“NAIDANIKA ADHYAYANA OF AMLAPITTA WITH SPECIAL ...

i

“NAIDANIKA ADHYAYANA OF AMLAPITTA WITH SPECIAL

REFERENCE TO HYPERACIDITY”

By

Dr. SHRADHA BAMS

Dissertation submitted to the

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

In Partial Fulfillment of the Requirements for the Degree Of

AYURVEDA VACHASPATI

DOCTOR OF MEDICINE (M.D)

In

ROGANIDANA

Under The Guidance Of

DR. RAMESH M. S. M.D. (Ayu)

Associate Professor, Department of Post Graduate studies in

Roganidana, Government Ayurvedic Medical College,

Bangalore - 560009

Department of Post Graduate studies in Roganidana,

Government Ayurvedic Medical College, Bangalore - 560009

2017-2018

List Of Abbreviations

“Naidanika Adhyayana Of Amlapitta With Special Reference To Hyperacidity”

Sl No Abbreviations Full form

1. Cha. Su. CharakaSutrasthana

2. Cha. Vi. CharakaVimanasthana

3. Cha. Ni. CharakaNidanasthana

4. Cha. Chi. CharakaChikitsasthana

5. Su. Su. SushruthaSutrasthana

6. Ha. Sa. Hareeta Samhita

7. A. Hr. Su. AstangaHridayaSutrasthana

8. Ka. Khi. KashyapaKhilasthana

9. Ma. Ni. MadhavaNidana

10. Bh. Pr. Bhavaprakasha

11. Y. R. Yogaratnakara

12. Ch. D Chakradatta

13. Ba.Ra BasavaRajeeyam

14. Bha.Ra BhaishajyaRatnavali

LIST OF ABBREVIATIONS

List Of Tables


Table No. NAME OF TABLES Page No.

1. Nidanas Of Amlapitta 17

2. Dosha Involvement According To Nidana 19

3. Prajnaparadhaja Hetu 20

4. Samanya Rupas 33

5. Symptoms Of Ekadoshaja Amlapitta 33

6. Symptoms Of Urdhvaga Amlapitta 37

7. Symptoms Of Adhoga Amlapitta 41

8. Upadravas Of Amlapitta 42

9. Sapeksha Nidana 44

10. Hyperacidity Questionnaire 51

11. Distribution based on Age 52

12. Distribution based on Gender 52

13. Distribution based on Religion 53

14. Distribution based on Education 53

15. Distribution based on Occupation 54

16. Distribution based on Socio-economic status 54

17. Distribution based on Habitat 55

18. Distribution based on Marital Status 55

19. Distribution based on Desha 55

20. Distribution based on Prakriti 56

21. Distribution based on Diet Pattern 56

LIST OF TABLE

List Of Tables


22. Distribution based on Pattern of Food Intake 57

23. Distribution based on Appetite 57

24. Distribution based on Bowel 57

25. Distribution based on Koshta 58

26. Distribution based on Tea Intake 58

27. Distribution based on Coffee Intake 59

28. Distribution based on Smoking 59

29. Distribution based on Tobacco Chewing 60

30. Distribution based on Alcohol 60

31. Distribution based on Sleep 60

32. Distribution based on Heated Honey 61

33. Distribution based on Curd at Night 61

34. Distribution based on Consuming Cold Water

Immediately After Taking Hot Tea Or Coffee

62

35. Distribution based on Sour fruits with milk 62

36. Distribution based on Milk With Curd 62

37. Distribution based on Unformed curd 63

38. Distribution based on Amlatakra 63

39. Distribution based on Curd 64

40. Distribution based on Sugar Cane Juice 64

41. Distribution based on Pepper 65

42. Distribution based on Unripe And Sour Mango 65

43. Distribution based on Sour Mosambi 66

44. Distribution based on Sour Orange 66

List Of Tables


45. Distribution based on Citrus Lemon 67

46. Distribution based on Sesame 67

47. Distribution based on Puffed Rice 67

48. Distribution based on Battened Rice 68

49. Distribution based on Black Gram 68

50. Distribution based on Horse Gram 69

51. Distribution based on Chicken 69

52. Distribution based on Fish 70

53. Distribution based on Pork 70

54. Distribution based on Avimamsa 71

55. Distribution based on Ajamamsa 71

56. Distribution based on Atilavana 72

57. Distribution based on Atikatu 72

58. Distribution based on Atiamla 73

59. Distribution based on Deep Fried 73

60. Distribution based on Stale Food 74

61. Distribution based on Viharaja Nidana 74

62. Distribution based on Haritakashaka 75

63. Distribution based on Beetle Leaf 75

64. Distribution based on Atiudakapana/ Antarodakapana 76

65. Distribution based on Manasika Nidana 76

66. Distribution based on Lakshanas 77

67. Distribution based on Hyperacidity Questionnaire 78

List Of Figures


Graph No. NAME OF GRAPHS Page No.

1. Distribution based on Age 79

2. Distribution based on Gender 79

3. Distribution based on Religion 79

4. Distribution based on Education 80

5. Distribution based on Occupation 80

6. Distribution based on Socio-economic status 80

7. Distribution based on Habitat 81

8. Distribution based on Marital Status 81

9. Distribution based on Desha 81

10. Distribution based on Prakriti 82

11. Distribution based on Diet Pattern 82

12. Distribution based on Pattern of Food Intake 82

13. Distribution based on Appetite 83

14. Distribution based on Bowel 83

15. Distribution based on Koshta 83

16. Distribution based on Tea Intake 84

LIST OF GRAPHS

List Of Figures


17. Distribution based on Coffee Intake 84

18. Distribution based on Smoking 84

19. Distribution based on Sleep 85

20. Distribution based on Heated Honey 85

21. Distribution based on Curd at Night 85

22. Distribution based on Consuming Cold Water

Immediately After Taking Hot Tea Or Coffee

86

23. Distribution based on Sour fruits with milk 86

24. Distribution based on Milk With Curd 86

25. Distribution based on Amlatakra 87

26. Distribution based on Curd 87

27. Distribution based on Sugar Cane Juice 87

28. Distribution based on Unripe And Sour Mango 88

29. Distribution based on Sour Mosambi 88

30. Distribution based on Sour Orange 88

31. Distribution based on Citrus Lemon 89

32. Distribution based on Puffed Rice 89

33. Distribution based on Battened Rice 89

34. Distribution based on Black Gram 90

List Of Figures


35. Distribution based on Horse Gram 90

36. Distribution based on Chicken 90

37. Distribution based on Fish 91

38. Distribution based on Pork 91

39. Distribution based on Avimamsa 91

40. Distribution based on Ajamamsa 92

41. Distribution based on Atilavana 92

42. Distribution based on Atikatu 92

43. Distribution based on Atiamla 93

44. Distribution based on Deep Fried 93

45. Distribution based on Stale Food 93

46. Distribution based on Viharaja Nidana 94

47. Distribution based on Manasika Nidana 94

48. Distribution based on Haritaka Shaka 94

49. Distribution based on Beetle Leaf 95

50. Distribution based on Atiudakapana 95

51. Distribution based on Lakshanas 95

52. Distribution based on Hyperacidity Symptoms 96

53. Distribution based on Alcohol 96

List Of Figures


Sl. No. NAME OF FLOWCHART Page No.

1. Samprapti of Amlapitta 25

Sl. No NAME OF IMAGES Page No.

1. Causes of Hyperacidity 116

LIST OF FLOWCHART

LIST OF IMAGES

Abstract


Modern era’s changing lifestyle along with changing food culture and also

depending upon one’s body constitution Amlapitta is one of the most common

diseases seen in the society. It is a gastrointestinal tract disorder which closely

resembles with hyperacidity in modern science.

Most of the gastrointestinal disorder are owing to results from abnormal

functioning of Agni(digestive fire), faulty dietary habits like excessive intake of

pungent, spicy food, irregular meals pattern and habits like smoking, alchohol,

psychological stress. It is very troublesome disease and it can give rise to many

serious problems if it is not treated in correct time.

Amlapitta is composed of two word Amla and Pitta. AcharyaSushruta has

mentioned the Prakrita Rasa of Pitta is Katu and Vikritarasa or Vidagdha Rasa of

Pitta is Amla. Hence when the Vidagdhata of Pitta increases the disease Amlapitta

manifest.

Amlapitta is one of the Annavahasrotas vyadhi caused by the vitiation of

Tridoshas when any of the Dosha causing Mandagni leads to Vidagdhajeerna

manifesting as Amlapitta4. Amlapitta are very similar to gastritis or hyperacidity,

characterized by anorexia, acid eructation, heart burn, nausea, abdominal discomfort.

A population-based study, using a validated questionnaire, found that 58.7% of

the population has heartburn or acid regurgitation at least once during the course of a

year and that 19.8% experience symptoms at least once weekly.

ABSTRACT

Abstract


Hence here an attempt is made here to understand the Naidanikaadhyayana

Of Amlapittaw.S.R To Hyperacidity.

OBJECTIVES OF THE STUDY

1. To study the aetiopathogenesis of Amlapitta according to Ayurvedic classics.

2. To study the Hyperacidity in modern science.

3. To compare and analyze Amlapitta with Hyperacidity.

METHODOLOGY

A minimum of 50 patients who are fulfilling the criteria for diagnosis and

inclusion will be selected for the study randomly irrespective of sex, religion,

educational , professional background and economic status.

A special case proforma will be prepared with details of history taking,

physical signs and symptoms as mentioned in our classics and allied science.

The study will be done using a structured questionnaire which will have the

factors covering Ahara, Vihara, family history, occupation etc

Results

In this study majority of the patients registered were between the age group of

31-40 years indulged in mixed diet. curd, sour butter milk, lemon, pepper, horse

gram, black gram, chicken, fish, flesh of goat and sheep, excess salt, spicy, deep fried

food, drinking more water in between the food, sleeping soon after taking the food,

Atikrodha, alcohol, coffee intake play a significant role in causation of the disease

Amlapitta.

Key words: Amlapitta, Mandagni, Vidagdha, Hyperacidity.

Introduction

“Naidanika Adhyayana Of Amlapitta With Special Reference To Hyperacidity” Page 1

In the 21st century, the era of competition with stress having more speed and

accuracy are the prime demands. People are inclined to earn a lot of money within a

short period leading to their stressful life. Also more attraction towards the junk

foods. Copying the Western life style, they are changing their diet pattern, life style

and behavioral pattern working with stress and strain. So, the people are becoming

stressful with worry, tension, and anxiety causing so many psychological disorders,

which hampers the digestion and is causing acidity, gastritis, dyspepsia, ulcer and

anorexia. All these symptoms can be covered under the broad umbrella of

AMLAPITTA in Ayurveda.

Amlapitta is a disease of Annahava Srotas and is more common in the present

scenario of unhealthy diets & regimens. The term Amlapitta is a compound one

comprising of the words Amla and Pitta Out of these, the word Amla is indicative of a

property which is organoleptic in nature and identified through the tongue while the

word Pitta is suggestive of one of the Tridoshas as well as responsible for digestion

and metabolism in the body. The classical Literature on Amlapitta explains that

Amlapitta is such a condition in which Pitta increased and side by side the sourness of

Pitta is also increased. To indicate this factor Acharya Chakrapani has stated that

“Amlapitta is Amla Guna Yukta Pitta”1.

The first recorded medical literature Charaka Samhita which bases the very

systematic and scientific description has not mentioned the disease Amlapitta. Though

a scattered references and the pathogenesis is found in Grahani Adhyaya that

Annavisha (food poisoning) when associated with Pitta causes burning sensation,

INTRODUCTION

Introduction


morbid thirst and mouth diseases leads to Amlapitta and such other paittika

disorders2.

Kashyapa Samhita is the first text which describes the disease Amlapitta as a

separate disease entity. It is also the first text which has counted the Manasika

Bhavas(Psychological factors) as a chief cause of the disease and analyses the disease

on the basis of Doshika predominance. Also Acharya Charaka has mentioned that if a

person is under some psychological problem even the wholesome food taken in

proper quantity does not get properly digested3. Kashyapa believed that the disease is

caused by vitiation of Tridoshas leading to Mandagni and Amlapitta4.

Madhavakara describes the pathogenesis of the disease due to Pittaprakopa

which is already increased due to its own causes. He describes the two gatis of

Amlapitta as Urdhvaga and Adhoga.

Amlapitta and its upadravas may consider in gastric syndrome or hyperacidity

according to the modern science. Hyperacidity is a very common dietary disorder that

affects almost 25% of the world's population. Overcoming hyperacidity is a very

important issue. Generally, the problem occurs due to our sedentary lifestyle.

In recent years there has been an unprecedented increase of incidence related

to GI system due to changing in life style, Diet pattern, Behavioral pattern and Mental

stress and strain. The prevalence rate of all digestive disease are 60-70 million (1985),

mortality rate is 191000 (1985) and hospitalization is 10 million (13% of all

hospitalization). Amlapitta is a such type of GI disorder due to Viruddhashana,

Adhyashana, Diwaswapna etc closely resembles with hyperacidity in modern science.

Introduction


Primarily, hyperacidity can be due to excessive intake of oily and spicy foods,

sour foods, alcohol consumption, smoking, heavy consumption of therapeutic drugs,

coffee or tea and inadequate exercise. Though some secondary and major reason may

also lead to the problem of hyperacidity. These are stomach ulcers, digestive system

related disorders or due to acid reflux, and inadequate exercise5.




The present study entitled “NAIDANIKA ADHYAYANA OF AMLAPITTA

WITH SPECIAL REFERENCE TO HYPERACIDITY” was carried out with the

following aims and objectives.

1. To study the aetiopathogenesis of Amlapitta according to Ayurvedic classics.

2. 2.To study the Hyperacidity in modern science.

3. To compare and analyze Amlapitta with Hyperacidity.

Conceptual Review


To start any type of research work, it is always necessary to study the

historical background of that particular subject. It not only helps to understand the

subject thoroughly, but also provides useful guidelines for the research work. Careful

review of the subject from ancient time to the recent era gives an idea of the total

evolution in research. Here are some of the references of Amlapitta in Indian

literature.

VEDIC PERIOD No direct reference regarding the disease Amlapitta could

not be traced in Vedic literature

SAMHITA KALA

I. CHARAKA SAMHITA :

Acharya Charaka has not mentioned Amlapitta as a separate disease, but

Charaka Samhita has many scattered references of Amlapitta which are as

follows.

1) While describing the indication of 8 types of milk, Amlapitta has also

been listed6.

2) Description of Kulattha as chief etiological factor of Amlapitta has

been mentioned7.

3) Adhika sevana of Lavana Rasa causes Amlapitta8.

4) The Amlapitta has been mentioned under the diseases caused by

Viruddhahara9.

5) Rajamasha has the property of relieving the Amlapitta10.

6) Mahatikta Ghrita has been indicated in Amlapitta11.

HISTORICAL REVIEW

Conceptual Review


7) The pathogenesis of Amlapitta is described in context to Grahani

dosha12.

8) The list of Paitika Nanatmaja vyadhis includes symptoms dhumaka,

Amlaka, Vidaha which are the symptoms of Amlapitta13.

9) Indications of Kansa-Haritaki also include Amlapitta14.

These references are sufficient to give clear cut indication regarding

the amlapitta in charaka period.

II. SUSHRUTA SAMHITA :

During the description of the Atilavana Sevanajanya Vyadhis Acharya

Sushruta has mentioned a disease called ‘Amlika’ which seems to be similar to

Amlapitta15.

III. ASTANGAHRUDAYA :

While describing Pittaja Hrudroga, Vagbhata has used the term

Amlapitta16.

IV. KASHYAPA SAMHITA :

Kashyapa Samhita is the first text which describes the disease

Amlapitta as a separate disease entity. It is also the first text which has counted

the Manasika Bhavas(Psychological factors) as a chief cause of the disease

Not only detailed description of Amlapitta with its treatment has been

mentioned in it, but also has been advised to change the place of living to get

rid of the disease17.

Conceptual Review


V. MADHAVA NIDANA :

Madhavakara has described two types of Amlapitta as follows:18.

1) Urdhavaga

2) Adhoga

VI. SHARANGDHARA SAMHITA :

Eventhough Sharangdhara has not explained about the

etiopathogenesis of the Amlapitta, he has given the drugs and their preparatory

methods and indicated it in the disease Amlapitta. He has also explained the

therapy Niruha Basti for Amlapitta19.

VII. HARITA SAMHITA :

Harita has described Amlapitta as a separate disease and the treatment

is also given separately. The special synonym ‘Amlahikka’ to Amlapitta is

contribution of Harita20.

VIII. BHELA SAMHITA :

In Bhela Samhita Amlapitta has not been described21.

IX. BHAVAPRAKASHA :

Etiopathological factors similar as Madhava Nidana have been

described in Bhavaprakasha22.

X. VANGASENA SAMHITA :

Amlapitta is described with chikitsa in Vangasen samhita.

XI. BHAISAJYA RATNAVALI :

Description of Amlapitta with detailed chikitsa is explained in

Bhaisajya ratnavali23.

XII. YOGARATNAKARA :

Description of amlapitta is similar as Madhava Nidana24.

Conceptual Review


XIII. BASAVARAJIYAM :

This text has included the Amlapitta under 24 Nanatmaja Vyadhi of pitta25.

XIV. VRINDA MADHAVA :

Vrinda Madhava in his Kusumavali Vyakhya mentions Amlapitta as a

separate disease and its treatment. He has mentioned Vamana, Virechana,

Anuvasana and Asthapana as the main Upakramas as well as Avasthika

Chikitsa.

Conceptual Review


CONCEPTUAL REVIEW (Disease Review)

DEFINITION OF AMLAPITTA

Many definitions have been quoted in the classics of Ayurveda regarding

Amlapitta.

According to Chakrapani

“Amla Pittam Cheti Amla Gunodriktam Pittam”.

That means the pitta possessing excessive Amlata or the excessive Amla Guna

Udrikrita Pitta is called Amlapitta26.

Amla according to Charaka is considered as the Prakruta Rasa of Pitta27

where as Acharya Sushruta says that Katu is the Prakruta Rasa of the Pitta and it

attains Amlata in Vidagdhavastha28. The condition where the prakruta Katu Rasa of

Pitta is replaced by Amlata due to Vidagdhapaka can be called Amlapitta.

Hence, when vidhagda pitta is increased amla guna also increased which leads

to manifestation of amlapitta.

Madhava Nidana has given a clinical definition of Amlapitta that presence of

Avipaka, Klama, Utklesha, Amlodgara, Gaurava, Hrit-Kantha- Daha and Aruchi

should be termed as Amlapitta29.

In Amlapitta, the Pitta gets vitiated by one or all Gunas, causing various

pathophysiological conditions of Anna and Purishavaha Srotasa.

Etymology

Amlapitta is composed of two words. Amla + Pitta = Amlapitta. The term

Amla refers to a particular type of taste equated with the sour taste which causes

Conceptual Review


excessive salivary secretion. Pitta denotes bodily chemical substance which is mainly

responsible for the maintenance of the process of digestion, transformation and

transmutation. On combining both these words the term Amlapitta implies to a disease

or condition in which the sourness of Pitta gets increased.

Synonyms

Pramilaka

Pitta Visuchika

Pittamlaka - Harita Amlika

Shuktata

Amlaka

Amlika

Dhumaka and vidaha

Prameelaka:

This terminology has been used by commentator Indu on A.S.Su.5/27 under

Kaphaja Vyadhi. The Pachyamana Vidagdha Annarasa immediately vitiates Pittadi

Doshas, there by producing Aruchi, Mukha Vairasya, Praseka, Lavana Tiktamla Udgara,

Chardi, emaciation, Hritshula and Sadana. This state is known as Prameelaka30.

Pitta Visuchika:

This term also used by commentator Indu on A.S. Su.5/27. This may refer to

both the types of Amlapitta i.e. Urdhvaga and Adhoga Amlapitta, where their respective

cardinal features are Urdhvaga Pravrutthi (Vamana) and Adhapravrutthi (Atisara) of

Pitta associated with burning sensation.

Shuktaka:

It is mentioned synonym for Amlapitta in Ka. S. Khi. 16th chapter31.

Pittamla:

Conceptual Review


The term would imply the sense of the term Amapitta mentioned in Amlapitta

Chikitsa in Y. R. also it has been used in Harita Samhita.

Amlaka:

The word Amlaka has been used by Charaka and Vagbhata in the list of

Pittananatmaja Vyadhi32.

Amlika

Means Amlodgara and would refer to one of the Lakshanas of Samapitta33.

Dhumaka and Vidaha

Charaka has enlisted both these in Pittananatmaja Vyadhi.

NIDANA

Nidana Panchaka i.e. Nidana, Purvarupa, Rupa, Upashaya, Samprapti are

said to be most important diagnostic tools of the disease. Understanding the concept

of Nidana of a disease helps us to diagnose and treat the disease properly. This can be

substantiated by Sushruta’s verse

“Sankshepataha Kriyayogo Nidana Parivarjanam”34.

Kashyapa, Harita, Madhavakara have described the etiological factors of

Amlapitta, Madhavakara has mentioned etiological factors which are mainly Pitta

Prakopaka35. Kashyapa has given etiological factors of Amlapitta, which are Kapha

Prakopaka – which shows his inclination towards the role of Kapha as main cause of

Amlapitta36. All scholars have mentioned Viruddhahara as a causative factor of

Amlapitta, which shows the importance of involvement of Viruddhahara as a

causative factors of Amlapitta.

Conceptual Review


The etiological factors of Amlapitta can be broadly classified as Aharaja,

Viharaja, Manasika and Aagantuja Hetus37. The brief explanation of these factors

may be presented as under

Aharaja Hetu [Dietary factors]:

Aharaja hetus are said to be the first and foremost group of etiological factors

of Amlapitta. Under this group the intake of food against the code of dietetics i.e.

Ahara Vidhi Vidhana and Ahara Vidhi Visheshayatana is included38. Various type of

viruddha ahara, excess of Pitta prakopaka factors like Katu, Amla, Vidahi, etc. and

irregular time of consumption of food are the factors against the dietetic code and they

are directly responsible for the vitiation of Pitta. Accoding to Kashyapa faulty dietaty

habits leads to agnimandya which further leads to amlapitta39. Whereas Madhavakara

mentioned pitta aggravating factors are responsible for amlapitta40.

Ahara group 41:

A. According to the type of Ahara :

a. Kulattha

b. Pruthuka

c. Pulaka (Husky food)

B. According to the Samskara of the Ahara :

a. Apakwanna Sevana (uncooked food)

b. Bhrishtadhanya Sevana (fried paddy)

c. Ikshuvikara Sevana (Sugar-cane products)

d. Pishtanna Sevana (flour)

C. According to the quality of food :

Conceptual Review


a. Abhishyandi

b. Atisnigdha (Unctuous)

c. Atiruksha (Very coarse and dry)

d. Gurubhojya (heavy diet)

e. Vidahi Anna-Pana

D. Faulty dietary habits:

a. Akala bhojana (untimely eAting)

b.Antarodaka Pana (drinking of excess water during meal)

c. Adhyashana

d.Visamashana

E. According to the capacity of weakening the digestive power :

i. Ati Snigdha Sevana (excessive oily diet)

ii. Ati Ruksha Sevana (excessive coarse dry diet)

F. According to Dushitanna:

i. Dushta Anna Sevana

ii. Paryushita Anna Sevana

G. According to the Pitta provocative potency of diet :

a. Adhyashana (eating before the previous diet is digested)

b. Ajirnashana (intake of food in indigestion condition)

c. Amapurnata

d. Ati Ushna (Very hot)

e. Ati Amla (intake of excessive acidic diet)

f. Ati Drava (intake of excessive liquid)

g. Ati Tikshna (intake of very sharp substance)

h. Ati Panam (Over drinking)

Conceptual Review


i. Katu Anna Pana (Pungent diet and drinks)

j. Viruddhashana (incompatible diet)

H. Miscellaneous :

i. Madya Sevana (alcohol drinking)

ii. Gorasa Sevana (milk products)

Viharaja Hetu 42

To maintain the good health one should follow the proper viharas. The

regular habits of eating properly, sleeping on time and excretion must be

followed. Vega dharana should be avoided. If this is not followed regularly,

the whole functioning of the body will be disturbed and in long run, they will

cause the disturbances of the equilibrium of Pitta and digestion, which

ultimately will lead to Amlapitta.

Atisnat (Taking excessive bath)

Ati Avagahanat (Excessive swimming)

Bhuktwa bhuktwa diwasvapnat (Sleeping in day time after meals)

Veganam Dhararam (Suppression of natural urges)

Shayya Prajagaraihi (Improper sleeping schedule)

Manasika Hetu43.

Psychology also plays a great role in maintaining the health and

psychological activities. On the other hand an abnormal psychology, in terms

of Kama, Krodha, Lobha, Moha, Irshya, Shoka, bhaya would affect the

physiology of digestion. Either there would be a lesser secretion of the

digestive juice or secreted at improper times and sometimes it may be secreted

Conceptual Review


in excessive quantity. All these conditions aggravates Pitta, which ultimately

gives rise to Amlapitta.

The modern investigators have established that Hyperacidity is nothing else but is the

syndrome resulting from stress and strain which shows the important role played by

psychogenic factors in the production of Amlapitta.

Manasa Hetu:

Chinta - worries

Shoka – Sad

Bhaya - Fear

Krodha - Anger

Moha - Over attachment

Agantuja Hetu:

Amlapitta is definitely caused by over use of certain drugs. Over use of

NSAIDs and anticoagulants cure one disease but it can produce Hyperacidity.

Ayurvedic drugs, especially ashodhita and faulty Rasa Aushadhi may cause

Amlapitta. Even Ushna, Tikshna drug if used excessively, without proper assessment

of disease for a long period may produce Amlapitta. Similarly Panchakarmas with

Heena Yoga or Mithya Yoga or Atiyoga lead towards many diseases by attacking on

Agni, hence Amlapitta also can be seen as an Upadrava of some other diseases like

chronic Vibandha, Arsha, Ajirna and Pandu. In this group constant and excessive

Consumption of alcohol, tobacco, beverages, smoking, or other irritant stuffs, etc are

taken. These substances cause local irritation in the stomach, which in turn secretes

more gastric juices, and infection of the stomach, which may be grouped under this

category.

Other causes:

Conceptual Review


Also Desha, Kala, Ritu takes a great extent in the causation of Amlapitta.

Deshaprabhava:

According to Acharya Kashyap the disease is more predominant in anupa

desha comparing to other desha because of Kapha provocating nature46. In the line of

treatment he gives its importance to change the place in untreated cases44.

Kalaprabhava [Influence of Time]:

Amlapitta is a chirakalina vyadhi.This disease is more prevalent in middle age

due to dominancy of Pitta. Also paittika disorders are more prevalent during Pitta

provocation time that is during midday and mid-night45.

Ritu prabhava [Seasonal Fluctuations]:

This group includes disease which is caused by variations in atmospheric

temperature. hot or cold, humidity or dryness, rain and winter, incidental to changes

in the seasons. The rainy season is responsible for amlavipaka of water and eatables

(due to weakened digestion power and vitiation of Vata and other Doshas) which in

turn vitiates Pitta and Kapha46.

Genetic Factors:

Acidity is seen mostly in persons with blood group ‘O’ and families with such

blood group prove relations of genetic factor, probably the blood group modifies the

oxyntic cell population. In Ayurveda Pitta prakruti persons are also more susceptible

for the process of aggravation of the diseases.

Trauma:

Certain things in diet can damage the gastric mucosa. The intake of spicy

food, solid matter, alcohol and other irritating things may damage the pyloric antrum

and lesser curvature of stomach.

Conceptual Review


Drugs:

Drugs like corticosteroids, xanthine, aspirin, alkaloids, NSAIDS, reserpine are

reported to be causing Hyperacidity.

Nicotine And Alcohol:

Alcohol can damage the gastric mucosa and produces ulcer. Smoking

(Nicotine) has been responsible to produce the amount of prostaglandin E2 in gastric

mucosa. Madhya sevana is explained as the causative factor for amlapitta.

Table No: – 1 A COMPARATIVE TABLE SHOWING THE CLASSICAL

NIDANAS OF AMLAPITTA

Sl.No Nidanas K.S. M.N. B.P. B.R. G.N. S.S.

1. Ajirna (Indigestion) + - - - - -

2. Abhishyandi Bhojana + - - - - -

3. Adhyashana (To eat before the

previous food is digested)

+ - - - - -

4. Ama (Undigested) + - - - - -

5. Ama Pakwanna(Semi-digested

food)

+ - - - - -

6. Akala Bhojana(Untimely diet) + - - - - -

7. Amla Sevana(Eating of acidic

substances)

+ + + + + +

8. Ame Ame Cha Puranant (To eat

without appetite)

+ - - - - -

Conceptual Review


9. Antarodaka Prana (To drink

much water during food)

+ - - - - -

10. Ati-ushna Ahara (Very hot diet) + + + + + +

11. Ati-snigdha Ahara (Fatty diet) + - - - - -

12. Ati-ruksha Ahara (Coarse diet) + - - - - -

13. Ati-drava- Sevana(Excess liquid) + - - - - -

14. Atisnana (Lengthy bath) + - - - - -

15. Avagahana (Tub-bath) + - - - - -

16. Bhuktwa – Buktwa Swapnat + - - - - -

17. Bhrista – Dhanya + - - - - -

18. Dustanna - + + + + +

19. Diwaswapa + - - - - -

20. Gorasa (milky product) + - - - - -

21. Guru Bhojana (Heavy diet) + - - - - -

22. Ikshuvikara(Sugarcane product) + - - - - -

23. Kulattha Sevana + - - - - -

24. Madya (Alcohol) + + + + + +

25. Paryushitanna + - - - - -

26. Pitta Prakopaka Annapana - + + + + +

27. Pistanna + - - - - -

28. Pruthuka Sevana + - - - - -

29. Pulaka Sevana + - - - - -

30. Vidhanya - + + + + +

31. Viruddhasana(Incompatible diet) + + + + + +

Conceptual Review


Table – 2: Dosha Involvement According To Nidana

Nidana Doshika

Involvement

K.S. M.N

.

B.P. S.N. H.S. G.N. Y.R. B.S.

Kulattha Sevana P + - - - - - - -

Pulaka Sevana P + - - - - - - -

Pruthuka Sevana P + - - - - - - -

Guru Ahara K + - - - - - - -

Abhishyandi

Ahara

PK + - - - - - - -

Atisnigdha Ahara PK + - - - - - - -

Ati Ruksha Ahara V - - + + - - - -

Vidahi Annapana P - + + - - + + +

Pistanna Sevana PK + - - - - - - -

Apakwanna

Sevana

PV + - - - - - - -

Phanita Sevana K + - - - - - - -

Ikshuvikara

Sevana

K + - - - - - - -

Paryushitanna

Sevana

VPK + - - - - - - -

Dushtanna

Sevana

VPK - + + - - + + +

Ati-ushna Ahara P + - - - - - - -

Conceptual Review


Viruddhahara VPK + + + + + + + +

Ati-amla Ahara PK + + + + + + + +

Ati-tikshna Ahara VP - - - + - - - -

Adhyashana VPK + - - - - - - -

Ajeernashana PK + - - - - - - -

Table – 3: Prajnaparadhaja Hetu

Akala Bhojana KP - - + - - - - -

Kale Anashana V + - - + - - - -

Vishamashana V + - + - - - - -

Vegavidharana VPK + - - - - - - -

Bhuktva

Divaswapna

K + - - - - - - -

Bhukta

Avagahanam

VK + - - - - - - -

Bhuktva Snanam VK + - - - - - - -

Ati-madya Sevana VPK + - - - - - - -

SAMPRAPTI:

Samprapti is the process of the formation of the disease starting right from the

contact of the causative factors with the body to complete manifestation of the

disease. It is a course of the formation of the disease beginning from the Dosha

Prakopa.

Acharyas of Ayurveda such as Kashyapa, Madhavakara & Gananatha Sena

have mentioned specific Samprapti for Amlapitta as follows.

Conceptual Review


Samprapti according to Achrya Kashyapa :-

Acharya Kashyapa has described one separate chapter of Amlapitta in

Khilasthana. Kashyapa explained the as extremely vitiated Pitta condition

“Vatadayah prakupyanti tesham anytamo yada |

Mandikaroti kayagnim agnau mardavamgate ||

Yetani eva tatha bhuyah sevamanasya durmate |

Yat kinchit ashitam peetam dehinah taddhi dahyati ||

Vidagdham shuktatam yaati shuktam amashaye sthitam |

Tad amlapittam eti ahu bhuyishtam pittadushanat. ||” 16/6-9

Acharya Kashaypa said that the Nidana, the Doshaprakopa especially of pitta

Dosh. This Dosha prakopa create mandagni, & Due to mandagni ingested food

becomes vidagdha and shuktibhava. This Vidagdha and shuktbhava of food create

Amlata in Amashaya. This condition is called Amlapitta. Kashyapa has given an

example for explaining the samprapti of Amlapitta47. The vessels containing some

curd or uncleaned vessel which containing Amlarasa, If one adds milk, immediately

milk becomes Amlarasa and converted in to curd same process in Amashaya - due to

vitiated Dosha, the Ahara becomes vidagdha & shuktibhava. The Rasa Dhatu is also

vitiated. It creates more Mandagni. So, a person who intake more vidahi Ahara

generate more shuktibhava of food, which is responsible for the development of

Amlapitta48. Acharya Kashyapa has given the importance to Desha as a main

causative factor of the Amlapitta. He said that Amlapitta is shown mainly in Anupa

Desha. In Anupa Desha the climate is always look like as rainy season. So the Ahara

of this Desha, creates pitta vriddhi just like during varsharitu in other Desha. This

pitta vriddhi is called as sanchaya of pitta. In this condition, if a person take excessive

Conceptual Review


vidahi, katu & viruddha Ahara, the sanchita pitta becomes prakupita. Amla & Drava

Guna of the pitta are increased and lead to mandagni. So the ahara is not digested

properly and become vidagdha & shuktibhava in Amashaya and this condition is

called Amlapitta.

SAMPRAPTI - ACCORDING TO MADHAVANIDANA.

Acharya Madhava has given more importance to Ritu vishesha in the

pathogenesis of Amlapitta. Varsha ritu & sharad ritu both seasons have relation with

sanchaya and prakopa of pitta. Pitta vriddhi is developed in varsha ritu naturally,

while pitta prakopa occurs in sharad ritu. Pittaprakopa and Vidagdhata of pitta

which was previously stagnated by its own vitiating factors manifest amlapitta49.

ACCORDING TO CHARAK SAMHITA:-

Charaka has not mentioned Amlapitta as separate disease entity like Kashypa,

Bhavprakash & Madhava. The samprapti of Grahani Roga mentioned by charak is

able to explain the pathogenesis of Amlapitta, Charak said that the viruddha, vidahi &

Dushta Bhojana and kamadi Manasika Bhavas lead to Agnimandya. Agnimandya

create Ajirna, Due to Ajirna, Annavisha is produced. This Annavisha mix with pitta

Dosha and creates pittaja disease like Amlapitta. This vitiated pitta has a

Amlagunadhikya and Dravagunadhikya properties. It also vitiates the Rasa Dhatu.

This vitiated Rasa Dhatu and Amlaguna, Dravguna of pitta lead to Agnimandya

again. It produce more Ajirna & Annavisha. So the Ahara even taking in proper

quality or quantity, becomes vidagdha in Amashaya. So the shuktibhava of Ahara

creates Amlapitta. In acute condition gastrointestinal symptoms & signs are developed

just like Amlodgar, chhardi, vidbheda, Avipaka etc. Chronic condition occur due to

this vicious cycle circling more & more. So the Rasadhatu and pitta are vitiated more

Conceptual Review


and more. In the chronic condition Bharma, Shiroruja, jwara, kandu, klama,

Angasada etc. are developed50.

ACCORDING TO SUSHRUTA:-

Sushruta described six clear-cut stages of samprapti of disease like sanchaya,

prakopa, prasara, sthansanshraya, vyakti and Bheda51.

(1) SANCHAYA :-

Anupa Desha, Varsha Ritu, Vidahi Annapana Sevana, Amla-katu Rasa

Sevana, Dushtanna sevana, Drava ati sevana etc causative factors creates pitta

vriddhi. This stage is called as a sanchayavastha. Pitta is a chief Dosha which is

necessarily vitiated but the associated kapha & vata Dosha are also vitated due to

Nidana sevana.

(2) PRAKOPA :-

Excessive use of Nidana factors, pitta is aggravated more and more. So,

sanchita pitta becomes prakupita, this stage is called as a prakopavastha. In this

stage Agnimandya, Ajirna, Amlodgar, Daha, Trushna, Avipaka etc. symptoms are

produced. The symptoms of this stage may be according to main Dosha involved.

Due to involvement of pita & kapha there may be Amlodgara, pipasa, Paridaha,

Annadvesha, Utklesha & Hrillasa developed.

(3) PRASARA:-

If the prakopavastha is not treated, the prasara avastha may start. In this stage

Ahara become shuktibhava due to Mandagni and Ajirna. So Annavisha is produced.

This annavisha is mixed with the pitta Dosha. Mixture of Annavisha and pitta Dosha

circulates in whole body with the help of Ahara Rasa and Dhamanis. So, Rasa Dhatu

is also vitiated in this stage. This type of Mixture is called as samapitta which has a

Conceptual Review


property of Amlarasa. This stage is called as prasaravastha. In this stage main

symptoms are Trishna, jwara and Avipaka.

(4) STHANASANSHRAYA:-

Mixture of Annavisha and pitta Dosha is stayed in Annavaha srotas mainly in

Amashaya. So, the Annavaha srotasa is vitiated. Amlarasa and dravaguna of the pitta

are increased more and more. According to kashayap kapha has also important role

in Amlapitta. This vitiated kapha also staying in pittadhara kala of the Amashaya. So,

in sthanasanshraya avastha, pittadhara kala of the Amashaya is vitiated. In this stage

purvarupa of Amlapitta is produced.

(5) VYAKTI:-

At this stage the symptoms of disease Amlapitta may get well

established and further differentiation in Doshik varieties according to

predominance may be established. The three Doshik predominant subtypes of

Amlapitta mentioned by Acharya Madhavakara i.e. Vatika, Kaphaja and

Vatakaphaja. Madhavakara has also given a separate classification according to the

expulsion root of Doshas i.e. Urdhvaga and Adhoga types.

(6) BHEDA:-

When the disease progresses further it reaches to Bheda avastha. In this stage

various upadravas are manifested such as Jvara, Shotha, Dhatu Ksheenata, Pandu

etc. In this stage pittadhara kala is severely vitiated and the disease is going into

incurable condition.

Conceptual Review


PITTA PRADHANA TRIDOSHA

PRAKOPA

(Increase in Amla and Drava Guna of

Pitta

MANDAGNI

AMA-ANNAVISHA

INCREASED AMLATA IN AMASHAYA

SHUKTA PAKA

VIDAGDHAPAKA

AMLAPITTA

NIDANA SEVANA

AHARAJ

A

VIHARAJ

AA

MANASIK

A

AGANTUJ

A

Conceptual Review


CHARAKOKTA SAMPRAPTI BHEDA:

(1) SANKHYA SAMPRAPTI :-

In sankhya samprapti, Sankhya means the Roga Bheda.

A. Two types according to Gati:52 .

1. Urdhvaga Amlapitta

2. Adhoga Amlapitta

B. According to Dosha Dusti:

1. Vataja

2. Pittaja

3. Kaphaja

C. Kashyapa has given three types of Amlapitta53.

1. Vatolvana

2. Pittolvana

3. Kapholvana

D. Madhavkar has given four types according to main and Anubandhaja

Dosha Dusti Lakshana54.

1. Vatadhika

2. Kaphadhika

3. Vatakaphadhika

4. Shlesmapittaja

(2) VIDHI SAMPRAPTI :-

a) Nija b) Agantuja

a) Swatantra b) Paratantra

Conceptual Review


(3) VIKALPA SAMPRAPTI :-

Vikalpa samprapti means Anshansha kalpana of aggravated dosha

1. Vata - Chala & Rukhsa Guna vriddhi

2. Pitta - Drava, Amla, Usma, tikshana Guna vriddhi

3. Kapha - Guru Guna Vriddhi

(4) PRADHANYA SAMPRAPTI:-

Independence or dependence of the aggravated Dosha

1. Pitta - VriddhatamaKapha - Vriddhatara

2. Vata - Vriddha.

(5) BALA & KALA VISHESHA SAMPRAPTI :-

1. Seasonal aggravation – Varsha, Sharad Ritu.

2. Day – Afternoon

3. Night - Mid-night

Samprapti Ghataka:

The different components producing Amlapitta are as follows:

Dosha Pachaka Pitta, Samana Vayu, Kledaka

Kapha

Dushya Rasa

Agni Agnimandya, Vishamagni

Ama Jatharagnimandyajanya Ama

Udbhava Sthana Amashaya and Pittadharakala

Sanchara Sthana Sarva shareera

Adhisthana Amashaya

Vyakta Sthana Uraha, Kantha, Amashaya etc

Conceptual Review


Srotas Annavaha, Rasavaha, Raktavaha,

Purishavaha

Srotodushti Sanga and Vimarga gamana

Rogamarga Abhyantara

Roga Prakriti Chirakari

DOSHA:

The causative factor for producing the Amlapitta is Pitta. The Amla Guna and

Drava Guna of Pitta is increased and leads to Agnimandya and Ajirna are produced

and finally leads to Amlapitta. According to Shrikanthadutta, the other Doshas like

Vata and Kapha are also involved and responsible for the development of the

symptoms like Gaurava, Klama etc. Kashyapa has mentioned Kapha and Vata dushti

in Amlapitta. Later he described Pitta and Kapha dominancy in Amlapitta.

DUSHYA:

Even though the involvement of Dushya is not mentioned clearly, all the

Acharyas accepted the process of Vidagdhata and Shuktata of the ingested food. Due

to Ajirna and Annavisha, the Rasadhatu is vitiated and produced symptoms like

Klama, Aruchi, Gaurava etc. Kandu, Mandala, Kotha, and Pandu etc. symptoms are

due to vitiation of the Rakta dushti.

AGNI:

Mandagni is the root cause of all the diseases. Various etiological factors like

Aharaja and Viharaja Hetu affect the Jatharagni leading to Jatharagni mandya which

is said to be the initiator for the pathogenesis Amlapitta.

Conceptual Review


AMA:

Charaka has mentioned the Annavisha as the causative factor for Amlapitta.

Annavisha can be considered as one type of Amadosha. In Amlapitta, Agni remains

Manda so Ama is formed. The Ama vitiates the Rasadhatu and Pitta Dosha leads to

pathogenesis of the disease.

UDBHAVA STHANA:

Kashyapa said that the disease is produced at the Amashaya. Amlapitta is

created by Annavisha mixing with Pitta dosha. The Annavisha is produced by the

Agnimandya and Ajirna. So Mandagni is the root cause of the disease Amlapitta.

Kashyapa has given an example for explaining the Amlapitta as the vessel containing

some part of curd or uncleaned vessel which contains Amla rasa when milk is added

to it; it turns to curd and becomes Amla.

ADHISHTHANA:

Amashaya (Urdhwa and Adho) is the Adhishthana for Amlapitta in general.

Bhavaprakasha and Madhavakara have given these types of Sthanadushti. Urdhwa

Amashaya is the Adhishthana for Urdhwaga Amlapitta whereas Adho Amashaya is

the Adhishthana for Adhoga Amlapitta.

VYAKTASTHANA:

The cardinal symptoms of Amlapitta are Uraha-Kantha Daha, Tikta

Amlodgara, Shirashoola etc. Hence these can be termed as the Vyakta Sthana of the

disease Amlapitta.

SROTASA:

Due to Mandagni and Ajirna, the Ahara rasa is semi-digested; Annavisha or

Amadosha will be formed so the vitiation of Rasavaha Srotas is involved. The main

seat of the origin of Amlapitta is in the Annavaha Srotas. Chhardi, Avipaka and

Conceptual Review


Aruchi are the symptoms of Amlapitta and are the cardinal symptoms of Annavaha

Sroto dushti also. Vibandha and Vidbheda are found in these patients, so Purishavaha

Srotas is also vitiated.

SROTODUSHTI LAKSHANA:

The type of Sroto dushti in Amlapitta is Sanga and Vimarga gamana. Sanga

because there will be formation of Ama due to the Vidagdha paka of the Ahara caused

by the Mandagni. Hence the Ama leads to the obstruction to the normal path of the

Pitta and hence the Pitta becomes Urdhwagami in case of Urdhwaga Amlapitta and

leads to the symptoms such as Uraha, Kantha daha, Shirashoola etc.

ROGAMARGA:

The roga marga of the disease amlapitta is abhyantara. All the pathogenesis,

prodromal symptoms are seen mainly in the koshta. Koshta is called as the

abhyantara rogamarga.

PURVARUPA OF AMLAPITTA

The symptoms that arising before the disease known as purvarupa that means

the purvarupas are being appeared before the real manifestation or exhibition of the

disease. The importance of purvarupa is to make accurate diagnosis and to provide

appropriate treatment in early stage. Purvarupa of this disease is not mentioned in any

classical text. While going through the Patient’s history, Ajirna is the common

symptom reported before the actual symptoms of Amlapitta started. The lower

intensity of the cardinal symptoms may be considered here as the purvarupa of

Amlapitta. some of the symptoms of Ajirnn specially vidagdhajirna may be

appearing before the manifestation of disease these may be considered as purvarupa

of Amlapitta. In charaka samhita while describing the samprapti of Grahani, he has

mentioned some purvarupa of Grahani like Trishna, Alasya, Balakshaya,

Conceptual Review


Annavidaha, heaviness of body etc. These symptoms may be considered as the

purvarupa of Grahani as well as of Amlapitta.

RUPAS (SYMPTOMS & SIGNS) OF AMLAPITTA.

Rupa is the Vyaktawastha in which the signs and symptoms of the

disease will be completely manifested. This is much more useful for the

clinical manifestation of a disease. Ancient Acharyas have given detailed

discription about the Rupas of Amlapitta. They have also given specific rupas

according to different types of Amlapitta.

The symptoms of Amlapitta according to Madhav Nidana are

- Avipaka

- Klama

- Hriddaha

- Kantadaha

- Amlodgara

- Tiktodgara

- Utklesha

- Gaurava

- Aruchi55.

Acharya Kashyapa added extra symptoms like Vibheda, Aantrakunjana,

Udaradhamana and Hridshula etc.

Conceptual Review


Table – 4: SAMANYA RUPAS (General Symptoms & Signs).

Sl.No SAMANYA RUPA K.S. M.N B.P Y.R B.S G.N. H.S S.N.

1 Amlodgara(sour

eruction)

- + + + + + + +

2 Tiktodgara(Bitter

eruction)

- + + + + + - -

3 Hrit Daha(Heart

buru)

- + + + + + + +

4 Kantha Daha

(Burning in throat)

+ + + + + + + +

5 Avipaka (Indigestion) - + + + + + - -

6 Klama (Lassitude) - + + + + + - +

7 Utklesha (Nausea) - + + + + + - -

8 Aruchi (Anorexia) - + + + + + - -

9 Gaurava (Heaviness

in body)

- + + + + + - -

10 Shiroruk (Headache) + - - - - - + +

11 Angasada (Fatigue) + - - - - - - -

12 Antrakunjana

(Gargling in intestine)

+ - - - - - - -

13 Vidbheda(Diarrhoea) + - - - - - - -

14 Gurukoshtata + - - - - - - -

15 Romaharsha (Horri + - - - - - - -

Conceptual Review


Pulation)

16 Hritshula (Pain in

heart region)

+ - - - - - - -

17 Urovidaha

(Burning in chest)

+ - - - - - - -

18 Amlotklesh + - - - - - - -

19 Udaradhmana + - - - - - - -

Table – 5: SYMPTOMS OF EKADOSHAJA AMLAPITTA.

No. K.S. M.N. B.P. Y.R. H.S. S.N.

:: Vatika

Angasada + - - - - -

Jrimbha + - - - - -

Shula + - - - - -

Snigdha Upasaya + - - - - -

:: Paittika

Bharma + - - - - -

Sitaupasaya + - - - - -

Svadupasaya + - - - - -

Vidaha + - - - - -

:: Sleshmika

Chhardi + - - - - -

Guruta + - - - - -

Conceptual Review


Ruksha Upasaya + - - - - -

Usma Upasaya + - - - - -

:: Vatadhikya Amlapitta

Bhrama - + + + - +

Cimcimatva - + + + - +

Gatra Sada - + + + - +

Harsha - + + + - +

Murccha - + + + + +

Moha - + + + - +

Pralapa - + + + -

Shula - + + + - +

Tamodarshna - + + + - +

:: Kaphadhikya

Amlapitta

Aruchi - + + + - +

Agnimandya - - - - - -

Gaurava - + + + - +

Jadyata - + + + - +

Kandu - - - - - -

Kaphanisthivana - + + + - +

Lepa - + + + - +

Nidra - - - - - -

Sada - + + + - +

Sheeta - + + + - +

Conceptual Review


Vami - + + + - +

:: Pitta - Sleshma

Amlapitta

Amlodgara - + + + -

Aruchi - + + + - -

Alasya - + + + - -

Bhrama - + + + - -

Chhardi - + + + - -

Hritdaha - + + + - -

Kanthadaha - + + + - -

Kukshidaha - + + + - -

Murchha - + + + - -

Mukha Madhurya - + + + - -

Praseka - + + + - -

Shiroroga - + + + - -

Tikta udgara - + + + - -

(1) AMLA / TIKTA UDGARA:-

The most common symptom of Amlapitta is Amlodgar and Tiktodgara. They

are found due to vitiated pitta Dosha. Prakruta pitta has katu Rasa. But when it

becomes Vidagdha, Katu Rasa is converted in to Amla Rasa. The Amla guna and

Dravaguna of pitta are increased. So Agnimandya and Ajirna are produced. The

Ahara becomes vidagdha in Amashaya and Amla/Tikta udgara are developed.

Conceptual Review


(2) HRIT - KANTHA DAHA:-

The patients of Amlapitta feels burning sensation in the throat, heart and

abdomen. Sometime whole body, palms and soles are also affected. It is due to

vitiated pitta Dosha.

(3) AVIPAKA:-

Mandagni and Ajirna are the roots of Amlapitta. Charaka said that Annavisha

is produced from Ajirna. It mixed with the pitta Dosha and creates the disease.

Avipaka due to Mandagni is automatically generated during and after completion of

the samprapti of Amlapitta and became a symptom.

(4) KLAMA, ANGASADA & GAURAVA:-

Its mean Fatigue without doing any work, lassitude and heaviness in body.

All these symptoms are present due to Amadosha vriddhi in body.

(5) UTKLESHA:-

Utklesha can be correlated with Nausea. It is generated due to Amadosha and

vitiated Kapha - vata Dosha. Aruchi, Avipaka, & Udgara may have some important

role in Utklesha.

(6) ARUCHI:-

Loss of taste of food and loss of interest of food intake both are considered as

an Aruchi. Sushruta said that Aruchi is a disease which has complete loss of interest in

food due to shoka, krodha, Bhayadi manasika Bhavas and vitiated vatadi Doshas that

staying in Jihva and Hridaya.

(7) GURUKOSHTHATA:-

Heaviness in abdomen is called as a Guru Koshthata. It is due to delayed

gastric emptying. Mandagni in Amlapitta is produced by Avipaka and vitiation of

Conceptual Review


vatadi Doshas. This Avipaka and Dosha Dushti are responsible for producing this

symptom.

(8) VIDBHEDA:-

Mala Pravrutti vegas are increased but the total quantity of Mala is

maintained as in normal. Amlapitta is created from Ajirna. Vata Dushti and Mandagni

are the main responsible factors for developing vidbheda.

(9) UDARADHMANA :-

It is found in Amashaya or in Pachyamanashya. The pain or discomfort may

be due to the sanchara of vata in particular organs. The excessive production of vayu

is due to Shuktata bhava of undigested food. Fermentation is accured due to Avipaka

or chirakala paka. Excessive production of vayu leads to increase force upon the wall

of Amashaya & Pachyamanashaya.

(10) SHIRORUK:-

Acharya Kashyapa has given this symptom. Mainly it is associated with

Bhrama in Amlapitta patient. Headache is produced due to vitiated pitta and vata

Dosha. Ajirna & Amadosha, which produces vibandha, are also responsible for it.

Most of the patient of Amlapitta have constipation, which may give a role for

producing shiroruk.

(B) According to Sthana Dusti:-

Table – 6: URDHVAGA AMLAPITTA.

Sl.No SYMPTOMS & SIGNS M.N. B.P. Y.R. B.S. G.N. H.S.

1. Kukshidaha (Burning in

abdome)

+ + + + + -

2. Karacharanadaha(Burning in + + + + + -

Conceptual Review


plam & soul)

3. Kandu (Itching) + + - + + -

4. Pidika (Papules) + + - + + -

5. Mandala (Erythema) + + - + + -

6. Avipaka (Indigestion) + + + - - +

7. Utklesha (Nausea) - - + + - +

8. Klama (Lassitude) + + - + - +

9. Kapha pittaja Jvara (Fever) + + - + + -

10. Mahati Aruchi (Anorexia) + + - + + -

11. Hritdaha (Heart Burn) + + + + + -

12. Kanthadaha(Burning in throat) + + + + + -

13. Abhukte Amlodgara + + + + + -

14. Abhukte Tiktodgara (Bitter

eruction on without food

ingestion)

+ + + + + -

15. Bhukte Vidagdhe Amlodgara

(Sour eruction occurs during

digestive process or after food

intake)

+ + + + + -

16. Bhukte vidagdhe

Tiktodgara(Bitter eruction

occures during digestive

process or after food intake)

+ + + + + -

Conceptual Review


17. Bhuktevidagdhe

Amlavami(Sour vomiting

occurs during digestive process

or after intake of food)

+ + + + + -

18. Bhukte Vidagdhe Tikta Vami + + + + + -

19. Abhukte Amlavami (Sour

Vomiting on empationy

stomach)

+ + + + + -

20. Abhukte Tikta Vami (Bitter

vomiting on empty stomach)

+ + + + + -

21. Vantam Harita

Varnam(Greenish vomiting)

+ + + + + -

22. Vantam peeta

varnam(Yellowish vomiting)

+ + + + + -

23. Vantam Neela varnam(Bluish

vomiting)

+ + + + + -

24. Vantam Krishna Varnam

(Blackish vomiting)

+ + + + + -

25. Vantam Rakta Varnam

(Reddish vomiting)

+ + + + + -

26. Vantam Raktabha Varnam

(Slight reddish vomiting)

+ + + + + -

27. Atyamla vamanam (Excessive

sour vomiting)

+ - + + + -

Conceptual Review


28. Mamsodakabham vaman

(Mutton wash like vomiting)

+ - + + - -

29. Ati picchilam vantam

(Excessive sticky vomiting)

+ + + - + -

30. Achham Vantam (Colourless

vomiting)

+ + + - + -

31. Shleshmanuja Vantam

(vomiting associated with

mucous)

+ + + + + -

32. Vantam Lavana rasam (Salty

vomiting)

+ + + + - -

33. Vantam Katurasam (Pungent

vomiting)

+ + + + - -

34. Vantam Tiktarasam (Bitter

vomiting)

+ + + + - -

35. Matsyodakabham vamana - + - - + -

Urdhvaga Amlapitta

Urdhvaga Amlapitta is vamana pradhana, in this type vamana is the

presenting symptom. The vomitus may be of various colors.

Harita & peeta varnayukta chardi may be due to the presence of bile.

Krishna varnayukta chardi is due to occult blood.

Raktabh chardi is due to presence of excessive blood. It suggests, hemorrhage

or perforation in Amashaya.

Conceptual Review


Amla vamana is due to excessive acid.

When Vitiated pitta Dosha combines with Ama in to the Bahya-Rogamarga,

then it produces kandu, pidika & Mandala.

Urdhvaga Amlapitta tends to affect the Annavaha srotas predominantly.

ADHOGA AMLAPITTA

In Adhoga Amlapitta sthanadushti occurs in the Adhoamashaya &

Pakvashaya. All the symptoms of pittaja Grahani are similar to the Adhoga

Amlapitta.

Table – 7: ADHOGA AMLAPITTA

Sl.No SYMPTOMS & SIGNS M.N. B.P. Y.R. H.S. B.S. G.N.

1. Nanavidha Adhah pravrutti

(fluids eliminated through rectum

in various colors)

+ + + + + +

2. Trushna (Excessive thirst) + + + + + +

3. Daha (Burning) + + + + + +

4. Murccha (Fainting) + + + + + +

5. Bhrama (Giddiness) + + + + + +

6. Moha (Fainting) + + + + + +

7. Analasada (poor digestive power) + + + + + +

8. Hrillasa (Nausea) + + + + + +

9. Sweda(Excessive perspiration) + + + + + +

10. Angapeetata (Yellowsh disease-

coloration of body)

+ + + + + +

Conceptual Review


Nanavidha Adhah pravrutti is the main clinical feature of Adhoga Amlapitta.

Nanavidha Adhah pravrutti means passing of different types of stool in color, smell,

quantity, quality etc. It is due to vitiated pitta Dosha that creates the Dushti of

pakvashaya & Adhoamashaya. It leads to Dhatukshaya. So patient suffering from

other symptoms like Trushna, Bhrama, Kotha, Moha etc.

UPASHAYANUPASHYA OF AMLAPITTA:-

Those factors which relieve and aggravate the signs and symptoms of the

disease are known as a Upashaya and Anupashaya of the specific disease. The disease

which difficult to diagnose can be diagnosed easily by the upashayanupashaya.

Vataja : Snigdha dravyas relieve the symptoms.

Pittaja : Swadu and Sheeta dravyas relieve the symptoms.

Kaphaja : Ruksha and Ushna dravyas relieve the symptoms56.

UPDRAVAS OF AMLAPITTA5 :-

In the progressive stage, if the Nidana sevana continues, samprapti spreads to

other Adhisthana causing different disease or symptoms other than pertaining to

Amlapitta. Kashyapa has given the upadravas of Amlapitta.

Jwara, Atisara, Pandu, Shula, Shotha, Aruchi, Bhrama, Kshina dhatavaha57.

TABLE NO – 8: UPADRAVAS

Sl.No. UPADRAVAS K.S. S.N.

1. Jvara (fever) + -

2. Atisara (Diarrhoea) + -

3. Pandu (Anemic condition) + -

4. Shotha (Odema) + -

Conceptual Review


5. Aruchi (Anorexia) + -

6. Vibhrama (Hallucination) + -

7. Kshina dhatvah + -

8. Shita - pitta - +

9. Shoola + -

10. Udarda - +

11. Kotha - +

12. Kandu - +

13. Mandala - +

14. vicharchika - +

15. Visphota - +

16. Amashayakshata - +

17. Grahani Kshata - +

18. Grahani Roga - +

SADHYA - SADHYATA OF AMLAPITTA:-

Acharya Kashyapa has given a reference on sadhya asadhyata of Amlapitta.

Kashypa said that when disease is of short duration then it is Sukhasadhya, it is Yapya

when chronic, when patient suffering from jvara, Atisara, Pandu, Shoola, Bhrama,

Dhatukhseenata etc. Updravas, it is incurable stage57. Amlapitta is a chronic disease it

has complicated pathogenesis. Samprapti vighatana is so difficult. So, curability of

Amlapitta has getting great efforts. Vangsena said that when Amlapitta is in acute

condition it is curable when it becomes chronic it is yapya or kruchrasadhya.

Madhavakara has pointed out that in case the patient has been suffering from

Amlapitta recently and is treated properly the prognosis is good. Chronic cases may

Conceptual Review


either improve a little or may be relieved completely during the course of treatment.

As soon as the patient deviates from the wholesome diet the disease relapses58.

TABLE NO: 9 - SAPEKSHA NIDANA

Amlapitta

Vidagdhajirna

Annadrava

shoola

Parinama Shoola

- Tikta Amla

udgara

- Hrit kanta daha

-Upashaya by

madhura/sheeta

dravya

- Sadhuma –

Amla udgara -

Upashaya by

shunti/pippali

churna

- Shoola occurs

before

digestion,

during digestion

and after

digestion. ie.

Jeerna jeeryate

ajeerna va yath

shulam

upajayate.

- Pathyapathya

Prayogena

bhojana

Abhojanena cha

na Shamam

yati.

-shoola occurs only

during

pachyamanavastha

and period of food

intake. i.e. bhukte

jeeryate yat shulam

tadeva

parinamajam.

- Relieves after

digestion of food

or by vomiting.

Conceptual Review


- Sometimes

feels better due

to vomiting of

vitiated pitta

Associated symptoms

Avipaka Klama

Utklesha Aruchi

Gaurava

Bhrama Trishna

Murcha Ruja

Sweda Daha

Amlodgara Hrit

kanta daha

Chardi may be

present Black

stool present

Amlodgara Hrit

kanta daha Chardi

may be present

Black stool present

Others

Mala pravrutti

may be prakrita/

drava/ vibandha

This is a chronic

disease Chardi

may be present

Chardi may be

present Acute

disease

Prognosis-sukha

sadhya

Chronic

disease

Prognosis

– krichra

sadhya or

yapya

Chronic disease

Prognosis –

krichra sadhya

or yapya

Conceptual Review


Prognosis-

krichra sadhya

Dosha

Pitta (Amla, Drava guna) Kapha

(Manda, Sheeta Guna) Pitta (Ushna)

Tridoshaja

Pitta predominant

tridosha

Dushya

Rasa, Rakta

Rasa

Rasa

Rasa

Srotas

Annavaha

Rasavaha

Raktavaha and

Purishavaha

Annavaha

Rasavaha

Purishavaha

Annavaha and

Raktavaha

Rasavaha

Purishavaha

Annavaha and

Raktavaha

Sroto dushti

Vimarga gamana

Atipravrutti

Vimarga

gamana

Atipravrutti

Vimarga

gamana

Vimarga gamana

Methodology


MATERIALS AND METHODS:

SOURCE OF DATA:

Patients attending both OPD and IPD of Jayachamarajendra Institute of

Indian Medicine and Hospital, Bengaluru will be screened for study.

METHODS OF COLLECTION OF DATA:

A minimum of 50 patients who are fulfilling the criteria for diagnosis

and inclusion will be selected for the study randomly irrespective of

sex, religion, educational, professional background and economic

status.

A special case proforma will be prepared with details of history taking,

physical signs and symptoms as mentioned in our classics and allied

science.

The study will be done using a structured questionnaire which will

have the factors covering ahara, vihara, occupation etc.

DIAGNOSTIC CRITERIA

Avipaka(indigestion)

Klama(exhaustion)

Utklesha(nausea)

Tiktaamlaudgara(eructations with bitter eructation)

Hrit-kanthadaha(burning sensation in chest and throat region)

Aruchi(anorexia)

METHODOLOGY

Methodology


INCLUSION CRITERIA

Patients of either sex of age group above 20yrs and below 60yrs.

Patients with signs and symptoms of Amlapitta.

EXCLUSION CRITERIA

Patient of age less than 20 and above 60 years

Chronicity of more than 5 years

Patients having Annadrava and Parinamashula

Pregnancy

Patients who are underwent surgery for GIT lesions.

Patient having any endocrine disorders or chronic complicated

diseases.

ASSESSMENT CRITERIA

Subjective criteria - Lakshanas of Amlapitta W.S.R to Hyperacidity

AVIPAKA:

No Avipaka 0

Prolongation of food digestion period + 1

occasionally related to heavy meals.

Daily after each meals and four to six hours for + 2

Udgara shuddhi Lakshanas

Eats only once in a day and does not + 3

have hunger by evening.

Methodology


KLAMA:

No Klama. 0

Occasionally feeling of Klama. + 1

Klama daily for short duration. + 2

Klama Daily for long duration. + 3

UTKLESHA:

No Utklesha 0

Presence of Utklesha with contents coming to the throat + 1

Presence of Utklesha with vomiting + 2

TIKTA-AMLAUDGARA:

No Tikta-Amlaudgara 0

Appears on consumption of Sour and Spicy food + 1

Appears on consumption of any type of food + 2

GAURAVA:

No Gauravata 0

Occasionally feeling of heaviness of the body

which do not affect the routine work. + 1

Daily feeling of heaviness over body,

which leads to Akarmanyata. + 2

HRIT-KANTADAHA:

Not present 0

Present Occasionally + 1

Daha occurs daily for one hour or more. + 2

Methodology


ARUCHI:

Absent. 0

Totally unwilling for meal. + 1

Unwilling for food but could take the meal. + 2

TAMA

No feeling of Tama 0

Occasional feeling of Tama + 1

Feeling of Tama < 2-3 times a day + 2

Many times a day with problem in Maintaining

posture, tries to sit. + 3

ADHMANA

No Adhmana 0

Occasionally feelings of distension of abdomen + 1

Daily distension of abdomen after intake of food

upto 1 hour + 2

Distension of abdomen up to 1 -3 hours after

intake of food + 3

Moderate distension of abdomen up to 6 hours

after intake of food + 4

Methodology


TABLE NO: 10 - HYPERACIDITY QUESTIONNAIRE

Symptoms Inensity Frequency

Lack of Appetite 0 -- No Symptoms

1 -- Symptoms noticeable, but not

bothersome

2—Symptoms noticeable and othersome,

but not every day

3 -- Symptoms bothersome every day

4 -- Symptoms affect daily activities

5 -- Symptoms are incapacitating, unable

to do daily activities

0 -- none

1 -- once a year

2 -- less than once a

month

3 – once a month

4 – once a week

5 – several times

during the week

6 – daily

Indigestion

Constipation

Sour Belching

Actual Vomiting

Feeling of restlessness

Stiffness in the stomach

Bloating

Flatulence

Headache

Excessive burping

Observation And Result


In the present study 50 patients fulfilling the diagnostic and inclusion criteria were

registered.

Table No – 11: - Distribution based on Age

Age Number of

Patients

Percentage %

20-30 yrs 14 28

31-40 yrs 20 40

41-50 yrs 11 22

51-60 yrs 5 10

In the present study maximum number of patients i.e. 40% belonged to the age group

of 31-40 years followed by 28% patients belonged to the age group 20-30 years.

Table No – 12: Distribution based on Gender

Gender Number of

Patients

Percentage %

Male 27 54

Female 23 46

The sample taken for the study shows 54% of the patients were males in comparison

to 46% of the females

OBSERVATION



Table No – 13: Distribution based on Religion

Religion Number of

Patients

Percentage %

Hindu 39 78

Muslim 8 16

Christian 3 6

The sample taken for the study shows 78% of the patients were Hindu, 16% of the

patients were Muslim, 6% were Christians.

Table No – 14: Distribution based on Education

Education Number of

Patients

Percentage %

Illiterate 6 12

High School 5 10

PUC 6 12

Graduate 13 26

Post graduate 20 40

This study shows that maximum number of patients i.e. 40% were Post graduates,

26% were Graduates, 12% were Illiterate.



Table No : 15 - Distribution based on Occupation

Occupation Number of

Patients

Percentage %

House wife 7 14

Service 25 50

Business 12 24

Student 6 12

This study shows that maximum number of patients i.e. 50% belonged to Service,

followed by 24% belonged to Business, 14% were House wife and 12% were

Students.

Table No: 16 - Distribution based on Socio-economic status

Socio-economic

status

Number of

Patients

Percentage %

Poor 6 12

Lower Middle 10 20

Upper middle 21 42

Rich 13 26

This study shows that maximum number of patients i.e. 42% belonged to Upper

Middle class, 26% belonged to Rich 20% belonged to Lower Middle and 12% were

Poor

.



Table No: 17 - Distribution based on Habitat

Habitate Number of

Patients

Percentage %

Urban 30 60

Rural 20 40

This study shows that maximum number of patients i.e. 60% belonged to Urban followed by

40% belonged to Rural area.

Table No: 18 - Distribution based on Marital Status

Marital status Number of

Patients

Percentage %

Married 36 72

Unmarried 14 28

This study shows that maximum number of patients i.e.72 % were married and 28% were

unmarried.s

Table No: 19 - Distribution based on Desha

Desha Number of

Patients

Percentage %

Anupa

12 24

Sadarana

32 64

Jangala

6 12



This study shows that maximum number of patients i.e. 64% belonged to

Sadaranadesha followed by 24% belonged to Anupadesha and 12% belonged to

Jangaladesha.

Table No: 20 - Distribution based on Prakriti

Prakriti Number of

Patients

Percentage %

Vatapitta

30 60

Pittakapha

8 16

Vatakapha

12 24

This study shows that maximum number of patients i.e. 60% belonged to

Vatapittaprakriti, followed by 24% of patients belonged to Vatakaphaprakriti and

16% of patients belonged to Pittakaphaprakriti

Table No: 21 - Distribution based on Diet Pattern

Diet Number of

Patients

Percentage %

Mixed

33 66

Vegetarian

17 34

In this study majority of the patients i.e. 66% were consuming mixed diet in

comparison to the patients i.e. 34% consuming vegetarian diet.



Table No: 22 - Distribution based on Pattern of Food Intake

Pattern of

food

Number of

Patients

Percentage %

Adhyashana

11 22

Vishamashana

13 26

None

26 52

Majority of the patient’s i.e.52% were taking food regularly, followed by 26% of

patients with Vishamashana and 22% of patients with Adhyashana.

Table No: 23 - Distribution based on Appetite

Appetite Number of

Patients

Percentage %

Not Altered

21 41

Reduced

29 56

In the present study maximum number of patients i.e. 56% had reduced appetite and

41% of the patients appetite was not altered.

Table No: 24 - Distribution based on Bowel

Bowel Number of

Patients

Percentage %

Prakruta Mala 20 40

Drava Mala 3 6

Baddha Mala 27 54



In this study maximum number of patients i.e. 54% had Baddha mala pravrutti, 6% of

patients had Drava mala pravrutti and 40% of patients had prakruta mala pravrutti.

Table No: 25 - Distribution based on Koshta

Koshta Number of

Patients

Percentage %

Mridu

6 12

Madhyama

31 62

Krura

12 24

Above table shows that maximum number of patients i.e.62% had Madhyamakoshta,

followed by 24% of patients had Krurakoshta and 12% of patients had Mridukoshta.

Table No: 26 - Distribution based on Tea Intake

Tea Intake Number of

Patients

Percentage %

1-3 times/day

14 28

4-6 times/day 2 4

6-8 times/day 1 2

Among 34% of patients consuming Tea, 28% of patients were consuming 1-3

times/day, 4% of patients were consuming 4-6 times/day and 2% of patients were

consuming 6-8% times/day



Table No: 27 - Distribution based on Coffee Intake

Coffee Number of

Patients

Percentage %

1-3 times/day

24 48

4-5 times/day 6 12

6-7 times/day 3 6

Among 66% of patients consuming Coffee, 48% of patients were consuming 1-3

times/day, 12% of patients were consuming 4-5 times/day and 6% of patients were

consuming 6-7 times/day.

Table No: 28 - Distribution based on Smoking

Smoking Number of

Patients

Percentage %

1-5 times/day 9 18

6-10 times/day 4 8

15-20 times/day 2 4

21-25 times/day 1 2

25-30 times/day 2 4

Among 36% of patients Smoking, maximum number of patients i.e. 18% were

Smoking 1-5 times/day, 8% were smoking 6-10 times/day, followed by 4% 15-20

times and 25 -30 times/day.



Table: 29 - Distribution based on Tobacco Chewing

Tobacco Number of

Patients

Percentage %

1-2

Packets/day

7 14

In this study 14% of patients were chewing Tobacco.

Table No: 30 - Distribution based on Alcohol

Alcohol Number of

Patients

Percentage %

Daily 6 12

Frequently 14 28

Sometimes 3 6

Occasionally 4 8

Among 54% of patients consuming alcohol, maximum number of patients i.e. 28%

were consuming frequently, 12% were consuming daily, 6% were taking sometimes

and 8% occasionally.

Table No: 31 - Distribution based on Sleep

Sleep Number of

Patients

Percentage %

Sound 19 38

Disturbed 31 62



In this study maximum number of patients i.e. 62% had Disturbed sleep and 38% of

patients had sound sleep pattern.

Table No: 32 - Distribution based on Heated Honey

Heated honey Number of

Patients

Percentage %

Frequently 4 8

Occasionally 2 4

Among 12% of patients consuming heated honey, 8% of patients were taking

frequently and 4% of patient was taking occasionally

Table No: 33 - Distribution based on Curd at Night

Curd at night Number of

Patients

Percentage %

Daily 5 10

Frequently 11 22

Sometimes 3 6

Occasionally 5 10

Among 48% of patients consuming curd at night, maximum number of patients i.e.

22% were consuming frequently. Followed by 10% of patients were consuming daily

and 6% sometimes.



Table No: 34 - Distribution based on Consuming cold water

immediately after taking hot tea or coffee

Consuming cold water

immediately after taking

hot tea or coffee

Number of

Patients

Percentage

%

Daily 4 8

Sometimes 3 6

In this study 6% of patients were consuming cold water immediately after

taking hot tea or coffee sometimes and 8% daily.

Table No: 35 - Distribution based on Sour fruits with milk

Fruits with

milk

Number of

Patients

Percentage %

Frequently 6 12

Sometimes 3 6

In this study 12% of patients were taking sour fruits with milk frequently and

6% were taking sometimes.

Table No: 36 - Distribution based on Milk with curd

Milk with

curd

Number of

Patients

Percentage %

Frequently 2 4

Sometimes 3 6



In this study 6% of patients were taking milk with curd sometimes and 4% of

patients were taking frequently.

Table No: 37 - Distribution based on Unformed curd

Unformed

curd

Number of

Patients

Percentage %

Sometimes 1 2

Among 50 patients only 1 patient was consuming unformed curd sometimes

Table No: 38 - Distribution based on Amlatakra

Amlatakra Number of

Patients

Percentage %

Daily 5 10

Frequently 23 46

Sometimes 6 12

Occasionally 16 32

Maximum number of patients i.e. 46% were consuming frequently followed

by 32% occasionally.



Table No: 39 - Distribution based on Curd

Curd Number of

Patients

Percentage %

Daily 10 20

Frequently 21 42

Sometimes 12 24

Occasionally 7 14

Maximum number of patients i.e. 42% were consuming curd frequently

followed by 24% were consuming sometimes and 20% daily.

Table No: 40 - Distribution based on Sugar Cane Juice

Sugar cane

juice

Number of

Patients

Percentage %

Frequently 3 6

Occasionally 8 16

Among 22% of patients consuming sugarcane juice, maximum number of

patients i.e. 16% were consuming occasionally followed by 6% frequently



Table No: 41 - Distribution based on Pepper

Pepper Number of

Patients

Percentage %

Daily 1 2

Frequently 9 18

Sometimes 11 22

Occasionally 19 38

Among 80 % of patients consuming pepper, maximum number of patients i.e. 38%

were consuming occasionally followed by 22% were consuming sometimes.

Table No: 42 - Distribution based on Unripe And Sour Mango

Unripe and

sour mango

Number of

Patients

Percentage %

Frequently 1 2

Sometimes 3 6

Occasionally 7 14

Among 22% of patients consuming unripe and sour mango, maximum number of

patients i.e. 14% were consuming occasionally followed by 6% sometimes.



Table No: 43 - Distribution based on Sour Mosambi

Sour Mosambi Number of

Patients

Percentage %

Frequently 6 12

Sometimes 16 32

Occasionally 3 6

Among 50% of patients consuming sour mosambi, maximum number of patients i.e.

32% were consuming sometimes followed by 12% were consuming frequently and

6% were consuming occasionally.

Table No: 44 - Distribution based on Sour Orange

Among 44% of patients consuming sour orange, maximum number of patients i.e.

22% were consuming sometimes followed by 14% were consuming occasionally.

Sour Orange Number of

Patients

Percentage %

Frequently 4 8

Sometimes 11 22

Occasionally 7 14



Table No: 45 - Distribution based on Citrus Lemon

Among 94% of patients consuming citrus lemon, maximum number of patients i.e.

42% were consuming occasionally followed by 38% were consuming sometimes.

Table No: 46 - Distribution based on Sesame

In this study 14% of patients were consuming sesame occasionally.

Table No: 47 - Distribution based on Puffed Rice

Citrus Lemon Number of

Patients

Percentage %

Daily 2 4

Frequently 5 10

Sometimes 19 38

Occasionally 21 42

Sesame Number of

Patients

Percentage %

Occasionally 7 14

Puffed rice Number of

Patients

Percentage %

Daily 1 2

Frequently 4 8

Sometimes 17 34

Occasionally 6 12



Among 56% of patients consuming puffed rice, maximum number of patients i.e.

34% were consuming sometimes followed by 12% were consuming occasionally.

Table No: 48 - Distribution based on Battened Rice

Among 62% of patients consuming battened rice, maximum number of patients i.e.

32% were consuming sometimes followed by 26% were consuming frequently.

Table No: 49 - Distribution based on Black Gram

Battened rice Number of

Patients

Percentage %

Frequently 13 26

Sometimes 16 32

Occasionally 2 4

Black gram Number of

Patients

Percentage %

Daily 1 2

Frequently 32 64

Sometimes 9 18

Occasionally 5 10



Among 94% of patients consuming black gram, maximum number of patients i.e.

64% were consuming frequently, followed by 18% were consuming sometimes and

10% occasionally.

Table No: 50 - Distribution based on Horse Gram

Among 84% of patients consuming horse gram, maximum number of patients i.e.

46% were consuming sometimes followed by 28% were consuming frequently.

Table No: 51 - Distribution based on Chicken

Among 70% of patients consuming chicken, maximum number of patients i.e. 48%

were consuming frequently followed by 18% were consuming sometimes.

Horse gram Number of

Patients

Percentage %

Frequently 14 28

Sometimes 23 46

Occasionally 5 10

Chicken Number of

Patients

Percentage %

Daily 1 2

Frequently 24 48

Sometimes 9 18

Occasionally 1 2



Table No: 52 - Distribution based on Fish

Among 48% of patients consuming fish, maximum number of patients i.e. 26% were

consuming frequently followed by 12% were consuming sometimes.

Table No: 53 - Distribution based on Pork

Among 16% of patients consuming pork, 10% of patients were consuming frequently

followed by 4% were consuming sometimes and 2% occasionally.

Fish Number of

Patients

Percentage %

Daily 1 2

Frequently 13 26

Sometimes 6 12

Occasionally 4 8

Pork Number of

Patients

Percentage %

Frequently 5 10

Sometimes 2 4

Occasionally 1 2



Table No:54 - Distribution based on Avimamsa

Among 48% of patients consuming avimamsa, maximum number of patients i.e. 22%


Table No: 55 - Distribution based on Ajamamsa

Among 76% of patients consuming ajamamsa, maximum number of patients i.e. 44%


Avimamsa Number of

Patients

Percentage %

Daily 3 6

Frequently 11 22

Sometimes 7 14

Occasionally 3 6

Ajamamsa Number of

Patients

Percentage %

Frequently 22 44

Sometimes 13 26

Occasionally 3 6



Table No: 56 - Distribution based on Atilavana

Among 60% of patients consuming atilavanaahara, maximum number of patients i.e.

48% were consuming daily followed by 12% frequently.

Table No: 57 - Distribution based on Atikatu

Among 74% of patients consuming atikatuahara, maximum number of patients i.e.

60% were consuming daily followed by 12% frequently.

Atilavana Number of

Patients

Percentage %

Daily 24 48

Frequently 6 12

Atikatu Number of

Patients

Percentage %

Daily 30 60

Frequently 6 12

Sometimes 1 2



Table No: 58 - Distribution based on Atiamla

Among 44% of patients consuming atiamlaahara, maximum number of patients i.e.

38% were consuming daily followed by 2% were consuming frequently.

Table No: 59 - Distribution based on Deep Fried

In this study maximum number of patients i.e. 46% were consuming frequently

followed by 30% were consuming sometimes.

Atiamla Number of

Patients

Percentage %

Daily 19 38

Frequently 1 2

Sometimes 1 2

Occasionally 1 2

Deep Fried Number of

Patients

Percentage %

Daily 2 4

Frequent 23 46

Sometimes 15 30

Occasionally 10 20



Table No: 60 - Distribution based on Stale Food

Among 48% of patients consuming stale food, maximum number of patients i.e. 22%

were consuming frequently and 18% occasionally.

Table No: 61 - Distribution based on Viharaja Nidana

In this study 10% of patients were doing vegadharana, 54% of patients were sleeping

soon after food, 24% of patients were doing divaswapna and 8% of patients were

doing excess fasting.

Stale food Number of

Patients

Percentage %

Daily 3 6

Frequently 11 22

Sometimes 1 2

Occasionally 9 18

Vihara Number of

Patients

Percentage %

Vegadharana 5 10

Sleeping soon after

food intake

27 54

divasswapna 12 24

Excess fasting 4 8



Table No: 62 - Distribution based on Haritakashaka

Among 92% of patients consuming haritakashaka, maximum number of patients i.e.

40% were consuming frequently followed by 26% sometimes.

Table No: 63 - Distribution based on Beetle Leaf

Among 24% of patients consuming beetle leaf, maximum number of patients i.e.10%

were consuming occasionally, 6% were consuming frequently and 4% Daily.

Haritakashaka Number of

Patients

Percentage %

Daily 5 10

Frequently 20 40

Sometimes 13 26

Occasionally 8 16

Beetle leaf Number of

Patients

Percentage %

Daily 2 4

Frequently 3 6

Sometimes 2 4

Occasionally 5 10



Table No: 64 - Distribution based on Atiudakapana/ Antarodakapana

In this study 72% of patients were drinking more water in between the food,

maximum number of patients i.e. 60% were drinking daily and 12% sometimes.

Table No: 65 - Distribution based on Manasika Nidana

In this study 44% of patients had Excess Anger, 24% of patients had Excess Grief and

12% of patients had Excess Fear.

Atiudakapana Number of

Patients

Percentage %

Daily 30 60

Sometimes 6 12

ManasikaNidana Number of

Patients

Percentage %

Excess Anger 22 44

Excess Grief 12 24

Excess Fear 6 12



Table No: 66 - Distribution based on Lakshanas

The data of the present series reveals that 76% of patients had Amlodgara, 74% of

patients had Hritdaha, 60% of patients had Klama, 60% of patients had Utklesha, 72%

of patients had Avipaka, 18% of patients had Tiktaudgara, 28% of patients had

Aruchi, 14% of patients had Kantadaha, and 20% of patients had Gourava.

Lakshanas Number of

Patients

Percentage %

Avipaka 36 72

Klama 30 60

Utklesha 30 60

Tiktaudgara 19 18

Amlaudgara 38 76

Gourava 10 20

Hritdaha 37 74

Kantadaha 7 14

Aruchi 14 28



Table No: 67 - Distribution based on Hyperacidity Questionnaire

In this study 28% of patients had Lack of appetite, 72% of patients had Indigestion,

52% of patients had Constipation, 76% of patients had Sour belching, 22% of patients

had Actual vomiting, 60% of patients had Feeling of restlessness, 52% of patients had

Bloating, 48% of patients had Flatulence, 28% of patients had Headache, 60% of

patients had Excessive Burping.

Symptoms Number of

Patients

Percentage %

Lack of Appetite 14 28

Indigestion 36 72

Constipation 26 52

Sour Belching 38 76

Actual Vomiting 11 22

Feeling of restlessness 30 60

Bloating 26 52

Flatulence 24 48

Headache 14 28

Excessive burping 30 60



GRAPH NO.1- DISTRIBUTION OF PATIENTS BASED ON AGE

GRAPH NO.2- DISTRIBUTION OF PATIENTS BASED ON GENDER

GRAPH NO. 3- DISTRIBUTION OF PATIENTS BASED ON RELIGION

0

5

10

15

20

20-30yrs

31-40yrs

41-50yrs

51-60yrs

1420

115

AGEWISE DISTRIBUTION

Number ofPatients

20

22

24

26

28

Male Female

27 23

GENDER WISE DISTRIBUTION

Number ofPatients

39

8

3

RELIGION WISEDISTRIBUTION

Hindu

Muslim

Christian



GRAPH NO.4- DISTRIBUTION OF PATIENTS BASED ON EDUCATION

GRAPH NO.5- DISTRIBUTION OF PATIENTS BASED ON OCCUPATION

GRAPH NO.6- DISTRIBUTION OF PATIENTS BASED ON SOCIO

ECONOMIC STATUS

0

5

10

15

20

6 5 6

13

20

EDUCATION

Number ofPatients

7

25

12

6

OCCUPATION WISE DISTRIBUTION

House wife

Service

Business

Student

6

10

21

13

SOCIO-ECONOMIC STATUS

Poor

Lower Middle

Upper middle

Rich



GRAPH NO.7- DISTRIBUTION OF PATIENTS BASED ON OCCUPATION

GRAPH NO.8- DISTRIBUTION OF PATIENTS BASED ON MARITAL

STATUS

GRAPH NO.9- DISTRIBUTION OF PATIENTS BASED ON DESHA

3020

HABITAT

Urban

Rural

36

14

MARITAL STATUS

Married

Unmarried

0

10

20

30

40

12

32

6

DESHA

Number ofPatients



GRAPH NO.10- DISTRIBUTION OF PATIENTS BASED ON PRAKRUTI

GRAPH NO.11- DISTRIBUTION OF PATIENTS BASED ON DIET

GRAPH NO.12- DISTRIBUTION OF PATIENTS BASED ON PATTERN OF

FOOD INTAKE

0

10

20

30

30

8 12

PRAKRUTI

Number ofPatients

0

20

40

Mixed Vegetarian

33 17

DIET

Number ofPatients

0

20

40

11 1326

PATTERN OF FOOD INTAKE

Number ofPatients



GRAPH NO.13- DISTRIBUTION OF PATIENTS BASED ON APPETITE

GRAPH NO.14- DISTRIBUTION OF PATIENTS BASED ON BOWEL

GRAPH NO.15- DISTRIBUTION OF PATIENTS BASED ON KOSHTA

0

10

20

30

Not Altered Reduced

2129

APPETITE

Number ofPatients

0

10

20

30

PrakrutaMala

BaddhaMala

Dravamala

2027

3

BOWEL

Number ofPatients

6

31

12

KOSHTA

Mridu

Madyama

Krura



GRAPH NO.16- DISTRIBUTION OF PATIENTS BASED ON TEA INTAKE

GRAPH NO.17- DISTRIBUTION OF PATIENTS BASED ON COFFEE

CONSUMPTION

GRAPH NO.18- DISTRIBUTION OF PATIENTS BASED ON SMOKING

14

21

TEA INTAKE

1-3 times/day

4-6 times/day

6-8 times/day

0

5

10

15

20

25

1-3times/day

4-5times/day

6-7times/day

24

63

COFFEE INTAKE

Number ofpatients

9

4

21

2

SMOKING

1-5 times/day

6-10 times/day

15-20 times/day

21-25 times/day

25-30 times/day



GRAPH NO.19- DISTRIBUTION OF PATIENTS BASED ON SLEEP

GRAPH NO.20- DISTRIBUTION OF PATIENTS BASED ON HEATED

HONEY

GRAPH NO.21- DISTRIBUTION OF PATIENTS BASED ON CURD AT

NIGHT

0

20

40

Anupa Sadarana

1232

SLEEP

Number ofPatients

4

2

HEATED HONEY

Frequently

Occasionally

5

11

3

5

CURD AT NIGHT

Daily

Frequently

Sometimes

Occasionally



GRAPH NO.22- DISTRIBUTION OF PATIENTS BASED ON

CONSUMING COLD WATER IMMEDIATELY AFTER TAKING

HOT TEA OR COFFEE

GRAPH NO.23- DISTRIBUTION OF PATIENTS BASED ON SOUR

FRUITS WITH MILK

GRAPH NO.24- DISTRIBUTION OF PATIENTS BASED ON MILK

WITH CURD

43

Consuming cold water immediately

after

taking hot tea or coffee

Daily

Sometimes

0

2

4

6

FrequentlySometimes

6

3

SOUR FRUITS WITH MILK

Number ofpatient

2

3

MILK WITH CURD

Frequently

Sometimes



GRAPH NO.25- DISTRIBUTION OF PATIENTS BASED ON AMLA

TAKRA

GRAPH NO.26- DISTRIBUTION OF PATIENTS BASED ON CURD


SUGAR CANE JUICE

05

10152025

5

23

616

AMLA TAKRA

Number ofpatients

0

5

10

15

20

25

10

21

127

CURD

Number ofPatients

0

5

10

Frequently Occasionally

38

SUGARCANE JUICE

Number ofPatients



GRAPH NO.28- DISTRIBUTION OF PATIENTS BASED ON UNRIPE

AND SOUR MANGO

GRAPH NO.29- DISTRIBUTION OF PATIENTS BASED ON SOUR

MOSAMBI


SOUR ORANGE

02468

13

7

UNRIPE AND SOUR MANGO

Number ofpatients

05

101520

616

3

SOUR MOSAMBI

Number of Patients

02468

1012

4

117

SOUR ORANGE

Number of Patients




CITRUS LEMON

GRAPH NO.32- DISTRIBUTION OF PATIENTS BASED ON PUFFED

RICE

GRAPH NO.33 - DISTRIBUTION OF PATIENTS BASED ON

BATTENED RICE

05

10152025

25

19 21

CITRUS LEMON

Number of patients

05

101520

14

176

PUFFED RICE

Number of Patients

0

5

10

15

20

13 16

2

BATTENED RICE

Number of patients



GRAPH NO.34- DISTRIBUTION OF PATIENTS BASED ON BLACK

GRAM

GRAPH NO.35- DISTRIBUTION OF PATIENTS BASED ON HORSE

GRAM


CHICKEN

0

10

20

30

40

1

32

95

BLACK GRAM

Number ofpatients

0

20

40

1423

5

HORSE GRAM

Number ofPatients

05

10152025

1

24

9

1

CHICKEN

Number ofpatients




FISH

GRAPH NO.38- DISTRIBUTION OF PATIENTS BASED ON PORK


AVIMAMSA

0

5

10

15

1

13

64

FISH

Number of patients

52

1

PORK

Frequently

Sometimes

Occasionally

02468

1012

3

117

3

AVIMAMSA

Number ofpatients



GRAPH NO.40- DISTRIBUTION OF PATIENTS BASED ON AJAMAMSA

GRAPH NO.41- DISTRIBUTION OF PATIENTS BASED ON ATILAVANA

GRAPH NO.42- DISTRIBUTION OF PATIENTS BASED ON ATIKATU

05

10152025

2213

3

AJAMAMSA

Number ofpatients

0

5

10

15

20

25

Daily Frequently

24

6

ATILAVANA

Number ofpatients

0

10

20

30

Daily Frequently Sometimes

30

6

1

ATIKATU

Number of patients



GRAPH NO.43- DISTRIBUTION OF PATIENTS BASED ON ATIAMLA

GRAPH NO.44- DISTRIBUTION OF PATIENTS BASED ON DEEP

FRIED FOODS

GRAPH NO.45- DISTRIBUTION OF PATIENTS BASED ON STALE

FOODS

0

20

19

1 1 1

ATIAMLA

Number ofpatients

05

10152025

223

15 10

DEEP FRIED FOODS

Number ofpatients

02468

1012

3

11

1

9

STALE FOOD

Number ofpatients




VIHARAJA NIDANA


MANASIKA NIDANA


HARITAKA SHAKA

0

20

40

527

12 4

VIHARAJA NIDANA

Number ofpatients

2212

6

MANASIKA NIDANA

Excess Anger

Excess Grief

Excess Fear

05

101520

5

2013

8

HARITAKA SHAKA

Number ofpatients



GRAPH NO.49- DISTRIBUTION OF PATIENTS BASED ON BEETLE

LEAF


ATIUDAKAPANA


LAKSHANAS

012345

BEETLE LEAF

Number ofpatients

0

1

2

3

Daily Frequently

23

ATIUDAKAPANA

Number ofpatients

36

30

30

1938

10

37

7 14

LAKSHANAS

Avipaka

Klama

Utklesha

Tiktaudgara

Amlaudgara

Gourava




HYPERACIDITY SYMPTOMS

GRAPH NO.53- DISTRIBUTION OF PATIENTS BASED ALCOHOL

Results

In this study majority of the patients registered were between the age group of

31-40 years indulged in mixed diet. curd, sour butter milk, lemon, pepper,

horse gram, black gram, chicken, fish, flesh of goat and sheep, excess salt,

spicy, deep fried food, drinking more water in between the food, sleeping soon

after taking the food, Atikrodha, alcohol, coffee intake play a significant role

in causation of the disease Amlapitta.

14 36

26

381130

26

24

14 30

HYPERACIDITY SYMPTOMS

Lack of Appetite

Indigestion

Constipation

Sour Belching

Actual Vomiting

Feelingof restlessness

Bloating

Flatulence

012345

2 3 2

5

ALCOHOL

Number ofpatients

DISCUSSION


Any research work without discussion about its nature, utility and importance

is said to be incomplete. Any hypothesis/ principle, if to be proved, must be discussed

from all angles. Discussion is the churning process done to obtain a reasonable and

logical conclusion. Discussion with the Shastra, becomes the base for establishment

of the concept.

Today’s life style is completely changed by all means. Our diet pattern, life

style and behavioral pattern is changed and it is not suitable for our normal

physiology of digestion of body. We had developed western culture, which is more

harmful to us. We adopted their diets, behavioral pattern and this is the reason for

most of the diseases. Especially gastric disorders. Diet which is against Ashtavidha

Ahara Vidhi Vishesayatana, dietetic code and conduct are mostly responsible for most

of the disease. It seems that our old pattern of diet and behavior was up to mark for

nourishing and carrying physiological processes.

The Annavaha srotas is the one that bears a direct impact of all the dietetic

errors that a person indulges. Improperly chewed or hurriedly gulped rough and hard

portions of food are not properly digested. Many a times the simple Agnimandya leads

to Vidagdhajirna (dyspepsia) in the initial stages and if it is neglected, leads to

Amlapitta. This is caused by Jivha-Laulya as patients are aware of the Nidanas and

still he tries to consume it due to Jivha–Laulya. Amlapitta is not a disorder caused

only by the irregular diet and activities, but also as a result of psychological

problems.

DISCUSSION

DISCUSSION


DISCUSSION ON ROOPA:

1. Hrit-Kanta daha:

In this study 74% of patients had Hritdaha, 14% of patients had Kanta daha.

Due to increased amlodgara, the Annavaha srotas and Kanta will be affected by the

ushna,teekshna and amla guna of pitta. It leads to Lekhana of mucous membrane and

causes erosions of the surface. Hence patient may suffer from Hrit- Kanta daha.

2. Avipaka:

In this study 72% of patient had avipaka. If the person indulges in faulty

dietary habits and activities pitta pradhana tridosha vitiates. Drava guna of vitiated

pitta dosha causes agnimandya there by hindering the normal digestion process which

leads avipaka.

3. Gouravata:

In this study 20% of patients had gouravata. Due to agnimandya ahara is not

digested properly and ama formation occurs. Because of this ama patient may feel

gouravata.

4. Amlodgara:

In this study 76% of patients had Amlodgara,Due to mandagni ingested food

becomes vidagdha and shuktibhava. This Vidagdha & shuktbhava of food create

Amlata in Amashaya. Hence patient may have amlodgara.

DISCUSSION ON OBSERVATION:

AGE:

Majority of patients were belonging to the age group 31-40 years. This

indicates that middle aged patients are affected by the disease more, which is pitta

predominant period and as well as during this period people have more attraction

DISCUSSION


towards the junk foods, faulty dietary habits like excessive intake of pungent, spicy

food, irregular meals pattern and habits like smoking, alcohol, psychological stress.

SEX:

Among 50 patients 54% were male. This may be due to increased

occupational stress and strain, consumption of outside food. It may also be because of

most of the men are exposed to the habit of smoking, tobacco chewing and alcoholism

OCCUPATION:

As per the occupational wise distribution, 50% of patients belong to service

this may be due to their irregular and faulty dietary habits, disturbed sleep, stress and

strain with their service which might have lead to more incidence of the disease.

Second higher percentage in the occupation wise distribution i.e. about 24% were

business man which may be due to sedentary lifestyle, excessive indulgence in coffee

/tea intake, tobacco chewing, smoking, stress etc.

SOCIOECONOMIC STATUS:

As per the socioeconomic status middle class people i.e. 42% were seen

suffering more with this disease, may be because of the stress induced by the struggle

to become rich and to lead luxurious life.

EDUCATIONAL STATUS:

In this study 88% patients were educated. This incidence is maximum in

educated people due to hurried and worried life, irregular diet habit etc.

HABITAT:

Maximum number of patients i.e 60% were belonging to urban area. This is

because of changing lifestyle along with changing food culture.

DISCUSSION


MARITAL STATUS:

Majority of the patients i.e. 72% were married. Family involved patients were

under stress due to various reasons.

DESHA:

Majority of the patients i.e. 56% were belonging to the Sadharana desha.

DIET PATTERN:

Mixed diet pattern was observed in 66% of the patients. Non vegetarian food

is spicy, oily, heavy for digestion which leads to Amlapitta.

PATTERN OF FOOD INTAKE:

26% of the patients were doing Vishamashana, 22% of the patients were doing

Adhyashana. This is responsible for vitiation of dosha which leads to agnidushti and

ultimately causes the disease Amlapitta.

APPETITE:

Reduced appetite is found in majority of the patients i.e. 56%. This is because

drava guna of vitiated pitta dosha leads to agnimandya in the Amlapitta patients.

BOWEL HABITS:

As per the bowel movement maximum number of patients i.e.54% of patients

had constipation.

SLEEP:

It was found that maximum number of the individuals were having disturbed

sleep i.e.62% which also hinders proper digestion. When digestion is hindered the

food attains shuktapaka leading to amlapitta.

DISCUSSION


CURD:

20% of patients took daily, 42% of patients took frequently, 24% of patients

took sometimes and 14% of patients took occasionally. Dadhi is Guru, Abhishyandi,

Ushnaveerya, Amlavipaki, Shleshmapittakara.

AMLATAKR

10% of patients took daily, 46% of patients took frequently, 12% of patients

took sometimes and 32% of patients took occasionally. Amlatakra is Pittakara which

is responsible for the manifestation of Amlapitta.

TOBACCO CHEWING:

14% of patients were chewing Tobacco. Tobacco is having Ushna, Tikshna

and Vyavayigunas which causes and aggravates Amlapitta.

CITRUS LEMON:

Among 94% of patients consuming citrus lemon, 4% of patients took daily,

10% of patients took frequently, 38% of patients took sometimes and 42% of patients

took occasionally. Nimbuka is Amlarasayukta, Pittakara.

SOUR ORANGE:

Among 44% of patients consuming sour orange, 8% of patients took

frequently, 22% of patients took sometimes, and 14% of patients took occasionally.

Naranga is having amla rasa, Pittakara properties.

PEPPER:

[[[[Among 84% of patients consuming pepper, 2% of patients took daily, 14%

of patients took frequently, 28% of patients took sometimes and 40% of patients took

occasionally.]]]]]]]] Maricha is having Katu rasa, Katu vipaka ,Ushna veerya and

Ushna-Teekshna gunayukta.

DISCUSSION


HORSE GRAM:

Among 84% of patients consuming horse gram, maximum number of patients

i.e. 46% were consuming sometimes, 28% were consuming frequently and 10% were

consuming occasionally. Kulatta is Amlavipaki, Ushnaveerya and Paramapittakara.

Charaka while explaining Agrya said that Kulattaha amlapittajanananaam.

BLACK GRAM:

Among 94% of patients consuming black gram, 64% of patients took

frequently, 18% of patients took sometimes and 10% of patients took occasionally.

Masha produces Amlapitta by its Guru guna, Ushnaveerya and Pittakara properties.

Charaka while explaining Agrya said that Mashah shleshmapittajanananaam.

HEATED HONEY:

Among 12% of patients consuming heated honey, 8% of patients were taking

frequently and 4% of patient was taking occasionally. consumption of heated honey is

considered as Samskara viruddha ahara sevana.

FISH:

Among 48% of patients consuming fish, 2% of patients took daily, 26% of

patients took frequently, 12% of patients took sometimes and 8% of patients took

occasionally. Matsya produces Amlapitta by its Guru guna, Ushnaveerya and

Raktapitta-vardhaka properties.

CHICKEN:

Among 70% of patients consuming chicken, 2% of patients took daily, 48% of

patients took frequently, 18% of patients took sometimes and 2% of patients took

occasionally. Kukkutamamsa is Guru and Ushnaveerya when consumed regularly in

excess quantity produces Amlapitta.

DISCUSSION


AJAMAMSA:

Among 76% of patients consuming Ajamamsa, 44% of patients took

frequently, 26% of patients took sometimes and 6% of patients took occasionally. Aja

mamsa by its Guru, Abhishyandi, Mandapittakaphakara properties produce Amlapitta

when consumed regularly in excess quantity.

AVIMAMSA:

Among 48% of patients consuming Avimamsa, 6% of patients took daily, 22%

of patients took frequently, 14% of patients took sometimes and 6% of patients took

occasionally. Avimamsa is Guru, Abhishyandi, Snigdha, Atiushna, Tridoshakara.

ATILAVANA:

Among 60% of patients consuming Atilavanaahara, 48% of patients took

daily, and 12% of patients took frequently. Lavana is having Ushna, Teekshna ,

Abhishyandi, Ushnaveerya, Pittakara properties when used in excess quantity

produces Amlapitta.

ATIKATU:

Among 74% of patients consuming Atikatuahara, 60% of patients took daily,

12% of patients took frequently and 2% of patients took sometimes. Katu rasa is

Ushnaveerya, Ruksha, Pittakara, produces Amlapitta when used in excess quantity.

ATIAMLA:

Among 44% of patients consuming Atiamlaahara, 38% of patients took daily,

2% frequently, 2% sometimes and 2% occasionally. Amla rasa is Ushnaveerya,

pittakara when used in excess quantity produces Daha in Kanta, Uras and

Hrudayapradesha.

DISCUSSION


HARITA SHAKA:

Among 92% of patients consuming Haritakashaka, 10%of patients took daily,

40% of patients took frequently, 26% of patients took sometimes and 16% of patients

took occasionally. Haritakshaka is Guru, Ruksha, Vishtambhi. When consumed regularly

in excess quantity produces Amlapitta.

ATIUDAKAPANA:

72% of patients drinking more water in between the food, 60% drinks daily and

12% drinks sometimes. Atiudakapana /Antarodakapana causes Agnimandya there by

hindering the normal digestion process which leads to Amlapitta.

VIHARAJA NIDANA:

In this study 10% of patients were doing Vegadharana, 54% of patients were

sleeping soon after food, 24% of patients were doing Divaswapna and 8% of patients

were doing excess fasting. These all things are responsible for improper digestion and

vitiation of Doshas, leading to Ama stage.

MANASIKA NIDANA:

In this study 44% of patients had Excess Anger, 24% of patients had Excess

Grief and 12% of patients had Excess Fear. Most of the patients were suffering from

mental tension and this is responsible for improper digestion which leads to Ajirna

like condition as Acharya Charaka has mentioned that if a person is under some

psychological problem even the wholesome food taken in proper quantity does not get

properly digested.

ALCOHOL:

Among 54% of patients consuming alcohol, maximum number of patients i.e.

28% were consuming frequently, 12% were consuming daily, 6% were taking

sometimes and 8% occasionally. Madya is Amala rasayukta, Tikshna, Ushnaveerya,

DISCUSSION


Ruksha. Hence produces Amlapitta when consumed in excess quantity for longer

duration.

COFFEE:

Among 66% of patients consuming Coffee, maximum number of patients i.e.

48% were consuming 1-3 times/day, 12% of patients were consuming 4-5 times/day

and 6% of patients were consuming 6-7 times/day. Coffee contains caffeine which is

highly acidic and it can stimulate the hyper secretion of gastric acids, decrease

pressure in the lower esophageal sphincter. Hence coffee consumption has been

associated with heartburn.

TEA:

Among 34% of patients consuming Tea, maximum number of patients 28%

were consuming 1-3 times/day, 4% of patients were consuming 4-6 times/day and

2% of patients were consuming 6-8 times/day. The effect of tea was mainly due to its

local chemical action on gastric mucosa and it is a potent stimulant of gastric acid

also.

SUGARCANE JUICE:

Among 22% of patients consuming sugarcane juice, maximum number of

patients i.e. 16% were consuming occasionally followed by 6% frequently. Ikshurasa

produces Amlapitta is Guru, Vidahi, Vishtambi guna.

UNFORMED CURD:

Among 50 patients only 1 patient was consuming unformed curd sometimes.

Unformed curd is Vidahi, Tridoshakaraka. Hence produces Amlapitta.

CONCLUSION


Conclusion in a nutshell is the essence of any study. Without finding some

conclusion on any study, it would not become successful in its aims. A scientific

discussion on the study gives rise to some fruitful conclusions. Conclusion drawn

from the present study are as follow:

From the historical review of Ayurvedic literature it has found that Kashyapa

Samhita is the first text which describes the disease Amlapitta as a separate

disease entity.

Changing lifestyle along with changing food culture, stress and strain of this

present era are related with the pathogenesis of this disease.

Amlapitta is the Agnimandyajanya vyadhi. The disease takes a longer time to

cure hence it is considered as Chirakari. If the symptoms subside due to Jihva

laulya (greedy) again if the individual involves the Mithyahara-vihara the

disease is provoked.

Rasavaha, Annavaha, purishvaha srotasdushti occur in Amlapitta.

It can be concluded that highest incidence of Amlapitta is seen in middle aged

persons, may be because of Pitta dominancy, stress, irregular food habits and

sleeping pattern.

Incidence of Amlapitta is more in Pitta Prakruti persons.

From this study it can be concluded that the intake of food against the code of

dietetics i.e. Ahara Vidhi Vidhana and Ahara Vidhi Visheshayatana is

responsible for Amlapitta.

CONCLUSION

CONCLUSION


Ahraja nidana such as excessive intake katu, amla, lavana ahara, Dadhi,

amlatakra, kulatta, masha, chicken, fish, ajamamsa, avimamsa, sour

mosambi, lemon, Adhyashana, Vishamashana plays an important role in

manifestation of Amlapitta.

Viharaja nidana such as Prajagarana, Sleeping soon after food intake have

shown significant role in Amlapitta.

Manasika nidana- atikrodha play an important role in the manifestation of

Amlapiita.

Alcohol consumption and smoking have shown high significance.

Avipaka, Hritdaha and Amlodgara are seen in almost all patients of

Amlapitta.

It was observed that the symptoms of Amlapitta were closely resembles with

hyperacidity conditions.

SUMMARY

“Naidanika Adhyayana Of Amlapitta With Special Reference To Hyperacidity” Page114

This dissertation work entitled “NAIDANIKA ADHYAYANA OF AMLAPITTA

WITH SPECIAL REFERENCE TO HYPERACIDITY” comprise Introduction, Review of

literature, Conceptual study, Material and methods, Discussion and Conclusion.

INTRODUCTION:

Introduction is the first part, comprising a brief introduction to the disease Amlapitta and

Hyperacidity.

REVIEW OF LITERATURE:

In this part historical aspect of Amlapitta beginning from Vedic period to Sangraha

period has been described.

CONCEPTUAL STUDY:

In this section etymological derivation, Paryaya, Nidana, Samprapti, Purvarupa, Rupa,

Upashaya, Upadrava, Sadhya-Asadhyata, Sapeksha Nidana, Pathyaapathya has been mentioned

according to different Acharyas.

Similarly derivation of the word Hyperacidity has been explained. The different

etiologies, signs and symptoms, incidence and prevalence of the disease have been mentioned.

MATERIALS AND METHODS:

In this section the material and methods of the present work, with complete description of

the assessment criteria were given. The observations were presented with the help of tables and

graphs.

SUMMARY

SUMMARY

“Naidanika Adhyayana Of Amlapitta With Special Reference To Hyperacidity” Page115

DISCUSSION:

Discussion part consists of discussion about the conceptual part, observational study was

done, including incidence of different observations made during the study.

CONCLUSION:

Lastly in conclusion part, different conclusions have been drawn depending upon the

conceptual as well as on observational study.

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Varanasi:

Chaukhamba samskrita samsthan; 2015.P.514

5. http://www.healtheo360.com/stories/top-7-natural-home-remedies-for-

hyperacidity/

6. Agnivesha, Charaka Samhita Ayurveda DeepikaComentary of

Chakrapanidatta. Varanasi: ChaukambhaOrientalia; 2011.P.22

7. Agnivesha, Charaka Samhita Ayurveda DeepikaComentary

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Chakrapanidatta. ChikitsaSthana, Shloka No.27/25, Varanasi:

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15. SangrahaSushruta, Sushruta Samhita with NibandhaCommentary of

Dalhanacharya. Varanasi: ChaukambhaSurabharatiPrakashan; 2013.P.185

16. Vagbhata, Astanga Hrudaya, Nidanasthana, collated by Anna Moreshwar

Kunte, ninth edition, Chaukhamba Orientalia, Varanasi, 2005, 5/41.

17. VriddaJeevaka, Kashyapa Samhita with vidyotini hindi commentary.

Varanasi: Chaukhamba samskrita samsthan; 2009.P.338

18. Shastri S, MadhavaNidanam with Madhukosha Commentary of Srikantadatta

and Vijayarakshita and Vidyotini Hindi Commentary. Shloka no.51/2,

Varanasi: Chaukhambha Sanskrit Sansthan; 1995.P.171

19. Sharangadhara Acharya, Sharangadhara samhita English translation by Dr.G.

Prabhakar Rao. Madhyama khanda 8/43, New Delhi, Chaukambha

Publications; 2013. P.158

BIBLIOGRAPHY


20. Harita, Harita Samhita with Nirmala Hindi commentary,

Chaukambhavishvabharat

21. Bhela Samhita - Ed. By Vd. Venkatasubrahmanya Shastri & Sri.Rajeshwar

Shastri, C.C.R.A.S., Delhi

22. Bhavamishra, Bhavaprakasha volume 2 Translated by Prof. K.R.Shrikanth

Murthi Chapt 10, Varanasi, Chaukambha Krishnadas Academy; 2005. P.223

23. Bhaishajya Ratnavali by Sri. Govind Dasji volume 3 Chapt 56, Varnasi,

Chaukhambha Sanskrit Sansthan; 2014. P.112

24. Yogaratnakara with vaidyaprabha hind commentary by Dr. Indra Tripathi, Dr,

Daya Shankar Tripathi Varanasi, Krishnadas Academy; 1998. P.664

25. Basavarajeeyam By Prof. Dr. M.S Krishna Murthi sholka no 7/3 Chaukhamba

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28. Sushruta, Sushruta Samhita with NibandhaSangraha Commentary of

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and Vijayarakshita and Vidyotini Hindi Commentary. Shloka no.51/2,

Varanasi: Chaukhambha Sanskrit Sansthan; 1995.P.171

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Chaukhambasamskritasamsthan; 2009.P.338

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34. Sushruta, Sushruta Samhita edited with Ayurveda tatva sandipika by Kaviraj

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Sansthan; 2015. P.14

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Chaukhambha Sanskrit Sansthan; 2012. P.285

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commentary. Varanasi: Chaukambhasamskritasamsthan; 2013.P.7

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Dalhanacharya. Varanasi: ChaukambhaSurabharatiPrakashan; 2013.P.103-6

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59. http://www.nejm.org/doi/pdf/10.1056/NEJM191801171780304

60. http://www.hyperacidity/wikipedia/the free- encyclopedia/amp/s

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62. https://www.jiva.com/diseases/hyperacidity.

63. www.polycrol.in/trends_india.aspx

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hyperacidity/

http://www.nejm.org/doi/pdf/10.1056/NEJM191801171780304

https://www.henriettes-herb.com/eclectic/thomas/stomach-hypers.html

https://www.jiva.com/diseases/hyperacidity

http://www.polycrol.in/trends_india.aspx

http://digestion.ygoy.com/2010/05/10/hyper-acidity-symptoms-and-causes-of-hyperacidity/

http://digestion.ygoy.com/2010/05/10/hyper-acidity-symptoms-and-causes-of-hyperacidity/

RESEARCH PROFORMA

DEPARTMENT OF ROGANIDANA

GOVERNMENT AYURVEDIC MEDICAL COLLEGE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE-562107

Title: NAIDANIKA ADHYAYANA OF AMLAPITTA WITH SPECIAL

REFERENCE TO HYPERACIDITY

Scholar: Dr. Shradha

Guide: Dr. Ramesh M. S.

INFORMED CONSENT FORM

I ------------------------------------- hereby willingly agree to participate in this

dissertation study titled

“NAIDANIKA ADHYAYANA OF AMLAPITTA WITH SPECIAL REFERENCE

TO HYPERACIDITY”

I affirm that there has been no compulsion or monetary inducement in my agreeing

to be volunteer for this study, which I do on my free will. I have been explained the

general purpose of the experiment. I am convinced that it is for the benefit of science

and mankind. I understand that the risk involved is very less. I agree to undergo

required investigations.

I also agree remain under observation for required period.

I can opt out the study at any time.

Signature of the investigator Signature of the Volunteer

Annexure


DEPARTMENT OF P.G. STUDIES IN ROGANIDANA

GOVERNMENT AYURVEDIC MEDICAL COLLEGE, DHANWANTARI

ROAD, BANGALORE – 560009

Clinical Case Sheet For

“NAIDANIKA ADHYAYANA OF AMLAPITTA WITH SPECIAL

REFERENCE TO HYPERACIDITY”

1) Name Sl.No

2) Father’s / Husband’s OPD RegNo

3) Age IPD RegNo

4) Sex Male Female Date

5) Religion Hindu Muslim Christian Other

6) Occupation Sedentary Active Labor

7) Marital Status Married Unmarried

8) Economical Status Poor

Middle Higher

Middle

Higher

class

9) ADDRESS

10) Contact Number

11) INFORMED CONSENT

I -------------------------------- Son/Daughter/Wife of -----------------------------------am

exercising my free will,

to participate in above study as a subject. I confirm that the study has been explained

to me adequately and I have understood the above study and had the opportunity to

ask questions. The information given by me will be used for medical research only and

I will not be identified in any way in the analysis and reporting of the results. I hope to

complete the study, but I understand that my participation is voluntary and I am free to

withdraw at any time, without giving a reason, and without my medical care or legal

rights being affected.

Patient’s Signature

Annexure


PRADHANA VEDANA(Chief Complaints with Duration)

Symptoms Duration

Avipaka

Klama

Utklesha

Tiktaudgara

Amlaudgara

Gourava

Hrithdaha

Kantadaha

Aruchi

ANUBANDHA VEDANA(Associated Complaints)

VEDANA SAMUCCHRAYA(History of present Illness)

POORVA VYADHI VRITTANTA(History of Past Illness)

Annexure


KULA VRITTANTA (Family History)

RAJAH VRITTANTA (Menstrual History)

Menarche Regular Irregular

Menstrual

cycle

Associated

with

Pain Foul smell

Clots White discharge

Heavy

bleeding

Others

Menopause

CHIKITSA VRITTANTA (Treatment History)

VRITTI VRITTANTA ss(Occupational History)

Type of employment

Sedentary Moderate Heavy

Duration of work ______hrs/day _______hrs/night

Intake of food during work

Annexure


Work involving any mental stress

If yes Mild Moderate Severe

Whether symptoms aggravates during

mental stress

Yes No

Weather symptoms relieved by change

of

place

Yes No

VAYAKTIKA VRITTANTA(Personal History)

Dite Type Veg Mixed

Quantity Les Moderate Heavy

Time Regular Irregular

Pattern Samashan

a

Adhyashana Vishamasha

na

Beverages Coffee/Tea Aerated drinks Others

Appetite Not

Altered

Reduced Increased

Bowel

Regular Irregular

Frequency /24hrs

Koshta Mridu Madhyama Krura

Sama Nirama

Vega dharana Vega udeerana

Associated Pain Discharge

Annexure


with Burning

sensation

Discoloration

Itching Foul smell

Incontinence Incomplete evacuation

Micturition Frequency Times/day Times/night

Associated

with

Pain Foul smell

Burning

sensation

Incontinence

Discoloration Incomplete

evacuation

Vega dharana Vega udeerana

Sleep

Duration Hrs/day Hrs/night

Nature of

Sleep

Sound Disturbed

Dreams Yes NO

Addiction

Smoking Beedi/Cigarette ______/day

Alcohol

Type ______ _____ml _____yrs

Daily Occasional

Tobacco Chewing Snuff _____yrs

Exercise

Regular Irregular Complete

absence

Mild Moderate

Annexure


VITAL SIGNS

Temperature Pulse Rate Heart Rate

Respiratory Rate

ASHTASTHANA PAREEKSHA

Nadi

Dosha Mootra Pravritti

Gati Varna

Jihwa

Shuska Ardra Mala Sama

Lipta Alipta Nirama

Shabda

Sparsha Sheeta Ushna

Ruksha Snigdha

Drik Akriti

DASHAVIDHA PAREEKSHA

1) Prakrutia.

a.Shareerik

a

V P K V

P

P

K

V

K

VPK

b.Manasika Satvika Rajasika Tamasik

a

2) Sara

Twaka Raktha Mamsa Medha

Asthi Majja Sukra Stawa

Annexure


3)Samhanan

a

Pravara Madhya

ma

Avara

4) Satmya Pravara Madhyama Avara

5) Satwa Pravara Madhyama Avara

6) Pramana Pravara Madhyama Avara

7)Vyayama

Shakti

Pravara Madhyama Avara

8)

Aharashakti

Abyavahara

na

Pravara Madhyama Avara

Jarana Pravara Madhyama Avara

9) Vaya Bala Madhayama Jeerna

10)Desa Sadarana Anupa Jeerna

GENERAL EXAMINATION

Consciousness

Appearance

Built

Nourishment

Decubitus

Gait

Height

SYSTEMIC EXAMINATION

Annexure


Respiratory System

Cardiovascular System

Central Nervous System

Gastro Intestinal System

Examination of oral

cavity

Ulcers

White lesions

Annexure


Buccal

mucosa

Vesicles Others

Teeth

Discoloration

Decaying

Abnormal

configuration

Others

Gums

Gingivitis

Pyorrhea

Scurvy Others

Tongue

Atrophy of

papillae

Tremors

Ulcers and white

lesions

Enlargement of

tongue

Examination of the

Abdomen

Inspection

Shape

Distended

Scaphoid

Normal

Umbilicus

Inverted

Everted

Surface

Discoloration

Glossy

Scar

Wrinkles

Pigmentation

Striae

Pulsation

Invisible

Annexure


Visible

Peristalsis Visible Invisible

Palpation

Tenderness

Present

Absent

Site

Guarding

Present Absent Site

Rigidity

Present Absent Site

Rebound

tenderness

Present Absent Site

Organomegaly

Present Absent Organ

Percussion

Tympanic

Dull

Hyper

Resonant

Stony

dull

Auscultation

Borborygmisonds

Succussion

splash

Bruits Rubs

Questionnaire

Sl.No Ahara Daily Frequently Sometimes Occasionally Never

1. Incompatible

foods

Fish with milk

Annexure


Heated honey

Curd at night

Consuming cold

water immediately

after having hot

tea or coffee

Milk and curd

Ogether

Sour fruits with

milk (milk shakes)

Other

2. Food prepared

from

pista

3. Unboiled milk

4. Unformed curd

5. Milk of sheep

6. Sour butter milk

7. Curd

8. Sugar cane juice

extracted from

machine

Annexure


9. Molasses

10. Pepper

11. Alcohol

preparations

12. Sour fruits

Unripe and sour

mango

Sour mosambi

Sour orange

Sour grapes

Unripe and sour

jujube fruit

hog plum

Wood apple

Citrus lemon

Others

13. Cereals and pulses

Freshly harvested

grains

Horse gram

Black gram

Sesame

Mustard

Flax seed

Annexure


14. Parched cereals

Battened rice

Puffed rice

Others

15. Non veg food

Fish

Goat

Sheep

Others

16. Excess salt

17. Spicy food

18. Excess sour

19. Very hot

20. Deep fried food

21. Drinking more

water in between

the food

22. Excess Liquid

food(juice, tea,

coffee etc

23. Stale food

24. Taking food

before digestion of

the previously

Annexure


taken food

25. Beetle leaf

26. Green leafy

vegetables

Viharaja Nidana

Sl.N

o

Vihara Yes No Occasiona

l

Regula

r

Remarks

1. Withholding the urges

2. Sleeping immediately after

taking the food

3. Day sleep

4. Excess bathing

5. Excess fatigue

6. Excess fasting

7. Others

ManasikaNidana

Sl.No ManasikaNidana Yes No Remarks

1. Excess anger

2. Excess grief

3. Excess fear

Annexure


4. Others

SAMPRAPTI GHATAKA

Dosha V P K VP PK VK VPK

Dushya

Rasa Rakta Mamsa Meda

Asthi Majja Shukra

Srotas

Rasa Rakta Mamsa Meda Asthi

Majja Shukra Artava Prana Udaka Anna

Srotodushti

prakara

Agni Sama Manda Tikshna Vishama

Ama Sama Nirama

Rogamarga

Udbhava

Sthana

Sanchara

Sthana

Vyakta

Sthana

Roga

Swabhava

Sadya

asadhyata

Annexure


Purvarupa

Agnimandya

Hrullasa

Hritkantha daha

Rupa

Avipaka

Klama

Utklesha

Tiktaudgara

Amlaudgara

Gourava

Hrithdaha

Kantadaha

Aruchi

Vidbheda

Gurukoshtata

Shiroruja

Romaharsha

Annexure


DoshicPredominance

Vata Pitta Kapha Shleshmapitta

Shula Bhrama Kaphanishtivana Tiktaudgara

Angasada Vidaha Gourava Amlaudgara

Jrumbha Swaduupashaya Jadata Katuudgara

Kampa Sheetaupashaya Aruchi Hritdaha

Pralapa Sheeta Kukshidaha

Murcha Sada Kantadaha

Chimichimigatra Chardi Bhrama

Avasada Jihvalepa Murcha

Tamasodarshana Dahana Aruchi

Vibhrama Balasada Chardi

Vimoha Kandu Alasya

Harsha Nidra Shiroruja

Snigdopashaya Rukshaupashaya Praseka

Ushnaupashaya Mukhamadhurya

Hyperacidity Questionnaire

Symptoms Intensity Frequency

Lack of appetite

Indigestion

Constipation

Sour belching

Annexure


Actual vomiting

Feeling of restlessness

Stiffness in the stomach

Bloating

Flatulence

Headache

Excessive burping

Scale:

0 = No Symptoms

1 = Symptoms noticeable, but not bothersome

2 = Symptoms noticeable and bothersome, but not every day

3 = Symptoms bothersome every day

4 = Symptoms affect daily activities

5 = Symptoms are incapacitating, unable to do daily activities

Annexure


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