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|title=Acid peptic diseases  

|title=Acid peptic diseases  

|titlemode=append

|titlemode=append

|keywords= Principles, diagnosis, management, acid peptic diseases,amlapitta, peptic ulcer, gastritis,parinama shoola, Inflammatory Bowel Diseases, Irritable Bowel Syndrome, Ayurveda, treatment interventions, medical system healthcare, symbiohealth, charak samhita, caraka samhita, Indian system of medicine, pathogenesis of disease  

|keywords= Principles, diagnosis, management, acid peptic diseases, gut health, amlapitta, peptic ulcer, gastritis, parinama shoola, Inflammatory Bowel Diseases, Irritable Bowel Syndrome, Ayurveda, treatment interventions, medical system healthcare, symbiohealth, charak samhita, caraka samhita, Indian system of medicine, pathogenesis of disease  

|description= Principles of diagnosis and management of acid peptic diseases in Ayurveda are described.   

|description= Principles of diagnosis and management of acid peptic diseases in Ayurveda are described.   

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|label1 = Section/Chapter/topic

|label1 = Section/Chapter/topic

|data1 = Concepts and Contemporary Practices-[[Nidana]] [[Chikitsa]] / [[Vyadhi]] / Acid peptic diseases  

|data1 = [[Concepts and Contemporary Practices]] -[[Nidana]] [[Chikitsa]] / [[Vyadhi]] / Acid peptic diseases  

|label2 = Authors

|label2 = Author

|data2 = Prof. Dr. H.M. Chandola.¹

|data2 = Prof. Dr. H.M. Chandola¹

|label3 = Reviewer  

|label3 = Reviewer  

|data3 = Basisht G.²

|data3 = Basisht G.²

|label4 = Editor

|label4 = Editors

|data4 = Deole Y.S.², Anagha.S.²,Basisht G. ²  

|data4 = Deole Y.S.², Anagha.S.²,Basisht G. ²  

|label5 = Affiliations

|label5 = Affiliations

|data5 = ¹Former Dean I.P.G.T& R.A, Jamnagar & Director-Principal, C.B.P.A.C.S., Delhi, India  

|data5 = ¹Former Dean I.P.G.T. & R.A, Jamnagar & Director-Principal, C.B.P.A.C.S., Delhi, India  

²[[Charak Samhita Research, Training and Development Centre]], I.T.& R.A., Jamnagar, Gujarat, India   

²[[Charak Samhita Research, Training and Development Centre]], I.T.& R.A., Jamnagar, Gujarat, India   

|label8 = DOI

|label8 = DOI

|data8 = Under process

|data8 = Under process

}}'''<big>Principles of diagnosis and management of acid peptic diseases in Ayurveda</big>'''<div style="text-align:justify;">  

}}

This article is based on the lecture delivered by Prof. H.M. Chandola, as part of Prof. M.S. Baghel Memorial Lecture Series on 09^th April 2021.  

 

'''<big>Principles of diagnosis and management of acid peptic diseases in Ayurveda</big>'''

 

<div style="text-align:justify;">  

This article is based on the lecture delivered by Prof. H.M. Chandola, as part of Prof. M.S. Baghel Memorial Lecture Series on 09^th April 2021.The video lecture can be accessed on the link of [https://fb.watch/8l8TUYT2eZ/ facebook page.]

 

==Introduction==

==Introduction==

In the present era, the world is changing focus on “preservation of health” rather than treating the diseases. New diseases are emerging day by day in new forms. It is high time to recognize the importance of boosting up the defense mechanism of the body. This helps to resist any kind of adverse circumstances and maintain the proper balance of all the components of health.

In the present era, the world is changing focus on “preservation of health” rather than treating the diseases. New diseases are emerging day by day in new forms. It is high time to recognize the importance of boosting up the defense mechanism of the body. This helps to resist any kind of adverse circumstances and maintain the proper balance of all the components of health.

E.g: mental disturbances or negative emotions can disturb the proper function of digestive power and vice versa. If a person is worried, sad, angry, or emotionally upset, even the wholesome food consumed in proper quantity will not get digested properly.[Cha. Sa.[[Vimana Sthana]] 2/9]

E.g: mental disturbances or negative emotions can disturb the proper function of digestive power and vice versa. If a person is worried, sad, angry, or emotionally upset, even the wholesome food consumed in proper quantity will not get digested properly.[Cha. Sa.[[Vimana Sthana]] 2/9]

== Good health begins in the gut==

== Three categories of [[agni]] ==

While explaining the concept of [[agni]], the main form of [[agni]] is called as the “jatharagni” (pachakagni) which refers to the digestive enzymes. There are five elemental enzymes (bhutagni) which are the micro-elemental converters, and also the seven corresponding tissue building enzymes (dhatwagni). The digestive enzymes (pachakagni) control the other two kinds of [[agni]] that are acting at the level of absorption and metabolism. The term “koshthagni” is used when it deals with the digestive process in the gastrointestinal tract (GIT).

 

Good health begins in the gut. While explaining the concept of [[agni]], the main form of [[agni]] is called as the “jatharagni” (pachakagni) which refers to the digestive enzymes. There are five elemental enzymes (bhutagni) which are the micro-elemental converters, and also the seven corresponding tissue building enzymes (dhatwagni). The digestive enzymes (pachakagni) control the other two kinds of [[agni]] that are acting at the level of absorption and metabolism. The term “koshthagni” is used when it deals with the digestive process in the gastrointestinal tract (GIT).

 

==Agni and patterns of digestion ==

==Agni and patterns of digestion ==

When the [[agni]] is in the balanced state, it is known as “samagni”. But when it is affected by three [[dosha]], it shows three pathological variations. If there is an excess of [[kapha]] [[dosha]], it lowers the power of [[agni]] and the condition is known as “mandagni” (slow digestion). When [[pitta]] is in excess form, the [[agni]] becomes “teekshnagni” (fast/quick digestion). It can digest anything and everything and when the food is not available, it starts digesting the tissue elements ([[dhatu]]). For example, in thyrotoxicosis the hyperactivity of the thyroid gland causes high basic metabolic rate (BMR) and cachexia develops.  

When the [[agni]] is in the balanced state, it is known as “samagni”. But when it is affected by three [[dosha]], it shows three pathological variations. If there is an excess of [[kapha]] [[dosha]], it lowers the power of [[agni]] and the condition is known as “mandagni” (slow digestion). When [[pitta]] is in excess form, the [[agni]] becomes “teekshnagni” (fast/quick digestion). It can digest anything and everything and when the food is not available, it starts digesting the tissue elements ([[dhatu]]). For example, in thyrotoxicosis the hyperactivity of the thyroid gland causes high basic metabolic rate (BMR) and cachexia develops.  

==The concept of digestion in Ayurveda==

==The concept of digestion in Ayurveda==

The whole digestive process in the gut starts right from the mouth, where there is the action of “bodhaka [[kapha]]” to start the process of digestion. Then it goes to the stomach (amashaya) where it is subjected to the action of "kledaka [[kapha]]" for adding the moisture content (kleda) to the food material. Subsequently, from the stomach (amashaya) it goes into the portion of the small intestine called "grahani" which is the seat of "pachaka [[pitta]]". The 6th internal layer  called "pittadhara kala" is also situated there. The main process of digestion occurs in this portion of the gut. It is followed by caecum (unduka) and large intestine (pakwashaya) where the separation of essence (sara) and excretory materials (kitta) occurs with the help of “samana [[vayu]]” which leads to the absorption and assimilation of nutrient portion and excretion of the waste products in the form of faeces ([[purisha]]) and urine ([[mutra]]) with the help of “apana [[vayu]]”.

The whole digestive process in the gut starts right from the mouth, where there is the action of “bodhaka [[kapha]]” to start the process of digestion. Then it goes to the stomach (amashaya) where it is subjected to the action of "kledaka [[kapha]]" for adding the moisture content (kleda) to the food material. Subsequently, from the stomach (amashaya) it goes into the portion of the small intestine called "grahani" which is the seat of "pachaka [[pitta]]". The 6th internal layer  called "pittadhara kala" is also situated there. The main process of digestion occurs in this portion of the gut. It is followed by caecum (unduka) and large intestine (pakwashaya) where the separation of essence (sara) and excretory materials (kitta) occurs with the help of “samana [[vayu]]” which leads to the absorption and assimilation of nutrient portion and excretion of the waste products in the form of faeces ([[purisha]]) and urine ([[mutra]]) with the help of “apana [[vayu]]”.

The action of kledaka [[kapha]] is also executed by the following secretions in the gut.

The action of kledaka [[kapha]] is also executed by the following secretions in the gut.

*Serous & mucous secretions of salivary glands & oesophagus.

*Serous & mucous secretions of salivary glands & esophagus.

*Mucous secreted by mucous glands of surface mucous cells and mucous neck cells of the stomach.

*Mucous secreted by mucous glands of surface mucous cells and mucous neck cells of the stomach.

The action of "samana [[vayu]]" can be partially understood by the regulation of the secretion of HCL by parietal cells. The activities of the vagus nerve, the amount of gastrin from G cells and somatostatin from D cells, and the level of histamine play a vital role in this process.

The action of "samana [[vayu]]" can be partially understood by the regulation of the secretion of HCL by parietal cells. The activities of the vagus nerve, the amount of gastrin from G cells and somatostatin from D cells, and the level of histamine play a vital role in this process.

==Acid-Peptic Diseases==

== Acid-Peptic Diseases ==

 

Acid peptic disorders include many conditions whose pathophysiology is directly related to the damage caused by acid and peptic activity of gastric secretions. It includes gastroesophageal reflux disease, peptic ulcer (gastric and duodenal), and stress-related mucosal injury. In all these conditions, mucosal erosions or ulcerations arise when the caustic effects of aggressive factors overwhelm the defensive factors of the gastrointestinal mucosa.

Acid peptic disorders include many conditions whose pathophysiology is directly related to the damage caused by acid and peptic activity of gastric secretions. It includes gastroesophageal reflux disease, peptic ulcer (gastric and duodenal), and stress-related mucosal injury. In all these conditions, mucosal erosions or ulcerations arise when the caustic effects of aggressive factors overwhelm the defensive factors of the gastrointestinal mucosa.

==Aggressive and defensive Factors==

==Aggressive and defensive Factors==

Here, the aggressive factors represent the acid, pepsin, bile salts, drugs (NSAIDs), and H. pylori and the defensive factors are represented by mucus, bicarbonate layer, proper blood flow, cell renewal prostaglandins, and phospholipids.

Here, the aggressive factors represent the acid, pepsin, bile salts, drugs (NSAIDs), and H. pylori and the defensive factors are represented by mucus, bicarbonate layer, proper blood flow, cell renewal prostaglandins, and phospholipids.

== Vitiation of Agni (Agni dushti) and Acid peptic disorders==

== Vitiation of Agni (Agni dushti) and Acid peptic disorders==

For maintaining health,[[agni]] should be in its balanced state, i.e. “samagni”. All other states of [[agni]] leads to acid peptic disorders.

For maintaining health,[[agni]] should be in its balanced state, i.e. “samagni”. All other states of [[agni]] leads to acid peptic disorders.

Improper dietary habits cause vitiation of [[agni]], which leads to the process of fermentation of food material and ultimately it forms the toxic material called “amavisha”. It leads to “indigestion” (ajeerna) by vitiating the [[dosha]]. Continuous indulgence in improper diet and erratic lifestyle aggravates [[pitta]] [[dosha]]. This leads to an acute condition of “vidagdhajirna”. This is converted into different acid-peptic disorders like gastritis, gastro-oesophageal reflux disease(amlapitta), duodenal ulcer (parinama shula), gastric ulcer(annadrava shula) etc.

Improper dietary habits cause vitiation of [[agni]], which leads to the process of fermentation of food material and ultimately it forms the toxic material called “amavisha”. It leads to “indigestion” (ajeerna) by vitiating the [[dosha]]. Continuous indulgence in improper diet and erratic lifestyle aggravates [[pitta]] [[dosha]]. This leads to an acute condition of “vidagdhajirna”. This is converted into different acid-peptic disorders like gastritis, gastro-oesophageal reflux disease(amlapitta), duodenal ulcer (parinama shula), gastric ulcer(annadrava shula) etc.

===Vidagdhajeerna and Amlapitta===

===Vidagdhajeerna and Amlapitta===

The clinical diagnosis of “vidagdhajeerna” is based on the symptoms like sour eructation, burning sensation, giddiness, thirst, and sweating.  

The clinical diagnosis of “vidagdhajeerna” is based on the symptoms like sour eructation, burning sensation, giddiness, thirst, and sweating.  

In case of “amlapitta”, the symptoms are indigestion, nausea, sour/bitter eructation, burning sensation in oesophagus, epigastric region, anorexia, and abdominal heaviness.

In case of “amlapitta”, the symptoms are indigestion, nausea, sour/bitter eructation, burning sensation in oesophagus, epigastric region, anorexia, and abdominal heaviness.

Here, mucosal resistance is very important. The abnormal acid medium erodes the mucous lining of the concerned segment of the gut leading to painful conditions of the upper abdomen like gastric ulcer (annadrava shula) and duodenal ulcer (parinama shula). So, where aggressive factors are dominant, like in hyper-secretors, it leads to duodenal ulcer (parinama shula). Where there is the weakness of defensive factors, like in hypo-secretors or normo-secretors, it leads to the gastric ulcer (annadrava shula).

Here, mucosal resistance is very important. The abnormal acid medium erodes the mucous lining of the concerned segment of the gut leading to painful conditions of the upper abdomen like gastric ulcer (annadrava shula) and duodenal ulcer (parinama shula). So, where aggressive factors are dominant, like in hyper-secretors, it leads to duodenal ulcer (parinama shula). Where there is the weakness of defensive factors, like in hypo-secretors or normo-secretors, it leads to the gastric ulcer (annadrava shula).

So, it is better to consider amlapitta as a syndrome (acid reflux syndrome) rather than a particular gastrointestinal disease. It closely resembles gastritis, non-ulcer dyspepsia, hyperchlorhydria as well as hypochlorhydria and in the chronic stage, it may lead to gastric ulcer.

So, it is better to consider amlapitta as a syndrome (acid reflux syndrome) rather than a particular gastrointestinal disease. It closely resembles gastritis, non-ulcer dyspepsia, hyperchlorhydria as well as hypochlorhydria and in the chronic stage, it may lead to gastric ulcer.

==Gastritis==

==Gastritis==

Gastritis is a clinical condition with upper abdominal discomfort like indigestion or dyspepsia in which specific clinical signs or radiological abnormalities are absent.  

Gastritis is a clinical condition with upper abdominal discomfort like indigestion or dyspepsia in which specific clinical signs or radiological abnormalities are absent.  

It is of two types- acute gastritis and chronic gastritis.

It is of two types- acute gastritis and chronic gastritis.

===Acute gastritis===

===Acute gastritis===

For acute gastritis, there are many causative factors including diet and personal habits like consumption of highly spiced food, excessive alcohol consumption, heavy smoking, infections like H. Pylori, viral hepatitis, drugs like NSAIDs, aspirin, chemotherapeutic agents, severe stress including emotional factors like anger, shock, resentment, trauma, surgery and excessive burn. Due to these stress factors and smoking habits, the tracheobronchial tree of the person becomes hypersensitive and there will be increased secretion of acetylcholine, catecholamines, and histamine. This leads to hypersecretion of HCL from parietal cells due to hyperstimulation of vagus and increased secretion of gastrin. It makes the person more prone to acid peptic disorders.

For acute gastritis, there are many causative factors including diet and personal habits like consumption of highly spiced food, excessive alcohol consumption, heavy smoking, infections like H. Pylori, viral hepatitis, drugs like NSAIDs, aspirin, chemotherapeutic agents, severe stress including emotional factors like anger, shock, resentment, trauma, surgery and excessive burn. Due to these stress factors and smoking habits, the tracheobronchial tree of the person becomes hypersensitive and there will be increased secretion of acetylcholine, catecholamines, and histamine. This leads to hypersecretion of HCL from parietal cells due to hyperstimulation of vagus and increased secretion of gastrin. It makes the person more prone to acid peptic disorders.

It is better to take advantage of recent technologies for finding out the exact cause of the condition. If the conventional Ayurvedic treatment is not giving the desired result, we should explore the other possibilities like H.pylori infection and treat accordingly.

It is better to take advantage of recent technologies for finding out the exact cause of the condition. If the conventional Ayurvedic treatment is not giving the desired result, we should explore the other possibilities like H.pylori infection and treat accordingly.

Principles of treatment in acute gastritis  

====Principles of treatment in acute gastritis====

*The related organ, stomach (amashaya) should be given due importance. ( amashaya vishesha chikitsa)

*The related organ, stomach (amashaya) should be given due importance. ( amashaya vishesha chikitsa)

===Chronic gastritis===

===Chronic gastritis===

Recurrent attacks of acute gastritis may result in chronic gastritis.

Recurrent attacks of acute gastritis may result in chronic gastritis.

In its advanced stage, there is progression from chronic superficial gastritis to chronic atrophic gastritis characterized by mucosal atrophy and metaplasia of intestinal or pseudopyrloric type.

In its advanced stage, there is progression from chronic superficial gastritis to chronic atrophic gastritis characterized by mucosal atrophy and metaplasia of intestinal or pseudopyrloric type.

=== Principle of treatment of chronic gastritis ===

==== Principle of treatment of chronic gastritis ====

For treating the chronic gastritis, the principle of treatment of “[[vata]]-[[pitta]] dominant gulma” is recommended. It includes protecting the [[kapha]], which is the defensive factor. Here, the measures to reduce the penetrating power (tikshnatva) of [[pitta]] should be administered, followed by healing or soothing type of medicines (ropana chikitsa). The combination of Glycyrrhiza Glabra (yashtimadhu), Asparagus racemosus (shatavari), Phyllanthus emblica (amalaki) with ghee and honey is best for healing action. Drugs with bitter (tikta) or sweet (madhura) tastes (rasa) are preferable here. Ghee or milk preparation processed with these kind of drugs are also advisable.  

For treating the chronic gastritis, the principle of treatment of “[[vata]]-[[pitta]] dominant gulma” is recommended. It includes protecting the [[kapha]], which is the defensive factor. Here, the measures to reduce the penetrating power (tikshnatva) of [[pitta]] should be administered, followed by healing or soothing type of medicines (ropana chikitsa). The combination of Glycyrrhiza Glabra (yashtimadhu), Asparagus racemosus (shatavari), Phyllanthus emblica (amalaki) with ghee and honey is best for healing action. Drugs with bitter (tikta) or sweet (madhura) tastes (rasa) are preferable here. Ghee or milk preparation processed with these kind of drugs are also advisable.  

== Peptic ulcer ==

== Peptic ulcer ==

It includes both gastric ulcer and duodenal ulcer formed due to the imbalance of aggressive factor and defensive factor as discussed earlier.

It includes both gastric ulcer and duodenal ulcer formed due to the imbalance of aggressive factor and defensive factor as discussed earlier.

Eating worsens the symptoms of gastric ulcer and improves the symptoms of duodenal ulcer.  Hunger pain is observed in duodenal ulcer. The diagnosis is based on endoscopy. For detection of H. pylori, “rapid urease test” or “clo test” is performed. Biopsy is done to exclude possibility of cancer. In the management, high dose of proton pump inhibitors is given in conventional medicine.

Eating worsens the symptoms of gastric ulcer and improves the symptoms of duodenal ulcer.  Hunger pain is observed in duodenal ulcer. The diagnosis is based on endoscopy. For detection of H. pylori, “rapid urease test” or “clo test” is performed. Biopsy is done to exclude possibility of cancer. In the management, high dose of proton pump inhibitors is given in conventional medicine.

===Gastric ulcer (annadrava shula)===

===Gastric ulcer (annadrava shula)===

In this condition, there is continuous severe pain not subsiding in any stages of digestion like after digestion or during digestion, whether at empty stomach or after taking food. It is relieved only after vomiting out the accumulated [[pitta]]. [M. Ni. Shula Nidana]

 

In this condition, there is continuous severe pain not subsiding in any stages of digestion like after digestion or during digestion, whether at empty stomach or after taking food. It is relieved only after vomiting out the accumulated [[pitta]]. [M. Ni. Shula Nidana]

===Duodenal Ulcer (Parinama shula)===

===Duodenal Ulcer (Parinama shula)===

[[Vata]] vitiated due to its causative factors, gets mixed and blocked by morbid [[pitta]] and [[kapha]]. It causes severe pain (shula), which is known as “parinama shula”.

[[Vata]] vitiated due to its causative factors, gets mixed and blocked by morbid [[pitta]] and [[kapha]]. It causes severe pain (shula), which is known as “parinama shula”.

==Inflammatory bowel Diseases (IBD)==

==Inflammatory bowel Diseases (IBD)==

This includes two idiopathic bowel diseases having many similarities but distinctive morphological appearance.

This includes two idiopathic bowel diseases having many similarities but distinctive morphological appearance.

==Summary and Conclusion==

==Summary and Conclusion==

*Ayurvedic diagnosis of Acid Peptic disorders mainly depends on etiological factors, clinical manifestation of disease (symptomatology), relieving factors (upashaya) and aggravating factors (anupashaya).

*Ayurvedic diagnosis of Acid Peptic disorders mainly depends on etiological factors, clinical manifestation of disease (symptomatology), relieving factors (upashaya) and aggravating factors (anupashaya).

==Interaction Session==

==Interaction Session==

'''Q:''' How to treat H.pylori infection through [[Ayurveda]]?

'''Q:''' How to treat H.pylori infection through [[Ayurveda]]?

'''A.''' There are a lot of differences in preparation of asava -arishta in traditional method of fermentation and the one which is followed in the current era. The readymade preparations available nowadays can cause undesirable effects especially in the condition of acid peptic disorders. But if they are prepared in the traditional method, and used judiciously, it can give good results.

'''A.''' There are a lot of differences in preparation of asava -arishta in traditional method of fermentation and the one which is followed in the current era. The readymade preparations available nowadays can cause undesirable effects especially in the condition of acid peptic disorders. But if they are prepared in the traditional method, and used judiciously, it can give good results.