Changes

=== Introduction ===

=== Introduction ===

[[Grahani Chikitsa]] is one of the most important chapters of this compendium because most of the diseases originate from disorders of digestion. This chapter is described after ''arsha roga'' (hemorrhoids) because pathophysiology of ''arsha'' influences ''agni'' and before [[Panduroga Chikitsa]] because ''grahani roga'' influences ''panduroga''. The initial portion of this chapter discusses the details of the physiological process of digestion and metabolism in human body. Agni, being the fundamental factor in maintaining health and in producing diseases, has been described in detail. The chapter begins with explanation of importance of normally functioning agni and then goes on to explain the various aspects of digestion, metabolism and tissue nourishment. Different theories of tissue nourishment as explained by the commentators play a crucial role in the entire process. The concept of upadhātu and dhātumala has also been dealt with. These descriptions are followed by the pathophysiology of grahaṇīdōṣha syndrome and its management. This chapter underscores that the knowledge of physiology is crucial in understanding the pathophysiology and therapeutics of a disease.

[[Grahani Chikitsa]] is one of the most important chapters of this compendium because most of the diseases originate from disorders of digestion. This chapter is described after ''arsha roga'' (hemorrhoids) because pathophysiology of ''arsha'' influences ''agni'' and before [[Panduroga Chikitsa]] because ''grahani roga'' influences ''panduroga''. The initial portion of this chapter discusses the details of the physiological process of digestion and metabolism in human body. ''Agni'', being the fundamental factor in maintaining health and in producing diseases, has been described in detail. The chapter begins with explanation of importance of normally functioning ''agni'' and then goes on to explain the various aspects of digestion, metabolism and tissue nourishment.

Protection of agni is very essential in treatment of all diseases. (Chakrapani Ca.Ci.14/244-246 )Arśha, atisāra and grahaṇīdōṣha 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.  

 

Ceratain drugs like chitraka (Plumbago zeylanica), pippalī (Piper longum), pippalīmula (root of Piper longum), shunthi (Zingiber officinale), nāgkesar, haridrā, danti, duralabhā, haritaki etc have been used in combinations with other drugs for the treatment of arśha considering the concept of agnibala vriddhi and vāta anulomanaṁ (fascilitating passage of vata) and the same drugs have been used in grahani chikitsā with the same concept. Caraka explains that all the above three diseases are caused by agnimāndya and if increase in agni is done then relief in the disease takes place. (Chakrapani  Ca.Ci.14/244-246)

Different theories of tissue nourishment as explained by the commentators play a crucial role in the entire process. The concept of ''upadhatu'' and ''dhatumala'' has also been dealt with. These descriptions are followed by the pathophysiology of ''grahanidosha'' syndrome and its management. This chapter underscores that the knowledge of physiology is crucial in understanding the pathophysiology and therapeutics of a disease.

Further vāta is said to be agnisakhā i.e. agnibala depends on vāta. vātakṣaya or prakopa results in agnimāndya. Therefore, anna, pāna and ausadha which bring about vāta anuloman are very useful in treatment of diseases like arśha and grahaṇī dōṣha.  

 

Vāta anulomanaṁ means to fascilitate the gati (motion) of vāta downwards to anus. Among five types of vāta, samāna and apāna have major role in diseases like arśha, atisāra and grahaṇīdōṣha. Obstruction to movement of vata (avarudha gati) or diarrhea (atisāraṇa) leads to agni kṣaya. Avarudha gati is the cause for vibandha (constipation), malavibandha (obstruction to feces) alongwith pravāhana (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 atisaraṇa (diarrhoea) causes increased motility of intestine. Hence vāta anulomanaṁ should not be understood as virechana or laxation but regularization of vāta gati so that there is no avarodha or atisaran. The same concept of vāta anuloman is also mentioned in grahani dōṣa chikitsā adhyāya.(Ca.Ci.14/247)

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)

 

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 kṣaya. Avarudha gati is the cause for vibandha (constipation), malavibandha (obstruction to feces) alongwith pravāhana (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 atisaraṇa (diarrhoea) causes increased motility of intestine. Hence vāta anulomanaṁ should not be understood as virechana or laxation but regularization of vāta gati so that there is no avarodha or atisaran. The same concept of vāta anuloman is also mentioned in grahani dōṣa chikitsā adhyāya.(Ca.Ci.14/247)

Therefore, the line of treatment used in arśha with regard to agni bala and vāta anulomana is basically similar to that of grahaṇīdōṣha hence Charaka has explained grahaṇī dōṣa chikitsā adhyāya after arśa chikitsā adhyāya.( Chakrapani  Ca.Ci.15/1) Caraka could have restricted the name of chapter to grahaṇīchikitsā i.e. treatment of the avayava grahaṇī whereas he has increased the scope of chapter by using the word grahaṇīdōṣha.(Chakrapani  Ca.Ci.15/1).

Therefore, the line of treatment used in arśha with regard to agni bala and vāta anulomana is basically similar to that of grahaṇīdōṣha hence Charaka has explained grahaṇī dōṣa chikitsā adhyāya after arśa chikitsā adhyāya.( Chakrapani  Ca.Ci.15/1) Caraka could have restricted the name of chapter to grahaṇīchikitsā i.e. treatment of the avayava grahaṇī whereas he has increased the scope of chapter by using the word grahaṇīdōṣha.(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 grahaṇīavayava is in normal state then agni the avayavi functions normally and vice versa also holds true, whereas if dusti of grahaṇī takes place agni vaishamyata (imbalance) is seen e.g. ileitis, wherein digestion is hampered. grahaṇī is the seat for jatharāgni. (Ca.Ci.15 /56) Agni is responsible for ayu (longevity of life), varṇa (complexion), bala (strength), svāasthya (health), utsāha (enthusiasm), upachaya (proper metabolism), prabhā (glow) and oja (core energy). Prākṛta agni (normal digestive power) is essential for long and healthy life while, vitiated agni is responsible for roga avasthā (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 grahaṇīavayava is in normal state then agni the avayavi functions normally and vice versa also holds true, whereas if dusti of grahaṇī takes place agni vaishamyata (imbalance) is seen e.g. ileitis, wherein digestion is hampered. grahaṇī is the seat for jatharāgni. (Ca.Ci.15 /56) Agni is responsible for ayu (longevity of life), varṇa (complexion), bala (strength), svāasthya (health), utsāha (enthusiasm), upachaya (proper metabolism), prabhā (glow) and oja (core energy). Prākṛta agni (normal digestive power) is essential for long and healthy life while, vitiated agni is responsible for roga avasthā (disease).(Ca. Ci. 15/3-4)