E-ISSN:2456-3110

Review Article

Gastroesophageal Reflux Disease

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

A review on Ayurveda dietetics for Amlapitta (Gastroesophageal Reflux Disease) by different Ayurveda classical texts

Padmaveer PS1*, Sagare S2
DOI:10.21760/jaims.8.11.21

1* Padmaveer PS, Post Graduate Scholar, Department Of Swasthavritta, Kahers Shri Bmk Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.

2 Sandeep S Sagare, Associate Professor, Department of Swasthavritta, KAHERS Shri BMK Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.

Amlapitta could be a commonly experienced illness of Annavaha Srotasa (gastrointestinal system) depicted in different classical Ayurvedic writings that affects people of all ages, genders, regions, and climates. The 21st century is regarded as the modern era due to which bygone eating habits and life style is totally changed. Indulgence of food articles such as over processed, under processed and incompatible dietary preparations are the root cause of most of the non-communicable disorders now a days. Ritucharya (a seasonal regime) and Dinacharya (a diurnal regime) were some of the dos and don'ts mentioned by Acharyas. In addition to being an integral part of the regimen of good health, the Ayurvedic teachings of Acharyas also included Pathya (healthy) and Apathaya (unhealthy) as a component in the treatment of diseases. This highlights the significance of Pathya (healthy) and Apathya (unhealthy) in Ayurveda. So, it is the pressing priority to know the Pathyas (wholesome) and Apathyas (unwholesome) of Amlapitta explained by different Acharyas.

Keywords: Amlapitta, Diet, Food, Pathya, Apathya

Corresponding Author How to Cite this Article To Browse
Padmaveer PS, Post Graduate Scholar, Department Of Swasthavritta, Kahers Shri Bmk Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.
Email: 		Padmaveer PS, Sagare S, A review on Ayurveda dietetics for Amlapitta (Gastroesophageal Reflux Disease) by different Ayurveda classical texts. J Ayu Int Med Sci. 2023;8(11):140-144.
Available From
https://jaims.in/jaims/article/view/2790

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-07 2023-09-12 2023-09-18 2023-09-23 2023-10-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 20.96%

© 2023by Padmaveer PS, Sagare Sand 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].

J Ayu Int Med Sci 2023;8(11)140
Padmaveer PS et al. A review on Ayurveda dietetics for Amlapitta

Introduction

Ayurveda the science of life has given much importance for prevention of diseases rather than treating the disease after manifestation. In the present-day scenario, the food and lifestyle have been greatly altered and is the leading cause for almost all the non-communicable diseases worldwide. In Ayurveda classical texts Acharyas have mentioned about the quality, quantity, method of preparations in detail   to   avoid   diseases   and   to   maintain  healthy livelihood.

Amlapitta is a common Annavaha Sroto-Dushti Vikara that affects people of all ages, genders, regions, and climates as people are practising inappropriate diet and lifestyle which are leading to disturbances in digestive system.[1] But in Ayurveda, the first and foremost entity to look in to is Agni. In Amlapitta, Agni is the one which is hampered and leading to the pathophysiology of the disease itself. To maintain and improve Agni and Kosta one must consume wholesome food and beverages in proper time. Indulgence of diet articles which can be Virudha (incompatible combinations), spoiled, bitter or inflicting burning sensation. Different food items and drinks which will vitiate the already aggravated Pitta and produces Amlapitta.[2] Pathya is derived from the root word Patha, which means a route or channel. Pathya is referred to as regimes or substances which are whole some to mind and body. The things which are not wholesome to mind and body is referred to as Apathya. Food is the first of the three pillars of existence that Charak had identified, along with regulated sexual activity and sleep. Sushruta had provided more evidence for this point when he said that food is the source of Oja, power, life, and complexion.[3] Around 20% of the total adult population of whole world suffers from GERD (Gastroesophageal reflux disease)[4] which can be correlated with Urdhwaga Amlapitta with the similar signs and symptoms.[5] By this above words it can be said as Amlapitta is a most common lifestyle disorder which is being often neglected in the present time. The Amlapitta is a disease which can be more often managed with diet and lifestyle of a person rather than putting on the medications. The contemporary medical system offers various medications such as antacids, PPI (proton pump inhibitors) & H2 Receptors.[6] These medications give temporary relief but the

long-term usage of these medications is not advisable and may lead to adverse effects such as reduced calcium absorption and reduced BMD (bone mineral density)[7] In Ayurveda also there are medications which can manage Amlapitta, but the challenge arises when people again start habituating the Apathya Ahara Viharas and stress which in turn leads to the same symptomatology. Manasika Nidanas also contributes to the formation of Amlapitta. In today’s world people are more stressed and anxious to the work environment, family etc. To this concern the dietetics plays an important role in controlling the recurrent status of Amlapitta. For this Acharyas have given detailed Pathyas to follow in a person inflicted with Amlapitta and the people who are prone to Amlapitta may also follow the same.

Materials and Methods

Literature search of Amlapitta have been done on Charaka Samhitha, Kashyapa Samhitha, Madhava Nidana, Bhava Prakasha, Yoga Rathnakara and Bhaishjya Ratnavali.

Review of Literature

Amlapitta could be a commonly experienced illness of Annavaha Srotasa (gastrointestinal system) that predominantly comprises of Avipaka (acid reflux), Hritkantha Daha (heart and throat burn) and Tikta-Amlodgara (sour and sharp burping).[1] Almost all the classical texts of ayurveda highlights the Nidanas in a similar manner. Among them Aharaja and Viharaja Nidanas are explained. The common Aharaja Nidanas are - Virudha Ahara (Incompatible food), Dushta-Amlavidahi Ahara (Acidified food), Pitta Prakopakara Ahara (Pitta aggravating food), Virudhyasana (Untimely food consumtion), Ajeerna (Indigestion), Madhya (Alcohol), Atyushna (Too hot), Snigdha (Too oily), Ruksha (Dry), Katu (Pungent) ahara. Similarly, the common Viharaja Nidanas are - Divaswapna (Repeatedly sleeping in day time), Ati Snana (excessive bathing) & Avagaha (tub bath).[8] The pathophysiology of Amlapitta is understood as the over indulgence of Nidanas (aetiology) in turn leading to aggravating Vatadi Doshas, which leads to Agnimandya and formation of Ama. Further the Ama and Vatadi Doshas localises in Amashaya which leads to Shukthatwa of Ahara Rasa. Ajeerna Ahara with Prakupita Pitta Dosha leads to the Amlapitta.[9] The Samanya Lakshanas


J Ayu Int Med Sci 2023;8(11)141
Padmaveer PS et al. A review on Ayurveda dietetics for Amlapitta

of Amlapitta are - Avipaka (Indigestion), Klama (exhaustion), Utklesha (discomfortness), Tikthamlodhgara (Sour belching), Gourava (Heaviness), Hruth Kanta Daha (Burning sensation in chest & throat), Aruchi (Anorexia). Pathya is referred to the Ahara and Vihara, which causes pacification of the disease.[10] Apathya is referred to the Ahara and Vihara, which causes complications and aggravate the disease.[3]

Pathya Ahara according to different Samhithas exclusively for Amlapitta are as follows –

  • Charaka Samhitha

Raja Masha (Cow peas)

  • Kashyapa Samhitha

Purana Shali (Old rice), Mudhga (Green gram), Masura (Lentil), Harenu (Green gram), Grutha (Ghee), Paya (Milk), Jangala Mamsa (Meat of arid animals), Kalaya Shaka (Leaves), Pouthika, Vasa Pushpa (Malabar nut flowers), Vaasthuka and Thiktha-Laghu Shaka Varga (Bitter and Light to digest Leafy veggies).

  • Bhava Prakasha

Yusha Yavagu (Thick gruel) of Yava (Barley) and Godhuma (Wheat), Laja Sakthu (Puffed grains) added with sugar and honey.

  • Yoga Rathnakara

Yava (Barley), Godhuma (Wheat), Mudhga (Green gram), Purana Raktha Shali (Old red rice), Taptha Sheetha Jala (Boiled water made to cool), Sharkara (Sugar), Madhu (Honey), Sakthu (Gruel), Karkotaka (Spiny gourd), Karavella (Bitter gourd), Rambapushpa, Vaasthuka, Vethra Agra, Vrudha Kushmanda (Aged Winter melon), Patola (Pointed gourd), Dadima (Pomegranate) and all Pitta and Kapha alleviating drinks.

  • Bhaishjya Ratnavali

Raktha Shali (red rice), Yava (barley), Godhuma (wheat), Mudgha (green gram), Jangala Rasa (dry arid meat soup), Taptha Sheeta Jala (boiled cool water), Sharkara (sugar), Madhu (honey), Karkota (spiny gourd), Karavellaka (bitter gourd), Patola leaves (pointed gourd leaves), Himlochika, Vethragram, Vridha Kushmanda (winter melon), Kadalipushpa (banana flowers), Vaastuka, Kapitta (Wood apple), Dadima (Pomegranate), Amlakki

(Indian gooseberry), Tikthani Sakalani (Bitter) and Kapha Pittahara diet.

Apathyas which are found in classical texts are as follows:

Tila (sesame), Masha (black gram), Kulatta (horse gram), Nava Anna (newly harvested rice), Kanji (fermented drink), Guru Ahara (Heavy to digest food), Dadhi (Curd), Madya (Alcohol), Avi Dugda (sheep milk), Dhanyamla (fermented liquid), Lavana (salt), Amla and Katu Ahara (sour and pungent food).

Therapeutic Diet advices on Samhithas

Vargas
ShookaPurana Shali / Old riceGodhuma / Wheat Vajranna / Pearl MillettShyamaka / Little millet
Shami Mudga / Green gramRaja Masha / cow peaMasur / Lentil
Mamsa Jangala Mamsa Rasa / Arid area animals
Shaka Karavellaka / Bitter gourdThanduliyaka / Amaranth Kadali Pushpa Patola /snake gourdTrapusa / cucumber
PhalaKadali /bananaKharjura / datesDadima / pomegranate
Harita Ardhraka / gingerDhanyaka / coriander
Madya Contraindicated
Jala Taptha Sheeta Jala / boiled & made to cool waterDhanyaka Hima / coriander waterJeeraka Jala / cumin waterShunti Jala / Ginger waterAjamoda Jala / Ajwain water
Gorasa Go Ksheera / Cow milkGo Ghritha / Cow Ghee
Ikshu Sharkara / Sugar  
KrutannaManda / Rice gruelYusha / Medicated soupSoopa / Soup
Aharopayogi Jeera / cumin seedsEla / CardamomAjamoda / Ajwain

Therapeutic diet plan for Amlapitta

Preparations Diet 1Diet 2Diet 3Diet 4
Morning beveragesDhanyaka Hima (coriander water)Jeeraka Jala (Jeera water)Shunti jala (Ginger water)Soaked dry grapes
BreakfastMixed boiled vegetables (indicated)Mudga Yusha (Green gram gruel)Rice / saame / Sheera Upma Wheat Dosa
Mid day snacksDadima / Pomegranate Kadali Phala / BananaKharjura / DatesSalads
Mid day beverageDhanyaka HimaJeera JalaShunti JalaSoaked dry grapes
Roti (in Numbers)1-2 Roti / Chapathi (Jawar / Bajra / Raagi / Rice flour)1-2 Roti / Chapathi (Jawar / Bajra / Raagi / Rice flour)1-2 Roti / Chapathi (Jawar / Bajra / Raagi / Rice flour)1-2 Roti / Chapathi (Jawar / Bajra / Raagi / Rice flour)
Vegetable sabji (in portionsKaravellaka Sabji / Bitter gourd SabjiPatola Sabji / pointed gourdThanduliyaka Sabji / Amaranth SabjiKushmanda Sabji / winter melon
Rice item (in portions1 cup Raktha Shali riceKichadiGanji   Ksheeranna
Roti (in Numbers)1-2 roti / chapathi (Jawar / Bajra / Raagi / Rice flour)1-2 roti / chapathi (Jawar / Bajra / Raagi / Rice flour)1-2 roti / chapathi (Jawar / Bajra / Raagi / Rice flour)1-2 roti / chapathi (Jawar / Bajra / Raagi / Rice flour)
Vegetable sabji (in portionsKaravellaka Sabji / Bitter gourd sabjiPatola Sabji / pointed gourdThanduliyaka sabji / amaranth sabjiKushmanda sabji / winter melon
Rice item (in portions1 cup Raktha Shali riceKichadiGanji   Ksheeranna

J Ayu Int Med Sci 2023;8(11)142
Padmaveer PS et al. A review on Ayurveda dietetics for Amlapitta

Conclusion

The non communicable diseases are on a rise since the modern civilisation begun. It is a great concern because the people are not well aware of the facts about risk factors, aetiology of disease pathology etc. The same applies in case of Amlapitta because the disease is majorly caused by faulty lifestyle and dietary habits. Manasika Nidanas are also to be taken in mind because of the stressful life which is been observed in modern society. So, the least we can do is to ensure the diet and lifestyles are proper. When people are aware of the Pathya-Apathyas of Amlapitta, the disease load can be controlled and primarily cured. The 1st line of treatment itself in case of NCD’s should be focused on lifestyle and dietary practices. Acharyas have emphasised on the Pathya-Apathyas so much that it should be considered as primordial line of management. In Charaka Samhitha acharyas have explained about the practice of Ahara Vidhi Vidhana and Ahara Visheshayathana, which is to be followed properly to reduce the NCD load in present era.

References

1. Meenakshi K, Vinteshwari N, Minaxi J, Vartika S. Effectiveness of Ayurveda treatment in Urdhwaga Amlapitta: A clinical evaluation. J Ayurveda Integr Med. 2021 Jan-Mar;12(1):87-92. doi: 10.1016/j.jaim.2020.12.004. Epub 2021 Feb 3. PMID: 33546994; PMCID: PMC8039346.

2. Murthy S.K., Madhavakara. Madhava Nidana. 2011th ed. Chaukambha Orientalia, Varanasi, 2011;p.166-7.

3. Agnivesha, Charaka, Chakrapani. SutraSthana. Chapter 25, Verse46. In: Sharma RK, Dash B (editors). Charaka Samhita with Chakrapaanidatta, Ayurved Dipika, Commentary. Reprint ed. Varanasi: Chowkambha Sanskrit Series. Volume 1, 2012;p. 438.

4. Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.

5. Kumar HK, Sridurga CH, Rao DB. Clinical efficacy of Baladi Manduram in the management of Amlapitta. Ayu. 2017 Jul-Dec;38(3-4):133-138. doi: 10.4103/ayu.AYU_201_17. PMID: 30254393; PMCID: PMC6153916.

6. Clarrett DM, Hachem C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018 May-Jun;115(3):214-218. PMID: 30228725; PMCID: PMC6140167.

7. Hansen KE, Jones AN, Lindstrom MJ, Davis LA, Ziegler TE, Penniston KL, Alvig AL, Shafer MM. Do proton pump inhibitors decrease calcium absorption? J Bone Miner Res. 2010 Dec;25(12):2786-95. doi: 10.1002/jbmr.166. Epub 2010 Jun 24. Erratum in: J Bone Miner Res. 2011 Feb;26(2):439. PMID: 20578215; PMCID: PMC3179281.

8. Madhavanidana of Shri Madhavakara with Madhukosa Sanskrit Commentary by Sri Vijayaraksita and Sri Kanthadatta with the Vidyotini Hindi Commentary by Sri Sudarasanasastri and Edited by Prof. Yadunandana Upadhyaya Part-II, Chaukhambha Prakashan Reprint Year (2014)51/1 Page No.-202.

9. Kasyapasamhita by Vrddhajivaka by Pandit Hemraj Sharma with the Vidyotini Hindi Commentary by Satyapalabhi sagacharya Reprint Year (2018) Chaukhambha Sanskrit Sansthan Khilasathana 16/7-13 Page No. 514

10. Agnivesha, Charaka, Chakrapani. SutraSthana. Chapter 25, Verse 45. In: Sharma RK, Dash B (editors). Charaka Samhita with Chakrapaanidatta, Ayurved Dipika, Commentary. Reprint ed. Varanasi: Chowkambha Sanskrit Series. Volume 1. 2012;p.437


J Ayu Int Med Sci 2023;8(11)143