Heartburn is due to excessive secretion of gastric acid or its reflux to the food pipe along with delayed gastric emptying and fermentation of food. Gastric acidity and inflammation of the stomach is called gastritis, which produces a common symptom of burning sensation in the middle part of the upper half of the abdomen, while acid reflux causes throat and heartburn and delayed gastric emptying with fermentation leads to gaseous distension of abdomen and belching. These abnormalities lead to symptoms like nausea, loss of appetite, indigestion and mild to moderate upper abdominal pain and distress.

Frequent dietary irregularities and ingestion of irritant materials like too spicy and sour foods, alcohol and analgesic drugs like aspirin are the common causes of acidity and gastritis. Mental stress significantly aggravates the symptoms of acidity and gastritis. Ayurveda designates the symptom complex of acid peptic disease as Amlapitta attributed to the impairment of digestive juices and protective lining of stomach. Improperly treated acidity may lead to peptic ulcer due to damage in the mucosal lining of the stomach and duodenum. Judicious use of Amalaki powder is effective in successful management of acidity and gastritis with certain do’s and dont’s described in the Ayurvedic texts:

• (1) It is advisable not to overeat and have long gaps between meals. Small frequent meals of soft and easily digestible food items should be taken.
• (2) Consumption of raw and leafy vegetables, fried, spicy, sour, salty, heavy and improperly cooked food, sheep’s milk, alcohol, curd, sesame seeds should be avoided.
• (3) Use of vegetables with bitter taste such as bitter gourd, banana flowers, and pumpkin, pomegranate, honey, boiled and cooled water and food grains like wheat, rice and barley is beneficial in patients with acidity and gastritis.
• (4) Suppression of natural urges, particularly of vomiting and passing stools should be avoided.

Amalaki (Phyllanthus emblica Linn.)

The formulation is made from the dried mature fruits of Amalaki, which is a small or medium-sized tree found abundantly in mixed deciduous forests and cultivated in gardens and home yards. Ripe fruits are collected in late winter or early summer and are dried in shade. Dried fruits are then separated from the seeds and are kept in airtight plastic bags or boxes under dry storage conditions. Extensive uses of Amalaki as medicine and tonic are described in Indian Medicine and the medicinal plant is included in the Ayurvedic Pharamacopoeia of India.

Composition: The formulation is a fine powder made of single herbal ingredient Amalaki.

English name	Indian gooseberry
Latin name	Phyllanthus emblica (Linn.)
Family	Phyllanthaceae
Plant part used	Fruit

Main chemical constituents: Vitamin C, minerals and aminoacids.

Quality standards

Purity and strength of dried mature fruits of Amalaki is determined on the basis of:

Foreign matter	Not more than 3%
Total ash	Not more than 7%
Acid insoluble ash	Not more than 2%
Acid-soluble extractive	Not less than 40%
Water-soluble extractive	Not less than 50%

Method of preparation

• (1) Seedless dried fruits of Amalaki are cleaned and ground into fine powder using a grinder or pulverizer.
• (2) Powder is sieved through mesh 80 to remove coarse particles and fibers.
• (3) The powder should be kept in a dry airtight container to prevent exposure to moisture.
• (4) Potency of the properly preserved dried fruits lasts for one year.

Dosage form: Fine, sour-tasting grayish to blackish powder.

Therapeutic properties: Antacid, anti-ulcer, anti-emetic, antiinflammatory, antioxidant, immunomodulator, rejuvenator and a rich source of vitamin C.

Dose and mode of administration

In adults, the dose of Amalaki powder is 3 to 6 grams and in children 500 mg to 1 gram, twice a day, to be swallowed on an empty stomach or just before meals with water.

Indications and uses

• (1) Hyperacidity, gastritis, anorexia, vomiting during pregnancy and anaemia associated with chronic acid peptic disease are the common indications for Amalaki powder.
• (2) Clinical trials have proven Amalaki to be effective in the management of acidic gastritis, non-ulcer dyspepsia and duodenal ulcer with significant prevention of recurrence of symptoms.
• (3) Amalaki powder can also be used as a natural supplement of vitamin C in nutritional deficiencies, pregnancy and chronic diseases.

Precautions and safety aspects

• (1) Amalaki powder is generally a safe medicine. No toxic or adverse effects are reported even with continuous use. Assay study for cellular toxicity of crude alcoholic extract of Amalaki has proved it safe. Safety of Emblica officinalis is attributed to its anti-mutagenic, anti-microbial, anti-inflammatory, anticarcinogenic, anti-oxidant, anti-tumour and immuno-modulatory activities and numerous indications for its use in children and pregnant women. It is also safe to the baby if the nursing mother is taking this medication.
• (2) Individuals sensitive to sour taste should add sugar to the formulation or consume it in capsule form. Mixing it in warm water or with sugar or honey makes ingestion of Amalaki powder easy.
• (3) Amalaki has a cooling property and hence individuals intolerant to cold should consume it with ginger powder and warm water or honey. Even then if symptoms worsen, medication with Amalaki powder may be stopped.
• (4) It is advisable for patients of acidity and gastritis to avoid the intake of spicy, hard, heavy, dry and raw foods, particularly leafy vegetables and salad. Tendency of overeating and frequent munching and use of alcoholic beverages should be avoided.

References:

• (1) The Ayurvedic Pharmacopoeia of India. Ministry of Health & Family Welfare, Department of Indian Systems of Medicine & Homeopathy, New Delhi, India, Reprinted Edition, 2001 Part I, Vol. I, p. 5-6.
• (2) Sharma PC, Yelne MB & Dennis TJ. Database on Medicinal Plants Used in Ayurveda, Central Council for Research in Ayurveda & Siddha, New Delhi, 2001, Vol. 3, p. 14.
• (3) The Ayurvedic Pharmacopoeia of India. Ministry of Health & Family Welfare, Department of Indian Systems of Medicine & Homeopathy, New Delhi, India, Reprinted Edition, 2001, Part I, Vol. I, p. 5.
• (4) Sharma PC, Yelne MB & Dennis TJ. Database on Medicinal Plants Used in Ayurveda, Central Council for Research in Ayurveda & Siddha, New Delhi, 2001, Vol. 3, p. 12, 14.

Further reading:

• (1) Kirtikar KR & Basu BD. Indian Medicinal Plants, reprinted edition. L.M. Basu, Allahabad, India, Vol. III. 1988.
• (2) Kurup PNV, Ramdas VNK & Joshi P. Hand Book of Medicinal Plants (revised and enlarged). Central Council for Research in Ayurveda and Siddha, New Delhi. 1979.
• (3) Mathew SM, Rao SB, Nair GRS. Anti-ulcer activity of Amla extract. Int. Seminar on Recent Trends in Pharm. Sci., Ootacamund, Abstr. No. A 7. 1995.
• (4) Parvathavarthini S et al. Anti-ulcer activity of Emblica officinalis (Indian gooseberry). Proc. Int. Cong. “Ayurveda 2000”, Chennai, Tamil Nadu, India, 28-30 Jan. 2000.
• (5) Rastogi RP & Mehrotra BN. Compendium of Indian Medicinal Plants, reprinted edition. Publications and Information Directorate, Council of Scientific and Industrial Research, New Delhi, Vol. 1, 2 & 3. 1993.
• (6) Sharma PV. Dravyaguna Vijnana. Chaukhambha Bharati Academy, Varanasi, Vol. II. 1981.
• (7) Sharma PV. Classical Uses of Medicinal Plants. Chaukhambha Visvabharati, Varanasi, India. 1996.
• (8) Shastri AD. Bhaishajyaratnavali. Chaukhambha Sanskrit Sansthana, Varanasi, India. 1981.
• (9) Varma MD et al. Amalaki rasayana in the treatment of chronic pepticulcer. J. Res. Indian Med. Yoga & Homeop., Vol. 12(4). 1977.

Source: Traditional Herbal Remedies for Primary Health Care - WHO