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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 10  |  Issue : 4  |  Page : 265-270

Indigestion-induced hyperacidity (Vidagdhajirna) treated with Ayurveda therapy: A single case study


Department of Basic Principles, Institute of Teaching and Research in Ayurveda (ITRA), Jamnagar, Gujarat, India

Date of Submission06-Jul-2022
Date of Decision02-Dec-2022
Date of Acceptance07-Dec-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Dr. Sunny C Patil
Department of Basic Principles, Institute of Teaching & Research in Ayurveda (ITRA), Jamnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jism.jism_57_22

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  Abstract 

Ayurveda, the ancient traditional system of medicine, believes that a majority of the diseases in humans arise due to hypofunctioning of Agni (~digestive fire). Disturbed function of Agni causing indigestion of food is termed as Ajirna (~indigestion) in Ayurveda. Vidagdhajirna is one of the types of Ajirna having Pitta predominance in its manifestation. Vidagdhajirna can be compared with indigestion-induced hyperacidity because of the resemblance in signs and symptoms observed in both the conditions. In this report, we are presenting a case of a 32-year-old female patient diagnosed with Vidagdhajirna. This case was treated with Ayurveda Shamana therapy prescribed at a specific drug administration time along with cessation of known etiological factors. Therapeutic assessment was done by using Reflux Disease Questionnaire (RDQ) scale. Significant improvement was noted in clinical parameters as well as on the standard RDQ scale without reported relapse of previous symptoms on follow-up visit. Also, there were no adverse events recorded during the treatment and follow-up period.

Keywords: Abhayadi Gutika, drug administration time, hyperacidity, Vidagdhajirna


How to cite this article:
Patil SC, Baghel AS, Kamble SB. Indigestion-induced hyperacidity (Vidagdhajirna) treated with Ayurveda therapy: A single case study. J Indian Sys Medicine 2022;10:265-70

How to cite this URL:
Patil SC, Baghel AS, Kamble SB. Indigestion-induced hyperacidity (Vidagdhajirna) treated with Ayurveda therapy: A single case study. J Indian Sys Medicine [serial online] 2022 [cited 2023 Feb 9];10:265-70. Available from: https://www.joinsysmed.com/text.asp?2022/10/4/265/366514


  Introduction Top


Ayurveda, the traditional medical science, is based on its own fundamental principles. In Ayurveda, Agni or digestive fire has been considered as the prime factor in general metabolism of the body leading to its growth and development. Maintenance of health and manifestation of diseases have also been attributed to normal and abnormal functioning of Agni, respectively. The term “Agni” here includes factors those are responsible for digestion and metabolism/transformation having predominance of Agni Mahabhuta (~fire element) in them. Agni may get vitiated because of unwholesome and irregular diet as well as erratic lifestyle. Disturbed functions of Agni causing incomplete digestion of food are termed as Ajirna (~indigestion) in Ayurveda. Vidagdhajirna is one of the types of Ajirna, which is mainly characterized by signs and symptoms like Hritdaha (~burning sensation in chest), Kanthadaha (~burning sensation in throat), Koshthadaha (~burning sensation in abdomen), Amlodgara (~sour eructation), Bhrama (~giddiness), Trishna (~excessive thirst), and Swedatipravritti (~excessive sweating).[1],[2] The vitiation of Pitta Dosha (~Dosha responsible for digestion and metabolism) is an essential stage in the manifestation of Vidagdhajirna. Irregularity in the functions of Samana Vata (~subtype of Vata Dosha responsible for digestion and propulsion of food) is also an important element in its pathology. In modern system of medicine, Vidagdhajirna can be correlated with indigestion-induced hyperacidity (IIH), which is a very common medical condition in day-to-day life. Heartburn is the typical and commonly occurring symptom of hyperacidity, which is characterized by burning sensation in the chest radiating toward the mouth. Because of acid reflux into the esophagus, heartburn is also accompanied by a sour taste in the back of the mouth with or without regurgitation of the refluxate.[3] Hyperacidity is diagnosed when frequency of acid reflux is more than two times a week. Diseases resulting from acid reflux are the most common gastrointestinal conditions that physicians come across in their daily practice.

Different systems of medicine offer a number of treatment modalities for the clinical management of hyperacidity, which involve medical therapy, surgical therapy, and lifestyle modifications. In modern system of medicine, treatment for hyperacidity generally includes proton pump inhibitors (PPIs) such as omeprazole, rabeprazole, and esomeprazole, and selective histamine type 2 receptor antagonists (H2 blockers) such as famotidine and cimetidine. Some over-the-counter medicines such as antacids like Digene, Omee MPS, and Digeplex are also available in the market for this condition. Though generally considered as safe and effective, these medications like any prescription drug are not suitable for all people suffering from hyperacidity. They do have the adverse effects such as headache, rash, dizziness, and gastrointestinal symptoms including nausea, abdominal pain, flatulence, constipation, and diarrhea.[4],[5] In some instances, they can cause trouble in absorbing nutrients, which can lead to malnutrition.

Considering the wide magnitude of hyperacidity in Indian subcontinent and the absence of its promising management with safety, suffering population is turning toward certain other systems for safe and effective remedies. Ayurveda is a good choice for patients suffering from IIH as this disease condition is well elaborated in different Ayurveda classics under the disease entity Vidagdhajirna. Different herbal, herbo-mineral formulations along with strict diet and lifestyle modifications have been in the common treatment regimen, which Ayurveda physicians are prescribing for Vidagdhajirna. In the present study, a 32-year-old female patient suffering from Vidagdhajirna was successfully treated with Ayurveda Shamana therapy (~oral medication) with special reference to specific drug administration time. Avoidance of known etiological factors was also an important aspect of the treatment.


  Patient Information Top


A 32-year-old female patient approached the out patient department (OPD) of Institute of Teaching and Research in Ayurveda (ITRA) Hospital, Jamnagar, with chief complaints of burning sensation in chest, abdomen, and at throat region along with sour eructation. The patient was asymptomatic 3 months back and gradually developed the above mentioned symptoms. Patient’s case history revealed that there was no any family history in the first-degree relation suggestive of similar or any other major disorder. No personal history of any autoimmune disorders such as psoriasis, vitiligo, atopic dermatitis, urticaria, and rheumatoid arthritis was found. There was no history of any major physical or psychological disorder for which patient had to take any prolonged treatment. The patient noticed an intake of citrus fruits, tomato products, and pepper as a triggering factor while the intake of milk was a relieving factor for her present disease condition. The patient had taken allopathic treatment for 15 days in the form of antacids and PPI tablets but did not find any significant relief in her condition. The patient then presented to OPD of Basic Principles Department, ITRA Hospital, Jamnagar, to seek Ayurveda management for the illness.


  Clinical Findings Top


On examination, it was found that the patient was having complaints of burning sensation in chest, abdomen, and at throat region and sour eructation since past 3 months. The severity of the symptoms was assessed using the Reflux Disease Questionnaire (RDQ), which is a standard scale used for clinical severity assessment in reflux diseases.[6] The patient was married for 2 years and was having normal menstrual history. On physical examination, the general condition of the patient appeared to be normal with body mass index = 21.3 kg/m2 (weight = 56 kg, height = 162 cm). Blood pressure and pulse were 114/78 mmHg and 68/min, respectively. The patient stated that she is having normal appetite and bowel motions and having a nonstressful life. The patient had Vata Pradhana Pitta Prakriti (~body constitution). Routine hematological, biochemical, and urine investigations were also carried out. Total hemoglobin count was 11.3 g% (normal count is 12.5–16.0 g%), and serum cholesterol level was 139 mg/dL (normal level is 140–250 mg/dL). The rest of all the parameters were found within normal limit. The patient’s diet history revealed habits such as intake of milk, butter milk, and curd regularly; and outside food comprising sour, oily, salty, spicy, and fermented food products once or twice a week and consumption of food at inappropriate time.


  Timeline Top


The patient was treated with prescribed treatment regimen for 14 days followed by 14 days period of follow-up. The detailed timeline of the treatment is given in [Table 1].
Table 1: Prescribed treatment protocol

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  Diagnostic Assessment Top


Diagnosis was made based on the clinical observations, history, and findings obtained from the RDQ. Differential diagnoses in the present case included peptic ulcer disease (involving epigastric pain, nausea, and vomiting), biliary tract disease (involving abdominal pain and jaundice), eosinophilic esophagitis (involving swallowing difficulties with hooking, reflux symptoms), and achalasia or other upper gastrointestinal motility disorders (involving swallowing difficulties, vomiting of undigested food). Criteria for assessment of therapy were improvement in the symptoms of Vidagdhajirna on the RDQ scale.

Reflux Disease Questionnaire

The RDQ is a self-administered questionnaire in which a patient is asked to report the frequency and severity of his/her upper gastrointestinal symptoms. Three subscales evaluating regurgitation, heartburn, and dyspepsia are used in RDQ. The time referent in the scale is symptoms that have occurred over the last 4 weeks. In this study, the time referent was the last 4 weeks at baseline, 2 weeks at the posttreatment visit, and 2 weeks for the follow-up visit. Item content in RDQ includes the following:

  1. Frequency and severity of acid taste in the mouth and movement of materials upward from the stomach (regurgitation scale)—four items;


  2. Frequency and severity of pain or burning behind the breastbone (heartburn scale)—four items; and


  3. Frequency and severity of pain or burning in the upper stomach (dyspepsia scale)—four items. Likert scale was used for response options having scores ranging from 0 to 5 for frequency (not present to daily) and severity (not present to severe) [Table 2].
Table 2: Criteria for assessment: The reflux disease questionnaire scale

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  Therapeutic Interventions Top


The prescribed treatment protocol had two important aspects: the first was disease-specific use of drug and the second was specific drug administration time with regard to involved dominant Doshas in the disease. The drug included a polyherbal compound formulation “Abhayadi Gutika,” which contains Haritaki (Terminalia chebula Retz.) and Draksha (Vitis vinifera Linn.) along with Sita (sugar candy) and Madhu (honey). This is the drug of choice indicated for the management of Vidagdhajirna in the Ayurveda text “Chakradatta.”[7] The administration of the selected drug was planned to be given at Madhyebhuktakaala (~in the middle of the meals). In Ayurveda classics, this specific drug administration time is indicated in diseases of Koshtha or Madhyashareera (~abdominal cavity/viscera) involving the vitiation of Pachaka Pitta (~subtype of Pitta Dosha responsible for digestion of food) and Samana Vata (~subtype of Vata Dosha responsible for digestion and propulsion of food).[8] The vitiation of both Pachaka Pitta and Samana Vata is an essential element in the manifestation of Vidagdhajirna; hence, Madhyebhukta Aushadhakaala was selected for the present study. Along with internal medicament, the patient was also advised to avoid the known etiological factors, which involved unwholesome dietary and living habits such as intake of milk and milk products, junk food, canned food, sour, oily, salty, spicy, and fermented food products; consumption of food at inappropriate time; Ratrijagarana (~late night sleep); and Divaswapa (~day sleep).


  Follow-Up and Outcome Top


Observations on consecutive visits of patients to the OPD were noted. Subsequent observational data of disease condition are depicted in [Table 3]. No adverse events were reported during the study. The treatment was given for the duration of 14 days. Then all the medications were stopped, and the patient was advised to just follow diet and lifestyle-related advice and to visit the OPD after 14 days for follow-up. The recurrence of symptoms was not found during the follow-up period of 14 days, i.e., after 28 days of starting the treatment. The severity of disease and outcome of treatment protocol were measured based on symptomatic relief in signs and symptoms and scoring on the RDQ scale. In the present case study, before-treatment score was 40, after-treatment score was 13, and the score on follow-up visit was 2 on RDQ scale. Complete recovery was observed in the symptoms like acid taste in mouth, movement of materials upward from the stomach, pain behind breastbone, burning behind breastbone, and pain at upper stomach region, while burning sensation at upper stomach region was seen markedly improved [Table 4].
Table 3: Observational data on subsequent outpatient department visits

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Table 4: Therapeutic effect of treatment protocol on clinical signs and symptoms

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  Discussion Top


The disease condition “Vidagdhajirna” can be compared with IIH because of the resemblance in signs and symptoms observed in both the conditions. Vidagdhajirna characterized by symptoms such as burning sensation and pain at chest, throat, and abdomen regions along with sour eructation is a common medical condition that physicians come across in their daily practice. In the present study, a case of Vidagdhajirna or IIH has been treated with Abhayadi Gutika prescribed at a specific drug administration time of Madhyebhukta Kaala along with the cessation of known etiological factors. As described earlier, the vitiation of Pachaka Pitta and Samana Vata plays a vital role in the manifestation of Vidagdhajirna. Abhayadi Gutika is one such polyherbal compound formulation, which acts on both of these causative factors. Though Leha (~electuary) form of this formulation is described in classical texts, Gutika (~chewable tablet) form is generally preferred because of the factors such as convenience to carry the drug, feasible timely administration, accurate dose fixation, and palatability. Looking at the composition of Abhayadi Gutika, Haritaki[9] is having Dipana (~metabolic fire enhancer) and Pittashamaka (~Pitta Dosha alleviator) properties, Draksha[10] and Sita[11] are also endowed with Pittashamaka actions, while Madhu[12] is again having Dipana property. Hence, Abhayadi Gutika turns out to be a perfect compound formulation designed for the disease condition Vidagdhajirna.

The selection of Madhyebhuktakaala as drug administration time was also an important aspect of the treatment protocol. In this, the patient was instructed to take medicine in the middle of the meal, i.e., the patient consumes a half part of the food, then takes the medicine, and later consumes remaining half part of the food. The food taken initiates the process of digestion by stimulating Samana Vata and Pachaka Pitta. The medicine is administered then, which acts on both these Doshas. Then again food is consumed, which covers the medicine and prevents its regurgitation. In classical texts, Madhyebhuktakaala is indicated in diseases involving the vitiation of Samana Vata, diseases of Pitta Dosha, and Koshtagata Vyadhis (~diseases of abdominal cavity/viscera).[13],[14]Madhyebhukta Aushadhi due to its quality of Avisari Bhava (~not spreading) subsides the diseases of Madhya Shareera or Koshtha, i.e., the medicine administered during this Kaala acts on Samana Vata and Pachaka Pitta situated in Madhya Shareera.[15] Hence, this specific time of drug administration also played an important role in the management of Vidagdhajirna in the present case.

In Ayurveda system of medicine, it is believed that the avoidance of the etiological factors is the primary key to success in the treatment; hence, the patient was advised not to indulge in unwholesome dietary and living habits such as intake of milk and milk products, junk food, canned food, sour, oily, salty, spicy, and fermented food products. Initially the patient was of the opinion that the intake of milk is beneficial for her disease condition as it was relieving her symptoms temporarily. The patient was instructed to stop this practice as though milk can temporarily buffer the stomach acid; nutrients in milk, particularly fats, proteins, and calcium may stimulate the stomach to produce more acid leading to deterioration in the condition.[16] The patient was also advised to stop taking meals at inappropriate times, late night sleep, and day sleep as these are the aggravating factors in Vidagdhajirna.[17],[18]

The clinical assessment of therapy showed that RDQ scores of after-treatment visit (score = 13) and follow-up visit (score = 2) were decreased as compared to before-treatment visit score (score = 40). The therapeutic effects on signs and symptoms of disease with respect to frequency and severity are depicted in [Graph 1] and [Graph 2] displayed in the form of line charts. The data denote that therapeutic effect is increased during follow-up period too without the recurrence of disease. Thus, multimodal approach therapy, i.e., Ayurveda Shamana therapy prescribed at a specific Aushadha Kaala along with Nidana Parivarjana (~avoidance of etiological factors), was found effective in the present case of Vidagdhajirna. Significant improvement was observed in clinical parameters as well as on the standard RDQ score scale adopted for the study.
Graph 1: Effect of treatment on the frequency of signs and symptoms

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Graph 2: Effect of treatment on the severity of signs and symptoms

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  Conclusions Top


Vidagdhajirna is a common clinical condition encountered by physicians nowadays. Though various treatment modalities are available for this, a promising therapy with safety is still lacking. Ayurveda with its unique principles of treatment has tremendous potential in disorders like this where other systems of medicine have limited scope. In the present study, a significant improvement in clinical signs and symptoms as well as on the standard scoring scale was observed in Vidagdhajirna through Ayurveda Shamana therapy prescribed at a specific drug administration time. The patient showed high compliance to the treatment prescribed as there were no adverse events recorded throughout the treatment and during the follow-up period.

Declaration of Patient Consent

The patient has given her consent for reporting the case along with required clinical information in the journal.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Tripathi B, editor. Agnimandya-Ajirna-Visuchika-Alasaka-Bilambika Nidan, chapter 6, verse 11. In: Madhav Nidana of Madhavakara. Varanasi: Chaukhambha Sanskrit Sansthan; 2006. p. 231.  Back to cited text no. 1
    
2.
Shastri A, editor. Sutra Sthana, chapter 46, verse 502. In: Sushruta Samhita of Sushruta. Varanasi: Chaukhamba Surbharati Prakashan; 2003. p. 289.  Back to cited text no. 2
    
3.
Clarrett D, Hachem C Gastroesophageal reflux disease (GERD). J Missouri State Med Assoc 2018;115:214-8.  Back to cited text no. 3
    
4.
Yibirin M, De Oliveira D, Valera R, Plitt AE, Lutgen S Adverse effects associated with proton pump inhibitor use. Cureus 2021;13:e12759.  Back to cited text no. 4
    
5.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012. Available from: https://pubmed.ncbi.nlm.nih.gov/31643176/. [Last accessed on 2022 Dec 01].  Back to cited text no. 5
    
6.
Shaw M, Dent J, Beebe T, Junghard O, Wiklund I, Lind T, et al. The reflux disease questionnaire: A measure for assessment of treatment response in clinical trials. Health Qual Life Outcomes 2008;6:31.  Back to cited text no. 6
    
7.
Sharma PV, editor. Agnimandyachikitsa, chapter 6, verse 74. In: Chakradatta of Chakrapanidatta. Jaipur: Swami Jayaramdas Ramprakash Trust; 1993. p. 210.  Back to cited text no. 7
    
8.
Shastri A, editor. Uttara Tantra, chapter 64, verse 69. In: Sushruta Samhita of Sushruta. Varanasi: Chaukhamba Surbharati Prakashan; 2003. p. 813.  Back to cited text no. 8
    
9.
Chunekar KC, Pandey GS, editors. Haritakyadi Varga, verses 18–24. In: Bhavaprakash Nighantu of Shri Bhavamishra. Varanasi: Chaukhambha Bharati Academy; 2010. p. 4.  Back to cited text no. 9
    
10.
Chunekar KC, Pandey GS, editors. Amradiphala Varga, verses 109–113. In: Bhavaprakash Nighantu of Shri Bhavamishra. Varanasi: Chaukhambha Bharati Academy; 2010. p. 573.  Back to cited text no. 10
    
11.
Chunekar KC, Pandey GS, editors. Ikshu Varga, verse 32. In: Bhavaprakash Nighantu of Shri Bhavamishra. Varanasi: Chaukhambha Bharati Academy; 2010. p. 780.  Back to cited text no. 11
    
12.
Chunekar KC, Pandey GS, editors. Madhu Varga, verses 1–5. In: Bhavaprakash Nighantu of Shri Bhavamishra. Varanasi: Chaukhambha Bharati Academy; 2010. p. 772.  Back to cited text no. 12
    
13.
Sharma SP, editor. Sutra Sthana, chapter 23, verse 16. In: Ashtanga Sangraha of Vagbhata. Varanasi: Chaukhambha Sanskrit Series Office; 2006. p. 179.  Back to cited text no. 13
    
14.
Paradkar HS, editor. Sutra Sthana, chapter 13, verse 38. In: Ashtanga Hridaya of Vagbhata. Varanasi: Chaukhambha Surbharati Prakashan; 2002. p. 219.  Back to cited text no. 14
    
15.
Shastri A, editor. Uttara Tantra, chapter 64, verse 72. In: Sushruta Samhita of Sushruta. Varanasi: Chaukhamba Surbharati Prakashan; 2003. p. 814.  Back to cited text no. 15
    
16.
Ippoliti AF, Maxwell V, Isenberg JI The effect of various forms of milk on gastric-acid secretion. Studies in patients with duodenal ulcer and normal subjects. Ann Intern Med 1976;84:286-9.  Back to cited text no. 16
    
17.
Shastri A, editor. Sutra Sthana, chapter 46, verse 500. In: Sushruta Samhita of Sushruta. Varanasi: Chaukhamba Surbharati Prakashan; 2003. p. 288.  Back to cited text no. 17
    
18.
Tripathi B, editor. Agnimandya-Ajirna-Visuchika-Alasaka-Bilambika Nidan, chapter 6, verse 7. In: Madhav Nidana of Madhavakara. Varanasi: Chaukhambha Sanskrit Sansthan; 2006. p. 230.  Back to cited text no. 18
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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