Evaluation of Saama Dosha Lakshana in Amlapitta

EVALUATION OF SAAMA DOSHA LAKSHANA IN AMLAPITTA

Ajantha1, Saranya K2, Anuradha B3

1Professor, 2 Final year PG scholar,3 Assistant professor

1 Department of Roga Nidana Evam Vikruthi Vijnana

1 SDM College of Ayurveda and Hospital, B M Road, Thanniruhalla, Hassan, Karnataka, India

ABSTRACT

In Ayurveda, the concept of Agni-Vaishamya plays a key role in understanding the pathogenesis of a disease, as vitiated Agni results in Apakwa Ahara Rasa, getting transformed into Ama triggering the process of Dosha-Dushya Sammurchana further leading to the manifestation of Vyadhi. Ama combining with Dosha produces varying manifestations in diseases. Hence assessment of Saama and Nirama Awastha becomes necessary for better diagnosis. Amlapitta, an Annavaha Srotovikara that has marked manifestation in Mahasrotas due to altered function of Agni is the best model to understand and assess the expression of Saama Dosha Lakshana. Thus in the present study, 30 patients diagnosed with Amlapitta in Saama Awastha were assessed for Saama Vata, Saama Pitta, and Saama Kapha Lakshana respectively. Further, these Saama Dosha Lakshana were regrouped into three domains such as Lakshana related to Mahasrotas, Shula and Anya Lakshana. Based on frequency and percentage, Saama Dosha Lakshana exhibited as Saama Vata, Saama Pitta and Saama Kapha Lakshana are analyzed and the result is obtained by the method of arbitration and assessment estimating the percentage of presence of Saama Dosha Lakshana into uncommon manifested Lakshana, commonly manifested Lakshana and very common manifested Lakshana. The present study indicates, Saama Dosha (Vata, Pitta, Kapha) Lakshana that manifest very common are Antrakujana, Agnisada, Guru, Hrit Daha, Amla Rasa, Amla Udgara, and Kshud-vighata. Lakshana that manifest common is Angapida and Ghana. Uncommon manifested Lakshanas are Vedana, Nistoda, Vibandha, Sthamba, Kanta Daha, Durgandha, Shyava-varna, Harita-varna, Styana, Durgandha, Tantula, Udgara-vighata, and Avila.

KEYWORDS: Ama, Saama Dosha Lakshana, Amlapitta.

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INTRODUCTION:

The concept of Ama is distinctive to Ayurveda and Amaya is synonymous with Vyadhi.[1] The term Ama, in general, denotes substances that are undigested, immature, unripe or incompletely metabolized. Ama primarily results due to the hypo-functioning of Jataragni. Due to the reduced strength of Agni, the malformed Adhya Dhatu (Ahara Rasa) undergoes vitiation, and on stasis, in Amashaya it attains Shuktatva (fermentation) and results in Ama. [2] The clinical features that manifest in Saama Dosha Awastha are mentioned in the classical literature of Ayurveda. They can be categorized into Samanya Lakshana (general features) and Vishishta Lakshana (specific features). Samanya Lakshana[3] denotes general features of Saama Dosha that are observed and are common during the involvement of all the three Doshas in different proportions. Vishishta Lakshana of Saama Dosha are specific symptoms produced due to individual Dosha in association with Ama. Therefore Saama Vata, Saama Pitta, and Saama Kapha Lakshanas are put forth. Vata essentially does not have a definitive form (Amurta). The features of Saama Vata are mentioned indicating symptoms produced by it in the body. On the other hand, Pitta and Kapha are having the specific form (Murta Bhava) and hence the features of its physical form are explained along with the symptoms produced by it in the body. Further Lakshanas exhibited by the Saama Doshas are regrouped as symptoms connected to Mahasrotas, Shula and Anya Lakshanas and analyzed accordingly in this study. The generation and manifestation of Ama primarily result from Mahasrotas due to the altered functioning of Agni. In this context, it is worth noting that Amlapitta is a disease that takes its origin with pronounced manifestation in Mahasrotas due to the altered function of Agni. In Charaka Samhita, though there is is no direct explanation regarding Amlapitta as a separate disease, the information remains scattered, that comprises information connected to Nidana, Samprapti, and Chikitsa. In Chikitsa Sthana, Grahani Roga Chikitsa Charaka Acharya mentions the word Amlapitta [4] but Madhavakara has dealt Amlapitta as a separate disease. [5] Amlapitta is composed of the word Amla and Pitta. The definition of Amlapitta indicates, Pitta possessing excessive Amlata or Amlaguna Udrikta Pitta.[6] Hence, evaluation of Saama / Niraama Awastha and further Saama Dosha Lakshana paves way for an appropriate understanding of the disease and contributes to better clinical evaluation of Samprapti of Amlapitta and plan management. This article highlights the clinical evaluation of manifested Lakshanas in 30 patients of Amlapitta in Saama Awastha with special reference to manifested Saama Dosha Lakshana's. This can clinically help the physician to know specific Saama Dosha involved, a cascade of pathogenesis and appropriately select the medication and management protocol.

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OBJECTIVES To evaluate Saama Dosha Lakshana in Sama Awastha of Amlapitta. MATERIALS AND METHODS In the present clinical observational study, thirty patients attending OPD and IPD of the tertiary hospital were screened. The diagnosis was made based on presence of Samanya Lakshanas of Amlapitta[7] like Avipaka (Indigestion), Tikta Amla Udgara (Bitter or sour belching), Hrit Kanta Daha (Heart or throat burn), with or without Klama (Exhaustion without activity), Uthklesha (Nausea), Gourava (Heaviness in the body and head), Aruchi (Lack of desire towards food or tastelessness) between the age group of 30-60 years of either gender.

They were assessed for Samanya Lakshanas of Ama, Saama Vata, Saama Pitta, and Saama Kapha Lakshana's. Patients having undergone gastric surgeries and suffering from any other disorder were excluded. Following Saama Dosha Lakshanas were considered for assessment in 30 patients of Amlapitta. Further, these Saama Dosha Lakshanas were regrouped into three domains respectively as Lakshanas related to Mahasrotas, Shula and Anya Lakshana's.

Table1: Saama Dosha Lakshana regrouped amongst three domains

Lakshana connected to Saama vata lakshana[8] Saama pitta lakshana[9] Saama kapha lakshana[10] Agnisada , Antra Hrit daha , Kanta daha Amla Kshud vighata , Udgara Mahasrotas kujana, Vibandha rasa, Amla udgara vighata Shula Vedana, Nistoda, - - Angapida, Sthamba Anya Lakshana Shopha Durgandha, Syava varna, Durgandha, Tantula, Harita varna, Ghana, Guru Styana, Avila

Saama Dosha Lakshans exhibited by Saama Vata, Saama Pitta and Saama Kapha in diagnosed 30 patients of Saama Awastha of Amlapitta were assessed based on frequency and percentage. The result is deduced by arbitration and assessment by evaluating for the percentage of presence of Saama Dosha Lakshanas as 0.0% to 33.33% as Uncommon manifested Lakshanas, between 33.34% to 66.66 % as Common manifested Lakshanas and 66.67% to 100% as Very common manifested Lakshanas respectively.

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OBSERVATION:

In the present study, 30 Diagnosed patients of Amlapitta in Saama Awastha were assessed for the manifestation of Saama Dosha Lakshana of Saama Vata, Saama Pitta and Saama Kapha respectively and the observation are tabulated as below: Table 2: Clinical observation of Saama Vata Lakshana in Saama Awastha of Amlapitta

Saama Vata Lakshana Amlapitta: Total number of patients (N = 30) Present Percentage Absent Percentage Agnisada (Decreased digestion) 25 83.3% 5 16.7% Antra kujana (Rumbling of the bowels) 22 73.3% 8 26.7% Angapida (Body ache) 11 36.7% 19 63.3% Vedana (Pain) 10 33.3% 20 66.7% Nistoda (Pricking pain) 03 10.0% 27 90.0% Vibandha (Constipation) 03 10.0% 27 90.0% Sthamba (Stiffness) 03 10.0% 27 90.0% Shopha (Swelling) 00 00.0% 30 100.0%

Table 3: Clinical observation of Saama Pitta Lakshana in Saama Awastha of Amlapitta

Saama Pitta Lakshana Amlapitta: Total number of patients (N = 30) Present Percentage Absent Percentage Guru (Heavy) 29 96.7% 1 3.3% Hrit daha (Heart burn) 27 90.0% 3 10.0% Amla rasa (Sour taste) 26 86.7% 4 13.3% Amla udgara (Sour belching) 25 83.3% 5 16.7% Ghana (Hard) 17 56.7% 13 43.3% Kanta daha (Throat burn) 6 20.0% 24 80.0% Durgandha (Foul smell) 5 16.7% 25 83.3% Syava varna (Dark brown) 00 00.0% 30 100.0% Harita varna (Yellowish or pale yellow 00 00.0% 30 100.0% color)

Table 4: Clinical observation of Saama Kapha Lakshana in Saama Awastha of Amlapitta Saama Kapha Lakshana Amlapitta = Total number of patients (N = 30) Present Percentage Absent Percentage Kshud vighata (Lack of appetite) 29 96.7% 1 3.3% Durgandha (Foul smell) 5 16.7% 25 83.3% Styana (thick) 3 10.0% 27 90.0% Tantula (Mucoid, slimy thread) 3 10.0% 27 90.0% Udgara vighata (obstructed eructation) 00 00.0% 30 100% Avila (Turbid) 00 00.0% 30 100%

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RESULT: Saama Dosha Lakshanas exhibited by Saama Vata, Saama Pitta, and Saama Kapha in diagnosed 30 patients of Saama Awastha of Amlapitta, assessed based on arbitration and assessment by evaluating for the percentage of presence of Lakshanas as 0.0% to 33.33% as Uncommon, between 33.34% to 66.66 % as Common and 66.67% to 100% as Very common respectively is tabulated below. Table 5: Saama Dosha Lakshana in Saama Awastha of Amlapitta Criteria for arbitration Saama Vata Lakshana Saama Pitta Lakshana Saama Kapha Lakshana and assessment (Presence of Lakshana in Percentage) 0.0% to 33.33% Shopha, Nistoda, Vedana, Kantadaha, Syava Varana, Avila, Tantula, Styana, (Uncommon) Sthambha, Vibandha Harita Varna, Durgandha Durgandha, Udgara Vighata 33.34% to 66.66% Angapida Ghana - (Common) 66.67% to 100% Agnisada, Antrakujana Hrit daha, Amla udgara, Kshut Vighata (Very common ) Guru, Amla rasa

Table 6: Criteria for arbitration and assessment of Saama Dosha Lakshana in Saama Awastha Of Amlapitta

Criteria for arbitration Saama Dosha Lakshana Mahasrotas related Lakshana related Anya Lakshana and assessment Lakshana to Shula (Percentage of the presence of lakshanas) 0.0% to 33.33% Sama Vata Lakshana Vibandha Nistoda, Sthambha, Shopha (Uncommon) Vedana Saama Pitta Lakshana Kanta daha, - Harita varna, Shyava Varna, Durgandha Saama Kapha Lakshana Udgara Vighata - Tantula, Durgandha, Avila, Styana 33.34% to 66.66 % Sama Vata Lakshana - Angapida, Ghana (Common) Saama Pitta Lakshana - - - Saama Kapha Lakshana - - - 66.67% to 100% Sama Vata Lakshana Agnisada, Antrakujana - - (Very common) Saama Pitta Lakshana Hrit daha, Amla rasa, - Guru Amlodgara Saama Kapha Lakshana Kshut Vighata - - DISCUSSION:

Ama is a factor that has an inevitable role in the pathogenesis of most of the Vyadhi. Agni is the key factor that manifests Ama. The hypo functioning of Agni is denoted by the term Ushmano Alpabalatvena. It can be analyzed in two ways, i) The strength of Agni itself is reduced, though the quantity and quality of food are appropriate. ii) The strength of Agni is good to digest normal quantity and quality of food, but the Agni is overloaded with increased quantity and quality of food thus there will be comparatively reduced strength of Agni to digest the overloaded food. These two conditions are responsible for the production of Ama. [11]

Three different opinions on Ama are compiled by Vijayarakshita the commentator of Madhava Nidana. The first view is about the improperly digested food, second states the accumulation of Malas in the different parts of the IJRAR2001745 International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 244

© 2020 IJRAR March 2020, Volume 7, Issue 1 www.ijrar.org (E-ISSN 2348-1269, P- ISSN 2349-5138) body as Ama. The third view is about the stage of Dosha Dushti or disease, wherein it is opined that the first stage of Dosha Dushti or disease is Ama. [12] In Ashtanga Hrudaya it is stated that impaired Dosha after mixing up with each other produces Ama. A simile is been quoted stating that, as Visha develops in Kodrava. Similarly, Ama originates from highly vitiated Doshas by their interaction. Ashtanga Hrudaya states that Amadosha is very dreadful and equated it to poison. [13] Srikanthdutta has defined Amlapitta as a disease mainly due to the vitiation of Pitta (Pachaka), but Kapha (Kledaka) and Vata vitiation may be involved secondarily causing Gourava, Udgara, Kampa, etc. Clinically Amlapitta can be defined as the presence of Avipaka, Klama, Utklesha, Amlodgara, Gourava, Hrit- Kantha Daha And Aruchi.[14]

Dosha attains Saama or Nirama Awastha based on which the pathogenesis varies and hence the Lakshana. Vitiated Dosha in association with Ama manifests Saaama Dosha Lakshana such as Saama Vata Lakshana namely Vibandha, Agnisada, Sthambha Antrakujana, Vedana, Shopha, Nistoda, Angapeeda. Durgandha, Harita Varna, Syava Varna, Amla Rasa, Ghana, Guru, Amla Udgara, Kanta Daha, Hrit Daha are Saama Pitta Lakshana. Saama Kapha Lakshana is Avila, Tantula, Styaana, Durgandha, Kshut Vighata, Udgara vighata. Assessment of the same Saama Dosha Lakshana in diseases helps in its management. In Amlapitta the term Amla has been considered as Prakruta Rasa of Pitta. Though, Amla has been said a natural property of Pitta along with Katu-Rasa according to Charaka. [15] Sushruta has enlisted Katu as its original Rasa and mentioned that when Pitta becomes Vidhagdha then it attains Amlata. [16] Shrikanthadatta in his commentary has defined that Amlapitta is a condition where excessive secretion of Amla Guna Pitta takes place causing Vidagdhawastha. Chakrapani says that –“Amlagunodriktam Pittam Amlapittam”.[6] According to Vijayarakshita, commentator of Madhava Nidana, Amlapitta means - Pitta which attains excessive Amlata because Vidagdha Paka is called Amlapitta.[17] In the present study, 30 patients were screened and Diagnosed based on Samanya Lakshanas of Amlapitta. They were subjected to physical examination along with the detailed recording of history, assessment of Samanya Lakshanas of Ama, further they were assessed for Saama Vata, Saama Pitta, and Saama Kapha Lakshana. In general pathogenesis of Amlapitta due to Nidana Sevana, Vatadi Dosha gets vitiated specifically Pitta, further increasing Amla Bhava and Drava-Guna of Pitta and cause Agnimandya. It is the inevitable factor in the pathogenesis of Amlapitta, hence explains the Lakshana of Agnisada present in 25 (83.3%) patients, which further leads to Kshut Vighata seen in 29(96.7%). Further intake of Nidanarthaka Ahara and vihara produces vidagdhata of Ahara and Vidagdha Ama combines with Pitta and produces Shuktata /Amla Paka in Amashaya hence at this stage Sama Pitta Lakshana like Amlarasa 26(86.7%), Amlodgara 25(83.3%), Hrit-Daha 27(90.0%), Kanthadaha 6(20.0%), Durgandha 5(16.7%), undigested Annarasa will have Dravatwa and attain Gurutwa and Snigdatwa and further stasis lead to Lakshana such as Durgandha5(16.7%), Tantula3(10.0%), Styana3(10.0%) which are Sama Kapha Lakshana. As there is Samana Vata Vaishamya which is responsible for Anna Grahana, Pachana, Vivechana, and Muchana, once Vidagdha Anna is produced, Sara Kitta Vibhajana doesn't take place completely, further produces Mala Apravruthi i.e. Vibandha 3(10.0%), further Antrakujana 22(73.3%). Ama, getting to Sarva Dehika, IJRAR2001745 International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 245

© 2020 IJRAR March 2020, Volume 7, Issue 1 www.ijrar.org (E-ISSN 2348-1269, P- ISSN 2349-5138) manifests Sama vata Lakshana such as Angapeeda 11(36.7%), Vedana 10(33.3%), Stambha 3(10.0%), Nistoda 3(10.0%). Vyadhi if not treated in Vyatka Awastha of Kriyakala then in Bhedha Awastha it produces Upadrava such as Shopha, Jwara, Atisara, Pandu and Arochaka. In the present study, none of the patients presented with Upadrava.

In a nutshell, the study result shows that patients of Amlapitta in Saama Awastha presents with Saama Dosha Lakshana that manifest very common such as Antrakujana, Agnisada among Saama Vata Lakshana, Guru, Hrit Daha, Amla rasa, Amla Udgara among Saama Pitta Lakshana and Kshud Vighata among Saama Kapha Lakshana.

Common manifested Saama Dosha Lakshana include Angapida in Saama Vata Lakshana and Ghana in Saama Pitta Lakshana.

Uncommon manifested Saama Dosha Lakshana include Vedana, Nistoda, Vibandha, Sthamba among Saaama Vaata Lakshana, Kanta Daha, Durgandha, Syava Varna, Harita Varna among Saama Pitta Lakshana and Styana, Durgandha, Tantula, Udgara Vighata, Avila among Saama Kapha Lakshana.

On regrouping the manifested Saama Dosha Lakshana into three domains namely Lakshana related to Mahasrotas, Lakshana related to Shula and Anya Lakshana it was evident that patient presents with Agnisada, Antrakujana, Hritdaha, Amla Rasa, Amlodgara and Kshut Vighata among Lakshana related to Mahasrotas and Guru among Anya Lakshana as very commonly manifested Lakshana's.

Commonly manifested Lakshana include Angapida among Lakshana related to Shula along with Ghana among Anya Lakshana.

Uncommon manifested Lakshana include Vibandha, Kanta Daha and Udgara Vighata among Lakshana related to Mahasrotas, Nistoda, Sthambha and Vedana among Lakshana related to Shula. Shopha, Harita Varna, Shyava Varna, Durgandha, Tantula, Styana, Avila among Anya Lakshana.

CONCLUSION:

Amlapitta Roga (disease) affects Annavaha Srotas and one among common diseases resulted due to lifestyle. Ama plays a key role in the pathogenesis and hence analyzing Sama Dosha Lakshana is pivotal in understanding Samprapti and further planing Chikitsa. In the present study on 30 patients of Amlapitta in Saama Awastha indicates, Saama Dosha (Vata, Pitta, Kapha) Lakshana that manifest very common are Antrakujana, Agnisada, Guru, Hrit Daha, Amla rasa, Amla Udgara, and Kshud vighata. Following are uncommon manifested lakshanas Vedana, Nistoda, Vibandha, Sthamba, Kanta Daha, Durgandha, Shyava-varna, Harita-varna, Styana, Durgandha, Tantula, Udgara vighata, and Avila. Lakshana that manifest common is Angapida and Ghana. Knowledge of the same is essential during Samprapthi Vighatana to plan better management and re-establish health in the patients.

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