E-ISSN:2456-3110

Case Report

Management of Mandagni

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 3 March
Publisherwww.maharshicharaka.in

Management of Mandagni (~diminution of Agni) a case study; evaluating the effect of Chitrakadi Vati and Ekakala Bhojana (one time meal in day) in alleviating gastrointestinal symptoms

Singh Jatav R1*, Kumar Padhar B2, Mutha R3, Muniraj4, Manmahendra5
DOI:10.21760/jaims.9.3.38

1* Rekha Singh Jatav, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

2 Bharat Kumar Padhar, Assistant Professor, Department of Kayachikitsa, National institute of Ayurveda, Jaipur, Rajasthan, India.

3 Rashmi Mutha, Assistant Professor, Department of Kayachikitsa, National institute of Ayurveda, Jaipur, Rajasthan, India.

4 Muniraj, Post Graduate Scholar, Department of Kayachikitsa, National institute of Ayurveda, Jaipur, Rajasthan, India.

5 Manmahendra, PhD Scholar, Department of Shalya Tantra, National institute of Ayurveda, Jaipur, Rajasthan, India.

Ayurveda, an ancient medical science, emphasizes the balance of Tridosha (Vata, Pitta, Kapha), proper functioning of Dhatus (tissues), and enhancement of Agni (digestive fire) for maintaining health. Mandagni, or diminished Agni, is a common ailment in Ayurveda associated with various gastrointestinal symptoms. This case study aims to evaluate the efficacy of traditional Ayurvedic interventions, specifically Chitrakadi Vati and Ekakala Bhojana (one-time meal in a day), in alleviating Mandagni and its related gastrointestinal manifestations. The study documents the case of a 38-year-old female patient exhibiting symptoms of Mandagni, including abdominal and head heaviness, cough, weakness, and tastelessness. Treatment involved Chitrakadi Vati and Ekakala Bhojana, aimed at enhancing Jatharagni and alleviating symptoms. Assessment criteria encompassed subjective and objective measures, showing improvements in symptoms and laboratory parameters post-treatment. Discussion highlights the pharmacological actions of Chitrakadi Vati and dietary modifications of Ekakala Bhojana in promoting digestion and alleviating symptoms. The study concludes positively, suggesting the efficacy of these Ayurvedic interventions in managing Mandagni and enhancing overall well-being.

Keywords: Mandagni, Chitrakadi Vati, Case report, Ekakala Bhojan, Ayurveda

Corresponding Author How to Cite this Article To Browse
Rekha Singh Jatav, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.
Email: 		Singh Jatav R, Kumar Padhar B, Mutha R, Muniraj, Manmahendra, Management of Mandagni (~diminution of Agni) a case study; evaluating the effect of Chitrakadi Vati and Ekakala Bhojana (one time meal in day) in alleviating gastrointestinal symptoms. J Ayu Int Med Sci. 2024;9(3):239-244.
Available From
https://jaims.in/jaims/article/view/3158

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-01-14 2024-01-24 2024-02-03 2024-02-13 2024-02-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 23.85

© 2024by Singh Jatav R, Kumar Padhar B, Mutha R, Muniraj, Manmahendraand 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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Rekha Singh Jatav et al. Management of Mandagni (~diminution of Agni) a case study

Introduction

The role of Jatharagni in food digestion and energy conversion is pivotal, as any alteration can disrupt the process, leading to Dosha imbalance and various health issues. Factors such as dietary habits, lifestyle choices, and psychological stressors significantly impact Jatharagni. Mandagni, characterized by sluggish digestion, often triggers the development of Kaphaja diseases due to delayed food processing. Chitrakadi Vati, rich in Katu, Tikta, Lavana Rasa, Ushna Virya, Sukshma, and Snigdha Guna, is recognized in Charak's Deepaniya Mahakashaya for its digestive benefits.[1-3]

Ayurveda underscores the importance of Ahara (Diet) and Dwadasha Ashana Pravicharana (Regulated meal patterns) in maintaining overall well-being, facilitating the smooth flow of Prana Anuvartan. Recommendations like consuming one meal a day, advocated by Acharya Dalhana, aim to boost Jatharagni and optimize digestive functions.[4]

This study delves into the efficacy of traditional Ayurvedic interventions, namely Chitrakadi Vati and Ekakala Bhojana, in addressing Mandagni-related digestive issues. Aligned with Ayurvedic principles, these interventions aim to restore digestive health and metabolic balance, offering promising solutions with their historical effectiveness and minimal invasiveness. Integrating traditional wisdom with pragmatic methodologies, this research provides cost-effective and holistic approaches to managing digestive concerns, thereby advancing understanding and treatment in Ayurveda.

Case Report

A 38-years-old non hypertensive, non-diabetic female patient presented at Outpatient Department (OPD) with reporting symptoms of Udara Gaurava (~heaviness of abdomen) , prolonged gastric emptying of a limited dietary intake / indigestion (Yastvalpamapyupayukta Annam Mahata Kalena Pachati) since 4 month and Shiro Gaurava (~heaviness of head), Kasa (~Cough), Praseka (~excessive salivation), Chardi (vomiting or nausea), Gatra Sadanam (~exhaustion or tiredness of body) and Aruchi (~tastelessness) since 2 months. Svash (~breathlessness/difficult breathing) was occasionally. That patient expressed her

concern about these symptoms, particularly given her history of Udar Gaurava and prolonged gastric emptying of a limited dietary intake. The patient also complained of irregular bowel habits and flatulence persisting the past three months. There was no significant medical or family history of chronic systemic diseases. The results of the genetic testing revealed no evidence of any known genetic abnormalities or mutations associated with common genetic diseases and there were also no notable psychosocial elements that appeared relevant to the patient's current medical situation. Her daily dietary intake primarily consisted of dairy products such as milk, buttermilk, coffee, and heavy meals, and she habitually slept for about 2 hours just after consuming food in the afternoon. The patient had previously consulted a gastroenterologist. She received symptomatic treatment, including a proton pump inhibitor, antibiotic, antispasmodic, and probiotic, consistently for one month. However, despite the prescribed regimen, she experienced no alleviation of her symptoms.

Diagnostic criteria for Mandagni

Patients presenting with symptoms such as abdominal and head heaviness post-meals, prolonged digestion time (>12 hours) before exhibiting signs of normal digestion, coupled with additional symptoms like nausea, coughing, breathlessness, body ache, and excessive salivation, are diagnosed with Mandagni based on clinical assessment.

Therapeutic Intervention

The treatment protocol was determined according to Ayurvedic Mandagni management principles, specifically focusing on for enhancing the digestive fire and Aam Pachana, Chitrakadi Vati and Ekakala Bhojan were advised as per table no. 1.

Table 1: Interventions: Dosage and Duration of Chitrakadi Vati and Ekakala Bhojana

SNInterventionDoseDuration
1.Chitrakadi Vati500 mg BD Orally with LWW before meal14 Days
2.Ekakala BhojanaOne-time meal at evening14 Days
mg - milli gram, BD - bis in die, LWW - Luke warm Water

Source and standardization of Chitrakadi Vati

The Chitrakadi Vati used in this study was sourced from GMP certified pharmacy. Chitrakadi Vati 500 mg BD orally with lukewarm water before a meal for 14 days.


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Table 2: Timeline of health events and treatment responses in Mandagni management case

TimelineHealth eventTreatment
19/10/23§ She had history of Indigestion, heaviness of head and abdomen, Nausea, Generalised weakness, cough, excessive salivation and Dyspnoea.§ First treatment was was started.
§ Chitrakadi Vati and Ekakala Bhojana was given according to table no 1.
26/10/2023§ Initial assessment and examination, as documented in Table 2, were conducted on the seventh day.
§ Grading for weakness and cough transitioned from 2 to 0.
§ Grading adjustments were observed for indigestion with a shift from 3 to 1.
§ Grading changes from 2 to 1 were noted for symptoms including nausea, cough, excessive salivation, and sensations of heaviness in the head and abdomen.		Continue same interventions for next 7 days.
02/11/2023§ On second follow-up all symptoms grading were change up-to 0.
§ She got relief in almost all symptoms except Dyspnoea occasionally.		No any further medication was advised and patient suggest to regular light diet for next 14 days
17/11/2023Last follow up was done after 15 days, no any symptoms was recorded so no follow up visit was advised.

Assessment Criteria

The subjective criteria for assessment included the improvement in symptoms, utilizing an appropriate scoring pattern for assessing symptom improvement (Table 3). The objective criteria for assessment included the investigation of laboratory parameters namely Fasting Blood Sugar (FBS), Liver Function Test (LFT), and Lipid profile was done before and after treatment.

Ekakala Bhojana Protocol

The Ekakala Bhojana protocol is structured with specific guidelines to optimize therapeutic benefits and ensure patient adherence. It revolves around Mudga Yusha, a nutritious dish made from boiled green gram, known for its easy digestibility and nutrient richness. Consumed in the evening as the last meal of the day, Mudga Yusha allows for ample digestion time before bedtime, promoting optimal assimilation of nutrients. Portion sizes are tailored to individual tolerance levels to avoid abdominal discomfort, and patients are advised to avoid heavy, oily, and spicy foods during the intervention, emphasizing light and nourishing options for enhanced digestive efficiency.

Quality assurance for Ekakala Bhojana includes sourcing organic ingredients from certified suppliers, ensuring they are free from pesticides through rigorous testing. Food preparation follows strict hygiene protocols to maintain safety standards. The meal is carefully designed to strike a balance between nutritional value and ease of digestion, promoting optimal health outcomes for the patient.

Assessment of Intervention

After intervention, Assessment of Patient symptoms by Likert scale at the day 0, 7th and 14th mentioned in table 3. The changes observed in symptoms scale and biochemical parameters. The changes observed in biochemical parameters were compared to normal ranges or baseline values before treatment to provide context for the improvements observed. Biochemical parameters mentioned in table 4.

Observations and Results

Observations and results were assessed using subjective and objective criteria, as detailed in table 3 and 4. Significant improvements were observed in symptoms related to Mandagni, with reductions noted in symptom gradation at both the 7th and 14th days. Additionally, there was a decrease in BMI (27.99 kg/m2) observed during the treatment period. Laboratory investigations including FBS, LFT, and Lipid Profile also showed improvement. No adverse events or side effects were reported with the use of Chitrakadi Vati and Ekakala Bhojana. Overall, the patient exhibited substantial clinical improvement with these traditional Ayurvedic interventions for Mandagni management.

Table 3: Symptom grading and assessment over the treatment period in Mandagni management case study

SymptomsGrading0th day 19/10/20237th day 26/10/202314th day 02/11/2023
Yastvalpamapyupayukta Annam Mahata Kalena Pachati0No320
1After heavy meal
2After intake of food in normal quantity
3After intake of food in less in quantity
Heaviness of abdomen0No210
11½ h after meal
21½ -3 h after meal
33-6 h after meal

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SymptomsGrading0th day 19/10/20237th day 26/10/202314th day 02/11/2023
Heaviness of head0No210
11½ h after meal
21½ -3 h after meal
33-6 h after meal
Cough0No100
11½ h after meal
21½ -3 h after meal
33-6 h after meal
Dyspnoea0No100
1Occasionally
22-3 times/week
3>3 times/week
Excess salivation0No210
1Present but no inconvenience
2Has to spit once or twice
3Spits continuously, hampering his speech or dribbling of saliva at night
Vomiting or nausea0No210
1Occasionally
22-3 times/week
3>3 times/week
Weakness0No100
1For 1 h after meal/dinner
2For 2 h after meal/dinner
3Whole day

Table 4: Comparison of Biochemical Parameters Before and After Treatment

SNInvestigationsB.T. (0th day, 19/10/2023)A.T. (02/11/2023)
1.Liver Function Test
Total S. Bilirubin (mg/dl)0.360.33
D. Bilirubin(mg/dl)0.1690.162
S.G.O.T. (U/L)5830
S.G.P.T. (U/L)5432
Serum Alkaline Phosphatase. (U/L)10082
Total Protein (g/dl)6.76.4
Serum Albumin(g/dl)2.722.61
2.Lipid Profile
S. Cholesterol (mg/dl)148.1145.1
S. Triglyceride (mg/dl)111.377.5
HDL (mg/dl)33.033.6
LDL (mg/dl)89.195.1
VLDL (mg/dl)22.2615.50
3.Blood Sugar (mg/dl)
F.B.S. (mg/dl)135.687.2

Discussion

In Ayurveda, the onset of Mandagni is primarily associated with the imbalance of KaphaDosha (~Dosha responsible for regulating body fluids and keeping the body constituents cohesive), leading to various symptoms like Shirogauravam, Udargauravam, Chardi, Prasek etc.[5]The progression from Dosha imbalance to the manifestation of the disease, known as Samprapti (~pathogenesis), requires interventions (Chikitsa) that disrupt this process. Chitrakadi Vati, recognized for enhancing Jathragni by Katu, Tikta, Lavana Rasa tastes, Ushna Virya, Sukshma, Snigdha Guna, and Katu Vipaka, Maximum contents of Chitrakadi Vati are enlisted in DeepaniyaMahakashaya mentioned by Acharaya Charaka. It is also indicated for various diseases originating from Mandagni like; Arsha, Atisara and Grahani.The ingredients of Chitrakadi Vati, including Chitraka (Plumbago zeylanica), Pippali (Piper longum), Chavya (Piper retrofractum Vahl.), Shunthi (Zingiber officinale), Maricha (Piper nigrum), Ajamoda (Carumroxburghianum), along with various salts like Yava Kshara, Sarji Kshara, Saurvachala Lavana, Saindhava Lavana, Vida Lavana, Samudra Lavan, and AudbhidaLavan, collectively possess potent digestion-enhancing properties.[6] The chemical composition of these ingredients reveals a rich array of bioactive compounds such as piperine, gingerols, plumbagin, and alkaloids, which contribute to their pharmacological actions. These actions include hepatoprotective, anti-inflammatory, immunomodulatory, analgesic, antioxidant, antimicrobial, and lipid-lowering effects. This synergistic combination of herbs and salts in Chitrakadi Vati underscores its efficacy in improving digestion and overall gastrointestinal health.[7]Ekakala Bhojana effectively treats Mandagni by modifying the frequency, quantity, and quality of the regular diet. It allows ample time for Jatharagni to process even small quantities of food properly. Adequate time is essential for the transformation of food. Skipping a meal provides Jatharagni with the opportunity to digest accumulated Ama in the absence of food, thereby strengthening the digestive fire. Laghu (~light diet) and Pathya Ahara (~Wholesome diet) stimulate Jatharagni as they require less time for digestion. Furthermore, Ekakala Bhojana reduces food quantity, facilitating easier digestion for Jatharagni


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.The article by Mesnage et al. (2019) titled "Changes in human gut microbiota composition are linked to the energy metabolic switch during 10 d of Buchinger fasting" provides evidence supporting the idea that fasting enhances digestive power. The study conducted a thorough analysis of the gut microbiota composition in individuals undergoing a 10-day Buchinger fasting period. This fasting regimen involved a significant reduction in external nutrient supply to the gut, leading to metabolic changes in the body, including a switch from glucose to fatty acids and ketones for energy. Furthermore, the study monitored intestinal permeability and inflammatory status, observing an increase in pro-inflammatory cytokines upon refeeding after the fasting period. This indicates a reactivation of the postprandial immune response, which is a crucial aspect of digestive power.[8]

Conclusion

In conclusion, this case study highlights the efficacy of Chitrakadi Vati and EkakalaBhojana in managing Mandagni and alleviating gastrointestinal symptoms. The interventions were based on Ayurvedic principles targeting Jatharagni enhancement and Aam Pachana. The patient experienced significant improvement in symptoms such as heaviness of abdomen and head, nausea, cough, excessive salivation, and weakness. Laboratory investigations also showed positive changes, including reduced liver enzymes, improved lipid profile, and normalized blood sugar levels. The study underscores the importance of traditional Ayurvedic therapies in addressing digestive disorders and promoting overall well-being. Further research and clinical trials may provide additional insights into the effectiveness of these interventions and their role in comprehensive healthcare management.

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