Nidan Panchak
- Nidana
- Vidahi and amla ahara, chai on empty stomach, skipped meals, late-night dinner, maida, excess salt, chronic NSAID or steroid use, chinta and krodha.
- Purvarupa
- Avipaka, utklesha, hrit-kantha daha, aruchi, mild udara gaurava after meals.
- Rupa
- Amla udgara, tikta-amla vamana, hrid-daha, urdhvaga variety with vomiting or adhoga variety with loose stools and burning micturition.
- Upashaya
- Cold milk, sheeta jala, madhura ahara, Shatavari, avoiding hunger gaps.
- Samprapti
- Vidahi ahara → Agni vaishamya → Ama formation in Amashaya → Pitta drava-amla vriddhi → Kapha anubandha → urdhva or adho gati of vitiated Pitta.
History to take in the first 3 minutes
- Meal clock: first meal time, gap between meals, dinner time versus sleep time.
- Tea and coffee count per day, and whether it is taken before food.
- Symptom timing — empty stomach burning points to Pitta; post-meal heaviness points to Ama and Kapha.
- Drug history: NSAIDs, steroids, long PPI use and how many times it has been stopped and restarted.
- Bowel pattern, sleep, and stress load — Amlapitta rarely resolves while these are untouched.
Chikitsa Sutra
Ama pachana first, then Pitta shamana, then Agni deepana, and Rasayana only after burning has settled. Prescribing a deepana drug while Ama is still present is the commonest reason Amlapitta relapses in the third week.
- Stage 1 (day 1–7): Ama pachana and Pitta shamana with sheeta-madhura-tikta dravyas.
- Stage 2 (day 8–21): Anulomana of Pitta downward, correct Vibandha if present.
- Stage 3 (day 22–42): Agni deepana with mrudu drugs plus Rasayana for the Amashaya mucosa.
- Chronic or relapsing cases: plan Virechana or Tikta ksheera basti after Snehana, once Ama is cleared.
Choosing between urdhvaga and adhoga Amlapitta
- Urdhvaga: vomiting, sour eructation, throat burning — favour Sheeta, Madhura and Vamana-anuloma line.
- Adhoga: loose stools, burning micturition, perianal burning — favour Grahi plus Pitta shamana, avoid drava-guru drugs.
Formulations, dose and anupana
Doses are for an average adult and are adjusted to Agni, Bala, Vaya and associated conditions. Pregnancy, lactation, renal or hepatic compromise need individual revision.
| Formulation | Dose | Anupana | Timing / note |
|---|---|---|---|
| Avipattikara churna | 3 g twice daily | Lukewarm water | 30 min before food |
| Kamdudha rasa (mouktikayukta) | 250 mg twice daily | Cold milk or Shatavari kalka | After food |
| Sutshekhara rasa | 250 mg twice daily | Honey or lukewarm water | After food |
| Shatavari churna | 3 g twice daily | Cold milk | Empty stomach and bedtime |
| Yashtimadhu churna | 2 g twice daily | Cold milk | Before food |
| Praval panchamrita | 125 mg twice daily | Milk | After food, for daha pradhan cases |
| Drakshadi kwatha / Patoladi kwatha | 40 ml twice daily | Equal warm water | Before food, for Ama with constipation |
Pathya
- Fixed meal times, never more than a 4-hour gap
- Old rice, moong, lauki, parwal, tinda, petha, amla, coconut water
- Cold milk, Shatavari kheer, ghee in small quantity
- Sheetali and Chandrabhedi pranayama, early dinner before 8 pm
Apathya
- Tea or coffee on an empty stomach
- Curd at night, pickles, fermented food, maida, deep-fried snacks
- Alcohol, tobacco, excess salt, chillies, vinegar
- Day sleep immediately after meals, and night vigil
Red flags — refer immediately
- Dysphagia, odynophagia or progressive weight loss — refer for upper GI endoscopy
- Haematemesis, melaena or unexplained anaemia
- New-onset dyspepsia above 45 years of age
- Retrosternal burning with exertional radiation to jaw or left arm — rule out cardiac cause first
- Persistent vomiting with dehydration or suspected gastric outlet obstruction
Frequently asked
- How long does Amlapitta take to settle with Ayurvedic treatment?
- Most uncomplicated OPD cases settle in 4–6 weeks when meal timing is corrected along with medicines. Relapsing cases with long PPI history usually need a Shodhana step and 3 months of follow-up.
- Can Avipattikara churna be given long term?
- It is used in courses, typically 3–4 weeks at a time, and stopped once Ama and constipation clear. Long uninterrupted use in an already Tikshnagni patient can aggravate burning.
- When should an Amlapitta patient be referred for endoscopy?
- Any alarm feature — difficulty swallowing, bleeding, anaemia, unexplained weight loss, or first onset after 45 years — is referred without waiting for a medicine trial.
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