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A CLINICAL STUDY ON THE EFFECT OF SHATAVARI CHOORNA WITH ABHRAKA BHASMA IN THE MANAGEMENT OF AMLAPITTA , Pratibha.C.Hullur , PG Studies in Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College ...

A CLINICAL STUDY ON THE EFFECT OF SHATAVARI CHOORNA WITH ABHRAKA BHASMA IN THE MANAGEMENT OF AMLAPITTA , Pratibha.C.Hullur , PG Studies in Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P. G. Centre, Koppa.

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Amlapitta kc007 kop Amlapitta kc007 kop Document Transcript

  • BY Dr. Pratibha.C.Hullur BAMS (K.U.Dharwad) Dissertation submitted to theRajiv 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
  • Department of Post Graduate A.L.N.Rao Memorial AyurvedicStudies in KAYACHIKITSA Medical College Koppa – 577126 Dist: Chikmagalur 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: Dr. Pratibha.C.Hullur Place: Koppa P.G.Scholar, Dept. of Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126
  • Department of Post Graduate A.L.N.Rao Memorial AyurvedicStudies in KAYACHIKITSA Medical College Koppa – 577126 Dist: Chikmagalur 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: Guide: Place: Koppa 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
  • Department of Post Graduate A.L.N.Rao Memorial AyurvedicStudies in KAYACHIKITSA Medical College Koppa – 577126 Dist: Chikmagalur 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: Dr.Jagadeesh Kunjal Place: Koppa 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 thisdissertation in print or electronic format for academic/research purpose.Date: Dr.Pratibha.C.Hullur P.G.Scholar, Dept. of Kayachikitsa,Place: A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126© Rajiv Gandhi University of Health Sciences, Karnataka
  • INDEX Page No. INTRODUCTION 1-2Chatper – I OBJECTIVES 3Chapter – 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 70-79Chapter –III METHODOLOGY Materials and Methods 80-90 Observations 91-116Chapter –IV RESULTS 117-132Chapter –V DISCUSSION 133-147Chapter –VI CONCLUSION 148-149 SUMMARY 150-152 BIBLIOGRAPHY ANNEXURES
  • LIST OF TABLESSl. No SUBJECT PAGE NO 1. Showing pitta guna 14 2. Guna-karma vivecana 21-22 3. Showing the lakshanas of amlapitta mentioned by different 41 authors 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 54 Amlapitta 10. Showing Pathya apathya 57-58 11. Distinguishing between functional and organic/structural disease 66 of gastrointestinal tract. 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 93 patients 17. Showing the Educational status wise distribution of 60 Amlapitta 94 patients 18. Showing the socioeconomic status wise distribution of 60 95 Amlapitta patients 19. Showing the Occupational status wise distribution of 60 Amlapitta 96 patients 20. Showing the onset wise distribution of 60 Amlapitta patients 96 21. Showing the Aggravating period wise distribution of 60 Amlapitta 97 patients
  • 22. Showing the Incidence Aggravating of symptoms due to 98 environmental factors in 60 Amlapitta patients23. Showing the Habitat status wise distribution of 60 Amlapitta 98 patients24. Showing the Dietary habit wise distribution of 60 Amlapitta 99 patients25. Showing the Ahara vidhi wise distribution of 60 Amlapitta 99-100 patients26. Showing the Type of diet wise distribution of 60 Amlapitta 100 patients27. Shows Rasa Satmya wise distribution of 60 Amlapitta patients 10128. Showing the Regimen wise distribution of 60 Amlapitta patients 10229. Showing the Mental stress/strain wise distribution of 60 Amlapitta 102 patients30. Shows incidence of Addictions in 60 Amlapitta patients 10331. Showing the Exercise wise distribution of 60 Amlapitta patients 10432. Shows incidence of nidra in 60 Amlapitta patients 10533. Shows Bowel habit wise distribution of 60 Amlapitta patients 10534. Shows Nature of stool wise distribution of 60 Amlapitta patients 10635. Shows Type of occupation wise distribution of 60 Amlapitta 107 patients36. Shows Nature of work wise distribution of 60 Amlapitta patients 10737. Shows incidence of Deha prakriti in 60 Amlapitta patients 10838. Shows Sara wise distribution of 60 Amlapitta patients 10939. Shows Samhanana wise distribution of 60Amlapitta patients 10940. Shows Satva wise distribution of 60 Amlapitta patients 11041. Shows Agni wise distribution of 60 Amlapitta patients 11142. Shows Koshta wise distribution of 60 Amlapitta patients 11143. Shows Bala wise distribution of 60 Amlapitta patients 11244. Shows Desha wise distribution of 60 Amlapitta patients 11345. Shows Duration of Illness wise distribution of 60 Amlapitta 113
  • patients 46. Shows Samanya lakshana wise distribution of 60 Amlapitta 114 patients 47. Shows Associated symptom wise distribution of 60 Amlapitta 115 patients 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 GRAPHSSl.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 94 patients 6. Showing the socioeconomic status wise distribution of 60 Amlapitta 95 patients
  • 7. Showing the Occupational status wise distribution of 60 Amlapitta 96 patients8. Showing the onset wise distribution of 60 Amlapitta patients 979. Showing the Aggravating period wise distribution of 60 Amlapitta 97 patients10. Showing the Incidence Aggravating of symptoms due to 98 environmental factors in 60 Amlapitta patients11. Showing the Habitat status wise distribution of 60 Amlapitta patients 9912. Showing the Dietary habit wise distribution of 60 Amlapitta patients 9913. Showing the Ahara vidhi wise distribution of 60 Amlapitta patients 10014. Showing the Type of diet wise distribution of 60 Amlapitta patients 10115. Shows Rasa Satmya wise distribution of 60 Amlapitta patients 10116. Showing the Regimen wise distribution of 60 Amlapitta patients 10217. Showing the Mental stress/strain wise distribution of 60 Amlapitta 103 patients18. Shows incidence of Addictions in 60 Amlapitta patients 10419. Showing the Exercise wise distribution of 60 Amlapitta patients 10420. Shows incidence of nidra in 60 Amlapitta patients 10521. Shows Bowel habit wise distribution of 60 Amlapitta patients 10622. Shows Nature of stool wise distribution of 60 Amlapitta patients 10623. Shows Type of occupation wise distribution of 60 Amlapitta patients 10724. Shows Nature of work wise distribution of 60 Amlapitta patients 10825. Shows incidence of Deha prakriti in 60 Amlapitta patients 10826. Shows Sara wise distribution of 60 Amlapitta patients 10927. Shows Samhanana wise distribution of 60Amlapitta patients 11028. Shows Satva wise distribution of 60 Amlapitta patients 11029. Shows Agni wise distribution of 60 Amlapitta patients 11130. Shows Koshta wise distribution of 60 Amlapitta patients 11231. Shows Bala wise distribution of 60 Amlapitta patients 11232. Shows Desha wise distribution of 60 Amlapitta patients 11333. 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 116 patients 36. Shows Srotodusti wise distribution of 60 Amlapitta patients 116 37. Showing comparative effect of therapies on main symptoms after the 126 treatment 38. Showing comparative effect of therapies on main symptoms after 127 follow up 39. Showing comparative effect of therapies on associated symptoms 128 after the treatment 40. Showing comparative effect of therapies on associated symptoms 129 after follow up 41. Showing comparative effect of therapies on srotodusti after the 130 treatment 42. Showing comparative effect of therapies on srotodusti after follow 130 up 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 202. Showing the classification of Nidanas of Amlapitta 243. Schematic Representation of Samprapti of Amlapitta 314. Schematic Representation of Samprapti on basis of Kriyakala 375. Schematic Representation of Vicious circle formed in Amlapitta 376. Schematic Representation of manifestation of symptoms 407. Schematic Representation of Classification according to different 47 Authors
  • ABBREVIATIONSA.T After treatmentAs.Hri Ashtanga hridayaAs.San Ashtanga sangrahaB.T Before treatmentBa.Pr Bhava prakashaBh. Bhela samhitaCh CharakaCh Su Charaka sutraChi Chikitsa sthanaDM Digestion and MetabolismHa Harita samhitaKha.Sam Kashyapa samhitaMa. Ni Madhava nidanaMa.Kha Madhyama khandaNi Nidana sthanaSha Sam Sharangadhara samhitaSa Sharira sthanaSu Su Sushruta samhita sutra sthanaVi Vimana SthanaUt Uttara TantraV.S Vanga senaY.R Yoga RatnakaraB.R Baishajya RatnavaliD.G Dravya GunaO.T.P Oxford Text book of PathologyR.R.S Rasa Ratna SammuchayaC.S.S Chikitsa Sara Sangraha
  • ABSTRACT Amlapitta has become one of the common problems today due to the change inlifestyle. 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 indiscriminationand mental stress and strain. A good member of medicines have been mentioned as themodern medicines for the management of Amlapitta, but their merits trail. Amlapitta is a pitta pradhana disease of the annavaha stotas caused due tomandagni, ama and annavaha sroto dusti. It is characterized by Amlodgara, Utklesha andHrtkanta daha indicating the vikruthi of pachakapitta along with the kledaka kapha andsamana vayu. the patho-physiology of the Amlapitta states it to be a diseases caused dueto functional disturbance rather than organic lesion. While describing the progonosis ofAmlapitta, it has been stated that it can be cured easily if promptly treated at the earliestwith proper pathyapthya. A larger number of yoga have been mentioned in Ayurveda in the management ofAmlapitta, among which “Shatavari Choorna” and “Abhraka Bhasma” are among thecommonly used ingredients. In the present study an attempt is being made to understand the pathophysiologyof the diseease in principles of Ayurveda and also to control and treat the disease with asimple 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 forthe study. Among them 4 patients dropped out. Hence, the study was conducted on thereaming 60 patients. The patients were randomly grouped into two groups i.e. trial groupand 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 aduration 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 wereobserved 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 1month, the observations which were recorded were subjected to statistical analyses. Itwas found that the trial group showed highly significant relief [p<0.001 to p<0.010] inalmost all the patients in their presenting complaints after treatment and highly significantto moderately significant relief even after the fallow-up. Whereas, the control drugshowed highly significant to moderately significant relief in all the presenting complaintsafter the treatment but the reccurence of symptoms was observed after follow-up.Traildrug showed more number of improved cases,whereas the control drug showedcontrolled effect in more number of cases after the follow-upConclusion: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 whohelped me in bringing out this work. Its my great pleasure to confirm my gratitude to my teacher and uncleDr.S.S.Hosmani. Retd. Principal Sri B.M.Kankanwadi AyurvedaMahavidhyalaya. Belgaum. who has been my inspiration to step into the field ofAyurveda. 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 throughoutthis 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 esteemedinstitution. I am grateful to Dr. Jagdeesh Kunjal M.D [Ayu.]Principal,A.L.N.Rao Memorial Ayurvedic College, Koppa, for his help andsupport, 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 toKayachiktsa , 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 fortheir help in my initial days of work and in preparing the base work for the presentstudy. My sincere gratitude to Prof. D.S. Lucas, M.D [Ayu.] FRAS[London] FRAV [India], H.O.D. Department of Dravyaguna for hismotivational inspiration and support. I am grateful to Dr. S.M. Shanbhag; M.B.B.S. Dr. LalithaBhaskar. 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 thepatients and during the study. I immensely thank Dr. Dinesh Kumar Mishra, Reader Dept. of Rasashastra and Bhaishajya Kalpana for his co-operation in preparing the medicinefor the trial, and also his suggestions. At this juncture, I take the opportunity tothank Mr. Mathew, Mr. Nityananda and Miss Violet, who took the pain inpreparing the medicine for the trial in a short duration of time. I am thankfull to Dr. Kajrekar, M.D [Ayu] Belgaum for helping me ingetting 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 collectingthe 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 AyurvedicMedical College Koppa, for their timely suggestions and help. My heartfelt thanks to Dr. Prasanna Kerur M.D.[Ayu] Dept ofKayachikitsa, S.D.M. Ayurveda College, Hassan; because of whom I was ableto pursue my P.G. studies. I am grateful to Dr. Mangalgi M.D [Ayu] H.O.D Dept ofKayachikitsa. Mysore and Dr. [Mrs.] Aruna. Mangalgi M.D. [Ayu] Deptof Kayachikitsa. Mysore for helping me to collect the study material and use theP.G. Library at Mysore. I am thankful to Dr. Rangesh Parmesh. M.D [Ayu] R&D. TheHimalaya Drug Company for helping me to get information regarding some recentstudies 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. RaoMemorial Ayurvedic Medical College for there help during my work.
  • I am thankful to Mrs. Jyotsna for her valuable help in conductinglaboratory investigations. I am grateful to Mr. Satish H.D Librarian and Miss Triveni who helpedme a lot in my reference work. I also thank Sri, Ramesh Gowda and Mrs. Jyothifor 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 hishelp. 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 mein 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. KrishnaKishore; Dr. Pankaj Prasad and Dr. Parthasarthy for their support and help incompleting 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. fortheir kind co-operation during my study. My heartfelt thanks to Dr. H.R. Pradeep M.D [Ayu] and his family fortheir moral support during my stay and also in my work. I am gratefull to Dr.Mangalagouri Rao,M.D [Ayu] andDr.Elizebeth.P.Johan M.D[Ayu]. A.L.N. Rao Memorial Ayurvedic MedicalCollege and my student Dr.Pratibha.Hegde for their help and moral supportduring my work.
  • I am thankful to Mr. Shreedhar Gowda and Miss.Sujaya for heirfriendly help in typing, editing and speedy completion of this dissertation work. I am indebted to my parents whose blessings, affection and encouragementhelped me to complete my work. I owe my salutation and thanks to them. I amgrateful to my brothers for their love, support and encouragement. Finally thanks to all those people who helped me directly and indirectly tocomplete this work.Date :Place : Dr. Pratibha C. Hullur.
  • Introduction INTRODUCTION Ayurveda is known to be one of the oldest scientific medical systems in theworld. Kayachikitsa is one of the important eight major specialties of Ayurveda whichcorresponds to general medicine. Its defined as ‘antaragni chikitsa’ by Chakrapaniduttawhich involves both digestive and metabolic disturbances. The therapeutic principles ofAyurveda 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 becomesthe 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 arecaused 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, alongwith sophistications and indiscriminate dietary habits has strong influence over theannavaha srotas leading to various diseases among which Amlapitta is one such. Amlapitta, being a disease of Annavaha srotar is a psycho-somatic disordercaused due to mandagni and vitiation of pitta. i.e. pachaka pitta. This presents a group ofsigns and symptoms viz Avipaka [Indigestion], Amlodgara [Acid eructation], Hrtdaha[Heart burn], Kanta daha [Burning in throat] Utklesha [Nausea] etc. which has a startlingsimilarities 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 toqualitative and quantitative increase of pachaka pitta especially in its amla and dravaguna 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 disorderswith no evidence of any organic lesions. 1
  • Introduction Dyspepsia is extremely prevalent, affecting up to 80% of the population at sometime, and very often no abnormality is discovered during investigations especially inyounger patients [< 40 years of age]. Hence, most of the patients fall under Non-Ulcersdyspepsia / functional dyspepsia. Women are said to be affected twice as commonly asmen. As proper pathogenesis is not established its termed as functional disorder andthought to be due to mucosal or motility disorder or psychological disturbances, drugs orhabits. These factors have been highlighted in the Ayurvedic science as the prime factorsfor the manifestation of Amlapitta. Hence to over come this, the trial drug Shatavarichoorna and Abhraka Bhasma with gritha was selected. A large mumber of yogas have been mentioned in classics for the management ofAmlapitta, among which the “Shatavari Choorna” and “Abhraka Bhasma” are one of theingredients in these yogas. Hence, an attempt has been made in this study to assess theefficacy of this simple, safe, easy to administer herbo mineral combination in themanagement of Amlapitta. The diagnosis of the disease Amlapitta is done on the basis of classical signs andsymptoms. 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 inthe management of Amlapitta and to provide a better, and simple herbo-mineralcombination. 2
  • Objectives 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.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. 3
  • Review of literature – Disease review CHAPTER-3 REVIEW OF LITERATURE A. DISEASE REVIEW The chronological description of the disease Amlapitta offers a very intrestingpictures about its evolution .The review of the vedic literature shows no suggestiveevidence of Amlapitta described in vedic period , but some passing references can beseen .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 Amlapitta2. In Garuda purana a passing reference to this disease and its treatment is found in the chapter of Nadivrana chikitsa3. The term “Shoola” an important feature of Amlapitta is that mentioned in Kaushika 1 sutra of Atharva vedaSAMHITA KALAIn 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 2 roga , Amlapitta etc.b) Kulatha has been mentioned as chief etiological factor for Amlapitta3c) While stating the effects caused due to excessive use of lavana rasa, there is a 4 mention that it provokes pitta , lohita pitta, amlapitta etc. 4
  • Review of literature – Disease review 5d) Amlapitta is also mentioned in the context of illeffects of vidhi virudha ahara sevana.e) Rajamasha is more beneficial in Amlapitta disorder.6f) While describing grahani dosha , pathogenesis of Amlapitta has been 7 clearly mentioned . 8g) Mahatikthaka gritha has been indicated in Amlapitta.h) While explaining the pittaja nantamja diseases the terms Dumaka 9 Amalaka and Vidaha have been mentioned which are seen in Amlapitta.i) Indications of Kansa Haritaki also includes Amlapitta. 10In Sushrutha Samhita : The term Amlapitta or the desription the disease has not been mentioned inSushrutha samhita . In Bhela samhita there is no any reference about this disease. 11 Vaghbhata has mentioned that excessive use of kulatha causes Amlapitta . In Harita samhita no description of Amlapitta is found. Kashyapa samhita first describes Amlapitta as a seperate disease entity in 12 khilasthana .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 andalso some original texts were written. In Baudha sarvaswa [Baudha literature] only the treatment of Amlapitta is mentiond. 5
  • Review of literature – Disease review 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 13 respect to nidana , lakshanas and bheda in 51th chapter. 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. 6
  • Review of literature – Disease review NIRUKTI , PARIBHASHA AND PARYAYA OF AMLAPITTANIRUKTI The word Amlapitta connotes the pathological change in humour pitta found inthis disease. Literally it means that the pitta is of sour taste. An attempt has been made inthe 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 oneof the properties of pitta. According to Charaka, the natural quality of pitta is said to be both Amla andKatu 1. It may be mentioned here that the sour taste of pitta has been considered as thephysiological property of pitta 2 . The justification for the use of the word as an adjectiveof 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 itattains vidagadhata it changes into amla3 . Hence it can be interpreted that the pitta in itsnirama 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 toburn or to warm 4 . This term seems to have three meaning ie. tap santape, tap dahe andtap 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 thewords furnish the Vyakarna version of the term pitta. 7
  • Review of literature – Disease review 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 ofpitta gets augmented, and consequently in turn disturbs the doshic equilibrium of thebody especially of pitta dosha.PARIBHASHA Chakrapani in his commentary on charaka samhita defines amlapitta as. 5 “ Amlapittam cheti amlagunoundriktam pittam”The augmented or increased amla guna of pitta is known as Amlapitta. Srikantadutta in his Madhukosha vyakya defines 6 “ Vidahadhyamla gunaoundrikta pittam amlapittam” . That is, the pitta becomes augmented or vidagdha because of excessive increaseof amla guna of pitta and 7 “ Amlam vidagdham cha tat pittam amlapittam”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 8 “ Amlaya Pittam Amlapittam “ Amlapitta is a disease where pitta attains sour taste. In this condition whatever iseaten is transformed into amla rasa due to pathological pitta. Sushrutha has also cited a reference to this fact that disorders of pitta of annavaha 9 srothas may lead to vidaha of food. According to Sanskrit dictionary [ viswakors] 10 “ Amlath ajeernath yat pittam amlapittam “ Amlapitta is a condition caused due to the increased sourness of pitta andimproper or ill digestion of the food. The same has been explained in Charaka where hequotes that the impaired agni is unable to digest even the lightest food and hence the 8
  • Review of literature – Disease reviewundigested food particles turns sour due to fermentation and leads to formation of 11annavisha. This annavisha combines with pitta and produces amlapittam. According to Kashyapa the vidagdha annarasa turns to shukta, this shukta annarasa is 12 retained in amashaya combines with the vrudda pitta and produces amlapitta. 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 13 [fried] and pitta provokating foods and drinks. These two definations to a certain extent speak of nindana and samprapti of thedisease.PARYAYAThe paryayas (synonyms) of amlapitta signify different aspects of it. Indu15 in hiscommentary on Ashtanga Sangraha has given synonyms of amlapitta as Prameelaka Amlapitta Pittavisuchika Yogaratnakara16 and Kashyapa17 have used the term pittamla and shuktatarespectively,as synonyms of amlapitta,though they have not directly stated so. The terms Amalaka and Amleeka may be added as synonyms to the above forthey imply the important features of the disease. Thus from the above,the following terms can be tsken as importsnt synonyms ofAmlapitta.They are;* Prameelaka * Amlapitta * Pittavisuchika * Pittamla* Shuktata * Amalaka * AmleekaPrameelaka: The pachyamana vidagdha annarasa immediately provokes pittadi doshas, thereby producing mukha vairasyat, hrtshula, sadana, continous lavana tiktamla, chardi, 9
  • Review of literature – Disease reviewdiscolouration, emaciation, distaste, restlessness and watering of mouth. This stateswhere all symptoms is spoken of as Prameelaka18.In Ashtanga sangraha we find this termmentioned under kaphaja vyadhis.Amlapitta: The implication of the term amlapitta signifies the abnormal state of pittaespecially in its amlaguna.Pittavisuchika: This may pertain to both the types of amlapitta. i.e. Urdhvagha and Adhogaamlapitta where, their respective cardinal features are urdhvagha pravruthi(vamana) andadhapravruthi (Atisara) of pitta associated with burning sensation.Pittamla: This term would imply the sense of the term amlapitta which is mentioned inamlapitta chikitsa in Yogaratnakara.Shuktata: Shuktata is mentioned as synonym of amlapitta in Kashyapa samhithaKhilasthana 16th chapter.Amalaka: It refers to one of the nanatmaja vyadhis of pitta mentioned in the context of pittananatmaja vyadhis19Amaleeka : 21 Means amlodgara and would refer to one of lakshana of samapitta. As stated above these synonyms would refer to different aspects of the abnormalstates of pitta. The similar symptom complex is considered as functional dyspepsia in modernmedicine, which will be discussed later. 10
  • Review of literature – Disease review ANATO -PHYSIOLOGICAL CONSIDERATION OF ANNAVAHA SROTAS To discreen the abnormal, it is necessary to thoroughly know the normal1. So, alsohere the rachana and kriya sarira pertaining to the main site of pathology . i.e Annavahasrotas is being elaborated .Anatomical Considerations: The Mahasrotas corresponding to the alimentary tract is immediately concernedwith the process of alimentation [ ingestion and egestion ]. Mahasrotas is also spoken of 2as kosta. The term kosta has several Synonyms Viz1. 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 , 3vrikka, basti, pureeshadhara, amashaya, uttaraguda, adhoguda , kshudrantra, sthoolantra . It would seem from the above that there is a mixup in the enumeration of theanatomical and functional parts especially the kostangas which can be classified asfollows 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 : 4 Amashaya with its two parts Viz1) 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, 11
  • Review of literature – Disease review 5Phuphusa . This description would appear to be purely functional. According to thisview, functional division of Mahasrotas will be as following. * Amashaya [ Stomach] * Pakwashaya [ large Intestine] 6 * Pachyamanshaya [Between Amashaya and Pakwashaya corresponding tokshudrantara] 7 Sushrutha has very clearly stated that amshaya is the seat of kapha where as 8Charaka and Vaghbhata have described amashaya, not only as the seat of kapha but also 9that of pitta. This contention may be strong by the fact that the amlabhava attained by 10the food, at the stage of amlabhavavastha during ahara pachana is due to an amlafactor 11or amlaguna of pitta [Pachaka Pitta] secreated by urdhwa amashaya.Amashaya : The word would literally translate as “ Receptacle of Ama “ The following pointsof 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 17Site : Between Nabhi and Stana 18 Above the pittashaya 19 Its continuous with the Annanadi and Kshudrantra below 20Related Structures :* 2 Pesis are present in Amashaya 21 * Supplied by 2 Dhamanis 22* Composed of Susira snayu 23 * Composed of Kala24 12
  • Review of literature – Disease review AHARAPAKA - PRAKRUTA AND VAIKRUTA AVASTHAS Amlapitta is a functional disorder caused due to qualitative and quantitativederangement of pitta, which has a major role in the normal digestive process, giving riseto clinical manifestation of the disease. Hence the proper knowledge of the prakrutaaharapaka becomes essential in order to understand the vikrutha avastha of aharapaka.PRAKRUTA AHARAPAKA The term paka means digestion. The different kinds of food ingested undergoesdigestion or paka by the influence of jataragni. The whole process of digestion/ paka andabsorption is influenced by factors like Ushma, Vayu. Kleda, Sneha, Kala and Samyoga 1among which Ushma plays a major role1. USHMA : The term ushma refers to agni comprehanding factors which participate in thecourse of digestion and metabolism from the point of view of Ayurveda, pitta has beendescribed 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 2varnakara[ complexion] and prakashana[ lustre] 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 adverseconsequences 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 otherthan this factor?’3b further he has furnished the answer that it is identical to agni,in the 13
  • Review of literature – Disease reviewview of the fact that such action as dahana (burning, oxidation, combustion),pachana,(digedtion), etc.cannot occur in the body without pitta.This clarifies agni asantaragni. Clarifing the implication of the term “ Pittantargataha” used in above descriptionChakrapani has observed that this term does not mean that the pitta of the body is 4flamning fire and it only refers to the phenomenon of heat which is associated with fire. The Medini and Amarkosha while explaining about functions of pitta have quotedthat the pitta has a direct bearing on the pakakramas to which ahara dravyas are subjectedresulting in their parinamana or transformation . The implication of these two aspects ofpitta vyapara are the digestion of food and its transformation into various functional andstructural factors of the body.Pitta Guna and Karma : The general physical characteristics and properties of pitta or agni availablefrom 5 6the classics are listed in the table No. 1 [ Charaka , Sushrutha , Kashyapa andVaghbhata]Table No. 1 Showing pitta guna Colour Consistency Naste Smell Other Density PropertiesSuklareena Sara, Laghu Katu, Amla Visra SatvaVarjyaPandu Drava Vidagdha Vaigandhya UshnaVivarjita Amla UshnaNeela Ishat or Tikta Putigandha TeekshnaPeeta anatisneha The qualities such as sara , drava,ushna and teekshna may pertain to all the pittas oragni’s of the body but is particular to pachakapitta. There is difference of opinionregarding the rasa of the pitta .Charaka quotes that the prakruta rasa of pitta as katu and 14
  • Review of literature – Disease reviewamla7, but Sushrutha quotes that the prakruta rasa of pitta as katu and it turns to amla to 8when it attains vidagdhavastha . The justification for the use of the word as an adjectiveof pitta may be interpred that the pitta in its nirama avastha has got katu rasa and in samaavastha it attains amla rasa.2) VAYU : Vayu is the controller of all the movemnets of the body .In the process ofdigestion, prana vayu helps in deglutation , samana vayu stimulates the agni , promotesdigestion , assimilation and does sara kitta vibhaga . Any abnormality in the functioningof the samana vayu leads to vaishamyata of agni and initiates the pathogenesis of thediseases related to the GIT.3) KLEDA : Kleda means moisture . The kapha located in the amshaya is called Kledaka forits moisturizing action. This along with the liquid part of the food breaks down thecompactness of food and disintigrates it to facilitate easy digestion. Emulsification of thefood is done by saliva and the liquid portion of the various digestive juices and hencekledaka 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. Thesneha which is consumed in the form of ahara brings softness to the food and alsoenhances the functions of agni.5) KALA : Kala is also very important factor influancing the proper digestion . The time ofintake of food decides the digestion power i.e. pachakagni because agni is influenced bythree doshas: Kapha, pitta and vata in the early middle and late hours of the day. Kalaalso cannotes the time taken for digestion on which the outcomes of the digestiondepends. 15
  • Review of literature – Disease review6) 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 theuser[Ayu] ,season and the time of eating [Kala] and following the rules of eating keepingin 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 asprathamapaka . This commences from the introduction of the food into the mouthfollowed by the digestion of the food in the upper part of the stomach i.e. urdhwaamashaya which is comprehended by madhurabhava. This phase can be referred to thedigestion that takes place in the buccal cavity.Vipaka: Vipaka has been defined as the outcome of the action of the jataragni on the aharadravya which is resultant of the prathamapaka , which is to be judged from the point ofview 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 kostaunder the influence of Jataragni. The avasthapaka/ aharapaka in the kosta may be statedto proceed in the following order: 16
  • Review of literature – Disease review 1. Madhura Avasthapaka 2 .Amla Avasthapaka 3. Katu Avasthapaka1] Madhura Avasthapaka : The presence of food in the mouth is followed by the perception of its taste under 9the influence of bhodaka kapha which is seated in the root of the tongue. The concept ofbhodaka kapha parallels with the description of saliva and its function marks thedigestion that takes place in the buccal cavity . The outcome of the action of bodhakakapha on food; especially that fraction of its composition which essentially is madhura intatse seems to be continued and complete in the upper portion of urdhwa amashaya. Bynow, the insoluble madhura portion of food becomes sufficiently soluble and mixed upwith the frothy kledaka kapha i.e mucin present in the urdhwa amashaya. Here with thehelp of kleda ,sneha and vayu it breaks down, becomes less complex and soft and as aresult frothy and sweet ahara rasa will be produced . Since, the ahara rasa produced is of 10madhura rasa and contributes to kapha, this is called madhura avasthapaka .2] Amla Avasthapaka: At this stage ahara reaches the lower part of the amashaya .Agni i.e pachakagniwhich is stimulated by samana vayu acts on it and results in the vidagdhata of the ahararasa, 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 insolubleproteins into soluble protein, under the influence of pepsin in the presence ofhydrochloric acid. This synchronises with the passing down of ahara rasa which hasattained amlabhava into the lower portion of mahasrotas where achha pitta is stated to besecreated and it comes in contact with the pittasthana 12. The final outcome of the entire gastric digestion is the acidified chime which hasbeen characterized by Charaka as vidagdha13, has been interpreted by Chakrapani as 14pakwa-apakwa or kinchit pakwa or kinchit apakwa.Even, Sushruta, in sutrasthana 17
  • Review of literature – Disease review 15.defines vidagdha as, “Vidagdha sangnyamata amlabhavam” At this stage, the foodsubstance remains partly digested orpartly indigested.3] Katu Avasthapaka: The food is subjected to further digestive events which takes place in thebhridantra or pakwashaya.This has been described by Charaka as katubhava16 or katuavasthapaka.The materials or digested food particles passed down from amashaya havingreached the pakwashaya being dried up by agni is rendered into lumps. During thisprocess the ahara rasa becomes katu in nature and vayu dosha will be nourished. The facts furnished above are fully supported by modern physiologicalcontribution, as regards the process of digestion according to which the starch digestionbegun in the mouth and is continued in the stomach, which is sweet . The consistency ofthe food at this stage is pasty and frothy .This step can be aptly described asmadhurbhava and the place where it occur as amashaya. Further digestion of sugar isarrested by HCL. Then commences the protein digestion under the influence of HCL andenzyme pepsin which results in the conversion of insoluble proteins into soluble proteins. The gastric digestion in this stage of digestion can be appropriately described asamlabhava 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 incontact with the mucosa of the duodenum through the common bile duct . These findingsfully confirm the Ayurvedic version of the mechanism responsible for the production ofaccha 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 vyaparaand bhautikagni vyapara. From here the ahara rasa is stated to be absorbed throughdhamanis to be distributed throughout the body18. 18
  • Review of literature – Disease review NIDANA The term Nidana refers to the causative factors which play an important role inthe manifestation of a disease. Nidana parivarjana forms the first and foremost step in thetreatment of any disease in general and specifically in Amlapitta, it is practicallyobserved 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 destinyon this planet”1. This statement holds good as the annavaha srotas and ahara have a directproximity. Thus a thorough knowledge of the Nidana is imperative such that preventivemeasures can be adopted. In classics a large number of nidanas have been explained in the content ofAmlapitta. Opinion of different authors are listed in Table No. basically under twoheadings. 1. Ahara sambandhi 2. Vihara sambandhi. Apart from these the other factors which can be included under the nidana of theamlapitta 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. 19
  • Review of literature – Disease reviewChart No. 1 Showing the Amlapitta Nidanana AMLAPITTA NIDANAAhara sambandhi Vihara Sambandhi1. Abhojana. 1. Bhukte Bhukte snana2. Atibhojana. 2. Bhukte Bhukte avagahana3. Ajeerna 3. Bhukte Bhukte divaswapna4. 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. 20
  • Review of literature – Disease review Acharya Charaka has aptly stated “Aharasambhavam vastuh rogascaaharasambhavah6”. The Guna-karma vivecana of the Ahararupi nidana are enlisted inTable No.2 GUNA-KARMA VIVECANA7-12 Nidana Guna-karmaA. Rasatah Laghu, Ushna, Pittakapharaktakrt, Kostha vidahi,Amla rasa Sithilatvam janayati, Rujakara, Ksatakara, Dagdhakara, Laghu, Ruksa, Ushna, Vatapittakrt,Katu rasa Lekhana, Snehakledasosana, Sulakari Ruksha, Sheeta, Vatapittakrt, Lekhana, SoshanaKashaya rasa Laghu, Ruksha, Sheeta, Kledasosana, Sulakara,Tikta rasa StambhakrtB. Gunatah Pittavardhaka, SoshakaUsna Pittakrt, LekhanaTiksna Vatakrt, Sulakara, SoshakaRuksa Vatakaphakrt, StambhakaSheeta KaphakrtSnigdhaC.Dhanya vargaVrihi Guru, PittakrtSastika SheetaYava Kashaya, Sheeta, Ruksa, VatakaphakrtMudga Laghu, Ruksa, Sheeta, Kashaya, VatakaphakrtMasa Guru, Snigdha, Ushna, PittakaphakrtKulattha Ushna, Amlavipaki, PittakaphakrtAdhaki VatakrtKalaya Laghu, Ruksha, VatakrtNispava Ruksha, VistambhiKoradusa Soshana, Vatakaphakrt 21
  • Review of literature – Disease review Nidana Guna-karmaMasura Laghu, Ruksha, Sheeta, VatakrtTriputaka Ruksha, VatakrtRajika Ushna, Tikshna, RaktapittakrtTila Madhura, Tikta, Kashaya, Katu, Snigdha, Ushna, PittakaphakrtD.Krtanna vargaPinyaka Ruksha, Lekhana, VisthambhiPalala Gurupaki, PittakaphakrtPistanna Guru, Ushna, Pittakaphakrt, VidahiSuskanna Na pakam gacchati, pindikrtam, asamklinnam, vidahamupagacchatiKrsara Guru, PittakaphapradaE. Mamsa vargaAnupa mamsa Guru, Snigdha, Picchila, Pittakaphakrt, Agnisadakrt,Varija mamsa AbhisyandiF. Payah vargaPayah Sheeta, Snigdha, Bahala, Picchila, KaphakrtDadhi Amlapaki, Abhisyandi, PittakaphakrtKilata Guru, KaphakrtG. MiscellaneousKsara Laghu, Ushna, Tikshna, Kledayati adou pascat visosayati, Dahakrt, VidaranakrtSura vikara Amla, Ushna, Amlavipaki, Tridosakrt, DahakrtViruddha ahara Amavisakrt, Grahanigadakrt, AmlapittakrtSaskuli Guru, KaphakrtIksu Sheeta, Snigdha, Kaphakrt, Vidahi (if machine pressed)Vihara sambandhi. Nidana : Among the viharaja nidanas. The Bhukte Bhukte snana, Bhukte Bhukte avagahaand bhukte bhukte diwaswapna will lead to agnimandya and formation of ama. Further 22
  • Review of literature – Disease reviewindulgence 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 henceamlapitta also. Physical stress, fatigue and overwork are known to augment amla type ofsrava – pitta srava consequent to agnidushti.13Manasika Nidana : More importance is being layed on the manasika karanas in the recent times.During emotional disturbances the food consumed in the stipulated quantity remainsundigested.14 In addition to this, these nidana are also capable of aggravating theindividual 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 leadingto agnidushti – which in turn produces amavisha or ama resulting in the manifestation ofAmlapitta. 15Anya Vyadhikruta : The concept of a disease begetting another disease has been explained by theAcharyas. Karshana due to longstanding disease is said to cause vataprakopa and hencethe agnimandya. Apart from the Jawara and Atisara being aJathragnimandhyajanyavikara, the agni dusthti may itself produce amlapitta when anindividual 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, theindividual role of the nidanas are not explained in the context of Amlapitta. Hence thenidanas can be summed up under 4 groups depending upon their mechanism of action inthe manifestation of Amlapitta.* Agnidushtikara Nidana. * Pittaprakopaka Nidana especially Amlagunavardhaka.* Vataprakopaka Nidana. * Kaphaprakopaka Nidana. 23
  • Review of literature – Disease review 24
  • Review of literature – Disease review SAMPRAPTI The concept of samprapti in Ayurveda describes the causative mode and 1development of disease as well as the evolutive process of the disease . Decephering the samprapti is relavent to know the modality in which the nidanahas effected the body.The body is continually threatened by a variety of Nidana . Thecapacity to withstand this, lies in the soundness of the dosha and the dhatu .Anyincompelence of these intrinsic factors paves way for the development of the disease .Samprapti covers the entire visage from the Nidana to the development and progressionof the Vyadhi. The Samprapti of Amlapitta innvolves three important factors in the manifestationof the clinical signs and symptoms .Hence the knowledge of these factors becomesessential 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 dustiAGNI Nearly all diseases included under kayachikitsa are engendered due to 2impairement of kayagni .Even so, is amlapitta annavaha srotodusti which latter is due topakavaigunya. Pitta, one of the trinity of doshas is also spoken of as agni for the reason 3that this factor in the body has been stated to perform actions similar to fire . As stated elsewhere agni is generally held to be responsible for the conduct of 4pakadi karma Viz, sarapaka in amashaya and pakwashaya the separation of sara from 5kitta in the pakwashaya , augmenting the action of bhutagni , thus renedering the 6digested food fit for further chemo thermal reaction described by Chakrapani as anupakaafter which follows the reactions in dhatu paripaka. 25
  • Review of literature – Disease review The two main aspects of Agni has been envisaged by all the authotities ofayurvedaa) Kostagni [Charaka], b) Pachakagni, Jataragni [ Sushrutha], c) Pachakapitta [Vagbhata] Dhatwagni by all the three authorities. The former is stated to be located between 7amashaya and pakwashaya . This aspect of pitta or agni while performing all thedigestive fuctions described in the foregoing paragraph is also stated to lend support andaugment the functions of other pittas elsewhere in the body including the dhatvagni . The main samhita granthas have described four satges of jatargni viz, sama, 8vishma , tekshana and manda . The three doshas become involved due to the operationof 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 statedto function normally. This state of its function has been described as Sama Agni. In thisstate jataragni ensures complete digestion of food in scheduled time without any harm to 9the bodyVishma Agni: An erratic state of agni arises, as a result of the influence of vata in the conditiondescribed as vishma agni . In this condition the agni varies with periods of strong appetite 10alternating with loss of appetite .Teekshna Agni : The agni in this state is excited by pitta hence it is known as teekshna agni .In this 11state agni digests even large quantities of food earlier to the scheduled time .Manda Agni : This is a state in which agni is considerably inhibited due to the dominance ofkapha dosha . In this state the agni is unable to digest and metabolise even a less quantity 12of otherwise easily digestable food in scheduled time . 26
  • Review of literature – Disease review Out of these the sama agni is considered as the samanya condition of the agni andthe rest three as the vaishamya condition. The vaishamyata of agni leads to improper digestion due to vridhi or kshaya ofagni in their guna, praman and karma . In mandagni the food will be apakwa .In case ofteekshnagni it will be dagdhapaka and pakwapakwa in case of vishamagni .All these leadto specific type of ajeerna leading to formation of Ama, one of the important cause forthe 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 havetheir origin in amadosha. Amadosha or amavisha, both as acute and subacute or chronicconditions appear to be related to the gastro-intestinal as well as metabolic disturbancesdeveloped due to the impairement of agni which is sited in amashaya i.e.antaragni orbetter still agnidushti.Ama has been defined as a condition in which the first dhatu 13namely, rasa dhatu is not properly formed due to the lowered strength of Ushma(agni)and in this state the food ingested becomes dushta. According to Vagabhata the impairedvatadi doshas become mixed up with one another leading to the formation of amadhosha 14very much like the production of visha from the spoiled kodrava . The general outlook of the two descriptions of ama would appear to be that inabsence of or due to the inhibition of kayagni the ingested food is not properlydigested.Products that arise out of such an impaired digestion is retained in the amashayaand they undergo such changes to yield toxic substances-‘Visha roopataam yati’ whichare known as amarasa . 15 The etiological factors of amadosha as described by Charaka and Sushruta rangefrom dietetic indiscretions including errors of nutrition to emotional tensions of differentkinds. 27
  • Review of literature – Disease reviewAma Lakshanas: The indulgence of the above mentioned etiological factors may lead to theformation of ama in the amashaya which travels throughout the body and producessymptoms like:1.Srotorodha 2.Bala bramsha 3.Gourava 4.Anilamoodata 5.Alasya 166.Apakti 7.Nishteeva 8.Malasanga 9.Aruchi 10.Klama The ama wich is situated in amashaya produces symptoms related to kosta orwhen they are traveling throughout the body, they produce sarvadaihika laxanas. Whenama co-exists along with the vrudha dosha then this condition is known as sama or samadosha. So, before going to amlapitta nidana,it is very important to note the sama andsamapitta conditions.Sama: The term sama refers to undigested,crude,not sufficiently prepared or matured (a 17 18morbid state of humour) In various refrences sama is defind as “Sahamena samaha”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 19malas get vitiated and permeated with th ama.it is the cause for all the diseases. 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 upwith amadosha, then it is called samavata,samapitta and samakapha respectively. In Amlapitta the mandagni leads to the formation of amarasa which gets retainedin the amashaya and combines with the deranged pitta giving rise to clinicalmanifestation of the disease . The lakshanas of samapittas are stated as; Durgandha, harita ,Shyava , amla , sthira ,guru , amlaka, uraha kanta daha. 28
  • Review of literature – Disease reviewSROTODUSTI The samprapti of amlapitta is also the study of srotas and the study of same bothat the physiological and pathological levels. Pathological events are stated to have their 21origin at the level of srotamsi as mentioned in the classics . Charaka quotes that theahara 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 thesrotases i.e. khavaigunyaath , abnormal changes are initiated .Dhoshas in such acondition 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 wasdiscussed in connection with pitta srava in urdhwa amashaya during amlabhava oravasthapaka , in the process of ahara pachana .It is due to this sroto vaigunya thatamlapitta is engendred. Srotovaigunya can be either functional or structural .The formeris due to aggravation of doshas and the latter due to sroto dusti. Due to annavaha sroto dusti the prakupita pittadosha having accumulated and 22expanded , spreads to amashaya to lodge there . Further, it gets exacerabated by vidahiand other pittaprakopa factors impairing the agni . In this condition, food is tormented tovidagdha to assume amlabhava. It is pointed that vidagdha annarasa which assumesamlabhava is an abnormal state in the process of digestion and this abnormality wouldappear to be due to the amlaguno udrikta pitta or excess amla type of srava. It can beobviously inferred that, this is resulted as to the atipravruti prakara of dushti in thesookshma srotases of annavaha srotas . The responsible dushya i.e. rasa gets vidagdha by amla factor assuming shuktata. 23This shukta rasa which retains in amashaya is resultant of amadosha .This may refer tosanga type of sroto dusti .Since, one of the distinct classification of this disease vizurdhwaga amlapitta and tikta amla vamana a symptom would speak of the direction 29
  • Review of literature – Disease reviewagainst the normal physiological course. Vimarga gamana type of dusti can also bereferred in this condition. On summing up, the following dusti prakaras of annavaha srotas would apper inthis disease 1. Atipravrutti 2. Sanga 3. VimargagamanaSamprapti can be clearly studied under the folloing headings1. Samanya and Vishesha samprapti 2. Samprapti ghatakani3. Kriyakala sampraptiSamanya Samprapti : Samanya refers to “ Similitude “ . Thus the samanya samprapti establishes acommon relationship .The samanya samprapti of a disease indicates the basicpathogenesis uninfluenced by secondary factors and that remains the same in all thestages of vyadhi . The samprapti of Amlapitta has been put forth in the followingmanner. Due to nidana sevana vatadi doshas become aggravated and affects the agni toproduced jataragni mandhya , which in turn leads to the vidagdhata of the consumedahara .This vidagdha amarasa combines with the vitiated pitta and undergoes shuktapakain amashaya. In this stage, if the person involves in ahithakara ahara and vihara it 24becomes more vitiated due to vidagdha pitta and produces amlapitta . Pitta which is already sanchita; due to its self aggravating factors further attainsvidagdhata due to virudha,dushta,amla ,vidahi and pittaprakopaka ahara and vihara andchanges into amlarasa.25 The first samprapti as told by Kashyapa stresses on all the tridoshas beingresponsible for agnimandya singly or all together leading to formation of ama rasa .Theso formed amarasa gets retained in the amashaya leading to formation of annavishawhich combines with the vitiated pitta and undergoes shuktatva resulting in themanifestation of the Amlapitta , if the person indulges himself further into ahitakara aharavihara. 30
  • Review of literature – Disease review Madhavakara has especially emphasised on the derangement of the pitta and thepittaprakopaka ahara - vihara in the manifestation of the Amlapitta and the conversion ofthe ahara rasa into amla rasa . This clearly indicates that the composition of pitta turnedabnormal. From the above information the manifestation of the Amlapitta can be putforthas 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 mandyata2) 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 AmlapittaPittaprakopaka 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 31
  • Review of literature – Disease reviewImplication of the term SHUKTATVA : The term shuktatva refers to sourness. Charaka while describing the secondavasthapaka has used term amlapaka which refers to the outcome of the normal digestive 26reactions that occurs in the amashaya due to pittasrava . It should be noted that even 27though shuktapaka and vidagdhapaka yields substances which are also amla has notbeen mentioned in the context of normal gastric digestion. From this it can be inferredthat the latter term relates to the outcome of abnormal digestive reactions which yieldpittasrava having excess amlarasa or guna.. Amadosha in which the food attains shuktatva obviously relates to thefermentation brought about by various factors which latter have become active due topavakavaigunya [impairment of agni ]. This is annavisha. This may abnormally increasethe amlaguna of pitta resulting in amlapitta. Kashyapa28 illustrates the same with an analogy viz as the formed curd turns sourassuming inspissated form on adding kshera, so also the rasadhatu responsible dushy inthis condition assumes vidagdha attaining shuktatva by excess of amlatype of srava, dueto 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 thedoshic 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 duringthe course of the disease and from individual to individual. 32
  • Review of literature – Disease reviewSankhya 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 types31On the basis of sandhyasadhyuta 2 types 32Vidhi Samprapti : This is final version of the sankhya samprapti 33Pravruti bhedena : 1) Urdhwaga amlapitta 2) Adhoga AmlapittaTridosha bhedena 34 1. Vatika 2. Pitta 3. Kaphaja 1. Vata Kaphaja 2. Sleshma Pittaja 3. Sanila 4. KaphanugataSadhyasadhayata 35 : Sadhya Naveena ; Proper pathya sevana in purana Asadhya PuranaBala and Kala Samprapti : The occurance and/or intensity of the symptoms are subject to the influence of thesecondary factors that can mould it.Diuranal Variations : As it is a pittapradhana vyadhi , occurrence or the intensity of the symptoms ismainly seen in madhyadina and madhyaratri.Variation in accordance with Aharakala : Pitta is predominant in the amlavasthapaka of the ahara and as such, thesymptoms occur in the jiryamana avastha of Ahara 33
  • Review of literature – Disease reviewSAMPRAPTI 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 : AbhyantaraSAMPRAPTI ACCORDING TO KRIYAKALA The concept of Kriyakala describes the mode and satges of development ofdisease. Significance of kriyakala lies in timely intervention to arrest the disease process.The recognition with respect to kriyakala becomes easier in cases of diseases pertainingto Annavaha srotas , as the lasksanas are very evident. The various stages and changes involved in Amlapitta. From the inception tomanifestation represents an evolution process. The evolutive process of the disease isbased 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 initialinsult 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 accordingto Kashyapa, the vata and kapha doshas are also associated factors in Amlapitta . 34
  • Review of literature – Disease review Sanchaya of doshas can either occur individually, in pairs or all together . Thisstage is characterized by vague and ill-defined symptomatology . The lakshana ifidentifiable would be ‘stabdhapurna koshtata’ in vata sanchaya , ‘mandoshmata’ inpittasanchaya and ‘angagourava’ and ‘alasya’ in kaphasanchaya. 36 An overall feature of this stage is stated to be an aversion towards similar nidanaand attraction towards contraries. 37 The symptoms of agnidusti may also be evident.II) Prakopa [ The stage of Provocation ] :- 38 “ Kopasthu Unmargagamita “ Further, indulgence in nidana leads to furthervitiation of the dosha. Its stated to be the condition in which the doshas having previouslyaccumulated 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 ofsanchaya due to continued inception of the dosha vardhaka ahara and vihara. As Amlapitta is pitta predominant disease the paittika lakshanas becomepronounced due to pitta provocating factors in particular. In the case of agnidusti, theapakwa ahara rasa may start to undergo vidagdhata and shuktata. Achaya purvakaprakopavastha without the previous accumulation of doshas/ sanchaya, where in it isreferred to as Unabhava39. This is in subject to the strength of the nidana , specially inmanasika 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 othersthanas too. In addition the combining of doshas with each other , thus potentiating thesamprapti is the main feature of this avastha. In Amlapitta the prakupita pitta dosharemains 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 theearlier avastha mingles with dosha producing sama dosha . The prasara is mediated via 35
  • Review of literature – Disease reviewrasarakta dhatu by vyana vayu . The laxanas of pitta are predominant as its pradhana inamlapitta.IV) Sthanasamsraya : [ The stage of location] The dosa dushya sammurchana is an integral part of the disease and occurs in thisavastha. This stage obviously represents the prodromal phase or purvarupa. The site ofsthanasamshraya may have a pre-existing khavaigunyata or it may occur simultaneously.In Amlapiita, the sthanasamshraya is in the annavaha srotas, amashaya in particular . Theprakupita 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 pittaand vitiates the rasavaha srotas, leading to dosha dushya sammurchana. PurvarupaofAmlapitta has not been described.V) Vyakta : [The stage of manifestation] Vyakta is the stage of manifestation of actual disease condition, which is theresult of dosha dushya sammurchana. In this stage, Amlapitta gets fully manifested anddifferentiated in doshic varieties depending upon the predominant dosha. The clinicalsigns and symptoms become evident.VI) Bheda : Depending on the extrinsic and intrinsic nidana the disease process is modified toexhibit the lakshanas based on the dominant dosha. The disease worsens and upadravamay 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 schematicdiagram in the Fig.No. The pachakapitta gets vrudh due to pittaprakopaka nidanas in itsamlaguna and dravatwa leading to agnimandya, which in turn leads to avipaka. Theapakwa ahara rasa undergoes vidagdhata giving rise to ama which leads to rasa dusti. Therasa dusti inturn causes agnimandya and the cycle continues as long as one indulges inthe nidanakara bhavas. 36
  • Review of literature – Disease reviewChart no. 4 Samprapti on basis of Kriyakala Nidana Amaraja Viharaja Manasika AgantukaSanchayaandPrakopa Agnidusti Pitta sanchaya Ajirna apachana Amotpatti Prakopa SuktatwaPrasaraSthana Shuktamlata VidagdhajirnaSanchayaVyakta Pitta amavisha Sammurchana AmlapittaBheda Urdhwaga Adhoga SitapittaUpadrava Udarda Kotha Annadrava shoola Parinama shoolaChart no. 5 Vicious circle formed in Amlapitta Hetu Pachaka pitta Ati Amlata Ati Dravata Rasa Agnimandya Avipaka Ama Vidagdhata 37
  • Review of literature – Disease review POORVA RUPA Poorvarupa are the promonitary symptoms, which appears before themanifestation of the main symptoms of the disease. The purvarupas are those that preceedthe actual manifestation of the disease1. The vitiated doshas at the stage ofsthanasamshraya will manifest the signs and symptoms of forthcoming disease2. They arethe 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 extentwithout giving any indication of the dosha derangement. Vishista purvarupas are the ones which give an idea of the doshas also in additionto idea of the disease. Samanya purvarapas generally disappear before the onset of the disease whereasvishista 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 lattercategory. Even if they are present it is not possible to recognize them, as minor functionof doshas are common events. Hence no purvarupas have been mentioned for amlapitta inthe classics. In Amlapitta samprapti, the agnimandya and pittavriddhi are the importantfactors; hence the laxanas due to these may manifest in milder forms or show variationsin accordance with the doshic variations. Aruchi , avipaka , chardi, utklesha and hrillasaare produced due to agnimandya[ama] and karadaha, charanadaha, angadaha, ushanataetc. denote the sarvadhaihika pitta prakopa. 38
  • Review of literature – Disease review RUPA The rupas are the charecteristic manifestation of the clinical features whichappears during the cause of the disease 1. Its defined as the clear manifestation of theprodromal symptoms itself is called as rupa 2. The word rupa indicates the signs andsymptoms by which a disease is identified 3 The clinical features or rupa of the Amlapitta can be described under followingheadings.* Pratyatma lakshanas * Samanya lakshanasLakshanas due to the pravritti of doshas* Urdhwaga Amlapitta * Adhoga Amlapitta* Vishista LakshanasSpecific lakshanas due to doshas involvedPratyatma lakshanas : The word atma lakshana denotes the cardinal features of the disease. From thename itself it is evident that Amlapitta is a pitta predominant disease caused due to thevitiation of pitta. Shuktapaka is a peculiar stage of samprapti. Hence, the lakshanasproduced by shuktapaka mainly amloudgara, haritdaha, kukshidaha, and kantadaha aretaken as pratyatma lakshanas of Amlapitta.Samanya Lakshanas: The lakshanas caused due to the other factors involved in samprapti ghatakas isknown 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 assamanya lakshanas. 39
  • Review of literature – Disease reviewThe lakshanas caused are as followsAgnimandya [Ama formation] - Avipaka. Aruchi, Chardi, Utkesha, Hrillasa, Gourava etcRasakshaya - Klama, brahmaSarvadaihika 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 symptomsPittaprakopaka nidana sevana Vata or kapha or vatakapha Prakopaka nidana + pitta Prakopaka nidana sevana Pitta vriddhi AgnimandyaLakshanas LakshanasKaradaha AruchiCharanadaha AvipakaAngadaha etc. Chardi Utklesha Hrillasa Shuktapaka Rasakshaya lakshanas Lakshanas Klama, Bhrama etc. Amloudgara, hritdaha Kukshidaha, kantadaha. 40
  • Review of literature – Disease reviewThe samanya lakshanas of the Amlapitta mentioned by different authors are listed inTable 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 5Urdhwaga Amlapitta and Adhoga Amlapitta 41
  • Review of literature – Disease review This is mainly based on the location of doshas and their subsequent urdhvaga andadhoga pravritti. These lakshanas may be seen along with the samanya lakshanas ofAmlapitta. The term ‘kadachith’ used by Madhavakara while envisaging lakshanas of thesetwo distinct varities as interpreted by Srikantadutta as “ Nasarva Kalam” 6 can be takenas ; that all lakshanas of these varities not necessarily be present always or they will beexhibited 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 Amlapittamentioned by different authores are listed in Table NoTable No.4 Lakshanas of Urdhvaga amlapittaSl.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 + + + + 42
  • Review of literature – Disease review 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 arepredominant the features of Adhoga Amlapitta mentioned by different authors areTrishna, Daha, Murcha, Bhrama, Moha, Hrillasa, Kotha, Analasada, Harsha, Sweda andAngapeetataSanila amlapitta:The aggravated pitta and vata which are situated in amashaya leads to abnormal digestioni.e. agnimandya which results in shuktapaka. In this condition along with earliermentioned factors,vata contributes for the manifeststion of symptoms. Vaikrita pitta + Vaikrita vata ------------------------ agnimandya (samanavata) (Abnormal digestion) shuktapaka Sanila amlapitta lakshanas. 43
  • Review of literature – Disease reviewThe symptoms of this type of amlapitta mentioned by Kashyapa10 and Madhavakara arelisted in the table no.Table No.5 Showing the lakshanas of Sanila Amlapitta Sl. Lakshanas Ka M.K. B.M. Y.R. V.S. No. 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 inagnimandya and produces shuktapaka. In this condition along with the above said factorskapha 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 arelisted in the table no. 44
  • Review of literature – Disease reviewTable No. 6 Showing the lakshanas of Sakapha Amlapitta Sl. Lakshanas Ka M.K. B.M. Y.R. V.S No. 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 pittaresults in agnimandya and produces shuktapaka. In this condition along with the abovesaid 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 arementioned in table no. . here the dominance of pitta and kapha dosha are observed andfeatures are similar to urdhvaga amlapitta.12 45
  • Review of literature – Disease reviewTable No.7 Showing the lakshanas of Shleshmapittaja Amlapitta Sl. Lakshanas Ka M.K. B.M. Y.R. V.S No. 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 vatawhich produces agnimandya results in shuktsa kapha. The laxanas produced arepredominantly of pitta dosha.Vaikrita pitta + prakrita vata and kapha ---------------- agnimandya shuktapaka Pittaja amlapitta laxanasThe symptoms of this type of amlapitta mentioned by Kashyapa13 are listed in the tableno.Table No.8 Showing the lakshanas of Pittaja Amlapitta Sl. Lakshanas Ka M.K. B.M. Y.R. V.S No.1 Bhrama + - - - -2 Vidaha + - - - -3 Upashaya Rukshoupashaya + - - - - Ushnoupashaya + - - - - 46
  • Review of literature – Disease review BHEDA Many authors clearly draft regarding the classification of Amlapitta According to Madavakara, amlapitta has been classified under two headingsbased 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 andothers2 amlapitta has been classified under four headings viz.* Sanila * Sakapha * Sanilakapha * Shleshma pittajaAccording to kashyapa, the classification is absed on the dosha responsible for Amlapitta,The classification is as follows 3* Vataja * Pittaja * KaphajaChart No. 7. Classification according to different Authors Amlapitta1. Urdhwaga 2. Adhoga1.Sanila 2.Sakapha 3.Sanilakapha 4.Sleshmapitta 1.Vataja 2.Pittaja 3.Kaphaja 47
  • Review of literature – Disease review UPASHAYA ANUPASHAYA Upashaya is one of the therapeutic measures adopted for confirming thediagnosis. The medicine or food or the external therapies which gives relief is called asupashaya and the one which worsens the condition is known as Anupashaya. Charakasays that. “ Ghudalingam vyadhim upshaya anupashayaabhyam pareeksheta” 1 i.e An unmanifested or obscure disease may be investigated by upashaya andanupashaya. The Upashaya are of two types 2Viparita [ Oppossite to hetu, Vyadhi or both]Viparitarthakari [ similar to hetu, Vyadhi or both]Here in Amlapitta, Kashyapa explains about upashaya of vataja, pittaja and kaphajavarieties as fallows: 3Vataja Amlapitta : Snigdha aharaPittaja Amlapitta : Swadu sheeta aharaKaphaja Amlapitta : Ruksha ushna ahara The anupashayas of amlapitta are not described in the classics. But however thecausative factors themselves may be taken as anuspshayas,especially amla, katu vidahiand other pitta provoking factors. 48
  • Review of literature – Disease review VYAVACHEDAKA NIDANA Amlapitta is a functional disorder which has to be differentiated from otherdiseases having similar features. The conditions from which it has to be differentiated areas 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 certainsymptoms are similar to Amlapitta. The difference between these two are only in itschronicity and its course.2) Pittaja Shula: Teevrashula, trishna, mutradaha, sweda, murcha, bhrama, chosha are thesymptoms which are aggravated by pittaprakopaka ahara, madhyadina, madyaratri andahara pachyamana kala. It is a ekdoshaja vyadhi where as amlapitta is a tridoshajavyadhi. The intensity of shula is very severe in pittaja shula and so varies from mild tomoderate in Amlapitta. Swadya; sheeta ahara, snigdha sheetopchara factors relieves thepain 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 aftervamana.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 thesymptoms,they differ from the etiological point of view,samprapti and classification. 49
  • Review of literature – Disease review SADHYASADHYATA The ayurvedic manuscripts bear the descrption regarding the prgnostic states orsadhyasadhyata of the disease. Before going to the treatment, the prognosis as to thecurability[sadhya] or incurable [asadhya] and also whether it is easily curable[ sukh-sadhya] or curable with difficulty [ krichrasadhya] or curable as long as treatment isgiven [yapya] should be estimated. Charaka says, ” A disease in its early stage is easily curable but when advanced iscured with quite difficulty or even becomes asadhya” 1Incurable diseases never becomecurable while curable diseases may pass into stage of incurability on account of the shortcomings in any of the four basic therapeutic factors or as the result of destiny. 2 Madhavakara states that , if Amlapitta is in its early satge is curable withefforts. If it becomes chronic it becomes yapya. In chronic cases and of persons withrecent origin indulging in apathya ahara vihara it becomes krischrasadhya[curable withdifficulty] . If amlapitta is accompanied with the upadravas[complications], then becomesasdhya [incurable]. Kashyapa has stated that in case if the patient develops upadravas along withdhatukshaya then it becomes asadhya[incurable] 3Hence the early diagnosis and prompt treatment of nava ao taruna amlapitta would notprocreed to obtain chronicity and produce complications. 50
  • Review of literature – Disease review UPADRAVA The occurance of another disease in the wake of primary disease, as acomplication or sequele is termed as upadrava1 and is meant as rogauttarakalaja,rogashraya and roghaeva. The upadhrava of the disease corresponds to the intensity ofseverity 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 51
  • Review of literature – Disease review CHIKITSA The basic principle of treatment of any disease is nidana parivarjana1 andsamprapti vighatana2. Nidana parivarjana has a vital role in management of any diseaseand is very important in case of amlapitta, which is explained in the context ofpathyapathya. Different measuers have been explained by many authores of our classics for thepurpose of Samprapti vighatana. Kashayapa, Bhavamishra and yogaratnakara havementioned 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 thanthis Rakthamokshana is mentioned by Vangasena and Yogartnakara5. The individual roleof these measures in the management of amlapitta is described below.Vamana and Virechana : The main objective of treatment in amashayotha vikaras including amlapitta is toexpell the doshas from nearest route. i.e. by vamana and virechana, if there isbahudoshavastha and the patient is fit for these procedures. The general principle is to dovamana, if the doshas are sited in urdhwa amashaya, and to do virechana if the doshas aresited in adho amashaya. Probably in this aspect Bhavamishra has advised vamana inurdhwaga amlapitta and virechana in adhoga amlapitta6. Rest of the authors have advisedvamana followed by virechana 7 . This seema to be ideal as Indu opines that vamana is amust before virechana, because if virechana is performed without vaman it may come outthrough the mouth after mixing with shleshma and proper virechana does not takes place. 52
  • Review of literature – Disease reviewEven if it takes place the sleshma does achachdana of grahani and produces angagouravaand pravahika. 8 Virechana is needed in Amlapitta as the main dosha involved in Amlapitta is pitta 9and virechana is the ideal treatment for elimination of pitta and it also expells theshesha doshas, that remains in amashaya after the vamana therapy . The vamana andvirechana 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 102. Another decoction prepared out of above-mentioned drugs except vasa 113. Lavana jala, warm milk , ikshu rasa, water prepared with honey or tiktha dravyas are beneficial for the purpose124. 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 : 53
  • Review of literature – Disease review1. Decoction prepared out of triphala kwath mixed with trivrit churna and honey is advocated.142. 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 authorsare listed below.Table No 9 Showing the referance of vamana and Virechana Karma in Amlapitta Authors Vamana VirechanaKashyapa Samhitha + +Yogaratnakara + +Bhaishajya Ratnavali + +Chakradutta + +Bhavaprakasha + +Basavarajeeyam + +Basti: After the above measures bastikarma has to be done to cleanse the residualmorbid matters. The necessity of basti does not usually arise unless vata is predominent.Anurvasana basti is the usual procedure followed before going for asthapana basti16Theasthapana basti has proven benefit in Amlapitta which has attained chronicity and also invata predominent amlapitta.Raktamokshana: The necessity of raktamokshana arises when the doshas do not subside by othermeasures. Vangasena & Yogartnakara observes this as a last measure restored to cleansethe unabated dosha by other measures. This is beneficial in Amlapitta associated withkota etc. synchronizing with raktadusti.17 54
  • Review of literature – Disease reviewSHAMANA Shamana is defined as which does not results into elimination of doshas neitherdoes it vitiates nor disturbs the normal balance of dhosas but results in correction of theimbalanced 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 withvridhpitta.Hence, the dravyas which have both the properties of ama pachana and pittashaman should be used. Therefore tikta rasa pradhana dravyas are indicated. In Sushrutha samhita while dealing with the pittatisara Dalhana expresses hisdoubt that how can tikta rasa dravyas be used as pachanas. Then the clarsifies that, evenin 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 thecondition 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 dealingwith the treatment of raktarasha he has told that tikta rasa is usefull in improving theagni[Deepnartha] and pachana of doshas [doshanam panchanatham] and in Ashtangahridaya, arsha chikitsa he has given a similar opinion.19 All these refrences suggests that tikta rasa drugs should be used in samapittaconditions and hence in amlapitta too. Even for the purpose of deepana and pachana which has to be performed prior tovamana, only tikta rasa pradhana dravyas have to be used and even for vamana virechanatiktarasa pradhana yogas have been mentioned. Mainly tikta rasa , laghu ,snigdha guna, katu or madhura vipaka , seta veeryadrugs have been mentioned by the acharyas. The yogas mentioned by acharyas for the shamana of the Amlapitta are asfollows: 55
  • Review of literature – Disease reviewSINGLE DRUGS20Herbal Drugs: Patola Patra, Nimba, Bhunimba, Amalaki, Guduchi, Yastimadhu, Dhanyak,Narikela, Haritaki, Vasa, Parpataka, Shunti, Katuki, ShatavariJangama Drugs: Shankha, Mukta, Cow’s Ghee, Cow’s MilkParthiva Drugs : Abhraka, Gairika, Tamra, Louha, Mandura, RajataCompound drug Preprations :Kwatha: Bhunimbadi, Guduchyadi, Patoladi, Vasadidashanga, Phalatrikadi, Dashanga,ShringberaChurna: Panchanimbadi, Avipattikara, Trikatukadi, Eladi ChoornaVati / Gutika : Panchanana Gutika, Phaniyabhakta Gutika, Shankhavati, Drakshadi Gutika,KshudavatiKhanda/ Modaka: Kushmanda Khanda, Narikela Khanda, Soubhagyashunti, Pippali Khanda,Amlapittantak Modaka, Gudadi Modaka, Khanda AmalakiGritha: Shatavari, Drakshadi, Panchatikta, Narayan, Vasa, TiktakaRasaousahadis: Amlapittanka Louha, Lilavilasa Rasa, SoothshekaraRasa, Amlapittantaka Rasa,Dhatri louha, Pravala Pisti, Mukta Pisti 56
  • Review of literature – Disease review PATHYAPATHYA “ The doctor of the future will give no medicine but will interest their patients inthe 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 notproduce any adverse effects are considered as wholesome and the opposite ones asunwholesome.1 Pathyapathya plays an important role in the prevention and causation of diseaserespectively.Some diseases in their intial stages can just be treated by following thepathya and even any treatment procedure followed for a particular disease is not completeunless the patient strictly follows the diet regimen. Pathyapathya attains more significance in the disease of the Annavaha srotas asthis is amongst the first to be affected by the aharaja nidanas. Along with this dueimportance 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 apathya5Sl.No. Food Stuffs Pathya Apathya 1. Cereals Rice [old], Wheat, Rice within one year of harvest Barley 2. Pulses Green Gram Black gram, Horse gram, Red gram, Sesamum 3. Vegetables Bitter guard,Snake Potato, garlic, chilli sweat potato gourd, Carrot, Ashgourd, drumstick leaves 57
  • Review of literature – Disease review 4. Seasoning Corriander, turmeric, Malabar, Tamarind 5. Fruits Gooseberry, Lemon , grapes, plantain , Sour fruits grapes[dry], Kadali,pineapple, orange,Robexta fruit 6. Food Sugar, Honey,Boiled Curd, buttermilk, goats milk, jaggery, oil, Addatives & cooled water tea , coffee, alcohol, dhanyamla 7. Type of food Sweat, bitter, Sour, pungent, salty, oily Aggravating astringent , subsiding pitta dosha Incompatible, difficult to kapha and pitta digest 8. Food Mamsa rasa, lajapeya, Pickles, fried items, baked items , Prepartaion Mastu, lassy, saktu pishtanna, biscuits, cake , carbonated drinks, 9. Non veg Jangala mamsa fishes 10. Activities Adequate rest, sleep Strenous labour, exposure to hot sun, fire, and Exercise suppression of natural urges 11. Emotions Happiness, Anxiety, worry , grief tension, Jealousy Satisfaction 12. Complaints Dadima, pippali, guduchi satwa, shatavari, kapitha, karkola As a guideline for selection of food and method of consumption, Astavidha aharavisesayatana and Aharavidhividhana are explained respectively.A. Astavidha ahara visesayatana2:1. Prakrti 2. Karana3. Samyoga 4. Rasi5. Kala 6. Upayoga samstha7. Desa 8. Upayokta 58
  • Review of literature – Disease reviewB. Ahara Vidhi Vidhana 3 : These have been explained for the healthy and the diseased.1. Usnamasniyat 2. Snigdhanamasniyat3. Matravadasniyat 4. Jirne asniyat5. Viryaviruddhamasniyat 6. Iste deshe, ista sarvopakaranam7. Nati drutam, nati vilambitam 8. Ajalpannahasan tanmana bhunjita9. 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. 59
  • Review of literature – Disease review DYSPEPSIA Dyspepsia [Indigestion] is a collective term for any symptoms thought to originalfrom the upper gastrointestinal tract1. From a clinical point of view the most common of disordered gastric emptying isDyspepsia. [Greek: “Dys” means bad and “peptin” means to digest]2. Understanding thisterm 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 andreferred to a set of vague upper abdominal symptoms like heart burn, belching, epigastricpain /discomfort, anorexia, nausea and excessive abdominal symptoms associated withintake of foods. A clear-cut diagnosis may not be possible clinically, and investigationsmay also be normal. In fact when clinical features are sharp enough for a reasonablediagnosis the term dyspepsia is not used.3 More than half of all dyspeptic patients do not have any organic disease, howevermuch we investigate. These patients may have aggravation of symptoms duringemotional upset. Hence, it is called “functional dyspepsia” or nervous dyspepsia. Dyspepsia means pain or any discomfortable symptoms associated with thefunction of digestion [Thomson – 1963]. Variation of digestion produce symptoms ofmany sorts, often not at all directly connected with the taking of food together withleisurely eating of meals by those accustomed to hurry. Frequently suffices to cureindigestion of longstanding. Edward and Coghill [1968] have reported when no cause for the dyspepsia wasapparent the condition is described as Non-Ulcer dyspepsia [NUD] 60
  • Review of literature – Disease review Causes of Dyspepsia4: Upper GIT Other GIT Systemic Drugs Others Disorders Disorders DiseasesFunctional [Non- Hepatic diseases Renal NSAID’s AlcoholUlcer dyspepsia [Hepatitis, failure Iron and Psychologicaland IBS] Metastases] Hyper- potassium [e.g anxiety,Peptic Ulcer. Pancreatic Calcaemia supplements. depression]Acute Gastritis diseases [Cancer, Corticosteroids.Gall stones Chronic DigoxinMotility disorders Pancreatitis][Oesophageal Colonicspasm] carcinoma. 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. 61
  • Review of literature – Disease reviewe) 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 ulcerdespite the documented absence of an ulcer by endoscope or barium x-ray studies andother demonstrable organic disorder [bilary tract disease] or evidence of irritable bowelsyndrome.6 The term Non-ulcer dyspepsia was coined by True Love [1972]. 62
  • Review of literature – Disease review Jone and Pollak [1945] have mentioned that half of all the patients with gastricsymptoms do not suffer from peptic ulcer, and in majority of these patients its impossibleto 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 : 81. 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 areconsidered 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 pepticulcer patients. Nevertheless, despite years of study, the relationship of acid to ulcer-typepain remains unclear. On the other hand most studies indicate that acid secretion isnormal in patents was NUD9. In general therefore, acid does not appear to play a pivotal role in thepathogenesis of Non-Ulcer Dyspepsia. 63
  • Review of literature – Disease reviewb) Motility The literature on the association of Non-Ulcer Dyspepsia with gastric dysmotilityis confusing, but some studies do point to delayed emptying of liquids or solids. Thetiming and variability of symptoms make this area difficult to study with current methodsbetween 25%-50% of patients with Non-Ulcer Dyspepsia have postprandial and antralhypomotality. 50% experience abdominal discomfort in response to ballon distension atvolumes lower than those provoke pain in healthy controls, suggesting visceralhypersensitivity.c) Chronic gastritis Chronic gastritis [Round cell infiltration of the mucosa] is a common conditionwhose prevalence increases with age. It would appear, however that many patients withthis finding are asymptomatic and that symptoms cannot be correlated with the degree ofinflammation10. Relation between non-ulcer dyspepsia and deuodenitis /duodenal ulcerhas not been demonstrated11.d) Helicobacter pylori: H-pylori is a short spiral shaped, micro-aeroplilic gram negative bacillus which isfound primarily in the deep portions of the mucus gel layer. that coats the gastroduodenalmucosa, but does not invade the mucosa. Role of H-pylori and associated chronicgastritis in causing dyspeptic symptoms in persons without peptic ulcers is unknown andthere is no convincing evidence that H-pylori accounts for the symptoms in NUD11b.Roleof H-pylori eradication remains controversial.e) Psychological factors and stress: Stress anxiety and depression are considered as the causative factors forfunctional dyspepsia 12. Stress has been known since the experiments of William to effectgastric function and secretion. 64
  • Review of literature – Disease reviewf) Diet : Excessive consumption of coffee, tobacco cola, hot spicy foods, citrus, irregulareating all favour the manifestation of the disease entity, many patent relate theirsymptoms to meals in general, and fatly food in particular.13g) Habits: Chiefly alcohol and smoking contribute to the disease. There is less evidence torelate it to NUD.14h) Drugs : Chronic usage of NSAID’s such as aspirin, ibubrufen, indomethacin, salicylatesand also steroids are found to induce Non-Ulcer-dyspepsia.15Clinical 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. 65
  • Review of literature – Disease reviewDiagnostic Approach:17 The patients presenting with dyspepsia may have any of the conditions related toupper 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 dyspepsiaof gastrointestinal tract are given in the table No.Table No 11 Distinguishing between functional and organic/structural disease ofgastrointestinal tract.18 Function Organic Neoplastic InflammatorySymptoms :Weight loss None Common SometimesDiarrhoea Day time only Nocturnal Day and NightBlood loss None Frequent FrequentFever None Rate FrequentPain Cramping, relieved by Minor to severe May be localized, defecation may be severeBowelhabit Alternating Constipation Diarrhoea or[diarrhoea/constipation] Diarrhoea/constipation (Rarely Normal pellet like stools dianhoea)Laboratory testsHematocrit Normal Often decereased May be decreasedW.B.C. count Normal Usually normal Often elevatedErythrocyteSedimentation rate Normal Usually Usually increased increasedInvestigations :1. Routine Urine Examination.2. Routine Blood Examination.3. Stool Examination. 66
  • Review of literature – Disease review4. Endoscopy if necessary. [especially in pts. Of age>55 yr.]Management and therapy: 19Drug 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 modifications3. Assurance and counseling with patients associated with an identifiable cause of psychological factors.4. Antacids are sometimes helpful5. H2 – Receptor antagonists may be helpful in night pain or heartburn6. 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 andqualitative derangement of pitta.Its the out come of digestive disturbance due to faultyfood and regimen.The pathogenesis of amlapitta clearly states it to be a functional 67
  • Review of literature – Disease reviewdisturbance rather than an organic disturbance.Amlapitta is characterized by utklesha(nausea), amlodgara (acid erructations), hrtdaha (heart burn), kantadaha (burningsensation 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 andsymptoms 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 Nonulcer Dyspepsia. An attempt is being made to draw a paralance between Amlapitta and Non ulcerDyspepsia. 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. 68
  • Review of literature – Disease review 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 69
  • Review of literature – Drug review B. DRUG REVIEW SHATAVARIBotanical name : Asparagus racemosus Willd.Famlily : LiliaceaeClassical name : ShatavariSanskrit name : Shatavari, Shatamuli, Shatavirya, Bahusuta, Atirasa,Kula : Rasona KulaGana : Madhuraskandha. Balya. Vayasthapana1 [Charaka ] Vidarigandhadi, Kantakapanchamoola, Pittashamana2. [Sushruta]English name : Wild Asparagus.Description3 : Scandent climber, tall climbing, excessively branched, prickly under shrub. Rootstuberous; 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 adventitiouslyfrom the root stock. Its cylindrical in the middle, tapered towards the ends and brown incolour. Surface of the fresh roots are easily removable and cover glistening materialinside. The drugs are entire roots or longitudinally broken pieces, surface of dried rootsexhibit deep irregular longitudinal furrows and minute transverse wrinkles due toshrinkage during drying. The drug is hard. However, it breaks with a short fracture. Thedrug has no odour and has slightly mucilaginous taste which leaves bitterish blend afterchewing for few minutes. 70
  • Review of literature – Drug reviewVarieties : 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, sigmasterolIn 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. 71
  • Review of literature – Drug reviewEffect 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 ; DrishtimandyaAmlapitta ; 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 urineand seminal weakness. The roots are also utilized for medicated oils, used for nervousand 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 groupof classical formulations; Viz: Eladya modakam. Guduchyadi modakam; Trayodashangaguggulu; 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 differentdiseases.Parts used : Tubers.Dose : Juice 10-20 ml. Decoction 50-100 ml. Powder 3-6 gms. 72
  • Review of literature – Drug review ABHRAKA BHASMAABHRAKA Abhraka is one among Maharasa and the first one in the series. It’s a doublesilicate of Magnesium and Aluminium with sodium or potassium. There are differentkinds of mica and they vary from the chemical stand point. The micas are silicates ofvarying 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 krushnaveriety vajra abhraka is said to be shreshta5 as it allievates the diseases and has gotrasayana property. In this study the vajra abhraka of krushna variety is used for the prepration ofabhraka bhasma.Shodhana6: The shodhana of Abhraka was made by heating it and dipping in Triphala kashayafor 7 times and Dhanyabhraka was prepared as per the procedure told in Rasa Ratnasammuchaya.Marana : Around 64 maraka ganas have been explained in the text. For this study, the Abhraka Bhasma is prepared by triturating it with Kasamardaswarasa7 and subjected to puta for 30 times. The bhasma becomes nischandra within 10putas, but to increase its therapeutic value 30 putas were given. 73
  • Review of literature – Drug reviewProperties : 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. Dependingupon 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 % 74
  • Review of literature – Drug review GRITHA Gritha is not only included in the Gorasavarga, but it is also used as the bestremedy for pitta disorders and vata pitta disorder8. Gritha is best among all snehadravyas9 used internally. It is the sneha par-excellence because of its remarkable propertyto assimilate the properties of other substances when added to it. With its own qualitiesintact, it has the capacity to transform itself, so as to imbibe the qualities of thesubstances 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 veeryaalleviates pitta, even though kapha possesses qualities homologous to ghee, the latterwhen mixed up with drugs possessing opposite qualities alleviates the former. Gritha has different actions when licked and when swallowed. For e.g whenlicked 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 12Vipaka : Madhura13Guna : Snigdha, GuruVeerya : Sheeta14Doshagnata : Pittahara Vata pitta hara. 75
  • Review of literature – Drug reviewKarma : 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 threeimportant factors leading to the pathogenesis of the disease are agnimandya, ama andsrotodushti. Pitta is the pradhana dosha which singly or along with samana vayu andkledaka kapha causes agnimandya, which leads to the formation of ama which combineswith 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 increasesthe agni, reduces the ama and pacifies the pitta. Along with these, the drug should be ableto correct the vitiated dosha involved. i.e. vata and kapha. So the selection of the drugplays a vital role in the management of Amlapitta. A large number of yogas have beenexplained in the classics for the management of Amlapitta, among which “Shatavarichoorna” and Abhraka Bhasma” are one of the commonly used ingredients. This studyaims at assessing the efficacy of this simple, herbo-mineral combination in themanagement of Amlapitta. A potent Amlapitta medication should possess tikta madhura rasa, madhuravipaka and sheeta veerya to pacify the pitta and also vata. It should also possess agnideepana property as agnimandya is the main causative factor in the pathogenesis ofAmlapitta. 76
  • Review of literature – Drug review In a drug combination the drug acts combindly to give the desired effect. This iscalled as the synergetic action of the combination. In this context, the Shatavari choorna and Abhraka Bhasma along with gritha actscombinedly to bring about a synergetic effect in management of the Amlapitta and reduceits recurrence rate in long run.Shatavari choorna : Shatavari choorna due to its madhura rasa, madhura vipaka and sheeta veeryahelps to pacify the pitta and hence relieves bilous dyspepsia. Due to its deepana propertyit 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 gotsoothing and demulcent action over the mucosal lining of the G.I.T. Because the balyaand rasayana effect of the drug helps in increasing the strength and general condition.The adaptogenic activity of shatavari helps in reducing the stress and increasingendurance and sustaining capacity.Abhraka Bhasma : Abhraka bhasma due to its tridoshagna property, pacifies all the doshas. Becauseof its madhura rasa, madhura vipaka and sheeta veerya it specifically acts on pitta andpacifies 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 andhence found to be very effective in Amlapitta due to its anti-dotal property. The deepanaproperty of the drug helps in stimulating the agni and reducing the ama. The rasayana andbalya properties indicate that the drug acts as a bioavailability enhancer and helps incorrecting the srotodusti. 77
  • Review of literature – Drug reviewGritha : Gritha because of madhura rasa and sheeta veerya pacifies the pitta and snehaguna alleviates vata. Its deepana property helps in promating agni and thus reducing theama. Its yogavahi guna helps in potentiating the gunas of the shatavari choorna andabhraka bhasma and acts synergetically. It has cooling and softening affect over themucosal 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 conservationand 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 totalacidity of gastric juice of albino rats with Satavari choorna. In a clinical study, Singh et al. (1985) observed Shatavari mandura showed atendency to decrease acid-pepsin secretion, significant decrease in cell shedding andincrease in mucin secretion indicating its predominant effect on mucosal defensivefactors in deudonal ulcer. Direct healing effect was proposed probably by enhancementof mucosal barrier, prolongation of life span of mucosal cells or cytoprotection. LIQUID ANTACIDANTACIDS Antacids remain an effective therapy relieve the symptoms of Non-ulcerdyspepsia. Gastric antacids are substance which on injection act by neutralizing HCLsecreted by gastric parietal cells thus devoting the gastric pH. They produce symptomaticrelief of pain partly by reducing the acidity and partly by the consequent relief of musclespasm. Reduction in acidity inhibits the action of pepsin. It also increases the tone of the 78
  • Review of literature – Drug reviewoesophago –gastric sphincter and reduces the reflex of the acid, gastric contents into theoesophagas.21Mechanism 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 ofMagnesium trisilicate and Aluminium Hydroxide.Aluminium and Magnesium Containing Antacids : Antacids such as magnesium carbonate, hydroxide and trisilicates and aluminiumglycinate and hydroxide, being relatively insoluble in water, are long acting if retained inthe stomach. Magnesium salts increase intestinal motility, where as Aluminium decreasesit; thus antacids containing former tend to be laxative whereas those containing latter maybe constipating.A right balance of aluminium and magnesium compounds can be used soas 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. 79
  • Methodology MATERIALS AND METHODS Samprapti vighatana forms, the basis of any chikitsa. Amlapitta is caused due tothe vitiation of pitta, and agnimandya leading to formation of ama or annavisha whichattains shuktatva leading to the clinical manifestation of the disease entity. Many numberof yoga’s have been mentioned in the classics for the treatment and management ofAmlapitta of which “Shatavari Choorna” and “Abhraka Bhasma” are also among themost commonly used ingredients in these yoga’s. Hence an attempt has been made in thisstudy to assess the efficacy of this simple herbo mineral combination in the managementof Amlapitta. Shatavari choorna and Abhraka Bhasma both are tridoshagna, madhura rasapradhana madhura vipaka, sheeta veerya and have deepana property which helps inpacifying the pitta and correcting the agnimandya.Materials : 1. Abhraka Bhasma 2. Shatavari choorna 3. Gritha for AnupanaMethod of Preparation of Shatavari choorna: Dry tubers of shatavari was procured from dealers and were properly identifiedwith 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 waspounded 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 thenpacked in an air tight container. 80
  • MethodologyMethod of preparation of Abhraka Bhasma: The layers of Krishna abhraka was separated and subjected to shodhana byheating it to red hot and dipping in triphala kashya for 7 times. Then Dhanyabhraka wasprepared as per the procedure described in Rasa Ratna sammuchaya. The so formeddhanyabhraka was subjected to marana process by triturating it with kasa marda swarasand giving puta. This was repeated for 30 times, though the bhasma became nischandraby 10 putas in order to increase its therapeutic value the finished product and was packedin an air tight container. A air tight pack of 7 days medication of shatavari choorna [63gm.] along withAbhraka Bharma [2.625gm.] was made after mixing the both thoroughly and given to thepatient at each visit the patient was asked to take 3/4th tsp. of the choorna mixing withlittle 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.METHODOLOGYObjectives : 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. 81
  • Methodology 4. Detailed study of disease covering classical and modern literature. 5. To establish an effective, simple herbo-mineral combination in the management of Amlapitta.Source of data: The patients of either sex diagnosed as Amlapitta on the basis of classical featureswere randomly selected from the OPD and IPD of A.L.N.Rao Memorial AyurvedicMedical College Hospital, Koppa and associated hospitals.Sampling Method: Total 64 diagnosed cases of Amlapitta were selected at random from clinicalsurvey of patients attending the IPD and OPD of A.L.N.Rao Memorial AyurvedicMedical College Hospital, Koppa and associated hospitals. A complete history including the general body condition of the patient wasassessed and few bio-chemical investigations were done to rule out systemic illness andother complications and were selected only after found fulfilling the diagnostic as well asinclusive criteria. There after the patients were registered and treated as outpatients forthe 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 withone or more associated symptoms and investigations were selected for the study. 1. Utklesha. 2. Hrithdaha. 3. Kantadaha. 4. Amlodgara. 82
  • Methodology 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 thestudy. 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. 83
  • Methodology 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 isthe trial drug.Selection of the patients : After the diagnosis as on the above parameters, the patients selected wereassigned 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. 84
  • MethodologyInvestigations : The following investigations were carried out on mandatory basis for each patientbefore starting the treatment in order to rule out general condition, systemic illness andother 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 monthFollow up - : 1 month. The follow up was done once a week during the treatment and there after for aduration of 1 month for both the groups. During this period the patient was advised to follow the pathyapthya.Assessment of Response : 85
  • Methodology 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. 86
  • MethodologyGrade 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 2 : Occurs on consuming food stuffs.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 2 : Occurs on consuming food stuffs.Grade 1 : Occasional; only on consuming spicy or sour food.Grade 0 : No Kantadaha. 5. Vamana : [Vomiting] Severity of vamana is scored as fallows 87
  • Methodology 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. 88
  • Methodology 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 3 : All the symptoms. Grade 2 : Presence of 5 - 8 symptoms. Grade 1 : Presence of 3 - 4 symptoms. Grade 0 : No symptoms. Pureeshavaha srotas : Severity of Pureeshavaha sroto dusti are scored as follows. Grade 3 : All the symptoms. Grade 2 : Presence of 3 - 5 symptoms. Grade 1 :Presence of 2 Symptoms. Grade 0 : No symptoms. 89
  • MethodologyStatistical analysis : Mean, Percentage, Standard Deviation, Standard Error, ‘t’ value and ‘p’ valuewere 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]. 90
  • Methodology OBSERVATIONS In the present study total 64 patients of Amlapitta were registered. Out of which60 patients completed the course of treatment in both the groups i.e. 30 patients in eachgroup and remaining 4 patients discontinued the treatment. The biostatistical observationsand total effect of the treatment is presented on findings of 60 patients (30 in each group)only.Incidence of AgeTable no. 13 Showing the age wise distribution of 60 Amlapitta patients. Sl. Trial Control Age (in yrs.) % % Total % No. Group Group 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 20Majority of patients belongs to age group of 26-33 yrs. i.e. 35% followed by 30% in theage group 34-41 yrs; 20% in 42-50yrs age group while 15% were in the 18-25 yrs agegroups.Graph no. 1 Showing the age wise distribution of 60 Amlapitta patients. 12 10 8 6 Trail Group Control Group 4 2 0 18-25 26-33 43-41 42-50 91
  • MethodologyIncidence of SexTable no. 14 Showing the Sex wise distribution of 60 Amlapitta patients. Sl Control Sex Trial Group % % Total % No Group 01 Male 12 40 15 25 25 45 02 Female 18 60 15 25 33 5555% of the patients in the study were females while 45% were males.Graph no. 2 Showing the Sex wise distribution of 60 Amlapitta patients. 20 15 Male 10 Female 5 0 1 2Incidence of ReligionTable no. 15 Showing the Religion wise distribution of 60 Amlapitta patients. Sl. Control Religion Trial Group % % Total % No Group 01 Hindu 15 25 18 60 33 55 02 Muslim 9 30 6 20 15 25 03 Christian 6 20 6 20 12 20Amongst the patients registered for the study 55% were Hindus, followed by 25%Muslims and 20% were Christians. 92
  • MethodologyGraph no. 3 Showing the Religion wise distribution of 60 Amlapitta patients. 18 16 14 12 10 Trial Group 8 6 Control Group 4 2 0 Hindu Muslim ChristianIncidence of Marital statusTable no. 16 Showing the Marital status wise distribution of 60 Amlapitta patients. Sl. Trial Control Status % % Total % No. Group Group 01 Married 12 40 18 60 30 50 02 Unmarried 15 50 9 30 24 40 03 Widow/ 3 10 0 0 3 5 Widower 04 Divorcee 0 0 3 10 3 550% of the patients were married , 40% were not married, 5% of them were divorcee. and5% were widow/widower.Graph no. 4 Showing the Marital status wise distribution of 60 Amlapitta patients. 18 16 14 12 10 8 Trial Group Control Group 6 4 2 0 Married Unmarried Widow/ Divorcee Widower 93
  • MethodologyIncidence of Educational statusTable no. 17 Showing the Educational status wise distribution of 60 Amlapittapatients. Sl. Trial Control Education % % Total % No. Group Group 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 upto 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. Trial roup Control Group Primary Middle Uneducated Graduate High school school school 94
  • MethodologyIncidence of Socioeconomic statusTable no. 18 Showing the socioeconomic status wise distribution of 60 Amlapittapatients. Sl. Trial Control Strata % % Total % No Group Group 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 3 540% of the patients belonged to the middle class. 25% representation was seen in middleclass. 15% belonged to poor class, 10% belonged to upper middle class, and 5% werefrom the very poor and rich class each.Graph no. 6 Showing the Socioeconomic status wise distribution of 60 Amlapittapatients. 16 14 12 10 8 Trial Group Control Group 6 4 2 0 Very poor Poor Lr. Middle Middle Ur. Middle Rich 95
  • MethodologyIncidence of Occupational statusTable no. 19 Showing the Occupational status wise distribution of 60 Amlapittapatients. Sl, Trial Control Occupation % % Total % No Group Group 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 businessclass. 20% to labour class; 10% to service and 5% of them were students.Graph No. 7 Showing the Occupational status wise distribution of 60 Amlapittapatients. 40 35 30 25 20 Trial group 15 Control group 10 5 0 Student House Labour Business Services wifeIncidence of OnsetTable No. 20 Showing the onset wise distribution of 60 Amlapitta patients. Sl, Onset Trial Control % % Total % No Group Group 01 Sudden 12 40 15 50 27 45 02 Gradual 18 60 15 50 23 55Table shows that 55% of patients presented gradual onset while 45% presented suddenonset. 96
  • MethodologyGraph No. 8 Showing the onset wise distribution of 60 Amlapitta patients. 60 50 40 30 Trial group 20 Control group 10 0 Sudden GradualIncidence of Aggravating PeriodTable No 21 Showing the Aggravating period wise distribution of 60 Amlapittapatients Sl, Aggravating Trial Control No Period % % Total % Group Group 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 4040% of patients presented with aggravation of symptoms in Mid-day;40% in themorning and10% in Mid-nightGraph No. 9 Showing the Aggravating Period wise distribution of 60 Amlapittapatients. 50 40 30 Trial group 20 Control group 10 0 Mid-day Mid-Night Morning 97
  • MethodologyIncidence of Aggravation due to Environmental FactorTable No 22 Showing the Incidence Aggravating of symptoms due toenvironmental factors in 60 Amlapitta patients Sl, Environmental Trial Control No Factor % % Total % Group Group 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 3 555% patients showed aggravation of symptoms in rainy season;followed by 30%insummer;10% in autumn and 5% in winter seasonGraph No.10 Showing the Incidence Aggravating Of symptoms due toenvironmental factors in 60 Amlapitta patients 60 50 40 30 Trial group 20 Control group 10 0 Rainy Autumn Summer WinterIncidence of HabitatTable no. 23 Showing the Habitat status wise distribution of 60 Amlapitta patients. Sl. Control Habitat Trial Group % % Total % No. Group 01 Urban 9 30 12 40 21 35 02 Rural 21 70 18 60 39 6565% of the patients were from rural populace while 35% were from urban populace. 98
  • MethodologyGraph no. 11 Showing the Habitat wise distribution of 60 Amlapitta patients. 25 20 15 Trial Group 10 Control Group 5 0 Urban RuralIncidence of Dietary habitTable no. 24 Showing the Dietary habit wise distribution of 60 Amlapitta patients. Sl. Trial Control Diet % % Total % No Group Group 01 Vegetarian 9 30 12 40 21 35 02 Mixed 21 70 18 60 39 6565% 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. 25 20 15 Vegetarian 10 Mixed 5 0 Trial Group Control GroupIncidence of Ahara vidhiTable no.25 Showing the Ahara vidhi wise distribution of 60 Amlapitta patients. Sl. Trial Control Ahara vidhi % % Total % No. Group Group 01 Samasana 9 30 6 20 15 25 02 Visamasana 18 60 21 70 39 65 03 Adhyasana 3 10 6 20 9 15 99
  • Methodology 04 Anashana 0 0 0 0 0 0 05 Pramitasana 9 30 6 20 15 25 06 Viruddhasana 6 20 9 30 15 2565% 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. 25 20 15 Trial Group 10 Control Group 5 0 Samasana Visamasana A dhyasana A nashana P ramitasana ViruddhasanaType Of DietTable No. 26 Showing the Type of diet wise distribution of 60 Amlapitta patients. Sl, Type Of Diet Trial Control % % Total % No Group Group 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 toVirudhanna; 20% were used to amlarasapradhana; 10% to vidahianna and 5% toatibhojana. 100
  • MethodologyGraph No.14 Showing the Type of diet wise distribution of 60 Amlapitta patients. 40 30 Trial group 20 Control group 10 0 Viruddhanna Pit t aprakopaka Vidahianna Amlarasapradhana Abhishyandhi At ibhojanaIncidence of Rasa satmyaTable no. 27 Shows Rasa Satmya wise distribution of 60 Amlapitta patients Sl. No. Control Rasa Trial Group % % Total % Group 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 6060% 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 25 20 15 Trial Group 10 Control Group 5 0 Madhura Amla Lavana Katu 101
  • MethodologyIncidence of RegimenTable no. 28 Showing the Regimen wise distribution of 60 Amlapitta patients. Sl, Regimen Trial Control % % Total % No Group Group 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% ofavagahana; 25% of vegadharana and remaining 15% of diwaswpna.Graph no. 16 Showing the Regimen wise distribution of 60 Amlapitta patients. 40 30 20 Trial group Control group 10 0 Diw asw apna Vegadharana Avagahana AtapasevanaIncidence of Mental stressstrainTable no. 29 Showing the Mental stress/strain wise distribution of 60 Amlapittapatients. Sl. Trial Control Mental stress % % Total % No Group Group 01 Present 18 60 21 70 39 70 02 Absent 12 40 9 30 21 3070% of the patients gave a history of mental stress while 30% did not have any mentalstress. 102
  • MethodologyGraph no.17 Showing the Mental stress/strain wise distribution of 60 Amlapittapatients. 25 20 15 Present 10 Absent 5 0 Trial Group Control GroupIncidence of AddictionsTable no.30 Shows incidence of Addictions in 60 Amlapitta patients Sl. Trial Control Habits % % Total % No. Group Group 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 3 565% of the patients gave a history of regular consumption of tea/coffee, 25% wereaddicted to smoking, 20% of the patients had history of consumption of NSAID’s,15% ofpatients were addicted to alcohol and cool-drinks,5% of them had no addictions. 103
  • MethodologyGraph no. 18 Shows incidence of Addictions in 60 Amlapitta patients 25 20 15 Trial Group 10 Control Group 5 0 Cool drinks NSAID’s None Tea/Coffee Smoking Tobacco AlcoholIncidence of ExerciseTable No. 31 Showing the Exercise wise distribution of 60 Amlapitta patients. Sl, Trial Control Exercise % % Total % No Group Group 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 12 40 9 30 21 35 Work Table shows that 35% of the patients did only routine work; 35% of patients onlyoccasional exercise; 25% did irregular exercise and only 5% did regular exercise.Graph No.19 Showing the Exercise wise distribution of 60 Amlapitta patients. 12 10 8 6 Trial Group 4 Control Group 2 0 Regular Irregular Occasional Only Routine Work 104
  • MethodologyIncidence of NidraTable no.32 Shows incidence of nidra in 60 Amlapitta patients Sl. Trial Control Nidra % % Total % No Group Group 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 3045% of the patients complained of disturbed sleep,while 30% of delayed sleep 20% ofirregular sleep and15% of no such complaints.Graph no. 20 Shows incidence of nidra in 60 Amlapitta patients 18 16 14 12 10 Trial Group 8 Control Group 6 4 2 0 Sound Irregular Disturbed DelayedIncidence of Bowel HabitTable no. 33 Shows Bowel habit wise distribution of 60 Amlapitta patients Sl, Bowel Habit Trial Control % % Total % No Group Group 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 bowelhabit and 15% had regular bowel habitGraph No. 21 Shows Bowel habit wise distribution of 60 Amlapitta patients 105
  • Methodology 60 50 40 30 Trial group 20 Control group 10 0 Regular Irregular ConstipationIncidence of Nature of StoolTable No. 34 Shows Nature of stool wise distribution of 60 Amlapitta patients Sl, Trial Control Nature Of Stool % % Total % No Group Group 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 softstool and remaining 15% of loose stools.Graph No. 22 Shows Nature of stool wise distribution of 60 Amlapitta patients 18 16 14 12 10 Trial Group 8 Control Group 6 4 2 0 Loose Soft Constipated 106
  • MethodologyIncidence of Type of occupationTable No.35 Shows Type of occupation wise distribution of 60 Amlapitta patients Sl. Trial Control Degree of work % % Total % No. Group Group 01 Heavy 9 30 3 10 12 20 02 Moderate 15 50 18 60 33 55 03 Sedentary 6 20 9 30 15 2555% 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 18 16 14 12 10 Trial Group 8 Control Group 6 4 2 0 Heavy Moderate SedentaryIncidence of Nature Of WorkTable No.36 Shows Nature of work wise distribution of 60 Amlapitta patients Sl, Nature Of Work Trial Control % % Total % No Group Group 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 natureof work. 107
  • MethodologyGraph No. 24 Shows Nature of work wise distribution of 60 Amlapitta patients 60 50 40 30 Trial group 20 Control group 10 0 Physical MentalIncidence of Deha prakrtiTable no. 37 Shows incidence of Deha prakriti in 60 Amlapitta patients Sl. Trial Control Prakrti % % Total % No. Group Group 01 Vata pittala 18 60 12 40 30 50 02 Pittakaphala 12 40 12 40 24 40 03 Vatakaphala 0 0 6 20 6 10Amongst the patients, 50% were of Vatapittala prakrti, 40% of Pittakaphala and 10% ofVatakaphala.Graph no. 25 Shows incidence of Deha prakrati in 60 Amlapitta patients 18 16 14 12 10 Trial Group 8 Control Group 6 4 2 0 Vata pittala Pittakaphala Vatakaphala 108
  • MethodologyIncidence of SaraTable no.38 Shows Sara wise distribution of 60 Amlapitta patients Sl. Control Sara Trial Group % % Total % No. Group 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 3 555% of the patients were of Mamsa sara, 25% were of Tvak sara while 15% were Asthisara and 5% were Majja sara.Graph no. 26 Shows Sara wise distribution of 60 Amlapitta patients 18 16 14 12 10 Trial Group 8 Control Group 6 4 2 0 Tvak Mamsa Asthi MajjaIncidence of SamhananaTable no. 39 Shows Samhanana wise distribution of 60Amlapitta patients Sl. Trial Control Samhanana % % Total % No. Group Group 01 Pravara 12 40 6 20 18 30 02 Madhyama 18 60 21 70 39 65 03 Avara 0 0 3 10 3 565% of the patients were of Madhyama samhanana followed by 30% of Pravara and 5%of Avara samhanana. 109
  • MethodologyGraph no. 27 Shows Samhanana wise distribution of 60Amlapitta patients 25 20 15 Trial Group 10 Control Group 5 0 Pravara Madhyama AvaraIncidence of SatvaTable no. 40 Shows Satva wise distribution of 60 Amlapitta patients Sl. Trial Control Satva % % Total % No Group Group 01 Pravara 3 10 6 20 9 15 02 Madhyama 18 60 18 60 36 60 03 Avara 9 30 6 20 15 2560% of the patients were of Madhyama satva, 25% of Avara satva and 15% of Pravarasatva.Graph no. 28 Shows Satva wise distribution of 60 Amlapitta patients 18 16 14 12 10 Trial Group 8 Control Group 6 4 2 0 Pravara Madhyama Avara 110
  • MethodologyIncidence of AgniTable no. 41 Shows Agni wise distribution of 60 Amlapitta patients Sl. Control Agni Trial Group % % Total % No Group 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 0 065% of the patients suffered from Mandagni while 25% had Visamagni,and10% of themhad tikshanagni.Graph no.29 Shows Agni wise distribution of 60 Amlapitta patients 25 20 15 Trial Group 10 Control Group 5 0 Tiksna Visama Manda SamaIncidence of KoshtaTable No. 42 Shows Koshta wise distribution of 60 Amlapitta patients Sl, Koshta Trial Control % % Total % No Group Group 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 and25% had krura koshta.Graph No.30 Shows Koshta wise distribution of 60 Amlapitta patients 111
  • Methodology 50 40 30 Trial group 20 Control group 10 0 Mrudu Madhyama KruraIncidence of BalaTable no.43 Shows Bala wise distribution of 60 Amlapitta patients Sl. Trial Control Bala % % Total % No Group Group 01 Pravara 6 20 15 50 24 30 02 Madhyama 24 80 15 50 39 70 03 Avara 0 0 0 0 0 0Pravara bala patients were 70% while 30% were of Madhyama bala.Graph no. 31 Shows Bala wise distribution of 60 Amlapitta patients 25 20 15 Trial Group Control Group 10 5 0 Pravara Madhyama Avara 112
  • MethodologyIncidence of DeshaTable no. 44 Shows Desha wise distribution of 60 Amlapitta patients Sl. No Desha Trial Control % % Total % Group Group 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 70 60 50 40 Trial group 30 Control group 20 10 0 Anoopa Jangala SadharanaIncidence of Duration of illnessTable no.45 Shows Duration of Illness wise distribution of 60 Amlapitta patients Sl. Duration Trial % Control % Total % No. Group Group 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 5 113
  • Methodology30% gave a history of 7mths to 12 mths and 13mths to 18mths of illness each, 15% hadsuffered for less than 6mths, 5% had the illness for 25mths to30mths and 31mthsto36mths each.Graph no.33 Shows Duration of Illness wise distribution of 60 Amlapitta patients 16 14 12 10 8 Trial Group 6 Control Group 4 2 0 > 6 mths. 7-12 mths 13-18 19-24 25-30 31-36 mths mths mths mthsIncidence of Samanya laksanaTable no.46 Shows Samanya lakshana wise distribution of 60 Amlapitta patients Sl. Trial Control Laksana % % Total % No. Group Group 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 mostall the patients in both the groups i.e87%; Amloudgara(acid erructations) was present in83% 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 thepatients gave a history of aggravation of symptoms following consumption of specificfoods and regimen. 114
  • MethodologyGraph No. 34 Shows Samanya lakshana wise distribution of 60 Amlapitta patients 100 90 80 70 60 50 40 Trial group 30 Control group 20 10 0 Vanti Utklesha Amlodgara Hrtdaha Kanthadaha UdarashoolaIncidence of Associated symptomsTable no.47 Shows Associated symptom wise distribution of 60 Amlapitta patients Sl. Trial Control Laksana % % Total % No Group Group 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 5260% 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 klamaand gourava each and 40% of patient complained of antrakujana. 115
  • MethodologyGraph No. 35 Shows Associated symptom wise distribution of 60 Amlapitta patients 25 20 15 10 Trial Group 5 Control Group 0 Tiktodgara Gurukoshtatha Klama Gourava Avipaka Adhamana Antrakujana Sirasula AruchiIncidence of SrotodustiTable no. 48 Shows Srotodusti wise distribution of 60 Amlapitta patients Sl. Trial Control Srotas % % Total % No Group Group 01 Annavaha 12 40 9 30 21 35 02 Rasavaha 9 30 12 40 21 35 03 Pureeshavaha 9 30 9 30 18 3035% of the patients had annavaha srotodusti and rasavaha srotodusti lakshanas each and30% of the patients had pureeshavaha srotodusti lakshanas.Graph No.36 Shows Srotodusti wise distribution of 60 Amlapitta patients 40 30 Trial group 20 Control group 10 0 Annavaha Rasavaha Pureeshavaha 116
  • Results RESULTS Effect of Trial drug on Main symptoms: Table no. 49 Effect of Trial drug on Main symptoms after Treatment Lakshana Mean % SD SE t P Remarks BT AT BT-AT (±) (±) 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 Lakshana Mean % SD (±) SE (±) t P Remarks BT AFU BT-AFU Utklesha 1.44 1.19 0.259 25.92 0.446 0.085 2.908 <0.010 MSAmlodgara 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 MSKanthadaha 1.55 1.273 0.277 27.77 0.460 0.108 2.549 <0.050 Mi. SUdarashoola 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 117
  • ResultsThe trial drug provided highly significant relief(p<0.001) in the management ofespecially udarashoola and amlodgara by 54.16% and 40.74% respectively even after thefollow 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 Lakshana Mean % SD SE t P Remarks BT AT BT- (±) (±) AT Utklesha 1.72 1.20 0.52 52.00 0.509 0.101 5.099 <0.001 HSAmlodgara 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 HSKanthadaha 1.33 0.875 0.458 45.80 0.508 0.103 4.408 <0.001 HSUdarashoola 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 HSThe control drug provided highly significant relief( p<0.001) in all the symptomsespecially in management of udarashoola and vamana by 75% and 69.50% respectively.The other symptoms like utklesha, amlodgara, hrtdaha, and kantadaha also showed highlysignificant relief by 52%, 56.52%, 50% and 45.8% respectively. 118
  • ResultsEffect of control drug on Main symptoms:Table no. 52 Effect of control drug on Main symptoms after follow up Lakshana Mean % SD(±) SE(±) t P Remarks BT AFU BT- AFU Utklesha 1.72 1.48 0.24 24.00 0.435 0.087 2.752 <0.020 MSAmlodgara 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 MSKanthadaha 1.33 0.96 0.32 32.00 0.476 0.095 3.360 <0.010 MSUdarashoola 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 MSThe control drug provided moderately significant relief(p<0.010) in the management ofamlodgara, 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) inthe management of utklesha by 24%.Effect of Trial drug on Associated symptoms:Table no. 53 Effect of Trial drug on Associated symptoms after Treatment Lakshana Mean % SD SE t P Remarks BT AT BT- (±) (±) AT 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 HSGurukoshtatha 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 119
  • Results 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 Lakshana Mean % SD(±) SE(±) t P Remarks BT AFU BT- 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 HSGurukoshtatha 1.411 0.881 0.529 52.94 0.701 0.170 3.800 <0.001 HS Adhamana 1.473 1.052 0.421 42.10 0.611 0.140 3.370 <0.010 MSAntrakujana 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. 120
  • Results The Trial drug provided mild significant relief (p<0.050) in the management ofklama by 35.17%. The Trial drug provided no significant relief (p>0.050) in the management ofantrakujana by 37.5%.Effect of Control drug on Associated symptoms:Table no. 55 Effect of Control drug on Associated symptoms after Treatment Lakshana Mean % SD(±) SE(±) t P Remarks BT AT BT- 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 HSGurukoshtatha 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 managementof 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 themanagement of klama and gurukostata by 50% and 46.10% respectively. The control drug provided no significant relief (p>0.050) in the management ofantrakujana by 30%. 121
  • Results Effect of Control drug on Associated symptoms: Table no. 56 Effect of Control drug on Associated symptoms after follow up Lakshana Mean % SD(±) SE(±) t P Remarks BT AFU BT- 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 NSGurukoshtatha 1.230 1.154 0.760 07.60 0.277 0.076 0.988 <0.001 HS Adhamana 1.437 1.312 0.125 12.50 0.341 0.085 1.463 >0.050 NSAntrakujana 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 The control drug provided highly significant relief (p<0.001) in the management 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. The control drug provided no significant relief (p>0.050) in the management of klama, gourava, aruchi, adhmana, antrakujana and shiroruja by 21.42%, 16.16%, 18.15%, 12.5%, 10% and 11.76% respectively after follow up. 122
  • Results Effect of Trial drug on Srotodusti: Table no. 57 Effect of Trial drug on Srotodusti after Treatment Srotas Mean % SD(±) SE(±) T P Remarks BT AT BT- AT 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 Srotas Mean % SD(±) SE(±) t P Remarks 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 HSPureeshavaha 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. 123
  • ResultsEffect of Control drug on Srotodusti:Table no. 59 Effect of Control drug on Srotodusti after Treatment Srotas Mean % SD(±) SE(±) t P Remarks 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 HSPureeshavaha 1.586 1.034 0.551 55.17 0.568 0.105 5.555 <0.001 HS The control drug provided highly significant relief (p<0.001) in the managementof 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 Srotas Mean % SD(±) SE(±) t P Remarks 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.SPureeshavaha 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 ofrasavaha srotodusti by 13.33%. The control drug provided no significant relief (p>0.050) in the management ofannavaha srotodusti and pureeshavaha srotodusti by 10% and 13.79% respectively. 124
  • Results Total effect of Trial drug and Control drug After treatment: Table no.61 Results Trial drug Control drug No. of patients % No. of patients %Complete relief 00 00 00 00Marked improvement 11 36.66 4 13.33Improved 14 46.66 15 50.00Controlled 5 16.66 11 36.66Unchanged 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 Results Trial drug Control drug No. of patients % No. of patients %Complete relief 00 00 00 00Marked improvement 02 6.66 00 00Improved 10 33.33 4 13.33Controlled 17 56.66 22 73.33Unchanged 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 125
  • Resultsimprovement in the condition by more than 75% relief. Only 3.33% of patients showedno change in any of the complaints. After the follow up in the control group 73.33% of patients showed controlledeffect where in there was 25% to 50% relief in the symptoms. 13.33% of the patientsshowed improved effect by 50% to 75% relief. 13.33% of the patients showed no changein any of the complaints.Graph No.37Showing comparative effect of therapies on main symptoms after the treatment 80 60 40 Trial drug 20 Control drug 0 V anti Hrtdaha K anthadaha Utklesha A m lodgara Udarashoola The trial drug showed highly significant relief (p<0.001) in all the symptomsespecially amlogdara and hritdaha by 78.07% and 72.77% respectively. While the controldrug also showed highly significant in all the symptoms especially in udarashoola andvamana by 75% and 69.05% respectively. Though there was highly significant relief in all the other symptoms also. But intrial group the percentage of relief was higher when compared to the control group. 126
  • ResultsGraph No.38Showing comparative effect of therapies on main symptoms after follow up 60 50 40 30 20 Trial drug 10 Control drug 0 V anti Utk les ha A m lodgara Hrtdaha K anthadaha Udaras hoola In the trial drug after follow up there was highly significant relief (p<0.001) inudarashoola and amlogdara by 54.16% and 40.74% respectively; where as in the controlgroup it showed moderate significant relief by 37.5% and 30.43% respectively. In hritdaha, vamana and utklesha, the trial group showed moderately significantrelief 33.33%, 37.5% and 25.92% respectively; where as in the control group it showed itshowed same result by 31.81%, 34.78% and 24% respectively. In kantadaha the trial drug showed mild significant relief by 27.77%, where ascontrol drug provided moderately significant relief by 32%. 127
  • ResultsGraph No.39Showing comparative effect of therapies on associated symptoms after the treatment 100 80 60 40 Trial drug 20 Conrol drug 0 A ruc hi Gourav a A dhamana A ntrakujana Siras ula A v ipaka Klama Tiktodgara Gurukos htatha 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. Whereas 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 by71.42% and 61.52% respectively; where as in control group showed moderatelysignificant relief by 50% and 46.10% respectively. In shiroruja the trial group showed moderately significant relief by 64.2%, whereas in control group it provided highly significant relief by 70.58%. In antrakujana the trial group showed highly significant relief by 75%, where asthe control group showed no relief. 128
  • ResultsGraph No.40Showing comparative effect of therapies on associated symptoms after follow up 60 50 40 30 20 Trial drug 10 Control drug 0 A ru c h i A v ip a ka K la ma Gourav a Tikto d g a ra A d h a ma n a A n tr a ku ja n a S ir a s u la G u r u ko s h ta th a In gurukostata there was highly significant relief by 52.94% in trial group, whereas in control group also showed same result by 7.6%. In avipaka there was highly significant relief in the trial group by 52.38%, whereas 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 incontrol 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 asin control group there was no significant change. In adhmana and gourava there was moderately significant relief in the trial groupby 42.10% and 37.5% respectively, where as in control group there was no significantchange. There was no significant change in antrakujana in both the groups. 129
  • ResultsGraph No.41Showing comparative effect of therapies on srotodusti after the treatment 100 80 60 Trial drug 40 Control drug 20 0 Annavaha Rasavaha Pureeshavaha In annavaha srotodusti, rasavaha srotodusti and pureeshavaha srotodusti the trialgroup 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.42Showing comparative effect of therapies on srotodusti after follow up 80 60 Trial drug 40 Control drug 20 0 Annavaha Rasavaha Pureeshavaha 130
  • Results 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% and61.53% respectively. Where as in control group there was mild significant relief inrasavaha srotodusti by 13.33%, but no significant change in annavaha srotodusti andpureeshavaha srotodusti.Graph No.43Showing comparative total effect of therapies after treatment 50 40 30 20 Trial drug Control drug 10 0 Improved Complete Controlled improvement Unchanged relief Marked The trial drug group was found to be more effective than the control drug groupafter the treatment. In the trial group 36.66% of the patients showed marked improved, while only13.33% of patients showed the same in control group. The trial group showed 46.66% of the patients with improved effect, where as50% of patients in control group with same effect. The trial group showed 16.66% of the patients with controlled effect, where as36.66% of patients in control group with same effect. The trial group showed unchanged cases where as the control group showedunchanged effect in 3.33% of patients. 131
  • ResultsGraph No.44Showing comparative total effect of therapies after follow up 80 70 60 50 40 30 Trial drug 20 Control drug 10 0 Improved Complete Controlled improvement Unchanged relief Marked After follow up the trial drug group was found to be more effective than thecontrol group. The trial group showed 6.66% of patients with marked improved where as in thecontrol group there was no such improvement. The trial group showed 33.33% of patients with improved effect where as in thecontrol group it was 13.33%. The trial group showed 56.66% of patients with controlled effect where as in thecontrol group it was 73.33%. The trial group showed 3.33% of patients with unchanged effect where as in thecontrol group it was 13.33%. From the above it can be observed that the trial drug showed maximum cases tobe markedly improved, improved and no unchanged cases, where as the control groupshowed maximum cases to be improved and having control effect after the treatment. Even after follow up the trial group shows maximum cases to be markedlyimproved and improved when compared to control group. The trial group also showsminimal 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. 132
  • Discussion DISCUSSION Amlapitta is a psycho-somatic disease of annavaha srotas mainly caused due toindulgence in faulty diet and regimen. It presents a group of signs and symptoms viz.,avipaka, amlodgara, hrtdaha, kantadaha utklesha, vamana, udaarashoola, adhmanavitbheda etc. which are more commonly termed as dyspeptic signs in the modernmedicine. Amlapitta is stated to be a disorder manifested due to agnimandya leading to theformation of ama. Inturn the ama combining with the vrudhpitta leads to the formation ofamavisha which turns into shuktapaka and manifests clinically. This disorder is stated tobe caused due to dusti occurring in the annavaha srotas first and involving the rasavahaand pureeshavaha srotas. From the samprapti explained it is clear that Amlapitta is theresult of functional disturbance of the annavaha srotas, especially during theamlaavastapaka where in the food in taken turns to shuktapaka due to agnimandya andama. This can be compared to non ulcer dyspepsia or functional dyspepsia in the modernmedicine 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 functionaldisturbance with no organic lesions any where in GIT. Amlapitta is most commonest disease met with in general practice requiring anadequate and proper management as it hampers the daily routine of an individual. Madhavakara states that Amlapitta is a condition which and when promptlytreated along with proper diet and regimen can be easily cured. If it is neglected and oneindulgence himself in apathya ahara vihara it becomes kastasadhya. 133
  • Discussion The patients of Amlapitta were randomly selected irrespective of sex fulfilling theinclusion and exclusion criteria. Freshly diagnosed cases and cases of recent origin wereselected for the study. The main symptoms of the disease were graded and scored for theassessment. Along with this the associated symptoms and srotodusti were also graded andscored for the assessment. The cases with chronic and acute onset were ruled out forulcers before including into the study by Endoscopy. The general condition of the patientwas also assessed by detailed history and routine bio-chemical investigations for otherdiseases so as to fulfill the inclusion criteria. The patients were grouped randomly andcontrolled 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 1month and the patients under control group received Syrup Gelusil 1 tsp. thrice dailybefore meals for 1 month. The result was assessed by statistical analysis of the symptomsthat 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 34-41yrs 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 demographiccause or distribution of the patients. 134
  • Discussion4] Marital status : More of the married individuals showed the presence of the disease. As thiscondition is more common in the middle age group, the presence of Amlapitta is more inthe married group. The life is more stressfull during the middle age due to greaterresponsibilities both physically and mentally; which becomes one of the cause for themanifestation of the amlapitta.5] Educational Status : Amlapitta was found to be more in graduates and the people who had completedhigher secondary schooling. In this phase the mental stress and strain is found to be morealong with improper food habits which becomes the causative factor for the clinicalmanifestation of the disease.6] Occupational status : The disease incidence was found to be highest in house wives followed bybusinessmen which indicated the sedentary life style and food habits which are more inthese individuals to be the causative factors.7] Diet : a) Type: The incidence of mixed diet was more ; which highlights that intake ofexcessive fatty and spicy foods leads to the manifestation of the disease. b) Habit :Majority of the patients were accustomed to vishama shana [untimelyintake 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 rasapradhana, and virudhanna which are also the cause for the vriddhi of pitta leading to themanifestation of the disease. 135
  • Discussion8] Socio – Economic status : More number of patients belonged to middle class which especially states thestressfull physical and mental condition and faulty diet which may be the cause for thedisease.9] Addictions : Majority of the patients were addicted to coffee and tea followed by smoking andNSAID’s , which are also considered as one of the causative factors in modern medicinefor Non-ulcer dyspepsia.10] Habitat : Majority of the patients belonged to the rural area which indicates the improperdietic habits and regimen leading to Amlapitta.11] Aggravating period : The i `ncidence of aggravation of the symptoms was found to be more duringmid-day and morning hours which indicates the pittaprakopaka and increase ama avasthaphases respectively giving rise to the symptoms.12] Influence of environmental factors : The incidence of aggravation of the symptoms was found to be higher in rainyseason 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 bemore in the majority of patient which clearly indicates that psychological factor hasgreater influence over the manifestation of the disease.14] Regimen : Majority of the patients gave a history of atapsevana, avagahana which are said tothe causative factors influencing pitta leading to the disease entity.15 Rasa- satmya : 136
  • Discussion The disease incidence was found to be more in the patients with katu-rasa satmyaand Amla-rasa-satmya, which has been stated to be the cause for the manifestation of thedisease.16] Prakruti : The disease incidence was found to be highest in pitta-vataja prakruti indicatingthat 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 thedisease 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 toAnoopa pradesha which is said to be having influence over the pitta and its aggravationleading 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 : 137
  • Discussion The incidence of the disease was found to be more in people who did only routinework and occasional exercise, indicating the sedentary or less physical work leading toagnimandya and hence the disease.25] Bowel Habit : The incidence of the disease is high in the patients with constipation and irregularbowel 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 theimportant 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 moderatelysignificant relief even after follow-up by 25.92% The control drug group showed highly significant relief by 52% after treatmentand 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 havemadhura rasa, madhura vipaka and sheeta veerya which will pacity the pitta which is thecause for utklesha along with vriddh kapha. The tikta rasa of the shatavari choorna willpacity 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 ofAmlodgara [Acid erructations] and showed highly significant relief by 73.07% after thetreatment 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 treatmentand moderately significant relief by 30.43% after the follow up. 138
  • Discussion This indicates that the trial drug has better effect on the amlodgara. The madhura and tikta rasa of Shatavari choorna and madhura rasa of AbhrakaBhasma and madhura vipaka and sheeta veerya of both the drug pacify the pitta andreduces the udrikta pitta which is cause for amlodgara. As both drugs have deepanaproperty 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 thepitta in to the upper part of the G.I.T. This was assessed by grading and scoring thesymptom. 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 thetreatment and after follow-up showed moderately significant relief by 33.33%. In the control group 73% of patients presented with mild to severe degree ofhrtdaha and showed highly significant relief by 50% and after follow-up showedmoderately significant relief by 31.81%. This clearly indicates that the trial drug is more effective than the control drugover Hrtdaha. Shatavari choorna and Abhraka bhasma both due to their madhura rasa, madhuravipaka and sheeta veerya pacify the pitta and reduces the daha produced in thehrtpradesha. Shatavari choorna due to its demulscent property reduces the burningsensation.Effect of therapies on Kantdaha : [Burning sensation in the throat]: This symptom is often associated with the Hrtdaha. Due to the regurgitation of thegastric contents into the mouth. In trial group 60% of patients presented with mild to severe degree of kantdahaand showed highly significant relief by 61.11% after the treatment and mild significantrelief by 27.77% after follow-up. 139
  • Discussion In control group 80% of patients presented with mild to moderate degree ofkantadaha and showed highly significant relief by 45.8% after the treatment andmoderately significant relief by 32% after follow-up. This indicates that the trial drug isbetter after the treatment where as the control drug showed a sustained relief even afterfollow-up. Shatavari choorna due to its demulscent action decreased the kantadaha and dueto its madhura rasa, madhura vipaka and sheeta veerya along with the same of theAbhraka 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 regurgitationinto the upper part of the G.I.T. by vata. The symptom was graded and scored for thepurpose 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 andmoderately significant relief by 25.92% after the follow-up. In control group 77% of patients presented with mild to severe degree of vamanaand showed highly significant relief by 69.50% after treatment and moderately significantrelief 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 inpacifying 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 udarashoola [Abdominal pain] and showed highly significant relief by 62.5% after thetreatment and the same relief by 54.16% even after the follow-up. 140
  • Discussion In control group 80% of patients presented with mild to severe degree of udarashoola and showed highly significant relief by 75% after the treatment and moderatelysignificant relief by 37.5% even after the follow-up. Though the control drug showed a greater percentage of relief than the trial drugafter 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 Bhasmadue to its tridoshagna property pacifies both vata and pitta and reduces the pain. Shatavarichoorna is said to have stomachic action due to its bitter taste. Along with this it hasdemulscent, and anti-spasmodic action.Effect of therapies on Avipaka : [Indigestion] : In trial group 70% of patients presented with mild to severe degree of Avipakaand showed highly significant relief by 95.23% after the treatment and even after thefollow-up by 52.38%. In control group 50% of patients presented with the Avipaka and showed highlysignificant relief by 66.66% after the treatment and moderately significant relief by33.33% after follow-up. This indicates that the trial drug has better effect over Avipaka than the controldrug. Shatavari choorna, Abhraka Bhasma and Gritha, due to their deepana propertyincreases the agni and reduce the avipaka. Gritha due to its sneha guna pacifies the vataand stimulates the Jataragni.Effect of therapies on Klama : [Fatigue] In trial group 47% of patients presented with klama which varied from mild tosevere degree and showed highly significant relief by 71.42% after the treatment andmild significant relief by 35.71% after the follow-up. 141
  • Discussion In control group 47% of patients presented with klama which varied from mild tosevere degree and showed moderately significant relief by 50% after the treatment and nosignificant relief by 21.42% after the follow-up. This indicates that the trial drug is more effective over klama than the controldrug. Both Shatavari choorna and Abhraka Bhasma due to thir madhura rasa, madhuravipaka and sheeta veerya pacify the pitta and due to their deepana property reduce theama, 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 mildto severe degree and showed highly significant by 61.53% after the treatment andmoderately significant relief by 46.15% after the follow-up. In control group 53% patients presented with tiktodgara and showed highlysignificant relief by 50% after treatment and mild significant relief by 25% afterfollowup. The trial drug had better effect over the Tiktodgara than control drug. The trial drug due to its madhura rasa, madhura vipkaka and sheeta veeryapacified the pitta and reduced the Tiktodgara.Effect of therapies on Gourava : In trial group 53% of patients presented with mild to severe degree of Gouravaand showed a highly significant relief by 56.25 % after treatment and showed moderatelysignificant relief by 37.5 % after follow up. In control group 40% of patients presented with mild to severe Gourava andshowed a highly significant relief by 66.66% after the treatment but no relief after followup by 16.16%.From this it indicates the trial drug is more effective than the control drug even afterfollow-up. 142
  • Discussion The trial drugs due to their deepana property increased the jataragni and helped toreduce 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 amongsampraptighatakas 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 sameresult by 50% even after the follow up. In control group 53% of patients presented with mild to severe Aruchi andshowed highly significant relief by 68.75% after the treatment and no relief after thefollow-up by 18.15% This indicates that the control drug showed better results after treatment comparedto trial drug. But the trial drug showed better results after follow up. The trial drug because of its deepana property increased jataragni and reducedama and in turn the Aruchi.Effect of therapies on Gurukoshtata : [Abdominal discomfort] Gurukoshtatha is mainly caused due to ama. Agnimandya is main cause of amawhich is one among the sampraptighatakas. In trial group 57% of patients presented with mild to severe degree of gurukoshtata and showed highly significant relief by 58.82% after the treatment and eve afterthe follow up the same effect by 52.94%. In control group 43% of patients presented with mild to severe degree ofgurukoshtata and showed moderately significant relief by 46.10% after the treatment andhighly significant relief by 7.6% after follow up. 143
  • Discussion This indicates that trial drug is more effective as it showed sustained effect evenafter follow-up, where as the control drug showed the good effect after follow-up, butonly in small percentage of subjects. The trial drug mainly because of its deepana property increase jataragni and helpsin reducing the ama and hence the gurukoshtata also,but takes time for reduction of theama.Effect of therapies on Adhmana : [Abdominal Distension] Ajeerna causes accumulation of vata in disacordance with pitta to produceAdhmana. In trial group 63% of patients presented with mild to severe degree of Adhmanaand showed highly significant relied by 78.94%, after the treatment and moderatelysignificant relief by 42.10% after the follow-up. In control group 53% of patients presented with mild to severe degree ofAdhmana and showed highly significant relief by 50% after the treatment and no reliefafter the follow-up by 12.5%. This indicates that the trial drug had better effect over Adhmana than controldrug. Shatavari choorna and Gritha because of their vata-pitta shamaka propertypacified 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 patientspresented with mild to severe degree of Anrakujana and showed highly significant reliefby 75% after the treatment and no significant relief after follow-up by 37.5%. 144
  • Discussion In control group 53% of patients presented with mild to severe degree ofAntrakujana 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 overAntrakujana. Shatavari choorna due to its property of vata-pitta shamana pacified the vata andpitta 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 andthe same result after follow up by 28.5% In control group 57% of patients presented with mild to severe degree ofshiroruja and showed highly significant relief by 70.58% after the treatment and nosignificant 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 andpitta and reduced shiroruja.Effect of therapies on Rasavaha srotodusti : In trial group 40% of patients presented with mild to severe degree of resavahasrotodusti and showed highly significant relief by 83.33% after the treatment and thesame result even after the follow-up by 46.66%. 145
  • Discussion In control group 30% of patients presented with mild to severe degree ofrasavaha srotodusti and showed highly significant relief by 76.66% after the treatmentand 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 andsheeta veerya pacify the pitta and vata and due to their deepana property reduce the amaby 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 Annavahasratodusti and showed highly significant relief by 86.66% after treatment and the someeffect even after follow-up by 56.66%. In control group 40% of patients presented with mild to severe degree ofAnnavaha srotodusti and showed highly significant relief by 53.33% after treatment andno 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 theremay 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 ofpureeshavaha srotodusti and showed highly significant relief by 73.07% after thetreatment and the same effect even after the follow up by 61.53%. 146
  • Discussion In the control drug 30% of patients presented with mild to severe degree ofpureeshavaha srotodusti and showed highly significant relief after follow-up by 13.79%. This indicates the trial drug had better effect than the control drug overpureeshavaha srotodusti. The vata pitta shamaka property of the trial drug counteracted the vata-pitta dushtiand 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 andno unchanged cases, where as the control group showed maximum cases to be improvedand having control effect after the treatment. Even after follow up the trial group shows maximum cases to be markedlyimproved and improved when compared to control group. The trial group also showsminimal 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. 147
  • Conclusion CONCLUSIONThe work entitled “A clinical study on the effect of Shatavari choorna with AbhrakaBhasma 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. 148
  • Conclusion10. 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. 149
  • Summary SUMMARY The dissertation titled “A clinical study on the effect of Shatavari choorna withAbhraka Bahasma in the management of Amlapitta” compraises of different topicsdiscussed under these headings. 1. Introduction : This comprises of the introduction to the Ayurveda, its aim and objectives and theimportance of kayachikitsa with respect to Angi. It also includes brief introduction of thedisease Amlapitta, along with its incidence, prevalence, pathology, and its paralance withfunctional / Non-Ulcer Dyspepsia, in the modern medicine. The aim of the study andselection of the drug has been putforth. 2. Objectives : The main aim and objectives of the study has been mentioned along with thehypothesis under this heading. 3. Review of the literature : This section includes the collection of all the available data regarding theetymology, definition, classification- nidana, poorvarupa, rupa, samprapti, sadhyaasadhyata, upadravas, and chikitsa along with pathyapataya of the disease Amlapitta. Italso includes a detailed description of the Dyspepsia, highlighting functional / Non-UlcerDyspepsia 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 referenceto patients, grouping, selection, inclusion and exclusion criteria, protocol criteria for 150
  • Summaryassessments of signs and symptoms, dose, duration, distribution of patients etc. of thepresent study has been discussed. 5. Results : Total of 32 patients in each group were selected for the present study and only 30patients 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 arediscussed under this heading. The scoring of the important features of Amlapitta beforeand after the treatment and also follow-up are tabulated and percentage of improvementis 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 patientsto be improved, and 16.66 % of patients to be controlled. While the standard groupshowed 13.33 % be markedly improved, 50 % of patients to be improved, 36.66 % ofpatients to be controlled. After the follow up the trail drug showed more number ofpatients 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. 151
  • Summary Thus the trial group showed better and significant result when compared tocontrolled 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 alongwith the limitation of the study and the scope for further improvisation. 152
  • REFERENCESHISTORICAL 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.MAHARAPAKA 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. 24/1022. Su.Su. 46/49723. Kha. Khi. 16/824. Kha. Khi. 16/7-925. Ma. Ni. 51/126. Ch. Su. 26/4027. Ch. Chi. 15/44 Chakrapani.28. Kha. Khi. 16/10-1129. Ma. Ni. 51/330. Kha. Khi. 16/16-1731. Ma. Ni. 51/3 ; Bha.Pra.Ma.Kha ; Y.R32. Kha. Khi. 16/4933. Ma. Ni. 51/334. Ma. Ni. 51/3 ; Kha. Khi. 16/16-1735. Kha. Khi. 16/4936. Su. Su. 21/1837. Ash. Hr. Su. 12/2238. Su. Su. 21/2539. SLS40. 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 1/8RUPA 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. 16/16SADYAASADYATA 1. Ch. Ni. 5/15 2. Ma. Ni. 51/7 3. Kha. Khi. 16/49UPADRAVA 1. Ch.Chi. 21/40 2. Kha. Khi. 16/49CHIKITSA 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 SangraPATHYA 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 7. Davidson’s principles and practice of Medicine. Ch 17 8. Davidson’s principles and practice of Medicine. Ch 17 9. Davidson’s principles and practice of Medicine. Ch 17 10. Davidson’s principles and practice of Medicine. Ch 17 11. Principal of Internal Medicine by Harrison 11b] Principal of Internal Medicine by Harrison part II. 12. Davidson’s principles and practice of Medicine. Ch 17 13. Davidson’s principles and practice of Medicine. Ch 17 14. Davidson’s principles and practice of Medicine. Ch 17 15. Davidson’s principles and practice of Medicine. chapter 20 16. Davidson’s principles and practice of Medicine. Ch 20 17. Davidson’s principles and practice of Medicine. Ch 17 18. Principal of Internal Medicine by Harrison 19. Davidson’s principles and practice of Medicine. Ch 17 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
  • BIBLIOGRAPHY1. Agnivesha; Charaka Samhita; redacted by Charaka and Dridabala with Ayurveda Dipika commentary by Chakrapanidutta; edited by Vaidya Yadavji Trikamji Acharya; 4th edition, 2001; published by Chaukhamba Surabharati Prakashana, Baranasi Uttar Pradesh.2. Anonymous; Yogaratnakara, with Vidyotini Hindi Commentary by Vaidya Laxmipathi Shastri; 7th edition 1999; Chaukhambha Sanskrit Samsthana, Varanasi, Uttar Pradesh.3. Bahadur, Raja Radhakanthadeva ; shabda kalpadruma ; Reprint 1998 ; published by Nagsharan Singh for Nag Publishers ; Delhi.4. Bhavamishra ; Bhramashankara Shastri and sri Roopalal vaishya ; Eighth Edition, 1997 ; Chaukambha Sanskrit Bhavan, Varanasi, Uttar Pradesh.5. Boyd, William ; Boyd’s textbook of pathology, Ed. Ritchie A-G 9th editions 1990; published by Lea and Febiger, Philadelphia/London.6. Chakrapanidutta ; Chakradutta [Chikitsa sura sangraha] ; 2nd edition, edited by P.V. Sharma ; Published by Chaukambha Orientalia, Varanasi.7. Davidson, Sir Stanley; Davidson’s Principles and Practice of Medicine Ed C.R.W. Edwards et al ; 19th edition ; 2002 ; Chuchill Livingstone, Edinburgh.8. Gogte V.M.; Ayurvedic Pharmacology and therapentic uses of Medicinal plants ; Dravya Guna Vignana ; Published by Bharatiya Vidya Bhavan Mumbai ; 2000.9. Govinda Dasa ; Bhaishajya ratnavali ; redacted by Bhishakratna Shri Brhama Shankara Mishra with Bidyotini tika by Kaviraja Sri Ambikadutta Shastri ; editied by
  • Sri Rajeshwara Dutta Shastri ; 13th edition 1999 ; published by Chaukambha Sanskrit Samsthan, Varanasi.10. Gupta Niranjana Prasad A.B. ; Paradha Samhita with Hindi Commentary ; Published by Khemraj Srikrishna Das, Mumbai11. Gyanendra Pandey : Dravya Guna Vignyana Vol III ; 7th edition – 2001 ; published by Krishnadas Academy Varanasi.12. Harsh Mohan, Text book of pathology, edited by Harsha Mohan ; published by Jaypee Brothers Medical publishers [p] Ltd. New Delhi 110002, India 3rd addition 1995.13. Harrison T.R. et al ; ed- Harrison’s principles of Internal Medicine ; Vol I and II, 14th International edition ; 1998 ; published by Mc. Graw – Hill Book Co. Singapore.14. Kashyapa Maricha ; Kashyapa Samhita ; ed. Pandit Laxmiraja sharma, Shri Satyapala Bhishagacharya with Vidyotini hindi vyakhya, 6th edition, 1998 ; Chaukambha sanskrit samsthan, Varanasi, Uttar Pradesh.15. Kaviraj Ramrakshak Pathak; Kaya Chikitsa Vol-III; 6th edition; 1993; Published by Chaukambha Bharati Academy, Varanasi16. Madhavakara ; Madhava Nidanam, Uttaradha with Madhukosha Vyakhya by Vijayarakshita and Srikantadutta, Vidyotini tika by Ayurvedacharya Sri Sudarshana shastri ; 29th edition, 1999 ; Chaukambha Sanskrit samsthan, varanasi Uttar Pradesh.17. Mahajan B.K. ; Methods in Biostatistics, 6th edition, published by Jaypee Brothers, Bombay.
  • 18. Nayak Sandhya rani et al ; A clinical study on Amlapitta and its management with patoladi kwatha [unpublished doctoral dissertation ; Uttkal University ; Bhuvaneshwar; Orissa; 1998]19. Prashanth A.S. et al . Randomised control trial of an Ayurvedic compound verses liquid Antacid in Non-Ulcer Dyspepsia. [unpublished Doctoral dissertation, Trivendrum University Kerala ; Trivendrum 1994]20. Sandeep Kumar et.al. Role of Ubhayoto shodhana in management of urdhwaka amlapitta [unpublished Doctoral dissertation, Mysore, RGUHS; 1999]21. Santosh Khandal;Rasa Baishajya Kalpana Vigyana; 4th edition 2002; Published by Publication Scheme; Jaipur.22. Satoskar R.S and Bhandarkar S.D. ; Part II, Pharmacology and pharmaco therapeutics ; Revised 10th edition 1987, Published by Popular prakashan private Ltd. Bombay.23. Sharangadhara, Sharangadhara samhita, Madhyama khanda; english translated edition by Ayurveda Vidwan Prof. K.R. Srikantamurthy. Chaukambha Orientalia, Varanasi, Uttar Pradesha.24. Sharma Priyavat ; Dravya Guna Vignana, Vol – II and IV, reprint edition, 1999 ; Chaukambha Bharati Academy, Varanasi, Uttar pradesh.25. Sheshadri Vasan ; Amlapitta and its management with kamaduga rasa [unpublished Doctoral dissertation, Mysore, 1976]26. Siddinandan Mishra; Ayurvediya Rasashastra; 5th Edition; 1994;Published by Chaukambha Orientalia, Varanasi27. Sushruta, Maharshi ; Sushruta samhita with Nibandha sarasangraha commentary of Sri Dalhana Acharya and Nyaya Chandrika Panjika of Sri Gayadasacharya ; ed. by
  • Vaidya Yadavji Trikamji Acharya and Narayan Ram Acharya ; Reprinted edition 1998 ; Krishnadas Academy, Varanasi, Uttar Pradesh.28. Tripathi K.D. ; essentials of Medical pharmacology ; Published by Jaypee Brothers, Bombay.29. Vachaspathyam; compiled by Sri Taranath Tarka, Vachaspi Vol - I Published by Chaukambha sanskrit series. Varanasi 1962.30. Vagbhata ; Ashtanga Sangraha; Vol-I; English translation by Prof.K.R.Shrikantamurthy; 2nd edition 1998; Published by Chaukambha Orientalia, Varanasi31. Vagbhatacharya ; Ashtanga Hridaya with commentaries sarvangasundara of Arunadutta and Ayurveda Rasayana of Hemadri, ed. by Pandit Bhishak Acharya, Harishastri Paradkar Akoln ; 8th edition, 2000 ; Chaukamba Orientatlia Varanasi, Uttar Pradesh.32. .Vagbhatacharya; Rasaratna Sammuchaya with Rasaprabha hindi commentary by Dr.Indradev Tripati;2nd edition 2003;Published by Chaukambha Sanskrit Bhavan, Varanasi.33. Vangasena; Vangasena Samhita[Chikitsa Sarasangraha]; Vol-II; with english translation by Dr.Nirmal Saxena; 1st edition 2002; Published by Chaukambha Sanskrit Series, Varanasi.34. Vargheese Anitha ; An evaluation of pathyapathya with regard to desha and kala [Unpublished doctoral dissertation, Trivendrum University,Keralas,Trivendrum 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 PROFORMAPatient 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 AFU1. Utklesha:2. Amlodgara3. Hrtdaha4. Kantadaha5. Udarashoola6. Vanti Colour: Consistency: Contents: TasteII. Associated complaints:1. Avipaka:2. Klama3. Tiktodgara:
  • 4. Gourava:5. Aruchi:6. Gurukoshtatha7 Adhamana8 Antrakujana9. Sirasula:III. History of present illness: A) Onset : Sudden / Gradual B) Aggravating Period : Mid-day/Mid-night/Morning C) Environmental factor : Rainy / Summer / Autumn / WinterIV. 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 total2. Vihara (Regimen) a) Diwaswapna Yes / No b) Vegadharana Yes / No c) Avagahana Yes / No d) Atapasevana Yes / No3. Manasika (Psychological factors) Mental Stress/ Strain Present / Absent4. Addictions: Smoking/Tobacco chewing/Alcohol/Narcotics/No habits5. Exercise: Regular/Irregular/occasional/only routine work.6. Sleep: Sound/Irregular/Disturbed/Delayed Night...........Hrs Day:.........Hrs7. Bowel: Regular/Irregular/constipation/Loose /Soft/Constipated No.of frequency ........./times.........days8. Micturation: Regular/Irregular ........times/day .......times/night6. Occupational history: Sedentary/moderate/Heavy a) Nature of work:Physical/mental b) Time of work:Day/Night/Day Night .........Hrs7. 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/VaikritaXII. 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 : 3Signature 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 FRUITS – No VEGETABLES – Yes VEGETABLES –Generally most Generally most sour Generally most sweet & No Generally mostsweet fruit fruit bitter vegetables 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& • Lemons • Cauliflower • Kohlrabi** purple] • Mangos [green] • Celery • 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 & whiteLEGUMES – Yes LEGUMES – No DAIRY –Yes DAIRY – No • Aduki beans • Miso • Butter [unsalter] • Butter [salted] • black beans • soy sauce • cheese [soft, not • buttermilk aged, unsalted] • 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 • goats cheese [soft & red & 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 beansGRAIN –Yes GRAINS –Yes BEVERAGES –Yes BEVERAGES –Yes• Amaranth • Bread [with • Almond milk • Apple cider yeast]• 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 • Rice [brown]** • Chai [hot, spiced • Chocolate milk [cooked] milk]*• Pancakes • Rye • Cherry juice • Coffee• Pasta • Cherry juice [sweet] • Cranberry juice• Rice • Cool dairy drinks • Grapefruit juice [basmati, white, wild]• Rice cakes • Grain “coffee” • Iced tea• Sago • Grape juice • Iced drinks• Seitan [wheat • Mango juice • Lemonade
  • meat]• Spelt • Miso broth* • Papaya juice• Sprouted • Mixed veg. juice • Tomato juice wheat bread [essene]• 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
  • • ChamomileNUTS – Yes NUTS – No SEEDS – Yes SEEDS – No• Almonds [soaked • Almonds [with • Flax • Chia and peeled] skin]• Charole • Black walnuts • Halva • Sesame• Coconut • Brazil nuts • Popcorn [no salt, • Tahini buttered] • Cashews • Psyllium • Filberts • Pumpkin * • Hazelnuts • Sunflower • Macadamia nuts • Peanuts • Pecans • Pine nuts • Pistachios • WalnutsOILS – Yes OILS – No SPICES – Yes SPICES – NoFor internal &external use : [most
  • suitable at top oflist]• 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 • FenugreekExternal 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 • ThymeCONDIMIENTS – CONDIMENTS – SWEETENERS – SWEETNERS –Yes No Yes No• Black pepper* • Chili pepper • Barley malt • Honey ** [raw & not processed]• Chutney, mango • Chocolate • Fructose • White sugar ** [sweet]• Coriander leaves* • Chutney, mango • Fruit juice • Jaggary [spicy] concentrate• 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 • VinegarFOOD 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