A Critical Review on Formulations Used in the Management of Malavstambha (Constipation)

Background: Malavstambha is not mentioned as a disease in any text of Ayurveda, but it is symptoms of many diseases. Many types of diseases caused by ‘Malavstambha’ (sarveshamev kupita malaha). Multiple reasons contribute to this phenomenon, such as the effects of ageing on gut physiology, certain illnesses, medications, reduced mobility, inadequate caloric intake, and anorectal sensory changes. It is a very common problem which is increase day by day. For readily available market preparation is used for malavstambha. There is many formulations are mentioned in Ayurvedic Text but it is not in practice or didn’t researches conduct. Aim: To find out the various formulations for malavstambha. Result and Observations: In Bhaishajya Ratnawali, Yogratnakar, Charak Samhita, Ashtanga Hriday and Sushruta Samhita,we found many formulations. Original Research Article Parwe et al.; JPRI, 33(34A): 92-100, 2021; Article no.JPRI.70584 93 Conclusion: There are many formulations mentioned in our Samhitas. Some of them are used in practice, but we have to conduct researches on mentioned formulations and create evidence based protocol for malavstambha.


INTRODUCTION
The Ayurvedic theory of tridosha stands for all times and circumstances and justifies the ancient needs and caring for the future. These three doshas maintain the integrity of the human body. The equilibrium of these three basic substances is responsible for maintaining good health. Similarly disequilibrium of these may cause disintegration of the body or may leading too death [1,2].
There are three main 'malas' like Shakrut, Sweda and Mutra. Kitta is produced after the digestion of food material in the large intestine. After digestion, food is divided in two parts, sara and kitta. Sara bhag is known as Aahar rasa, while kitta bhag is known as mala, sweda, mutra, purisha etc. are nourished by this second part of digestion i.e. kitta bhag [3]. The undigested food residue which is expelled out of pakvashaya with the help of apan vayu is called purisha to which this topic is related i.e. purishavastambha means Malavstambha [4].
Malavstambha is not mentioned as a disease in any text of Ayurveda, but it is symptoms of many diseases. Much type of diseases was caused by 'Malavstambha' (sarveshamev kupita malaha). Multiple reasons contribute to this phenomenon, such as the effects of aging on gut physiology, certain illnesses, medications, reduced mobility, inadequate caloric intake, and anorectal sensory changes [5].
A normal pattern of stool evacuation is thought to be a concerning of all ages. In modern science it is correlated with Constipation. Constipation is almost always associated with slowed bowel transit. It may be due to the sphincter in coordination concerning the destructor mechanism or to the destructor. Weakness is causing loss of propulsive force (Swash et al., 2001). Rajput et al. reported in their study 'the prevalence of Constipatithe in the last year was 24.8% whereas 16.8 % of participants had Constipation according to the Rome II criteria. In his study, most subjects (83%) within the age group 18-59 years. He reported; their male was more frequent than in male (20 % vs 13%) and in nonworking population than in working population (20% vs 12%)' [6].
Constipation is defined as the infrequent passage of hard stools; there may also be complaints of straining, the sensation of incomplete evacuation and perianal or abdominal discomfort. Constipation may have a significant impact on quality of life detailed would restrict patient's social activities, increasing levels of anxiety and depression, so that symptoms' management is critically important [7]. This review will focus on providing a detailed account of Malavstambha formulations mentioned in Ayurvedic text.

RESULTS
Formulation indicated in the treatment of Malavstambha.

DISCUSSION
During Constipation, the diet should be easily digestible, with plenty of fruits, vegetables, salads, freshly cooked food, including probiotic foods like curd and chew food thoroughly. Include Vitamin C and Magnesium rich your daily diet. During eating keep yourself in your present mind and pay full attention on food [15]. There are so many kalpas are mentioned in Samhitas for Malavstambha but only few formulations were used in practice.  and koshtavibandha.In the above text, three churnas, six ghrutas, elevan rasa kalpas, four kwathas, two avalehas and one guda kalpa are mentioned.

Table 3 Shows
In the text of Chakradutta, there are total sixteen formulations are mentioned for malavstambha. Formulations are mentioned under following heading Vibandha, vitsange, vidvibamdha, gadpurushe. In the text Chakradutta, three ghrutas, two guggul, two yoga, three vati, one lavana prayoga and swaras are mentioned for malavstambha.

Table 4 Shows
In the text of Sahastra yoga, two formulations are mentioned for malavstambha. Both arishtas are mentioned under the headings malanulomaka and varcho mutra vibandha.   [20]. Zadpe et al said in their study that Shunthyadi Syrup has shown significant effect in alleviating the sign and symptoms of Vibandha(Constipation) in children [21]. HM IL et al studied the Pharmacognosy and phytochemical evaluation of Vaishvanara Churna. They reported that it was performed which is a potent medicine in the management of Vibandha (Constipation) [22]. Satani et al reported in his study that Yogic Ahara and Vihara can be a good alternative for all geriatric disorders like chronic gastro-intestinal problems, especially Constipation [23].
Mangal et al studied on Avipattikar churna in Hyperacidity (Amlapitta).He reported that it is very effective in amlapitta and it holds potent neutralizing the pitta dosha in stomach [24]. Parwe et al said in her study that Panchalavan with Goghruta is effective in malavstambha w r t age, gender and symptoms of malavstambha, and it is the safest drugs in all age group [25].

CONCLUSION
There are many formulations mentioned in our Samhitas. Some of them are used in practice, but we have to conduct researches on mentioned formulations and create evidence based protocol for malavstambha.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
It's not applicable.