AMLAPITTA Treatment Protocol by Ayush
INTRODUCTION
Amlapitta is a disease of Annavaha Srotas with main characteristics like Urodaha, Avipaka, Tikta Amla Udgara etc. The chronic conditions may cause Kotha, Kandu, Mandala, etc. The condition may be co-related with Acid Peptic Disorders.
Case Definition:
Patients presenting with Tikta Amla Udgara (Bitter and sour belching), Hrit Kantha Daha (Burning sensation in throat and chest), Aruchi (Tastelessness), Hrillasa (Nausea), Uthklesha (Nausea), Avipaka (Indigestion) etc. can be diagnosed as a case of Amlapitta.
Types:
Amlapitta is of three types according to Anubandha Dosha as Vataja, Vatakaphaja and Kaphaja. According to clinical presentation Amlapitta is of two types Urdhwaga and Adhoga. Urdhwaga is characterised with upper GIT symptoms and Adhoga is characterised with lower GIT symptoms.
Differential Diagnosis
- Chhardi
- Pittaja Gulma
- Pittashmari
- Annadravashoola
- Parinamashoola
- Udara Poorvarupa
Line of Treatment
- Nidana Parivarjana should be the first line of treatment.
- Shodhana Chikitsa – Vamana and Virechana
- Shamana Chikitsa - Langhana, Pachana, Deepana
- Treatment according to Doshik involvement
LEVEL 1: AT SOLO AYURVEDIC PHYSICIAN’S CLINIC/PHC
Clinical Diagnosis: On the basis of history and clinical presentation
Investigations: nothing specific
Treatment: any of the following drugs:
Table 3.1: Medicines at level 1 for Amlapitta
Drugs |
Dosage form |
Dose |
Time of administration |
Duration |
Anupana |
Shunthi Churna |
Churna |
2-3 gm |
Before meal / twice a day |
1-2 weeks |
Warm water |
Amalaki Churna |
Churna |
2-3 gm |
Before meal / twice a day |
1-2 weeks |
Warm water |
Yashtimadhu Churna |
Churna |
2-3 gm |
Before meal / twice a day |
1-2 weeks |
Warm water |
Hingwashtaka Churna |
Churna |
2-3 gm |
Before meal / twice a day |
1-2 weeks |
Warm water |
Shivakshara Pachana Churna |
Churna |
2-3 gm |
Before meal / twice a day |
1-2 weeks |
Warm water |
Avipattikara Churna1 |
Churna |
4-6 gm |
Before meal / twice a day |
1-2 weeks |
Warm water / Madhu |
Kamadudha Rasa |
Vati |
1-2 tab (125-250 mg) |
Before meal / thrice a day |
1-2 weeks |
Warm water |
Pathya-Apathya (Diet and life style education):
Do’s:
- Ahara – Yava, Godhuma, Seasoned Shali, Mudga Yusha, Laaja Saktu, Karavellaka, Patola, Kushmanda, Dadima, Amalaki, Kapittha, Godugdha, Mamsarasa, Sharkara, Madhu, Narikelodaka
- Vihara – Follow dinacharya, Yogasana
Don’t s:
- Ahara: Heavy food, Vidahi, Viruddha Ahara, Kulatha, Udada, Navanna, Tila, fermented foods like bread, excessive intake of curd, spicy food, bakery food, untimely food habit, deep fried food, alcohol intake and smoking.
- Vihara – Suppression of urges, worry, anger, stress, day sleep.
Referral criteria:
- Patients not getting relief
- Chronic cases
LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES
Clinical diagnosis: Same as level 1 for a fresh case reporting directly.
Investigations:
- Stool for occult blood
- LFT
- USG abdomen / pelvis
Treatment: Virechana and Rasaushadhis along with Shamana Aushadhi mentioned in Level 1 can be given:
Table 3.2: Medicines at level 2 for Amlapitta
Drugs |
Dosage form |
Dose |
Time of administration |
Duration |
Anupana |
Pravala panchamrita Rasa2 |
Vati |
1 to 2 tab (125-250 mg) |
After meal / thrice a day |
1-2 weeks |
Warm water |
Sutashekhara Rasa3 |
Vati |
1 to 2 tab (125-250 mg) |
Before meal / thrice a day |
1-2 weeks |
Warm water |
Shankha Bhasma4 |
Churna |
125-500 mg / day |
Before meal |
1-2 weeks |
Warm water / Takra |
Narikela Lavana |
Churna |
1 gm |
Before meal |
1-2 weeks |
Warm water / Takra. |
Pravala Bhasma5 |
Churna |
250 mg - 500 mg / day |
Before meal |
1-2 weeks |
Warm water |
Kapardika Bhasma |
Churna |
125-500 mg / day |
Before meal |
1-2 weeks |
Warm water / Takra |
Patoladi Kwatha |
Kwatha |
10-15 ml |
Empty stomach |
1-2 weeks |
- |
Kalyanaka Kshara |
Churna |
2-3 gms |
Before meals |
1-2 weeks |
Warm water |
Virechana Karma – Abhyantara Snehapana with Dadimadi Ghrita, Vidaryadi Ghrita, plain Gau Ghrita followed with Virechana by Trivritta Lehya, Panchasakara Churna, Eranda Bhrishta Haritaki etc.
Referral criteria:
- Patients not responding to treatments mentioned in level 2
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL
LEVEL OR DISTRICT
HOSPITAL/ INTEGRATED
AYURVEDIC HOSPITALS
Clinical diagnosis: Same as level 1 & level 2 for a fresh case reporting directly.
Investigations: In addition to those mentioned in Level 2.
- Endoscopy
Treatment:
Shodhana:
- Vamana - Madanaphala, Vacha, Patola, Nimba Kalka, Yashtimadhu Phanta, Saindhava Lavana Jala.
- Virechana
Pathya-Apathya (Diet and life style education): Same as mentioned in level 1.
REFERENCES
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (7/2), 2000.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part II (16/37), 2000.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (20/52), 2000.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (18/18), 2000.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (18/8), 2000.