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