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Ayurvedic Treatment for IBS (Irritable Bowel Syndrome)
by Dr. Anil Joy Pulikkotill
Ayurveda is an alternative treatment developed in India. In this various treatments are described based upon signs and symptoms. Some of the signs and symptoms are similar to the condition in Irritable Bowel Syndrome. In this article I described various aspect according to ayurveda and modern Medicine.
Discussion: various aspects of Irritable Bowel Syndrome modern medicine as well as Ayurveda. Considering both side formulating a guideline in ayurveda for IBS
KEYWORDS: Ayurvedic Treatment for IBS, Irritable Bowel Syndrome, IBS, Ayurvedic Treatment for Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is characterised by recurrent abdominal discomfort in association with alternate episodes of diarrhea and constipation.
Physiological, Luminal, Behavioural and psychosocial factors are responsible for IBS. They are caused by two entirely different mechanisms. Bowels habit is disturbed by diarrhea or constipation occurring alone or alternating. Some forms of this IBS have in the past been called spastic colon and idiopathic or nervous diarrhea. Constipation occurs from a sluggish contraction of the bowel and diarrhea by an overactive bowel.According to ayurveda this disease is due to vitiation of Dosha. It is clear that Agni mandhya ( low digestive fire ) * and Manas (Mind)* are involved in this disease. Treatment without considering the psychological part of the patient will not give good result. According to the updated ROME III criteria, IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M)
AIMS AND OBJECTIVES
To design a treatment guidelines or protocol to Irritable Bowel Syndrome according to Ayurveda
About 10–15% of the population are affected at some time but only 10% of these consult their doctors because of symptoms. Nevertheless, IBS is the most common cause of gastrointestinal referral and accounts for frequent absenteeism from work and impaired quality of life. Young women are affected 2–3 times more often than men. Coexisting conditions, such as non-ulcer dyspepsia, chronic fatigue syndrome, dysmenorrhoea and fibromyalgia, are common. Between 5 and 10% of patients have a history of physical or sexual abuse.
What are the symptoms of IBS?
Diarrhea characteristically occurs in the morning, and almost never at night.
• Urge to defecate after meals.
- Pain in the lower abdomen, pain often occurs in attacks usually relived by defecation and sometimes provoked by food.
- Bowel habit is variable. All most all patients notice ribbon like stools with or without mucus.
- Sensation of incomplete emptying of the rectum.
- Abdominal distension, excessive flatus, dyspepsia, heartburn, increased urine frequency
The Pathophysiology of this disease considered as Physiological, Luminal, Behavioural and psychosocial factors. Behavioural and psychosocial factors Only 50 % patient shows psychiatric problems like anxiety, depression, somatisation , neurosis and Panic attacks.
There is some evidence that IBS may be a serotoninergic (5-HT) disorder, as evidenced by relatively excessive release of 5-HT in diarrhoea-predominant IBS (D-IBS) and relative deficiency with constipation-predominant IBS (C-IBS).
Both quantitative and qualitative alterations in intestinal bacterial contents (the gut microbiota) have been reported. Small intestinal bacterial overgrowth (SIBO) may be present in some patients and lead to symptoms.
Dietary factors are also important. Some patients have chemical food intolerances (not allergy) to poorly absorbed, short-chain carbohydrates (lactose, fructose and sorbitol, among others), collectively known as FODMAPs (fermentable oligo-, di- and monosaccharides, and polyols). Their fermentation in the colon leads
to bloating, pain, wind and altered bowel habit. Noncoeliac gluten sensitivity (negative coeliac serology and normal duodenal biopsies) seems to be present in some IBS patients, while others may be intolerant of chemicals such as salicylates or benzoates, found in certain foods
Ayurveda Point of View
Ayurveda mentioned one disease known as ‘Grahani’. The symptom of this grahani resembles most of IBS symptoms. Grahani is the seat of Agni and is called so because of holding up the food. Normally, it holds up the food (till it is digested) and releases it from the side after it is digested. But when it is deranged due to weak digestive fire it releases the ingested material even in unripe condition.
Causes of deranged Agni -
Agni is deranged by fasting, eating during indigestion, over eating, irregularly eating, intake of unsuitable, heavy, cold, too rough and contaminated food, emaciation due to some disease, faulty adaptation to place, time and season, faulty administration of emesis, purgation and unction and suppression of natural urges. Agni thus deranged becomes unable to digest even the light food and the food being undigested gets acidified and toxic.
This agnimandya may be due to psychological factor or local bowel factor. It lead to defective absorption of rasa dhathu. So that function other dhathu will be impaired body became week.
That will lead to amma condition in body.
Although the etiology of the irritable bowel syndrome is uncertain, some relate this to psychological disturbances, especially anxiety. Some relate their onset to an attack of infective diarrhoea or certain foods may precipitate symptoms.
It is true that stress can affect bowel function. It has been demonstrated that the bowel can flush or become very pale in response to emotional reactions. Severe acute stress may cause diarrhea.
- A close look at dietary factors is a must in evaluating the cause for an irritable bowel, one cause i.e. lactose intolerance is a very common problem. The inability to digest lactose sugar in milk and dairy products. The undigested lactose acts like a laxative and causes the symptoms of an irritable bowel.
• Another and less common is gluten intolerance. Some individuals may have an allergic reaction to gluten protein, which is found in all cereals except rice and corn. This can cause diarrhea.
- Fat may also be a cause of diarrhea, they stimulate strong contractions of colon contributing to pain and diarrhea.
- Alcohol is another often-unrecognised cause for such symptoms, particularly diarrhea. The patient may not think that his or her alcohol habit can be the cause. Alcohol is a cellular poison. Its initial contact with the lining of the bowel may cause some cellular damage. As the alcohol in the blood is recirculated regularly and bathes the intestinal cells, it creates further damage. Damaged cells mean inadequate digestion, followed by diarrhea and IBS.
- Coffee, tea, colas and chocolate are all can cause IBS, as they stimulate muscular contractions and acts as a causative factor in diarrhea.
- Spices may also irritate the bowel. In some case it may be due to food allergies or food poisoning.
- Diarrhea may also be a symptom of vitamin deficiency e.g. niacin, B-12 or folic acid.
- The abuse of laxatives is a common cause, which is often overlooked.
- Disease of the pancreas may cause large, frequent, fatty stools. The pancreatic enzymes needed for digestion and when these are in short supply symptoms follows
- 50% cases shows physiological relation, always treat it.
- Treatment for amma with amma pachanna dravya
- Agni is low treatment to increase digestive power
- Gritha preparation is good if agni is very low.
- Use Takra it will help to prevent unwanted bacterial flora in the Intestine.
Formulations useful reliving the symptoms
1. Powder of four sours (Vrukshamla, Amlavetasa, Dadima and Badara) 40 gm, trikatu 12 gm (Pippali, Shunthi, Black Pepper), and five salts 10gm added with sugar 10 gm should be used with vegetables, pulses, cooked cereals etc. It is efficacious in colic, indigestion, anorexia etc.
- Panchakola is to be added in cereal soup, Radish soups with black pepper are recommended as diet.
- Buttermilk, sour gruel, and arishta should be taken as post meal drink.
- Buttermilk is specifically advised in this disease due to its appetizing nature, astringency and lightness in all ways. This aids recovery of disease. So take in profuse quantity.
- One passing undigested diarrheic stools due to deficient Agni should take adequate
- Dose of ghrita (ghee) mixed with appetizing drugs, as they are excellent stimulants of weak fire.
- Ayurveda advise ‘Parpati Kalpa’ in this disorder, which is very efficient for treating this disorder, but strict dietary regimens one has to follow during this therapy.
- Various Asavas / Arishta’s, Medicated ghee & appetizer drug formulations are advised some of them are –
- ASHTHA CHOORNAM
- PANCHA KOLASAVAM
- BUKTHANJARI GULIKA
- GRAHANYANDAKAM KASHAYAM
- PANCHAKOLAM KASHAYAM
- VISVANARA CHOORNAM
- PACHANAMRUTHAM KASHAYAM
- CHARNGERYADHI GRITHA
Do’s & Don’ts:
Do’s - Eat old rice, jawar, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, wood apple, Pomegranate, nutmeg, skimmed milk, buttermilk, hot water, complete rest, adequate sleep.
Don’ts - Eat wheat, maize, barley, pigeon pea, pea, cow pea, spiked dolichos, black gram, gram, Soya bean, saga, kidney bean, potato, sweet potato, navalkoal, onion, coconut, groundnut, chili, oily food, chicken, red meat, crabs, prawns, fish, leafy vegetable like sorrel, drum stick etc, mango, pineapple, apple, watermelon, cashew, pumpkin gourd, papaya, fig, jack fruit, excess milk, day sleep, awakening at night, tension, suppression of urges before bed.
Ayurveda treatments to irritable bowel syndrome gives good result. The treatment must consider various aspects like amma, agni mandhya and psychiatric problems along with pathya.
- Shivprasada Sharma, Ashtanga Samgraha - verse no.6; Chaukhamba Sanskrit Series, Varanasi, 2008
- Davidson’s Principles and Practice of Medicine, 22nd Edition
- Rosa LS Soares,Irritable bowel syndrome: A clinical review,World J Gastroenterol. 2014 Sep 14; 20(34): 12144–12160.
- H Vahedi, 1 R Ansari, 1 MM Mir-Nasseri, 1 and E Jafari 1 ,Irritable Bowel Syndrome: A Review Article,Middle East J Dig Dis. 2010 Sep; 2(2): 66–77.
- Lekha Saha,Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine,World J Gastroenterol. 2014 Jun 14; 20(22): 6759–6773.
- Medicinal Plants Useful in IBS cited on December 25,2012. Available on https://indianmedicinalplants.info/herbs/
- Ayurveda treatments for IBS cited on December 25,2011. Available on https://www.ayurvedatreatments.co.in