KAMADUGHA RASA AN EFFECTIVE AYURVEDIC FORMULATION FOR PEPTIC ULCER: A REVIEW

Abstract

At the present time, peptic ulcer diseases (PUD) is common problem in societies due to various behavioral and environmental factors. Further excessive use of non steroidal anti inflammatory drugs and infection of Helicobacter pylori contribute major part in pathogenesis of PUD. PUD is gastrointestinal disorder that has been recognized since ancient time. In Ayurveda, it is equivalent to amlapitta and is common throughout the world and prevalence has been estimated to approximately 11%-14% for men and 8%-11% for women. These crises lead to the search for natural products from plant or mineral origin possessing potential anti-ulcer activity. Rasaushadhis are unique dosage forms having benefit of longer shelf life, better therapeutic efficacy at low dose. Kamadugha Rasa is one of them and effectively used for anti ulcer activity. In the present review, an attempt was made to understand the possible mode of action of Kamadugha Rasa as a gastro-protective and for its anti-ulcer activity.

Headnote

ABSTRACT

At the present time PUD (peptic ulcer diseases) is common problem in societies due to various behavioral and environmental factors. Further excessive use of NSAID's (non steroidal anti inflammatory drugs) and infection of Helicobacter pylori also contribute major part in pathogenesis of PUD. PUD is gastrointestinal disorder that has been recognized since ancient time. In Ayurveda, it is equivalent to amlapitta (hyperacidity/acid peptic disorders) and is common throughout the world and prevalence has been estimated to approximately 11-14% for men and 8-11% for women. The usage of synthetic drugs such as antacids, H2 receptor blockers and proton pump inhibitors have abbreviated due to their side effects. These crises lead to the search for natural products from plant or mineral origin possessing potential anti-ulcer activity. Rasaushadhis (mineral and herbo-mineral ayurvedic medicines) are unique dosage forms having benefit of longer shelf life, better therapeutic efficacy at low dose. Kamadugha Rasa is one of them and effectively used for anti ulcer activity. The ingredients of Kamadugha Rasa like bhasmas (Powder obtained by calcinations of mixture of minerals and herbs or any one) of Mukta (pearl), Pravala (coral: Corallium rubrum), Shankha (conch shell), Shukti (oyster shell) and Varatika (cowries shell: Cyprea moneta Linn.) are the sudha varga dravyas (calcium containing group) which are known for their importance in the management of Amlapitta, Pittaja vikara, (disorder related to biological fire or metabolic catabolic enzymes), Jirna Jwara (chronic fevers) and Somaroga (The condition in which there is an excessive urination in women). In the present review, an attempt was made to understand the possible mode of action of Kamadugha Rasa as a gastro-protective and for its anti-ulcer activity.

KEYWORDS: Kamadugha Rasa, Amlapitta, Rasaushadhis, Peptic Ulcer Disease, Anti-Ulcer Activity

INTRODUCTION

The demand of herbal drugs is increasing day by day due to their excellent efficacy, fewer side effects and good faith by Indian community on herbal medicine and also their products (Rawat et al., 2003). The drugs which are available in Ayurvedic system of medicine are obtained either from herbal, animal and mineral sources. Rasaushadhis (mineral and herbo-mineral ayurvedic medicines) are unique dosage forms having benefit of long shelf life and better therapeutic efficacy at lower dose. In the current kinetic era, Rasaushadhis have given Ayurveda a complete novel health care look (Chaudhary and Singh, 2010).

Kamadugha Rasa is a unique Kharaliya Rasayana (medicine prepared in mortar and pestle) which contains equal amount of Mukta bhasma (calcined pearl), Pravala bhasma (calcined coral: Corallium rubrum), Shankha bhasma (calcined conch shell), Shukti bhasma (calcined oyster shell) and Varatika (cowries shell: Cyprea moneta Linn.), Shuddha Gairika (purified red ochre) and Guduchi Satva (cold water extract of Tinospora cordifolia). It is a completely balanced healing agent which is designed to tackle the various types of diseases ailments such as Amlapitta, Pittaja vikara, Jirna Jwara and Somaroga (Hariprapannaji, 1999, Palbag et al., 2013). It is also advised in many complications of Amlapitta (Anonymous, 2006) like Parinama shula (duodenal ulcer), Annadrava shula (abdominal pain related with poor digestion) and other Gastro-intestinal disturbances which are now a day's regarded as the most commonly occurring diseases due to present life style and food habits. Since times immemorial, this drug has been most widely and successfully used in clinical practice. Several variations of Kamadugha Rasa have also been mentioned in many classical texts (table 1) and are described in various chapters of Jwara (fevers) (Hariprapannaji, 1999) and Amlapitta (Hariprapannaji, 1999). In addition, it is also indicated in many diseases such as unmada (psychosis), apasmara (epilepsy), pradara (leucorrhooea), mutra daha (burning micturation), raktarsha (bleeding piles), vrana (ulcer/wound) produced due to Amlapitta (Anonymous, 2006; Anonymous, 2000), bhrama (vertigo), daha (burning sensation), murcha (loss of consciousness), rakta pitta (bleeding diathesis/ innate haemorrhage) and trishna (thirst) (Joshi and Rao, 2003).

Peptic ulcer disease (PUD), encircling gastric and duodenal ulcer is a major gastrointestinal disorder (Valle, 2005). An ulcer forms when there is an imbalance between aggressive forces, i.e., the aggressive power of acid and pepsin and defensive factors mucus layer, mucosal blood flow, PGs (prostaglandin) and growth factors (Sairam et al., 2003; Szabo et al., 1998). However, in majority of patients, acid secretion is within normal limits or is moderately raised. It can occur at any age, including infancy and childhood, but are most common in the middle aged adults (Beer and Berkow, 2006). Lifetime prevalence is approximately 11-14% for men and 8-11% for women (Le and Fantry, 2008). In the present times, approximately 80% of the patients that suffers from PUD are mainly associated with the Helicobacter pylori infections (Warren and Marshall, 1983; Matsukura, 1995). The excessive consumption of NSAID's (non steroidal anti inflammatory drugs) is also one of the main contributing factors for the development of PUD (Wallace, 2000). However, various behavioral and environmental factors such as smoking (Kaur et al., 2012), excessive consumption of alcohol, improper diets and excessive stress leads to the generation of PUD. Current therapy for the treatment of PUD mainly includes various combinations of antacids, H2 receptor blockers (ranitidine, famotidine) and proton pump inhibitors (omeprazole, lansoprazole) (Rao et al., 2004). The aim of such therapy is attributed to the reduction of gastric acid production and strengthening of gastric mucosa (Hoogerwerf and Pasricha, 2001). The complete cure of peptic ulcers is still one of the challenging problems, since the disease is likely believed to re-occur in the future (Bandyopadhyay, 2002). Most of the synthetic drugs are cost effective and can produce several health problems that generate unusual adverse effects in the body. Hence, there is a necessity to discover newer, cheaper, and safe antiulcer agents. Herbal medicines have been shown to produce promising results in the treatment of PUD. They have often shown to reduce the aggressive factors and strengthening the mucosal defensive layers, thus serving as important tools in the prevention of gastric ulcers (Laloo et al., 2013).

As long as samprapti (etiopathogenesis) of Amlapitta is concerned, it is explained with the help of samprapti of grahani roga mentioned by Charaka. In Amlapitta the Nidanas (etiology) are predominantly from the non compliance of dietetic code of selection and eating. However psychological status of a person also plays an important role. The etiological factors like Ati snigdha ahara, Ati ruksha ahara, Vishamashana, Akale bhojana, Akale anashana Veganigraha (suppression of natural urges) (Sharma, 1988), Vidahi anna sevana, Vidahi pana sevana, Dusta anna sevana (Upadhaya, 1981) and seasonal variation etc. cause the vitiation of Dosha (especially liquidity of Pitta) and Agni which results in Agnimandhya (digestive weakness). Once Agnidushti occurs it results in Ajirna (indigestion). In this state of whatsoever food material are consumed by an unwise person, become Vidagdha (acidic) and are converted into Shukta (acid) form which leads to formation of Amavisha. Thus, Amavisha (acidic dietary toxins in the body) produced disturbs the Grahani and once it happened it further produces the Amadosha (excessive accumulation of dietary toxins) and vicious cycle starts. Amavisha Produced by this Samprapti when mixes with Pitta, it will produce Amlapitta (Jadavji, 2004). In the present review an attempt has been made to understand and explore the possible mode of gastro-protective and anti-ulcer activity of Kamadugha Rasa.

MODE OF ACTION OF KAMADUGHA RASA

Ayurvedic Perspective

Some of the ingredients of Kamadugha Rasa such as pravala and mukta have dipana (appetizer) and pachana (digestive) properties (Kulkarni, 2006) maintain the normalcy of agni (digestive fire) and thus help in curing and preventing the production of ulcers (Ghosh and Baghel, 2011). The kshariya (alkaline) nature of these drugs would reduce the amliyata (acidic nature) and help in vrana ropana (promotes wound healing). These are sita virya dravyas (the drug having cold potency or cooling effect usually resembles to endothermic) which does Pitta shamana (pacify the biological fire) and Vrana ropana. Shankha Bhasma being Sita Virya, alkaline in nature, Grahi (absorption enhancing), it is indicated in gastrointestinal disorders like Amlapitta, Parinama Shula, Grahani (Irritable bowel syndrome) and Agnimandhya (Shastri, 1989) which is clinically proved (Pandey, 2000). Gairika is another ingredient which is madhura (Sweet), kashaya (Astringent), snigdha (smooth), hima (cold), rakta pitta hara (effective in bleeding diathesis) and Vrana ropaka. These properties are very necessary in the healing of ulcer. Guduchi Satva being another important ingredient is known for its Rasayana property (Upadhyay et al., 2010). It is having tikta (Bitter), kashaya rasa with madhura vipaka (post digestive effect which is sweet in nature), snigdha guna and is tridosha shamaka (pacify three Bio energy Principles, Vata, Pitta, and Kapha), dipaniya. These all would support in the anti ulcer activity along with Rejuvenation.

Pitta is having tiksna (sharpness), usna (heat), sara (mobility), laghu (lightness), snigdha, etc. properties by which it brings biochemical changes at the cellular and tissue levels. Pitta maintains digestion, thirst, appetite energy production and body temperature, colour, complexion. Pitta is Drava (liquid) in consistency, inspite of which, it performs actions similar to Agni, in the course of process of digestion, largely due to its actual Teja (heat) component (discarding its liquidity-Drava). This fact is inferred from the way in which Pachaka Pitta (digestive component of biological fire) performs pachana (digestive) Karma (action). The capacity of digestion also depends on the qualitative increase of Usna Guna of Pitta. Conceptually it was concluded that substances having the properties like ruksha, kasaya, laghu had the effect to decrease the drava guna of pitta and maintaining the proper function of agni. Similarly substances having madhura, sita properties, decreased the usna property of pitta to maintain the proper function of agni.

Modern Perspective

Kamadugha Rasa mainly contains calcium compounds chiefly calcium carbonate (CaCO3), calcium oxide (CaO) and some amount of calcium silicates. Calcium carbonate is widely used in the treatment of peptic ulcer (Loevenhart and Crandall, 1927; Meletis et al, 2008). It is a fast acting antacid and reduces gastric acidity resulting in an increase in the pH of stomach (Akhter, 2007). Calcium being the main ingredient plays an important role in many physiological activities not only related to bones but also includes blood clotting, nerve conduction, muscle contraction, regulation of enzyme activity and cell membrane function. It takes part in production of many enzymes and hormones which regulate digestion process and metabolism. (Piste et al., 2013). Calcium is essential for the normal transport of nutrients through membranes, blood coagulation and muscle functioning (Piste et al., 2013). Calcium also helps in regulating potassium and magnesium balance in the body (Swaminathan, 2003). It prevent blood loss if ulcers are bleeding, heal the ulcers by muscle contraction and hardening and also reduces the pain by regulating nerve function (Piste et al., 2013) and perhaps most importantly, Calcium is the main buffer used in the body to neutralize acids and maintains the proper pH (Akhter, 2007). Even it is evident that excess intake of calcium leads to production of peptic ulcers instead of healing. The administration of calcium both orally or intravenously, stimulates acid secretion and increases circulating concentration of gastrin (Petersen et al., 1984). Stimulation of acid secretion by the parietal cells occurs by at least three major pathways: the cholinergic transmitter such as acetylcholine, histamine, which is locally released in the gastric epithelium and the hormone gastrin. The effect of histamine is mediated by increasing adenylate cyclase activity, whereas the effects of the acetylcholine and gastrin seem to involve an increase in cytosolic free calcium (Zhou et al., 1997). Kamadugha Rasa contains not only calcium but also other minerals thus reducing excess absorption of calcium. Magnesium is one of the minerals which is said to reduce the absorption of calcium in the intestine. However, the action of magnesium is very weak; hence it may not hinder the absorption of calcium to large extent. Kamadugha Rasa also contains many elements like iron, oxygen, sodium, zinc, aluminium, silicon potassium and others which are essential minerals for the maintenance of healthy body. The presence of zinc, aluminium and magnesium also helps in the ulcer healing process (Varas et al., 1991; Frommer 1975; Watanabe T, et al., 1995; Itoh et al., 2004; McIntosh and Sutherland, 1940). Kamadugha Rasa displays gastroprotective activity against different ulcer inducing agents, as well as it has ability to decrease gastric secretion (Chandra et al., 2010).

Ingredients of Kamadugha Rasa are individually useful in peptic ulcer. Kirtikumar et al., 2010 performed a comparative clinical study between Jala Shukti Bhasma and Mukta Shukti Bhasma with reference to Amlapitta (Parmar, 2010; Chouhan et al., 2010) which justifies this claim. The study conducted by Pandya (1968) assesses the effectiveness of Pravalapanchamrita (formulation containing Mukta Bhasma, Shankha Bhasma, Shukti Bhasma, Varatika Bhasma and Pravala Bhasma) in patients of Amlapitta and conclude that it is a highly effective medicine (Pandya, 1968). Momin Ali (1970) evaluated the effect of Shukti Bhasma against Amlapitta to observe its clinical efficacy (Ali, 1970). Shankha Bhasma acts like antacid. Its acid neutralizing capacity, speed of antacid action and prolonged buffering action were excellent (Pandey, 2000). Shankha Bhasma causes noteworthy decrease in ulcer index in both the indomethacin and cold resistant stress models for studying PUD. Thiobarbituric acid reacting substances (TBARS) of stomach in the indomethacin treated rats were also reduced by Shankha Bhasma, but serum calcium level was not altered (Pandith et al., 2000). Guduchi satva is the most effective drug against hyperacidity as observed in pylorus ligated (Shay) rat model (Prashanth et al., 2011). Treatment with a formulation containing guduchi has been shown to reduce ulcer index and total acidity, with an increase in the pH of gastric fluid in pylorus-ligated rats and in the ethanol-induced gastric mucosal injury in rats. (Bairy et al., 2001; Kaur et al., 2012; Chandan et al., 2013)

CONCLUSION

In the present era, various types of allopathic drugs are used to treat PUD, but the most important lacunas in them are their side effects. Some alternative therapies from the natural sources are used in the treatment of peptic ulcer disease. Kamagudha rasa, a herbo-mineral formulation is widely used for the treatment of PUD in common practice. It is expected that this formulation would be beneficial for society to eradicate this problem and their further use would also be expected. The advanced research may discover its exact mechanism in PUD. In context to the present review, it can be concluded that the ingredients of Kamadugha Rasa can be regarded as the contributing factors in the treatment of peptic ulcer disease. It is worthy of exploring the opportunity of employing the therapeutic advantages of Kamadugha Rasa.

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Cite this article:

Kumar Maurya Santosh, Arka Ghosh, Kumar Yadav Amit, Kumar Dileep, Singh Anil Kumar., (2014), KAMADUGHA RASA AN EFFECTIVE AYURVEDIC FORMULATION FOR PEPTIC ULCER: A REVIEW, Global J Res. Med. Plants & Indigen. Med., Volume 3(1): 24-32

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