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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 34-40

A Clinical Study of Grahaninigraha Churna in the Management of Grahani Roga with Special Reference to Irritable Bowel Syndrome


1 Medical officer (Ayurveda), Government of Rajasthan, Jaipur, Rajasthan, India
2 Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India
3 Research Officer, CCRAS, New Delhi, India
4 Ex-Professor, Department of Kriyasharira, National Institute of Ayurveda, Jaipur, India

Date of Submission21-Mar-2022
Date of Decision29-Apr-2022
Date of Acceptance08-May-2022
Date of Web Publication15-Sep-2022

Correspondence Address:
Bharatkumar Chhaganbhai Padhar
National Institute of Ayurveda, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_18_22

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  Abstract 


Background: Clinical manifestation of Grahani Roga is similar to irritable bowel syndrome (IBS). The prevalence of IBS varies from 11% to 14% in India. Due to the wide spectrum of diseases, much prevalence in society, and lack of effective medicines, the disease has been chosen for the trial. Aim: The aim of this study was to study the efficacy of Grahaninigraha Churna in the management of Grahani Roga (IBS). Materials and Methods: Twenty clinically diagnosed patients were selected and administered Grahaninigraha Churna – 4 g two times a day with buttermilk after meal for 30 days. Study Design: It was a single-center, open-label clinical study. Results: Improvement in Muhurbadhdmmahurdravm (alternative loose motion and constipation) and Ajirna (indigestion) was 64.91% and 50.00%, respectively, which was statistically highly significant (P < 0.001). Conclusion: Grahaninigraha Churna is effective in the management of Grahani Roga (IBS).

Keywords: Grahani Roga, Grahaninigraha Churna, irritable bowel syndrome


How to cite this article:
Rawat S, Padhar BC, L Meena H M, Mutha R, Bhatnagar A, Sasane PU, Meena MS. A Clinical Study of Grahaninigraha Churna in the Management of Grahani Roga with Special Reference to Irritable Bowel Syndrome. AYUHOM 2022;9:34-40

How to cite this URL:
Rawat S, Padhar BC, L Meena H M, Mutha R, Bhatnagar A, Sasane PU, Meena MS. A Clinical Study of Grahaninigraha Churna in the Management of Grahani Roga with Special Reference to Irritable Bowel Syndrome. AYUHOM [serial online] 2022 [cited 2022 Oct 7];9:34-40. Available from: http://www.ayuhom.com/text.asp?2022/9/1/34/356167




  Introduction Top


Ayurveda is not merely a system of medicines, but it also imparts the knowledge to masses about the art of living a healthy life without suffering from various ailments. Recently, over a few decades, our society has changed a lot. Technological advancement has led to a sedentary lifestyle and unhealthy eating habits. Irregular food habits, fast and junk food culture, eating outside foods, eating preserved, tinned and precooked foods, and an unpredictable resting and waking pattern have all pervaded our society in subtle ways. These dietetic and lifestyle indiscretions vitiate the Agni as well as the normal physiological function of Grahani. Due to the interdependence of Agni and Grahani, the vitiation of Agni leads to the development of Grahani Roga.

Irritable bowel syndrome[1] (IBS) is one of the most commonly encountered chronic gastrointestinal disorders. The prevalence of IBS varies from 11% to 14% in India.[2] IBS is a motility disorder of the gastrointestinal tract, essentially of functional nature with a definite psychosomatic basis. The patients present with a variety of symptoms such as pain in the abdomen, erratic bowel habits, and an incomplete sense of evacuation. Anxiety, sadness, and obsessive–compulsive disorder are all common comorbidities of IBS. Due to the nature of the disease, it was hypothesized that addressing the role of Vata Dosha in the disease might be necessary. The etiopathogenesis and the symptoms of IBS suggest the involvement of Vata Dosha. Hence, based on the clinical symptoms of IBS, we can link it to Ayurvedic Grahani Roga. The reason for the selection of this disease is because of its high prevalence rate in society and its effect on the quality of life. Several studies have also emphasized the role of constitutional, psychological, and dietary habits as predisposing factors. IBS has almost always been incurable, and the approach, therefore, can only be palliative. Many drugs have been advocated in the treatment of IBS. For a long, most of them being spasmolytic, bulking, and psychotropic agents, often selected empirically, but the results are not satisfactory. In the treatment of IBS, the current approach of modern medicine is not yielding satisfactory results. The management aspect remains symptomatic with troublesome side effects as a result, safe, cost-effective, long-lasting, and noninvasive treatments are required. It is critical at this point to investigate the efficacy and safety of Ayurvedic medication in the treatment of IBS.

Aims and objectives

  1. This study aimed to evaluate the efficacy of “Grahaninigraha Churna” in the management of Grahani Roga w.s.r. to IBS.



  Materials and Methods Top


Selection of patients

A total of 20 patients of Grahani Roga were selected for the present study from the outpatient department and inpatient department of the hospital attached to the institute. The cases were selected regardless of age, sex, occupation, and socioeconomic conditions. The study was conducted in 2006. The study was approved by the Departmental Research Committee and the Research Review Board of the Institute (NIA, Jaipur) on June 16, 2006. Details of the study were explained to all the enrolled patients, and written consent was taken on the form mentioning details of the study.

Inclusion criteria

  1. Patients of either gender having symptoms of Grahani Roga aged between 18 and 60 years
  2. Patients having chronicity of Grahani Roga for 3 months to 5 years.


Exclusion criteria

  1. Patients under the age of 18 and over the age of 60 years, regardless of gender
  2. Chronicity of Grahani Roga for more than 5 years
  3. Mixed infection with parasites such as roundworms and hookworms
  4. Patients with bleeding per rectum
  5. Patients with evidence of malignancy
  6. Patients having concomitant illnesses such as diabetes mellitus, malignant hypertension, cardiac disease, pulmonary tuberculosis, renal function impairment, amoebic dysentery, ulcerative colitis, malabsorption syndrome, intestinal tuberculosis, and lactase deficiency diarrhea
  7. Patients suffering from major systemic illness with corticosteroids, antidepressants, anticholinergic, or any other drug that may influence the outcome of the study
  8. Alcoholics and drug abusers
  9. Pregnant or lactating women
  10. Patients who have completed participation in any other clinical trial during the past 6 months.


Drug administration

Twenty cases of clinically diagnosed and registered patients of Grahani Roga were treated by Grahaninigraha Churna – 4 g twice a day with buttermilk after meal for 30 days.

Withdrawal criteria

Following were the criteria to withdraw participants from the trial:

  1. If she/he developed any serious adverse effect (necessitating hospitalization)
  2. There is noncompliance with the treatment regimen (a minimum of 80% compliance is essential to continue in the study).


Drugs and method of its preparation

The trial drug Grahaninigraha Churna was selected from Siddha Bhaishajyamanimala which contains Jatiphal (Myristica Fragrans Houtt.), Kutaja (Holorrhena antidysenterica Linn.), Mustaka (Cyperus rotundus Linn.), and Bilva (Aegle marmelos Corr.) in equal proportion.[3] The medicine was prepared in the GMP-certified pharmacy of the institute.

Duration of clinical trial and follow-up study:

  1. Oral drug administration for 30 days.
  2. All patients were followed up fortnightly for 1 month.


Criteria for assessment

Subjective parameters

Clinical features of Grahani Roga as mentioned in Ayurveda classics:[4]

  • Muhurbadhdmmahurdravm (irregular loose motion and constipation)
  • Ajeerna (indigestion)
  • Trishna (excessive thirst)
  • Arochaka (anorexia)
  • Praseka (excessive salivation)
  • Chardi (vomiting)
  • Hrillas (nausea)
  • Vairasya (distaste of mouth)
  • Atrakoojana (borborygmi)
  • Pravahana (straining while defecation)
  • Agnimandya (loss of appetite)
  • Aalaysa (lethargy)
  • Tvakarauksha (rough skin)
  • Uadarshoola (gripping pain in the abdomen)
  • Pandu (anemia)
  • Krushata (weakness)
  • Asthiparvaruka (joint pain)
  • Tiktamoldgara (bitter and acidic eructation)
  • Saphenmalapravrutti (frothy stool)
  • Sashbdamalapravrutti (gaseous stool)
  • Sashoolamalapravrutti (pain while defecation)
  • Punhpunhmalapravrutti (frequent defecation)
  • Bhojanottarmalapravrutti (defecation after intake of food)
  • Durgandhitmalaprarutti (defecation with smell)
  • Guda me kartanvatpeeda (pain in anus)
  • Aam shleshmayuktamalpravrutti (steatorrhea).


Assessment of signs and symptoms was done pre- and posttrial on a Severity Grading Scale for various aspects of the disease [Table 1].
Table 1: Grading of symptoms of Grahani Roga

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Asthiparvaruka (joint pain) - Assessment of pain was done by Visual Analog Scale [Figure 1]:
Figure 1: Visual Analog Scale

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Objective parameters

Hematological – Hemoglobin gram percentage (HB g%), total leukocyte count (TLC), and erythrocyte sedimentation rate (ESR).

Study design

  • Study type: single-center, interventional
  • Purpose: → treatment
  • Masking: → open-label
  • Duration of the clinical trial: Total duration of the clinical trial was 30 days
  • Number of group: 1 (one).


Observation and results

The present study has shown that 12 patients were in the age group 21–35 years and 4 patients in the age group 36–50 years; it shows that overall, 80% of patients belong to 3rd to 5th decade of life. Incidence of the disease is found notably higher in males (75%) than in females (25%), i.e., (3:1). The majority of the patients (90%) were following Hindu religion. About 80% of patients were married. Patients from the middle-class account for up to 80% of the total, with the poor accounting for 15% of the total. Patients with Vata-Pittaja Prakriti make up the majority of patients, followed by Vata-Kaphaja Prakriti, which is linked to the development of Grahani Roga. About 65% of patients showed Madhyama Ahara Shakti, followed by 35% of patients had Avara Ahara Shakti. About 65% of patients had Madhyama Koshtha, whereas 25% of patients had Mrudu Koshth. Mandagni was reported by 60% of the patients, whereas Vishamagni was reported by 40% of patients. Tea addiction was observed in 90% of the cases. Duration of illness <1 year was found in a maximum 55% of the patients, followed by 15% of patients were having a duration of illness between 1 and 2 years. About 46.67% of patients informed drug history of allopathic medicines.


  Results Top


The data were analyzed using Instat graph pad-3, free trial version, GraphPad by Dotmatics.

  • For nonparametric data, Wilcoxon matched-pairs signed-ranks test is used, while for parametric data, paired t-test is used.


Effect of therapy in subjective parameters

Twenty patients treated with Grahaninigraha Churna – 4 g twice in a day with buttermilk after meals for 30 days showed highly significant results regarding subjective parameters – Muhurbadhdmmahurdravm (irregular loose motion and constipation), Ajeerna (indigestion), Trishna (excessive thirst), Vairasya (distaste of mouth), Antrakoojana (borborygmi), Agnimandya (loss of appetite), Aalaysa (lethargy) Tvakarauksha (rough skin), Uadarshoola (gripping pain in abdomen), Krushata (weakness), Asthiparvaruka (joint pain), Tiktamoldgara (bitter and acidic eructation), Saphenmalapravrutti (frothy stool), Sashbdamalapravrutti (gaseous stool), Sashoolamalapravrutti (pain while defecation), Punahpunahmalapravrutti (frequent defecation), Bhojanottarmalapravrutti (defecation after intake of food), Durgandhitmalaprarutti (defecation with smell), Guda me kartanvatpeeda (pain in anus), and Aam shleshmayukta malpravrutti (Steatorrhea) with percentage relief of 64.91%, 50%, 66.67%, 75%, 55.56%, 63.64%, 63.33%, 75%, 92.59%, 50%, 66.67%, 61.11%, 72.41%, 64.29%, 80%, 61.82%, 65.96%, 65.96%, 67.86%, 55.56%, and 56.36%, respectively. In the case of other subjective parameters, i.e., Arochaka (anorexia), Praseka (excessive salivation), Hrillas (nausea), Pravahana (straining while defecation), and Pandu (anemia), there was a significant result with percentage relief of 53.85%, 57.14%, 75%, 45.45%, and 64.29%, respectively, and nonsignificant results with respect to Chhardi (vomiting) (P > 0.1) [Table 2].
Table 2: The effect of therapy in subjective parameters (Wilcoxon matched paired single ranked test)

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Effect of therapy in objective parameters (lab investigations)

In objective parameters, Hb% has shown a highly significant result (P < 0.005) with an improvement of 7.66%, and ESR has shown nonsignificant result (P < 0.1) with an improvement of 18.94%, whereas in the case of TLC, nonsignificant results (P > 0.1) with an improvement of 10.24% [Table 3].
Table 3: The effect of therapy on laboratory investigations (paired t-test)

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  Discussion Top


Probable mode of action of Grahaninigraha Churna

Ingredients of Grahaninigraha Churna are Jatiphal (M. Fragrans Houtt.), Kutaja (Holorrhenaanti dysenterica Linn.), Mustaka (C. rotundus Linn.), and Bilva (A. marmelos Corr.) which are in equal proportion.

In this combination, Tikta-Katu dominant Rasa of the ingredients help in digestion of Ama and ultimately break the pathogenesis of the disease. Besides this, there is dominancy of Laghu, Ruksha Gunas in Grahaninigraha Churna which also helps in Kaphaghna property. This formulation dominantly has two Dravyas with Ushnavirya and two Dravya with Sheeta virya which helps to pacify the Vata Dosha while Deepana and pachana properties of the ingredients help to digest the Ama and control the Vata Dosha.

Jatiphal (M. Fragrans Houtt.) has Tikta Katu rasa, Katu vipaka, Ushna Virya, Laghu, Teekshna guna, and Kaphavatahara. It possesses pharmacological actions such as antidiabetic, anticarcinogenic, antidepressant, anti-obesity, anti-diarrheal, hepatoprotective, aphrodisiac, enhancing memory skills, antimicrobial, antioxidant, anti-inflammatory, and anti-analgesic effects properties.[5]

Kutaja (Holorrhena antidysenterica Linn.) possess Tikta Kashaya rasa, Katuvipaka, Sheeta Virya, Laghu, Rukshaguna, and Kaphapittahara. It has many qualities as Deepana, Grahi, Jwarghna, Atisarghna, Arshoghna, Krimighna, Kushthaghna, Upashoshana, Raktastambhana, Dhatushoshana, and Vamaka. It shows pharmacological actions such as antidiabetic, antiurolithic, antibacterial activity, antihemorrhoidal, analgesic activity, anti-inflammatory, antimalarial, anti-diarrheal, antimutagenic, antihypertensive, antioxidant/free radical scavenging, diuretic, antiamoebic, anthelmintic, antitubercular, antispasmodic, antiprotozoal, antifungal, and antigiardia properties.[6]

Mustaka (C. rotundus Linn.) has Tikta, Katu, Kashaya Rasa, Laghu, Ruksha Guna, Sita Virya, and Katu Vipaka with Kapha-Pittahara properties. It has Sthoulyahara, Dipana, Pachana, Grahi, and Jwaraghna properties so have been indicated in Agnimandya, Jwara, and Sangrahani. It also possesses pharmacological actions such as anti-inflammatory, hepatoprotective, antipyretic, anti-obesity, and antidiabetic.[7]

Bilwa (A. marmelos Corr.) possess Kashaya Tikta Rasa, Laghu, Ruksha Guna, UshanaVirya, and KatuVipaka. It is Deepana, Pachana, Graahi, and Vatakapha Shamana. It works on Grahani due to Grahi property; on Agni due to Laghu Guna KatuVipaka and Deepana Guna. It has property of Amapachaka due to Tikta Rasa, Ushana Virya, and Laghu Guna. It also possesses pharmacological actions such as antimicrobial, anti-inflammatory, anti-diarrheal, antipyretic, analgesic, antidiabetic, hepatoprotective, and anticancer effects.[8]

Grahaninigraha Churna has Deepana, Pachana, Graahi, and Vatakapha Shamana properties along with anti-inflammatory, anti-diarrheal, antispasmodic, antioxidant, analgesic activity, gut motility regulation, and immunomodulatory effect.


  Conclusion Top


  • Based on Rogaprakriti, Adhishthana, and Samutthana as well as the clinical manifestations, Grahani Roga has a similarity with IBS
  • Vitiated Vata Dosha and the deranged status of Agni are the main components in the pathogenesis of Grahani Roga
  • No adverse or side effects were encountered during the study
  • Grahaninigraha Churna is primarily found to be effective in the management of Grahani Roga as it has provided statistically significant relief in most of the symptoms of the diseases
  • A further randomized controlled trial should be carried out to confirm the efficacy of Grahaninigraha Churna in Grahaniroga.


Financial support and sponsorship

National Institute of Ayurveda, Jaipur.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Harrison TR, Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, et al. Harrison's Principles of Internal Medicine. Part-13., 17th International edition., Vol. I., Ch. 290. Singapore: McGraw-Hill Book; 2007.  Back to cited text no. 1
    
2.
Rahman MM, Mahadeva S, Ghosha UC. Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh, and Malaysia: A review. World J Gastroenterol 2017;23:6788-801.  Back to cited text no. 2
    
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Kalandhara Bhatta SR. Chaturthogucchaka 3. In: SidhaBhaishajyamanimala. Varanasi: ChaukhabhaKrishnadas Academy; 2008. p. 182.  Back to cited text no. 3
    
4.
Shastri, K. Chaturvedi G.N, Charak Samhita, Chikitsasthana Adhayay-15 Shlok no.53-55. Part II, Vidyotini Hindi Commentary, Chaukhabha Bharati Academy Varanasi; 2003. p. 461-462.  Back to cited text no. 4
    
5.
Honey J, Arya KR, Sindhu TJ, Syamjith P, Vinod KR, Sandhya S, et al. Descriptive review on myristica fragrans houtt. J Drugs Med 2016;8:35-43.  Back to cited text no. 5
    
6.
Kavitha D, Shilpa PN, Devaraj SN. Antibacterial and antidiarrhoeal effects of alkaloids of Holarrhena antidysenterica WALL. Indian J Exp Biol 2004;42:589-94.  Back to cited text no. 6
    
7.
Satyanarayan P, Subash S, Kumar Madan SA. A review of medicinal properties on Musta (Cyperus rotunduslinn.). Ayushdhara 2019;6:(3):2235-41.  Back to cited text no. 7
    
8.
Parmar N, Patel BR, Patil B. A review on classical therapeutic uses of Bilva (Aegle marmelos corr.) Pharma Sci Monitor 2014;5:21-30.  Back to cited text no. 8
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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