Welcome to my blog :)

rss

Friday, June 21, 2013

Scientific Basis for Ayurvedic Therapies -21































































Scientific Basis for
Ayurvedic Therapies 


edited by
Brahmasree Lakshmi Chandra Mishra





Indigestion (Ajirna)
Shankar K. Mitra and Paramesh R. Rangesh

17.1 Introduction
Gastrointestinal (GI) symptoms are among the most common and widespread of health
complaints among the general populace. An alternative term is dyspepsia. Dyspepsia is
often used to refer to upper abdominal pain or discomfort but may also encompass
symptoms of early satiety, postprandial abdominal bloating or distension, nausea, and
vomiting. Dyspepsia can be episodic or persistent and is often exacerbated by eating.
Indigestion is a general term used to describe discomfort or pain in the upper abdomen
or chest, usually after meals.
Ayurvedic treatment is focused on the correction of gastrointestinal pathology for most
of the endogenous disorders ranging from indigestion to arthritis. Ayurvedic texts describe
the anatomy and physiology of the digestive system at great lengths. Here is a brief insight
into the concepts of digestion and indigestion.
17.2 Ayurvedic Concept
17.2.1 The Stomach and Digestion
The stomach is one of the vital organs of the body (
marma
). The other important organs
are the heart, lungs, kidneys, and the brain. The stomach not only stores food during the
process of digestion, but also makes it more permeable through the juices it produces.
The stomach has minute glands from which gastric juice (
pachaka pitta
) is produced. The
gastric juice helps break down food into smaller molecules. The moment food enters the
stomach, the wall of the organ starts a
churning action to mix the food with the gastric
juice so that it becomes absorbable. Foods that are easy to digest (
laghu ahara
), such as fatfree
or low-fat milk and fat-free cereals or fruits, take far less time to digest than heavier
foods (
guru ahara
), such as fried substances, which are rich in fat.
The partially digested food from the stomach enters the intestine and is then exposed
to the action of bile, pancreatic and intestinal juices, and bacteria. The food is broken down
into various easily absorbable substances, which are vital for growth and development,
because these form the building blocks of the body. It is only when food has been eliminated
from the intestine that the process of digestion is complete and the process of
absorption starts.
17.2.2
Agni
and Disease
Ayurvedic literature has recognized 13 types of enzymes (
agni
); the most important is the
digestive enzyme (
jatharagni
), the primary factor of digestion
.
The others are the seven
intracellular enzymes (
dhatu agni
) and the five organic catalysts (
bhuta agni
). The
digestive
enzyme (also called
koshthagni
) contained in the gastric juice
is the source of all the enzymes
of the body. In addition to the digestive enzyme,
there are six other factors that help
digestion process. They are gastric juice
,
gut motility factor (
samana
vata
), moisture and
water, mucin (
kledaka kapha
), time, and a proper combination of the first five. The gut
motility factor propels the food into the stomach, bringing it into contact with gastric juice
,
and supports the
enzymes; moisture breaks down the compactness of the food and mucin
softens the food. Time is required for completing the process of digestion, and a proper
combination of all factors is vital for completion of the process. The food is digested with
the help of the digestive enzyme. This process results in the separation of the nutrient
factors from the food, which circulate in the body and help in tissue building through the
help of intracellular enzymes.
As long as this enzyme is in homoeostasis, it results in a state of health. Disease is the
result of a deviation from this state. The imbalance of the digestive enzyme (including the
enzymes of the stomach and intestine)
gives rise to most disorders of the stomach, particularly
anorexia and dyspepsia. This enzyme occurs in four states: balanced (s
amagni
),
abnormal (
vishamagni
), increased (
tikshnagni
), and decreased (
mandagni
). Except the balanced
state, others are pathological states. These pathological states of enzymes are due
to the influence of three
dosas
:
vata
,
pitta,
and
kapha,
respectively.
Physiologically, food undergoes three stages of conversion in the GI tract. The first is a
mucilaginous neutral stage (
madhurabhava
) under the influence of
kapha
. The second stage,
due to the interference of
pitta
, is an acidic stage (
amlabhava
), and the final stage is a dry,
pungent stage (
katubhava
) under the effect of
vata
. Due to etiological factors such as
abnormal food habits, emotional disturbances, etc., a pathological state of enzyme results
called
agnimandya
.
Agnimandya
is the principal cause for all metabolic disorders commencing
with indigestion
(
ajirna
).
17.2.3 Indigestion
Indigestion, a deviation in any of the steps described above, also known as upset stomach,
dyspepsia, or gastric indigestion, is discomfort or a burning feeling in the upper abdomen.
It is often accompanied by nausea, abdominal bloating, belching, and sometimes vomiting.
1
Dyspepsia, which means bad (dys) digestion (pepsia), is a term often used by doctors
to describe a set of symptoms believed to have their cause somewhere in the upper part
of the GI tract.
Ayurvedic physicians diagnose the disease with clinical interrogation about the state of
digestive enzymes and digestion with certain clinical features such as absence of hunger,
abdominal discomfort, and belching of undigested food. The physicians also examine the
abdomen by palpation and percussion for the presence of flatulence.
To diagnose indigestion, the doctor of conventional medicine might perform tests for
problems like ulcers. In the process of diagnosis, a person may have x-rays of the stomach
and small intestine or undergo an endoscopy, in which the doctor uses an instrument to
look at the inside of the upper GI tract.
17.3 Definition
According to classic Ayurveda, the word
ajirna
in Sanskrit means bad (a) digestion (
jirna
).
It is defined as a pathological condition in which food is not digested easily and is the
root cause for many internal diseases (metabolic). In conventional medicine, the term
dyspepsiais,
derived from the Greek words
dys
(bad) and
pepsis
(digestion), refers to symptoms
thought to originate in the upper GI tract.

17.4 Clinical Description
Indigestion, lassitude, heaviness in the body, the retention of flatus and constipation, or
loose motion are the common signs and symptoms of
ajirna
, as described in classic texts.
In conventional medicine, dyspepsia is characterized by upper abdominal pain or discomfort.
It may also encompass symptoms of early satiety, postprandial abdominal bloating
or distension, nausea, and vomiting.
17.5 History and Epidemiology
Dyspepsia is common; surveys in Western societies have recorded a prevalence of between
23 and 41%. For many people, dyspeptic symptoms are an acceptable part of living. Why
some sufferers (about 25% of the population) seek help from doctors is not clear, but
concern about symptoms seems to be as important as the symptoms themselves. The
minority of sufferers (5% of the population) who do consult doctors are the major consumers
of resources. In the U.K., in 1994, more than 400 million pounds was spent on
ulcer-healing drug prescriptions issued by general practitioners. About 4% of general
practice consultations are for dyspepsia and 2% of the entire populations receive either
an endoscopy or barium swallow (upper GI) each year. Time lost from work and interference
with quality of life is more difficult to measure but are likely to be considerable.
2
Only 10% of patients attending their general practitioner with dyspepsia will be referred
for hospital consultation or investigation.
The prevalence of dyspepsia ranges from 26% in the U.S. to 41% in the U.K. Although
only 20 to 25% of persons with dyspepsia seek medical care; the problem is responsible
for 2 to 5% of visits to primary care physicians. Nonulcer dyspepsia results in substantial
health-care costs.
2
17.6 Etiology
According to Ayurveda, the chief causes that affect digestion are the following:
1. Drinking too much liquid or water
2. Irregular eating habits, which include erratic schedules and quantities (i.e., eating
at abnormal intervals [between meals, middle of the night, etc.] or too large or
too small a serving)
3. Food allergies
4. Iatrogenic indigestion due to improper application of
panchakarma
(the detoxification
procedures)
5. Suppression of nature’s call or urges like hunger, defecation, etc.
6. Sleep disturbances
7. Emotional disturbances (e.g., envy, phobia, fury, depression, vengeance)
© 2004 by CRC Press LLC
Indigestion (Ajirna)
311
8. Seasonal changes
9. Debilitating chronic illnesses
In general, food selection, frequency of intake, seasonal changes, and emotional disturbances
affect digestion.
According to conventional medicine, the main causes of dyspepsia are overeating, eating
wrong food combinations, eating too rapidly, and neglecting proper mastication and
salivation of food. Causes also include overeating and making the stomach, liver, kidneys,
and bowels harder. When the food putrefies, its poisons are absorbed into the blood and
consequently the whole system is poisoned. Certain foods, if not properly cooked, can
cause dyspepsia. Other causes are intake of fried, rich, and spicy foods; excessive smoking;
intake of alcohol; constipation; insomnia; lack of exercise; and emotions such as jealousy,
fear, and anger.
17.7 Pathogenesis and Pathology
Ayurvedic texts state that diminished digestive enzymes lead to a state in which the patient
is unable to digest even wholesome (
satmya
) and easily digestible food taken in an orderly
time frame. This condition is known as
ajirna
.
Etiological factors disturb the homoeostasis of the
dosas
, which in turn influence the
digestive enzyme and result in three states dependent on the three
dosas
. They are the
vata
-dependent abnormal state (
vishamagni
),
pitta
-dependent increased state (
tikshnagni
)
and
kapha
-dependent decreased state (
mandagni
). These three pathological states of enzyme
bring about
dosa
-specific indigestion. They are static indigestion (
vishtabdha ajirna
), acid
indigestion (
vidagdha ajirna
), and endotoxic indigestion (
ama ajirna
), which are caused by
vata
,
pitta,
and
kapha
dosas
, respectively. Section 17.9 details the types indigestion as
described in Ayurvedic texts.
17.8 Clinical Diagnosis
The following clinical features as described in classic Ayurveda help to diagnose the three
pathological states of enzyme:
1. Abnormal state of enzyme (
vishamagni
) — In this state, the enzyme is antagonistic
due to involvement of vitiated
vata
. Symptoms include a very unpredictable
digestive capacity. Sometimes the food is digested well, whereas at other times
even light food in small quantities cannot be tolerated. Gaseous distension is
common.
2. Increased state of enzyme (
tikshnagni
) — In this circumstance, the appetite is good,
but the food that is eaten is not assimilated in the body. At such times, eating
more food does not help at all. In fact, the enzyme will become more disturbed
and so will the digestion process. A typical feature of this condition is that whatever
the food that is eaten (and digested) seems to disappear down a slightly
overburdened gut.

3. Decreased state of enzyme (
mandagni
) — In this condition, simple meals are
difficult to digest and there is an uneasy feeling of indigestion. Other symptoms
are malaise and vomiting.
17.9 Classification of Indigestion
Ayurvedic literatures describe a total of six types of indigestion, of which three are
pathological types. They are static indigestion (
vishtabdha ajirna
), acid indigestion
(
vidagdha ajirna
), and endotoxic indigestion (
ama ajirna
). The other three are transient
indigestion (
rasasesha ajirna
), diurnal indigestion (
dinapaki ajirna
),
and successive indigestion
(
prativasara ajirna
). Although the latter three are not pathological types, they are
transitional and occur physiologically in between any two meals every day. Dislike for
food intake until the earlier food is digested is known as transient indigestion. The
feeling of abdominal heaviness and lethargy soon after food ingestion is a natural process
called diurnal indigestion and
successive indigestion. The three pathological types are
described below.
1. Endotoxic indigestion (
ama
ajirna
) — The clinical features, such as abdominal
heaviness, hypersalivation, puffiness of face, and belching out undigested food
particles help diagnose this type of indigestion.
2. Acid indigestion (
vidagdha
ajirna
) — This condition is presented with clinical
features such as giddiness, intense thirst, daze, acid reflux, increased sweating,
and a burning sensation all over the body.
3. Static indigestion (
vishtabdha
ajirna
) — Clinical features, such as pain in the abdomen,
abdominal distension, obstruction to bowel and flatus movements, bewilderment,
and myalgia, are presented in this type of indigestion.
In conventional medicine, the clinical diagnosis is based on several signs and symptoms.
As dyspepsia is a group of symptoms, it alerts doctors to suspect diseases of the upper
GI tract. It includes symptoms of upper abdominal discomfort, retrosternal pain, anorexia,
nausea, vomiting, bloating, fullness, early satiety, and heartburn, among others. A firm
clinical diagnosis can be difficult based on these symptoms, as few symptoms are discriminatory.
Many diseases cause dyspepsia; these include peptic ulcers, esophagitis, cancer
of the stomach or pancreas, and gallstones. In a large proportion of cases, no clear pathological
cause for a patient’s symptoms can be determined. Other symptoms include a foul
taste in the mouth, coated tongue, and foul breath. At times, a sensation of tightness in
the throat is experienced. In most cases of indigestion, the patients suffer from constipation.
An organic cause is found in 40% of patients with dyspeptic symptoms. The most
common organic disorders causing dyspepsia are gastroduodenal ulcer, gastroesophageal
reflux disease, and gastric cancer. In 50% of patients, no cause is apparent and the dyspepsia
is considered idiopathic, meaning the diagnosis is essential, functional, or nonulcer
dyspepsia.
2
The history and physical examination do not reliably differentiate organic
from nonulcer dyspepsia.
Many people do not require invasive investigation. However, as persistent indigestion
may suggest a more serious underlying complaint, the doctor of conventional medicine
may decide to arrange the following:

1. An endoscopy to enable the doctor to look into the stomach
2. A barium swallow test to enable the outline of the stomach to show up on an x-ray
3. An ultrasound to scans the abdominal organs
4. A blood test to detect anemia or any other abnormality
Ayurvedic physicians currently also use these diagnostic procedures.
17.10 Clinical Course and Prognosis
Indigestion not treated in time may lead to the development of sequelae such as stupor
(
murcha
), incoherent talk (
pralapa
), vomiting (
vamathu
), hypersalivation (
praseka
), severe
myalgia (
sadana), vertigo (bhrama), and even death (marana).3 The GI disturbances that
may be followed by metabolic imbalances, either due to toxic states (especially metabolic
histotoxic anoxia) or malnutritional states (which are acute to begin with) may tend to
become chronic.
The acute conditions are among others that are caused by the impairment of enzymes
(agni) and the formation of endotoxin (ama). Among the subacute and chronic conditions,
both GI and metabolic, that may occur in a kind of chain sequence, the following may be
mentioned here: functional impairment of colon, liver damage, and hepatic diseases. In
fact, according to Ayurveda, most of the diseases included under internal medicine may,
from this point of view, be stated to be the outcome of this endotoxin and dosa combined
with this, called sama.
There is increasing evidence that individuals with autoimmune diseases, like rheumatoid
arthritis, have intestines that are more permeable to certain antigens, allowing these
antigens to invade the body and stimulate the symptoms. These antigens may be akin
with the Ayurvedic concept of ama.4
17.11 Management
17.11.1 Ayurvedic Therapy and Management of Indigestion
The management of indigestion begins with treating enzyme disturbance because it is
considered the basic cause of this condition. Agnimandya is treated as follows5:
1. The abnormal state of enzyme is treated with food and drinks that have sour and
salty tastes, along with some quantity of fat.
2. The increased state of enzyme is brought to equilibrium with dairy products such
as curds, milk, and milk gruel (payasam).
3. The decreased state of enzyme is treated with food and drinks that have pungent,
bitter, and astringent tastes, which stimulate enzymes.
Indigestion is generally treated with drugs that have digestive and carminative activities:

1. In endotoxic indigestion, digestive drugs have to be used. If there is excess kapha,
then vamana (emesis) is done under a physician’s supervision followed by digestive
drugs such as panchakola curna, agnitudi vati, and rasonadi vati (Table 17.1).
2. Acid indigestion is treated with light and easily digestible food. If there is excess
pitta, virecana (purgation) is followed by using antacids, such as sankha vati (Table
17.1).
3. To control vata in static indigestion, virecana with castor oil or Terminalia chebula
is used followed by basti (enema) treatment done under medical supervision. To
relieve constipation and indigestion, compound herbal powders such as bhaskaralavana
curna and hingvastaka curna are used (Table 17.1).
4. In any stage of indigestion, ginger (Zingiber officinale), cumin (Cuminum cyminum),
asafetida (Ferula foetida), and rock salt are used as digestives and carminatives.6
Therapy for functional gastrointestinal disorders comes under phytotherapeutic treatment.
From ancient times, phytotherapeutics played a very important role in patients with
dyspeptic symptoms. Bitter herbal drugs stimulate at even very small concentrations,
sensorially, the secretions of the stomach as well as the digestive glands, and also
strengthen the smooth musculature of the digestive tract (via the gustatory system, vagus,
and the enteric nervous system). At higher dosages, herbs and food articles with bitter
tastes probably directly affect the mucous membranes of the stomach and the bowels as
stimulants. Bitters often are combined with essential oils (some volatile oils such as
aromatic bitters, drug combinations of a volatile oil with a bitter taste). Essential oils act
primarily as spasmolytic, carminative, and local anesthetic. In the past few years, several
controlled studies were carried out with phytotherapeutic combinations (e.g., with Iberis
amara, caraway oil, peppermint oil, curcuma, and ginger extracts) in which the herbal
drugs proved to be superior compared with placebo and were as effective as prokinetics
(studies according to evidence-based medicine).7
17.11.2 Clinical Experiences
1. In case of abdominal pain, shankha vati is used at 250 to 500 mg twice daily with
warm water.
TABLE 17.1
Compound Formulas for Indigestion, Poor Digestion, and Dyspepsia
Name of Formulation Activity Dose Adjuvant Ref
Bhaskaralavana curna Digestive, appetizer 1–3 g twice/day
before meals
Warm water and
lemon juice
10
Hingvastaka curna Carminative,
antiflatulent
1–2 g twice/day
before or with
meals
Warm water,
buttermilk, and
ghee
5
Panchakola curna Digestive,
carminative
1–2 g twice/day
before or with
meals
Warm water 10
Agnitudi vat Carminative,
antispasmodic
240–480 mg twice/
day before meals
Warm water 10
Rasonadi vati Digestive,
antiflatulent
240–480 mg twice/
day before meal
Warm water 10
Sankha vati Digestive,
antiflatulent
240–480 mg twice/
day before meals
Lime water 6

2. To control and relieve borborygmi, 1 to 3 g of hingvashtaka curna is used with 1/2
tsp of cow’s ghee along with the first morsel of cooked rice twice daily.
3. If there is constipation with indigestion, 1 to 3 g bhaskaralavana curna is used with
warm water twice daily.
17.11.3 Lifestyle Changes
A person with an abnormal enzyme and indigestion should avoid stale, cold, and oily
foodstuffs, cold drinks, and cold water. Onions, potatoes, sweet potatoes, eggplant,
yogurts, bananas, pickles fried, hot and spicy foods, dairy products, liquor, and desserts
should be avoided.
Items like ginger, garlic, cumin, coriander, coriander leaves, curry leaves, and lemon
should be added to the diet. Vegetables such as radishes, yams, drumsticks, snake gourd,
bitter gourd, and pumpkin or fruits (e.g., pomegranates) can be eaten freely. Whole wheat
bread, whole cereals, and rice (harvested and stored for a long time) are also helpful.
To avoid indigestion, adhere to the following guidelines:
1. Eat meals at regular times.
2. Do not rush meals.
3. Enjoy eating and drinking, but do so in moderation.
4. Avoid those foods that are associated with symptoms.
5. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs). If possible, consult a doctor
before doing so.
6. Avoid stressful situations that cause emotional upset.
7. Stop smoking.8
17.11.4 Review of Ayurvedic Therapies
The provision of dosage information in this section does not constitute a recommendation
or endorsement but rather indicates the range of doses commonly used in Ayurvedic
practice. Doses are given for single herb use and must be adjusted when using herbs in
combinations. Doses may also vary according to the type and severity of the condition
treated and individual patient conditions.
17.11.4.1 Imbalanced States of Digestive Enzymes
1. 2 g of dried ginger (Zingiber officinale) powder taken, twice daily, with warm water
stimulates enzymes and relieves indigestion.
2. 5 g of fresh ginger taken with salt or jaggery twice daily before meals.
3. 3 g of chebulic myrobalan (Terminalia chebula) powder taken twice daily before
meals with salt or jaggery.
4. 7 to 14 ml of lemon juice taken three times daily after meals.
5. Heat 1 g each of long pepper (Piper longum) powder and salt on a half lemon fruit
over blue flame. The juice of this cooked lemon is to be sucked two or three times
daily with meals.

6. 1 g each of the powdered fruit of long pepper and salt to be taken with lemon
juice twice daily with meals.
7. Take equal parts of fruit rind of chebulic myrobalan, dried ginger, and rock salt
in powder form, and add to it jaggery (approximately one third of the total
weight). This is to be taken in 1 to 3 g doses with warm water once daily before
the first meal.9
8. Fennel is one of the ingredients in a compound pill called rasonadi vati. It is useful
in low enzyme states.10
9. Distillate of peppermint leaves relieves nausea, stimulates enzyme secretion, and
improves appetite and taste.11
17.11.4.2 Indigestion
Various Ayurvedic formulas commonly used for indigestion are commercially available
listed below.
1. Dried ginger tea should be taken several times a day.
2. Take 1 to 3 g of the powdered fruit rind of black chebulic myrobalan (Terminalia
chebula) with an equal quantity of raw unrefined sugar twice daily before meals.
3. 1 to 3 g powdered dried ginger taken three times daily with jaggery.
4. 3 to 6 g of a paste prepared from equal parts of chebulic myrobalan fruit rind,
raw unrefined sugar, and raisins is to be taken with honey twice daily before meals.
5. 1 g of the powder of equal parts of rock salt, fruit rind of chebulic myrobalan,
fruit of long pepper, and root of leadwort (Plumbago zeylanica) should be taken
with warm water twice daily after meals.
6. 14 to 28 ml of a decoction prepared from equal parts of clove (Syzygium aromaticum),
fruit rind of chebulic myrobalan, and rock salt should be taken twice daily
before meals.
7. 14 to 28 ml of decoction of equal parts of fruit of coriander (Coriandrum sativum)
and dried ginger should be taken twice daily before meals.9
8. The powder of the turmeric rhizome (3 g) is useful in distaste and indigestion.11
17.11.4.3 External Applications
1. A hot poultice prepared from equal parts of asafetida (Ferula foetida), rock salt,
and hot water may be applied on the abdomen when it is warm to relieve abdominal
discomfort.
2. A warm poultice prepared from equal parts of asafetida powder, black pepper
(Piper nigrum), rock salt, and hot water may be applied on the abdomen to relieve
abdominal discomfort.9
According to conventional medicine, the treatment of indigestion includes avoidance
of the foods and situations that seem to cause indigestion; in some cases this is the most
successful way to treat indgestion. Excess stomach acid does not usually cause or result
from indigestion, so antacids are not an appropriate long-term treatment, although some
people report that they do help. Smokers can help relieve their indigestion by quitting
(Table 17.1). Other simple home remedies consisting of single herbs or multiple herbs are

smoking, or at least not smoking right before eating. Exercising with a full stomach may
cause indigestion, so scheduling exercise before a meal or at least an hour after might help.
To treat indigestion caused by a functional problem in the digestive tract, the doctor
may prescribe medicine that affects stomach motility. Because indigestion can be a sign
of or mimic a more serious disease, patients should see a doctor if they have vomiting;
weight or appetite loss; black tarry stools or blood in the vomit; severe pain in the upper
right abdomen; discomfort unrelated to eating; and indigestion accompanied by shortness
of breath, sweating, or pain radiating to the jaw, neck, or arm.
17.12 Scientific Basis
17.12.1 Zingiber officinale (Ginger)
17.12.1.1 Antinausea and Antiemetic Effects
17.12.1.1.1 Animal Studies
In mice, ginger’s effect in enhancing intestinal motility was similar to metoclopramide’s.12
In shrews, dogs, and rats, ginger extracts effectively reduced chemotherapy-associated
vomiting.13,14 Ginger also protected frogs against experimentally induced emesis.15 An
herbal combination including ginger and ginkgo was as effective as metoclopramide in
another animal study of experimentally induced nausea.16 Studies in rats and mice suggest
that ginger produces its antiemetic effects by stimulating peripheral anticholinergic and
antihistaminic receptors and by antagonizing 5-hydroxytryptamine (serotonin) receptors
in the gut.17,18
17.12.1.1.2 Clinical Studies
Both during fasting and after a standard test meal, ginger extracts significantly enhanced
gastroduodenal motility in 12 normal volunteers.19 Several randomized controlled trials
support ginger’s use as an antiemetic for nausea secondary to several conditions: morning
sickness, chemotherapy-associated nausea, postoperative nausea, and motion sickness. In
a randomized, double-blind, placebo-controlled crossover trial of 30 women with hyperemesis
gravidarum, ginger (250 mg four times daily) proved significantly more effective
than placebo in preventing and reducing nausea.20 Ginger also proved useful in treating
chemotherapy-induced nausea in a small pilot study of 11 adult patients; their nausea
scores fell from an average of 2 (out of maximum of 4) to 0.7 after taking 1.5 g of powdered
ginger.21 Another case series also supported ginger’s use as an antiemetic in patients
undergoing chemotherapy.22
Data on ginger’s effectiveness in preventing postoperative nausea have been conflicting.
In two randomized, double-blind studies of women undergoing gynecologic surgery,
those treated with ginger had significantly less postoperative nausea and vomiting than
those treated with placebo; ginger was as effective as metoclopramide in preventing
postoperative GI symptoms.23,24 Two other randomized, controlled trials failed to document
any statistically significant benefits of preoperative ginger (500 to 2000 mg) on
postoperative nausea or vomiting.25,26 Several studies have evaluated ginger’s effectiveness
in preventing motion sickness or seasickness and the potential mechanisms for this
effect. In an open study of 1741 tourists traveling by sea, ginger supplements (250 mg

every 2 h) were as effective as both nonprescription and prescription medications in
preventing sea sickness.27
In a randomized, crossover trial of eight healthy volunteers, ginger supplements were
significantly more effective than placebo in alleviating vertigo associated with motion sickness.
28 In a randomized, controlled trial of naval cadets, ginger was significantly more
effective than placebo in preventing seasickness, both vomiting and vertigo.29 In an early
trial involving 36 college students prone to motion sickness, ginger was as effective as a
dimenhydrinate in preventing nausea.30 In a randomized, controlled trial in healthy volunteers,
ginger was an effective antiemetic, but its mechanism of action appeared not to rely
on alterations in gastric emptying.24 In a study evaluating potential mechanisms for ginger’s
ability to reduce motion sickness, ginger had no impact on experimentally induced nystagmus
associated with motion sickness; the investigators concluded that ginger’s primary
effect was on the stomach rather than the central nervous system.31 In one National Aeronautics
and Space Administration (NASA)-sponsored study in healthy volunteers, ginger
(500 to 1000 mg) had no apparent effect on gastric emptying.32 Other studies have reported
enhanced intestinal motility after oral administration of ginger.12
17.12.1.2 Carminative and Antiulcer Effect
17.12.1.2.1 Animal Studies
In mice, zingiberene and gingerol significantly reduced gastric ulceration experimentally
induced by ethanol and hydrochloric acid.33
These results were confirmed in several subsequent studies using several of ginger’s
constituents, including beta-sesquiphellandrene, beta-bisabolene, gingesulfonic acid, curcumene,
and 6-shogaol. The results showed a demonstration of antiulcer effects and
protection of gastric mucosa against alcohol, NSAIDs, and hydrochloric acid.34,35 Rats given
ginger extracts (gingerols) had enhanced bile secretion.36
17.12.1.2.2 Clinical Studies
A Chinese case series reported that an herbal mixture containing ginger was effective in
halting upper gastrointestinal hemorrhage.37 There are no randomized, controlled trials
in humans evaluating ginger’s effect as a carminative or ulcer remedy.
17.12.1.2.3 Dose
There is disagreement on the optimal form and dose of ginger. A pediatric dose is not
established. Reputable physicians and herbalists recommend a range of doses. A dose of
dried ginger at 250 mg, four times daily taken orally,38 is commonly used. Some German
herbalists recommend up to four times this amount.39 Chinese herbalists may use up to
ten times this amount. The following methods for preparing ginger can be used:
1. Tea — 1 tsp of fresh ginger root boiled in 1 to 2 cups of water for 10 to 20 min.
Cool for 5 minutes and sweeten as desired. May be mixed with peppermint or
chamomile.
2. Ginger tincture 1.5 to 3.0 ml/dose.38
3. Candied ginger — A 1-in. square piece is presumably equivalent to 500 to 1000
of dried ginger.40,41

Ginger is used worldwide as a cooking spice, condiment, and herbal remedy. Rhizomes
of ginger have long been used in traditional medicine for alleviating symptoms of GI
illness.14 It is used as a carminative to enhance digestion and reduce intestinal gas and
flatulence. In experimental studies, gingerol, an active constituent of ginger, had enhanced
bile secretion.36 Ginger in combination with long pepper and black pepper (the combination
is called trikatu in Ayurvedic literature) promoted the secretion of digestive juices and
an increased appetite; it is also reported useful in patients with gastric disorders accompanied
with clinical symptoms of achlorhydria and hypochlorhydria.42
17.12.2 Foeniculum vulgare (Fennel)
Fennel is a promoter of normal GI motility and is an antispasmodic.43 In experimental
studies, fennel was reported to stimulate bile flow from the liver, which could help in
relieving GI discomfort.44
17.12.3 Curcuma longa (Turmeric)
Experimental study with ethanolic extract of turmeric has proved its ability to inhibit
gastric secretion and to protect gastroduodenal mucosa against the injuries caused by
pyloric ligation; hypothermic-restraint stress; indomethacin; reserpine and cysteamine
administration; and cytodestructive agents, including 80% ethanol, 0.6 M HCl, 0.2 M
NaOH, and 25% NaCl. Turmeric extract has found to increase the gastric wall mucus and
also restored the nonprotein sulfhydryl (NP-SH) content in the glandular stomachs of
rats.45
A number of clinical trials on turmeric have proved it beneficial in the treatment of
peptic ulcer and nonulcer dyspepsia and right upper abdominal pain that may often be
caused by biliary dyskinesia.46–50 Further acute and chronic oral toxicity studies on the
turmeric rhizomes in mice, rats, guinea pigs, and monkeys found it to be safe.51,52
17.12.4 Mentha piperita (Peppermint Oil) and Carum carvi (Caraway Oil)
A combination of peppermint and caraway oils in the treatment of functional dyspepsia
has been extensively studied in experimental models and in clinical conditions of dyspepsia.
53,54
The peppermint and caraway oil combination was found to be a safe preparation that
acted locally to cause GI smooth muscle relaxation.55 The favorable risk-benefit ratio of a
peppermint and caraway oil combination was demonstrated for the treatment of functional
dyspepsia.56 Peppermint oil was known to inhibit enterocyte glucose uptake via a
direct action at the brush border membrane in the intestinal lumen.57
Acknowledgments
The authors acknowledge the data input provided by M.V. Venkatranganna and S. Gopumadhavan,
Pre-Clinical Pharmacology Laboratory, R&D Center, The Himalaya Drug Company,
Makali, Bangalore, India.

References
1.
NIH Publication No. 02-4549, National Institutes of Health, U.S.A, Feb. 2002, available at:
2. Drossman, D.A. et al., U.S. Householder survey of functional GI disorders: prevalence, sociodemography
and health impact, Dig. Dis. Sci., 38, 1569, 1993.
3. Dwarakanath, C., Introduction to Kayachikitsa, Chowkhambha Orientalia, Varanasi, U.P. India,
1996.
4. Madhava, Madhavanidanam, Vol. 1, Sastri, S. and Uapadhyaya, Y., Eds., Chaukhambha Sanskrit
Sansthan, Varanasi, U.P. India, 1976, chap. 6, p. 198.
5. Bhavamishra, Bhavaprakasha, Vol. 2, Mishra, B.S., Ed., Chaukhambha Sanskrit Sansthan, Varanasi,
U.P. India, 1972, chap. 6, p. 78.
6. Anon., Yogaratnakara, Part I, Shastri, B.B., Ed., Chaukhambha Sanskrit Sansthan, Varanasi, U.P.
India, 1997, p. 310.
7. Saller, R. et al., Dyspeptic pain and phytotherapy: a review of traditional and modern herbal
drugs, Forsch. Komplementarmed. Klass Naturheilkd., 8(5), 263, 2001.
8. Anon., Dyspepsia Management Guidelines, British Society of Gastroenterology, London, 2002,
9. Anon., Hand Book of Domestic Medicine and Common Ayurvedic Remedies, Central Council for
Research in Indian Medicine and Homoeopathy, New Delhi, India, 1978, chaps. 2 and 3, p. 43.
10. Das, G., Bhaishajyaratnavali, Chaukhambha Sanskrit Sansthan, Varanasi, U.P. India, 1997, chap.
10, p. 237.
11. Vaishya, S., Shaligramanighantu Bhushana, Vols. 7 and 8, Khemaraj Srikrishnadas Publications,
Mumbai, Maharashtra, India, 1953, pp. 71 and 158.
12. Yamahara, J. et al., Gastrointestinal motility enhancing effect of ginger and its active constituents,
Chem. Pharm. Bull. (Tokyo), 38, 430, 1990.
13. Yamahara, J. et al., Inhibition of cytotoxic drug-induced vomiting in suncus by a ginger
constituent, J. Ethnopharmacol., 27, 353, 1989.
14. Sharma, S.S. et al., Anti-emetic efficacy of ginger (Zingiber officinale) against cisplatin-induced
emesis in dogs, J. Ethnopharmacol., 57, 93, 1997.
15. Kawai, T. et al., Anti-emetic principles of Magnolia obovata bark and Zingiber officinale
rhizome, Planta Medica, 60, 17, 1994.
16. Frisch, C. et al., Blockade of lithium chloride-induced conditioned place aversion as a test for
antiemetic agents: comparison of metoclopramide with combined extracts of Zingiber officinale
and Ginkgo biloba, Pharmacol. Biochem. Behav., 52, 321, 1995.
17. Qian, D.S. and Liu, Z.S., Pharmacologic studies of antimotion sickness actions of ginger, Chung
Kuo Chung Hsi I Chieh Ho Tsa Chih, 12, 95, 1992.
18. Huang, Q. et al., Anti-5-hydroxytryptamine effect of galanolactone, diterpenoid isolated from
ginger, Chem. Pharm. Bull., 39, 397, 1991.
19. Micklefield, G.H. et al., Effects of ginger on gastroduodenal motility, Int. J. Clin. Pharmacol.
Ther., 37, 341, 1999.
20. Fischer-Rasmussen, W. et al., Ginger treatment of hyperemesis gravidarum, Eur. J. Obstet.
Gynecol. Reprod. Biol., 38, 19, 1991.
21. Meyer, K. et al., Zingiber officinale (ginger) used to prevent 8-Mop associated nausea, Dermatol.
Nurs., 7, 242, 1995.
22. Pecoraro, A. et al., Efficacy of ginger as an adjunctive anti-emetic in acute chemotherapyinduced
nausea and vomiting, ASHP Midyear Clin. Meet., 33, 429E, 1998.
23. Bone, M.E. et al., Ginger root: a new antiemetic. The effect of ginger root on postoperative
nausea and vomiting after major gynaecological surgery, Anaesthesia, 45, 669, 1990.
24. Phillips, S., Hutchinson, S., and Ruggier, R., Zingiber officinale does not affect gastric emptying
rate. A randomised, placebo-controlled, crossover trial, Anaesthesia, 48, 393, 1993.
Anon., Indigestion, National Institute of Diabetes and Digestive and Kidney Diseases of NIH,

25. Arfeen, Z. et al., A double-blind randomized controlled trial of ginger for the prevention of
postoperative nausea and vomiting, Anaesth. Intensive Care, 23, 449, 1995.
26. Visalyaputra, S. et al., The efficacy of ginger root in the prevention of postoperative nausea
and vomiting after outpatient gynaecological laparoscopy, Anaesthesia, 53, 506, 1998.
27. Schmid, R. et al., Comparison of seven commonly used agents for prophylaxis of seasickness,
J. Travel Med., 1, 203, 1994.
28. Grontved, A. and Hentzer, E., Vertigo-reducing effect of ginger root: a controlled clinical study,
ORL, J. Otorhinolaryngol. Relat. Spec., 48, 282, 1986.
29. Grontved, A. et al., Ginger root against seasickness: a controlled trial on the open sea, Acta
Otolaryngol. (Stockholm), 105, 45, 1988.
30. Mowrey, D.B. and Clayson, D.E., Motion sickness, ginger, and psychophysics, Lancet, 1, 655,
1982.
31. Holtmann, S. et al., The anti-motion sickness mechanism of ginger. A comparative study with
placebo and dimenhydrinate, Acta Otolaryngol. (Stockholm), 108, 168, 1989.
32. Stewart, J.J. et al., Effects of ginger on motion sickness susceptibility and gastric function,
Pharmacology, 42, 111, 1991.
33. Yamahara, J. et al., The anti-ulcer effect in rats of ginger constituents, J. Ethnopharmacol., 23,
299, 1988.
34. Yamahara, J. et al., Stomachic principles in ginger. II. Pungent and anti-ulcer effects of low
polar constituents isolated from ginger, the dried rhizoma of Zingiber officinale Roscoe cultivated
in Taiwan: the absolute stereostructure of a new diarylheptanoid, Yakugaku Zasshi, 112,
645, 1992.
35. al-Yahya, M.A. et al., Gastroprotective activity of ginger Zingiber officinale rosc. in albino rats,
Am. J. Chin. Med., 17, 51, 1989.
36. Yamahara, J. et al., Cholagogic effect of ginger and its active constituents, J. Ethnopharmacol.,
13, 217, 1985.
37. Gong, Q.M., Wang, S.L., and Gan, C., A clinical study on the treatment of acute upper digestive
tract hemorrhage with wen-she decoction, Chung Hsi I Chieh Ho Tsa Chih, 9, 272, 1989.
38. Newall, C.A., Anderson, L.A., and Phillipson, J.D., Herbal medicines: A Guide for Health-Care
Professionals, Pharmaceutical Press, London, 1996, p. 296.
39. Blumenthal, M., The Complete German Commission E Monographs: Therapeutic Guide to Herbal
Medicine, American Botanical Council, Austin, 1998.
40. Robbers, J.E. and Tyler, V.E., Tyler's Herbs of Choice: The Therapeutic Use of Phytomedicinals,
Haworth Herbal Press, New York, 1999, p. 287.
41. Peirce, A., The American Pharmaceutical Association Practical Guide to Natural Medicines, William
Morrow and Company, Inc., New York, 1999.
42. Johri, R.K. and Zutshi, U., An Ayurvedic formulation “trikatu” and its constituents, J. Ethnopharmacol.,
37, 85, 1992.
43. Westphal, J., Horning, M., and Leonhardt, K., Phytotherapy in functional upper abdominal
complaints, Phytomedicine, 2, 285, 1996.
44. Kline, R.M. et al., Enteric-coated pH-dependent, peppermint oil capsules for the treatment of
irritable bowel syndrome in children, J. Pediatr., 138, 125, 2001.
45. Rafatullah, S. et al., Evaluation of turmeric (Curcuma longa) for gastric and duodenal antiulcer
activity in rats, J. Ethnopharmacol., 29(1), 25, 1990.
46. Prucksunand, C. et al., Phase II clinical trial on effect of the long turmeric (Curcuma longa
Linn) on healing of peptic ulcer, Southeast Asian J. Trop. Med. Public Health, 32(1), 208, 2001.
47. Eigner, D. and Scholz, D., Ferula asafetida and Curcuma longa in traditional medical treatment
and diet in Nepal, J. Ethnopharmacol., 67(1), 1, 1999.
48. Niederau, C. and Gopfert, E., The effect of chelidonium- and turmeric root extract on upper
abdominal pain due to functional disorders of the biliary system: results from a placebocontrolled
double-blind study, Med. Klin., 94(8), 425, 1999.
49. Kositchaiwat, C., Kositchaiwat, S., and Havanondha, J., Curcuma longa Linn. in the treatment
of gastric ulcer comparison to liquid antacid: a controlled clinical trial, J. Med. Assoc. Thailand,
76(11), 601, 1993.

50. Thamlikitkul, V. et al., Randomized double blind study of Curcuma domestica Val. for dyspepsia,
J. Med. Assoc. Thailand, 72(11), 613, 1989.
51. Qureshi, S., Shah, A.H., and Ageel, A.M., Toxicity studies on Alpinia galanga and Curcuma
longa, Planta Medica, 58(2), 124, 1992.
52. Shankar, T.N. et al., Toxicity studies on turmeric (Curcuma longa): acute toxicity studies in
rats, guineapigs and monkeys, Indian J. Exp. Biol., 18(1), 73, 1980.
53. Freise, J. and Kohler, S., Peppermint oil-caraway oil fixed combination in non-ulcer dyspepsia:
comparison of the effects of enteric preparations, Pharmazie., 54(3), 210, 1999.
54. May, B. et al., Efficacy of a fixed peppermint oil/caraway oil combination in non-ulcer dyspepsia,
Arzneim. Forsch., 46(12), 1149, 1996.
55. Micklefield, G.H., Greving, I., and May, B., Effects of peppermint oil and caraway oil on
gastroduodenal motility, Phytother. Res., 14(1), 20, 2000.
56. May, B., Kohler, S., and Schneider, B., Efficacy and tolerability of a fixed combination of
peppermint oil and caraway oil in patients suffering from functional dyspepsia, Aliment
Pharmacol. Ther., 14(12), 1671, 2000.
57. Beesley, A. et al., Influence of peppermint oil on absorptive and secretory processes in rat
small intestine, Gut, 39(2), 214, 1996.

 





Om Tat Sat
                                                        
(Continued...) 


(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)

0 comments:

Post a Comment