IAJPS, 2015, Volume2, Issue 2, 601-608 Byadgi et al ISSN 2349-7750

ISSN 2349-7750

INDO AMERICAN JOURNAL OF

PHARMACEUTICAL SCIENCES

Available online at: [Link] Review Article

A CRITICAL APPRAISAL OF VIBANDHA (CONSTIPATION)

Gond Pushpa *1, Kumar Jitendra2, Byadgi P. S3, Singh Lakshman 4
1. Ph.D. Scholar, Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences,
Banaras Hindu University, Varanasi
[Link] Resident, Department of Vikriti Vigyan, Faculty of Ayurveda, Institute of Medical Sciences,
Banaras Hindu University, Varanasi
[Link] Professor, Department of Vikriti Vigyan, Faculty of Ayurveda, Institute of Medical Sciences,
Banaras Hindu University, Varanasi
[Link] and Head, Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences,
Banaras Hindu University, Varanasi
Abstract:
Vibandha/vibaddha/baddhapurisha means obstruction or constipation .i.e. sanga and which indicates one of the
state of srotodusti especially in Purishavaha srotas. The word constipation comes from the Latin constipare meaning
"to press, crowd together". According to Medilexicon's medical dictionary, constipation is "A condition in which
bowel movements are infrequent or incomplete". Constipation is also known as costiveness, and
[Link] (Constipation) is one of the most common gastrointestinal complaints, resulting in over 2
million physician visits per year and accounting for more than 1 billion in sale of over the counter laxatives. In
India, the normal stool frequency is 1 per day in contrast to 3 per week in West. Constipation may be the end result
of many gastrointestinal and other medical disorders. People think that it’s a simple problem but in reality it may
hindered a day to day life. Ignorance of Vibandha may generate groups of disease which are very painful condition
and make life disturbed. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in
particular situations surgery may be required. Insufficient dietary fiber intake, inadequate fluid intake, diminished
activities; side effects of medications, hypothyroidism and obstruction by colorectal cancer are the possible causes in
elderly for constipation. Constipation is usually easier to prevent than to treat. Following the relief of constipation,
maintenance with adequate exercise, fluid intake, and high fiber diet is recommended.
Keywords: Vibandha, Constipation, Purishvaha srotas
Corresponding Author:
QR code
Byadgi P. S
Assistant Professor,
Department of Vikriti Vigyan,
Faculty of Ayurveda,
Institute of Medical Sciences,
Banaras Hindu University, Varanasi.
E-Mail:psbyadgi@[Link]

Please cite this article in press as Byadgi et al. A Critical Appraisal of Vibandha (Constipation), Indo American J
of Pharm Sci, 2015;2(2):601-608.

[Link] Page 601

 IAJPS, 2015, Volume2, Issue 2, 601-608 Byadgi et al ISSN 2349-7750

INTRODUCTION 1. Infrequent passage of stool (3 bowel

Body is originally composed of dosas, dhatus and movements/week)
malas [1]. Consumed food as well as dhatus manifest 2. Hard stools
malas during the process of digesttion and 3. Straining at stool
metabolism for example ; vida or Varcha or purisha 4. Incomplete evacuation
(Stool) and Mutra (Urine) are the wase product of In India, the normal stool frequency is 1 per
anna (food) etc.[2]. It is called mala because of day in contrast to 3 per week in West [11].
having a tendency to vitiate others [3]. When mala Constipation Vs Kostha:
excessively increased than its normal amount it Bowels (Kostha) are three types- mridu (soft), krura (
became shalya (Foreign body) which causes painful hard) and madhyama ( medium). The soft bowels
disorder in body[4,5]. The Words have abundance of pitta and are purgated even by
Vibandha/vibaddha/baddhapurisha is similar to milk; the hard bowels have predominance of vata and
constipation and it means obstruction or constipation kapha and are purgated with difficulty while the
.i.e. sanga and which indicates one of the state of medium bowels have balanced dosas and as such are
srotodusti especially in Purishavaha srotas. In moderate [12]. According to Acharya
Description of classification of srotodusti, example of Sharangadhara, the individuals who have more pitta
sanga (complete or partial obstruction of srotas) is are of mild type of alimentary canal (mridukostha),
vibandha etc, are given [6]. The sites of origin of the those with more kapha are of medium type of
channels carrying feces are the colon and the rectum. alimentary canal (Madhyam kostha) and people with
The characterstic manifestations of their vitiation are more vata are graded as having wild type of
the voiding of small quantity of feces with difficulty, alimentary canal (krura kostha) and are constipated
voiding of large quantity of very watery and very [13].
scybalous stool associated with sound and pain [7]. Description of Vibandha (Constipation) in
Varchovahasrotansi (channels carrying feces) get Ayurveda:
vitiated by the suppression of the urge for defecation, Vibandha is vyapada of Vamana and Virechana [14].
intake of food in large quantity, intake of food before It is side effect of sansodhan (Vamama or Virechana)
the digestion of the previous meal specially in those in Ajirna [15], symptoms of parikartika (fissure in
who are emaciation and having weak power of ano) [16]. It is apatarpanjanya roga (Diseases
digestion [8]. Purisha or Faeces support the body caused by nutritional deficiency) [17], and one of the
and maintain the equilibrium of vayu and agni[9]. complications of immediate haemostasis in Raktarsha
Material and Method: This study is based on a (bleeding piles) [18].
review of Ayurvedic text. Materials related to Causes of Vibandha (Constipation):
Vibandha, Constipation and their relation have been A frequent functional cause of constipation is
collected and compiled. The main Ayurvedic texts irregular bowel habits that have developed through a
used in this study are Charak Samhita, Susruta lifetime of inhibition of the normal defaecation reflex
Samhita, etc. [19]. According to Acharya Charak, If one holds the
Constipation: urge for defecation it causes colic pain, headache,
Constipation (also known as costiveness or dyschezia retention of faeces and flatus, cramps in the calf
) refers to bowel movements that are infrequent or muscles and distension of abdomen [20].
hard to pass. Constipation is a common cause of Constipation may be the end result of many
painful defecation [10]. gastrointestinal and other medical disorders. The
It is defined (ROME II criteria) as the presence of any causes (Table 1) may be luminal (obstructive) or
two or more of the following symptoms for at least 3 functional (abnormal motility).
months:

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Table 1: Causes of Constipation

Causes of Constipation
A. GASTROINTESTINAL B. NON-GASTROINTESTINAL
(1)Dietary (1)Drugs
 Low fiber, Inadequate food  Opiates
(2)Motility  Calcium antagonists
 Slow transit  Iron Supplements
 Irritable bowel syndrome  Anticholinergics
 Drugs(given in non-gastrointestinal  Aluminium containing antacids
causes) (2)Neurological
 Intestinal Obstruction and Pseudo-  Multiple Sclerosis
Obstruction  Parkinsonism
 Spinal Cord Disease
 CVA
 Autonomic
 neuropathy
(3) Structural (3)Metabolic /Endocrine
 Colonic carcinoma  Diabetes mellitus
 Megacolon e.g., Congenital or acquired  Pregnancy
 Diverticulosis of colon  Hypocalcaemia
 Amyloidosis
 Hypothyroidism

 (4) Defecatory disorders (3)Others

 Obstructive  Schizophrenia
 Anorectal Disease e.g., fissure, piles.  Depression

Table 2: Different presentation of mala or Purisha according to Ayurveda which are form of
vibandha(constipation)
Type of presentation of Causes
Purisha
Baddha Purisha Ajirna Lakshan, Vistabdhajirna, Alasaka, Pravriddha Amavata
Purishaja Anaha, Arsha Purvaroop, Vataj Arsha,Vataj Asthila,
Atisara Purvaroop,Vatadushtastanyapaanaj Balaroga, Gudagat Vata, Gulma Roga,
Antarvega Jwara ,Sannipataja Jwar ,
Vataja Jwara, Kaphavrita Samaan, Kosthashrita Vata,
Kostha Vrana , Purishaja Krimi ,Pandu Ashadhya Lakshana,
Paramad,Vataj Parinamshoola, Vataj Prameha Upadrava ,
Pratyashthila ,Sanniruddha, Kaphaj Shool ,Vataj Shoola,
Mahashwasha, Baddhagudodar, Udar Roga Lakshana,
Purishaja Udavarta, Vataj Udavarta, Kosthagata Vata,
Pakvashayagat Vata, Vatavyadhi Upadrava, Vistabdhajirna

Ghan Purisha/ Smgrahani

Grathit Purisha Vataja Arsha
Sushka Purisha Udavarta, Vataj Grahani Dosha
Stoka Purisha Vaataj Arsha

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Investigation: Rechana: The excreta, whether formed or unformed,

Digital rectal examination, evacuating proctoscopy is liquefied and expelled from the body by the effect
and sigmoidoscopy are useful investigations to know of a rechana (cathartic) drug as in the case of trivrt
the exact cause of constipation. Blood Biochemistry (turpeth) [33].
e.g. serum calcium and thyroid function tests. Colonic Sramsana and Basti: Sramsana (purgation)
transit studies by radio opaque markers help to eliminates either pitta or kapha or both of them from
distinguish slow transit constipation from normal the pittashaya (lower portion of the stomach and
transit constipation. If symptoms persist, then barium small intestine) [34], kritmala (Cassia fistula) is the
enema and colonoscopy should be carried out to look example for this [35]. Basti eliminates all the three
for the structural disease [21]. dosas lodged in the pakvashaya (colon).[36]
Different presentation of mala or Purisha according Administration of anuvasana basti ,when there is
to Ayurveda which are form of ununctuousness (rukshatva) and adhesion
vibandha(constipation) given in Table 2:[22]. (baddhatva) in the feces [37].
According to Maharshi Charak, for purgation in the
MANAGEMENT event of the vitiated dosas of the colon, the physician
Treatment According To Ayurveda: should prescribe Trivrut (Operculina turpethum),
In nutshell, the management consists of elimination Haritaki (Terminalia chebula), Amalaki (Embelica
of etiological factors [23]. Treatment of constipation officinalis), Bibhitaki (Terminalia belerica), danti
which having cause to hold defaecation urge is- (Baliospermum montanum), Nilini (Indigofera
fomentation [24], massage, tub bath, suppositories tinctoria), Saptala (Acacia cocinna), vacha (Acorus
and enema should be given and one should take foods calamus), Kampillaka (Mallotus philippinensis),
and drinks which are laxative in nature [25]. Gavakshi (Citrullus colocynthis), Kshirini (Mimosops
Rasa’s role in stool evacuation: hexandra), Udakiryaka (Pongamia pinnata),
Owing to their unctuousness drugs and diets having Pilu(Salvadora persica), Aragvadha (Cassia fistula),
sweet, sour and saline tastes are useful for the Draksha (Vitis vinifera), dravanti (Jatropha
elimination of stool. On the other hand ,drugs and glandulifera), Nichula(Borringtonia acutangula [38],
diets having pungent, bitter, and astringent taste Shatavaryadi Ghrita [39], Yavanishadav [40],
creates difficulty in elimination of stool [26]. So, Astashatarishta [41], Pippalyadi ghrita,[42],
drugs and diets should be managed accordingly to Phalarishta, [43], Dvitiya Phalarishta [44], Mustadi
rasa help to alleviates Vibandha (constipation). enema [45], Patala (Stereospermum suaveolens) for
In treatment of Vibandha (constipation), purgation asthapana vasti (A variety of enema) in the treatment
eliminates pitta. There are three types of virechan of Constipation etc [46]. Vibandha (constipation)
(purgation): (1) Sukha Virechana (causing easy must be treated in the beginning by drugs that
purgation) e.g; Trivrit (Operculina turpethum), (2) promote digestion [47]. Administration of milk
mridu virechana (causing mild purgation) e.g; (boiled with trikantaka, bala, vyaghri, guda and
Aragvadha (Cassia fistula) (3) Tikshna Virechana nagara) and Niruha basti is useful to remove malas
(causing strong purgation) e.g; Milk of snuhi (waste products) [49, 50].
(Achyranthes aspera) [27]. Luke warm water is Pathya in Constipation:
indicated in vibandha [28]. If vayu is occluded by Sidhu (made of uncooked juice) [50].
feces, then castor oil and oleation therapy as indicated Phalavarga : Matulunga [51, 52], ambira [53],
for udavarta [29]. Draksha (Grape) is laxative [54].
Vibandha is one of the Apatarpana janya roga and in Shakavarga:Puspaphala(Kusmanda), alabu, kalinda
its treatment, drinks prepared of roasted corn flour, [55].
alcohol, honey and sugar which help in elimination of Harita varga: Plant that are use in salad form.
faeces [30]. Ginger juice cures vibandha( constipation) [56].
Mode of action of drug in constipation: Vataghni madira Sauviraka and Tushodaka and sour
Anulomana Drug: The drug which helps in proper kanji are laxative [57]. Sauvarchal (black salt with
formation of malas (excreta) and also breaks the smell) is light in digestion , alleviates constipation
obstruction and brings them downwards is known as [58],
anulomana (aperients). Haritaki (Chebulic Vibandha (Constipation) is instantaneously cured by
myrobalan) is an example for this action [31]. the administration of Bhallataka [59], Rasona (garlic)
Bhedana: The drug which breaks down either is laxative [60].
constipated or loose faecal matter or the vitiated
dosas and expels them out is known as bhedana According to Modern text:
(purgative) as in the case of katuki (Picrorrhiza The basic aim of treatment is to find out the cause and
kurroa) [32]. treat it.

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1. Dietary adjustment: Fiber supplementation is the

first line therapy for normal or slow transit DISCUSSION
constipation. Wheat bran is the most effective Surprisingly in Ayurveda, there is no description of
supplement followed by vegetables, fruits, mucilages, vibandha independently as a disease but it has been
corn and cellulose. This adjustment is suitable for described as apatarpana janya gada (roga) in Charak
simple constipation and not for obstructive Samhita and treatment is described in association
constipation and faecal impaction. with many disease and result of complication of much
2. Behavioral therapy: Habit training is important to disease. By the definition of constipation, with Rome
achieve regular defecation. The patient is advised to II crieteria , we can correlate it with the vibandha
attempt defecation after meals when colonic motility which are given below: Malakshaya may come under
is maximum. Once post-pra ndial defecation was the one of the point of constipation i.e, Infrequent
regularly, the laxative is gradually withdrawn. passage of stool. The symptoms of malakshya is pain
3. Drug Treatment: Laxatives are used for short- in cardiac region and sides and wind, with gargling
term therapy of severe constipation. Most laxatives sound goes upward and moves around in the belly
lose their effect over time. Long term use of laxatives [66]. In Charak Samhita it is described that Various
produces laxative misuse syndrome characterized by types of diseases occur by the suppression of urges.
brown discoloration of the colonic mucosa Thus, by suppression of defecation reflex, retention
resembling ‘tiger skin’, which resolves when result in of faeces occur which result in hard stool. Hard stool
mega colon or’ cathartic colon’. is another one of the point of Rome II Criteria. If
Osmotic laxatives (increase the flow of fluid into once there is hard stool, incomplete evacuation of
stool and soften them) are preferred over the bowel which results in straining during defecation
stimulatory laxatives (they stimulate colonic leads to several complications like haemorrhoids, etc.
contractions and also increase intestinal It can be hypothesized that concept of vibandha is
secretion).The suppositories are helpful in some similar to constipation.
patients with defecatory disorders. The use of enema
is restricted to elderly, inform and immobile patients CONCLUSION
and those with neurological disorders. Prokinetic After overall description, lastly it may be consider
agents e.g., Mosapride or Itocpride has been found that vibandha(Constipation) is independently a
useful in most cases of slow transit constipation disease and also a complication of some diseases. Its
(idiopathic). management should be according to type of kostha
Surgery: Patients with structural lesions like (Alimentary canal). In nutshell, it may be concluded
strictures and/or obstruction require surgery. Surgery that treatment according to its cause along with plenty
is the treatment of choice Hirschprung’s disease. It is of fluid, physical exercise, many more form of
also indicated in defecatory disorders with rectocoele, laxative like anulomana, bhedan etc which should be
intussusceptions, rectal prolapsed, pelvic floor given according to state of dosa and kostha.
dyssynergia (anismus).
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