Amlapitta kc007 kop

BY Dr. Pratibha.C.Hullur

BAMS (K.U.Dharwad)

Dissertation submitted to the

Rajiv Gandhi University of Health sciences, Karnataka, Bangalore

in partial fulfillment of the requirements for the degree of

Ayurveda Vachaspati” [M.D.]

in

KAYACHIKITSA

GUIDE Prof. Pramod Kumar Mishra

MD (Ayu), (RSU) Head of the Department

Kayachikitsa

DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA A.L.N.RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE KOPPA - 577126

CHIKMAGALUR DISTRICT, KARNATAKA, INDIA MARCH - 2006

Ayurmitra

TAyComprehended

A.L.N.Rao Memorial Ayurvedic Medical College Koppa – 577126 Dist: Chikmagalur

Department of Post Graduate Studies in KAYACHIKITSA

I here by declare that this dissertation entitled “A CLINICAL STUDY

ON THE EFFECT OF SHATAVARI CHOORNA WITH ABHRAKA BHASMA

IN THE MANAGEMENT OF AMLAPITTA” is a bonafide and genuine

research work carried out by me under the guidance of Prof. Pramod Kumar Mishra, HOD, Department of Post Graduate

Studies in Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and

P. G. Centre, Koppa.

Date:

Place: Koppa

Dr. Pratibha.C.Hullur P.G.Scholar, Dept. of Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

Ayurmitra

TAyComprehended



This is to certify that the dissertation entitled “A CLINICAL STUDY ON

THE EFFECT OF SHATAVARI CHOORNA WITH ABHRAKA BHASMA IN

THE MANAGEMENT OF AMLAPITTA” is a bonafide research work done by

Dr.Pratibha.C.Hullur., in partial fulfillment of the requirement for the

degree of Ayurveda Vachaspati (MD) in Kayachikitsa of Rajiv Gandhi

University of Health Sciences, Bangalore, Karnataka.

Date:

Place: Koppa

Guide:Prof. Pramod Kumar Mishra

MD (Ayu), (RSU) Head of the Department Post Graduate Studies in Kayachikista A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126



This is to certify that the dissertation entitled “A CLINICAL STUDY ON

THE EFFECT OF SHATAVARI CHOORNA WITH ABHRAKA BHASMA IN

THE MANAGEMENT OF AMLAPITTA” is a bonafide research work done by

Dr.Pratibha.C.Hullur., under the guidance of Prof. Pramod Kumar Mishra, HOD, Department of Post Graduate Studies in

Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P. G.

Centre, Koppa.

Date:

Place: Koppa

Dr.Jagadeesh Kunjal MD., (Ay).,

Principal, A.L.N.Rao Memorial Ayurvedic Medical College. Koppa –577126, Dist: Chikmagalur

COPYRIGHT

I here by declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this

dissertation in print or electronic format for academic/research purpose.

Date:

Place:

Dr.Pratibha.C.Hullur P.G.Scholar, Dept. of Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

© Rajiv Gandhi University of Health Sciences, Karnataka

INDEX

Page No.

INTRODUCTION 1-2

Chatper – I OBJECTIVES 3

Chapter – II REVIEW OF LITERATURE

Historical Review 4-6

Nirukti,Paribhasha,Paryaya. 7-10

Anato-physiological consideration 11-18

Nidana 19-24

Samprapti 25-37

Poorvarupa 38

Rupa 39-47

Upashaya – Anupashaya 48

Vyavacheddaka Nidana 49

Sadhya asadhyata 50

Upadravas 51

Chikitsa 52-56

Pathya Apathya 57-59

Dyspepsia 60-69

Drug Review 70-79

Chapter –III METHODOLOGY

Materials and Methods 80-90

Observations 91-116

Chapter –IV RESULTS 117-132

Chapter –V DISCUSSION 133-147

Chapter –VI CONCLUSION 148-149

SUMMARY 150-152

BIBLIOGRAPHY

ANNEXURES

LIST OF TABLES Sl. No SUBJECT PAGE NO

1. Showing pitta guna 14

2. Guna-karma vivecana 21-22

3. Showing the lakshanas of amlapitta mentioned by different

authors

41

4. Lakshanas of Urdhvaga amlapitta 42-43

5. Showing the lakshanas of Sanila Amlapitta 44

6. Showing the lakshanas of Sakapha Amlapitta 45

7. Showing the lakshanas of Shleshmapittaja Amlapitta 46

8. Showing the lakshanas of Pittaja Amlapitta 46

9. Showing the referance of vamana and Virechana Karma in

Amlapitta

54

10. Showing Pathya apathya 57-58

11. Distinguishing between functional and organic/structural disease

of gastrointestinal tract.

66

12. Symptoms of Functional dyspepsia Comparison with Amlapitta 69

13. Showing the age wise distribution of 60 Amlapitta patients. 91

14. Showing the Sex wise distribution of 60 Amlapitta patients. 92

15. Showing the Religion wise distribution of 60 Amlapitta patients 92

16. Showing the Marital status wise distribution of 60 Amlapitta

patients

93

17. Showing the Educational status wise distribution of 60 Amlapitta

patients

94

18. Showing the socioeconomic status wise distribution of 60

Amlapitta patients

95

19. Showing the Occupational status wise distribution of 60 Amlapitta

patients

96

20. Showing the onset wise distribution of 60 Amlapitta patients 96

21. Showing the Aggravating period wise distribution of 60 Amlapitta

patients

97

22. Showing the Incidence Aggravating of symptoms due to

environmental factors in 60 Amlapitta patients

98

23. Showing the Habitat status wise distribution of 60 Amlapitta

patients

98

24. Showing the Dietary habit wise distribution of 60 Amlapitta

patients

99

25. Showing the Ahara vidhi wise distribution of 60 Amlapitta

patients

99-100

26. Showing the Type of diet wise distribution of 60 Amlapitta

patients

100

27. Shows Rasa Satmya wise distribution of 60 Amlapitta patients 101

28. Showing the Regimen wise distribution of 60 Amlapitta patients 102

29. Showing the Mental stress/strain wise distribution of 60 Amlapitta

patients

102

30. Shows incidence of Addictions in 60 Amlapitta patients 103

31. Showing the Exercise wise distribution of 60 Amlapitta patients 104

32. Shows incidence of nidra in 60 Amlapitta patients 105

33. Shows Bowel habit wise distribution of 60 Amlapitta patients 105

34. Shows Nature of stool wise distribution of 60 Amlapitta patients 106

35. Shows Type of occupation wise distribution of 60 Amlapitta

patients

107

36. Shows Nature of work wise distribution of 60 Amlapitta patients 107

37. Shows incidence of Deha prakriti in 60 Amlapitta patients 108

38. Shows Sara wise distribution of 60 Amlapitta patients 109

39. Shows Samhanana wise distribution of 60Amlapitta patients 109

40. Shows Satva wise distribution of 60 Amlapitta patients 110

41. Shows Agni wise distribution of 60 Amlapitta patients 111

42. Shows Koshta wise distribution of 60 Amlapitta patients 111

43. Shows Bala wise distribution of 60 Amlapitta patients 112

44. Shows Desha wise distribution of 60 Amlapitta patients 113

45. Shows Duration of Illness wise distribution of 60 Amlapitta 113

patients

46. Shows Samanya lakshana wise distribution of 60 Amlapitta

patients

114

47. Shows Associated symptom wise distribution of 60 Amlapitta

patients

115

48. Shows Srotodusti wise distribution of 60 Amlapitta patients 116

49. Effect of Trial drug on Main symptoms after Treatment 117

50. Effect of Trial drug on Main symptoms after follow up 117

51. Effect of Control drug on Main symptoms after Treatment 118

52. Effect of control drug on Main symptoms after follow up 119

53. Effect of Trial drug on Associated symptoms after Treatment 119

54. Effect of Trial drug on Associated symptoms after follow up 120

55. Effect of Control drug on Associated symptoms after Treatment 121

56. Effect of Control drug on Associated symptoms after follow up 122

57. Effect of Trial drug on Srotodusti after Treatment 123

58. Effect of Trial drug on Srotodusti after follow up 123

59. Effect of Control drug on Srotodusti after Treatment 124

60. Effect of control drug on Srotodusti after follow up 124

61. Total effect of Trial drug and Control drug After treatment 125

62. Total effect of Trial drug and Control drug After follow up 125

LIST OF GRAPHS Sl.No. Page No.

1. Showing the age wise distribution of 60 Amlapitta patients. 91

2. Showing the Sex wise distribution of 60 Amlapitta patients. 92

3. Showing the Religion wise distribution of 60 Amlapitta patients 93

4. Showing the Marital status wise distribution of 60 Amlapitta patients 93

5. Showing the Educational status wise distribution of 60 Amlapitta

patients

94

6. Showing the socioeconomic status wise distribution of 60 Amlapitta

patients

95

7. Showing the Occupational status wise distribution of 60 Amlapitta

patients

96

8. Showing the onset wise distribution of 60 Amlapitta patients 97

9. Showing the Aggravating period wise distribution of 60 Amlapitta

patients

97

10. Showing the Incidence Aggravating of symptoms due to


98

11. Showing the Habitat status wise distribution of 60 Amlapitta patients 99

12. Showing the Dietary habit wise distribution of 60 Amlapitta patients 99

13. Showing the Ahara vidhi wise distribution of 60 Amlapitta patients 100

14. Showing the Type of diet wise distribution of 60 Amlapitta patients 101

15. Shows Rasa Satmya wise distribution of 60 Amlapitta patients 101

16. Showing the Regimen wise distribution of 60 Amlapitta patients 102

17. Showing the Mental stress/strain wise distribution of 60 Amlapitta

patients

103

18. Shows incidence of Addictions in 60 Amlapitta patients 104

19. Showing the Exercise wise distribution of 60 Amlapitta patients 104

20. Shows incidence of nidra in 60 Amlapitta patients 105

21. Shows Bowel habit wise distribution of 60 Amlapitta patients 106

22. Shows Nature of stool wise distribution of 60 Amlapitta patients 106

23. Shows Type of occupation wise distribution of 60 Amlapitta patients 107

24. Shows Nature of work wise distribution of 60 Amlapitta patients 108

25. Shows incidence of Deha prakriti in 60 Amlapitta patients 108

26. Shows Sara wise distribution of 60 Amlapitta patients 109

27. Shows Samhanana wise distribution of 60Amlapitta patients 110

28. Shows Satva wise distribution of 60 Amlapitta patients 110

29. Shows Agni wise distribution of 60 Amlapitta patients 111

30. Shows Koshta wise distribution of 60 Amlapitta patients 112

31. Shows Bala wise distribution of 60 Amlapitta patients 112

32. Shows Desha wise distribution of 60 Amlapitta patients 113

33. Shows Duration of Illness wise distribution of 60 Amlapitta patients 114

34. Shows Samanya lakshana wise distribution of 60 Amlapitta patients 115

35. Shows Associated symptom wise distribution of 60 Amlapitta

patients

116

36. Shows Srotodusti wise distribution of 60 Amlapitta patients 116

37. Showing comparative effect of therapies on main symptoms after the

treatment

126

38. Showing comparative effect of therapies on main symptoms after

follow up

127

39. Showing comparative effect of therapies on associated symptoms

after the treatment

128

40. Showing comparative effect of therapies on associated symptoms

after follow up

129

41. Showing comparative effect of therapies on srotodusti after the

treatment

130

42. Showing comparative effect of therapies on srotodusti after follow

up

130

43. Showing comparative total effect of therapies after treatment 131

44. Showing comparative total effect of therapies after follow up 132

LIST OF CHARTS No. Page No.

1. Schematic Representation of Amlapitta Nidanana 20

2. Showing the classification of Nidanas of Amlapitta 24

3. Schematic Representation of Samprapti of Amlapitta 31

4. Schematic Representation of Samprapti on basis of Kriyakala 37

5. Schematic Representation of Vicious circle formed in Amlapitta 37

6. Schematic Representation of manifestation of symptoms 40

7. Schematic Representation of Classification according to different

Authors

47

ABBREVIATIONS

A.T After treatment

As.Hri Ashtanga hridaya

As.San Ashtanga sangraha

B.T Before treatment

Ba.Pr Bhava prakasha

Bh. Bhela samhita

Ch Charaka

Ch Su Charaka sutra

Chi Chikitsa sthana

D M Digestion and Metabolism

Ha Harita samhita

Kha.Sam Kashyapa samhita

Ma. Ni Madhava nidana

Ma.Kha Madhyama khanda

Ni Nidana sthana

Sha Sam Sharangadhara samhita

Sa Sharira sthana

Su Su Sushruta samhita sutra sthana

Vi Vimana Sthana

Ut Uttara Tantra

V.S Vanga sena

Y.R Yoga Ratnakara

B.R Baishajya Ratnavali

D.G Dravya Guna

O.T.P Oxford Text book of Pathology

R.R.S Rasa Ratna Sammuchaya

C.S.S Chikitsa Sara Sangraha

ABSTRACT

Amlapitta has become one of the common problems today due to the change in

lifestyle. Sophistication and a stressful life to keep pace with the fast developing world.

Amlapitta is more of a psycho somatic disorder caused due to dietetic indiscrimination

and mental stress and strain. A good member of medicines have been mentioned as the

modern medicines for the management of Amlapitta, but their merits trail.

Amlapitta is a pitta pradhana disease of the annavaha stotas caused due to

mandagni, ama and annavaha sroto dusti. It is characterized by Amlodgara, Utklesha and

Hrtkanta daha indicating the vikruthi of pachakapitta along with the kledaka kapha and

samana vayu. the patho-physiology of the Amlapitta states it to be a diseases caused due

to functional disturbance rather than organic lesion. While describing the progonosis of

Amlapitta, it has been stated that it can be cured easily if promptly treated at the earliest

with proper pathyapthya.

A larger number of yoga have been mentioned in Ayurveda in the management of

Amlapitta, among which “Shatavari Choorna” and “Abhraka Bhasma” are among the

commonly used ingredients.

In the present study an attempt is being made to understand the pathophysiology

of the diseease in principles of Ayurveda and also to control and treat the disease with a

simple herbo-mineral combination.

Objectives:

1. To evaluate the efficacy of “Shatavari Choorna” with “Abhraka Bhasma” in the

management of Amlapitta.

2. To compare the effect of “Shatavari Choorna” with Abhraka Bhasma over liquid

antacid by controlled trial.

3. Treating the disease by correcting the samprapti rather than symptoms.

4. Detailed study of disease covering classical and modern literature.

5. To establish an effective, simple herbo-mineral combination in the management

of Amlapitta.

Methodology :

Total of 64 patients who fulfilled the inclusion criteria were randomly selected for

the study. Among them 4 patients dropped out. Hence, the study was conducted on the

reaming 60 patients. The patients were randomly grouped into two groups i.e. trial group

and control group each comprising of 30 patients.

The trial group was given “Shatavari choorna” – 3 gms. and Abhraka Bhasma –

125 mg. along with gritha before meals thrice daily for a duration of 1 month.

The control group was given Syrup Gelusil – 1tsp. before meals thrice daily for a

duration of 1 month.

During this period both the groups were adviced to follow the pathyapathya

Both the groups were fallowed up for a month after the treatment.

During the treatment schedule, the various subjective signs and symptoms were

observed and recorded in the special perform made for purpose.

Interpretation of the Results:

At the end of the treatment schedule of 1 month and also the follow-up period of 1

month, the observations which were recorded were subjected to statistical analyses. It

was found that the trial group showed highly significant relief [p<0.001 to p<0.010] in

almost all the patients in their presenting complaints after treatment and highly significant

to moderately significant relief even after the fallow-up. Whereas, the control drug

showed highly significant to moderately significant relief in all the presenting complaints

after the treatment but the reccurence of symptoms was observed after follow-up.Trail

drug showed more number of improved cases,whereas the control drug showed

controlled effect in more number of cases after the follow-up

Conclusion:

1. The trial drug is more effective in the management of Amlapitta as it pacifics pitta

does Agnideepana, reduces the ama and corrects the srotodusti.

2. The trial drug provides significant relief in the management of symptoms like

Hrthdaha –Amlodgana. Utklesha, and Udarashoola even after the follow-up.

3. It also showed highly significant relief in the management of Aruchi, Avipaka,

Gurukoshtata and Adhmana after the treatment as well as after the follow-up.

4. The trial drug showed highly significant relief in the srotodusti symptoms after the

treatment as well as after the follow-up when compared to control drug.

5. The control drug does give significant and fast relief but does not show sustained

effect after follow-up and reccurence of symptoms was observed.

6. The trail drug seems to act like an antacid and pacify the symptoms.It also corrects

the agni at the same time and reduces further reccurence of the symptoms.

ACKNOWLEDGEMENT

It would be a great pleasure to acknowledge my gratitude to all those who helped me in bringing out this work. Its my great pleasure to confirm my gratitude to my teacher and uncle Dr.S.S.Hosmani. Retd. Principal Sri B.M.Kankanwadi Ayurveda Mahavidhyalaya. Belgaum. who has been my inspiration to step into the field of Ayurveda. My sincere thanks and salutation to him. I will remain grateful forever to Prof. P.K.Mishra. M.D [Ayu.] H.O.D. Dept of Kayachikitsa , A.L.N.Rao Memorial Ayurvedic College, Koppa, Post Graduate Centre, for his valuable guidance, meticulous supervision, timely advices, motivation and co-operation that he extended towards me throughout this dissertation work. I am grateful to Sri. Aroor Ramesh Rao President. Aroor Trust Koppa, for giving me a chance to pursue my post graduation studies in his esteemed institution. I am grateful to Dr. Jagdeesh Kunjal M.D [Ayu.] Principal,A.L.N.Rao Memorial Ayurvedic College, Koppa, for his help and support, both as the head of the institute and as a guide in completing his work. I am grateful to Prof.Narayana Sharma, M.D.[Ayu] Dept to Kayachiktsa , Prof. Pandey M.D [Ayu.] Dept of Rasashastra, Jamnagar, Dr. Sarshetty. M.D [Ayu.] HOD Dept of Rasa shastra, Bijapur and Dr. Prashanth. A.S. M.D [Ayu.] Prof. Department of Kaya chikitsa, Hubli for their help in my initial days of work and in preparing the base work for the present study. My sincere gratitude to Prof. D.S. Lucas, M.D [Ayu.] FRAS [London] FRAV [India], H.O.D. Department of Dravyaguna for his motivational inspiration and support. I am grateful to Dr. S.M. Shanbhag; M.B.B.S. Dr. Lalitha Bhaskar. M.D [Ayu.]; Dr. N.V. Ramesh M.D [Ayu.] A.L.N. Rao

Memorial Ayurvedic Medical College Koppa for their support in selection of the patients and during the study. I immensely thank Dr. Dinesh Kumar Mishra, Reader Dept. of Rasa shastra and Bhaishajya Kalpana for his co-operation in preparing the medicine for the trial, and also his suggestions. At this juncture, I take the opportunity to thank Mr. Mathew, Mr. Nityananda and Miss Violet, who took the pain in preparing the medicine for the trial in a short duration of time. I am thankfull to Dr. Kajrekar, M.D [Ayu] Belgaum for helping me in getting the Abhraka Bhasma prepared from his pharmacy. I am grateful to Dr. Sanjay K.S, M.D [Ayu] : Dept of Dravya guna. A.L.N. Rao Memorial Ayurvedic College Koppa, for his support in collecting the study material. I am thankful toDr. Banmali Das, M.D [Ayu] Dept. of Roga Vignana, Dr. Galib, M.D [Ayu] , Dept of Rasa Shastra and Bhaishajya Kalpana , Dr. Sridhar V, M.D [Ayu] Dept of Dravya guna, A.L.N. Rao Ayurvedic Medical College Koppa, for their timely suggestions and help. My heartfelt thanks to Dr. Prasanna Kerur M.D.[Ayu] Dept of Kayachikitsa, S.D.M. Ayurveda College, Hassan; because of whom I was able to pursue my P.G. studies. I am grateful to Dr. Mangalgi M.D [Ayu] H.O.D Dept of Kayachikitsa. Mysore and Dr. [Mrs.] Aruna. Mangalgi M.D. [Ayu] Dept of Kayachikitsa. Mysore for helping me to collect the study material and use the P.G. Library at Mysore. I am thankful to Dr. Rangesh Parmesh. M.D [Ayu] R&D. The Himalaya Drug Company for helping me to get information regarding some recent studies on the trial drug used in the study. I am thankful to Dr. T.K. Mohanta, M.D [Ayu] Ph.D and Dr. Rashmi, Rekha, Mishra, M.D. [Ayu]. Dept of Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College for there help during my work.

I am thankful to Mrs. Jyotsna for her valuable help in conducting laboratory investigations. I am grateful to Mr. Satish H.D Librarian and Miss Triveni who helped me a lot in my reference work. I also thank Sri, Ramesh Gowda and Mrs. Jyothi for the help. I am thankful to Dr. Mahesh Desai. P.G. Dept of Shalya Tantra, Hubli Ayurveda College for his valuable support throughout my P.G studies. I am grateful to Dr. Sanjay, P.G. Dept of Kayachiksta, Mysore for his help. I express my sincere thanks and gratitude to my friend Mr. Srinivas. H.M. for his support throughout my work, and also in completing it. I would like to submit my heartfelt thanks to Mr. Sanjay K. Handur, Senior Manager, Regulatory Affairs, Himalaya Drug Company for helping me in collecting the study material and his moral support throughout my work. I express my sincere thanks and gratitude to my P.G. Classmates Dr. Ravi Ganesh; Dr. James chako; Dr. Sharat Babu; Dr. Bijayendra; Dr. Kavitha B.M.; Dr. Suja Nair; Dr. Roshy Joseph; Dr. Prashanth B.K; Dr. Vishwanath; Dr. Binu Alapat; Dr Sajeev Athani; Dr. Pradeepa; Dr. Krishna Kishore; Dr. Pankaj Prasad and Dr. Parthasarthy for their support and help in completing this work. I am thankful to my seniors Dr. Srinivas, Dr. Sujatha Tenginkai; Dr. Pradeep K.V; Dr. Christy Joseph ; Dr. Indu and also my junior P.G.’s. for their kind co-operation during my study. My heartfelt thanks to Dr. H.R. Pradeep M.D [Ayu] and his family for their moral support during my stay and also in my work. I am gratefull to Dr.Mangalagouri Rao,M.D [Ayu] and Dr.Elizebeth.P.Johan M.D[Ayu]. A.L.N. Rao Memorial Ayurvedic Medical College and my student Dr.Pratibha.Hegde for their help and moral support during my work.

I am thankful to Mr. Shreedhar Gowda and Miss.Sujaya for heir friendly help in typing, editing and speedy completion of this dissertation work. I am indebted to my parents whose blessings, affection and encouragement helped me to complete my work. I owe my salutation and thanks to them. I am grateful to my brothers for their love, support and encouragement. Finally thanks to all those people who helped me directly and indirectly to complete this work. Date :

Place : Dr. Pratibha C. Hullur.

Introduction

1

INTRODUCTION

Ayurveda is known to be one of the oldest scientific medical systems in the

world. Kayachikitsa is one of the important eight major specialties of Ayurveda which

corresponds to general medicine. Its defined as ‘antaragni chikitsa’ by Chakrapanidutta

which involves both digestive and metabolic disturbances. The therapeutic principles of

Ayurveda governing both the prevention and cure of diseases are based on this concept.

Most of the diseases arise from abnormal functioning of the digestive system.

Improper digestion results in the accumulation of undigested food which inturn becomes

the pathogen in the body, breeding toxins leading to upsetting of auto immune system.

The role of agni draws greater importance in Ayurveda, as most of the diseases are

caused by mandagni.

In this fast advancing era, the modernization has led to the advent of bad cooking,

over indulgence, anxiety and stress induced hectic unhealthy schedules. These, along

with sophistications and indiscriminate dietary habits has strong influence over the

annavaha srotas leading to various diseases among which Amlapitta is one such.

Amlapitta, being a disease of Annavaha srotar is a psycho-somatic disorder

caused due to mandagni and vitiation of pitta. i.e. pachaka pitta. This presents a group of

signs and symptoms viz Avipaka [Indigestion], Amlodgara [Acid eructation], Hrtdaha

[Heart burn], Kanta daha [Burning in throat] Utklesha [Nausea] etc. which has a startling

similarities in all most all the aspects to Non-ulcer Dyspepsia or Functional Dyspepsia.

The pathogenesis of Amlapitta involves three important factors, i.e Agnimandya,

Ama and Annavaha sratodusti. Along with these, the vitiation of pitta leading to

qualitative and quantitative increase of pachaka pitta especially in its amla and drava

guna gives rise to Amlapitta. Non-ulcer dyspepsia is a condition or disorder of G.I.T.

characterized by dyspeptic signs and symptoms seen in most of the acid-peptic disorders

with no evidence of any organic lesions.

Introduction

2

Dyspepsia is extremely prevalent, affecting up to 80% of the population at some

time, and very often no abnormality is discovered during investigations especially in

younger patients [< 40 years of age]. Hence, most of the patients fall under Non-Ulcers

dyspepsia / functional dyspepsia. Women are said to be affected twice as commonly as

men.

As proper pathogenesis is not established its termed as functional disorder and

thought to be due to mucosal or motility disorder or psychological disturbances, drugs or

habits. These factors have been highlighted in the Ayurvedic science as the prime factors

for the manifestation of Amlapitta. Hence to over come this, the trial drug Shatavari

choorna and Abhraka Bhasma with gritha was selected.

A large mumber of yogas have been mentioned in classics for the management of

Amlapitta, among which the “Shatavari Choorna” and “Abhraka Bhasma” are one of the

ingredients in these yogas. Hence, an attempt has been made in this study to assess the

efficacy of this simple, safe, easy to administer herbo mineral combination in the


The diagnosis of the disease Amlapitta is done on the basis of classical signs and

symptoms. Before the assessment, the signs and symptoms will be graded and scored.

Then they will be subjected to statistical analysis.

The whole study has been distributed into two major divisions –

The conceptual study : which is grouped into Literary Review and Drug Review.

The clinical study : contains Material Methods, Observations, Results,

Discussion, Conclusion, Summary and Bibliography.

The whole study is a stepping-stone to the evolution in the field of Ayurveda in

the management of Amlapitta and to provide a better, and simple herbo-mineral

combination.

Objectives

3

OBJECTIVES


management of amlapitta.

2. To compare the effect of Shatavari choorna with Abhraka Bhasma over liquid





of Amlapitta.

HYPOTHESIS

1. Null Hypothesis : Shatavari choorna and Abraka Bhasma with Gritha does not

have any effect in the management of patients suffering from

Amlapitta.

2. Alternative Hypothesis : Shatavari choorna and Abraka Bhasma with Gritha is

effective in the management of patients suffering from

Amlapitta.

Review of literature – Disease review

4

CHAPTER-3

REVIEW OF LITERATURE

A. DISEASE REVIEW

The chronological description of the disease Amlapitta offers a very intresting

pictures about its evolution .The review of the vedic literature shows no suggestive

evidence of Amlapitta described in vedic period , but some passing references can be

seen .

VEDIC PERIOD [from Pre- historic era to 2500 B.C]

1. In Atharvaveda the term ‘Agni’ has been described which plays an important role in

the genesis of Amlapitta

2. In Garuda purana a passing reference to this disease and its treatment is found in the

chapter of Nadivrana chikitsa

3. The term “Shoola” an important feature of Amlapitta is that mentioned in Kaushika

sutra of Atharva veda 1

SAMHITA KALA

In Charaka Samhita [1000 B.C]:

Scattered refences of Amlapitta is available .

a) While explaining about the qualities of milk it has been indicated as pathya in Pandu

roga , Amlapitta etc.2

b) Kulatha has been mentioned as chief etiological factor for Amlapitta3

c) While stating the effects caused due to excessive use of lavana rasa, there is a

mention that it provokes pitta , lohita pitta, amlapitta etc.4


5

d) Amlapitta is also mentioned in the context of illeffects of vidhi virudha ahara sevana.5

e) Rajamasha is more beneficial in Amlapitta disorder.6

f) While describing grahani dosha , pathogenesis of Amlapitta has been

clearly mentioned .7

g) Mahatikthaka gritha has been indicated in Amlapitta. 8

h) While explaining the pittaja nantamja diseases the terms Dumaka

Amalaka and Vidaha have been mentioned which are seen in Amlapitta. 9

i) Indications of Kansa Haritaki also includes Amlapitta. 10

In Sushrutha Samhita :

The term Amlapitta or the desription the disease has not been mentioned in

Sushrutha samhita .

In Bhela samhita there is no any reference about this disease.

Vaghbhata has mentioned that excessive use of kulatha causes Amlapitta .11

In Harita samhita no description of Amlapitta is found.

Kashyapa samhita first describes Amlapitta as a seperate disease entity in

khilasthana 12

.and has explained its nidana , lakshana , samprapti and chikitsa

elaborately.

SANGRAHA KALA(500 B.C. to 600 B.C.)

Most of the commentaries were written during this period on various texts and

also some original texts were written.

In Baudha sarvaswa [Baudha literature] only the treatment of Amlapitta is mentiond.


6

In Ranvir Prakash a gleaming description of Amlapitta with some astrological

relations has been described .

MADHYA KALA [ 600 A.D to 1800 A.D]

Madhavakara [18th A.D] in his treatise has seperatly dealt with Amlapitta with

respect to nidana , lakshanas and bheda in 51th chapter.13

Bhavaprakasha [16 A.D]14 in the the 10th chapter and Yogaratnakara[ 17 A.D] in

Amlapitta nidana chapter have dealt in detail reagrding nidana , lakshana , samprapti

and chikitsa of Amlapitta.

Sharangadhara[14 A.D]15 has explained a few yogas usefull in Amlapitta in different

context and 3 types of Amlapitta.

Basavrajeeyam deals about the nidana , lakshana and chikitsa of Amlapitta in its

saptama prakarna.

A detailed description regarding Amlapitta chikitsa has been quoted in Chakradutta

52nd chapter.

ADHUNIKA KALA

In Bhaishajya Ratnavali [ 19th cent A.D] amlapittadhikara and Yogatarangini 64th

taranga : the nidana lakshana and chikitsa have been explained in detail .

In Rasaratna sammuchaya a detailed description of the samanya lakshanas and

treatment of Amlapitta is found.

In Sidhanta Nidana [ 20 A.D] 6th chapter a brief explainantion about nidana

samprapti , lakshana, upadrava and sadyasadhyata of Amlapitta has been explained .

Apart from these texts later subsequent authors have decribed Amlapitta as a disease

in their works.


7

NIRUKTI , PARIBHASHA AND PARYAYA OF AMLAPITTA

NIRUKTI

The word Amlapitta connotes the pathological change in humour pitta found in

this disease. Literally it means that the pitta is of sour taste. An attempt has been made in

the available ayurvedic and allied literatures to define the word differently.

Etymologically the word “Amlapitta” comprises of two components i.e .“Amla”

and “ Pitta ”

The word ‘amla’ has commonly been used to express one of the six kinds of tastes

[Shabda Kalpadruma] In this present context the meaning of the amla can be taken as one

of the properties of pitta.

According to Charaka, the natural quality of pitta is said to be both Amla and

Katu 1. It may be mentioned here that the sour taste of pitta has been considered as the

physiological property of pitta 2 . The justification for the use of the word as an adjective

of pitta may be interpreted that though the physiological properties of pitta is sour,

normally it is never felt in physiological states.

Sushrutha in sutrasthana quotes that the natural quality of pitta is katu and when it

attains vidagadhata it changes into amla3 . Hence it can be interpreted that the pitta in its

nirama avastha has got katu rasa and in sama avastha it attains amla rasa.

The second component word “pitta” is derived from the dhatu ‘tap’ ie to heat or to

burn or to warm 4 . This term seems to have three meaning ie. tap santape, tap dahe and

tap aishwarye [ siddanth kaumudi]

1. Tap santape :- Refes to the generation of heat.

2. Tap dahe :- Relates to the act of burning of nutrition which is consumed .

3. Tap aishwarye :- Refers to those factors which are responsible to make one achieve

the eight folds of benefits .

These references are obtained from the Bhattaji’s “ Siddanth Kaumudi” and the

words furnish the Vyakarna version of the term pitta.


8

In this present context, if from the word ‘amla’ we take its meaning as diseased,

then etymologically amlapitta may be said to be a diseased state, where the amla guna of

pitta gets augmented, and consequently in turn disturbs the doshic equilibrium of the

body especially of pitta dosha.

PARIBHASHA

Chakrapani in his commentary on charaka samhita defines amlapitta as.

“ Amlapittam cheti amlagunoundriktam pittam” 5

The augmented or increased amla guna of pitta is known as Amlapitta.

Srikantadutta in his Madhukosha vyakya defines

“ Vidahadhyamla gunaoundrikta pittam amlapittam” 6 .

That is, the pitta becomes augmented or vidagdha because of excessive increase

of amla guna of pitta and

“ Amlam vidagdham cha tat pittam amlapittam” 7

The pitta which attains amla guna and vidagdhata is called as amlapitta.

Apart from the above there are other definitions of amlapitta they are:

In Sanskrit dictionary vachaspathyam its defined as

“ Amlaya Pittam Amlapittam “ 8

Amlapitta is a disease where pitta attains sour taste. In this condition whatever is

eaten is transformed into amla rasa due to pathological pitta.

Sushrutha has also cited a reference to this fact that disorders of pitta of annavaha

srothas may lead to vidaha of food. 9

According to Sanskrit dictionary [ viswakors]

“ Amlath ajeernath yat pittam amlapittam “ 10

Amlapitta is a condition caused due to the increased sourness of pitta and

improper or ill digestion of the food. The same has been explained in Charaka where he

quotes that the impaired agni is unable to digest even the lightest food and hence the


9

undigested food particles turns sour due to fermentation and leads to formation of

annavisha. This annavisha combines with pitta and produces amlapittam. 11

According to Kashyapa the vidagdha annarasa turns to shukta, this shukta annarasa is

retained in amashaya combines with the vrudda pitta and produces amlapitta. 12

According to Madhava Nidana, the amlapitta is that condition where the pitta which

has previously accumulated from its self aggravating causes gets vidagadha due to

viruddha [incompatible diets], dushta [ spoiled / state food ], amla [sour] , vidahi

[fried] and pitta provokating foods and drinks.13

These two definations to a certain extent speak of nindana and samprapti of the

disease.

PARYAYA

The paryayas (synonyms) of amlapitta signify different aspects of it. Indu15 in his

commentary on Ashtanga Sangraha has given synonyms of amlapitta as

Prameelaka

Amlapitta

Pittavisuchika

Yogaratnakara16 and Kashyapa17 have used the term pittamla and shuktata

respectively,as synonyms of amlapitta,though they have not directly stated so.

The terms Amalaka and Amleeka may be added as synonyms to the above for

they imply the important features of the disease.

Thus from the above,the following terms can be tsken as importsnt synonyms of

Amlapitta.They are;

* Prameelaka * Amlapitta * Pittavisuchika * Pittamla

* Shuktata * Amalaka * Amleeka

Prameelaka:

The pachyamana vidagdha annarasa immediately provokes pittadi doshas, there

by producing mukha vairasyat, hrtshula, sadana, continous lavana tiktamla, chardi,


10

discolouration, emaciation, distaste, restlessness and watering of mouth. This states

where all symptoms is spoken of as Prameelaka18.In Ashtanga sangraha we find this term

mentioned under kaphaja vyadhis.

Amlapitta:

The implication of the term amlapitta signifies the abnormal state of pitta

especially in its amlaguna.

Pittavisuchika:

This may pertain to both the types of amlapitta. i.e. Urdhvagha and Adhoga

amlapitta where, their respective cardinal features are urdhvagha pravruthi(vamana) and

adhapravruthi (Atisara) of pitta associated with burning sensation.

Pittamla:

This term would imply the sense of the term amlapitta which is mentioned in

amlapitta chikitsa in Yogaratnakara.

Shuktata:

Shuktata is mentioned as synonym of amlapitta in Kashyapa samhitha

Khilasthana 16th chapter.

Amalaka:

It refers to one of the nanatmaja vyadhis of pitta mentioned in the context of pitta

nanatmaja vyadhis19

Amaleeka :

Means amlodgara21 and would refer to one of lakshana of samapitta.

As stated above these synonyms would refer to different aspects of the abnormal

states of pitta.

The similar symptom complex is considered as functional dyspepsia in modern

medicine, which will be discussed later.


11

ANATO -PHYSIOLOGICAL CONSIDERATION OF ANNAVAHA SROTAS

To discreen the abnormal, it is necessary to thoroughly know the normal1. So, also

here the rachana and kriya sarira pertaining to the main site of pathology . i.e Annavaha

srotas is being elaborated .

Anatomical Considerations:

The Mahasrotas corresponding to the alimentary tract is immediately concerned

with the process of alimentation [ ingestion and egestion ]. Mahasrotas is also spoken of

as kosta. The term kosta has several Synonyms2 Viz

1. Mahasrotras [ the great channel ] 2. Shareer Madhya [ the middle part of the trunk]

3. Mahanimna [ the great cavity ]

4. Amapakwashaya [ the organs of preliminary and final aspects of digestion ]

In other sense, the ashayas contained in them, such as, nabhi , hridaya, pleeha ,

vrikka, basti, pureeshadhara, amashaya, uttaraguda, adhoguda , kshudrantra, sthoolantra3.

It would seem from the above that there is a mixup in the enumeration of the

anatomical and functional parts especially the kostangas which can be classified as

follows for proper understanding of the subject.

Anatomical division of Mahasrotas -

Amashaya [Stomach] , Kshudrantra ( small intestine,) Unduka [ ceacum],

Sthoolantra [ large intestine] , Uttaraguda [upper segment of the rectum] and Adhoguda [

lower segment of the rectum and anus].

Physiological or Functional Divisions of Mahasrotas :

Amashaya with its two parts Viz 4

1) Urdhwa amashaya : Also known as pachyamanashaya . (Stomach and small intestine

including duodenum]

2) Adho-amashaya : Pakwashaya (large intestine) and Pureeshadhara [ Rectum]

According to Sushrutha, the following constitute Kosta: Amashaya, Pakwashaya ,

Agnayashaya [Pachyamanashaya], Mutrashaya, Raktashaya, Hridaya, Unduka,


12

Phuphusa5. This description would appear to be purely functional. According to this

view, functional division of Mahasrotas will be as following.

* Amashaya [ Stomach] * Pakwashaya [ large Intestine]

* Pachyamanshaya6 [Between Amashaya and Pakwashaya corresponding to

kshudrantara]

Sushrutha has very clearly stated that amshaya is the seat of kapha 7 where as

Charaka 8 and Vaghbhata have described amashaya, not only as the seat of kapha but also

that of pitta. This contention may be strong by the fact that the amlabhava9 attained by

the food, at the stage of amlabhavavastha during ahara pachana is due to an amlafactor10

or amlaguna of pitta11

[Pachaka Pitta] secreated by urdhwa amashaya.

Amashaya :

The word would literally translate as “ Receptacle of Ama “ The following points

of the Amashaya may be noted .

Amashaya is a matruja avayava 12

Its enumerrated amongst Ashayas 13, Kostanga 14

It can be subdivided into Urdhwa Amashaya and Adhoamashaya 15

It’s the seat of both Pitta and Kapha 16

It’s the moola of Annavaha srotas 17

Site :

Between Nabhi and Stana 18

Above the pittashaya 19

Its continuous with the Annanadi and Kshudrantra below 20

Related Structures :

* 2 Pesis are present in Amashaya 21 * Supplied by 2 Dhamanis 22

* Composed of Susira snayu 23 * Composed of Kala24


13

AHARAPAKA - PRAKRUTA AND VAIKRUTA AVASTHAS

Amlapitta is a functional disorder caused due to qualitative and quantitative

derangement of pitta, which has a major role in the normal digestive process, giving rise

to clinical manifestation of the disease. Hence the proper knowledge of the prakruta

aharapaka becomes essential in order to understand the vikrutha avastha of aharapaka.

PRAKRUTA AHARAPAKA

The term paka means digestion. The different kinds of food ingested undergoes

digestion or paka by the influence of jataragni. The whole process of digestion/ paka and

absorption is influenced by factors like Ushma, Vayu. Kleda, Sneha, Kala and Samyoga

among which Ushma plays a major role1

1. USHMA :

The term ushma refers to agni comprehanding factors which participate in the

course of digestion and metabolism from the point of view of Ayurveda, pitta has been

described as agni [ fire] since it performs action like fire ie paka which refers to pachana

[digestion], dahana [burning] binnasanghata [splitting], tapana [heat production] ,

parinama [conversion ], paravritti [transformation], prakashana[illumination], ranjana or

varnakara[ complexion] and prakashana[ lustre] 2

Charaka has recorded marichi as having stated that

“ Agnireva shareere pittantargataha kupit a kupitaha shubhashubhani karoti”.3a

It is only agni which is located in pitta that gives rise to beneficial or adverse

consequences accordingly as it is in normal and abnormal state of functioning.

Sushruta himself has raised the question-‘is pitta same as agni or it is something other

than this factor?’3b further he has furnished the answer that it is identical to agni,in the


14

view of the fact that such action as dahana (burning, oxidation, combustion),

pachana,(digedtion), etc.cannot occur in the body without pitta.This clarifies agni as

antaragni.

Clarifing the implication of the term “ Pittantargataha” used in above description

Chakrapani has observed that this term does not mean that the pitta of the body is

flamning fire and it only refers to the phenomenon of heat which is associated with fire. 4

The Medini and Amarkosha while explaining about functions of pitta have quoted

that the pitta has a direct bearing on the pakakramas to which ahara dravyas are subjected

resulting in their parinamana or transformation . The implication of these two aspects of

pitta vyapara are the digestion of food and its transformation into various functional and

structural factors of the body.

Pitta Guna and Karma :

The general physical characteristics and properties of pitta or agni availablefrom

the classics are listed in the table No. 1 [ Charaka 5 , Sushrutha

6 , Kashyapa and

Vaghbhata]

Table No. 1 Showing pitta guna

Colour Consistency Density

Naste Smell Other Properties

Suklareena Varjya

Sara, Laghu Katu, Amla Visra Satva

Pandu Vivarjita

Drava Vidagdha Amla

Vaigandhya Ushna

Ushna

Neela Peeta

Ishat or anatisneha

Tikta Putigandha Teekshna

The qualities such as sara , drava,ushna and teekshna may pertain to all the pittas or

agni’s of the body but is particular to pachakapitta. There is difference of opinion

regarding the rasa of the pitta .Charaka quotes that the prakruta rasa of pitta as katu and


15

amla7, but Sushrutha quotes that the prakruta rasa of pitta as katu and it turns to amla to

when it attains vidagdhavastha8. The justification for the use of the word as an adjective

of pitta may be interpred that the pitta in its nirama avastha has got katu rasa and in sama

avastha it attains amla rasa.

2) VAYU :

Vayu is the controller of all the movemnets of the body .In the process of

digestion, prana vayu helps in deglutation , samana vayu stimulates the agni , promotes

digestion , assimilation and does sara kitta vibhaga . Any abnormality in the functioning

of the samana vayu leads to vaishamyata of agni and initiates the pathogenesis of the

diseases related to the GIT.

3) KLEDA :

Kleda means moisture . The kapha located in the amshaya is called Kledaka for

its moisturizing action. This along with the liquid part of the food breaks down the

compactness of food and disintigrates it to facilitate easy digestion. Emulsification of the

food is done by saliva and the liquid portion of the various digestive juices and hence

kledaka kapha can be said compared to the saliva and other various digestive juices.

4) SNEHA :

Sneha means unctousness and its the specific quality of kapha and pitta also. The

sneha which is consumed in the form of ahara brings softness to the food and also

enhances the functions of agni.

5) KALA :

Kala is also very important factor influancing the proper digestion . The time of

intake of food decides the digestion power i.e. pachakagni because agni is influenced by

three doshas: Kapha, pitta and vata in the early middle and late hours of the day. Kala

also cannotes the time taken for digestion on which the outcomes of the digestion

depends.


16

6) SAMYOGA :

The cordination of certain factors influence the digestion. They are food,

nature of food [Prakriti] processing [Samskara], additives[Samayoga] quantity [Rashi]

consideration of the place regarding the food as well a the user [Desha] age of the

user[Ayu] ,season and the time of eating [Kala] and following the rules of eating keeping

in consideration of one’s needs etc.

AHARAPAKA :

The process of aharapaka has got two phases i.e.

1) Prathama Paka / Prapaka 2) Vipaka

The priliminary phase of digestion or the first outcome of the paka is known as

prathamapaka . This commences from the introduction of the food into the mouth

followed by the digestion of the food in the upper part of the stomach i.e. urdhwa

amashaya which is comprehended by madhurabhava. This phase can be referred to the

digestion that takes place in the buccal cavity.

Vipaka:

Vipaka has been defined as the outcome of the action of the jataragni on the ahara

dravya which is resultant of the prathamapaka , which is to be judged from the point of

view of the taste of the end product of gastro intestinal digestion Viz. Madhura [Sweet]

Amla [Sour] and Katu [Pungent].

Vipaka ocurs in 2 phases

a) Avasthapaka [ Auring digestion]

b) Nishtapaka [ At the end of the digestion ]

Avasthapaka :

Avasthapaka refers to the changes that the ahara dravya undergoes in the kosta

under the influence of Jataragni. The avasthapaka/ aharapaka in the kosta may be stated

to proceed in the following order:


17

1. Madhura Avasthapaka

2 .Amla Avasthapaka

3. Katu Avasthapaka

1] Madhura Avasthapaka :

The presence of food in the mouth is followed by the perception of its taste under

the influence of bhodaka kapha9 which is seated in the root of the tongue. The concept of

bhodaka kapha parallels with the description of saliva and its function marks the

digestion that takes place in the buccal cavity . The outcome of the action of bodhaka

kapha on food; especially that fraction of its composition which essentially is madhura in

tatse seems to be continued and complete in the upper portion of urdhwa amashaya. By

now, the insoluble madhura portion of food becomes sufficiently soluble and mixed up

with the frothy kledaka kapha i.e mucin present in the urdhwa amashaya. Here with the

help of kleda ,sneha and vayu it breaks down, becomes less complex and soft and as a

result frothy and sweet ahara rasa will be produced . Since, the ahara rasa produced is of

madhura rasa and contributes to kapha, this is called madhura avasthapaka10

.

2] Amla Avasthapaka:

At this stage ahara reaches the lower part of the amashaya .Agni i.e pachakagni

which is stimulated by samana vayu acts on it and results in the vidagdhata of the ahara

rasa, the so formed ahara rasa attains amla guna and hence the name amla avasthapaka11.

The ahara is stated to undergo amlabhava, corresponding to the conversion of insoluble

proteins into soluble protein, under the influence of pepsin in the presence of

hydrochloric acid. This synchronises with the passing down of ahara rasa which has

attained amlabhava into the lower portion of mahasrotas where achha pitta is stated to be

secreated and it comes in contact with the pittasthana 12.

The final outcome of the entire gastric digestion is the acidified chime which has

been characterized by Charaka as vidagdha13, has been interpreted by Chakrapani as

pakwa-apakwa 14 or kinchit pakwa or kinchit apakwa.Even, Sushruta, in sutrasthana


18

defines vidagdha as, “Vidagdha sangnyamata amlabhavam” 15. At this stage, the food

substance remains partly digested orpartly indigested.

3] Katu Avasthapaka:

The food is subjected to further digestive events which takes place in the

bhridantra or pakwashaya.This has been described by Charaka as katubhava16 or katu

avasthapaka.The materials or digested food particles passed down from amashaya having

reached the pakwashaya being dried up by agni is rendered into lumps. During this

process the ahara rasa becomes katu in nature and vayu dosha will be nourished.

The facts furnished above are fully supported by modern physiological

contribution, as regards the process of digestion according to which the starch digestion

begun in the mouth and is continued in the stomach, which is sweet . The consistency of

the food at this stage is pasty and frothy .This step can be aptly described as

madhurbhava and the place where it occur as amashaya. Further digestion of sugar is

arrested by HCL. Then commences the protein digestion under the influence of HCL and

enzyme pepsin which results in the conversion of insoluble proteins into soluble proteins.

The gastric digestion in this stage of digestion can be appropriately described as

amlabhava and the state of the digested material as pakwapakwa. As the acidified chyme,

which is passed down in small quantities to the duodenum through the pylorus comes in

contact with the mucosa of the duodenum through the common bile duct . These findings

fully confirm the Ayurvedic version of the mechanism responsible for the production of

accha pitta 17. Subsequent digestive events take place leading to the formation of chyle.

The formation of the chyle in this manner can also be aptly described as anupaka vyapara

and bhautikagni vyapara. From here the ahara rasa is stated to be absorbed through

dhamanis to be distributed throughout the body18.


19

NIDANA

The term Nidana refers to the causative factors which play an important role in

the manifestation of a disease. Nidana parivarjana forms the first and foremost step in the

treatment of any disease in general and specifically in Amlapitta, it is practically

observed fact that many of the patients can be managed only by nidana parivarjana.

It is said “the character of a man’s digestive system moulds and shapes his destiny

on this planet”1. This statement holds good as the annavaha srotas and ahara have a direct

proximity. Thus a thorough knowledge of the Nidana is imperative such that preventive

measures can be adopted.

In classics a large number of nidanas have been explained in the content of

Amlapitta. Opinion of different authors are listed in Table No. basically under two

headings.

1. Ahara sambandhi 2. Vihara sambandhi.

Apart from these the other factors which can be included under the nidana of the

amlapitta can be summed up under the following headings.

1. Manasika Hetu. 2. Anya vyadhikruta 3. Oushadha / Vaidyakruta.

Aharaja nidana:

Much stress has also been laid on the benefits of following regular timings for

Aharasevana.

Adhyasana leads to Ajirna as the previously ingested meal is yet to be digested.

Visama bhojana in the form of Akala bhojana produces Ama2 while Atita kala

bhojana suppresses the Jatharagni due to prakupita vata3.

Atimatra bhojana is also Amapradosakara4.

Ahara vidhi visesa ayatana has been explained for Svasthya raksana. Vidhityakta

bhojana hence can lead to Agnidusti5.

Langhana/upavasa produces vataprakopa that in turn has a bearing on the Agni.


20

Chart No. 1 Showing the Amlapitta Nidanana

AMLAPITTA NIDANA

Ahara sambandhi Vihara Sambandhi

1. Abhojana. 1. Bhukte Bhukte snana

2. Atibhojana. 2. Bhukte Bhukte avagahana

3. Ajeerna 3. Bhukte Bhukte divaswapna

4. Amepurna 3. Vegadharana.

5. Vishamashana.

6. Adhyashana.

7. Gurubhojana.

8. Gorasa Atisevana.

9. Apalkwa Atisevana.

10. Abhishyanda atisevana.

11. Phanita atisevana.

12 Pishta atisevana.

13. Ikshurvikara atisevana.

14. Prutuka atisevana.

15. Ushna atisevana.

16. Katurasa atisevana.

17. Amla atisevana.

18. Lavana atisevana.

19. Drava atisevana.

20. Kulatha atisevana.

21. Madhya atisevana.

22. Ruksha atisevana.

23. Brishtadhanya atisevara.


21

Acharya Charaka has aptly stated “Aharasambhavam vastuh rogasca

aharasambhavah6”. The Guna-karma vivecana of the Ahararupi nidana are enlisted in

Table No.2 GUNA-KARMA VIVECANA7-12

Nidana Guna-karma

A. Rasatah

Amla rasa

Katu rasa

Kashaya rasa

Tikta rasa

B. Gunatah

Usna

Tiksna

Ruksa

Sheeta

Snigdha

C.Dhanya varga

Vrihi

Sastika

Yava

Mudga

Masa

Kulattha

Adhaki

Kalaya

Nispava

Koradusa

Laghu, Ushna, Pittakapharaktakrt, Kostha vidahi,

Sithilatvam janayati, Rujakara, Ksatakara,

Dagdhakara, Laghu, Ruksa, Ushna, Vatapittakrt,

Lekhana, Snehakledasosana, Sulakari

Ruksha, Sheeta, Vatapittakrt, Lekhana, Soshana

Laghu, Ruksha, Sheeta, Kledasosana, Sulakara,

Stambhakrt

Pittavardhaka, Soshaka

Pittakrt, Lekhana

Vatakrt, Sulakara, Soshaka

Vatakaphakrt, Stambhaka

Kaphakrt

Guru, Pittakrt

Sheeta

Kashaya, Sheeta, Ruksa, Vatakaphakrt

Laghu, Ruksa, Sheeta, Kashaya, Vatakaphakrt

Guru, Snigdha, Ushna, Pittakaphakrt

Ushna, Amlavipaki, Pittakaphakrt

Vatakrt

Laghu, Ruksha, Vatakrt

Ruksha, Vistambhi

Soshana, Vatakaphakrt


22

Nidana Guna-karma

Masura

Triputaka

Rajika

Tila

D.Krtanna varga

Pinyaka

Palala

Pistanna

Suskanna

Krsara

E. Mamsa varga

Anupa mamsa

Varija mamsa

F. Payah varga

Payah

Dadhi

Kilata

G. Miscellaneous

Ksara

Sura vikara

Viruddha ahara

Saskuli

Iksu

Laghu, Ruksha, Sheeta, Vatakrt

Ruksha, Vatakrt

Ushna, Tikshna, Raktapittakrt

Madhura, Tikta, Kashaya, Katu, Snigdha, Ushna,

Pittakaphakrt

Ruksha, Lekhana, Visthambhi

Gurupaki, Pittakaphakrt

Guru, Ushna, Pittakaphakrt, Vidahi

Na pakam gacchati, pindikrtam, asamklinnam,

vidahamupagacchati

Guru, Pittakaphaprada

Guru, Snigdha, Picchila, Pittakaphakrt, Agnisadakrt,

Abhisyandi

Sheeta, Snigdha, Bahala, Picchila, Kaphakrt

Amlapaki, Abhisyandi, Pittakaphakrt

Guru, Kaphakrt

Laghu, Ushna, Tikshna, Kledayati adou pascat visosayati,

Dahakrt, Vidaranakrt

Amla, Ushna, Amlavipaki, Tridosakrt, Dahakrt

Amavisakrt, Grahanigadakrt, Amlapittakrt

Guru, Kaphakrt

Sheeta, Snigdha, Kaphakrt, Vidahi (if machine pressed)

Vihara sambandhi. Nidana :

Among the viharaja nidanas. The Bhukte Bhukte snana, Bhukte Bhukte avagaha

and bhukte bhukte diwaswapna will lead to agnimandya and formation of ama. Further


23

indulgence in pitta prakopake ahara and vihara will lead to the manifestation of amlapitta.

Diseases of the stomach or Jathara is said to be due to vata veghedharana and hence

amlapitta also. Physical stress, fatigue and overwork are known to augment amla type of

srava – pitta srava consequent to agnidushti.13

Manasika Nidana :

More importance is being layed on the manasika karanas in the recent times.

During emotional disturbances the food consumed in the stipulated quantity remains

undigested.14 In addition to this, these nidana are also capable of aggravating the

individual dosha like vata prakaopa by chinta, shoka, trasa; pitta prakopa due to bhaya,

krodha, ershya. These mental stress and strains may augment amla type of srava leading

to agnidushti – which in turn produces amavisha or ama resulting in the manifestation of

Amlapitta. 15

Anya Vyadhikruta :

The concept of a disease begetting another disease has been explained by the

Acharyas. Karshana due to longstanding disease is said to cause vataprakopa and hence

the agnimandya. Apart from the Jawara and Atisara being a

Jathragnimandhyajanyavikara, the agni dusthti may itself produce amlapitta when an

individual indulges into pittaprakopaka ahara vihara.

Oushadha / Vaidyakruta :

Panchakarama vyapad may cause Agnimandya leading to Amlapitta. Non-

compliance with Ashtamaha do shakara bhava also causes Agnimandya.16

Though the specific nidana for Amlapitta has been mentioned in the classics, the

individual role of the nidanas are not explained in the context of Amlapitta. Hence the

nidanas can be summed up under 4 groups depending upon their mechanism of action in

the manifestation of Amlapitta.

* Agnidushtikara Nidana. * Pittaprakopaka Nidana especially Amlagunavardhaka.

* Vataprakopaka Nidana. * Kaphaprakopaka Nidana.


24


25

SAMPRAPTI

The concept of samprapti in Ayurveda describes the causative mode and

development of disease as well as the evolutive process of the disease .1

Decephering the samprapti is relavent to know the modality in which the nidana

has effected the body.The body is continually threatened by a variety of Nidana . The

capacity to withstand this, lies in the soundness of the dosha and the dhatu .Any

incompelence of these intrinsic factors paves way for the development of the disease .

Samprapti covers the entire visage from the Nidana to the development and progression

of the Vyadhi.

The Samprapti of Amlapitta innvolves three important factors in the manifestation

of the clinical signs and symptoms .Hence the knowledge of these factors becomes

essential as its been quoted in the classics that “ Samprapti vighatanamewa chikitsa “ i.e.

reversal of pathogenesis is the complete treatment.

The factors involved are

1) Agni 2) Ama 3) Sroto dusti

AGNI

Nearly all diseases included under kayachikitsa are engendered due to

impairement of kayagni2.Even so, is amlapitta annavaha srotodusti which latter is due to

pakavaigunya. Pitta, one of the trinity of doshas is also spoken of as agni for the reason

that this factor in the body has been stated to perform actions similar to fire3 .

As stated elsewhere agni is generally held to be responsible for the conduct of

pakadi karma Viz, sarapaka in amashaya and pakwashaya the separation of sara4 from

kitta in the pakwashaya , augmenting the action of bhutagni5, thus renedering the

digested food fit for further chemo thermal reaction described by Chakrapani as anupaka6

after which follows the reactions in dhatu paripaka.


26

The two main aspects of Agni has been envisaged by all the authotities of

ayurveda

a) Kostagni [Charaka], b) Pachakagni, Jataragni [ Sushrutha], c) Pachakapitta [Vagbhata]

Dhatwagni by all the three authorities. The former is stated to be located between

amashaya and pakwashaya 7 . This aspect of pitta or agni while performing all the

digestive fuctions described in the foregoing paragraph is also stated to lend support and

augment the functions of other pittas elsewhere in the body including the dhatvagni .

The main samhita granthas have described four satges of jatargni viz, sama,

vishma , tekshana and manda 8 . The three doshas become involved due to the operation

of different etiological factors on the body leading to reciprocal influence between them.

Sama Agni :

In the well-equilibrated state of fuctioning of tridoshas, the jataragni is also stated

to function normally. This state of its function has been described as Sama Agni. In this

state jataragni ensures complete digestion of food in scheduled time without any harm to

the body9

Vishma Agni:

An erratic state of agni arises, as a result of the influence of vata in the condition

described as vishma agni . In this condition the agni varies with periods of strong appetite

alternating with loss of appetite 10.

Teekshna Agni :

The agni in this state is excited by pitta hence it is known as teekshna agni .In this

state agni digests even large quantities of food earlier to the scheduled time 11

.

Manda Agni :

This is a state in which agni is considerably inhibited due to the dominance of

kapha dosha . In this state the agni is unable to digest and metabolise even a less quantity

of otherwise easily digestable food in scheduled time 12

.


27

Out of these the sama agni is considered as the samanya condition of the agni and

the rest three as the vaishamya condition.

The vaishamyata of agni leads to improper digestion due to vridhi or kshaya of

agni in their guna, praman and karma . In mandagni the food will be apakwa .In case of

teekshnagni it will be dagdhapaka and pakwapakwa in case of vishamagni .All these lead

to specific type of ajeerna leading to formation of Ama, one of the important cause for

the further vitiation of the Annavaha srotas and manifestation of the disease Amlapitta.

AMA

All the diseases, studied under the heading of Kayachikitsa are stated to have

their origin in amadosha. Amadosha or amavisha, both as acute and subacute or chronic

conditions appear to be related to the gastro-intestinal as well as metabolic disturbances

developed due to the impairement of agni which is sited in amashaya i.e.antaragni or

better still agnidushti.Ama has been defined as a condition in which the first dhatu

namely, rasa dhatu is not properly formed due to the lowered strength of Ushma(agni) 13

and in this state the food ingested becomes dushta. According to Vagabhata the impaired

vatadi doshas become mixed up with one another leading to the formation of amadhosha

very much like the production of visha from the spoiled kodrava14.

The general outlook of the two descriptions of ama would appear to be that in

absence of or due to the inhibition of kayagni the ingested food is not properly

digested.Products that arise out of such an impaired digestion is retained in the amashaya

and they undergo such changes to yield toxic substances-‘Visha roopataam yati’ which

are known as amarasa .

The etiological factors of amadosha as described by Charaka and Sushruta15

range

from dietetic indiscretions including errors of nutrition to emotional tensions of different

kinds.


28

Ama Lakshanas:

The indulgence of the above mentioned etiological factors may lead to the

formation of ama in the amashaya which travels throughout the body and produces

symptoms like:

1.Srotorodha 2.Bala bramsha 3.Gourava 4.Anilamoodata 5.Alasya

6.Apakti 7.Nishteeva 8.Malasanga 9.Aruchi 10.Klama16

The ama wich is situated in amashaya produces symptoms related to kosta or

when they are traveling throughout the body, they produce sarvadaihika laxanas. When

ama co-exists along with the vrudha dosha then this condition is known as sama or sama

dosha. So, before going to amlapitta nidana,it is very important to note the sama and

samapitta conditions.

Sama:

The term sama refers to undigested,crude,not sufficiently prepared or matured (a

morbid state of humour)17

In various refrences sama is defind as “Sahamena samaha”18

i.e. the substances associated with ama are known as sama.(As.Su by Arunadutta)

Samadosha:

The sama doshas can be defined as condition in which the doshas, dhatus and

malas get vitiated and permeated with th ama.it is the cause for all the diseases.19

Hemadri commenting on this says

“Samairdoshair dhatubir malaischa janita roga api sama uchyate”20

The ama which combines with dosha,dhatu and malas is called as sama doshas,

sama dhatus and sama malas respectively. When vata, pitta and kapha doshas mixes up

with amadosha, then it is called samavata,samapitta and samakapha respectively.

In Amlapitta the mandagni leads to the formation of amarasa which gets retained

in the amashaya and combines with the deranged pitta giving rise to clinical

manifestation of the disease . The lakshanas of samapittas are stated as;

Durgandha, harita ,Shyava , amla , sthira ,guru , amlaka, uraha kanta daha.


29

SROTODUSTI

The samprapti of amlapitta is also the study of srotas and the study of same both

at the physiological and pathological levels. Pathological events are stated to have their

origin at the level of srotamsi as mentioned in the classics21. Charaka quotes that the

ahara rasa is continuosly circulated throughout the body being propelled by vyana vayu.

If ahararasa accumulates in any part of the body due to pathological involvement of the

srotases i.e. khavaigunyaath , abnormal changes are initiated .Dhoshas in such a

condition become localised and initiate the process of disease in their places i.e.

karotivikritim tatra.

The srotas involved in Amlapitta is annavaha srotas. Annavaha srotas was

discussed in connection with pitta srava in urdhwa amashaya during amlabhava or

avasthapaka , in the process of ahara pachana .It is due to this sroto vaigunya that

amlapitta is engendred. Srotovaigunya can be either functional or structural .The former

is due to aggravation of doshas and the latter due to sroto dusti.

Due to annavaha sroto dusti the prakupita pittadosha having accumulated and

expanded , spreads to amashaya to lodge there22 . Further, it gets exacerabated by vidahi

and other pittaprakopa factors impairing the agni . In this condition, food is tormented to

vidagdha to assume amlabhava. It is pointed that vidagdha annarasa which assumes

amlabhava is an abnormal state in the process of digestion and this abnormality would

appear to be due to the amlaguno udrikta pitta or excess amla type of srava. It can be

obviously inferred that, this is resulted as to the atipravruti prakara of dushti in the

sookshma srotases of annavaha srotas .

The responsible dushya i.e. rasa gets vidagdha by amla factor assuming shuktata.

This shukta rasa which retains in amashaya23 is resultant of amadosha .This may refer to

sanga type of sroto dusti .Since, one of the distinct classification of this disease viz

urdhwaga amlapitta and tikta amla vamana a symptom would speak of the direction


30

against the normal physiological course. Vimarga gamana type of dusti can also be

referred in this condition.

On summing up, the following dusti prakaras of annavaha srotas would apper in

this disease

1. Atipravrutti 2. Sanga 3. Vimargagamana

Samprapti can be clearly studied under the folloing headings

1. Samanya and Vishesha samprapti 2. Samprapti ghatakani

3. Kriyakala samprapti

Samanya Samprapti :

Samanya refers to “ Similitude “ . Thus the samanya samprapti establishes a

common relationship .The samanya samprapti of a disease indicates the basic

pathogenesis uninfluenced by secondary factors and that remains the same in all the

stages of vyadhi . The samprapti of Amlapitta has been put forth in the following

manner.

Due to nidana sevana vatadi doshas become aggravated and affects the agni to

produced jataragni mandhya , which in turn leads to the vidagdhata of the consumed

ahara .This vidagdha amarasa combines with the vitiated pitta and undergoes shuktapaka

in amashaya. In this stage, if the person involves in ahithakara ahara and vihara it

becomes more vitiated due to vidagdha pitta and produces amlapitta24

.

Pitta which is already sanchita; due to its self aggravating factors further attains

vidagdhata due to virudha,dushta,amla ,vidahi and pittaprakopaka ahara and vihara and

changes into amlarasa.25

The first samprapti as told by Kashyapa stresses on all the tridoshas being

responsible for agnimandya singly or all together leading to formation of ama rasa .The

so formed amarasa gets retained in the amashaya leading to formation of annavisha

which combines with the vitiated pitta and undergoes shuktatva resulting in the

manifestation of the Amlapitta , if the person indulges himself further into ahitakara ahara

vihara.


31

Madhavakara has especially emphasised on the derangement of the pitta and the

pittaprakopaka ahara - vihara in the manifestation of the Amlapitta and the conversion of

the ahara rasa into amla rasa . This clearly indicates that the composition of pitta turned

abnormal. From the above information the manifestation of the Amlapitta can be putforth

as follows;

1) Due to the pitta prakopaka nidana sevana especially amlaguna vardhaka ahara , the

amlaguna of pitta increases and its known as vidagdha pitta, which leads to

agnimandya i.e. jataragni mandyata

2) In such a condition if one indulges in vatakara or kaphakara or both vata and

kaphakara nidanas then it contributes to agnimandya.

3) Due to the vidagdha pitta and jataragnimandya the ahara rasa undergoes shuktapaka

in the amashaya.

4) Further if one indulges in more nidanakara ahara and vihara it leads to more shuktatva

leading to clinical manifestation of the disease Amlapitta.

From this it can be inferred that there is a functional derangement of pachana karma.

Samprapti of Amlapitta is stated in Fig.No.

Chart no. 3 Showing the Samprapti of Amlapitta Pittaprakopaka nidana Vata or kapha or vatakapha Prakopaka nidana with pitta Prakopaka nidana Amlaguna vriddhi in pitta Vata or kapha or vatakapha Vidagdha pitta Agnimandya

Vidagdha anna Shukta paka Amlapitta


32

Implication of the term SHUKTATVA :

The term shuktatva refers to sourness. Charaka while describing the second

avasthapaka has used term amlapaka which refers to the outcome of the normal digestive

reactions that occurs in the amashaya due to pittasrava 26. It should be noted that even

though shuktapaka 27 and vidagdhapaka yields substances which are also amla has not

been mentioned in the context of normal gastric digestion. From this it can be inferred

that the latter term relates to the outcome of abnormal digestive reactions which yield

pittasrava having excess amlarasa or guna..

Amadosha in which the food attains shuktatva obviously relates to the

fermentation brought about by various factors which latter have become active due to

pavakavaigunya [impairment of agni ]. This is annavisha. This may abnormally increase

the amlaguna of pitta resulting in amlapitta.

Kashyapa28 illustrates the same with an analogy viz as the formed curd turns sour

assuming inspissated form on adding kshera, so also the rasadhatu responsible dushy in

this condition assumes vidagdha attaining shuktatva by excess of amlatype of srava, due

to over indulgence in aggravating factor.This augments the amlagunoudriktam pittam i.e.

Amlapitta.

VISHESHA SAMPRAPTI

The vishista samprapti indicates the various transformations and intricacies in the

doshic involvement. Its studied under five headings

* Sankhya Samprapti * Vidhi Samprapti

* Vikalpa Samprapti * Pradhanya Samprapti

* Bala -kala Samprapti

Some of these like Pradhanya, vikalpa samprapti are subject to alterations during

the course of the disease and from individual to individual.


33

Sankhya Samprapti:

As the name indicates , the enumeration of the disease is done under this heading

On the basis of pravruti 2 types 29

On the basis of Doshas 3 types30

4 types31

On the basis of sandhyasadhyuta 2 types 32

Vidhi Samprapti :

This is final version of the sankhya samprapti

Pravruti bhedena 33 :

1) Urdhwaga amlapitta 2) Adhoga Amlapitta

Tridosha bhedena 34

1. Vatika 2. Pitta 3. Kaphaja

1. Vata Kaphaja 2. Sleshma Pittaja

3. Sanila 4. Kaphanugata

Sadhyasadhayata 35 :

Sadhya Naveena ; Proper pathya sevana in purana

Asadhya Purana

Bala and Kala Samprapti :

The occurance and/or intensity of the symptoms are subject to the influence of the

secondary factors that can mould it.

Diuranal Variations :

As it is a pittapradhana vyadhi , occurrence or the intensity of the symptoms is

mainly seen in madhyadina and madhyaratri.

Variation in accordance with Aharakala :

Pitta is predominant in the amlavasthapaka of the ahara and as such, the

symptoms occur in the jiryamana avastha of Ahara


34

SAMPRAPTI GHATAKANI

Dosa : Pitta - Pachakapitta [ Pradhana ]

Vata : Samana Vayu

Kapha : Kledaka Kapha

Dusya : Rasa

Agni : Jataragni

Ama : Jataragni Janya ama

Srotas : Annavaha, Rasavaha

Srotodusti Prakara : Sanga, Vimargagamana , Atipravruti

Udbhavasthana : Amashaya

Adhistana : Amashaya.

Sancharasthana : Annavaha Srotas

Vyaktasthana : Amashya

Rogamarga : Abhyantara

SAMPRAPTI ACCORDING TO KRIYAKALA

The concept of Kriyakala describes the mode and satges of development of

disease. Significance of kriyakala lies in timely intervention to arrest the disease process.

The recognition with respect to kriyakala becomes easier in cases of diseases pertaining

to Annavaha srotas , as the lasksanas are very evident.

The various stages and changes involved in Amlapitta. From the inception to

manifestation represents an evolution process. The evolutive process of the disease is

based on the description of dosha kriya kalas furnished by sushrutha.

I) Sanchaya : [ The stage of accumulation]

The term sanchaya means accumulation of dosas in its own place. The initial

insult to the body by the nidana results in accumulation of the dosas in their own sites.

According to Madhava , pitta dosha is main causative factor , where as according

to Kashyapa, the vata and kapha doshas are also associated factors in Amlapitta .


35

Sanchaya of doshas can either occur individually, in pairs or all together . This

stage is characterized by vague and ill-defined symptomatology . The lakshana if

identifiable would be ‘stabdhapurna koshtata’ in vata sanchaya , ‘mandoshmata’ in

pittasanchaya and ‘angagourava’ and ‘alasya’ in kaphasanchaya. 36

An overall feature of this stage is stated to be an aversion towards similar nidana

and attraction towards contraries. 37

The symptoms of agnidusti may also be evident.

II) Prakopa [ The stage of Provocation ] :-

“ Kopasthu Unmargagamita “ 38 Further, indulgence in nidana leads to further

vitiation of the dosha. Its stated to be the condition in which the doshas having previously

accumulated and stagnated in its own sites, become swollen or excited.

This may occur under two circumstances such as :

* Chaya purvaka prakopa * Achaya purvaka prakopa

Chaya purvaka prakopa is a condition which suceeds the previous stage of

sanchaya due to continued inception of the dosha vardhaka ahara and vihara.

As Amlapitta is pitta predominant disease the paittika lakshanas become

pronounced due to pitta provocating factors in particular. In the case of agnidusti, the

apakwa ahara rasa may start to undergo vidagdhata and shuktata. Achaya purvaka

prakopavastha without the previous accumulation of doshas/ sanchaya, where in it is

referred to as Unabhava39. This is in subject to the strength of the nidana , specially in

manasika karanas and aganthuja karanas this kind of prakopa can be observed.

III) Prasara : [ The stage of pervation of vitiation process]

The vitiated doshas unable to contain themselves in svasthana spill out into other

sthanas too. In addition the combining of doshas with each other , thus potentiating the

samprapti is the main feature of this avastha. In Amlapitta the prakupita pitta dosha

remains quiescent , retaining as it40 was in amashaya and exacerbate to cause vidagdha,

due to vidahi and pitta provoking factors. In addition, the ama/ shuktarasa produced in the

earlier avastha mingles with dosha producing sama dosha . The prasara is mediated via


36

rasarakta dhatu by vyana vayu . The laxanas of pitta are predominant as its pradhana in

amlapitta.

IV) Sthanasamsraya : [ The stage of location]

The dosa dushya sammurchana is an integral part of the disease and occurs in this

avastha. This stage obviously represents the prodromal phase or purvarupa. The site of

sthanasamshraya may have a pre-existing khavaigunyata or it may occur simultaneously.

In Amlapiita, the sthanasamshraya is in the annavaha srotas, amashaya in particular . The

prakupita pitta gets lodged in the amashya and marks the beginning of disturbance there.

The vidagdha ahara rasa attains amlabhava/shuktatva and mixes with the vitiated pitta

and vitiates the rasavaha srotas, leading to dosha dushya sammurchana. Purvarupaof

Amlapitta has not been described.

V) Vyakta : [The stage of manifestation]

Vyakta is the stage of manifestation of actual disease condition, which is the

result of dosha dushya sammurchana. In this stage, Amlapitta gets fully manifested and

differentiated in doshic varieties depending upon the predominant dosha. The clinical

signs and symptoms become evident.

VI) Bheda :

Depending on the extrinsic and intrinsic nidana the disease process is modified to

exhibit the lakshanas based on the dominant dosha. The disease worsens and upadrava

may manifest in this avastha. Upekshana of this avastha leads to upadravas such as jwara,

atisara, parinamashoola and annadravashoola.

A vicious cycle is formed in Amlapitta which is represented by the schematic

diagram in the Fig.No. The pachakapitta gets vrudh due to pittaprakopaka nidanas in its

amlaguna and dravatwa leading to agnimandya, which in turn leads to avipaka. The

apakwa ahara rasa undergoes vidagdhata giving rise to ama which leads to rasa dusti. The

rasa dusti inturn causes agnimandya and the cycle continues as long as one indulges in

the nidanakara bhavas.


37

Chart no. 4 Samprapti on basis of Kriyakala Nidana

Amaraja Viharaja Manasika Agantuka

Sanchaya and Prakopa Agnidusti

Pitta sanchaya Ajirna apachana Amotpatti Prakopa Suktatwa

Prasara

Sthana Shuktamlata Vidagdhajirna Sanchaya

Vyakta Pitta amavisha Sammurchana

Amlapitta

Bheda

Urdhwaga Adhoga

Sitapitta Upadrava Udarda Kotha Annadrava shoola Parinama shoola Chart no. 5 Vicious circle formed in Amlapitta Pachaka pitta Ati Amlata Ati Dravata Rasa Avipaka Ama Vidagdhata

Hetu

Agnimandya


38

POORVA RUPA

Poorvarupa are the promonitary symptoms, which appears before the

manifestation of the main symptoms of the disease. The purvarupas are those that preceed

the actual manifestation of the disease1. The vitiated doshas at the stage of

sthanasamshraya will manifest the signs and symptoms of forthcoming disease2. They are

the indications of the impending disease 3.

According to Madhavkara they are of two kinds4.

1. Samanya: [General] 2. Vishista [Specific]

Samanya purvarupas are the ones, which indicate the disease to some extent

without giving any indication of the dosha derangement.

Vishista purvarupas are the ones which give an idea of the doshas also in addition

to idea of the disease.

Samanya purvarapas generally disappear before the onset of the disease whereas

vishista purvarupas are likely to continue after the actual manifestation of the disease.

According to Chakrapani purvarupas are of two kinds5.

Vyakta laxanas – manifested or visible

Avyakta laxanas – Unmanifested or invisible

In Amlapitta, purvarupas are not evident as they probably belong to the latter

category. Even if they are present it is not possible to recognize them, as minor function

of doshas are common events. Hence no purvarupas have been mentioned for amlapitta in

the classics.

In Amlapitta samprapti, the agnimandya and pittavriddhi are the important

factors; hence the laxanas due to these may manifest in milder forms or show variations

in accordance with the doshic variations. Aruchi , avipaka , chardi, utklesha and hrillasa

are produced due to agnimandya[ama] and karadaha, charanadaha, angadaha, ushanata

etc. denote the sarvadhaihika pitta prakopa.


39

RUPA

The rupas are the charecteristic manifestation of the clinical features which

appears during the cause of the disease 1. Its defined as the clear manifestation of the

prodromal symptoms itself is called as rupa 2. The word rupa indicates the signs and

symptoms by which a disease is identified 3

The clinical features or rupa of the Amlapitta can be described under following

headings.

* Pratyatma lakshanas * Samanya lakshanas

Lakshanas due to the pravritti of doshas

* Urdhwaga Amlapitta * Adhoga Amlapitta

* Vishista Lakshanas

Specific lakshanas due to doshas involved

Pratyatma lakshanas :

The word atma lakshana denotes the cardinal features of the disease. From the

name itself it is evident that Amlapitta is a pitta predominant disease caused due to the

vitiation of pitta. Shuktapaka is a peculiar stage of samprapti. Hence, the lakshanas

produced by shuktapaka mainly amloudgara, haritdaha, kukshidaha, and kantadaha are

taken as pratyatma lakshanas of Amlapitta.

Samanya Lakshanas:

The lakshanas caused due to the other factors involved in samprapti ghatakas is

known as samnya lakshanas .

In Amlapitta the symptoms caused due to agnimandya[formation of ama]

sarvadaihika pitta prakopa and rasa kshaya as a result of shuktapaka are considered as

samanya lakshanas.


40

The lakshanas caused are as follows

Agnimandya [Ama formation] - Avipaka. Aruchi, Chardi, Utkesha, Hrillasa, Gourava etc

Rasakshaya - Klama, brahma

Sarvadaihika pitta prakopa - Karadaha, Charanadaha,Angadaha,Ushnata etc.

The Schematic diagram showing the manifestation of the symptoms is presented in fig.

Chart no. 6 Showing the manifestation of symptoms Pittaprakopaka nidana sevana Vata or kapha or vatakapha Prakopaka nidana + pitta Prakopaka nidana sevana Lakshanas Lakshanas Karadaha Aruchi Charanadaha Avipaka Angadaha etc. Chardi Utklesha Hrillasa Rasakshaya lakshanas Lakshanas Klama, Bhrama etc. Amloudgara, hritdaha Kukshidaha, kantadaha.

Pitta vriddhi Agnimandya

Shuktapaka


41

The samanya lakshanas of the Amlapitta mentioned by different authors are listed in

Table No.3. Showing the lakshanas of amlapitta mentioned by different authors

Sl.No Lakshanas Ka M.K B.M Y.R V.S

1. Amlodgara (Acid eructation) - + + + +

2. Tiktodgara (Bitter eructation) - + + + +

3. Kantavidaha

(Burning sensation in throat)

+ + + + +

4. Urovidaha (Chest burn) + - - - -

5. Kukshidaha (Abdominal burning) - + + + +

6. Utklesha (Nausea) - + + + +

7. Amloutklesha

(Nausea with the sour taste)

+ - - - -

8. Avipaka (Indigestion) - + + + +

9. Hritdaha (Heart burn) - + + + +

10. Gurukoshtata + - - - -

11. Udaradhmana + - - - -

12. Antrakujana

(Gurgling sound in the intestine)

+ - - - -

13. Vitbheda(Loose bowels) + - - - -

14. Aruchi (Anorexia) + - - - -

15. Klama (Fatigue without exertion) - + + + +

16. Gourava (Heaviness) - + + + +

17. Angasada (Bodyache) + - - - -

18. Romaharsha + - - - -

19. Shiroruja (Headache) + - - - +

According to madhavakara, amlapitta has been classified under two headings viz

Urdhwaga Amlapitta and Adhoga Amlapitta 5


42

This is mainly based on the location of doshas and their subsequent urdhvaga and

adhoga pravritti. These lakshanas may be seen along with the samanya lakshanas of

Amlapitta.

The term ‘kadachith’ used by Madhavakara while envisaging lakshanas of these

two distinct varities as interpreted by Srikantadutta as “ Nasarva Kalam” 6 can be taken

as ; that all lakshanas of these varities not necessarily be present always or they will be

exhibited rarely or occasionally as the case may be.

Urdhwaga Amlapitta:

In this type the dosas tend to have urdhwagati hence features like hritkantadaha,

kukshidaha, utklesha, chardi are predominant. These features of urdvaga Amlapitta

mentioned by different authores are listed in Table No

Table No.4 Lakshanas of Urdhvaga amlapitta

Sl.No. Lakshanas Y.R7 B.M8 V.S9 M.K 1. Vantam haritam + + + + 2. Vantam peetma + + + + 3. Vantam Neelam + + + + 4. Vantam Krishnam + + + + 5. Vantam Arunam + + + + 6. Vantam Raktam + + + + 7. Vantam ateevamlam + + + + 8. Vantam mamasodakabham + + + + 9. Vantam Atipichilam + + + + 10. Vantam + + + + 11. Shleshmanugatam + + + + 12. Vantam rasena vividham + + + + 13. Vantam bhukte vidagdhe Tiktavami + + + + 14. Vantam bhukte vidagdhe amlavami + + + + 15. Vantam abhukte tiktavami + + + + 16. Vantam abhukte amlavami + + + + 17. Tiktoudgara + + + +


43

18. Amloudgara + + + + 19. Hritdaha + + + + 20. Kantadaha + + + + 21. Kukshidaha + + + + 22. Karadaha + + + + 23. Charanadaha + + + + 24. Ushnata + + + + 25. Aruchi + + + + 26. Jwara + + + + 27. Kandu + + + + 28. Mandala + + + + 29. Pidaka + + + +

Adhoga Amlapitta :

In this type the doshas tend to have Adhpravrtti and the features related to that are

predominant the features of Adhoga Amlapitta mentioned by different authors are

Trishna, Daha, Murcha, Bhrama, Moha, Hrillasa, Kotha, Analasada, Harsha, Sweda and

Angapeetata

Sanila amlapitta:

The aggravated pitta and vata which are situated in amashaya leads to abnormal digestion

i.e. agnimandya which results in shuktapaka. In this condition along with earlier

mentioned factors,vata contributes for the manifeststion of symptoms.

Vaikrita pitta + Vaikrita vata ------------------------ agnimandya

(samanavata) (Abnormal digestion)

shuktapaka Sanila amlapitta lakshanas.


44

The symptoms of this type of amlapitta mentioned by Kashyapa10 and Madhavakara are

listed in the table no.

Table No.5 Showing the lakshanas of Sanila Amlapitta

Sl. No.

Lakshanas Ka M.K. B.M. Y.R. V.S.

1 Tamodarshana - + + + +

2 Sheeta + + + + +

3 Gatravasada + + + + +

4 Murcha - + + + +

5 Kampa - + + + +

6 Chimichimitva - + + + +

7 Pralapa - + + + +

8 Vibhrama - + + + +

9 Vimoha - + + + +

10 Harsha - + + + +

11 Jrimbha + - - - -

12 Upashaya Shigdhoupashaya + - - - -

Sakapha Amlapitta:

In this vaikrita pitta and kapha which are situated in amashaya results in

agnimandya and produces shuktapaka. In this condition along with the above said factors

kapha contributes to the manifestation of symptoms.

Vaikrita pitta + Vaikrita kapha ------------------------ agnimandya

(kledaka kapha) (Abnormal digestion)

shuktapaka Sakapha amlapitta laxanas.

The symptoms of this type of amlapitta mentioned by Kashyapa11 and Madhavakara are

listed in the table no.


45

Table No. 6 Showing the lakshanas of Sakapha Amlapitta

Sl. No.

Lakshanas

Ka M.K. B.M. Y.R. V.S

1 Kaphashteevana - + + + +

2 Vamana - + + + +

3 Aruchi - + + + +

4 Sleshmaliptasya - + + + +

5 Gourava + + + + +

6 Jadata - + + + +

7 Sheetatva - + + + +

8 Balasada - + + + +

9 Angasada - + + + +

10 Kandu - + + + +

11 Nidra - + + + +

12 Chardi + + + + +

Sanilakapha Amlapitta:

In this vaikrita kapha and vata located in amashaya along with vaikrita pitta

results in agnimandya and produces shuktapaka. In this condition along with the above

said factors vata and kapha contributes to the manifestation of symptoms.

Vaikrita pitta + Vaikrita vata and kapha ---------------- agnimandya

shuktapaka Sanila kapha amlapitta laxanas.

Shleshma pittaja Amlapitta:

This variety of amlapitta is mentioned in Madhava nidana.The laxanas are

mentioned in table no. . here the dominance of pitta and kapha dosha are observed and

features are similar to urdhvaga amlapitta.12


46

Table No.7 Showing the lakshanas of Shleshmapittaja Amlapitta

Sl. No.

Lakshanas


1 Shiroruk - + + + + 2 Praseka - + + + + 3 Chardi - + + + + 4 Tiktoudgara - + + + + 5 Amloudgara - + + + + 6 Katukoudgara - + + + + 7 Kantadaha - + + + + 8 Kukshidaha - + + + + 9 Aalasya - + + + + 10 Murcha - + + + + 11 Bhrama - + + + + 12 Upashya

Rukshoupashaya Ushnoupashaya

- -

+ +

+ +

+ +

+ +

Pittaja Amlapitta:

When only vaikrita pitta is sited in amashaya without vitiated kapha and vata

which produces agnimandya results in shuktsa kapha. The laxanas produced are

predominantly of pitta dosha.

Vaikrita pitta + prakrita vata and kapha ---------------- agnimandya

shuktapaka Pittaja amlapitta laxanas

The symptoms of this type of amlapitta mentioned by Kashyapa13 are listed in the table

no.

Table No.8 Showing the lakshanas of Pittaja Amlapitta

Sl. No.

Lakshanas


1 Bhrama + - - - - 2 Vidaha + - - - - 3 Upashaya

Rukshoupashaya Ushnoupashaya

+ +

- -

- -

- -

- -


47

BHEDA

Many authors clearly draft regarding the classification of Amlapitta

According to Madavakara, amlapitta has been classified under two headings

based on location of doshas their subsequent urdhavaga and adhoga pravritti Viz.

* Urdhwaga Amlapitta 1 * Adhoga Amlapitta

Again from the point of view of doshas samsarga Madhavakara, Bhavamishra and

others2 amlapitta has been classified under four headings viz.

* Sanila * Sakapha * Sanilakapha * Shleshma pittaja

According to kashyapa, the classification is absed on the dosha responsible for Amlapitta,

The classification is as follows 3

* Vataja * Pittaja * Kaphaja

Chart No. 7. Classification according to different Authors

Amlapitta

1. Urdhwaga 2. Adhoga

1.Sanila 2.Sakapha 3.Sanilakapha 4.Sleshmapitta

1.Vataja 2.Pittaja 3.Kaphaja


48

UPASHAYA ANUPASHAYA

Upashaya is one of the therapeutic measures adopted for confirming the

diagnosis. The medicine or food or the external therapies which gives relief is called as

upashaya and the one which worsens the condition is known as Anupashaya. Charaka

says that.

“ Ghudalingam vyadhim upshaya anupashayaabhyam pareeksheta” 1

i.e An unmanifested or obscure disease may be investigated by upashaya and

anupashaya. The Upashaya are of two types 2

Viparita [ Oppossite to hetu, Vyadhi or both]

Viparitarthakari [ similar to hetu, Vyadhi or both]

Here in Amlapitta, Kashyapa explains about upashaya of vataja, pittaja and kaphaja

varieties as fallows: 3

Vataja Amlapitta : Snigdha ahara

Pittaja Amlapitta : Swadu sheeta ahara

Kaphaja Amlapitta : Ruksha ushna ahara

The anupashayas of amlapitta are not described in the classics. But however the

causative factors themselves may be taken as anuspshayas,especially amla, katu vidahi

and other pitta provoking factors.


49

VYAVACHEDAKA NIDANA

Amlapitta is a functional disorder which has to be differentiated from other

diseases having similar features. The conditions from which it has to be differentiated are

as follows;

1. Vidagdajeerna 2. Pittaja shula

3. Parinama shula. 4. Annadrava shula.

1) Vidagdajeerna :

Vidagdhajeerna is mainly caused due to pitta dosha. Bhrama, murcha , amlodgara,

sweda , daha, pittaja vividharuja are the lakshanas of vidagdajeerna among which certain

symptoms are similar to Amlapitta. The difference between these two are only in its

chronicity and its course.

2) Pittaja Shula:

Teevrashula, trishna, mutradaha, sweda, murcha, bhrama, chosha are the

symptoms which are aggravated by pittaprakopaka ahara, madhyadina, madyaratri and

ahara pachyamana kala. It is a ekdoshaja vyadhi where as amlapitta is a tridoshaja

vyadhi. The intensity of shula is very severe in pittaja shula and so varies from mild to

moderate in Amlapitta. Swadya; sheeta ahara, snigdha sheetopchara factors relieves the

pain in pittaja shula.

3) Parinama Shula :

This is shula pradhana vyadhi associated with adhmana, vibandha, atopa, trishna,

atisweda lakshanas. The shula relieves by intake of food, after the digestion and after

vamana.

4) Annadrava Shula :

In this condition shula is continuously present and relieved only after vamana

From the above all the diseases though mimic amlapitta in some of the

symptoms,they differ from the etiological point of view,samprapti and classification.


50

SADHYASADHYATA

The ayurvedic manuscripts bear the descrption regarding the prgnostic states or

sadhyasadhyata of the disease. Before going to the treatment, the prognosis as to the

curability[sadhya] or incurable [asadhya] and also whether it is easily curable[ sukh-

sadhya] or curable with difficulty [ krichrasadhya] or curable as long as treatment is

given [yapya] should be estimated.

Charaka says, ” A disease in its early stage is easily curable but when advanced is

cured with quite difficulty or even becomes asadhya” 1Incurable diseases never become

curable while curable diseases may pass into stage of incurability on account of the short

comings in any of the four basic therapeutic factors or as the result of destiny.

Madhavakara 2 states that , if Amlapitta is in its early satge is curable with

efforts. If it becomes chronic it becomes yapya. In chronic cases and of persons with

recent origin indulging in apathya ahara vihara it becomes krischrasadhya[curable with

difficulty] . If amlapitta is accompanied with the upadravas[complications], then becomes

asdhya [incurable].

Kashyapa has stated that in case if the patient develops upadravas along with

dhatukshaya then it becomes asadhya[incurable] 3

Hence the early diagnosis and prompt treatment of nava ao taruna amlapitta would not

procreed to obtain chronicity and produce complications.


51

UPADRAVA

The occurance of another disease in the wake of primary disease, as a

complication or sequele is termed as upadrava1 and is meant as rogauttarakalaja,

rogashraya and roghaeva. The upadhrava of the disease corresponds to the intensity of

severity or chronicity of the disease.

Kashyapa in khilasthana2 describes upadravas of amlapitta as follows:

Jwara

Atisara

Pandutva

Shula

Shotha

Aruchi

Bhrama

According to Gananath Sen

Sheetapitta

Udarda

Kandu

Kotha

Mandala

Vicharchika

Visphota

Pidaka

Amashaya Kshata

Grahani Kshata


52

CHIKITSA

The basic principle of treatment of any disease is nidana parivarjana1 and

samprapti vighatana2. Nidana parivarjana has a vital role in management of any disease

and is very important in case of amlapitta, which is explained in the context of

pathyapathya.

Different measuers have been explained by many authores of our classics for the

purpose of Samprapti vighatana. Kashayapa, Bhavamishra and yogaratnakara have

mentioned the line of treatment of Amlapitta as vamana,virechana and shamana theropy3.

In Bhaishajya ratnavali and Chakradutta there is a mention of vamana, virechana,

anuvasana basti and asthapana basti in the context of treatment of Amlapitta 4. Other than

this Rakthamokshana is mentioned by Vangasena and Yogartnakara5. The individual role

of these measures in the management of amlapitta is described below.

Vamana and Virechana :

The main objective of treatment in amashayotha vikaras including amlapitta is to

expell the doshas from nearest route. i.e. by vamana and virechana, if there is

bahudoshavastha and the patient is fit for these procedures. The general principle is to do

vamana, if the doshas are sited in urdhwa amashaya, and to do virechana if the doshas are

sited in adho amashaya. Probably in this aspect Bhavamishra has advised vamana in

urdhwaga amlapitta and virechana in adhoga amlapitta6. Rest of the authors have advised

vamana followed by virechana 7 . This seema to be ideal as Indu opines that vamana is a

must before virechana, because if virechana is performed without vaman it may come out

through the mouth after mixing with shleshma and proper virechana does not takes place.


53

Even if it takes place the sleshma does achachdana of grahani and produces angagourava

and pravahika. 8

Virechana is needed in Amlapitta as the main dosha involved in Amlapitta is pitta

and virechana is the ideal treatment for elimination of pitta 9 and it also expells the

shesha doshas, that remains in amashaya after the vamana therapy . The vamana and

virechana yogas mentioned in the context of amlapitta chikitsa are listed below.

Vaman Yogas:

1. A decoction prepared out of the leaves of patola vasa nimbatwak mixed with

madanaphala, saindhava lavana and honey is advocated 10

2. Another decoction prepared out of above-mentioned drugs except vasa 11

3. Lavana jala, warm milk , ikshu rasa, water prepared with honey or tiktha dravyas are

beneficial for the purpose12

4. Kashayapa gives gritha prepration for the same purpose. The following dravayas viz

patola patra, triphalatwak measuring ardhaphala, trayamana, rohini, nimba, yasti

measuring karshamatra, masoora measuring phaladwayam has to be mixed well

together in a morter. These should be boiled in post with one adaka water to reduce it

to one eighth [1/8 part]. Then this is mixed with one khudava quantity of gritha and

boiled again to reduce it to half prastha; this residual quantity measuring half prastha

should be administered which should be neither too hot nor too cold. This produces

vamana quietly and abolishes amlapitta of long duration 13.

Virechana Yogas :


54

1. Decoction prepared out of triphala kwath mixed with trivrit churna and honey is

advocated.14

2. A decoction prepared out of triphala, trayamana, katuka rohini, trivrit, measuring

ardhaphala and trivrit half the quantity of all. This is advocated for virechana karma15

Vamana & Virechana karma in amlapitta chikitsa mentioned by different authors

are listed below.

Table No 9 Showing the referance of vamana and Virechana Karma in Amlapitta

Authors Vamana Virechana

Kashyapa Samhitha + +

Yogaratnakara + +

Bhaishajya Ratnavali + +

Chakradutta + +

Bhavaprakasha + +

Basavarajeeyam + +

Basti:

After the above measures bastikarma has to be done to cleanse the residual

morbid matters. The necessity of basti does not usually arise unless vata is predominent.

Anurvasana basti is the usual procedure followed before going for asthapana basti16The

asthapana basti has proven benefit in Amlapitta which has attained chronicity and also in

vata predominent amlapitta.

Raktamokshana:

The necessity of raktamokshana arises when the doshas do not subside by other

measures. Vangasena & Yogartnakara observes this as a last measure restored to cleanse

the unabated dosha by other measures. This is beneficial in Amlapitta associated with

kota etc. synchronizing with raktadusti.17


55

SHAMANA

Shamana is defined as which does not results into elimination of doshas neither

does it vitiates nor disturbs the normal balance of dhosas but results in correction of the

imbalanced doshas i.e. it bring them to normal state.

Generally the medicines used for the pittaja disorder consists of tikta, madhura,

kashaya rasa, sheekta veerya and madhuravipaka dravyas.

In Amlapitta the pitta is in the state of samavastha. Here ama co-exists along with

vridhpitta.Hence, the dravyas which have both the properties of ama pachana and pitta

shaman should be used. Therefore tikta rasa pradhana dravyas are indicated.

In Sushrutha samhita while dealing with the pittatisara Dalhana expresses his

doubt that how can tikta rasa dravyas be used as pachanas. Then the clarsifies that, even

in jwaratisara, tikta pachanas have been indicated. In jwara samanya chikitsa, langhana,

swedana tikta rasa pradhana yavagus are used for the purpose of pachana karma in the

condition of apkawa doshas in taruna jwara.

Above mentioned both refernaces show that tiktarasa is more useful in sama.

Which also applies for samapitta condition because in Charaka samhita, while dealing

with the treatment of raktarasha he has told that tikta rasa is usefull in improving the

agni[Deepnartha] and pachana of doshas [doshanam panchanatham] and in Ashtanga

hridaya, arsha chikitsa he has given a similar opinion.19

All these refrences suggests that tikta rasa drugs should be used in samapitta

conditions and hence in amlapitta too.

Even for the purpose of deepana and pachana which has to be performed prior to

vamana, only tikta rasa pradhana dravyas have to be used and even for vamana virechana

tiktarasa pradhana yogas have been mentioned.

Mainly tikta rasa , laghu ,snigdha guna, katu or madhura vipaka , seta veerya

drugs have been mentioned by the acharyas.

The yogas mentioned by acharyas for the shamana of the Amlapitta are as

follows:


56

SINGLE DRUGS20

Herbal Drugs:

Patola Patra, Nimba, Bhunimba, Amalaki, Guduchi, Yastimadhu, Dhanyak,

Narikela, Haritaki, Vasa, Parpataka, Shunti, Katuki, Shatavari

Jangama Drugs:

Shankha, Mukta, Cow’s Ghee, Cow’s Milk

Parthiva Drugs :

Abhraka, Gairika, Tamra, Louha, Mandura, Rajata

Compound drug Preprations :

Kwatha:

Bhunimbadi, Guduchyadi, Patoladi, Vasadidashanga, Phalatrikadi, Dashanga,

Shringbera

Churna:

Panchanimbadi, Avipattikara, Trikatukadi, Eladi Choorna

Vati / Gutika :

Panchanana Gutika, Phaniyabhakta Gutika, Shankhavati, Drakshadi Gutika,

Kshudavati

Khanda/ Modaka:

Kushmanda Khanda, Narikela Khanda, Soubhagyashunti, Pippali Khanda,

Amlapittantak Modaka, Gudadi Modaka, Khanda Amalaki

Gritha:

Shatavari, Drakshadi, Panchatikta, Narayan, Vasa, Tiktaka

Rasaousahadis:

Amlapittanka Louha, Lilavilasa Rasa, SoothshekaraRasa, Amlapittantaka Rasa,

Dhatri louha, Pravala Pisti, Mukta Pisti


57

PATHYAPATHYA

“ The doctor of the future will give no medicine but will interest their patients in

the case of the human frame in diet and in the cause and prevention of disease”

- Thomas Edison

The diet, drugs or regimen which are condusive to the body and mind do not

produce any adverse effects are considered as wholesome and the opposite ones as

unwholesome.1

Pathyapathya plays an important role in the prevention and causation of disease

respectively.Some diseases in their intial stages can just be treated by following the

pathya and even any treatment procedure followed for a particular disease is not complete

unless the patient strictly follows the diet regimen.

Pathyapathya attains more significance in the disease of the Annavaha srotas as

this is amongst the first to be affected by the aharaja nidanas. Along with this due

importance should also be paid to the viharaja and manasika nidana.

The pathya and apathya of Amlapitta as mentioned in Ayurvedic texts as follows.

Table No. 10 Showing Pathya apathya5

Sl.No. Food Stuffs Pathya Apathya

1. Cereals Rice [old], Wheat, Barley

Rice within one year of harvest

2. Pulses Green Gram Black gram, Horse gram, Red gram, Sesamum

3. Vegetables Bitter guard,Snake gourd, Carrot, Ashgourd, drumstick leaves

Potato, garlic, chilli sweat potato


58

4. Seasoning Corriander, turmeric, Malabar, Tamarind

5. Fruits Gooseberry, grapes[dry], Kadali,pineapple, orange,Robexta fruit

Lemon , grapes, plantain , Sour fruits

6. Food Addatives

Sugar, Honey,Boiled & cooled water

Curd, buttermilk, goats milk, jaggery, oil, tea , coffee, alcohol, dhanyamla

7. Type of food Sweat, bitter, astringent , subsiding kapha and pitta

Sour, pungent, salty, oily Aggravating pitta dosha Incompatible, difficult to digest

8. Food Prepartaion

Mamsa rasa, lajapeya, Mastu, lassy, saktu

Pickles, fried items, baked items , pishtanna, biscuits, cake , carbonated drinks,

9. Non veg Jangala mamsa fishes

10. Activities Adequate rest, sleep and Exercise

Strenous labour, exposure to hot sun, fire, suppression of natural urges

11. Emotions Happiness, Satisfaction

Anxiety, worry , grief tension, Jealousy

12. Complaints Dadima, pippali, guduchi satwa, shatavari, kapitha, karkola

As a guideline for selection of food and method of consumption, Astavidha ahara

visesayatana and Aharavidhividhana are explained respectively.

A. Astavidha ahara visesayatana2:

1. Prakrti 2. Karana

3. Samyoga 4. Rasi

5. Kala 6. Upayoga samstha

7. Desa 8. Upayokta


59

B. Ahara Vidhi Vidhana 3 :

These have been explained for the healthy and the diseased.

1. Usnamasniyat 2. Snigdhanamasniyat

3. Matravadasniyat 4. Jirne asniyat

5. Viryaviruddhamasniyat 6. Iste deshe, ista sarvopakaranam

7. Nati drutam, nati vilambitam 8. Ajalpannahasan tanmana bhunjita

9. Atmanamabhisamiksya bhunjita

The following are also to be avoided 4 :

Samasana: Combination of pathya and apathya ahara

Adhyasana: Eating repeatedly

Amatrasana: Unwholesome quantity

Visamasana: Eating prior to or after regular mealtimes

All the above factors have a bearing on the efficacy of the Jatharagni and thus on

the Aharapaacana. Hence, one should observe the above regimen at every

mealtime for the maintenance of health.


60

DYSPEPSIA

Dyspepsia [Indigestion] is a collective term for any symptoms thought to original

from the upper gastrointestinal tract1.

From a clinical point of view the most common of disordered gastric emptying is

Dyspepsia. [Greek: “Dys” means bad and “peptin” means to digest]2. Understanding this

term is key to interpreting the literature in this area but, unfortunately, definations vary.

In Harrison’s medicine it is considered as a word equivalent to indigestion and

referred to a set of vague upper abdominal symptoms like heart burn, belching, epigastric

pain /discomfort, anorexia, nausea and excessive abdominal symptoms associated with

intake of foods. A clear-cut diagnosis may not be possible clinically, and investigations

may also be normal. In fact when clinical features are sharp enough for a reasonable

diagnosis the term dyspepsia is not used.3

More than half of all dyspeptic patients do not have any organic disease, however

much we investigate. These patients may have aggravation of symptoms during

emotional upset. Hence, it is called “functional dyspepsia” or nervous dyspepsia.

Dyspepsia means pain or any discomfortable symptoms associated with the

function of digestion [Thomson – 1963]. Variation of digestion produce symptoms of

many sorts, often not at all directly connected with the taking of food together with

leisurely eating of meals by those accustomed to hurry. Frequently suffices to cure

indigestion of longstanding.

Edward and Coghill [1968] have reported when no cause for the dyspepsia was

apparent the condition is described as Non-Ulcer dyspepsia [NUD]


61

Causes of Dyspepsia4:

Upper GIT Disorders

Other GIT Disorders

Systemic Diseases

Drugs

Others

Functional [Non-Ulcer dyspepsia and IBS]

Peptic Ulcer. Acute Gastritis Gall stones Motility disorders

[Oesophageal spasm]

Hepatic diseases [Hepatitis, Metastases]

Pancreatic diseases [Cancer, Chronic Pancreatitis]

Colonic carcinoma.

Renal failure

Hyper-Calcaemia

NSAID’s Iron and

potassium supplements.

Corticosteroids. Digoxin

Alcohol Psychological

[e.g anxiety, depression]

Functional / Non-Ulcer Dyspepsia : 5

Frequently however a clear etiologic explanation for the patients complaint of

symptoms cannot be established and descriptive designations are applied.

a) Non-Ulcer Dyspepsia:

This is defined as chronic dyspepsia [pain/upper abdominal discomfort] with no

evidence of organic disease on investigation. i.e, Ulcer like symptoms with no

evidence of ulcer.

b) Functional dyspepsia:

When clinical evaluation fails to reveal any explanation for indigestion then its

known as functional dyspepsia. The term is interchangeable with Non-ulcer

dyspepsia. This is mainly due to some forms of stress, such as

* Nervous * Physical stress * Alimentary stress

c) Flatulent Dyspepsia:

When Belching, abdominal distension and early satiety are predominant.

d) Dysmotility like Dyspepsia:

Same as flatulent dyspepsia.


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e) Acid-Dyspepsia:

Is due to the presence of an excessive amount of hydro-chloric acid or acid salts in the

gastric juice. Commonly seen in young patients of sedentary occupation, who eat

irregularly as to time and amount of food and who are in the habit of bolting their

meals.

f) Nervous Dyspepsia :

Occurs in those who are exposed to psychological stress. The symptoms being more

or less like functional dyspepsia. The diagnosis turns on the absence of evidence of

organic disease and the elicitation of psychological factors.

g) Fermentive Dyspepsia:

Arises in connection with the dilatation of stomach due to some obstruction at its exit,

in consequence of which food is retained, ferments and distends the organ giving rise

to the symptoms.

h) Acute dyspepsia:

Sometimes occurs in people who ordinarily digest food with comfort and still more

frequently in persons of weak digestive powers.

In all these conditions there is no evidence of any sort of organic disease on

investigation and are termed as synonyms of Non-Ulcer Dyspepsia / Functional

Dyspepsia.

Non-Ulcer Dyspepsia:/Functional Dyspepsia:

Non-Ulcer dyspepsia refers to symptoms that suggest a diagnosis of peptic ulcer

despite the documented absence of an ulcer by endoscope or barium x-ray studies and

other demonstrable organic disorder [bilary tract disease] or evidence of irritable bowel

syndrome.6

The term Non-ulcer dyspepsia was coined by True Love [1972].


63

Jone and Pollak [1945] have mentioned that half of all the patients with gastric

symptoms do not suffer from peptic ulcer, and in majority of these patients its impossible

to make any form of diagnosis.

Incidence:7

Usually seen in young patients [<40yrs]

Women affected twice as commonly as men.

Twice as common as peptic ulcer affecting 20%-30% of populllation.

Etiology of NUD : 8

1. Covers a spectrum of

a) Mucosal Disorders

b) Motility Disorders.

c) Psychiatric Disorders.

Etiology and Pathogeneses :

All though the precise etiology of NUD is unknown, several candidate factors are

considered here.

a. Gastric acid. b. Motility.

c. Chronic gastritis d. H-pylori Infection.

e. Psychological factors and stress. f. Diet, habits and drugs.

a) Gastric Acid

Certainly the clinical features of NUD are reminiscent of those in actual peptic

ulcer patients. Nevertheless, despite years of study, the relationship of acid to ulcer-type

pain remains unclear. On the other hand most studies indicate that acid secretion is

normal in patents was NUD9.

In general therefore, acid does not appear to play a pivotal role in the

pathogenesis of Non-Ulcer Dyspepsia.


64

b) Motility

The literature on the association of Non-Ulcer Dyspepsia with gastric dysmotility

is confusing, but some studies do point to delayed emptying of liquids or solids. The

timing and variability of symptoms make this area difficult to study with current methods

between 25%-50% of patients with Non-Ulcer Dyspepsia have postprandial and antral

hypomotality. 50% experience abdominal discomfort in response to ballon distension at

volumes lower than those provoke pain in healthy controls, suggesting visceral

hypersensitivity.

c) Chronic gastritis

Chronic gastritis [Round cell infiltration of the mucosa] is a common condition

whose prevalence increases with age. It would appear, however that many patients with

this finding are asymptomatic and that symptoms cannot be correlated with the degree of

inflammation10. Relation between non-ulcer dyspepsia and deuodenitis /duodenal ulcer

has not been demonstrated11.

d) Helicobacter pylori:

H-pylori is a short spiral shaped, micro-aeroplilic gram negative bacillus which is

found primarily in the deep portions of the mucus gel layer. that coats the gastroduodenal

mucosa, but does not invade the mucosa. Role of H-pylori and associated chronic

gastritis in causing dyspeptic symptoms in persons without peptic ulcers is unknown and

there is no convincing evidence that H-pylori accounts for the symptoms in NUD11b.Role

of H-pylori eradication remains controversial.

e) Psychological factors and stress:

Stress anxiety and depression are considered as the causative factors for

functional dyspepsia 12. Stress has been known since the experiments of William to effect

gastric function and secretion.


65

f) Diet :

Excessive consumption of coffee, tobacco cola, hot spicy foods, citrus, irregular

eating all favour the manifestation of the disease entity, many patent relate their

symptoms to meals in general, and fatly food in particular.13

g) Habits:

Chiefly alcohol and smoking contribute to the disease. There is less evidence to

relate it to NUD.14

h) Drugs :

Chronic usage of NSAID’s such as aspirin, ibubrufen, indomethacin, salicylates

and also steroids are found to induce Non-Ulcer-dyspepsia.15

Clinical presentation: 16

1. Abdominal pain. 2. Acid Erructations.

3. Anorexia. 4. Heartburn [pyrosis]

5. Nausea. 6. Vomiting

7. Water brash. 8. Flatulence / Bloating / Gaseousness.

9. Abdominal discomfort / Fullness. 10. Constipation /Diarrhoea.

11. Food Intolerance. 12. Early satiety.

The Non-ulcer dyspepsia usually presents with dyspeptic symptoms or ulcer like

symptoms or symptoms suggestive of IBS.

Symptoms may appear disproportionate to clinical well being. But morning

symptoms are characteristic.

Psyehological symptoms may be seen sometimes like depressive illness.


66

Diagnostic Approach:17

The patients presenting with dyspepsia may have any of the conditions related to

upper gastro-intestinal tract. Hence the following approach has to adopted.

1. A detailed history and physical examination.

2. Upper G.I.T. Endoscopy. [In Elderly]

3. Barrium- Meal X-ray [In Elderly]

The distinguishing features between functional and organic /structural dyspepsia

of gastrointestinal tract are given in the table No.

Table No 11 Distinguishing between functional and organic/structural disease of

gastrointestinal tract.18

Function Organic Neoplastic Inflammatory Symptoms : Weight loss None Common Sometimes Diarrhoea Day time only

Nocturnal Day and Night

Blood loss None

Frequent Frequent

Fever None

Rate Frequent

Pain Cramping, relieved by defecation

Minor to severe May be localized, may be severe

Bowelhabit [diarrhoea/constipation]

Alternating Diarrhoea/constipation pellet like stools

Constipation (Rarely dianhoea)

Diarrhoea or Normal

Laboratory tests Hematocrit Normal Often decereased May be decreased W.B.C. count Normal Usually normal Often elevated Erythrocyte Sedimentation rate Normal Usually

increased Usually increased

Investigations :

1. Routine Urine Examination.

2. Routine Blood Examination.

3. Stool Examination.


67

4. Endoscopy if necessary. [especially in pts. Of age>55 yr.]

Management and therapy: 19

Drug treatment is not especially successful, and merits trail.

1. Avoidance of factors responsible for worsening the conditions such as stress, foods

medications etc.

2. Life – style modifications

3. Assurance and counseling with patients associated with an identifiable cause of

psychological factors.

4. Antacids are sometimes helpful

5. H2 – Receptor antagonists may be helpful in night pain or heartburn

6. Prokinetic drugs such as metaclopromide may be given before meals.

Diet 20:

The diet recommended in functional dyspepsia are,

1. Avoiding foods known to excerbate symptoms.

2. Frequent small meals, low in fat.

3. Avoid tea, coffee, chocolate and carbonated drinks.

4. Avoid regular and decaffeinated coffee.

5. Avoid heavy use of alcohol.

6. Avoid smoking.

7. Avoid aspirin containg compounds and NSAID’s etc.

8. Avoid activities causing more mental and physical stress/ strain.

9. Adequate physical exercises and adoption of relaxation technique like yoga,

meditation etc.

Discussion on disease review:

Amlapitta is defined as a pitta pradhana vyadhi caused due to the quantitative and

qualitative derangement of pitta.Its the out come of digestive disturbance due to faulty

food and regimen.The pathogenesis of amlapitta clearly states it to be a functional


68

disturbance rather than an organic disturbance.Amlapitta is characterized by utklesha

(nausea), amlodgara (acid erructations), hrtdaha (heart burn), kantadaha (burning

sensation in the throat), vamana (vomiting),udarashula (abdominal pain), avipaka

(indigestion), klama (fatigue), gourava (heaviness in the body), vitbheda

(constipation/loose stools), adhmana (abdominal fullness), etc.All tese signs and

symptoms are broadly termed as Indigestion or Dyspepsia in the modern medicine.As,

Amlapitta is a functional disorder we can compare it to Functional dyspepsia or Non

ulcer Dyspepsia.

An attempt is being made to draw a paralance between Amlapitta and Non ulcer

Dyspepsia.

A clear description of etiology of Non ulcer Dyspepsia has not been stated, but some

factors like; Nervous(psychological factors,viz fear, anxiety, depression etc.),

Physical stress(long hours of working,walking etc.), Alimentary stress(faulty eating

habits,spicy food,badly cooked food,drugs etc) have been said to be pre disposing

factors.These have been highlighted in Amlapitta as the nidana of the disease.

Non ulcer Dyspepsia is said to be more comman in middle age (< 40yrs.) and more

common especially in women.The same can be seen to be quoted in Ayurveda stating

it to be pitta pradhana kala in the life of an individual.

A clear pathogenesis of Non ulcer Dyspepsia is not found,but its stated to be

characterized by dyspeptic signs and symptoms with no any organic lesions anywhere

in the G.I.T. This clearly specifies it to be a functional disorder and so also in

amlapitta there is no mention of any organic lesion in the pathogenesis.


69

Different descriptive terms are used for Functional dyspepsia/ Non ulcer Dyspepsia

viz Fermentive dyspepsia, Flatulent dyspepsia, Nervous dyspepsia, Acid dyspepsia,

Dysmotility like dyspepsia etc. on the basis of the predominant symptom as given by

the patient.These can be to some extent said to be due to the involvement

/predominant of a particular dosha leading to those signs and symptoms,i.e. it can be

compared to doshic varieties explained in Ayurveda.

The signs and symptoms of Non ulcer Dyspepsia more aptly ressemble to that of

amlapitta than any other disorders of the G.I.T.

As Non ulcer Dyspepsia is a fuctional disorder there are no diagnostic signs and only

history will often suggest the diagnosis.Even in amlapitta no diagnostic signs are

present ,only the signs and symptoms suggestive of the deranged pitta along with vata

and kapha are seen.

Non ulcer Dyspepsia is said to show considerable relief with proper diet and regimen

and avoidance of the causative factors. In amlapitta ,more stress has been laid on the

pathyapathya and nidana parivarjana in the management of amlapitta.Its also stated

that with proper pathya itself the Amlapitta can be managed.

Table No.12. Symptoms of Functional dyspepsia Comparison with Amlapitta

1 Kukshidaha - Epigastric pain 2 Kantadaha - Retrosternal burning 3 Hritdaha - Heartburn 4 Udgara [amla or tikta - Belching 5 Utklesha - Nausea 6 Chardi - Vomiting 7 Aruchi - Anorexia 8 Avipaka - Indigestion 9 Antrakujana - Barborygmus 10 Udaradhmana - Flatulence, Abdominal distension, bloating 11 Vidbheda - Change in bowel habits

Review of literature – Drug review

70

B. DRUG REVIEW

SHATAVARI

Botanical name : Asparagus racemosus Willd.

Famlily : Liliaceae

Classical name : Shatavari

Sanskrit name : Shatavari, Shatamuli, Shatavirya, Bahusuta, Atirasa,

Kula : Rasona Kula

Gana : Madhuraskandha. Balya. Vayasthapana1 [Charaka ]

Vidarigandhadi, Kantakapanchamoola, Pittashamana2. [Sushruta]

English name : Wild Asparagus.

Description3 :

Scandent climber, tall climbing, excessively branched, prickly under shrub. Roots

tuberous; prickles 0.6-1.5 cm, straight or recurved, cladodes 2.5 cm, curved. Terete,

spreading in tufts of 2-6, channeled beneath. Flowers in recemes. Fruit a berry, pea-like,

red when ripe; fruit containing seeds 1-2.

Drug Morphology :

The drug comprises of dried tuberous succulent roots which arise adventitiously

from the root stock. Its cylindrical in the middle, tapered towards the ends and brown in

colour. Surface of the fresh roots are easily removable and cover glistening material

inside. The drugs are entire roots or longitudinally broken pieces, surface of dried roots

exhibit deep irregular longitudinal furrows and minute transverse wrinkles due to

shrinkage during drying. The drug is hard. However, it breaks with a short fracture. The

drug has no odour and has slightly mucilaginous taste which leaves bitterish blend after

chewing for few minutes.


71

Varieties :

1. Shatavari [Asparagus racemosus Willd]

2. Mahashatavari [Asparagus sarmentosa]

Pharmaco dynamics :

Rasa : Madhura, tikta.

Guna : Guru, snigdha.

Virya : Sheeta.

Doshakarma : Tridoshagna.

Chemical Composition :

• Shatavari contains large amount of saccharine matter and mucilage.

• The plant contains 4 saponins i.e shatavarin I-IV.

• Tubers contain rhamnose, glucose, sarsapogenin, sitosterol, glycosides and

carbohydrates.

• Flower contains qurcetin, rutin and hyperoside.

• Leaves contain disosgenin.

• Mature fruit contains glycosides, sitosterol, sigmasterol

In fresh tubers :

Water soluble ingredient 52.5 %

Fibre : 33.3 % Water :9 %

Water soluble ingredients contain :

Sugar : 7 % Mucilagenous principle : 6 %

Volatile Oil : 52.4 % Ash : 4 %

Karma :

Effect on Dosha : Tridoshagna, Pittashamaka.

Effect on Dhalus : Balya ; Rasayana ; Shukrajanana; Vrshya;

Stanyajanana; Garbhaposhaka; Raktaja vikaras;

Medhya; Nadibalya.


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Effect on Mala : Grahi ; Mutrala.

Effect on other organs : Shulahara; Vednaasthapana; Eye; Stomach; Gall

bladder; Liver; and cardia.

Rogagnata :

Shukrakshaya; Garbhasrava ; Chalitagarbha ; Rakta pradara ; Sveta pradara ;

Stanyakshaya ; Dourbalya ; Dhatukshaya ; Mutrakrucchra ; Kshayaroga ; Drishtimandya

Amlapitta ; Sula , Arsha ; Vatavyadhi ; Siroroga ; Apasmara ; Moorcha ; Grahani.

Therapeutic Uses :

The drug shatavari is alternative, anti-diarrhoeal anit-dysentric; anti-spasmodic;

aphrodisiac; astringent; cardiac tonic; carminative; demulcent; diuretic; glactagogue;

nervine tonic; nutritive; ophthalmic; strengthening and tonic.

It is also used in blood diseases, pulmonary complaints, rheumatism; scanty urine

and seminal weakness. The roots are also utilized for medicated oils, used for nervous

and rheumatic disorders.

It is much used in kshaya, atisara, rakta and amatisara, apasmara [epilepsy],

haemophilic disorders and shotha.

The roots of drug are exploited for use in several preprations belonging to group

of classical formulations; Viz: Eladya modakam. Guduchyadi modakam; Trayodashanga

guggulu; Shatavari guda; Shatavaryadi gritha; Shatmulyadi louha; Shatavari manduram;

Shatavari pakam; Shatavari panaka; Phala gritha; Anu taila ; Narayan taila etc.

Medicinal preprations are incorporated in content of the management of different

diseases.

Parts used : Tubers.

Dose :

Juice 10-20 ml.

Decoction 50-100 ml.

Powder 3-6 gms.


73

ABHRAKA BHASMA

ABHRAKA

Abhraka is one among Maharasa and the first one in the series. It’s a double

silicate of Magnesium and Aluminium with sodium or potassium. There are different

kinds of mica and they vary from the chemical stand point. The micas are silicates of

varying composition of Aluminum and Potassium, containing hydroxil, magnesium, iron,

sodium, lithium, fluorine. The silica content varies between 33-55 %

Types4 :

Based on colour Abhraka is of four types.

1. Shwetha. 2. Peetha.

3. Raktha. 4. Krushna.

Krshna Abhraka is said to posses roganashaka property. And among the krushna

veriety vajra abhraka is said to be shreshta5 as it allievates the diseases and has got

rasayana property.

In this study the vajra abhraka of krushna variety is used for the prepration of

abhraka bhasma.

Shodhana6:

The shodhana of Abhraka was made by heating it and dipping in Triphala kashaya

for 7 times and Dhanyabhraka was prepared as per the procedure told in Rasa Ratna

sammuchaya.

Marana :

Around 64 maraka ganas have been explained in the text.

For this study, the Abhraka Bhasma is prepared by triturating it with Kasamarda

swarasa7 and subjected to puta for 30 times. The bhasma becomes nischandra within 10

putas, but to increase its therapeutic value 30 putas were given.


74

Properties :

Colour : Brick Red Colour.

Guna : Laghu, snigdha.

Rasa : Madhura Kashaya.

Vipaka : Madhura.

Veerya : Sheeta.

Doshagnatha : Tridoshagna .

Karma :

Balya, Rasayana, Medhya, Deepana, Pachana, Anulomana, Sthanya vardhaka,

Jwaragna,.Shonitha sthapana. Dhatuvardhaka., Yogavahi.

Indications :

Kasa, Shwasa, Pandu, Kshaya, Parinamashoola, Amlapitta, Grahani, Arsha,

Bhrama, Sheetapitta, Prameha, Mutrakruchra, Agnimandya, Hrudroga, Vatavyadhi.

Anupana :

Anupana for some of the diseases have been mentioned in the texts. Depending

upon the disease appropriate anupana should be selected.

Chemical Composition :

Analytical report of Abhraka Bhasma.

Silica [SiO2] - 36.01 % Allumina [Al2O3] - 27.57%

Ferric Oxide [Fe2O3] - 12.78% Potash [K2O] - 13.17 %

Lime [CaO] - 5.03 % Soda [Na2O] - 3.06 %

Magnesia [MgO] - 1.92 % Chloride. - 0.09 %

Phosphate. - Faint trace Moisture - 0.37 %


75

GRITHA

Gritha is not only included in the Gorasavarga, but it is also used as the best

remedy for pitta disorders and vata pitta disorder8. Gritha is best among all sneha

dravyas9 used internally. It is the sneha par-excellence because of its remarkable property

to assimilate the properties of other substances when added to it. With its own qualities

intact, it has the capacity to transform itself, so as to imbibe the qualities of the

substances added to it.

Though gritha has properties contrary to those of pitta, yet it is agnideepana.

Increase intellect, memory, strengthens eyesight and increases shukra dhatu10.

Gritha because of its sheha quality alleviates the vata and due to its sheeta veerya

alleviates pitta, even though kapha possesses qualities homologous to ghee, the latter

when mixed up with drugs possessing opposite qualities alleviates the former.

Gritha has different actions when licked and when swallowed. For e.g when

licked its pittashamaka. Whereas when swallowed it pacifies vata.

Cows gritha is considered as the best one11.

Meeting point 33-37° C.

Contains more of oxygen than any other oils.

Varga : Gorasa, Ghrita, Ksheera, Suvarnadi.

Rasa : Madhura 12

Vipaka : Madhura13

Guna : Snigdha, Guru

Veerya : Sheeta14

Doshagnata : Pittahara

Vata pitta hara.


76

Karma :

Medhya, Deepaneeya, Snehana, Anulomana, Hrudya, Vrushya, Garbhasthapana,

Jwaragana, Daha prashamana, Balya, Bruhana, Rasayana, Chakshushya, Varnya,

Vayasthapana.

Rogagnata :

Karshya; Daurbalya, Udavarta, Gulma, Kasa, Raktapitta, Jeernajwara, Anaha,

Shula.

Problable mode of action of the Trial drug :

Amlapitta is a pitta pradhana vyadhyi caused due to agnimandya. The three

important factors leading to the pathogenesis of the disease are agnimandya, ama and

srotodushti. Pitta is the pradhana dosha which singly or along with samana vayu and

kledaka kapha causes agnimandya, which leads to the formation of ama which combines

with the vrudh pitta (due to its own causes) leading to amavisha which turns to suktatva.

This further vitiates the pitta leading to Amlapitta.

To overcome this condition, the medication used should be such that it increases

the agni, reduces the ama and pacifies the pitta. Along with these, the drug should be able

to correct the vitiated dosha involved. i.e. vata and kapha. So the selection of the drug

plays a vital role in the management of Amlapitta. A large number of yogas have been

explained in the classics for the management of Amlapitta, among which “Shatavari

choorna” and Abhraka Bhasma” are one of the commonly used ingredients. This study

aims at assessing the efficacy of this simple, herbo-mineral combination in the


A potent Amlapitta medication should possess tikta madhura rasa, madhura

vipaka and sheeta veerya to pacify the pitta and also vata. It should also possess agni

deepana property as agnimandya is the main causative factor in the pathogenesis of

Amlapitta.


77

In a drug combination the drug acts combindly to give the desired effect. This is

called as the synergetic action of the combination.

In this context, the Shatavari choorna and Abhraka Bhasma along with gritha acts

combinedly to bring about a synergetic effect in management of the Amlapitta and reduce

its recurrence rate in long run.

Shatavari choorna :

Shatavari choorna due to its madhura rasa, madhura vipaka and sheeta veerya

helps to pacify the pitta and hence relieves bilous dyspepsia. Due to its deepana property

it helps to stimulate the agni and thereby reduce the agnimandya and promote appetite.

Because of its tikta rasa it has got stomachic action and reduces the pain. It also has got

soothing and demulcent action over the mucosal lining of the G.I.T. Because the balya

and rasayana effect of the drug helps in increasing the strength and general condition.

The adaptogenic activity of shatavari helps in reducing the stress and increasing

endurance and sustaining capacity.

Abhraka Bhasma :

Abhraka bhasma due to its tridoshagna property, pacifies all the doshas. Because

of its madhura rasa, madhura vipaka and sheeta veerya it specifically acts on pitta and

pacifies it. Based on experimental studies it is found to be more effective in Amlapitta,

Anemia which are caused due to pitta vitiation. Its possess high antacid property and

hence found to be very effective in Amlapitta due to its anti-dotal property. The deepana

property of the drug helps in stimulating the agni and reducing the ama. The rasayana and

balya properties indicate that the drug acts as a bioavailability enhancer and helps in

correcting the srotodusti.


78

Gritha :

Gritha because of madhura rasa and sheeta veerya pacifies the pitta and sneha

guna alleviates vata. Its deepana property helps in promating agni and thus reducing the

ama. Its yogavahi guna helps in potentiating the gunas of the shatavari choorna and

abhraka bhasma and acts synergetically. It has cooling and softening affect over the

mucosal lining of the G.I.T. Gritha is said to have pitta shamaka property when licked.

Herbo-mineral compounds act as bio-catalyst, for biological energy conservation

and for signal transduction. [Ghosal.S. 1996] and thus rasayana.

Cakradutta has given emphasis on the utility of juice of rhizomes of Satavari

(Asparagus racemosus, Fam.: Liliaceae) in Daha and Sula (Cakr. 26: 28).

Maheswari and Chaturvedi (1977) have reported significant fall in free and total

acidity of gastric juice of albino rats with Satavari choorna.

In a clinical study, Singh et al. (1985) observed Shatavari mandura showed a

tendency to decrease acid-pepsin secretion, significant decrease in cell shedding and

increase in mucin secretion indicating its predominant effect on mucosal defensive

factors in deudonal ulcer. Direct healing effect was proposed probably by enhancement

of mucosal barrier, prolongation of life span of mucosal cells or cytoprotection.

LIQUID ANTACID

ANTACIDS

Antacids remain an effective therapy relieve the symptoms of Non-ulcer

dyspepsia.

Gastric antacids are substance which on injection act by neutralizing HCL

secreted by gastric parietal cells thus devoting the gastric pH. They produce symptomatic

relief of pain partly by reducing the acidity and partly by the consequent relief of muscle

spasm. Reduction in acidity inhibits the action of pepsin. It also increases the tone of the


79

oesophago –gastric sphincter and reduces the reflex of the acid, gastric contents into the

oesophagas.21

Mechanism of Action:

These drugs act as weak bases. They raise the gastric pH above 4.

The antacid used for the study is Syrup-Gelusid which is a combination of

Magnesium trisilicate and Aluminium Hydroxide.

Aluminium and Magnesium Containing Antacids :

Antacids such as magnesium carbonate, hydroxide and trisilicates and aluminium

glycinate and hydroxide, being relatively insoluble in water, are long acting if retained in

the stomach. Magnesium salts increase intestinal motility, where as Aluminium decreases

it; thus antacids containing former tend to be laxative whereas those containing latter may

be constipating.A right balance of aluminium and magnesium compounds can be used so

as not to significantly change bowel function.

Sodium-bi-carbonate is a systemic antacid and not usually the antacid of choice,

especially if it has to be administered for a long period.

Advantages of Antacid combinations 22:

a) Fast [Mag.hydrox] and slow [Alum-hydrox] acting components yield promp] as well

as sustained effect.

b) Mag. Salts are laxative while Alum. Salts are constipating.Combination may annual

each others action and bowel movement each others action and bowel movement may

be least affected.

c) Gastric emptying is least affected.

d) Dose of individual components is reduced and systemic toxicity is minimized.

Methodology

80

MATERIALS AND METHODS

Samprapti vighatana forms, the basis of any chikitsa. Amlapitta is caused due to

the vitiation of pitta, and agnimandya leading to formation of ama or annavisha which

attains shuktatva leading to the clinical manifestation of the disease entity. Many number

of yoga’s have been mentioned in the classics for the treatment and management of

Amlapitta of which “Shatavari Choorna” and “Abhraka Bhasma” are also among the

most commonly used ingredients in these yoga’s. Hence an attempt has been made in this

study to assess the efficacy of this simple herbo mineral combination in the management

of Amlapitta.

Shatavari choorna and Abhraka Bhasma both are tridoshagna, madhura rasa

pradhana madhura vipaka, sheeta veerya and have deepana property which helps in

pacifying the pitta and correcting the agnimandya.

Materials :

1. Abhraka Bhasma

2. Shatavari choorna

3. Gritha for Anupana

Method of Preparation of Shatavari choorna:

Dry tubers of shatavari was procured from dealers and were properly identified

with the help of the Botanist and faculty members of Dravya guna department.

The drug was cleaned and dried in sun to remove the moisture the drug was

pounded to coarse powder and then made into a fine powder with help of a pulverizer.

The choorna thus obtained was filtered through a cloth to get a fine powder and then

packed in an air tight container.

Methodology

81

Method of preparation of Abhraka Bhasma:

The layers of Krishna abhraka was separated and subjected to shodhana by

heating it to red hot and dipping in triphala kashya for 7 times. Then Dhanyabhraka was

prepared as per the procedure described in Rasa Ratna sammuchaya. The so formed

dhanyabhraka was subjected to marana process by triturating it with kasa marda swaras

and giving puta. This was repeated for 30 times, though the bhasma became nischandra

by 10 putas in order to increase its therapeutic value the finished product and was packed

in an air tight container.

A air tight pack of 7 days medication of shatavari choorna [63gm.] along with

Abhraka Bharma [2.625gm.] was made after mixing the both thoroughly and given to the

patient at each visit the patient was asked to take 3/4th tsp. of the choorna mixing with

little of gritha to make it in the form of leha thrice daily 10-15 mins. before meals.

Form of administration of medicine : Choorna.

Dose of Medicine : 3 gms of shatavari choorna

+

125mg of Abhraka Bhasma.

Anupana : Gritha [little quantity] to mix the choorna to make it

like leha.

Time and Duration : 10-15 mins before meals thrice daily for a month.

METHODOLOGY

Objectives :


management of amlapitta.

2. To compare the effect of Shatavari choorna with Abhraka Bhasma over liquid



Methodology

82



of Amlapitta.

Source of data:

The patients of either sex diagnosed as Amlapitta on the basis of classical features

were randomly selected from the OPD and IPD of A.L.N.Rao Memorial Ayurvedic

Medical College Hospital, Koppa and associated hospitals.

Sampling Method:

Total 64 diagnosed cases of Amlapitta were selected at random from clinical

survey of patients attending the IPD and OPD of A.L.N.Rao Memorial Ayurvedic

Medical College Hospital, Koppa and associated hospitals.

A complete history including the general body condition of the patient was

assessed and few bio-chemical investigations were done to rule out systemic illness and

other complications and were selected only after found fulfilling the diagnostic as well as

inclusive criteria. There after the patients were registered and treated as outpatients for

the present study with the help of the case proforma specially designed for the study.

Criteria for selection of the patients :

Diagnostic Criteria:

The patients presenting with the following subjective signs and symptoms with

one or more associated symptoms and investigations were selected for the study.

1. Utklesha.

2. Hrithdaha.

3. Kantadaha.

4. Amlodgara.

Methodology

83

5. Vanti.

6. Udara shoola.

7. Normal hematocrit, White Bllod cell. Count and erythrouyte sedimentation rate.

8. Normal urine free from sugar, albumin and microbes

9. Normal stool with no ova and cysts.

10. Endoscopy if necessary to rule out ulcers.

Inclusion Criteria :

Patients fulfilling the following conditions were included for the study.

1. Patients presenting with pratyatma laxanas of Amlapitta like utklesha

[Nausea].Hrithdaha [heart burn], Kantadaha [Burning sensation in throat],

Amlodgara [acid erructations], Vanti [Vomiting] and Udara shoola [pain in

abdomen with or without other laxanas like Aruchi, Adhamana, Kalama etc.

2. Patients of either sex between 18-50 years of age.

3. A minimum history of 3 months were selected.

Exclusion Criteria :

Patients presenting with the below mentioned conditions were excluded from the

study.

1. Patients below 18yrs and above 50yrs of age.

2. Subjects suffering from acute-gastro intestinal disorders like.

i. Peptic ulcers.

ii. Duodenal ulcers.

iii. Panceratic and Hepatic diseases.

iv. Motility disorders.

Methodology

84

v. Inflammatory Bowel Disease.

3. Lactating and pregnant women.

4. Any other severe complicating systemic illness.

Research Design:

It is a randomized single single blind control study where liquid antacid i.e.

Syrup. Gelusil is control drug and Shatavari choorna and Abhraka Bhasma with gritha is

the trial drug.

Selection of the patients :

After the diagnosis as on the above parameters, the patients selected were

assigned into two groups of 30 patients each.

Trail group received Shatavari choorna - 3gms + Abhraka Bhasma – 125 mg

With Gritha thrice daily before meals.

Duration 1 month.

Control group, received Syrup. Gelusil 1 tsp thrice daily before meals.

Duration 1 month.

Total number of patients registered for study : 64.

Total number of patients in Trial Group : 32.

No. of patients completed the treatment in Trial Group : 30.

No. of patients discontinued the treatment in Trial Group : 2.

Total number of patients in Control Group : 32.

No. of patients completed the treatment in Control Group : 30.

No. of patients who discontinued the treatment in Control Group : 2.

Methodology

85

Investigations :

The following investigations were carried out on mandatory basis for each patient

before starting the treatment in order to rule out general condition, systemic illness and

other complications and also to fulfill the diagnostic as well as inclusive criteria.

a) Blood investigations - Hb%

E.S.R.

T.C. & D.C.

b) Urine investigations - Albumin.

Sugar.

Microscopic.

c) Stool Examination - Ova & Cyst.

d) Endoscopy - If necessary.

Interventions :

Trial group – Drugs : Shatavari choorna – 3 gms. + Abhraka Bhasma – 125 mg.

- Anupana : Gritha.

- Duration : Thrice daily before meals for 1month.

Control group - Drug : Syrup Gelusil.. 1 Tsp thrice daily

before meals

- Duration : 1 month

Follow up - : 1 month.

The follow up was done once a week during the treatment and there after for a

duration of 1 month for both the groups.

During this period the patient was advised to follow the pathyapthya.

Assessment of Response :

Methodology

86

The assessment of response of patients were made on the basis of improvements

observed in the following subjective parameters.

I. Cardinal complaints :

1. Ulklesha [Nausea] 2. Hrthdaha [Heart Burn]

3. Kanta daha [Burning in throat] 4. Amlodgena [Acid Erructation]

5. Vanti [Vomiting] 6. Udara shoola [Abdominal pain]

II. Associated complaints :

1. Avipaka 2. Klama. 3. Tiktodgara.

4. Gourava. 5. Aruchi. 6. Gurukoshtata.

7. Adhmana. 8. Antrakujana. 9. Sirashula.

Criteria of Assessment :

The following criteria were adopted to assess the results at the end of the

treatment schedule.

1. Improvement in the cardinal signs and symptoms of the disease on the basis of

symptom score.

2. Improvement in the associated signs and symptoms of the disease on the basis of

symptom score.

3. Improvements in dusti score of Annavaha, Rasavaha and Pureeshavaha srotas.

Scoring of cardinal symptoms:

1. Utklesha : [Nausea]

Severity of utklesha is scored as fallows.

Grade 3 : Frequent with vomiting.

Methodology

87

Grade 2 : Frequent but no vomiting.

Grade 1 : Occasionally only on consumption of faulty diet.

Grade 0 : No utklesha.

2. Amlodgara : [Acid Erructation]

Severity of Amlodgara is scored as fallows :

Grade 3 : Continuous throughout the day.

Grade 2 : Occurs on consuming food stuffs.

Grade 1 : Occasional; only on consuming sour or spicy food.

Grade 0 : No Amlodgara.

3. Hrithdaha : [Heart burn]

Severity of Hrithdaha is scored as follows.

Grade 3 : Continuous burning, throughout the day.


Grade 1 : Occasional; only on consuming sour and spicy food.

Grade 0 : No Hrithdaha.

4. Kantadaha : [Burning sensation in throat]

Severity of Kantadaha is scored as fallows.

Grade 3 : Continuous throughout the day.


Grade 1 : Occasional; only on consuming spicy or sour food.

Grade 0 : No Kantadaha.

5. Vamana : [Vomiting]

Severity of vamana is scored as fallows

Methodology

88

Grade 3 : Frequently.

Grade 2 : Occurs only in early morning.

Grade 1 : Rarely

Grade 0 : No Vamana.

6. Udara Shoola : [Pain Abdomen]

Severity of Udarashoola is scored as fallows

Grade 3 : Severe pain, disturbing daily routine.

Grade 2 : Moderate pain enough to take medical advice.

Grade 1 : Mild pain or dull aching pain.

Grade 0 : No Pain.

Associated symptoms :

The severity of associated symptoms are scored with following rating method.

Grade 0 : Normal. Grade 1 : Mild.

Grade 2 : Moderate. Grade 3 : Severe.

I. The patients with mild associated symptoms are defined as those with one or more

of the following.

1. Symptoms occur less than twice in a week or when exposed to causative factors.

2. Presence of symptoms for few hours, does not interfere with daily routine,

occasionally feeling of inconvenience during routine work.

3. Nausea may be present but vomiting is rare.

II. The patients with moderate associated symptoms are defined as those with one or

more of the following.

1. Presence of symptoms 2 to 4 times in a week.

2. The symptoms present during day and night does interfere, but doesn’t prohibit

work performance and other activities.

Methodology

89

3. Occasional presence of vomiting.

III. The patients with severe Amlapitta are defined as those with one or more of the

following.

1. Continuous presence of symptoms.

2. Symptoms develop during the day as well as in night.

3. Frequent vomiting.

Scoring of Sroto dusti :

Amlapitta being a disease involving mainly Annavaha, Rasavaha and

Pureeshavaha srotas, the sroto dusti lakshanas of these srotas are assessed and scoring of

the sroto dusti is done as follows:

1. Annavaha srotas :

Severity of Annavaha sroto dusti is scored as follows:

Grade 3 : All the symptoms.

Grade 2 : Chardi along with any 1 or 2 symptoms.

Grade 1 : Only Aruchi and Avipaka.

Grade 0 : No symptoms.

Rasavaha srotas :

Severity of Rasavaha sroto dusti are scored as follows :


Grade 2 : Presence of 5 - 8 symptoms.



Pureeshavaha srotas :

Severity of Pureeshavaha sroto dusti are scored as follows.



Grade 1 :Presence of 2 Symptoms.


Methodology

90

Statistical analysis :

Mean, Percentage, Standard Deviation, Standard Error, ‘t’ value and ‘p’ value

were calculated.

Paired ‘t’ test was used for calculating the ‘t’ value in the paired data.

Assessment of overall effect of therapy :

The overall effect of the therapy was assessed as stated below.

1. Patients in whom there was 100% relief in all signs and symptoms with no recurrence

was considered as cured. [cases]

2. Patients in whom there was relief in signs and symptoms my more than 75% with no

recurrence was considered be marked improvement. [cases]

3. Patients in whom there was relief in signs and symptoms by more than 50% with

recurrence of signs and symptoms in milder form was considered to be improved.

[cases]

4. Patients in whom there was relief in signs and symptoms by more than 25% with

recurrence of signs and symptoms in moderate form was considered be controlled.

5. Patients in whom there was less than 25% relief in signs and symptoms and

recurrence of all the signs and symptoms in severe form was considered to be

unchanged].

Methodology

91

0

2

4

6

8

10

12

18-25 26-33 43-41 42-50

Trail GroupControl Group

OBSERVATIONS

In the present study total 64 patients of Amlapitta were registered. Out of which

60 patients completed the course of treatment in both the groups i.e. 30 patients in each

group and remaining 4 patients discontinued the treatment. The biostatistical observations

and total effect of the treatment is presented on findings of 60 patients (30 in each group)

only.

Incidence of Age

Table no. 13 Showing the age wise distribution of 60 Amlapitta patients.

Sl.

No. Age (in yrs.)

Trial

Group %

Control

Group % Total %

01 18-25 3 10 6 20 9 15

02 26-33 12 40 9 30 21 35

03 34-41 9 30 9 30 18 30

04 42-50 6 20 6 20 12 20

Majority of patients belongs to age group of 26-33 yrs. i.e. 35% followed by 30% in the

age group 34-41 yrs; 20% in 42-50yrs age group while 15% were in the 18-25 yrs age

groups.

Graph no. 1 Showing the age wise distribution of 60 Amlapitta patients.

Methodology

92

0

5

10

15

20

1 2

MaleFemale

Incidence of Sex

Table no. 14 Showing the Sex wise distribution of 60 Amlapitta patients.

Sl

No Sex Trial Group %

Control

Group % Total %

01 Male 12 40 15 25 25 45

02 Female 18 60 15 25 33 55

55% of the patients in the study were females while 45% were males.

Graph no. 2 Showing the Sex wise distribution of 60 Amlapitta patients.

Incidence of Religion

Table no. 15 Showing the Religion wise distribution of 60 Amlapitta patients.

Sl.

No Religion Trial Group %

Control

Group % Total %

01 Hindu 15 25 18 60 33 55

02 Muslim 9 30 6 20 15 25

03 Christian 6 20 6 20 12 20

Amongst the patients registered for the study 55% were Hindus, followed by 25%

Muslims and 20% were Christians.

Methodology

93

0

2

4

6

8

10

12

14

16

18

Married Unmarried Widow/Widower

Divorcee

Trial GroupControl Group

0

2

4

6

8

10

12

14

16

18

Hindu Muslim Christian


Graph no. 3 Showing the Religion wise distribution of 60 Amlapitta patients.

Incidence of Marital status

Table no. 16 Showing the Marital status wise distribution of 60 Amlapitta patients.

Sl.

No. Status

Trial

Group %

Control

Group % Total %

01 Married 12 40 18 60 30 50

02 Unmarried 15 50 9 30 24 40

03 Widow/ Widower 3 10 0 0 3 5

04 Divorcee 0 0 3 10 3 5

50% of the patients were married , 40% were not married, 5% of them were divorcee. and

5% were widow/widower.

Graph no. 4 Showing the Marital status wise distribution of 60 Amlapitta patients.

Methodology

94

Une

duca

ted

Prim

ary

scho

ol

Mid

dle

scho

ol

Hig

h sc

hool

Gra

duat

e

Trial roupControl Group

Incidence of Educational status

Table no. 17 Showing the Educational status wise distribution of 60 Amlapitta

patients.

Sl.

No. Education

Trial

Group %

Control

Group % Total %

01 Uneducated 9 30 6 20 15 25

02 Primary school 3 10 3 0 6 10

03 Middle school 0 0 6 20 6 10

04 High school 9 30 6 20 15 25

05 Graduate 9 30 9 30 18 30

30% of the patients were graduates, 25% were uneducated, 25% were educated up

to high school, 10% up to middle school and 10% up to primary school.

Graph no. 5 Showing the Educational status distribution of 60 Amlapitta patients.

Methodology

95

0

2

4

6

8

10

12

14

16

Very poor Poor Lr. Middle Middle Ur. Middle Rich

Trial Group

Control Group

Incidence of Socioeconomic status

Table no. 18 Showing the socioeconomic status wise distribution of 60 Amlapitta

patients.

Sl.

No Strata

Trial

Group %

Control

Group % Total %

01 Very poor 3 10 0 0 3 5

02 Poor 6 20 3 10 9 15

03 Lr. Middle 6 20 9 30 15 25

04 Middle 9 30 15 50 24 40

05 Ur. Middle 3 10 3 10 6 10

06 Rich 3 10 0 0 3 5

40% of the patients belonged to the middle class. 25% representation was seen in middle

class. 15% belonged to poor class, 10% belonged to upper middle class, and 5% were

from the very poor and rich class each.

Graph no. 6 Showing the Socioeconomic status wise distribution of 60 Amlapitta

patients.

Methodology

96

05

10152025303540

Student Housewife

Labour Business Services

Trial groupControl group

Incidence of Occupational status

Table no. 19 Showing the Occupational status wise distribution of 60 Amlapitta

patients.

Sl,

No Occupation

Trial

Group %

Control

Group % Total %

01 Student 3 10 - 0 3 5

02 House wife 12 40 9 30 21 35

03 Labour 6 20 6 20 12 20

04 Business 6 10 12 40 18 30

05 Service 3 10 3 10 6 10

35% of the patients were house wives followed by 30% belonged to business

class. 20% to labour class; 10% to service and 5% of them were students.

Graph No. 7 Showing the Occupational status wise distribution of 60 Amlapitta

patients.

Incidence of Onset

Table No. 20 Showing the onset wise distribution of 60 Amlapitta patients.

Sl,

No

Onset

Trial

Group %

Control

Group % Total %

01 Sudden 12 40 15 50 27 45

02 Gradual 18 60 15 50 23 55

Table shows that 55% of patients presented gradual onset while 45% presented sudden

onset.

Methodology

97

010

2030

4050

60

Sudden Gradual


0

10

20

30

40

50

Mid-day Mid-Night Morning


Graph No. 8 Showing the onset wise distribution of 60 Amlapitta patients.

Incidence of Aggravating Period

Table No 21 Showing the Aggravating period wise distribution of 60 Amlapitta

patients

Sl, No

Aggravating Period

Trial Group % Control

Group % Total %

01 Mid-day 15 50 12 40 27 40

02 Mid-Night 3 10 3 10 6 10

03 Morning 12 40 15 50 27 40

40% of patients presented with aggravation of symptoms in Mid-day;40% in the

morning and10% in Mid-night

Graph No. 9 Showing the Aggravating Period wise distribution of 60 Amlapitta

patients.

Methodology

98

0

10

20

30

40

50

60

Rainy Autumn Summer Winter


Incidence of Aggravation due to Environmental Factor

Table No 22 Showing the Incidence Aggravating of symptoms due to


Sl, No

Environmental Factor


Group % Total %

01 Rainy 15 50 18 60 33 55 02 Autumn 03 10 03 10 06 10 03 Summer 09 30 09 30 18 30 04 Winter 3 10 0 0 3 5

55% patients showed aggravation of symptoms in rainy season;followed by 30%

insummer;10% in autumn and 5% in winter season

Graph No.10 Showing the Incidence Aggravating Of symptoms due to


Incidence of Habitat

Table no. 23 Showing the Habitat status wise distribution of 60 Amlapitta patients.

Sl.

No. Habitat Trial Group %

Control

Group % Total %

01 Urban 9 30 12 40 21 35

02 Rural 21 70 18 60 39 65

65% of the patients were from rural populace while 35% were from urban populace.

Methodology

99

0

5

10

15

20

25

Urban Rural


0

5

10

15

20

25

Trial Group Control Group

Vegetarian

Mixed

Graph no. 11 Showing the Habitat wise distribution of 60 Amlapitta patients.

Incidence of Dietary habit

Table no. 24 Showing the Dietary habit wise distribution of 60 Amlapitta patients.

Sl.

No Diet

Trial

Group %

Control

Group % Total %

01 Vegetarian 9 30 12 40 21 35

02 Mixed 21 70 18 60 39 65

65% of the patients were consuming mixed diet, while 35% were strict vegetarians.

Graph no. 12 Showing the Dietary habit wise distribution of 60 Amlapitta patients.

Incidence of Ahara vidhi

Table no.25 Showing the Ahara vidhi wise distribution of 60 Amlapitta patients.

Sl. No. Ahara vidhi Trial

Group % Control Group % Total %

01 Samasana 9 30 6 20 15 25 02 Visamasana 18 60 21 70 39 65 03 Adhyasana 3 10 6 20 9 15

Methodology

100

0

5

10

15

20

25

Samasana Visamasana Adhyasana Anashana Pramitasana Viruddhasana

Trial Group

Control Group

04 Anashana 0 0 0 0 0 0 05 Pramitasana 9 30 6 20 15 25 06 Viruddhasana 6 20 9 30 15 25

65% of the patients gave a history of Visamasana, 25% each gave history of Samasana,

Viruddhasana and Pramitasana and 15% of Adhyasana.

Graph no. 13 Showing the Ahara vidhi wise distribution of 60 Amlapitta patients.

Type Of Diet Table No. 26 Showing the Type of diet wise distribution of 60 Amlapitta patients.

Sl, No

Type Of Diet


Group % Total %

01 Viruddhanna 9 30 6 20 15 25 02 Pittaprakopaka 9 30 12 40 21 35 03 Vidahianna 3 10 3 10 6 10 04 Amlarasapradhana 6 20 6 20 12 20 05 Abhishyandhi 3 10 0 0 3 5 06 Atibhojana 0 0 3 10 3 5

35% of patients were used to pittaprakopaka ahara; while 25% were used to

Virudhanna; 20% were used to amlarasapradhana; 10% to vidahianna and 5% to

atibhojana.

Methodology

101

0

10

20

30

40

Viruddhanna Pit t aprakopaka Vidahianna Amlarasapradhana Abhishyandhi At ibhojana

Trial group

Control group

0

5

10

15

20

25

Madhura Amla Lavana Katu

Trial Group

Control Group

Graph No.14 Showing the Type of diet wise distribution of 60 Amlapitta patients.

Incidence of Rasa satmya

Table no. 27 Shows Rasa Satmya wise distribution of 60 Amlapitta patients

Sl. No. Rasa Trial Group %

Control

Group % Total %

01 Madhura 9 30 6 20 15 25

02 Amla 12 40 9 30 21 35

03 Lavana 9 30 9 30 18 30

04 Katu 18 60 21 70 39 60

60% of the patients showed Katu rasa satmyata, 30% were Lavana rasa satmya, 35%

were Amla rasa satmya and 25% were Madhura rasa satmya.

Graph no. 15 Shows Rasa Satmya wise distribution of 60 Amlapitta patients

Methodology

102

0

10

20

30

40

Diw asw apna Vegadharana Avagahana Atapasevana

Trial group

Control group

Incidence of Regimen

Table no. 28 Showing the Regimen wise distribution of 60 Amlapitta patients.

Sl,

No

Regimen

Trial

Group %

Control

Group % Total %

01 Diwaswapna 6 20 3 10 9 15

02 Vegadharana 9 30 6 20 15 25

03 Avagahana 6 20 12 40 18 30

04 Atapasevana 9 30 9 30 18 30

Above table shows 30% of patients gave a history of atapasevana; 30% of

avagahana; 25% of vegadharana and remaining 15% of diwaswpna.

Graph no. 16 Showing the Regimen wise distribution of 60 Amlapitta patients.

Incidence of Mental stress\strain

Table no. 29 Showing the Mental stress/strain wise distribution of 60 Amlapitta

patients.

Sl. No Mental stress Trial


01 Present 18 60 21 70 39 70

02 Absent 12 40 9 30 21 30

70% of the patients gave a history of mental stress while 30% did not have any mental

stress.

Methodology

103

0

5

10

15

20

25

Trial Group Control Group

PresentAbsent

Graph no.17 Showing the Mental stress/strain wise distribution of 60 Amlapitta

patients.

Incidence of Addictions

Table no.30 Shows incidence of Addictions in 60 Amlapitta patients

Sl. No. Habits Trial


01 Tea/Coffee 21 70 18 60 39 65

02 Smoking 9 30 6 20 15 25

03 Alcohol 3 10 6 20 9 15

04 Tobacco 0 0 3 10 3 5

05 Cool drinks 3 10 6 20 9 15

06 NSAID’s 6 20 6 20 12 20

07 None 3 0 0 0 3 5

65% of the patients gave a history of regular consumption of tea/coffee, 25% were

addicted to smoking, 20% of the patients had history of consumption of NSAID’s,15% of

patients were addicted to alcohol and cool-drinks,5% of them had no addictions.

Methodology

104

0

5

10

15

20

25

Tea/

Cof

fee

Smok

ing

Alco

hol

Toba

cco

Coo

l drin

ks

NSA

ID’s

Non

e

Trial Group

Control Group

0

2

4

6

8

10

12

Regular Irregular Occasional Only RoutineWork

Trial Group

Control Group

Graph no. 18 Shows incidence of Addictions in 60 Amlapitta patients

Incidence of Exercise

Table No. 31 Showing the Exercise wise distribution of 60 Amlapitta patients.

Sl, No Exercise Trial


01 Regular 3 10 0 0 3 5

02 Irregular 6 20 9 30 15 25

03 Occasional 9 30 12 40 21 35

04 Only Routine

Work 12 40 9 30 21 35

Table shows that 35% of the patients did only routine work; 35% of patients only

occasional exercise; 25% did irregular exercise and only 5% did regular exercise.

Graph No.19 Showing the Exercise wise distribution of 60 Amlapitta patients.

Methodology

105

0

2

4

6

8

10

12

14

16

18

Sound Irregular Disturbed Delayed


Incidence of Nidra

Table no.32 Shows incidence of nidra in 60 Amlapitta patients

Sl. No Nidra Trial


01 Sound 6 20 3 10 9 15

02 Irregular 6 20 6 20 12 20

03 Disturbed 9 30 18 60 27 45

04 Delayed 9 30 9 30 18 30

45% of the patients complained of disturbed sleep,while 30% of delayed sleep 20% of

irregular sleep and15% of no such complaints.

Graph no. 20 Shows incidence of nidra in 60 Amlapitta patients

Incidence of Bowel Habit

Table no. 33 Shows Bowel habit wise distribution of 60 Amlapitta patients

Sl, No

Bowel Habit


Group % Total %

01 Regular 6 20 3 10 9 15

02 Irregular 9 30 9 20 18 30

03 Constipation 15 50 18 60 33 55

Above table shows 55% of patients had constipation; 30% had irregular bowel

habit and 15% had regular bowel habit

Graph No. 21 Shows Bowel habit wise distribution of 60 Amlapitta patients

Methodology

106

0

10

20

30

40

50

60

Regular Irregular Constipation


0

2

4

6

8

10

12

14

16

18

Loose Soft Constipated

Trial Group

Control Group

Incidence of Nature of Stool

Table No. 34 Shows Nature of stool wise distribution of 60 Amlapitta patients

Sl, No Nature Of Stool Trial


01 Loose 3 10 6 20 9 15

02 Soft 12 40 6 20 18 30

03 Constipated 15 50 18 60 33 55

Majority of the patients i.e.55% complained of constipated stool; 30% of soft

stool and remaining 15% of loose stools.

Graph No. 22 Shows Nature of stool wise distribution of 60 Amlapitta patients

Methodology

107

0

2

4

6

8

10

12

14

16

18

Heavy Moderate Sedentary


Incidence of Type of occupation

Table No.35 Shows Type of occupation wise distribution of 60 Amlapitta patients

Sl. No. Degree of work Trial


01 Heavy 9 30 3 10 12 20

02 Moderate 15 50 18 60 33 55

03 Sedentary 6 20 9 30 15 25

55% had moderate degree of work, 20% were heavy workers, 25% while were sedentary.

Graph No.23 Shows Type of occupation wise distribution of 60 Amlapitta patients

Incidence of Nature Of Work

Table No.36 Shows Nature of work wise distribution of 60 Amlapitta patients

Sl, No

Nature Of Work


Group % Total %

01 Physical 15 50 18 60 33 55

02 Mental 15 50 12 40 27 45

55% of the patients were in physical nature of work, while 45% in mental nature

of work.

Methodology

108

010

2030

4050

60

Physical Mental


0

2

4

6

8

10

12

14

16

18

Vata pittala Pittakaphala Vatakaphala


Graph No. 24 Shows Nature of work wise distribution of 60 Amlapitta patients

Incidence of Deha prakrti

Table no. 37 Shows incidence of Deha prakriti in 60 Amlapitta patients

Sl. No. Prakrti Trial


01 Vata pittala 18 60 12 40 30 50

02 Pittakaphala 12 40 12 40 24 40

03 Vatakaphala 0 0 6 20 6 10

Amongst the patients, 50% were of Vatapittala prakrti, 40% of Pittakaphala and 10% of

Vatakaphala.

Graph no. 25 Shows incidence of Deha prakrati in 60 Amlapitta patients

Methodology

109

0

2

4

6

8

10

12

14

16

18

Tvak Mamsa Asthi Majja

Trial Group

Control Group

Incidence of Sara

Table no.38 Shows Sara wise distribution of 60 Amlapitta patients

Sl.No. Sara Trial Group % Control

Group % Total %

01 Tvak 9 30 6 20 15 25

02 Mamsa 15 50 18 60 33 55

03 Asthi 6 20 3 10 9 15

04 Majja 0 0 3 10 3 5

55% of the patients were of Mamsa sara, 25% were of Tvak sara while 15% were Asthi

sara and 5% were Majja sara.

Graph no. 26 Shows Sara wise distribution of 60 Amlapitta patients

Incidence of Samhanana

Table no. 39 Shows Samhanana wise distribution of 60Amlapitta patients

Sl. No. Samhanana Trial


01 Pravara 12 40 6 20 18 30

02 Madhyama 18 60 21 70 39 65

03 Avara 0 0 3 10 3 5

65% of the patients were of Madhyama samhanana followed by 30% of Pravara and 5%

of Avara samhanana.

Methodology

110

0

5

10

15

20

25

Pravara Madhyama Avara


0

2

4

6

8

10

12

14

16

18


Trial Group

Control Group

Graph no. 27 Shows Samhanana wise distribution of 60Amlapitta patients

Incidence of Satva

Table no. 40 Shows Satva wise distribution of 60 Amlapitta patients

Sl. No Satva Trial


01 Pravara 3 10 6 20 9 15

02 Madhyama 18 60 18 60 36 60

03 Avara 9 30 6 20 15 25

60% of the patients were of Madhyama satva, 25% of Avara satva and 15% of Pravara

satva.

Graph no. 28 Shows Satva wise distribution of 60 Amlapitta patients

Methodology

111

0

5

10

15

20

25

Tiksna Visama Manda Sama


Incidence of Agni

Table no. 41 Shows Agni wise distribution of 60 Amlapitta patients

Sl.No Agni Trial Group % Control

Group % Total %

01 Tiksna 3 10 3 10 6 10

02 Visama 6 20 9 30 15 25

03 Manda 21 70 18 60 39 65

04 Sama 0 0 0 0 0 0

65% of the patients suffered from Mandagni while 25% had Visamagni,and10% of them

had tikshanagni.

Graph no.29 Shows Agni wise distribution of 60 Amlapitta patients

Incidence of Koshta

Table No. 42 Shows Koshta wise distribution of 60 Amlapitta patients

Sl, No

Koshta


Group % Total %

01 Mrudu 09 30 9 30 18 30

02 Madhyama 12 40 15 50 27 45

03 Krura 9 30 6 20 15 25

45% of the patients had madhyama koshta followed by 30% of mrudu koshta and

25% had krura koshta.

Graph No.30 Shows Koshta wise distribution of 60 Amlapitta patients

Methodology

112

0

10

20

30

40

50

Mrudu Madhyama Krura


0

5

10

15

20

25



Incidence of Bala

Table no.43 Shows Bala wise distribution of 60 Amlapitta patients

Sl. No Bala Trial


01 Pravara 6 20 15 50 24 30

02 Madhyama 24 80 15 50 39 70

03 Avara 0 0 0 0 0 0

Pravara bala patients were 70% while 30% were of Madhyama bala.

Graph no. 31 Shows Bala wise distribution of 60 Amlapitta patients

Methodology

113

010203040506070

Anoopa Jangala Sadharana


Incidence of Desha

Table no. 44 Shows Desha wise distribution of 60 Amlapitta patients

Sl. No Desha

Trial


01 Anoopa 21 70 15 50 36 55

02 Jangala 9 30 12 40 24 40

03 Sadharana 0 0 3 10 3 5

Table shows 55% of patients were from anoopa desha; 40% from jangala and 5%

from sadharana desha.

Graph No. 32 Shows Desha wise distribution of 60 Amlapitta patients

Incidence of Duration of illness

Table no.45 Shows Duration of Illness wise distribution of 60 Amlapitta patients

Sl.

No.

Duration Trial

Group

% Control

Group

% Total %

01 > 6 mths. 6 20 3 10 9 15

02 7-12 mths 12 40 6 20 18 30

03 13-18 mths 3 10 15 50 18 30

04 19-24 mths 6 20 3 10 9 15

05 25-30 mths 3 10 0 0 3 5

06 31-36 mths 0 0 3 10 3 5

Methodology

114

0

2

4

6

8

10

12

14

16

> 6 mths. 7-12 mths 13-18mths

19-24mths

25-30mths

31-36mths


30% gave a history of 7mths to 12 mths and 13mths to 18mths of illness each, 15% had

suffered for less than 6mths, 5% had the illness for 25mths to30mths and 31mths

to36mths each.

Graph no.33 Shows Duration of Illness wise distribution of 60 Amlapitta patients

Incidence of Samanya laksana

Table no.46 Shows Samanya lakshana wise distribution of 60 Amlapitta patients

Sl. No. Laksana Trial


01 Utklesha 27 95 25 83 52 87 02 Amlodgara 27 95 23 77 50 83 03 Hrtdaha 27 95 22 73 49 81 04 Kanthadaha 18 60 24 80 42 70 05 Udarashoola 24 80 24 80 48 80 06 Vanti 16 53 23 77 39 65

The most prominent feature was that of Utklesa (Nausea) and was seen in all most

all the patients in both the groups i.e87%; Amloudgara(acid erructations) was present in

83% of the patients, Hrtdaha (Burning in cheste) in 81%;Udara shoola (pain in abdomen)

in 80%;kantadaha(Burning in throat) in 70% and 60% of patients presented vanti.All the

patients gave a history of aggravation of symptoms following consumption of specific

foods and regimen.

Methodology

115

0102030405060708090

100

Utkle

sha

Am

lodg

ara

Hrtd

aha

Kant

hada

ha

Udar

asho

ola

Van

ti

Trial group

Control group

Graph No. 34 Shows Samanya lakshana wise distribution of 60 Amlapitta patients

Incidence of Associated symptoms

Table no.47 Shows Associated symptom wise distribution of 60 Amlapitta patients

Sl. No Laksana Trial


01 Avipaka 21 70 15 50 36 60 02 Klama 14 47 14 47 28 47 03 Tiktodgara 13 43 16 53 29 48 04 Gourava 16 53 12 40 28 47 05 Aruchi 18 60 16 53 34 57 06 Gurukoshtatha 17 57 13 43 30 50 07 Adhamana 19 63 16 53 35 58 08 Antrakujana 8 27 16 53 24 40 09 Sirasula 14 47 17 57 31 52

60% of the patients complained of avipaka; 58% of patients complained of adhamana;

57% of aruchi; 52% of sirasula; 50% of gurukoshtatha; 48% of tiktodgara; 47% of klama

and gourava each and 40% of patient complained of antrakujana.

Methodology

116

0

5

10

15

20

25

Avip

aka

Klam

a

Tikt

odga

ra

Gou

rava

Aruc

hi

Gur

ukos

htat

ha

Adha

man

a

Antra

kuja

na

Sira

sula

Trial Group

Control Group

0

10

20

30

40

Annavaha Rasavaha Pureeshavaha

Trial group

Control group

Graph No. 35 Shows Associated symptom wise distribution of 60 Amlapitta patients

Incidence of Srotodusti

Table no. 48 Shows Srotodusti wise distribution of 60 Amlapitta patients

Sl. No Srotas Trial


01 Annavaha 12 40 9 30 21 35

02 Rasavaha 9 30 12 40 21 35

03 Pureeshavaha 9 30 9 30 18 30

35% of the patients had annavaha srotodusti and rasavaha srotodusti lakshanas each and

30% of the patients had pureeshavaha srotodusti lakshanas.

Graph No.36 Shows Srotodusti wise distribution of 60 Amlapitta patients

Results

117

RESULTS Effect of Trial drug on Main symptoms:

Table no. 49 Effect of Trial drug on Main symptoms after Treatment

Mean Lakshana BT AT BT-AT

% SD (±)

SE (±)

t P Remarks

Utklesha 1.44 0.852 0.598 59.85 0.500 0.096 6.143 <0.001 HS

Amlodgara 2.07 1.270 0.730 73.07 0.567 0.111 7.19 <0.001 HS

Hrtdaha 1.92 1.111 0.727 72.77 0.483 0.093 8.750 <0.001 HS

Kanthadaha 1.55 0.944 0.611 61.66 0.501 0.118 5.168 <0.001 HS

Udarashoola 2.125 1.375 0.625 62.50 0.516 0.137 3.872 <0.001 HS

Vanti 1.562 1.062 0.500 50.00 0.675 0.129 5.437 <0.001 HS

The trial drug provided highly significant relief(p<0.001) in all the symptoms

especially in management of amlodgara and hrtdaha by 73.07% and 72.77%

respectively.

The other symptoms also showed highly significant relief i.e.utklesha kantadaha,

udarashoola and vamana by 59.85%,61.11%,62.5% and 50% respectively.

An overall highly significant result was observed in the main symptoms after the

treatment.

Effect of Trial drug on Main symptoms:

Table no. 50 Effect of Trial drug on Main symptoms after follow up

Mean Lakshana BT AFU BT-AFU

% SD (±) SE (±) t P Remarks

Utklesha 1.44 1.19 0.259 25.92 0.446 0.085 2.908 <0.010 MS

Amlodgara 2.07 1.63 0.407 40.74 0.577 0.111 3.996 <0.001 HS

Hrtdaha 1.92 1.58 0.333 33.33 0.480 0.092 3.601 <0.010 MS

Kanthadaha 1.55 1.273 0.277 27.77 0.460 0.108 2.549 <0.050 Mi. S

Udarashoola 2.125 1.584 0.541 54.16 0.508 0.103 5.207 <0.001 HS

Vanti 1.562 1.187 0.375 37.50 0.500 0.125 3.000 <0.01 MS

Results

118

The trial drug provided highly significant relief(p<0.001) in the management of

especially udarashoola and amlodgara by 54.16% and 40.74% respectively even after the

follow up.

The drug provided moderately significant relief(p<0.010) in the management of hrtdaha,

vamana and utklesha by 33.33%, 37.5% and 25.92% respectively.

It provided mild significant relief(p<0.050) in the management of kantadaha by 27.77%.

Effect of Control drug on Main symptoms:

Table no.51 Effect of Control drug on Main symptoms after Treatment

Mean Lakshana BT AT BT-

AT

% SD (±)

SE (±)

t P Remarks

Utklesha 1.72 1.20 0.52 52.00 0.509 0.101 5.099 <0.001 HS

Amlodgara 1.52 0.956 0.565 56.52 0.506 0.105 5.345 <0.001 HS

Hrtdaha 1.54 1.06 0.50 50.00 0.500 0.106 4.690 <0.001 HS

Kanthadaha 1.33 0.875 0.458 45.80 0.508 0.103 4.408 <0.001 HS

Udarashoola 1.50 0.772 0.75 75.00 0.607 0.129 5.249 <0.001 HS

Vanti 1.78 1.086 0.695 69.50 0.634 0.132 6.043 <0.001 HS

The control drug provided highly significant relief( p<0.001) in all the symptoms

especially in management of udarashoola and vamana by 75% and 69.50% respectively.

The other symptoms like utklesha, amlodgara, hrtdaha, and kantadaha also showed highly

significant relief by 52%, 56.52%, 50% and 45.8% respectively.

Results

119

Effect of control drug on Main symptoms:

Table no. 52 Effect of control drug on Main symptoms after follow up

Mean Lakshana BT AFU BT-

AFU

% SD(±) SE(±) t P Remarks

Utklesha 1.72 1.48 0.24 24.00 0.435 0.087 2.752 <0.020 MS

Amlodgara 1.52 1.217 0.304 30.43 0.470 0.098 3.098 <0.010 MS

Hrtdaha 1.54 1.22 0.318 31.81 0.476 0.101 3.128 <0.010 MS

Kanthadaha 1.33 0.96 0.32 32.00 0.476 0.095 3.360 <0.010 MS

Udarashoola 1.50 1.12 0.375 37.50 0.499 0.101 3.714 <0.010 MS

Vanti 1.78 1.47 0.347 34.78 0.486 0.101 3.417 <0.010 MS

The control drug provided moderately significant relief(p<0.010) in the management of

amlodgara, hrtdaha, kantadaha,vamana and udarashoola by 30.43%, 31.85%, 32%,

34.78% and 37.5.% respectively. It provided moderately significant relief (p<0.020) in

the management of utklesha by 24%.

Effect of Trial drug on Associated symptoms:

Table no. 53 Effect of Trial drug on Associated symptoms after Treatment


AT

% SD (±)

SE (±)

t P Remarks

Avipaka 1.761 0.809 0.952 95.23 0.316 0.069 14.49 <0.001 HS

Klama 1.428 0.174 0.714 71.42 0.662 0.177 4.836 <0.001 HS

Tiktodgara 1.230 0.615 0.615 61.53 0.506 0.140 4.37 <0.001 HS

Gourava 1.312 0.750 0.562 56.25 0.512 0.128 4.38 <0.001 HS

Aruchi 1.388 0.833 0.555 55.55 0.607 0.143 4.265 <0.001 HS

Gurukoshtatha 1.411 0.823 0.588 58.82 0.685 0.166 4.237 <0.001 HS

Adhamana 1.473 0.684 0.789 78.94 0.567 0.130 6.871 <0.001 HS

Antrakujana 1.125 0.375 0.750 75.00 0.462 0.163 4.582 <0.001 HS

Sirasula 1.500 0.858 0.642 64.20 0.633 0.169 3.792 <0.001 HS

Results

120

The trial drug provided a highly significant relief(p<0.001) in the management of

avipaka, adhamana, antrakujana, klama, tiktodgara, gurukoshtata, gourava and aruchi by

95.323%; 78.94%; 75%; 71.42%; 61.53% 58.82% 56.25% and 55.55% respectively.

The trial drug provided moderately significant relief(p<0.010) in the management of

shiroruja by 64.2%.

Effect of Trial drug on Associated symptoms:

Table no. 54 Effect of Trial drug on Associated symptoms after follow up


AFU


Avipaka 1.761 1.237 0.523 52.38 0.511 0.111 4.656 <0.001 HS

Klama 1.428 1.070 0.357 35.71 0.497 0.132 2.686 <0.050 Mi.S

Tiktodgara 1.230 0.768 0.461 46.15 0.660 0.183 2.938 <0.020 MS

Gourava 1.312 0.937 0.375 37.50 0.500 0.125 3.000 <0.010 MS

Aruchi 1.388 0.888 0.500 50.00 0.511 0.120 3.684 <0.001 HS


Adhamana 1.473 1.052 0.421 42.10 0.611 0.140 3.370 <0.010 MS

Antrakujana 1.125 0.750 0.375 37.50 0.517 0.182 2.049 >0.050 NS

Sirasula 1.500 1.215 0.285 28.50 0.468 0.125 2.274 <0.020 MS

The trial drug provided a highly significant relief(p<0.001)in the management of avipaka,

aruchi and gurukoshtata by 52.38%, 5 0% and 52.94% respectively after follow up.

The Trial drug provided moderately significant relief(p<0.010) in the management of

adhmana and gourava by 42.10% and 37.5% respectively.

The Trial drug provided moderately significant relief(p<0.020) in the management of

tiktodgara and shiroruja by 46.15% and 28.5% respectively.

Results

121

The Trial drug provided mild significant relief (p<0.050) in the management of

klama by 35.17%.

The Trial drug provided no significant relief (p>0.050) in the management of

antrakujana by 37.5%.

Effect of Control drug on Associated symptoms:

Table no. 55 Effect of Control drug on Associated symptoms after Treatment


AT


Avipaka 1.530 0.860 0.666 66.66 0.487 0.125 5.286 <0.001 HS

Klama 1.280 0.780 0.500 50.00 0.518 0.138 3.605 <0.010 MS

Tiktodgara 1.187 0.687 0.500 50.00 0.516 0.129 3.872 <0.001 HS

Gourava 1.166 0.583 0.583 58.30 0.514 0.148 3.922 <0.001 HS

Aruchi 1.312 0.625 0.687 68.75 0.478 0.119 5.744 <0.001 HS

Gurukoshtatha 1.230 0.769 0.461 46.10 0.518 0.143 3.203 <0.010 MS

Adhamana 1.437 0.937 0.500 50.00 0.516 0.129 3.872 <0.001 HS

Antrakujana 1.000 0.700 0.300 30.00 0.483 0.152 1.963 >0.050 NS

Sirasula 1.470 0.764 0.705 70.58 0.469 0.113 6.189 <0.001 HS

The control drug provided highly significant relief (p<0.001) in the management

of shiroruja, aruchi, avipaka, gourava, tiktodgara and adhmana by 70.58%, 68.75%,

66.66%, 58.30%, 50% and 15% respectively.

The control drug provided moderately significant relief (p<0.010) in the

management of klama and gurukostata by 50% and 46.10% respectively.

The control drug provided no significant relief (p>0.050) in the management of

antrakujana by 30%.

Results

122

Effect of Control drug on Associated symptoms:

Table no. 56 Effect of Control drug on Associated symptoms after follow up


AFU


Avipaka 1.530 1.197 0.333 33.33 0.487 0.125 2.643 <0.020 MS

Klama 1.280 1.066 0.214 21.42 0.425 0.113 1.880 >0.050 NS

Tiktodgara 1.187 0.937 0.250 25.00 0.447 0.111 2.230 <0.050 MS

Gourava 1.166 1.000 0.166 16.66 0.389 0.112 1.482 >0.050 NS

Aruchi 1.312 1.124 0.187 18.75 0.403 0.100 1.860 >0.050 NS


Adhamana 1.437 1.312 0.125 12.50 0.341 0.085 1.463 >0.050 NS

Antrakujana 1.000 0.900 0.100 10.00 0.316 0.100 1.000 >0.050 NS

Sirasula 1.470 1.352 0.117 11.76 0.332 0.080 1.460 >0.050 NS


of gurukostata by 7.6% after follow up.

The control drug provided moderately significant relief (p<0.020) in the

management of avipaka by 33.33% after follow up.

The control drug provided mild significant relief (p<0.050) in the management of

tiktodgara by 25% after follow up.


klama, gourava, aruchi, adhmana, antrakujana and shiroruja by 21.42%, 16.16%, 18.15%,

12.5%, 10% and 11.76% respectively after follow up.

Results

123

Effect of Trial drug on Srotodusti:

Table no. 57 Effect of Trial drug on Srotodusti after Treatment

Mean Srotas BT AT BT-

AT

% SD(±) SE(±) T P Remarks

Annavaha 1.633 0.766 0.866 86.66 0.490 0.089 10.795 <0.001 HS

Rasavaha 1.933 1.100 0.833 83.33 0.520 0.095 9.811 <0.001 HS

Pureeshavaha 1.615 0.884 0.730 73.07 0.688 0.134 6.837 <0.001 HS

The Trial drug provided highly significant relief (p<0.001) in the management of

annavaha srotodusti, rasavaha srotodusti and pureeshavaha srotodusti by 86.66%,

83.33%and 73.07% respectively.

In total the effect of trial drug on the srotodusti involved in the amlapitta is highly

significant.

Effect of Trial drug on Srotodusti:

Table no. 58 Effect of Trial drug on Srotodusti after follow up

Mean Srotas BT AFU BT-AFU


Annavaha 1.633 1.067 0.566 56.66 0.773 0.141 5.421 <0.001 HS

Rasavaha 1.933 1.466 0.466 46.66 0.678 0.123 4.566 <0.001 HS

Pureeshavaha 1.615 0.999 0.615 61.33 0.496 0.097 6.320 <0.001 HS

The Trial drug provided highly significant relief (p<0.001) in the management of

annavaha srotodusti, rasavaha srotodusti and pureeshavaha srotodusti by 56.66%, 46.66%

and 61.53% respectively.

Results

124

Effect of Control drug on Srotodusti:

Table no. 59 Effect of Control drug on Srotodusti after Treatment

Mean Srotas BT AT BT-

AT


Annavaha 1.733 1.200 0.533 53.33 0.568 0.103 5.454 <0.001 HS

Rasavaha 1.866 1.100 0.766 76.66 0.718 0.131 7.875 <0.001 HS

Pureeshavaha 1.586 1.034 0.551 55.17 0.568 0.105 5.555 <0.001 HS


of annavaha srotodusti, rasavaha srotodusti and pureeshavaha srotodusti by 53.33%,

76.66%and 55.17% respectively.

Effect of control drug on Srotodusti:

Table no. 60 Effect of control drug on Srotodusti after follow up

Mean Srotas BT AFU BT-

AFU


Annavaha 1.733 1.633 0.100 10.00 0.434 0.079 1.677 >0.050 NS

Rasavaha 1.866 1.732 0.133 13.33 0.345 0.063 2.106 <0.050 Mi.S

Pureeshavaha 1.586 1.448 0.137 13.79 0.724 0.134 0.765 >0.050 NS

The control drug provided mild significant relief (p<0.050) in the management of

rasavaha srotodusti by 13.33%.


annavaha srotodusti and pureeshavaha srotodusti by 10% and 13.79% respectively.

Results

125

Total effect of Trial drug and Control drug After treatment:

Table no.61

Trial drug Control drug Results No. of patients % No. of patients %

Complete relief 00 00 00 00 Marked improvement 11 36.66 4 13.33 Improved 14 46.66 15 50.00 Controlled 5 16.66 11 36.66 Unchanged 00 00 00 00

In the trial group 46.66% of patients showed improved effect where in there was

50% to 75% relief in the symptoms. 36.66% of the patients showed marked improvement

in the condition by more than 75% relief. 16.66% of the patients showed control effect of

the drug by 25% to 50% of the result in the symptoms.

In the control group 50% of patients showed improved effect where in there was

50% to 75% relief in the symptoms. 36.66% of the patients showed control effect in the

condition by 25% to 50%% relief. 13.33% of the patients showed marked improvement

in the condition by more than 75% relief in the symptoms.

Total effect of Trial drug and Control drug After follow up:

Table no.62

Trial drug Control drug Results No. of patients % No. of patients %

Complete relief 00 00 00 00 Marked improvement 02 6.66 00 00 Improved 10 33.33 4 13.33 Controlled 17 56.66 22 73.33 Unchanged 1 3.33 4 13.33

After the follow up in the trial group 56.66% of patients showed controlled effect

where in there was 25% to 50% relief in the symptoms. 33.33% of the patients showed

improved effect by 50% to 75% relief. 6.66% of the patients showed marked

Results

126

0

20

40

60

80

Utk

lesh

a

Am

lodg

ara

Hrtd

aha

Kan

thad

aha

Uda

rash

oola

Van

tiTrial drug

Control drug

improvement in the condition by more than 75% relief. Only 3.33% of patients showed

no change in any of the complaints.

After the follow up in the control group 73.33% of patients showed controlled

effect where in there was 25% to 50% relief in the symptoms. 13.33% of the patients

showed improved effect by 50% to 75% relief. 13.33% of the patients showed no change

in any of the complaints.

Graph No.37

Showing comparative effect of therapies on main symptoms after the treatment

The trial drug showed highly significant relief (p<0.001) in all the symptoms

especially amlogdara and hritdaha by 78.07% and 72.77% respectively. While the control

drug also showed highly significant in all the symptoms especially in udarashoola and

vamana by 75% and 69.05% respectively.

Though there was highly significant relief in all the other symptoms also. But in

trial group the percentage of relief was higher when compared to the control group.

Results

127

0102030405060

Utk

lesh

a

Am

lodg

ara

Hrtd

aha

Kan

thad

aha

Uda

rash

oola

Van

ti

Trial drug

Control drug

Graph No.38

Showing comparative effect of therapies on main symptoms after follow up

In the trial drug after follow up there was highly significant relief (p<0.001) in

udarashoola and amlogdara by 54.16% and 40.74% respectively; where as in the control

group it showed moderate significant relief by 37.5% and 30.43% respectively.

In hritdaha, vamana and utklesha, the trial group showed moderately significant

relief 33.33%, 37.5% and 25.92% respectively; where as in the control group it showed it

showed same result by 31.81%, 34.78% and 24% respectively.

In kantadaha the trial drug showed mild significant relief by 27.77%, where as

control drug provided moderately significant relief by 32%.

Results

128

020406080

100

Avi

paka

Klam

a

Tikt

odga

ra

Gou

rava

Aru

chi

Gur

ukos

htat

ha

Adh

aman

a

Ant

raku

jana

Sira

sula

Trial drug

Conrol drug

Graph No.39

Showing comparative effect of therapies on associated symptoms after the treatment

The trial drug showed highly significant relief in avipaka, adhmana, tiktodgara,

gourava and aruchi by 95.23%, 78.94%, 61.53%, 56.25% and 55.5% respectively. Where

as in the control group also showed the same result in these symptoms by 68.75%, 50%,

58.30%, 66.66% and 50% respectively.

In klama and gurukostata the trial drug showed highly significant relief by

71.42% and 61.52% respectively; where as in control group showed moderately

significant relief by 50% and 46.10% respectively.

In shiroruja the trial group showed moderately significant relief by 64.2%, where

as in control group it provided highly significant relief by 70.58%.

In antrakujana the trial group showed highly significant relief by 75%, where as

the control group showed no relief.

Results

129

0102030405060

Avi

paka

Klam

a

Tikt

odga

ra

Gou

rava

Aru

chi

Gur

ukos

htat

ha

Adh

aman

a

Ant

raku

jana

Sira

sula

Trial drug

Control drug

Graph No.40

Showing comparative effect of therapies on associated symptoms after follow up

In gurukostata there was highly significant relief by 52.94% in trial group, where

as in control group also showed same result by 7.6%.

In avipaka there was highly significant relief in the trial group by 52.38%, where

as in control group there was moderately significant relief by 33.33%.

In aruchi there was highly significant relief in the trial group by 50%, where as in

control group there was no significant relief by 18.15%.

In tiktodgara there was moderately significant relief in the trial group by 46.15%,

where as in control group there was mild significant relief by 25%.

In klama there was mild significant relief in the trial group by 35.71%, where as

in control group there was no significant change.

In adhmana and gourava there was moderately significant relief in the trial group

by 42.10% and 37.5% respectively, where as in control group there was no significant

change.

There was no significant change in antrakujana in both the groups.

Results

130

0

20

40

60

80

100


Trial drugControl drug

0

20

40

60

80


Trial drugControl drug

Graph No.41

Showing comparative effect of therapies on srotodusti after the treatment

In annavaha srotodusti, rasavaha srotodusti and pureeshavaha srotodusti the trial

group showed highly significant relief by 86.66%, 83.33% and 73.07% respectively.

Where as in control group also showed the same result by 53.33%, 76.66% and 55.17%

respectively.

Graph No.42

Showing comparative effect of therapies on srotodusti after follow up

Results

131

0

10

20

30

40

50

Com

plet

ere

lief

Mar

ked

impr

ovem

ent

Impr

oved

Cont

rolle

d

Unch

ange

d

Trial drug

Control drug

After follow up also there was highly significant relief in annavaha srotodusti,

rasavaha srotodusti and pureeshavaha srotodusti in trial group by 56.66%, 46.66% and

61.53% respectively. Where as in control group there was mild significant relief in

rasavaha srotodusti by 13.33%, but no significant change in annavaha srotodusti and

pureeshavaha srotodusti.

Graph No.43

Showing comparative total effect of therapies after treatment

The trial drug group was found to be more effective than the control drug group

after the treatment.

In the trial group 36.66% of the patients showed marked improved, while only

13.33% of patients showed the same in control group.

The trial group showed 46.66% of the patients with improved effect, where as

50% of patients in control group with same effect.

The trial group showed 16.66% of the patients with controlled effect, where as

36.66% of patients in control group with same effect.

The trial group showed unchanged cases where as the control group showed

unchanged effect in 3.33% of patients.

Results

132

01020304050607080

Com

plet

ere

lief

Mar

ked

impr

ovem

ent

Impr

oved

Cont

rolle

d

Unch

ange

d

Trial drug

Control drug

Graph No.44

Showing comparative total effect of therapies after follow up

After follow up the trial drug group was found to be more effective than the

control group.

The trial group showed 6.66% of patients with marked improved where as in the

control group there was no such improvement.

The trial group showed 33.33% of patients with improved effect where as in the

control group it was 13.33%.

The trial group showed 56.66% of patients with controlled effect where as in the


The trial group showed 3.33% of patients with unchanged effect where as in the


From the above it can be observed that the trial drug showed maximum cases to

be markedly improved, improved and no unchanged cases, where as the control group

showed maximum cases to be improved and having control effect after the treatment.

Even after follow up the trial group shows maximum cases to be markedly

improved and improved when compared to control group. The trial group also shows

minimal cases to be unchanged when compared to control group after follow up.

The control group shows maximum cases to be controlled than in the trial group,

but the improved and markedly improved cases are found to be more in trial group.

Hence it can be concluded that the trial drug provided better result than the control drug.

Discussion

133

DISCUSSION

Amlapitta is a psycho-somatic disease of annavaha srotas mainly caused due to

indulgence in faulty diet and regimen. It presents a group of signs and symptoms viz.,

avipaka, amlodgara, hrtdaha, kantadaha utklesha, vamana, udaarashoola, adhmana

vitbheda etc. which are more commonly termed as dyspeptic signs in the modern

medicine.

Amlapitta is stated to be a disorder manifested due to agnimandya leading to the

formation of ama. Inturn the ama combining with the vrudhpitta leads to the formation of

amavisha which turns into shuktapaka and manifests clinically. This disorder is stated to

be caused due to dusti occurring in the annavaha srotas first and involving the rasavaha

and pureeshavaha srotas. From the samprapti explained it is clear that Amlapitta is the

result of functional disturbance of the annavaha srotas, especially during the

amlaavastapaka where in the food in taken turns to shuktapaka due to agnimandya and

ama. This can be compared to non ulcer dyspepsia or functional dyspepsia in the modern

medicine as most of the symptoms seen in Amlapitta are similar to it and more over non-

ulcer dyspepsia is said to be characterized by dyspeptic signs caused due to functional

disturbance with no organic lesions any where in GIT.

Amlapitta is most commonest disease met with in general practice requiring an

adequate and proper management as it hampers the daily routine of an individual.

Madhavakara states that Amlapitta is a condition which and when promptly

treated along with proper diet and regimen can be easily cured. If it is neglected and one

indulgence himself in apathya ahara vihara it becomes kastasadhya.

Discussion

134

The patients of Amlapitta were randomly selected irrespective of sex fulfilling the

inclusion and exclusion criteria. Freshly diagnosed cases and cases of recent origin were

selected for the study. The main symptoms of the disease were graded and scored for the

assessment. Along with this the associated symptoms and srotodusti were also graded and

scored for the assessment. The cases with chronic and acute onset were ruled out for

ulcers before including into the study by Endoscopy. The general condition of the patient

was also assessed by detailed history and routine bio-chemical investigations for other

diseases so as to fulfill the inclusion criteria. The patients were grouped randomly and

controlled study was carried out. Patients under the trial group received Shatavari churna

-3gms and Abhraka bhasma 125mg along with litte ghrita before meals thrice daily for 1

month and the patients under control group received Syrup Gelusil 1 tsp. thrice daily

before meals for 1 month. The result was assessed by statistical analysis of the symptoms

that was graded and scored.

Nidanatmaka aspect of the disease:

Age:

Most of the patients belonged to age group of 26-33 yrs of age followed by 34-41

yrs of age group. This findings shows a very similar statistics about prevalence of non-

ulcer dyspepsia in the middle age group.

Sex :

Majority of the patients were females which is similar to the incidence of Non-

Ulcer dyspepsia described in modern medicine.

3] Religion :

The disease incidence was quite more in Hindus this may be due to the demographic

cause or distribution of the patients.

Discussion

135

4] Marital status :

More of the married individuals showed the presence of the disease. As this

condition is more common in the middle age group, the presence of Amlapitta is more in

the married group. The life is more stressfull during the middle age due to greater

responsibilities both physically and mentally; which becomes one of the cause for the

manifestation of the amlapitta.

5] Educational Status :

Amlapitta was found to be more in graduates and the people who had completed

higher secondary schooling. In this phase the mental stress and strain is found to be more

along with improper food habits which becomes the causative factor for the clinical

manifestation of the disease.

6] Occupational status :

The disease incidence was found to be highest in house wives followed by

businessmen which indicated the sedentary life style and food habits which are more in

these individuals to be the causative factors.

7] Diet :

a) Type: The incidence of mixed diet was more ; which highlights that intake of

excessive fatty and spicy foods leads to the manifestation of the disease.

b) Habit :Majority of the patients were accustomed to vishama shana [untimely

intake of food] which is also the cause for the manifestation of the disease.

c) Nature of diet :Majority of the patients had pittaprakopaka ahara, amla rasa

pradhana, and virudhanna which are also the cause for the vriddhi of pitta leading to the

manifestation of the disease.

Discussion

136

8] Socio – Economic status :

More number of patients belonged to middle class which especially states the

stressfull physical and mental condition and faulty diet which may be the cause for the

disease.

9] Addictions :

Majority of the patients were addicted to coffee and tea followed by smoking and

NSAID’s , which are also considered as one of the causative factors in modern medicine

for Non-ulcer dyspepsia.

10] Habitat :

Majority of the patients belonged to the rural area which indicates the improper

dietic habits and regimen leading to Amlapitta.

11] Aggravating period :

The i `ncidence of aggravation of the symptoms was found to be more during

mid-day and morning hours which indicates the pittaprakopaka and increase ama avastha

phases respectively giving rise to the symptoms.

12] Influence of environmental factors :

The incidence of aggravation of the symptoms was found to be higher in rainy

season which indicates that the pittaprakopaka kala is one of the causative factor.

13] Psychological factors : The incidence of mental stress or strain was found to be

more in the majority of patient which clearly indicates that psychological factor has

greater influence over the manifestation of the disease.

14] Regimen :

Majority of the patients gave a history of atapsevana, avagahana which are said to

the causative factors influencing pitta leading to the disease entity.

15 Rasa- satmya :

Discussion

137

The disease incidence was found to be more in the patients with katu-rasa satmya

and Amla-rasa-satmya, which has been stated to be the cause for the manifestation of the

disease.

16] Prakruti :

The disease incidence was found to be highest in pitta-vataja prakruti indicating

that the prakruti also has influence over the manifestation of the disease.

17] Sara :

Majority of the patients belonged to mamsa sara and twak sara individuals.

18] Samhanana :

Majority of the patients belonged to madhyama samhanana.

19] Satva :

Majority of the patients belonged to madhyama satva.

20] Agni :

Majority of the patients having mandagni showed the higher incidence of the

disease which indicates the pathogeness of the diesese.

21] Koshta :

The incidence of the disease was found to be higher in madhyama koshta people,

indicating the vata-pitta influence in the manifestation of the disease.

22] Desha :

The incidence of the disease was found to be higher in the subjects belonging to

Anoopa pradesha which is said to be having influence over the pitta and its aggravation

leading to the disease.

23] Bala :

Majority of the patients of the present study had madhyama bala and pravara bala,

indicating the loss of bala due to improper digestion and assimilation of nourishment.

24] Exercise :

Discussion

138

The incidence of the disease was found to be more in people who did only routine

work and occasional exercise, indicating the sedentary or less physical work leading to

agnimandya and hence the disease.

25] Bowel Habit :

The incidence of the disease is high in the patients with constipation and irregular

bowel habit which indicates the influence of vata and pitas over the pureeshavaha srotas.

26] Past Illness :

Majority of the patients gave a history of agnimandya and ajeerna which are the

important factors involved in the samprapti of the disease.

Effect of therapies on Utklesha [Nausea]:

In trial group 95% of patients presented with mild to severe degree of utlklesha

[Nausea] and showed highly significant relief by59.85% after treatment and moderately

significant relief even after follow-up by 25.92%

The control drug group showed highly significant relief by 52% after treatment

and moderately significant relief even after follow-up by 24%.

This indicates that the trial drug has better effect on the symptom utklesha.

The Shatavari choorna and Abhraka Bhasma both are tridoshagna and have

madhura rasa, madhura vipaka and sheeta veerya which will pacity the pitta which is the

cause for utklesha along with vriddh kapha. The tikta rasa of the shatavari choorna will

pacity the kapha, which is anubandha dosha in this symptom.

Effect of therapies on Amlodgara [Acid Erructations]:

In trial group 95% of patients presented with mild to severe degree of

Amlodgara [Acid erructations] and showed highly significant relief by 73.07% after the

treatment and even after follow-up also it showed highly significant relief by 40.74%.

The control drug group showed highly significant relief by 56.52% after treatment

and moderately significant relief by 30.43% after the follow up.

Discussion

139

This indicates that the trial drug has better effect on the amlodgara.

The madhura and tikta rasa of Shatavari choorna and madhura rasa of Abhraka

Bhasma and madhura vipaka and sheeta veerya of both the drug pacify the pitta and

reduces the udrikta pitta which is cause for amlodgara. As both drugs have deepana

property they increase the agni and reduce the ama.

Effect of therapies on Hrthdaha [Heart burn]:

Hrthdaha or in other words known as pysosis is caused due to the reflux of the

pitta in to the upper part of the G.I.T. This was assessed by grading and scoring the

symptom.

In trial group 95% of patients presented with mild to severe degree of hrtdatha

[Burning behind the sternum] and showed highly significant relief by 72.77% after the

treatment and after follow-up showed moderately significant relief by 33.33%.

In the control group 73% of patients presented with mild to severe degree of

hrtdaha and showed highly significant relief by 50% and after follow-up showed

moderately significant relief by 31.81%.

This clearly indicates that the trial drug is more effective than the control drug

over Hrtdaha.

Shatavari choorna and Abhraka bhasma both due to their madhura rasa, madhura

vipaka and sheeta veerya pacify the pitta and reduces the daha produced in the

hrtpradesha. Shatavari choorna due to its demulscent property reduces the burning

sensation.

Effect of therapies on Kantdaha : [Burning sensation in the throat]:

This symptom is often associated with the Hrtdaha. Due to the regurgitation of the

gastric contents into the mouth.

In trial group 60% of patients presented with mild to severe degree of kantdaha

and showed highly significant relief by 61.11% after the treatment and mild significant

relief by 27.77% after follow-up.

Discussion

140

In control group 80% of patients presented with mild to moderate degree of

kantadaha and showed highly significant relief by 45.8% after the treatment and

moderately significant relief by 32% after follow-up. This indicates that the trial drug is

better after the treatment where as the control drug showed a sustained relief even after

follow-up.

Shatavari choorna due to its demulscent action decreased the kantadaha and due

to its madhura rasa, madhura vipaka and sheeta veerya along with the same of the

Abhraka Bhasma reduced the daha by pacifying the pitta.

Effect of therapies on Vamana : [Vomiting]:

Vamana occuss due to the co-mixture of ama along with pitta and its regurgitation

into the upper part of the G.I.T. by vata. The symptom was graded and scored for the

purpose of assessment.

In trial group 53% of patients presented with mild to severe degree of vamana

[vomiting] and showed highly significant relief by 50% after the treatment and

moderately significant relief by 25.92% after the follow-up.

In control group 77% of patients presented with mild to severe degree of vamana

and showed highly significant relief by 69.50% after treatment and moderately significant

relief by 34.78% after follow-up.

This indicates that the control drug had better effect over vamana than trial drug.

The trial drug Shatavari choorna and Abhraka Bhasma, especially helps in

pacifying the pitta and due to its deepana property reduces ama.

Effect of therapies on Udara shoola : [Abdominal pain]:

The pain is characteristic of vata and hence its seen when pitta is associated with vata.

In trial group 80% of patients presented with mild to severe degree of udara

shoola [Abdominal pain] and showed highly significant relief by 62.5% after the

treatment and the same relief by 54.16% even after the follow-up.

Discussion

141

In control group 80% of patients presented with mild to severe degree of udara

shoola and showed highly significant relief by 75% after the treatment and moderately

significant relief by 37.5% even after the follow-up.

Though the control drug showed a greater percentage of relief than the trial drug

after the treatment the trial drug had a greater and sustained effect after follow-up.

Shatavari choorna due to its vata pitta shamana property and Abhraka Bhasma

due to its tridoshagna property pacifies both vata and pitta and reduces the pain. Shatavari

choorna is said to have stomachic action due to its bitter taste. Along with this it has

demulscent, and anti-spasmodic action.

Effect of therapies on Avipaka : [Indigestion] :

In trial group 70% of patients presented with mild to severe degree of Avipaka

and showed highly significant relief by 95.23% after the treatment and even after the

follow-up by 52.38%.

In control group 50% of patients presented with the Avipaka and showed highly

significant relief by 66.66% after the treatment and moderately significant relief by

33.33% after follow-up.

This indicates that the trial drug has better effect over Avipaka than the control

drug.

Shatavari choorna, Abhraka Bhasma and Gritha, due to their deepana property

increases the agni and reduce the avipaka. Gritha due to its sneha guna pacifies the vata

and stimulates the Jataragni.

Effect of therapies on Klama : [Fatigue]

In trial group 47% of patients presented with klama which varied from mild to

severe degree and showed highly significant relief by 71.42% after the treatment and

mild significant relief by 35.71% after the follow-up.

Discussion

142

In control group 47% of patients presented with klama which varied from mild to

severe degree and showed moderately significant relief by 50% after the treatment and no

significant relief by 21.42% after the follow-up.

This indicates that the trial drug is more effective over klama than the control

drug.

Both Shatavari choorna and Abhraka Bhasma due to thir madhura rasa, madhura

vipaka and sheeta veerya pacify the pitta and due to their deepana property reduce the

ama, and hence reduces the klama. Which is seen due to ama and pitta.

Effect of therapies on Tiktodgara :

In trial group 43% of patients presented with tiktodgara which varied from mild

to severe degree and showed highly significant by 61.53% after the treatment and

moderately significant relief by 46.15% after the follow-up.

In control group 53% patients presented with tiktodgara and showed highly

significant relief by 50% after treatment and mild significant relief by 25% after

followup.

The trial drug had better effect over the Tiktodgara than control drug.

The trial drug due to its madhura rasa, madhura vipkaka and sheeta veerya

pacified the pitta and reduced the Tiktodgara.

Effect of therapies on Gourava :

In trial group 53% of patients presented with mild to severe degree of Gourava

and showed a highly significant relief by 56.25 % after treatment and showed moderately

significant relief by 37.5 % after follow up.

In control group 40% of patients presented with mild to severe Gourava and

showed a highly significant relief by 66.66% after the treatment but no relief after follow

up by 16.16%.

From this it indicates the trial drug is more effective than the control drug even after

follow-up.

Discussion

143

The trial drugs due to their deepana property increased the jataragni and helped to

reduce the ama which is cause for the Gourava.

Effect of therapies on Aruchi : [Anorexia]:

Aruchi is mainly due to ama caused by agnimandya, which is one among

sampraptighatakas of this disease.

In trial group 60% of patients presented with mild to severe Aruchi [Anorexia]

and showed highly significant relief by 55.55% after the treatement and showed the same

result by 50% even after the follow up.

In control group 53% of patients presented with mild to severe Aruchi and

showed highly significant relief by 68.75% after the treatment and no relief after the

follow-up by 18.15%

This indicates that the control drug showed better results after treatment compared

to trial drug. But the trial drug showed better results after follow up.

The trial drug because of its deepana property increased jataragni and reduced

ama and in turn the Aruchi.

Effect of therapies on Gurukoshtata : [Abdominal discomfort]

Gurukoshtatha is mainly caused due to ama. Agnimandya is main cause of ama

which is one among the sampraptighatakas.

In trial group 57% of patients presented with mild to severe degree of guru

koshtata and showed highly significant relief by 58.82% after the treatment and eve after

the follow up the same effect by 52.94%.

In control group 43% of patients presented with mild to severe degree of

gurukoshtata and showed moderately significant relief by 46.10% after the treatment and

highly significant relief by 7.6% after follow up.

Discussion

144

This indicates that trial drug is more effective as it showed sustained effect even

after follow-up, where as the control drug showed the good effect after follow-up, but

only in small percentage of subjects.

The trial drug mainly because of its deepana property increase jataragni and helps

in reducing the ama and hence the gurukoshtata also,but takes time for reduction of the

ama.

Effect of therapies on Adhmana : [Abdominal Distension]

Ajeerna causes accumulation of vata in disacordance with pitta to produce

Adhmana.

In trial group 63% of patients presented with mild to severe degree of Adhmana

and showed highly significant relied by 78.94%, after the treatment and moderately

significant relief by 42.10% after the follow-up.


Adhmana and showed highly significant relief by 50% after the treatment and no relief

after the follow-up by 12.5%.

This indicates that the trial drug had better effect over Adhmana than control

drug.

Shatavari choorna and Gritha because of their vata-pitta shamaka property

pacified vata and pitta and hence reduced ajeerna and in turn Adhmana.

Effect of therapies on Antrakujana :

Antrakujana is mainly caused due to vata vrudhi. In trial group 27% of patients

presented with mild to severe degree of Anrakujana and showed highly significant relief

by 75% after the treatment and no significant relief after follow-up by 37.5%.

Discussion

145


Antrakujana and showed no significant relief after the treatment and follow-up by 30%

and10% respectively.

This indicates that the trial drug has better effect than the control drug over

Antrakujana.

Shatavari choorna due to its property of vata-pitta shamana pacified the vata and

pitta and gritha due to its sneha guna pacified the vata and reduced Antrakujana.

Effect of therapies on Shiroruja : [Headache]

In trial – group 47% of patients presented with mild to severe degree of shiroruja

[Headache] and showed moderately significant relief by 64.2% after the treatment and

the same result after follow up by 28.5%


shiroruja and showed highly significant relief by 70.58% after the treatment and no

significant relief after the follow-up by 11.76%

This indicates that trial drug has better effect than the control drug over shiroruja.

Shatavari choorna and Gritha due to their vata-pitta shyamaka property pacified vata and

pitta and reduced shiroruja.

Effect of therapies on Rasavaha srotodusti :

In trial group 40% of patients presented with mild to severe degree of resavaha

srotodusti and showed highly significant relief by 83.33% after the treatment and the

same result even after the follow-up by 46.66%.

Discussion

146


rasavaha srotodusti and showed highly significant relief by 76.66% after the treatment

and mild significant relef by 13.33%.

This indicates that the trial drug is more effective than the control drug.

Shatavari choorna and Abhraka bhasma due to their madhura rasa,madhura vipaka and

sheeta veerya pacify the pitta and vata and due to their deepana property reduce the ama

by increasing the agni and thus correct the srotodusti.

Effect of therapies over Annavaha Srotodusti :

In trial group 30% of patients presented with mild to severe degree of Annavaha

sratodusti and showed highly significant relief by 86.66% after treatment and the some

effect even after follow-up by 56.66%.


Annavaha srotodusti and showed highly significant relief by 53.33% after treatment and

no significant relief after follow-up.

This indicates that the trial drug is more effective than the control drug.

The deepana property of the trial drug influences the agni and as a result there

may be reduction in features of annavaha srotodusti..

Effect of therapies on pureeshavaha srotodusti.

In the trial drug 30% of patients present with mild to severe degree of

pureeshavaha srotodusti and showed highly significant relief by 73.07% after the

treatment and the same effect even after the follow up by 61.53%.

Discussion

147

In the control drug 30% of patients presented with mild to severe degree of

pureeshavaha srotodusti and showed highly significant relief after follow-up by 13.79%.

This indicates the trial drug had better effect than the control drug over

pureeshavaha srotodusti.

The vata pitta shamaka property of the trial drug counteracted the vata-pitta dushti

and hence lead to the reduction in the dusti of pureeshavaha srotas.

Total effect of therapies:

The trial drug showed maximum cases to be markedly improved, improved and

no unchanged cases, where as the control group showed maximum cases to be improved

and having control effect after the treatment.

Even after follow up the trial group shows maximum cases to be markedly

improved and improved when compared to control group. The trial group also shows

minimal cases to be unchanged when compared to control group after follow up.

The control group shows maximum cases to be controlled than in the trial group,

but the improved and markedly improved cases are found to be more in trial group.

Hence it can be concluded that the trial drug provided better result than the control drug.

Conclusion

148

CONCLUSION

The work entitled “A clinical study on the effect of Shatavari choorna with Abhraka

Bhasma in the management of Amlapitta” draws out following conclusions.

1. Amlapitta is a psycho-somatic disorder, where psychological factors play an equally

important factor along with the dietary indiscretions.

2. Amlodgara, Hrtdaha and Utklesha are inevitable manifestations of Amlapitta.

3. Pitta is the pradhana dosha, but the predominance/ aggravation of vata causes

undarashoola along with other Amlapitta symptoms, as such its not found in all

patients.

4. Agnimandya, Ama and Srotodusti are the prime factors in the manifestation of the

Amlapitta, the same can be considered in the manifestation of Non-Ulcer-Dyspepsia.

5. Amlapitta is a functional disorder caused due to the vikruti in the amlavastha paka

during the processes of digestion and involves no organic lesions as the pathogenesis

does not specify.

6. Poorvarupa of the Amlapitta has not been stated in the classics but most of the

patients give a history of Ajeerna and Agnimandya which can be considered as

poorvarupa or pre-disposing factors of Amlapitta.

7. Amlapitta if becomes chronic and the vitiation of the doshas lead to other conditions

like annadravashoola, parinama shoola etc.

8. Jwara, Atisara, Grahani, the upadravas of the Amlapitta states that severity of

agnidushti.

9. Its observed that most of the patients present mainly the urdhwaga amlapitta laxanas

along with samanya lakshanas.

Conclusion

149

10. Pathyapthya plays definate role in the management of Amlapitta.

11. The overall effect of the trial drug with proper diet and regimen was more significant

and better than the effect of the control drug after treatment and even follow-up.

12. The trial drug showed marked improvement in the srotodusti especially in the

annavaha srotodusti and pureeshavaha srotodusti after the follow-up also.

13. The standard drug showed significant relief in the symptoms during the treatment, but

during the follow-up, the recurrence rate was high.

14. Abhraka Bhasma acts as an Antacid and helps in neutralizing the HCl and thus giving

an instant relief.

15. Abhraka Bhasma and Shatavari choorna along with Gritha act synergistically to bring

about quick and better effect in the management of Amlapitta, than an liquid antacid.

16. No any side effects or adverse effects were observed during the study.

17. To get still more precise data the study must be carried out over a larger population

with more number of patients. The total duration of the study was only 2 months. In 2

months its not possible to evaluate all the effects and adverse effect if any of drug.. A

long term study must be conducted to know the effect of the drug in long – run.

18. Similar studies can be under taken by taking single drugs or simple combinations of

one or two herbal and mineral drugs to assess their efficacy in management of

Amlapitta.

19. As shodhana treatment gives better results, it will be ideal to follow shamana after

shodhana therapy.

Summary

150

SUMMARY

The dissertation titled “A clinical study on the effect of Shatavari choorna with

Abhraka Bahasma in the management of Amlapitta” compraises of different topics

discussed under these headings.

1. Introduction :

This comprises of the introduction to the Ayurveda, its aim and objectives and the

importance of kayachikitsa with respect to Angi. It also includes brief introduction of the

disease Amlapitta, along with its incidence, prevalence, pathology, and its paralance with

functional / Non-Ulcer Dyspepsia, in the modern medicine. The aim of the study and

selection of the drug has been putforth.

2. Objectives :

The main aim and objectives of the study has been mentioned along with the

hypothesis under this heading.

3. Review of the literature :

This section includes the collection of all the available data regarding the

etymology, definition, classification- nidana, poorvarupa, rupa, samprapti, sadhya

asadhyata, upadravas, and chikitsa along with pathyapataya of the disease Amlapitta. It

also includes a detailed description of the Dyspepsia, highlighting functional / Non-Ulcer

Dyspepsia in the modern medicine to draw its paralance to Amlapitta.

4. Materials and methods :

Clinical study :

Under this heading a detailed description of clinical study with specific reference

to patients, grouping, selection, inclusion and exclusion criteria, protocol criteria for

Summary

151

assessments of signs and symptoms, dose, duration, distribution of patients etc. of the

present study has been discussed.

5. Results :

Total of 32 patients in each group were selected for the present study and only 30

patients from each group continued the full course of the therapy.

Results of clinical study :

The results obtained after 30 days of treatment and 30 days of follow-up are

discussed under this heading. The scoring of the important features of Amlapitta before

and after the treatment and also follow-up are tabulated and percentage of improvement

is noted. The grading of the improvement is done and analyzed statistically with students

‘t’ test. The total relief obtained after the treatment schedule was recorded as:

1. Completely cured 2. Marked improvement

3. Improved 4. Controlled and

5. Unchanged.

The same was recorded even after the follow-up.

In present study no patients of either group got completely cured.

The trial group showed 36.66 % patients markedly relieved. 46.66 % of patients

to be improved, and 16.66 % of patients to be controlled. While the standard group

showed 13.33 % be markedly improved, 50 % of patients to be improved, 36.66 % of

patients to be controlled. After the follow up the trail drug showed more number of

patients to be markedly improved and improved in comparison with the control drug.

The percentage of controlled and unchanged were found to be more in the control group.

Summary

152

Thus the trial group showed better and significant result when compared to

controlled group.

6. Discussion :

Under this the nidanatmaka study and results obtained from this study have been

described. The probable mode of action of the trial drug Shatavari choorna,

Abhraka Bhasma and also gritha in the management of Amlapitta has been

discussed.

7. Conclusion :

In this chapter conclusion drawn from the above study has been highlighted along

with the limitation of the study and the scope for further improvisation.

REFERENCES

HISTORICAL GLIMPSES

1. Atharva veda kaushika sutra 31/7

2. Ch.Su.1/110.

3. Ch.Su. 25/40

4. Ch.Su. 26/43

5. Ch.Su 26/103

6. Ch.Su 12/52

7. Ch.Chi.15/47

8. Ch.Chi 7/148

9. Ch. Su. 20/14

10. Ch.Chi.12/52

11. Ash.San.Su.13/3

12. Kh.Sam.Khi.16

13. Ma.Ni.51

14. Bha.Pra.Ma.Kha.10

15. Sha.Sam.pra.Kha.1

NIRUKTI

1. Ch.Su 1/60

2. Ch.Su 1/60 ; Ch . Su 20/ 15 ; Kh . Su 27/38

3. Su. Su 21/1

4. Siddantha Kaumudi

5. Ch.Chi. 15/47 ; Chakrapani

6. M.Ni. 51/ Srikantadutta

7. M.Ni. 51/ Srikantadutta

8. Sanskrit dictionary Vachaspathyam [ P.333]

9. Su.Su. 46 / 504

10. Ch.Chi. 15/10

11. Sanskrit Dictionary Viswakor

12. Ch.Chi 15/10 Ckakrapani

13. Ka.Khi 16/7.8.9

14. M.Ni . 51/1

15. Ash. San 20/16 Indutika

16. Yogaratnakara, uttarardha Amlapitta Chikitsa/3

17. Kh.Khi . 16/42-43

18. Ash.San. Su. 20/16 Indutika

19. Ash. San. Su. 20/16

20. Ash.San.Su. 20/16 Indutika

21. Su.Su. 42/10 Dalhana

ANATO PHYSIOLOGY

1. Ch. Chi. 15/3 Chakrapani

2. Ch.Su . 11/48

3. Ch. Sha 7/10

4. Ch.Su. 20/8 Chakrapani

5. Su.Chi.2/11-12

6. Su Su.21/10 ;Su. Ut.40/169

7. Su.Su.21/13

8. Ch.Su.20/8 ;Ash.Hr.Su.12/2

9. Ch.Chi. !5/10

10. Ash.Hr.Su.12/10-12

11. Ch.Chi.5/9

12. Ch.Sha.3/6

13. Su.Sha.5/8

14. Ch.Sha.7/10

15. Ch.Su. 20/8 Chakrapani

16. Ch.Su. 20/8

17. Ch.Su. 5/8

18. Ch.Vi. 2/17

19. Su.Su. 21/12

20. D.M

21. Su.Su.4/37

22. Su.Sha.9/7

23. Su.Sha.5/32

24. D.M

AHARAPAKA

1. Ch.Sha6/14

2. Ch.Su 12/11

3. Ch.Su.12/11

4. Ch.Su.12/11 Chakrapani

5. Ch.Su.1/60

6. Su.Su.20/15

7. Ch.Su.1/60

8. Su.Su.21

9. Su.Su.21/13

10. Ch.Chi.15/9

11. Ch.Chi.15/9

12. Ch.Chi 15/10

13. Ch.Chi 15/10

14. Ch.Chi 15/10 Chakrapani

15. Su.Su.46/502

16. Ch.Chi.15/9 Chakrapani

17. Ch.Chi.15/9

18. Ch.Sha.2/18

NIDHANA :

1. PP. Ch. 36

2. Ch. Vi. 2/8

3. Su.Su.46/473

4. Su.Su.46/473

5. Ch.Chi.15/41-44

6. Ch. Su. 28/45

7. Ch. Su. 26

8. Ch. Su. 27

9. D.G. Vol – I

10. Su.Su.46

11. Su.Su.45

12. Bh. Pr. 9

13. O.T.P. Ch. 15

14. O.T.P. Ch. 15

15. Ch. Vi. 2/8

16. Ch. Si. 12/56

SAMPRAPTI

1. Ma.Ni. 1/8

2. Ash. Hr. Ni. 12/5 ;Ch. Chi. 13/9

3. Ash. Hr Su. 12/11

4. Ash. Hr Su. 12/11

5. Ch. Chi. 15/39

6. 6. Ch. Chi. 15/9-11 Chakrapani

7. Ash. Hr Su. 15/10

8. Ash. Hr Su. 3/74 ;Su.Su. 35/20

9. Ch. Chi. 15/51 ; Ch. Vi. 6/12 ; Su.Su. 35/20 ; Ash. Hr. Sa. 3/74

10. Ch. Chi. 15/50 ; Su.Su. 35/20 ; Ash. Hr. Sa. 3/75

11. Ch. Chi. 15/50 ; Su.Su. 35/20 ; Ash. Hr. Sa. 3/76

12. Ash. Hr. Sa. 12/11

13. Ash. Hr. Su. 13/25

14. Ash. Hr Su. 13/26

15. Ch. Chi. 15/42-43 ; Su.Su. 46/535

16. Ash. Hr. Su. 13/23-24

17. Moniere Williams

18. Ash. Hr. Su. 13/27 Arunadutta

19. Ash. Hr. Su. 13/27

20. Ash. Hr. Su. 13/27 Hemadri

21. Ch. Chi. 15/37 ; Su.Su. 24/10

22. Su.Su. 46/497

23. Kha. Khi. 16/8

24. Kha. Khi. 16/7-9

25. Ma. Ni. 51/1

26. Ch. Su. 26/40

27. Ch. Chi. 15/44 Chakrapani.

28. Kha. Khi. 16/10-11

29. Ma. Ni. 51/3

30. Kha. Khi. 16/16-17

31. Ma. Ni. 51/3 ; Bha.Pra.Ma.Kha ; Y.R

32. Kha. Khi. 16/49

33. Ma. Ni. 51/3

34. Ma. Ni. 51/3 ; Kha. Khi. 16/16-17

35. Kha. Khi. 16/49

36. Su. Su. 21/18

37. Ash. Hr. Su. 12/22

38. Su. Su. 21/25

39. SLS

40. Su. Su. 21/30

POORVARUPA

1. Ch.Ni 1/8

2. Ch.Ni.1/8 Chakrapani

3. Madhukosha Vyakhya

4. Madhukosha Vyakhya

5. Ch Ni 1/8

RUPA

1. Ch. Ni. 1/9

2. Ash. Hr. 1

3. Ash. Hr. Su. 1; Ma. Ni. Vijayarakshita teeka

4. Ma. Ni. 51

5. Ma. Ni. 51

6. Ma. Ni. 51

7. Ma. Ni. 51/4-6

8. Yogaratnakara amlapitta chikitsa /4

9. Bha. Pra. Ma. Kha. 10/3

10. Bha. Pra. Ma. Kha. 10/8 ;Kha. Khi. 16/16 ; Ma. Ni. 51/4 ; Yogaratnakara

11. amlapitta chikitsa /8

12. Ma. Ni. 51/10 ; ;Kha. Khi. 16/16

13. Ma. Ni. 51/11

14. Kha. Khi. 16/16

BHEDA

1. Ma.Ni. 51/3

2. Ma.Ni. 51/3

3. Kha.Khi. 16/16-17

4. UPASHAYA

5. Ch. Vi. 4

6. Ch. Vi. 1/20

7. Kha. Khi. 16/16

SADYAASADYATA

1. Ch. Ni. 5/15

2. Ma. Ni. 51/7

3. Kha. Khi. 16/49

UPADRAVA

1. Ch.Chi. 21/40

2. Kha. Khi. 16/49

CHIKITSA

3. Kha. Khi. 16/42

4. Ash. San. Ni. 2/4 Indu teeka

5. Kha. Khi. 16/ ; Bha. Pra. Ma. Kha. 10/ ;Yogaratnakara amlapitta chikitsa.

6. Bhaishajya ratnavali 56/ ;Chakradutta Ch. 52/

7. Va. Se. 59/21

8. Bha. Pra. Ma. Kha. 10/13

9. Kha. Khi. 16/

10. Ash . Hr. Su. 1/25 Indu Teeka

11. Ash. Hr. Su. 1/25

12. Va. Se. 62/13

13. Bha. Pra. Ma. Kha. 10/13

14. Kha. Khi. 16/ 31

15. Kha. Khi. 16/ 33-36

16. Bha. Pra. Ma. Kha. 10/13

17. Kha. Khi. 16/ 31-32

18. V. M. 33/1

19. Va. Se. 62/21

20. Ch. Chi. 3/142 ;Su. Ut. 40/60 Dalhana ;Ash. Hr. Chi. 1/21

21. Ch. Chi. 14/182

22. Kha. Khi. 16 ; Chakradutta Ch. 52 ; Bha. Pra. Ma. Kha. 10 ; B.Ratnavali 56 ;

Y.R

23. C.S.S ; R.R.S ; Vaidya Jeevana ; Rasaidriya Sangra

PATHYA APATHYA

1. Ch..Su.25/45

2. Ch. Vi 1/21

3. Ch. Vi 1/24

4. Ch. Vi 1/24-6-8

5. Anita Varghees etal. [2000]

DYSPEPSIA

1. Davidson’s principles and practice of medicine. Ch. 17

2. Medical Dictionary

3. Principal of Internal Medicine by Harrison.

4. Davidson’s principles and practice of Medicine. Ch 17.

5. Davidson’s principles and practice of Medicine. Ch 17

6. Principal of Internal Medicine by Harrison





11. Principal of Internal Medicine by Harrison 11b] Principal of Internal

Medicine by Harrison part II.




15. Davidson’s principles and practice of Medicine. chapter 20



18. Principal of Internal Medicine by Harrison


20. 5 Minute Clinical Assist – CIMS

Drug review -

1. Ch. Su. 4

2. Su.Su. 38

3. D.G.Vol - III

4. R.R.Samu 2/9

5. R.R.Samu 2/10

6. R.R.Samu 2/16-17

7. R.R.Samu 2/22

8. Ch. Su. 13/25.

9. Ch. Su 27/231

10. Ch. Su 13/18

11. Yoga Ratnakara. Pu. Ar. Rutu charya.

12. Ch. Vi. 1

13. Yoga Ratnakara. Pu. Ar. Rutu charya.

14. Ch. Vi. 1

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; Revised 10th edition 1987, Published by Popular prakashan private Ltd. Bombay.

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Chaukambha Orientalia, Varanasi

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Sri Dalhana Acharya and Nyaya Chandrika Panjika of Sri Gayadasacharya ; ed. by

Vaidya Yadavji Trikamji Acharya and Narayan Ram Acharya ; Reprinted edition

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Varanasi

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Arunadutta and Ayurveda Rasayana of Hemadri, ed. by Pandit Bhishak Acharya,

Harishastri Paradkar Akoln ; 8th edition, 2000 ; Chaukamba Orientatlia Varanasi,

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2000].

Department of Kayachikitsa

A.L.N.R.M.A.Medical College, Koppa-577126

A CLINICAL STUDY ON THE EFECT OF SHATAVARI CHOORNA WITH

ABHRAKA BHASMA IN THE MANAGEMENT OF AMLAPITTA

CLINICAL PROFORMA

Patient Name: Group:

Age/Sex: .......yrs M/F Sl. No:

Religion: H/M/CH/J OPD/IPD:

Education: UE/P/M/HS/GR/ Ward/Bed No:

Marital status: M/UM/W/D D.O.A./D.O.D:

Socio Economic status: VP/P/LM/M/UM/R Diagnosis:

Occupation: HW/L/B/S/E Result:

Postal Address:

Chief Complaints Duration BT AT AFU

1. Utklesha:

2. Amlodgara

3. Hrtdaha

4. Kantadaha

5. Udarashoola

6. Vanti

Colour:

Consistency:

Contents:

Taste

II. Associated complaints:

1. Avipaka:

2. Klama

3. Tiktodgara:

4. Gourava:

5. Aruchi:

6. Gurukoshtatha

7 Adhamana

8 Antrakujana

9. Sirasula:

III. History of present illness:

A) Onset : Sudden / Gradual

B) Aggravating Period : Mid-day/Mid-night/Morning

C) Environmental factor : Rainy / Summer / Autumn / Winter

IV. History of past illness:

V. Drug History:

VI. Family History:

VII. Personal history:

1. Ahar (Diet) :

a) Virudhha Ahar : Yes / No

b) Pittaprakopaka Yes / No

c) Vidahianna Yes / No

d) Amlarasapradhana Yes / No

e) Abhishyandhi Yes / No

f) Atibhojana Yes / No

g) Nature : Veg/Mix

h) Habits: Samasana/Visamasana/Adhyasana/Anasana/Pramitasana

i) Rasapradhana: M/A/L/K/T/KS/Sarva rasa

j) Guna Pradhana: U/St/G/L/S/R/T/M

k) Supplimentary diet: Tea/coffee/Milk/cold drink

l) Water intake: Every morning, During or after lunch & dinner

Day or night .......... ltr total

2. Vihara (Regimen)

a) Diwaswapna Yes / No

b) Vegadharana Yes / No

c) Avagahana Yes / No

d) Atapasevana Yes / No

3. Manasika (Psychological factors)

Mental Stress/ Strain Present / Absent

4. Addictions: Smoking/Tobacco chewing/Alcohol/Narcotics/No habits

5. Exercise: Regular/Irregular/occasional/only routine work.

6. Sleep: Sound/Irregular/Disturbed/Delayed

Night...........Hrs Day:.........Hrs

7. Bowel: Regular/Irregular/constipation/Loose /Soft/Constipated

No.of frequency ........./times.........days

8. Micturation: Regular/Irregular ........times/day .......times/night

6. Occupational history: Sedentary/moderate/Heavy

a) Nature of work:Physical/mental

b) Time of work:Day/Night/Day Night .........Hrs

7. Social history:

Hygienic condition of residence: Poor/Moderate/Good

8. Gynacological history:

VIII. Atura Bala Pariksha:

i) Prakriti :

Sharira : V/P/K/VP/VK/PK/VPK

Manas : S/R/T

ii) Sara : Pravara /Madhayama /Avara

iii) Samhana : Pravara /Madhayama /Avara.

iv) Satva : Pravara /Madhayama /Avara

v) Satmya : Pravara /Madhayama /Avara

vi) Pramana : Height ......ft

Weight ...... Kg: (BT).......Kg:(AT)

vii) Ahara shakti :

Abhyavaharan shakti : Pravara /Madhayama /Avara

Jarana shakti : Pravara /Madhayama /Avara

Agni : Sama/Visama/Manda/Tikshna

Kostha : Mridu/Madhyama/Krura

viii) Vyayama shakti : Pravara /Madhayama /Avara

ix) Vya : Bala/Madhyama/vridda

x) Desha : A/J/S

xi) Vikrititaha : Pravara /Madhayama /Avara

IX. General Examination: BT AT

Pulse rate:

Respiration rate:

Temp:

B P:

X. Systemic Examination.

RS:

CVS:

CNS:

GIT:

Inspection:

Mouth : Stomatitis/Other/Normal

Shape : Distended/Scaphoid/Bulging of flanks/Normal

Umbilicus : Inverted/Everted/Normal

Surface : Smooth/Glossy/scar/wrinkles/Pigmentation/striae

Asymetrical Bulging : Epigastric/Hypogastric/Umbilical/lumbar/

Hypocondriac/Illiac/None

Movement : Symetrical/ Asymetrical

Pulsation : Visible/Invisible

Palpation : Superfical-Region of tenderness...............

Hyperasthesia:Present/Absent/Site...........

Muscle guard:Rigid/Normal

Liver : Palpable/Tender/Normal

Spleen : Palpable/Tender/Normal

Kidney : Palpable/Tender/Normal

Colon : Palpable/Tender/Normal

Any Other Mass : Present/Absent

Percussion:

XI. Srotas Examination:

Annavaha Srotas : Aruchi/Avipaka/Chardi/Anannabhilasha/Prakrita

Rasavaha scotas : Angasad/Praseka/Alasya/Gaurava/Bhrama

Sosha/Glani/Pandu/Asraddha/Asyavairasya

Arasagnata/Prakrita

Purishavaha srotas :

Atridrava/Atigrathita/Bahula/Alpalpa/Sasabda/Sasula

malapravritti/Prakrita

Other Srotas : Prakrita/Vaikrita

XII. Laboratory Investigations:

1.Heamatoligical: Hb%

Total count-

Differential count:

Neutrophils- Lymphocytes-

Monocytes- Basophils-

Erythrocyte Sedimentation Rate:

2. Urine: Albumin

Sugar

Microscopy

3. Stool: Ova and Cysts Present/Absent

4.Endoscopy ( If Necessary ):

5. Any Relevant Investigation :

Untoward Symptoms:

Comments:

Grading No Sign/symptom: 0 Mild : 1

Moderate : 2 Severe : 3

Signature of Guide Signature of scholar

chart no. 2 Showing the classification of Nidanas of Amlapitta NIDANAS

I. Agnidustikara II. Pittaprakopaka III. Vataprakopaka IV. Kaphaprakopaka Ahara Vihara Ahara Vihara * Abhojana * Bhukte Bhukte snana * Atibhojana * Bhukte Bhukte avagaha * Rooksha atisevana * Vegadharana * Ajeerna * Bhukte Bhukte diwaswapna * Brista atisevana * Viruddhasana * Vishamashana * Dushta bhojana Ahara Vihara Ahara Vihara * Adhyasana * Apakwa atisevana * Katurasa atisevana * Ushna desha * Snigdha atisevana Diwaswapna * Snigdha atisevana * Amlarasa atisevana * Ushna kala * Guru atisevana * Guru atisevana * Lavanarasa atisevana * Pista atisevana * Pishta atisevana * Kulatha atisevana * Gorasa atisevana * Ikshuvikara atisevana * Ushna atisevana * Panita atisevana * Gorasa atisevana * Drava atisevana * Panita atisevana * Madhya atisevana

FRUITS – Yes

Generally most

sweet fruit

FRUITS – No

Generally most sour

fruit

VEGETABLES – Yes

Generally most sweet &

bitter vegetables

VEGETABLES –

No Generally most

pungent vegetables

• Apples [sweet] • Apples [sour] • Artichoke • Beet greens

• Applesauce • Apricots [sour] • Asparagus • Beets raw

• Apricots [sweet] • Bananas • Beets [cooked] • Burdock root

• Avocado • Berries [sour] • Bitter melon • Corn [fresh]**

• Berries [sweet] • Cherries [sour] • Broccoli • Daikon radish

• Cherries [sweet] • Cranberries • Brussels sprouts • Eggplant **

• Coconut • Grapefruit • Cabbage • Garlic

• Dates • Grapes [green] • Carrots[cooked] • Green chilies

• Figs • Kiwi ** • Carrots [raw]* • Horseradish

• Grapes [red&

purple]

• Lemons

• Mangos [green]

• Cauliflower

• Celery

• Kohlrabi**

• Leeks [raw]

• Limes * • Oranges [sour] • Cilantro • Mustard greens

• Mangoes [ripe] • Peaches • Cucumber • Olives, green

• Melons • Persimmons • Dandelion greens • Onions [raw]

• Oranges [sweet] • Pineapple [sour] • Fennel [anise] • Peppers [hot]

• Papaya * • Plums [sour] • Green beans • Prickly pear

[fruit]

• Pears • Rhubarb • Jerusalem • Radishes [raw]

Artichoke

• Pineapple [sweet] • Strawberries • Kale • Spinach

[cooked]**

• Pomegranates • Tamarind • Leafy greens • Spinach [raw]

• Prunes • leeks [cooked] • Tomatoes

• Raisins • lettuce • Turnip greens

• Watermelon • Okra • Turnips

• Olives, black

• Onions [cooked]

• Parsley

• Parsnips

• Peas

• Peppers, sweet

• Potatoes, sweet &

white

LEGUMES – Yes LEGUMES – No DAIRY –Yes DAIRY – No

• Aduki beans • Miso • Butter [unsalter] • Butter [salted]

• black beans • soy sauce • cheese [soft, not

aged, unsalted]

• buttermilk

• black-eyed peas • soy sausages • cottage cheese • Cheese [hard]

• Chick peas • Tur dal • Cows milk • Sour cream

[garbanzo

beans]

• Kidney beans • Urad dal • Ghee • Yougurt [plain,

frozen or with

fruit]

• Lentils, brown

& red

• goats cheese [soft

& unsalted]

• Lima beans • goats milk

• Mung beans • ice cream

• Mung dal • yogurt [freshly

made &diluted]*

• Navy beans

• Peas [dried]

• Pinto beans

• Soy beans

• Soy Cheese

• Soy flour*

• Soy milk

• Soy powder

• Split peas

• Tempeh

• Tofu

• White beans

GRAIN –Yes GRAINS –Yes BEVERAGES –Yes BEVERAGES –Yes

• Amaranth • Bread [with

yeast]

• Almond milk • Apple cider

• Barley • Buckwheat • Aloe vera juice • Berry juice [sour]

• Cereal, dry • Corn • Apple juice • Caffeinated

• Couscous • Millet • Apricot juice • Caffeinated

beverages

• Crackers • Muesli** • Berry juice [sweet] • Carbonated drinks

• Durham flour • Oats [dry] • Black tea • Carrot juice

• Granola • Polenta ** • Carob • Cherry juice [sour]

• Oats

[cooked]

• Rice [brown]** • Chai [hot, spiced

milk]*

• Chocolate milk

• Pancakes • Rye • Cherry juice • Coffee

• Pasta • Cherry juice [sweet] • Cranberry juice

• Rice

[basmati,

white, wild]

• Cool dairy drinks • Grapefruit juice

• Rice cakes • Grain “coffee” • Iced tea

• Sago • Grape juice • Iced drinks

• Seitan [wheat • Mango juice • Lemonade

meat]

• Spelt • Miso broth* • Papaya juice

• Sprouted

wheat bread

[essene]

• Mixed veg. juice • Tomato juice

• Tapioca • Orange juice* • Sour juices

• Wheat • Peach nectar Hearb Teas:

• Wheat bran • Pomegranate juice • Ajwan

• Prune juice • Basil**

• Rice milk • Cinnamon *

• Soy milk • Clove

• Vegetable • Eucalyptus

Bouillon • Fenugreek

• Ginger [dry]

Herb Teas: • Ginseng

• Alfalfa • Hawthorne

• Bancha • Hyssop

• Barley • Juniper berry

• Blackberry • Pennyroyal

• Borage

• Burdock

• Catnip

• Chamomile

NUTS – Yes NUTS – No SEEDS – Yes SEEDS – No

• Almonds [soaked

and peeled]

• Almonds [with

skin]

• Flax • Chia

• Charole • Black walnuts • Halva • Sesame

• Coconut • Brazil nuts • Popcorn [no salt,

buttered]

• Tahini

• Cashews • Psyllium

• Filberts • Pumpkin *

• Hazelnuts • Sunflower

• Macadamia nuts

• Peanuts

• Pecans

• Pine nuts

• Pistachios

• Walnuts

OILS – Yes

For internal &

external use : [most

OILS – No SPICES – Yes SPICES – No

suitable at top of

list]

• Sun flower • Almond • Basil [fresh] • Ajwan

• Ghee • Apricot • Black pepper* • Allspice

• Canola • Corn • Caraway* • Almond extract

• Olive • Safflower • Cardamom * • Anise

• Soy • Sesame • Cinnamon • Asafetida [hing]

• Flax seed • Coriander • Basil [dry]

• Primrose • Cumin • Bay leaf

• Walnut • Curry leaves • Cayenne

• Dill • Cloves

• Fennel • Fenugreek

External use only • Ginger [fresh] • Garlic

• Mint • Ginger [dry]

• Avocado • Neem leaves* • Mace

• Coconut • Orange peel* • Marjoram

• Parsley* • Mustard seeds

• Peppermint • Nutmeg

• Saffron • Oregano

• Spearmint • Paprika

• Tarragon* • Pippali

• Turmieric • Poppy seeds

• Vanilla* • Rosemary

• Wintergreen • Sage

• Salt

• Savory

• Star anise

• Thyme

CONDIMIENTS –

Yes

CONDIMENTS –

No

SWEETENERS –

Yes

SWEETNERS –

No

• Black pepper* • Chili pepper • Barley malt • Honey ** [raw

& not

processed]

• Chutney, mango

[sweet]

• Chocolate • Fructose • White sugar **

• Coriander leaves* • Chutney, mango

[spicy]

• Fruit juice

concentrate

• Jaggary

• Dulse* • Gomasio • Maple syrup • Molasses

• Hijiki • Horseradish • Rice syrup • Molasses

• Kombu * • Kelp • Sucanat

• Lime * • Ketchup • Turbinado

• Sprouts • Mustard

• Tamari * • Lemon

• Lime pickle

• Mayonnaise

• Pickles

• Salt [in excess]

• Scallions

• Seaweed

• Soy sauce

• Vinegar

FOOD SUPPLEMENTS – Yes FOOD SUPPLEMENTS – No

• Aloe vera juice • Amino acids

• Barley green • Bee pollen**

• Brewer’s yeast • Royal jelly **

• Minerals: calcium, magnesium, zinc • Minerals: copper, iron, vitamin

A,B,B12 & C

• Spirolina

• Blue-green algae

• Vitamins D & E

Amlapitta kc007 kop

Documents

onset wise

religion wise

diet wise

sex wise distribution

age wise distribution

exercise wise

occupation

meals thrice