An effort to differentiate Atisar- Grahani-Pravahika

 

An effort to differentiate Atisar- Grahani-Pravahika

S.No.	Vibhedakatva	Atisaar	Grahani	Pravahika
1.	Vyadhitva	Independent disease mentioned in Brihat-trayi.	Independent disease mentioned in Brihat-trayi.	Not an independent disease; a specific pattern/presentation of Atisaar.
2.	Nidan-Panchaka	Clearly mentioned	Clearly mentioned	Not mentioned separately
3.	Types	6: Vataja, Pittaja, Kaphaja, Sannipataja, Bhayaja & Shokaja.	4: Vataja, Pittaja, Kaphaja, Sannipataja (Charak)	4: Vataja, Pittaja, Kaphaja & Raktaja
4.	Dosha	Tridosha	Tridosha	Tridosha, but initiated by Vata & Kapha
4-A.	Pachak-pitta	Pittaja: Dravya-gunatah vriddhi, Karmatah Hani.	Pittaja: Dravya-gunatah vriddhi, Karmatah Hani	Pitta/Raktaja: Dravya-gunatah vriddhi & Karmatah Hani.
		Above ‘Pitta-vriddhi’ is only seen in ‘Pittaja- variant, Vataja & Kaphaja types have Pitta-kshaya & vitiation of Vata & Kapha as mentioned ‘Nidanas’.
4-B.	Samaan-vayu	Pittaja: Dravya-gunatah vriddhi, Karmatah Hani.	Pittaja: Dravya-gunatah vriddhi, Karmatah Hani.	Pitta/Raktaja: Dravya-gunatah vriddhi & Karmatah Hani
		This is other aspect of ‘Pachak-pitta’,usually not seen in other 2 types.
4-C.	Vyaan-vayu	Karmatah Hani.	Karmatah Hani.	Karmatah Hani.
			Obstructive (Baddha) phase shows increased ‘Vyan’ activities.
4-D.	Apaan-vayu	Increased activities	Increased / sometimes partially obstructed.	Increased / sometimes obstructed
4-E.	Kledak-kapha	Usually increased by conversion in Udak (Drav) Dhatu.	Aashayapakrishta by Vat-dosha.	Aashayapakrishta by Vat-dosha.
5.	Dushya	Initially: Ras, Mutra, Purish & Sweda. Later: Other dhatus.	Initially: Ras mainly. Later: Ras onward Dhatus up to the level of Ojas.	Initially: Ras mainly. Later: Ras onward Dhatus up to the level of Ojas.
6.	Dhatu-gatatva	Frequently in Sannipataja only.	Frequent in all types	Frequent in all 4 types
7.	Ojo-affection	Not frequent	Frequent	Frequent
8.	Dosha Prakop Pattern	Prakriti-sam-samveta.	Prakriti-sam-samveta / Vikriti-visham-samveta.	Vikriti-visham-samveta.
9.	Srotas	Anna, Purish, Mutra, Sweda, Rasa, Manovah.	Anna, Purish, Mutra, Sweda, Rasavaha onward	Anna, Purish, Mutra, Sweda, Rasavah onward
10.	Adhishthan	Mano-daihik	Mano-daihik	Mano-daihik
	Vyakti-sthan	Guda	Aamashaya, Pakwashaya & Guda	Guda, Pakwashaya
11.	Agni	Manda	Manda/Vishama/Tikshnagni.	Manda/Vishama
12.	Saam/Niraam	Saam	Saam/Niraam	Saam/Niraam
13.	Aashaya	Aamashay-sammuttha	Aamashay-sammuttha	Aamashay-sammuttha
14.	Sroto-Dushti	Ati-pravritti	Ati-pravritti & on/off Sanga	Ati-pravritti & on/off Sanga.
15.	Vyadhi-Prakar	Ashukari mainly.	Ashukari/Chirkari	Ashukari/Chirkari
16.	Sadhyasadhyata	Eka-doshaja: Sadhya; Sannipataja: Krichhrasadhya.	Not clearly mentioned; converts if untreated	Not mentioned specifically.
17.	Poorva-Roopa	Mentioned	Mentioned	Not Mentioned
18.	Upadrava	Mentioned	Not mentioned but to be understood as per Agni-dushti & Dhatu-poshan disturbance.	Not mentioned but To be understood as per Agni-dushti & Dhatu-poshan disturbance.
19.	Nidanartha-karatva	Leads to Gud-bhransha & Grahani.	Converts into other chronic disorders like Arsha, Gulm, Shotha & Udar-roga etc.	Leads to Gud-bhransha & other chronic disorders.
20.	Mala-pravritti	Less frequency (comparatively).	Alternate Episodes of frequency or constipation.	More frequency (comparatively).
21.	Mala-praman	More (Amount of stool).	Less (Amount of stool) comparatively.	Very Less (Amount of stool).
22.	Dhatu-Poshan	Not affected in acute phase.	Affected later in chronicity (Dhatu-kshaya).	Affected later (Dhatu-kshaya).
23.	Beeja-Dushti	Not mentioned.	Not mentioned.	None
		But the affection of ‘Matrija/Pittrija-bhavas’ are seen practically.
24.	Sar-Sanhananadi	Not mentioned.	Not mentioned.	Not mentioned.
25.	Pratyatma Lakshana	Bahu-drava-saranam	Muhur-baddham-Muhur-Dravam.	Ati-pravaahanam
26.	Pain	Vatik- +++ Paittika-++ Kaphaja- +	In Vatik Grahani mainly.	Present

 

Conclusions-

1.     Atisar, Grahani & Pravahika are three different variations of ‘Agni-dushti’, manifested in ‘Alimentary-canal’ (G. I. Lumen) where intra-luminal causes are prime factors either concerned to diet or dietary patterns with season (Ritu) etc.

2.     In these three ailments, Atisar is most acute presentation and this may convert in ‘Pravahika’ or Atisar may manifest as ‘Pravahika’ that is a little modified presentation; while ‘Grahani’ is relatively chronic intra-luminal pathology where extra-luminal involvement gets started as seen in ‘Purvaroopa’ & ‘Roopa’. Atisar does act as ‘Nidanarthakar’ for Grahani.

3.     Generally, Atisar or Chchhardi may be called first body response after the condition of  ‘Ajeerna’ (Indigestion) concerned to GIT pathology where body expels out ‘Doshas/malas’ naturally that are harmful for the body.

4.     Manas/psychological factors are also responsible for Atisar & Grahani specifically in ‘Bhayaja’ & ‘Shokaja Atisar’ along with ‘Vatik Grahani’ and this may be linked to the increased neuronal activities in ‘Gut-brain-axis’.

5.     As stated, that almost all diseases are the result of ‘Agni-dushti’ or ‘Saamata’, that is confirmatory with the description mentioned in Ch. Chi.- 15/42-49, because ‘Dhatuposhan-krama’ (nourishment of all body tissues & organs) is dependant on ingested diet, its digestion, (Avastha-pak), distribution and metabolism (Nishtha-pak). Atisar & Pravahika are the initial indicators of disturbance in ‘Avastha-pak/Koshtha’ while ‘Grahani’ is little deep pathology where interruption in ‘Nishtha-pak’/tissue metabolism or ‘involvement of Shakha (Dhatus) found and so, there are possibility of involvement of ‘Gambheera-dhatus’, Manas/psyche & ‘Marmas’ too, that is indicated in ‘Vatik-grahani’ very well.

6.     The genuine ‘Nidan-panchak’ understanding and therapeutic approach of these GI diseases has great importance if these are to be eradicated, especially if diarrhoeal phase is treated with antibiotics, antidiarrheals, anti-amoebics or opioid-derivatives etc then complete reversal is almost impossible if patient is unable to tolerate well such chemical based drugs that only provide symptomatic relief and this may lead to a new series of generalised signs & symptoms gradually as indicated in Ch.Chi.-19/15-16.  Similarly the use of anxiolytics and antipsychotics also provide temporary relief in cases of Bhayaja/shokaja-atisarn (IBS), prolonged use may lead to other deeper (Dhatu-gatatva) pathologies in chronic abuse condition.

7.     As, there are general increase in the availabilities of medical-facility and general health awareness, rarely these initial GI symptoms are taken seriously, when patients approach to Ayurveda fraternities after so many trials, there are chance of complete modification of signs & symptoms with the burden of self or over medication induced toxicity or side/adverse drug effects, So, careful analysis of these multiple factors provides appropriate guidance to frame the exact ‘Samprapti’ of the disease & diseased that lays the foundation of proper management.  

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Presented by

Dr. Shubham Tripathi
B.A.M.S.
MD IInd Yr. Scholar
P. G. Dept. of Kayachikitsa
Govt. Akhandanand Ayu. College,
Bhadra, Ahmedabad, Gujarat, India
Mob.- +91-6260097626

Guided by

Prof. Surendra A. Soni

M.D., Ph.D (Kayachikitsa)

H.O.D.

P.G. Dept. of Kayachikitsa

Govt. Akhandanand Ayurved College,

Bhadra, Ahmedabad, Gujarat, India.

email: kayachikitsagau@gmail.com