E-ISSN:2456-3110

Case Report

Amlapitta

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 10 OCTOBER
Publisherwww.maharshicharaka.in

An Ayurvedic management of Amlapitta: A Case Study

Appu A1*, Verma S2, Ahlawat M3, Sharma SK4
DOI:10.21760/jaims.9.10.46

1* Athira Appu, Post Graduate Scholar, Dept of Roga Nidana Evum Vikriti Vigyana, National Institute of Ayurveda, Jaipur, Rajasthan, India.

2 Sudeeksha Verma, Post Graduate Scholar, Dept of Roga Nidana Evum Vikriti Vigyana, National Institute of Ayurveda, Jaipur, Rajasthan, India.

3 Manita Ahlawat, Assistant Professor, Dept of Roga Nidana Evum Vikriti Vigyana, National Institute of Ayurveda, Jaipur, Rajasthan, India.

4 Surendra Kumar Sharma, Professor and HOD, Dept of Roga Nidana Evum Vikriti Vigyana, National Institute of Ayurveda, Jaipur, Rajasthan, India.

Introduction: Agni is the primary factor which decides whether the body is healthy or sick. According to Charaka pitta itself is Agni. Amlapitta a gastrointestinal tract disorder which developed due to the Vikriti of Pachaka Pitta. The Pachaka Pitta gets vitiated and it changes from normal bitter taste {alkaline} to Vidagda /sour (acidic) taste. The symptoms of Amlapitta can be seen in gastro esophageal reflux disease. Accompanying symptoms like nausea, vomiting, loss of appetite, acid belching and sour taste in mouth.

Aim and Objectives: The primary aim of this paper is to study the efficacy of Shamana Chikitsa in Ayurveda in the management of Amlapitta.

Materials and Methods: This is a case study of a 27-year-old female patient who had signs and symptoms of Amlapitta. Ayurvedic Shamana Oushadas were used according to patients Prakriti, Avastha of Roga and Rogi, Ama, Agni for the follow-up and post-test assessments.

Observation and Results: Improvement in the condition of patient in terms of Avipaka, Tikta Amla Udgara, Urokanda Daha Ruja, Utklesa, Dourbalya, Adhmana. This case study highlights the possibilities of Ayurveda and displays its evidence-based treatments.

Keywords: Amlapitta, Pachaka Pitta, Agni, Gastroesophagal reflux disease

Corresponding Author How to Cite this Article To Browse
Athira Appu, Post Graduate Scholar, Dept of Roga Nidana Evum Vikriti Vigyana, National Institute of Ayurveda, Jaipur, Rajasthan, India.
Email: 		Appu A, Verma S, Ahlawat M, Sharma SK, An Ayurvedic management of Amlapitta: A Case Study. J Ayu Int Med Sci. 2024;9(10):279-283.
Available From
https://jaims.in/jaims/article/view/3590

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-09-08 2024-09-18 2024-09-28 2024-10-08 2024-10-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.83

© 2024by Appu A, Verma S, Ahlawat M, Sharma SKand 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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Athira A et al. An Ayurvedic management of Amlapitta

Introduction

“Bala Arogya Ayuscha Pranascha Agnou Pratistitha.”[1] according to Acharya Charaka, the power of Agni, or normal condition of Agni, is responsible for proper health, longevity, and vital breath. Acharya Vagbata says that Roga Sarveapi Mandagnou.[2] Mandagni is the primary cause of all diseases. So, Agni plays a crucial role in understanding the development of illness, diagnosis, and therapy protocols. In the modern era, Amlapitta (hyperacidity) is the one of the most prevalent disease conditions of Annavaha Strotas. Ayurveda says that Pitta is of 2 types Prakrita and Vaikrita. In this condition, Pitta becomes Vaikrita or Vidagda because the Amlaguna of Pachaka Pitta increases due to their similarity. References to Amlapitta and its management are scattered in Brihathrayees of Ayurveda. Amlapitta was first made explicit in the Kashyapa Samhita. Later on, Bhavaprakasha, Madhava Nidana, and Yogaratnakara also described it clearly. Ayurvedic classics describe two varieties of Amlapitta: Urdhwaga and Adhoga Amlapitta. Dosha classifications include Vatanubandhi, Kaphanubandhi, and Vatakaphanubandhi. Excessive consumption of Virudha Ahara which includes a combination of Kshira Matsya and foods that have attained Amlata or that are fermented or that are acidic which aggravates Pitta is the main Nidana of Amlapitta. The general term "Amlapitta” covers a number of common GIT disorders, including hyperacidity, dyspepsia, gastritis, peptic ulcers, etc.

Hyperacidity, or acid reflux, is the term for the condition that arises from an excess of hydrochloric acid in the stomach. It is usually caused by bacterial infection, lifestyle choices such as drinking alcohol, unhealthy eating habits, mental stress as well as the prolonged use of NSAIDs like aspirin, ibuprofen, muscle relaxants etc. leads to gastric related complaints like nausea, vomiting, heart burn, acidic regurgitation etc. In modern medicine, the treatment of GERD (Gastro Esophageal Reflux Disease) typically involves medications and lifestyle modifications, and it comes with many drawbacks. Long term use of proton pump inhibitors causes risk of decreased magnesium levels, increased risk of bone fractures, and potential interference with nutrient absorption. While these medications give mainly symptomatic relief, they often do not address any underlying causes of GERD such as hiatal hernia, obesity, or poor dietary habits etc.

Simply taking the drugs without proper investigations has the potential to mask other conditions which mimics similar symptoms of GERD such as gastric ulcer or esophagal ulcer.

Ayurveda the science of healthy living gives a holistic approach to the management of Amlapitta considering Nidana, Avastha of Roga, Rogi, Agni, Dosha, Dushya, Desa etc. Acharya Kasyapa describes Shodhana and Samana Chikitsa including Dinacharya and Ritucharya.[3]

Case Report

A 27 year old female patient came to OPD with complaints of intermittent bouts of Avipaka, Tikta Amlaudgara, Utklesa, Urokanta Daha Ruja, Gourava, Vibandha Adhmana, Dourbalya[4] since 3 years.

History of present illness

The Patient was apparently asymptomatic three years ago. She had gradually developed above symptoms during her final year exams. She was diagnosed with GERD and was prescribed modern medical treatment. But she didn’t get any relief. Since last year, her symptoms have been occurring intermittently and worsening when she skips food.

Past history: No major illness
Family history: Father has similar complaints since many years

Examination of the patient:

Ashtavidha Pareeksha:

Nadi: Vata Pittaja
Mala: Asamyak (Constipation i.e., hard, sticky, unsatisfactory bowel evacuation most of the time)
Mutra: Anavilam, Samyak Mutrapravartana
Jihwa: Saama
Sabda: Prakrita
Sparsa: Anushna Aseeta
Drik: Prakrta
Akriti: Madhyamam
Provisional diagnosis: Amlapitta

General examination

Pulse: 72/min.
BP: 120/72 mm of Hg.

Agni: Vishamagni, Abhyavaharana Shakti is reduced Jarana Shakti is normal


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Koshta: Krura Koshta
Prakruti: Vatapradhana Kaphaja

Nidana

Aharaja Nidana: Virudhasana, Anasana (Occasionally), Ati Katu Amla Lavana, Vidahi Aharas, Guru Bhojana, Alpasana
Viharaja Nidana: Rathri Jagarana, Atapa Sevana  

Samprapti

Nidana Sevana
↓
Severe aggravation of Pitta along with Vata and Kapha
↓
Agnimandya
↓
Vidagdha Ajeerna leads to Shuktatva of Anna.
↓
Turning more sour due to increasing Amla and Drava Guna of Pitta in Amashaya.
↓
Suktatam Yaati Samsrajyamanena Pittena Janayati Amlapittam (Amlapitta)[5]

Management

To effectively cure Amlapitta (Shudha Chikitsa), Shudha Nirnaya is important. Doshadhikya, condition of Agni, Ama, Avastha of Vata, patient’s Ahara Vihara, Vegas should be assessed according to symptomatology.

Table 1: Treatment Given

SNMedicineDoseTime of administrationAnupanaDuration
1.Avipattikara Churna3 gmBefore mealWith Luke warm water20 days
Pittantak Yoga 1 gm
Shankha Bhasma 250 gm
Kaparda Bhasma250 mg
2.Mahashankha Vati2 tabsAfter mealLuke warm water20 days
3.Mishri + Yashtimadhu Churna5 gmAfter mealMilk20 days
4.Guduchyadi Gana Kwatha 40 mlBefore mealWater20 days

Table 2: Assessment of symptoms before and after treatment.

SNLakshanaBefore treatmentAfter treatment
1.Avipaka++++
2.Tikta Amla Udgara+++Cured
3.Urokanta Daha Ruja++++
4.Dourbalya+++Cured
5.Adhmana+++Cured

Discussion

In this study observations were done before and after the intervention based on the symptoms and the results are mentioned in the table 2. The result shows reduction in all the symptoms, some being completely cured.

Mode of action of Avipattikara Churna: Churna contains the drugs like Amalaki, Vidanga, Musta, Vibhitaki, Shunti, Maricha, Pippali, Haritaki, Twak etc. These drugs are mainly Madhura, Katu, Tikta, Kashya and possess Madhura Vipaka and Sheeta Virya. The symptoms like Tikta Amlaudgara, Urokanta Daha, Ruja can be relieved by this Kapha Pitta Samaka Rasa Virya Vipaka drugs. Pippali, Shunti, Maricha, Haritaki etc. are Deepana Pachana and Vatanulomana which helps in relieving the symptoms like Adhmana, Avipaka and Gourava. Ingredients like Shunti, Pippali, and Twak have natural anti-inflammatory properties, which help in reducing inflammation in the gut mucosa. It is thus aptly said in the Phalasruthi that “Amlapittam Nihantyashu Vibandham Malamutrayo” [6]

Shankha Bhasma: Shankha Bhasma (also known as Conch Shell Calx) is a unique Ayurvedic preparation made from conch shells. It has Kshariya and Sheeta nature neutralizing excessive acid production in the stomach. Due to its Sheeta property which is beneficial in pacifying Pitta Dosha. It is Deepana Pachana and also anti-inflammatory in nature. In Ayurvedic classics it is indicated in Amlapitta, Grahani, Udarashoola, Parinamashoola etc.

Kaparda Bhasma: Prepared from Cowrie shell (Cypraea moneta). Calcium carbonate which is present in this will act as an antacid to alleviate Urokantaruja Daha, Tiktamla Udgara and helps in curing Agnimandhya.[7]

Mahashankha Vati: As per A.F.I, Maha Shankha Vati are specified by Bhaishjya Ratnavali, but the most commonly practiced reference is from Rasendra Chintamani. It contains several potent ingredients known for their Dipana and Pachana properties. The composition of Mahashankha Vati can vary slightly based on the specific manufacturer or traditional formulation, but generally it contains the ingredients like Shankh Bhasma, Trikatu, Chincha Kshara, Pancha Lavana, Vatsanabha, Hingu etc.


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Pittantaka Yoga: as the name implies it is a Pittahara Yoga developed in the pharmacy of National Institute of Ayurveda, Jaipur. Ingredients are Shudha Swarna Gairika (red ochre), Amrit Dhara (contains Karpura Satva, Putina Satva, Ajwain Satva), Agnimantha, Maricha, Sugar. Almost all these drugs are Madhura Tikta Kashaya and having Seeta Virya, thus helps in pacifying Vata and Pitta. Ajwain Satva act as Vatanulomana, Vedana Samaka, Ajirna, Anaha, Aruchi, Udarashula etc. Karpura especially cures Agnimandhya which is the root cause of Amlapitta. Gairika has long been widely used as a pacifier for Pitta Dosha and used particularly in case of Amlapitta, Pittaja Shira Shoola, Udara etc. disorders.

Mishri and Yashtimadhu Churna with milk: Glycyrrhiza glabra is a Seeta Virya drug which pacifies Pitta Vataja, Rakta Rogas and its active compounds, such as glycyrrhizin, glycyrrhetinic acid, and flavonoids, which have antacid, anti-inflammatory, analgesics, anti-oxidants and anti-stress properties. It mainly helps to heal gastric ulcers and GERD disorder. It is Vatahara due to Madhura Vipaka Madhura Rasa. Pittahara due to its Seeta Virya, Madhura Vipaka and Madhura Rasa. Yashtimadhu is indicated in Dourbalya, Aruchighna and it is Dahaghna.

When Yashtimadhu is consumed with mishri and milk, these compounds may work synergistically to promote overall health because of Madhura Rasa, Snigdha Guna, Ojasya, Dhathuvardhana, Vatapittahara and Seetala property of milk, which helps in curing Amlapitta.

Guduchyadi Gana Kwatha Churna: Mentioned in Ashtanga Hrdaya Sutrasthana 13th chapter, Sodhanadigana Sangrahana Adhyaya. It has only 5 drugs which are Guduchi, Padmaka, Arishta, Dhanyaka and Raktachandana. This Gana is Pittasleshmahara, Chardighna, Dahahara, Thrishnahara and Agnivardhaka.[8] Guduchi has Tikta Rasa and Seeta Virya and is Jwaraghna and Pittaghna. Dhanyaka has Madhura Vipaka but is Ushna Virya and hence Agnikrith. So, it helps in Agnimandya. Padmaka has mainly Dahagna property, so reduces Hrtkanda Daharuja. Nimba which has Tikta Kashaya Rasa and Pitta Shamaka property due to its Seeta Virya, and is Kaphahara due to Katu Vipaka. Thus, it helps in healing Vrana, promoting Ruchi and reduces Vata to cure Adhmana.

Conclusion

Amlapitta, commonly known as gastro oesophagal reflux disease, a prevalent Annavaha Sroto Dushti Vikara that affects many individuals worldwide. While its symptoms can range from mild discomfort to severe complications, understanding its Nidana, Dosha Dushya, Avastha of Ama and Rogi, its Samprapti and management strategies is crucial for effective treatment. Acharya Kasyapa clearly mentions the management plan for Amlapitta. By Vamana, the Dushta Dravarupa Pitta is eliminated and becomes normal. After that, intake of Aushadas which is Deepana Pachana for Ama and Lina Dosha. When all treatments fail, it is recommended to relocate the patient since Amlapitta is common in Anupa Deshas, emphasizing the significance of Desha in Amlapitta Vyadhi. This is particularly common in Anupa Desha. So, both Sodhana and Shamana are included in the management and Tikta Rasa foods and liquids are advised for intake.

References

1. Edited by Dr Ram Karan Sharma. Charaka Samhita English translation. Choukhambha Sanskrit Series Office, Varanasi. Sutrasthana. 27-342.
2. Prof.k.R.Srikantha Murthy. Ashtangahrdayam. Choukhambha Krishnadas Academy. Chikitsa Sthana.12th chapter.1-112
3. Edited by Premavati Tiwari. Kasyapa Samhita. Choukhambha Visvabharati. Khilasthana. Reprint 2020, 18-23.632
4. Madhukosa commentary. Narendranadha Sastri.Madhava nidana.Motilal banarasidas. chapter 51.2-51
5. Text book for Roga Nidana and Vikriti Vigyana. Nisha kumari. Chaukhambha Orientalia Varanasi 418
6. Kaviraj Govind Das Sen. Translated by Siddhi Nandan Mishra Hindi Commentary. Bhaishajya Ratnavali. Chaukhambha Surbharati Prakashan.56th25-27.903
7. Edited by Dr. Ashok D. Satpute. Rasaratnasammuchaya. Chaukhamba Sanskrit Pratishthan. Reprint 2010. 128-80
8. Vagbata . Dr. T. Sreekumar. Ashtangahrdaya. Harisree Publications. Sutrasthana.13th chapter.16-339


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