A randomized controlled clinical study on the efficacy of Chinnadi Kashaya in Amlapitta (Chronic Gastritis)

Anojkar KS; Shripathi Acharya G; Malini M Moger

doi:10.21760/jaims.9.11.1

E-ISSN:2456-3110

Research Article

Chronic Gastritis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 11 NOVEMBER

Publisher

www.maharshicharaka.in

A randomized controlled clinical study on the efficacy of Chinnadi Kashaya in Amlapitta (Chronic Gastritis)

Anojkar KS^1*, Shripathi AG², Malini MM³

DOI:10.21760/jaims.9.11.1

^1* Anojkar KS, Post Graduate Scholar, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India.

² Shripathi Acharya G, Professor and HOD, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India.

³ Malini M Moger, Assistant Professor, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India.

Nearly 25–30% of Indians suffer from Amlapitta or chronic gastritis. In this open-label, randomised clinical study, the effectiveness of Patoladi Kwatha and Chinnadi Kashayam in treating Amlapitta (chronic gastritis) was studied. Heartburn, nausea, and indigestion are some of the symptoms of Amlapitta, a disorder associated with the vitiation of Pitta dosha brought on by unhealthy eating and lifestyle choices. Two groups of forty Amlapitta patients were formed: For 30 days, Group B received Patoladi Kwatha, while Group A received Chinnadi Kashaya. When compared to Patoladi Kwatha, observations revealed that Chinnadi Kashaya had considerably reduced symptoms such as bloating, acid reflux, and indigestion. On the other hand, Patoladi Kwatha was far more effective in lowering appetite loss and fatigue. With each formulation providing distinctive benefits, these results offer credence to the therapeutic implementation of Ayurvedic medicines in the management of disorders like gastritis. The study demonstrates the therapeutic potential of both Ayurvedic formulations in treating digestive diseases, primarily Amlapitta, and indicates that Chinnadi Kashaya may provide superior overall comfort. Both formulations exhibited no adverse reactions. The long-term consequences and possible combinations of these medicines need to be investigated further.

Keywords: Amlapitta, Chinnadi Kashaya, Patoladi Kashaya, Chronic Gastritis

Corresponding Author	How to Cite this Article	To Browse
Anojkar KS, Post Graduate Scholar, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India. Email:	Anojkar KS, Shripathi AG, Malini MM, A randomized controlled clinical study on the efficacy of Chinnadi Kashaya in Amlapitta (Chronic Gastritis). J Ayu Int Med Sci. 2024;9(11):1-7. Available From https://jaims.in/jaims/article/view/3789

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2024-10-25	2024-10-26	2024-11-06	2024-11-16	2024-11-24
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None	Nil	Yes	11.17

© 2024by Anojkar KS, Shripathi AG, Malini MMand 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 2024;9(11)1

Download PDF Back To Article Introduction Objectives Materials and
Methods Observations Results Discussion Conclusion References

Anojkar KS et al. A randomized controlled clinical study on the efficacy of Chinnadi Kashaya

Introduction

The science of Ayurveda emphasizes a balanced lifestyle for overall well-being, but modern materialistic living has led to increased stress, anxiety, and health issues, including gastrointestinal disorders like Amlapitta (gastritis). Amlapitta can be compared to chronic gastritis in modern medicine, characterized by heartburn, increased stomach acid, and upper abdominal pain, affecting 25-30% of people in India.^[1] Ayurveda attributes this condition to the vitiation of Pitta Dosha due to improper diet and lifestyle choices, leading to symptoms like bloating, nausea, and indigestion. Being an of Annavaha Srotas disease, due to Nidana Sevana, the Shuktata of Pitta Dosha gets elevated and causes Mandagni and results in a pathological condition called Amlapitta with the prodromes like Avipaka, Klama, Utklesha, Tiktamlodgara, Gourava, Hrutkantadaha, and Aruchi.^[2] According to Ayurveda, Amlapitta arises from an imbalance in Agni (digestive fire), which is central to health. This study aims to assess the efficacy of the classical Ayurvedic formulation Chinnadi Kashayam,^[3] compared to Patoladi Kwatha.^[4] The research seeks to provide evidence of Chinnadi Kashaya’s effectiveness in managing Amlapitta and its symptoms.

Objectives

1. To determine the efficacy of Chinnadi Kashayam in the management of Amlapitta.
2. To compare the efficacy of Chinnadi Kashayam and Patoladi Kwatha in the management of Amlapitta.

Materials and Methods

Study Design: An open-labelled, randomized, comparative, interventional clinical study

Source

Clinical source: A minimum of 40 candidates were selected based on inclusion and exclusion criteria from the OPD and IPD of PG studies in Kayachikitsa of MIAMS, Manipal & medical camps, and other referrals.

Drug: Chinnadi Kashaya Choorna contains Guduchi, Khadira, Yastimadhu,

and Daruharidra in equal quantities prepared in Rasashala of Muniyal Institute of Medical Science and Hospital, Manipal after collecting the authenticated drugs. Method of collection of data: A special case proforma was prepared incorporating the clinical manifestations and assessment criteria including the classical signs of Amlapitta mentioned in the texts with a minimum of 40 patients suffering from Amlapitta selected as per inclusion and exclusion criteria including detailed history and physical examination.

Diagnostic criteria

History of diabetes with any of the following signs and symptoms

1. Avipaka
2. Klama
3. Utklesha
4. Tiktamlodgara
5. Gourava
6. Hrutkantadaha
7. Aruchi

Inclusion criteria

1. Patients with classical Lakshanas of Amlapitta.
2. Age 18 - 60
3. Subjects of either gender irrespective of caste, creed, occupation, religion, and socio-economic
4. Patients with recurrent symptoms over 6 weeks or

Exclusion criteria

1. Patients pre-diagnosed with Gastric carcinoma gastric ulcer and Duodenal Ulcer.
2. Patients with a history of systemic illness like Cardiac pathology, and Immune deficiency disorders were excluded.
3. Patients on diabetic or Hypertension medications are excluded.
4. Patients are presenting with hematemesis and
5. Pregnant woman/Lactation

Investigations

Hb %, TC & DC, ESR, RBS, Gastroscopy (when required).

Assessment criteria

The clinical features of Amlapitta mentioned as per Ayurvedic texts will be the basis for diagnosis.

1. Avipaka

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Anojkar KS et al. A randomized controlled clinical study on the efficacy of Chinnadi Kashaya

2. Klama
3. Utklesha
4. Tiktamla Udgara
5. Gaurava
6. Hrit Kanta Daha
7. Aruchi

Intervention

Group A (Study group)

Chinnadi Kashaya Choorna with lukewarm water will be given 30 minutes before food twice a day (Morning and Night) for 30 days with honey as Anupana.

Group B (Control group)

Patoladi Kwatha Choorna with Lukewarm water will be given 30 minutes before food twice a day (Morning and Night) for 30 days with honey as Anupana.

Observations

Among the 40 patients taken for the study 35% of the patients were 18-30 years. 62.5% of patients were females and 37.5% were males. 85% of the patients belonged to Hindu Religion. 60% of patients were married. 55% of patients had sedentary lifestyles and were graduates.

Most of the patients belonged to the middle class i.e., 67.5%. 77.5% of the patients had the dietary habit of taking a mixed diet. 57.5% of the patients had mental stress. 60% of the patients had a sedentary lifestyle. 67.5% had an irregular bowel habit. Most patients belonged to Vatapitta Prakruti i.e., 42.5%; 77.5% of patients had Madhyama Akruti, 92.5% of patients exhibited Madhyama Sara, 87.5% recorded Madhyama Samhanana, 82.5% patients had Madhyama Saatmya, 67.5% patients having Madhyama Satva and Vishama Agni,

55% of the patients had Madhyama Abhyavarana Shakti. And 55% had Madhyama Koshtha.

Results

Effect on Avipaka: there was 72.7% relief in Group A which is slightly more when compared to Group B (71.4%). Hence, the result on the effect of treatment on Avipaka in Group A was better than Group B (p=0.002).

Effect on Klama: there was 88.3% relief in Group B which is more when compared to Group A (70%) (p=0.031).

Effect on Utklesha: There was 85.1% relief in Group A which is slightly more when compared to Group B (80%). Hence, the result on the effect of treatment on Utklesha in Group A was better than Group B (p<0.001).

Effect on Tiktamlodgara: There was 87.5% relief in Group A which is significantly more when compared to Group A (63.4%). Hence, the result on the effect of treatment on Tiktamlodgara in Group A was better than Group B (p<0.001).

Effect on Gourava: There was 79.1% relief in Group A which is slightly more when compared to Group B (63.3%). Hence, the result on the effect of treatment on Gourava in Group A was better than Group B (p<0.001).

Effect on Hrutkantadaha: There was 87.8% relief in Group A which is slightly more when compared to Group B (73.6%). Hence, the result on the effect of treatment on Hrutkantadaha in Group A was better than Group B (p<0.001).

Effect on Aruchi: There was 80% relief in Group B which is slightly more when compared to Group A (60%). Hence, the result on the effect of treatment on Aruchi in Group B was better than Group A (p= 0.016).

Table 1: Effects of Chinnadi Kashaya and Patoladi Kwatha on the symptoms of Amlapitta.

Avipaka	Mean			AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Avipaka	BT	AT	AF	AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Group A	1.10	0.3	0.4	72.7%	63.6%	BT	1.252	0.280	0.5	-2.889	0.002
Group A	1.10	0.3	0.4	72.7%	63.6%	AF	0.598	0.134	0.0	-2.889	0.002
Group B	1.050	0.3	0.35	71.4%	66.6%	BT	1.356	0.303	0.0	-2.640	0.008
Group B	1.050	0.3	0.35	71.4%	66.6%	AF	0.489	0.109	0.0	-2.640	0.008

Klama	Mean			AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Klama	BT	AT	AF	AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Group A	1.0	0.30	0.35	70%	65%	BT	1.257	0.281	0.0	-2.739	0.004
Group A	1.0	0.30	0.35	70%	65%	AF	0.366	0.0819	0.0	-2.739	0.004
Group B	0.850	0.15	0.10	82.3%	88.2%	BT	1.348	0.302	0.0	-2.251	0.031
Group B	0.850	0.15	0.10	82.3%	88.2%	AF	0.308	0.0688	0.0	-2.251	0.031

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Anojkar KS et al. A randomized controlled clinical study on the efficacy of Chinnadi Kashaya

Utklesha	Mean			AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Utklesha	BT	AT	AF	AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Group A	1.350	0.20	0.150	85.1%	88.8%	BT	1.348	0.302	1.5	-2.980	<0.001
Group A	1.350	0.20	0.150	85.1%	88.8%	AF	0.366	0.0819	0.0	-2.980	<0.001
Group B	1.250	0.250	0.20	80%	84%	BT	1.482	0.331	0.0	-2.714	0.004
Group B	1.250	0.250	0.20	80%	84%	AF	0.410	0.0918	0.0	-2.714	0.004

Tiktamlodgara	Mean			AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Tiktamlodgara	BT	AT	AF	AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Group A	2.0	0.250	0.100	87.5%	95%	BT	1.170	0.262	2.0	-3.601	<0.001
Group A	2.0	0.250	0.100	87.5%	95%	AF	0.308	0.0688	0.0	-3.601	<0.001
Group B	2.050	0.750	0.750	63.4%	63.4%	BT	1.191	0.266	2.5	-3.640	<0.001
Group B	2.050	0.750	0.750	63.4%	63.4%	AF	0.444	0.0993	1.0	-3.640	<0.001

Gourava	Mean			AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Gourava	BT	AT	AF	AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Group A	1.20	0.25	0.3	79.1%	75%	BT	1.152	0.258	1.0	-3.140	<0.001
Group A	1.20	0.25	0.3	79.1%	75%	AF	0.470	0.105	0.0	-3.140	<0.001
Group B	1.50	0.55	0.5	63.3%	66.6%	BT	1.433	0.320	2.0	-3.127	<0.001
Group B	1.50	0.55	0.5	63.3%	66.6%	AF	0.513	0.115	0.5	-3.127	<0.001

Hrut-kanta daha	Mean			AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Hrut-kanta daha	BT	AT	AF	AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Group A	1.650	0.20	0.10	87.8%	93.9%	BT	1.387	0.310	2.0	-3.247	<0.001
Group A	1.650	0.20	0.10	87.8%	93.9%	AF	0.308	0.0688	0.0	-3.247	<0.001
Group B	1.9	0.5	0.55	73.6%	71%	BT	1.447	0.324	3.0	-3.354	<0.001
Group B	1.9	0.5	0.55	73.6%	71%	AF	0.510	0.114	1.0	-3.354	<0.001

Aruchi	Mean			AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Aruchi	BT	AT	AF	AT % Relief	AF %Relief		SD	SEM	M	Z (+/-)	P
Group A	0.500	0.2	0.15	60%	70%	BT	0.946	0.212	0.0	-2.070	0.063
Group A	0.500	0.2	0.15	60%	70%	AF	0.366	0.0819	0.0	-2.070	0.063
Group B	0.750	0.15	0.25	80%	66.6%	BT	1.070	0.239	0.0	-2.428	0.016
Group B	0.750	0.15	0.25	80%	66.6%	AF	0.444	0.0993	0.0	-2.428	0.016

Discussion

The consumption of excessive salty and other (Lavanadi Rasa) foods leads to purification (shuktatva), which further results in the formation of toxic substances (Ama Visha), ultimately causing Amlapitta. A basic impairment of digestion (Agnimandya) can develop into indigestion (Vidagdhajirna), and if this is neglected and poor dietary habits continue, it escalates into Amlapitta. Since Amlapitta is predominantly a pitta-related condition (Pitta Pradhana Vyadhi), the qualities of pitta, such as fluidity (Dravaguna) and sourness (Amlaguna), become aggravated, initially leading to indigestion (Vidagdhajirna) and eventually causing inflammation and erosion of the stomach and duodenal mucosal membranes (Amashaya). Amlapitta corresponds to chronic gastritis, starting with the initial phase (superficial gastritis) and advancing to the active phase (moderate gastritis). In superficial gastritis, inflammation is often caused by factors like H. pylori infection, NSAID use, or dietary irritants that increase stomach acid and irritate the lining.

This manifests as symptoms akin to Amlapitta, including indigestion, bloating, and nausea. In moderate gastritis, the inflammation becomes more severe, leading to deeper mucosal damage and worsening symptoms such as epigastric pain, early satiety, nausea, and vomiting, with inflammatory cells penetrating deeper into the mucosa. The herbal formulation Chinnadi Kashaya, which contains Guduchi, Khadira, Yastimadhu, and Daruharidra, is effective in pacifying Pitta (Pitta Shamana). Guduchi, Khadira, and Daruharidra are primarily bitter (Tikta Rasa), which aids in digesting toxins (Ama Pachana) and cooling pitta. Daruharidra and Khadira also possess drying (Ruksha Guna) and light (Laghu Guna) qualities, which help reduce the excess fluidity (Dravatwa) and acidity (Amlatwa) of Pitta. Furthermore, the cooling properties (sita veerya) of Khadira and Yastimadhu help reduce the heat and intensity (Ushna and Teekshna Guna) of Pitta, making them useful in treating acid reflux and heartburn. The warming properties (Ushna Veerya) of Guduchi and Daruharidra enhance digestion (Deepana) and improve indigestion (Pachana), reducing symptoms such as nausea, indigestion, and heaviness.

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Anojkar KS et al. A randomized controlled clinical study on the efficacy of Chinnadi Kashaya

Guduchi and Yastimadhu also have a sweet post-digestive effect (Madura Vipaka), which soothes pitta and strengthens the mucosal lining (Shleshmadhara Kala) of the stomach (Amashaya) due to their nourishing (Guru Guna) and oily (Snigdha Guna) properties.

By preventing the formation of excessive acidity (Amlatwa Nirodhatwa), Guduchi and Yastimadhu eliminate vitiated Pitta (Vidagdha Pitta) and restore digestive fire (Agni), effectively treating symptoms of Amlapitta such as acid belching, heartburn, and digestive issues. Amlapitta, being a psychosomatic disorder, can be managed with Chinnadi Kashaya. Yastimadhu, a cognitive-enhancing herb (Medhya drug), helps stabilize mood and reduce symptoms of depression and anxiety.

Guduchi, known as a nerve tonic and adaptogen (Medhya Rasayana), alleviates stress, making it beneficial for managing psychosomatic conditions.

Avipaka

Both the Kashayas exhibited similar pitta and kapha balancing properties. However, during the follow-up, symptoms reappeared as the medication was discontinued. The recurrence was linked to Hetu Sevana, which increased the Drava Guna of Pitta, leading to Agni dysfunction and causing Avipaka.

Klama

Klama was significantly reduced in the patients who used Chinnadi Kashaya, due to the Kapha-reducing and Pitta-cleansing effects of ingredients like Guduchi, Khadira, Daruharidra, and Yastimadhu. However, once the medicine was stopped, the pre-existing Ama (toxicity) associated with Pitta might have caused the symptoms to return.

The recipients of Patoladi Kashaya continued to show improvement during follow-up, as it further reduced Kapha and Pitta and improved Agni (digestive fire) and Rasa Dhatu (nutritional fluid), resulting in sustained relief.

Utklesha

Utklesha typically occurs due to an excess of Samapitta combined with Kapha Dosha involvement. The significant relief observed in the recipients of Chinnadi Kashaya may be attributed to the sweet (Madura Rasa) taste of Yastimadhu and the bitter (Tikta Rasa) taste of the other ingredients.

Here the result was sustained even after the stoppage of the medications.

Tiktamlodgara

Tiktamlodgara is one of the symptoms of imbalanced Pitta. Normally, Pitta has a pungent (Katu Rasa) taste, but in its vitiated state, it transforms into a sour (Amla Rasa) taste. This increase in Amla and Drava Guna of Pitta leads to impaired digestion and results in sour or bitter belching (Amla or Tikta Udgara).

The significant relief in this symptom was due to the correction of Agni (digestive fire) through the Amapachana (digestion of toxins) properties of Khadira and Daruharidra, along with the Amashaya Amlatwa Nirodhatwa and Anulomana actions of Guduchi and Yastimadhu.

Gourava

Gourava is caused by Kapha aggravation, and the significant relief observed in the patients of Chinnadi Kashaya is attributed to the pacification of Kapha and the Kaphachedhana action of Yastimadhu.

Additionally, the Deepana (digestive stimulant) and Pachana (digestive corrective) actions of Guduchi and Yastimadhu further contributed to this improvement.

Hrutkantadaha

Hrutkantadaha is primarily caused by Pitta aggravation and Kapha depletion. The significant relief observed in this symptom can be attributed to the Sita Veerya properties of Khadira and Yastimadhu, as well as the Daha Prashamana actions of Guduchi and Yastimadhu.

Yastimadhu contains licorice, which has soothing properties that can reduce the burning sensation in the stomach lining caused by acid reflux.

Aruchi

The effectiveness of the Chinnadi Kashya is due to the bitter (Tikta Rasa) and astringent (Kashaya Rasa) tastes of its ingredients, which help dry up excess Kapha and Pitta due to their light (Laghu Guna) and rough (Ruksha Guna) qualities.

These medicines also aid in the digestion of Ama (toxins) through their Deepana Pachana actions, which ultimately improve Aruchi.

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Anojkar KS et al. A randomized controlled clinical study on the efficacy of Chinnadi Kashaya

Flowchart 5: Chart showing the probable mode of action of Chinnadi Kashaya.

Conclusion

Amlapitta is an Ayurvedic disorder primarily attributed to unhealthy lifestyle choices, such as irregular eating habits and the overconsumption of spicy, acidic foods, as well as stimulants like alcohol and caffeine. It is considered both a physical and psychosomatic condition, with stress often playing a role in its onset. Managing impaired digestion (Agnimandhya) involves addressing the root causes (Nidana Parivarjana) and adopting appropriate dietary and lifestyle practices (Pathya-Palana). In a study of 40 patients with Amlapitta, two groups were formed: Group A was treated with Chinnadi Kashaya and Honey, while Group B received Patoladi Kwatha and Honey. The key findings were

A higher prevalence was observed in middle-aged individuals, especially women and those with sedentary lifestyles.
The condition was more common in patients with Vatapittaja Prakruti and Vishama Agni, with symptoms progressively worsening.
Chinnadi Kashaya showed significant improvement in symptoms like indigestion, nausea, burning sensation, acid belching, and heaviness, except for fatigue and loss of appetite, where Patoladi Kwatha was more effective.

No adverse reactions were

In summary, Chinnadi Kashaya is more effective for digestive-related symptoms, while Patoladi Kwatha is better for addressing fatigue and loss of appetite, highlighting the therapeutic value of these treatments.

References

1. Bikash Raj Ghimire, Samichha Neupane, Sanjay Pokharel, Shwetha Kumari Pokharel, Amrita Ghimire, Management of Amlapitta (Gastritis) in Ayurveda: A Review, International Journal of Multidisciplinary Research and Growth Evaluation.2021; vol 2; issue 1: Page no 278-280. Available on: http://www.researchgate.net/publication/349003536_ Management_of_Amlapitta_gastritis_in_Ayurveda_A_r eview

2. Acharya Vagbhata, Astanga Sangraha, Sutrasthana, by Dr.Shivaprasad Sharma, 3rd edition, Chaukhamba Sanskrit Series Office - Varanasi, Sutra Sthana, 20th Chapter, Shloka no.16, Page No.113.

3. Padhye, H.K. (ed)Srimad-Vrnda-pranito Vrndamadhava paranama Siddhayogah., revised by Shrikanda Dutta with commentary of Kusumavallyakya Tikka, edited by Krishna Sastri and Hanamantha Sastri, 1894; Anandasrama samskrta granthavalih. Pune; Pp-388-

4. Yogaratnakara-Haridas Ayurveda series, 2010, editor and translator Kumari Asha and Premavati Tewari, Varanasi; Choukamba Vishvabharati; Pp-947, p-943.

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J Ayu Int Med Sci 2024;9(11)6

Research Article

Chronic Gastritis

Journal of Ayurveda and Integrated Medical Sciences

A randomized controlled clinical study on the efficacy of Chinnadi Kashaya in Amlapitta (Chronic Gastritis)

Anojkar KS1*, Shripathi AG2, Malini MM3

Introduction

Objectives

Materials and Methods

Observations

Results

Discussion

Conclusion

References

Anojkar KS^1*, Shripathi AG², Malini MM³