A Clinical Study to Evaluate the efficacy of Vasti Karma in the management of Grahani Roga

Today there is tremendous increase in life style disorders because of a change in dietary and living habits. This type of lifestyle and food habits affects the function of Grahani (site of Agni or Pitta) by means of vitiation (Vishamagni) or suppression (Mandagni) of Agni. When proper digestion of food does not take place in Grahani and this undigested food material passes through it to further parts of intestine, then it disturbs further digestion, absorption and other functions of small and large intestine. In Grahani Roga, although Rogadhisthan is Grahani but dysfunction occurs in whole G.I. tract. Vasti karma is indicated in the management of Grahani. It helps in improving the function of gut and also nourishes it. The common symptoms of gastro-intestinal disorders include abdominal pain, bowel disturbance i.e. diarrhea, constipation, nausea, vomiting, abdominal pain, alteration in appetite, indigestion, malabsorption and ultimately failure to thrive, are also the result of indigestion. These features cannot be grouped under any particular heading. In Ayurvedic Texts, conditions like Udara Shoola, Kshudha-Alpata, Aruchi, Adhmana, Hrillasa, Avipaka, Vibaddha Mala Pravritti and Abaddha Mala Pravritti alternately etc. have been described under the heading of Grahani Roga. The present study entitled, “A clinical study to evaluate the efficacy of Vasti karma in the management of “GRAHANI ROGA” Aim and Objective- • To evaluate the effect of Vasti karma in management of Grahani Roga. • To study Grahani Roga with reference to I.B.S. and other disorders from Ayurveda and modern system of medicine. Present thesis work comprises of four parts viz. conceptual Study, clinical study, discussion and summary & conclusions. Conceptual study: This chapter dealt with the concept of Grahani, anatomical and physiological review of Grahani, review of Grahani Roga, and modern review of diseases related to Grahani Roga, review of Grahani Roga in respect of modern literature. Under the conceptual study various Ayurvedic and modern text books, journals, previous and ongoing research works related to the subject are thoroughly screened, analysed and summarized. Definitions of Grahani, etymology, anatomy and physiology of organ - Grahani, Agni Adhisthana, Pittadhara Kalaa, Argala, main functions of Grahani, Doshas associated with Grahani (i.e. Kledaka Kapha, Pachaka Pitta and Samana-Vayu), concept of Agni, concept of Pachana, modern anatomy and physiology of digestive system along with physiology of digestion are also described under this section. In the modern medical science, no disease or condition is found exactly similar to Grahani Roga; but the conditions which have very close similarity with the Grahani Roga, which are commonly observed are malabsorption syndrome, celiac disease tropical sprue, irritable bowel syndrome, worm infestations like Amoebiasis and Giardiasis are also explained in this section. Drug Review- The drugs – Vidangadi Taila and Dhanyapanchak Kwatha having almost same Ayurvedic properties, i.e. predominant Rasa is Katu and Tikta; predominant Guna is Laghu and Ruksha. Most of the drugs of both formulas are having Ushna Veerya, predominantly Katu Vipaka. The Doshghnata of drugs is Kapha-Vata Shamaka. So, because of predominantly Katu Tikta rasa and Katu Vipaka and Ushna veerya the drug has an action on Jhathargni and as, Agni and Grahani has Adheya –Adhar Sambandha and Paraspara Upakaraka bhava, the drug acts on Grahani too Both compound drugs having properties like digestive, carminative, antispasmodic, appetizer, anti inflammatory, anthelmintic, hepato-protective, stomachic, antiviral, antibacterial, anti-amoebic, antigiardial, haematinic properties, anti ulcerative, immunomodulator. Clinical study: In this section plan of study with material and methods, criteria for selection, criteria for assessment, observation in tabular form along with statistical analysis of result were observed. Clinical trial was carried out in 30 patients of 16-60 year of age group from O.P.D. and I.P.D. of department of Panchakarma and Kayachikitsa, Rishikul state ayurvedic P.G. College and hospital, Haridwar, having cardinal signs and symptoms of Grahani Roga. Routine haematological & biochemical examination, Stool and urine investigations were done to rule out any systemic disorder in all the registered patients. In all patients Vasti schedule (2 course of Yoga Vasti with Parihar kaala). Pathyaapathya were also kept during complete course. Observation- Majority of patients i.e. 66.67% were from 31-50 year of age. The disease was found higher in males 63.33% as compared to females 36.67%. Majority of the patients were Hindu 73.33%. Maximum of the patients i.e. 80% were married. 76.67% patients were educated. Maximum of patients were housewives and service class, 46.67% were belonging to middle class. 53.33% patients were observed as mixed diet, and 46.67% patients were having vegetarian. Maximum of patients i.e. 60% were having regular diet pattern. In dietetic habit, Vishamashana in 43.33% patients were observed. 83.33% patients were taking Katu Rasa. Maximum of patients i.e. were having disturbed or less sleep. 100% patients were complaining unsatisfactory bowel. 73.33% patients were doing physical work. Maximum of patients i.e. 53.33% were having anxious / tensive type of nature. In 53.33% patients, Vata-Pittaja Prakriti was observed, While 33.33% of the patients had Vata-Kahaja Prakriti. 56.67% patients were found as Tamas Pradhana Manasa Prakriti. Maximum patients, i.e. 70% were observed as Madhyama Sara, Madhyama Samhanana was found in 53.33% of the cases, 50% patients were observed as Madhyama Satva. 73.33% of patients were observed as Madhyama Satamya, 50% were having Avara Vyayama Shakti. Abhyavarana Shakti was Avara in 73.33% of patients, 86.66% patients were having Avara Jarana Shakti, and Mandagni was found in 86.67% of patients. In 43.33% patients, the frequency 3 to 4 times/day of bowel was observed. 70% patients were having 1-2 year chronicity. According to Nidana, in Aharaja Nidana various Nidana were observed, i.e. Katu Ahara in 83.33% patients, Ati Snigdha in 63.33%, While Amla in 46.66%, Guru in 53.33%, Vidahi Ahara in 43.33% patients. In Viharaja Nidana, Divaswapna was found in 53.33% of patients, Vega Vidharana in 36.67% and Ratri Jagarana was found in 43.33% of patients. In Manasa Nidana, Chinta and Shoka were found in 73.33% & in 46.67% patients respectably. Regarding chief complain, Muhurbaddha/Muhurdrava Mala Pravriti was observed in 100% patients, and other symptoms were found i.e. Arochak were found in 90% patients, Trishna in 86.66% patients, Praseka in 70% of patients, Asthiparvaruk in 100% patients, Chhardan in 86.67% patients, Lohaamagandhi-tiktaamla Udgara in 60% patients, and Alasya in 90% patients, Udara Shoola (Abdominal pain or Discomfort) and Atopa (Gas / Flatulence) in 100% patients. Effect of Therapy – Patients who completed treatment have showed average percentage improvement obtained was 80%.In patients treated with therapy, highly significant were obtained in the symptoms of Muhurbaddha-Muhurdrava Mala Pravriti(75%), Arochaka (86.15%), Trishna (100%), Praseka (68.29)%, Asthiparvaruk (81.42)%, Chhardan in (92.30)%, Lohaamagandhi-tiktaamla Udgara , Udara Shoola (68.91%) and Atopa (82.66%)and Alasya (81.25%). In Agnibala, highly significant results obtained with Abhyavaharana Shakti (48.86%), and Jarana Shakti (50.0%). Highly significant result was obtained with Vyayama shakti (52.46%). Overall effect of therapy: After therapy administration, twenty four patients (80%) were marked improvement, six patients (20%) were moderate improvement, and no any patient was unchanged or complete remission. The Vasti karma was found to be definitely effective in the cases of Grahani. The effect of Vasti karma obtained probably due to Vatanulomana property and balancing effect on equilibrium of Tridosha and more probably due to Vasti ingredients having Deepana, Pachana, Grahi and Snehan effects. The overall activity may be improving the function of digestion and absorption of food with correcting the peristaltic movement of intestine. The disease becomes more difficult to cure in chronic form as described in classic.