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

Ayurveda is a time-tested science that systematically explains its concepts through eight branches. GrahasChikitsa (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.

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:

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.

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 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.

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 PradhanGrahas. [Table/Fig-2] presents the Graha types along with the typical features and odours observed in children affected by Grahas (microbes) [12,13].

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.

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 PutanaGraha.

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 Mukhamandikagraha.

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.

1. Daiva Vyapashraya:

2. Yukti Vyapasraya:

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].

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 SiddhaKoshna 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 KashyapaSamhita, 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 [25-65].

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 GrahaRogas, 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.

Acharya Sushrut has explained the concept of GrahaAvesha 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]. AcharyaCharaka 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].

Various smells emanate from each Grahasroga. 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.

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.

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.

[1].  Kashyapa Samhita, edited by Sri Stayapala Bhisgacharya with Hindi commentary Vidyotini, 10^th edition, Kalpa sthana, Revatikalapa adhaya, Verse no. 8 2005 VaranasiChaukhambha Sanskrit Sansthan:190  [Google Scholar]

[2].  Riga Veda Samhita Edited by F Max Muller and Commentary by Sayanacarya, Vol. I-IV, Verse no.10-16, 2 1983 VaranasiKrishnadas Academy  [Google Scholar]

[3].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16^th edition, Volume-II Uttara tantra, Verse no. 37/6 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:154-155.  [Google Scholar]

[4]. Acharya SK, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:176  [Google Scholar]

[5]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:179  [Google Scholar]

[6]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 2, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:190  [Google Scholar]

[7]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:195  [Google Scholar]

[8].  Ashtanga Hridaya edited by Dr. Brahmanand Tripathi with Hindi commentary Nirmala, Reprint edition 2009, Uttar Sthana, Adhyaya 3, Shloka No. 32 DelhiChaukhamba Sanskrit Prakashana:903  [Google Scholar]

[9]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:197  [Google Scholar]

[10]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:205  [Google Scholar]

[11]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Chaukhamba OrientaliaVaranasi, India:210  [Google Scholar]

[12].  Vagbhatta, Astanga Hridaya edited by Kaviraj Atridev Gupta with Hindi commentary Vidyotini, Reprint edition, Uttara Tantra, verse no. 6/32 2005 Varanasi, IndiaChaukhambha Sanskrit Sansthan:463  [Google Scholar]

[13].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16^th edition, Volume-II Uttara tantra, Verse no. 6/20 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:142  [Google Scholar]

[14]. Kumar SH, Prasad GG, Neetu S, Jitesh V, A review on clinical application of the concept of BalaGrahas in modern times J Biol Sci Opin 2014 2(1):117-20.10.7897/2321-6328.02128  [Google Scholar]  [CrossRef]

[15].  Vagbhatta, Astanga Hridaya edited by Kaviraj Atridev Gupta with Hindi commentary Vidyotini, Reprint edition, Uttara Tantra, verse no. 3/32 2005 Varanasi, IndiaChaukhambha Sanskrit Sansthan:463  [Google Scholar]

[16].  Vagbhatta, Astanga Hridaya edited by Kaviraj Atridev Gupta with Hindi commentary Vidyotini, Reprint edition, Uttara Tantra, verse no. 3/32 2005 Varanasi, IndiaChaukhambha Sanskrit Sansthan:464  [Google Scholar]

[17].  Vagbhatta, Astanga Hridaya edited by Kaviraj Atridev Gupta with Hindi commentary Vidyotini, Reprint edition, Uttara Tantra, verse no. 3/32 2005 Varanasi, IndiaChaukhambha Sanskrit Sansthan:462  [Google Scholar]

[18]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:180  [Google Scholar]

[19].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16^th edition, Volume -II Uttara tantra Chapter 28, Verse no.4-7 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:110  [Google Scholar]

[20].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 2-3 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[21].  Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:196  [Google Scholar]

[22]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:198  [Google Scholar]

[23]. Acharya Kumar Shrinidhi, Acharya’s Textbook of Kaumarbhritya, 1st edition, Vol. 1, section 4, chapter 22, General concept and treatment 2016 Varanasi, IndiaChaukhamba Orientalia:200-201.  [Google Scholar]

[24]. Sarkar S, Lakra A, Ji D, A review on concept of bala graha with its modern aspects World Journal of Pharmaceutical and Medical Research 2023 9(8):55-63.  [Google Scholar]

[25].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16^th edition, Volume -II Uttara tantra Chapter 28, Verse no. 8/9 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:126  [Google Scholar]

[26]. Shastri Lakshmipati, Yogaratnakar with vidyotini Hindi commentary, Balchikitsa 1999 VaranasiChaukambha Sanskrit Sansthan:448  [Google Scholar]

[27].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 28, Verse no.9 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:127  [Google Scholar]

[28].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 28, Verse no.11-14 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:129  [Google Scholar]

[29].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 4-5 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[30].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 6 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[31].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 4 Sasilekha sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[32].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 28, Verse no. 10 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:128  [Google Scholar]

[33].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 13 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[34].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 29, Verse no. 1-10 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:136  [Google Scholar]

[35].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 29, Verse no.4 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:135  [Google Scholar]

[36].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 15 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[37]. Shastri Lakshmipati, Hindi commentary, Yogaratnakar with vidyotini Hindi commentary, Balchikitsa 1999 VaranasiChaukambha Sanskrit Sansthan:451  [Google Scholar]

[38].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 17 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[39].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 16 Sasilekha sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[40].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 18 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[41]. Shastri Lakshmipati, Hindi commentary, Yogaratnakar with vidyotini Hindi commentary, Balchikitsa 1999 VaranasiChaukambha Sanskrit Sansthan:452  [Google Scholar]

[42].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 21 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[43].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 24 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[44].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 23 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[45].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16^th edition, Volume -II Uttara tantra Chapter 30, Verse no. 9-10 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:145  [Google Scholar]

[46].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 31 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[47].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 30, Verse no. 5 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:142  [Google Scholar]

[48].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 30, Verse no. 8-11 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:145  [Google Scholar]

[49].  Kashyap Samhita edited by Shri Satyapal Bhishagacharya with Hindi commentary Vidyotini, Reprint edition, Choukhmbha Sanskrit Series VaranasiChikitsa sthana. Balgraha chikitsa:102  [Google Scholar]

[50]. Shastri Lakshmipati, Hindi commentary. Yogaratnakar with vidyotini Hindi commentary, Balchikitsa 1999 VaranasiChaukambha Sanskrit Sansthan:461  [Google Scholar]

[51].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 35-36 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[52].  Sushruta Samhita edited by Kaviraja Dr. Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 34, Verse no. 5-9 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:172  [Google Scholar]

[53].  Kashyap Samhita edited by Shri Satyapal Bhishagacharya with hindi commentary Vidyotini, Reprint edition, Choukhmbha Sanskrit Series VaranasiChikitsa sthana. Balgraha chikitsa:101  [Google Scholar]

[54].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 38 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[55].  Kashyap Samhita edited by Shri Satyapal Bhishagacharya with Hindi commentary Vidyotini, Reprint edition, Choukhmbha Sanskrit Series VaranasiChikitsa sthana . Balgraha chikitsa:103  [Google Scholar]

[56].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 43-46 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[57].  Sushruta Samhita edited by Kaviraja Dr. Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 33, Verse no. 5-9 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:162  [Google Scholar]

[58].  Kashyap Samhita edited by Shri Satyapal Bhishagacharya with Hindi commentary Vidyotini, Reprint edition, Choukhmbha Sanskrit Series VaranasiChikitsa sthana. Balgraha chikitsa:104  [Google Scholar]

[59].  Sushruta Samhita edited by Kaviraja Dr. Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 35, Verse no. 4-9 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:170  [Google Scholar]

[60].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 50-51 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[61].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 59 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[62].  Sushruta Samhita edited by Kaviraja Dr. Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra Chapter 31, Verse no. 10-11 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:158  [Google Scholar]

[63].  Vagbhata. Ashtanga SamGrahas. Uttara sthana, Chapter 6, Verse 51 Sasilekha Sanskrit commentary by Indu. Edited by Shivprasad Sharma VaranasiChowkhambha Sanskrit series office  [Google Scholar]

[64].  Kashyap Samhita edited by Shri Satyapal Bhishagacharya with hindi commentary Vidyotini, Reprint edition, Choukhmbha Sanskrit Series VaranasiChikitsa sthanaBalgraha chikitsa 104. Available at: https://www.iamj.in/posts/2021/images/upload/466_472_1.pdf  [Google Scholar]

[65].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16^th edition, Volume -II Uttara tantra Chapter 31, Verse no. 10-11 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:159  [Google Scholar]

[66].  Vagbhatta, Astanga Hridaya edited by Kaviraj Atridev Gupta with Hindi commentary Vidyotini, Reprint edition, Uttara Tantra, verse no. 3/1 2005 Varanasi, IndiaChaukhambha Sanskrit Sansthan  [Google Scholar]

[67].  Sushruta Samhita edited by Kaviraja Dr Ambika Dutta Shastri with Hindi Commentary Ayurved Tatva Sandipika 16th edition, Volume -II Uttara tantra, Verse no. 27/7-8 2003 Varanasi, IndiaChaukhamba Sanskrit Sansthan:183  [Google Scholar]

[68]. Rathi R, Rathi B, Bhutada RS, Dasar D, Khatana R, Review on role of dhupan in the prevention of airborne infections (COVID-19) International Journal of Research in Pharmaceutical Sciences 2020 11(SPL (1)):246-52.10.26452/ijrps.v11iSPL1.2706  [Google Scholar]  [CrossRef]

[69]. Kale SV, Pawar MM, Grahabadha- A study of microbial infection in ancient times International Ayurvedic Medical Journal (online) 2021 [cited February, 2021] 10.46607/iamj2309022021  [Google Scholar]  [CrossRef]

[70]. Rathi R, Rathi B, Bhutada R, An experimental study on mahehwar dhoop to evaluate fumigation effect in comparison with bacillocid Indian Journal of Forensic Medicine and Toxicology 2020 14(4):6669-74.10.37506/ijfmt.v14i4.12659  [Google Scholar]  [CrossRef]

[71]. Bhatwalkar SB, Shukla P, Srivastava RK, Mondal R, Anupam R, Validation of environmental disinfection efficiency of traditional Ayurvedic fumigation practices J Ayurveda Integr Med 2019 10(3):203-06.10.1016/j.jaim.2019.05.00231427141  [Google Scholar]  [CrossRef]  [PubMed]

[72]. Braithwaite M, Vuuren SFV, Viljoen AM, Validation of smoke inhalation therapy to treat microbial infections Journal of Ethnopharmacol 2008 119(3):501-06.10.1016/j.jep.2008.07.05018778765  [Google Scholar]  [CrossRef]  [PubMed]

[73]. Yassin MF, Almouqatea S, Assessment of airborne bacteria and fungi in an indoor and outdoor environment International Journal of Environmental Science & Technology 2010 7(3):535-44.10.1007/BF03326162  [Google Scholar]  [CrossRef]

[74]. Niraj A, A short textbook of psychiatry 2011 New DelhiJaypee Brothers Medical Publishers (P) Ltd:13  [Google Scholar]

[75]. Hegde R, Shetty SK, A critical analysis of atatvabhinivesha as mahagada, and its modern interpretation International Ayurvedic Medical Journal 2021 9:1050-53.10.46607/iamj170905202110.46607/iamj1709052021  [Google Scholar]  [CrossRef]  [CrossRef]

[76]. Yadavji Trikamji Acharya, Caraka Samhitā by Agnivesha 2000 2nd EditionVaranasiKrishnadas Academy:223(CS Ni 7/7)  [Google Scholar]

[77]. Nordquist N, Oreland L, Serotonin, genetic variability, behaviour, and psychiatric disorders- A review Ups J Med Sci 2010 115(1):02-10.Available from: https://doi.org/10.3109/0300973090357324610.3109/0300973090357324620187845  [Google Scholar]  [CrossRef]  [PubMed]

[78]. Ak N, Chowta J, A view of ayurveda on autism spectrum disorders- A conceptual study International Ayurvedic Medical Journal 2021 9:1419-26.10.46607/iamj1509072021  [Google Scholar]  [CrossRef]

[79].  Agnivesha, Charaka Acharya, Yadavji Trikamj Acharya editor. Charaka Samhita 1992 New DelhiMunshiram Manoharlal Publishers Pvt. Ltd:477  [Google Scholar]

[80]. Upadhyay AN, Gupta MN, An holistic approach on bala-grha with their prevention and management Eur J Biomed Pharmaceutical Sci 2021 8(2):301-03.Available from: https://storage.googleapis.com/journal-uploads/ejbps/article_issue/volume_8_february_issue_2/1612776577.pdf  [Google Scholar]