and prepare ''yavāgu'' by adding curd or ''svarasa'' of ''kapittha'' or ''chukrikā'' or ''vrikshāmla'' or ''dadima''. It helps in curing all types of ''atisara, grahani, gulma, arsha'' and ''pleeha'' disease [112-114]

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==== Beverages ====

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=== Beverages ===

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Patient may be given buttermilk, ''aranala'' (sour drink), ''madya'' (medicated alcohol) and ''arishtha'' as liquid diets [115-116]

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==== Qualities and benefits of buttermilk ====

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=== Qualities and benefits of buttermilk ===

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Buttermilk due to its ''dīpana, grahi'' (substances which increases appetite and digestive power and absorb fluid from the stool) and easy to digest actions is very useful in ''grahanidosha''. It is ''madhura'' in ''vipaka'' therefore reduces ''pitta''; due to ''kashaya'' (astringent) taste, ''ushna virya'' (hot potency), ''vikashi'' and ''ruksha guna'' it is useful in ''kapha'' dominated disorders and due to ''madhura'' and ''amla rasa, sandra guna'' it reduces ''vata''. Freshly churned butter milk does not cause burning sensation; therefore, buttermilk is very useful in treatment of ''udara, arśa'' and all ''grahanidosha'' [117-119]

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==== ''Takrarishtha'' ====

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=== ''Takrarishtha'' ===

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Take ''yavani, amalaki, haritaki'' and ''maricha'' each in three ''pala'' (144 gm) and ''pancha-lavana'' in one ''pala'' (48 gm) and powder together and add buttermilk to it and ferment till sour taste is obtained. This preparation called ''takrarishtha'' stimulates the digestive power and relieves ''sotha, gulma, arsha, krimi, prameha'' and ''udara roga'' [120-121]

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==== Management of ''pitta'' dominant ''grahani'' ====

+

=== Management of ''pitta'' dominant ''grahani'' ===

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If ''agnimandyata'' is due to ''utklishtha'' (ready to come out) ''pitta'' in its own place then in such a situation ''virechana'' or ''vamana'' should be administered for removal of ''pitta'' [122]

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==== Diet after ''shodhana'' ====

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=== Diet after ''shodhana'' ===

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Pomegranate having sour taste should be taken along with ghee, ''deepana'' and ''grahi dravyas''. With help of powders of ''deepaniya'' drugs and ghee fortified with bitter drugs, the digestive power should be increased (123-124).

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==== ''Chandanadya ghrita'' ====

+

=== ''Chandanadya ghrita'' ===

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''Tikta ghrita'' as mentioned in [[Kushtha Chikitsa]] [Ca.Ci.7/140-150] may also be prescribed in ''pittaja grahani'' [128]

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==== ''Nagaradya churna'' ====

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=== ''Nagaradya churna'' ===

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Take equal quantity of ''nagara, ativisha, musta, dhataki, rasanjana,'' bark and fruit of ''vatsaka, bilva, patha'' and ''katuki'' and powder together, is known as ''nagaradya churna'' explained by ''krishnatreyena''. It is to be taken along with honey and ''tandulodaka'' (rice water, prepared cold) by patient suffering from ''paittika grahani'' with bloody stools, hemorrhoids, pain in anal area and dysentery. [129-131]

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==== ''Bhunimbadya churna'' ====

+

=== ''Bhunimbadya churna'' ===

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The combination of ''vacha, ativisha, patha, saptaparna, rasanjana, syonaka, udeechya, kathvanga'' (type of ''syonaka'' having small fruits), bark of ''vatsaka, duralabha, darvi, parpataka, patha, yavani, madhushigru,'' leaf of ''patola, siddhartha, yuthika,'' fresh new leaf of ''jati,'' seeds of ''jambu'' and ''amra'', pulp of ''bilva'' and leaves and fruits of ''nimba'' is useful in all condition as mentioned for ''bhunimbadya churna'' [134-136]

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==== ''Kiratadya churna'' ====

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=== ''Kiratadya churna'' ===

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Mix powder of ''kiratatikta, shadgrantha, trayamana, trikatu, chandana, padmaka, usheera,'' bark of ''darvi, katurohini,'' bark and fruit of ''kutaja, mushta, yavani, devadaru, patola,'' leaves of ''nimba, ela, saurashtra, ativisha, tvak,'' seeds of ''madhushigru, murva'' and ''parpataka'' and prescribe it as linctus prepared with honey or may be taken with water or alcoholic preparation. This preparation is known as ''kiratadyam churna'' whih cures ''hridaya roga, pandu, grahaniroga, gulma, shula, aruchi, jwara, kamala, sannipatika'' type of diarrhea and eight types of ''mukharoga'' [137-140]

−

==== Treatment of ''kaphaja grahani'' ====

+

=== Treatment of ''kaphaja grahani'' ===

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Soup of dried radish or ''kulatha'' is to be given regularly and repeatedly. Food which is easy to digest should be fortified with ''katu, amla, kshara'' and ''lavana rasa''. Patient should take such foods which are easy to digest, along with buttermilk slightly sour or ''takrarishtha, madira'' (medicated alcoholic preparation), ''madhvarishtha'' or well prepared ''seedhu'' [144-145]

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==== ''Madhukasava'' ====

+

=== ''Madhukasava'' ===

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In the same manner fermentation of ''svarasa'' of ''draksha'' (grapes), sugarcane and date palm is helpful for the patient [150-151]

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==== ''Duralabhasava'' ====

+

=== ''Duralabhasava'' ===

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Boil two ''prastha'' (1.53 kg) each of ''duralabha'' and ''amalaki'', one ''mushthi'' each of ''danti'' and ''chitraka'' and two hundred matured fruits of ''haritaki'' in four ''drona'' (48.88 kg/l) of water and reduce to one ''drona'' (12.228 kg/l). When it comes to room temperature add two hundred ''pala'' (9600 gm) of jaggery and one ''kudava'' (192 gm) of honey as well as powder of ''priyangu, pippali'' and ''vidanga'' each in one ''kudava'' (192 gm) and keep in jar pasted with ghee on the inner wall for period of fifteen days. This preparation is known as ''duralabhasava'' and is indicated in ''grahani, pandu, arsha, kushtha, visarpa'' and ''prameha''. It promotes voice and complexion and cures ''raktapitta'' and other ''kaphaja'' disorders [152-155]

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==== ''Moolasava'' ====

+

=== ''Moolasava'' ===

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Boil five ''pala'' (240 gm) each of ''haridra,'' two types of ''panchamoola'' i.e. ''brihat'' and ''laghu panchamoola, veera'' (''shatavari''), ''rishabhaka, jeevaka'' in four ''drona'' (48.88 kg/l) of water and reduce to one ''drona'' (12.22 kg/l); to this add two hundred ''pala'' (9600 gm) of jaggery and half ''kudava'' (96 gm) of honey as well as powders of ''priyangu, musta, manjishtha, vidanga, madhuka, plava,'' and ''sabaraka lodhra'' and fermented for a fortnight. This ''mulasava'' does ''deepana'' and is effective in ''raktapitta, anaha, kaphaja vikara, hridroga, pandu'' and ''angasada'' [156-159]

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==== ''Pindasava'' ====

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=== ''Pindasava'' ===

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One ''prastha'' of ''pippali'' is mixed with jaggery and seed pulp of ''bibhitaki'' and to it one ''prastha'' of water is added and kept in a vessel covered with ''yava'' (barley) for fermentation; this is called as ''pindasava''. One ''pala'' (48 gm) of ''pindasava'' is mixed with one ''anjali'' (192 gm) of water and is given to patient. It is helpful in earlier mentioned disorders. Even a healthy person may take this preparation for period of one month and take unctuous and liquid diet (mainly soups). It helps in prevention of genesis of disease [160-162]

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==== ''Madhvarishtha'' ====

+

=== ''Madhvarishtha'' ===

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''Satpala ghrita'' (Ca.Ci. 5/147-148) and ''bhallataka ghrita'' (Ca.Ci.5/143-146) as explained in [[Gulma Chikitsa]] may also be administered [170]

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==== ''Ksharaghrita'' ====

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=== ''Ksharaghrita'' ===

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''Pippali, pippalimoola, patha, chavya, indrayava, nagara, chitraka, ativisha, hingu, svadamishthra'' (''gokshura''), ''katurohini'' and ''vacha'' are taken in one ''karsha'' (12 gm) quantity each. To this one ''pala'' (12 gm) of ''panchalavana'' is added along with two ''prastha'' of curds and two ''kudava'' (384 gm) of ''taila'' and ''ghrita''. The combination is boiled till water is completely evaporated. It is again burned by ''antaradhooma'' method and the end product is powdered and mixed with ghee its dosage is one ''panitala'' and when medicine gets digested patient is advised to take sweet diet. It is indicated in ''vata kaphaja'' disorders and in ''visha'' and ''gara visha'' [173-176]

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==== ''Kshara'' preparations ====

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=== ''Kshara'' preparations ===

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Two types of ''haridra'' (''haridra'' and ''daruharidra''), ''vacha, kuṣṭha, chitraka, kutaki'' and ''musta'' after mixing in goat's urine are burned and ''kshara'' is prepared as per ''kshara kalpana''. It helps in increasing ''agnibala'' [182]

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==== ''Ksharagudika'' ====

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=== ''Ksharagudika'' ===

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Four ''pala'' (192 gm) of stems of ''sudha'', three ''pala'' (144 gm) of three types of ''lavana'' i.e. one ''pala'' (48 gm) each of ''saindhava, sauvarchala'' and ''bida'', one ''kudava'' (192 gm) of ''vartaki,'' eight ''pala'' (388 gm) of ''arka'' and two ''pala'' (96 gm) of ''chitraka'' are burned and the ''kshara'' thus prepared is triturated with ''svarasa'' of ''vartaku'' and pills are prepared. Its administration after food helps in quick digestion and useful in ''kasa, shvasa, arsha, vishuchika, pratishyaya'' and ''hridroga''. This preparation is called ''ksharagudika'' and is propounded by ''krishnatre'' [183-185]

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==== ''Chaturtha-kshara'' ====

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=== ''Chaturtha-kshara'' ===

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''Vatsaka, ativisha, patha, duhasparsha, hingu'' and ''chitraka'' should be powdered together and mixed with ''palashagrakshara''. It is cooked in cow’s urine in an iron pan till it becomes semisolid. Its dosage is one ''kola'' (6 gm) to be taken with lukewarm water or with ''madya'' (medicated alcohol). It is indicated in ''grahanidosha, shotha, arsha'' and ''pandu''. The preparation is known as ''chaturtha kshara'' [186-187]

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==== ''Panchamakshara'' ====

+

=== ''Panchamakshara'' ===

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It is one among the best stimulants of ''agni''. Once the medicine is digested ''mamsarasa'' or sweet diet or milk should be administered. This ends the explanation of the ''panchamakshara'' [188-193]

−

==== Treatment of ''tridoshaja grahani''====

+

=== Treatment of ''tridoshaja grahani''===

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''Snehana, swedana, shodhana, langhana, deepana,'' various powder preparation of ''lavana, kshara, madhvarishtha, surasava,'' various ''takra'' preparation, ''deepaniya ghrita'' are to be prescribed to the ''grahanidosha'' patient [196-197]

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==== Treatment of various states of disease and ''dosha'' aggravation ====

+

=== Treatment of various states of disease and ''dosha'' aggravation ===

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If ''agnimandya'' has been chronic and patient has become indolent, weak and emaciated then soup of ''prasaha'' group of animals (animals who snatch their food) fortified with ''amla'' drugs is advised. As this meat soups are light for digestion having penetrating, hot, purifying qualities stimulates the ''agni''. Further as the animals feed on other animals their meat ''mamsa'' is well nourished and compact therefore causes quick nourishment [209-210]

−

==== Factors affecting status of ''agni'' ====

+

=== Factors affecting status of ''agni'' ===

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Management of ''mandagni'' has been explained previously henceforth management of ''ativriddha agni'' will be explained [214-216]

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==== ''Samprapti'' of ''atyagni'' ====

+

=== ''Samprapti'' of ''atyagni'' ===

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Digestive power can be pacified by taking foods and drinks which are heavy to digest, unctuous, cold, sweet and liquid same way as fire is extinguishes by water in nature. The patient should be administered food at regular interval although previously eaten meal is undigested so that ''atyagni'' due to lack of fuel does not digest the tissues [220-222]

−

==== Management of ''atyagni'' ====

+

=== Management of ''atyagni'' ===

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When ''dhatus'' are in equilibrium ''anna'' gets digested resulting in increase in nutrition, longevity and strength [232-234]

−

==== Improper dietary habits ====

+

=== Improper dietary habits ===

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All the above three are causes for death or give rise to serious disorders [235-236]

−

==== Variation in digestion as per day-night cycle ====

+

=== Variation in digestion as per day-night cycle ===

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In the night, the channels are closed, so is the heart which functions at slow rate as demand is less, the ''apakva ahara rasa'' increases in viscosity; thus ''ama'' adheres to the ''dhatus'' and if another food is taken the indigestion causes more ''apakva ahara rasa'' causing disease. The condition resembles, wherein uncooked milk mixed with warm milk gets spoiled. Therefore, a wise person should not take meals if food taken at night is not digested; this will surely effect strength and life of a person [241-243]

−

==== Summary ====

+

=== Summary ===

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== Vidhi Vimarsha (Applied Inferences ) ==

−

==== Importance of ''agni'' ====

+

=== Importance of ''agni'' ===

The functions of gut are vital for maintenance and preservation of health. ''Grahani'' is the seat of ''jatharagni'', which is the initiator of digestive process and strengthens the other 12 ''agnis''. ''Jatharagni'' transforms food into biological substance (''ahara rasa'') which is further trifurcated into ''madhura, amla'' and ''katu avastha paka'' which gets transformed into three biological energies ''kapha, pitta'' and ''vata'' respectively. From the physiological point of view, the ''jatharagni'' or the active form of ''pachaka pitta'' is responsible for the digestion of all kinds of foods in the gut. Therefore, this should include all amylolytic, proteolytic and lipolytic enzymes secreted by various kinds of exocrine glands in the gut, which actually cause digestion, i.e., breaking down of different macromolecules into their constituent units.

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Thus, the three major stages of the catabolism (involving fats, carbohydrates and proteins) i.e. digestion, intermediary metabolism and Kreb’s cycle - seem to represent the three sets of ''agnis,'' viz., ''jatharagni, bhutagni'' and ''dhatvagni'' respectively.

−

==== Role of ''vata'' in digestion ====

+

=== Role of ''vata'' in digestion ===

''Samana vayu'' separates nutritive (''prasad'') and waste (''kitta'') part from ''ahara rasa''. Nutritive part is circulated to entire body after absorption through ''rasayini'' (villi) by ''vyana vayu''. Waste part is excreted as feces, urine and sweat through their excretory channels by ''apana vata''. Absorbed nutritive substances circulate all over the body through seven specific micro channels of each of the seven ''dhatus''.

−

==== ''Dhatvagni'' ====

+

=== ''Dhatvagni'' ===

Each ''dhatu'' has its own transforming ''agni'' and ''srotas''. ''Srotas'' or micro channels have two functions of carrying and transforming the tissues with the help of their specific ''dhatvagni''. Five ''bhutagnis'', one for each ''mahabhuta'', transform five ''bhautic'' elements into the body tissues and organs. Seven ''dhatvagni'' or tissue transformers, form the tissue elements of seven ''dhatus'' by their needed nutrients. After formation of ''dhatu'', the microchannels permeates them into the organs for functioning. During this transformation process, ''upadhatu'' or subtissues and ''dhatumala'' or waste products are formed. ''Updhatus'' of ''rasa dhatu'' is breast milk; menstrual blood is ''upadhatu'' of ''rakta''; tendons and six layers of skin are ''upadhatu'' of ''mamsa dhatu'' etc.

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Apart from digestion, the gut performs various other significant functions as well. The gut has its own protective mechanism in the form of gut-associated lymphoid tissue, which prevents the entry of pathogens into the bloodstream. The micro-biota in the gut serves vital functions related to various aspects of health. The enteric nervous system of the gut has its own functional significance and has been proven to be very closely associated with the central nervous system functions. The gut secretes several hormone-like substances that are helpful in regulating long-term energy balance. All the factors mentioned are either directly or indirectly dependent on these functional domains of the gut. <ref>W I Khan, J E Ghia. Gut hormones: emerging role in immune activation and inflammation. Clin Exp Immunol. 2010 July; 161(1): 19–27</ref> <ref>Andrew L. Kau, Philip P. Ahern, Nicholas W. Griffin, Andrew L. Goodman, Jeffrey I. Gordon. Human nutrition, the gut microbiome, and immune system: envisioning the future. Nature. 2011 June 15; 474(7351): 327–336. doi: 10.1038/nature10213</ref> Other forms of ''agni'' in this context are indicative of ''bhutagni'' and ''dhatvagni'', which in turn, are functionally dependent on ''jatharagni''. ''Prana'' in this context may stand for all types of ''vata'' as well.

−

==== Three stages of digestion ====

+

=== Three stages of digestion ===

There are three stages of digestion in the gut. The first stage (''madhura'') takes place in the upper gastro-intestinal tract, i.e., inside the esophagus and stomach; the second stage (''amla'') takes place in the middle portion of the gut, i.e., in the small intestine; and the last stage (''katu'') takes place in the colon.

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The portion that reaches the colon is the one that is designated as ''kitta''. During the third stage of digestion, there occurs the solidification of fecal matter and formation of certain pungent gases such as ammonia, methane, hydrogen sulfide etc. The term ''pakva'' in this context indicates ''pakva mala''; not ''pakva ahara'' (Verse 9-11).

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==== Formation of the seven ''dhatus'' ====

+

=== Formation of the seven ''dhatus'' ===

+

''Rasa, rakta, mamsa, meda, asthi, majja'' and ''shukra'' are the seven fundamental entities that sustain the human body. These can be called ‘tissues’ for the sake of convenience, though some of them are not tissues in a strict sense. It will be pertinent to look into these individual entities at this stage to understand what they really are in terms of anatomy.<ref>Patwardhan K. Human Physiology in Ayurveda. Varanasi, India: Chaukhambha Orientalia, 2013, Jiakrishnadas series no. 134.</ref>

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#The one that is formed from ''majja'' (the tissue that fills the bony cavities) which in turn circulates all over the body both in males and females. Reproduction is the function of this second form of ''shukra'' too. Therefore, on careful examination, it seems that the first form of ''shukra'' stands for the semen in general and for sperms in particular; and, the second form of ''shukra'' stands for hypothalamo-pituitary-gonadal axis of hormones that circulate all over the body.

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==== The process of nourishment of ''dhatu'' ====

+

=== The process of nourishment of ''dhatu'' ===

The process of nourishment of ''dhatus'' is explained by three analogies: ''Ksheera-dadhi'' (milk curdling analogy), ''khalekapota'' (analogy of pigeons picking up the choicest grains) and ''kedari-kulya'' (irrigation analogy).

−

==== ''Ksheera-dadhi nyaya'' (milk curdling analogy) ====

+

=== ''Ksheera-dadhi nyaya'' (milk curdling analogy) ===

According to this analogy, the nourishment of a ''dhatu'' takes place according to the rule of conversion (of one substance into another). Just as the milk is converted into different forms (from milk to curd, curd to butter, butter to ghee) successively, the preceding ''dhatu'' too is converted into the next one. The sequence of this conversion is as follows: ''rasa, rakta, mamsa, meda, asthi, majja'' and ''shukra'' in the same order.

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The transformation of various substances that takes place due to various biochemical reactions could be one way of understanding this analogy. For instance, the process of glycolysis involves different enzymes acting on different substrates at different steps and converting them from one to another. The ability of one kind of stem cell derived from one tissue in giving rise to different forms of cell types of different tissues is known. The response of mesenchymal stem cells to certain stimuli such as hypoxia in the form of migration and tissue regeneration is also known, which can further support this analogy.

−

==== ''Khalekapota nyaya'' (analogy of pigeons picking up the choicest grains) ====

+

=== ''Khalekapota nyaya'' (analogy of pigeons picking up the choicest grains) ===

According to this analogy, the nourishment of different ''dhatus'' takes place according to the rule of selectivity. Just as the pigeons coming from far off places, picking up the grains of their choice from the granary (a storehouse for thrashed grain, ''khala'') and flying back to their destination, the different ''dhatus'' too, pick up the required nourishment from the common nutrient pool known as ''rasa''. The ''dhatu'' that is situated nearer to ''rasa'' is nourished first and the remaining later, just as the pigeon from a nearer place gets a chance to pick up grains quickly in the given analogy.

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In this analogy, the choice that the pigeons have in picking up the grain (selectivity) and the energy they spend in the process of obtaining grains (actively) are the vital features. The tissue metabolism can influence the extent of vasodilatation and thus its own perfusion. This is known as auto-regulation of blood supply. Similarly, the specific kind of tissue has affinity for specific nutrient and other substances. For example, the calcium gets deposited normally in bones, but not in the mucous membranes. Similarly, vitamin B-12 is stored in liver and not in other tissues.

−

==== ''Kedari-kulya nyaya'' (analogy of irrigation) ====

+

=== ''Kedari-kulya nyaya'' (analogy of irrigation) ===

According to this analogy, the nourishment of ''dhatu'' takes place according to the rule of irrigation. Just as the ''kulyas'' (small canals / trenches / channels) receive water from the ''kedarika'' (the bigger water reservoir) and then irrigate the nearest field first, the ''rasa'' too, nourishes the ''dhatus'' in a sequential fashion depending on the location of the ''dhatu''.

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Circulating provoked ''dosha'' settles in a tissue whose channels are defective (''kha-vaigunya'') and perfuce the lesion. This pathogenesis has been compared with rain production. The obstruction to the moving ''rasa'' by the abnormality of ''srotas,'' results in causation of disease, just as the obstruction to the cloud laden monsoon winds by the tall mountains results in the causation of rainfall (Verse 37).

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==== Causes of ''grahani'' disorder ====

+

=== Causes of ''grahani'' disorder ===

''Abhojana'' (starvation) leads to increase in ''vata'' and in turn ''agnimandya''.(Ca.Vi/ 2/7) Starvation and protein malnutrition disrupts the normal indigenous gastrointestinal tract micro-flora and impairs host antibacterial defenses. Both starvation and protein malnutrition increases the cecal levels of gram negative enteric bacilli and decrease the level of lactobacillus and promote growth of anaerobes that in turn disturb the gut flora. Gut flora also known as gut microbiome has a unique role in digestion and absorption. Once the gut microbiome gets vitiated it leads to indigestion and malabsorption.

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Treatment of ''grahanidosha'' is to enhance ''jatharagni, bhutagni'' and ''dhatvagni'' which encompasses the whole digestive process. Food and drinks are also medicated depending upon the patient and the stage of disease, for extended period of time.

−

==== Effect on immunity ====

+

=== Effect on immunity ===

''Prayatna'' (effort), ''urja'' (energy) and ''bala'' (strength) are the role played by ''vata, pitta'' and ''kapha'' in building up of immunity. When the ''dosha'' gets vitiated ''prayatna, urja'' and ''bala'' are hampered leading to suppression of immunity.

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''Tridosha'' play role in impairing immunity and depending on the dominance of a particular ''dosha'' they are classified as ''vataja, pittaka'' and ''kaphaja'' disorders.(Ca. Su. 28/7)

−

==== Equilibrium of ''agni'' ====

+

=== Equilibrium of ''agni'' ===

''Agni'' should be associated with balance of ''vata, pitta'' and ''kapha'' or ''samagni''. Digestive enzyme secretion is controlled by sympathetic and parasympathetic nerve supply. ''Samagni'' may be compared with balanced state of sympathetic/ parasympathetic activity which explains the role of balanced or ''samana vata''. It may also be noted that ''prana vata'' and ''apana vata'' also have impact on balancing the normal status of ''agni''.

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Mucosal resistance explains role of ''kapha'' in maintaining ''samagni''. Intact mucosal lining is present in stomach and small intestine. Breach in mucosal lining causes gastritis, burning sensation etc whereas increased size of mucosal cells alters the pH thereby a balanced ''kapha'' plays essential role in ''samagni''. Role of prostaglandins to maintain gastric mucosal resistance to prevent the action of HCl in gastric mucosa is to be considered as part of ''kledaka kapha'' as sodium bicarbonate and mucus is secreted by prostaglandins. Drugs which inhibit prostaglandins e.g. aspirin, impairs gastric mucosal barriers leading to gastritis, duodenitis and peptic ulcers.

−

==== Clinical features ====

+

=== Clinical features ===

''Arochaka'' (aversion to food), ''vairasya'' (distaste), ''praseka'' (excessive salivation) are general gastrointestinal manifestations of indigestion. ''Tamaka'' or blackout occurs due to nutritional deficiency. Mal-absorption causes diarrhea which leads to decrease in circulating liquid, a cause of hypo-tension a reason for blackout. Impaired absorption of iron, folate, vit. B12 leads to anemia which may be the cause for blackout (''tamakanvitah''). Resulting anemia and electrolyte depletion (particularly K+) leads to weakness.

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''Kleda'' can also be considered as inter-mediory product of metabolism like ketones, pyruvate, lactate which are well utilized in active/healthy persons as fuel and therefore does not cause inflammation/disease process (Verse 237-239).

−

==== Current clinical practices ====

+

=== Current clinical practices ===

{| class="wikitable"

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*To understand concept of ''ama'' with relation to autoimmune diseases.

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=== References ===

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== References ==

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