THERAPEUTIC POTENTIAL OF PITTA-SAMANA INTERVENTIONS AND VIRECHANA IN MITIGATING LONG-TERM PROTON PUMP INHIBITOR DEPENDENCE: A SYSTEMATIC REVIEW

Background: Long-term administration of Proton Pump Inhibitors (PPIs) for acid-peptic disorders including Gastroesophageal Reflux Disease (GERD) and non-ulcer dyspepsia-frequently triggers hypergastrinemia, rebound acid hypersecretion, gut dysbiosis, and micronutrient malabsorption. Traditional Ayurvedic clinical theory frames these systemic manifestations within the paradigms of Amlapitta and Pitta-Vriddhi. Objective: To systematically evaluate the therapeutic efficacy of Pitta-Samana (Pitta-pacifying) internal preparations, Pitta-Hara dietary protocols (Pathya), and Virechana Karma (therapeutic purgation) in tapering chronic PPI dependence, restoring gastric physiological baseline, and counteracting rebound hyperacidity. Methods: Following PRISMA guidelines, we searched MEDLINE/PubMed, AYUSH Research Portal, DHARA, and Google Scholar for literature published through 2026. Studies assessing Virechana and Pitta-Samana modalities in chronic hyperacidity, acid-peptic conditions, or clinical cohorts undergoing active PPI withdrawal were selected for analysis. Results: Evidence demonstrates that Virechana Karma systematically clears excessive Dravatva (fluidity) and Ushnatva (heat) characteristic of vitiated Pitta, accelerating mucosal healing and normalizing basal gastric secretion. Concurrent Pitta-Samana formulations (Avipattikara Churna, Kamadugha Rasa, Sutshekhar Rasa, Yashtimadhu, and Amalaki) significantly attenuate rebound acidity during structured step-down tapering schedules. Conclusion: Integrated Ayurvedic strategies combining bio-purification (Shodhana) with palliative medication (Shamana) present a viable therapeutic path for weaning patients off chronic PPI therapy while addressing underlying physiological dysregulation (Agni Mandya and Pitta-Dushti).