Agnimandya is a precursor in Grahani disease

Ankita Patil*¹, Anaya Pathrikar², Nitin Kamat³

¹3^rd year PG Scholar,

²HOD and Professor,

³Professor and Ex Principal

Kayachikitsa Department, APM’S Ayurved Mahavidyalaya,

Sion, Mumbai, Maharashtra.

*Corresponding Author: ankspatil13@gmail.com

ABSTRACT:

Grahani a chronic disease is caused due to imbalance in Agni. The primary function of Grahani part is to retain food, digest it then segregate and remove it out to intestine. When the Grahani function is hampered, absorption process is affected at major, which leads to inadequate absorption of essential material to healthy wellbeing. Thus, this study was carried out to determine role of different types of agni in Grahani. To fulfill the aim a total of 60 patients showing cardinal symptoms of Agnivikruti, Mahastrotas vikruti were enrolled and were checked with various subjective criteria. Upon statistical analysis of the gathered data, it became evident that patients who had Agni impairment, consequently landed into the Grahani disorder.

Keywords:

Grahani dosha, Grahani, Agni, Agni Dushti.

INTRODUCTION:

Ayurveda establishes a close relationship between Agni and Grahani, where they are reliant on each other. Agni is the key factor in maintenance of health when its normal viz and viz causative factor for almost all diseases, when it’s abnormal.

सर्वेरोगामन्दानिलो..(A H Nidan)

It means all the disease arrive as an outcome of Agnimadhya¹. Also rightly said,

शान्तेअग्नौम्रियते, युक्तेचिरञ्जीवत्यनामयः।

रोगीस्याद्विक्रुतेमूलंअग्निस्तस्माद्निरुच्यते॥

Impairment of agni leads to range of diseases and ultimately to death also and if agni is good then human life increases. Thus, agni is the main base of healthy life². It is also because Agni is the power present in each body element and is responsible for conversion of material into a form which is acceptable and favorable for nutrition and growth of body i.e along with Pachan the Parinaman is to be emphasized.

So it is imperative to manage ‘Agni’ i.e. if it’s normal maintain, nourish and nurture it. If Agnidushti/ Agnivikruti/ Derailment of Agni is evident; immediate rectification with best available drugs, therapies is essential. Additionally, its classical function involves propelling well-digested food toward the next stage for nourishment. Four functional states of Agni are based on predominant Dosha : (a) Mandagni, with suppressed Jatharagni due to kapha; (b) Tikshnagni, hyperactive Jatharagni due to pitta, facilitating rapid digestion; (c) Vishamagni, irregular Agni due to vata, leading to unpredictable digestion; and (d) Samagni, equilibrated Agni when tri doshas are balanced, ensuring consistent and harmonious digestion. Mandagni shows indigestion complaint for longer period of time, Tikshnagni accelerates digestion causing intense hunger and potential discomfort, Vishamagni results in erratic digestion and associated issues due to vaat.

So management of Agni is one of the 8 branches of Ayurveda; namely ‘Kayachikitsa’. ‘Grahani’ organ is seat of Agni and Grahanivyadhi is disease due to abnormal Agni where there is a ultimate abnormality of organ also. Functionally weak Agni i.e., Mandagni, causes improper digestion of ingested food, which leads to Ama Dosha. This Ama Dosha is a root cause of most of the diseases. It has pivotal importance in the pathogenesis of Grahani Roga.

AIMS AND OBJECTIVE:

1. To rule out that Grahani Disease is proceeded by Agnidushti.

2. To assess Agnidushti in Grahani.

MATERIALS AND METHODS:

Type of study - Observational study.

Study location - OPD and IPD of our Ayurvedic Hospital.

Sample size – 30 in Group A of OPD, 30 in Group B of IPD.

INCLUSION CRITERIA :

• Patients between 16-60 years of age of all genders.
• Patients having lakshanas of Grahani.

For.eg : Aruchi, Kshudhamandhya, Bahudravasaranam, Murhubaddham Murhudravam, etc.

DIAGNOSTIC CRITERIA - All the patients were diagnosed on the basis of classical signs and symptoms of Grahani Roga. For the purpose of perfect diagnosis and assessment, a special research scale and case record form was designed for the study incorporating all the relevant points from both Ayurvedic and modern views. A subjective and the objective criteria scale was decided.

Subjective Criteria - Following symptoms will be assested ^3-13 –

Sthanik Lakshan/Koshthagat/Mahastrotasgat lakshan -

Arochak Prasek Annavidvesh Hrut Kantha Daah Hrullas Kanthasosh Avipak/ Ashraddha Aadhman Udgar vikruti Vaat varcha nirodh Kshudhamandya

· Pravahan Purisham bhrushagandhi picchilam Sakaf malapravrutti Krute api akrut sanyatam Saruja mal pravrutti Puti mal pravrutti Muhru drava murhu baddham Sashabda maal Angagaurav Alasya Gruddhi sarva rasanam cha manasah

Following gradation & scoring are taken as subjective parameters to study the presence of agnimandhya janit vikruti of Agni and GrahaniAvaya.
Grade 0 – Nil, Grade 1- Mild, Grade 2 – Moderate, Grade 3 – Severe

Objective criteria of assessment –

Modified Izumo Scale, new questionnaire for quality of life assessment of patients with gastrointestinal symptoms¹⁴ –

Select appropriate box for each question based on your most recent one week daily activities.	Not bothered	Not so bothered	Slightly bothered	Bothered	Strongly bothered	Intolerably bothered
1. Are you bothered by acid reflux? (Amloudgar)	0	1	2	3	4	5
2. Are you bothered by heartburn centered in the anterior chest? (Uradaha)	0	1	2	3	4	5
3. Are you bothered by epigastric pain? (Udarshul)	0	1	2	3	4	5
4. Are you bothered by throat discomfort? (Shukkantha)	0	1	2	3	4	5
5. Are you bothered by epigastric burning sensation? (Udardaha)	0	1	2	3	4	5
6. Are you bothered by hunger epigastric pain?	0	1	2	3	4	5
7. Are you bothered by early satiation?	0	1	2	3	4	5
8. Are you bothered by post-prandial long lasting epigastric fullness or nausea? (Hrullas)	0	1	2	3	4	5
9. Are you bothered by epigastric bloating? (Aadhman)	0	1	2	3	4	5
10. Are you bothered by a feeling of incomplete defecation? (Krute api akrutasanyatam)	0	1	2	3	4	5
11. Are you bothered by constipation or hard stool? (Maal vaat stambh)	0	1	2	3	4	5
12. Are you bothered by stress related constipation?	0	1	2	3	4	5
13. Are you bothered by fecal urgency?	0	1	2	3	4	5
14. Are you bothered by diarrhoea or soft stool? (Bahudravasaranam)	0	1	2	3	4	5
15. Are you bothered by stress related diarrhoea?	0	1	2	3	4	5

The above questionairre was given to all patients to check on agnidushti related symptoms.

OBSERVATION AND DISCUSSION:

It was observed that 63% were male while 27% where female in Group A, whereas 56% were male and 44% were female in Group B; Group A included 93% Hindu and 7 % Muslim religion patients, while Group B included 90% Hindu and 10% Muslim religion patients. Both Group A and B included people of all education and occupational background. Group A included 93% Married and 7% Unmarried patients, while Group B included 96% married and 4% unmarried patients. In Group A 70% were non addictive while Group B had 90% non addictive patients. Diet-wise Group A included 70% Non vegetarians and 30% Vegetarians while Group B included 78% Non-vegetarians and 22% Vegetarians. Avastha wise Jeerna Madhyam Naava all avastha patients were included of approximately similar count.

The subjective and the objective criteria of all the patients were measured and each patient were observed to have maximum symptoms shown in the graphical form below.

Graph 1 – This shows all the patients had symptoms of Agnimandya janit Grahani Vyadhi.

Sr no	Symptom	GROUP A	GROUP B
1	Arochak	25	21
2	Prasek	4	6
3	Annavidvesh	9	9
4	Hrutkanthadaha	4	13
5	Hrullas	14	7
6	Kanthashosh	3	8
7	Avipak	16	20
8	Vaatvarcha nirodh	27	4
9	Udgar vikruti	10	11
10	Pravahan	10	9
11	Brushgandhi purish	19	12
12	Picchil purish	4	9
13	Krute api akrut sanyatam	19	14
14	Saruja mal	11	14
15	Murhu drava murhu baddha mal	14	6
16	Shashabda mal	14	14
17	Kshudhamandya	30	30
18	Udargauravta	27	28
19	Gruddhi sarva rasanam cha manasah	8	3

Sl no	Symptoms based on Objective Crieteria of IZUMO SCALE	GROUP A	GROUP B
1	Acid Reflux (AMLOUDGAR) BT	11	11
2	Heartburn (URADAHA) BT	7	14
3	Epigastric pain (URASHUL) BT	19	3
4	Discomfort in throat (SHUKKANTHA) BT	6	5
5	Gastric Burning (UDARDAHA) BT	13	6
6	Hunger epigastric pain (ABHUKTEURASHUL) BT	10	11
7	Early Satiation BT	15	6
8	Nausea (HRULLAS) BT	15	23
9	Epigastric Bloating (ADHMAN) BT	21	27
10	Incomplete defecation (KRUTE API AKRUT SANYATAM) BT	22	12
11	Constipation (MAAL VAAT STHAMBH) BT	30	5
12	Stress related constipation BT	10	1
13	Faecal Urgency BT	4	14
14	Diarrhoea (DRAVA MAL) BT	9	29
15	Stress related diarrhoea BT	2	11

The above questionaire was given to patients and it was found that each one had the symptoms disturbing the digestive system due to Agnimandya leading to all symptoms of Grahani.

Discussion:

Thus, with the above unbaised distributed data it is proved that all the symptoms related to Agni are observed in the patients of Grahani disease.

Conclusion:

From the above Survey Study : it was observed that -

Maximum number of patients who were suffering from Grahani was found to be having most of lakshanas of Agnimandhya. Further leading to conclude Agnimandya can be the main cause of GrahaniRoga in my survey study.

References:

1. Ganesh Krishna Gadre,Sarth Vagbhat, Nidansthan Chapter no 12, Verse no 1 Anmol prakashan,Pune, reprint 2007,pg no 197
2. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 3-5, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000,pg.589
3. Ganesh Krishna Gadre,Sarth Vagbhat, Nidansthan chapter no 8, Verse no. 17, Anmol prakashan,Pune, reprint 2007, shlok no 21,pg no. 187
4. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 61, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg.602
5. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 64, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg.602
6. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 60, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg.602
7. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 62, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg.602
8. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 63, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg.602
9. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 59, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg.602
10. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 64, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg.602
11. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 64, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg.602 - 603
12. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 64, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg. 603
13. Acharya Agnivesha, Charaka Samhita, Ayurveda Deepika Teeka of Chakrapanidutta, Chikitsa Sthana, Chapter 15, Verse no 65, edited by Kaviraj Atreyaji Gupta, Chaukamba Surabharati Prakashana, 2^nd edition 2000, pg. 603
14. Pubmed Development and verification of the Izumo Scale, new questionnaire for quality of life assessment of patients with gastrointestinal symptoms (researchgate.net) The Japanese journal of gastro-enterology, October 2009.