Ajirna (Indigestion)

Introduction

An abnormality in digesting food or lack of proper digestion is termed as Indigestion(dyspepsia). Indigestion refers to number of gastro-intestinal complaints, which can include gas (belching or flatulence) and upset stomach. Ageing is accompanied by several changes in the gastro-intestinal system and older adults frequently present with gastro-intestinal problems. Physiological changes of ageing may be difficult to differentiate from disease. According to Ayurveda, those who are not following dietary guidelines and consume food without self control become victims of Ajirna (Indigestion). This leads to various diseases.

Aetiology

1. Excessive drinking of water after meal

2. Incompatible and unwholesome diet (Samasana)

3. Irregular food habits (Visamsana)

4. Suppression of natural urges of nidra (sleep),vata (flatus) and purisha (stool)

5. Improper sleeping habits

6. Emotional disturbances

7. Loss of teeth due to ageing

8. Decreased saliva production

9. Over eating (Adhyasana)

Patho-physiology

In elderly people, ingested food doesn't digest properly due to

1. Diminished secretion of digestive enzymes

2. Impaired chewing due to loss of teeth

3. Decrease in saliva production due to ageing may also contribute to severity of acid reflux

4. Slowing of gastric emptying, which may produce abdominal distention, increase meal induced fullness

Clinical features

1. Pain or burning sensation in the upper abdomen

2. Feeling of undue satiety after eating

3. Nausea, heartburn, bloating and belching

4. Regurgitation, vomiting (occasionally)

5. Heaviness in the body

6. Headache and body ache

7. Thirstiness

8. Loss of taste etc.

The severity of these symptoms is often associated with eating.

Investigations

Following Investigations may be helpful to know whether indigestion is physiological as a process of ageing or secondary to any disease condition

1. Liver function test (LFT)

2. Ultrasonography (USG-Abdomen)

3. Upper G.I. Endoscopy

4. Barium meal follow through

Management approaches

a. Prevention

1. Consumption of godhuma (wheat), mudga (green gram), old rice, rasona (garlic),seasonal fruits, diet of high fiber content, hingu (asafoetida), draksha (grapes),Amalaka (Phyllanthus emblica Gartn), pippali (long pepper),Shunthi(dry ginger),green leafy vegetables and luke warm water

2. Consumption of light and easily digestible food  after chewing properly

3. Use of Triphala churna 3 gm with lukewarm water at the bed time.

4. Practice of vajrasana after meal regularly

5. Avoidance of  irregular food habits, heavy, unwholesome, oily and spicy food items.Bakery

and preserved items need to be avoided.

6. Avoidance of  over eating, suppression of natural urges, excess tea, coffee, smoking is recommended.

7. Avoidance of irregular sleep, worries, anxiety and depression prevents indigestion.

b. Medical management

Line of treatment (A.H.Su.8/27)

1,Nidana parivarjana :Avoidance of aetiological factors like Incompatible diet, irregular food habits, drinking of excess water   immediately after meal  e.t.c.

2. Sarvanga svedana for a day is beneficial.

3. Dipana (Accelaration in digestive fire) with the use of the powder prepared from Trikatu(sonth papal,maricha in equal quantity)in the dose of 1-3 gm. Before or with food. helps in acceleration of digestive fire and appetite.

4. Pachana (digestion) Use of  Chitrakadi vati and Lashunadi vati 2 pills each  after food supports in proper digestion of ingested food material.

5. Shodhana chikitsa (bio-cleansing therapies) followed by Shamana chikits (Palliative therapy) also advisable

5 A: Virechana (therapeutic purgation) with Draksha/Munakka  (Vitis vinifera)10 gm or Aragvadha phala majja (Cassia fistula fruit pulp) 10 gm or Haritaki/Harad (Terminalia chebula Linn.seedless fruit powder)10 gm Or Kutaki (Picrorhiza kurroa powder) 5 gm or 1 teaspoon full Eranda taila(Medicated caster oil)(oil of Ricinus communis seeds) seperataly on different days or mixed together (Depending on the strength of koshtha) can be taken at bed time.

It need be decided by physician according to the severity condition of the situation and strength of  patient

6. Drug therapy

KTCHEN ORIENTED METERIALS

Name of matrial

Dosage form and dose

Vehicle

Shunthi/shonth(Dried ginger)Gingiber officinale Rose

1gm of powder Twice daily before principal meal

Warm water

Pippali/chhoti pipar(Long pepper)Piper Longam linn

2 -3 Gm. Of powder.Twice daily after food

Luke Warm water

 

 

 

Ajmoda(Apium graveolance Linn

3-5 gm of powder Twice or thrice daily

Luke warm water or butter milk

 

FORMULATIONS

Drug

Dosage (per dose)

Vehicle

Duration

Hingwastaka churna

1.5-3 gm.

Ghrita/ Lukewarm water

7 - 10 days

Lavanaabhaskara churna

1-2.5 gm

Butter Milk

7 - 10 days

Gandharvahastadi kashaya

15 ml

Water

7 - 10 days

Ajamodarka

12 - 24 ml

Water

7 - 10 days

Sankha  vati

250 - 500 mg

Honey/ warmwater/ Butter milk

7 - 10 days

Citrakadi vati

1.5 gm

Warm water/Butter milk

7 - 10 days

Hingvadi vati

1.5 gm

Warm water

7 - 10 days

Lashunadi vati

1.5 gm

Warm water

7 - 10 days

Agnitundi vati

125 - 250 mg

Water

7 - 10 days

Sanjivani  vati

125 mg

Ardraka Svarasa/ Warm water

 

7 - 10 days

Indukanta ghrita

10 gm

Warm water/Milk

7 - 10 days

Pippaly!di ghrita

10 gm

Warm water/Milk

7 - 10 days

Pippalyasava

12 - 24 ml

Water

7 - 10 days

Kumaryasava

12 - 24 ml

Water

7 - 10 days

Draksharishta

12 - 24 ml

Water

Water

Jirarakadyarisha

12 - 24 ml

Water

7 - 10 days

NOTE: Out of the drugs mentioned above any one of the drug or in the combination may be prescribed by the physician.The duration of the treatment may vary from patient to patient. Physician should decide the dosage (per dose) and duration of the therapy based on the clinical findings and response to therapy

c. Yogic practices - The following yogic practices are beneficial in Indigestion;however, these should be performed only under the guidance of qualified Yoga therapist. Duration should be decided by the Yoga therapist.

1. Suryanamask!ra, Katichakrasana, Bhujangasana, Dhanurasana, Vajrasana,Pavanamuktasana etc.

2. Pranayama (Surya anuloma viloma, Bhastrika)

3. Agnisara kriya, Bhujangini mudra

4. Kunjala, Danda dhauti, Vastra dhauti etc.

 D,Counselling - Advice the patient to

1. Ensure the digestion of previously consumed food before having next meal

2. Eat properly in a pleasant, quite atmosphere without watching T.V., reading, talking,etc.

3. Take food at a regular time

4. Take dinner 2-3 hours before sleep

5. Walk regularly after dinner

6. Include fiber rich food in diet

7. Avoid the habit of skipping breakfast

8. Avoid spicy, oily and heavy food articles

9. Avoid tea or coffee before sleep

10. Avoid the habit of drinking too much water after meal

11. Avoid junk food like pizza, burger, samosa, kachori etc.

Indications for referral

1. Patients who are suffering from indigestion secondary to another disease may be referred.

2. Having carcinoma of esophagus or other alimentary tract must be reffered.

Reference

AYURVEDIC MANAGEMENT OF SELECT GERIATRIC DISEASE CONDITIONS2011

 CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA Department of AYUSH, Ministry of Health & Family Welfare Government of India, New Delhi - 110 058  

  • PUBLISHED DATE : Jun 09, 2016
  • PUBLISHED BY : NHP Admin
  • CREATED / VALIDATED BY : Janardan Panday
  • LAST UPDATED ON : Jun 09, 2016

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