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Chapter 51 – Amlapitta Nidana

The 51st Chapter of Madhava Nidana is Amlapitta Nidana which deals with Hyperchlorhydria, Gastritis.

Etiopathogenesis —

विरुद्ध – दुष्ताम्ल – विदाहि – पित्तप्रकोपिपानान्नभुजो विदग्धम् |
पित्तं स्वहेतूपचितं पुरा यत्तदम्लपित्तं प्रवदन्ति सन्तः || १ ||

viruddha – duṣtāmla – vidāhi – pittaprakōpipānānnabhujō vidagdham |
pittaṁ svahētūpacitaṁ purā yattadamlapittaṁ pravadanti santaḥ || 1 ||

Causes for morbid increase in pitta include the following:

  •  Indulgence in eatables in incompatible combinations.

Moreover, taking food items that are spoiled, very sour, and capable to produce burning sensation prepares ground for the amlapitta in persons in whom pitta has already increased. 1

Clinical Features —

 अविपाक – क्लमोत्क्लेश – तिक्ताम्लोद्गार – गौरवैः |
हृत्कण्ठदाहारुचिभिश्चाम्लपित्तं वदेद् भिषक् || २ || 

avipāka – klamōtklēśa – tiktāmlōdgāra – gauravaiḥ |
hr̥tkaṇṭhadāhārucibhiścāmlapittaṁ vadēd bhiṣak || 2 ||

Amlapitta is the disease in which a patient has indigestion, exhaustion without any exertion, nausea, vomiting tendency with a bitter or sour taste, feeling of heaviness in the body, burning sensation in the chest, throat, and loss of appetite. 2

Adhoga Amlapitta —

 तृड – दाह – मूर्च्छा – भ्रम – मोहकारि प्रयात्यधो वा विविधप्रकारम् |
हृल्लास – कोठानलसाद – हर्ष – स्वेदाङ्गपीतत्वकरं कदाचित् || ३ || 

tr̥ḍa – dāha – mūrcchā – bhrama – mōhakāri prayātyadhō vā vividhaprakāram |
hr̥llāsa – kōṭhānalasāda – harṣa – svēdāṅgapītatvakaraṁ kadācit || 3 ||

Features of adhoga (downward) amlapitta include the following:

  • Thirst
  • Burning sensation
  • Fainting
  • Giddiness
  • Delusion
  • Downward movement of acidity – induced liquid materials and
  • Occasional oppression in the chest
  • Urticarial rashes in the skin,
  • Poor digestion,
  • Horripilation
  • Perspiration and
  • Yellowish skin. 3
Urdhvaga Amlapitta (Hyperchlorhydria) —

वान्तं हरित्पीतक – नील – कृष्णामारक्त – रक्ताभमतीव चाम्लम् |
मांसोदकाभं त्वतिपिच्छिलाच्छं श्लेष्मानुजातं विविधं रसेन || ४ ||
भुक्ते विदग्धे त्वथवा आप्यभुक्ते करोति तिक्ताम्लवमिं कदाचित् |
उद्गारमेवंविधमेव कण्ठ – हृत्कुक्षिदाहं शिरसो रुजं च || ५ ||
कर – चरण – दाहमौष्ण्यं महतीमरुचिं ज्वरं च कफपित्तम् |
जनयति कण्डूमण्डल – पिडकाशतनिचितगात्ररोगचयम् || ६ ||

vāntaṁ haritpītaka – nīla – kr̥ṣṇāmārakta – raktābhamatīva cāmlam |
mānsōdakābhaṁ tvatipicchilācchaṁ ślēṣmānujātaṁ vividhaṁ rasēna || 4 ||
bhuktē vidagdhē tvathavā āpyabhuktē karōti tiktāmlavamiṁ kadācit |
udgāramēvanvidhamēva kaṇṭha – hr̥tkukṣidāhaṁ śirasō rujaṁ ca || 5 ||
kara – caraṇa – dāhamauṣṇyaṁ mahatīmaruciṁ jvaraṁ ca kaphapittam |
janayati kaṇḍūmaṇḍala – piḍakāśatanicitagātrarōgacayam || 6 ||

The features of upward (urdhvaga) amlapitta are manifested through such symptoms as

  • green, yellow, blue, black, slightly red, or bright red coloured and very sour materials.
  • The vomited liquid resembles mutton wash in colour.
  • It is followed by kapha and it appears very sticky, and thin.
  • The vomiting occurs during digestion of eatable or even on empty stomach, with bitter or sour taste.

On occasions, there appear belching of identical nature with burning sensation in the throat, chest, and upper stomach. Other symptoms of upward amlapitta include

  • headache,
  • Burning sensation in the palms and soles,
  • feeling of great heat
  • Loss of appetite
  • Fever of kaphapittaja type
  • Appearance of rashes that are circular in shape, itching, studded with numerous small vesicles on the skin and other troubles. 4-6

 रोगो अयमम्लपित्ताख्यो यत्नात् संसाध्यते नवः |
चिरोत्थितो भवेध्याप्यः, कृच्छ्रसाध्यः स कस्यचित् || ७ || 

rōgō ayamamlapittākhyō yatnāt sansādhyatē navaḥ |
cirōtthitō bhavēdhyāpyaḥ, kr̥cchrasādhyaḥ sa kasyacit || 7 ||

The disease amlapitta — that is of recent onset, responds to treatment with difficulty. However, the cases of this disease that is of long duration could remain chronic or it could be cured with difficulty in case of some patients. 7

Prognosis (Association with other doshas) —

सानिलं सानिलकफं सकफं तच्च लक्षयेत् |
दोषलिङ्गेन मतिमान् भिषङ्गमोहकरं हि तत् || ८ ||

sānilaṁ sānilakaphaṁ sakaphaṁ tacca lakṣayēt |
dōṣaliṅgēna matimān bhiṣaṅgamōhakaraṁ hi tat || 8 ||

Features of amlapitta caused by morbid vata, Vatakapha and kapha doshas must be clearly recognized by the physician as it can otherwise create confusion.8

Association with Vata —

 कम्प – प्रलाप – मूर्च्छा – चिमिचिमि – गात्रावसाद – शूलानि |
तमसो दर्शन – विभ्रम – विमोह – हर्षाणयनिलकोपात् || ९ || 

kampa – pralāpa – mūrcchā – cimicimi – gātrāvasāda – śūlāni |
tamasō darśana – vibhrama – vimōha – harṣāṇayanilakōpāt || 9 ||

Features of amlapitta caused by vata include the following:

  • Tremors,
  • delirium
  • fainting, and a
  • feeling of pricking through pins and needles,
  • Weakness of the body parts,
  • pain and
  • Appearance of darkness before the eyes,
  • Giddiness,
  • Delusion, and
  • Horripilation. 9
Association with kapha —

कफनिष्तिवन – गौरव – जडतारुचि – शीत – साद – वमि – लेपाः |
दहन – बलसाद – कण्डू – निद्राः चिन्हम् कफानुगते || १० ||  

kaphaniṣtivana – gaurava – jaḍatāruci – śīta – sāda – vami – lēpāḥ |
dahana – balasāda – kaṇḍū – nidrāḥ cinham kaphānugatē || 10 ||

Features of amlapitta caused by kapha include the following:

  • Expectoration of thick phlegm,
  • Feeling of heaviness,
  • Lassitude,
  • Loss of appetite,
  • Coldness,
  • Weakness,
  • Vomiting,
  • Coating on the tongue,
  • Burning sensation,
  • Loss of strength,
  • Itching of the skin and
  • Excessive sleep. 10
Association with Vata and kapha —

 उभयमिदमेव चिन्हं मारुत – कफसम्भवे भवत्यम्ले |  

ubhayamidamēva cinhaṁ māruta – kaphasambhavē bhavatyamlē |

Both of the above features are seen in those cases of amlapitta in which vata and kapha are together instrumental.

 Shleshma Pitta —

तिक्ताम्लकटुकोद्गार – हृत्कुक्षिकण्ठदाहकृत् || ११ ||
भ्रमो मूर्च्छारुचिश्च्छर्दिरालस्यं च शिरोरुजा |
प्रसेको मुखमाधुर्यं श्लेष्मपित्तस्य लक्षणम् || १२ ||

 tiktāmlakaṭukōdgāra – hr̥tkukṣikaṇṭhadāhakr̥t || 11 ||
bhramō mūrcchāruciścchardirālasyaṁ ca śirōrujā |
prasēkō mukhamādhuryaṁ ślēṣmapittasya lakṣaṇam || 12 ||

Features of amlapitta caused by kapha and pitta doshas in combination include the following:

  • Expectoration having bitter, sour, and pungent tastes,
  • Burning sensation in the chest,Upper stomach
  • Giddiness
  • Fainting, and
  • Loss of appetite,
  • Vomiting,
  • Lassitude,
  • Headache,
  • Salivation, and the
  • Throat turning arid,
  • A sweet taste in the mouth. 11 – 12

इति श्रीमाधवकरविरचिते माधवनिदाने अम्लपित्तनिदानं समाप्तम् || ५१ ||

iti śrīmādhavakaraviracitē mādhavanidānē amlapittanidānaṁ samāptam || 51 ||

Thus concludes the Chapter on Amlapitta.