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.
*************************************************************************************************************************************************************************
Presented by
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
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