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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 73-76

Efficacy of Indukanta ghritam in the management of Jirna urdhwaga amlapitta: A case report


1 Department of Rasa Shastra and Bhaishajya Kalpana, Bhagwant Ayurvedic College and Bhagwant Hospital, Muzzafar Nagar, Uttar Pradesh, India
2 Department of Kayachikitsa, Parul Institute of Ayurved and Research, Limda, Vadodara, Gujarat, India
3 Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India
4 Department of Rasa Shastra and Bhaishajya Kalpana, All India Institute of Ayurveda, New Delhi, India

Date of Submission14-Jul-2020
Date of Acceptance17-May-2021
Date of Web Publication16-Aug-2021

Correspondence Address:
Dr. Punam Aggarwal
Assistant Professor, Department of Rasa Shastra and Bhaishajya Kalpana, Bhagwant Ayurvedic College and Bhagwant Hospital, Muzzafar Nagar, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_48_20

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  Abstract 


Amlapitta (~hyperacidity) is a disease of Annavaha srotas (~gastrointestinal tract) that originates from Amasaya (~stomach). Mandagni (~low digestive fire) plays an important role in its manifestation. The disease is easy to treat in its early stage while difficult to manage in chronic stage. It can cause various complications if not treated early. The disease has close resemblance with acid peptic disorder or hyperacidity. Various treatment modalities are available in conventional medical science, but they have certain limitations. In Ayurveda, various herbs, minerals, and their compound formulations have been mentioned in its management, and Indukanta ghritam is one among such formulations. In the present case report, a 17-year-old female with complaints of Amlodgara (~sour belching), Hritkanthadaha (~burning sensation in throat and chest), Utklesha (~nausea) and Chardi (~vomiting), Avipaka (~indigestion), Shiroruja (~headache), and Vibandha (~constipation) visited outpatient department. The condition was diagnosed as Jirna urdhwaga amlapitta. Indukanta ghritam and wholesome dietary regimen were given to the patient for 28 days. The results suggested that the patient was benefited in all symptoms within 28 days. However, the Shamana therapy was continued for 50 days. The patient, after two months of follow-up, presented without any complications.

Keywords: Amlapitta, Annavaha srotas, hyperacidity, Indukanta ghritam


How to cite this article:
Aggarwal P, Shinsha P, Huddar VG, Prajapati PK. Efficacy of Indukanta ghritam in the management of Jirna urdhwaga amlapitta: A case report. J Ayurveda Case Rep 2021;4:73-6

How to cite this URL:
Aggarwal P, Shinsha P, Huddar VG, Prajapati PK. Efficacy of Indukanta ghritam in the management of Jirna urdhwaga amlapitta: A case report. J Ayurveda Case Rep [serial online] 2021 [cited 2021 Oct 25];4:73-6. Available from: http://www.ayucare.org/text.asp?2021/4/2/73/323904




  Introduction Top


Amlapitta (~hyperacidity) is a common disease in the present time, which can cause serious problems if not treated in time. Mandagni (~low digestive fire) plays an important role in manifestation of various diseases.[1] Due to Mandagni, the consumed food becomes Vidagdha (~indigestion leading to acidic food) and it transforms into Shuktabhava (~fermented form). The food changes into Shuktabhava due to which Amlata (~acidic/sourness nature) increases in Amasaya (~stomach), which is called Amlapitta.[2] It is said to be Sadhya (~easily curable) in acute stage and Yapya or Krichhasadhya (~difficult to treat) in chronic stage.[3] In contemporary science, these conditions are comparable with acid peptic disorders. Various treatment modalities are available in the conventional medical system such as antacids and H2 receptor antagonists, but they are known for certain limitations including side effects such as head ache, bowel upsets, and disorientation.[4] On the other hand, Ayurveda has time-tested formulations, which can be used in such manifestations. Indukanta ghritam is one such compound herbal formulation which is mentioned in Sahasrayoga.[5] A case of Jirna urdhwaga amlapitta effectively managed by Indukanta ghritam and Shamana therapy within a period of 50 days is presented here.


  Patient Information Top


A 17-year-old female from middle class family visited outpatient department with the complaints of Amlodgara (~sour belching), Hritkanthadaha (~burning sensation in throat and chest), Utklesha (~nausea), Chardi (~vomiting), Avipaka (~indigestion), Shiroruja (~headache), and Vibandha (~constipation) for the last eight months. She also had Kandu (~itching) and Mandala (~erythematous papular eruptions) all over the body for the last three months that occurs frequently and subsides of their own in few minutes.

She had a history of acute ascending paralysis-suspected case of Guillain–Barre syndrome according to previous medical prescriptions which was presented with pain and weakness in both lower limbs before 16 months ago. These complaints were completely relieved after one year of treatment. She had complaints of headache, fever, vomiting, pain in abdomen, and sour belching for the past 8 months. Even after taking allopathic medications for these complaints for eight months from local practitioner and by herself, she didn't get any relief. Hence, she did not get any relief, and hence, she approached for Ayurvedic management. No history of hypertension, diabetes, hyperthyroidism, or hypothyroidism was found.

Detailed history of dietetic and physical regimens, stress, etc., was taken. The patient was taking mixed diet, which is irregular in terms of both time and quantity. She used to take spicy, salty, deep-fried, and baked food items frequently. She had a habit of sleeping in day time with no physical activities and mild stress was present.

General and systemic examination

The patient has Vata-Pittaja prakruti. Mala was Alpa (~less in quantity), Pichila (~sticky), and Gaadha (~hard) in nature. Ahara shakti was Avara, Koshta was Krura (~irregular nature of bowel), and Agni was Manda. There was no cyanosis, pallor, or icterus. Thus, Annavaha, Rasavaha, Raktavaha, and Purishavaha srotases were found vitiated. No abnormalities were found on systemic examination.

Diagnosis

On the basis of symptoms, the condition is diagnosed as Jirna urdhwaga amlapitta[6] with associated symptoms Kandu and Mandala.[7] All the laboratory investigation findings of the patient were within the range, except decreased hemoglobin (10.1 g/dl), elevated alkaline phosphate (155.70 IU/L), absolute eosinophil count (776/mm3), and erythrocyte sedimentation rate (34 mm for 1st h).


  Timeline Top


Due to age, Deha and Satva bala (~physical and mental strength) and Vamana (~therapeutic emesis) are not appropriate; thus, Shamana chikitsa (~alleviative treatment) along with Yoga was planned. The patient was advised to follow regular meditation and Yogasana along with restriction of day sleep, bath just after food, consumption of sour, spicy, excessive salty, junk food, tinned food, soft drinks, and food items which are heavy to digest during the treatment period. The details of the treatment given to the patient are mentioned in [Figure 1]. Observations were recorded at regular intervals of week during the treatment till 50 days and follow-up was taken on every 7th day up to two months. The efficacy of the treatment was assessed by improvement in the symptoms score and change in Agnibala.[8]
Figure 1: Details of intervention. BD: Twice a day; B/M: Before meal

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  Follow-Up and Outcome Top


Improvement was noted in the frequency and severity of the symptoms [Table 1]. The digestive power was markedly increased [Table 2]. Before treatment, the frequency of Amlodgara was continuous throughout the day and after treatment its frequency was reduced. Daha was thrice per week before treatment and was not present after two weeks of treatment. Utklesha was there before treatment throughout day which was absent after a week of treatment. Chardi, Shiroruja, Vibandha, and Avipaka were also reduced considerably. The cutaneous manifestations were also responded to the treatment to a satisfactory level.
Table 1: Improvement in severity of symptoms of Amlapitta

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Table 2: Agnibala assessment

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  Discussion Top


Amlapitta is a disease of Annavaha srotas (~gastrointestinal tract) which originates in Amasaya. Pitta vitiated by Amla, Katu, Lavana rasa ahara, Vidahi ahara, etc., gets Vidagdha. Vidagdha pitta has Amla rasa and it causes Amlapitta which is applicable in the present case.[9] Even though the quantitative increase of Pitta happened, the quality got declined functionally and thereby the Agni becomes unable to digest even light foods in a proper way, or in other words, it causes Jatharagnimandya due to increased Drava guna of Pitta.[10] In this particular case, the etiological factors resulted in aggravation of Pitta along with Kapha dosha, and the features are similar to Kapha-pitta amlapitta. The vitiated Dosha when reaches skin produces symptoms such as Kandu and Mandala.[11] After the treatment, the frequency of Kandu and Mandala was decreased. It may be due to Nidana parivarjana.[12]

The Mandagni is the prime cause of the diseases; the Ghrita has Agni deepana (~enhances digestive fire) property, and due to increased Agni, Ama or Vidagdhavastha of Pitta reduces.[13] The formulation has Dashamula dravyas {Bilva [Aegle marmelos (L.) Correa.], Agnimantha (Premna integrifolia Willd.), Shyonak [Oroxylum indicum (L.) Kurz.], Patala [Stereospermum suaveolens (Roxb.) DC.], Gambhari (Gmelina arborea Roxb.), Salaparni [Desmodium gangeticum (L.) DC.], Prsniparni [Uraria picta (Jacq.) DC.], Brihati (Solanum indicum Linn.), Kantakari (Solanum xanthocarpum Schrad. and H. Wendl.), Gokshura (Tribulus terrestris Linn.)} which have Tridoshahara (~normalizes all Tridoshasa), Anaha, Adhmanahara (~anti-flatulent), Aruchi, Agnidipana (~increasing the power of digestion), Shothahara (~anti-inflammatory), etc., properties. Ksheera (~milk) is Vata-pitta haram, Balya (~strength, stamina, and immunity promoter). Ghritam has Vata-pitta haram, Agnidipana, Balya, Rasayana, Shulahara (~reduces pain), Vranahara (~heals wound), etc., properties. Prakshepa dravyas (~ adding powdered substances) such as Pippali (Piper longum Linn.), Pippalimula (root of Piper longum Linn.), Cavya (Piper chaba Trel and Yunck.), Chitraka (Plumbago zeylinica L.), Nagara (Zingiber officinale Roscoe.) and Yavakshara are having Deepana (~enhancing metabolic fire), Pachana (~digestion), and Anulomana (~proper elimination of flatus, feces, urine, etc.,) properties. These ingredients will be useful in addressing symptoms such as flatulence, indigestion, and constipation. Pippali and Pippalimula are also having Shulahara property.[14] Thus, Ama pachana and Deepana decrease the Ama and enhance the Agni. It may be the cause of relief in symptoms.

Nidana parivarjana is important in the treatment,[12] considering which the patient was advised to follow dietary restrictions. Suryanamaskara, Tadasana, Pavanamuktasana, and Mandukasana were advised to the patient under the consultation of Yoga expert. In Pranayama, Anuloma-viloma and Bhramari were advised which helps in maintenance of physical, mental, social, and spiritual health.[15] The chronicity made her a habit of burping continuously, irrespective of the actual discomfort; hence, counseling was done and advised to do Pranayama regularly that helped her to control this habit up to certain extent.

After the administration of Indukanta ghritam for 28 days, the patient was maintained with Sutashekhara rasa[16] for one week and Amlapitta mishrana syrup for 14 days. Both the formulations are mentioned for Amlapitta and having Agni-vardhana property. Then after, she was asked to do Yoga regularly as well as follow Pathya ahaara vihaara (~wholesome diet and regimen). No symptoms were noticed by the patient even after follow-up period.

This case is an example, substantiating the efficacy of Indukanta ghritam along with diet and Yoga in the management of Jirna urdhwaga amlapitta, showing significant improvement in symptoms and thus improving the quality of life.


  Conclusion Top


The study infers that Indukanta ghritam is effective in Urdhwaga amlapitta due to its properties such as Deepana and Pachana. Nidana parivarjana, Yoga, and other medications also help in the early restorative process.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Paradakara HS, editor. Astanga Hrudaya of Vagbhatta, Nidana Sthana. Ch. 2., Ver. 1. Varanasi: Chaukhambha Surabharati Prakashana; 2007. p. 513.  Back to cited text no. 1
    
2.
Sharma H, editor. Kashyapa Samhita of Vriddha Jivaka, Khila Sthana. Ch. 16., Ver. 7-9. Varanasi: Choukhambha Sanskrita Sansthana; 2015. p. 514.  Back to cited text no. 2
    
3.
Upadhaya Y, editor. Madhava Nidana of Madhavakara. Part 2, Ch. 51., Ver. 7. Varanasi: Choukhambha Prakashan; 2014. p. 205.  Back to cited text no. 3
    
4.
Tripathi KD. Essentials of Medical Pharmacology. 7th ed. New Delhi: Jaypee Brothers Medical Publishers Pvt Ltd.; 2013. p. 649-55.  Back to cited text no. 4
    
5.
Anonymous. Sahasrayogam. 1st ed. New Delhi: CCRAS; 1990. p. 298-9.  Back to cited text no. 5
    
6.
Upadhaya Y, editor. Madhava Nidana of Madhavakara. Part 2, Ch. 51., Ver. 4-5. Varanasi: Choukhambha Prakashan; 2014. p. 204.  Back to cited text no. 6
    
7.
Upadhaya Y, editor. Madhava Nidana of Madhavakara. Part 2, Ch. 51., Ver. 6. Varanasi: Choukhambha Prakashan; 2014. p. 204.  Back to cited text no. 7
    
8.
Sharma N. An Applied Study to Assess the Role of Viruddha Aaharra in Meda Pradoshaja Vikaraas with Special Reference to Madhumeha, MD Ayurveda Thesis, AIIA; 2019.  Back to cited text no. 8
    
9.
Upadhaya Y, editor. Madhava Nidana of Madhavakara. Part 2, Ch. 51., Ver. 1. Varanasi: Choukhambha Prakashan; 2014. p. 203.  Back to cited text no. 9
    
10.
Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana. Ch 15., Ver. 66. New Delhi: Rastriya Sanskrita Sansthana; 2011. p. 463.  Back to cited text no. 10
    
11.
Upadhaya Y, editor. Madhava Nidana of Madhavakara. Part 2, Ch. 51., Ver. 4-6. Varanasi: Choukhambha Prakashan; 2014. p. 203.  Back to cited text no. 11
    
12.
Acharya YT, editor. Sushruta Samhita of Sushruta, Uttar Tantra. Ch. 1., Ver. 25. Varanasi: Choukhambha Orientalia; 2017.p. 597.  Back to cited text no. 12
    
13.
Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 27., Ver. 231-2. New Delhi: Rastriya Sanskrita Sansthana; 2011. p. 528.  Back to cited text no. 13
    
14.
Prasad GP, Nagalakshmi V, Babu G, Swamy GK. Effect of Vardhamana Indukanta Ghrita in Parinamashula (duodenal ulcer). J Res Ayurveda Siddha 2008;XXIX: 15-28.  Back to cited text no. 14
    
15.
Available from: https://www.researchgate.net/publication/278673574_IMPORTANCE_OF_YOGA_IN_DAILY_LIFE. [Last accessed on 2020 May 06].  Back to cited text no. 15
    
16.
Kumar A, Singhal T. Scientific explanation of mode of action of sutshekhar ras in amlapitta with special reference to acid peptic disorders: A review. Int J Res Ayurveda Pharm 2018;9:47-49.  Back to cited text no. 16
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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