Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2024 | Month : November | Volume : 18 | Issue : 11 | Page : YE01 - YE09 Full Version

Conceptual Study of Balgrahas (Microbes) in Kaumarbhritya: A Narrative Review


Published: November 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/72591.20247
Riya Rajendra Rathor, Renu Bharat Rathi, Shruti Prakash Kapatkar

1. Postgraduate Scholar, Department of Kaumarbhritya, Datta Meghe Institute of Higher Education and Research Centre, Wardha, Maharashtra, India. 2. Professor and Head, Department of Kaumarbhritya, Datta Meghe Institute of Higher Education and Research Centre, Wardha, Maharashtra, India. 3. Assistant Professor, Department of Kaumarbhritya, Mahatma Gandhi Ayurved College and Hospital and Research Centre, Salod, Hirapur, Wardha, Maharashtra, India.

Correspondence Address :
MS. Riya Rajendra Rathor,
Mahatma Gandhi Ayurved College and Research Centre, Salod, Hirapur, Wardha-442001, Maharashtra, India.
E-mail: riyarathor1495@gmail.com

Abstract

Ayurveda is a time-tested science that systematically explains its concepts through eight branches. Grahas Chikitsa (Ayurvedic treatment of microbes) is one of these branches, and it is well-explained in the texts. “Graha” refers to a tiny, invisible living organism that may undergo several stages of development and can be pathogenic or antigenic to the body. Microorganisms can cause generalised pathogenic alterations in the body that affect multiple systems, similar to the concept of Grahas. This suggests a deeper understanding of microbes in relation to Grahas. This review paper aims to explore the age-old concept of Balgrahas (microbes) and its relevance in modern times. The review was conducted using published articles on paediatric disorders, electronic databases, textbooks on paediatrics, and traditional Ayurvedic writings related to Kauamarbhritya (Paediatrics). A distinguishing feature of this study is its compilation of information on Balgraha from classical texts, covering clinical characteristics, causal factors, and various internal and external treatments. It also discusses Ayurvedic treatment modalities such as Daiva Vyapashraya Chikitsa (Spiritual therapy) and Yukti Vyapashraya Chikitsa (Rational therapy). In this review, authors discussed several formulations for treating conditions associated with Balgraha (microbes) that have not been detailed in previous studies. Additionally, some Shodhan karma (Detoxification) procedures that are particularly recommended for both children and nursing mothers are also highlighted.

Keywords

Daiva vyapashraya chikitsa, Grahas, Yukti vyapashraya chikitsa

The particular disease complex that constitutes the majority of childhood diseases in Kaumarbhritya (Paediatrics) is known as Grahas Rogas. This area is currently one of the most neglected, possibly due to the overuse of mythical justifications and the challenges associated with its clinical comprehension, diagnosis, and treatment. Sushruta and other authors have effectively highlighted the importance of Grahas Rogas by providing definitions that demonstrate the value of their treatment. In Shareera Sthana, Sushruta offers a unique definition: every Graha has a distinctive morphological structure, origin, and features (Nava Grahas Akriti Vignana), which only cover explanations of Grahas Rogas (1).

Grahas Rogas differ from other prominent disorders in several ways. Their aetiopathogenesis, clinical features, magnitude, effects, and course of action are distinct from those of typical childhood diseases. These disorders can enter the human body rapidly, leading to a high rate of morbidity and mortality if not addressed promptly. They can also pose risks to the lives of others affected by these children. Following types of disorders fall under the category of Bala Graha: Balgrahas, Jataharanis, diseases caused by matrikas, Adibal, and Janma Bal privritta, among other sins from former births, are attributed to goddesses in our classical texts (2).

The characteristics of Grahas are as follows:

Grahas, which are described in Ayurvedic texts as beings that can only be seen with divine vision.
• Their territories consist of countless colonies.
• They survive and grow rapidly by consuming rakta (blood), mamsa (muscle), and ojas (the finest end product of digestion), and they take control of the host’s body and mind.
• These beings are nocturnal rovers.
• Affected individuals often reside in abandoned homes, cowsheds, water tanks, and at the bases of trees (as seen in Shitaputana, Mukhamandika, and Pitri Grahas).
Jataharini (gynaecological disorders) is a disease that affects pregnant women and foetuses and is considered deadly and infectious.
• They also taint the breast milk of Dhatris (wet nurses).
Acharya Sushruta issued a warning, advising that wounds should be protected from Grahas and that a newborn should be separated from an injured individual (3).

All the above explanations are available about Grahas. By considering the verses mentioned, one can assume that Grahas are living organisms, as they attack and seize others like parasites. They also thrive in dark areas, which are conducive to their growth, and in low-temperature, high-humidity environments, as evidenced by their movement at night. They are invisible to the naked eye and require special visual aids to be seen. Because they are invisible, they are presumably unicellular and microscopic. They pass through different life phases, changing their size and shape like eggs, spores, larvae, single cells, etc., (Microorganisms can change their size and shape at different phases of development, such as amoebas). They cause diseases in humans when they enter the body, which proves that they are antigenic and pathogenic to the human body. They can cause both physical and psychological disturbances in the human body, indicating their generalised nature of affliction. Typically, they do not attack the human body; rather, adharma (a wrong lifestyle) makes the human body vulnerable to their entry. Treating these conditions can be quite difficult and often requires advice from experts (4).

According to the preceding interpretations, “Grahas” may refer to tiny, invisible living organisms that undergo several stages of development and can be pathogenic or antigenic to the body. Therefore, they are microorganisms, such as viruses, bacteria, fungi, spirochetes, yeast, amoeba, or the eggs or larvae of various worms. These organisms are too small to be seen with the naked eye and can only be observed under a microscope (5).

Taking into account the information mentioned above, it is clear that Grahas are living organisms with a microscopic nature. The terms “Jyana Chakshu” and “Shastra Chakshu” likely refer to specific visual tools that enhance vision, such as microscopes, or a unique ability acquired through knowledge to perceive them (6).

The flexibility of the nature of Grahas allows for frequent changes in their dimensions. This variability is also observed in many stages of the life cycles of microorganisms, including viruses and bacteria (such as protozoa, parasites, and certain viruses). Microorganisms can produce generalised pathogenic alterations in the body that affect several systems, similar to the effects of Grahas.

Microorganisms are widely distributed throughout the cosmos, and their invasion of the human body often results from mistakes made by humans that lead to Adharma. The term “Adharma” primarily refers to any deviation from the guidelines and regulations of Sadvritta (the code of right conduct) and Swasthavritta (the Ayurvedic concept of healthy living), which can pose risks to one’s health as well as to social, environmental, and personal safety.

All Graha rogas are the result of the infant, mother, Dhatri (wet nurse), or caregiver engaging in varying degrees of adharma behaviour. Long-term adharma practices make the body more susceptible to microbial invasion (7).

This review paper aims to examine the age-old concept of Balgrahas and its utilisation in modern times, focusing on early diagnosis, prognostic assessment, and treatment protocol decisions. It aims to classify the various treatment modalities, including Ayurvedic herbs, Panchakarma procedures, and modern treatments, in the management of Balgraha.

The review was conducted using published research on paediatric disorders, electronic databases, textbooks relevant to paediatric diseases, and traditional Ayurvedic classics on Kaumarabhritya.

Graha Avesha Hetu (Entry of Grahas in Body) (8)

As previously mentioned, microorganisms are all around us and cannot be eliminated from the cosmos, as they are an essential component of nature. However, human mistakes in the form of Adharma leave people vulnerable to their onslaught. Adharma can weaken the body’s immune system, allowing Grahas (microorganisms) to penetrate the human body more easily. According to classical knowledge, Grahas have three reasons for entering the body: Himsa, Rati, and Archana.

Himsa: Himsa here means torturing someone rather than murdering them. When microbes enter the body, the immune system initiates an antigen-antibody reaction in response, based on specific antigenicity. This reaction can lead to tissue damage and phagocytosis. Consequently, the patient may experience various symptoms, such as coughing, sneezing, fever, and hypersensitivity, all of which are manifestations of excruciating pain, or Himsa. For example, during influenza, the body’s immune response results in symptoms like fever and cold.

Rati: A microorganism needs a host to complete its life cycle and reproduce. It begins life as an “egg” or spore inside the body, develops into a gametocyte, and ultimately leaves the body. This process can be observed in bacteria, protozoa, and worm parasites. Sometimes microorganisms may not primarily aim to cause illness, but the host’s low immunity allows the microbes to proliferate and eventually lead to disease. This phenomenon is referred to as “Rati”- the inclination of microorganisms to invade human tissue and complete their reproductive cycle. For example, in malaria, sexual reproduction and the formation of malaria gametocytes occur inside the patient’s Red Blood Cells (RBCs).

Archana: The definition of Archana is to be nurtured and worshipped. A specific type of microorganism enters the body purely for the purpose of feeding. Their main goal is to obtain energy, but they also grow their colonies and generate illnesses. For example, roundworms and tapeworms attach to the intestinal wall, where they feed and produce eggs or larvae that travel through the bloodstream and form cysts elsewhere in the body.

The Incubation Period of Grahas (Entry of Grahas in the Body) (9)

The phenomenon of the entry of the Grahas (celestial bodies) into the human body is invisible. Acharyas (teachers) describe this entry as being imperceptible, similar to the entry of the Atma (soul) into the body, or the way an image appears in a mirror, or how oil (taila) is present within a seed (beeja). Just as the image in the mirror signals that light rays have entered, the body’s functions acknowledge the presence of the Atma. Similarly, the entry of Graha rogas (diseases caused by celestial bodies) into the body can only be assessed after the production of Purva Rupa and the Roopas, which refer to the symptomatology. The period of incubation is the time interval between the entry of microorganisms into the body and the appearance of the first symptom.

Types of Graha According to Different Acharyas (10)

Sushruta-09

Vagbhatta, Ravan-12

Madhavnidan, Yogratnakar-09

Kashyap-10

Harita-8

Charak-1

The aforementioned types can be easily understood from (Table/Fig 1) (11), which outlines the Graha types according to different Acharyas, along with the subtypes of Purush Pradhan and Stree Pradhan Grahas. (Table/Fig 2) presents the Graha types along with the typical features and odours observed in children affected by Grahas (microbes) (12),(13).

Purva Roopas (14)

Continuous crying (Pratata Rodan)- The absence of symptoms in newborns can often result in restrictions on language development. Crying is a common symptom that may be caused by various factors, including otitis media, septicaemia, a cold, fright, hunger, or even a wet diaper. A similar presentation may be observed in Graha Roga as well. Intense, unrelenting, and persistent crying is a distinguishing characteristic of Graha Roga.

Fever (Jwara): Fever is known to be the most prevalent symptom in all transmissible illnesses. It is one of the key signs of Grahas Rogas, and understanding this provides us with a better insight into how infectious and antigenic these conditions are.

General Symptoms of Grahas Roga

Smell of body (14): A child’s ability to perceive changes in their body is greatly enhanced by their sense of smell, as distinct odours often indicate various influences or circumstances. Children may emit different smells, all of which could be related to the influence of specific ‘Grahas,’ as explained in detail in (Table/Fig 2).

General symptoms of balgraha (15): Infants and young children’s general symptoms are important markers of their health and any underlying issues. Fever is an indication of a potential disease or infection and is sometimes accompanied by irritability and excessive crying. Clenching teeth or fists and screaming can be signs of agony or discomfort. These feelings can be exacerbated by self-harming behaviours such as biting or frequently scratching the nose, eyes, and ears, as well as lip biting. Such behaviours may be observed in a child afflicted with conditions like Balgrahas, such as Skandapasmara.

The previously mentioned irrelevant self-harming and agitated behaviour observed in children affected by Balgraha, such as Skanda, Skandapasmara, and Naigamesha, is one of the key features of Autism Spectrum Disorders (ASD). This behaviour can be related to Ayurvedic concepts including Unmad (schizophrenia), Apasmar (epilepsy), and Atatvabhinivesh (delusional disorder).

Gastrointestinal symptoms (16): Significant markers of digestive wellbeing and gastrointestinal manifestations may include a range of symptoms that require monitoring and treatment. Frequent loose or watery stools and vomiting, which is the evacuation of stomach contents, are indicative of gastrointestinal distress and are often linked to infections, food-related issues, or underlying medical conditions. This is particularly evident in a child afflicted by Putana Graha.

Respiratory symptoms (14): Respiratory symptoms are not limited to the common cold and cough; they encompass a range of symptoms that provide information about how the respiratory system is functioning. Grunting respiration, characterised by a distinctive sound made during exhalation, often indicates increased effort in breathing. It can occur in infants experiencing respiratory distress or illnesses in which the airways are restricted or weakened, such as pneumonia or bronchiolitis. The symptoms mentioned can also be observed in Balgrahas, such as Naigmesha.

Central nervous system symptoms (14): Physical manifestations: Central nervous system symptoms, particularly organic ones, encompass a variety of manifestations. These include fatigue, irritability, giddiness, and vacant stares. Other symptoms may include rolling of the eyes, hypotonia, jerky head movements, and twitching of the facial muscles and eyelids. Additional symptoms may encompass incontinence of urine and stools, tremors, altered posture, changes in voice and speech, and dribbling of saliva (which can be caused by facial palsy). The above symptoms can also be observed in Balgrahas such as Skandapasmara, Skanda, and Naigmesha.

Psychological Manifestations: Disorders related to the central nervous system may manifest as hair pulling, irrational laughter, loud screaming, tics, fasciculations, and anxiety. These symptoms can also be observed in Balgrahas like Skandapasmara.

Skin symptoms (17): Changes in skin tone, blister development, and urticaria (hives) are examples of various skin complaints. Engorgement of vessels in the abdomen and flank regions is observed in a child affected by Mukhamandika graha.

Graha Rogas and Microorganisms

Graha rogas and microorganisms can be related similarly on various grounds. This relationship can be easily understood from (Table/Fig 3) (18), which explains the nature and characteristics of both grahas and microbes.

Regulations for Management

• The therapies for Grahas rogas were extensively addressed by Sushruta, Vagbhata, and Kashyapa (7).
Vagbhata listed several distinctive practices.
• Both Daiva and Yukti Vyapashraya Chikitsa are employed during the course of therapy (19).
• The anti-infective concepts used in Grahas rogas are nearly comparable to those used in contemporary science (20).

Grahas Rogas’s Fundamental Tenets (7)

1. Daiva Vyapashraya:
Swasti Vachana (Auspicious prayers)
Mantra Prayoga (Chanting)
Mangala Homa/Havana (Offerings to sacred fire)
Bali (animal oblations)

2. Yukti Vyapasraya:

Oushadhi Dharana (carrying medicine)
Avagaha (tub bath sudation)
Snana (Medicated bath)
Dhupana (Fumigation)
Ghrita Prayoga (Use of Ghee preparations)
Dhoomapana (Herbal smoke practices)
Parisheka (steam pouring or showering of warm decoction)
Lepas (local medicament application)
Agni danda Homa (purification of house by use of sacred agni)

Daiva Vyapashraya in Psychological and Psychosomatic Disorders

Daiva Vyapashraya Chikitsa is explained as the mainstay of treatment for Grahas rogas.
Daiva Vyapashraya Chikitsa is an Adravyabhoota Chikitsa (treatment devoid of medicines) that helps in adapting the confused mind.
• Each health issue is a psychosomatic ailment (as evidenced by present-day practice); hence, Daiva Vyapashraya Chikitsa should be employed in every case.

Swasthi vachana (Auspicious prayers) (7): This means offering prayers for the patient’s wellbeing. This can be linked to counseling the patient to help him understand the genuine health realities.

Mantra (Chanting) (21): Mantras help attain self-realisation. They also aid in understanding our role in maintaining the biodiversity and ecosystem of the universe. When chanted rhythmically, mantras produce sound waves with a range of wavelengths and amplitudes that can alter the brain’s electromagnetic wave patterns.

Havana Chikitsa and Mangala Homa (Offerings to sacred fire): Homa was performed in the past to determine the prognosis of Graha rogas. Since the body of a Graha rogi emits a variety of unusual odours, its vapours may take on different colours when they come into contact with fire. Additionally, the expired breath of a Graha rogi may contain specific hazardous substances due to abnormal metabolism. When these substances interact with fire, they may alter the colour of the vapours. These therapeutic vapours purify the air, eliminating environmental infections and their effects.

Bali (animal oblations): The term “Bali” refers to an Ayurvedic method of mass disinfection or communal disinfection, rather than merely the act of slaughtering animals as a ritual to appease God and ward off bad spirits (22).

Yukti Vyapasraya Chikitsa

Oushadhi dharana (Tying bag of herbs): A drug called Aparajita is mainly used against evil spirits. The Aparajita drug is Mardana (triturated) with Gorochana (cow dung) and then tied into a pottali (cotton cloth) along with other ingredients such as Lakshmana, Sahadevi, Indrayana, Nagadanti, Katambara, Markati, and Brihati, all wrapped in the broad leaves of Bhoorjaar. This pottali is then tied around the neck of the child. The traditional practice of tying a holy thread around the wrist still exists today.

Parishekh and Avagaha (sudation by showering of warm decoction or tub bath): Avagaha and Parishekh are prepared using water that has been treated with medications that possess antibacterial qualities. Both functions externally to prevent the spread of illness, eliminate odours, sanitise wounds, and keep them clean.

Snana chikitsa (Bath): Aushadhi Siddha Koshna Jala is recommended for bathing purposes. Herbs with antibacterial and Kashaya rasa qualities, such as Agnimantha, Nimba, Shigru, Karanja, and Paribhadra, are utilised for this purpose. Taking a bath with Siddha Koshna Jala helps eliminate unpleasant odours, provides a sense of freshness, and prevents skin contamination from the buildup of unsanitary materials (23).

Dhupan (Fumigation): Dhupana is a special procedure explained in the Kashyapa Samhita, with a separate chapter dedicated to it in the Kalpa Sthana. Acharya Kashyapa has highlighted the multidimensional utility of Dhupana, showing particular interest in its non invasive nature and ease of implementation in children. Drugs are burned in Ghrita, Taila, or any other lipid medium. Upon combustion, the chemical constituents of the drug are converted into an oxide form. Thus, a substance that exists in a solid, inactive form is transformed into an active gaseous form. In this way, the oxides present in the gaseous state are freely available in the surrounding air. This air can be collected and inhaled to yield beneficial effects, particularly in cases of acute respiratory tract disorders such as dyspnoea.

Ghrita prayoga (Use of Ghee preparations): Ghrita preparations aid chemical ingredients by dissolving them in lipid media, making absorption easier from a pharmacological standpoint.

Lepas (local medicament application): The application of Lepas externally not only eliminates odours but also prevents the spread of illness caused by mosquito bites.

Dhoomapana (Herbal smoke practices): Dhoomapana is a personalised disinfection method. It involves the use of antiseptic, disinfecting, and anti-infective substances, such as katu, tikta, and kashaya ras, as well as natural compounds that possess the qualities of ushna, tikshna, sukshma, and shlakshna. These substances are burned, and their fumes are inhaled for therapeutic effects (9).

Balgraha and its relationships can be easily understood from (Table/Fig 4) (24). Additionally, (Table/Fig 5) describes the management of Grahas according to various Acharyas, along with modern interventions that can be incorporated (25),(26),(27),(28),(29),(30),(31),(32),(33),(34),(35),(36),(37),(38),(39),(40),(41),(42),(43),(44),(45),(46),(47),(48),(49),(50),(51),(52),(53),(54),(55),(56),(57),(58),(59),(60),(61),(62),(63),(64),(65).

Discussion

Graha and Microorganism

Grahas were created to protect the universe’s biosphere and, consequently, people’s health. Lord Shiva created Grahas as creatures to guard his son Guha (13),(66). However, the key point is that these beings, initially intended to be protective, became pathological and caused Graha Rogas, which deprived children of their lives.

Microorganisms can produce generalised pathogenic alterations in the body that affect several systems, similar to Grahas. Therefore, Grahas can be seen as microscopic structures or microorganisms, such as infectious agents, bacteria, molds, yeasts, or the eggs and larvae of various worms that are undetectable to the naked eye. Moreover, these Grahas possess the properties of adarshan hetu (idiopathic causes), meaning they cannot be seen when they enter the human body.

Thus, the vivid descriptions provided by our respected ashtasiddhi prapta acharyas (those possessing eight heavenly wisdoms) regarding the lakshana (signs and symptoms) observable in humans during the entry of these microbes need to be studied thoroughly (67). Most likely, the term Shastra Chakshu (vision of knowledge) refers to a unique visual ability acquired through education, which explains the detailed descriptions of Grahas by our Acharyas and the intellect they possessed at that time.

Graha and Adharma

Acharya Sushrut has explained the concept of Graha Avesha Hetu (the entry of grahas into the body), which is responsible for causing ill effects in children due to Graha Badha (affliction by grahas) (67). Adharma plays a vital role in the formation of pathology. Adharma refers to improper ways of living in terms of behaviour, thinking, motivation, diet, routine, lifestyle, and cleanliness. Acharya mentions that when a lactating woman or mother does not follow a hygienic lifestyle and proper feeding habits, including the principles of Swasthavritta (the Ayurvedic concept of healthy living), Sadvritta (the code of right conduct), and adequate cleaning of a child after passing stool, it can lead to the entry of grahas into the human body.

Indulgence in Adharma, neglecting mangalacharan (prayer), and avoiding contact with sacred objects (such as swastika, darbha, durva, etc.,) are also considered reasons for this issue. Heena, ati, and mithya yoga of kala (time), artha (senses), and karma (functions), as well as the observance of pragnyapradh (human error), can lead to a weakening of the immune system and the destruction of the protective barrier. This makes the body susceptible to invasion by microorganisms or grahas, resulting in pathology. Therefore, Acharyas have detailed the guidelines of Garbhini Paricharya (the code of conduct for pregnant women) to avoid Graha Avesha, which should be strictly followed by lactating mothers (67).

Dhupan: Dhoopkalpas for fumigation purposes, such as Rakshoghna (antimicrobial/sterile), have been evaluated in research outlining the advantages of Dhupan (fumigation) (68). Drugs like Ghrita (ghee) and Taila (oil) are designed to burn in lipid media during Dhupan. Initially solid, these drugs burn to become gaseous, which is easily absorbed by the mucous membranes of the respiratory tract to provide the desired effects. Inhalation treatments, such as nebulisation, spacers, and puffs, operate on a similar premise. Dhupan creates a nebulisation-like effect by employing a Naadi (tube) (69).

In an additional study published by Rathi R et al., Maheshwar Dhoop demonstrated a significant effect (p-value<0.0001) with a one-week residual impact while fumigating minor procedure rooms and surgery theaters, in comparison to Basilocid (70). According to research, Dhupan of Rason peels, Loban, Carom seeds (Ajmoda), and Curcuma longum may significantly combat Methicillin-resistant

Staphylococcus aureus (MRSA 1-3) strains (71),(72). Furthermore, research by Yassin MF and Almouqatea S (73) assessed the effectiveness of herbal fumigation with Devdaru in treating airborne illnesses (73).

When studying Grahas, descriptions of psychotic symptoms are encountered. It is possible to relate the current understanding of Atatvabhinivesha (Delusional Disorder) to psychotic symptoms such as delusions and hallucinations. Psychosis is characterised by a loss of awareness in the patient. The pathophysiology of Atatvabhinivesha involves the obstruction of an exacerbated dosha affecting the mind and intellect, resulting in intellectual derangement. The most crucial aspects of the mind become impaired, making it impossible for the individual to recognise good as good and eternal things as eternal (74).

There are five different types of hallucinations: gustatory, tactile, olfactory, visual, and auditory (75). Punarvasu Athreya advises Kramavat Shodana (Detoxification), which includes Snehana (oleation), Swedana (sudation), Vamana (vomiting), Virechana (purgation), Basti (enema), and Nasya (nasal therapy). After purification rituals, Medhya foods (brain-boosting foods) and drinks such as Brahmi swarasa with Panchagavya Gritha and Shankapushpi are administered.

When treating Atatvabhinivesha, Medhya Rasayana is particularly important because it directly affects Budhi (intelligence) in patients with Atatvabhinivesha. Several Agantuja (external) and Sahaja (genetic) factors may lead to Khavaigunya (defective channels of transport and transformation), which could be a potential cause of autism. Furthermore, further vitiated doshas may intensify the Khavaigunya, resulting in numerous key symptoms of autism (76).

According to earlier research, the neurotransmitter serotonin is implicated in autism, and its metabolism is influenced by hereditary factors. Serotonin is important for neurogenesis, which is the development of new neurons in the brain (77). Studies show that a variety of factors, including genetic and environmental influences, neurotransmitter abnormalities, metabolic issues, immune system involvement, and structural and functional changes in the brain, may contribute to ASD (78). Acharya Charaka stated that Satvavajaya Chikitsa (Ayurvedic Psychotherapy) aims to teach dharma (the proper way to live) and artha (the proper way to earn) through the guidance of compassionate preceptors and close friends who support the sufferer (79).

Graha and Gandha

Various smells emanate from each Grahas roga. Bad body odour and urine odour are typically signs of inherited or acquired metabolic problems. The hazardous intermediate metabolic waste or waste buildup causes a characteristic alteration in the body that leads to the discharge of odour from the skin. Conditions such as phenylketonuria and diabetes mellitus demonstrate how toxic metabolites can alter the colour of urine. Extremely unsanitary conditions, often resulting from excessive sweating, can also produce an unpleasant odour. The accumulation of apocrine secretions not only causes odour but also serves as a breeding ground for the development of microorganisms. Every illness likely results in some degree of dysfunction in metabolism, and bacterial toxins are expelled through urine or perspiration, releasing an unusual scent. It is common to notice a strange, inexplicable odour when experiencing a fever. This symptom prompts us to consider the connection between metabolic illnesses and Graha rogas.

Graha and Daivavyapashraya Chikitsa

The treatment modality of Daivavyapashraya (spiritual therapy) is not currently used as a treatment. In contrast, principles of Yuktivyapashraya (rational therapy) such as aushadhi dharana, mani dharana, dhupana, snana, ghrutapana, avgaha, parisheka, and lepa are still practiced daily in Indian households. The concept of Balgrahas clarifies many other Ayurvedic principles, including dhupana and mantra, which are described in our prehistoric literature. These guidelines can still be followed and are beneficial to humanity.

There are apparent similarities between various microbiological illnesses and Balgrahas. Balgraha roga may be treated with both therapeutic and psychiatric interventions. It is crucial to prevent Balgraha rogas by improving the hygienic standards. Therefore, hygiene is essential for the treatment of Shuchi and Shuddhi (asepsis and antisepsis). Several hygienic precautions are advised for children and women going through puberty, which are effective in preventing infections. Fumigation is recommended for children and pregnant women.

It is well established that a healthy individual who contracts a microorganism will always retain some degree of immunity (Raksha) against that species, which reduces the likelihood of reinfection in the future. In ancient times, advanced medical equipment for diagnosis or treatment was not available. Contemporary language is more explicit and represents illness-causing organisms in a more organised manner. Modern science employs advanced techniques to identify germs and categorise them as viruses, bacteria, etc.,

The Balgrahas, one of the most significant components of Ayurvedic texts, need to be studied as a whole to comprehend Balgraha rogas. Therefore, using modern scientific methods, Graha rogas may be more easily understood and recognised (80).

Modern paediatricians have expressed amazement at the complete and precise descriptions of a variety of syndromes and groups of diseases with numerous systemic origins during in-depth conversations. The concept of Balgraha has often been disregarded by Ayurvedic scholars; however, now that it has been thoroughly studied and is being properly taught to scholars, there is significant potential to relate it to various modern concepts. This is especially helpful in the current era, where new viruses are emerging and wreaking havoc among the general population.

Due to the abundance of explanations and challenges in clinical interpretation, diagnosis and therapy, Graha roga is the most neglected aspect of Ayurvedic medicine. In addition to symptomatic therapy, the previously described therapeutic strategies prioritise complete hygiene and immunity. The treatment protocols mentioned earlier can disinfect individuals, groups, communities, and objects by acting as antibacterial, antimicrobial, antiseptic, disinfectant, bactericidal, and bacteriostatic agents.

Conclusion

Balgrahas can be appropriately compared to microorganisms. Microorganisms are widely distributed throughout the cosmos and can enter the human body as a result of mistakes made by humans, referred to as Adharma. This occurs in three main ways: Asatmendriyartha sanyog (misuse of senses), Pradnyapradha (improper understanding of an object), and Parinam (time). These three factors can lead to the attraction of microbes, and if a person’s immunity is low, it may result in the occurrence of Balgrahas.

Adharma refers to poor lifestyle choices related to eating, exercising, maintaining a routine, living, acting, thinking, and being indulgent. Long-term practice of Adharma increases a person’s susceptibility to microbial invasion. Therefore, the importance of cleanliness and hygiene practices should be taught to children and incorporated into daily life.

Pregnant women and their unborn children should live in well-maintained and fumigated environments, following the Garbhini and Sutika paricharya (code of conduct for pregnant and lactating mothers) and various preventative strategies mentioned as prevention methods.

Authors’ Contribution: RRR: Developed and designed the study. RBR: Gave guidance on how to correct the article in light of the Ayurvedic context, whereas SPK: Offered insightful suggestions for the manuscript’s design. The manuscript was read and approved in its final form by all writers.

Editorial Note: This paper is being published to highlight the ancient understanding of balgrahas (infections in children) and document ayurvedic concepts in context of modern medical history. While medicine has significantly evolved with advanced diagnostic and treatment methods, this article provides a perspective on how infections in children are viewed and managed in ayurveda.

It was a challenging task for the editors to understand the text of this article. To ensure accuracy and clarity, the editors consulted ayurvedic textbooks and sought the expertise of professionals in the field to better understand and verify the content.

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DOI and Others

DOI: 10.7860/JCDR/2024/72591.20247

Date of Submission: May 02, 2024
Date of Peer Review: May 18, 2024
Date of Acceptance: Jul 20, 2024
Date of Publishing: Nov 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 03, 2024
• Manual Googling: May 23, 2024
• iThenticate Software: Jul 19, 2024 (3%)

ETYMOLOGY: Author Origin

EMENDATIONS: 6

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