A CASE STUDY OF MANAGEMENT OF AMLAPITTA BY AYURVEDIC TREATMENT
1 2 3
Dr.MrunalC.Khilare,YogeshT.Kotangale,SumedhaYogeshKotangale1P.G. Scolar, Kayachikitsa Dept., M.A.M.'s Sumatibhai Shah Ayurved Mahavidyalaya, Malwadi, Hadapsar, Pune, Maharashtra, India.
2Associate Professor, Ph.D. Sch. Kayachikitsa Dept., M.A.M.'s Sumatibhai Shah Ayurved Mahavidyalaya, Malwadi, Hadapsar, Pune,Maharashtra,India.
3Associate Professor, Ph.D. Sch. Shalakyatantra Dept., M.A.M.'s Sumatibhai ShahAyurved Mahavidyalaya, Malwadi, Hadapsar, Pune,Maharashtra,India.
ABSTRACT
Amlapittaisoneofthemostcommondiseasesseeninthesociety Itisseeninallages,allclasses,andallcommunity AmlapittacorelatedwithHyperacidityreferstoa setofsymptomscausedbyanimbalancebetweentheacidsecretingmechanismofthestomachandproximalintestineandtheprotectivemechanismsthatensuretheir safety Thestomachnormallysecretesacidthatisessentialinthedigestiveprocess.Whenthereisexcessproductionofacidinthestomach,itresultsinthecondition knownasacidity Amlapittaismanagedthrough Pitta Shaman with Vaman and Virechana becauseaccordingtoouracharyasitoccursduetovitiationof Kaphas Pitta Doshas Swamarg Chikitsta isdescribedforthetreatmentof Amlapitta InAyurved,Hyperaciditycanbeexplainedunderbroadumbrellaof Urdward Amplapitta, Vidagdhajeerna, Samapitta Laxanas, Pittaja Grahani Laxana. Thismarksimprovementinsymptomssuchthatretrosternalburning,acidityeructation,nausea,indigestion and flatuation. Laghusutshekhar Ras, Avipattikar Churna,Praval Panchamruta along with lifestyle -dietary modification provided significant relief in symptopmsofAmlapittawithspecificreferenceto GERD). Gastroesophagealrefluxdisease(
KEYWORDS:Gastroesophagealrefluxdisease,Acidity,Agnimandya,Amlapitta.
INTRODUCTION:
InAyurved, Agnimandya istherootcauseofallthediseases.Themajorreason behind Agnimandya is faulty dietary habits as Adhyashana (eating after meal), Vishamashana (dietonirregulartimeandquantity),andwrongbehaviouralpatterns such as Vegadharana (Suppression of urges) leads to vitiation of Doshas (fundamental bodily bio-elements) of Doshas (fundamental bodily bioelements)eitherindependentlyorsynonymously Duetothepresentlifestyleand unawarenessofonesPrakriti,digestivedisordersareverycommoninallgroups andalsohighlyignoredissues.InIndia,prevalenceis7.6to30%,being<10%in studiesandthedietaryfactorassociatesincludeuseofspicesandnon-vegetarian food.
Gastroesophageal reflux is a disease occurring due to improper functioning of esophageal sphincter It is a very common disease, It also occurs in children. Patientswithgastroesophagealrefluxdisease(GERD)hasthesignsandsymptoms such as heartburn, chest pain, gastric discomfort, abdominal distension, sourbelching,foodregurgitation,nauseaandreducedappetite.Thesesignsand symptomscanbeseeninthediseaseAmlapittamentionedinAyurveda.
Amlapitta hasbeenmentionedinvariousAyurvedictextssince Samhita period. This disease has been described in detail in classical texts such as Kashyapa Samhita,YogaRatnakara,andBhaishajyaRatnavali Amlapittaisconsideredas a Pitta Pradhana Vyadhi (pre-dominantdisease)andpossesssymptomssuchas Amlodgara (sour and bitter belching), Hritkantha Daha (heartburn), Gaurava (heaviness), Avipaka (indigestion), Klama (fatigue), Aruchi (tastelessness), Utklesha (nausea), Antra Kujana (gurgling sounds in intestines), Hritshula (chestpain)andVidbheda(diarrhea).Overindulgenceofetiologicalfactorssuch asfaultylifestylecausesvitiationof Vata Pitta Dosha Pitta alongwith Vata or Kapha slackens the Jatharagni factor responsible for digestion, i e , Jatharagnimandya (deminitionofdigestion).Duringthisstate,consumedfood becomes Vidagdha (undigested).Lateron,itturnsinto Shukta (acidified)andit remainsinthestomachforlong.Atthisstage,Vidagdhajirna(indigestioncaused duetoacidifiedchyle)manifestswhichisthepremonitarysymptomofthedisease Amlapitta Further, vitiated Pitta gets mixed with Shukta and causes Pitta AmavishaSammurchhana(combinationofunmetabolized Rasaandundigested foodwithRasa). ThisconditioniscalledasAmlapitta
UrdhwagaAmlapitta 2
Aruchi Gurukoshthatva Gaurav (anorexia), (heavinessabdomen), (Lethargy), Vibandh Shiroruja Utklesh Tiktamlodgar (Constipation), (Headache), (Nausea), (acid eructation) is mainly caused by intake of Aharas Urdhwaga Amlapitta whichisnotsuitedtoonesPrakritii.efaultydiete.g (sour), (pungent), Amla Katu Lavana Guru Snigdha (salty), (heavy meal), (oily/excessive liquid), Abhishandhi (food that is difficult to digest) Aharas Besides, addictions like smoking, alcohol, tobacco chewing, excessive stress, condiments also lead to UrdhwagaAmlapitta
DrugslikeNSAID's,corticosteroids,alsocausedyspepsia.Ayurvedaphysicians aretreatingdyspepsiasincelongtimewiththehelpofknowledgeasgiveninclassicalAyurvedatext(causativefactors,pathogenesis,treatmentplan,andpreventivetool)butthereisalackofevidenceaspermodernstandards.
Burning sensation, poor digestion, thirst, perspiration, nausea, sour or bitter belching,feversduetovitiatedpittaandkaphaandheaviness.Chardi(vomiting), Pittaja Gulma (hard mass in the abdomen caused due to vitiated pitta), Parinamshoola (duodenal ulcer), Pittashmari (stones formed due to vitiated pitta)and Annadravashoola (gastritis/pepticulcer)arethemostcommonlyseen symptomsinpeoplewithacidity.3
CaseReport:
Inthisstudy,a42yrs/femalepatientwithchiefcomplaintsofretrosternalburning,Acidic Eruction, Nausea, Indigestion and Flatulence for 2 months, visited forayurvedicmanagements.Thepatientwasworkinginaprivatecompanyand hadhistoryofeatingtoomuchspicyandfattyfood,stress,tobaccochewingand drinkingcoffeeinlast6months.
History:Nomedicalandsurgicalmajorpasthistory
PhysicalExamination: Temp-98,R/R=20,Pulse=80/min,BP=130/80,WT=70Kgs
PerAbdomenwassoft,non-tender,noabnormalitydetected.
AshtavidhaPariksha: Nadi[Pulse]=80/min
Mala[stool]=Asamyaka[unsatisfactorybowelhabit]
Jeevha[Tongue]=Saam[Coated]
Mutra[Urine]=Samyaka[Clear]
Shabda[Speech]=Spashta[Clear]
Sparsh[Skin]=Rukshatwak
Druka[Eyes]=Prakruta[nopallornoicterus]
Akruti[posture]=Hina[Thin]
SystemicExamination: Respiratotysystem:Onauscultation,normalbronchiovasculacursoundsheard andnoabnormalitydetected.
Cardiovascularsystem:S1S2heardandnoabnormalitydetected.
CentralNervousSystem:Highermentalfunctionfoundtobenormal.
Diagnosis:Basedonpatientshistory,assessmentofclinicalfeatureandphysical examination the final diagnosis made was Amlapitta with special reference to GERD.
Medicalmanagement: Palliative treatment -As the disease is of Pitta origin, all measures are undertakentopacifyPitta
Weightreduction,stoppingcigarettesmoking,Mealsshouldbeofsmallvolume. Alcohol,fattyfoodandcaffeineshouldbe avoided.No snacksto be takenafter eveningmeal topreventnocturnalregurgitation.Heavystoopingorbendingat thewaistshouldbeavoidedespecially aftermeals.Headinthebedshouldbeelevatedby15cm.
4
AyurvedTreatmentforAmlapitta
AccordingtoAcharyaCharakchikitsaofalldiseasecanbedividedin3part: 1.Nidanparivarjan2.Samshodhana3.Shamana.
1. Nidana Parivarjana
Thetherapyof Nidana Parivarjana aimsatavoidingthecausesofdisease.Itis recommendedastheprimarytreatmentformanydiseases. Nidana Parivarjana helpsstoptheprogressionofadiseaseandavoidsrelapse.
Withdrawal of the aetiological factors of the disease is called Nidan Parivarjana asthefirstlineoftreatmentofallthediseases.In Amlapitta excessiveNidanaSevanaleadstoMandagniandPittaVriddhi.SoNidanofAmlapitta shouldberemovedinitsfirsttreatment.
Ruksha Annapana (consuming dry foods), Langhana (fasting) and Vatika Annapana (consuming a diet that aggravates Vata in the body) are some of the causesthatshouldbeavoidedincaseofacidity Faultydietaryhabits,excessive sexualindulgence,excessmentalandphysicalwork,consumingalcoholicbeverages and consuming excessive amounts of rice and beans are some of the Nidanas (causes)of Amlapitta Adhyasana (eatingtoosoonafterameal)should alsobeavoidedtopreventacidity
2. Shodhana:
Ayurveda uses the following shodhana therapies for acidity treatment Samshoshanakarmaeliminatesthevitiated Doshas from their root cause and thus cures thediseaseentirelysothatthereisleastprobabilityofrecurrenceof disease. Acharya Kashyap has mentioned Amlapitta is developed from Amashaya (stomach)and kapha and Pitta Dosha arehaving Ashrayas. Vamana andVirechanakarmaasthebesttreatmentforAmlapitta,foranexampleasifwe cutdown the root of any tree, the stem of the tree diesautomatically
3. Shamana:
ThefollowingShamanatherapiesareusedforthetreatmentofacidity:
Langhana:
Langhana therapybringslightnessinthebodyasitcreatesabalancebetween theDoshasandDhatus Langhanaismentionedasthefirstlineoftreatmentfor diseasesoriginatinginthestomachandcausedbyvitiationofthe Rasa Dhatu Nirahara (abstaining from food) and Phalahara (consuming only fruits) are twotypesoffastingmethodspractisedinLanghanatherapy Langhanatherapy provides relief from Chardi, Atisara (diarrhoea) and Arochaka (indigestion); therefore,itisbeneficialintreatingacidity.Itimprovesthedigestivefireand providesnourishmenttothebody Langhana also reduces constipation andis beneficial in treating skin and urinary disorders, stiffness in the thighs, and abscess.
OralMedications
1. Avipattikar Churna –1tsp. Pragbhakta
2. Laghusutshekhar Ras-2tab Adhakta And Adhobhakta
3
. Prawal Panchamrut- 2tab. Adhakta And Adhobhakta
4
. Patoladi Kadha- 4tsp. Pragbhakta withwater
5 Ushirasav -4tsp. Pragbhakta withwater.
10
Pravala Panchamrita Rasa :
The formulation of Pravala Panchamrita Rasa consists of five ingredients including Pravala Bhasma, Mauktik Bhasma (calcinedpreparationof pearl), Shauktik Bhasma (calcinedpreparationofpearlshell), Shankha Bhasma (calcinedpreparationofconch)and Kapardika Bhasma Itisindicatedforacidity, ascitesandpaincausedduetoPitta
11
LaghusutashekharaRasa :
Sutashekhara Rasa hasanantacidandanticholinergiceffectinthebodyandis commonly used for the treatment of acidity inAyurveda.It primarily acts on Pitta Dosha and provides relief from many symptoms including abdominal pain,nausea,vomiting,epigastrictenderness,heartburn,fevers,headachesand breathingtroubles.
12 AvipattikarChurna : Avipattikar Churna is anAyurvedic formulation including Musta (nutgrass), Vidanga (falseblackpepper), Ela, Lavanga (clove), Trikatu (acombinationof the three acrids – Pippali, Shunthi, and Maricha) and other ingredients. It is mainly indicated for acidity treatment in Ayurveda. Dietary and lifestyle changesforaciditypatientasperayurveda.
19Do's
Ÿ
Consume foods like barley, Patola, green gram, Amalaki, bitter gourd, green veggies, Kapittha (wood apple), wheat, pomegranate, honey, cane root,meatbroth,coldwater,banana,rawsugarandwhitegourdmelon.
Drinkcoldwater
Ÿ
Ÿ
Performtherapeuticpurgation,therapeuticenema,andtherapeuticemesis undertheguidanceofanAyurvedicphysician.
Ÿ Followahealthyroutineincludingabalanceddietandtimelymeals.
Ÿ PerformYogasanas
20Don'ts
Ÿ Don'teatchickpeaflour,rice,brinjals,blackgram,potato,spicyandsalty food,astfood,sourvinegarandrocksalt.
Ÿ Donotdrinkcoffee,alcoholortea.
Ÿ Donotsleepduringtheday.
Ÿ
Donotsuppressnaturalurgeslikeurinatingorbowelmovement.
Ÿ Donoteatincompatiblefoodcombinations.
Ÿ Donoteatsesameseeds, Kulattha (horsegram),blackbeans,wine,'goats milk,curd,andoilyfoods.
DISCUSSION:
AmlapittaisaPittadominantdiseaseinassociationwithKaphaandVataDosha Excess formation of vitiated Pitta is the main pathological mechanism behind manifestationofthisdisease.The Pitta getsvitiatedduetoimproperdietaryand lifestyle habits. The drugs that have Tikta–Madhura Rasa (bitter–sweet taste), Madhura Vipaka (post digestive effect in sweet taste), Sheeta Virya (cooling energy of substance), Laghu (light), Ruksha Guna (dry) and pacifies to PittaKapha properties are beneficial in the management of Amlapitta Numerous herbal and herbomineral formulations are mentioned inAyurvedic classics for themanagementofAmlapitta
The observation releaved that, this specific treatment which Laghusutshekhar Ra,s Amalaki Churna, Praval Panchamrut Ras, Avipattikar Churna is significant relief in the management of symptoms Amlapitta and no unward effect of medicine.ThisAyurvedicCombinationtreatmentprovedaneffectivealternative treatmentinthemanagementofAmlapitta.
Amlapitta is a psychosomatic disorder, where psychological factors play an equally important factor along with the dietary indiscretion. Principle of Asta Ahar Vidhi Visheshayatana and Dashvidh Ahar Vidhi Vidhan mentioned in Charak Samhita aremostimportantaspectforpreventiveandcurativeaspectof health.Theyaretobeexaminedbeforefoodintakeandaretobefollowedduring foodintake.The Samprapti of Amlapitta,thenormal functionof Amla Ras are basically attributed to Pitta Dosa. Amla Ras and Amla Vipaka plays important roleinthe pathogenesis of Amlapitta. Dosha, Dushya, Strotas, Adhisthan, Agni, Ama are basic component of any disease process and also Amlapitta Urdhva Gati Amlapitta symptoms related to Annavaha Srotodushti and Adho Gati symptomsof Amlapitta isrelatedwith Purishvaha Strotodushti Duetothe incidenceandimportanceofAmlapitta,Acharyamayhavegivendetailed explanation of Amlapitta and its way ofapproachinmanagement.
CONCLUSION:
Aswecanseenowadayspeopleareverybusyintheirlifesotheyhavetotake instants,oilyandfermentedfoodanddonotliveahealtylifesotheyhavetosuffer hyperacidity In this way through Ayurveda we can manage effectively Amlapitta withfollow Dincharya and Rutucharya rulesandsome Shodhan ShamanChikista
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