Introduction

Amlapitta is a highly common illness which is characterised by Amlodgara, Hrid Kanth Daha, and Avipaka. This is one of the most pressing issues for society. A busy, hectic stressful lifestyle with irregular and improper eating patterns are important causative factor for Amlapitta. Charaka, Sushrut and Vagbhata has not directly described this disease. But in Grahanidoshchikitsa chapter, Charak has mentioned that when Amavisha get mixed with the Pitta, diseases such as Amlapitta will develop.[1] Sushruta has described “Amlika” disease which is similar to Amlapitta.[2] The description of the disease Amlapitta has been mentioned separately in Kashyap Samhita,[3] In Madhav Nidan, two types of Amlapitta are described namely, Urdhvaga and Adhoga Amlapitta,[4] Yogratnakar also described Amlapitta with treatment separately.[5]. Ayurvedic text describes causes of this disease including mainly improper diet habits such as Virudhashana, Adhyashan, Anashan, excessive intake of food containing Tikta-Amla Rasa, spicy irritant and heavy, Abhishandi food. some fast-food, bakery products, etc. Suppression of natural urges of urination and defecation (Vegavdharan), drinking excess of water while taking meal, Diwaswap, etc. [6]. When the Amla and Drava Guna of Pitta Dosha become exaggerated, the disease Amlapitta is produced. Amlapitta is a frequently occurring psychosomatic disease. It can be correlated with diseases like gastritis, hyperacidity, non-ulcer dyspepsia in modern science. Antacids and PPI (proton pump inhibitor) gives symptomatic relief only and these are not reliable for long term use. Long term PPI therapy is associated with reduced absorption of iron, B12 and magnesium and small but increased risk of osteoporosis and fractures.[7] Amlapitta is caused by Vidagdha Pitta. Virechan is the main treatment suggested for Pittadoshaj Vyadhi in Ayurveda.[8] As Aamashaya is the Sthana of Pitta, Virechan is found beneficial on Pittajvyadhi. Rakta Dhatu and Pitta are related to each other. When Raktadushi happens, Pitta also gets vitiated. Virechan has equally advantageous effect on both Pitta and Rakta dushti diseases.[9] Hence Virechan was planned for the treatment of this patient.

METHODOLOGY:

Patient information:

A 51-year-old male known case of hypertension for 4 years came in OPD of Kayachikitsa department at GAC Nagpur having complaints of pain in abdomen, Amlodgar, burning sensation in epigastric and throat region, nausea on and off and sometimes severe headache for 5 years. He took antacids and/or proton pump inhibitors when pain is more. Patient was on modern medication for hypertension. (Tab. Telmisartan 40 mg 1 OD)

History of patient:

Personal history: Patient is doing field work.

Family history: He had family history of hypertension to mother. Stress factor was observed while taking personal family history.

Personal habits: He took 4 to 5 times tea per day. He also had addiction of smoking occasionally.

 Aahar: He took Madhur, Snigdha, Katu rasatmaka aahar, non-veg occasionally.

 Past history of medicine: Tab Pan 40 mg SOS

Present history of medicine: Tab Telma 40 mg 1 OD

History of doing any work fast within time was given by him. Hence hurry, curry and worry all the three factors responsible for GI disorders were found in him.

Findings:

General examination: General condition of patient was moderate. Patient was afebrile, pulse 78/min, blood pressure 140/90 mmHg. RR 20/min. Cyanosis, pallor, icterus were absent.

Systemic examination: In systemic examination, respiratory, cardiovascular system examination were within normal limits. Patient was conscious, active, well oriented. In per abdomen examination, abdomen was soft, non-tender, liver & spleen were not-palpable.

Ashtvidh parikshan: His nadi (~pulse) was Pittaj, Jivha (tongue) was Sama (~coated), Akruti was Madhyam having body weight 59.5Kg. Druk (Vision) was normal. Bowel habit were irregular. Sleep was not proper. Dashvidh parikshan showed that Pittaj Prakruti, Madhyam Sarata, madhyam Satva, madhyam Satmya, Pravar Bala and Vyayamshakti. middle age, Pittaj Pradhan vikruti, Abhyavaran and Jaranshakti was Madhyam.

Investigations:

Routine investigations were done. Hb% 17,8%, TLC 6460/cumm, ESR was 05 mm, Urine routine microscopy report was normal, BSL Random 88.1mg/dl. All investigations were within normal limits.

Clinical findings: Patient had complaints of pain in abdomen, Amlodgar, burning sensation in epigastric and throat region, nausea on and off and sometimes severe headache for 5 years.

Diagnostic assessment:

Patient was diagnosed on the basis of clinical findings. Following assessment scale was used for signs and symptoms of Amlapitta.[10]

Methods:

Therapeutic interventions:

Pittaj Prakruti and Pitta dushti, as well as Rakta dhatu dushti were considered in this patient as he is a known case of hypertension. Shodhan chikitsa was decided as disease in chronic stage. Virechan is the best option for Pittaj dushti as described in Ayurvedic text. Studies also showed that Virechan is beneficial in the management of hypertension.[11] Hence Virechan was planned for this patient.

Purvakarma:

For Agni Deepana, Rukshan Pachan Kwath containing Triphala, Musta, Vidang, Guduchi was given 40 ml twice a day for 7 days. Then Snehpan (internal oleation with increasing dose) was started with Panchtiktak Ghrut from 30ml till symptoms of proper Snehan found in patient. (Table1)

During the gap of two days (Snehviram Kala) and day of Virechana, Sarvanga Abhyanga (oil massage) with Tila Taila was done followed by Svedana in the morning.

Pradhankarma:

Virechana Karma was performed by the administration of Ichhabhedi Rasa 2 tablets along with cold water on the 3rd day after performing of Abhyanga and Svedana on empty stomach.

Paschat Karma:

Samsarjana Krama (post-Virechana dietary regimen) was advised for 7 days.

Observation and Results:

Assessment was done by using Amlapitta assessment scale on the basis of improvement in signs and symptoms of the Amlapitta. It was observed that on the first visit of the patient, the assessment score was 9, while after Virechan it decreased to 1, and after following Sansarjan krama, it was zero. Hence, there was a significant decrease in the signs and symptoms of the Amlapitta after Virechan in this patient. (Table2).

Follow up: after 21 days patient came to OPD. He has no complaints. His appetite and bowel habit were good. Excess fat on abdomen was also reduced after Virechan. Weight 57kg. BP 130/80 mmHg. He was very satisfied with the Virechan and he promotes other patients for ayurvedic treatment.

Discussion

Now a days, a fast-paced life has seen in human beings. People doesn’t have time to follow a healthy lifestyle and dietetic rules. A busy, hectic, stressful lifestyle with improper diet habit leads digestive impairment in which Pitta get vitiated and ultimately causes Amlapitta. There are two types of treatment described in Ayurveda, i.e., Shodhan and Shaman Chikitsa.[12] Shodhan chikitsa includes Panchkarma in which impurities, vitiated Dosha, Dhatudushti are removed from the body.[13] In the present study, patient was a known case of hypertension suffering from Amlapitta. Virechan was given to the patient considering Pitta and Rakta Dhatu Dushti. As per Amlapitta assessment scale, patient had Amlodgar, Aruchi, and Hrutkanthdaha of moderate degree while Avipak, Gaurav and Utklesh of mild degree. Patient also had abdominal pain and sometimes severe headache. The effectiveness of the treatment is considered positive on the basis of scoring pattern before treatment and after the completion of treatment. In this patient, all of the symptoms of Amlapitta were resolved after Virechan within 21 days. (Table 2). It was observed that there was significant reduction in symptoms like abdominal pain, Hrutkanthdaha, Amlodgar and severe headache. In addition to this, excess abdominal fat was also reduced. Chaturvedi A. Nath G. et. al., have showed that Virechan is effective in the management of the obesity due to decrease in the Escherichia coli colonization and is active over the gut flora imbalance. [14] In the present study, the effect of Virechan on signs and symptoms of Amlapitta was assessed on a single patient. Hence there is future scope for further researches on more patients of Amlapitta.  

Conclusion

On the basis of this study, it can be concluded that, present lifestyle that has improper diet habits, mental stress, and strain play an important role in producing and aggravating Amlapitta. The effect of Virechan has seen in the reduction of excess abdominal fat and hypertension. This case study highlights the significant effect of Virechan in the management of Amlapitta.