Charaka Grahani Dosha Chikitsa 15th Chapter

The 15th chapter of Charaka Samhita Chikitsa Sthana is Grahani Dosha Chikisa. Grahani disease is correlated with Irritable bowel syndrome, sprue, malabsorption syndrome. This chapter also explains in detail about food digestion process as per Ayurveda.

Let us now explore the chapter on the treatment of Grahani dosha
Thus, said lord Atreya. [1-2]
In the previous chapter (chikitsa 14), treatment of arshas (piles) is presented. Grahani dosha (sprue-syndrome) is [often] caused by arshas (piles). Therefore, the chapter on the treatment of grahani dosha follows that of arshas.

Agni functions

Functions of Agni – Digestive fire:
Dehagni or Jatharagni (power of digestion and metabolism) is the reason for
Ayu – life,
Varna – colour, complexion
Bala – strength and immunity
Swasthya – good health
Utsaha – energy, enthusiasm
Upachaya – bulk, shape, plumpness of body
Ojas – immunity, disease resisting power (read more about Ojas)
Tejas – aura, complexion, radiance
Maintenance of other varieties of Agni and
Prana , Vital breath.

Extinction of Agni leads to death. Its proper maintenance helps a person to live longer and its impairment gives rise to diseases. Therefore Jataragni is considered to be the root or the most important sustaining factor (mula) of living beings. [3-4]

Importance of Agni

Food provides nourishment to body and tissues and it is the reason for Ojas (vital essence, immunity), strength and complexion. But in effect, it is the agni (digestive strength) that plays a vital role in this connection because tissue elements like, rasa, etc., cannot even originate from undigested food particles, if Agni is not present.

Process of digestion

Prana Vata, draws the ingested food into the koshta – alimentary tract. In stomach, the food gets softened by the unctuous (oily)substance after which it gets split into small particles by the liquid.
The Agni (enzymes) located in the udara (stomach), gets stimulated by Samana vata. This Agni stimulated by vata, digests the food that is taken in required quantity and in right time for the promotion of longevity.

Consider a cooking pot containing rice and water, placed on fire. As the fire, placed below the cooking pot helps in the cooking of food, similarly, Agni (enzyme) helps in the digestion of food located in the Amashaya – stomach. This leads to the production of Rasa – chyle – nutrition rich resultant of digestion and Mala (waste products).

Avastha Paka

Avastha-paka – three stages of digestion process
1. Madhura Avastha Paka
As soon as the food consisting of 6 rasa (tastes) is taken, it goes to stomach and sweetness (madhura-bhava) is manifested during the 1st stage of digestion. It results in the stimulation of kapha which is thin and frothy in nature.

2. Amla Avastha Paka
During the second stage of digestion, the food remains in semi digested form (vidagdha) which results in sour. While moving downwards from the amashaya (stomach), this (semi digested and sour stuff) stimulates the production of a transparent liquid called pitta (bile). Pitta itself is sour in taste.

3. Katu Avastha Paka
When this food product reaches pakvashaya (large intestine), it gets further digested (cooked) and dehydrated by the agni (enzymes), and it takes a bolus-form resulting in pungent taste. This stimulates Vata Dosha. [9-11]

Satiation of sense organs by food

Intake of delicious and wholesome food that has pleasant appearance, smell, colour, touch and sound nourishes and satiates the sense organs – nose, eyes,skin, tongue and ears. [12]

Bhutagni Paka

Bhutagni paka – digestion by elemental fires
There are five types of Agni (digestive factors) based on 5 basic elements.
Parthivagni – responsible for digestion of solid food matters
Apyagni – responsible for digestion of liquid foods
Tejasagni- responsible for digestion of foods with fire element
Vayuvagni – responsible for digestion of air element and
Akashagni – responsible for digestion of food with ether element

They digest the respective elements and nourish the respective elements in the body. For example, Parthivagni digests solid foods and nourishes the solid body elements. [13-14]

Dhatvagni Paka

Dhatvagni- paka – absorption of digested foods at tissue level:
Thereafter, the digested food is subjected to Dhatu Paka. Dhatu means 7 types of tissues (Rasa, Rakta, Mamsa, Meda, Asthi, Majja and Shukra). Each of these Dhatu have their own Agni – digestion power. With this agni, the digested food gets divided into,
Sara bhaga – essence part. This nourishes the respective Dhatu.
Kitta bhaga – waste product – this forms the waste product (Mala) of the respective Dhatu. [15]

Process of metabolic transformation
The nutrient fraction of Rasa dhatu provides nourishment to Rakta (blood).
The nutrient part of Rakta (blood) nourishes mamsa (muscle tissue),
that of mamsa to medas (fat),
that of medas to asthi (bone),
that of asthi to majja (bone marrow), and
the nutrient fraction of majja nourishes Shukra (semen). The foetus (garbha) is the product of nutrient of sukra or semen (sperm). [16]

Upadhatu nourishment

Nourishment of upadhatus (subsidiary / secondary tissue elements)
Breast milk (Stanya)and menstrual blood (Arthava) are formed out of Rasa
Kandara (tendons) and vessels (Sira) are formed out of Rakta,
Vasa (muscle fat) and 6 layers of skin are formed out of Mamsa and
Snayus (sinews) are formed out of medo-dhatu. [17]

Malas (waste products)

The following are the malas (waste products) of anna (food) and dhatus (tissue elements):
Anna/ dhatu Mala(waste product)
1. Anna (food) yields stool and urine as waste products
2. Rasa yields Kapha (phlegm) as waste products
3. Rakta (blood) gives out pitta
4. Mamsa (muscle tissue) kha-mala(waste products excreted from the cavities like eras, eyes, nose, mouth and genital organs)
5. Medas (fat tissue) – sweat
6. Asthi (bone) kesha(big hair) and loma ( small hair)
7. Majja (bone-marrow) the unctuous substance present in the eyes, stool and skin

Thus, Prasada (nutrient fraction) and Kitta (waste product) these 2 categories of products arise out of the paka (metabolic transformation) of the dhatus (tissue elements). Therefore, the process of successive transformation of the dhatus is mutually inter- woven. [18-1/2 20]

Prabhava

Usually, for the nourishment of Shukra Dhatu (semen and female reproductive components) first, Rasa dhatu should be nourished, then Rakta etc. and at the end, the nourishment reaches Shukra.
But some herbs when administered, bypass nourishing all the other Dhatus and directly nourish Shukra dhatu. They act as aphrodisiac herbs – Vrushya. This action is caused by special efficacy of that herb – called Prabhava. [20 ½]

Time taken for metabolic transformation,
According to some scholars, the transformation of dhatus from rasa to Shukra is effected in 6 days and nights. This process of transformation of the tissue elements requiring nourishment is a continuous one, like a moving wheel. [21]

Answer to query about metabolic transformation
On hearing the discussion or discourse from Lord Punarvasu, Agnivesha enquired: “How is rakta (blood) produced out of dissimilar rasa (plasma) in the body
Rasa is free from any colour. How does it acquire colour (redness) Raktha is liquid by nature and how does the compactness and stability of Mamsa (muscle tissue) come out of raktha
How is medas (fat tissue), which is semisolid, produced out of compact Mamsa, How do the bones attain kharatva (roughness and hardness) when they are produced out of mamsa and medas, that are smooth and soft

On the other hand, the bones being so hard, how does majja (bone-marrow) which is so smooth and soft come out of them, How does majja (bone marrow) get transformed into Shukra (semen) According to the wise, shukra pervades the entire body and majja from out of which it is produced is located inside the bone. No holes are visible in the bones. So, how does Shukra (semen) ooze out through the bones

Lord Punarvasu’s reply

Lord Punarvasu replied as follows:
“Rasa dhatu (chyle, blood plasma) represents the essence (tejas) of all the rasas (ingredients of food and drinks having six tastes). That essence of rasa gets transformed into rakta (blood) by virtue of the colour (raga) imparted by the heat of Pitta.

This rakta again, accompanied by Vayu (air), Jala (water), tejas (fire) and heat (ushma) attains compactness and gets transformed into Mamsa (muscle tissue).

That mamsa cooked by its own heat (ushma = enzymes), gets transformed into medas (fat tissue) with the influence of liquidity (Ambu Guna) and Snigdha (unctuousness).

The Asthi dhatu (bone tissue) is produced by the transformation of medas (fat tissue) into a compact form. This compactness is brought about by the action of the Ushma (enzymes) of Medas. It is influenced by Pruthvi (earth), jala, and vayu elements. This enzymatic action gives rise to kharatva (hardness and roughness), with the result that asthi (bone) is manifested.

Vayu causes porosity in the interior of bones, and this porous spaces gets filled up with medas (fat). This unctuous substance is, thereafter, called majja (bone marrow)
The unctuous substance (essence) of that majja (bone marrow), thereafter, gives rise to Shukra (male and female reproductive system). Porosity of bones is caused by vayu, akasha etc., and through these porous holes, exudation of Shukra takes place. This can be compared to exudation of water through the porous walls of a new earthen pot. The entire body is pervaded by fine channels carrying semen.

When a person gets excited because of the sexual urge, determination and amorous mental attitude, then semen comes out from the entire body through pores to the testicle. The displacement (ejaculation) of semen takes place because of the heat that is produced during the physical exercise involved at the time of sexual intercourse. This heat causes melting of semen. This happens on the analogy of the melting of ghee by the application of physical heat. From the testicles, semen gets ejaculated as water flows from a higher altitude to a place of lower altitude. [22-35]

Circulation of Rasa

Vyana-vata (a type of Vata Dosha), which by nature stimulates the process of circulation, causes circulation of Rasa- dhatu all over the body simultaneously and continuously.
Rasa- dhatu during the process of circulation, gets stuck up due to the vitiation of the channels of circulation (Kha Vaigunya). It is at this very site of morbidity, that the disease is manifested. As the rains are caused by the (obstructed) cloud in the sky, similarly, the Doshas get vitiated in that particular spot to cause morbidity in a part of the body. [36- 38]

Jataragni importance

Importance of Jataragni – digestive fire
Thus, 5 Bhautikagni (elemental digestive fire), 7 Dhatvagnis (tissue level digestive fire) and 1 Jatharagni (digestive enzymes in stomach and intestines) are responsible for food digestion and assimilation.

In all these 13 types of Agnis, Jatharagni (digestive fire in the stomach and intestines) is the chief. Bhutagni and Dhatvagni s are dependent upon it.
Aggravation or diminution of Jatharagni results in the aggravation or diminution of Bhutagni and Dhatvagni. Therefore, with appropriate types of fuel in the form of wholesome foods and drinks, the Jataragni should be carefully maintained. The strength of a person depends upon the strength of Jataragni.

If a person takes food without following appropriate procedure, then he quickly succumbs to disease caused by the vitiation of Grahani (duodenum and the upper part of the small intestine) because of this uncontrolled habits.These ailments will be described hereafter. [38 ½- 41]

Ajeerna Nidana, Samprapti

Ajeerna – Low digestion causes and pathogenesis:
Agni (enzymes responsible for digestion and metabolism) gets vitiated of the following:
Abhojanat – Excessive fasting
Ajeernati Bhojanaat – Eating when digestion strength is low
Vishamashana – irregular eating
Asatmya – Intake of unwholesome,
Guru, Sheeta, Atirooksha Sandushta Bhojana – intake of heavy, cold excessively unctuous and polluted food
Improper administration of Vamana, Virechana, and Snehana therapies
Vyadhi Karshanat – Emaciation as a result of affliction by diseases
Residing in improper country and in inappropriate time
Seasonal perversions (raining during summer, high temperature during winter etc) and
Vega Vidharana – Suppression of manifested natural urges.

The above activities causes Vitiation of Agni. The agni becomes so weak that it cannot digest even light foods. The undigested food becomes sour and it works like poison. This leads to the manifestation of Ajeerna. [42-44]

Ajirna Lakshana

General signs and symptoms of Ajeerna
Vishtambha – abdominal distension
Sadana – felling of prostration,
Shira ruk – headache,
Murcchha – fainting,
Bhrama – giddiness,
Prshta kati graha -stiffness of the back and lumber region,
Jrumbha – yawning,
Anga marda – malaise,
Trshna – morbid thirst,
Jwara – fever,
Chardi – vomiting,
Pravahanam – tenesmus
Aruchi – anorexia and
Avipaka – indigestion of food
This is a serious condition called Anna – visha – food turning into poison. [45-46]

Ajeerna Bheda Lakshana:
Signs and symptoms of different types of Ajeerna:

Ajeerna when associated with Pitta, causes below symptoms –
Daha -burning sensation,
Trushna – morbid thirst and
Mukha roga – mouth ulcer
Amla pitta – hyper acidity and such other Paittik diseases.

When associated with kapha it gives rise to
Yakshma – tuberculosis,
Peenasa – chronic rhinitis, coryza
Meha – urinary diseases, diabetes and such other morbidity.

When associated with Vata Dosha, it gives rise to several vatika diseases.
When located in the urine, it causes urinary diseases and when located in the stools, it gives rise to diseases of the pelvic region. When associated with tissue elements, like rasa etc. it causes diseases of the concerned tissues, viz Rasa. etc [47-49]

Vishamagni, Teekshnagni

Vishamagni – irregular type of Agni causes irregularity in the digestion of food, leading to discordance of tissue elements.
Teekshnagni – when digestive fire is intense, but the food quantity is low, it causes emaciation of tissue elements. [50]

Samagni

Samagni – Normal state of Agni
If Agni is in normal state and if the individual takes appropriate quantity of food, then there will be proper digestion of food, which leads to the maintenance of the equilibrium of all tissue elements. [1/2 51]

Mandagni, Grahani gada

Signs of Mandagni and Grahani Gada
Mandagni (weak digestion strength) brings about vidaha (semi-digested food) which moves upwards and downwards in gastro- intestinal tract. When the digested and undigested food (Apaka) move downward, this condition is called Grahani. Here, the food remains in the state of vidagdha (partly undigested).

This leads to below symptoms:
Constipation or diarrhoea.
Trushna – excess thirst
Arochaka – anorexia
Vairasya – distaste in mouth,
Praseka – excessive salivation and
Tamaka shwasa -asthma
Parvaruk – pain in small joints,
Chardi – vomiting,
Jwara – fever and
Udgara – belching, eructation having metabolic smell, smell of ama (undigested food) and bitter and sour tastes. [51 ½- 54]

Grahani Poorvaroopa

Premonitory signs and symptoms
Trushna – excess thirst
Alasya – laziness
Bala kshaya – diminution of strength
Vidaha – burning sensation
Chirat anna paka – delay in the digestion of food and
Kaya Gauravam – heaviness of the body [55]

Definition of Grahani:
Grahani (duodenum, first part of intestine), which is the site of Agni (digestive enzymes), is called so, because of its power to restrain (Grahanat) the downward movement of food. It is located above the umbilical region, and is supported and nourished by the strength of Agni.
Normally, it restrains the downward movement of undigested food and after the digestion it releases the food through its Lumen. In the abnormal condition, when it gets vitiated because of weakness of Agni (power of digestion), it releases the food in undigested form only. [56-57]

Grahani Roga Bheda

Grahaniroga is of 4 types, viz,
Vatika – caused by the aggravation of vata
Paittika – caused by the aggravation of pitta
Kaphaja – caused by the aggravation of kapha and
Sannipatika – caused by the simultaneous aggravation of all the 3 Doshas
Their etiology, signs and symptoms (linga and rupa) are explained below. [58]

Vataja Grahani

Vataja Grahani Nidana, Samprapti, lakshana:
Etiology, signs and symptoms of vatika grahani
Causes:
Intake of-
Katu – pungent,
Tikta – bitter,
Kashaya – astringent,
Rooksha Sheetala bhojana – dry, cold foods
Pramitashana – intake of less of food, fasting,
Atyadhva – walking long distance,
Vega nigraha – suppression of natural urges and
Ati maithuna – excessive sexual intercourse.

Because of the above mentioned factors, Vata Dosha gets aggravated and covers (Sanchadya) the suppressed Agni (power of digestion). As a result of this, the food taken by the patient does not get easily digested.

Symptoms:
This leads to acidity and roughness in the body,
Kanta Asya Shosha – dryness of throat and mouth,
Kshut, Trushna – excessive hunger & thirst,
Timira – appearance of darkness in the eyes,
Karnayo Swana – abnormal sound in the ears, tinnitus
Parshwa ruk – frequent pain in the sides of the chest, thighs, pelvic region, pain in the cardiac region and neck.
Visuchika – severe diarrhoea,
pain in the cardiac region, emaciation, weakness, distaste in the mouth, sawing pain in the abdomen, craving for (ingredients of food having) all tastes, mental frustration, flatulence after and burning the process of digestion, and temporary feeling of relief immediately after the intake of food.

The patient suspects as if he is suffering from Vataja diseases and splenic disorder. He passes stools with difficulty. Stool is liquid mixed, hard stool, thin and associated with ama (mucous), produces gurgling sounds and forth. He voids stool frequently and gets afflicted with cough and dyspnoea. All these signs and symptoms are manifested because of the aggravated Vata Dosha. [59-64]

Pittaja grahani

Pittaja Grahani Nidana, Lakshana:
Causes, signs and symptoms of paittika grahani
Pitta gets aggravated by the intake of food ingredients which are
Katu – pungent,
Ajirna – Indigestion
vidahi – which cause burning sensation
Amla – sour
Kshara – alkaline etc.
The aggravated pitta suppresses and extinguishes agni (digestive enzymes), as hot water causes extinction of physical fire. The patient voids loose stool containing undigested material, which is bluish-yellow or yellow in colour.
He also suffers from eructation foul smell and sour taste.
Hrut Kanta Daha – Burning sensation in the cardiac region and throat,
Aruchi – anorexia as well as
Trushna – excess thirst [65-66]

Kaphaja grahani

Kaphaja Grahani – Nidana, Lakshana
Causes, signs and symptoms of Kaphaj Grahani:
Kapha gets aggravated by the intake of food, which is
Guru – heavy,
Snigdha – excessively unctuous,
Sheeta – cold etc.
By the intake of food in excess quantity and by sleeping immediately after food, in such circumstances,food does not get easily digested and the patient suffers from
Hrullasa – nausea,
Chardi – vomiting
Aruchi – anorexia
Stickiness and
Madhura aasya – sweet taste in the mouth,
Kasa – cough
Sthivana – spitting (excessive salivation) and
Pinasa – chronic rhinitis
A feeling of sluggishness in the cardiac region,
Stimita – Numbness and
Udara gurutvam – heaviness in the abdomen
Eructation with foul smell and sweet taste
Low libido.
He voids stool which is split into pieces, mixed with mucous and phlegm, and heavy. Even if not emaciated, the patient feels weak and indolent. [67-70]

In roganika chapter (Vimana sthana 6:12), 4 types of Agni, viz,
Tiksnagni – sharp
Mandagni – mild
Vishamagni —irregular and
Samagni – regular digestive fire are explained.

The first 3 types of disorders of agni also constitute Grahani dosha. [71]

Sannipatika grahani

Signs and symptoms of sannipatika grahan:
The sannipatika (where all the 3 doshas are simultaneously vitiated) type of grahani gada is to be determined on the basis of simultaneous manifestation of all signs and symptoms pertaining to the 3 doshas (vide verse nos. 59-70). The treatment of these varieties of agni- dosha is expounded hereafter. [72]

Ama grahani

Description of Ama-grahani: 
Ama-grahani – when Grahani disease is associated with Ama (product of altered digestion and metabolism)
When Dosha is located in Grahani is afflicted by food, which is not fully digested (vidagdha – partly digested), then the signs of ama (product of improper digestion and metabolism) are manifested –
Vistambha – constipation
Praseka – salivation
Shoola – Pain
Vidaha – burning sensation
Aruchi – anorexia and
Gauravam – heaviness are manifested.

Such a patient is administered emetic therapy with the help of lukewarm water.
Alternatively, the decoction of Madanaphala – Randia dumetorum mixed with Pippali – long pepper- piper longum and Sarshapa is used for Vamana – emetic therapy. (read more about Vamana therapy)

If the Ama (undigested food mix) moves downwards and remains adhered to the colon, then the patient is given Virechana purgation therapy with such herbs that stimulate digestion strength.

If the dosha in its ama (undigested) stage is converted into Rasa (chyle) and pervades other parts of the body, then the patient is made to fast, and should be given medicines conducive to Pachana (digestion) of the undigested material, e.g yavagu (thick gruel).

After the amashaya is cleared, by the administration of appropriate Vamana (purgation) and Langhana (fasting) therapies, the patient is given
– Peya (thin gruel) prepared of the decoction of Panchakola (pippali—Piper longum, pippalimula – long pepper root, Chavya – Piper retrofractum, chitraka – Plumbago zeylanica and nagara – Zingiber officinale), etc.
He may also be given light food and such other ingredients as are stimulants of digestion. [73-76]

Vataja grahani treatment

Treatment for Vataja Grahani:
Having ascertained that Vata and Grahani roga has become free from Ama, the physician should administer medicated ghee prepared with Deepaneeya (improving digestion strength)drugs in small quantities.
After the agni (power of digestion) is slightly stimulated, the patient becomes capable of retaining the stool, urine and flatus. To such a patient, Snehaha (oleation) therapy is administered for 2 or 3 days, followed by fomentation and massage therapies. Thereafter, niruha type of medicated enema is administrated.
After the Dosha has become loosened (free from adhesion, Srastha Dosha), and the Vata is eliminated or alleviated as a result of the administration of niruha enema, the patient is given purgation therapy with the help of castor-oil or Tilvaka- Ghrita mixed with Kshara.

Even after the colon is cleansed, stool has become well formed, the dryness of the colon might persist. For correcting this dryness, the patient is given anuvasana basti (oil / fat enema) with the help of appropriate quantity of oil cooked with drugs which stimulates digestion, which are sour in taste and which balance Vata Dosha.
After the appropriate administration of Niruha, Virechana and Anuvasana therapies the patient is given light food, and a course of medicated ghee is administered. [77-81]

Dashamuladya Ghrita

2 varieties of Panchamula, Sarala, Devadaru – Cedrus deodara, Nagara – Zingiber officinale, pippali – long pepper- piper longum mula, gaja-pippali, seeds of sana, Yava, kola, kulattha and Suravi is boiled in Aranala, Dadhi manda or sauvira and reduced to 1/4th .
To this, 1 adhaka (2 adhakas according to general rule for manufacture) of ghee is mixed and reduced to 1/4th .To this, 1 adhaka (2 adhakas according to general rule for manufacture) palas of each of the powders of Svarjiksara, Yavaksara, Saindhava, Audbhida, Samudra, Vida, Romaka, Sauvarchala and pakya (pakaja) types of salt inappropriate time. After the recipe is cooked, it is administered to the patient in the dose of 1 prastha.
It promotes Agni – power of digestion, Bala – strength and Varnam – complexion.
It alleviates vayu, and helps in the digestion of the undigested food. Thus, ends the description of Dashamuladya- ghrta. [82-86]

Tryusanadi- ghritam

8 palas (384 g) of ghee is cooked by adding 1 pala (48 g) of the paste of Trikatu (ginger, pepper and long pepper) and Triphala (Haritaki, Vibhitaki and Amalki) taken together and 1 pala (48 g) of guda – Jaggery. This medicated ghee is taken by a person suffering from mandagni (suppressed power of digestion). [87]

Panchamuladya Ghrita, Taila, Churna

Ghee is cooked by adding the paste of Panchamula (bilva – Aegle marmelos, Shyonaka Oroxylum indicum, Gambhari – Gmelina arborea, Patali – stereospermum suaveolens and ganikarika), Haritaki – Terminalia chebula, Trikatu (Sunthi – Zingiber officinale, pippali- Piper longum and Maricha – Piper nigru) pippali mula – long pepper- piper longum, Saindhava, Rasna – Alpinia galangal, Svarji- ksara, Yavaksara, Ajaji – Nigella sativa, Vidanga – Embelia ribes and Sati—Hedychium spicatum and liquids, viz sukta, Matulunga(juice), Ardraka – wet ginger (rhizome) – zingiber officinalis( juice) suska- mulaka (decoction), kolambu, Chukrika, dadima – Punica granatum(juice),takra, mastu, Suramanda, Sauviraka, Tusodaka and kanjika.
It is an excellent promoter of the power of digestion.
It cures
Shoola – colic pain
Gulma – abdominal tumour distension (phantom tumour)
Udara – ascites (obstinate abdominal diseases including ascites),
Shvasa – asthma and
Kasa – cough
It also alleviates Vata and Kapha.

Alternatively, this medicated ghee can be prepared by adding the juice of Bijapuraka – Citrus medica to the above given to the patient.
Oil cooked with the above mentioned ingredients is useful for massage.
The powder of panchamula (Bilva – Aegle marmelos, Shyonaka – Oroxylum indicum, Gambhari – gmelina arborea , Patala – stereospermum suaveolens and ganikarika), haritaki – Terminalia chebula,Trikatu (Ginger, pepper and long pepper), Pippali mula – long pepper root, Saindhava, Rasna – Alpinia galanga, Svarji ksara, Yava ksara, Ajaji – Nigella sativa, Vidanga – Embelia ribes and Shati – Hedychium spicatum (which are mentioned to be added as paste in the above recipe) can be given to the patient along with luke- warm water.
This powder is useful for alleviating vayu occluded by kapha in its association with ama (product of improper digestion); or kapha stimulated by vayu. This powder recipe is carminative and it is an excellent stimulator of the power of digestion.
Thus, ends the description of Panchamula- ghrta and Panchamuladya churna. [88-93]

Determination of Sama Nirama grahani

Determination of Sama and nirama types of grahani roga:
The stool associated with ama sinks in water due to its heaviness. If the stool is voided after proper digestion (pakva, i.e if it is not associated with ama), then it floats over the water.

This rule does not hold good or apply in cases where the consistency of the stool is thin or exceedingly compact, and if the stool is afflicted with excessive cold or Kapha. Therefore, the Nirama (Ama – less) or Sama nature of the stule should be tested well before administering suitable therapies.

Chitrakadi gutika

Chitraka – Plumbago zeylanica, Pippali mula – long pepper- piper longum, Yavaksara, Svarjiksara (5 types of) salt, Sunthi – Zingiber officinale, pippali – long pepper- piper longum,maricha – Piper nigrum, Hingu – Asaefetida, Ajamoda – ajowan seed – trachyspermum ammi and chavya – Piper retrofractum—all these drugs taken together, is made to a powder. This is then triturated by adding juice of Matulunga – Citrus medica or dadima – Punica granatum and made to pills. Intake of these pills is efficacious for the metabolic transformation (cooking) of ama (product of improper digestion and metabolism). It also stimulates agni (power of digestion and metabolism).
Thus, ends the description of Chitrakadhya –gutika [96-97]

Read more about side effects, indication etc of Chitrakadi Vati

Nagaradi Kashaya, Churna

Intake of the decoction of Nagara – Zingiber officinale, Ativisha – Aconitum hetrophyllum and Musta – cyperus rotundus (root) helps in the metabolic transformation (cooking) of ama (product of improper digestion and metabolism).
Similarly, the paste / powder of the above herbs, taken along with hot water for pachana (cooking or metabolic transformation) of ama.
Intake of the powder of Haritaki – Terminalia chebula or Nagara – ginger along with hot water also helps in the Pachana of Ama. [98]

Devadarvadi Churna with varuni:                                                            Devadaru – Cedrus deodara,
Vacha –Acorus calamus,
Musta – cyperus rotundus (root),
Nagara – ginger – Zingiber officinale,
Ativisha – Aconitum heterophyllum and
Abhaya – harad – terminalia chebula is soaked in Varuni (an alcoholic preparation) and taken by the patient by adding a small quantity of salt along with hot water. This recipe is used if there is ama (mucus) in the stool and if the patient is having colic pain.
Alternatively, the above powder is administered along with pomegranate juice. [ 99 ½ – 100]

Vida lavanadi churna

If the pain in the kostha (abdomen, pelvis) is caused by Vata and is associated with ama (mucus) or kapha, then the patient should take the paste of bilva – bael – aegle marmelos, Chitraka – Plumbago zeylanica and Nagara – ginger which is made saline by adding Vidalavana (Bida salt).

Kalingadi Churna

If there is vomiting, piles and colic pain, then the patient should take the powder of kalinga, Hingu – Asafoetida, ativisha – Aconitum heterophyllum, Vacha – Acorus calamus, Sauvarchala- Black salt and Abhaya – harad – along with hot water.
Alternatively, the patient having vomiting etc., (mentioned above) should take the powder of Pathya, Sauvarcala and Ajaji – Nigella sativa mixed with Maricha – Black pepper. [101 ½- 102]

Abhayadi kashaya, Churna

The patient should take the decoction or the powder of
Abhaya – harad – terminalia chebula,
Pippalimula – Long pepper root,
Vacha – Acorus calamus,
Katuka rohini – Picrorhiza kurroa,
Patha – Cyclea peltata,
seeds of Vatsaka – Kutaja beeja,
Chitraka – Plumbago zeylanica and
Vishvabheshaja – ginger along with luke warm water, which is useful for curing colic pain in Grahani roga caused by the affliction of Pitta and kapha. [103- 104]

If grahani is associated with ama (mucus), then the patient is given the decoction or powder of abhaya – harad – terminalia chebula, pippalimoola – long pepper root– long pepper- piper longum, Vacha, Katuka-rohini – Picrorhiza kurroa, patha – Cyclea peltata, seeds of vatsaka, chitraka – Plumbago zeylanica and visvabhesaja) along with ativisha – Aconitum heterophyllum,shunthi – Zingiber officinale, pippali – long pepper- piper longum, maricha – Piper nigrum, lavana ksara and hingu with luke-warm water. [105]

Pippalyadya churna

The powder of
Pippali – piper longum
Nagara – Zingiber officinale
Patha – Cyclea peltata
Sariva – hemidesmus indicus
Brhati – Solanum indicum
Kantakari – solanum surattense
Chitraka – Plumbago zeylanica
Seed of kutaja – Hollarhena dysentrica
Saindhava – rock salt
Samudra lavana
Vida lavana
Audbhida
Sauvarcala is given along with
Yavaksara
Yogurt, hot water and different types of alcoholic drinks for the promotion of agni (power of digestion) and elimination of vayu (flatus) from the kostha (gastro- intestinal tract). [106-107]

Marichadya churna

Marichadya- curna for Vataja Grahani
1 kudava of each of
Maricha – Piper nigrum
Kunchika
Ambastha – Cyclea peltata
Vruksamla – Garcinia indicia
10 palas of
Amla vetasa – Garcinia pedunculata
½ palas of each of sauvarcala
Vida salt
Pakya (pamsuja-lavana)
Yavaksara saindhava
Sati – Hedychium spicatum
Puskaramula – Inula racemosa
Hingu – Asafoetida
Hingu-sivatika (vamsapatri) is taken together and make to a fine powder.
Administration of this recipe is useful in grahani, caused by the affliction of vayu and in anorexia.
Thus, ends the description of marichadya – churna. [108- 110

1 prastha (768 g) of 4 sour herbs
1 pala of
Sunthi – Zingiber officinale
Pippali – long pepper- piper longum
Maricha – Piper nigrum taken together 4 palas of salts
Saindhava
Sauvarcala
Bida
Audbhida
Samudra types of salt taken together and 8 palas of sugar is made to a powder.
This powder is added to vegetable preparations, powder. This powder is added to vegetable preparations, dals, rice, raga (pickles and preparations used as appreciations), which cures
Kasa – cough
Ajirna – indigestion
Aruchi – anorexia
Shvasa – asthma
Hrud roga – heart diseases
Pandu – anaemia and
Shula – colic pain [111-1/2 112]

Yavagu

1 kola (6 g) of each of chavya – Piper retrofractum
Tvak – Cinnamomum zeylanica
Pippali mula – Piper longum
Dhataki – Woodfordia floribunda
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha – Piper nigrum
Chitraka – Plumbago zeylanica
Kapittha – limonia acidissima
Bilva – bael – aegle marmelos
Ambastha – Cyclea peltata
Gum of shalmali – Salmalia malabarica
Gaja pippali
Silodbheda (sailaja)
Ajaji – Nigella sativa is made to a paste.
This paste added with curd is fried by adding ghee. With the help of this paste gruel is prepared by adding the juice of
Kapittha – limonia accidisima
Cukrika (changeri) – Oxalis corniculata
Vrksamla – Garcinia ambogia
Dadima – Punica granatum
Intake of this medicated gruel cures all types of
Atisara – diarrhoea,
Grahani,
Gulma – phantom tumour
Arshas – piles and
Pliha – splenic disorders. [112 ½- ½ 115]

Diet and drinks

Diet and drinks for Vataja Grahani
Soup of Panchakola
Pippali – long pepper- piper longum
Pippali mula – long pepper- piper longum
Chavya – Piper retrofractum
Chitraka – Plumbago zeylannica
Nagara – Zingiber officinale
Or the soup of mulaka prepared by adding marica and ghee or oil, or the soup of the meat of birds and animals inhabiting arid land prepared by sizzling (with ghee etc) or the soup of the meat of kravyada (meat eating) types of birds and animals prepared by adding drugs, which stimulate the power of digestion is made sour by adding dadima – punica granatum and butter- milk and administered as food to the patient suffering from grahani. He is given butter- milk, aranala (a sour drink), alcoholic drinks and aristha (a type of alcoholic drink) as drinks.

Buttermilk

Butter milk for Vataja Grahani
For a patient suffering from grahani, butter milk is an excellent drink because it stimulates the power of digestion, it is grahi – absorbent, bowel binding, useful in IBS, diarrhoea (constipative) and light for digestion.

It is sweet in vipaka (the taste that emerges after digestion) and therefore, it does not cause aggravation of pitta. Because of its astringent taste, hot potency, vikasitva (which relives the stiffness and causes looseness of joints and ununctuousness, it is useful for counteracting the aggravated kapha.

Because of the sweet and sour tastes and density, it is useful for counter-acting aggravated vayu.

When freshly prepared, it does not cause burning sensation. Therefore, all the recipes of buttermilk described for the treatment of Udara (ascites) and piles is used for the treatment of Grahani. [117 ½- ½ 120]

Takrarishta

Takrarista for Vtaja Grahani
3 palas each of Yavani – Carum copticum
Amalaki (indian gooseberry fruit – emblica officinalis gaertn)
Pathya
Maricha – Piper nigrum as well as one pala each of saindhava, sauvarcala
Audbhida
Bida
Samudra types of salt are made to a powder.
To this, butter- milk is added and kept till it is fermented and becomes sour. This recipe is called “takrarista”.
Intake of this recipe stimulates the power of digestion and cures
Shotha – oedema,
Gulma – abdominal tumour, distension (phantom tumour),
Arshas – piles, parasitic infestation,
Meha – urinary tract disorders, diabetes (obstinate urinary disorders including diabetes) and
Udara – ascites (obstinate abdominal disorders including ascites).
Thus ends the description of takrarista [120 ½ – 121]

Read more about Takrarishta
This ends the treatment for Vataja Grahani.

Pittaja grahani treatment

Treatment for Pittaja type of Grahani:
Panchakarma therapy in Pittaja Grahani:

Having ascertained that the aggravated pitta is located in its natural habitat, the physician should administer Virachana treatment – Purgation or Vamana – emetic therapy for the removal of aggravated Pitta from the body. [122]

Diet

Diet for Paittika Grahani                                                                                          The patient suffering from Paittika grahani is given such diet which does not cause Vidaha (burning sensation), which is light and which is added with the powder of bitter ingredients.
He is given the soup of the meat of animals inhabiting an arid zone (Jangala mamsarasa), the soup of vegetable products like mudga (green gram) and khasa (a sour drink).
These food preparations are added with sour dadima – Punica granatum, ghee, herbs which cause stimulation of the digestion and which are constipative, absorbent (grahi).
His power of digestion is stimulated by the administration of the powder of bitter herbs. [123-124]

Chandanadya ghrita

Chandanadya ghruta for Pittaja Grahani
2 palas each of chandana – Santalum album
Padmaka – Prunus cerasoides
Ushira – Vetiveria zizanoides
Patha – Cyclea peltata
Murvakutannata (kaivarta-mustaka)
Shadgrantha (vacha) – Acorus calamus
Sariva – Hemidesmus indicus
Asphota (asphura-mallika)
Saptaparna – Alstonia scholaris
Atarusaka – Vasa – Adhatoda vasica
Patola – Trichosanthes dioica
Udumbara – Ficus racemosa
Asphura
Vata – Ficus bengalensis
Plaksa – Ficus religiosa
Kapitana (gandha-munda)
Asvattha – Ficus religiosa
Katuka rohini – Picrorhiza kurroa
Musta – nut grass (root) – cyperus rotundus
Nimba – Azadirachta indica is boiled in 2 dronas (double the prescribed quantity in view of mana-pribhasa) of water and reduced to 1/4th.
To this decoction, 2 prasthas (double the prescribed quantity in view of mana paribhasa) of ghee and the paste of 1 aksa of each of
Kirata tikta – Swertia chirata
Indrayava – Hollarrhena dysentrica
Vira
Magadhika and
Utpala – water lily is added and cooked.
This medicated ghee is taken by a patient suffering from paittika type of grahani.
Thus, ends the description of chandanadya ghrta. [125 – ½128]

Tiktaka ghrita

Tikata grtha for Pittaja Grahani
Tikata ghrita described for the treatment of kustha (skin diseases including leprosy) may also be administered to the patient suffering from grahani. [128 ½]

Nagaradya churna

Nagaradya Churna for Pittaja Grahani
Nagara – Zingiber officinale
Ativisa – Aconitum heterophyllum
Musta – nut grass (root) – cyperus rotundus
Dhataki – Woodfordia floribunda
Rasanjana
Bark and fruit of Vatsaka
Bilva – bael – aegle marmelos
Patha – Cyclea peltata
Katuka-rohini – Picrorhiza kurroa is taken in equal quantities and made to a powder.
This powder is taken along with honey and tandulambu (rice water) by the patient suffering from paittika type of grahani with the symptomatic voiding of blood along with stool, and suffering from piles and pain in anal region. It also cures pravahika (dysentery). This recipe is called nagaradya-curna. This is highly esteemed by lord krsnatreya.
Thus, ends the description of nagaradya- curna. [129-131]

Bhunimbadya churna

Bhunimbadya churna for Pittaja Grahani
1 part of each of Bhunimba – Andrographis paniculata
Katuka
Sunthi – Zingiber officinale
Pippali- long pepper fruit – piper longum
Maricha – Piper nigrum
Musta – nut grass (root) – cyperus rotundus
Indrayava
2 parts of chitraka and 16 parts of the bark of vatsaka is made to a powder.
Intake of this recipe along with cold water mixed with jaggery cures
Grahani,
Gulma – abdominal tumour, distension (phantom tumour)
Kamala – Jaundice
Jwara – Fever,
Pandu – anaemia,
Meha – obstinate urinary disorders including diabetes),
Aruch – anorexia and
Atisara – diarrhoea
Thus ends the description of bhunimbadya churna [132- 133]

Supplement to bhunimbadya- churna
Vacha – Acorus calamus
Ativisha – Aconitum heterophyllum
Patha – Cyclea peltata
Saptaparna – Alstonia scholaris
Rasanjana
Shyonaka – Oroxylum indicum
Udichya
Katvanga (a type of syonaka having smaller fruits),
Bark of vatsaka
Duralabha – Fagonia arabica
Darvi – Berberis aristata
Parpataka
Yavani – Carum copticum
Madhu
Shigru – Moringa oleifera
Leaf of patola – Trichosanthes dioica
Siddhartha
Yuthika
Leaves of Jati – Jasminum grandiflorum
Seed pulp of jambu – Syzygium cumini
Seed-pulp of amra – Mangifera indica
Pulp of (unripe) bilva – Aegle marmelos
Leaves and fruits of nimba – Azadirachta indica is used in a powder form along with the ingredients of bhunimbadya- churna (described above) [134-136]

Kiratadya Churna

Kiratadya Churna for Pittaj Grahni:

The powder of kirta-tikta – Swertia chirata
Shadgrantha – Acorus calamus
Trayamana – Gentiana kurroo
Sunthi – Zingiber officinale
Pippali – Piper longum
Maricha – Piper nigrum
Chandana – Santalum album
Padmaka – Prunus cerasoides
Ushira –Vetiveria zizanoides
Bark of daru-haridra – Berberis aristata
Katuka-rohini – Picrorhiza kurroa
Bark and fruits of kutaja – Hollarhena dysentrica
Musta – Cyperus rotundus
Yavani – Carum copticum
Devadaru – cedrus deodara
Patola – Trichosanthes dioica
Nimba – neem (azadirachta indica)
Patra – Cinnamon leaves
Ela – Cardamom
Saurastri
Ativisha – Aconitum heterophyllum
Tvak – Cinnamomum zeylanica
Seeds of madhu-sigru – Moringa oliefera
Murva – Marsedenia tenacissima
Parpataka is made to linctus by adding honey, and taken by the patient. This recipe may also be taken along with alcohol or water.
It cures
Hrud roga – heart diseases,
Pandu – anemone,
Grahani- roga,
Gulma (phantom tumour),
Shoola – colic pain,
Aruchi – anorexia,
Jwara – fever,
Kamala – jaundice,
Sannipatika type of diarrhoea and
Mukha roga – diseases of the mouth
Thus ends the description of kiratadya – curna [137-140]

This ends the treatment for Pittaja Grahani.

Kaphaja grahani treatment

Treatment for Kaphaja Grahani:
Elimination therapy for kaphaja grahani
If the Grahani is caused by aggravated kapha, then the patient is given Vamana – emetic therapy according to the prescribed procedure. Thereafter pungent, sour, saline, alkaline and bitter drugs are administered for the promotion of this power of digestion. [141]

Drinks, diet

Drinks for kaphaja grahani
1 karsa (12 g) of each of
Palasha – Butea monosperma
Chitraka – leadword – plumbago zeylanica,
Chavya – Piper retrofractum
Matulunga – lemon variety – citrus decumana / citrus limon
Haritaki – Terminalia chebula
Pippali mula – long pepper fruit – piper longum
Patha – Cyclea peltata
Nagara – Zingiber officinale and
Dhanyaka is boiled in 1 prastha (2 prasthas is taken according to mana- paribhasa) of water, and reduced to 1/4th.
This decoction is given as drink to the patient. With the help of this decoction, gruel is prepared and given to the patient (suffering from kaphaja type of grahani) [142-143]

Diet and kaphaja grahani
Ingredients of food which are light for digestion, along with the soup of dried radish or kulattha (horse gram) mixed with pungent, sour, alkaline and saline drugs. [144]

Butter milk in kaphaja grahani
After taking light food, the patient should drink sour butter-milk or takrarista, madira (a type of alcohol), madhvarista and well- fermented sidhu (a type of alcohol). [145]

Madhukasav (first recipe)

Madhukasav (first recipe) for Kaphaj Grahni:
1 drona (12.288 g) of the flowers of madhuka– licorice – glycyrrhiza glabra,
½ drona of vidanga – embelia ribes
1/4th drona of chitraka – Plumbago zeylanica
1 adhaka of bhallataka – semecarpus anacardium linn
8 palas of manjistha – rubia cordifolia is boiled with 3 dronas (in actual practice 6 dronas to be used according to mana-paribhasa) of water till 1 drona (2 dronas according to manna-paribhasa) of water remains.
The decoction is cooled. To this, ½ adhaka (1 adhaka according to mana- paribhasa) of honey is added. This is kept in a jar, the interior wall of which is smeared with the paste of
Ela (elettaria cardamomum maton)
Mrunala – lotus stalk
Aguru – Aquallaria agallocha
Chandana (sandalwood – santalum album) for 1 month till it is well fermented.
Administration of this asava (medicated alcoholic drink) stimulates the grahani (enzymes in the duodenum and small intestine), promotes nourishment, alleviates kapha and pitta, and cures oedema, kushta (obstinate skin diseases including leprosy), kilasa (a type of leucoderma) and prameha (obstinate urinary diabetes).
Thus, ends the description of madhukasava. [146-149]

Madhukasava (second recipe)

The juice of the flower of madhuka – Madhuka longifolia is boiled, reduced to ½ and cooled.
To this, 1/4th in quantity of honey is added and kept in a jar as described above. Intake of this potion cures all types of grahani-dosha, while using this recipe, the patient should take wholesome food.
In the above mentioned manner, the juice of grape, sugar-cane and date-palm is got fermented and taken by the patient [150-151]

Duralabhasava

Duralabhasava for Kaphaja Grahani
Duralabhasav
2 prasthas of duralabha –
2 prasthas of amalaki – Phyllanthus emblica
1 musti of danti – Baliospermum montanum
1 musti of chitraka – Plumbago zeylanica
200 matured fruits of haritaki – Terminalia chebula is boiled by adding 4 dronas (in actual practice 8 dronas to be taken according to mana-paribhasa) of water and reduced to 1 drona (actual practice, 2 dronas according to mana-paribhasa). The decoction, thus obtained, is cooled. To this, 200 palas of jaggery and 1 kudava of honey are added.
1 kudava each of priyangu – Callicarpa macrophylla
Pippali – long pepper fruit – piper longum
Vidanga – false black pepper – embelia ribes in powder from is added in this and kept in a ghee- smeared jar for 15 days, till it becomes well- fermented.
Intake of this potion cures
Grahani, Pandu – anaemia,
Arshas – piles,
Kustha (obstinate skin diseases including leprosy), erysipelas and
Meha (obstinate urinary disorders including diabetes)
It promotes Swara – voice and Varna – complexion and cures raktapitta- bleeding disorders like nasal bleeding, ulcerative colitis and menorrhagia (a disease characterised by bleeding from different parts of the body) and diseases caused by aggravated kapha.
Thus ends the description of duralabhasava. [152-155]

Moolasav

5 palas each of haridra – Berberis aristata
Bilva – bael – aegle marmelos
Shyonaka – Oroxylum indicum
Gambhari – Gmelina arborea
Patala – stereospermum suaveolens
Ganikarika – Clerodendrum phlomidis
Shalaparni – Desmodium gangeticum
Prsniparni – Uraria picta
Brhati – Solanum indicum
Kantakari – Solanum surratense
Gokshura – Tribulus terrestris
Vira (shatavari) – Asparagus racemosus
Rishabhaka
Jivaka is boiled by adding 4 dronas (in actual practice 8 dronas according to mana-paribhasa) of water till 1 drona (2 dronas according to mana- paribhasa) remains. To this, 200 palas of jaggery and palas (4 palas according to mana- paribhasa) of honey and 2 palas each of priyangu – Callicarpa macrophylla
Musta – Cyperus rotundus
Manjistha – Rubia cordifolia
Vidanga – Embelia ribes
Madhuka – Madhuca longifolia
Plava –
Lodhra – Symplocos racemosa in powder form is added.
This potion is then kept in an earthen jar for 15 days till well fermented. This is called mulasava.
This is effective recipe to power the strength of digestion and cures
Raktapitta (a diseases characterised by bleeding) and
Anaha (abdominal tymphanitis),
Diseases caused by aggravated kapha,
Hrid roga – heart diseases
Pandu – anaemia and
Angasada – prostration of limbs
Thus, ends the description of mulasava [156- 159]

Pindasava

Pindasava for Kaphaj Grahani:
1 prastha each of
Pippali – long pepper fruit – piper longum,
Jaggery and
Seeds of bibhitaka – Terminalia bellerica is made to a paste and added with 1 prastha (2 prasthas according to mana-pribhasa) of water.
This is broken it in a jar and covered with the grains of barely till it is well-fermented. This is called pindasava.
1 pala of this medicated alcoholic drink is mixed with 1 anjali of water and taken.
This recipe cures all the diseases (described earlier). Even a healthy person is advised to take this potion for 1 month in order to prevent the occurrence of these diseases. While taking this medicine, he should take soups added with ghee or oil.
Thus ends the description of pindasava. [160-162]

Madhvarista

Madhvarista for Kaphaja Grahni
The interior wall of a new earthen jar is smeared with the paste of pippali – Piper longum and honey, and then the inside of the jar is fumigated with the smoke of aguru – Aquallaria agallocha in this jar, 1 adhaka (2 adhakas according to mana- paribhasa) each of honey and water is kept.
To this liquid, the powders of
½ kudava of vidanga – Embelia ribes,
1 kuduva of pippali – long pepper fruit – piper longum
1/4th kuduva of vamsa-lochana
1 karsa each of
Keshara
Maricha – black pepper fruit – piper nigrum,
Tvak – Cinnamomum zeylanica
Ela – Elettaria cardamomum
Patraka,
Sati – Hedychium spicatum
Karmuka,
Ativisha – Aconitum heterophyllum
Ghana,
Harenu
Elvau,
Tejohva – Zanthoxylum alatum
Pippali mula – long pepper fruit – piper longum- and
Chitraka – leadword – plumbago zeylanica is added and kept for 1 month.
Thereafter, it is administered to the patient.
It stimulates the power of digestion, and makes the irregular agni (powder of digestion) regular.
This recipe called madhvarista cures
Hrid roga – heart diseases
Pandu – anaemia
Grahani-sprue
Kushta – obstinate skin diseases including leprosy,
Arshas – piles,
Shotha – oedema,
Jwara – fever and other diseases caused by aggravated vayu and kapha.
Thus, ends the description of madhvarista [163-167]

Pippalyadya churna

Pippali – long pepper fruit – piper longum
Pippali mula – long pepper fruit – piper longum-
Yavaksara
Svarjiksara
Saindhava
Samudra
Bida
Audbhida
Sauvarcala
Matulunga – Citrus medica
Abhaya – Terminalia chebula
Rasna – Alpinia galangal
Sati – Hedychium spicatum
Marica – Piper nigrum
Nagara – Zingiber officinale taken in equal quantities is made to powder.
This recipe is taken early in the morning with luke-warm water.
It cures Kaphaja type of grahani and promotes strength, complexion and the power of digestion. [168-169]

Recipes
If grahani is caused by kapha along with aggravated vayu, then the patient is given medicated ghee prepared by boiling with the above mentioned herbs..
He may also be given satpala ghrta (vide- chikitsa 5: 147- 148) and bhallataka ghrta (vide chikitsa 5: 143-146) described in the chapter dealing with the treatment of gulma – abdominal tumour, distension (phantom tumour) [170]

Kshara ghrita

Kshara ghrita for Kaphaja grahani
Bida lavana
Kalottha-lavana – Sauvarchala
Svarji- ksara
Yava-ksara
Saptala –
Kantakari – yellow berried nightshade (whole plant) – solanum xanthcarpum
Chitraka – Plumbago zeylanica is burnt mixed with water and filtered for 7 times.
From out of this, kshara (alkaline part of these plants) is collected.
2 adhakas of this kshara is cooked with 1 adhaka (2 adhakas according to mana paribhasa) of ghee.
Intake of this medicated ghee promotes agni (power of digestion). Thus, ends the description of kshara-ghrta. [171- 172]

Pippalimooladi Yoga

1 karsha each of pippali – long pepper fruit – piper longum
Pippali mula – long pepper fruit – piper longum
Patha – Cyclea peltata
Chavya – Piper retrofractum
Indra-yava
Nagara – Zingiber officinale
Chitraka – Plumbago zeylanica
Ativisha – Aconitum heterophyllum
Hingu – Asafoetida
Svadamstra – Tribulus terrestris
Katuka-rohini – Picrorhiza kurroa
Vacha – Acorus calamus is made into pieces, and 1 pala each of
Saindhava
Sauvarcala
Bida
Audbhida
Samudra types of salt are added with
2 prasthas (4 prasthas according to mana-paribhasa) of curd,
1 kudava (2 kudavas according to mana-paribhasa) of each of oil and ghee
It is then boiled over mild fire till the water portion of the recipe gets evaporated.
The recipe is kept inside a jar and cooked according to antardhuma method.
After cooking, the recipe is then culled from the jar and made to a powder. This is then mixed with appropriate quantity of ghee and ghee and taken in the dose of 1 panitala.
After the recipe is digested, the patient should take sweet food.
It cures all the diseases caused by vayu and kapha. It also cures poisoning caused by visha (natural poison) and gara (artificially prepared poison). [173-176]

Bhallatakadya kshara

2 palas each of bhallataka – semecarpus anacardium
Sunthi – Zingiber officinale
Pippali – long pepper fruit – piper longum
Maricha – Piper nigrum
Haritaki – Terminalia chebula
Bibhitaka – Terminalia bellerica
Amalaki – Pjyllanthus emblica
Saindhava
Sauvarcala
Bida should be cooked by antaradhuma method with the help of the fire of cow-dug cakes.
Intake of this alkaline preparation along with ghee or by sprinkling over food-ingredients cures
Hrud roga – heart diseases,
Pandu – anaemia,
Grahani dosha
Gulma – phantom tumour
Udavarta – bloating (upward movement of wind in the abdomen) and colic pain [177-178]

Duralabhadya kshara

Duralabha – Fagonia arabica
Karanja – Pongamia pinnata
Lata-karanja
Saptaparna – Alstonia scholaris
Vatsaka
Sadgrantha
Madana – Randia dumetorum
Murva – Marsedenia tenacissima
Patha – Cyclea peltata
Aragvadha – Cassia fistula is made to a powder and triturated by adding equal quantity of cow’s urine.
This is cooked.
Intake of this alkaline preparation promotes the strength of grahani (small intestine including duodenumn). [179- 180]

Bhunimbadya kshara

Bhunimba – Andrographis paniculata
Rohini – Kutki
Tikta – Kiratatikta
Patola – Trichosanthes dioica
Nimba – Azadirachta indica
Parapata is [made to a powder] and triturated with buffalo-urine
Thereafter, the recipe is cooked (by antardhuma method). Intake of this alkali preparation promotes agni (power of digestion). [181]

Haridradya kshara

Haridra – Berberis aristata
Daruharidra
Vacha – Acorus calamus
Kustha – Sausserea lappa
Chitraka – Plumbago zeylanica
Katuka-rohini – Piccrorhiza kurroa
Musta – nut grass (root) – cyperus rotundus is [made to a powder] and triturated by adding goat’s urine
Thereafter, the recipe is cooked by antardhuma method. Intake of this alkali preparation promotes agni (power of digestion). [182]

Kshara gutika

4 palas of the stems of sudha
1 pala of each
Saindhava
Sauvarcala
Bida
2 palas of chitraka – Plumbago zeylanica is cooked by antardhuma method.
This alkali preparation is then triturated with the juice of vartaki and made to pills.
Intake of his pill after meals helps in quick digestion of food and it is beneficial for patients suffering from Kasa – coughing, Svasa – asthma and Arshas – piles.
It also cures
Visuchika – choleric diarrhoea
Pratisyaya – chronic cold and
Hrud roga – heart diseases
This is called ksara-gutika and it is propounded by Lord Krshnatreya.
Thus, ends the description of ksara- gutika. [183-185]

Fourth recipe of kshara
Vatsaka – Kutaja – Holarrhena antidysenterica
Ativisa – Aconitum heterophyllum
Patha – Cyclea peltata
Duhsparsha
Hingu and
Chitraka – Plumbago zeylanica is made to a powder
This is mixed with the alkaline liquid of palasha-ksara – Butea monosperma prepared by adding cow’s urine and straining and cooked in an iron-pan till it becomes semi- solid.
1 kola of this paste is taken along with luke-warm water or alcohol by a person suffering from grahani -dosha, Shotha – oedema, Arshas – piles and Pandu – anaemia.
Thus, ends the description of the fourth recipes of ksara [186- 187]

Fifth recipe of kshara
One karsha (12 g) of each of
Haritaki – Terminalia chebula
Bibhitaka – Terminalia bellerica
Amalaka – Phyllanthus emblica
Katabhi
Chavya – Piper retrofractum
Pulp of bilva – bael – aegle marmelos
Powder (bhasma) of iron
Katuka rohini – Picrrorhiza kurroa
Musta – nut grass (root) – cyperus rotundus
Kustha – Sausserea lappa
Patha – Cyclea peltata
Hingu
Madhuka alkali preparations of
Mushkaka
Yava – Barley
Sunthi – Zingiber officinale
Pippali – long pepper fruit – piper longum
Maricha – Piper nigrum
Vacha – Acorus calamus
Vidanga – false black pepper – embelia ribes
Svarjika kshara
Nimba – Azadirachta indica
Chitraka – Plumbago zeylanica
Murva – Marsedenia tenacissima
Ajamoda – ajowan seed – trachyspermum ammi
Indrayava
Guduchi – Tinospora cordifolia
Devadaru – Cedrus deodara
1 pala of each of the 5 kudavas of curd (yogurt)
It is mixed with 3 small quantities of ghee and oil.
This is then cooked by air-tight (antardhuma) method over slow fire.
Intake of 1 panitala of this recipe along with ghee is useful for a patient suffering from
Kaphaja and vatika types of Arshas – piles
Grahani and pandu – anaemia, initial stages of liver disorders (anaemia).
It cures
Pleeha (splenic disorders)
Mutra graha – anuria
Shvasa – asthma
Hikka – hiccup
Kasa – cough
Krimi – parasitic infection
Jwara – fever
Sosha – consumption,
Atisara – diarrhoea,
Shotha – oedema,
Prameha – obstinate urinary disorders including diabetes
Anaha – constipation
Hrd-graha – cardiac spasm and all types of toxicosis
This alkaline preparation is an excellent stimulant of digestive fire.
After this potion is digested, the patient should take food along with meat-soup, sweet ingredients or milk.
Thus, ends the description of the fifth variety of alkali preparation (kshara)
This ends the treatment for Kaphaja Grahani.

Tridoshaja grahani treatment

Treatment of Tridoshaja grahani
Tridoshaja Grahani chikitsa:
Grahani caused by the simultaneous vitiation of all the 3 Doshas is treated by the physician with the appropriate administration of Panchakarma.
The patient is given medicated ghee, alkalies, asavas (medicated wine) and aristas (medicated wine of another type) which stimulate the power of digestion (gastric fire).
For the patient suffering from different types of grahani various therapeutic for the alleviation of vayu, etc are described.
These are administered by the physician either separately or jointly after ascertaining the nature of the doshas involved in the causation of this ailment. [194 ½- ½ 196]

Summary of therapies
The patient suffering from grahani should, in brief use the following categories of therapies:
1. Snehana or oleation therapy
2. Swedana of fomentation therapy
3. Suddhi or elimination (purificatatory) therapies
4. Langhana or fasting therapy
5. Dipana or the therapy for the stimulation of the power of digestion
6. Churna or recipes in the form of powder
7. Lavana or recipes containing salt
8. Kshara or recipes containing alkalies
9. Madhvarista, i.e an alcoholic preparation containing honey
10. Sura or alcohol
11. Asava or a type of alcoholic preparation or wine
12. Tarka-yoga or various recipes containing butter-milk and
13. Deepana- sarpis or recipes of medicated ghee which stimulate the power of digestion. [196 ½- ½ 198]

Treatment of associated conditions

The associated disorders of the patient suffering from grahani are the treatment as follows:
In kaphaja type of grahani steevana (spitting therapy), medicines that are dry, digestion stimulants containing bitter herbs are administered.
If kapha is excessively aggravated and the patient is weak, then alternatively dry (rookshana treatment) and unctuous therapies (snehana) is administered.

If the body is pervaded with ama (product of improper digestion and metabolism) then after proper examination, the patient is given digestive stimulants along with sneha (ghee / oil).
If pitta is aggravated in excess, then digestive stimulants which are bitter in taste is administered along with sweet ingredients. If vayu is aggravated in excess, then the administered along with sweet ingredients.

If Vata is aggravated in excess, then the administration of digestive stimulants mixed with sneha (ghee) and saline as well as sour ingredients is useful.
The above recipes will work as fuel, and when appropriately administered, they will stimulate the gastric fire (power of digestion). [198 ½- ½ 201]

Use of fats

Sneha – fat / ghee is excellent for stimulating the Jataragni – digestive fire. If Jataragni is stimulated (kindled) by the fuel in the form of fat (ghee), then it cannot be suppressed even by heavy-to-digest food.
If the patient has weak digestive power and he voids undigested stool in excess, he is given ghee cooked with Deepaniya drugs (ingredients that stimulate the power of digestion) in proper dose.

The Samana Vata is located in the abdomen regulating the functions of digestive fire in stomach). Since this samana-vayu has its functions near the gastric fire. It instantaneously promotes the strength of digestion.
If the patient finds it difficult to void stool because of the latter’s hardness, then he should take his food, the middle portion (avagraha) of which is mixed with ghee and salt.
If the digestive fire is suppressed because of the excessive intake of unctuous ingredients, then the patient should drink medicated ghee or medicated oil prepared by cooking with deepaniya drugs (which stimulate the power of digestion) [201 ½ – 205]

Treatment of suppressed Agni

If the gastric fire becomes suppressed because of excessive intake of ghee (Fat), then recipes in the form of powder, asava (medicated wine) and Arishta (medicated wine) are useful. If the anus gets adhered with stool because of loose motions [and there is suppression of the gastric fire], then the patient should be given oil, sura (alcohol) and asava (medicated wine, prepared without boiling).

If the digestion strength is suppressed because of urdhva-vata (bloating, upward movement of the vayu), the patient is given niruha and anuvasana types of medicated enema.

If the Agni gets suppressed because of aggravated Doshas, then the patient is given appropriate Panchakarma and thereafter, he should take appropriate medicines for the alleviation of the aggravated Dosha.

If Agni get suppressed because of Grahani, then the patient is given medicated ghee which stimulates the power of digestion.
If Agni is suppressed because of fasting (upavasa), then the patient should take ghee along with yavagu (a type of gruel). The patients added to the middle portion of the gruel while taking. The recipe promotes strength, stimulates the power of digestion and enhances nourishment.

If the suppression of Agni has become chronic as a result of which the patient has become indolent, weak and emaciated, then he should be given the meat soup of Prasaha type of animals (that eat food by snatching), who are carnivorous and whose meat is light for digestion. Such meat-soups instantaneously stimulates the gastric fire because of their sharp, hot and Shodhana (which purifies the body by elimination of Doshas) properties. The meat of these carnivorous animals is nourished by the meat of other animals; hence it causes nourishment of the body more quickly. [206- ½ 211]

Food and digestion fire

The Agni is not stimulated by fasting or by over-eating, just as the physical fire is not kindled without fuel or with too much of fuel.
Intake of ghee / fat along with food according to the prescribed procedure, and with appropriate administration of the different recipes of powders, Arishtas, Asava (medicated wines), the strength of digestion is improved. As the physical fire for which hard-wood is used as fuel remains stable for a long time, similarly intake of ghee with food according to the prescribed procedure brings about stability in digestion.

Intake of wholesome food in appropriate quantity after the digestion of the previous meal helps a person to enjoy good health for a long time. A person should strive to promote the gastric fire without provoking the discordance of Dhatus (tissue elements including doshas).

Digestion strength and Tridosha balance:
The digestion fire remains in balanced state if the Doshas are in balance. This type of agni (gastric fire) helps in proper digestion of food resulting in good health, proper nourishment and promotion of longevity as well as strength.
If there is imbalance in Doshas, then the digestion fire becomes either weak or exceeding sharp (ati-vrddha) giving rise to several diseases.
The management of the condition caused by the weak gastric fire is already explained. The same in respect of the gastric fire which is exceedingly sharp is going to be spelt out in the succeeding verses. [211 ½- ½ 217]

Atyagni causes, pathogenesis, signs

Etiology and pathogenesis of Atyagni
Causes and pathogenesis of Atyagni – excess digestion strength:
If in a person with diminished kapha, if Pitta located in the site of Agni (gastric fire) gets aggravated, then along with Vata, it makes the Agni very strong.
Because of the under-nourishment of the body along with Vayu, the strengthened Agni surrounds the food, and by its sharpness (Teekshna), immediately digests the food taken frequently. After digesting the food, it even consumes tissue elements etc. Thereafter, the patient becomes weak and succumbs to death being afflicted by diseases. [217 ½ – ½ 220]

Causes and pathogenesis of Atyagni – excess digestion strength:
If in a person with diminished kapha, if Pitta located in the site of Agni (gastric fire) gets aggravated, then along with Vata, it makes the Agni very strong.
Because of the under-nourishment of the body along with Vayu, the strengthened Agni surrounds the food, and by its sharpness (Teekshna), immediately digests the food taken frequently. After digesting the food, it even consumes tissue elements etc. Thereafter, the patient becomes weak and succumbs to death being afflicted by diseases. [217 ½ – ½ 220]

Signs and symptoms of Atyagni
A person having atyagni (excessively sharp gastric fire) feels pacified after food. But after the food is digested, he gets tremors. Because of this atyagni, he suffers from morbid thirst, dyspnoea, burning sensation in the body, fainting etc. [220 ½- ½ 221]

Atyagni management

Management of atyagni
As a burning fire is extinguished by water, similarly Atyagni (excessively strong digestive fire) is pacified with heavy, unctuous, cold, sweet and slimy food and drinks
Even if the previous meal is not digested, the patient of atyagni is given food by afflicting the interior of the body (tissue elements) in the absence of fuel (food).

He is given payasa (milk-pudding), krishara (thick gruel prepared of rice and lentils), pastries added with ghee (fat), preparations of jaggery and minced as well as roasted meat of aquatic and marshy land, inhabiting creatures (Jaleshaya).

He should particularly take fish (without scales, smooth skinned) inhabiting in stagnant water and minced as well as roasted of sheep which counteract the excessively sharp gastric fire.

The patient, when hungry should take Yavagu (thick gruel) mixed with bee’s wax or should take ghee or should take wheat flour mixed with liberal quantity of water (Mantha) after venesection (Raktamokshana). He may also take milk boiled with Jeevaneeya Gana herbs after adding sugar and ghee.

Intake of paste (utkrunca or utkarika) of oil- bearing seeds (fruits) along with sugar, and meat- soup mixed with ghee(fat) reduces the excessive sharpness of the agni (gastric fire)the patient should take ghee with bee’s wax along with cold water. He may also take wheat-flour added with milk and mixed with ghee.

For the alleviation of atyagni (excessively sharp gastric fire), the patient may take the following recipes:
1. Excluding oil, there unctuous substance [out of the 4] viz: ghee vasa – (muscle fat) and majja (bone –marrow) boiled with the soup of the meat of the marshy- land inhabiting birds/ animals.
2. Wheat flour mixed with milk
3. Curd mixed with ghee, vasa (muscle fat) and majja (bone- marrow) powder of the bark of Udumbara – Ficus racemosa mixed with woman’s milk and
4. Milk pudding (payasa) prepared with the powder of the bark of udumbara – Ficus racemosa and woman’s milk.

For the alleviation of pitta, purgation therapy is administered frequently with the milk boiled by adding shyama and trivrt – Operculina turpethum.

The purgation therapy is followed by diet of molk pudding (payasa). This therapy is administered after proper examination by an expert physician who is proficient in these methods.
Intake of any of such ingredients of food such as sweet, fatty, aggravator of kapha and heavy for digestion and sleep during the day time after meals are useful for the patient suffering from atyagni (excessively sharp gastric fire)
If a patient of atyagni, even if he is hungry, takes different types of fat-producing food he does not succumb to death. On the other hand, this type of food causes robustness of such patients.
When the kapha is aggravated and pitta as well as the vata is subdued. Then the Agni (gastric fire) regains its normal (equilibrium) state. In a patient whose tissue dhatus are in a state of equilibrium, the gastric fire digests food resulting in the promotion of strength and longevity. [221 ½ – ½ 235]

Different types of meals

Definition of Samashana:
When the wholesome and unwholesome ingredients of food are taken together, intake of such mixed food, according to this treatise, is called Samashna (mixed food).

Definition of Vishamashana:
If the food is too much or too little in quantity, and if it is taken too early or too latte, then it is called Vishamashana(irregular food).

Definition of Adhyashana If food is taken again, even before the previous meal is digested, then it is called adhyasana (predigestion – food).
All the above mentioned three types of meal cause death or give rise to serious diseases.

However, taking food in the evening, even if the morning meal is not digested is not injurious. As the lotus flower blossoms during the day time because of the sun, similarly the heart of a person becomes awakened (more active) during the day time, and because of this awakened (stimulated) heart, all the channels in the body become more dilated. Because of exercise and physical – mental activities during day time, the Dhatus of a person do not develop stickiness (kleda). As a result of this non- stickiness, when the food components after digestion of the subsequent meal reach these tissue is on the analogy of the unspoiled milk being added with fresh milk which do not get spoiled (curdled) and gets mixed up uniformly.

In the night, however, the heart becomes sluggish (mlana) or contracted, and thus, the channels of circulation become contracted. Therefore, the food in the kostha (abdominal and thoracic visceras) become sticky, and it surrounds (adheres to) the tissues elements. If these sticky undigested materials are further added with other similar material, then this produces injurious effects. This is on the analogy of adding warm milk to curdled milk both of which get spoiled. Therefore, a wise person, with a view to protecting his strength and life, should avoid taking food if the night meal is not digested. [235 ½ – 243]

Summary

In this chapter dealing with the treatment of grahani, the topics described by the sage are as follows:
1. Attributes of antaragni (enzymes inside the body that help in the digestion and metabolism)
2. The manner in which the agni helps in the sustenance of the body
3. The process of food digestion
4. The ultimate functions of the food
5. various types of the agni and their support to different attributes in the body
6. The method of providing nourishment to different attributes in the body
7. different types of agni which helps in the nourishment of different tissue elements.
8. The order of synthesis of tissue elements, etc. Serious
9. The waste products coming out of the tissue elements during the metabolic process
10. The reasons why aphrodisiacs produce their effects instantaneously
11. The time taken for the synthesis of tissue- elements
12. The reason for the location of diseases in a particular part of the body
13. The importance of antaragni or jatharagni
14. The manner in which abnormal agni produces diseases
15. The diseases which are caused by the abnormal agni
16. Identification of grahani
17. Signs and symptoms of grhani- dosha in general
18. Premonitory signs and symptoms of grahani-dosha
19. Signs and symptoms of 4 different types of grahani dosha
20. Treatment of different types of grahani dosha
21. Treatment of different states of grahani dosha
22. Causative factors of atyagni
23. Treatment of atyagni

Thus, ends the 15th chapter of Chikitsa Sthana dealing with Granahi, in the work of Agnivesha which was redacted by charaka, and supplemented by Dridhabala.