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Introduction

‘Amlapitta’ is one of the most common lifestyle disorders which leads to many complications like ulcer, gastritis, anemia, IBS, and malabsorption etc. The burden of lifestyle disorders is rapidly increasing worldwide. Changing in environment and lifestyle has leads to different diseases one among them is amlapitta, which is related to annavaha strothas and various research shows that the consumption of viruddha ahara (incompatible food) will cause agnimandya and there by ajjeerna which is root cause for all the diseases. According to the Center for Disease Control and Prevention (CDC), more than 72 million adults are suffering from GERD and no state has a GERD rate less than 15% the national goal. The prevalence of acid peptic disease was found to be very high, Descriptive analysis were done. Results: About 39.2% and 37.1% patients had reported GERD and PUD respectively (duodenal ulcer: 10.5%, gastric ulcer: 9.9% and peptic ulcer-non-specified: 16.7%); 25.2% patients were reported to have non-ulcer dyspepsia (1). It also leads many complications like ulcer, gastritis, anemia, IBS, and malabsorption etc. In spite of many available drugs in market there is no significance reduction in the prevalence and incidence of this illness which remarkably emphasis on the need of novel approaches in combating those illnesses. Yoga is a holistic and integral science of life dealing with physical, mental, emotional and Spiritual health of the individual and the society. It is the best lifestyle designed and is effective in managing prevalent lifestyle disorders. Patanjali has propounded the comprehensive and multi objective Anataranga and Bahirang practices of yoga through the Classical Ashtanga Yoga in the form of Yama, Niyama, Asana, Pranayama, Pratyahara, Dharana, Dhyana and Samadhi. (2)

AIM AND OBJECTIVES:1. To elaborate the concept of yoga in prevention and management of Amlapitta.

2. To understand clinical concepts of importance of yoga in Amlapitta.

3.To understand the concept of Amlapitta & Acid Peptic Disorder.

Materials and Methods: -For present study we collected information from various Samhita Granthas like Laghuttrayi, modern text books and published article and also information available on net studied review articles available on PubMed, Google scholar, Research gate, Ayushdhara etc.

Prevention & Management of Gastrointestinal Diseases from Yoga Point of View (3) :

Once the liquid food material enters the stomach, it will be digested and later on absorbed in the small intestine within half an hour. Solid food (e.g., lunch) will take 2 - 2.5 hours for main digestion and 4-6 hours for complete absorption. That is why yoga practices should be done either in the morning or in the evening with an empty stomach. The central nervous system has no direct control on the digestive function but the appetite and satiety centers lie in the hypothalamus. Our emotional balance and behavior are also controlled by the hypothalamic centers. It has been found that even the muscular tone of the smooth muscles of the visceral parts is affected due to our emotional status (e.g., anger, hatred and irritation). Thus, our digestion is affected due to our thinking style, tense and unsatisfied mind and the negative approach. This causes indigestion, acidity and gastric troubles. If the digestive function is disturbed, our health is also affected. It is therefore advisable to maintain mental peace and balance all the time with the positive approach, contentment and happiness, which can also be achieved through yoga. Almost all the asanas as well as kriyas influence stomach, colon, urinary bladder and the liver.  Dhauti is mainly related to esophagus and stomach while basti is concerned with the anus, rectum and the colon. The external sphincters of the anus are contracted and relaxed alternately in ashwini mudra. Shatkarma detoxifies internal system and expel out waste material and therefore after completion of shatkarma before yoga therapy enhances digestive system. Therefore, aim of the study is to analyses the yoga therapy and Lifestyle modification on gastrointestinal diseases specially Amlapitta.

Pathophysiology of Amlapitta - Chakrapani has defined amlapitta as “Amlapittam cheti amlagounodriktam pittam.” Amlapitta is a condition in which amla guna of pitta is increased. (4) According to Kashyapa, vidagdha annarasa staying in aamashaya attains shuktata and produces amlapitta. Kashyapa explained that the nidan causes the doshaprakopa especially pitta dosha. Here mostly amla and drava gunatamaka pitta increased. This leads to mandagni and vitiation of doshas situated near amashaya. Here formation of aamvisha takes place due to aamvisha ingested food becomes vidhagdha and shuktibhava. This vidhagdha and shuktibhava food create amlata in aamashaya and travels all over body produces symptoms according to the involvement of dosha and gati (5)

Samprapti (6) (7): The word Amlapitta made up of two words, ‘Amla’ + ‘Pitta’

Pathophysiology of Acid Peptic Disorder – (8) (9): The acid peptic diseases also known as acid peptic disorders are a collection of diseases involving acid production in the stomach and nearby parts of the gastrointestinal tract. It includes gastro esophageal reflux disease, gastritis, gastric ulcer, duodenal ulcer, esophageal ulcer. Zollinger-Ellison syndrome and Meckel’s diverticulum ulcer. Acid peptic disorders are the result of distinctive, but overlapping pathogenic mechanisms leading to either excessive acid secretion or diminished mucosal defense. Acid peptic disease-commonly called APD-includes a number of conditions. All these conditions are the result of damage from acid and peptic activity in gastric secretions. APD occurs when the acid starts irritating the inner cells (mucosal layer) of the stomach. Acid peptic diseases mostly affect the oesophagus, stomach, and duodenum. “The commonest ulcers are the gastric and the duodenal ulcers.”

Amlapiita (Acid Peptic Disorder) From Yoga Point of View –

Panchakosha Siddhant (10): According to yoga we all have five bodies. The solid physical body visible to our eyes made of a permutation and combination of hydrogen, oxygen, carbon, nitrogen, calcium, and potassium etc. is called Annamaya kosa (Physical body). The life energy (prana) that makes each and every cell carry on its functions is Pranamaya kosa (vital energy body). Right dose of prana is supplied to all cells to maintain health. The mind which carries on the functions of perception, memory and emotions is called Manomaya kosa (mind body or astral body). The inner mind that controls and guides the manomaya kosa is called Vijninamaya kosa (knowledge body). This is the judge who decides what is right and wrong based on lives of contentment, bliss & happiness. In the fifth which is Anandmaya kosha (bliss body), the person in perfect health at physical, mental, emotional, social and spiritual level because of total inner mastery over the functioning of each one of the other four koshas.

1. Annamaya Kosha (1): - A satvik diet, kriyas, sutra neti, jal neti, agnisara, kapalabhati, Sankhaprakshalana, vamana dhouti etc, loosening exercises, and Yogasanas are operative at this level, to reduce the physical symptoms.

2. Pranamaya kosha: - Practice of Nadisuddhi, sectional breathing, cooling pranayama, with special emphasis to Candranuloma viloma are useful.

3. Manomaya kosha- Cyclic meditation, Om meditation, Nadanusandhana, devotional sessions are helpful in calming down the mind.

4. Vijnanamaya kosha: - Yogic counseling, lectures, Satsang bring forth knowledge, which burns strong attachments, obsessions, likes and dislikes which are basic reasons for agitations.

5.  Anandamaya kosha: - Happy Assembly, tuning to the nature, doing action in relaxation leads to bliss.

Following some procedures of yoga therapy are useful in management of Amlapitta (10)

A) Shatkarma: Human body being deteriorates day by day. To make it stronger and pure, one should make it hard in the fire of physiological straining i.e., regular practice of the yoga, exercise to train and strengthen the body. Person having excess of Shleshma and Medas should practice Shatkarma.

a) Vatasar Dhauti (11): The technique called Vatasar Dhauti mentioned in yogic classical text Gherand samhita is helpful in curing all GIDs and stimulating digestive fire. It is a secrete process which cleans body destroys all diseases and improve digestive fire H. pylori is an anaerobic bacterium which dies in presence of oxygen. Regular practice of same can be helpful in inhibiting it.

b) Agnisar Dhauti (12): Press the navel region or intestine towards the spine for hundreds time this agnisar process give success in the practice of yoga. Benefits: it cures all the diseases of abdomen and enhance Agni, use of PPI with Kapalbhati and agnisar Kriya helps to control GERD symptoms. Dhauti Kriya and Basti clean gastrointestinal tract.

c) Kapalbhati (13): It is excellent not only for physical body but also for subconscious mind as well as this process involves forceful movement of abdominal organ thus increases intraabdominal pressure which helps in increasing their functions it removing unwanted waste from the body kapalbhati should be performed empty stomach 3 to 4 hours after meal, it stimulates the six chakras in body, it tones the digestive organs.

B) Pranayam-

a) Anulom-vilom Pranayam (14): Benefits: it promotes the balance between two nostrils, it increases the digestive fire and appetite, being the balance between sympathetic and parasympathetic nervous system by relaxing the sympathetic nervous system and strengthening the parasympathetic nervous system. This helps in reducing stress related to indigestion by regulating stress hormone. Therapeutic effect- it lowers the level of stress and anxiety by harmonizing the pranas. As stress is the one of cause of amlapitta disease so pranayam is beneficial.

b) Shitali Pranayam(15) : It cools the system. It quenched thirst and appears hunger. It helps the people who get hot flushes or suffering from acidity. By regular practice of these Pranayam, it destroys gulma, inflammation of various chronic diseases, constipation, Indigestion, trishna rog.

c) Ujjayi Pranayam: Benefits: It removes the heat in the head, gastric fire is increased that’s why it is helpful in Amlapitta.

d) Sitkari Pranayam: Benefits: the practice of this Pranayam will be free from increase appetite, thirst, sleep and laziness this posture is helpful in the people who get hot flushes or suffer from acidity it also extremely useful in calming anger, bringing down high blood pressure as well as curing the tendency of over eating.

C) Yogasanas: One can control his mind efficiently only when he controls his body properly this is brought about by asana. Asanas not only develop the body and soul they prevent diseases and gives relief from lifestyles diseases.

Vajrasana(16) : Normally Yogasanas should be performed on empty stomach but vajrasana is one of the few exceptions. It is more effective after the meal. It helps to prevent acidity and gastric ulcer by improving the digestion.

Pawanmuktasana: This pose is useful in improving digestion and gases evacuation problems.

Shashankasana: It improves gastritis, indigestion, constipation it improves flexibility and strength of the spine which can counter all the adverse effects of sedentary lifestyle.

Shavasana (17): Physiological benefits of deep relaxation are numerous. It removes fatigue and gives rest to mind. Other Yogasanas also helpful in Amlapitta disease increase appetite and improve digestive system such as, paschimotasana, dhanurasan, bhujangasana, trikonasana, Salabhasana, Ushtrasana.

D) Dhyana – Meditation for relieving stress, stress play an important role including precipitating or worsening all lifestyle, therefore needs to manage it by meditation. Secretion of digestive hormones is regulated by autonomic nervous system and central nervous system; meditation can be helpful in reducing stress caused due to sympathetic dominance and the level of stress hormones and severity of diseases decreases.

Discussion

This review paper emphasizes on strict yoga interventions to prevent and to cure Amlapitta. Abnormal psychology in terms of mental stress and strain, anger, anxiety, greed shows their effect upon Amlapitta. So yogic practices play significant role in prevention and management of width by reducing stress and improving digestion.  So, for cure of Amlapitta we can advise the Yogasanas like vajrasan, Pawanmuktasana, Paschimottasan. Etc.

Pranayam like nadi shodhan, anulom vilom, Sheetali, Shitkari, bhramari. Yogic Kriya like jala dhauti, agnisar, Basti, Neti, kapalbhati etc. And Mudras like pruthivi mudra, prana mudras would be helpful in prevention and cure of Amlapitta.

Conclusion

The aim of the study is to analyses the yoga therapy and lifestyle modification on gastrointestinal diseases specially Amlapitta. Shatkarma detoxifies internal system and expel out waste material and there for after completion of Shatkarma before yoga therapy enhances digestive system.

Other yogic practices like Anulom-vilom Pranayam, Different types of Asanas, Dhyana helps to produce soothing effect on inner layer of stomach, reverses inflammatory changes and controls the digestive secretions, ultimately relives the symptoms of Amlapitta. So, we can say that Yogic practices play a significant role in the prevention & management of Amlapitta.