Whatsapp discussion series- 6 : Spastic Colon/IBS by Dr. D.C. Katoch, Prof. S. N. Ojha, Prof. Upendra Dixit & others

[29/03 7:34 PM] Dr Anamika:

 How can we approach  in spastic colon....

[29/03 7:38 PM] Dr Anamika A. Soni: 

Pt. Aged about 55 came with c/o incomplete and frequent bowel evacuation...occasional dull mild pain in lower abdomen....since last 7-8 yrs.

No other associated symptoms.

Appetite, micturation is ok.

No h/o htn, dm.

[29/03 7:46 PM] Dr Anamika: 

No h/o tennesmus, mucoid or blood in stool or malenna...

[29/03 8:23 PM] Dr Ranga prsad Ay Pith: 

मुहूर्द्रवं मुहुर्बद्धम् अवस्था in spastic colon (IBS)

↓

भास्कर लवण

या

परुषकादि लेहयं

→ अग्नि दीपन पाचन सहित वातानुलोम का परिपालनार्थं ।। 

[29/03 8:34 PM] Prof. Ramakant Chulet Sir NIA: 

Stokam stokam vibaddham va sakriccham va yadatisaryate. Abhaya pippali kalkai sukhoshnai s tamanusaryet  may be the perfect way to treat such pt

[29/03 8:37 PM] Chulet Sir Nia: 

@ tam virechayet may b there 2nd va is typing mistake

[29/03 8:41 PM] Dr Anamika: Thanx sir...

[29/03 8:45 PM] Chulet Sir Nia: 

After this one can use palashadi paneey and tatsiddh yavagu for apunaridbahv of such situation . 

Prof R K Joshi HOD KC NIA, Jaipur studied it during his MD under my co guidance it's simply Excellent

[29/03 9:59 PM] Katoch sir:

 In IBS, the basic pathology has psychological background and is equated to Shokajatisaar. Therefore, don't  you think some psychotropic intervention (pharmacological or non-pharmacological) is essentially required. One such remedy I frequently use and would recommend is Madananand Modak made from bhanga (cannabis), which works at higher centres as  destresser and  at involuntary lower centres as antispasmodic and intestinal movement regulator.

[29/03 10:02 PM] Dr. D.C. Katoch sir:

 Non pharmacological intervention of deep breathing and meditation also works well in IBS cases.

[29/03 10:04 PM] shekhar singh MP: कटोच सर  !

[29/03 10:05 PM] Katoch sir: Hanji

[29/03 10:05 PM] Dr Ranga prsad Ay Pith:

 Sir shokaja atisar for IBS-D probably.

But for IBS-C too the same rationality sir ?

[29/03 10:06 PM] Katoch sir:

 Yes, same Vaat does both the symptoms.

[29/03 10:07 PM] Katoch sir: 

And the background is same for the symptoms. Hit the cause, not the effect.

[29/03 10:08 PM] Dr Ranga prsad Ay Pith: 

But in IBS-C, the āntra gati is erratic. Slow at times and fast at times.

Giving sthambhaka yogas , thinking over the line of atisara (shokaja) will it not increase the mala vibandata , sir ?

Please clarify. 

[29/03 10:08 PM] pawan madan Dr:

 Katoch sir..I also agree with u on this matter...🏻

[29/03 10:09 PM] Dr Ranga prsad Ay Pith:

 Jalīyāmsa absorption is either too fast or too low in IBS-C ain't !?

[29/03 10:09 PM] pawan madan Dr:

 Ranga sir..
I think there is no need of stambhaka med even......in shokaja atisaar...

Stambhan med dont work in shokaj atisaar or IBS D OR IBS C....

[29/03 10:10 PM] shekhar singh MP:

 I hv seen in few patients suffering from irregular bowl, not exactly IBS in my school days, got relief after few sittings of भावातीत ध्यान of महर्षि महेश योगी।

[29/03 10:11 PM] pawan madan Dr: 

Madananad modak wud actually act like a euphoria producing like agent not as graahi...

Something like  Prahlaadakar..

Is that like this Katoch sir ?

[29/03 10:11 PM] Katoch sir: 

Bhanga is not stambhak, it is psychotropic anticholinergic and smooth muscle relaxant facilitating normalization of intestinal movements.

[29/03 10:11 PM] pawan madan Dr: 🏻🏻🏻🏻

[29/03 10:13 PM] Dr Ranga prsad Ay Pith: 

Thank you sir. I'll just give a thought about it laterally and  update myself.

But, that concept was really new to my understanding, hence the query.

[29/03 10:15 PM] Katoch sir:

 In IBS, constipation and diarrhoea percolates from cerebral cortex to manifest in gastrointestinal system.   Better to hit the root (cause) than the leaves (symptoms).

[29/03 10:15 PM] Saroj Mishra Dr (Ankur):

 anticholinergic is muscle relaxant,reduces all body secretions,broncho dilator.opium also have the same quality would it work katoch sir in IBS.

[29/03 10:17 PM] pawan madan Dr:

 More action is psychotropic I experienced that...

[29/03 10:17 PM] Saroj Mishra Dr (Ankur):

 So the line of treatment would be on brain than to work directly on bowel.

[29/03 10:18 PM] Katoch sir:

 Opium causes constipation is well known and its pathway of action is perhaps different.

[29/03 10:18 PM] Saroj Mishra Dr (Ankur):

 Ok
[29/03 10:18 PM] pawan madan Dr: 

All medicines qorking on bowel here go in vein at all....

[29/03 10:19 PM] Katoch sir:

 Dr Saroj, not brain but mind.

[29/03 10:19 PM] Saroj Mishra Dr (Ankur):

 Ok sir that i want to say

[29/03 10:20 PM] Dr Ranga prsad Ay Pith:

 Pawan sir, I actually can't buy the arguement that all medicines acting on bowel have gone invain.. 

[29/03 10:22 PM] pawan madan Dr: 

Sir I said ....in the above mentioned case....shokaja atisaar.......or in IBS due to stress.......

Aap dura meaning samajh gaye...🏻🏻
🏻
[29/03 10:22 PM] Dr Ranga prsad Ay Pith:

 Bhavana shunthi - you need to try this once, at least once before concluding as above sir.with takra as anupana.

Just a request from my end.

[29/03 10:22 PM] Katoch sir: 

Dr Ojha can throw more light please.

[29/03 10:22 PM] pawan madan Dr: 

Okk sir...I will keep this in mind...Ranga sir..🏻🏻

[29/03 10:22 PM] Dr Ranga prsad Ay Pith: 

Shokaja par bhi kaam karta hein, lekhin counseling ke saath saath. 

[29/03 10:23 PM] pawan madan Dr:

 I have been trying too many medicines in different types of IBS........but qithout counselling ...goes in vein...tgat was my meaning...

[29/03 10:23 PM] Saroj Mishra Dr (Ankur): 

I have managed the cases by gangadhar,bilva,mukta sukti,sankh,kapardak,kutaj ghan vati and chitrakadi vati.What other medicines should be added that can work on mind.???brahmi

[29/03 10:24 PM] satyendra ojha sir: 

Gastrocolic & colorectal transit time is affected in IBS.. Shorter transit time due to hypermotility leads to IBS-D , and in IBD-C longer transit time is present.. IBS can be correlated with vaataja grahani..  In IBS-D, apaana avrit vyaana and in IBS- C vyaana aavrita apaana , in IBS-M samaana aavrita apaana should be considered. Line of treatment is specific for various subtype of IBS..

[29/03 10:25 PM] Katoch sir:

 DAV Pharmacy, Jalandhar manufactures Madananand Modak. Try it Dr Pawan for your cases.

[29/03 10:26 PM] pawan madan Dr: 

Yes sir I am.using that..
even.it is made by Multaani pharma.also...
will try this again....
🏻
[29/03 10:26 PM] Saroj Mishra Dr (Ankur): 

What r d doses of madnanand modak

[29/03 10:27 PM] pawan madan Dr: 

Cud be from 2-5 g acc to the need...

[29/03 10:27 PM] Katoch sir: 

5gm bd with Luke warm water or takra or ark saunf

[29/03 10:28 PM] Saroj Mishra Dr (Ankur):

 It is cannabis based

[29/03 10:28 PM] pawan madan Dr:

 No worries.....

[29/03 10:28 PM] Katoch sir: 

Cannabis leaves based.

[29/03 10:28 PM] Saroj Mishra Dr (Ankur): 

Ok sir
[29/03 10:29 PM] Sukhvir Verma J. KC:

 In history of IBS case i usually found that they have weak digestion power since childhood. They usually aware after age of 20 or their disease worse once they statr to live on another place.

[29/03 10:29 PM] pawan madan Dr: 🏻🏻🏻
🏻
[29/03 10:31 PM] Katoch sir: 

IBS, Dr Sukhbir, is basically not a digestive disorder but a prakriti disorder.

[29/03 10:31 PM] Daya Shnkrji Sir: 

Medicine  containinv  canabis i.dica will work

[29/03 10:32 PM] Saroj Mishra Dr (Ankur):

 Katoch sir and pawan sir What is d prognosis of coeliac disease?It should also discussed along IBS because of like symptoms.Here antibodies are produced against gluten proteins in children.

[29/03 10:33 PM] Katoch sir: 

Thanks Acharya Dayashankar Ji for the endorsement of Matulani.

[29/03 10:33 PM] Sukhvir Verma J. KC:

 Sir I never said it is digestive or prakruti raletd disorder. I am telling the hard observations which are found clinically.

[29/03 10:34 PM] Katoch sir: 

True Dr Soni.

[29/03 10:35 PM] Katoch sir:

 Erratic bowel movements indeed cause indigestion, malabsorption and evacuation.

[29/03 10:37 PM] Sukhvir Verma J. KC: 

Second i think there is confusion like अण्डा and मुर्गी.  No body knows psycho first or indigestion first. Dictors usually speak the allopathic words.

I have the case of 4-5 years age diagnosed as IBS without any stress and etc.

[29/03 10:37 PM] pawan madan Dr: 

If we can diagnose each case qhich have disturbed bowel movents under particular typw of Grahmi and apply the chikitsa sidhaant of that.....then we can achieve some success..

I have been applying this methid in IBS, COELIAC DIS , UC, CROHNS DISEASES AND similar such conditions..

[29/03 10:38 PM] Saroj Mishra Dr (Ankur):

 I also have seen that what the ayurvedic medicines works in renal failure and diabetes also works in IBS.Like aam ki guthali ka powder,jamun ki guthali ka powder,(kashay ras).Bel ka churna,methi,saunf powder,dry coriander powder,anaardaana powder,bhuna jeera powder,ajwain etc.chaach

[29/03 10:38 PM] Katoch sir: 

Yes Dr Sukhbir, diagnosis could be wrong.

[29/03 10:38 PM] puja sabrwal j Ay Pth:

 With due respect Dr Katoch sir , can we use cannabis frequently .? Legally are we  safe ? May be I am wrong but plz sir guide me .

[29/03 10:40 PM] puja sabrwal j Ay Pth: 

In some cases of cancer studies r showing use of cannabis based medicines , but legally they r not allowed in some countries.

[29/03 10:41 PM] Sukhvir Verma J. KC: 

Yes sir diagnosis may be wrong, but the parents of kids are doctor and civil servant. I think they had discussed it with many senior paediatricians  

[29/03 10:42 PM] pawan madan Dr: 

Pedias always make this diagnosis by exclusion method.....so when nothing diagnosed....they just lebel this IBS...

[29/03 10:42 PM] Saroj Mishra Dr (Ankur): 

Cannabis is really anticholinergic sir ? But many times it aggravates muscular cramps.

[29/03 10:42 PM] Katoch sir: 

Cultivation and harvesting of cannabis is regulated under Narcotics & Psychotropic Substances Act, but Cannabis standards are given in Ayurvedic Pharmacopiea and its medicines can be prepared as per the provisions of Drugs & Cosmetics Act and Rules pertaining to SAY drugs.

[29/03 10:44 PM] Ankur Sharma Dr Delhi:

 I want to say one thing

Are there any parameters to measure stress in clinical practices.

I don't think a doctor can get whole clue about stress.

Gut motility depend upon sympathetic & parasympathetic nervous system

Slight triggers of sympathetic nervous system may lead to frequency of motions.

[29/03 10:44 PM] Katoch sir: 

Yes Dr Soni, diagnosis might be right as children today have more implicit reasons to be stress affected.

[29/03 10:45 PM] Sukhvir Verma J. KC: 

Pawan sir i think allopathic paediatricians are better judge for IBS than me and i can be better judge in ग्रहणी than them

[29/03 10:45 PM] Ankur Sharma Dr Delhi: 

Even slight fear may increase hear beat sweating palpitations.

Examples - lots of competition exam study stress etc

[29/03 10:46 PM] Dr Anamika:

 Thanx .......gurujan & respected gp. Members...for  providing such heartful guidance and valuable inputs  ........blessed....

[29/03 10:46 PM] puja sabrwal j Ay Pth:

 Many thanks sir for guidance .

[29/03 10:47 PM] Katoch sir:

 Grahani is at all a gastrointestinal disorder but not IBS.

[29/03 10:47 PM] pawan madan Dr: 

Sure Soni sir...right

I never make a diagnosis of IBS

only the type of Grahni....and go my way
🏻🏻
[29/03 10:48 PM] pawan madan Dr: 

I keep many IBS cases under Vaataj Grahni....may be not all but most of...

[29/03 10:49 PM] Katoch sir: 

Why not Shokaj or Manoabhighataj Annavah Srotodushti or Pureeshvah Srotodushti.

[29/03 10:49 PM] Ankur Sharma Dr Delhi:

 But it is my personal view for diagnosis either allopathic or Ayurveda,

Always Trust urself
Make diagnosis
&
Differential diagnosis should kept in mind.

It is not necessary that allopathic are always right.

[29/03 10:51 PM] pawan madan Dr:

Yes Katoch sir...
many IBS under shokaj atisaar depending on hetus, history and laxan....

That way I decide ....what med to use preferably in that particular case..

[29/03 10:52 PM] Sukhvir Verma J. KC: 

In reference to Ras Ksaya Acharya Vaghbhatt say:

रसे रौक्ष्यं श्रमः शोषो ग्लानिः शब्दासहिष्णुता।

Can we use this reference in IBS?

[29/03 10:53 PM] Katoch sir:

 Dr Saroj, wonderful ! You preserved three years old news clipping when I made a statement about WHO Collaborating Centres designation of Morarji Desai National Institute of Yoga and IPGTRA, Jamnagar.

[29/03 10:54 PM] Haresh Soni Dr. Parul: 

One way to understand irritable bowel syndrome (IBS) is that there is increased gastrointestinal (GI) response to stress. The stress can be understood as anything that can stimulate the GI tract, including:

DietHormonal changesPhysical activityPsychological stress

Stress can arise from a perceived or actual event that disturbes the balance between mind, brain, and body. Stress can occur with or without conscious feelings of anxiety, distress, or anger.

Stress can be acute (short term) or chronic (long acting, more than three months). It can range from daily hassles to life-threatening events.

Chronic stress experienced in early life (less than 18 years of age) has been shown to be associated with an increased prevalence of many medical conditions, including:

Asthma High blood pressure Obesity IBS

Stressors are any factors that produce stress. There are various types of stressors which may impact IBS symptoms. These may be physical (such as infection, surgery) and/or psychological (such as loss of job, divorce, history of abuse) in origin.

Stress has been shown to increase motility and sensation of the colon to a greater degree in IBS patients compared to healthy individuals without IBS.

IBS results from a complex biologic interaction between the brain and gut. To understand IBS, it's important to recognize that this condition represents a heightened sensitivity of the bowel and this can be manifested in response to internal and external stressors.

Addressing stressors that may be associated with IBS symptoms is the first step in understanding the relationship between stress and IBS. People suffering with IBS should work with their health care providers in developing a management plan to address these issues effectively, when present, in order to decrease symptoms and improve overall quality of life.

[29/03 10:55 PM] Dr Anamika: 

Gut is the second brain......
Many centrally acting drugs act by blocking vagus nerve activity..& producing  anticholinergic effect
Like sedatives....
So useful in diarrhoea,& ibs....

[29/03 10:55 PM] Daya Shnkrji Sir:

 Not multni but u Dr Katoch ji

[29/03 10:55 PM] Daya Shnkrji Sir:

 Katoch ji it is for u

[29/03 10:56 PM] Dr Anamika:

 Stress act by same pathway.....increasing vagal activity....

[29/03 10:58 PM] Katoch sir:

 Now I have started having the hangover of bhanga discussions, Good Night!!

[29/03 10:58 PM] Haresh Soni Dr. Parul: 

good one sir....good night...

[29/03 11:02 PM] Dr Surendra A. Soni:

 Great inputs 
One important history I observed in many patient that often the father of patient in his fertile age had addiction that results the "alpasattva" genetically in the patient. Initially I noted in 3-4 patient later on searched on net and got confirmation. As Katoch sir also pointed out that it's a prakriti of the patient.
Great interpretation and correlation Ojha Sir.


[29/03 11:07 PM] Haresh Soni Dr. Parul:

 Prakriti....
Always unchangeable....
So IBS patient with alpa sattva due to prakriti...

How to tackle.....
Medhya rasayana
Counselling
Daivavyapashraya
Yoga
Naishthiki chikitsa
Or
Pratyakhyeya

[29/03 11:07 PM] Dr Surendra A. Soni: 

B bageswar ras is my choice of drug along with symptomatic management to improve Sattva and Oja.
I saw one research work being conducted in Udaipur college during my UG tenure on Brihat Nayakadi Choorna from Bhaishajya Ratnavali, a combination of Bhang. It showed great efficacy as I got inputs from PG Seniors.

[29/03 11:08 PM] Ankur Sharma Dr Delhi:

 Good point dr harish soni  sir

[29/03 11:08 PM] Ankur Sharma Dr Delhi: 

[29/03 11:09 PM] Haresh Soni Dr. Parul: 

sharmaji

[29/03 11:09 PM] Ankur Sharma Dr Delhi:

 That's why pt get temporary relief till medication. Relapses occur

[29/03 11:10 PM] Dr Surendra A. Soni:

 That prakriti is due to addiction or some kind of fear some condition Haresh Sir...

[29/03 11:10 PM] Sukhvir Verma J. KC:

 I opines that this is Sahaj Bala vikriti. Specially bala related to digestive system. Gradually in life a person requires more dhatu poshan  for their daily routine. If his mechanism do not support and cope up the requirements there is Ras kshaya first it creats the  शब्दासहिष्णुता , anxiety and other psychological symtoms. Again this psychological disturbace creats the indigestion.

[29/03 11:10 PM] Ankur Sharma Dr Delhi:

 In same way hyperacidity can't be permanently cured in partik prakriti purush

[29/03 11:11 PM] Haresh Soni Dr. Parul:

 Exactly....lifestyle modification with medicines discussed above are helpful yet total remission is always under question.

[29/03 11:11 PM] Dr Surendra A. Soni: 

That prakriti is due to addiction or some kind of fear some ccondition Haresh Sir... during shukra dushti or pregnancy / maturaharavihar.

[29/03 11:12 PM] Ankur Sharma Dr Delhi:

 But influence of disease precipitating factors also can't be denied. Hence pathya apathya is itself a treatment part.

[29/03 11:15 PM] Sukhvir Verma J. KC:

 Weak bala can check by Yukti and Kaala

[29/03 11:20 PM] rupesh bhai dr: 

Keen observation Soni ji 🏼

[29/03 11:22 PM] satyendra ojha sir: 

It may be concluded that aggravated vāta has following effect
1) Impairs contraction and relaxation of sphincters thereby impairing the entry and exit of food within GI tract.
2) Either increases peristalsis thereby reducing transit time and thereby impairing the digestion or may reduce the peristalsis (due to kaṣāya rasa) and increase the transit time thereby hampering digestion.
3) Vāta can cause atrophy by rukṣa, khara guna and thereby reduce secretion of digestive glands and enterendocrine hormones.
4) Vāta can present neural transport of specific ions, amino acids and thus impair the digestion.
All the above process proves aggravated vāyu encompassing the agni and leading to indigestion.

[29/03 11:24 PM] Dr Surendra A. Soni: 

[29/03 11:26 PM] satyendra ojha sir: 

Gut - Brain relationship has been observed by research; Praana - samaana - apaana interrelationship is important to digestion and absorption of nutrients and vitamins..

[29/03 11:27 PM] K. Nistheswar Sir: 

Jatiphaladi churna contains Bhanga indicated in Grahani and atisara may holds good as intestinal sedative and GIT conditioner.

[29/03 11:28 PM] Dr Surendra A. Soni:

 Yes Sir

[29/03 11:33 PM] satyendra ojha sir: 

Spastic colon is very common in elders , and due to autonomic nervous system dysfunction as in DM ; purishaavrita vaata , udaavarta , pakvaashayagata vaata and guda gata vaata are concerned with slow transit time.. In all these conditions snigdha anulomana is reffered , for which eranda sneha , or gandharva haritaki , or/and  sinhanaada guggula should be given for effective treatment..

[29/03 11:36 PM] satyendra ojha sir: 

Dr Anamika , need to confirm specific cause of spastic colon in your patient.. Fibres rich diet , good amount of water , and proper exercise schedule help a lot in normalizing colon motility..

[29/03 11:40 PM] satyendra ojha sir:

 Bilva , karkatashringi , ativishaa , manjistha , hingaavashtaka like drugs are more effective in IBS-D , avipattikara is better choice in IBS-C , in IBS- M combination of above mentioned drugs (as per conditions and as per consultant ) should be given.

[30/03 6:51 AM] satyendra ojha sir:

 My Approach to IBS in ayurveda perspective ; Gastrocolic & colorectal transit time is affected in IBS.. Shorter transit time due to hypermotility leads to IBS-D , and in IBD-C longer transit time is present.. IBS can be correlated with vaataja grahani..  In IBS-D, apaana avrit vyaana and in IBS- C vyaana aavrita apaana , in IBS-M samaana aavrita apaana should be considered. Line of treatment is specific for various subtype of IBS.It may be concluded that aggravated vāta has following effect
1) Impairs contraction and relaxation of sphincters thereby impairing the entry and exit of food within GI tract.
2) Either increases peristalsis thereby reducing transit time and thereby impairing the digestion or may reduce the peristalsis (due to kaṣāya rasa) and increase the transit time thereby hampering digestion.
3) Vāta can cause atrophy by rukṣa, khara guna and thereby reduce secretion of digestive glands and enterendocrine hormones.
4) Vāta can present neural transport of specific ions, amino acids and thus impair the digestion.All the above process proves aggravated vāyu encompassing the agni and leading to indigestion. Gut - Brain relationship has been observed by research; Praana - samaana - apaana interrelationship is important to digestion and absorption of nutrients and vitamins..Spastic colon is very common in elders , and due to autonomic nervous system dysfunction as in DM ; purishaavrita vaata , udaavarta , pakvaashayagata vaata and guda gata vaata are concerned with slow transit time.. In all these conditions snigdha anulomana is reffered , for which eranda sneha , or gandharva haritaki , or/and  sinhanaada guggula should be given for effective treatment.. Fibres rich diet , good amount of water , and proper exercise schedule help a lot in normalizing colon motility.. Bilva , karkatashringi , ativishaa , manjistha , hingaavashtaka like drugs are more effective in IBS-D , avipattikara is better choice in IBS-C , in IBS- M combination of above mentioned drugs (as per conditions and as per consultant ) should be given.. Bhaanga containing kalpa is not choice of drugs to use for long term since IBS relapse frequently. Addiction is fear. Praana - udaana interplay in addiction and hamper feedback mechanism..

[30/03 7:18 AM] satyendra ojha sir:

 n Ca.Vi.2/6-9, it has been explained that food and human behavior contribute to formation of āma. Āma is an entity which is caused due to durbalata of agni or alpabala of agni whereby ādya āhar parināma dhatu i.e. none other than rasa dhatu is formed in apāchit swaroop. The dushit rasa which is seated/ situated in the āmashaya is known as āma.109 The nature of āma / apāchit annarasa is similar to poison (viṣa) which alongwith vātadidōṣa can contribute to sthanik (local) or sarvadaihik (full body ) signs and symptoms.
Apākva āhar means that the specific ratio of āpa and prithvi mahabhuta is lost thus leading to increase of viscosity or increase of solute concentration. Increased viscosity leads to decrease in prokinetic movement of the intestine. Decreased prokinesia leads to increase in transit time in intestine and in-turn results in  retention of food110 which is known as alasaka, if the retention of feces takes place it is understood as malāvaṣṭambha or constipation, if  retention of gas takes place it leads to ādhmāna (abdominal distention),  mütrasanga (retention of Urine ). Therefore Viṣṭambha may be understood as retention of food, feces, gas and urine.
This retention causes increased blood flow in the abdomen leading to decrease flow in the periphery therefore leading to reduced blood supply and nutrition to other body parts. Considering biofeedback there is need to increase blood supply in splanchnic circulation therefore there is decreased in other parts of body resulting in reduced nutritional supply (apatarpana) to other parts of the body this may be manifested by symptoms like exhaustion without exertion, bodyache, headache, vertigo / dizziness or loss of postural tone / consciousness for some moment. Muscles may go into spasm causing stiffness of body mainly in the back and lumbar region. Patient feels incomplete evacuation due to hypokinesia which causes increase in rectal pressure therefore the patient feels tenesmus and strains for evacuation of stools (pravähan).
Increase in solute concentration within the gastrointestinal tract leads to increase of jala sanchaya for bandhan karma (binding process) due to osmosis, thereby, leading to increase of fluid within the gastrointestinal tract.111 As the capacity to hold the content of gastrointestinal tract is over, there is either vomiting or diarrhea understood by another āma pradōṣak vikar known as visücikä.112
The presence of āma in rasaraktadi dhatu increases osmolality in plasma which stimulates thirst centre to increase the desire for intake of water (tr̥ṣṇā). Secondly fluid loss through vomiting and diarrhea reduces plasma volume and inturn increases osmolality of plasma and manifest thirst.113
Antigenic determination is present in indigested food therefore after absorption it circulates and activates immune cells to secrete endogenous pyrogens (interleukins, leukotriene etc) which alleviate set-point of heat regulation centre in the hypothalamus and manifest as fever.114 Hypoxia due to decrease nutritional flow to brain centre causes yawning.

[30/03 7:24 AM] satyendra ojha sir:

 In Ca.Vi.2/9 mānas hetus have been explained which causes agnimāndya. Psychological pervasions have shown to either cause excessive enzymatic secretion or inhibit enzymatic secretion thus a normal pH is not maintained in the gastrointestinal tract. Research in animals shows it is associated with elevated cytokines IL-6 and TNF alpha. Exposure to stress resulted in
reduction in microbial diversity and richness. The brain can exert a powerful influence on gut bacteria even mild stress can tip the microbial balance in the gut making the host more vulnerable to infectious disease and triggering a cascade of molecular reaction that feedback to central nervous system. 105
Although not discussed in above shlok yet one must consider role of genetic predisposition. Bīja and bījabhaga have their impact on anatomical and physiological development of organ and system for e.g. Hirschsprung disease resulting from absence of the intramural intestinal ganglions. Developmental disorders like atresia of common bile duct etc also have major effect on digestion; similar is the case in hereditary disorders.
Thus, the above etiological factors vitiate the agni i.e. either one or more of the factors such as mechanical, hormonal, enzymatic and neural digestive process are hampered wherein even the easily digestible food is unable to digest. As digestion is hampered, absorption does not take place. The undigested food is now acted upon by the microbial inhabitants which perform two types of action mainly fermentation and putrefaction. The term shuktatwa implies for both fermentation and putrefaction. The term fermentation is used here to signify the action of a living organism in causing the split of a complex substance into its simpler components106 usually as a result of bacterial fermentation various gases are produced which may further cause distention of abdomen. The undigested food gets fermented and putrefied due to which there is sourness which is explained by Chakrapani as shuktatwam amlatam. There is always inter-reaction between ingested food and gutflora. The undigested food becomes substratum for bacterial overgrowth, the ecosystem of gut microbiome is affected and gut microbiome now starts producing toxins;107 hence the word āmaviṣa has been used which is the cause for various disorders.108

[30/03 7:28 AM] Katoch sir:

 Fibre rich diet in spastic colon does not seem appropriate. It is contradictory to Ayurvedic principles of Vaatchikitsa. More so, IBS manifestions compared to different gastrointestinal upsets mentioned in Ayurveda (Aadhman, Aatop, Grahani, Koshthagat Vaat, Pakwashayagat Vaat, Gudgatvaat etc) definitely need sthan specific treatment but duration of treatment and  required regimen always call for consideration of gastrointestinal behaviour. In IBS, involvement of ANS is by design of the disease process and there happen to be remissions and relapses of the symptom complex depending upon the psychogical status. Apparently deranged psychological background always need psychotropic medication to control the physical symptoms of diarrhoea, constipation or spasmodic pain. Only for this phase of the manifestation of IBS bhanga-based remedies are recommendable, not for long term use. Secondly, except infectious diseases no other disease has specific duration of treatment. It is for the physician to see how long and how much treatment is to be given to subside the clinical problem of the patient.
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[30/03 7:33 AM] satyendra ojha sir:

 Nice discussion on IBS , Thank you very much Dr Katoch sir ..
[30/03 7:34 AM] Dipak Shirude Dr. AP: 

Excellent partnership on IBS !!

[30/03 7:45 AM] Katoch sir: 

Very Good Dr Dixit !
 I am afraid how many of the listed conditions are diagnosed or found in the clinical settings to apply the corresponding line of treatment or combination of drugs.

[30/03 7:52 AM] Katoch sir: 

Your list of conditions Dr Dixit reveals that our Acharyas had fairly good idea of the range and varieties of IBS manifestions. Salutations to Them.

[30/03 7:59 AM] Upendr dixit Prof. Goa:

 Sir, I have tried to find out conditions from this list in practice. I had given a presentation in world Ayurveda congress regarding this. Of course all conditions I haven't seen yet.

[30/03 8:00 AM] satyendra ojha sir: 

Rajayakshma , kshataksheena like disorders should not be considered as cause of IBS.

[30/03 8:02 AM] Upendr dixit Prof. Goa: 

No direct reference about IBS is available in the texts. But these are the conditions in which the symptoms which are mentioned for IBS are observed.

[30/03 8:04 AM] satyendra ojha sir: 

Then , why not jvara , gulma , kamala , like disorders , where few features of IBS are present..

[30/03 8:06 AM] satyendra ojha sir:

 If , every time , our correlation will be based on symptoms , then , what's about samprapti vivechana.. We need specificity , Prof. Dixit..

[30/03 8:07 AM] satyendra ojha sir:

 Even few features of IBS are mentioned in amlapitta..

[30/03 8:15 AM] Upendr dixit Prof. Goa:

 In my presentation I have written around 11 conditions which I have observed in my practice. So that way we can have specificity, by actual observations. You are right Ojha Sir, if we understand the Samprapti of these diseases, we will understand how Aantra or Grahani are affected by these Samrapti. Then even other diseases like you have mentioned can be considered.

[30/03 8:16 AM] Chandrakant Ji AP:

 Respected Vaidya's It gives me immence pleasure to tell that I had an opprtunity to treat a few pt's of IBS  treated by modern experts & got nice results.Nidanparivarjan, Aampachak anulomak , sthambhak medicines were used.Kept on diet.Fear aggraveted symptoms in some pt's.Some were treated as Grahani .Line of treatment as Grahani.Assurance is a kee in some pt's.🏾

[30/03 8:16 AM] satyendra ojha sir: 

Yes , Prof. Dixit ji..

[30/03 8:17 AM] Katoch sir:

 Shastra is a mirror with whose help one can see how to dress the hair and to do the make up.  Dressing the hair and make up as such may not be there in Shastra.

[30/03 8:19 AM] Katoch sir:

 Dr Chandrakant,  Stambhak medicines in IBS not digestible?

[30/03 8:22 AM] Chandrakant Ji AP: 

Are in combination with pachak dravyas sir . Not used regularly.According to requirements, occasionly.

[30/03 8:23 AM] pawan madan Dr:

 Shastra is a mirror with whose help one can see how to dress the hair and to do the make up.  Dressing the hair and make up as such may not be there in Shastra.

Most imp....

Thank.U sir.

[30/03 8:24 AM] Katoch sir:

 Vaat-anuloman, Pureesh-anuloman and Mano-anuloman is the key in IBS.

[30/03 8:26 AM] Chandrakant Ji AP: 

True Katoch sir 

[30/03 8:28 AM] Somraj Kharche Dr. KC: 

न तू संग्रहणं देयम्। ये शात्रार्थ है।पर व्यवहार ये है की ऐसे व्याधियोंमे में आपको माइल्ड ही क्यू न सही पर स्तंभक use करना ही पड़ता है। पहले मैं भी आमपाचन करता था पर इसमें कभी कभी frequency कम होने में समय लगता था और आजकल लोगो को instant relief चाहिए सो पेशेंट भाग जाता था।इसीलिए आपको कुछ ऐसा माइल्ड स्तंभक द्रव्य जो आमपाचन भी करे उपयोग में लाना ही पड़ता है। फिर पहले हफ्ते में जैसे ही frequency कम हो जाती है फिर तो आप सालभर आमपाचन करते रहो , पेशेंट रुकता है। इसीलिए जोशी सर से सहमत हु। ये व्यवहार है। शास्त्रार्थ भी अपनी जगह सही ही है।

[30/03 8:30 AM] Prof gujjarwar ay pith: 

Very good discussion about IBS.

Beutiful references collection of Vd. DIXIT ji.

Thanks for sharing Dr. Katoch sir and Dr Ojha sir.
🏼
[30/03 8:31 AM] Mamta Bhagwat Dr @ B'lore:

 Mano anulomana  very unique word sir

[30/03 8:34 AM] ‪+91 94223 57002‬: 

Nice breakfast 

[30/03 8:45 AM] ‪+91 94817 45630‬: 

Good morning &🏻🏻All
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[30/03 9:00 AM] Pawan mali Dr. A P:

 Good mg ...nice inputs from experts on ibs..... grahi drug should be choice in patients of ibs that can be used for longer time ...if frequency is more stambhan may be needed but normally we are using kutaj which is also best pachan..and most importantly which I have observed is strict following of aharvidhividhan in patients of ibs is needed ...to maintain grahanibala along with drugs and satvavajay chikitsa.purish nishkramana is function of apan but when to excrete is under control of prana vayu which is hampered in ibs so control of prana and apan both are needed in management..
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[30/03 9:26 AM] Katoch sir:

 Dr Pawan Mali, rightly said- IBS patient being psychologically labile must know minutely what to eat, how much to eat, when to eat and how to eat.

[30/03 9:30 AM] Pawan mali Dr. A P:

 Yes sir now days ....these things play major role in disease prevalence...but I have rarely used medhya drugs in management of ibs still I get good results with these technique..
[30/03 9:37 AM] Pawan mali Dr. A P:

 Useful for satvavajay chikitsa..

[30/03 9:41 AM] Katoch sir: 

Medhya effect can also be achieved with non-pharmacological interventions like Reassurance, Autosuggestion, Pranayam, Meditation etc.

[30/03 9:45 AM] satyendra ojha sir: 

Here , one town area , ichalakaranji , known for its textiles , since 23 years of my work in kolhapur and surrounding areas , I have too many ( may be hundreds ) patients of IBS , Gluten enteropathy , GERD from that place belongs to businessman, professionals like doctor ( MBBS , BAMS , BHMS ), engineers , advocates , etc. Water , diet pattern and stress are found common in all.. I treated them successfully with drugs selected ( as per clinical status ) from  laghu sootashekhar rasa , sanjivani vati , hingavaashtaka , avipattikara , pravaala panchaamrita , baala chaturbhadra , bilva , mustaa , manjishtha , and jatamansi . Because of understanding of disease process and selecting drugs accordingly, response is satisfactory , and people develop trust in ayurveda ..

[30/03 9:48 AM] Pankaj Chhayani dr ndyad: 

When we irritate anyone ,he will react two way..
1) He becomes quite silent 
2) he becomes very angry...
Samething happen to intestine(motility),as our emotions and motility have relations..when emotions irritate intestine, intestine will react two way 
1) becomes quite silence that is constipation 
2) becomes angry that is loose motion...

[30/03 9:49 AM] Pawan mali Dr. A P: 

Jee sir...righly said... that should be part of management ..

[30/03 9:52 AM] satyendra ojha sir:

 Dr Pankaj , Brain - Gut  and Panchaatmaa vaata interrelationship shows variable features..

[30/03 9:52 AM] Pankaj Chhayani dr ndyad: Yes sir

[30/03 9:55 AM] Pawan mali Dr. A P: Oza sir 🏽🏽🏼
🏼
[30/03 9:56 AM] satyendra ojha sir:

 व्यायाम - व्यान - समान - अग्नि interrelationship can be elaborated.. Acharya charak recommended vyaayaam in presence of avarana by vyaana..

[30/03 9:59 AM] Chandrakant Ji AP: 

Senior Vaidyas , In ref to IBS When I was in search of referances I came accross घोरातिसारं ग्रहणीगदं च हरेच्च दृढशूलयुक्तम् \फलश्रुती  of गंधकरसायन .In vatkaphaj laxnadhikya I have used गंधकरसायन as a medicine of choice & got very nice results in combination with other medicines.I may be wrong ,if so please correct me.@ Vd , Katoch गुरूजी , डाॅ. सोमराज खरचे, डाॅ.पवन माळीजी.

[30/03 9:59 AM] satyendra ojha sir:

 Laghu annna and vyaayaam are mentioned

[30/03 10:01 AM] satyendra ojha sir:

 Combination with other Medicine (name ) should be clearly pointed out for perfect discussion , Dr joshi

[30/03 10:01 AM] Pankaj Chhayani dr ndyad:

 Ojha sir, here in surat also same condition..many people work in textile and they take their dinner at  between 10 p.m. to 12 p.m. They take light lunch and so they become too much hungry at night. So they take late night heavy dinner and soon after dinner go to sleep. In this situation ,schedule of  digestive system become disturb in order to maintain own work schedule. When people arise in morning and can't do complete evacuation and they have breakfast..this whole vicious cycle disturbed biological clock system...

[30/03 10:02 AM] satyendra ojha sir:

 Vague presentation will not help to reach on conclusion..

[30/03 10:02 AM] Katoch sir: 

True Dr Ojha. Rogamaadau prikshet

[30/03 10:03 AM] satyendra ojha sir:

 Absolutely right , Dr Pankaj..

[30/03 10:03 AM] satyendra ojha sir:

 Yes Sir..!

[30/03 10:10 AM] Pawan mali Dr. A P:

 Dr.pankaj kolhapur ho Surat ho ya Delhi ....faulty dietary habits are Main hetus for annavaha and purishvaha srotas vikar....thats where ayurved has major role in prevention and awareness in public.

[30/03 11:01 AM] ‪+91 94223 57002‬:

 At least 20% population is suffering from grahani IBS like disease due to faulty diet habit
But one bitter truth is also there natural body structure is also responsible
Some pt needs to follow diet ethics code N conduct throught life and have to take Deepan pahchan medicines intermittently throughout life

Charak acharya also supported this statement by saying that krush purushas malavaha strotas is always dusta naturally.

==============================================

Above discussion held on 'Ayurveda Peetha"(initiated by Prof. S.N. Ojha) and 'Kaysampraday'  2 Famous Whatsapp group of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

email: surendraasoni@gmail.com

Mobile No. +91 9408441150