Inflammatory Bowel Disease [IBD]
The inflammatory bowel disease (IBD) is an idiopathic disease involving an immune reaction of the body to its own intestinal tract. IBD comprised of 2 major disorders which includes Crohn's disease and ulcerative colitis. These disorders have both distinct and overlapping pathologic and clinical characteristics.
What is Ulcerative colitis?
Ulcerative colitis is a disease that causes ulcers in the lining of rectum and colon. Ulcers from where inflammation has killed the cells that usually line the colon. The disease extends proximally from the anal verge to involve all or part of the colon.
What is Crohn's disease?
Crohn's disease causes inflammation of the digestive system. The disease can affect any area from the mouth to the anus. It often affects the lower part of the small intestine called ileum.
AyurVAID's treatment model for IBD includes both internal medications and therapies, judiciously administered after assessing the patient's individual clinical condition. The main aim of treating a IBD patient is to control the symptoms, maintain disease remission and prevent relapse. Significant reduction in symptoms and improvement in patient’s general health can be brought about by appropriate Ayurveda treatment.
As the lining of the intestine becomes inflamed and ulcerated, it loses its ability to adequately process food and waste or absorb water, resulting in loose stools (diarrhea), and in severe cases weight loss. Most people with Crohn’s disease or ulcerative colitis experience an urgency to have bowel movement and have abdominal cramps. Inflammation can cause small sores (ulcers) to form in the colon and rectum. These can join together and become large ulcers that bleed, resulting in bloody stools. Blood loss can eventually lead to anemia if unchecked
Common symptoms of ulcerative colitis include rectal bleeding and diarrhea .Variability of symptoms reflects differences in the extent of disease (the amount of the colon and rectum that are inflamed).Generally patients with inflammation confined to the rectum and short segment of colon adjacent to rectum have milder symptoms and a better prognosis than patient with more wide spread inflammation of colon. Based on the area of inflammation there are 4 types of UC ie, Ulcerative Proctitis, Procto sigmoiditis, Left sided colitis, Pan colitis, Fulminant colitis.
Common symptom of Crohn's disease are abdominal pain, diarrhea, weight loss. Less common symptoms include Poor appetite, Fever, Night sweats, rectal pain and rectal bleeding. Some patients with CD also develop symptoms outside of the gastrointestinal tract;these include Arthritis, Skin rash and inflammation of iris of the eye.
IBD with colon involvement is among the top three high-risk conditions for colorectal cancer. Today, colorectal cancer accounts for approximately 10–15% of all deaths among IBD patients. Indeed, patients with IBD colitis are six times more likely to develop colorectal cancer than the general population and have a higher frequency of multiple synchronous colorectal cancers.
Due to the nonspecific gastrointestinal symptoms of Crohn disease and ulcerative colitis, several other diagnoses must be considered before establishing a diagnosis of Crohn's disease or ulcerative colitis, particularly in the absence of typical endoscopic findings and in populations at higher risk for other diagnoses.
Presentations may include increased c-reactive protein, ESR level, Platelet count, decreased Hemoglobin levels.
Testing is extremely important to determine the stage of the disease and in selection of appropriate treatment options. Testing can include laboratory tests, Endoscopy, Sigmoidoscopy, Radiography, Biopsy and Barium enema.
C -reactive protein
Erythrocyte Sedimentation Rate
Fecal Calprotectin levels
In Ayurveda literature Vatika grahani, Rakta and Pithathisara are related to this condition.
The root cause of all the disease lies within the process of digestion, when the digestive system is working at its optimum supported by correct lifestyle and correct quantity and quality of food as per individual prakruti the food ingested is broken down in to the constituents that nourish the tissues and supports our everyday function.
The seat of Agni is known as grahani. The relation between Grahani and agni is similar to relation between structure and function. When the digestive fire which burns within our stomach is affected by incorrect lifestyle and eating habits leads to production of food toxins (Ama visha). Aama gets stuck in the villi of the intestine to form a thick coating. This ama and increased heat in the abdomen causes vitiation of Kapha, resulting in the loss of snigdhatha (Oiliness and mucous secretion) of intestines. Mucous thus eliminated will be present in the stool. Gradually loss of properties of Kapha leads to aggravation of Pitta. This initiate inflammatory changes and ulcerations. These changes result in bloody diarrhea. Long term advancement of the situation cause structural changes of intestinal walls leading to failure of absorption mechanism. Failure of absorption and impaired intestinal movement cause weakness, diarrhea, tiredness, weight loss, anemia etc.
Ayurveda treatment aims to heal the ulcers, digest ama, remove toxins and balance the doshas in the body and boost immune system to control such troubling condition.
In chronic conditions structural changes of intestinal lining cause the patient very weak. In such a situation primary importance will be for gaining normal health.
The internal medicines (Oushadha prayoga) of following qualities in the form of various kinds of churnas (powders), Lavanas (salts), ksharas (alkalis), sura, asava and different varieties of Buttermilk are often used.
- Agni Deepana (Stimulation of appetite)
- Digestive Pachana oushadha (Formulations that can directly digest ama)
- Grahi (Digestive and retain food-formulations are useful in diarrhea and lack of appetite).
- Vrana ropana(Healing of ulcers, Drugs and formulations with wound healing properties).
- Stambhana ( Formulations that stop movement or elimination. When there is bloody diarrhea with normal appetite.)
- Mrudu virechana (Indused Purgation) aiming on Vathanulomana (helping in Vatha to move in normal route) which is shoola prasamana (pain relieving)
- Vasthi(Medicated enema) - If lower gastro-intestinal tract is the affected part, Vasthi is the most useful procedure. Vasti with suitable medication will cure the ulceration of the bowel and enhance healing and subside inflammation and irritability of colon. Anuvasana vasthi (medicated oil enema) and Picha vasthi (special vasthi preparation containing mocha rasa ie, gum of Bombax malabaricum) are the common varieties of vasthi used in UC.
- In the initial stages of disease, if only symptoms of Grahani present and no ulcerations developed then if the ama accumulated in amashaya the physician will do vamana karma(Induced Emesis); If ama is in pakwasaya, virechana karma. And residuel morbid matters in the intestine is removed through sneha sweda poorva asthapana vasthi (abhyanga and swedana follwed by medicated decoction enema) followed by anuvasana vasthi(medicated oil enema).
Treatment specific information:
Along with the treatments, life style modifications like Good Sleep, Physical activities, Activities to maintain healthy peaceful mind and Healthy food habits such as wholesome food at right time, In right quantity, In right place when feeling hunger are often recommended.
Modern medicine has limited source of medical treatment such as temporary medication with intestinal antibiotics, anti-diarrhoeal, salazopyrine, steroids, immune modulator or drugs and lastly surgery. But these drugs only control the episodes of the disease and not cure them. Moreover these modern drugs have a huge list of possible side effects like intolerance and toxicity to other organs like kidney, liver, pancreas, eyes etc. Ayurveda therapy is very vital and has been proven effective in limiting the symptoms of the disease. AyurVAID has a rigorous process driven approach to identify the causes of IBD, assessment of the severity of disease based upon Ayurveda and allopathy parameters, a systematic flow to derive the pathogenesis of the disease and plan a Chikitsa based upon the same. Also a unique approach to have the sustained well-being after the main treatments to prevent the relapse of the inflammatory bowel disease. This is done with planned reviews to keep a track of the health status. Diet and lifestyle recommendations are advised to follow.