Tamakswas kc005 kop

BY Dr. SUJATA .S.TENGINAKAI

BAMS (Karnataka University, Dharward)

DISSERTATION SUBMITTED TO THE

RAJIV GANDHI UNIVERSITY OF HEALTHSCIENCES, KARNATAKA, BANGALORE IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE OF “DOCTOR OF MEDICINE” (AYURVEDA)

in

KAYACHIKITSA

GUIDE Prof. P.K.MISHRA

MD (Ay)., (RSU).,

H.O.D of KAYACHIKITSA

DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA A.L.N.RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE KOPPA - 577126

CHIKMAGALUR DISTRICT, KARNATAKA, INDIA MARCH - 2004

Ayurmitra

TAyComprehended

A.L.N.Rao Memorial Ayurvedic Medical College Koppa – 577126 Dist: Chikmagalur

Department of Post graduate Studies in KAYACHIKITSA

I here by declare that this dissertation entitled “A CLINICAL STUDY ON THE

MANAGEMENT OF TAMAKA SHWASA WITH SPECIAL REFERENCE TO

VIRECHANA AND SHAMANA” is a bonafide and genuine research work

carried out by me under the guidance of Prof. P.K.MISHRA.

H.O.D of Post Graduate Studies in KAYACHIKITSA, A.L.N. Rao Memorial

Ayurvedic Medical College P. G. Centre, Koppa.

Date:

Place: Koppa

Dr. Sujata .S.Tenginakai P.G.Schalor,

Dept. of Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

Ayurmitra

TAyComprehended



This is to certify that the dissertation entitled “A CLINICAL STUDY ON THE


VIRECHANA AND SHAMANA” is a bonafide research work done by

Dr. Sujata .S.Tenginakai. in partial fulfillment of the requirement for

the degree of Ayurveda Vachaspati (MD) in Kayachikitsa of Rajiv Gandhi

University of Health Sciences, Bangalore, Karnataka.

Date:

Place: Koppa

Prof. P.K.MISHRA MD (Ay)., (RSU).,

Head of the Department, Kayachikista

A.L.N.Rao Memorial Ayurvedic Medical College.

Koppa –577126, Dist: Chikmagalur



This is to certify that the dissertation entitled “A CLINICAL STUDY ON THE


VIRECHANA AND SHAMANA” is a bonafide research work done

by Dr. Sujata. S.Tenginakai. of under the guidance of

Prof. P.K.MISHRA. H.O.D of Post Graduate Studies in

Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College P. G. Centre,

Koppa.

Date:

Place: Koppa

Dr.Jagadeesh.Kunjal. MD (Ayu).,

Principal, A.L.N.Rao Memorial Ayurvedic Medical College. Koppa –577126, Dist: Chikmagalur

COPYRIGHT

I here by declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this

dissertation in print or electronic format for academic/research purpose.

Date:

Place:

Dr. Sujata .S.Tenginakai. P.G.Schalor, Dept. of Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

© Rajiv Gandhi University of Health Sciences, Karnataka

ACKNOWLEDGEMENT

I remain grateful forever to respective Guide Prof.P.K.Mishra. M.D (Ayu)., HOD,

Dept. of Kayachikitsa, A.L.N.Rao Ayurvedic Medical College Koppa, for his valuable

guidance, meticulous supervision, timely given advises, motivational inspiration and co-

operation that he extended kindly towards me throughout this dissertation work.

I am grateful for ever indebted to Sri Aroor Ramesh Rao, President, A.L.N.Rao

Ayurvedic Medical College Koppa, for giving me an opportunity to do my P.G.Studies.

I am grateful to Dr.Jagadeesh Kunjal M.D (Ayu), Principal, A.L.N.Rao Ayurvedic

Medical College Koppa, for his help and support in completing this work.

My sincere gratitude to Prof.D.S.Lucas, M.D (Ayu), FRAS (London), for his

motivational inspiration and support.

My sincere gratitude to Dr.Sanjaya K.S., M.D (Ayu)., Dept. of Dravya guna,

A.L.N.Rao Ayurvedic Medical College Koppa, for his timely guidance and moral

support.

My sincere gratitude to Prof.Narayan Sharma M.D., Dept. of Kayachikista,

Dr.Prashanth .A.S, Asst.Prof. Dept. of Kayachikitsa, Hubli, Dr.Dinesh Mishra M.D,

Dept. of Rasashastra, Dr.Sreedhar .V, Dr.Lalitha Bhaskar, Dr.Das, Dr.Poornima,

Dr.Manasa for their guidance and advises.

My special thanks to Dr.Anandalakshmi, Tutor, Dept. of Shareerakriya,

Trivendrum for her kind and valuable help.

My special thanks to Dr.Rahul, Lecturer, Bagalokot, Dr.Aparaj, Dr.Ramesh N.V,

Dr.Shanubag.

I am grateful to Mr.Satish, Librarian and Miss.Triveni who helped me a lot in my

reference work.

I express my sincere gratitude to Prof.Narayan Tantri, Dept. of Statistics

Bandakar’s College Kundapur who assisted in the statistical analysis of my dissertation

work.

I am equally grateful to Mr. Ramesh Gowda, Smt.Jyothi, and all office staff. My

special thanks to Miss.Jyotsa, Lab technician, Mr.Thomas and all hospital staff.

I am especially thankful to Mr.Mathew, Miss.Vimala of college pharmacy for

their timely help while preparing the medicine.

My special thanks to Miss.Nandini, Mr.Bhavesh of Panchakarma Department for

their help in giving Bahyabhyanga and Nadisweda to the patients. And also to Nurses

Miss.Manjula, Miss.Lalita, Miss.Sunitha who took care of patients during their

admission.

I grateful to my electronic crew Mr.Shrikanth Shetty and Mr.Shreedhar Gowda of

Koppa for their kind support during typing, editing and printing of this dissertation work.

I special to thanks to my friends Dr.Indu, Dr.Pradeep, Dr.Pankaj, Dr.Pratibha, and

Dr.Kavitha for their help in completing the dissertation work.

My special thanks to U.G.Students Mr.Raghavedra, Mr.Srinivas, Mr.Srinath for

their help in arranging the matter.

I would like to submit my heartfelt thanks to all my patients who participate in my

study took the medicine with the great faith.

I remain grateful forever to my brother and sisters who offered me great moral

support in my P.G.Studies. I am heartly grateful to my loving husband Dr.M.S.Koppad,

M.B.B.S., who inspired me and helping me to pursue the master degree and his friend

Dr.Sanjay Patil, M.D. General Medicine, who helped in the collection of modern literature

and gave guidance.

I dedicate this work to my parents who helped me financially and in all aspect.

Finally a thank all who helped directly or indirectly to complete this work I wish

to acknowledge the please.

Dr.Sujata. S.Tenginakai.

ABBREVATION

Cha.Sa.Su – Charaka Samhita Sutrasthana

Cha.Sa.Ni - Charaka Samhita Nidansthana

Cha.Sa.Chi – Charaka Samhita Chikitsasthana

Cha.Sa.K – Charaka Samhita Kalpasthana

Cha.Sa.Ind - Charaka Samhita Indriyasthana

Cha.Sa.Si - Charaka Samhita Siddhisthana

Su.Sa.Su – Shusruta Samhita Sutrasthana

Su.Sa.Chi – Shusruta Samhita Chikitsasthana

Su.Sa.U – Shusruta Samhita Uttaratantra

A.H.Su – Astanga Hridaya Sutrasthana

A.H.Ni – Astanga Hridaya Nidanasthana

A.H.Chi - Astanga Hridaya Chikitsasthana

A.S.Su – Astanga Sangraha Sutrasthana

A.S.Ni - Astanga Sangraha Nidanasthana

Sha.Sa.P.K – Sharangadhar Samhita Prathama Khanda

Sha. Sa.M.K - Sharangadhar Samhita Madhyma Khanda

Sha.Sa.U.K - Sharangadhar Samhita Uttara Khanda

Y.R.Swa.Chi – Yoga Ratnakara Swasa Chikitsa

B.R. – Bhishajya Ratnavali.

Ma.Ni – Madhava Nidana.

Ha.Sa. – Harita Samhita

B.P.Ni.H.V – Bhavaprakasha Nighantuadhyaya Haritakyadi Varga

B.P.Ni.G.V - Bhavaprakasha Nighantuadhyaya Guduchyadi Varga

A.P of India – Ayurvedic Pharmacopoeia of India

INDEX

Page No.

INTRODUCTION 1-2

Chatper – I OBJECTIVES 3

Chapter – II REVIEW OF LITERATURE

Historical Review 4-5

Nirukti 6

Nidana 7-9

Samprapti 10-13

Poorvarupa 14

Rupa 15-17

Upashaya Anupashaya 18

Upadrava Arista, Sadhya Sadhyata 19

Vyavachedaka Nidana 20

Chikitsa vivechana 21-24

Pathya Apathya 25-26

Concept of Virechana 27-32

Modern Review 33-38

Drug Review 39-44

Chapter –III METHODOLOGY 45-52

Chapter –IV RESULTS 53-93

Chapter –V DISCUSSION 94-110

Chapter –V CONCLUSION 111-112

SUMMARY 113

REFERENCES

BIBLIOGRAPHY

CLINICAL PROFORMA

LIST OF TABLES

Page No.

1) Nidana of Shwasa/Tamaka shwasa 7-9

2) Poorvarupa of shwasa roga. 14

3) Lakshanas of Tamaka shwasa 15-16

4) Vyavachedaka nidana 20

5) Pathya in Tamaka shwasa 25

6) Apathya in Tamaka shwasa 26

7) Samsarjana karma in Tamaka shwasa 32

8) Symptom dairy 49-50

9) Grading for assessment of severity of Tamaka shwasa 51

10) Distribution of patients according to age group. 53

11) Distribution of patients according to sex. 54

12) Distribution of patients according to economic status 54

13) Distribution of patients according to education 55

14) Distribution of patients according to food habits 56

15) Distribution of patients according to agni 56

16) Distribution of patients according to prakrati 57

17) Distribution of patients according to koshta 58

18) Distribution of patients according to satwa 58

19) Distribution of patients according to habitat 59

20) Distribution of patients according to chronicity 60

21) Distribution of patients according to relation to food 60

22) Distribution of patients according to sleep pattern 61

23) Distribution of patients according to relation to exercise 62

24) Distribution of patients according to relation to climate 62

25) Distribution of patients according to relation to smoking 63

26) The response of therapies after treatment. 69-70

27) The response of therapies at the end of follow up. 78

28) Statistical analysis of group A results 84

29) Statistical analysis of group B results 85

30) Statistical analysis of group C results 86

31) Observations based on laboratory findings. 93

LIST OF DIAGRAMS, CHARTS & GRAPHS

Page No.

A. List of diagrams

1. Fig No 1 – Incidence of Age. 53

2. Fig No 2- Incidence of sex 54

3. Fig No 3 - Incidence of Economical status 55

4. Fig No 4 - Incidence of Education 55

5. Fig No 5 - Incidence of food habits 56

6. Fig No 6 - Incidence of Agni 57

7. Fig No 7 - Incidence of Prakruti 57

8. Fig No 8 - Incidence of Koshta 58

9. Fig No 9 - Incidence of Satwa 59

10. Fig No 10 - Incidence of Habitat 59

11. Fig No 11 - Incidence of Chronicity 60

12. Fig No 12 - Incidence Relation to food 61

13. Fig No 13 - Incidence of Sleep pattern 61

14. Fig No 14 - Incidence Relation to Exercise 62

15. Fig No 15 - Incidence Relation to Climate 63

16. Fig No 16 - Incidence of smoking 63

B. List of Charts

17. Flow Chart showing Samprapti of Tamaka Swasa 11

C. List of Graphs

1. Overall response at the end of treatment 70

2. Response on Shwasakrichrata at the end of treatment 71

3. Response on Ghurghuraka at the end of treatment 71

4. Response on Kasa at the end of treatment 72

5. Response on Shwasakrichrata (Duration) at the end of treatment 72

6. Response on Nidra at the end of treatment 73

7. Response on Prajna at the end of treatment 73

8. Response on Shwasakrichrata (speech) at the end of treatment 74

9. Response on Vyavyama at the end of treatment 74

10. Response on PEFR at the end of treatment 75

11. Overall response at the end of follow up. 79

12. Response on Shwasakrichrata at the end of follow up 79

13. Response on Ghurghuraka at the end of follow up 80

14. Response on Kasa at the end of follow up 80

15. Response on Shwasakrichrata (Duration) at the end of follow up 81

16. Response on Nidra at the end of follow up 81

17. Response on Prajna at the end of follow up 82

18. Response on Shwasakrichrata (Speech) at the end of follow up 82

19. Response on Vyayama at the end of follow up 83

20. Response on PEFR at the end of follow up 83

21. Mean scores of Shwaskrichrata in A, B & C groups. 87

22. Mean scores of Ghurghuraka in A, B & C groups. 87

23. Mean scores of Kasa in A, B & C groups. 88

24. Mean scores of Shwaskrichrata(Duration) in A, B & C groups. 88

25. Mean scores of Nidra in A, B & C groups. 89

26. Mean scores of Prajna in A, B & C groups. 89

27. Mean scores of Shwaskrichrata (Speech) in A, B & C groups. 90

28. Mean scores of Vyayama in A, B & C groups. 90

29. Mean scores of PFERin A, B & C groups. 91

30. Mean scores of Overall response in A, B & C groups. 91

ABSTRACT

Tamaka Shwasa the disease of pranavaha srotas is said to be sadhya in its initial

stage of onset provided that it is accurately diagnosed and treated properly, otherwise it

becomes yapya. It is prevalent in almost all parts of the world.

Tamaka shwasa is vatakaphaj vyadhi being pittasthana samudhbhava, Virechana

has been considered effective therapy. In the same way Acharya Charaka mentioned the

importance of shamana therapy, also opines ‘Tamaketu Virechanaam’ hence it is the need

of time to find out effective therapy for this dreadful disease.

Objective :-

1. To evaluate the effect of Virechana and Bharangyadi kwatha in bringing

symptomatic relief.

2. To find out effect of the treatment on the lung functions

Methods :-

In this clinical study 36 patients were selected for the study (6 patients left in

between) coming under inclusive criteria and are randomly allocated into three groups

For Group A – Virechana

Group B – Bharangyadi kwatha

Group C – Virechana followed by Bharangyadi kwatha has been given.

Severity of disease was assessed by subjective and objective parameters.

Interpretation and Results:

Group A has greater significant effect on PEFR, Shwasakrichrata (speech) and

Prajna at the end of follow up and significant effect on vyayama at the end of follow up,

non significant effect on Shwasakrichrata, Kasa, Nidra. Group B has highly significant

effect on Shwasakrichrata (duration), Shwasakricrta (speech) PEFR, Group C has overall

highly significance. Thus Virechana improves vital capacity of lungs, effort based

activities, whereas Bharangyadi kwatha relieves air way obstruction as well as improves

vital capacity of lungs and effort based activities.

Conclusion:

• Virechana helps in enhancing vital capacity of lungs effort based activities.

• Virechana acts as Vatanulomaka, Raktashodaka, Shonita sthapaka and has little effect

on air way obstruction.

• Bharangyadi kwatha has better effect on both air way obstruction, effort based

activities.

Keywords:

Pittasthana; PEFR; Tamaka shwasa; Virechana; Bharangyadi kwatha; Shamana;

Shwasakrichrata; Prajna; Raktashodaka; Shonita sthapaka;

Introduction

Page 1

INTRODUCTION

¦ddeªd±¤dZ §d‚dPd§d®d¦dZ ±§dmßd Umµ£I¶«d¬dd¦£dT«dŠ | I¶PMµdÙeUµe®d‰e¦dSdd‰£d §dd£dga e®d°Pdg§dQd«dm£d«dŠ | §df£®dd Ÿdd«©dT§dfSdj°da §dg¦dTdSde£d ®dy›d£dZ || §d‚fPdSd¦QyUµ«dešd¬da ¡df®dSd¢¡dMµTd¦d¬d«dŠ ||

¯dTfT§d‚dPdSddyTy®d ±daSddy›ddQdSdgèŸSd£dy || 1

Thus respiration is the vital sign of life, its normalcy indicates the health; its

abnormality suggests disease and ceasation marks death. This unique indicator of life is

affected in the disease Tamaka shwasa 2. Any illness in person enforces him to be

restricted to bed. But in Tamaka shwasa patient is made to prop up instead of lying on the

bed 3. Rest for Tamaka shwasa patient is not on the bed but on the chair. Two mirrors

facing each other produces infinite numbers of images, like wise the patient of

Tamakashwasa living in the hostile environment suffers from frequent and innumerable

attacks of shwasa. Pre existing khavaigunya or reduced Vyadhi Kshamatva is said to be

the reason for abnormal response of the patient towards the trivial changes in the

environment which behaves as enemy of the patient. During an asthma attack it is

actually harder to breath out than it is breath in.

Tamaka shwasa which may be considered as Bronchial Asthma with the parlance

of modern medical science has a high incidence as 5-10% of the population are suffering

from Bronchial Asthma with irrespective of age, sex, occupation and socioeconomic

status etc in the present day. Even though with the best possible measures for the

management of Tamaka shwasa; the incidence of the disease is markedly increasing.

Hence it is the need of the time to ascertain an effective management of Tamaka shwasa.

The word ‘Asthma’ is a derivation of Greek word, meaning panting or gasping.

The word remains as we have no better word to describe it. Difficulty in breathing

whenever present cannot be called as Asthma. The prefix bronchial specifies the fact that

the basic problem is in the tracheobronchial tree, with the growing knowledge about

asthma, this condition is clearly defined and differentiated from other breathlessness.

Introduction

Page 2

In Ayurvedic science more emphasis is laid on the Shodhana upakramas as

Apunarbhava chikitsa. In the context of Tamaka shwasa. It is seen that more importance

is given to virechana i.e. Tamaketu virechanam 4.

Classically the concept of virechana in Tamaka shwasa seems quite encouraging

as virechana is vatanulomaka, chikitsa for pittasthana, pittasthanagata kapha and for

kapha samsristha doshas 5. All of the above concepts hypothetically indicates virechana

as a concept modality of treatment of Tamak shwasa, by restoring the normal flow of

vata, relieving the obstruction, the augmenting the normal functions of the pittasthana,

the seat of origin and expelling the morbid humors.

Bharangyadi kwathaa 6, 7 on the other hand possess all the properties, which can

mitigate the morbid doshas, facilitating normal flow of vata by reliving the obstruction.

Considering long term, effect of virechana and a short duration management by

Bharangyadi kwatha encouraged to under take the present study to clinically asses the

efficacies of the either of therapies considering the classical background.

The present dissertation work entitled – ‘A Clinical Study on the effect of

Virechana and Bharangyadi kwatha in Tamakashwasa with special reference to Bronchial

Asthma consists of following chapters.

objectives

Review of Literature

Methodology

Results

Followed by Discussion, Conclusion and Summary.

Objectives

� Page 3

OBJECTIVES

1) To evaluate the efficacy of virechana and Bharangyadi kwatha in bringing

symptomatic relief.

2) To find out the effect of therapies on lung functions.

3) Evaluating the role of Shamana and Shodhana chikitsa over the Tamaka shwasa by

following three group of studies.

a. Shamana chikitsa of Bharangyadi kwatha

b. Shodhana chikitsa of Virechana

c. Shodhana followed by Shamana chikitsa

4) To establish the utmost the utility of Bharangi over Tamaka shwasa on using

clerodendrom serratum roots under shamana group of studies.

5) Finding the benefit of purificatory therapy as virechana over Tamaka shwasa

according to major classical treaties of Ayurveda.

6) Analysing the subjective parameters of the disease Tamaka shwasa according to the

contemporary classical literature.

7) To find out the mode action of drug sample over the Tamaka shwasa as

Bronchodilator or with any other specific action.

8) To establish a safest and economically, easily feasible drug sample over Tamaka

shwasa.


A. DISESE REVIEW

HISTORICAL REVIEW

PREVEDIC AND VEDIC PERIOD

Reference regarding Tamaka shwasa is not available in the Vedic scripts, there is

only reference regarding the Prana vata and Apana vata available in Vedic scripts.

UPANISHATH KALA

Reference of respiration, opinion of absence of respiration suggesting the death is

available Amanaskopanishath.

In Brhadaranyakopanishath, Chandogyopanishath Prana has been named as

Angeeras, Ayusha, Brahaspati.

In Yoga Chudamanyam, the diseased conditions of Pranavaha srotas which

includes Hikka, shwasa and Kasa are described.

SAMHITA PERIOD

Charaka Samhita:

Detail descriptions regarding the Nidana Samprapti, Lakshanas, Sadhyasadhyatva

and Chikitsa have been explained in Charaka Samhita chikitsa sthana 17th chapter.

Sushruta Samhita:

The entire description of Shwasa roga is Nidanadi treatment is available in

Sushruta Samhita 51st chapter of Uttaratantra.

Bhela Samhita:

Shwasa as a symptom is mentioned in Bhela Samhita. In the form of complication

of many disorders shwasa is described in this treatise.

Page 4


Harita Samhita:

Nidana Chikitsa Pathyapathya of shwasa roga are described in Harita Samhita in

its 14th chapter of third sthana.

Kashyapa samhita:

The brief description of shwasa roga, and its treatment is described along with

Kasa roga in Khila sthana.

Astanga Hridaya and Astanga Sangraha:

In both Nidana and Chikitsa sthana, description of shwasa is available.

Madhava Nidana:

In this book diagnostic aspect of shwasa roga is described in the 12th chapter.

MEDIEVAL PERIOD

Chakrapanidatta:

Description of shwasa roga available in this book is in accordance with

Brihatrayi.

Chakradatta:

His treatise describe shwasa chikitsa in the 12th chapter along with Hikka roga.

Arunadatta:

In his commentary “Sarvangasundara on Astanga Hridaya, he has mentioned the

involvement of Kapha Dosha in the Etiopathogenesis of shwasa roga.

Bhavaprakasha and Yogaratnakara:

Nidanas and Chikitsa of Tamaka shwasa have been explained in Bhavaprakasha

Madhyama khanda 4 chapter and also in Shwasa Chikitsa Adhyaya by Yogaratnakara.

Bharangyadi kwatha is mentioned by Yogaratnakara for Tamaka shwasa.

Page 5


NIRUKTI

[ETYMOLOGICAL DERIVATION]

In Ayurveda, criteria for naming of the disease is not uniform. The diseases

Raktapitta and Vatarakta are named after the Dosha and Dushya involved in their

Samprapti. Grahani is named considering the site of illness. Cardinal symptom of illness

is the criteria for naming diseases like Chardi and Atisara. Likewise the predominant

symptom breathlessness is the basis for naming the disease shwasa. The word Tamaka

shwasa consists of two words. They are Tamaka and Shwasa.

TAMAKA

“Tamyati Anena Iti Tamaka, Tamaka Glanou” per this Sanskrit derivation, the

word Tamaka means, to choke darkness, be suffocated (VS Apte dictionary).

‘Tamyati Iti Tamaka, Tama Eva Tama’ in Shabdakalpadruma, according to this

the illness that causes darkness or the illness itself is the darkness is called by the name

Tamaka.

SHWASA

The word Shwasa is defined from the Sanskrit root shwasa, meaning “to breathe”.

“Shwasati Anena Iti Shwasaha” – breathing of air is known as shwasa (Apte dictionary).

This derivation represents the physiological aspect of breathing.

“Shwasasthu Basthrikadhmana Vatordwagamitha” – as per this derivation word

shwasa refers to expiration of the air producing sound similar to the one generated while

blowing the air with a blower by the blacksmith. This refers to the forceful laboured

breathing, probably with wheezing sound, thus it unravels the pathological expression of

breathing.

TAMAKA SHWASA

‘Tamakascha Asoushwasacha Tamaka Shwasa’ – this line explains manifestations

of the difficulty in breathing which occurs mainly during the night time.

“Visheshyaddurdine tammyethi Shwasaha Sa tamaka mataha”. The attack of

shwasa with tamapravesha which occurs specially during durdina is called Tamaka

shwasa.

Page 6


NIDANA

“Setikartavyataha rogatpadakaheturnidanam”8. The causative factor that

aggravates the doshas produces the diseases is called Nidana.

The causative factors of Shwasa roga which is of five types in general are also the

etiological factors of Tamaka shwasa. Tamaka shwasa may develop as an independent

illness, as a result of exposure to specific vata and kapha vitiating factors.

The disease may also manifest as a sequel of certain disorders like Anaha,

Raktapitta. Here Tamaka shwasa manifests as Nidanarthakara roga 9. To be more precise,

the illness Tamaka shwasa may be,

1.Nidanottha : the resultant of specific incriminatory factors

2. Rogottha : a sequel of certain disease 10, 11.

Chakrapani commenting on the nidanas (explained by Charaka) has classified

them into the Vataprakopaka gana and Kaphaprakopaka gana suggesting the rest of

nidanas as Viprakristha karanas.

Etiologies mentioned in Modern science are seen to resemble with nidanas

explained by our classics.

Table No.1 Showing Samanya nidanas of Tamaka shwasa

AAHARA SAMBANDHI

No CS12 SS13 AS14 AH15 BP16 YR17 MN18

1 Abhishyandi Bhojana + + - - + + + 2 Amaksheera + - - - - - - 3 Anoopa Mamsa + - - - - - - 4 Apatarpana + + - - + + + 5 Dadhi + - - - - - - 6 Guru Bhojana + + - - + + + 7 Jalaja Mamsa + - - - - - - 8 Masha + - - - - - - 9 Nishpava + - - - - - - 10 Pinyaka + - - - - - - 11 Pistha + - - - - - - 12 Ruksha Bhojana + + - - + + +

Page 7


13 Shalooka + - - - - - - 14 Sheeta Anna Sevana - + - - + + + 15 Sheeta Jala Pana + + + + + + + 16 Sleshmala Aahara + - - - - - - 17 Tila Taila + - - - - - - 18 Vidahi Bhojana + + - - + + + 19 Vistambhi Bhojana + + - - + + +

VIHARA SAMBANDHI

CS SS AS AH BP YR MN 20 Adhvagamana + + - - + + + 21 Adhyashana - + - - - - - 22 Anala - + - - - - - 23 Anila + + + + + + + 24 Atapa - - - - - + + 25 Ati Vyavaya + + - - - - - 26 Ati Vyayama + + - - + + + 27 Dhuma + + + + + + + 28 Karmabhara - + - - + + + 29 Raja + + + + + + + 30 Samashana - + - - - - - 31 Sheeta Jala Snana + - - - + + - 32 Sheeta Sthana Vasa + + - - - - + 33 Vegavidharana - + - - + + + 34 Vishamashana + + - - - - -

NIDANARTHAKAR ROGAS CS SS AS AH BP YR MN 35 Alasaka + - - - - - - 36 Amapradosha + + - - - - - 37 Amatisara - - + + - + - 38 Anaha + - - - - - - 39 Atisara + - - - - - - 40 Chardi + - + + - + - 41 Dosha Prakopa - + + + - + - 42 Dourbalya + - - - - - - 43 Jwara + - + + - + - 44 Kasa - - + + - + - 45 Kshaya + + - - - - - 46 Pandu + - + + - + - 47 Pratishya + - - - - - - 48 Raktapitta + - - - - - - 49 Udavarta + - - - - - - 50 Vibandha + - - - - - - 51 Visuchika + - - - - - -

Page 8


UPAKRAMA SAMBANDHI

CS SS AS AH BP YR MN 52 Ati Rukshana + - - - - - - 53 Vamana Atiyoga + - - - - - - 54 Virechana atiyoga + - - - - - - 55 Abhighata - + - - - - - 56 Kanthapratighata + - - - - - - 57 Kshatha + - - - - - - 58 Marmaghata + - + + - + - 59 Uropratighata + - - - - - - 60 Visha + - + + - + - 61 Durdina - + - - - - - 62 Meghaachidata

Dina + - - - - - -

The etiologies listed above can independently cause the imbalance of Vata and

Kapha dosha, some factors which may vitiate pitta dosha as well as dearrange the

pittasthana. Most of the factors vitiates the dosha through the Amashaya. Some other

factors like exposure to dust directly provoke the vata dosha in pranavaha srotas.

Concept of Dusivisha can be correlated with the allergic manifestation. The type

of poisonous substances which manifests its poisonous effects after the lapse of some

time is called dusivisha19. This visha vitiates blood and produces symptoms like uru

(eczema), Kitima (Psoriasis) Kothal (Urticaria). It when remains in amashaya produce

kapha vataj disorders 20. Shwasa is told as Amashayottha and Kaphavataj disease

Madhavakara has included shwasa in the list of disorder produced by dushivisha21. Thus

if we consider dushivisha as allergic factor is not incorrect.

Page 9


SAMPRAPTI

The unique nature of Samprapti of Tamaka shwasa determines this clinical

presentation of illness.

Some nidanas mentioned in classics, for which normal person on exposure rarely

get affected but patients of Tamaka shwasa, suffers from an episode of Tamaka shwasa.

Ayurveda explain this phenomenon as Avyadhisaha sharira (lack of resistance) to

the illness22. To elaborate either because of the faulty habits or due to mal development or

else the result of inborn errors related to the Pranavaha srotas predisposes to illness.

Variations in the environment, rainy season cloudy atmosphere, winter, smoke, dust are

described as enemies of the patient23 having weak Pranavaha srotas.

The intermittent nature of the environmental variation determines the episodic

nature of the Tamaka shwasa 24. As year passes more attack of Tamaka shwasa becoming

more and more frequent and ultimately looses its episodic nature and becomes a

continuous phenomena with excecerbations and remissions.

Charaka has told Tamaka shwasa as “Kaphavatatmakavetou pittasthana

samudbhava” it may be to indicate the two way pathogenesis occurring in Tamaka

shwasa. Most of the factors vitiates the dosha through the amashaya (Pittasthana

samudbhava) these nidanas lead to doshodhirana, agnimandhya, ama, this ama and excess

secreted kapha cause the obstruction in prana vaha srotas (Pranavahasrotomula

mahasrotas) that led to vilomagati of prana vayu

Some factors like exposure to raja dhumu directly provoke the vata dosha in

pranavahasrotas

Page 10


Chart No. 1

Vata Kapha prakopaka nidana

Doshodhirana Vata kapha prakopa in Pranavaha srotas Sanchay [Sanchayaprakopadi avastha] Agnimandhya Ama

Obstruction of srotas Tamaka shwasa

Prakopa

Doshaprakopa

Prasara

Sthana samsraya Pranavaha srotas

Vyakta Tamaka shwasa

Vata and Kapha both are involved in this disease. Vata dosha is best treated by the

snigdha line of treatment, where as kapha best treated by ruksha line of treatment thus

naturally contradictory thus posing practical problem. Kapha dosha and Rasa dhatu

belong to same categories. It is a general principle of pathogenesis that the dosha and

dusya belonging to the same category rapidly progress in the process of pathogenesis. In

Tamaka, Kapha dosha afflicts the Rasa dhatu.

Independent vitiation of Pranavata and Kapha dosha occurs in Tamaka shwasa

due to the effect of specific etiological factors. By virtue of its Ruksha, Sheet and Khara

qualities the abnormal Prana vayu renders hardening and narrowing of Pranavaha srotas.

The normal upward course of the Prana vayu is obstructed by the abnormally

congested Pranavaha srotas 25.

Page 11


Sleshma is the normal secretion and is abnormally increased by the vitiated Prana

vayu. Vitiated Prana vayu also irritates the Nasa causing increased secretion and

manifestation like Peenasa, Kshawathu etc.26.

Samprapti has been classified as Sankhya, Pradhanya, Vidhi, Vikalpa, Bala and

Kala according to Acharya Charaka27. By detail study of Hetu, Samprapti, Lakshanas and

Sadhyasadhyata of Tamaka shwasa, it can be elaborated in the frame work of samprapti

bhedas as.

Sankhya:

Tamaka shwasa doesn’t have direct classification to fit in the Sankhya samprapti

have Pratamaka and Santamaka as the avastha bhedas28. Where as Tamaka shwasa is

categorised under Pancha bheda of shwasa.

Pradhanya:

Acharya Charaka has considered Kapha vatamaka vyadhi29. Where as

Madhavakara considered Tamaka shwasa as Kapha Pradhana vyadhi30. Samprapti of

Tamaka shwasa indicates Pradhanyata of Kapha, where as according to the clinical

course of the disease and principles of treatment both kapha and vata seems to be

Pradhana. Vata holds prime importance in the management of Tamaka 31.

Vidhi:

Tamaka shwasa can be classified in different categories under Vidhi samprapti as.

Ashukari32, Yapya33, Krichra sadhya34 Acharya Charaka has considered hikka and

shwasa as Ashukari, Ghora and Sheeghra pranaharaka. TS with chronicity more than one

year are considered as yapya and of duration less than one year in durbala rogi, as

Krichra sadhya Acharya Sushruta has considered TS as Krichra sadhya and asadhya in

durbala rogi.

Page 12


Vikalpa:

Prana vayu is aggravated by the property such as Sheeta, Ruksha gunas and

increase in its chala guna. Similarly Urasthita Avalambaka kapha gets aggravated by

guru, Snigdha, Sheeta, Abhisyandi and becomes Ghana and Picchila.

Bala

Balabala of vyadhi depends on the virulence of hetus, presence of Porvarupa in

their developed form or in the course of development and also the involvement of

different srotas, rogamargas and involvement of the vital parts of the body. Hence the

bala of the vyadhi differs from individuals. Even though TS can be considered as balavan

and Ghora vyadhi.

Kala:

It is episodic paroxysmal and mostly nocturnal in its nature, Tamaka shwasa is

mostly precipitated or aggravated in the winter and autumn due to cold climate 35 and

concentration of air borne pollens.

Factors involved in the generation of Samprapti of Tamaka shwasa are elaborated

in the following lines.

1. Dosha - Vata, Kapha dosha

2. Dhushya - Rasa Dhatu

3. Srotas - Pranavaha, Udakavaha, Annavaha

4. Srotodusthi - Sanga, Vimargagamana- Atipravarti

5. Utpattisthana - Amashaya

6. Sanchar Sthana - Urakantha

7. Vyaktha sthana - Uras

8. Rogamarga - Abhyantara

9. Adhistana - Pranavaha srota

Page 13


POORVA RUPA

In classics, Poorva rupa is explained as 36

1) Samanya i.e. which predicts the on coming disease.

2) Vishista i.e. which not only predicts the on coming disease, but especially about

the doshic subtype of the particular on coming disease (Madhukosha).

In case of Tamaka shwasa there is reference of vishista poorva rupas. All Acharyas have

explained regarding Samanya Poora rupas of shwasa.

Table No. 2 Showing the Poorva rupa of shwasa/Tamaka shwasa

POORVA RUPA

Sl.No. CS37 SS38 AS39 AH40 BP41 YR42 MN43

1. Anaha + + + + + + + 2. Adhmana - - - - + + + 3. Arati - + - - - - - 4. Bhaktadwesha - + - - - - - 5. Hritpeeda + + + + + + + 6. Kantha gurutwa + - - - - - - 7. Kashaya

vadanata + - - - - - -

8. Parswa shoola + + + + + + + 9. Prana vilomata + - + + - - - 10. Shankha Toda - - + + + + + 11. Uro guruta + - - + - - - 12. Vaktra vairasya - + - - + + +

Premonitory symptoms explained by A.F Golwall or sneezing, flatulence,

drowsiness or restlessness, irritability dry irritant cough may precede or accompany

attacks of wheezy breathlessness and called it as asthmatic aura. Polyuria and itching are

added to above in the text of Suraj Gupta. At the onset of an attack patients experience a

sense of constriction in the chest with an unproductive cough (ER Mc Fadden).

Page 14


RUPA

Predominant factors involved in pathogenesis of Tamaka shwasa are vata and

kapha dosha, rasadhatu and pranavaha srotas. The classics have explained the lakshanas

of Tamaka shwasa in continuous flow which represents the clinical course of disease. The

Vyakta lakshanas can be classified as Samanya lakshanas, Vishista/Pratyatma lakshanas

and Upashanupashaya rupi lakshanas.

Samanya lakshanas start with shirogreeva to the ‘meghambuseetapragvatahi

sleshmalaschiva abhivardhe yate’.

Some of the symptoms can be considered as Vishista/Pratyatna lakshanas are:

Swaskrichrata, Kasa Ghurghurata (added sounds), Pramoha. Other symptoms indicates

the upashaya anupashaya swaroopi lakshanas.

Table No.3 Lakshanas of Tamaka

LAKSHANAS

No CS44 SS45 AS46 AH47 BP48 YR49 MN50

1 Ghurghuraka + + + + + + + 2 Shayanasya Shwasapeedita + + + + + + + 3 Peenasa + - + + + + + 4 Lalata Sweda + + + + + + + 5 Meghaambusheetapragvatair

Vardheyat + + + + + + +

6 Ateeva Teevra Vega Shwasa + - + + + + + 7 Prana Prapeedana + - + + + + + 8 Pratamyati + - + + + + + 9 Muhur Muhur Pramoha + - + + + + + 10 Sleshma Vimokshante Kshanam

Sukham + - + + + + +

11 Muhusvaso Muhuschiradhmayate + - + + + + +

12 Aseenolabhate Sukham + - + + + + + 13 Ushnabhinandana + - + + + + + 14 Uchritaksha + - + + + + + 15 Kasa + + + + - - - 16 Sannirudha + - - - + + + 17 Sleshmanya Amuchyamane

Dukhitaha + - - - + + +

18 Vishuskasya + - + + + + +

Page 15


19 Aruchi - - + + - - - 20 Parshva Shula - - + + - - - 21 Trishna - + + + - - - 22 Shayanasya Parshva Graha + - - - + + + 23 Nidram na Labhante + - - - + + + 24 Krichra Bhashana + - - - + + + 25 Kanthodhwamsa + - - - + + + 26 Vepatu - - + + - - - 27 Trasyate - - - - - + - 28 Kapha Heene Shamayate - + - - - - - 29 Annadvit - + - - - - - 30 Vamathu - + - - - - -

It is easy if one categorises the clinical features into subjective and objective

features.

1) Subjective features (symptoms) Ex: Parswa peeda, Aruchi, Trishna, Pramoha,

Shirogreeva sangraha etc.

2) Objective features (signs) Ex: Teevra shwasa roga, Gurguraka, Shabda, Kasa,

Peenasa, Uchritaksha.

In addition as for as Tamaka shwasa is concerned there are two more stages have

been mentioned and their features are stated. Due to the Udavarta, Raja, Ajeerna, Klinna

ahara and Vegadharana, Pratamaka shwasa is caused, having features like Jwara,

Moorcha in addition to the Tamaka shwasa lakshanas 51.

Santamaka shwasa on the other hand is caused due to the tamovardhana and

makes the patient to go deep into darkness more over it subsides by seetopachara 52.

Shwasa:

Teevra vega shwasa is produced due to the aggravated vata and due to its

pratilomagati led by Kaphavarodha. Patient is likely to experience Hridaya peedana 53.

Expiration becomes difficult due to obstruction. Forceful respiration results, its audibility

with a wheeze.

Page 16


Kasa:

It is produced as a result of Kapha aggravation, which produces obstruction Kasa

is effort to clear this obstruction, at the onset of attack. Since Kapha does not come out,

the patient becomes all the more restless. He is relieved for sometime soon after the

kapha comes out54.

Muhur Muhur shwasa:

In extreme situations, Ghurguraka may lessen, even disappear cough may become

extremely ineffective and patient may suffer from a gasping type of respiratory effort

because of excessive mucous plugging and impending suffocation. This phenomena have

been mentioned as feature Muhur Muhur shwasa 55, Pranaprapeedana can be attributed.

Aseeno labhate sukhamsayane56

shwasa peedana is seen implying the influence of posture. The sticky and liquid

Kapha (mucous) spreads all over the bronchial passage in supine position. Causing the

severe obstruction to the major bronchiole leading to severe distress in the patient. But

when the patient acquires a erect position, the major bronchioles are cleared for

respiration as mucous settles down only in the alveolar level. The respiratory muscles are

little comfort in Aseena than Shayana and also position of diaphragm influences the

respiration.

Usna Chivabhinandati57

The patient develops special liking for hot things against the sheetala guna of

kapha, which probably results in to Kapha vilayana, thus srotomukha vishodhana.

Page 17


UPASHAYA – ANUPASHAYA

Upashaya

“Oushadhadi janita Sukhanubandha upashaya”58

Any of the Dravyabhuta (Oushadhi, Ahara) or Adaravyabhuta (Vihara) Upacharas

which leads for Sukhanubandha is Upashaya.

Sleshma Vimokshana, which can be achieved by mechanical process such as

coughing59, by pharmacological measures such as administrating sleshmavilayana

dravyas. The dravyas possessing Ushna properties can be administered as Upashaya 60.

Non pharmacological procedures such as change of position, changing to the sitting

position from recumbent position, relieves from the severity for short period 61. Kala

other than Meghakala, Durdina can be considered as Upashaya.

Anupashaya

“Veparito anupashayo vyadhyasatmyam iti smrita” 62

Aupashaya is considered contradictory to Upashaya i.e. factors such as Ahara,

Vihara and Oushadhi, which aggravates the condition of disease called Anupashaya.

Meghambusheetapragvatai sleshlamalaischabhivardhayate is called as

Anupashaya63.

“Shayanasha shwasapeedithaha” indicates the aggravation of the disease in the

recumbent position 64.

Page 18


UPADRAVA ARISTHA & SADHYASADHYATA

Upadrava

There is no any direct reference regarding the Upadravas of Tamak shwasa. In the

context of Trishna chikitsa, Charaka chikitsa sthana 22/7 has explained, manifestation of

Trishna as Upadrava. Dalhana states that Deerga kalanubandhi lakshanas of a disease can

be called as Upadrava.

Aristha

Regarding the Aristha laxana, there is no direct reference in the context of

Tamaka shwasa, where as in reference with different contexts aristha lakshanas for

shwasa can be established. It is mentioned that the person producing unnatural sounds

with heavy respiration, suffering with Atisara, Trishna, Shushkasyata and loss of body

strength is definitely going to die 65.

The person whose Urdhva shwasa is rapid, throat occluded by Kapha, reduction in

strength, complexion and food intake is not going to survive for longer period 66. The

person of shwasa presenting with feeble and shallow respiration, feels of tearing pain all

over the body is mentioned of having short life span 67. The person taking long

inspiration and gives of short expiration gets fainted, such person is stated to die within

short period 68.

Sadhyasadhyata

Tamaka shwasa with chronicity more than one year are considered as Yapya and

of duration less than one year in the durbala rogi, as Krichra sadhya 69. Acharya Sushruta

has considered T.S as Krichrasadhya and asadhya in durbala rogi 70. According to

Vaghbhata Tamaka shwasa is sadhya before it is manifested completely (Aspasta avasta)

and become prananasaka when gets manifested completely71.

Page 19


VYAYACHEDAKA NIDANA

Table No. 4 Showing differential diagnosis of shwasa

Laxana Tamaka

Shwasa

Maha

Shwasa

Urdhva

Shwasa

Chinna

Shwasa

Kshudra

Shwasa

Shwasa Atteva teevra

vega shwasa

Uchaihi

shwasati

Dheergam

shwasati,

Urdhvam

shwasati,

adhoshwasa

nirodha

Shwasate

vichinnam

Ruksha

ayasottha

shwasa

Shabdha Ghur-ghuraka

Matta

vrashabho

vatt

---- --- ---

Consciousness Pramoha

Pranastha

jnana

vijnana

Pramoha Moorcha ---

Netra Uchritaksha

Vibhranta

lochana

and

vivrataksha

Urdhvadristhi

and

vibhrantaksha

Viplutaksha,

raktaika

lochana

---

Shula Shayanasya

parshvagraha --- Vedanarta

Marmachedavat

rugarditaha ---

Vak Kruchrakrichnoti

bhashitaha

Viksheena

vak --- Pralapana ---

Asya Vishushkasya --- Shushkasya Parishushkasya ---

Sweda Lalata sweda --- --- Sarva daihika

sweda ---

Upashaya Sleshma

vimokshana --- --- --- ---

Sadhyasadhyata Yapya Asadhya Asadhya Asadhya Sadhya

Page 20


CHIKITSA VIVECHANA

Tamaka shwasa, in its pathology involves multiple varying factors, vitiated Vata,

Kapha afflicting the Rasa dhatu from their root in pittasthana manifesting in Pranavaha

srotas. Therapies for the treatment of the patient suffering from shwasa can be divided in

three 72

1. Therapy which alleviates both Kapha and Vayu.

2. Therapy which alleviates Kapha but aggravates Vayu.

3. Therapy which alleviates Vayu but aggravates Kapha.

Among three first type should always be preferred out of the remaining two

categories, the last one can, however be administered if found essential, in exceptional

circumstances. The second category of therapy should be avoided. The therapy which

alleviates Vayu is generally nourishing (bramhana). Administration of such therapy may

produce some adverse effects, but such adverse effects would be minimal and not

difficult to cure because the patient will gain strength by nourishing therapy as a result of

which he can easily overcome these adverse effects.

The depletion therapy (Karshana) on the other hand would create tremendous

amount of adverse effects, which may be incurable. It is only the alleviation therapy

which is absolutely free from these adverse effects & such a therapy should be preferred

for the treatment of shwasa 73.

Fundamentals of management of Tamaka shwasa have been explained exclusively

by Acharya Charaka. The principles of management are.

Nidana parivarjana:

One has to be very precise regarding the precipitating or triggering factors, avoid

exposing to that particular factor, which mostly helps to prevent the onset of acute

episodes. It is also justified by Acharya Sushruta statement ‘Sankshepatha Kriyaprokta

nidana parivarjanam’74. Tamaka shwasa is a heterogenic disease, have a wide range of

etiological factors, it becomes difficult to identify the specific cause and avoid it.

Page 21


More ever it is a typical disease where in the initial sensitization by specific factor

sets a platform for the onset of acute episodes with exposure to even smallest or mildest

stimuli hence it becomes difficult to manage the condition, only by nidan parivarjan. So

as to control the condition the systematic management procedures are explained they are,

Snehana and Swedana

Bahya snehana on uras by lavana taila, as an intial course of action swedana

followed by either of (Nadi, prastara or Sankara). Swedan measures with the help of

snigda dravyas, helps for liquification of the grathita kapha, facilitating easy expelling of

vitiated kapha helps for Vatanulomana, smoothness of srotas. Swedana is contraindicated

in pitta dosha predominant, person of pittaj prakrati, persons suffering from daha,

raktapitta, atisara, dhatu ksheenata, bala ksheenata, gharbini, person of Ruksha prakrati.

In them mridu swedana has to be performed i.e. parisheka by ushna snehas,

sharkarayukta ushna utkarika or upanaha 75.

Vamana

Vamana is not ideal choice for the patients present with symptoms suggestive of

dominant vata dosha. In patients with the predominant vitiation of Kapha dosha, Vamana

karma is most ideal who present with symptoms like paroxysmal productive cough where

sputum is tenacious, bouts of distressing paroxysmal cough brings small amount of sticky

sputum.

Vamana is advisable only in patients who are physically strong and can tolerate

the strain of Vamana karma 76. After Abhyanga and Nadi sweda over the chest, in the

evening the food that provokes the Kapha; like meals with curds or fish is given to

patient, which helps in the easy elimination of Kapha dosha by Vamana procedures.

Dhoomapana:

It is advised after Vamana karma and it eliminates Kapha dosha still left out after

Vamana karma 77. In patients who are debilitated where purificatory procedure is not

possible in them dhoomapana alone can be given which helps for the elimination of

Kapha dosha. It also brings relief by reducing spasm or stiffness of Pranavaha srotas, thus

ensures free movement for Vata dosha.

Page 22


Virechana:

Management of swas rogi depends on

1) Bala bala (Balawan or Durbala)

2) Doshadhikya (Kapha or Vata)

In case of Kpahadhikya, balawan rogi, doshas are to be expelled by Vamana and

Virechana, maintaining Pathya ahara, Vihara and later followed by

Shwasanashakandhuma, avaleha etc. In case of Vatadhikya, Durbala, Vruddha,

Vatanashak dravyas, tarpana, sneha, yusha, Mamsarasa etc should be used 78. If

Samshodhana is performed in condition of anutklistha Kapha, durbala, who have not

undergone swedana, vata gets grossly provoked becomes fatal causing

marmasamshoshana 79.

Obstruction in Pranavaha srotas because of sticky kapha is best relieved by

Vamana. Where as doshas stemming out from pitta sthana is best eliminated by

Virechana procedure. Virechana normalizes the course of vata dosha and thus helps in the

reversal of the vilomagati of pranavayu 80. Distension of abdomen, constipation and such

other symptoms may be associated in some patients and these symptoms are best treated

by this procedure.

Doshanubandhi Shwasa chikitsa:

In case of Vatanubandhi shwasa, the ghrita prepared by mamsa of shosha,

shallaka etc. and ghrita prepared by pippali, mamsa and shonita has to be administered 81.

In case of Vatapittanubandhi shali odana prepared with Souvarchala, dugdha, ghrita and

trikatu has to be administered 82. In case of Kaphapittanubandha, Shirisha pushpa Swaras

or Saptaparna swaras mixed with pippali choorna and madhu has to be administered 83.

If the path of pranavayu is obstructed by Kapha Ksharavaleha has to be

administered in order to relieve the obstruction of pranavayu 84.

Intelligent physician has to expel doshas by Vamana if patient is suffering from

Kasa, Swarabhanga, and by Virechana by Kaphavatahara dravyas in Tamaka85

Page 23


Gangadhara comments on it states to administer Kaphavatahara virechana in

swarabhanga yukta shwasa and Tamaka shwasa.

Nasya prayoga:

Different yogas such as rasona, palander, grinjanaka swarasa, madhura varga

dravyas siddha ghrita are indicated for nasya karma for hikka in the context of hikk and

shwasa chikitsa, but it is not directly indicated in shwasa, Vagbhata also supports the

same, where as Arunadatta commenting on the same indicates nasya prayoga in shwasa

also.

Acharya Sushruta explains the utility of Bhringaraja siddha taila as nasya,

ahyanga and acchapana 86. Shwasa rogi having ruksha shareera suffering from shuskata

in uros kanta and talu has to be treated by ghrita 87.

Management of Shwasa according to Doshas

Acharya Charaka explains a special modality of treatment in managing the

shwasa rogi with respect to doshas. Vatakruddha kaphahara: i.e. the upakramas which

aggravates vata and mitigates kapha. Kaphakruddha Anilopham: the upakramas which

aggravates kapha and mitigates vata.

Treatment aiming towards single dosha must not be performed i.e. Vatakaraka,

Kaphakaraka, Vatashamaka or Kaphashamaka. In indispensable condition to implement

one amongst the above four, it is mostly superior to go for vatashamaka upakramas 88.

Brimhana and Rasayana chikitsa:

Atmospheric changes which rarely have any effect in normal person reflects as

disease in patients is due to Khavaigunya, an abnormality of the Pranavaha srotas. This

can be rectified by Vyadhihara rasayana. This unique treatment may be much helpful in

subsiding the attack of Asthma. Also in due course, improves the resistance power by

Pranavaha srotas, chronic illness emaciate the body, in the Brimhana chikitsa is going to

help 89. With all above principles of management of Tamaka there are many number of

swasha yogas explained in the context of hikkashwasa chikitsa.

Page 24


PATHYA APATHYA

Knowledge of Pathya, Apathya is very important in preventing the disease. Vata

and Kapha dosha are responsible for the manifestation of disease Tamaka shwasa. Pathya

are those one which pacify the vata and kapha, Apathya are the one which aggravates the

kapha and vata dosha.

Acharya Sushruta and his commentators and Yogaratnakar have explained the

Pathyapathya in separate headings, where as most of the apathyas explained by them are

found in the nidanas of shwasa listed by Acharya Charaka.

Table No.5 Pathya in Tamaka shwasa

AHARA Purana shastika shali84 Purana tandula Kulattha Godhuma Yava Shasaha mamsa Titira mamsa Dakshamamsa Shuka mamsa Dwija (andaja) mamsa Purana sarpi Aja dugdha Aja ghrita Sura85 Madhu87 Patola Vartaka Rasona Bimbi Jambeera Tanduliyaka Vastuka86 Draksha Ela pushkara Ushna jala Nidigdhika Pippali Purana sarpi Jangala mamsa Souvarika Hingu Matulunga Amalaka Bilwa Jeevanti mula Kapotika Katutraya Gomutra88 Kaphavatahara annapana

VIHARA Diwaswapna

UPAKRAMA Virechana Swedana Dhumapana Vamana Agni karma by pradipta loha at vaksha pradesha, yougma parshva, kara madhya, kara urdhva and kantha kupa.

Page 25


Table No.6 Apathya in Tamaka shwasa

AHARA Mesha dugdha Mesha ghrita Dushita jala Matsya Kanda Sarshapa Ruksha bhojana Sheeta bhojana Guru bhojana Vistambhi Vidahi Anoopa mamsa Taila bhrista nishpava Sleshmala

ahara Masha

VIHARA Poorva vata Gramya

dharma Shrama Adhvabhara

Vega dharana of Mutra, Udgara, Chardi, Trishna and Kasa. Raktasrava

Strictly following the Pathya, Apathya in asymptomatic phase prevent an episode

of disease, which can modify the strength of the disease.

Page 26


CONCEPT OF VIRECHANA

Virechana karma is one of the important karmas used for the elimination of

vitiated doshas from the body, through adhomarga i.e. from anus 95. The word Virechana

Na, Vi+Rich, Plut – Maladeha Nissaranam. Thus it means to expel doshas/malas from the

body. The term virechana is widely used in a sense of expulsion of secretary or excretory

matter0 from the body.

Ex: Mutra virechana, Sirovirechana, Shkra virechana.

In any case when the term virechan is mentioned alone, it indicates the

elimination of doshas through the anus. Virechana is regarded as the main shodhana

chikitsa for pitta vikaras 96, because the virechana oushadha act mainly in pittha sthana.

For vata rogas also virechana indicated as one of the treatment 97. virechana is told to be

suitable or indicative to the following conditions 98.

1) In diseases where pittha is predominantly vitiated.

2) In diseases where kapha is combined with pittha.

3) In cases where kapha is migrated in huge quantity to pitta sthana.

A seasonal cleansing therapy in healthy person is also recommended for

maintenance of health. Virechana karma is mentioned in Ayurveda not only cures

diseases but also make the body healthy vigorous by expelling the doshas and making the

body soft and increasing the jataragni.

Classification of Virechaka Dravyas: -

Virechana drugs can be classified on the basis of:

1) The intensity of action.

2) The character of action (Gunanusara)

3) The mechanism of action on the intestines.

According to the intensity of action virechana drugs are classified into Mridu,

Madhya, Teekshna Charaka has mentioned, the following drugs as the best for specific

purposes 99.

Page 27


Sukha virechana - Trivrit

Mridu virechana - Aragwadha

Teekshna virechana - Snuhi ksheera.

According to guna, 1) Snigdha virechana 2) Ruksha virechana.

Snigdha virechana is prohibited to subjects who shows more snehana or who

himself has the athisnigdha symptoms. In this condition Ruksha virechana is indicated100.

According to mechanism of action of the drug on the intestines Sarangadhara has

classified virechana drugs into four categories 101.

1) Anulomana

The virechana dravyas which digests the undigested mala, breakdown the adhesion

and relieves vibandha are called as Anulomaka dravyas.

2) Sramasana

The one which breaks the adhesions irrespective of the pakwa or apakwata of mala

and leads for adhobhaghaharana are called as Sramsana dravyas.

3) Bhedana

The one which breaks adhesions accumulation and hard stools and expels are called

as Bhedaka dravyas.

4) Rechana:

The one which liquifies the mala irrespective of pakwa-apakwa avastha of mala and

expels are called as Rechaka dravyas.

Virechaka dravyas: -

According to different Acharyas, there are number of virechaka dravyas, some of

the non virechaka dravyas are mentioned here under different headings.

Mulini dravyas : Trivruta, Hastidanti, Gavakshi, Saptala etc102.

Phalini : Abhaya, Aragwadha, Kampillaka etc103.

Ksheerini : Snuhi, Arka etc.104

Twak : Tilvaka etc.105

Page 28


Taila : Eranda etc. 106

Swarasa : Karavellaka 107

Lavana : Saindhava, Souvarchala etc. 108

Acharya Charaka has devoted six chapters in the Kalpasthana only for the sake of

virechana dravyas and their utility. Where as Acharya Sushruta and Vagbhata have

explained elaborately, virechaka dravyas in their Surasthana 44th & 15th chapters

respectively.

Yogya and Ayogya for Virechana:

In all the major classics of Ayurveda, every one has explained virechana yogya

and ayogya as virechya and avirechya. The one among those who are classified under

avirechya are strictly prohibited from undergoing virechana karma. Where as in the

context of virechya and conditions other than avirechya, which are not clearely

mentioned as virechya, depending on the need of the time virechana can be administered.

The reference regarding them is available in Charaka Siddhisthana 2nd chapter, Sushruta

chikitsasthana 33rd chapter and Astanga Hridaya Sutrasthana 18th chapter.

Virechana karma procedure:

For the purpose of satisfactory fulfillment of virechana karma, the procedure is

divided into three phases;

Purva karma:

The activities that are to be performed before administering of virechana dravya,

they are

Sambhara Sangraha – Collection of materials required

Atura pareeksha – The patient has to be thoroughly examined for the Dosha, Bheshyaja,

Desha, Kala, Shareera, Ahara, Satmya, Satwa, Prakruti and Vaya 109.

Atura Siddata – The person who is undertaking virechana has to be subjected by proper

oleation and sudation and later administered virechanopaga bhojana.

Page 29


Matra vinischaya – The matra of any dravya generally depends on vayu, agni and kostha,

where as in case of virechana, prime importance is given in considering the koshta. The

matra is classified Uttama, Madhyama and Heena 110 and is as following,

Kwatha:

Uttama matra 2 Pala (8 Tola)

Madhyama matra 1 Pala (4 Tola)

Heena matra 0.5 Pala (2 Tola)

Choorna/Kalka:

Uttama matra 4 Pala

Madhyama matra 2Pala

Heena matra 1 Pala

Pradhana karma

It is the main procedure which includes administration of virechaka dravya, vega

Nirekshana and Vyapat nirharana.

Virechana dravya prayoga:

In the early morning, next to the day of Snehana & Swedana, Virechaka dravya is

administered in appropriate dose on an empty stomach.

Vega nireekshana:

After administration of virechaka dravya patient develops vegas after some time.

The first few vegas containing mala are to be excluded and observed for the

corresponding vegas for pitta, Aushadha and Kapha respectively 111.

Observation for Shuddhi Lakshanas:

When the virechaka dravya is administered, one has to observe for the type of

shuddhi i.e. Samyak shuddhi or asamyak shuddhi, asamyak shuddhi may be atiyoga,

ayoga or mithya yoga.

Page 30


Samyak shuddhi:

Samyak shuddhi lakshanas are considered when the doshas are expelled in order

of mala, pitta, Aushadha and kapha i.e. Kaphantya virechana112 which is objective. It is

also called as antiki shuddhi laxana. Where as in case of laingiki shuddhi

srotovishoddhata indriya prasannata, laghuta, agnideepti and relief from the symptoms of

the disorder are observed113 this type of shuddhi is subjective.

Suddhi prakara:

Based on the number of vegas and quantity of expelled doshas, the shuddhi is

classified as:

Pravara - 30 vegas – 4 prastha

Madhyama - 20 vegas – 3 prastha

Heena - 10 vegas – 1 prastha

Management of Ayoga and Vyapat:

In case if any ayoga lakshanas are observed, immediate action has to be towards

relieving the ayoga lakshanas and facilitating Samyak virechana.

Charakacharya in Siddhistana 6th chapter has elaborately explained regarding 10

types of vamana and virechana vyapat and their appropriate management.

Paschat karma:

The procedure adopted after complete attainment of Shuddhi lakshanas, till the

person attains the normal state of health is called as Paschat karma and is comprised of,

Sansarjana karma, Shamana Chikitsa and Pariharya visheyas.

Sansarjana karma:

The mandata of Agni, due to the Shodhana has to be brought to normal by gradual

process 114, for which a well organized dietic regime was formulated and that regime is

called as Sansarjana karma.

Page 31


Peya, Vilepi, Akrita-krita yousha and mamsa rasa have to be used in three, or one

annakalas respectively in case of pravara madhyama and avara shuddhi 115. Detail

description regarding Sansarjana karma is available in Charaka Samhita 116.

Table No. 7 showing the Sansarjana karma

Day Annakala Pravarashuddhi Madhyama

shuddhi

Heena suddhi

1 Morning --- --- --- 1

2 Evening Peya Peya Peya

3 Morning Peya Peya Vilepi 2

4 Evening Peya Vilepi Krita yusha

5 Morning Vilepi Vilepi Krita mamsarasa 3

6 Evening Vilepi Akrtia yusha Prakrita bhojana

7 Morning Vilepi Krita yusha 4

8 Evening Akrita yusha Akrita mamsarasa

9 Morning Krita yusha Krita mamsarasa 5

10 Evening Krita yusha Prakrita bhojana

11 Morning Akrita mamsarasa 6

12 Evening Krita mamsarasa

13 Morning Krita mamsarasa 7

14 Evening Prakrita bhojana

Shamana chikitsa:

After Sansarjana karma in order to pacify the residual doshas if any, Shamana

aushadhis are administered.

Pariharya visheys:

In order to get the maximum benefit and to avoid ill effects of Samshodhana

Acharyas have advised to strictly avoid certain activities and such restrictions are called

Pariharya visheyas.

Page 32


MODERN REVIEW

Anatomy:

The respiratory system is divided for descriptive purposes in to the upper and

lower respiratory tracts. The dividing line being the lower border of cricoid cartilage.

The upper respiratory tract:

The upper respiratory, which includes the nose, nasopharynx and the larynx, is

lined by vascular mucous membrane covered by ciliated columnar epithelium. The rich

blood supply ensures that the inspired air enters the lungs at body temp and fully

saturated with water vapour. The cilia aided by the layer of sticky mucous covering them,

have the important function of trapping foreign particles and bacteria and propelling them

towards the pharynx. The nasal sinuses communicate with the nasal cavities by narrow

openings and frequently involved in nasal and nasopharyngeal infections.

The larynx in addition to being the organ of voice production has the function of

preventing the particles larger than can be dealt with by the cilia from reaching the lower

respiratory tract. This it does by means of cough reflex. As the left recurrent laryngeal

nerve runs part of its course within the thoracic cavity in close relation to the aortic arch

and the left pulmonary hilum a bronchial carcinoma in the left hilar region and less

frequently an aortic aneurysm may cause paralysis the left vocal cord.

The Trachea, Bronchi and Lungs:

The Trachea begins at the cricoid cartilage and ends at the level of the sternal

angle by bifurcation into two main bronchi. The trachea is usually palpable in the

suprasternal notch. The right principal bronchus is shorter (1inch) wider, the left principal

bronchus is longer (2 inches) narrower and more oblique than the right bronchus.

Each principal bronchus enters the lung through the hilum, and divides into

secondary (lobar) bronchi one for each lobe of the lungs (3 on the right side and 2 on left

side). Each lobar bronchus divides into tertiary (segmental). One for each

Page 33


bronchopulmonary segment (10 on the right side and 8 on the left side). The segmental

bronchi divide repeatedly to form very small branches called terminal bronchioles. Still

smaller branches are called respiratory bronchioles.

Each respiratory bronchiole aerates a small part of the lung known as pulmonary

unit. The respiratory bronchiole ends in microscopic passages which are termed (in that

order) as i) alveolar duess, ii) atria, iii) air succules, iv) pulmonary alveoli gaseous

exchange take place in the alveoli.

Pleura:

Each lung is closely invested with visceral pleura parietal pleura lines the chest

wall, mediastmum and diaphragm and is continuous with the visceral pleura at the lung

hilum. In health the two pleural layers are separated only by a thin film of lymph, but

between them there is a negative tension.

Mediastinum:

The anatomy of the mediastmum has an important bearing on the diagnosis of

intra thoracic disease, particularly tumours and aneurysms. These lesions are liable to

involve mediastinal structures and as a result readily recognizable symptoms, physical

signs and radiological abnormalities may be produced.

Physiology:

Ventilation & Exchange of gases in the lungs:

The pulmonary ventilation-rate (minute-volume) is normally about 6 lts/ minute at

rest and may reach 100 lts/minute during the heaviest exercise. It is controlled by the

respiratory center in the brainstem (medulla oblongata and phenotoxic center in the

pansvaroly) the activity of which is influenced by many factors.

The most important of these are cortical activity (breathing may be altered voluntarily)

CO2 excess metabolic acidosis, lack of oxygen, body temperature and impulses from

pulmonary stretch receptors and possibly from receptors in the limbs Hyper ventilation

due to excess CO2 is thought to be due to increase in hydrogen-ion concentration within

Page 34


or around cells of the respiratory center and metabolic acidosis acts in the same way. The

center is stimulated reflexly, via the carotid bodies by a fall in the partial pressure of

oxygen (PO2) in the arterial blood. The control by CO2 and hydrogen ions is more

important for the day today regulation of breathing, but the effect of a reduced PO2

(hypoxia) is less affected by drugs or by deep unconsciousness and is thus important for

survival. Apart from its own stimulant effect, hypoxia increases the sensitivity of the

respiratory ‘Centre’ to CO2 in healthy subjects. Contrary to widespread belief there is no

direct evidence that acute or chronic hypoxia is ever responsible for lowering

responsiveness to CO2 in disease though severe hypercapnia (rise in PCO2) does depress

both CO2 response and consciousness.

About one quarter of minute-volume ventilates the conducting airway

(respiratory dead-space) the remaining three quarters constitutes the alveolar ventilation.

Ventilation of the dead space increases with respiratory frequency. When frequency is

high, therefore a greater total ventilation is needed to yields a normal alveolar ventilation.

Hypoventilation of the alveoli may occur, when the respiratory center is depressed by

narcotics anaesthetics or intra cranial disease or when there is paralysis affecting.

Normal alveolar ventilations are not fully effective unless it is distribution

uniformly to different parts of the lungs and is matched by uniform description of

pulmonary arterial blood. When there is considerable mismatching, incompletely

oxygenated blood leaves alveoli, which are under ventilated or over perfused. Although

this blood mixed in the left atrium with fully oxygenated blood from well-ventilated

alveoli some degree of hypoxia is inevitable. At first arterial PCO2 may remain normal as

a result of compensatory hyperventilation of some alveoli, but with gross defects of

distribution, there is hypercapnia as well. Breathing oxygen corrects the hypoxia unless

considerable amount of lung is completely unventilated but not relieve hypercapnia.

Abnormalities of distribution are very common and occur especially in emphysema,

asthma and organic bronchial obstruction.

Page 35


Asthma:

Asthma is characterized by episodic reversible bronchospasm resulting from an

exaggerated broncho constrictor response to the various stimuli.

The basis of bronchial hyper reactivity is not entirely clear, but it is widely believed to

result from persistent bronchial inflammation. Hence bronchial asthma is best considered

a chronic inflammatory disorder of the airway, clinically, asthma is manifested by

episodic dyspnoea, cough and wheezing. This common disease affects about 5% of adults

and 7-10% of children. It can be classify in to 2 category.

1. Extrinsic Asthma:- In which asthmatic episode is typically initiated by type I

hypersensivity reaction induced by exposure to an extrinsic antigen. Three types of

extrinsic asthma are –Atopic asthma, Occupational asthma and Allergic bronco

pulmonary aspergillosis. Atopic asthma is the most common type of asthma, it’s on

set is usually in the first two decades of life associated with other allergic

manifestations. Serum IgE levels are usually elevated, as is the blood eosinophil

count.

2. Intrinsic Asthma:- In which the triggering mechanisms are nonimmune. In this form,

a number of stimuli that have little or no effect in normal subjects can trigger

bronchospasm. Such factors include Aspirin, pulmonary infections; especially those

caused by viruses cold, psychological stress, exercise and inhaled such as sulfur

dioxide.In many cases a neat distinction between intrinsic and extrinsic asthma is not

possible.

Pathogenesis:

Exaggerated bronchoconstricar response to a variety of stimuli is common to all

forms of asthma. Although the importance of increased airway reactivity is

established, the basis of the abnormal bronchial response is not fully understood.

Most current evidence suggest that bronchiole inflammation is the substrate for

hyperresponsiveness, persistence inflammation of the bronchi manifested by presence

Page 36


of inflammatory cells and by damage to the bronchial epithelium, is the constant

feature of bronchial asthma.

Atopic Asthma:-

Like all type I hypersensitive reactions, allergic asthma is driven by sensatisation

of CD4+ cells of the TH

2 type. It may be recalled that TH2 cells release cytokines such

as intelucin 4 &5 (IL-4 &IL-5) that favour the synthesis of IgE growth of mast cells

(IL-4) & growth and activation of eosinophils (IL-5) IgE, mast cells & eosinophils

are key players in the allergic asthma.

Attacks of atopic asthma often demonstrate in two phases. An early phase, beginning

30-60 minutes after inhalation of antigen and then remitting, followed 4-8 hours later

by a more protracted late phase. As might be expected the initial triggering of mast

cells occurs on the mucosal surface, the resultant mediator release opens mucasal

intercellular junction allowing penetration of the antigen to more numerous mucosal

cells. In addition direct stimulation of subepithelial vagal receptors provokes reflex

bronco constriction. Mast cell activation lead to the release of a variety of primary

and secondary mediators. Leukotrienes C4 D4 & E4, Prostaglandin D2 (PGD2),

Eosnophilic & neutrophilic chemo tactic factors & leakotriene B4, Platelet-activating

factor (PAF) which causes aggravation of platelets & release of histamine from their

granules.

Together these mediators induce broncho constriction, oedema & mucus

secretion. These are followed by the late phase in which leukocytes are dominant,

basophiles, cytokines such as tumour necrosis factor α from mast cells that up

regulate adhesion molecules on vascular endothelium & also on inflammatory cells.

Not only these release the mediators & thus intensify the initial response. They also

cause epithelial cell damage. epithelial cells themselves are source of mediators, such

as endothelium & nitric oxide (NO) that can cause smooth muscle contraction &

relaxation respectively. Loss of epithelial integrity by reducing available NO, may

Page 37


thus contribute to airway hyper responsiveness. eosinophils are particularly important

in the late phase. Their accumulation at sites of allergic inflammation is favoured by

mast cells derived chemo tactic factory IL-5 & Paf. Recent studies have implicated

several chemokines in eosinophil chemotaxis. The most potent of these appears to be

eotoxin, produced in part by activated bronchial epithelial cells. The accumulated

eosinophils exert a variety of effects. Eosinophils can amplify & sustain the

inflammatory response without additional exposure to the triggering antigen.

Intrinsic asthma:

The mechanism of bronchial information & hyper responsiveness is much less

clear in patients with intrinsic asthma & incriminated in such case are viral infection of

the respiratory tract & inhaled air pollutants such as sulfur dioxide ozone & nitrogen

dioxide. These increases hyperactivity in both normal and asthmatic. In the latter

however, the bronchial response is manifested as spasm is much more severe &

sustained.

Clinical course:

An attack of asthma is characterized by severe dyspnoea wheezing. The chief

difficulty lies in expiration the victim labours to get air into the lungs and then cannot get

it out, so that there is progressive hyperinflation of the lungs with air trapped distal to the

bronchi, which are constricted and filled with mucus and debris. In the usual case, attacks

last from 1 to several hours and subside either spontaneously with therapy, usually

bronchodilations corticosteroids. Intervals between attacks are characteristically free

from respiratory difficulty but persistent subtle respiratory deficits can be detected by

spirometric methods. Occasionally a severe paroxysm occurs that does not respond to

therapy and persists for days and even weeks, associated hypercapnia, acidosis and severe

hypoxia may be fatal although in most cases the disease is more disabling than lethal.

Page 38


Page 39

DRUG REVIEW

Vata and Kapha are the doshas involved in the Samprapti of the Tamaka Shwasa.

Thus medicine alleviates both vata and kapha should be selected according to

Charakacharya has advised to select the drugs having vata kaphahara properties for the

virechana. 117.

In this study, Shunti phanta consisting shunti which does the agnideepana is used

for, agnideepana and amapachanartha.

Tila taila in which Saindhava is mixed is used for bahyabhyanga at ura pradesha.

Tila taila has qualities like ushna, teekshna, Madhura rasa vyavayi 118 and Saindhava is

also sukshma (subtle), ushna laghu, thus helps in easy and immediate penetration of taila

in to the body tissues 119.

Eranda taila is used for virechana which is having qualities to subside both vata

and kapha according to Sushruta 120. Bharangi and Shunti are used in different drug

combination for shwasa121-124 Bharangyadi kwatha is mentioned by Yogaratnakara 125 and

Bhaishajya ratnavali 126 for Tamaka shwasa.

Bharangyadi kwatha consists of only two drugs.

Contents

Name of the drug Latin name Quantity

1) Bharangi Clerodendrum serratum 15gm (Yavakuta churna)

2) Shunti Zingiber officinale 15gm (Yavakuta churna)

Kwatha is prepared by adding 8 times of water 127(i.e. 240ml) and reduced to one

eighth 128 (i.e.30ml). kwatha is administered in a dose of 15-20ml twice daily (morning

and evening).


Page 40

BHARANGI 129

Bharangi consists of dried roots of Clerodendrum serratum (Linn) Moon (Fam.

Verbenaceae), a shrub distributed throughout the country.

Sanskrit : Angaravalli, Brahmanayastika

Hindi : Bharangee

Kannada : Gantubarangee

Marathi : Bharangee, Bharang

DESCRIPTION

Mature root hard, woody cylindrical up to 5cm thick, external surface light brown

having elongated lenticles, bark, thin and easily separated from a broad wood which

shows marked medullary rays and concentric growth rings in a transversely cut surface

fracture, short, taste, acrid.

Foreign matter : Not more than 2%

Total ash : Not more than 4%

Acid insoluble ash : Not more than 1%

Alcohol soluble extractive : Not more than 36%

Water soluble extractive : Not more than 6%

Fixed oil : Not more than 37%

CONSTITUENTS: Saponins

Rasa : Katu, Tikta, Kashaya

Guna : Laghu, Ruksha

Veerya : Ushna

Vipaka : Katu

Karma : Vatahara, Kaphahara, Deepana, Pachana,

Swasahara, Ruchya.


Page 41

IMPORTANT FORMULATIONS

Ayaskrit, Kanakasava, Dashamularista, Bharangyadi kwatha churna,

Mahavatagajankusa rasa.

THERAPEUTIC USES

Gulma, Jwara, Shwasa, Kasa, Yakshma, Hikka, Raktadosha.

Dose - 3-6 gm of powder

10-20 gm of Kwatha churna

SHUNTI 130

Ardraka consists of fresh rhizome of Zingiber officinale Rose. (Fam.

Zingiberaceae); a herbaceous rhizomatous perennial; reaching up to 90cms in height,

wildly cultivated in India. Rhizomes are dug in January-February, buds and roots are

removed and washed well.

Sanskrit : Katubhadra, Shingavera.

English : Ginger.

Hindi : Adarakh.

Kannada : Alla, Hashishunthi.

Marathi : Ardrak, Ale.

DESCRIPTION

Drug occurs as entire rhizome or in pieces, rhizome laterally compressed bearing

flattish ovate, oblique branches on upper side, each having a depressed scar at its apex,

pieces 5-15cm long, 1.5-6.5cms wide (usually 3-4cms) and 1-1.5cm thick, fracture, short

with projecting fibers, transversely cut surface shows a wide central stele having

numerous grayish cut ends of fibers and yellow secreting cells, odour, gingery; taste,

pungent.


Page 42

Foreign matter : not more than 0.5%.

Total ash : not more than 8%.

Acid insoluble ash : not more than 1%.

Alcohol soluble extractive : not less than 5%.

Water soluble extractive : not less than 2%.

Moisture content : not more than 90%.

CONSTITUENTS

Volatile oil containing Cineole zingiberol, and sesquiterpene like zingiberene,

bisobolene and sesqui phellandrene, gingersol in the oleo-resin.

Rasa : Katu

Guna : Teekshna, Ruksha, Guru.

Veerya : Ushna.

Vipaka : Madhura.

Karma : Vatahara, Kaphahara, Rochana, Deepana, Bhedana, Svarya,

Hridya, Vrashya.


Ardraka khandavaleha, saraswataristha.

THERAPEUTIC USES

Anaha, Vibandha, Shula, Shopha, Kantharogas.

DOSE

2-3ml of the drug in juice form with honey; 20-40ml of infusion with honey.


Page 43

ERANDA 131

Eranda consists of dried seed of Ricinus communis Linn. (Fam. Euphoriaceae); a

tall glabrous shrub or almost small tree, 2-4 m high; found throughout India, mostly

growing wild on waste land and also cultivated for its oil seeds.

Sanskrit : Gandharva-Hasta, Panchangula, Vatari.

English : Castor oil plant.

Hindi : Erand, Rendee, Andeo.

Kannada : Harlu.

Marathi : Erand, Erandee.

DESCRIPTION

Castor oil is colourless or faintly yellow or straw-coloured, practically odourless, with a

bland and slightly acrid taste.

Foreign matter : not more than 2%.

Total ash : not more than 4%.

Acid insoluble ash : not more than 1%.

Alcohol soluble extractive : not less than 36%.

Water soluble extractive : not less than 6%.

Fixed oil : not less than 37%.

CONSTITUENTS

Seeds contain fixed oil 43-52%, proteins 20%, starch, mucilage, sugar and ash

10%. The oil chiefly consists of ricinoleate of glycerol, or tri-ricinolein, with small

quantity of palmatin and stearin.

Rasa : Madhura, Katu, Kashaya.

Guna : Snigdha, Teekshna, Sukshma.

Veerya : Ushna.

Vipaka : Madhura.


Page 44

Karma : Deepana, Amapachana, Vidbhedana, Anulomana,

Srotoshodhana, Vayasthapana,


Brahat Saindhavadi taila, Gandharvahastayadi taila, Simhanada Guggulu,

Mishraka Sneha.

THERAPEUTIC USES

Amavata, Vibandha, Yakrit roga, Plihodara, Arsha, Katishula, Gradhrasi, Jwara,

Svasa, Kasa, Kustha.

DOSE

10-20ml (Shamanartha), 30-60ml (Shodhanartha).

Shunti is pachaka kaphaghna, vatahara 132. Being a pachaka, digest the ama,

which is root cause for disease. As it is vatahara and kaphaghna facilitates normal flow of

vata relieving obstruction.

Bharangi is having qualities like ushna, kaphaghna, vataghna, pachana,

shothahara 133. Thus helps in reducing shotha of pranavaha srotas, being vataghna,

softens the pranavaha srotas srotas also controls the over secretion of mucus, being

kaphaghna liquefies the kapha thus relieves the obstruction. Shunti and Bharangi together

are kaphavatahara, shotaghna, pachaka, thus directly acting on pranavaha srotas and also

on pittasthana (amahara). Thus the combination of these drugs are beneficial in

counteracting all the aspects of pathological process of Tamaka shwasa.

Eranda taila is told to be soumya, sramshana, dahashamaka, vatahara 134 and

according to Sushruta kaphavatahara. So it act as best virechaka dravya for Tamaka

shwasa. Snehana (Bahyabhyanga with lavanataila) and Nadiswedana helps in the

liquification of kapha dosha remove the obstruction, controls vata, bring the doshas to the

kosta. Virechana with Eranda taila which is given after snehana and swedana removes the

doshas from pittasthana. Thus Eranda taila is beneficial.

Methodology

METHODOLOGY

Following materials were taken for the clinical study

A] Drugs:

a) Deepana pachanartha : Shunti phanta

b) Snehanartha : Lavan taila

c) Shodhanartha : Eranda taila

d) Shamanartha : Bharangyadi kwath

B] Instrument:

Peak flow meter.

COLLECTION OF MATERIALS

A] Drugs:

Shunti, Eranda taila, Saidhava lavana and Tila taila Bharangi were properly

identified and purchased from Subbarao medicals Koppa.

B] Methodology of peak flow meter analysis

After preliminary examination, they were advised in detail and proper

demonstration was given regardly performing on the peak flow meter. They were advised

to attend the OPD at the time when they were symptom free and feel normal PEFR was

recorded at base line recording of particular individual. The severity and the clinical

improvement was assessed with respect to the base line PEFR, test with bronchodilator

therapy was not performed.

Method:

1. Patient was advised to relax for few minutes and to breathe normally.

2. When patient feels comfortable and becomes familiar with peak flow meter method.

Patient was advised to take a deep inspiration and to hold the mouth piece tightly

between the teeth and to fasten the lips.

Page 45

Methodology

3. Patient was advised to expire out as fast and rapidly as possible with full efforts i.e. in

the form of blast; through the mouth piece.

4. The value on the peak flow meter gauge to which the pointer indicates; corresponds

to the PEFR of that attempt.

Three trials were taken each time and the best of three readings was considered.

Shunti phana:

1 part of finely powdered Shunti was mixed to 4 times of boiling water and

allowed to cool, the mixture was filtered and stored. It was prepared a fresh every time

whenever required.

Bharangyadi kwath:

Equal quantity of Bharangi and shunti was taken and 8 times of water added

boiled and reduced it to 1/4th water. It was prepared a fresh everytime whenever required.

Lavana taila:

1 part of Finely powdered Saidhanva lavana was mixed with 4 parts of Tilataila,

the mixture was heated on mandagni allowed to cool and stored in clean, dry glass

container.

METHODS

Aim:

The aim of the study was to assess the effect of virechana and Bharangyadi kwath

in the management of Tamaka shwasa.

RESEARCH DESIGN

It is a comparative clinical study where patients suffering from Tamaka shwasa of

either sex of age group of above 15 years were selected and randomly allocated into

group A, B and C respectively.

Page 46

Methodology

Selection of the patients:

Patients visiting the OPD, A.L.N.Rao.Ayurvedic Medical College and Hospital,

Koppa; were screened and patients diagnosed as Tamaka Shwasa were selected for the

study; appropriately satisfying the selection criteria.

INCLUSION CRITERIA

1. Diagnosed patients of Tamaka shwasa.

2. Patients of Tamaka shwasa without any upadrava.

3. Patients between the age 15-65.

4. Patients fit for Snehana, Swedana and Virechana karma.

EXCLUSION CRITERIA

1. Patients below 15 and above the age 65.

2. Patients of Tamaka shwasa who are suffering form other systemic disorders like

Rajayakshma complication like emphysema, corpulmonale

3. Patients of Tamaka shwasa with secondary infections.

4. Cardiac and Renal asthma.

INTERVENTION

The three groups assigned as A, B and C; were treated with Virechana,

Bharangyadi kwath and Virechana followed by Bharangyadi kwath respectively

GROUP A: (VIRECHANA GROUP)

Patients were administered with Shunthi phanta; between 20-40ml depending on

the bala of the patient and assessing the sama/niramavastha. It was administered till

niramavastha is attained.

Sukoshna lavan taila was applied on the urapradesh and gentle massage was done;

patient was subjected for nadi sweda; taking precaution to protect the hridaya marma

from swedana process by wrapping the chest region by kadali patra. Patient was

Page 47

Methodology

administered with 15-45ml of Eranda taila depending on the kostha of the patient, with

ushna jala on empty stomach on the next day morning. After observing the samyak

virikta lakshanas; patient was advised samsarjana krama; based on the degree of

shodhana. Pathya-apathya advised according to classical consideration.

GROUP B (Bharangyadi group)

15-20 ml of Bharagyadi kwatha was administered twice daily for 1 week. The

dose was varied according the roga and rogibala. Pathya apathya advised according to

classical consideration. Patients were advised to prepare the fresh kwatha daily. They

were provided packets of Shunti and Bharangi kwatha churna.

GROUP C: (Virechana and Bharangyadi group)

The patients were subjected to virechana karma similar to the group A;

intervention, and were followed by Bharangyadi kwath similar to the intervention of

group B, after the samsarjana krama.

Patients were strictly advised to maintain the symptom dairy provided to them;

and to attend the OPD weekly; for periodic follow-up, till the end of follow-up for 1

month. They were also advised to consult immediately; if any discomfort felt in the

course of follow-up period.

SYMPTOM DIARY

A symptom diary was formatted to record the severity of the symptoms; which

was completely based on subjective feeling. The grading pattern was advised and the

recording was maintained through out the course of follow up. The purposes of

maintenance of symptom diary were;

1. To know the frequency of attacks, periodicity between the consecutive attacks and

specific time of attack.

2. To compare the severity recorded by subjective feeling and the severity graded by

fixed standards.

Page 48

Methodology

Table No. 8 Symptom dairy

SYMPTOM DIARY FOR TAMAKA SVASA (Bronchial asthma) Name Date Age OP.D. no Sex No assigned (for clinical trial) Occupation Group Address Start date End date Signature of the patient Signature of the Research Scholar

1. This is a unique method adopted for the grading of the particular symptom on the daily recording basis. 2. The grading will be purely based on subjective feelings of individual.

3. Overall grading will be compared with assessment criteria fixed as standards. INSTRUCTIONS GRADING 1. On every day morning patient has to mark grading; as he was informed. (Patients feelings about individual symptom in last 24 hours). 2. In case of confusion/unable to record; put “X” mark against individual symptom on that particular day.

3. Patient has to bring the diary for weekly visit as well as visits in between (if needed).

SEVERITY GRADE

4. Prakrita 1 5. Mridu 2 6. Madhyama 3 7. Teevra 4 Sl.No. Day

Symptom

01 02 03 04 05 Up to 30th

Total score (T)

T/N

1. Svasakrichrata 2. Kasa 3. Dhurdhuraka 4. Nidra 5. Vyayama

Page 49

Methodology

Assessment of the following variables for there severity in six concluding visits mentioned in the table.

SL. no VARIABLES BT AT I W II W III W FU 1. Svasakrichrata 2. Kasa 3. Dhurdhuraka 4. Nidra 5. Vyayama BT = Before Treatment AT = After Treatment W = Week FU = end of Follow Up At the end of 30th day; score for individual symptoms are summed and assigned for the degree of severity; with the help of score ranges. Score ranges (Total scoring divided by number of recordings). = T ÷ N The remarks are given on the basis of relief in degrees as A Excellent = 3 degree reduction in severity B Good = 2 degree reduction in severity C Encouraging = 1 degree reduction in severity D Stable = Disease status remains same E Deteriorated = Increase in the degree of severity SYMPTOM SCORE SEVERITY REMARKS OVERALL

ASSESSEMENT T ÷ N BT FU Svasakrichrata SEVERITY RANGE Kasa Prakrita 0-1 Dhurdhuraka Mridu 1-2 Nidra Madhyama 2-3 Vyayama Teevra 3-4 ASSESSMENT OF VARIABLES

Clinical assessment was made for the severity of the disease and for the clinical

improvement. Grading for the severity of individual symptom as well as for over all

assessment was framed as four point scale (1-4) on the basis of; guidelines on the

management steps of Asthma; British Thoracic Society. The grading of 9 variables is

given along with clinical proforma especially formatted for the study on Tamaka shwas.

The severity of each variable ranging from Prakrita(1), Mridu(2), Madhyama(3) and

Teevra(4).

Page 50

Methodology

Table No. 9 GRADING FOR THE ASSESSEMENT OF SEVERITY OF

TAMAKA SVASA (Bronchial Asthma)

Scorings Prakrata (1) Mridu (2) Madhyama (3) Daruna (4) Assessment for

Svasakrichrata Attack per week

Attack free One attack 2-4 attacks More than 4 attacks

Svasakrichrata Duration

Attack free Brief for minutes

Prolonged for 2-3 hours

Almost continuous

Kasa Absent Relieved by expectoration

Relieved by treatment

Persistent

Svasakrichrata (on speech)

Normal speech

Speaks in sentences for short period

Speaks in phrases or partial sentences

Speaks only in single words or short phrases

Dhur-dhuraka Wheeze absent

End expiratory wheeze only

Wheeze during entire expiration and inspiration

Breath sounds becoming inaudible/ silent chest

Nidra Normal Difficult in getting sleep

Disturbed at the time of attacks

Disturbed at the time of attacks (Frequent)

Vyayama Normal Perform lightly

Reduced Unable

Prajna Normal Varied Confused Loss of consciousness

PEFR More than 90% predicted

70-90% predicted

50-70% predicted

Less than 50% predicted

OVERALL ASSESSMENT OF SEVERITY

Based on the scoring of variables, overall severity was graded as:

Prakrita 00-09

Mridu 10-18

Madhyama 19-27

Teevra 28-36

LABORATORY INVESTIGATIONS

Following investigations were performed; before and after treatment and at the

end of follow-up; to assess the severity and clinical improvement respectively.

Blood: Hb%, TLC, DLC, ESR, AEC.

Sputum: Eosinophils.

Page 51

Methodology

In suspected cases Sputum AFB, Chest X-ray and ECG were performed to rule out,

pulmonary tuberculosis, other pulmonary diseases and cardiac involvement.

ASSESSMENT OF CLINICAL IMPROVEMENT

Clinical improvement of the disease was based on:

Reduction in the severity of the symptom, overall severity of the disease and

improvement in laboratory findings. Grading for clinical improvement individual

symptom and overall severity is as,

Grading for clinical improvement for individual symptom

1. CD : Clinically determined i.e. increase in severity score against the initial score.

2. CS : Clinically stable i.e. severity score remains same as the initial score.

3. CI-1- Encouraging i.e. 1 degree reduction in the severity score against the initial score

i.e. reduction from mild-normal, moderate-mild and severe-moderate.

4. CI-2- Good i.e. 2 degree reduction in the severity score against the initial score. Ex.-

severe-mild.

5. CI-3- Excellent, 3 degree reduction in the severity score against the initial score,

reduction from severe-normal.

Grading for clinical improvement on overall severity

1. C-D- Deteriorate (increase in the severity score).

2. C-S - Stabilized (no change in the severity score).

3. CI-1- Encouraging (9 degree reduction in the severity score from initial score).

4. CI-2- Good (18 degree reduction in the severity score from initial score).

5. CI-3- Excellent (27 degree reduction in the severity score from initial score).

DATA COLLECTION

Weekly assessment for individual symptom and over-all clinical assessment was

done. The data was collected from each group at the end of follow-up and scoring was

done and finally the data was compared and analysed statistically.

Laboratory investigations were done before treatment, after treatment and at the

end of the follow-up period for 1 month.

Page 52

Results

OBSERVATIONS AND RESULTS

In the present study 36 patients suffering from Tamaka shwasa fulfilling the

inclusion criteria were selected and registered. Out of which 6 patients failed to complete

the study for different non medical reasons. The remaining patients were randomly

categorized into group A, B and C.

Following contains the detail explanation along with

Observation of the over all patients.

The detail statistical analysis of the symtomatology before and after treatment in

three groups.

Comparative statistical analysis of the results in between three groups.

OBSERVATIONS

Analysis of age incidence of the 30patients suffering from Tamaka shwasa

showed more number of patients between the age group of 20-30 yrs (36.67%).

Details of the age incidence is given in table below.

Table No. 10 Distribution of patients according to Age groups:

AGE GROUP No of Patients % 10-20 yrs 07 23.33 20-30 yrs 11 36.67 30-40 yrs 04 13.33 40-50 yrs 03 10.00 50-60 yrs 05 16.67

Fig No-1 INCIDENCE OF AGE

0%

37%13%

10%17%

23%00-10 yrs10-20 yrs20-30 yrs30-40 yrs40-50 yrs50-60 yrs

Page 53

Results

In the sample taken for the study 60% of males were registered in comparison to

40% to females table shows the details.

Distribution of patients according to sex

Table No.11

SEX GROUP No of Patients % MALE 18 60

FEMALE 12 40

Fig No – 2 SEX INCIDENCE

60%

40%

MALE FEMALE

SOCIO ECONOMIC STATUS:

In the present study maximum number of patients were belongs to the middle

class i.e. 50%. Upper class were (12 pts, 40%) lower class were (2 pts, 6.67%) lower

middle class were (1pt 3.33%).

Table No.12

ECONOMICAL STATUS No of Patients % UPPER CLASS 12 40.00

MIDDLE CLASS 15 50.00 LOWER MIDDLE CLASS 01 03.33

LOWER CLASS 02 06.67

Page 54

Results

Fig No – 3 INCIDENCE OF ECONOMICAL

STATUS

40%7%3%

50%UPPER CLASS MIDDLE CLASSLOWER MIDDLE CLASS LOWER CLASS

EDUCATION:

Most of the patients were educated up to graduation 12pts (40%). Patients

educated up to PUC were 12 pts, 40.00%. Patients up to primary were 4pts 13.33%.

Table No.13

EDUCATION No of Patients % PRIMARY 04 13.33

PUC 12 40.00 GRADUATION 12 40.00

POST GRADUATION 02 06.66

Fig No – 4 INCIDENCE OF EDUCATION

4, 13%

12, 40%12, 40%

2, 7%

PRIMARY PUC

GRADUATIO N PO ST GRADUATIO N

Page 55

Results

FOOD HABITS

In the present study it was observed that vegetarian were (14pts, 46.67%), mixed

were (16 pts, 53.33%).

Table No.14

DIET No of Patients % VEGETERIAN 14 46.67

MIXED 16 53.33

Fig No.5

INCIDENCE OF DIET

47%

53%

VEGETERIN MIXED

AGNI

Patients registered for the study were assessed for samagni, mandagni,

teekshnagni and vishamagni. Majority of patients were presenting with mandagni (17pts,

56.67%), teekshnagni (7pts, 23.33%), vishamagni (6pts, 20%). None of the patient was

with samagni.

Table No.15

AGNI No of Patients % MANDA 17 56.67

TEEKSHNA 07 23.33 VISHAMA 06 20.00

Page 56

Results

Page 57

INCIDINCE OF AGNI

57%23%

20%

Manda Teekshna Vishama

INCIDENCE OF PRAKARTIVP

27%

VK46%

PK27%

VP

VK

PK

Fig No – 6

DISTRIBUTIONS OF PATIENTS ACCORDING TO PRAKARTI

The patients registered for the study were assessed to be of dwandwaja prakrati;

among which majority of patients were of vatakaphaja (14pts, 46.66%), vatapittaja (8pts,

26.67%) and pittakaphaja (8pts, 26.67%).

Table No.16

PRAKARTI No of Patients % VATAPITTAJA (VP) 08 26.67

VATAKAPHAJA (VK) 14 46.66 PITTAKAPHAJA (PK) 08 26.67

Fig No – 7

Results

KOSTHA

Patients registered for the study were assessed for mridu, madhyama and krura

kostha. Majority of patients were with krura kostha (13pts, 43.33%), madhyama kostha

(9pts, 30%) and mridu kostha (8pts, 26.67%).

Table No.17

KOSTHA No of Patients % MRUDU 08 26.67

MADHYAMA 09 30.00 KRURA 13 43.33

Fig No – 8 INCIDENCE OF KOSTHA

8, 27%

9, 30%

13, 43%

MRIDU MADHYAMA KRURA

SATWA:

In the present study patients of madhyama satwa (14pts, 46.67%), avara satwa

(12pts, 40%) and pravara satwa (4pts, 13.33%).

Table No.18

SATWA No of Patients % PRAVARA 04 13.33

MADHYAMA 14 46.67 AVARA 12 40.00

Page 58

Results

Page 59

INCIDENCE OF HABITAT

14, 47%16, 53%

URBAN RURAL

INCIDENCE OF SATWA

12, 40%

4, 13%

14, 47%

PRAVARA MADHYAMA AVARA

Fig No – 9

HABITAT Patients registered for the study were nearly evenly distributed regarding their

habitat, i.e. belonging to urban area (16pts, 53.33%) and belonging to rural area (14pts,

46.67%).

Table No.19

HABITAT No of Patients % RURAL 14 46.67 URBAN 16 53.33

Fig No – 10

Results

CHRONICITY

In the present study the chronicity of the disease was categorised as 0-5 yrs, 6-10

yrs, 11-15 yrs and 16-20 yrs (inclusive). Majority of patients belonging to 0-5 yrs (17pts,

56.67%), patients with 6-10 yrs were (9pts, 30%), patients with 16-20 yrs were (3pts,

10%) and patient with 11-15 yrs was (1pt, 3.33%).

Table No.20

CHRONICITY No of Patients % 00-05 yrs 17 56.67 06-10 yrs 09 30.00 11-15 yrs 01 03.33 16-20 yrs 03 10.00

Fig No – 11 INCIDENCE OF CHRONICITY

30%

3%10%

57%

00-05 yrs

06-10 yrs

11-15 yrs

16-20 yrs

RELATION TO FOOD

In the present study it was observed that patients presenting with positive

response for variation of the disease status with relation to food were (20pts, 66.67%), no

response were (10pts, 33.33%)

Table No.21

RELATION TO FOOD No of Patients % PRESENT 20 66.67 ABSENT 10 33.33

Page 60

Results

Page 61

INCIDENCE OF SLEEP PATTERN

30% 30%

13%27%NORMALDIFFICULTY IN GETTING SLEEPDISTURBED AT THE TIME OF ATTACKDISTURBED FREQUENTLY

INCIDENCE SHOWING RELATION WITH FOOD

PRESENT ABSENT

Fig No – 12

NIDRA

In the present study it was observed that patients with normal sleep were (9pts,

30%), with frequently disturbed sleep were (9pts, 30%), with disturbed sleep at the time

of attack were (8pts, 26.67%) and patients with difficulty in getting sleep were (4pts,

13.33%).

Table No.22

SLEEP PATTERN No of Patients % NORMAL 09 30.33

DIFFICULTY IN GETTING SLEEP 04 13.33 DISTURBED AT THE TIME OF ATTACK 08 26.66

DISTURBED FREQUENTLY 09 30.00

Fig No – 13

Results

RELATION TO EXERCISE

In the present study patient in whoom exercise have no effect in causing the

disease attack were (14 pts 46.67%) in whoom causes attack were (16 pts 53.33%).

Table No.23

RELATION TO EXERCISE No of Patients % PRESENT 14 46.67 ABSENT 16 53.33

Fig No – 14 INCIDENCE SHOWING

RELATION WITH EXERCISE

14, 47%

16, 53%

PRESENT ABSENT

RELATION TO CLIMATE

In the present study patients presenting with no response to climatic changes

influencing the disease status were (16pts, 53.33%) and patients positively responding to

the climatic changes were (14pts, 46.66%).

Table No.24

RELATION TO CLIMATE No of Patients % PRESENT 16 53.33 ABSENT 14 46.67

Page 62

Results

Fig No – 15

INCIDENCE RELATION TO CLIMATE

PRESENT, 16, 53%

ABSENT, 14, 47%

PRESENT ABSENT

SMOKING

In the present study it was observed that non smokers were (20pts, 66.66%) and

smokers were (10pts, 33.33%).

Table No.25

SMOKING No of Patients % SMOKERS 10 33.33

NON SMOKERS 20 66.66

Fig No – 16 INCIDENCE OF SMOKING

33%

67%

SMOKERS NON SMOKERS

Page 63

Results

ALCHOHOL

In this study 8 patients (26.677) were alcohol consumers and non consumers 22

patients (73.33%).

TOBACCO CHEWING

In the present study it was observed that non tobacco chewers were (21pts, 70%)

and tobacco chewers were (9pts, 30%).

DISTRIBUTION OF PATIENTS ACCORDING TO SIGNS AND SYMPTOMS

1) PRATISHYAYA

In the present study it was observed that the patients associated with pratishyaya

at the time of attack were (20pts, 66.66%) and not associated with pratishyaya at the time

of attack were (10pts, 33.33%).

2) TIGHTNESS IN THE CHEST

In the present study it was observed that the patients presenting with chest

tightness at the onset of an episode were (23pts, 76.66%) patients presenting with vague

discomfort in the chest and unable to distinguish it as chest tightness were (2pts, 6.66%)

patients without chest tightness were (5pts 16.66%)

3) NIDRA

Patients with this work with normal sleep were (9pts, 30%), with frequently

disturbed sleep were (9pts, 30%), with disturbed sleep at the time of attack were (8pts,

26.66%) and patients with difficulty in getting sleep were (4pts, 13.33%).

4) SHWASAKRICHRATA

Shwasakrichrata was graded as mridu, madhyama and teevra. Patients with mridu

grade were (13pts, 43.33%), madhyama grade were (13pts, 43.33%) and with teevra

grade were (4pts, 13.33%).

Page 64

Results

5) DURATION OF SHWASAKRICHRATA

Patients with 10-60mins of duration of Shwasakrichrata were (14pts, 46.66%),

with 1-4hrs of duration of shwasakrichrata were (9pts, 30%) and patients with more than

4hrs duration of shwasakrichrata were (7pts, 23.33%).

6) GHURGHURAKA

In the present study ghurghuraka was graded as mridu, madhyama and teevra.

Patients with mridu grade were (12pts, 40%), madhyama grade were (10pts, 33.33%) and

with teevra grade were (8pts, 26.66%).

7) KASA

In this clinical work kasa was graded as mridu, madhyama and teevra. Patients

with madhyama grade were (10pts, 33.33%), with teevra grade were (8pts, 26.66%) with

and with mridu grade were (5pts, 16.66%) patient without Kasa (Prakrita) were (7 pts

23.33%)

8) PRAJNA

In the present study it was observed that patients with confused state of

consciousness at the time of attack were (13pts, 43.33%), with normal state of

consciousness were (9pts, 30%) and patients with varied state of consciousness were

(8pts, 26.66%).

9) OVER ALL SEVERITY

In this study it was observed that patients affected moderately were (21pts, 70%),

affected mildly were (5pts, 16.66%) and affected severely were (4pts, 13.33%).

OBSERVATIONS FOR INDIVIDUAL GROUPS

OBSERVATIONS (GROUP A)

1. All the patients were presenting with varied degree of sama lakshanas.

2. Patients received Shunti Phanta; twice daily in a dose of 20-40ml till niramavastha.

The mean dosage (each dose) was calculated to be 38ml.

Page 65

Results

3. It was observed that the duration taken to attain niramavastha was 2-4 days, with a

mean duration of 2.5 days.

4. Patients received Eranda taila in a dose of 15-45ml (single dose), with a mean dose of

28.5ml.

5. It was observed that 9-22 vegas were required to attain shuddhi lakshanas, with mean

of 15.7 vegas.

6. The time required for the onset of vega was between 90-150mins (rounded to nearest

one), with a mean time of 111mins.

7. Number of vegas in the 1st hour after the onset of the vega, were 5-13, with a mean of

9.7 vegas.

8. Samsarjana krama was performed for 3-5 days with a mean of 4.4 days.

9. It was observed that 8-11 days were required for the completion of intervention, with

a mean of 8.9 days.

(GROUP B)

1. In this group all patients were having sama lakshanas.

2. Patients received Bharangyadi kwath 15-20ml twice daily for 1 week with a mean of

17ml.

(GROUP C)

1. All the patients were presenting with varied degree of sama lakshanas.

2. Patients received shunti phanta; twice daily in a dose of 20-40ml till niramavastha

with a mean of 32ml.

3. It was observed that the duration taken to attain niramavastha was 2-4 days, with a

mean duration of 2.7 days.

4. Patients received Eranda taila in a dose of 15-45ml (single dose), with a mean dose of

31.5ml.

5. It was observed that 8-22 vegas were required to attain shuddhi lakshanas, with mean

of 15.2 vegas.

Page 66

Results

6. The time required for the onset of vega was between 90-120mins (rounded to nearest

one), with a mean time of 103.5mins.

7. Number of vegas in the 1st hour after the onset of the vega, were 4-13, with a mean of

9.2 vegas.

8. Samsarjana krama was performed for 3-5 days with a mean of 4.2 days.

9. Patients received Bharangyadi kwath 15-20ml twice daily for 1 week with a mean of

34ml.

RESULTS RELATED OBSERVATIONS FOR INDIVIDUAL GROUPS

GROUP A RESULTS (at the end of treatment)

EXCELLENT

30% (for kasa) and 10% (for nidra) patients showed excellent response at the end

of treatment.

GOOD

10% (for shwasakrichrata), 30% (for ghurghuraka), 40% (for kasa), 20% (for

shwasakrichrata {duration}), 20% (for nidra), 40% (for prajna), 20% (for shwasakrichrata

{speech}), 10% (for vyayama) and 30% (over all severity) patients showed good

response at the end of treatment.

ENCOURAGING



{speech}), 70% (for vyayama), 60% (PEFR) and 60% (over all severity) patients showed

encouraging response at the end of treatment.

STABLE



Page 67

Results

{speech}), 20% (for vyayama) and 40% (PEFR) patients showed no response at the end

of treatment.

10% patients showed increase in the severity of the kasa, nidra, prajna and over

all severity scores at the end of treatment.

GROUP B RESULTS (at the end of treatment)

EXCELLENT

20% (for ghurghuraka), 30% (for kasa), 10% (for shwasakrichrata {duration})

and 40% (for nidra) patients showed excellent response at the end of treatment.

GOOD





ENCOURAGING


shwasakrichrata {duration}), 40% (for prajna), 60% (for shwasakrichrata {speech}), 40%

(for vyayama), 70% (PEFR) and 20% (over all severity) patients showed encouraging


STABLE



{speech}) and 30% (PEFR) patients showed no response at the end of treatment.

GROUP C RESULTS (at the end of treatment)

EXCELLENT

20% (for kasa), 10% (for shwasakrichrata {duration}) and 20% (for nidra)

patients showed excellent response at the end of treatment.

Page 68

Results

GOOD





ENCOURAGING




encouraging response at the end of treatment.

STABLE




of treatment.

Table No. 26 THE RESPONSE OF THE THERAPIES FOR INDIVIDUAL GROUP

(PERCENTAGE) AFTER TREATMENT

Variable GROUP CD CS CI-1 CI-2 CI-3

A 0% 60% 30% 10% 0% B 0% 10% 60% 30% 0% Shwasakrichrata

C 0% 30% 50% 20% 0% A 0% 50% 20% 30% 0% B 0% 20% 50% 10% 20% Ghurghuraka

C 0% 10% 40% 50% 0% A 10% 10% 10% 40% 30% B 0% 20% 20% 30% 30% Kasa

C 0% 30% 20% 30% 20% A 0% 40% 40% 20% 0% B 0% 40% 30% 20% 10% Shwasakrichrata (Duration)

C 0% 40% 30% 20% 10%

Page 69

Results

A 10% 20% 40% 20% 10% B 0% 40% 0% 20% 40% Nidra

C 0% 30% 30% 20% 20% A 10% 30% 20% 40% 0% B 0% 30% 40% 30% 0% Prajna

C 0% 20% 20% 60% 0% A 0% 20% 60% 20% 0% B 0% 10% 60% 30% 0% Shwasakrichrata (Speech)

C 0% 30% 60% 10% 0% A 0% 20% 70% 10% 0% B 0% 0% 40% 60% 0% Vyayama

C 0% 10% 50% 40% 0% A 0% 40% 60% 0% 0% B 0% 30% 70% 0% 0% PEFR

C 0% 30% 70% 0% 0% A 10% 0% 60% 30% 0% B 0% 0% 20% 80% 0% Over all

C 0% 0% 30% 70% 0%

OVER ALL RESPONSE AT THE END OF TREATMENT

Graph No. 1

1 0

63

0 002

8

0 0 03

7

0 1 0

11

18

00

5

10

15

20

group A group B group C total

Over all response at the end of treatment

C-D C-S CI-1 CI-2 CI-3

Page 70

Results

Page 71

0

6

10 01

30 0

3 20 0

10

6

00

5

10

15


Response on Svasakrichrata at the end of treatment


0

53

0 02 120 1

5

0 0

8 9

2

0

5

10

15


Response on Ghurghuraka at the end of treatment


RESPONSE ON SHWASAKRICHRATA AT THE END OF TREATMENT

Graph No. 2

RESPONSE ON GHURGHURAKA AT THE END OF TREATMENT

Graph No. 3

Results

Page 72

1 1

43

02

33

0

3 3 2 1

6

108

02468

10


Response on Kasa at the end of treatment


0

4 2

0 04

21 0

42 1 0

12

6

2

0

5

10

15


Response on Svasakrichrata (Duration) at the end of treatment


RESPONSE ON KASA AT THE END OF TREATMENT

Graph No. 4

RESPONSE ON DURATION OF SHWASAKRICHRATA AT THE END OF

TREATMENT

Graph No. 5

Results

Page 73

12 2

1 0

42

4

0

32 2 1

9

6 7

02468

10


Response on Nidra at the end of treatment


13 4

0 03 3

0 02

6

0 1

8

13

00

5

10

15


Response on Prajna at the end of treatment


RESPONSE ON NIDRA AT THE END OF TREATMENT

Graph No. 6

RESPONSE ON PRAJNA AT THE END OF TREATMENT

Graph No. 7

Results

Page 74

02 2

0 013

0 03

1 0 0

6 6

00

5

10

15

20


Response on Svasakrichrata (Speech) at the end of treatment


02 10 00

6

0 0 14

0 03

11

00

5

10

15

20


Response on Vyayama at the end of treatment


RESPONSE ON SHWASAKRICHRATA ON SPEECH AT THE END OF

TREATMENT

Graph No. 8

RESPONSE ON VYAYAMA AT THE END OF TREATMENT

Graph No. 9

Results

Page 75

04

0 0 03

0 0 03

0 0 0

10

0 00

5

10

15

20


Response on PEFR at the end of treatment


RESPONSE ON PEFR AT THE END OF TREATMENT

Graph No. 10

GROUP A RESULTS (at the end of follow up)

EXCELLENT

30% (for kasa) and 10% (for nidra) patients showed excellent response at the end

of follow up.

GOOD




response at the end of follow up.

ENCOURAGING




encouraging response at the end of follow up.

Results

STABLE




of follow up.

10% patients showed increase in the severity of the kasa, nidra, prajna and over

all severity scores at the end of follow up.

GROUP B RESULTS (at the end of follow up)

EXCELLENT

20% (for ghurghuraka), 30% (for kasa), 10% (for shwasakrichrata {duration})

and 40% (for nidra) patients showed excellent response at the end of follow up.

GOOD





ENCOURAGING


shwasakrichrata {duration}), 40% (for prajna), 60% (for shwasakrichrata {speech}), 40%

(for vyayama), 70% (PEFR) and 20% (over all severity) patients showed encouraging


STABLE



{speech}) and 30% (PEFR) patients showed no response at the end of follow up.

Page 76

Results

GROUP C RESULTS (at the end of follow up)

EXCELLENT

20% (for kasa), 10% (for shwasakrichrata {duration}) and 20 % (for nidra)

patients showed excellent response at the end of follow up.

GOOD





ENCOURAGING




encouraging response at the end of follow up.

STABLE




of follow up.

Page 77

Results

Table No. 27 THE RESPONSE OF THE THERAPIES FOR INDIVIDUAL

GROUP (PERCENTAGE) AT THE END OF FOLLOW

Variable GROUP CD CS CI-1 CI-2 CI-3

A 0% 60% 30% 10% 0% B 0% 10% 60% 30% 0% Shwasakrichrata

C 0% 30% 50% 20% 0% A 0% 50% 20% 30% 0% B 0% 20% 50% 10% 20% Ghurghuraka

C 0% 10% 40% 50% 0% A 10% 10% 10% 40% 30% B 0% 20% 20% 30% 30% Kasa

C 0% 30% 20% 30% 20% A 0% 40% 40% 20% 0% B 0% 40% 30% 20% 10% Shwasakrichrata (Duration)

C 0% 40% 30% 20% 10% A 10% 20% 40% 20% 10% B 0% 40% 0% 20% 40% Nidra

C 0% 30% 30% 20% 20% A 10% 30% 20% 40% 0% B 0% 30% 40% 30% 0% Prajna

C 0% 20% 20% 60% 0% A 0% 20% 60% 20% 0% B 0% 10% 60% 30% 0% Shwasakrichrata (Speech)

C 0% 30% 60% 10% 0% A 0% 20% 70% 10% 0% B 0% 0% 40% 60% 0% Vyayama

C 0% 10% 50% 40% 0% A 0% 40% 60% 0% 0% B 0% 30% 70% 0% 0% PEFR

C 0% 30% 70% 0% 0% A 10% 0% 60% 30% 0% B 0% 0% 20% 80% 0% Over all

C 0% 0% 30% 70% 0%

Page 78

Results

Page 79

10 0 00 0 00 0 10 005

101520

number


Over all response at the end of follow up


0

6

0 01 0 03

0 0

10

00

5

10

15

number


Response on Svasakrichrata at the end of follow up


OVER ALL RESPONSE AT THE END OF THE FOLLOW UP

Graph No. 11

RESPONSE ON SHWASAKRICHRATA AT THE END OF THE FOLLOW UP

Graph No. 12

Results

Page 80

0

5

0 02 2

0 1 0 0

8

2

0

5

10

15

number


Response on Ghurghuraka at the end of follow up


1 13

02

3

0

32 1

68

02468

10

number


Response on Kasa at the end of follow up


RESPONSE ON GHURGHURAKA AT THE END OF THE FOLLOW UP

Graph No. 13

RESPONSE ON KASA AT THE END OF THE FOLLOW UP

Graph No. 14

Results

Page 81

0

4

0 0

41 0

4

1 0

12

2

0

5

10

15

number


Response on Svasakrichrata (Duration) at the end of follow up


12 1 0

4 4

0

32 1

97

02468

10

number


Response on Nidra at the end of follow up


RESPONSE ON DURATION OF SHWASAKRICHRATA AT THE END OF THE

FOLLOW UP

Graph No. 15

RESPONSE ON NIDRA AT THE END OF THE FOLLOW UP

Graph No. 16

Results

Page 82

1 30 0

30 0

20 1

8

00

5

10

15

number


Response on Prajna at the end of follow up


0 20 01 0 0

30 0

60

0

5

10

15

20

number


Response on Svasakrichrata (speech) at the end of follow up


RESPONSE ON PRAJNA AT THE END OF THE FOLLOW UP

Graph No. 17

RESPONSE ON SHWASAKRICHRATA ON SPEECH AT THE END OF THE

FOLLOW UP

Graph No. 18

Results

Page 83

0 20 00 0 0 1 0 0

30

0

5

10

15

20

number


Response on Vyayama at the end of follow up


04

0 03

0 03

0 0

10

00

5

10

15

20

number


Response on PEFR at the end of follow up


RESPONSE ON VYAYAMA AT THE END OF THE FOLLOW UP

Graph No. 19

RESPONSE ON PEFR AT THE END OF THE FOLLOW UP

Graph No. 20

Results

Table No. 28 STATISTICAL ANALYSIS OF GROUP A RESULTS

Variable Grading on Mean SD SE t P value Significance

BT 2.6 0.68 0.20 AT 2.1 0.47 0.16 6.13 0.0019 Significant Shwasakrichrata FU 2.0 0.00 0.00 1.95 0.0112 NS BT 2.9 0.86 0.26 AT 1.8 0.41 0.14 8.41 0.0003 HS Ghurghuraka FU 2.2 0.01 0.003 5.66 0.0023 S BT 2.7 1.09 0.35 AT 1.7 0.48 0.14 6.04 0.0016 S Kasa FU 1.3 0.39 0.14 2.48 0.056 NS BT 2.9 0.73 0.24 AT 1.7 0.41 0.14 5.71 0.0022 S Shwasakrichrata

(Duration) FU 2.1 0.00 0.00 2.88 0.0334 NS BT 2.8 1.08 0.34 AT 1.7 0.65 0.21 1.89 0.1350 NS Nidra FU 1.8 0.54 0.17 3.16 0.146 NS BT 2.1 0.90 0.28 AT 1.4 0.45 0.15 3.80 0.123 NS Prajna FU 1.2 0.30 0.09 7.95 0.0004 HS BT 2.7 0.45 0.14 AT 1.7 0.48 0.16 8.58 0.0004 HS Shwasakrichrata

(Speech) FU 1.6 0.49 0.16 8.60 0.0004 HS BT 2.8 0.40 0.13 AT 1.9 0.31 0.10 7.69 0.0006 HS Vyayama FU 2.0 0.30 0.10 5.62 0.0025 S BT 2.7 0.50 0.16 AT 2.0 0.29 0.08 7.66 0.0006 HS PEFR FU 2.1 0.00 0.00 11.23 0.0001 HS BT 22.9 3.28 1.06 AT 15.7 1.88 0.60 3.23 0.0270 NS Over all FU 15.9 1.15 0.39 3.24 0.0270 NS

Page 84

Results

Table No. 29 STATISTICAL ANALYSIS OF GROUP B RESULTS


BT 2.8 0.69 0.23 AT 1.9 0.56 0.16 11.21 0.0001 HS Shwasakrichrata FU 1.6 0.47 0.15 11.23 0.0001 HS BT 2.9 0.86 0.29 AT 2.0 0.31 0.08 4.82 0.0049 S Ghurghuraka FU 1.6 0.50 0.17 7.05 0.0008 S BT 2.6 1.02 0.36 AT 1.6 0.60 0.14 8.17 0.0005 HS Kasa FU 1.1 0.00 0.00 7.72 0.0006 HS BT 2.8 0.80 0.30 AT 1.9 0.40 0.14 6.65 0.0004 HS Shwasakrichrata

(Duration) FU 1.8 0.47 0.15 6.63 0.0004 S BT 2.7 1.25 0.46 AT 1.3 0.50 0.19 5.64 0.0003 S Nidra FU 1.2 0.01 0.01 5.48 0.0004 S BT 2.2 0.76 0.23 AT 1.3 0.40 0.08 5.91 0.0019 S

Prajna FU 1.2 0.00 0.00 6.08 0.0018 S BT 2.4 0.45 0.14 AT 1.8 0.50 0.16 5.71 0.0025 S Shwasakrichrata

(Speech) FU 1.3 0.32 0.09 11.18 0.0001 HS BT 2.7 0.51 0.16 AT 1.5 0.51 0.16 5.70 0.0025 S Vyayama FU 1.2 0.00 0.00 5.38 0.0031 S BT 2.4 0.60 0.17 AT 2.0 0.30 0.09 4.66 0.0055 S PEFR FU 1.9 0.42 0.13 7.67 0.0006 HS BT 23.0 3.42 1.10 AT 15.1 2.45 0.78 7.68 0.0006 HS Over all FU 12.1 1.70 0.53 11.19 0.0001 HS

Page 85

Results

Table No. 30 STATISTICAL ANALYSIS OF GROUP C RESULTS


BT 2.8 0.62 0.21 AT 1.8 0.43 0.13 7.93 0.0005 HS Shwasakrichrata FU 1.8 0.40 0.13 5.94 0.0019 S BT 3.1 0.73 0.23 AT 1.7 0.39 0.12 4.32 0.0072 NS Ghurghuraka FU 1.8 0.45 0.14 4.18 0.0087 NS BT 2.5 1.12 0.35 AT 1.6 0.48 0.15 4.89 0.0043 S

Kasa FU 1.2 0.00 0.00 5.78 0.0023 S BT 2.7 0.86 0.27 AT 1.6 0.45 0.14 4.71 0.0088 NS Shwasakrichrata

(Duration) FU 1.7 0.41 0.13 4.43 0.0072 NS BT 2.4 1.11 0.35 AT 1.2 0.29 0.09 5.62 0.0025 S Nidra FU 1.2 0.00 0.00 5.38 0.0031 S BT 2.5 0.81 0.26 AT 1.3 0.39 0.12 8.18 0.0005 HS Prajna FU 1.1 0.00 0.00 9.23 0.0003 HS BT 2.1 0.64 0.20 AT 1.5 0.50 0.16 3.48 0.0183 NS Shwasakrichrata

(Speech) FU 1.3 0.40 0.13 6.39 0.0015 S BT 2.4 0.63 0.20 AT 1.7 0.48 0.15 7.68 0.0006 HS Vyayama FU 1.0 0.00 0.00 11.28 0.0001 HS BT 2.6 0.51 0.16 AT 1.8 0.42 0.13 7.63 0.0006 HS PEFR FU 1.7 0.41 0.13 7.63 0.0006 HS BT 22.4 2.39 0.76 AT 13.8 2.64 0.83 7.64 0.0006 HS Over all FU 12.1 1.69 0.53 9.21 0.0003 HS

Page 86

Results

Graph No. 21

0

1

2

3M

ean

valu

es

Mean scores of Shwasakrichrata in A, B & C groups

BTATFU

Group A Group B Group C

Graph No. 22

0

1

2

3

4

Mea

n va

lues

Mean scores of Ghurghuraka in A, B & C groups

BTATFU


Page 87

Results

Graph No. 23

00.5

11.5

22.5

3M

ean

valu

es

Mean scores of Kasa in A, B & C groups

BTATFU


Graph No. 24

0

1

2

3

Mea

n va

lues

Mean scores of Shwasakrichrata (Duration) in A, B & C groups

BTATFU


Page 88

Results

Graph No. 25

00.5

11.5

22.5

3M

ean

valu

es

Mean scores of Nidra in A, B & C groups

BTATFU


Graph No. 26

0

0.5

1

1.5

2

2.5

Mea

n va

lues

Mean scores of Prajna in A, B & C groups

BTATFU


Page 89

Results

Graph No. 27

0

1

2

3M

ean

valu

es

Mean scores of Shwasakrichrata (Speech) in A, B & C groups

BTATFU


Graph No. 28

00.5

11.5

22.5

3

Mea

n va

lues

Mean scores of Vyayama in A, B & C groups

BTATFU


Page 90

Results

Graph No. 29

00.5

11.5

22.5

3M

ean

valu

es

Mean scores of PEFR in A, B & C groups

BTATFU


Graph No. 30

0

5

10

15

20

25

Mea

n va

lues

Mean scores of Overall in A, B & C groups

BTATFU


Page 91

Results

OBSERVATION OF LABORATORY INVESTIGATIONS

All the groups have show similar effect on the individual laboratory investigation.

HEMOGLOBIN

Group C had shown a highest increase on Hemoglobin (3.05gms/dl), while group

A showed 2.15gms/dl increase and group B with an increase of 1.55gms/dl.

TOTAL LEUCOCYTE COUNT

Group C has shown highest reduction in TLC with 1420 cells/cc, group B with a

reduction of 1257 cells/cc and group A with a reduction of 760 cells/cc.

POLYMORPHS

Count in polymorph cells was increased in all groups with, 3.7% in group B

which was relatively greater than group C and group A with 3.4% and 3% respectively.

MONOCYTES

Group A and group B have shown no changes in the monocyte counts, where as

group C had shown a mild increase of 0.5%.

EOSINOPHILS

Group B had shown higher reduction in eosinophil count with 7% reduction

against 6.2% and 5.4% reduction in group C and group B respectively.

BASOPHILS

No change was observed in basophil count in any of the group.

ERYTHROCYTE SEDEMENTATION RATE

Group C had shown higher reduction in ESR with 16.7mm compared with

14.4mm and 13.4mm for group B and group A respectively.

ABSOLUTE EOSINOPHILIC COUNT

Group B higher influence on reduction of AEC i.e. 240 in comparison with 191

and 130 for group C and group A respectively.

Page 92

Results

SPUTUM EOSINOPHILS

Sputum eosinophils were greatly reduced in group B (6.1 HPF) in comparison

with (5.7 HPF and 5.1 HPF) respectively for group C and group A.

Table No. 31 OBSERVATIONS BASED ON LABORATORY FINDINGS

INVESTIGATION GROUP BT AT FU MEAN DIFFERENCE

A 9.65 9.65 11.8 2.15 (Increased) B 9.90 10.0 11.45 1.55 (Increased) HEMOGLOBIN C 10.0 10.55 13.05 3.05 (Increased) A 9574 9118 8814 760 (Decreased) B 9782 8800 8525 1257 (Decreased) TLC C 10820 10225 9400 1420 (Decreased) A 31.6 33.7 34.6 3.0 (Increased) B 31.3 33.8 35.0 3.7 (Increased) Polymorphs C 31.2 32.9 34.6 3.4 (Increased) A 5.6 5.6 5.6 0.0 B 5.6 5.6 5.6 0.0 Monocytes C 5.6 5.6 6.1 0.5 (Increased) A 53.1 54.2 55.5 2.4 (Increased) B 52.2 54.4 55.5 3.3 (Increased) Neutrophils C 52.4 53.7 55.7 3.3 (Increased) A 9.30 6.1 3.9 5.4 (Decreased) B 10.5 5.8 3.5 7.0 (Decreased) Eosinophils C 10.4 7.4 4.2 6.2 (Decreased) A 0.4 0.4 0.4 0.0 B 0.4 0.4 0.4 0.0 Basophils C 0.4 0.4 0.4 0.0 A 25.4 19.9 12.0 13.4 (Decreased) B 26.9 20.0 12.5 14.4 (Decreased) ESR C 26.2 18.0 9.5 16.7 (Decreased) A 490 416 358 132 (Decreased) B 515 450 275 240 (Decreased) AEC C 521 448 330 191 (Decreased) A 7.1 4.3 2.0 5.1 (Decreased) B 8.0 4.0 1.9 6.1 (Decreased) Sputum Eosinophils C 8.0 5.1 2.3 5.7 (Decreased)

Page 93

Discussion

Page 94

DISCUSSION

The ‘Tamaka shwasa’ caused by vata and Kapha doshas and dushya rasa dhatu is

the disorder of Pranavahasrotas. Pitta dosha if get involved in the pathogenesis lead to

pratamaka and santamaka shwasa. The detail description of Tamaka shwasa is available

in Brahatrayees and Laghutrayees.

Tamaka shwasa can be considered as bronchial asthma of modern science. In

Ayurvedic science more emphasizes is laid on the Shodhana Upakramas. In the treatment

of Tamaka shwasa more importance is given to Virechana i.e. Tamaketu Virecham: As

Virechana restores the normal flow of Vata, relieves the obstruction, normalise functions

of Pittasthana and expels the morbid humors Bharangyadi: kwatha on the other hand

possesses all the properties, which can expel the morbid Doshas, facilitating normal flow

of vata by relieving the obstruction. Considering long-term effect of Virechana and a

short duration management by Bharangyadi kwatha encouraged to undertake the present

study to clinically assess the efficacies of the either of therapies considering the classical

background.

NIDANA

Tamaka Shwasa is caused by wide range of etiological factors, in general from

dust, smoke, inherited factors. Even though it is difficult to establish a particular factor as

a causative factor for Tamaka shwasa.

As prevention is better than cure; classics have explained nidan parivarjana as a part of

preventive measures. It is important to understand the nidanas, which leads to the

Pathogenesis of the disease to prevent and also to provide appropriate treatment.

Some classics have explained nidanas of kasa and shwasa together, where as

some have explained hikka and shwasa nidanas together. It may to indicate the factors

affecting pranavaha srotas. Acharya chakrapani classified the nidanas into Vata

prakopaka and kapha prakopaka ganas. Nowhere in classics we get explanation of

Discussion

Page 95

pathological changes occurring due to causative factor. Hence to understand

Pathophysiology caused by ‘nidanas’ we can compare with modern science.

The Vataprakopaka and Kaphaprakopaka ganas explained by chakrapani can be

broadly considered as bronco constrictor and impaired secretary functions respectively.

Vataprakopaka Gana:

The functions of vata can be correlated with the neurological activities. And

Pranavata functions with the cranial nerve activities. The vagus nerve, which crosses the

thoraco abdominal limits reaches abdomen. It supplies to Pharynx trachea, heart stomach.

About pranavayu, sharangadhara has told ‘nabhista pranapavanaha’. Amashaya comes

almost towards space of naphi Any stimulation of epithelial vagal receptors, provokes

bronchoconstriction through both central and local reflexes. These factors leading to

bronchoconstriction may be included under Vataprakopaka Ganas.

Kaphaprakopaka Karanas:

¯¬dy°«d§Sd«dgŸŸSd«dd¦dy £dg ªdm¯d‰ ªd®de£d QgZešd£dZ | £d±Sdz®d Ÿd e®d«ddy´dd¦£dy «dgUgµ£dy‰ ¬dªd£dy ±dgšd«d Indicates excessive

secretion of the mucous thus Kaphaprakopaka lakshanas. In the modern science,

increased mucous secretion is because of the chemical mediators thus producing

pathophysilogy of the asthma. Hence the factors responsible for the release of mediators

can be considered as Kaphaprakopaka Ganas.

CONCEPT OF PITTASTHANA

I¶R¶®dd£dd£«dI¶®dy£ddz e§dÏd±¤dd¦d±d«dg×®ddz | Thus Charaka has described Tamaka shwasa as Pittasthana

samudbhava, but not clarified the role of Pittasthana in Pathogenesis. Chakrapani

described adho amashaya as pittasthana. It can be analised in three ways.

Discussion

Page 96

Biochemical View:

Histamine is responsible for the allergic & anaphylactic manifestations. It is

formed by decorboxylation of amino acid histidine and also synthesized by the micro

flora in the gastrointestine from dietary histidine. Concentration of histamine is rich in

stomach wall. It is present in biological fluids, in platelets, leucocytes, basophils and mast

cells. Histamine is present in animal lung. Histamine stimulates both H1 & H2 receptors

by acting on H1 receptors produces increased vascular permeability mucous secretion, by

acting on H2 receptors increases the gastric acid secretion.

Heamatological view:

The pitta sthana are said to be Sweda, rasa, lasika, rudhira and amashaya thus can

be considered as fluid tissues in the modern views. Chemical mediators Ex:- Histamine

Bradykinine leukotriens, when get increased in concentration in the blood produce an

inflammatory reaction involving bronchoconstriction, Vascular congestion and edema

formation.

Organic Concept:

Studies have revealed that increased gastric secretion, which tend to esophageal

reflux aggravate the asthmatic symptoms. In night, cardiac opening of stomach get

reduces its elasticity, thus gastric secretion regurgitates leading to sudden

bronchoconstriction due to irritation by regurgitated gastric contents which produces the

proximal nocturnal episodes which can be accounted for organopathological

consideration of adhoamashaya as pitta sthana.

INFECTION AND ALLERGY

Concept of Dushivisha can be correlated with the allergic manifestation

Madhavkara has included Shwasa in the list of disorder produced by Doshivisha. When

this visha remain in amashaya produces kapha vataja disorder. Thus we can consider

doshivisha as allergic factor.

Discussion

Page 97

Another view is graha rogas explained by Kashyapa, the infliction of bhutas are

invisible indicating towards the infective allergen or the invisible virus.

POORVARUPA

The poorva rupas for Shwasa are explained in the context of Hikka and Shwasa

and they are hritpeeda, anaha, adhmana, vaktravairasya and toda in shankapradesha.

Before the actual manifestation of the episode, due to narrowing of the air ways,

expiration become difficult and air gets trapped, which may be considered as anaha,

lateron the lungs gets over inflated, due to the trapped air and which may be considered

as Adhmana.

When the lungs are grossly distended, due to over stretching of the pleurae,

patient feels discomfort and uneasiness in the chest region, which may be considered as

Hritpeeda. In modern science it is already evident that histamine initiates episodes of BA.

Subcutaneous injection of the histamine produces severe throbbing headache and

temporal pulsation, which may be compared with Shanka Nistoda.

RUPA

Bronchial asthma is episodic in nature having asymptomatic phase in between. In

asymptomatic. Phase patient remain without symptoms. Hence the lakshanas explained

by classics are lakshanas during attack (Vegakaleena lakshanas).

Along with usually upper reparatory tract is involved that may be why peenasa is

also included in lakshana. Bronchial epithelium get dislodged because of inflammation

and increased mucous secretion in asthma. Because of these airway get partially

obstructed and produce wheezy sounds, when the air passes forcibly through narrowed

air ways. Acharya Charaka has explained kapha udeereana, srotoroda and ghurghur

shabdha. If obstruction is more person begins to respire forcefully, and suffers from

respiratory distress. Which Charaka has explained of ateeva teevravega shwasa and prana

Discussion

Page 98

prapedana. Patient of Tamaka shwasa, suffers from hypoxia when bronchial obstruction

is not relieved in spite of bouts of cough. Hence the lakshana “kasyata sanniruddhate

pramoham kasamanascha”. Patients feels more distressed due to failure to relieve

obstruction and feels relief for a short period when the sputum is expectorated, i.e. given

by Charaka sleshmanya muchyamane tu bhrisham bhavati dukhita tasyaiva cha

vimokshante muhurtam labhate sukham.

Patient feels too difficult to speak or difficulty in speaking due to respiratory

distress “krichana krichnoti bhashium”. Patient feel better in sitting position than lying

this is because, of diaphragm comes up reducing the space for expansion of lungs in lying

position. Thus the lakshana na chapi nidram labhate shayanasya swasaapeeditaha, aseeno

labhate soukhyam ushnam chivabhinandati.

Sweating dryness of mouth severe distress can be seen in reparatory failure & in

hypoxia are included by classics as lalata sweada, vishushkasya etc.,

SAMPRAPTI

The Samprapti should be understood thoroughly in order to treat or manage

Tamakaswasaa as it is very important to treat the disease. In Charaka samhitha we get

samanya samprapti of hikka and shwasa samanya samprapti for shwasa and specific

samprapti for Tamaka shwasa together will give clear idea regarding the pathogenesis of

the disease, sequential changes taking place in the pranavaha srotas leads to Tamaka

shwasa and in such condition if pitta gets associated it leads to the pratamaka or

santamaka shwasa, the avastha bhedas of Tamaka shwasa.

DISCUSSION ON CHIKITSA

Acharya Charaka has explained shodhana and shamana chikitsa according to

rogibalabala. That may be classified as treating acute condition and chronic condition.

Snehana, swedan and vaman help in the liquification and expulsion of kapha obstructing

Discussion

Page 99

the vata. Bahya snehan is advised may be in view that abhyantara snehana leads for

doshotkleshana. Sadhya vamana is advised for shwasa rogi suffering from jwara and

amadosha indicates management in emergency Nasya may helps in relieving congestion,

as peenasa is one of the lakshana and may act on respiratory center in the brain. Shamana,

bramhana indicate management of chronic conditions. Doshanusar chikitsa seems to be

avarana chikitsa.( supported chikitsa of kaphavrita pranavata).

‘Tamaketu Virechanama‘ told by Charaka seems interesting as there is no direct

reference regarding involvement of pitta except pratamaka santamaka avastha.

We can put hypothesis of virchana having adhobhagahar karma & vatanulomana

karma. thus relieving obstruction of vata by kapha. In bronchial asthama parasymphetic

hyperactivates, probably Virechana by its prabhava suppress the parasymphathetic

activities and stimulate the symphathetic.

Virechana is indicated pittasthanagata kapha for expelling vikrita kapha.

Pittasthanagata kapha can be compared with gastro intestinal secretion concentrated with

histamine which should be eliminated. Micro flora in the gut which synthesize histamine

may be inactivated by the Virechana & these mediators are circulating in the body

initiates episodes of bronchial asthma. Virechana being is a shodhana upakrama for pitta

thus acting as raktha shodhaka hence removes the circulating mediators.

MATERIAL & METHODS

Materials:

Shunti phanta: It is used for amapachana and agnideepana. Shunti is uttama amapachaka

vata kaphara and nati pittakara, swarya hridya. Phanta was preferred as it is easy for the

preparation.

Lavana taila: Lavana is aruksha, sookshma, ushna and vyavaya helps in snehana when

mixed with sneha dravyas. The tila taila is vatahara. Lavana taila was taken for bahya

snehana for dosha vilayana.

Discussion

Page 100

Nadi sweda: Nadi sweda was preferred as it easy procedure & was done with, vatahara

dravyas having ushna veerya.

Erand taila: Acharya Charaka explained Erand taila as uttama in snigda Virechana. It

is katu, snigdha, vatakaphahara. In patient where snehapana is not given or sarvanga

abhyanga is not done there acharya Charaka indicated snigdha Virechana. In Tamaka

shwasa sthanica snehana with lavana taila is mentioned as doshotkleshana is not

indicated.

Bharangyadi kwatha: Which is indicated for Tamaka shwasa by Yogaratnakara and

Bhaishajya ratnavali contains Bharangi, Shunti both are kaphavatahara, pachana,

Bharangi is shotaghna act on pathology of Tamaka shwasa hence proved

uttamashamanadravya.

Methods:

Aim:

“A clinical study on the management of Tamaka shwasa with special reference to

Tamaka shwasa”. The aim of the study was took clinically assesses the efficacy of the

Virechana and Bharangyadi kwatha as the classical statement regarding the undertaken

therapies seems quit encouraging toward management for TS.

Plan of study:

In the present study, a total of 36 patients suffering from Tamaka shwasa where

taken from OPD and IPD of ALN Rao Ayurveda & Hospital, out of 36 patients, 6

patients discontinued the study because of non medical reason. The signs and symptoms

of Tamaka shwasa, among those 3 major symptoms are considered as diagnostic purpose

swasakrichrata, Ghurguraka kasa

PEFR:

PEFR values varies from age, sex, height, weight. In normal persons also dirunal

variation in PEFR values is observed & also on different days with relation to nature of

Discussion

Page 101

stress and strain. Hence a resting PEFR was recorded when patient seems to be normal

and was considered as base line reading for that particular individual at least 15% dirunal

variation from the base line value was considered as diagnostic. A pre determined

randomized sampling method was adapted patients are categorized into 3 groups each

group contain of 10 patients. The technique was adapted in order to avoid the sampling

bias.

Intervention:

A pilot study on 6 patients was done, in order to grade the severity for individual

symptom & overall severity, dose fixation, determine end point & grading for the

assignment of clinical improvement.

Group A:

All the patients were having varied degree of Sama lakshanas hence shunti phanta

between 20-40ml was given to all twice daily till nirama lakshanas observed. Snehana &

Swedana was performed on the next day after nirama lakshanas 15-45ml of Eranda taila

was given for the Virechana. The dose was decided on the basis of kostha. 15ml for

mridu, 30ml for madhyama and 45ml for krura kostha. Antiki & laingiki shuddhi where

considered as the end point of Virechana and considered as samyak virikta. Samsarjana

krama was advised after Virechana. After samsarjana krama all the patients visited OPD

weekly for a regular follow up for 1 month.

Group B:

Bharangyadi kwatha 15-20ml twice daily for a week was administered to the

patients in this group. All patients were advised to visit the OPD weekly for a regular

follow up for 1 month.

Group C:

After completion of intervention similar to Group a, each patient was provided

with the medicine in the order as of group b. All the patients received the medicine in the

Discussion

Page 102

proper manner for all the 1 week. All the patients visited OPD weekly for a regular

follow up for 1 month.

GENERAL DESCRIPTION OF PATIENTS

In the present sample taken for the study the patients belonged to the age group

15-65 years maximum number of patients belonged to the age group of 20-30 years.

Bronchial asthma occurs at all ages but predominantly found from the very start of early

childhood (below 10 years). This tendency is not seen in this sample, as the patients

below the age 15 years were not taken for the study. In this study male and female patient

ratio was 3:2. Earlier studies tells about the sex ratio i.e. in the childhood there is 2:1

male/female preponderance but sex ratio equalizes by the age (E.R. Mc Fadden Jr) in the

present study no cases were registered below the age 15.

About prakruti, there is no any direct reference regarding the particular prakruti

person getting affected more by Tamaka shwasa but with the observation in the present

study it can be presumed that vatakaphaj prakruti persons gets affected more by Tamaka

shwasa compared to other prakruti persons i.e. 46.66% of the vatakaphaj prakruti persons

gets affected by Tamaka shwasa. Hence it can be said that vatakaphaj prakruti persons

are more prone towards Tamaka shwasa.

In present sample of 56.66% patients were having mandagni, no one patients was

with samagni by which it can be inferred that mandagni acts as an exciting factor for the

episodes of Tamaka shwasa.

Acharya Charaka has mentioned hat when disease become chronic, it leads to

dhatu kshaya. It is reflected in this study that rogibala declines gradually with progression

of the disease or its chronicity.

Patients were almost equally distributed in rural & urban area (46.67%, 53.33%),

hence in present study, no significance regarding habitat was observed, in comparison

Discussion

Page 103

with environmental difference between rural and urban areas as the hospital, is in urban

area surrounded by many villages.

In this study most of the patients were students contributing about 36.66% and

20% housewives rests were distributed widely in other occupations. A large sample may

be required to reveal and support the previous studies.

All the patients were educated, at least to understand the instruction correctly and

also that every one followed the instruction properly 67% patients showed positive

response for variation of the disease status with relation to food stuffs, 33% showed no

response to food, which suggest food stuff were exciting factors. Acharya Charakadhi

have described influence of ahara in nidana and pathyadi is justified here.

In this study patients having influence of climatic changes on the disease attacks

were 53.33% and not having influence were 46.67% thus it supports the role of climate.

Majority of patients in this study were non-smokers (66.66%) 33.33% incidents of

smoker to get affected by Tamaka Shwasa indicating smoking is non-specific nidana for

Tamaka shwasa.

Only 30% patients were tobacco chewers, 70% were non tobacco chewers and

26.67% patients were alcohol consumers and 73.33% were non-consumer hence showing

tobacco and alcohol are not having significant role in Tamaka shwasa. 66.66% patients of

Tamaka shwasa were also having pratishyaya (allergic rhinitis) which support pervious

studies.

INTERVENTIONS BASED OBSERVATIONS

Group A and C:

Involvement of pitta sthana and also the annavaha srotas is supported by study as

all the patients were presented with samalaxana. Shunti phant given for agni deepagna,

amapachana was palatable. It was given 20-40%ml for the patients of group A and group

C. Considering the patients tolerance 40ml of shunti phanta can be fixed within 2 days

Discussion

Page 104

50% of patients attainted niramavastha with a mean of 2.5 days. Hence the minimum of 3

days is needed in order to attain niramavastha in majority of patients.

To attain samyak shuddhi lakshanas of Virechana quantity of Eranda taila

required was 15-45ml for group A and group C. In this study varied number of Vegas 8-

22 were observed indicating alpa, madhyama doshavastha. On an average of 15-16 Vegas

are essential to attain the shuddhi lakshanas. Study has supported the importance of antiki

and laingiki shuddhi lakshanas.

After the administration of Eranda taila for the on set of Vegas on an average of

110min were required. Eranda taila acts on intestines is evident by increased peristalsis.

The stool was semisolid for initial few Vegas then become watery at the end was

associated with mucous like substance thus we can include Eranda taila in Rechaka

group. In the first hour on an average of 9 Vages were observed depending upon the

degree of shodhana samsarajan krama (3-5 days) was advised. On an average 9 days were

required for the completion of Virechana chikista in both group A & group C and in

group c after 9 days patients were advised to take Bharangyadi kwatha 15-20ml twice

daily for 1 week.

Group B:

In this group also all patients were having samalakshanas as Bharangyadi kwatha

itself is having Shunti as well as Bharangi both does the pachana instead of giving Shunti

phata Bharangyadi kwatha was directly given. Bharangyadi kwatha 15-20ml twice daily

was given for 1 week.

ASSESSMENT OF VARIABLES

During the pilot study which was done on 6 patients, where in the presentation

from each patients was collected against each variable. With the help of textual

references slight modification were done and variables were graded as Prakritha ‘1’,

Discussion

Page 105

Mridu ‘2’, Madhyama ‘3’ and teevra ‘4’. Grading for all the variable and mode of

grading are presented along clinical proforma, formulated for present study.

For present study 9 variables were taken overall severity is based on the total

values of 9 variable and was graded as

Prakrita - 0-9

Mridu - 10-18.

Madhyama - 19-27

Teevra - 28-36

Clinical improvement:

Was assessed using the severity grades. It is graded as follows

CD: -clinically deteriorated, i.e. increase in severity score against the initial score.

CS: -clinically stable i.e. severity remains as against the initial score.

CI-1: -Encouraging i.e, one degree reduction in the severity score against the initial

score this means reductions. From, mild - normal, moderate - mild and severe -

moderate.

CI-2: -good i,e. 2 degree reduction in the severity score against the initial score. This

means reduction from, moderate-normal severe mild.

CI-3:-Excellent, 3 degree reduction in the severity score against the initial score this

means reduction from severe-normal.

Overall severity of the disease was also graded in similar manner and was as,

CD: -clinically deteriorated, i,e. increase in severity score against the initial score.

CS: -clinically stable i.e. severity remains as against the initial score.

CI-1: -Encouraging i.e. reduction of 9 degree from initial score.

CI-2: -good i.e. reduction of 18 degree from initial score.

CI-3:-Excellent, i.e. reduction of 27 degree from the initial score.

Discussion

Page 106

TREATMENT DURATION

Group A:

Virechana was given to this group of patient and duration was 9 days and is

including samsarjana krama. .

Group B:

Bharangyadi kwatha was given for 1 week.

Group C:

Virechana and Bharangyadi kwatha was given to this group of patients and

duration was 16 days. (for Virechana 9 days and for Bharangyadi kwatha 1 week).

DURATION OF FOLLOW UP

One moth of duration was taken for follow up, as the patients with at least one

attack per week were selected. Hence the effect can be assessed in the course of one

month. In case of encouraging results a long term study can be recommended as this

disease has the variable duration of remission period from days to few years.

COLLECTION OF DATA AND STATISTICAL ANALYSIS

Data was collected before treatment, after treatment and every weekend during

follow up and at the end of follow up. This is properly documented for statistical

analysis. Data collected before treatment, after treatment and at the end of the follow up

were considered the data collected were statistically analysed under the guidance of

statistician.

DISCUSSION ON RESULTS

Swasakrichrita :

The mean score of swasakrichrata in group A reduced from 2.6 to 2.1 at the end

of treatment this result was statistically significant at end of treatment where as for group

B mean score reduced from 2.8 to 1.7, showing result as highly significant at the end of

treatment. Result of group C was highly significant at the end of treatment.

Discussion

Page 107

At the end of follow up result in group A was nonsignificant, while group B was

highly significant in group C it was reduced from highly significance to significance.

Hence it can be said that alone Bharangyadi kwatha has highly significant effect

on swasakrichrita over the whole course of management.

Ghurguraka:

Group A had highly significant result at the end of treatment (P<0.001)

Was reduced to significant at the end of follow up, mean score of ghurguraka in group B

reduced from 2.9 to 2.0 at the end of treatment thus effect was significant and it increased

to higher significance at the end of follow up. In case of group C effect was non

significant at the end of treatment till the end of follow up. Hence, Virechana alone has

good result on ghurguraka after the treatment and later course its effect was reduced,

while Bharangyadi kwatha has improved effect during the follow up and end of the

follow up.

Kasa:

Mean score of Kasa in group A reduced from 2.7 to 1.7 at the end of treatment

thus showing significancy and at the end of follow up mean score was 1.3 significance

thus reduced to nonsignificance (P<0.001).

Mean score of group B reduced from 2.6 to 1.6 and 1.1 at the end of treatment and

follow up respectively thus remained highly significant through out observation. Group C

shown significant result both at the end of treatment as well as end of the follow up.

Duration of Swasakrichrita:

Group A shows significant result at the end of treatment was reduced to non

significant. Group B result remained highly significant at the end of treatment and at the

end of follow up Group C result remained non significant.

Discussion

Page 108

PEFR:

In group A, P value was <0.001 at both the end of treatment and follow up,

Virechana was highly significant effect on PEFR value. Bharangyadi kwatha had

significant effect on PEFR after treatment and effect was improved highly significant at

the end of the follow up. Group C had a highly significant effect on PEFR after treatment

and at the end of follow up.

Nidra:

Group A, mean score reduced from 2.8 to 1.8 P value >0.001. Hence Virechana

was non significant after treatment and at the end of follow up. While Bharangyadi

kwatha had significant effect on Nidra after treatment and at the end of follow up. Group

C results were similar to that of group B.

Prajna:

Effect of Virechana was non significant on Prajna after treatment and had a highly

significant improvement at the end of follow up, while Bharangyadi Kwatha had a

significant effect on Prajna after treatment and end of follow up. In group C, Virechana

and Bharangyadi kwatha together had a highly significant effect on Prajna after treatment

and at the end of follow up.

Swasakrichrita on speech:

Mean score of Swasakrichrita in group A reduced from 2.7 to 1.6 at the end of

treatment thus Virechana had highly significant on Swasakrichrita on speech. Group B

i.e. Bharangyadi kwatha had significant at the end of treatment improved to highly

significant at the end of follow up. In group C result was non significant at the end of

treatment improved to significant at the end of follow up.

Vyayama:

Virechana had highly significant effect on Vyayama after treatment and the effect

was reduced to significant at the end of the follow up. While Bharangyadi kwatha had a

Discussion

Page 109

stable significant effect on Vyayama after treatment and at the end of follow up. Group C

had highly significant effect on Vyayama after treatment and at the end of the follow up.

Overall:

Effect of Virechana on overall severity was non significant, where as Bharangyadi

kwatha has highly significant effect after treatment and highly significant at the end of

the follow up. Group C had highly significant effect after treatment and at the end of the

follow up on the overall severity of the disease.

Hence Virechana alone is not having significant efficacy to clear the air way

obstruction. Which is evident by the effect of Virechana on Swasakrichrita Kasa and

ghurguraka; but it had a highly significant effect on the Swasakrichrita on speech,

vyayama and PEFR, which indicates that Virechana helps in increasing the vital capacity

of the lungs and effort based activity. Bharangyadi kwatha is more effective in relieving

on Swasakrichrita, Kasa, ghurguraka, and also had a significant effect on effort based

activities. Virechana followed by Bharangyadi kwatha on an overall had highly

significant effect.

Acharya Charaka has mentioned, Shamana therapy, which is absolutely free from

the adverse effects, should be preferred for the treatment of shwasa. This is supported by

the present study.

DISCUSSION ON LABORATORY INVESTIGATIONS

Mean score for hemoglobin in group A increased from 9.65 to 11.8 at the end of

follow up and in group B increased from 9.90 to the 11.45. Thus reveals that Virechana

being pittashodhaka acts on raktadhatu as a shonita sthapaka, Rakta shodhaka, better than

Bharangyadi kwatha. In group C increased from 10.0 to 13.05, combined effect of

Virechana and Bharangyadi kwatha can be seen in this group.

Discussion

Page 110

Mean difference of TLC in the group A was 760 (decreased) and in group B, 1257

and group C, 1420. Thus Bharangyadi kwatha have significant effect on the reduction of

TLC.

Both Bharangyadi kwatha and Virechana have increased polymorphs, neutrophils,

whereas they have no specific effect on monocytes and basophils, as the count remain

unchanged. Esinophil count have been significantly reduced both by Virechana and

Bharangyadi kwatha.

Mean score for ESR in group A reduced from 25.4 to 12.0, in group B it is

reduced from 26.9 to 12.5 and it was reduced from 26.2 to 9.5 in group C. Thus revealing

that, both Virechana and Bharangyadi kwatha have significantly reduced the ESR, more

reduction was seen in group A and group C thus once again revealing the action of

Virechana on raktadhatu.

Mean difference of sputum Esinophils in three groups was 5.1, 6.1 and 5.7 (all

decreased). Hence both Virechana Bharangyadi kwatha have reduced the sputum

Esinophils, more effect was observed by Bharangyadi kwatha.

Conclusion

CONCLUSION

The disease Tamaka shwasa though it is yapya by its nature it is Sadhya when it is

new onset in patient having enough strength. When disease becomes yapya, we can try at

least to reduce its severity.

A close perusal of the observations the following conclusions can be drawn.

• For the disease Tamaka shwasa which is episodic in nature, no specific etiology can

be established.

• Tamaka shwasa affects invariably patients of any age with more incidences in the age

20-30.

• One of the exciting factor may be mandagni.

• Strength of the patient decreases with the chronicity of the disease.

• Virechana proved its efficacy in enhancing the vital capacity of lungs as well as effort

based activities

• Virechana showed little effect over the airway obstruction

• Bharangyadi kwatha is more effective in relieving over the airway obstruction as well

as it has a significant effect on effort based activities.

• Virechana followed by Bharangyadi kwatha on an overall has highly significant

effect.

• From this study we can conclude that Virechana acts as Vatanulomaka,

Shonitasthapaka and Raktashodhak.

• Both Bharangyadi kwatha and virechana both showed greater significance in reducing

E.S.R and overall remarkable effect on hematological values

Page 111

Conclusion

Limitations:

• The size of sample was small to draw a generalized conclusion.

Recommendation for the future study:

• The study is advised in large sample for longer duration.

• Role of virechana as well as Bharangyadi kwath on CD4 count.

• Role of frequent virechana in the prevention of the onset of episodes.

Page 112

Summary

Page 113

SUMMARY

“A clinical study on the management of Tamaka shwasa with special reference to

virechana and Shamana” has been carried out to find out the efficacies of either of

therapies on patients of Tamaka shwasa. This study contains Introduction, Objectives,

Review of literature, Methodology, Results, Discussion and Conclusion.

Chapter I objectives of study are explained.

Chapter II under Review of literature detail description about Tamaka shwasa

according to Charaka Samhita, Sushruta Samhita, Astanga Hridaya and Madava nidana

etc. are compiled. The description of Bronchial asthma according to modern science is

also complied. Concept of Virechana according to different authors is also explained.

Brief description about drugs Bharangi, Shunti, used in Bharangyadi kwatha and Eranda

which is content of Eranda taila was also included under review of literature.

Chapter III methodology – material and methods includes collection of drug,

instrument, method of using the instrument. Grading for the disease and grouping of

patient etc. are explained.

Chapter IV Results – general observation of patients, distribution of patients,

according to age, sex, economical status, education, habitat, food etc. is represented along

with pie charts. Results of the therapies after end of the treatment, end of the follow up

along the statistical analysis is mentioned.

Chapter V Discussion - includes elaborated discussion about disease, chikitsa,

and results of therapies.

Chapter VI Conclusion – here it is concluded that Virechana alone is not having

significant effect to clear the air way obstruction but it has a highly significant effect in

improving the vital capacity of lungs. Virechana mainly acts as pittashodaka thus

raktashodaka. Bharangyadi kwatha more effective in relieving the air way obstruction

also has significant effect on effort based activities. Virechana followed by Bharangyadi

kwatha on an overall has a highly significant effect.

REFERENCES

1. Sha .Sa.P.K.5/47-50.

2. C.Sa.Chi.17/17.

3. C.Sa.Chi.17/60.

4. C.Sa.Chi. 17/121

5. A. San.Su 27/5.

6. Y.R.Swa.Chi.39

7. B.R.16/23

8. Madhukosha - Ibid.

9. Su.Sa.U 51/1

10. Cha. Sa.Chi.17/13

11. A.H.Ni.4/1

12. Cha.Sa.Chi. 17/11-16

13. Su.Sa.U.51/3

14. A.Sa.Ni.4/2-3.

15. A.H.Ni.4/1.

16. B.P 14/1

17. Y.R.Swa.Chi.1

18. Ma.Ni.12/1-2

19. Cha.Sa.Chi. 23/31.

20. Su.Sa.K.2/28

21. Ma.Ni.69/31.

22. A.San.Ni.4/12.

23. Cha.Sa.Chi. 17/10-13.

24. Cha.Sa.Chi. 17/62.

25. Cha.Sa.Chi. 17/55

26. Cha.Sa.Chi. 17/56

27. Cha.Sa.Ni.1/11.

28. Chakrapani – Ibid (Cha.Sa.Chi

17/63-64)

29. Cha.Sa.Chi.17/8.

30. Ma.Ni 12/15

31. Cha.Sa.Chi.17/148.

32. Cha.Sa.Chi.17/68.

33. Cha.Sa.Chi. 17/62.

34. Su.Sa.U.51/13.

35. Cha.Sa.Chi.17/62.

36. Ma.Ni.1/5-6

37. Cha.Sa.Chi.17/20.

38. Su.Sa.U.51/6.

39. A.San.Ni.4/6.

40. A.H.Ni.4/4.

41. B.P.14/3

42. Y.R.Swa.Chi.6

43. Ma.Ni.12/17.

44. Cha.Sa.Chi.17/56-62.

45. Su.Sa.U.51/8-10

46. A.San.Ni.4/8-12.

47. A.H.Ni.4/6-10.

48. B.P.14/14-21

49. Y.R..Swa.Chi.16-23

50. Ma.Ni.12/27-34.

51. Cha.Sa.Chi.17/63.

52. Cha.Sa.Chi.17/64.

53. Cha.Sa.Chi.17/56.

54. Cha.Sa.Chi.17/58

55. Cha.Sa.Chi.17/61.

56. Cha.Sa.Chi.17/60.

57. Cha.Sa.Chi.17/60.

58. Madhukosha –Ibid (Ma.Ni.1/8).

59. Cha.Sa.Chi.17/58

60. Cha.Sa.Chi.17/60.

61. Cha.Sa.Chi.17/60.

62. A.H.Ni.1/7.

63. Cha.Sa.Chi.17/62.

64. Cha.Sa.Chi.17/59.

65. Cha.Sa.Ind. 7/24.

66. Cha.Sa.Ind. 7/25.

67. Cha.Sa.Ind.7/26.

68. Cha.Sa.Ind.8/15

69. Cha.Sa.Chi.17/62.

70. Su.Sa.U.51/13.

71. A.H.Ni.4/18.

72. Cha.Sa.Chi.17/147-150.

73. Cha.Sa.Chi.17/149.

74. Su.Sa.U.1/25.

75. Cha.Sa.Chi.17/82.

76. Cha.Sa.Chi.17/89.

77. Cha.Sa.Chi.17/77.

78. Cha.Sa.Chi.17/90.

79. Cha.Sa.Chi.17/91.

80. A.San.Su.27/5.

81. Cha.Sa.Chi.17/112.

82. Cha.Sa.Chi.17/113.

83. Cha.Sa.Chi.17/114.

84. Cha.Sa.Chi.17/117.

85. Cha.Sa.Chi.17/121.

86. Su.Sa.U.51/30.

87. Cha.Sa.Chi.17/139.

88. Cha.Sa.Chi.17/149.

89. Cha.Sa.Chi.17/149.

90. Cha.Sa.Chi.17/100.

91. Su.Sa.U.52/46-47.

92. A.H.Ni.4/54.

93. Y.R. Swa.Chi.1-4.

94. B.R.16/134.

95. Cha.Sa.Ka.1/4.

96. Cha.Sa.Su.25/40.

97. A.H.Su.13/1.

98. A.S.Su.27/5.

99. Cha.Sa.Su.25/40.

100. Cha.Sa.Chi.6/9.

101. Sha.Sa.P.K.4/3-6.

102. Cha.Sa.Su.1/77-80.

103. Cha.Sa.Su.1/81-85.

104. Cha.Sa.Su.1/114-115.

105. Su.Sa.Su.44/1-2.

106. Su.Sa.Su.44/1-2.

107. Su.Sa.Su.44/1-2.

108. Cha.Sa.Su.1/89.

109. Cha.Sa.Su.15/17.

110. Sha.Sa.U.K.4/16-17.

111. Cha.Sa.Si. 1/18.

112. Su.Sa.Chi.33/23.

113. Cha.Sa.Si.1/17.

114. Cha.Sa.Si.9/12.

A.H.Su.18/30.

115. Cha.Sa.Si.1/11.

A.H.Su.18/129.

116. Cha.Sa.Si.12/10-11.

117. Cha.Sa.Chi.17/121.

118. Su.Sa.Su.45/112.

119. Cha.Sa.Su.27/301.

120. Su.Sa.Su.45/114.

121. Cha.Sa.Chi.17/109-110.

122. Su.Sa.U.51/44.

123. A.H.Chi.4/32.

124. B.P.M.K.14/34.

125. Y.R. Swa.Chi.39.

126. B.R.16/23.

127. Iatro.Che.Ayu. 146-147.

128. Ha.Sa.3/1.

129. A.P. of India Part –I Vol III.



132. B.P.Ni.H.V

133. B.P.Ni.H.V

134. B.P.Ni.G.V

BIBLIOGRAPHY

1) Sharangdharacharya, Saharangdhara Samhita, edited by Prof.K.R.Shrikanta Murthy,

published by Chaukhambha Orentalia, Varanasi, 3rd edition, 1997.[Page No.25]

2) Agnivesha, Charaka Samhita vol II, edited by Pandit Kashinath Shastri and Dr

Goraknath Chaturvedi, published by Chowkhamba Vidyabhavan, Varanasi, 2nd

edition, 1970, [Page No.508-531]

3) Vagbhata Astanga Sangraha Edited by Kaviraj Athrideva Gupta, Published by

Krishnadas Academy, Varanasi, 1st Edition Reprinted 1993. [Page No.197]

4) Shri Laxmipati Shastri , Yogaratnakara, edited by Brahmashankara shastri, published

by Chaukhambha Sanskrit sansthana, Varanasi, 7th edition, 1999, [Page No.427-436].

5) Bhishagaratna nshri Bharmhashankarmishra Bhaishajya Ratnavali edited by Kaviraj

shri Ambikadatta Shastri published by Chowkhambha Sanskrit series office, Varanasi

16th edition 2002 (Page No 332).

6) Madhavakara, Madhavanidanam, edited by Sudarshanashastri yadunandanopdhaya,

published by Chaukhambha Sanskrit sansthana, Varanasi, 23rd edition, 1994, [Page

No. 281-301].

7) Sushruta, Sushruta Samhita Uttaratantra, edited by Ambikadatta Shastri, published by

Chowkhambha Sanskrit series office, Varanasi, 3rd edition, 1976, [Page No. 372-382].

8) Vagbhatta, Astanga Hridaya, edited by, Harishastri Paradkar Vaidya, published by

Krishnadas Academy, Varanasi, 1st edition, 2000, [Page No.472-476, 602-609].

9) Bhavamishra, Bhavaprakasha Samhita, edited by Bramhashankar Mishra, published

by Chaukhambha Sanskrit sansthana, Varanasi, 7th edition, 2000, [Page No. 159-166].

10) Chakrpanidatta, Ayurveda Deepika, edited by Vaidya Jadavaji Trikamji Acharya,

puyblished by Chaukhambha Sanskrit sansthana, Varanasi, 5th edition, 2001, [Page

No. 533-539].

11) Chakradatta, Chakradatta, edited by Privratta Sharma, Chaukhambha Orentalia,

Varanasi, 1994, [Page No.145-149].

12) Arunadatta, Sarvanga Sundara, edited by Harishastri Paradkar Vaidya, published by


13) Dalhana, Nibandha Sangraha Vyakhya, Narayan Ram Acharya, Chaukhambha

Orientalia, Varanasi, 7th edition, 2002, [Page No.761-765].

14) Haridas. S. Kasture, Ayurvediya Panchakarma Vijnana, edited by Haridas. S.

Kasture, published by Baidynath Ayurveda Bhavan, Nagapur, 4th edition, 1993, [Page

No. 307-383].

15) Hemadri, Ayurveda Rasayana, edited by Harishastri Paradkar Vaidya, published by


16) Kashirams, Gudarthadeepika, edited by parusharama Shastri Vidyasagar, published

by Chaukhambha Orentalia, Varanasi, 4th edition, 2000.

17) Prof R. H. Singh, Panchakarma Therapy, edited by Prof R. H. Singh, Chaukhambha

Sanskrit Series, Varanasi, 1st edition, 1992, [Page No.64-75].

18) Sri Gangadhar, Jalpakalpataru, edited by Kaviraj Shree Narendranath Sengupta,

published by Chaukhambha Orentalia, Varanasi, 1st edition, 1991, [Page No.3001-

3032].

19) The Ayurvedic Pharmacopoeia of India, published by Government of India, ministry

of health and family welfare, Department of health.

20) Arthur.C.Guyton and John.E.Hall, Text book of Medical Physiology, edited by

Arthur.C.Guyton and John.E.Hall, published by Prism Books Pvt. Ltd, Bangalore, 9th

edition, 1996, [Page No.477-561].

21) Catron, Kumar, Collins et.al. Robbins Pathological Basis of diseases, edited by

Catron, 6th edition, [Page No.711-716].

22) Chandi Charan Chatterjee, Human Physiology Vol-I, edited by Chandi Charan

Chattergi, published by A. K. Chatterjee, Calcutta, 11th edition, 1992, [Page No.365-

426].

23) Dr A. C. Tripathi, Differential Diagnosis, a manual of common complaints, edited by

Dr. A. C. Tripathi, published by Paras Medical Publisher, Hyderabad , 1st edition,

1997, [Page No.331-372].

24) Dr Mark Levy, Asthma at your finger tips, edited by Dr Mark Levy, published by B.

Jain publishers, New Delhi.

25) Dr O. P. Jaggi, Asthma and Allergies, causes prevention and treatment, edited by Dr

O. P. Jaggi, published by Orient Paperbacks, Delhi, 2nd edition, 9th printing, 1999.

26) Dr Paul. J. Hannaway, The Asthma Self-help Book, edited by Dr Paul. J. Hannaway,

published by Orient Paperbacks, 1st edition second printing, 1996.

27) Harison, Harison Principles of Internal Medicine vol II, edited by Anthony

Significant Fauci, Grow hill health professions division, New Delhi, 14th edition,

2002, [Page No.1456-1463].

28) Harsha Mohan, Text Book of Pathology, edited by Harsha Mohan, published by

Jaypee Brothers Medical Publishers (P) Ltd. New Delhi 110002, India, 2nd edition,

1995, [Page No. 465-467].

29) Henrey Gray, Gray’s Anatomy, edited by Peter.L.Williams and Roges Warwic,

published by Churchill Livingstone, Edinburgh London, 37th edition, 1989, [Page

No.1248-1286].

30) J.S.Guleria, API Text book of Medicine, edited by Gurmukh.S.Saini, published by

Association of Physicians of India, Bombay, 5th edition, 1997, [Page No.286-290].

31) John Macleod, Christopher Edwards, Davidson’s Principle and Practice of Medicine,

edited by Christopher Edwards, published by Churchill Livingstone, U.K. ltd, 15th

edition, 1990, [Page No.243-240].

32) K. Sembulingam, Prema Sembulingam, Essentials of Medical Physiology, edited by

K and Prema Sembulingam, published by Jaypee Brothers Medical Publishers (P)

Ltd. New Delhi, India, 2nd edition, 2002, [Page No.517-579].

33) K.D.Tripathi, Essentials of Medical Pharmacology, edited by K.D.trapathi, published

by Jaypee Brothers Medical Publishers (P) Ltd. New Delhi, India, 4th edition, 1999,

[Page No.226-238].

34) K.Park, Text book of preventive and social medicine, edited by K.Park, published by

M/S banarsidas Bhanot, Jabalpur (India), 16th edition, 2000, [Page No.131-137 and

504-510].

35) Mary.F.Lipscomb, Basic Pathology (Indian edition), edited by Vinay Kumar, Prism

Books Pvt. Ltd, Bangalore, 5th edition, 1992, [Page No.389-391].

36) Michael Swash, Hutchison’s Clinical Methods, edited by Michael Swash, published

by Bailliere Tindall, 19th edition, 1993, [Page No.186-217].

37) O. P. Ghai, Essential Pediatrics, edited by O. P. Ghai, Interprint publishers, New

Delhi-, 4th edition, 1996, [Page No.285-289].

38) R. S. Satoskar and S. D. Bhandarkar, Pharmacology and Pharmacotherapeutics, vol I,

edited by R. S. Satoskar and S. D. Bhandarkar, published by popular prakashan pvt.

Ltd. Bombay, 10th edition, 1986, [Page No. 269-278, 292-299].

39) Ramnik Sood, Medical Laboratory technology, methods and interpretations, edited by

Ramnik Sood, published by Jaypee Brothers, New Delhi, 4th edition, 1994.

40) Rustom Jal Vakil, Physical Diagnosis A Text book of symptoms and signs, edited by

Rustom Jal Vakil, 8th edition, 1999, [Page No.336-394].

CLINICAL PROFORMA FOR THE STUDY ON TAMAKA SVASA

Name: Date: Case No: Age/Sex: Caste: Education: Occupation: Socio-Economical Status: OPD no: Address: IPD no: Group:

PRADHANA VEDANA: Svasa Krichrata, Kasa, Kapha Stheevana, Pratishya, Nasanaha, Urashula, Kanthakandu, Shirashula, Dhur Dhur Dwhani, Jwara, Bhrama, Murcha. DURATION: . . Days/Weeks/Months/Years. ANUBANDHI VEDANA: ADYATANA VYADHI VRATTANTA: SVASA: MODE OF ONSET & COURSE

Shigrotpatti Chirotpatti.

Ashukari Chirakalasthi.

Nirantara Saantara Savegan.

Prograssive Exacerbations and Remissions.

Nocturnal Episodes Induced By Aspiration of Food.

Oropharyngial Contents Foreign Body.

Precipitated By Aahara, Vihara, Raja, Dhuma, Others.

Attacks, Once/ Twice/ Frequently Per; Day/ Week/ Month/ Year.

Individual Attacks Last In Response to Treatment.

Type of Treatment.

CHARACTER

Krichra Prana Vilomata (Laboured Expiration).

Sudheerga Sashabdha Svasa (Loud Prolonged Expiration).

Sudheerga Urdhva Svasa, Nisvasa Rahita (Prolonged Expiration with,

No or Little Inspiration).

Sudheerga Urdhva Svasa Nisvasa Youktha

(Prolonged Expiration Followed, by Inspiration).

Pause in Between Respiratory Phases.

Sense of Fatigue in Respiratory Muscles/ Chest.

Vague Discomfort in the Chest.

Sense of Suffocation / Chocking.

Undue Awareness of Breathing.

Abnormal Form of Breathing.

SEVERITY

Present at rest Exertional Spontenaneous.

Mridu - good functional ability.

Daruna- poor functional ability/ confined to bed.

Madhyama- disturbed functional ability.

Develops with gentle activities (undressing, walking on plain ground).

Develops during moderate exertion (climbing the stairs).

Develops during strenuous exercise.

Disturbed sleep due to Dyspnoea.

Functionally fit.

AGGRAVATING FACTORSAbhashyandi aahara Sleshmavarodha Sheeta Ambupana Sheeta Vata sevana Dhuma Raja Manasodvega Vegadharana Meghachadhana Nisha samaya Nidra Shayanavastha Allergens Drugs Followed by bout of coughing. RELIEVING FACTORS Asine sukhanubhava Oushadhi. Sheetopachar Sleshma nisthevana. Ushnapana Vishrana. ASSOCIATED FACTORS Jwara, Arti, Angamarda, Ruja, Lalata Sweda, Kampa, Kantha-Udhwamsa, Kasa, Pratishya, Mutra Daha, Mutrarodha, Vikrita Anana, Urdhva Dristhi, Vibhranta Lochana. Disturbed mentality, Fainting, Loss of consciousness, Wheezing, Chest Pain, Palpitation, and Perspiration. SEASONAL VARIATIONSheeta kale vriddhi Varsha kale vriddhi Aniyamita. Non seasonal non specific. KASA DURATION: . Days/ Weeks/ Months/ Year. MODE OF ONSET Shigrotpatti Chirotpatti Ashukari Chirakalasthi. COURSE Nirantara Santara Savegan Progressive. Duration of episode. Symptom free period.

TYPE Shushka, Ardra, Bhinna, Kamsyopam Dwhani. Short, Paroxysmal, Metallic, Brassy, Bovine, Hoarseness, Harsh. TIMEOn rising in the morning Going to the bed at night Change in the lying posture Nocturnal Non specific SEVERITY Tamo darshana. Jyoti darshana. Maha vega kasa (expulsive). Maha dwhani kasa (loud). Kshobha. Moha. Fainting. Vomiting. Exhaustion. AGGRAVATING FACTORS Cold food articles. Allergens and pollutants. Change in climate and atmosphere. RELIEVING FACTORS Kapha nisthevana. Snigdha aahara. Amla aahara. Ushna aahara. SEASONAL VARIATION Sheeta kale vriddhi. Varsha kale vriddhi. Aniyamita. Non seasonal. Non specific. ASSOCIATED WITH: Hrit shula, shira shula, parshwa shula, prista graha, katigraha, parvabheda, kantha

ruk. Swara bheda, ura shushkata, kantha shushkata, pinasa, svasa, santapa,

trishna, daha, moha, bhrama, gourava, dourbalya, krishata, tiktasyata, aruchi,

mandagni, chardi, utklesha.

URASHULA Duration: . . Days/ week/ month/ year. MODE OF ONSET Sudden, gradual, insidious, episodic. SITE Mid sternal, sub sternal, sub mammary, precordial, left inframammary, left supramammary, spinal, breast, axillary. TYPE Sharp, dull, pressing, constricting, pricking, heaviness, burning, boring, deep, superficial, synchronous to heart beat, related to respiration. RADIATION Shoulder, tip of shoulder, arm, neck, along the course of intra costal nerve, back abdomen.

AGGRAVATING / PRECIPITATING FACTORS Effort, excitement, fatigue, over eating, empty stomach, food intake, recumbency,

swallowing, coughing, sneezing, straining, breathing, twisting the trunk, lying on the

affected side, muscular contraction.

RELIEVING FACTORS

Rest, sitting posture, food intake, vomiting, breath holding, muscle relaxants,

sub lingual nitrates, analgesics.

ASSOCIATED WITH:

Palpitation, perspiration, dyspnoea, fatigue, haemoptysis, emaciation.

SPUTUM:

MOUNT: Bahu/ alpa . . Ml/ 24 hours.

CHARACTER: snigdha, ghana, tanu, grathita, kuthita, puyamaya.

COLOR: Pita, samishra, harita, lohita, shweta shava, shonita.

ODOUR: Nirgandha, durganhi, lohagandhi, visragandha.

TASTE:

BROUGHT OUT BY: Cough, vomiting, clearing the throat.

JWARA:

DURATION: . . Days/weeks/ months.

MODE OF ONSET:

Sudden, insidious, gradual, step ladder fashion, recurrent.

TYPE:

Continuous, remittent, quadition, tertian, quatrain, irregular.

SEVERITY:

Mild, moderate, severe.

DIFERVESCENCE:

Crisis, lysis.

ASSOCIATED WITH:

Rigor, chills, convulsions, delirium, headache, body ache, anorexia.

CHIKATSANUKRAMINIKA VRATTANTA:

PURVA VYADHI VRATTANTA:

KULA VRATTANTA:

VRATTANTA FOR ANURJATA:

ATURA CHARYA

AAHARA Veg/non-veg/mixed: Quantity of food: Frequency of intake: Particulars of the food items: Specific food item (if any), leads to the disorder or aggravates the symptoms:

JALAPANA

Type: source: Purified/Unpurified Chlorinated/non chlorinated:

VIHARA

Nature of work: Laborious Strenuous Sedated Exercise: Indulgence in any out door games:

NIDRA Regular/Irregular Sound Sleep/Disturbed Day/Hours: Night/Hours:

MALA Prakrita Malabaddhata Atipravratti Pramana: Sankhya: Vedana:

MUTRA Prakrita Alpa Atipravratti Pramana: Day/ Night: Sankhya: Day/ Night: Vedana:

SWEDA Prakrita Alpa Atipravratti Day: Night: Perspiration with dyspnoea (nocturnal)

VYASANAS

Smoking: Tobacco chewing: Alcoholism:

Narcotics:

MENSTRUATION Menarche: Menopause: Issues: Miscarriages/Abortions:

PLACE: (Residence)

Condensed: Free Spacious: Dry: Humid: Cold: Warm: Hygienic: Unhygienic: Any other specific conditions:

PLACE: (Working)

Condensed: Free Spacious: Dry: Humid: Cold: Warm: Hygienic: Unhygienic: Any other specific conditions: Clothing: Beddings:

GENERAL EXAMINATION Body Structure: Body Strength: Height: Weight: Blood Pressure: Pulse: Respiration: Temperature: Face: Lips:

SYSTEMIC EXAMINATION GI TRACT

Inspection: Palpation:

Percussion: Auscultation: Others:

CARDIOVASCULAR SYSTEM

Inspection: Palpation: Percussion: Auscultation: Others:

CNS/NEUROLOGICAL SKELETAL/MOTOR FUNCTIONS URO-GENITAL SYSTEM

RESPIRATORY SYSTEM INSPECTION: Shape, Size of the chest

Rate, Rhythm and type of respiration. A] ANTERIOR: 1. 2. Size 3. Shape 4. Symmetry 5. Respiratory movements 6. Swellings and pulsation 7. Drooping of the shoulders B] POSTERIOR:

1. 2. Curvature of the spine [scoliosis] 3. Distance of the spine from either scapulae

C] EITHER SIDES OF THE CHEST: 1. 2. Anterioposterior curvature [kyphosis or lordosis] 3. Anterioposterior diameter or depth. D] UPPER PART OF THE CHEST:

1. 2. Diminution or delay of respiratory excursion. 3. Retraction or flattening of chest [unilateral/bilateral]

E] Movements of the sub costal angle F] Action of the accessory muscles of respiration. G] Position of apical thrust. H] Diaphragmatic movements. PALPATION A] Respiratory movements [expansion of upper, middle lower zones] B] Diaphragmatic movements C] Mediastinal position D] Apex impulse E] Position of trachea F] Tracheal descent with inspiration G] tactile vocal fremitus H] localized swelling I] Localized tenderness J] Crepitus K] Rhoncial fremitus L] Palpable rales M] Friction fremitus N] Lymph node enlargement O] Jugular notch P] Laryngeal fixation Q] Fluctuation of the trachea PERCUSSION 1] Apical percussion 2] Basal percussion 3] Percussion of mediastanum. AUSCULTATION 1] Intensity/loudness 2] Quality/character

(rustling, breezy, blowing, tubular) 3] Comparison between inspiratory and expiratory elements of sounds.

(intensity, duration, length, pitch) 4] Pause in-between inspiration and expiration (present/absent). 5] Other characters. 6] ADDED SOUNDS. A] WHEEZES (RHONCI), Inspiratory/Expiratory. 1] Monophonic [fixed/random] 2] Stridor 3] Polyphonic [expiratory polyphonic, sequential inspiratory wheezes] B] CRACKLES (RALES, CREPITATIONS)

1] Early inspiratory crackles. 2] Late inspiratory crackles. 3] Basal crackles 4] Expiratory crackles. C] Crackle-wheeze. D] Coarse rales (bubbling rales) E] Fine rales (crackling rales,) F] Medium rales G] Post-tussive rales H] Tracheal rales I] Pleural rub J] Vocal sounds (vocal resonance) K] Spoken voice sounds. increased/decreased/absence) L] Whispered voice sounds.

ASTHAVIDHA PAREEKSHA

Nadi: Shabda: Mutra: Sparsha: Mala: Drik: Jheewa: Akriti:

DASHAVIDHA PAREEKSHA Prakritatha: Satmyatatha: Vikritatha: Satwatha: Saratatha: Aahara Shaktitha: Samvahanatha: Vyayama Shaktitha: Pramanatha: Vayatha:

SAMPRAPTHI GHATAKAS

Dosha: Dushya: Srotas: Dusthi: Rogamarga: Adhisthana: Utpattisthana: Vyaktha Sthana:

AGNI Sama Manda Teekshna Vishma KOSTHA Mrudu Madhya Krura

INVESTIGATIONS

BLOOD: HB%, TLC/DLC, ESR, AEC. URINE: Routine SPUTUM: AFB, Eosonophils. CHEST X-RAY, ECG, Pulmonary Function Test

NIDANA PANCHAKAS Hetu: Purva Roopa: Roopa: Upashaya/Anupashaya: Samprapthi: Sambhavya Vyadhis: Sapeksha Nidana: Vyadhi Vineschaya: Upadravas: Aristha Laxanas: Sadhyasadhyata:

GRADING FOR THE ASSESSEMENT OF SEVERITY OF TAMAKA SVASA (Bronchial Asthma)

Scorings Prakrata (1) Mridu (2) Madhyama

(3) Daruna (4)

Assessment for

Svasakrichrata Attack per week

Attack free One attack 2-4 attacks More than 4 attacks

Svasakrichrata Duration

Attack free Brief for minutes

Prolonged for 2-3 hours

Almost continuous

Kasa Absent Relieved by expectoration

Relieved by treatment

Persistent

Svasakrichrata (on speech)

Normal speech

Speaks in sentences for short period

Speaks in phrases or partial sentences

Speaks only in single words or short phrases

Dhur-dhuraka Wheeze absent

End expiratory wheeze only

Wheeze during entire expiration and inspiration

Breath sounds becoming inaudible/ silent chest

Nidra Normal Difficult in getting sleep

Disturbed at the time of attacks

Disturbed at the time of attacks (Frequent)

Vyayama Normal Perform lightly

Reduced Unable

Prajna Normal Varied Confused Loss of consciousness

PEFR More than 90% predicted

70-90% predicted

50-70% predicted

Less than 50% predicted

MEASUREMENT OF VARIABLES (TAMAKA SVASA).

INSTRUCTIONS:

A] Every morning patient has to write, in the squares for each symptom, how he

is feeling, using the following scores.

SLNO SYMPTOMS/COMPLAINTS SCORES 1 Prakrata 0 2 Mridu 1 3 Madhyama 2 4 Daruna 3 B] One has to add up the symptom scores to observe the progress. C] Following symptoms to be observed for scorings.

SVASAKRICHRATA (attacks/week) SVASAKRICHRATA (duration) SVASAKRICHRATA (on speech) KASA DHUR-DHURAKA NIDRA VYAYAMA PRAJNA

ASSESSMENT OF LAB INVESTIGATIONS: INVESTIGATION BEFORE

TREATMENT AFTER TREATMENT

AFTER FOLLOW UP

TC DC ESR AEC Sputum Eosonophils PEFR

ASSESSEMENT OF SEVERITY OF TAMAKA SVASA (Bronchial Asthma)

Assessment of the following variables for there severity in six concluding visits mentioned in the table. SL. no VARIABLES BT AT I W II W III W FU 1. Svasakrichrata

(attacks/ week)

2. Svasakrichrata (Duration )

3. Svasakrichrata (on speech)

4. Kasa 5. Dhur-dhuraka 6. Nidra 7. Vyayama 8. Prajna 9. PEFR BT = Before Treatment AT = After Treatment W = Week FU = end of Follow Up PEFR = Peak Expiratory Flow Rate.

DISSERTATION DETAILS

Title : “A clinical study on the management of

Tamaka shwasa

with special reference to virechana and

Shamana”

Name of Candidate: Dr. Sujata .S.Tenginakai B.A.M.S

Degree Name : M.D. (Ayurveda Vachaspati)

Subject : Kayachikitsa

Name of the Guide: Prof.P.K.Mishra MD (Ay)., (RSU)., Department : Kayachikitsa

College : A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

Year : March 2004.

Tamakswas kc005 kop

Documents

rajiv gandhi

peak flow

alcohol soluble

acid insoluble

water soluble

post graduate

ayurvedic

facilitating