E-ISSN:2456-3110

Case Report

Amalpitta

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Ayurvedic management of Amalpitta - A Case Report

Akanksha1*, Prajapati ML2, Sason R3
DOI:10.21760/jaims.9.8.45

1* Akanksha, Post Graduate Scholar, PG Dept of Agada Tantra, RG Govt Pg Ayurvedic College and Hospital, Paprola, Himachal Pradesh, India.

2 Munna Lal Prajapati, Professor, PG Dept of Agada Tantra, RG Govt Pg Ayurvedic College and Hospital, Paprola, Himachal Pradesh, India.

3 Rajveer Sason, Lecturer, PG Dept of Agada Tantra, RG Govt Pg Ayurvedic College and Hospital, Paprola, Himachal Pradesh, India.

Amlapitta is one of the most prevalent diseases in today's culture. It can be found in people of diverse ages, socioeconomic backgrounds, and communities. Amlapitta is the most common illness in the modern period. Because of indulgence in incompatible food habits and activities, Amlapitta is the most common disorder in today's fast increasing culture. Materialistic lifestyles drive people to lead hectic, stressed lives with little regard for good eating habits. Hyperacidity is a condition that occurs when the stomach produces too much acid. The defining characteristics of Amlapitta are described in classical Ayurvedic books as Avipaka (indigestion), Urodaha (chest burning), Utklesha (nausea), Aruchi (anorexia), and Tikta-Amlodgara (sour and bitter belching). A 38-year-old male patient arrived at the outpatient department complaining of burning in his chest, sour eructation, anorexia, etc. Vitals are normal at the time of the examination. Based on this, the patient was treated with Kamadudha rasa, Avipattikar churana, Hingavashtak Choorna, and Sutshekar Rasa. It was advised to the patient to follow up every fifteen days. The patient was instructed to keep to dietary and lifestyle guidelines in addition to taking medication.

Keywords: Amlapitta, hyperacidity, acidity

Corresponding Author How to Cite this Article To Browse
Akanksha, Post Graduate Scholar, PG Dept of Agada Tantra, RG Govt Pg Ayurvedic College and Hospital, Paprola, Himachal Pradesh, India.
Email: 		Akanksha, Prajapati ML, Sason R, Ayurvedic management of Amalpitta - A Case Report. J Ayu Int Med Sci. 2024;9(8):294-299.
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https://jaims.in/jaims/article/view/3522

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-15 2024-07-25 2024-08-05 2024-08-15 2024-08-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.32

© 2024by Akanksha, Prajapati ML, Sason Rand 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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Introduction

The traditional medicinal science of Ayurveda is founded on its own fundamental principles. According to Ayurveda, the primary factor in the body's general metabolism, which promotes growth and development, is Agni, or digestive fire. Both the preservation of health and the development of diseases have been linked to normal and abnormal Agni functioning, respectively. Here, "Agni" refers to elements that have a high concentration of the fire element i.e., Agni Mahabhuta (which is responsible for digestion, metabolism, and transformation). Agni can become affected by an unbalanced diet, an unpredictable lifestyle, and other factors. Agnimandya is the fundamental cause of all ailments according to Ayurveda. The main cause of Agnimandya is faulty dietary habits such as Adhyashana (eating after meal), Vishamashana (diet on irregular time and quantity), and incorrect behavioural patterns such as Vegadharana (Suppression of urges), which causes vitiation of Doshas (fundamental bodily bio-elements), either independently or synonymously. Digestive diseases are very widespread in all groups and are also highly disregarded difficulties due to today's lifestyle.

Amlapitta is classified as a Pitta Pradhana Vyadhi (illness with a predominance of Pitta). Overindulgence in etiological variables, such as poor lifestyle choices, promotes vitiation of the Vata Pitta Dosha. Pitta, in conjunction with Vata or Kapha, weakens the JatharAgni component, i.e., Jatharagnimandya. Consumed food becomes Vidagdha (undigested) during this condition. It eventually becomes acidified, or Shukta, and remains in the stomach for an extensive period of time. Vidagdhajirna (indigestion caused by acidified chyle) emerges at this stage, which is a premonitory symptom of the disease Amlapitta. Additionally, vitiated Pitta combines with Shukta, resulting in Pitta Amavisha Sammurchhana (a combination of un metabolized Rasa and undigested food with Rasa). Amlapitta is the medical term for this condition. Ayurvedic writings describe two varieties of Amlapitta: Urdhwaga and Adhoga Amlapitta. The pathology of Urdhwaga Amalpitta is caused by vitiated Pitta and Kapha. Excessive ingestion of Amla, Katu, Ushna, Vidahiaharsevana, and Viruddhashana, spicy, sour, salty material, greasy, and difficult to digest aliments, elicits Pitta Dosha.

Pitta is normally associated with Katu Rasa, however when Katu Rasa is changed into Amla Rasa, Amlapitta results. According to modern medical science, the most common causes of gastritis are H. pylori infections and prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDS), aspirin, and other drugs, such as iron preparations, severe physiological stress, such as burns, multi-organ failure, central nervous system trauma, and autoimmunity. Heartburn is the most prevalent symptom of hyperacidity, and it is characterised by a burning sensation in the chest that radiates towards the mouth. Heartburn is accompanied by a sour taste in the back of the mouth due to acid reflux into the oesophagus, with or without refluxate regurgitation.[1] Acid reflux that occurs more than twice a week is considered hyperacidity.

Case Report

A 38-year-old male patient came in OPD with the following symptoms

  • Tikta-Amlodgara (eructation with bitter and sour taste)
  • Urodaha (Burning in the chest)
  • Utklesha (Nausea)
  • Aruchi (Anorexia)
  • Gauravta (Feeling of heaviness in abdomen)
  • Avipaka (indigestion)

History of Patient

History of present illness

Patient has been experiencing the symptoms listed above for a year. He had been suffering with Amlapitta for a year. He did not get relief despite numerous treatments.

Complaints were Tikta Amlodgara (+), Urodaha (+++), Aruchi (+++), Utklesha (++), Avipaka (+++), Gauravta (++)

His symptoms were on and off.

History: No major illness.

Family History: NAD

Examination of the patient

Ashtavidha Pareeksha:

  • Nadi (Pulse): Dominance of Pitta dosha with Vata.

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  • Mala (Stool): Incomplete digestion, constipation (occasional)
  • Mutra (Urine): Normal
  • Shabda (Speech): Normal
  • Sparsh (Skin): oily, soft or gentle
  • Druk (Eyes): normal
  • Akruti: Mandya
  • Jivha (Tongue): coated, Mukhapaka (occasional).
  • Bala: medium

Diagnosis: Amlapitta.

General examination

  • Pulse: 76/min.
  • S: normal
  • P: 126/88 mm of Hg.
  • Agni: Mandagni
  • Abhyavaharan Shakti (digestive power): decreased
  • Jarana Shakti (metabolic power): decreased
  • Koshtha: Krura (hard)
  • Prakruti: Predominantly Pitta with Vata influence
  • Udara Pariskha: Adhmana (bloating), Udara Kathinya (Abdominal rigidity or hardness)

Samprapti Ghataka

  • Dosha: Pitta Pradhana, Kapha Anubandhi
  • Dushya: Rasa Dushti
  • Strotodushti: Annavaha, Purishvaha, Rasavaha.
  • Vyadhi Avastha: Sama Avastha, Kapha Utkelsha, Dosha Urdhwa Gati.
  • Sadhyasadhyatva: Kashta Sadhya.
  • Vyadhi Marga: Abhyantar.

Vyadhi Nidana (Diagnostic Criteria)

  • Burning sensation in the chest (Urodaha),
  • Eructation with a bitter and sour taste (Tikta-amlodgar),
  • Nausea (Utklesha),
  • Indigestion (Avipaka), Loss of appetite (Aruchi)
  • Heaviness in abdomen (Gauravta)
  • Exertion without work (klama) these are cardinal symptoms of

Therapeutic intervention:

SNName of drugDoseFrequency and Anupana
1.Sutshekar Rasa1 tab. after mealsTwice a day with Madhu.
2.Avipattikar Churna + Giloy Satva + Shankh Bhasma3 grams after mealsTwice a day with lukewarm water.
3.Hingavashtak Choorna3 grams after mealsTwice a day with lukewarm water
4.Kamadudha Rasa500 mg bd after mealsKoshna Jala

This Amlapitta patient's improper digestion resulted in the formation of an inappropriate Rasa Dhatu. Giloy Satva, a Rasayan medication, was therefore added first. Guduchi also lowers Samta.

Additional medications used in treatment, such as Kamdudha Rasa, Hingvashtak Choorna, and Avipattikar Choorna, lower Dosha Samata and cause Anulomana and Shamana of Dosha. Shankha Bhasma aids Deepana, Pachan, Pittahara, and Dravata.

Criteria for assessment

The improvement of Amlapitta signs and symptoms both before and after treatment served as the evaluation criterion. Cardinal symptoms and signs were scored for this purpose.

Gradation Assessment of Subjective Parameters

Amlodgara

No belching: 0

Feeling of belching with no sound: 1

Feeling of belching with mild sound: 2

Feeling of belching with severe sound: 3

Daha

No burning sensation (no retrosternal discomfort): 0

Sensation of warmth on throat occasionally: 1

Burning sensation on throat and chest after a mild oily/spicy food: 2

Feeling of burning sensation always irrespective of the diet: 3 


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Gaurava

Normal: 0

Feeling of heaviness in morning: 1

Feeling of heaviness in morning and evening after food: 2

Feeling of heaviness always: 3

Utklesha

No nausea: 0

Mild nausea: 1

Severe Nausea: 2

Severe nausea with vomiting: 3

Avipaka

No indigestion: 0

Unable to digest mild fatty food: 1

Unable to digest 3‑course meal (breakfast, lunch and dinner): 2

Unable to digest any kind of food: 3

Aruchi

Normal: 0

Only takes lunch and dinner: 1

Loss of interest in lunch or dinner: 2

No desire to take food: 3

Gradation Assessment of Objective Parameters

Epigastric tenderness

No tenderness: 0

Mild tenderness and tolerable: 1

Moderate tenderness: 2

Severe tenderness and not allowing to touch: 3

Physical Examination of the regurgitated sample

No regurgitation: 0

Regurgitation of only little amount (about 5 ml) of gastric juice: 1

Regurgitation of excess amount of gastric juice with no food content: 2

Regurgitation of gastric juice with food content: 3

Pathya

Yava, Godhuma, Mudga, old rice, boiled and cooled water, Sharkara, Madhu, Sattu, all bitter and light vegetables, Vruddha Kushmanda, Dadima, Patol3.

Apathya

Seasame, blackgram, garlic, curd, Amla and Katu Padarth, Guru Anna, oily and spicy food, fermented foods.[4]

Discussion

Amlapitta has become a major issue in today's society as a result of bad eating practices and routines. Continued use of an unsuitable food, routine, and habits might result in stenosis, anemia, duodenitis, chronic gastritis, malabsorption, and irritable bowel syndrome. Many people frequently experience a burning sensation in their chest and stomach. All of the medications used in the study were Pitta Shamak, which stabilize and balance the Kapha and Pitta Doshas. In terms of Shamana, the majority of medications have Tikta Rasa, which contains Vayu + Akasha Mahabhuta. The Vayu Mahabhuta eliminates the Srotorodha during a Samprapti Vighatana, and this Akasha Mahabhuta dries up the Dravtva of Dushita Pitta. These medications treat subjective symptoms and promote good physical, mental, and emotional health.

Mode of action of Sutshekhar Ras[2]

An essential Ayurvedic medication, Sutshekhar Ras balances Pitta Dosha and relieves symptoms such as heartburn, nausea, vomiting, abdominal pain, epigastric tenderness, hiccups, fever, headaches, and breathing difficulties."Sutshekar Rasa"- the Pitta's vitiated state - improves the entire digestive process and leads to Agni's efficient operation. Sutshekar Rasa's Ruksha, Laghu, Katu, and Ushan qualities have the ability to reduce vitiated Pitta and keep Agni functioning properly. Ingredients of Sutshekhar Rasa are mostly Agnivardhak & Amapachak properties.

Mode of action of Shankha Bhasma

This is a Calcium carbonate compound. This directly reacts with gastric HCl and neutralise them, so this acts as potent antacid.

CaCO3 + HCl = H2O + CO2 + CaCl2


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Shankha Bhasma, being Sita Virya, alkaline in nature, Grahi (absorption enhancing), it is indicated in gastrointestinal disorders like Amlapitta, Parinama Shula, Grahani (irritable bowel syndrome), and Agnimandhya.

Mode of action of Avipattikara Churna

Avipattikara Churna is a herbomineral compound formulation with clinical applications in the treatment of Amlapitta (hyperacidity and dyspepsia). Katu, Tikta, Madhura Rasa, Laghu, Ruksha, Tikshna, Snigdha Guna, Ushna Sheeta Virya, Madhura, and Katu Vipaka constitute the majority of the drugs in Avipattikara Churna. Aside from Khandasharkara, the main ingredient is Trivrut (Nishoth). It comprises Katu, Tikta Rasa, Laghu, Tikshna, Ruksha Guna, Ushna Virya, and Katu Vipaka. It has Bhedana, Rechana, and Shothahara properties, which make Pitta Virechana useful in Amlapitta's Samprapti Vighatana. This action of Trivrut is also aided by the Mridu Rechana/Anulomana action of Triphala. Trivrut and Triphala are both effective remedies for Vibandha. Deepana, the Pachana Karma of all drugs, maintains Agni and prevents Aama formation. Additionally, Avipattikara Churna improves gastric secretion and motility, which facilitate better digestion.

Action of Kamdudha Rasa[7]

Some of the ingredients of Kamadudha Rasa such as Pravala and Mukta have Dipana (appetizer) and Pachana (digestive) properties maintain the normalcy of Agni (digestive fire). The Kshariya (alkaline) nature of these drugs would reduce the Amliyata (acidic nature). These are Sita Virya Dravyas (the drug having cold potency or cooling effect usually resembles to endothermic) which does Pitta Shamana (pacify the biological fire).

Action of Guduchi

Guduchi Satva, another important ingredient, is known for its Rasayana properties. It has Tikta (bitter), Kashaya Rasa with Madhura Vipaka (sweet post-digestive effect), Snigdha Guna, Tridosha Shamaka (pacifies three bioenergy principles, Vata, Pitta, and Kapha), and Dipaniya.

Action of Hingavashtak Churna[8]

It is a traditional Indian combination of Trikatu (Shunthi, Pippali, and Maricha), Ajmoda/Yavani, Saindhav Lavana, Jeeraka, Krishna Jeeraka & Hingu.

Sunthi's Katu Rasa and Ushna Veerya properties increase the Agni (digestive fire), relieving Mandagni (low fire). Katu Rasa and Laghu, along with Tikshna Guna, cause Srotoshodhana. This converts the indigested and Pakva-Apakva food into an assimilable form, and because of Katu Rasa and Ushna Virya, the Agni returns to normal, resulting in Vyadhi Shamana, or disease subsidence. Furthermore, the constituent ingredients of Hingvashtak Churna stimulate digestion through a variety of enzymatic secretions.

SNSymptomsBefore treatment (BT)After treatment (AT)
1.  Amlodgara10
2.  Avipaka21
3.  Aruchi21
4.  Utklesha10
5.  Daha20
6.  Gaurava20

Conclusion

As a result, it can be concluded that the aforementioned Ayurvedic management is important in the treatment of Amlapitta. Even in such a short period of time, we can have major disorders completely cured with no recurrence by making some lifestyle changes. “Sutshekar Rasa”- the vitiated state of pitta improves the entire digestion process, resulting in proper Agni function. Sutshekar Rasa, which contains Ruksha, Laghu, Katu, and Ushan, has the effect of reducing vitiated pitta and ensuring the proper functioning of Agni. Sutshekhar Rasa contains ingredients with mainly Agnivardhak and Amapachak properties. “Avipattikar Churana" is a more potent drug for the treatment of Amlapitta with no side effects. The drug used in this Churana is Madhur Tikta Kasaya, Katu Rasa Yukta, Madhur Vipaka, and Sitavirya. Avipattikar Churna's ingredients neutralize Vidagada Pitta in Amlapitta. Shamana Upakram combined with Pathyahara for an extended period of time is beneficial for any gastrointestinal disease. According to Ayurvedic principles, patients with any disease who are treated with their Dosha, Dhatu, Mala Avastha, and Ashtavidha Pariksha will experience Upashaya. In this case study, Shamana Chikitsa combined with Pathyapathya was found to be effective in reducing Amlapitta symptoms. This is evident from the manner in which Pachaka Pitta (digestive component of biological fire) performs Pachana Karma (digestive action).


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The capacity for digestion is also determined by the qualitative increase of Pitta's Usna Guna. Conceptually, it was concluded that substances with properties such as Ruksha, Kasaya, and Laghu had the effect of decreasing Pitta's Drava Guna while maintaining the proper function of Agni. Similarly, substances with Madhura and Sita properties reduced Pitta's Usna property, allowing Agni to function properly.

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3. Vidya Lakshmipati Shastri.Yogratnakar. edited by Bhishagratna Brahmashankar Shastri. Amlapitta Pathyapathya.1-3.Pg.No.244.
4. The Ayurvedic Formulation of India, Part I. Second revised English Edition, Government of India, Bhaishjayaratnavali, Amlapittadhikara.Pg.No.106.
5. Sri Bhavamishra, Bhavaprakash Nighantu, Commentary by K C Chunekar, edited by G S Pandey, Choukamba Bharati Academy, Varanasi: Revised & Enlarged ed. 2010; p. 39-40.
6. Sri Bhavamishra, Bhavaprakash Nighantu, Commentary by K C Chunekar, edited by G S Pandey, Choukamba Bharati Academy, Varanasi: Revised & Enlarged ed. 2010; p. 166.
7. Purohit H. Kamadugha Rasa An Effective Ayurvedic Formulation For Amla Pitta, Tantia University Journal of Homoeopathy & Medical Science, Volume 3|Issue 3|July–Sept. 2020|
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