Colitis is a general term indicating an inflammatory condition of the large bowel, and almost invariably, of the rectum. Two broad categories of this condition are usually seen - specific and idiopathic. The specific type of colitis commonly arises from protozoal and/or tubercular infiltrations, although the latter form is quite rare. Amoebic colitis forms the major group of the specific type. The idiopathic variety cannot be traced to a specific cause and is often termed 'ulcerative colitis'.
Medical knowledge has advanced a great deal today in all spheres of inquiry, but ulcerative colitis is one condition in which science has made little progress. The present management of this condition remains unsatisfactory. The physician is far more able to control the disease than to cure it. Antibiotics and the intestinal disinfectants for the control of diarrhoea have been the chief medicine so far. The introduction of cortico-steroids was thought to revolutionize the management of this disease, but the side effects of these drags are as serious as the disease itself, while their control of the primary condition remains poor. The latest celebrated drug, salazopyrine, is claimed to have minimal side effects, but it has the drawback of creating dependency, and the condition worsens if there is no proper supply of the medicine. The surgical approach is total colectomy (removal of the colon) or proctocolectomy with ileostomy, in which the anus is removed along with the colon, necessitating the construction of an alternative opening in the abdominal wall. Both procedures cause permanent and severe restrictions in the patient's lifestyle.
The psychological aspect of colitis is also significant. Recent studies have shown that stress and strain are the major contributory factors in causing and aggravating the disease. Our survey also confirmed that environmental stress, personal stress and stress resulting from natural calamities were important factors. So the psychosomatic nature of the disease must be kept in mind while undertaking its treatment.
Grahani has been widely described In the classic ayurvedic literature. It shows exactly the same clinical picture as chronic colitis. Frequency of loose motions with profuse mucus discharge, pain and foul odour are the most prominent diagnostic symptoms of grahani. In ulcerative colitis, bleeding is an additional feature which may occasionally be present in cases of grahani also.
Grahani is a syndrome in which agni, the digestive power, is supposed to be at fault. When agni becomes depressed, ama dosha (undigested waste material) accumulates and is passed in the stools. So the aim of treatment should be to enhance the potency of agni, thereby reducing the formation of ama dosha.
Though ayurvedic medicines are capable of regularizing the agni to normalcy, yogic exercises, by virtue of their specificity, work as catalytic agents for stabilizing the agni at a higher level even if the medicines are withdrawn. This in itself is an Important achievement, as medicines cannot be used permanently. The disease can only be considered as cured when the agni is balanced without the use of any external medicine.
This study consisted of ten patients with chronic colitis (five of them with ulcerative lesions) who had undergone modern medical treatment for a number of years in various hospitals in India and abroad. In five patients ulcerative colitis was diagnosed after radiological investigations (barium enema X-ray) histopatholog-Ical investigations (microscopic examination of diseased tissues) and sigmoidoscopy (visual examination of the rectum and lower colon through a sigmoidoscope). One young patient, age 12, had been treated in London, where doctors felt an urgent total colectomy was indicated. Tills patient had been dependent on retention enema of hydrocortisone solution for several years. Another four cases of proven ulcerative colitis were dependent on salazopyrine and bestozyme. Patient no. 7 (VKG), dependent on salazopyrine, had an advanced case of ulcerative colitis with the involvement of the anorectal canal. Five patients had mixed symptoms of chronic colitis without detectable ulcerative lesions in the colon. All these patients were given yoga and panchamrita parpati therapy. Relevant history with duration of illness, frequency of acute attacks, and relation of the disease to stress is given in Table 1.
| Name of patient | Age in years | Duration in years | Frequency of acute episodes | Sources of stress |
|---|---|---|---|---|
| 1. RSS | 40 | 4 | 4-6 times per year | Death of 2 children |
| 2. SNS | 30 | 6 | 2-3 " " | Severely affected by flood |
| 3. VS | 35 | 7 | 6-8 " " | Frequent touring |
| 4. PNM | 22 | 3 | 3-4 " " | Examination stress |
| 5. BP | 12 | 6 | Dependent on cortisone enema | Stress between parents |
| 6. SMS | 32 | 8 | Dependfintonsalszopyrine & bestozyme | Profession (criminal lawyer) |
| 7. VKG | 31 | 14 | " " | Business |
| 8. KS | 37 | 10 | " " | Employer |
| 9. NNS | 26 | 3 | " " | Ph D. guide |
| 10. BPP | 33 | 7 | 1-2 times per year | Family (wife) |
Treatment consisted of a combined program of yoga and ayurvedic therapy. Those yogic practices which stimulate and normalize the agni were selected, in accordance with various classical texts of yoga and ayurveda, including 'Charaka Samhita', 'Gheranda Samhita' and 'Hatha Yoga Pradipika'. As indicated in Table 1, every patient had a stress factor aggravating the disease. Some pranayama exercises were selected to tranquillize the mind and relieve stress. The asanas given to the patient were bhujangasana, mayurasana, shalabhasana, paschimottanasana and matsyendrasana. Each of these asanas was done two or three times, and maintained for a duration of 20-30 seconds. Shavasana was practised once daily for 15-20 minutes, and pranayama for 10 minutes once daily. All yoga practices were performed under observation for 60 days while patients were in hospital. Scheme and sequence of asanas is shown in Table 2.
| Name of asana | Duration of asana | No. of rounds |
|---|---|---|
| 1. Bhujangasana | 20-30 sec. | 2-3 |
| 2. Mayurasana | " " | " " |
| 3. Shalabhasana | " " | " " |
| 4. Paschimottanasana | " " | " " |
| 5. Matsyendrasana | " " | " " |
| 6. Sarvangasana | 5-7 minutes | 1 |
| 7. Shavasana | 15 - 20 minutes | " " |
| 8. Pranayam | 10 minute | " " |
Along with yoga therapy, panchamrita parpati was administered. It was prepared in the ayurvedic pharmacy of Banaras Hindu University according to the method outlined, in the Bhahajya Ratnavali. The ingredients of this drug are shuddha gandhaka 16 parts, shuddha parada 8 parts, loha bhasma 4 parts, abhraka bhasma 2 parts and tamra bhasma 1 part.
Panchamrita parpati was given orally in an increasing dosage schedule along with madhu (honey) and jeera (cumin). The initial dosage was one ratti (125 mg.) of parpati for three days, increasing to two rattis for a further three days, then to a maximum of eleven rattis. The decreasing dosage schedule for the gradual withdrawal of the medicine followed the reverse pattern, back down to one ratti.
Before the commencement of therapy, patients were instructed to reduce their intake of salt. Water was restricted and replaced by milk. Later on, salt, water and food were totally replaced by milk. The drugs on which the patients were dependent before the therapy were gradually tapered off and replaced by parpati.
Table 3 lists the maximum dosage levels used in this study.
| Name & age (in Years) | Maximum dose of parpati | Max. milk comsumption | Weight gain during treatment | Period required for relief |
|---|---|---|---|---|
| 1. RSS-40 | 1,100 mg | 9.0 kg. | 8.0 kg. | 45 days |
| 2. SMS-30 | 800 " | 7.0 " | 10.0 " | 45 " |
| 3. VS-38 | 600 " | 5.5 " | 5.0 " | 50 " |
| 4. PNM-22 | 500 " | 5.0 " | 6.0 " | 35 " |
| 5. BP-12 | 400 " | 3.0 " | 3.0 " | 40 " |
| 6. SMS-32 | 800 " | 6.0 " | 7.5 " | 47 " |
| 7. VKG-31 | 600 " | 6.0 " | 10.0 " | 55 " |
| 8. KS-37 | 1,400 " | 12.0 " | 10.0 " | 60 " |
| 9. NNS-26 | 1,100 " | 12.0 " | 15.0 " | 60 " |
| 10. BPP-33 | 1,100 " | 8.0 " | 6.0 " | 50 " |
Results of this study are shown in Table 3. All the parents were kept under strict dietary restrictions, but nevertheless they showed tremendous increases in body weight. During the 45-60 days of treatment, they showed complete relief from, the previous signs and symptoms of the disease.
All 10 cases were followed up to record any recurrences of the disease. As described in Table 4, stressful life situations continued to occur for all 10 patients. Nevertheless, 5 out of 10 showed no recurrence of any symptoms, On enquiry, it was found that they were doing the yogic exercises regularly. All those patients who discontinued yoga showed mild recurrences of symptoms. No further drugs were given, but after re-commencing the yogic practices their symptoms were relieved in one or two months, and no recurrences were reported as long as they continued practising.
| Name & age (in Years) | Yoga Practice | Reurrence & duration of symptoms | Period required for relief of symptoms using yoga alone |
|---|---|---|---|
| 1. RSS-40 | continued | No | |
| 2. SMS-30 | continued | No | |
| 3. VS-38 | discontinued | Recurrence after 2 months (2 loose motions) | 20 days |
| 4. PNM-22 | continued | No | |
| 5. BP-12 | discontinued | Recurrence after 3 months (painful defecation) | 1 month |
| 6. SMS-32 | discontinued | Recurrence after 6 months (3 loose motions) | 1 month |
| 7. VKG-31 | discontinued | Recurrence after 1.5 month (mucus - 2 months) | 1 month |
| 8. KS-37 | continued | No | |
| 9. NNS-26 | discontinued | Recurrence after 2 months | 1 month |
| 10. BPP-33 | continued | No |
The selected asanas and pranayama bring the agni back to normal and maintain it at its normal level without medication. Yoga even relieves the stress and strain factors. In this way yoga acts as a buffer in the treatment of grahani with the ayurvedic drug parpati. Permanent cure is achieved from just a two month course of medication, provided asanas were continued in the daily life. By simultaneously treating both the psyche and the soma, yoga provides permanent relief from the symptoms of colitis.
(courtesy 'Sachitra Ayurved')