SURVEY STUDY ON EFFECT OF AHARA AND VIHARA IN …

i

“SURVEY STUDY ON EFFECT OF AHARA AND VIHARA IN

AMLAPITTA’’

By

DR. RAKSHITH K.R

Dissertation Submitted To

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

In Partial Fulfillment of the Requirements for the Degree of

AYURVEDA VACHASPATI (M.D. AYURVEDA)

In

SWASTHAVRITTA AND YOGA

Under The Guidance Of

Dr. SHIVAKUMAR M.D. (AYU)

Associate Professor

Department of Post Graduate Studies in Swasthavritta and Yoga

SDM College of Ayurveda & Hospital, Hassan

DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITTA

AND YOGA

SRI DHARMASTHALA MANJUNATHESHWARA

COLLEGE OF AYURVEDA & HOSPITAL,

HASSAN –573 201, KARNATAKA

2017

ii

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “Survey Study On Effect Of

Ahara and Vihara In Amlapitta” is a bonafide and genuine research work carried out by

me under the guidance of Dr. Shivakumar, M.D.(AYU), Associate Professor, Department

of Post Graduate Studies in Swasthavritta and Yoga, SDM College of Ayurveda, Hassan -

573 201, Karnataka.

Date: Signature of the candidate

Place: Hassan (Dr. Rakshith K.R)

iii

DEPARTMENT OF POST-GRADUATE STUDIES IN


SRI DHARMASTHALA MANJUNATHESHWARA

COLLEGE OF AYURVEDA & HOSPITAL, HASSAN –573 201

(Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka)

Certificate

This is to certify that the dissertation entitled “Survey study on effect of

Ahara and Vihara in Amlapitta” is the bonafide record of research work

conducted by Dr. Rakshith K.R under my direct supervision and guidance as a

partial fulfillment for the award of the degree of Ayurveda Vachaspati (M.D.

Ayurveda) in Swasthavritta and Yoga.

The candidate has fulfilled all the requirements of ordinances laid down in

the prospectus of Rajiv Gandhi University of Health Sciences, Bangalore,

Karnataka, for the award of Degree of Ayurveda Vachaspati (M.D. Ayurveda) in

Swasthavritta and Yoga.

I am fully satisfied with his work and recommend this thesis to be

submitted for adjudication.

Date: Guide:

Place: Hassan Dr. Shivakumar M D (AYU)

Associate Professor,

Department of Swasthavritta and Yoga

S.D.M. College of Ayurveda, Hassan

iv

DEPARTMENT OF POST GRADUATE STUDIES IN


SRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF AYURVEDA

& HOSPITAL, HASSAN –573201

(Affiliated to Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka)

ENDORSEMENT BY THE HOD AND HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “SURVEY STUDY ON EFFECT OF

AHARA AND VIHARA IN AMLAPITTA” is the bonafide record of research work

conducted by “Dr. RAKSHITH K.R” under the guidance of Dr. SHIVAKUMAR,

Associate Professor, Department of Post Graduate Studies in Swasthavritta and Yoga,

SDM College of Ayurveda, Hassan –573 201, Karnataka.

Dr. M B Kavita MD (AYU ) Dr. Prasanna N Rao, M.S.(AYU),PhD

Associate Professor and HOD Principal

Department of P G Studies in Swasthavritta SDM College of Ayurveda, Hassan

And Yoga Karnataka

SDM College of Ayurveda, Hassan, Karnataka

Date: Date:

Place: Hassan Place: Hassan

v

COPYRIGHT

Declaration by the candidate

I hereby declare that Rajiv Gandhi University of Health Sciences, Bangalore,

Karnataka shall have the rights to preserve, use and disseminate this dissertation /

thesis in print or electronic format for academic/ research purpose.

Date: Signature of the candidate.

Place: Hassan (Dr. RAKSHITH K.R)

© Rajiv Gandhi University of Health Sciences, Karnataka

vi

ACKNOWLEDGEMENT

My gratitude, which is the mother of all virtues and most capital of all duties, has all

there order and diligence to all those who graciously involved in this venture of mine. There

is much greatness of mind in acknowledging a good turn, as in doing it.

I humbly, seek this opportunity to bow my head to the feet of The Almighty for

showering His blessings and empowering me to this eventful outcome without any

impediments.

Words are not enough to express my gratitude and indebt to the sacrifices of my

beloved and respected parents Shri. Ramaprasad and Smt. Rajalakshmi who are the cause

for me to take this noble profession and shape me into what I am today.

I pay my respectful salutations to His Holiness Rev. Sri Veerendra Heggadeji,

founder father of Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital,

Hassan and fountainhead of educational movements, for his divine blessings in disguise and

who has been kind enough to provide me an opportunity to study and render my service in

this esteemed institution.

My vocabulary falls short of suitable words to express my recondite sense of

indebtedness to my compassionate teacher Prof. Prasanna Narasimha Rao, Principal and

Prof. Gurdeep Singh. Director, P.G. Board of Studies, they have been guiding force and

instrumental in all the proceedings of my postgraduate study and stood as an excellent

encouraging stanchion in all strides in accomplishing this meticulous effort.

It is beyond the reach of my language to inscribe the profound respect and devotion

towards my guide and guru Dr. Shivakumar for his constant support, timely guidance and

valuable suggestions to get this work done successfully.

vii

I express my sincere gratitude to my guru Dr. M. B. Kavita H.O.D., Dept. of

Swasthavritta & Yoga as without her guidance and support, this work would not have

completed.

I am extremely grateful to Dr. T.B. Tripathy, Professor Dept. of Swasthavritta &

Yoga for his constant support and guidance during my thesis work. I whole heartedly thank

Dr. Bargale Sushant Sukumar, Dr. Gurubasavaraj Yalagachin Lecturers Department of

Swasthavritta & Yoga, SDM Ayurveda College and Hospital, Hassan for their timely and

valuable advises.

Having an able team of members with distinct characters is necessary to keep the

journey flawless. It was my privilege to get such an able team in my friends, my classmates,

Dr. Dheeraj Kumar Tyagi, Dr. B Mahesh Raju, Dr. Vijeth Kumar L A, Dr. Sreeharsha N,

Dr. Asha S A, and Dr. Manjunath Kotiyal I would like to express my deepest gratitude to all

of them for they made me understand the true value of friendship. The whole work would

have been futile without their support and whole hearted cooperation.

I am very much thankful to my seniors, Dr. Abhishek Magotra, Dr. Arun K,

Dr. Sandeep, Dr. Shibu Issac , Dr. Arathi, Dr. Harish Deshpande, Dr. Saurabh Agarwal,

Dr. Arun, Dr. Jyothi Jalakoti, Dr. Haripriya, Dr. Deepuram, Dr. Rajesh Chandran without

their able guidance it would have been an impossible task to finish this work.

It was my privilege and pleasure to have such able and wonderful juniors

Dr. Venu s Achar, Dr. Harshita K J, Dr. Siddarth Yadav, Dr. Anjali Pant, Dr. Lakshmi

Varma, Dr. Pooja Hassan, Dr. Sonia, Dr. Swathi Sharma, Dr. Aparajitha , Dr. Sahana,

Dr. Swathi, Dr. Anjana, Dr. Veekshan Shetty Dr. Sushil Kumar, Dr. Sagar k kora, Dr.

Madan kumar and Dr. Vivek Aradhya for their support and encouragement throughout the

research work.

viii

Words are not enough to express my gratitude towards my dearest Brother Panith

K.R, who has always been with me in my ups and downs and has been a constant inspiration.

I express my gratitude towards grandparents Smt.Seetalakshmamma, Shri

Srinivasamurthy and Smt.Seetalakshmamma, Shri Keshavamurthy whose support has

proved to be in par with my parents.

I once again extend my heartfelt gratitude to each and every person who has

directly or indirectly helped me in this study.

Dr. Rakshith K R

ix

ABSTRACT

“SURVEY STUDY ON EFFECT OF AHARA AND VIHARA IN AMLAPITTA”

BACKGROUND

The period of 21st century is regarded as the era of modern technology and tough

competition due to which eating habits and lifestyle is totally changed. Indulgence of food

articles which are incompatible combinations, spoiled, sour or causing burning sensation and

other food and drinks which increases Pitta dosha produces Amlapitta in person, whose Pitta

dosha is already aggravated. The man of this era is becoming prey to series of life-style

disorder which are much more bothering than the infective diseases. The altered life-style

pattern like night shifts, mental stress, addictions etc. is the major risk factors for Amlapitta.

Medicine alone cannot bring the desired therapeutic effect without Pathya. On the other hand

if Pathya is observed there will be no need of medications. Hence it is necessary to educate

the people regarding dos and don'ts about diet and lifestyle as it plays a major role in

manifestation of Amlapitta.

OBJECTIVE

To study the effect of Ahara and Vihara in Amlapitta.

METHODOLOGY

Simple Random Sampling - Alternate method was used in this study. It was

questionnaire based survey study on 345 subjects from OPD and IPD of Sri Dharmasthala

Manjunatheshwara College of Ayurveda and Hospital and subjects from in and around

Hassan city who fulfils the inclusion and exclusion criteria, were selected and set of

questionnaire containing 45 questions which contains Aharaja and Viharaja Nidanas of

Amlapitta were given to them and their responses regarding the study was taken.

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INCLUSION CRITERIA

Diagnosed subjects of Amlapitta.

Individuals of age group between 16 to 60 years.

EXCLUSION CRITERIA

Subjects who are not willing to participate.

Drug induced Amlapitta cases.

Pregnant women.

Subjects with Systemic disorders.

RESULT

Chi square and odds ratio shown risk in the manifestation for Amlapitta.

CONCLUSION

Based on result it can be concluded that there is effect of Ahara and Vihara in

manifestation of Amlapitta.

KEYWORDS

Amlapitta, ahara, vihara, hyperacidity, odds ratio, chi square.

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LIST OF ABBREVIATIONS

1. M N - Madhava Nidana

2. K S - Kashyapa Samhita

3. S N - Siddanta Nidana

4. B R - Bhaishajya Ratnavali

5. H S - Harita Samhita

6. Y R - Yoga rathnakara

7. S S - Susruta Samhita

8. A H - Astanga Hridaya

9. A S - Astanga Sangraha

10. B S - Bhela Samhita

11. C S - Charaka Samhita

12. Ch. Chi - Charaka Chikitsa sthana

13. B P - Bhava Prakasha

14. Vij - Vijayarakshita

15. C D - Chakradatta

16. Ckp - Chakrapani

17. S G S - Sri Gananatha Sena

18. Van - Vangasena

19. K C - Kaya Chikitsa

20. Ch Su - Charaka Sutrasthana

21. Hcl - Hydrochloric acid

22. NSAID - Non-steroid anti-inflammatory

drug

23. PGs - Prostaglandins

24. CCK - Cholecystokinin

25. GERD - Gastrooesophageal reflux

26. OD - Once daily

27. PUD - Peptic ulcer disease

28. GU - Gastric ulcer

29. DU - Duodenal ulcer

30. BAO - Basal acid output

xii

CONTENTS

No Chapters Page

1. Introduction 1-4

2. Aims and Objectives 5-6

3. Review of Literature 7-49

4. Materials and methods 50-54

5. Observation and results 55-100

6. Discussion 101-116

7. Conclusion 117-120

8. Summary 121-123

9. References 124-131

10. Annexure 132-141

xiii

LIST OF TABLES

Sl No Contents Page No.

1. Apathya according to various authors 3-4

2. General Nidanas of Amlapitta 23

3. Types of Amlapitta 26

4. Samprapti Ghataka of Amlapitta 29

5. Describe about Aggressive and Protective factors in PUD 46

6. Differentiating Chronic Gastric Ulcer from Duodenal Ulcer 47

7. How frequently you use Garlic in a week? 56

8. How frequently you use Ginger in a week? 57

9. How frequently you use Sour taste Food in a week? 58

10. How frequently you use Spoiled Food in a week? 59

11. How frequently you use Spicy Food in a week? 60

12. How frequently you use Horse gram in a week? 61

13. How frequently you use Flour items in a week? 62

14. How frequently you use Green Chili in a week? 63

15. How frequently you use Sour Curd in a week? 64

16. How frequently you use Red Chili in a week? 65

17. How frequently you use New Jaggery in a week? 66

18. How frequently you use Salty Food in a week? 67

19. How frequently you use Domestic meat with Honey in a

week?

68

20. How frequently you use Black Gram in a week? 69

21. How frequently you use Pickle in a week? 70

22. How frequently you use Fish with Curd in a week? 71

23. How frequently you use Fish with Milk in a week? 72

24. How frequently you use Horsegram with Curd in a week? 73

25. How frequently you use Milk with Raddish in a week? 74

26. How frequently you use Salt with Milk in a week? 75

27. How frequently you use Pork with Curd in a week? 76

28. How frequently you use Sour Fruits with Milk in a week? 77

xiv

LIST OF FIGURE

29. How frequently you use Leafy Vegetables with Butter in a

week?

78

30. How frequently you use Banana with Curd in a week? 79

31. How frequently you use Aerated Drinks in a week? 80

32. How frequently you use Heated Curd Preparations in a

week?

81

33. Do you have Habit of eating food irrespective of hunger? 82

34. Do you have Habit of Day sleep? 83

35. Do you have Habit of Alcohol Consumption? 84

36. Do you have Habit of Smoking? 85

37. Do you have Habit of excess intake of Tea or Coffee? 86

38. Do you have Habit of Skipping Meals? 87

39. Do you have Habit of drinking excess water soon after food? 88

40. Do you have Habit of Betal nut with tobacco? 89

41. Do you have Habit of adding extra salt or spice for food you

eat?

90

42. Do you have Habit of Hot atmosphere? 91

43. Do you have Habit of Bathing soon after having food? 92

44. Do you have Habit of Suppressing Natural urges? 93

45. Do you have Habit of Sleeping soon after having food? 94

46. Do you have Habit of Excess bath or tub bath 95

47. Do you have Habit of Drinking water between the meal? 96

48. How Often you express your Anger? 97

49. How Often you express your Stress? 98

50. How Often you express your Depression? 99

51. How Often you express your Anxiety? 100

Sl No Contents Page No.

1 Composition of Gastric juice 34

INTRODUCTION

SURVEY STUDY ON EFFECT OF AHARA AND VIHARA IN AMLAPITTA Page 1

INTRODUCTION

INTRODUCTION


INTRODUCTION

The people now days are living in an era of fast growing technology and tough

competition. The man of this era is becoming more susceptible to series of life style

disorders. The altered life style activities like having fried food, night shifts, mental stress

and addictions etc are the major risk factors for Amlapitta which is emerging as a

common lifestyle modification disorder. Amlapitta is one of the commonest Annavaha

Srotas Vyadhi,1 caused by vitiation of Tridosha. When any of Dosha causes Mandagni it

leads to Vidagdhajirna manifesting as Amlapitta.2 Excess intake of sour food containing

high acid levels and sedentary life style with little or no physical activity like exercise has

also been the known culprits.

Ayurveda gives a complete look into the life style of a person starting from his or

her personality to the daily food habits. The science teaches how to live in healthy way,

importance of both preventive and therapeutic aspects of medicines.

In Ayurveda the Nidanas mentioned for Amlapitta can be classified into

Aaharajanya, Vihaarajanya and Maanasika Bhavajanya all of which can be correlated to

etiologies mentioned under life style changes. The need for hour is required to find out

ways by which we can manage the condition hyper acidity through dietary and life style

modifications rather than medicines.

Need For the Study

A population-based study, using a validated questionnaire, found that 58.7% of

the population has heartburn or acid regurgitation at least once during the course of a year

and that 19.8% experience symptoms at least once weekly.3 Hence it is necessary to

INTRODUCTION


educate the people about do’s and don'ts about diet and lifestyle as it plays a major role in

causing Amlapitta.

Due to work load, stress, poor eating habits, not following dinacharya,

ratricharya, ritucharya and sadvritta leads to so many diseases and as well tridosha

prakopa, which are causing so many diseases of new origin. As we know importance of

good lifestyle and healthy eating is require for a healthy and fruitful living. Amlapitta is a

disorder which is related with Ahara and Vihara factors. So here an effort was made to

study the effect of Aharaja and Viharaja Nidanas which are mentioned in classics which

cause Amlapitta.

The following table showing some of the common Aharaja and Viharaja Nidanas

mentioned in classics which induce Amlapitta.

Table no. 1 . Apathya according to various authors

Apathya Ahara K S9

B R10

Y R11

Virrudda + + -

Pitta Prakopakara _ + -

Kullatta + + +

Lavana _ + +

Amla + + +

Katu _ + +

Gurvanna + + +

Dadhi _ + +

INTRODUCTION


Madhya + + +

Adhyasana + _ -

Ajirna + _ -

Pistanna + _ -

Abhishyandi bhojana + _ -

Ati Ushna + _ -

Ati Ruksha + _ -

Ati Snigdha + _ +

Apathya Vihara

Vami vegadharana _ + -

Vegana dharana + _ -

Divaswapna + _ -

Atisnana + _ -

Ati avagahana + _ -

Antharodaka pana + _ -

AIMS & OBJECTIVES


AIMS

&

OBJECTIVES

AIMS & OBJECTIVES


AIMS AND OBJECTIVES

The present survey study entitled “Survey study on effect of Ahara and Vihara in

Amlapitta” was carried out with following aims and objectives.

1. To study the effect of Ahara and Vihara in Amlapitta.

REVIEW OF LITERATURE


REVIEW

OF LITERATURE




AMLAPITTA:

For the better understanding of the subject, it is necessary to find out its historical

background, which gives a concrete understanding in the development of the concept of

the disease from time to time.

Charaka Samhita:

In Charaka Samhita, at nine different places reference regarding Amlapitta can

been found, however the disease has not been listed among the diseases in Ashtodariya

chapter.

1. While describing the indication of milk Amlapitta has been listed. 4

2. The word “Amlaka” has been included in the list of 40 Pittaja Nanatmaja

vyadhis. 5

3. Among the chief Agrya Dravyas “Kulattha” considered as the chief causative

factor for Amlapitta. 6

4. Excessive use of Lavana Rasa causes Amlapitta and due to intake of more Amla

Rasa there is burning sensation in Kanta, Uraha and Hridaya. 7

5. Intake of Viruddha Anna is responsible for diseases like sterility, blindness,

Visarpa, Amlapitta etc. 8

6. Raja Masha is the pacifying factor for Amlapitta. 9

7. Mahatikta Ghrita has been indicated in Amlapitta. 10

8. While describing the Grahani Dosha pathogenesis of Amlapitta has been clearly

mentioned. 11



9. One of the many indications of Kansa Haritaki is Amlapitta. 12

Though in Charaka Samhita there is no mention of Amlapitta as a separate

disease, from the above reference it gives a clear cut indication regarding the Nidana,

Samprapti and management during this period.

Sushruta Samhita (1000 BC):

Description of Amlapitta as a disease or word is not found, but while describing

the disease caused due to excessive use of salt he has mentioned a disease called

“Amlika” 13

which is similar to Amlapitta.

Kashyapa Samhita (1000 BC):

Kashyapa Samhita 14

is the first textbook in which Amlapitta has been explained

as a separate disease entity. It contains not only the vivid description i.e. etiological

factors, signs, symptoms, complications and treatment, but also suggests changing the

place ( Deshantargamana), for the peace of mind when the habitat itself is a triggering

factor.

Bhela Samhita (1000 BC):

There is no description about Amlapitta.

Harita Samhita (1000 BC):



Amlapitta as a separate disease and its treatment is mentioned in Harita

Samhita.15

Here it is mentioned that, Guda is the causative factor and “Amlahikka” as a

special symptom for Amlapitta.

Vagbhatta:

Amlapitta has not been described as a disease entity but description of Paittika

Hridroga seems very nearer to Amlapitta.

Madhava Nidana (7th Century):

It is the first available textbook next to Kashyapa Samhita which has description

of Amlapitta along with clinical subtypes i.e. Urdhvaga and Adhoga Amlapitta.

Chakradatta (11th century):

Mentioned only Amlapittahara Yoga.

Vangasena (12th century):

Explained details of Amlapitta and its treatment in this textbook, Avipattikara

Choorna along with some other Yoga are also mentioned.

Sharangadhara Samhita (13th century):

Amlapittahara Yoga has been described along with etiopathology of the disease.



Basavarajiyam (15th Century):

Mentioned Amlapitta under 24 Nanatmaja Vyadhi of Pitta. Among the other

symptoms Swara Hinata, Jihva–vak Paridaha have been attributed to Amlapitta, which

have not been mentioned in other texts.

Bhavaprakasha (16th century):

Etiopathological factors similar as Madhava Nidana have been described. In

Bhavaprakasha, many recipes along with the Khanda Kushmanda Avaleha and Narikela

Khanda can be found.

Bhaishajya Ratnavali (18th century):

Some recipes for Amlapitta also mentioning of Soubhagya Suntimodaka and

Shunthi Khanda as an effective treatment along with Pathya - Apathya.

Yogratanakara (19th century):

Author of this textbook followed Madhava Nidana completely and also described

Avastha Vaisheshika Chikitsa along with Rasa Aushadhi.

DEFINITION AND ETYMOLOGY OF AMLAPITTA

Amlapitta is a combination of two words Amla and Pitta. Among these two words

the Amla denoted the Rasa (sour taste) and the Pitta denotes the Dosha involved in this

disease. The Pitta Dosha is bestowed with the function of digestion and metabolism.

Amla Rasa is considered as the Prakruta Rasa of Pitta 16

, where as other

authorities believe that Katu is the Prakruta Rasa of the Pitta and attains Amlata in



Vidagdhavasta.17

The disease where the natural Katu rasa of Pitta is replaced by Amlata

due to Vidagdhavastha can be called Amlapitta.

Definition:

Many definitions can be found in the textbooks of Ayurveda about Amlapitta.

According to Vijayarakshita, commentator of Madhava Nidana, Amlapitta means-the

Pitta which attains excessive Amlata because of Vidagdha Paka is called Amlapiitta.18

Other definition quotes Amlapitta as Pitta possessing excessive Amlata or the

excessive Amlaguna Udrikta Pitta.19

Srikanthdutta has defined Amlapitta as a disease

mainly due to vitiation of Pitta (Pachaka), but Kapha (Kledaka) and Vata vitiation may

be involved secondarily causing Gourava, Udgara, Klama etc.

Clinically Amlapitta can be defined as presence of Avipaka, Klama, Utklesha,

Amlodgara, Gourava, Hrit-Kantha Daha and Aruchi.[20]

So, Amlapitta is a condition

where Amlaguna of Pitta increases due to Samata causing Vidahadi condition.

Paryaya:

The paryayas (synonyms) of Amlapitta signify different aspects of it. Synonyms

of Amlapitta are as follows: 21

Prameelaka

Amlapitta

Pittavisuchika



Other synonyms of Amlapitta are Pittamla and Shuktata.22

The terms Amalaka

and Amleeka may be added as synonyms to the above for they imply the important

features of the disease.

Prameelaka:

The Pachyamana Vidagdha Annarasa immediately provokes Pittadi Dosha, there

by producing Aruchi, Mukha Vairasya, Praseka, and continuous Lavana Tiktamla

Udgara, Chardi, discolouration, emaciation, Hritshula, Sadana and restlessness. This

state is known as Prameelaka23

this term is mentioned under Kaphaja Vyadhi.

Amlapitta:

The implication of the term Amlapitta denotes the abnormal state of Pitta

especially in its Amlaguna.

Pittavisuchika:

This may pertain to both the types of Amlapitta i.e. Urdhvaga and Adhoga

Amlapitta, where their respective cardinal features are Urdhvaga Pravrutthi (Vamana)

and Adhapravrutthi (Atisara) of Pitta associated with burning sensation.

Pittamla:

This term would imply the sense of the term Amlapitta which is mentioned in

Amlapitta Chikitsa in Yogratanakara.

Shuktata:

Shuktata is mentioned as a synonym of Amlapitta in Kashyapa Samhita. 24



Amlaka:

It refers to one of the Nanatmaja Vyadhi of Pitta mentioned in the context of

Pittaja Nanatmaja Vyadhi.25

Amaleeka:

Means Amlodgara and would refer to one of the Lakshana of Samapitta.26

AGNI AND AHARA PAKA

For proper understanding of Amlapitta the knowledge of Agni and Ahara Pachana

Karma is essential and is presented below:

Agni:

Nearly all diseases included under Kayachikitsa are engendered due to impairment

of Kayagni.27

Even Amlapitta which is an Annavaha Srotodusti Vikara is caused due to

Ahiara Paka Vaigunya. Pitta, one of the trinity of Doshas is also spoken of as Agni for

the reason that this factor in the body has been stated to perform actions similar to fire.

28As stated elsewhere, Agni is generally held responsible for the conduct of Pakadi

Karma viz. Sarapaka in Amashaya and Pakwashaya, the separation of Sara from Kitta in

the Pakwashaya, 29

augmenting the action of Bhutagni, 30

thus rendering the digested

food fit for further chemo-thermal reaction described by Chakrapani as Anupaka 31

after

which follows the reactions in Dhatu Paripaka.

The two main aspects of Agni have been envisaged by all the authorities of

Ayurveda as:



[1] Koshtagni [Charaka], Pachakagni, Jataragni [Sushrutha], Pachakapitta [Vagbhata].

[2] Dhatwagni

The former is stated to be located between Amashaya and Pakwashaya.32

This

aspect of Pitta or Agni while performing all the digestive functions described in the

foregoing paragraph is also stated to lend support and augment the functions of other

Pitta elsewhere in the body including the Dhatwagni. There are four stages of Jatargni as

Sama, Vishama, Tikshna and Manda. 33

The Tridosha become involved due to the operation of different etiological factors on the

body leading to reciprocal influence between them.

Sama Agni:

In the equilibrium state of functioning of Tridosha, Jatargni is stated to function

normally. This state of its function has been described as Sama Agni. Jatargni ensures

complete digestion of food in scheduled time without any harm to the body. 34

Vishama Agni:

An erratic state of Agni arises, as a result of the influence of Vata in the condition

described as Vishama Agni. The Agni varies with periods of strong digestive power

alternating with loss / decreased digestive power. 35

Tikshna Agni:

The Agni in this state is excited by Pitta known as Tikshna Agni. In this state, Agni

digests even large quantities of food faster to the scheduled time. 36



Manda Agni:

This is a state in which Agni is considerably inhibited due to the dominance of

Kapha dosha. In this state, the Agni is unable to digest and metabolize even a less

quantity of food which is easily digestible in scheduled time. 37

Out of these, the Sama Agni is considered as the Samanya condition of the Agni

and the rest three as the Vaishamyas.

The Vaishamyata of Agni leads to improper digestion due to Vruddhi or

Kshaya of Agni in their Guna, Pramana and Karma. In Mandagni, the food will be

Apakwa. In case of Tikshna Agni, it will be Dagdhapaka and Pakwa-apakwa in case of

Vishamagni. All these lead to specific type of Ajeerna leading to formation of Ama, one

of the important causes for the further vitiation of the Annavaha Srotas and manifestation

of the disease Amlapitta.

Aharapaka:

The Aharapaka has got two phases:

1. Prathama Paka / Prapaka 38

2. Vipaka 39

Prathama Paka/Prapaka:

The preliminary phase of digestion or the first outcome of the Paka is known as

Prathama Paka. This commences from the introduction of the food into the mouth

followed by the digestion of the food in the upper part of the stomach i.e. Urdhwa

Amashaya which is comprehended by Madhurabhava.



Vipaka:

Vipaka has been defined as the outcome of the action of the Jataragni on the

Ahara Dravya which is resultant of the Prathamapaka, which is to be judged from the

point of view of the taste of the end product of gastro intestinal digestion viz. Madhura

(sweet), Amla (sour) and Katu (pungent).

Vipaka occurs in 2 phases:

1. Avasthapaka (during digestion)

2. Nishtapaka (at the end of the digestion)

Avasthapaka:

Avasthapaka refers to the changes that the Ahara Dravya undergoes in the Ama -

Pakwashaya under the influence of Jatargni as follows:

Madhura Avasthapaka

Amla Avasthapaka

Katu Avasthapaka

Madhura Avasthapaka:

The presence of food in the mouth is followed by the perception of its taste under the

influence of Bodhaka Kapha 40

which is seated in the root of the tongue. The outcome of

the action of Bodhaka Kapha on food, especially that fraction of its composition which

essentially is Madhura in taste seems to be continued and complete in the upper portion

of Urdhwa Amashaya. By now, the insoluble Madhura portion of food becomes



sufficiently soluble and mixed up with the frothy Kledaka Kapha. With the help of Kleda,

Sneha and Vayu, it breaks down, becomes less complex and soft and as a result, frothy

and sweet Ahara Rasa will be produced. Since, the Ahara Rasa produced is of Madhura

Rasa and contributes to Kapha, this is called Madhura Avasthapaka. 41

Amla Avasthapaka:

At this stage, Ahara reaches the lower part of the Amashaya. The Agni i.e.

Pachaka Agni which is stimulated by Samana Vayu acts on it and results in the

Vidagdhata of the Ahara Rasa. Thus formed Ahara Rasa attains Amla Guna and hence

the name Amla Avasthapaka. 42

This synchronizes with the passing down of Ahara Rasa

which has attained Amlabhava into the lower portion of Mahasrotas where Achha Pitta is

stated to be secreted and it comes in contact with the Pittasthana.43

The outcome of

second stage of digestion is characterized a state called as Vidagdha44

, which means

Pakwa-Apakwa 45

or Kinchit Pakwa or Kinchit Apakwa. Vidagdha can be defined as

“Vidagdha Sangnyamata Amlabhavam”.46

At this stage, the food substance remains partly

digested or partly undigested.

Katu Avasthapaka:

The food is subjected to further digestive events which take place in the

Pakwashaya which attains Katubhava47

or Katu Avasthapaka. The digested food particles

passed down from Amashaya having reached the Pakwashaya being dried up by Agni 48

is

rendered into lumps. During this process, the Ahara Rasa becomes Katu in nature and

Vayu Dosha will be nourished.



AHARA PARINAMAKARA BHAVA:

Six factors are responsible for proper digestion, assimilation and metabolism of

food in human body, viz. Usma, Vayu, Kleda, Sneha, Kala and Samyoga. 49

Usma:

Usma is a quality of Agni Mahabhuta. In this regard, two terms are to be

considered viz. Agni and Pitta. There is no Agni except Pitta in body. Pachaka Pitta is

situated in Amashaya and it performs the function of Agni (digestion).

They should be released at proper time and proper quantity. Usma of Pachaka

Pitta is essential for proper digestion; disturbance of it will lead to diseases of Agni.

Vayu:

Samana Vayu is seated in Amashaya, helps the Pachaka Pitta in digestion. There

is a inter connection between Prana-Apana-Samana Vata 50

, it means all these helps to

maintain Agni. The Grahana and Munchana Karma of Vayu are essential for proper

digestion. Any exacerbation or cessation in these functions will lead to improper

digestion. As certain time is required for proper digestion, delayed emptying will cause

the Shuktapaka and formation of Amavisha, which is the causative factor of Grahani

Dosha. Now it is clear that all secretary regulations can be termed as functions of Samana

Vayu. If Samana Vayu is disturbed it will lead to Ajeerna and start the pathogenesis of

Annavaha Sroto Vyadhi.



Kleda:

This factor is necessary for proper digestion; it loosens and emulsifies the food.

This function is performed mainly by liquid portion of food itself i.e. saliva, mucosa and

liquid portion of various digestive juices. Kledaka and Bodhaka Kapha may be

considered in this regard. Drava has been termed as Kleda in Ahara Parinama Bhava.

The function of Kledaka Kapha can be summarized as Kledana Shithilikarana-Mrudu

karana and Sangatha bedha. The excessive klinnatha may hamper the Agni directly as

mentioned in the literature that Dravatwa ceases the Agni. Ingestion of any Ati - Ushna,

Tikshna and Katu Dravya may cause increase in Kleda, which may interfere with

digestion process and increase in Kapha causes Mandagni.

Sneha:

Usually Ahara contains Sneha. Kapha as well Pitta are having the property of

Sneha 51

, it also belongs to Apamahabhuta, Sneha is a specific quality of Ap- Dhatu.

Hence, it can be said that Sneha is also the quality of Kledaka Kapha and Pachaka Pitta.

Sneha coming from Ahara as well as Kledaka Kapha and Pachaka Pitta, perform the

function of Mardava (softness of food stuff).

Kala:

Time required for the proper secretion of all the digestive factors and for digestion

and absorption. Kala means mainly the time required for the digestion of ingested food.

But other time factors considerations are also necessary for proper digestion and

absorption of food, i.e. Kshudhakala, Trishakala, Doshakala and also Charvanakala. The

food is to be taken after the proper digestion of previous meal. The meal taken without



proper digestion of previous meals is called as Adhyasana and this is the main cause of

Agnidushti.52

Emptying of stomach requires certain time. Retention of food material in

intestine is regulated by Vayu. Any disturbance of Vata will disturb the Grahana and

Munchana period leading to improper digestion and absorption which will lead to further

provocation of Doshas. The Adhyasana and Ajeerna-bhojana, may cause the Prakopa of

the Tridosha, simultaneously Agnidushti.

Samyoga:

Equilibrium of all above factors is necessary for the proper digestion of ingested

food material. Ashtavidha Ahara Ayatana should be considered to avoid Agnidushti. Most

of the diseases have a long list of etiological factors from dietary habits and food articles

53 and hence unbalanced dietary habit is cause for vitiation of Agni.

NIDANA OF AMLAPITTA:

After a careful screening and analysis, the etiological factors of Amlapitta can be

discussed under four groups, i.e. Aharaja Hetu, Viharaja Hetu, Manasika Hetu, and

Aagantuja Hetu.54

A brief description of these factors has been presented as under.

Aharaja Hetu [Dietary Factors]:

The first and the foremost group of etiological factors of Amlapitta may be

considered as the dietary factors. Under this, the intake of food against the code of

dietetics i.e. Ahara Vidhi Vidhana and Ahara Vidhi Visheshaayatana is included. Various

types of incompatible substances, excess of Pitta aggravating factors like Katu, Amla,



Vidahi, etc. and irregular time of consumption of food are the factors against the dietetic

code and they are directly responsible for the aggravation of Pitta.

Viharaja Hetu [Behavioural Factors]:

Irregular habits of defecation, eating, sleeping time, suppression the natural call,

may disturb the equilibrium of the body; may in turn disturb Pitta as well digestion which

ultimately will lead to Amlapitta.

Manasika Hetu [Psychological Factors]:

A disturbed psyche in terms of anxiety, anger, greediness, etc. would affect the

Prana and Vyana Vata, in turn may influence Samavata. Impaired Samanavata may

vititiate Jatargni which leads to impaired physiology of the digestion.

Aagantuja Hetu [Other Related Factors]:

Under this group constant and excessive consumption of alcohol, tobacco,

beverages, smoking, or other irritant stuffs, etc are taken. These substances cause local

irritation in the stomach, which in turn vitiate the Pitta leading to increased Amla Guna of

Pitta. All these factors are as given beneath:



Table 2: Showing general Nidanas of Amlapitta

Adhyasana Bhrishta Dhanya

Abhishyandi Bhojana Dushtanna

Ajeerna Divaswapana

Akala Bhojana Ati Gorasa Sevana

Ama Guru Bhojana

Ama Pakwa Anna Sevana Ikshuvikara

Atyamla Sevana Kulattha Sevana

Antarodaka Paana Madhya

Ati Ushna Ahara Paryushitanna Sevana

Ati Ushna Ahara Pitta Prakopi Anna Pana

Ati Ruksha Ahara Pisthanna

Ati Drava Ahara Pruthuka Sevana

Ati Ashana Vidahi Anna

Ati Avagahana Viruddhaasana

These may again be simplified in a more systemic way as follows.

Ahara group:

1. According to the type of Ahara:

[a] Kulattha [b] Pruthuka [c] Pulaka (husky food)

2. According to the quality of food:



[a] Abhishyandi [b] Ati-snigdha [c] Ati-ruksha [d] Gurubhojya [e] Vidahianna

3. According Samskara done on the Ahara: -

[a] Apakwa Anna [b] Bhrishta Dhanya [c] Ikshu Vikara [d] Pishta Anna

4. According to Dushti of Ahara:

[a] Dushta Anna [b] Paryushita Anna

5. According to the Pitta provocative properties of Ahara: [a]

Adhyasana [b] Ajirniasana [c] Ama Purnata [d] Ati Ushna [e]

Ati Amla [f] Ati Drava [g] Ati Teekshna [h] Ati Panam [i]

Katvannapana [j] Viruddhashana

6. According to the capacity of weakening the digestive power by the food:

[a] Ati Snigdha Sevana [b] Ati Ruksha Sevana

Vihara group:

[a] Akala Bhojana

[b] Antrodaka Pana

[c] Bhuktwa Divaswapa

[d] Bhuktwa Ati Avagahana

[e] Kale Anashana

[f] Vegavadharana

[g] Vishamashana

[h] Bhuktwa Ati Snana



Other related factors to the disease:

[A] Annahina Madya Sevana

[B] Gorasa Sevana

[C] Madya Sevana

POORVARUPA OF AMLAPITTA:

Poorvarupa or premonitory symptoms of this disease are not narrated in any

classics. But in practice it is observed that in the patients suffering from the disease

Amlapitta, there are certain symptoms, which are present for a quite long period before

manifestation of the disease. Some of them are Ajeerna, Utklesha, feeling of reduced

digestion etc.

ROOPA OF AMLAPITTA:

Amlapitta, out of which some are short-listed here, which are having predominance in the

patients coming for treatment.

The general symptoms of Amlapitta55

are:

Avipaka (indigestion), Klama (fatigue), Hrit-Kanta Daha (retro sternal/ epigastric

burning sensation), Amlodgara (sour belching), Gaurava (heaviness), Utklesha (nausea),

Tiktodgara, Aruchi (anorexia). Other symptoms are Vidbheda (loose bowels),

Aantrakoojana (gurgling sound intestine), Udaradhmana (distension of abdomen) and

Hritsoola (pain in chest region) 56



TYPES OF AMLAPITTA:

According to Gati of Pitta Madhava Nidana has described 2 types of Amlapitta57

a) Urdhvaga Amlapitta

b) Adhoga Amlapitta

According to involvement of dosha, Kashyapa and Madhavakara both have divided.

Table 3: Showing types of Amlapitta

Kashyapa Samhita 58

Madhava Nidana 59

Vatika Sanila

Paittika Kaphanugata

Shlaishmika Vatakaphadhika

Shleshmapitta

SAMPRAPTI OF AMLAPITTA:

The word Samprapti is the process of the disease formation beginning right from

the contact of the causative factors with the body to complete manifestation of the

disease. It is a course followed by a disease in which the Dosha gets vitiated and the path

it follows for the manifestation of disease.



The etiological factors, which are against Ashtavidha Ahara Vidhi Vidhana and

Asana Pravicharanas, cause the vitiation of Dosha and Agni, which results in

Agnimandya and Avipaka, and in this stage even light diet cannot be digested. It remains

as it is in Amasaya and produces Suktatva, which leads to formation of Annavisha. This

Annavisha produces Ajeerna. Once Agnidushti occurs it results in Avipaka, Ajeerna and

this further damage the Agni. Agnidushti causes Shuktapaka of Ahara, which further

disturbs the Agni. Thus, Amavisha produced disturbs the Grahani Dosha and once it

happens it further produces the Ama Dosha and vicious cycle starts. Few etiological

factors mentioned in the list directly provoke Dosha (Pitta). Few of them result in

Dooshya Daurbalya e.g. Panchakarma Vibhrama and Vyadhikarshana.

Charaka has mentioned that if Annavisha Produced by this Samprapti mixes with

Pitta, it will produce Amlapitta. Kashyapa has described the Samprapti of Amlapitta in

detail first time and it seems similar to the Samprapti of Grahani Roga described by

Charaka. Chakrapani Datta has commented on it to describe whole mechanism.

Madhavakara has mentioned the involvement of only one Dosha i.e. Pitta but Kashyapa

has given the involvement of Tridhosha by writing the word

“Vatadyavaha” with the dominance of Pitta, Shrikantha Datta has clarified that

the causative factors of Amlapitta are Kapha and Pitta. He also explained Gaurava,

Udgara and Kampa symptoms are due to involvement of Kapha and Vata respectively. 60

Hence from above discussion it is clear that Kapha and Pitta Dosha i.e. Kledaka Kapha

and Pachaka Pitta are the main Dosha but same time we know that vice versa relation of

Pachaka Pitta and Samana Vayu (As per Sushruta).



Hence, it can be concluded that there is involvement of Tridosha but with the

dominancy of Pitta and Kapha.61

In the pathogenesis of Amlapitta, the involvement of the

Dosha can be categorized as Pitta on first place and Kapha on second place and the least

involved is Vata. The conditions Pittavrita (Vata) Prana are nearer to symptomatology of

Amlapitta. Hence it seems that the Amlapitta is a disease condition produced due to Pitta-

Kaphavrita Vata mainly Prana and Samana.62

Kashyapa has described that this disease occurs mostly in individuals having

Jihvalaulya.63

Patients generally know the etiological factor of the disease but due to

greed, they continue to consume them and this disease progress to Kashtasadhya stage

and it may manifest as Upadrava like Parinama Shoola etc.

Madhavakara has given two types i.e. Adhoga and Urdhvaga, Doshaja varieties

are also mentioned by various Acharya and differentiation in this type is difficult job.

This is also supported by Madhavakara by writing Bhishaka-Mohakara Vyadhi.64

The Adhoga type is very difficult to diagnose as it coincides with Paittika,

Atisara, and Paittika Grahani. Amlapitta is a disease of Annavaha Srotas. Mithya Ahara

and Vihara are the chief causes in the origin of this disease. The etiological factors

further may be classified into two groups. The first group includes those factors, which

are responsible for the state of Agnimandya and the etiological factors under the second

group include the factors, those vitiate the liquidity of Pitta and aggravate its quantity.

Two more additional Pitta vitiating factors, Anupa Desha and the Varsha Ritu have

specifically been observed and mentioned by Kashyapa and Madhavakara respectively.

Both these factors vitiate the Pitta via Jatargni leading to Mandagni.



As a result of above stated various causes any of the Dosha is vitiated and may

cause Mandagni. In this state of Mandagni whatsoever food material are consumed by an

unwise person, become Vidagdha and are converted into Suktavastha, This Vidagdha and

the vitiated Pitta later manifests in the form of Amlapitta.65

If not treated properly in this stage, the disease leads to Bheda Avastha where the

typical characteristics and types like Urdhavagata and Adhogata are differentiated.

Further complications like Sheetapitta, Udarda, Kotha, etc. are differentiated.

Samprapti Ghataka of Amlapitta:

The different components producing Amlapitta are as follows:

Table no 4 . Samprapti Ghataka of Amlapitta

Dosha Pitta - Pachakapitta [ Pradhana ]

Tridosha

Vata Samana Vayu, Udana vayu

Kapha Kledaka Kapha

Dushya Rasa

Agni Jataragni

Ama Jataragni Mandhya Janya Ama

Srotas Annavaha, Rasavaha

Srotodusti Prakara Sanga, Vimargagamana ,

Atipravrutti

Udbhavasthana Amashaya

Adhistana Amashaya

Sancharasthana Annavaha srotas- Sarva shareera

Vyaktasthana Shareera

Rogamarga Abhyantara



Differential Diagnosis:

Kashyapa, Madhava and Gananath Sen have mentioned specific Samprapti of

Amlapitta. The Samprapti of Grahani Roga mentioned by Charaka may be borrowed to

explain the pathogenesis of Amlapitta. There are many disease conditions which present

similar to Amlapitta e.g. Poorvarupa of Raktapitta, Gulma, Udara Poorvarupa, Arshas

symptoms, Grahani Poorvarupa, Pittaja Pandu, Udavarta, Pittavrita Vata, Pittavrita

Prana etc.

There are two main conditions from which we must differentiate the disease

Amlapitta; those are Vidagdhajirna and Samapitta. Out of which Samapitta is the stage of

Dosha. As there is no specific Dosha-Dooshya-Samurchana taken place, it cannot be

called as a disease. Vidagdhajirna is an acute state, if it occurs repeatedly it may results

into Amlapitta.

From treatment point of view we must differentiate these stages and diseases,

which may change the line of treatment. In primary stage of Vidagdhajirna, Alpa

Jalapana can relieve the symptom but in Amlapitta along with it Amla Drava Guna is

also increased.

SADHYASADHYATA

The Ayurvedic manuscripts bear the description regarding the prognostic status or

Sadhyasadhyata of the disease. Before going to the treatment, the prognosis as to the

curability [Sadhya] or incurable [Asadhya] and also whether it is easily curable [Sukha-

Sadhya] or curable with difficulty [Krichrasadhya] or maintained as long as treatment is

given [Yapya] should be estimated.



Charaka says, “A disease in its early stage is easily curable but when advanced, is

cured with quite difficulty or even becomes Asadhya”.66

Incurable diseases never become

curable while curable diseases may pass into stage of incurability on account of the short

comings in any of the four basic therapeutic factors or as the result of destiny.

Madhavakara states that, if Amlapitta is in its early stage is curable with efforts. If

it becomes chronic it becomes Yapya. In chronic cases and in persons with recent origin

indulging in Apathya Ahara Vihara, it becomes Krichrasadhya [curable with difficulty].

If Amlapitta is accompanied with the Upadrava [complications], then becomes Asadhya

[incurable].67

Kashyapa has stated that in case if the patient develops Upadrava

along with Dhatukshaya, then it becomes Asadhya [incurable].68

Hence, the early

diagnosis and prompt treatment of Nava or Taruna Amlapitta would not proceed to

become chronic and produce complications.

UPADRAVA

The occurrence of another disease in the wake of primary disease, as a

complication or sequel is termed as upadrava and is meant as Rogottarakalaja,

Rogashraya and Rogameva. The Upadrava of the disease corresponds to the intensity of

severity or chronicity of the disease.

Kashyapa in Khilasthana describes Upadrava of Amlapitta as follows:69

Jwara Shotha

Atisara Aruchi

Pandutva Bhrama



According to Gananath Sen:

Sheetapitta Vicharchika

Udarda Visphota

Kandu Pidaka

Kotha Amashaya Kshata

Mandala Grahani Kshata

MODERN REVIEW

HYPERACIDITY:

Hyperacidity word is composed of two components i.e. „hyper‟ and „acidus‟.

„Hyper‟ means over or excess and „acidus‟ means sour. So a straight meaning may be

derived as excess of sourness; i.e. any acid not particularly the HCl in stomach and a

disease, which contains this abnormal pathology, is defined as hyperacidity

The word Hyperchlorhydria indicates the condition in which there is an excessive

production of HCl in the stomach It is a characteristic observation in certain forms of

dyspepsia particularly associated with duodenal ulcer. It causes heartburn and water

brash. This term indicates about the functional abnormality i.e. hyper activity of the

secreting glands.



Four processes normally take place in the stomach.

1. The conversion of starch into sugar, begun in the mouth, is carried a stage

further.

2. Proteins are changed into peptone

3. Fat globules are set free from their envelopes.

4. Milk is curdled.

Delay in digestion may be caused by

i) Deficient peristalsis of the stomach walls

ii) Deficient quality or quantity of the gastric juice

iii) Consumption of indigestible article

iv) The dilution of the gastric juice by drinking too much fluid at meal time.70

Properties of gastric juice71

Volume – 1200-1500ml/day

Reaction – highly acidic due to presence of HCl

Specific gravity – 1.002 to 1.004

PH – 0.9 to 1.2



Figure no 1- Showing Composition of Gastric Juice

Gastric juice

Water ( 99.5%) Solid ( 0.5%)

Organic substance Inorganic substance

CAUSES: 72

1. General Factors:

Vagal effect, hormonal effects, insufficient circulation, shock, general ischemia.

2. Constitutional and environmental factor:

Sex, Age, Family history, social class, Geographical distributions & Occupation

Enzymes Other substance

1

) HCl

Pepsin 1) Mucus

2

) Na

Renin 2) Intrinsic factor

3

) Ca

Gastric

lipase 3) Bicarbonate K

Gelatinase 4) Phosphate

Urase Cl



3. Local factors related to Stomach:

A) Aggressive Factors: -

Hydrochloric acid, Pepsin, Refluxed bile, NSAIDs, Alcohol, Pancreatic and

Proteolytic enzymes, ingested irritants, bacterial toxins and Psychological trauma.

B) Defensive Factors: -

Mucus, bicarbonates, blood flow, restitution of epithelium. Thus defensive factors

are responsible for the enhancement of mucosal protection. Although no single element

may account for mucosal protection, all may be potentially contributing factors. Insight

into mucosal protective mechanisms was provided by studies performed by Robert. These

studies lead to the introduction of term “Cytoprotection” generally accepted to mean

protection of the gastric mucosal by prostaglandins (PGs) against damaging agents.

Defense of normal gastric mucosa against aggressive factors:

Three basic levels of defense underlined the remarkable ability of normal gastro

duodenal mucosal to resist injury from the acid and peptic activity in gastric juice.

1. Surface epithelial cells secret mucus and bicarbonates, creating a pH gradient

in the mucous layer and change the very acidic gastric lumen to the nearly

neutral surface of the mucosa.

2. Gastric mucosal cells have a specialized apical surface membrane that resists

the diffusion of acid back into the cell.



3. Mucosal cells may directly resist injury by intrinsic mechanisms; such as

extrusion a back diffused hydrogen ions by means of basolateral carriers (e.g.

Sodium - hydrogen or Sodium bicarbonate exchange).

The rapid repair of injury to the mucosa is essential to maintain the mucosal

integrity. Surface epithelial cells continually slough and adjacent cells that move to fill

them by cell replication in response to still unknown trophic signals reseal the gaps.

Blood flow in normal mucosa removes the acid that has diffused across a compromised

mucosa. Prostaglandins enhance the mucosa‟s resistance to injuries under certain

conditions, perhaps by increasing mucosal blood flow, stimulating the secretion of mucus

and bicarbonate, strengthening of the gastric mucosal barrier, decreasing the gastric

motility, increasing release of endogenous mediators of gastric Cytoprotection like

Sulfahydryls and epidermal growth factors, etc. scavenging of free radicals, decreasing

release of endogenous mediators of gastric injuries vasoactive amines and leukotrienes

and stimulation of cellular growth and repair

Role of Infection:

Lately some more information has poured in about the prevalence and changing

pattern of the disease, the influence of environmental factors and speculation on the role

of recently characterized bacterial organisms, Helicobacter pylori, which colonized the

gastric mucosa, particularly the antral region. H. Pylori are a gram-negative spiral

bacterium that is found in a patchy distribution overlaying in gastric epithelium. It was

formally named as campylobector pylori.



At present 9 species of Helicobacter genus are available and all excluding

H.plyori, are of animal origin. H. Felis can be introduced into mice to produce intense

colonization and inflammation of stomach. H.plyori organisms have strong capability of

urease production. The bacteria then split urea and the ammonia thus released may

become cause of increased acidity and hence enabling organism to survive. The released

ammonia may also be cytotoxic. H.pylori has been implicated in the etiology of belching,

indigestion and chronic peptic ulceration. H.pylori induced gastritis present in about 60%

of patient with gastric ulcer. Until recently pathogenesis of gastric and duodenal ulcers

has been attributed to an imbalance between aggressive factors such as acid and pepsin

that damage the gastric mucosa and protective factors such as prostaglandins that prevent

the damage. Recent evidences relate H.pylori to the pathogenesis of chronic duodenal

ulcer as H.pylori infection and antral gastritis are found together in more than 95% of

patients with duodenal ulcers.

Pathogenesis:

Following factors are important in development of hyperacidity:

[1] Luminal acid and pepsin are requisite.

[2] Increased mucosal tissue acidosis with subsequent decrease secretion of bicarbonate.

[3] Reduced mucosal blood flow, whatever its basis (Shock, Drugs, Stress) causing

hypoxic injury & impairing the secretion of bicarbonate.

[4] Disruption of the mucosal barrier (i.e. the intake layer of surface mucosal epithelial

cells), permitting back diffusion of hydrogen ions and in turn increased shedding of

surface of cell.



Species of Helicobacter genus are available and all excluding H.plyori, are of

animal origin. H. Felis can be introduced into mice to produce intense colonization and

inflammation of stomach. H.plyori organisms have strong capability of urease production.

The bacteria then split urea and the ammonia thus released may become cause of

increased acidity and hence enabling organism to survive. The released ammonia may

also be cytotoxic. H.pylori has been implicated in the etiology of belching, indigestion

and chronic peptic ulceration. H.pylori induced gastritis present in about 60% of patient

with gastric ulcer. Until recently pathogenesis of gastric and duodenal ulcers has been

attributed to an imbalance between aggressive factors such as acid and pepsin that

damage the gastric mucosa and protective factors such as prostaglandins that prevent the

damage. Recent evidences relate H.pylori to the pathogenesis of chronic duodenal ulcer

as H.pylori infection and antral gastritis are found together in more than 95% of patients

with duodenal ulcers.

Symptoms:

Disease Hyperacidity is the commonest disease of the fast, fashionable and fast

food based modern life. This is one of the commonest terms also used by the

patients to subject each gastric discomfort as Hyperacidity. Usually patients

having following signs and symptoms are coming with the chief complaint as

hyper acidity.

[1] Heart Burn

[2] Chest Pain

[3] Gastric discomfort

[4] Abdominal distention



[5] Sour Belching

[6] Refluxes of the food

[7] Nausea

[8] Loss of Appetite

TREATMENT:

Controlling gastric acidity, hyper motility and spasm and thus relieving the

associated pain. One or more of the following methods may achieve it.

Uses of antacids, or ion exchange resins.

Stimulating the release of cholecystokinin by means of a fatty meal or vegetable oil

Inhibiting gastric acid secretion by drugs.

Withdrawal of stimulants of gastric acid secretion such as alcohol and tobacco etc

Surgical removal of the acid producing gastric mucosa by gasterctomy and

Vagotomy.

All these causes, pathogenesis and symptomatology can be correlated with the

disease named Amlapitta in Ayurvedic Literature. Due to the similarity in causative

factors & signs and symptoms, one can easily correlate these two diseases as a same

disease to some extent. It is not always necessary that each sign & symptoms of the

diseases should be met with each other but the maximum possible findings are suggestive

of the similarity between both the diseases.



Acid peptic disease

Etiopathogenesis – Gastrointestinal problem is one of the most common problems

for which patient seek medical help. Amlapitta can be correlated with wide range of

diseases related to lower oesophagus, stomach and duodenum which are discussed below.

1. Gastro esophageal reflux disease:

GERD is one of the most prevalent gastrointestinal disorders. Reflux occurs

because of sustained or transient decrease in lower oesophageal tone. It may be due to

muscle weakness, myopathy, smoking and smooth muscle relaxant drugs.

Regurgitation of sour material in the mouth and heartburn are the characteristic

symptoms of GERD. Heartburn is produced by the contact of refluxed material with

inflamed or sensitized esophageal mucosa. Angina like or atypical chest pain may occur

in some patients. Severe reflux may reach pharynx and mouth and result in laryngitis,

morning hoarseness and pulmonary aspiration.

Treatment: The goal of treatment is to decrease gastroesophageal reflux, improve

oesophageal clearance and oesophageal mucosa.

• Weight reduction

• Sleeping with the head of bed elevated by about 4-6 inches blocks.

• H2 receptor blockers like Ranitidine 150 mg BD or Famotidine 20 mg BD.

• In resistant cases Proton pump inhibitors like – Omeprazole 20 mg OD or

Pantoprazole 40mg OD.



2. Oesophagitis: It is inflammatory disorder of the oesophagus. There is inflammation

of the mucosa of oesophagus and thereafter mucosal damage takes place giving rise to

dyspepsia, odynophagia, chest pain, nausea and vomiting.

3. Hiatus hernia – A Hiatus hernia is a herniation of part of stomach into thoracic cavity

through esophageal hiatus in the diaphragm.

o Sliding hiatus hernia – Here Gastroesophageal junction and fundus of

stomach slides upward.

o Para-oesophageal hernia – Here oesophagogastric junction remains fixed in

its normal location and stomach is herniated beside of gastroesophageal

junction.

Both these hernias present with nausea, vomiting, belching specially on bending

forwards. A herniated gastric pouch may cause dysphagia, develop gastritis or ulcerate

and may lead to acute chest pain and dysphagia.

4. Gastritis – The term gastritis is reserved for histologically documented inflammation

of the gastric mucosa. It is not mere mucosal erythema. The etiological factors leading

to gastritis are broad and heterogenous.

Classification of Gastritis:

a) Acute gastritis –

b) Acute H pylori infection

c) Other acute infectious gastritis-

d) Bacterial (other than H. pylori)



e) Helicobacterium helmanni

f) Phlegmonus

g) Mycobacterium

h) Syphilitic

i) Viral

j) Parasitic

k) Fungal

l) Chronic atropic gastritis –

m) Type A – Autoimmune – Body predominant

n) Type B – H. Pylori related, Antral predominant

o) Indeterminant

Uncommon forms of gastritis –

a) Lymphocytic

b) Eosinophilic

c) Crohn‟s disease

d) Sarcoidosis

e) Isolated granulomatous gastritis

Acute gastritis:

The common causes with H-pylori induced gastritis are infection e.g. acute

infection with H pylori induced gastritis. Limited mucosal histologic studies demonstrate

a marked infiltrate of neutriphils with oedema and hyperemia. Patients present with

epigastric pain, nausea and vomiting. If not treated, this picture will evolve into one of

chronic gastritis. Hypochlorhydria lasting for upto one year may follow acute H. Pylori



infection. Bacterial infection of the stomach or phlegmanous gastritis is a rare, potentially

life threatening disorder characterized by marked and diffuse acute inflammatory

infiltrates of the entire gastric wall, at times accompanied by necrosis. Elderly

individuals, alcoholics and AIDS patients may be affected. Organisms associated with

this entity include streptococci, staphylococci, E. coli, proteus and haemophilus.

Chronic gastritis:

Chronic gastritis is identified histologically by inflammatory cell infiltrates

consisting primarily of lymphocytes and plasma cells. Distribution of inflammation may

be patchy, initially involving superficial and glandular portions of the gastric mucosa.

Chronic gastritis has been classified according to histologic characteristics. These include

superficial gastritis and atrophic gastritis.

Superficial gastritis:

The inflammatory changes are limited to the lamina propria of the surface mucosa

with edema and cellular infiltrates. Additional findings may include decreased mucus in

the mucus cells and decreased mitotic fingures in the glandular cells. This is early phase

of chronic gastritis.

Atrophic gastritis:

The next stage is Atrophic gastritis. The inflammatory infiltrates extend deeper

into the mucosa with progressive distortion and destruction of the glands. The final stage

is gastric atrophy. Glandular structures are lost. Endoscopically the mucosa may be

substantially thin, permitting clear visualization of the underlying blood vessels.



Type A - gastritis:

The less common of two form (type A and B) involves primarily the fundus and

body with antral sparing. Traditionally this form of gastritis is associated with pernicious

anaemia in the presence of circulating antibodies against parietal cells and intrinsic factor.

Thus it is also called autoimmune gastritis. Antiparietal cells antibodies are cytotoxic for

gastric mucus cells.

Anti-intrinsic factor antibodies are more specific than parietal cell antibodies for

type A gastritis, being present in approximately 40% of patients. The parietal cell

containing gastric gland preferentially targeted in this form of gastritis and achlorhydria

results. Gastric acid plays an important role in feedback inhibition of gastric release from

G cells. Achlorhydria, coupled with relative sparing of the antral mucosa (site G cells)

leads to hypergastrinemia. The role of gastrin in carcinoid development is well proved.

Type B gastritis:

Type B or antral predominent gastritis is the most common form of chronic

gastritis.H. Pylori infection is the cause of this entity. This form of gastritis increases with

age, being present in up to 100% of people over age 70. Multifocal atrophic gastritis,

gastric atrophy with subsequent metaplasia, has been observed in chronic H. Pylori

induced gastritis. This may ultimately lead to development of gastric adenocarcinoma. H.

Pylori infection is now considered an independent risk factor for gastric cancer.



Treatment:

All forms of gastritis require mucosal protective agents like sucralfate, misoprostil.

Acid suppressing antagonists are helpful. Proton pump inhibitors are the most potent acid

inhibitory agents available.

For diagnosed H. Pylori infection triple therapy to eradicate H. Pylori is advised.

Failure of therapy with triple therapy is usually due to infection with a resistant organism.

Quadruple therapy in these cases should be the next step.

Peptic Ulcer Disease (PUD):

An ulcer is defined as disruption of the mucosal integrity of the stomach and or

duodenum leading to a local defect or excavation due to active inflammation of > 5 mm

with depth to the submucosa. PUD encompasses both gastric and duodenal ulcers. DU

and GU share many common features in terms of pathogenesis, diagnosis and treatment.

Pathophysiology:

GU tends to occur later in life with a peak incidence reported in sixth decade. In

contrast to duodenal ulcers, gastric ulcers can represent malignancy. Benign GU is most

commonly found distal to the junction between the antrum and the acid secretary mucosa.

In general the antral mucosa extends about 2/3rd

of the distance of lesser curvature and

1/3rd

the way up the greater curvature. Benign GU associated with H. Pylori is associated

with antral gastritis. Gastric acid output (basal and stimulated) tends to normal or

decreased in GU patients when GU develop in the presence of minimal acid levels

impairment of mucosal defense factors may be present. A concomitant increase in



duodenal gastric reflux has been implicated in some patients. Delayed gastric emptying of

solids has been also been described in GU patients.

Duodenal ulcer occurs often in the first portion of duodenum (>95%) with

approximately 90% located within 3 cm of pylorus. They are usually < 1 cm in diameter.

Ulcers are sharpely demarcated – with depth at time reaching the muscularis propria. The

base of the ulcer often consists of a zone of eosinophilic necrosis with surrounding

fibrosis. Malignant DUs are extremely rare average basal and nocturnal gastric acid

secretion appears to be increased in DU patients as compared to GU. Bicarbonate

secretion is significantly decreased in the duodenal bulk of patients with an active DU, H.

pylori infection may also play a role in this process.

Table 5 - Describe about Aggressive and Protective factors in PUD:

Aggressive factors Protective factors

Increased parietal cell mass with increased Prostaglandin secretion (decreased By

HCL & pepsin. Aspirin, NSAIDs, Cigarette smoking).

Helicobacter pylori infection Bicarbonate secreted by stomach,

Duodenum, Pancreas and Biliary tree.

Tea, coffee in excess Mucus secretion

Irritant food, chillies Blood flow

Alcohol

Rapid mucosal cell

turnover



Table 6 - Differentiating Chronic Gastric Ulcer from Duodenal Ulcer

Particulars Chronic GU Chronic DU

Age Usually middle aged

Usually young or middle

aged(20-40 Years)

Sex More common in males Males dominating

Characteristics Patient is usually thin and

anemic

Patients are healthy with

steer horn Stomach.

Attacks Usually lasts for several

weeks with intervell of

freedom from 2-6 months

Attack lasts for several

weeks

Usually accuring in spring

or autumn.

Pain Pricking in nature. More severe and

spasmodic.

Investigations: 73

Routine investigations like Haemogram, ESR, urine routine for accessing

general condition of the patient are necessary. A routine stool examination for bowel

diseases, helminthes and occult blood suggesting an ulcer, neoplasm or an

inflammation.

Gastric acid secretory studies – the study consist of passing a Nasogastric tube in a

fasting subject and measuring the amount of resting gastric juice and basal and maximal

acid output (BAO/MAO) after stimulation with secretogogues such as histamine, acid



phosphate or pentagastrin. Bicarbonate concentration can also be determined. In the past,

these tests were used in diagnosis of achlorhydria, PU and Zollinger – Ellison syndrome

however, with the advent of flexible fibrotic endoscopy and availability of serum gastrin

levels, acid secretary studies are no longer routinely performed.

Manomatry: Abnormality of gastrointestinal motility is an important cause of

gastrointestinal disorder. Oesophageal manomatry is useful in patients with non cardiac

chest pain and dysphagia due to lesions such as Achalasia cardia. Ambulatory 24 hour pH

monitoring of the oesophagus is useful in patients with GERD.

Barium studies: A Barium swallow (oesophagogram) is done to evaluate oesophageal

morphology to assess motility and distensibility and for investigating gastro oesophageal

junction for hiatus hernia or reflux disease. Liquid barium is routinely used but semisolid

or solid boluses may be used. Barium meal examination is done to evaluate the stomach

and duodenum. Upper gastrointestinal series is performed for symptoms related to the

gastro oesophageal junction, stomach and duodenum.

Gastrointestinal Endoscopy:

It includes upper gastrointestinal endoscopy and lower gastro oesophageal

endoscopy. Modern endoscopes are of two types – Fiber optic and Video endoscopy. This

consists of an insertion of tube which is introduced into the patient‟s gastrointestinal tract.

A control unit for viewing as well as controlling the functions of the endoscope and an

umbilical cord which connects with the cold light source. In addition there is a channel in

the endoscope which carries air to distend the lumen and water to clean the lens during

procedures. A separate channel permits suction and allows passage of a variety of

instruments like biopsy forceps, polypectomy smear, cytology brushes and foreign body



forceps. A majority of present endoscopes are waterproof and can therefore be fully

immersed in solutions allowing better cleaning and adequate disinfection.

Endoscopic Ultrasonography (EUS): This newer technique provides a much clear

image than conventional abdominal sonography, as imaging is performed through the

gastrointestinal wall and is hence not affected by gas in the bowel. The layers of the gut

wall can easily be identified. It is very useful in the diagnosis of submucosal tumors and

in determining the infiltration and depth of CA in the GI tract.

Treatment:

Before the discovery of H Pylori, the therapy of PUD was centered on the old dictum “No

acid – No Ulcer”. Although acid secretion is still important in the pathogenesis of PUD,

eradication of H Pylori and NSAID induced disease is the mainstay.

MATERIAL & METHODS


MATERIAL

&

METHODS

MATERIAL & METHODS


MATERIALS AND METHODS

The present study was planned as a Survey study and the study was approved by

Institutional Ethics Committee (IEC) prior to the starting of the work.

AIMS AND OBJECTIVES:

To study the effect of Ahara and Vihara in Amlapitta.

Research Question

Is there any effect of Ahara and Vihara in Amlapitta?

Hypothesis

Null Hypothesis: There is no effect of Ahara and Vihara in Amlapitta.

Research Hypothesis: There is effect of Ahara and Vihara in Amlapitta.

METHODOLOGY:

Study design

Cross sectional observational study.

MATERIALS & METHODS:

Source of Data

• Subjects of Amlapitta visiting different OPD and IPD of Sri Dharmasthala

Manjunatheshwara College of Ayurveda and Hospital, Hassan and subjects from

in and around Hassan city.

MATERIAL & METHODS


DIAGNOISTIC CRITERIA:

The patients having Hrit, Kanta Daaha and Tikta and/or Amlodgaara along with

having at least two symptoms among the following list were diagnosed as having

Amlapitta:

• Aruchi

• Shiroruja

• Chardi

• Nausea

METHOD OF COLLECTION OF DATA:

• The subjects were be selected from OPD and IPD of Shree Dharmasthala

manjunatheshwara College of Ayurveda and Hospital and patients in and around

Hassan irrespective of Age , gender and religion .

DURATION OF THE STUDY:

Period of Study: 18 months

Settings

1. Shree Dharmasthala manjunatheshwara College of Ayurveda and Hospital

College of Ayurveda & Hospital, Hassan, Karnataka

2. Subjects from In and Around Hassan, Karnataka

Sample size

345 members out of which 155 are healthy and 196 were diseased.

MATERIAL & METHODS


Recruitment of participants

During the study period, the participants were taken from SDM College of

Ayurveda, Hassan and subjects in and around Hassan satisfying the inclusion criteria. 155

subjects of control group and 196 subjects of case group were selected. An informed

consent was obtained from the participants.

Case Group: The participants in study group were diagnosed cases of Amlapitta .

Control Group: The participants of healthy group were apparently Healthy.

INCLUSION CRITERIA:

• Diagnosed subjects of Amlapitta.

• Individuals of age group between 16 to 60 years.

EXCLUSION CRITERIA:

• Subjects who are not willing to participate.

• Drug induced Amlapitta cases.

• Pregnant women.

• Subjects with Systemic disorders.

PLAN OF STUDY:

After assessing the inclusion/exclusion criteria’s, details were recorded in the

special case

proforma and questionnaires included in the study were filled.

Questionnaire

MATERIAL & METHODS


Self validated questionnaire covering the lifestyle under the four domains of

Ahara and

Vihara. The reliability for the questionnaire has been analyzed via Cronbach’s alpha,

which is 0.97.

DATA ANALYSIS:

Information, lifestyle questionnaire based on Ahara and Vihara were used to

collect the data. The data was tabulated and subjected to statistical analysis with the help

of IBM Statistical Package for Social Sciences v20. Statistical test done includes Chi

Square Test and Odds test.

OBSERVATIONS & RESULTS


OBSERVATIONS

&

RESULTS



Table 7: AH. How frequently you use garlic in a week

Chi square test was performed with subjects with or without Amlapitta , who are

exposed to garlic who consumed and who did not consume and an association was

found between Amlapitta and Garlic , x2 (1, N=351)=295.537, P=0.000.

In this study those who consume Garlic showed a probable risk of having

Amlapitta 14.355 times (OR) than that of who did not.

Crosstab Risk Estimate

Q1: How frequently you

use garlic in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

155 0

Odds Ratio for presence

of disease (disease present

/ disease absent)

14.3

55 8.098

25.44

7

Expected

Count 75.1 79.9

For cohort How

frequently you use garlic

in a week = yes

6.25

6 4.006 9.769

Absent Count

15 181

For cohort How

frequently you use garlic in a week = no

.436 .357 .533

Expected

Count 94.9 101.1 N of Valid Cases 351

Total Count 170 181

Expected Count

170.0 181.0

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)

Pearson Chi-Square 295.537a 1 .000

Continuity Correctionb 291.851 1 .000

Likelihood Ratio 380.321 1 .000

Fisher's Exact Test .000 .000

Linear-by-Linear Association 294.695 1 .000

N of Valid Cases 351

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 75.07.

b. Computed only for a 2x2 table



Table 8: AH. How frequently you use Ginger in a week


exposed to Ginger who consumed and who did not consume and an association

was found between Amlapitta and Ginger , x2 (1, N=351)=282.362, P=0.000.

In this study those who consume Ginger showed a probable risk of having

Amlapitta 12.294 times than that of who did not.


Q2:How frequently you

use Ginger in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

155 0


of disease (disease

present / disease absent)

12.29

4 7.403

20.41

7

Expected

Count 76.8 78.2

For cohort How

frequently you use

ginger in a week = yes 3.477 2.646 4.570

Absent Count

19 177

For cohort How

frequently you use ginger in a week = no

.283 .208 .384

Expected Count

97.2 98.8 N of Valid Cases 351

Total Count 174 177

Expected Count

174.0 177.0

Chi-Square Tests

Value Df Asymp. Sig.

(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)







a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 76.84.




Table 9: AH. How frequently you use sour taste food in a week


exposed to Sour taste food who consumed and who did not consume and an

association was found between Amlapitta and Sour taste food , x2 (1,

N=351)=295.465, P=0.000.

In this study those who consume Sour taste food showed a probable risk of having

Amlapitta 713.231 times or than that of who did not.


Q3: How frequently

you use sour taste food

in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

152 3

Odds Ratio for presence of

disease (disease present /

disease absent)

713.23

1

199.56

3

2549.0

60

Expected

Count 72.9 82.1

For cohort How frequently

you use sour taste food in a week = yes

14.785 8.740 25.012

Absent Count 13 183

For cohort How frequently you use sour taste food in

a week = no

.021 .007 .064

Expected


Total Count 165 186

Expected

Count 165.0 186.0

Chi-Square Tests

Value Df Asymp. Sig. (2-sided)

Exact Sig. (2-sided)

Exact Sig. (1-sided)







a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 72.86. b. Computed only for a 2x2 table



Table 10: AH. How frequently you use spoiled food in a week


exposed to Spoiled food who consumed and who did not consume and an

association was found between Amlapitta and Spoiled food , x2 (1,

N=351)=244.102, P=0.000.

In this study those who consume Spoiled food showed a probable risk of having



Q4: How frequently you

use spoiled food in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

144 11


of disease (disease


129.45

5 59.248

282.85

3

Expected

Count 71.5 83.5

For cohort How

frequently you use spoiled food in a week =

yes

10.116 6.500 15.745

Absent Count

18 178

For cohort How

frequently you use

spoiled food in a week =

no

.078 .044 .138

Expected


Total Count 162 189

Expected

Count 162.0 189.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)











Table 11: AH. How frequently you use spicy food in a week


exposed to Spicy food who consumed and who did not consume and an

association was found between Amlapitta and Spicy food , x2 (1,

N=351)=214.398, P=0.000.

In this study those who consume Spicy food showed a probable risk of having



Q5: How frequently

you use spicy food

in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

153 2



disease absent)

298.3

50 70.862

1256.

141

Expected

Count 85.2 69.8


you use spicy food in a

week = yes

4.837 3.666 6.381

Absent Count

40 156


you use spicy food in a

week = no

.016 .004 .064

Expected


Total Count 193 158

Expected

Count 193.0 158.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)

Pearson Chi-Square 214.398

a 1 .000

Continuity Correctionb

211.246 1 .000









Table 12: AH. How frequently you use horsegram in a week


exposed to Horse Gram who consumed and who did not consume and an

association was found between Amlapitta and Horse Gram, x2 (1,

N=351)=291.536, P=0.000.

In this study those who consume Horse Gram showed a probable risk of having



Q6: How frequently

you use horsegram in

a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

154 1

Odds Ratio for

presence of disease

(disease present /

disease absent)

1858.

267 242.690

14228

.658

Expected

Count 74.6 80.4

For cohort How

frequently you use

horsegram in a week =

yes

12.98

2 7.981

21.11

7

Absent Count

15 181

For cohort How

frequently you use

horsegram in a week =

no

.007 .001 .049

Expected


Total Count 169 182

Expected

Count 169.0 182.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


287.875 1 .000









Table 13: AH. How frequently you use flour items in a week


exposed to Flour items who consumed and who did not consume and an

association was found between Amlapitta and Flour items, x2 (1,

N=351)=237.923, P=0.000.

In this study those who consume Flour items showed a probable risk of having



Q7: How frequently

you use flour items in

a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

155 0


of disease (disease


4.828 2.996 7.780

Expected

Count 83.5 71.5

For cohort How

frequently you use flour

items in a week = yes

1.815 1.516 2.172

Absent Count

34 162

For cohort How

frequently you use flour

items in a week = no

.376 .271 .521

Expected


Total Count 189 162

Expected

Count 189.0 162.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


234.609 1 .000









Table 14: AH. How frequently you use green chilli in a week


exposed to Green chili who consumed and who did not consume and an

association was found between Amlapitta and Green chili, x2 (1,

N=351)=287.579, P=0.000.

In this study those who consume Green chili showed a probable risk of having



Q8: How frequently

you use green chilli in

a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

153 2


of disease (disease


923.1

00

207.82

8

4100.

086

Expected

Count 74.2 80.8

For cohort How

frequently you use green

chilli in a week = yes

12.89

8 7.928

20.98

3

Absent Count

15 181

For cohort How

frequently you use green

chilli in a week = no

.014 .004 .055

Expected


Total Count 168 183

Expected

Count 168.0 183.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


283.942 1 .000









Table 15: AH. How frequently you use sour curd in a week


exposed to Sour curd who consumed and who did not consume and an association

was found between Amlapitta and Sour curd, x2 (1, N=351)=287.579, P=0.000.

In this study those who consume Sour curd showed a probable risk of having



Q9: How frequently

you use sour curd in a

week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

154 1


of disease (disease


1732.

500

227.15

1

1321

3.950

Expected

Count 75.1 79.9

For cohort How

frequently you use sour

curd in a week = yes

12.17

1 7.609

19.46

8

Absent Count

16 180

For cohort How

frequently you use sour

curd in a week = no

.007 .001 .050

Expected


Total Count 170 181

Expected

Count 170.0 181.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


284.549 1 .000









Table 16: AH. How frequently you use red chilli in a week


exposed to Red chili who consumed and who did not consume and an association

was found between Amlapitta and Red chili, x2 (1, N=351)=252.860, P=0.000.

In this study those who consume Red chili showed a probable risk of having



Q10: How frequently

you use red chilli in a

week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

153 2


of disease (disease


500.1

92

116.77

9

2142.

445

Expected

Count 79.0 76.0

For cohort How

frequently you use red

chilli in a week = yes

7.441 5.200 10.64

9

Absent Count

26 170

For cohort How

frequently you use red

chilli in a week = no

.015 .004 .059

Expected


Total Count 179 172

Expected

Count 179.0 172.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


249.453 1 .000









Table 17: AH. How frequently you use new jaggary in a week


exposed to New Jaggery who consumed and who did not consume and an

association was found between Amlapitta and New Jaggery, x2 (1,

N=351)=271.250, P=0.000.

In this study those who consume New Jaggery showed a probable risk of having



Q11: How frequently

you use new jaggary in

a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

153 2


of disease (disease


673.2

00

154.84

7

2926.

746

Expected

Count 76.4 78.6

For cohort How

frequently you use new

jaggary in a week = yes

9.674 6.383 14.65

9

Absent Count

20 176

For cohort How

frequently you use new

jaggary in a week = no

.014 .004 .057

Expected


Total Count 173 178

Expected

Count 173.0 178.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


267.721 1 .000









Table 18: AH. How frequently you use salty food in a week


exposed to Salty food who consumed and who did not consume and an association

was found between Amlapitta and Salty food, x2 (1, N=351)=210.645, P=0.000.

In this study those who consume Red chili showed a probable risk of having



Q12: How frequently

you use salty food in

a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

152 3



disease absent)

197.6

00 59.854

652.3

45

Expected

Count 84.8 70.2


you use salty food in a

week = yes

4.805 3.641 6.341

Absent Count

40 156


you use salty food in a

week = no

.024 .008 .075

Expected


Total Count 192 159

Expected

Count 192.0 159.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


207.522 1 .000









Table 19: AH. How frequently you use domestic meat with honey in a week


exposed to Domestic meat with honey who consumed and who did not consume

and an association was found between Amlapitta and Domestic meat with honey,

x2 (1, N=351)=243.321, P=0.000.

In this study those who consume Domestic meat with honey showed a probable

risk of having Amlapitta 121.529 times or than that of who did not.


Q13: How

frequently you use

domestic meat with

honey in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

141 14



disease absent)

121.5

29 56.784

260.0

93

Expected

Count 68.9 86.1


you use domestic meat

with honey in a week =

yes

11.88

6 7.290

19.38

0

Absent Count

15 181


you use domestic meat

with honey in a week = no

.098 .059 .161

Expected


Total Count 156 195

Expected

Count 156.0 195.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


239.958 1 .000









Table 20: AH. How frequently you use blackgram in a week


exposed to Black Gram who consumed and who did not consume and an

association was found between Amlapitta and Black Gram, x2 (1,

N=351)=271.250, P=0.000.

In this study those who consume Black Gram showed a probable risk of having



Q14: How frequently

you use blackgram in

a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

153 2



disease absent)

673.2

00

154.8

47

2926.

746

Expected

Count 76.4 78.6


you use blackgram in a

week = yes

9.674 6.383 14.65

9

Absent Count

20 176


you use blackgram in a

week = no

.014 .004 .057

Expected


Total Count 173 178

Expected

Count 173.0 178.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


267.721 1 .000









Table 21: AH. How frequently you use pickle in a week


exposed to Pickle who consumed and who did not consume and an association

was found between Amlapitta and Pickle, x2 (1, N=351)=222.061, P=0.000.

In this study those who consume Pickle showed a probable risk of having



Q15: How frequently

you use pickle in a

week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

155 0



disease absent)

5.638 3.554 8.943

Expected

Count 86.1 68.9


you use pickle in a week =

yes

2.376 1.871 3.018

Absent Count

40 156


you use pickle in a week =

no

.422 .325 .546

Expected


Total Count 195 156

Expected

Count 195.0 156.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


218.849 1 .000









Table 22: AH. How frequently you use fish with curd in a week


exposed to Fish with Curd who consumed and who did not consume and an

association was found between Amlapitta and Fish with Curd, x2 (1,

N=351)=243.121, P=0.000.

In this study those who consume Fish with Curd showed a probable risk of having



Q16: How frequently

you use fish with curd

in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

139 16



disease absent)

122.2

93

56.94

5

262.6

34

Expected

Count 67.1 87.9


you use fish with curd in a

week = yes

13.52

1 7.974

22.92

4

Absent Count

13 183


you use fish with curd in a

week = no

.111 .069 .176

Expected


Total Count 152 199

Expected

Count 152.0 199.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


239.750 1 .000





a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 67.12..




Table 23: AH. How frequently you use fish with milk in a week


exposed to Fish with Milk who consumed and who did not consume and an

association was found between Amlapitta and Fish with Milk, x2 (1,

N=351)=229.780, P=0.000.

In this study those who consume Fish with Milk showed a probable risk of having



Q17: How frequently

you use fish with

milk in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

137 18



disease absent)

91.84

1

44.69

2

188.7

30

Expected

Count 67.1 87.9


you use fish with milk in a

week = yes

11.54

9 7.078

18.84

5

Absent Count

15 181


you use fish with milk in a

week = no

.126 .081 .195

Expected


Total Count 152 199

Expected

Count 152.0 199.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


226.503 1 .000









Table 24: AH. How frequently you use horsegram with curd in a week


exposed to Horse gram with Curd who consumed and who did not consume and

an association was found between Amlapitta and Horse Gram with curd, x2 (1,

N=351)=300.237, P=0.000.

In this study those who consume Horse Gram with Curd showed a probable risk of

having Amlapitta 669.524 times or than that of who did not.


Q18:How frequently

you use horsegram

with curd in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

148 7



disease absent)

669.5

24

220.3

40

2034.

410

Expected

Count 68.0 87.0


you use horsegram with

curd in a week = yes

31.19

1

14.17

7

68.62

8

Absent Count

6 190


you use horsegram with

curd in a week = no

.047 .023 .096

Expected


Total Count 154 197

Expected

Count 154.0 197.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


296.496 1 .000









Table 25: AH. How frequently you use milk with raddish in a week


exposed to Milk with Raddish who consumed and who did not consume and an

association was found between Amlapitta and Milk with Raddish, x2 (1,

N=351)=307.791, P=0.000.

In this study those who consume Milk with Raddish showed a probable risk of

having Amlapitta 948.633times or than that of who did not.


Q19: How frequently

you use milk with

raddish in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

149 6



disease absent)

948.6

33

284.0

15

3168.

518

Expected

Count 68.0 87.0


you use milk with raddish

in a week = yes

37.68

3

15.85

3

89.57

2

Absent Count

5 191


you use milk with raddish

in a week = no

.040 .018 .087

Expected


Total Count 154 197

Expected

Count 154.0 197.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


304.002 1 .000









Table 26: AH. How frequently you use salt with milk in a week


exposed to Salt with Milk who consumed and who did not consume and an

association was found between Amlapitta and Salt with milk, x2 (1,

N=351)=289.113, P=0.000.

In this study those who consume Salt with Milk showed a probable risk of having



Q20: How frequently

you use salt with

milk in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

147 8



disease absent)

431.8

13

158.3

06

1177.

855

Expected

Count 68.4 86.6


you use salt with milk in

a week = yes

23.23

5

11.77

6

45.84

8

Absent Count

8 188


you use salt with milk in

a week = no

.054 .027 .106

Expected


Total Count 155 196

Expected

Count 155.0 196.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


285.445 1 .000









Table 27: AH. How frequently you use pork with curd in a week


exposed to Pork with Curd who consumed and who did not consume and an

association was found between Amlapitta and Pork with Curd, x2 (1,

N=351)=244.943, P=0.000.

In this study those who consume Pork with Curd showed a probable risk of having



Q21:How frequently

you use pork with

curd in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

146 9



disease absent)

142.7

56

63.08

0

323.0

67

Expected

Count 73.3 81.7


you use pork with curd in

a week = yes

9.231 6.083 14.00

9

Absent Count

20 176


you use pork with curd in

a week = no

.065 .034 .122

Expected


Total Count 166 185

Expected

Count 166.0 185.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


241.585 1 .000









Table 28: AH. How frequently you use Sour fruits with Milk in a week

Chi square test was performed with subjects with or without Amlapitta , who are exposed to Sour

fruit with Milk who consumed and who did not consume and an association was found between

Amlapitta and Sour fruit with milk, x2 (1, N=351)=274.712, P=0.000.

In this study those who consume Sour fruit with Milk showed a probable risk of having Amlapitta

272.828 times or than that of who did not.


Q22: How frequently

you use Sour fruits

with Milk in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

146 9



disease absent)

272.8

28

110.1

21

675.9

42

Expected

Count 69.3 85.7

For cohort How

frequently you use Sour

fruits with Milk in a week

= yes

16.78

4 9.440

29.84

0

Absent Count

11 185

For cohort How

frequently you use Sour

fruits with Milk in a week

= no

.062 .033 .116

Expected


Total Count 157 194

Expected

Count 157.0 194.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


271.141 1 .000









Table 29: AH. How frequently you use Leafy Vegetable with Butter in a week

Chi square test was performed with subjects with or without Amlapitta , who are exposed to Leafy

vegetables with butter who consumed and who did not consume and an association was found

between Amlapitta and Leafy vegetables with butter, x2 (1, N=351)=282.748, P=0.000.

In this study those who consume Leafy vegetables with butter showed a probable risk of having



Q23: How frequently

you use Leafy

Vegetable with Butter

in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

150 5



disease absent)

422.3

08

147.2

28

1211.

343

Expected

Count 72.0 83.0


you use Leafy Vegetable

with Butter in a week =

yes

14.59

1 8.622

24.69

1

Absent Count

13 183


you use Leafy Vegetable

with Butter in a week =

no

.035 .015 .082

Expected


Total Count 163 188

Expected

Count 163.0 188.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


279.135 1 .000









Table 30: AH. How frequently you use Banana with Curd in a week

Chi square test was performed with subjects with or without Amlapitta , who are exposed to

Banana with curd who consumed and who did not consume and an association was found between

Amlapitta and Banana with curd, x2 (1, N=351)=267.593, P=0.000.

In this study those who consume Banana with Curd showed a probable risk of having Amlapitta



Q24: How frequently

you use Banana with

Curd in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

145 10



disease absent)

222.3

33

93.43

0

529.0

85

Expected

Count 69.3 85.7

For cohort How

frequently you use Banana

with Curd in a week = yes

15.28

0 8.818

26.47

7

Absent Count

12 184

For cohort How

frequently you use Banana

with Curd in a week = no

.069 .038 .125

Expected


Total Count 157 194

Expected

Count 157.0 194.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


264.068 1 .000









Table 31: AH. How frequently you use Aerated Drinks in a week


Aerated drinks who consumed and who did not consume and an association was found between

Amlapitta and Aerated drinks, x2 (1, N=351)=289.113, P=0.000.

In this study those who consume Aerated drinks showed a probable risk of having Amlapitta



Q25: How

frequently you

useAerated Drinks

in a week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

147 8



disease absent)

431.8

13

158.3

06

1177.

855

Expected

Count 68.4 86.6

For cohort. How

frequently you use Aerated

Drinks in a week = yes

23.23

5

11.77

6

45.84

8

Absent Count

8 188

For cohort. How

frequently you use Aerated

Drinks in a week = no

.054 .027 .106

Expected


Total Count 155 196

Expected

Count 155.0 196.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


285.445 1 .000









Table 32: AH. How frequently you use heated curd preparations in a week


Heated curd preparations who consumed and who did not consume and an association was found

between Amlapitta and Heated curd Preparations, x2 (1, N=351)=241.834, P=0.000.

In this study those who consume heated curd preparations showed a probable risk of having



Q26: How

frequently you use

Heated curd

preparations in a

week

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

146 9



disease absent)

135.

185

60.06

7

304.2

44

Expected

Count 73.7 81.3


you use Heated curd

preparations in a week = yes

8.79

1 5.858

13.19

4

Absent Count

21 175


you use Heated curd

preparations in a week = no

.065 .034 .123

Expected

Count 93.3

102.

7 N of Valid Cases 351

Total Count 167 184

Expected

Count 167.0

184.

0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


238.499 1 .000









Table 33: VH. Do you have the habit of eating food irrespective of hunger

Chi square test was performed with subjects with or without Amlapitta , who are exposed to eating

food irrespective hunger who consumed and who did not consume and an association was found

between Amlapitta and eating food irrespective hunger, x2 (1, N=351)=132.799, P=0.000.

In this study those who consume eating food irrespective hunger showed a probable risk of having



Q27: Do you have the

habit of eating food

irrespective of hunger

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

141 14



disease absent)

23.96

3

12.77

5

44.95

1

Expected

Count 87.9 67.1

For cohort Do you have

the habit of eating food

irrespective of hunger =

yes

3.074 2.463 3.837

Absent Count

58 138


the habit of eating food

irrespective of hunger = no

.128 .077 .213

Expected


Total Count 199 152

Expected

Count 199.0 152.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


130.311 1 .000









Table 34: VH. Do you have the habit of Day sleeping

Chi square test was performed with subjects with or without Amlapitta , who are exposed to Day

sleep who consumed and who did not consume and an association was found between Amlapitta

and Aerated drinks, x2 (1, N=351)=126.901, P=0.000.

In this study those who consume Day Sleep showed a probable risk of having Amlapitta 29.858

times or than that of who did not.


Q28: Do you have

the habit of Day

sleeping

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

146 9



disease absent)

29.85

8

14.32

9

62.22

0

Expected

Count 94.9 60.1


the habit of Day sleeping =

yes

2.676 2.204 3.248

Absent Count

69 127


the habit of Day sleeping =

no

.090 .047 .170

Expected


Total Count 215 136

Expected

Count 215.0 136.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


124.428 1 .000









Table 35: VH. Do you have the habit of Alcohol Consumption


Alcohol who consumed and who did not consume and an association was found between

Amlapitta and Alcohol, x2 (1, N=351)=131.483, P=0.000.

In this study those who consume Alcohol showed a probable risk of having Amlapitta 18.975times

or than that of who did not.


Q29: Do you have

the habit ofAlchohol

Consumption

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

111 44



disease absent)

18.97

5

10.86

3

33.14

6

Expected

Count 59.2 95.8


the habit of Alcohol

Consumption = yes

6.103 4.105 9.073

Absent Count

23 173


the habit of Alcohol

Consumption = no

.322 .249 .415

Expected


Total Count 134 217

Expected

Count 134.0 217.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


128.958 1 .000









Table 36: VH. Do you have the habit of Smoking

Chi square test was performed with subjects with or without Amlapitta, who are exposed to

Smoking and who did not consume and an association was found between Amlapitta and

Smoking, x2 (1, N=351)=102.932, P=0.000.

In this study those who consume Smoking showed a probable risk of having Amlapitta 14.355




habit of Smoking

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

94 61



disease absent)

14.35

5 8.098

25.44

7

Expected

Count 49.9 105.1

For cohort .Do you have

the habit of Smoking = yes 6.256 4.006 9.769

Absent Count 19 177


the habit of Smoking = no .436 .357 .533

Expected


Total Count 113 238

Expected

Count 113.0 238.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


100.611 1 .000









Table 37: VH. Do you have the habit of excess intake of tea or coffee


Excess coffee or tea and who did not consume and an association was found between Amlapitta

and excess coffee or tea, x2 (1, N=351)=117.501, P=0.000.

In this study those who consume excess coffee or tea showed a probable risk of having Amlapitta




habit of excess intake

of tea or coffee

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

119 36



disease absent)

14.20

5 8.473

23.81

4

Expected

Count 68.9 86.1


the habit of excess intake

of tea or coffee = yes

4.067 3.004 5.506

Absent Count

37 159


the habit of excess intake

of tea or coffee = no

.286 .213 .384

Expected


Total Count 156 195

Expected

Count 156.0 195.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


115.168 1 .000









Table 38: VH. Do you have the habit of Skipping Meals


Skipping meals and who did not consume and an association was found between Amlapitta and

Aerated drinks, x2 (1, N=351)=75.060, P=0.000.

In this study those who consume Skip Meals showed a probable risk of having Amlapitta 7.502



Q32:Do you have

the habit of skipping

Meals

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

114 41



disease absent)

7.502 4.660 12.07

8

Expected

Count 73.7 81.3


the habit of Skipping

Meals = yes

2.720 2.121 3.487

Absent Count

53 143


the habit of Skipping

Meals = no

.363 .275 .478

Expected


Total Count 167 184

Expected

Count 167.0 184.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


73.207 1 .000









Table 39: VH. Do you have the habit of drinking excess water soon after meals


drinking excess water soon after food and who did not consume and an association was found

between Amlapitta and drinking excess water after food, x2 (1, N=351)=44.684, P=0.000.

In this study those who consume excess water soon after food showed a probable risk of having




habit of drinking excess

water soon after meals

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

122 33


of disease (disease


4.828 2.996 7.780

Expected

Count 91.4 63.6


the habit of drinking

excess water soon after

meals = yes

1.815 1.516 2.172

Absent Count

85 111


the habit of drinking

excess water soon after

meals = no

.376 .271 .521

Expected


Total Count 207 144

Expected

Count 207.0 144.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


43.235 1 .000









Table 40: VH..Do you have the habit of eating Betalnut Leaf with Tobbaco

Chi square test was performed with subjects with or without Amlapitta , who are exposed to who

consumed betel nut with tobacco and who did not consume and an association was found between

Amlapitta and eating betel nut with tobacco, x2 (1, N=351)=80.286, P=0.000.

In this study those who consume Betel nut with tobacco showed a probable risk of having




habit of eating

Betalnut Leaf with

Tobbaco

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

107 48



disease absent)

8.174 5.048 13.23

6

Expected

Count 65.8 89.2


the habit of eating Betalnut

Leaf with Tobbaco = yes

3.222 2.415 4.297

Absent Count

42 154


the habit of eating Betalnut

Leaf with Tobbaco = no

.394 .308 .504

Expected


Total Count 149 202

Expected

Count 149.0 202.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


78.349 1 .000









Table 41: VH. Do you have the habit of Adding extra salt and spice for the food you eat

Chi square test was performed with subjects with or without Amlapitta , who are exposed to who consumed excess salt and spice above food and who did not

consume and an association was found between Amlapitta and excess extra spice

and salt above food, x2 (1, N=351)=107.471, P=0.000.

In this study those who consume excess salt and spice with food showed a

probable risk of having Amlapitta 12.294 times or than that of who did not.



habit of Adding extra

salt and spice for the

food you eat

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

121 34


of disease (disease


12.29

4 7.403

20.41

7

Expected

Count 72.9 82.1


the habit of Adding extra

salt and spice for the food

you eat = yes

3.477 2.646 4.570

Absent Count

44 152


the habit of Adding extra

salt and spice for the food

you eat = no

.283 .208 .384

Expected


Total Count 165 186

Expected

Count 165.0 186.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


105.250 1 .000









Table 42: VH. Do you work in too hot atmosphere


exposed to hot atmosphere and who did not consume and an association was

found between Amlapitta and exposure to excess hot atmosphere, x2 (1,

N=351)=117.501, P=0.000.

In this study those who consume excess hot atmosphere showed a probable risk of



Q36:Do you work in

too hot atmosphere

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

119 36



disease absent)

14.20

5 8.473

23.81

4

Expected

Count 68.9 86.1

For cohort .Do you work

in too hot atmosphere =

yes

4.067 3.004 5.506

Absent Count 37 159

For cohort .Do you work

in too hot atmosphere = no .286 .213 .384

Expected


Total Count 156 195

Expected

Count 156.0 195.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


115.168 1 .000





a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 68.89




Table 43: VH. Do you have the habit of Bathing soon after having food

Chi square test was performed with subjects with or without Amlapitta, who are exposed to Bathing soon after food and who did not consume and an association

was found between Amlapitta and Bathing soon after food, x2 (1,

N=351)=141.718, P=0.000.

In this study those who Bath soon after food showed a probable risk of having




habit of Bathing soon

after having food

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

122 33



disease absent)

20.45

7

11.83

9

35.34

6

Expected

Count 67.1 87.9


the habit of Bathing soon

after having food = yes

5.142 3.663 7.220

Absent Count

30 166


the habit of Bathing soon

after having food = no

.251 .185 .342

Expected


Total Count 152 199

Expected

Count 152.0 199.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


139.147 1 .000









Table 44: VH. Do you have the habit of Suppressing Natural Urges

Chi square test was performed with subjects with or without Amlapitta , who are exposed to Suppression of natural urges and who did not and an association was

found between Amlapitta and Suppressing natural urges, x2 (1, N=351)=149.654,

P=0.000.

In this study those who suppress a natural urges showed a probable risk of having Amlapitta 23.034 times or than that of who did not.



habit of Suppressing

Natural Urges

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

124 31



disease absent)

23.03

4

13.19

6

40.20

9

Expected

Count 67.6 87.4


the habit of Suppressing

Natural Urges = yes

5.407 3.829 7.635

Absent Count

29 167


the habit of Suppressing

Natural Urges = no

.235 .170 .323

Expected


Total Count 153 198

Expected

Count 153.0 198.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


147.014 1 .000









Table 45: VH. Do you have the habit of sleeping soon after having food


sleeping soon after food and who did not consume and an association was found between

Amlapitta and sleeping soon after food, x2 (1, N=351)=57.571, P=0.000.

In this study those who sleep soon after food showed a probable risk of having Amlapitta

5.638times or than that of who did not.


Q39:Do you have the

habit of sleeping soon

after having food

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

109 46



disease absent)

5.638 3.554 8.943

Expected

Count 73.7 81.3


the habit of sleeping soon

after having food = yes

2.376 1.871 3.018

Absent Count

58 138


the habit of sleeping soon

after having food = no

.422 .325 .546

Expected


Total Count 167 184

Expected

Count 167.0 184.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


55.950 1 .000









Table 46: VH. Do you have the habit of Excess Bath or Tub Bath


exposed to excess bath or tub bath and who did not and an association was found

between Amlapitta and excess bath or tub bath, x2 (1, N=351)=54.220, P=0.000.

In this study those who excess bath or tub bath showed a probable risk of having




habit of Excess Bath or

Tub Bath

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

102 53



disease absent)

5.329 3.368 8.434

Expected

Count 68.0 87.0


the habit of Excess Bath or

Tub Bath = yes

2.480 1.914 3.214

Absent Count

52 144


the habit of Excess Bath or

Tub Bath = no

.465 .368 .588

Expected


Total Count 154 197

Expected

Count 154.0 197.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


52.637 1 .000









Table 47: VH. Do you have the habit of Drinking Water between the meal

Chi square test was performed with subjects with or without Amlapitta , who are exposed

to drinking water between the meal and who did not and an association was found

between Amlapitta and drinking excess water between meal, x2 (1, N=351)=88.340,

P=0.000.

In this study those who drink water between the meal showed a probable risk of having




habit of Drinking Water

between the meal

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

121 34



disease absent)

9.358 5.717 15.32

0

Expected

Count 77.3 77.7

For cohort Do you have the


between the meal = yes

2.833 2.225 3.609

Absent Count

54 142

For cohort Do you have the


between the meal = no

.303 .222 .413

Expected


Total Count 175 176

Expected

Count 175.0 176.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


86.331 1 .000









Table 48: VH. How often you express your Anger


exposed to Anger and who did not and an association was found between

Amlapitta and Anger, x2 (1, N=351)=98.023, P=0.000.

In this study those who express more anger showed a probable risk of having



Q42: How often you

express your Anger

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

122 33



disease absent)

10.79

5 6.541

17.81

7

Expected

Count 76.0 79.0

For cohort how often you

express your Anger = yes 3.085 2.396 3.973

Absent Count 50 146


express your Anger = no .286 .209 .391

Expected


Total Count 172 179

Expected

Count 172.0 179.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


95.906 1 .000









Table 49: VH. How often you express your stress


exposed to stress and who did not and an association was found between

Amlapitta and stress, x2 (1, N=351)=73.702, P=0.000.

In this study those who express more stress showed a probable risk of having



Q43: How often you

express your stress

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

122 33



disease absent)

7.625 4.686 12.40

7

Expected

Count 82.1 72.9


express your stress = yes 2.410 1.940 2.995

Absent Count 64 132


express your stress = no .316 .230 .434

Expected


Total Count 186 165

Expected

Count 186.0 165.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


71.865 1 .000









Table 50: VH. How often you express your depression

Chi square test was performed with subjects with or without Amlapitta, who are

exposed to Depression and who did not and an association was found between

Amlapitta and Depression, x2 (1, N=351) =183.332, P=0.000.

In this study those who express depression drinks showed a probable risk of



Q44: How often you

express your

depression

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

131 24



disease absent)

39.11

8

21.26

0

71.97

5

Expected

Count 68.4 86.6


express your depression =

yes

6.902 4.716 10.10

1

Absent Count

24 172


express your depression =

no

.176 .122 .256

Expected


Total Count 155 196

Expected

Count 155.0 196.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


180.413 1 .000









Table 51: VH. How often you express your Anxiety

Chi square test was performed with subjects with or without Amlapitta, who are

exposed to Anxiety and who did not and an association was found between

Amlapitta and Anxiety, x2 (1, N=351) =256.860, P=0.000.

In this study those who e showed a probable risk express more anxiety having



Q45: How often you

express your Anxiety

Value

95% Confidence

Interval

Yes No Lower Upper

Present Count

140 15



disease absent)

173.6

00

75.72

4

397.9

85

Expected

Count 66.2 88.8


express your Anxiety =

yes

17.70

3 9.658

32.45

1

Absent Count 10 186


express your Anxiety = no .102 .063 .165

Expected


Total Count 150 201

Expected

Count 150.0 201.0

Chi-Square Tests


(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)


a 1 .000


253.389 1 .000







DISCUSSION


DISCUSSION

DISCUSSION


DISCUSSION

This study entitled “Survey study on effect of Ahara and Vihara in Amlapitta”

was aimed to find the effect of Ahara and Vihara in manifestation of Amlapitta.

Food is considered as supreme or Brahma in Upnishads. It is responsible for life

of all beings74

. Food is one among the three sub pillars supporting the life75

. Pathya is that

which will not harm the Srotas of the body, which is liked by an individual and help in

the maintenance of health. Consuming Pathya Ahara provides wholesome effect on body

and mind without causing any untoward effect. Many diseases can be cured without any

medicines by just following wholesome regimen whereas even hundreds of medicines

cannot cure a disease in absence of wholesome regimen76

. No medicine is equivalent to

food; it is possible to make a person disease free with just proper diet 77

.

The activities done by the person in a normal condition are considered under

Vihara. These may include the way he takes his food, his sleep pattern, exercise etc. The

Acharyas have given a detailed explanation of the things to be done on a daily basis under

the preview Dinacharya, Ritucharya etc. These activities have an effect on the Doshas

and thus if done in an improper manner may lead to different diseases.

In the present era different types of lifestyle disorders are dominating the list of

health problems. Amlapitta (Hyperacidity) is one among the commonest health problem

in the society which is triggered by irregular and improper food habits and lifestyle. It

may eventually lead to complications like gastric ulcers, perforation and carcinoma.

Amlapitta is potentially preventable disease. By this study it was found that altering one‟s

Ahara (diet) and Vihara (lifestyle) it can be tackled in a simple and cost effective manner.

DISCUSSION


DISCUSSION ON QUESTIONNAIRE VALIDATION:

Based on Nidana of Amlapitta as per the classical texts of Ayurveda and different

research articles, questionnaire containing a total of 45 questions was designed. The items

were divided into two domains of Ahara (diet) and Vihara (lifestyle). Questionnaire was

distributed to 25 healthy subjects and 25 Amlapitta patients. After that data collected

from the subjects and evaluated by using SPSS version 20, with Cronbach‟s alpha. A

Cronbach‟s alpha value of 0.976 was obtained for all questions which was highly

significant. (A high value for Cronbach‟s alpha indicates good internal consistency of the

items in the scale, >0.9 = Excellent). All questions were framed in the final questionnaire

without any deletion. On further analysis by odds ratio, all questions showed odds ratio

value of more than 1 which show the risk related to Amlapitta.

After validation of questionnaire it contained 45 closed end questions, framed in 5

Likert scale having options Daily, Frequently, Occasionally, Very rarely and None. The 5

Likert scale was further collapsed into dichotomous scale (Daily, Frequently,

Occasionally as „Yes‟ and Very rarely, None as „No‟).

Questionnaire was distributed to 351 subjects (196 diseased and 155 healthy). On

their response statistical test was run to analyze the observations with odds ratio and chi

square and result was drawn.

Discussion on Odds Ratio:

An odds ratio is a measure of association between exposure and outcome of a

disease and its risk factor. The OR represents the odds that an outcome will occur given a

particular exposure, compared to the odds of the outcome occurring in the absence of that

DISCUSSION


exposure. Odds ratio are mostly used in case control study, however they can also be used

in cross sectional and cohort study design as well (with some modification and / or /

assumptions)

Odds ratio are used to compare relative odds of the occurrence of the outcome of

interest (e.g. disease or disorder), given exposure to the variable of interest (e.g. health

characteristic, aspect of medical history). The odds ratio can also be used to determine

whether a particular exposure is a risk factor for a particular outcome, and to compare the

magnitude of various risk factors for that outcome.

OR = 1, Exposure does not affect odds of outcome

OR > 1 Exposure associated with higher odds of outcome

OR < 1 Exposure associated with lower odds of outcome [67]

In the present study odds ratio value of each question was analyzed and the values

which were obtained were very high. Thus all the items were proved to be risk factors for

Amlapitta. This may be due to the fact that the items were selected based on the Nidanas

of Amlapitta. Thus substantiating the Nidanas told in our classics practically.

Discussion on Chi Square:

In medical research, there are studies which often collect data on categorical

variables that can be summarized as a series of counts. These counts are commonly

arranged in tabular format known as contingency tables. The chi square test static can be

used to evaluate whether there is association between the rows and columns in a

contingency table. More specifically this static test can be used to determine whether

DISCUSSION


there is any difference between the study groups in the proportions of the risk factor of

interest.

Chi square test is a non parametric test used for two specific purposes.

1. To test the hypothesis of no association between two or more groups, population

or criteria (i.e. to check independence between the two variables)

2. To test how likely the observed distribution of data fits with the distribution that is

expected (i.e., to test goodness of fit)

It is used to analyze categorical data (e.g. male or female patients, alcoholic and non-

alcoholic etc.)

Chi square test can be calculated by using formula and value is obtained, i.e. „P‟ value.

The conventionally accepted P value is less than 0.05. If obtained P value is greater than

accepted P value i.e. less than 0.05, null hypothesis is accepted and research hypothesis is

rejected.

DISCUSSION ON AHARA:

All the Ahara Dravyas mentioned in the questionnaire were proved to be risk

factors of Amlapitta statistically. Based on the nidanas of Amlapitta 26 questions were

framed. The probable reason behind each of them causing Amlapitta is discussed below

Garlic

It is Ushna in Veerya and Teekshna in Guna which aggravates Pitta hence it

causes Amlapitta if consumed in excess. According to modern science the main chemical

component of garlic, allicin a sulfur containing compound has been seen to cause

DISCUSSION


heartburn and increased acidity on excessive consumption. This is more common when

raw garlic is consumed. This study reveals eating garlic in excess shows risk (14.355 OR)

factor of Amlapitta.

Ginger

As a good eventhough it is Deepana Pachana its Teekshna and Lekhana Gunas

increases burning sensation if taken more frequently. In some studies conducted by the

modern researchers it was seen that a consumption of more than 4 grams of ginger

powder caused increased heartburn. This study reveals eating ginger in excess shows risk

(12.294 OR) factor of Amlapitta.

Sour food items

Amla Rasa is Laghu, Ushna and Snigdha all properties that are similar to Pitta.

Thus foods that are having Amla rasa predominant increases the Pitta thus increasing the

risk of Amlapitta. Amla food mostly contain acids, when there is addition of acidic items

into the stomach more that what is required it increases the corroding action of the gastric

acids on the mucus lining. This study reveals eating sour food items in excess shows risk


Spoiled food

Food items that spoilt may have undergone fermentation process which may result

in them having Amla rasa predominance and Abhisyandhi Guna in them. These properties

not only vitiate Pitta but also are heavy for digestion thus making the stomach secrete

DISCUSSION


more juices thus becoming a causative factor for Amlapitta. This study reveals eating

spoiled food in excess shows risk (129.455 OR) factor of Amlapitta.

Spicy food

Spicy food mostly have Ushna , Teekshna guna and Lavana , Katu Rasas. Both

Lavana and Katu Rasas are having Agni Mahabhoota predominance hence increases Pitta

and burning sensation. According to modern concept the spicy food items cause irritation

to mucus membranes of esophagus, stomach etc thus resulting in thinning of the mucosa

and causing ulcers. This study reveals eating spicy food in excess shows risk (298.350

OR) factor of Amlapitta.

Horse gram

It has properties like Teekshna , Amla Vipaka , Vidahi , Ushna Veerya , Ruksha

and Raktapitta karaka. It is also told as the Agrya among those that cause amlapitta. One

among the major chemical constituents of Kulattha is ascorbic acid which may be the

reason behind its action as an Amlapitta Janaka. This study reveals eating horsegram in

excess shows risk (1858.267 OR) factor of Amlapitta.

Flour items

Food items made out of flour like bread , pizza , burger are Guru and Abhisyandhi

in nature which causes Agni Mandyata which is also causative factor of Amlapitta. They

stay in the stomach for a long time and may undergo fermentation process there. This can

also lead to increased gastric acidity. This study reveals eating flour items in excess

shows risk (4.828 OR) factor of Amlapitta.

DISCUSSION


Green Chili

The Katu rasa and Ushna Teekshna gunas of green chili causes burning sensation

in throat and chest region. It is also Pitta Vardhaka. Like other katu rasa items this also

causes mucosal erosion and gastric ulcer. This study reveals eating green chili in excess

shows risk (923.100 OR) factor of Amlapitta.

Sour curd

The sour curd is Amla Rasa Pradhana ,Ushna , Kapha Pitta Vardhaka , Vata

Rakta Kara , Pitta Prakopara and Abhishyandi. It has all the properties enlisted in the

nidanas for Amlapitta. The acidic nature of the curd due to lactic acid may increase the

acidity of stomach. The formation of curd is by the process of fermentation which is also

a factor in causing acidity. This study reveals eating sour curd in excess shows risk


Red chili

It has similar properties like the green chili. Having properties like Teekshna

Ushna Ruksha Guna , Katu Rasa , Katu Vipaka , Ushna Veerya , Vidahi Janani ,

Raktapitta Krut which makes it more efficient in causing Gastritis. This study reveals

eating red chili in excess shows risk (500.192 OR) factor of Amlapitta.

New Jaggary

Jaggary which is newly prepared is considered to be very heavy in nature and is

said to cause Agnisada. Thus when a person consumes Guda in a large quantity there is

hampering of the digestive power which may lead to Vidagdha Ajeerna and further

DISCUSSION


Amlapitta. Thus it is one of the causative factors for Amlapitta. This study reveals eating

new jaggary in excess shows risk (673.200 OR) factor of Amlapitta.

Salty food items

Lavana Rasa has the properties like Teekshna , Kaphapitta vardhaka , Vidahi ,

Ushna veerya which are favorable for causing Amlapitta. It also causes increase in the

secretions. This study reveals eating salty food in excess shows risk (197.600 OR) factor

of Amlapitta.

Black gram

Excess intake of Idly , Vada , Dosa etc which are made up of black gram and also

fermented can cause Pitta Prakopa. Masha is told to be the best among Kaphapitta

Janana Dravyas. It is Ushna and guru burning sensation in chest and sour erectations.

This study reveals eating black gram in excess shows risk (673.200 OR) factor of

Amlapitta.

Pickle

Regular intake of pickles in excess quantity increases Pitta dosha and burning

sensation leading to the manifestation of Amlapitta. The cause for this is similar to the

other Katu Dravyas. They are Laghu, Ushna and Teekshna causing the Vidahata in body.

They are also mucosal irritants. This study reveals eating pickle in excess shows risk


DISCUSSION


Discussion on Viruddha Ahara:

Indulgence of food articles which are contradictory produces disease or death.In

Astanga Hrudaya Sutrasthana Acharya says that the food ,drink and medicine which does

dislodgement of Dosha from its site that is Dosha Utklesha but does not expel it out from

the body is called Viruddha.

Acharya Charaka opines that the food and drugs which dislodge the Dosha from

its normal seat but does not expel it out of the body.

These contradictory foods are unwholesome to the body like acute poison and

chronic poison and can cause death.

The reason behind the Viruddhahara causing Amlapitta may vary according to the

type of Viruddha, but it may be attributed to the tri Dosha Dooshana and Durjaratva of

such Ahara.

This study reveals eating viruddahara in excess of domestic meat with honey

(121.529 OR), fish with curd (122.293 OR), fish with milk (91.841 OR), horse gram with

curd (669.524 OR), milk with raddish (948.633 OR), salt with milk (431.813 OR), pork

with curd (142.756 OR), sour fruit with milk (272.828 OR), leaf vegetable with butter

(422.308 OR), banana with curd (222.333 OR), aerated drinks (431.813 OR), heated curd

preparation (135.185 OR) shows a risk factor in Amlapitta.

Chi Square value for above all questions on Ahara is (P = 0.000), which is highly

significant in all Aharaja nidanas.

DISCUSSION


DISCUSSION ON VIHARA:

Vihara is an important pillar in Ayurveda. It means activity. Vihara plays a very

significant role in proper functioning of the body. The principles of vihara explain clearly

how to act in different ways that are life supportive and it also includes lifestyle

guidelines for maintaining good health.

Eating Food Irrespective of Hunger

When food taken previously is completely digested only then does a person feel

hungry. So if there is no hunger it means the digestion is not complete. When a person

eats again without feeling hungry it hampers Agni and causes indigestion. The new food

mixes with the previous half digested food and may undergo fermentation. There is also

the secretion of gastric juices onto the half digested food which will increase the acidity.

This study reveals eating irrespective of hunger shows (23.963 OR) risk factor in causing

Amlapitta.

Sleeping During Day

The body has a specific timetable for its functioning called the circadian rhythm.

In this the night is the time for sleep. When a person sleeps during the day time this clock

is disrupted which will have an effect on the hormones and GIT secretions also. The sleep

slows down the process of digestion thus increasing the contact period of the gastric

juices in the stomach. Acid presence in the stomach for a long time can cause mucosal

erosion leading to ulcer. According to Ayurveda sleeping during daytime increases kapha

Pitta Dosha producing Ama which paves way for the condition of Vidagdha Ajeerna in

DISCUSSION


turn leading to Amlapitta. This study reveals sleeping during daytime shows (29.858 OR)

risk factor in causing Amlapitta.

Consumption of Alcohol

Alcohol is a very potent causative factor of Amlapitta. Its consumption in excess

quantity increases acid secretions in stomach and causes inflammation of stomach. The

properties of alcoholic beverages are all Pitta Prakopaka in nature. It has Lavana Varjita

Pancha Rasa, Amla Vipaka and Teekshna, Ushna Gunas these increase burning sensation

in chest and throat region. Taking alcohol in empty stomach also has a corrosive effect on

the gastric mucosa. Drinking alcohol relaxes the lower esophageal sphincter, making it

easier for stomach contents to escape into the esophagus thus causing Urdvaga Amlapitta.

This study reveals alcohol consumption shows (18.975 OR) risk factor in causing

Amlapitta.

Smoking

Smoking is considered to be a very potent Pitta Prakopaka Vihara Dhoomapana

is contraindicated in Pitta Kala, Pitta Prakopa, along with Madya, Matsya, Dadhi etc

thus stating its role in Pitta and Rakta Dooshana.. Smoking causes digestive stress and

lead to indigestion. It slows down production of saliva which is a natural defense of body

against stomach acid, stimulates production of stomach acid and Injures esophagus.

Smoking also results in the washing of bile salts from the intestine into the stomach,

producing acid reflux. This study reveals smoking shows (14.355 OR) risk factor in

causing Amlapitta.

DISCUSSION


Tea or Coffee

The main constituent in tea and coffee is caffeine which is a stimulant. It causes a

rise in pulse, blood pressure and stomach acid production. Indulgence in excess of tea or

coffee also decreases pressure in lower esophageal sphincter, contributing to more gastro

esophageal reflux. Coffee is highly acidic and it can stimulate the hyper secretion of

gastric acids. Coffee tends to speed up the process of gastric emptying, which may result

in highly acidic stomach contents passing into the small intestine more rapidly than

normal leading to inflammation there. This study reveals tea or coffee shows (14.205 OR)


Skipping meals

Skipping meals when hungry has a very direct and clear effect on the production

of Amlapitta symptoms. When a person is hungry it means that the previous food has

been digested and the stomach is empty awaiting the next meal. There is production of the

gastric acid during this time. So when food is not provided then, the produced acid

attacks stomach lining leading to erosion of mucosa, ulcers, inflammation and abdominal

pain every time when we consume food thereafter. This study reveals skipping meals

shows (7.502 OR) risk factor in causing Amlapitta.

Drinking excess water soon after meal

Drinking a lot of water soon after meals may cause Agni mandya causing

indigestion and produce Ama which is a cause of Amlapitta. The drop in the temperature

of stomach due to the water will cease the digestion process and will also make the

DISCUSSION


contact period of acid more. This study reveals drinking excess water soon after food

shows (4.828 OR) risk factor in causing Amlapitta.

Extra spice and salt

As told for each food item that is Katu and Lavana these food items having

Teekshna and Ushna Guna whih causes aggravation of Pitta. There is also increases level

of HCL in the stomach due to such food, which causes burning sensation and damages

stomach lining causing inflammation. This study reveals eating extra spice and salt shows

(12.294 OR) risk factor in causing Amlapitta.

Bathing soon after food

Taking bath soon after a meal will lead to Mandagni which may leads in the

condition of Tridosha Prakopa and formation of Ama takes place. This can lead to

condition Ajeerna and then Amlapitta. In the modern context, bathing will lead to a

reduced blood supply to the GIT organs leading to delayed digestion. Digestion requires a

lot of energy and a good amount of blood flow toward the stomach. When you take a bath

or shower right after eating dinner, it causes a slight decrease in body temperature thus

hampering the digestion. This study reveals bathing soon after food shows (20.457 OR)


Suppressing natural urges

The suppression of the natural urges like Pureesha, Mootra Adhovata etc,leads to

vitiation of Apana vayu and causes Udavarta and subsequently vitiation of Samana Vata

which is instrumental in digestion. The Vegas are generated by action of Vata and if it is

DISCUSSION


suppressed Tridosha vitiation takes place which will also affect Agni. This study reveals

suppressing natural urges shows (23.034 OR) risk factor in causing Amlapitta.

Sleeping immediately after food

Sleeping soon after having food may feel good, but when the body is in supine

position, is difficult for the digestive system to work which may lead to abnormal HCL

leading to hyperacidity. The position can also facilitate easy refluxes of the gastric

content into the esophagus causing heartburn. The sleep also slows down the process of

digestion. Sleep according to Ayuveda causes Mandagni and Ajeerna as results. This

study reveals sleeping immediately after food shows (5.638 OR) risk factor in causing

Amlapitta.

Drinking water between meals

As per Ayurveda water is to be taken in between the meal but it is not that large

amounts of water are to be drunk. This will do more bad than good. The digestive juices

may get diluted hampering the digestion or the more liquid content may trigger acid

reflux symptoms. This study reveals drinking water between meals shows (9.358 OR) risk

factor in causing Amlapitta.

Anger, depression, stress and anxiety

The Manasika Bhavas like anger and stress vitiates Pitta Dosha. The increased

Pitta also increases the Agni and Daha in the person. Sometimes in the conditions like

depression and stress due to intense emotional feeling and lack of mood to do anything

the person may also get aversion towards everything including normal dietary intake

DISCUSSION


which lead to manifestation of gastritis. Stress can also deplete the production of

substances called "prostaglandins," which normally protect the stomach from the effects

of acid. When in stress body produces hormones that slow down digestion. Food stays in

your stomach longer. That means stomach acids have more time to move up into your

esophagus. This study reveals anger (10.795 OR), stress (7.625 OR), depression (39.118

OR) and anxiety (173.600 OR) shows risk factors in causing Amlapitta.

Other Vihara Factors

Eating Betalnut leaf with tobacco (8.174 OR), work in too hot atmosphere (14.205

OR), excess bath (5.329 OR) shows risk factor in Amlapitta.

Chi Square value for above all questions on Vihara is (P = 0.000), which is highly

significant in all Viharaja nidanas.

CONCLUSION


CONCLUSION

CONCLUSION


CONCLUSION

The presence study entitled “Survey study on effect of ahara and vihara in

amlapitta”, was an attempt to draw an insight on risk factors associated with ahara and

vihara in amlapitta, as amlapitta is an emerging common disease. After a detail

conceptual study critical review, observations, analysis of data and discussion, the

following conclusions were evolved. All the factors analyzed were arranged in decreasing

order of obtained odds ratio and chi square values.

This study revealed that Ahara, Vihara, Aachara, Vichar, if not following in

proper manner become a causative factor of Amlapitta.

Based on Ahara (Diet):

Horsegram (1858.267 OR), sour curd (1732.500 OR), milk with raddish

(948.633 OR), green chili (923.100 OR), sour taste food (713.231 OR), new jaggary

(673.200 OR), black gram (673.200 OR), horsegram with curd (669.524 OR), red chili

(500.192 OR), salt with milk (431.813 OR), aerated drinks (431.813 OR), leafy vegetable

with butter (422.308 OR), spicy food (298.350 OR), sour fruit with milk (272.828 OR),

banana with curd (222.333 OR), salty food (197.600 OR), pork with curd (142.756 OR),

heated curd preparation (135.185 OR), spoiled food (129.455 OR), fish with curd

(122.293 OR), domestic meat with honey (121.529 OR), fish with milk (91.841 OR),

garlic (14.355 OR), ginger (12.294 OR), pickles (5.638 OR), flour items (4.828 OR) all

CONCLUSION


these factors have shown risk in causing Amlapitta. Chi Square value for all questions( P

= 0.000).

Based on Vihara (Lifestyle):

Anxiety (173.600 OR), depression (39.118 OR), day sleep (29.858 OR), eating

irrespective of hunger (23.963 OR), suppressing natural urges (23.034 OR), bathing soon

after food (20.457 OR), alcohol (18.975 OR), smoking (14.355 OR), tea or coffee (14.205

OR), work in hot atmosphere (14.205 OR), adding extra salt and spice (12.294 OR),

anger (10.795 OR), drinking water between meal (9.358 OR), betalnut leaf with tobacco

(8.174 OR), stress (7.625 OR), skipping meal (7.502 OR), sleeping soon after food (5.638

OR), excess bath or tub bath (5.329 OR), drinking excess water soon after food (4.828

OR) all these factors shows risk factor in Amlapitta.

This study reveals that there is an effect of Ahara and Vihara in manifestation of

Amlapitta.

CONCLUSION


Further Scope of Study

Survey study based on measurement of food items which is consumed in routine

causes Amlapitta.

Effect of risk factors associated with Vihara in Amlapitta.

SUMMARY


SUMMARY

SUMMARY


SUMMARY

The present work entitled “Survey study on effect of Ahara and Vihara in

Amlapitta” was broadly dealt under following headings:

Introduction

Aims & Objectives

Review of Literature

Materials and Methods

Observations and Results

Discussion

Conclusion

Introduction:

It gives a brief review, why the work was selected for research.

Aims and Objectives:

The present survey study was carried out with following aims and objectives.

1. To find out the effect of Ahara and Vihara in Amlapitta.

Review of Literature:

It puts forward review on concepts of diet and lifestyle in Vedic principles,

concept of lifestyle as per Ayurveda, concept of Swastha as per Ayurveda, concept of

Agni and Ama, Arogya karanam and Roga, preventive principles in Ayurveda and

contemporary science .

SUMMARY


Materials and Methods:

Data for framing questionnaire was collected from Ayurvedic books,

contemporary books, journals and research articles. A set of 45 questions were framed on

considering possible Nidana for Amlapitta and were given to 25 healthy and 25 Amlapitta

cases. After collecting data, analysis done with SPSS 20 version, using Chronbac’s alpha

and odds ratio then questions were used to collect data from 196 cases (Amlapitta) and

155 controls (Healthy). Data analysis was done using odds ratio and chi square and

conclusion was drawn.

Discussion:

Discussion was done on framing of questionnaire, validation of questionnaire,

odds ratio, chi square. After that discussion on Ahara (diet) and Vihara (lifestyle) was

done separately. Discussion on Ahara and Viruddha Ahara was done. Discussion on

Vihara was further divided into Sharirika Vihara and Manasika vihara

Conclusion:

Conclusion was drawn on the basis of obtained odds ratio and chi square value in

decreasing order and hence proves that there is a significant role of Ahara and Vihara in

causing Amlapitta.

REFERENCE

SURVEY STUDY ON EFFECT OF AHARA AND VIHARA IN AMLAPITTA

REFERENCE

REFFERNCES


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REFFERNCES





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2010.P 185.

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Choukambha Sanskrit Sansthan; 2010 .p.336.

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Chukhamba Vishvabharti,Varanasi 2010,P.384.



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2010. P 101

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and Srikanthadatta. Reprint ed. Chaukambha orientalia; Varanasi; 2010.p.170.

Acharya




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commentary of Indu. Varanasi (India): Chaukambha Orientalia; 2008 .p.159 .

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Choukambha Sanskrit Sansthan; 2010 .p.338


commentary of Indu. Varanasi (India): Chaukambha Orientalia; 2008 .p.159

24) Satyapala. Kashyapa Samhita with Vidyotini hindi commentary.

Varanasi:Choukambha Sanskrit Sansthan; 2010 .p.338







28) Paradakara HSS, Ashtanga Hrudayam with Sarvanga Sundaram commentary of

Arunadutta and Ayurveda Rasayana of Hemadri. 9thed. Varanasi (India):

Chaukambha Sanskrit Sansthan; 2005. p.193.






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2010. p. 102.

REFFERNCES




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2011.p.512. Acharya


Reprint ed. Varanasi (India): Chaukambha Orientalia; 2011.p.512 .



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2011.p.512



2010.p. 253.



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Ayurveda University; 2004.P.88

71) K Sembulingam, Sembulingam p. Essential of Medical Physiology. # 5th

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New Delhi: Jaypee Brothers Medical Publisher ( P) Ltd; 2010, p.221.

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jala as Pathya in the Amlapitta( Hyperacidity). MD Thesis. Bangalore: Rajiv

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or Vrddhajivakiya Tantra with vidyotini Hindi commentary. Reprint ed .


ANNEXURE

SURVEY STUDY ON THE EFFECT OF AHARA AND VIHARA IN AMLAPITTA Page 132

ANNEXURE

ANNEXURE


ANNEXURE

CONSENT FORM

1. TITLE OF STUDY: “SURVEY STUDY ON EFFECT OF AHARA AND VIHARA IN

AMLAPITTA”.

2. Participant enrollment ID for this trial:

3. Name of the Investigating Physician (Research Scholar): Dr Rakshith K. R

4. Name of the Guide: Dr. Shivakumar MD (Ayu)

5. I confirm that I have read / the study has been explained to me adequately and I have

understood the information sheet for the above study and had the opportunity to ask questions.

6. I hope to complete the study, but I understand that my participation is voluntary and that I am

free to withdraw at any time, without giving a reason, and without my medical care or legal rights

being affected.

7. I understand that the information will be used for medical research only and that I will not be

identified in any way in the analysis and reporting of the results. I understand that sections of any

of my medical notes may be looked at by the authorities or responsible individuals from the

members of the IEC, Regulatory authorities or Court, if necessary. I give permission for these

individuals to have access to my records.

8. I understand what is involved in this trial and agree to take part in this survey study for a

period of 1 day.

Name of the Patient: _________________________ IP NO: ____________________________

Gender: (M/F) ______________ Age: ___________ Religion:___________________________

Address: _________________________________ Signature_____________________________

Guardian(s) Signature Date: ____________________Mobile No: _________________________

Name of the witness Signature Date:_________________________________________________

Investigating physician

(Research Scholar)

Signature with Date: Dr. Rakshith K.R

Guide Signature with Date: Dr. Shivakumar MD (Ayu)

ANNEXURE


A SURVEY STUDY ON EFFECT OF AHARA AND VIHARA IN AMLAPITTA

1.How frequently you use Garlic in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಬೆಳ್ಳುಳ್ಳು G¥ÀAiÉÆV¸ÀÄwÛÃj?)

a)Daily

(ನತ್ಯವೂ)

b)Frequently

(ಪದೆೀಪದೆೀ)

(4-6 days)

c) Occasionally

(ಎಂದದರೆೊಮ್ಮೆ)

(1-3 days)

d)Very Rarely

(ಅತ್ಯಂತ್ಕಡಿಮ್ಮಬರಿ)(Less

than once)

E)None

(ಇಲಿ್)

How many times in a day? (M0zÀÄ ¢£ÀzÀ°è J¸ÀÄÖ¨Áj G¥ÀAiÉÆV¸ÀÄwÛÃj?)

a) once (M0zÀÄ¨Áj)b) twice (JgÀqÀÄ¨Áj)c) thrice (ªÀÄÆgÀÄ¨Áj) d) More than three times

(ªÀÄÆgÀQÌ0vÀºÉZÀÄÑ¨Áj)

2. How frequently you use Ginger in a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಶುಂಠಿ G¥ÀAiÉÆV¸ÀÄwÛÃj? )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




3.How frequently you use sour taste foodin a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ºÀÄ½¥ÀzÁxÀð

G¥ÀAiÉÆV¸ÀÄwÛÃj?)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




4.How frequently you use spoiled food in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ºÀ¼À¹zÀ DºÁgÀ

w£ÀÄßwÛÃj?)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally

(ಎಂದದರೆೊಮ್ಮೆ) (1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

ANNEXURE





5.How frequently you use spicy food in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ SÁgÀ G¥ÀAiÉÆV¸ÀÄwÛÃj? )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




6.How frequently you use Horsegram in a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಹುರುಳ್ಳ ತಿನ್ುುತಿತೀರಿ?)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




7.How frequently you eat flour items in a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ »nÖ£À¥ÀzÁxÀð

ತಿನ್ುುತಿತೀರಿ?) (Like Pizza , Burger , Sandwitch , Bread)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




8.How frequently you use Green ChillI in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ºÀ¹ªÉÄt¸ÀÄ

ತಿನ್ುುತಿತೀರಿ )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

ANNEXURE





9.How frequently you use sour Curd in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಮೊಸರು ತಿನ್ುುತಿತೀರಿ? )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




10.How frequently you use Red Chilli in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ PÉ0¥ÀÄªÉÄt¸ÀÄ


a)Daily


b)Frequently

(ಪದೆೀಪದೆೀ) (4-6 days)

c) Occasionally


d)Very Rarely


than once)

E)None

(ಇಲಿ್)




11.How frequently you use new Jaggery in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಬೆಲಿ್ ತಿನ್ುುತಿತೀರಿ )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




12.How frequently you use Salty food in a week? (ನೀವುಒಂದುವರದಲಿ್ಲಎಷುುಬರಿG¦à£À DºÁgÀ


a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

ANNEXURE




(ªÀÄÆgÀQÌ0vÀºÉZÀÄÑ¨Áj

13.How frequently you use Black gram in a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಉದಿ್ದನ್ಬೆೀಳ ೆತಿನ್ುುತಿತೀರಿ)?

(Idly ,Vada , Dosa)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




14.How frequently you eat Pickle in a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಉಪ್ಪಿನ್ಕಯಿ ತಿನ್ುುತಿತೀರಿ)?

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)




15. How frequently you useAerated Drinks in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ

vÀ0¥ÀÄ¥Á¤ÃAiÀÄ¸ÉÃ«¸ÀÄwÛÃj? )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

16.How frequently you use Domestic meat with honey in a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ªÀiÁ0¸À

ªÀÄvÀÄÛ eÉÃ£ÀÄ vÀÄ¥Àà ತಿನ್ುುತಿತೀರಿ)?

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

ANNEXURE


17. How frequently you eat Fish with Curd in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿಮೀನ್ು, ಮೊಸರು

ಜೆೊತೆಯಗಿ ತಿನ್ುುತಿತೀರಿ )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


d)Very Rarely


than once)

E)None

(ಇಲಿ್)

18. How frequently you eat Fish with Milk in a week?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಹಲ್ು-ಮೀನ್ು

ಜೆೊತೆಯಗಿ ತಿನ್ುುತಿತೀರಿ)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


d)Very Rarely


than once)

E)None

(ಇಲಿ್)

19. How frequently you eat Horsegram with curd in a week ? (ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ

ªÉÆ¸ÀgÀನೆೊಂದ್ದಗೆ ºÀÄgÀ½PÁ¼ÀÄ ತಿನ್ುುತಿತೀರಿ? )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

20. How frequently you use Milk with Raddishin a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಹಲ್ಲನೆೊಂದ್ದಗೆ

ªÀÄÆ®0V ತಿನ್ುುತಿತೀರಿ? )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

21. How frequently you use salt with milk in a week? (ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ಹಲ್ಲನೆೊಂದ್ದಗೆ

ಉಪ್ಿಗಿರುವ ತಿನಸುಗಳ್ನ್ುು ತಿನ್ುುತಿತೀರಿ?)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

ANNEXURE


22.How frequently you use pork with curd in a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ªÉÆ¸ÀgÀನೆೊಂದ್ದಗೆ

ºÀ0¢ªÀiÁ0¸À ತಿನ್ುುತಿತೀರಿ?)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

23. How frequently you use Sour fruits with Milk in a week? (ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ

ಹುಳ್ಳಹಣ್ುುಗಳ್ ಹಲ್ಲನ್ಸೆೀವನೆಮಡುತಿತೀರಿ )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

24. How frequently you use Leafy Vegetable with Butter in a week? (ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ

¸ÉÆ¦à£À dvÉ ¨ÉuÉÚAiÀÄ£ÀÄß w£ÀÄßwÛÃj?)

a)Daily


b)Frequently

(ಪದೆೀಪದೆೀ) (4-6 days)

c) Occasionally


d)Very Rarely


than once)

E)None

(ಇಲಿ್)

25. How frequently you use Banana with Curd in a week? (ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ ¨Á¼ÉºÀtÂÚ£À dvÉªÉÆ¸ÀgÀ£ÀÄß ಸೆೀವನೆ ಮಡುತಿತೀರಿ? )

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

26. How frequently you use Heated curd preparations in a week ?(ನೀವು ಒಂದು ವರದಲಿ್ಲ ಎಷುು ಬರಿ

©¹ªÀiÁrzÀªÉÆ¸ÀgÀ£ÀÄß¸É«¸ÀÄwÛÃj)

a)Daily


b)Frequently


(4-6 days)

c) Occasionally


(1-3 days)

d)Very Rarely


than once)

E)None

(ಇಲಿ್)

27.Do you have the habit of eating food irrespective of hunger? (¤ªÀÄUÉ ºÀ¹ªÀÅ E®èzÉ HlªÀ£ÀÄßªÀiÁqÀÄªÀ

C¨sÁå¸À«zÉAiÉÄÃ?[ Yes (ಹೌದು) / No(ಇಲಿ್) ]

28.Do you have the habit of Day sleeping? (ನಮಗೆºÀUÀ°£À°èªÀÄ®UÀÄªÀ C¨sÁå¸À«zÉAiÉÄÃ?[ Yes (ಹೌದು) /

No(ಇಲಿ್) ]

ANNEXURE


29.Do you have the habit of Alchohol Consumption? (ನಮಗೆªÀÄzsÀå¥Á£À¸ÉÃ«¸ÀÄªÀ C¨sÁå¸À«zÉAiÉÄÃ?

[ Yes (ಹೌದು) / No(ಇಲಿ್) ]

30.Do you have the habit of Smoking? (ನಮಗೆ zsÀÆªÀÄ¥Á£À ¸ÉÃ«¸ÀÄªÀ C¨sÁå¸À«zÉAiÉÄÃ?[ Yes (ಹೌದು) /

No(ಇಲಿ್) ]

31.Do you have the habit of excess intake of tea or coffee? (ನಮಗೆCwºÉZÀÄÑ nÃCxÀªÀ PÁ¦üûÃ PÀÄrAiÀÄÄªÀ


32.Do you have the habit of Skipping Meals? (ನಮಗೆ Hl vÀ¦à¸ÀÄªÀ C s̈Áå¸À«zÉAiÉÄÃ?


33.Do you have the habit of drinking excees water soon after meals? (ನಮಗೆ Hl ªÀiÁrzÀ vÀPÀêt ¤ÃgÀÄ

PÀÄrAiÀÄÄªÀ C¨sÁå¸À«zÉAiÉÄÃ?[ Yes (ಹೌದು) / No(ಇಲಿ್) ]

34.Do you have the habit of eating Betalnut Leaf with Tobbaco? (ನಮಗೆ vÀ0ªÀiÁâQ£À dvÉ«¼ÉîÃzÉ¯ÉAiÀÄ£ÀÄß

w£ÀÄßªÀ C¨sÁå¸À«zÉAiÉÄÃ?


35.Do you have the habit of Adding extra salt and spice for the food you eat? (ನಮಗೆHlzÀ°èCwºÉZÀÄÑ

SÁgÀªÀÄvÀÄÛ G¥Àà£ÀÄß w£ÀÄßªÀ C¨sÁå¸À«zÉAiÉÄÃ?


36.Do you work in too hot atmosphere? (¤ÃªÀ Å Cw ºÉZÀÄÑ ©¹°£ÀªÁvÁªÀgÀtzÀ°è PÉ®¸ÀªÀiÁqÀÄwÛÃgÁ?[ Yes

(ಹೌದು) / No(ಇಲಿ್) ]

37.Do you have the habit of Bathing soon after having food? (¤ÃªÀÅ Hl ªÀiÁrzÀ vÀPÀêt ¸Áß£ÀªÀiÁqÀÄªÀ


38.Do you have the habit of Supressing Natural Urges? (¤ªÀÄUÉ¤ªÀÄäªÉÃUÀªÀ£ÀÄß¤AiÀÄ0wæ¸ÀÄªÀ C¨sÁå¸À«zÉAiÉÄÃ?[

Yes (ಹೌದು) / No(ಇಲಿ್) ]

ANNEXURE


39.Do you have the habit of sleeping soon after having food? (ನಮಗೆ Hl ªÀiÁrzÀ vÀPÀêt ¤zÉÝªÀiÁqÀÄªÀ

C¨sÁå¸À«zÉAiÉÄÃ?[ Yes (ಹೌದು) / No(ಇಲಿ್) ] 40.Do you have the habit of Excess Bath or Tub Bath? (¤ªÀÄUÉ

Cw ºÉZÀÄÑ ¸Áß£ÀªÀiÁqÀÄªÀ C¨sÁå¸À«zÉAiÉÄÃ?[ Yes (ಹೌದು) / No(ಇಲಿ್) ]

41.Do you have the habit of Drinking Water between the meal? (ನಮಗೆHlzÀªÀÄzsÀåzÀ°è¤ÃgÀÄ PÀÄ¢AiÀÄÄªÀ


42.Do you often feelAngry? (¤ªÀÄUÉ«ÃUÀªÁV ¹lÄÖ§gÀÄvÀÛzÉAiÉÄÃ?[ Yes (ಹೌದು) / No(ಇಲಿ್) ]

43.Do you often feel Stress? (ನಮಗೆCwAiÀiÁzÀªÀvÀÛqÀ«zÉAiÉÄÃ?[ Yes (ಹೌದು) / No(ಇಲಿ್) ]

44.Do you often feelDepressedl? (ನಮಗೆzÀÄ:R«zÉAiÉÄÃ?[ Yes (ಹೌದು) / No(ಇಲಿ್) ]

45.Do you often feel Anxiety? (ನಮಗೆ?[ Yes (ಹೌದು) / No(ಇಲಿ್) ]

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