Ayurvedic management of Irritable Bowel Syndrome (Grahani Roga): A case report

Abstract

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterised by irregular bowel movements and abdominal discomfort in the absence of detectable structural abnormalities. This condition significantly affects both physical and mental health. Although the precise etiology remains unclear, factors such as abnormal gut motility and sensory function, central nervous system disturbances, psychological stress, and luminal changes are implicated. IBS affects approximately 10–15% of the population, yet only 10% of those affected seek medical care. The prevalence is highest between ages 15 and 50, ranging from 3% to 22%, with young women more frequently affected than men. Conventional management primarily involves dietary modification, pharmacotherapy, and stress reduction, but these approaches rarely provide complete relief. Evidence indicates increased mortality risks associated with antibiotics and antispasmodics, highlighting the need for adjunctive therapeutic strategies. In Ayurveda, IBS is analogous to Grahani Roga, which is characterised by Muhurbaddha-muhurdrava Mala Pravritti (alternate formed and loose stools), Udara Shoola (colicky abdominal pain), Adhmana (abdominal distention), and Dourbalya (weakness). This report presents a 71-year-old female with frequent evacuation of stools of varying consistency (4–5 times daily), abdominal pain, bloating, generalised weakness, and reduced sleep for three years. The diagnosis of Grahani Roga was established based on clinical features, and the Rome IV criteria confirmed IBS with predominant diarrhea. The patient experienced minimal relief from three years of conventional therapy. She subsequently received Piccha Basti (enema) for 16 days and Shamana (pacifying) medicine for four months. Improvements were observed on the IBS-GAI, IBS-SSS, IBS-AR, and IBS-QoL scales, suggesting the potential benefit of Ayurvedic interventions in the management of IBS.

1. Introduction

The symptoms of irritable bowel syndrome (IBS) (ICD-10-CM: K58.0), a common functional gastrointestinal (GI) condition, include altered bowel habits and persistent abdominal pain or discomfort. Furthermore, there is no discernible biochemical or anatomical anomaly that could explain the symptoms [1]. It is a chronic, uncomfortable functional gastrointestinal condition that places a major economic and psychological burden on affected people by reducing their quality of life and increasing morbidity. The underlying pathophysiology of IBS is still poorly understood, despite its high incidence and frequently chronic, recurring character [2]. The estimated global prevalence of IBS is 11.2% [3], though community-based studies in India report lower prevalence estimates of 4–7% [4]. The symptoms are usually nonspecific and include irregular bowel habits (constipation, diarrhea, or alternating between the two), pellet-like faeces, an enhanced gastrocolic reflex, unexplained stomach discomfort, and weight loss in approximately 20% of patients. The four subtypes of IBS identified by the Rome IV criteria are constipation-predominant (IBS–C), diarrhea-predominant (IBS-D), mixed or alternating (IBS-M), and unclassified (IBS–U) [5]. Clinical symptoms and the exclusion of somatic disorders are the basis for the diagnosis of IBS. It is a complicated, multifaceted illness that involves dysregulation in different systems such as the neurological, immunological, digestive, microbiome, and environmental [6]. Bulk-forming agents, antispasmodics, antidepressants, and other current IBS treatments lack proven effectiveness [7]. When weighing the potential advantages and disadvantages of conventional treatment (such as severe constipation, severe diarrhea, and ischemic colitis), the risks are greater than the potential advantages [8]. Hence, Ayurveda management and medications should be explored in the management of IBS.

In Ayurveda, IBS closely aligns with Grahani Roga, a Tridoshatmaka (manifested by imbalances of Vata, Pitta, and Kapha) disorder of the Koshtha (digestive tract) that primarily affects the Grahani organ. The inclusion of Grahani Roga among the Ashta Mahagada (eight challenging disorders) underscores its significance [9]. Grahani, situated above the Nabhi (navel), is part of the GI tract responsible for receiving and digesting food [10]. According to Sushruta, Grahani, also known as Pittadhara Kala (GI mucosa), lies between the stomach (Amashaya) and the large intestine (Pakvashaya) [11]. Charaka attributes Grahani Roga to improper dietary and lifestyle practices such as excessive fasting (Abhojanata), eating before previous meals are digested (Ajeernabhojanata), overeating (Atibhojanata), irregular eating habits (Vishamashanata), and suppression of natural urges (Vegavidharanata). [Charaka Samhita Chikitsa Sthana 15/42-44] These behaviours disturb the Doshas (regulatory factors) and Srotasas (channels), including excretory (Purishavaha), GI (Annavaha), neurological (Vatavaha), and psychological (Manovaha) pathways, weakening digestive fire (Agnimandya) and impairing Koshtha function. Grahani Roga disrupts digestion by impairing Pachaka Pitta (digestive Pitta), Samana Vata (digestion and assimilation), and Kledaka Kapha (food lubrication), resulting in symptoms such as frequent alternation between constipation and diarrhea (Muhurbaddha-Muhurdrava), frequent large bowel movements (Bahusho Vimunchoti), painful and foul-smelling stool with undigested food (Sarujama Ama-apakwa Puti Malapravritti), depression (Manasa Sadanama), and weakness (Dourbalya) [12]. Management encompasses avoidance of triggers (Nidana Parivarjana), digestion of undigested substances (Amapachana), stimulation of digestive fire (Agnideepana), stabilisation of stool (Sangrahana), removal of vitiated Doshas (Shodhana), and Dosha pacification (Shamana).

In this case, principal causative factors (Nidanas) included frequent consumption of fermented foods, irregular meal timing, excessive intake of spicy and oily foods, daytime sleep (Diwaswapna), irregular eating patterns (Vishamashana), recurrent indigestion, and psychological stress. These dietary and lifestyle factors primarily disrupted Vata and Pitta, leading to impaired digestive fire (Agni Dushti) and the accumulation of Ama (undigested substances), ultimately resulting in Grahani Roga. This report details the clinical presentation and Ayurvedic management of Grahani Roga, highlighting the potential role of Ayurveda in IBS care.

2. Patient information

2.1. De-identified patient-specific information

A 71-year-old married housewife from a middle economic background attended the OPD with abnormal bowel habits, abdominal pain, and weakness lasting 3 years. She reported a stressful life and poor appetite. Her diet often included fermented foods like idlis and dosas, and for breakfast, she ate poha, besan chilla, or bread. She consumed foods with Ushna (hot) and Snigdha (unctuous) qualities, mainly Katu Rasa (pungent-tasting), at irregular times and without digesting previous meals.

2.2. Primary concerns and symptoms of the patient

The patient reported irregular bowel habits (constipation, diarrhea, or alternating), occurring 4–5 times daily, persistent abdominal pain, and abdominal distension for the past three years. Symptoms were progressive, accompanied by impaired digestion and generalised weakness, and had intensified over the past six months.

2.3. Medical, family, and psycho-social history, including relevant genetic information

The patient has been hypertensive for five years. There is no family history of IBS or genetic disease. She reports significant psychological distress from her condition, including irritability and frequent stress.

2.4. Relevant past interventions with outcomes

The patient had been experiencing symptoms since January 2022 and was under conventional medical care for nearly three years. During this period, she underwent colonoscopy and upper gastrointestinal endoscopy, which revealed no significant lower gastrointestinal pathology but showed features of antral gastritis and hiatus hernia. She received multiple pharmacological treatments, including antidiarrheal, anticholinergic, anti-amoebic, antidepressant medications, and proton pump inhibitors; however, no significant or sustained improvement was observed, and symptoms progressively worsened over time. The patient used Telmisartan 40mg and Hydrochlorothiazide 12.5mg once daily for five years for hypertension. She had a history of jaundice 20 years ago but recovered. She was on Dexlansoprazole (30 mg) and Librax (2.5 mg) daily for one year without significant improvement.

3. Clinical findings

3.1. Significant physical examination and important clinical findings

The patient was moderately built and nourished, with a height of 157 cm, a weight of 50.9 kg, and a BMI of 20.64 kg/m2. She was afebrile with stable vitals: pulse 82 beats/min, respiratory rate 18 breaths/min, blood pressure 130/80 mmHg. Examination revealed no pallor, icterus, clubbing, cyanosis, edema, lymphadenopathy, or abdominal tenderness.

3.2. Ashtavidha Pariksha (eight-fold examination of the patient)

Nadi (pulse) was 82/min, Mala (bowel) was Sama (faces mixed with Ama), Muhurbaddha-muhurdrava (frequent alternate passage of formed and loose stools), Mutra (urine) was Prakrita (normal), and Jivha (tongue) was Sama (coated). Shabda (voice), Sparsha (touch), and Drika (vision) were Prakrita, while Akriti (body build) was Madhyama (moderately built).

4. Timeline

The timeline of the patient's symptoms, diagnosis, treatment and outcomes is outlined in Table 1.

Table 1.

Timeline of the disease course, diagnosis, treatment and outcomes.

Time Period	Clinical events and intervention
23 May, 2025	Patient visited the geriatric OPD of Kayachikitsa department, diagnosed as Grahani Roga, started Ayurvedic oral medication, and showed mild improvement in symptoms
21 June, 2025	Admitted in IPD and Pichha Basti [Table 4] was administered along with oral medications [Table 3] (stopped allopathic medications), significant improvement in all the symptoms
09 July, 2025	Discharged from IPD, and oral medication continued
10 October, 2025	Follow up at OPD, no fresh complaints

5. Diagnosis

5.1. Diagnostic testing

To rule out any known etiology, investigations were performed, including hematological tests, biochemical profiles and endoscopic tests. All haematological tests were within normal limits [Table 2]. Upper GI Endoscopy was done in 2022 and 2023, which showed a hiatal hernia with antral gastritis. A colonoscopy was performed on March 23, 2022, with no abnormalities noted. The case was diagnosed as IBS with predominant diarrhea (IBS-D).

Table 2.

Haematological tests reports.

Biochemical Parameters (23/06/25)
CBC (Complete Blood Count) With ESR	Hb (gm%)	10.5
	TLC (/cumm)	5000
	DLC (P, L, E + M)	(55, 36, 09)
	Platelets (lacs/cumm)	2.62
	ESR (mm/hr)	67
BSL (Blood Sugar Level)	Fasting (mg/dl)	99
	Post meal (mg/dl)	102
LFT (Liver Function Test)	SGOT (IU/L)	21.9
	SGPT (IU/L)	9.9
	Bilirubin (Total) (mg/dl)	0.30
	Bilirubin (Direct) (mg/dl)	0.17
KFT (Kidney Function Test)	Blood Urea(mg/dl)	19.9
	Sr. Creatinine(mg/dl)	0.92
	Uric Acid(mg/dl)	6.0
Lipid Profile	Cholesterol(mg/dl)	189
	Triglyceride(mg/dl)	93.8
	HDL	37.2
Urine	A/B	NIL
	Sugar
	ME
	BS/BP

5.2. Diagnostic challenges

According to current standards, a restricted diagnostic evaluation is advised to rule out other illnesses that exhibit symptoms comparable to IBS. This strategy promotes the prompt initiation of appropriate therapy and helps prevent unnecessary testing. For patients with IBS-D, recommended testing includes faecal calprotectin or lactoferrin, celiac serologies and C-reactive protein (CRP) to exclude inflammatory bowel disease (IBD). Further testing for bile acid diarrhea may be suitable when clinically suspected.

5.3. Diagnostic reasoning, including differential diagnosis

Depending on the predominant symptoms, several differential diagnoses for IBS-D should be considered, including IBD, celiac disease, bile acid diarrhea, small intestinal bacterial overgrowth (SIBO), microscopic colitis, food intolerance (lactose, fructose), chronic infections (e.g., giardiasis), medications, and malignancy. In this case, no other metabolic, infection, or inflammatory causes were identified, leading to a diagnosis of IBS based on the patient's history, clinical symptoms, IBS Symptom Severity Score (IBS-SSS) and Rome IV criteria. From an Ayurvedic diagnostic perspective, the patient presented with features suggestive of Saama Grahani, indicated by a coated tongue, impaired digestion, abdominal distension, weakness, and irregular bowel habits with passage of partially digested stools. The predominance of Vata and Pitta Dosha was inferred from symptoms such as frequent loose stools and abdominal pain associated with digestive disturbance. The state of Agni was assessed as Mandagni, which plays a central role in the pathogenesis of Grahani Roga. In addition, the patient reported persistent stress and irritability, suggesting the involvement of Rajasika Manasika Dosha.

5.4. Prognosis

IBS is a chronic illness marked by repeated symptoms of different intensities. However, life expectancy among those with IBS is equivalent to that of the general population. During follow-up, the diagnosis usually does not change.

6. Therapeutic intervention

6.1. Types of therapeutic intervention

The Ayurvedic treatment was administered as Shamana (pacifying) medicine, followed by Shodhana. She was prescribed oral formulations initially for a month. The patient was admitted for Pichha Basti (a medicated enema) for 16 days. After discharge, oral medications were continued. A Pathya (dietary regimen) emphasising Supachya (easy to digest) and Laghu (light) foods, such as buttermilk, ghee, green gram soup, and jawar roti, was implemented.

The classical reference of Piccha Basti is described in Charaka Samhita, where a mucilaginous enema prepared using Shalmali (Bombax ceiba) processed with milk along with Ghrita (ghee), Taila (oil), and Yashtimadhu (Glycyrrhiza glabra) is indicated for conditions such as Pittatisara (Pittaja variant of diarrhea), Grahani, and Jeernatisara (chronic diarrhea). [Charaka Samhita Chikitsa Sthana 19/43-68]

In the present study, Piccha Basti was administered with slight modifications. Instead of the classical preparation using Shalmali stalk paste, Mocharasa (Bombax ceiba exudate) was used in the form of Kshirapaka, providing a similar Picchila and Grahi effect on the intestinal mucosa. Additional ingredients such as Madhu (honey), Saindhava (rock salt), and Madanaphala Churna (Randia dumetorum) were incorporated to facilitate proper emulsification of the Basti Dravya (enema components) and enhance mucosal protection and intestinal healing. These modifications were made with consideration of drug availability, ease of preparation, and the patient's clinical condition, while maintaining the therapeutic principles of classical Piccha Basti.

6.2. Administration of therapeutic intervention

The Ayurvedic therapeutic interventions are described in Table 3 (Shamana Chikitsa) and Table 4 (Shodhana Chikitsa).

Table 3.

Shamana Chikitsa.

Shamana Chikitsa
Duration	Treatment	Avastha (condition) of disease and rationale for medication
May 23-June 23, 2025	Sanjivani Vati 500mg BD after meal with lukewarm water	The patient presented with Saama Grahani with Agnimandya. Hence, medicines with Amapachana and Agnideepana properties (Sanjivani Vati, Arogyavardhini Vati) were prescribed to digest Ama and improve Agni. Laghusutashekhara Rasa and Avipattikara Churna aided Pitta-shamana and digestive regulation, while Takrarishta provided Deepana and Grahi action.
	Arogyavardhini Vati 500mg BD after meal with lukewarm water
	Laghusutashekhara Rasa 125mg BD before meal with lukewarm water
	Avipattikara Churna 5 gm BD before meal with lukewarm water
	Takrarishta 20ml TDS with lukewarm water
June 24- July 08, 2025	Sanshamani Vati 250mg BD after meal with lukewarm water	At this stage, although some improvement in digestion was noted, features suggestive of residual Ama and persistent loose stools remained. Therefore, Ativisha + Shunthi + Musta Kwatha was introduced for Amapachana. Loose stools persisted. Hence, medicines with Grahi, Deepana, and Atisarahara properties were emphasized, while Guduchi Satva and Sanshamani Vati supported Pitta-shamana.
	Laghusutashekhara Rasa 125mg BD before meal with lukewarm water
	Avipattikara Churna 5 gm + Guduchi Satva 500mg BD before meal with lukewarm water
	Takrarishta 20ml TDS with lukewarm water
	Ativisha + Shunthi + Musta Kwatha 40ml BD before meal
July 09-October 10, 2025	Avipattikara Churna 10 gm HS with lukewarm water	By this phase, the stool frequency had reduced, and Agni had improved, indicating a transition toward Nirama Grahani. Therefore, the medicines focused on strengthening digestion, regulating Vata, and promoting mucosal healing. Hingwashtaka Churna helped with Vatanulomana and Agnideepana, while Yashtimadhu Ghrita was introduced for its Pitta-shamana, anti-inflammatory, and mucosal-protective effects, aiding the restoration of intestinal integrity.
	Hingwashtaka Churna 3 gm BD before meal with Goghrita
	Yashtimadhu Ghrita 10ml OD on empty stomach with lukewarm water
	Takrarishta 20ml TDS with lukewarm water
October 11,2025	Advised to continue	At this stage, the patient showed significant symptomatic improvement with stable bowel habits, indicating the recovery phase of Grahani. Therefore, maintenance therapy was advised to support Agni, maintain intestinal mucosal health, and prevent relapse.
	Yashtimadhu Ghrita 10ml OD on empty stomach with lukewarm water
	Takrarishta 20ml BD with lukewarm water

Table 4.

Shodhana Chikitsa.

Shodhana Chikitsa- Pichha Basti (June 24- July 09, 2025)
Sr. No.	Karma (Procedure)	Process
1	Poorva Karma (preparatory procedures)	Sarvanga Abhyanga (therapeutic whole-body massage) was performed with Tila Taila for 30 minutes, followed by Sarvanga Bashpa Swedana (whole-body sudation) with Dashmoola Kwatha for 15 minutes.
2	Pradhana Karma (main therapeutic procedures)	120 ml of Basti Dravya was administered
		Madhu (honey) - 10 gm
		Saindhava (rock salt) - 2 gm
		Tila Taila (sesame oil) - 20ml
		Goghrita (cow ghee) - 20ml
		Mocharasa (Bombax ceiba) Kshirapaka (decoction made in milk by adding 10 gm Mocharasa, 120ml milk, 120ml water) - 60ml
		Yashtimadhu Churna (Glycyrrhiza glabra) - 5 gm
		Madanaphala Churna (Randia dumetorum) - 5 gm
3	Pashchata Karma (post therapy procedures)	Lifting of the legs, patting the buttock region, and anti-clockwise massage of the abdomen were performed for 5 minutes.

7. Follow-up and outcomes

7.1. Clinician and patient-assessed outcomes

Improvement was observed in the IBS Global Assessment of Improvement Scale (IBS-GAI), IBS Symptom Severity Scale (IBS-SSS), IBS-Adequate Relief (IBS-AR) and IBS-Quality of Life (IBS-QoL) noted during and after treatment along with clinical improvement in stool frequency and consistency (assessed on Bristol stool examination), pain and gaseous distention of the abdomen [Table 5]. The detailed scoring methodology and parameters of each scale are provided in [Annexure 1]. After 4.5 months of treatment, the patient showed improvement in all the above-mentioned complaints.

Table 5.

Follow up assessments.

Assessment parameter	23 May, 2025	21 June, 2025	09 July, 2025	10 October, 2025
IBS-GAI	Not applicable -baseline	5	6	7
IBS-SSS	320	250	100	70
IBS-AR (Yes/No)	Not applicable -baseline	Yes	Yes	Yes
IBS- QoL	50	58	72	86
Frequency of stool	4-5 times/day	3-4 times/day	2-3 times/day	1-2 times/day
Pain/Abdominal discomfort	Moderate	Moderate	Mild	Absent
Bristol stool form scale	Type 6/7	Type 6/7	Type 5/6	Type 4/5

The detailed scoring methodology and parameters of each scale are provided in [Annexure 1].

7.2. Intervention adherence and tolerability

The patient reported that all medications were tolerated and that no discomfort was experienced.

7.3. Adverse and unanticipated events

The treatment was found to be safe and effective with no adverse effects.

8. Discussion

8.1. Discussion of the relevant medical literature with references

In the present case, a patient with long-standing symptoms of diarrhea-predominant irritable bowel syndrome (IBS-D) demonstrated clinical improvement following Ayurvedic management. The patient had persistent symptoms for nearly three years despite conventional medical treatment, which prompted the exploration of Ayurvedic care.

The therapeutic approach in this case was based on classical Ayurvedic principles - Nidana Parivarjana, Agnideepana, Amapachana, Vatanulomana (normalising the downward movement of Vata), Grahi Karma (improves absorption and solidifies stools) and Pitta-Shamana. Avoidance of causative factors was the first step, including cessation of faulty food habits, irregular eating patterns, daytime sleeping, and incompatible foods. Dietary correction was central to management. Ghee served as a Tridoshaghna (pacifies all three Doshas) and Agnideepaka, while its Sheeta Virya (cold potency) pacified aggravated Pitta [13]. Takra (buttermilk) is described as highly effective in Grahani due to its Deepana, Grahi, and Tridoshaghna properties. IBS is significantly influenced by the gut-brain axis, the link between the gut and the brain. Takra's positive effects on mood and psychological well-being may be explained by this axis, which can help reduce the stress and anxiety linked to IBS [14].

A significant therapeutic component in this case was Piccha Basti, one of the specialised types of Niruha Basti (decoction enema) described in Ayurveda. [Charaka Samhita Chikitsa Sthana 19/43-68] Due to its Picchila (mucilaginous, protective) nature, it forms a soothing layer over the intestinal mucosa, reducing irritation, friction, hypersensitivity, and excessive motility, which are the key features in IBS [15].

8.1.1. Mode of action of contents of Pichha Basti

Additional advantages of Sandhana (healing), Ropana (replenishment of body tissues), and alleviation of Atisara (diarrhea) pathologies may be obtained by adding Madhu (honey) to certain Piccha Basti combinations [16]. Although Lavana (rock salt) is a necessary ingredient in Niruha Basti, it is typically used in very small amounts in Basti intended for Pitta Dosha. [Charaka Samhita Chikitsa Sthana 19/118] In addition to its Pitta pacifying properties, Ghrita is beneficial for replenishing tissue elements and bodily strength. Use of Tila Taila (sesame oil) with Ghrita is referenced only in one Piccha Basti combination recommended for the treatment of Atisara. [Charaka Samhita Chikitsa Sthana 19/64-68] Milk is being Madhura (sweet), Sheeta (cold), and Pitta pacifying; it is also Sandhaaniya (tissue binding), Jeevaniya (vitalizer), Deepana (digestion enhancing), Bruhana (anabolic), and Atisaranashaka (antidiarrheal), etc. [17] Mocharasa (Bombax ceiba) is synonymous with Picchila or Piccha because it has a higher amount of mucilage. It performs the Lepana Karma (coating) and has Tantulata (thread-like formations), which are associated with mucoadhesive properties that protect and nourish the GI tract's mucosa, which is inadequate in several types of inflammatory diseases [18]. Madanaphala has anti-inflammatory and analgesic activities [19].

8.1.2. Mode of action of oral medications

Other oral medicines were prescribed to stimulate Agni, digest Ama, regulate bowel movements, and stabilise intestinal absorption.

Sanjivani Vati contains antioxidant qualities and acts as Tridoshaghna, Aampachaka, and Amavishahara (antitoxic activity). It is recommended for Ajeerna (indigestion), Gulma (fantum abdominal tumours), and Visuchika (cholera) [20].

Arogyavardhini Vati is traditionally used for Agnideepana, Amapachana, and Vata-Pitta Shamana, thereby helping to correct metabolic disturbances associated with Grahani Roga [21]. It has stomachic, carminative, and antispasmodic effects. It is useful for diarrhea [22].

Laghusutashekhara Rasa balances Pitta Dosha and advances Agnideepana by calming Amlata (sourness) and Tikshnata (sharpness) [23].

Sanshamani Vati, which contains Guduchi (Tinospora cordifolia), is used as a Rasayana (immunomodulatory) with anti-allergic, anti-inflammatory, and antioxidant properties [24].

Hingwashtaka Churna is the medication of choice for treating a variety of digestive problems, including Ajeerna, Agnimandya, and Grahani, due to its Vata and Kaphahara qualities and its Agnideepana property, which promotes digestion [25].

Avipattikara Churna, as a formulation, is primarily known for its Pitta-shamana, Amapachana, and Agnideepana actions, and it was used to correct Agnimandya and Pitta aggravation, which were considered important contributors to the pathogenesis of Grahani Roga [26]. The components of Avipattikara Churna have cytoprotective and anti-ulcer qualities [27].

Takrarishta cures Shotha (swelling), Gulma, Arsha (haemorrhoids), Krimi (worms), Prameha (diabetes), and Udara Roga (abdominal problems) by stimulating the digestive system. [Charaka Samhita Chikitsa Sthana 15/120-121]

Yashtimadhu Ghrita was administered in the later phase of treatment, considering the endoscopic finding of antral gastritis. Yashtimadhu has Madhura Rasa, Sheeta Virya, and Madhura Vipaka. It possesses Vata-Pitta-shamana, Shothahara and Vranaropana properties, which help to soothe gastric mucosal irritation and promote healing of the gastrointestinal lining [28]. Also, it has anti-inflammatory, anti-ulcer, healing, and skin-regenerating qualities [29].

Shunthi, Ativisha, and Musta decoction helps in Amapachana. [Charaka Samhita Chikitsa Sthana 15/98] Musta (Cyperus rotundus) possesses analgesic, anticonvulsant, nootropic, anti-diarrheal, and central nervous system depressant properties [30]. Ativisha (Aconitum heterophyllum) is beneficial in IBS-D, as it has anti-inflammatory, anti-diarrheal, anthelmintic and immunomodulatory activities [31]. And Shunthi (Zingiber officinale) also affects digestion-related issues [32].

The symptomatic relief achieved in this patient can be attributed to the synergistic integration of dietary regulation, lifestyle correction, Shamana medicines, and Piccha Basti, all of which together addressed the contributors of IBS. By correcting Agni, reducing Ama, normalising bowel movements, stabilising Vata, calming Pitta, and strengthening the intestinal mucosa, sustained clinical improvement was observed.

8.2. Scientific discussion of the strengths and limitations associated with this case report

8.2.1. Strengths

This case underscores the potential benefit of a comprehensive Ayurvedic treatment plan, illustrating the benefits of a multimodal approach—including Pathya-Apathya and Nidana Parivarjana—alongside medical management, rather than reliance on a single-drug intervention. Given the limited documentation of Piccha Basti for IBS, this report provides a structured clinical observation of its mucosal-protective properties. Follow-up observations demonstrating sustained improvement further enhance the reliability of the treatment outcomes.

8.2.2. Limitations

As a single case report, the findings cannot be generalised to the broader IBS population due to the lack of sample size and statistical analysis. The study primarily relies on subjective and clinical parameters. Although colonoscopy and endoscopy were performed, faecal calprotectin, stool analysis, microbiome, and motility studies were not included to correlate with biological changes. The results also depended on strict adherence to Pathya Ahara, Nidana Parivarjana, and the Piccha Basti regimen, which may not be easily replicable in all patients.

9. Conclusion

This case demonstrates that an individualised Ayurvedic regimen, particularly Piccha Basti in combination with Shamana therapy and dietary regulation, can lead to improvement in symptoms and quality of life in IBS-D (Grahani Roga), even when conventional treatments are ineffective. Correction of Agni, reduction of Ama, and stabilisation of bowel function contributed to clinical and quality-of-life improvements. However, as these findings are based on a single case, larger studies are necessary to validate the therapeutic potential of this approach.

10. Patient perspective

Following completion of therapy, the patient reported satisfaction with the improvement in her initial symptoms and noted that she no longer required allopathic medication, which she had previously used for an extended period. This response indicates a positive perception of the treatment's overall efficacy. The patient's perspective was documented during a telephonic follow-up on 25 November 2025.

Informed consent

Written patient consent was taken by the author before this case report was submitted to the journal. The patient was informed that her name and initials would not be published, and reasonable efforts would be made to conceal her identity.

Author contributions

M.M.: Conceptualisation, methodology, validation, formal analysis, investigation, resources, data curation, visualisation, writing of the original draft, and writing – review and editing.

A.T.: Conceptualisation, methodology, validation, supervision, and critical review and editing of the manuscript.

Declaration of generative AI in scientific writing

The authors used Grammarly to check spelling, punctuation, and grammar. After this, the authors reviewed and edited the content as needed, taking full responsibility for the publication's content. No generative AI tools were used to create content, generate ideas, or interpret results.

Funding sources

None.

Conflict of interest

None.

Appendix A. Supplementary data

The following are the Supplementary data to this article: