Colitis In Ayurveda: Pathogenesis, Causes, Treatment, Diet

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

The term colitis refers to inflammation of the colon. It may be associated with enteritis (inflammation of the small intestine), proctitis (inflammation of the rectum), or both. Inflammatory bowel disease (IBD) is a generic term used to describe 3 idiopathic disorders that are associated with gastrointestinal (GI) inflammation: (Read more)

· Crohn disease (CD)
· Ulcerative colitis (UC)
· Indeterminate colitis

Table of Contents

Other conditions which can cause colitis

· Necrotizing enterocolitis (NEC)
· Allergic colitis
· Pseudomembranous colitis
· Infectious colitis (bacterial, parasitic, or viral)
· Ischemic colitis
· Colitis secondary to immune deficiency disorders
Read – Hypertension Causes, Types, Symptoms, Ayurvedic Treatment

Causes

Infection
Hypersensitivity to various allergens
Ischemia
Vasculitis, or several drugs.

The cause of colitis in IBD is unknown, but the available evidence suggests that IBD involves an abnormal immune response, likely to environmental factors, in a genetically susceptible host.
In the United States, bacterial and viral infections are very common causes of colitis, whereas in developing countries, parasitic infections are very common causes.
Read – IBS: Ayurvedic Treatment, Home Remedies, Lifestyle Tips

Treatment

Antibiotics
Supportive therapy with fluids and electrolytes
Surgical therapy is initiated if medical therapy fails

Therapy for IBD includes
Pharmacotherapy
Surgery
Nutrition and bone health
Supportive therapy
Psychotherapy
Cancer screening

Medications used to treat IBD –

· Aminosalicylates
· Corticosteroids
· Immunomodulators
· Antibiotics
· Probiotics
· Biologic agents (eg, infliximab)

Patients with moderate and severe disease require supportive treatment, often with IV hydration. Hospitalization is often indicated for management of acute disease with corticosteroids or immunosuppressive agents.

Click here to read about
Allergic colitis
Pseudomembranous colitis
Inflammatory bowel disease
Infectious colitis –
Infectious colitis is the most common cause of pediatric colitis, particularly beyond the first year of life. It can be caused by bacterial, viral, and parasitic pathogens.
Bacterial colitis
Parasitic colitis

Ayurveda in Ayurveda

The below mentioned conditions explained in Ayurveda describe signs of inflammation of colon and small bowel.

Pitta Atisara and Rakta Atisara – Diarrhea caused by vitiation of pitta or blood can be included in this disease description. Pitta causes inflammation of the small bowel and colon. Pitta is anyways located in the duodenum, small intestine, gallbladder and pancreas. When there is excessive production of pitta, there is obvious damage to the small gut. Similarly when there is vitiation of blood, which is a residence for pitta in the intestine and colon, the blood vitiated by pitta or individually vitiated will cause inflammatory changes in the intestine leading to diarrhea and bleeding diarrhea, as happens in inflammatory bowel disease and colitis. When pittaja atisara is not treated, it leads to raktaja atisara. This condition can be identified and diagnosed by the presence of pitta symptoms, mainly inflammatory changes, burning sensation in the anus and feces mixed with blood.
Read – Effective Kashayas For Diarrhea And Cholera From Sahasrayogam

Grahani, Pittaja Grahani – Grahani is the name given for small bowel, especially duodenum. The term also includes ileum and jejunum. Though bleeding is rare in pittaja grahani, the inflammation of the small bowel cannot be ruled out. This condition can be diagnosed with altered bowel movements wherein there are episodes of loose stools and diarrhea. If inflammation is severe, there may be bleeding from anus.

Pittaja Pravahika – dysentery of pitta origin too has blood in stools. It is diagnosed with the presence of straining during defecation.

Shokaja Atisara – diarrhea caused due to constant grief and stress also presents with blood mixed diarrhea along with many other symptoms. Stress is one of the trigger factors for inflammatory bowel disease.

Adhoga Raktapitta – blood contaminated with vitiated pitta getting discharged from the anus. The blood is not frank blood, is contaminated and has dark color and is not mixed with feces.

Ashayapakarsha – In this condition, the vitiated vata displaces the pitta into the colon, which is basically the seat of vata. This pitta causes inflammation in the colon and pelvic organs including urinary bladder and uterus and also may cause bleeding from anus.

Samprapti – pathogenesis

Dosha – Pitta pradhana
Dushya – rasa, rakta, mamsa, purisha
Srotas – annavaha srotas, purishavaha srotas
Srotodushti lakshana – atipravrutti (excessive discharge)
Roga marga – abhyantara (colon and intestine are visceral organs)
Sadhya Asadhyata – Krichra Sadhya (curable with difficulty)
Read – Ayurveda Ulcerative Colitis Diet Tips, Home Remedies

Ayurvedic Treatment for colitis

Lines of treatment

Pitta Atisara Chikitsa – initially langhana i.e. fasting and light food should be advised to digest ama. Later digestive gruels should be administered. Following this the medicines to check diarrhea and bleeding are administered.
Rakta Atisara Chikitsa – treatment on the lines of pittaja diarrhea is administered. Apart from that, measures to check bleeding is done by administering medicines consisting of herbs like Holarrhena antidysenterica, Aegle marmelos, Pomegranate, Cyperus rotundus etc.

Shokatisara / Bhayatisara – for those who are suffering from diarrhea or bloody diarrhea due to excessive grief, stress or fear, vata pacifying measures, counseling and measures to keep them stress free should be adapted.

Pravahika Chikitsa – treatment for dysentery should be administered.
Pittaja Grahani Chikitsa – Ama should be dealt with and pitta alleviating medicines and diet should be administered.

Ashayapakarsha Chikitsa – vitiated vata should be controlled and pitta should be restored. Inflammation should be treated by giving pitta alleviating foods, medicines and comforts.
Adhoga Raktapitta Chikitsa – initially bleeding should not be checked if the patient has retained his strength and muscle strength. When the contaminated blood has been eliminated, therapeutic emesis should be given followed by disease modifying treatment.

Balya and Brimhana Chikitsa – strength gaining and bulk promoting treatment shall be administered after the bowel inflammation has been cured. This will enable the patient to gain weight and health.
Rasayana – immune-modulating medicines should be administered after the disease has been cured. This will prevent recurrence of the disease and strengthen the small bowel and colon.
Krimihara Chikitsa – if infection is found to be causal of colitis.
Read – Ayurvedic Treatment For Worm Infestation

Role of Panchakarma

Vamana – therapeutic emesis in case of bleeding from lower passages i.e. anus as in adhoga raktapitta (pratimarga harana)
Virechana – therapeutic purgation should be given after the disease has been cured (in the interval period wherein the disease is not active), to expel morbid pitta and prevent recurrence.
Pittahara vasti – enemas to combat vitiated pitta with decoctions and oils / ghee prepared using pitta alleviating herbs.
Piccha Basti – special forms of enema meant for bleeding disorders, especially inflammatory bowel disease and colitis associated with bleeding.

Upakarmas

Nabhi Lepa / Nabhi Vasti – Nabhi i.e. navel is considered to be the chief site of pitta. If pastes of pitta alleviating herbs are applied over the navel, the pitta will be controlled. This is an effective treatment for inflammatory bowel disease.

Shirodhara / Shiro Basti – medicated liquids (milk) and oil is poured over the head in streams or pooled over the head. This controls vata and pitta, alleviates stress and is effective in controlling the episodes of inflammatory bowel disease and colitis.

Useful medicines

Kutaja Ghana Vati
Kutajarishta
Dadimashtaka Churna
Bilwadi Lehya
Kalyanaka Avaleha
Chitrakadi Gulika
Gangadhara / Vriddha Gangadhara Churna
Talisadi Churnam
Grahanikapata ras
Panchamruta Parpati
Vasarishta
Dadimavaleha
Vasavaleha
Kushmadavaleha

Proprietary Medicines

Tablet Entoform
Capsule Imidin
Tablet Kosht-Sanjivini
Tablet Kutajadi
Capsule Mebarid
Tablet Berb-enterone
Capsule Bilva
Tablet Diarex (Himalaya)

Diet

Old rice – has densely packed nutrition and is considered as better than freshly harvested rice, as per Ayurveda
Rice grown in sixty days – called as Shashtika Shali, it is considered as one of the best quality of rice. It is also called Navara Rice. Read more about Navara rice
Soup prepared from green gram is healing and is advised daily (Mudga Yusha)
Drink made of parched rice / puffed rice – It is light to digest and helps to kindle the digestion strength
Juice / soup of lentils
Milk of goat and cow
Ghee – helps to nourish and soothe the mucosal layer of large intestine. 1 – 2 teaspoon of ghee per day is recommended.
Buttermilk – being astringent dominant, buttermilk is useful, but it should not be taken in excess as it is hot. Sour buttermilk should be avoided as it can aggravate Pitta dosha.
Butter extracted from the milk of cow or goat – is coolant and soothing and heals the ulcers and inflammation faster
Bael fruit, Pomegranate, Jamun fruit, Unripe plantain – are astringent dominant and balance Pitta dosha
Honey – because of its wound healing nature, a teaspoon of honey can be used daily
Ginger – though slightly hot, it is one of the best anti inflammatory spices and can be used.
Wood apple
Oxalis corniculata (changeri)
Cannabis, Manjishta (Rubia cordifolia)
Cumin seed, Coriander
All types of astringent tasting things
All foods which stimulate digestive fire, not very hot and are light to digest