DUODENAL ULCER

( PARINAMA SHOOLA)
A peptic ulcer is an erosion or sore in the stomach (gastric ulcer) or the first few  centimeter of the duodenum ( duodenal ulcer), that penetrates through the muscularis  mucosa .           

 Causes

1. Helicobacter pylori
2.Stress
3.Smoking                                                                                                                  4.Radiation therapy
5. Use of NSAIDs such as aspirin and ibuprofen .
6.Spicy foods do not cause ulcers, but can make them worse .

Symptoms

1.The pain is usually in the upper middle part of the abdomen .

2. The  pain can feels like burning or gnawing , and it may go through to the back  3.Nausea
4. Vomiting
5.Loss of appetite
6.Loss of weight .

Upashaya and Anupashaya

Samanya  Vishesa  Siddhanta  is applied in all fields of Ayurveda . The extension of this siddhanta in the form of Upashaya and Anupashaya  respectively is used for diagnosis of a disease as well as for  therapeutics . The avoidance of factors that aggeavate the Shula and Indulgence in those that relieve the Shula is advisable.                                                                                                                                                      Upashaya

Relieving factors for Parinama Shula are:
1. Immediately after Bhojana
2. Following vomiting
3. On completion of aharapachana
4.Vataja parinama shula : Shingdha, ushna annapana
5. Pittaja parinama shula : Sita annapana
6. Kaphaja parinama : Katu , tikta  annapana .                                                                                                                                                Anupashaya

The  aggravating factors for parinama shula are:
1. Pachyamanavastha of aharapachana
2. Sastika Sali ,vrihi odana
3. Pittaja parinama shula : Katu, Amla , lavana annapan.                                                                                                                                                      Investigations:

1. Inspect the stool , and test it for occult blood .
2. Fiberoptic   endoscopy or a double –contrast  barium  study of the upper GI tract.
3.  Test for the presence of H pylori infection .

Treatment

Principles of Treatment

Panchakarma

Vamana is indicated when the dosa is Amashayagata and is Kaphaja  Parinama Shoola.
Virechana  is indicated when the dosa are in the Pachyamanashya and in Pittaja Parinama Shoola.
Basti indicated in chronic stage
Pachana , Vataulomana.
1. Shamana  Snehapana – MTG 20 ml BD with milk
2. Avapeedaka Sneha with Dadima  Ghrita
3. Vamana is to be performed using Tikta and  Madhura dravya . The dravya to be  used are Madanpala  kvatha with ksira , kantakari rasa, Nimba kvatha or katutumbi rasa , Akanthaapana of any of the above is indicated.                                                                                                                4.Virechana with Trivrit , Danti or Eranda taila.
5. Yashtimadhu Ksheerabasti
6. Shirodhara, Takradhara.

Single drugs:
Amalaki , Yashtimadhu, Shatavari, Patola ,Mandoora Bhasma, Pravala Pisti.                                                                                                                                                                                                                               
Naimittika rasayana
Amalaki rasayana, Drakshamalaka leha,  Dhari Loha,  Saptamrita loha, Ksheera Mandoora, Shatavari Mandora.

Formulations
1. Sutashekara rasa – 1-2 tab with water thrice a day before meal
2. Kamadugha rasa – 1-2 tab with water thrice a day before meal                  3.Tiktaka Ghrita -1-2 tsf with warm water twice a day before meal
4.Avipattikara  churna -1-2 tsf with warm milk twice a day before meal          5.Shatavri ghrita- 1-2 tsf with milk twice a day before meal                        6.Shatavri –yashthimadhu ksheerapaka – 30 ml BD                                              7.Bhunimbadi kashaya – 20 ml TID                                                                 8.Saptamrita lauha – 250 -500 mg TID BF with milk                                         9.Shatavari Mandoora -250-500 mg TID BF with milk
10. Ksheera Mandoora -250-500mg TID with milk
11. Pravala panchamrita rasa -250-500  TID with milk
12. Syrup Himcocid – 1-2 tsf with water thrice a day before meal
13. Syrup  Amlapitta Mishrana  -2tsf TID before meal.                                                                                                                                                              Yoga Therapy

Asana
1. Vajrasana
2.Paschimottanasana
3. Bhujangasana
4.Ardha matsyendrasana
5.Sarvangasana
6. Padahasthasana
7.Shashankasana
8.Virasana
9.Viparita karni
10. Padmasana
11. Shavasana                             
12. Makaraasana
13. Pavanamuktasana                                                                                                Pranayama
Ujjayi , Kapalbharti
Yoga Nidra
Om Mantra Chanting
Diet and Lifestyle
Pathya : Eating smaller meal , Drink water after 30 mint of the meal.             Apathya:  Avoid heavy, spicy ,sour, hot, too much oily food.                        Excessive or scanty and also taken too early or too late.
Avoid anxiety, worry ,anger, etc.
Avoid alcohol and acidic foods.
Avoid aspirin and other NSAIDs.
Don’t take anything in between meals except liquids.                                Suppression of the natural urges.

Prevention                                                            
Avoiding the Pitta  –aggravating diet , smoking, tobacco chewing ,alcohol.          Presons of Pitta Prakriti should take purgation therapy once in year.