Introduction
Irritable bowel syndrome (IBS) is a chronic disorder of gut–brain interaction characterized by recurrent abdominal pain associated with altered bowel habits, including constipation, diarrhea, or a mixed pattern. Although it is classified as a functional gastrointestinal disorder without identifiable structural abnormalities, IBS significantly affects patients’ quality of life, daily functioning, and psychological well-being. The condition is highly heterogeneous, with variable symptom patterns and severity across individuals.1
Complex pathophysiology and clinical challenges
The pathophysiology of IBS is multifactorial and incompletely understood. Key mechanisms include altered gastrointestinal motility, visceral hypersensitivity, immune dysregulation, gut microbiota imbalance, and dysfunction of the brain–gut axis. Psychological stress and emotional disturbances further exacerbate symptom expression. This complexity makes IBS difficult to manage with a single-target therapeutic strategy.
Limitations of conventional treatment approaches
Current management of IBS is primarily symptom-based and includes laxatives, antidiarrheals, antispasmodics, dietary modification, and neuromodulators. While these interventions provide partial relief, they often fail to achieve sustained symptom control or address underlying pathophysiological mechanisms. In addition, long-term pharmacological use may be associated with side effects, leading to increasing interest in complementary and integrative treatment approaches.
Ayurvedic perspective on IBS
In Ayurveda, IBS is broadly correlated with Grahani disorder, which arises due to impaired digestive fire (agni), accumulation of undigested metabolic waste (ama), and imbalance of vata and pitta doshas. Ayurvedic management emphasizes a holistic approach aimed at restoring digestive function and systemic balance rather than merely suppressing symptoms. Treatment includes individualized herbal formulations, dietary regulation, and psychological interventions tailored to patient constitution and disease state.
Whole system Ayurveda (WSA) framework
The WSAP is grounded in the WSR model, which integrates traditional Ayurveda with modern clinical frameworks while preserving holistic principles. Ayurveda emphasizes individualized, multidimensional care addressing physical, psychological, emotional, and behavioral domains. WSAP consisted of structured diagnostic and therapeutic components tailored to patient-specific disease presentations.
Diagnostic protocol in WSAP
The diagnostic framework assessed agni status, sama and nirama conditions, stool characteristics, sharirika dosha (vata, pitta, kapha), and manasika dosha (rajas, tamas). At baseline, 60.41% patients were nirama and 39.58% were sama. Predominant doshic involvement included vataja (60.41%), kaphaja (29.16%), and pittaja (10.41%). IBS subtypes included IBS-C (60.41%) and IBS-D (39.58%). Psychological assessment revealed high prevalence of mild anxiety (64.5%) and mild depression (83.33%), consistent with known psychosomatic associations in IBS. Most patients presented with severe IBS-SSS scores (79.1%). Sleep disturbances were observed in 39.5% of patients.
Therapeutic protocol and interventions
The therapeutic approach was individualized and multi-component, combining oral Ayurvedic formulations with psychological interventions. A total of 41 medicines were identified and 27 were actively used in combinations of 2–3 drugs at a time based on diagnostic profiling. Treatments were administered under the supervision of an experienced physician with 20 years of clinical practice.
Psychological interventions were incorporated for patients with predominant rajasika and tamasika mental states, including Ayurvedic counseling techniques addressing anxiety and depression. The WSAP group received more counseling sessions compared to the KC group, reflecting its integrative approach.
Medicinal strategies for IBS-C included formulations such as Hareetaki churna, Triphala, Abhayarishta, Shunthi churna, and Lavanabhaskara churna, which support bowel regulation through deepana, pachana, and anulomana actions. In IBS-D, formulations such as Kutajarishta, Agnitundi vati, and Kutaja-based preparations were used for their antidiarrheal, astringent, and gut-stabilizing effects. Herbs like Terminalia chebula and Holarrhena antidysenterica contributed to improved bowel regulation through antidiarrheal and motility-modulating properties. Psychological symptoms were addressed using both counseling and, when required, psychotropic support aligned with IBS-associated anxiety and depression.
Overall clinical efficacy
WSAP showed significant improvement in primary outcomes, including IBS Adequate Relief (IBS-AR) and IBS Severity Scoring System (IBS-SSS). Secondary outcomes such as IBS Visual Analog Scale (IBS-VAS), Complete Spontaneous Bowel Movements (CSBM), and Bristol Stool Form Scale for diarrhea and constipation (BSF-D and BSF-C) also improved significantly. Both WSAP and KC groups showed comparable outcomes in Gastrointestinal Symptom Rating Scale (GSRS), Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS), and IBS Quality of Life (IBS-QOL). Laboratory parameters, including blood and stool indices, showed comparable improvement in both groups. Hemoglobin levels improved in both cohorts, indicating systemic benefit beyond symptom control. No adverse events were reported, highlighting the safety of both interventions.2
Conclusion
The Whole System Ayurveda Protocol demonstrated significant clinical efficacy and safety in IBS management, with superior improvement in symptom severity, abdominal pain, bowel regulation, psychological distress, and overall quality of life compared to Kalingadi Churna. Both interventions were safe and effective, but WSAP provided broader and more integrated therapeutic benefits. These findings support the potential of Whole System Ayurveda as a holistic and evidence-based approach for IBS management, warranting further large-scale, rigorously designed clinical trials.
References:
- Farmer AD, Wood E, Ruffle JK. An approach to the care of patients with irritable bowel syndrome. CMAJ. 2020;192(11):E275-E282. doi:10.1503/cmaj.190716 https://pmc.ncbi.nlm.nih.gov/articles/PMC7083544/
- Naik TD, Tubaki BR, Patankar DS. Efficacy of whole system ayurveda protocol in irritable bowel syndrome - A Randomized controlled clinical trial. J Ayurveda Integr Med. 2023;14(1):100592. doi:10.1016/j.jaim.2022.100592 https://pmc.ncbi.nlm.nih.gov/articles/PMC10105243/#sec4