Singh Vijeyta et al / Int. J. Res. Ayurveda Pharm.

7(4), Jul - Aug 2016

Review Article
www.ijrap.net

EFFICACY OF VIRECHANA KARMA AND KHANDA PIPPALI AVALEHA IN THE MANAGEMENT OF

AMLAPITTA: A REVIEW
Singh Vijeyta 1*, Srivastava Kumar Alok 2, Kushawaha Singh Yogesh 1
1
PG Scholar Final year, Department of Panchkarma, Rishikul Campus, Uttarakhand Ayurved University, Haridwar,
Uttarakhand, India
2
Associate Professor, Department of Panchkarma, Rishikul Campus, Uttarakhand Ayurved University, Haridwar,
Uttarakhand, India

Received on: 08/05/16 Revised on: 16/06/16 Accepted on: 22/06/16

*Corresponding author
E-mail: [email protected]

DOI: 10.7897/2277-4343.074127

ABSTRACT

Amlapitta is very common disease encountering in present population with more or less severity. 80% of the top ten life threatening disease of the
world are due to faults in dietary habits. It is characterized by acid regurgitation, nausea, Heart burn indicating the Vikruti of Pachaka Pitta along with
Kledaka Kaphaand Samana Vayu. Though it is not possible to find exact correlation of disease in contemporary system of medicine but some of the
diseases explained certainly have similarities with symptoms of Amlapitta which is described under broad category Acid Reflux syndrome but more
precisely seems it closely resemblance with Hyperacidity, Gastritis. Modern treatment include PPIs, H2 blockers, antacids etc. The US Food and Drug
Administration (FDA) warned that there is increased risk of fractures with the use of Proton Pump Inhibitors (PPIs) including Esomeprazole,
Omeprazole and Pantoprazole. This has encouraged to assess the effect of the Ayurvedic approaches, both Shodhana (Virechana) and Shamana
(Khanda Pippali Avaleha) in the management of Amlapitta. Virechanais a method, which is much safer, less complicated and an almost painless
procedure as compared to others. In Amlapittathere is a need for purification of GIT which is very well done by Virechanaand oral medication is in
the form of Avaleha which form protective coating over gastrointestinal mucosa and prevent it from further erosion, has same efficacy as that of ulcer
protective drugs. Thus, this whole treatment can prove to be an efficacious management of Amlapittaby reducing the symptoms and dismantling the
pathophysiology.

Keywords: Amlapitta, Hyperacidity, Khanda Pippali Avaleha, Virechana.

INTRODUCTION of disease.2 The main cause is the indiscretion in taking food

which leads to three types of Doshik (physical energies)
In this rapidly growing civilization and multimedia technology imbalance: Vata, Pitta and Kapha. The three DoshasVata, Pitta
life become full with stress having more speed and accuracy are and Kapha present in the human body are found in the Grahani
the prime demands. So, people neglect healthy food and are (Duodenum) which is considered as the seat of digestive fire or
attracted towards the junk food, they are changing their diet Agni.3 It is also said that eating and fasting during indigestion
pattern, lifestyle and behavioural pattern. People are becoming leads to problem like Acidity, heart burn, gastritis which is
more stressful with worry, tension and anxiety causing so many referred as Amlapitta.4
psychological disorders which hampers the digestion and is
causing hyperacidity, gastritis, dyspepsia, peptic ulcer disorders Before talk about the plan of management and its evaluation
and anorexia. All these pathological disorders covered under the there is needed to understand Amlapitta in terms of modern
broad umbrella of “Amlapitta” in Ayurveda. science. The most common causes of gastritis are Helicobacter
pylori infections and prolonged use of Non-Steroidal Anti
It is very common disease encountering in present population Inflammatory Drugs (NSAIDS) such as Aspirin or ibuprofen.
with more or less severity. It is the one that which bears the Along with this there is an increased and frequent consumption
direct impact of the dietic errors that a person indulges. 80% of of tea, Coffee, Chocolate, spicy food, tobacco, smoking and
the top ten life threatening disease of the world are due to faults alcohol with an intention to reduce the stress, this has resulted in
in dietary habits.1 incompatibility of food and ending in gastric related complaints
such as nausea, vomiting and heartburn etc. Treatment is
In Ayurveda Amlapitta cannot be correlated with one particular directed at the cause but often includes acid suppression and for
disease more precisely. But it can be correlated with Acid H. pylori infection, antibiotics is used. If left untreated it leads to
Reflux syndrome which comprises of GERD, Gastritis, several life-threatening complications such as ulceration,
dyspepsia, Acid peptic disorder, hyperacidity etc. In Ayurveda, perforation, gastrointestinal bleeding, and adenocarcinoma.
sign and symptoms of Amlapitta mentioned by Ayurveda
stalwart’s looks very similar to GERD and Gastritis. Because of increase trend of the disease, scholars of different
Gastroesophageal reflux and gastritis resulting in heartburn system of medicine are working hard to develop various means
affects approximately 30% of the general population and measures to overcome it. Modern treatment include PPIs, H2
blockers, antacids etc. But these have their own limitations.
In Ayurvedic terminology, Agni (digestive fire) is considered as However the antacids are among the one of the most widely
the protector of the human body while Ama (toxic) is the cause used medicine all over the world. The US Food and Drug

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 Singh Vijeyta et al / Int. J. Res. Ayurveda Pharm. 7(4), Jul - Aug 2016

Administration (FDA) warned that there is increased risk of Manasika Bhava (psychological factors) as a chief cause of
fractures with the use of Proton Pump Inhibitors (PPIs) this disease as well as the analysis of Amlapitta on the basis
including Esomeprazole, Omeprazole, and Pantoprazole.5 All of Doṣha has been done by Acharya Kashyapa, whereas
these modern treatment modalities burn a hole in the pocket Kashyapa believed that the disease is caused by the vitiation
without permanently curing the disease and are only effective of Tridoshas causing Mandagni leading to Vidagdha jirna
until used, with a very high rate of relapse on leaving medicine. ultimately manifesting as Amlapitta.8
3. Acharya Vagbhaṭa has described that all the diseases are
Looking into the above mentioned facts there is a need for caused by Mandagni.9 Acharya Charaka and Kashyapa have
treatment which can prevent complication of the disease, safer, clearly indicated that Grahaṇi Doṣha and Amlapitta occur in
cost effective and easily available as well as reduce the the persons who could not check the temptation of food.
recurrence effectively. The Ayurvedic scientists have claimed 4. Acharya Madhavakar has given detailed description about
that the natural drug materials or approaches used according to this disease including classification of the same according to
the Ayurvedic system of medicine are not found to produce any Gatii.e. Urdhvaga Amlapitta and AdhogaAmlapitta.10
resistance or side effects. This has encouraged to assess the 5. Chikitsa of Amlapitta has been described by Bhavmishra.
effect of the Ayurvedic approaches, both Shodhana (Virechana)
and Shamana (Khanda Pippali Avaleha) in the management of Description of Drug (Khanda Pippali Avaleha)
Amlapitta. For selection of the drug should be kept in the mind –
a) Non – controversial b) easily available c) safety profile of the
References of Amlapitta in Ayurvedic texts drug d) acceptable form of presentation e) economic criteria is
Disease Amlapittahas very long history. also important.
It was mentioned in Kashyapa Saṃhita, Madhava-Nidana, The treatment of Amlapitta is very difficult because usually the
Yogaratnakara, Bhavaprakasa, Cakradatta and Rasaratna- patients cannot follow the Pathya – Apathya all the time.
Samuccaya. Ayurveda has a lot to offer in the management of G.I.T.
Acharya Charaka, Sushruta and Vagbhaṭa have not described disorder. Many single and compound drugs have been tried on
disease Amlapitta in a separate chapter though it has been Amlapitta. In Shamana (Ayurvedic palliative drugs) Chikitsa,
referred at certain places in their Saṃhita. Acharyas have mentioned the drugs, which are mainly having
1. Acharya Charaka has given some references about Tikta and Madhura –Rasa (pungent and sweet taste) , Sheeta –
Amlapitta.6 In Charak Samhita Amlapitta has not been Virya (cold in potency) and Katu – Vipaka, Laghu and Ruksha
directly described as disease, he has mentioned that when property.
Amavisha get directly mixed with Pitta, Amlapitta will On the basis of above description Khand Pippali Avaleha has
develop.7 been selected for the treatment of Amlapitta which is a classical
2. Acharya Kashyapa has first of all mentioned the disease reference mentioned in the Yogratnakar Uttaradh Amlapitta
Amlapitta in a separate chapter and he has also mentioned nidanamas its contents are as follows: 11

Name Rasa Guna Virya Vipaka Doshaghnata

Kapura Tikta Laghu Sheeta Katu Tridoshahar
(Cinnamom camphora)
Jaatiphala Tikta Laghu Usna Katu Kapha-Vatahar
(Myristica fragrans)
Jeeraka Katu Laghu Usna Katu Kapha-Vatahar
(Cuminum cyminum)
Daalchini Tikta, Madhur Laghu, Ruksha Usna Katu Pittashamak
(Cinnamamom zeylnica)
Naagkesar Kasaya, Tikta Laghu, Ruksha Usna Katu Kapha-Pittahar
(Messuae ferrae)
Elaichi Katu, Madhur Laghu, Ruksha Sheeta Madhur Tridoshahar
(Elletaria cardamamum)
Tejpatra Madhur,tikta Laghu, Ruksha Usna Katu Vata- Pittahara
(Cinnamomum cassia)
Dhyanak Kasaya,Tikta, Laghu, Snigdha Usna Madhur Tridoshahar
(Corriandarum sativum) Madhur
Nagarmotha Kasaya,Tikta Laghu, Ruksha Sheeta Katu Kapha-Pittahara
(Cyperus rotundus)
Pippali Katu Laghu, Snigdha Usna Madhur Vata- Slesmahara
(Pipper longum)
Vanslochan Kasaya, Madhur Laghu, Ruksha Sheeta Madhur Vata- Pittahar
(Bambusa arundinaceae)
Satavari Madhur,Tikta Guru, Snigdha Sheeta Madhur Vata-Pittahar
(Asparagus racemosus)
Haritaki Kasaya Laghu, Ruksha Usna Madhur Tridoshahara
(Terminalia chebula) Pradhana
Aamlaki Madhura, Amla Guru, Rusha, Sheeta Madhur Pittashamak
(Emblica officinalis) Pradhan Sheeta
Krisnajeera Katu Ruksha Usna Katu Kaphahara
(Carum carvi Linn.)
Maricha Katu Laghu Usna Katu Kapha- Vatahara
( Piper nigrum)
Sarkara Madhur Snigdha, guru Sheeta Madhur Vata–Pittahara
Godugdha Madhur Laghu Sheeta Madhur Tridosahara
Goghrita Madhur Snigdha, Guru Sheeta Madhur Tridosahara
Madhu Madhur Laghu Sheeta Tridosahara

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 Singh Vijeyta et al / Int. J. Res. Ayurveda Pharm. 7(4), Jul - Aug 2016

Method of Preparation aqueous extract of P. longum in stress rat models. With this
Pippali churna, Goghrita, Sarkara, Satavari, Aamla Swarasa, evidence stress- induced memory loss was found to be reversed
Godughda will be taken in dose of 1 kudava (184 gm), 2 kudava by aqueous extract of P. longum. Treatment with P. longum
(368 gm), 16 pala (736 gm), 8 pala (368 gm), 16 pala (736 gm), decreased the latent period indicating extract produced nootropic
2 prastha (1kg, 472 gm) cook them till Samyak Avaleha Paak activity. Thus, it helps in counteract the Psychological factors.12
Vidhi lakshan will present. When Avaleha get ready Daalchini, Shatavari has been reported to have Antiulcer and Antisecretory
Elachi, Tejpatra, Jeera, Nagarmotha, Haritaki, Vanslochana, activity.13
Dhaniyawill be added in amount of 2 karsa ( 11.5 – 23 gm), From the above discussion, we can say that Khanda Pippali
Krisnajeera ½ karsa ( 5.75 gm), Naagkesar, Jaayphala, Maricha, Avaleha acts on four main etiological factors i.e. Aharaja
Karpura in amount of ½ - 2 Karsa ( 5.75 – 23 gm)stirred them (dietic), Viharaja, Manasika (psychological), Agantuj (external
properly, when Avaleha get cooled add honey and will kept in factors). Thus it helps in unearthing the pathogenesis.
vessel smeared with Ghrita.
Probable mode of action of Virechana (Purgation)
Virechana Shodhana (Purification) therapy has been given an importance
Right from Kashyapa, Chakradatta, Bhavamishra and all the as it is based on expulsion of vitiated Doshas produced by the
scholars of Ayurveda have given emphasis to Shodhana non-homological factors from the body and avoids the relapses
procedure especially Vamana and Virechana in the management of diseases. Virechana is best measure for Paittika disorders as a
of Amlapitta. Virechana is best measure for Paittika disorder Shodhana remedy of disease. As per Ayurveda the Virechana
and in which Pittais associated with Vata or Kapha as a drug acts in Pachyamana Awastha i.e. the digestion of drug is in
Shodhana remedy. In Amlapitta vitiation of Annavaha, process. So, Virechana drugs starts action in stomach.
Rasavaha, Purishvaha, Raktavaha Srotas occurs, Virechana is Amashaya is the specific seat of Pitta and Kapha. Amlapitta is
clearly indicated in Annavaha Srotas Vyadhi. For this reason Amashaya (stomach) and Grahani (duodenum) Sthanjanya
Virechana has been chosen for present study. Vyadhi: as per modern science also i.e. H.pylori bacteria resides
Virechana is given by Triphala and Trivrita Yavakuta (coarse in antrum part of stomach, 90% of acid peptic disorders are
powder) and honey will be taken in dose of 100gm, 40 gm and mainly due to this bacteria but reason behind this is not yet
20 gm. After adding 8 times of water it will be boiled until it clear). Acid peptic disorder is mainly pathology of antrum or
reduces to ¼ of initial amount. oxyntic part of stomach which is nothing but Pachymanashaya
Virechana is also given by different Dravyas as per the as per Ayurveda. Action of Virechana occurs more specifically
condition of patients or after assessing the Kostha, Agni, and up o Grahani which is the seat of Agni and it also draws the
Rogi- Roga Bala. Doshas which is resides in Amashaya as mentioned by Acharyas
In Mridu, Madhyamaand Krura Kostha persons, Mridu, it is necessary to do the Vamana (emesis) prior to Virechana
Madhyam and Teekshna Dravya should be given respectively. If otherwise it draws the Kapha from Amashaya and causes
the Kostha of the patient is unknown then he should be Pravahika (dysentery) and Mandagni.14 Though Virechana is a
administered Mridu Aushadhi. specific therapy for Pitta Dosha, it may also be used for
eliminating Kapha Dosha.
DISCUSSION In Amlapitta vitiation of Pitta and Kapha Dosha. The main
pathological factors associated with this disease are Kapha and
Probable mode of action of Khanda Pippali Avaleha Pitta Dosha, Rasa Dhatu, Ama and vitiated Agni. Breaking the
Most of the drugs are Tikta (pungent), Kashaya (astringent)and pathology is the key to successful outcome so; every procedure
Madhura Rasa Pradhana (sweet). Madhura, Tikta and Kashaya involved here is focused on alleviation of Pitta and Kapha and
Rasa are Pitta Shamaka. Tikta Rasaand Kashaya Rasa also correction of Agni.
subsides Kapha Dosha. 50% of drugs have Madhura Rasa Every Panchakarma procedure is started with Deepana-Pachana
counteract the Tikshna Guna of Vitiated Pitta having soothing Karma. These medicines digest Ama and remove the obstruction
effect promotes strength and pacify Pittaand Vata Dosha and in Srotas (channels). In Amlapitta, Mandagniis present.
useful in Daha(burning sensation). 8 ingredients have Tikta Samarasadhatu (metabolic stage) are most affected in this.
Rasa, according to Charaka Samhita, Tikta Rasa (pungent) is Therefore, Deepana-Pachana is important in Amlapitta.
having following properties like Krimighna (anti- microbial), Deepana-Pachana is followed by Purva Karma i.e Snehana and
Murcha (syncope), Daha (burning sensation), Kandu (itching), Swedana (oleation and sudation therapy). Snehana and Swedana
Trishna (thirst), Jwaraghna (anti-pyretic), Agnidipana (increase as Purvakarma (pre- operative)cause aggravation (Vridhdhi),
digestive fire)and Pitta Sleshma Upasoshana (antagonist to Pitta increase the fluidity (Vishyandana), suppuration (Pakata),
and Sleshma). In pathogenesis of Amlapitta, Mandagni removal of the obstruction in the channel of circulation
(impaired digestive function) leads to Ama (substance resulting (Srotomukha Vishodhanat). Due to these Purvakarma
in the process of transformation before attaining finality) procedures the vitiated Doshas leave the periphery and come to
formation. Pippali is the best medicine for Amapachana and the central part of the body (Kostha) and then get eliminated by
alleviates the Srotorodha (obstruction in channels) by Ushna, Virechana.
Tikshna Guna. Natural Rasa of Pitta i.e Katu is converted into
Vidagdha Amla Rasa due to Agnimandhya (diminished Virechana effect at Dosha level- Virechana is said to be the
metabolism) by virtue of Dravata (fluidity) increase of Pitta best treatment of Pitta but it is also a treatment of Kapha Dosha
Dosha occurs. Tikta Rasa drugs directly act on the Vidagdha especially which is situated in Pitta Sthana.15
Pitta and converted it into Nirama Pitta (digestive form of Pitta),
also decreases the Pitta Dravata Vriddhi, so its benefits in Effect at Ama and Agni- As it is a disorder arising due to
pacifying symptoms like Utklesha (nausea), Amlaudgara (acid vitiation of Agni, mainly Dhatvagni, Virechana removes
regurgitation), Avipaka (indigestion) are seen. Vatanulomana Avarana of Vayu in Kostha and corrects the Agnivaigiunyata.16
(downward movement of vayu) property of Haritaki and Thus, the production of Ama Annarasa is stopped.
Amalaki helps in expelling the excessive Vidgdha Pitta from the
body. All the drugs having Deepana- Pachana (digestive and Effect at Srotas level- Srotas Vaigunya is involved in
carminative) property which improves the status of Agni. pathogenesis and Srotovishuddhi17 is achieved by proper
Srikanth and Venkatesh evaluated the anti- stress activity of

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 Singh Vijeyta et al / Int. J. Res. Ayurveda Pharm. 7(4), Jul - Aug 2016

Virechana. So, by breaking pathology at Srotas level it pacifies 6. Gorakhnath Chaturvedi, Kasinath Shastri, Agnivesha.
the disease. Charaka Samhita (Ca.Su.1/111), (Ca.Su.20/14),
Deepana – Pachana along with Virechana helps in the proper (Ca.Su.25/40), (Ca.Ci.15/47), edition 2005, 2009, Varanasi:
functioning of Agni, as a result Amla Rasa of Pitta will not get Chaukhambha Sanskrita Sansthana, pg. 46, 403, 467, 430
increased which is nothing but Vidagdha Awastha of Pitta and it 7. Rakesh Shukla. Efficacy of amlapittantak lauha in amlapitta.
no longer get accumulated in stomach. Further proper formation Int. J. Res. Ayurveda Pharm. Mar - Apr 2016;7(2):8-11
of Rasa Dhatu takes place. http://dx.doi.org/10.7897/2277-4343.07246
Virechana by Vataanulomana property helps in expulsion of 8. Pt. Hemraj Sharma, Vridha Jeevak Tantra, Kashyapa
Vidagdha Pitta Dosha after converting it in Samawastha (normal Samhita, Khilsthan, Chapter 16, 2006, Chaukambha Sanskrit
stage) from Adhomarga which is responsible for mandagni in Publication, Varanasi, pg. 338
Amlapitta. So, by the Virechana process increase in Agni is 9. Kaviraj Atridev Gupt, Vagbhatavirachitam, Astang
observed and it helps in purification of Srotas (Sroto shodhana) Hridyam, Nidan Sthan, Chapter 12, verse-1, edition 2011,
as a result Ama Dosha was pacified. Varanasi: Chaukhambha Sanskrita Sansthana, pg. 358.
Charaka Samhita has cleared that wholesome food taken even in 10. Yadonandan Upadhyay, , Madhukosha Tika, Madhav
proper quantity do not get properly digested when the individual Nidan, 2nd part, Uttaradh, Chapter 51, , verse 4-6, 2008,
is afflicted with grief, fear, sorrow, excessive sleep and Chaukambha Sanskrit Publication, Varanasi, pg. 204
excessive vigil. These factors are the major cause Agnimandya. 11. Vaidya Shri LaxmipatiShastri, Vidhyotani Hindi Tika,
Agnimandya is involved in Amlapitta. Yogratnakar, Uttaradh, Amlapittasya Chikitsa, Chapter 53,
As psychological factors are also involved in pathogenesis of 2013, Chaukambha Sanskrit Publication, Varanasi, pg. 241
disease. Manindriya Prasadan (normal functioning of sense 12. Srikanth L., Venkatesh G, effect of piper longum on urinary
organs and mind) property of Virechana helps in rectifying the metabolites and its correlation with nootropic activity in rat
physic factors involved. models Research & Reviews: a journal of medical science &
By seeing its above discussion, we can say Virechana helps in Technology 2012. 1 (1): 10-27
dismantling the pathogenesis of Amlapitta, may provide 13. Bhatnagar M, Sisodia SS. Antisecretory and antiulcer
effective and longer lasting remedy for Amlapitta. activity of Asparagus racemosus Willd. Against
indomethacin plus phyloric ligation-induced gastric ulcer in
CONCLUSION rats. J Herb Pharmacother. 2006; 6(1):13–20
14. Vasant C. Patil, Principle and practice of Panchkarma,
Virechana Karma and Khanda Pippali Avaleha by correcting the Chapter 12, Virechana Karma, edition 2012, Atreya
vitiated state of Pitta corrects the whole digestion process and Ayurveda Publication, pg. 329
results in proper functioning of Agni. It also helps in abolishing 15. Pt. Kashi Nath Shastri and Gorakh Nath Chaturvedi.
all the four major factors involved in pathogenesis of disease. Vidyotini commentary of Charaka Samhita. Chikitsa Sthan
Hence, proves to be an effective measure in treating Amlapitta. Chapter 3, Verse 171. Chaukhamba Bharti Academy:
This study can prove a real breakthrough in the coming times for Varanasi. Reprinted 2012. pg 143.
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Vidyotini commentary of Charaka Samhita. Siddhi Sthan
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