Irritable Bowel Syndrome: An Ayurvedic Perspective (Expert Article)

Types Of IBS:

IBS is presented in three different forms: IBS - D (diarrhoea prone), IBS - C (constipation prone) and IBS - M (mixed characteristics - alternative symptom of diarrhoea and constipation). Indigestion, abdominal discomfort, flatulence, mood changes, and worry are observed in all varieties. Diarrhoeal presentation is commonly observed in the majority of cases of IBS, the lesser cases were with irregular bowel on constipation and alternating diarrhoea and constipation.

IBS - D - This is the most commonly observed IBS; patients have characteristic features of increased frequency of bowel movement, loose stools, often with mucus, occasionally with pus and/or blood, tenesmus, gastric disturbances, abdominal pain, dyspepsia, heartburn, nausea, vomiting, other constitutional symptoms of malaise, fatigue, vague pain, muscle pain, myalgia, psychological disturbances, etc.

IBS - C - constipation prone IBS is a lesser common form of IBS than diarrhoeal prone IBS. The disease manifests with symptoms of irregular bowel, incomplete stool passage, constipation (classically means passing stool less than three times a week), hard stool, sticky stools, abdominal cramps, abdominal discomfort, headache, malaise, and other constitutional symptom. In India, this type of IBS is commonly observed with certain symptoms of allergy especially rhinitis, cold, excessive sneezing, sinusitis, or migraines headache. Psychological disturbances like anorexia, nausea, and insomnia are not rare.

IBS - M - This is a mixed form of the disease, in India the prevalence of the disease is quite high but as per global demography, this variety is listed third in the classification. In this disease, a patient has alternative characteristics of diarrhoeal presentation and constipation. The alternation may be triggered by psychological factors, diet changes, drugs, etc., patient often complaints about a feeling of incomplete evaluation, passing stools more than one time a day with hard stool on occasion and liquid consistency at other times. Patients, if managed with purgatives, may face any diarrhoeal problems and using anti-diarrhoeal may lead to constipation. So the patient may need individualised management with medication that regulates the bowel, and intestinal motility, improves digestion, regulate absorption and mental pacification.

Ayurveda Understanding Of IBS

IBS is a disease under the big umbrella of Pravahika (there are many different medical conditions that may be grouped under Pravahika). The disease is believed to be occurring due to two different mechanisms. The first mechanism is acute inflammation characterised by catarrhal inflammation that is characterised by the passing of stools with marked tenesmus, mucus, pus, blood discharge, abdominal pain and discomfort.

The second variety is due to chronic inflammation due to improper management during the period of pathological recovery. There are two types of recovery in microbial illness, the first one is clinical recovery. In this recovery, a patient is regaining health, presenting - harassing symptoms were relieved and the patient feels healthy - but there is the presence of microbial agents, the changes in tissues were not restored, the gross level digestion and metabolism are not restored and the microbial agents continues to remain in body fluids or gets into dipper tissues. the second type of recovery is named pathological recovery or complete recovery.

It is evident that the ancient Ayurveda scholars were well aware of the phenomenon and thus they advocate purification (therapeutic emesis - vamana and therapeutic purgation - virechana after illness or relief in presenting symptoms) in the recovery phase or last phase of the disease. This practice allows the microbial organism to get out of the body and doesn't produce the disease - if the morbid Doshas were pacified they may provoke if finds a favourable atmosphere, and if they are eliminated by purification there is no chance of disease due to the morbid Doshas. The following stanza from Charaka Samhita explains this:

दोषाः कदाचित् कुप्यन्ति जिता लङ्घनपाचनैः|
जिताः संशोधनैर्ये तु न तेषां पुनरुद्भवः||२०||
दोषाणां च द्रुमाणां च मूलेऽनुपहते सति|
रोगाणां प्रसवानां च गतानामागतिर्ध्रुवा||२१||

Patient with the diarrhoeal disease, it doesn't follow the regulation of diarrhoeal disease, drugs, observes and ingests unwholesome food, drinks, routine, and discontinues medication without advice, which may lead to changes in gastric digestion, non-restoration of the original histological status of diseased tissues and thus with little cause or exposure of etiological factors patient gets blow of disease.

Ayurveda Management Of IBS

Ayurveda offers holistic management of IBS and this includes medication - single herb, polyherbal compound, herbo-mineral compounds, diet management, diet planning and management, purification procedures - virechana - therapeutic purgation, Basti - therapeutic enema, psychological management through herbal medicines and tranquilization.

The commonly used medicines for medicinal management are as follows:

1) Kutaj - H. antidysentrica - This is a commonly available herb. The herb possesses anti-malarial, anti-diabetic, anti-oxidant, anti-urolithic, anti-mutagenic, CNS-stimulating, Angiotensin-converting-enzyme inhibitory and acetylcholinesterase inhibitory activity. Thus it makes a better choice for managing chronic bowel disease and IBS (diarrheal prone). The herb is well tolerated and doesn't have any major adverse drug reactions in therapeutic dosages.

2) Haritaki - Popularly known as Harad in the local language. The medicine possesses antiulcer, antioxidant, anticarcinogenic, antimutagenic, radioprotective, hepatoprotective, cardioprotective, cytoprotective, antidiabetic, and renoprotective, antibacterial, antifungal, antiviral, antiprotozoal, anti-inflammatory, antiarthritic, antispasmodic, wound healing and anticonceptive, molluscicidal, anthelmintic, anaphylactic, hypolipidemic, hypocholesterolemic. Also has chemopreventive potential and adaptogenic activities.

3) Bilva - Bilva (Aegle marmelos)- This is used for long for diarrhoeal diseases and malabsorption syndrome for ages. Its leaves, fruit, and even root bark are used for different medicinal purposes. It has anti-dysentery action, antimicrobial, antidiabetic, cardioprotective, and bowel regulatory properties. Long term use is also not associated with a major adverse drug reaction.

4) Jira - cumin seeds - Jira or cumin seeds (Cuminum cyminum) are used as a condiment in Indian cuisine. It has several medicinal properties and is commonly used in diarrheal conditions. As per Sharangdhara it first corrects the digestion (corrects digestion, restores host defence and then stops diarrhoea), as per modern pharmacology, cumin possesses antimicrobial, insecticidal, anti-inflammatory, analgesic, antioxidant, anticancer, antidiabetic, antiplatelet aggregation, hypotensive, bronchodilatory, immunological, contraceptive, anti-amyloidogenic, anti-osteoporotic, aldose reductase, alpha-glucosidase and tyrosinase inhibitory effects, protective and central nervous effects.

5) Nimbu - Lemon is commonly used in Indian households. This is considered a good source of vitamin c and citrus acid. It can be used in acute conditions of diarrhoea as well as chronic mucus colitis.

6) Cow's ghee - Cow's ghee can be used for the treatment of mucus colitis. Ghee contains fats and important vitamins A, D, and E and thus acts as a rejuvenator. As per classical descriptions, the Ghee is considered as Deepana i.e. increases metabolic fire (essential for digestion of food). This is used for the management of Grahani (analogues to mal-absorption syndrome) and mucus colitis - with pomegranate and ghee.

7) Trifala - The combination of three fruits Haritaki, Bhibhitaki and Amalaki is considered the best laxative as it is not habit-forming, well tolerated by patients and safe for longer use. The medication can also be used as Rasayana i.e. rejuvenator.

Ayurveda Management Of IBS - Importance Of Digestion

Indigestion and improper action of metabolic fire (Agni) is considered the major cause of all disease and are especially responsible for the disease of the alimentary tract.

The SOP of treatment laid down by the classics is as follows:

1. Improve the status of Agni (metabolic fire)
2. Improve functions of Grahani (duodenum) and Pakwashaya (colon) and Purishadhara Kala (caecum & colon mucosa)
3. Improve the function of Samana Vyau (neurological regulation of alimentary tract) and Apana Vayu (neurological regulation of colon, and pelvic organs)
4. Regulate functions of absorption, biological flora of the colon - maintain a symbiotic relationship
5. Improve nutritional status of the colon, and host defence mechanism
6. Restoration to normal homeostasis

This can be achieved by improving the functions of Agni (metabolic fire for digestion and metabolism of food). This can be achieved by medication, regulating diet (as per the individual constitution and present health status) and mental peace (meditation).

Ayurveda Management Of IBS: Why Choose Ayurveda?

IBS is a chronic inflammatory medical condition with occasional acute exacerbation. It affects the somatic sphere as well as a psychological sphere and thus patient suffers from a viscus circle that leads to chronic and long term suffering (acute disease --> psychologically disturbed --> vitiates agni and disturbs psychological -neurological immunological functions of body --> inflammation of colon --> irregular bowel --> acute disease). The best way to tackle the tricky situation is using holistic Ayurveda treatment.

April is declared as IBS awareness month by IFFGD (International Foundation for Gastrointestinal Disorders) and this article is intended to increase awareness about Ayurveda management options for chronic bowel disease or IBS.

Article is published in the public interest to increase awareness about understanding disease ayurvedically. For more details and consultation readers may contact the Ayurveda physician or Ayurveda College.