Introduction

Ayurveda, traditional medical science, is based on its own fundamental principles. In Ayurved, Agni has considered as prime factor in general metabolism of body leading to its growth & development. Maintenance of health & manifestation of disease have also been attributed to normal & abnormal functioning of Agni, respectively. The term Agni here includes factors those are responsible for digestion & metabolism having predominance of Agnimahabhuta in them. Agni may get vitiated because of unwholesome & irregular diet as well as lifestyle. Disturbed functions of Agni causing incomplete digestion of food are termed as Ajirna in Ayurved. Vishtabhadajirna is one of type of Ajirna, which is mainly characterized by sings & symptoms of pricking type of pain in epigastric region & chest with burning sensation, long stasis tympanitis, abnormal movement of Vata, obstruction to stool & flatus, delusion, general malaise & other symptoms of Vata-Vriddhi. The vititation of Vata Dosha is an essential stage in manifestation of Vishatabhadhajirna. Irregularity of Saman Vata is also important elements in its pathology. In modern system of medicine, Vishatabhadhajirna can be correlated with indigestion induced hyperacidity (IIH), which is a very commom medical condition in day-to-day life. Heartburn is typical & commonly occurring symptom of hyperacidity, which is characterized by burning sensation in chest radiating toward the mouth. Because of acid reflux into esophagus, heartburn is also accompanied by sour taste in the back of mouth with or without regurgitation of the refluxate. Hyperacidity is diagnosed when the frequency of acid reflux is more than two times a week. Diseases resulting from acid reflux are most common gastrointestinal condition that physicians come across in their daily practice.

Different system of medicine offer a number of modalities for the clinical management of hyperacidity modification. In modern system of medicine, treatment for hyperacidity generally includes proton pump inhibitors (PPIs) such as rabeprazole, omeprazole & esomeprazole & selective histamine type 2 receptor antagonists (H2 blockers) such as famotidine & cimetidine. Some over the-counter medicines such as antacids like Digene, Omee MPS & Digeplex are also available in the market for this condition.

Clinical Findings

On examination, it was found that patient was having complaints of burning sensation in chest, abdomen & at throat region with sour eructation and obstruction to stool & gases, since past 3 months. The severity of symptoms was assessed using Reflux Disease Questionnaire (RDQ), which is a standard scale used for clinical severity assessment in reflux diseases. On physical examination, general condition of patient appeared to be normal with BMI=21.3kg/m (wt.=56kg, ht.=162cm), BP=110/80mmHg, Pluse=72/min. The patient stated that he is having normal appetite but irregular & obstructed motions. The patient had Vata-Pradhan-Pitta-Prakruti. Routine hematological, biochemical & urine examination were also carried out, all parameters were found within normal limits. The patients diet history revealed habits such as intake of milk, buttermilk, curd regularly & outside food comprising sour, oily, salty, spicy & fermented food products once or twice a week & consumption of food at inappropriate time.

Timeline

The patient was treated with prescribed treatment regimen for 15 days followed by 15 days period of follow-up. The detailed timeline of the treatment is given as following-

Prescribed Treatment Protocol

Therapeutic Interventions

The prescribed treatment protocol had two important aspects; the first was disease-specific use of drug & the second was specific drug administration time with regard to involved dominant Doshas in the disease. The drug included a polyherbal compound formulation Sutshekar Rasa (Kajjali, Tankan Bhasma, Suddha Vatsanabh,Suddha Dhaddutr Beeja, Shankh Bhasma, Trikatu, Ela, Nagkeshar) & Abhayadi Gutika (s). This is the drug of choice indicated for the management of Vishtabadhajirna in the Ayurved text of Chakradatta. The administration of drug was planned to be given on empty stomach & after food twice a day. In Ayurveda classics, this specific drug administration time is indicated in disease of Koshtha involving the vitiation of Pachak Pitta & Saman Vata (responsible for digestion & propulsion of food). The vitiation of both Pachak Pitta & Saman Vata is an essential element in the manifestation of Vishtabhdajirna. Along with the internal medicament, the patient was also adviced to know etiological factors, which involved unwholesome dietary & living habits such as intake of milk & its product, junk food, sour, oily, salty, spicy & fermented food products; consumption of food at inappropriate time; Ratrijagaran & Divaswapa.

Follow-Up & Outcome

Observation on consecutive visits of patients to the OPD were noted. Subsequent observational of disease condition are depicted in table no. 3. No adverse events were reported during the study. The treatment was given for the duration of 15 days. Then all the medications were stopped & the patient was advised to just follow diet & life-style related advice to visit the OPD after 15 days for follow-up. The recurrence of symptoms was not found during the follow-up period of 15 days, i.e., after 30 days of starting the treatment. The severity of disease & outcome treatment protocol were measured based on symptomatic relief in signs & symptoms and scoring on the RDQ scale. In the present case study, before treatment score was 40, after treatment score was 13 & the score on follow-up visit was 2 on RDQ scale.

As described earlier, the of dosha plays a vital role in the manifestation of Vishtabhajirna. In Ayurved system of medicine, it is belived that the avoidance of the etiological factors is the primary key to success in the treatment; hence, the patient was advised not to indulge in unwholesome dietary & living habits. Initially the patient was of the option that the intake of milk is beneficial for his disease condition as it was reliving his symptoms temporarily. The patient was adviced to stop this practice & also to stop taking meals at inappropriate times, late night sleep & day sleep as these are the aggravating factors.

The clinical assessment of therapy showed in table no.4. The data denote that therapeutic effect is increased during follow-up period too without the recurrence of disease. Thus, multimodel approach therapy, i.e., Ayurved Shaman therapy prescribed at a specific Aushadha Kaala along with Nidan Parivarjana. Significant improvement was observed in clinical parameters as well as on the standard RDQ score scale adopted for the study.

Conclusion

Vishatbhadhajirna is a common clinical condition encountered by a physicians now-a-days. Though various treatment modalities are available for this, a promising therapy with safety is still lacking. Ayurveda with its unique principles of treatment has tremendous potiential in disorder like this where other systems of medicine have limited scope. In the present study, a significant improvement in clinical signs & symptoms was observed through Shaman therapy prescribed at a specific drug administration of time. The patient showed high compliance to the treatment prescribed as there were no adverse events recorded throughout the treatment & during the follow-up period.

Declaration of the patient consent

The patient has given his consent for reporting the case along with required clinical information in the journal.