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Introduction

When waste materials stagnate in the body, it leads to issues like constipation. This condition occurs when stools become blocked and cannot be eliminated. It involves infrequent, difficult, or incomplete bowel movements with abnormal stool consistency. Constipation is a common gastrointestinal issue that most people experience at some point in their lives.

Ayurveda is deeply rooted in the Doshik theory of disease, emphasising the importance of maintaining balance among the three Doshas, the seven Dhatus, and the three Malas for good health. This equilibrium ensures the preservation of the body (Dehadharana), while any imbalance may lead to bodily disintegration or even death. The three main Malas are Purisha (stool), Mutra (urine), and Sweda (sweat). After digestion, food is divided into two parts: Sara (the nutritious part) and Kitta (the waste part). The Sara Bhaga becomes Ahara Rasa (nutrient essence), while the Kitta Bhaga forms Mala. The undigested residue excreted from the large intestine with the help of Apana Vayu is known as Purisha Mala, which this review focuses on. The terms Malavarodha and Malavashtambha refer to the obstruction of Purisha Mala, where the stool is prevented from being eliminated from the body.

Aim and objectives-

To establish Malavarodha (constipation) as a distinct disease in Ayurveda by exploring its Nidanapanchak (causative factors and pathogenesis) and developing a comprehensive approach for its diagnosis and treatment, contributing to better management of constipation in today's fast-paced urban society.

Objectives:

1. To analyse the scattered references related to Malavarodha in the classical Ayurvedic texts (Bruhattrayee and Laghutrayee).
2. To formulate the Nidanapanchak (etiology, pathogenesis, prodromal symptoms, signs, and complications) specific to Malavarodha as a separate disease entity.
3. To explore the lifestyle factors in modern urban settings, such as poor diet, stress, and suppression of natural urges, contributing to the increasing prevalence of Malavarodha.
4. To propose a diagnostic framework for Malavarodha based on Ayurvedic principles, integrating classical descriptions.
5. To develop a detailed treatment protocol for Malavarodha in Ayurveda, including dietary, lifestyle modifications, and therapeutic interventions like Panchakarma and herbal formulations.

Materials & Methods-

Literary review

Malavarodha is a concept rooted in Ayurveda. It refers to constipation or obstructed bowel movements, but in Ayurvedic terms, it is more than just a simple physical problem. Malavarodha can be considered a disease with its own set of causes, symptoms, complications, and treatments based on Ayurvedic principles.

Malavarodha-Mala+ Avarodha

Constipation of the Bowels - Monier Williams

"Mala" refers to waste products of the body, and "Avarodha" means obstruction. So, Malavarodha indicates the obstruction or improper elimination of waste (primarily feces) from the body.

Synonyms for the term Malavarodha in Classics –

Varchograha, Varchanirodha, Gadhvarchas, Malagraha, Malasanga, Purishanichaya, Purisha Rodham etc.

Nidanapanchak of Malavarodha –

Nidan or cause of Malavarodha

Since there is no direct reference in the classics, the factors causing vitiation in mechanism Apana Vayu, Agni, and Purishavaha Strotas can be considered the causes of Malavarodha.

Apana Vayu: This subtype of Vata is primarily responsible for downward movement and elimination, governing the expulsion of stool, urine, and reproductive fluids. Any imbalance in Apana Vayu can result in stagnation, improper movement, or retention of waste, contributing to Malavarodha.

Table No.01 Nidana for Apana Vayu Dushti [1]

Agni: Impaired Agni—whether in the form of Mandagni (sluggish digestion) or other types of imbalances—affects digestion and the formation of stool, leading to improper digestion and elimination. A weak Agni can lead to incomplete digestion, causing constipation.

Table No.02-Nidana of Agni Dushti [2]

Purishavaha Strotas: These are the channels responsible for carrying and eliminating feces. Any blockages, damage, or imbalances in the Purishavaha Strotas can lead to difficulties in bowel movement.

Table No.03-Nidana for Purishavaha Srotas Dushti [3]

Lakshana or symptoms of Malavarodha-

As Vega Nigraha is regarded as a Nidana for Malavarodha, the Lakshanas of Adhovata Vega Nigraha and Pureesha Vega Nigraha can be considered indicative of Malavarodha.

Suppressing the natural urges governed by Apana Vayu, particularly the urge to defecate (Pureesha Vega), directly contributes to the development of Malavarodha and its associated symptoms.

In Gadhpurishiya Adhyaya, Acharya Bhel explains the pathology as follows: Due to vitiated Vata, the stool becomes hard, knotty, and dry. The obstruction of channels leads to rectal edema, causing Vayu to move in an upward direction, where it becomes trapped in the pelvic region, back, and cardiac area. This trapped Vayu accumulates in the head, leading to various disturbances such as deafness, blurred vision, and cold sensations. Additionally, the vitiated Vayu disrupts the natural balance of Pitta and Kapha, and further vitiates the seven Rasadi Dushyas.

Upadrava – [12]

The continued deterioration of Rasadi seven Dhatu results in Upadrava, which includes the following conditions:

1. Balawan Jwara

2. Pandu

3. Shwayathu

4. Grahani Dushti

Management of Malavarodha-[13]

According to the Bhel Samhita, patients with hard, lumpy stools should avoid dry foods. Relying solely on Sansrana for treatment is not advisable. Instead, these patients can benefit from unctuous foods such as Odana or Peya, enriched with a generous amount of Sneha (fat). Additionally, Kulattha Rasa (horse gram soup) combined with Hrudya Mamsa (nourishing meat soup) can be helpful. The condition can be effectively managed with Anuvasana or Asthapana Basti using oil or decoction that pacifies Vata Dosha. This approach is safe and does not lead to complications for patients suffering from Gadhpurisha (hard, lumpy stools).

Nidana Parivarjana (Removal of cause)

Before recommending any medication or treatment plan, the physician must prioritise Nidana Parivarjana (removal of the cause) as it is the essential first step toward achieving successful outcomes.

Management based on Koshtha examination

In cases of Krura Koshthi (characterised by excessive Vata), the frequent use of laxatives or purgatives can exacerbate the condition. Here, administering Saindhavyukta Snehapana can yield significant benefits. When Vata Dosha is highly vitiated, Matra Basti is the optimal choice to enhance the defecation process. Conversely, for Mrudu Koshthi (characterised by excessive Pitta), treatment can be effectively managed with Rechan using mild substances like milk.

For conditions resulting from Margavarodhajanya or Udavartajanya Samprapti, it is crucial to remove the obstruction and rectify the direction of Vayu. Initial treatments include the use of Varti (suppositories), such as Phalavarti, along with Abhyanga and Swedan, particularly Avagaha Swedan, which helps normalise the Doshas and correct the path of Pratiloma Vayu. Administering various medicated enemas is essential for addressing aggravated Vata Dosha. The approach known as Vidbhedi Annapana, which includes both solid and liquid diets to break down hard stools—such as Yavaka, Mastu, and Vastuka—should be employed for cases of Malavarodha.

Management of Sama Mala-

The Sama Doshas, which are dispersed throughout the body and reside within the Dhatus without moving from their sites of accumulation, should not be forcibly expelled through purification therapies. Attempting to extract juice from an unripe fruit led to its destruction; similarly, trying to expel Doshas along with Ama can damage their dwelling places. Therefore, it is crucial to confirm whether the condition is Samavastha or Niramavastha before initiating therapeutic interventions. For Sama Dosha, the initial treatment should involve Pachan-Dipana, followed by Snehan and Swedan (oleation and sudation) therapies. Finally, purification therapies can be administered at the appropriate time and according to the patient's strength.

Snehan (oleation) therapy as management of Malavarodha-

According to Ayurvedic texts, Snehan is described as a process that alleviates Vata Dosha, primarily responsible for Malavarodha. As stated in Charaka Samhita, "Snehan is the source of nourishment, promoting softness and moisture" (Ch. Su. 22/11). Furthermore, "Sneha mitigates Vata, softens the body, and eliminates waste obstructions" (Ch. Si. 1/7). For treating conditions related to Vata Dosha, Snehan is recommended as the primary therapeutic approach.

Acharya Charaka, in the first chapter of Siddhisthana, elaborates on the effects of Snehan with the following principles:

Sneho Anilam Hanti: Sneha possesses qualities opposite to those of Vata, thus guiding Vayu's movement. This Vatashamak effect helps transport the Shakhagata Dosha to the Koshtha, making it a vital first-line treatment for conditions like Nirupasthambhit Vatavyadhi.

Mrudu Karoti Deham: The properties of Sneha being Mrudu (soft) and Snigdha (unctuous) ensure the softening of accumulated Doshas and facilitate relaxation in bodily channels. The resultant softness of the body indicates the effectiveness of Snehan.

Malanam Vinihanti Sangam: The excessive Ruksha Guna leads to Mala Sanga, or obstruction of waste. By counteracting Rukshata with its Snigdha and Vishyanda qualities, Sneha resolves this obstruction.In the case of Malavarodha, Snehan remains a critical intervention for correcting Vata Dosha, applicable both externally and internally.

Swedana (sudation) therapy as Mamanagement of Malavarodha:

Swedana, when performed after Snehana (oleation therapy), helps Vata attain proper direction. It works by loosening and liquefying toxins and widening the circulatory channels, facilitating the movement of the aggravated Doshas from the Shakha to the Koshtha, where they can be easily eliminated. Swedana is particularly beneficial in conditions such as Udavarta (reverse movement of Vata), Purishavruta Vata (obstruction of Vata by stool), or Pakwashayagata Vata, where constipation is a prominent symptom.Avagaha Sweda, a type of Agni Sweda, is the most recommended form of Swedana for treating Malavarodha, according to classical Ayurvedic texts.

Shodhan

The normal flow of Apana Vayu is directed downward, so treatments that promote this natural movement, like Virechan (purgation) and Basti (medicated enema), help regulate Apana Vayu.

Virechan

Virechan therapy focuses on expelling the Pitta Dosha, and sometimes Kapha Dosha, from the body through the downward route, typically via the anal canal. In classical Ayurvedic texts, various purgative medicines are discussed. Acharya Charaka classifies them into three categories: Mrudu (mild), Sukha (easy), and Tikshna (strong). Sharangadhar Samhita elaborates on different types of purgation: Anulomana, Samsrana, Bhedana, and Rechana, with recommended purgative drugs such as Haritaki, Aragwadha, Katuki, and Trivrutta, respectively. The key to successful Virechan therapy is the careful selection of the appropriate purgative drug. Improper selection can cause complications. In cases of Malavarodha, it is crucial to choose the correct category of purgation, whether Mrudu, Sukha, Tikshna, Anulomana, Samsrana, etc. The dosage and type of drug depend on several factors, including the patient's Dosha, Dushya, Koshtha, age, and strength. Therefore, it is essential for a Vaidya to have a thorough knowledge of Virechana Dravya before administering them.

Basti

Basti Chikitsa is regarded as a key therapeutic method, especially for managing Vata disorders. In classical texts, it is often considered a half or even a complete treatment in itself. The substances used in Basti have various therapeutic actions, including Vatahara (pacifying Vata), Shulahara (relieving pain), Shothahara (reducing inflammation), Strotoshodhaka (clearing bodily channels), Yogavahi (enhancing drug delivery), Agnidipaka (stimulating digestion), and Rasayana (rejuvenating).Basti primarily acts on the Pakwashaya (large intestine), which is the main site affected in the pathogenesis of Malavarodha (constipation). When administered through the rectum, Basti reaches the Pakwashaya and helps normalise Apana Vayu, facilitating Vatanulomana (proper movement of Vata) and improving the overall functioning of Vata Dosha. The appropriate use of different types of Basti, such as Anuvasana, Matra, or Niruha, is crucial to the effective treatment of Malavarodha.

Besides all these treatment protocols, other factors like diet, exercise, and stress management are equally important for long-term relief. Ayurveda emphasises a daily routine that includes waking up early, proper elimination habits, and regular meal times. This helps synchronise the body’s natural rhythms, supporting digestive health.

Discussion

"Malavarodha" is not explicitly elaborated as a standalone classical disease in Ayurvedic texts. However, numerous scattered references suggest its significant role in the manifestation of various diseases. By analysing its etiology, pathogenesis, symptoms, and treatment, a comprehensive understanding of the disease is developed in this study. Defining Malavarodha as a standalone disease, especially in the context of Ayurveda, holds significance for several reasons:

Holistic Understanding of Health: In Ayurveda, Malavarodh is seen not just as a symptom but as a condition affecting the overall balance of doshas. Recognising it as a disease underscores its impact on the whole body, helping to maintain optimal health by addressing its root causes rather than just temporary relief.

2. Complexity and Chronic Nature: While constipation may seem like a minor issue, chronic tendency can lead to various complications such as bloating, headaches, hemorrhoids, indigestion, and other gastrointestinal disturbances. A standalone classification enables

practitioners to treat it as a complex and potentially chronic issue, necessitating more in-depth and tailored treatment approaches.

3. Improved Diagnosis and Treatment: By identifying Malavarodh as a disease rather than a symptom, practitioners are encouraged to explore its underlying causes, which can vary from dietary habits to stress, doshic imbalances, or metabolic disorders. This distinction allows for personalised treatment strategies in Ayurveda, including internal remedies, dietary modifications, lifestyle changes, and Shodhan.

4. Preventive Healthcare: Recognising Malavarodh as a disease encourages individuals to adopt preventive measures such as following Dinacharya, regular bowel movements, a balanced diet, and appropriate hydration. This can lead to better long-term gastrointestinal health and prevent more severe diseases related to poor digestion and elimination.

In essence, viewing Malavarodh as a standalone disease encourages a more thorough and preventive approach to healthcare, both in Ayurveda and potentially in broader medical practices.

Conclusion

This study highlights the importance of recognising Malavarodha (constipation) as a distinct disease within the framework of Ayurveda, moving beyond its traditional view as merely a symptom. By exploring its etiology, pathogenesis, and treatment in depth, it becomes evident that Malavarodha plays a crucial role in various health complications. Defining it as a standalone disease allows for a holistic approach to diagnosis and treatment, addressing not just temporary relief but the root causes of doshic imbalances, dietary habits, and lifestyle factors.

This classification empowers practitioners to

adopt personalised and preventive strategies, such as following Dinacharya and promoting regular bowel movements, ultimately enhancing both immediate and long-term gastrointestinal  health. The study underscores the significance of a comprehensive understanding of Malavarodha,

aligning Ayurvedic principles with contemporary health needs in the modern world.