amakaswasa#dg05 gdg
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Evaluation of efficacy of haritaki phala churna in the management of tamaka shwasa -ANAND. M. DODAMANI, Department of Dravya Guna, Post Graduate Studies & Research Centre, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAGTRANSCRIPT
“EVALUATION OF EFFICACY OF HARITAKI PHALA CHURNA IN THE MANAGEMENT OF TAMAKA SWASA”
BY
ANAND.M.DODAMANI
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the degree of Ayurveda Vachaspati M.D.
In
DRAVYA GUNA
Under the Guidance of
Dr. KUBER. SANKH .MD (AYU)
Department of Dravya Guna
Post Graduate Studies & Research Centre,
D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG - 582103
2004-2007
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “Evaluation of efficacy
of Haritaki phala churna in Tamakaswasa”is a bonafide and genuine
research work carried out by me under the guidance of
Dr. Kuber Sankh M D (AYU) Asst. Professor in Dept of Dravya Guna,
DGMAMC, PGS&RC, Gadag
Date: Anand.M.Dodamani
Place: Gadag
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH
CENTRE
GADAG-582103
This is to certify that the dissertation entitled “Evaluation of Efficacy of Haritaki
phala churna in Tamakaswasa” is a bonafide research work done by
Anand.M.Dofamani. in partial fulfillment of the requirement for the post graduation
degree of “Ayurveda Vachaspati M.D. (Dravya Guna)” Under Rajiv Gandhi
University of Health Sciences, Bangalore, Karnataka.
Date:
Place: Gadag Guide: Dr. KUBER SANKH
M.D. (Ayu) Asst.Professor
Dept. of Dravya Guna
DGMAMC, PGS&RC, GADAG
© Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health
Sciences, Karnataka shall have the rights to preserve, use and
disseminate this dissertation/ thesis in print or electronic format for the
academic / research purpose.
Date : ANAND.M.DODAMANI.
Place : Gadag
© Rajiv Gandhi University of Health Sciences, Karnataka
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTRE
GADAG, 582 103
Endorsement by the H.O.D,Principal / Head of the Institution
This is to certify that the dissertation entitled “Evaluation of efficacy of
Haritaki phala churna in Tamakaswasa” is a bonafide research work done by
Anand.M.Dodamani under the guidance of Dr. KUBER SANKH, MD (AYU)
Asst.Professor in Dept of Dravya Guna, in partial fulfillment of the requirement for
the post graduation degree of “Ayurveda Vachaspati M.D. (Dravya Guna)” Under
Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
(Dr. G. B. PATIL) Principal,
DGM Ayurvedic Medical College, Gadag
Date:
Place: GADAG
(Dr. G. V. MULAGUND) Professor & HOD
Dept. of Dravya Guna PGS&RC.
Date: Place: GADAG
ABSTRACT
Tamaka Swasa vis-a- vis Bronchial Asthma is one of the most distressing disease
and is quite common in all the socio-economic strata in all the age groups and almost all
over the world. The ancient sages knew the entity of this disease from very beginning.
The Objective of the study is - To evaluate the efficacy of Haritaki Phala Churna
in the management of Tamaka Swasa.and To evaluate the Bronchodilatory effect of
Haritaki Phala Churna. Through pulmonary function test – Peak Expiratory Flow Rate.
Method:
In this Prospective Clinical study 30 patients are selected from suffering from Tamaka
Swasa. The study duration is 60 days In Tamaka Swasa there is predominance of Kapha
Vata Dosha, here Haritaki is Tridosha Shyamaka action and Ushna veerya property.
Haritaki Phala Churna is implemented in this clinical study. With dose of 3 gms in
divided dose with Ushna Jala Anupana. Efficacy was assessed by the difference of before
and after treatment from the subjective and objective parameters.
Results:
Teevra vega Swasa and Ghurgurukatwam is pratyatma niyata lakshana of Tamaka Swasa
observed 100% in all patients.Statistically all subjective and objective parameters show
Highly significance.
Haritaki Phala Churna doesn’t cause any untoward effect. Thus Haritaki
Phala Churna in Tamaka Swasa is the best-recommended drug with their requisite action.
Key words:
Haritaki, Tamaka Swasa, Asthma, Swasa Roga, PEFR, BHT, AEC.
III
CONTENTS
Page No
1. Introduction 1-3
2. Objectives 4
3. Literature Review
a) Drug Review 5-35
b) Disease Review 36-72
4. Methodology 73-86
5. Results 87-119
6. Discussion 120-128
7. Conclusion 129-131
8. Summary 132-134
9. Bibliographic References 135-149
10. Annexure 1-7
IV
ABBREVIATIONS
A.H. Asthanga Hridhaya
A.S. Asthanga Samgraha
ARM.N Abhidana Ratnamala Nigantu.
B.P. Bhavaprakash
B.P. N. Bhavaprakash Nighantu
B.R. Bhaishajya Ratnavali
B.S. Bhela Samhita
C.Chi. Charaka Samhita Chikitsa sthana
C.D. Chakradatta
C.S. Charaka Samhita
D.N. Dhanvantari Nighantu
D.G. Dravya Guna by P.V.Sharma
G.N. Gada nigraha
I.M.M Indian Materia Medica
I.M.P. Indian Medicinal Plants.
K.N. Kaiyadev Nighantu
M.N. Madanapala Nighantu.
Mao.N Maoushadhi Nighantu
N.A. Nighantu Adarsha.
R.N. Raja Nighantu
R.T. Rasa tarangini
SH.N Shaligrama Nigantu
S.S. Sushruta Samhita
Y.R. Yoga Ratnakara
V
LIST OF TABLES
Table No List of Table Page No
Table - 1 Paryaya of Haritaki according to different authors 9-10
Table -2 Gana and Varga of Haritaki according to different authors 11-12
Table - 3 Rasa of Haritaki according to different authors 14
Table - 4 Guna of Haritaki according to different authors 14
Table - 5 Veerya of Haritaki according to different authors 14
Table - 6 Vipaka of Haritaki according to different authors 14
Table - 7 Dosha Karma of Haritaki according to different authors 16
Table - 8 Actions of Haritaki according to different authors 16-17
Table - 9 Prayoga of Haritaki according to different authors 18-19
Table - 10 Contraindications of Haritaki according to different authors 20
Table - 11 Vishishta Yoga of Haritaki 22-24
Table - 12 Prayojya Anga of Haritaki according to different authors 33
Table – 13 Nidana of Tamaka Swasa 41-43
Table – 14 Poorva Roopa of Tamaka Swasa 44
Table – 15 Roopa of Tamaka Swasa 45-46
Table – 16 Vyavachedika Nidana of Tamaka Swasa 56
Table – 17 Types of Asthma 61-62
Table – 18 Pathya in Tamaka Swasa 67-70
Table – 19 Apathya in Tamaka Swasa 71-72
Table – 20 Table showing the demographic data 87-88
Table – 21 Distribution of patients by age 89
VI
Table No List of Table Page No
Table – 22 Results of patient by age 89
Table – 23 Results of patient by gender 90
Table – 24 Distribution of patients by Religion 91
Table – 25 Results of Patient by Religion 92
Table – 26 Distribution of patients by Occupation 92
Table – 27 Results of patients by Occupation 93
Table – 28 Distribution of patient by Economical status 94
Table – 29 Results of patients by Economic status 94
Table – 30 Distribution of patient by Food Habits 95
Table – 31 Distribution of patient by Presenting Complaints 97
Table – 32 Distribution of patient by Associated features 99
Table – 33 Results of patients by mode of onset 101
Table – 34 Distribution of patients by frequency of attack 102
Table – 35 Distribution of patients by Duration of attack 102
Table – 36 Distribution of patient by mode of progress 102
Table – 37 Distribution of patient by Periodicity 103
Table – 38 Distribution of patient by Preceding Factors 103
Table – 39 Distribution of patients by aggravation factors 103
Table – 40 Distribution of patients by Comfort Posture at attack 104
Table – 41 Distribution of patients by Agni 104
Table – 42
Distribution of patients by Bowel habits 104
VII
Table No List of Table Page No
Table – 43 Distribution of patients by Addiction 105
Table – 44 Distribution of patients by Prakruti 105-106
Table – 45 Distribution of patients by Dosha Vruddhi 106-107
Table – 46 Distribution of patients by Dosha Kshaya 108
Table – 47 Distribution of patients by Ahara Nidana 109
Table – 48 Distribution of patients by Vihara Nidana 110
Table – 49 Distribution of patients by Anya Nidana 111
Table – 50 Distribution of patients by Srotas 112
Table – 51 Distribution of patients by Poorva Roopa 113
Table – 52 Subjective parameter assessment 114
Table – 53 Showing Objective parameters 115-116
Table – 54 Statistical Assessment of Subjective Parameters 117
Table – 55 Statistical Assessment of Objective Parameters 118
Table – 56 Over all assessment and Result 119
VIII
LIST OF GRAPHS
Graph No List of Graph Page No
Graph -1 Distribution of patient by Age – Gender 90
Graph –2 Distribution of patients by Religion 91
Graph –3 Distribution of patients by Occupation 93
Graph -4 Distribution of patients by Economic status 95
Graph –5 Distribution of patient by Food Habits 96
Graph –6 Distribution of patients by presenting complaints 98
Graph -7 Distribution of patient by Associated features 100
Graph –8 Distribution of patients by mode of onset 101
Graph –9 Over all assessment and Result of Clinical trail 119
IX
ACKNOWLEDGEMENT
This is a moment of great pleasure and contentment for me as the last phase in
completion of this research work
I am deeply indepted to our beloved Principal Dr.G.B.Patil. For his constant
encouragement during the entire phase of the study
I take this glorious opportunity to knowledge with deep sense of gratitude to
Dr.G.V.Mulagund. Professor, H.O.D.Department of postgraduate studies research
Dravyaguna Shri D.G.M.A.M.C.Gadag. For his valuable guidance and close supervision
throughout the dissertation work
I express my deep sense of gratitude to my guide Dr.Kuber Sankh. Lecturer
Department of Dravyaguna Shri D.G.M.A.M.C.Gadag. For his constant encouragement
throughout this dissertation work
I also take this opportunity with deep sense of gratitude to Dr.G.S.Hiremath.
Professor Department of Dravyaguna Shri D.G.M.A.M.C.Gadag.
I express my heartly gratitude to Dr.S.B.Nidagundi.lecturer Department of
Dravyaguna Shri D.G.M.A.M.C.Gadag. I am very much thanks full to Dr.Veena kori,
lecturer Department of Dravyaguna Shri D.G.M.A.M.C.Gadag. I thank to department of
Dravyaguna, teaching and non-teaching staff for providing the necessary facilities to
carry out this work.
I wish to convey thanks to my respected HOD’s of other dept Dr.
V.Varadacharyalu,Dr.Purushottamacharyulu,Dr.M.C.Patil,and lecturers Dr.K.S.R.Prasad,
Dr. Shivaramudu, Dr. Shashidhar Doddamani, Dr.R.V.Shetter, Dr.Girish Danappagoudar,
Dr. Santosh Belavadi, Dr Jagadish Mitti, Dr.Mulkipatil, Dr.Shankargouda.
Acknowledgement I
My Sincerely thanks to P.M.Nandakumar Statistician,Sri.V.M.Mundinamani
Librarian for their timely help during my study I wish to thank R.M.O and all the
physicians and other staff of the hospital and all my patients for their co-operation during
my clinical study.
I am very much thankfull to my roommates Dr. Umesh Kumbar,
Dr.Vijay.G.Hiremath, Dr.Sharanu.Angadi, Dr.Jagadish Handiganoor, Dr.Linagareddy
Biradar, Shivu, Naveen & Manjunath for supporting me in preparing the dissertation right
from beginning to end.
My sincere thanks to my colleaguesDr.C.B.Inamdar, Dr.S.S.sajjanar,Dr.Ashok Bi
ngi,Dr.AshwinDev,Dr.KrishnaJigalur,Dr.AshokM.G,Dr.K.S.Hiremath, Dr.S.S.Gangur,
Dr.V.M.kataraki,Dr.Suvarna,Dr.Anita.Dr.Ashwini vastrad, Dr.Shivalilakudari, Dr.Shalini
Sharma, Dr.Shivakumar. Somlapur, Dr.Savita Bhat, Dr.Jaya Malgoudar, Dr.Kalavati
Pethlur, Dr.Mukta Arali
I am thankful to my friends Santosh Meti, Amith Das, Vinay Achalkar for their kind
co-operation and encouragement during the course of this study.
I express my deepest gratitude to my parents Sri.M.B.Dodamani, Smt.G.M.Dodamani
Sri.L.Udaykumar, Smt.Shoba Udaykumar,Sri.S.G.Babaleshwar. My brothers Sunil and
Anil and my wife Smt.Laxmi.A.Dodamani
Who have inspired me to continue my PG Study with their constant moral
support.Finally my sincere thanks to who are nearer and dearer to me for their
encouragement and help during the course of this study.
Anand.M.Dodamani
Acknowledgement II
Introduction
Introduction
Ayurveda, the Indian System of Medicine, can easily be said the mother of all the
systems of medical sciences. When we peep in to the history of medical sciences, the
records of this system of medicine are the oldest to find. It is in Vedas – the ancient most
literature of human world that details of Ayurveda System of Medicine are found.
Breathing is one of the normal physiological functions of body starts with birth and
ends with death. Pranavata and Apanavata are responsible for the breathing in and
breathing out. 1To and fro air through the Pranavaha Srotas is the vital sign of Prana.2
Normalcy of breathing in and breathing out suggests health and abnormality
indicates diseases and its cessation indicates death.3 This is the unique sign of life, is
affected in the diseases of Tamaka Swasa.4 The disease Tamaka Swasa has been
mentioned in the classics. Its similarities with the bronchial asthma according to the
contemporary sciences are well known.
Tamaka Swasa is one of the most distressing disease and is quite common in all the
socio-economic strata in all the age groups and almost all over the world. The entity of
this disease was known to the ancient sages from very beginning.
The human being appears to be afflicted with more diseases than any other animal
species. There can be little doubt then that he, very early, sought to alleviate his
sufferings from injury and disease by taking advantage of plants growing around him. In
the past, almost all the medicine s used were from the plants, the plant being man’s only
chemist for ages.
The Samhitas classified drugs in different ways based on the features of
morphology, pharmacological action and on the basis of the therapeutic effect in clinical
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 1
Introduction
conditions. The classification of Charaka Samhita under dashemani points to use of ten
single drugs having specific therapeutic potential. Sushruta Samhita and Ashtanga
Hridaya have also made classification of drugs in the form of ganas to groups listing a
number of drugs with specific therapeutic potentials. Further, these drug group (gana) in
toto can be utilized or by removing a few from them or by adding a few more also with
immense therapeutic advantage suited to the clinical conditions.
According to Acharya Charaka (Chi.S.1/33) Haritaki is explained in the
management of Tamaka Swasa and many nighantukaras explained Haritaki having the
Swasa Hara property. The present work “ Evaluation of Efficacy of Haritaki Phala
Churna in the Management of Tamkaswasa” is planned to assess its therapeutic effect
in cases of shwasa roga.
Because of the faulty methods of living, scarcity of balanced diet and various other
reasons the incidence of Tamaka Swasa is increasing day by day. There is no satisfactory
treatment available in contemporary sciences. It was because of these facts that decision
was taken to take up this problem for intensive study.
Tamaka Swasa some times severe and fatal also. It is the serious public health
problem in the countries through out the world. Nearly 5-to10% of the world population
at some stage during life suffers from asthma. 5 The disease can occur at any age and
affects 5% of adults and 7-10% children commonly.6
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 2
Introduction
Between 100 and 150 million people around the globe, suffer from asthma and this
number is rising. Worldwide, deaths from this condition have reached over 180,000 7
yearly. Tamaka Swasa is also generally comes in proximal attacks and one has to manage
the attack immediately.8 Tamaka Swasa if not treated properly it will kill the patient like
the fire burns the dried bush even though it is a Yapya Vyadhi, it becomes Sadhya if it is
Navothitha.9
There is a feeling among the common masses that shwasa roga will go only when
shwasa (prana) goes away. Shwasa is considered krichhra sadhya or difficult to cure. In
this condition Kapha, the predominant dosha causes obstruction in the Pranavaha srotas,
thereby disturbing the movement of Vata. Consequently Vata is aggravated and its
pratilomagati takes place, which results in shwasakashtata. Pranavaha srotas, Annavaha
srotas and Udakavaha srotas are also involved in the Tamaka shwasa, a condition, which
in modern parlance is known as bronchial asthma.
Bronchial asthma is characterized by paroxysms of dyspnoea, accompanied by
wheezing, resulting from narrowing of the bronchial airways by muscle spasm, mucosal
swelling or viscid secretion. The airflow obstruction causes mismatching of alveolar
ventilation and perfusion and increases the work of breathing. Being more marked during
expiration it also causes air to be trapped in the lungs. The narrowed bronchi can no
longer effectively clear mucus by the act of coughing and in patients with severe acute
asthma; many of the smaller bronchi become obstructed by inspissated and often very
tenacious mucus. 10
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 3
Objectives
Objectives
Tamaka Swasa vis-a vis Asthma and allergies, such as atopic disease (i.e, bronchial
asthma, allergic rhinitis, atopic dermatitis and allergic contact dermatitis), are common
medical problems. Tamaka Swasa and its management through various methods are
possible viz. Abhyanga Swedana, Virechana, Vamana, Dhoomapana, Shamana, Kapha
nissarana, Srotomardavata, vata kaphahara, kapha vilayana, Kasagnee, Brumhana effects
will be very effective in combating the Tamaka Swasa. Considering the above the
Haritaki Phala Churna as a shamanoushadhi is under taken for the trail that has all of
these therapeutic effects is opted for this study.
The present study intended to focus on the disease evaluation of efficacy of Haritaki
Phala Churna in the Management of Tamaka Swasa vis-à-vis. Bronchial asthma.
Hypothetically Haritaki Phala Churna is the best therapeutic efficacy on the Tamaka
Swasa (Bronchial Asthma).
In this regard the objectives proposed in the study are-
1. To evaluate the efficacy of Haritaki Phala Churna in the management of
Tamaka Swasa.
2. To evaluate the Bronchodilatory effect of Haritaki Phala Churna.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 4
Disease Review
Disease Review
Nirukti:
The word Tamaka Shwasa composed of two conjoint words. They are Tamaka
and Shwasa. The word Tamaka is derived from the Dhatu (root). “Tamaka glanou” with
Kwip Pratyaya (syllable). It suggests to choke, darkness, be suffogatted (Apti dicti).
It is also defined as “Tamayati iti Tamaka”.122
“Tama eva Tamaka” in Shabdha Kalpa dhruma.
It means where “Tama” occurs that is Tamaka.
The word Shwasa is derived form the dhatu. ‘Swas’ with ‘Gahs’ pratyaya. It
means to breath (Apti).
In shabdhartha kousthubha, it is stated that ‘Shwasathi iti Shwasa’. It means to
breath, by which respiratory movements takes place. 123
The word Tamaka Shwasa is formed by Karmadhareya Samasa as “Tamakaccha
Aska Shwasacha Tamaka Shwasa’. It means difficulty in breathing which occurs mainly
during night hours. 124
Paribhasha:
Susruta: Defines “Tamaka Shwasa as Vischeshat durdine tamyethi Shwasaha” as
“Tamaka Shwasa”. It means the attack of Shwasa with tamapravesha which occurs
especially during “Durdhina”.
The meaning of durdhina is not explained in this context. But in Charaka Samhita
it is stated that symptoms aggravated during cloudy days. 125
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 36
Disease Review
Vijaya Rakshita: Explains Tamaka Shwasa as:
“Shwasasthu bhasthrikadmana Samavathordwa gamani”.
It means it is a disease where in the expiration of air produces a sound similar to
the sound of bellow of blacksmith.
HISTORICAL REVIEW
PREVEDIC AND VEDIC PERIOD:
The description of Prana Vayu as well as Apana Vayu and its role in the act of
respiration is available in literatures of Prevedic and Vedic period. Few references to
mention from Rigveda - Pranadvayu jayate (10-90-13), 126 Ayumapranaha (1-66-1), 127 in
these citations the word Prana is used to refer the act of respiration. At a number of
occasions the mentioning of the word Hridaya is seen in Rigveda. This Hridaya is
considered as the Mula of Pranavaha Srotas in Ayurveda. Quite similar to this few more
references from Yajurveda like Vatam Pranena Nasike 128 (Yaju 15-2) Pranasya
Apyathatvam 129 (Yajur 16-15), these lines express the act of respiration and effort of
expiration in regards to Prana Vayau. Further in Atharvaveda, Pranavayu is referred by
the name Matarishwa. “Vatoprana Ucyata” is a line from Atharvaveda that express the
role of Pranavayu in respiration. 130 Pundarika is the word used to describe the Hridaya in
Atharvaveda. Pundarika refers to the blossom of Nelumbo nucifera and the shape of this
blossom simulates the Hridaya.
UPANISHATH KALA:
The detailed account of respiration; inspiration and expiration the two phases of
respiration all are available in the Upanishats. Inhaling and exhaling the air is mentioned
as the sign of life in Amanaskopanishath. The original reference in this regard goes like
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 37
Disease Review
this - Svasocchvasatmaka Prana (am-1-33) and Avasocchusa Hinastu Niscitam
Muktaevasaha. Angira and Brihaspati are the two names used in Chandogyopanishath
referring to Pranavayu. 131 Added to this Pranavayu is said to nourish the body (CHA
1:2:10/11/12).
Yogachudamanyam is another treatise in which the diseases related to Pranavaha
Srotas like Hikka, Swasa and Kasa are elaborated to some extent.
The cardio respiratory system is compared to the bird Crane; the two wings of the
bird representing the lung, the trunk indicating the heart, and the neck of the bird
symbolically expressing the windpipe are discussed in detail in Swetaswatara
Upanishat.132
The rate of respiration is said to be 21600 per day in Varahopanisat. Similar
references are also available in other Upanishats.
SAMHITA PERIOD:
Caraka Samhita:
The full account of the illness Swasa Roga is elaborated in the 17th chapter of
Cikitsa Sthana in Caraka Samhita. The text includes the Nidana, Samprapti, Purvarupa,
Rupa, Sadhyasadhyata and Cikitsa of the Swasa Roga. Santamaka and Pratamaka Swasa
are told as variant forms of Tamaka Swasa. Swasa is also cited as a symptom of many
other diseases like Pandu, Udara, and Karshya etc. Few prescriptions of Dhumapana in
Tamaka Swasa are also available in this Caraka Samhita and are worth mentioning. 133
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 38
Disease Review
Susruta Samhita:
Even in Susruta Samhita elaboration of etiology, types, pathogenesis, clinical
manifestation as well as treatment is made. 134
Bhela Samhita: Harita Samhita: 135, 136
Falling in line with Caraka and Susruta Samhita, even in Bhela and Harita
Samhita vivid description of the etiology, types, signs and symptoms as well as treatment
is elaborated at full length.
Kashyapa Samhita:
Explanation related to Swasa Roga is restricted to brief description in the Khila
Sthana of Kashyapa Samhita 137
Ashtanga Hridaya and Ashtanga Sangraha: 138, 139
In these treatises the Nidana aspect of the illness is described in the Nidana
Sthana, like wise therapeutic aspect of the Swasa Roga is elaborated in the Cikitsa
Sthana. The interrelation between Kasa Roga and Swasa Roga in the causation is stressed
in these works.
Madhava Nidana:
Swasa Roga is elaborated in the 12th chapter of Madhava Nidana. The description
includes the etiology, pathogenesis, types, symptomatology as well as prognosis of the
Swasa Roga. 140
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 39
Disease Review
MEDIEVAL PERIOD:
Cakrapanidatta: On the basis of the information available in Brihatrayi, the illness Swasa
Roga is described in Cakradatta. 141
Arunadatta: In his nowel work, a commentary on Astangahridaya, Aruna Datta has
stressed the importance of Vata and Kapha Dosha in the pathogenesis of Swasa Roga.
Further he opined that Kasa Roga in due course may precipitate Swasa Roga and like
wise the Swasa Roga may also lead to the occurrence of Kasa Roga.
Ayurvedarasayana: Morbid Kapha Dosha is incriminated to cause the illness Swasa
according to Indukara.
Bhavaprakasha 142 and Yogaratnakara: 143 In these two texts the description of Swasa
Roga at full length is based on the Bhrihatrayi. The Pathya- apathya of the Swasa Roga is
also mentioned in these works. The addition of herb mineral compounds in the treatment
of Swasa Roga is unique.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 40
Disease Review
Nidana of Tamaka Swasa
Table –13 Nidana of Tamaka Swasa 144-148 S.No Nidana C.S S.S A.H M.N G.N
A) Ahara Sambandhi
1 Sheetapana + + + + +
2 Shaata ashana - + - + +
3 Guru bhojana + + - + +
4 Abhishyandi bhojana + + - + +
5 Rooksha bhojana + + - + +
6 Vidahi ahara + + - + +
7 Vistambi ahara + + - + +
8 Adyashana + + - - -
9 Sleshmala ahara + - - - -
10 Jalaja mamsa + - - - -
11 Anupa mamsa + - - - -
12 Ama ksheera + - - - -
13 Dadhi + - - - -
14 Shaluka + - - - -
15 Masha + - - - -
16 Nishpava + - - - -
17 Vishamashana + + - - -
18 Pinyaka + - - - -
19 Tila taila + - - - -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 41
Disease Review
20 Pista padartha + - - - -
21 Ama rasa - + - - -
B) Vihara Sambandhi
24 Sheeta vata sevana + + + + +
25 Raja sevana + + + + +
26 Dooma sevana + + + + +
27 Vyayama + + + + +
28 Vega dharana + + - + +
29 Sheeta sthana - + - + +
30 Bhara vahana - + + + +
31 Atapa sevana - - - + +
32 Abhishyandhi upachara + - - - -
33 Sheetashana - + - - -
34 adhwagamana + - - - -
35 Dwandwa sevana + - - - -
B) Vyadhi/Avastha
Sambandhi
36 Apatharpana + + - + +
37 Atisara + - + + +
38 jwara + - + + -
39 Chardi + - + - -
40 Kasa - + + - -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 42
Disease Review
41 Pandu + - + - -
42 Rookshana + - - - -
43 Anaha + - - - -
44 Vibandha + - - - -
45 Amapradosha + + - - -
46 Shuddhi atiyoga + - - - -
47 Pratishyaya + - - - -
48 Kshata kshaya + - - - -
49 Dourbalya + - - - -
50 Vishoochika + - - - -
51 Udavarta + - - - -
52 Raktapitta + - - - -
D) Agantu Karana
53 Marmaghata + + + - -
54 Visha + - + - -
55 Kantorasa pratighata + - - - -
E) Kala
56 Durdina - + - - -
57 Meghacchadita dina + - + + +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 43
Disease Review
Poorva Roopa of Tamaka Swasa
Table – 14 Poorva Roopa of Tamaka Swasa 149-153
S.No Poorva Roopa C.S S.S A.H M.N G.N
1 Anaha + + + + +
2 Adhmana - - - + +
3 Arathi - + - - -
4 Bhaktadwesha - + - - -
5 Hritpeeda + + + + +
6 Kantha Gurutwa + - - - -
7 Kashaya Vadanata + - - - -
8 Parshwa Shoola + + + + +
9 Prana Vilomata + - + - -
10 Shankha Toda - - + + +
11 Uro Guruta + - - - -
12 Vaktra Vairashya - + - + +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 44
Disease Review
Roopa (Lakshana) of Tamaka Swasa
Table – 15 Roopa of Tamaka Swasa 154-158
S.N Laxanas C.S S.S A.H M.N G.N
1 Swasa (Dyspnoea) + + + + +
2 Ghurughuraka (Wheezing) + + + + +
3 Prana prapeedana (Discomfort) + + + + +
4 Kasa (Cough) + + + + +
5 Pratamyati (Loss of consciousness) + + + + +
6 Sannirudyati (Immobilized) + - - + +
7 Pramoha + + + + +
8 Shleshma vamokshante labhate sukham + + + + +
9 Kantodwamsa (Throat irritation) + - - + +
10 Krichrena bhashitam (Difficulty in
speech)
+ - - + +
11 Na labhate nidra (Sleeplessness) + - - + +
12 Shayanasya swasa peedita (Discomfort in
lying down posture)
+ + + + +
13 Parshwa shoola (Sides pain) + - + + +
14 Ushna abhinandana (Like hot thing) + - + + +
15 Uchritaksha (Wide opened eyes) + + + + +
16 Lalat sweda (sweating on forehead) + + + + +
17 Brushramarthi (Maximum distress) + - + + +
18 Shushkasyata (Dryness of mouth) + - + + +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 45
Disease Review
19 Muhar swasa, Muhuschiva avadhamyati
(Short breath with all effort to breath)
+ + + + +
20 Megha, Ambu, Sheeta,
Pragwaha,Shleshmalancha pravardhanti
(Increase after exposure to kaphakaraka
ahara)
+ - + + +
21 Pratishyaya (Normal discharge) + - + + +
22 Aruchi (Anorexia) - + + - -
23 Trishna (Excessive thirst) - + + - -
24 Vepathu (Tremors) - - + - -
25 Vamathu (Expectoration) - + - - -
26 Ghoshena Mahate - + - - -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 46
Disease Review
Samprapti (Pathogenesis) of Tamaka Swasa
Swasa Roga Samprapti
Charaka opines that the Vitiated Kapha along with vitiated Vata obstructs the
Srotas; the obstructed Vayu tries to over come the obstruction and moves in all the
direction resulting in Swasa. 159
Sushruta says the pranavayu goes against its individual (Prakruti) combines
with Kapha causing Swasa Roga. 160
Bhavamishra 161 and Yogaratnakar,s 162 opinion regarding Samprapti coincides
with Charaka, Madhavakara,s 163 corresponds with Sushruta.
Vagbhata 164 further emphasized that the Annavaha Srotas is also involved
and hence the production Kapha in Amashaya is affected. Thus Swasa Roga is regarded
as Amashaya Samudbhava.
Tamaka Swasa Samprapti
Vata Dosha and Kapha Dosha are invariably involved in the pathogenesis of
Tamaka Swasa. 165 Imbalance of Vata Dosha is best treated by Snigdha line of
treatment.166 Whereas, vitiated Kapha Dosha is treated by Ruksha line of treatment. 167
Theoretically, when both Vata and Kapha Dosha are vitiated mutually, contradictory
therapeutic procedures have to be employed, thus posing a practical problem in planning
the final treatment. Kapha Dosha and Rasa Dhatu both belong to the same category in
relation to their properties. 168 It is a general principle of pathogenesis, that the Dosha and
the Dhatu belonging to the same category have a natural tendency to rapidly progress in
the process of pathogenesis. 169
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 47
Disease Review
Similar to this in Tamaka Swasa also,Kapha Dosha that afflicts the Rasa Dhatu
contributes to the rapid development of the illness. Further, during the course of the
illness, the Hridaya Marma is said to be afflicted.170This adds to the severity of illness.
Put together, the mutual contradictory treatment, involvement of Dosha and
Dushya belonging same category, as well as affliction of Hridaya Marma explains in the
acute onset, chronic course and severity of the illness.
The normal upward course of the Pranavata is obstructed by the abnormally
stiff Pranavaha Srotas. Secondly, like the other Srotas, secretion is the natural process
seen in the Pranavaha Srotas. Here Kapha is the normal secretion and the vitiated
Pranavata abnormally increases it. In further it adds to the obstruction of the passages and
Pranavata leading to Prana vilomata. Narrowing of the Pranavaha Srotas together with
the accumulation of Sleshma obstructs the smooth flow of Pranavata. Prana vilomata and
resulting turbulent breathing lead abnormal audibility of respiration or to say this
procedure Wheezing. Charaka opines that the obstruction to the passage of Pranavata also
leads to rapid breathing. 171
Vitiated Prana Vata irritates the causing increased secretion and
manifestation like Peenas Kshawathu etc. 172
Further the prasena of Kapha in Pranavaha Srotas more particularly in Kanta
(neck) region obstructs the Pranavata. The Pranavata passing through this Kapha, causes
bubbling and a peculiar sound, which is called as Kanta Ghurughuruka is, produced. 173
It is said that this Sleshma is thick, sticky and tenacious and contributes to the
Pranavaha Srotas. Excessively secreted tenacious Sleshma is expectorated out with much
difficulty during the bouts of coughing. 174
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 48
Disease Review
Productive cough is another effect of obstruction of Pranavata in the Pranavaha
Srotas. As the cough brings out the sleshma, obstruction to the Pranavata is minimized,
leading to temporary relief in breathlessness to the patient. 175
Other than the usual presentation, involvement of Pitta Dosha may be seen in
certain patient of Tamaka Swasa.176When this is the case the over all presentation of the
Tamaka Swasa is also changed accordingly.The frequent episodes of Tamaka Swasa are
related to the exposure to cold, cloudy days, and heavy breeze and/ or such other factors
that are provocative to Vata and Kapha Dosha, which is the usual presentation in Tamaka
Swasa. 177 If the association of Pitta Dosha is present this nature of the illness is reversed
and hence exposure to these factors may bring about remittance of symptoms in the
patient. This unique nature of the illness is attributed to Pitta Dosha involvement. These
symptoms like Jwara, Murcha are suggestive of Pitta vitiation. Such a varient form of
Tamaka Swasa with the typical symptoms of Pitta Dosha is called as Pratamaka and
Santamaka Swasa. 178
The imbalance of Vata and Kapha Dosha afflicts the Rasa Dhatu in the
pathogenesis of Tamaka Swasa.during the attack of Tamaka Swasa almost all the
symptoms of Kapha Dosha vitiation are mediated through the Rasa Dhatu. Among the list
of symptoms: productive cough, sputum etc are the symptoms pathogenic of Rasa Dhatu
abnormality. Moreover, abdominal symptoms like Anaha, etc are also the result of
incriminated Rasa Dhatu.179 As the disease runs a chronic course, the vitiated Vata Dosha
dries up the circulating Rasa Dhatu contributing to the weakness and emaciation in the
patient.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 49
Disease Review
Schematic diagram of Samprapti of Tamaka Swasa
NIDANA SEVANA
SANCHAYA AGNIMANDYA DOSHA DUSHTI (VATA & KAPHA
DUSHTI)
PRAKOPA AMARASOTPATTI
MALAROOPA KAPHA
PRASARA PARIBHRAMANA PRATILOMAGATI OF VATA
PRANAVAHA SROTOGAMANA
STHANA
KAPHA makes AVARANA to PRANA VAYU
SANSHRAYA
PRANA try to overcome the AVARANA
VYAKTAVASTHA SHWASA (shwasavarodha, shwasativriddhi, Ghurghurkam etc.)
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 50
Disease Review
Smprapti Ghataka
Dosha : Charaka – Kapha, Vata
: Sushruta- Dominance of Kapha
: Arunadatta – Both Kapha and Vata are involved
Dushya : Rasa
Srotas : Pranavaha, Udakavaha, Annavaha
Srotodushti : Atipravrutti
Utpatti sthana : Vagbhata – amashaya
: Charaka – Pitta sthana
Sanchara sthana : Urah Kantha Siras
Vyaktatha sthana : Urahas
Rogamarga : Abhyantara
Adhisthana : Shareerika
Samprapti Bhedas
For the complete understanding of the disease, Samprapti can be classified as
Sankhya, Pradanya, Vidhi, Vikalpa, Bala and Kala. 180
In the disease Tamaka Swasa also detail study of Hetu Samprapti, Lakshana
and Sadhyasadhyata can be elaborated in the framework of Samprapti bhedas as-
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 51
Disease Review
1) Sankhya Samprapti
The Tamaka Swasa is categorized under pancha bheda of Swasa.181Tamaka
Swasa doesn’t have direct classification to fit in the Sankhya Samprapti, but have
Pratamaka and Santamaka as avastha bhedas. 182
2) Pradhanya Samprapti
Charaka has considered Tamaka Swasa, as Kaphavatatmaka Vyadhi. 183 Where as
Madhavakara has considered it as Kapha pradhana.184its Samprapti indicates the
KaphaPradhanyata, as per the clinical course of the disease and principles of treatment
both Kapha and Vata seems to be Pradhana. 185 Vata holds prime importance in the
management.
3) Vidhi Samprapti
Under Vidhi Samprapti, Tamaka Swasa can be classified in different categories as,
Ashukari, 186 Yapya, 187 and Krichra sadhya. 188 According Charaka Hikka and Swasa are
Ashukari, Ghora, and Sheeghra Pranaharaka.
Further he explained with chronicity as more than one year are considered as
Yapya and of duration less than one year in the durbala rogi, as Krichra sadhya. Achary
Sushruta has considered Tamaka Swasa as Krichra sadhya; and Asadhya in durbala rogi.
4) Vikalpa Samprapti.
Observing of Tamaka Swasa Samprapti, lakshana, Upashsaya and Anupashayas
presence of vikriti in Pranavata and is aggravated by the properties such as Sheet, Ruksha
gunas and increase in its Chala guna. 189 Similarly Urosthitha Avalambhaka Kapha gets
aggravated by Guru, Snigdha, Sheeta, and Abhishyandhi gunas and becomes Ghana and
Pichchila.
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5) Bala Samprapti
Bala of Vyadhi depends on virulence of the hetus, presence of Poorva roopa in
the course development of disease or in developed form. And also it depends on the
involvement of different Srotases, Rogamarga and vital parts of the body. Hence the bala
of the Vyadhi differs for individual patients, thus the Tamaka Swasa is considered as
Krichra Sadhya, Yapya and Ashukari Vyadhi by various authors. 190
6) Kala Samprapti
The name of disease itself indicates of the nature of disease with respect to the
time factor. It is episodic, paroxysmal and mostly nocturnal in its nature. Some times it is
even observed that the symptoms get aggravated in the early morning, and with respect to
seasons it aggravates in the winter and autumn due to cold climate. 191
Upashaya of Tamaka Swasa
Any of the Dravya bhuta (Oushadhi, Ahara etc.) or Adravyabhuta (Vihara)
Upacharas leads to Sukhanubandha is defined as Upashaya. 192 Sleshma Vimokshana is
considered as Upashaya in Tamaka Swasa, 193 which can be achieved by mechanical
process such as coughing etc, by pharmacological measures such as administering
Sleshmavilayana dravyas.
The Dravyas possessing Ushna guna i.e. properties can be administered as
Upashaya in Tamaka Swasa. 194 Non-pharmacological procedures such as change of
position; relives from the severity for short period. 195
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Anupashaya of Tamaka Swasa.
Ahara, Vihara, and Oushadhi aggravates the condition of the Tamaka Swasa are
called as Anupashaya of Tamaka Swasa. They are Asatmya to the Vyadhi. 196 Meghambu
sheetapragvatai sleshmalaischa abhivardheyate is considered as Anupashaya. 197 “
Nachapinidramlabhate Shayanahasvasapeeditaha” indicates the aggravation of the
disease in the recumbent position. 198
Upadrava of Tamaka Swasa.
There is an direct reference regarding the upadravas of Tamaka Swasa mentioned
in ‘Trishna Chikitsa’ is Trishna appears as upadrava in Jwara, Kshaya, Swasa etc. 199
Aristha of Tamaka Swasa.
Regarding the Aristha lakshana, there is no direct reference in the context of
Tamaka Swasa, where as in reference with different contexts Aristha laxana for Swasa
can be established. At the time of death whatever the disease he may suffer, ultimately he
will die with Hikka and Swasa. 200
It is mentioned that the person producing unnatural sounds with heavy breath,
suffering with Atisara, Trishna, Shushkasyata and loss of body strength is definitely
going to die. 201 The person whose Urdhwa swasa is rapid, throat occluded by Kapha;
reduction in strength, complexion and food intake is not going to survive for longer
period. 202 The person taking long inspiration and gives of short expiration gets fainted;
such person is stated to die within short period.203
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 54
Disease Review
Sadhyasadhyata of Tamaka Swasa.
Tamaka Swasa, which is chronic of more than one year, is considered as Yapya
and of duration less than one year in the durbala rogi, as Krichrasadhya.204 If Tamaka
Swasa is Navovita (newly developed) it is Sadhya (curable). 205 Sushruta has considered
Tamaka Swasa as Krichrasadhya Vyadhi and Asadhya in Durbala rogi.206 According to
Vagbhata Tamaka Swasa is Yapya, but can be Sadhya if it is treated in early stages in the
strong persons.207
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Disease Review
Vyavachedaka nidana of Tamaka Swasa
Differential Diagnosis between panchavidha Swasa
Table –16 Vyavachedaka nidana of Tamaka Swasa 208
Lakshana Tamaka Swasa Maha Swasa Urdhwa Swasa Chinna Swasa Kshudra
Swasa
Swasa Ateva teevra vega
swasa
Uchaihi Swasati Dheergam swasati,
Urdhwam swasati,
adhoswasa nirodha
Swasate
vichinnam
Ruksha
aayasottha
Swasa
Shabda Ghur-ghurak 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
Upashaya Sleshma
vimokshana
Sadhyasadhyata Yapya Asadhya Asadhya Asadhya Sadhya
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Disease Review
CHIKITSA
The effective treatment of Tamaka Shwasa cannot be united, as its pathology
involves multiple varying factors as vitiated Vata and Kaphadosha stemming out from the
Pittasthana, afflicting the Rasadhatu in Pranavaha Srotas produces the illness. Therefore
the treatment aimed at the rectification of the imbalances of Vatadosha as well as
Kaphadosha, forms the sheet anchor of treatment of Tamaka Shwasa which is
individually quite opposite. Thus, the unique pathogenesis posses complexity in planning
the treatment. The final treatment planned should pacify the Vata dosha as well as
Kaphadosha effectively. Simultaneously not causing any further addition to the
imbalance of Vata and Kaphadosha, with the due consideration of this, following
principles of treatment for Tamaka shwasa are advocated in the Ayurvedic classics.
Abhyanga and Swedana:
Treatment of Tamaka Shwasa differs both during the attack and in between the
attacks. During the episode of Tamaka Shwasa, the Doshas are in a state of provocation
and contrary to this, in between the attacks the Doshas are silent and are not apparent.
Thus demanding different treatment to make it more clear, the treatment is planned
during the attack to negate the effect of Samprapthi. In contrast to this, in between the
attack, the treatment is planned to prevent the initiation of new Samprapthi thereby
forming the complete treatment of Tamaka Shwasa.209
Prana vaya vilomata is a pathological event during an episode of Tamaka Shwasa
and is said to be due to tenacious Kapha obstructing the passage of Pranavayu. Bringing
it out by liquifying the sputum is the principle and first treatment of this condition. This
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 57
Disease Review
can be achieved by Abhyanga and Swedana over the chest thereby allowing the free
passage of Pranavayu.
Acharya Charaka has prescribed application of oil added with rock salt over the
chest followed by sudation in the form of Nadi, Prastara and Sankara Sweda.
Vamana Karma:
The clinical presentation is patients suffering from Tamaka Shwasa are not
uniform. Some patients present with symptoms suggestive of dominant Vata Dosha and
are characterized mostly by dry cough and prominent wheezing. In such patients,
Vamana Karma is not ideal choice. Yet, other patients presents with symptoms
suggestive of dominance of Kaphadosha, which is characterized by paroxysmal
productive cough, where the sputum is tenacious, bouts of distressing paroxysmal cough
brings out small amount of sticky sputum and this is associated with breathlessness. In
such patients, with the predominant vitiation of Kaphadosha, Vamana Karma is most
ideal. This renders clarify of the Pranavaha Srotas and thereby allowing free passage of
the Pranavayu.
The procedure of Vamana Karma is advisable only in patients who are physically
strong and can tolerate the strain of Vamana Karma. The mild form of Vamana is always
advisable in all patients of Tamaka Shwasa and it can be repeated during every attacks.
After subjecting the patient to Abhyanga and Nadi Sweda over the chest, in the
evening, the patient is allowed to take food that provocates the Kaphadosha like meals
with curds or fish. This Kaphotklesha procedure renders easy elimination of Kaphadosha
by Vamana procedure, which is carried out on the immediate next day, in the morning
hours.210
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Dhoomapana:
This is another procedure also aimed at eliminating the Kaphadosha from the
Srotas. Dhoomapana is advised after the Vamana Karma and it eliminates some amount
of Kaphadosha that is still left out after the Vamana Karma or else, if the Kaphadosha in
the Srotas is minimum, as in Vata dominant cases or in cases of milder attacks.
Dhoomapana may be performed alone without prior Vamana Karma. Further, in
debilitated patients, where prefactory procedure is not possible. Dhoomapana alone helps
in the elimination of Kaphadosha. Added to this, the drugs used in Dhoomapana also
reduces spasm or stiffness of Pranavaha Srotas bringing about Srotomardavata that
ensures free passage of Vatadosha.211
Virechana Karma:
Abnormal response of patients for simple factors like dust is said to be due to Kha
vaigunyata of the Pranavaha Srotas. In the modern counterpart, this is described as
hypersensitivity or allergy of the respiratory system. This may be said as Khavaigunyata
or else called as Asatmyata or even may be named as faulty Vyadhi Kshamatva, and the
fact is that, the patients unfavourably respond to simple factors like dust, atmospheric
change or food.
The answer for such a nature of illness is Virechana Karma and Rasayana
Chikitsa. Charaka pronounced this as “Tamaketu Virechanum”212 when employed in
between the attacks, prevents the attack of Shwasa, renders its severity, minimizes the
duration of illness. Even in some patients, this procedure in combination with Rasayana
Chikitsa brings about complete cure.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 59
Disease Review
After Virechana, Samsarjana Karma is advised for about 3 to 5 days. This
procedure eliminates Doshas in Tamaka Shwasa eliminated as is told in the classics.
Virechana procedure eliminates Doshas stemming out from Pittasthana is. It is worth
mentioning here that, Vata Dosha is the predominant Dosha involved in the Samprapti of
Tamaka Shwasa, Virechana normalizes the course of Vata Dosha and thus helps in the
reversal of Vilomagati of Pranavayu. Distension of abdomen, constipation and such other
symptoms may be associated in some patients and these symptoms are best treated by this
procedure.
Brimhana and Rasayana Chikitsa:
The difference in response to atmospheric changes in a normal person, in contrast
to patients of Tamaka Shwasa, where in atmospheric changes reflects as disease in patient
is said to be due to Khavaigunyata 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 defence mechnism of Pranavaha Srotas, reduces
the tendency of abnormal reaction to simple factors in the surroundings. Further, in the
long run, the disease cause emaciation of the body. this can be corrected by the Brimhana
Chikitsa. This adds to the benefit.213
To sum up, sequential administration of Abhyanga and Swedana over the chest,
and increasing the tendency of Kapha to get eliminated Vamana and Dhoomapana
followed by Shamana Chikitsa is the sheet anchor of treatment of Tamaka Shwasa during
an episode.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 60
Disease Review
Virechana followed by Vyadhihara Rasayana and Brihmana Chikitsa forms the
ideal treatment in between the attacks. These procedures are very much effacacious in
eliminatig the symptoms as well as preventing the attack of Tamaka Shwasa.
BRONCHIAL ASTHMA
Definition:
Bronchial asthma is a disease characterised by hyper reactive airways, leading to
episodic, reversible broncho constriction, owing to increased responsiveness of the
tracheo-bronchial tree to various stimuli.214
Types:215
In western science for the epidemiological and clinical purpose asthma is broadly
classified into 2 varieties but because of the unclear pathological and clinical distinction,
a third variety is added. They are,
1) Allergic asthma or extrinsic asthma.
2) Idiosyncratic asthma or Intrinsic asthma.
3) Mixed variety.
Table- 17 Types of Asthma
Sl. Extrinsic Intrinsic
1) Immune reaction type 1 hyper sensitivity Non immune abnormal autonomic
regulation of airways.
2) Family history of hyper sensitivity is
common
No family history
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 61
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3) Usually starts in childhood Starts in adult life
4) Proceeded by infantile eczema and hyper
sensitivity to food
No evidence of atopy
5) Predisposition to form IgE antibodies IgE antibodies may be found but no
particular predisposition
6) Recognisable allergens like pollens,
dandruff, house dust, mite, etc.
No recognisible allergens
7) Attacks often diminish in later years Attacks increases in severity as years
passes
8) Chronic bronchitis seldom develops Associated with nasal polyps chronic
bronchitis
9) Emphysema unusual Emphysema commonly develops
10) No drug sensitivity Drug sensitivity may develop
(Aspirin, Pencilin, etc.)
11) Increased level of IgE found in serum Normal level of IgE in serum
12) Positive response to skin provocation test Negative skin provocation test
Clinical features: Cardinal symptoms of all these types of asthma are
1) Dyspnoea
2) Wheeze
3) Cough
4) Sensation of chest tightness.216
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Pathogenesis of Asthma: This can be expalined under two heading.
i) Atopic Asthma
ii) Non-atopic Asthma.
Atopic Asthma can be explained in two phases
i) Early phase Reaction
ii) Late phase Reaction.
Early phase Reaction:
This occurs in case of airborne antigen, The reaction occurs 1st in sensitised mast
cells on the mucosal surface. So, mediators released from the mast cells i.e. is histamine,
leukotriens, cytokinease, etc. So, these mediatiors opens the mucosal intercellular tight
junction, more antigen entered into submucosal mast cells. In addition direct stimulation
of sub epithelial vagal receptors provokes bronchial constriction through central and local
reflexes. This occurs within a minute after the stimulation and is called the acute or
immediate reaction or response. IgE triggered reaction includes release of both primary
and seconday mediators.
The primary mediators are Histamine and Leukotriens B4. The Histamine causes
broncho constriction by direct and cholinergic reflex action. Increased venular
permiability and increases the secretion. Leukotriens B4, which attracts eosonophils and
neutrophils.
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Disease Review
The secondary mediators are, Leukotreins C4, D4 and E4, extremely potent
mediators which causes prolonged broncho constriction and increased vascular
permiability and increases mucus secretion. Prostoglandin D2, which causes broncho
constriction and as well as increased permiability and increased mucus secretions.
Platelete activating factor. which causes aggregation of platelets and release of histamin
and serotonin from the mast granules.
In late phase reaction, it starts after 4-8 hours later and may persist for 12-24
hours. It is mediated by leukocytes i.e. eosonophils, neutrophils and lymphocytes. These
are released by the chemotactic fatcors and cytokines, derived from the mast cells during
acute phase response or by other mediators produced by the chronic inflammatory cells
already present in asthmatic patient. These leukocytes releases a mediators that stimulates
the late reaction. Histamine releasing factor produced by various cell types i.e. Basophils,
Neutrophils, Eosonophils. Basophilis causes broncho construction and edema.
Neutrophils causes further inflammatory injury. Eosonophils causes epithelial damage
and airway constructions.
Non-atopic Asthma:
It is non-allergic, microbial antigen play a role. Here there will be a hyper
sensivity to microbial antigen. “Viruses induces inflammation of the respiratory mucosa
lowers the threshold of the sub epithelial vagal receptors to irritants. So, inhaled air
pollutants such as So2, ozone, No2, etc. contribute to chronic airway inflammation and
hyper reactivity.217
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 64
Disease Review
Differential Diagnosis:
COPD: History of cigaratte smoking, chronic cough, sputum production (i.e. is in chronic
bronchitis) and dyspnoea (in emphysema), rhonchi, decreased intensity of breath sounds
and prolonged expiration on physical examination. airway limitation on pulmonary
function tests.
Left heart failure (Cardiac asthma): Usually there will be a history of paroxysmal
nocturnal dyspnoea with cardiac abnormality or hypertension or other signs of cardiac
failure. The sputum will be wateryfrothy crackles are more than wheeze. Basal
crepitation is observed on physical exmaination.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 66
Disease Review
PATHYAPATHYA
In a patient suffering from Tamaka Swasa certain predisposing factors are said to
initiate an attack of the illness. Or else, if the patient is in an attack of breathlessness
these predisposing factors are likely to worsen the attack. Further in the long run, there
occurs deterioration of the immune mechanism of the Pranavaha Srotas there by
increasing risk of frequent attacks of the Tamaka Swasa on exposure to trivial factors.
There fore it is mandatory to identify and avoid these incriminatory factors to get
maximum relief. Thus it is important to know the Pathya and Apathya in patients of
Tamaka Swasa. The following tables show the list of Pathya and Apathya of Tamaka
Swasa.
Table -18 Pathya in Tamaka Swasa: 218-222
Pathya Ahara C .S. S .S. A .H. Y.R. B.R.
I Shaali Dhanya
Purana Shali + - - + +
Tandula - - - + +
II Vrihi Dhanya
Shashtika + - + + +
III Shooka Dhanya
Yava + - + + +
Godhuma + - + + +
IV Shimbi
Mudga + - + - -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 67
Disease Review
Kulatha - - + + +
V Shakha Varga
Guduchi + - - + +
Patola - - - + +
Vartaka - - + + +
Rasona - - - + +
Bimbi - - - + +
Vastuka - - - - +
Moolaka + - + - +
Potaki - - - - +
Shigru + - - - -
Kasamarda + - - - -
VI Mamsa Varga
Janghala - - - + +
Shasha + - - + +
Titira - - - + +
Bhuka - - - + +
Lava - - - + +
Dhanva - - - + +
Shuka - - - + +
Mruga Dwija - - - + +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 68
Disease Review
VII Phala Varga
Jambira - - - + +
Draksha + + - + +
Mathulunga + + + - +
Amalaka + + + - -
Bilwa + + + - -
VIII Madhya Varga
Sura - + - + +
Varuni - - + - -
IX Madhu Varga
Madhu + + + + +
X Mootra Varga
Gomutra - - - - +
XI Dugdha Varga
Aja Kshira - - - + +
XII Ghrta Varga
Purana sarpi - + - + +
Ajasarpi - - - + +
XIII Krtanna Varga
Yusha + - + - -
Yavagu + - - - -
Peya + - + - -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 69
Disease Review
Sathu - - + - -
Varuni - - + - -
Pathya Vihara
Virechana + - - + +
Swedana + - - + +
Dhumapana + - - + +
Prachardana - - - + +
Swapanam Diva - - - + +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 70
Disease Review
Table –19 Apathya in Tamaka Swasa:
Apathya Aahara
I Shimbi Dhanya
Nishpava + - - + -
Masha + - - + -
Thila + - - - -
Sarshapa - - - + +
II Shaaka Varga
Kanda - - - + +
III Mamsa Varga
Jalaja + - - - -
Anupa + - - - +
Pishita + - - - -
Matsya - - - + +
IV Dadhi Varga
Dadhi + - - - -
V Kshira Varga
Kshira + - - + +
Mahisha Kshira + - - - -
VI Grita Varga
Mahisha Gritha - - - + +
VII Kritanna Varga
Tailabhrsta Nishpava - - - - +
Pistanna + - - - -
Pinyaka + - - - -
Apathya Vihara
Sheeta Snana + + + - -
Raja + + + + +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 71
Disease Review
Dhuma + + + + +
Anila + + + + +
Vyayama Karma + + - - -
Bhara - + - - +
Adhwat - + - - +
Vegaghata - + - - -
Apatharpana + + - - -
Marmaghata + - + + +
Sooryatapa - - - - +
Daurbalya + - - - -
Aanaha + - - - -
Abhighata - + - - -
Strigamana - + - - -
Vegavarodha-Mootra,
Udgara, Chardi, Trushna, Kasa
- + - - -
The diet, behavioral as well as environmental factors that helps in homeostasis of
Vata and Kapha Dosha both during and in-between the attacks are considered as Pathya
in Tamaka Swasa. The patient is encouraged to follow these Pathya. Contrary to this,
factors related to food, behavior or environment that incriminates the Vata and Kapha
Dosha or Pranavaha Srotas is identified as Apathya in Tamaka Swasa. These have to be
strictly avoided by the patient suffering from Tamaka Swasa. Strict observation of the
Pathya and avoidance of Apathya minimizes the severity of the illness, reduces the
frequency of the attacks and helps in early recovery from the illness.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 72
Drug Review
Drug review
Historical review of Haritaki
Among the earliest references, Panini described it for the management of dysurea /
anurea and constipation (Mootra Purisha Nirodha) – (Pa.Ga. 4/4/53).
Haritaki is one of the important as well as commonest herbs used by folk, household
and traditional medicine. Its fruit rind is used in medicine and is one of the ingredients
in Triphala.
It is mainly indicated for constipation, Respiratory problems, certain Skin disorders,
Eye disease etc. charaka highlighted its Rasayana properties in Chikitsa sthana. He
specially stated Haritaki as best among the herbs to be used regularly (Haritaki
Pathyanam Ch.Su.25.)
Sushruta in his Samhitha Sutrasthana mentioned that Haritaki can be used for bringing
about chemical reaction i.e. Rasakriya. Sushruta in his Samhitha Sutrasthana
mentioned that Haritaki can be used as a pad or pill i.e. Varthi.
Vagbhata in his Samhitha in 10th Chapter 31st sloka mentioned Haritaki under Kashaya
varga.
Vagbhata in his Samhitha mentioned Haritaki in the context of treatment, which
reduces Medas.
Shivadatta described Haritaki plant by making simile with Vasa leaves (Vasadalo
drumo adristhaha phalam tasya Haritaki).
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 5
Drug Review
There are references about Haritaki in almost all Nighantu’s. A story has been told in
Bhavaprakasha Nighantu, Raja Nighantu about the origin of the drug, Haritaki.
Dakshaprajapati asks Ashvini Kumara’s about Haritaki, questioning them. Where
the Haritaki was born, what are its features, Colourrs, types etc.
Ashvini Kumara’s say that when Lord Indra was drinking Amruta the drops of
Amruta that fell down to earth grew as Haritaki plant. (B.P.Ni.1-3).
And also Bhavaprakasha explains importance of Haritaki as follows-
As mother is supreme and she always make Hita to their children’s, like that
Haritaki is best for humans. It will not cause any harm to the body. Some times mother
may become angry but use of Haritaki does not make any complication, hence
Haritaki is supreme than mother.
Whose mother is not there, those can be consider Haritaki as a mother like
That, Bhavaprakasha given prime importance for Haritaki.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 6
Drug Review
Synonyms and its meanings
1) Abhaaya----“Na bhayam asyaha iti ||” (Bh.D)
It relives fear against all the disease.
2) Avyatha---- “Na vyatha yasyaha iti ||” (Bh.D)
“Na vyathayati iti va | (Ni.A)
Its usage will provide relief from many Diseases.
3) Kayastha---- “ Kayaha tishtati anaya iti |” (Bh.D)
“ Kaye tishtati iti va nishphala na bhavati ityarthaha |” (Ni.A)
Once used internally, it does not go waste i.e it definitely.
Provides relief any disease.
4) Chetaki---- “ Chetayati anaya srotaha shuddhe |” (Ni.A)
It will do the Sroto Sudhi.
5) Pathya-----“ Pathoanapeta iti |
Pathi sadhu iti pathya hita ityarthaha ||” (Ni.A)
It is useful for all the Srotas (Channels).
6) Putana-----“ Pootam karoti iti | Virechanatwat |” (Ni.A)
It purifies (puta or pavitra) the body through the process of
Purgation.
7) Shreyashi—“ Ati prashasta iti | Shreyaskartwat |” (Ni.A)
It is renouned for its good Qualities /
Properties.
8) Shiva------“ Shivam (Mangalam) karoti iti |” (Bh.D)
It brings good fortunes.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 7
Drug Review
9) Haritaki----“Harasya Bhavane jata Hareeta cha swabhavataha |
Sarvaroganscha cha Harate ten Khyata Haritaki ||” (D.N, M.N.)
Its utpanna in shivasya nivasasthana i.e. Himalaya parvatha.
Swarupatha it is Haritha varna and cures all types of roga, thus
It is prasidha by the name Haritaki.
“Harate prasabham Vyadhin Bhuyastarati yadvapuhu |
Haritaki tu sa prokta tatra keerdiptivachakaha ||” (R.N).
The Haritaki is one, which forcibly removes the disease from
Ones body. The Ki Shabdha is Deepti Vachaka.
“Dehe sanga malanam harati bahutaram sa haritabhyabhikhya||”
(P.N).
Haritaki, the name because it does nirharana of vibaddha mala
of Shareera.
10) Haimavati— “ Himavati jata | Tatrai jataha | (Bh.D)
It grows on Himavati parvata.
11) Amruta ------- The drug which having the nectar like properties.
12) Rechani ------ It does the purgation.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 8
Drug Review
Synonyms of Haritaki
Table – 1 Paryaya (Synonyms) according to different authors 11-18.
Sl
No
Synonyms
D.N
M.N
R.N
K.N
BP.N
Mao.N
ARM.N
SH.N
1 Haritaki + + + + + + + +
2 Abhaya + + + + + + + +
3 Pathya + + + + + + + +
4 Kayastha - + + + + + - +
5 Putana + + + - + + - +
6 Amruta + + + - + - - +
7 Haimavati + + + + + + - +
8 Avyatha + - + - + + - +
9 Chetaki + + - - + + - +
10 Shreyasi - + + + + + + +
11 Shiva + - + + + + + +
12 Vayastha - + - - + + - +
13 Vijaya + + + + + + + +
14 Jivanti - - + - + - + -
15 Rohini + + + - + + - +
16 Jaya + + + - - + + -
17 Prapathya + + + + - - + -
18 Jivapriya - - + - - + - +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 9
Drug Review
19 Bhishagvara - - + - - + - +
20 Pranada + - + + - - + -
21 Jivaya - - + - - + - -
22 Nandini + + - - - - - -
23 Amogha - + - - - - - -
24 Jeevaneeya - + - - - - - -
25 Divya - - + - - - - -
26 Shaka - - - - - + - -
27 Balya - - - - - + - -
28 Sudha - - - - - + - -
29 Bhishagpriya - - - - - + - -
30 Chetanika - - + - - - - -
31 Jeevanika - - + - - - - -
32 Devi - - + - - - - -
33 Rechani - - - - - - + -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 10
Drug Review
Classifications:
Classification is the basis of development of every branch of science. The 1st
attempts on classification of drugs was seen in the Vedas on the basis of leaf, flowers,
fruits, stem, etc. and as per the availability, property and action the Dravyas has been
classified into several Vargas.
In the Samhitas drugs are classified more systematically and scientifically. The
classifications in Samhitas are based on the source of drugs, properties and action, etc.
Table- 2. GANA AND VAARGA ACCORDING TO DIFFERENT CLASSICS
Sl.No CLASSICS GANA
1 Charaka samhita Arshoghna gana
Kusthaghna gana
Kasahara gana
Jwarahara gana
Prajasthapana gana
Virechanopaga gana
2 Sushruta samhita Mustadi gana
Triphala gana
Amalakyadi gana
Parushakadi gana
3 Bhavaprakasha nighantu Haritakyadi varga
4 Madanapal nighantu Haritakyadi varga
5 Kaiyadeva nighantu Aoushadhi varga
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 11
Drug Review
6 Dhanavantari nighantu Guduchyadi varga
7 Priya nighantu Haritakyadi varga
8 Raja nighantu Amradi varga
9 Shaligrama nighantu Haritakyadi varga
10 Mahaoushadhi nighantu Phaladi varga
11 Nighantu adarsha Haritakyadi varga
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 12
Drug Review
TYPES OF HARITAKI
Seven types of Haritaki 19-21
1. Vijaya
2. Rohini
3. Putana
4. Amruta
5. Abhaya
6. Jeevanti
7. Chetaki
Two types of Haritaki 22
1. Haritakki
2. Bala haritaki
Three types of Haritaki 23
1. Neeraja or Jalaja
2. Vanaja
3. parvateeya
Three types of Haritaki 24
1. Sukahali haradee (Guj)\ Badi harada (Hindi)/ Ilelekabali (Parsi)
Two tola in weight rounded Haritaki place- Bombay
2. Harad (Guj)/ Ilelaha Asfar (Arabi)/ ilela Jarda(Parsi)
it is used for colour.
3. 3.Himaja (Guj)/ Jouhada, Chote harre (Hindi)/ Balaharada (Marati)/ Ilale
shyaha(Parsi).
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 13
Drug Review
PROPERTIES ACCORDING TO DIFFERENT AUTHORS
Table – 3.RASA 25-36
S.N
o
Rasa C.S S.S AH.S B.N K.N D.N P.N R.N M.N S.N N.A Mou.
N
1 Lavana
Varjita
Pancha
rasa
+
-
-
+
+
+
+
+
+
+
+
+
2 Kashaya
Amla
-
+
-
-
-
-
-
-
-
-
-
-
3 kashaya - - + - - - - - - - - -
Table – 4.GUNA 37-46
S.No Guna C.S S.S AH.S B.N D.N P.N M.N S.N Mou.N K.N
1 Laghu + - - - - + - - - -
2 Laghu
Ruksha
- + + + + - + + + +
Table – 5.VEERYA 47-56
S.No Veerya C.S S.S AH.S B.N K.N P.N M.N S.N NA Mou.N
1 Ushna + + + + + + + + + +
Table – 6.Vipaka 57-64
S.No Vipaka S.S AH.S B.N K.N M.N S.N NA Mou.N
1 Madhura
+ + + + + + + +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 14
Drug Review
Probable Mahabhuta dominance of Haritaki, according to Rasapancaka
1) Rasa → Pancarasa, Kasaya dominance (Lavanavarjita)
Kasaya → Prthvi + Vayu
Tikta → Akasa + Vayu
Katu → Agni + Vayu
Amla → Prthvi + Agni
Madhura → Prthvi + Jala
Thus, total picture of Mahabhuta dominance, according to Rasa
Prthvi - 3 + Jala - 1 + Agni - 2 + Vayu - 3 + Akasa - 1
According to Guna
1) Laghu → Agni + Vayu + Akasa
2) Ruksa → Agni + Vayu
According to Virya
Usna → Agni
According to Vipaka
Madhura → Prthvi + Jala
Therefore, total Picture of Mahabhuta Dominance, according to Rasa Pancaka
Prthvi - 4 + Jala -2 + Agni - 5 + Vayu - 5 + Akasa - 2
So, Agni and Vayu Mahabhutas are showing equal dominancy according to
Rasa Pancaka
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 15
Drug Review
Table – 7.Dosha Karma 65-73
S.No DoshaKarma S.S AH.S BP.N K.N D.N M.N S.N N.A P.N
1 Tridosha hara - - + + + + + + +
2 KaphaPitta hara + - - - - - - - -
3 KaphaVata hara - + - - - - - - -
Table – 8.ACTIONS 74-84
S.N Action C.S S.S AH B.N K.N D.N P.N R.N M.N S.N Mou.
N
1 Doshanulomana + - - + - - + - - - +
2 Deepana + + + + + - + - + + +
3 Pachana + - + - + - + - - - -
4 Ayushyam + - + - + - - - - - +
5 Poustika + - - - - - - - - - -
6 Vayassthapana + - + - + - - - - + -
7 Medhya - + + + + + - - + + +
8 Smrutibuddhi balaprada + - - - + - - - + - -
9 Kapha praseka + - - - - - - - - - -
10 Chaksusya - + - + + + - - + + +
11 Bhedhana - + - - - - - - - - -
12 BuddhiInndriya
balaprada
- - + - - + + - - + -
13 Rasayana - - - + + - - + + + +
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 16
Drug Review
14 Brunhana - - - + + - - - + - +
15 Vrushya - - - - - - - - + - -
16 Malasaraka - + + - - - + - + + -
17 Bahurogaprashamani - - - - - - + - - - -
18 Yogavahini - - - - - - - + - + -
19 Lekhana - - - - - + - - - + -
20 Vatanulomana - - - - - + - - - + -
21 Hriddya - - - - - - - - - + -
22 Smrutikaraka - - - - - - - - - + -
23 Balya - - - - - - - - - + -
24 Netra rujapahara - - - - - - + - - -
25 Rechani - - - - - - + - - -
26 Santarpanakruta roga
hara
- - - - - + - - - - -
27 Sarva roga prashamana + - - - - - - - - - -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 17
Drug Review
Table – 9.PRAYOGA OF HARITAKI 85-94
S.No Uses C.S SU.S A.H.S B P.N K.N M.N P.N S.N Mao.N D.N
1 Kushta + + + + + + - + + +
2 Gulma + - + + + + + + + -
3 Udavarta + - - - - - + - - -
4 Shosha + - + - + - - + - -
5 Pandu + - + - + - + + - -
6 Mada + - - - - - - - - -
7 Arsha + - + + + + + + + -
8 Grahani + - + + + + - - + -
9 Puranajwara + - + - + - - + - -
10 Vishamajwara + - + + + + - + + -
11 Hridroga + - + + + + - + - +
12 Shiroroga + - + - + - - + + -
13 Atisara + - + - + - - + - -
14 Arochaka + - + - + - - - - -
15 Kasa + - + + + + + + + -
16 Prameha + - + + + + - + + +
17 Anaha + - + + + + - + + -
18 Pleeharoga + - + + + + - + + -
19 Udararoga + - - + - + + - + -
20 Yakritvikara - - - + - - - - + -
21 Swararoga + + + + + + + + + -
22 Vaivarna + - + - + - - - - -
23 Kamala + - + + + + - + + -
24 Vruna - + - - + + - + + +
25 Krimiroga + + + + + + - + + -
26 Shotha + + + + + + + + + +
27 Tamaka swasa + - - - - - - - - -
28 Karnaroga - - - - - - - + - -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 18
Drug Review
29 Chardi + - - + - + - - + +
30 Swasa - - + + + + - + + -
31 Klaibhya + - - - - - - - - -
32 Angavasad + - - - - - - - - -
33 Srotovibhanda + - + + + + - - + -
34 Netraroga - + + - + - - + - -
35 Medoroga - - + - - - - - - -
36 Urusthamba - - + - + - - + - -
37 Adhmana - - - + + + - - + -
38 Trishna - - - + - - - - - -
39 Hikka - - - + - + - + + -
40 Kandu - - - + - + - - - -
41 Shoola - - - + + + - + + -
42 Ashmari - - - + - - - + + -
43 Mootrakriccha - - - + - - - - + +
44 Mootraghata - - - + - - - + + -
45 Moha - - - - + - - - - -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 19
Drug Review
Table – 10Contraindications of Haritaki 95-99 S.N Contraindication C.S D.N. B.P.N R.N. S.N.
1 Ajeerna + - - - -
2 Ruksabhujaha + - - - -
3 Atimaithuna + - - - -
4 Madirapana + - - - -
5 Vishakarshita + - - - -
6 Kshata + - - - -
7 Trishna + + - + -
8 Krusha shareera + - - + +
9 Mukhashosha - + - - -
10 Hanusthambha - + - + -
11 Galagraha - + - + -
12 Navajwara - + - + -
13 Ksheena - + - - -
14 Jeerna (old age) - - - + -
15 Garbhini - + + + +
16 Adhwati - - + - +
17 Kinna - - + - +
18 Balavarjita - - + - +
19 Ruksha - - + - +
20 Langana karshita - - + - +
21 Pittadhika - - + - +
22 Vimukta raktastva - - + - +
23 Shosha - - - + -
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 20
Drug Review
Rutu Haritaki 100-102
Rutu Haritaki is explained on the basis of different Anupana in different Rutus.
These Anupana’s helps to increase the Rasayana property of Haritaki.
Varsha --- Saindavalavana
Sharad --- Sharkara
Hemanta --- Shunti
Shishira --- Pippali
Vasanta --- Madhu
Greeshma ---Gudha
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 21
Drug Review
Table – 11.Vishishta yoga of Haritaki
S.N Vishishta yoga Indication Reffernce
1 Agastya Haritaki Promotes complexion, Cough, Dyspnoea,
Hiccup,
Fever,Arsha,Grahani,Coryza,Hridroga.
Ch.Chi.18/57-
62
2 Haritaki Leha Dyspnoea, All type of Cough Ch.Chi.18/16
8-169
3 Abhayarishta Arsha,Grahaniroga,Panddu,Hridroga,
Gulma,Udararoga,Kushta,Shopha,Kamala
,Sweta pradara,Jwara.
Ch.Chi.14/13
8-143
4 Triphaladi Kashaya Laxative,Pitta&Kaphaja Jwara. Ch.Chi.3/208
5 Triphaladi Churna Numbness,Kushta Ch.Chi.7/68-
69
6 Triphaladi Grita Kushta,Visarpa,Vatarakta,Gulma,Vidradi. Ch.Chi.7/136-
139
7 Triphaladi Taila Apasmara Ch.Chi.10/43
8 Triphaladyarishta Arsha,Pandu,ssShopha, Ch.Chi.12/39-
40
9 Haritakyadi Yoga All type of Shopha Ch.Chi.12/22
10 Triphaladya Lauha Pandu,Kushta,Jwara,Kamala,Spleenomeg
aly.
Ch.Chi.16/99
11 Haritakyadi Kashaya Prameha Ch.Chi.6/27
12 Haritakyadi Grita Hridroga, Abdomen pain, Back pain Ch.Chi.26/73
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 22
Drug Review
13 Trayushanadi Grita Kasa,Jwara,Gulma,Kamala,Arsha,Urhaks
hata.
Ch.Chi.17/39-
42
14 Abhayadi Kwatha Shotha,Jwara,Daha,Visarpa,Trishna,Visha
dosha
B.R. 42/11
15 Abhayadi Kwatha Kaphaja Jwara,Malabhedhaka, B.R. 5/148
16 Abhayadi Guggulu Snayu and Mastishka sambandi
rogas,Sarvarogahara
B.R.101/18-
22
17
Abhaya Vati JeernaJwara,Pleehavridhi,Udararoga,Vato
dara,Ajeerna,
Kamala,Panduroga,Kumbakamala
B.R.40/94-97
18 Abhayadi Churnam Smaronmada B.R.77/2-3
19 Abhaya Lavana All type of Koshta vikara,Yakrit Pleeha
vriddi,Udara roga,
Anaha,Gulma,Asthilagranthivridhi,Agima
ndya,Shirashoola,Hridroga,Ashmari
B.R.41/32-40
20 Pathyadi Yoga Parinama shoola B.R.30/76
21 Pathyadi Kwatha Amayukta jeernajwara, B.R.5/67
22 Pathyadi Churnam Kaphatisara B.R.7/49
23 Triphala Rasayana Rasayana,Jwara B.R73/5-6
24 Pathya Rasayanam For long life up to 100 years B.R73/17
25 Pathya Vati Mukhadurganda B.R61/122
26 Chiitraka Haritaki Pachakagnivridhi, Ksaya, Kasa, Peenasa,
Krimi,
B.R.63/25-28
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 23
Drug Review
Gulma, Udavarta, Swasa
27 Vyagra Haritaki Kshaya, kshata, peenasa, swasa,
Rajayakshma, Kasa
B.R.15/169-
172
28 Dashamoola Haritaki
29 Danti Haritaki Virechana, Pleehavridhi, shotha,
gulmavikara,
Panduroga,grahanivikara,Utklesha,Visha
majwara,Kushta, Aruchi
B.R32/81-85
30 Triphaladi Kwatha Kaphajajwara, Amadosha B.R.5/139
36 Triphala Guggulu All type of Vruna B.R.47/51
31 Triphaladi Lepam Kesharanjana B.R.60/69
32 Triphala mandooram Amlapittashoola B.R56/97
33 Triphala yoga Mada, Murcha, Kamla, Unmada B.R.21/7
34 Triphala Rasayanam Jara&Vyadhi nashaka B.R.73/5-6
35 Triphala leham Amavata, Panduroga, Halimaka,
Parinamashoola,
Shotha, Vishamajwara
B.R.29/99-
101
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 24
Drug Review
MODERN REVIEW OF THE DRUG HARITAKI
Botinical name – Terminalia Chebula
Terminalia- Proceeding from the extremity at the end;
Chebula- Distorted from of the word Kabul. 103
Vernacular names 104
English – chebulia, Black myrobalans
Hindi - harre,Harda, Harada, Hada.
Marathi - Hirada, Bala hirada.
Baangaali- Haritaki, Gaachcha, Harra.
Gujarati- Haaraade, Himaja.
Kaannada- Anileya, Alalekai, Harra, Karaakkayi.
Pharsian- Ilelaj, Asfar, Ilelejarda, Ilailaha.
Arabi- Aahaleelaj, Asfar, Eahaleelaj, Kavali, Asvad.
Telagu- Kaaraakkaaya, Charaka, Chetaka, Karitaki.
Tamil- Kadukkai.
Malayalam- Kaatukka, Divya, kayastha, Putanam.
Panjab- Har, Halelu, hurh, Harrar.
Oriya- Horidra, Haritoli, Jongihoridra, Karedha, Harisu.
Sind- Har.
Urdu- Haaaejarad.
Gond- Kara, Harro, Hor.
Sikkim- Han, Silimakanga.
Udi- Karratha, Harida, Kaaredu.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 25
Drug Review
Assam- Hilikha, sillika.
Portugusee – Mirabolanos.
Nepal – Harra, Herro.
Konkani – Ordo.
Chinese – He Li Le, Pi Li Le, P’o Lo Te.
Lepcha – Salim-kung, Silim.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 26
Drug Review
CLASSIFICATION OF HARITAKI
Haritaki has been mentioned in various Ganas due to its manifold actions by
different authors. They have been listed below. 105
• Kingdom---------- Plant Kingdom.
• Subking ---------- Phanerogams.
• Division----------- Spermatophyta.
• Sub Division------ Angeosperms.
• Class--------------- Dicotyledonae.
• Sub Class--------- Polypetalae.
• Series------------- Calyciflorae.
• Order------------- Myrtales.
• Family------------ Combretaceae.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 27
Drug Review
FAMILY FUTERS
COMBRETACEAE 106
Trees or Shrubs, erect or climbing.
Leaves alternate or opposite, coriaceoous or membranous, simple, entire;
Petiole often glandular at the top;
Stipules 0.
Flowers usually hermaphrodite, rarely unisexual or poly gamous.
Calyx bracteolate at the base; tube adnate to the ovary and prolonged above it; limb 4-
5 (rarely 6-8) –fid or –partite, its lobes valvate in bud, deciduous or persistent.
Corolla 0, or Petals inserted on the calyx, alternate with its lobes, valvate in bud.
Stamens inserted with the petals, some times alternate with them, some times double
their number, of which the alternate 5 or inserted higher than and opposite to the
petals;
Filaments free, filiform or subulate.
Ovary inferior, 1-celled, usually crowned with a disk;
Ovules 1-7 (usually 2-4), pendulous from the apex of cell;
Style terminal;
Stigma usually simple.
Fruit usually indehiscent, coriaceoous or drupaceous, ovoid angular, frequently
winged, crowned in CALYCOPTERIS by the greatly enlarged calyx.
Seed 1, exalbuminous; cotyledons large, plaited or convolute.
Genera -16.
Species – 480. Distribution – Tropical and sub tropical regions
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 28
Drug Review
GENUS
TERMINALIA LINN. 107
Trees. Leaves alternate or suboposite, frequently crowded at the ends of the branches,
often with glands on the petiole or at the base of the mid rib beneath.
Flowers green or white rarely coloured, small, spicate (the spikes sometimes
panicled), hermaphrodite or often the upper flowers on the spikes male and the lower
hermaphrodite.
Calyx – tube ovoid or cylendric, constricted above the ovary; limb of 5 short valvate
triangular lobes, soon deciduous.
Petals 0.
Stamens 10, inserted on the calyx- lobes (the epigynous disk within them densely
hairy), biseriate, the 5 lower opposite the calyx teeth, the 5 upper longer and alternate
with the calyx teeth; filaments subulate or filliform, exserted.
Ovary inferior, 1-celled;
Ovules 2-3, pendulous from the apex of the cell;
Style subulate, often thickened and villous at the base;
Stigma simple.
Fruit ovoid, various in size and texture, smooth or angular or 2-5 winged, indehiscent,
coriaceoous.
Seed solitary, exalbuminous; cotyledons convolute.
Species 120- Tropics.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 29
Drug Review
SPECIES
TERMINALIA CHEBULA RETZ. 108
A moderate sized or large deciduous tree, attaining 25-30 m. in height. Leaf – buds,
branchlets and youngest leaves with soft, shining, generally rust- coloured hairs.
Leaves 7-20 cm. by 4-8 cm., glabrous or nearly so when mature, not clustered, distant,
alternate or sub opposite, elliptic- oblong, acute, rounded or cordate at base,
penninerved, secondary nerves 6-8 pairs, arching, prominent; Petioles 2-5.cm long,
pubescent, usually with 2 glands near the top. Flowers all hermaphrodite, 4mm.
across, sessile, dull-white or yellow, with an offensive smell. Spikes sometimes
simple, usually in short panicles, terminal and in the axils of the uppermost leaves;
Bracts exceeding the flowers, subulate or lanceolate, hairy, consicuous among the
buds but soon deciduous. Calyx campanulate, 3mm. long, flat at the base expanding a
little towards the mouth, glabrous outside, hairy within; Teeth 5, short, some times
obscure. Drupe pendulous, 2-4 cm. long, ellipsoid or obovoid from a broad base,
glabrous, more or less 5-ribbed, when dry yellowish green; Stone oblong, bony, very
thick, obscurely angled.
Bark 6-mm. thick, dark brown with many generally shallow vertical cracks.
Wood very hard, brownish grey with a greenish or yellowish tinge, with irregular
small dark purple heartwood, close-grained.
Distribution: Throughout the greater part of India, Burma and Ceylon, up to 5,000ft.
In the Himalayan and up to 6,000 ft. Travancore. 109
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 30
Drug Review
Chemical composition
Myrobalon fruits are an important source of tannin. Depending upon the geographical
source, they vary in tannin content and fruits collected from Madras are very rich in
tannin. The approximate analyses of the fruits is as follows
Moisture -10%, Tannin – 25-32%;
Water - insoluble matter – 40-50%
The tannins of myrobalan are of pyrogallol type (hydrolysable tannins), which on
hydrolysis yield chebulic acid and d-dalloyl glucose. Chebulagic, chebulinic, ellagic
and gallic acids are the other contents of myrobalan. Myrobalan also contains glucose
and sorbitol (about 3.5%). During the maturation of the tree, the amount of tannin
decreases, where as the acidity of fruits increases. 110
Tanins –
Tannic acid is used as an astringent for mucous membrane of mouth and throat,
and employed for soar throat and receding gums. It is also used in treatment of piles in
the form of suppositers. Tannic acid is also used as an antidote for poisoning due to
alkaloids, heavy metals and some glycosides.111
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 31
Drug Review
PHYTOCHEMISTRY:
Following principles are isolated from Haritaki fruit (Terminalia Chebula).
Extract
Colour – Yellow Red
PH - 3-3.7
Tannin – 20-45%
Chebulinic acid – 30%
Gallic acid – Traces
Resin - Traces
Mucilage – Trace
Brownish Yellow colouring maths – Traces
Anthrax Quininin like purgative principle – Trace
Total moisture – 10%
Total Non Tannius – 13.9-16.4%
Total unsolubles – 41.1-50.1%
Seed: Oil resembling almond oil –50%
Ash of Bark: Potash and Tannins 112
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 32
Drug Review
Table – 12 PARTS USED
Haritaki Fruit 113-116 Fruit,
bark117
Dried fruits,
Immature fruits 118
Fruit, Bark, and
Seed oil. 119
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 33
Drug Review
Cultivation and Collection.
It is found growing at an altitude of 1800 m. it is not cultivated and fruits are
collected from wild grown forest plants.120
Trade and Commerce.
During 93 – 94, 94 –95 and 95 –96 India has exported Myrobalan fruit extract
to the extent of about Rs. 218 lakhs, Rs. 325 lakhs and Rs. 284 lakhs, respectively. 121
Its fruit is sold in the rate of Rs. 40 – 50 per Kg. The fruit powder retail price is Rs.
40-60 per Kg.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 34
Drug Review
Latest research work done showing different actions of Haritaki:
1) Anti oxidant and free radical scavenging activities of terminalia chebula
(G.I.O.P.S., K.M. University, Taiwan)
2) Inhibitory action of water-soluble fraction of terminalia chebula on systemic
and local anaphylaxis (college of pharmacy, chonbuk, South Korea)
3) Antibacterial activity of terminalia chebula against helicobacter pylori (Dept of
Microbiology of Biological Sciences, Tehran, Iran)
4) Inhibition of cancer cell growth by crude extract and the phenolics of
terminalia chebula (Dept. of Chemistry, University of Turk, Finland)
5) Inhibition of HIV-1 integrase by galloyl glucoses from terminalia chebula
(Ahn. M. J., Kim Cr. Lee JS)
6) Potential of the aqueous extract of terminalia chebula as an anticaries agent
(Bombay College of Pharmacy, Mumbai).
7) Animutagenecity of hydrolysable tannins from terminalia chebula in
salmonella typhimurium (Guru Nanak Dev University, Amritsar)
8) Immunosuppressive effects of gallic acid and chebulagic acid on CTL
mediated cytotoxicity (Tokyo Institute of Technology, Yokohama, Japan)
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 35
Methodology
Methodology
Tamaka Swasa is a Pranavaha srotojanya vikara, where cold, dust, smoke and
excessive work are the causative factors for it. The severity of the disease is seen during
condition like Meghavarana, Sheeta rutu, Sheeta sthana and excessive intake of Sheeta
jala and purva dishagata vayu according to Ayurveda. In most of atopic subject allergy
out of many factors including exercise, infection and emotional upsets provokes attacks
of Tamaka Swasa.
All age groups of people are prone to get this condition, but it is commonly seen in
early age groups, as Kapha is predominanant and at the late ages as the Vata
dominance.as this disease is Kapha Vata pradhana, and Pitta Sthana samudbhava,
Haritaki is said to be a Tridosha Shyamaka and according to Astang Hridaya Uttaratantra
in Agrya Dravyas Haritaki is a best medicine for Vata Kapha disorders. Protocol of this
study relieves avarodha of Vata by Kapha, Vata Kapha Shyamaka or Tridosha Shyamaka
Dravyas acts on Tamaka Swasa. It is necessary to discuss the materials and methods in
detail.
Materials and Methods
Method of collection of data
1) Patients:
Patients suffering from Tamaka Swasa will be selected from Department of
Dravyaguna Post Graduation Studies and Research OPD of D G Melmalagi
Ayurvedic Medical College and Hospital by present inclusion and exclusion
Criteria.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 73
Methodology
2) Literary:
Literary aspects of study is collected from classical Ayurvedic and modern texts,
Which is discussed widely in literary review.
3) Study design:
Prospective clinical trial
4) Sample size:
Minimum of 30 patients irrespective of sex is under taken in the study.
5) Exclusion Criteria:
1. Patients suffering from any systemic or congenital diseases are excluded
Because, it is very difficult to assess the disease condition with other
Systemic disorders and congenital disease associated.
2. History above 10 years of period are excluded because, commonly history
Above 10 years are chronic asthmatic patients, which falls under the COPD
Conditions, difficult for treatment and also assessment.
3. Patient below 18 years and above 60 years are excluded because, study
restricted only to adults, the drug efficacy cannot be assessed in full length.
4. Status asthmatics are excluded because this condition is chronic and needs
hospitalization with supervision.
5. Pregnant and lactating women are excluded because, Haritaki is contra
indicated in pregnant women.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 74
Methodology
6) Inclusion Criteria:
1. Patients having stated lakshana as per Ayurvedic classics are included
Because, they are the prime subjective parameters of assessment.
2. Patients between 18 to 60 years irrespective of sex are included because,
restriction of the study.
3. History below 10 years are included because, the disease said as Kasta sadhya
from the Ayurvedic classics.
7) Criteria of Diagnosis:
The sign and symptoms of Tamaka Swasa mentioned in the Ayurvedic texts and
objective investigations mentioned in contemporary texts are the criteria for the
diagnosis.
8) Posology:
Haritaki Phala Churna – 3 gms / per day in divided doses
500 mg 1 capsule = 2 capsule TID.
Anupana – Sukoshna jala.
9) Study Duration:
45 Days.
10) Follow up:
15 Days.
11) Assessment of Results:
Results are assessed from subjective and objective parameters of base line data
of before and after treatment as discussed in the result section. The cumulative of the
drug over disease and the body are considered here.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 75
Methodology
12) Subjective parameters:
As explained in classical Ayurvedic texts and modern texts the subjective
Parameters are noted here under are vividly discussed in the literary review –
1. Teevra vega Swasa – Swasa Krichrata (Dyspnonea).
2. Kasa (Cough).
3. Dukhena Kapha nissaranam (Expectoration).
4. Ghurghuratwam (Wheezing).
5. Peenasa (Coryza).
6. Kruchrena bhasate (Difficulty in speech).
7. Kantodhwamsham (Hoarseness of voice).
8. Greevashirasangraha (headache & Stiffness).
9. Urah Peeda (Chest pain).
10. Shayane Swasa peedita (Discomport at supine).
13) Objective parameters:
As explained in different texts the objective parameters are noted here under
are vividly discussed in the context of examination of patient in the same
chapter
1. Peak expiratory flow rate.
2. Breath holding time.
3. Absolute Eosinophil counts.
4. Erythrocyte sedimentation rate.
5. Chest X-Ray.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 76
Methodology
14) Statistical analysis:
The parameters, Subjective and Objective parameters are tested with the
paired, and un-paired T- test and non-parametric test used for the testing of hypothesis. If
p<0.05, the test is highly significant.
15) Examination of a Tamaka Swasa Patient vis-à-vis asthma:
1) Demographic data:
The patient identity is diagnosing the disease as Ayurveda specific the Sadhya
and Asadhya based on age and relative factors such as Desha, Kala etc. thus Name, Age,
Gender, Occupation, Economical status, Birth data and Food habits are recorded in the
demographic data of the case sheet along with the consent signed.
2) Chief complaints (Subjective Parameters) and Associated complaints:
The symptoms enumerated in the classical textbooks and contemporary systems
are detailed for the studies are noticed here under the pre prescribed grades of
declaration. The detailed discussion is made in the literary review. The grades of
observation are as follows.
Swasa Kricchrata - 0 – Normal – No symptoms.
Teevra vega Swasa - 1 – Mild – breathless with activity, frequency 1-2 times/ week
2 – Moderate – breathless with talking, frequency 2-4
times / week.
3 – Severe – breathless at rest, frequency 4 to 6 times/week,
limited activity.
Kasa - 0 – Normal – No cough.
1 – Mild – morning bouts or after exercise-don’t disturb work.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 77
Methodology
2 – Moderate – continuous cough during day and morning
disturbing work.
3 – Severe – continuous and night cough disturb activities.
Dukhena kapha 0 – Normal – no phlegm.
Nissaranam 1 – mild – less than 2.5 ml/day without pain.
2 – Moderate – 2.5 ml to 15 ml/day with mild pain.
3 – Severe – 15 to 25 ml/day with pain.
Ghurghurthwam - 0 – Normal – No wheezing.
1 – Mild – moderate wheezing at mid to end respiration, brief,
not more than 1 to 2 times / week.
2 –moderate – loud wheezes through out expiration, not more
than 2 to 4 times / week.
3 – Severe – loud inspiration and expiration wheeze, more than
4 to 6 times / week.
Peenasa - 0 – Normal – no common cold & cough.
1 – mild – initially present or occasionally.
2 –moderate – continuous days with cough.
3 – Severe - continuous day and night.
Krucchena bhasate – 0 – Normal – difficult to speak.
1 – Mild – able to speak in sentences.
2 – Moderate – able to speak in phrases.
3 – Severe – able to speak in words.
Kantodwamsa 0 – Normal – hoarseness of voice.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 78
Methodology
1 – Mild – 0 or 1 bout while speaking sentence.
2 – Moderate – 1 or 2 bout while speaking phrase.
3 – Severe – associated with words and phrase.
Greeva shira 0 – Normal – no symptoms.
Sangraha - 1 – Mild –occasionally.
2 – Moderate – 1 to 2 times in a week.
3 – Severe – 2to 4 times or often.
Uraha peeda - 0 – Normal – no chest tightness.
1 – Mild – able to tolerate the tight or pain.
2 – Moderate – persists during cough + mild differs.
3 – Severe – feels difficulty to tolerate pain and tightness.
Shayanasya Swasa 0 – Normal – no discomfort.
Peedita - 1 – Mild - < 1 or 2 time / month.
2 – Moderate – 2 time / week.
3 – Severe - > or frequently
3) History of present illness:
At the history of present illness, Mode of onset, Course, Frequency of attack,
Duration of attack, Mode of progress, Periodicity, Preceded by what factors, Sputum,
Aggravating factors and Comfort posture at attack are discussed as listed in the annex-1
(Case Sheet).
4) Personal history:
The personal history is discussed as – Food habits with reference to taste, Taste
preferred, Agni, Kosta, Nidra, Addictions, Bowel habits, Menstrual history, Family
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 79
Methodology
history – specific if any has the same disease, Treatment history and History of past
illness.
5) Examination of Patients (RS):
The sequence of the Respiratory Examination done in two position 1) Patient
supine or seated, examining anteriorly and patient in sitting position, examining
posteriorly along with the standard inspection, palpation, percussion and auscultation.
Apart from these under the headings of Darshana, Sparshana, Akotana, Shravana are sub
classified with symptoms for convenience of study. They are as follows –
Patient supine or seated, examining anteriorly
Inspection:
Respiratory rate, depth.
Muscle use.
Respiratory distress.
Chest wall anomalies.
Palpation:
Tracheal position.
Thoracic excursion.
Abdominal, costal paradox.
Percussion:
Auscultation:
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 80
Methodology
Patient in sitting position, examining posteriorly
Inspection:
Anomalies of spine and back.
Palpation:
Thoracic excursion.
Percussion:
Diaphragmatic excursion.
Auscultation:
Breath sounds, adventitious sounds
Transmission of sounds.
Darshana (Inspection) Shape
Movement
Resp. Rhythm
Respiration
Accessory muscles
Inter coastal spaces
Visible veins
Venous pulses
Sparshana (Palpataion) Tracheal position
Pain / Tenderness
Swelling
Vocal fremitus
Shape
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 81
Methodology
Lymph nodes
Akotana (Percussion) As dull, resonant etc
Shravana (Auscltation) Type of breath
Vocal resonance
Respiratory Sounds
6) Ayurvedic examination
In Ayurvedic examination Dosha Vrudhi, Kshaya lakshanas are examined along
with the Desha vidha and Astasthsna pareeksha. The emphasis of the Agni is made
specially. The Srotas is important to examine for the disease diagnosis, as it is one of the
Samprapti Ghataka. Thus the Pranavaha, Annavaha and Udakavaha Srotases are
examined with their vitiated symptoms.
7) Observation of Pancha Lakshana Nidana
The Pancha Lakshana Nidana i.e. Nidana, Poorva rupa, Lakshana along with the
Upashaya and Anupashaya are examined according to the classical references as detailed
in the annex-1.
8) Investigation and Objective parameters
The investigations and objective parameters considered in the study are –
a) Breath holding time
b) Peak expiratory flow rate
c) Absolute eosinophilic count
d) Erythrocytes sedimentation rate
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 82
Methodology
a) Breath holding time
Breath in can be held for variable period of time by different individuals
depending upon the functional states of lungs development of respiratory muscles
practice, age, and sex etc. the normal BHT after deep inspiration may vary from 40
seconds to over a minute. The BHT decreases in many diseases such as chronic
bronchitis emphysema, asthma, and etc. of lung disease.
Procedure:
Breath holding time (BHT) is a simple test, in which, ask the patient to take
a deep breath and count the time in seconds.
Grading of BHT
BHT Grades are declared for sake of final assessment is as follows.
Grade 0 30 and above
Grade 1 30 to 20
Grade 2 20 to 10
Grade 3 10 and below.
b) Peak expiratory flow rate
The Wright’s peak flow meter, introduced in 1959 is a simple, portable device.
PEFR has a very good correlation with FEVI and for measuring the ventilatory
functions of lungs. This simple objective measurement of lung function helps
detecting early deterioration of lung function. Measurement of PEFR is valuable in
medical care settings to measure response to therapy during an acute exacerbation.
Out of function, the PEFR is more useful.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 83
Methodology
Procedure
Step 1) ask patient to hold PEFR in position
Step 2) let the patient take a deep breath in
Step 3) patient keep the PEFR instrument in the mouth with out any
Leakage of air from sides in to flow meter with a sharp blast
Step 4) the movement of the needle on the dial indicates the PEFR in
Liters / minute, which is to be noted
Taken 3 readings at one minute intervals and recorded the average of higher
readings brought to the needle back to zero by pressing the button located near the
mouth piece. Normal range of PEFR is 350 – 500 liters/ minute.
Grading of PEFR
PEFR Grades are declared for the sake of final assessment is as follows.
Grade 0 350 and above
Grade 1 350 to 250
Grade 2 250 to 150
Grade 3 150 and below
c) Absolute Eosinophilic count
Eosinophils are important in the defence against parasites, worms, and to any
infection. Because they are also sensitive to circulating allergens (materials that
trigger allergies), Eosinophils increase in number allergic reactions as well. Thus the
Absolute Eosinophils Count is a good parameter to study the Asthma. Normal range
of AEC is 40 to 440.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 84
Methodology
Grading of AEC
AEC Grades are declared for the sake of final assessment it as follows.
Grade 0 240 and below
Grade 1 240 to 440
Grade 2 440 to 640
Grade 3 640 and above
d) Erythrocytes Sedimentation Rate
Westergren’s method (pipette method) Erythrocytes sedimentation rate
measures in the graduated tubes facilitate to understand possible presence of organic
disease. It is universally accepted that it is a good prognostic method in clinical
laboratory.
Procedure:
Step 1) draw the sufficient blood sample from patient vein
Step 2) add anti coagulant to the blood
Step 3) suck the blood in to the ESR tube
Step 4) note the point of sedimentation on graduated tube
d) Chest X- Ray
X – Ray taken during an acute attack of uncomplicated Asthma resembles
those of patients with pulmonary emphysema.
9) Differential diagnosis
It is observed that the Tamaka Swasa for the differences of diagnosis as told
in Ayurveda texts viz. Santamaka and Pratamaka with its stipulated symptoms.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 85
Methodology
10) Result declaration
Result declaration is made upon the cumulative assessment of the parameters.
Out of Subjective parameters, Teevravega Swasa, Kasa and Uraha peeda were
considered. At the Objective parameters BHT, PEFR and AEC are considered. The
result is declared as Well Responded, Moderately Responded, Poorly Responded and
Not Responded categories. The discontinued patients were not considered for the
result declaration.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 86
Results
Results
Table showing the demographic data
Table – 20 showing the demographic data S.No OPD Age Gender Religion Occupation Economical
Status
Food
Habits
Result
1 5043 30 Male Hindu Active HM Veg MR
2 5046 38 Female Hindu Active Middle Veg MR
3 5050 38 Male Hindu Active Middle Veg MR
4 5053 48 Male Hindu Sedentary Middle Mix PR
5 5054 49 Male Hindu Sedentary Middle Veg PR
6 5055 30 Male Hindu Active Middle Mix WR
7 5052 49 Male Hindu Active Middle Mix PR
8 5056 29 Male Hindu Active HM Mix MR
9 5058 26 Male Hindu Active Middle Mix WR
10 5060 38 Male Hindu Active Middle Mix MR
11 5059 28 Male Hindu Active Middle Mix WR
12 5061 49 Female Hindu Sedentary Middle Veg NR
13 5062 36 Male Hindu Labor Poor Veg MR
14 5064 43 Female Hindu Labor Poor Veg PR
15 5077 47 Male Hindu Sedentary Middle Mix PR
16 5079 20 Female Hindu Labor Middle Veg WR
17 5075 48 Male Muslim Sedentary HM Mix PR
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 87
Results
18 5081 37 Male Hindu Labor Poor Mix MR
19 5084 43 Male Hindu Active Middle Mix PR
20 5085 41 Female Hindu Active Middle Veg PR
21 5087 46 Female Hindu Labor Poor Mix PR
22 5088 49 Male Hindu Labor Poor Mix NR
23 5089 39 Female Hindu Active Poor Mix MR
24 5092 33 Male Hindu Active Middle Mix MR
25 5093 48 Male Hindu Labor Poor Mix PR
26 5095 49 Male Hindu Sedentary Middle Mix NR
27 6000 48 Male Muslim Labor Poor Mix PR
28 6001 46 Female Hindu Active Middle Veg PR
29 6008 49 Female Hindu Labor Poor Mix NR
30 6010 50 Male Muslim Sedentary Middle Mix NR
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 88
Results
Distribution of patients by age
Table –21 Showing Distribution of patients by age
Age Male % Female % Total %
20 – 30 5 16.66 1 3.33 6 20
30 – 40 5 16.66 2 6.66 7 23.33
40 – 50 11 36.66 6 20 17 56.66
Total 21 70 9 30 30 100
Resulting of patient by age
Table –22 Showing Resulting of patient by age
Age
Tota
l no
of
patie
nts
%
Wel
l R
espo
nded
% M
oder
atel
y R
espo
nded
%
Po
orly
R
espo
nded
%
Not
R
espo
nded
%
Total 30 100 4 13.33 9 30 12 40 5 16.67
20 – 30 6 20 2 6.66 3 10 1 3.33 0 0
30 – 40 7 23.33 1 3.33 2 6.66 3 10 1 3.33
40 – 50 17 56.66 1 3.33 4 13.33 8 26.67 4 13.33
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 89
Results
Resulting of patient by gender
Table –23 Showing Resulting of patient by gender G
ende
r
Tota
l no
of
patie
nts
%
Wel
l R
espo
nded
% M
oder
atel
y R
espo
nded
%
Po
orly
R
espo
nded
%
Not
R
espo
nded
%
Male 21 70 3 10 6 20 9 30 3 10
Female 9 30 1 3.33 3 10 3 10 2 6.66
Total 30 100 4 13.33 9 30 12 40 5 16.67
Graph –1 Distribution of patient by Age – Gender Pictorial presentation
5
1
5
2
11
6
02468
1012
20 - 30 30 - 40 40 - 50
Male
Female
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 90
Results
Distribution of patients by Religion
Table –24 Showing Distribution of patients by Religion Religion Male % Female % Total %
Hindu 18 60 9 30 27 90
Muslim 3 10 0 0 3 10
Christian 0 0 0 0 0 0
Others 0 0 0 0 0 0
Total 21 9 30 100
Graph 2 Distribution of patients by Religion
Muslim
Christian
Other
Hindu
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 91
Results
Results of Patient by Religion Table –25 Showing Results of Patient by Religion Religion
Tota
l no
of
patie
nts
%
Wel
l R
espo
nded
% M
oder
atel
y R
espo
nded
%
Po
orly
R
espo
nded
%
Not
R
espo
nded
%
Hindu 27 90 3 10 9 30 11 36.67 4 13.33
Muslim 3 10 1 3.33 0 0 1 3.33 1 3.33
Christian 0 0 0 0 0 0 0 0 0 0
Others 0 0 0 0 0 0 0 0 0 0
Total 30 4 9 12 5
The results of Religion category as depicted in the table are encouraging. Here we
observe an over all well responded 4 patients with moderately responded 9 patients out of
30 patients.
Distribution of patients by Occupation
Table –26 Showing Distribution of patients by Occupation
Occupation Male % Female % Total %
Sedentary 6 20 1 3.33 7 23.33
Active 10 33.33 4 13.33 14 46.66
Labor 5 16.67 4 13.33 9 30
Total 21 70 9 30 30
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 92
Results
Graph -3 patients by Occupation
Labor
Active
Sedentary
Sedentary
Active
Labor
Results of patients by Occupation Table –27 Showing Results of patients by Occupation
Occ
upat
ion
Tota
l no
of
patie
nts
%
Wel
l R
espo
nded
% Mod
erat
ely
Res
pond
ed
%
Po
orly
R
espo
nded
%
Not
R
espo
nded
%
Sedentary 7 23.33 0 0 1 3.33 3 10 3 10 Active 14 46.66 3 10 4 13.33 6 20 1 3.33 Labor 9 30 1 3.33 4 13.33 3 10 1 3.33 Total 30 4 9 12 5 The results of Occupation category as depicted in the table are encouraging. Here
we observe an over all well responded 4 patients with moderately responded 9 patients
out of 30 patients. A maximum 12 patients are exhibited with poor response and in the
not responded as per the occupation differentiation as tabulated above.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 93
Results
Distribution of patient by Economical status.
Table –28 Showing Distribution of patient by Economical status
Economical
status
Male % Female % Total %
Poor 5 16.67 4 13.33 9 30
Middle 13 43.33 5 16.67 18 60
Higher Middle 3 10 0 0 3 10
Higher 0 0 0 0 0 0
Total 21 9 30
Results of patients by Economic status
Table –29 Showing Results of patients by Economic status
Economical Status
Tota
l no
of
pa
tient
s
%
Wel
l R
espo
nded
% M
oder
atel
y R
espo
nded
%
Po
orly
R
espo
nded
%
Not
R
espo
nded
%
Poor 9 30 1 3.33 3 10 4 13.33 1 3.33
Middle 18 60 3 10 5 16.67 7 23.33 3 10
Higher
Middle
3 10 0 0 1 3.33 1 3.33 1 3.33
Higher 0 0 0 0 0 0 0 0 0 0
Total 30 4 9 12 5
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 94
Results
The results of Occupation category as depicted in the table are encouraging. Here we
observe an over all well responded 4 patients with moderately responded 9 patients out of
30 patients. A maximum 12 patients are exhibited with poor response and in the not
responded as per the occupation differentiation as tabulated above.
Graph-4 patients by Economic status
9
18
3
002468
1012141618
Poor Middle Highermiddle
Higher
Distribution of patient by Food Habits Table –30 Showing Distribution of patient by Food Habits Food Habits
Male % Female % Total %
Vegetarian 4 13.33 6 20 10 33.33 Mixed diet 17 56.67 3 10 20 66.67 Total 21 9 30
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 95
Results
Graph – 5 Distribution of patient by Food Habits
0 5 10 15 20 25
Vegitarian
Mixed Diet
Data Related to the Disease Distribution of patients by presenting complaints
As explained in the literary review, the symptoms that are taken as subjective
parameters are evaluated as this study under the heading of Tamaka Swasa vis-à-vis
Bronchial Asthma with the presenting complaints are put forth here. The first and fore
most complaint in Tamaka Swasa, Teevra vega Swasa – Swasa Kruchrata (Dyspnonea)
Ghurghuratwam (Wheezing) with all patients involved. 27 patients are included with the
Dukhena Kapha nissaranam (Expectoration) and Kasa (Cough). Later to that the
symptoms Peenasa (Coryza), Uraha peeda (Chest pain), Shayane Swasa peedita
(Discomfort at supine) and Kruchrena bhasate (Difficulty in speech) are also seen
enlisted in the table below.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 96
Results
Presenting Complaints
Table –31 Showing Presenting Complaints
Presenting Complaints Patients %
Teevra vega Swasa (Dyspnonea) 30 100
Kasa (Cough) 27 90
Dukhena Kapha nissaranam (Expectoration) 27 90
Ghurghuratwam (Wheezing) 30 100
Peenasa (Coryza) 25 83.33
Kruchrena bhasate (Difficulty in speech) 18 60
Kantodhwamsham (Hoarseness of voice) 9 30
Greevashirasangraha (Headache and Stiffness) 17 56.67
Uraha peeda (Chest pain) 23 76.67
Shayane Swasa peedita (Discomfort at supine) 24 80
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 97
Results
Graph –6 Graphical presentation of patients by presenting complaints
3027 27
3025
18
9
1723 24
05
101520253035
Dyspnonea
Cough
Expec
toration
Wheezin
g
Coryza
Difficu
lty in
spee
ch
Hoarsen
ess o
f voice
Haedac
he & Stiff
ness
Chest p
ain
Discomfort
at su
pine
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 98
Results
Distribution of patients by Associated features
Table –32 Showing Distribution of patients by Associated features
Presenting Associated features Patients Percentage
Anidra (Disturbed sleep) 14 46.67
Pratamyati or Bhrushamatra (Distressed) 6 20
Aruchi (Anorexia) 9 30
Vishukasyata (Dryness of mouth) 12 40
Lalata sweda (Sweat over forehead) 8 26.67
Trushna (Thirst) 9 30
Angamarda (Malaise) 16 53.33
Kampa (Tremors) 2 6.67
Jwara (Fever) 4 13.33
Pramoha (Fainting) 0 0
Vamathu (Nausea) 3 10
Muhur Swasa (Frequent respiration) 16 53.33
Muhuchaiva dhamyati (Puts all effort to breath) 7 23.33
Muhur Swasa along with Anidra and Angamarda are the major Associated
symptoms observed. Pramoha and Kampa are the symptoms seldom witnessed. Other
wise all symptoms are some or the other time expressed by the patients. All the
observations pertained, are the enlisted in the above table. The pictorial expression is as
follows below,
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 99
Results
Graph - 7 Graphical presentation of patient by Associated features
14
69
12
8 9
16
24
03
16
7
02468
1012141618
Ani
dra
Prat
amya
ti or
Bhr
usha
mat
ra
Aru
chi
Vish
ukas
yata
Lala
ta s
wed
a
Trus
hna
Ang
amar
da
Kam
pa
Jwar
a
Pram
oha
Vam
athu
Muh
ur s
was
a
Muh
ucha
iva
dham
yati
Distribution of patients by Mode of On set
As the mode of onset is observed more gradual onset patients are listed. In this
study sudden onset patients express only response to the management, enlisted below.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 100
Results
Results of patients by mode of onset
Table –33 Showing Results of patients by mode of onset
Mode of Onset
Tota
l no
of
patie
nts
%
Wel
l R
espo
nded
% M
oder
atel
y R
espo
nded
%
Po
orly
R
espo
nded
%
Not
R
espo
nded
%
Gradual 23 76.67 4 13.33 8 26.67 8 26.67 3 10
Sudden 7 23.33 0 0 1 3.33 4 13.33 2 6.67
Total 30 4 9 12 5
Graph – 8 of patients by mode of onset
23
7
0
5
10
15
20
25
Gradual Sudden
It is observed that people of episodic are more than that of either continuous or
initially episodic patients in this study as enlisted and expressed in the Graph.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 101
Results
Distribution of patients by frequency of attack
Table –34 Showing Distribution of patients by frequency of attack
Frequency Patient Percentage
Few hours 2 6.67
Few Weeks 9 30
Few days 19 63.33
Total 30 100
Distribution of patients by Duration of attack
Table –35 Showing Distribution of patients by Duration of attack
Duration Patient Percentage
Continuous 4 13.33
Intermittent 13 43.33
Subsides with medication 13 43.33
Total 30 100
Distribution of patient by mode of progress
Table –36 Showing Distribution of patient by mode of progress
Mode of progress Patient Percentage
Typical 11 36.67
Rapid 6 20
Long term progress 13 43.33
Total 30 100
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 102
Results
Distribution of patient by Periodicity
Table –37Showing Distribution of patient by Periodicity
Periodicity Patient Percentage
Seasonal 7 23.33
Irregular 18 60
Permanent 5 16.67
Total 30 100
Distribution of patient by Preceding Factors
Table –38 Showing Distribution of patient by Preceding Factors
Preceding Factors Patient Percentage
Sneezing 9 30
Nasal irritation 5 16.67
Cough with Nasal irritation 16 53.33
Total 30 100
The listed tables are expressive of the contents. In this Distribution of patient by
mode of progress and Distribution of patient by Periodicity to Distribution of patient by
Preceding Factors it is expressed that the typical progress, irregular periodicity and cough
and sneezing as precipitating factors of the Tamaka Swasa. Thus the statements drown at
the observations are supportive to the pathogenesis of the disease Tamaka Swasa.
Distribution of patients by aggravation factors
Table –39 Showing Distribution of patients by aggravation factors
Aggravation factors Patient Percentage
Dust 7 23.33
Smoke 4 13.33
Both of above 19 63.33
Total 30 100
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 103
Results
Distribution of patients by Comfort Posture at attack
Table –40 Showing Distribution of patients by Comfort Posture at attack
Comfort Posture Patient Percentage
Sitting 14 46.67
Lying 3 10
Sitting & Forward bending 13 43.33
Total 30 100
The listed tables are expressive of the contents. In this Distribution of patients by
aggravation factors and Distribution of patients by Comfort Posture at attack it is
expressed that the dust and smoke are the aggravating factors and where in the sitting
posture offers the comfort to the patients of Tamaka Swasa. Thus the statements drown at
the observations are supportive to the pathogenesis of the disease Tamaka Swasa.
Distribution of patients by Agni
Table –41 Showing Distribution of patients by Agni
Agni Patient Percentage
Samagni 6 20
Vishamagni 8 26.67
Mandagni 16 53.33
Total 30 100
Distribution of patients by Bowel habits
Table –42 Showing Distribution by Bowel habits of patients
Bowel habits Patient Percentage
Constipation 11 36.67
Loose 0 0
Normal 19 63.33
Total 30 100
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 104
Results
The listed tables are expressive of the contents. In this Distribution of patients by
Agni and Distribution of patients by Bowel habits it is expressed that the Mandagni
patients are predominately susceptible for Tamaka Swasa along with normal bowel
habits. Thus the statements drown at the observations are supportive to the pathogenesis
of the disease Tamaka Swasa.
Distribution of patients by Addiction
Table –43 Showing Distribution of patients by Addiction
Addiction Patient Percentage
Tobacco 5 16.67
Alcohol 1 3.33
Alcohol + Tobacco 7 23.33
Drugs 0 0
Total 13 43.33
The listed tables are expressive of the contents. In this Distribution of patients by
Addiction it is expressed that the addictions are the aggravating factors in which alcohol
and tobacco-consuming patients of male category are recorded. Thus the statements
drown at the observations are supportive to the pathogenesis of the disease Tamaka
Swasa.
Distribution of patients by Prakruti
Table –44 Showing Distribution of patients by Prakruti
Prakruti Patient Percentage
Vata 2 6.67
Pitta 0 0
Kapha 1 3.33
Vata Pitta 5 16.67
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 105
Results
Vata Kapha 17 56.67
Pitta Kapha 5 16.67
Tridosha 0 0
Total 30 100
The listed tables are expressive of the contents. In this Distribution of patients by
Prakruti it is expressed that the prakruti impact over the Tamaka Swasa. In which Vata
Kapha patients of category are recorded maximum. Thus the statements drown at the
observations are supportive to the pathogenesis of the disease Tamaka Swasa.
Distribution of patients by Dosha Vruddhi
Table –45 Showing Distribution of patients by Dosha Vruddhi
Dosha Dosha Vruddhi Patient Percentage
Karshya 6 20
Karshnya 9 30
Ushna kamitwa 21 70
Kampa 3 10
Anaha 5 16.67
Shakrudgraha 3 10
Balabhramsha 2 6.67
Nidrabhramsha 19 63.33
Pralapa 0 0
Vata
Bhrama 0 0
Peeta mootrata 0 0
Peetanetra 0 0
Peetavit 0 0
Peetatwak 0 0
Adhikshudha 4 13.33
Pitta
Adhidaha 0 0
Agni sadana 11 36.67
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 106
Results
Praseka 6 20
Alasya 13 43.33
Kapha Swetangata 7 23.33
Sheetangata 21 70
Gowrava 12 40
Slatangata 0 0
Swasa 30 100
Kasa 28 93.33
Atinidra 0 0
The listed tables are expressive of the contents. In this Distribution of patients by
Dosha Vruddhi it is expressed that the Dosha Vruddhi impact over the Tamaka Swasa. In
which Vata lakshana patients of category are recorded maximum with Ushna kamitwa
and Nidrabhramsha. Pitta predominant symptoms noted are Adhika kshudha. Kapha
related symptom Swasa is the pratyatma niyata lakshana seen in all patients along with
Kasa, Sheetangata and Alasya. Thus the statements drown at the observations are
supportive to the pathogenesis of the disease Tamaka Swasa.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 107
Results
Distribution of patients by Dosha Kshaya
Table –46 Showing Distribution of patients by Dosha Kshaya
Dosha Dosha Kshaya Patient Percentage
Angasada 5 16.67
Alpabhashite ahitam 0 0
Chesta heenata 0 0
Vyamoha 0 0
Vata
Sleshma Vruddhi 0 0
Mandagni 16 53.33
Shareera sheetatwam 21 70
Pitta
Prabha hani 0 0
Bhrama 0 0
Uraha shoonyata 0 0
Shira shoonyata 0 0
Hridrava 0 0
Kapha
Sandhi saithilya 0 0
The listed tables are expressive of the contents. In this Distribution of patients by
Dosha Kshaya, it is expressed that the Dosha kshaya impact over the Tamaka Swasa. In
which Vata lakshana patients of category are recorded with Angasada. Pitta preminant
symptoms noted are Shareera sheetatwam and Mandagni. Kapha related symptoms are
not seen in any patients. Thus the statements drown at the observations are supportive to
the pathogenesis of the disease Tamaka Swasa.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 108
Results
Distribution of patients by Ahara Nidana
Table –47 Showing Distribution of patients by Ahara Nidana
Dosha Ahara Nidana Patient Percentage
Vishamasana 5 16.67
Adhyasana 9 30
Anasana 1 3.33
Sheetashana 0 0
Visha 0 0
Sheetapana 27 90
Vata
Rukshanna 25 83.33
Tilataila 0 0
Pitta Vidahi 0 0
Pistanna 5 16.67
Nispava 0 0
Saluka 0 0
Guru dravyas 20 66.67
Jalajamamsa 8 26.67
Anupa mamsa 10 33.33
Abhishyandi 22 73.33
Masa 6 20
Dadhi 21 70
Vistambhi 4 13.33
Amakshira 0 0
The listed tables are expressive of the contents. In this Distribution of patients by Ahara
Nidana it is expressed that the Ahara Nidana impact over the Tamaka Swasa. In which
Vata Ahara Nidana consuming patient of category Sheeta pana and Rookshanna are
recorded with Adhyasana. Pitta Ahara are not seen. Kapha related Nidana are
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 109
Results
Abhishyandi and Dadhi. Thus the statements drown at the observations are supportive to
the pathogenesis of the disease Tamaka Swasa.
Distribution of patients by Vihara Nidana
Table –48 Showing Distribution of patients by Vihara Nidana
Vihara Nidana Patient Percentage
Rajas (V) 30 100
Vata (V) 30 100
Sheeta sthana (V) 0 0
Sheeta ambu (V) 13 43.33
Ativyayama (V) 8 26.67
Abhighata (V) 0 0
Dhuma (V) 12 40
Apatarpana (V) 3 10
Bharakarshita (V) 1 3.33
Adhwahata (V) 9 30
Kanthapratighata (V) 0 0
Karmahata (V) 0 0
Veganirodha (V) 6 20
Shuddhi Atiyoga (V) 0 0
Gramya dharma (V) 0 0
Urahapratighata (V) 0 0
Marmabhighata (V) 0 0
Ushna (P) 0 0
Abhishyandi Upachara (K) 0 0
Divaswapna (K) 5 16.67
The listed tables are expressive of the contents. In this Distribution of patients by
Vihara Nidana it is expressed that the Vihara Nidana impact over the Tamaka Swasa. In
which Vata Vihara Nidana consuming patients of category Rajas and Vata are recorded
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 110
Results
with Sheetambu sevana and Karmahata. Pitta Vihara are not seen. Kapha related Vihara
Nidana is Divaswapna. Thus the statements drown at the observations are supportive to
the pathogenesis of the disease Tamaka Swasa.
Distribution of patients by Anya Nidana
Table –49 Showing Distribution of patients by Anya Nidana
Dosha Anya Nidana Patient Percentage
Kshatakshaya 0 0
Udavarta 0 0
kshaya 0 0
Atisara 0 0
Vibandha 11 36.67
Anaha 5 16.67
Visuchika 0 0
Panduroga 0 0
Vata
Dourbalya 2 6.67
Rakta pitta 0 0
Pitta Jwara 4 13.33
Kasa 28 93.33
Pratishyaya 19 63.33
Amapradosha 0 0
Amatisara 0 0
Kapha
Chardi 5 16.67
The listed tables are expressive of the contents. In this Distribution of
patients by Anya Nidana, it is expressed that the Anya Nidana impact over the Tamaka
Swasa. In which Vata Anya Nidana consuming patients of category Vibandha and Anaha
are recorded with Dourbalya. Pitta Anya nidana only Jwara is recorded. Kapha related
Anya Nidana are Kasa and Pratishyaya along with Chardi for 5 patients. Thus the
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 111
Results
statements drown at the observations are supportive to the pathogenesis of the disease
Tamaka Swasa.
Distribution of patients by Srotas
Table –50 Showing Distribution of patients by Srotas
Srotas Patient Percentage
Atisrustam 21 70
Kupitam 17 56.67
Alpalpa 21 70
Ati badham 10 33.33
Abheeknam 15 50
Pranavaha
Sashoolam 12 40
Aruchi 12 40
Chardi 5 16.67
Ajeerna 11 36.67
Annavaha
Anannabhilasha 5 16.67
Jihwashosha 6 20
Ostashosha 6 20
Talushosha 4 13.33
Udakavaha
Pipasa 16 53.33
The listed tables are expressive of the contents. In this Distribution of
patients by Srotas, it is expressed that the Srotas examination in Tamaka Swasa. In which
Pranavava Srotas symptoms are predominant in patients as Atisrusta, Alpalpa,
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 112
Results
Abheeshana and sashoola. On the other hand symptoms of Annavaha Srotas also
expressed as Aruchi and Ajeerna. Out of Udakavaha Srotas Pipasa is predominant. Thus
the statements drown at the observations are supportive to the pathogenesis of the disease
Tamaka Swasa.
Distribution of patients by Poorva Roopa
Table –51 Showing Distribution of patients by Poorva Roopa
S.No Poorva Roopa Patient Percentage
1 Hrutpeeda 7 23.33
2 Kshudr Swasa 9 30
3 Shakha bheda 12 40
4 Shoola 3 10
5 Pranavilomata 18 60
6 Vaktra vairasya 0 0
7 Parhwashoola 13 43.33
8 Vibandha 11 36.67
9 Anaha 5 16.67
10 Arati 13 43.33
11 Bhakta dwesha 15 50
12 Admana 0 0
The listed tables are expressive of the contents. In this Distribution of patients by
Poorva Roopa, it is expressed that the Poorva Roopa examination in Tamaka Swasa. In
which Prana vilomata, Parshwa shoola, Arati and Bhakta dwesha are predominant.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 113
Results
Occasionally Ksudra swasa and Shankha Bheda are also observed along with other
symptoms enlisted in the tabular statements drawn at the observations are supportive to
the pathogenesis of the disease Tamaka Swasa.
Subjective parameter assessment
Table –52 Showing Subjective parameter assessments
Subjective parameter Patients
Before
%
Patients
After
%
Patients
Relived
%
Teevra vega Swasa
(Dyspnonea)
30 100 22 73.33 8 26.67
Kasa (Cough) 27 90 20 66.67 7 23.33
Dukhena Kapha
nissaranam
(Expectoration)
27 90 22 73.33 5 16.67
Ghurghuratwam
(Wheezing)
30 100 22 73.33 8 26.67
Peenasa (Coryza) 25 83.33 17 56.67 8 26.67
Kruchrena bhasate
(Difficulty in speech)
18 60 9 30 9 30
Kantodhwamsham
(Hoarseness of voice)
9 30 5 16.67 4 13.33
Greevashirasangraha
(Headache and
Stiffness)
17 56.67 13 43.33 4 13.33
Uraha peeda (Chest
pain)
23 76.67 15 50 8 26.67
Shayane Swasa peedita
(Discomfort at supine)
24 80 16 53.33 8 26.67
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 114
Results
Objective parameters
Table –53 Showing Objective parameters
PEFR BHT AEC ESR
S.No
OPD B A B A B A B A
Result
1 5043 150 270 14 25 500 400 10 8 MR
2 5046 130 260 12 23 500 400 8 6 MR
3 5050 160 290 15 25 450 300 12 10 MR
4 5053 120 250 11 22 450 350 8 10 PR
5 5054 70 160 8 15 650 550 16 14 PR
6 5055 210 370 22 36 450 300 12 12 WR
7 5052 150 240 13 20 500 450 14 12 PR
8 5056 190 350 15 28 550 450 12 14 MR
9 5058 180 380 18 32 550 400 10 8 WR
10 5060 180 290 15 24 550 450 14 12 MR
11 5059 220 380 25 35 450 350 12 8 WR
12 5061 120 230 12 20 600 500 8 6 NR
13 5062 160 310 12 25 550 450 12 10 MR
14 5064 130 300 12 26 550 450 14 12 PR
15 5077 110 200 11 18 550 450 10 6 PR
16 5079 280 400 25 38 450 400 10 8 WR
17 5075 90 140 8 14 650 600 14 14 PR
18 5081 200 310 18 28 500 400 8 9 MR
19 5084 140 240 14 22 500 450 16 14 PR
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 115
Results
20 5085 100 170 10 16 600 550 12 10 PR
21 5087 70 150 7 13 650 650 12 14 PR
22 5088 110 190 10 16 600 600 10 10 NR
23 5089 150 270 12 23 500 400 12 12 MR
24 5092 190 350 15 28 550 450 12 14 MR
25 5093 130 200 11 17 600 550 8 6 PR
26 5095 180 240 14 20 450 400 14 10 NR
27 6000 170 260 14 18 550 550 8 8 PR
28 6001 190 280 15 23 550 450 10 12 PR
29 6008 160 240 12 20 550 500 12 10 NR
30 6010 110 190 10 16 600 550 10 8 NR
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 116
Results
Statistical Assessment of Subjective Parameters
Table –54 Showing Statistical Assessments of Subjective Parameters
Subjective Parameters Mean SD SE t Value P value Remarks
Teevra vega Swasa
(Dyspnonea)
1.033 0.182 0.332 3.11 <0.005 HS
Kasa (Cough) 0.866 0.434 0.079 10.96 <0.001 HS
Dukhena Kapha nissaranam
(Expectoration)
0.633 0.556 0.1015 6.236 <0.001 HS
Ghurghuratwam (Wheezing) 1.096 0.597 0.108 10.148 <0.001 HS
Peenasa (Coryza) 0.6 0.498 0.0909 6.6 <0.001 HS
Kruchrena bhasate
(Difficulty in speech)
0.433 0.495 0.0909 4.76 <0.001 HS
Kantodhwamsham
(Hoarseness of voice)
0.266 0.492 0.0806 3.3 <0.005 HS
Greevashirasangraha
(Headache and Stiffness)
0.4 0.498 0.0909 4.4 <0.001 HS
Uraha peeda (Chest pain) 0.566 0.504 0.092 6.152 <0.001 HS
Shayane Swasa peedita
(Discomfort at supine)
0.566 0.504 0.092 6.152 <0.001 HS
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 117
Results
Statistical Assessment of Objective Parameters
Table –55 Showing Statistical Assessments of Objective Parameters
Subjective
Parameters
Mean SD SE t Value P value Remarks
PEFR 111.67 39.22 7.166 15.58 <0.001 HS
BHT 9.2 2.998 0.545 16.88 <0.001 HS
AEC 83.33 37.9 6.919 12.04 <0.001 HS
ESR 1.833 1.053 0.192 9.546 <0.001 HS
Statistical report of Haritaki Phala Churna in Tamaka Swasa
Among the Objective Parameter all the parameter shows highly significant (as
p<0.001). But there is mostly highly significant in the parameter BHT and PEFR, where
all AEC and ESR shows less significant. The parameter PEFR having more net mean
effect with more variation, where as the parameter ESR having less net mean effect with
less variance (By comparing t-value-value).
Among the Subjective parameters all the parameter shows highly significant, there is
more highly significant in the parameter Kasa and Ghurghuratwam (by comparing p-
value and t-value). The parameter Uraha peeda and Shayane Swasa peedita having equal
significant. The parameter Ghurghuratwam shows high net mean effect with more
variance where as the parameter Kantodhwamsam is having less net mean effect with less
variance (by comparing p-value, t-value, mean and variance).
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 118
Results
Over all assessment and Result of the Haritaki Phala Churna inTamaka Swasa
Table –56 Showing Over all assessment and Result
Category Patient Percentage
Well Responded 4 13.33
Moderate Responded 9 30
Poor Responded 12 40
Not Responded 5 16.67
Total 30 100
Graph - 9 Over all assessment and Result of Clinical trail
Moderate respondedPoor
responded
Not responded
Well responded
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 119
Discussion
DISCUSSION
In this study the Evaluation of Efficacy of Haritaki Phala Churna in the
management of Tamaka Swasa A prospective clinical study is done.
Tamaka Swasa is one of the important diseases pertaining to the respiratory
disorder. It affects the people of all age groups. It is the serious public health problem in
the countries through out the world. Nearly 5 to 10 % of the world population. The
disease can occur at any age and affects 5 % of adults and 7 – 10 % children commonly.
Between 100 and 150 million people around the globe, suffer from asthma and
this number is rising. Worldwide, deaths from this condition have reached over 180,000
yearly. India has an estimated 15 – 20 million asthmatics; in India rough estimates
indicate a prevalence of between 10 % and 15 % and 15 % in 5 –11 year old children.
Who recognizes asthma as a disease of major public health importance and plays
a unique role in the co – ordination of international efforts against the disease.
International action needed to:
• Increase public awareness of the disease to make sure patients and health
professionals recognize the disease and are aware of the severity of associated
problems;
• Organize and co – ordinate global epidemiological surveillance to monitor global
and regional trends in asthma;
• Develop and implement an optimal strategy for its management and prevention
(many studies have shown that this will result in the control of asthma in most
patients); and
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 120
Discussion
• Stimulate research into the causes of asthma to develop new control strategies and
treatment techniques.
Out of the above policies of WHO, the ancient Ayurveda, a medical system of India
places lots of management modalities to neutralize the effect of Tamaka Swasa, a
demon in the present air polluted society. The present trail entitled “ Evaluation of
Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa” is an
optimal strategy to develop and implement a perfect treatment to the Tamaka Swasa
as research stimulation into the causes of asthma.
The Haritaki Phala is used in this study it is considered in Arshoghna gana,
Kusthaghna gana, Kasahara gana, Jwarahara gana, Prajasthapana gana,
Virechanopaga gana. By Charaka, Mustadi gana, Triphala gana, Amalakyadi gana,
Parushakaadi gana. By Sushruta, having Lavana varjita Kashaya pradhana
pancharasa, Ushna Veerya, Laghu Ruksha Guna, Madhura Vipaka, it supports in
treating the Tamaka Swasa.
In Tamaka Swasa there is predominance of Kapha Vata Dosha, here Haritaki is
Tridosha Shyamaka. Haritaki Phala Churna is implemented in this clinical study.
Every possible aspect of the drug Haritaki, botanically known as Terminalia
Chebula Linn. Has been described in drug review section –1. Starting from historical
review various aspects concerning drug Haritaki has been covered. But the less
reference in the Vedic period and the Haritaki is well described at Samhita and
Nighantu period.
Various synonyms have been discussed with their interpretation and classification
considering different aspects. Virtually there is no controversy in drug Haritaki.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 121
Discussion
Brief botanical description of the Terminalia Chebula Linn. Is found in flora of
particular zone and in Indian medicinal plants by Kirtikar & Basu.
Almost all the Nighantukaras described similar Rasa panchaka and rogaghnata.
Properties of the drug Haritaki according to different texts have been described in
a nutshell; other than medicinal uses of Haritaki have been described under separate
heading.
Different preparations in which Haritaki is one of the constituents described are
given with reference.
There is specific Nidana for Tamaka Swasa is not mentioned in classics as it is a
sub type of Swasa roga same nidana are applicable to Tamaka Swasa also. We cannot
find a clear view regarding the patho-physiological changes occurring due to specific
type of Tamaka Swasa Nidana. Chakrapani commenting on the Nidana verses as he
explains about vata prakopaka gana and Kapha prakopaka gana, which are responsible
for the development of Tamaka Swasa.
Nidana parivarjana i.e. prevention of etiological factors as a part of supportive
therapeutic measures of the treatment is idol any time. Especially as Tamaka Swasa
patients are very much exposed to the different verities of the subjects at different times
and places in the atmosphere particularly air and dust, it is very much necessary to
evaluate.
As per the Tamaka Swasa Samprapti is concerned the vitiated Kapha Dosha along
with Vata Dosha obstructs the Srotas to secrete Kapha from Pranavaha Srotas. Here the
Kapha is the normal secretion and is abnormally increased by the vitiated Pranavata.
Further this action adds to the obstruction of the passage where Pranavata gets the Prana
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 122
Discussion
vilomata. Narrowing of the pranavaha srotas along with accumulation of Kapha in it
obstructs the smooth flow of Pranavata. Prana vilomata is resultant with turbulent
breathing which leads to abnormal audibility of respiration even to out side or to say
produces wheezing.
In Tamaka Swasa the course of the illness starts from Hridaya said to be afflicted
adds the severity of illness. Kapha Dosha (Dosha) and Rasa Dhatu (Dushya) belonging to
the same category and affliction of Hridaya indicates the acute onset chronic course and
severity of illness.
• Prana vilomata: it is observed as 59.9% it is suggest that the symptom is related to
Prana, Pranavaha srotas and the obstructive phenomenon of it.
• Bhakta dwesha: it is observed as 52.3% patients having symptom Bhakta dwesha
it is suggest that the disease is Amashaya samutha, producing Ahara dwesha.
• Arati and Parshwa shoola: these are observed as 43.3%
• Shankha Bheda: It is a pain condition occurred because of Prana Urdhwa gati and
there by observed as 40%.
• Vibandha: it is observed as 36.6% is because of the Prana Vata Urdhwa gati in
Tamaka Swasa.
Lakshana in Tamaka Swasa:
• Teevra Vega Swasa and Ghurgurukatwam is pratyatma niyata lakshana of
Tamaka Swasa observed 100% in all patients.
• Kasa and dukhene Kapha nissarnam observed almost all i.e.90%.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 123
Discussion
• Peenasa is a relevant disease associated and also a symptom, observed 83.3%.
• Shayane Swasa peeditam, which is causing inconvenience in Tamaka Swasa, is
seen 80% suggests the blockage of Kapha while sleeping.
• Uraha peeda i.e. chest pain is observed as 76.6% as the chest is the seat of disease.
Samprapti Ghataka
• Agni: as Agni is observed it is found that 53.3% of patients are subjected for the
Agnimandya or Mandagni. It is explained in Ayurveda the Mandagni is the root
cause of development of disease and Ama.
• Prakruti: Many patients are of Vata Kapha Prakruti observed in the study 56.6%.
The disease manifest to the people with Vata Kapha people as the disease is of
Kapha Vata Dosha predominant.
• Prana vaha Srotas: 70% of patients are reported with prime symptom of
Pranavaha sroto dushti are Atisrustam and Alpalpam. The adhistana of the vyadhi
is uras i.e. chest in terms of pranavaha srotas, thus the symptoms pertained to that
of pranavaha srotas is relevant.
• Annavaha Srotas: Symptoms observed in this are Aruchi 40% Ajeerna 36.6%. All
the disease manifestation as it is discussed from GIT and that too from stomach.
The importance of Annavaha srotas and Amashaya is relevant with symptoms of
Aruchi exhibited to state the disease is Amashaya samudbhava.
• Udakavaha Srotas: In this category Pipasa is 53.3%. The other symptoms are
Jihwa sosha and Oshtasosha are 20%. The air ventilation is naturally through
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 124
Discussion
nasal cavity but when it is not possible gives rise to oral breathing, which causes
the Jihwa sosha, which is a Udakavaha Srotas symptom.
• Onset of disease: The onset is observed, as gradual in many patients is 76.6%. It
suggests that the disease in chirakari and takes the long time to manifest its
symptoms.
• Frequency of attack: it is observed that few day onset is 63.6% in patients.
• Mode of progress: The disease development is long term progress as observed
43.3% in patients.
• Periodicity: An irregular periodicity is observed in the study with 60%.
• Preceding factors: these are sneezing, nasal irritation and cough out of cough is in
53.3% of patient.
• Aggravating factors: Dust and Smoke are observed as the aggravating factors
63.3% of patient.
• Comfort posture: the Comfort posture recorded for the patients are sitting is
46.6%.
Age: More prevalence i.e.56.6% is observed in the category of 50-60 age group. As
observations are noticed it is clearly evidential that the higher age group people are
prone to get this disease because of the decreased lung capacity in terms of Vata
Dosha predominance.
Gender: The male female ratio pf the study is 2:1. it is because of Male dominant
society observing and moving or exposing to the etiology much more than that of
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 125
Discussion
Females who are staying at home. Out of which no much gender specifications were
observed as per results are concerned.
Religion: Most of the cases are of Hindu community with 90%. The rest are of
Muslim community with 10%. It may not discriminate the community. As results are
observed 3 patients of well responded are from Hindu community. 1 patients of well
responded are from Muslim community. This may be because of the dietetics (Jalaja
and Anupa Mamsa ) followed at this community.
Occupation: At the study 46.6% of patients show Active Occupation suggests that
people who are exposure to the external atmosphere with pollution are getting the
disease Tamaka Swasa.
Economical status: Middle class people are always recorded much in any study
because of incapability of getting corporate treatment. Here in this study it is 60%.
Dietetic Habits: It is observed that mixed diets practitioners are 66.67%. Mixed diet
practice impacts the result and creates Ama in the body and aggravates the Kapha.
Effect of Haritaki Phala Churna in Tamaka Swasa
The Ayurvedic methods of determining the properties of drugs are evolved from
the observations of their actions and reactions on human beings. The action of drug is
decided in Ayurveda on the basis of Rasa panchaka of drug used and the response of the
body thereupon. Therefore, it is necessary to study carefully the structural units of the
human organism as well as that of drug and also the process of interaction between the
ultimate units of drug and organism. Since in Ayurveda there is no difference between
the physical or pharmacological properties of drug constituents and bodily elements. That
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 126
Discussion
is to say, the same laws that regulate the vegetable life are also to be found operating in
animals. Also confirms one of the major principles advocated. Also confirms one of the
major principle advocated by Acharya Charaka –
This is fundamental principle by the application of which mechanism of action of
drug in the body after use could be explained. Here ‘pravrittirubhayasya tu’ may means
interaction in between the properties or ultimate units of body and to that of drug after
their recognition as samanya or vishesha in that particular bio-organic unit and then
effects are produced accordingly i.e. the samanya results increase in their samanya
elements and vishesha decreases.
The other principle of treatment is samprapti vighatana means to dismantle the
samprapti ghatakas of the disease.
In the present study we have assessed the drug Terminalia Chebula (Haritaki) in
Tamaka shwasa. In Tamaka shwasa initially vitiation of jatharagni occurs, leading to
amarasotpatti causing kapha provocation, obstructing natural function of vata resulting in
disease Tamaka shwasa.
Acharya Charaka has clearly stated describing chikitsa of Tamaka shwasa –
Whatever drug, food or drink is alleviative of kapha and vata, and have ushna property
and regulative of the movements of vata, is beneficial for patients afflicted with shwasa.
(C.Ci.17/142).
Haritaki is having ushna veerya and capable of curing shwasa, aruchi etc.
diseases.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 127
Discussion
Charaka also explained that vipaka is potent than rasa, but veerya is even potent
than vipaka (C.Su 26/72).
So keeping in view above explanation, it is presumed that by virtue of ushna
veerya of the test drug Haritaki, it alleviates kapha and vata both, thereby helping in
samprapti vighatana process of Tamaka shwasa. The drug is also efficient in curing
aruchi that means, it also improves the state of jatharagni, the root cause of the disease. In
this way the probable mode of action of Haritaki can be explained.
As per charaka chikitsa 1/33. Haritaki having the Kapha prasekam property and
also Haritaki contains Tannins. Tannic acid is used as an astringent for mucous
membrane of mouth and throat, and employed for soar throat and receding gums.
These properties are much beneficial in treating the Tamaka Swasa.
Haritaki having the Anulomana property in Tamaka Swasa Kapha is Avarana to
Vata and Viloma gati of Pranavata is takes place. Haritaki does the Anulomana of
Vata and helps treat in the Tamaka Swasa.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 128
Conclusion
CONCLUSION
Tamaka Swasa is one of the most distressing diseases and is quite common
among all the socio economic strata in all age groups.
Haritaki (Terminalia Chebula) have the effect on Tamaka Swasa.with dose of
3 gms/day for 60 days Haritaki Phala Churna doesn’t cause any untoward
effect in patients.
Haritaki is said to be a multi purpose useful drug and many Nighantukaras
explains Haritaki is a Sarva Rogahara. Because of it’s having the Rasayana
property.
The Rutu Haritaki will help for to increase the Rasayana property of Haritaki.
As mother is supreme and she always make Hita to their children’s, like that
Haritaki is best for humans. It will not cause any harm to the body. Some
times mother may become angry but use of Haritaki does not make any
complication, hence Haritaki is supreme than mother.
Specific Nidana for Tamaka Swasa is not mentioned in classics as it is a sub
type of Swasa roga same Nidana are applicable to Tamaka Swasa also.
Lakshana (Roopam) of Tamaka Swasa corresponds Vata as well as Kapha
Dosha.
The imbalance of Vata and Kapha Dosha afflicts the Rasa Dhatu in the
pathogenesis of Tamaka Swasa. During the attack of Tamaka Swasa almost all
the symptoms of Kapha Dosha vitiation are mediated through the Rasa Dhatu.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 129
Conclusion
If the Tamaka Swasa is Navovita it is as Sadhya. Sushruta has mentioned
Tamaka Swasa as Krichrasadhya vyadhi and Asadhya in durbala rogi.
Therefore, the Haritaki Phala Churna aimed at the rectification of the
imbalances of Vata Dosha, as well as Kapha Dosha forms the sheet anchor of
treatment of Tamaka Swasa, which is individually opposite.
Beside the treatment, the patients of Tamaka Swasa must follow the regime of
Pathya and Apathya.
Teevra Vega Swasa and Ghurgurukatwam is pratyatma niyata lakshana of
Tamaka Swasa observed 100% in all patients.
Vibandha is observed as 36.6% in patients. Is because of the Prana Vata
Urdhwa gati in Tamaka Swasa.
An effort is made to uproot the ailment in this trail ultimately observed with
the less percentage of maximum relief patients suggests that the Haritaki
Phala Churna is a good choice of palliative medicament in Tamaka Swasa.
Well-responded patients are 4 with 13.3% and Moderately responded patients
are 9 i.e.30%. Poor responded patients are 12 i.e. 40% and 5 patients i.e.
16.6% of Not responded.
Statistically all subjective and objective parameters show Highly significance.
With the above observations it is clear that the Haritaki is used in the study for
the Tamaka Swsa is effective at their functional area to relieve Kapha from
the Pranavaha Srotas.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 130
Conclusion
Scope of further study
• To achieve the aims and objectives of study the maximum work is to
be done to present this clinical study. Even though there is wider scope
to study further.
• In larger samples the study reveals the good sort of results.
• Long standing administrations of medicaments required for long
standing disease.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 131
Summary
SUMMARY
The present study entitled “A Comprehensive study of Haritaki (Terminalia
Chebula Retz.) With special reference to Tamaka Shwasa”, has been carried out to assess
the Shwasahara potential of the drug Haritaki. The whole work has been divided into six
sections viz. Drug review, Disease review, Clinical study, Discussion, Summary and
Conclusion.
Apart from these, a brief preface to the subject is given in the beginning of
the thesis, explaining the priorities of selection of the drugs and the disease, aims and
objects with plan of study.
The first section deals with the comprehensive approach about the drug
Haritaki (Terminalia Chebula Retz.) viz. historical background, review of previous work
on Haritaki, classification, nirukti of word Haritaki, probable origin of the word Haritaki,
synonyms, interpretation and classification of synonyms, vernacular names, botanical
description of the plant, chemical properties and pharmacology of the drug, Rasa
panchaka and guna karmas, properties, therapeutic & other uses, official part, dose
fixation, in Brihattrayi and Laghuttrayi, cultivation, Haritaki on internet and taste
thresholds.
Haritaki finds its mention since Samhita period. Charaka described under
Arshoghna, Kusthaghna, Kasahara, Jwarahara,Prajasthapana and Virechanopaga
deshamani ganas. Acharya Sushruta, Vagbhata and in most of the Nighantus, Haritaki is
advised in the treatment of Shwasa, Aruchi etc. No clinical work on Haritaki as single
drug is reported.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 132
Summary
Thirty-three synonyms of the Haritaki attributed in various granthas, in
which some important are Abhaya, Kayastha, Chetaki, Pathya, Shreyashi, and Amruta.
The fruit of Haritaki is used as medicine; is described by most of authors having
Laghu, Ruksha guna, Lavana varjita Kashaya pradhana pancha rasa, ushna veerya,
Madhura vipaka and Tridosha shamaka
In most of medicinal plant literature, Haritaki has been advised in the treatment of Swasa,
Kasa,Arsha, Gulma, Kushta,Swararoga, Grahaniroga etc. Haritaki is described one of the
constituents of many compounds like Triphala, Agasthya Haritaki, Abhayarishta, Vyagra
Haritaki, Abhayadhi kwatha etc.
In second section, named disease review, there is brief description of the disease
Tamaka Shwasa, covering all the aspects viz. historical review of the disease, review of
the previous work, classification of Shwasa, Nidana, Poorva rupa, Roopa, Samprapti of
Tamaka Shwasa, Upshayanupashaya, Sadhyasadhyata, Chikitsa, Pathyapathya.
In modern parlance Tamaka Shwasa has been correlated with bronchial
asthma. It is a disease characterized by difficulty of breathing, recurring at intervals
accompanied by wheezing, sense of constriction in chest, cough and expectoration. In
this disease there is forceful expiration.
In Ayurvedic classics Tamaka Shwasa has been described due to Vata-
Kapha vitiation causing obstruction to prana vayu and ultimately difficulty in breathing.
In the treatment of Tamaka Shwasa Charaka explained that whatever the drugs, foods and
drinks are alleviative of Kapha and Vata as well as having ushna property and regulating
the movement of Vata are beneficial.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 133
Summary
The fourth section deals with the clinical study. The aim of the clinical
study was to assess the Shwasahara potential of Haritaki, which has been advocated by
most Nighantukaras. Total of 30 patients of Tamaka Shwasa were selected randomly
from O.P.D. of D.G.M.ayurvedic Medical College post graduation dept of Dravya Guna
Vignana. All 30 patients were administered Haritaki Phala choorna capsules in a dose of
1 gm. t.i.d for 45 days. In beginning and end of the treatment, pathological investigations
were carried out.
In this section, observations and then analysis of vital data’s, viz. age, sex
occupation, family history, history of past illness, Nidana, Poorva roopa, Roopa etc. and
effect of drug on cardinal signs and symptoms and overall effect of the therapy were
carried out. The study resulted in 13.33% patients well responded, 30% patients
moderately responded, 40% patients are poorly responded and 16.6% patients not
responded. The outcome of the clinical study confirmed the Shwasahara potential of the
trial drug Haritaki.
The fifth section deals with the discussion on the results obtained from
different studies, in correlation to conceptual study along with logical reasoning to the
significant findings.
The sixth section designated for the summary and conclusion, includes the
ongoing summary as well as the conclusion drawn as under –
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 134
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choukambha Surabharati prakashana Varanasi, 2004. Shloka 6, pp 6.
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121) Ibid, pp 259.
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123) Ibid.
124) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Dalhana commentary,
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125) Ibid.
126) H.H.Wilson, Rigveda Samhita, Vol 4, 10-90-13, 1st ed, Primal publications,
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127) Ibid.Vol.I,1-66-1,pp 167
128) Ravi prakasha Arya,Yajurveda Samhita,15-2, 3rd ed,Primal publications,New
Delhi.2002.pp 207.
129) Ibid,16-15,pp228.
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131) Sriram Sharma.Acharya 101 Upanishat,Vol.1st ,7th ed,
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152) Yadhunadhan Upadyaya,Madhava Nidhana,vol 1st ,15th ed, Choukambha
Sanskrit samsthana Varanasi,1985.Shloka 12/5, pp 285.
153) Ganga Sahaya Pande ed, Gadhanigraha, 1st ed, Vol 2, Choukambha Sanskri
Samsthana Varanasi, 1969. Shloka 11/18. pp 361.
154) Yadavaji Trikamji Acharya edited, Charaka Samhita, chikitsa, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala.-34,reprint
Choukambha Surabharati prakashana,Varanasi,1992.Shloka 17/55-62.pp 535.
155) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Dalhana commentary,
Dalhana Nibandha Sangraha, Choukambha Ayurvijnana Grandhamala-42, 1st
ed, Reprint, Published by Choukambha Surabharati prakashan, Varanasi, 1994,
Shloka 51/8-10. pp 762.
156) K.R.Srikanth murthy ed.Astanga Hridaya, Nidana, 3rd ed.Krishna Das academy
Varanasi. 1996.Shloka 4/6-10. pp 38.
157) Yadhunadhan Upadyaya,Madhava Nidhana,vol 1st ,15th ed, Choukambha
Sanskrit samsthana Varanasi,1985.Shloka 12/27-34, pp 296-7.
158) Ganga Sahaya Pande ed, Gadhanigraha, 1st ed, Vol 2, Choukambha Sanskri
Samsthana Varanasi, 1969. Shloka 11/29-38. pp 363-4.
159) Yadavaji Trikamji Acharya edited, Charaka Samhita, chikitsa, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala.-34,reprint
Choukambha Surabharati prakashana,Varanasi,1992.Shloka 17/17.pp 533.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 145
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Sanskrit samsthana Varanasi,1985.Shloka 12/4, pp 283.
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165) Yadavaji Trikamji Acharya edited, Charaka Samhita, chikitsa, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala.-34,reprint
Choukambha Surabharati prakashana,Varanasi,1992.Shloka 17/8.pp 533.
166) K.R.Srikanth murthy ed.Astanga Hridaya, Nidana, 3rd ed.Krishna Das academy
Varanasi. 1996.Shloka 13/1. pp 182.
167) Ibid, 13/10, pp 183.
168) Ibid, 11/8, pp 156.
169) Yadavaji Trikamji Acharya edited, Charaka Samhita, Sutra, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala.-34,reprint
Choukambha Surabharati prakashana,Varanasi,1992.Shloka 10/14.pp 66.
170) Ibid, Chikitsa 17/8-9, pp 533.
171) Ibid, 17/17, pp 533.
172) Ibid, 17/55, pp 535.
173) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Dalhana commentary,
Dalhana Nibandha Sangraha, Choukambha Ayurvijnana Grandhamala-42, 1st
ed, Reprint, Published by Choukambha Surabharati prakashan, Varanasi, 1994,
Shloka 51/8. pp 762.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 146
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Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint
Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/57pp 535.
175) Ibid, 17/58, pp 535.
176) Ibid, 17/63-4, pp 535.
177) Ibid, 17/62, pp 535.
178) Ibid, 17/63, pp536.
179) K.R.Srikanth murthy ed.Astanga Hridaya, Sutra 3rd ed.Krishnadas academy
Varanasi. 1996.Shloka 11/6. pp 156.
180) Yadavaji Trikamji Acharya edited, Charaka Samhita, Nidana, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint
Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 1/11, pp 196.
181) Ibid, Chikitsa, 17/63-64, pp 536.
182) Ibid, Sutra, 19/4, pp 110.
183) Ibid, Chikitsa, 17/8, pp 533.
184) Yadhunadhan Upadyaya, Madhava Nidhana, vol 1st, 15th ed, Choukambha
Sanskrit samsthana Varanasi, 1985.Shloka 12/12, pp 286.
185) Yadavaji Trikamji Acharya edited, Charaka Samhita, Chikitsa, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint
Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/148, pp 539.
186) Ibid, 17/68, pp 536.
187) Ibid, 17/62, pp 535.
188) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Dalhana
commentary, Dalhana Nibandha Sangraha, Choukambha Ayurvijnana
Grandhamala-42, 1st ed, Reprint, Published by Choukambha Surabharati
prakashan, Varanasi, 1994, Shloka 51/13. pp 762.
189) Yadhunadhan Upadyaya, Madhava Nidhana,vol 1st ,15th ed, Choukambha
Sanskrit samsthana Varanasi,1985.Shloka 12/17, pp 290-2.
190) Yadavaji Trikamji Acharya edited, Charaka Samhita, Chikitsa, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint
Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/68, pp 536.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 147
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191) Antony Seaton, et.al, Crofton and Dougla’s Respiratory diseases, Chapter 26,
edited by Neil O. Brein, Published by oxford university press, New Delhi, 4th
edition, 1989, pp 682.
192) Yadhunadhan Upadyaya, Madhava Nidhana,vol 1st ,Madhukosha 15th ed,
Choukambha Sanskrit samsthana Varanasi,1985.Shloka 1/8, pp 44.
193) Yadavaji Trikamji Acharya edited, Charaka Samhita, Chikitsa, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint
Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/58, pp 535.
194) Ibid, 17/60, pp 535.
195) Ibid, pp 535.
196) Yadhunadhan Upadyaya, Madhava Nidhana, vol 1st, 15th ed, Choukambha
Sanskrit samsthana Varanasi, 1985.Shloka 1/9, pp 53.
197) Yadavaji Trikamji Acharya edited, Charaka Samhita, Chikitsa, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint
Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/62, pp 535.
198) Ibid, 17/59, pp535.
199) Ibid, 22/17, pp 567.
200) Ibid, 17/7, pp 533.
201) Ibid, Indriya, 7/24, pp 366.
202) Ibid, 7/25, pp 366.
203) Ibid, 8/15, pp367.
204) Ibid, Chikitsa, 17/62, pp 535.
205) Ibid, 17/58, pp 535.
206) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Dalhana
commentary, Dalhana Nibandha Sangraha, Choukambha Ayurvijnana
Grandhamala-42, 1st ed, Reprint, Published by Choukambha Surabharati
prakashan, Varanasi, 1994, Shloka 51/13. pp 762.
207) K.R.Srikanth murthy ed. Astanga Hridaya, Nidana,3rd ed.Krishnadas academy
Varanasi. 1996.Shloka 4/18. pp 40.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 148
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Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint
Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/49-67,
pp 534-6.
209) Ibid, 17/71, pp 537.
210) Ibid 17/75, pp 538.
211) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Dalhana
commentary, Dalhana Nibandha Sangraha, Choukambha Ayurvijnana
Grandhamala-42, 1st ed, Reprint, Published by Choukambha Surabharati
prakashan, Varanasi, 1994, Shloka 51/49. pp 773.
212) Yadavaji Trikamji Acharya edited, Charaka Samhita, Chikitsa, Chakrapani,
Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint
Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/121,
pp 542.
213) Ibid, 17/147-150, pp 561-2.
214) Harrions, principles. Of Internel Medicine,. Fouci, Brauwald, Isselbacher, Wilson, Martin, Kasper.et.al.editor.Vol 2nd 14thedition.Singapore:International edition; 1988. pp 1419.
215) Ibid, pp 1420.
216) Ibid, pp 1420.
217) Ibid, pp 1420.
218) Satya Narayana Shastri, Charaka Samhita Chikitsa, 1st ed, Choukambha Bharati
Academy, 2001. Shloka 17/47, pp529.
219) Ambika Datta Shastri, Susruta Samhita Uttara, 15th edition, Choukambha
Sanskrit Samsthana, 2002. Shloka 51/46-47,pp 381.
220) K.R.Srikanth murthy ed. Astanga Hridaya, Chikitsa, 2nd ed, Krishnadas
Academy, Varanasi, 1996. Shloka 4/25, pp 249.
221) Brahma sahanaka Shastri, Yogaratnakara, Swasadhikara, 5th ed, Choukambha
Sanskrit Samshtana Varanasi, 1993. Shloka 1-8 pp 435-36.
222) Ambikadatta Shastri, Govindadas, Bhaishajya Ratnavali, 6th ed, Choukambha
Sanskrit Pratistan, Varanasi, 1981. Shloka 16/132-6, pp 339.
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 149
Annexure Special case sheet for the evaluation of efficacy of HARITAKI PHALA CHURNA IN THE MANEGEMENT OF TAMAKA SWASA POST GRADUATE STUDIES AND RESEARCH CENTER (DRAVYAGUNA) SHRI. D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG
Guide: Dr.Kuber Sankh M.D,(Ayu)
Scholar:
Anand.M.Dodamani
1) Name of the patient
Sl.No
2) Sex Male
Female
OPD.No
3) Age Years
IPD.No
4) Religion
Hindu
Muslim
Chistian
Other
5) Occupation
Sedentary
Active
Labor
6) Economical status
Poor
Middle
Higher middle
Higher class
7) Address Pin 8) Birth data
Date
Month
Year
9) Selection
Included
Excluded
10) Schedule dates
Initiation
Completion
11) Result
Well Responded
Moderately Responded
Not Responded
Discontinued
INFORMED CONSENT I________________________Son/Daughter/Wife of__________________________________ Am exercising my free will, to participate in above study as a subject. I have been informed to my satisfacation,by the attending physician the purpose of the clinical evaluation and nature of the drug treatment. I am also aware of my right to opt out of the treatment schedule, at any time during the course of the treatment. Patient’s Signiture
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 1
Annexure 12) CHIEF COMPLAINTS (Subjective parameter)
13) ASSOCIATED COMPLAINTS
Sl.no
Complaints Before After Follow-up
1 Teevra Vega Swasa (Dyspnoea) 2 Kasa (Cough) 3 Duhkhena Kaaapha nissaranam (Expectoration) 4 Ghurughurutwam (Wheezing) 5 Peenasa (Coryza) 6 Kruchrena bhasate (Difficulty in speech) 7 Kantodhwamsham (Hoarseness of voice) 8 Greevashirasangraha (Headache & Stiffness) 9 Uraha Peeda (Chest pain) 10 Shayane Swasa peedita (Discomfort at supine)
S.No
Associated Complaints Before After Follow-up
1 Anidra (Disturbed sleep) 2 Pratamyati or Bhrushamatra (Distressed) 3 Aruchi (Anorexia) 4 Vishukasyata (Dryness of mouth) 5 Lalata sweda (Sweat over forehead) 6 Trushna (Thirst) 7 Angamarda (Malaise) 8 Kampa (Tremors) 9 Jwara (Fever) 10 Pramoha (Fainting) 11 Vamathu (Nausea) 12 Muhur Swasa (Frequent respiration) 13 Muhuchaiva dhamyati (Puts all effort to breath)
14) HISTORY OF PRESENT ILLNESS Mode of onset Sudden / Gradual Course Episodic/Continuous/Initially episodic Frequency of attack few hours/few days/few weeks Duration of attack continuous/intermittent/subsides with medication Mode of progress Typical/Rapid/Long time non progressive Periodicity Seasonal/Irregular/Perennial Preceded by Sneezing/Nasal irritation/Cough/Talking Sputum Non purulent / Purulent Aggravation factors Dust/Food/Smoke/Pets/Pollens/Stress Comfort posture at attack Sitting/Lying/Standing/Forward bending 15) Occupational history if any
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 2
Annexure
16) PERSONAL HISTORY
Food habits Vegitarian Mixed diet Taste preferred Sweet Sour Salty Pungent Bitter Astringent Agni Sama Vishama Manda Teekshna Kosta Mrudu Madhyama Krura Nidra Day Night Sound Disturbed Addictions Tobacco Alcohol Drugs Bowel habits Normal Loose Constipated Menstrual History Regular Irregular Amenorrhea Menopause Family history – Specific if any has the same disease
Other system medications Bronchodilators Treatment history
Cortico steroids Other medicines RS Since how long
History of past illness 17) EXAMINATION (a) Vitals
Temperature F Pulse /min Respiration rate /min Height Cms Weight Kg Blood pressure mmHg
(b) General Oedema Present Absent Icterus Present Absent Pallor Present Absent Cyanosis Present Absent Clubbing Present Absent Palpable lymph
nodes Present Absent
(c) Respiratory system Shape Normal/Kyphosis/Scoliosis/Flattening/Over inflation Movement Normal / Reduced Resp. Rhythm Normal / Abnormal Respiration Thoracic / Abdominal / Thoraco abdominal Accessory muscles Not involved / Involved / Inter coastal spaces Visible veins Absent / Present
Dar
shan
a
Venous pulses Normal / Raised Tracheal position Centrally placed / Deviated Pain / Tenderness Swelling Vocal fremitus Shape Symmetrical / Asymmetrical
Spar
shan
a
Lymph nodes Not palpable / Palpable at Akotana Normal / Resonant / Hyper resonant / Dull
Type of breath Broncho-vesicular / Vesicular / Bronchial
Sh rav
an aVocal resonance Normal / Increased / Decreased / Absent
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 3
Annexure
Resp. Sound Rales / Ronchi / Crepitating / Plural Rub / (d) Dosha Examination (Ayurvedic)
Desham (Deha) Bhumi Jangala Anupa sadharrna Vata B A Pitta B A Kapha B AKarshya Peeta mootrata Agni sadana
Karshnya Peetanetra Praseka Ushna kamitwa Peetavit Alasya Kampa Peetatwak Swetangata Anaha Adhikshudha Sheetangata Shakrudgraha Adhidaha Gourava Balabramsha Slathangata Nidrabhramsha Swasa Pralapa Kasa
(a) Dosha Vruddi
Bhrama Atinidra Vata B A Pitta B A Kapha B AAngasada Mandagni Bhrama Alpabhasite ahitam
Shareera sheetatwam
Urah shoonyata
Chesta heenata Prabha hani Shira Shoonyata
Vyamoha Hridrava
(b) Dosha kshaya
Sleshma vruddi Sandhi saidhilya
Nadi V P K VP VK PK VPK Prakruti V P K VP VK PK VPK Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyama samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Ahara Shakti Uttama Madhyama Alpa Vyayama Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya
Nadi Dosha Pravrutti Gati Varna Purnata Gandha Spandana Kathinya
Mutra
Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa
Mala
Ata
stas
than
a
Shabda Sparsha Sheeta Ushna
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 4
Annexure
Drik Akruti (e) Srotas Before After Before After Pranavaha Atisrustam Ati badhdama Kupitam Abheekhnam Alpalpa Sashoolam Annavaha Aruchi Ajeerna Chardi Anannabhilasha Udakaavaha Jihwashosha Talushosha Ostashosha Pipasa 18) Tamaka swasa nidana
Visamasana (V) Tilataila (P) Pistanna (K) Masa (K) Adhyasana (V) Vidahi (P) Nispava (K) Dadhi (K) Anasana (V) Saluka (K) Vistambhi(K) Sheetashana(V) Guru dravyas(K) Amaksira (K) Visha (V) Jalajamamsa (K) Sheetapana (V) Anupamamsa (K)
Aha
ra
Rukshanna (V) Abhishyandi (K) Rajas (V) Abhighata (V) Kanthapratighata(V) Urahpratighata(V) Vata (V) Dhuma (V) Karmahata (V) Marmabhighata(V)Sheetasthana(v) Apatarpana(V Veganirodha (V) Ushna (P) Sheeta ambu (V)
Bharakarshit (V)
ShuddhiAtiyoga(V) Abhishyandi upachara (K)
Vih
ara
Ativyayama(V) Adhwata(V) Gramya dharma (V) Divaswapna (K)
Kshatakshaya Atisara Visuchika
Udavarta Vibandha Panduroga Vata Kshaya Anaha Dourbalya
Pitta Raktapitta Jwara Kasa Amapradosa Charddi
A
nya
/Vya
dhi
av
asth
a
Kapha Pratisyaya Amatisara
19) Tamaka Swasa Poorvaroopa BT AT BT AT Hrutpeeda Parshwshoola Kshudra Swasa Vibandha Shankha bheda Anaha Shoola Arati Pranavilomata Bhakta dwesha Vaktra vairasya Admana
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 5
Annexure
20) Tamaka Swasa Vikalpa Samprapti Santamaka Pratamaka Udavarta Jwara Rajaobhighata Moorcha Ajeerna Vata nirodha 21)Upashaya andAnupashaya
Asheena labhate sowkyam Sleshma vimokshante sukham Upashaya Ushnam chaivabhinandate Shayanasya sameerane
parshwe ghranati
Anupashaya Shayanasya swasa peedita Meghambu sheeeta pragwata 22) INVESTIGATIONS (Objective parameters) Investigation for screening Sputum examination (if necessary) Chest X-Ray (if necessary) Erythrocyte Sedimentation Rate Absolute Eosinophilic Count Peak Expiratory Flow Rate 23) Assessment A) Disease assessment
1) Subjective parameters Before After Follow-up
comment
1 Teevra Vega Swasa (Dyspnonea) 2 Kasa (Cough) 3 Duhkhena kapha nissaranam (Expectoration) 4 Ghurghuratwam (Wheezing) 5 Peenasa (Coryza) 6 Kruchrena bhasate (Difficulty in speech) 7 Kantodhwamsham (Hoarseness of voice) 8 Greevashirasangraha (Headache & Stiffness) 9 Uraha Peeda (Chest pain) 10 Shayane Swasa peedita (Discomfort at
supine)
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 6
Annexure
2) Objective parameter Before After Follow-up
1 Walking time Sec/100feet Sec/100feet Sec/100feet
2 Breath holding time /sec /sec /sec
3 Peak Expiratory Flow Rate L/m L/m L/m
4 Erythrocyte Sedimentation Rate Mm/1stHour Mm/1stHour Mm/1stHour
5 Absolute Eosinophilic Count /cumm /cumm /cumm
6 Hemoglobin % Gm% Gm% Gm%
24) Treatment schedule of “Haritaki Phala Churna in Tamaka Swasa” schedule Investigator’s observation Day 1 Day 15 Day 30 follow up Day 45 (final follow up) Investigator’s Note:
Signature of guide (Dr. Kuber Sankh M.D.(Ayu))
Signature of Scholar (Anand.M.Dodamani.)
Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 7