Irritable Bowel Syndrome | Vata Digestion
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Vata indigestion or visham agni is an extremely common condition which may manifest with sufficient severity to earn a diagnosis of Irritable Bowel Syndrome or IBS. Visham agni is characterised by gas, bloating, constipation (krura kostha), irregular appetite, abdominal gurgling and anxiety. IBS is diagnosed when there is a similar cluster of gas, bloating, anxiety and abdominal pain, accompanied by constipation, diarrhoea, or alternating diarrhoea and constipation. The difference between a mild case of visham agni that can be managed by home remedies and full blown IBS is one of degree of severity and prolonged duration of the symptoms.
Affecting approximately one in five people worldwide, IBS cuts across distinctions of ethnicity and geographical location, although it is more commonly diagnosed in women than in men. In this article we will look at the subdoshas and gunas involved in vata indigestion and IBS in order to understand more deeply which herbal therapies to apply and why these herbs are likely to be effective.
Subdoshas involved in IBS
At the outset, it is important to appreciate the involvement of prana vayu and sadhak pitta in vata indigestion, particularly when this indigestion is severe enough to merit medical attention and a diagnosis of IBS. Although it is samana vayu that is involved in peristalsis and the digestive process, this activity of samana vayu is regulated by the tenth cranial nerve, the Vagus nerve, which is a channel of prana vayu. The gut is a seat of serotonin receptors and is affected by alterations of serotonin levels regulated by sadhak pitta. (1) In current Western medicine, tricyclic antidepressants are used for IBS. (1) Brahmi and Bacopa, which normalize both sadhak pitta and prana vayu, are of value in vata indigestion and IBS. Bacopa has also been shown to have an antispasmodic effect on the gut, thus directly reducing the pain associated with IBS. (2)
Both samana and apana vayu are key players in vata indigestion and IBS. When prana vayu is excessive and blocks samana vayu, there may be a cluster of visham agni/IBS-related symptoms including irregular appetite, burping, feeling of fullness in the stomach and heartburn. In this situation, prana can be calmed by Brahmi or Bacopa and samana can be strengthened using Shatavari. When apana vayu blocks samana there may be constipation-dominant IBS accompanied by heartburn. In this event Shatavari can be used to strengthen samana and Triphala or Haritaki to encourage the correct downward (adhah) vector of apana. When samana blocks apana there may be constipation-dominant IBS accompanied by low backache, menstrual irregularities or menstrual cramps and dyspareunia (pain on coitus). Dashamoola decoction basti alternating with sesame oil basti will help apana to return to its normal vector instead of displacing sideways (tiryaga) such as to cause symptoms in the sacrum and reproductive tract. Triphala or Haritaki will also strengthen apana.
Pachak pitta has a part in diarrhoea-dominant IBS. It this instance, samana vayu pushes pachak pitta, leading to mrudu kostha or loose bowels. Shatavari is indicated both to normalize samana and to calm pachak pitta.
Gunas involved in IBS
Ruksha (dry) and kathina (hard) are important gunas in constipation-dominant IBS, since the stools are very hard and dry in this manifestation of vata indigestion. Hence it is important to give guidance regarding a vata-soothing diet. Soft, well cooked foods add the mrudu (soft) quality to balance hardness of the stools. Snigdha (moist, oily) foods balance ruksha, so sufficient ghee and sesame oil should be included in the diet. Salt is moist/snigdha and also softening. As an ingredient of Hingvastak, rock salt and sea salt provide the snigdha quality to balance the ruksha quality of hing and give an overall moistening effect to this formula. Both Ashwagandha and Shatavari are snigdha and thus helpful for constipation-dominant IBS.
Khara (rough) is an aspect of vata indigestion that is often poorly understood by patients. Faced with chronic constipation, it may seem logical to consume extra roughage such as bran cereal. Yet insoluble fibre is indeed rough and will only serve to aggravate vata and perpetuate the condition. Slakshma (smooth) is needed, so it is best to use ‘smoothage’ rather than roughage, soluble rather than insoluble fibre. Sat Isabgol is an excellent source of slakshma and can bring ease to chronic constipation while concurrently calming vata. Licorice is slakshma and mrudu and hence has usefulness in balancing vata indigestion.
The chala quality of IBS is seen in gurgling and colicky pain. Furthermore, when one subdosha pushes another, the chala quality is also seen in the form of abnormal movement of doshas, leading to heartburn, burping or back pain. How can it be that there is constipation even though the gut is actually hypermobile? One reason is the excess ruksha and kathina qualities of vata, which lead to constipation. The other cause is the abnormal vector of the doshas. Sat Isabgol is valuable in balancing the excess motility through its sthira (static) quality while simultaneously promoting normal bowel movements through its smooth and soft qualities. To address the abnormal vector of the doshas, it is best to use both Haritaki and Hingvastak. These herbs promote normal movement of vata though the digestive tract. Herbs that are calming and antispasmodic such as Brahmi and Bacopa will also help the gut’s hyperperistalsis.
Shita (cold)and ushna (hot) can both be involved in IBS, and it is important to understand which one predominates in order to give the correct chikitsa. The standard constipation-dominant IBS, which corresponds with classic vata indigestion, is a shita condition. Hence hing, a very hot herb, will be suitable for this condition, which typically responds well to Hingvastak. Hing is also antispasmodic and brings relief of colicky abdominal pain associated with this cold type of IBS. Ajwain, (celery seed) another ingredient of Hingvastak, also has a hot virya and antispasmodic effect. When prana blocks samana, with symptoms of burping and reflux, Hingvastak may again be of benefit it balancing the subdoshas of vata so that burping does not occur. However, if excess pachak pitta is involved in this situation, giving ushna virya, Shatavari will be helpful and Hingvastak will aggravate the symptoms. The involvement of pachak pitta may be indicated by mrudu kostha or by alternating constipation and diarrhoea. When apana blocks samana, Hingvastak may again be helpful in promoting proper downward movement of apana vayu.
Manda (dull) is involved in advanced stages of vata indigestion. At this point, visham agni gives way to mandagni. There is a feeling of fullness, inability to eat a normal quantity of food and generally low appetite. The patient, especially if they are of vata prakruti, may complain of weight loss due to low appetite. Because Hing is tikshna in quality, Hingvastak will help kindle appetite in this case. Mandagni will revert to visham agni and thence, with continued treatment, to samagni.
Diarrhoea-dominant IBS is an amla-pitta condition. The sour (amla) and liquid (drava) qualities of pitta are in excess. Shatavari is sweet and will balance the excess sour quality. Ashoka is astringent and drying, promoting firmness of stools and balancing the excess drava quality of pitta. Ashoka will also heal inflamed or irritated mucous membranes.
Differential Diagnosis
Before settling on a diagnosis of Vata indigestion or IBS, it is important to be certain that there is no organic disease process. A change in bowel habit occurring in a person over fifty could be the first symptom of colon cancer. At the very least, a faecal occult blood test should be done, to exclude colon cancer. Alternating constipation and diarrhoea accompanied by gas and bloating could indicate intestinal parasites, so look for ridges on the nails, a thickly coated tongue and shaved areas at the back of the tongue, all of which could be signs of parasites. Brain fog, low energy and low motivation can also suggest a parasitic infection. Studies have linked many cases of IBS to mild (occult) celiac syndrome or gluten intolerance (3, 4). While a blood test can be used to screen for this, one of the most effective clinical and diagnostic tools is a one month exclusion diet, cutting out all gluten grains(wheat, spelt, kamut, rye and barley) for a month. If the symptoms improve significantly on the exclusion diet, one can assume that it is best for the individual to stay away from gluten, since it is irritating their gut. In a severe case of vata indigestion or IBS, both mild celiac syndrome and parasitic infection or candida overgrowth may be significant factors which must be addressed.
By understanding the intricacies of the subdoshas involved in IBS, our Ayurvedic diagnosis becomes more refined, giving us a clearer understanding of the disease process. Appreciation of the gunas at play in this condition helps us be aware not just of what herbs to use, but what the energetics are that lead us to select these particular herbs.
All products mentioned in this article are available from www.banyanbotanicals.com.
Tomasz Mach: The brain-gut axis in irritable bowel syndrome–clinical aspects Med Sci Monit, 2004; 10(6): RA125-131
Yadav SK, Jain AK, Tripathi SN, Gupta JP. Irritable bowel syndrome: therapeutic evaluation of indigenous drugs. Indian J Med Res 1989;90:496503.
Wahnschaffe U, Ullrich R, Riecken EO, Schulzke JD Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome Gastroenterology. 2001 Dec;121(6):1329-38
O'Leary C, Wieneke P, Buckley S, O'Regan P, Cronin CC, Quigley EM, Shanahan F. Celiac disease and irritable bowel-type symptoms .Am J Gastroenterol. 2002 Jun;97(6):1463-7.
Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda community both nationally and internationally.
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