4. Grahani Roga Nidanam

The fourth chapter of Madhava Nidana deals with Grahani which is co related Disease of the Duodenum, Sprue.

अतिसारे निवृत्ते अपि मन्दाग्नेरहिताशिनः |
भूयः सन्दूषितो वह्निर्ग्रहणीमभिदूषयेत || १ ||

atisāre nivrtte api mandāgnerahitāśinaḥ |
bhūyaḥ sandūṣito vahnirgrahaṇīmabhidūṣayeta || 1 ||

As regards the etiopathogenesis of the disease grahani it may be noted that in the case of persons who have been recently cured of diarrhoea but who still have poor digestion as well as those otherwise having a poor digestion and who indulge in unsuitable foods and activities, the doshas get provoked and affect the grahani (duodenum). This situation further destroys the functions of agni that is the digestive capacity. 1

एकैकशः सर्वशश्च दोषैरत्यर्थमूर्च्छितैः |
सा दुष्टा बहुशो भुक्तमाममेव विमुञ्चति || २ ||
पक्वं वा सरुजं पूति मुहुर्बद्धं मुहुर्द्रवम् |
ग्रहणिरोगमाहुस्तमायुर्वेदविदो जनाः || ३ ||

ekaikaśaḥ sarvaśaśca doṣairatyarthamūrcchitaiḥ |
sā duṣṭā bahuśo bhuktamāmameva vimuñcati || 2 ||
pakvaṃ vā sarujaṃ pūti muhurbaddhaṃ muhurdravam |
grahaṇirogamāhustamāyurvedavido janāḥ || 3 ||

When the grahani (duodenum) gets severely afflicted by the provoked doshas either by each one of the three doshas separately or by a combination of them, it expels the food in an undigested form and the stool turns liquid and is passed repeatedly and with a foul smell. Sometimes, the process of digestion is complete, and the stools appear well formed. Nonetheless, it is passed repeatedly. This condition is known as the grahani roga by the Ayurvedic Experts. 2-3

Purvarupa (prodromal features) of Grahani –

पूर्वरूपं तु तस्येदं तृष्णा आलस्यं बलक्षयः |
विदाहो अन्नस्य पाकश्च चिरात् कायस्य गौरवम् || ४ ||

pūrvarūpaṃ tu tasyedaṃ trṣṇā ālasyaṃ balakṣayaḥ |
vidāho annasya pākaśca cirāt kāyasya gauravam || 4 ||

The premonitory symptoms of this disease —

• Thirst,
• Lassitude,
• weakness,
• improper digestion,
• delayed digestion, and
• heaviness in the body. 4

Etiology, pathogenesis and symptomatology of the Vata type of Grahani Roga —

कटु तिक्त कषायातिरुक्ष संदुष्टभोजनैः |
प्रमितानशनात्यध्व – वेगनिग्रह – मैथुनैः || ५ ||
मारुतः कुपितो वह्निं संच्छध्या कुरुते गदान् |
तस्यान्नं पच्यतेदुःखं शुक्तपाकं खराङ्गता || ६ ||
कण्ठास्यशोषो अक्षुत्त्रुष्णा तिमिरं कर्णयोः स्वनः |
पार्श्वोरु वङ्क्षन ग्रीवारुगभीक्षनम् विसूचिका || ७ ||
ह्रुत्पीडा कार्श्य दौर्बल्यंवैरस्यं परिकिर्तिका |
गृद्धिः सर्वरसानां च मनसः सदनं तथा || ८ ||
जीर्णेजीर्यतिचाध्मानंभुक्ते स्वास्थ्यमुपैति च |
सवातगुल्म हृद्रोग प्लीहाशङ्कीचमानवः || ९ ||
चिराद् दुःखं द्रवंशुष्कं तन्वामं शब्दफेनवत् |
पुनः पुनःस्रुजेद्वर्चः कास श्वासार्दितो अनिलात् || १० ||

kaṭu tikta kaṣāyātirukṣa saṃduṣṭabhojanaiḥ |
pramitānaśanātyadhva – veganigraha – maithunaiḥ || 5 ||
mārutaḥ kupito vahniṃ saṃcchadhyā kurute gadān |
tasyānnaṃ pacyateduḥkhaṃ śuktapākaṃ kharāṅgatā || 6 ||
kaṇṭhāsyaśoṣo akṣuttruṣṇā timiraṃ karṇayoḥ svanaḥ |
pārśvoru vaṅkṣana grīvārugabhīkṣanam visūcikā ||7||
hrutpīḍā kārśya daurbalyaṃvairasyaṃ parikirtikā |
grddhiḥ sarvarasānāṃ ca manasaḥ sadanaṃ tathā || 8 ||
jīrṇejīryaticādhmānaṃbhukte svāsthyamupaiti ca |
savātagulma hrdroga plīhāśaṅkīcamānavaḥ || 9 ||
cirād duḥkhaṃ dravaṃśuṣkaṃ tanvāmaṃ śabdaphenavat |
punaḥ punaḥsrujedvarcaḥ kāsa śvāsārdito anilāt ||10||

Regular indulgence in pungent, bitter, astringent, dry, contaminated food items and taking scanty or no food at all; too much walking, Suppression of natural urges and excess sexual activities result in provoked Vata which subsequently destroys the digestive activity and produces the disease identified as Vataja Grahani roga. In the case of this ailment the food is digested with difficulty and it undergoes fermentation. Moreover, there occur the following symptoms:

• Hardness of the body parts
• Dryness of the throat and mouth
• Absence of hunger
• Feeling of thirst
• Darkness before the eyes
• Noise In the ears
• Constant pain in the flanks, thighs, groins and the neck;
• Vomiting
• Diarrhoea
• Pain in the region of the heart
• Emaciation
• Weakness
• Bad taste in mouth
• Cutting pain in the rectum
• Desire for eatables of all the tastes
• Mental depression
• Distension of the abdomen during the period of digestion
• And feeling of comfort on taking eatables.

The features are very much identical with those of abdominal tumor (vata gulma), disease of the heart (hrdroga), and splenic disorder (pliha), thus causing difficulty in diagnosis. The patient voids feces after a long time, it is watery or dry, thin, frothy, improperly processed and is accompanied with pain and noise; he has cough and an increased or difficult respiration as well. 5-10

Pitta type of Grahani Roga –

कट्वजीर्ण – विदाह्याम्ल – क्षाराध्यैः पित्तमुल्बणं |
आप्लावयद्धन्त्यनलं जलं तप्तमिवानलम् || ११ ||
सो अजीर्ण – नील – पीताभं – पीताभः सार्यते द्रवम् |
पूत्यम्लोद्गार – हृत्कण्ठदाहारुचि – तृडर्दितः || १२ ||

kaṭvajīrṇa – vidāhyāmla – kṣārādhyaiḥ pittamulbaṇaṃ |
āplāvayaddhantyanalaṃ jalaṃ taptamivānalam || 11 ||
so ajīrṇa – nīla – pītābhaṃ – pītābhaḥ sāryate dravam |
pūtyamlodgāra – hrtkaṇṭhadāhāruci – trḍarditaḥ || 12||

Intake of pungent and heartburn producing eatables as well as acidic or alkaline foods and drinks, etc., cause morbid increase of pitta which inturn inactivates the gastric fire (digestive activity) just like warm water poured over a burning fire and generates pittaja grahani roga. The aggravated pitta submerges the metabolic fire and impairs its action just as even warm water is capable of extinguishing a fire. In this condition, the patient would eliminate faeces that are inadequately processed, bluish yellow or deep yellow, watery, and fetid; as the skin is yellowish. The patient will have bad., sour belching as well as burning sensation in the chest and throat. Moreover, he would have a lost appetite and thirst. 11 -12

Kapha Type of Grahani Roga –

गुर्वतिस्निग्ध – शीतादिभोजनादतिभोजनात् |
भुक्तमात्रस्य च स्वप्नाद्धन्त्यग्निं कुपितः कफः || १३ ||
तस्यान्नं पच्यते दुःखं हृल्लास च्छर्द्यरोचकाः |
आस्योपदेह – माधुर्यंकास – ष्टिवन – पीनसाः || १४ ||
हृदयं मन्यते स्त्यानमुदरं स्तिमितं गुरु |
दुष्टो मधुर उद्गारः सदनं स्त्रीष्व हर्षणम् || १५ ||
भिन्नामश्लेष्मसंसृष्टगुरुवर्चः प्रवर्तनम् |
अकृशस्यापि दौर्बल्यमालस्यं च कफात्मके || १६ ||

gurvatisnigdha – śītādibhojanādatibhojanāt |
bhuktamātrasya ca svapnāddhantyagniṃ kupitaḥ kaphaḥ || 13 ||
tasyānnaṃ pacyate duḥkhaṃ hrllāsa cchardyarocakāḥ |
āsyopadeha – mādhuryaṃkāsa – ṣṭivana – pīnasāḥ || 14 ||
hrdayaṃ manyate styānamudaraṃ stimitaṃ guru |
duṣṭo madhura udgāraḥ sadanaṃ strīṣva harṣaṇam || 15 ||
bhinnāmaśleṣmasaṃsrṣṭaguruvarcaḥ pravartanam |
akrśasyāpi daurbalyamālasyaṃ ca kaphātmake || 16 ||

The kapha which is increased by heavy, very oily, and very cold foods and by over eating and sleeping immediately after eating. This habit destroys the digestive fire. Consequently individual’s diet is digested with difficulty; he has nausea, vomiting, distaste, sticky sensation and sweetness in the mouth, cough salivation, coryza, gripping sensation in the heart, heaviness and stability in the abdomen, sweet and stinking belching.

There is, moreover, loss of appetite and the individual has no desire for the company of women. He defecates in fragments accompanied with phlegm and his stool remains heavy in nature. He gets debilitated though not emaciated and he remains non-enthusiastic. These features are seen in the Kapha type of grahani roga. 13-16

Sannipata Grahani Roga (Sprue caused by all the three of the doshas) —

पृथग्वातादिनिर्दिष्टहेतुलिङ्ग समागमे |
त्रिदोषं निर्दिशेदेवं, तेषां वक्ष्यामि भेषजम् || १७ ||

prthagvātādinirdiṣṭahetuliṅga samāgame |
tridoṣaṃ nirdiśedevaṃ, teṣāṃ vakṣyāmi bheṣajam || 17 ||

In the case of Grahani roga, the presence of causes and features of all the three doshas together is noticed. 17

Prognosis of Grahani Roga –

दोषं सामं निरामं च विध्यादत्रातिसारवत् || १८ ||

doṣaṃ sāmaṃ nirāmaṃ ca vidhyādatrātisāravat || 18 ||

As it vis done in the case of atisara, in the cases of Grahani Roga also, one should thoroughly examine the stool passed by the patient in the saama (undigested) as well as in the nirama (digested) conditions (in other terms the unformed and formed).

लिङ्गैरसाध्यो ग्रहणीविकारो यैस्तैरतीसारगदो न सिध्येत |
वृद्धस्य नूनं ग्रहणीविकारो हत्वा तनुं नैव निवर्तते च || १९ ||

liṅgairasādhyo grahaṇīvikāro yaistairatīsāragado na sidhyeta |
vrddhasya nūnaṃ grahaṇīvikāro hatvā tanuṃ naiva nivartate ca || 19 ||

The signs and symptoms that prove the cases of atisara as incurable ones, are also applicable to decide incurability of grahani as well. The same view is to be held regarding curability and incurability of both the diseases. Therefore, the stool testing should be done in the case of the grahani disease. The grahani vikara is incurable like atisara. Grahani Roga does not spare the old and generally kills them. 19

इति श्री विजयरक्षित कृतायां मधुकोशव्याख्यायां ग्रहणी निदानं समाप्तं || ४||

iti śrī vijayarakṣita krtāyāṃ madhukośavyākhyāyāṃ grahaṇī nidānaṃ samāptaṃ || 4||

Thus concludes the Chapter of Grahani Roga