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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 14-18

A randomized controlled trial to assess the effect of Pathya Ahara in Grahani


Department of Swasthavritta and Yoga, National Institute of Ayurveda, Jaipur, Rajasthan, India

Date of Submission24-Sep-2020
Date of Decision01-Feb-2021
Date of Acceptance04-Feb-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Mamta Saini
Department of Swasthavritta and Yoga, National Institute of Ayurveda, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_128_20

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  Abstract 


Introduction: The disorders of digestion and absorption are broadly covered under the heading of “Grahani roga” in Ayurvedic classics. Grahani is the seat of agni. It retains the food till the food is fully digested and passed to Pakvashaya. Mandagni (weak digestive fire) causes improper digestion of food and leads to Grahani roga. In Grahani roga, mala is released in undigested form. The role of diet and Deepana-Pachana is very important, while treating the patient of the Grahani. Pathya Ahara, Bilva, and Panchakola Churna help to cure Grahani Dosha with considerable health benefits. Objectives: This study was conducted with the objectives to prepare a dietary module for the patients of Grahani and to study the clinical effect of the prescribed diet (Pathya Ahara) in Grahani. Material and Methods: A total of 60 patients of Grahani Dosha of either sex were registered. These patients were divided into two groups by random sampling method in Groups A and B. In Group A, patients were given Bilva and Panchakola Churna without any dietary modification, and patients of Group B were given a diet module to modify their diet along with Bilva and Panchakola Churna. All the patients were evaluated for subjective parameters. Results: Statistical analysis was done after the intervention of therapies for 6 weeks. Group B showed statistically significant results in all signs and symptoms as compared to Group A. Conclusion: Pathya Ahara improves the efficacy of the medicine in Grahani roga without the presence of any adverse effects.

Keywords: Grahani, Bilva Churna, Panchakola Churna, Pathya Ahara, IBS


How to cite this article:
Saini M, Kumar AS, Kumar SK. A randomized controlled trial to assess the effect of Pathya Ahara in Grahani. J Ayurveda 2021;15:14-8

How to cite this URL:
Saini M, Kumar AS, Kumar SK. A randomized controlled trial to assess the effect of Pathya Ahara in Grahani. J Ayurveda [serial online] 2021 [cited 2021 Apr 13];15:14-8. Available from: http://www.journayu.in/text.asp?2021/15/1/14/311912




  Introduction Top


Faulty dietary habits, sedentary lifestyle, and stress are the main causative factors for various disorders. The disorders of digestion and absorption are broadly covered under the heading of “Grahani roga” in Ayurvedic classics. Grahani is the seat of agni. It retains the food till the food is fully digested and passed to Pakvashaya. Mandagni (weak digestive fire) causes improper digestion of food and leads to Grahani roga. In Grahani roga, mala is released in undigested form.[1] Ama Dosha (undigested waste material) is accumulated in Grahani and passed in the stool.

Need of the study

The role of Pathya Ahara (wholesome diet) is very important, especially while treating the patient of Grahani because Grahani occurs due to faulty eating habits and impaired digestive functions. Till now, no research work has been done or published on Pathya Ahara for Grahani. Therefore, this gap of knowledge has been fulfilled in this study.

Aims and objectives

  1. To prepare a dietary module for the patients of Grahani
  2. To study the clinical effect of prescribed diet (Pathya Ahara) in Grahani.



  Materials and Methods Top


  • Study setting: National Institute of Ayurveda (NIA), Jaipur
  • Total duration of trial: 18 months
  • Recruitment period: 6 months
  • Treatment period: 6 weeks
  • Follow-up period: Assessment was done after every week
  • Type of study: Interventional.


Research design

  • Type: Open randomized clinical trial
  • Allocation concealment method: Centralized randomization
  • Number of groups: Two
  • Types of groups: Controlled with standard Ayurveda drug therapy
  • Source of data (population of interest): Patients of Grahani roga fulfilling the inclusion criteria were selected from OPD of NIA hospital
  • Sample size: Total number of patients – 60
  • Group A (control group) – 30
  • Group B (trial group) – 30
  • Sampling technique: Simple randomization
  • Dropouts: No dropouts
  • Ethical Clearance: Ethical committee of the National Institute of Ayurveda, Jaipur, IEC/ACA/2017/79 on April 26, 2017
  • CTRI registration: CTRI/2019/01/016894.


Interventions

  • Group A: Five grams of Bilva churna and 1 g of Panchakola churna in mixed form were given twice a day before major meals with lukewarm water. No dietary modifications were advised to this group
  • Group B: A printed diet chart was prepared and given to patients to follow that dietary module along with Bilva and Panchakola Churna [Figure 1].
Figure 1: (a and b) Dietary module for the patient of Grahani Roga

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Diagnostic criteria

The diagnosis was done on the basis of clinical symptoms of Grahani roga mentioned in Ayurvedic classics.

Inclusion criteria

  1. Patients between 18 and 60 years of either sex
  2. Patients having classical symptoms of Grahani roga, namely Atisrishta mala (frequency of stool), Drava mala (loose stool), Ama mala (sticky stool), Vibaddha mala (hard stool), Annavidaha (improper digestion of food), and Chirapaka (delayed digestion)
  3. Patients ready to take treatment for 6 weeks.


Exclusion criteria

  1. Known case of peptic ulcer, ulcerative colitis, pancreatitis, and celiac disease
  2. Patients taking any other treatment of Grahani, I. B. S. and chronic amebiasis
  3. Known case of any systematic disorder.


Assessment criteria

Assessment has been done on the basis of following criteria: Atisrishta mala (frequency of stool), Drava mala (loose stool), Ama mala (sticky stool), Vibaddha mala (hard stool), Annavidaha (improper digestion of food), Chirapaka (delayed digestion). The scoring has been done on the basis of the self-grading assessment tool.[2]

  1. Atisrishta Mala


    • 0 – Passing stool (once/day)
    • 1 – Passing stool (2–3 times/day)
    • 2 – Passing stool (3–4 times/day)
    • 3 – Passing stool (>5 times/day).


  2. Drava mala


    • 0 – Normal Consistency (firm and soft stool)
    • 1 – Semi liquid
    • 2 – liquid
    • 3 – Watery stool.


  3. Ama mala


    • 0 – No visible mucous in stool
    • 1 – Mild mucous in stool
    • 2 – Moderate mucous in stool
    • 3 – Huge mucous in stool.


  4. Vibaddha mala


    • 0 – Normal consistency (firm and soft stool)
    • 1 – Sausage shaped with crakes
    • 2 – Sausage shaped with lumps
    • 3 – Separate hard lumps.


  5. Annavidaha


    • 0 – Normal digestion
    • 1 – Mild heartburn
    • 2 – Moderate heartburn
    • 3 – Severe heartburn.


  6. Chirapaka


    • 0 – Food digests up to next mealtime
    • 1 – Food digests in 12–18 h
    • 2 – Food digests in 18–24 h
    • 3 – Food digests in more than 24 h.


Assessment of overall effect of therapy

The overall effect of the therapy was assessed as follows:

  1. Cured – patients in whom there was 100% relief in all symptoms
  2. Marked improvement – patients in whom there was relief in symptoms more than 50%
  3. Improved – patients in whom there was relief in symptoms in between 25% and 50%
  4. Unchanged – patients in whom there was <25% relief in symptoms.



  Results Top


To access the efficacy of two therapies, the intergroup comparison was done using Mann–Whitney test for statistical analysis. The results are as follows.

[Table 1] shows that in intergroup comparison, symptoms such as Ama mala, Drava Mala, and Chirapaka have significant difference (P < 0.05) which indicates a statistical difference in efficacy of both treatments. The symptoms such as Atisrishta mala and Vibbaddha Mala have nonsignificant difference (P > 0.05) which indicates no statistical difference in efficacy of both treatments for these symptoms.
Table 1: Intergroup comparison between Group A and Group B for assessment parameters

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[Table 2] indicates that Group B has more clinically significant effect in comparison to Group A.
Table 2: Overall effect in control Group A and trial Group B

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  Discussion Top


Selection of Bilva churna

In our Ayurvedic classics, the properties and uses of Bilva are described thoroughly for many diseases. Acharya Charaka, Sushruta, and Vagbhata have described the properties and actions of Bilva which are almost same. Bilva Churna has been selected in this study due to its Deepana and Sangrahi properties. It predominantly contains Katu and Tikta Rasa. These Rasa also stimulate Agni which leads to Amapachana. Katu and Tikta Rasa also help to promote the absorption of food. Bilva churna has Ushna veerya which helps in enhancing the Koshthagni. It causes digestion of Ama on the basis of principle Sarvada Sarva Bhavanam Samanyam Vriddhi Karanam.[3] Kapha-Vata shamaka property of Bilva churna helps to pacify Kapha and Ama. Ama is the undigested Annarasa which is the root cause of Srotorodha and Atipravarti type Srotodusti.

Probable mode of Action of Bilva Churna

At the level of Agni

Grahani Dosha mainly occurs due to the vitiation of Agni. In general, Mandagni is responsible for this. Bilva Churna is predominant in Agni, Vayu, and Akasha Mahabhuta which shows Tiksna Guna. Ushna Veerya, Tikta, and Katu Rasa stimulate Jatharagni which in turn stimulates all other Agni.

At the level of Grahani Dosha

All three Doshas are involved in Samprapti of Grahani Dosha. Tikshna, Deepana properties, and Katu, Tikta, Kashaya Rasa of Bilva subside the aggravated Kapha Dosha.[4] Its Ushna Veerya and Tikshna and Snigdha Guna are pacifying the Vata Dosha. Due to Snigdha guna, it balances the Pitta Dosha. Because of Sangrahi property, it reduces Drava Mala and Atisrista Mala pravritti. It said to be Bhavaprakasha Samhita that treatment of Grahani Dosha should be according to Atisara.[5] Deepan property of Bilva Churna helps to digest undigested food. Acharya Sushruta says that Deepana Chikitsa should be done in all patients of Grahani Dosha.[6]

At the level of Srotasa

Due to its Katu, Tikta Rasa, Laghu, Tiksna Guna, and Ushna Veerya, it removes Srotorodha. It reduces Atipravritti Srotodusti due to Sangrahi properties.

At the level of Dushya

In the samprati of Grahani Dosha, it is clear that the main Dushya involved is Rasa Dhatu. Katu and Tikta Rasa helps to improve the digestion, thereby causing the formation of healthy Rasa Dhatu.[7]

At the level of Ama

Bilva Churna stops the Ama production by its Katu, Tikta Rasa, Tikshna Guna, Ushna Veerya, and Deepana property. It helps to break the Samprapti of Grahani Dosha by Ama Pachana and Srotomukha Vishodhana.

Selection of Panchakola Churna

Panchakola Churna has predominately Katu Rasa and Katu Vipaka; due to these qualities, it has a specific action on Jatharagni and ultimately on the Grahani Dosha too. It has Ushna veerya, by this virtue, it acts on Jathargni and Grahani dosha. The feature of Ushna veerya is very specific for the process of digestion, i.e., Ashu pakita. Panchakola churna has other properties such as Deepana, Pachana, Ruchya, and Kapha-Vata Shamaka.[8]

Probable mode of Action of Panchakola Churna

At the level of Agni

Panchakola Churna stimulates the Agni by its Tikshna Guna and Ushna Veerya. Agni and Grahani have Adhey-adhara Sambandha; therefore, the drug also acts on Grahani Dosha.

At the level of Grahani Dosha

Tridosa are involved in Samprapti of Grahani Dosha. It is clearly mentioned in the properties of Panchakola that it has Kapha-Vatashamaka property. One ingredient of Panchakola, Pippali has Anushnasheet Veerya, due to this property, it does not cause pittaprakopa.[9]

At the level of Dushya

It is clear by the Samprapti of Grahani Dosha that the main Dushya involved in Grahani roga is Rasa Dhatu. The combination shows the dominancy of Katu Rasa. Katu Rasa helps to improve digestion and causes the formation of healthy Rasa Dhatu.[10]

At the level of Ama

Panchakola Churna stops the Ama production by its Katu Rasa, Deepana, Pachana property, Tikshna Guna, and Ushna Veerya. It helps to break the Samprapti of Grahani Dosha and this Ama Pachana leads to Shrotomukha Vishodhana.

At the level of Shrotasa

Its ingredients Shunthi and Chitraka have Grahi property; due to this Sangrahi property, it reduces to Atipravritti type of Srotodushti. Due to Katu Rasa, it helps to Srotovishodhana by Amapachana and improving the digestive system.

Probable mode of Action of Pathya Ahara

There is nothing else except Ahara for sustaining the life. A man remains disease free only with the congenial diet. Acharya Kashyapa also considered Ahara as Mahabheshajya.[11]

Acharya Lolambaraja has given a very important concept regarding Pathya-Apathya. He says that “when a person adheres to proper diet (pathya) why does he need any kind of medication and when a person does not follow a proper diet regimen what is the use of medicine.”[12]

This concept shows that the Pathya Ahara is very important to maintain health as well as treat any kind of disease.

It is clear by the Samprapti of Grahani Dosha that Mandangni and Ama play an important role. Keeping this concept in mind, a printed dietary module was prepared and given to the patients. All of its Ahara Dravyas had the following properties – Amla, Katu, Tikta, Deepan, Pachan, Grahi, Tikshna, Ushna, and most of Drvyas are Tridosha-shamaka.

Amla and Katu Rasa have Agnideepana, Pachana and Rochana effect. Therefore, Amla and Katu Rasa food relives anorexia, increases appetite and digests the food. Tikta Rasa also has Deepan, Pachana, Laghu, and Sheet properties. These properties also help to reduce Amadosha and stimulate the Jatharagni. Grahai property of Ahara Dravyas also stops the Atipravriti type of Srotodusti.

Difficulty during trial

It is very difficult to monitor the diet actually taken by a patient at home which was observed during follow-ups of the patients. Therefore, a study on indoor patients with controlled drugs and diet may be used in the future for more reliable results.


  Conclusion Top


  1. Grahani is a disease of Annavaha and Purishavaha Srotasa related to Agni and Ama. The main causative factor for the manifestation of Grahani Dosha is the vitiation of Agni, i.e., Mandagni, Tikshnagni, and Vishamagni. Primarily, Mandagni is responsible for this
  2. Grahani Dosha is a Rasa Dushya Vyadhi and Kricchsadhya
  3. The first line of treatment of Grahani Dosha is Deepana and Pachana
  4. Pathya Ahara improves the efficacy of medicines
  5. It was observed in the overall effect of therapy that 6.66% of patients remain unchanged in the trial group, while 36.66% of patients remain unchanged in the control group
  6. No side effect was reported among the patients of any group.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Charaka Samhita, Chikitsasthana. Grahanidosha Chikitsa Adhyaya, 15/52. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2020 Jan 02].  Back to cited text no. 1
    
2.
Charaka Samhita, Chikitsasthana. Grahanidosha Chikitsaadhyaya, 15/53- 55. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2020 Jan 02].  Back to cited text no. 2
    
3.
Charaka Samhita, Sutrasthana. Deerghjeevitiyoadhyaya, 1/44. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2020 Jan 02].  Back to cited text no. 3
    
4.
Charaka Samhita, Sutrasthana. Annapanavidhiadhyaya, 27/138. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2020 Jan 02].  Back to cited text no. 4
    
5.
Sri Bhavamishra, Bhavaprakash. Chikitsaprakarana, Vidyotini Hindi Commmentry by Pt. Sri Brahmashankar Mishra. Vol. II., Reprint 2016 ed. Chakhambha Sanskrita Bhawan; 2016, Ch. 4., Ver. 25..p. 34  Back to cited text no. 5
    
6.
Sushruta Samhita, Uttartantra. Atisarpratisedhiyaadhyaya, 40/182. Available from: http://niimh.nic.in/ebooks/esushruta. [Last accessed on 2020 Jan 02].  Back to cited text no. 6
    
7.
Charaka Samhita, Sutrasthana. Atreyabhadrakapiyaadhyaya, 26/42/4-5. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2020 Jan 02].  Back to cited text no. 7
    
8.
Sri Bhavaprakasha, Bhavaprakash Nighantu, Hindi Commentary by KC Chunekar. Reprint 2013 ed, Varanasi: Chaukhambha Bharati Academy Publication 2013, Chapter Haritakyadivarga. Ver. 73. p. 24.  Back to cited text no. 8
    
9.
Sri Bhavaprakasha, Bhavaprakash Nighantu, Hindi Commentary by KC Chunekar. Reprint 2013 ed., . Varanasi: Chaukhambha Bharati Academy Publication; 2013. Chapter Haritakyadivarga. Ver. 54. p. 15.  Back to cited text no. 9
    
10.
Charaka Samhita, Sutrasthana. Atreyabhadrakapiyaadhyaya, 26/42/4. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2020 Jan 02].  Back to cited text no. 10
    
11.
Kashyapa, Kashyapa Samhita, Hindi Vidyotini Commentary by Sri Satyapal Bhishagachary. Khil Sthana. . Reprint 2013 ed., Varanasi: Chakhambha Sanskrita Bhawan; 2013, Ch. 4., Ver. 6. p. 249.  Back to cited text no. 11
    
12.
Shri Lolambaraj, Vaidajivanam, Hindi Commentary by Vd. Kalikacharan Pandey. 1st. Edition. Varanasi: Chaukhambha Sanskrit Series Office Publication; 2016, Ch. 1., Ver. 10, p. 4.  Back to cited text no. 12
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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