Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction characterised by recurrent abdominal pain associated with altered bowel habits, including diarrhoea, constipation, or a combination of both. Although it is not generally associated with life-threatening complications, its persistent symptoms can substantially affect daily functioning and quality of life. In India, reported prevalence estimates vary across populations and diagnostic criteria, with some studies reporting rates of approximately 12%-15%.1 In Ayurveda, Grahani Roga is described as a disorder associated with impaired digestive function (Agni) and may present with features such as irregular bowel movements, abdominal discomfort, bloating, and altered stool consistency. These manifestations overlap with those of IBS; however, Grahani Roga and IBS are not directly equivalent diagnoses. Ayurvedic assessment considers the status of Agni, the presence of Ama, and the involvement of different Doshas to guide treatment. In this context, Jeeraka (Cuminum cyminum), Bilva (Aegle marmelos), and Kutaja (Holarrhena antidysenterica) are traditionally used in digestive disorders and may be explored in the context of Grahani Roga management.
Traditional rationale and proposed role
In Ayurveda, Grahani is closely associated with the function of Agni. Impaired Agni (Agnimandya) is traditionally linked to incomplete digestion, Ama formation and irregular stool patterns. Management may include Nidana Parivarjana, Deepana, Pachana and Dosha Shamana, according to the individual's presentation.
- Jeeraka (Cuminum cyminum): Traditionally used for Deepana and Pachana, Jeeraka is incorporated into dietary and digestive preparations to support digestive function. Its specific therapeutic effect in IBS has not been established clinically.
- Bilva (Aegle marmelos): The fruit is traditionally used in bowel disorders, particularly presentations involving loose stools. Its Grahi application is relevant to diarrhoea-predominant symptoms.
- Kutaja (Holarrhena antidysenterica): Traditionally used in Atisara and Pravahika, Kutaja has an established place in Ayurvedic management of diarrhoeal conditions and associated bowel disturbances.
Clinical considerations and relevant clinical applications
- Symptom-based selection: Bilva and Kutaja may be considered within traditional management when loose stools predominate, while Jeeraka may be incorporated for digestive support. Selection should reflect Agni, stool pattern and associated symptoms rather than the IBS diagnosis alone.
- Clinical assessment: IBS subtype, symptom duration, dietary triggers and psychological factors should be evaluated. Gastrointestinal bleeding, unexplained weight loss and anaemia warrant investigation for alternative diagnoses.
- Individualised care: Dietary regulation, regular meal patterns and attention to stress and gut–brain interactions remain relevant alongside appropriate conventional management.
Evidence and research priorities
Clinical findings involving Kutaja and Bilva have primarily concerned multi-ingredient formulations rather than either herb independently. Reported improvements in Grahani Roga symptoms therefore cannot establish the individual contribution of these ingredients. Bilva has also been investigated in combination with Bacopa monnieri in IBS, with findings suggesting potential benefit, particularly for diarrhoea-predominant symptoms. These results should be interpreted in the context of the formulations studied and should not be extrapolated to Jeeraka or Kutaja.1,2
Conclusion
Jeeraka, Bilva and Kutaja have distinct traditional roles in Grahani Chikitsa, particularly in digestive support and bowel regulation. Their application should be individualised according to the patient's presentation. Contemporary clinical findings remain formulation-specific and do not establish the independent efficacy of all three herbs in IBS.
References
- Jat R, Gavali P, Godatwar P, Jain H, Kumar Patel N, Peston Jamas J. A clinical study of Digestive Health Capsules in the management of Grahani Roga with special reference to irritable bowel syndrome. J Ayurveda Integr Med Sci. 2024;9(4):16-28. doi:10.21760/jaims.9.4.3. https://jaims.in/jaims/article/view/3107
- Yadav SK, Jain AK, Tripathi SN, Gupta JP. Irritable bowel syndrome: therapeutic evaluation of indigenous drugs. Indian J Med Res. 1989;90:496-503. https://pubmed.ncbi.nlm.nih.gov/2697693/