Comparative Study Of Effect Of Pippali Churna And Abhayadi

www.wjpr.net Vol 7, Issue 9, 2018. 571

Gaikwad et al. World Journal of Pharmaceutical Research

“COMPARATIVE STUDY OF EFFECT OF PIPPALI CHURNA AND

ABHAYADI LEHA IN MANAGEMENT OF AMLAPITTA”

Dr. Aniket A. Gaikwad*1

and Dr. Snehalata S. Salunkhe

2

1P.G. Scholar, Department of Kayachikitsa, Bharati Vidyapeeth Deemed To Be University

College and Hospital of Ayurveda, Katraj-Dhankawadi, Pune-43.

2Associate Professor, M.D., Ph.D, Department of Kayachikitsa, Bharati Vidyapeeth Deemed

To Be University College and Hospital of Ayurveda, Katraj-Dhankawadi, Pune-43.

ABSTRACT

Background and Objective: Comparative Study of Effect of Pippali

Churna and Abhayadi Leha in Management of Amlapitta.

Aim:

• To study the comparative effect of Pippali churna and Abhayadi

Leha in the Management of Amlapitta.

Objectives:

• To study Amlapitta in detail.

• To study the efficacy of Pippali churna and Abhayadi Leha in the

management of Amlapitta.

Method: Randomized Control study. 40 patients were selected for the

study and divided into two groups randomly. Group A was given

Pippali Churna with Madhu (1gm) twice in a day with koshna Jala

Group B was given Abhayadi Leha with Madhu (1gm) twice in a day

with koshna Jala Duration of treatment: 21 days with assessment on 0th

, 7th

, 14th

and 21st Day.

This study was carried out in BVU College of Ayurveda & Hospital attached to Bharati

Medical Foundation in Year 2017 and 2018. Results: Comparing all the symptoms of

Amlapitta before and after treatment. Group B is more effective than A. Statistical Analysis:

The Statistical Analysis reveals that Group B is more effective than Group A.

Conclusion:

• The drugs used in both groups can be safely administered in patients with amlapitta.

• Abhayadi Leha is useful in reducing 5 out of 8 symptoms of Amlapitta.

• Pippali churna have better results on 3 out of 8 symptoms as compare to abhayadi leha.

World Journal of Pharmaceutical Research SJIF Impact Factor 8.074

Volume 7, Issue 9, 571-588. Research Article ISSN 2277– 7105

Article Received on

04 March 2018,

Revised on 25 March 2018,

Accepted on 15 April 2018

DOI: 10.20959/wjpr20189-11752

*Corresponding Author

Dr. Aniket A. Gaikwad

P.G. Scholar, Department of

Kayachikitsa, Bharati

Vidyapeeth Deemed To Be

University College and

Hospital of Ayurveda,

Katraj-Dhankawadi, Pune-

43.



• Hence we conclude that Abhayadi Leha is more effective than Pippali churna in reducing

symptoms of Amlapitta.

• No serious adverse effects were found in any groups.

• The Drug is safe & cost effective.

INTRODUCTION

Amlapitta (Acidity) has become one of the common problems in present era due to change in

lifestyle. It is a pitta dosha dushti disease of the Annavaha strotas (Digestive System) caused

due to mandagni (Poor Apetite) and ama. Amlapitta (Acidity) is mentioned by laghutrayee.

At around 700 A.D Madhavakar describes amlapitta vyadhi separately in Madhavnidan.

Amlapitta (Acidity) also mentioned by Yogratnakar, Bhaishjyaratnavali,

Rasaratnasamuchhaya etc. According to Charak Samhita in Grahani Adhyaya (Cholitis

Chapter) finds similar and identical symptoms of Amlapitta in the purva rupa (Pre

Symptoms) named under the term Shukta paka. Amlapitta may be caused due to excessive

intake of oily, spicy, tinned, frozen, half cooked food, fast food, irregular meal patterns,

habits like alcohol, smoking and psychological stress. i.e. Hurry, Worry and Curry have to

avoid.

Hetusevan increases vidagadha guna of pitta dosha which undergoes fermentation and

become sour (amlibhava) may causes Amlapitta.

There are many drugs available in Samhita for the treatment of Amlapitta (Acidity). Pippali

Chruna and Abhayadi Leha is one of the formulations which are used in Amlapitta (Acidity).

Therefore this study has been undertaken to see the efficacy of Pippali Churna and Abahyadi

Leha in the management of Amlapitta.

Need for Study

Many of individuals are suffering from Amlapitta. To avoid further complications, Amlapitta

have to treat in early stages. Almost all available antacid drugs are liable to have side effects

on body. eg. Ranitidine shows side effects like… Headache, Dizziness.

However many studies have been conducted to evaluate the effectiveness of ayurvedic

formulae on Amlapitta. For better results and convenient medication purpose, comparative

study of effect of Pippali churna and Abhayadi Leha were taken for this study.



AIM AND OBJECTIVES

Aim

To study the comparative effect of Pippali churna (Ref- Bhaishajya Rat.56/19) and Abhayadi

Leha (Ref- Yogratnakar nidan-35) in the Management of Amlapitta.

Objectives

• To study Amlapitta in detail.

• To study the efficacy of Pippali churna and Abhayadi Leha in the management of

Amlapitta.

Hypothesis

• Pippali churna and Abhayadi Leha are equally effective in the management of Amlapitta.

Null Hypothesis

• Pippali churna and Abhayadi Leha are not equally effective in the management of

Amlapitta.

MATERIALS AND METHODS

1) Pippali churna:- (Bhaishajya Ratnavali 56/16)

No Drug Latin Name Family Part Used Quantity

1 Pippali Piper Longum Piperaceae Fruit 1 Part

2 Madhu Honey --------------- ----------------- As required

Rasa Panchak of Pippali Churna & Madhu

Sr. No. Ingredients Rasa Veerya Vipaka Guna Karma Doshaghanata

1) Pippali Churna Katu Anushna Madhur Guru Deepan, Pachan Pittashamak

2) Madhu Madhur Ushna Madhur Laghu, Ruksha Lekhan Kaphapittahara

Over all Properties of Drug

Rasa:- Katu- Madhur

Veerya:- Ushna

Vipaka:- Madhur

Karma:- Deepan, Pachan

Doshaghanata:- Kaphapittashamak

2) Abhayadi Leha:- (Ref- Yogratnakar nidan-35)

No Drug Latin Name Family Part Used Quantity

1 Haritaki Tarminelia Chebula combretaceae Fruit 1 Part

2 Pippali Piper Longum Piperaceae Fruit 1 Part



3 Draksha Vitis vinifera linn. Vitaceae Fruit 1 Part

4 Sita (Sugar Cube) Saccharum Officinarum Linn Poaccac Fruit juice 1 Part

5 Dhanvayas Fagonia cretica Linn. Zygophyllaceae Whole plant 1 Part

Rasa Panchak of Abhayadi Leha

Sr No Ingrediants Rasa Veerya Vipaka Guna Karma Doshghnata

1 Haritaki

Kashay

Pancharasa

Pradhana

Ushna Madhur Laghu Ruksha Rechana

Rasayana Tridoshahara

2 Pippali Katu Anushna Madhur Laghu Snigdha

Tikshna

Deepan Medhya

Pachana

Kaphavata

Shamak

3 Draksha Madhur Sheeta Madhur Snigdha

Madhur

Mrudu

Rechaka Vatapittaghna

4 Sita Madhur Sheeta Madhur Snigdha Daha-prashmana Vatapittaghna

5 Dhanvayas Madhur Tikta

Kashay Sheeta Madhur Laghu Snigdha

Deepan Pachana

Ruchikara Vatapittaghna

Over all Properties of Drug

Rasa:- Madhur, Kashay, Tikta

Veerya:- Sheeta

Vipaka:- Madhur

Karma:- Deepan, Pachan, Dahaprashaman, Mrudu Rechak

Doshaghanata:- Vatapittaghna, tridoshahara.

Method of Preparation

All the above mentioned ingredients of Pippali Churna and Abhaydi Leha taken in equal

quantity separately & the churna will be mixed thoroughly. Then each churna is passed

through sieve no. 85 Then churnas are mixed together according to ingredients of Pippali

churna and Abhayadi Leha respectively. Separate pouches of 14gm of are prepard and kept in

air tight container and labeled accordingly.

METHODOLOGY

Type of study

Randomized Comparative clinical study of established drugs.

Method of randomization: by lottery method.

Statistical Test Used

Wilcoxon sign rank W.



Place of study

The clinical trial carried out at OPD and IPD Of Bharati Vidyapeeth University, Ayurved

Hospital Dhankawadi, Pune-43. Drugs were collected from pune local market.

Standardisation was done at Late Principle B.V. Bhide Foundation, Pune. Authentication

of drugs was done at Botany Department, Pune University.

Sample Size

40 patients were selected for study. The sample size is decided according to prevalence of

Amlapitta. The study divided into 2 groups i.e 20 patients each group.

Selection Criteria

Inclusion Criteria

1) Gender - Male / Female

2) Age - 16 years to 60 years

3) Patient having clinical signs and symptoms of Amlapitta as described in Madhava Nidan.

Ref. (Madhav Nidan 34/2,3)

Avipaka (Suffering from Indigestion)

Klama (Fatigue)

Utklesh(Nausea)

Tikta Udgar (Bitter belching)

Amla Udgar (Sour belching)

Hruddah (Heartburn)

Kanthadaha (Burning sensation in throat)

Aruchi (Disliking of food)

Exclusion Criteria

- Pregnancy / lactation

- Urdhwaga Amlapitta along with other chronic diseases or complications.

- Raktavaman (Blood Vomiting)

- Chronic Alcoholic Patients

- Drug induced Amlapitta

- Patients suffering from acid- peptic disease for more than 2 yrs.

- Patients on any ayurvedic drugs during the last 15 days for same reason.

- Known case of –



1) Amasayavrana (Gastric Ulcer)

2) Grahanivrana(Duodenal Ulcer)

3) Pittasayaasmari (Cholelithiasis)

4) Tuberculosis

5) Immuno Compromised Diseases

Plan of Work

Particulars Group A Group B

No. of Patients 20 20

Medicine Pippali Churna (In Lehya Form) Abhayadi leha (In Lehya Form)

Anupan Madhu (1gm) Madhu (1gm)

Dose 1 gm 1 gm

Time Pragbhaktakal Pragbhaktakal

Route of Administration Oral Oral

Duration 21 Days 21 Days

Follow Up

Treatment was given for 21 Days duration and follow up were taken on every 7th day from

the commencement of treatment.

Parameters of Assessment

Efficacy Score System

Efficacy of treatment was assessed by adopting scoring methods for the clinical features of

Amlapitta.

Absence of symptoms 0 Grade

Mild degree of symptoms 1 Grade

Moderate degree of symptoms 2 Grade

Severe degree of symptoms 3 Grade

Grading of Lakshanas

1) Avipaka (Suffering from Indigestation) Grade

No Avipaka 0

Avipaka occurs occasionally 2-3 times per week 1

More than 2-3 Ajirna lakshanas like: Anutsaha

Amlamutrapravrutti

Guruta

Glani

2

Avipaka is of severe type which does not subside without medicine & langhana &

which disturbs the routine of patient. 3

2) Klama (Fatigue) Grade

No Klama 0

Occasionally feeling of lassitude without shrama & remains for

sometimes & vanishes. 1



Lassitude without shrama daily for sometimes. 2

Lassitude without shrama daily for long duration. 3

3) Utklesh (Nausea) Grade

Absent (0) 0

Presence of symptom < 1 time per day 1

Presence of symptom 1-3 time per day 2

Presence of symptom > 4 times per day 3

4) Tikta Udgar (Bitter Belching) Grade

Absent (0) 0




5) Amla Udgar (Sour Belching) Grade

Absent (0) 0




6) Hruddaha (Heartburn) Grade

Absent (0) 0

No hearburn (score 1 /7) on all 7 days. 1

No more than mild symptoms overall (score < 3/7) over the 7 days

prior to the visit 2

Moderate to severe heartburn score (> 4/7) on > 2days during a 7 day

period in the treatment 3

7) Kanthadaha (Burning Sensation In Throat) Grade

No daha 0

Daha of moderate degree relieves by milk, cold drink, antacid 1

Daha of severe degree involving kantha & relieved after digestion of

food or vomiting 2

Severe degree of daha involving major areas of abdomen but does not

relieve by any measures mentioned above 3

8) Aruchi (Disliking of food) Grade

Willing towards all bhojya padarth 0

Unwilling towards some specific ahara but less than normal 1

Unwilling for food but could take the meal 2

Unwilling toward unliking foods but not to the other 3

Primary End Point

Improvement in the signs and symptoms of Amlapitta in the patients.



Secondary End Point

Comparison of effect of Pippali Churna and Abhayadi leha in Amlapitta.

OBSERVATIONS

The 40 patients of Amlapitta were randomly selected from the OPD & IPD of Bharati

Vidyapeeth Ayurveda Hospital (Dept. of Kayachikitsa) with fulfilment of all subjective

criteria.

The OPD patients were given Pippali Churna with Madhu and Abhaydi Leha. They were

thoroughly educated about the method of preparation of the Leha, so that they can prepare

it daily on their own.

The IPD patients were given Pippali churna with Madhu in lehya form and Abhaydi Leha

prepared in the Hospital itself by the trained hospital staff.

Proper follow up was taken after every 7 days and patients were assessed for any change

in the subjective and objective parameters.

In the study, the subjective parameters were tested with the appropriate Statistical Tests to

determine the level of significane of their improvement if any.

1) Avipaka

Showing Statistical analysis for Avipaka symptom

Avipaka Median Wilcoxon Signed

Rank W P-Value % Effect Result

BT AT

Group A 2 0 -3.108a 0.002 75.8 Significant

Group B 2 0 -3.624a 0.000 88.2 Significant

Since observations are on ordinal scale, we have used Wilcoxon Signed Rank test to test the

efficacy in Group A and Group B. From above table we can observe that P-Values for Group

A and Group B are less than 0.05 hence we conclude that effect observed in both groups are

significant.

2) Klama

Showing Statistical analysis for Klama symptom

Klama Median Wilcoxon Signed


BT AT

Group A 0 0 -.108b 0.914 0.0 NS



efficacy in Group A and Group B. From above table we can observe that P-Value for Group



A is greater than 0.05 and Group B is less than 0.05 hence we conclude that effect observed

in Group A is not significant while effect observed in Group B is significant.

3) Utklesh

Showing Statistical analysis for Utklesh symptom

Utklesh Median Wilcoxon Signed


BT AT

Group A 0 0 .000c 1.000 0.0 NS






4) Tiktaudgar

Showing Statistical analysis for Tiktaudgar symptom

Tikta Udgar Median Wilcoxon Signed


BT AT

Group A 0 1 -1.155b 0.248 -25.0 NS

Group B 1.5 0 -2.969a 0.003 76.0 Significant





5) Amlaudgar

Showing Statistical analysis for Amlaudgar symptom

Amla

Udgar

Median Wilcoxon Signed


BT AT






significant.



6) Hruddaha

Showing Statistical analysis for Hruddah symptom

Hruddaha Median Wilcoxon Signed


BT AT

Group A 2 1 -1.578a 0.115 26.9 NS

Group B 1.5 0 -3.363a 0.001 85.2 Significant





7) Kanthadaha

Showing Statistical analysis for Kanthadaha symptom

Kanthadaha Median Wilcoxon Signed


BT AT






significant.

8) Aruchi

Showing Statistical analysis for Aruchi symptom

Aruchi Median Wilcoxon Signed


BT AT

Group A 0.5 0 -2.745a 0.006 82.6 Significant





significant.



Comparative Effect of Treatment on

All Parameters for Both Groups

Parameter

Effect of Therapy

Comparative

Efficacy

Group A Group B

Mean %

Effect Remark

Mean %

effect Remark

Avipaka 75.8% Significant 88.2% Significant Equally effective

Klama 0.0 % Not Significant 70.6% Significant Group B

Utklesh 0.0% Not Significant 85.7% Significant Group B

Tiktaudgar 25% Not Significant 76% Significant Group B

Amlaudgar 70.6% Significant 93.1% Significant Group B

Hruddaha 26.9 Not Significant 85.2% Significant Group B

Kanthadaha 50% Significant 85.3% Significant Group B

Aruchi 82.6% Significant 84.2% Significant Equally effective

For comparison between Group A and Group B, we have used Mann Whitney U test. From

above table we can observe that, For Tikta Udgar, Amla Udgar, Hrudadaha, Group B is more

effective than Group B (P-Value is less than 0.05 and Mean rank is more in Group B). For

other symptoms there is no significant difference in Group A and Group B. (P-Value is

greater than 0.05).

Overall effect of treatments on both groups

Mild (50%) effect was seen in Group A and Moderate (60%) effect was seen in Group B.

DISCUSSION

On Basis of Demoghraphic Data

1) Age:- Most of the patient belong to age group 20-40 (65%)



The probable cause for increasing in this age group may be that the person of this age group

are more exposed towards the changing external environment & mental stress owing to their

socio-economical responsibilities i.e. improper vihar and irregularity in diet. In this age group

pitta Dosha was dominate. It also responsible for the aggravation of the disease process.

2) Gender:- Out of 40 patients Males 14 (35%), Females 26 (65%)

Mejority of the patients were females. In females this may due to faulty diatery habits, and

females not giving priority to there health as they are of the mindset that health and well

being of family comes first.

3) Occupation:- Out of 40 patients Employees 12 (30%) Housewifes 14 (35%)

It was observed that most of house wives were taken Diwasvapna, and Diwasvapa leads to

Agni Mandhya and Tridosha prakopa & then Amlapitta. Service men suffered from mental

stress as Amlapitta is considered as a Psycho-somatic disease.

4) Habitat:- Out of 40 patients 33 (82.5%) were from urban area.

This disease was more found in urban habitat because of improper lifestyle more intake of

junk food & fermented food.

5) Prakruti:- 77.5% patients having Pittapradhan prakruti.

The disease incidence was found to be highest in pitta pradhan prakruti. When they take

Mithya Ahara Vihara all these Doshas get vitiation and produce disease.

6) Agni:- 70% patients having Visham agni.

Most of the patients were having visham agni due to adhyashan, vishamashan, diwaswap, &

improper management of ahar and vihar.

7) Koshtha :- 80% patients having madhyam koshtha.

8) Diet :- 90% patients had mix diet habit.

In this present study, 90% patients had mixed diet group and 10% patient were intaking veg

diet. Maximum number of the patients (90%) have the habit of irregular food intake. Non

vegetarian diet and irregular pattern of food intake lead to Agnimandhya & Tridosha Dusti

which also lead the aggravation of this disease.

9) Manas Bhav:- Most of patient is in stress were having chinta, Most of the patients were

suffering from mental tension and this is responsible for improper digestion which leads to



Ajirna like condition as mentioned in Ayurvedic classics. For the process of digestion your

Manasika Bhavas should be under control.

10) Guna Pradhanya Aahar:- Out of 40 patients: 30 (75%) Ushna

11 (27.5%) Tikshna Gunatmak Ahar

7 (17.5%) Vidahi

On Basis of Subjective Parameters

1) Avipaka:- On observation Group B (88.2%) and Group A (75.8%) approximately equal

effect seen. Avipaka lakshan reduced due to pittakaphahar, mrudu virechak properties of

Abhayadi Leha and Pippali Churna has katu ras, anushan veerya which improves pachan.

2) Klama:- On observation Group B (70.6%) is more effective than Group A (0.0%) The

symptom decreses due to tridoshahara, vatapittaghana, rasayan and laghu gunatmak property

of Abhayadi Leha.

3) Utklesh:- On observation Group B (85.7%) is more effective than Group A (0.0) The

symptom decreased due to Abhayadi leha is Madhur rsatmak, Sheeta veerya, madhur vipaki

and vatapittghana properties.

4) Tikta udgar:- On observation Group B (75%) is more effective than Group A (25%) The

symptom decreased due to madhur rasatmak, sheet veerya, madhur vipaki and vatapittaghna

property of Abhyadi Leha.

5) Amlaudgar:- On observation Group B (93.1%) is more effective than Group A (70.6%).

The symptom decreased due to deepan, pachan property of both the drugs.

6) Hruddah:- On observation Group B (85.2%) is more effective than Group A (26.9%) The

symptom reduce dure to madhur rasa, sheet veerya, madhur vipak and vatapittaghna

properties of Abhyadi Leha. Pippali has the property of madhur vipaki so it reduces the

symptoms.

7) Kanthadaha:- On observatin Group B (85%) is more effective than Group A (39.6%) The

symptom is reduced due to madhur vipak, pittaghna, madhur rsa and sheeta veerya properties

of Abhaydi Leha. Pippali has the property of madhur vipaki so it reduces the symptoms.



8) Aruchi:- On observation Group B (84.2%) and Group A (82.6%) approxmetaly equal

effect seen. The symptom is reduced due to tikta kashay rasa, laghu ruksha tikshna gunatmak

and tridoshhara property of Abhyadi Leha. Pippali churna is having propeerties of ushna

veeryatmak, laghutikshna gunatmak kaphavata shamak reduces aruchi.

9) Out of 8 lakshanas Avipaka, Amlaudgar, Aruchi were eviated to greater extend by the

pippali churna as pippali churna having katu rasa, deepan pachan properties it digest ama and

increase agni and improves annavaha strotodusti.

10) Out of 8 lakshanas Klama, Utklesh, Tiktaudgar, Hruddaha, Kanthadaha were eviated to

greater extend by the Abhayadi Leha as Abhayadi Leha having madhur tikta rasa, sheeta

veerya, madhur vipak agnidipan, pittashamak and rechan properties it digest ama and

increase agni and improves annavaha strotodusti.

Thus we can say Abhayadi Leha is showed reduction in grades of maximum subjective

parameters.

Over all effect on both groups

15% marked effect is may be because of chronicity of disease.

Moderate effect were noted on B group because of properties like deepan, Pachan, mrudu

virechan pittashaman properties that construsted with the pittapradhan pathogenesis.

Mild effect i.e 32.5% no effect i.e 15% was observed after treatment.

RESULT

• The clinical trial of Abhaydi leha and Pippali churna is observed to be effective in

reducing the symptoms of Amlapitta.

• The drug Abhaydi leha have significant result on Klama, Utklesh, Tikta-udgar, Hruddah,

Kanthdaha symptoms as compaired to Pippali churna.

• Avipaka, Amla-udgar, Aruchi symptoms there is no significant result found for both

groups.

CONCLUSION

• The purpose of this present study was to compare the efficacy of Pippali churna and

Abhayadi leha in the management of Amlapitta, The cases were selected randomly from

B.V.’s Ayurved Hospital, Pune. This study was designed as Group A- Pippali churna in

lehya form -20 Patients and Group B-Abhayadi leha– 20 Patients.



• Amlapitta is seen common in middle age people living in urban area having sedentary and

moderate lifestyle.

• Amlapitta is more seen in Visham agni, pitta pradhan prakruti.

• The drugs used in both groups can be safely administered in patients with amlapitta.

• Abhayadi Leha is useful in reducing 5 out of 8 symptoms of Amlapitta.

• Pippali churna have better results on 3 out of 8 symptoms as compare to abhayadi leha.

• Hence we conclude that Abhayadi Leha is more effective than Pippali churna in reducing

symptoms of Amlapitta.

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Documents

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