Introduction
Modern life is fraught with stress. Its negative consequences manifest in lifestyle-related illnesses. Irritable bowel syndrome (IBS) is one such condition. Several studies in recent years have shown that a large number of people suffer from symptoms related to IBS. It is striking that this number is steadily increasing. IBS manifests as persistent intestinal spasms, diarrhea, constipation, abdominal pain, and indigestion. The condition does not directly affect life expectancy. However, it significantly impacts work absenteeism, reduces personal productivity, causes depression, weakness, poor immunity, and hampers the patient's social interactions. Modern medicine offers no ready-made treatment for IBS. Treatment often involves symptom management and psychological counseling. Although IBS appears to be a relatively recent condition, its causes, symptoms, and treatment are already described in detail in Ayurvedic medicine. Not only do people feel that it relieves their intestinal complaints and spasms, they also feel that Ayurveda improves their quality of life.
The main symptoms of IBS are pain and discomfort in the abdominal region, often accompanied by frequent diarrhea or constipation, as well as bowel dysfunction. The latter symptom is often triggered by emotional or psychological stress. In addition, people with IBS experience intestinal spasms, the feeling of being unable to fully empty their bowels, bloating, or abdominal distention. In some cases, these symptoms are relieved by bowel movements. People with IBS are more likely than others to experience acid reflux (esophageal reflux), symptoms related to the urogenital system, chronic fatigue syndrome (CFS), headaches, back pain, and psychiatric symptoms such as depression and anxiety.
Some studies indicate that up to 60% of IBS patients suffer from psychological disorders, often anxiety disorders or depression. Conventional medicine today offers no explanation for the precise cause of IBS. Nor is there a specific method for diagnosis. Infections and food allergies are often blamed. In the chapter "Grahani" of the Ayurvedic texts, Ayurveda offers an alternative explanation for the disease. The Ayurvedic perspective on IBS will be described in the following sections.
The Ayurvedic View on IBS
The most important Ayurvedic texts are the Charaka Samhita and the Sushruta Samhita. These texts describe the disease "Grahani," a condition that primarily manifests with specifically defined symptoms: irregular bowel movements, diarrhea, constipation, and abdominal pain. Grahani is described in several ways, but encompasses everything that is understood as irritable bowel syndrome (IBS). The following texts explain the causes and symptoms of Grahani, with IBS being a subset of Grahani. Strictly speaking, the Grahani is the part of the small intestine that retains food after ingestion. This allows our food to be absorbed by our digestive system (Agni) in the Grahani. Once the food is digested there, it moves down.
Agni is our digestive system. It is associated with various functions, such as enzyme absorption, healthy intestinal contractions, healthy bacteria, and normal nutrient absorption through the intestinal wall. According to Ayurveda, there are thirteen different types of Agni. Specific supplements are available to treat specific Agni disorders. Disrupted functioning of Agni, or digestive enzymes, manifests as a number of symptoms. These symptoms are called a diseased "Grahani." In such a case, the primary cause of Grahani or IBS lies in poor functioning of the digestive enzymes and related processes (collectively referred to as "Agni"). The causes of Grahani are explained in the following sections.
Common Causes of IBS
"Prevention is better than cure." Therefore, it's valuable to also consider the underlying causes when treating IBS. Anything that weakens Agni (digestive enzymes) is a direct cause of Grahani (IBS). Long-term causes include irregular eating habits, excessive consumption of hard-to-digest foods, consumption of foods to which one is hypersensitive, insufficient nutrition, fasting, overeating, eating at irregular times, excessive exertion, suppression of the natural urge to urinate, defecate, hunger, thirst, belching, excessive sexual activity, retention of intestinal gas, and excessive consumption of spicy junk food. Excessive consumption of foods that are very sour, bitter, or spicy can also be a cause of IBS.
The initial symptoms of Grahani are caused by a disruption of the digestive enzymes, the Agni. This is followed by diarrhea, digestive difficulties, emotional problems, stress, and so on. Diarrhea is usually treated with antibiotics, without considering the Agni. Once the problems are relieved, people return to their usual eating habits. However, the Agni is weakened by the diarrhea and has insufficient resistance, which significantly reduces its function. So, even after the infection has been successfully fought off, the digestive system remains in a weakened state. It cannot cope with the continuous strain of an unhealthy lifestyle, which eventually leads to Grahani. The following flowchart shows how the disease develops.
General symptoms of Grahani
People with Grahani or IBS experience one or a combination of the following symptoms: persistent, abnormal, loose stools—requiring multiple bowel movements. Sometimes bowel movements improve spontaneously, while other times the patient becomes constipated. Irritable bowel syndrome (IBS) also occurs. Bowel movements are sometimes painful. Besides these main symptoms, Grahani is also accompanied by additional symptoms. These include excessive thirst, anorexia, salivation, edema (fluid retention in the extremities), joint pain, fever, foul-smelling acid reflux, heartburn, and, in some cases, even vomiting.
Classification of Grahani
There are different forms of Grahani depending on which Dosha predominates (the three bodily doshas/bio-entities that contribute to bodily functions). These are Vataja, Pittaja, and Kaphaja Grahani. The category is also determined by the degree to which food is digested. Grahani can be Sama (incompletely digested), for example, or Pakwa (digested). The symptoms of Pakwa Grahani are described under the heading "General Symptoms.". The remaining classification of patients is as follows: A person may have the typical single form of Grahani or two or more forms of Grahani at the same time.
Sama Grahani
The Grahani caused by indigestion of Dosha is called Sama Grahani. The main symptoms are a history of Aama disorders, repeated constipation, salivation, abdominal pain, burning sensation, anorexia, a feeling of heaviness in the abdomen and the rest of the body, mucous or oily discharge in the stool, and painful cramping during bowel movements (tenesmus). Diagnosing Sama and Pakwa requires a very thorough understanding of Ayurveda.
Vataja Grahani
Excessive thirst, dry throat, pain in the heart region, altered taste sensation, weight loss, flatulence several hours after meals, loose stools, and the urge to eat more food even after persistent indigestion. Vataja Grahani is sometimes accompanied by repeated coughing fits or asthma.
Pittaja Grahani
Yellowish or bluish stools, foul-smelling reflux, acid reflux, anorexia, burning sensation in the heart and throat area. Yellowish skin discoloration in some chronic cases.
Kaphaja Grahani
Slow digestion, slimy stools, nausea, vomiting, anorexia, a strange sensation in the mouth, a sweet taste in the mouth. Kaphaja Grahani is sometimes accompanied by nasal inflammation and a cold.
Treatment of Grahani
Treating Grahani or IBS with Ayurveda consists of three aspects: diet, behavior, and supplements.
Diet
Unhealthy eating habits are the direct cause of disturbed Agni. Therefore, as a precaution, one should eat meals at regular times. Avoid junk food, foods to which you are hypersensitive or intolerant, and foods that are difficult to digest. Everyone has a unique physical constitution. Based on this, Ayurveda recommends a diet that best suits each person. For personalized nutritional advice based on your health, consult a qualified Ayurvedic practitioner. During a consultation, your Ayurvedic practitioner can also determine which foods you have difficulty tolerating.
To promote healing, you can follow a diet for certain Agni conditions, such as diarrhea, indigestion, or other ailments. This diet is listed in Ayurveda as "Sansarjana Krama." It is a clearly structured diet plan that, depending on the Agni's condition, begins with easily digestible foods in limited quantities. As the Agni recovers, you are gradually introduced to heavier foods. This gradually adjusts you to a normal diet. Moreover, the Agni is given time to recover, which, over time, provides better protection against irregularities in our daily diet. Several foods described in Ayurveda are considered beneficial for the Agni. They are also included in the aforementioned diet and used for therapy.
Such diets promote digestive enzymes, digestion, absorption, restore normal intestinal flora, and address nutrient deficiencies. More importantly, they contribute to regular and normal bowel movements. There are also special diets for people with IBS who are chronically constipated and experience painful bowel movements. These diets have a calming effect on the intestines. Moreover, they regulate the Vata dosha, which provides relief from constipation, pain, and tenesmus. For a personalized diet plan, please consult your Ayurvedic practitioner.
Behavior
Factors like stress and depression can lead to the onset of symptoms related to Grahani or IBS. Stress and depression disrupt the functioning of the Agni. Sufficient and regular exercise strengthens the body, promotes Agni, and relieves the body of stress. Meditation, yoga, and pranayama are beneficial for the mind and increase stress resistance. Ayurveda prescribes a number of systematic lifestyle rules, such as seasonal rules (Ritucharya) and daily rules (Dinacharya). These can protect oneself against ailments resulting from an unhealthy lifestyle. By adjusting one's behavior, one can prevent IBS and also shorten the recovery period. Ayurvedic-based cleansing and Shodhana supplements detoxify the body, remove undigested and malformed intermediate products (metabolites), naturally cleanse the body's channels, and support the effectiveness of supplements.
Supplements
Based on the symptoms of IBS and the patient's overall health, Ayurveda offers a wide range of supplements. All supplements are based on a single principle: improving digestion and Agni, improving IBS, and, thanks to a personalized therapy, fully restoring the patient's health.
Ayurvedic therapy can be highly personalized: some people only need warm water, others may only need a single herbal powder or a combination of pills, while yet another may need a detoxification program. For optimal results, a herbal treatment should always be combined with lifestyle and dietary changes. A thorough examination by a qualified Ayurvedic practitioner and an assessment of Prakriti, or general health, increases the likelihood of prescribing the right therapy. Ayurvedic supplements should only be used under the strict supervision of a qualified Ayurvedic physician. This is crucial, as treating Agni requires close observation and a precise treatment tailored to the individual patient.
A personalized treatment for everyone is the great added value of Ayurveda. In Ayurvedic therapy, the focus is not on the disease, but on the individual. Ayurveda emphasizes how people can prevent illness and how they can resist an unhealthy lifestyle. Many Ayurvedic supplements for improving IBS have antimicrobial properties. However, these supplements are not characterized by their effectiveness against microorganisms, but rather by the fact that they trigger the healing process in patients. According to Ayurveda, a person is not cured once the pathogen has been eliminated from their body; instead, the immune system is made dependent on Ayurvedic herbs. A treatment that strengthens the body and gives it the opportunity to fight the disease benefits from Ayurveda. This is why Ayurveda is a promising therapy for the many conditions related to IBS and other chronic complaints.
Dr. Pranit Ambulkar MD, Ph.D. (Sch.)
Ayurveda Consultant Physician & Ayurvedic Pharmaceutist