Drakshyadi gutika in amlapitta kc

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To study the efficacy of Drakshyadi Gutika in Amlapitta

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Drakshyadi gutika in amlapitta kc

  1. 1. INTRODUCTION Today’s life style is completely changed by all the means ourdiet pattern, life styles and behavioral pattern is changed & it is notsuitable for our normal physiology of digestion of body & all abovementioned causes aggravated dosha which creat agnimandya & dueto improperly it metabolized it get convert into shukata (vitiatedliquid acid) & this gets situated in Amahsaya which is called asAmlapitta1. In recent years there has been an unprecedented increase ofincidences related to GI system due to changing in life style. Dietpattern, behavioral pattern & mental stress & strain. Amlapitta is a such type of GI disorder due to same causativefactor as above described in Ayurvedic parlance, closely resembleswith Gastritis in modern science also and in chronic stage it maylead to ulceration condition. Charak & Kashyapa have clearly indicated that the GrahaniDosha & Amlapitta occur in the persons who could not check thetemptation of food. Ajirna ofter encountering the specific Doshas &affinity with specific site may cause various diseases. Annavishaproduces due to Ajirna when mixed with pittadi Dosha & lodges inAmashaya then it produces the Amlapittadi diseases. The first & foremost task in Ayurvedic disease management isa proper understanding & description of its etiopathogenesis. In thisrespect Acharya Charaka has told that Agni is responsible for Ayu,Varna, Bala, Swasthya. Utsaha, Upachaya, Prabha, Ojo & Teja & italso gives the importance as long life in the functioning state2 &even death in unfunctioning state of Agni also Acharya Charaka3. & 1   
  2. 2. Acharya Vagbhata has clearly defined the role of Agni in theetiopathogenesis of all the human ailments4. Charak has explained the sequential progression of diseasesof G.I.T. to which Sanghara Granthakara has given a separatedisease status. In samhita Amlapitta is no mentioned as a separatedisease entity but there are several references in charaka samhitaregarding Amlapitta. The terminology has been used at 9 places.From the references it gives a clear cut idea of Nidana Panchaka &management in his period. Acharya kashapa was the first who gives detail description ofthe disease5. And analyzed first it only Doshik basis, where asmadhavakara gives status to the disease and he further classified iton according to Gati i.e. Urdhvaga Amlapitta & Adhoga Amlapitta aswell as on Doshika basis6. Acharya Kashapa belived that the disease is caused byvitiation of Doshas (Tridosha) causing mandagni leading tovidagdhajirna manifesting as Amlapitta. Madhavakara following Charaka has described thedevelopment of Amlapitta due to Vitiation of pitta which is alreadyincreased due to its own causes. This disorder is the result ofGrahani Dosha. Gastritis & non-ulcer dyspepsia have been co-related withAmlapitta by several MD & Ph. D. Scholars of Ayurveda. As perModern interpretation the symptoms of Amlapitta found in certainpathophysiological condition of GI such as hyperacidity with occur inAPD diseases7. 2   
  3. 3. Modern medicine is not having proper medication for gastricdyspepsia. Ayurveda has a lot to offer in this regard. Ayurvedicphysicions are providing cure for the patients of these chronicdyspeptic disorders. Several single & compound drug has been tried in thisdisease. Acharyas told to use the drugs which are having Tikta-Madhura rasa. Madhura Vipaka Sheeta Virya & Laghu Rukshaproperty with kapha-Pittahara action. Taking all these points into consideration the study wasplanned to evaluate aims & objectives. 3   
  4. 4. AIM & OBJECTIVES1. To study the efficacy of ‘Drakshyadi Gutika’ in Amlapitta.2. To evaluate clinical effect of ‘Drakshyadi Gutika’ in the management of Amlapitta.3. To study the etiopathogenesis of Amlapitta according to Ayurvedic text as well as modern science.4. To study side effects of ‘Drakshyadi Gutika’ if any. 4   
  5. 5. BRIEF REVIEW OF ANNAVAHA SROTASA ANATOMICAL & PHYSIOLOGICAL ASPECTS.DEFINATION :- The word Annavaha srotasa means the channel through whichfood is transported. The functions of organs of ANNAVAHA SROTAS(Alimentary system) concerned with ANNA ADANA (ingestion offood), ANNA PACHANA (digestion) SARA KITTA VIVECHANA(Separation of nutrient and waste portions) and RASA SOSHANA(Absorption of nutrients)MOOLA 8 :- According to Charaka - Amashya & vamparshva According tosushruta - Amashaya & Annavahi Dhamanyas. Charaka has saidthat Amashaya and vamparshva are the Moola of Annavaha srotasa.Acharya Sushruta has said that Amashaya and AnnavahiDhamanyas are the Moola of Annavaha srotasa. Chakapani hasgiven two terminologies - Urdhva and Adho for Amashya. UrdhvaAmashaya was the place of kapha while Adho Amashaya was thepalce of pitta. The deglutination and ingestion process of food isstart from mouth and in upper part of the stomach. main digestiveprocess is start from stomach. Digestive juices secreat from lowerpart of the stomach and intestine Bile and panereatic juices secretfrom liver and pancreas than after come into the small intestine.Therefore we can include oesophagus and upper part of thestomach in Urdhva Amashaya and lower part of the stomach &small intestine in Adho Amashaya. The term Annavahi Dhamanyasare also a Moola of Annavaha srotasa. It means the channels whichtransplant the end products of Anna from the intestine to theplasma blood. Under the microscope the mucous membrance of thesmall intestine contains millions of finger like projections known as 5   
  6. 6. villia. This villus is lined by a single layer of epithelial cells and smallarteries, veins and lymphatic vessels. In function, the villi act as asemi permeasble membrane and permit the passage of digestedfood through the Rasavaha and Raktavaha srotansi contained intheir. In other words, these microscopic parts of the membranecarry out the transportation of the Anna Rasa though the intestinalbarrier.Pittadhara Kala:- Acharya Sushruta & vagbhatta both have described pittadharakala. Acharya Sushruta say "THe sixth Kala situated betweenPakvashaya and Amashaya is the pittadhara kala and it is known asGrahani. In his view, "The intrgity of Grahani depends upon Agni9."In charaks opinion "Grahani is so called beacuse it receives andretains the food for the duration of its digestion. He observed thatthe food, which has reached the Amashaya after under goingdigestion absorbed." Pittadhara kala is provides the digestive juicescollectively termed as Pachakagni or Jatharagni. These juices notonly digest the food but also aid the sepration of the sara from thekittabhaga10. (Sara kitta vibhajana kriya) The description ofpittadhara Kala shows that it is a macroscopic structure which notonly serves as a protective lining of the small intestine membrane,but also as a secreting and absorbing structure.Samana Vayu11 :- Vagbhatta said that Samana Vayu is present near the Agniand responsible for the reception, digestion, separation andpropulsion of the food. The Samana Vayu function are similar tointrinsic nervous system of the stomach and intestine. This systemis related to brain and spinal cord. The peristaltic movement ofintestine are responsible for mechanically breakdowns intestinalcontents and throughly mixed up with the juice of pancreas liver 6   
  7. 7. and intestine. They absorbed through the intestinal wall. This hasbeen described the function of Samana Vayu as digestion of food,separation of nutrients fraction of food and expulsion of undigestedfood. (Annapachana, Vivechana and Munchana.) So, as anAnatomical view, we can consider fallowing orgens & systems inAnnavaha srotasa.(A) Amashaya :-(i) Urdhava :- (a) Oesophagus (b) Upper part of the stomach(ii) Adho:- (a) Lowerpart of the stomach (b) Small intestine(B) Pittadhara kala:- Innner Laner of mucous membrance of thesmall intestine and lower part of the stomach also.(C) Annavali Dhamanyas:- The channels that receives the endparticlesof the food from the intestine.(D) Samana Vayu:- Intrinsic nervous system of the stomach &small intestine.AHARA PAKA KRIYA:-The Ahara undergoes two preoceses for complete digestion.(A) Avasthapaka(B) Vipaka In Ayurveda, the digestion and metabolism is related to Agni.Mainly the pachaka pitta is responsible for the digestion of food12.The pachaka pitta is situated in Grahani that directly participated inthe digestion of food Grahani is also considered as a pittadharakala. Avastha paka is the first phase and vipaka is the secondphase. Avasthapaka is the first phase of the digestion completed by 7   
  8. 8. Pachakagni in Annawaha srotasa, and vipaka is the second phase ofdigestion that completed by Bhutagni and Dhatvagni. vipaka is startafter Avasthapaka.(A) AVASTHAPAKA:-There are three stage of Avasthapaka.(i) Madhur Avasthapaka(ii) Amla Avasthapaka(iii) Katu Avasthapaka(i) Madhura Avasthapaka13:- Four type of Ahara dravyas like Asita, Pitta, Lidha and Khaditathat reaches to Amashaya forms in to Madhura Bhava. At this stagesalivary digestion will be completed in the fundus of stomach, werethe insoluble starch and polysaccharides. Converted in to soluble dextrin under the influence of salivaryamylase. The final Rasa in the upper portion of the urdhavaAmashaya is madhura. The prana vayu is responsible for the entiremovement of food from the mouth to Amashaya. The BodhakaKapha and Kledaka Kapha is also responsible for MadhuraAvasthapaka. Bodhaka kapha is responsible for perception of tastein the mouth. The Bodhaka Kapha is analogue of saliva whichdissolves some substances, the enzyme content begins to act and itlubricates the food, kledaka kapha also lubricates the food inAmashaya. We can considered it as mucine. 14(ii) Amla Avasthapaka :- Amla types of strava occurs here, and after completition of it.Ahara becomes Amla. So it is called Amla Avasthapaka. In thisstage Ahara converting in to insoluble proteins to soluble proteins,under the influence of the pepsin, in the presence of HCL. According 8   
  9. 9. to charaka and vagbhatta the final out come of the entire gastricdigestion is the acidified chyme, that is interpreted by Tikakarchakapani as pakvapakva (partialy digested). At this phase theahara pachana is due to an amla factor sereted by the urdhvaAmashaya. The ahara which becomes Amla Bhava, passes in to thenext lower portion of Annavaha srotasa, were Achhapitta issecreted. Modern science says that the acidified chyme passes downfrom the pylorus in to the duodenum. acts as a stimulates theduodeneal glands (Burners gland) to secreate a number of internalsecretion like secretin, cholecystokinin, enterogastrone,Pancreozymine etc. The presence of acid in duodenum is liberatesthe circulation of secretin hormone and stimulate the flow ofpancreatic juice. Secretins also enhance the secretion of bile andintestinal juice. The pancreozymine and intestinal hormone alsostimulates the secretions of enzymes from the pancreas, occurs inintestinal mucosa cholecystokinin also responsible for thecontraction of the gallbladder and therefore discharges of bile induodenum. All these hormeones acts due to entering the acidifiedchyme in to duodemum and there fore pancreatic juices, biles andintestinal juices secreated in small intestine. In Ayuarveda,Achhapitta is combination of these three juices. We can say thatmadern physiology also supports the Ayurvedic approach ofAchhapitta Nirman Kriya. Due to these juices all the Facts and semidigested proteins are completly digested and converted in to fattyacids and glyceral and Amino acids.(iii) Katu Avasthapaka15:- In this stage, the materials phases down the pakvashaya fromthe Amashya and being dried by Agni. and rendered in to lumps.(paripindita pakva) During this process vayu and Mala areproduced. In Modern physiology, minerals from the end products ofdigested food, the remaining materials are converted in to feaces. 9   
  10. 10. The bacteria precessed on it and created some vitamins and indoleand sketol like gases.(B) VIPAKA:- According to charaka the digestion of food by jatharagni breakdown the food in to five physicochemical groups viz parthiva, Apya,Agneya, Vayavya and Akashiya. Activated Agni Bhuta present ineach one of these Bhautika groups. The Bhutagni thus activateddigests the substance of that group16.(i) Bhutagni Paka17 :- Bhutagni paka follows jatharagni paka and it completes theprocess of intestinal digestion. After Bhutagni paka, the Ahara Rasais completed and the Rasa shoshana is possible. Thus the Agniconstituents of the predominantly parthiva molecule spoken asparthivagni digest the substances of the molecules. SimilarlyApyagnidi gets the substance of the moleoules of Apya and it forAgneya, Vayavya, and Akashiya, the out come of this type ofdigestion according to chakrapani is the transformation of thecharcteristic qualities of each group and the assumption by them ofvilakshana Gunas or all together new qualities.(ii) Dhatvagni Paka18:- After Jatharagni Paka & Bhutagni Paka of the Ahara Rasa iscreated and it is absorbed from the Anna Vaha Srotasa andcirculates throughout the body by Dhamanies This Annarasaundergoes the process of Dhatvagni Vyapara and thus saptadhatusare created. Seven different kinds of Dhatvagnis correspondence tospecific seven types of Dhatus viz Rasagni, Raktagni, Mansagni,Medogni, Asthyagni, Majjagni and Shukragni. The Rasagni does thedigestion of the Ahararasa so Rasadhatu and its Mala aredeveloped. In the same process every Dhatvagni digests the same 10   
  11. 11. molecular particles of Ahararasa and same Dhatus were developed.Acharya Charaka said that the pakas act upon seven Dhatus givingrise to Kitta and prasada bhaga19. The prasada paka is related to anabolic aspects and the kittapaka is of the catabolic. Dhatvagni converts the Ahara rasa in tosthayi & Asthayi Dhatu. Prasada Paka is being an Asthayi Dhatu.Asthayi Dhatu is converted into sthayi Dhatu by particularDhatvagni. In Dhatvagni Vyapara Kitta paka like sveda, Mutra,Purisha, vata pitta, kapha smashru, Nakha, Kesha etc are alsodeveloped. Indian medicine books have given various concepts likekhalekapota Nyaya, Ksheeradadhi Nyaya. Kedari Kulya etc. onDhatvagni Vyapara or Dhatu Nirman.PATHOPHYSIOLOGICAL ASPECTS OF ANNAVAHA SROTASADusti Hetu20(1) Ati matra Bhojana(2) Akalae Bhojana(3) Ahita Bhojana(4) Agni Dusti Meaning of Ati matra bhojana is, the excessive intake of food.Akalae bhojana means irregular patern of food intake. Ahitabhojana means the food taken by the person is not reliable for Phishealth. Agni Dusti means the improper digestive power. First threecausative factors creat Agni Dusti by Dosha Vaishmya. Agni Dustri,the fourth causes is due to some diseases like Rajayakshma. All ofabove causative factors create the disease of Annavaha srotasa likeAmlapitta. They generate the Adadrasha & dusha vaisamya, whichresponsible for the aggravation of the process of the diseases like 11   
  12. 12. Ajirna, Chhardi, Atisara, Arasha, Grahani, Amlapitta, Alasaka,Aruchi, Visuchika etc. These causative factors vitiate the pittadharakala. So these symptoms are developed.DUSTI LAKSHANA :-Four main symptoms of the Annavaha srotodusti. They are thecardinal symptoms of the Annavaha sroto dusti.(1) Arochaka (3) Chhardi(2) Avipaka (4) Anannabhilasha(1) Arochaka21:- The loss of taste of food is called Arochaka loss of interestingof food intake even though the food is very good and delicious.Acharya sushruta said that Arochaka is a disease, which hascomplete loss of interest in food due to shoka, Bhaya, Krodha,Lobha etc. Vitiated vatadi doshas and manasika Bhavas that stayingin Jihva, Hridaya and Bhaktayana. According to sushruta, shokadiManasika Bhavas as the causative factors of it. They create vatadiDosha Dusti. vitiated Dosha dusti. vitiated doshas stayed in Jihva,Hridaya and Bhaktayana means the Amashaya and Annanalika so,the Annavaha srotodusti is there.(2) Avipaka :- Avipaka means indigestion of the food. The ahara paka kriyais disturbed due to Agni vaishmya & avipaka is created. The Grahaniis the main organ in Annavaha srotasa as an anatamical andphysiological both. In annavaha srotodusti, Grahani Dosha is there.So, the pittadhara kala and Agni is also distrubed, because there isa reciprocal relationship between Agni & Grahani. In the modern science, the mucosal membrane lined in thestomach and small intestine is responsible for the secretion of 12   
  13. 13. enzymes. If there is some distrubance in it, the enzymes are notsecreted in proper way. In this condition the indigestion or Avipakais occurred. Acute & chronic gastritis, peptic ulcer, tropical & nontropicalsprue, malabsorption, syndroimes, non ulcer dyspepsia. etc,disease. have Avipaka as a first symptom In all these diseases innermucous membrance is affected which called pitadhara kala inAyurveda.(3) Chhardi :- Meaning of chhrdi is forceful expulsions of the gastric and / orduodenal contents through the mouth. It is due to Avipaka and AgniVaishamya. Mainly vata Dosha – Udana and Samana Vayudistrubed. It is occured when any part of the upper gastrointestinal tract becomes excessively irrited Impulses are transmittedby both vagal and sympathetic afferent to the bilateral vomittingcenter of the Medulla, which lies near the tractus solitarious. Motorimpulses are tremsmitted though the 5th, 7th, 9th, 10th and 12thcranial nerves to the upper gastro intestinal tract and through thespinal nerves to the diapharm and abdominal muscles. This nervousmechanism is considered as a vitiation of vata dosha in Ayurveda.Mainly observation or anti peristalsis activity is responsible forvomiting. Irritation of mucus membrance like gstritis, enteritis etc isalso responsible for it.(4) Anannabhilasha :- Anannabhilasha means the total loss of desirement or interestof food even though it is given as per demand of the person.Chakarapani has said that the pt. can digest the Ahara in tostomach through the mouth but the loss of interest of food is there. 13   
  14. 14. In modern science, it is due to mental stress or sensation of stietywhile complete loss of appetitite is not there. Digestive System 14   
  15. 15. CONCEPT OF DIGESTION Gastro intestinal digestion or change in the state or form ofthe food substances in Aamaashaya and Pakvaashaya in the courseof digestive process. Two phases of the Paaka i.e, Prapaaka andVipaaka have been envisaged. The Prapaka has been defined byChakrapanidatta as Prathama Paka22. These changes have beendescribed in terms of the Rasa or taste of the end products ofgastro-intestinal digestion viz. Madhura, Amla and Katu23. Prapakacommences right from the time, when food is introduced into themouth. This aspect of digestion and the digestion in the upperportion of Urdhwa Aamaashaya are comprehended by MadhuraBhava. When the food is introduced into the mouth, the perceptionof its Rasa takes place which is stated to be enabled by BodhakaKapha24. The next event which takes place is Vibhajana of food bythe Tejas element of the Lala Strava, which is described inAyurveda Sootra and Yoganand Natha commentary. Tasteperception and preparatory digestion and the beginning of theMadhura Bhava occurs here. The movements are brought by PranaVayu25. The second phase i.e. Amla Avasthaa Paaka involves theVidagdhavastha of food. The term Vidagdha has been interpreted byChakrapanidatta as Pakva- Aapakvam or Kinchit Pakvam KinchitAapkvam i.e. partly or not fully digested26. As the partly digestedfood which has attained Amla Bhaava is moved down, Achha Pitta issecreted27. The term amla refers to the production of Pitta underinfluence of the Aahaara which has since assumed Amla Bhaava.The third aspect of Avasthaa Paaka is the Katu Bhava. This aspectrelates to the acrid and pungent nature of the reactions that occurin the Pakvaashaya. Charaka says that the material passed downfrom the Aamaashaya having reached the Pakvaashaya isdehydrated and converted into lumps by heat28. 15   
  16. 16. Chakrapanidatta has observed that the term Shoshana usedby Charaka instead of Paachana is significant. The former relates tothe dehydration of the food residue which has been brought toPakvaashaya whereas the later refers to the digestion of food in theAamaashaya by Agni. The term Paripindita Pakvasya according tohim refers to the process of formation of fecal lumps. The termVaayu syat KatubhaVaatah describes the production of acrid andpungent gas29. Pakvaashaya is the seat of Vayu where five Vayusare produced. According to Sushruta, the separation of Rasa, Mala andMootra brought about by Paachaka Pitta. Sharangdhara andBhaavamishra have stated that the Saara Bhaaga is known as Rasa,and the Saraheena Bhaaga is Mala. The factors responsible fordigestion is six Ahara Parinama Kara Bhavas30. i.e.i) Ushma ii) Vayu iii) Kledaiv) sneha v) Kala and vi) Samyoga.i) Ushma: Ushma is a quality of Agni mahabhuta only. In thisregard two terms are to be considered i.e. Agni and Pitta. Sushrutaexplains that there is no Agni excepts Pitta in body31. Out of fivetypes of Pitta, Pachaka Pitta situated in Amashaya performs allfavorable and unfavorable functions described as functions of Agnivarious secretion of GIT can be considered in the light of PachakaPitta. So release of these secretions in proper time, quality includingthe temperature of stomach is essential for proper digestion,disturbance of any will lead to Agni Dusti and start the Samprapti ofdisease.ii) Vayu: Samana Vayu is seated in Amashaya and helps thePachaka Pitta in digestion. According to Sushruta31. There is viciousrelationship between Prana - Apana – Samana Vayu. Where as 16   
  17. 17. Prana and Apana Vayu helps to maintain the Agni. Prana Vayudirectly takes place in act of digestion by transporting food uptostomach and Samana Vayu moves in koshtha all around andperforms the functions attributed to Agni, Grahani and PachakaPitta. Three phases of gastric acid secretion can be consideredunder the karma of Vayu. That is cephalic phase, gastric phase andintestinal phase. The apakarshana, grahana and munchana karmaof Vayu are essential for proper digestion. Any exacerbate orcessation in these functions will lead to improper digestion. Ascertain time is required for proper digestion, delayed emptying willcause the shuktapaka and formation of annavisha, which are theessential features of Grahani dosha samprapti. Now, it is clear thatall secretory regulations can be said the function of Samana Vayu.Any disturbance of Samana Vayu will cause the Agni Vaishamya,which will lead to Ajeerna etc. and start the pathogenesis. Theetiological factors like Krodha, Shoka, Bhaya, Chinta and otherstress factor work through the vagus chain, which is mediatingthrough Vayu. Provocation of Vata by any factor will result in hypersecretion leading to hyperactivity.iii) Kleda: This factor is necessary for proper digestion. Kleda loosesand emulsifies the food substance. So that it may easily digested33.This function is performed mainly liquid portion of food. Kledaka andBodhaka Kapha may be considered in this regard. Charaka hasmentioned the function of disintegration and softening of foodsubstance in the Koshtha due to ‘Drava’ and ‘Sneha’. Though Kaphahas not been mentioned having Drava quality but Kapha is made upof ‘Ap’ dhatu and so that Kapha most possess Dravata but itdepends upon the temp. so the function of Kledaka Kapha can besummarized as Kledana - Shithilikarana – Mridukarana andSamghata Bheda. Also the functioning of Bodhaka Kapha mayinclude moistening of mouth to help in speech and helps in 17   
  18. 18. mastication. Dravata is also the quality of Pitta and Kledana functioncan also be attributed to the dravansha of Pachaka Pitta. Theexcessive klinnata may hamper the Agni directly as mentioned inthe literature that Dravata create the Agni. Ingestion of anyAtiushna, Tikshna and Katu Dravya may cause excessive secretionof mucosa, which may interfare with digestion process and causethe Vidagdha Avastha in excess leading to Ajirna etc. in the sameway increase in Kapha cause Mandhaagni. Hence, if the function ofKapha create, the ulcer can directly be produced due to action ofAgni on mucosa. Hence, a very delicate balance of responsiblefactor is required for proper digestion.iv) Sneha: Sneha mainly comes from Ahara, Kapha also have theproperty of Sneha. Also Chakrapani clarifies that sneha is present infeeble quantities in Pitta. Hence it can be said that sneha is alsoquality of kledaka Kapha and Pachaka Pitta. Sneha performs thefunction of Mardava of food stuff. Ultimately it helps in the propermastication and churning by stomach musculature, so that properdigestion can takes place. The decrease in the quality of Sneha maydamage the intestinal mucosa due to roughness of food stuff andalso due to Ruksha Guna of various food materials. Hence,Snehaguna also performs the protective effect to the stomachmusculature. Decrease of Sneha in stomach will lead to provocationof Vayu (Samana Vayu) which causes imbalance of Agni leading toAgni Vaishamya.v) Kala: Kala means mainly the time required for the digestion ofingested food stuff. Time required for the proper secretion of all thedigestive factors and for proper digestion and absorption. But othertime consideration are also necessary for proper digestion andabsorption of food i.e. Kshudhakala (hunger time). Trishnakala,Doshakala and also Charvana Kala. The meals taken without proper 18   
  19. 19. digestion of previous meal is called adhyasana and this untimely,food intake causes Amadosha which leads to Agnidushti. Emptyingof stomach requires certain time, liquid empties rapidly than solid.Timing of relation of food material in intestine is regulated by Vayu.Any disturbance of Vata will disturb the Dharana and Munchanaperiod leading to improper digestion and absorption, which will leadfurther provocation of Doshas and Agni Dushti.vi) Samyoga: Equilibrium of all the above factor is necessary forthe proper digestion of ingested food material. Therefore AshtavidhaAhara Ayatana, 12 Ahara Vidhi Vidhana should be considered sothat Agni Vaishamya and vitiation of Doshas may not take place.vii) Ashtavidha Ahara Vidhi Visheshayatana (eight lines forselection of food)a. Prakriti (Natural Qualities) – before ingestion of food, thenatural properties of food must be considered so that these may nothamper Agni and Doshas.b. Karana (Preparation) – Various cooking procedure may increaseor decrease the properties of food stuffs. This may be due toadmixture of water, heating and predominance of time and season.Also other factors i.e. Desha, Kala and Bhajana (utensils) must beconsidered.c. Samyoga (Combination) – Charaka has discussed 18 types ofincompatible diet. He has also enlisted various diseases producedincluding Amlapitta and Grahani roga due to ingestion ofincompatible diet. 19   
  20. 20. d. Rasi (Quantum) – It refers to the total quality of food as wellas quality of various constituents of diet. Every body must eatrequired quality which may directly interfere gastric juice secretionand digestion process. Atimatra and Amatra Bhojana may lead tovitiation of Doshas.e. Desha (Habitat) – This denotes place relating to growth as welldistribution of substance which also direct affect the Agni indigestion process.f. Kala (Time) – Here both Nityaga and Avasthika Kala should beconsidered. Seasonal dietetic variation, age wise variation, day andnight variation and disease wise variation can be considered.g. Upayoga Sanstha (rules of use) – This depends on thedigested food.h. Upayokta – means who consumes the food. i.e. the user. Dietmay vary person to person according to their body compatibility andhabits on him depends the Oka Satmya.Aharavidhi vidhana (code of healthy eating) –Charaka has also prescribed the code of healthy eating afterdescribing the basis for selection of healthy diet which are 12 innumbers. They are –i) Ushnamashniyat – It enhances test, increases Agni, easilydigestible and does Vatanulomana and decrease Kapha.ii) Snigdhamshniyat - It diminishes the Rukshata of ingested foodand regulates the action of Vayu. 20   
  21. 21. iii) Matravadashniyat – Quantity is related with individual’sAgnibala. Heena and ati qualities of food create the disturbance inAgni.iv) Jirne ashniyat – Ingestion of food before digestion of previousmeal cause vitiation of Agni and all the Dosha. Hence meal shouldbe taken only after digestion of previous meal.v) Viryaviruddhamshniyat – Intake of Virya Viruddha Dravyas causetridosha prakopa.vi–xi Ekdesha, Ekasarvopakarana, Natidruta Nativilambita TanmanaBhunjita Ajalpannahasanam - All the above factors causes properdigestion of food by which there is no chance of vitiation of Agni.xii) Atmanam Abhisamikshabhunjita – Every user must consider hisself well. Hence all the above factors are responsible for propersecretion of gastric juice and digestion occurs. If any one causevitiation of Pachakapitta/ Samanavayu leads to Agni Dushti.Sushruta has also prescribed the code of behaviour after takingmeal. He has advised walking for at least 100 steps. There aftertaking rest for sitting position for a while and there lying supine inleft side position. This gives proper time for digestion34.According to modern Digestion means the breaking down of larger food moleculesinto smaller molecule. The passage of these smaller molecules intoblood and lymph is termed as absorption. So the organs whichperform both these constitute the digestive system. Digestionincludes 6 basis process i.e. ingestion, secretion, mixing andpropulsion, mechanical and chemical digestion, absorption anddefecation. 21   
  22. 22. 1. Ingestion – This process involves taking food and liquid intomouth.2. Secretion – Cells within the walls of GI tract and accessorydigestive organs secret seven liter of water, acid, buffers andenzymes within the tract/day.3. Mixing and Propulsion – Alternating contraction and relaxation ofsmooth muscle in the walls of GI tract mix food properly themtowards anus.4. Digestion – The process of digestion starts from mouth. Twotypes of digestion i.e. mechanical and chemical process break downingested food into small molecules.a. Mechanical digestion – Teeth cut and grind food, then smoothmuscles of stomach and small intestine churne the food. So thatfood molecules become dissolved and mixed thoroughly withdigestive enzymes.b. Chemical digestion – A series of hydrolysis reaction that breakdown large carbohydrates, lipids, proteins and nucleic acid with thehelp of digestive juice (saliva, gastric juice, pancreatic juice, succusentericus and bile) into smaller molecules that are usable by bodycells.c. Mechanical Chemical digestion in mouth Mechanical digestion – Ithelps the process of mastication of the food stuff and in preparing itinto a bolus and suitable for deglutition. Here saliva acts aslubricant. Chemical digestion – two enzymes i.e. salivary amylaseand lingual lipase contribute in it. Salivary amylase initiates thebreak down of starch, into monosaccharides for which it can be 22   
  23. 23. easily absorbed into the blood stream. Lingual lipase secreted byglands in the tongue. It breaks down dietary triglycerides into fattyacids and diglycerides.d. Mechanical and chemical digestion in stomach Mechanicaldigestion – It consists of mixing waves (peristaltic movements) bywhich food mix well with secretion of gastric glands and form asouping liquid called chyme and also these waves pushes the chymeinto duodenum through pyloric sphincter. Chemical digestion –Gastric juice secretion from the cells of stomach which takes part indigestion i.e. Cell Secretion Results1. Chief cellsa. pepsinogen Inactivateform becomes activate with the help of HCland breaks down proteins into smaller peptide fragments.b. Gastric lipase Splits short chain triglycerides into fattyacids andmono glycerides.2. Parietal cellsa. HCl - Kills microbes in food.- Denatures proteins in food.- Converts pepsinogen into pepsin.- Stimulates the secretion of hormones that promotes the flow of bile and pancreatic juice.b. Intrinsic factor Needed for absorption of vit. B12, which is used in redblood cell formation. (erythropoiesis)3. Surface mucusa. Mucus forms a protective barrier that prevents digestin ofstomach wall. 23   
  24. 24. b. Absorption small quantity of water, ions, some drugs enter theblood stream.4. G cellsa. Gastrin stimulates parietal cells to secrete HCl and chief cells tosecret pepsinogen.- Contract lower oesophageal sphincter,- Increases motility of the stomach and relaxes pyloric sphincter.Regulation of gastric secretion and motility:Both neural and hormonal mechanism control the secretion andcontraction of stomach wall. Gastric digestion occurs in threehases. i.e. -1. Cephalic phase2. Gastric phase3. intestinal phaseCephalic phase: This phase of gastric secretion occurs even beforefood enters the stomach. It results from sight, smell, thought ortaste of food, and greater the appetite, the more intense is thestimulation. Neurogenic signals causing the cephalic phase ofsecretion can originate in the cerebral cortex or in thehypothalamus. They transmit impulses through vagus nerve tostomach. This phase of secretion accounts for one tenth to one fifthof the gastric secretion.Gastric phase: Once food enters the stomach, it excites the gastrinmechanism, which in turn causes a low rate of secretion of gastricjuice that continues throughout the several hours that the foodremains in the stomach. In addition, the presence of food in thestomach also causes- i) local reflexes in the intramural plexus of 24   
  25. 25. stomach and ii) vasovagal reflexes that pass all the way to thebrain stem and back to the stomach. Both these reflexes causesparasympathetic stimulation of gastric glands and add to thesecretion caused by gastric mechanism. The gastric phase ofsecretion accounts for more than two thirds of the total gastricsecretion associated with eating a meal.Intestinal phase: Even after the food has left the stomach, smallamount of gastric juice. Continue to be secreted for six to eighthours, i.e. As long as chyme remains into the small intestine.Further more, this secretion will still occur even when all nerveconnections are cut. Further presence of fatty acids and glucose inchyme triggers enter endocrine cells in the small intestinal mucosato release two hormones that affect the stomach ie. Secretin andcholecystokinin. Secretin mainly decreases gastric secretionwhereas CCK mainly inhibits stomach emptying. Also bothhormones have other important effect on pancreas, liver and Gallbladder that contribute to regulation of digestive protcess. Onlyabout 5% of total gastric secretion occurs during the intestinalphase.Pancreatic juice:The enzymes in pancreatic juice digest all the foods i.e.i) Pancreatic amylase – hydrolyzes starch, glycogen and otherCarbohydrate except cellulose.ii) Several protein digesting enzyme i.e. trypsin, chymotrypsin,carboxypeptidase and elastase. Break down proteins into peptides.iii) Ribonucleic and deoxy ribonucleic acid – Both are nucleic aciddigesting enzyme.iv) Pancreatic lipase – hydrolyzing neutral fat into glycerol and fattyacids. 25   
  26. 26. The above pancreatic secretion are regulated by nervous andhormonal mechanism.a. Nervous mechanism starts 1-2 minutes after taking food.b. Hormonal mechanism starts when stomach empties intoduodenum. Two hormone i.e. secretin and pancreozymin isresponsible for increased secretion of pancreatic enzymes. Bile –Bile secretion by liver is continuous. Though it contains no digestiveenzyme, but important for digestion because of the presence of bilesalts,which help –1. To emulsify by fat globules so that they can be digested by theintestinal lipase.2. Render the end products of fat digestion soluble so that they canbe absorbed through the GI mucosa into the lymphatics. Machanicaland chemical digestion in the small intestine. Chyme entering thesmall intestine contains partially digested carbohydrates, proteinsand lipids. The completion of digestion is a collective effort ofpancreatic juice, bile, and intestinal juice. Machanical digestion- Itinvolves segmentation and migrating motility complexes.Segmentation mix chyme with the digestive juice and bring theparticles of food into contact with the mucosa for absorption.Migrating motility complex is the type of peristalsis begins in thelower portion of stomach and pushes chyme forward along smallintestine. Altogether, chyme remains in small intestine for 3-5hours.Chemical digestion – various enzymes secretes from the brushborder of the intestine, which also takes part in digestion. Theseare- 26   
  27. 27. Carbohydrate digesting enzyme – Brush border enzymes i.e.i) α- dextrinase - acts on α- dextrins to glucose.ii) Maltase - splits maltose, maltotriose into glucose.iii) Lactase - Digest lactose into glucose and galactose.iv) Sucrase - breaks sucrose into glucose and fructose.Protein digesting enzyme –Protein digestion completed by two brush border enzymes. i.e. –i) Amino peptidase – acts on peptides by breaking the peptide bondthat attaches the terminal amino acid to the amino end of thepeptide.ii) Dipeptidase – splits dipeptides into single amino acids.Fat digesting enzyme –i) Lipase (intestinal) – splitting neutral fats into glycerol and fattyacid. Digestion of nucleic acids: The nucleotides result from theaction of pancreatic nucleases are further digested by brush borderenzyme called nucleosidases and phosphatases into pentoses,phosphates, and nitrogenous bases. Mechanical and chemicaldigestion in large intestine-Mechanical digestion – it involves the movements of largeintestine includes haustral churning, peristalsis and mass peristalsisby which the contents of colon drives into rectum.Chemical digestion – it occurs through bacterial action.- It ferment remaining carbohydrates and release hydrogen,carbondioxide and methane gases.- It converts remaining proteins to aminoacids and break down theaminoacids into simpler substances, ie. Indole, skatole, hydrogensulfide, and fatty acids.- It decomposes bilirubine to simpler pigments, including stercobilin, 27   
  28. 28. which give faeces their brown colour.- It also produces some vitamins i.e. vit. B and vit. K that areabsorbed in the colon.5. Absorption – The entrance of ingested and secreted fluids, ionsand the small molecules that are products of digestion into epithelialcells lining the lumen of the GI tract is called absorption. Theabsorbed substances pass into blood or lymph and circulate to cellsthroughout the body.6. Defecation – wastes, indigestible substances, bacteria, cells-sloughed from the lining of the GI tract and digested materials thatwere not absorbed leave the body through the anus in a processcalled defecation the eliminated material is termed feces. 28   
  29. 29. DISEASE REVIEW The word ‘Disease’ literary means the lack of ease. Accordingto Taber’s encyclopedic medical dictionary, disease means “Apathological condition of the body that presents a group ofsymptoms peculiar to it & that sets the condition apart as anabnormal entity differencing from other normal or pathological bodystates.” Amlapitta is a disease which is commonly found almost allpart of world. Ayurvedic View:HISTORICAL REVIEW: To have a complete knowledge of subject it is necessary totrace out its historical background for the disease Amlapitta one hasto trace out its original concepts various developments at presentstage & the work done on the subject by various research workers.A) VAIDIC KALA : In Vedic literature, showed no suggestive references ofAmlapitta description.B) SAMHITA KALA :1. Charaka Samhita : Acharya charaka has not mentioned Amlapitta as a separateentity but Charaka Samhita has many scattered references ofAmlapitta which are as below.a) Amlapitta has been listed as an indication of eight types of milk35.b) The list of paittika nanatmaj Vyadhi is includes Dhumaka, Amlaka, Vidaha which are the symptoms of Amlapitta36. 29   
  30. 30. c) Kulattha has been considered as a chief causative factors of Amlapitta37.d) Excessive use of lavana Rasa has been also considered as causative factor of Amlapitta37.e) Amlapitta has been included in the list of diseases caused by viruddhasana38.f) Rajmasha has the property of relieving the Amlapitta38.g) Mahatikta Ghrita has been indicated in Amlapitta39.h) Amlapitta has been mentiones as an indication of Kansa – Haritaki40.i) In Grahani dosha. Pathogenesis of Amlapitta has been clearly mentioned41. A clear cut samprapti of this disease is available ‘kulatta’,lavan rasa, & viruddhahar were listed as the causes of Amlapittawhere as ‘Mahatikta ghrita & kansaharitaki are prescribed for itstreatment. Hence it can be concluded that during the period ofcharka all aspects of Amlapitta disease were considered.2. Sushruta Samhita Acharya Charaka has mentioned the word Amlapitta but it isnot found in sushruta samhita. Sushruta has mentioned symptom.Known as ‘Amlika’ results from excessive use of Lavan Rasa, issimilar to Amlapitta, ‘Amlika’ word has found in sushruta samhitasu. 21 & 22 & in Nidan sthana – 2 & 6. In the Sanskrit English dictionary by Monier-Monier Williams meaning of Amlika is mentioned as acidity of stomach.3. Kashyapa Samhita Among the ancient texts Kashyap Samhita is the first text,which has mentioned Amlapitta as separate disease. This text has 30   
  31. 31. given aetiopathogenesis, clinical features complications &treatment & also gives suggestion to change the place of living tohave good peace of mind to cure the disease thus in the Upanishadkala also it was firmly believed that manasika bhavas are affectingthe disease Amlapitta.4. Harita Samhita Harita Samhita in 24th chapter of 3rd sthana has describedAmlapitta as a separate disease & given the treatment. It alsogives. One special symptoms of the disease as ‘Amla Hikka’(Hiccups with sour taste)5. Bhel Samhita In Bhela Samhita, Amlapitta is not mentioned in this samhita.C) Samgraha Kala1. Ashtang Sangrah & Hridaya Vagbhata I & II were one of the most eminent of ancientphysicians who written the Astanga Samgraha & Astanga Hridyamrespectively. In both these text Amlapitta word & synonyms of Amlapittai.e. ‘Amlak’ is mentioned with scattered references as follows.a) Vagbhata – I also mentioned ‘Dhumaka’ & ‘Amlaka’ in pittaja nanatmaja disorders.b) While describing the symptoms of1. Pittaja Jawara 2. Pittaj Kasa 3. Pittaj Hridroga ‘Amlaka’ is mentioned.c) In the indications of Dashmula-leha “Vagbhata I” mentioned Amlapitta while ‘Vagbhata II’ mentioned ‘Amlaka’. 31   
  32. 32. 2. Madhava Nidana After Kashypa Samhita, Madhava Nidana is first available textwhich gives importance to Amlapitta and describes itsaetiopathogenesis & symptomatology in details along with twoclinical subtypes viz.1. Urdhvaga Amlapitta2. Adhoga Amlapitta Vri. Madhav has described Amlapitta is an independentdisease & also its therapy.3. Chakradatta In this classics, vamana, Virechana, Basti etc. treatments areadvised for Amlapitta along with its Chikitsa Sutra thesymptomatology of Amlapitta is given the detailed treatment ofAmlapitta is given by Chakradatta.4. Sharangadhara Samhita Sha. Sa. Being a book of pharmacoped has given onlyAmlapittahara recipes without describing the aetiopathologicalconcepts of the disease.5. Basavarajiyam This text has included the Amlapitta under 24 NanatmajaVyadhi of pitta.6. Bhavaprakasha Two separate chapters on Amlapitta has been devoted in thistext. Upadrava & arista are explained in this text. 32   
  33. 33. 7. Yogaratnakara Regarding Amlapitta, he has followed Madhav Nidana totally &this text has added four more upadravas to list of upadravas ofAmlapitta.8. Vangasena Samhita Acharya Vangsena in Vangsena Samhita described Amlapittain 59th chapter as “Amlapitta Rogadhikara”.9. Siddhanta Nidana Detailed information about Amlapitta is given accordingModern medicine. Upadrava one also mentioned.10. Bhaisajya Ratnavali Detailed Chikitsa is given in this Granth same more reliable &more effective Yoga is also describe in this text.11. Rasaratna Samucchaya In this text Amlapitta Nidana Panchaka with its treatment isdescribed in detail. D) Previous Research work On specially Urdhwaga Amlapitta following research scholarshave done work & they were found encouraging results. 1. Tayade V. – Urdhwaga Amlapittapar Patoladi Qwathka Adhyana 1988 – Bombay. 2. Kulkarni A.B. – A study of Avipattikara curna on Urdhwaga Amlapitta 1989-Nasik. 3. Bhande U.M. – Effect of vamana of Katu Nimba & Katu Pravala on Urdhwaga Amlapitta 1991-Pune. 33   
  34. 34. 4. Panjihade – Urdhwaga Amlapittaka Samavesat Agnitundi Parinamala Abhysa 1992-Nanded.5. Sephal S.S. – Clinical study of Urdhwaga Amlapitta & effect of Bhunimbadi Rucatha – 1992 – Pune.6. Prasad Kailash – A clinical study of Amalaki kwatha bhavita shankha Bhasma in the Amlapitta 2001- Lucknow.7. Jogad G. – Clinical study on the role of Virechana & Bhunimbadi Vati in the management of Urdwaga Amlapitta – 2004 – Jamanagar.8. Utkalini Nayak – Classification of Amlapitta on Doshik predominance. Their management 2006-Jamnager. 34   
  35. 35. AMLAPITTA – AYURVEDIC REVIEW To know the Ayurvedic view about Amlapitta one must gothrough the following factors : 1. Nirukti 2. Paribhasha 3. Paryaya 4. Vargikarana 5. Nidana 6. Samprapti 7. Purvarupa 8. Rupa 9. Upasaya 10. Anupasaya 11. Upadrava & Arista 12. Sadhyasadhyata 13. Sapeksa Nidana 14. Cikitsa Vivechana 15. Pathyapathya Nirukti (Etymology) Amlapitta is a combination of two words : Amla Pitta Sourtaste + Digestivesubstance = Amlapitta Excessive salivation of the human body The terms Amla refers to a particular type of taste equatedwith the sour taste which causes excessive salivary secretion pittais a bodily chemical substance which is mainly responsible for themaintenance of the process of digestion transformation &transmutation on combining both these words the term Amlapittaimplies to a disease or condition in which the sourness of pitta getincreased.Paribhasha/Defination 1. Vachaspatyam According to vachaspatyam, Amlapitta means pitta leading tosour taste. 2. Chakrapani 35   
  36. 36. Which means that the quality of pitta i.e. sourness whenincrease leads to Amlapitta. 3. Vijayrakshita Commentator of madhav Nidana defines the words asAmlapitta which means that the pitta having vidahi quality give viseto Amla or sour taste. 4. Shri Gananath sen in his book sidhanta Nidana has givensimilar defintaion of Amlapitta. The above classical description of Amlapitta emphasises thatAmlapitta is a patho-physiological condition in which the pitta getsvitiated in terms of Vridhi (excessiveness) & also the sourness ofpitta is increased.Paryaya/SynonymsPramilaka44 – VagbhatPitta visuchika45 – VagbhtPittamlaka – HaritaAmlika – SushrutaShukta – KashyapaDhumaka46 – VagbhatVargikarana / Classification 1. Madhavkara classified Amlapitta in two ways as follows :a) According to pravriti : Urdhwaga Adhogab) According to Dosha : Vataja Amlapitta Vata kaphaja Amlapitta Kaphaja Amlapitta 36   
  37. 37. 2. Kashyapa described this disease in to three types according to Dosha : Vataja Pittaja Kaphaja 3. Yogratnakara & Bhavaprakasa Classified disease according to Dosha as follows : Kapha pittaja Vat-Kaphaja Vataja KaphajaAmlapitta can also be classified according to various factorsas follows – a) Koshthagata – according to its site b) Nija Vyadhi – according to its aetiology c) Amasaya samutpanna vyadhi d) Abhyantara margajaneet vyadhi e) Doshabalapravritta vyadhiNidana / Aetiology After a careful screening & analysis of the etiological factors ofAmlapitta, they may be discussed under four groups. They are a) Aharaj Hetu b) Viharaj Hetu c) Manasika Hetu d) Aagantuja Hetu A brief resume of these factors may be presented as under47Aharaj Hetu (Dietary factors) The first & the foremost group of etiological factors ofAmlapitta may be considered as the dietary factors. Under thisgroup the intake of food against the code of dietetics i.e. AharaVidhi Vidhana & Ahara Vidhi Visheshaayatana is included. 37   
  38. 38. Various type of incompatible substance excess of pittaaggravating factors like katu Amla, Vidahi etc. & irregular time ofconsumption of food are the factors against the dietetic code & theyare directly responsible for the annoyance of pitta. a) Viharaj Hetu (Habit oriented factors) To maintain the sound & good health one has to follow thecode of habits. He is required to have regular habits of defecationeating & sleeping in time. He has not to suppress the natural calls.Maintain the equilibrium of the body constituents and by that,obviously, he would maintain good health & proper functioning ofthe body. If this is not followed regularly, the whole functioning ofthe body will be disturbed & in long run; they will cause thedisturbances of the equilibrium of pitta & digestion which ultimatelywill lead to Amlapitta. b) Manasika Hetu (Psychological factors) Psychology also plays a great role in maintaining the health of aperson. An abnormal psychology of a person in terms of anxiety,anger, greediness, etc. would affect the physiology of the digestion.These factors tend to affect the secretion of the gastric juice & bythat, they are disturbing the homeostasis which interns Amlapitta. c) Agantuja Hetu (Other related factors) Now a days Gastrogenic diseases are common. Amlapitta couldbe a sequel of faulty drug use. Over the counter intake of nonsteroidal anti-inflammatory drugs & antico-agulant cure one diseasebut it can produce Amlapitta, Ayurvedic drugs specially unpurified &faulty Rasa Aushadhi may cause Amlapitta. Even Ushna, Tikshnadrug if used excessively without proper assessment of disease for along period may produce Amlapitta similarly panchakarmas withHeenayoga or mithya yoga or Atiyoga lead towards many diseases 38   
  39. 39. by attacking on Agni hence Amlapitta also can be seen as anUpadrava of some other diseases like chronic Vibandha, Arsha,Ajirna, Pandu.1) Ahara group48a) According to the type of Ahara Kulattha Pruthuka Pulaka (Husky food)b) According to the quality of food Abhisyandi Gurubhojya Atisnigdha Vidhahi Anna Ati ruksha Vidahi panac) According to the Samskara of the Ahara Apakwanna sevana Bhristadhanya sevana Isksuvikara sevana Pistanna sevanad) According to Dusitanna Dusta anna sevana Paryusita anna sevanae) According to the pitta provocative potency of diet. Adhyasana Ajirnsana Ati drava Ati Usna Ati Amla Ati Tikshna Virruddhasanaf) According to the capacity of weakening the digestive power Ati snigdha sevana Ati Ruksha sevanag) Faulty dietary habits Akala bhojana Antarodakapana Kala anasana Visamasana 39   
  40. 40. h) Miscellaneous Annahina madya Madya sevana Gorasa sevana2. Vihara Group49a) Atisnatb) Ati avagahanatc) Bhuktwa bhuktwa diwasvapnatd) Veganam Dharaname) Shaiya prajagaran3. Manasa Group50a) Chinta b) Shoka c) Bhaya d) Krodha e) Moha4. Others –Other factors are –Ayurvedic drugs especially unpurified and faulty Rasa Aushadhis.Ushna and Tikshna drugs if used excessively without properassessment for a long period. Panchakarma with heenayoga,mithyayoga and atiyoga by attacking on the seat of Agni i.e.Amashaya. Upadrava of some diseases like chronic vibandha, Arsha,Ajirna and Pandu. In ayurvedic texts it is noted that sight and smellof certain food items provoke a strong reflex vomiting in whichstomach is powerfully irritated. Also Desha, Kala, Ritu takes a greatextent in the causation of Amlapitta i.e. –Deshaprabhava: According to Acharya Kashyap the disease ismore predominant in anupa desha comparing to other deshabecause of Kapha provocating nature51. In the line of treatment hegives its importance to change the place in untreated cases52. 40   
  41. 41. Kalaprabhava: Amlapitta is a chirakalina vyadhi this kala or timefactor is responsible for physiological/ anatomical structure of thebody i.e. Balavastha, Madhya and Vriddha Vastha. The disease ismore prevalent in middle age due to Pittapradhanya. Also paittikadisorders are more prevalent during Pitta provocation time that isduring mid-day and mid-night.Ritu prabhava: This group includes disease which is caused by themeteorological changes such as variations in atmospherictemperature, hot or cold, humidity or dryness, rain and winter,incidental to changes in the seasons. The rainy season isresponsible for amlavipaka of water (due to weakened digestionpower and vitiation of Vata and other Doshas) and eatables, whichin turn vitiates Pitta and Kapha.Modern view –According to modern the aetiological factors (of P U and gastritis)may be as follows –i) Genetic factors:Involvement of blood group O & A and presence of ulcer history infamilies prove relation of genetic factors. Probably the blood groupmodifies the oxyntic cell population.ii) Dietary factors:Irritant food materials such as rich and spicy diet, hot tea andcoffee, pickles etc. are responsible for stimulation of gastricsecretion.iii) Trauma:Due to passage of any solid matter, pyloric obstruction or stenosisresulting, from cicatrical changes following the ulcers, Chronic 41   
  42. 42. Functional spasm, carcinomia and congenital defects are alwaysassociated with gastritis.iv) Drugs:Coricosteroids, xanthine, aspirine, alkaloids, NSAIDS, reserpine arereported to be the predisposing factor.v) Neurogenic and psychosomatic factors:There is a well recognized association between mental stress andhyperchlorhydria.vi) Nicotine and alcohol:Alcohol directly damages the gastric mucosa and produces ulcer.Smoking has been reported to produce the amount of prostaglandinE2 in gastric juice and to inhibit prostaglandin synthesis in gastricmucosa.vii) Predisposing factors:Duodenal ulcer occurs specially in energetic ambitious young menwho have irregular and often hurried meals and tend to over work.Such as in Bus drivers, business executives, medical practitionersetc.viii) Endocrine factors:Emotional and systemic stress can act on the stomach throughhormonal as well as nervous pathway, namely hypothalamus, ant.Pituitary, ACTH, adrenals, cortisone and gastric glands. (Sincepeptic ulcer is more common in males it has been suggested thatestrogen hormones may protect against the development of ulcers.Moreover, specific endocrine disease or condition have been provedto be associated with peptic ulcer i.e., excessive adrenocortecal 42   
  43. 43. activity, hyperparathyroidism. Zollinger Ellison syndrome multipleadenoma syndromes.ix) Social factor:It is reported that a markedly increased incidence of gastritis foundin unhygienic and lower social economical classes.x) Reflexes: Reflex stimuli from heart, pleura and other organs in the bodymay also set up gastric symptoms. Patients having bronchiectasis orPTB also shows symptoms of gastritis and gastric ulcers. Stressulcer i.e. Curling and Cushing ulcer are included under peptic ulcer.In Curling ulcer excessive burn of skin cause more secretion ofadrenaline and noradrenaline which mixed with circulation andstimulate HCl Producing gastroduodenal ulcer. Whereas in Cushingulcer raised intracranial pressure due to head injury causesstimulation of parasympathetic responsible for increased secretionof HCl lead to peptic ulcer.Infection: Helicobactor pylori plays a significant role in developinggastritis also a number of viral, fungal and other bacterial infectionwere accompany by gastritis.Samprapti:According to Ayurvedic concept, for the proper manifestation of aDisease the vitiated Doshas and dushyas unite in several stages.These stages are known are Kriyakalas, which mean, it guides theproper time for treatment at a particular stage of Doshika imbalancein a given disease. Various stages is very necessary for earlydiagnosis as well as for prompt treatment and for adoptingprophylactic measures at the onset. Therefore, in explaining the 43   
  44. 44. samprapti, it is very appropriate and logical to take the Sushruta’sconcept of kriyakala with six clear cut stages. They are-1. Sanchaya (accumulation of Doshas)2. Prakopa (excitation)3. Prasara (spread)4. Sthana Samsraya (localisation)5. Vyakti (manifestation)6. Bheda (final stage of complication) One can call a group of signs and symptoms as a disease,only when the Doshas and dushyas undergo upto vyakti stage in aparticular and a special pattern which is called the melaka visheshaor end product of Dosha dushya samurchhana. Similarly in themanifestation of all diseases, Dosha, dushya and malas are thecommon factors also some other factors are responsible i.e.Rogamarga, Adhisthana, Sanchara, Udbhava, Agnimandya, Amaand Strotas. Samprapti ghataka is necessary before starting todiscuss samprapti.Samprapti Ghataka of Amlapitta The different components producing Amlapitta are as follows :  Udabhava – Amashaya & Pittadharakala  Sanchaya – From pittadharakala to Shleshmadharakala of Amashaya and Pachyamanashaya  Adhisthana – Adhoamashaya  Strotas – Annavaha, Rasavaha, Purishvaha, Raktavaha.  Dosha – Pachaka pitta, Samana Vayu Kledaka Kapha  Dushya – Ahara Rasa, Rakta  Agni – Jatharagnimandhaya  Ama – Jatharagnimandhaya janya ama  Swabhava – Chirkari 44   
  45. 45.  Vyadhi – Amashayotha  Rogamarga – Abhayantara rogamarga  Paradhanta – Pitta dosha pradhanya  Prabhava – DarunaDosha- In pathophysiology the involved sites of lesion anddisturbance are Pachaka Pitta, Samana Vayu and Kledaka Kapha.Samana vayu – It controls all the secreting and motility functionsof the two Ashayas and helps in the action of digestive enzymes,assimilation of end products of food and their separation intovarious tissue elements and when vitiated, it causes indigestion,diarrhoea and defective assimilation.Pachaka Pitta- The Amlaguna and Dravaguna of Pachakapitta getvitiated. Kledaka Kapha situated in amashaya is to counteract thedestructive action of Pachaka Pitta. Due to imbalance of Pitta thePachana Kriya is also disturbed. This leads to the formation ofVidagdhajeerna then to Suktapaka and later to Ama.a. The term ‘Ama’ means Apakva Annarasa. If Anna is not properlydigested then the out come of such an Apakva Rasa is Ama.b. Due to impairment of Kayagni. The Annarasa is not properly formand in this state, it is known as Ama.c. The undigested Annarasa possessing foul odour and excessivestickness deprive the body of its nutrition causes sadana. This stickysubstance is known as Ama. 45   
  46. 46. e. Due to poor strength of jatharAgni residue of ahara rasa is stillleft behind undigested towards the end of digestion. It is ama whichis root cause of all diseases.f. The first stage or phase of Dosha dushti s also known as ama.When this ama is combined or impregnated with tridosha orsaptadhatus or with malas. Then they are called Sama. The diseaseproduced is also called as Sama rogas.Symptoms of Sama Doshas –Samavata Samapitta SamaKaphaVibandha Durgandhi AvilaStambha Haritam Shyavam TantulaAntrakunjaam Amlam StyanaVedana Ghanam PralepiShopha Guru PichhilaNistoda Amlikarkaram KandhdesheAdhmanam Kantha-Hrid AvatishthateAsanchara Dahakaram Kshudrudgaravigh atakaraAgni – Sushruta explains that the prana, samana and apana whileremaining at their original sites maintain Agni54. The vitiation of anyone of these may lead to Agni dushti and sometimes vitiation ofAgni may lead to disturbance in function of these three or any oneof them. Amashaya and grahani are the place of Jatharagni i.e.Pachakapitta55. The function of Agni performed with the help of samana vayu(for proper digestion). Kledaka Kapha and partially Bodhaka kapha,(protects host body from damage). Any type of disturbance of Agnimay start the pathogenesis i.e. Vishamagni, ii) Tikshnagni and iii)Mandagni, which are said to be the work of tridosha. As the disease 46   
  47. 47. of GIT are caused due to Agni Dushti, hence, all the three doshasmay affect the Agni but the manifestation may be according to thedominance of three Doshas. Kashyap Samhita is the first whichexplains the symptoms of Amlapitta according to involvement ofpredominat Doshas.Srotas – The disease involve Amashaya, Grahani and Pakvashaya.Hence Anna and Purishavaha Srotas seems to be mainly concernedbut the Rasavaha Srota which receives the first Ama Visha produceddue to Agni Dushti may get involved. Regarding the types ofSrotodushti the three types of disturbance of Annavaha andPurishavaha can be observed i) Sanga, ii) Atipravritti and iii)Vimarga Gamana.Dushya – While reviewing the symptomatology of Amlapitta andGrahani, it seems that the main Dushya may be Rasa. This is thefirst dhatu to receive the Ama Anna Rasa. The aetiological factorsand symptomatology is also suggestive of Rakta Dushti.Mala – “Na Vegan Dharyet”Ayurved gives one of the most important cause of diseasesaccording to Ayurvedic conceptualization is Vegavarodha i.e.suppression of natural urges.eg. Micturation, defaecation, hunger and sleep, etc. This supressionof natural urges affects the sphincteric competence adversely.Natural contractility and motility of smooth muscles of variousviscera, the GI tract and the macro and micro channels of the bodyare also affected adversely. Once the sphincter of various srotas orchannels get affected, it leads to abnormality in them leading toaccumulation and later vitiation of Doshas. 47   
  48. 48. Samprapti of AmlapittaIn vrihatrayee, the disease has not been mentioned in detail but inCharaka samhita the Amlapitta terminology is used at variousplaces. Though Charaka has not mentioned it as a separate diseaseentity, but in the context of grahani chikitsa he has explained theetiopathogenesis of disease. The etiological factors like Abhojana,Atibhojana, Veganigraha, Panchakarma Vyapat and seasonalvariation etc. cause vitiation of Doshas and Agni which ultimatelyresults Mandagni which is treated as mother of all the diseases. ThisMandagni leads to Avipaka and due to Avipaka even light and smallmeals are not digested. This undigested and ill digested food getsshuktatva which leads to the formation of Annavisha. ThisAnnavisha is manifestated in the form of Ajirna56. Nidana sevana Agni dushti Dosha dushti Ajirna Shuktatva Annavisha Amadosha As per Charaka it is said that when diet is not properlydigested it gets formented and forms Annavisha. This Ama whenmixed with Pitta then it develops the disease Amlapitta. UsuallyDravaguna and Amlaguna of Pitta vitiates causing Vidagdhajirna atthe initial stage. If neglected as suggested in Siddhanta Nidana57.This will progress causing inflammation and erosion ofsleshmadhara kala of amashaya leading to manifestation of GrahaniRoga. 48   
  49. 49. Kriyakala –Sanchaya – Stage of Agni dushti may be described as the stage ofsanchaya i.e. Due to Sanchaya of Pachaka Pitta, Samana Vayu andKledaka Kapha at their own place i.e. Amashaya.Prakopa – This stage may include the stages of Vidagdha Anna,Shuktapaka of Annapana and Visharupata leading to Ajirna. Thesymptom of this stage may be according to main Dosha involved.Prasara – This stage may differentiates ajirna like – Amajirna,Vidagdhajirna and Vishatabdhajirna due to involvement of doshaswith Visharupa Annapana. Also it is noted Manovaha srotas getsvitiated due to excessive manifestation of various mental factorscausing symptoms of Ajirna and Amlapitta.Sthana sanshraya – This is the further stage and from here thespecific pathogenesis of each disease starts according to thespecificity of Nidanas, quality of Doshas by which they are vitiatedand the place of khavaigunya. So, the three Doshas Samanavayu,Pachaka Pitta and Kledaka Kapha may get Sthana Sanshrita inAmashaya (including Grahani) where simultaneously khavaigunyamight have been produced by the same nidanas or by any othernidana. The symptoms produced in this stage may be same assymptomatology of the Amlapitta and having less severity. Iftratement is not done in this stage the pathogenesis may proceedfurther and may produce the disease like Parinama Shula. This isthe stage from where the Vidagdhajirna can be separated fromAmlapitta. Vidagdhajirna is an acute stage occurring due to nidanasdirectly. And is Nidana Sapeksha, which means after theMithyaahara Vihara of Pittaprakopa diet articles will lead tovidagdhajirna, but here the Doshas have not established theiraffinity with any organ on tissue and only langhana or time will cure 49   
  50. 50. the condition, but symptoms may be produced again and againwhenever the Mithyaahara and vihara will be done. But due to againand again provocation, the Doshas will establish their affinity inAmashaya and Grahani (sthanasamshraya). After this stage eventhe laghu and Alpa Bhojana will cause shuktatva and Vidagdhata toAnnapana leading to the production of Amlapitta Roga.Vyakti – At this stage the symptoms of disease Amlapitta may getwell established and further differentiation in Doshik varietiesaccording to predominance may be established. The three Doshikpredominant subtypes of Amlapitta have been advocated byAcharyas i.e. Vatika, Kaphaja and Vatakaphaja. Madhavakara hasalso given a separate classification according to the expulsion rootof Doshas i.e. Urdhvaga and Adhoga types.Samprapti of Amlapitta (interms of Charaka)1. Sankhya sampraptia. Two types according to Gati.i. Urdhvagaii. Adhogab. Three types according to Kashyapi. Vatolvanaii. Pittolvanaiii. Kapholvanac. Three types according to Madhavakarai. Vatikaii. Vata kaphaiii. Kaphaiv. Also counted fourth types as shleshma Pitta 50   
  51. 51. 2. Vidhi Samprapti –a. i. Nija ii. Agantukab. i. Svatantra ii. Paratantrac. According to curability –i. Naveena - curable by tactful persuationii. Chirothita - krichhra sadhyaiii. Chirothita – yapya3. Vikalpa samprapti –i. Vata - Chala, Ruksha, Karmatahii. Pitta - Dravyatah, Ushma, Tikshna, Sara, Amla, Katu, Dravaiii. Kapha - Dravyatah, Karmatah, Guru, Mridu.4. Pradhanya samprapti –i. Pitta - Vriddhatamaii. Kapha - Vriddhataraiii. Vata – Vriddha5. Bala – kala visheshaa. Seasonal aggravation i. Sharada ii. Greeshmab. Day/ night i. Noon ii. Mid-nightc. Dietetic time i. BhojanottaraBheda – When the disease progresses further it reaches to sixthstage. Due to the manifestation of various symptoms, the diseasecan be categorised as Vatika, Vata Shleshmika or Shleshmapitta asdescribed by Madhavakara. Due to further involvement of Vata andRakta, the disease can produce Parinama Shula, as a Upadravas oras Nidanarthakaratva. 51   
  52. 52. SHADAVIDHA KRIYAKALA OF AMLAPITTA Kriyakala Name TreatmentUse of Ahara withoutfollowing the AshtavidhaAhara Ayatana and AsanaPravichara Agnidushti I Sanchaya NidanaParivarjana Ajirjna II Prakopa LanghanaFurther Dosha prakopa due to their own Nidana III Prasara Special protection Amlapitta Raktagata Vyamalata Grahani Shotha IV Sthanasansraya Early detection prompt treatment Grahanivrana Kaphapittavrita Vata V Vyakti Limitation of disabilityDoshik type of manifestation Upadravagamana Amashayagata Rakta VI Bheda Rehabilitation Pakvashayagata Rakta Bhinna KoshtaFurther manifestation of symptoms of Amlapitta Doshik variance Upadrava Rupata 52   
  53. 53. Swatantra and paratantra status of Amlapitta – The above pathogenesis described for production of Amlapittashows that this is a Paratantra Vyadhi produced by one another. But Swatantra type occurs, due to the potency andmultiplicity of Nidanas, diminution of Vyadhi, ofUtpadapratibandhaka Shakti and due to such other reasons,Amlapitta may be caused directly. Hence if the nidanas are sostrong it causes vitiation of Doshas and Dushya, producing Shothain Pitta Dhara Kala of amashaya and grahani lead to occurance ofAmlapitta roga.Different opinions regarding samprapti of Amlapitta- Acharya Kashyap was the first to analyze the disease onDoshik basis, he described the samprapti in detailed. He believedthat (the disease caused by vitiation of three Doshas (Vatadayah)causing Mandagni leads to Vidagdhajirna manifesting as Amlapitta.Whereas Madhavakara describes the development of Amlapitta dueto vitiation of pitta which is already increased due to its own cause.Also Kashyap considered Apakva Madya and Dugdha as causativefactor, whereas Charaka lists Dugdha as one of the pathya forAmlapitta. Harita counts Guda as the causative factor for Amlapitta.In the management, single drugs like Haritaki, Pippali and Rasonawere advised by Kashyap whereas Kapittha, dadima and dhatriadvised by other of Yogaratnakara among the comound drugs‘Narikela Lavana” suggested by author of Rasatarangini, NarikelaKhanda, soubhagyasunthi, Shunthi Khand suggested by BhaisajyaRatnavali etc.are the good remedies for Amlapitta. On analyzing,the pharmacodynamics of these above drugs proved effective in themanagement are contraindicated in increased Pitta condition. 53   
  54. 54. Where as the drug of choice should be tikta and madhura rasapradhana. Even present day scholars have ventured on research oneffect of drug like Amalai, Shatavari, Madhuyukta, Guduchi,Bhringaraj, Patol, Pippali, Puga, Udumber etc. in the managementof Amlapitta. That’s why Doshik predominance has been consideredand stressed on the classification according to Kashyap and even byMadhavakara.Why pitta kapha classification considered not Vata?a. Acharyas decribed that diseases are not produced due to anysingle Dosha but by all the three Doshas58. Also they explained thatnon-compliance of healthy eating causes the vitiation of threeDoshas simultaneously. So, whenever Annavisha mixed withSamsrijyamana Pitta (Pitta predominant Tridosha). It will causesPaitika disorders. In the same way whenever Annavisha mixed withVatasamshrista and kapha Samshrista (Vata predominant andkapha predominant tridosha).It leads to Vataja and Kaphaja disorders respectively. So, all thedisease produced are Tridoshajanya.b. Madhavakara explained that Pitta is responsible for thepathogenesis of Amlapitta, but the Nidana like Viruddha Ahara hasbeen enlisted which is said to be the causative factor of threeDoshas.c. Samanavayu, Pachaka Pitta and Kledaka Kapha may get SthanaSanshrita in Amashaya. And these have various relation ship. Whenvitiation of any one, may disturb the others. Kledaka Kapha protectsthe amashaya by counteract the secretion of Pachakapitta. AlsoSamana Vayu maintains / balances the Agni and proper digestion.So when Vata gets vitiated, it seems the possibilities due to 54   
  55. 55. margaavarana from Pitta and Kapha. Hence Amlapitta is a diseasecondition produced due to Pitta Kphavrita Vata.d. Kanthadutta has classified that like Kotha, the causative factorsof Amlapitta are kapha and pitta. He has further clarified thatthough the pitta is chief Dosha in Amlapitta, Gaurava, Udgara andKampa symptoms are due to Kapha and Vata respectively. Hence itis clear that Kapha pitta Doshas are the main involved in the patho-physiology of disease.e. Chakrapani explains that urdhva amashaya is the seat for Kaphaand adho Amashaya is the seat for Pitta. Hence Kapha and piitapredominace should be considered due to the predominace. There ismore chances of involvement of local factors in pathogenesisprocess.f. Acharya Kashyap quoted the Doshas as ‘Vatadayah’ but later hehas stressed that the dominant Doshas are Pitta and Kapha59.SAMPRAPTI The word samprapti is the process of disease formationbeginning right from the contact of the causative factor with thebody to complete manifestation of the symptoms. It is a coursefollowed by a disease in which a Dosha get vitiated & the path itfollows for the manifestation of disease. The same idea is reflectedby the word pathogenesis used in the modern medicinal sciences. Kashyap, Madhava & Gananatha sen have mentioned specificSamprapti of Amlapitta as follows. Over indulgence in above mentioned factors cause vitiation ofvata & pitta doshas Anyone of the involved doshas slackens 55   
  56. 56. jatharagni (to below normal level) i.e. jatharagnimandhaya. Duringthe stage, what so ever food is consumed becomes vidhagadha.Then it becomes Shukta & it lies in the stomach stagnant. Any food,which is taken, becomes Vidhaga, at this stage Vidhagadhajirnamanifests which is the purvarupa of the disease Amlapitta. Further vitiated pitta get mixed with shukta & causes pittaAma Visha samurchhana. The disease Amlapitta with its cardinalsymptoms is then takes place. If not treated properly in this stage the disease leads toBheda avastha where the typical Characteristics & types likeUrdhavagata & adhogata are differentiated. Further, complication like shita pitta, Udarda, Kotha, etc. aredifferentiated. 56   
  57. 57. The samprapti of Amlapitta can be shown into schematic diagram as below : Nidana sewana Aharaja Viharja Manasika Agantuja Pittadhika tridosha prakopa Increase the gastric secreation & or damage the gastric mucosa Pachaka Pittadika Kledaka Kaphadhikya Amasaya dusti Amla gunadhikya Dravagunadhikya pittapradhana of pitta of pitta tridosha prakopaVidagdhavastha of pitta Overcome the Usnagana of pitta Agni dusti Agnimandya Punacha nidana sewana Vidagdhavastha of Anna Shuktpaka Amotpatti Rasadhatu dusti Raktadhatu dusti Annavaha srotodusti Purisavaha srotodusti Atipravritti Vimargagamna Amlapitta Urdhag Adhoga 57   
  58. 58. Purvarupa In Ayurvedic classics, no specific purvarupas of Amlapitta arementioned but by applying tarka & pratical knowledge someimportant inferences can be drown. As already explained in the sampropti Agnimandya & Ajirnaare the successive stages towards the manifestation of Amlapitta.Also they are practically observed in the patients. Annavaha &purishavahasrotodusti symptoms can also be considered aspurvarupa of Amlapitta. RupaRupas or Lakshanas are useful for the clinical knowledge of adisease symptomatology of Amlapitta has been described byKashyap, Madhavakara and Harita. Later workers of Sangraha kalaviz, Bhavamishra, Vangasena, and Yogaratnakar have blindlyfollowed Madhavakara in this regard Basavarajiyam has includedAmlapitta in the Nanatmaja diseases of Pitta and given three newsymptoms i.e. Swarahinata, Vak-jihva Paridosha. The generalsymptoms ofAmlapitta described by madhavakara as follows53.- Avipaka - Tikta-Amla Udgara- Gaurava - Klama- Utklesha - Hritdaha- Aruchi - KanthadahaKashyap added extra symptoms like –AntrakujanaUdaraadhmanaVidbhedaHritshula etc. 58   
  59. 59. On analysing the classical references pertaining to Amlapitta,it is revealed that quite a big list of symptoms may be prepared.Below a comparative table of the symptoms of Amlapitta is beingpresented on different authorities.Symptoms K.S. H.S. M.N. B.P. Y.R. S.N.Avipaka - - + + + -Amlautklesha + - - - - -Amlaudgara - - + + + +Amlahikka - + - - - -Angasada + - - - - -Antrakujana + - - - - -Aruchi - - + + + -Bhranti - - - - - +Dahayuktatisara - - - - - +Gaurava - - + + + -Gurukosthata + - - - - -Hritshula + - - - - -Hritdaha - - + + + +Kanthavidaha + - + + + +Klama - - + + + +Romharsha + - - - - -Shiroruja + - - - - +Tiktodgara - - + + + -Tiktasya - - - - - +Udara Adhman + - - - - -Utklesha - - + + + -Uro Vidaha - - - - - +Vanti + - - - - - 59   
  60. 60. Symptoms of Ekadoshaja AmlapittaSymptoms K.S. H.S. M.N. B.P. Y.R. S.N.VatikaAngasada + - - - - -Jrimbha + - - - - -Shula + - - - - -Snigdha Upasaya + - - - - -PaittikaBhrama + - - - - -Sitaupasaya + - - - - -Svadupasaya + - - - - -Vidaha + - - - - -SleshmikaChhardi + - - - - -Guruta + - - - - -Ruksha Upasaya + - - - - -Usma Upasaya + - - - - -Vatadhikya AmlapittaBhrama - - + + + +Cimcimatva - - + + + +Gatra Sada - - + + + +Harsha - - + + + +Kampa - - + + + +Murccha - - + + + +Moha - - + + + +Pralapa - - + + + +Shula - - + + + +Tamodarshana - - + + + +Kphadhikya AmlapittaAruchi - - + + + +Agnimandya - - - - - + 60   
  61. 61. Gaurava - - + + + +Jadyata - - + + + +Kandu - - - - - +Kaphanisthivana - - + + + +Lepa - - + + + +Nidra - - - - - -Sada - - + + + +Sheeta - - + + + +Vami - - + + + +Pitta – Sleshma AmlapittaAmlodgara - - + + + -Aruchi - - + + + -Alasya - - + + + -Bhrama - - + + + -Chhardi - - + + + -Hritdaha - - + + + -Kanthadaha - - + + + -Kukshidaha - - + + + -Murchha - - + + + -Mukha Madhurya - - + + + -Praseka - - + + + -Shiroroga - - + + + -Tikta-udgara - - + + + -Vishishta Lakshana of Urdhvag AmlapittaSymptoms K.S. H.S. M.N. B.P. Y.R.Abhuktevami - - + + +Abhukte va tiktavami - - + + +Abhuktetiktaudgara - - + + +Abhukteamlavami - - + + + 61   
  62. 62. Bhukte vidragdhatiktavami - - + + +Bhukte vidhagdha Amlavami - - + + +Bhute vidagdha Tiktodgara - - + + +Caranadaha - - + + +Hritdaha - - + + +Karadaha - - + + +Kukshidaha - - + + +Kandu - - + + +Kanthadaha - - + + +Mandal - - + + +Mahati aruchi - - + + +Pidika - - + + +Shiroruja - - + + +Usnata - - + + +Vanta harita - - + + +Vanta pitta - - + + +Vanta neela - - + + +Vanta Krishna - - + + +Vanta arakta - - + + +Vanta raktabha - - + + +Vanta ativamla - - + + +Vanta mamsdokabham - - + + +Vanta atipichilla - - + + +Vanta Atiachha - - + + +Vanta Sleshma anujata - - + + + 62   
  63. 63. Adhoga AmlapittaSymptoms K.S. H.S. M.N. B.P. Y.R.Analasada - + + + -Anga pitata - + + + -Bhrama - + + + -Daha - + + + -Harsha - + + + -Hrillasa - + + + -Murchha - + + + -Moha - + + + -Vividhapradosa - + + + -Adhoyan - + + + -Trita - + + + -Sweda - + + + -Kotha - + + + - 63   
  64. 64. SAPKESHA NIDANALANDSCAPE PAGE TABLE 64   
  65. 65. Upashaya – Anupashaya:These factors provide a diagnostic aid for the disease which areotherwise difficult to diagnose. Specific description about upashayaand anupashaya is given only by Kashyap while describing Doshajatypes of Amlapitta.Vataja Aamlapita – Snigdha UpashayaPittaja Amlapitta - Swadu and Shita UpashayaKaphaja Amlapitta - Ruksha and Ushna Upashaya Upadrava – Complications of Amlapitta have not been described byancient Acharyas except Kashyap. He has mentioned Upadravas andstated that the disease is incurable in their presence. Also AcharyaGananath Sen has given Upadrava of Amlapitta. These are –SYMPTOMS K.S. S.N. SYMPTOMS K.S. S.N.Jwara + - Shitapitta - +Atisara + - Udarda - +Pandu + - Kandu - +Shula + - Mandala - +Shotha + - Vicharchika - +Aruchi + - Vishphotaka - +Bhrama + - Pidika - +Grahani kshata - + Asamashaya kshata - + Though madhavakara has not mentioned the complication ofAmlapitta, but included shoola in its vatika predominant variety.Hence, Parinama and Annadrava Shula can be taken ascomplication of Amlapitta. 65   
  66. 66. Shadhya asadhyata – Madhavakara has pointed out that, if the disease is of recentorigin. It can be cured with proper efforts. In chronic conditionrecurrence occurs where treatment is stopped. In some patients itbecomes more difficult to cure even with proper treatment, so thedisease becomes sukhasadhya when it is of short duration, Yapyawhen it is chronic and kruchhrasadhya when the duration of diseaseis long and cured with great difficulty60. Kashyap has indicated thatif it is accompanied with other Upadravas and Dhatu Kshinata thenit becomes Asadhya61. Chikitsa Ayurveda has emphasised 3 basics of chikitsa regarding alltypes of diseases.i. Nidana Parivarjana - It is to be advised the patient to avoidsuch aggravating factors of ahara and vihara which are responsiblefor causation of the disease. So only wholesome and beneficialdietetic articles are to be provided along with compliance AharavidhiVisesayatana..ii. Apakarshana – Apakarshana mean pacification of Doshas eitherby Shodhana or Shamana or by both. So far Amlapitta is concerned,it is originated in Amashaya and mostly the Doshas are localizedthere. For this condition Vamana is the best treatment. If Doshasare localized in Pachyamanashaya, then Virechana is the idealtherapy. In Shodhana therapy Vamana is advocated in UrdhagaAmlapitta and Virechana in case of Adhoga Amlapitta use ofNiruhabasti is stated by Chakrapani, Vrinda Madhava and GovindDas. Whereas Vangasen and Yogaratnakar has mentioned the useof Raktamokshana. 66   
  67. 67. iii. Prakritivighata – It means use of drugs resuscitation ofDhatus. Such treatment is termed as shamana therapy. Hencedrugs having Pitta/ Kapha shamaka property according topredominant Doshas have been prescribed but these drugs shouldbe good for Rasa, Rakta and Annavaha Srotas. Prakruti vighata means the sanshaman chikitsa the root of thedisease must be ruled out for curation and it can be possible withthe help of prakrutivighta. Without sanshodhan karma, onlysanshaman may help for removing the vitiated Doshas. The drugthat removes the vititation of theDoshas and not expulses it fromthe body is called as sanshman karma62 shansaman chikitsa bringsthe imbalance Doshas in to its normal position.- Kashaypa has mentioned following sanshaman chikitsa inAmlapitta.(1) Langhana(2) Laghu bhojana(3) Satmya Kala & Desha Sevana(4) Pachana Karma with Samanyoga* Langhana :-Amlapitta is an Amashayetha Vyadhi so langana has role for it.Charaka said that Amavisha is produced by Ajirna which responsiblefor Amlapitta Langhana is best receipie for removing the Ama Doshaand Ajirna, Langhana in crease the Agni and so, the root cause ofAmlapitta will be ruled out.* Laghu Bhojana :-If the Ahara that taken by the pition digest easily it is called aslaghu bhojana. Laghu Bhojana are not creat Mandagi and Ajirna. 67   

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