PEPTIC ULCERS

In simple terms, ulcer is a lesion on the surface of the skin on a mucous surface caused by superficial loss of tissue accompanied by inflammation. Ulcer occurs in various parts of the digestive systems such as the lower part of the esophagus (food pipe, gullet), the lower part of the stomach and the duodenum (the first part of the small intestine). The ulcer in the above areas is collectively referred to as Peptic Ulcer. Ulcer found in the colon, a part of the large intestine is known as Stercoral Ulcers.

To a great extent, peptic ulcer is a life-style induced disease of the modern man. The factors that contribute to the incidents of peptic ulcer worldwide are, among others, anxiety and depression, stress at the workplace and home, irregular food habits, smoking and drinking, consumption of ‘fast foods’ and aerated drinks. An old adage goes like this: ‘ulcers appear in the stomach, but are located in the brain’. In the early eighties, microbiologists suggested that a species bacteria known as ‘ Helicobacter Pylori’ damage the mucous membrane of the fundus (of the stomach), pylorus and duodenum and cause lesions.

Another cause of peptic ulcer is the acid present in the digestive juice of the stomach. Gastric glands, which are of three types, numbering approximately forty million, are found on the mucous membrane (the lining that comes in immediate contact with food) of the stomach. They secrete a strongly acidic gastric juice, which contains digestive enzymes, mucin (mucous secretion) and hydrochloric acid.  By volume, the acid makes up for more than 50% of the gastric juice.

It has been observed that the quantity and the acid content of the gastric juice are enhanced in a peptic ulcer patient. The etiology is not very clear. This brings about stomachache, heartburn, tastes of acid in the saliva, excessive salivation, flatulence etc and the patient gets fatigued after a spell of brief physical activities.

Treatment

The treatment is patient specific in Ayurveda; hence the following discussion is only a generalization. There are two basic types of treatment

a.      Reduce the volume of gastric juice secreted.
b.      Neutralize the acid content of the gastric juice.

Ayurveda has identified food materials and the ingredients of recipes of cooked food that aggravate, ameliorate or cure the ulcer condition. Meat, eggs, certain raw vegetables and fruits, hot chilly, tamarind (it has tartaric acid), spices etc in excess, carbonated drinks, beverages, tinned and packed food are likely to aggravate the ulcer condition. Medicated milk (cow’s) ameliorates the condition by neutralizing the gastric acid. Ashes extracted by burning certain marine shells (shells of mollusca – conch like cells) and the bark of plants like Plassu (Buteafrondosa) mixed with ghee (clarified butter) is used as a curative ingredient. The treatment regime of consuming properly medicated cow’s ghee is called Snehapanam.

Snehapanam activates and regulates the neuro hormones (epinephrine and nor epinephrine), strengthens the central nervous system (CNS) and the endocrine systems. The quantity and the quality of the medicines used in Snehapanam vary from patient to patient.

The treatment is started at an auspicious time in the morning. Snehapanam is done in three time frames or Matras namely, ALPA MATRA, MADHYA MATRA and UTTAMA MATRA. A matra or time frame denotes the time taken to digest a specific quantity of the medicine ingested. It takes six hours to digest the medicine in Alpa Matra, 12 hours in Madhyama Matra and 24 hours in Uttama Matra. The criteria for deciding the matra are

a.      The physical condition of the patient.
b.      Severity of the disease and
c.      Ability of the patient to digest the fatty medicine.

Initially a test dose of two fluid ounces (30 ml) of medicine is consumed by the patient. The patient remains prostrate on the bed. The physician monitors the time taken by the patient to digest the medicine. From this test, the matra is decided. When the medicine is fully digested, the patient is given a watery rice gruel known as ‘peya’ to drink. ‘Peya is finely broken rice, cooked in lots of water. Based on the ability to digest the medicine and the nature of the ulcer, the quantity of the medicine may go up to 24 ounce a day.

The patient is not allowed to eat or drink till the medicine is fully digested. In normal cases the patient remains without food for 18 hours or more. The patient is given warm water to drink at the end of the designated matra. When the eructation (belching) has no smell or taste of the medicated ghee, it is presumed that the digestion of the medicine is completed.

Snehapanam does not exceed seven days at a stretch. It can be stopped earlier if in the opinion of the physician, the ulcer is cured. The medicated ghee remains in the stomach for 8 to 10 hours and it stops or reduces gastric secretions considerably. The daily routine prevents hydrochloric acid from coming in contact with the mucous coat of affected area. The damaged mucous lining gets rejuvenated and the ulcer disappears.

In the case of ulcer caused by bacteria, the acid is found to be at an above normal level. This condition is called as Amla Pittam.

During the course of the treatment, the patient consumes very little carbohydrate and no protein but plenty of liquids. He / She draws on previously stored potential energy (glycogen) in liver, muscles etc for all metabolic activities. The lipids play stellar roles in metabolism. The CNS and the endocrine systems are simulated. Cortico steroids inhibit bacterial growth. Neuro secretions from the pituitary show enhanced levels. The immune system of the body is activated and strengthened. 

The Medicine

In Snehapanam, the ghee is both a medicine and a carrier of the medicine it holds. The medicines and the ghee act in tandem with each other. The ghee has many lipids containing fatty acids and glycerol. The fatty acids may be saturated or unsaturated. The lipids of the cow’s ghee are a storehouse of phospho lipids, which strengthen the CNS, encourage healthy cell membrane and the myelin sheaths of the nerve fibers. The medicine works in five ways, namely as an

a.      Anticholinergic
b.      Antispasmodic
c.      Anti H 2 receptor
d.      Antacid
e.      Nerve tonic

All the ingredients of the medicine are lipid soluble (fat soluble). They penetrate deep into the mucous coat, incapacitate and kill the ulcer causing bacteria and encourage vigorous tissue growth on the effected intestinal lining.

Conclusion

As in all diseases, in peptic ulcer also, prevention is much more desirable than curative management. A change in life style is the best bet. On the curative aspect, Snehapanam is the most effective treatment to fight peptic ulcer.

 …Contributed by Dr Raghavan Vettath, Kandanassery, Kerala 680 102, INDIA

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