Vol - 4, Issue - 2, Apr 2013 ISSN: Sapate et al PHARMA SCIENCE MONITOR CLINICAL EVALUATION OF GUDUCHYADI YOGA ON AMLAPITTA

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1 PHARMA SCIENCE MONITOR AN INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCES CLINICAL EVALUATION OF GUDUCHYADI YOGA ON AMLAPITTA Sapate Suresh M. 1 *, Gurav Santosh K. 2, Deeja C.R. 3, G.Lavanya 4 and G.P.Ram Reddy 5 1 PG- Scholar, Dept. of Ayurveda Siddhanta, S. V. Ayurvedic College, Tirupati. 2 PG- Scholar, Dept. of Ayurveda Siddhanta, S. V. Ayurvedic College, Tirupati. 3 PG- Scholar, Dept. of Ayurveda Siddhanta, S. V. Ayurvedic College, Tirupati. 4 PG Lecturer, Dept. of Ayurveda Siddhanta, S.V.Ayurvedic College, Tirupati 5 Professor and H.O.D, Department of Post Graduate studies in Ayurveda Siddhanta, S. V. Ayurvedic College, Tirupati. ABSTRACT In recent years there has been an extraordinary increase of incidence related to GI system. As per Modern interpretation the symptoms of Amlapitta are found in certain pathophysiological conditions of GI such as hyperacidity which occur in Acid peptic diseases (APD). Too much acidity results in early degenerative diseases, early aging, and premature death. Modern medicine is not having proper medication for gastric dyspepsia. Ayurveda has a lot to offer in this regard. Study is conducted to evaluate efficacy of Guduchyadi yoga in the management of Amlapitta basing on this concept. The present paper intends to highlight the utility of drug in reducing sign-symptoms and recurrence of the disease. Details of the study will be discussed in full paper. Keywords: GI system, Amlapitta, Ayurveda. INTRODUCTION Nowadays Gastrointestinal diseases are common in the world. Prevalence of gastrointestinal (GI) diseases in the United States indicates that five to ten percent of consultations were only on digestive problems. In India prevalence rate of Gastritis was 10 million. For many pathologies, allopathic medicine obtains poor results. The basic reasons for failure of allopathic medicine are its inability to reach the root causes of chronic diseases, lack of safety and economical cures. IC Value

2 These include various chronic diseases such as allergies, hyperacidity, digestive problems and so on-and many acute conditions, particularly chief killers like cancer and heart disease. These entire cry out for safe, sure and cost-effective alternative. Modern medicine is not having proper medication for gastric dyspepsia. Ayurveda has a lot to offer in this regard. As Ayurveda stands apart from the rest of medical fraternity with its holistic and all encompassing approach to disease management on the basis of Nidana Panchaka which enables this eternal science to handle effectively many apparently minor ailments which certainly hamper the quality of life of humanity. Disease Review The description of Amlapitta disease is noticeable right from the Samhitakala. Charaka [1] expressed references regarding Amlapitta at 9 places, though he has not considered Amlapitta as a separate disease entity. Kasyapa was the first person to document Amlapitta as a separate disease and as well classified it on Doshik basis and had given importance to its management. Madhavakara has also described the disease separately. Nidana Kasyapa and Madhavakara [2] both have given a comprehensive list of Hetus of Amlapitta. Kasyapa has mentioned the Nidanas which represent the involvement of Tridoshas. Whereas Madhavakara has described mainly Pitta aggravating factors. TABLE 1: ILLUSTRATING CAUSES OF AMLAPITTA Hetu 1.Ahara a. Dravya Kulattha, Pruthuka, Pulaka, Gorasa, Madya b. Quality Abhisyandi, Gurubhojya, Atisnigdha, Vidahi Anna-pana, Atidrava, Ati Ushna, Ati Teekshna, Pitta prakopi c. Samskara Apakwanna, Bhristadhanya, Ikshuvikara, Pistanna d. Dushita anna Dushita anna, Paryusita e. Miscellaneous Viruddhasana, Ati Amla, Akala Bhojana, Antarodakapana, Anasana, Vishamasana, Adhyasana, Ajeernasana 2.Vihara Atisnath, Atiavagahanat, Bhuktwabhuktwa Diwasvapnat 3.Manasika Chinta, Shoka, Bhaya, Krodha, Bhaya IC Value

3 Rupa TABLE 2: RUPA OF AMLAPITTA [3] BY MADHAVAKARA S.No. Rupa S.No. Rupa 1 Avipaka 5 Klama 2 Gaurava 6 Tikta-Amla Udgara 3 Utklesha 7 Hritdaha 4 Aruchi 8 Kantadaha Samprapti Acharya Charaka while describing the Samprapti of Grahani dosha has mentioned the word Amlapitta. According to him when diet is improperly digested, it gets fermented and forms Amavisha, when this Amavisha gets mixed with Pitta, it manifests as Amlapitta. Whereas Kashyapa believed that the disease is caused by vitiation of tridoshas causing Mandagni leading to Vidagdhajirna manifesting as Amlapitta. Samprapthi Ghataka TABLE 3: THE DIFFERENT COMPONENTS INVOLVED IN THE PATHOGENESIS OF AMLAPITTA Udbhava Amashaya & Pittadharakala Sanchaya Amashaya and Pachyamanashaya Adhistana Adhoamashaya Srotas Annavaha, Rasavaha, Purishavaha, Raktavaha. Dosha Pachaka pitta, Samana Vayu, Kledaka Kapha Dushya Ahara Rasa, Rakta Agni Jatharagnimandhya Ama Jatharagnimandhaya janya ama Swabhava Chirakari Vyadhi Amashayotha Rogamarga Abhyantara rogamarga Pradhanyata Pitta dosha pradhanya Prabhava Daruna IC Value

4 AIMS To evaluate efficacy of Guduchyadi Yoga in patients of Amlapitta. MATERIALS AND METHODS Selection of Cases Patients attending OPD & IPD sections in Dept. of Ayurveda Siddhanta -PG, S.V. Ayurvedic Hospital fulfilling the diagnostic criteria of selection were included in this study.patients were selected by random sampling technique i.e. irrespective of sex, caste, religion & occupation, they were advised to visit the hospital every 2 weeks for regular check up & to assess the effect of the therapy there by.in case any patient leaves the treatment without completing 30 days he / she will be declared as dropped out from the research work. ADMINISTRATION OF DRUG In selected patients of Amla pitta Guduchyadi quatha [4] was administered orally for about 30 days and advised to come to Hospital after 15 days for follow up study. Dose: 4 Karsha i.e. 40 ml of quatha in divided doses i.e. 2 times a day Type of trial Single blind open trial. Rasapanchaka of Guduchyadi quatha TABLE 4: PROPERTIES OF INGRADIENTS [5] Dravya Rasa Guna Virya Vipaka Karma Guduchi Tikta, Kashaya Guru, Snigdha Ushna Madhura Tridoshaghna, Deepana, Daha and Kamala nashaka Nimba Tikta, Laghu Sheeta Katu Kapha- Pitta Shamaka, Agni Kashaya vardhaka, Chardi- Hrillasa- Trishna nashaka Patola Tikta Laghu, Snigdha Ushna Katu Tridosa Shamaka, Pitta Saraka, Daha & Amlapitta nashaka Tikta rasa is the best for Agnidipana and dosha Pachana, which are the basic lines of treatment in Amlapitta [6]. IC Value

5 Selection of cases Inclusion criteria 1. Patients having classical signs and symptoms of Amlapitta. 2. Free from other associated complications. 3. Patients between the age group 15 years - 70 years we selected. Exclusion criteria 1. Gastric ulcer,peptic ulcer. 2. Pregnancy 3. Gastric carcinoma 4. Esophageal varices 5. Haematemesis CRITERIA FOR ASSESSMENT OF RESULTS: Assessment was done only under subjective parameters.the results of treatment were assessed on the basis of classical signs and symptoms of the disease. For statistical analysis, multidimensional scoring system was adopted and was checked before and after treatment which follows Subjective Criteria: Scoring pattern of General symptoms TABLE 5: GRADING OF SYMPTOMS No symptoms 0 Mild 1 Moderate 2 Severe 3 Intense 4 IC Value

6 Assessment of total effect of therapy On the basis of improvement in the signs and symptoms of Amlapitta, the following criteria were followed to evaluate the total efficacy therapy. TABLE 6: TOTAL EFFECT OF THERAPY 1 Complete remission (cure) 100% relief in signs and symptoms of Amlapitta. 2 Marked improvement: 75-99% relief in symptoms of Amlapitta. 3 Moderate Improvement: 50-74% relief in symptoms of Amlapitta. 4 Mild improvement: 25-49% relief in symptoms of Amlapitta. 5 No improvement: Less than 25% relief in symptoms of Amlapitta. Statistical Analysis The obtained information was analyzed statistically in terms of mean score (x), Standard Deviation (S.D.), Standard Error (S.E.). Paired t-test was carried out at the level of 0.05, 0.01, and of P levels. P > Insignificant; P < Significant P < 0.01 & < Highly Significant] Presentation of Data The data collected & analyzed has been depicted in the following sequence: 1. General observations viz. age, sex, religion etc. 2. Results of therapy evaluated on the basis of improvement in symptomatology. OBSERVATIONS The general observations found in 30 patients of Amlapitta registered in this study are as follows: Age Maximum numbers of patients i.e. 30% belong to the age group years. This indicates the higher incidence of the disease in middle aged population, reasons for this high incidence may be attributed to predominance of pitta in that age group, exposure to excess stress levels as it is the most productive age in the human life. IC Value

7 Sex Maximum number of patients i.e.53.33% were males; this may be due to irregularities in dietary habits, exposure to peak stress levels. As per the seventeen edition of Davidson - Male: Female ratio for Duodenal ulcer is 5:1 in different communities while for Gastric ulcer is 2:1 is concomitant with the above data, at the global level. Religion Maximum number of patients i.e % were Hindus. This observation is based upon the location in which hospital is located [Hindu dominant society]. As this study involved limited number of patients it cannot be concluded that Hindus are more prone to Amlapitta. Marital Status Of the total number of patients 83.33% were married, which is concomitant with the age group of patients registered. Responsibility, adjustments to different situations, economical condition and attention to family could be the probable reasons for this observation. Education Illiteracy was observed in 23.33% of patients followed by higher secondary education in 20% of patients. This is suggestive of the fact that lack of awareness of the healthy life style, proper dietary habits etc in illiterate population. Socio-economic status Majority of patients i.e % belong to middle class. This depicts that this class of people have to cope up with economic deficit, for which they are exposed to more stressful situations. Occupation Majority of patients i.e.46.66% were engaged in laborious work followed by 20% indulged in service; house hold work was done by 16.66%.A combination of irregular dietetic schedule, psychological stress at work place, and heavy physical work are the IC Value

8 common factors observed in majority of the patients; which are the potential Nidanas of Amlapitta; Where as in housewives, responsibilities towards family members and divaswapna may be the familiar reasons. Mode of Onset Majority of patients i.e % were chronic in nature, while 46.66% patients were acute in nature. TABLE 7: EFFECT OF THERAPY ON SUBJECTIVE PARAMETERS OF AMLAPITTA Effect on Avipaka Statistically highly significant relief (p< ). Percentage wise relief in 80.30%. Effect on Klama Statistically highly significant relief (p< ). Percentage wise relief in 71.15%. Effect on Utklesha Statistically highly significant relief (p< ). Percentage wise relief in 54.55%. Effect on Tikta amlodhgara Statistically highly significant relief (p< ). Percentage wise relief in 87.5%. Effect on Gaurava Statistically highly significant relief (p< ). Percentage wise relief in 91.43%. Effect on Hrith daha Statistically highly significant relief (p< ). Percentage wise relief in 89.71%. Effect on Kantha daha Statistically highly significant relief (p< ). Percentage wise relief in 96.61%. Effect on Aruchi Statistically highly significant relief (p< ). Percentage wise relief in 92.65%. IC Value

9 Graphical Representation of Result of Study Graph 1 Symptomatic Evaluation of the Effect of Guduchyadi Quatha. Graph 2 Overall Assessment of Clinical trial. DISCUSSION Chakrapanidatta while commenting on Jwara Chikitsa has emphasized two types of Pitta i.e. Sadravapitta and Nirdravapitta. This Dravata is nothing but due to the involvement of Jala in the formation of Pitta [7]. In Amlapitta disease Pitta vikriti occurs in two stages. IC Value

10 In the first stage, drava guna of pitta is aggravated (dravagunolbana stage) due to which digestive activity of pitta is impaired leading to Amlata and Shuktata of ahara manifesting in the form of Amlodgara, Ajirna, Guruta, Utklesha, Udara gaurava etc. In this stage treatment must be aimed at removing excess drava dhatu of pitta i.e., in the form of Deepana and Pachana. In the second stage, ushna guna is aggravated (drava guna is normal or increased) and this condition is called teja gunolbanata, in this condition the digestive activity is well maintained but the excess Ushna guna manifests in the form of kantha daha, urodaha, bhrama, shirashula etc. During this stage sheetalopacharas may be effective. In dravagunolbana stage Tikta rasatmaka, Ushna Virya drugs like Guduchi and Patola work as Deepana, Pachana and Dravashoshaka.( Tikta rasa-drava shoshaka). Whereas in the tejogunolbana stage Nimba pacifies Pitta through Sheeta Virya, Guduchi, Patola are Tridosha Shamaka where as Patola is Pitta Saraka. The aim of the present study was to evaluate effect of an Ayurvedic formulation Guduchyadi quatha in patients of Amlapitta. Symptomatic relief was observed in80.30%,71.15%, 54.55%, 87.5%, 91.43%, 89.71%, 96.61% and 92.65% cases regarding Avipaka, Klama, Utklesha, Tikta-Amlodgara, Hrithadaha, Kanthadaha And Aruchi Respectively. CONCLUSIONS From this study it can be understood that unhealthy dietetic code & eating habits play a major role in causation of this disease. Study of etiopathogenesis clearly indicates Amlapitta as a Tridoshaja vyadhi with Pitta dosha adhikyata and kapha anubandhata Drugs having the properties like deepana, pachana, dravashoshaka and pittahara are preferable in the treatment of Amlapitta. IC Value

11 The drug of present trial Guduchyadi quatha is effective in hyperacidity condition and its efficacy can be attributed to its tikta rasa, laghu, Ruksha properties & Pitta hara, drava shoshaka properties. REFERENCES 1. Charak Samhita - Hindi Translation by Brhamananda Tripathi, Chaukhambha Bharati Academy Varanasi Madhava Nidana Hindi Translation by Narendranath Shastri, Motilal banarasidas Pratisthana, Dellhi-Ma.Ni.51/1 3. Madhava Nidana Hindi Translation by Narendranath Shastri, Motilal banarasidas Pratisthana, Dellhi -Ma.Ni.51/2 4. Bhavaprakasha Samhita Madhyama Khanda Chi.10/16 5. Bhavaprakasha Nighntu Hindi Translation by Vishwanatha Dwivedishastri, Motilal banarasidas Pratisthana, Dellhi 6. Charak Samhita - Hindi Translation by Brhamananda Tripathi, Chaukhambha Bharati Academy Varanasi Charak Samhita Chakrapanis Ayurveda Dipika Sanskrita Commentary by Yadavaji Trikamji Acharya, Chaukhambha Subharati Prakashana Varanasi. - C.Chi.3/217 For Correspondence: Sapate Suresh M drsureshsapate@gmail.com IC Value