JSS INSTITUTE OF NATUROPATHY & YOGIC SCIENCES

NAVAKKARAI, COIMBATORE- 641105

DISSERTATION ON

MANAGEMENT OF PEPTIC ULCER

THROUGH NATUROPATHY AND YOGA

SUBMITTED BY: MS. SYAFARINA

REGISTRATION NO: 821712087 0

 DECLARATION

I hereby declare that the dissertation entitled Management of Peptic Ulcer Through
Naturopathy and Yoga submitted for partial fulfilment of the requirement for
Bachelor of Naturopathy And Yogic Sciences in JSS Institute of Naturopathy and
Yogic Sciences is my original work and the dissertation has not formed the basis for
the award of any degree, diploma, fellowship or other title, it has not been submitted
to any other university or institution for the award of any degree of diploma.

PLACE:

DATE: SIGNATURE OF THE INTERNEE

1
 CERTIFICATE

This is to certify the dissertation entitled Management of Peptic Ulcer Through

Naturopathy and Yoga submitted by Ms. Syafarina in partial fulfilment of the
requirement for Bachelor Of Naturopathy And Yogic Sciences in JSS Institute of
Naturopathy and Yogic Sciences, done by her during the period of April 2023- April
2024 under my guidance, supervision and this dissertation or any part of these has not
been submitted elsewhere for any degree.

SIGNATURE OF THE GUIDE SIGNATURE OF THE PRINCIPAL

(DR. ARYA) (DR. DHILIP V.R)

PLACE:

DATE:
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 ACKNOWLEDGEMENT

I would like to extend my gratitude and sincere acknowledgement to DR.DHILIP

RAVINDRAN V. R ,for giving me such a good opportunity to do a dissertation and
learnt a lot during the internship period. I wish to express my profound respect to my
guide DR.ARYA for her mentorship and her tireless support throughout the
dissertation, I am deeply indebted to all the doctors at JSS institute of naturopathy and
yogic sciences, for their valuable guidance and support.

SIGNATURE OF THE INTERNEE

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 INDEX
S. NO CONTENTS PAGE
NO

1 Introduction 8

1.1 Background 8

1.2 Epidemiology 8

2 Literature Review 9

2.1 Definition 9

2.2 Etiology 12

2.3 Clinical features 16

2.4 Symptoms 18

2.5 Risk factors 20

2.6 Complications 21

2.7 Gastric physiology 22

2.8 Pathophysiology 27

2.9 Histopathology 30

2.10 Differential diagnosis 32

2.11 Conventional diagnosis 34

2.12 Conventional management 37

2.13 Disease prognosis 39

3 Naturopathy and Yogic management of disease 39

3.1 Naturopathy diagnosis 39

3.2 Naturopathy definition and concept on disease 43

3.3 Yoga definition and concept on disease 45

4 Methodology 47

5 Naturopathy and Yoga treatments 48

6 Results 63

4
7 Discussion 64

8 Conclusion 64

9 References 65

10 Appendices 68

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 LIST OF FIGURES

S. NO FIGURES PAGE
NO

1 Peptic Ulcer Disease 10

2 Common Causes 13

3 Etiologies 15

4 Quadrant of Abdomen 18

5 Symptoms 19

6 Risk Factors 21

7 Mucosal defence 23

8 Mechanism of HCl secretion 25

9 Phases of Gastric secretion 26

10 H. pylori Virulence Factors 28

11 H. pylori Pathogenesis 29

12 Pathophysiology of NSAIDS 30

13 Gross Appearance 31

14 Microscopic Features 32

15 Endoscopy 35

16 Barium Swallow 36

17 Urea Breath Test 37

18 Action of PPI 38

19 Tongue Map 40

20 Facial Diagnosis 41

21 Diagnosis in Iris 42

22 Naturopathic Approach in Peptic Ulcer 44

23 Yogic Concept of Disease 46

24 Acupuncture Points for Peptic Ulcer 51

25 Aroma therapy 53

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 LIST OF TABLES

S. NO TABLES PAGE
NO

1 Difference between Duodenal & Gastric ulcers 12

2 Acupuncture points for Peptic ulcer 51

3 Recommended daily diet for peptic ulcer 56

4 Yoga Protocol 61

5 Result of Case 1 63

6 Result of Case 2 63

7 Result of Case 3 63

8 Result of Case 4 64

9 Result of Case 5 64

10 Case 1 Treatment chart 73

11 Case 1 Diet chart 75

12 Case 2 Treatment Chart 81

13 Case 2 Diet chart 83

14 Case 3 Treatment chart 88

15 Case 3 Diet chart 90

16 Case 4 Treatment chart 95

17 Case 4 Diet chart 97

18 Case 5 Treatment chart 102

19 Case 5 Diet chart 104

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 PEPTIC ULCER

1.INTRODUCTION

1.1 BACKGROUND

▪ An Ulcer is defined as disruption of the mucosal integrity of stomach or

duodenum leading to local defect or excavation due to inflammation.
▪ Ulcers are different from erosions based on size. Lesions less than 5mm in
diameter are Erosion; Lesions greater than 5mm in diameter are Ulcers.

1.2 EPIDEMIOLOGY

▪ Peptic ulcer disease (PUD) is a global problem with a lifetime risk of

development ranging from 5% to 10%. Almost half of the world’s population
is colonized by H. pylori, which remains one of the most common causes of
peptic ulcer disease. The prevalence of H. pylori is higher in developing
countries, especially in Africa, Central America, Central Asia, and Eastern
Europe. The organism is usually acquired in childhood in an environment of
unsanitary conditions and crowding, mostly in countries with lower
socioeconomic status. H. pylori causes epithelial cell degeneration and injury,
which is usually more severe in the antrum, by the inflammatory response with
neutrophils, lymphocytes, plasma cells, and macrophages.

▪ Overall, there is a decrease in the incidence of PUD worldwide due to improved

hygienic and sanitary conditions combined with effective treatment and
judicious use of NSAIDs. Duodenal ulcers are four times more common than
gastric ulcers. Also, duodenal ulcers are more common in men than in the
woman.

▪ There is strong evidence that cigarette smoking, coffee, regular use of aspirin,
and prolonged use of steroids are associated with the development of peptic
ulcer. Genetic factors play a role in both duodenal and gastric ulcer. About half
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 of the patients with duodenal ulcer have elevated plasma pepsinogen I. A small
increase in risk of duodenal ulcer is found in persons with blood group O and
in subjects who fail to secrete blood group antigens into the saliva. In most
Western countries, morbidity from duodenal ulcer is more common than from
gastric ulcer, even though deaths from gastric ulcer exceed or equal those from
duodenal ulcer. In Japan, both morbidity and mortality are higher for gastric
ulcer than for duodenal ulcer.

▪ DUODENAL ULCER
Estimated to occur in 6 to 15% of Western population. Incidence declined
steadily from 1960 to 1980 and has remained stable since then. The reason for
reduction is likely related to the decreasing frequency of H. pylori.

▪ GASTRIC ULCER
Tend to occur in later life as in 6th decade. Common in males. Less common
than DUs.

2. LITERATURE REVIEW

2.1 DEFINITION

▪ Peptic ulcers are acid-induced lesions found in stomach and duodenum

characterized by denuded mucosa with the defect extending into submucosa or
muscularis propria layers.
▪ The formation of peptic ulcer depends on the presence of gastric juice pH and
decrease in mucosal defences (imbalance between stomach acid and mucosal
defence barriers.)

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 Fig 1: Peptic Ulcer Disease

2.1.1 SITE OF OCCURANCE

▪ Ulcers occur within stomach or duodenum and are often chronic in nature. May
occur in lower esophagus, distal duodenum and jejunum.

2.1.2 GASTRIC ULCER

Gastric ulcers are a break in the mucosa of the stomach lining that penetrates
through the muscularis mucosa and extends more than 5 mm in diameter. When
alterations occur to the defence mechanisms of the stomach, it can cause changes
in the gastric mucosa which will eventually result in erosion and then ulceration.

2.1.3 DUODENAL ULCER

Duodenal ulcers occur when there is a disruption to the surface of the mucosa
of the duodenum. Anatomically, both the gastric and duodenal surfaces contain a
defence system that includes pre-epithelial, epithelial, and subepithelial elements.

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 Ulceration occurs from damage to the mucosal surface that extends beyond the
superficial layer.

FEATURES DUODENAL ULCER GASTRIC ULCER

INCIDENCE • Four times more • Less common than
common than Gastric duodenal ulcers
ulcer • Occurs usually beyond
• Occurs usually at age of 6th decade
25-50 years • More common in males
• More common in males than in females (3:1)
than in females (4:1)
ETIOLOGY • H. pylori infection • H. pylori infection
• Hypersecretion of acid- • Association with
pepsin, association with gastritis, bile reflux,
alcoholic cirrhosis, drugs, alcohol, tobacco
tobacco,
hyperparathyroidism,
chronic pancreatitis,
blood group O, genetic
factors
PATHOGENESI • Mucosal digestion from • Mucosal digestion from
S hyperacidity hyperacidity
• Damage of gastric • Damage of gastric
mucous barrier mucous barrier
PATHOLOGIC • Most common in first • Most common along
CHANGES part of duodenum lesser curvature and
• Often solitary, 1-2.5 cm pyloric antrum
in size, round to oval, • Grossly similar to
punched out duodenal ulcers
• Histologically composed • Indistinguishable from
of 4 layers- necrotic, duodenal ulcers

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 superficial exudative,
granulation tissue,
cicatrisation
COMPLICATIO Commonly haemorrhage, Commonly haemorrhage,
NS perforation, sometimes perforation, sometimes
obstruction. Malignant obstruction. Malignant
transformation never occurs transformation occurs in less
than 1% cases
CLINICAL • Pain-food-relief • Food-pain
FEATURES • Night pain common • No night pains
• No vomiting • Vomiting common
• Melana more common • Haematemesis common
• No weight loss • Significant weight loss
• No particular choice of • Patient choose bland
diet diet
• Deep tenderness in the • Deep tenderness in the
right hypochondrium midline in epigastrium
• Common in people at • Common in labouring
greater stress groups

Table 1- Difference between Duodenal & Gastric ulcers

2.2 ETIOLOGY

The cause of ulceration differs between individuals. The immediate cause of peptic
ulcer is disturbance in normal protective mucosal barrier by gastric acid secretion.
The etiology is multifactorial.

Common

• H. pylori infection
• NSADs
• Medications

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 Fig 2: Common causes

Less Common

• Zollinger-Ellison syndrome, a condition that occurs when one or

more tumours called gastrinomas—causing the stomach to make too much
acid

• Malignancy (gastric/lung cancer, lymphomas)

• Stress (Acute illness, burns, head injury)
• Viral infection
• Vascular insufficiency
• Radiation therapy
• Crohn’s disease
• Chemotherapy
• Cystic fibrosis
• Hyperparathyroidism
• Antral G cell hyperplasia
• injury, blockage, or lack of blood flow that affects the stomach or duodenum
• severe chronic diseases, such as cirrhosis or chronic obstructive pulmonary
disease

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❖ Helicobacter Pylori-Associated PUD

H. pylorus is a gram-negative bacillus that is found within the gastric epithelial

cells. This bacterium is responsible for 90% of duodenal ulcers and 70% to
90% of gastric ulcers. H. pylori infection is more prevalent among those with
lower socioeconomic status and is commonly acquired during childhood.
NSAID-associated PUD

❖ NSAIDs

Nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, and

naproxen) use is the second most common cause of PUD after H. pylori
infection. NSAIDs relieve pain, but they also make the stomach lining more
prone to damage and ulcers if

• NSAIDs are taken for a long time

• high doses of an NSAID or more than one NSAID

• NSAIDs along with other medicines that increase the risk for ulcers

• NSAIDs and infection with H. pylori

❖ Medications

Apart from NSAIDs, corticosteroids, bisphosphonates, potassium chloride,

and fluorouracil have been implicated in the etiology of PUD.

❖ Gastritis

Some degree of gastritis is always present in the region of gastric ulcer.

Other Local IrritantsSome substances are heavy spiced food, alcohol

consumption, smoking, aspirin. Pyloric antrum and lesser curvature of the
stomach are the sites most exposed for longer periods to local irritants and are
the common sites for occurrence of gastric ulcers

❖ Dietary Factors

Nutritional deficiencies- gastric ulcer in poor socioeconomic strata

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❖ Psychological Factors

Stress, anxiety, fatigue may predispose to peptic ulcer.

❖ Genetic Factors

People with blood group O appear to be more prone to develop peptic ulcer
than other blood groups. Genetic influences in duodenal ulcers by their
occurrence in families, monozygotic twins and association with HLA-
B5ntigen.

Fig 3: Etiologies

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 ❖ Hormonal Factors

Secretion of certain hormones by tumours associated with peptic ulcers-

Gastrin by islet-cell tumour in Zollinger-Ellison syndrome; Endocrine
secretions in hyperplasia and adenomas of parathyroid gland, adrenal cortex
and pituitary gland.

2.3 CLINICAL FEATURES

Peptic ulcers are remitting and relapsing lesions. “Once a peptic ulcer patient, always
a peptic ulcer patient”

❖ Age
Duodenal ulcer- 5th decade

Gastric ulcer- 6th decade

❖ People at risk

Duodenal ulcer- people with more stress and strains like executives, leaders

Gastric ulcer- labouring groups

❖ Periodicity

Duodenal ulcer- worsened by ‘work, worry, weather’

Gastric ulcer- attacks last from 2 to 6 weeks with interval from 1 to 6 months

❖ Pain

Duodenal ulcer- pain is severe and occurs at night (hunger pain) and is relieved
by food.

Gastric ulcer- epigastric pain immediately or within 2 hours after food and not
at night.

❖ Vomiting

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 Duodenal ulcer- rarely vomiting. Heart burn (retrosternal pain); water brash
(burning fluid into the mouth)

Gastric ulcer- vomiting relieves pain

❖ Haematemesis and Melaena

Duodenal ulcer- comparatively more common. 40:60

Gastric ulcer- 60:40

❖ Diet

Duodenal ulcer- take all kinds of diet

Gastric ulcer- take bland diet like milk, eggs, etc and avoid taking fried foods,
curries and heavily spiced food.

❖ Weight

Duodenal ulcer- gain weight due to frequent ingestion of milk to avoid pain

Gastric ulcer- loss of weight

❖ Deep Tenderness

Duodenal ulcer- right hypochondrium

Gastric ulcer- midline pf epigastrium

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 Fig 4: Quadrants of abdomen

2.4 SYMPTOMS

Signs and symptoms of peptic ulcer disease may vary depending upon the location of
the disease and age. Common symptoms include

• pain or discomfort in the upper part of abdomen

• feeling full too soon while eating a meal
• feeling uncomfortably full after eating a meal
• nausea and vomiting
• bloating
• belching
• Weight loss/weight gain
• Hematemesis
• Melena

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 Fig 5: Symptoms

Abdominal pain is the most common symptom of a peptic ulcer. The pain may be dull
or burning and may come and go over time. Sometimes the pain may occur when
the stomach is empty or at night, and it may go away for a short time after they eat.
Sometimes eating may make the pain worse.

Many people who have peptic ulcers don’t have any symptoms until an ulcer leads
to complications.

Symptoms caused by complications include:

• black or tarry stool, or red or maroon blood mixed with your stool

• red blood in vomit or vomit that looks like coffee grounds

• sudden, sharp, or severe abdominal pain that doesn’t go away

• feeling dizzy or fainting

• a rapid pulse or other symptoms of shock

• a change in or worsening of peptic ulcer symptoms

Gastric and duodenal ulcers can be differentiated from the timing of their symptoms
in relation to meals. Nocturnal pain is common with duodenal ulcers.

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Warning symptoms or alarm symptoms that should prompt urgent referral include:

• Unintentional weight loss

• Progressive dysphagia

• Overt gastrointestinal bleeding

• Iron deficiency anemia

• Recurrent emesis

• Family history of upper gastrointestinal malignancy

2.5 RISK FACTORS

• Smoking
• H.pylori infection
• Alcohol consumption
• Old age

➢ The risk of both gastric and duodenal ulcers progressively increased with
increasing pack-years of cigarette smoking. The risk of gastric ulcer was
positively associated with the use of table salt/soy sauce.
➢ Increased gastric acid output, Helicobacter pylori, NSAIDs and stress are the
basic risk factors in peptic ulcer disease. H. pylori infection is a widely known
risk factor in peptic ulcer disease

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 Fig 6: Risk factors

2.6 COMPLICATIONS

Peptic ulcer disease (PUD) if not diagnosed and treated promptly can lead to serious
complications. Following complications can occur in PUD:

• Upper gastrointestinal bleeding

• Gastric outlet obstruction

• Perforation

• Penetration

• Gastric cancer

Acute and subacute peptic ulcers usually heal without leaving any visible scars.
Healing of chronic, larger and deeper ulcers may result in complications

1. Obstruction

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Healed duodenal ulcers cause duodenal stenosis. Healed gastric ulcers along the lesser
curvature produce ‘hourglass’ deformity due to fibrosis and contraction.

2. Haemorrhage

Minor bleeding by erosion of small blood vessel may occur. Chronic blood loss may
lead to iron deficiency anemia. Severe bleeding may cause ‘coffee ground’ vomitus or
melaena. A penetrating ulcer may erode major artery and cause a massive and severe
haematemesis and sometimes death.

3. Perforation

It is an acute abdominal emergency. Occurs more commonly in chronic duodenal

ulcer. On perforation the contents escape into the lesser sac or into peritoneal cavity
causing acute peritonitis. Perforation may extend to adjacent organs like liver,
pancreas.

4. Malignant Transformation

‘Cancers ulcerate but ulcers rarely cancerate’

A chronic duodenal ulcer never turns malignant. 1% chronic gastric ulcer may
transform into carcinoma.

2.7 GASTRIC PHYSIOLOGY

The stomach is a hollow organ that is a part of gastrointestinal system. The gastric
epithelial lining consists of gastric glands made up of highly specialized
epithelial cells. There are 2 glands namely

• Oxyntic gland- contains mucous neck cells, parietal cells, chief cells, endocrine
and enterochromaffin cells.
• Pyloric gland- contains mucous cells, endocrine cells

2.7.1 Gastro-duodenal mucosal defence

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The gastric epithelium is under a constant assault by a series of endogenous noxious
factors including HCl, pepsinogen/pepsin, and bile salts. In addition, a steady flow of
exogenous substances such as medications, alcohol, and bacteria encounter the gastric
mucosa. A highly intricate biologic system is in place to provide defence from mucosal
injury and to repair any injury that may occur. The mucosal defence system can be
envisioned as a three-level barrier, composed of pre-epithelial, epithelial, and
subepithelial elements.

Fig 7: Mucosal defence

The first line of defence is a mucus-bicarbonate layer, which serves as a

physicochemical barrier to multiple molecules including hydrogen ions. Mucus is
secreted in a regulated fashion by gastroduodenal surface epithelial cells. It consists
primarily of water (95%) and a mixture of lipids and glycoproteins. Bicarbonate,
secreted by surface epithelial cells of the gastroduodenal mucosa into the mucous gel,
forms a pH gradient ranging from 1 to 2 at the gastric luminal surface and reaching 6
to 7 along the epithelial cell surface.

Surface epithelial cells provide the next line of defense through several factors,
including mucus production, epithelial cell ionic trans- porters that maintain
intracellular pH and bicarbonate production, and intracellular tight junctions. If the
pre-epithelial barrier is breached, gastric epithelial cells bordering a site of injury can
migrate to restore damaged region (restitution). Several growth factors including

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epidermal growth factor (EGF), transforming growth factor (TGF), and basic
fibroblast growth factor (FGF) modulate the process of restitution.

An elaborate microvascular system within the gastric submucosal layer is the key
component of the subepithelial defense/repair system. A rich submucosal circulatory
bed provides HCO3, which neutralizes the acid generated by parietal cell
secretion of HCl. Prostaglandins play a central role in gastric epithelial defense/repair.
The gastric mucosa contains abundant levels of prostaglandins.

2.7.2 Gastric Secretions

The oxyntic gland contains 3 cells namely mucous neck cells which secrete mucous;
chief cells which secrete large quantities of pepsinogen; parietal cells which secrete
hydrochloric acid and intrinsic factor.

2.7.3 Mechanism of HCl production

Hydrochloric acid and pepsinogen are the two principal gastric secretory products
capable of inducing mucosal injury. When stimulated, the parietal cells secrete an acid
solution that contains about 160 mmol/L of hydrochloric acid, which is nearly isotonic
with the body fluids. The pH of this acid is about 0.8, demonstrating
its extreme acidity. The hydrochloric acid is formed at the villus-like projections inside
the canaliculi and is then conducted through the canaliculi to the secretory end of the
cell.

The main driving force for hydrochloric acid secretion by the parietal cells is a
hydrogen-potassium pump (H+-K+ adenosine triphosphatase [ATPase]).

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 Fig 8: Mechanism of HCl secretion

• Water inside the parietal cell becomes dissociated into H+ and hydroxide
(OH−) in the cell cytoplasm. The H+ is then actively secreted into the
canaliculus in exchange for K+, an active exchange process that is catalyzed
by H+-K+ ATPase. Potassium ions transported into the cell by the sodium
Na+-K+ ATPase pump on the basolateral (extracellular) side of the membrane
tend to leak into the lumen but are recycled back into the cell by the H+-K+
ATPase. The basolateral Na+-K+ ATPase creates low intracellular Na+, which
contributes to Na+ reabsorption from the lumen of the canaliculus. Thus, most
of the K+ and Na+ in the canaliculus is reabsorbed into the cell cytoplasm, and
hydrogen ions take their place in the canaliculus.
• The pumping of H+ out of the cell by the H+-K+ ATPase permits OH− to
accumulate and form bicarbonate (HCO3 −) from CO2, either formed during
metabolism in the cell or while entering the cell from the blood. This reaction
is catalyzed by carbonic anhydrase. The HCO3 − is then transported across the
basolateral membrane into the extracellular fluid in exchange for chloride ions,
which enter the cell and are secreted through chloride channels into the
canaliculus, giving a strong solution of hydrochloric acid in the canaliculus.
The hydrochloric acid is then secreted outward through the open end of the
canaliculus into the lumen of the gland.
• Water passes into the canaliculus by osmosis because of extra ions secreted
into the canaliculus. Thus, the final secretion from the canaliculus contains
water, hydrochloric acid at a concentration of about 150 to 160 mEq/L,

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 potassium chloride at a concentration of 15 mEq/L, and a small amount of
sodium chloride

2.7.4 Stimulation of Gastric secretion

Acetylcholine released by parasympathetic stimulation excites secretion of pepsinogen

by peptic cells, hydrochloric acid by parietal cells, and mucus by mucous cells. In
comparison, both gastrin and histamine strongly stimulate secretion of acid by parietal
cells.

2.7.5 Phases of Gastric secretion

Gastric secretion occurs in three phases: a cephalic phase, a gastric phase, and an
intestinal phase.

Fig 9: Phases of gastric secretion

• Cephalic Phase. The cephalic phase of gastric secretion occurs even before
food enters the stomach, especially while it is being eaten. It results from the
sight, smell, thought, or taste of food, and the greater the appetite, the more
intense is the stimulation. Neurogenic signals that cause the cephalic phase of
gastric secretion originate in the cerebral cortex and in the appetite centers of
the amygdala and hypothalamus. They are transmitted through the dorsal motor
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 nuclei of the vagi and thence through the vagus nerves to the stomach. This
phase of secretion normally accounts for about 30 percent of the gastric
secretion associated with eating a meal.
• Gastric Phase. Once food enters the stomach, it excites (1) long vagovagal
reflexes from the stomach to the brain and back to the stomach, (2) local enteric
reflexes, and (3) the gastrin mechanism, all of which cause secretion of gastric
juice during several hours while food remains in the stomach. The gastric phase
of secretion accounts for about 60 percent of the total gastric
secretion associated with eating a meal.
• Intestinal Phase. The presence of food in the upper portion of the small
intestine, particularly in the duodenum, will continue to cause stomach
secretion of small amounts of gastric juice, probably partly because of small
amounts of gastrin released by the duodenal mucosa. This secretion accounts
for about 10 percent of the acid response to a meal.

2.8 PATHOPHYSIOLOGY

The dominant aggressors are strong acid and high proteolytic (pepsin) activity in
gastric secretions. The dominant defensors are the phospholipid surfactant layer,
covering the mucus bicarbonate gel, the mucus bicarbonate layer covering the
epithelium, the tight junctional structures between the epithelial cells, restricting
proton permeability, and the epithelial trefoil peptides, contributing to healing after
injury.

2.8.1 H. pylori

H. pylori infection can result in either hypochlorhydria or hyperchlorhydria, thus

determining the type of peptic ulcer. The organism has a wide spectrum of virulence
factors allowing it to adhere to and inflame the gastric mucosa. This results in
hypochlorhydria or achlorhydria, leading to gastric ulceration.

Virulence Factors of Helicobacter Pylori

1. Urease: The secretion of urease breaks down urea into ammonia and protects
the organism by neutralizing the acidic gastric environment.

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 2. Toxins: CagA/VacA is associated with stomach mucosal inflammation and
host tissue damage.

3. Flagella: Provides motility and allows movement toward the gastric

epithelium.

Fig 10: H. pylori virulence factors

H. pylori multiply in the mucus layer of the stomach lining and duodenum. The
bacteria secrete an enzyme called urease that converts urea to ammonia. This ammonia
protects the bacteria from stomach acid. As H. pylori multiply, it eats into stomach
tissue, which leads to gastric ulcer.

The main mediators of H. pylori infection are cytokines that inhibit parietal cell
secretion, but H. pylori can directly affect the H+/K+ ATPase α-subunit, activate
calcitonin gene-related peptide (CGRP) sensory neurons linked to somatostatin, or
inhibit the production of gastrin. Although the formation of gastric ulcers is associated
with hyposecretion, 10–15% of patients with H. pylori infection have increased gastric
secretion caused by hypergastrinemia and reduced antral somatostatin content. This
leads to increased histamine secretion, and subsequently the increased secretion of acid
or pepsin from parietal and gastric cells.

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 Fig 11: H.pylori pathogenesis

2.8.2 NSAID- Associated

The main mechanism of NSAID-associated damage of the gastroduodenal mucosa is

the systemic inhibition of constitutively expressed cyclooxygenase-1 (COX-1), which
is responsible for prostaglandin synthesis, and is associated with decreased mucosal
blood flow, low mucus and bicarbonate secretion, and the inhibition of cell
proliferation. NSAIDs inhibit the enzyme reversibly in a concentration-dependent
manner. The co-administration of exogenous prostaglandins and cyclooxygenase-2
(COX-2)-selective NSAIDs use reduces mucosal damage and the risk of ulcers.
However, the different physicochemical properties of NSAIDs cause differences in
their toxicity. NSAIDs disrupt mucus phospholipids and lead to the uncoupling of
mitochondrial oxidative phosphorylation, thus initiating mucosal damage. When
exposed to acidic gastric juice (pH 2), NSAIDs become protonated and cross lipid
membranes to enter epithelial cells (pH 7.4), where they ionize and release H+. In that
form, NSAIDs cannot cross the lipid membrane, and are trapped in epithelial cells,
29
leading to the uncoupling of oxidative phosphorylation, decreased mitochondrial
energy production, increased cellular permeability, and reduced cellular integrity.

Fig 12: Pathophysiology of NSAIDs

2.9 HISTOPATHOLOGY

Gross and microscopic changes in gastric and duodenal ulcers are similar. Gastric
ulcers are most commonly located on the lesser curvature in the region of pyloric
antrum in posterior than anterior wall, whereas duodenal ulcers are found in first part
of the duodenum, more common on anterior than posterior wall.

2.9.1 Gross Features

Typical peptic ulcers are usually solitary, small (1-2.5 cm in diameter), round to oval
with a smooth base and characteristically punched out.

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 Fig 13: Gross appearance

2.9.2 Microscopic features

Acute ulcers have regular borders, while chronic ulcers have elevated borders with
inflammation. Inflammatory debris on the epithelial surface is often present. In the
submucosa, fibrosis and thickened blood vessels are present. H. pylori, a spiral-shaped
bacterium, can be seen in hematoxylin and eosin (H&E) staining.

Microscopically, peptic ulcers have 4 histological zones

• Necrotic Zone

Lies in the floor of the ulcer. It consists of fibrous exudate containing necrotic debris
and a few leucocytes.

• Superficial exudative zone

Lies underneath the necrotic zone. The tissues in this zone exhibit coagulative necrosis
which gives eosinophilic, smudgy appearance with nuclear debris.

• Granulation tissue zone

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It is seen merging into the necrotic zone. It is composed of nonspecific inflammatory
infiltrate and proliferating capillaries.

• Zone of cicatrisation

It is found to be merging into thick layer of granulation tissue. It is composed of dense

fibro-collagenic scar tissue over which granulation tissue rests. Thrombosed or
sclerotic arteries may cross the ulcer which on erosion may result in haemorrhage.

Fig 14: Microscopic Features

2.10 DIFFERENTIAL DIAGNOSIS

The following conditions can present with symptoms similar to peptic ulcer disease
and it is important to be familiar with their clinical presentation in order to make the
correct diagnosis.

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 • Gastritis - an inflammatory process of the gastric mucosa from immune-
mediated or infectious etiology presenting with upper abdominal pain and
nausea. Clinical presentation is very similar to that of peptic ulcer disease.

• Gastroesophageal reflux disease (GERD) - patients usually describe a burning

sensation in the epigastrium and lower retrosternal area, excessive salivation,
or intermittent regurgitation of food material.

• Gastric cancer - apart from abdominal pain, alarm symptoms like weight loss,
melena, recurrent vomiting, or evidence of malignancy elsewhere in case of
metastasis.

• Pancreatitis - epigastric or right upper quadrant pain that is more persistent and
severe, worse in the supine position, and patients usually have a history of
alcoholism or gallstones. Elevated serum amylase and lipase are useful in the
diagnosis.

• Biliary colic - intermittent, severe deep pain in the right upper quadrant or
epigastrium precipitated by fatty meals.

• Cholecystitis - right upper quadrant or epigastric pain that usually lasts for
hours and is exacerbated by fatty meals and is associated with nausea and
vomiting. Fever, tachycardia, positive Murphy sign, leukocytosis, and
abnormal liver functions help further distinguish this from biliary colic.

These are some potentially life-threatening conditions that can also have similar
presentations.

• Myocardial infarction - especially in the inferior wall and right ventricular

involvement, sometimes patients can present with epigastric pain with nausea
and vomiting. The presence of other symptoms like dizziness, shortness of
breath, and abnormal vital signs in a high-risk patient should alert the clinician
to look for this.

• Mesenteric ischemia - while acute mesenteric ischemia presents with severe,

acute onset abdominal pain; the chronic variant usually presents with ongoing
post-prandial epigastric pain and can be mistaken for peptic ulcer disease.

33
 Older age, presence of risk factors for atherosclerosis, and weight loss should
prompt a workup for the same.

• Mesenteric vasculitis - unexplained abdominal symptoms with or without

lower gastrointestinal bleeding in a patient with other features from underlying
systemic vasculitis should raise the suspicion of mesenteric vasculitis.

2.11 CONVENTIONAL DIAGNOSIS

Diagnosis of PUD requires history taking, physical examination, and invasive/non-

invasive medical tests. A careful history should be obtained and noted for the presence
of any complications. Patient reporting of epigastric abdominal pain, early satiety, and
fullness following a meal raise suspicion of PUD. The pain of gastric ulcers increases
2 to 3 hours after a meal and may result in weight loss, whereas the pain of duodenal
ulcers decreases with a meal which can result in weight gain. Any patient presenting
with anemia, melena, hematemesis, or weight loss should be further investigated for
complications of PUD, predominantly bleeding, perforation, or cancer. A physical
exam may reveal epigastric abdominal tenderness and signs of anemia.

2.11.1 Investigations

1. Esophagogastroduodenoscopy (EGD)

2. Barium swallow: It is indicated when EGD is contraindicated.

3. Complete blood work, liver function, and levels of amylase and lipase.

4. Serum gastric is ordered if Zollinger Ellison syndrome is suspected.

5. Helicobacter pylori testing:

• Serologic testing

• Urea breath test

• Antibodies to H.pylori can be measured.

• Stool antigen test

• Urine-based ELISA and rapid urine test

• Endoscopic biopsy
34
 6. Computerized tomography of the abdomen with contrast is of limited value in
the diagnosis of PUD itself but is helpful in the diagnosis of its complications
like perforation and gastric outlet obstruction.

2.11.2 Esophagogastroduodenoscopy (EGD)

It is the Gold standard and most accurate diagnostic test in diagnosing gastric and
duodenal ulcers. During the procedure, a flexible tube called endoscope is inserted
through the mouth into the esophagus, stomach and duodenum. The end of the
endoscope has a light, camera and special tools. This helps in visualizing the lining of
these organs and identify the ulcers.

Fig 15: Endoscopy

2.11.3 Endoscopic Biopsy

Culture is not generally recommended as it is expensive, time-consuming, and

invasive. Biopsies from at least 4-6 sites are necessary to increase sensitivity. If the
presence of ulcer is detected, the special tool at the end of the endoscope helps in
collecting a small tissue sample which is called as biopsy. The tissue sample will then

35
be tested in the laboratory for Helicobacter pylori bacteria. Gastric ulcers are
commonly located on the lesser curvature between the antrum and fundus. The
majority of duodenal ulcers are located in the first part of the duodenum.

2.11.4 Barium Swallow

Barium swallow is the specialized X-ray procedure for detecting the abnormalities.
During the procedure a contrast solution called barium is to be swallowed as the
barium coats the gastrointestinal tract making it easier for the diagnosis of the
abnormalities.

Fig 16: Barium Swallow

2.11.5 Urea Breath Test

It has high sensitivity and specificity. It is used for detecting H,pylori bacteria. The H.
pylori bacteria secretes urease. The secretion of urease breaks down urea into ammonia
and protects the organism by neutralizing the acidic gastric environment.

By the urease activity of H. pylori, the 13C- or 14C-labeled urea ingested by the patient
is hydrolysed to labelled CO2 in stomach, then labelled CO2 is absorbed in the blood
and exhaled by breathing in which labelled CO2 can be measured. If the measured
36
breath detects the labelled carbon atoms, then the presence of H. pylori bacteria is
confirmed.

Fig 17: Urea Breath Test

2.12 CONVENTIONAL MANAGEMENT

2.12.1 Medical Treatment

The goal of treatment and management of peptic ulcer is first to increase the gastric
pH and allowing the gastric mucosa to heal, which is possible through
administering proton pump inhibitors, such as pantoprazole followed by an EGD
which should be the next consideration. Alarm symptoms should be recognized, which
would make the need for an EGD more urgent. Alarm symptoms include unintentional
weight loss, bleeding, age over 50, nausea, and vomiting. If a gastric ulcer is present
on EGD, biopsies of the mucosa surrounding the ulcer will be necessary to rule out
gastritis, Helicobacter pylori infection, and malignancy. These patients need to be on
PPI therapy twice daily for 8 weeks and then undergo a repeat endoscopy to confirm
for healing.

The treatment plan of duodenal ulcers is developed initially based on the degree of
disease noted at the time of diagnosis. Majority of patients are treated with
antisecretory agents to help reduce the amount of acid exposure to the ulcerated region
37
and, in turn, provide symptomatic relief and promote healing. Smoking and alcohol
cessation is also encouraged, as these may also exacerbate symptoms.

Antisecretory drugs used for peptic ulcer disease (PUD) include H2-receptor
antagonists and the proton pump inhibitor (PPIs). PPIs have largely replaced H2
receptor blockers due to their superior healing and efficacy. PPIs block acid production
in the stomach, providing relief of symptoms and promote healing. Treatment may be
incorporated with calcium supplements as long-term use of the PPIs can increase the
risk of bone fractures.

Fig 18: Action of PPI

For patients who present with a history of heavy NSAID use, the first step is to advise
patients to avoid NSAID use as this is not only a possible etiology but also a cause of
worsening symptoms. NSAIDs induced PUD can be treated by stopping the use of
NSAIDs or switching to a lower dose. Corticosteroids, bisphosphonates, and
anticoagulants should also be discontinued if possible. Prostaglandin analogs
(misoprostol) are sometimes used as prophylaxis for NSAID-induced peptic ulcers.
First-line treatment for H. pylori-induced PUD is a triple regimen comprising two
antibiotics and a proton pump inhibitor. Pantoprazole, clarithromycin, and
metronidazole, or amoxicillin are used for 7 to 14 days. Antibiotics and PPIs work
synergistically to eradicate H. pylori. The antibiotic selected should take into
consideration the presence of antibiotic resistance in the environment. If first-line
therapy fails, quadruple therapy with bismuth and different antibiotics is used.

38
2.12.2 Surgical Treatment

Surgical treatment is indicated if the patient is unresponsive to medical treatment,

noncompliant, or at high risk of complications such as perforation or bleeding, may
require surgical intervention. A refractory peptic ulcer is one over 5 mm in diameter
that does not heal despite 8-12 weeks of PPI therapy. The common causes are
persistent H.pylori infection, continued use of NSAIDs, or significant comorbidities
that impair ulcer healing or other conditions like gastrinomas or gastric cancer. If the
ulcer persists despite addressing the above risk factors, surgical treatment is necessary.
Surgical options include vagotomy or partial gastrectomy.

2.13 DISEASE PROGNOSIS

The prognosis of peptic ulcer disease (PUD) is excellent after the underlying cause is
successfully treated. Recurrence of the ulcer may be prevented by maintaining good
hygiene and avoiding alcohol, smoking, and NSAIDs.

3. NATUROPATHIC AND YOGIC

MANAGEMENT OF DISEASE
3.1 NATUROPATHIC DIAGNOSIS

3.1.1 Tongue Diagnosis

TCM (Traditional Chinese Medicine) uses inspection of tongue as one of the

diagnostic methods. The inspection of tongue manifestation plays a routine assessment
and critical reference basis for TCM dialectics. Examination is based on the changes
of tongue fur, shape, size, color, texture of the tongue body, and sublingual veins,
whose exterior signs provide useful information to understand the patients' physiologic
status inside the body (helps to reveal the state of organ functions and progression of
condition). Tongue fur is a layer of moss-like materials coated on the tongue surface,
formed by stomach-qi according to TCM theory. The manifestation of tongue fur is a
critical index for diagnosis of GI problems.

39
 Fig 19: Tongue Map

Presence of white-slimy or yellow fur indicates increased H.pylori infection as

compared with white-thin fur. Red or purple color tongue indicates increased
susceptibility to H.pylori infection than light white or light red color. In Duodenal
Ulcer, a light red color in the tongue body with white-thin fur can be seen. In Gastric
Ulcer, red tongue with yellow-slimy fur can be seen. During the active stage of PUD,
the tongue is described as red in color with slimy fur. During the healing stage of PUD,
the tongue is described as white or light red color with white-thin, yellow-thin, or
white-slimy fur.

3.1.2 Facial Diagnosis

Facial diagnosis is the ability to determine the physical status of the person from
external appearance. By this facial diagnosis it is possible to discover the amount and
location of the body, foreign to its normal condition.

40
 Fig 20: Facial Diagnosis

There is no abnormal condition of any part of the body, which can affect that part
alone. The least deviation from the normal condition of the health, inevitably produces
a change in the form, carriage, coloring, etc. of the individual.

An encumbered body functions differently from a healthy body in every aspect.

Consequently, a person’s condition is easily determined from the manner of action.

If the stomach is weakened by deposits, then even the healthful food can no longer be
properly digested. The substances thus insufficiently assimilated are, in turn, deposited
as poisonous accumulations.

Foul matter also enters the body through the lungs and skin, but, as long as digestion
remains unimpaired, there will usually be sufficient vitality to throw this off.
Sometimes nature constructs artificial sewers for the removal of effete matter, such as
open sores, hemorrhoids, fistulas, foot-sweat, etc. Though the body, as a whole, may
appear in fair health, the presence of any one of these is a sure indication that the
system is heavily encumbered. And, should theses sewers be suddenly closed. This is
usually accompanied by considerable swelling, inflammation and even ulcerations.

41
Encumbrance is of 3 kinds such as front, side and back encumbrances. In case of peptic
ulcers, front encumbrance may be seen such as bloated abdomen.

3.1.3. Iris Diagnosis

Iridology (also referred as Iridodiagnosis or Iridiagnosis) is the science and practice

that can reveal the presence of inflammation, accumulation of toxins in the tissue, the
gland dam, including the location and condition severity (acute, subacute, chronic, and
degenerative) through reading patterns, colors, and other characteristics or signs that
is visible in the iris of the eye.

In the basic concepts of Iridology, iris consists of 28,000 nerve fibers linked to the
brain through the nerves that nourish the eye, the optic nerves, and autonomic nerves
that pass from the brain to the organs of the body. In case of organ malfunctioning, the
information will be sent to the brain as the center of information through the autonomic
nervous control. The signal will be transmitted from brain to the optic nerve through
the iris of the eye, to form a pattern, color, or certain characteristics in the iris. Thus, a
biometric technology based on iris recognition can be used to assist the identification
purposes. In peptic ulcer, there is increased gastric acid secretion. Hence, a change is
seen in the stomach region of the iris.

Fig 21: Diagnosis in Iris

42
3.2 NATUROPATHY DEFINITION AND CONCEPT OF
DISEASE

Nature cure is the system of building the entire being in harmony with constructive
principle of Nature on the physical, mental, moral and spiritual planes of being.

3.2.1 CONCEPT OF DISEASE

Disease is an abnormal or inharmonious vibration of the elements and forces

composing the human entity on one or more planes of being, in conformity with the
destructive principle of Nature applied to individual life.

3.2.2 NATUROPATHIC UNDERSTANDING OF DISEASE

Naturopathy is a holistic treatment. Gastrointestinal system has an essential role on the

overall health of the body. Any disturbances in the gut affects the any parts of the body.
Lifestyle changes such as smoking, alcohol, improper food habits, etc leads to lowered
vitality due to which there is decreased blood flow causing abnormal composition of
blood and lymph which leads to impaired digestion leading to accumulation of morbid
matters which leads to infection. Infection then leads to ulcer formation.

According to germ theory, the bacteria do not affect our body until our body is healthy
with good immune system. The imbalances in our body such as accumulation of
morbid matters paves the way for the bacteria to grow, multiply and affect our body.

The present understanding of ulcers is that excessive hydrochloric acid (HCL)

secretion erodes the membranes lining the esophagus, stomach, and duodenum.
Naturopathic medicine attributes this ulceration to the abuse at various levels like
eating, drinking, smoking, sex and emotions. Right food, water consumption, frequent
changes of mucosal layer and bile regurgitation are seen as the four natural protections
provided to the stomach lining. When all these mechanisms get altered or fail, it results
in acidity or ulcers.

HCL secretion is a normal phenomenon in digestion and hence this cannot be termed
as the cause of ulcers. There may be excess secretion of HCL owing to some temporary
causes but this will only give rise to discomfort and distress but not ulcers.

43
The acids of decomposition resulting from overeating and eating wrong combination
of food complicate and cause gastric and duodenal ulcer. Preliminary to the ulcer, there
exists a persistent inflammation, which is followed by hardening of that surface and
subsequent tissue breakdown. The increased hardening blocks arterial circulation and
terminates oxygen supply to that area, which breaks down the tissues and give rise to
open sores or ulcer. This phenomenon, if not remedied by proper lifestyle changes, can
eventually result in cancer.

Fig 22: Naturopathic approach in Peptic ulcer

44
3.3 YOGA DEFINITION AND CONCEPT OF DISEASE

According to Maharishi Patanjali- ‘Yoga is the cessation of modification of mind’

International Association of Yoga Therapists (IAYT) defines Yoga as ‘the power of

empowering individuals to progress towards improved health and well-being through
the application of teachings and practice of yoga.’

3.3.2 CONCEPT OF DISEASE

❖ Patanjali Yoga Sutras

In Samadhi pada of the yoga sutras, a total of 13 obstacles in the path of Samadhi
(antarayas) are described. Vyadhi or disease is one of them.

In sadhana pada Five kleshas or afflictions are described. They are said to be the root
of mental illnesses. They include ignorance (avidya), ego (asmita), desire (raga),
aversion (dvesha) and fear of death (abhinivesha). Among these, ignorance
(AVIDYA) is the root of all other afflictions.
According to Yoga Vasista,
❖ The yoga vashishta is a treatise on yoga that contains the teachings of sage
Vashishta to Lord Rama. In this text, the concept of disease is explained as
follows:

In the Anandamayakosha (bliss body), an individual is healthiest with perfect harmony

and balance. In the Vijnanamayakosha (intellectual body), there are movements but
channelized in the right direction. Imbalances start in the Manomayakosha (emotional
body). It is the root of all diseases. These mental imbalances arise due to avidya or
ignorance. This leads to an imbalance in the thought process called as Adhi.

The physical manifestation of the adhis occur in three forms:

•Ajeernatva: indigestion or decreased activity of digestive tract
•Atijeernatva: excessive functioning of the digestive tract.
• Kujeernatva: abnormal functioning of the digestive tract.

The adhis manifest themselves as physical disease called as vyadhi. Vyadhi is of 2

types
• Adhijavyadhi: stress-borne psychosomatic illness.
Sara adhijavyadhi: Influenced by heredity. They are congenital disorders. This
can only be destroyed by realizing the subtle states of mind or attaining
Samadhi. In that state, man transcends the cycle of birth and death.
Samanyaadhijavyadhi: These are not inherited.

45
• Anadhijavyadhi: somatic ailments like injury, infection, toxin etc. They are not
stress-borne. The causes are external.

Fig 23: Yogic concept of Disease

46
3.3.3. YOGIC UNDERSTANDING OF PEPTIC ULCER

Yoga is the science and art of healthy living physically, mentally, morally and
spiritually. “Yoga” means “to integrate”. The integration of physical, mental and
spiritual energies of the health and well-being is yoga. The main aim of yoga is made
balance between the body and the mind. According to yogic concepts, the disease
occurs due to Avidya (Ignorance) which is the root cause. So the root cause of peptic
ulcer is lifestyle changes. Under the classifications of vyadhi it comes under samanya
adhija vuadhi being thepsychosomatic disorder.

4. METHODOLOGY
4.1 SELECTION OF PARTICIPANTS

Case 1 from SLNS Nature Cure Hospital, Telangana

Cases 2 and 3 from Nisarga Mane, Sirsi

Cases 4 and 5 from Nirvana Hospital & Retreat, Nashik

4.2 DATE AND PERIOD OF DATA COLLECTION

CASE 1: 02.08.2023

CASE 2: 10.11.2023

CASE 3: 19.12.2023

CASE 4: 12.03.2024

CASE 5: 13.04.2024

4.3 DURATION OF INTERVENTION

CASE 1: 10 Days

CASE 2: 10 Days

CASE 3: 7 Days

CASE 4: 7 Days

CASE 5: 7 Days

47
5. NATUROPATHY TREATMENTS AND YOGA
5.1 HYDROTHERAPY

Hydrotherapy is the external or internal use of water in any of its forms (water, ice,
steam) for promotion of health or treatment of various diseases with various
temperatures, pressure, duration, and site. It is one of the naturopathic treatment
modalities. Water has different physiological/therapeutic effects on different part of
the system for maintaining health, preventing, and treating the diseases. Hydrotherapy
is an essential part of prescription in treating gastrointestinal disorders. Use of
hydrotherapy in the form of packs and compresses such as cold abdominal pack have
tremendous effects in reduction of peptic ulcer size and enhanced resistance to stressful
factors. Hydrotherapy helps to reduce epigastric pain and heartburn by enhancing the
digestive functions.

Gastro-Hepatic Pack

Fomentation is placed anteriorly and ice bag placed on lumbar spine. This pack helps
to mitigate congestion over the abdominal area, which is the main reason for
inflammation. As there are hot and cold applications, the mechanism of action occurs
by derivative and reflex effects.

Alternate Hot and Cold Hip Bath

The switching of temperatures constricts and dilates the blood vessels which increases
the circulation. Increase in blood flow leads to increased oxygen supply which helps
in improving the healing process.

Cold Abdomen Pack

It consists of cotton cloth dipped in cold water and wrung out which is then wrapped
on abdomen. A dry woollen cloth is wrapped over the cotton cloth. It acts through
prostaglandins to induce epithelial cell proliferation of the mucosal layer.

Revulsive Compress

An alternate hot and cold compress applied on abdomen. Hot compress is placed for
the duration of 4 to 5 mins which is followed by the cold compress for 30 to 60 seconds.

48
It is helpful to reduce the pain due to atonic and tonic action of hot and cold
respectively.

5.2 MUD THERAPY

Mud is one of five elements of nature having immense impact on the body in health as
well as disease. Mud has the ability to heal the body from inside and outside by
correcting the imbalance. Mud contains lot of essential minerals that help in filtering
toxins from the body.

The application of mud pack makes abdominal part more active that increases the
circulation and removes dirt and debris. It influences prostaglandins and leukotrienes
which prevent unwanted aggregation of platelets which is beneficial in treating ulcers.
Mud also helps in reduction in the circulating levels of interleukin-1β (IL-1β) and
tumour necrosis factor-α (TNF-α), which are important mediators of inflammation and
pain.

5.3 MASSAGE

Massage or systemic rubbing and manipulation of the tissues of the body which is used
for the bodily infirmities. It is a great technique for relaxation, pain relief, easing
muscle tension, etc.

Through partial massage to abdomen, the organs of the abdomen get more blood
supply and morbid matter localized in that part is removed. Oil applied to the abdomen
is absorbed into the whole skin of the abdomen which in turn is connected with the
nerve fibers of that area. So, the nervous system calms and creates the regulation of all
functions related with the abdominal organs which helps in reducing the acid secretion.

Massage also helps in improving appetite by general improvement in nutrition

occasioned by removal of waste and the acceleration of blood and lymph circulations.

5.4 ACUPUNCTURE

Acupuncture is a system of medical treatment and ideology based on the principle of

applying small needles or pressure to specific points in the body. The origins of this
treatment system are grounded in traditional Chinese medicine (TCM), with
underlying philosophical principles associated with Confucianism and Taoism. Under

49
this ideology, health stems from the alignment of qi, which means “vital energy” and
encompasses the yin/yang dichotomy that flows through all of the physical worlds.
Five elements are the foundation of this theory of qi: wood, water, fire, earth, and
metal. A blockage or excess of any disrupts this vital energy. Acupuncture aims to
open the blockage or reduce the excess of qi flowing through specific channels in the
body, known as meridians. Balancing the qi restores the interconnectedness, thus
restoring wellness.

Acupuncture has the potential to alleviate gastrointestinal symptoms, including

stomach pain, bloating and belching. It benefits in enhancing the psychological well-
being of individuals diagnosed with gastric ulcer, alleviating discomfort caused by
medication, and promoting the healing of the gastric mucosa. Acupuncture reduces
disease activity and inflammation by increasing vagal activity.

Acupuncture for gastric ulcers should be treated based on syndrome differentiation and
the application of specific points should be stressed. Acupoints of choice
were Zusanli (ST36), Zhongwan (CV12), Neiguan (PC6) and Sanyinjiao (SP6). The
common syndrome types of gastric ulcers include stomach disorders due to liver Qi,
deficient cold of the spleen and stomach, static blood in stomach collaterals, and
stomach-yin deficiency, and the acupoints selected are Taichong (LR3), Guanyuan
(CV4), Xuehai (SP10) and Taixi (KI3).

CAUSES ACUPUNCTURE POINTS

Cold in the spleen and stomach UB 21, UB 20, P 6

Qi stagnation and blood stasis UB 21, UB 20, P 6, UB 17

Liver Qi invading the stomach P 6, Liv 3

Weakness of spleen and stomach UB 21, UB 20

Cold in the stomach UB 21, UB 20, P 6, SP 4

50
 Yin deficiency in stomach UB 21, UB 20, P 6, SP 6

Table 2: Acupuncture points for Peptic ulcer

ST 36, CV 12, PC 6 help in relieving nausea, and vomiting, promote gastric emptying,
relieve dyspepsia symptoms and improve the quality of life of patients.

ST 25, ST 36: Improve gastric mucosal blood flow and regulate somatostatin

UB 21: Back shu point for stomach

LI 4: Analgesic point

Fig 24: Acupuncture points for Peptic ulcer

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5.5 HELIOTHERAPY

Heliotherapy is the use of sunlight for therapeutic purposes by exposing the body to
sunlight. It prevents disease by bringing the body to its state of maximum resistance,
so that it can ward off infection. It cures infections, once they are established, by
summoning all the body's protective forces to the front. Heliotherapy is a treatment
modality with high anti-inflammatory effects. Oxidative stress is involved in the
pathogenesis of peptic ulcer. Sunlight stimulates the body to produce vitamin D. the
active form of vitamin D is vitamin D3 which counteracts the intracellular death and
improve epithelial regeneration. Hence, sun exposure for 15-20 mins is beneficial for
the management for peptic ulcers.

5.6 CHROMOTHERAPY

Chromotherapy is a method of treatment that uses the visible spectrum (colours) of

electromagnetic radiation to cure diseases.

Light is energy, and the phenomenon of color is the product of interaction of the energy
and matter. The wavelength, frequency and quantity of energy of every colourful ray
are fixed for each color; that is, a specific wavelength, a certain frequency and a
particular amount of energy in that wave have been denominated as a distinct color.

According to the doctrine of chromotherapy, the human body is basically composed

of colors. The body comes into existence from colors, the body is stimulated by colors
and colors are responsible for the correct working of various systems that function in
the body. All organs and limbs of the body have their own distinct color. Each of our
organs and energy centers vibrates and harmonizes with the frequencies of these
colors. When various parts of the body deviate from these expected normal vibrations,
the body is either diseased or at least not functioning properly. The vibratory rates
inherent in the vibrational technique (chromotherapy) are such that they balance the
diseased energy pattern found in the body. For in every organ there is an energetic
level at which the organ functions best. Restoring the appropriate energy levels to the
physical organs results in a healed body.

Chromotherapy is a narrow band in the cosmic electromagnetic energy spectrum,

known to humankind as the visible color spectrum. It is composed of reds, greens,
blues and their combined derivatives, producing the perceivable colors that fall
52
between the ultraviolet and the infrared ranges of energy or vibrations. Colors generate
electrical impulses and magnetic currents or fields of energy that are prime activators
of the biochemical and hormonal processes in the human body, the stimulants or
sedatives necessary to balance the entire system and its organs. The quantum
mechanical dipole moment as a result of the absorption of different colors, produces
charge quantization phenomena.

It can be given from chromothermoleum or charged water (3/4 th water filled in a glass
bottle of desired colour and keep it in sunlight for at least 3 hours between 10 a.m and
3 p.m). Indigo and green color can be given. Green color restores the balance in the
body. The colors can be kept in the abdomen area through filters, charged water or
chromothermoleum.

5.7 AROMA THERAPY

Fig 25: Aroma Therapy

It is a powerful healing art that has profound effect on both body and mind.
Aromatherapy makes use of the essential oils, which are extracted from the plants.
Essential oil can therefore be absorbed either through the sense of smell or if massaged
into the body then through the pores of the skin. Essential oils are highly volatile,
evaporating readily on exposure to air and when inhaled may enter the body. When
diluted and applied externally, essential oil molecules enter the skin. All essential oils
appear to be antiseptic and bactericidal. These essential oils have the potential to
stimulate healthy cell renewal and growth and to regulate and restore balance to mind.

53
Essential oils have therapeutic effect on the body as they are analgesic; antifungal;
anti-inflammatory; antioxidant; antiseptic; anti-spasmodic; antiviral; carminative;
digestive; diuretic; expectorant; hepatic; laxative hypertensive and hypotensive;
sedative; stimulant; toning, etc. Essential oils restore balance to the emotions and
mind. It soothes nervous tension and settle a worried mind, calms anxiety and
apprehension. Essential oils are absorbed by the body through massage or
hydrotherapy. They penetrate the skin and the lining of the lungs to be carried around
the body in the blood. Citronella helps in curing digestive troubles. Clary sage relives
stress, tension, and eases pain. Fennel helps in indigestion. Ginger and Grapefruit
increase circulation and stimulate appetite. Lavender balances emotion and helps in
relieving stress and tension.

5.8 DIET THERAPY

Diet and Health are the two sides of same coin. Diet therapy is concerned with the
modification of the normal diet to meet the requirements of the sick individual. Diet is
used for therapeutic purpose because of the presence of nutrients, chemical substances
which act as antioxidants, detoxifying agents or suppressing agents, maintain proper
intestinal flora and to improve immunity. The role of diet therapy is to promote healing
and repair the damaged tissues. Diet therapy plays a key role in the prevention and
treatment of Peptic ulcer, with the main purpose of recovering and protecting the
gastrointestinal lining, improving digestion, relieving pain, and contributing to a
satisfactory nutritional status.

A bland diet is suggested for peptic ulcer. Bland diet is a diet which is mechanically,
chemically, and thermally non-irritating. Bland diet prevents irritation to the mucosa,
avoids increase in acidity and aids in control of pain. Mechanically irritating foods
include those with indigestible carbohydrate, such as whole grains and most raw fruits
and vegetables. Foods that are chemically irritating because of their stimulatory effect
on gastric secretion include extractives, caffeine, alcohol, and some spicy foods. The
capsaicin present in chillies cause shedding of surface stomach cells and may cause
peptic distress. Foods believed to be thermally irritating are those ordinally served at
extremes of temperatures, such as very hot or iced liquids which may cause pain.

54
Characteristics Recommendations

Sufficient to maintain or recover the nutritional status 20-25

Daily energy needs
Kcal/Kg: weight loss 25-30 Kcal/Kg: maintenance 30-35
(DEN)
Kcal/Kg: weight gain31

Acute phase Recovery phase

Carbohydrate (%)29 50-60 50-60

Protein
1.2 1.5
(g/Kg/weight)29

Lipid (%)18,29 25-30 25-30

Zinc (mg)13 11 40

Selenium (μg)20 55 400

Vitamin A (μg)113 900 3000

Vitamin C (mg)13 75 500

Vitamin B¹² (μg)13 2.4 2.4

Folic acid (μg)13 400 400

55
 Characteristics Recommendations

Iron (mg)13 45 45

Fibers (g)13 20 to 30 20 to 30

Probiotics
18
109 to 1011 lactic acid bacteria 109to 1011 lactic acid bacteria
(UFC/day)

Table 3: Recommended daily diet for peptic ulcer

Probiotics: Probiotics are living organisms that when taken in a sufficient amount,
have beneficial effect on the overall health of the host (WHO Definition). It is a food
supplement based on live microorganisms, which affect beneficially the human
organism by providing a microbial balance.

Probiotics play a crucial role in the pathogenesis of peptic ulcer. Probiotics have
therapeutic agents against H. pylori. They alter the local pH to create an unfavourable
environment for the growth of pathogens. They produce bacteriocins to inhibit
pathogens. They strengthen the mucosal barrier by producing antimicrobial
substances, coaggregation with pathogens, competing with H. pylori for adhesion
receptors, stimulating mucin production, and stabilizing of the gut mucosal barrier.

Probiotics inhibit the development of mucosal lesions and accelerate the process of
healing in ulcers and also help in maintaining the mucosal integrity by upregulating
prostaglandins, mucus secretion and inhibiting apoptosis. Common probiotics include
yogurt, curd, nut milk.

Protein foods: Milk and protein foods do have some buffering effect. Milk should be
included as a source of nutrient factors for healing purposes. Protein provides the
necessary amino acids for synthesis of tissue protein which helps in healing ulcer.

56
Fat: Moderate amounts of fat help to suppress gastric secretion and motility through
the enterogastrone mechanism. Fats such as cream, butter and olive oil are helpful.
Fried foods are not advised as they are difficult to digest and often aggravate the
symptoms.

Ascorbic acid: Vitamin C helps in wound healing and has anti-oxidant property. The
pH of food before ingestion has little significance. No food is sufficiently acid by itself
to affect a significant pH change or cause direct irritation on an ulcer.

Fibre foods: A diet rich in fibers for peptic ulcer is advisable (20 to 30 g/day,
according to WHO – World Health Organization), because fibers act as buffers,
reducing concentrations of bile acids in the stomach and the intestinal transit time,
resulting in less abdominal bloating, thus decreasing discomfort and pain in the
gastrointestinal tract. Soluble fibers, are found in apple, oatmeal, and pear. Insoluble
fibers include whole grains, granola, flaxseed.

Phytochemicals

A number of plants derived chemical constituents have been reported to possess anti-
ulcer properties in various preclinical studies. These constituents belong to the class of
tannins, flavonoids, alkaloids, terpenoids, saponins, carotenoids

Polyphenols- Dietary polyphenols exhibit protective and therapeutic effect in peptic

ulcer due to upregulation of growth factors and prostaglandins, enhanced
angiogenesis, improved cytoprotection, improved antioxidant, antacid and
antisecretory activity, improved mucosal defense, and blocking of H. pylori. A
balanced diet of fruits and vegetables including apples, grapes, pineapple, curcumin,
ginger etc. help in prevention and management of peptic ulcers.

Tannins- Tannins have gastroprotective effects that inhibit gastric secretion and local
gastric mucosal protection. They react with the proteins of the tissue layers. Tannins
precipitate micro proteins at the site of the peptic ulcer, forming a protective pellicle
that prevents absorption of toxic substances, and promote resistance to the action of
proteolytic enzymes, an associated activity against Helicobacter pylori.

57
Flavonoids- Flavonoids exert anti-ulcer effects through regulating gastric secretion
pathways and prostaglandin levels. Flavonoids (1) decrease acetylcholine, gastrin,
histamine, and somatostatin levels and inhibit H+K+-ATPase activities, therefore
inhibiting gastric acid secretion; (2) promote mucus and bicarbonate secretion; (3)
inhibit pepsin activity; (4) exhibit cytoprotective activity by regulating prostaglandin
levels.

Alkaloids- Alkaloids work with a mechanism to reduce gastric acid secretion, increase
mucus and alkaline secretions, and increase gastric mucosal blood flow to aid in the
healing and prevention of gastric ulcers against irritant agents/factors.

Carotenoids- Reactive Oxygen Species has been considered as one of the potential
toxic factors involving helicobacter pylori induced gastric injury. Glutathione and
glutathione-S-transferase are decreased in gastric mucosa by h. pylori which leads to
loss of gastric defence mechanism against h. pylori infection. These have inhibitory
effect on h. pylori induced chemokine expression by inhibiting the activation of
transcription factor NF-kB.

Terpenoids- Terpenoids inhibits acid secretion and H. pylori growth and induces
Prostaglandin secretion.

Phospholipids and Sterols- Phospholipids help in preventing intracellular

acidification by improving the viscosity of the mucus layer and play an important role
in both gastric and duodenal ulcers. The protective activity of phospholipids is
enhanced by phytosterols because of its anti-inflammatory properties. Both
phytosterols and phospholipids exhibit protective activity in pyloric ligation, which
stimulates acid output. Fresh rice bran, unrefined wheat, ginger oil, millets, maize,
soya and certain pulses like horse gram have shown protective action against peptic
ulcers.

Protective foods:

Yogurt, flaxseeds, walnuts, apple, papaya, melon, banana, dark green leafy vegetables,
carrot, beet, green bean, spinach, radish, cabbage, lentils, chickpeas, soybean, etc.

58
Contraindicated foods:

Fried foods, spicy peppers (black pepper, chilli), chocolate, coffee, black tea, fizzy or
cola drinks, mustard, preserved and stored food, alcohol, pickle etc. A well-balanced
diet which includes fresh fruits, vegetables, nuts and whole plant-based foods
exhibiting anti-ulcerogenic properties has been shown to be effective in the
management of peptic ulcers.

Dietary Guidelines

• Whether a patient is on bland diet or regular diet, he needs to know which foods
are needed for a nutritionally adequate diet and the importance of including
these daily.

• He should select from a wide variety of foods, omitting those foods that are
distressing.

• Regularity of mealtimes is essential. The patient gets benefitted by small and

frequent meals.

• In between meals, protein rich snacks can be taken.

• Moderate amounts of food should be eaten. Heavy meals should be avoided.

Volume of any foods sufficient to exert antral pressure against the stomach
wall stimulates gastric secretion through the gastrin mechanism.

• The diet should be planned in consultation with patient, taking into

consideration his preferences, cultural pattern and economic status.

• A short rest before and after meals may be conducive to greater enjoyment of
meals.

• Food should be eaten slowly and chewed well. How one eats is mor important
than what one eats because fast eating provokes gastric feeding reflux.

Lifestyle Modifications

As lifestyle changes is the root cause for the peptic ulcer, its modification is
essential.
59
 • Avoid more spicy foods, processed foods
• Carbonated drinks, caffeine, alcohol, tobacco and preserved food products
should be avoided.
• Maintain work timing and stress levels
• Practice yoga, pranayama regularly
• Practice regular food timings
• Chew the food well and eat- Eat the Liquids; Drink the Solids
• Start the day with normal water intake
• Include alkaline foods like ash gourd regularly
• Keep normal sleep timings- Early to Bed; early to Rise

5.9 HERBAL REMEDIES

• There are many anecdotal herbal remedies used in treating and preventing
peptic ulcers.

• Aegle marmelos (Indian bael): The aqueous extract of its leaves is to be

administered orally for 21 days in the daily dose of 1gm/kg for significant
reduction in the ulcer lesion.

• Allium sativum (garlic): The extract of its bulb is known to increase the healing
of gastric ulcer and also prevents the development of gastric and duodenal
ulcers.

• Aloe vera (aloe gel): Its oral intake has significant anti-ulcer activity.

• Annona squamosa (custard apple, sitaphal): The extract of its leaves is known
to heal gastric ulcers.

5.10 YOGA THERAPY

Complete rest and a change of environment is highly recommended as the first step in
ulcer therapy. Faulty diet and lifestyle create indigestion, food stored in stomach get
fermented which leads to increased acid secretion.

Psychological factors like stress play a major role in development and exacerbation of
gastrointestinal disorders like peptic ulcer disease by disrupting the brain-gut axis.
60
Yoga practice regulates inappropriate autonomic functions in peptic ulcer patients and
improves their physiological and psychological profiles. According to yoga, diseases
are disturbances in the panchakoshas (the five intertwined layers of human existence).
Hence mind-body practices are essential to address this condition.

While doing yoga asanas and pranayama, brain releases all sorts of chemicals which
are needed not only help to relax but also lower stress and anxiety levels including,
gamma-aminobutyric acid (GABA), endorphins, dopamine, oxytocin and serotonin.
GABA is a neurotransmitter or a brain’s chemical messenger. Its job is to suppress
neural activity in order to prevent brain from getting overly excited. In doing so, it
controls fear, stress, anxiety or nervousness.

By performing yogasanas, abdomen and chest region is pressurized and blood

circulation of that area is increased which helps the digestive secretion as well as waste
products excretion process. Asanas produce soothing effect on inner layer of stomach,
reversing inflammatory changes and controlling the digestive secretions, thereby
reliveing the symptoms of acid secretion.

SERIES ASANAS

Suryanamaskar Pranamasana, Hasta uttanasana,

Padahastasana, Ashwa sanchalanasana,
Parvatasana, Ashtanga namaskarasana,
Bhujangasana
Standing Tadasana, Vrikshasana, Ardhakati
chakrasana
Sitting Vajrasana, Shalabhasana, Ushtrasana,
Vakrasana
Prone Bhujangasana, Shalabhasana

Supine Pawanamuktasana, Shavasana

Pranayama Anulom-vilom, Sheetali, Sheetkari

Table 4: Yoga Protocol

61
• Suryanamaskar revitalizes each and every cell or tissues of the body. It gives
physical strength, flexibility and mental calmness. During the practice the
abdominal muscles get stretched and compressed which results in complete
massage to the organs. It increases the blood flow and activates the digestion
and relieves dyspepsia and other gastrointestinal problems.
• Standing postures like Tadasana, Vrikshasana provide the mind and body
balance to increase the self-consciousness and self-awareness
• In prone postures Shalabhasana, Bhujangasana, the abdomen region is
pressurized and blood circulation of that area is increased which helps in
excretion process.
• Sitting postures like Vajrasana, Shashankasana increase blood flow to the
stomach and intestine and helps to digest food effectively and aid in reducing
acid secretion. Vajrasana also has calming effect on the nervous system. It
activates parasympathetic nervous system and helps in reducing stress.
• Supine postures like Pawanamuktasana, Shavasana improve blood circulation
and digestion
• Pranayama helps in calming down the mind. When we breathe, the olfactory
nerves situated in the roof of nose is stimulated and reaches the olfactory bulb
of skull. This is connected with the median frontal bundle in the front of the
brain. This in turn gets connected with hypothalamus. Hypothalamus has a
function of regulating the hormones by which serotonin is released. Serotonin
receptors regulate stress by splanchnic pathway.
• Practices such as Sheetali and Sheetkari pranayama have cooling and soothing
effect on the body and helps in reducing inflammation. Anulom-vilom lowers
the level of stress and anxiety and reduces stress related indigestion by
regulating the stress hormone by relaxing the sympathetic nervous system and
strengthening the parasympathetic nervous system.

62
6. RESULTS

6.1 CASE-1

PARAMETERS PRE-TREATMENT POST-TREATMENT

VAS 7 3
GSQ 19 11
APPETITE DECREASED IMPROVED

Table 5: Result of Case 1

6.2 CASE-2

PARAMETERS PRE-TREATMENT POST-TREATMENT

VAS 7 3
GSQ 18 10
APPETITE DECREASED IMPROVED

Table 6: Result of Case 2

6.3 CASE-3

PARAMETERS PRE-TREATMENT POST-TREATMENT

VAS 4 2
GSQ 12 7
APPETITE DECREASED IMPROVED

Table 7: Result of Case 3

6.4 CASE-4

PARAMETERS PRE-TREATMENT POST-TREATMENT

VAS 5 2
GSQ 16 9

63
 APPETITE DECREASED IMPROVED

Table 8: Result of Case 4

6.5 CASE-5

PARAMETERS PRE-TREATMENT POST-TREATMENT

VAS 3 1
GSQ 11 6
APPETITE DECREASED IMPROVED

Table 9: Result of Case 5

7. DISCUSSION

Life of humans has changed these years. A drastic change occurred in our lifestyles
due to which we are moving away from the Nature. Naturopathy is a holistic treatment.
According to Naturopathy, disease occurs due to violation of Nature’s law. And the
treatment starts from finding the root cause. Peptic ulcers can be treated through
Naturopathy by diet and various other naturopathic treatments like hydrotherapy, mud
therapy, yoga. Bland, Alkaline diet is beneficial. Peptic ulcer’s main cause would be
due to life style changes. There are chances of recurrence when there are life style
changes (like continuing smoking, alcohol).

8. CONCLUSION

Naturopathy and Yoga are holistic approaches in treating the disease conditions. The
effect of naturopathic treatments like hydrotherapy, massage therapy, heliotherapy,
acupuncture, mud therapy; yoga therapy; diet therapy were very beneficial in treating
the peptic ulcer disease. Naturopathy identifies the root cause. The root cause of peptic
ulcer is lifestyle changes. Correcting the lifestyle is the primary step in treatment. As
a whole there is improvement in the quality of life of patients.

64
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Salehi B, Martins N, Iriti M, Sharifi-Rad J. Antiulcer Agents: From Plant Extracts to
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68
10. APPENDICES

CASESHEET-1

PRELIMINARY DATA

Name: Mrs. XXX

Age: 60 years

Gender: Female

Marital status: Married

Address: Warangal, Telangana

Occupation: Home maker

CHIEF COMPLAINTS:

C/O pain in the abdomen

C/O heartburn

C/O bloating of abdomen

C/O belching

C/O disturbed sleep

HISTORY OF PRESNTING COMPLAINT:

The patient had the complaint of abdomen pain since 1 year, the pain subsides after
the food intake associated with bloating and belching since 11 months and also
complaint of heartburn since 10 months associated with disturbed sleep

PAST HISTORY: P/H/O Heart attack 2 years back

FAMILY HISTORY: Nil

69
MEDICAL HISTORY:

Tab. Aspirin

Tab. Pantoprazole

PERSONAL HISTORY:

Diet: Mixed

Appetite: Loss of appetite

Bowel: Irregular

Micturition: Normal in frequency (6 times/day)

Habit: Tea 3 cups/day

Sleep: Disturbed

Thirst: Normal

Addiction: Nil

Allergy: Nil

VITAL DATA:

Pulse rate: 80 bpm

Respiratory rate: 17 cpm

Blood pressure: 130/86 mmHg

Temperature: Afebrile

Height: 166 cm

Weight: 85 kg

70
BMI: 31 kg/m2

GENERAL PHYSICAL EXAMINATION:

Built: Obese

Gait: Normal

Edema: Absent

Cyanosis: Absent

Pallor: Absent

Tongue: coated

Nails: Pale

Icterus: Absent

Lymphadenophathy: Absent

Clubbing: Absent

MENSTRUAL HISTORY: Menopause

Menarche: at 14 years

LMP: at 48 years

Cycle: -

Flow: -

Clots: -

Leucorrhea: -

OBSTETRICS HISTORY:

71
G-2; P-2; A-0; L-2

SYSTEMIC EXAMINATION:

Cardiovascular System:

Normal S1 and S2 sound heard

Respiratory System:

Normal Bronchovesicular sound heard.

Central Nervous System:

Conscious and well oriented

Gastro Intestinal System:

Inspection: Bloated abdomen

Palpation: tenderness in right hypochondriac region

NATUROPATHIC DIAGNOSIS:

FACIAL DIAGNOSIS: Mixed encumbrance

TONGUE DIAGNOSIS: Thick white coated

DIFFERENTIAL DIAGNOSIS:

Gastro Esophageal Reflux Disease (GERD)

Peptic ulcer

INVESTIGATION:

WBC count- 17.7

Endoscopic report: lesion in duodenum about 1 cm

72
FINAL DIAGNOSIS:

Peptic ulcer

TREATMENT PLAN

DAY MORNING AFTERNOON

1 Full body massage + Steam Cold abdomen pack

2 Full mud bath Cold abdomen pack

3 Full body massage + Steam Cold abdomen pack

4 Jacuzzi Cold abdomen pack

5 Full body massage + Steam Cold abdomen pack

6 Partial massage to abdomen + Mud Cold abdomen pack + Cold hip

pack to abdomen bath

7 Full mud bath Cold abdomen pack + Cold hip

bath

8 Full body massage + Steam Cold abdomen pack + Cold hip

bath

9 Turmeric + Kanji bath Cold abdomen pack + Cold hip

bath

10 Partial massage to abdomen + Mud Cold abdomen pack + Hot foot

pack to abdomen bath

Table 10: Case 1 Treatment chart

73
DIET CHART

DAY 7.00 am 10.00 am 2.00 pm 4.00 pm 6.30 pm 8.00 pm

1 Nelausiri Millets + Wheatgrass Ginger 2 chappathis + Probiotic

+ Ginger Boiled juice + water Boiled kanji
water vegetables Moringa vegetables+Salads
+ Salads

2 Nelausiri Millets + Wheatgrass Ginger 2 chappathis + Probiotic

+ Ginger Boiled juice + water Boiled kanji
water vegetables Moringa vegetables+Salads
+ Salads

3 Nelausiri Millets + Wheatgrass Ginger Millets + Boiled Probiotic

+ Ginger Boiled juice + water vegetables+Salads kanji
water vegetables Moringa
+ Salads

4 Nelausiri Idly+Salads Wheatgrass Ginger Rice + Boiled Probiotic

+ Ginger juice + water vegetables+ kanji
water Moringa Salads

5 Nelausiri Rice + Wheatgrass Ginger Rice + Boiled Probiotic

+ Ginger Boiled juice water vegetables+ kanji
water vegetables+ +Moringa Salads
Salads

6 Nelausiri Millet kanji Wheatgrass Coconut Rice + Boiled Probiotic

+ Ginger + Boiled juice + water vegetables+ kanji
water vegetables Moringa Salads

74
7 Nelausiri Millets + Wheatgrass Coconut Rice + Boiled Probiotic
+ Ginger Boiled juice + water vegetables+ kanji
water vegetables Moringa Salads
+ Salads

8 Nelausiri Millets + Wheatgrass Coconut Millets + Boiled Probiotic

+ Ginger Boiled juice+Moringa water vegetables+Salads kanji
water vegetables
+ Salads

9 Nelausiri Millets + Wheatgrass Ginger Rice + Boiled Probiotic

+ Ginger Boiled juice+Moringa water vegetables+ kanji
water vegetables Salads
+ Salads

10 Nelausiri Millets + Wheatgrass Ginger 2 chappathis + Probiotic

+ Ginger Boiled juice+Moringa water Boiled kanji
water vegetables vegetables+Salads
+ Salads

Table 11: Case 2 Diet chart

75
 CASESHEET-2

PRELIMINARY DATA

Name: Mrs. XXX

Age: 35 years

Gender: Female

Marital status: Married

Address: Karnataka

Occupation: IT Employee

CHIEF COMPLAINTS:

C/O abdomen pain

C/O heartburn

C/O bloated abdomen

C/O vomiting

C/O disturbed sleep

HISTORY OF PRESNTING COMPLAINT:

The patient has the complaint of persisting abdomen pain since 8 months associated
with heartburn and bloated abdomen after having meals since 7 months along with
disturbed sleep since 7 months and also complaint of vomiting since 4 months

PAST HISTORY: Nil

FAMILY HISTORY: Nil

MEDICAL HISTORY: Tab. Pantoprazole

76
PERSONAL HISTORY

Diet: Vegetarian

Appetite: Loss of appetite

Bowel: Constipated

Micturition: Normal in frequency (5 times/day)

Habit: Nil

Sleep: Disturbed

Thirst: Normal

Addiction: Nil

Allergy: Nil

VITAL DATA:

Pulse rate: 74 bpm

Respiratory rate: 17 cpm

Blood pressure: 118/78 mmHg

Temperature: Afebrile

Height: 165 cm

Weight: 68 kg

BMI: 24 kg/m2

GENERAL PHYSICAL EXAMINATION:

Built: Moderate

77
Gait: Normal

Edema: Absent

Cyanosis: Absent

Pallor: Absent

Tongue: coated

Nails: Pinkish

Icterus: Absent

Lymphadenophathy: Absent

Clubbing: Absent

MENSTRUAL HISTORY

Menarche: at 13 years

LMP: 1.11.23

Cycle: 5/30 days

Flow: Normal

Clots: -ve

Leucorrhea: -ve

OBSTETRICS HISTORY

G-3; P-2; A-1; L-2

78
SYSTEMIC EXAMINATION:

Cardiovascular System:

Normal S1 and S2 sound heard

Respiratory System:

Normal Bronchovesicular sound heard

Central Nervous System:

Conscious and well oriented

Gastro Intestinal System:

Inspection: Bloated abdomen

Palpation: Tenderness in the epigastric region

NATUROPATHIC DIAGNOSIS:

FACIAL DIAGNOSIS: Front encumbrance

TONGUE DIAGNOSIS: Yellow coated

DIFFERENTIAL DIAGNOSIS:

Gastro Esophageal Reflux Disease (GERD)

Peptic ulcer

INVESTIGATION:

WBC- 16.8

Blood test for H.pylori- positive

Endoscopic findings- Ulcer formation on stomach about 1.7cm

79
FINAL DIAGNOSIS:

Peptic ulcer

TREATMENT PLAN

DAY 7.30 am 9.00 to 12.30pm 2.30 to 5.30pm

1 Mud pack to Full body massage+ Cold abdomen pack

myolab
abdomen and
Neutral trunk pack
eyes Steam room
Neutral hip bath

2 Mud pack to Vibro massage Gastro-hepatic pack

abdomen and
Sauna bath Neutral trunk pack
eyes
Individual yoga Neutral immersion bath

3 Mud pack to Full mud bath Cold abdomen pack

abdomen and
Sauna bath Alternate hip bath
eyes
Individual yoga Acupuncture

4 Mud pack to Full body massage Gastro-hepatic pack

abdomen and
Steam room Neutral trunk pack
eyes
Individual yoga Neutral hip bath

Acupuncture

5 Mud pack to Vibro massage Cold abdomen pack

abdomen and
Sauna bath Neutral trunk pack
eyes
Alternate hip bath

Acupuncture

80
6 Mud pack to Full mud bath Gastro-hepatic pack
abdomen and
Sauna bath Neutral immersion bath
eyes
Cold abdomen pack

Acupuncture

7 Mud pack to Full body massage Cold abdomen pack

abdomen and
Steam room Neutral trunk pack
eyes
Acupuncture

8 Mud pack to Neem bath Gastro hepatic pack

abdomen and
Sauna bath Neutral immersion bath
eyes

9 Mud pack to Full mud bath Cold abdomen pack

abdomen and
Sauna bath Alternate hip bath
eyes
Gastro hepatic pack

10 Mud pack to Full body massage Cold abdomen pack

abdomen and
Steam room Neutral hip bath
eyes

Table 12: Case 2 Treatment Chart

81
DIET PLAN

DAY 7.30am 8.30 am 10.30 am 12.30 pm 3.30 pm 7.30 pm

1 Ashgour Normal Watermel Normal Cucumb Normal diet

d juice diet on juice diet + er juice
Buttermilk

2 Ashgour Mix Watermel Natural Cucumb Normal diet

d juice fruits + on juice diet + er juice
Buttermi carrot
lk soup +
Probiotic
kashaya

3 Ashgour Mix Watermel Natural Cucumb Normal diet

d juice fruits + on juice diet + er juice
Buttermi drumstick
lk soup +
Probiotic
kashaya

4 Ashgour Mix Coconut Natural Coconut Normal diet

d juice fruits + water diet + corn water
Buttermi soup +
lk Probiotic
kashaya

5 Ashgour Mix Coconut Natural Coconut Normal diet

d juice fruits + water diet + mix water
Buttermi veg soup +
lk Probiotic
kashaya

82
6 Ashgour Mix Coconut Natural Coconut Normal diet
d juice fruits + water diet + water
Buttermi tomato
lk soup +
Probiotic
kashaya

7 Ashgour Mix Coconut Fermented Coconut Normal diet

d juice fruits + water kanji + water
Buttermi boiled
lk vegetable

8 Ashgour Mix Pomegra Fermented Cucumb Normal diet

d juice fruits + nate juice kanji + er juice
Buttermi boiled
lk vegetable

9 Ashgour Mix Pomegra Fermented Cucumb Normal diet

d juice fruits + nate juice kanji + er juice
Buttermi boiled
lk vegetable

10 Ashgour Normal Pomegra Natural Cucumb Normal diet

d juice diet nate juice diet + er juice
carrot
soup +
Probiotic
kashaya

Table 13: Case 2 Diet chart

83
 CASESHEET-3

PRELIMINARY DATA

Name: Mr. XXX

Age: 42 years

Gender: Male

Marital status: Married

Address: Karnataka

Occupation: Business

CHIEF COMPLAINTS:

C/O abdomen pain

C/O abdomen pain at night

C/O abdominal bloating and belching

HISTORY OF PRESNTING COMPLAINT:

The patient has the complaint of abdominal persisting since 1 month associated with
bloating and belching since 20 days along with abdomen pain at night (sometimes)

PAST HISTORY: Nil

FAMILY HISTORY: Nil

MEDICAL HISTORY: Nil

PERSONAL HISTORY:

Diet: Mixed

84
Appetite: Loss of appetite

Bowel: Regular

Micturition: Normal in frequency (6 times/day)

Habit: Coffee (2 cups/day)

Sleep: Disturbed

Thirst: Normal

Addiction: Smoking (6 cigarettes/day)

Allergy: Nil

VITAL DATA:

Pulse rate: 78 bpm

Respiratory rate: 18 cpm

Blood pressure: 128/82 mmHg

Temperature: Afebrile

Height: 168 cm

Weight: 79 kg

BMI: 28 kg/m2

GENERAL PHYSICAL EXAMINATION:

Built: Overweight

Gait: Normal

Edema: Absent

85
Cyanosis: Absent

Pallor: Absent

Tongue: coated

Nails: Pinkish

Icterus: Absent

Lymphadenophathy: Absent

Clubbing: Absent

MENSTRUAL HISTORY: Not applicable

SYSTEMIC EXAMINATION:

Cardiovascular System:

Normal S1 and S2 sound heard

Respiratory System:

Normal Bronchovesicular sound heard.

Central Nervous System:

Conscious and well oriented

Gastro Intestinal System:

Inspection: Bloated abdomen

Palpation: tenderness in right hypochondriac region

NATUROPATHIC DIAGNOSIS:

FACIAL DIAGNOSIS: Front encumbrance

86
TONGUE GIAGNOSIS: White coated

DIFFERENTIAL DIAGNOSIS

Gastritis

Peptic ulcer

INVESTIGATION:

WBC- 11.6

Blood test- positive for H.pylori

FINAL DIAGNOSIS:

Peptic Ulcer

TREATMENT PLAN

DAY 7.30 am 9.00 to 12.30pm 2.30 to 5.30pm

1 Mud pack to Full body massage+ Cold abdomen pack

myolab
abdomen and
Gastro hepatic pack
eyes Steam room
Neutral hip bath

2 Mud pack to Full mud bath Gastro-hepatic pack

abdomen and
Sauna bath Neutral trunk pack
eyes
Individual yoga Neutral immersion bath

Slimming, cupping,
heating

Acupuncture

87
3 Mud pack to Vibro massage Cold abdomen pack
abdomen and
Sauna bath Neutral hip bath
eyes
Individual yoga Acupuncture

4 Mud pack to Neem bath Gastro-hepatic pack

abdomen and
Sauna bath Alternate hip bath
eyes
Individual yoga Slimming, cupping,
heating

Acupuncture

5 Mud pack to Vibro massage Cold abdomen pack

abdomen and
Sauna bath Neutral trunk pack
eyes
Neutral immersion bath

Acupuncture

6 Mud pack to Full mud bath Gastro-hepatic pack

abdomen and
Sauna bath Alternate hip bath
eyes
Cold abdomen pack

Slimming, cupping,
heating

Acupuncture

7 Mud pack to Full body massage Cold abdomen pack

abdomen and
Steam room Gastro hepatic pack
eyes
Neutral hip bath

Table 14: Case 3 treatment chart

88
DIET PLAN

DAY 7.30am 8.30 am 10.30 am 12.30 pm 3.30 pm 7.30 pm

1 Ashgour Normal Muskmel Normal Cucumb Normal diet

d juice diet on juice diet + er juice
Buttermilk

2 Ashgour Mix Muskmel Natural Coconut Normal diet

d juice fruits + on juice diet + water
Buttermi carrot
lk soup

3 Ashgour Mix Muskmel Natural Coconut Normal diet

d juice fruits + on juice diet + water
Buttermi drumstick
lk soup +
Probiotic
kashaya

4 Ashgour Mix Muskmel Natural Coconut Normal diet

d juice fruits + on juice diet + corn water
Buttermi soup +
lk Probiotic
kashaya

5 Ashgour Mix Watermel Natural Coconut Normal diet

d juice fruits + on juice diet + mix water
Buttermi veg soup +
lk Probiotic
kashaya

6 Ashgour Mix Watermel Natural Coconut Normal diet

d juice fruits + on juice diet + water
tomato

89
 Buttermi soup +
lk Probiotic
kashaya

7 Ashgour Mix Watermel Natural Coconut Normal diet

d juice fruits + on juice diet + water
Buttermi carrot
lk soup +
Probiotic
kashaya

Table 15: Case 3 Diet chart

90
 CASESHEET-4

PRELIMINARY DATA

Name: Mr. XXX

Age: 38 years

Gender: Male

Marital status: Married

Address: Nashik

Occupation: Business

CHIEF COMPLAINTS:

C/O pain in the abdomen region

C/O nausea and vomiting

C/O bloated abdomen

C/O tiredness

HISTORY OF PRESNTING COMPLAINT:

The patient had the complaint of abdominal pain which aggravates after the food intake
associated with nausea and vomiting since 5 months along with bloating in the
abdomen since 3 months

PAST HISTORY: Nil

FAMILY HISTORY: Nil

MEDICAL HISTORY: Nil

PERSONAL HISTORY:

91
Diet: Mixed

Appetite: Loss of appetite

Bowel: Constipated

Micturition: Normal in frequency (7 times/day)

Habit: Nil

Sleep: Sound

Thirst: Normal

Addiction: Smoking 5 cigarettes/ day & alcohol 3 times/week

Allergy: Dust allergy

VITAL DATA:

Pulse rate: 84 bpm

Respiratory rate: 15 cpm

Blood pressure: 126/88 mmHg

Temperature: Afebrile

Height: 172 cm

Weight: 89 kg

BMI: 30 kg/m2

GENERAL PHYSICAL EXAMINATION:

Built: Overweight

Gait: Normal

92
Edema: Absent

Cyanosis: Absent

Pallor: Absent

Tongue: coated

Nails: Pinkish

Icterus: Absent

Lymphadenophathy: Absent

Clubbing: Absent

MENSTRUAL HISTORY: Not applicable

SYSTEMIC EXAMINATION:

Cardiovascular System:

Normal S1 and S2 sound heard

Respiratory System:

Normal Bronchovesicular sound heard.

Central Nervous System:

Conscious and well oriented

Gastro Intestinal System:

Inspection- slightly bloated abdomen

Palpation- Tenderness in the epigastric region

NATUROPATHIC DIAGNOSIS:

93
FACIAL DIAGNOSIS: Front encumbrance

TONGUE DIAGNOSIS: slightly yellow coated

DIFFERNTIAL DIAGNOSIS:

Gastritis

Peptic ulcer

INVESTIGATION:

WBC count- 13.5

Blood test for H.pylori- Positive

FINAL DIAGNOSIS:

Peptic ulcer

TREATMENT PLAN

DAY 6.30 am to 8.30 am to 2.00 pm to 5.30 pm to

7.30 am 12.30 pm 5.30 pm 6.15 pm

1 General yoga Mud pack to Alternate hip Pranayama

abdomen & bath + Gastro and Meditation
eyes + Full hepatic pack
body massage
+ Steam with
chest pack

2 General yoga Mud pack to Cold abdomen Pranayama

abdomen & pack + and Meditation
eyes + Hot Graduated
stone massage

94
 immersion
bath

3 General yoga Mud pack to Full mud bath Pranayama

abdomen & + Sauna bath and Meditation
eyes + Deep
tissue massage

4 General yoga Mud pack to Turmeric bath Pranayama

abdomen & + Gastro and Meditation
eyes + hepatic pack
Shirodhara

5 General yoga Mud pack to Alternate hip Pranayama

abdomen & bath + Cold and Meditation
eyes + D- tan abdomen pack
massage

6 General yoga Mud pack to Neem hip bath Pranayama

abdomen & + Castor oil and Meditation
eyes + Herbal pack
powder
massage

7 General yoga Mud pack to Cold hip bath Pranayama

abdomen & + Gastro and Meditation
eyes + Partial hepatic pack
massage to
abdomen and
legs

Table 16: Case 4 Treatment chart

95
DIET PLAN

DAY 7.30 7.45 am 10.00 12.20 pm 2.00 pm 7.00 pm 8.30

am am pm

1 Jeera Ash gourd Cockta Normal Panchamrit Normal diet Com

kadha aloe vera il leaf diet + 2 water + 1 millet mon
juice + juice roti drink
Papaya

2 Ajwain Ash gourd Cocon Ash gourd Panchamrit Drumstick Com

kadha aloe vera ut soup + water soup + mon
juice + water beans + Bhindi veg + drink
Papaya Lettuce Kodo millet
salad + 1
roti

3 Cinna Ash gourd Cocon Corn soup Panchamrit Tomato soup Com
mon aloe vera ut + snake water + Raw mon
kadha juice + water gourd veg papaya veg drink
Papaya & + + Oats
apple Buttermilk

4 Saunf Ash gourd Cocon Mix veg Jeera water Barley soup Com
kadha aloe vera ut soup + + lauki veg mon
juice + water Almond + Barnyard drink
Papaya & curry + millet
apple Buttermilk

5 Ajwain Ash gourd Cocon Drumstick Jeera water Moong dal Com
Kadha aloe vera ut soup + soup + Mix mon
juice + water Bhindi veg + Porso drink
Papaya & veg + millet
apple Raw
papaya
96
 salad +
Buttermilk

6 Jeera Ash gourd Pomeg Ash gourd Jeera water Mix veg Com
kadha aloe vera ranate soup + soup + mon
juice + juice beans + Beans + drink
Papaya & Carrot Sama millet
apple salad +
Buttermilk

7 Cinna Ash gourd Pomeg Normal Jeera water Normal diet Com
mon aloe vera ranate diet + 2 + 1 millet mon
kadha juice + juice roti + drink
Papaya & Buttermilk
apple

Table 17: Case 4 Diet chart

97
 CASESHEET-5

PRELIMINARY DATA

Name: Mrs. XXX

Age: 48 years

Gender: Female

Marital status: Married

Address: Mumbai

Occupation: Business

CHIEF COMPLAINTS:

C/O pain in the abdomen region

C/O abdominal discomfort after having food

HISTORY OF PRESNTING COMPLAINT:

The patient had the complaint of dull abdominal pain since 1 month associated with
abdominal discomfort after the intake of food

PAST HISTORY: Nil

FAMILY HISTORY: Nil

MEDICAL HISTORY: Nil

PERSONAL HISTORY:

Diet: Mixed

Appetite: Loss of appetite

98
Bowel: Regular

Micturition: Normal in frequency

Habit: occasionally alcohol (social drinker)

Sleep: Sound

Thirst: Normal

Addiction: Nil

Allergy: Nil

VITAL DATA:

Pulse rate: 77 bpm

Respiratory rate: 18 cpm

Blood pressure: 122/84 mmHg

Temperature: Afebrile

Height:160cm

Weight: 63 kg

BMI: 24.6 kg/m2

GENERAL PHYSICAL EXAMINATION:

Built: Moderate

Gait: Normal

Edema: Absent

Cyanosis: Absent

99
Pallor: Absent

Tongue: coated

Nails: Pinkish

Icterus: Absent

Lymphadenophathy: Absent

Clubbing: Absent

MENSTRUAL HISTORY: Menopause

Menarche: at 15 years

Cycle: -

Flow: -

Clots: -

Leucorrhea: -

OBSTETRICS HISTORY:

G-1; P-1; A-0; L-1

SYSTEMIC EXAMINATION:

Cardiovascular System:

Normal S1 and S2 sound heard

Respiratory System:

Normal Bronchovesicular sound heard.

Central Nervous System:

100
Conscious and well oriented

Gastro Intestinal System:

Palpation- tenderness over right hypochondriac region

NATUROPATHIC DIAGNOSIS:

FACIAL DIAGNOSIS: Front encumbrance

TONGUE DIAGNOSIS: Slight white coated

DIFFERENTIAL DIAGNOSIS

Gastritis

Peptic ulcer

INVESTIGATION:

WBC count- 11.1

Blood test for H.pylori- positive

FINAL DIAGNOSIS:

Peptic ulcer

TREATMENT PLAN

DAY 6.30 am to 8.30 am to 2.00 pm to 5.30 pm to

7.30 am 12.30 pm 5.30 pm 6.15 pm

1 General yoga Mud pack to Cold hip bath Pranayama

abdomen & + Gastro and Meditation
eyes + Deep hepatic pack
tissue massage

101
2 General yoga Mud pack to Full mud bath Pranayama
abdomen & + Sauna bath and Meditation
eyes +
Shirodhara

3 General yoga Mud pack to Neem hip bath Pranayama

abdomen & + Castor oil and Meditation
eyes + Full pack
body massage
with steam

4 General yoga Mud pack to Turmeric bath Pranayama

abdomen & + Gastro and Meditation
eyes + Herbal hepatic pack
massage

5 General yoga Mud pack to Alternate hip Pranayama

abdomen & bath + Cold and Meditation
eyes + D- tan abdomen pack
massage

6 General yoga Mud pack to Gastro hepatic Pranayama

abdomen & pack + and Meditation
eyes + Royal Graduated
massage immersion
bath

7 General yoga Mud pack to Neem bath + Pranayama

abdomen & Cold abdomen and Meditation
eyes + Partial pack
massage to
abdomen and
legs

Table 18: Case 5 Treatment chart

102
DIET PLAN

DAY 7.30 7.45 am 10.00 12.20 pm 2.00 pm 7.00 pm 8.30

am am pm

1 Jeera Ash gourd Cockt Normal diet Panchamrit Normal Commo

kadha aloe vera ail leaf + 2 roti water diet + 1 n drink
juice + juice millet
Papaya

2 Ajwai Ash gourd Green Drumstick Panchamrit Moong Commo

n aloe vera dhaniy soup + water dal soup n drink
kadha juice + a juice Bhindi veg + Mix
Papaya + Raw veg +
papaya Porso
salad + 1 millet
roti

3 Saunf Ash gourd Pomeg Corn soup Panchamrit Tomato Commo

kadha aloe vera ranate + snake water soup + n drink
juice + juice gourd veg + Raw
Papaya & Barley papaya
apple salad + veg +
Buttermilk Oats

4 Cinna Ash gourd Cocon Mix veg Barley Barley Commo

mon aloe vera ut soup + water soup + n drink
kadha juice + water Almond lauki veg
Papaya & curry + +
apple Quinoa Barnyard
salad + millet
Buttermilk

103
5 Ajwai Ash gourd Cocon Ash gourd Barley Drumstic Commo
n aloe vera ut soup + water k soup + n drink
Kadha juice + water beans + Bhindi
Papaya & Lettuce veg +
apple salad + Kodo
Buttermilk millet

6 Jeera Ash gourd Pomeg Sol curry Panchamrit Mix veg Commo
kadha aloe vera ranate soup + water soup + n drink
juice + juice beans + Beans +
Papaya & Carrot Sama
apple salad + millet
Buttermilk

7 Cinna Ash gourd Pomeg Normal diet Panchamrit Normal Commo

mon aloe vera ranate + 1 roti + water diet + 1 n drink
kadha juice + juice Buttermilk millet
Papaya &
apple

Table 19: Case 5 Diet chart

104