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922
Review Article
Nitin et al. WORLD JOURNAL OF PHARMACEUTICAL
World Journal of Pharmaceutical and Medical Research
AND MEDICAL RESEARCH ISSN 2455-3301
[Link] Wjpmr

A REVIEW ARTICLE ON AMLAPITTA W. S. R TO G.E.R.D

Vd. Nitin Suryawanshi*1, Vd. Pravin Mogle2, Vd. Suryakant Dwivedi3 and Sneha Tiwari4
1
Associate Professor, Dept. of Stri Prasuti Tantra Shri. K.R. Pandav Ayurved College.
2
Assistant Professor, Dept. of Shalakya Tantra Om Ayurved College and Hospital Betul.
3
Assistant Professor, Dept. of Stri Prasuti Tantra Om Ayurved College and Hospital Betul.
4
Assistant Professor, Dept. of Kayachikitsa Shri. [Link] Ayurvedic College.

*Corresponding Author: Vd. Nitin Suryawanshi

Associate Professor, Dept. of Stri Prasuti Tantra Shri. K.R. Pandav Ayurved College.

Article Received on 29/11/2021 Article Revised on 19/12/2021 Article Accepted on 09/01/2022

INTRODUCTION
Ayurveda has a significant status among the various types of Indian medicine. From stone-age to space age, food
pattern of people has undergone innumerable changes. these changes have been always for the better aspect of life,
yet most of the diseases are firmly rooted in poor dietary habits and life style.[1]

Improper and faulty dietary habits causes dushti of 2. Kulattha is mentioned as one of the causative factors
annavaha strotas which leads to various disorders and of Amlapitta in Charak Sutrasthana.[11] Ch. Su.
Amlapitta is one of them. 25/40
3. In Charak Sutrasthana, Amlapitta has been listed as
Amlapitta is not mentioned in Brihattrayi. It was first a disease occurring due to excessive use of lavana
mentioned in Kashyapa samhita.[2] Madhava Nidana, rasa and viruddhaahar.[11] Ch. Su. 26/43
Bhavaprakasha and Yoga Ratnakara have also described 4. It described Rajamasha as Amlapittaro
it very well. Vagbhata has described that all diseases are ganashaka.[11] Ch. Su. 27/25
caused due to Mandagni. Excessive consumption of 5. In Charakchikit sasthana, Amlapitta has been listed
Amla, Katu, Ushna and Vidahiaharsevana and as an indication of Kansa Haritaki.[12] Ch. Chi. 12/52
Viruddhashana causes aggravation of Pitta dosha. 6. According to Charaka, due to Agnimandya when the
Normally Pitta has Katu rasa but when Katu rasa is food is not digested properly, it forms Annavisha
converted into Amla rasa, it causes Amlapitta.[3] which when mixed with Pitta causes Amlapitta12Ch.
Chi. 15/47
MATERIAL METHORD
1. Ayurvedic grantha  Sushrutsamhita
1. Symptom like “Amlika” has been described 13Su.
2. Internet Aritical and research work
Ni.21/2,
3. Modern Medical Literature
 Kayashapysamhita
Method 1. Kayashapy samhita is the first which described the
Historical Review Amlapitta with its nidana, rupa, chikitsa and pathya and
3.1 Disease Review apathya. Importance of Desha and Kala in Amlapitta has
(1) VEDIC KALA also mentioned in this Samhita.[14]
No reference of Amlapitta was found in Vedic kala.  Harita samhita
1. The word „Amlahikka‟ has been used for Amlapitta
(2) SAMHITA KALA and separate chapter has been given in Haritsamhita.[15]
 Charaka Samhita
Separate references of Amlapitta are not found in Charak (3) SANGRAHA KALA
Samhita, but the word “Amlapitta” has been used at  Madhava Nidana
different places in Sutrasthana & Chikitsasthana.[10] In Madhava Nidana Amlapitta is described with its
nidana, rupa, types and samprapti.[16]
Following references regarding Amlapitta were found in  Chakradutta
Charak Sutrasthana In Chakradutta, Chikitsa of Amlapitta is described in
1. While describing the properties of milk (8 type), detail.[17]
Amlapitta has been listed as an indication.[11] Ch.  Sharangadhara samhita
Su. 1/111 In Sharangadhara Samhita, Chikitsa and methods of

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Nitin et al. World Journal of Pharmaceutical and Medical Research

preparation of different types of food useful in Amlapitta  Amla Avasthapaka

is described in detail.[18] It is the second stage of avasthapaka in which the food
 Bhavaprakasha attains the Amlabhava, after the secretion of Amla rasa
In Bhavaprakasha separate chapter of Amlapitta have secreted by Urdhva amashaya.
been described with its upadrava & Arishtalakshan in
Bhavaprakasha.[19]  Katu Avasthapaka
 Yoga Ratnakara It is the third stage of avasthapaka. In this stage, the
Yogratnakar described nidana, rupa, prakara, samprapti pakvapakva ahara is propelled forward to the
along with upadravas of Amlapitta.[20] pakvashaya where Agni makes it ruksh. The undigested
 Bhaishajyaratnavali food materials are converted into mala.
In Bhaishajyaratnavali, chikitsa of Amlapitta and
effectiveness of various yogas have been described in Nidan of Annavahastroto dushti[28]
detail.[21] 1. Ati matra bhojana: Excessive intake of food.
2. Akale bhojana: Irregular pattern of food intake.
Ayurvedic review of Annavaha Srotasa 3. Ahita bhojana: Intake of food which is harmful for
Annavaha srotasa means the channel which transports health.
the food from the mouth to the anus. 4. Agni dusti: Imbalance of digestive power (due to
doshavaishamya)
Moola
According to Acharya Charaka, Amashaya & Lakshana of Annavahastroto dushti
Vamparshvaare the Moolsthana of Annavahasrotasa.[22] Four symptoms of the Annavaha sroto dusti described by
Acharya Charaka
According to Acharya Sushruta Amashaya and  Anannabhilasha - Lack of interest in food
Annavahidhamanyas are the moola of  Arochaka - Loss of taste of food
Annavahasrotasa.[23]  Avipaka - Indigestion of food
 Chhardi - Vomiting
Amashaya
Chakrapani has divided Amashaya into two parts: Definition of Amlapitta[29]
Urdhva amashaya and Adho amashaya which are the According to Acharya Kashyapa, the Vidagdha ahara
places of Kapha and Pitta respectively.[24] becomes Amla and remains still in the stomach which
provokes the Pitta dosha. Vitiated Pitta causes manda-
Pittadhara Kala agni due to this katu rasa get converted into Amla rasa
Acharya Sushruta has described the sixth kala situated causing “Amlapitta”.[Link] 16/9
between Pakvashaya and Amashaya as pittadhara kala.
According to him grahani is covered by pittadhara kala. The condition in which Vidahi and Amla guna of Pitta is
Its main function is to provide Pachaka Pitta, which is exaggerated, is called “Amlapitta.[30] [Link] 51/1
necessary for the digestion of the food.[25] (madukoshtika)

Samana Vayu  Nidana[31]

According to Vagbhatta, sthana of Samanavayu is just The etiological factors of Amlapitta can be broadly
near the Agni and it is responsible for the Pachana classified as
(digestion), Vivechana (separation) and Munchana  Aharaja
(propulsion & expulsion) of the food.[26]  Viharaja
 Manasika
Ahara Paka Kriya
 Agantuja
Following two phases (avastha)
1. Avasthapaka (1st phase of digestion)
1. Viharaja Hetu
2. Nisthapaka (2nd phase of digestion)
 Ati snan (Taking excessive bath)
Avasthapaka  Ati avagahanat (Excessive swimming)
The process of digestion by Pachakagni is known as  Bhuktwabhuktwadiwasvapna(Sleeping in day time
Avasthapaka. after meals)
1. Madhura Avasthapaka  Veganam dharanam (Suppression of natural urges)
2. Amla Avasthapaka  Shayyaprajagaraihi (Improper sleeping schedule)
3. Katu Avasthapaka[27]
2. ManasaHetu
 Madhura Avasthapaka Chinta, Shoka, Bhaya, KrodhaMoha
It is the first stage of Avasthapaka which takes place in
the upper portion of the Urdhva amashaya i.e. fundus of 3. Agantuj
the stomach.  Desha,

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 Nitin et al. World Journal of Pharmaceutical and Medical Research

 Kala, 5. Ama: Jatharagnimandhyajanya

 Ritu 6. Udbhavasthana: Amashaya
 Prakriti 7. Adhisthana: Adhoamashaya
8. Sanchara: Annavaha
Desha 9. Swabhava: Chirkari
According to Acharya Kashyapa the disease is more 10. Pradhanta: Pitta Doshapradhana
predominant in Anupa Desha, because of Kapha
provocation nature. 6. Purvarupa
In ancient Ayurvedic texts, no specific purvarupa are
Kala given for Amlapitta.
Kala or time factor is responsible for physiological
/anatomical structure of the body Balyavastha, Madhya 7. Rupa
and Vriddhavastha. According to Acharya Sushruta, rupa appears in the
vyakti stage. Rupa of Amlapitta are as follows.
Retu
The rainy season is responsible for Amlavipaka of water Vishishta Rupas
(due to weakened digestion power and vitiation of Vata Table no. 1 showing vishishta rupas according to Dosha
and other Doshas) and eatables, which in turn vitiates dusti.
Pitta and Kapha
8. BHEDA (classification)
Prakriti 9. Sapekshanidana (Differential Diagnosis)
Pitta Prakriti persons are also more susceptible for the  Vidagdh ajirna,
process of aggravation of the diseases.  Pittaja atisara,
 Pittaja grahani
4. Samprapti
According to Acharya Kashyapa, the nidanasevana 10. Upasaya Anupasaya (According to Acharya
causes Doshaprakopa especially Pitta Dosha. This Kaypasha)
eventually creates Mandagni due to which ingested food 1. Vataja Amlapitta - Snigdha upasaya
become Vidagdha form and attains Shuktibhava). This 2. Pittaja Amlapitta - Swadu and sita upasaya
Vidagdha and Shuktibhava of food creates Amlata in 3. Kaphaja Amlapitta - Ruksha and ushna upasaya
Amashaya. This condition is called Amlapitta (k.s 16 /10
-12) 11. Upadrava (kayashapyaSamhita)
Atisara, Pandu Shotha, Aruchi, Bhrama, Dhatukshinata,
Shoola

12. Sadhyasadhyata[33]
1) According to Acharya Madhava Nidana, Amlapitta
with recent origin is sadhya but in chronic stage it
becomes yapya or krichhasadhy.
2) According to Acharya Kashyapa, Amlapitta
becomes asadhya (incurable) when its associated
with upadrava.

13. Chikitsa[34]
Samanya chikitsa of Amlapitta
According to Acharya Yogaratnakara and Acharya
Kashyapa -
1) Vamana is the first line of treatment for Amlapitta
(patol+neem + madanfal).
2) Virechana –after that mrudu virechan is indicated
for Amlapitta (triphala +madhu).
3) Basti – Anuvasan and Asthapan Basti should be
administered in Chronic Amlapitta,
4) Shaman chikitsa- Shodhan Chikitsa is followed by
Shaman chikitsa. Ahar, and aushdi according to
5. Samprapti Ghatakas[32] predominance Dosha. (Patoladi Kwath, Bhunimbadi
1. Dosha: Tridosha (mainly Pitta) Kwath, guduchi Moodak are given in different
2. Dushya: Rasa, Rakta Samhita.)
3. Srotasa:Annavaha
4. Agni: Jatharagni

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Nitin et al. World Journal of Pharmaceutical and Medical Research

According to Madhava Nidan telemetry

1. Udarvagat Amlapitta -Vamana should be 3) Endoscopy.
administered at first. After the Vamana, shamana
drug should be used. Management
2. Adhogata Amlapiita -Virechana should be  Managed by relieving the causative factors.
administrated for adhogata Amlapitta. Then shaman  Drugs like antacids, H2 receptor antagonists, proton
therapy to be performed. pump inhibitors, prokinetics, anticholinergics
 Surgery in advanced stage like (anti-reflux surgery)
Modern review of Amlapitta
Various researches were found on Amlapitta with there DISCUSSION AND CONCLUSION
co-relation with modern disease which are as follows –
Vidya Tripathi co-relate Amlapitta with GERD Vaidya Amlapitta is a dominant disease in the present scenario
Purushttam co-relate with Chronic gastritis, Vaidya S.N of unhealthy food habits and regimens. The Brahtrayi
Tripathi co related with Non –Ulcer dyspepsia and Granthas has a scattered references about the Amlapitta
Vaidya Harinath Jha co relate with Hyperacidity but doesn‟t give detailed explanation or protocol of
Gastroesophageal Reflux Disease.[53] treatment for Amlapitta. Acharya Madavakara has
divided Amlapitta into Urdwva and Adha on the basis of
GERD resulting in heart burn affect approximately 30% Doshagati(16) and Madavanidana is a compilation of all
of the general population Samhitas and is limited to the Nidana aspect only.
Acharya Kashypa was the first person to give detailed
Pathophysiology protocol of treatment for Amlapitta. Acharya gives
Reflux are normally followed by esophageal peristaltic instruction to do Vamana where the Dushita Drava
waves which efficient clear the gullet, alkaline saliva Yukta Pitta goes out and Agni gains its normalcy. After
neutralize residual acid, and symptoms do not occurs. this Aushadi is given to do the Pachana of Dosha and
GERD develops when the esophageal mucosa is exposed further is eliminated from the body through purgation.
to gastro-duodenal component for prolong period of Advice for change of place in Amlapitta treatment also
time. considered as the peculiarity of Kashyapa Samhita where
the Acharya says to change the habitat where all the
Causes above treatment modality fails. Acharya says Amlapitta
1. Abnormality of lower esophageal sphincter – Due to is more common in marshy land so one should be away
reduce of lower esophageal sphincter tone, from the Desha which is more prone for it.
permitting when inter abdominal pressure rise.
2. Hiatus hernia – Pressure increase in Abdominal and Interpretation of Chikitsa with Panchamahabhuta
thoracic cavity which pinches the Hiatus and cause siddhantha Most of the drugs (in samana aspect) are
reflux. having Tikta Rasa which has Vayu + Akasha Mahabhuta.
3. Delayed esophageal clearance – Defective This Vayu Mahabhuta dries up the Dravtva of Dushita
esophageal peristaltic activity is commonly found in Pitta and this Akasha Mahabhuta removes the Srotorodha
patient who have esophagitis. Poor esophageal which in turn is the Samprapti Vighatana. So by applying
clearance lead to increased acid exposure time. Samuchaya Tantrayukti one should understand that all
4. Gastric content- It is most important esophageal Tikta Rasa drugs can be used in the treatment of
irritant. Amlapitta. Further Acharya says about the Pathya to be
5. Increased intra-abdominal pressure. followed which is good for the Srotas, does the Dipana
6. Dietary and environment factors. of Agni and promotion of Bala.

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