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Introduction

According to Acharya Vagbhata 1, Graha are Indicates as a hidden disease in children where both psychic and medical treatment is employed. Balagraha is one of the important portion of ayurveda which have their impact over all states of children need proper explanation but have comparative clinical importance. Balagraha are now compared with various microbial infections which can be treated with a combined approach of therapeutic and psychiatric management. Diseases caused by unidentified factors are termed as idiopathic in modern science but these disorders can be considered as balagraha, jataharinis, adibalpravritta, and janmabalpravritta etc in our ancient texts. In ancient period there was no advanced technology for the diagnosis, equipment’s for treatment and multispecialty setup of hospitals, but peoples of that time were describe the details and accurate description of multiple syndromes and group of diseases of multi systemic origin. Now modern terminologies are more specific and specified causative organism of diseases. Current article is an approach toward the ancient aspect of such disorders and their correlations with the modern era.

Objective of study:

1. To explore knowledge about the concept of Balgraha.
2. To understand different etiological factors, symptoms and management of grahabadha.

Mythological Concept:

These grahas were produced from shiva and parvati for purpose is as a body guards to his son.  Narratod by God Shiv himself.2

Ancient Aspect:

In our ancient texts, the oldest reference of Balagraha is present in Rig-veda as bhutas menacing foetus and neonate.3 Balagrahas are described to be created long back by lord shiva for the protection of Kartikeya, These balgraha were Skanda, Vishakha, Meshakhya, Svagraha, pitrugraha, Shakuni, Putana, Sheetaputana, Adrishtaputana, Mukhamandika, Revati and Sushkarevati.  Here first five are males and remaining are females. In Ashtanga, Acharya Vagbhata describes the general features of these balgrahas, the clinical features of individual grahas, etiology and treatment in details.4 In Aganipurana-2 terms have been explained: graha and grahi (female graha). It also effects baby from first day to 17 years of life such a way 38 graha are explained. Markandeya purana-16 demons appeared from nirmasti wife of dusaha out of this 8 are males and 8 are females. This may be affecting since womb or after birth

Skandagraha produced by lord Shiva, SkandaApasmara by agni, Naigamesa by Parvati and Mukhamandika and Putana by Kartikeya.5 Shatapatha Brahman depicts graha as some mythical power.6

In Charak samhita, there is direct reference of grahas, according to Charaka Samhita grahas were innumerable in number.7 Acharya Sushruta elaborate balagrahas in many aspects, including predisposing factors, mode of seizure, manifestations and management of individual grahas. There are 9 Grahas are explained by Sushrutacharya include 3 Purusha Graha and 6 Stree Graha are as follows: 8

Purusha Graha (3): 1. Skanda 2. Skand-apasmara 3. Naigmesha

Stree Graha (6): 1. Shakuni 2. Revati 3. Putana 4. Andha-putana 5. Sheeta-putana 6. Mukha-mandika

Acharya Vagbhatta has added three more grahas (Swagraha, Pitrugraha and Shushka Revati) with slight variation in nomenclature thus the total numbers become twelve which have been classified as male and female grahas9 (Gram + ve and Gram –ve microbes)

Purusha Graha (5) 1. Skanda 2. Vishakha 3. Naigmesha 4. Pitru 5. Shwa Graha

Stree Graha (7) 1. Shakuni 2. Revati 3. Shuska Revati 4. Putana 5. Adrista-putana 6. Sheeta-putana 7. Mukha-mandika

In Kashyapa samhita , in sutrasthana described vitiation of breast milk of wet nurse by graha like Shakuni, Skanda, Shashthi and Putana. On consumption of such milk child can suffer various features of graha.10 There is also description of  balagraha is in Indriyasthana in Aushadha Bheshaja Indriya Adhyaya where the  symptoms of affected child with various graha like Skanda, Skandapasmara, Pitriskanda, Pundarika, Revati, Shushkarevati, Shakuni, Mukhamandika, Putana and Naigamesa.11 In Chikitasa sthana, in Balagraha chikistha Adhyaya about treatment of child is given who affected by Revati, Putana, Andhaputana, Shitaputana, Kataputana and Mukharika (Mukhamandika) grahas. Here Acharya Kashyapa given more stress to Revati and it has been mentioned with 22 names. 12

Causes 13

There are several reasons by which graha affects on child health’s which includes not following the sadvritta and swasthavritta, vitiated milk of mother, fearful conditions for child, disrespect to saints teachers, improper indulgence in eating, sex, sleep, exercise-by mother and dhatri ,taking food in broken kasya patra , child carried to lonely and inauspicious places  and psychologically unwell child etc.

Etiopathogenesis of Graha:14

Generally, these graha attain shapes of different animals like cat, bear, and owl and frighten the person. They attack on specific days like full moon, no-moon, eclipses, etc. and may even attacks during sleep, awake and during time of committing sin. Disorders produced primarily due to grahas will not show the vitiation of doshas and causes are invisible and Agantuja in nature. Who do not worship guests or not worship gods, ancestors, even on special days or not follow Dharma and indulged in Adharma or not offer oblations to god or eat in broken bronze vessels or among the persons with anger, who are frightened, cruel minded or the person who roam in forbidden places (burial ground, haunted house etc.) or eat the food left by others or wear the garland, dress, ornaments of others or Child or mother who are dirty, and who weeps in both morning and evening, etc.

Microscopic nature of Balgraha:

Grahas are invisible and can be correlated with  microbes. These grahas are visible only to divine vision i.e. microscope. These are night wanderers. They dwell at water tanks (sheetputana), ruined houses (putana), cow-sheds (Mukhamandika) and bases of the trees (pitrigraha). Jataharini described by Kashyapa attacks pregnant women and foetus is highly contagious. They affect breast milk of dhatri too.

 

Table no.1 Correlation between Graha Rogas and Micro-organism

S. N.	Nature	Graha Rogas	Micro-organism
1	Living	Living ( as they move and attack)	Living
2	Prone time of movement	Night hours	Dark area/ low temperature & humidity
3	Method of invasion	Hold the body , attack and cause Prachhana Vyadhi	Entry will be identified only after the first symptom
4	Intubation period	Can’t be identified like entry of Atma inside the body, image inside a mirror	Period after invasion to the production of first symptom
5	Size & shape	Change as per demand	Pass through different stages of life cycle like larva, egg, sore etc.
6	Presence of Fever	Causes as a Purva Rupa	Usually causes as the first symptom
7	Generalized	Causes Generalized affliction of body requiring both yukti & Daiva Vypashraya Chikitsa	Causes generalized involvement (both mind & body)
8	Visibility	Invisible & visible only through special vision power (Gyana Chkshu)	Invisible by naked eye & visible by Microscope
9	Entry inside the body	Enters the human body who follows Adharma	Enters the human body in search of definite & indefinite host in an immune deficient person
10	Diagnosis	Difficult due to rapid onset, progression and severity	Diagnosis of an individual organism is Impossible without culture study
11	Treatment	Apta Vakya should be followed suggesting need of an expert’s opinion	Previous experiences, prevalence rate of infection in a given area and empirical treatment will be followed
12	Intension of entry	Himsa ( tissue injury), Rati (sexual thrust to complete life cycle) Archana (nourishment)	In search of host To get nourishment To complete reproductive cycle
13	Outcome of invasion	Raksha of the body	Infections leave back certain immunity

 Prodromal Symptoms (Purva Rupa):

1. Continuous crying: Newborns always face the paucity of symptoms due to limitations in language development. It uses the same symptom to indicate many diseases. Septicemia, hypothermia, fear, hunger or even wet napkin, otitis media like conditions will be presented with a common symptom of crying. In Graha Rogas also, similar presentation will be observed, but the major difference is, it is continuously crying. Vigorous inconsolable, fearful continuous cry is a characteristic symptom to infer Graha Rogas.

2. Fever :- We know fever is the most common symptom in almost all the infective cases with some rare exceptions. Graha Rogas are also presented with fever as a preliminary symptom. This helps us to understand the antigenicity and infective nature of the Graha Rogas.

General Symptoms (Samanya Rupa):15,16,17

All these symptoms point toward seizures after an attack of fever. That is acute infection cause high fever or some neurological sequelae ending up into a seizure attack. The symptoms appearing in a child due to affection of balagraha may depend upon the infliction of that graha.

Prognosis Child which has rigidity of the body, aversion to the breast, becomes unconscious often and the graha exhibiting all its features kills the child soon; that with opposite features and seizure being recent, it is curable and so should be treated. All the Graha Rogas are fast progressive & difficult for diagnosis treatment.  Skandgraha finally leads to residual physical disability or death.18 If there is abdomen surrounded with cysts, fecal matter with different colours, depressed tounge and blackish colouration of palate, then such patients should be avoided.19

Treatment: 20,21

As “Prevention is better than cure “ the general line of management as mentioned earlier holds good for all balagrahas by giving priority to absolute hygiene and immunity instead of symptomatic management. Principle followed in Graha Rogas is almost similar to anti- infective treatment followed by modern science.

General treatment principles of Graha Rogas includes  Daiva Vyapashraya and Yukti Vyapasraya chikitsa.  Mantra Prayoga, Swasti Vachana,Bali, Mangala Homa are the part of Daiva Vyapashraya chikitsa while Aushadhi Dharana, Snana, Ghrita Prayoga, Parisheka, Lepas, Avagaha , Dhupana , Dhoomapana, Snapana  and Agni danda are specific measures under Yukti Vyapasraya chikitsa.

Some specific treatment measures according to types of graha roga are as follows-

1. Skandagraha: vatashamakdravya, gayatri-mantra

2. Skandapasmar: kaphashamakdravya, dashamula,

3. Swagraha:shatavari, sariva siddha taila

4. Pitrugraha – bath with kshirvruksha mula kashaya

5. Shakuni – Kashaya ras Pradhan dravya

6. Putna – kakolyadi madhur aushadha, bali, ghrita pana

7. Mukhamandika – vatashamak chikitsa

8. Shushkarevati – same as skandagraha

Some oral and topical medicines also used. Pure herbal medicines or pure mineral medicines ( rasa aushadies) and even herb-mineral combination can be used judiciously as per clinical picture , i.e. system involved, site of lesion, severity of pathology and complications occur.

External use: 22

1. Abhyanga: Oleation done with oil prepared from Lochana, Tagara, Jatamasi, Priyangu, Savira, Madhuka, Ela and Bhunimbha etc
2. Parisheka: Steam pouring done with decoction prepared from Varuna, Haridra, Agnimantha , Chitraka, Rohisha, Putika, Paribhadra, Kurubhaka etc.
3. Dhupana: Fumigation has been done with Sarpa-Kubusa, Gaja-Naka,Gridhra-Mala, Ushtra-Roma etc.
4. Bali and Snanam: Oblation and bathing by Tandula, Mudga, Tila, Mamsa, Matsya etc.

Internal use: 23

1. Churna: Powder prepared from Kasha, Mridvika , Madhuka , Kharjura , Mushtka,Narikela etc.
2. Kwatha: Decoction prepared from Badhari, Yava, Laghu-Panchamula , Bimbi ,Gambhari, Kulattha .
3. Taila: Kshirbhala Oil, Mahamasha Oil, Prasarini Oil, Jyotishmati Oil etc.
4. Ghrita: Balgrahanasaka ghrita, Balahitakari ghrita, Ashamangala ghrita etc.
5. Rasaushadhies: Jayamangala Rasa, Rajamriganka Rasa, Kumar Kalyana Rasa etc.

Discussion

Bala-grahas impact on all over nation of children need proper explanation but have comparative clinical importance. Though etiopathogenesis, general symptoms of balagrahas has now been felt as fake among scholars but really they are explained in an applied clinical manner. This research paper is an approach towards the concept of Balgraha by considering ancient conceptual aspect and critical analysis done with applying the modern medicine concepts. The concept of microorganism do also well with relating all graha with viral etiology unless earlier some are thought to be noninfectious.  On average, enteroviruses cause about four infections per child per year during the first several years of a child's life. Once a child has had an infection with a specific enterovirus, the child is typically immune to that virus for life. So, these are truly "pediatric viruses" primarily affecting children. This is why a child may become ill with a certain enterovirus and the parent usually will not become ill with that virus. The younger the infected person, the more severe the disease. Some very young infants infected with an enterovirus may have the appearance of sepsis (a severe bacterial infection of the blood) with high fever and lethargy, requiring tests to investigate what is causing the illness. Newborns who become infected with an enterovirus may rarely develop an overwhelming infection of many organs, including liver and heart, and die from the infection. Along with this as balagrahas caused by uncleanliness and unhygienic atmosphere, it is important to adopt cleanliness and hygienic measures in routine practice.

Conclusion

Finally, based on all above description of bala-grahas are now resemble to various microbial infection e.g virus, bacteria, fungus, etc. Balagraha are now compared with various microbial infections which can be treated with a combined approach of therapeutic and psychiatric management. In Ayurveda the management of such viruses is given with both therapeutic and psychiatric approach. So, with Ayurved approach it is necessary to implement the concept and utilize its clinical importance in child health care. Further study can be conducted to establish evidence-based facts for Balagraha and its clinical manifestation with microorganism  which would be helpful in protocol development of management of such illness.