Kunmam (Acid Peptic Disease)

KUNMAM (ACID PEPTIC DISEASE)

INTRODUCTION

“Acid peptic disease” is a collective term used to include many conditions such as gastro-esophageal reflux disease (GERD), gastritis, gastric ulcer, duodenal ulcer, esophageal ulcer, Zollinger Ellison Syndrome (ZES) and Meckel’s diverticular ulcer. The commonest ulcers are the gastric and the duodenal ulcers.

Symptoms of peptic ulcers include abdominal pain, nausea, heart burn, regurgitation, vomiting, loss of appetite and weight loss.

Excessive secretion of acid and pepsin or a weakened stomach mucosal defense is responsible for damage to the delicate mucosa and the lining of the stomach, esophagus and duodenum resulting in ulceration.

Causes of acid peptic disease include:

Helicobacter pylori: H.pylori is responsible for around 60%-90% of all gastric and duodenal ulcers.
NSAIDs: Prostaglandins protect the mucus lining of the stomach. Non steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, diclofenac and naproxen prevent the production of these prostaglandins by blocking cyclo-oxygenase enzyme leading to ulceration and bleeding.
Smoking, alcohol and tobacco: Cigarettes, alcohol and tobacco cause an instant and intense acid production.
Blood group O: People with blood group “O” are reported to have higher risks for the development of stomach ulcers as there is an increased formation of antibodies against the Helicobacter bacteria, which causes an inflammatory reaction and ulceration.
Heredity: Patients suffering from peptic ulcer diseases usually have a family history of the disease, particularly the development of duodenal ulcer which may occur below the age of 20.
Steroids/Other medicines: Drugs like corticosteroids, anticoagulants like warfarin (Coumadin), niacin, some chemotherapy drugs, and spironolactone can aggravate or cause ulcers.
Diet: Low fiber diet, caffeinated drinks and fatty foods are linked to peptic ulcer.
Other diseases: Chronic liver, lung and kidney diseases especially tumors of the acid producing cells all predispose to peptic ulcers. Zollinger-Ellison Syndrome (ZES) is a rare pre-cancerous condition which causes peptic ulcer disease. It is a syndrome disorder wherein tumors in the pancreas and duodenum also known as gastrinomas produce a large amount of gastrin which is a hormone that stimulates gastric acid secretion. Endocrine disorders such as hyperparathyroidism are also implicated in the development of peptic ulcers.
Stress: Stress and neurological problems can also be associated with the Cushing ulcer and peptic ulcer.

SIDDHA CONCEPT

In Siddha system of medicine, Kunmam or gulmam is the collective term used for Acid peptic disorders. Severe pain in the abdomen present as one of the symptoms in this disease makes the patient to bend forward and hence this name, it is believed.

According to the classification of Yugi muni, there are 8 types as follows:

1. Vazhi kunmam

2. Azhal kunmam

3. Iya kunmam

4. Mukkutra kunmam

5. Vayu kunmam

6. Eri kunmam

7. Vanthi kunmam

8. Vali kunmam

This classification is based on the symptoms that are exhibited in different forms of the disease, which is tabulated below.

TYPE	SYMPTOMS
Vazhi kunmam	Abdominal pain, loss of weight, walking inability, constipation, malaise , fatigue, headache, presence of blood in vomit, dryness of mouth
Azhal kunmam	Face turns yellow, giddiness, constipation, loss of weight, dark urine
Iya kunmam	Food aversion, pale skin, giddiness, heart burn, body tremors
Mukuttra kunmam	Abdominal distension, heart burn, salty taste, cold sensations
Vayu kunmam	Crampy abdominal pain, indigestion, vomiting, loss of weight, walking inability, profuse sweating, bloating and abdominal distension
Eri kunmam	Heart burn, severe abdominal pain, head ache, bloating, abdominal distension, loss of weight, profuse sweating.
Vanthi kunmam	Nausea, mild abdominal pain with vomiting, giddiness, constipation, loss of taste
Vali kunmam	Abdominal distension and bloating, insomnia, loss of appetite, back and body pain

CAUSE & PATHOLOGY

In Siddha system of medicine Gunmam is considered to be a life style disorder and the following causative factors are found mentioned in ancient siddha texts like Yugi chinthamani.

Ø Excessive accumulation of astringent food/taste in intestine

Ø Excessive indulgence in sex

Ø Consumption of tubers

Ø Intake of spicy food

Ø Indigestion

Ø Anger & boredom (stress)

It is quoted from a siddhar called Theran as,

“தொடர் வாத பந்தமலாது குன்மம் வராது”

meaning - ‘Kunmam does not occur without derangement of vatham humour’

Due to alteration in the dietary habits and life style the vatham humour gets deranged from its normal proportion leading to derangement of other humors also resulting in this disease. The deranged humours affect the functions of two important vayus namely uthana vayu and abana vayu producing symptoms like indigestion, abdominal pain, constipation or diarrhea, flatulence, vomiting and thereby this disease.

MANAGEMENT & PREVENTION

The line of treatment followed for this disease as mentioned in the siddha texts are as follows

1. The deranged humours should be normalized by giving proper emetics or purgatives

2. Appropriate medicines to cure the disease and

3. Proper diet to be followed.

Since the deranged humour primarily is vatham, it should be normalized first followed by proper medication. There are specific medicines for different types of kunmam, say for example sembu parpam for vatha kunmam and naga parpam for Vanthi kunmam.

Few medicines found to be very effective in treating this disease are Anda leghiyam, Seeraga chooranam, Elathi chooranam, Maan kombu parpam, Kozhi avarai elai chooranam (Canavalia Virosa (Roxb), Thiribala karpam, Hingu chooranam, Sirucinni Uppu (Herbal salt of Acalypha fruticosa Forssk), Catthi charanai chooranam (Trianthema decandra) , Sangu parpam and Silasithu parpam.

The following diet is advised to be taken during the acute phase of the disease and during the convalescence period.

Double time boiled rice for easy digestion
Fresh vegetables
Any one of the vegetables like brinjal, drumstick, ladies finger, ribbed gourd, snake gourd to be taken daily
Coconut, horse gram, black gram and non vegetarian diet should be avoided
If indigestion persists only porridge should be taken and all other diet should be avoided.

Since this disease is attributed primarily to the derangement of vatham humour as discussed above, the disease can be prevented by avoiding factors that leads to increase of this humour like over consumption of tubers along with spicy food. Stress and worries should be avoided and if any should be managed by yoga and meditation as this also tends to be a precursor of this disease.

References:

http://www.medindia.net/patients/patientinfo/acid-peptic-disease.htm

http://www.avpayurveda.com

http://www.ijpbs.com

http://scholarsresearchlibrary.com

http://www.scopemed.org

http://ijam.co.in/index.php

https://www.researchgate.net

http://ijiit.webs.com

http://www.ijlpr.com

http://www.japsonline.com

http://www.irjponline.com