1. Introduction

Chronic colitis represents a spectrum of inflammatory conditions affecting the colonic mucosa. In some patients, endoscopic inflammation and histological chronic inflammatory changes are present without sufficient evidence to establish a specific inflammatory bowel disease.

Ayurveda approaches gastrointestinal disorders through assessment of Agni, Grahaṇī, Doṣa, Koṣṭha and Srotas, with emphasis on the patient's digestive function, bowel pattern and associated symptoms.

The present case describes a patient with histopathologically documented chronic non-specific colitis who subsequently underwent individualized Ayurvedic treatment with longitudinal clinical and endoscopic assessment.

2. Patient Profile

3. Clinical Presentation

The patient's predominant presentation was gastrointestinal and was clinically suggestive of Grahani dysfunction.

The documented symptoms included:

• poor/impaired digestion,
• abdominal discomfort,
• abdominal distension,
• Āṭopa/gaseous abdominal symptoms,
• disturbed digestion,
• and fatigue.

The symptoms fluctuated during the treatment period. Improvement in digestive function was subsequently documented, followed by a later episode of abdominal discomfort and disturbed digestion.

From the Ayurvedic perspective, the presentation was considered in relation to Agni Vaiguṇya and Grahaṇī dysfunction, with later assessment showing Vāta–Pitta predominance.

4. Initial Investigative Findings

The initial colonoscopic examination demonstrated localized inflammatory mucosal changes, specifically erythema and erosions in the distal transverse and descending colon. The terminal ileum and remaining visualized colonic mucosa were normal.

Biopsy from the abnormal mucosa showed:

• oedematous lamina propria,
• chronic inflammatory cell infiltration,
• predominantly lymphocytes,
• few plasma cells,
• and pus cells.

There was no evidence of IBD, SRUS, dysplasia or malignancy in the examined sections.

The final histopathological impression was:

Chronic Non-Specific Colitis

The reported microbiological culture showed no growth.

Thus, the baseline clinical and investigative picture was consistent with chronic non-specific colitis without documented evidence of a specific inflammatory bowel disease.

5. Ayurvedic Clinical Correlation

The gastrointestinal presentation was evaluated through the Ayurvedic concepts of:

• Agni
• Grahani
• Vāta
• Pitta
• Annavaha Srotas
• Purīṣavaha Srotas

The clinical symptoms of poor digestion, abdominal discomfort, distension and Āṭopa were considered compatible with Grahaṇī dysfunction.

During the later treatment assessment, the clinical record specifically documented:

Nadi: Vāta–Pitta
Diagnosis: Grahani

This provided the basis for further modification of treatment according to the patient's prevailing clinical state.

6. Ayurvedic Pathophysiological Correlation

A conceptual Ayurvedic sequence for the case can be represented as:

This represents an Ayurvedic clinical framework and should not be interpreted as a direct molecular explanation of the histopathological findings.

7. Treatment Initiation and Therapeutic Objectives

The earliest documented Ayurvedic treatment was on 18 February 2026.

The treatment strategy was individualized according to the patient's symptoms and Ayurvedic assessment.

The principal therapeutic objectives were:

• correction and stabilization of Agni,
• support of Grahaṇī function,
• regulation of bowel function,
• management of Pitta-associated digestive symptoms,
• Vāta regulation where clinically indicated,
• dietary correction,
• lifestyle modification,
• and supportive Panchakarma.

8. Ayurvedic Medicines Used

The therapeutic regimen was modified over time according to the patient's clinical condition rather than being maintained as one fixed combination.

9. Panchakarma Management

Panchakarma was incorporated as part of the individualized treatment plan.

The previously documented protocol included Indukantham Ghrita and Madhuyashtyadi Taila with an appropriate Kalka component.

The Ayurvedic therapeutic rationale was directed toward:

• Grahaṇī support,
• Vāta regulation,
• chronic bowel dysfunction,
• and functional intestinal stabilization.

Janu Basti is not included in this case study.

10. Dietary Management

Dietary modification was an integral part of treatment.

The patient was advised regarding:

• regular meal timing,
• freshly prepared and easily digestible food,
• appropriate portion size,
• adequate hydration,
• avoidance of individually identified food triggers,
• adequate nutritional intake,
• reduction of excessive spicy, oily and highly irritant foods during Pitta-associated symptoms,
• and warm, appropriately digestible food during Vāta-associated digestive disturbance.

The dietary objective was to support Agni and digestive stability while maintaining adequate nutrition.

11. Lifestyle Management

Lifestyle modification accompanied the dietary and medicinal treatment.

The approach included:

• regular physical activity,
• appropriate exercise,
• adequate sleep,
• stress management,
• regular meal timing,
• and maintenance of a consistent daily routine.

Diet and exercise were documented repeatedly as components of the overall management strategy.

12. Phase-wise Treatment Course

13. Treatment Timeline

14. Before-and-After Endoscopic Comparison

Objective outcome

The follow-up examination demonstrated normalization of the previously documented visible colonic abnormalities.

15. Follow-up Histopathology

A repeat biopsy was not performed during the follow-up evaluation.

The clinical reason documented for this approach was that the patient had experienced significant symptomatic relief and improvement in digestive function, and the follow-up colonoscopic examination did not demonstrate the previously observed mucosal abnormalities.

Therefore, the outcome in this case should be described as:

Clinical improvement with endoscopic normalization

rather than histological remission.

16. Integrated Ayurvedic–Scientific Correlation

These correlations represent an Ayurvedic clinical interpretation and should not be considered equivalent to modern histopathological mechanisms.

17. Discussion

The present case demonstrates chronic non-specific colitis documented by initial endoscopic and histopathological evaluation, followed by clinical improvement and normalization of the visible colonic mucosa during individualized Ayurvedic management.

The initial investigation demonstrated localized erythema and erosions in the distal transverse and descending colon. Histopathology showed chronic inflammatory changes without evidence of IBD, SRUS, dysplasia or malignancy. The reported culture showed no growth.

The clinical presentation was predominantly gastrointestinal, with poor digestion, abdominal discomfort, distension and Āṭopa. These manifestations were considered within the Ayurvedic framework of Agni and Grahaṇī dysfunction. During follow-up, Vāta–Pitta Nadi and Grahani were documented, supporting further individualized modification of therapy.

The treatment strategy consisted of digestive and Grahaṇī-oriented medicines, bowel regulation, dietary and lifestyle modification and Panchakarma including Piccha Basti. The patient's treatment was progressively adapted according to the changing clinical presentation.

Clinical improvement was documented during follow-up, including "relief good" in April and "digestion good" in June. Although some digestive symptoms subsequently recurred, the patient continued to be managed through individualized treatment modification.

The follow-up ileo-colonoscopy demonstrated normal visualized mucosa, with no recurrence of the previously described erythema or erosions. Because the patient had experienced clinical relief and the follow-up endoscopic examination was normal, repeat tissue biopsy was not performed.

Thus, the strongest documented outcome is clinical improvement accompanied by endoscopic normalization. Since repeat histopathology was not performed, microscopic remission cannot be established.