Management of Amlapitta w.s.r to Gastritis

This ppt is regarding the management of Amlapitta in Ayurveda and with its correlation to Gastritis

1. Management of Amlapitta w.s.r. Gastritis
Dr. Riya Goyal
2
nd
M.D Scholar
Department of Kayachikitsaand Manasaroga
SDM College of Ayurveda & Hospital, Udupi
Under the valuable guidance of Department of Kayachikitsaand Manasaroga

2. Gastritis

3. GENDER
Gastritis is more common in men rather than women
INCIDENCE
.
Globally,50.8%ofthepopulationindevelopingcountries
sufferfromgastritisand34.7%ofthedevelopedcountries
hadhealthproblemduetogastritis.
AGE
Gastritis is more common in adult and old age
10 years of age more than 50% , 20 years of age-80%
AREA
GastritisishighlyprevalentinAsiancountries.InIndia,
incidencerateofgastritisisapprox.3in869i.eabout
12,25,614outof1.4millionofpopulationsufferingfrom
gastritis.InIndianearly10%ofthepeoplewhocameto
hospitalemergencydepartmentwithabdominalpainhave
gastritis.

4. HISTORICAL REVIEW

वैिदक काल
चरक संिहता •Not mentioned as separate ?यािध
•But word is discussed at several places
पा?डुरोगेऽ?लिप?े(Ca. Su. 1/110)
कुल?था

अ?लिप?जननानां(Ca. Su. 25/40)
राजमाषःसरो

A?यः

कफशु?ा?लिप?नुत् (Ca. Su. 27/25)
जनय?य?लिप?ं(Ca. Chi. 15/47)
सु?ुत संिहता
आचाय? सु?ुतwhiledescribingthediseasecauseddueto
excessiveuseof
लवण
hasmentionedadisease
अि?लका
whichissimilarto
अ?लिप?
.
संिहता काल
No reference of
अ?लिप?
was found in Vedic kala

5. HISTORICAL REVIEW

का?यप
संिहता
अ6ांग सं?ह
If शोधन is not done in time, many diseases occur, one of which is
?िमिलका . Indu says ?िमिलकाis a synonym of अ?लिप?
अ6ांग Cदय
While describing िप?ज Cदयरोग , आचाय? वा?भ has used the
term अ?लिप?
सं?ह काल का?यप संिहता is the first available text where अ?लिप?has been
mentioned as a separate entity in chapter 16th of िखल?थान .
माधव िनदान
Afterका?यप,माधव िनदान isthesecondtext whichgives
importancetoअ?लिप?anddescribes itsaetiopathogenesisand
symptomatologyindetail alongwithtwoclinicalsubtypesi.e.
उ&?ग and अधोग अ?लिप?

6. अ?लिप? is composed of two words अ?ल+िप?= अ?लिप?
अ?लिप?
अमलाय िप?म अ?लिप?म(Vachaspatyam)
Acc.to Vachaspatyam, अ?लिप? means
िप?
leading to
sour taste
िवदा;ा+?लगुणोि? ं िप?ं अ?लिप?म्(Vijayaraksita)
Vijayarakshita, commentator of Madhava Nidana
defines the words as that the िप?having िवदाही
quality give rise to अ?लor sour taste
अ?लं चेित अ?लगुणोि? ं िप?म् । ” (Chakrapani)
Which means the qualities of िप?i.e. sourness is
increased leading to अ?लिप?

7. The increasedअ?लगुण ofिप? isknownasअ?लिप?.
Theिप? whichattainsअ?लगुण andिवद?धता iscalledas
अ?लिप?
आचाय? सु?ुतhasenlistedकटु asitsoriginalrasaand
mentionedthatwhenिप? becomesिवद?ध changesinto
अ?ल.
अ?लिप?
The above classical description of अ?लिप? emphasizes
that अ?लिप?is a patho-physiological condition in which
the िप? gets vitiated in terms of वृि& (excessiveness)and
sourness of िप? is increased.
अ?लं िवद?धं च तत् िप?म् अ?लिप?म् । मधुकोष

8. िनदान
आहारज िनदान मानिसक िनदान
िवहारजिनदान
आग?तुज िनदान

9. आहारज
िनदान
िवहारज
िनदान
मानिसक
िनदान
िवA& आहार
अ?यशन
अित A?
आम भोजन
अजीण? भोजन
अित गुA भोजन
अित ि?न?ध भोजन
रा?ीजागरण
उपवास
वेगधारण
िदवा?व?न
भय
िचंता
शोक
?ोध
मोह
काल
?कृित
शरद ऋतु
आनुप देशी
आगंतुज
िनदान

10. दुग??ध ह?रत ?यावं िप? अ?लं घनं गुA ।
अ?लीका क?ठ Cद् दाहकर साम िविनिद?शेत्॥
अ.C.सू.१३
साम िप? िवद?धता
साम िप? leading to अ?ल िप?
अ?ल िप?

11. सं?ाि.

मंदाि?न शूक?ा िनदान िप? ?कोप अ?लिप?

आहारज
िवहारज
मानिसक
आग?तुज
रसधातु दुि6
अ?ल ?व गुण वृि&
िप? िवद?धता
आमिवष
अ?निवष
अजीण? (if अप?य is taken continuously)
अ?ल ित उ#ार
ल?ण उ?पि?

12. Acc. To माधवकर
•गित भेद –
1.ऊ?व?
2.अधोग
•दोष भेद –
1.सािनल
2.सािनलकफ
3.सकफ
Acc. To का?यप –
•वाितक
•पैितक
•4ेषमीक
सािनलं सािनलकफं सकफं त?च ल?येत् |
दोषिलङ्गेन मितमान् िभषङ्गमोहकरं िह तत् || ८ ||

13. सामा?य ल?ण
?लम
अAिच
अिवपाक
Cदय क?ठ दाह
उ??लेश
ित -अ?लो#ार

14. िविश6 ल?ण
ऊ?व?ग
वा?तं ह?र?पीतक –नील –कृ?णामार –र ाभमतीव चा?लम् |
मांसोदकाभं ?वितिपि?छला?छं 4े?मानुजातं िविवधं रसेन || ४ ||
भु े िवद?धे ?वथवा आ?यभु े करोित ित ा?लविमं कदािचत् |
उ#ारमेवंिवधमेव क?ठ –C?कुि?दाहं िशरसो Aजं च || ५ ||
कर –चरण –दाहमौ??यं महतीमAिचं ?वरं च कफिप?म् |
जनयित क?डूम?डल –िपडकाशतिनिचतगा?रोगचयम् || ६ ||
अधोग
तृड –दाह –मू?छा? –म –मोहका?र ?या?यधो वा िविवध?कारम् |
C?लास –कोठानलसाद –हष? –?वेदाङ्गपीत?वकरं कदािचत् || ३ ||

15. भेदनुसार ल?ण
िविश6 Bप वात िप ? कफ
का?यप शूल
अंगसाद
जृंभा
म
िवदाह
गौरव
छद?
माधव िनदान क ?प
?लाप
मू?छा?
िचिमिचिम
गा?ावसाद
शूलािन
तमसो दश?न
िवम
िवमोह
ित ा?लकटुको#ार
C?कुि?क?ठदाह
मो
मू?छा?
अAिच
छिद?
आल?य
कफिनि?तवन
गौरव
जडताAिच
शीत
साद
विम
लेपाः
दहन
बलसाद
क?डू
िन?ाः

16. िचिक?सा सू?
पूव? तु वमनं काय? प2ात् मृदु िवरेचनम् ।
कृतवाि?त िवरेक?य सुि?न?ध?य अनुवासनम् ॥ ( Y.R 57 / 14 )
पूव? तु वमनं काय? प2ात् मृदु िवरेचनम् ।
कृतवाि?त िवरेक?य सुि?न?ध?य अनुवासनम् ॥ ( Y.R 57 / 14 )
ऊ?व?गंवमनैध?मान्अधोगंरेचनैहरेत्।
अ?लिप?ेतुवमनंपटोला?र6प?कै॥
कारयेन्मदन?ौ?िस?धुयु ैःकफो?बणैः।
िवरेचनंि?वृत्चूण?मधुधा?ीफल?वैः॥(B.R. 56/53-5)
ऊ?व?गंवमनैध?मान्अधोगंरेचनैहरेत्।
अ?लिप?ेतुवमनंपटोला?र6प?कै॥
कारयेन्मदन?ौ?िस?धुयु ैःकफो?बणैः।
िवरेचनंि?वृत्चूण?मधुधा?ीफल?वैः॥(B.R. 56/53-5)

17. िचिक?सा
िनदान प?रवज?न संशमन
संशोधन प?य अप?य

18. िनदान प?रवज?न
Acharya susurutamentioned nidana
parivarjanaas the primary treatment of all the
diseases. In amlapitta excessive nidanasevana
leads to Mandagniand pitta vriddhi. So nidan
of amlapitta should be removed in its first
treatment.
Acharya Kashyap advices to avoid the food
material which are processed and while
explaining the sadhyasadhyta, he adds that the
disease like amalpitta becomes Sadhya in those
who are not greedy towards their food habits.

19. संशोधन िचिक?सा
वमन

मृदु
िवरेचन

अनुवासन

बि?त

र मो?ण

20. वमन
•Firstlineoftreatment
•Drugs-
(Acc. to Chakradutta& Yogratnakara)
•लवणा?बु
•दु?ध
•इ?ु रस
•ित ??य

21. मृदु िवरेचन

•Second line of treatment
•Drugs-
(Acc. to Chakradutta& Yogratnakara)
•ि?फला
•?यमाणा
•कटुक?
•ि?वृत
(Acc. to Bhavprakash )
•मधू
•आमलक?

22. अनुवासन बि?त
•Third line of treatment
•Drugs-
•ित घृत
•इंदुकांत घृत
•आर?वधािद घृत
•मधुयि6 तैल ?ीर
•बला तैल

23. र मो–ण
•Fourth line of treatment
कृतवमनिवरेक?यािप दोषोपशाि?तभ?वित न यिद कायM
र मो??य यु??या । कृतिशिशरिवलेप?य अ?लिप??न
भ?यौदनसमुिदततृ.े वात र–ा च काया? ॥ (Y.R 57/14)
Even after vamanaand virechana, if
the aggravated doshas are not pacified,
then raktamokshanais to be done.

24. ि?या शु&?य शमनी ;नुब?ध?यपे?या ।
दोषसंसग?जे काया? भेषजाहारक?पना ॥
पाचनं ित भूिय7ं प?यं च प?रक?पयेत् ।(Y.R 56)
संशमन िचिक?सा

25. संशमन
वटी क?पना
अवलेह कषाय
रस भ?म
चूण? घृत

26. रस भ?म
•सूतशेखर रस
•लघुसूतशेखर रस
•लीलािवलास रस
•अ?लिप?ा?तक लोह
•कामदूदा रस
•शंख भ?म
•?वाल िप6ी
•?वाल पंचामृत रस
•?वण? मि?क भ?म
•धा?ी लोह
•मा?ा = 1-2 र?ी
•अनुपान = जल, मधु

27. वटी क?पना
•पानीय भ वटी
•सोभा?य शु?ठी मोदक
•ा:ी वटी
•कू?मा?ड अवलेह
•ना?रकेल खंड
•?ा?ावलेह
अवलेह
•मा?ा = 1 पल
•अनुपान = दु?ध
•मा?ा = 1 कष?
अनुपान = जल

28. कषाय
•पटोलादी कषाय
•पंचित कषाय
•वासादी दशांग कषाय
•गुडूचीयिद कषाय
•मा?ा = 1 पल
•अनुपान = जल

29. आसव
•चंदनासव
•उशीरासव
•मा?ा = 1 पल
•अनुपान = जल

30. चूण?
•अिवपि?कार चूण?
•ि?फला चूण?
•हरीतक? चूण?
•शतावरी चूण?
•आमलक? चूण?
•पंचिन?ब चूण?
•ि?वृत चूण?
•मा?ा = ½ कष?
अनुपान = जल

31. घृत
•वासा घृत
•शतावरी घृत
•नारायण घृत
•पटोल शु?ठी घृत
•पंचित घृत
•दिड़मक घृत
•सुकुमार घृत
•मा?ा = 1 पल
•अनुपान = जल

32. INTRODUCTION
Gastritis was first coined by German physician,Georg
Ernst Stahl in 1728.
GASTRO + ITIS
It is the inflammation , irritation and erosion of
stomach mucosa
.

33. GasTRITIs

34. PATHOPHYSIOLOGY
The mucosal lining of the stomach normally protects it from the action of gastric
acid. The mucosal barrier is composed of prostaglandins.
Due to any cause
This barrier get penetrated
HCL comes in contact with mucosa
Inflammation to the lining
Edema, Haemorrhage & possible Ulcer formation

35. Acute
Chronic

36. CAUSES
H. pyloriUnhealthy FoodAlcohol Medicine

38. GASTRITIS & HCL
HYPERCHLORHYDRIA
HYPOCHLORHYDRIA
Normal stomach pH = 1.5 –2.5
Hyperchlorhydria
pH = less than 1.5
Excessive formation of HCL
Gastritis
Hypochlorhydria
pH = more than 2.5
Deficient production of HCL
Lack of digestion
Increase toxic load of undigested
food

39. DIAGNOSIS
Clinical Examination
Gastroscopy (Upper Gastrointestinal Endoscopy)
•Gastrin Levels in Blood Test
•Occult Stool Test
•Serology & Histology for H. Pylori
Biopsy
Ba Meal x-ray

40. TREATMENT PLAN
MEDICAL
MANAGEMENT
PREVENTIVE
MANAGEMENT

41. MEDICAL MANAGEMENT
H2
Antagonists
Antibiotics
Proton Pump
Inhibitors
Antacids

42. H2
CIMETIDINE
RANITIDINE
FAMOTIDINE
NIZATIDINE
-tidine
H2 antagonists block
the H2 receptors in the
parietal cells of the
stomach and decrease
the gastric acid
secreation
Diarrhoea
Dizziness
Headache
ANTAGONISTS

43. H2 antagonists

44. PROTON PUMP
PANTAPRAZOLE
OMEPRAZOLE
LANSOPRAZOLE
ESOMEPRAZOLE
RABEPRAZOLE
-prazole
PPI’s effectively block
gastric acid secreationby
irreversibly binding to and
inhibiting the H+/K+
ATPase pump that resides
on the luminal surface of the
parietal cell membrane.
Nausea
Headache
Constipation
INHIBITORS

45. PPI’s

46. ANTACIDS ANTIBIOTCS
•Sodium
Bicarbonate
•Aluminum
Hydroxide
•Magnesium
Hydroxide
•Calcium
Carbonate
These are
inorganic salts
acts by direct
chemical
neutralization of
HCL & decrese
the pepsin activity
•Amoxycillin
•Clarithromycin
•Metronidazole
•tetracycline
Antibiotics are
used to kill the
H pylori
bacteria

47. H. PYLORI TREATMENT
Triple Therapy
1.Pan 40 BD
2.Amoxycillin 1gm BD
3.Clarithromycin 500mg BD
-14 days
1.PPI
2.Metronidazole 500mg BD /
Tinidazole 500mg BD
3.Clarithromycin 500mg BD
-14 days
QuadripleTherapy
Without Bismuth
1.PPI
2.Metronidazole 500mg BD /
Tinidazole 500mg BD
3.Clarithromycin 500mg BD
4.Amoxycillin 1gm BD
-14 days
With Bismuth
1.PPI
2.Bismuth 420 mg QID
3.Tetracyclin500mg QID
4.Metranidazole500mg TID /
Tinidazole 500mg TID
-14 days
FIRST LINE

48. H. PYLORI TREATMENT
SECOND LINE
1.Levofloxacin 500mg QID
2.Amoxycillin 1gm BD
3.PPI BD
-14 days
THIRD LINE
1.Antibiotic 1
st
2.Antibiotic 2
nd
3.Bismuth 420 mg BD
4.PPI
-14 days

50. •Follow the meal times.
•Light food, Coconut water, articles having
cooling properties.
•Seasonal vegetables of bitter taste.
•Seasonal Fruits like gooseberry, dry grapes,
black grapes, sweet lime, pomegranate, fig, dry
fig.
•Ushir, laja, Dadimakapreparation
•Take adequate amount of fluids.
•Take warm water.
•A cup of lukewarm milk after every two or three
hours.
•Practice Yoga, Pranayama, meditation &
exercise regularly
DO’S (PATHYA)

51. DON’TS ( APATHYA )
•Avoid excessive spicy, sour, salty food items
•Avoid fried & junk food items
•Do not remain hungry all the time
•Do not over eat
•Avoid food containing excessive amount of
garlic, chilli, salt, oil very often
•Avoid rice, curd, sour fruits
•Avoid bakery items, fermented foods like
bread, pickles, maidaetc
•Avoid lying down in supine position (best
position is left lateral)
•Avoid smoking, alcohol, tea, coffee, aspirin
drugsetc
•Avoid stress, anger

53. •अ?लिप?isoneofthemajorlifestyledisorderand
incidencesaregoinghigherdaybyday.
•Ourmaintargetistotreattheconditionwithout
leadingtocomplicationinwhichmodernscience
islackingbehind.
•Intherecentarticlesithasbeenshownmany
adverseeffectsofmedicationsleadingto
cancerouscondition.
•Ayurvedahasanexcellenttreatmentmodalityfor
अ?लिप?inbothcurativeandpreventiveaspects.

54. Thank You