Randomized controlled clinical study to evaluate the efficacy of Shuntyadi Yoga in Vibandha with special reference to constipation in children.

Nurturing today’s children is essential for a brighter future, as they symbolize tomorrow’s potential. The physical wellbeing of young children has a direct effect on their overall development. Regular defecation is one of the indicators of good health. The normal defecation pattern of children might change according to age and dietary habits. Changes in defecation pattern may cause some physical and psychological problems. Thus, understanding the individual age-related normal and abnormal defecation patterns is considerably important. Understanding Constipation/Vibandha, i.e. infrequent defecation, painful defecation, or both, will help in understanding the overall health of the child.

The prevalence of childhood constipation in general population varies widely ranging from 0.7% to 29.6%. It accounts for 3% of visits to general Pediatric clinics and accounts for about 25-30% of visits to pediatric gastroenterologists.

Constipation is gastro intestinal disease, defined as infrequent defecation, painful defecation, or both. Initial painful defecation leads to voluntary withholding which further paves way for prolonged stasis of fecal matter, as a result of this there is increase in its size and consistency thus a vicious cycle is initiated with more pain on defecation and constipation.

This leads to distress for the child further causing recurrent discomfort in abdomen, reduced appetite also exhibits changes in behavior, such as mood swings and lack of interest in studies or difficulty in concentrating. Constipation is often negatively perceived by peers and possess a significant burden on both the child and parents. So, it is important that the disease is treated at the beginning stage itself before it leads to further complications like painful defecation with partial evacuation and Fissure in Ano.

Vibandha can be described as Mala Apravrutti due to solidification of Purisha caused by Dushti of Apana Vayu, Annavaha and Purishwaha Srotas. It is seen as one of the symptoms of Udavarta, Anaha, Adhmana and Arsha. In Vibandha there is Purisha Vega Dharana which has the potential to manifest systemic complications such as Pindikodveshta (Calf muscles cramps), Pratishyaya (Coryza), Shiroruja (Headache), Parikartika (Anal fissures), Agnivadha (Loss of digestion capacity) Vatamutra Sanga (Obstruction of urine and flatus) and Hrudgada (Diseases of the heart). Thus, early diagnosis and management of Vibandha is essential for Swasthya of a growing child.

Main line of treatment according to modern science is considered to be use of laxatives and enema which might temporarily relieve the condition and might reoccur later for the prevention of recurrence long term laxative maintenance is required. Most common side effects of laxatives are excessive gassiness, bloatedness and crampy abdominal pains. Long term use has adverse effects as overstretched or lazy colon which can result in Irritable Bowel Syndrome. The body’s nutrient balance is also negatively impacted by causing a disturbance in mineral balance like magnesium, sodium, potassium, and phosphates, which hamper child’s normal growth and development.

The treatment principles adapted in Ayurveda are Deepana (Increase the digestive fire), Pachana (Process of Digesting Food), Vata-anulomana (downward movement of Vata) and Rechana (Purgation). There is an impetus to explore the drugs having capacity to cure Vibandha without side effects and recurrence. One such formulation is Shuntyadi yoga mentioned in Bhavaprakasha which is administered with Sahapana of Guda (jaggery). It has main stay on Amajirna, Arsha and Malavibandha by the virtue of its properties. This Yoga is easily acceptable and palatable by children to relieve and prevent Vibandha. Thus, this study is an attempt to evaluate the efficacy of Shuntyadi Yoga on Vibandha in children.