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|title=Grahani Chikitsa

|titlemode=append

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|keywords=Digestion in Ayurveda, metabolism in Ayurveda, jatharagni, bhutagni, dhatvagni, grahani, grahanidosha, grahani roga, annavisha, atyagni, samashana, vishamashana, adhyashana, Ayurveda, charak samhita, Indian system of medicine.

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|keywords=Digestion in Ayurveda, metabolism in Ayurveda, jatharagni, bhutagni, dhatvagni, grahani, grahanidosha, grahani roga, annavisha, atyagni, samashana, vishamashana, adhyashana, Ayurveda, charak samhita, Indian system of medicine,Patwardhan K., Ojha S.N.,Upadhyaya W., Samant A., Dharmadhikari A., Kajaria D.,Singh G., Goyal M., Deole Y.S., Basisht G., dietary guidelines, digestion and metabolism in Ayurveda, indigestion, nutrition, nourishment

|description=Chikitsa Sthana Chapter 15. Management of Grahani (Diseases of digestion and metabolism)

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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[[Grahani Chikitsa]] consists of three parts. The first part explains the concept of normal digestion process. The second part describes the abnormal digestion and third part is about diseases caused by abnormality of digestive factors and its interaction with proximal intestine or ''grahani''. These disorders are called ''grahanidosha''.

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~~''Agni''~~ (digestive and metabolic agents), based on their specific functions of conversion of food into biological elements of the body are classified into thirteen types. First, the ''jatharagni'' is most important because it is the initiator of digestive process and it strengthens the digestive ability of other twelve ''agnis''. Five ''bhutagnis'' transform the ''panchmahabhauika'' components of ''ahara rasa'' created by ''jatharagni'' into different structures of the body. Seven ''dhatvagnis'' create seven tissues elements(''[[dhatu]]'').

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[[agni]] (digestive and metabolic agents), based on their specific functions of conversion of food into biological elements of the body are classified into thirteen types. First, the ''jatharagni'' is most important because it is the initiator of digestive process and it strengthens the digestive ability of other twelve ''agnis''. Five ''bhutagnis'' transform the ''panchmahabhauika'' components of ''ahara rasa'' created by ''jatharagni'' into different structures of the body. Seven ''dhatvagnis'' create seven tissues elements(''[[dhatu]]'').

''Jatharagni'' initiates the first phase of digestion process by conversion of food into nutrient fluid (''ahara rasa''). This nutrient fluid is further trifurcated into three biological substances ''[[kapha]], [[pitta]]'' and ''[[vata]]'' in three stages to ''madhura, amla'' and ''katu awastha paka'' respectively. This biofluid is separated into excretable waste or impure products by ''samana vata'' in ''grahani'' (middle part of GI Tract) and useful, pure circulable products. ''Samana vata'' analyzes and separates the useful products (''prasada'') and waste (''kitta''). Useful products get absorbed by ''rasayani'' (villi) of the intestine, sent to the micro channels (''srotas'') by ''vyanvata'', simutaneouly, to the entire body. Waste products are excreted out by ''apana vayu'' through urine, feces and sweat.

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== Introduction ==

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[[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.

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[[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 ''pandu roga''. 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.

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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.

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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.

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Protection of ''agni'' is very essential in treatment of all diseases.[Chakrapani,Cha.Sa.[[ Chikitsa Sthana ]]14/244-246 ]''Arsha, atisara'' and ''grahanidosha'' are said to be ''paraspara hetu'' which means one disease becomes cause for another disease[Cha.Sa. [[ Chikitsa Sthana ]]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''.

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Protection of [[agni]] is very essential in treatment of all diseases.[Chakrapani,Cha.Sa.[[ Chikitsa Sthana ]]14/244-246 ]''Arsha, atisara'' and ''grahanidosha'' are said to be ''paraspara [[hetu]]'' which means one disease becomes cause for another disease[Cha.Sa. [[ Chikitsa Sthana ]]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''.

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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. Charak 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 Cha.Sa.[[Chikitsa Sthana]] 14/244-246]

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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. Charak 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 Cha.Sa.[[Chikitsa Sthana]] 14/244-246]

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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''.

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Further, ''[[vata]]'' is said to be ''agnisakha'' i.e. ''agnibala'' depends on ''[[vata]]''. ''Vatakshaya'' or ''prakopa'' results in ''agnimandya''. Therefore, ''anna, pana'' and ''aushadha'' 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 kshaya''. ''Avarudha gati'' is the cause for ''vibandha'' (constipation), ''malavibandha'' (obstruction to feces) along with ''pravahana'' (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 ''atisarana'' (diarrhea) causes increased motility of intestine. Hence ''vata anulomanam'' should not be understood as ''[[virechana]]'' or laxation but regularization of ''[[vata]] gati'' so that there is no ''avarodha'' or ''atisarana''. The same concept of ''vata anulomana'' is also mentioned in [[Grahani Chikitsa]].[Cha.Sa. [[Chikitsa Sthana]] 14/247]

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Therefore, the line of treatment used in ''arsha'' with regard to ''agni bala'' and ''vata anulomanam'' is basically similar to that of ''grahanidosha'' hence Charak has explained [[Grahani Chikitsa]] after [[Arsha Chikitsa]].[Chakrapani Cha.Sa.[[Chikitsa Sthana]]15/1] Charak could have restricted the name of chapter to [[Grahani Chikitsa]] i.e. treatment of the ''avayava grahani'' whereas he has increased the scope of chapter by using the word ''grahanidosha''.[Chakrapani, Cha.Sa. [[Chikitsa Sthana]] 15/1].

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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 ''grahaniavayava'' is in normal state then ''agni'' the ''avayavi'' functions normally and vice versa also holds true, whereas if ''dusti'' of ''grahani'' takes place ''agni vaishamyata'' (imbalance) is seen e.g. ileitis, wherein digestion is hampered. ''Grahani'' is the seat for ''jatharagni''. [Cha.Sa.[[Chikitsa Sthana]] 15 /56] ''Agni'' is responsible for ''ayu'' (longevity of life), ''varna'' (complexion), ''bala'' (strength), ~~''svasthya''~~ (health), ''utsaha'' (enthusiasm), ''upachaya'' (proper metabolism), ''prabha'' (glow) and ''[[oja]]'' (core energy). ''Prakrita agni'' (normal digestive power) is essential for long and healthy life while, vitiated ''agni'' is responsible for ''roga avastha''(disease).[Cha. Sa. [[Chikitsa Sthana]] 15/3-4]

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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 ''grahaniavayava'' is in normal state then [[agni]] the ''avayavi'' functions normally and vice versa also holds true, whereas if ''dusti'' of ''grahani'' takes place ''agni vaishamyata'' (imbalance) is seen e.g. ileitis, wherein digestion is hampered. ''Grahani'' is the seat for ''jatharagni''. [Cha.Sa.[[Chikitsa Sthana]] 15 /56] [[Agni]] is responsible for [[ayu]] (longevity of life), [[varna]] (complexion), [[bala]] (strength), [[swasthya]] (health), ''utsaha'' (enthusiasm), ''upachaya'' (proper metabolism), ''prabha'' (glow) and ''[[oja]]'' (core energy). ''Prakrita [[agni]]'' (normal digestive power) is essential for long and healthy life while, vitiated [[agni]] is responsible for ''roga avastha''(disease).[Cha. Sa. [[Chikitsa Sthana]] 15/3-4]

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In this chapter, Charak describes formation of body tissues in detail with the role of ''ahara'' which is supplied continuously to maintain homeostasis. ''Vyana vata'' is promoter of ''[[rasa]] [[rakta]]di'' circulation.[ Cha. Sa. [[Chikitsa Sthana]] 15/36] It transports ''[[rasa]] [[rakta]]di drava'' ''[[dhatu]]'' throughout body continuously and as per metabolic demand. This explanation shows that closed circulation in human was known to Charak.

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In this chapter, Charak describes formation of body tissues in detail with the role of [[ahara]] which is supplied continuously to maintain homeostasis. ''Vyana vata'' is promoter of ''[[rasa]] [[rakta]]di'' circulation.[ Cha. Sa. [[Chikitsa Sthana]] 15/36] It transports ''[[rasa]] [[rakta]]di drava'' ''[[dhatu]]'' throughout body continuously and as per metabolic demand. This explanation shows that closed circulation in human was known to Charak.

''Grahani'' is prime place where digestion and absorption of ''ahara rasa'' takes place. ''Ahara rasa'' provides nutrition for the ''[[rasa]]di sapta [[dhatu]]'', along-with three ''sharirika [[dosha]]'' and three ''manasika dosha''. Nourishment of ''[[sattva]], [[raja]]'' and ''[[tama]]'' is influenced by ''sattvika, rajasika'' and ''tamasika ahara''. ''Tamasika'' and ''rajasika ahara'' suppresses ''[[sattva]] [[guna]]'' thereby causing ''alpa sattva'' in individual, a common predisposing factor of psychiatric disorders for e.g. ''alpa sattva'' as mentioned in ''unmada'' [Cha.Sa [[Chikitsa Sthana]] 9/5] In ''vataja grahanivyadhishanka'' (feeling of suffering from disease) manifests in patients with ''alpa sattva''.

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Homeostasis at cellular level and gross level is maintained by ''[[vata]], [[pitta]]'' and ''[[kapha]]'' in which digestive and metabolic contributions are due to ''agni''. This chapter has been dedicated to ''agni'' to understand the manner in which it gets vitiated by ''[[dosha]]'' and accordingly the line of treatment for the ''agni dosha'' is explained. As the functions of ''agni'' take place in ''grahani'' hence disease related to ''grahani'' has been given the name.

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Homeostasis at cellular level and gross level is maintained by ''[[vata]], [[pitta]]'' and ''[[kapha]]'' in which digestive and metabolic contributions are due to [[agni]]. This chapter has been dedicated to [[agni]] to understand the manner in which it gets vitiated by ''[[dosha]]'' and accordingly the line of treatment for the ''agni dosha'' is explained. As the functions of [[agni]] take place in ''grahani'' hence disease related to ''grahani'' has been given the name.

Secondly, ''pandu roga'' is due to ''alpata'' of ''raktaposhaka sara bhaga'' [Chakrapani, Cha. Sa. [[Chikitsa Sthana]] 16/3-7] and, one of the main causes of this ''alpata'' is mal-digestion and mal-absorption which takes place in ''grahani''. It is well known fact, that various contributory factors for blood formation have their absorption in gastrointestinal tract such as folic acid, vitamin B12, iron, etc which if not absorbed causes anemia this is the reason why Charak has placed this chapter in between ''arsha'' and ''pandu roga''.

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</div></div>

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''Dehagni'' (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ''[[ojas]]'', normal body temperature and various other forms of ''agni''. Even the existence of an individual is said to be because of ''dehagni'' [3]

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[[Dehagni]] (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ''[[ojas]]'', normal body temperature and various other forms of [[agni]]. Even the existence of an individual is said to be because of [[dehagni]]. [3]

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When the ''agni'' stops functioning, the individual dies; if the ''agni'' functions normally, the individual can lead a healthy and long life. Similarly, if the ''agni'' becomes abnormal, the individual suffers from various diseases; and hence, the ''agni'' is said to be the root cause of health and longevity [4]

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When the [[agni]] stops functioning, the individual dies; if the [[agni]] functions normally, the individual can lead a healthy and long life. Similarly, if the [[agni]] becomes abnormal, the individual suffers from various diseases; and hence, the [[agni]] is said to be the root cause of health and longevity [4]

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The food one consumes becomes capable of nourishing the body tissues and of promoting the ''[[ojas]]'' (vital essence), strength, complexion etc., only in the presence of normally functioning ''agni''. In the absence of normal digestion (and metabolism), the normal body tissues such as ''[[rasa]]'' cannot be formed nor nourished [5]

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The food one consumes becomes capable of nourishing the body tissues and of promoting the ''[[ojas]]'' (vital essence), strength, complexion etc., only in the presence of normally functioning [[agni]]. In the absence of normal digestion (and metabolism), the normal body tissues such as ''[[rasa]]'' cannot be formed nor nourished [5]

=== Process of digestion-first phase ===

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The ingested food is carried to ''koshtha'' by ''prana vata''. The food disintegrates because of the liquids, and further it becomes soft because of the fatty substances. The ''samana vata'', that has an inherent ability to intensify the ''agni,'' intensifies the digestive enzymes and properly digests the food that one consumes timely and in an appropriate quantity, thus leading to longevity. This process of digestion by ''agni'' in the gut which leads to the formation of ''[[rasa]]'' and ''[[mala]]'' is comparable to the process of cooking of the raw rice kept in an earthen vessel containing water on a fire [6-8]

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The ingested food is carried to ''koshtha'' by ''prana vata''. The food disintegrates because of the liquids, and further it becomes soft because of the fatty substances. The ''samana vata'', that has an inherent ability to intensify the ''agni,'' intensifies the digestive enzymes and properly digests the food that one consumes timely and in an appropriate quantity, thus leading to longevity. This process of digestion by [[agni]] in the gut which leads to the formation of ''[[rasa]]'' and ''[[mala]]'' is comparable to the process of cooking of the raw rice kept in an earthen vessel containing water on a fire [6-8]

=== Three states of digestion and provoking ''[[dosha]]'' ===

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When the semi-digested food leaves the stomach, the release of liquid form of [[pitta]] known as ''accha-pitta'' occurs.

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When the ''pakva'' part (the non-absorbable remnant part after the absorption of the nutrients), reaches the ''pakvashaya'' (the colon), the drying effect of ''agni'' converts it into a solid mass. There also occurs the release of ''[[vata]]'' which is ''katu'' (pungent) state [9-11]

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When the ''pakva'' part (the non-absorbable remnant part after the absorption of the nutrients), reaches the ''pakvashaya'' (the colon), the drying effect of [[agni]] converts it into a solid mass. There also occurs the release of ''[[vata]]'' which is ''katu'' (pungent) state [9-11]

=== Second phase of digestion by ''[[panchamahabhuta]]'' ===

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There are five types of ''agni'' namely, ''bhauma, apya, agneya, vayavya'' and ''nabhasa''. These five ''bhutagni'' are one of each ''[[mahabhuta]]'' transform/metabolize those components of the food that are homologous to them in their composition of structure of human organism. (such as ''parthiva, apya'' etc) [13]

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There are five types of [[agni]] namely, ''bhauma, apya, agneya, vayavya'' and ''nabhasa''. These five ''bhutagni'' are one of each ''[[mahabhuta]]'' transform/metabolize those components of the food that are homologous to them in their composition of structure of human organism. (such as ''parthiva, apya'' etc) [13]

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</div></div>

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Due to the action of heat along with the ''[[vata]], ambu'' (water) and ''[[teja]]s,'' the ''[[rakta]]'' is converted into stable ''[[mamsa]],'' after being acted upon by its own ''agni'' (''mamsadhatvagni'') [29]

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Due to the action of heat along with the ''[[vata]], ambu'' (water) and ''[[teja]]s,'' the ''[[rakta]]'' is converted into stable ''[[mamsa]],'' after being acted upon by its own [[agni]] (''mamsadhatvagni'') [29]

=== Formation of ''[[meda dhatu]]'' ===

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''Jatharagni'' is known as the King among all the forms of ''agni''. The intensification and diminution of all other forms of ''agni'' is in fact dependent on ''jatharagni'' [39]

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''Jatharagni'' is known as the King among all the forms of [[agni]]. The intensification and diminution of all other forms of [[agni]] is in fact dependent on ''jatharagni'' [39]

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An individual should take utmost care to maintain the ''agni'' by providing fuel in the form of food and drinks which should be taken as per the rules mentioned, because life and strength of an individual depends on ''agni'' [40]

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An individual should take utmost care to maintain the [[agni]] by providing fuel in the form of food and drinks which should be taken as per the rules mentioned, because life and strength of an individual depends on [[agni]] [40]

=== Initiation of ''grahani dosha'' ===

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If an individual indulges in food without following the rules and regulation of diet intake, then he quickly suffers from diseases caused by the vitiation of ''grahani'' because of his greedy habits. Such diseases are being described henceforth [41]

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=== Causes of vitiation of ''agni'' ===

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=== Causes of vitiation of [[agni]] ===

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Excessive starvation, indulging in food intake although there is indigestion, overeating, irregular habit of eating, eating unwholesome food, indulging in food which is heavy to digest or having excessive nutritional value, food which is having cold qualities or eating chilled or frozen items, food which is dry in nature or food which brings about emaciation, contaminated food, perversion of procedures like ''[[vamana]], [[virechana]]'' and ''sneha'', emaciation of body due to disease, sudden migration to unsuitable place and of time and of season, suppression of natural urges are causes for vitiation of ''agni''. Thus, vitiated ''agni'' is unable to digest even the light food. [42-43]

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Excessive starvation, indulging in food intake although there is indigestion, overeating, irregular habit of eating, eating unwholesome food, indulging in food which is heavy to digest or having excessive nutritional value, food which is having cold qualities or eating chilled or frozen items, food which is dry in nature or food which brings about emaciation, contaminated food, perversion of procedures like ''[[vamana]], [[virechana]]'' and ''sneha'', emaciation of body due to disease, sudden migration to unsuitable place and of time and of season, suppression of natural urges are causes for vitiation of [[agni]]. Thus, vitiated [[agni]] is unable to digest even the light food. [42-43]

This vitiated digestive agent forms an intermediate substance called ''ama'', which turns sour (''shukta'') during fermentation and finally turns in poisonous substance (''amavisha'') [44]

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The ''annavisha'' when enters renal system, urine related disorders occur; similarly, ''kukshigata roga'' (ailments related to abdomen) have their origin when ''sakrita'' (feces) is involved. ''Rasadi pradoshaja vikara'' (tissue related ailments) occur when ''rasadi srotas'' are involved [47-49]

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=== Effects of ''Vishamagni'' (irregular ''agni'')and ''tikshanagni''( excessive ''agni'') ===

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=== Effects of ''Vishamagni'' (irregular [[agni]])and ''tikshanagni''( excessive [[agni]]) ===

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The ''vishamagni'' (improper ''agni'') causes irregularity in digestion and therefore defective formation of ''[[dhatu]]'' takes place whereas, ''tikshanagni'' (excessive ''agni'') when associated with little quantity of fuel (in the form of food) causes depletion of ''[[dhatu]]'' (tissue elements) [50]

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The ''vishamagni'' (improper [[agni]]) causes irregularity in digestion and therefore defective formation of ''[[dhatu]]'' takes place whereas, ''tikshanagni'' (excessive [[agni]]) when associated with little quantity of fuel (in the form of food) causes depletion of ''[[dhatu]]'' (tissue elements) [50]

=== ''Samagni'' ===

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If ''agni'' is ''sama'' i.e. in balanced condition and correct diet regimen (as explained in [Cha.Sa.[[Sutra Sthana]] 5] and [Cha.Sa.[[Vimana Sthana]] 1/21] are also followed then there is proper digestion of food which helps in maintaining proper balance within the ''[[dhatu]]'' [50½]

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If [[agni]] is ''sama'' i.e. in balanced condition and correct diet regimen (as explained in [Cha.Sa.[[Sutra Sthana]] 5] and [Cha.Sa.[[Vimana Sthana]] 1/21] are also followed then there is proper digestion of food which helps in maintaining proper balance within the ''[[dhatu]]'' [50½]

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=== ''Durbala'' (weak) ''agni'' ===

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=== ''Durbala'' (weak) [[agni]] ===

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''Durbala'' (weak) ''agni'' brings about partial digestion of food. These partially digested bio substances then enter in circulation, which may move either in upward or downward direction [51]

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''Durbala'' (weak) [[agni]] brings about partial digestion of food. These partially digested bio substances then enter in circulation, which may move either in upward or downward direction [51]

=== ''Grahani gada''(diseases of ''grahani'') ===

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''Grahani'' is seat of ''agni'' and it is so called since it holds/retains the food (for proper digestion and assimilation). It holds the food just above the umbilical region and it is supported and nourished by the ''agni''. ''Grahani'' with help of ''agni'' holds the undigested food and pushes forward digested food, but when ''agni'' becomes weak and vitiated due to ''vidagdha ahara murchita dosha'' (afflicted by improperly digested food) i.e ''sama dosha''(''[[dosha]]'' associated with ''ama'') it vitiates the ''grahani'' and releases food in the form of ''ama'' i.e. undigested form [56-57]

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''Grahani'' is seat of [[agni]] and it is so called since it holds/retains the food (for proper digestion and assimilation). It holds the food just above the umbilical region and it is supported and nourished by the [[agni]]. ''Grahani'' with help of [[agni]] holds the undigested food and pushes forward digested food, but when [[agni]] becomes weak and vitiated due to ''vidagdha ahara murchita dosha'' (afflicted by improperly digested food) i.e ''sama dosha''(''[[dosha]]'' associated with ''ama'') it vitiates the ''grahani'' and releases food in the form of ''ama'' i.e. undigested form [56-57]

=== Four types of ''grahani'' disease ===

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Excessive indulgence in diet having ''katu'' (pungent), ''tikta'' (bitter), ''kashaya'' (astringent) dominant food, which is dry in nature or having absorptive or emaciative qualities; cold, chilled or frozen items, eating quantitatively less amount of food, suppression of natural urges and excessive sexual intercourse contribute to aggravation of ''[[vata dosha]]'' which encompass the ''agni'' causing suppression of ''agni'' [59½]

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Excessive indulgence in diet having ''katu'' (pungent), ''tikta'' (bitter), ''kashaya'' (astringent) dominant food, which is dry in nature or having absorptive or emaciative qualities; cold, chilled or frozen items, eating quantitatively less amount of food, suppression of natural urges and excessive sexual intercourse contribute to aggravation of ''[[vata dosha]]'' which encompass the [[agni]] causing suppression of [[agni]] [59½]

=== Symptoms of ''[[vata]]ja grahani'' ===

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</div></div>

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''Katu'' (spicy), ''ajeerna'' (undigestable food), ''vidahi'' (food causing eructation), ''amla'' (sour), ''kshara'' (alkali) and other food items which aggravate ''pitta'' are causes for ''[[pitta]]ja grahani''. The aggravated ''[[pitta]]'' hampers the function of ''agni'' similar to condition wherein hot water extinguishes fire [65]

+

''Katu'' (spicy), ''ajeerna'' (undigestable food), ''vidahi'' (food causing eructation), ''amla'' (sour), ''kshara'' (alkali) and other food items which aggravate ''pitta'' are causes for ''[[pitta]]ja grahani''. The aggravated ''[[pitta]]'' hampers the function of [[agni]] similar to condition wherein hot water extinguishes fire [65]

=== Symptoms of ''[[pitta]]ja grahani'' ===

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</div></div>

−

Heavy to digest or excessively unctuous foods, frozen or chilled items or food having cold nature or food which has qualities similar to ''[[kapha]]'', excessive intake of food and sleeping just after the meals hamper the function of ''agni'' and simultaneously vitiates ''[[kapha]]'' [67]

+

Heavy to digest or excessively unctuous foods, frozen or chilled items or food having cold nature or food which has qualities similar to ''[[kapha]]'', excessive intake of food and sleeping just after the meals hamper the function of [[agni]] and simultaneously vitiates ''[[kapha]]'' [67]

=== Symptoms of ''[[kapha]]ja grahani'' ===

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</div></div>

−

Four types of ''agni'' have been previously explained in [[Roganika Vimana]]. Except ''samagni'' other three types of ''agni'' contribute to the ''grahani dosha'' [71]

+

Four types of [[agni]] have been previously explained in [[Roganika Vimana]]. Except ''samagni'' other three types of [[agni]] contribute to the ''grahani dosha'' [71]

=== ''Sannipataja grahani'' ===

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</div></div>

−

As stimulation of ''agni'' is observed and still if patient finds difficulty in passing stool, urine and flatus then in such condition every two or three days ''niruha [[basti]]'' should be administered after proper ''[[snehana]]'' and ''[[swedana]]'' [78]

+

As stimulation of [[agni]] is observed and still if patient finds difficulty in passing stool, urine and flatus then in such condition every two or three days ''niruha [[basti]]'' should be administered after proper ''[[snehana]]'' and ''[[swedana]]'' [78]

=== ''[[Virechana]]'' ===

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</div></div>

−

Boil the ''svarasa'' of two ''panchamoola'' (''brihat'' and ''laghu''), ''sarala'' ((''trivrita'') Operculina turpethum), ''devadaru'' (Cedrus deodara), ''nagara'' (Zingiber officinale), ''pippali'' (Piper longum), ''pippalimoola, chitraka'' (Plumbago zeylanica), ''gajapippali'' (Piper retofractum), ''sanabeeja'' (seeds of Crotalaria juncea), barley, ''kola, kulatta'' and ''susavi'' (Woodfordia fruticosa) with ''aranala, dadhimanda'' or ''sauviraka''. After one fourth reductions add one ''adhaka'' (3.073 kg) of ghee and ''svarjikakshara'' and ''yavashukakshara'' as per ''yukti pramana'' i.e. either in small quantity or at the time of ''ghrita siddhi lakshana'' alongwith ''saindhava'' (rock salt), ''audbhida'' (salts derived from plants), ''samudra'' (table salt), ''bidha'' (red granular salt), ''romaka, sauvarchala'' and ''pakya'' (''pakaja'') types of salt in two ''pala'' quantity each (96 gm each). After preparation, it may be administered up to one ''prasrita'' i.e. 96 gm. It increases ''agni'', strength and complexion and helps in alleviation of ''[[vata]]'' and thus digestion of food [82-86]

+

Boil the ''svarasa'' of two ''panchamoola'' (''brihat'' and ''laghu''), ''sarala'' ((''trivrita'') Operculina turpethum), ''devadaru'' (Cedrus deodara), ''nagara'' (Zingiber officinale), ''pippali'' (Piper longum), ''pippalimoola, chitraka'' (Plumbago zeylanica), ''gajapippali'' (Piper retofractum), ''sanabeeja'' (seeds of Crotalaria juncea), barley, ''kola, kulatta'' and ''susavi'' (Woodfordia fruticosa) with ''aranala, dadhimanda'' or ''sauviraka''. After one fourth reductions add one ''adhaka'' (3.073 kg) of ghee and ''svarjikakshara'' and ''yavashukakshara'' as per ''yukti pramana'' i.e. either in small quantity or at the time of ''ghrita siddhi lakshana'' alongwith ''saindhava'' (rock salt), ''audbhida'' (salts derived from plants), ''samudra'' (table salt), ''bidha'' (red granular salt), ''romaka, sauvarchala'' and ''pakya'' (''pakaja'') types of salt in two ''pala'' quantity each (96 gm each). After preparation, it may be administered up to one ''prasrita'' i.e. 96 gm. It increases [[agni]], strength and complexion and helps in alleviation of ''[[vata]]'' and thus digestion of food [82-86]

=== ''Tryushanadya ghrita'' ===

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Make paste of ''panchamoola'' (''bilva, shyonaka, gambhari, patala'' and ''gambharika''), ''abhaya'', ''trikatu, pippalimoola, saindhava, rasna,'' two ''kshara'' (''sarjika'' and ''yavakshara''), ''ajaji, vidanga'' and ''sati'' and prepare medicated ghee with ''sukta,'' juice of ''matulunga'' and ''ardraka, suṣkamoolaka, kolambu, chukrika,'' pomengranate, butter milk, ''mastu'' (supplement liquid portion in the curd/yoghurt), ''suramanda'' (indigenous beer beverage prepared from fermented cereals) ''sauviraka'' (acidic fermented liquid obtained from wheat), ''tushodaka'' (fermented liquid using the coarse grains of barley) and ''kanji'' (fermented liquid).

−

The medicated ghee helps in digestion and increase strength of ''agni'' and cures colicky pain, ''gulma, udara'', asthma and cough. It also pacifies ''[[vata]]'' and ''[[kapha]]''. ''Beejapuraka svarasa'' can also be used for ''sneha siddhi''.

+

The medicated ghee helps in digestion and increase strength of [[agni]] and cures colicky pain, ''gulma, udara'', asthma and cough. It also pacifies ''[[vata]]'' and ''[[kapha]]''. ''Beejapuraka svarasa'' can also be used for ''sneha siddhi''.

''Taila siddhi'' with above medicine may be used for ''abhyanga'' (massage) and the ''choorna'' used in above preparation may be taken with lukewarm water.

−

In condition such as ''kapha avrite vata'' (''[[vata]]'' occluded by ''[[kapha]]''), ''sama [[kapha]]'' and ''[[vata]]'' aggravated due to ''[[kapha]]'' give the above ''choorna'' for digestion and to stimulate ''agni''. The medicine is known as ''panchamooladyam ghritam choornam'' [88-93]

+

In condition such as ''kapha avrite vata'' (''[[vata]]'' occluded by ''[[kapha]]''), ''sama [[kapha]]'' and ''[[vata]]'' aggravated due to ''[[kapha]]'' give the above ''choorna'' for digestion and to stimulate [[agni]]. The medicine is known as ''panchamooladyam ghritam choornam'' [88-93]

=== Examination of feces ===

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</div></div>

−

''Chitraka, pippalimoola,'' two ''kshara'' (''yavakshara'' and ''sarjikshara''), salt, ''trikatu, hingu, ajamoda'' and ''chavya'' are mixed together and trichurated with either ''matulunga svarasa'' or ''dadima svarasa'' and tablets are prepared. This ''chitrakadya guthi'' is useful for digestion of ''ama'' and stimulation of the ''agni'' [96-97]

+

''Chitraka, pippalimoola,'' two ''kshara'' (''yavakshara'' and ''sarjikshara''), salt, ''trikatu, hingu, ajamoda'' and ''chavya'' are mixed together and trichurated with either ''matulunga svarasa'' or ''dadima svarasa'' and tablets are prepared. This ''chitrakadya guthi'' is useful for digestion of ''ama'' and stimulation of the [[agni]] [96-97]

=== Recipes for ''[[pachana]]'' of ''ama'' ===

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</div></div>

−

''Choorna'' of ''pippali, nagara, patha, sariva, brihatidvayam'' (''brihati, kantakari''), ''chitraka,'' seeds of ''kutaja'', five types of ''lavana'', along with ''yavakshara,'' curd, hot water and different types of fermented liquids such as ''kanji, sauviraka'' etc is taken for increasing the power of ''agni'' and to eliminate the ''[[vata]]'' in abdomen [106-107]

+

''Choorna'' of ''pippali, nagara, patha, sariva, brihatidvayam'' (''brihati, kantakari''), ''chitraka,'' seeds of ''kutaja'', five types of ''lavana'', along with ''yavakshara,'' curd, hot water and different types of fermented liquids such as ''kanji, sauviraka'' etc is taken for increasing the power of [[agni]] and to eliminate the ''[[vata]]'' in abdomen [106-107]

=== ''Marichadya choorna'' ===

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</div></div>

−

In ''[[kapha]]ja grahani'' first administer ''[[vamana]]'' and then increase ''agni'' (digestive power) with help of drugs having ''katu, amla, lavana, kshara'' and ''tikta rasa'' [141]

+

In ''[[kapha]]ja grahani'' first administer ''[[vamana]]'' and then increase [[agni]] (digestive power) with help of drugs having ''katu, amla, lavana, kshara'' and ''tikta rasa'' [141]

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</div></div>

−

''Pippali, pippalimoola,'' two types of ''kshara'' (''yavakshara, svarjikakshara''), five types of ''lavana, matulunga, haritaki, rasna, saṭi, maricha'' and ''nagara'' are taken in equal quantity and powdered and administered with warm water early in the morning. It cures ''[[kapha]]ja grahani dosha'' and improves ''bala,'' complexion and ''agni''.

+

''Pippali, pippalimoola,'' two types of ''kshara'' (''yavakshara, svarjikakshara''), five types of ''lavana, matulunga, haritaki, rasna, saṭi, maricha'' and ''nagara'' are taken in equal quantity and powdered and administered with warm water early in the morning. It cures ''[[kapha]]ja grahani dosha'' and improves ''bala,'' complexion and [[agni]].

''Ghrita'' fortified with above medicines is useful in ''[[kapha]]'' associated with ''[[vata]]ja grahanidosha'' [168-169]

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</div></div>

−

''Duralabha'', two types of ''karanja'' (''karanja, lata karanja''), ''saptaparna, vatsaka, sadgrantha'' (''vacha''), ''madanaphala, murva, patha'' and ''aragvadha'' should be mixed with equal quantity of ''gomutra'' and boiled and prepared as per ''kshara kalpana''. This ''kshara'' increases ''bala'' of ''grahani'' i.e. of ''agni'' [179-180]

+

''Duralabha'', two types of ''karanja'' (''karanja, lata karanja''), ''saptaparna, vatsaka, sadgrantha'' (''vacha''), ''madanaphala, murva, patha'' and ''aragvadha'' should be mixed with equal quantity of ''gomutra'' and boiled and prepared as per ''kshara kalpana''. This ''kshara'' increases ''bala'' of ''grahani'' i.e. of [[agni]] [179-180]

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''Triphala, kaṭabhi, chavya,'' pulp of ''bilva'', powder of ''ayoraja'' (''mandura''), ''katutki, musta, kushtha, patha, hingu, madhuka, kshara'' of ''muskaka'' and ''yavakshara, trikatu, vacha, vidanga, pippalimoola, svarjikakshara, nimba, chitraka, murva, ajamoda, indrayava, guḍuchi'' and ''devadaru'' are taken in one ''karsha'' (12 gm) quantity and one ''pala'' each of five salts are taken. All are mixed with three ''kudavas'' (576 gm) of ''dadhi, ghrita'' and ''taila''. The mixture is burned by ''antardhooma'' method. One ''panitala'' is the dose which is given with ghee. It is indicated in ''[[kapha]]'' and ''[[vata]]ja arsha, grahani, pandu, pleeha, mutragraha, svasa, hikka, kasa, krimi, jwara, sosha, atisara, sotha, prameha, anaha, hridgraha'' and in all types of toxicity.

−

It is one among the best stimulants of ''agni''. Once the medicine is digested ''mamsarasa'' or sweet diet or milk should be administered. This ends the explanation of the ''panchamakshara'' [188-193]

+

It is one among the best stimulants of [[agni]]. Once the medicine is digested ''mamsarasa'' or sweet diet or milk should be administered. This ends the explanation of the ''panchamakshara'' [188-193]

=== Treatment of ''tridoshaja grahani''===

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</div></div>

−

In ''tridoshaja grahani, [[Panchakarma]]'' should be carried out as per predominance of ''[[dosha]]''. Various ghee, ''kshara, asava'' and ''arishtha'' preparation useful in stimulation of ''agni'' should be administered.

+

In ''tridoshaja grahani, [[Panchakarma]]'' should be carried out as per predominance of ''[[dosha]]''. Various ghee, ''kshara, asava'' and ''arishtha'' preparation useful in stimulation of [[agni]] should be administered.

Previously described line of treatment for ''[[vata]]ja'' etc ''grahani'' should be accordingly followed. This line of treatment should be done either separately or jointly after finding the predominance of ''[[dosha]]'' [194-195]

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</div></div>

−

Proper management as mentioned in earlier verses stimulates the ''agni'' (digestive power). ''Sneha'' is the best among the ''[[deepana]] dravya'' which helps in stimulating the inefficient ''agni'' [201]

+

Proper management as mentioned in earlier verses stimulates the [[agni]] (digestive power). ''Sneha'' is the best among the ''[[deepana]] dravya'' which helps in stimulating the inefficient [[agni]] [201]

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</div></div>

−

If the patient has inefficient digestive power and voids undigested food in excess in stools or frequency of motions is more, then appropriate quantity of ''ghrita'' fortified by ''[[deepana]]'' medicines should again be given. Thus, ''samana vata'' is regularized and moves in its normal tract. As ''samana vata'' is associated with ''agni'' it instantaneously promotes the strength of ''agni''.

+

If the patient has inefficient digestive power and voids undigested food in excess in stools or frequency of motions is more, then appropriate quantity of ''ghrita'' fortified by ''[[deepana]]'' medicines should again be given. Thus, ''samana vata'' is regularized and moves in its normal tract. As ''samana vata'' is associated with [[agni]] it instantaneously promotes the strength of [[agni]].

Digestive power thus stimulated by ''ghrita'' cannot be suppressed even by heavy meals [202-203]

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</div></div>

−

If ''agni'' is suppressed due to ''ruksha [[guna]]'' then either ''ghrita'' or ''taila'' fortified with ''deepaniya'' drugs should be administered [205]

+

If [[agni]] is suppressed due to ''ruksha [[guna]]'' then either ''ghrita'' or ''taila'' fortified with ''deepaniya'' drugs should be administered [205]

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</div></div>

−

If ''udavarta'' (mis-peristalsis) is responsible for suppression of ''agni'' then ''niruha'' and ''sneha [[basti]]'' should be administered; whereas if ''[[dosha]] vriddhi'' is the cause for suppression of ''agni'' then ''[[shodhana]]'' as per ''[[dosha]]'' is indicated [207]

+

If ''udavarta'' (mis-peristalsis) is responsible for suppression of [[agni]] then ''niruha'' and ''sneha [[basti]]'' should be administered; whereas if ''[[dosha]] vriddhi'' is the cause for suppression of [[agni]] then ''[[shodhana]]'' as per ''[[dosha]]'' is indicated [207]

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</div></div>

−

If suppression of ''agni'' has taken place due to diseases than ''ghrita'' is best for ''agni [[deepana]]'' but if fasting is the causes of ''agni'' suppression than ''yavagu'' (gruel) along with ''ghrita'' should be taken. ''Ghrita'' when taken in between the meal, it increases the strength, stimulates the digestion and nourishes the body [208]

+

If suppression of [[agni]] has taken place due to diseases than ''ghrita'' is best for ''agni [[deepana]]'' but if fasting is the causes of [[agni]] suppression than ''yavagu'' (gruel) along with ''ghrita'' should be taken. ''Ghrita'' when taken in between the meal, it increases the strength, stimulates the digestion and nourishes the body [208]

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</div></div>

−

If ''agnimandya'' has been chronic and patient has become indolent, weak and emaciated then soup of ''prasaha'' group of animals (animals who snatch their food) fortified with ''amla'' drugs is advised. As this meat soups are light for digestion having penetrating, hot, purifying qualities stimulates the ''agni''. Further as the animals feed on other animals their meat ''mamsa'' is well nourished and compact therefore causes quick nourishment [209-210]

+

If ''agnimandya'' has been chronic and patient has become indolent, weak and emaciated then soup of ''prasaha'' group of animals (animals who snatch their food) fortified with ''amla'' drugs is advised. As this meat soups are light for digestion having penetrating, hot, purifying qualities stimulates the [[agni]]. Further as the animals feed on other animals their meat ''mamsa'' is well nourished and compact therefore causes quick nourishment [209-210]

−

=== Factors affecting status of ''agni'' ===

+

=== Factors affecting status of [[agni]] ===

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</div></div>

−

Fasting or over eating does not stimulate ''agni'', as like fire in environment is extinguished if there is no fuel supply or if excessive fuel covers the ''agni''. [211]

+

Fasting or over eating does not stimulate [[agni]], as like fire in environment is extinguished if there is no fuel supply or if excessive fuel covers the [[agni]]. [211]

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</div></div>

−

Proper intake of ''sneha'', followed by eating proper food preparations as well as appropriate use of various ''churna, arishtha, sura'' and ''asava'' along with proper medication as per condition, enhances the power of ''agni'' similar to the environmental fire which remains stable for long duration when good hard wood catches fire [212-213]

+

Proper intake of ''sneha'', followed by eating proper food preparations as well as appropriate use of various ''churna, arishtha, sura'' and ''asava'' along with proper medication as per condition, enhances the power of [[agni]] similar to the environmental fire which remains stable for long duration when good hard wood catches fire [212-213]

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Eating wholesome diet in appropriate quantity after previously eaten food is digested helps in maintaining good health for long duration.

−

A person should workout so that ''agni vriddhi'' takes place without disturbing the balance of ''[[dhatu]]s''. Such ''agni'' digests the food, maintains health and nourishment, promotes longevity and increases strength. The same ''[[dosha]]'' when vitiated causes ''mandagni, tikshnagni'' and ''vishamagni'' and such a vitiated ''agni'' gives rise to various diseases.

+

A person should workout so that ''agni vriddhi'' takes place without disturbing the balance of ''[[dhatu]]s''. Such [[agni]] digests the food, maintains health and nourishment, promotes longevity and increases strength. The same ''[[dosha]]'' when vitiated causes ''mandagni, tikshnagni'' and ''vishamagni'' and such a vitiated [[agni]] gives rise to various diseases.

Management of ''mandagni'' has been explained previously henceforth management of ''ativriddha agni'' will be explained [214-216]

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</div></div>

−

Person having diminished ''[[kapha]]'', aggravated ''[[pitta]]'' and associated ''[[vata]]'' leads to increase in the ''ushma'' of ''agni'' resulting in enhancing the capacity and power of ''agni''. In such patient if the body is already undernourished, ''[[vata]]'' increases which further strengths the ''agni'' wherein both, together with help of ''tikshna [[guna]]'' digests the food even if taken frequently. After digestion of food, the increased ''agni'' starts digesting ''[[rakta]]'', etc ''[[dhatu]]s'' also [217-219]

+

Person having diminished ''[[kapha]]'', aggravated ''[[pitta]]'' and associated ''[[vata]]'' leads to increase in the ''ushma'' of [[agni]] resulting in enhancing the capacity and power of [[agni]]. In such patient if the body is already undernourished, ''[[vata]]'' increases which further strengths the [[agni]] wherein both, together with help of ''tikshna [[guna]]'' digests the food even if taken frequently. After digestion of food, the increased [[agni]] starts digesting ''[[rakta]]'', etc ''[[dhatu]]s'' also [217-219]

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</div></div>

−

Paste of fruits, substances containing oil like ''tila'' (sesame seeds) with sugar and meat soup with ghee pacifies the ''agni'' [227]

+

Paste of fruits, substances containing oil like ''tila'' (sesame seeds) with sugar and meat soup with ghee pacifies the [[agni]] [227]

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</div></div>

−

Foods which are sweet in taste, fatty, increases ''[[kapha]]'' and heavy to digest should be given. All food items are good for ''atyagni'' and sleeping after meals during day time is beneficial in ''atyagni''. Patient who takes fatty diet even though he is not hungry does not succumb to death. If he is suffering from ''atyagni'' on the other hand such diet pattern is nutritional. Whenever due to medication and diet, ''[[kapha]]'' is increased; it subdues ''[[pitta]]'' and ''[[vata]]'' and normalizes the ''agni''.

+

Foods which are sweet in taste, fatty, increases ''[[kapha]]'' and heavy to digest should be given. All food items are good for ''atyagni'' and sleeping after meals during day time is beneficial in ''atyagni''. Patient who takes fatty diet even though he is not hungry does not succumb to death. If he is suffering from ''atyagni'' on the other hand such diet pattern is nutritional. Whenever due to medication and diet, ''[[kapha]]'' is increased; it subdues ''[[pitta]]'' and ''[[vata]]'' and normalizes the [[agni]].

When ''[[dhatu]]s'' are in equilibrium ''anna'' gets digested resulting in increase in nutrition, longevity and strength [232-234]

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To conclude, this chapter has addressed the following points:

#Qualities of ''antaragni'',

−

#Manner in which ''agni'' does ''dharana'' (sustenance) of the body,

+

#Manner in which [[agni]] does ''dharana'' (sustenance) of the body,

#Manner in which food is digested,

#How digested food functions?

−

#How different types of ''agni'' does nutrition after digesting the fuel?

+

#How different types of [[agni]] does nutrition after digesting the fuel?

#Development of ''[[rasa]]di [[dhatu]]s'' and their associated waste products after digestions at ''[[dhatu]]'' level (tissue level)

#How aphrodisiacs act instantly and time taken for the ''[[dhatu]]'' formation and order of development?

#Reason why diseases are located in one part of the body and role of ''antaragni'' in disease formation,

−

#Diseases caused by abnormal ''agni''

+

#Diseases caused by abnormal [[agni]]

#Definition of ''grahani'' and sign and symptoms of ''grahani dosha'',

#Premonitory symptoms along with four types of ''grahani dosha'' their signs and symptoms with treatment as per various condition,

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== Tattva Vimarsha (Fundamental Principles) ==

−

*''Dehagni'' (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ''[[ojas]]'', normal body temperature and various other forms of ''agni''. Even the existence of an individual is said to be because of ''dehagni'' (3).

+

*''Dehagni'' (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ''[[ojas]]'', normal body temperature and various other forms of [[agni]]. Even the existence of an individual is said to be because of ''dehagni'' (3).

−

*When the ''agni'' stops functioning, the individual dies; if the ''agni'' functions normally, the individual can lead a healthy and long life. Similarly, if the ''agni'' becomes abnormal, the individual suffers from various diseases; and hence, the ''agni'' is said to be the root cause of health and longevity (4).

+

*When the [[agni]] stops functioning, the individual dies; if the [[agni]] functions normally, the individual can lead a healthy and long life. Similarly, if the [[agni]] becomes abnormal, the individual suffers from various diseases; and hence, the [[agni]] is said to be the root cause of health and longevity (4).

−

*Normal functioning of ''agni'' is essential to make the consumed food capable of nourishing the body tissues and of promoting the ''[[ojas]]'' (vital essence), strength, complexion etc. In the absence of normal digestion (and metabolism), the normal body tissues such as ''[[rasa]]'' cannot be formed nor nourished (5).

+

*Normal functioning of [[agni]] is essential to make the consumed food capable of nourishing the body tissues and of promoting the ''[[ojas]]'' (vital essence), strength, complexion etc. In the absence of normal digestion (and metabolism), the normal body tissues such as ''[[rasa]]'' cannot be formed nor nourished (5).

*''[[Vata dosha]]'', specifically ''prana vata'' and ''samana vata'' play significant role in process of digestion and metabolism.

*Three ''[[dosha]]s'' are produced in three consequent stages of digestion after consumption of food. ''[[Kapha]]'' is produced in first stage of ''madhura avasthapaka''; pitta in second stage of ''amla avasthapaka'' and ''[[vata]]'' is produced in third stage of ''katu avasthapaka''. The site of production and time of production of ''[[dosha]]'' is in sequence as the process of digestion proceeds. Increase or decrease in quantity of ''[[dosha]]'' depends upon similarity or dis-similarity of basic composition of food consumed.

−

*The first phase of digestion is carried out by ''jatharagni'', second phase by ''bhutagni'' and third phase by ''dhatvagni''. These are different levels of action of ''agni'' where various digestive and metabolic processes take place.

+

*The first phase of digestion is carried out by ''jatharagni'', second phase by ''bhutagni'' and third phase by ''dhatvagni''. These are different levels of action of [[agni]] where various digestive and metabolic processes take place.

*During the processing by ''dhatvagni, stanya'' (breast milk) and the menstrual blood are derived after ''[[rasa]]''. ''Kandara'' (tendon) and ''sira''(vein) are derived after ''[[rakta]]''. ''Vasa''(fat) and the six layers of ''tvacha'' (skin) are derived after ''[[mamsa]]'' (muscle) and ''snayu''(ligament) are derived after ''[[meda]]s'' (adipose tissue) (17).

*The feces and the urine are the ''kitta'' (non-nutrient portion/waste portion/byproduct) of ingested food. The ''kiṭṭa'' of ''[[rasa]]'' is ''mala-[[kapha]]'' (excretions). ''Mala-[[pitta]]'' (bile pigment) is the ''kitta'' of ''[[rakta]]''. ''Kha-mala'' (the wastes accumulated in the hollow structures of the body such as external ears and nostrils) are the ''kitta'' of ''[[mamsa]]''. ''Sweda'' (sweat) is the ''[[mala]]'' of ''[[medas]]''. ''Kesha'' (hairs on the head) and ''loma'' (body hair) are the ''[[mala]]'' of ''[[asthi]]''. The ''[[mala]]'' of ''[majja]]'' is the oily excretion of the eye and the skin (sebum). Thus, the ''[[dhatu]]s'' continuously undergo two kinds of transformation: ''prasada'' (nutrient portion) and ''kitta'' (non-nutrient portion). This entire sequence of transformation and metabolism of ''[[dhatu]]'' is thus inter dependent (18-19½ ).

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*''Vyana vata'' forcefully propels the ''[[rasa dhatu]]'' out of the heart and spreads it all over the body simultaneously, continuously and for the entire life (36).

*Disease is produced only at the site of abnormality of body systems.

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*Life and strength of an individual depends on ''agni'' hence one should take utmost care to maintain the ''agni'' by providing fuel in the form of food and drinks which should be taken as per the rules mentioned. (40)

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*Life and strength of an individual depends on [[agni]] hence one should take utmost care to maintain the [[agni]] by providing fuel in the form of food and drinks which should be taken as per the rules mentioned. (40)

*If the rules of diet and dietary habits are not followed due to greed, then disease of ''grahani'' occurs.

*The ''anna-visha'' (toxins) produced due to improper digestion and metabolism causes diseases at the sites of affliction.

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*The ''vishamagni'' (improper ''agni'') causes irregularity in digestion and therefore defective formation of ''[[dhatu]]'' takes place. Whereas, ''teekshnagni'' (excessive ''agni'') when associated with little quantity of fuel (in the form of food) causes depletion of ''[[dhatu]]'' (tissue elements) (50).

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*The ''vishamagni'' (improper [[agni]]) causes irregularity in digestion and therefore defective formation of ''[[dhatu]]'' takes place. Whereas, ''teekshnagni'' (excessive [[agni]]) when associated with little quantity of fuel (in the form of food) causes depletion of ''[[dhatu]]'' (tissue elements) (50).

*The digestive disorder of ''grahani'' can lead to secondary disorders related with other body systems along with digestive system.

*''Grahani'' disease is classified into four types viz ''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' and ''sannipataja'' depending upon the dominance of ''[[dosha]]'' and on the basis of the classification, etiological factors, symptoms and signs are varied.

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*''[[Vata]]'' dominant ''grahani'' shall be treated with ''[[basti]], [[virechana]]'' and unctuous preparations.

*If ''[[pitta]]'' is dominant in its own place then ''[[virechana]]'' or ''[[vamana]]'' should be administered for removal of ''[[pitta]]'' (122).

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*In ''[[kapha]]ja grahani'', ''[[vamana]]'' and then drugs having ''katu, amla, lavana, kshara'' and ''tikta rasa'' shall be administered to increase ''agni'' (digestive power) (141).

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*In ''[[kapha]]ja grahani'', ''[[vamana]]'' and then drugs having ''katu, amla, lavana, kshara'' and ''tikta rasa'' shall be administered to increase [[agni]] (digestive power) (141).

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*In ''tridoshaja grahani'', [[Panchakarma]] should be carried out as per predominance of ''[[dosha]]''. Various ghee, ''kshara'', ''asava'' and ''arishta'' preparation useful in stimulation of ''agni'' should be administered.

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*In ''tridoshaja grahani'', [[Panchakarma]] should be carried out as per predominance of ''[[dosha]]''. Various ghee, ''kshara'', ''asava'' and ''arishta'' preparation useful in stimulation of [[agni]] should be administered.

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*''Sneha'' is the best among the ''[[deepana]] dravya'' which helps in stimulating the inefficient ''agni'' (201)

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*''Sneha'' is the best among the ''[[deepana]] dravya'' which helps in stimulating the inefficient [[agni]] (201)

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*Fasting or over eating doesn’t stimulate ''agni''. Proper intake of ''sneha'', followed by eating proper food preparations as well as appropriate use of various ''churna, arishta, sura'' and ''asava'' along with proper medication as per condition, enhances the power of ''agni''.

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*Fasting or over eating doesn’t stimulate [[agni]]. Proper intake of ''sneha'', followed by eating proper food preparations as well as appropriate use of various ''churna, arishta, sura'' and ''asava'' along with proper medication as per condition, enhances the power of [[agni]].

*''Atyagni'' is caused by diminished ''[[kapha]]'', aggravated ''[[pitta]]'' and associated ''[[vata]]''. This leads to emaciation if proper food is not consumed. Excessively increased digestive power can be pacified by taking foods and drinks which are heavy to digest, unctuous, cold, sweet and liquid.

*''Samashana'' is taking wholesome and unwholesome foods together in diet. ''Vishamashana'' is taking food either in excess quantity or very little quantity and also if taken before or after appropriate time. ''Adhyashana'' is having food even though previously eaten food is not yet digested. All the above three are causes for death or give rise to serious disorders (235-236).

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== Vidhi Vimarsha (Applied Inferences ) ==

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=== Importance of ''agni'' ===

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=== Importance of [[agni]] ===

The functions of gut are vital for maintenance and preservation of health. ''Grahani'' is the seat of ''jatharagni'', which is the initiator of digestive process and strengthens the other 12 ''agnis''. ''Jatharagni'' transforms food into biological substance (''ahara rasa'') which is further trifurcated into ''madhura, amla'' and ''katu avastha paka'' which gets transformed into three biological energies ''[[kapha]], [[pitta]]'' and ''[[vata]]'' respectively. From the physiological point of view, the ''jatharagni'' or the active form of ''pachaka pitta'' is responsible for the digestion of all kinds of foods in the gut. Therefore, this should include all amylolytic, proteolytic and lipolytic enzymes secreted by various kinds of exocrine glands in the gut, which actually cause digestion, i.e., breaking down of different macromolecules into their constituent units.

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=== ''Dhatvagni'' ===

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Each ''[[dhatu]]'' has its own transforming ''agni'' and ''srotas''. ''Srotas'' or micro channels have two functions of carrying and transforming the tissues with the help of their specific ''dhatvagni''. Five ''bhutagnis'', one for each ''[[mahabhuta]]'', transform five ''bhautic'' elements into the body tissues and organs. Seven ''dhatvagni'' or tissue transformers, form the tissue elements of seven ''[[dhatu]]s'' by their needed nutrients. After formation of ''[[dhatu]'', the microchannels permeates them into the organs for functioning. During this transformation process, ''upadhatu'' or subtissues and ''dhatumala'' or waste products are formed. ''Updhatus'' of ''[[rasa dhatu]]'' is breast milk; menstrual blood is ''upadhatu'' of ''[[rakta]]''; tendons and six layers of skin are ''upadhatu'' of ''[[mamsa dhatu]]'' etc.

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Each ''[[dhatu]]'' has its own transforming [[agni]] and ''srotas''. ''Srotas'' or micro channels have two functions of carrying and transforming the tissues with the help of their specific ''dhatvagni''. Five ''bhutagnis'', one for each ''[[mahabhuta]]'', transform five ''bhautic'' elements into the body tissues and organs. Seven ''dhatvagni'' or tissue transformers, form the tissue elements of seven ''[[dhatu]]s'' by their needed nutrients. After formation of ''[[dhatu]'', the microchannels permeates them into the organs for functioning. During this transformation process, ''upadhatu'' or subtissues and ''dhatumala'' or waste products are formed. ''Updhatus'' of ''[[rasa dhatu]]'' is breast milk; menstrual blood is ''upadhatu'' of ''[[rakta]]''; tendons and six layers of skin are ''upadhatu'' of ''[[mamsa dhatu]]'' etc.

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Apart from digestion, the gut performs various other significant functions as well. The gut has its own protective mechanism in the form of gut-associated lymphoid tissue, which prevents the entry of pathogens into the bloodstream. The micro-biota in the gut serves vital functions related to various aspects of health. The enteric nervous system of the gut has its own functional significance and has been proven to be very closely associated with the central nervous system functions. The gut secretes several hormone-like substances that are helpful in regulating long-term energy balance. All the factors mentioned are either directly or indirectly dependent on these functional domains of the gut. <ref>W I Khan, J E Ghia. Gut hormones: emerging role in immune activation and inflammation. Clin Exp Immunol. 2010 July; 161(1): 19–27</ref> <ref>Andrew L. Kau, Philip P. Ahern, Nicholas W. Griffin, Andrew L. Goodman, Jeffrey I. Gordon. Human nutrition, the gut microbiome, and immune system: envisioning the future. Nature. 2011 June 15; 474(7351): 327–336. doi: 10.1038/nature10213</ref> Other forms of ''agni'' in this context are indicative of ''bhutagni'' and ''dhatvagni'', which in turn, are functionally dependent on ''jatharagni''. ''Prana'' in this context may stand for all types of ''[[vata]]'' as well.

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Apart from digestion, the gut performs various other significant functions as well. The gut has its own protective mechanism in the form of gut-associated lymphoid tissue, which prevents the entry of pathogens into the bloodstream. The micro-biota in the gut serves vital functions related to various aspects of health. The enteric nervous system of the gut has its own functional significance and has been proven to be very closely associated with the central nervous system functions. The gut secretes several hormone-like substances that are helpful in regulating long-term energy balance. All the factors mentioned are either directly or indirectly dependent on these functional domains of the gut. <ref>W I Khan, J E Ghia. Gut hormones: emerging role in immune activation and inflammation. Clin Exp Immunol. 2010 July; 161(1): 19–27</ref> <ref>Andrew L. Kau, Philip P. Ahern, Nicholas W. Griffin, Andrew L. Goodman, Jeffrey I. Gordon. Human nutrition, the gut microbiome, and immune system: envisioning the future. Nature. 2011 June 15; 474(7351): 327–336. doi: 10.1038/nature10213</ref> Other forms of [[agni]] in this context are indicative of ''bhutagni'' and ''dhatvagni'', which in turn, are functionally dependent on ''jatharagni''. ''Prana'' in this context may stand for all types of ''[[vata]]'' as well.

=== Three stages of digestion ===

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''Accha [[pitta]]'' is ‘liquid’ in nature, released in the duodenum and can be correlated with bile.

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''Pachaka pitta'' has the functional site between ''amashaya'' (stomach) and ''pakvashaya'' (colon), which is indicative of small intestine. It is composed of five ''[[mahabhuta]]s'' but the ''[[agni mahabhuta]]'' is predominant; and hence, it becomes devoid of fluidity and therefore is also known as ''agni''. It splits the food into sāra (nutritive) and ''kitta'' (non-nutritive) portions.<ref>Vagbhata. Sutra Sthana, Cha.12 Doshabhediya Adhyaya verse 10-12. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>

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''Pachaka pitta'' has the functional site between ''amashaya'' (stomach) and ''pakvashaya'' (colon), which is indicative of small intestine. It is composed of five ''[[mahabhuta]]s'' but the ''[[agni mahabhuta]]'' is predominant; and hence, it becomes devoid of fluidity and therefore is also known as [[agni]]. It splits the food into sāra (nutritive) and ''kitta'' (non-nutritive) portions.<ref>Vagbhata. Sutra Sthana, Cha.12 Doshabhediya Adhyaya verse 10-12. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>

''Sara'' of the food is the minutest fraction (''parama sukshma''). This portion reaches the heart in the form of ''ahara rasa''. From the heart, it then gets re-distributed into 24 pulsatile vessels to be carried into the whole body.<ref>Sushruta. Sutra Sthana, Cha.14 Shonitavarnaniya Adhyaya verse 3. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1</ref>

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Suppression of manifested natural urges may have impact on nervous system resulting in effect either on enzymatic secretion or on the hormonal secretion. These factors have role in digestion and absorption as may be understood in case of ''adhovata'' (accumulation of ''[[vata]]'' in rectum and pelvic region) and ''[[purisha]] vegadharana'' (suppression of urge of defecation), wherein regular urge suppression disturbs the intestinal pro-kinetic movement.[Cha. Sa. [[Sutra Sthana ]] 7/ 6,8,12] Disturbed pro-kinesia increases the transit time leading to the change in pH which further has its impact on electrolytes and enzymatic secretion leading to reduced digestive power (''agnimandya'').

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Further ''kshudha vegadharana'' (avoiding sense of hunger) effect will be similar to ''abhojana'' (not eating). It may also be noted that repeated ''kshudha vegadharana'' leads to atrophy of the stomach which further weakens the perception of hunger which is controlled by the percentage of the stomach that remains empty similar to the explanation given by Charak that excessive fasting leads to diminution in ''agni''.[Cha.Sa. [[Sutra Sthana]] 22/37] ''Trishna vegadharana'' (avoiding thirst) leads to reduced fluid balance in the body.

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Further ''kshudha vegadharana'' (avoiding sense of hunger) effect will be similar to ''abhojana'' (not eating). It may also be noted that repeated ''kshudha vegadharana'' leads to atrophy of the stomach which further weakens the perception of hunger which is controlled by the percentage of the stomach that remains empty similar to the explanation given by Charak that excessive fasting leads to diminution in [[agni]].[Cha.Sa. [[Sutra Sthana]] 22/37] ''Trishna vegadharana'' (avoiding thirst) leads to reduced fluid balance in the body.

Nearly seven liters of water is secreted during various gastrointestinal secretions. Reduced water intake in long term will reduce gastrointestinal secretion leading to impaired digestion.

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''Tridosha'' play role in impairing immunity and depending on the dominance of a particular ''[[dosha]]'' they are classified as ''[[vata]]ja, [[pitta]]ka'' and ''[[kapha]]ja'' disorders.[Cha.Sa. [[Sutra Sthana]] 28/7]

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=== Equilibrium of ''agni'' ===

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=== Equilibrium of [[agni]] ===

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''Agni'' should be associated with balance of ''[[vata]], [[pitta]]'' and ''[[kapha]]'' or ''samagni''. Digestive enzyme secretion is controlled by sympathetic and parasympathetic nerve supply. ''Samagni'' may be compared with balanced state of sympathetic/ parasympathetic activity which explains the role of balanced or ''samana vata''. It may also be noted that ''prana vata'' and ''apana vata'' also have impact on balancing the normal status of ''agni''.

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[[Agni]] should be associated with balance of ''[[vata]], [[pitta]]'' and ''[[kapha]]'' or ''samagni''. Digestive enzyme secretion is controlled by sympathetic and parasympathetic nerve supply. ''Samagni'' may be compared with balanced state of sympathetic/ parasympathetic activity which explains the role of balanced or ''samana vata''. It may also be noted that ''prana vata'' and ''apana vata'' also have impact on balancing the normal status of [[agni]].

Acidic and alkaline pH of digestive secretions explains the balanced ''[[pitta]]''. Modern science explains specific range of pH of digestive secretions e.g. pancreatic juice has pH in range of 7.1 – 8.2 that buffers acidic gastric juice in chyme, stops the action of pepsin from the stomach and creates proper pH for action of digestive enzymes in small intestine. Specific pH of gastric juice is essential to convert pepsinogen into pepsin, an active form of proteolytic enzyme thus improper pH will cause variation in digestion.

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Etiological factors as mentioned in the text have impact mainly on the neural stimulation of digestive secretions affecting the flow of gastrointestinal secretions into the gastrointestinal tract thereby hampering the digestion.

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Hence it is explained that aggravated ''[[vata]]'' encompasses the ''agni''. Altered canalicular functions hampers digestion, easily understood in primary biliary cirrhosis wherein biliary secretion is restricted. Atrophy of gastric mucosa reduces HCl secretion causing indigestion. The gastric gland contains three types of exocrine gland cells that secrete their products into stomach lumen.''Srotasam kharatvam'' (hardness in channels) quality of ''tikta rasa'' destroys the exocrine gland cell reducing their secretions. Gastric glands include a type of enteroendocrine cell, the G cell which is located mainly in the pyloric antrum and secretes the hormone gastrin into the blood stream which stimulates parietal cells to secrete HCl and chief cells to secrete pepsinogen, it also contracts the lower esophageal sphincter, increases motility of the stomach and relaxes pyloric sphincter.

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Hence it is explained that aggravated ''[[vata]]'' encompasses the [[agni]]. Altered canalicular functions hampers digestion, easily understood in primary biliary cirrhosis wherein biliary secretion is restricted. Atrophy of gastric mucosa reduces HCl secretion causing indigestion. The gastric gland contains three types of exocrine gland cells that secrete their products into stomach lumen.''Srotasam kharatvam'' (hardness in channels) quality of ''tikta rasa'' destroys the exocrine gland cell reducing their secretions. Gastric glands include a type of enteroendocrine cell, the G cell which is located mainly in the pyloric antrum and secretes the hormone gastrin into the blood stream which stimulates parietal cells to secrete HCl and chief cells to secrete pepsinogen, it also contracts the lower esophageal sphincter, increases motility of the stomach and relaxes pyloric sphincter.

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G cells when get destroyed the above action of ''[[kapha]]'', in turn, ''agni'' is hampered so also contraction and relaxation karma of ''[[vata]]'' is vitiated.

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G cells when get destroyed the above action of ''[[kapha]]'', in turn, [[agni]] is hampered so also contraction and relaxation karma of ''[[vata]]'' is vitiated.

Further ''kashaya rasa'' reduces peristaltic movements called as mixing waves which reduces the maceration and mixing of food with secretions of gastric glands, thus improper chyme is formed. Deficiency of gastrointestinal secretions due to damage to the glands or canaliculi or intestine may be mostly considered as having [[vata]]ja origin. Loss of ''pravartana karma'' is to be understood where the transport of secretions is hampered (except in obstructive pathology where ''[[kapha]]'' to be considered). Hartnup’s syndrome a defect in neutral amino acid transport and cystinuria a defect in dibasic amino acid transport explain the rare genetic disorders (''Bija Dusti'') involved in protein digestion absorption.

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Bacterial overgrowth due to undigested ''guru, klinna, snigdha'' and ''abhishyandi ahara'' causes increased mucoid secretion, thus formed stool is not observed instead ''bhinnamashleshma-samsrishta varcha''(loose stools with ''ama'' and ''[[kapha]]'') is seen; which is also cause for heaviness of stools (''guru-varchah-pravartanam'') Due to diet pattern and sedentary lifestyle there is accumulation of fat (obesity) but due to decrease protein absorption and malabsorption of essential elements patient feels weakness and laziness without weight loss (Verse 68-70).

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Normalcy of ''[[vata]] [[pitta]]'' and ''[[kapha]]'' keeps the ''agni'' in balanced condition, it means that a specific pH is maintained (''[[pitta]]''); secretion, transportation and villi movement are normal (''[[vata]]'') and mucosal bed secretes normal mucus and is healthy (''[[kapha]]''), thus maintains ''samagni'' or a normal digestive process (Verse 71).

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Normalcy of ''[[vata]] [[pitta]]'' and ''[[kapha]]'' keeps the [[agni]] in balanced condition, it means that a specific pH is maintained (''[[pitta]]''); secretion, transportation and villi movement are normal (''[[vata]]'') and mucosal bed secretes normal mucus and is healthy (''[[kapha]]''), thus maintains ''samagni'' or a normal digestive process (Verse 71).

Protein losing enteropathy is increased protein loss into the gastrointestinal tract which is classified into three groups.

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Further research shows that incase of uncontrolled growth of gut microbiome, flushing of gut reduces both psycho-somatic symptoms. ''[[Shodhana]]'' therapy not only flushes the vitiated gut microbiome but also flushes out the substrata due to which growth of microbiome is controlled (Verse 73-74).

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''Kshara'' has been advised along with ''tilvaka sneha; kshara'' has alkaline pH. In duodenum and small intestine, enzymes with alkaline pH are secreted. ''Ushna, teekshna'' and ''laghu [[guna]]'' help in digestion. ''Kledayati ado paschata visoshayati''[Cha.Sa.[[ Vimana Sthana]] 1/17 ] i.e. secretion are first increased and later on absorbed is very essential in ''grahani dosha''. Both these actions help in secretion of digestive enzymes thereby increasing ''agni'' and by absorption correct the malabsorption. Therefore use of ''kshara'' is more in ''grahani dosha'' and ''gulma'' (Verse 79).

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''Kshara'' has been advised along with ''tilvaka sneha; kshara'' has alkaline pH. In duodenum and small intestine, enzymes with alkaline pH are secreted. ''Ushna, teekshna'' and ''laghu [[guna]]'' help in digestion. ''Kledayati ado paschata visoshayati''[Cha.Sa.[[ Vimana Sthana]] 1/17 ] i.e. secretion are first increased and later on absorbed is very essential in ''grahani dosha''. Both these actions help in secretion of digestive enzymes thereby increasing [[agni]] and by absorption correct the malabsorption. Therefore use of ''kshara'' is more in ''grahani dosha'' and ''gulma'' (Verse 79).

''Aranala''(a fermented preparation), ''dadhimanda''(curd whey) or ''sauviraka'' are all fermented liquids. Fermented liquids contain probiotic organisms. Probiotic foods are produced by chemical action of lactic acid, bacteria, yeast or combination of both. These useful microorganisms help in breaking down carbohydrates, sugars making them easily digestible. Probiotics improves absorption of nutrients; improve synthesis of vitamins, essential fatty acids and enhance nutritional qualities of food grains. Fermented foods increase the absorption of vital minerals from gastrointestinal tract thus preventing mineral deficiencies and also treat the diarrhea. It explains the role of helpful gut microbiome (Verse 82-86). Use of fermented products explains the concept of gut microbiome and use of ''kshara'' and ''amla'' drug for maintaining pH (Verse 88-93).

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