Managing Hyperacidity: The Efficacy of Sutashekhara Rasa in Ayurvedic Treatment

Amlapitta, a prevalent gastrointestinal issue affecting a significant portion of the population, stems from imbalanced Agni in the digestive system. Sutshekhar Ras, comprising ingredients like Parad, Gandgak, Dhatura, and others, is recognized in Ayurvedic texts like Yog Ratnakar for its efficacy in managing Amlapitta. This formulation is not only recommended for Amlapitta but also for conditions like Gulma, Mandagni, Tridoshaj Atisara, and Daha Rogas. This review aims to explore the potential mechanisms through which Sutshekhar Ras alleviates symptoms of Amlapitta.


Introduction
Vitiation of agni in Amashaya (stomach) region due to various reasons causes Amlapitta.Some of the common pitta vitiating factors are fasting, eating between meals, worry, hurry, spicy foods etc.These factors derange the pachaka pitta (digestive enzymes etc.) and as a re-sult pachaka pitta vitiates.Thus developed condition is called Amlapitta.Hydrochloric acid (HCl) when not utilized well, or when produced in large quantity in the stomach region causes inflammation of stomach (gastric = related to stomach), that is called gastritis.This can derange the digestive procedures.The increased or nor-mal level of HCl can destroy the soft tissue (epithelium) lining of esophagus, stomach, duodenum etc.If not managed on time this can give rise to ulceration (breech in tissue).Usually the esophageal sphincter muscle contracts thus preventing the stomach acid from shooting up into the esophagus, but if this muscle are not functioning properly, the acid can slip past it and this is when heart-burn symptoms start, which is called Gastroesophageal reflux.Ayurvedic Samhita's have described healthy routine under Dinacharya and Rutucharya but in present scenario due to busy life style people are unable to follow the norms of Dinacharya and Rutucharya resulting in Agnimandya which ultimately lead to disease like Amlapitta.In Ayurveda, all the diseases are due to hypofunctioning of Agni.The word "Amlapitta" (Hyperacidity) comprised of two words-'Amla' (Sour) and 'Pitta' (Gastric juice).In Amlapitta the quantity of pachaka pitta is increased, its quality of normal bitter taste (alkaline) is change to more sour taste (acidic) as a result of fermentation, because of this increased sour quality of pitta (Gastric juice) it is called Amlapitta (Hyperacidity) Amlapitta is commonly encountered disease of Annavahastrotas (GIT) especially mentioned in Kashyap Samhita.Though it can be described as a disease of modernization due to irregular eating habits, it is more of psycho-somatic disorder caused due to mental stress and strain Table 1 Classification of Amlapitta with its sign and symptoms.

Ayurvedic Treatment for Amlapitta
The main key for treating Amlapitta is to improve digestion.As the saying goes "Prevention is better than cure" it is better to avoid all the causative factors of Amla-pitta.One should follow the meal times.Avoid eating spicy foods, or foods contain-ing excess amount of garlic, salt, oil, chillies, etc. very often.Include liquids like lemon juice, kokam juice, sweetlime juice, pomogranate juice, amla juice.Shatavari kalpa mixed with water.Medicated water with ushir (wala) or coriander seeds, or laja (puffed rice).Shadangodak (water medicated with musta, parpatak, ushir, chandan, udichya & shunti).Moramla (jam of amla), gulkand (jam of rose petals) can be taken singly or along with milk gives good relief, dadimpak (sweet syrup of pomogranate juice).Vegetables like white pumpkin, bitter gourd, okra, all leafy vegetables can be eaten except methi which should be definitely avoided.Fruits like black grapes, sweet lime, pomogranate, fig, dry fig, black resins.

Physiology of acid secretion
In the stomach parietal cell secretes hydrochloric acid intrinsic factor which are predominantly present in oxyntic glands.Chief cell secretes the digestive enzyme precursor pepsinogen.The histamine, gastrin and acetylcholine released from postganglionic enteric neurons are the principle stimulants for acid secretion by binding to muscarinic receptors on parietal cells.[11] 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 pepsin.[12] These all antacids are administered orally, and their potency is measured by the amount of acid neutralized by a given dose of the antacid.

Sutashekhara Rasa
Sutashekhara Rasa is an Ayurvedic medicine formulation composed of purified mercury, sulfur, and aconite, along with other herbs and minerals, aimed at managing digestive disorders effectively.Its ingredients, like purified mercury and sulfur, undergo rigorous purification processes to eliminate toxins while retaining therapeutic benefits.Additionally, aconite, known for its analgesic and antiinflammatory properties, is included in small quantities.This formulation is primarily used to alleviate symptoms such as gastritis, hyperacidity, indigestion, and peptic ulcers by enhancing digestion and regulating stomach acid secretion.Furthermore, its antacid and anti-inflammatory properties help neutralize excess stomach acid and reduce inflammation in the gastrointestinal tract.Sutashekhara Rasa also aids in balancing the Vata and Kapha doshas, promoting overall digestive health.However, it's crucial to consult a qualified Ayurvedic practitioner for proper dosage and guidance to ensure safety and efficacy, as improper use may lead to adverse effects like abdominal discomfort or allergic reactions Sutshekhar Ras is an important medicine used in Ayurveda, which act on Pitta Dosha and reduce the symptom of Amlapitta.This preparation is indicated (Phalashruti) in Amlapitta, Gulma, Mandagni, Tridoshaja Atisara, Daha Rogas (burning sensation).

Dhatura
Dhatura stramonium is main ingredient of Sutshekhar Ras.It contains atropine, hyoscyamine and scopolamine which can produce poisoning with a severe anticholinergic syndrome.
[15] atropine, hyoscyamine and scopolamine (the 1-enantiomer of atropine) are the primary active constituents in all Dhatura species The three primary alkaloids in Dhatura are antimuscarinic, anticholinergic which means they competitively antagonize (block) the muscarinic acetylcholine receptors.As it is potent anticholinergic drug, it inhibits the action of acetylcholine by blocking action of acetylcholine, dhatura inhibit acid (HCl) production in gastric mucosa and relive hyperacidity.

Shankha bhasma
Other component of Sutshekhar Ras is Shanka Bhasma.This is a calcium carbonate compound.This directly react with gastric HCL and neutralise them, so this act as potent antacid.

Louha bhasm
Another compound Lauha bhasma also directely 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.

Mode of action of different ingredients according to ayurvedic point of view
In the treatment of Amalapitta (hyperacidity or acid reflux), Ayurvedic Acharyas recommend the use of herbs and substances with specific properties to pacify the aggravated Pitta dosha and improve digestion.
Here's a breakdown of the treatment approach and the properties of the recommended drugs: Properties of Drugs for Amalapitta: Katu, Tikta, and Madhur Rasa: These tastes (flavors) include pungent, bitter, and sweet tastes.They have a cooling effect on the body and help balance the excess heat associated with aggravated Pitta dosha.
Sheet Veerya: Refers to cooling potency, which helps alleviate the heat and inflammation associated with Amalapitta.Katu Vipak: Refers to pungent post-digestive effect, which aids in balancing the digestive fire (Agni) and promoting healthy digestion.Ruksha Guna: Indicates dryness, which can help absorb excess moisture and acidity in the gastrointestinal tract.
Role of Tikta, Kashaya, and Madhur Ras: Pitta Shamaka: These tastes (bitter, astringent, and sweet) help pacify the aggravated Pitta dosha, which is responsible for the symptoms of hyperacidity.
Counteracting Tikshna Guna: The sweet taste of Madhura Rasa counteracts the sharp and penetrating nature of the vitiated Pitta, providing a soothing effect.
Relief from Daha (Burning Sensation): The combination of these tastes and properties helps relieve the burning sensation associated with Amalapitta and promotes overall strength.

Role of Pipali (Pippali):
Ampachan: Pipali, or long pepper, is renowned for its digestive properties.It helps in the digestion of undigested food (Ama) and improves digestive fire (Agni), which is often compromised in cases of Amalapitta.
Role of Sankha Bhasma and Tankan (Tankana): Kshariya Nature: Refers to alkaline properties, which help neutralize acidity in the stomach and maintain a proper acid-base balance.
Reduction of Amliyata (Acidic Nature): Sankha Bhasma (prepared from conch shell) and Tankan (borax) have alkaline properties that counteract the acidic nature of the stomach, thus reducing hyperacidity.

DISCUSSION
The treatment of Amlapitta, or hyperacidity, often involves the use of Sutashekhara Rasa, a classical Ayurvedic formulation renowned for its efficacy in managing digestive disorders.Sutashekhara Rasa contains ingredients with Katu, Tikta, and Madhur tastes, along with Sheet Veerya and Ruksha properties, which work synergistically to pacify the aggravated Pitta dosha and alleviate symptoms such as burning sensation and acid reflux.Additionally, the Tikta, Kashaya, and Madhur ras predominant properties of Sutashekhara Rasa help balance digestive fire (Agni), neutralize excess stomach acid, and promote overall digestive health, making it a valuable remedy for Amlapitta.Furthermore, the inclusion of Pipali aids in digestion and alleviates Ama formation, while Sankha Bhasma and Tankan, with their alkaline nature, effectively counteract the acidic environment in the stomach, providing relief from hyperacidity.Overall, Sutashekhara Rasa presents a holistic approach to the management of Amlapitta, addressing both the symptoms and underlying imbalances with its well-balanced composition and therapeutic actions.

CONCLUSION
Sutshekhar Rasa correcting the vitiated state of pitta improves the whole digestion process and results in proper functioning of Agni.Conceptually it is concluded that the substances having properties like Ruksha, Laghu, Katu and Ushan has the effect to decrease the vitiated Dravya roop of pitta and maintain the proper functioning of Agni.This study can prove a real breakthrough in the coming times for the treatment of Amlapitta.