|Year : 2014 | Volume
| Issue : 1 | Page : 35-41
Effect of Pippalimula on Ama w.s.r. to Samavaya
Anil D Avhad, Rambabu Dwivedi
Department of Basic Principles, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
|Date of Web Publication||29-Sep-2014|
Anil D Avhad
Ph.D. Scholar, Department of Basic Principles, I.P.G.T. and R.A, Gujarat Ayurved University, Jamnagar - 361 008, Gujarat
Source of Support: None, Conflict of Interest: None
Clinical trial registration CTRI/2013/06/003779
| Abstract|| |
Background: Shad Karanas mentioned in Ayurveda are the means for attaining the state of Dhatusamyata. Samavaya is the sixth Karana among these and it provides the knowledge of relation between Dravya, Guna and Karma. This kind of knowledge becomes the basic tool in the field of diagnosis as well as in the selection of proper drug. Aim: To assess the Samavaya relation between Ama and its Hetu and Lakshanas along with Practical evaluation of Samavaya by using Pippalimula on Ama. Materials and Methods: The study comprising of total 23 patients of Ama and divided into two groups. Pippalimula tablet (each of 500 mg, 2 tablets four times daily) was administered in Group A (n = 13) while Group B (n = 10) was treated with placebo tablet (each of 500 mg, 2 tablets four times daily) for the duration of 10 days. Results: After the completion of treatment, all the parameters of Group A showed statistically highly significant results, whereas in Group B some parameters showed significant results and others were insignificant. Conclusion: The study specified the Karanatva of Samavaya as the Laghu, Ruksha and Ushna Gunas which were present Samavayatvena in Pippalimula, and were absent in placebo.
Keywords: Ama, Pippalimula, Samavaya, Shadkarana
|How to cite this article:|
Avhad AD, Dwivedi R. Effect of Pippalimula on Ama w.s.r. to Samavaya. AYU 2014;35:35-41
| Introduction|| |
In Ayurveda, "Karana-Karya Siddhanta" (cause-effect theory) is considered as one of the most important Siddhanta (principle) and for the practical approach Shad Karanas (six causative factors viz., Samanya, Vishesha, Guna, Dravya, Karma and Samavaya) are considered as Karana (cause) and Dhatusamya (equilibrium of body elements) is accepted as Karya (effect).  Samavaya (inherent relation) being the sixth Karana among these, also useful in the field of Chikitsa (treatment). 
Samavaya is defined as the inseparable relation between Dravya (substance) and Guna (property).  It is also considered as the inherent relationship between the Karana and Karya; due to which one understands "this is in that".  Samavaya is said to be present in five pairs viz., Avayava-Avayavi (whole and its parts), Guna-Guni (substance and its property), Karma-Karmavan (object and its motion), Vyakti-Jati (individual and its class) and Vishesha-Nityadravya (particularity and eternal substances).
In clinical practice while prescribing the medicine to the patient physician always keeps in mind that which properties are going to remain permanently in the particular drug which is intended for use. In the diagnostic field also one has to depend upon the Pratyatma Lakshanas (cardinal symptoms) which are inseparably concerned with the particular disease. So here in both the context Samavaya is an unavoidable cause as it provides the knowledge of relation between Dravya, Guna and Karma (action).
Ama is a unique concept of Ayurveda and plays an important role in vitiation of Dosha and occurrence of diseases. Ama has the properties such as Guru (heavy), Snigdha (unctous), Picchila (stickey), Tantu (forming threads), Avipakva (undigested), Asamyukta (uncombined), Anekavarna (different colours), Durgandha (foul smell) etc., which are considered as Samavayatvena (inherently) present in it. , It has been selected here for the applied study considering the Samavaya relation between Dravya and Guna as well as between Vyadhi (disease) and its Lakshanas (symptoms). Pippalimula (roots of Piper longum Linn.) was chosen as a drug for the clinical study since it is a drug of choice among all the drugs having Deepaniya (appetizer) and Pachaniya (digestive) properties.  It has mentioned in the classics that Pippalimula possesses Laghu (light), Ushna (hot) and Ruksha (dry) properties which are present in Samavaya relation. 
Hence the clinical study was planned considering the hypothesis that Ama should be mitigated by the opposite Gunas like Laghu, Ruksha and Ushna which are Samavayatvena present in the drug Pippalimula while the drug placebo (rice flour) possessing the Gunas like Guru, Sheeta and Snigdha Samavayatvena should not be able to relieve the symptoms of Ama (undigested food material).  Hence, the present study was carried out with the aim to assess the Samavaya relation between Ama and its Hetu and Lakshanas along with Practical evaluation of Samavaya by using Pippalimula on Ama.
| Materials and Methods|| |
Patients having the classical signs and symptoms of "Ama" attaining the Out-Patient Department and In-Patient Department were selected without any bar of cast, religion, occupation and sex. The study was approved by Institutional Ethics Committee (No. PGT/7-A/Ethics/2010-11/1858; dated on 01/09/2010).
Criteria for selection
- Patients suffering from the state of Ama
- Patients of age between 20 and 60 years.
Criteria for exclusion
- Patients of age <20 years and >60 years
- Patients having the condition of "Samshrishta Dosha" (chronic stage)
- Patients having any major systemic disease
- Patients having the dominancy of "Pitta Prakriti".
Grouping and sampling
Patients were randomly divided into two groups as:
Group A: Tablets (500 mg each) of Pippalimula Churna (P. longum root powder) has been provided
Group B: Tablets (500 mg each) of rice flour (placebo) has been provided [Table 1].
Routine pathological tests such as blood, urine, stool etc., has been carried out to assess the actual status of the patients and to rule out any pathology.
Criteria for assessment
The result was assessed on relief of the signs and symptoms of the disease. , The sign and symptoms were Aruchi (aversion), Avipaka (indigestion), Udaragaurava (heaviness of abdomen), Kshudhanasha (dyspepsia), Tandra (lassitude), Hrillasa (nausea), Alasya (idleness), Gurugatrata (heaviness in body), Bahumutrata (polyuria), Malasamata (sticky stool) and decrease in Abhyavaharana and Jarana Shakti (slowness of hunger and digestion). The patient's sign and symptoms were noticed before and After treatment with scoring pattern depending upon their severities. 
Assessment of result
Overall percentage of improvement of each patient was calculated by the formula
Paired t-test was carried out at each symptom individually in both groups, whereas unpaired t-test was applied to study the comparative results of both groups at the level of P < 0.05, P < 0.01 and P < 0.001 levels. The obtained results were interpreted as:
Insignificant: P >0.05, Significant: P <0.05 or P < 0.01, Highly significant: P <0.001.
Total effect of therapies
- Complete remission 100% relief
- Marked improvement 75-100% relief
- Moderate improvement 50-75% relief
- Mild improvement 25-50% relief
- Unchanged 0-25% relief
| Observations|| |
A total of 23 patients were registered in the present study out of which 13 patients were in Group A and 10 were in Group B.
In the present study, 100% patients were suffering from Avipaka, Udaragaurava and Ksudhanasha while Aruchi was present in 95.62% patients. Maximum 91.30% patients were having Alasya as associated complaint whereas Tandra was found present in 79.91% patients. 60.87% and 56.52% patients were suffering from Gurugatrata and Hrillasa respectively. It has been observed that 91.30% patients were having Mandagni while Vishamagni was found in 8.70% patients.
Madhyama and Avara Abhyavaharana Shakti was found in 69.56% and 26.09% patients respectively whereas 65.22% and 34.78% patients were having Avara and Madhyama Jarana Shakti respectively.
Irregular and Picchila Malapravritti were found in 69.57% and 52.17% patients respectively whereas 82.61% patients were having unsatisfactory evacuation of their bowel.
According to the data Atiguru and Atiruksha Ahara found in 69.57% and 43.48% patients whereas habit of Adhyashana (eating before the last meal is digested), Vishamashana (irregular eating) and Atimatrashana (over eating) was found in 47.83%, 43.48% and 39.13% patients respectively.
The data also showed that 52.17% patients were drinking water in more quantity while 65.22% patients were drinking excess water after consuming the food.
Divaswapa (sleep by day), Vegavidharana (suppression of natural urges) and Chinta (stress) were found as causative factors in 78.26%, 43.48% and 62.21% patients respectively.
| Results|| |
Effect of therapy in Group A
In the present study, maximum 94.44% relief was observed in Avipaka whereas Kshudhanasha, Udaragaurava and Aruchi were reduced by 83.73%, 82.85% and 76% respectively. Statistically all the parameters of chief complaints showed highly significant results (P < 0.001) [Table 2].
The data revealed that maximum 100% relief found in Bahumutrata followed by 91.67% in Gurugatra, 90.92% in Tandra, 88.23% in Hrillasa and 81.48% relief was observed in Alasya. Statistically Alasya (P < 0.001) and Tandra (P < 0.001) showed highly significant results while Hrillasa (P < 0.01) and Gurugatrata (P < 0.01) showed significant results. Bahumutrata showed insignificant result (P > 0.05) [Table 3].
Further in Group A Malasamata reduced by 85.26% whereas Abhyavaharana Shakti and Jarana Shakti increased by 83.64% and 82.50% respectively. Statistically all the parameters showed highly significant results (P < 0.001) [Table 4].
Effect of therapy in Group B
In Group B maximum 46.83% relief found in Avipaka while Aruchi, Udaragaurava and Kshudhanasha were reduced by 38.09%, 37.50% and 24.64% respectively. Statistically Udaragaurava (P < 0.001) and Kshudhanasha (P < 0.001) showed highly significant result, whereas Aruchi (P < 0.01) and Avipaka (P < 0.01) showed significant results [Table 5].
In Group B the data reveals that maximum 47.09% relief observed in Tandra followed by 44.44% in Hrillasa, 37.50% in Gurugatrata, 23.52% in Alasya and 16.67% relief in Bahumutrata [Table 6].
Further Jarana Shakti and Abhyavaharana Shakti found increased by 27.71% and 27.38% respectively whereas Malasamata reduced by 33.33% [Table 7].
Comparative effect of therapy in both the groups
Comparatively Group A showed statistically highly significant results in Avipaka (P < 0.001), Udaragaurava (P < 0.001), Kshudhanasha (P < 0.001), Alasya (P < 0.001) and Tandra (P < 0.001) whereas significant results in Aruchi (P < 0.01), Hrillasa (P < 0.01), Gurugatrata (P < 0.01) and Bahumutrata (P < 0.01) than Group B. In Abhyavaharana Shakti, Jarana Shakti and Malasamata also Group A showed statistically highly significant results compared with Group B (P < 0.001) [Table 8] and [Table 9].
|Table 8: Comparative effect of therapy on chief and associated complaints in both groups|
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|Table 9: Comparative effect of therapy on Agni and Malasamata in both groups|
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Total effect of therapies
Maximum 100% patients showed marked relief in Group A whereas 80% patients in Group B showed mild improvement and 20% patients unchanged [Table 10].
| Discussion|| |
The cardinal symptoms of Ama like Aruchi, Avipaka, Udaragaurava and Kshudhanasha were found present in almost all the patients who show the presence of Samavaya relation between "Ama" and these symptoms. Further the presence of associated symptoms indicates that Ama is the base of all these symptoms. Agnimandya is the prior state for production of Ama and in case of Vishamagni it is mentioned that sometimes it digests the heavy food and occasionally unable to digest proper or less food also and hence it leads to the production of Ama.  Here Samavaya relation is applicable in between Agnimandya and Ama which are Karana and Karya respectively. In Ama condition presence of Agnimandya and Udaragaurava leads to aversion towards the food and one feels satisfied with lesser quantity of food which results into a reduction in Abhyavaharana Shakti.  Further due to inadequate and feeble Agni the food consumed also not get properly digested, i.e. the Jarana Shakti also gets hampered. The properties of Ama like Guru, Picchila, Snigdha etc., reflects in the stool as Picchila (sticky), i.e. Sama Malapravritti and due to its sticky nature it adheres in Mahasrotasa making various difficulties in the bowel habits.
Atiguru Ahara qualitatively while Atimatrashana and Adhyashana quantitatively becomes load over Agni, hence are responsible for Agnimandya and Ama.  Ajirnashana and Vishamashana directly causes the vitiation of Agni up to the extent that even the Laghu Ahara is not digested properly and becomes Visharupa (Poisonous), i.e. Ama.  Drinking excess amount of water causes trouble in the digestion process which ultimately causes Ama.  Divasvapa leads to Kapha-Pitta Vriddhi due to which Agnimandya occurs or the food consumed doesn't digest properly causing Ama production.  Habit of Vegavidharana leads to vitiation of Apana Vayu which in turn disturbs the function of Samana Vayu. Due to this the process of digestion gets hampered, ultimately leading to the production of Ama.  Chinta is directly mentioned as the causative factor for the production of Ama.  A person suffering from stress usually doesn't follow the Aharavidhividhana and consumes more or less food, without giving due concentration (Tanmana Bhunjita), which leads to indigestion and production of Ama.  All these causative factors work as Karana for the production of Ama (Karya). Hence a Samavaya relation is established between these Karanas (Hetu) and Ama.
In Group A, due to the presence of Ushna, Laghu and Ruksha properties Samavayatvena in the drug Pippalimula, it mitigates the Guru, Snigdha, Picchila properties of Ama. Hence all the chief and associated complaints got relieved. The Agnidipaka action of Pippalimula helped to increase the Abhyavaharana and Jarana Shakti. Furhter due to the Amapachaka action Malasamata got completely eradicated. In Group B, the absence of Ushna, Laghu, Ruksha properties in placebo makes it incapable to act on Ama. Hence, the Amapachana did not occur completely in this group. Some amount of results in Group B was due to the presence of luke warm water given as Anupana and also due to the general instructions of "Pathyapathya" (diet regimen) and "Nidanaparivarjana" (avoidance of causative factors) in both the groups.
All these results proved the Samavaya relation between Laghu, Ruksha, Ushna Guna and Pippalimula and further it also indicates that such kind of relation is absent in placebo.
| Conclusion|| |
Based on the above study concluded it can be concluded that directly or indirectly everything in this universe depends on Samavaya and hence its presence is inevitable in every concept of Ayurveda. Each and every Dravya in this universe possesses Guna and Karma Samavayatvena likewise Aushadha and its Gunakarma, Vyadhi and its Lakshana are related with each other by Samavaya. The relation of Pippalimula and Ushna, Ruksha, Laghu Guna is a type of Guna-Guni samavaya and similarly the relation between Ama and its properties like Guru, Snigdha, Picchila etc., also taken as Guna-Guni kind of Samavaya. Further, the relation of Ama and its symptoms like Aruchi, Avipaka and Udaragaurava etc., comes under the category of Karma-Karmavan Samavaya. On the basis of observations and results it is opined that, Pippalimula having Laghu, Ruksha and Ushna properties Samavayatvena in it, mitigated the symptoms of Ama; which proved the Samavaya relation between Dravya and Guna as well as between Vyadhi and its Lakshanas.
| References|| |
|1.||Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana, Deerghamjivitiya Adhyaya, 1/53, Ayurveda Deepika Commentry by Charapanidutta, Pt. Yadavaji Triamaji Acharya editor, reprint edition. Chaukhamba Surabharati Prakashana, Varanasi, 2009; 14. |
|2.||Ibidem. Charaka Samhita, Sutra Sthana, Deerghamjivitiya Adhyaya, 1/29; 7. |
|3.||Ibidem. Charaka Samhita, Sutra Sthana, Deerghamjivitiya Adhyaya, 1/50; 12. |
|4.||Prashastadevacharya, Prashastapadabhashya, 7/2/26. Shri Mishra N. editor, revised edition. Chaukhamba Sanskrit Sansthan, Varanasi, 2007; 41. |
|5.||Madhava, Vijayarakshita, Madhavanidana along with Madhukosha Commentry, Amavata Nidana, 25/1-5, reprint edition. Motilal Banarasidas, Varanasi, 2002; 424. |
|6.||Vagbhata, Arunadatta, Ashtangahriday, Sutra Sthana, Doshopakramaniya Adhyaya, 13/27, reprint edition. Chaukhamba Sanskrit Sansthana, Varanasi, 2009; 217. |
|7.||Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana, Yajjapurushiya Adhyaya, 25/40, Ayurveda Deepika Commentry by Charapanidutta, Pt. Yadavaji Triamaji Acharya editor, reprint edition. Chaukhamba Surabharati Prakashana, Varanasi, 2009; 131. |
|8.||Bhavamishra, Bhavaprakasha, Commentary by Chunekar KC, Haritakyadi Varga, Pandey GS editor, revised edition. Chaukhamba Bharati Academy, Varanasi, 2010; 19. |
|9.||Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana, Annapanavidhi Adhyaya, 27/13-15, Ayurveda Deepika Commentry by Charapanidutta, Pt. Yadavaji Triamaji Acharya editor, reprint edition. Chaukhamba Surabharati Prakashana, Varanasi, 2009; 154. |
|10.||Sharma G, Dwivedi RR. A clinical and comparative study of Ama and free radical theory w.s.r. to Amavata, M.D. Thesis. Jamnagar: Dept. of B.P., IPGT and RA, Gujarat Ayurved University; 2001. |
|11.||Vaja M, Dwivedi RR. A critical study of Trividha-Kuksheeya Vimana w.s.r. to Amotpatti and its management, M.D. Thesis. Jamnagar: Dept. of B.P., IPGT and RA, Gujarat Ayurved University; 2005. |
|12.||Baghel MS, Rajgopala S. Guidelines for Clinical Research Methodology in Ayurveda: A report submitted to WHO. Jamnagar: IPGT and RA, Gujarat Ayurved University, 2011. |
|13.||Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Grahanidoshachikitsa Adhyaya, 15/44, Ayurveda Deepika Commentry by Charapanidutta, Pt. Yadavaji Triamaji Acharya editor, reprint edition. Chaukhamba Surabharati Prakashana, Varanasi, 2009; 517. |
|14.||Sushruta, Sushruta Samhita, Sutra Sthana, Aturopakramaniya Adhyaya, 35/24, Aacharya VJ editor, reprint edition. Chaukhamba Surabharati Prakashana, Varanasi, 2008; 154. |
|15.||Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Grahanidoshachikitsa Adhyaya, 15/46, Ayurveda Deepika Commentry by Charapanidutta, Pt. Yadavaji Triamaji Acharya editor, reprint edition. Chaukhamba Surabharati Prakashana, Varanasi, 2009; 517. |
|16.||Ibidem. Charaka Samhita, Sutra Sthana, Yajjapurushiya Adhyaya, 25/40; 132. |
|17.||Ibidem. Charaka Samhita, Chikitsa Sthana, Grahanidoshachikitsa Adhyaya, 15/42; 517. |
|18.||Ibidem. Charaka Samhita, Sutra Sthana, Annapanavidhi Adhyaya, 46/500; 251. |
|19.||Vriddha Vagbhata, Ashtangasamgraha, Sutra Sthana, Viruddhanavijnaniya Adhyaya, 9/35, Sharma S editor, 2 nd edition. Chaukhamba Sanskrit Series Office, Varanasi, 2008; 92. |
|20.||Ibidem. Ashtangasamgraha, Sutra Sthana, Roganutpadaniya Adhyaya, 5/3; 31. |
|21.||Agnivesha, Charaka, Dridhabala, Charaka Samhita, Vimana Sthana, Trividhakukshivimana Adhyaya, 2/9, Ayurveda Deepika Commentry by Charapanidutta, Pt. Yadavaji Triamaji Acharya editor, reprint edition. Chaukhamba Surabharati Prakashana, Varanasi, 2009; 238. |
|22.||Ibidem. Charaka Samhita, Vimana Sthana, Rasavimana Adhyaya, 1/24/9; 237. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]