Vous êtes sur la page 1sur 9

MATERIAL AND METHOD

Amlapitta is a very common disease affecting to adults mostly. It had been


found that at least 30% patients of gastritis do convert in peptic ulcer. This pressed us
to think about a common line of treatment for the disease. Even in Ayurveda its very
difficult to diagnose. Bhavamishra says that urdhvaga and adhoga Amlapitta can be
misdiagnosed as Chhardi and Atisara respectively (16/7). Even Madhavakara has called
this disease as Bhisagamohakara (56/8). Hence, the first criteria for selection of
treatment was to select a common treatment.
Chakradutta, Harita, Rasaratnasamuchaya, Bhavaprakasha, Bhaisajya Ratnavali
have quoted the line of treatment for Amlapitta.
The line of treatment consists of mainly Panchakarma and samana therapy.
Hence our goal to use both therapy according to dosihik predominance. Vaman therapy
used as shodhan therapy and Kushmandakhanda avlehya used as shaman therapy the
present study was carried out with following aims and objectives.
AIMS AND OBJECTIVES
A study on psychosomatic disorder in Ayurveda and the comparative evaluation
of the role of Kushmandkhand Aveleha and Vamana Therapy in the management of
Amlapitta.
CRITERIA FOR SELECTION OF PATIENTS
The present study was done in a series 90 patient of stress induced APD
with special reference to Amlapitta . patients having classical signs and symptoms
of Amlapitta. They are selected irrespective of their Age, Sex, Caste, Religion and
profession from OPD/IPD of Department of Kayachikitsa and S.S. Hospital I.M.S.,
BHU.
Exclusive Criteria
Following types of patient of APD were not included in the present study:
The patient suffering with signs and symptom of Zolinger Elson Syndrome.
The patient suffering with acute stress e.g. septicemia, hed injury, CVA,
Burn, patient on ventilator.
Patient who have associated with congenital Gastro intestinal anomaly.
Patient who are treated with any other antipsychotic medication.

~1~
Patient who are less than 16 year old age group
Patient suffering with liver abscess, CaGB, pancreatitis, Gastric carcinoma
and other acute abdominal disorder.
Patient of Angina pectoris, Costochondritis who suffering with APD are any
other chronic disease like Diabetes, RA, chronic aneamia etc.
Inclusive Criteria
The diagnosis of patient of Psychosomatic APD was confirmed on the basis of
inclusion criteria as mentioned below:
At least more than one month recurrent episode of chest burning, epigastric
distress.
Present H/O stress factor , Anxiety, overwork since two month.
Patient suffering from recurrent pain in upper abdomen and incomplete bowel
evacuation heaviness in abdomen.
History of using PPI and H2 blocker more than 2 month .
Characteristic Epigastric pain and burning sensation in chest, throat and acid
eructation.
Willingness to be treated with an Ayurvedic regimen.
Patient who have belief in Ayurvedic regimen.
The Study Group
All the patients have divided in three group in following manner-
Group I - 30 Patients These patients have given pantoprazole 40 mg orally daily
in morning for per day.
Group II 30 Patients These patients have given kushmankhanda aveleha 40 gm
per day in two divided dose.
Group III 30 Patients These patients have given Vamana therapy and followed by
Kushmankhand Avelehya 40 gm per day in two divided dose. All patients were
evaluated on the basis of criteria recorded before treatment and after on each follow up-
Follow ups :
The clinical trial was conducted for total period of three month and all the
patients were undergone for follow up at one month interval each.

~2~
Basal study
Based on inclusive criteria the patients registered were thoroughly interviewed
for detail of information about the patient and their disease. The collected data were
presented in a case sheet prepared specially for this study.
The data has been presented in the following profiles.
1- Demographic profile of patients.
2- Clinical profile of patients
Demographic profile
The demographic profile consists the following points-
1. Name 2.Age 3.Sex 4. Religion 5. Marital status 6. Family status 7.
Socio economic status 8. Occupation 9. Address 10. Habitat 11. Education
Clinical profile
All the patients registered in this study were subjected to a detailed clinical
history taking, physical examination and mental status examination. Both Ayurvedic
and modern clinical methodology were adopted and applied in clinical examination.
This includes the investigations e.g. hematological, biochemical , and radiological etc.
The clinical profile includes:
1. Chief complaint with duration of illness.
2. Nature, quality and intensity of pain.
3. Location, frequency and type of pain.
4. Associated symptoms, nausea vomiting etc.
5. Triggering factors Alcohol, spicy food , stress etc.
6. Alleviating factors if any.
7. History of past illness of APD or any other disease.
8. Family history of APD or any other disease.
9. Personal history
(a) Diet (b) Appetite (c) Sleep (d) Micturition (e) Addiction
(f) Food habits (g) Menstrual history (h) Bowel habits
10.Treatment history

~3~
Clinical examination
Physical examination
The following were included under physical examination and were recorded at
basal study and at successive follow ups :
-General condition - Blood pressure
- Pulse - Temperature (0F)
- Respiratory rate (Per Min) - Height (cm)
- Weight (kg) - Body surface area
- BMI - Pallor
- Icterus - Clubbing
- Cyanosis - Lymphaedenopathy
- JVP - Any previous surgical scar
Systemic examination:
-Gastro Intestinal System

-Respiratory System

-Cardiovascular System

-Central Nervous System

-Genitourinary System
-Musculoskeletal System
1. Psychometric Evaluation: the psychometric evaluation has been done with the
following psychometric scales
a. Samayojan suchika - R. R. Tripathi
b. Psychosocial stress scale Prof. A.K. Srivastava
c. Presumptive stress full life event scale Gurmeet Singh and Kaur
2. Laboratory Investigation
a. Occult blood for stool
b. CBC , LFT/RFT, RBS
c. Upper GI Endoscopy

~4~
Evaluation of assessment
Grading of symptom
The grading/score are recorded as subjected as subjected by patient in the
following grades
(1) Epigasric pain (Dyspepsia)
0 = No pain
1= Mild pain
2 = Moderate pain
3 = Sever pain
4 = Sever pain with I cannot do any things
(2) Burning sensation in chest and Epigastrium reagion
0 = Absent
1= Mild
2 = Moderate
3 = Sever
4 = Very sever Burning with I cannot do any things
(3) Acid eructation
0 = Absent
1= Mild (some time)
2 = Moderate (mostly after taking food)
3 = Sever
(4) Heaviness in abdomen
0 = Absent
1= Mild
2 = Moderate
3 = Sever
4 = Very sever with distended abdomen and difficulty in breathing
(5) Nausea
0 = Absent
1= Mild (some time)
2 = Moderate (after taking food)
3 = Sever (at both empty or full stomach)

~5~
(6) Vomiting
0 = Absent
1= Mild (some time)
2 = Moderate
3 = Sever (just after taking food)
(7) Anorexia
0 = Absent
1= Mild (some time)
2 = Moderate
3 = Sever
(8) Weight loss
0 = Absent
1= Mild (some time)
2 = Moderate
3 = Sever
Psychometric scales
a. Adjustment scale (Samayojan suchika):
We use adjustment scale (Samayojan suchika) in this study preard by Pro. R.R.
Tripathi published by Raghuveer Saran publication , Varanasi. This scale was used to
determine the quality of adjustment in the human subject. This scale consist of eighty
two question basing 9 items (including positive and negative question ). These question
are answered in Yes or No. In which subject have been asked to go through the
instruction and then to go head with reading each item (question) and then responding
to the same by marking in appropriate box representing Yes or NO .Through this
scale we can conclude the range of adjustment in terms of T- scores. The T- scores
represesenting the normal limits are from 41 to 60. A T- score above 60 is a clear
departure/deviation from the adjustment .The higher the T-Scores the lower the
adjustment.

~6~
b. Psychosocial stress scale : ( Prof. A.K. Srivastava )
The Questionnaires was designed to assess the extent of individuals feeling of
the basis component of psychological stress (such as pressure, tension, anxiety,
conflict, frustration etc .)
Result from perceived stress situation (such as adversities, hardships, threats, affiction,
failures, constraints, excessive demands, conflicting role, etc.) in various spheres of his
social life.
The Questionnaires altogether consisted of 40 items representing following
seven categories of social situation of stress .
In addition to the questionnaires consisting of the routine or chronic situations
of psychological stress , a short measure of the psycho-social stress arising from
crucial life event Takes place in respondents personal/social life in last one year was
also prepared in order to cover the broader area of operation of psychosocial stress and
to make the tool more comprehensive . This inventory of Stressful Life Event
comprises 13 crucial event which generally takes place in social life of the people. The
respondents were instructed to mark out ( ) those event which took place in their life
in last one year or so and also the severity of stress they felt out of these events.
In order to indicate the frequency or amount of stress experienced by the
respondent each item in two measures of psychosocial stress was to be rated by the
respondent on 4- point scale, i.e. not at all, little, mild or sometimes, moderate or many
time, severe or often .
Scoring
The subjects are required to give either of the four responses (rating) to each of
the times of the psychological stress scale. The responses should be scored as given
below.
Numerical value the responses (Rating )
Responses ( Ratings) Scores
1. Not at all 0
2. Alittle/Mild/Some times 1
3. Moderate/Many times 2
4. Severe/often 3

~7~
Working Norms
Total stress score Life event Level of stress
0-20 0-2 Very low
21-40 3-5 Low
41-80 6-10 Moderate
81-100 11-12 High
101-120 13-15 Very High

c. Presumptive stress full life event scale :-(Gurmeet Singh and


Kaur )
Presumptive stress full life event scale invented by Dr. Gurmeet Sing, Ms.
Dalbir Kaur,
and Mrs. Harsharan Kaur.
This scale consisting of 51 life events (attached in appendix). These 51 items
were future classified according to (a) Where they were personal or impersonal (not
dependent on the individuals action), (b) according to whether they were (1) desirable
(2) undesirable (3) ambiguous.
Number of events experienced in life time :
The average number of events experienced in life time by this population was
found to be 10.34 5.40 .
1. Sex:- Male experience an average 0f 10.185.24 stressful life events whereas
female experienced 11.265.28.
2. Age:- Below thirty-five year age group experienced an average 10.53 5.27 &
which above the thirty five year age group experienced an average 10.56
5.29 stressful life event.
3. Marital status :- the average number of stressful event experienced by married
population was 10.80 5.49 in comparison to 9.18 4.48 for single population.
Number of events experienced in past one year :
The average number of stressful life events experienced in past one year was
found to be 1.90 2.62 .

~8~
1. Sex :- There was a tendency for female to report larger number of stressful life
event mean of 2.46 3.27 as compared to male who reported 1.62 2.21
stressful event .
2. Age :- Below thirty-five year age group experienced an average 11.71 2.48 &
which above the thirty five year age group experienced an average 2.05 2.73
stressful life event.
3. Marital status :- the average number of stressful event experienced by married
population was 1.91 2.71in comparison to 1.95 2.2 for single population.
Observed mean stress score
1- Age :- Below thirty-five year age group experienced mean stress 45.35 with
S.D. 17.16 as compared to which above the thirty- five year age group with
mean stress 45.12 and S.D. 21.67 .
2- Education :- It was found that education group six and above on an average
experienced mean stress of 45.49 with S.D. 18.32 & which uneducated group
(below six) on an average experienced mean stress of 44.28 with S.D. 20.98 .
3- Marital status :- Tendency to experienced more stress on specified life event
was observed among single which mean stress 41.56, and S.D. 17.94 than
among married which mean stress 37.4 and S.D. 21.99.

~9~

Vous aimerez peut-être aussi