Role of panchakarma in Amlapitta.

1. ROLE OF PANCHAKARMA IN
AMLAPITTA

2.  Charaka Samhitha (C.Su.1)
 Sushruta Samhitha (Su.Su.42/1)
 Kashyapa Samhitha (Ka.Khi.16)
 Haritha Samhitha
 Madhava Nidana (M.Ni. 51)
 Chakradatta
 Sharangadhara Samhitha (Sh.Ma)
 Yogaratnakara (Y.R.56/1-24)
 Gada Nigraha
 Vangasena Samhitha
 Basavarajiyam
 Bhavaprakasha (B.P 10)
 Bhaishajya Ratnavali (B.R.57)
REFERENCES

3. DEFINITION
 “ अम्लाया पित्तं अम्लपित्तम् । ” (Vachaspatyam)
According to Vachaspatyam, Amlapitta means Pitta leading to sour taste.
 “ पिदाह्याद्यम्लगुणोपिक्तं पित्तं अम्लपित्तम् । ” (Vijayaraksita)
Vijayarakshita, commentator of Madhava Nidana defines the words as that the Pitta having Vidahi quality give
rise to Amla or sour taste.
 “ अम्लं चेपि अम्लगुणोपिक्तं पित्तम् । ” (Chakrapani)
Which means the qualities of Pitta i.e. sourness is increased leading to Amlapitta.
 “ अम्लं अम्लापदक
ं पित्तं यत्र िदम्लपित्तम् । ” (Gananatha Sen)
Shri Gananath Sen in his book Sidhanta Nidana has given similar definition, as the qualities of Pitta i.e. sourness
is increased which leads to Amlapitta.
The above classical description of Amlapitta emphasizes that Amlapitta is a patho-physiological condition in
which the Pitta gets vitiated i.e., Vriddhi (excessiveness) and sourness of Pitta is increased.

4. SYNONYMS
 Pramilaka - A.S. Su. 5 / 27 ( Indu Commentary )
 Pitta Visuchika - A.S. Su. 5 / 27 ( Indu Commentary )
 Pittamlaka - Harita
 Amlika - Su. Su. 42 / 9

5. NIDANAM
No. ETIOLOGICAL FACTORS Ka.S M.Ni B.P B.R Sh.S
1. Adhyashana + - - - -
2. Abhishyandi ahara + - - - -
3. Ajeerna + - - - -
4. Aama + - - - -
5. Apakwanna sevana + - - - -
6. Akaala bhojana + - - - -
7. Ati amla sevana + + + + +
8. Ajeerna ahara + - - - -
9. Vidahi annapana - + + - -

6. No. ETIOLOGICAL FACTORS Ka.S M.Ni B.P B.R Sh.S
10. Ati ushna ahara + + + + +
11. Ati snigdha ahara + - - - -
12. Ati tikshna ahara + - - - -
13. Ati drava sevana + - - - -
14. Ati rooksha sevana - - + - -
15. Bhukte Avagaha + - - - -
16. Bhukte snanam + - - - -
17. Vega dharanam + - - - -
18. Dushtanna - + + + +
19. Bhukte divaswapna + - - - -
20. Kale anashanam + - + - -

7. No. ETIOLOGICAL FACTORS Ka.S M.Ni B.P B.R Sh.S
21. Guru bhojana + - - - -
22. Ikshu vikara + - - - -
23. Kulatha sevana + - - - -
24. Ati Madhya sevana + + + + +
25. Paryushitha anna + - - - -
26. Pitta prakopi annapana - + + + +
27. Pishta anna + - - - -
28. Virudha ashana + + + + +

8. SAMPRAPTHI
NIDANA SEVANA
AHARAJA VIHARAJA MANASIKA AGANTUJA
PITTA SANCHAYA
PUNA SEVANA
PITTA PRAKOPA
ATIDRAVATA ATIAMLATA
PITTA VRIDHI
AMLAPITTA
ANNA VISHA
SUKTA PAKA
AGNI MANDHYA
AGNI DUSHTI
AVIPAKA RAKTA DUSHTI
KLEDAKA K. KSHAYA
SAMANA VATA KOPA

9. SAMPRAPTI GHATAKA
 DOSHA - Pitta(Pachaka),
Vata(Samana,Prana,Apana),
Kapha (Kledaka, Bodhaka)
 AGNI - Mandagni,
Vishamagni
 SROTUS - i. Annavaha
ii. Rasavaha
iii. Purishavaha
iv. Raktavaha
 SROTODUSHTI - Sanga,
Vimarga gamana,
Atipravriti
 ADHISHTANA - Amashaya,
Grahani
 DUSHYA - Rasa,
Rakta
 ROGA MARGA - Abhyantara (Kostha)
 SWAROOPA - Chirakari
 PRABHAVA - Daruna

10. TYPES
Acharya Kashyapa has mentioned three types.
1. Vataja
2. Pittaja
3. Kaphaja
Madhavakara has explained four types.
1. Vatadhika
2. Kaphadhika
3. Vatakaphadhika
4. Shleshma pittaja
According to dusti sthana of the srotus - Madhavakara and Bhavamishra both have described mainly two types
1. Urdhavaga Amlapitta
2. Adhoga Amlapitta
This classification is mainly based on the presentation of the symptoms suggestive of the GI tract. This classific
ation has its own importance in the management, as far as the clinical strategy is considered.

11. SAMANYA LAKSHANAS OF AMLAPITTA
SL.N
O
SYMPTOMS Ka.S M.Ni B.P S.Ni B.R G.N
1. Amlodgara + + - - - -
2. Antrakujana + - - - - -
3. Amlotklesha + - - - - -
4. Angasada + - - - - -
5. Avipaka - + + - + +
6. Aruchi - + - - - +
7. Gaurava - + + - + +
8. Gurukoshtata + - - - - -
9. Hriddaha - + + + + +
10. Hritsula + - - - - -

12. SL.NO SYMPTOMS Ka.S M.Ni B.P S.Ni B.R G.N
11. Kantadaha + + + + + +
12. Klama - + + + + +
13. Kara - charana daha + - + + + +
14. Romaharsha + - - - - -
15. Srama - - - - - +
16. Shiroruk + - - + - -
17. Tiktodgara - + + - + +
18. Udaradhamana + - - - - -
19. Uravidaha + - - - - -
20. Utklesha + + - - + +
21. Vidbheda + - - - - -

13. SYMPTOMS OF URDHWAGA AMLAPITTA
SL.NO SYMPTOMS M.Ni B.P S.Ni Y.R G.N
1. Abhukte va tikta vami + - - + +
2. Abhukte va amla vami + - - + +
3. Abhukte va amlodgara + - - + +
4. Abhukte va tiktodgara + - - + +
5. Bhukte vidagdhe tikta vami + + - + +
6. Bhukte vidagdhe amla vami + - - + +
7. Bhukte vidagdhe tiktodgara + - - + +
8. Bhukte vidagdhe amlodgara + - - + +
9. Carana daha + - - + -
10. Jwara (kp) + - - + +

14. SL.N
O
SYMPTOMS M.Ni B.P S.Ni Y.R G.N
11. Kandu + - - + +
12. Kara daha + - - + -
13. Kukshi daha + - - + +
14. Mandala + - - + -
15. Pidika + - - + -
16. Roga chaya + - - + +
17. Ushnata + - - + +
18. Vantam harita vamanam + + + + +
19. Vantam peetam + + - + +
20. Vantam neelam + + - + +
21. Vantam krishnabham + + - + +
22. Vantam raktabham + + - + +

15. SL.NO SYMPTOMS M.Ni B.P S.Ni Y.R G.N
23. Vantam araktam + + - + +
24. Vantam ati va amlam + - - + +
25. Vantam mamsa dhavana
toyabham
+ - - + +
26. Vantam ati pichilam + + - + +
27. Vantam accham + + - + +
28. Vantam sleshmanujatam + + - + +
29. Vantam rasena vividham + + - + +

16. SYMPTOMS OF ADHOGAAMLAPITTA
SL.NO SYMPTOMS M.Ni B.P S.Ni Y.R G.N
1. Analasada + + - + +
2. Angapeetata + + - + +
3. Bhrama + + + + +
4. Daha + + - + +
5. Hrullasa + + - + +
6. Harsha + + - + +
7. Kota + + - + +
8. Moha + + - + +
9. Moorcha + + - + +
10. Sweda + + - + +

17. SL.NO SYMPTOMS M.Ni B.P S.Ni Y.R G.N
11. Thrit + + + + +
12. Vividhaprakara mala + + - + +

18. UPADRAVAS OF AMLAPITTA
SL.NO SYMPTOMS K.S S.N
1. JWARA + -
2. ATISARA + -
3. PANDU + -
4. SHOOLA + -
5. SHOTHA + -
6. BHRAMA + -
7. AMASHAYA KSHATA - +
SL.NO SYMPTOMS K.S S.N
8. SEETAPITTA - +
9. UDARDA - +
10. KANDU - +
11. MANDALA - +
12. VICHARCHIKA - +
13. PIDAKA - +
14. GRAHANI KSHATA - +

19. TREATMENT PRINCIPLE
1. Nidana parivarjanam
Kashyapa Acharya advises to avoid the food materials which are processed. While explaining the sadhya
sadhyata, he adds that the disesases like Amlapitta becomes sadhya in those who are not greedy towards t
heir food habits.
2. Apakarshanam or shodhanam
Kashyapa acharya has described vamana as the first line of treatment, followed by langhana and laghu -
bhojana. Eventhough the Amlapitta is a Pittika disease, the most effective sodhana is vamana. Kashyapa
opines that just like a tree with its trunk and branches are destroyed by striking the blow at its root. He
says that, pecuiliarly for the chronic conditions; vamana is to be done definitely.
पूर्वं तु र्वमनं कार्यं पश्चात् मृदु वर्वरेचनम् ।
क
ृ तर्वान्ति वर्वरेकस्य सुविग्धस्य अनुर्वासनम् ॥
( Y.R 57 / 14 )

20. As per the Chakradatta and Yogaratnakara, the second line of treatment is to perform mridu virechana.
Drugs used for vamana are lavanambu, sukhosna, dugdha, ikshurasa, madhudaka or tiktadravyas and for
the virechana triphala, trayamana, katuki along with trivrit is mentioned.
According to Bhavaprakasha, the decoction of patola, nimba, and madanaphala with saindhava lavana sh
ould be used for vamana in Amlapitta
Avipathi choorna is one of the most commonly used yogas for virechana, which is mentioned by Vaghba
ta acharya.
The next regimen consists of administration of anuvasana followed by asthapana, in the chronically afflic
ted patients. The drugs such as tiktaka gritha, indukanta gritha, aragwadhadi gana gritha etc. are usually
used for the purpose of anuvasana. Madhuyashtyadi taila and Ksheerabala taila are also used in this
regard.
After anuvasana, in chronic cases, nirooha is mentioned. Usually ksheeravasthi is the ideal one to be
administered here. Instead of plain ksheera, ksheera kwathas with guduchyadi gana, tiktaka kwatha, indu
kanta kwatha, aragwadhadi gana is usually used.

21. Yogaratnakara added raktamokshana as a tool if Amlapitta is not cured by both of the sodhan
a procedures, vamana and virechana.
ऊर्ध्वगं र्वमनैर्धीमान् अर्धोगं रेचनैर्वरेत् ।
अम्लवपत्ते तु र्वमनं पटोलाररष्टपत्रक
ै ॥
कारर्येन् मदन क्षौद्र वसन्धुर्युक्ैैः कफोल्बणैैः ।
वर्वरेचनं वत्रर्वृत् चूणं मर्धुर्धात्रीफलद्रर्वैैः ॥
( B.R. 56 / 53 – 5 )
विर्या शुद्धस्य शमनी ह्यनुबन्धव्यपेक्षर्या ।
दोषसंसगवजे कार्याव भेषजार्ारकल्पना ॥
पाचनं वतक्भूवर्यष्ठं पथ्यं च पररकल्पर्येत् ।
( Y.R 56 )

22. 3. Prakriti vighatam or shamana chikitsa
Prakritivighata refers to the use of drugs which suppress the elevated dosha, such treatment is also term
ed as the samana therapy.
Kashyapa opines that after vamana, if the doshas persist, the physician should resort to the samana chik
itsa with the aid of laghu bhojana, samana and pachana.

23. Kashaya kalpanas
Patoladi kashayam
Panchatikta kashayam
Vasadi dashanga kashayam
Gudoochyadi kashayam
Choornam kalpanas
Avipattikara choornam
Triphala choornam
Haritaki choornam
Shatavari choornam
Amalaki choornam
Panchanimbadi choornam
Trivrit choornam
Ghrita kalpanas
Vasa ghrita
Shatavari ghrita
Narayana ghrita
Patolashundi ghrita
Jeerakadya ghrita
Avaleha kalpanas
Khanda kushmanda avaleha
Narikela khanda
Shundi khanda
Vati kalpanas
Paneeya bhakta vati
Soubhagya shunti modaka
Rasa Oushadhis
Sootashekhara rasa
Laghusootashekhara rasa
Leela vilasa rasa
Amlapittantaka loha
Kamadugdha rasa
Shankha bhasma
Pravala pishti
Pravala panchamrita rasa
Swarna makshika bhasma
Dhatri lauha

24. PANCHAKARMA IN AMLAPITTA
 Vamana
 Virechana
 Anuvasana vasti
 Rakta mokshana

25. VAMANAM
Drugs used for Vamana are:-
According to Chakradutta and Yoga ratnakara
Lavanambu
Sukhosna
Dugdha
Ikshurasa
Madhudaka
Tiktadravyas
According to Bhavaprakasha,
Decoction of Patola, nimba, and Madanaphala with Saindhava lavana should be used for Vamana in Amlapitta

26. VIRECHANA
Drugs used for the Virechana are :-
According to Chakradutta and Yoga ratnakara,
Triphala, Trayamana, Katuki, along with Trivrit is used.
According to Bhavaprakasha,
Trivrit choorna, Madhu, and Amalaki is used.

27. ANUVASANA
The drugs such as Tiktaka gritha, Indukanta gritha, Aragwadhadi gana gritha etc are usually used
for the purpose of Anuvasana.
Madhuyashtyadi taila and Ksheerabala taila are also used

28. RAKTA MOKSHANA
क
ृ ििमनपिरेकस्यापि दोषोिशान्तिर्भिपि न यपद कायो रक्तमोक्षस्य युक्त्या ।
क
ृ िपशपशरपिलेिस्य अम्लपित्तघ्न र्क्ष्यौदनसमुपदििृप्ते िाि रक्षा च कायाभ ॥
( Y.R 57 / 14 )
If even after vamana and virechana, if the aggravated doshas are not pacified, then raktamokshana
should be administered methodically.
After that cold application should be done and pathya aharas for amlapitta can be applied. Also
vata dosha should be taken care of.

29. PATHYAS IN AMLAPITTA
Ahara
1) Anna Varga – Yava, godhuma, purana sali, mudgayusha, lajasaktu.
2) Saka Varga – Karavellaka, patola, kusmanda etc.
3) Phala Varga – Dadima, amalaki, kapittha etc.
4) Dugdha Varga – Godugdha
5) Mamsa Varga – Jangala, mamsa rasa
6) Miscellaneous – Sarkara, madhu, narikelodaka.
Vihara
Seetopachara, vishrama etc.

30. APATHYAS IN AMLAPITTA
Ahara
A) Guru, vidahi, viruddha, ushna, katubhojana, kulatha, rasona, navanna, tila
B) Lavana, amla, katurasa, madya, arishta, preservatives in food as well as drugs
C) Adhyasana, samashana, vishamashana, virudhashana
D) Bakery items which are excess in salts and oil
E) Fermented foods like bread, pickles, maida products
Vihara - Vegadharana, atapasevana, ayasa after food, divaswapna, vishama nidra
Psychological - Chinta, krodha, shoka, bhaya.