A REVIEW ON FIND OUT THE MOST EFFECTIVE AYURVEDA

FORMULA IN THE MANAGEMENT OF AMLAPITTA.

Data collection to be submitted as a partially fulfilment of Research & Methodology Subject

of
BACHELOR OF AYURVEDA MEDICINE AND SURGERY

Presented by

S.A.S.D.PIERIS

GWAI/2014/057

Under the supervision of

Dr.W.J.WICKRAMARACHCHI
M.D. (Ay), Ph.D.(India)
SENIOR LECTURER
DEPARTMENT OF CIKITSA

GAMPAHA WICKCKRAMARACHCHI UNIVERSITY OF

INDIGENOUS MEDICINE

YAKKLA

SRI LANKA

2021

i
 GAMPAHA WICKRAMARACHHI

UNIVERSITY OF INDIGENOUS MEDICINE

YAKKALA, SRI LANKA

CERTIFICATE

I certify that is is and independent dissertation on the title ‘’ A REVIEW ON FIND OUT THE MOST
EFFECTIVE AYURVEDA FORMULA IN THE MANAGEMENT OF AMLAPITTA’’done by
S.A.S.D.Pieris (GWAI/2014/057),under my supervision and guidance ,is in accordance with the rules
and regulations of the prescribed course and also the subject matter and ideas are adequate.

………………….. …………………….

signature Date

Dr.W.J.WICKRAMARACHCHI

M.D. (Ay), Ph.D.(India)

SENIOR LECTURER

DEPARTMENT OF CIKITSA

ii
 GAMPAHA WICKRAMARACHHI

UNIVERSITY OF INDIGENOUS MEDICINE

YAKKALA, SRI LANKA

DECLARATION

I hereby declared that this submission is my own work and to the best of my knowledge, it contains
no material previously published or written by another person, no material wish to substantial extend
has been submitted or accepted for award any other degree or diploma of a university or any other
institute of higher learning ,except where the acknoeledgement is made in the text.

……………… 2021.08.03

(S.A.S.D.Pieris) Date

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CONTENTS Page no

DECLARATION ii

CERTIFICATE iii

CHAPTER I - INTRODUCTION

1.1 Background of the research 1

1.2 Research problem 1

1.3 Justification 1

1.4 Hypothesis 2

1.5 Objectives 2

1.6 Significant of the study 2

CHAPTER II - LITERATURE REVIEW

2.1 Modern Literature review of gastritis 3

2.1.1Introduction 3

2.1.2 Types of Gastritis 4

1.1.2.1 Chronic Gastritis 4

2.1.1.2 Acute gastritis 5

2.1.2Causes for gastritis 5

2.1.3 Pathophysiology for gastritis 5

2.1.4 Symptoms of gastritis 6

2.1.5 Histopathology for Gastritis 6

2.1.6 Etiology for Gastritis 7

2.1.7 Complication of gastritis 8

2.1.8 Management of Gastritis 9

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2.2 Ayurveda view of Gastritis

2.2.1 Introduction to Amlapitta 10

2.2.2 Etymology 10

2.2.3 Definition 11

2.2.4 Synonyms for Amlapitta 11

2.2.5 Nidana for Amlapitta 12-13

2.2.6 Samprapti For Gastritis 14

2.2.7 Purvaroopa for Amlapitta 15

2.2.8 Roopa of Amlapitta 15

2.2.9 Types of Amlapitta 15

2.2.9 Upadrava of Amlapitta 16

2.2.10 Sadhyasadhyata 16

2.2.11 Sapeksha Nidana of Amlapitta 16

2.2.12 Chikitsa of Amlapitta 16-17

2.2.13 Drugs used in Amlapitta 18

2.2.14 Famous formulations: 18

2.2.15 Pathyapathya 19

2.3.Previous Reserches (Secondary data)

2.3.1 Article 1 19

2.3.2 Article 2 19-20

2.3.3 Article 3 21

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 2.3.4 Article 4 22-23

2.3.5 Article 5 24

2.3.6 Article 6 25

2.3.7 Article 7 26

2.3.8 Article 8 27

CHAPTER III-METHODOLOGY

3.1 Research Design 28

3.2 Praimary data collection 28

3.3 Secondary data collection 28

3.4 Exclusive criteria 28

3.5 Inclusive criteria 29

3.6 Data collection method 29

3.7 Data analysis methods 29

3.8 Interpretation of results 29

3.9 Conclusion 29

3.10 Suggestions 29

CHAPTER IV – REFERENCES 30

TABLE LIST

Table 1 20

Table 2 21

Table 3 2

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CHAPTER I-INTRODUCTION

1.1Background of the research

Ayurveda means the science of the life. The main objective of Ayurveda is not only the cure but also
the prevention. Nowadays Gastritis/Amlapitta very common disease among the peoples without any
Age barrier. Gastritis is an inflammation, irritation or erosion of the lining of the stomach. It can occur
suddenly (Acute) or gradually (Chronic).if not treat it can lead to sever blood loss and may increase
the risk of developing stomach cancer. It may be short in or long duration. Most common symptom is
Upper abdominal burning sensation. (Jennifer Robinson, 2020)

In treatment procedure of the Ayurveda based on herbal formulas that not lead to sideffects.
Nowadays there is world trend to using herbal formulas to cure and prevention from disease.Herbal
preparation contain many of identical and non-identical formulas that can cure the diseases. So when
we use some Ayurveda formula its may be better than modern drug which contain Active chemical
compounds. Apart from that When we consider about one Formula from the Ayurveda, it contains
few number of herbal plant materials. So it will be support to not only cure the disease but also
prevention rejuvenation,body purification and increase appetite that may lead to prevention from other
illness also. Its helps to maintain wellbeing of the people.

In Ayurveda there are many research were conducted to find out the effectiveness of the various
Ayurveda formulas. From them this study design to identification wide Ayurveda knowledge about
Amlapitta and find out the most effective drug that can manage the Amlapitta.

1.2 Research problem

What is the most effective Ayurveda treatment in the management of Gastritis?

1.3 Justification

Gastritis is very common disease among the society. It’s very common among the students and
employees because of missed their breakfast. When increase the symptom just like people tend to take
a drug which can reduce the acidity level of gastric juice.it may relief burning sensation of the upper
abdominal area. Hyperacidity simply means an increased level of acid in the stomach. The Stomach
normally secretes HCl acid that essential in the digestive process. Normal ph. value of the gastric is
1.53.5. The acid helps in the breakdown of food during digestion. When there is excess production of
the acid by gastric gland of the stomach, it results in the condition known as acidity. When there is
excess amount of HCl in stomach known as hyperacidity. Long standing of hyperacidity level may
lead to formation of ulcer in the stomach which may gain complication like perforation. So many
modern drugs and product are available for in the management of gastritis. Some products were
commercially available and some are western drug. Eno is commercially available product that we

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can use easily in the gastric acidity level management.Omeprasole is also the western drug doctor
prescribe for control acidity level of the stomach. Gastric medicine in Ayurveda involves the
reduction of aggravated body energies and the restoration of the digestive fire using cooling herbal
preparations and pitta pacifying diet that poses as best home remedies for gas. Ayurvedic medicine for
digestion problem includes techniques of reducing tension and stress are also proven to be effective in
treating this condition.(Dr Jiva) Nowadays there is world trend to use natural herbal product and
medicines. So there are few formulas mentioned in ayurved in the management of the
gastritis.Avipattikara churna and Bhashkara lavana is commonly used for the management of the
gastritis.

1.4 Hypothesis

Ayurveda Formula is the most effective in the control acidity level of the stomach in the management
of Amlapitta.

Null Hypothesis

Ayurveda Formula is not the most effective in the control acidity level of the stomach in the
management of the Amlapitta.

1.5 Objectives

General objectives

To determine the best effective Ayurveda formula is better in the management of the Gastritis.

Specific objectives

 To study of the gastritis causes and symptoms

 To study pathophysiology of the gastritis.
 To determine the best Ayurveda management for gastritis
 To determine the clinically importance of the Ayurveda formula
 To study the outcomes of the research

1.6 Significant of the study

Gastritis is common disease among the students and employees. There no specific time for the
showing symptoms. When someone who suffering from gastritis on missed their meals within proper
time acidity level of the stomach is become increased. Then symptoms of gastritis may
occure.Burning sensation and pain of upper abdominal area and chest, vomiting, diarrhoea, nausea,
may occur as symptoms of gastritis. At that movement we can manage the gastric acidity level
symptoms may control. Through this study I am going to introduce best Ayurvedic formula to manage
gastritis by themself at that movement easily. Its may better to use of herbal product to the mange this

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condition other than the tablet or commercially available products.Its will be better to free of side
effects.

CHAPTER II - LITERATURE REVIEW

2.1Modern Literature review of gastritis

2.1.1 introduction

Nowadays Gastritis is common among the peoples.Its define as inflamatioon of the gastric
mucosa.Definition of gastritis has its basis in histological features of the gastric mucosa.simply we
can define it as inflammation of gastric mucosa.It is not erythema observed during gastroscopy, and
there are no specific clinical features or symptoms defining it. The current classification of gastritis
centers on time course (acute versus chronic), histological features, anatomic distribution, and
underlying pathological mechanisms. Acute gastritis may lead to chronic if not treated. Helicobacter
pylori (H. pylori) is the most common cause of gastritis. However, 60 to 70% of H. pylori-negative
subjects with functional dyspepsia or non-erosive gastroesophageal reflux were also found to have
gastritis. H. pylori-negative gastritis is a consideration when an individual fulfill all four of these
criteria for A negative triple staining of gastric mucosal biopsies (hematoxylin and eosin, Alcian blue
stain and a modified silver stain), A negative H pylori culture, A negative IgG H. pylori serology, and
No self-reported history of H. pylori treatment. In these type of patients, the cause of gastritis may
corelate to tobacco smoking, consumption of alcohol, and/or the use of non-steroidal anti-
inflammatory drugs (NSAIDs) or steroids (Daniel Murrelli,written Carmella2020 july 24)

Causes for Gastritis can be caused by irritation due to excessive alcohol use, chronic vomiting, stress,
or other anti-inflammatory drugs. It may also be caused by any of the following.Helicobacter pylori:
A bacteria that lives in the mucous lining of the stomach. If not treat the infection can lead to ulcer
and in some people stomach cancer Bile reflux: Backflow of bile into the stomach from the bile tract
(that connects to the liver and gallbladder)Infections: Caused by bacteria and viruses. (Jennifer
Robinson, 2020)

Mostly symptoms of the gastritis is vary from each other .sometimes it may be asymptomatic.
However most common symptoms of gastritis may include as Nausea or recurrent upset
stomach,Abdominal bloating ,Abdominal pain,Vomiting ,Indigestion,Burning or gnawing sensation in
the stomach,hiccup, Loss of appetite, Vomiting blood or coffee ground like material,Black tarry stool
(Jennifer Robinson,2020)

Complications of Gastritis are Stomach bleeding ,Stomach ulcers & Stomach tumours(Jennifer
Robinson,2020) Acute erosive gastritis typically involves discrete foci of surface necrosis due to

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damage to mucosal defeneses.NSAIDs inhibit cyclooxygenase-1 or COX-1, an enzyme responsible
for the biosynthesis of eicosanoids in the stomach, which increases the possibility of peptic ulcers
forming. Also, NSAIDs such as aspirin reduce a substance that protects the stomach called
prostaglandin. These drugs used in a short period are not typically dangerous. However regular use
may lead to gastritis. Additionally sever physiologic stress from sepsis, hypoxia, trauma or surgery is
also a common etiologic for acute erosive gastritis. This form of gastritis can occur in more than 5%
of hospitalize patients. Also note the alcohol consumption does not cause chronic gastritis. It does not
cause chronic gastritis.it erode the mucosal lining of the stomach: low doses of alcohol stimulate
hydrochloric secretion. High doses of alcohol do not stimulate secretion of acid (Jennifer Robinson,
2020)

Chronic gastritis refers to a wide range of problems of the gastric tissue. The immune system makes
proteins and antibodies that fight infections in the body to maintain a homeostatic condition. In some
disorders the body targets the stomach such as if it’s were a foreign body targets the stomach as if it
were a foreign body protein or pathogen: it makes antibodies against severely damages and may even
destroy the stomach or its lining .In some cases bile normally used to aid digestion in the small
intestine, will enter through the pyloric valve of the stomach if it has been removed during surgery or
does not work properly also leading to gastritis. Gastritis may also be caused by other medical
conditions including HIV/AIDS, Crohn’s disease, Connective tissue disorders and liver or kidney
failure. (Jennifer Robinson, 2020)

2.1.2 Types of Gastritis

1.1.2.1 Chronic Gastritis

Stomach lining or mucosa has gland that produce stomach acid and other important compounds. This acids in
the stomach is strong to damage your lining mucosa. So lining mucosa secretes mucus to protect from the acid.
Chronic gastric occur when your stomach lining becomes inflamed. It is caused by Bacteria, consuming too
much alcohol, certain medications, chronic stress, or other immune system problems can lead to inflammation,
When inflammation occurs, stomach lining change and loss its protective cells. This is the cause for stomach
feels full after eating just a few bites of food. Chronic gastritis occur over a long period of time it gradually
ewers away at your stomach lining. And it can cause metaplasia or dysplasia these are precancerous changes in
your cells that can lead to cancer if untreated .usually chronic gastritis gets better with treatment.

Types of chronic gastritis are Type A,B and C .Type A is caused by immune system destroying stomach cells.
And it can increase your risk of vitamin deficiencies, Anaemia and cancer. Type B the very common type is
caused by Helicobacter pylori bacteria and cause to stomach ulcer, intestinal ulcer and cancer. Type C is caused
by Chemical irritants like no steroidal anti-inflammatory drug, alcohol, or bile. And it can also cause stomach

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lining erosion and bleeding. Other type of gastritis include giant hypertrophic gastritis include giant hypertrophic
gastritis, which can be related to protein deficiencies.Eosinophilic gastritis can happen alongside other allergic
conditions like asthma or eczema.( Daniel Murrelli,written Carmella,2020 july 240)

2.1.1.2 Acute gastritis

Acute gastritis is a transient mucosal inflammatory process that may be asymptomatic or cause
variable degrees of epigastric pain nausea vomiting. In more severe cases, there may be erosion,
ulceration, hemorrhage, haemetemesis Malena or rarely massive blood loss.Acute gastritis is often
irosive and haemorrhagic. Neutrophils are the predominant cells in the superficial epithelium. Many
case results from drugs intake like aspirin and anasid ingestion. Acute gastritis often produces no
symptoms but may cause dyspepsia, anorexia or vomiting and haematemesis or Malena. (Shugufta
Nisa,2018 may)

2.1.2Causes for gastritis:

Long term use of certain medications, such as asprin and ibuprofen, Excessive alcohol consumption,
The presence of H.pylori becteria,Certain illness, Such as diabetes or kidney failure, Week immunity,
Persistent intense stress and Bile flowing into the stomach or bile reflux Autoimmune gastritis
associated with serum anti-parietal and anti-intrinsic factor antibodies; characterized by chronic
atrophic gastritis limited to the corpus and fundus of the stomach that is causing marked diffuse
atrophy of parietal and chief cells. Microbial organisms H. pylori, Mycobacterium avium
intracellular, Herpes simplex, and Cytomegalovirus. Gastritis can caused by acid reflux. Rare
causes of gastritis include collagenous gastritis, sarcoidosis, eosinophilia gastritis, and
lymphocytic gastritis. (Shugufta Nisa,2018 may)

2.1.3 Pathophysiology for gastritis

Gastritis depending on the causes may be classified into acute gastritis, chronic gastritis, tropic gastritis
and H.pylori associated gastritis. In the majority of patients with acute gastritis the initial acute phase of
gastritis is subclinical and is of short duration about 7 to 10 days. Acute gastritis also referred to as
reactive gastritis occurs as a results of the trigger by factors such as NSAIDs,stress,bile reflux ,radiation,
alcohol abuse, cocaine addiction and ischemic damage. In chronic gastritis, the H.pylori infection persists
leading to accumulation of large number chronic inflammatory cells leading to active chronic gastritis.

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Pathophysiology for Acute gastritis also referred to as reactive gastritis occur as a result of the trigger by
factor such as NSAIDS, stress, bile reflux, radiation, alcohol abuse and ischemic damage. The outcome
of these triggers may result in ulcers, haemorrhage and erosion of the gastric mucosa.

The decrease in the prostaglandin synthesis is thought to be the reason for the injury to the
gastric mucosal layer. (Shugufta Nisa,2018 may)

2.1.4 Symptoms of gastritis

Gastritis doesn’t cause noticeable symptoms in everyone. The most common symptoms are nausea,
vomiting, a feeling of fullness in your upper abdomen, particularly after eating, indigestion. Erosive
gastritis you might experience different symptoms including black, tarry stool, vomiting blood or material
that looks like coffee grounds.(Daniel Murrelli,Carmella,2020 July 24)

2.1.5 Histopathology for Gastritis

When we study histopathology of Gastritis below conditions are important.Inflammatory infiltrate containe
mainly with lymphocytes (dispersed or organized in follicular/nodular structures), plasma cells, histiocytes, and
granulocytes in lamina propria (sometimes in the single glands units). The term “lymphocytic gastritis” is used
when lymphocytes are detected within the glandular epithelia and it is can sugesttes of an immunomediated
component of the inflammatory disease . A more severe (nodular) intra-glandular lymphocytic infiltrate
destroys and partially replaces the by the glandular structure like “lympho-epithelial lesions” are mostly
pathognomonic of primary gastric lymphomas (almost always associated with H. pylori).

Inflammatory infiltrate: polymorphs (neutrophils and eosinophils) is “Active” inflammation in the gastric
mucosa is described by the consists of neutrophils within the lamina propria or the glandular lumen). A case
where the eosinophils are predominant is described as “eosinophilic gastritis”. The etiopathogenesis and clinical
impact of such a histological category is still not clear.

Fibrosis of the lamina propria and smooth muscle hyperplasia is a condition Expansion of the collagen tissue of
the lamina propria (fibrosis) is associated with the loss of glandular units and the lesion is known as mucosal
atrophy. lamina propria become fibrosis may also be focal when scarring after peptic ulcer. Hyperplasia of the
muscularis mucosae may result from long-term PPI therapy. Smooth muscle fascicles may push the glandular
coils apart, giving rise to a pseudo-atrophic pattern.

Hyperplasia of the columnar epithelia condition. All inflammatory conditions of the gastric mucosa are related
with some degree of regenerative epithelial changes (regenerative hyperplasia) and this is typically seen at sites

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associated with erosions and peptic ulcers. Expansion of the proliferative compartment of the gastric glands (in
the neck region) leads to foveolar hyperplasia. Chemicals (NSAID, biliary reflux into the stomach) or infectious
stimuli that increase the cell turnover result in hyperplastic foveolae. An atypical regeneration of the glandular
neck and/or expansion of the glandular proliferative compartment may make it difficult to differentiate
regenerative from dysplastic lesions (the so-called “indefinite for non-invasive neoplasia” lesions). Changes
occurring in the oxyntic epithelia as a result of treatment with proton pump inhibitors, in response to the acid
secretion being inhibited, are sometimes considered as hyperplastic changes, but they may simply represent a
remodeling of the epithelial structure due to cytoskeletal rearrangements.

Gastric mucosa atrophy:Normal gastric biopsy show populations of glands (mucosecreting or oxyntic),
appropriate for the functional compartment (antrum or corpus) from which the specimen is obtained
Occasionally, minuscule foci of metaplastic (goblet) cells may be encountered in the foveolar epithelium (i.e.
“foveolar-restricted intestinal metaplasia”), however overall density of appropriate glands are not affected. The
latest definition of gastric atrophy is “loss of appropriate glands”. In this definition, an international group of
gastrointestinal pathologists arranged the histological spectrum of atrophic changes into a formal classification.
Different phenotypes of atrophic transformation may be encountered, Shrinkage or complete disappearance of
glandular units, replaced by expanded (fibrotic) lamina propria. These situation results in a reduced glandular
mass, but does not imply any modification of the original cell phenotype. Sometimes (particularly in H. pylori-
associated gastritis), severe inflammation obscures the gland’s population, making a reliable assessment of
mucosal atrophy impossible. In this type of cases can be (temporarily) labeled as “indefinite for atrophy” and
the final judgment can be deferred until the inflammation has regressed(e.g. after eradicationof the H. pylori
infection); Replacement of the native glands by metaplastic glands featuring a new commitment (= intestinal
and/or pseudopyloric metaplasia). The number of glands is not necessarily lower, but the metaplastic
replacement of native glands results in fewer glandular structures being “appropriate” for the compartment
concerned. Such a condition is consistent with the definition of “loss of appropriate glands”.These are the
histopathological conditions associated with Gastritis. ( Digestive and Liver Disease 43S (2011) S373–
S384)

2.1.6 Etiology for Gastritis

1. H. pylori-associated gastritis: Most of cases are caused by this bacteria.

2. H. pylori-negative gastritis: this is cause of gastritis associated with tobacco smoking, use of alcohol,
drugs
3. Like NSAIDs or steroids.
4. Autoimmune gastritis: Chronic inflammatory disease characterized by chronic atrophic gastritis
related with increased serum anti-parietal and anti-intrinsic factor antibodies. Low number of parietal

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 cells and in a reduction of gastric acid secretion, this is essential for absorption of inorganic iron. So
most peoples affected with this type of Gastritis suffering from iron deficiency and also this may lead
to B12 deficiency. This is very common in women.
5. Apart from the H. pylori gastritis can caused by Mycobacterium avium-intracellulare, enterococcal
infection, Herpes simplex, and cytomegalovirus and Parasitic gastritis may result from
cryptosporidium, Strongyloides stercoralis, or anisakiasis infection.
6. Bile acid reflux.
7. Radiation gastritis.
8. Crohn disease-associated gastritis:uncommon cause for gastritis.
9. Collagenous gastritis: This is a rare condition. The disease characteristically presents with marked
subepithelial collagen deposition accompanying with mucosal inflammatory infiltrate.
10. Eosinophilic gastritis: Rare cause for gastritis. The disease could be part of the eosinophilic
gastrointestinal disorders which is characterized by the absence of known causes of eosinophilia.
11. Sarcoidosis-associated gastritis: Sarcoidosis is a multisystemic disorder characterized by the presence
of non-caseating granulomas.This affect any body organ, the gastrointestinal tract, including the
stomach, is rare condition.
12. Lymphocytic gastritis: This may result of H. pylori infection or celiac disease has been suggested.
13. Ischemic gastritis: Uncommon type and associated with high mortality.
14. Vasculitis-associated gastritis: Diseases causing systemic vasculitis can cause granulomatous
infiltration of the stomach. This Granulomatosis with polyangiitis, formerly known as Wegner
granulomatosis. 
15. Ménétrier disease: This disease is characterized by formation of large gastric mucosal folds in the
body and fundus of the stomach,huge foveolar hyperplasia of surface and glandular mucous cells,
Protein-losing gastropathy, hypoalbuminemia, and edema in most of patients, and (iv) decrease
gastric acid secretion due to of loss of parietal cells. (Samy azer,2021/06/07)

2.1.7 Complication of gastritis

Peptic ulcer,Chronic atrophic gastritis (loss of appropriate glands resulting mainly from long-standing H.
pylori infection),Gastric metaplasia/dysplasia,Gastric cancer (adenocarcinoma),Iron-deficiency anemia
(chronic gastritis and early stages of gastric autoimmunity),Vitamin B12 deficiency (autoimmune
gastritis),Gastric bleeding,Achlorhydria (autoimmune gastritis, chronic gastritis),Gastric
perforation,Mucosa-associated lymphoid tissue (MALT) lymphoma,Neuroendocrine tumors (NET)
(previously referred to as gastric carcinoid; complicates autoimmune gastritis),Autoimmune gastritis
predisposes to the development of both gastric adenocarcinoma and gastric type 1 NET,The development

8
of NET in these patients is related to mucosal atrophy and hyperplasia of immature mucus neck cells,The
enhanced differentiation of immature precursor neck cells into histamine-producing enterochromaffin-
like (ECL) cells secondary to hypergastrinemia is the process,Vitamin C, vitamin D, folic acid, zinc,
magnesium, and calcium deficiency (atrophic autoimmune gastritis)( Samy azer,2021/06/07)

2.1.8 Management of Gastritis

Treatment procedure is differ from antibiotics (in H. pylori gastritis) to vitamin supplementation (in
autoimmune metaplastic atrophic gastritis) to immunomodulatory therapy (in autoimmune enteropathy) with
dietary modifications (in eosinophilic gastritis).

H. pylori-associated gastritis: A triple-therapy of clarithromycin/proton-pump inhibitor/amoxicillin for 14 to 21

days as first line of treatment. Clarithromycin is better than metronidazole because the recurrence rates with
clarithromycin are far less compared to a triple-therapy using metronidazole. However, in areas where
clarithromycin resistance is known, metronidazole is the option of choice. Quadruple bismuth containing
therapy would be of benefit, particularly if using metronidazole.After two eradication failures, H. pylori culture
and tests for antibiotic resistance should be a performed.

Autoimmune gastritis: Substitution of deficient iron and vitamin B12 (parenteral 1000 micrograms or oral 1000
to 2000 micrograms) should be prescribed. Then the Monitor Iron and folate levels, and eradicate any co-
infection with H. pylori. Endoscopic examination done for identification cancer risk and gastric neuroendocrine
tumors (NET) is required.

Other forms of treatment in gastritis include cessation of alcohol, smoking, anti-inflammatory drugs, spicy food,
as well as managing stress, immunomodulatory therapy in autoimmune enteropathy, and dietary modification in
the management of eosinophilic gastritis. (Samy azer,2021/06/07)

2.2 Ayurveda view of Gastritis

2.2.1 Introduction to Amlapitta

According to Charaka Samhita, Amlapitta is not mentioned as a separate entity but the word is discussed
at several places like Pandurogo Amlapitta But while describing the indication of Asthavidha Dugda,
Amlapitta has been listed.

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 Kulathaha Amlapitta Janakanam Kulattha means chief etiological factor of Amlapitta .Lavana
Rasatiyogajanya Vikara The excessive intake of Lavana Rasa causes Amlapitta Viruddha Aharajanya
Vikara Amlapitta has been included in the listed of diseases may caused by Viruddhahara.

Rajamaashaha ----Amlapittanut Rajamasha has the ability of relieving the Amlapitta.

Visarpamamlapittam ----- Jitanmahavikara Mahatikta Ghrita has been indicated in Amlapitta .

Janayantyamlapittam Cha in Grahani Dosha pathogenesis of Amlapitta has been clearly mentioned.

Asrug Amlapittavaivarnya Indication of Kansaharitaki also includes Amlapitta .

Amlakasya Vidahascha Antardaahascha |The list of Paittika Natmaja Vyadi includes Amlaka,
Dhumaka, Vidaha that are the symptoms of Amlapitta. (Dr Ariyadasa Kumarathunga,, 1996)

The above references are evidence for occurrence of Amlapitta. A clear cut Samprapti of this disease is
available, Kulattha, Lavana Rasa and Virudhahara were listed as the causes of Amlapitta where as
Mahatikta Ghrita and Kansaharitaki are prescribed for its treatment. Hence, it can be concluded that
during the period of Caraka all aspects of Amlapitta disease were considered.

In Sushruta Samhita Sushruta Acharya was describing the disease caused due to excessive use of Lavana
has mentioned a disease Amlika which is similar to Amlapitta.

In Kashyapa Samhita :Kashyapa Samhita is the first available text where Amlapitta has been mentioned
as a separate entity in chapter 16th of Khilasthana. Not only vivid description of Amlapitta with its
treatment has been mentioned in it, but suggestion to change the lack of peace of mind in case where
medicine does not work out has also given.

The etiopathological factors have been explained similar to that of Madhava Nidana and many
medicaments are given for the treatment in this text.Seven new mineral formulations have been added to
the existing formulation starting from Bhaskaramrutabhrakam to Sitamanduram. Many palatable
formulations have been mentioned which includes Amlapittantaka Modaka,Saubhagya Shunti
Modaka,Avipattikara Churna one of the Taila is Sribilva Taila.In this book Narikela Khanda has been
indicated for Amlapitta. (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.2 Etymology

Amlapitta is composed of two words that Amla + Pitta = Amlapitta.

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The term Amla refers to a particular type of taste equated with the sour taste which causes excessive
salivary secretion. Pitta is a 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.

2.2.3 Definition

Amlaya Pittam Amlapittam | (Vachaspatyam) According to Vachaspatyam, Amlapitta means Pitta

leading to sour taste. (Dr Ariyadasa Kumarathunga,, 1996)

Vidahyamlagunodriktam Pittam Amlapittam | (Vijayaraksita) Vijayarakshita, commentator of

Madhava Nidana defines the words as that the Pitta having Vidahi quality give rise to Amla or sour taste.
(Acharya Madhawa,2005)

Amlapittam Chaiti Amlagunodriktam Pittam | (Chakrapani) Which means the qualities of Pitta i.e.
sourness is increased leading to Amlapitta.

Amlam Amladhikam Pittam Yatra Tadamlapittam | (Gananatha Sen) Shri Gananath Sen in his
book Sidhanta Nidana has given similar definition, as the qualities of Pitta i.e. sourness is increased
which leads to Amlapitta.

The above classical description of Amlapitta emphasizes that Amlapitta is a patho-physiological

condition in which the Pitta gets vitiated in terms of Vruddhi (excessiveness) and sourness of Pitta is
increased. (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.4 Synonyms for Amlapitta

Pramilaka

Pitta Visuchika

Pittamlaka

11
Amlika (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.5 Nidana for Amlapitta

After careful screening and analysis of the etiological factors of Amlapitta, they may be discussed under
four groups viz. the Aharaja Hetu (dietary factors), Viharaja Hetu (habit factors), Manasika Hetu
(psychogenic factors) and Agantuka Hetu (miscellaneous factors). (Pramod C. Baragi ,Jan - Feb 2017 )

1. Aharaja Hetu (Dietary factors):

The first and the foremost group of etiological factors of Amlapitta may be considered as the
dietaryfactors. Under this group intake of food against the code of dietetics i.e. Ahara Vidhividhana and
Aharavidhi Visesayatana is included. Various types of incompatible substances, excess of Pitta
aggravating factors like Katu, Amla, Vidahi etc. Bharjitanna and untimely consumption of food are the
factors against the dietetic code and they are directly responsible for the disturbances of Pitta.

According to the type of Ahara.:i. Kulattha ii. Pruthuka iii. Pulaka (Husky food)

According to the quality of Ahara i. Abhisyandi, iv. Gurubhojya (heavy diet) , ii. Atisnigdha
(Unctuous) ,iii. Ati Ruksha (Very coarse) ,vi. Vidahi Pana , v. Vidahi Anna

According to the Samskara of the Ahara i. Apakwanna Sevana (uncooked food), ii. Bhristadhanya
Sevana (fried paddy), iii. Iksuvikara sevana (Sugar-cane products), iv. Pistanna Sevana.

According to Dusitanna i. Dusta Anna Sevana, ii. Paryusita Anna Sevana

According to the Pitta provocative potency of diet i. Adhyasana ii. Ajirnasana iii. Amapurnata iv. Ati
Usna (Very hot) v. Ati Amla (intake of excessive acidic diet) vi. Ati Drava (intake of excessive liquid)
vii. Ati Tikshna (intake of very sharp substance) viii Ati Panam (Over drinking) ix. Katu Anna Pana
(Pungent diet and drinks) x. Virruddhasana (incompatible diet)

12
According to the capacity of weakening the digestive power i. Ati Snigdha Sevana (excessive fatty diet),
ii. Ati Ruksha Sevana (excessive coarse)

Faulty dietary habits i. Akala Bhojana (untimely eating) ii. Antarodaka Pana (drinking of excess water
during meal) iii. KalaAanasana (avoiding the diet in proper time) iv. Visamasana

Miscellaneous i. Annahina Madya (Alcohol without eating), ii. Madya Sevana (alcohol drinking) ii.
Gorasa Sevana (milk products). (Pramod C. Baragi ,Jan - Feb 2017 )

2. Viharaja Hetu (Habit factors)

To maintain sound and good health, one has to follow the code of habits. He is required to have regular
habits of defecation, to have food in time and to sleep in time. He has not to suppress natural urges
forcefully. If one follows all these codes regularly, one would certainly maintain the equilibrium of the
body constituents and by that, obviously, he would maintain good health and proper functioning of the
body. If this is not followed regularly, the whole functioning of the body will be disturbed and in the long
run, they will cause the disturbance of the equilibrium of Pitta and digestion which ultimately will lead to
Amlapitta.

 Atisnat (Taking excessive bath)

 Ati Avagahanat (Excessive swimming)
 Bhuktwa Diwasvapnat (Sleeping in after meals)
 Vega Dhararam (Suppression of urges)
 Shayya Prajagarae (Improper sleeping schedule)
 Manasika Hetu (Psychogenic factor)

Psychology always plays a great role in maintaining the health and psychological activities.As well as an
abnormal psychology, in terms of anger, anxiety, greed etc.may be affect the physiology of digestion.
Either there may be a lesser secretion of the digestive juice or secreted at improper times and sometimes
it may be secreted in excessive quantity. All these conditions aggravates Pitta, which ultimately gives rise
to Amlapitta.

The modern investigators have established that acid gastritis is nothing else but is the syndrome resulting
from stress and strain that shows the important role played by psychogenic factors in the production of
Amlapitta. (Pramod C. Baragi ,Jan - Feb 2017 )

4. Agantuka Hetu:

13
Amlapitta could be a sequel of faulty drug or drug abuse habits. Over the counter intake of non steroidal
anti-inflammatory drugs and anticoagulant cure one disease but it can produce Amlapitta. Ayurvedic
drugs, specially unpurified and faulty Rasa Aushadhi may be cause Amlapitta. 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 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. (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.6 Samprapti For Gastritis

The word Samprapti is the process of disease formation beginning right from the contact of the causative
factor with the body to complete manifestation of the symptoms. It is a course followed by a disease in
which the Dosha gets vitiated and the path it follows for the manifestation of the disease. The same idea
is reflected by the word pathogenesis used in modern medical science.

Kashyapa, Madhava and Gananatha Sen have mentioned specific Samprapti of Amlapitta as follows.
Over indulgence in above mentioned

Etiological factors cause vitiation of Vata and Pitta Dosha. Anyone of the involved Dosha decreases the
Jatharagni (to below the normal level) i.e. Jatharagnimandya. During this state, whatsoever food
consumed, becomes Vidagdha. Then it becomes Sukta and it lies in the stomach stagnant. Any food
which is taken becomes Vidagdha. At this stage Vidagdhajirna manifests which is the Purvarupa of the
disease. Further vitiated Pitta gets mixed with Sukta and causes Pitta Amavisa Sammurchhana. The
Amlapitta with its cardinal symptoms is then born. If not treated properly in this stage, the disease leads
to Bhedavasta where the typical characteristic types like Urdhwaga, Adhoga etc. are differentiated.
Further complications like Sitapitta, Udara, Annadrava and Parinama Shula etc. may occur in the
advanced course of the disease.

Gananath Sen in Sidhanta Nidana has mentioned that when food is dominant with Amlarasa, then in
Amashaya also Amlarasa is produced and when it is taken in more quantity it irritates the Amashaya. If
food is not consumed at proper time, then the secretion of Amlarasa increase and it then irritates the
Amasayakala resulting in various incurable disorders like Shula etc. (Pramod C. Baragi ,Jan - Feb 2017 )

Dosha-Pitta pradhana kapha

Dushya - rasadhatu
agni - jatharagni

14
ama  - jatharagnijanya ama
srotas - annavaha and rasavaha
sroto dushti prakara - sanga , vimarga gamana
udbhava sthana - amashaya
sanchara sthana-maha srotas
vyakta sthana - amashaya
rogamarga-abhyantara (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.7 Purvaroopa for Amlapitta

In Ayurvedic classics, no specific Purvarupas of Amlapitta are mentioned, but by applying Tarka and
practical knowledge, some important inferences can be drawn.

As already explained in the Samprapti, Agnimandya and Ajirna are the successive stages towards the
manifestation of Amlapitta. Also they are practically observed in the patients. Annavaha and Purishavaha
Srotodusti symptoms can also be considered as Purvarupa of Amlapitta. (Pramod C. Baragi ,Jan - Feb
2017 )

2.2.8 Roopa of Amlapitta

Symptoms of Amlapitta have been described by Kashyapa, Madhava Kara and Harita. Later workers of
Sangrahakala like Bhavamishra, Vangasen and Yogaratnakara have followed Madhavkar. In this regard
Basavaraja has included Amlapitta in Nanatmaja diseases of Pitta and Vakshiva Paridosha (Saptam
Prakarana) to Amlapitta . The symptoms of Amlapitta according to Madhava are, Avipaka, Kanthadaha,
Klama, Tikta Amla Udgara, Gaurava, Aruchi, Utklesha, Hritdaha. (Pramod C. Baragi ,Jan - Feb 2017 )

Visishta laxanas      

                                                   VATAJA                            PITTAJA                            KAPHAJA

                                 shoola                               brhma                        shareera guruta
                            angasada                           vidaha                       vanti
                            jrumba

15
2.2.9 Types of Amlapitta

According to the Gati of Pitta, Madhava has described 2 types of Amlapitta. i.e.

1. Urdhvaga Amlapitta

2. Adhoga Amlapitta

According to the involvement of Dosha, Kashyapa and Madhava both have divided Amlapitta as in
Kashyapa Vatika Amlapitta , Paittika Amlapitta, Slesmika Amlapitta in Madhava Sanila Amlapitta
,Sanila Kapha Amlapitta Sakapha Amlapitta Shleshmapittaja Amlapitta described by only Madhava

Upasaya Anupasaya :Specific mentioning about Upasaya and Anupasaya is given only by Kashyapa
while describing Dosaja types of Amlapitta.

Vataja Amlapitta - Snigdha Upasaya

Pittaja Amlapitta - Swadu and Sita Upasaya

Kaphaja Amlapitta - Ruksha and Ushna Upasaya (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.9 Upadrava of Amlapitta

Complication of Amlapitta have been not described by ancient Acharyas except Kashyapa. The author
has mentioned eight Upadravas and stated that the disease is incurable in their presence. The Upadravas
are; Jvara, Atisara, Panduta, Shula, Shotha, Aruchi, Bhrama, Grahani Roga.

Though Madhavakara has not mentioned the complication of Amlapitta but included Shoola in its Vatika
predominant variety. Hence, Parinama and Annadrava Shoola can be taken as complications of
Amlapitta.

According to Acharya Gananath Sen, Upadravas of Amlapitta are Amasayakala Shopha, Grahani Kala
Shopha, Kandu, Mandala, Pidaka, Shitapitta, Udara, Vicharchika, Vispota. (Pramod C. Baragi ,Jan - Feb
2017 )

2.2.10 Sadhyasadhyata

Madhava has described the Sadhyasadhyata of this disease. If the disease is of recent origin, it can be
cured with proper efforts. In chronic condition, recurrence occurs when treatment is stopped. In some

16
patients it becomes more difficult to cure, even with proper treatment. If accompanied by other
Upadravas, Chronic Amlapitta may be Asadhya. (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.11 Sapeksha Nidana of Amlapitta

The disease Amlapitta should be diagnosed differentially from Pittaja Atisara, Pittaja Grahani,
Vidagdhajirna. (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.12 Chikitsa of Amlapitta

The line of treatment of Amlapitta may be considered in 2 ways viz. general principles of management
and also management according to particular condition. According to Charaka also almost all diseases
may be treated in 3 ways.

1. Apakarsana

So far Amlapitta is concerned, it originates in Amashaya and mostly the Doshas are localized there. For
this condition Vamana is the best treatment. If the Doshas are localised in Pachyamanasaya, then
Virechana is the ideal therapy. If the Doshas are localised in Pakwasaya then Basti is the suitable therapy.
In other words Apakarsana is the Shodhana therapy. In Shodhana therapy Vamana is advocated in
Urdhwaga Amlapitta and Virechana in case of Adhoga Amlapitta. Use of Niruhabasti is stated by
Chakrapani,Vrinda Madhav and Govind Das where as Yoga Ratnakara has mentioned the use of
Raktamokshana.

2. Prakritivighata

Prakritivighata refers to the use of drugs which suppress the Doshas. Such treatment is termed as
Shamana therapy. In Amlapitta also the Shamana therapy is advised and various Pitta Shamaka recipes
have been prescribed. The Shamana drug should be of Madhura and Tikta Rasa, Snigdha Guna and
Sheeta Veerya which are opposite to Pitta.

3. Nidana Parivarjana

Nidana Parivarjana refers to avoiding those factors from the diet which are Dosha aggravating and
disease producing. Naturally only those dietetic articles are advisable to be used which are wholesome
and beneficial.

1. Since the disease is Amashaya oriented and Kapha and Pitta are the dominating Doshas, Vamana
should be administered at first.

17
2. After the Vamana, Shamana drug (anti-Pitta, Kapha drugs) should be used. At the same time Pachana
drugs should be given.

3. When the Samsarga Doshas are eliminated and stomach becomes clear, Deepana drug should be
administered.

4. If the Doshas have shifted into Pakwashaya, Virechana or Sransana drugs should be used to eliminate
the Doshas. (Pramod C. Baragi ,Jan - Feb 2017 )

2.2.13 Drugs used in Amlapitta

common drugs (herbal)

ATIVISHA            SHATAVARI               DHANYAKA
MUSTA                AMALAKI                   HINGU
TRAYAMANA        YASHTI MADHU        NARIKELA
PATOLA               BHRINGARAJA          KUSHMANDA
GUDUCHI            VASA                         YAVASA
KIRATA TIKTA       NIMBA                       ARKA
TRIVRITA              PIPPALI                    VIDANGA
TRIPHALA            UDUMBARA              DRAKSHA
DANTI                  PARPATAKA              CHANDAN

Rasa Dravyas

SHANKHA               SHILAJIT                 SUKTI

ABHRAKA               MANDOORA            SWARNA
LOHA                      RAUPYA                  GANDHAKA
SWARNAMAKSHIKA           PARADA         VARATIKA
KAPARDA                 MANAHSHILA          KHATIKA

2.2.14 Famous formulations

18
  Drakshavaleha
 Sootasekhar Rasa
 Kamadudha Rasa
 Satavari Mandura
 Avipattikara Churna
 Satavari Ghrita
 Bhahkara lavana
 Bhunimbadi kwatha
 Narikela khanda
 Varunadi kwatha
 Lilavilasa rasa     (Pramod C. Baragi ,Jan - Feb 2017 )
                                    

2.2.15 Pathyapathya

Various references of Pathya Apathya can be found in various classics.Ahara Purana Shali, Mudga,
Goghrita, Godugdha, Jangala Mamsa, Patola, Vastuka, Dadima, Amalaki etc. are pathya ahara.Amla,
Lavana, Katu, Vidahi, Guru, Tila, Kulattha, Madya etc. are the apathy ahara.Vihara Sitopachara, Visrama
Atapasevana, are pathya vihara and Vega Vidharana, Krodha, Soka, Chinta etc. are apathya vihara.
(Pramod C. Baragi ,Jan - Feb 2017 )

2.3.Previous Reserches (Secondary data)

2.3.1 Article 1

MANAGEMENT OF AMLAPITTA IN AYURVEDA:A REVIEW

Dr Bikash Raj Ghimire ,Dr. Samichha Neupane,Dr Shwetha Kumari Pokhare,AmeithaGhimre was
conducted a review onManagment of Amlapitta.In the management of hyperacidity devided in to 3
parts.1.Nidana parivarjana,2. Sanshodhanacikitsa and 3.Sanshamana cikitsa.As oral medicine they
havementionedAvipattikarachuna,Sutsekharrasa,Kamadugha rasa,Prawal panchamrit,Laghusutshekar
rasa,ChurnalikeShathavari,Yashtimadhu,Sariva,Vasa,Bhringa,Dhamasa,Amla,Chandana,Guduchi
sattva,Musta,Parpatak,Chandanasawa,Ushirasava,Bhunimbadikada,Abhayarishta,Amlapitta
kanda,Patoladi kashaya and Dhanvantari gutika.

19
They concluded Amlapitta is most irritating disease due to fauly of life pattern with mental
stress.Vitiation of pitta is most clinical manifestation for amlapitta.If not treated It may lead to
complications just like Jwara,Atisara,Pandu, Shotha,Aruchi and Brama.The person perform with
adequate diet and mode of lifestyle helpe in the management of Amlapitta

2.3.2 Article 2

STUDIES ON URDHAVAGA AMLAPITTA(GASRITIS)AND ITS MANAGEMENT WITH

SHATAVARI GHRITA.

Sanjore(Naringe) Seema S., Kharche G. Y. conducted a research to Studies on Urdhwaga Amlapitta

(Gastritis) and its Management with Shatavari Ghruta . The research was design To assess the efficacy
of Shatavari Ghruta in the management of Urdhwaga Amlapitta comparative with the results of Shatavari
Ghruta to Sutshekhara Rasa & Kamdudha Rasa in Urdhwaga Amlapitta. Also study the changes of acid
level of patients of Urdhwaga Amlapitta with Shatavari ghrta and Sutsekhara Rasa & Kamdudha Rasa.

53 patients were selected and diagnosed as Urdhwaga Amlapitta and included in study, out of which 3
drop outs during the complete course of treatment. Patient is treated as outdoor patient of Ayurveda
Rugnalaya and Anusandhan Kendra & Ayurveda Rugnalaya (old hospital) station Road, Akola and
indoor patient of Ayurveda Rugnalaya and Anusandhana Kendra, Akola.

Subjective Criteria:-Patients suffering from Urdhwaga Amlapitta fullfilling essential criteria were
included for present study as inclusion criteria.i) Avipaka ii) Utklesha iii) Tikta-amlodgara iv)
Kantha-hrut-kukshidaha v) Agnimandya vi) Chardi. The patients of either sex and between the ages of
20 – 70 were selected. Exclusion criteria are Patients with significant hepatic, renal, hematological,
neurological or psychiatric disorders were excluded from the study and Patients who suffering gastric or
duodenal ulcer or with its complications, Gastric carcinoma or Zollinger– Ellison syndromes were
excluded from the study.

Objective Criteria:- Gastric analysis test: - Free HCl more than 15-18.5 Meq/L and Total acidity level
more than 25- 30 Meq/L was considered for the patient of Urdhwaga Amlapitta. Laboratory
investigations:- 1. Hb%, 2.TLC, 3.DLC, 4.ESR, 5.Urine complete, 6. Stool complete, 7. Serological test
for detection of antibodies developed by H. Pylori.

Present clinical study 50 patient devided randomly to group A and group B each contain 25 patients.
Group A: - This group was treated with Shatavari Ghruta. Dose: - 10 -20 ml, BD (orally) for 12 week.

20
Anupana: - Lukewarm milk. Group B: - This group was treated with Sutashekhara Rasa and Kamadudha
Rasa. Dose: - Each 250 to 500 Mg. TDS (orally) for 12 weeks.Anupana: - Lukewarm milk.

The patients were examined according to symptomatic relief at every week and reporting was noted in
specially prepared research Proforma.

Results of the study

Sr. No. Group Number of Patients Total

Cured Improved
1 Group 'A' 19 06 25
2 Group B 18 7 25
Total 37 13 50

Table 1-results of the study

Mode of action of Shathavari gritha

Samprapti Ghataka By Samprapti Ghataka By Samprapti Ghataka By property

property Action property Action Action
Dosa- I Pachaka Pitta

Shitavirya Ushna, Oja&Medhavardhaka property iUshna, tiksna, Laghuguna of sadhak

of Godugdha&Goghruta pitta
ii) Snehaguna of sadhak pitta.
iii) Rajo&Tamodosa of mana
Satwaguna of mana So function of
sadhaka pitta get corrected.
Samanvayu Vatpittagna Ruksa, Laghu, Cala, Guna of
samanvayu
Udanavayu Vatpittagna Laghu, Cala, Guna of Udanavayu.
Dhatu :- i) Rasa RaktaMamsa Balya,Rasayana Correct dhatu vishama
Mamsa Snigdha, pichilmrduguna, Produces a protective layer on gastric
sitvirya mucosa, gastric irritation & heals the
ulcer.
Agni-Jathragni Dipanaprabhava of goghrta Jatharagnivardhana
Mala Snigdhaguna Purusa Help in soft defecation

Table 2-Mode of action of Shathavari gritha

21
From the study concluded that Urdhvaga Amlapitta can he managed effectively with Shatavari Ghruta as
well as Sutsekhara & Kamdudha Rasa. Both groups have shown individually high significant of results.

2.3.3 Article 3

A NOVEL APPROACH IN THE MANAGEMENT OF AMLAPITTA (GASTRITIS) THROUGH

ODANA KALPANA –A CLINICAL STUDY

Shweta Dewan, Susantha .P. Molligoda was conducted the clinical study on Novel approach In the
management of Amlapitta (Gastritis)Through Odana kalpana.The study was conducted in 30 number of
patients who clinically diagnosed of Amlapitta, to clinical evaluate the efficacy of Odana Kalpana(Orzya
Sativa) and Virecana Yoga. (Operculina turpethum).These patients were randomly devided into two
groups of 15 patients each. Patients of group A were treated with Odana Kalpana 50 g as the Mantha
preparation with water twice a day for one month after 3 days of shodhana karma (bio purification).
Patient of group B were only given Odana Kalpana 50 g as Mantha preparation with water twice a day
for one month.
When consider of Results It was observed that the patients of Amlapitta of Group A treated with Odana
Kalpana and Virecana yoga showed maximum percentage of improvement i.e. 53.20 %.where as it was
42.01% in patients of Group B. No side effects were noted in any of the patients during the studying
period. So we can Conclude Odana Kalpana is effective in the management of amlapitta.

2.3.4 Article 4
A CLINICAL STUDY ON AMLAPITTA AND ITS MANAGEMENT WITH
CHHINNODBHAVADI GHANAVATI

Mohapatra Nibedita conducted research on A CLINICAL STUDY ON AMLAPITTA AND ITS

MANAGEMENT WITH CHHINNODBHAVADI GHANAVATI.
In this study “Chhinnodbhavadi Ghanavati” was taken to prove its efficacy for the appropriate
management of Amlapitta. Chhinnodbhavadi kwath 6 (decoction) consists of equal proportion of
Terminalia chebula Retz, Terminalia belerica Roxb, Emblica officinalis Gaertn, Tinospora cordifolia
(Willd), Azadirachta indica A juss and Trichosanthus dioica Roxb. Coarse powder of these drugs was
taken make Ghanavati form the decoction for interal administration (of the drug) along with honey.
Special reference to Chakradutta (52/17) and Bhaisajya ratnavali (56/17)

Patients who diagnosed with Amlapitta were selected from the O.P.D. & I.P.D. of GAM&H random
manner. Basing on the screening, Out of 47 registered patients, Forty (40) patients (20 patients in Grade–
1 and 20 patients in Grade-2) completed therapy and 7 patients left the treatment schedule between the

22
procedure, which were counted as dropout cases. The study was carried out from May 2013 to October
2013.

The case selection for trial was according to the following criteria inclusive criteria for the study 1. Age-
20 to 60 yrs 2. Both sexes 3. Mentally stressed and strained 4. Spicy and oily food in takers5. Patients
with classical symptoms of Amlapitta. 6. Patients who were co-operative and ready give written consent.
Exclusion criteria for the study1. Below 20yrs and above 60 yrs 2. Pregnant and lactating 3. Intestinal
Koch’s 4. Ca stomach 5. Cholecystitis 6. Addicted to alcohol 7. Barrett's oesophagus

Subjective Parameters are 1) Avipaka Klama 2) Utklesha 3) Vamana 4) Tiktoamlodgara 5)

Hritkanthadaha 6) Aruchi 7) Udarashoola Objective Parameters 1) Gastric juice baseline pH 2)
Endoscopic findings.

Assessment scale of the symptoms were recorded in terms of clinical grades as per the statement of the
patients. The different gradations were done for different complains.

Statistical assessment of results The sign and symptoms observed for the study of trial and control groups
were recorded. The sign and symptoms before and after treatment are also recorded. The mean ± SD
before treatment of each sign and symptoms was compared with after 15days, 30 days and 45 days of
treatment in each group. Then the paired t- test was used for the purpose of test of significance. The
effectiveness of the trial and control drug to different sign and symptoms of each group were assessed
through p- value.
In this study “Chhinnodbhavadi ghanabvati” has been selected as the trial drug consisting of six different
drugs in equal amount. All the six drugs are Pittasamaka and Deepan in nature. In many studies reported
that Guduchi acts as an antacid, Medhya (anti stress activity) and also immunomodulator which
strengthens the mucosal defence mechanism. About Nimba, it has direct impact on H+K+ ATPase
inhibition. Patola patra is stomachic and cholagogue in nature, while Triphala increases gut transit time or
gastric motility. Madhu13 (honey) is taken as Anupana which is Madhura in rasa and Kasaya in Anurasa,
Anushnasheeta veerya and Pittasamaka in nature. It also creates coating on the mucosal surface.

One group treated with Chhinnodbhavadi ghanavati Dose 500mg 2 tab bd and it compare with other
group who treated with pantoprazole 40 mg 1 tab OD Duration 45 days.

Acharya Madhava was described this disease as a separate chapter and Acharya Kashyap described it
with its management. Amlapitta is a Pitta predominant Vata, Kapha disease. The cardinal features of
Amlapitta are Avipaka, Klama, Utklesha, Tiktoamlodgara, Gaurava, Aruchi, Hritkanthadaha. With the
trial drug, there was a symptomatic relief in the patients i.e. improvement in Avipaka, Tikta Amla

23
Udgara, Hridakanthadaha, Utklesha, Aruchi, Vamana and Udarashoola. A comparative gastric pH and
endoscopy before and after the treatment showed that the trial drug increases the base line pH of the
gastric juice as well as strengthen the mucosal defense mechanism.

Out of the 20 patients of Amlapitta who treated with trial drug, 40 % patients had shown the best
improvement and 55% patients were moderately improved. This implies that Chhinnodbhavadi ghanavati
may be considered as an effective drug for Amlapitta (GERD). As Amlapitta (GERD) is a chronic
condition it needs a long period study. Statistically it has been observed that the trial drug is significantly
effective to reduce all the sign and symptoms of Amlapitta.

Finally conclude the drugs are significantly effective in Amlapitta but control drug is highly significant in
comparison to trial drug.( Mohapatra Nibedita,December 2015 )

2.3.5 Article 5
A COMPARATIVE CLINICAL STUDY OF SHATAPATRAYADI CHURNA TABLET AND
PATOLADI YOGA IN THE MANAGEMENT OF AMLAPITTA.
Jitendra Kumar, Alankruta R. Dave, and Madhuri G. Vyas were conducted a study on A comparative
clinical study of Shatapatrayadi churna tablet and Patoladi yoga in the management of Amlapitta
To evaluate the efficacy of the Shatapatrayadi churna tablet and Patoladi Yoga tablet in Amlapitta
and To compare the efficacy of both the drugs.

The drug was selected for the study Shatapatriadi churna is described in Bheshaja Samhita which
contains Shatapatri, Amrita, Draksha, and Yashtimadhu. Most of these drugs have Tikta, Madhura,
Kashaya, Katu Rasas, Laghu, and Ushna Gunas which can react against excessive Drava and Tikshna
Gunas of Pitta.As well as they all have a specific role in the management of Mandagni. The drug
selected as control is Patoladi Yoga described in Bhaishajya Ratnavali, Amlapitta Adhikara, which
contains Patola, Shunthi, Guduci, and Katuki having Agnideepaka, Pittashamaka,
and Pittarechaka properties.

Composition of Shatapatryadi tablet are Shatapatri (Rosa centifolia), Guduchi (Tinospora

cordifolia), Nimba (Azadiracta indica), Haritaki (Terminalia chebula), Bhunimba (Andrographis
paniculata), Bhringraja (Eclipta alba), Patola (Trichochosanthes dioica), Madhuyasthi (Glycyrrhiza
glabra), Amalaki (Emblica officinalis), Darvi (Barberis aristata), Chandan (Santalum
album), Devdaru (Cedrus deodara), Bhuamalaki (Phyllanthus urinaria), Draksha (Vitis vinifera),
and Haridra (Curcuma longa).

Composition of Patoladi Yoga tablet are Patola (Trichochosanthes dioica), Guduchi (Tinospora

cordifolia), Sunthi (Zingiber officinalae), and Kutki (Picrorhiza kurrooa).

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41 patients between the age group of 15 and 60 years were selected from the O.P.D.
of Kayachikitsa of I.P.G.T. and R.A., G.A.U., Jamnagar hospital who diagnode Amlapitta were
registered and randomly divided into two groups. In group A, 23 patients were registered and 20
patients completed the treatment. In group B, 18 patients were registered and 15 patients completed
the treatment.

Inclusion criteria  were selected on the basis of presence of classical symptoms of Amlapitta. Patients
were subjected to detailed clinical history on the basis of specially prepared proforma. Written
consent was taken from the patients before starting the treatment after explaining the details regarding
the treatment.

Exclusion criteria were Patients of age less than 15 and above 60 years. ,Chronicity more than 5
years,Patients having cardiac problems, tuberculosis, carcinoma, etc,Patients
having Annadrava or Parinama shula,Patients having organic diseases such as gastric ulcers and
duodenal ulcers.

Group A was terated with Shatapatrayadi churna  2tablet(500 g)30 days with milk and Patoladi
yoga 2 tablet (500g) 30 days with milk.

When assessment of total remission of therapy Complete remission 100%,Marked improvement

76%to 99%,Improvement 51%-75%,Mild improvement 25% to 50% and Unchanged below 25%..

Finally conclude the Shatapatrayadi tablet showed better result with comparing patoladi yoga.as well
as Both the drugs are free from side effects.( Jitendra Kumar, Alankruta R. Dave, and Madhuri G.
Vyas, 2011 Jul-Sep)

2.3.6 Article 6
GASTRITIS (AMLAPITTA) – A CASE STUDY
Shivappa Pujari, Shreevathsa, Bharathi Hiremath,Dileepkumar KJ were conducted a case study of
Gasritis(Amlapitta).Diagnostic Criteria for this study are Burning sensation in chest and
throat(HritKantha daha), Sour belching (Amlodgara), Nausea (Utklesha), Vomiting (Chardi), Indigestion
(Avipaka), Tastelessness (Aruchi), Exertion without work (Klama).
Method of Collection of Data and Analysis was the case sheet Performa was prepared contains lifestyle
of the patient and who comes under diagnostic criteria were collected and pre and post test
assessment was done according on the symptoms gradation. Then analysed by using descriptive
statistics.
Amalaki churna was prscribed 6 g. BD after food. For Intervention period of 1 month BD. Lifestyle chart
given containing Ahara (food), Vihara (lifestyle) and Achara (code and conducts).
Follow up: 15th day of intervention.

25
Assessment was done based on the symptoms gradation.
1. Sour belching (amlodgara) BT (Grade)2 and AT (Grade) 0 ,2. Burning sensation in throat and chest
(hritkanthadaha) BT( Grade 2) and AT Grade 1 ,3. Indigestion (avipaka) BT (Grade)2 and AT
(Grade)0, 4. Exertion without work (klama) BT( Grade) 2and AT (Grade) 0

In this case study, observed before and after treatment based on the symptoms gradation.Observed result
are - the amlodgara before treatment it was 2 and after treatment reduced 0. Hritkanthdaha BT was 2 and
AT reduced to 1. Avipaka BT it was 2 and AT minimized to 0 and the klama BT was 2 and reduced to 0
AT. Fron this results can see significant reduction in the symptoms. Effect of the amalaki churna and
lifestyle chart containing ahara, vihara and achara which was advised during the course of treatment.
In this study the effect of Amalaki curna might be due to its effect like Deepana, Pachana and properties
like Kashaya Rasa govern with Sheeta Virya. Amalaki is said to be antagonist to be the properties of Pitta
or else is the possessing Tridoshahara effect in any of the levels of Doshadushti and the effect of Amalaki
and Amlapitta can also be attributed to its property of Madhura Vipaka.The Free radicals are natural by -
products of our own metabolism.Without supplementing nutrition, amalaki gets rid of these free radicals
which enhance cell aging due to high amount of vitamin-c and flavonoids in it. The presence of tannoid
principles also keeps away the stress induced brain damage.
Through this study we can conclude the amalaki chunrna have Rasayana property and It helps to relief
symptoms of Amlapitta without side effects.( Shivappa Pujari, Shreevathsa, Bharathi
Hiremath,Dileepkumar KJ)

2.3.7 Article 7

CLINICAL EFFICACY OF BALADI MANDURAM IN THE MANAGEMENT OF

AMLAPITTA.

Hanumanthu Kishore Kumar, C. H. Sridurga, and Dabbu Bhaskar Rao conducted a clinical study on
Efficacy of Baladimanduram in the management of Amlapitta.

Clinical trial was conducted in thirty patients who were having classical symptoms of Amlapitta,
administered with 500 mg of Baladi Manduram twice a day after meals for 30 days. The assessment
was done based on subjective parameters, i.e., Amlodgara (sour belching), Daha (heart
burn), Gaurava (heaviness), Utklesha (nausea), Avipaka (indigestion) and Kshudha Alpata (loss of
appetite). The results were statistically analyzed using the paired t-test.

Inclusion criteria:Patients aged between 20 and 60 years having signs and symptoms
of Amlapitta such as Amlodgara, Daha, Gaurava, Utklesha, Avipaka, Agnimandya were

26
selected.Diagnosis of Amlapitta was purely decided only by considering the above-mentioned signs
and symptoms present in the patients.

Exclusion criteria:Patients of age <20 years and >60 years. Patients already diagnosed with or having
any history of other systemic diseases such as cardiovascular, nephropathic, neuropathic and any type
of malignant disorders were excluded.

In results of this study are Statistically highly significant relief (P < 0.001) was noted
in Amlodgara, Hritkantha Daha, Utklesha and Agnimandya and statistically highly significant relief
(P < 0.01) was seen in Gaurava and Avipaka.

In this study marked improvement in 67% of patients, mild improvement in 27% of patients, and
complete remission was noticed in 6% of patients

Conlusion of this study Baladi Manduram can be considered as an effective formulation in the

management of Amlapitta.( Hanumanthu Kishore Kumar, C. H. Sridurga, and Dabbu Bhaskar
Rao,2017 July-Dec)

2.3.8 Article 8

CLINICAL MANAGEMENT OF AMLAPITTA WITH KHANDA KUSHMANDA AVALEHA

Dr. Deepika Yadav Conducted a research of Clinical management of Amlapitta with Khanda
kushmanda Avaleha.Material that have used for this study Avipattikara churna and Khanda kushmandaw
avaleha. Avipattikara churna containe Pippali,
Shunti,Maricha,Harithaki,Vibhitaki,Amalaki,Musta,Vayavidanga,Ela,Lavanga,Trivruta and
Sharkara.Khanda kushmanda avaleha consists with Kushmanda pulp and swarasa, Amlaki choorna,
Sharkara, Goghrita, Godugdha, Madhu.

The patients attending the OPD and IPD, PG Department of Kaya Chikitsa, Ayurveda Mahavidyalaya
Hospital, Hubli diagnosed as Amlapitta & fulfilling the inclusion criteria were selected for clinical
trial.

Inclusion criteria for the study are Subjects with classical features of Amlapitta ,Subjects of either sex
were taken for study,Subjects of age group between 18-50 Years and Chronicity < 6 Months.

Exclusive criteria for the study are Subjects presenting with the features of carcinoma of stomach,
gastric ulcer and duodenal ulcer,Subjects who are less than 18 Years and more than 50 Years of age,
with chronicity more than 6 Months,Subjects suffering from other systemic and metabolic disorders,
HIV & HBsAg positive, Pregnant and lactating women and Subjects with history of hematemesis,
malena and severe anemia (Hb< 7 gm%)

27
Clinical evaluation of patient was done by collection of data/information obtained by history, clinical
findings obtained by physical examination and laboratory test.

Amapachana with Avipattikara Churna 5 gm BID was given 30 minutes before food with Ushnodaka
as Anupana for 3 to 5 days till nirama lakshana were obtained.

After Amapachana, Subjects were subjected for Shamana Chikitsa with Khanda Kushmanda Avaleha
(25gm BID) along with Sukhoshna Dugdha as anupana for 30 days. Pathya Aahara and Pathya Vihara
was advised to all the Subjects Duration:30 days - Weekly examine.

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Overall results of the study :

No. of
Response of Therapy Average %
Subjects
Excellent >75% 20 80
Good 51 – 75% 3 12
Moderate 26 – 50% 2 8
No Response 0 – 25% 0 0
Table 3-Overall study of the results
Finally conclude The study revealed that Khanda Kushmanda Avaleha gives excellent results in the
management of Amlapitta and its absolutely free from any kind of side effects and toxic effects.

CHAPTER III-METHODOLOGY

3.1 Research Design

This research is design to a review on to identify the most effective formula in Ayurveda in the
management of Amlapitta.This review based on clsiical Ayurveda text and Previous researches
done on Amlapitta.

3.2 Praimary data collection

Praimary data colletion is going to be done from Susruta samhitha ,Charaka samhitha Madhawa
nidhana,Kashyapa samhitha and yogarathnakaraya. Were selected to collect data.

3.3 Secondary data collection

Secondary data collection is going to be done from Research articles.Reserch papers done on the
Amlapitta and effectiveness Ayureda formula.This is mostly base on previos researchers.

3.4 Exclusive criteria

Details mentioned in classical text About Amlapitta

Details mentioned in research articles about Amlapitta

Research articles about Ayurveda conceptual

Research articles about Ayurveda management

29
3.5 Inclusive criteria

Research articles on Ayurveda formula comparing with modern drug.

Research articles on Ayurveda drug which not available now.

Details that mentioned in classical text about management ways by Activities(Excersices,Yoga.Daily

routine)

3.6 Data collection method

Data collection going to be collect from classical text and research articles of Amlapitta according to
exclusive and inclustive criteria.

3.7 Data analysis methods

Data analysis done from the Rasa guna veerya vipaka of ingredients in the formula and its distributioned
to manage the symptoms of Amlapitta that mentioned in Classical text and the resach papers.

3.8 Interpretation of results

The results of the study will be interpretated through graphs, charts and recommended methods.

3.9 Conclusion

According to the results of the study, conclusion will be produced.

3.10 Suggestions

Suggestions will be given according to the conclusions.

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CHAPTER IV-REFERENCES

1. Acharya Charaka,DrKumarathunga,, A.(1996)Charaka samhitha,Department of Ayurveda.

.cikitsa sthana 15/44-47.
2. Dr.Ghimire,B.R.(2021),Management of Amlapitta (gastritis) in Ayurveda,ISSN:2582-
7138,volume 2,issue 1:.page no 278-280
3. Indukarathmaja Mahamathi Sri Madhawakara.(2005).Madhawa Nidhanaya,chapter 2,51/3,4
4. Robinson,J.(2020) WebMD,LLC
5. Sanjore(Naringe),S.S.,.Kharche,G.Y.(2019),Studies on Urdhwaga Amlapitta (Gastritis) and its
Management with Shatavari Ghruta. ISSN: 2320-4850.
6. Meenakshi K.,Vartika S.(2021).Effectiveness of Ayurveda treatment in Urdhwaga Amlapitta:A
clinical evaluation.Volume 12,Issue 1.Pages 87-92.
7. Naringe S, Seema S., Kharche G. Y.(2019).Studies on Urdhwaga Amlapitta (Gastritis) and its
Management with Shatavari Ghruta.
8. Baragi P.C.(2017)A Critical Review of Disease Amlapitta (Gastritis). Journal of Ayurveda and
Integrated Medical Sciences.Jan - Feb 2017. Vol. 2 .Issue 1.ISSN: 2456-3110.
9. Dewan S.,Molligoda S.P.(2014).A NOVEL APPROACH IN THE MANAGEMENT OF
AMLAPITTA (GASTRITIS) THROUGH ODANA KALPANA –A CLINICAL STUDY.22 ND
MARCH 2014.Volume 2,ISSUE 1,eISSN2348-0173.

10. Nisa S.Gastritis.(2018). (Warm-e-meda): A review with Unani approach .ISSN: 2455-
4227.www.allsciencejournal.com Volume 3. Issue 3.Page No. 43-45.
11. Nibedita M.(2015).A CLINICAL STUDY ON AMLAPITTA AND ITS MANAGEMENT
WITH CHHINNODBHAVADI GHANAVATI. V,ol 3. Issue 12.
12. Kumar J.Dave A.R.,Vyas M.G.(2011). A comparative clinical study of Shatapatrayadi
churna tablet and Patoladi yoga in the management of Amlapitta .32(3): 361–364.
13. Pujari S., Shreevathsa , Hiremath B. , Dileepkumar K .J.GASTRITIS (AMLAPITTA) – A CASE
STUDY.Volume-II.Issue-IX,EISSN 2321-1563.
14. Yadav D.,CLINICAL MANAGEMENT OF AMLAPITTA WITH KHANDA
KUSHMANDA AVALEHA.

15. Kumar H.K., Sridurga, C.H.,Rao D.B.(2017)CLINICAL EFFICACY OF BALADI

MANDURAM IN THE MANAGEMENT OF AMLAPITTA..38(3-4): 133–138.

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