WDS 57: 'Amla-pitta' and prolonged use of 'Proton Pump Inhibitor drugs' by Dr. Harish Verma, Prof. Deep Narayan Pandey, Dr. Shashi Jindal, Dr. Pawan Madaan, Dr. Ankur Sharma, Dr. Reena Purani, Vd. Subhash Sharma, Dr. Bhadresh Nayak., Dr. Pankaj Chhayani, Dr. Priy-ranjan Tiwari & others.

[8/20, 5:02 PM] Harish Verma Canada: 

Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. 

Does it mean these drugs cause *Agnimandhya*.

Can we include PPIs in list of Modern Causative Factors of Agnimandhya.

[8/20, 5:27 PM] Dr Shashi Jindal, Chandigarh: 

If given without indications, in large doses and for prolonged period.

[8/20, 5:34 PM] Prof. Deep Narayan Pandey: 

एसिडिटी या पेट की जलन के लिये ओमेज़, ओम्प्रजोल या प्रिलोसेक या ऐसी तमाम प्रोटोन पंप इन्हिबिटर्स का दीर्घकालिक प्रयोग बहुत हानिकारक है| प्रोटॉन पंप अवरोधक दवा उनमें से हैं जिनका लंबी अवधि के उपचार के लिए उपयोग विशेष रूप से बढ़ रहा है| अक्सर इनके निर्धारित मात्रा से ज्यादा और अनुचित उपयोग से भारी प्रतिकूल प्रभावों का पता चला है| इनमें संक्रमण का खतरा बढ़ना, विटामिन और खनिजों के आंतों में अवशोषण को कम करना, गुर्दे की क्षति और मनोभ्रंश या डेमेंशिया शामिल हैं। इसके अलावा, कुछ अध्ययनों में बृहदान्त्र कैंसर, गैस्ट्रिक कैंसर, हृदय जोखिम, विटामिन बी 12 की कमी, हाइपोमैग्नेसीमिया, हाइपोनैट्रीमिया और फ्रैक्चर का जोखिम बढ़ने का खतरा बताया गया है। 

तब क्या किया जाये ? आयुर्वेद में बड़ा आसान और सुरक्षित इलाज है| एक माह के बाद आप इन हानिकारक औषधियों से मुक्ति पा सकते हैं| 

इस मसले में मेरे परिवार के अनुभव भी महत्वपूर्ण हैं|

Long term use of Omaze, omeprazol, prilosec or all such proton pump inhibitors for burning of acidity or stomach is very harmful.. Proton pump inhibitors are among those whose long-term use is particularly increasing. Often, excessive and improper use of their prescribed quantities has shown huge adverse effects. These drugs increase the risk of infection, reduce the absorption of vitamins and minerals, and result in kidney damage and dementia. In addition, some studies have pointed out the risk of colon cancer, gastric cancer, cardiovascular risk, vitamin B12 deficiency, hypomagnesaemia, hyponatremia, and increased risk of fracture.

Then what to do ? Ayurveda provides a very easy and safe treatment. You may get rid of these harmful medicines within a month. 

The experience of my own family are instructive in this regard.

[8/20, 5:39 PM] Dr Shashi Jindal, Chandigarh:

 

but pts. never know all these, its duty of govt. to advertise the side effects.

[8/20, 5:44 PM] Dr Dipti Soni, Amareli: 

Respected sir ! 
auyrved me iska kya upay he .plz detail me btayenge.n wil u plz share experience of ur own family ?

[8/20, 5:45 PM] Prof. Deep Narayan Pandey: 

First, our duty to let patient know. 

Pharma companies will  hardly wish people to know, for the reasons best known to all of us.  

And, my own data, gathered through a large number of Ayurvedacharyas I trained on this, informs me that tens of hundreds of people have benefited by Ayurvedic therapy. They have left these harmful substances completely.

[8/20, 5:52 PM] Prof. Deep Narayan Pandey: 

I will certainly share that with you here. The ethical dilemma is that I have developed a double-standardized drug to overcome this challenge, so I will avoid sharing the trade name (although I do not earn any money whatsoever out of any drugs I developed).

That said, I will certainly share with you the full formula and the process for the common good.

Give me a couple of hours.

[8/20, 5:58 PM] Dr Shashi Jindal, Chandigarh: 

these drugs r been used unethically

Not really unethically, but large amount of self medication in India is the real challenge.

 by chemists.

[8/20, 6:01 PM] pawan madan Dr:

 

*Very right*.

*One most imp effect is that long use of PPIs makes the original digestion and digestive power....to almost nil.* 

*Agni becomes so less that pt even cany digest the small light food even while taking the PPIs.....*

[8/20, 6:02 PM] Prof. Deep Narayan Pandey: 

धन्यवाद आचार्य 

यह वास्तव में बहुत भारी पचड़ा है।

[8/20, 6:06 PM] Harish Verma Canada: 

Pranaam Dr Pandey Ji,

You have mentioned list of side effects  of PPIs.

But sir, my question is not answered. Do PPIs cause *Agnimandhya*?

From Ayurvedic point of view Agnimandhya leads to many incurable diseases, which are different from above mentioned side effects.  Please clarify. 

[8/20, 6:15 PM] Prof. Deep Narayan Pandey: 

*Yes indeed, in fact any of the named diseases cannot happen without agnimandya. So yes, it does.* 

So, let us discuss PPIs only. 

[8/20, 6:19 PM] Prof. Deep Narayan Pandey: 

असल में PPIs के कारण होने वाले जो जो रोग बताए गए हैं, उनमें लगभग सब के सब की पैथोजेनेसिस में अग्निमांद्य का एक रोल मिलेगा। वैसे भी कहा जाता है कि मंदाग्नि से सब रोग होते हैं।

[8/20, 6:20 PM] Prof. Deep Narayan Pandey: 

Sorry for a couple of spelling errors. Most of the time I type by dictation, so it creates a problem.

[8/20, 6:24 PM] Harish Verma Canada: 

PPIs are the largest selling drugs in the world. 

How to get rid off these drugs is a challenge. Please help.....

[8/20, 6:33 PM] Dr Shashi Jindal, Chandigarh: 

grahni is the right word  used for side effects ?

[8/20, 7:28 PM] Ankur Sharma Dr Delhi: 

Ppi is indicated for gastric ulcers, hyperacidity ,gerd etc

Then if we want to replace it

Then shouldn't we advise

Saumya,sheet virya pitta shamak medicine??

[8/20, 7:32 PM] Prof. Deep Narayan Pandey: 

Doctor saheb, thank you for pointing this out. 

It could really take days to discuss the scientific and Ayurvedic principles behind why they help overcome the challenges of PPI. Today, suffice it to say that together they are useful.

[8/20, 7:49 PM] Prof. Deep Narayan Pandey: 

Great, I would be happy to learn how many people have really left PPIs by this combination, a rough estimate perhaps, and have not returned to PPIs again since a lapse of reasonable amount of time.

[8/20, 7:51 PM] Rameshwar Rao Rane Mu: 

most of the people taking ppi generally suffer from amlapitta. we have to treat amlapitta to get rid of it.

[8/20, 8:01 PM] pawan madan Dr: 

Nothing works like ppis.

We need to delect aushadha as per the patient.

...if there is ajeerna....deepan aushadhi like shiva kshar paachan churan works

...if amlapitta.....sootshekhar works

....if vibandha....abhyarishta works

....if udavarta....avipattikar + haritaki works

...in chronic gastritis... a combination of shatavari and madhuyashti works best

Rest...depends on the patient.

[8/20, 8:01 PM] Deepak Bassi Dr:

 

This really works sir.

Narikela lavanam also works in chronic gastritis.

[8/20, 8:03 PM] Dr Bhadresh Nayak, Surat: 

For G I tract we must understand ajirna chapter.

[8/20, 8:12 PM] Dr Shashi Jindal, Chandigarh:

 

late night dinner, bed tea, fast food, painkillers, alcohol etc. r few life routines which r causing great need for ppis.

[8/20, 8:19 PM] Ankur Sharma Dr Delhi: 

Ppi has no role in ajeern

Vivandh,

Hence can't be compared

But gastric ulcer

Ppi work

Only

Pitta shamak sheet virya madhur  work and katu tikshan aml ushn cause harmful effect.

[8/20, 8:26 PM] pawan madan Dr: 

[8/20, 8:29 PM] pawan madan Dr: 

Dear Ankur Ji....right.....ppis have no role in ajeerna.... but ajeern is causing.......symptoms of APD for which people are advised ppis.....so we must need understand the cause..... Similarly is for Vibandha......this is a routine practice by allopaths........                                                                        Every time pitta shamaka sheeta virya madhur dravya doesnt work in gastritis......different cases of gastritis have different hetus and they present with different symptms....

[8/20, 8:31 PM] Dr Surendra A Soni: 

We are look that pitta are being obstructed to flow in its natural way directly or indirectly that is never desired as per Ayu concept. This lead to shakha gaman of pitta and this is main cause of side and adverse effects of this drug. In practice we should target such signs and symptoms through observation as well as documentation. This is the time that we should do hard work on drug history through discussion on such topic.

[8/20, 8:32 PM] pawan madan Dr: 

Very true..........sir

[8/20, 8:33 PM] Dr Yogesh Gupta:

 

SIR IS THERE ANY HARM WHILE THE PATIENT IS TAKING PPIS AND WANTS TO TAKE AYURVEDIC ANTI ACID TREATMENT SIMULTANEOUSLY ?? PLEASE GUIDE. 

[8/20, 8:34 PM] Dr Surendra A Soni: 

Why together ?

We have better option.

[8/20, 8:35 PM] pawan madan Dr: 

Saath hi deni padati hai.....because agar ek dum se ppis band kar de to patient waapis nahi aayega.....it has to be tapered like steroids in few weeks along with the treatment of the specofic hetu and vyaadhi in that particular patient. There is no any harm practically.

[8/20, 8:35 PM] pawan madan Dr: 

Together means....ppis in a process of tapering for few weeks......

[8/20, 8:36 PM] Dr Yogesh Gupta: 

 GRADUALLY PUT OFF KAR DENGE.

[8/20, 8:36 PM] Prof. Deep Narayan Pandey: 

To my understanding absolutely none.

However, because PPIs are fear-derived habit forming, patients repeatedly come back. They come back, not because they require it but because their mind requires it due to low sattva.

[8/20, 8:38 PM] Dr Surendra A Soni: 

As per my experience....

I never plan tapering. I stop immediately. Never felt any problem with available opd drugs in govt hospital. Not bounded to any specific drugs too.

Anuloman is essential in such cases.

[8/20, 8:38 PM] Prof. Deep Narayan Pandey: 

PPIs से मुक्ति आपको पादांशिक क्रम में ही मिलेगी, बाकी, देखते रहिए।

[8/20, 8:39 PM] Prof. Deep Narayan Pandey: 

Very happy to learn this. Great.

[8/20, 8:39 PM] Dr Yogesh Gupta:

 

THANKS A LOT SIR FOR YOUR PRECIOUS GUIDANCE. 

[8/20, 8:40 PM] Ankur Sharma Dr Delhi: 

Correct 

Agreed ! Pandey Sir !

[8/20, 8:41 PM] Dr Surendra A Soni: 

It(Padansha-kram) should not be a principle. I think not a principle.

This is not a big issue.

[8/20, 8:41 PM] Ankur Sharma Dr Delhi: 

Prior to ppi

Gastric ulcer repair surgery was bread & butter to surgeons.

[8/20, 8:42 PM] Ankur Sharma Dr Delhi: 

TApering is required 

Otherwise rebound hyperacidity occurs.

[8/20, 8:43 PM] Prof. Deep Narayan Pandey: 

Because you have that kind of experience, so I will have to agree. 

However, I would suggest that there are very few cases that have not fallen back to PPIs.

[8/20, 8:43 PM] Ankur Sharma Dr Delhi: 

Malena was big issue.

[8/20, 8:43 PM] Dr Surendra A Soni: 

I never felt such problem Dr Ankur.

It's an unnecessary fear only.

Just decide sam/niram and give Rx.

[8/20, 8:44 PM] Ankur Sharma Dr Delhi: 

In case of gastric ulcer induced malena

There should be use of only pitta shamak dravya.

[8/20, 8:45 PM] Ankur Sharma Dr Delhi: 

THanks sir

For sharing ur valuable experience 

[8/20, 8:46 PM] Ankur Sharma Dr Delhi: 

In fact vaman is one of the best medicine to get rid of ajeerna amlpitta etc.

[8/20, 8:46 PM] Prof. Deep Narayan Pandey: 

एकदम एकदम !

 बहुत कमाया खाया इन लोगों ने।

और आज मैं बहुत ज़ोर देकर कहना चाह रहा हूं कि आयुर्वेद की मदद से PPIs को सदैव के लिए छोड़ना बहुत आसान है। हां निदानपरिवर्जन की शर्त है।

[8/20, 8:46 PM] pawan madan Dr: 

Soni ji

All depends on the particular case...

Pts taking ppis are for years.....always feel a craving for ppis.....so this tapering is used.....this is majboori....

[8/20, 8:47 PM] pawan madan Dr: That great really.

[8/20, 8:47 PM] Dr Vinit Arora: 

Very informative and must to know facts about PPis..thanks a lot sir.

[8/20, 8:47 PM] Ankur Sharma Dr Delhi: 

Many times ppi don't work.

Sitaphal kheer act better.

Petha sweets.

[8/20, 8:49 PM] Dr Surendra A Soni: 

[8/20, 8:54 PM] Vd. Subhash Sharma Ji Delhi: 

*कूष्मांड स्वरस 30 ml empty stomach bd*

[8/20, 8:55 PM] Dr Priy-ranjan Tiwari, Haridwar: 

vaman se srotodusti aur srotovarodh dur hoga.

[8/20, 9:00 PM] Dr Priy-ranjan Tiwari, Haridwar: 

Without vaman only 25% logon ko labh milta hai wo bhi jabtak medicine chalti hai lekin vaman evum virechan se 3 to 4 months tak aaram rahta hai.

[8/20, 9:08 PM] Ankur Sharma Dr Delhi: 

You can manage heart burn (severe tearing pain)

Acute oesophagitis 

With induced emesis

Faster than any medicine.

[8/20, 9:09 PM] Dr Surendra A Soni: 

You are to see *yogyayogya* first.

Not applicable in all cases.

[8/20, 9:10 PM] Raghuram Dr Banguluru: 

*I second this*. I too hv not tapered. Even modern doctors change it switch over haphazardly. 

I haven't seen many doctors tapering PPI's. 

I too hv *stopped them immediately* and switched over to Ayurvedic medicines. 

 Some are mentally addicted to these drugs and some doctors hv fed them with *strong theories* which in due course if time hv become *panic theories* to patients. These ppl suffer from *time programmed symptoms* in these I hv asked them to continue modern drug, added Ayurvedic...later slowly withdrew PPI's. This too worked.

*What always work?*

 *Vamana* or *Sadhyo Vamana*... Nothing like this in majority of cases 

 *Virechana* in chronic cases, following Vamana if needed ( *ubhayatah Shodhana*). Virechana in pitta predominant cases. *Nitya Virechana* with medicines like *Avipattikar* along with disease modifying ayurvedic compounds in less severe to moderate cases. 

*Ubhayatah Shodhana* has worked like golden standard in mighty no of cases.

 *Diet modifications* + *Lifestyle management* with tips for *stress management*... + 

*Shirodhara* or *Takradhara*

 *Yoga*, *Meditation* etc as value added...

*Homeopaths* give *Nux Vomica* before starting any medicines to *nullify the effects of previously taken medications*...

*Might be it's a copy paste of Vamana*... 

( *Disclaimer* - Due respects to other systems of medicine including allopathy and homoeopathy).

[8/20, 9:11 PM] Ankur Sharma Dr Delhi: 

As per my little clinical experience 

I get satisfactory results in every case of acid reflux

Oesophagitis

[8/20, 9:11 PM] Raghuram Dr Banguluru: 

it works sir.

golden standard as I said...

[8/20, 9:20 PM] pawan madan Dr: 

Very nicely explained.... Raghu Sir !👍

Vaman may give time being shaman perhaps...I dont know....I havent seen such results. 

Anyhow I use shaman aushadhis and get success.

[8/20, 9:21 PM] Dr Surendra A Soni: 

Raghu Sir 

Thanks for sparing time.

[8/20, 9:23 PM] Dr Surendra A Soni: 

Dr. Ankur !

*condition apply.

Be careful...

Like varicosities...

Gest./oeso. Rupture

Udavart

Ulceration etc.

[8/20, 9:24 PM] Dr. Reena Purani: 

Even I second this...

I got result with shatavari yastimadhu guduchi amalaki and in some cases ashwagandha churna each 1 gm bd with milk.

Within a time period of 1 week in govt clg

[8/20, 9:24 PM] Dr Surendra A Soni: 

[8/20, 9:28 PM] Dr. Reena Purani: 

As per my experience no need of vaman & virechan if patient follows pathyapathya as per our instructions & medicines 

[8/20, 9:28 PM] Ankur Sharma Dr Delhi: 

Yes sir

Oesophageal varicosities, bleeding gastric ulcer is totally fatal condition obviously vaman

Can't be advised in such conditions.

[8/20, 9:28 PM] Dr. Reena Purani: 

This yoga is best Daha shamak

[8/20, 9:32 PM] Dr. Reena Purani:

Koth & kandu are complications of Amlapitta... in such cases I add nimba & khadir churna in that yoga.

[8/20, 9:36 PM] Dr. Reena Purani:

Such patent formulations contains preservatives so it's better to prescribe our own yogas if possible.

[8/20, 9:42 PM] Ankur Sharma Dr Delhi: 

I want to share my belated

Dog's experience 

He had recurring urticaria

But whenever he vomited

His urticaria get subsided immediately 

He hardly require any antihistaminic.

 In same way whenever he got indigestion,he simply vomited whole undigested food material 

Got better.

They don't require neither ppi

Nor avipitikar churun etc

God has given such technique to every creature but human forget it.

[8/20, 9:43 PM] Prof. Deep Narayan Pandey:

 *शेर भी यही करता है*

[8/20, 9:46 PM] Dr Surendra A Soni: 

Charak doesn't accept Amlapitta as disease, we are the strong and blind follower of charak.

Ghritpan in niram pitta is best medicine either achchha or siddha.

[8/20, 9:47 PM] Dr Surendra A Soni: 

[8/20, 9:50 PM] Dr Shashi Jindal, Chandigarh:

 panchtiktak ghrit gives good results.

[8/20, 9:51 PM] Dr Bhadresh Nayak, Surat:

Commonly vidhajijirna is seen

Usually we gave pitshamak may be it's controversial ?

[8/20, 10:06 PM] Raghuram Dr Banguluru: 

It's good to go with good shaman aushadhis sir, it's always good

Vamana and Virechana are not *tatkalik* remedies...they provide a suitable back drop in which good medicines act in best possible way...

As you said, Vaman can't be administered alwys and everyone...but if patients oblige and if we could administer...then it's *sone pe suhaaga*.

[8/20, 10:06 PM] Raghuram Dr Banguluru: 

My pleasure sir, thanks

[8/20, 10:13 PM] Dr. Reena Purani: 

Charak has not described as separate disease but given little bit description (we can say in one line)in some chapters 

 Mainly in Grahani

 Ch. Chi. 15

[8/20, 10:16 PM] Dr Shashi Jindal, Chandigarh: 

in pittaj ch sut 19 and raktj ch sut 24

[8/20, 10:18 PM] Dr. Reena Purani:

Yes sir... at many instances

[8/20, 10:19 PM] Dr. Reena Purani:

Shloka no. 47

[8/20, 10:40 PM] Dr Jayshri Kulkarni: 

 अगर हम इस उपशय का कार्यकारणभाव समझ़ लेते है तो वमन के आगे जाकर समग्र चिकित्सा विचार अपना सकते हैं ।

 It is a specific अवस्थाविशेष where दोषावसेचन is "the only correct move "

[8/20, 10:47 PM] Dr Priy-ranjan Tiwari, Haridwar: 

Vaman atyant aavasyak upaya hai srotovarodh aur badhe hue aam ke liye amlapitta me anyatha ayurvedic medicine daily use karna kaafi costly ho sakta hai.

[8/20, 10:51 PM] Dr. D C Katoch sir: 

शुभमस्तु -सफला अस्तु !

 क्योंकि चरक काल में  अधिकतर लोग द्विकाल भोजी थे।

[8/20, 11:07 PM] Dr Jayshri Kulkarni: 

Perhaps you have accrossed  patients with" उपस्थित दोष".

Which one has to decide before inducing वमन. In these cases if you don't induce वमन, प्रकृति itself results in same.

But a वैद्य should think beyond this to complete चिकित्सा.

So those लक्षणानि should not appear again.

And  that is applying दीपन योग followed by दीपनीय घृत followed by विधिवत निरूह / विरेचन/अनुवासन whichever is according to दोष.

Lastly to maintain give शमनयोग if necessary. 

As per my experience शमनयोग r least in use.

[8/20, 11:21 PM] Ankur Sharma Dr Delhi: Agree.

[8/20, 11:36 PM] Dr Surendra A Soni: 

[8/20, 11:56 PM] Anupma Patra AIMS AYU:

 

 if it is vidagdhajirna then definitely it will give good result in all cases irrespective of age or strength of patient.

[8/21, 12:08 AM] Dr Surendra A Soni: 

A drug can't cause dependency unless it has neurotropic or psychotropic effects. Very less chance in absence of said two factors.

There may be a nocibo effect because of deep routed in conscious level..

[8/21, 1:07 AM] Vd. Subhash Sharma Ji Delhi: 

*अगर pracrical हो कर रोग के स्थान देखें तो रोग ‘शरीरेन्द्रिय सत्वात्मा संयोगो ....’ इन्द्रियों के समूह शरीर में, मन में या आत्मा में आयेगा। आत्मा निर्विकार है तो शरीर या मन ही रहे, रोग तो आया शरीर में मगर उसे मन के तल में बिठा लिया और शारीरिक रोग को मन के स्थान से ना निकाल पाना ही समस्या है।*

*नियमित मद्यपान करने वाले नवरात्रों मे, सावन में या श्राद्धों में मद्य त्याग करते है तो कोई withdrawl symptoms नही मिलते, क्योंकि मनोबल अच्छा होता है।हर एक घंटे में सिगरेट पीने वाले USA की flight 18 घंटे बिना सिगरेट और बेचैनी के निकाल देते है और बिना विबंध के।*

*त्यागने के दो ही मार्ग है भय या ज्ञान , कई बार रोगी को दोनो ही दिखाने पड़ते है और वैद्य जब तक गुरू, पथ प्रदर्शक और मनोवैज्ञानिक नही बनेगा तब तक रोगी का रोग मूल से नष्ट नही होगा।*

[8/21, 6:52 AM] Prof. Ramakant Chulet Sir: 

[8/21, 6:54 AM] Dr Jayshri Kulkarni AP: 

[8/21, 7:37 AM] Dr Shashi Jindal, Chandigarh: 

to maintain blood ph h ions should be released as hcl in stomach, with ppis this mechanism is blocked, and increase in h ions cause fall in blood ph, acidic blood or dushit blood, kidneys have to work more to maintain blood ph causing renal damage.

 hypothetical explanation.

[8/21, 8:55 AM] Vd. Subhash Sharma Ji Delhi:

 *hypothesis ठीक भी हो सकती है, क्योंकि research करने का पहला step यही है, इस group के बहुत से विद्वानों की hypothesis पर मैने clinical work किया और positive result भी मिला, इसलिये हमेशा आशावादी रहिये और परिणाम आशानुरूप ना हो तो भी एक अनुभव तो मिला।*

[8/21, 9:13 AM] Dr Shashi Jindal, Chandigarh: 

[8/21, 9:45 AM] Dr Priy-ranjan Tiwari, Haridwar: 

Specially in pittaj grahni also.

[8/21, 9:47 AM] Dr Shashi Jindal, Chandigarh: 

yes i missed.

[8/21, 9:53 AM] pawan madan Dr: 

Gud mng Soni ji.

Here dependency is not on the lines of psychotropic drugs.

I have seen in hundreds of pts...when a person is taking ppis for more than 6 months it becomes its habit due to the reasons..

...ppis stop all HCl production so pt feel very good without any burning and enjoys all types of food

...as soon as we stop the ppis at once...there is rebound hyper secretion of HCl and syms of APD manifest with more strength and pt cant bear this

...in that case even if the pt is taking very very light food like only milk or simple daal them also there is extreme feeling of acidity in chest and abdomen

...pt always remembers the Sakoon when taking ppis daily so craves for that

So we prefer to withdraw that in tapering form.

On pt of IBS came to me after taking 4 yrs of old and new ppis by the Gastroenterologist with nil digestion....it took me complete one year to completely cure him and to completely stop ppis.

[8/21, 9:55 AM] Prof. Deep Narayan Pandey: 

True, analysis holds in a large and large number of cases.

[8/21, 9:56 AM] Dr Shashi Jindal, Chandigarh: true

[8/21, 10:00 AM] pawan madan Dr: 

*AMALPITTA – ACID PEPTIC DISORDERS*

In Charaka Samhita - Scattered refences of Amlapitta is available . 

--While explaining about the qualities of milk it has been indicated as pathya in Pandu 

roga , Amlapitta etc.

--Kulatha has been mentioned as chief etiological factor for Amlapitta3 

--While stating the effects caused due to excessive use of lavana rasa, there is a mention that it provokes pitta, lohita pitta, amlapitta etc

--Amlapitta is also mentioned in the context of ill effects of vidhi virudha ahara sevana

--Rajamasha is more beneficial in Amlapitta disorder 

--While describing grahani dosha , pathogenesis of Amlapitta has been clearly mentioned 

--Mahatikthaka gritha has been indicated in Amlapitta

--While explaining the pittaja nantamja diseases the terms Dumaka, Amalaka and Vidaha have been mentioned which are seen in Amlapitta

--Indications of Kansa Haritaki also includes Amlapitta.

[8/21, 10:03 AM] Dr Shashi Jindal, Chandigarh: 

[8/21, 11:05 AM] Dr Harsh Kishore: 

I think in case of PPI intake for longer duration like patients come to me taking PPI since 10 to 15 years.... It becomes ओकसात्म्य..... And this might be the reason it is difficult to leave..... Acharya charak has explained about this and said if a person is habitual of taking viruddh aahar also we should not stop it immediately..... It should be decreased in padamsh krama...... Please correct if anything wrong...

[8/21, 11:27 AM] Dr Shashi Jindal, Chandigarh: 

this is true

 Mal living style is the cause of need of allopathy

 sir I think oksatmya is actually ritu satmya charak, but taking ppis etc are asatmya drugs(anaushadh), which cause side effects nor immidiatly but tater on (sanbadhan )

[8/21, 11:40 AM] Dr Harsh Kishore: 

Sir ritu satya and oaksatmya are different types of satymya.... Total 6 in no.

[8/21, 11:43 AM] Pankaj Chhayani dr nadiad: 

We have around 150 pts in IPD at our hospital. We immediately stop PPIs in almost all pts .

But no food is allowed other than our hospital.

 We never use Tomatoes, lemon , chillies..

[8/21, 11:56 AM] Dr Harsh Kishore: 

अनुचित अपथ्य आहार विहार भी यदि निरंतर सेवन करते रहने से प्रकृति के अनुकूल हो जाये अतः हानि न पहुंचाए तो उन्हें भी ओकसात्म्य कहते हैं।

[8/21, 11:56 AM] Dr Harsh Kishore: विमर्श

[8/21, 12:04 PM] Dr Shashi Jindal, Chandigarh: 

u r right, but body can  adapt to apathya /asatmya etc it does not mean it has become satmya. my opinion as pr oksatmya definition of  charak.

[8/21, 12:05 PM] Pankaj Chhayani dr: 

[8/21, 12:07 PM] Dr Shashi Jindal, Chandigarh: 

and these adaptaions end with mutations and become cause of malignancies later on.

[8/21, 12:08 PM] Pankaj Chhayani dr: 

Many pts consume PPIs along with milk. PPIs block proton pump and decreases acid. Acid  is necessary in digestion of milk. Undigested milk may cause bloating and other problems.

[8/21, 12:11 PM] Pankaj Chhayani dr: 

Chymosin, known also as rennin, is a proteolytic enzyme related to pepsin that synthesized by chief cells in the stomach of some animals. Its role in digestion is to curdle or coagulate milk in the stomach, a process of considerable importance in the very young animal. If milk were not coagulated, it would rapidly flow through the stomach and miss the opportunity for initial digestion of its proteins.

[8/21, 12:14 PM] Dr Shashi Jindal, Chandigarh: 

[8/21, 12:21 PM] Dr Ranga prasad: 

In pts who are not willing to be under Omeprazole like PPI, any willing vaidyas, just once try using, *Parushakadi lehyam* of AVS and observe for its clinical efficacy. The lehyam then would be one of the frequently indented medicine for supplies. 

[8/21, 12:34 PM] Dr Shashi Jindal, Chandigarh: 

Parushakadi Leham Ingredients:

Parushaka – Phoenix pusilla

Ikshu – Sugarcane

Draksha – Dry grapes – Vitis vinifera

Lodhra – Symplocos racemosa

Twak – Cinnamon – Cinnamomum zeylanicum

Patra – Cinnamomum tamala

Devadaru – Cedrus deodara

Sharkara – Sugar

copied from google.

[8/21, 2:02 PM] Dr Shashi Jindal, Chandigarh: 

The hydrogen ion in normal metabolism: a review.Review article

Alberti KG, et al. Ciba Found Symp. 1982.

Show full citation

Abstract

The production of hydrogen ions (H+) by metabolic processes is described, with particular emphasis on glycolysis and ketogenesis. Total metabolic production of H+ is approximately 150 g day-1 but utilization closely balances production, so that intracellular and extracellular H+ production is maintained within narrow limits. H+ is generated at several sites in glycolysis but no net H+ production occurs unless the ATP formed is hydrolysed. The other main source of metabolic H+ production is ketogenesis. Here H+ accumulation depends on both the relative dominance of ketone body production over utilization and the loss of base in urine. The H+ is produced during the synthesis of 3-hydroxy-3-methylglutaryl-CoA and not because of dissociation of acetoacetic acid. Lipolysis and re-esterification of fats are additional major producers of H+, while net H+ production also occurs with pathological accumulation and incomplete combustion of other organic acids. Many metabolic systems are sensitive to the changes in pH. These effects have been examined in vivo using an ammonium chloride acidaemia model in the rat. Severe insulin resistance and impaired glucose metabolism in liver and muscle were found. One mechanism involved inhibition, by H+, of the binding of insulin to its receptors. Further mechanisms include inhibition of key glycolytic enzymes including phosphofructokinase. It is concluded that too little attention is paid to metabolic production of hydrogen ions and to their effects, in turn, on metabolism.

PMID 6804190 [Indexed for MEDLINE]

[8/22, 12:10 AM] Harish Verma Canada: 

Is this called *Agnimandhya*?

 In such circumstances can we call undigested milk as Ama Ras ?

Does this Ama Ras responsible for Ama Vata ?

Or can long term use of PPIs cause Ama Janya disorders ?

[8/22, 5:47 AM] Dr Shashi Jindal, Chandigarh: 

gastric hcl is decreased,  not other enzymes, we can say vishamagni.

[8/22, 6:46 PM] pawan madan Dr: 

Anything which is in the process of digestion and metabolism but has not reached its finality can act as Aama Rasa and can produce diseases like Aamavaat and many others.

[8/22, 6:57 PM] Manu Vats Dr Patiala: 

Yes agreed...Further as Dr Harish pointed out decreased Hcl and mandagni....so I explain it as considering 2 conditions...

1)being kledak kf sthan is amshay so in any case kledak is decreased it will cause Amalpitt  because of increased pachak pitt 

 2) in any case kledak increase then its sanchy or accumulation leads to decreased pachk pitt or dilution of hcl ..this further leads to Aroochee or Agnimandya..and this condition is main cause of Aamras thus may cause Aamvaat when it is transported by smaan vayu ......Regards

[8/23, 4:59 PM] Harish Verma Canada: 

 Dr Manu Ji, 

Autoimmune Disorders are increasing day by day in our society. Amavata is commonly co-related with RA  by Ayurvedic Scholars. 

As PPIs in the modern time drug. So I wanted to draw attention of our group members that *Excessive use of PPIs lead to Agnimandhya*, which of course will lead to any Ama Janya disorders. This causative factor of Agnimadhya is not touched so far. 

Do you think long term use of PPIs can lead to Agnimandhya? 

Sales of PPIs is on the top in the world.

[8/23, 9:37 PM] Dr Surendra A Soni: 

What are the side effects of proton pump inhibitors (PPIs)?

The most common side effects of proton pump inhibitors are:

1.Headache
👆
(Koshthe Pittakshaye vatvriddhi)

2.Diarrhea
👆
(Pittakshaye kaphavriddhi)

3.Constipation
4.Abdominal pain
5.Flatulence
👆
*(Koshthe Pittakshaye vatvriddhi)*

6.Fever
👆
*(Mandagne Shakhashrita pitta)*

7.Vomiting
8.Nausea
👆
*(Koshthe Pittakshaye kaphavriddhi viguna vat)*

9.Rash
👆
*(Shakhayam pittagaman)*

Nevertheless, proton pump inhibitors generally are well tolerated.

PPIs may increase the risk of Clostridium difficile infection of the colon. 
(Saamata)
High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine.
👆
*(Mandagne dhatukshaya)*
👇
 Prolonged use also reduces absorption of vitamin B12 (cyanocobalamin).

*Abhyase Vishishtha Nidana/hetu roop*
👇👇👇

Long-term use of PPIs has also been associated with low levels of magnesium (hypomagnesemia). Analysis of patients taking PPIs for long periods of time showed an increased risk of heart attacks.

Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.

Other serious side effects associate with PPIs include:

Serious allergic reactions
👆
*(shakhagami pitta)*

Stevens-Johnson syndrome
Toxic epidermal necrolysis
Reduced kidney function
Pancreatitis
Reduced liver function
Erythema multiforme

👆👆👆👆👆👆
*(Koshthe-pittasrava* *avarodha)*

*Like wise we may understand the reverse symptomatology emerged with long term use of a drug as per our concept.*

Dr. Harish ji
Dr. Manu Vatsa ji

[8/24, 7:39 AM] pawan madan Dr:

 Great sharing sir..

******************************************************

Above discussion held on 'Kaysampraday" a Famous WhatsApp-discussion-group  of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

Email: surendraasoni@gmail.com

Mobile No. +91 9408441150