A Literary Review on Nidana of Amlapittaw.s.r. to Aetiological Factors of...

[Full title: A Literary Review on Nidana of Amlapittaw.s.r. to Aetiological Factors of Dyspepsia and Various Modern Terms Related to Amlapitta.]

Volume- 2, Issue- 5 IRJAY 52 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 Abstract- Dyspepsia is a condition of impaired digestion. Hyperacidity or acid dyspepsia is a very common dietary disorder.Curbing the problem of hyperacidity needs a total overhaul of the dietary regimen in addition to healthy exercise and lifestyle conquering hyperacidity is certainly a very important issue.Prevalence of dyspepsia is about 20-30% worldwide. A study reported that prevalence of dyspepsia to be 30.4% in India.This article discusses the various aetiological factorsof hyperacidity or Dyspepsia (Amlapitta) both Morden and ancient classical texts and various modern relative term with Amlapitta .In this articlevarious symptoms and aetiological factor show that Volume- 2, Issue- 5 Review Article A Literary Review on Nidana of Amlapitta w.s.r. to Aetiological Factors of Dyspepsia and Various Modern Terms Related to Amlapitta. Dr.Dharmendra Kumar Vyas 1 , Dr.Shri Ram Saini 2 , Dr. B.K. Sevatkar. 3 1 M.D. Scholar, Email: vyas.63290@gmail.com , Mobile no.9680163290 2 Ph.D Scholar, Email: drshribams 06@gmail.com , Mobile no. 08432220468. 3 Associate Professor, Email: drbks 6@gmail.com , Mobile no. 09352311105 P.G.Department of Roga Nidana EvamVikritiVijanana, NIA, Jaipur Article received on- 13 oct Article send to reviewer- 14 oct. Article send back to author- 18 oct. Article again received after correction- 22 oct. Corresponding author - Dr. Dharmendra Kumar Vyas, M.D. Scholar, Email: vyas.63290@gmail.co m , Mobile no.9680163290

Volume- 2, Issue- 5 IRJAY 53 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 many conditions in Modern Science like Gastritis, Gastro-esophageal Reflux Diseases, Dyspepsia, Ulcers can be included under the broad umbrella of Amlapitta .Certain foods ( Pitta provocative potency of diet ) and lifestyle are considered to promote gastro-esophageal reflux. Foods that have been implicated include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods. Stopping smoking and not drinking alcohol do not appear to result in significant improvement in symptoms. ManasikaHetu [Psychological factors] plays an important role in promoting Amlapitta . Keywords : Amlapitta , Hyperacidity and Gastro-esophageal Reflux Diseases. INTRODUCTION: ‘ Amlapitta ’ is a combination of two words Amla and Pitta . Among these two words the word Amla denotes the Rasa (Sour taste) and the Pitta denotes the Dosha involved in this disease. The Pitta dosha is bestowed with the functions of digestion and metabolism Amla according to Charaka is considered as the Prakruta rasa of Pitt a 1 whereas AcharyaSushruta says that Katu is the Prakruta rasa of the Pitta and it attains Amlata in Vidagdhavastha 2 . The condition where the natural Katu Rasa of Pitta is replaced by Amlata due to Vidagdhapaka can be called Amlapitta . In the 21 st century, the era of competition life it is full with stress havingmore speed and accuracy are the prime demands. Nowadays, people are tempted to earn a lot of money within a short period leading to their stressful life. Also more attraction for fast food, copying the Western life style, diet habits, behavioural pattern, stressful works and many other Psychological disorders hampers the digestion and lead to lots of health problems like Amlapitta , IBS due to improper digestion. Many conditions in Modern Science like Gastritis, Gastroesophageal Reflux Diseases, Dyspepsia, Ulcers can be included under the broad umbrella of Amlapitta AcharyaCharaka has mentioned that if the person is under some psychological problem even the wholesome diet taken in proper quantity does not get properly digested 3 There is no direct description of etiopathogenesis as well as treatment protocol of Amlapitta in Brihatrayi , may be due to less or nil prevalence of disease, stability in life, Satvapradhanya in that era. Many scattered references are there for the

Volume- 2, Issue- 5 IRJAY 54 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 disease AcharyaCharaka describes that when Annavisha gets associated with Pitta it leads to Pittaja diseases like Amlapitta 4 . CONCEPTUAL STUDY: Historical Review: Any direct reference regarding the disease Amlapitta could not be traced in Vedic literature CharakaSamhita : AcharyaCharaka has not mentioned the disease Amlapitta as a separatedisease, but the word Amlapitta is mentioned in the text at several places in the text. They are:  In the indications of 8 types of milk, Amlapitta has been listed 5  Description of Kulattha as chief etiological factor of Amlapitta has been mentioned 6  AdhikaSevana of Lavana causes Amlapitta 7  The condition Amlapitta has been mentioned under the diseases caused by Viruddhahara 8  Rajamansha has the property of relieving Amlapitta 9  MahatiktakaGhrita has been indicated in Amlapitta 10  The pathogenesis of Amlapitta is described in context to Grahanidosha 11 The symptoms of Amlapitta include Dhumaka , Amlaka , Vidaha , which are listed under Paittika Nanatmaj Vyadhis 12  Kansa Haritaki’s indications also include Amlapitta 13 It can be said that the clear picture of Amlapitta is seen in description of PittajaGulma & PittajaGrahani and their treatment resembles very much nearer tothe disease Amlapitta . SushrutaSamhita : During the description of the AtilavanaSevanajanyaVyadhis 14 ,AcharyaSus hruta has mentioned a disease called ‘ Amlika ’ which seems to besimilar to Amlapitta .Also he has described Amlika in second Kriyakala i.e Prakopakala 15 . KashyapaSamhita is the first text which describes the disease Amlapitta as a separate disease entity. Kashyapa believed that the disease is caused by vitiation of Tridoshas leading to Mandagni and Amlapitta. 16 Harita has described Amlapitta as a separate disease and the treatment is also given separately. The special synonym ‘ Amlahikka ’ to Amlapitta is contribution of Harita 17 (Hiccups with sour taste). MadhavaNidana :Madhavakara has

Volume- 2, Issue- 5 IRJAY 55 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 described two types of Amlapitta 18 as follows: Urdhavaga and Adhoga NIDANA ( Aetiological Factors): The etiological factors of Amlapitta can be broadly classified as AharajaViharaja , Manasika and AgantujaHet us . The brief explanations of these factors maybe presented as under. Aharaja group 19 : a) According to the type of Ahara : Kulattha , Pruthuka and Pulaka (Husky food) b) According to the quality of food: Abhishyandi , Atisnigdha (Unctuous) ,Atiruksha (Very coarse and dry), Gurubhojya (heavy diet) and VidahiPana. c) According to the Samskara of the Ahara : ApakwannaSevana (uncooked food) , BhrishtadhanyaSevana (fried paddy) , IkshuvikaraSevana (Sugar-cane products)a nd PishtannaSevana (flour) d) According to Dushitanna : Dushta Anna SevanaParyushita Anna Sevana. e) According to the Pitta provocative potency of diet: Adhyashana (eating before the previous diet is digested), Ajirnashana (intake of food in indigestion condition), AtiAmla (intake of excessive acidic diet), Ati Drava (intake of excessive liquid), AtiTikshna (intake of very sharp substance), AtiPanam (Over drinking), Katu Anna Pana (Pungent diet and drinks) and Viruddhashana (incompatible diet) f) According to the capacity of weakening the digestive power: AtiSnigdhaSevana (excessive oily diet)and AtiRukshaSevana (excessive coarse dry diet) g) Faulty dietary habits: Akalabhojana (untimely eating) , AntarodakaPana (drinking of excess water during meal) , Kala Anashana (avoiding the diet in proper time and Visamashana. h) Miscellaneous: AnnahinaMadya (Alcohol without eating) , MadyaSevana (alcohol drinking) and GorasaSevana (milk products) ViharajaHetu 20 : Proper Viharas are to be followed to maintain the good health. The regular habits of eating, sleeping and excretion must be followed.If this is not followed regularly, the whole functioning of the body will be disturbed and in long run, they will cause the disturbances of the equilibrium of Pitta and digestion, which

Volume- 2, Issue- 5 IRJAY 56 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 ultimately will lead to Amlapitta . AcharyaKashyapa has mentioned that the causative factors may be Vegadharana , Diwaswapna after intake of bhojana , excessive Snana, and Avagahana AtiSnat (Taking excessive bath), AtiAvagahanat (Excessive swimming), Bhuktwabhuktwadiwasvapna (Sl eeping in day time after meals), VeganamDharanam (Suppression of natural urges) and ShayyaPrajagaraihi (Improper sleeping schedule) ManasikaHetu 21 [Psychological factors]: Mental factors also play a great role in maintaining the health. Abnormal mental factors such as Chinta – (worries, anxiety etc.), Shoka – ( Sad), Bhaya – (Fear), Krodha – (Angar), Moha - Over attachment etc. would affect the physiology of digestion. Either there would be a lesser secretion of the digestive juice or secreted at improper times and sometimes it may be secreted in excessive quantity. All these conditions lead to Agnimandya , which further produces Amlapitta . The modern science also have established that gastritis is nothing but is thesyndrome resulting from stress and strain which shows the important role played bypsychogenic factors in the production of Amlapitta . An abnormal Manobhavas of aperson in terms of anxiety,anger, greediness, etc. would affect the Pachanakriya. These factors tend to affect the secretion of the gastric juice and by that; they are disturbing the homeostasis, which interns Amlapitta . Psychosomatic and cognitive factors are important in the evaluation of patients with chronic dyspepsia. The psychiatric hypothesis holds that the symptoms of dyspepsia may be due to depression, increased anxiety, or a somatisation disorder. Epidemiological studies suggest there is an association between functional dyspepsia and psychological disorders. Symptoms of neurosis, anxiety, hypo-chondriasis, and depression are more common in patients being evaluated for unexplained gastrointestinal complaints than in healthy controls. Comparisons of functional and organic dyspepsia have demonstrated that patients with functional dyspepsia are less likely to have decreased stress or anxiety at 1-year follow-up after being reassured of having no serious disease. This suggests that functional dyspepsia symptoms are longlasting, compared with those of organic dyspepsia, and that the emotional ties are strong 22 . Anxiety is also associated with functional dyspepsia. In some people, it

Volume- 2, Issue- 5 IRJAY 57 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 appears before the onset of gut symptoms; in other cases, anxiety develops after onset of the disorder, which suggests that a gutdriven brain disorder may be a possible cause. Although benign, these symptoms may be chronic and difficult to treat 23 . AgantujaHetu : Amlapitta is definitely caused by over use of certain drugs. Over use ofNSAIDs and anticoagulants cure one disease but it can produce gastritis. Ayurvedic drugs, especially Ashodhita and faulty Rasa Aushadhi may cause Amlapitta . Even Ushna , Tikshna drug if used excessively, without proper assessment of disease for along period may produce Amlapitta . Similarly Panchakarmas with Hinayoga or Mithyayoga or Atiyoga lead towards many diseases by attacking on Agni , hence Amlapitta also can be seen as an Upadrava of some other diseases like chronic Vibandha , Arsha , Ajirna and Pandu . In this group constant and excessiveconsumption of alcohol, tobacco, beverages, smoking, or other irritant stuffs etc. are taken 24 . These substances cause local irritation in the stomach, which in turn secretes more gastric juices, and infection of the stomach, which may be grouped under this category Other causes: Also Desha , Kala , Ritu takes a great extent in the causation of Amlapitta. Deshaprabhava : According to AcharyaKashyapa the disease is more predominant in AnupaDesha comparing to other Desha, because of Kapha provocating nature 25 . Inthe line of treatment he gives its importance to change the place in untreated cases 26 Kalaprabhava [Influence of Time] : Amlapitta is a ChirakariVyadhi. This Kala ortime factor is responsible for physiological/anatomical structure of the body i.e. Balyavastha , Madhya and Vriddhavastha .The disease is more prevalent in middle age due to dominancyof Pitta 27 .Also Paittika disorders are more prevalent during Pitta provocation time that is during mid-day and mid-night. RituPrabhava [Seasonal Flutuations] 28 : This group includes disease which is causedby the meteorological changes such as variations in atmospheric temperature, hot or cold, humidity or dryness, rain and winter, incidental to changes in the seasons.Rainy season is responsible for Amlavipaka of water (due to weakened digestion power and vitiation of Vata and other Doshas ) and eatables, which in turn vitiates Pitta and Kapha .

Volume- 2, Issue- 5 IRJAY 58 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 Genetic Factors: Acidity is seen mostly in persons with blood group ‘O’ 29 andfamilies with such blood group prove relations of genetic factor, probably the blood group modifies the oxyntic cell population. In Ayurveda , Pitta Prakriti persons are also more susceptible for the process of aggravation of the diseases. Trauma: Certain things in diet can damage the gastric mucosa. The intake of spicyfood, solid matter, alcohol and other irritating things may damage the pyloric antrum and lesser curvature of stomach. Drugs: Many medications cause dyspepsia, including aspirin, non-steroidal antiinflammatory drugs(NSAIDs) 30 , antibiotics (metronidazole , macrolides), diabetes drugs (metformin, Alpha-glucosidase inhibitor, amylin analogs, GLP-1 receptor antagonists), antihypertensive medications (angiotensin converting enzyme [ACE] inhibitors, Angiotensin II receptor antagonist), cholesterol-lowering agents (niacin, fibrates), neuropsychiatric medications (cholinesterase inhibitors [donepezil, rivastigmine]), SSRIs (fluoxetine, sertraline), serotoninnorepinephrine-reuptake inhibitors (venlafaxine, duloxetine), Parkinson s drugs (dopamine agonist etc. ) corticosteroids, estrogens, dioxin, iron, and opioids 31 . Smoking and Alcohol 32 : Alcohol consumption and cigarette smoking both have a close relationship with peptic ulcer diseases. Chronic active gastritis is reportedly associated with chronic alcohol ingestion. Alcohol can damage the gastric mucosa and produces ulcer.Smoking (Nicotine) has been responsible to produce the amount of prostaglandin E 2 in gastric mucosa.The reduction of mucus secretion, increase in leukotriene B 4 level, increased activities of inducible nitric oxide synthase, xanthine oxidase and myeloperoxidase, and the expression of adhesion molecules in the gastric mucosa accompanied such potentiating effects. Substances other than nicotine in cigarette smoke may also contribute to the above effects. Predisposing factors: Energetic and ambitious young men are more prone toduodenal ulcer formation due to irregular and hurried meals and they tend to over work. Emotional stresses and acute anxiety leads to predispose duodenal ulcer. Such types of predisposing factors are found in certain occupations like in bus drivers,

Volume- 2, Issue- 5 IRJAY 59 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 waiters, business executives and medical practitioners etc Endocrine factors: Since peptic ulceration is more common in males it has beensuggested that estrogenic hormones may protect against the development of ulcer. The effect of emotional and other stress factors are also transmitted to the stomach by way of the pituitary adrenocortical axis. Moreover, specific endocrine diseases or conditions have been proved to be associated with peptic ulcerations e.g. excessive adrenocortical activity, hyper parathyroidism, Zollinger Ellison syndrome, multiple adenoma syndromes. Infection: Helicobacter pylori play a significant role in the pathogenesis of pepticulcer disease.Indeed, infection with Hpylori is associated with a greatly increased risk of duodenal and gastric ulceration, from 95 to 100% of patients with duodenal ulcer and 75 to 85% of patients with Gastric ulcer harbour the organism.The infection of the stomach also may be grouped under this category Up to 85% of people infected with H. pylori never experience symptoms or complications 33 Acute infection may appear as an acute gastritis with abdominal pain (stomach ache) or nausea. Colonization of the stomach by H. pylori can result in chronic gastritis, an inflammation of the stomach lining, at the site of infection. Helicobacter cysteine-rich proteins (Hcp), particularly HcpA (hp 0211), are known to trigger an immune response, causing inflammation 34 . Chronic gastritis is likely to underlie H. pylori -related diseases 35 . The comprehensive list of these etiological factors with the references is being presented here under. In Ayurveda Paryushitanna , Dushtannasevana is given as the causative factor of Amlapitta . This type of Dushtanna may have an infected property Gastritis syndrome 36 : Gastritis is inflammation of the gastric mucosa of the stomach. Depending on the cause, gastritis may persist acutely or chronically and may coincide with more serious conditions such as atrophy of the stomach. Causes: Bacterial infection (most often by Helicobacter pylori and other Helicobacter spp.) Fungal infection (most often in people with immunodeficiency),Parasitic infection,Bile reflux, NSAIDs,Cigarette smoke,Autoimmune disorders,Excessive alcohol consumption,Excessive caffeine

Volume- 2, Issue- 5 IRJAY 60 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 consumption,Certain allergens,Certain types of radiationand stomach injury and stress Hyperacidity 37 : Hyperacidity or acid dyspepsia simply means increase of acidity in the stomach. The human stomach secretes hydrochloric acid which is necessary for the digestion of food. When the stomach contains an excessive amount of hydrochloric acid, then the condition is called as hyperacidity or acid dyspepsia Triggering factors for Hyperacidity: Excessive intake of oily, spicy and salty food , Excessive intake of sour foods that contain high acid content, going to bed immediately after a heavy meal, too much mental stress and worries, taxing the mind excessively consumption of alcohol smoking and drug addiction addictive consumption of coffee too much intake of therapeutic drugs like aspirin diseases of the digestive organs such as the stomach, intestines, gallbladder or the pancreas peptic ulcer and Spinal lesions. Correlation between Hyperacidity, Gastritis,Dyspepsia and Amlapitta: Amlapitta Hyperacidity Gastritis Dyspepsia Hritdaha Heart Burn Heart Burn Heart Burn HritShoola Chest pain Udaradhmana Abdominal distension upperabdominal discomfort Upper abdominal pain Amlodgara Sour belching Belching Belching Amlotklesha Acid refluxes of the food taken upper abdominal fullness Utklesha Nausea Nausea Nausea Aruchi Loss of appetite Anorexia Loss of appetite Chhardi Vomiting Vomiting From the above table similarity between Hyperacidity, Gastritis,Dyspepsia and Amlapitta can be illustrated.It is very much essential to co-relate the diseases which are mentioned in classics with the recent disease of Modern medicine for a better comprehension of the pathogenesis. In modern medical literature, some technical terms have been used to indicate an abnormal condition resembling to Amlapitta . These terms either explain the pathological

Volume- 2, Issue- 5 IRJAY 61 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 condition of the disease or explain the characteristics of the disease It is very difficult to correlate Amlapitta with a single disease of Modern science. Following is the opinion of scholars. Table 2 Year Scholar Disease correlated 1962 Tripathi Gastritis Syndrome 1968 Fourth National Seminar on Ayurveda a) Sri PurushottamVaidya b) Vd. VishwanathDwivedi Acute Gastritis Chronic Gastritis 1982 Tripathi Non-ulcer dyspepsia 1986 HarinathJha Hyperacidity A conference of vaidyas held at Hrishikesh, has decided the conditions like Hyperacidity, Gastritis, Gastric atropy, Gastric and Peptic ulcer, Gastric carcinoma etc., can be included in Amlapitta ( UtkaliniNaik et. al 2006). Conclusion: The conclusion of this article is that many digestive disorders are included in Amlapitta . To prevent from Amlapitta change in diets habits & life style. References: 1 Agnivesha, CharakaSamhita with „Ayurveda-Deepika‟ Commentary of Chakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009, Ch.Su.1/60 Ibidem(1),Ch.Su.1/60 2 Sushruta,edited by Vd.JadavjiTrikamjiAcharya,Sushrutasamhita,Dalhana commentary, ChaukhambaSurbharatiPrakashan, Varanasi 2010, Su.Su.21/11,Pg.no.101 Ibidem(10),Su.Su.21/11,Pg.no.101 3 Agnivesha, CharakaSamhita with „Ayurveda-Deepika‟ Commentary of Chakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009, Ch.chi.15/47 Ibidem(1)Ch.chi.15/47

Volume- 2, Issue- 5 IRJAY 62 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 4 Agnivesha, CharakaSamhita with „Ayurveda-Deepika‟ Commentary of Chakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009, Ch.chi.15/47 Ibidem(1)Ch.chi.15/47 5 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Su.1/110,Pg.no.22. 6 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Su.25/40.Pg.no.131. 7 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Su.26/44(3),Pg.no.144. 8 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Su.26/103,Pg.no.151. 9 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Su.27/25,Pg.no.155. 10 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Chi.7/148,Pg.no.457. 1111 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Chi.15/47,Pg.no.517. 12 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Su.20/14,Pg.no.115. 13 Agnivesha, CharakaSamhita with ‘Ayurveda-Deepika’ Commentary ofChakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009,Ch.Chi.12/52,Pg.no.487.

Volume- 2, Issue- 5 IRJAY 63 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 14 Sushruta,edited by Vd.JadavjiTrikamjiAcharya,Sushrutasamhita,Dalhana commentary, ChaukhambaSurbharatiPrakashan, Varanasi 2010,Su.Su.42/9(3),Pg.no.185 15 Sushruta,edited by Vd.JadavjiTrikamjiAcharya,Sushrutasamhita,Dalhana commentary, ChaukhambaSurbharatiPrakashan, Varanasi 2010,Su.Su.21/27,Pg.no.104 16 Pt. Hemraja Sharma, Vidyotini Hindi commentary, KashyapaSamhita, Chaukhamba Sanskrit Sansthan, Varanasi (2009),Kash.khi.16/6,pg.no.335 17 Harita,Vd.JayminiPandey,Haritasamhita with Nirmala Hindi commentary,ChukhambaVishvabharti,Varanasi 2010,Ha.24/2,Pg.no.384 18 Madhavanidanam, Madhavacharya, ‘Madhukosha’ Vyakhya by AcharyaYadunandanaUpadhya, ChaukhambaPakashan, Varanasi (2004), part 2,51/1,page no.170 19 Pt. Hemraja Sharma, Vidyotini Hindi commentary, KashyapaSamhita, Chaukhamba Sanskrit Sansthan, Varanasi (2009),Kash.khi.16 Ibidem(12),Ka.Khi.16 &Ibidem(14),M.N.51 20 Pt. Hemraja Sharma, Vidyotini Hindi commentary, KashyapaSamhita, Chaukhamba Sanskrit Sansthan, Varanasi (2009),Kash.khi.16 Ibidem(12),Ka.Khi.16 21 Agnivesha, CharakaSamhita with „Ayurveda-Deepika‟ Commentary of Chakrapanidatta,edited by VaidyaJadavajiTrikamjiAcharya, Ed. Reprint, ChaukhambaSurbharatiPrakashan, Varanasi, 2009, ,Ch.Vi.2/9,Pg.no.238 Ibidem(1),Ch.Vi.2/9,Pg.no.238 22 Pajala, M; Heikkinen, M (2006). "A prospective 1-year follow-up study in patients with functional or organic dyspepsia: changes in gastrointestinal symptoms, mental distress and fear of serious illness". Aliment PharmacolTher. 24 : 1241–1246. 23 Talley NJ, Ford AC (Nov 5, 2015). "Functional Dyspepsia". N Engl J Med (Review). 373 (19): 1853–63. 24 Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965. 25 Pt. Hemraja Sharma, Vidyotini Hindi commentary, KashyapaSamhita, Chaukhamba Sanskrit Sansthan, Varanasi (2009),Kash.khi. 16/44,pg.no.338,Ibidem(12),Ka.Khi.16/44,pg.no.338 26 Pt. Hemraja Sharma, Vidyotini Hindi commentary, KashyapaSamhita, Chaukhamba Sanskrit Sansthan, Varanasi (2009),Kash.khi.16 Ibidem(12),Ka.Khi. 16/45,pg.no.338,Ibidem(12),Ka.Khi.16/45,pg.no.338 27 Agnivesha, CharakaSamhitawithVidyotini-Hindi commentaryedited byPt.KasiNathPandaiya and Dr.GorkhanathChaturvediChokhabhaBharati Academy ,Varanasi, reprinted 2014 ,ch. viman.8/122 pp-781

Volume- 2, Issue- 5 IRJAY 64 IRJAY, vol- 2, issue-5, Sept-Oct:2019; 52-64 28 Agnivesha, CharakaSamhitawithVidyotini- Hindi commentary edited by Pt.KasiNathPandaiya and Dr.GorkhanathChaturvediChokhabhaBharati Academy ,Varanasi, reprinted 2014 ,ch.su.6/34.pp-143. 29 Influence of blood group and secretor status on gastric acidity The American Journal of Digestive diseases Vol.14,Issue 6,pp-380-384 authors G.P.Jori,C.Balestrieri 30 Assessing NSAID prescription use as a predisposing factor for gastroesophageal reflux disease in a Medicaid population. Phar Res 2001 Sep;18(9):1367-72.pupmed authersKotzan J, Wade W, Yu HH. 31 Ford AC, Moayyedi P (2013). "Dysepsia" . BMJ. 347 : f 5059. doi : 10.1136/bmj.f 5059 . PMID 23990632 . 32 Alcohol drinking and cigarette smoking: a "partner" for gastric ulceration.pupmed Zhonghua Yi XueZaZhi (Taipei). 2000 Dec;63(12):845-54 Authors Ko JK 1 , Cho CH . 33 Bytzer P, Dahlerup JF, Eriksen JR, Jarbøl DE, Rosenstock S, Wildt S (April 2011). "Diagnosis and treatment of Helicobacter pylori infection" . Dan Med Bull. 58 (4): C 4271. PMID 21466771 .Archived from the original on 5 January 2014.Retrieved 7 August 2013. 34 Dumrese C, Slomianka L, Ziegler U, Choi SS, Kalia A, Fulurija A, Lu W, Berg DE, Benghezal M, Marshall B, Mittl PR (May 2009). "The secreted Helicobacter cysteine-rich protein A causes adherence of human monocytes and differentiation into a macrophage-like phenotype" . FEBS Letters . 583 (10): 1637–43. 35 Shiotani A, Graham DY (November 2002). "Pathogenesis and therapy of gastric and duodenal ulcer disease". Med. Clin. North Am. 86 (6): 1447–66, 36 Gastritis sources:Adams,PF,HendershotGE,MaranoMA.Current estimates from the National Health Interview survey,1996.National Centre for Health Statistics.Vital Health Stat.1999,10(200) and National Centre for Health Statistics.(Technical Appendix from Vital Statistics of United States:Mortality).2002.Hyatttsville.Maryland:2004 37 www.Ayushveda.com

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