c







 



.

This is caused by the following:

Y {ating too fast, over eating , or irregular eating.

Y ©ntake of unwholesome, heavy, cold, un -unctuous, or contaminated

food.

Y ©mproper use of purgation, emetic, and oelation therapy.

Y {maciation as a result of disease.

Y iving in improper country, or seasons.

Y 3uppression of natural urges.

The vitiated agni is then abnormally sour and works like poison or can be
the beginning of several diseases (19).

½




 
 a type of grahani
disorder. The seat of agni is in the grahani or small intestine and stomach,
which may not be used exactly the same way as in modern anatomy and
physiology. The signs and symptoms of amla pitta are indigestion, mental
fatigue, nausea, sour and bitter belching, and heartburn. Other pitta
symptoms in the digestive system and elsewhere are yellow tongue
coating, red tongue, loose stools, and anger.

  



 
 



 


Other high vata symptoms in the digestive system are gas or belching,
bloating, constipation, erratic appetite, a brownish and dry tongue
coating, and nervousness or anxiety. There will also be pain with both
conditions.
   
 

 
 but not likely to
suffer from NUD as much as high pitta and high vata so only pitta and vata
out of balance will be considered.

Agni has four different states: normal, irregular, sharp or high, and low. ©n
the normal state a person would eat the right quality and quantity of food
and there would be proper digestion, metabolism, and tissue
development. `



  
 
 . With any of
the abnormal agnis digestion and tissue development is compromised.
3harp agni can cause depletion of tissues if not enough food is eaten.
©rregular agni usually results in an under nourished individual with an
under developed body as in a typical vata typ e person. ow agni is
associated with excessive development of poorer quality tissue as in a
kapha type person.

Grahani (small intestine) is the site of agni and grahani and agni can be
used interchangably because agni restrains (grhnati) the downward
movement of undigested food and retains it until it is fully digested in the
region above the unbilicus (20). ikewise food is also retained in the
stomach until it is fully digested. When agni is weak food is only partly
digested and there is some undigested food in the stools.






  is caused by intake of pungent,
bitter, astringent, cold dry foods, not enough food, over exertion,
suppression of natural urges, and excessive sexual intercourse. Vayu gets
aggravated, suppresses agni, and food is not easily digested.

©n paittika grahani pitta is aggravated by foods that are pungent, heavy

(ajirna), vidahi (cause burning sensation), sour, alkaline, etc. This
aggravated pitta supresses agni. A person has foul smelling and so ur
belching, heartburn, anorexia, thirst, and loose stools (21).
-Y When ama becomes manifest because of the aggravated dosa in the
grahani, and food is not fully digested, then emetic therapy should
be given. After the amasaya (stomach including small intes tine) is
cleased of the ama by purgation and fasting the patient should be
given a light diet and herbs that stimulate digestion (22).

-Y ©f pitta is aggravated then digestive stimulants that are bitter

should be given along with sweet ingredients.
-Y ©f vata is aggravated then digestive stimulants mixed with ghee,
salty, and sour items are helpful. 3amana vayu in particular is
regulated with medicated ghee and promotes the proper
functioning of the gastric fire.
-Y ©f the gastric fire gets suppressed because of urdhva-vata (upward
movement of vata) the patient should be given niruha and
anuvasana medicated enemas (23).
-Y ©n the Ayurvedic view digestion in the stomach cannot be
completely separated from digestion in the small intestine since the
seat of agni lies mainly in the small intestine but also in the lower
part of the stomach. Digestion is a continuum and the stoma ch and
small intestine and the whole G© tract is interdependent.
-Y ©ndigestion or NUD begins with eating habits and improper food
choices, but most digestive disorders begin in the stomach or are
first noticed there (24). The digestive problems may then cont inue
into the rest of the Upset stomach or occasional heartburn may not
be due to excess stomach acid but there are several OTC
medications available to reduce stomach acid and apparently solve
the problem.

What are the options a person has when they have an upset stomach
or NUD (non-ulcer dyspepsia) due to eating?

©s there one problem or many?

3hould the treatment be the same for each person or should it depend
upon the person?
 Are medications ever necessary?

With the heavy promotion of antacids and many other medications for
heartburn and indigestion, many people may not know that there are
other choices for these very common problems.

-

   
 

 , both
mainstream and non-drug approach and then the Ayurvedic view.

NUD is upper abdominal pain without an ulcer, which is twice as common

as an ulcer and may lead to one. ©n half of the cases of NUD or indigestion
no cause is found, but medication is commonly use d to control symptoms.
Allopathic medicine is focused on organic damage and may over look
function of the G© tract.

The gastrointestinal tract is a very integrated system via nervous and

hormonal regulation, and all medications have side effects of disrup tion or
turning off some of the G© function. There is poor understanding of NUD
and consequently no specific care from standard medical treatment. NUD
can resemble G{ D, ulcers, gastritis, or hiatal hernia but if there is no
cause or damage found it is called NUD or functional dyspepsia, or just
plain indigestion with no apparent treatment. The symptoms are similar
for each condition: dull ache, uncomfortable fullness, or static stomach,
distention, overt pain or burning or both with or without nausea. {xce ss
stomach acid is not thought to be the problem, more likely inadequate
protection of the stomach from the acid. The symptoms may also be due
to slower gastric motility or to increased gut sensitivity.

Psychological issues also affect NUD. 3tressful events produce responses

in the gut, but people with NUD do not seem to have more stress in their
lives than those without NUD. Do those with NUD react more strongly to
stress leading to symptoms? elaxation techniques have been shown to
reduce gastric acid secretions in hyperchlorhydric patients. Balancing
digestive function by reducing stress maybe partially attributed to a global
nervous system shift from a sympathetic to a parasympathetic tone (1).

Diet involvement in NUD is important but not well defined. C ertain foods
and other substances are known to increase symptoms; spicy, acidic, and
high fat foods, alcohol, tobacco, coffee, analgesics and other medications.
These are reduced or eliminated to help with symptoms.

©n a functional approach to health and n utrition diet and eating habits play
a more important role than the standard allopathic model. The following
is a functional view of digestion.

Digestion begins with the cephalic phase in which any sensory stimulus or
even thoughts can provoke a digestive related response in the body.
These include thermodynamic, salivary, cardiac, mesenteric blood flow,
diuretic, digestive enzyme secretion, altered gastric acid secretion, altered
intestinal motility, release of G© hormones and other intestinal process
changes (2). ©mpulses travel via the vagus nerve to the stomach where
acetylcholine stimulates mucus, acid, and pepsinogen secretion in the
body and gastrin release in the antrum. The response is greater to foods
that the person likes and is less in bland food s, an important fact with an
anorectic client (3). To fully support digestion eating in a calm manner and
chewing properly are necessary. For some this may be more helpful than
relying on digestive enzymes, glandulars, bitters, or other digestive aids.

©n the mouth or lingual phase adequate salivary output is necessary for

proper digestion. Besides enzymes like alpha amylase the saliva also
contains other important substances such as mucopolysacirides, ion
containing fluids, and transcobalamin ©©© necessary for vitamin B12
absorption. The digestion of fats is initiated in the month by lingual lipase
from glands at the base of the tongue. ingual lipase hydrolysis short chain
and medium chain triglycerides more readily than it does long chain
triglycerides. This is also true of gastric lipase. Both lipases are resistant to
the proteolytic enzymes and the acid environment of the stomach,so that
the digestion of the short and medium chain triglycerides continues in the
stomach, but the main digestion of fats is done in the small intestine.
Dehydration can reduce salivary output as can old age and thus reduce the
digestive response.

Digestion in the stomach results from proper coordination of hydrochloric

acid and pepsin along with other substances. Gastrin and in trinsic factor
are the other two compounds that are exclusively produces in the
stomach. ©n the gastric phase stimulation of secretions is by direct contact
with food, a rise in ph, and by distention or mechanoreceptors. Besides
the main job of digesting protein foods, appropriate amount of
hydrochloric acid is necessary for:

The absorption of minerals.

Acid-base balance.
To kill microorganisms.
Converts pepsinogen to pepsin (at ~ ph of 2).
©nhibits the secretion of gastrin.
And stimulates the secretion of secretin.

Gastrin stimulates the secretion of acid and pepsinogen, increases gastric

blood flow, circular muscle contractions in the stomach, and growth of the
mucosa of the stomach and small intestine. Thus there are not only many
coordinated responses to food for adequate secretions and proper
digestion, but also feedback systems to down regulate the secretions
when they are no longer needed. Mixing of the stomach contents is from
the middle of the stomach toward the duodenum. This mixing, with
downward pressure from the upper part of the stomach, help to empty
the contents. The time required to empty the stomach depends on several
factors. 3olids, lipids, and solutions of high osmotic pressure empty more
slowly than solutions that are isotonic. 3olids empty more slowly than
liquids. There are receptors in the duodenum that respond to lipid
content, acidity, and osmotic pressure of the chyme. 3ome of the factors
involved in the emptying are gastrointestinal hormones and neurological
reflexes. The enterogastric reflex inhibits peristalsis in the antrum, which
is next to the duodenum, because of high or low osmotic pressure, or
when acidity is high in the duodenum. Particle size, viscosity of the chyme,
and volume of the gastric contents also affects emptying time (4).
{motional stress affects motility through the autonomic nervous system.

Hypochlorhydria ʹ inadequate secretion of gastric acid by the parietal cells

in the stomach wall is a component of poor digestion. A diet of excess
protein increases acid production and high fat diet encourages over
secretion of acid. Medications to reduce acid, H2 histamine receptor
blockers and proton pump inhibitors are now available OTC so that diet
induced hyper acidity becomes medication induced hypoacidity in many
U.3. adults with causes of indigestion not explored. esearch suggests that
low gastric acidity may influence the development of diseases such as:

Y heumatoid arthritis

Y Acne rosacea

Y Celiac disease

Y Diabetes mellitus

Y {czema

Y Hepatitis

Y Asthma and others (5).

The ability to produce acid decreases with age and over half the
population over 60 has insufficient secretory ability. Common sign and
symptoms of low gastric acidity are:

Y Bloating, belching, burning, and flatulence immediately after meals

Y A sense of fullness after meals

Y ©ndigestion, diarrhea, or constipation

Y Mild food allergies

Y Undigested food in the stool

Y Post adolescent acne

Y Nausea after taking supplements

Y And other sysmptoms

Y Chronic reduction of gastric acid secretion invites bacterial over

growth in the stomach

(Heliobacter pylori) and the small intestine which compromises nutrient

digestion and absorption especially B vitamins , iron, and calcium. H. pylori
does not appear to cause ulcers but let untreated may lead to atrophic
gastritis (6). © f gastritis progresses to an ulcer then H. pylori has to be
addressed usually with acid controlling medication and antibiotics.

©n the treatment of NUD it is recognized in allopathic medicine that there

is no reason for medication but it is often given because of its placebo
effect and the drugs are considered safe. Though excess acid may not be
the problem in the short term some people feel better with medication to
reduce acid or to increase the rate of stomach emptying (7). Treatment
also requires dietary and lifestyle changes to reduce symptoms. First a
look at the medications then the diet and other changes.

Drugs that were developed for ulcer treatment are now being used for any
problem that manifests itself as acid indigestion even if there is no known
ulcer. The following are the drugs commonly used:

Y c
are used to neutralize acid: Those with aluminum can

cause constipation, those with magnesium can cause diarrhea,
prelief (calcium glycerophosphate) is taken at meals to reduce
stomach acid. HŒ
 



 
to reduce acid
secretion from the parietal cells, via histamine release stimulated by
the vagus nerve. This includes Tagamet, Pepsid, Axid, and Zantac.

Y The 
  
Previcid, Prilosec, Nexium, Aciphex, and

Protonix that are so heavily advertised today, and are in use more
now than the H2 histamine receptor blockers.

Y Î



that speed up gastric emptying and increase lower
esophageal sphincter ({3) pressure. eglan, and Propulsid.

Y And 





Cytotec, Arthrotec, and Carafate (8).

©n the case of an infection or apparent infection of H. pylori the common

medication of Pepto-Bismol has been shown to be affective with a usual
four times a day dosage over two weeks with less side effects than the
typical drug and antibiotic therapy (9). The possible side effects of these
medications are numerous, as listed below (10).
that turn off stomach acid secretions, like Prilosec and Prevacid: Diarrhea,
abdominal pain, nausea, vomiting, heartburn, liver necrosis, p ancreatitis,
Headaches, back pain, anemia, infections, and others.

u



 
like Propulsid and eglan: Ventricular tachycardia,
and fibrillation, headache, diarrhea, abdominal pain, nausea, constipation,
joint aches.

 
  
like Cytotec that increase bicarbonate and mucus
production: Nausea, vomiting, gas, heartburn, diarrhea, constipation,
abdominal pain, abortion, Menstrual irregularities, headaches, depression,
impotence, chest pain, arrythmia, High blood pressure, blood clot s, G©
bleed, liver malfunction and others.


 

 for protection from acid like Carafate:

Diarrhea, nausea, vomiting, dry mouth, turns off pepsin , and contains
Aluminum, which has possible links to Alzheimer's disease and bone loss.

 
ʹ Tagamet, Zantec, Pepcid, Axid, Mylanta ʹ which turn down
acid production: ©mpair liver detoxification processes thus increase the
side effects of other drugs and environmental chemicals that use the same
detoxification pathways. Arrthymias, Hypertension, headaches, liver
malfunction, hair loss, anemia, arthritis, blockage of Nerve conduction in
the heart, and others.

The above medications are intended to reduce the symptoms of NUD and
reduce any pain associated with it, but end up causing more G© problems
and further cover up the causes of the indigestion.

There are several supplements and medications, listed below, that can
worsen the symptoms of G{ D and may also negatively effect NUD (11).

Y arge doses of vitamin C

Y Potassium supplements

Y White willow bark

Y Calcium channel blockers for high blood pressure

Y Certain antibiotics
 Y ed yeast rice

Y Fosamax

Y N3A©D3 (Motrin, Aleve, Nuprin, Orudis)

Y Theophylline

Y Glucosamine

Y Fish oil capsules

Y Aspirin, which can also affect the stomach lining directly.

The health and proper function of the stomach is dependant on the

balance of the defensive factors (mucin secretion, cellular mucus,
bicarbonate secretion, mucosal blood flow, and cell turnover), and the
aggressive factors (hydrochloric acid, pepsin, H. pylori, bile salts) (12). The
role of the defensive factors is gaining importance over simply reducing
the aggressive factors. With more evidence of adverse effects of the
various drugs more research is being done with herbs to find new
compounds to aid in ulcer treatment without the side effects, which may
also prove beneficial in treating NUD. ©n a review of anti -ulcer drugs of
Ayurveda i, authors .K. Goel and K. 3airam listed the commonly used
herbs of Ayurveda and the studies with vario us herbal extracts and their
use in ulcer treatment. The extracts used were fresh juice, water
decoction, ethanolic ,methanolic , hot water, acetone, chloroform, and
petroleum ether extracts. For the following herbs they were extracted
from one of the first five methods: ashwaganda, shatavari, licorice root,
brahmi (Bacopa monniera), gotu kola (Centella asiatica), and amla.
Aswaganda showed anti-stress activity which wasn't specified. The other
herbs had no effect on the acid-pepsin secretion but an increase in the
defensive factors of mucin secretion and the life span of the mucosal cells.
3hilajit had a per se effect of both reducing acid -pepsin secretion and
increase in mucin secretion (13). 3everal anti-ulcer compounds have been
isolated from ginger and studies have shown that ginger increases
gastrointestinal propulsion (14). ©n the conclusion of the review the
emphasis was on standardized active constituents of the herbs and not
use of the whole herb.
©n a non-medication approach to better digestion the re are several herbs,
juices, and other compounds used to heal the stomach, or aid in digestion.
Common ones are DG ʹ deglycyrrhizinated licorice, sulfate mucin, aloe
juice, ginger tea, chamomile tea, fresh vegetable juices (cabbage, carrot,
cucumber, beet), digestive enzymes, baking soda, and even Pepto -Bismol.
DG is licorice with the compound that is responsible for hypertension
removed. ©t is known to normalize {3 (lower esophageal ) pressure,
increase the protective factors of the stomach, increase immunity by
increase in secretin, and is antinflamatory and antioxidant (15). Of the
vegetables juices cabbage is recommended more than any other to help
heal the stomach lining. There are also various combinations of digestive
enzymes and gladulars for those with poor digestion. Chinese and
Ayurvedic herbal formulas for digestion are available through supplement
suppliers with only general guidelines on their use.

©n the Western view whether mainstream allopathic or a natural approach

certain dietary and lifestyle changes have to be made if a person with NUD
is to have an improvement in symptoms and better digestion. ©t is well
recognized that digestion is improved if a person eats in a calm and
relaxing environment. 3ome health care practitioners emphasize this
much more than others. This and proper chewing is the beginning of
proper digestion. Appropriate sized meals are important since large meals
take longer to digest, distend the stomach and increase acid production,
and expose the stomach longer to the aggressive factors of digestion.
There is the need to eliminate or reduce offending foods such as orange
juice, tomato products, other acid foods or ingredients, radishes, spicy
foods, fatty foods, excessive protein, dry beans, or any other foods an
individual may have symptoms with. 3ubstances to avoid if causing
problems are alcohol, tobacco, coffee, caffeineated tea, colas, ©buprofen
and other N3A©D3, aspirin, or any other medication that causes symptoms
of NUD. 3ome healer also emphasize proper food com bining or simplifying
meals for easier digestion. Others are adamant about cutting out all
processed foods from the diet and eliminating any foods with additives or
preservatives. There is also the possibility of a food allergy in which case
the offending foods will have to be identified and eliminated. This could
be a lengthy and difficult process and would not usually be done unless all
other changes proved unfruitful.

Food combining deserves further expounding since it is commonly

referred to for digestive ailments in natural health and nutrition literature.
The principal is fairly simple, don't eat foods together that don't digest
well together. This won't overtax the digestive enzymes and compromise
digestion. Food combining can be somewhat to very rest rictive even
though there is little scientific evidence that certain foods inhibit the
secretion of digestive enzymes. This is not to say there has not been
success to varying degrees with food combining. The most common rule is
not to eat fruit, or sweets, with meals. Fruits digest sooner than other
foods and they can be fermented by microorganisms before the heavier
foods are digested. The resulting gas can distend the gut and cause
bloating and indigestion. The gas is also toxic to the nerves and tissues ,
causing an inflammatory reaction that impairs normal peristaltic action
(16). Also milk dose not combine well with any foods and is best eaten
alone. A person would make their meals as simple as necessary to have
good digestion, starting with mono meals if necessary. Other foods can be
added one at a time as all previous foods are well tolerated. A person then
builds a history of what they can and cannot eat and what foods they
tolerate together.

©n the Caraka-3amhita chapter ʹ xv treatment of grahani dosa the

digestion function, dysfunction, and treatment are discussed. This is the
classical Ayurvedic approach which will be summarized, then the modern
interpretation will follow. That which has an influence on the stomach and
thus important in the care of NUD will be noted. All digestion is dependant
upon proper functioning of the digestive fire or agni. Jatharagni (enzymes
in the G© tract), bhutagnis (the elemental agnis ʹ enzymes to transform
heterogenous elements into homologous ones) dhatuagnis (enzymes for
the synthesis of the seven categories of tissues) make up the 13 agnis of
which jatharagni is the most important for the other depend upon its
proper functioning, and is considered to be the most important sustaining
factor of living beings (17). 3ince it resides in the G© tract it will be referred
to as agni in this report.
©ngested food needs to be both delicious and wholesome to nourish the
senses, the sense organs, and the rest of the body. Once ingested the food
is mixed with dravas (liquids) of saliva and other fluids of the G© tract that
contain the enzymes or agni . 3amana vayu in its normal state will
stimulate agni appropriately. Too little samana vayu and agni is low and
digestion is inadequate. Too much and agni is too hot and digestion too
fast which may deplete the kapha in the stomach making it more
suseptable to symptoms of NUD or eventually to an ulcer. During the first
stage of digestion in the mouth and stomach, or the kapha stage, the
sweet taste is digested. Once the semidigested (vidagdha) food mass
leaves the stomach it is sour. This sour stuff stimulates the production of
pitta i(bile), and since pitta is sour it gets stimulated by sour food matter
(18). Thus the appropriate amount of pitta or acid needs to be produced in
the stomach for proper digestion or agni there before leaving the stomach
and continuing to stimulate normal pitta and agni for optimal digestion.

u  From indigestion comes ama which d isrupts not only the

digestive system but also the immune system and results in low energy.
The two sub doshas of most concern are pachaka pitta and samana vayu.
When pachaka pitta is high there is excess gastric acid and the typical
symptoms of heartburn, sour belching, and other pitta symptoms in the G©
tract and mind. With high samana vayu there is nervous stomach and
variable appetite, digestion, and peristalsis (25). There could also be other
vata symptoms in the rest of the G© tract and mind. 3o hyper acidity could
also occur with vata and a weak digestion where the food stays too long in
the stomach which is then exposed to acid after the food can no longer
buffer the acid. Apana vayu could also be involved. ©f it is not properly
flowing downward, with possible gas and constipation, then this could
slow or alter digestion further up in the G© tract and indirectly affect
stomach functioning and emptying. Or apana vayu could rise upward due
to nervous system vata stress and negatively effect digestion (26 ). ow
kapha may accompany high vata and there is not adequate protection for
the stomach lining from the acid even if the acid is not in excess. The
eating habits that lead to excess pitta and hyperacidity are eating too
much, or eating foods that are too sour, spicy, or fatty, too many sweets
which can also be fatty, too much alcohol, tea, or coffee, poor food
combining, and too much salty foods. {ating habits that would throw vata
out of balance and lead to NUD would be eating irregular meals, eating
too much, eating cold, dry, or raw foods, eating too much variety at a
meal, or eating foods that are hard to digest. Other eating habits that
could cause NUD with anyone are eating when not hungry, eating poorly
prepared or cooked foods, eating too much processed foods instead of
freshly prepared foods, and eating leftovers.

©n the Ayurvedic view food, eating habits, and herbs make up the
treatment for NUD. For a vata person with NUD meals may have to be
smaller and more frequent, regular, and generally cooke d foods. A pitta
person can eat three regular meals a day, more raw food, and more
variety in a meal than a vata person. A vata person needs rich and
moderately spicy food , while a pitta person needs less richness and spice.
{ach person should also take those foods that digest easily for their
constitutioni, or pacifying for the high dosha. 3kipping a meal until the
appetite comes back may be needed.

To avoid digestive difficulties the first step would be to follow

Upayogasamatha - the general guidelines for healthy eating according
Ayurveda (27). To begin eat in a proper place or setting. The main point is
that it is calm and peaceful. The mind should also be peaceful when
eating, prepared by saying grace. This is done with awareness of the
sacredness of the experience and acknowledges the spirit of the food. The
food should be prepared in a loving way or in a sattvic state of mind. The
food is then eaten with no distractions and a calm mind including
confidence that what a person is eating is perfectly fine so there is no
anxiety about eating. Time is taken to chew the food properly or to an
even consistency and to fully taste and enjoy the meal. The f ood should be
warm, and moist with some richness, which stimulates digestion, is more
easily digested, and is more nourishing than dry food. ©t could also be said
that food should be freshly prepared and cooked since it would also be
warm and moist and best for digestion. Foods of opposite potencies
should not be eaten in equal amounts so that they cancel each other out
and end up with a neutral potency that does not promote digestion. A
small amount of cool spices may be included in a dal for instance but the
overall spice mix would be warm for a vata digestion. Only enough liquids
to aid in eating should be taken with a meal. The more liquid the meal the
less other liquid is needed, and it should not be cold. A person is best
eating until about 75% full, t o room for the stomach to mix and digest the
food. One should feel satisfied but not full. {ating in a calm manner,
chewing appropriately, taking the time to eat, and being aware of eating
without distractions will give one the opportunity to sense when th ey are
satisfied but not full. ©t is best to rest and not do any intense mental or
physical activities after eating for up to an hour if possible. ©f work or other
strenuous activities cannot be avoided then a smaller or lighter meal
might be in order. Once the meal is finished one should not eat again until
they are hungry, or the previous meal is fully digested. This is usually three
hours or more. ©f it is sooner the person may want to or need to eat larger
meals. ©f too long a time has past the person m ay have eaten too large a
meal or need to strengthen their agni. {ating before the previous meal is
fully digested will mix ahara rasa with the new food and vitiate all three
doshas (28). This will disrupt proper digestion.

Following the Upayogasamaatha will for most people alleviate their NUD
or indigestion. ©f that is not sufficient then each person needs to follow a
diet plan for their dosha as outlined above and specifically avoid foods
that aggravate them.

A general diet plan for vata and pitta follow s (29). A diet for vata types
would include fruits except dry fruits, unless well soaked, apples, pears,
and melons.

A large variety of vegetables can be tolerated if properly cooked and

spiced if needed or with ghee. The cruciferous vegetables may not be
tolerated but some may depending on the individual.

Other common vegetables that may cause some indigestion are

artichokes, asparagus, cucumber, green beans, potatoes, spinach,
tomatoes, turnips, and zucchini. ©t is more important to avoid too much
raw vegetables and eat cooked vegetables, and avoid mushrooms and
lettuce. For grains stick to wheat, rice, and oats. For beans only mung
usually. All nuts, seeds, and oils are acceptable, as is dairy except ice
cream because it is too cold.

Condiments are fine and can help to pique the appetite.

3weeteners should be used in moderation and best not to use refined

sugar.

Animal foods are nourishing and grounding for vata but consideration
should be given to the karmic consequences of eating when there is no
necessity to do so.

-

   avoid sour, pungent, and salty foods when there
is any imbalance or tendency to get out of balance. For fruits eat sweet
and astringent ones like apples, dates, figs, mango, grapes, melons, pears,
persimmons, and plums. Certain fruits may cause problems ʹ citrus,
strawberries, cherries, bananas, and any sour tasting or under ripe fruit.
Vegetables to avoid are hot peppers, onion, garlic, radishes, etc. Others
that may be a problem are beets, carrots, spinach, cha rd, tomatoes, and
parsley. For grains basmati rice, oats, wheat, and corn are recommended.
Most dry beans can be digested well except lentils. Nuts are limited for
use, best are coconut and sunflower seeds. For oils coconut, sunflower,
ghee, olive, and corn. For dairy, sour products ʹ yogurt, buttermilk, aged
cheeses - limit or avoid. For sweeteners all are ok except honey and
molasses. No condiments are good because of the salt and or vinegar. For
animal foods egg whites and white chicken meat are good (30 ). This is a
general list to help someone dominated by a vata or pitta constitution but
is not all inclusive. {ach person must also be aware when they eat if a
particular food or combination of foods aggravates their digestion if they
are to learn to improve their digestion and health. ©f a person is a duel
dosha, vata ʹ pitta, then they would have to take in foods acceptable to
both doshas and avoid or limit those foods that aggravate both doshas or
strongly do so to either dosha. Or if one dosha is predominately out of
balance then that one would take precedence over the other dosha and
the secondary dosha may not need to be addressed at that time.
©f a person still has NUD after following the above guidelines then
digestion may be weak and proper food com bining would be appropriate.
The summary of proper food combining follows: (31)

Bitter green salads should be eaten at the end of the meal not the
beginning since bitter taste reduces agni.

Astringent foods or tea should be taken at the end of the meal or between
meals because astringent taste reduces the secretion of digestion
enzymes.

3weets are best eaten at the beginning of the meal because they are
preferentially digested and will interfere with digestion if eaten later in
the meal by stopping digestion at that point to digest the sweets. 3weets
can also be eaten separately between meals.

When digestion is very challenged eat only one carbohydrate and only one
protein at a meal, in general simplify the meal as much as needed to
improve digestion.

Avoid any difficult to digest foods such as cruciferous vegetables, raw

onions, fried foods especially breaded and fried foods, heavy sweets that
have high fat content, and dried beans.

For NUD there is also herbal treatment for the dosha out of balance. For a
high pachaka pitta cool and demulcent herbs are used. The bitter and
sweet taste predominate with a cooling effect to reduce acid and also cool
the liver, small intestine, and pancreas. Typical herbs are aloe gel, amalaki,
barberry, cilantro, coriander, gentian, licorice, marshmallow, shatavari,
and Avipattikar churna. Other spices that can be used unless pitta is very
high are cumin, fennel, mint, and turmeric. Avipattikar churna is taken
after meals to reduce acidity. Bitters can also be taken before meals to
counter high pitta (32). Avipattikar churna : trikatu, triphala, cyperus,
vidanga, cardamom, cinnamon leaf, cloves, trivit, raw sugar. Take 1 -4
grams 2-3 times a day after meals with warm water.

-


 in the stomach and digestive system
the types of herbs given are carminatives to calm the system and help
balance digestion. 
 
 

 !!


!  !
!
 . 3pices are best taken with food or
something sweet or demulcent to counter the dryness of the spices. Vata
in the stomach is also likely to dry out the stomach lining and a demulcent
would be beneficial. 3ince the site of accumulation for vata is in the colon,
herbs for the colon may also need to be given to help reduce vat a in the
stomach. ©n that case the formula Asafoetida 8 is appropriate, to counter
gas, bloating, and constipation. Triphala would also be used for
constipation since it is the chief laxative in Ayurveda (33).

Another approach is to treat NUD by increasing the agni or by alleviating

the indigestion. The following are modern Ayurvedic remedies (34). To
rekindle agni use:

Before a meal - Fresh ginger with a little lime juice and a pinch of salt, or
ginger tea.

Y Garlic pwd. ¼ tsp., ½ tsp. trikatu, and a pinch o f rock salt.

Y One clove fresh garlic chopped with ¼ tsp. cumin pwd. a pinch of
rock salt, a pinch of trikatu, and a tsp. of lime juice.

Y Ayurvedic herbal wine, Draksha. Use 2 to 4 tbs with equal amount

of water.

Y A tea of ginger, brahmi, and chamomile (equ al parts) for emotional

causes

After a meal a tea of bay leaves with a pinch of cardamom may help to
improve agni.

-



   
 

"

Y Fresh pineapple juice with pinch of ginger and black pepper, and ½
tsp. sugar.

Y Onion juice, fresh ¼ cup, with ½ tsp. honey, and ½ tsp. black pepper.

Y Fresh garlic one clove chopped with a pinch of salt and a pinch of
baking soda.
 Y Juice of ¼ of a lime in one cup of water, add ½ tsp. baking soda and
drink right away.

Y This drink is for acute indigestion.

Y For chronic indigestion : trikatu 1 part, chitrak 2 parts, kutki 1 part.

Take ¼ tsp. before meals, with a little honey and fresh ginger juice.

Y Cumin pwd. 1/3 tsp., a pinch of asafetida, and a pinch of rock salt.
Take with warm water.

Y Chew Ajwan seed ½ tsp. with ¼ tsp. baking soda and take with
warm water.

Y Chew a mixture of roasted fennel, cumin, and coriander seeds ½

tsp.

Y Or a tea of the above three seeds, equal amounts of each ½ tsp. per
cup of water.

Y Or a tea of angelica, chamomile, and comfrey equal amounts, ½ tsp.

per cup.

The approach to nutrition is similar in the natural western and the

Ayurvedic viewpoints, and there

are some differences. Both emphasis eating wholesome unprocessed

foods, organic when possible, healthy eating habits, and appropriate
amounts of food for normal healthy digestion. But Ayurveda has
Upayogasamaatha, the guidelines for healthy eating that acknowledges all
levels of our being that need nourishment and can be practiced by anyone
regardless of their spiritual outlook.

©n the care of NUD a western medicine approach, a natural health or

nutritional approach, and an Ayurveda approach to healing have much in
common but there are also some differences. The typical allopathic
practitioner, usually an M.D., has extensive knowledge of human anatomy
and physiology. They are trained to diagnose illness or diseases and when
there is no manifest disease then there is often no protocol to follow in
the care of the patient. 3igns and symptoms maybe ignored assuming th ey
will naturally abate, while not looking further for the causes. The patient
maybe pacified with medication and the M.D. may feel it can do no harm.
This is a narrow version of allopathic health care but it is typical of acute
care medicine with the admi nistration of only standardized
pharmacological medications for any ailment the standard. At the other
end of the spectrum M.D. and natural care practitioners are practicing
medicine without medicine, using only supplements, herbals, extracts,
enzymes, and an increasing number of what are considered natural
products with little or no side effects. More time and care is taken with
the patient to discover the underlying cause of the problem the patient
presents with and not just focusing on symptoms. ©n acute care medicine
bodily systems are separated while in a holistic view the body is
integrated, and the approach to health is preventative or even to optimize
health. Ayurveda's goal is to keep the body and mind healthy and to guide
one on their path in life. ©t can touch every aspect of a person's life, and is
intended to as a person is ready to let Ayurveda into their body, mind, and
inner life. Comparing just the physical health aspect of each approach
Ayurveda is similar to the holistic form of health care that treats each
individual as an individual, with natural healing methods in assessment,
diagnosis, nutrition, herbs and supplements, and other therapies.
Ayurveda differs in that it is a fully integrated system consistent
throughout the care of the client. The principals and therapies are in
harmony with each other and support each other in the healing of the
patient. ©n holistic care of NUD a less specific approach is used. Though a
person is treated as an individual some may be given similar care of NU D
though their constitutions are different. Though there is the attempt to
treat the whole person and as an individual there is still a temptation to
treat the symptoms or the disorder and not the imbalance that caused the
symptoms. Holistic care has the benefits of extensive knowledge of the
human body from medical school and research, a vast array of newer
diagnostic tests that are useful in discovering underlying causes of G©
symptoms, and a large choice of supplements, herbs, probiotics, natural
foods, etc. for their clients. The holistic or natural or functional medicine
care still has some of the analytical approach that is the hallmark of
modern science and western medicine. Though the amount of knowledge
and wisdom is enormous the modern systems are not completely
integrated; in philosophy, principals, and practice as Ayurveda is. ©t might
be seen as the difference of nature and science. Our bodies and minds are
a part of nature and Ayurveda is natures medicine. 3cience is descriptive
of nature and can be very knowledgeable of nature but is still separated
from nature. Using science to help us heal can be very beneficial but it is
still putting science first and not allowing direct communication from
nature to teach and to heal directly.