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<p style="text-align:justify;">‘Anna’ means food that is consumed. Srotas are the channels for transportation and transformation of various body constituents.  Annavaha srotas are the body channels which carry food (anna). They can be correlated to gastrointestinal system. The channels are responsible for not only transportation, but also digestion and absorption of ingested food. This article deals with description of physiological and pathological aspects of annavaha srotasa. </p>
{{Infobox
|title =  Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts/[[Srotas]]/[[Annavaha srotas]]  
|label2 = Authors
|data2 = Bhojani M. K. <sup>1</sup>, <br/>Arun Lal  <sup>1</sup> 
|label3 = Reviewer 
|data3 = [[Gopal Basisht|Basisht G.]]<sup>2</sup>
|label4 = Editor
|data4 = [[Yogesh Deole|Deole Y.S.]]<sup>3</sup>
|label5 = Affiliations
|data5 = <sup>1</sup> Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India <br/><sup>2</sup> Rheumatologist, Orlando, Florida, U.S.A. <br/><sup>3</sup> Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India 
|label6 = Correspondence emails
|data6 = [mailto:meera.samhita@aiia.gov.in meera.samhita@aiia.gov.in], [mailto:carakasamhita@gmail.com carakasamhita@gmail.com]
|label7 = Publisher 
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label8 = Date of publication:
|data8 = September 27, 2023
|label9 = DOI
|data9 = {{DoiWithLink}}
}}
== Origin and location ==
<p style="text-align:justify;">Annavaha srotas is originated from  amashaya (stomach) and annavahini dhamani (channels carrying food) [Su. Sa. Sutra Sthana 9/12]. According to Acharya Charak, the roots are stomach (amashaya) and left lateral part of chest (vamaparshwa) [Cha. Sa. Vimana Sthana 5/7].  Annavahini dhamani plays a significant role in the nourishing function (preenana) of rasa dhatu. It carries the nutrient fluids (ahararasa), constituted by panchamahabhuta, and formed by the action of jatharagni (digestive capacity). Amashaya is the storage site of undigested food for the action of jatharagni. Annavahini dhamani & left lateral part of chest (vama parshwa) is related to the circulation of nutrient fluids (ahararasa). <br/>Amashaya is situated in between the umbilicus and breast [Cha. Sa. Vimana Sthana 2/22]. The upper part of amashaya is the site of kapha and lower part is site of pitta dosha [Cha. Sa. Sutra Sthana 14/9], [Cha. Sa. Sutra Sthana 20/8].</p>

== Annavahini dhamani ==
<p style="text-align:justify;">Annavaha srotas transports four types of food and drinks –  eatables (ashita), drinkables (peeta), linctuses (leedha), and chewable (khadita).  The consumed food moves down the alimentary canal stimulated by prana vayu [A. Hri. Sutra Sthana 12/5]. Activities including digestive processes in amashaya is under the control of samana vayu, situated near agni and travels throughout koshtha. It helps in the digestion process (pachana) and separation of nutrient part (sara) and wastes (kitta) [A. Hri. Sutra Sthana 12/8]. After the action of kayagni  and pachaka pitta, absorption and assimilation of the nutrient fluid (ahararasa) occurs at annavahini dhamani. </p>

== Left lateral part of chest (vama parshwa) ==
<p style="text-align:justify;">Annavaha srotas is mainly concerned with the transportation and digestion of food materials. All major activities take place in stomach (amashaya), which is in the upper abdomen, on the left side of the body. Many of the disorders related to the deformities of annavaha srotas show pain and distension of the area. It might be because of that, the Acharya Charak includes left flank (vama parshwa) as one of the roots of annavaha srotas. <br/>Amashaya is considered root because of its storage function from diagnostic and clinical point of view. Vama parshwa is root from a clinical view point and annavahini dhamani is root in conduction and circulatory point of view.<ref name="ref1">Lahange, Sandeep Madhukar, Archana Nivrutti Bhangare, and Vikash Bhatnagar. "Critical review on srotomool of annavaha srotas and its sigificance in clinical practice in present era." (2016).</ref> Anatomically, annavaha srotas can be considered as upper part of gastrointestinal tract from mouth upto the small intestine where digestion and absorption occur.<ref name="ref2">Khobragade, Shyam D., M. Yusuf M. Shareef Sheikh, and Gopal B. Sharma. "Conceptual review of the annavaha srotas with respect to its moolasthana." (2019).</ref> <br/>Vayu, with the help of pitta helps in the formation of body channels. Annavaha srotas is originated from maternal factors (matrija bhava). The essence (sara) of rakta and kapha, acted upon by pitta and vayu form intestines (antra), rectum (guda) and bladder (basti) [Su. Sa. Sharira Sthana 3/31].</p>

== Clinical features of vitiation of annavaha srotas ==
# Disinterest for food (anannabhilasha)
# Indigestion (avipaka)
# Anorexia (arochaka)
# Vomiting (chhardi) [Cha. Sa. Vimana Sthana 5/8]

The clinical features of injury to annavaha srotas are:
# Abdominal distention (adhmana)<ref name="ref3">http://namstp.ayush.gov.in/#/sat</ref> 
# Pain (shula)
# Aversion to food (annadwesha)
# Vomiting (chhardi)
# Thirst (pipasa)
# Blindness (andhya)
# Death (maranam) [Su. Sa. Sharira Sthana 9/12]

== Causes of vitiation of annavaha srotas ==
# Intake of food in excess quantity (atimatra bhojana)
# Untimely intake of food (akala bhojana)
# Intake of unwholesome food (ahita bhojana)
# Vitiation of agni (dushti of pavaka) [Cha. Sa. Vimana Sthana 5/12]
<p style="text-align:justify;">For the proper functioning of the digestive process two factors are responsible, food and digestive capacity. Eight considerations are laid down relating to the ordinances about food and drink. They are: nature (prakriti), transmutation (karana), combination (samyoga), measure (rashi), desha (place of origin etc), kala (season and age), upayoga-samstha (conditions of use) and upayoktri (taker himself of food and drink).<ref name="ref4">Narayana A. Diseases of Annavaha Srotas (gastroenterology): historical view point. Bull Indian Inst Hist Med Hyderabad. 2002 Jan-Jun;32(1):15-30. PMID: 15307207.</ref> <br/>In this modern era, improper diet habits and changes in lifestyle cause vitiation. It causes poor digestive capacity (agnimandya) leading to indigestion and various disorders. Hence irrespective of any disorder, agni should be considered first.<ref name="ref5">Biswas SG, Dasar D, Diwedi AK. Review on Annavahasrotodushti with Respect to Arsha Vyadhi. Indian Journal of Forensic Medicine & Toxicology. 2021;15(1):330-4.</ref>  </p>

== Management of disorders of annavaha srotas ==
<p style="text-align:justify;">Acharya Charak explains that the treatment of disorders of annavaha srotas should be done along the line of amapradoshaja vikara (diseases caused by the absorption of undigested food that is absorbed by the body, which acts as toxin) [Cha. Sa. Vimana Sthana 5/26]. Restricted nutrition (apatarpana) is the principle of management for this. [Cha. Sa. Vimana Sthana 2/9(13)]. Apatarpana (therapy to decrease excessively increased body components like fats (medo dhatu) etc.) is of three types – langhana (therapeutic fasting, hunger or intentional starving), langhana-pachana, and doshavasechana (shodhana). Langhana is done in mild cases (alpa bala dosha). Langhana-pachana (therapeutic fasting + digestion or promoting digestion) in moderate cases (madhyama bala dosha) and doshavasechana in excessively aggravated dosha (bahu dosha) [Cha. Sa. Vimana Sthana 3/23(43)].</p>

== Manipur chakra (solar plexus) and annavaha srotas ==
<p style="text-align:justify;">Chakra are the energy points or nodes in the subtle body described in Yogic science. Manipur chakra is 3<sup>rd</sup> among six chakras. It is known as solar plexus. According to modern anatomy, these chakra are parts of autonomic nervous system and are formed from the medial division of sympathetic ganglia. Manipur chakra has control on several functions of digestive system. It is even affected by psychosomatic disorders. The manipura chakra delineated in yogic compendia has similar activities as that of coeliac plexus which is autonomic in nature. Practicing measures to stimulate them, especially manipura chakra helps in proper functioning of abdominal organs and thereby helps in preventing and managing diseases related to GIT.<ref name="ref6">Smitha Jha and Sachin Khedikar. Inuence of Manipur Chakra (Coeliac Plexus) on Annavaha Srotas (Gastro Intestinal Tract). J. Res. Trad. Medicine 2016; 2(4): 113-116 http:dx.doi.org/10.21276/jrtm.2016/183</ref></p> 

== Annavaha srotas and mental health ==
<p style="text-align:justify;">Defective agni (vaigunya) is one of the important causes for the vitiation of annavaha srotas. Excess intake and unwholesome food, as well as mental conditions like excess desires (kama), anger (krodha), greed (lobha), negligence (moha) etc., cause the formation of ama in body. Worry (chinta), grief (shoka), fear (bhaya), anger (krodha) etc. may also contribute to improper digestion of food [Cha. Sa. Vimana Sthana 2/8-9].<ref name="ref7">Charak Samhita; edited with Vidhyotani hindi commentary by Kashinath Pandeya et all published by Chaukhambha bharti academy, Varanasi; viman sthan 2/8-9 page no.688 (2009)</ref> <br/>According to classical texts and modern literature, various psychological factors play a significant role in the pathology of gastrointestinal diseases. Stressful conditions activate the sympathetic nervous system. This is responsible for alteration in gut motility, permeability, and secretions. A variety of neurotransmitters in stressful situations modify the gut flora, which is ultimately responsible for digestive disorders.<ref name="ref8">Nitin Kumar, Harish Chandra Gupta, Vikash Bhatnagar. Physio-Anatomical Exploration of Role of Mental Health in Annavaha Srotas Disorders. AYUSHDHARA, 2016;3(2):649-651.</ref> <br/>When the Agni (digestive capacity) is weak, a number of unwanted unripe byproducts of digestion and metabolism start forming and accumulating in the body at different levels from the gross to the molecular level, from a local gastrointestinal tract (GIT) level to the systemic level in tissues and cells. Such products are collectively called ama and act as toxic and antigenic materials, giving rise to many antibodies. The presence of ama (including the production of antibodies) renders an ama state (amavastha) in the body, which is characterised by increasing impermeability and sluggishness of the srotas (body channels) resulting in srotodusti (vitiation).<ref name="ref9">Amruthesh S. Dentistry and Ayurveda--III (basics-ama, immunity, ojas, rasas, etiopathogenesis and prevention). Indian J Dent Res. 2007 Jul-Sep;18(3):112-9. doi: 10.4103/0970-9290.33786. PMID: 17687173.</ref> This indigestion is the basic culprit which causes many systemic illnesses. Therefore, first and foremost need is to take care of our stomachof  and appetite.<ref name="ref10">Dr. Kalpana Ladvikar. A systematic review on concept of Annavaha Srotas and its clinical aspect. J Ayurveda Integr Med Sci 2019;6:115-118.</ref> </p>

== Functional anatomy of gastrointestinal tract ==
<p style="text-align:justify;">Digestion is defined as the process by which food is broken down into simple chemical substances that can be absorbed and used as nutrients by the body. Most of the substances in the diet cannot be utilized as such. These substances must be broken into smaller particles so that they can be absorbed into blood and distributed to various parts of the body for utilization. Digestive system is responsible for these functions. Digestive process is accomplished by mechanical and enzymatic breakdown of food into simpler chemical compounds. A normal young healthy adult consumes about 1 kg of solid diet and about 1 to 2 litre of liquid diet every day. All these food materials are subjected to digestive process, before being absorbed into blood and distributed to the tissues of the body. Digestive system plays the major role in the digestion and absorption of food substances. <br/>Thus, the functions of the digestive system include:</p>
# Ingestion or consumption of food substances
# Breaking them into small particles
# Transport of small particles to different areas of the digestive tract
# Secretion of necessary enzymes and other substances for digestion
# Digestion of the food particles
# Absorption of the digestive products (nutrients)
# Removal of unwanted substances from the body<ref name="ref11">Sembulingam K, Sembulingam P. Essentials of Medical Physiology. 6th ed. Vol. 1. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2012.</ref> 

== Functional organization ==
<p style="text-align:justify;">The digestive system comprises of gastrointestinal tract (GIT) and accessory organs of digestion like teeth (danta), tongue (jihwa), salivary glands (praseka granthi), liver (yakrut) and exocrine part of pancreas (agnyasaya). <br/>Gastrointestinal tract, also known as alimentary canal, is basically a muscular tube extending from the mouth to the anus. At either end, the lumen is continuous with external environment. It measures about 10 m (30 feet) and comprises of following parts:</p>
<ul style="list-style:none; text-align:justify;"><li style="font-weight: bold;">Mouth (mukha) : <span style="font-weight: normal;">Mouth is a loosely used term to denote the external opening and for the cavity it leads to. Strictly speaking, the term mouth should be applied only for the external opening which is also called oral fissure. The cavity containing anterior two-third of tongue and teeth is the mouth cavity or oral cavity or buccal cavity. The oral cavity extends from the lips to the oropharyngeal isthmus, i.e., junction of the mouth with the pharynx. The oral cavity is subdivided into two parts: the vestibule and oral cavity proper.</span></li>
* Vestibule lies between the lips and cheeks externally, and the gums and teeth internally.
* Oral cavity proper lies within the alveolar arches, gums and teeth.
<li style="font-weight: bold;">Tongue (jihwa): <span style="font-weight: normal;">In the digestive system, tongue plays two important roles:</span></li>
* Tells the taste of food and
* Helps in chewing and swallowing of food.
<li style="font-weight: bold;">Teeth (danta): <span style="font-weight: normal;">Functions of different types of teeth in chewing are:</span></li>
* Incisors provide strong cutting action.
* Canines are responsible for tearing action.
* Premolars and molars have grinding action.
<li style="font-weight: bold;">Pharynx (kantha): <span style="font-weight: normal;">The pharynx is a median passage that is common to the gastrointestinal and respiratory systems. It is divisible, from above downwards, into three parts:</span></li>
* Nasal part or nasopharynx into which nasal cavities open,
* Oral part or oropharynx which is contiguous with the posterior end of oral cavity and
* Laryngeal part or laryngopharynx which is contiguous in front with larynx, and below with oesophagus.
<li style="font-weight: bold;">Oesophagus (anna nalika): <span style="font-weight: normal;">It is a fibromuscular tube about 25 cm long. At its junction to the pharynx, upper oesophageal sphincter is present and at its junction with the stomach, lower oesophageal sphincter is present. During swallowing, the upper oesophageal sphincter opens and food passes into the oesophagus. The peristaltic movements of the oesophagus propel the food into stomach.</span></li>
<li style="font-weight: bold;">Stomach (amashaya): <span style="font-weight: normal;">It is a hollow muscular bag connected to the oesophagus at its upper end and to the duodenum at the lower end. It serves the following motor functions:</span></li>
* Storage of food till it can be accommodated in the duodenum,
* Mixing of food with gastric secretions to form a semiliquid mixture
called chyme and 
* Slow emptying of food into the small intestine.
<li style="font-weight: bold;">Small intestine (kshudrantra): <span style="font-weight: normal;">It is a long tubular structure which can be divided into three parts:</span></li>
* Duodenum is the first part of small intestine. It is C shaped and measures about 25 cm in length.
* Jejunum, the middle part of the small intestine is about 25 m long and
* Ileum, the last part of small intestine, is about 3.5 m long.
Gastric chyme enters the duodenum where it meets with pancreatic juice, bile and secretions of the small intestine (succus entericus). The partially digested foodstuff in the gastric chyme is digested further and the final products of digestion are absorbed by the villi of small intestine. The movements of small intestine help in mixing, digestion and absorption of the food. The peristaltic activity of small intestine also helps in moving the undigested and unabsorbed food material to the large intestine.
<li style="font-weight: bold;">Large intestine (pakvashaya): <span style="font-weight: normal;">It arches around and encloses the coils of the small intestine and tends to be more fixed than the small intestine. It is divided into following parts:</span></li>
* Caecum is a blind-ended sac into which opens the lower end of ileum. The ileocecal junction is guarded by the ileocecal valve which allows on flow but prevents backflow of intestinal contents.
* Appendix is a worm-shaped tube that arises from the medial side of caecum which in humans is a vestigial organ.
* Ascending colon extends upward from the caecum along the right side of the abdomen up to the liver. On reaching the liver, it bends to the left, forming the right hepatic flexure.
* Transverse colon extends from the right hepatic flexure to the left splenic flexure. It forms a wide U-shaped curve.
* Descending colon extends from the left splenic flexure to the pelvic inlet below.
* Sigmoid colon begins at the pelvic inlet as continuation down to the descending colon and joins the rectum in front of the sacrum.
* Rectum descends in front of the sacrum to leave the pelvis by piercing the pelvic floor. Here it becomes continuous with the anal canal in the perineum.
* Anal canal opens to the exterior through the anus, the opening which is guarded by two sphincters.
<p style="text-align:justify;">In large intestine, absorption of water and electrolytes occurs from the intestinal contents. The remaining material is called faecal matter. The mucus secreted from the wall of large intestine lubricates the faecal matter. The faecal matter is stored in the sigmoid colon (pelvic colon) till expelled by the process of defaecation which is assisted by the movements of large intestine, activity of anal canal and anal sphincters.<ref name="ref12">Khurana I. Textbook of Medical Physiology. 2nd ed. Khurana A, editor. New Delhi: Reed Elsevier India Pvt. Ltd.; 2015.</ref> <br/>The gastrointestinal system is the portal through which nutritive substances, vitamins, minerals, and fluids enter the body. Proteins, fats, and complex carbohydrates are broken down into absorbable units (digested), principally, although not exclusively, in the small intestine. The products of digestion and the vitamins, minerals, and water cross the mucosa and enter the lymph or the blood (absorption). <br/>Most substances pass from the intestinal lumen into the enterocytes and then out of the enterocytes to the interstitial fluid. The processes responsible for movement across the luminal cell membrane are often quite different from those responsible for movement across the basal and lateral cell membranes to the interstitial fluid.<ref name="ref13">Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong’s Review of Medical Physiology. 25th ed. New York: McGraw-Hill Education; 2016.</ref> </p>
[[File:Different parts of mahasrotas.jpg|center]]
<center>Annavaha srotas in relation with mahasrotas (gastrointestinal tract)<ref name="ref14">Dash B. Concept of Agni in Ayurveda with special reference to Agnibala Pariksha. Revised. Varanasi: Chaukhamba Amrabharati Prakashan; 2015.</ref> [Source: Dash B. Concept of Agni in Ayurveda]</center>

== Deglutition reflex == 
<p style="text-align:justify;">Swallowing or deglutition is the process by which the food material from oral cavity is transported into the oesophagus. Though it is initiated voluntarily, most part of it is involuntary or reflexive. Therefore, this is also called the deglutition reflex.</p>
# During the reflex act of deglutition, respiration is inhibited, which prevents the entry of food into the trachea.
# The receptors for the deglutition reflex are present near the opening of the pharynx.
# The afferent impulses are transmitted to deglutition centres in medulla and pons.
# The efferent impulses are directed to the muscles of pharynx and upper oesophagus via cranial nerves.<ref name="ref15">Pal GK, Pal P, Nanda N. Comprehensive Textbook oof Medical Physiology. Vol. 1. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2017.</ref> 

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