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EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI

IN THE MANAGEMENT OF TAMAKA SWASA By

KALMATH. BASAYYA. LINGAYYA

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fu

Ayurved

KaUnde

Dr. V.

Dr. Shiva RamM.D. (Ayu) (Osm), C

DepartmPost Graduate St

D.G. MELMALAGI AYURV

lfillment of the degree of

a Vachaspati M.D. In

yachikitsa r the Guidance of

Varadacharyulu M.D. (Ayu) (Osm)

a Prasad Kethamakka .O.P. (German) M.A., [Ph.D] (Jyotish)

ent of Kayachikitsa udies & Research Center EDIC MEDICAL COLLEGE, GADAG 2003-2006

Ayurmitra

TAyComprehended

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103

This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF

ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA

SWASA” is a bonafide research work done by KALMATH. BASAYYA. LINGAYYA in

partial fulfillment of the requirement for the post graduation degree of “Ayurveda

Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,

Bangalore, Karnataka.

Dr. Shiva Rama Prasad Kethamakka

M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish)

Co- Guide

Professor in Kayachikitsa

DGMAMC, PGS&RC, Gadag

Date:

Place: Gadag

Dr. V. VARADACHARYULUM.D. (Ayu) (Osm)

GuideProfessor & HOD

Dept. of Kayachikitsa

PGS&RC

Date:

Place: Gadag

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103

Endorsement by the H.O.D, principal/ head of the institution

This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF

ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA

SWASA” is a bonafide research work done by KALMATH. BASAYYA. LINGAYYA under

the guidance of Dr. V. VARADACHARYULU, M.D. (Ayu) (Osm), Professor & HOD and

Dr. Shiva Rama Prasad Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D]

(Jyotish), Professor in Kayachikitsa Co- Guidance, in partial fulfillment of the requirement for

the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev

Gandhi University of Health Sciences, Bangalore, Karnataka.

.

DP

(Dr. G. B. Patil) Principal,

DGM Ayurvedic Medical College, Gadag

Date: Place:

(Dr. V. Varadacharyulu)Professor & HOD

Dept. of Kayachikitsa PGS&RC

ate: lace: Gadag

Declaration by the candidate

I here by declare that this dissertation / thesis entitled EVALUATION OF THE

EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF

TAMAKA SWASA is a bonafide and genuine research work carried out by me under the

guidance of Dr.V.Varadacharyulu M.D.(Ayu) and Dr. Shiva Rama Prasad

Kethamakka, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa Co-

Guidance, DGMAMC, PGS&RC, Gadag.

Date

Place


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

Place


© Rajiv Gandhi University of Health Sciences, Karnataka

i

i

Acknowledgement

I express my deep gratitude to my Guide Dr. V.V.Varadacharyulu M.D. (Ayu)

Goldmedalist, professor and H.O.D and my Co-guide, Dr. Shiva Rama Prasad

Kethamakka, M.D.(Ayu),M.A.Ph.D., Professor, PG Dept, Kayachikitsa for their time to

time help and critical suggestions associated with expert guidance at the completion of

this dissertation.

I express my obligation to my beloved princ pal Dr.G.B.Patil, for his

encouragement as well as providing all necessary facilities for this research work. I

extend my gratitude to Dr. R.V.Shettar, M.D, lecturer, Dept. of KC (PG), Sri Nanda

Kumar, Statistician and Librarian Sri Mundinamani, and assistant Sureban for their

encouragement, as well as timely suggestions at this research work.

I express my acknowledgement to my parents who are responsible for my

existence and success Smt Basamma and Shri Lingayya along with my relatives who are

helpful to me at each and every step of development.

I extend my gratitude to Dr. G.Purushottamacharyulu, Dr.M.C.Patil, Dr.

Mulgund, Dr. G.S. Hiremath, Dr.P.Shivaramudu, Dr.S.H.Doddamani, Dr.

G.Danappagoudar, Dr. S.N.Belawadi, Dr.J.Mitti, Dr.Nidugundi, Dr. Samudri, Dr.

Kubersankh.who helped me time to time.

I extend my gratitude to my U.G. Teachers Dr. B.G. Swam , Dr. C.S. Hiremath,

Dr. S.A. Patil, Dr. R.K. Gacchinamath, Dr. V.M. Malagoudar, Dr. V.M. Sajjanar, and Dr.

U. V. Purad, who gave support and inspiration during my studies. I grateful to my teacher

Dr. S.B. Govindappanavar,Asst. Registrar, RGUHS, Bangalore.

I would like to mention the support and inspiration provided by professor S. B.

Shetter Rtd. Principal, Professor Mallikar un,Rtd. Principal, Shri. V.B. Shetter, Prof.

Siddu yapalparavi, Shri. Basavaraj Ganavari, and Shri. Shyamsundar Rao..

j

t

I express my sincere thanks to my colleagues and friends, Ratnakumar, Mouli,

Aswin, Uday Kumar, Venkareddi, , Hugar, Jayraj, Swami, Ganti, Pradeep, Sajjan,

Ashok,, Shiba, Jigulur, Umesh, G.G.Patil, Sarvi, Subin, sathish, Febin, Joshi, Shyju,

Shajil, Renjith, Srinivasa Reddy, Ravi, Pattanashetti, Koteshwar, V.S. Hiremath, Santosh

Yadahalli, Santoji, Jaggal, Suvarna, Lingaraddi, Suresh Hakkandi, Manjunath Akki,

Anand, Payapagoudar, Sharanu, Anita, Sobagin, Meenakshi, Inamdar, Sunitha and other

P.G. Scholars for their support.

I acknowledge my patients for their whole hearted consent to participate in this

clinical trial. I express my thanks to all the persons who have helped me directly and

indirectly with apologies for my inability to identify them individually.

(B.L. Kalma h)

EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA SWASA

Abstract

By KALMATH. BASAYYA. LINGAYYA

Tamaka Swasa vis-à-vis bronchial asthma patients were diagnosed on the basis of

symptomatology explained by Bruhatrayee (subjective parameter) and objective

parameters fixed on contemporary scientific descriptions and parameters. Out of the 67

patients of Tamaka Swasa 65 (97.01%) were undertaken for the study. The remaining 50

(76.93%) patients of Tamaka Swasa fulfilling the criteria of diagnosis and inclusive

criteria were included in the study. Hindu religion patients were more (92%) recorded.

Out of the symptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patients

initially are relieved 58%. Another symptom found for all patients is Ghurgurukatwam is

relieved for the 50% of patients in the study. Kasa a symptom appeared for 47 patients

initially relived 61.7% in the study. 39 patients of Urahpeeda corrected at the end of

study by 58.97%. Greevashirasangraha (16 patients) and Kantodhwamsham (12 patients)

are the other two symptoms of assessment got relief with 43.75 and 58.33 percentages

respectively. At the Objective Parameters assessment in Tamaka Swasa in the study of

Ardhedashemaniya Swasaharavati five objective parameters are assessed are enlisted in

the table 43. The result in the study ascertains the best activity of the Ardhedashemaniya

Swasaharavati over the Tamaka Swasa vis-à-vis Asthma. After through study of the

entire parameters and materials available for the assessment of results it was drawn a

conclusion of results as - 27 (54%) well responded, 11 (22%) moderately responded, 7

(14%) poorly responded and 5 (10%) patients not responded and the 12 patients

discontinued in the study, were not considered for the result declaration.

Ardhedashemaniya Swasaharavati is very economic safe and effective drug hence it can

be employed in all cases of Tamaka Swasa and it can be used as preventive type of

medication. This Ardhedashemaniya Swasaharavati is new therapeutic option for

optimizing the asthma control.

PEFR, BHT, TS, BA, CS, SS, AH, AS, MN, Lung Function Test,

Contents of

EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI

IN THE MANAGEMENT OF TAMAKA SWASA By


Chapter Content Pages

1 Introduction 1 to 9

2 Objectives 10 to 13

3 Review of literature 14 to 87

4 Methods 88 to 100

5 Results 101 to 151

6 Discussion 152 to 174

7 Conclusion 175 to 175

8 Summary 176 to 179

9 Bibliographic References I to IX

10 Annex – Case sheet 1 to 6

- 1 -

Tables of EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA

SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA SWASA By

KALMATH. BASAYYA. LINGAYYA SN Title of Table Page

Number 1 Showing Nidana of Swasa / Tamaka Swasa 36 2 Showing Poorvaroopa of Shwasa Roga: 60 3 Shows lakshanas of Tamaka Swasa 65 4 Vyavacchedaka Nidana in Tamaka Swasa 67 5 Showing Pathya in Tamaka Swasa 78 6 Showing Apathya Aahara in Tamaka Swasa 79 7 Showing Apathya Vihara in Tamaka Swasa 80 8 Pharmacological properties of Ardhedashemaniya Swasaharavati 87 9 Demographic Data 102 10 Distribution of patients by Age gender - 104 11 Result of Ardhedashemaniya Swasaharavati in trail patients by

Age 105

12 Distribution of patients by Gender in Tamaka Swasa 106 13 Distribution of patients by Religion and gender identification 108 14 Result Distribution of patients by Religion 109 15 Distribution of patients by occupation 110 16 Distribution of patients by Economic status 112 17 Distribution of patients by diet in Tamaka Swasa 113 18 Distribution of patients by presenting complaints 115 19 Presenting Associated features 116 20 Distribution of patients by Mode of on set 118 21 Distribution of patients by course 119 22 Distribution of patients by frequency 120 23 Distribution of patients by duration of attack 121 24 Distribution of patients by periodicity 122

- 2 -

25 Distribution of patients by preceding factors 123 26 Distribution of patients by aggravating factors 124 27 Distribution of patients by comfor posture t 125 28 Distribution of patients by Dosha Kshaya lakshana 126 29 Distribution of patients by Dosha vruddhi Prakruti 127 30 Distribution of patients by Ahara Nidana 128 31 Distribution of patients by Vihara Nidana 129 32 Distribution of patients by Anya / Vyadhi Avasta sambandha

Nidana 130

33 Distribution of patients by Sro as t 130 34 Distribution of patients by Poorva Roopa 131 35 Distribution of patients by Chief complaints and Associated

complaints 132

36 Distribution of patients by History of present illness 133 37 Distribution of patients by Dosha Vruddhi Lakshana 135 38 Distribution of patients by Dosha Kshaya Lakshana 136 39 Distribution of patients by Ahara Nidana 138 40 Distribution of patients by Vihara Nidana 139 41 Distribution of patients by Anyavyadhi avasta sambandhi 140 42 Subjective parameters assessment in Tamaka Swasa 142 43 Objective Parameters assessment in Tamaka Swasa 143 44 Cumulative effect in percentages obtained through subjective and

objective Parameters for Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis bronchial Asthma

146

45 Result of Ardhedashemaniya Swasaharavati in Tamaka Swasa 147 46 Statistical analysis of Objective parameters 148 47 Statistical analysis of Subjective parameters 149 48 Objective parameters Baseline comparison in Ardhedashemaniya

Swasaharavati in TS 150

- 3 -

Figures and Photos of EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA

SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA SWASA By

KALMATH. BASAYYA. LINGAYYA SN Title of Figures and photos Page

Number 1 Upper and Lower Respiratory System 20

2 The Bronchi and Lobules of the Lung 21

3 Gross Anatomy of the Lungs 23

4 The Bronchi and Lobules of the Lung 25

5 Pressure changes during inhalation and exhalation 29

6 Ageing and the decline in Respiratory performance 31

7 Schematic representation of Tamaka Swasa Samprapti 51

8 Cross section of the lung in Tamaka Swasa i.e. Asthma 58

9 Ingredients of Ardhedashemaniya Swasaharavati 81

10 Distribution of patients by Age – Gender 104

11 Result of Ardhedashemaniya Swasaharavati in trail patients by

Age

105

12 Distribution of patients by Gender in Tamaka Swasa 106

13 Resul Distribution of patients by Gender in Tamaka Swasa t 107

14 Distribution of patients by religion in Tamaka Swasa 108

15 Result Distribution of patients by Religion in Tamaka Swasa 109

16 Distribution of patients by Occupation 110

17 Result of patients by occupation in Tamaka Swasa 111

18 Resul Distribution of patients by Economic status t 112

19 Distribution of patients by diet in Tamaka Swasa 113

20 Result Distribution of patients by diet in Tamaka Swasa 114

- 4 -

21 Distribution of patients by presenting complaints 115

22 Distribution of patients by Associated features of Tamaka Swasa 117

23 Distribution of patients by Mode of on se t 118

24 Distribution of patients by course 119

25 Depicting the frequency episodes in Tamaka Swasa 121

26 Depicting the duration of attack in Tamaka Swasa 122

27 Depicting the periodici y in Tamaka Swasa t 123

28 Depicting the preceding factors in Tamaka Swasa 124

29 Depicting the aggravating factors in Tamaka Swasa 125

30 Depicting the comfort posture in Tamaka Swasa 126

31 Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa 148

- 5 -

Chapter 1

Introduction From childhood as children we play with the conditions and are exposed to dust

mites, fungi, and other allergens as a part of game or unnoticing. Human bodies produce

chemicals known as antibodies and there by the immunity is enriched. But the same

allergens concurs any individual common problem is respiratory tract infection along with

difficulty in respiration. The function of antibodies in the body is to fight off the invasion of

materials from the environment. However, the release of antibodies also inflames the

bronchi and bronchioles. The more often a child is exposed to allergens, the more serious the

response becomes. This condition is known as atopy i.e. “A genetically determined state of

hypersensitivity to environmental allergens. Type I allergic reaction is associated with the

IgE antibody and a group of diseases, principally asthma, hay fever, and atopic dermatitis”,

is thought to occur in anywhere from 30 to 50 percent of the general population.

The lungs, which are exposed to the external environment needs a protection

especially in the “World of Heat and Dust”. The human body is continuously under the

influence of environmental changes subjected to environmental pollution. Our urbanized life

style and industrialization etc. compound the problem. As a result of smoke (dhooma) and

dust (raja) Pranavaha srotodusti occurs, and terminates into the disease Tamaka Swasa other

wise Asthma 1.

Atmospheric pollution

The effect of indoor and outdoor air pollution on allergic disease has received

considerable attention. Environmental pollutants have been reported to contribute to the

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction

1

prevalence of allergic disease, the precipitation of allergic symptoms, and their intensity

(Ollier & Davies, 1994). Both epidemiological and experimental studies have demonstrated

that a variety of atmospheric substances including sulfur dioxide (SO) 2, nitrogen dioxide

(NO2), ozone (O3) and particles influence the induction and elicitation phases of the

allergic response. Effects have included adjuvant activity for allergen-specific IgE

production, modulation of mediator release from inflammatory cells, and irritant effects

on effector organs of the allergic response 2.

The question of whether environmental factors may be involved in the observed

increase in the prevalence of allergy is a matter of controversy 3. There is no doubt that

pollutants such as suspended particles, automobile exhaust, ozone, sulfur dioxide and nitric

oxides can be measured in rather high concentrations in the air of many countries that show

an increasing prevalence of atopic diseases. However, some of these pollutants, like sulfur

dioxide, have shown a decrease in air concentrations during the last decades.

In a controlled prospective trial comparing different living areas with various

degrees of air pollution in western and eastern Germany, striking differences were shown

with regard to the prevalence of respiratory atopic diseases, with higher values for western

compared to East-Germany 4. In contrast to atopic respiratory diseases, there was a trend to

higher prevalence rates of atopic eczema in eastern Germany. In the same study there was

evidence of an increased risk of developing atopic eczema after exposure to natural allergens

as well as air pollutants from outdoor and indoor sources 5. These observations made now

are affirmed long back in Ayurveda.

A common condition of transportation in flights or working as crew in them is

problematic for people those have respiratory problem. This situation is stated form Oxford


2

Textbook of Medicine as “People with respiratory disease (Asthma) often have difficulty in

assessing its true severity and aircrew with the condition may fly unaware of how severe it

is. Exacerbations of asthma are often precipitated by upper respiratory infections. If such an

exacerbation occurs when the aircrew member is overseas, there is considerable pressure on

the individual to fly; alternatively, serious disruption of flight scheduling may result. An

acute episode of asthma in flight is likely to interfere seriously with the flying task and has

been reported to result in loss of control of the aircraft. Aircrews with very mild, intermittent

asthma requiring only occasional treatment are fit to fly. Those with more continuous

symptoms requiring regular suppressive medication, inhaled steroids, or cromoglycate are fit

for restricted licensing provided their asthma is well controlled. Those whose symptoms

persist in spite of medication or who have very reactive airways with unexpected attacks are

unfit to fly”.

Living cells need energy for maintenance, growth, defense, and replication. Our cells

obtain that energy through aerobic mechanisms that require oxygen and produce carbon

dioxide. Many aquatic organisms can obtain oxygen and excrete carbon dioxide by diffusion

across the surface of the skin or in specialized structures, such as the gills of a fish. Such

arrangements are poorly suited for life on land, because the exchange surfaces must be very

thin and relatively delicate to permit rapid diffusion. In air, the exposed membranes

collapse, evaporation and dehydration reduce blood volume, and the delicate surfaces

become vulnerable to attack by pathogenic organisms. Our respiratory exchange surfaces are

just as delicate as those of an aquatic organism, but they are confined to the inside of the

lungs-in a warm, moist, protected environment. Under these conditions, diffusion can occur

between the air and the blood 6.


3

It is a fact that the mentions of Charaka, that the Air as a fundamental unit of

external environment is a unique factor of biological activity providing the strength and

consciousness becomes a criteria of living activity through respiration 7. Pranavata and

Apanavata are responsible for breathing out and breathing in, which is an important day to

day experiences of life 8.

Pranavaha Srotas, the origin is Hrudaya as well as Mahasrotas. Chakrapani

commenting on this stated that a special air known as Prana is related intimately to this

Srotas 9.

Therefore, it is clear that the specific air known as Prana is breathed into the

respiratory system during the act of inspiration. The normalcy of Pranavata suggests health

in the body 10, 11, 12. The abnormality of respiration indicates disease, and its cessation marks

death 13, 14, 15. This unique sign of life is affected in the disease Tamaka Swasa 16. And this

Pranavata vikaruti lead to the Swasa 17 if it is neglects. This leads to the emergency

condition, 18 later on death.

Tamaka Swasa is a disease, characterized by Swasa kricchata, Ghurghurakatwa,

Kasa, Peenasa etc., with patient feels as if entering darkness. During the paroxysm which is

due to where on holy association of Vata with Kapha obstructing the passages of Pranavata

leads to excitement of Vata to produce upward movement or abnormal expiratory dyspnoea.

Which vary in severity and frequency from person to person is in an individual, they may

occur from hour to hour and day to day.

Bronchial asthma is a disease. Characterized by variable air flow obstruction, air way

inflammation and bronchial hyper responsiveness, the disease manifests wide variations on

air way obstruction over a short period of time until recently, bronchospasm was considered


4

cardinal feature of asthma but now in addition to bronchospasm, air way inflammation is

recognized as an essential component of the disease 19.

Need and significance of the study

The world health organization estimated in 1998 that asthma affect 155 million

people world wide, based on data collected in epidemiological studies in more than 80

countries. Asthma rate has increased significantly in recent decade which is increased 50%

every decade 20 worldwide, deaths from this condition have reached over 180,000 annually.

Asthma is not just a public problem for developed countries. In developing countries,

however, the incidence of the disease varies greatly. India has an estimated 15-20 million

asthmatics.

Economic burden

Mortality due to asthma is not comparable in size to the day to day effects of the

disease. Although largely avoidable, asthma tends to occur in epidemics and affects young

people. The human and economic burden associated with this condition is severe. World

wide the economic costs associated with asthma are estimated to exceed those of TB and or

AIDS combined 21.

Above mentioned all points shows its severity of incidence and prevalence rate is

crucial that we should gain more insight into its causation and management. WHO

recognizes asthma as a disease of major health, public health importance and plays a unique

role in the co-ordination of international efforts against the disease.

The international action is needed to stimulate research into the causes of asthma, to

develop new control strategies and treatment techniques and develop and implement an

optimal strategy for its management and prevention increase public awareness of the disease


5

Drugs

The management of asthma is two fold, i.e. pharmacological and non

pharmacological. First one includes the bronchodilators, anti inflammatory corticosteroids,

and anti histamines. Inflammatory is the now target of therapy and the role of inhaled.

Corticosteroids have been formerly established in long term therapy. NAEP 1991 suggests

minimizing the toxicities of oral steroids. Non-pharmacological is the education 22.

The goal of asthma treatment has shifted from symptom relief to disease control this

can be achieved through usage of prophylactic category of medicaments.

Asthma is considered to increase direct and indirect medical expenditures. So reduce

the cost of treatment also to prevent the disease. Ayurveda suggest the cost effective

management from different treatment modalities.

Sequential administration of the snehana, swedana,shodhana, dhumapana, shamana,

Rasayana, diet etc., line of treatment forms the complete treatment of Tamaka Swasa

expounded in the Ayurvedic literature 23.

Among these procedure shamana line of treatment that includes oral administration

of medicines is of utmost importance as the administration is very easy and also effective.

Plenty of research works have been carried out in relation to shaman treatment as

directed in Ayurveda and their therapeutic effect is proved. Many more herbal combinations

are described on Ayurveda, and therapeutic effect in is yet to be explored.

Ardhedashemaniya Swasaharavati is one such herbal combination, includes the shati,

puskaramula, bhumyamalaki, amlavetasa and tulasi. Which were taken from Dashemaneeya

Swasahara gana of Charaka Samhita in Shadvirechanashatasritadhyaya 24.


6

The efficacy of Dhashemaneeya Swasahara dravyas are still to be proved by modern

research methods. By looking at the individual herbal constituents, (easy availability in the

market cost effective all the drugs which suit for disintegration of pathology of TS) it

appears that this combination should be very effective in combating the attack of Tamaka

Swasa.

Therefore the present work is planned to evaluation and efficacy of

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa (bronchial asthma)

REVIEW OF PREVIOUS WORKS:

1. 1962, Haridra Vigyanam - Action of Haridra on Tamaka Shwasa and Eosinophilia -

Singh Rajpal, G.A.U., Jamnagar

2. 1971, Dhatoor Multwaka Swarasa Bhavita Kajjali on Tamaka Shwasa Roga - Patel

K. K., G.A.U., Jamnagar

3. 1974, Arkapatri Swarasa Bhavita Rasasindoor in Tamaka Shwasa - Somanandon G.

G.A.U., Jamnagar

4. 1976, Bharangi Nagarayoh Kalkam Tamakae - Sharma D. P. G.A.U., Jamnagar

5. 1979, Study of effect of Shwasahar Kwath during acute attack of Tamaka Shwasa

and Dipaniya Kwatha during interval of attack.- Mehata P. S. G.A.U., Jamnagar

6. 1981, Tamaka Shwasa Men Bharangiguda Ki Karmukata –Sharma C. B., N. I. A.

7. 1982, Tamaka Shwasa Ki Shastrokta Chikitsa - Pathade C. N. G.A.U., Jamnagar

8. 1983, A comparative study of Bhumyamalaki and Kapittha in the management of

Tamaka Shwasa - Thaker L. V. G.A.U., Jamnagar

9. 1984 - A study of Dhumapana with its clinical evaluation on tamaka shwasa” - by

Dr.Hariprakash. H.


7

10. 1984, Studies on the Samprapti of Tamaka Shwasaroga and its management with

Katuki Vati and Gojihvadighanavati - Tamboli P. K. G.A.U., Jamnagar

11. 1985, A Clinical study on the systemic effect of Vamana Karma W.S.R. to Tamaka

Shwasa - Kabra P. R. G.A.U., Jamnagar

12. 1986, Astasanskarita Evam Samanya Shodhita Parada Se Nirmita Shwasakuthara

Rasa Ka Tamaka Shwasa Roga Par Tulanatmaka Adhyayana. - Modh K. G. G.A.U.,

Jamnagar

13. 1987, Clinical management of Tamaka Shwasa with reference to it's attack -

Singhald A. K. G.A.U., Jamnagar

14. 1988, Comparative study of media in the preparation of Tamra Bhasma W.S.R. to

Tamaka Shwasa. - Vododkar D. S. G.A.U., Jamnagar

15. 1988, Studies on Mutrala Dravya W.S.R. to Tamaka Shwasa - Chara R. K. G.A.U.,

Jamnagar

16. 1989, A Critical study on Shati W.S.R. to Tamaka Shwasa - Suthar R. D. G.A.U.,

Jamnagar

17. 1991, Role of Virechana and Rasayana in the prevention and cure of Tamaka

Shwasa - Modh K. G. G.A.U., Jamnagar

18. 1993 - Study on Tamaka Shwasa - by Dr. Saraswati. H.

19. 1994, A clinical study of Ginger and Guda in the management of Nija Swayathu

and Tamaka Shwasa - Shah V. V. G.A.U., Jamnagar

20. 1995, A clinical study on standardization of Vamana Karma W.S.R. to its

effect on respiratory function tests in the patients of Tamaka Shwasa -

Patnayaka Krishna. G.A.U., Jamnagar


8

21. 1995-Tamaka Swasa with Gouripashana - by Dr. Jayaraj. R.

22. 1998 - The role of Rasayana in tamaka shwasa with special reference to the effect of

Bharangiharitaki avalehya - by Dr. Ashok. M. Iti. .

23. 1999 - A study on the role of upavasa in the management of tamaka Swasa by Dr. K.

Ajithanarthindra

24. 2000- Evaluate the efficacy of Manashiladi dhoomayoga on tamaka shwasa by

Dr.Prasanna. N. Mogasale

25. 2001, A comparative and pharmaco-clinical study of vasarishta and vasakasava in

the management of Shwasa, Dr. Kulkarni Shailaja.

26. 2001, A Comprehensive study of Katphala (Myrica esculenta Buch - Ham.) with special

reference to Tamaka shwasa - Jaram Singh G.A.U., Jamnagar

27. 2001 - The Evaluation of the effect of Padmapatradi yoga in Tamaka Swasa,

R.D.Suresh. RGUHS, Bangalore

28. 2002, A comprehensive study of Plant Acalypha indica. Linn. And efficacy in

Tamaka Shwasa - Asmita Shinde. G.A.U., Jamnagar

29. 2002, Clinical Study on the effect of Pippalyavaleha and Virecana karma in the

Management of Tamaka Shwasa - Sangeetha G.A.U., Jamnagar


9

Chapter – 2

Objectives of Study

The present study intended to focus on the disease evaluation i.e., Tamaka Swasa

vis-à-vis. Bronchial asthma and the management with Ardhedashemaniya Swasaharavati

used as a shamanaoushadi.

The Dashemaniya Swasahara gana is mentioned in shadvirechana shatasritadhya

of Charaka Samhita Sutrasthana. Among ten drugs we have selected five drugs, which

are prepared into choorna form then subjected to same dravya kwath bhavana three times,

finally made it in vati which weighing about 500 mg for this vati we named it as

Ardhedashemaniya Swasaharavati. Hypothetically this has the best therapeutic efficacy

on the Tamaka Swasa vis-à-vis bronchial asthma.

In this regard the objectives proposed in the study are discussed under the

headings.

1) To assess the effect of selected Ardhedashemaniya compound in Tamaka Swasa

The condition Tamaka Swasa characterized by recurrent attacks of Swasa

kricchrata, and ghurgurakatwa along with other symptoms like –

1. Kasa (cough)

2. Duhkhena Kapha nissaranam (Expectoration)

3. Peenasa (Coryza)

4. Kruchrena bhasate (Dysphonoea)

5. Kantodhwamsham (Hoarseness of voice)

6. Greevashirasangraha (Headache & Stiffness)

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives

10

7. Urah Peeda (Chest Pain)

8. Shayane Swasa peedita (Discomfort at supine), etc.

Tamaka Swasa and its management through various methods are possible viz.

Ahhyanga Swedana, Virechana, Vamana, Dhoomapana, Shamana, Kapha nissarana,

srotomardavatu, Vata kaphahar Kapha vilayana, kasagnee, bruhamana effects will be

very effective in combating the Tamaka Swasa. Considering the same the

Ardhedashemaniya compound having almost all of these therapeutic effects is opted for

this study.

Administrating of Ardhedashemaniya compound in this disease may be helpful as

Shodhana and Shamana types of effect, which supports the Shodhana and Shamana

principles of treatment of Tamaka Swasa. As the disease is episodic therefore, distinct

planning of the treatment is required during the attack and in between the attacks.

Liquefaction and elimination of sleshma sheet anchor of the treatment. There by thus

removes the obstructing (Snehana Swedana followed dhomapana) shleshma from the

Pranavaha Srotas, and allowing the free movement of Pranavata.

This gives relief in the symptoms of Swasa kricchrata, preventing the attacks

removing the khavaigunyata and improving the resistance of the disease.

So, the Ardhedashemaniya compound comprises the Vata Kapha pacification

effect in nature and by which it reduces the recurrent attacks of breathlessness, and

wheezing and features and its duration along with frequency and nature of the disease.

The effect of Ardhedashemaniya compound in Tamaka Swasa is evaluated by

means of studying the subjective parameters such as Swasa kricchrata, and Ghrgurukatwa


11

(wheeze) etc., with specified parameters in comparison to that of baseline data to that of

final data.

The understanding of the study from base line data to the final data differences

after the drug administration to the patients those who are included by preset parameters

of exclusion and inclusion criteria.

2) To assess the lung functions (Peak Expiratory Flow Rate) improvement by

Ardhedashemaniya compound in Tamaka Swasa

Tamaka Swasa vis-à-vis bronchial asthma is characterized by spastic contraction

of the smooth muscle on the bronchiole, which causes extremely difficult breathing. This

is due to localized edema in the walls of the small bronchioles as well secretion of thick

mucus in to the bronchiolar lumens and spasm of the bronchiolar smooth muscle

therefore air way resistance increases greatly.

The bronchiolar diameter becomes more reduced during expiration than during

inspiration in Tamaka Swasa (Bronchial Asthma) because the increased intrapulmonary

pressure during expiratory effort compresses the out sides of the bronchioles. Because the

bronchioles are already partially occluded, further occlusion resulting from the external

pressure creates especially severe obstruction during expiration. So the Tamaka Swasa

patient usually can inspire quite adequately but has great difficulty expiring.

The functional residual capacity and the residual volume of the lung become

greatly increased during the asthmatic attack because of the difficulty in expiring air from

the lungs.

The clinical measurements show great reduced maximum expiratory rate and

timed expiratory volume. So in this study the lung function assessment is recorded with


12

the help of Peak Expiratory Flow Rate. The readings are taken before the administration

of the drug and every 15 days once, after the treatment schedule and follow up.

The Peak Expiratory Flow Rate or a lung function test is done to document the

severity of air flow obstruction and to establish bronchodilator responsiveness. The

measurement of Peak Expiratory Flow Rate is useful for monitoring and assessing

variations in lung function and providing information about allergies and environmental

factors or asthma triggers.

The drug Ardhedashemaniya compound hypothetically stated that it improves the

lung function, because the individual drugs of Ardhedashemaniya are having anti

inflammatory. Bronchodilator, expectorant, anti histamine, anti viral, etc., properties

there by disintegrates the pathology of Tamaka Swasa.

By these actions the drug which reduces the functional residual capacity and

residual volume of the lung and improves the expiratory effort all these should be

assessed by Peak Expiratory Flow Rate.

This can be understood that when using Peak Expiratory Flow Rate measurement

(lung function assessment) to judge response to treatment or severity of exacerbation. It is

useful to compare the measurement to patient base line. This base line is usually regarded

as the norm or personal (Best Peak Expiratory Flow Rate) for the individual patient.


13

Chapter -3

Literary review Most of the times Tamaka Swasa (asthma) guidelines of recommendations and

assessing Swasa complications with their control according to a series of criteria based on

symptoms and pulmonary function is difficult. Swasa treatment should aim at minimizing

Tamaka Swasa symptoms, rescue bronchodilator needs, and exacerbations, while optimizing

pulmonary function. Many methods for assessing airway inflammation non-invasively have

been developed, but they are not currently integrated into the assessment of asthma control

globally. Studies or surveys on asthma generally use an "all or none" approach or a strictly

qualitative evaluation of asthma control, without specific quantification of its magnitude or

degree compared with optimal goals. Other means of assessing these parameters include

evaluating or scoring each separate component of asthma control and comparing the effects

of treatment or interventions on these specific parameters.

In current practice of Ayurveda, however, both patients and physicians assess Swasa

control globally, although there is no simple, practical method for truly quantifying it. This

may contribute to an overestimate of the adequacy of asthma control by the Ayurvedic

physician, and even more so by the patient, and may consequently contribute to the poor

asthma control observed in the asthmatic population.

Quantification of control with tools such as the validated questionnaire developed by

researchers has been welcomed, providing a most interesting way to assess asthma control.

However, busy clinicians may not have the time or personnel required for administering such

questionnaires, and the scoring system used may not necessarily be meaningful to the

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review

14

practitioner and the patient. But for a researcher amount of literature and derived questions,

through understanding of Samprapti (pathogenesis) is valuable for the further scopes of

development in the field.

HISTORICAL REVIEW

PREVEDIC AND VEDIC PERIOD:

The available literatures of Pre-vedic and Vedic period reveal that the physiology of

respiration, the role of Prana in respiration, the concept of Apanavata are mentioned at a

number of occasions. Akin to the present understanding in Rigveda, the word Prana is coined

to describe the act of respiration. Some of the references like Pranadvayu jayate 25,

ayumapranaha 26 reveal the same. In Yajurveda also, the process of respiration, the act of

inspiration, the effort of expiration and involvement of Prana Vayu in respiration are

elaborated. Few to mention here are - vatam pranena nasike 27 pranasya apyathatvam 28.

Further, in Atharvaveda, the word Matarishwa is coined to denote the Pranavayu. The

concept of respiration and the role of Pranavayu in respiration is also clearly described in the

last treatise among the Vedas. vatoprana ucyata 29- this is one of the lines from the

Atharvaveda revealing the Prana Vayu and the concept of respiration.

UPANISHATH KALA:

The act of inspiration and expiration is mentioned as the prime physical sign of life in

Amanaskopanishath. Further, the opinion of absence of respiration suggesting the death is

also described. The line from this Upanishad goes like this - svasocchvasatmaka prana 30 and

avasocchusa hinastu niscitam muktaevasaha

In Brhadaranyakopanishath the Prana is referred by the names Angirasa and Ayusya.

The function of controlling the body mechanisms are attributed to Prana Vayu in this book.


15

In the Chandogyopanishath, the Prana has been named as Angeera and Brhaspati. The role of

Prana in nourishing the body is elaborated here 31.

The diseased conditions of Pranavaha srotas that includes Hikka, Shwasa and Kasa

are described and the role of deranged Vata in its causation is explained in Yoga

Chudamanyam.

The organ of respiration is compared to the bird Crane; the two wings of the bird

representing the organ of respiration, the trunk indicating the heart, and the neck of the bird

symbolically expressing the wind pipe are discussed in detail in Hamsopanishath.

SAMHITA PERIOD:

Charaka Samhita: The detailed description of Swasa and its five varieties are found in

17th chapter of Chikitsa. The elaborate explanation of etiological factors,

pathogenesis, premonitory symptoms, clinical manifestations as well as complete

radical treatment of Swasa is given here. Pratamaka and Santamaka Swasa, the

variant forms of Tamaka Swasa are also described in Charaka Samhita 32.

Susruta Samhita: The whole description of Swasa roga, its types and the treatment is

available in Susruta Samhita 33.

Bhela Samhita: Swasa as a symptom is mentioned in Bhela Samhita. In the form of

complication of many disorders Shwasa is described in this treatise 34.

Harita Samhita: Etiopathogenesis, line of treatment and dietetics of Kasa Roga are

described at full length in Harita Samhita. The relevant descriptions are available in

the 12th chapter of third Sthana of this work; where in Swasa is not available 35.

Kasyapa Samhita: In Khila Sthana, the brief description of Swasa Roga with its

treatment is described along with Kasa Roga 36.


16

Ashtanga Hridaya and Ashtanga Sangraha: In both Nidana Sthana and Chikitsa

Sthana the relevant description of Swasa Roga is available in these books 37.

Madhava Nidana: 12th chapter deals with the diagnostic aspect of the Swasa Roga in

this book of Madhava Nidana 38.

MEDIEVAL PERIOD:

Chakradatta: Chakrapanidatta’s description of Swasa Roga available in this book is in

accordance with the Brihatrayi. His treatise describes Swasa Chikitsa in the 12th

chapter along with Hikka Roga 39.

Arunadatta: Arunadutta commentator, in his commentary titled Sarvangasundara on

Ashtanga Hridaya, Arunadatta has mentioned the etiological factors of Swasa and has

opined the predominant involvement of Kapha Dosha in the etiopathogenesis of

Swasa Roga 40.

Kalyanakaraka: The description of herbo-mineral combinations that may be

prescribed in patients suffering from Swasa Roga is unique in this text book.

Ayurvedarasayana: Indu discuss the aggravated Kapha as the cause of Swasa.

Bhavaprakasha and Yogaratnakara: Both these works describe the Swasa Roga at full

length and this is in accordance with the description available in Brihatrayi 41, 42.

Nirukti of Tamaka Swasa

The word Tamaka Swasa (TS) is composed of two words. They are Tamaka and

Swasa.

The word ‘Tamaka’ is derived from the dhatu (root) “Tamaka glanu” with “Kwip”

pratyaya. It means; to choke, darkness, be suffocated 43. It is also defined as “Tamyati


17

iti Tamaka”- “tama eva Tamaka” in Shabdakalpadruma, which means dark curtains

i.e. ‘tama’ occurs, in Tamaka Swasa 44.

The word ‘Swasa’ is derived from the dhatu “Swas” with “gahs” pratyaya. It means

to breathe 45

The word Tamaka Swasa means difficulty in breathing; which occurs mainly during

night hours.

Tamaka Swasa vis-à-vis Bronchial Asthma is a condition of the lungs in which there

is widespread narrowing of airways, varying over short periods of time either

spontaneously or as a result of treatment, due in varying degrees to contraction

(spasm) of smooth muscle, edema of the mucosa, and mucus in the lumen of the

bronchi and bronchioles; these changes are caused by the local release of spasmogens

and vasoactive substances (e.g., histamine, or certain leukotrienes or prostaglandins)

in the course of an allergic process 46.

Paribhasha of Tamaka Swasa

The attack of Swasa with tamapravesha which occurs specially during durdina

is called as Tamaka Swasa. i.e. “Visheshyaddurdine tammyethi Swasa ha sa

tamako mataha” 47.

Vijayarakshita the commentator of Madhavanidana explained as “Swasastu

bastrikadmana samavatordwa gamitha”. I.e. sounds similar to the sound of

bellow of blacksmith 48.

Dalhana 49 and Chakrapani 50 commented Tamah praveshana which refers to

the darkness or black curtains in front of the eyes.


18

The features or the clinical picture of TS; looks identical with the features of

Bronchial Asthma (BA) and resembles for a greater extent.

Definition

The American thoracic society defined BA as a clinical syndrome characterized by

increased responsiveness of the trachio-bronchial tree to a variety of stimuli, which is

manifested physiologically by generalized airway obstruction which varies in severity over

short periods of time either spontaneously or as a result of treatment 51.

In current medical diagnosis and treatment 1999- Asthma is defined as a chronic

inflammatory disorder of the airway. Airway inflammation contributes to airway hyper

responsiveness, airflow limitation, respiratory symptoms (which include recurrent episodes

of wheeze, breathlessness, chest tightness and cough particularly during the night and early

morning).

The word “asthma” is derived from Greek, which means hard drawn breath or

panting. Asthma is a disease of airways i.e., characterized by increased responsiveness of the

trachea bronchial tree to a multiplicity of stimuli. Asthma is manifested physiologically by a

wide spread narrowing of air-passages, and clinically dysponea, cough and wheezing, it is an

episodic disease. Its prevalence, is a very common disorder and it is estimated that 4-5% of

the world population 52.

Relevant information from Shareera

Respiratory System

The respiratory system is responsible for supplying oxygen to the blood and

expelling waste gases, of which carbon dioxide is the primary constituent, from the body.

The upper structures of the respiratory system are combined with the sensory organs of smell


19

and taste (in the nasal cavity and the mouth) and the digestive system (from the oral cavity to

the pharynx). At the pharynx, the specialized respiratory organs diverge into the airway.

The larynx, or voice box, is located at the head of the trachea, or windpipe. The trachea

extends down to the bronchi which branch off at the tracheal bifurcation to enter the hilus of

the left or right lung. The lungs contain the narrower passageways, or bronchioles, which

carry air to the functional unit of the lungs, the alveoli. There, in the thousands of tiny

alveolar chambers, oxygen is transferred through the membrane of the alveolar walls to the

blood cells in the capillaries within. Likewise, waste gases diffuse out of the blood cells into

the air in the alveoli, to be expelled upon exhalation. The Diaphragm, a large, thin muscle

below the lungs, and the inter-costal and abdominal muscles are responsible for contracting

and expanding the thoracic cavity to effect respiration. The ribs serve as a structural support

for the whole thoracic arrangement, and pleural membranes help provide lubrication for the

respiratory organs so that they are not chafed during respiration.

Figure -1

Upper and Lower Respiratory System


20

Trachea

The trachea, or windpipe, is the upper section of the airway, separated from the

pharynx by the larynx. It is composed of ribbed cartilage which extends about four inches

down to the bronchi of the lungs. Resting flatly against the esophagus, the trachea can

extend slightly during swallowing, breathing, or bending the neck. It is lined with a mucous

layer and cilia which help to filter out dust. The constant action of these cilia carry mucous

and debris upward into the pharynx, where upon it is swallowed. When the upper trachea or

pharynx become blocked so as to cut off the airway, as from swelling of the tissues, a small

incision is made in the throat and into the trachea, in an operation called a tracheotomy,

which allows air to pass into the windpipe.

Figure -2

The Bronchi and Lobules of the Lung
A rdhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 21

Bronchus

The bronchi are the tubes which carry air from the trachea to the inner recesses of the

lungs, where it can transfer oxygen to the blood in small air sacs called alveoli. Two main

bronchi, the right and left bronchus, branch off of the low end of the trachea in what is called

the tracheal bifurcation. One bronchus extends into each of the right and left lung. The

bronchi continue to divide into smaller passageways, called bronchioles, forming a tree-like

network of branches which extends throughout the spongy lung tissue. The exterior of the

bronchi are composed of elastic, cartilaginous fibers and feature annular reinforcements of

smooth muscle tissue. The bronchi are able to expand during inspiration, to allow the lungs

to expand, and contract during expiration as air is exhaled.

Upper Lobe

The right and left lung feature fissures divide the overall structures into smaller

lobes. The left lung (the body's left, the viewer's right) has one horizontal fissure which

divides it into two lobes (upper and lower). The right lung has one horizontal fissure and one

oblique fissure, dividing the right lung into three lobes (upper, middle, and lower). Because

of this third lobe, the right lung is larger than the left, extending further down in the

abdominal cavity. The right and left lung are each enclosed in a pleural sac and are separated

by the mediastinum, a membrane which extends from the vertebral column in back to the

sternum in front.

Middle Lobe





22





sternum in front.

Figure - 3

Gross Anatomy of the Lungs

Ardhedashe
maniya Swasaharavati in the management of Tamaka Swasa – Literary review 23

Lower Lobe








sternum in front.

Alveoli

The alveoli are the tiny sacs at the ends (or "leaves") on the bronchial tree. Each

small bronchiole divides into half a dozen or so alveolar ducts, which are the narrow inlets

into alveolar sacs. Each alveolar duct subdivides, leading into three or more alveolar sacs.

Each large alveolar sac is like a grape cluster which contains ten or more alveoli. Because the

membrane separating the alveolus and the capillary network which carries blood over them is

very thin and semi-permeable, oxygen can transfer from the air into the blood cells within the

capillaries. Likewise, carbon dioxide and other waste gases can transfer out of the blood and

into the air to be exhaled from the lungs. The alveoli are particularly susceptible to infection,

as they provide bacteria and viruses a perfect place to grow. This accounts for the tendency

for a chest cold or other lung problem to advance into pneumonia and pneumonitis, both

potentially dangerous conditions in which the innermost parts of the lungs become infected

and inflamed, diminishing air flow and oxygen transport.


24

Figure - 4

The Bronchi and Lobules of the Lung

FUNCTIONS OF

The respiratory sy

1. Providing

blood.

2. Moving a

3. Protecting

environme

invasion b

4. Producing

5. Providing

superior p

Ard

THE RESPIRATORY SYSTEM

stem has five basic functions:

an extensive area for gas exchange betw

ir to and from the exchange surfaces of the l

respiratory surfaces from dehydration,

ntal variations and defending the respirator

y pathogens.

sounds involved in speaking, singing, and n

olfactory sensations to the CNS from t

ortions of the nasal cavity.

hedashemaniya Swasaharavati in the management o

een the air and the circulating

ungs.

temperature changes, or other

y system and other tissues from

onverbal communication.

he olfactory epithelium in the

f Tamaka Swasa – Literary review 25

In addition, the capillaries of the lungs indirectly assist in the regulation of blood

volume and blood pressure, through the conversion of angiotensin I to angiotensin II 53.

Tamaka Swasa vis-à-vis Asthma

Asthma affects an estimated 3-6 percent of the population. There are several forms of

asthma, but each is characterized by unusually sensitive and irritable conducting

passageways. In many cases, the trigger appears to be an immediate hypersensitivity reaction

to an allergen in the inspired air. Drug reactions, air pollution, chronic respiratory infections,

exercise, or emotional stress can also induce an asthmatic attack in sensitive individuals.

The most obvious and potentially dangerous symptoms include -

(1) The constriction of smooth muscles all along the bronchial tree,

(2) Edema and swelling of the mucosa of the respiratory passageways, and

(3) Accelerated production of mucus.

The combination makes breathing very difficult. Exhalation is affected more than

inhalation; the narrowed passageways often collapse before exhalation is completed.

Although mucus production increases, mucus transport slows, and fluids accumulate along

the passageways. Coughing and wheezing then develop. The broncho-constriction and mucus

production occurs in a few minutes, in response to the release of histamine and

prostaglandins by mast cells. The activated mast cells also release interleukins, leukotrienes,

and platelet-activating factors. As a result, over a period of hours, neutrophils and eosinophils

migrate into the area. The area then becomes inflamed, further reducing airflow and

damaging respiratory tissues. Because the inflammation compounds the problem,

antihistamines alone are often unable to control a severe asthmatic attack.


26

When a severe attack occurs, it reduces the functional capabilities of the respiratory

system. Peripheral tissues gradually become oxygen starved, a condition that can prove fatal.

Asthma fatalities have been increasing in recent years.

Pulmonary Lobules

The connective tissues of the root of each lung extend into the lung's parenchyma.

The fibrous partitions, or trabeculae, contain elastic fibers, smooth muscles, and lymphatic

vessels. The trabeculae branch repeatedly, dividing the lobes into ever smaller compartments.

The branches of the conducting passageways, pulmonary vessels, and nerves of the lungs

follow these trabeculae.

The finest partitions or interlobular septa (septum, a wall) divide the lung into

pulmonary lobules, each supplied by branches of the pulmonary arteries, pulmonary veins,

and respiratory passageways. The connective tissues of the septa are in turn continuous with

those of the visceral pleura, the serous membrane covering the lungs.

RESPIRATORY PHYSIOLOGY

The general term respiration refers to two integrated processes: external respiration

and internal respiration. The precise definitions of these terms vary from reference to

reference. In this discussion, external respiration includes all the processes involved in the

exchange of oxygen and carbon dioxide between the interstitial fluids of the body and the

external environment. The goal of external respiration, and the primary function of the

respiratory system, is to meet the respiratory demands of living cells. Internal respiration is

the absorption of oxygen and the release of carbon dioxide by those cells. We shall consider

the biochemical pathways responsible for oxygen consumption and carbon dioxide

generation by mitochondria, often called cellular respiration.


27

Our discussion of respiratory physiology focuses on four integrated steps involved in

external respiration:

1. Pulmonary ventilation, or breathing, which involves the physical movement of air

into and out of the lungs.

2. Gas diffusion across the respiratory membrane between the alveolar air spaces and

the alveolar capillaries.

3. The storage and transport of oxygen and carbon dioxide between the alveolar

capillaries and capillary beds in other tissues.

4. The exchange of dissolved gases between the blood and the interstitial fluids.

Abnormalities affecting any one of these steps will ultimately affect the gas

concentrations of the interstitial fluids and thereby cellular activities as well. If the oxygen

content declines, the affected tissues will become oxygen-starved. Hypoxia, or low tissue

oxygen levels, places severe limits on the metabolic activities of the affected area. For

example, the effects of coronary ischemia result from chronic hypoxia affecting cardiac

muscle cells. If the supply of oxygen is cut off completely, the condition of anoxia is results.

Anoxia kills cells very quickly. Much of the damage caused by strokes and heart attacks is

the result of localized anoxia.

Respiratory Reflexes

The activities of the respiratory centers are modified by sensory information from:

1. Chemo-receptors sensitive to the PCO2, pH, and/or PO2 of the blood or CSF.

2. Changes in blood pressure in the aorta or carotid sinuses.

3. Stretch receptors that respond to changes in the volume of the lungs.

4. Irritating physical or chemical stimuli in the nasal cavity, larynx, or bronchial tree.


28

5. Other sensations, including pain, changes in body temperature, and abnormal visceral

sensations.

Information from these receptors alters the pattern of respiration. The induced

changes have been called respiratory reflexes.

Figure – 5

Pressure changes during inhalation and exhalation

Hypercap

Hy

hypercapn

bodies an

blood-bra

ni

p

ia

d

in

a and Hypocapnia

ercapnia is an increase in the PCO2 of arterial blood. The central response to

is triggered by the stimulation of chemo-receptors in the carotid and aortic

reinforced by stimulation of CNS chemo-receptors. Carbon dioxide crosses the

barrier quite rapidly, so a rise in arterial PCO2 almost immediately elevates CSF

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 29

CO2 levels, lowering the pH of the CSF and stimulating the chemoreceptive neurons of the

medulla oblongata.

These receptors stimulate respiratory centers to increase the rate and depth of

respiration. Breathing becomes more rapid, and more air moves into and out of lungs with

each breath. Because more air moves into and out of the alveoli each minute, alveolar

concentrations of carbon dioxide de-cline, accelerating the diffusion of carbon dioxide from

the alveolar capillaries. Thus homeostasis is restored.

If the rate and depth of respiration exceed the demands for oxygen delivery and

carbon dioxide removal, the condition of hyperventilation exists. Hyperventilation will

gradually lead to hypocapnia, an abnormally low PCO2. If the arterial PCO2 drops below

normal levels, chemoreceptor activity decreases and the respiratory rate fall. This situation

continues until the PCO2 returns to normal and homeostasis is restored.

The most common cause of hypercapnia is hypoventilation. In hypoventilation, the

respiratory rate remains abnormally low and is insufficient to meet the demands for normal

oxygen delivery and carbon dioxide removal. Carbon dioxide then accumulates in the blood.

AGING AND THE RESPIRATORY SYSTEM

Many factors interact to reduce the efficiency of the respiratory system in elderly

individuals. Three examples are -

1. As age increases, elastic tissue deteriorates throughout the body. This deterioration

reduces the compliance of the lungs, lowering the vital capacity.

2. Chest movements are restricted by arthritic changes in the rib articulations and by

decreased flexibility at the costal cartilages. The stiffening and reduction in chest


30

movement effectively limit the respiratory minute volume. This restriction contributes

to the reduction in exercise performance and capabilities with increasing age.

3. Some degree of emphysema is normally found in individuals over age 50. However,

the extent varies widely with the lifetime exposure to cigarette smoke and other

respiratory irritants. The respiratory performance of individuals who have never

smoked with individuals who have smoked for varying periods of time.

After through discussion of the concern organ anatomical and physiological

perceptions it is relevant to understand the Tamaka Swasa vis-à-vis Asthma from the

classical Ayurvedic texts and also of modern parlance 54.

Figure – 6

Ageing and the decline in Respiratory performance

PRANAVAHA SRO

Tamaka Swasa

Physiology of Prana

detail.

Ardheda

T

v

s

AS

is a disease of Pranavaha Srotas. Therefore detailed Anatomy and

aha Srotas (Respiratory system) is essential to study the disease in

hemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 31

Chakrapani had clearly stated that this Srotas is related to a special "Vata" called

“prana 55. Adhamalla, the commentator of Sharangadhara Samhita had also explained that

Pranavata is the Vayu in which the life is located 56. The word "prana" is derived from the

Sanskrit root "An" with a prefix "Pra". "An" means to breathe, to live 57. The word "prana"

of Pranavaha Srotas should not be misunderstood as Pranavata, one of the five subdivisions

of Vata. The act of respiration is one of the functions of Pranavata 58 but the function of

Pranavaha Srotas is only respiration.

According to Charaka, the moola (source or origin) of Pranavaha Srotas is Hridaya and

maha srota 59. (The word Moola here indicates that the organs mentioned as moolas of srotas

are capable of bestowing strength and efficacy or even influences that particular srotas). But

Sushruta considered hridaya and rasavahini dhamanis as the moola 60. A patantara was

mentioned in the Nirnayasagar press of Susruta Samhita as "Pranavahini dhanianya" instead

of "rasavahini dhamanis".

Here the word "Hridaya" requires explanations. This word is derived from three

Sanskrit roots "Hri", "Da" and "ya", which respectively mean Harana, Dana and Ayana.

These three words respectively mean receipt, giving away and moving for the continuous

activity to execute the two earlier functions. The word 'Ayana" indicates path, way or

through which movement of materials takes place. Therefore it is evident that the

designation "hridaya" denotes only the functional aspect of an organ but not its anatomical

location. The anatomical identity can be decided only on the basis of the substance / material

conveyed by it.

In the light of the above-mentioned definition and other explanations, there are certain

organs, which can qualify for the designation of "Hridaya' of these, three are important.


32

1. Pupphusam or a lung, which takes in and gives out the air by continuously

functioning/ moving for the vital respiratory act.

2. Hridaya (or thoracic heart), which receives and ejects the blood (Rasa- Rakta

complex) by continuous contractions and relaxations for the maintenance of the

circulation to perform the preenana and jeevana kriyas to the body tissues.

3. The manas or mind, located in the Mastishka, receiving the information about the

indriyarthas from the sense organs and giving out the instructions of the Buddhi

regarding the requisite action to the karmendriyas or other musculature. This

action of the Manas correlate, the functions of the cognitive and connective

organs.

These are the other organs that qualify to be designated as "Hridaya". But the

anatomical identification is mainly based on the substance dealt by that organ. Based on the

explanation of Chakrapani that the pranavaha Srotas 61 is concerned with the visishta vayu

known as Prana, the puppusha have to be accepted as the moola of these srotases. The word

"Mahasrotas", which according to Charaka is one of the two moolas of pranavahasrotases,

indicates that it is a large tube and large in diameter.

As the "Pranavata” is a corporeal substance, the mahasrotas should be a patent

structure (but not Koshta). Therefore the mahasrotas associated with pupphusa (lungs) is the

trachea, its two branches, bronchi and their further branching into bronchioles to the alveoli.

All these structures participate in the act of respiration (the movement of the visishta Vata).

Charaka seems to indicate what Sharangadhara opined is that only the external respiration

comprising of inspiration and expiration with the absorption of visishta Prana vayu (oxygen)

and removal of the carbon dioxide from the body as a whole 62.


33

The internal or tissue respiration consisting of the gaseous exchange between the cells

and their fluid medium is equally important for the jeevanakriya. Susruta seemed to have

indicated this aspect by stating that the Hridaya (in this context, the thoracic heart) and

Rasavahini dhamanis are the moolas of the Pranavaha srotases. These two moolas require

some explanation.

Nidana Panchaka of Tamaka Swasa

An attempt has been made to review the Nidana panchaka of Tamaka Swasa, those

are Nidana, Samprapti, poorvaroopa, roopa, upashaya, and Chikitsa from various classical

texts and contemporary explanation regarding the (Asthma) aetiology, pathophysiology of

the Bronchial Asthma (Tamaka Swasa) also be reviewed from various texts and recent

journals website for better understand the disease aspect as well as treatment aspect of the

Tamaka Swasa.

Nidana of Tamaka Swasa

The disease of Tamaka Swasa has its own etiological factors and Nidanottara karanas

Charaka has claimed. A single etiological factor may produce a single disease or many

etiological factors may produce the single disease 63 contemporary sciences also reveals the

bronchial asthma is heterogeneous disease 64. Various Authors of Ayurvedic texts 65 to 69 have

been mentioned the general etiological factors of the Swasa which are also considered for the

Tamaka Swasa. But aggravating factors like meghambu(rainy season) sheeta sthana(cold

place) and preceding factors like peenasa (common cold) kasa(cough) are clearly explained

in the pathology of Tamaka Swasa 70, 71. Nidana (etiological factors) are classified into

mainly two groups 72. The general etiological factors of Swasa roga also divide into two

categories, viz. – Bahya and Abhyantara.


34

Bahya karana like raja sevena vayu sevana, (acharajanya) karana considered as

aharajanya. Abhyantara Karana are also responsible for the cause of Swasa such as – Ama

Dosha, Vibandha, Rooksha bhojana, etc.

Chakrapani has classified Nidana of Swasa under three categories 73.

1. Vataprokopaku gana - The Aetiological factors which vitiate the Vata Dosha are

grouped ex.-raja sevana dhumapana

2. Kapha prokopaka gana - The Aetiological factors which vitiate the Kapha Dosha are

grouped ex-nishpava, mash

3. Agnimandhya karaka and Ama utpadaka Nidana are also grouped. Agnimadyakara

nidanas are for diminish the Agni there by Ama takes place. The most of the disease

are due to Ama dosha only i.e. amay. Ex-Ama ksheer Jalaja Mamsa 74.

Other classification has been made fewer than four headings 75, Ahara sambandi, Vihara

sambandi, Nidanarthakara and Agantu sambani.

1. Ahara sambandi nidanas – in this category the etiological factors related to food, drinks

are grouped. Example: sheeta jala sevan, sheeta ashana (intake of cold foods) etc 76.

2. Vihara sambandi nidanas – in this category the etiological factors like external activities

of person exposed to vayu sevan, shetasthan are grouped.

3. Nidanarthakara (avastha sambhandhi) – the different physiological and pathological

conditions which play a very important role in manifestation of Tamaka Swasa. Ex-

pandu, kasa, atisara, pratisyaya jwara etc 77.

4. Agantu nidanas – in this classification injuries and trauma related factors are mentioned

ex-marmaghata, like stanarohita 78, stanamoola apasthamba, Sirama –vishalyagna 79

marma.


35

Like wise again grouped under three headings –

1) Asatmendriyartha samyoga, 2) Parinama and 3) Prajnaparadha

ASATMENDRIYARTHA SAMYOGA

In Tamaka Swasa asatmendriyartha plays an important role in the causation of

Tamaka Swasa. Mainly Ghranendriya, Rasanendriya and Sparsanendriya and their samyoga

with Asatmyaartha will precipitate Tamaka Swasa immediately. Affect of allergy and atopy

has discussed in modern science as Aetiological factors. Nidana of Tamaka Swasa like raja,

dhuma sevana, anoopa mamsa sevana may be considered in this category.

PRAJNAPARADHA

Either conscious or unconscious indulgence in harmful activities causes disease.

These prajnaparadha like atimaithun, atyadhika padayatra, adhika vyayam will cause Tamaka

Swasa.

PARINAMA

Parinama means the effect of climatic condition. This is very well observed that

paroxysmal attacks of Tamaka Swasa during specific time and season. Example: night,

winter season, cloudy climate and rainy season.

Table No: 1 Showing Nidana of Swasa / Tamaka Swasa

Factors CS 80 SS 81 AH 82 AS 83 MN 84

Vata-Prakopa Ahara Rukshanna - Ununctuous food + + - - + Visamashana - Irregular food habit + + - - + Adhyashana - Habit of eating frequently - + - - - Anasana - Observation of fast for long - + - - + Dvandvatiyoga - Mutually contradicting foods

+ - - - -

Sheetashana - Cold foods - + - - + Visha – Poison + + - - + Sheetapana - Cold drinks - + - - +


36

Pitta-Prakopa Ahara Tilataila - Gingely oil + - - - - Vidahi - Food causing burning sensation + + - - + Katu -Spicy food - - - + - Usna - Hot food - - - + - Amla - Sour - - + - - Lavana - Salt - - + + -

Kapha-Prakopa Ahara Nispava - Dolichos lablab + - - - - Masa - Vigna radiatus + - - - - Pistanna – Pastries + - - - - Saluka - Rhizome of lotus + - - - - Guru dravyas - Heavy food + + - - + Jalajamamsa - Meat of aquatic animals + - - - - Anupa mamsa - Meat of marshy animals + - - - - Dadhi – Curds + - - - - Amaksira - Unboiled milk + - - - - Utkleda - Kaphakara food + + - - + Vistambhi + + - - +

Vata-Prakopa Vihara Rajas - Dust / Pollen + + + + + Dhuma - Smoke + + + + + Vata - Cold breeze + + + + + Sheeta Sthana - Cold places + + - - + Sheeta ambu - Cold water + + + + + Ativyayama - Excessive exercises + + - - + Gramya dharma - Excessive sexual intercourses

+ - - - +

Apatarpana - Emaciating techniques + - + - + Shuddhi Atiyoga - Excessive purification + + - - + Kantha/Urah pratighata - Injury to throat/chest

+ - - - +

Bharakarshita - Emaciation due to lifting heavy weights

+ + - - +

Adhwahata - Excessive walking + + - - + Karmahata - Excessive-work + + - - + Veganirodha - Suppression of urges - - - + - Abhighata - Injury - + + + - Marmabhighata–Injury to vital structures + - - - +

Pitta-Prakopa Vihara Usna – Hot - - - + -


37

Kapha -Prakopa Vihara Abhishyandi Upacara - Administration of substances which obstruct the channels

+ - - - +

Divasvapna - Day sleeping - - - - -

Vataja-Vyadhi / Avastha Sambandhi Nidana

Anaha + - - - -

Dourbalya + - - - -

Atisara + - - - +

Kshaya - + - - -

Ksataksaya + - - - -

Udavarta + - - - -

Visucika + - - - -

Panduroga + + + + -

Visa Sevana + + + + -

Vibandha + - - - -

Pittaja Vyadhi / Avastha Sambandhi Nidana

Rakta pitta + - - - -

Jwara + - - - +

Kaphaja Vyadhi / Avastha Sambandhi Nidana

Kasa - - + + -

Amapradosa - + - - -

Chardi + - + + -

Pratisyaya + - - - -

Amatisara - - + + -

Aetiology of Asthma

Aetiological factors of asthma are of two types. Some factors called inducing factors

can set initial development of asthma, whereas some other factors provoke an episode in

predisposed individuals suffering from asthma and these are called provoking or trigger

factors 85.


38

1) INDUCING FACTORS

Genetic factors are important to determine why asthma occurs in a particular

individual. Asthma occurs more commonly in relatives of atopic individuals and therefore

atopy has been recognized as an important risk factor for developing asthma. A distinct gene

for atopy on chromosome 11q has been identified 86. The frequent clinical observation that

asthma runs in families has been supported by many more formal investigations 87.

The genetics of production of total serum IgE have studied. In such studies

consideration has to be given to the following factors since each has been shown to effect of

IgE levels allergic exposure, parasitic infection age, gender, and smoking. A correlation was

found between the total serum IgE of parents and children, suggesting the involvement of

one or more genes. However agreement on the model of inheritance blocking linkage of loci

for total serum IgE and BHx to chromosome has been reported 88. A gene for IgE response

with maternal inheritance was identified at chromosome. High level of IgE in cord blood

appears to be strong indicator of subsequent development of atopic disease 89. Further it is

likely that different genes and different environmental factors contribute to asthma in

different populations. The chromosome 5 contains a 1l-4 gene cluster, which is closely linked

inheritance of an increased IgE response and to increased bronchial asthma 90.

2) PROVOKING FACTORS

a) Atopy and allergy

The association between asthma and allergy has long been recognized. It has been

reported that 75 to 85 percent of patients with asthma have positive immediate skin reactions

to common inhalant allergens. There are at least 6 major evidences to prove that asthma is

due to exposure to allergens.


39

1. Most people with asthma are atopic, which can be measured by skin tests or with

measurements of specific IgE.

2. Challenge with allergens in atopic asthmatics increases the severity of the disease.

3. Occupational asthma is known to be caused by allergens and sensitisers

4. It has been shown that subjects with apparently intrinsic asthma have higher levels of

circulating IgE than the non-asthmatic population.

5. Improvement in the symptomatology occurs on allergen withdrawal which proves the

causal relationship between the two.

6. Population studies have clearly demonstrated association between atopy and asthma 91.

Taken together these facts are strong evidence for the role of atopy in asthma. The

most important are house dust mites, grass pollens, animal proteins, and moulds. Danders

from these animals like dog, cats, horses, and other pet animals contribute greatly to the

allergenic components of house dust 92.

b) Food and drinks

Atopic asthmatics may occasionally notice that their symptoms are provoked by certain

foods or drinks. The foods most frequently suspected are milk, eggs, fish, cereals, nuts and

chocolates, but very many others have been described 93. Indians are reported to be more

sensitive and broncho-constrict to Ice and cola drinks 94. Food preservatives also provokes

attacks of asthma, such as benzoates, sodium nitrate and sodium metabisulphite, anti-

oxidants, the yellow food colorings agents such as tartrazine 95.

Food allergies are common triggers for asthma and their symptoms are provoked by

certain foods. The allergens are compared with asatmya sevana in Ayurveda. These factors


40

are discussed under Asatmendriyartha samyoga Nidana. Our Acharya's have mentioned

dhuma, raja, jalaja and anoopa mamsa sevena etc are inducing asthma.

c) Infection

The observations have suggested that viral infections may be intimately involved in the

development of asthma. The viral respiratory illnesses may produce their effect by causing

epithelial damage, producing specific immunoglobulin IgE antibodies directed against

respiratory viral antigens and enhancing mediator release. Interestingly in recent years, it is

also observed that some infections are protective of bronchial asthma. Viral or bacterial

infections during the first three years of life may serve a protective function against the

development of allergic disease. Multiple Infections occur during the first few years of life,

high concentrations of these Th 1 Cytokines could inhibit the release of Th 2 Cytokines, there

by turning the mucosal immune response away from allergen sensitization 96. The viruses

usually responsible are influenza, rhinovirus, and respiratory syncytial virus, together with

bacterium Mycoplasma pneumonia 97. The role of infections in causation of Tamaka swasa is

not mentioned but effects of viral infections like kasa, prathishyaya, jwara have mentioned as

Nidana of Tamaka Swasa are also included in Nidanarthakara roga Karanas 98.

d) Drug 99

About 5 to 20 percent of adults with asthma will experience severe and even fatal

exacerbations of broncho-constriction after ingestion of aspirin or NSAIDS. Although the

exact mechanism is not known, it is non-immunologic and probably depends on inhibition of

cyclooxygenase. Other drugs include beta-blocker drugs; eye drop preparations of this class

like nadolol drugs can also induce asthma. Recently inhaled verapamil, a calcium channel

blocker has been reported to induce severe bronchospasm in mild asthma.


41

e) Exercise

Exercise induced asthma" is often used to describe the asthma of persons in whom

exercise is the predominant or even the only identified trigger to air flow obstruction.

Exercise induced broncho-constriction is one manifestation of the asthmatic diathesis;

untreated EIA can limit and disrupt normal life.

Airway narrowing develops within 2 to 3 minutes after cessation of exercise. It

generally reaches its peak about 5 to 10 minutes after cessation of activity and usually

resolves spontaneously in the next 30 to 90 minutes or with bronchodilators 100. A rapid

change to warm, moist air post exercise tends to worsen the development of airflow

obstructions 101.

In contrast to asthma in general, EIA is due to smooth muscle contraction. The key

aspects of the triggering stimulus are the level of ventilation during exercise and the

temperature / water content of the inspired air 102. To reduce / avoid EIA, avoidance of cold /

dry environment is preferable. The role of exercise (Vyayama) is well recognized in

Ayurveda.

f) Occupational factors

With increased industrialization, simple chemicals and organic compounds have been

used more often with a consequent increase in new respiratory hazards, particularly

occupational asthma. Over 250 agents have been recognized to cause occupational asthma

103. Occupations like veterinarians, laboratory workers, formers, processing, pharmaceuticals,

painter, and hospital workers are more prone for occupational asthma 104.

Occupational asthma can be mediated by any of the several mechanisms. They

include, reflex vagal broncho-constriction in response to an irritant effect on specific


42

receptors, inflammatory broncho-constriction secondary to toxic concentration of gases or by

immunologic mechanisms 105. Typically, the symptoms initially occur towards the end of the

working day and in the evening, and are relieved at weekends and on holiday 106.

Some of the aetiological factors mentioned under vihara category can be incorporated

with occupational factors mentioned by modern literature. They are sheetastana,

bharavahanam, adhwagamana, etc.

g) Rhinitis & Sinusitis

A possible relation between sinusitis and activation of asthma has been postulated

recently. It is also likely that nasal and sinus pathology can aggravate asthma, particularly if

there is uncontrolled drainage of mucoid or muco-purulent material down the nasopharynx

where it can contribute to cough and irritability of larynx.

It is now being appreciated that allergic rhinitis and bronchial asthma are considered

as one air way, and one disease 107. It is estimated that 60 to 70 percent of patients who have

asthma have also co-existing allergic rhinitis. Traditional therapies originally indicated for

allergic rhinitis and asthma are being reassessed to explore their potential utility in both these

condition 108.

These Nidana are well recognized by our Acharyas. They have mentioned Pratishyaya

and Peenasa like rogas. They have predisposing or sometimes accompanying with the

Tamaka Swasa.

h) Gastro-esophageal reflux (GOR) 109, 110

Two separate mechanisms are involved in the gastro-esophageal reflux and asthma

relationship -


43

i) Reflex vagal broncho- constriction occur secondary to stimulation of sensory nerve

fibres in the lower oesophagus. This mechanism is supported by the findings that

acid infusion of the oesophagus in asthmatic patients leads to increased airway

resistance that rapidly reverses with antacids.

ii) The second proposed mechanism is micro-aspiration, a high prevalencerate of

hiatus hernia and gastroesophageal reflux in patients with bronchial asthma

A number of reports are available in medical literature on the relationship between

gastro esophageal reflux and pulmonary disease. In Ayurveda, the disease is being

mentioned as Amashaya (pittastana) samudbhava 111 and findings also support this

explanation.

i) Psychological factors 112

There has been a great deal of controversy regarding the cause and effect relationship

of asthma and psychological factors. Many of patients with asthma acknowledge that

exacerbations are provoked by psychological events, such as shock, excitement,

bereavement, depression. Other psychological problems like recent family loss, disruption,

recent unemployment, and schizophrenia. Occasionally, psychological illness, family

disputes or marital disharmony may be major factors in the aetiology of intractable asthma.

Definite emotional factors are not mentioned in the nidanas of Swasa. But their role in

disease development is well approved by Ayurveda. The above mentioned nidanas mainly

vitiate Vata which has important role in Tamaka Swasa.

j) Pollution 113

Pollution with particulate matter adds to the allergenicity of aeroallergens. Passive

smoking is known to be a risk factor.


44

SAMPRAPTI OF TAMAKA SWASA

Samprapti is a process from Dosha-vaishamya up to the manifestation

of disease Study of Samprapti is very important, because it is mentioned as Samprapti

vighatanameva Chikitsa" i.e., the disintegration of Samprapti completes the treatment 114.

Samprapti explains the complete disease process which starts immediately after Nidana

sevana, by the way the Dosha vitiated and where by vitiating doosya leading to Dosha -

doosya sammurchana, producing a disease. It includes the explanation about the

derangement of Dosha and pathological changes that takes place in the disease process and

also mode of manifestation of clinical features.

SAMANYA SAMPRAPTI

Vata located in the Uras after afflicting the Pranavaha Srotas, get aggravated and

stimulates Kapha which is located in uras 115.

It is observed that,

1. The Dosha-involved are Vata and Kapha.

2. Srotas involved is Pranavaha Srotas.

3. Vata is the main factor.

Again Samprapti explained as, the disease originate from the Pittastana, and are

caused by simultaneous aggravation of Kapha and Vata. They adversely affect the Hridaya

and all the Rasadi Dhatu. Here the disease originate from Pittastana, here implies Amashaya,

where the disease originate. Both Vata and Kapha simultaneously aggravated. Hrudaya and

rasadi dhatu are also affected in this disease.


45

VISISTA SAMPRAPTI OF SWASA

The visista Samprapti of Tamaka Swasa says, Vata predominantly associated with

Kapha, obstructs the Srotas, the obstructed Vata trying to overcome the obstruction and

moves in all direction, resulting the disease i.e., Swasa 116.

In the above reference in first line the word 'Kapha purvaka' has been used.

Chakrapani says it means 'Kapha pradhana' i.e. predominance of Kapha. Also here Srotas

word being said. The commentator considered the pranavaha and udakavaha srotas

involvements in this disease 117. In second line "vishug vrajati" is being used. For this

Gangadhara opines that "sarva shareera gacchati." Chakrapani says the meaning of this word

is "Sarvata gacchati" i.e., moves in all direction. It is better to considered movement in chest

only 118.

In short it can be summarizes like -

1. Mainly Pranavaha srotas gets obstructed by Kapha, by which Vata

aggravated due to srotosanga. Also vitiation of Udakavaha and

Annavaha Srotas are to be considered.

2. Kapha Dosha is predominant.

3. Vata moves all over the chest resulting in Swasa.

SAMPRAPTI PARTICULARLY RELATED TO TAMAKA SWASA

Vata moving in the reverse direction pervades the Srotas (channel) afflicts the shira and

griva, and stimulates Kapha causes Tamaka Swasa Vyadhi 119.

Vagbhata has mentioned Samprapti of Tamaka Swasa similar to that of Charaka, but he

has directly mentioned the vitiation of Pranavaha, Annavaha and Udhakavaha Srotas 120. The


46

disease originates from Amashaya. Susruta states that the deranged Vata attains 'urdwa gati '

and along with Kapha produces Swasa. It is almost similar to that of Charaka's explanation.

It is more acceptable almost in all cases Pranavaha and Udakavaha Srotas are involved,

but in rare cases involvement of Annavaha Srotas is also seen. The disease originates from

Amashaya, and Annavaha Srotas moola is Amashaya. In all cases in vitiated states the

moola stana's of Srotas are also vitiated.

The udbhava stana Amashaya still needs more explanation. Water loss through

respiration is common, and vitiated Udakavaha Srotas symptoms are appeared in this disease.

Thus the Samprapti of Tamaka Swasa is complex one. It can be summarized as

follows, in first three Kriyakala i.e. Sanchaya, Prakopa and Prasara. The physiological

derangement takes place due to exposure to aetiological factors (Nidana sevana). These

three levels occur in doshic level only. Here the doshic general symptoms appear i.e.

Dosha Sanchaya or Dosha prakopa lakshanas in Tamaka Swasa,

1. Vata prakopa (dushti) occurs due to vatika Nidana sevana

2. Kapha prakopa (dushti) occurs due to Kaphakara Nidana

3. Agnimandya and subsequently Ama utpatti occurs due to

Agnimandyakara Nidana and as sequele to dosha prakopa.

Samprapti explained, indicate that both Vata, Kapha are mainly involved, though

Kapha is predominant in obstruction of Pranavaha Srotas where by causing Vata prakopa.

In later stages the physiological derangements leads to pathological manifestations.

These three Kriyakalas more gravies because Vyadhi vinischaya, Vyadhi lakshanas, Vyadhi

avasta (prognosis) are being done.


47

Stana samshraya in Tamaka Swasa

Here the predromal symptoms of Tamaka Swasa are manifested. In this stage the

doshas which are already aggravated and circulating throughout the body affects the tissues

of pranavaha srotas, where the khavaigunya occurs. This Khavaigunya better understood

with modern science prevalence. Due to stana samshraya of doshas in Pranavaha Srotas gets

obstructed (srotosanga) and Vata moves in all directions.

Vyakta in Tamaka Swasa

The sroto sanga due to Kapha and Ama Dosha in Pranavaha Srotas causes vimarga

gaman of Pranavata; where by the lakshanas of Tamaka Swasa will be manifested.

Bhedavastha in Tamaka Swasa

The pathological process which is already ongoing in a patient reaches this stage if

the patients suffer from long time or uncontrolled disease. In long term permanent

irreversible air flow obstruction takes place in affected Dhatu and Srotas, also affect

srotomoolas, as a result complication arises in this stage.

Obstructive phenomena in Pranavaha Srotas:

By the influence of etiological factors there occurs independent vitiation of Pranavata

as well as Kapha Dosha. The morbid Pranavata, by virtue of its Ruksa, Sita and Khara

qualities tends to harden and narrow the Pranavaha Srotas. This narrowing as well as

hardening hinders the free passage of Pranavata in the Pranavaha Srotas 121. In Charaka

Samhita, this aspect of pathogenesis is explained while dealing with the therapeutics. In this

context it is said that Srotomardava Chikitsa has to be done by way of Snehana and Swedana

to reduce the obstruction 122.


48

Stiffness of the Pranavaha Srotas is not the only cause of obstruction. Quite similar to

the other Srotas, secretion of the Kapha is the natural process. In Tamaka Swasa there occurs

abnormal secretion and accumulation of Kapha in the Pranavaha Srotas obstructing it. This

obstruction prevents smooth and free flow of Prana Vata causing the Prana Vilomata the

prime pathology of Tamaka Swasa. The obstruction and the resultant Prana Vilomata results

in turbulent breathing causing audible wheezing. This is the cardinal symptom of Tamaka

Swasa.

Rapid breathing is another effect of obstruction in the Pranavaha Srotas as opined in

Charaka Samhita. In an adult normal person the rate of respiration is said as 15 per minute. In

patients suffering from Tamaka Swasa this may go up to 40 per minute.

Another effect of obstruction in the Pranavaha Srotas is the Kantha Gurghuraka. The

Sleshma accumulated in the Kantha region obstructing the Pranavayu causes bubbling and

the resultant sound is Kantha Gurghuraka 123.

Samprapti Ghataka's of Tamaka Swasa

Dosha Pranavata, Udanavata,

Avalambhakakapha, Pachakapitta

Dushya Rasa

Agni Jataragni, Rasadhatwagni.

Ama Jataragnijanya and dhatwagnijanya.

Srotas Pranavaha srotas directly, indirectly Udakavaha,

Annavaha and Rasavaha Srotas.

Srotodusti prakara Sanga, vimargagamana.

Udbhava sthana Amasaya (Stomach).

Sanchara Pranavaha srotas.

Adhistana Uras, Pranavaha srotas.

Vyakta sthana Uras (lungs).

Roga marga Abhyantara

Vyadhi swabhava Chirakari (chronic).


49

Physiological Swasa has two components and are named as Praswasa and Niswasa.

The ability of the Swasa may be improved by specific pulmonary exercise. This is popularly

known as Pranayama. The assessment of chest expansion, which is approximately 4 to 5 cm

roughly, expresses the ventilatory capacity. Further the understanding of the Pranayama

gives way to think about the ventilation 124 capacities. The following lines give the

description of the same.

The maximum amount of air that may be inhaled is known as Puraka. This refers to vital

capacity and the spirometric evaluation of FVC quantifies the Puraka. In a normal individual

FVC may reach up to 3000 ml. Inhaled air is then held for a maximum period with no

movement of inhalation and exhalation and this is known as Kumbhaka. This may be easily

quantified by the breath holding time. In a normal adult the average breath holding time is

estimated as 50 to 70 seconds. Further this may be improved by another 20 seconds by

practicing pulmonary exercise.

Further exhaling with maximum force is known as Recaka. The capacity of the

Recaka can be evaluated by the spirometry. By assessing the FVC, FEV1 one can quantify

the Recaka. More over the 40 mm test and the expiratory blast test also quantify the capacity

of Recaka activity 125. Further the distance covered by the exhaling air during Recaka

exercise is told as 12 Angula. And this is appreciated by the movement of insects that come

along the way of exhaling air. The same in the present day is quantified by the Snider’s test.

In Tamaka Swasa, as there is obstruction in the Pranavaha Srotas, there will be

reduction in the ventilatory capacity affecting the Puraka, Kumbhaka and Recaka. Reduction

in these ventilarory capacities can be understood by assessing FVC, FEV1, PEF and FVC /

FEV1.


50

Figure – 7

Schematic representation of Tamaka Swasa Samprapti

NIDANA SEVANA

SANCHAYA AGNIMANDYA DOSHA DUSHTI (Vata & Kapha dusti)

AMARASOTPATTI

PRAKOPA

MALAROOPA KAPHA

PRASARA PARIBHRAMANA PRATILOMAGATI OF VATA

PRANAVAHA SROTOGAMANA

KAPHA makes AVARANA to PRANAVATA STHANA

SANSHRAYA

PRANA try to overcome the AVARANA

VYAKTAVASTHA SWASA (swasavarodha, shwasativriddhi, Ghurghurkam etc.)


51

PATHOPHYSIOLOGY OF BRONCHIAL ASTHMA

The hallmark of the disease is the air flow obstruction. Most of asthma is of allergic

origin. It is viewed as sum of three features,

i.The early asthmatic reaction (EAR)

ii.The late asthmatic reaction (LAR) and

iii.Bronchial hyper-responsiveness, with varying contribution from each.

Three factors narrow airway caliber to limit the flow.

1) Airway smooth muscle contraction

2) Gland and epithelial secretions and exudation into the airway lumen, and

3) Inflammatory oedema and vasodilatation (hyperemia).

EARLY ASTHMATIC REACTION (EAR)

In atopic persons, an early response, this begins at 15 minutes and characterised by

smooth muscle contraction, exudation of plasma, and mucous production.

This reaches its peak in about 30 minutes and resolves within 90 to 180 minutes. This

early reaction is IgE dependent and is the result of IgE binding to the mast cells by its Fc

portion and to specific antigens by its F(ab) portion.This results in the release of preformed

and newly generated mediators.This early responce is being accounted for by the release of

histamine 126.

LATE ASTHMATIC REACTION (LAR) AND BRONCHIAL HYPERREACTIVITY (BHR)

The LAR is also characterized by the release of inflammatory mediators into the same

fluids. However, during this phase there is striking infiltration of inflammatory cells with

activation of these cells which include eosinophils, neutrophils and lymphocytes. This LAR


52

is thought to be a primary mechanism responsible for airway (bronchial hyper

responsiveness.

The BHR is an exaggerated branchocontriction of smooth muscles and airway

narrowing on exposure to small quantity of nonallergic stimulant that usually does not

provoke such a reaction in normal subjects. The BAL fluid from these subjects contains

increased eosinophils, eosinophilic cationic protein, CD4+ T lymphocytes, macrophages,

monocytes, basophils and neutrophils. Mucosal oedema and vasodilatation are the important

components of airway obstruction during the LAR.

Bronchial asthma is now established as an inflammatory disease of the airways

associated with inflammatory cell infiltration, epithelial damage, and sub epithelial fibrosis.

Presence of increased number of eosinophils in the sputum and peripheral blood of patients

with bronchial asthma has been known for many years. It is also reported subsequently that

eosinophils and mast cells increase quantitatively during exacerbations of asthma 127.

INFLAMMATORY CELLS IN ASTHMA

MAST CELLS

Normal human respiratory tract contains large numbers of mast cells beneath the

bronchial epithelium and alveolar walls. Increased numbers of mast cells and histamine (a

product of mast cells) have been found in broncho-alveolar lavage fluid obtained from the

patients with bronchial asthma. These cells are derived from CD3 4-+ positive cells in the

bone marrow. A large number of biologically active molecules, both preformed i.e.,

histamine, proteases and newly synthesized are released from the mast cell-during the

allergic reaction when its high affinity, IgE receptors are cross-linked with antigen. All mast

cells have secretary granules that contain large amounts of histamine, proteoglycans, heparin,


53

and protease's. These preformed substances are exocytosed from the cell after immunologic

activation. The mast cells play an important role in the development of LAR in addition to

its primary role in EAR.

EOSINOPHILS 128

Eosinophils development is dependent on T-cell function. The IL-5 specifically

stimulates eosinophil differentiation. They have receptors for IgG, IgA and IgE on their cell

surface. These cells are able to produce many mediators that are responsible for the

disordered airway function characteristic of asthma. These substances includes, Platelet

activating factor, LTB4, LTC4, PGE2,15-HETE, Oxygen radicals, four cytotoxic proteins

MBP,ECP,EPO, EDN.

All these mediators are released by activated eosinophils. The release of these mediators

results in bronchoconstriction, epithelial damage and recruitment and priming of other

inflammatory cells. Another molecule present in the eosinophils is the CharcotLeydon

crystal protein that possesses lysophospholipase activity.

LYMPHOCYTES 129

The production of IgE by B lymphocytes, there are a number of evidences to prove

that these cells play important roles in this disease.

i. T lymphocytes secrete lymphokines, IL-4, and interferon -y that closely regulate IgE

ii. production by B lymphocytes, while IL-4 stimulates, inter feron-7 inhibits lgE

synthesis,

iii. T Cells are attracted to the bronchial mucosal surface to the site of inflammation by

specific receptors both on themselves and on the mucosal capillary and endothelial

venules.


54

MONOCYTES AND MACROPHAGES

A subpopulaton of peripheral blood monocytes and alveolar macrophages are IgE

receptor positive. The macrophage IgE receptor (IgEFcR) has a low affinity for IgE

compared to that of the mast cell. It has been demonstrated that active macrophages are

present at the air surface interface of human airways as well as in alveoli. Therefore, it is

possible that these cells interact with inhaled allergen.

BASOPHILS

Basophils are histamine releasing cells in the late phase reaction of asthma unlike

mast cells, which release histamine in the early phase reaction.

ADHESION MOLECULES

Adhesion molecules are considered to be important in the causation of airway

inflammation although the specific mechanism is still under investigation.

INFLAMMATORY MEDIATORS IN ASTHMA

LEUKOTRIENES

Their involvement principally in bronchial asthma includes severe airway obstruction,

i.e., bronchoconstriction, oedema and increased secretion of bronchial mucus from sub-

mucosal gland secretion. The recent development and usefulness of leukotriene receptor

antagonists and synthesis inhibitors in bronchial asthma further emphasizes the role of this

leukotriene in the pathogenesis of this condition.

MAST CELL PROTEASES

As much as 70% of the weight of mast cell consists of proteases that are

enzymatically active at neutral pH. There cells express a complex array of proteases which


55

consist of serine proteases, tryptases and chymase. These enzymes regulate neuropeptide

regulation in the airways, smooth muscle contraction and submucosal gland secretion.

HISTAMINE

Histamine induces broncho-constriction, increases epithelial and vascular

permeability, and increases the secretion of mucous glycoproteins.

PROSTAGLANDINS

PGD2 and PGF2(x are very potent broncho-constrictor agents.

PLATELET ACTIVATING FACTOR (PAF)

PAF has attracted attention as an important mediator of bronchial asthma. It is an

important mediator involved in the bronchial hyper responsiveness in addition to having

action of bronchial construction, stimulation of eosinophil and eodsinophil accumulation in

the airway induction of airway micro-vascular leakage and oedema and increased airway

secretions.

BRADYKININ

It also important inflammatory mediator, bradykinin mediates its effect, through BKI

and BK2 receptors.

NITRIC OXIDE

In patient with bronchial asthma the peak or mixed expired NO is about 50% higher.

Expired concentrations of NO reflect the inflammatory microenvironment of the asthmatic

airway wall.

NEUROPEPTIDES IN ASTHMA

There is increasing evidence that abnormal neurogenic mechanisms and

neuropeptides contributing in the pathophysiology of bronchial asthma. Autonomic nerves


56

regulate airways smooth muscle tone, mucous secretion, blood flow, vascular permeability

and migration and release of inflammatory cells. Neuropeptides are small aminoacid

components that are localized to neurons. Neuropeptides such as VIP (Vasoactive intestinal

peptide)has been identified in various inflammatory cells including eosinophits, mast cells,

and mononuclear and polymorpho nuclear leucocytes. Once release peptides act as either of

neurotransmitters, hormones or mediators. Their widespread distribution and different

physiological effects make neuropeptides excellent candidates to play important roles in

asthma.

Pathology of Asthma

The morphologic changes in asthma have been described principally in patients dying

of status asthmatics, but it appears that the pathology in non-fatal cases is similar.

Grossly the lungs are over distended because of overinflation. The most striking

macroscopic finding is occlusion of bronchi and bronchioles by the thick tenacious mucous

plugs. Histologically the mucous plugs contain whorls of shed epithelium, which give rise to

the well known Curschmann-spirals. Numerous Eosinophils and Charcot Leyden crystals are

present; the latter are collections of crystalloid made up of Eosinophilic membrane protein.

The other characters are -

1) Thickening of the basement membrane of the bronchial epithelium.

2) Oedema and an inflammatory infiltrate in the bronchial walls with a prominence of

Eosinophils which form 5 to 10% of the cellular infiltrate.

3) An increase in size of the sub mucosal glands,

4) Hypertrophy of the bronchial wall muscle, a reflection of prolonged broncho

constriction.


57

Though the Samprapti of Tamaka Swasa is inadequate to explain in some aspects of

physiological and pathological manifestation, starts due to Nidana sevan to disease

development. The knowledge helps in poorva roopa, roopa, Chikitsa and Vyadhi vinischaya.

The analysis pathophysiology of Tamaka Swasa, found that Ayurveda emphasized the

Pranavaha Srotas, where as modern science pointed out bronchiols and other inflammatory

cells and mediators.

Figure – 8

Cross section of the lung in Tamaka Swasa i.e. Asthma

POORVA-ROOPA

The poorva roopa

sthana samshraya.

are of two types.

Agnimandya and A

Ardhe

defined as the premonitory symptoms, which appears immediately after

In this stage of clinical manifestation of the disease premonitory features

The poorva roopa of Tamaka Swasa are due to Vata Kapha prakopa,

ma. The vitiated Kapha and Vata Dosha first settled in Amashaya and

dashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 58

produce symptoms like adhmana, anaha, arati, bhaktadwesa. It may persist for long period

before the manifestation of Tamaka Swasa. As Dosha lodged in Pranavaha Srotas Tamaka

Swasa is manifested with episodic attacks. Between the attacks patient may be free from

symptoms of respiratory illness.

Before each attack some premonitory symptoms like parshwashoola, pranavilomata

and shankanistoda are manifested. The premonitory symptoms are visista type; hence they

persist during attack also.

In modern science, premonitory symptoms are not mentioned but some of preceding

symptoms which are explained in clinical presentation of asthma can be interpreted as

premonitory symptoms. Most patients will complain of the onset of an attack of bronchial

asthma following allergic pharangitis in the form of sore throat, pain in the throat, itching,

sneezing, running nose or a blocked nose. Viral infection of upper airways is another

important preceding event in many patients of bronchial asthma. Further allergic rhinitis

has been recognized as a risk factor for asthma.

The study of poorva roopa helps in early detection of diseases; appropriate treatment

can be started immediately and succeeded in preventing the disease or at least to

minimizing its severity 130.

To sum up, the vitiated Doshas stemming out from the Adhoamasaya circulates in the

Uras, Kantha and Siras. Consequently, these Doshas getting localized in the Pranavaha

Srotas produces symptoms like Parshva Shoola, Hridaya Peedana and Prana Vilomata, before

the actual onset of breathlessness. The poorva roopa are explained by different authors are

listed in table following.


59

Table No. 2

Showing Poorvaroopa of Shwasa Roga

Symptoms C.S 131 S.S132 A.H 133 M.N 134

Anaha – distension of abdomen + + + +

Adhmana – fullness of the abdomen - - - +

Arati – restlessness - + - -

Bhaktadwesa – aversion to take food - + - -

Vadanasya vairasya – abnormal taste in the mouth - + - -

Parshwa shoola – pain in the sides of the chest + + + +

Peedanam hridayasya – tightness of the chest + + + +

Pranasya vilomata – obstruction to expiration + - + +

Shankha nistoda – temporal headache - - + +

Roopa (Lakshana) of Tamaka Swasa

In our classics there are number of symptoms being explained but it does not mean that

all the symptoms are to be present in every patient, for some patients very few symptoms

may be present but some are with many symptoms. The symptomatology can be rearranged

according to severity of the symptoms.

In modern science, clinical presentations of bronchial asthma are heterogeneous, falling

into every age group from infancy to old age, and the spectrum of signs and symptoms

various in degree of severity from patient to patient, as well as within each patient, overtime.

Detailed clinical history taking is very important in clinical diagnosis of bronchial asthma.

The pattern of symptoms may be perennial, seasonal, or perennial with seasonal

exacerbations. The symptomatology is generally episodic, although may be continuous or

continuous with acute exacerbation 135.


60

Out of symptoms of Tamaka Swasa mentioned in the table, ati-teerva vega Swasa,

ghurghur shabda, kasa, shleesma are the direct manifestation of the disease process hence,

they considered to be main symptoms of Tamaka Swasa.

In modern science, the usual symptom includes cough, wheezing, shortness of breath,

chest tightness and modest degree of sputum production 136. Ghurghurka (wheezing) occurs

due to avarodha in Pranavaha Srotas due to Kapha. A wheeze is generated by vibration in

the wall of an airway on the point of closer due to smooth muscle contraction (sankocha) 137.

The srotorodha is one of the important manifestations of Samprapti of Tamaka Swasa. But in

modern science it is, often said - that entire wheeze is not asthma, because of the following

reason. Presence of rhonchi is a characteristic finding in asthma and will be present in most

patients. However neither its presence nor absences will confirm or exclude bronchial

asthma. Rhonchi may be heard in many other condition including chronic bronchitis,

pulmonary oedema, bronchial stenosis, foreign body aspiration, upper airway obstruction and

pulmonary emboli 138.

Swasa is produced due to obstruction in Pranavaha Srotas. In normal circumstances

one is not aware of respiration. Here the patient finds difficulty to breath and increased in

rate of respiration to compensate oxygen requirement. Dyspnoea can be due to obstruction to

the flow of air into and out of the lungs; Atiteerva vega Swasa is the pratyatma lakshana of

Tamaka Swasa.

Kasa (cough) is also one of the important symptoms of Tamaka Swasa. It is due to

irritation in the airways (Pranavaha Srotas) and also it is an effort to expel the Kapha

(sputum) secreted in the airways.


61

Greeva - shiraso- urasa sangraham these due to over inflation of the lungs and patient

feels a sort of discomfort or ache or pain in the bilateral sides of the chesta 139.

Some symptoms are very peculiar to a particular disease; there existence confirmed the

diagnoses and these are called pratyatma lakshanas of that particular disease. In our classics

there is no direct reference of pratyatma lakshanas of Tamaka Swasa. As already mentioned

above in comparison with modern science, usual symptoms of asthma are considered to be

pratyatma lakshanas of Tamaka Swasa.

Rest of the features of Tamaka Swasa includes the explanation of the above said

features, their effects and complications. Other symptoms are associated with upper

respiratory track infection.

Kastena-shlesma nisharanam i.e. difficulty in expectoration, caused due to the over

inflated lung, with both large and small airways being filled with plugs comprising of a

mixture of mucus, serum proteins, inflammatory cells and cell debris 140 . After the expulsion

of sputum patients feel relief i.e., shlesma vimokshanthe sukham. This is because of

expectoration, the plugging of the airways cleared off and make easy for respiration. Patient

likes hot things i.e., ushnam abhinandate. The hot things help in liquefying the plug

(sputum) and become easy to expectorate.

Shayanasya Swasa peeditha i.e., dyspnoea increases in lying down posture. This is due

to lying down position, the diaphragm is raised and reducing the lungs volume. The

secretion in the lungs tends to obstruct the airways in this position. Shayanasya sameerina

parswe avagrihnati, this is due to intercostals are put into maximum efforts to compensate the

diaphragmatic breathing which is ineffective due to tense diaphragm. As a result patient

feels a sort of griping sensation in the sides of the chest.


62

Aasenolabhate soukhyam i.e., due to sitting position diaphragm is lowered and

secretion of airways will not obstruct the airways completely. There will be more space for

gaseous exchange. Hence patient feels relatively comfortable in this position.

Kricchena bhashate i.e., dysphonoea, during episodic attack of Tamaka Swasa patient

can hardly speak anything. This is due to dyspnoea and also due to tenacious mucous may be

coated in the throat including vocal cords.

Nalabhate nidra i.e. Anidra Patients does not get proper sleep. This is due to

characteristic attacks of dyspnoea during night hours (Nocturnal attacks). This is because of

lowest level of serum adrenalise and cortisol and highest levels of histamine during night

hours could be responsible for nocturnal episodes in asthmatic individua 141. Also changes

the body temperature i.e. lowering of temperature and increased accumulation of secretion in

the respiratory track during sleep may be additional factors. The symptoms aggravates

during cloudy weather, after consuming cold water etc., these factors increase Vata and

Kapha by their sheeth guna leading to increased obstruction i.e., in other way increases

broncho-constriction 142.

If the disease becomes severe certain ominous features will be developed, the patient

may go into syncope during the bouts of coughing i.e., pramoham kashamanascha. In case

increased respiratory distress i.e., pratamyati, patient becomes motionless i.e., sannirudyate,

some times patient may develop loss of consciousness i.e. pramoham. The patient develop

the wide opening of the eyes i.e., Ucchita akshata, sweating of the forehead i.e., lalata sweda,

dryness of mouth due to air hunger i.e., vishukasyata, excessive thurst i.e., trishna, tremors

i.e. kampa, malaise i.e., angamarda. Patient takes short breaths and puts all his efforts in


63

breathing i.e., muhurswasa mushuschaiva avadhamyate. Also sometimes patient is present

with jwara (fever) this is because of upper respiratory infection or viral infection.

All patients with bronchial asthma are at risk of developing severe asthma attack,

which places them at risk of developing respiratory failure. These disorders refer to as status

asthmatics. In most cases, severe life threatening asthma develops against a background of

poorly controlled disease.

All features above discussed can be compared to status asthmatics and complications

of asthma in modern science. However in 10 % to 20% of cases fatal or near fatal asthma,

the onset appears to be sudden and unexpected, such episode are called "sudden asphyxia

asthma". Acute severe asthma said to "run to type" meaning there by, if hypercapnia

develops during one severe attack i.e. likely reverse in subsequent episodes 143.

The clinical features of status asthmaticus include increased breathlessness, cough,

wheezing, and chest tightness. The patient is typically anxious, breathless, fatigued, sitting

upright in bed and is preoccupied with task of breathing. Clinical signs include tachypnoea,

tachycardia, hyper inflated lungs, wheeze, use of accessory muscles pulses paradoxus and

diaphoresis 144. The clinical features which are mentioned included severe or fatal asthma

with complication of bronchial asthma. Hypoxia results in the manifestation of features like

tachycardia, sweating, wide pulses, pressure and cyanosis. Lakshana Table is followed.


64

Table No. 3 Shows lakshanas of Tamaka Swasa

SL Vega Kaleena Lakshanas Cs SS AH YR BP MN No 1 Ghur-Ghur Shabda (Wheezing) + + + + + + 2 Ati-Teerva Vega Swasa (Acute dyspnoea) + + + + + + 3 Kasa (Cough) + + + + + + 4 Muhur-Swasa(Rapid Inspiration) + - I + + -+ + 5 Greeva-Shiraso-Urasa Sangraham (Pain/stiffness + + + + + + in head, neck and chest) 6 Kastena-Shlesma Nihsarnam (Difficult + + + + + + Expectoration) 7 Shleshma-Vimokshanthe Sukham (Relief after + + + + + - Expectoration) + 8 Ushnam-Abhinandate (Liking hot things) + - + + + 9 Shayanasya-Swasa Peeditha, Aseena Labhate- + + + + + + Soukhyam (Discomfort in lying down posture, comfortable in sitting posture) 10 Shayanasya Sameerana Parshve Grahnati + - + + + + (Discomfort in sides of the chest on lying down posture) 11 Kricchen-Bhasate (Dysphonoea) + - - + + + 12 Na-Labhate Nidra (Sleeplessness) + - - + + + 13 Megha, Ambu, Sheeta, Pragrath, Shlesmadalancha + - + + + + Pravradati (Increase after exposure to cloudy whether, cold water, Kaph-kara ahara) 14 Pramoham Kashamanascha (Fainting during + - + + + + cough) 1 15 Pratamyati (feels much distressed) + + + + + + 16 Sannirudyathi (Steady voluntary movements) + - + + + 17 Uchita Akshata (Wide-open eyes) + - + + + + 18 Lalata Sweda (Sweety forehead) + + + + + + 19 Vishu Kasyata (Dryness of mouth) + + + + + 20 Trishna (Excessive thirst) + + - - - 21 Kampha (Tremors) + - + - - - 22 Anqamarda (Malaise) + + - - - - 23 Mushira avadhamyati (Puts all efforts to breath) + - + + + + 24 Jwara (Fever) + - + 25 Pratishyaya (Coryza + - + + + + 26 Brashamartha (Maximum distress) + - + + + + 27 Aruchi (Anorexia) - + + 28 Kantaddvamsha (Hoarseness of voice) + + + +


65

VYAVACCHEDAKA NIDANA (differential diagnosis)

While making diagnosis of Tamaka Swasa the following diseases which are having

similar symptamatology haves to be excluded. They are other types of Swasa roga and

kaphajakasa. Features are shown in the table 145.

Kaphaja kasa

In kaphajakasa mandagni, aruchi, chardi, peenas, uthklesha, gourava, romharsha,

madurya in mouth. snigda, nistevana kapha, samprapti in uras. According to modern science,

the following diseases should be differentiated from bronchial asthma 146.

i.Chronic bronchitis

ii.Pulmonary emphysema

iii.Congestive heart failure

iv.Pulmonary embolism

v.Mechanical obstruction of the airways

vi.Pulmonary infiltration's with eosinophilia

vii.Cough due to drugs (Beta-blockers, AIE inhibitors)

The signs and symptoms of the disease are 147

1) Chronic Bronchitis: The clinical signs are persistent cough productive of copious

sputum. For many years, no other respiratory functional impairment present. But

eventually dyspnoea on exertion develops. Cyanosis and hemoptysis are present. X-

rays shows the features of increased bronchovascular markings.

2) Pulmonary emphysema: Increasing breathlessness with wheezing but no cough or

sputum. Chest is barrel shaped, percussion note hyper-resonant. Auscultatory

finding is slowing of forced expiration. X-rays shows hyper-translucency, low flat

diaphragm.


66

3) Congestive heart failure: Weakness, fatigue, oedema, restlessness, insomnia, cough,

dyspnoea, orthopnoea, anorexia, nausea. Signs raised JVP, liver enlargement,

peripheral cyanosis.

4) Pulmonary embolism: Sever chest pain, dyspnoea, shock, elevation of temperature,

increased level of serum, lactic, dehydrogenase. X-rays shows pulmonary infarct, as

a wedge shaped infiltrate.

TABLE No - 4

Vyavacchedaka Nidana in Tamaka Swasa

Symptoms Tamak-Swasa Maha-Swasa Urdwa Swasa Chinna-Swasa Kshudra

Swasa Swasa Ateerva vega Uchaiti Deergam

Urdhwam Vichhinnam Rooksha

ayaasodbhava Shabda Ghurgurukatw

am Matta vrisha bhavat

Conscious ness

Pramoha Pranas Hta jnanavignance

Pramoha Murcha

Netra Uchritaksha Vibrantalochana

Urdhvadrishti and vibrantaksa

Viplutaksha, raktaika lochana

Shoola Parshwa shoola

Vedanartha Marmachedha rugarditha pralapa

No indriyavyatha

Vak Kricchena bhasate

Vishirna vak Pralapana

Asya Vishu kasyate Shuskasya Parishuskasya Sweda Lalata sweda Sadya asadyatha

Yapya/sadya Asadya Asadya Asadya Sadya

Upadrava of Tamaka Swasa

Upadarava are the complications of a disease occur at the end of stage of disease. An

observational finding in symptomatology of Tamaka Swasa includes upadrava even. We can

consider hridaya vikriti as one of upadrava because hridaya is moola of Pranavaha Srotas.

The complications of bronchial asthma are pneumothorax, pneumomediastinum,


67

subcutaneous emphyseam, pneumopericardium, myocardial infarction, mucus plugging,

atelectassis, electrolyte imbalance, dehydration, myopathy, lactic acidosys, and hypoxic brain

injury etc.

Arista lakshanas

Arista Lakshanas are the features or symptoms which occur just before death. In other

words they are the definite signs towards death. This Swasa is also fatal because all the

patients at the end will suffer from Swasa. As Tamaka swasa has been said as sadhya in its

initial stages to take up for the treatment, the Arista lakshanas all to be examined. The

patient presenting with deergha uchwasa and hriswa nishwasa are the arista lakshanas of

Tamaka Swasa 148. The swasa complicated with atisara, jwara, hikka, chardi, medrashotha

and shotha are said to be arista lakshanas 149. The swasa with jwara, chardi, trishna, atisara,

and shopha are said to be arista lakshana 150. The colour of the skin is also changed to blue

due to Swasa, which is explained in varna context of arista. This can be explained as the

central and peripheral cyanosis, which is manifested in the superficial skin and mucous

membrane due to hypoxemia.

Sadhyasadhyata

Ayurveda is advised to assess the prognosis i.e., Sadhyasadhyata of the disease before

starting the treatment. For the sadhyasadhyata of Tamaka Swasa, Charaka has said it is

yapya, but it becomes sadhya only in its early stages 151. Also said, it is sadhya, when its

signs and symptoms are not fully manifested and if the patient is strong 152. Susruta has said

that Tamaka swasa is kastasadhya but becomes asadhya in durbala rogi 153. According to

vagbhata Tamaka swasa is yapya but can be sadhya if it is treated in the beginning and if it

occurs in strong person 154.


68

In modern science mentioned, it was long believed that the prognosis for asthma

originating in infancy or childhood was good, and that in most patients the symptoms would

resolve by the age of puberty. In fact an asthma symptom persists in 30 to 80 % of adult

patients. Although epidemiological studies have shown a fair chance of either remission or

reduction in asthma symptoms between the ages of 10 and 20 years, no definite information

is available about progression of asthma through childhood and adolescence.

The assessment of sadya- asadyatha is very important to physician to undertake patient

for the treatment. If a patient come to physician in his later stages i.e., worsened conditions

of a disease, a wise physician should not take for treatment. With sadhyaasadyatha physician

can convenience the patients and their relatives about the prognosis of the disease. Here

patient education important in such yapya disease. This makes the patients co-operation with

physician for long term treatment.

UPASHAYA –

Factors relieving the severity of disease –

Asino labhate saukhyam (sitting posture gives relief).

Shleshma vimokshe sukham (expectoration of kapha gives relief).

Ushnabhinandati (liking toward hot things).

ANUPASHAYA –

Factors aggravating the severity of the disease –

Sheeta pana (cold drinks).

Sheeta vata (cold weather).

Guru bhojana (heavy eatables).

Vyayama (exercise).

Shayane shwasavriddhi (sleeping or lying down intensify shwasa).


69

Chikitsa in Tamaka Swasa

The effective treatment of Tamaka Swasa can not be unified, as the pathology

involves multiple varying factors. Vitiated Vata and Kapha Dosha stemming out from the

Pitta Sthana, afflicting the Rasa Dhatu in the Pranavaha Srotas produces the illness.

Therefore, the procedures 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

quite opposite. Thus, the unique pathogenesis poses complexity in planning the treatment.

The final treatment planned should pacify the Vata as well as Kapha Dosha effectively,

simultaneously not causing any further addition to the imbalance of Vata and Kapha Dosha.

With the due consideration of this, following principles of treatment are advocated in the

Ayurvedic classics.

1. Abhyanga and Swedana –Application of the oil over the chest followed by sudation.

2. Vamana – Therapeutic emesis

3. Dhoomapana – Therapeutic inhalation of the smoke from the burning herbs

4. Virechana Karma – Therapeutic purgation

5. Pratisyaya Chikitsa – Treatment of rhinitis

6. Kasaroga Chikitsa – Treatment of Kasaroga

7. Vatahara Chikitsa – Elimination of vitiated Vata Dosha

8. Kaphahara Chikitsa – Pacification of vitiated Kapha Dosha.

9. Manasa Dosha Chikitsa –Correction of emotional disturbances

10. Kapha Vilayana Chikitsa –Liquification of the sputum

11. Srotomardavakara Chikitsa – Softening of the channels of respiration

12. Kaphanissaraka Chikitsa – Expectoration of sputum

13. Kasaghna Chikitsa – Treatment of cough

14. Rasayana Chikitsa – Rejuvenating the Pranavaha Srotas and body


70

Judicial employment of these therapeutic procedures brings about maximum relief to

the patient suffering from Tamaka Swasa. The details of these procedures are given in the

following paragraphs.

Abhyanga and Swedana:

Treatment of Tamaka Swasa differs both during the attack and in between the attacks.

During the episode of Tamaka Swasa, the Dosha 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 Samprapti. In contrast to this, in between the attacks, the treatment is

planned to prevent the initiation of new Samprapti thereby, forming the complete treatment

of Tamaka Swasa 155.

Pranavilomata is a pathological event during an episode of Tamaka Swasa and is said

to be due to the tenacious Kapha obstructing the passage of Pranavata. Bringing it out by

liquefying the sputum is the principle and first treatment of this condition. This can be

achieved by Abhyanga and Swedana over the chest thereby allowing the free passage of

Pranavata. Charaka has prescribed application of oil added with rock salt over the chest

followed by sudation in the form of Nadi, Prastara or Sankara Sweda 156.

Vamana Karma:

The Clinical presentation in patients suffering from Tamaka Shwasa is 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 the ideal choice. Yet, other patients present with symptoms suggestive of

dominance of Kapha Dosha, which is characterized by paroxysmal productive cough, where


71

the sputum is tenacious, bouts of distressing paroxysmal cough brings out small amounts of

sticky sputum and this is associated with breathlessness. In such patients, with the

predominant vitiation of Kapha Dosha, Vamana Karma is most ideal. This renders clarity of

the Pranavaha Srotas and thereby allowing free passage of the Pranavata.

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 Swasa and it can be repeated during every attack 157.

In children, spontaneous vomiting is a natural defense mechanism that clears the

passage of respiratory tract. Here, act of vomiting along with emptying the stomach, also

includes forced expiration that clears the respiratory passage.

After subjecting the patient to Abhyanga and Nadi Sweda over the chest, in the

evening, the patient is allowed to take the food that provocateur the Kapha Dosha - like

meals with curds or fish. This Kaphotkleshana procedure renders easy elimination of the

Kapha Dosha by the Vamana procedure, which is carried out on the immediate next day, in

the morning hours 158.

Dhoomapana:

This is another procedure also aimed at eliminating the Kapha Dosha from the Srotas.

Dhoomapana is advised after the Vamana karma and it eliminates some amount of Kapha

Dosha that is still left out after the Vamana karma. Or else, if the minimum Kapha Dosha in

the Srotas 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

putrefactive procedure is not possible, Dhoomapana alone helps in the elimination of Kapha


72

Dosha. Added to this, the drugs used in Dhoomapana also reduces spasm or stiffness of

Pranavaha Srotas bringing about Srotomardavata that ensures free passage of Vata Dosha.

Improvement from the respiratory distress can be spontaneously seen, as

expectoration is improved and made easy. Also, it produces broncho-dilatation, bringing

maximum relief to the patient. Here, the medicines are directly delivered into the system and

hence response is prompt and immediate. The procedure is akin to the inhalers prescribed by

the modern counterparts. Procedure can be repeated regularly depending upon the

requirement 159. Occasionally, due to irritant cough, breathlessness may worsen in some

patient. This is mostly seen if the patient cannot smoke smoothly, and is especially true in

females and children.

Virechana Karma:

Abnormal response of patients for simple factors like dust is said to be due to

Khavaigunyata 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 Vyadhikshamatva. And the fact is

that, the patient unfavorably responds to simple factors like dust, atmospheric change, or

food. The friendly environment in which the patient has to live becomes hostile to him and is

like the enemy of the patient. The interaction in such a situation between the patient and the

environment is just like the two mirrors facing each other. The mirrors facing each other

produce infinite number of images and quite similar to this, the patient suffers from

innumerable attacks of Tamaka Swasa.

The answer for such a nature of illness is Virechana karma and Rasayana Chikitsa.

Charaka pronounced this as “Tamake Tu Virechanam” 160.


73

The Virechana procedure may not be of much use during the attack of Tamaka

Swasa. But when employed in between the attack, prevents the attacks of Swasa, reduces its

severity, minimizes the duration of illness. Even in some patients, this procedure in

combination with Rasayana Chikitsa brings about complete cure.

After Virechana, Samasarjana Karma is advised for about 3 to 5 days. By this

procedure, Doshas in Tamaka Swasa get eliminated, as is told in the classics, Doshas

stemming out from Pitta Sthana is best eliminated by Virechana procedure. It is worth

mentioning here that, Vata Dosha is the predominant Dosha involved in the Samprapti of

Tamaka Swasa. Virechana normalizes the course of Vata Dosha and thus helps in the

reversal of the Vilomagati of Pranavata. Distension of the abdomen, constipation and such

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

this procedure.

Pratishyayahara Chikitsa:

Charaka opines that, Pratishyaya is a cause of Tamaka Swasa. Sneezing, running

nose, stuffiness of the nose are the prominent symptoms that associates Tamaka Swasa. In a

typical attack, the patient develops these upper respiratory tract symptoms. Within hours,

following this, the patient develops wheezing. This chronological order of symptom

manifestation is more suggestive of Pratishyaya Roga as the cause of Tamaka Swasa. In such

patients, along with other medicines of Tamaka Swasa, the Pratishyayahara Chikitsa should

be adopted. By this planning of the treatment, one can draw maximum favorable results 161.

Kasa Roga Chikitsa:

Kasa Roga is another disease said to predispose Tamaka Swasa. The clinical course in

this case, could be the initial development of productive cough, with or without manifestation


74

of fever. Characteristically, sputum is muco-purulent or yellowish. Within a day or two,

breathlessness and wheezing follows. This unique evolution of symptoms is very much

indicative of Kasa Roga, precipitating Tamaka Swasa. Therefore, addition of treatment of

Kasa Roga in patients of Tamaka Swasa is thus justified 162.

Vatahara Chikitsa:

Vata Dosha as well as Kapha Doshas is invariably involved in the pathogenesis of

Tamaka Swasa. But relative dominance and accordingly the clinical picture of these two

doshas may vary in individual patients. Minimal cough, when present, mostly dry,

insignificant amount of sputum, prominent breathlessness and wheezing, all are suggestive of

dominance of Vata Dosha. In such case, Tamaka Swasa Chikitsa should mainly include

measures to pacify the Vata Dosha to get best results 163.

Kaphahara Chikitsa:

In patients of Tamaka Swasa, relative dominance of Kapha Dosha is characterized by

paroxysmal productive cough with profuse whitish sputum. Associated breathlessness is

comparatively lesser than the Vata dominant variety. In such a clinical state, measures to

pacify the Kapha Dosha are a better approach in the treatment of Tamaka Swasa 164.

Manasa Dosha Chikitsa:

Patients’ expression of anxiety may not be in the eyes, face or their activity, but it

may be through the Pranavaha srotas in the form of Swasa. The absolute cause is related to

the mind but its reflection is through the Pranavaha srotas. In such clinical presentation,

additions of Manasa Dosha Chikitsa are more beneficial 165.


75

Kapha vilayana Chikitsa:

Tenacious sputum is most distressing to the patients of Tamaka Swasa. Here

exhausting bouts of paroxysmal cough, fail to bring out rubbery sputum. In such patients,

typical sound of productive cough is diagnostic. Liquefaction of the sputum by oral

administration of specific medicines brings more comfort to the patients 166.

Srotomardavakara Chikitsa:

Stiffness, constriction or to say spasm is responsible for the breathlessness and the

musical sounds in patients of Tamaka Swasa. Charaka has advised Srotomardavakara

Chikitsa to relieve the detrimental effect of Vata Dosha 167.

Kaphanissaraka Chikitsa:

Effective removal of Sleshma secreted in the Pranavaha Srotas forms the principal

treatment of Tamaka Swasa. Symptomatic approach with expectorant treatment is desired

when the mucoid sputum is disturbing 168.

Kasa Laksanika Chikitsa:

Exhausting dry cough is observed in most of the patients of Tamaka Swasa. Here, the

respiratory tract secretions are minimal but the irritation in the throat is most disturbing. It is

true that bouts of irritant cough leads to worsening of breathlessness. In these conditions,

Kasaghna Chikitsa minimizes the suffering of breathlessness, thus improving the total

efficiency of the treatment 169.

Brimhana and Rasayana Chikitsa

The difference in response to atmospheric changes in a normal person, in contrast to

patients of Tamaka Swasa, where in atmospheric changes reflects as disease in patients is

said to be due to Khavaigunyata, an abnormality of the Pranavaha Srotas. This can be


76

rectified by Vyadhihara Rasayana. This Rasayana treatment is much helpful to reduce the

further attacks of Asthma. Also, in due course, improves the defense mechanism of

Pranavaha Srotas, reduces the tendency of abnormal reaction to simple factors in the

surrounding. Further, in the long run, this disease causes emaciation of the body. This can be

corrected by the Brimhana Chikitsa. This adds to the benefit 170.

To sum up, sequential administration of Abhyanga and Swedana over the chest, diet

increasing the tendency of Kapha to get eliminated, Vamana, Dhoomapana followed by

Shamana Chikitsa is the sheet anchor of treatment of Tamaka Swasa during an episode.

Virechana followed by Vyadhihara Rasayana and Brimhana Chikitsa forms the ideal

treatment in between the attack. These procedures are very much efficacious in remitting the

symptoms as well as preventing the attack of Tamaka Swasa. Vatahara Chikitsa, Kaphahara

Chikitsa, Pratishyayahara Chikitsa, Kasaroga Chikitsa, Manasa Dosha Chikitsa,

Kaphavilayana Chikitsa, Kaphanissaraka Chikitsa, Srotomardavakara Chikitsa, and

Kasaghna Chikitsa are the principles of Shamana treatment.

Pathya – Apathya in Tamaka Swasa

A number of predisposing factors initiate an attack of Tamaka Swasa or may worsen

the episode, if the patients are already in the symptomatic phase. As discussed earlier, in a

patient who has reduced immune mechanism of the Pranavaha Srotas, which is described as

Khavaigunyata or Asathmyata, exacerbation or else initiation of an attack of the Swasa, is

likely. Hence, understanding of Pathya as well as Apathya gains importance both in

preventing as well as planning the treatment. Mainly the factors that influence the balance of

Vata and Kapha Dosha are either Pathya or Apathya as per their role in pacifying or else


77

aggravating these Doshas respectively. Following table depicts the list of Pathya and

Apathya factors in Tamaka Swasa.

Table No.5

Showing Pathya in Tamaka Swasa

Pathya Ahara C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175

Purana Shali + - - + + Shaali Dhanya Tandula - - - + +

Vrihi Dhanya Shashtika + - + + + Yava + - + + + Shooka Dhanya Godhuma + - + + + Mudga + - + - - Shimbi Kulatha - - + + + Guduchi + - - + + Patola - - - + + Vartaka - - + + + Rasona - - - + + Bimbi - - - + + Vastuka - - - - + Moolaka + - + - + Potaki - - - - + Shigru + - - - -

Shakha Varga

Kasamarda + - - - - Janghala - - - + + Shasha - - - + + Titira - - - + + Bhuka - - - + + Lava - - - + + Dhanva - - - + + Shuka - - - + +

Mamsa Varga

Mruga Dwija - - - + + Jambira - - - + + Draksha + + - + + Mathulunga + + + - + Amalaka + + + - -

Phala Varga

Bilwa + + + - - Sura - + - + + Madhya Varga Varuni - - + - -

Madhu Varga Madhu + + + + + Mootra Varga Gomutra - - - - + Dugdha Varga Aja Kshira - - - + +


78

C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175

Purana sarpi - + - + + Ghrita Varga Ajasarpi - - - + + Yusha + - + - - Yavagu + - - - - Peya + - + - - Sathu - - + - -

Krtanna Varga

Varuni - - + - - Virechana + - - + + Swedana + - - + + Dhoomapana + - - + + Prachardana - - - + +

Pathya Vihara

Swapanam Diva

- - - + +

Table No.6

Showing Apathya Aahara in Tamaka Swasa

Apathya

C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175

Nishpava + - - + - Masha + - - + - Thila + - - - -

Shimbi Dhanya

Sarshapa - - - + + Shaaka Varga

Kanda - - - + +

Jalaja + - - - - Anupa + - - - + Pishita + - - - -

Mamsa Varga

Matsya - - - + + Dadhi Varga

Dadhi + - - - -

Kshira + - - + + Kshira Varga Mahisha Kshira + - - - - Grita Varga

Mahisha Gritha - - - + +

Tailabhrsta Nishpava

- - - - +

Pistanna + - - - -

Krtanna Varga

Pinyaka + - - - -


79

Table No.7

Showing Apathya Vihara in Tamaka Swasa

C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175

Sheeta Snana + + + - - Raja + + + + + Dhooma + + + + + Anila + + + + + Vyayama Karma + + - - - Bhara - + - - + Adhwa - + - - + Vegaghata - + - - - Apatharpana + + - - - Rakta srava - - - - - Pragvata - - - - - Marmaghata + - + + + Sooryatapa - - - - + Daurbalya + - - - - Aanaha + - - - - Abhighata - + - - - Strigamana - + - - - Vegavarodha-Mootra, Udgara, Chardi, Trushna, Kasa

- + - - -

In a nut shell, the factors that help in maintenance of normalcy of Vata Dosha and

Kapha Dosha, both during the symptomatic and asymptomatic period are considered as

Pathya. Added to this, the factors that favour the normal physiological functioning of

Pranavaha Srotas, is popularly known by the name Pathya. In contrast to this, the factors

either related to food or behavior that can affect the balance of the Vata and Kapha Doshas

are regarded as Apathya. Any factor that has detrimental effect on the Pranavaha Srotas is

listed as Apathya. Strict observation of the Pathya and Apathya prevents an episode of the

illness in patients who are asymptomatic. Likewise, Pathya and Apathya have great influence

in modifying the severity of the illness during the acute attack of breathlessness.


80

Figure - 9

Drug Review

The pharmaco dynamics and kinetics of the individual herbs of composition

“Ardhedashemaniya Swasaharavati” is very efficacious result in hypothesis are studied

from various contexts of textual references from different Samhita of Ayurveda and

reviewed to found with its relevance to the present day study 176

Trial Drugs composition 177, 178, 179, 180

The combination will be equal parts of Ardhedashemaniya Swasaharavati is as

follows.

1. Shati : Hedychium spicatum

2. Pushkaramool : Inula recemosa

3. Amlavetas : Garcinia pedunculata

4. Tulasi : Ocimum sanctum

5. Bhumyamalaki : Phyllanthus urinaria

All the herbs will be identified and collected from local area. Good

Manufacturing Practice will be followed for preparation of vati. The individual details of

the composition are as under.

1) Shati (Hedychium spicatum – Zingiberaceae)

Description: Woodland, Sunny Edge, By Walls, By South Wall, By West Wall, Forest

clearings, shrubberies, 1800 - 2800 meters 181, Perennial growing to 1.5m by 0.7m. It is

hardy to zone 8 and is frost tender. It is in flower in October. The scented flowers are

hermaphrodite (have both male and female organs). We rate it 1 out of 5 for usefulness.


81


82

The plant prefers light (sandy), medium (loamy) and heavy (clay) soils. The plant prefers

acid, neutral and basic (alkaline) soils. It cannot grow in the shade. It requires moist soil.

Actions & Uses: Ca minative; Digestive; Emmenagogue; Expectorant; Stimulant;

Stomachic; Tonic; Vasodilator. The rootstock is carminative, emmenagogue, expectorant,

stimulant, stomachic and tonic. It is useful in the treatment of liver complaints, and is also

used in treating vomiting, diarrhoea, inflammation, pains and snake bite 182 and a wide

range of references and details of research into the plants chemistry 183. It is digestive,

stomachic and vasodilator. It is used in the treatment of indigestion and poor circulation

due to thickening of the blood 184. The rootstock yields 4% essential oil. This oil, which

has a scent somewhat like hyacinths, is so powerful that a single drop will render clothes

highly perfumed for a considerable period. The dried root is burnt as incense and notable

anti histamine activity 185. Rhizomes possess anti-inflammatory and analgesic activity.

The anti-inflammatory activity was localised mainly in the hexane fraction from which

one of the pure active constituents, hedychenone has been isolated. The analgesic activity

was more prominent in the benzene fraction. Some other minor active constituents are

also present which may contribute to the total activity of the rhizomes.

r

2) Pushkarmoola (Inula racemosa - Compositae family)

Part used: Roots, Root powder

Description: Pushkaramoola grows in the hilly regions in the northwestern Himalayas.

The plant is a stout herb about 150 cms tall. It bears a large inflorescence in a racemose

arrangement. The stem is grooved and very hairy. Leaves are elliptical, large (46 cms)

and have long petioles. The fruits are 4 mm long and bearded with long hairs.


83

Chemical constituents: On extraction of the plant with hexane and isolation, the

compounds obtained are dihydroisoalantolactone, isoalantolac-tone and alantolactone 186.

Alantolacton, Isoalantolactone, Dihydroalantolactone, Dihydroisoalantolactone, Beta

sitosterol, Daucosterol, Inunolide are found in Pushkarmoola.

Actions & Uses: The extract showed potent, anti-inflammatory, antipyretic and

antispasmodic effect against bronchial spasm induced by histamine,5-hydroxytryptamine,

and various plant pollens Zea mays, Helioptelia & and Acacia Arabica 187.

The essential oil of 1 racemosa was tested for antibacterial and antifungal

activity. It is moderately effective against S. aureus, Ps aeruginosa, B.subtillis, mildly

against E. coli and B. anthracis 188. Alantolactone and isoalantolactone exhibited

antidermatophytic activity. Antifungal activity of these two compounds against two ring-

worm fungi was comparable to that of Nystatin but inferior to that of Amphotericin B 189.

In Ayurvedic practice, it is mainly used as an expectorant and bronchodilator. It

has been used in the treatment of tuberculosis and topically in the treatment of skin

diseases 190. It is used for cardiovascular system, angina, and dyspnoea.

Animals given Inula had smaller increases in SGOT, LDH, CPK, CAMP, cortisol,

pyruvate, lactate, and glucose than those in an untreated control group 191. 200 patients

with ischemic heart disease were used in the trial. Twenty-five percent of the subjects had

no chest pain, and patients experiencing dyspnea fell from 80 percent at the beginning of

the study to 32 percent 192. In another trial, all subjects had improvement in ST-segment

depression on ECG. However, the improvement was greater for those who were given

Pushkaramoola 193.


84

3) Amlavetasa 194 (Garcinia pedunculata - Roxburgh) Indian Rhubarb

Description: Yields a yellow fruit having an acidulous taste and it is 20 meters height,

leaves 15-30 cms in length, androcium is bigger than gynaecium

Chemical constituents: Anthraquinone derivatives such as chrysophanic acid

(=chrysophanol), emodin, aloe-emodin, rhein & physcion, with their O-glycosides such

as glucorhein, chrysophanein, glucoemodin; sennosides A-E, reidin C & others. Tannins;

Action and Uses: Amlavetas is stomachic, bitter, tonic, cathartic. Purgative, alterative,

hemostatic, antipyretic, anthelmintic, stomachic, bitter tonic, cathartic, laxative, atonic

indigestion Constipation (with fevers, ulcers, infections), diarrhea, Pitta dysentery,

jaundice, liver disorders. Rhubarb Root has a purgative action for use in the treatment of

constipation, but also has an astringent effect following this. It therefore has a truly

cleansing action upon the gut, removing debris and then astringing with antiseptic

properties as well.

4) Tulasi (Ocimum Sanctum – Labiatae) Basil

Parts Used: Leaf, Herb, Panchanga

Chemical constituents: Volatile oils (up to 28 percent methyl cinnamate)

Description: An annual plant found wild in the tropical and subtropical regions of the

world. The bushy stem grows to 1 to 2 feet high. The toothed leaves are often purplish

hued. The flowers vary in color from white to red, sometimes with a tinge of purple,

appear from June to September. The plant emits a spicy scent when bruised.

Actions and Uses: Antispasmodic, appetizer, carminative, galactagogue, stomachic,

demulcent and expectorant along with anti viral property. The tea made from the leaves

of the basil plant is used for nausea, gas pains, and dysentery. Tea made with basil and


85

peppercorns is a folk remedy to reduce fever. Basil is antispasmodic, appetizer,

carminative, galactagogue, and stomachic. Basil is vary useful for ailments affecting

stomach and the related organs. It is used for stomach cramps, gastric catarrh, vomiting,

intestinal catarrh, constipation, and enteritis. It had been sometimes used for whooping

cough as an antispasmodic. It is Antibacterial, antiseptic, antispasmodic, diaphoretic,

febrifuge, nervine. Used in Coughs, colds, fevers, headaches, lung problems, abdominal

distention, absorption, arthritis, colon (air excess), memory, nasal congestion, nerve

tissue strengthening, purifies the air; sinus congestion, clears the lungs, heart tonic; it

frees ozone from sun's rays and oxygenates the body, cleanses and clears the brain and

nerves; relieves depression and the effects of poisons; difficult urination, prevents the

accumulation of fat in the body (especially for women after menopause), obstinate skin

diseases, arthritis, rheumatism, first stages of many .cancers, builds the immune system.

Tulsi contains trace mineral copper (organic form), needed to absorb iron.

5) Bhumyamalaki (Phyllanthus niruri)

Parts Used: Leaves, root, whole plant

Description: Bhumyamalaki is a perennial herb found in Central and Southern India, to

Sri Lanka. It can grow to 12-24 inches in height and blooms with many yellow flowers.

All parts of the plant are employed therapeutically.

Chemical constituents: Phyllanthus primarily contains lignans (e.g., phyllanthine and

hypophyllanthine), alkaloids, and bioflavonoids (e.g., quercetin). While it remains

unknown as to which of these ingredients has an anti-viral effect, research shows that this

herb acts primarily on the liver. This action in the liver confirms its historical use as a

remedy for jaundice.


86

Actions and Uses: Bhumyamalaki is having various actions based on the properties. All

the parts are used in different disorders. Used as Kapha Pitta Shamaka Vatakrit, it is

Yakrit uttejaka, Deepana, Pachana, Anulomana, Ruchikaraka, Balya, Puranatisara hara.,

Rakta shodhaka, Sthambhaka, Pandu Rakta Pitta hara Atiraktasravahara., Swasaghna,

Kshaya roga hara., Mutrala., Putradayaka, Garbhasaya shodhahara., Vishama jwaraghna,

Niyatakalika Jwara Pratibandhaka and is also Vishahara, Nidrakaraka, Kshathapaha,

Netra roga hara.

Preparation of the Ardhedashemaniya Swasaharavati

All the drugs of this vati are well identified with the help of taxonomist and

dravya guna experts. The alaphashuska drugs are taken, than processed in to churna form

and messed into the fine cloth (vastragalitha). It is well documented that bhavans

increases the potency of the drugs, the effect of the kwathas also superimposed over the

composition. The kwatha is prepared from these drugs only. And three bhavanas was

given. Then it is made in the form of vati weighing about 500mg.

Advantages to prepare in the form of vati

1. they are easy to carry

2. they are easy to swallow

3. patient cannot experience unpleasant taste

4. they donot require any measurement dose

5. an accurate amount of medicament and prolonged stability to medicament

6. The in compatibility of medicaments and their deterioration due to environmental

factors.

Table – 8

Pharmacological properties of Ardhedashemaniya Swasaharavati

Name and Latin name

Part used Gana Rasa Guna Veerya Vipaka Doshagnatha

Dose in gm

Shati

(hedychim spicatum)

Kanda Swasahara,

hikkahara

Katu, Tikta,

kasaya

Laghu,

tikshna

Ushna Katu Kapha

Vata hara

1-3

Pushkara moola

(inula recemosa)

Moola Swasahara Tikta, katu Laghu,

tikshna

Ushna Katu Kapha

Vata

1-3

Amlavetasa

(garcinenia

pedenculata)

Phala Swasa hara

,deepaneya,

hrudya

Amla Laghu,

ruksha,

tikshna

Ushna Amla Kapha

Vata

1-3

Tulasi

(ocimum sanctum)

Patra, pushpa,

beja, moola

Swasa hara Katu, Tikta Laghu,

ruksha

Ushna Katu Kapha

Vata

1-3

Bhumyamalaki

(phyllantus niruri)

Panchanga Swasa hara,

kasa hara

Tikta,

kasaya,

madhura

Laghu,

ruksha

Seeta Madhura Kapha

pita

3-6


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Chapter – 4

Methods

The clinical study is based on the classical explanations with scientific well

designed research protocols, which enumerates the patient before to administrate the trial

drug to after effects in comparison.

Criteria for selecting drugs

1. The above mentioned drugs, which are taken from the Dashemaniya Swasa hara

gana of Charaka Samhita.

2. The pharmacological actions of the individual drugs are swasahara, hikka nigraha,

kasaharas which are mentioned in different gana/varga

3. The trial drug, Ardhedashemaniya Swasaharavati is selected according to the

pharmacological action and properties of individual drugs.

4. Ardhedashemaniya Swasaharavati is purely herbal, they are cheaper and easily

available as in the local market

5. Ardhedashemaniya Swasaharavati is very easy to process and vati making

6. Ardhedashemaniya Swasaharavati is very easy to dispense.

7. Among the ten drugs mentioned only five are selected in the study by considering

the following facts –

In different contexts the texts referred these group of herbs are potent

All of these are considered for multi dimensional actions

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods

88


89

All these yields results not only to Swasa but also to the Parshwa shoola,

Kasa, etc, which are associative of Tamaka Swasa

The said combination is hypothetically effective in reversal of Samprapti i.e.

the patho-physiological normalcy induction

Criteria for quantity of the drug

All the drugs which are selected and taken from Dasheminiya gana has

pharmacological action against Swasa with therapeutic effects which are the equitant so it

is considered to under take in equal quantity of the Ardhedashemaniya Swasaharavati

ingredients.

Methods followed in trail

1) Method of Research design

The trail is an observational clinical study. In this Patients were taken in

randomized selection.

2) Posology of Trial drug

3 gm/day 195 in divided dose or 6 vati per day in divided dose – flexible acc

rogabala

3) Anupana of Trial drug

Hot water because it is pathya 196 for Tamaka Swasa

4) Study duration of Trial drug

Ardhedashemaniya Swasaharavati observational clinical trial study was conducted

for 30 days. The medicine was dispensed for 15 days to all patients and advised to report

for every 15 days interval, asked to note the nature, frequency and other symptoms of their

disease and noted during their visits.


90

5) Follow up of Trial drug

Ardhedashemaniya Swasaharavati trail offered a further follow up 15 days was

done. The effect of yoga was analyzed according to clinical and functional response before

and after the treatment with 15 days intervals is compared to that of follow up data. In

further the final declaration of the trail drug effect and result is done on the basis of the

follow up data.

6) Source of data of Trial drug

The data was collected from the patients suffering from Tamaka Swasa in the OPD

of post graduation and research center DGM Ayurvedic medical college Gadag. The

method of the present study consists of following headings.

a) selection of the patient

b) examination of the patient

c) criteria of assessment

a) Selection of the patient

Patients of Tamaka Swasa (bronchial asthma) fulfilling the criteria of diagnosis

were selected in the present study. Patients were distributed randomly for the study, based

on present inclusion and exclusion criteria. Patients were excluded, as they are

discontinuous at the treatment or unable to fulfill the study design.

i) Inclusion criteria

Patients with symptoms of Tamaka Swasa are included with classical

symptoms enumerated at the classical texts under the lime light of contemporary

medical context. The symptoms of inclusion are as under.

Teevra vega Swasa (Dyspnoea)


91

Kasa (cough)

Duhkhena Kapha nissaranam (Expectoration)

Ghurghuratwam (Wheezing)

Peenasa (Coryza)

Kruchrena bhasate (Dysphonoea)

Kantodhwamsham (Hoarseness of voice)

Greevashirasangraha (Headache & Stiffness)

Urah Peeda (Chest Pain)

Shayane Swasa peedita (Discomfort at supine)

ii) Exclusion criteria

Patients other than exclusion criteria are included in the study of

Ardhedashemaniya Swasaharavati trail. The specified exclusions are as under with

their causes.

i. Patients with infective disease and status asthmatics cases are excluded –

as the superseded infection hampers the study and misleads.

ii. Patients with other systemic disease and status asthmatics cases are

excluded - as the drug effect could not be assessed specifically relevant

symptoms and possible misleads are suggestive of exclusion.

iii. Patients below 15 years are excluded from the study – as the children are

exposed recurrently to the dust at play and not possible to under take

response as they are subjected for growth.

iv. Patients above 65 years are excluded from the study – these elderly are

subjected for degeneration thus excluded from study.


92

v. Patients undertaking medication – intervenes the effect of the trail drug,

so such additive medications are prohibited in the study.

vi. Pregnant and lactating women are also excluded from the study – as the

placental barrier components may be there in the compound which may

harmful, even though Ayurvedic herbals are safe in this part as a routine

Pregnant and lactating women are excluded from the study.

b) Examination of the patient

Patient through examination is necessary to obtain clear picture of disease and also

the effect of trail drug - Ardhedashemaniya Swasaharavati. For that the following methods

are obtained in the study.

b-1) Physical signs of asthmatic patients –

A. During attack – 197

i. On Inspection – Accessory muscles e.g. sternomastoid, scalenus and

pectorals are in continual action to aid breathing.

Barrel shape chest is common with prolonged expiration

Jugular vein is distended

With each short breath there is marked sucking in of “supra clavicular

hallows”.

The lips, cheeks and nail beds and later the skin as a whole becomes

cyanosed in severe conditions

ii. On palpation – Expansion of chest diminished.

Vocal frematus diminished.


93

iii. On percussion – Note the hyper resonant, especially after many attacks,

emphysema also supervenes.

iv. On auscultation – The inspiratory effort is shortened and may hardly be

audible.

Expiration prolonged with rapid inspiration

High – pitched musical rhonchi with prolonged expiration replaces the

normal vesicular murmurs.

Expiration phase is unduly prolonged and wheezy

In severe asthma airflow may be insufficient to produce rhonchi and a

silent chest is an ominous (arishta) sign

B. Between attacks –

There are usually no physical signs between attacks except in patients with chronic

asthma, who are seldom without rhonchi. Prolonged asthma in elder may be complicated

with emphysema, but severe asthma starting in childhood usually causes ‘pigeon chest’

deformity.

b-2) Diagnosis measurements

The signs and symptoms of Tamaka Swasa mentioned in Ayurveda and modern

science were the main basis of diagnosis and criteria for assessing the response to the

treatment. Assessments of results were made according to clinical and functional

improvement observed in the study. Clinical assessment was made on the body change in

the severity of the symptoms and for clinical assessment symptoms viz. Swasakricchata,

kasa, dukhena kapha nissaranam, ghurguratwam, Uraha peeda and shayaneswasapeedit,


94

which are allotted grades according to their severity or to that of normalcy. The grades are

followed as under.

Swasa kricchrata 0 – Normal - no symptoms 1 – Mild – breathless with activity, frequency 1 to 2 times/week 2 – Moderate – breathless with talking, frequency 2 to 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 2 – Moderate - continuous cough during day and morning disturbing work 3 – Severe - continuous and night cough disturb activities

dukhen kapha nissaranu

0 – Normal - no phlegm 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

Ghurghurtwam

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 wheeze 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 day with cough 3 – Severe - continuous day and night

Krucchana 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 - no hoarseness of voice 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 samgrah

0 – Normal – no symptoms 1 – Mild - occasionally 2 – Moderate - 1 to 2 times in a week. 3 – Severe - 2 to 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


95

Shayanasy Swasa peedita

0 – Normal – no discomfort 1 – Mild - < 1 or 2 time/month 2 – Moderate - 2 time/week 3 – Severe - > 3 or frequently

Functional assessments like Peak Expiratory Flow Rate, Breath Holding Time are

considered in the study along with Absolute Eosinophilic Count to know the effect of

therapy on Eosinophilic activity in the study. The functional units of these parameters are

taken to consideration according to their normal values.

Grade 0 No symptoms of Swasa - Asthma

Grade 1 Mild – the patients of mild asthma are defined as those with one or more of the following –

Brief wheezing no more often than 1 – times/week

Exacerabations of cough

Breathless with activity

Infrequent nocturnal cough

Nocturnal asthma < 1-2times/month

PEER> 80% of base line data (when asymptomatic) predicted variability < 20%

Grade 2 Moderate asthma –

Symptoms 1-2 times/week

exacerbation that may as 1-several days

occasional emergency care

PEER 60-80% of base line 20-30% variability

Grade 3 Severe asthma

Daily wheezing

limited activity level

exacerbations that are often severe

frequent nocturnal symptoms

hospitalization 1 or 2 times/1 year or

emergency

PEER < 60% of base line/predicted variability >30%

The Swasa vis-à-vis bronchial asthma can be defined as mild, moderate and severe

based on the disease symptoms. This enables the clinician to put the disease in a specified

category for the overall assessment of asthma patient. As the severity of bronchial asthma,

defined by the national asthma education program 198 (NAEP) expert panels of 1991 is as


96

below mentioned is considered in the present study. The characteristics are generalized and

as the asthma is highly variable with these characters may overlap some times.

b-3) Assessment measures and Laboratory-investigations

The following investigations are under taken to fulfill the criteria of inclusions and

exclusions. The effective parameters which are considered for the assessment are as under.

a) Breath holding time (BHT)

Breath holding time (BHT) 199 is a simple test which can provide useful information

in health and disease of the lungs. 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. 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, etc.

Procedure:

Ask the patient to take a deep breath and count the time in seconds

b) Peak expiratory flow rate 200

In any lung disease such as asthma patients, PEFR values are decreased. This

PEFR measurement has many benefits in clinical medicine. It provides simple,

quantitative and reproducible measures of airway obstruction. PEFR has a very good

correlation with FEVI. This simple objective measurement of lung function helps detecting

early deterioration of lung function.

Measurement of PEFR is valuable in medical care settings to, asses the severity of

asthma as a basis for making treatment decisions, for increasing or decreasing the

medicaments. It monitors response to therapy during an acute exacerbation. With this we


97

can diagnose exercise induced asthma. To asses the overall success of ant therapy

concerned to lung function, the PEFR is more useful.

The Wright’s peak flow meter, introduced in 1959 is a simple, portable device used

for measuring the ventilatory function of lungs. This instrument measures the maximum

flow rate or peak flow rate, which is achieved during a single forced expiration. This

estimation is useful in distinguishing reversible (asthma) from irreversible (emphysema)

disease. The peak flow meter, which measures PEER is of special value cases of asthma

where the effectiveness of the treatment with bronchodilatory can be quickly evaluated.

Procedure

Step 1) ask patient to hold the 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 the flow meter with a sharp blast

Step 4) the movement of the needle on the dial indicates the PEER 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 350-500liters/minute.

c) Erythrocytes sedimentation rate

Erythrocytes sedimentation rate 201 is measures in the graduated tubes under

Westergren’s method (pipette method). This facilitates to understand possible presence of

organic disease or to follow the course of the disease. It is universally accepted that it is a

good prognostic method in clinical laboratory.


98

Procedure:

Steps 1) draw the sufficient blood sample from patient vein

Step 2) add anti coagulant to the blood

Steps 3) suck the blood in to the ESR tube

Step 4) note the point of sedimentation on graduated tube

d) Hemoglobin % 202

The hemoglobin content of whole blood is reported in terms of grams of Hb per 100

ml of whole blood (g/dl). Normal ranges are 14-18 g/dl in males and 12-16 g/dl in females.

Hemoglobin is responsible for the cell's ability to transport oxygen and carbon dioxide.

This is estimated with the Shali’s method in general, which will show the Hb% in grams/

dl.

e) Absolute Eosinophilic count 203

Eosinophils attack objects that have already been coated with antibodies. They are

phagocytic cells and will engulf antibody-marked bacteria, protozoa, or cellular debris.

However, their primary mode of attack involves the exocytosis of toxic compounds,

including nitric oxide and cytotoxic enzymes, onto the surface of their targets. Eosinophils

are important in the defense against large multicellular parasites, such as flukes or parasitic

worms, and they increase in number dramatically during a parasitic infection. Because they

are also sensitive to circulating allergens (materials that trigger allergies), eosinophils

increase in number during allergic reactions as well. Eosinophils are also attracted to sites

of injury, where they release enzymes that reduce the degree of inflammation and control

its spread to adjacent tissues.


99

This test is being done to all the patients before and after the treatment. To study the

effect of Ardhedashemaniya Swasaharavati on Eosinophils, considering normal range of

Eosinophils in peripheral blood as up to 250 cells, the AEC examination is performed.

The following are investigations were done prior to the study according to the need

either to make an exclusion or inclusion in to the study, which are commonly undertaken

for the lung disease.

a) Blood TC & DC

b) Radiological X-ray of chest (if necessary) and

c) Sputum examination (if necessary)

c) Criteria of assessment

Over all assessment of results are done considering the cumulative

subjective and objective parameters assessments. As the disease is not

totally curable in the scheduled time span of the study, the grades of

assessment made for the results declaration are as follows -

1. Not responded –

i. Patient not at all relieved with symptoms or

ii. PEER was not shown any improvement

iii. BHT not improved

iv. AEC not shown any significant reduction

v. not responded to the treatment by any means

2. Poor responded –

i. Incomplete Symptomatic relief for the patient,

ii. PEFR ≥ 150 L/min


100

iii. BHT > 10 sec

iv. AEC reduced but not in normal limits

3. Moderately responded –

i. Symptomatic relief for the patient is witnessed

ii. Relived with symptoms, while medicine is continued

iii. Shown PEFR improvements with the PEER ≥ 250 to 350 L/ min

iv. BHT ≥ 20 sec

v. AEC comes back in to normal limits

vi. Moderate symptoms within follow up schedule

4. Well responded

i. Patient relieved with symptoms after discontinuous of medicine even in

follow up schedule

ii. No further attacks reported even after exposure to aggravating factors

iii. Peak expiratory flow rate shows ≥ 350 L/min

iv. BHT comes to normal limits i.e. 40 sec

v. AEC reduces to normal limits

CHAPTER-5 RESULTS

Present study registers 65 patients, out of 135 approached patients. The

percentages of patients undertaken from the scrutinised are 48.14%. Out 135 patients, 67

(49.62%) were Tamaka Swasa patients and the rest of 68 (50.38%) patients were having

respiratory tract problem but not a condition of Tamaka Swasa. Out of the 67 patients of

Tamaka Swasa 65 (97.01%) patients were undertaken for the study. Out of 65 patients 15

(23.07%) patients were discontinued hence their data has not been included in the

assessment. The remaining 50 (76.93%) patients of Tamaka Swasa viz. Bronchial

Asthma, fulfilling the criteria of diagnosis and inclusive criteria were included in the

study. Peak Expiratory Flow Rate (PEFR) and Breath Holding Time (BHT) are

considered as an objective for the inclusion in the present study.

All the patients were examined before and after the trail, according to the case

sheet format given in the annex. Both the subjective and objective criteria were recorded.

The data recorded are presented under the following headings.

A. Demographic data

B. Evaluating disease Data

C. Result of the Ardhedashemaniya Swasaharavati in Tamaka Swasa and

D. Statistical analysis of the subjective (clinical) and objective parameters

A) Demographic data:

The details of Age, Gender, Religion, and Occupation etc. of the 50 patients are as

follows.

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results

101

Table – 9 Demographic Data

SN OPD Age Gender Religion Occupation Economical status

Food habits Result

1 5154 32 M Hindu Active High middle Mixed Diet WR 2 5285 38 F Hindu Sedentary High middle Vegetarian WR

3 5395 55 M Hindu Active Middle Vegetarian MR

4 5402 48 F Hindu Active High middle Mixed Diet WR 5 5541 50 M Muslim Labor Poor Mixed Diet WR 6 5642 34 M Hindu Sedentary High middle Vegetarian WR

7 5648 24 F Hindu Active High middle Vegetarian WR

8 18 53 F Muslim Active Middle Mixed Diet NR 9 45 50 M Hindu Active Middle Vegetarian MR

10 63 18 F Hindu Labor Poor Mixed Diet MR 11 201 58 M Hindu Active Middle Mixed Diet WR 12 812 55 F Hindu Active Middle Vegetarian PR

13 527 27 M Hindu Active High middle Mixed Diet WR 14 530 22 M Hindu Active High middle Vegetarian WR

15 562 53 F Hindu Active Middle Vegetarian NR

16 566 33 M Hindu Active High middle Vegetarian WR

17 572 23 M Hindu Labor Poor Vegetarian WR

18 605 50 M Hindu Active Middle Vegetarian MR

19 606 50 M Hindu Sedentary High middle Mixed Diet NR 20 611 24 M Hindu Active Middle Mixed Diet WR 21 624 60 M Hindu Active Middle Vegetarian PR

22 626 35 M Hindu Labor Middle Mixed Diet WR 23 676 24 M Hindu Active High middle Mixed Diet MR 24 677 45 M Hindu Active Middle Vegetarian PR

25 681 19 M Hindu Active High middle Vegetarian WR

26 748 42 F Hindu Active High middle Mixed Diet WR 27 749 45 M Hindu Active Middle Vegetarian WR


29 775 50 F Hindu Sedentary High middle Vegetarian MR

30 955 50 M Hindu Active Middle Vegetarian PR

31 994 22 M Hindu Active Middle Mixed Diet WR 32 995 24 F Hindu Active Middle Vegetarian WR


34 1497 48 F Hindu Active Middle Vegetarian PR

35 1498 51 F Hindu Active Middle Vegetarian MR

36 2210 50 F Hindu Active Middle Vegetarian PR

37 2310 45 M Hindu Active Middle Vegetarian WR


102

38 2283 45 M Muslim Labor Poor Mixed Diet WR 39 2332 40 M Hindu Active Middle Mixed Diet WR 40 2333 45 F Muslim Labor Poor Mixed Diet MR 41 2334 38 M Hindu Active Middle Vegetarian WR

42 2381 39 F Hindu Active High middle Vegetarian MR

43 2380 26 M Hindu Active Middle Mixed Diet WR 44 2398 50 F Hindu Labor Poor Mixed Diet PR 45 2399 55 M Hindu Labor Poor Mixed Diet MR 46 2433 47 M Hindu Active Middle Vegetarian MR

47 2481 56 M Hindu Active High middle Vegetarian NR

48 2493 46 F Hindu Labor Poor Vegetarian WR

49 2494 52 M Hindu Active Middle Vegetarian NR

50 2541 52 M Hindu Labor Poor Vegetarian WR

F = Female, M = Male, WR = Well Responded, MR = Moderately Responded,

PR = Poor Responded, NR = Not Respond,

A1) distribution of patients by Age

Age – gender distributions Observation and Results:

An interval of 10 has considered from the ages 15 to 65 as discussed in the

methods. In the study it is revealed that Tamaka Swasa is continued from the ages of 15

onwards and as the age advances the samples are settled with Tamaka Swasa. At the

older age group of 55-65 only 3 (6%) patients are reported. Where in 45-55 and 35-45

age groups reported with 20 (40%) and 10 (20%) patients in each group respectively. 15-

25 age group reported with the 11 (22%) patients with the symptoms of Tamaka Swasa

vis-à-vis Asthma. It is interested to note that the active age group patients of 25-35 age

groups reported only 6 (12%) patients. The tabulations are depicted as under.


103

Table- 10

Distribution of patients by Age- gender

Male patients Female patients Total patients Age

Number % Number % Number %

15 -25 6 12 5 10 11 22

25- 35 6 12 0 0 6 12

35 – 45 6 12 4 8 10 20

45 – 55 10 20 10 20 20 40

55 – 65 3 6 0 0 3 6

Total 31 19 50

Graph – 10

Distribution of patients by Age – Gender

Her

the manage

65

60

64 10

10

30

0 2 4 6 8 10

15 -25

25- 35

35 – 45

45 – 55

55 – 65

DISTRIBUTION OF PATIENTS BY AGE - GENDER

Female 5 0 4 10 0

Male 6 6 6 10 3

15 -25 25- 35 35 – 45 45 – 55 55 – 65

e in this study an attempt is made to understand the male female responses to

ment with respect to that of the age groups.

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 104

Table- 11

Result of Ardhedashemaniya Swasaharavati in trail patients by Age

Age

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

15 -25 11 22 9 18 2 4 0 0 0 0

25- 35 6 12 6 12 0 0 0 0 0 0

35 – 45 10 20 7 14 2 4 1 2 0 0

45 – 55 20 40 4 8 7 14 5 10 4 8

55 – 65 3 6 1 2 0 0 1 2 1 2

Total 50 100 27 54 11 22 7 14 5 10

Graph – 11


Obs

patients in 2

one (2%) pa

(14%) patie


1

0

1

5

0 0 0

4

9

7

6

4

0

2

7

2

00

1 1

0

1

2

3

4

5

6

7

8

9

10

15 -25 25- 35 35 – 45 45 – 55 55 – 65

Well Responded

ModerateResponded Poor Responded

Not Responded

ervations of well-responded group has 9 (18%) patients in the 15-25 interval, 6 (12%)

5-35 interval, 7 (14%) patients in 35-45 interval, 4 (8%) patients in 45-55 interval and

tient in the interval of 55-65. Out of the moderately responded group it is found that 7

nts out of 11 patients are from 45-55 age groups. At the category of poor responded


out of 7 patients 5 (10%) are from the same group i.e. 45-55 age groups. The rest of the

percentages and patients results are tabulated in the table number 11. The observation of this

study suggests that the Tamaka Swasa effects to that of 45-55 and 15-25 ages. The pictorial

representation is as above.

A2) Distribution of patients by Gender

Table- 12

Distribution of patients by Gender in Tamaka Swasa

Gender

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

Male 31 62 18 36 6 12 3 6 3 6

Female 19 38 9 18 5 10 4 8 2 4

Total 50 100 27 54 11 22 7 14 5 10

Graph - 12



Male62.00%

Female 38.00%


The male female ratio in the study is approximately 2:1 patients. The percentage

of the distribution does not show any gender differentiation to get this respiratory disease

in specific, except a small lean towards male population. The observations are 31 Patients

i.e. (62%) male and 19 patients i.e. (38%) were female.

Graph - 13

Result Distribution of patients by Gender in Tamaka Swasa

A3) dist

F

Christia

commun

Muslim

(52%) p

respond

observe

Result of patients by Gender in Tamaka Swasa

18

9

6

5

3

4

3

2

0 5 10 15 20

Male

Female

Not Responded

Poor Responded

Moderate Responded

Well Responded

ribution of patients by Religion

or the convenience of the study, the religion groups are noted as Hindu, Muslim,

n and Others. The maximum number of patients are noticed from the Hindu

ity as the ratio of community at the study area is more i.e. 46 (92%) along with

patients 4 (8%). At the results observed, out of 46 (92%) of Hindu patients, 26

atients Well responded, 9 (18%) patients moderately responded, 7 (14%) Patients

ed poor and 4 (8%) patients not responded. On the other hand the results

d at Muslim community are, out of 4 (8%), 2 patients fall under the category of


well responded and one each in moderately responded and not responded respectively.

The tabulation and graphical representation is as under.

Table- 13

Distribution of patients by Religion and gender identification

Male patients Female patients Total patients Religion

Number % Number % Number %

Hindu 29 58 17 34 46 92

Muslim 2 4 2 4 4 8

Christian 0 0 0 0 0 0

Others 0 0 0 0 0 0

Total 31 62 19 38 50 100

Graph – 14

Distribution of patients by religion in Tamaka Swasa

Distribution of patients by religion in Tamaka Swasa

Christian 0.00%

Hindu92.00%

Muslim8.00%

Others0.00%


Table- 14

Result Distribution of patients by Religion

Religion

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

Hindu 46 92 26 52 9 18 7 14 4 8

Muslim 4 8 2 4 1 2 0 0 1 2

Christian 0 0 0 0 0 0 0 0 0 0

Others 0 0 0 0 0 0 0 0 0 0

Total 50 100 27 54 11 22 7 14 5 10

Graph - 15

Result Distribution of patients by Religion in Tamaka Swasa

Result Distribution of patients by Religion in Tamaka Swasa

26

2

0

0

9

1

0

0

7

0

0

0

4

1

0

0

0 5 10 15 20 25 30

Hindu

Muslim

Christian

Others Not Responded

Poor Responded

Moderate Responded

Well Responded


A4) Distribution of patients by Occupation

Table- 15

Distribution of patients by occupation

Occupation

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

Sedentary 4 8 2 4 1 2 0 0 1 2

Active 36 72 19 38 7 14 6 12 4 8

Labour 10 20 6 12 3 6 1 2 0 0

Total 50 100 27 54 11 22 7 14 5 10

Graph - 16 Distribution of patients by Occupation

At

responded

treatment.

responded

PATIENTS BY OCCUPATION

Active72.00%

Sedentary8.00%

Labour20.00%

the results observed, out of 4 (8%) of sedentary patients, 2 (4%) patients well

, 1 (2%) patient moderately responded and 1 (2%) patient not responded to the

At the active group, out of 36 (72%) patients, 19 (38%) patients well

, 7 (14%) patients moderately responded, 4 (8%) patients not responded and 6


(12%) patients poorly responded. At the results are observed, out of 10 (20%) of Labour,

6 (12%) patients well responded, 3 (12%) patients moderately responded and 1 (2%)

patient poorly responded to the Ardhedashemaniya Swasaharavati. The pictorial

representation is as follows.

Graph – 17 Result of patients by occupation in Tamaka Swasa

A5) Distri

At

responded

and no pa

patients a

poorly res

(34%) pat

patients m

Result of patients by occupation in Tamaka Swasa

2

19

6

1

7

3

0

6

1

1

4

0

0 5 10 15 20

Sedentary

Active

Labour

Not Responded

Poor Responded

Moderate Responded

Well Responded

bution of patients by economic status

the results observed, out of 9 (18%) of poor patients, 5 (10%) patients are well

, 3 (6%) patients are moderately responded, 1 (2%) patient is poorly responded

tient is not responded. Out of 24 (48%) of Middle class patients, 10 (20%)

re well responded, 5 (10%) patients moderately responded, 6 (12%) patients

ponded and 3 (6%) patients are not responded. From higher middle class 17

ients reported and out of them 12 (24%) patients are well responded, 3 (6%)

oderately responded and 2 (4%) patients are not responded. No patients are


reported from the higher class of classification. The tabulation and pictorial graph is

expressed as here.

Table- 16

Distribution of patients by Economic status

Economic

status

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

Poor 9 18 5 10 3 6 1 2 0 0

Middle 24 48 10 20 5 10 6 12 3 6

Higher Middle 17 34 12 24 3 6 0 0 2 4

Higher 0 0 0 0 0 0 0 0 0 0

Total 50 100 27 54 11 22 7 14 5 10

Graph- 18

Result Distribution of patients by Economic status

5

10

12

0

3

5

3

01

6

0 00

32

00

2

4

6

8

10

12

14

Poor Middle Higher Middle Higher

Result by economical statusPatients


A6) Distribution of patients by diet

Table- 17 Distribution of patients by diet in Tamaka Swasa

Age

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

Vegetarian 29 58 16 32 6 12 4 8 3 6

Mixed diet 21 42 11 22 5 10 3 6 2 4

Total 50 100 27 54 11 22 7 14 5 10

The vegetarian and mixed diet ratio in the study is approximately 1:1 patients.

The percentage of the distribution does not show any diet differentiation to get this

respiratory disease in specific, except a small lean towards vegetarian population. The

observations are 29 Patients i.e. (58%) vegetarian and 21 patients i.e. (42%) were mixed

diet practitioners.

Graph - 19 Distribution of patients by diet in Tamaka Swasa

Distribution of patients by diet in Tamaka Swasa

Vegetarian 58.00%Mixed diet

42.00%


Graph - 20

Result Distribution of patients by diet in Tamaka Swasa

Not Responded

A

response

(6%0 pa

populati

respond

treatmen

B) Data

B1) Dis

A

under th

complai

Teevra v

Result of patients by Gender in Tamaka Swasa

16

11

6

5

4

3

3

2

0 2 4 6 8 10 12 14 16 18

Vegetarian

Mixed diet

Poor Responded

Moderate Responded

Well Responded

s the results observed, out of 29 (58%) vegetarians, 16 (32%) patients well

, 6 (12%) patients moderately responded, 4 (8%) patients poorly responded and 3

tients not responded to the management. As the results observed in mixed diet

on, out of 21 (42%), 11 (22%) patient well response, 5 (10%) patients moderately

ed, 3 (6%) patients poorly responded and 2 (4%) patients not responded to the

t.

related to the disease.

tribution of patients by presenting complaints

s the above table explains about the different symptoms evaluated at the study

e heading of Tamaka Swasa vis-à-vis Bronchial Asthma with the presenting

nts are foot forth here. The first and fore most complaint in Tamaka Swasa is

ega Swasa – Swasa Kruchrata (Dyspnonea) and Ghurghuratwam (Wheezing).


Table- 18

Presenting complaints Patients %

Teevra vega Swasa – swasa Kruchrata (Dyspnonea) 50 100

Ghurghuratwam (Wheezing) 50 100

Kasa (cough) 47 94

Duhkhena Kapha nissaranam (Expectoration) 43 86

Urah Peeda (Chest Pain) 39 78

Shayane Swasa peedita (Discomfort at supine) 37 74

Peenasa (Coryza) 33 66

Kruchrena bhasate (Dysphonoea) 22 44

Greevashirasangraha (Headache & Stiffness) 16 32

Kantodhwamsham (Hoarseness of voice) 12 24

Graph – 21

Distribution of patients by presenting complaints

Distribution by Presenting Complaints

Shayane Swasa peedita

37

Urah Peeda 39

Greevashirasangraha

16

Kruchrena bhasate 22

Kantodhwamsham

12

Peenasa 33

Kasa (cough), 47

Duhkhena Kapha nissaranam, 43

swasa Kruchrata 50

Ghurghuratwam, 50

0

10

20

30

40

50

60


All the patients in the study (100%) reported the above symptoms. The next most

common complaint is Kasa (cough) followed with Duhkhena Kapha nissaranam

(Expectoration). Only 12 patients (24%) reported with the Kantodhwamsham

(Hoarseness of voice). The other complaints such as Peenasa (Coryza) (33 patients –

66%), Kruchrena bhasate (Dysphonoea) (22 patients – 44%), Greevashirasangraha

(Headache & Stiffness) (16 patients – 32%), Urah Peeda (Chest Pain) (39 patients – 78%)

and Shayane Swasa peedita (Discomfort at supine) (37 patients – 74%) are reported in the

study. The tabulation and graphical representation is expressed above.

B2) Distribution of patients by Associated features

Table- 19

Presenting Associated features Patients Percentage

Muhur Swasa (frequent respiration) 28 56

Anidra (disturbed sleep) 26 52

Angamarda (Malaise) 23 46

Vishukasyata (Dryness of mouth) 20 40

Aruchi (Anorexia) 18 36

Lalata sweda 16 32

Muhuchaiva dhamyati (puts all effort to breath) 15 30

Trushna (Thirst) 14 28

Jwara (fever) 8 16

Pratamyati or Bhrushamarta (distressed) 7 14

Kampa (Tremors) 5 10

Vamathu (nausea) 3 6

Pramoha (fainting) 0 0

As many as features are associated with the study Tamaka Swasa vis-à-vis

Asthma with the associated complaints are foot forth here. Many complaints of


116

associative are not observed in the study. Muhur Swasa (frequent respiration), Anidra

(disturbed sleep), Angamarda (Malaise), Vishukasyata (Dryness of mouth), Aruchi

(Anorexia), Lalata sweda, Muhuchaiva dhamyati (puts all effort to breath), Trushna

(Thirst), Jwara (fever), Pratamyati or Bhrushamarta (distressed), Kampa (Tremors),

Vamathu (nausea) and Pramoha (fainting) are the associated listed below show their

involvement in the most frequently presented to the least along with the percentages.

Graph –22

Distribution of patients by Associated features of Tamaka Swasa

B3) Dis

T

under. O

8 (16%)

(4%) pa

Distribution of patients by Associated features

Vamathu 3

Pramoha 0

Kampa 5

Pratamyati or Bhrushamarta

7

Jwara8

Lalata sweda, 16 Trushna

14

Muhuchaiva dhamyati

15

Aruchi 18

Anidra 26

Angamarda 23

Muhur Swasa 28

Vishukasyata 20

0

5

10

15

20

25

30

tribution of patients by mode of on set

he modes of onset of the Tamaka Swasa vis-à-vis asthma results observed are as

ut of 38 (76%) of Gradual onset patients, 22 (44%) patients are well responded,

patients are moderately responded and 6 (12%) patients poorly responded and 2

tients are not responded. Out of 12 (24%) of sudden onset patients, 5 (10%)


patients are well responded 3 (6%) patients are moderately responded, 1 (2%) patients

poorly responded and 3 (6%) patients not responded.

Table- 20

DISTRIBUTION OF PATIENTS BY MODE OF ON SET

Onset

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

Gradual 38 76 22 44 8 16 6 12 2 4

Sudden 12 24 5 10 3 6 1 2 3 6

Total 50 100 27 54 11 22 7 14 5 10

Graph –23

Distribution of patients by Mode of on set

PATIENTS BY MODE OF ON SET

Gradual 76.00%

Sudden24.00%


B4) Distribution of patients by course

Table- 21

Distribution of patients by course

course

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

Episodic 30 60 20 40 7 14 2 4 1 2

Continuous 11 22 4 8 1 2 3 6 3 6

Initially episodic

9 18 3 6 3 6 2 4 1 2

Total 50 100 27 54 11 22 7 14 5 10

Graph – 24

Distribution of patients by course

observ

PATIENTS BY COURSE

Initially episodic18.00%

Episodic 60.00%

Continuous22.00%

The course distributions of the Tamaka Swasa vis-à-vis Asthma results are

ed as under. It classified under three headings as Episodic, Continuous and initially


episodic. Out of 30 (60%) of Episodic course patients, 20 (40%) patients are well

responded 7 (14.2%) patients are moderately responded, 2 (4%) patients are poorly

responded and 1 (2%) patient is not responded. Out of 11 (22%) of Continuous course

patients, 4 (8%) patients are well responded 1 (2%) patient are moderately responded, 3

(6%) patients poorly responded and 3 (6%) patients not responded. Out of 9 (18%) of

initially episodic course patients, 3 (6%) patients are well responded, 3 (6%) patients are

moderately responded, 2 (4%) patients are poorly responded and 1 (2%) patient is not

responded to the management. The graphical expression is as above.

B5) Distribution of patients by frequency

Table -22

Distribution of patients by frequency

Frequency

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

Few Hours 14 28 4 8 2 4 5 10 3 6

Few Days 27 54 15 30 8 16 2 4 2 4

Few Weeks 9 18 8 16 1 2 0 0 0 0

Total 50 100 27 54 11 22 7 14 5 10

The distributions of frequency are observed as much (27) patients with few days

interval of frequency of episode. The graphical expression is as under.


120

Graph – 25

Depicting the frequency episodes in Tamaka Swasa

B6) Di

Duratiattack

Contin

Interm

Subsidwith mediciTotal

with in

14

27

9

0

5

10

15

20

25

30

Few Hours Few Days Few Weeks

Depicting the Frequency episodes in Tamaka Swasa

stribution of patients by duration of attack

Table -23

Distribution of patients by duration of attack

on of

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

uous 10 20 5 10 1 2 2 4 2 4

ittent 32 64 20 40 9 18 2 4 1 2

es

ne

8 16 2 4 1 2 3 6 2 4

50 100 27 54 11 22 7 14 5 10

The distributions of duration observed in the study is as much as (32) patients

termittent duration of attack. The graphical expression is as under.


Graph – 26

Depicting the duration of attack in Tamaka Swasa

B7) Di

Period

Season

Irregul

Perenn

Total

with ir

10

32

8

05

10152025

3035

Continuous Intermittent Subsides withmedicine

Depicting the duration of attack in Tamaka Swasa

stribution of patients by periodicity

Table -24

Distribution of patients by periodicity

icity

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

al 11 22 6 12 2 4 2 4 1 2

ar 30 60 16 32 7 14 4 8 3 6

ial 9 18 5 10 2 4 1 2 1 2

50 100 27 54 11 22 7 14 5 10

The distributions of duration observed in the study is as much as (30) patients

regular periodicity. The graphical expression is as under.


Graph – 27

Depicting the periodicity in Tamaka Swasa

B7) Di

Precedfactors

Cough

Sneezicough Sneezicough nasal iNasal with coSneeziNasal

Nasal

Total

11

30

9

0

5

10

15

20

25

30

Seasonal Irregular Perennial

Depicting the periodicity in Tamaka Swasa

stribution of patients by preceding factors

Table -25

Distribution of patients by preceding factors

ing

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

11 22 6 12 4 8 0 0 1 2

ng with 21 42 12 24 3 6 3 6 3 6

ng, with

rritation

12 24 5 10 4 8 3 6 0 0

irritation ugh

3 6 3 6 0 0 0 0 0 0

ng, irritation

2 4 1 2 0 0 0 0 1 2

irritation 1 2 0 0 0 0 1 2 0 0

50 100 27 54 11 22 7 14 5 10


The distributions of duration observed in the study are as much as (21) patients

with Sneezing with cough followed with (11) patients of only cough. The graphical

expression is as under.

Graph – 28

Depicting the preceding factors in Tamaka Swasa

B9) Di

Aggravfactors

Dust

Smoke

Dust &

Total

Cough,11

Sneezing with cough, 21 Sneezing, cough

with nasal irritation,

12Nasal irritation

with cough , 3

Sneezing, Nasal irritation,

2 Nasal irritation, 1

0

5

10

15

20

25

Depicting the preceding factors in Tamaka Swasa

stribution of patients by aggravating factors

Table -26

Distribution of patients by aggravating factors

ating

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

17 34 8 16 5 10 1 2 3 6

6 12 4 8 0 0 2 4 0 0

smoke 27 54 15 30 6 12 4 8 2 4

50 100 27 54 11 22 7 14 5 10



with dust and smoke followed with (17) patients of only dust. The graphical expression is

as under.

Graph – 29

Depicting the aggravating factors in Tamaka Swasa

B10) D

Comfopostur

Sitting

ForwabendinSittingForwaBendinTotal

Cough,11

Smoke,

Dust_Smoke, 27

6

0

5

10

15

20

25

30

Depicting the aggravating factors in Tamaka Swasa

istribution of patients by comfort posture

Table -27

Distribution of patients by comfort posture

rt e

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

e R

espo

nded

% P

oor

Res

pond

ed

%

Not

R

espo

nded

%

24 48 14 28 7 14 2 4 1 2

rd g

5 10 3 6 0 0 2 4 0 0

& rd g

21 42 10 20 4 8 3 6 4 8

50 100 27 54 11 22 7 14 5 10



felt comfort with sitting followed with (21) patients with Sitting and Forward Bending of

comfort. The graphical expression is as under.

Graph – 30

Depicting the comfort posture in Tamaka Swasa

Sitting &

B11) D

observ

Vata

Angas

Alpabhahitam

Chesta

Vyamo

Sleshmvruddh

Sitting, 24 Forward bending,

5

Forward Bending, 21

0

5

10

15

20

25

Depicting the comfort Posture in Tamaka Swasa

istribution of patients by Dosha Kshaya lakshana

The Shareerika Prakruti distributions of the Tamaka Swasa vis-à-vis Asthma

ations are as under. It classified under three headings as Vata, Pitta, Kapha,

Table - 28 Pts % Pitta Pts % Kapha Pts %

ada 4 8 Mandagni 23 46 Bhrama 0 0

ashite

0 0 Shareera sheetatwam

32 64 Urah shoonyata

0 0

heenata 0 0 Prabha hani 0 0 Shira soonyata

0 0

ha 0 0 Hridrava 0 0

a i

0 0 Sandhi saidhilya

0 0


B12) Distribution of patients by Dosha vruddhi Prakruti

Table- 29 Vata Vruddhi

Lakshana Pts % Pitta Vruddhi

Lakshana Pts % Kapha

Vruddhi Lakshana

Pts %

Karshya 17 34 Peeta mootrata

0 0 Agni sadana 23 46

Karshnya 19 38 Peetanetra 0 0 Praseka 18 34

Ushna

kamitwa

38 76 Peetavit

0 0 Alasya

20 40

Kampa 5 10 Peetatwak 0 0 Swetangata 16 32

Anaha 14 28 Adhikshudha 0 0 Sheetangata 32 64

Shakrudgraha 12 24 Adhidaha 9 18 Gowrava 22 44

Balabhrmsha 6 12 Slathangata 0 0

Nidrabhramsha 26 52 Swasa 50 100

Pralapa 0 0 Kasa 47 94

Bhrama Atinidra

Out of the Dosha Kshaya Angasada (4 pts) of Vata and Shareera sheetatwam of

Pitta lakshana are observed. But at the Dosha vruddhi lakshana maximum of Kapha

lakshana and the pratyatma niyata lakshana of the disease Swasa is observed 50 patients

along with the Kasa of 47 patients. Nidra bhramsha (Vata) is observed with 26 patients

and ushna kamitwa for 38 patients. Anidra of Pitta and Nidra rahityata of Vata more or

less mimic and are observed as 9 patients in the study. Sheetangata of Kapha symptom is

observed for the 32 patients along with gowrava (22) and swetangata (16) patients.


127


128

B13) Distribution of patients by Ahara Nidana

Table -30

Vata Pts % Pitta Pts % Kapha Pts %

Visamashana (V) 14 28 Tilataila (P) 0 0 Pistanna (K) 11 22

Adhyashana (V) 12 24 Vidahi (P) 0 0 Nispava (K) 0 0

Anasana (V) 5 10 Saluka (K) 0 0

Sheetashana (V) 0 0 Guru dravyas (K) 40 80

Visha (V) 0 0 Jalajamamsa (K) 7 14

Sheetapana (V) 36 72 Anupamamsa (K) 17 34

Rukshanna (V) 34 68 Abhishyandi (K) 41 82

Masa (K) 27 54

Dadhi (K) 39 78

Vistambhi (K) 5 10

Amaksira (K) 0 0

It is observed those 40 patients under take Guru dravyas, 41 patients Abhishyandi

padartha, and 39 patients Dadhi, in their food, which is Kapha kara Ahara. Sheeta (36)

and Rooksha (34) anna, which is Vata kara ahara consumed by patients also listed here.

The percentage and the number of patients enrolled to the Ahara Nidana are tabulated in

the table – 30.


129

B14) Distribution of patients by Vihara Nidana

Table -31

Vihara Pts % Vihara Pts %

Rajas (V) 50 100 Abhighata (V) 0 0

Vata (V) 50 100 Dhuma (V) 23 46

Sheeta Sthana (V) 30 60 Apatarpana (V) 5 10

Sheeta ambu (V) 0 0 Bharakarshita (V) 5 10

Ativyayama (V) 11 22 Adhwahata (V) 20 40

Kanthapratighata (V) 0 0 Urahpratighata (V) 0 0

Karmahata (V) 6 12 Marmabhighata(V) 0 0

Veganirodha (V) 9 18 Usna (P) 0 0

Shuddhi Atiyoga (V) 0 0 Abhishyandi Upacara (K) 0 0

Gramya dharma (V) 0 0 Divasvapna (K) 0 0

It is observed that exposure to rajas and Vata is common among all 50 patients of

the study. Seta stnana, Dhooma, adwavata, Ati Vyayama, veganirodha, Karmahata,

apatarpana and Bharakarshita Vihara Nidana took the place of aetiology is tabulated in

the table – 31.

B15) Distribution of patients by Anya / Vyadhi Avasta sambandha Nidana

Out of the other symptoms scrutinized, Vibandha, Anaha, Panduroga, Dourbalya

of Vata lakshana are found in the study. At the same time Kasa and Pratishyaya which

are of Kapha lakshana and also lakshana of Tamaka Swasa show remarkable listing.


130

Jwara, which is Pitta lakshana also found as one of the avasta sambandha Nidana here.

The tabulation is as under.

Table - 32

Distribution of patients by Anya / Vyadhi Avasta sambandha Nidana

Lakshana pts % Lakshana pts % Lakshana pts %

Ksataksaya 0 0 Atisara 0 0 Visucika 0 0

Udavarta 0 0 Vibandha 9 18 Panduroga 4 8

Vat

a

Kshaya 0 0 Anaha 11 22 Dourbalya 4 8

Pit

ta Rakta Pitta 0 0 Jwara 5 10

Kasa 47 92 Amapradosa 0 0 Chardi 3 6

Kap

ha

Pratisyaya 28 56 Amatisara 0 0

B16) Distribution of patients by Srotas

Table – 33

Distribution of patients by Srotas

Lakshana pts % Lakshana pts %

Pranavaha Atisrustam 38 76 Ati badhdama 12 24

Kupitam 32 64 Abheekhnam 27 54

Alpalpa 38 76 Sashoolam 22 44

Annavaha Aruchi 19 38 Ajeerna 14 28

Chardi 3 6 Anannabhilasha 2 4

Udakavaha Jihwashosha 14 28 Talushosha 4 8

Ostashosha 11 22 Pipasa 14 28

The enlisted symptoms pertaining to that of the Srotas examination observations

are put forth here. The chief Srotas involved in the Tamaka Swasa is Pranavaha Srotas.

Out of the vitiated symptoms of the Pranavaha Srotas almost all symptoms are observed

here and specifically Atisrusta and Alpalpa found for as many as 38 patients.


131

Involvement of the Annavaha Srotas could not be ruled out as it is the udbhava stana. In

the Annavaha Srotas Aruchi and Ajeerna found for many. Udakavaha Srotas involvement

is established by the Jihwa sosha and Pipasa complaints of the patients. There were no

patients with out having either of the vitiated symptoms of the three Srotas which are said

to have the pathological involvement in the study. The symptoms involved patients with

percentages shown in the table 34 above.

B17) Distribution of patients by Poorva Roopa

Table -34

Distribution of patients by Poorva Roopa

Poorva Roopa Patients Percentage

Hrutpeeda 18 36

Kshudra Swasa 15 30

Shankha bheda 15 30

Shoola 0 0

Pranavilomata 28 56

Vaktra vairasya 0 0

Parshwashoola 26 52

Vibandha 9 18

Anaha 11 22

Arati 24 48

Bhakta dwesha 19 38

Admana 0 0

Out of the many told poorva Roopa, Prana vilomata, Parshwa shoola, Arati,

Hrutpeeda, shankha peeda and Kshudra Swasa are found to be more generalized. The

patients at the later course of the treatment period were not expressed. The tabulated

symptoms are depicted above in the table -34.


132

Table No-35 Distribution of patients by Chief complaints and Associated complaints

SN OPD S

was

a kr

uchr

ata

Kas

a

Ghr

gura

twa

Pee

nasa

Sha

yane

sw

asa

peed

ita

Kru

chre

na b

hash

ita

Ura

h pe

eda

Gre

eva

shir

a sa

mgr

aha

Kan

todh

wam

sha

Ani

dra

Pra

tam

yati

Aru

chi

Vis

huka

syat

i

Lal

ata

swed

a

Tru

shna

Ang

amar

da

Kam

pa

Jwar

a

Pra

moh

a

Vam

athu

Muh

ursw

asa

Duh

khen

akap

ha n

issa

rana

ma

Muh

ucha

vsad

amya

ti

1 5154 + + + + + + + + + + 2 5285 + + + + + + + + + 3 5395 + + + + + + + + + + + + + 4 5402 + + + + + + + + + + + + + + + 5 5541 + + + + + + + + + + + + + + + + + + + 6 5642 + + + + + + + + + + 7 5648 + + + + + + + + + + + + + + 8 18 + + + + + + + + + + + + + + + + + + 9 45 + + + + + + + + + + + + + + + 10 63 + + + + + + + + + + + + + + + + 11 201 + + + + + + + + + + + + 12 812 + + + + + + + + + + 13 527 + + + + + + + + 14 530 + + + + + + + + + + 15 562 + + + + + + + + + + + + 16 566 + + + + 17 572 + + + + + + + + + + 18 605 + + + + + + + + + + 19 606 + + + + + + + + + + 20 611 + + + + + + + + 21 624 + + + + + + + + + + + + + + + + 22 626 + + + + + + + + + 23 676 + + + + + + + + + + 24 677 + + + + + + + + + + + + 25 681 + + + + + + + 26 748 + + + + + + + + + 27 749 + + + + + + + + + + + + 28 774 + + + + + + + + + 29 775 + + + + + + + + + + + + + + + 30 955 + + + + + + + + + + 31 994 + + + + + + + + + + + + + 32 995 + + + + + + + + + 33 1001 + + + + + + + + + + + + +


133

34 1497 + + + + + + + + + + 35 1498 + + + + + + + + + + + 36 2210 + + + + + + + + + + + 37 2310 + + + + + + + + + + + + 38 2283 + + + + + + + + + 39 2332 + + + + + + + + + 40 2333 + + + + + + + + + + + 41 2334 + + + + + + + + + + 42 2381 + + + + + + + + + + 43 2380 + + + + + + + + 44 2398 + + + + + + + + + + + 45 2399 + + + + + + + + + + 46 2433 + + + + + + + + 47 2481 + + + + + + + + + + 48 2493 + + + + + + + 49 2494 + + + + + + + + + 50 2541 + + + + + + +

Table No-36 Distribution of patients by History of present illness

Mod

e of

on

set

Cou

rse

Fre

quen

cy

of a

ttac

k

Dur

atio

n of

att

ack

Per

iodi

city

Pre

cedi

ng

fact

ors

Spu

tum

Agg

rava

tin

g fa

ctor

s

Com

fort

po

stur

e at

at

tack

Ser

ial N

umbe

r

OPD

Sud

den

Gra

dual

Epi

sodi

c

Con

tinu

ous

Init

iall

y ep

isod

ic

Few

day

s

Few

hou

rs

Few

wee

ks

Con

tinu

ous

Inte

rmit

tent

Sub

side

s w

ith

med

icin

e

Sea

sona

l

Irre

gula

r

Per

inea

l

Sne

ezin

g

Nas

al ir

rita

tion

Cou

gh

Non

pur

ulen

t

Pur

ulen

t

Dus

t

Sm

oke

Pet

s

Pol

lens

Sit

ting

Lyi

ng

Sta

ndin

g

For

war

d be

ndin

g

1 5154

+ + + + + + + + + + +

2 5285 + + + + + + + + + + + 3 5395 + + + + + + + + + 4 5402 + + + + + + + + + + + 5 5541 + + + + + + + + + + + + +6 5642 + + + + + + + + + + +7 5648 + + + + + + + + + + + 8 18 + + + + + + + + + + +9 45 + + + + + + + + + +10 63 + + + + + + + + + + +11 201 + + + + + + + + + + +12 812 + + + + + + + + + +


134

13 527 + + + + + + + + + + + 14 530 + + + + + + + + + + +15 562 + + + + + + + + + + + +16 566 + + + + + + + + + + +17 572 + + + + + + + + + + + + 18 605 + + + + + + + + + + +19 606 + + + + + + + + + + + +20 611 + + + + + + + + + + + +21 624 + + + + + + + + + + + 22 626 + + + + + + + + + + +23 676 + + + + + + + + + 24 677 + + + + + + + + + + + + 25 681 + + + + + + + + + + + 26 748 + + + + + + + + + + + 27 749 + + + + + + + + + + + +28 774 + + + + + + + + + + + + 29 775 + + + + + + + + + + 30 955 + + + + + + + + + + + +31 994 + + + + + + + + + 32 995 + + + + + + + + 33 1001 + + + + + + + + + + +34 1497 + + + + + + + + + + + + + +35 1498 + + + + + + + + + +36 2210 + + + + + + + + + + + +37 2310 + + + + + + + + + + + 38 2283 + + + + + + + + + 39 2332 + + + + + + + + + + +40 2333 + + + + + + + + + + + + 41 2334 + + + + + + + + + + + +42 2381 + + + + + + + + + + + 43 2380 + + + + + + + + + + + +44 2398 + + + + + + + + + +45 2399 + + + + + + + + + + 46 2433 + + + + + + + + + + + + +47 2481 + + + + + + + + + +48 2493 + + + + + + + + + + + 49 2494 + + + + + + + + +50 2541 + + + + + + + + +


135

Table - 37 Distribution of patients by Dosha Vruddhi Lakshana

Vata vruddhi lakshana Pittavruddhi

lakshana Kapha vruddhi lakshana

SN

OPD

Kar

shya

Kar

shny

a

Usn

a ka

mit

wa

Kam

pa

Ana

ha

shak

rut g

raha

m

Bal

abhr

amsh

a

Nid

ra b

hram

sha

Pra

lapa

Bhr

ama

Pee

ta m

ootr

ata

Pee

ta n

etra

Pet

a vi

t

Pee

ta tw

ak

Adh

ika

kshu

dha

Ati

dah

a

Agn

isad

ana

Pra

seka

Ala

sya

Sw

etas

ngat

a

She

etan

gata

Gow

rava

Sla

than

gata

Sw

asa

Kas

a

Ati

nidr

a

1 5154 + + + + + + + + + + + 2 5285 + + + + + + + + + + 3 5395 + + + + + + + 4 5402 + + + + + + + 5 5541 + + + + + + + + + + + 6 5642 + + + 7 5648 + + + + + + + + + + 8 18 + + + + + + 9 45 + + + + + + 10 63 + + + + + + + + + 11 201 + + + + + + 12 812 + + + + + + + + + + 13 527 + + + 14 530 + + + + + + 15 562 + + + + + + 16 566 + + + 17 572 + + + + + + + + 18 605 + + + + + + + + 19 606 + + + + + + + + + 20 611 + + + + + + + 21 624 + + + + + + + 22 626 + + + + + + 23 676 + + + + + + + + + + + 24 677 + + + + + + + + + + 25 681 + + + + + + + 26 748 + + + + + + + + + 27 749 + + + + + + + + + 28 774 + + + + + + 29 775 + + + + + + + + + + + 30 955 + + + + + + + + + + 31 994 + + + 32 995 + + + + + + + + +


136

33 1001 + + + + + + + + 34 1497 + + + + + + + + 35 1498 + + + + + 36 2210 + + + + + + + + + 37 2310 + + + + + + + 38 2283 + + + + + + + + + + + 39 2332 + + + + + + 40 2333 + + + + + + + 41 2334 + + + 42 2381 + + + + + + + + + + + + 43 2380 + + + + + + 44 2398 + + + + + + + + + + + + 45 2399 + + + + + + + + 46 2433 + + + + + + + + 47 2481 + + + + + + + + 48 2493 + + + + + + + + + 49 2494 + + + + + 50 2541 + + + + + + + + +

Table - 38 Distribution of patients by Dosha Kshaya Lakshana

Vata Kshaya lakshana Pitta Kshaya

lakshana Kapha Kshaya lakshana

SN

OPD

Ang

asad

a

Alp

a bh

ashi

te h

itam

Che

sta

heen

ata

Vya

moh

a

Shl

eshm

a vr

uddh

i

Man

dagn

i

Sha

reer

a sh

eeta

ta

Pra

bhah

ani

Bhr

ama

Ura

h sh

oony

ata

Shi

ra s

hoon

yata

Hru

drav

a

San

dhi s

hait

hily

a

1 5154 + + 2 5285 + + 3 5395 + + 4 5402 5 5541 + + 6 5642 7 5648 + + + 8 18 + + 9 45 10 63 + + 11 201 + + 12 812 + +


137

13 527 14 530 + + 15 562 + + 16 566 17 572 + + 18 605 + + 19 606 + + 20 611 + 21 624 22 626 + 23 676 + + + 24 677 25 681 + + 26 748 + 27 749 + + 28 774 + 29 775 + + 30 955 + + 31 994 32 995 33 1001 34 1497 + + 35 1498 + + 36 2210 37 2310 + + 38 2283 + + 39 2332 + 40 2333 + 41 2334 42 2381 + + 43 2380 44 2398 + + 45 2399 46 2433 + + 47 2481 + 48 2493 + + 49 2494 50 2541 +


138

Table - 39 Distribution of patients by Ahara nidana

Vata Pitta Kapha

SN

OPD V

isha

mas

hana

Adh

yasa

na

Ana

shan

a

She

eta

snan

a

Vis

ha

She

etap

ana

Roo

ksha

nna

Til

a ta

ila

Vid

hahi

Pis

tann

a

Mas

ha

Nis

hpav

a

Dad

hi

Sha

look

a

Vis

tam

bhi

Gur

udra

vya

Am

a ks

heer

a

Jala

ja m

amsa

Ano

opa

mam

sa

Abh

ishy

andi

1 5154 + + + + + + + + 2 5285 + + + + + + + + + 3 5395 + + + + + + 4 5402 + + + + + + + + + 5 5541 + + + + + + + + + + 6 5642 + + + + + + + + + 7 5648 + + + + + + + + + 8 18 + + + + + + + + 9 45 + + + + + 10 63 + + + + + + + + 11 201 + + + + + + + + 12 812 + + + + 13 527 + + + + + + + 14 530 + + + + + 15 562 + + 16 566 + + + + + 17 572 + + + + 18 605 + + + + + + 19 606 + + + + + + + 20 611 + + + + + 21 624 + + + + + + 22 626 + + + + + 23 676 + + + + + + 24 677 + + 25 681 + + 26 748 + + + + + + + + 27 749 + + + + + 28 774 + + + + + + 29 775 + + + + + 30 955 + + + + + + 31 994 + + + + 32 995 + + + + 33 1001 + + + + + 34 1497 + + + 35 1498 + + + + +


139

36 2210 + + + + 37 2310 + + + + + + + 38 2283 + + + + + 39 2332 + + + + + 40 2333 + + + + + + + 41 2334 + + + 42 2381 + + + + + + 43 2380 + + + + + + + 44 2398 + + + + + + 45 2399 + + + + + 46 2433 + + + + + 47 2481 + + + + + 48 2493 + + + + + + 49 2494 + + + + + + 50 2541 + + + + + +

Table - 40 Distribution of patients by Vihara Nidana

SN

OPD

Raj

a se

vana

Vay

u se

vana

Ati

vyay

ama

Abh

igha

ta

Dho

oma

Apa

tarp

ana

Bha

raka

rsha

ta

Adh

wah

ata

Kan

tapa

rati

ghat

a

Kar

mah

ata

Veg

anir

odha

Sud

dhi a

tiyo

ga

Gra

mad

harm

a

Ura

h pr

atig

hata

Mar

mab

high

ata

Abh

shya

ndi

uapa

char

a

Diw

asw

apna

1 5154 + + + 2 5285 + + + + + + 3 5395 + + + + 4 5402 + + + + + + 5 5541 + + + + + + 6 5642 + + + 7 5648 + + + + + + + 8 18 + + + 9 45 + + + + + 10 63 + + + + + 11 201 + + + 12 812 + + 13 527 + + 14 530 + + 15 562 + + + 16 566 + + + + + 17 572 + + + + + + 18 605 + + + + + + + 19 606 + + 20 611 + + + 21 624 + + +


140

22 626 + + + + + 23 676 + + + 24 677 + + + 25 681 + + 26 748 + + 27 749 + + + + + + 28 774 + + + 29 775 + + + + + + + 30 955 + + 31 994 + + + 32 995 + + + + 33 1001 + + 34 1497 + + 35 1498 + + + 36 2210 + + + + 37 2310 + + + + 38 2283 + + + + + + 39 2332 + + 40 2333 + + + + 41 2334 + + + + 42 2381 + + + + 43 2380 + + 44 2398 + + + + + 45 2399 + + + + 46 2433 + + + + 47 2481 + + + 48 2493 + + + + 49 2494 + + + + 50 2541 + +

Table - 41 Distribution of patients by Anyavyadhi avasta sambandhi

SN

OPD

Ksh

ata

ksha

ya

Ksh

aya

Ana

ha

Dou

rbal

ya

Uda

vart

a

Vib

andh

a

Pan

duro

ga

Rak

tapi

tta

Jwar

a

Kas

a

Pra

tish

yaya

Am

apra

dosh

aja

vyad

hi

Am

atis

ara

Cha

rdi

Vis

huch

ika

1 5154 2 5285 + + 3 5395 + 4 5402 + + 5 5541 + + 6 5642 + 7 5648 + + +


141

8 18 + 9 45 + 10 63 + 11 201 12 812 13 527 14 530 + 15 562 16 566 + 17 572 + 18 605 + + 19 606 20 611 21 624 + 22 626 23 676 + 24 677 + 25 681 26 748 + 27 749 28 774 + 29 775 + 30 955 31 994 32 995 + 33 1001 + 34 1497 + + 35 1498 36 2210 37 2310 + 38 2283 39 2332 + 40 2333 41 2334 + + 42 2381 43 2380 44 2398 + 45 2399 46 2433 + 47 2481 48 2493 49 2494 50 2541


142

C) Result of the Ardhedashemaniya Swasaharavati in Tamaka Swasa vis-à-vis Asthma

C1) Assessment of Subjective parameters in Tamaka Swasa

Table- 42 Subjective parameters assessment in Tamaka Swasa

Presenting complaints

Pat

ient

s B

efor

e

%

Pat

ient

s A

fter

%

Pat

ient

s re

liev

ed

%

Teevra vega Swasa (Dyspnonea)

50 100 21 42 29 58

Kasa (cough)

47 94 18 36 29 61.7


43 86 20 40 23 53.48


50 100 25 50 25 50

Peenasa (Coryza)

33 66 15 30 18 54.54


22 44 10 20 12 54.54


12 24 5 10 7 58.33


16 32 9 18 7 43.75


39 60 16 20 23 58.97


37 70 14 28 23 59.45

All the subjective parameters which are declared for the assessment of the

Ardhedashemaniya Swasaharavati are tabulated here in the table 42. Out of the

symptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patients initially are

relieved 58%. Another symptom found for all patients is Ghurgurukatwam is relieved for

the 50% of patients in the study. Kasa a symptom appeared for 47 patients initially

relived 61.7% in the study. Next best appeared symptom is Duhkhena Kapha nissaranam


143

for the 43 patients noticed relieved for the 53.48% of patients. Shayane Swasa peedita is

the next symptom with 37 patients found corrected at the end by 59.45%. 39 patients of

Urahpeeda corrected at the end of study by 58.97%. Peenasa, a symptom of the

Pranavaha Srotas always found associated with the Tamaka Swasa found for 33 patients

got through by the end with 54.54% of relief. Greevashirasangraha (16 patients) and

Kantodhwamsham (12 patients) are the other two symptoms of assessment got relief with

43.75 and 58.33 percentages respectively. The tabulation is as expressed above.

C2) Assessment of Objective Parameters in Tamaka Swasa

At the Objective Parameters assessment in Tamaka Swasa in the study of

Ardhedashemaniya Swasaharavati five objective parameters are assessed are enlisted in

the table 43. All these are of disease oriented and specific to assess the

Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis Bronchial Asthma.

The table is followed as under.

Table - 43

Objective Parameters assessment in Tamaka Swasa

Breath Holding Time

Peak Exploratory Flow Rate

Erythrocyte Sedimentation

Rate Hemoglobin %

Absolute Eosinophilic

Count SN

OPD

Before After Before After Before After Before After Before After 1 5154 10 24 180 350 10 8 10 11 500 3002 5285 8 20 150 360 10 10 9 10.2 450 2503 5395 8 15 125 290 14 10 10.4 12 500 3504 5402 10 20 200 380 8 6 9.6 10.4 450 2505 5541 12 22 160 350 10 10 9.2 10 500 3506 5642 12 20 180 370 10 8 12 12 550 3507 5648 10 20 150 370 10 10 10.8 11.2 500 2508 18 5 5 90 90 14 12 9.6 11 600 6009 45 8 14 140 250 8 10 11.4 12.6 550 35010 63 10 18 125 250 10 6 9.4 10.4 550 30011 201 10 22 140 350 12 10 10 11.8 500 30012 812 8 12 120 160 12 8 11 12.2 550 450


144

13 527 12 25 180 360 10 10 12 13 500 25014 530 10 21 150 350 8 10 11.2 12 500 35015 562 6 6 80 80 12 14 10.4 11.8 650 60016 566 8 20 160 350 10 6 9 10.6 500 25017 572 10 20 180 380 7 10 12 12.8 550 35018 605 7 15 120 270 8 8 12 13 500 35019 606 5 6 70 80 14 12 10 10 600 60020 611 14 30 240 450 8 6 12.6 13 500 25021 624 6 10 100 160 10 10 12.8 12 550 45022 626 12 25 200 380 8 8 9.8 11 500 25023 676 8 15 145 320 6 10 11.2 12.4 500 35024 677 5 10 120 180 12 10 10 11 450 35025 681 10 22 160 380 10 8 11 12.6 500 25026 748 12 22 150 380 10 10 10.6 11 550 35027 749 14 30 180 400 10 8 11 12.4 500 25028 774 10 20 140 350 8 10 9.2 10.4 550 35029 775 8 14 120 280 8 8 8 9.6 500 35030 955 8 12 100 150 12 12 12 12.6 550 45031 994 10 18 170 360 10 5 10.6 11 500 25032 995 10 20 150 380 8 8 12 13 500 25033 1001 12 22 160 370 10 10 8 9 500 35034 1497 8 12 90 140 12 10 11.2 12 600 50035 1498 10 18 125 250 10 8 12.2 11.8 550 35036 2210 6 10 110 170 10 10 12 12 550 45037 2310 12 25 200 350 8 6 8.2 10.4 500 25038 2283 10 22 140 360 12 8 10 11.8 500 25039 2332 10 20 170 350 10 10 10.6 12 500 35040 2333 7 16 130 300 10 8 9 9.8 550 35041 2334 10 24 150 380 6 6 10.4 12.2 500 25042 2381 8 15 135 250 8 10 12.8 13.2 500 35043 2380 10 18 140 360 12 10 11.2 12.8 500 25044 2398 6 10 100 130 14 12 10.4 11 550 40045 2399 8 14 160 280 10 10 11 12.6 550 35046 2433 7 18 130 300 8 6 9.2 10.4 500 35047 2481 5 5 80 90 15 14 10 10 650 55048 2493 10 25 160 370 10 8 12 13.2 500 25049 2494 5 8 90 80 12 12 11 10.8 550 50050 2541 12 20 140 350 10 10 10 10.8 500 250

Total 452 875 7085 14490 504 459 529 575.8 26200 17350Mean 9.04 17.5 141.7 289.8 10.08 9.18 10.58 11.51 524 347

SD 2.381 6.171 35.36 103.5 2.088 2.057 1.232 1.093 43.14 100.2


145

Out of the assessments of objective parameters it is clearly understood that the

Breath Holding Time (BHT) means are compared and observed that a lot of 8.46 suggests

that the lung capacity is enriched. This is conformed by the second significant test Peak

Expiratory Flow rate (PEFR). In the PEFR readings it is clear once again that the

difference is as wide as 148.1, almost more than 50% improvement. Oxygen is the most

essential to live and that is carried by the Red Blood Corpuscles and Haemoglobin. The

Hb% in the blood are studied as one of the parameter has 0.93 variance of mean shows

that the drug even has the effect over the increasing the haemoglobin and RBC. The next

best prognostic and also estimating objective parameter is the Erythrocyte Sedimentation

Rate; record the marked decrease, which is a significant of disease regression, is 0.9

difference to that of baseline data to the final data. As many as Pranavaha Srotas

symptoms are seen along with the Tamaka Swasa needs the Absolute Eosinophilic Count

as the parameter is studied here and observed that 177 mean AEC decrease.

C3) Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa vis-à-vis Asthma

The result in the study ascertains the best activity of the Ardhedashemaniya

Swasaharavati over the Tamaka Swasa vis-à-vis Asthma. For the convenience the results

are grouped as four categories, viz. Well-Responded (WR), Moderately Responded

(MR), Poorly Responded (PR) and Not-responded (NR). All these patients are studies

with the cumulative percentages obtained through subjective and objective Parameters is

as under.


146

Table – 44 Cumulative effect in percentages obtained through subjective and objective Parameters for

Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis bronchial Asthma

OPD

Sw

asa

Kru

chra

te

Kas

a

Duh

khen

akap

hani

ssa

rana

m

Ghr

guru

katw

a

Ura

hpee

da

Sha

yane

sw

asa

pe

edita

PE

FR

BH

T

ES

R

AE

C

Tota

l

Per

cent

age

Res

ult

5154 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 5285 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 5395 2 3 2 2 3 3 2 2 1 2 22 73.33 MR 5402 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 5541 3 3 2 3 2 2 3 2 3 3 26 86.66 WR 5642 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 5648 3 3 3 2 3 3 3 2 3 3 28 93.33 WR

18 0 0 0 0 0 0 0 1 0 0 1 3.33 NR 45 2 2 2 2 2 2 2 2 3 3 22 73.33 MR 63 2 3 2 2 3 2 2 1 3 1 21 70 MR

201 3 3 2 2 3 3 3 2 3 3 27 90 WR 812 1 0 1 1 3 3 1 1 2 1 14 46.66 PR 527 3 3 3 3 3 3 3 3 3 2 29 96.66 WR 530 3 3 3 2 3 3 3 2 3 2 27 90 WR 562 0 1 0 0 3 0 0 1 0 1 6 20 NR 566 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 572 3 3 2 2 3 3 3 2 3 2 26 86.66 WR 605 2 1 2 2 3 3 2 2 3 2 22 73.33 MR 606 0 0 1 0 0 0 1 0 1 0 3 10 NR 611 3 3 3 3 3 3 3 3 3 3 30 100 WR 624 1 0 1 1 0 0 1 1 3 1 9 30 PR 626 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 676 1 2 1 1 3 3 2 2 2 2 19 63.66 MR 677 1 1 0 1 3 2 1 1 2 1 14 46.66 PR 681 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 748 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 749 3 3 3 3 3 3 3 3 3 3 30 100 WR 774 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 775 2 1 1 2 3 1 2 2 3 2 19 63.33 MR 955 1 1 0 1 2 1 1 1 0 1 9 30 PR 994 3 3 3 3 3 3 3 2 2 3 28 93.33 WR 995 3 3 3 3 3 3 3 2 3 3 29 96.66 WR

1001 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 1497 1 1 0 1 3 3 1 1 2 1 14 46.66 PR 1498 2 1 2 1 3 3 2 2 3 2 21 70 MR 2210 0 1 0 3 3 1 1 1 3 1 14 46.66 PR 2310 3 3 3 3 3 3 3 2 3 3 29 96.66 WR


147

2283 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2332 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 2333 2 2 2 2 2 3 2 2 3 2 22 73.33 MR 2334 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2381 1 2 2 1 2 1 2 2 3 2 18 60 MR 2380 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2398 1 1 1 0 3 0 1 2 1 1 11 36.66 PR 2399 2 2 2 2 2 3 2 2 2 2 21 70 MR 2433 2 3 2 3 1 3 2 2 2 2 22 73.33 MR 2481 0 0 0 0 0 0 0 0 0 1 1 3.33 NR 2493 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2494 0 1 0 0 0 0 0 1 0 1 3 10 NR 2541 3 3 3 3 3 3 3 2 3 3 29 96.66 WR

As par the discussions made and the results observed in the study of

Ardhedashemaniya Swasaharavati, the results are declared as under keeping the all

subjective and objective parameter developments in view. After through study of the

entire parameters and materials available for the assessment of results it was drawn a

conclusion of results as - 27 (54%) well responded, 11 (22%) moderately responded, 7

(14%) poorly responded and 5 (10%) patients not responded and the 12 patients

discontinued in the study, were not considered for the result declaration. The tabulated

result and pi-diagram graphical expression is as under.

Table-45 Result of Ardhedashemaniya Swasaharavati in Tamaka Swasa

Result Number of patients Percentage

Well Responded 27 54

Moderately Responded 11 22

Poorly Responded 7 14

Not Responded 5 10

Total 50 100


148

Graph – 31

Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa

D) Statistical analysis of the Subjective and Objective parameters

D1) Objective parameters

Table – 46

Statistical analysis of Objective parameters

Objective Parameters

Mean SD SE Z-Value p-Value Significance

PEFR 147.7 73.59 10.407 14.19 < 0.01 HS

BHT 8.84 4.037 0.57 15.48 < 0.01 HS

AEC 178.00 69.73 9.81 18.14 < 0.01 HS

ESR 1.9 2.032 0.287 6.608 < 0.01 HS

HS = Highly Significant

Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa

Not Responded10.00%

Moderately Responded

22.00%

Well Responded54.00%

Poorly Responded14.00%


149

D2) Subjective parameters Ardhedashemaniya Swasaharavati in Tamaka Swasa

Table – 47 Statistical analysis of Subjective parameters

Subjective parameters

Mean SD SE Z-Value p-Value

sign

ific

ance

Teevra vega Swasa (Dyspnonea)

1.58 0.731 0.103 15.33 < 0.01 HS

Kasa (cough)

1.4 0.832 0.117 11.88 < 0.01 HS


1.18 0.774 0.109 10.77 < 0.01 HS


1.44 0.704 0.099 14.45 < 0.01 HS

Peenasa (Coryza)

0.68 0.74 0.104 6.49 < 0.01 HS


0.38 0.567 0.08 4.73 < 0.01 HS


0.16 0.42 0.05 2.68 < 0.01 HS


0.22 0.418 0.059 3.71 < 0.01 HS


0.68 0.767 0.108 6.263 < 0.01 HS


0.58 0.537 0.076 7.623 < 0.01 HS


Individually all the parameters shows highly significance, as p value is <0.01. But

in the subjective parameters Swasakruchrata, Ghrgurukatwa, Kasa and Duhkhena

kaphanissaranam shows highly significance than the Urahpeeda, Shanasya Swasa peedita

(comparing Z values).

In the objective parameters AEC, BHT and PEFR show high significance that the

ESR (by comparing Z value). The parameter PEFR shows more variation. The mean net

effect of AEC is more before and after treatment. The subjective parameter


150

Swasakruchrata and Ghrgurukatwa, mean net effect is more. The parameter Kasa shows

more variation and the Shayanasya Swasa peedita show less variation (by comparing

mean and SD).

Here we assume that if sample size is more than or equal to 30 the sampling

distribution will follow normal distribution with specified mean and SD for respective

parameters.

As sample size is more that 30 we use the technique of paired t-test to find out the

effect of the drug before and after the treatment. Here instead of the t-table value we used

the Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is a large sample test to find

the p-value.

D3) Objective parameters Baseline comparison Ardhedashemaniya Swasaharavati in TS

Table -48

Objective parameters Baseline comparison in Ardhedashemaniya Swasaharavati in TS

Parameters Mean SD SE Z-Value p-Value Significance

BT 141.7 35.36 5.00 PEFR

µ o = 350 AT 289.8 103.53 14.64 4.11 <0.01 HS

BT 9.04 2.38 0.36 BHT

µ o = 40 AT 17.5 6.17 0.872 25.8 <0.01 HS

BT 524 43.141 6.101 AEC

µ o = 250 AT 347 100.2 14.17 6.84 <0.01 HS

BT 10.08 2.088 0.295 ESR

µ o = 10 AT 9.18 2.057 0.29 2.82 <0.01 HS


Further the analysis is done by using large sample test with specified mean value.

The parameter PEFR show high significance as p value is < 0.01 after the treatment. The


151

population mean is 350 litres/ minute. The mean effect after the treatment is improved

with more variance.

The parameter BHT show high significance as p value is < 0.01 after the

treatment where the population mean is 40 seconds. The mean effect BHT after the

treatment is more than the before with more variance.

The parameter AEC show high significance as p value < 0.01 after the treatment

for population mean 250 cells / cubic millimetre. The mean value after the treatment is

reduced than the before treatment with more variance which is towards normal.

The parameter ESR show high significance as p value is < 0.01 after the treatment

where the population mean is 10 millimetre /hour. There is reduction in mean value of

ESR after the treatment with less variance than the before treatment (by comparing mean

and SD).

Chapter- 6 Discussion

Tamaka Swasa is a chronic disease of Pranavaha Srotas and it is characterized by

Swasa kricchrata or tevra vega Swasa, ghurghurakatwa, kasa, shayanasya Swasa peedita,

uraha peeda, peenasa, etc with patient feels as if entering dark ness during the paroxysm

which is due to where un holy association of Vata with Kapha obstructing the passage of

Pranavata leads to a excitement of Vata to produce up ward movement or abnormal

expiratory dyspnoea. Which vary in severity and frequency from person to person is in an

individual they may occur from hour to hour and day to day. The entity of disease is well

known to Ayurvedic word since the time immemorial. The well established detail

description of aetio-pathogenesis and treatment is found in our Ayurvedic literature.

The contemporary medical science also has a vast description of bronchial asthma

parallel to Tamaka Swasa earlier concept about bronchial asthma that is broncho spastic

disease have changed in recent years where as it is proved that it is an inflammatory

disease.

The national asthma education program panel states that asthma is a complex

syndrome of reversible airway obstruction, airway inflammation and bronchial hyper

irritability that occurs following exposure to stimuli such as allergens viral respiratory

infections, vigorous exercise, cold air, cigarette smoke, and air pollutants.

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion

152

The acceptable definition of bronchial asthma is still remains elusive. And the

means of interaction are not understood by modern community. According to global

initiative for asthma the working definitions of asthma is a chronic inflammatory disorder

of the airways. In susceptible individuals this inflammation causes recurrent episodes of


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wheezing, breathlessness, chest tightness, and cough particularly at night or in the early

morning. These symptoms are usually associated with widespread but variable airflow

limitation that is at least partly reversible either spontaneously or with treatment. The

inflammation also causes as associated with increased in airway responsiveness to a

verity of stimuli.

The recent survey of the WHO reveals that 155 million people world wide and

asthma has increased significantly i.e., 50% every decade. India has an estimated 15-20

million asthmatics. The concept of Tamaka Swasa and concept of bronchial asthma

seems to quite similar to the description given by contemporary medical world. The

aetio-pathogenesis, aetiological factors symptoms, prognosis has been explained vividly

and these are all equivalent to the description of asthma giving by contemporary medical

science.

Ayurvedic authors has been clarified and its prognosis and its chronisity. Till to

day which is been truth and eternal modern world also has a same opinion regarding this,

they stated that asthma cannot be cured but could control.

Keeping the above fact in view it was decided to go through detailed available

Ayurvedic literature. The Ardhedashemaniya Swasaharavati is a combination of 5 drugs

out of 10 herbs told by Charaka swasahara gana from shad-vireechana shatasriteeya

chapter.

Discussion improves the knowledge and discussion with science becomes base

establishment of the concept. Thus discussion is the most essential phase of any research

work. Keeping this in view, the facts which have emerged from the study can be studied

in five ways. They are -


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1. Discussion on demographic data

2. Discussion on disease Tamaka Swasa

3. Discussion on probable mode of action of Ardhedashemaniya

Swasaharavati over subjective and objective parameters

4. Assessment of Ardhedashemaniya Swasaharavati over subjective

and objective parameters

5. Limitations of the study

6. Recommendations

1) Discussion on demographic data

The efficacy of any drug can not be proved unless it is subjected to clinical trials

and analyzed statistically. The trial drug Ardhedashemaniya Swasaharavati is considered

for the evaluation in Tamaka Swasa (bronchial asthma). The clinical study was conducted

on 50 patients in a single group. In the foregone pages observations were made

systematically presented. These discussions will be done over respective data and

observations.

a) Relevancy of Age and Gender

Age is a factor of asserting the Dosha impact in the human. In this study the drug

over different age groups of the patients were enumerated, ages taken from 15 years to

65years and 10 years interval period was given in each group for study purpose.

Maximum numbers of patients were observed in 45-55 years of age. The effect of

Ardhedashemaniya Swasaharavati, over these patients i.e., 45-55 years out of 20 patients

4 patients responded very well. But this is very less comparatively 15-25 age group out of

11(22%) patients 9 (18%) responded well. It clearly shows that age factor also plays

important role. 100% effect was observed in 25-35 age groups. It is observed that among


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20 patients (40%) from 45-55 age groups male and female patients are equally

distributed. In this disease out of 50 patients 31 patients’ male, 19 patients were female.

Out of 31male patients 18 patients responded well, where as in female out of 19, 9

patients responded well.

b) Relevancy of Religion

Out of the 50 patients, 46 patients were Hindus and the rest 4 were Muslims. This

is due to the increased dominance of Hindus in this area, where the trail is undertaken.

Out of 46 patients 26 patients responded well. 9 patients were moderately responded. 7

patients were poorly and 4 patients not responded. Among 4 Muslim patients 2 patients

responded well and moderately 2 patients responded.

c) Relevancy of Occupation

It was observed that out of 50 patients 4 patients (8%) were leading sedentary life

style. 36 patients (72%) were active and rest 10 patients (20%) are labour. As the activity

of a person is having a say on Tamaka Swasa and the labour people are more susceptible

for asthma the observations made were supportive. The results of these major group

active patients are for discussion, at this maximum out of 36 patients (72%) 19 patients

well responded to the treatment. By which prove the efficacy of Ardhedashemaniya with

its properties against the disease.

d) Relevancy of Socio-economical status

In any research, a socio economic condition plays an important role. Some times

it could be one of the reasons. Here Tamaka Swasa is a condition corresponded to the

high frequency of affect and prevalence, is based upon the food habits and living style

referred to the socio economic conditions. Drugs may not be sufficient to fulfill the needs


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of diseased and need better food and life style also for the benefit of patients. Out of 50

patients, 24 patients (48%) were belongs to the middle class. 17 patients (34%) were

higher middle and 9 patients (18%) poor class. It is very obvious that 12 patients

responded well from the higher middle class and 10 patients from middle at the same

time. 2 patients from higher middle and 3 patients from middle not responded to the

treatment. It was noted that 9 patients were belongs to poor class among 9 patients, 5

patients were responded well though they are poor but patient noticed that they followed

good regimen i.e. Pathya. This study shows that even though socio economical status has

mild impact over the disease but more importance should be given to be dietary

restrictions and Pathya and Apathya.

e) Food habits

Out of 50 patients 29 patients (58%) were vegetarians 21 (42%) were consuming

mixed diet. The percentage of the distributaries does not show any diet differentiation to

get this disease, because verity of vegetables are allergens and some foods like fish, milk,

eggs, yeasts, wheat, etc., are also responsible for the disease, this may be the reason,

dietary regimens were less impact over the disease, the effect of drug responded well.

The observations made in this study support the above view.

2) Discussion on disease Tamaka Swasa

The discussion on Tamaka Swasa vis-à-vis Asthma can be divided under 4 headings.

i. Etiological considerations (Nidana)

ii. Patho-physiological concepts (Samprapti)

iii. Symptomatic evaluations (Lakshana)

iv. Treatment concepts (Chikitsa)


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i) Etiological considerations

Tamaka Swasa is a type of Swasa according to Charaka explained the etiological

factors in general. But Chakrapani commenting the Nidana of Swasa he has grouped like

Vata prakopaka, Kapha prakopaka gana as Nidana of Tamaka Swasa. In Vata Kapha

prokopaka gana, sheeta vayu, sheeta sthana, sheeta jala sevana, all are having similar

character and causes gunatwa vriddhi of Vata Kapha Dosha. Vata Rooksha gana vriddhi

cause hardening of bronchial walls due to rooksha quality of diet and regimen. The

excessive intake of above said factors like dadhi, masha, amakshera, etc., leads to Kapha

vruddhi. The jalaja mamsa, etc., are also factors by which guru guna and picchila guna

increased. Adhysana, vishamashana, causes agnimandya as a result Ama production takes

place. Ama and Kapha having similar character mix together causing blocking the

bronchial airways. (srotosanga) dhatukshaya also leads to Vata prokopa in terms of

excessive exercise and bharavahana.

The out door and in door (vihar Nidana) allergens exposure have increased

asthma morbidity. Allergy can incriminated as asatmya in Ayurveda. Asatmya has been

defined as which is not accepted by the body allergy can defined as an aquired

hypersensitivity to a substance. Raja doohma are well known allergens which are capable

of producing bronchospasm. Rajah can be compared dhooli, which is considered as dust

animal dander, pollen etc., dust and smoke causes bronchospasm by releasing the

mediators like histamine from mast cells. Certain foods cause allergies manifestations in

certain individuals. Finally by summarizing all the etiological factors we can assume that

some factors produce Dosha vruddhi some factors causes’ dushya dusti and reaming

causes the srotovaigunya.


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ii) Discussion on patho-physiological concepts

Tamaka Swasa Samprapti can be discussed according to Nidana. By the above

mentioned Nidana, vitiated Vata enters to Pranavaha Srotas cause rookshyata, and

katinyata of the srotomarga resulting the srotosanga. The Vata exaggerated in Pranavaha

Srotas only due to srotosanga due to localized increase of Kapha. Because of obstruction

in Pranavaha Srotas Vata changes its direction (vimarga gamana) results in sankocha.

On the contrary modern science explained the above fact as follows.

1) Narrow airway caliber to limit the flow in airway by smooth muscle contractions

2) Gland and epithelial secretions and exudation in to the airway lumen and

3) Inflammatory oedema

The involvement of Srotas in this disease is mainly the Pranavaha Srotas. But in

the poorva roopa the involvement of Annavaha Srotas and in severity of the disease the

Udakavaha also involved. Ayurveda explained the symptoms related to Annavaha Srotas

like anaha, admana, parshawashoola, hritpeeda bhakta dwesha arati and vibhanda.

It has been found that maximum patients suffer from agnimandya, giving raise to

Ama utpatti leading to faulty production of prasadarasa, and more production of mala

rupa Kapha leading to vitiation of Rasa vaha Srotas. The moola of Pranavaha Srotas is

mahasrotas and hridaya. Ama Rasa produced in Amashaya produces dusti of Pranavaha

Srotas and Annavaha Srotas so symptoms of Annavaha are occurred. Modern science

explained the premonitory symptoms of respiratory system. (Pranavaha Srotas) like

pharyngitis, sore throat, pain in the throat itching sneezing running nose, viral infection of

upper airway, nasal irritation etc., which is due to allergic manifestation and infection.


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iii) Symptomatic evaluations

The clinical presentation of Tamaka Swasa, are heterogeneous. The spectrum of

signs and symptoms varies in degree of severity from patient to patient from child to old

age. Patients may be free from symptoms in between the attack. The vegakaleena

symptoms Swasa kricchruta or teevra vega Swasa, ghurguraktwa kasa, dukhena Kapha

nissarana, uraha peeda.

The pratiloma Vata gets obstructed by Kapha in Pranavaha Srotas. It causes the

ghurghura shabda. But contemporary science wheeze is not considered as confirmatory

sign in asthma. Because wheeze can be heard from many others conditions including

chronic bronchitis, pulmonary oedema, bronchial stenosis, foreign body aspiration upper

airway obstruction and pulmonary embolism, which is generated by vibration in the wall

of an airway on the point of closer due to smooth muscle contraction.

The next symptom is occurred due to obstruction caused by Kapha in the passage

of Vata and an attempt is made for its expulsion and this is presented as kasa, where in

relief is felt by expulsion of shelshma i.e., shelsma vimokshante sukham. Some patients

experience dry cough in the manifestation of asthma. Cough is reflux action which is

produced by the irritation of bronchial mucosa muhurswasa and alpalpa Swasa can occur

due to increase the rate of respiration to compensate the oxygen requirement because

oxygen saturation is reduced in bronchial asthma.

Parshwa shoola is due to over inflation of the lung due to shlesma vruddhi and

patient feels a sort of discomfort or ache, or pain in the bilateral sides of the chest. All the

patients of Tamaka Swasa are at risk of developing teevra Tamaka Swasa the symptoms

like pratamyati (feels distress) pramoha (faint) kampa (tremors) these can occur in the


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acute stage indicating sudden asphyxic asthma, which is due to bronchospasm and

impaired oxygen supply to the brain and accumulation of carbolic acid in the blood

producing respiratory acidosis.

The sadhyasadyata is depending upon age and immuno-status. Ayurveda

emphasized asthma originating in childhood is sadhya, who is having strength (uttama

bala) and alpakaleena naveena Vyadhi according to Charaka. Susruta stated that durbala

patients for bad prognosis. Vagbhata states that uttam rogibala is for good prognosis.

The course of Tamaka Swasa is not uniform with periods of exacerbation and

remission which varies from days to weeks to months to years. Therefore the

management requires to continuous care approach to the symptoms.

iv) Treatment concepts

The management of Tamaka Swasa depends on the Dosha predominance and

physical stage of the patient. Therefore the treatment modalities classified according to

patient like kaphadhika, vatadhika, balawana, and durbala. Vata and Kapha involve in the

pathogenesis of Tamaka Swasa. So the treatment modalities depend upon state of

vitiation of Dosha in the disease process. The therapy which alleviates both the Dosha

should be adopted. When both Dosha are aggravated in equal ratio but reverse modalities

is followed when Dosha are involved in different ratio. The drugs which are Vata

kaphagna vatanulomaka, properties should be used as shamanoushadhi depending upon

body strength treatment varies as karshan Chikitsa indicated for balavana and brumhana

shamana treatment for durbala and vrudha patients.

Our science has given more importance to the shodana therapy also. It is stated

that vamana should be done in Kapha predominant disease. Where as vireechana also


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indicated. For durbala and vatadhika patients’ shamana tarpana, mamsasevana, are

mentioned.

Susruta stated that Nidana parivarjan is must in management of the disease. Step

wise approach is management of Tamaka Swasa can be designed depending upon the

severity of the disease condition quick relief medications quoted in acute symptoms by

means of Nasya and dhomapana sadvrutta is power full to for helping the patients to gain

motivation and skill to control asthma

3) Probable mode of action of Ardhedashemaniya Swasaharavati

Ardhedashemaniya Swasaharavati is combinations of five drugs with properties

are Vata kaphagna, laghu, ruksha, tikshna, ushna virya and vatanulomaka. Herbs are

selected according to Charaka explanation.

As disease is mainly Kapha vatatmaka in nature and agnimandya as its roots. The

drugs are acting over these Dosha by their properties. The gunas of the drugs are laghu,

teekshana, rooksha, which are antagonistic to the gunas of Kapha Dosha there by drugs

are normalizing or super imposing the Kapha Dosha. The veerya of these drugs in ushna

except Bhumyamalaki, which is having Kapha pittahara property as the disease is

pittasthana samudbhava.

The veerya of these drugs is Ushna, where as that of Vata is Sheeta. These drugs

are normalizing the prakopita Vata Dosha by veerya, and vitiated Pranavaha Srotas,

which is corrected by all these drugs. As they are under the Swasa hara heading and

kasahara hikkahara gana, Srotodusti other wise sanga, is relieved by Ushna properties of

drugs and swasahara property. Adhistana is Amashaya is seat of Kapha (urdwa) and Pitta

(adho) as the drugs are katu, Tikta kashaya Rasa pradhana for Kapha, and kashaya Tikta


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madhura rasapradhana, where by acting over the Pitta and madhura, and amla Rasa

pradhana where by acting over Vata Dosha and restoring the normal functioning of

Amashaya by these properties Samprapti vighatana is taking place.

Also many clinical and experimental studies were being conducted on these drugs

either single or in combination and showed their efficacy in Tamaka Swasa vis-à-vis

bronchial asthma treatment. Combined effect of all drugs with same properties may have

acted on the disease Tamaka Swasa and support Charaka explains the combination herbs

provides more sustained therapeutic effect than using individually. The pharmacological

properties pertained to that of the present research is enlisted here.

Shati Swasa hara - (CSu 4/37), Hikka hara - (CSu 4/30), Shotha hara,

Vedanastapana, Jwarahara, Kasa hara - (Kayadeva Nighantu –

1393),

Pushkaramoola Swasa hara, Kasa hara, Hikka hara, Parshwa shoolahara - (CSu

20/40 & AS Su 30/2)Shophaghna , Panduhara – (Dhanvamtari

Nighantu -154)

Amlavetasa Bhedaneeya, Deepaneeya, Anulomaneeya, Vata shleshma hara –

(AS Su 13/2, CSu 25/40, 27/ Phalavarga)

Tulasi Hikka, Kasa Swasa hara, Parshwashoolahara, Kaphavataghna (CSu

27/169, SSu 46/all)

Bhumyamalaki Kasahara (CSu 4/36), Kapha Pitta hara, Pandughna, Swasa hara,

Trushna Daha nasha (Kayadeva NIghantu – 250)


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According to modern science, bronchial asthma is a chronic inflammatory

disorder in which many cells play a role like mast, Eosinophils, and T-lympocytes. The

inflammation also causes an associated increase in airway hyper-responsiveness to

stimuli. The pharmacological therapy is needed to treat reversible air flow obstruction

and airway hyper responsiveness. Medications include bronchodilators and anti-

inflammatory agents and antihistamine inflammation is the now target of therapy.

A recent research carried out on these drugs the pharmacological action of all the

drugs is as follows.

1. Shati – it is proved as a anti inflammatory analgesic, expectorant, extract has

notably anti histamine activity and laxative vasodilator

2. Pushkaramoola – Anti-inflammatory, expectorant, analgesic, antipyretic,

antispasmodic activity. (Effect against bronchial spasm induced by histamine, 5

hydroxy tryptamind and various plant pollens). So it is also having anti histamine

activity anti bacterial, and anti fungal activity bronchodialator.

3. Amlavetasa – it is stomachic, bitter tonic, purgative and antipyretic,

4. Tulasi – Demulcent, expectorant, antipyretic antiviral (leaf extract)

antispasmodic carminative, antibacterial and nervine tonic (nerve tissue

strengthening) it frees oxygen from sun rays and oxygenates the body, which

builds the immune system.

5. Bhumyamalaki – Anti viral (phyllunthes primarly contains eg. – phyllanthine

and hypophyllanthine) alkoloids and bio flavonoids while it remains un known as

to which of these ingredients has anti viral effect appetizer, digestive, laxative,

carminative.


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By above said pharmacological action may be these drugs acting in bronchial

asthma. Mechanism of action of this Ardhedashemaniya Swasaharavati is not clear but

the drugs are known of their bronchodilator, anti inflammatory, antihistamine activity

expectorant. Antiviral, antibacterial analgesic etc., as explained above, here proposing the

following mechanism of action may be hypothetical presume they are -

1. Mechanism of Bronchodilators

a) By relaxing bronchial smooth muscle

b) By reducing the bronchial hyperactivity

c) Also by improving the respiratory functions by increasing the

strength and reducing the fatigue of the respiratory muscle

2) Anti inflammatory mechanism

As the inflammation is the target of therapy, the pharmacological action i.e., anti-

inflammatory action can be interpreted for these drugs.

An acute anti inflammatory action medicated via inhibition of micro vascular leakage

Prevention of the direct migration and activation of inflammatory cells

Human airway smooth muscle cells express before receptor from the trachea to the

terminal bronchioles. This drugs as function antagonists can prevent and reverse the

effects of all bronco constriction, with substance like histamine and endothelies.

3) Anti histamine

Hyper-responsiveness of airways by histamine can be interpreted as Vata

prokopa. The drugs probably acting as Vatahara other wise anti histamine property by

reducing the hyper responsiveness of airways is substantiated.


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These agents block the acute bronco constricting effect produced by inhaled

histamine. They have also bronchodilator action

4) Immuno-modulatary mechanism

As the recurrence of the disease is because of lessened immunity, the

pharmacological action i.e., immunomodulatory can be interpreted by the combination of

these drugs. i.e., synergetic action which is as follows.

1. Eliminates the toxic metabolites and pollutants.

2. Preventing recurrent infection expelling the damaged cells

3. Nourishes and maintains the cell life.

4. Encouraging growth of new cells.

Above all explanation with comparative to contemporary medical science we tried

to propose the probable mode of action of these drugs.

4. Assessment of Ardhedashemaniya Swasaharavati over subjective and objective

parameters

a) Mode of action of Ardhedashemaniya Swasaharavati over subjective parameters

1. Teevra vega Swasa (Dyspnoea) Swasakrichrata: In this study 100% patients i.e.,

out of 50,50patients reported this complaint after the treatment 21 patients were

not relieved completely. But severity and frequency attack were reduced. Rests of

29 (58%) patients are relieved by their symptoms within the follow up schedule. It

was observed that maximum patients were belongs to mild and moderate degree

of Swasa kricchrata.

Above mentioned data clearly shows that there is an effect of

Ardhedashemaniya Swasaharavati over this subjective parameter. This is due to


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the trial drug is having such qualities like bronchodilator, anti-inflammatory, anti

histamine, demulcent – immuno-modulator effect, as the Swasa kricchrata is

result of the broncho-constriction (srotosanga), hyper-responsiveness of the

airway due to inflammation and other patho-physiological causes. Like increased

secretion of bronchial mucus airway smooth muscle contraction, gland and

epithelial secretions and exudation in the air way lumens etc.,

2. Kasa (cough): In this study out of 50 patients 47 patients (74%) were given the

history of cough. Out of 47 patients 29 patients (61.7%) were relieved by their

symptom. Remaining 18 (36%) were not relieved but maximum patients migrates

severe to mild degree of cough.

Kasa is due to irritation in the Pranavaha Srotas and another cause it is an

effort to expel the Kapha. (malaroopa) secreted in the Pranavaha Srotas. The trial

drug is having antagonistic quality like expectorant immuno-modulator,

demulcent by these action subsides the kasa. The effect of drug

Ardhedashemaniya swasahara vati is proved on this subjective parameter.

3. Duhkhena Kapha nissaranam (Expectoration): In this study out of 50 patients 43

patients were got difficult expectoration. This is due to the over inflated lung with

both large and small airways being filled with plugs comprising mixer of mucus.

The drug disintegrates this pathology by its demulcent bronchodilator and

expectorant actions. The mucus plugs smoothened by its demulcent property.

Then arrowed airway try to dilate by its bronchodilator action expels out by its

expectorant property. By this mechanism plugging of airways cleared of and

make easy for respiration.


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Out of 43 patients 23 (46%) patients improved a lot 20 patients (40%)

improved severe to moderate to mild degree of expectoration. This study shows

the there is a drug effect over this subjective parameter.

4. Ghurghuratwam (Wheezing): The study shows that 50% of patients responded

well out of 50 patients 25 patients (50%) improved severe to moderate to mild.

This ghurgurakatwa occurs due to avarodha in Pranavaha Srotas due to Kapha. A

wheeze is generated by vibration in the wall of an airway on the point of closer

due to smooth muscle contraction. The drug which clears the srotorodha by the

virtue of its actions. Anti inflammatory bronchodilator expectorant thee by it may

improves the mucociliary clearance. This study shows that there is a effect of

Ardhedashemaniya Swasaharavati over this parameter.

5. Peenasa (Coryza): In this study out of 50 patients (100%) 33 (66%) patients were

suffering from this symptom considered one of the symptoms of Tamaka Swasa

and it is also preceding factor of this disease. Which induces the allergen induced

inflammation and it is also caused by viral infections and specific allergens. Out

of 33 patients (66%) 18 patients (54.54%) improved a lot. remaining 15 patients

were improved moderate to minima. The drug which may inhibit stimulation of

IgE machinism there by prevents the hyper secretion and hyper responsiveness of

the airways, by its immunomodulatory, anti histamine antiviral activity. The study

shows that the effect of trial rug proved on this parameter

6. Kruchrena bhasate (Dysphonoea): In this study out of 50 (100%) patients 22

(44%) patients were reported these symptoms. This is due to the dyspnoea, and

also due to tenacious mucous may be coated in the throat including vocal cords.


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This is relived by the drug which is smoothened the mucus and expels out by its

properties. There by it clears the passage of the airways and subsides the

symptom. Out of 22 patients (44%),10 patients (20%) were got minimal

improvement where as 12 (24%) patients were got well response out of 22

patients at the end 54.54% got relived . this study shows that there is a effect of

trial drug over this parameter.

7. Kantodhwamsham (Hoarseness of voice): Out of 50 patients only 12(24%)

patients were reported out of 12 patients 5 (10%) patients minimal improved and

7 patients responded well at the end 58.33% were relived from the symptom. This

is the effect of obstruction on the Pranavaha Srotas is the kantadwamsam. The

shlesma accumulated in the kanta region obstructing the Pranavata causes the

bubbling and resultant sound in kanta Pradesh. The result which is achieved by

the action of the trail drug which is having Kapha hara sroto mardavakar,

expectorant, etc. qualities.

8. Greevashirasangraha (Headache & Stiffness): Out of 50 only 16 patients were

reported this symptom. Out of 16 (32%) patients 7 (43.75%) patients result at the

end of treatment. These may due to over inflammation of the lungs and patient

feels some sort of discomfort t or ache or pain. Which is relieved by the drug

action i.e., antiinflammatory analgesic quality of drug taken care of this.

9. Urah Peeda (Chest Pain): In this study out of 50 patients 39 patients were reported

uraha peeda. This is because of over inflation of lungs and patient feels some sort

of discomfort or ache or pain in the bilateral sides of the chest. The drug

Ardhedashemaniya Swasaharavati acted very effectively on this parameter. The


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analgesic and antiinflammatory actions relieves the pain or ache, the

bronchodilator and expectorant qualities clears the airway passage.

The data shows that out of 39 patients 23 patients i.e., 58.97% were

relieved from the chest pain. 16 patients were got minimal improvement. This

study shows that there is an effect of trial drug over this parameter

10. Shayane Swasa peedita (Discomfort at supine): In this study out of 50 patients 37

(74%) patients were reported for this symptom. This is due to lying down position

the diaphragm is raised and reducing the lung volume. It may occur at any time or

during the attack or night time. If it is night time because of the lowest serum

adrenaline and cortisol and highest level of histamine during night hours could be

the responsible for nocturnal episodes of asthma.

The trial drug improves lung volume by its bronchodilator and anti

inflammatory and expectorant effect. The trial drug also having anti histamine

activity there by it compensate the level of histamine may be the these action at

the end of the study out of 37 patients 23 patients were relieved i.e. 59.45% and

remaining 14 patients responded moderate to mild.

b) Mode of action of Ardhedashemaniya Swasaharavati over objective parameters

i. Breath Holding Time: Breathing can be held for variable period of time by

different individuals upon the functional status of lungs, development of

respiratory muscles. This BHT is a simple test which provides useful in

formation in health and disease of the lung.

In this study breath holding time were assessed before and after the

treatment. All 50 patients breath holding time recorded, this is highly


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variable person to person for that purpose we made eight group of

intervals each interval shows 5 seconds difference. It was observed that

maximum patients i.e. 35 (70%) were belongs to 5-10 group of interval

and 5 patients were belongs to 0-5 interval and 10 (20%) belongs to 10-15

intervals.

This is because of there is a broncho constriction, and bronchioles

already partially occluded and there is a increased functional residual

capacity and residual volume of the lung. This is reason why patients can

not hold the breath long time.

After the completion of treatment schedule again BHT has been

documented maximum patients were shows less than 20 or 20 seconds i.e.

16 (32%) patients. 13 (23%) were belongs to 20-25 seconds group of

interval and only 2 (4%) patients in 25-30 seconds group of intervals. All

these considered as markedly improvement comparatively before

treatment. 10(20%) patients and 7(14%) patients were belongs to 10-15

group and 5-10 group intervals respectively. These 7(14%) patients and 2

(4%) were remains 5-10, 0-5 group of intervals respectively.

This study shows that there is effect of the trail drug over this

parameter.

ii. Peak expiratory flow rate: The Wright peak flow meter which measures

PEFR is of special value in cases of asthma where the effectiveness of the

treatment with bronchodilator can be evaluated.


171

In this study the lung function assessment was recorded with help

of this measurement. The readings were taken before and after the

treatment for the analytical study purpose we made eight groups of

intervals each interval difference is 50 lit/minute. (The normal PEFR 350

lit/minute.

It was observed that maximum patients i.e., 24 (48%) were belongs

to 100-150 group of intervals. 16 (32%) were observed in 150-200 group

of intervals 9 (18%) patients were belongs to 50-100 group of intervals.

Only one patient was belongs to the 200-250 groups of intervals.

These clinical measurements shows greatly reduced maximum

expiratory rate and timed expiratory volume. This is because of the

functional residual capacity and residual volume of the lung becomes

greatly increased during the asthmatic attack there by the difficulty in

expiring air from the lung. The bronchial diameter becomes more reduced

than during expiration than during inspiration. This is because the

increased intrapulmonary pressure during expiratory effort compresses the

out sides of the bronchioles. Because the bronchioles are already partially

occluded further occlusion resulting from the external pressure creates

especially severe obstruction during expiration. So the Tamaka Swasa

patient usually can inspire quite adequately but great difficult expiration.

After the treatment it is observed that maximum patients i.e., 17 (34%)

patients were belongs to 350-400 group of intervals 9 (18%) patients and

one patient belongs to 300-350 and > 400 group of intervals all these


172

shows markedly improvement. 7 (14%) patients and 4 (8%) patients were

belongs to 250-300 and 200-250 group of intervals respectively and shows

moderately responded. 3(6%) and 4(8%) patients were belongs to 100-150

and 150-200 group of intervals respectively and shows poorly responded.

5 (10%) patients not responded to the treatment.

This study shows the lung function improvement. The drug

Ardhedashemaniya Swasaharavati it improves the lung function.

Ardhedashemaniya Swasaharavati acts as anti inflammatory, analgesic

bronchodilator, expectorant. Anti histamine anti viral, antibacterial,

demulcent, etc., there by it clears the broncho construction reduces the

inflammation and airway hyper responsiveness.

Thus it improves the bronchiolar diameter decreases the

intrapulmonary pressure reduces the functional residual capacity and

residual volume of the lung and improves the expiratory rate.

iii. Erythrocytes Sedimentation Rate: This test is being done before and after

treatment there are minimal changes in the values of ESR. This facilitates

to understand the possible presence of organic disease or to follow the

course of the disease. This is universally accepted that it gives prognostic

value. So the effect of Ardhedashemaniya Swasaharavati has very less

impact over the parameter.

iv. Absolute Eosinophilic Count: this test is being done to all the patients

before and after treatment. It was observed that maximum patients i.e.,

27(54%) patients were belongs to 450-500 cells/ cu mm group of intervals.


173

15 patients (30%) observed 500-550 cells/ cu mm group of intervals. 3

(6%) and 2 (4%) patients from 550-600 and >600 group of intervals

respectively.

Eosinophils are phagocytes particularly effective in the elimination

of parasite. They also participate in hyper sensitivity reactions. Especially

in lungs Eosinophils play an important role, in the asthmatic inflammatory

reaction which is being characterized by cellular infiltration rich in

activated Eosinophils increase in number during allergic reactions as well.

After the treatment the maximum i.e., 19(38%) and 17 (34%)

patients were belongs to 300-350 and 200-250 group of intervals

respectively. 3 patients were belongs to 250 300 group of intervals and

shows that thee is a markedly reduced the number of Eosinophils. 3 (6%)

patients remain same 1 patient 500-550 and 1 (2%) from 350-400 cells/cu

mm group of intervals. In this group minimal reduction of Eosinophils

were seen. It is proved that the effect of Ardhedashemaniya Swasaharavati

on Eosinophils.

5) Statistical discussion of parameters

Individually all the parameters shows highly significance, as p value is <0.01. But

in the subjective parameters Swasakruchrata, Ghrgurukatwa, Kasa and Duhkhena

kaphanissaranam shows highly significance than the Urahpeeda, Shanasya Swasa peedita

(comparing Z values). In the objective parameters AEC, BHT and PEFR show high

significance that the ESR (by comparing Z value). The parameter PEFR shows more

variation.


174

Further the analysis is done by using large sample test with specified mean value.

The mean effect of PEFR, BHT after the treatment is improved with more variance. The

mean value of AEC after the treatment is reduced than the before treatment with more

variance which is towards normal. The parameter ESR show high significance as p value

is < 0.01 after the treatment where the reduction in mean value after the treatment is with

less variance than the before treatment.

As sample size is more that 30 we use the technique of paired t-test to find out the

effect of the drug before and after the treatment. Here instead of the t-table value we used

the Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is a large sample test to find

the p-value.

6) Limitations of the study –

1. The sample size was small to generalize the result

2. Drug is being a compound form it was difficult to draw its direct mode of action.

3. Samples are selected incidentally.

7) Future scope for the further study

Long standing administration can also suggested.

Pharmaco-dynamics of these drugs should be tried in different level and also

to study the effect of other inflammatory cells.

To study its effect with the help of Spirometry

Immunological study can be done by comparing IgG and IgE levels.

Long standing administration can also be suggested.

Muhur muhur Aushadhi sevana in Tamaka Swasa can be tried

Chapter – 7 Conclusion

A close perusal of the observation and interference for that can be drawn to the

following conclusion.

By studying literature Tamaka Swasa can be compared with bronchial

asthma.

The Ardhedashemaniya Swasaharavati is very effective in reducing the

subjective parameters of this study. And statistically highly significant i.e.,

p- value < 0.01

Ardhedashemaniya Swasaharavati increasing the lung function i.e. the

PEFR and BHT. Which are statistically highly significant i.e., p <0.01

There is no relationship between the therapeutic effect of

Ardhedashemaniya Swasaharavati gender and economical status.

The individual drugs of Ardhedashemaniya Swasaharavati are acting as a

bronchodilator anti inflammatory anti histamine and immuno modulator and

expectorant.

Ardhedashemaniya Swasaharavati is very economic safe and effective drug

hence it can be employed in all cases of Tamaka Swasa.

It can be used as preventive type of medication

This Ardhedashemaniya Swasaharavati is new therapeutic option for

optimizing the asthma control.

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Conclusion

175

Chapter – 8 Summary

The W.H.O. recognizes Tamaka Swasa vis-à-vis Asthma as a disease of major

public health importance and plays a unique role. The international action is

needed to stimulate research into the causes of asthma to develop new control

strategies and treatment techniques and develop an optimal strategy for its

management and prevention which increases public awareness of this disease.

Tamaka Swasa is selected for research study to arrive at a specific, economic,

and more effective, without side effects in the management, also selected the

research to find out a new therapeutic option for optimizing asthma control.

Keeping in the mind to establish the effect of Shamana therapy i.e.,

Ardhedashemaniya Swasaharavati on Tamaka Swasa (Bronchial asthma) is

studied here.

Initially at the dissertation Historical review, Vyutpatti, Nurukti, Paribhasha,

Nidana, Lakshana, Sadhyasadhaya, Chikitsa, and Pathypathya of the Tamaka

Swasa as well as the contemporary medical descriptions are detailed as par

available information. About the components of the drug, latest researches on

these individual herbs are procured.

Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary

176

The research design was a pre-test and post test with an observational study of

50 cases incidentally selected for the study. Patients were diagnosed on the

basis of symptomatology explained by Bruhatrayee (subjective parameter) and

objective parameters fixed on contemporary scientific descriptions and

parameters.


177

Out of the 67 patients of Tamaka Swasa 65 (97.01%) were undertaken for the

study. Out of 65 patients 15 (23.07%) patients were discontinued hence their

date has not been included in the assessment. The remaining 50 (76.93%)

patients of Tamaka Swasa vis-à-vis bronchial asthma fulfilling the criteria of

diagnosis and inclusive criteria were included in the study. PEFR and BHT

are considered as an objective for the inclusion in the present study.

In this study recorded observations were analyzed, it reveled that 62% were

males in 31 patients, 38% were female (19 patients and more number of

patients were belongs to 45-55 age group i.e., 20 (40%) patients. Hindu

religion patients were more (92%) recorded. More patients were belongs to

middle economical status, the dietary distribution does not show any

differentiation.

All the subjective parameters which are declared for the assessment of the

Ardhedashemaniya Swasaharavati are tabulated here in the table 42. Out of

the symptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patients

initially are relieved 58%. Another symptom found for all patients is

Ghurgurukatwam is relieved for the 50% of patients in the study. Kasa a

symptom appeared for 47 patients initially relived 61.7% in the study. Next

best appeared symptom is Duhkhena Kapha nissaranam for the 43 patients

noticed relieved for the 53.48% of patients. Shayane Swasa peedita is the next

symptom with 37 patients found corrected at the end by 59.45%. 39 patients

of Urahpeeda corrected at the end of study by 58.97%. Peenasa, a symptom of

the Pranavaha Srotas always found associated with the Tamaka Swasa found


178

for 33 patients got through by the end with 54.54% of relief.

Greevashirasangraha (16 patients) and Kantodhwamsham (12 patients) are the

other two symptoms of assessment got relief with 43.75 and 58.33

percentages respectively. The tabulation is as expressed above.

At the Objective Parameters assessment in Tamaka Swasa in the study of

Ardhedashemaniya Swasaharavati five objective parameters are assessed are

enlisted in the table 43. All these are of disease oriented and specific to assess

the Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis

Bronchial Asthma. The table is followed as under. The objective parameters,

PEFR AEL, BHT, show high significance then the ESR, the PEFR shows

more variation. All are shows statistically high significance i.e., P value is

<0.01.

Out of the assessments of objective parameters it is clearly understood that the

Breath Holding Time (BHT) means are compared and observed that a lot of

8.46 suggests that the lung capacity is enriched. This is conformed by the

second significant test Peak Expiratory Flow rate (PEFR). In the PEFR

readings it is clear once again that the difference is as wide as 148.1, almost

more than 50% improvement. Oxygen is the most essential to live and that is

carried by the Red Blood Corpuscles and Haemoglobin. The Hb% in the

blood are studied as one of the parameter has 0.93 variance of mean shows

that the drug even has the effect over the increasing the haemoglobin and

RBC. The next best prognostic and also estimating objective parameter is the

Erythrocyte Sedimentation Rate; record the marked decrease, which is a


179

significant of disease regression, is 0.9 difference to that of baseline data to

the final data. As many as Pranavaha Srotas symptoms are seen along with the

Tamaka Swasa needs the Absolute Eosinophilic Count as the parameter is

studied here and observed that 177 mean AEC decrease.

As sample size is more that 30 we use the technique of paired t-test to find out

the effect of the drug before and after the treatment. Here instead of the t-table

value we used the Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is a

large sample test to find the p-value.

The result in the study ascertains the best activity of the Ardhedashemaniya

Swasaharavati over the Tamaka Swasa vis-à-vis Asthma. For the convenience

the results are grouped as four categories, viz. Well-Responded (WR),

Moderately Responded (MR), Poorly Responded (PR) and Not-responded

(NR). All these patients are studies with the cumulative percentages obtained

through subjective and objective Parameters is as under.

As par the discussions made and the results observed in the study of

Ardhedashemaniya Swasaharavati, the results are declared as under keeping

the all subjective and objective parameter developments in view. After

through study of the entire parameters and materials available for the

assessment of results it was drawn a conclusion of results as - 27 (54%) well

responded, 11 (22%) moderately responded, 7 (14%) poorly responded and 5

(10%) patients not responded and the 12 patients discontinued in the study,

were not considered for the result declaration. The tabulated result and pi-

diagram graphical expression is as under.

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Choukumbha Bharati Academy, Varanasi, pp 509-10 112) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,

pp 22 113) American Thoracic Society, J. Xgene Medicine, 2005, www.niaid.nih.com 114) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 1/20, 15th ed, 1985,

Choukumbha Samskrut samstan, Varanasi, pp 115) Satya Narayan Shastri, Charka Samhita Chikitsa 17/137, Chakrapani, 1st ed. 2001,

Choukumbha Bharati Academy, Varanasi, pp 510 116) Ibid, 17/45, pp 515


V

http://www.niaid.nih.com/



117) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Chikitsa, 17/45, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 535

118) Ibid, 17/17, pp 533 119) Satya Narayan Shastri, Charka Samhita Chikitsa 17/56, Chakrapani, 1st ed. 2001,

Choukumbha Bharati Academy, Varanasi, pp 516 120) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/3, 2nd ed, 1996, Krishnadas

Academy, Varanasi, pp 367 121) Satya Narayan Shastri, Charka Samhita Chikitsa 17/8, Chakrapani, 1st ed. 2001,

Choukumbha Bharati Academy, Varanasi, pp 374 122) Ibid, 17/71, pp 518 123) Ibid, 17/56, pp 516 124) Arthur. C, Gutyton ed, TB of Medical Physiology, 9th ed, 1996, Prism Books pvt.

Ltd, pp 481 125) Ibid, pp 482, 542 126) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995;

Page No. 336-8 127) Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th

ed. India: Mcgraw Hill, New York, 1998.p 1419 -1426. 128) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995;

Page No. 337-8 129) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,

pp 45 130) Ganga Sahay Pande ed, Charka Samhita Nidana 1/8, 6th ed. 2000, Choukumbha

Samskrut Samstan, Varanasi, pp 466 131) Satya Narayan Shastri, Charka Samhita Chikitsa 17/18-20, Chakrapani, 1st ed.

2001, Choukumbha Bharati Academy, Varanasi, pp 510 132) Ambika Datta Shastri, Susruta Samhita Uttara 51/6, 15th edition, 2002,

Choukumbha Sanskrit Samsthana, Varnasi, p 374 133) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/5, 2nd ed, 1996, Krishnadas

Academy, Varanasi, pp 38 134) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 12/16, 15th ed, 1985,

Choukumbha Samskrut samstan, Varanasi, pp 290 135) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,

pp 66 136) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995;

Page No. 338 137) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed,

1989, Blackwell scientific publications, New Delhi, pp 688 138) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,

pp 67 139) Ibid, pp 66 140) Ibid, pp 63 141) Ibid, pp 53 142) Ibid, pp 66


VI

143) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed, 1989, Blackwell scientific publications, New Delhi, pp 676, 685

144) Ibid, pp 786 145) Satya Narayan Shastri, Charka Samhita Chikitsa 17/55-68, Chakrapani, 1st ed.

2001, Choukumbha Bharati Academy, Varanasi, pp 534-9 146) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,

pp 72 147) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995;

Page No. 287, Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association

of physicians of India, Mumbai, pp 293 148) Ganga Sahay Pande ed, Charka Samhita Indriya 8/25, 6th ed. 2000, Choukumbha

Samskrut Samstan, Varanasi, 149) Ambika Datta Shastri, Susruta Samhita Sutra 31/20, 15th edition, 2002,

Choukumbha Sanskrit Samsthana, Varnasi, 150) K.R. Sriknta Murty ed, Astanga Hridaya Shareera, 5/76, 2nd ed, 1996, Krishnadas


Choukumbha Bharati Academy, Varanasi, 152) Ibid, 17/68-69, pp 518 153) Ambika Datta Shastri, Susruta Samhita Uttara 51/14, 15th edition, 2002,

Choukumbha Sanskrit Samsthana, Varnasi, p 378 154) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/10, 2nd ed, 1996, Krishnadas


Choukumbha Bharati Academy, Varanasi, pp 518 156) Ibid, 17/72-3, pp 518 157) Ibid, 17/89, pp 521 158) Ibid, 17/74-76, pp 519-520 159) Ibid, 17/77-80, pp 519 160) Ibid, 17/121, pp 525 161) Satya Narayan Shastri, Charka Samhita Chikitsa 26/134-43, Chakrapani, 1st ed.

2001, Choukumbha Bharati Academy, Varanasi, 162) Ambika Datta Shastri, Susruta Samhita Uttara 51/43, 15th edition, 2002,

Choukumbha Sanskrit Samsthana, Varnasi, 163) Ibid, 51/48, pp 381 164) Satya Narayan Shastri, Charka Samhita Chikitsa 17/148, Chakrapani, 1st ed. 2001,

Choukumbha Bharati Academy, Varanasi, pp 529 165) Ambika Datta Shastri, Susruta Samhita Uttara 51/15, 15th edition, 2002,

Choukumbha Sanskrit Samsthana, Varnasi, 166) Satya Narayan Shastri, Charka Samhita Chikitsa 17/72, Chakrapani, 1st ed. 2001,

Choukumbha Bharati Academy, Varanasi, pp 518 167) Ibid, 17/73, pp 518 168) Ibid, 17/74, pp 518 169) Ambika Datta Shastri, Susruta Samhita Uttara 51/43, 15th edition, 2002,

Choukumbha Sanskrit Samsthana, Varnasi, p 380


VII

170) Satya Narayan Shastri, Charka Samhita Chikitsa 17/92, Chakrapani, 1st ed. 2001, Choukumbha Bharati Academy, Varanasi, pp 521

171) Ibid, 17/47, pp 529 172) Ambika Datta Shastri, Susruta Samhita Uttara 51/46-47, 15th edition, 2002,

Choukumbha Sanskrit Samsthana, Varnasi, p 381 173) K.R. Sriknta Murty ed, Astanga Hridaya Chikitsa, 4/25, 2nd ed, 1996, Krishnadas

Academy, Varanasi, pp 249 174) Brahma Shankara Shastri, Yogaratnakara, Swasadhikara, 1-8 sl, 5th ed, 1993,

Choukumbha Sanskrit samsthan, Varanasi, pp 435-36 175) Ambikadatta Shastri, Govindadas, Bhaishajya Ratnavali, 6th ed, 1981,

Choukumbha Samskrut Pratistan, Varanasi, pp 339 176) Ganga Sahay Pande ed, Charka Samhita Sutra 25/40, 2nd ed. Choukumbha

Samskrut Samstan, Varanasi, 1983. pp 218-20 177) P.V. Sharma, Dravya guna vignyana, Vol 2, Chukumba Bharati academy,

Varanasi, 2001, pp 292-93,296-97,338-40,513-16,640-41. 178) P.V.Sharma, Dhanvantri nighantu 1/60-61, 65-66, 2/93-94, 3/83-84, 4/45-46,

Chukumba Sanskrit samsthana, Varanasi, 1982 pp 26, 27, 87, 129, 106. 179) P.V.Sharma, Kaideva nighantu, 1/1392-93, 1320-22, 3192-24, 1551-55, 247-50,

Chukumba orientalia, varnasi, 1979, pp 258, 244, 61, 633, 49 180) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,

Bombay, 1996, pp 608,683,565,865,949 181) Phillips. R. and Rix. M. Bulbs Pan Books 1989 ISBN 0-330-30253-1 182) Chopra. R. N., Nayar. S. L. and Chopra. I. C. Glossary of Indian Medicinal Plants

(Including the Supplement). Council of Scientific and Industrial Research, New Delhi. 1986

183) Medicinal P ants of Nepall Dept. of Medicinal Plants. Nepal. 1993 - Terse details of the medicinal properties of Nepalese plants, including cultivated species and a few imported herbs.

184) [Tsarong. Tsewang. J. Tibetan Medicinal Plants Tibetan Medical Publications, India 1994 ISBN 81-900489-0-2, A nice little pocket guide to the subject with photographs of 95 species and brief comments on their uses.

185) Genders. R. Scented Flora of the World. Robert Hale. London. 1994 ISBN 0-7090-5440-8, An excellent, comprehensive book on scented plants giving a few other plant uses and brief cultivation details. There are no illustrations.

186) Purmhothaman, K. K. et al.: J. Res. Ind. Med. 7: 39 (1972) 187) Singh, N. et al.: J. Res. Ind. Med. Yoga & Homeo. ll: 3 (1976) 188) Mishra, S. H. et al.: ind. Drugs, p.141 (1979) 189) Tripathi, V. D. et al.. Ind. J. Pharm. Sci. 40: 129 (1978) 190) Kirtikar, K. M. and B. D. Basu: Indian Medicinal Plants, Bishen Singh

Mahendrapal Singh, Dehradun (1985) 191) Patel V, Banu N, Ojha JK, et al. Effect of indigenous drug (Pushkarmula) on

experimentally induced myocardial infarction in rats. Act Nerv Super 1982; Suppl 3:387-394

192) Singh RP, Singh R, Ram P, Batliwala PG. Use of Pushkar-Guggul, an indigenous antiischemic combination, in the management of ischemic heart disease. Int J Pharmacog 1993; 31:147-160


VIII

193) Tripathi SN, Upadhyaya BN, Guptha VK. Beneficial effect of Inula racemosa (Pushkarmoola) in angina pectoris: a preliminary report. Ind J Physiol Pharmac 1984; 28:73-75

194) Botanical Magazine t., 1847. Of G. indica, Bentley and Trimen, Med. Plants, 32 195) Sailaja srivatsava, Sharangadhara Samhita, Poorvakhanda, 6/1, 2nd ed, 1998,

Choukumbha Orientalia, Varanasi, pp 173 196) Ambika Datta Shastri, Susruta Samhita Uttara 45/39-40, 15th edition, 2002,

Choukumbha Sanskrit Samsthana, Varnasi, p 171 197) Aspi F Golwal, Golwal Physical Diagnosis, 8th ed, 1999, Media Promotors and

Publishers pvt. Ltd. Mumbai, pp 346 - 375 198) NAEP, 1991, Guidelines for the diagnosis and management of asthma,

www.niaid.nih.gov 199) Ibid, www.niaid.nih,gov 200) Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association

of physicians of India, Mumbai, pp 294 201) Ramnik Sood, Medical Lab Technology, 4th ed, 1994, Jaypee Brothers, New

Delhi, pp 194-95 202) Ibid, pp 184-85 203) Ibid, pp 234


IX

http://www.niaid.nih.gov/


SPECIAL CASE SHEET FOR THE EVALUATION OF “ARDHEDASHEMANEEYA SWASAHARAVATI” IN TAMAKA `’SWASA

POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) SHRI. D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG

Guide: Dr .V. Varadacharyulu Co-Guide: Dr. K.S.R. Prasad

Scholar: B.L.Kalmath

1) Name of the Patient Sl.No

2) Sex Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

5) Occupation Sedentary Active Labor

6) Economical status Poor Middle Higher middle Higher class

7) Address

Pin

8) Birth data Place of Birth

AM Date Month Year Time

Hours Minutes PM

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 satisfaction, 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 Signature

If the patient have status Asthmatics or under modern medication or Pregnant and lactating women or of 3 years-chronic symptoms are excluded.

1

12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints Duration Remarks

1 Teevra vega Swasa (Dyspnonea) 2 Kasa (cough) 3 Duhkhena Kapha nissaranam (Expectoration) 4 Ghurghuratwam (Wheezing) 5 Peenasa (Coryza) 6 Kruchrena bhasate (Dysphonoea) 7 Kantodhwamsham (Hoarseness of voice) 8 Greevashirasangraha (Headache & Stiffness) 9 Urah Peeda (Chest Pain) 10 Shayane Swasa peedita (Discomfort at supine) 13) ASSOCIATED COMPLAINTS Associated Complaints Duration Remarks

1 Anidra (disturbed sleep)

2 Pratamyati or Bhrushamarta (distressed)

3 Aruchi (Anorexia) 4 Vishukasyata (Dryness of mouth)

5 Lalata sweda 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 / Longtime non progressive Periodicity seasonal / irregular / perennial Preceded by sneezing / nasal irritation/ cough Sputum non purulent / purulent Aggravating factors dust/ food/ smoke/ pets / pollens Comfort posture at attack sitting/ lying/ standing/ forward bending

15) Occupational History if any

2

16) PERSONAL HISTORY

Food habits Vegetarian 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 – Specify if any has the same disease

Other system medications Bronchodialtors Treatment history Cortico steroids Other medicines RS Since how long

History of past illness

17) EXAMINATION (a) Vitals

Temperature ºF 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 Sp

arsh

ana

Lymph nodes Not palpable / palpable at Akotana Normal / Resonant / Hyper Resonant / Dull

Type of breath Broncho-vesicular/ Vesicular / Bronchial Vocal resonance Normal / Increased/ Decreased/ Absent

Shra

vana

Resp. Sound Rales/ Ronchi/ Crepitating/ Plural Rub /

3

(d) Dosha Examination (Ayurvedic)

Desham (Deha) Bhumi Jangala Anupa Sadharana Vata Pitta Kapha

Karshya Peeta mootrata Agni sadana

Karshnya Peetanetra Praseka

Ushna kamitwa Peetavi t Alasya

Kampa Peetatwak Swetangata

Anaha Adhikshudha Sheetangata

Shakrudgraha Adhidaha Gowrava

Balabhrmsha Slathangata

Nidrabhramsha Swasa

Pralapa Kasa

(a) Dosha Vruddhi

Bhrama At in idra

Vata Pitta Kapha

Angasada Mandagni Bhrama Alpabhashite

ahitam Shareera sheetatwam Urah

shoonyata

Chesta heenata Prabha hani Shira soonyata

Vyamoha Hridrava

(b) Dosha Kshaya

Sleshma vruddhi Sandhi saidhi lya

Nadi V P K VP VK PK VPK

Prakruti V P K VP VK PK VPK

Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam 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

Shabda Sparsha Sheeta Ushna

Ast

asth

ana

Drik Akruti

4

(e) Srotas Lakshana Status Lakshana Status Pranavaha Atisrustam Ati badhdama Kupitam Abheekhnam Alpalpa Sashoolam Annavaha Aruchi Ajeerna Chardi Anannabhilasha Udakavaha Jihwashosha Talushosha Ostashosha Pipasa

18) Tamaka Swasa Nidana Visamashana (V) Tilataila (P) Pistanna (K) Masa (K)

Adhyashana (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) Anupa mamsa (K)

Aha

ra

Rukshanna (V) Abhishyandi (K)

Rajas (V) Abhighata (V) Kanthapratighata (V) Urahpratighata (V) Vata (V) Dhuma (V) Karmahata (V) Marmabhighata(V) Sheeta Sthana (V) Apatarpana (V) Veganirodha (V) Usna (P) Sheeta ambu (V) Bharakarshita

(V) Shuddhi Atiyoga (V) Abhishyandi

Upacara (K) Vi

hara

Ativyayama (V) Adhwahata (V) Gramya dharma (V) Divasvapna (K) Ksataksaya Atisara Visucika

Udavarta Vibandha Panduroga

Vata

Kshaya Anaha Dourbalya

Pitta Rakta pitta Jwara

Kasa Amapradosa Chardi

Any

a / V

yadh

i Ava

sta

sam

band

ha

Kapha

Pratisyaya Amatisara

19) Tamaka Swasa Poorvaroopa

Poorvaroopa Status Poorvaroopa Status

Hrutpeeda Parshwashoola

Kshudra Swasa Vibandha

Shankha bheda Anaha

Shoola Arati

Pranavilomata Bhakta dwesha

Vaktra vairasya Admana

5

20) Tamaka Swasa Vikalpa Samprapti

Santamaka Pratamaka

Udavarta Jwara

Rajaobhighata Moorcha

Ajeerna

Vata nirodha

21) Upashaya and Anupashaya

Asheene labhate sowkhyam Sleshma vimokshante sukham Upashaya

Usnamchaivabhinandate Shayanasya sameerane parshwe

ghrnnati

Anupashaya Shayanasya Swasa peedita Meghambu sheeta pragwata

22) INVESTIGATIONS (Objective parameters)

Investigations for screening Before After

Sputum examination (if necessary)

Chest-X-Ray (if necessary)

Objective parameters

Breath holding time /sec /sec

Peak expiratory flow rate L/m L/m

Erythrocytes sedimentation rate mm/1st Hour mm/1st Hour

Hemoglobin % Gm% Gm%

Absolute eosinophilic count /cumm /cumm

23) Treatment schedule of “ARDHEDASHEMANEEYA SWASAHARAVATI” Schedule Investigator’s observation

Day 1

Day 15

Day 30

Day 45

(Final Follow up) 45th day Investigators Note:

Signature of Guide

(Dr .V. Varadacharyulu)

Signature of Co-Guide

(Dr. K. Shiva Rama Prasad)

Signature of Scholar

(B.L.Kalmath)

6

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA

BANGALORE

Proforma for registration of subject for dissertation

1) Name of the candidate and

address (in block letters)

: KALMATH. BASAYYA.LINGAYYA

IRAKAL GADA POST KOPPAL TQ. DIST

2) Name of the institute : Sri D.G. Melmalagi Ayurvedic Medical College,

Post graduation & Research Centre,

Gadag - 582103

3) Course of study and subject : AYURVEDAVACHASPATHI (M.D.)

KAYACHIKITSA

4) Date of admission : October 2003

5) Title of the topic : EVALUATION OF THE EFFICACY OF

ARDHEDASHEMANIYA SWASA HARA VATI IN

THE MANAGEMENT OF TAMAKA SWASA

6. Brief Review of Intended Work

6.1 Need for Study:

The human body is continuously under the influence of environmental changes

subjected to environmental pollution. Our urbanized life style and industrialization1 compound

the problem.

As a result of smoke and dust Pranavaha srotodushti occurs and terminates in to the

diseases like Kasa, Swasa, Rajayakshma, etc. Among these Tamaka Swasa (Bronchial

Asthma) is very common disease of Pranavaha srotas2.

The world health organization (WHO) estimated in 1998 that Asthma affects 155 million

people world wide, based on data collected in epidemiological studies in more than 80

countries. These are estimating as Bronchial Asthma may affect as many as 300 million of

population worldwide. Asthma rate has increased significantly in recent decade. The number of

1

disability adjusted life years (DALYs) lost due to Asthma worldwide has been estimated at 15

million per year. Asthma accounts for around 1% of all DALYs lost worldwide reflecting the high

prevalence and severity of the disease. It is crucial that we should gain more insight in to its

causation and management3.

Even though the scientific world has conducted extensive studies but couldn’t find a safe

and effective medicine for this disease. Ayurveda treat this disease confidently and increase the

quality of life in individuals and contributive several modalities of management. Amongst herbal

combination is said to be the best. Tamaka Swasa management has shifted from symptomatic

relief to disease control this can be achieved through usage of prophylactic category of

medicaments.

Asthma is considered to increase direct and indirect medical expenditures, so to reduce

the cost of treatment also to prevent the disease. Ayurveda suggest cost effective management

of Tamak Swasa. To fulfill the ideology 5 herbs are selected from Swasa hara Dashemaniya of

Charaka as Ardhedashemaniya Yoga4.

6.2 Review of Literature:

The elaborated descriptions of Tamaka Swasa Nidana, Poorvaroopa, Roopa,

Sadhya, Asadhyata and Chikitsa are reviewed from Bhruhatryees 5,6,7. The definition of Tamaka

Swasa enumerated in Susruta Samhita very well. Susruta 8 defined it as “ÌuÉvÉåwÉå SÒÌSïlÉå iÉÉqrÉÌiÉ xuÉÉxÉÉ

xÉ iÉqÉMüqÉiÉå” which means that the attack of Swasa with iÉqÉ:mÉëuÉåvÉ (Darkness) occurs specially

during Durdina. Durdina means or compared with aggravating season or climate “

Vijayarakshita interpreted as it is a condition where the air is expired out by producing sound.

Apart from above said references of Tamaka Swasa Laghutrayee references along with

other classical references of Madhava nidana9, Yogaratnakar10, Bhavaprakasha 11,

chakradatta12, Vangasen13, and Bhaishajya Ratnavali14 explained Tamaka Swasa disease and

treatment in detail.

2

The etiology, pathology and the management of Bronchial asthma has been considered

as the Tamaka Swasa of the contemporary and reviewed from various texts of contemporary

medicine textbooks viz. Davidson’s TBM 15, Harrison’s TBM16, API text book of medicine17.

The pharmaco dynamics and kinetics of the individual herbs of composition have very

efficacious result in hypothesis are studied from various contexts of textual references from

different Samhita of Ayurveda and reviewed to found with its relevance to the present day

study18.

6.3 Objective of the Studies: -

1. To assess the effect of selected Dashemaniya compound in Tamaka Swasa

2. To assess the lung function’s improvement by Dashemaniya compound in

Tamaka Swasa

7. Material and Methods:

7.1 Source of Data

a. Patients: suffering from Tamaka Swasa will be selected from postgraduate

Studies and research center, Dept of Kayachitsa OPD and IPD of DGM Ayurvedic

Medical College & Hospital by Pre-set inclusion & exclusion criteria.

b. Literary: Literary aspect of study will be collected from classical Âyurvedic texts

and contemporary texts with updated recent medical journal.

c. Trial Drugs19,20,21,22 : The combination will be equal parts of Ardhedashmaniya

Swasahara yoga is as follows.

1. Shati : Hedychium spicatum

2. Pushkaramool : Inula recemosa

3. Amlavetas : Garcinia Pedunculata

4. Tulasi : Ocimum sanctum

5. Bhumyamalaki : Phyllanthus Urinaria

All the herbs will be identified and purchased from local area. Good

Manufacturing Practice will be followed for preparation of vati.

3

7.2 Method of collection of data:

a. Study designs: Observational Clinical Study

b. Sample: Minimum 50 patients are taken in randomized selection.

c. Exclusion Criteria: The following were the criteria to exclude the patients of Tamaka Swasa

from the study.

1. Patients with infective disease or other systemic disease and status Asthmatics

cases are excluded.

2. Patients below 14 years & above 60 years are excluded from the study.

3. Patients undertaking modern medication are excluded.

4. Pregnant and lactating women are also excluded.

d. Inclusion Criteria:

1. Patients other than exclusion criteria are included

2. Patients with symptoms of Tamaka Swasa are included

a. Teevra vega Swasa (Dyspnonea)

b. Kasa (cough)

c. Duhkhena Kapha nissaranam (Expectoration)

d. Ghurghuratwam (Wheezing)

e. Peenasa (Coryza)

f. Kruchrena bhasate (Dysphonoea)

g. Kantodhwamsham (Hoarseness of voice)

h. Greevashirasangraha (Headache & Stiffness)

i. Urah Peeda (Chest Pain)

j. Shayane Swasa peedita (Discomfort at supine)

4

e. Criteria of Diagnosis:

1. The symptoms and signs of Tamaka Swasa mentioned in Ayurvedic

texts in comparison with contemporary medical science

2. Objective parameters with relevance investigations mentioned in

contemporary texts will be the basis of diagnosis.

f. Posology : 3gm/day in divided doses/24 hrs

g. Study Duration: 30 Days

h. Follow up : 15 days

i. Assessment of Result: Subjective and objective parameters of base line data to after

treatment data comparison is done for the assessment of results. Results are assessed from

subjective and objective parameters of pre declared.

j. Subjective Parameters:

a. Teevra vega Swasa (Dyspnonea)

b. Kasa (cough)

c. Duhkhena Kapha nissaranam (Expectoration)

d. Ghurghuratwam (Wheezing)

e. Peenasa (Coryza)

f. Kruchrena bhasate (Dysphonoea)

g. Kantodhwamsham (Hoarseness of voice)

h. Greevashirasangraha (Headache & Stiffness)

i. Urah Peeda (Chest Pain)

j. Shayane Swasa peedita (Discomfort at supine)

k. Objective Parameters 23 : 1. Peak expiratory flow rate.

2. Erythrocytes sedimentation rate.

3. Absolute eosinophilic count.

5

l. Statistical assessment: The paired “t” test, unpaired “t” test and non-parametric test are

used to test the hypothesis. If “P” < 0.05, the test is highly significant.

7.3 Investigation for exclusion:

1. Sputum examination (if necessary)

2. Chest-X-Ray (if necessary)

7.4 Ethical Clearance : Obtained, certificate enclosed

References :

1. Petersdorf R.G editor, Harison principles of internal medicine,Vol-2, 252 ch. 14th ed. India:

Mcgraw Hill, New York, 1998.p 1419 to 1426.

2. Satya Narayan Shastri, Charka Samhita Chikitsa 17/13, 17, 22nd ed. Choukumbha Bharati

Academy, Varanasi, 1996. pp 509-10

3. http://www.globalburdenasthma.com,

4. Ganga Sahay Pande ed, Charka Samhita Sutra 4/37, 2nd ed. Choukumbha Samskrut

Samstan, Varanasi, 1983. pp 67

5. Ambika Datta Shastri, Susruta samhita Uttar Tantra 51/8, 13th edition, Choukumbha

Sanskrit samsthana, Varnasi, 2000, p 374

6. Satya Narayan Shastri, Charka Samhita Chikitsa 17/1-6, 55-62, 68-83, 121, 147-48, 155,

22nd ed. Choukumbha Bharati Academy, Varanasi, 1996. pp 508-531

7. Ambika Datta Shastri, Susruta samhita Uttar Tantra 51/1-6, 8-10, 14-15, 13th edition,

Choukumbha Sanskrit samsthana, Varnasi, 2000, p 372-378

8. Srikanta Murty, Astanga Hrudayam Nidana 4/6-10, Chikitsa 4/1-51, 2nd ed, Chukumba

orientalia, Varanasi, 1995, pp 38, 245-54

9. Shri Sudarshan Shastri ed, Madhava Nidana, Vol-1, 12/27-41, 15th ed, Madhukosh

commentary, Chukumba Sanskrit samsthan, Varanasi, 1985, pp 290-301

10. Vaidya Shri Laxmi Pathishastri ed, Yogaratnakara, Swasa Adhikara, 1-8 sloka, 5th edition,

Chukumba Sanskrit samsthan, Varanasi, 1993, pp 427-37

6

http://www.globalburdenasthma.com/

11. Brahmsankar Misra, Bhava Prakash, 14th chapter, 5th edition, Chukumba orientalia,

Varanasi, 1980, pp 150-166

12. P.V.Sharma ed, Chakradatta, Hikkaswasa Chikitsa 12/1-30, 5th edition, Chukumba

publishers, Varanasi, 1998, pp 149-153

13. Shri Shaligramaj Vaishy, Vangasena, Swasa roga, 1-86, khemaraja shri Krishnadas

prakashana, Mumbai, 1996, pp 265-71

14. Ambikadatta Shastri, Bhaishajya Ratnavali, Hikka swasa Chikitsa, 16/1-139, 2nd ed,

Chukumba Samskruta samstan, Varanasi, 1981, pp 329-339

15. C.R.W Edwards ed, Davidson’s Principals and Practice of the medicine,6th chapter- Disease

of Respiratory system, 17th edition, Churchil Living stone, Edinburg, 1995, pp 336-344

16. Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th ed. India:

Mcgraw Hill, New York, 1998.p 1419 -1426.

17. G.S.Sainani ed, API text book of medicine, sec-6, 7th chapter, 6th edition, Association of

physician of India, Mumbai, 1999, pp 226-30

18. Ganga Sahay Pande ed, Charka Samhita Sutra 25/40, 2nd ed. Choukumbha Samskrut

Samstan, Varanasi, 1983. pp 218-20

19. P.V. Sharma, Dravya guna vignyana, Vol 2, Chukumba Bharati academy, Varanasi, 2001,

pp 292-93,296-97,338-40,513-16,640-41.

20. P.V.Sharma, Dhanvantri nighantu 1/60-61, 65-66, 2/93-94, 3/83-84, 4/45-46, Chukumba

Sanskrit samsthana, Varanasi, 1982 pp 26, 27, 87, 129, 106.

21. P.V.Sharma, Kaideva nighantu, 1/1392-93, 1320-22, 3192-24, 1551-55, 247-50, Chukumba

orientalia, varnasi, 1979, pp 258, 244, 61, 633, 49

22. K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan, Bombay, 1996,

pp 608,683,565,865,949

23. G.S.Sainani ed, API text book of medicine, sec-3, 2nd 3rd 4th chapters, 6th edition, Association

of physician of India, Mumbai, 1999, pp 214-20

7

9. Signature of the Candidate: -

KALMATH.B.L

10. Remarks of the Guide

11. Name and Designation

11.1 Guide : Dr.V.VARADACHARYULU M.D.(Ayu) Professor and HOD P.G.S. & R.C.D.G.M.A.M.C. Gadag

11.2 Signature :

11.3 Co-Guide : Dr.SHIVA RAMA PRASAD KETHAMAKKA M A (Jyo) M.D.(K.C) (OSM) READER IN KAYACHIKISTA P.G.S & R.C. D.G.MA.M.C. Gadag.

11.4 Signature :

11.5 Head of the Department : Dr.V.VARADACHARYULU M.D.(Ayu) Professor and HOD P.G.S. & R.C.D.G.M.A.M.C. Gadag 11.6 Signature :

12 Remarks of Chairman & Principal:

21.1 Signature : Dr. G.B. Patil

Principal /CMO

8

tamaka swasa kc033gdg

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