Login   |  Users Online: 955 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Search Article 
  
Advanced search 
   Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts


 
  Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 38  |  Issue : 1  |  Page : 15-23  

A clinical study to evaluate the role of Doshik predominance in the management of Amlapitta


1 Department of Kayachikitsa, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Ex. Director, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Web Publication20-Apr-2018

Correspondence Address:
Dr. Kuntal Ghosh
Bhaskar Apartment, 3rd Floor, Flat C, 68/1 KNC Road, Barasat, Parganas (N), Kolkata - 700 124, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ayu.AYU_75_14

Rights and Permissions
   Abstract 


Background: Amlapitta is a lifestyle disorder caused due to vitiation of Pitta and Kapha by Ama. Objective: The objective was to assess the role of Doshik predominance in the management of Amlapitta. Materials and Methods: Patients who had fulfilled the inclusion criteria were registered primarily for this study. Out of them, those who were selected only by the presence of cardinal features of Amlapitta were allotted randomly in Group C-1 and Group C-2 and rest of them were allotted in Group A and B after diagnosed by typical features of Kapha and Pitta Dosha predominant Amlapitta and had been treated with Shunthikhanda and Vasakhanda Kushmandaka granules, respectively. Results: Regarding overall effect of therapy, marked positive improvement in Group A was 35.29%, in Group B, 26.47%, in Group C-1, 23.08%, and Group C-2, 16.67%. No improvement was observed only in Group C-1 (4.76%) and C-2 (5.56%). Complete remission (2.56%) was observed only in Group C-2 (5.56%) Discussion: Out of 112 registered patients with a mean age of 42 years, 107 had completed their treatment. Maximum patients were male (66.96%), Hindu (83.93%), married (94.64%), middle class (43.75%), and educated (93.75%) from Jangala Desha (96.43%) and used to take Viruddha Ahara (83.04%). Patients of Group A and Group B, who were diagnosed and treated according to the Doshik predominance, showed better improvement than of Group C-1 and Group C-2 where patients were diagnosed and treated as per the cardinal features of Amlapitta only. Conclusion: Treatment of disease according to Doshik predominance is more effective than of only cardinal features.

Keywords: Amlapitta, Doshik predominance, Shunthikhanda, Vasakhanda Kushmandaka granules


How to cite this article:
Ghosh K, Baghel M S. A clinical study to evaluate the role of Doshik predominance in the management of Amlapitta. AYU 2017;38:15-23

How to cite this URL:
Ghosh K, Baghel M S. A clinical study to evaluate the role of Doshik predominance in the management of Amlapitta. AYU [serial online] 2017 [cited 2019 Sep 18];38:15-23. Available from: http://www.ayujournal.org/text.asp?2017/38/1/15/230786




   Introduction Top


According to Ayurvedic classics, Agni is responsible for Ayu (age), Varna (colour), Bala (power), Swasthya (health), Utsaha (excitement), Upachaya (digestion), Prabha, Oja and Teja[1] and Agni takes a pivot role in the etiopathogenesis of all human ailments.[2],[3] According to Acharya Charaka, indulging in Ajirna, Atibhojana (over eating), Vishama Bhojana (irregular diet), Asatmya (incompatible diet) and Sandushta Bhojana produces Shuktata due to Agni Dushti (impairment of Agni) followed by Ama and Amavisha which further develops Ajirna (indigestion) by vitiating Dosha.[4] Continuous indulgence in improper diet and erratic lifestyle basically aggravates Pitta Dosha which leads the disease into acute condition of Vidagdhajirna (indigestion) which due to ignorance inturn converts into Amlapitta in long run.

It is better to consider Amlapitta as a syndrome (acid reflux syndrome)[5] rather than a particular gastrointestinal disease due to the same causative factors with similar signs and symptoms as in Ayurvedic parlance closely resembles with gastritis,[6] non-ulcer dyspepsia,[7] hyperchlorhydria,[8] as well as hypochlorhydria [9] and in chronic stage, it may lead to gastric ulcer. Gastrointestinal disorders become lifestyle maladies when people shift their eating pattern toward ready-to-eat commercial junk meals from homemade food and adopt erratic lifestyles. According to the National Digestive Diseases Information Clearinghouse, the prevalence rate of gastritis in India is 10,572,391 and that of peptic ulcer is 5 million (1987).[10]

Knowledge of etiological factors, responsible for genesis of a particular disease, is essential in the selection of appropriate therapies which are opposite to disease as well as etiological factors (Vyadhi-Hetu Pratidwandwi) because the attributes of Dosha resembles the etiological factors which vitiate the Dosha.

Various types of Avarana (layer) should be considered into the pathogenesis. Avarana is mainly of three types, viz., 1. Sama-Vata Avrita by Vriddha-Pitta and Kapha, 2. Vriddha-Vata Avrita by Sama-Pitta and Kapha, 3. Vriddha-Vata Avrita by Vriddha-Pitta and Kapha. In the disease Amlapitta, third pathogenesis is rare. Hence, the first two are commonly considered in which clinical conditions such as Kapholvana and Pittolvana type of Amlapitta have been found.

Increased Drava and Amla Guna of Pachaka Pitta plays an important role in the pathogenesis of Amlapitta. Sneha is one of the special qualities of both Kapha and Pitta, but Sneha is present in Pitta in feeble quantity. Dravya which have the property of Kleda are Snigdha. Sneha performs the function of Mardava (softens the food stuff). Hence, it can be declared that Sneha is the common property of Kledaka Kapha and Pachaka Pitta. Hence, both of them are responsible for the pathogenesis of Amlapitta which is a Pathya Asadhya, Bheshaj Asadhya and Kashtasadhya Vyadhi. Hence, Nidana Parivarjana, Hetu Viparita, Vyadhi and Dosha Pratyanika (Kapha-Pittahara) therapies would be beneficial in Amlapitta [Figure 1] and [Figure 2].
Figure 1: Probable mode of action of Shunthikhanda granules

Click here to view
Figure 2: Probable mode of action of Vasakhanda Kushmandaka granules

Click here to view


Aims and objectives

  1. To assess the role of Doshik predominance in the management of Amlapitta.



   Materials and Methods Top


This clinical study is registered in the Clinical Trial Registry of India, ICMR, New Delhi (CTRI; www.ctri.nic.in) vide CTRI/2011/09/002003 and explained as per the Consolidated Standards of Reporting Trials statement 2010.[11] A total of 112 clinically diagnosed patients of Amlapitta attending outpatient and inpatient department of PG Hospital, Kayachikitsa at IPGT and RA, Gujarat Ayurved University, Jamnagar, were registered for this study. Out of 112, five patients were dropped out for several reasons.

Criteria for diagnosis

Subjective criteria

A total of 112 patients were diagnosed and confirmed by the presence of Pratyatma Niyata Lakshana (cardinal features)[12] of Amlapitta (Avipaka [indigestion], Klama [exhaustion], Utklesha [nausea], Tikta-Amla Udgara [eructation with bitter and sour taste], Gaurava [feeling of heaviness of the body], Hrit-Kantha-Daha [burning sensation in the chest and throat], and Aruchi [loss of appetite]) in general.

Patients of Kaphaja Amlapitta will be diagnosed by the presence of the symptoms [13],[14] such as Aruchi, Gaurava, Jadyata, Kaphanisthivana (expectoration of thick phlegm), Lepa (coating of tongue), Sada (Lassitude), Sheeta (coldness), Vami (vomiting) and Kandu (itching sensation) whereas Pittaja Amlapitta will be diagnosed by the presence of the symptoms [14],[15] such as Nanavidha Pravritti (fluids eliminated through rectum with different colors), Trishna (excessive thirst), Hrit-Kantha-Kukshi Daha (burning sensation in chest, throat, and abdomen), Murccha (fainting), Bhrama (giddiness), Moha (delusion), Anala Sada (poor digestive power), Hrillasa (nausea), Sweda (excessive sweating) and Anga Peetata (yellowish discoloration of the skin).

Objective criteria

Out of 112, five patients were dropped out for several reasons. The objective criteria were taken; however, to exclude other pathological conditions, the following investigations were carried out (a) blood: total leukocyte count (TLC), differential leukocyte count (DLC), hemoglobin percentage (HB%), erythrocyte sedimentation rate (ESR), fasting blood sugar (FBS), liver function tests (LFT), lipid profile (b) stool: routine microscopic examination of the stool and (c) urine: routine examination.

Criteria for selection of patients

Inclusion criteria

(1) Age: Patients between 21 and 60 years of age. (2) Sex: Patients of both sex. (3) Presence of cardinal features of Amlapitta as well as typical features of Kapha and Pitta Dosha-predominant Amlapitta. (4) Patients not taking any other medicines for Amlapitta. (5) Chronicity of >3 months.

Exclusion criteria

(1) Patients with peptic ulcer, duodenal ulcer, carcinoma stomach, cardiac disorders. (2) Taking medicines for any other diseases such as hypertension, diabetes mellitus, ischemic heart diseases and chronic renal failure.

Plan of study

Clinically diagnosed 34 cases of Kapha predominant Amlapitta were allocated in Group A and 39 patients of Pitta predominant Amlapitta were allocated in Group B whereas 39 patients were allocated in Group C irrespective of their Doshik predominance. Shunthikhanda granules was administered to the patients of Group A, Vasakhanda Kushmandaka granules were given to the patients of Group B and one of these two drugs was administered randomly to the patients of Group C.

Further, the patients who were randomly treated with Shunthikhanda granules, allocated in Group C-1 and the patients who were randomly treated with Vasakhanda Kushmandaka granules were allocated in Group C-2 to observe the comparative effectiveness of drugs in between the groups where patients were treated according to Doshik predominance and without Doshik predominance, respectively. All patients of three groups were administered their recommended drug in a dose of 5 g, orally, twice a day, in between food with water for a period of 30 days. Computer-generated randomization [16] from www.randomization.com vide seed 18,135 created on Tuesday; January 03, 2012, at 2:12:18 PM was used for the clinical study.

Criteria for assessment

In this study, an effort has been made to follow the guidelines laid down by Acharya Charaka for the assessment of results. Having close acquaintance with the various states of the disease, such therapies should be prescribed which may help attainment of the four-fold blessings (Chatuhshreya).[17]Amlapitta symptoms rating scale (ASRS) was adopted to assess the relief in each symptom in Amlapitta patients. The ASRS is 20 items based on Rogabala, Agnibala, Dehabala, and Chetasabala; a disease-specific instrument used to evaluate symptoms of Amlapitta. The items are measured on a 5-point Likert-type scale [18] ranging from 0 = “no discomfort” to 4 = “very severe discomfort.” The ASRS was administered at baseline and after the end of 30 days' clinical trial.

Total 100 scores were divided into Rogabala, Dehabala, Agnibala and Chetasabala. Thirty-five scores allotted for “Rogabala” were subdivided into seven items such as Hrit-Kantha-Daha, Tiktamlodgara, Vami, Gaurava, Utklesha, Shula and Brahma for the assessment of the severity of symptoms of Amlapitta. Twenty-five scores allotted for “Agnibala” were subdivided into five items such as Abhyavaharana Shakti (capacity of ingestion of food), Jarana Shakti (power of digestion), Avipaka and Aruchi for the assessment of power of digestion in Amlapitta. Twenty scores allotted for “Dehabala” were distributed into four items, viz., Balavriddhi (strength), Klama, Swara-Varna Yoga (clarity in voice and luster) and Sharira Upachaya (weight gain) for the assessment of bodily strength in Amlapitta. Twenty scores allotted for “Chetasabala” were subdivided into four items such as Nidra Labho Yathakalam (regularity in sleep), “Sukhena Cha Pratibodhanam” (feeling of well-being), “Vaikarikanam Cha Swapnana Darshanam” (uncomfortable dreams) and “Mano Buddhi Indriya Avyapatti” for the assessment of strength of mental faculties in Amlapitta.

Statistical analysis

The data obtained on the basis of observations were subjected to statistical analysis by applying Sigmastat 3.5 software (Software is now based in San Jose, California) in terms of mean, percentage, standard deviation, and standard error. The t-test and P values were calculated by using paired t-test and unpaired t-test considered at the level of P ≥ 0.05 (insignificant), P ≥ 0.002 to ≤ 0.04 (significant), and P ≤ 0.001 (highly significant).

Assessment of overall effect of therapy

For the overall assessment of the therapy, following five categories were taken into consideration:

  • Complete remission- 100% relief in the clinical signs and symptoms
  • Marked improvement- 76%–99% relief in the clinical signs and symptoms
  • Moderate improvement- 51%–75% relief in the clinical signs and symptoms
  • Mild improvement- 26–50% relief in the clinical signs and symptoms
  • Unchanged- Below 25% relief in the clinical signs and symptoms.


Follow-up study

After completion of due course of treatment, all the patients were requested to report for follow-up study for 1 week. During this period, no medicine was provided to the patients and recurrence of any symptoms regarding Rogabala, Dehabala, Agnibala and Chetasabala as well as impact of therapies on quality of life were observed.

Observations

Epidemiological data observed among 112 patients of Amlapitta was exhibited in [Graph 1]. However, features of Pitta Prakriti were observed in 51 (45.54%) patients, Kapha Prakriti was observed in 33 (29.46%) patients and Vata Prakriti was in 28 (25%) patients. Different types of dietary habits such as Viruddhashana (intake of contraditory food combination), Atiguru Bhojana (excessive heavy diet), Atiruksha Bhojana (excessive ununctous diet), Vidahi Bhojana (spicy food), intake of Katu Rasa and Lavana Rasa dominant diet, Bhuktamatrasya Swapna (going to sleep just after lunch and dinner), Atidaryta (intake diet hurriedly) and Ativilambita Bhojana (intake of in a diet very slowl pattern) were observed among 112 patients of Amlapitta [Graph 2].



26.79% of patients were not doing exercise at all, 52.68% were habituated of Vegavidharana (suppression of their natural urges) and 40.18% had the habit of Prajagarana (night vigilance). Maximum patients were addicted with tea (97.32%) followed by tobacco (51.79%) observed in this study.

Most of patients were afflicted with Krodha (anger – 54.46%) followed by Avasada (depression – 35.71%), Chinta (tension – 31.25%), and Lobha (greedy – 21.43%).

In this study, all the patients had the cardinal symptoms such as Avipaka, Tiktamlodgara, Hrit-daha, Kantha-daha, Utklesha, Gaurava, Aruchi and Klama. Other signs and symptoms observed were Adhmana (flatulence), Udara shula (abdominal pain), Nidralpata (insomnia), Vibandha (constipation), Atipipasa (excessive thirst), Bhrama (giddiness), Kampa (tremor) and Angasada (lethargy) [Graph 3].



Maximum patients had the previous history of Ajirna (49.11%) followed by Amlapitta (47.32%) and had the chronicity of 3 months to 1 year (45.54%).

Strotodushti observed in 112 of patients in this study were Purishavaha (100%), Rasavaha (72.31%), Annavaha (62.89%), Raktavaha (39.30%) and Swedavaha Strotas (25.50%). Of the total observed 1117 frequency of symptoms of involvement of Dosha, majority represented Kapha (55.68%) followed by Pitta (47.36%) and Vata (32.77%).

Effect of therapy

Rogabala

Shunthikhanda granules in Group A and C-1 and Vasakhanda Kushmandaka granules in Group B and C-2 provided highly significant relief (P< 0.001) in the symptoms of Utklesha, Tiktamlodgara, Gaurava and Angasada, Hrit-Kantha Daha, Chardi and Shula. On Brahma, Shunthikhanda granules in Group A provided highly significant relief (P< 0.001) and in Group C-1 provided significant relief (P< 0.05) whereas Vasakhanda Kushmandaka granules provided significant relief in Group B (P = 0.002) and Group C-2 (P< 0.05) [Graph 4].



Agnibala

Shunthikhanda granules in Group A and Vasakhanda Kushmandaka granules in Group B provided highly significant relief (P< 0.001) in the symptoms of Abhyavaharana Shakti, Jarana Shakti, Aruchi, Avipaka and Vata-Mutra-Retasam Mukti. Shunthikhanda granules in Group C-1 and Vasakhanda Kushmandaka granules in Group C-2 provided highly significant relief (P< 0.001) in the symptoms of Abhyavaharana Shakti, Jarana Shakti, Aruchi and Avipaka but insignificant relief (P > 0.05) in Vata-Mutra-Retasam Mukti [Graph 5].



Dehabala

Shunthikhanda granules in Group A and Vasakhanda Kushmandaka granules in Group B provided highly significant relief (P< 0.001) in the symptoms of Bala Vriddhi, Swara-Varna Yoga, Klama and Sharira Upachaya. Shunthikhanda granules in Group C-1 and Vasakhanda Kushmandaka granules in Group C-2 provided highly significant relief (P< 0.001) in the symptoms of Balavriddhi, Swara-Varna Yoga and Klama and insignificant relief (P > 0.05) in Sharira Upachaya [Graph 6].



Chetasabala

Shunthikhanda granules in Group A and Vasakhanda Kushmandaka granules in Group B showed highly significant relief (P< 0.001) in the symptoms of Nidra Labho Yathakalam, Sukhena Cha Pratibodhanam, Vaikarikanam Cha Swapnana Darshanam and Mano Buddhi Indriya Avyapatti. Shunthikhanda granules in Group C-1 showed highly significant relief (P< 0.001) in the symptoms such as Sukhena Cha Pratibodhanam, Vaikarikanam Cha Swapnana Darshanam and Mano Buddhi Indriya Avyapatti and significant relief (P< 0.05) in Nidra Labho Yathakalam. Vasakhanda Kushmandaka granules in Group C-2 showed statistically highly significant improvement (P< 0.001) in Sukhena Cha Pratibodhanam, Vaikarikanam Cha Swapnana Darshanam, Nidra Labho Yathakalam (P = 0.001) and significant relief in Mano Buddhi Indriya Avyapatti (P< 0.01) [Graph 7].



Comparative effect of therapy

Rogabala

In comparison between Group A and Group C-1 [Table 1], both showed statistically insignificant improvements with P > 0.05, except in Gaurava and Shula; therapeutic effect was statistically significant with P < 0.05. In comparison between Group B and Group C-2 [Table 2], both showed statistically insignificant improvements with P > 0.05. In comparison between Group C-1 and Group C-2 [Table 3], both showed statistically insignificant improvements with P > 0.05.
Table 1: Comparison of the effect of therapy on Rogabala between Group A and Group C-1 (unpaired t-test)

Click here to view
Table 2: Comparison of the effect of therapy on Rogabala between Group B and Group C-2 (unpaired t-test)

Click here to view
Table 3: Comparison of the effect of therapy on Dehabala between Group B and Group C-2 (unpaired t-test)

Click here to view


Agnibala

In comparison between Group A and Group C-1 [Table 4], both showed improvements which were statistically highly significant with P < 0.001 in Abhyavaharana Shakti, Jarana Shakti and Aruchi. The effect was statistically insignificant on Avipaka and Vata-Mutra Retasam Mukti with P > 0.05. In comparison between Group B and Group C-2 [Table 5], both showed statistically insignificant improvement with P > 0.05.
Table 4: Comparison of the effect of therapy on Agnibala between Group A and Group C-1 (unpaired t-test)

Click here to view
Table 5: Comparison of the effect of therapy on Agnibala between Group B and Group C-2 (unpaired t-test)

Click here to view


Dehabala

In comparison between Group A and Group C-1 [Table 6], both showed statistically insignificant improvements in Swara-Varna Yoga and Sharia Upachaya with P > 0.05, highly significant (P< 0.001) in Balavriddhi and statistically significant (P< 0.05) in Klama. In comparison between Group B and Group C-2 [Table 3], both showed statistically insignificant improvements with P > 0.05.
Table 6: Comparison of the effect of therapy on Dehabala between Group A and Group C-1 (unpaired t-test)

Click here to view


Chetasabala

Comparative effect of therapy on Nidra Labho Yathakalam and Vaikarikanam Cha Swapnana Darshanam in between Group A and Group C-1 was statistically insignificant with P > 0.05 [Table 7] but significant on Mano Buddhi Indriya Avyapatti with P < 0.05 and highly significant on Sukhena Cha Pratibodhanam (P< 0.001). In comparison between Group B and Group C-2 [Table 8], both showed statistically insignificant improvements with P > 0.05.
Table 7: Comparison of the effect of therapy on Chetasabala between Group A and Group C-1 (unpaired t-test)

Click here to view
Table 8: Comparison of the effect of therapy on Chetasabala between Group B and Group C-2 (unpaired t-test)

Click here to view


Comparison of overall effects as well as average relief of therapies

Regarding overall effect of therapy, marked positive improvement in Group A was 35.29%, in Group B, 26.47%, in Group C-1, 23.08% and Group C-2, 16.67%. Moderate improvement in Group A was 52.94%, in Group B, 58.82%, in Group C-1, 42.86% and in C-2, 61.11% whereas mild improvement observed in Group A was 11.76%, in Group B, 14.71%, in Group C-1, 23.81%, and in Group C-2, 11.11%. No improvement was observed only in Group C-1 (4.76%) and C-2 (5.56%). Complete remission (2.56%) was observed only in Group C-2 (5.56%) [Table 9].
Table 9: Overall effect of therapy

Click here to view


Average relief of Group A and Group B where Shunthikhanda and Vasakhanda Kushmandaka granules were given according to Doshik predominance was far better (68.78% and 65.4%, respectively) than that of Group C-1 and C-2 (60.40% and 64.46%) where Shunthikhanda and Vasakhanda Kushmandaka granules were given randomly without any doshik predominance [Table 10].
Table 10: Comparison on average relief of the effect of therapy between Group A, Group B, Group C-1, and Group C-2

Click here to view


After 1 week of follow-up, lesser incidence of recurrence of disease was reported in Group A (14.71%) and Group B (20.59%) rather than Group C-1 (33.33%) and Group C-2 (22.22%). Shunthikhanda granules in Group A exert a more sustained effect than Vasakhanda Kushmandaka granules in Group B on patients of Amlapitta even after discontinuation of the drug for 1-week follow-up [Table 11].
Table 11: Recurrence of Amlapitta during follow-up

Click here to view



   Discussion Top


Manifestation of a disease depends upon the intensity of conjunction of Nidana, Dosha and Dushya. Amlapitta is one of the most prevalent lifestyle disorder caused by Mandagni due to vitiation of Vata (32.77%), Pitta (47.36%) and Kapha (55.68%) as well as Purishavaha (100%), Rasavaha (72.31%), Annavaha (62.89%), Raktavaha (39.30%) and Swedavaha (25.50%) Strotasa. Amashaya is the seat of Samana Vayu, Pachaka Pitta, Kledaka Kapha and also the root of Annavaha Strotasa whereas Grahani is the seat of Agni. Samana Vayu, Pachaka Pitta and Kledaka Kapha may involve in the Sthanasamshraya at Amashaya including Grahani where simultaneously Khavaigunya takes place. When Vata gets vitiated by Ama, there is the possibility of Marga Avarana by Vriddha Pitta and Kapha. Hence, Amlapitta is the disease condition produced by Pitta-Kapha Avrita Vata.

A patient constitutes the Karyadesha or the site for administration of therapies with a view to bringing about equilibrium of Dhatu. Manifestation of disease depends on resemblance of the afflicted Dosha-Dushya-Prakriti-Desa-Kala-Bala of individual with that of the Hetubala and Vyadhibala. The dosage in which a therapy is to be administered depends on the intensity of morbidity as well as the strength of the patients.

Maximum patients (29.46%) were in the age group of 41–50 years (Pitta-predominant state). Pitta Prakriti (45.54%), afflicted with Krodha (54.46%), habituated in taking of Viruddhashana (83.04%); Vidahi (84.82%), Katu (80.36%) and Lavana Rasa (53.57%) predominant diet as well as intake of Guru Ahara (heavy in quantity and quality – 96.43%), Shita Ahara (32.14%) and habits of Bhuktamatrasya Swapna (73.21%) cause Agninirvapana by increasing Dravatva of Pachaka Pitta and Snigdhata of Kledaka Kapha because basically Drava and Snigdha Guna procreate Klinnata in our body. This excessive Kleda causes Agnimandya and produces Ama. Due to Shuktapaka, Ama gets vitiated and produces Amavisha which again comes in contact with Vidagdha Pachaka Pitta which is evolve as Vidagdhajirna. If the disease is neglected, establishing their affinity in Amashaya and Grahani, the vitiated Doshas lead the condition into Amlapitta.

In Shamana therapy, Kapha-Pittahara Chikitsa is the principle of treatment for Amlapitta. Due to Kapha-pacifying ingredients in Shunthikhanda granules and Pitta-pacifying ingredients in Vasakhanda Kushmandaka granules, the drugs were advocated to the patients of Kapha-predominant and Pitta-predominant Amlapitta, respectively [Figure 1] and [Figure 2].

Average relief of the patients (in Group A and B) whom medicines were given according to Doshik predominance was far better (68.78% and 65.4%) than the patients (in Group C-1 and C-2) where medicines were given randomly without any doshik predominance (60.40% and 64.46%, respectively).

The Phalashruti is that the vitiated Dosha, alleviated by Langhana and Pachana, may be aggravated at any time, but those who are eliminated by proper Samshodhana therapies do not recur further.[19] However, in this study, we knowingly had to ignore Aptopadesha to compromise on patients' preference and it was reflected on recurrence of the disease which was observed more in the patients of Group C-1 (33.33%) and C-2 (22.22%) than of Group A (14.71%) and Group B (20.59%).


   Conclusion Top


In the era of rapid civilization, Amlapitta evolves as the most developing lifestyle disorder where Pitta and Kapha take pivot role associated with Vata in etiopathogenesis of Amlapitta. Amlapitta adversely affects the quality of life of patients, making it difficult to make dietary choices and causing sleep loss even hampering social life and contributes to a higher medical cost. The long-term effects can also lead to poorer quality of life. Diagnosis of the disease and treatment (Dosha-Dushya Vighatana) on the basis of Doshik predominance proved beneficial in this study.

Financial support and sponsorship

The study was supported by IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana. Reprint edition. Ch. 15, Ver. 3. New Delhi: Rashtriya Sanskrit Sansthana; 2006. p. 512.  Back to cited text no. 1
    
2.
Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana. Reprint edition. Ch. 15, Ver. 44-49. New Delhi: Rashtriya Sanskrit Sansthana; 2006. p. 517.  Back to cited text no. 2
    
3.
Anna Moreswara K, Shastri Krishna Ramachandra, Paradkar Vaidya Harishastri, editor. Vagbhata, Ashtanga Hridaya, Nidana Sthana. 9th ed. Ch. 12, Ver. 1. Varanasi: Chaukhambha Orientalia; 2005. p. 513.  Back to cited text no. 3
    
4.
Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana. Reprint edition. Ch. 15, Ver. 42-43, 47. New Delhi: Rashtriya Sanskrit Sansthana; 2006. p. 517.  Back to cited text no. 4
    
5.
Fauci Anthony, Kasper Dennis, Hauser Stephen, Longo Dan, Loscalzo Joseph, Jameson J. Larry, Harrison's Principles of Internal Medicines, Disorders of the Gastrointestinal Symptoms. 17th ed., Vol. II. United States of America: McGraw Hill Medical; 2008. p. 1851, 1852.  Back to cited text no. 5
    
6.
Fauci Anthony, Kasper Dennis, Hauser Stephen, Longo Dan, Loscalzo Joseph, Jameson J. Larry, Harrison's Principles of Internal Medicines, Disorders of the Gastrointestinal System. 17th ed., Vol. II. United States of America: McGraw Hill Medical; 2008. p. 1870-1.  Back to cited text no. 6
    
7.
Fauci Anthony, Kasper Dennis, Hauser Stephen, Longo Dan, Loscalzo Joseph, Jameson J. Larry, Harrison's Principles of Internal Medicines, Alteration in Gastrointestinal Function. 17th ed., Vol. I. United States of America: McGraw Hill Medical; 2008. p. 243.  Back to cited text no. 7
    
8.
Hyperacidity. Available from: http://www.hyperacidity-acid-reflux-esophagitis-peptic-ulcers; and http://www.en.wikipedia.org/wiki/Hyperacidity. [Last accessed on 2011 Aug 19].  Back to cited text no. 8
    
9.
Hypoacidity. Available from: http://www.phcapsule.com/nutinfo.htm. [Last accessed on 2011 Aug 19].  Back to cited text no. 9
    
10.
Digestive Diseases in the United States: Epidemiology and Impact – NIH Publication No. 94-1447. NIDDK; 1994. Available from: http://www.rightdiagnosis.com/g/gastritis/stats.htm. [Last accessed on 2012 July 07].  Back to cited text no. 10
    
11.
Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Obstet Gynecol 2010;115:1063-70.  Back to cited text no. 11
    
12.
Acharya YT, editor. Madhavanidana of Madhavakara, 6th ed. Ch. 51, Ver. 2. Varanasi: Chaukhambha Orientalia; 2001. p. 292.  Back to cited text no. 12
    
13.
Acharya YT, editor. Madhavanidana of Madhavakara. 6th ed. Ch. 51, Ver. 9-10. Varanasi: Chaukhambha Orientalia; 2001. p. 293.  Back to cited text no. 13
    
14.
Tewari PV, editor. Vriddhajivaka, Kashyapa Samhita, Khilasthana. Reprint edition. Ch. 16, Ver. 16-17. Varanasi: Chaukhambha Vishvabharati; 2008. p. 631.  Back to cited text no. 14
    
15.
Acharya YT, editor. Madhavanidana of Madhavakara. 6th ed. Ch. 51, Ver. 3. Varanasi: Chaukhambha Orientalia; 2001. p. 292.  Back to cited text no. 15
    
16.
Randomization Plan. Available from: http://www.randomization.com. [Last accessed on 2012 Jan 03].  Back to cited text no. 16
    
17.
Acharya YT, editor. Charaka Samhita of Agnivesha, Nidana Sthana. Reprint edition. Ch. 8, Ver. 36-37. New Delhi: Rashtriya Sanskrit Sansthana; 2006. p. 229.  Back to cited text no. 17
    
18.
Likert Scale from Wikipedia. Available from: http://www.en.wikipedia.org/wiki/Likert_Scale. [Last accessed on 2012 Nov 11].  Back to cited text no. 18
    
19.
Narayana Shastri S, editor. Charaka Samhita of Agnivesha, Sutra Sthana, Vol. I. Reprint edition. Ch. 16, Ver. 20. Varanasi: Chaukhambha Bharati Academy; 1998. p. 321.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1372    
    Printed25    
    Emailed0    
    PDF Downloaded179    
    Comments [Add]    

Recommend this journal