Peptic Ulcer

By John Douillard, DC, PhD

Peptic ulcer in Ayurveda is considered a type of acid gastritis or Amla pitta. This disorder is more generally classified as a grahani disorder which is a disorder in the seat of agni is the stomach. Caraka Samhita describes some of the common causes for such a deranged agni (or digestive fire). Fasting, eating when one has indigestion, over-eating, irregular eating habits, eating unsuitable foods, eating in a negative atmosphere, or at the wrong time, or eating foods that have been ill-prepared; all these will produce acid indigestion even with the lightest of fare.

The actual ulceration of the stomach wall which is the classic description of a peptic ulcer is clearly due to an excessive amount of heat or pitta in the body. The question to ask before treating the increased pitta is, why is the pitta excessive? In the West we often relate gastric ulcers with stress and anxiety. This factor is not overlooked in Ayurveda and is properly handled with the eating and lifestyle changes mentioned above. With regard to the treatment of peptic ulcer, it is not necessary to take Ayurvedic medicines if these lifestyle eating changes are not made. No medicine will work unless the cause is appropriately addressed. There are typically three factors that are essential for good and balanced digestion.

What you eat:

Food must be fresh and grown locally, or at least seasonally, and prepared with a caring and loving attitude.

How you eat:

Food must be eaten with attention and awarenness. Our sense of taste both prepares and ignites digestive process before food ever reaches the stomach, as does our sense of composure and calm. Being distracted with books, driving, computers, and phones during a meal negates any hope of a balanced digestive process.

When you eat:

Eat is best done during pitta kala, between 10 AM and 2 PM; this is when the agnis are the strongest and digestion will be the most effective. Eating at other times will eventually compromise the body’s ability to digest and assimilate nutrition and give energy over a long period of time. This is, in part, the cause for the increased incidence of hypoglycemia and the need for a grazing approach to eating which has become vogue here in the west. In the west we are too busy to stop and take the time to eat. This one aspect of modern life has a devastating effect on the health, longevity, and quality of one’s life.

Peptic ulcer may also be an expression of excessive digestive pitta due to an aggravated vata. A form of wind, this aggravated vata can blow on the digestive fire (agni) like a bellows, creating excessive heat. This heat will dry out the kaphic mucous lining of the stomach, leading to irritation and eventually to ulceration. There are two common causes of this type of vata aggravation:

1. Samana vata, which normally fans the digestive fire, much like a carburetor provides air to the spark plugs of a car engine, is the vata aspect of digestion, and relates the state of mind one is in when one is eating. Remember that vata controls the nervous system, so the quality of the nervous system is directly related to the proper functioning of the samana vata. If one is stressed and hurried during a meal, or skips a meal, or eats fast, non-digestible food, then these stressors will affect the quality of digestion.

2. Apana vata in the intestinal tract is often siphoned upwards through the enteric cycle into the liver and digestive organs. This reversed flow of the apana vata can excessively fan the pachaka pitta in the stomach and irritate the stomach lining. Apana vata can then be pulled upwards from an already aggravated pitta which will need more air to burn the fire. Or, apana vata may rise as a result of nervous system vata stress, wherein the nervous system is under such extreme stress that apana vata is drawn upwards for nervous system support. Along the way the apana would fan the pachaka pitta and leave the seat of vata in the intestines depleted.Pitta can also be at the root of such a disorder. this is typically seen in a pitta constitution with a pitta imbalance. Classically, pitta types are the ones who eat fast without awareness and have a very hectic lifestyle. Their competitive nature can drive them excessively and aggravate the pitta in both the stomach (pachaka) and the liver and small intestine (ranjaka). This pitta imbalance will irritate and eventually ulcerate the wall of the stomach.

Diagnosis

The diagnosis of this condition is made by a combination of signs and symptoms. The classic symptoms are burning (during, after, and in-between meals), gastric reflux, fatigue, increased stress, loose stools, constipation. In vata-conditions, symptoms are associated with a dry throat and mouth, blurred vision, tinnitus, cardiac pain, excessive hunger, and an abnormal taste in the mouth. A pitta-type will have stools that are more liquid and yellow and will probably complain of a chronic burning in the cardiac region and throat. The pulse will reveal excessive pitta along with a deep causative vata aggravation if vata is involved.

The tongue will usually have a crack in the midline of the anterior 2⁄3rds of the tongue. This indicates an imbalance in the Annavaha srota. The annavaha srota regulates digestion and is responsible for gastritis, heartburn, and peptic ulcer when out of balance. Nails are usually thin, soft, and bending.

Treatment

Behavioral modification: See above.

Dietary Guidelines

When condition is acute, patient should be given a diet of liquefied cooked vegetables and kitchery (a soupy mixture of rice and dahl).Barley water can be taken throughout the day (boil one cup of barley with three cups of water and down to two cups of water. Drink as tea three times per day).
Avoid onions, garlic and pungent, salt, and sour foods.
Increase consumption of bitter foods (cooked leafy green vegetables and sweet fruits are mostly good) (See light pitta pacifying diet)

Herbs

Mostly bitter herbs are good.

Mahasurdarshan churna (combine triphala (Emblica offcinialis, Terminalia belerica, Terminalia chebula); gudduci (Tinospora cordifolia); katuka (Picrorrhiza kurroa); patrpat; nimb (lime), suddha surastraja, bamshalochan; kairat): take 1⁄2 teaspoon 3 times a day after meals (if apana vata involved)

Avipittkar churna (ginger (Zingiber officinalis), black pepper (Piper longum), trifala (Emblica officinalis, Terminalia belerica, Terminalia chebula), nut grass (Cyperus rotundus), vidanga (Embelia ribes), cardamom (Elettaria cardamomum), clove (Syzygium aromaticum), cinnamon (Cinnamomum cassia), sugar): this is the medicine of choice in treating peptic ulcer. Take one teaspoon before meals 3 times a day with lemon juice.

Aloe vera (Aloe littoralis): 1 tablespoon fresh gel from plant, 3 times a day.

Coriander (Coriandrum sativum) and cumin (Cuminum cyminum) tea.

Psyllium (Plantago ovata); snigdhajira: 1 teaspoon husk, 1 hour after meals with 8 ounces warm water.

Milk decoction: 1 teaspoon amalaki (Emblica officinalis) with 1 teaspoon raw sugar, 1 cup of milk, and 1 cup water. Boil to 1 cup. Drink as tea with meals or anytime, 3 times a day.

Fenugreek (Trigonella foenum-graecum); madhu: 1⁄2 teaspoon powder with 1⁄2 teaspoon turmeric on an empty stomach, with warm water or warm milk.

Licorice (Glycyrrhiza glabra) ghee: make licorice decoction with 1 teaspoon licorice in 2 cups of water. Boil to 1 cup. Add 1 cup ghee and 1 cup water; boil off water. Take 1⁄2 teaspoon 3 times a day on an empty stomach with hot water. Can be used in cooking.

Light Pitta Pacifying Diet

This diet is indicated when there is low agni (weak digestive power) combined with a Pitta constitutional type or a Pitta imbalance.Food should be fresh, well-cooked, tasty, and satisfying. It is important to eat only when hungry and to take meals according to a regular schedule. Eat in a settled environment, without distractions. Do not overeat.
Grains
Wheat, rice, and barley, prepared as follows:
Wheat: Finely ground whole wheat flour, in foods such as crackers, biscuits with low fat and low sugar, toasted light bread, unleavened flat breads (chapati, pita bread, tortillas), couscous, semolina, cream of wheat.
Rice: Basmati rice (or other white rice), rice flour, puffed rice, cream of rice. You can fry the rice in a pan without oil, then steam or boil it into a soup.
Barley: Light preparations such as in soup, crackers, unleavened bread, etc.
Legumes
Adding a pinch of hing (Ferula asafoetida) to lentils increases their digestibility. Green or yellow mung beans or red lentils (dal), which are available in health food stores, Indian shops or by mail order. To prepare, boil one part legumes in 2 to 3 parts water. You can also boil it with rice and a lot of water to make a thin soup.
Vegetables
Vegetables should be well-cooked and prepared in soups, stews, and casseroles with a lot of water. Asparagus, artichokes, white pumpkin, zucchini, cucumber, spinach, cabbage, eggplant (peeled), celery (not the root), spinach, chicory, tender white radish (prepared in oil), green and papaya.
Dairy ProductsLow-fat milk, goat’s milk, buttermilk, yoghurt mixed with water 1:1 (called lassi or ayurvedic buttermilk), small amounts of clarified butter (ghee).
Sweeteners: Sugar or Sucanat, in small amounts. Sucanat is dried whole sugar cane juice, available in health food stores.
Oils
Ghee, sunflower oil, and olive oil, in very small amounts for cooking only.
Spices and Condiments
Coriander, cumin, ginger (small amounts), turmeric, fennel, cinnamon, cardamon, lemon juice.
Fruits
Fruits should be sweet, ripe, and in season.
Grapes, pomegranates, papayas (small amounts), pineapple (only if very sweet), figs, persimmons, and fresh apricots. The juice of these fruits is also good. Raisins are fine in small amounts, if pre-soaked and chewed well.

Further Information

http://www.lifespa.com/article.asp?art_id=37