SCIENTIFIC EXPLANATION OF MODE OF ACTION OF SUTSHEKHAR RAS IN AMLAPITTA WITH SPECIAL REFERENCE TO ACID PEPTIC DISORDERS: A REVIEW

Abstract

Amlapitta or hyperacidity is a very common disease in present era and not only present but also since past era. It is very troublesome disease and can
give rise to many serious problems if not treated in time. Signs and symptoms of Amlapitta are very similar to gastritis or hyperacidity. The main cause
of hyperacidity is the aggravation of Pitta Dosha in the body. Pitta is an Ayurvedic humor that symbolizes heat or fire. There are many causes for the
aggravation of Pitta, main among them are: Eating foods that do not suit the constitution or foods that should not be taken together (milk and fish, milk
and salt), excessively sour or spicy foods and liquids. Hyperacidity is known as Amlapitta in Ayurveda. Hyperacidity therefore is a condition
characterized by an increase of sourness and heat in the body. The aggravated Pitta impairs the digestive fire, leading to improper digestion of food and
production of Ama. Sutshekhar Ras is an important medicine used in Amlapitta. In this review article, we are trying to explain the mechanism of action
of this drug on scientific basis.

Full text

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SCIENTIFIC EXPLANATION OF MODE OF ACTION OF SUTSHEKHAR RAS IN AMLAPITTA
WITH SPECIAL REFERENCE TO ACID PEPTIC DISORDERS: A REVIEW
Ajay Kumar 1*, Tina Singhal 2
1Lecturer, Dept. of Kayachikitsa & Panchkarma, Government Post Graduate Ayurveda College and Hospital, Varanasi,
Uttar Pradesh, India
2Lecturer, Dept. of Rachana Sharir, Government Post Graduate Ayurveda College and Hospital, Varanasi,
Uttar Pradesh, India
Received on: 15/07/18 Accepted on: 15/09/18
*Corresponding author
E-mail: drajay2000@gmail.com
DOI: 10.7897/2277-4343.095154
ABSTRACT
Amlapitta or hyperacidity is a very common disease in present era and not only present but also since past era. It is very troublesome disease and can
give rise to many serious problems if not treated in time. Signs and symptoms of Amlapitta are very similar to gastritis or hyperacidity. The main cause
of hyperacidity is the aggravation of Pitta Dosha in the body. Pitta is an Ayurvedic humor that symbolizes heat or fire. There are many causes for the
aggravation of Pitta, main among them are: Eating foods that do not suit the constitution or foods that should not be taken together (milk and fish, milk
and salt), excessively sour or spicy foods and liquids. Hyperacidity is known as Amlapitta in Ayurveda. Hyperacidity therefore is a condition
characterized by an increase of sourness and heat in the body. The aggravated Pitta impairs the digestive fire, leading to improper digestion of food and
production of Ama. Sutshekhar Ras is an important medicine used in Amlapitta. In this review article, we are trying to explain the mechanism of action
of this drug on scientific basis.
Keywords: Amlapitta, Hyperacidity, Acid peptic disorder, Sutshekhar Ras.
INTRODUCTION
Amlapitta is a disease of gastro-intestinal tract, especially
mentioned in Kashyap Samhita1, Madhava Nidana2, Bhava
Prakasha, Kashyap Samhita3 and Chakradatta. This disease is not
separately described in Charaka Samhita, Sushruta Samhita and
Ashtang Hriday or Ashtang Samgraha. Amlapitta is mentioned in
these Brihatrayi as a symptoms or complication of many
disorders.
Excess production of acids in stomach is termed as the
hyperacidity. There are varieties of reasons which cause excess
acid production. Heartburn and hyperacidity4 are primarily
lifestyle or age related. While there are various health conditions
and circumstances that could cause hyperacidity and heartburn,
for the most part, the condition results from unhealthy lifestyle
choices. Sutshekhar Ras is an important medicine used in
Amlapitta and it is need of today to explain the mechanism of
action of this drug on scientific basis.
REVIEW OF DISEASE
Etymologically the word Amlapitta comprises of two components
i.e. Amla & pitta. Chakrapani5 in his commentary on Charak
Samhita defines “Amlapittam Cheti amlagunoundriktam pittam”
means the augmented or increased amla guna of pitta is known as
Amlapitta. Whereas Shrikanthadutta in his Madhukosha
vyakhya6 of Madhav Nidan defines “Vidahadhyamla
gunaoundrikta pittam amlapittam” i.e. the pitta becomes vidagdha
because of excessive increase of amla guna of pitta & “Amlam
vidagdham cha tat pittam amlapittam” the pitta which attains
amla guna & vidagdhata is called as Amlapitta. Indulgence of
foods which are incompatible combinations, spoiled, very sour,
causes increase of pitta and produces Amlapitta.
The Samprapti i.e. pathogenesis of Amlapitta involves three
important factors7 i.e.
1. Agnimandya,
2. Ama
3. Annavaha Srotodushti.
Along with these factors, the vitiation of pitta leading to
quantitative & qualitative increase of its Ama & Drava Guna
gives rise to Amlapitta. The main sign and symptoms as
mentioned in Madhav Nidan are described under two types.
[Table 1]
1. Adhoga Amlapitta
Thirst, burning sensation, fainting, giddiness, delusion, rashes on
skin, poor digestion are the main symptoms of this type of
Amlapitta.
2. Urdhwaga Amlapitta
Vomiting of green, yellow, black, bright red coloured sour
material, resembling mutton wash, belching, burning sensation in
throat, chest and upper abdomen, headache, loss of appetite,
fever, appearance of rashes are the main symptoms of this type of
Amlapitta.
Table 1: Classification of Amlapitta
Type
Direction
Symptoms
Adhoga
Amlapitta
Downward
Thirst, Burning sensation,
fainting, rashes on skin etc
Urdhwaga
Amlapitta
Upward
Vomiting, Headache, Burning
sensation, Loss
of appetite
The biggest contributing factor towards heartburn and
hyperacidity is bad eating habits. Eating large meals and foods
that are high in unhealthy fats, starch, sugars, spices and oil can
all lead to heartburn. Eating heavy meals before sleeping also
causes hyperacidity, as you are not giving your body adequate

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time to digest the food properly. When you sleep soon after
eating, the reclined position also makes it easier for acid reflux to
occur. Keeping long gaps between meals and skipping meals can
also cause acids to build up in the stomach and lead to heartburn
and acidity. Bad eating habits put extra stress on the digestive
system making it work overtime to try and function normally.
Acid peptic disorders are the result of distinctive, but overlapping
pathogenic mechanisms leading to either excessive acid secretion
or diminished mucosal defence. They are common entities
present in daily clinical practice that, owing to their chronicity,
represent a significant cost to healthcare.
PHYSIOLOGY OF ACID SECRETION8
The stomach consists of two primary functional zones i.e., the
oxyntic gland area, representing approximately 80% of the organ,
and the pyloric gland area representing the remaining 20%.
Parietal cells secrete hydrochloric acid and intrinsic factor which
are predominantly present in the oxyntic glands. Chief cells
secrets the digestive enzyme precursor pepsinogen9. The
histamine, gastrin and acetylcholine released from postganglionic
enteric neurons10 are the principal stimulants for acid secretion
from gastric mucosa.
Basal acid secretion is modulated by acetylcholine from
parasympathetic vagal efferent. It directly stimulates acid
secretion by binding to muscarinic receptors on parietal cells.
Indirectly, acetylcholine also stimulates acid secretion through
activation of M2 and M4 receptors on D cells11.
Antacids work instantaneously and give rapid relief from
hyperacidity. The primary effect of antacids is partial
neutralization of gastric hydrochloric acid and inhibition of the
proteolytic enzyme pepsin12. These all antacids are administered
orally, and their potency is measured by the amount of acid
neutralized by a given dose of the antacid.
Most Commonly we use sodium bicarbonate, calcium carbonate,
magnesium hydroxide and aluminium hydroxide as antacids. For
example, calcium carbonate is sparingly soluble and it reacts with
HCl and generates soluble calcium chloride, which is converted
back to calcium carbonate in the alkaline conditions of the small
intestine. Other used antacids are the insoluble aluminium
hydroxide and magnesium hydroxide. Aluminium and calcium-
containing products generally cause constipation therefore these
agents are often combined with magnesium hydroxide, which can
cause diarrhoea and loose stools when administered alone.
SUTSHEKHAR RAS
Sutshekhar Ras is an important medicine used in Ayurveda,
which acts on Pitta Dosha and reduces symptoms like heartburn,
nausea, vomiting, abdominal pain, epigastric tenderness, hiccup,
fever, breathing troubles, headache etc. The main ingredients are
given in Table 2.
Table 2: Ingredients of Sutshekhar Ras (Siddha Yoga Samgraha)
S.N.
Contents
Parts
S.N.
Contents
Parts
1
Parad
1
2
Gandhak
1
3
Raupya Bhasm
1
4
Shunthi
1
5
Marich
1
6
Pippali
1
7
Dhatura
1
8
Tankan
1
9
Tamra Bhasm
1
10
Dalchini
1
11
Tejpatra
1
12
Ela
1
13
Nagkeshar
1
14
Shankh
1
15
Bilwa
1
16
Karchur
1
17
Bhringraj Kwath
Bhawana Dravya
MODE OF ACTION OF DIFFERENT INGREDIENTS
DHATURA
Datura stramonium is a main ingredient of Sutshekhar Ras. It is
a widespread annual plant, containing atropine, hyoscyamine, and
scopolamine, which can produce poisoning with a severe
anticholinergic syndrome13. Atropine, scopolamine, and
hyoscyamine/daturine (the l-enantiomer of atropine) are the
primary active constituents in all dhatura species. The three
primary alkaloids in dhatura are antimuscarinic anticholinergics,
which means they competitively antagonize (block) the
muscarinic acetylcholine receptors.
As this is a potent anticholinergic drug, it inhibits the action of
Acetylcholine. Previously we said that Acetylcholine from
parasympathetic vagal efferent modulates basal acid secretion
and stimulate acid secretion indirectly by inhibiting the release of
somatostatin, so ultimately by blocking the acetylcholine,
Dhatura inhibits acid(HCl) production in gastric mucosa and
relieves hyperacidity.
SHANKH BHASM
The other component of Sutshekhar Ras is Shankh Bhasm. This
is a Calcium carbonate compound. This directly reacts with
gastric HCl and neutralise them, so this acts as potent antacid.
CaCO3 + HCl = H2O + CO2 + CaCl2
LAUHA BHASM
Another compound Lauha Bhasm also directly neutralises HCl as
Fe + 2HCl = FeCl2 + H2
HCl is strong acid and FeCl2 is soluble ionic compound. Both
have ions as major species in their solution.
TANKAN
Another ingredients Tankan (Borax) reacts with HCl and
neutralise it as following.
Na2B4O7⋅10H2O+2HCl⟶4H3BO3+2NaCl+5H2O
DISCUSSION
Amlapitta is caused by aggravated pitta due to excessive intake
of pungent and sour food items, alcoholic preparations, salt, hot
and sharp stuff. This aggravated pitta cause burning sensations.
To pacify the pitta, anger, fear, excessive exposure to sun and fire,
intake of dry vegetables and alkalis, irregularity in taking food,
and all pitta prakopak factors should be avoided14. Various drugs
are described for treatment of Amlapitta. Among these
Avipattikar Churna, Leela Vilas Ras, Amla-Pittantak Lauha,
Triphala Mandur, Kushmand Khand, Prawaal Panchamrit,
Shankh Bhasm, Prawaal Pishti, Mukta Pishti, and Yavakshar are
the main drugs. Sutshekhar Ras is used very commonly used in
Amlapitta. But due to lack of scientific explanation, nobody
wants to believe that it is as useful as allopathy drugs. After
scientific explanation of its mechanism everyone has proud on the
concepts of Ayurveda that it is also very scientific.

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CONCLUSION
Sutshekhar Ras is a very commonly used drug in Amlapitta and
it helps not only in reducing the symptoms but also maintains the
health. The specially prepared lifestyle chart containing Ahara
and Vihara helps in reducing the symptoms and maintaining the
healthy lifestyle. This drug is very beneficial in this disease due
to multiple actions such as anticholinergic and directly acting
antacid.
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Cite this article as:
Ajay Kumar and Tina Singhal. Scientific explanation of mode of
action of sutshekhar ras in amlapitta with special reference to acid
peptic disorders: A review. Int. J. Res. Ayurveda Pharm.
2018;9(5):47-49 http://dx.doi.org/10.7897/2277-4343.095154
Source of support: Nil, Conflict of interest: None Declared
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