Changes

===Duodenal Ulcer (Parinama shula)===

===Duodenal Ulcer (Parinama shula)===

[[Vata]] vitiated due to its causative factors, gets mixed and blocked by morbid [[pitta]] and [[kapha]]. It causes severe pain (shula), which is known as “parinama shula”.

[[Vata]] vitiated due to its causative factors, gets mixed and blocked by morbid [[pitta]] and [[kapha]]. It causes severe pain (shula), which is known as “parinama shula”.

Excess [[pitta]] or acidic secretions damage the mucous layers ([[kapha]]) of the duodenum. The mucous layer sheds from its place and gets admixed with pitta (acids). Since the mucous layer forms a buffer and protective sheath of the intestines, shedding of the mucous membrane (kapha) leads to the formation of ulcers or sores in the intestinal mucosal walls. This is the stage of the ulcer formation. The [[vayu]] gets aggravated and causes severe pain. This may be correlated with the irritation of nerve fibers at the region of sores.  

 

Excess [[pitta]] or acidic secretions damage the mucous layers ([[kapha]]) of the duodenum. The mucous layer sheds from its place and gets admixed with [[pitta]] (acids). Since the mucous layer forms a buffer and protective sheath of the intestines, shedding of the mucous membrane (kapha) leads to the formation of ulcers or sores in the intestinal mucosal walls. This is the stage of ulcer formation.

 

The [[vayu]] gets aggravated and causes severe pain. This may be correlated with the irritation of nerve fibers at the region of sores.  

When the acidic food from the stomach enters the duodenum for further digestion, it corrodes and irritates the sores causing severe pain during the process of digestion. The pain remains until the acidic food is pushed forward from the duodenum or until the afflicted person consumes food.  

When the acidic food from the stomach enters the duodenum for further digestion, it corrodes and irritates the sores causing severe pain during the process of digestion. The pain remains until the acidic food is pushed forward from the duodenum or until the afflicted person consumes food.  

In [[vata]] predominant type of duodenal ulcer, abdominal distension, gurgling sound and non-passage of stool and urine are the main symptoms. It is relieved by the use of unctuous and hot substances.  

 

In [[pitta]] predominant type, there is excessive thirst, burning sensation, restlessness and sweating. It is aggravated by the use of spicy, sour and salty diet. The pain is relieved by the use of cold articles.  

In [[vata]] predominant type of duodenal ulcer, abdominal distension, gurgling sound, and non-passage of stool and urine are the main symptoms. It is relieved by the use of unctuous and hot substances.  

In [[kapha]] predominant type, vomiting, nausea, disorientation are the main symptoms. Mild pain persists for long time and relieved by pungent and bitter foods.

 

In case of peptic ulcer, rice, bean, salt, sour food articles, and condiment should be avoided. Milk, banana, and coconut water are advisable.

In [[pitta]] predominant type, there is excessive thirst, burning sensation, restlessness, and sweating. It is aggravated by the use of a spicy, sour, and salty diet. The pain is relieved by the use of cold articles.  

Principles of treatment of peptic ulcer

 

As first line of treatment, drugs having predominantly bitter taste (tikta rasa) and inducing dryness(ruksha) are used.

In [[kapha]] predominant type, vomiting, nausea, disorientation are the main symptoms. Mild pain persists for a long time and relieved by pungent and bitter foods.

In second phase, drugs with sweet taste (madhura rasa) and bitter taste(tikta rasa) and medicated milk preparations are used.

 

In last phase, medicated milk processed with drugs having sweet and bitter tastes is preferred. It is added with mental-health promoting (medhya) drugs. Avoiding the causative factor is the most important step in treatment. Mild purgation, enema with medicated milk (kshira basti), pouring of medicated buttermilk on forehead (takradhara), and anointment of medicated paste on forehead or scalp (shirolepa) are effective procedures in this condition.

In case of peptic ulcer, rice, bean, salt, sour food articles, and condiments should be avoided. Milk, banana, and coconut water are advisable.

In a research work on duodenal ulcer(parinama shula) by Antony Jose & H.M.Chandola(2004), a formulation called “Akshadi churna” [a combination of Terminalia chebula (haritaki) , Terminalia bellirica(bibhitaki) , Phyllanthus emblica (amalaki)  and Piper longum(pippali)][ Chakradatta  27/6] along with ghee preparation called “medhya rasayana ghrita”[a combination of Convolvulus pluricaulis(shankhapushpi) , Centella asiatica(mandukaparni), Glycyrrhiza Glabra (yashtimadhu)  and Tinospora cordifolia (guduchi) ] were used. It showed better results than administering only Akshadi churna. Significant difference was observed in the parameters of Brief Psychiatry Rating Scale. This shows importance of dealing with the psychic component in this disease.

 

Inflammatory bowel Diseases (IBD)

'''Principles of treatment of peptic ulcer'''

 

As the first line of treatment, drugs having predominantly bitter taste (tikta rasa) and inducing dryness(ruksha) are used.

 

In the second phase, drugs with sweet taste (madhura rasa) and bitter taste(tikta rasa), and medicated milk preparations are used.

 

In the last phase, medicated milk processed with drugs having sweet and bitter tastes is preferred. It is added with mental-health promoting (medhya) drugs. Avoiding the causative factor is the most important step in treatment. Mild purgation, enema with medicated milk (kshira [[basti]]), pouring of medicated buttermilk on the forehead (takradhara), and anointment of medicated paste on forehead or scalp (shirolepa) are effective procedures in this condition.

 

In a research work on duodenal ulcer(parinama shula) by Antony Jose & H.M.Chandola(2004), a formulation called “Akshadi churna” [a combination of Terminalia chebula (haritaki) , Terminalia bellirica(bibhitaki) , Phyllanthus emblica (amalaki)  and Piper longum(pippali)][ Chakradatta  27/6] along with ghee preparation called “medhya rasayana ghrita”[a combination of Convolvulus pluricaulis(shankhapushpi) , Centella asiatica(mandukaparni), Glycyrrhiza Glabra (yashtimadhu)  and Tinospora cordifolia (guduchi) ] were used. It showed better results than administering only Akshadi churna. Significant difference was observed in the parameters of Brief Psychiatry Rating Scale. This shows the importance of dealing with the psychic component in this disease.

 

===Inflammatory bowel Diseases (IBD)===

This includes two idiopathic bowel diseases having many similarities but distinctive morphological appearance.

This includes two idiopathic bowel diseases having many similarities but distinctive morphological appearance.

a) Crohn’s disease (regional enteritis)

 

It affects the segment of terminal ileum and/ or colon, though any part of gut may get involved.  

a)Crohn’s disease (regional enteritis)

b) Ulcerative colitis

 

It is the acute and chronic ulcero-inflammatory colitis affecting chiefly the mucosa and sub mucosa of the rectum and descending colon. Sometimes it may involve the entire length of large bowel.  

It affects the segment of terminal ileum and/ or colon, though any part of the gut may get involved.  

The etiological factors of IBD include genetic factors, immunologic factors, microbial factors and environmental factors like long term administration of NSAIDs, psychological factors, smoking, oral contraceptive pills etc. In a genetically predisposed individual, the effect of environmental factors and deranged microbiota, result in dysregulation of mucosal and immune function, which leads to chronic inflammation. It is diagnosed using endoscopy with tissue biopsy, colonoscopy, flexible sigmoidoscopy etc.  

 

Symptoms like elimination of faecal matter mixed with blood and mucous, having offensive smell are observed with weight loss in patient. These conditions  are mentioned in the contexts of raktatisara, tridoshaja atisara and shokaja atisara. These symptoms are similar to IBD.  

b)Ulcerative colitis

Principle of treatment for ulcerative colitis

 

The treatment protocols of “pittatisara” or “raktatisara”, “pitta-kapha grahani chikitsa”, “jirna pravahika chikitsa”, “adhoga raktapitta chikitsa” are adopted here. Anti-inflammatory (pakahara and shophahara) and anthelminthic (krimighna) treatments are preferred in cases of ulcerative colitis. Drugs having bitter (tikta) or sweet (madhura) taste, with healing (ropana) property, in the form of medicated milk are recommended here.  

It is the acute and chronic ulcero-inflammatory colitis affecting chiefly the mucosa and submucosa of the rectum and descending colon. Sometimes it may involve the entire length of the large bowel.  

 

The etiological factors of IBD include genetic factors, immunologic factors, microbial factors, and environmental factors like long-term administration of NSAIDs, psychological factors, smoking, oral contraceptive pills etc. In a genetically predisposed individual, the effect of environmental factors and deranged microbiota, result in dysregulation of mucosal and immune function, which leads to chronic inflammation. It is diagnosed using endoscopy with tissue biopsy, colonoscopy, flexible sigmoidoscopy etc.  

 

Symptoms like the elimination of faecal matter mixed with blood and mucous, having offensive smell are observed with weight loss in patients.These conditions  are mentioned in the contexts of raktatisara, tridoshaja atisara and shokaja atisara. These symptoms are similar to IBD.  

 

'''Principle of treatment for ulcerative colitis'''

 

The treatment protocols of “pittatisara” or “raktatisara”, “[[pitta]]-[[kapha]] grahani chikitsa”, “jirna pravahika chikitsa”, “adhoga raktapitta chikitsa” are adopted here. Anti-inflammatory (pakahara and shophahara) and anthelminthic (krimighna) treatments are preferred in cases of ulcerative colitis. Drugs having bitter (tikta) or sweet (madhura) taste, with healing (ropana) property, in the form of medicated milk are recommended here.  

 

In the chronic stage, and if there is excessive blood loss, weight loss, the treatment for anaemia (pandu) and emaciation (dhatukshaya) also should be done.

In the chronic stage, and if there is excessive blood loss, weight loss, the treatment for anaemia (pandu) and emaciation (dhatukshaya) also should be done.

The decoction preparations like drakshadi kashaya, ambashthadi gana kashaya, mahatikta kashaya, jivaniya gana kshira kashaya, guduchyadi kashaya, musta kshira kashaya etc. and the fermented preparations like lodhrasava, jirakarishta, kutajarishta, madhukasava, mustakarishta etc. are effective in this condition. However, fermented preparations should not be prescribed in the bleeding phase.

The decoction preparations like drakshadi kashaya, ambashthadi gana kashaya, mahatikta kashaya, jivaniya gana kshira kashaya, guduchyadi kashaya, musta kshira kashaya etc. and the fermented preparations like lodhrasava, jirakarishta, kutajarishta, madhukasava, mustakarishta etc. are effective in this condition. However, fermented preparations should not be prescribed in the bleeding phase.

Medicines in the powder (churna) form namely dadimashtaka churna, kapitthashtakam churna, laksha churna with honey, lodhra-yashti churna, and pushyanuga churna are effective. Tablets like jatiphaladi gutika and bilvadi gutika are also prescribed.

Medicines in the powder (churna) form namely dadimashtaka churna, kapitthashtakam churna, laksha churna with honey, lodhra-yashti churna, and pushyanuga churna are effective. Tablets like jatiphaladi gutika and bilvadi gutika are also prescribed.

Medicated ghee preparations like changeryadi ghrita, mahatiktaka ghrita and shatavari ghrita are effective.   

Medicated ghee preparations like changeryadi ghrita, mahatiktaka ghrita and shatavari ghrita are effective.   

Butter milk is a very good remedy to treat this condition. The formulation panchamrita parpati along with butter milk gives excellent relief when administered orally or per rectal routes. The other preparations like swarna parpati, rasa parpati, bola parpati, dhatri loha, sutashekhara rasa,  punarnava mandura etc. are also used for the treatment of ulcerative colitis.

Buttermilk is a very good remedy to treat this condition. The formulation panchamrita parpati along with butter milk gives excellent relief when administered orally or per rectal route. The other preparations like swarna parpati, rasa parpati, bola parpati, dhatri loha, sutashekhara rasa,  punarnava mandura etc. are also used for the treatment of ulcerative colitis.

Medicated milk preparations using Holarrhena antidysenterica(kutaja), Aconitum Heterophyllum(ativisha), Salmalia malabarica (shalmali), Vetiveria zizanioides (ushira), Symplocos racemosa roxb(lodhra), Woodfordia fruticosa(dhataki) and Nymphaea caerulea(utpala)are prescribed. Goat’s milk (aja kshira) is especially preferred for consumption.

 

The medicated enema called “pichcha basti” is observed very effective in this condition.

Medicated milk preparations using Holarrhena antidysenterica(kutaja), Aconitum Heterophyllum(ativisha), Salmalia malabarica (shalmali), Vetiveria zizanioides (ushira), Symplocos racemosa roxb(lodhra), Woodfordia fruticosa(dhataki), and Nymphaea caerulea(utpala)are prescribed. Goat’s milk (aja kshira) is especially preferred for consumption.

Irritable Bowel Syndrome (IBS)

 

IBS is a psychosomatic intestinal motility disorder presenting as altered bowel habits, abdominal pain and the absence of detectable organic pathology. Altered bowel habits, i.e. frequent constipation and diarrhea or anyone of these two symptoms is observed as the main characteristic feature.  

The medicated enema called “pichcha [[basti]]” is observed as very effective in this condition.

 

===Irritable Bowel Syndrome (IBS)===

IBS is a psychosomatic intestinal motility disorder presenting as altered bowel habits, abdominal pain, and the absence of detectable organic pathology. Altered bowel habits, i.e. frequent constipation and diarrhea or any one of these two symptoms is observed as the main characteristic feature.  

 

In Ayurvedic parlance, it can be interpreted under the following clinical conditions.

In Ayurvedic parlance, it can be interpreted under the following clinical conditions.

a. Atisara [Cha. Sa. [[Chikitsa Sthana]] 19, Su. Sa. Uttara Tantra. 40 ]

 

b. Grahani [Cha. Sa. [[Chikitsa Sthana]].15, Su. Sa.Uttara Tantra 40,  A. Hr. Nidana Sthana 8]

a.Atisara [Cha. Sa. [[Chikitsa Sthana]] 19, Su. Sa. Uttara Tantra. 40 ]

c. Pravahika [Cha.Sa. [[Chikitsa Sthana]] 19]

 

d. Pakvashayagata vata [Cha. Sa. [[Chikitsa Sthana]] 28 /28-29 ]

b.Grahani [Cha. Sa. [[Chikitsa Sthana]].15, Su. Sa.Uttara Tantra 40,  A. Hr. Nidana Sthana 8]

Among these conditions, symptoms of [[vata]] predominant [[grahani]] shows more resemblance with IBS. Poor digestion, hyperacidity, roughness in body and flatulence during and after digestion are observed in this condition. The patient frequently passes stool with difficulty. The consistency of faecal matter is liquid mixed with hard stool, associated with sound and frothiness. [Cha. Sa. [[Chikitsa Sthana]]15/6-10] In pravahika, there is frequent expulsion of stool containing mucus in less quantity accompanied by pain and straining (tenesmus).

 

Dietary modifications including more dietary fibres, psycho-social therapies, drugs like anticholinergics, antidepressants, antidiarrheals, anxiolytics and those acting on serotonin receptors are being used in the management of IBS. Probiotics have greater role to enhance or support the bacterial flora in the gut.  

c.Pravahika [Cha.Sa. [[Chikitsa Sthana]] 19]

Principles of treatment of IBS

 

The treatment principles of vataja grahani, atisara and pakwashayagata vata are used in management of IBS. The psychological health component is taken care by therapies like pouring of liquid medicines like oil, medicated butter milk etc on forehead (shirodhara/ takradhara) and anointment of medicated paste on scalp(shirolepa).  

d.Pakvashayagata vata [Cha. Sa. [[Chikitsa Sthana]] 28 /28-29]

Sitz bath with lukewarm medicated water(avagaha sweda), enema using medicated oil or ghee(anuvasana basti) are effective procedures in this condition.

 

Among these conditions, symptoms of [[vata]] predominant [[grahani]] show more resemblance with IBS. Poor digestion, hyperacidity, roughness in the body and flatulence during and after digestion are observed in this condition. The patient frequently passes stool with difficulty. The consistency of faecal matter is liquid mixed with hard stool, associated with sound and frothiness. [Cha. Sa. [[Chikitsa Sthana]]15/6-10]  

 

In pravahika, there is frequent expulsion of stool containing mucus in less quantity accompanied by pain and straining (tenesmus).

 

Dietary modifications including more dietary fibers, psycho-social therapies, drugs like anticholinergics, antidepressants, antidiarrheals, anxiolytics and those acting on serotonin receptors are being used in the management of IBS. Probiotics have a greater role to enhance or support the bacterial flora in the gut.  

 

'''Principles of treatment of IBS'''

 

The treatment principles of vataja grahani, atisara and pakwashayagata [[vata]] are used in the management of IBS. The psychological health component is taken care of by therapies like the pouring of liquid medicines like oil, medicated butter milk etc on the forehead (shirodhara/ takradhara) and anointment of medicated paste on scalp(shirolepa).  

 

Sitz bath with lukewarm medicated water(avagaha [[sweda]]), enema using medicated oil or ghee(anuvasana [[basti]]) are effective procedures in this condition.

 

The treatment principles can be divided into two as per the stages or phases:

The treatment principles can be divided into two as per the stages or phases:

a) In Diarrhoea dominant stage, drugs having the properties of enhancing digestive power (agni dipana), styptic (grahi) and improving the strength of tissues (dhatubalakara) are used.

 

b) In Constipation dominant stage, drugs that produce the effects of clearing the minute channels (srotoshodhana), enhancing the digestive power (koshthagnidipana) and promoting the downward movement of [[vata]] (vatanulomana) are used.

a)In Diarrhoea dominant stage, drugs having the properties of enhancing digestive power ([[agni]] dipana), styptic (grahi), and improving the strength of tissues (dhatubalakara) are used.

In first phase of IBS, mainly medicines in the powder (churna) form or medicated liquids (paneeya kalpana) are used to promote the digestive power. In diarrhoea dominant stage, “panchakola churna” and in constipation dominant stage, “ vaishwanara churna” are the drugs of choice.  

 

In the second phase, if the person acquires good digestive capacity(agni dipti),medicated ghee (ghritas) and linctus preparation (avaleha) are used. These medicines pacify [[vata]](vatahara) and help to maintain the proper function of digestive fire(agni satmyakara). For example, dadimadi ghrita or sukumara ghrita mixed with rock salt(saindhava) can be prescribed.

b)In Constipation dominant stage, drugs that produce the effects of clearing the minute channels (srotoshodhana), enhancing the digestive power (koshthagnidipana), and promoting the downward movement of [[vata]] (vatanulomana) are used.

 

In the first phase of IBS, mainly medicines in the powder (churna) form or medicated liquids (paneeya kalpana) are used to promote digestive power. In diarrhoea dominant stage, “panchakola churna” and in constipation dominant stage, “ vaishwanara churna” are the drugs of choice.  

 

In the second phase, if the person acquires good digestive capacity([[agni]] dipti),medicated ghee (ghritas) and linctus preparation (avaleha) are used.These medicines pacify [[vata]](vatahara) and help to maintain the proper function of digestive fire([[agni]]satmyakara).

For example, dadimadi ghrita or sukumara ghrita mixed with rock salt(saindhava) can be prescribed.

 

The formulations like brihat gangadhara churna, dadimadi churna, hingvashtaka churna, jatilavangadi churna, kapitthashtakam churnam, chitrakadi vati, changeryadi gutika, manasa mitra vatakam, parushakadi lehya, kutajadi lehya, panchamrita parpati, kshara parpati, swarna parpati, with butter milk and medicated meat soups are also effective in this condition.

The formulations like brihat gangadhara churna, dadimadi churna, hingvashtaka churna, jatilavangadi churna, kapitthashtakam churnam, chitrakadi vati, changeryadi gutika, manasa mitra vatakam, parushakadi lehya, kutajadi lehya, panchamrita parpati, kshara parpati, swarna parpati, with butter milk and medicated meat soups are also effective in this condition.

The dietary items like wheat, maize, barley, peas, black gram, soya bean, kidney bean, potato, sweet potato, onion, ground nut, chilli, oily food, chicken, red meat, crabs, mango, pineapple, apple, watermelon, cashew, fig, pumpkin papaya and jackfruit shall be avoided by the patients of IBS.

The dietary items like wheat, maize, barley, peas, black gram, soya bean, kidney bean, potato, sweet potato, onion, ground nut, chilli, oily food, chicken, red meat, crabs, mango, pineapple, apple, watermelon, cashew, fig, pumpkin papaya and jackfruit shall be avoided by the patients of IBS.

The diet plan including the use of old rice, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, pomegranate, nut meg buttermilk and hot water are suitable.  

 

In a clinical study, by Raksha Mer & H. M. Chandola (2004), the effect of kutajadi avaleha alone and kutajadi avaleha along with medhyarasayana ghrita was compared. Better results were observed in the combined group. This shows the importance of addressing the psychological component in the treatment protocol.

The diet plan including the use of old rice, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, pomegranate, nutmeg buttermilk, and hot water are suitable.  

 

In a clinical study on IBS, by Raksha Mer & H. M. Chandola (2004), the effect of kutajadi avaleha alone and kutajadi avaleha along with medhyarasayana ghrita was compared. Better results were observed in the combined group. This shows the importance of addressing the psychological component in the treatment protocol.

 

==Butter milk - the best medicine for gut related disorders==

==Butter milk - the best medicine for gut related disorders==

Butter milk has astringent taste (kashaya rasa) and hot potency (ushna virya). It increases the digestive power (deepana) and absorbs fluid from the stool (grahi). It decreases aggravated [[kapha]] and rectifies the digestive process. It’s sweet and sour taste do not provoke [[vata]]. Its property of “madhura vipaka”, do not cause the aggravation of [[pitta]]. So, it is best to keep the balance of all the three [[doshas]] in gut.

Butter milk has astringent taste (kashaya rasa) and hot potency (ushna virya). It increases the digestive power (deepana) and absorbs fluid from the stool (grahi). It decreases aggravated [[kapha]] and rectifies the digestive process. It’s sweet and sour taste do not provoke [[vata]]. Its property of “madhura vipaka”, do not cause the aggravation of [[pitta]]. So, it is best to keep the balance of all the three [[doshas]] in gut.