E-ISSN:2456-3110

Research Article

Amlapitta and Amavata

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 3 MARCH
Publisherwww.maharshicharaka.in

A Pilot Study to develop an Ajirna Inventory in Grahanidosha, Amlapitta and Amavata

Suvarsh1*, Vidyalakshmi K2, Mahalakshmi MS3
DOI:10.21760/jaims.10.3.13

1* Suvarsh, Post Graduate Scholar, Department of PG Studies in Samhita Siddhanta and Sanskrit, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

2 Vidyalakshmi K, Professor and HOD, Department of Samhita Siddhanta and Sanskrit, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

3 Mahalakshmi MS, Assistant Professor, Department of Samhita Siddhanta and Sanskrit, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

Introduction: Impairment of Agni, can be triggered by various factors such as the consumption of heavy and dry foods, ultimately leading to Ajirna. Proper diagnosis of Ajirna and its subtypes - Amajirna, Vidagdhajirna, and Vistabdhajirna - based on classical Lakshana is often limited in practice. Digestive disorders affect millions globally, causing economic burdens through healthcare costs, work absenteeism, and reduced quality of life. Thus, this study focuses on the practical challenges faced while deriving at diagnosis of Ajirna. In this regard a series of questions based on the Lakshana play a key role in accurate differentiation of the types of Ajirna and there by forming inventory for the same.

Methodology: The primary data sources included Ayurveda classical texts, contemporary books, articles, journals, and relevant web references. An Ajirna inventory is prepared by using review of Lakshana of Ajirna. Pilot study was carried out in Grahanidosha, Amlapitta, Amavata patients and findings were analysed.

Results: Vidagdhajirna symptoms were predominant in Amlapitta patients, while Samanya Ajirna symptoms were moderately high in Grahani dosha patients. Amajirna symptoms were minimal in Amavata patients

Discussion: The different types of Ajirna Lakshana highlight the involvement of specific Doshas and impaired Avasthapaka, leading to disrupted digestion and Dhatu nourishment.

Keywords: Agni, Avasthapaka, Ajirna, Amlapitta, Grahanidosha, Amavata

Corresponding Author How to Cite this Article To Browse
Suvarsh, Post Graduate Scholar, Department of PG Studies in Samhita Siddhanta and Sanskrit, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.
Email: 		Suvarsh, Vidyalakshmi K, Mahalakshmi MS, A Pilot Study to develop an Ajirna Inventory in Grahanidosha, Amlapitta and Amavata. J Ayu Int Med Sci. 2025;10(3):85-90.
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https://jaims.in/jaims/article/view/4104/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-02-09 2025-02-19 2025-03-01 2025-03-10 2025-03-24
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© 2025 by Suvarsh, Vidyalakshmi K, Mahalakshmi MS and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Download PDFBack To ArticleIntroductionObjectives of the StudyMaterials and MethodsObservations and ResultsDiscussionConclusionReferences
Suvarsha et al. A Pilot Study to develop an Ajirna Inventory

Introduction

Ayurveda places great importance on maintaining Agni, which is primarily responsible for digestion and absorption. Any imbalances or abnormalities in Agni can lead to the development of various diseases. Ajirna is one such disease caused due to malfunctioning of Agni.[1] Ajirna is caused due to various Aharaja and Viharaja Nidana. It is classified into 4 types based on the involvement of doshas. They are: Amajirna, Vidagdhajirna, Vishtabdhajirna and Rasashesha Ajirna.[2] Proper diagnosis of Ajirna and its various types like Amajirna, Vidagdhajirna, based on classically said Lakshana are very limited in practice. Inappropriate management of Ajirna without proper diagnosis leads to alleviation of the symptoms and it may become a cause for other diseases. Hence assessing each Lakshana of various types of Ajirna helps the physician to form a proper diagnosis and also assist in treatment of the disease. This further helps in preventing the causation of other serious diseases. Amlapitta is an Annavaha Sroto Vikara which mainly occurs due to Agnimandya. It is a Pittaja Vikara caused due to Vidagdha Pitta.[3] Grahanidosha is a both functional and structural defect of structure Grahani majorly disturbing the Agni. Amavata is a disease that manifests due to 2 entities Ama and Vata. Ama is caused due to defect in Jatharagni or Dhatwagni. Various symptoms of Amavata are related with Ajirna symptoms. Hence Ajirna is a main condition which acts as Nidana for various other diseases. Proper diagnosis of Ajirna and its treatment in initial stage will help in reducing the other consequences like Amlapitta, Grahanidosha and Amavata.

Objectives of the Study

1. To develop inventory for Ajirna Lakshana.
2. To assess Ajirna Bheda (Amajirna, Vidagdhajirna, Vistabdhajirna) with the help of Inventory

Materials and Methods

Source of data: Literary source of the present study was collected from all classical texts of Ayurveda, Ayurvedic literature and journals. Additional information’s was collected from relevant websites, articles, and presentations. The following materials are used for the study

  • Bruhattrayee with the commentaries.
  • Laghutrayee with commentaries.

  • Vedic literature.
  • Other Samhitas of ayurveda.

Survey source: The study was conducted on 60 patients, 20 each from three diseases i.e., Amlapitta, Grahnidosha and Amavata respectively. Patients for the study are randomly selected from OPD & IPD of Shri Dharmasthala Manjunatheshwara Ayurveda Hospital Kuthpady udupi.

Inclusion Criteria: 1. Subjects who belong to the age group 16-60 years. 2. Diagnosed cases of Grahanidosha, Amlapitta and Amavata.

Exclusion Criteria: 1. Subjects who are below 16 years and above 60 years 2. Cases except Grahanidosha, Amlapitta and Amavata diseases. 3. Pregnant, lactating woman. 4. Chronic stage. 5. Subjects taking long term medications which can hamper the status of Agni 6. Rasashesha Ajirna.

Diagnostic Criteria: Patients diagnosed with Amlapitta, Grahani dosha, and Amavata based on their respective symptoms were provided with a custom-made questionnaire for assessment.

Study Design

Questionnaire Development

Ajirna symptoms such as Vishtambha, Sadana, Shiroruja, Murcha, Bhrama, Prushta Kati Nigraha, Jrumbha, Angamarda, Trushna, Jwara, Chardi, Pravahana, Arochaka, Avipaka, Gourava, Maruta Mudhata, Sadyobhukta Udgara, Praseka, Utklesha, Akshiganda Shopha, Shula, Adhmana, Moha, and Amlaudgara were identified as the domains of the study. The meanings of these terms, such as Vishtambha meaning "Aprachalatwam" (immobility), were collected from various Ayurvedic texts.

Using these definitions, a questionnaire was developed with questions framed in both Kannada and English, along with demographic information and a diagnosis section.

This preliminary version was reviewed by five subject experts, and their suggestions were incorporated. The revised questionnaire was then tested with non-medical faculty to assess patients' understanding of the questions. Following these revisions, two final questionnaires were created one in Kannada and one in English with the updated questions and options. This process culminated in development of final version of questionnaire.


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Pilot study: A total of 60 patients, with 20 from each of three different diseases, were evaluated using a specialized questionnaire called the Ajirna Inventory.

20 subjects of each disease i.e., Grahanidosha, Amlapitta and Amavata will be assessed to know the relation with Vistabdhajirna, Vidagdhajirna and Amajirna Lakshana respectively.

Method of Data Collection

  • A detailed questionnaire in both English and Kannada was prepared based on Ajirna Lakshana (symptoms) and their meanings.
  • The questionnaire includes sections for personal information, diagnosis, and questions related to Ajirna Lakshana.
  • Most questions are closed-ended, with "yes" or "no" answers, while some include four options for responses.
  • It was designed to be simple and easy for subjects to answer.
  • The questionnaire was administered using the interview method.
  • Patients of both genders diagnosed with Amlapitta, Grahani dosha, and Amavata were randomly selected based on inclusion and exclusion criteria.

Observations and Results

Among 60 patients previously diagnosed with Grahani Dosha, Amlapitta, and Amavata, demographic details such as age, gender, occupation, and other factors were analysed.

  • Age Distribution: 58.44% of patients aged 45-60 years exhibited symptoms.
  • Gender Distribution: The condition was more prevalent among females, particularly housewives, who accounted for 48.33% of cases.
  • Other demographic parameters were also assessed.

Ajirna Lakshana were assessed among these three diseases by following domains:

Lakshana: The symptoms of Vishtambha, Atipravrutti, and Pravahika were evaluated based on the following parameters.

1. Frequency of bowel movements

  • In Amlapitta, 13 patients had a bowel movement once a day, while 7 had more than one bowel movement per day. The patterns of once in every two days or longer intervals were not observed.
  • In Grahani Dosha, 11 patients reported once-daily bowel movements, and 9 had more than one per day.
  • In Amavata, 15 patients had a once-daily bowel movement, 4 had more than once per day, and 1 experienced it once every two days.

2. Sinking of stools

  • This symptom was observed in 13 Amavata

3. Difficulty in passing stools:

  • Reported by 9 Grahani Dosha

4. Urgency in voiding stools:

  • Seen in 10 patients with Amlapitta.

5. Lack of satisfaction in complete stool voiding:

  • Experienced by 16 Grahani Dosha

6. Consistency of stools:

  • Observations varied: 13 Amavata patients had smooth stool consistency, 8 Grahani Dosha patients had hard stools, and 5 had loose stools.

7. Foul-smelling stools:

  • Reported by 9 Grahani Dosha

8. Difficulty in passing flatus regularly:

  • Noted in 11 Amlapitta

9. Gurgling sounds in the stomach:

  • Observed in 11 Grahani Dosha

Abdominal pain was assessed based on its location, type, and onset. Among 11 Amlapitta patients who experienced abdominal pain:

  • 4 reported severe burning pain.
  • 4 experienced pricking pain.
  • 1 had tearing pain.
  • 2 described it as dull pain.
  • Additionally, 4 patient experienc persistent pain

Sadana/Glani: The symptoms were assessed using the following parameters:

  • Fatigue without any work: Reported by 10 Amlapitta and 10 Amavata

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  • Mental tiredness: Observed in 9 Amavata
  • Lack of enthusiasm to work: Noted in 11 Amlapitta
  • Exhaustion from minimal work: Experienced by 13 Amlapitta

Gourava: Three questions were framed based on the symptoms of heaviness in the abdomen, heaviness in the head, and heaviness in body parts. These symptoms were observed in 10 patients diagnosed with Amavata.

Udgara: In this study, 13 Amlapitta patients,13 Grahani Dosha patients and 5 Amavata patients exhibited this symptom.

Additional parameters used to assess Udgara included the frequency of belching, the onset of belching, and the taste associated with belching.

Table 1: Distribution of subjects based on frequency of belching

Frequency of belchingAmlapittaAmavataGrahani Dosha
Normal belching2-3 times639
Frequently belching623
Disturbs the daily routine001

Table 2: Distribution of subjects based on time of onset of belching.

Time of belchingAmlapittaAmavataGrahani Dosha
Just after food729
1hr after food111
2 hr after food411
Always present112

Table 3: Distribution of subjects based on taste while belching.

Taste while belchingAmlapittaAmavataGrahani Dosha
Same taste as that of food425
Sour taste736
Bitter201
Burning fumes like001

Discussion

Ajirna Lakshana in all three disorders

Highest number of Ajirna Lakshana i.e., 17 Lakshanas were noted in Amlapitta patients.

Reason: Amlapitta is a disorder of the Annavaha Srotas and is caused by an imbalance of Vatadi Dosha affecting Agni, leading to Agnidushti.

This results in the Shuktata of Ahara,[4] which stays in the stomach for an extended period and food becomes toxic. The general symptoms of Amlapitta resemble those of Ajirna, as both manifest in the Amashaya. According to Acharya Charaka, Amlapitta is caused by Annavisha mixing with Pitta, making it a continuation of the disease Ajirna.[5] Amlapitta is a disease caused due to aggravation of Pitta i.e., Vidagdha Pitta, caused due to Pitta Prakopakara Ahara Vihara. This imbalance in Pitta cause Vidagdha Paka of food. hence Vidagdhajirna symptoms were most present in Amlapitta. Presence of Samanya Ajirna Lakshana shows the Dushti of other Doshas along with Pitta. In addition, Amajirna Lakshana was observed due to involvement of Kapha long with Pitta.

Grahani Dosha patients show moderate number of symptoms of Ajirna. i.e., 12 symptoms were present.

Reason: It is a disease which occur due to Agnidusti. Grahani is a structural entity that is supported and nourished by Agni. Acharya Sushruta considers it as Pittadharakala. Prakruta Pitta resides inside Grahani.[6] This Pitta and Agni maintain the normal functioning of Grahani. Disturbance in Agni like Vishamagni, Teekshnagni and Mandagni causes various complication. One of the conditions that occurred due to Mandagni is Ajirna. Durbala Agni further disturbs normal function of Grahani.[7] i.e., Apakwa Dharana and Pakwa Srujana and further cause Ama Vimunchana. The symptom is related with Atipravrutti of Ajirna. Irregularity in Grahani function leads to alternate episodes of hard stools with loose stools. This is a disease that causes malabsorption of the nutrients from the food. This disease involves fault in digestion as well as absorption of the nutrients hence the disease has slightly reduced number of symptoms of Ajirna. Grahanidosha has most of the symptoms that are similar to Samanya Lakshana of Ajirna compared to other types. Traces of Vishtabdhajirna and Amajirna are also present. Few symptoms belong to Vidagdhajirna. Ajirna occurs in Amashaya, due to Ajirna further Agni Dushti occurs in Grahani Pradesha. Grahani is the site of Pitta and Here Amla Avasthapaka takes place. Thus, imbalance in Pitta and Agni leads to the Vidagdha Paka of food, leading to Vidagdhajirna. Absorption of nutrients will occur even in Pakwashaya. In Pakwashaya Katu Avasthapaka takes place.


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Hence imbalance in Vata cause hindrance in absorption as well as Katu Avasthapaka of food. this will further cause Vishtambha etc. symptom in Grahani Dosha. Thus causes Vishtabdhajirna. It has no significant Lakshana of Amajirna, because involvement of Prathama Avasthapaka is very less.

Amavata patients had minimum number of Ajirna symptoms

Reason: Ama is a condition that occurs due to improper digestion of food due to hypo functioning of Agni. Involvement of Vata has equal importance in manifestation of disease. Other opinions related to Ama depicts that Ama produced due to Dhatwagnimandya, hindrance in producing Adya Dhatu i.e. Rasa. and Mala Sanchaya. Hence the Lakshana related to Ajirna is less. Acharya Sushruta explained that the location or site where Ama gets lodged, symptoms like pain heaviness occurs in that place.[9]

Even though Ama is caused due to Agnimandya but its symptoms vary due to different site of lodgement. Here it is lodged in Sandhi which comes under Madhyama Roga Marga. Hence most of the symptoms are related with Sandhi itself. Few Lakshana of Amajirna was present in Amavata. Because general symptom of Amavata is interlinked with Amajirna or Ama. Thus, Amavata being joint disorder shows week association with Ajirna symptoms. Grahanidosha and Amlapitta being Annavaha Sroto Vikara has more association with Ajirna symptoms.

Conclusion

In the current study, a questionnaire comprising questions related to all the symptoms of Ajirna was developed. This inventory was administered to 60 randomly selected patients who met the inclusion criteria. The chosen patients were then interviewed regarding the symptoms of Ajirna.

Conclusions that can be drawn from the data and observations are as follows:

  • Grahanidosha has a moderate level of association with Additionally, it is primarily associated with the general symptoms of Ajirna. Traces of Amajirna and Vishtabdhajirna, and few symptoms of Vidagdhajirna are present.
  • Amlapitta has a stronger connection with Ajirna and is primarily linked to Vidagdhajirna.

  • Amavata is a joint disease which shows weaker association with Ajirna. Few symptoms are related to Amajirna, due to the involvement of Ama in initial stage of Amavata.
  • Symptoms such as Vishtambha, Anaha, and Atipravrutti are associated with impaired digestion. Whereas other symptoms like Glani, Angamarda, and Bhrama indicate a disruption in the nourishment of Dhatu and Indriya. Therefore, involvement of both impaired digestion and hindrance in dhatu nourishment is evident in these 3 diseases.

References

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7. Acharya Yadavji Trikamji, editor. Charaka Samhita of Agnivesha. 2021 reprint ed. Varanasi: Chaukhambha Orientalia; 2021. Chikitsasthana, Grahanidosha Chikitsa Adhyaya, 15th Adhyaya, verse 51 [Crossref][PubMed][Google Scholar]

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