E-ISSN:2456-3110

Research Article

Non Ulcer Dyspepsia

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

To evaluate the clinical efficacy of Drakshadi Gutika in the management of Urdhwaga Amlapitta (Non Ulcer Dyspepsia)

Lawate R.1*, Managoli S.2
DOI: http://dx.doi.org/10.21760/jaims.8.2.2

1* Rajaram Lawate, Post Graduate Scholar, Dept. of PG Studies in Kayachikitsa, BLDEA’s AVS Ayurveda Mahavidyalaya, Vijayapur, Karnataka, India.

2 S. P. Managoli, Professor & HOD, Dept. of PG Studies in Kayachikitsa, BLDEA’s AVS Ayurveda Mahavidyalaya, Vijayapur, Karnataka, India.

Amlapitta is a condition where Amla Guna of Pachaka Pitta increases due to Samata causing Vidahi condition. Gastritis and non-ulcer dyspepsia have been correlated with Amlapitta by several M.D. and Ph.D. Scholars of Ayurveda. In recent years there has been an unprecedented increase of incidences related to gastro intestinal system due to changing life style like diet pattern, behavioural pattern and mental stress and strain. The prevalence rate of gastritis in India is around 10 million. Ayurveda is having good answer to Amlapitta. Ayurvedic physicians are providing cure for the patients of these chronic dyspeptic disorders. Yogartnakar has said that Drakshadi Gutika cures severe Amlapitta. Drakshadi Gutika, containing Draksha, Haritaki, Sita are having Madhura, Kashaya, Tikta Rasa and Pitta Shamaka, Pitta Rechana Gunas. These drugs are cost effective, easily available and have a good palatability. So, the present study has been planned to evaluate the clinical efficacy of Drakshadi Gutika in the management of Urdhwaga Amlapitta (Non Ulcer Dyspepsia).

Keywords: Urdhwaga Amlapitta, Non Ulcer Dyspepsia, Gastritis, Drakshadi Gutika

Corresponding Author How to Cite this Article To Browse
Rajaram Lawate, Post Graduate Scholar, Dept. of PG Studies in Kayachikitsa, BLDEA’s AVS Ayurveda Mahavidyalaya, Vijayapur, Karnataka, India.
Email: 		Rajaram Lawate, S. P. Managoli, To evaluate the clinical efficacy of Drakshadi Gutika in the management of Urdhwaga Amlapitta (Non Ulcer Dyspepsia). J Ayu Int Med Sci. 2023;8(3):15-18.
Available From
https://jaims.in/jaims/article/view/2328

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-26 2023-12-28 2023-01-05 2023-01-12 2023-01-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2023by Rajaram Lawate, S. P. Managoliand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Lawate R et al: Drakshadi Gutika in Urdhwaga Amlapitta (Non Ulcer Dyspepsia)

Introduction

Today’s life style is completely changed by all the means our diet pattern, life styles, mental stress, strain and behavioural pattern is changed and it is not suitable for our normal physiology of digestion of body. 25 - 30% peoples are suffering from dyspepsia.

These diseases are chronic in nature and affecting to adults mostly. Patients of gastritis often results into peptic ulcer. Charaka has explained the sequential progression of diseases of G.I.T. to which Sangraha Granthakara has given a separate disease status.[1]

In Samhita, Amlapitta is not mentioned as a separate disease entity but there are several references in Charaka, Shushruta and Vagabhata Samhita regarding Amlapitta. Laghutrayi have described this disease as a separate entity with detailed description. Later workers followed the same. Kashyapa[2] has accepted the involvement of three Doshas in Amlapitta while Madhavakara has accepted the dominance of Pitta in this disease.[3] This disorder is the result of Grahani Dosha. Gastritis and non-ulcer dyspepsia have been correlated with Amlapitta by several M.D. and Ph.D. scholars of Ayurveda.[4][5]

Ayurveda has a lot to offer in this regard. Ayurvedic physicians are providing cure for the patients of these chronic dyspeptic disorders. Several single and compound drugs has been tried in this disease. Shodhana procedure has not given a due importance in this disease by Sangraha Granthakara as Shodhan is the only procedure in Bahudoshaavastha.

As Shodhan removes the vitiated Doshas from the body from the roots but in Amlapitta a small amount of Hetusevan can relapse of the same Lakshanas seen in Amlapitta, hence the study was concentrated on Shaman Chikista in Amlapitta by using Drakshadi Gutika from Yogratnakar[6] to check the efficacy of Drakshadi Gutika in Urdhvaga Amlapitta and to assess any other associated benefits as well as side effects. A good number of research works have been carried out on Amlapitta at various institutes of Ayurveda and many of the clinical trials have proved effective to some extent but failed to provide satisfactory answers to all associated problems.

Keeping all these factors into consideration here is an attempt to effect of Drakshadi Gutika in the management of Amlapitta.

Aim and Objectives

1. To study in detail the disease Urdhvaga Amlapitta.

2. To study the aetiopathogenesis of Urdhwaga Amlapitta.

3. To evaluate the clinical efficacy of Drakshadi Gutika in the management of Urdwaga Amlapitta.

Materials and Methods

Source of data

a. Literary Source: Literary and conceptual study for the present study was based on the data from Ayurvedic books available from BLDEA’s AVS Ayurveda Mahavidyalaya library, and other sources which include magazines, previous work done, research paper’s, website etc.

b. Drug Source: The medicines required for the present study were procured from the Pharmacy of BLDEA’S AVS Ayurveda Mahavidyalaya, Vijayapur, Karnataka.

c. Clinical Source: Patients of either sex diagnosed suffering from Amlapitta were selected from OPD & IPD of BLDEA’s AVS Ayurveda Mahavidyalaya Hospital, Vijayapur.

Method of collection of data
A special proforma was prepared with details of history, physical signs and symptoms mentioned for the Amlapitta. Patients were analyzed and selected accordingly. A viable and indigenously designed method was used to assess the parameters of signs and symptoms.

Design of the study

Study Design: Randomized Single Blind Comparative Clinical Study.

Sample Size: Total number of patients taken for the study are 60 excluding dropouts.

Duration of Treatment: 30 days

Duration of Follow-up: 15 days

Study Duration

Total study duration: 30 days


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Lawate R et al: Drakshadi Gutika in Urdhwaga Amlapitta (Non Ulcer Dyspepsia)

Treatment duration: 30 days

Follow up duration: 15 days

Statistical Analysis: The obtained data was analyzed statistically and presented as mean ± SEM. The data generated during the study was subjected student’s “Unpaired ‘t’ Test” for unpaired data to assess the statistical significance between the two groups. The change in signs and symptoms will be analyzed by Paired ‘t’ test.

Inclusion Criteria

1. Patients of both sexes were selected.

2. Patients of age group between 18-60 yrs.

3. Patients suffering from signs and symptoms of Urdhwag Amlapittae., Avipaka (Indigestion), Hrit-Kanthadaha (Heart burn), Tiktamla Udgara (acid eructation), Utklesa (Nausea), Vamana (Vomiting), Udarshula (abdominal pain), Adhman (Flatulence), Klama (Tiredness), Aruchi (Anorexia)

4. Patient from all socio-economic status were taken.

Exclusion Criteria

1. Known Patients having Nilkrushnarakta Vamana (bile-blood vomiting), Murchha (syncope), Angapitata (yellow coloration of body), Krushnaraktmalasarana (black and bloodletting stool), Amashayavrana (stomach ulcer), Grahnivrana (Duodenal ulcer).

2. Patients of Pittashayasmari were excluded.

3. Patient with Adhog Amlapitta were excluded.

4. Patient having fever more than 100°F were excluded from study

5. Patients below 18 years & above 60 years of age.

6. Patients suffering from acid peptic disorder for more than 3 years.

7. Patient with pregnancy, severe anaemia, heart disease, Known patients of malignancy of G.I.T. were excluded.

Criteria for diagnosis: Diagnosis was made on the basis of Samanya Lakshanas of Amlapitta viz. Avipaka (Indigestion), Hrit-kanthadaha (Heart burn), Tiktamlaudgara (acid eructation), Utklesa (Nausea), Vamana (Vomiting), Udarshula (abdominal pain), Adhmana (Flatulence), Klama (Tiredness), Aruchi (Anorexia).

Subjective Parameters

1. Chhardi / Vaanti

2. Shiroruja

3. Kara-Charan Daha

4. Hrid-Kantha Daha

5. Tikta-Amlodgar

6. Hrullasa

Similarly other symptoms were also given scores on the basis of this before & after treatment score.

1. Chhardi

Score Grading of the symptoms
0 No vomiting
1 Nausea & vomiting occasionally.
2 Frequency is not more than 2-3 per week.
3 Frequency of vomiting is between 4- 6 per week.
4 Frequency of vomiting is daily.

2. Tikta-Amlodgar

Score Grading of the symptoms
0 No Tikta-amlodgar.
1 Sometimes during the day.
2 Tikta-amlodgar within one Annakala.
3 Amount of fluid regurgitate to patient’s mouth.
4 Persistent throughout the day & can’t perform day to day work.

3. Kantha-Hridaya-Kukshi Daha

Score Grading of the symptoms
0 No Daha
1 Daha in any area of Udara/Abdomen.
2 Daha in Uro Pradesh with regurgitation.
3 Daha in Kanth Pradesh.
4 Daha relieved by vomiting.

4. Shirashula

Score Grading of the symptoms
0 No Shirashula.
1 Occasionally Shirshula.
2 Frequency is not more than 2-3 per week.
3 Frequency of Shirshula is between 4- 6 per week.
4 Shirshula relieved after vomiting/ medication.

Agnidushti Symptoms: Aruchi, Avipak, Agnimandhya.

SN Symptoms Score
1. Aruchi 2 - if present, 1 - if improvement in the symptoms, 0 - if absent.
2. Avipak 2 - if present, 1 - if improvement in the symptoms, 0 - if absent.
3. Agnimandhya 2 - if present, 1 - if improvement in the symptoms, 0 - if absent.



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Associated Symptoms: Klama, Gaurav, Gurukoshtata, Aadhman.

SN Symptoms Score
1. Klama 2 - if present, 1 - if improvement in the symptoms after, 0 - if absent.
2. Gaurav 2 - if present, 1 - if improvement in the symptoms after, 0 - if absent.
3. Gurukoshtata 2 - if present, 1 - if improvement in the symptoms after, 0 - if absent.
4. Aadhman 2 - if present, 1 - if improvement in the symptoms after, 0 - if absent.

Laboratory investigations

1. Blood Routine for Hb %, TC, DC, ESR.

2. Urine examination for sugar, albumin, and micro-organism.

3. Stool examination for occult blood.

Observations and Results

Out of 71 patients, 5 patients (7.04%) were with age 18-24years, 14 patients (19.72%) were with age 25-30 years, 12 patients (16.90%) were from age group 31-36 years, 17 patients (23.94%) were from age group 37-42 years, 10 patients (14.08%) were from age group 43-48 years, 4 patients (05.63%) were from age group 49-54years, 9 patients (12.68%) were from age group 55-60 years. Out of 71 patients, 41 patients (57.75%) were male while 30 patients (42.25%) were female. Out of 71 patients, 2 patients (2.81 %) were lower class, 49 patients (69.01 %) were Middle class while 20 patient (28.16) was Upper class. Out of 71 patients, 8 patients (11.26 %) were Active, 16 patients (22.53%) were Sedentary, 42 patients (59.15%) were in Labour while 5 patients (07.04%) were Student. Out of 71 patients, 61 patients (85.91%) were married, 10 patients (14.08%) were unmarried.

Out of 71 patients, 15 patients (21.12%) were with Kapha - Pitta Prarkuti, 30 patients (42.25) were with Pitta-Kapha, 18 patients (25.35 %) were with Vata - Kapha Prakruti, while 23 patients (32.39%) were with Vata - Pitta Prakruti. Out of 71 patients, 35 patients (49.30 %) were taking mixed diet while 36 patients (50.70 %) were vegetarian. Out of 71 patients, 29 patients (40.84%) were Mrudu Kostha, 24 patients (33.80 %) were Krura Kostha, 18 patients (25.35%) were in Madhyama Kostha. Out of 71 patients, 33 patients

(46.47 %) were Mandagni, 17 patients (23.94%) were Tiksnagni, 21 patients (29.57%) were in Vishamagni. Out of 71 patients, 22 patients (30.98%) were addicted to Alcohol, Tobacco, 15 patients (21.12%) were addicted to Tobacco, 34 patients (47.88%) were consuming Tea in excess quantity. Out of 71 patients, 43 patients (60.56 %) were doing Vegavidharan, 28 patients (39.43 %) were doing Divaswapna.

Effect of therapy: In the present study total 71 patients were registered, out of which 6 patients have dropped out the treatment, out of remaining 30 patients were treated with Drakshadi Gutika (Group A) and 30 patients were treated with Sutashekhar Rasa (Group B).

Effect of therapy in Group A: In this group total 36 patients were registered out of which 6 patients were dropped out while remaining 30 patients have completed the full course of treatment. Here the effect of drug Drakshadi Gutika on various parameters is presented in the following tables.

Group A Mean N SD SE Wilcoxon W P % relief
Avipaka BT 0.67 30 0.88 0.16 -2.919a 0.004 65.0
AT 0.23 30 0.43 0.08
Hrit Kantha Daha BT 0.93 30 0.94 0.17 -3.666a 0.000 75.0
AT 0.23 30 0.50 0.09
Tikta Amla Udgara BT 1.37 30 1.19 0.22 -3.729a 0.000 63.4
AT 0.50 30 0.57 0.10
Utklesha BT 1.97 30 0.93 0.17 -4.817a 0.000 50.8
AT 0.97 30 0.72 0.13
Vamana BT 0.47 30 0.86 0.16 -2.251a 0.024 64.3
AT 0.17 30 0.46 0.08
Udarashula BT 0.53 30 0.90 0.16 -2.428a 0.015 62.5
AT 0.20 30 0.48 0.09
Adhmana BT 0.40 30 0.81 0.15 -2.251a 0.024 75.0
AT 0.10 30 0.31 0.06
Klama BT 0.47 30 0.86 0.16 -2.460a 0.014 64.3
AT 0.17 30 0.38 0.07
Aruchi BT 0.67 30 0.96 0.18 -3.051a 0.002 95.0
AT 0.03 30 0.18 0.03

Since observations are on ordinal scale (gradation), we have used Wilcoxon Signed Rank test to test efficacy in Group A. In Aruchi 95%, Hritkanthadaha 75%, Adhman 75%, Avipak 65%, Klama 64.3%, Vaman 64.3% Tiktamlodgar 63.4%, Udarshoola 62.5%, Utklesh 50.8% relief was recorded. From above table we can observe that P-Values for all parameters are less than 0.05. Hence, we conclude that effect observed in Group A is significant.


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Effect of therapy in Group B

Group B Mean N SD SE Wilcoxon W P % relief
Avipaka BT 0.47 30 0.86 0.16 -2.271a 0.023 57.1
AT 0.20 30 0.48 0.09
Hrit Kantha Daha BT 0.53 30 0.57 0.10 -3.606a 0.000 81.3
AT 0.10 30 0.31 0.06
Tikta Amla Udgara BT 1.07 30 0.78 0.14 -3.900a 0.000 53.1
AT 0.50 30 0.57 0.10
Utklesha BT 0.90 30 1.09 0.20 -3.606a 0.000 48.1
AT 0.47 30 0.82 0.15
Vamana BT 1.50 30 1.11 0.20 -3.963a 0.000 57.8
AT 0.63 30 0.67 0.12
Udarashula BT 1.87 30 1.17 0.21 -4.326a 0.000 60.7
AT 0.73 30 0.69 0.13
Adhmana BT 0.60 30 0.93 0.17 -2.598 0.009 72.2
AT 0.17 30 0.46 0.08
Klama BT 0.60 30 0.93 0.17 -2.585 0.010 66.7
AT 0.20 30 0.48 0.09
Aruchi BT 0.67 30 0.96 0.18 -2.739 0.006 70.0
AT 0.20 30 0.48 0.09

Since observations are on ordinal scale (gradation), we have used Wilcoxon Signed Rank test to test efficacy in Group B. In Aruchi 70%, Hritkanthadaha 81.3%, Adhman 72.2%, Avipak 57.1%, Klama 66.7%, Vaman 57.8% Tiktamlodgar 53.1%, Udarshoola 60.7%, Utklesh 48.1% relief was recorded. From above table we can observe that P-Values for all parameters are less than 0.05. Hence, we conclude that effect observed in Group B is significant.

Discussion

Amlapitta is a psychosomatic disorder either it may be because of Aharaja, Manasika or Viharaja Nidana. So, in the present study we selected Drakshadi Gutika and Laghu Sutashekhar Rasa to see the effect of both drugs in the patients. Mandagni is the main cause for all the disease, this Mandagni causes Avipaka, it turns in to Shukta Paka acts like Amavisha which is nothing but Ama, this Ama vitiates Annavaha Srotases produces the symptoms like Aruchi, Agnimandhya, Vamana, these are the factors which are involved in the manifestation of the disease Amlapitta.

In the present study Drakshadi Gutika was used as trail drug to evaluate its efficacy in Amlapitta. The ingredients are Draksha, Haritaki and Khandsharakara.

The ingredients having the properties like Katu, Tikta, Kashaya and Madhura Rasa pacify Pitta and Kapha. The Gunas Laghu, Ruksha pacifies Kapha Dosha; Snigdha Guna help in the digestion by doing Agnideepana (Kledana). Katu Vipaka pacifies Kapha Dosha and brings back to normal Rasa of Pitta. Sheeta Virya pacifies Pittadosha and Ushnavirya acts as Agnideepaka by increasing its Teekshna Guna and does Kapha Shaman. Both the drugs Draksha and Haritaki having Deepaka and Pachaka Karma. The Draksha that is Sheeta Virya and Madhura Vipaka acts as Pitta and Daha Shamaka. This Draksha when processed with Deepaka and Pachaka Dravyas acquires the Deepaka Pachaka and Pittashamaka attributes due to its Sanskarasyanuvartana property, So, Drakshadi Gutika is one of the best Aushadhi for Amlapitta.

Conclusion

In this study after treatment Drakshadi Gutika (Group A) showed significant effect on the symptoms Avipaka, Aruchi and Chardi. And highly significant effect on Klama, Utklesha, Hrutkantha Daha, Tiktamla Udghara, Gourava and Shirashula. But in the follow-up period non-significant effect was observed in the symptoms

Reference

1. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Vimana Sthana, Trividha Kukshi Vimana Adhyaya, 2/4. Vaidya Jadavaji Trikamji Aacharya. Reprint ed. Varanasi: Chaukhambha Surabharati Prakashana; 2005. p. 238.

2. Vruddha Jivaka, Kashyapa Samhita, with Sanskrit introduction by Pandit Hemraj Sharma, Chaukhamba Sanskrit Sansthan, Varanasi, 2006, Lehadhyaya, Pg. 4-5.

3. Madhavakara, Madhava Nidana, Part 2nd, with Madhukosha Sanskrit commentary by Sri Sudarshan Sastri, 13th edition, Chaukhamba Sanskrit Sansthan, Varanasi, 2001, 51/3-4.

4. Baragi UC, Vyas MK. Clinical evaluation of the efficacy of Dashanga Kwatha Ghana Vati in the management of Urdhwaga Amlapitta (Non-ulcer dyspepsia). Ayu. 2012 Apr;33(2):219-23. doi: 10.4103/0974-8520.105241. PMID: 23559793; PMCID: PMC3611627.



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5. Baragi UC, Vyas MK. Evaluation of diet and life style in the etiopathogenesis of Urdhwaga Amlapitta (non-ulcer dyspepsia). Ayu. 2013 Oct;34(4):352-5. doi: 10.4103/0974-8520.127705. PMID: 24695749; PMCID: PMC3968695.

6. Yogratnakar commentary by Shastri Vaidya Laksmapati Shastri, Amlapitta Chikitsa Adhyaya, Uttarakhanda Ver se 1-2, edited by Vd. Brahmhashankar Shastri, 2nd edition Varanasi; Chaukhambha Prakashan; 2010, pg. 241


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