Changes

Protection of ''agni'' is very essential in treatment of all diseases.(Chakrapani Ca.Ci.14/244-246 )''Arsha, atisara'' and ''grahanidosha'' are said to be ''paraspara hetu'' which means one disease becomes cause for another disease(Ca.Ci.14/244) e.g. in patients with chronic colitis, intestinal polyps are seen, in patients suffering from diarrhea colitis is observed. Therefore, one finds interrelation between these disorders and as explained earlier, special precaution should be taken with respect to ''agni bala''.  

Protection of ''agni'' is very essential in treatment of all diseases.(Chakrapani Ca.Ci.14/244-246 )''Arsha, atisara'' and ''grahanidosha'' are said to be ''paraspara hetu'' which means one disease becomes cause for another disease(Ca.Ci.14/244) e.g. in patients with chronic colitis, intestinal polyps are seen, in patients suffering from diarrhea colitis is observed. Therefore, one finds interrelation between these disorders and as explained earlier, special precaution should be taken with respect to ''agni bala''.  

Certain drugs like ''chitraka'' (Plumbago zeylanica), ''pippali'' (Piper longum), ''pippalimula'' (root of Piper longum), ''shunthi'' (Zingiber officinale), ''nagakesara, haridra, danti, duralabha, haritaki'' etc have been used in combinations with other drugs for the treatment of ''arsha'' considering the concept of ''agnibala vriddhi'' and ''vata anulomanam'' (facilitating passage of ''vata'') and the same drugs have been used in ''grahani chikitsa'' with the same concept. Charaka explains that all the above three diseases are caused by ''agnimandya'' and if increase in ''agni'' is done then relief in the disease takes place. (Chakrapani  Ca.Ci.14/244-246)

Certain drugs like ''chitraka'' (Plumbago zeylanica), ''pippali'' (Piper longum), ''pippalimula'' (root of Piper longum), ''shunthi'' (Zingiber officinale), ''nagakesara, haridra, danti, duralabha, haritaki'' etc have been used in combinations with other drugs for the treatment of ''arsha'' considering the concept of ''agnibala vriddhi'' and ''vata anulomanam'' (facilitating passage of ''vata'') and the same drugs have been used in ''grahani chikitsa'' with the same concept. Charak explains that all the above three diseases are caused by ''agnimandya'' and if increase in ''agni'' is done then relief in the disease takes place. (Chakrapani  Ca.Ci.14/244-246)

Further, ''vata'' is said to be ''agnisakha'' i.e. ''agnibala'' depends on ''vata''. ''Vatakshaya'' or ''prakopa'' results in ''agnimandya''. Therefore, ''anna, pana'' and ''ausadha'' which bring about ''vata anulomana'' are very useful in treatment of diseases like ''arsha'' and ''grahani dosha''.  

Further, ''vata'' is said to be ''agnisakha'' i.e. ''agnibala'' depends on ''vata''. ''Vatakshaya'' or ''prakopa'' results in ''agnimandya''. Therefore, ''anna, pana'' and ''ausadha'' which bring about ''vata anulomana'' are very useful in treatment of diseases like ''arsha'' and ''grahani dosha''.  

''Vata anulomanam'' means to facilitate the ''gati'' (motion) of ''vata'' downwards to anus. Among five types of ''vata, samana'' and ''apana'' have major role in diseases like ''arsha, atisara'' and ''grahanidosha''. Obstruction to movement of ''vata'' (''avarudha gati'') or diarrhea (''atisaraṇa'') leads to ''agni kshaya''. ''Avarudha gati'' is the cause for ''vibandha'' (constipation), ''malavibandha'' (obstruction to feces) along with ''pravahana'' (urge to defecate) which increases the intra-lumen pressure leading to incompetency of valves in rectal veins leading to their varicosity which causes hemorrhoids where as ''atisarana'' (diarrhea) causes increased motility of intestine. Hence ''vata anulomanam'' should not be understood as ''virechana'' or laxation but regularization of ''vata gati'' so that there is no ''avarodha'' or ''atisarana''. The same concept of ''vata anulomana'' is also mentioned in [[Grahani Chikitsa]].(Ca.Ci.14/247)

''Vata anulomanam'' means to facilitate the ''gati'' (motion) of ''vata'' downwards to anus. Among five types of ''vata, samana'' and ''apana'' have major role in diseases like ''arsha, atisara'' and ''grahanidosha''. Obstruction to movement of ''vata'' (''avarudha gati'') or diarrhea (''atisaraṇa'') leads to ''agni kshaya''. ''Avarudha gati'' is the cause for ''vibandha'' (constipation), ''malavibandha'' (obstruction to feces) along with ''pravahana'' (urge to defecate) which increases the intra-lumen pressure leading to incompetency of valves in rectal veins leading to their varicosity which causes hemorrhoids where as ''atisarana'' (diarrhea) causes increased motility of intestine. Hence ''vata anulomanam'' should not be understood as ''virechana'' or laxation but regularization of ''vata gati'' so that there is no ''avarodha'' or ''atisarana''. The same concept of ''vata anulomana'' is also mentioned in [[Grahani Chikitsa]].(Ca.Ci.14/247)

Therefore, the line of treatment used in ''arsha'' with regard to ''agni bala'' and ''vata anulomanam'' is basically similar to that of ''grahanidosha'' hence Charaka has explained [[Grahani Chikitsa]] after [[Arsha Chikitsa]].( Chakrapani  Ca.Ci.15/1) Charaka could have restricted the name of chapter to [[Grahani Chikitsa]] i.e. treatment of the ''avayava grahani'' whereas he has increased the scope of chapter by using the word ''grahanidosha''.(Chakrapani  Ca.Ci.15/1).

Therefore, the line of treatment used in ''arsha'' with regard to ''agni bala'' and ''vata anulomanam'' is basically similar to that of ''grahanidosha'' hence Charak has explained [[Grahani Chikitsa]] after [[Arsha Chikitsa]].( Chakrapani  Ca.Ci.15/1) Charak could have restricted the name of chapter to [[Grahani Chikitsa]] i.e. treatment of the ''avayava grahani'' whereas he has increased the scope of chapter by using the word ''grahanidosha''.(Chakrapani  Ca.Ci.15/1).

There is always an inter-relationship between ''avayava'' (organ) and ''avayavi'' (part of organ) or ''ashraya''(seat) and ''ashrayi'' (seated). Either of the one has an impact on the other, hence if ''grahaniavayava'' is in normal state then ''agni'' the ''avayavi'' functions normally and vice versa also holds true, whereas if ''dusti'' of ''grahani'' takes place ''agni vaishamyata'' (imbalance) is seen e.g. ileitis, wherein digestion is hampered. ''Grahani'' is the seat for ''jatharagni''. (Ca.Ci.15 /56) ''Agni'' is responsible for ''ayu'' (longevity of life), ''varna'' (complexion), ''bala'' (strength), ''svasthya'' (health), ''utsaha'' (enthusiasm), ''upachaya'' (proper metabolism), ''prabha'' (glow) and ''oja'' (core energy). ''Prakrita agni'' (normal digestive power) is essential for long and healthy life while, vitiated ''agni'' is responsible for ''roga avastha''(disease).(Ca. Ci. 15/3-4)  

There is always an inter-relationship between ''avayava'' (organ) and ''avayavi'' (part of organ) or ''ashraya''(seat) and ''ashrayi'' (seated). Either of the one has an impact on the other, hence if ''grahaniavayava'' is in normal state then ''agni'' the ''avayavi'' functions normally and vice versa also holds true, whereas if ''dusti'' of ''grahani'' takes place ''agni vaishamyata'' (imbalance) is seen e.g. ileitis, wherein digestion is hampered. ''Grahani'' is the seat for ''jatharagni''. (Ca.Ci.15 /56) ''Agni'' is responsible for ''ayu'' (longevity of life), ''varna'' (complexion), ''bala'' (strength), ''svasthya'' (health), ''utsaha'' (enthusiasm), ''upachaya'' (proper metabolism), ''prabha'' (glow) and ''oja'' (core energy). ''Prakrita agni'' (normal digestive power) is essential for long and healthy life while, vitiated ''agni'' is responsible for ''roga avastha''(disease).(Ca. Ci. 15/3-4)  

In this chapter, Charaka describes formation of body tissues in detail with the role of ''ahara'' which is supplied continuously to maintain homeostasis. ''Vyana vata'' is promoter of ''rasa raktadi'' circulation.( Ca. Ci. 15/36)  It transports ''rasa raktadi drava'' ''dhatu'' throughout body continuously and as per metabolic demand. This explanation shows that closed circulation in human was known to Charaka.

In this chapter, Charak describes formation of body tissues in detail with the role of ''ahara'' which is supplied continuously to maintain homeostasis. ''Vyana vata'' is promoter of ''rasa raktadi'' circulation.( Ca. Ci. 15/36)  It transports ''rasa raktadi drava'' ''dhatu'' throughout body continuously and as per metabolic demand. This explanation shows that closed circulation in human was known to Charak.

''Grahani'' is prime place where digestion and absorption of ''ahara rasa'' takes place. ''Ahara rasa'' provides nutrition for the ''rasadi sapta dhatu'', along-with three ''sharirika dosha'' and three ''manasika dosha''. Nourishment of ''sattva, raja'' and ''tama'' is influenced by ''sattvika, rajasika'' and ''tamasika ahara''. ''Tamasika'' and ''rajasika ahara'' suppresses ''sattva guna'' thereby causing ''alpa sattva'' in individual, a common predisposing factor of psychiatric disorders for e.g. ''alpa sattva'' as mentioned in ''unmada'' (Ca. Ci. 9/5)In ''vataja grahanivyadhishanka'' (feeling of suffering from disease) manifests in patients with ''alpa sattva''.  

''Grahani'' is prime place where digestion and absorption of ''ahara rasa'' takes place. ''Ahara rasa'' provides nutrition for the ''rasadi sapta dhatu'', along-with three ''sharirika dosha'' and three ''manasika dosha''. Nourishment of ''sattva, raja'' and ''tama'' is influenced by ''sattvika, rajasika'' and ''tamasika ahara''. ''Tamasika'' and ''rajasika ahara'' suppresses ''sattva guna'' thereby causing ''alpa sattva'' in individual, a common predisposing factor of psychiatric disorders for e.g. ''alpa sattva'' as mentioned in ''unmada'' (Ca. Ci. 9/5)In ''vataja grahanivyadhishanka'' (feeling of suffering from disease) manifests in patients with ''alpa sattva''.  

Homeostasis at cellular level and gross level is maintained by ''vata, pitta'' and ''kapha'' in which digestive and metabolic contributions are due to ''agni''. This chapter has been dedicated to ''agni'' to understand the manner in which it gets vitiated by ''dosha'' and accordingly the line of treatment for the ''agni dosha'' is explained. As the functions of ''agni'' take place in ''grahani'' hence disease related to ''grahani'' has been given the name.

Homeostasis at cellular level and gross level is maintained by ''vata, pitta'' and ''kapha'' in which digestive and metabolic contributions are due to ''agni''. This chapter has been dedicated to ''agni'' to understand the manner in which it gets vitiated by ''dosha'' and accordingly the line of treatment for the ''agni dosha'' is explained. As the functions of ''agni'' take place in ''grahani'' hence disease related to ''grahani'' has been given the name.

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 Charaka has placed this chapter in between ''arsha'' and ''pandu roga''.

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''.

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

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

Suppression of manifested natural urges may have impact on nervous system resulting in effect  either on enzymatic secretion or on the hormonal secretion.These factors have role in digestion and absorption as may be understood in case of ''adhovata'' (accumulation of ''vata'' in rectum and pelvic region) and ''purisha vegadharana'' (suppression of urge of defecation), wherein regular urge suppression disturbs the intestinal pro-kinetic movement.( Ca. Su. 7/ 6,8,12) Disturbed pro-kinesia increases the transit time leading to the change in pH which further has its impact on electrolytes and enzymatic secretion leading to reduced digestive power (''agnimandya'').  

Suppression of manifested natural urges may have impact on nervous system resulting in effect  either on enzymatic secretion or on the hormonal secretion.These factors have role in digestion and absorption as may be understood in case of ''adhovata'' (accumulation of ''vata'' in rectum and pelvic region) and ''purisha vegadharana'' (suppression of urge of defecation), wherein regular urge suppression disturbs the intestinal pro-kinetic movement.( Ca. Su. 7/ 6,8,12) Disturbed pro-kinesia increases the transit time leading to the change in pH which further has its impact on electrolytes and enzymatic secretion leading to reduced digestive power (''agnimandya'').  

Further ''kshudha vegadharana'' (avoiding sense of hunger) effect will be similar to ''abhojana'' (not eating). It may also be noted that repeated ''kshudha vegadharana''  leads to atrophy of the stomach which further weakens the perception of hunger which is controlled by the percentage of the stomach that remains empty similar to the explanation given by Charaka that excessive fasting leads to diminution in ''agni''.(Ca.Su.22/37) ''Trishna vegadharana'' (avoiding thirst) leads to reduced fluid balance in the body.  

Further ''kshudha vegadharana'' (avoiding sense of hunger) effect will be similar to ''abhojana'' (not eating). It may also be noted that repeated ''kshudha vegadharana''  leads to atrophy of the stomach which further weakens the perception of hunger which is controlled by the percentage of the stomach that remains empty similar to the explanation given by Charak that excessive fasting leads to diminution in ''agni''.(Ca.Su.22/37) ''Trishna vegadharana'' (avoiding thirst) leads to reduced fluid balance in the body.  

Nearly seven liters of water is secreted during various gastrointestinal secretions. Reduced water intake in long term will reduce gastrointestinal secretion leading to impaired digestion.  

Nearly seven liters of water is secreted during various gastrointestinal secretions. Reduced water intake in long term will reduce gastrointestinal secretion leading to impaired digestion.