Dr.B.R.K.R GOVT. AYURVEDIC COLLEGE HYDERBAD.TAMAKA SWASA

Gautham BAMS-3rd sem.

SHVASA

• Shvasati Vayu iti Shvasah (Hem Chandra)• Shvasiti Anena iti Shvasah (Shabda Kalpa Druma)• Shvasiti Iti Shvasah • Shvasa word is used to denote respiration and exchange of

air in the body. The Word Shvasa is used for both Physiological and Pathological states.

• Shvasa Roga may be defined simply as a disease in which the respiration and exchange of air is disturbed.

• Shvasa is classified in followingtypes:1. Mahashvasa2. Urdhvashvasa3. Chinnashvasa4. Tamakashvasa5. Kshudrashvasa

ETYMOLOGY OF TAMAKA SHVASA:

• Tamaka Shvasa comprises of two words i.e. Tamaka and Shvasa.

• TAMAKA: The word is derived from the Dhatu "Tamglanou" which means Sadness (Panini)

1. The word "Tamaka" is derived from the root "Tam" means oppression of chest (Monier Williams).

2. The Sanskrit English Dictionary by Vidyadhar Vamana (1926) shows the different meanings of Tam i.e. to choke, to be suffocated, to be exhausted, to be unease, and to be distressed.

3. Tamaka - Tamyati Atra Tama Vachaspatyama 3237 V IV. It is described as a one variety of disease Shvasa in Vachaspatyama.

4. Tama Tamyati Anena Iti Tama - Halayudhakosha page 326. The word Tama denotes Andhakara, Nishacharma, Divantaka, Dinantarama, Andhakam.

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1. Pinasa: In this condition there is excessive secretion of shleshma (mucus) in the pranvaha srotas. Nasal secretion increases & pinasa (coryza) develops. This hinders the free flow of pranvayu.

2. Griva siriska sngraha: When prakupita vata moves in pratiloma marga, it contracts the neck & head muscles because of which the patient feels if his head & neck are tightly held by someone. It also indicates the use of extra respiratory muscles during the attack.

3. Ghurghurkiam: It is a typical sound produced, when excessive secretion of the kapha, obstructs the free flow of pranvayu.

4. Ativativra Vega shwasa: When the attack of shwasa comes, the heart rate also increases as the respiration rate & heart rate is in a ratio of 1:4. When the shwasa kriya increases, the heart rate also increases which causes sevre discomfort. The excess secretion of mucus & sputum clogs the path of pranvayu, this causes kasa & when unable to expectorate the thick, sticky sputum it further aggravates the coughing & a sense of suffocation.

5. Pratamayati Ativegata: The pluging of the tract with the mucus and sputum and continuous effort to expectorate causes severe dyspnoea, he sits up frequently panting & feels if surrounded by darkness.

6. Kaste Sanniruddtiyate: During severe coughing, the patient breath withheld for a few seconds and becomes motionless.

7. Kasat Muhur Muhur Pramahom: Repeated coughing and paroxysmal attacks ofdyspnoea and frequent panting, makes him feel if he is entering into darkness & Distress.

8. Sleshma Amuchamane Bhrusam Dukhita: In a patient of tamak shwasa the sputaum is thick, tenacious, and sticky in nature and is not easily exporated. Thus situation is very distressing.

9. Slashmani Vimokshante Muhurtam Sukham: Once the sputum is expectorated the frequency of coughing reduces and there is momentarily relief due to easy flow of prana vayu.

10. Kanthodhvansa: Because of repeated coughing the patient develops hoarseness of voice.

11. Kruchrat Bhasitam: During the shwasa Vega, the patient cannot speak properly due to the tenacious mucus coated in the throat and vocal cords get affected.

12. Nachapi Nidra labhate Sayana Shwasa Piditam: Due to frequent kasa & Shwasa patient cannot sleep and on lying, the flow of prana vayu is obstructed and patient again sits on bed.

13. Parshva Tasyavagrhyate Sayansya Samiranaha: When the patient lies in recumbent position, the space for air exchange reduces in lungs which cause sudden pressure on the lungs due to raised diaphragm. The air trapped cannot easily escapes and severe pain occurs.

14. Asinolabhata Saukhyam: On sitting position the diaphragm is lowered and the space for air exchange increases and the pressure is also reduced, this fecilitates the flow of pranavayu.

15. Ushnaabhinandti: The patient has inclination towards hot things like tea; coffee, hot food because taking hot things gives relief to the patient.

16. Ucchritaksha: When there is diffciency of pranvayu & its path is obstructed. The patient suffering from tamaka shwasa raise his face upward to fascilitate easy entry of pranvayu. His eyes are wide open.

17. Lalateswada: During Asthamatic attack, patient continuously makes effort to take breath, is exhausted and this further increases his heart rate (Tachycardia). Severity of tamaka shwasa forces him to use accessory muscles for respiration and all this causes sweating on forehead.

18. Bhrusum Aratimana: Increased respiration rate, worsen his condition and he feels giddiness.

19. Vishuskasysta: Continuous rapid shwasa-prashwasa (respiration) process causes dryness of mouth due to excess loss of water from the body.

20. Muhuchiva Avadhamyate: Here the patient expires for a longer duration of produicing sound with a shorter phase of inspiration. In this condition the body trunk is raised and lowered alternately as explained by Gangadhar.

21. Muhur Muhur Shwasa: Patient respiration rate increases due to irritative cough, dyspnoea occurs time and again at short intervals.

22. Annadhvesa: In this there is agni dushti which leads to agni manda and this causes indigestion and production of Amarasa and this causes Annadhvesa.

23. Meghambu Sita Pragavate Sleshmaischabhi Vardhyate: The condition of the shwasa is aggrevated by megha (clouds) Ambu (rainy season) Shita (Cold) Pragavate(winds coming directly) and Kapha vardhaka diet.

24. Uraha Pida: Due to vitated vayu dosha there is pain in chest.

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Samprapthi ghatakas

Dosha : Vata - Especially Prana Vayu , Udana, Samana,( Apana and Vyana are also affected in due course.)

Kapha - Kledaka and Avalambaka Kapha

Dushya : Rasa, (Rakta),(udaka) Mala : rasa mala kaphaAgni : Mandagni, Vishamagni

Ama : Rasa gata Dhatvagnimandya(agni maandhya janya ama)( Mandagni janya Ama)

Srotas : Prana, Anna, Udakavaha Srotasa,(rasa)

Udbhavasthana : Pittasthana (Charaka) Adho Amashaya (Chakrapani) Aamashaya (Vagbhat) Adhistaana : urah,phupphusa(kapha sthana)Vyaktisthana : UrahSrotodusti : Sanga in pranavaha & anna vaha , Atipravritti in Udakavaha and Pranavaha and Vimarggamana in pranavaha 

rogamarga : AbhyantaraVyadhi : Amashayotha

Nidana sevanaKapha prakopaVata

prakopa

Ama formation

Agni dusti

Saama vata

Ama yuktha rasa dathu

Kledaka kapha vruddhiAdho aamasaya

Yugapat Sarvato Vikshepa

Mala rupa kapha utpatti

Vyana Vikriti

Avalambaka kapha vriddhi

Kapha sanga(mucus plug)

Kapha makes avarana to prana vayu

urasSrotorodha, Shotha,Sankocha in PranavahaSrotasa (Inflammation,Broncho constriction)

Pratiloma gati of Pranavayu

Utklesha of sthanika kapha

Margavarana of Vata

Vishamagni

Tamaka swasa

Udana vayu

Pratamaka Shwasa:• Patients suffering from Tamaka Shwasa when gets afflicted with

fever and fainting, the condition is called as Pratamaka Shwasa. It is suggestive of involvement of Pittadosha in Pratamaka Shwasa.

• It is aggravated by Udavarta, dust, indigestion, humidity (Kleda),

suppression of natural urges, Tamoguna, darkness and gets alleviated instantaneously by cooling regimens. Ch.chi-17/63

Santamaka Shwasa:• When the patients of Pratamaka Shwasa feels submerged in

darkness, the condition is called as Santamaka Shwasa.Though Chakrapani has mentioned these two as synonyms of each other Charaka refers them as two different ailments representing two different stages of Tamaka Shwasa,

• These two conditions differs from each other according tointensity of attack. This can be taken as the severe stage of Pratamaka ch.chi-17/64

SADHYASADHYATA :

• Tamakashvasa in general is described as Yapya (palliable) disease. However in individual with recent origin of disease person Pravara bala or both said to be Sadhya(Ch. Chi. 17/.62).

• While mentioning prognosis of any disease following characters are mentioned in case of Yapya disease.

• Disease has affected the deep seated Dhatus• Disease involving many Dhatus• If affects vital organs and joints• Affects patient continuously for longer period• Disease is caused by two Doshas.

In disease Tamakashvasa Kapha and Vata Dosha are involved primarily. Both of them exhibit opposite qualities. Hence management will be also difficult as factors, which excite Vata, alleviate the Kapha Dosha and vice Versa.

• Rasaadi Dhatu gets involved in Tamaka Shvasa, which is suggestive of the involvement of more than one Dhatu.

• Pranavaha Srotasa is mainly involved. This Srotas is having direct exposure to environment hence persons are more exposed to Nidana like Raja, Dhuma etc.

• Disease Tamakashvasa is having Multifactorial origin along with diet, environmental and meteorological factors like rains, cloudy weather, chilly wind etc & patients can not avoid this Nidana.

• Sushruta opines Kasa, Shvasa and Vilambika are very difficult to cure like setting in together of fire, wind and thunder. (Su. Utt. 51/56) Regarding Tamaka Shvasa he says that it is a disease, which can be cured with much difficulty. If it is appears in adebilitated individuals its prognosis becomes very difficult (Su. Ut. 51/15).

Management in tamaka swasa

The management Shwasa in practical of Tamaka sense has two aspects :

1. Management of Vegavastha of Tamaka shwasa; i.e. acute exacerbations, and2. Chronic management of the avegavastha, where the frequency, duration and intensityof the attacks are minimised/ totally cured to give a quality life to the patient.

• “focus on alleviating Vata without agitating kapha, and balance the kapha, liquefy it and expel it from the

pranavaha srotas, without agitating vata.”• Hence the drug of choice should be of Ushna veerya.

3 categories of therapies in treatment:

1. Samana of k & v always preferred2. Samana of v but aggravates k preferred if essential in

exceptional circumstances3. Samana of k but aggravates v is avoided

1. Vegavastha :Snighdairadou -by lavana tailena , • {In Snehadhaya (Cha.Su. 13/98) Charaka has mentioned properties

of Salavana Sneha}. It supervenes within short period of time because both of them are having Sukshma property hence having greater penetration power. It is also having Doshasanghata Vichedakara property. Taila is having Ushna property, and thus alleviates vata, and does not increase Kapha. There fore it is better for Abhyanga. (Cha.Su.13/15)

• In Shwasa, Grathita Kapha (Mucous plug) is present; and Salavana Sneha is useful in vilayana of this grathitha kapha, thereby removing the sanga (Obstruction of airway). How this Sneha penetrates all Dhatu’s and pacifies Dosha is mentioned by Dalhana (Su.Chi.

25/30, Dalhana).

• Then(Nadi Sweda), (Prastara) sankara sweda is done. In infants and small children, hasta sweda is preferred .

• Swedana helps to dissolve this Kapha. Also heat applied by Sweda is carried from skin to internal organ through blood. Blood is the only medium in body to transfer heat from outer environment to internal organs. In response to the above-mentioned procedures, Kapha, which has become stagnated and get dried, thickened in the Srotas, gets softened and dissolved which is then eliminated from body by Shodhana procedure.

• After profuse perspiration by doing swedana. Then snigdha odna (Rice) or soup of fish, pork, meat or the supernantant of the curd should be given to increase the kapha dosha.

• Then vamana is done by pippali choorna, Saindhava lavana, honey, but the drugs used should not be antagonistic to vata. Thus the sputum (Dusta Kapha) is easily expectorated and free flow of prana vayu is maintained.

• After vamana the residual doshas which are not completely eliminated are cleared with help of dhumpana. For this haridra patra, Eranda mula, lac, realgar, devdaru, orpiment, jatamansi powder is utilized along with ghee.

• A varthi is made ,and is smeared with ghee & used .

• However, in children less than 7 years, mrdu vamana and Virechana are to be performed if the Vega tivrata is very high. Instead, Shamana drugs of ushna veerya, which pacify the vata-vatanulomaka- as well as liquefying kapha (kapha vilayaka), making it flow out to its base in Amashaya, where it can be pacified using kapha hara drugs.

2. Avegavastha:

• In Avegavastha due consideration should be given to avoid pathogenesis which further leads to exacerbations. Hence, particularly Deepana - Paachana and Vatanulomaka treatment should be adopted; Deepana Paachana treatments are useful in maintenance of Agni as Kapha Dosha

aggravation results due to Mandagni. Vitiation of Dosha doesn’t occur if Agni is in proper state. By Vatanulomaka treatment, Vayu traverses through its own path.• Vitiation of all these Dosha depends on the status of Agni (Cha.Chi.

5/136).

• How Agnimandya results into Dosha prakopa is explained by Chakrapani - Agnimandya results into Avipaka, and Vidaaha leading to Kapha and Pitta prakopa and due to absence of Dhatuposhaka rasa it results into Dhatu kshaya further leads to Vataprakopa. Hence along with Deepana Paachana therapy Brmhana therapy is also prescribed to increase the Bala of patient. Brmhana dravya also improves the status of Dhatu.

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ROLE OF VIRECHANA IN TAMAKA SHVASA :

1. The site of origin of shwasa roga is “Pitta Sthana Samudhbhava.” And this pitta sthana is described by Chakrapani as Adho Amashya. This is the region between the hridaya and nabhi. At this place the main pathology of shwasa roga takes place and the pre-dominant dosha pitta is present here. And to purify the site of origin virechana is advocated. (Ch. Su.20/18)

2. The patient of tamaka shwasa is oftenly weak and in chronic stage, hridya as the mula of pranavaha shrotas is also involved. In this condition vamana is very difficult and complicated procedures & the virechana is easily done with out threatening the life of the patient.

3. Accumulation of Mala and Vayu in Udara leads to Apana vayu vitiation, which is followed by vitiation of Prana Vayu leading to Shvasa. In patients of Tamaka Shvasa Anaha like condition is often seen, Virechana by ensuring purgation is expected to relive this condition and thus therapy is more helpful in the treatment of Shvasa.

4. If Tamakashvasa presents due to Saama Vayu it leads to inflammation.As per modern view Asthma is considered as chronic inflammatorycondition of airways. In the management of Shotha Virechana is havingprime importance, as Shotha results due to obstruction in natural path ofVayu. Virechana overcomes this obstruction and reduces inflammatorycondition.

5. Udakavaha Srotasa is involved in pathogenesis of Shvasa. In derangedstate it results into excessive Kleda formation. Kleda is having ApaMahabhuta dominancy particularly in Kaphapradhana samprapti thevitiated status of Kleda is observed. The excessive secretions in thelungs are present at this stage. The word Virechana itself is formed from‘rech’ Dhatu meant for secretion. Virechana removes this Kleda, thus itreduces severity of Shvasa.

6. ShvasaVyadhi is mentioned as Aamashaya samutha where derangement of Agni leading to Agnimandya. In this case Virechana will be helpful by maintaining proper status of Agni, which is the root cause for almost many diseases.

7. Embryological development of Phupphusa occurs from Shonitaphenai.e. main source is Shonita. In case of Shvasa Vyaktisthana is Urahwhere Phupphusa is situated, hence Khavaigunya mainly occurs herehence Virechana which is best treatment for purification of Rakta maybe useful for clearing the Khavaigunya in Phupphusa

Vamana is done in initial stages where there is pravrudda kapha (ch.chi.17/76)& virechana is indicated after vamana.

In tamaka swasa spasm of diaphragm occurs ,which causes aggravation of svasa krichrata.virechana alleviates spasm & improves resp.movementsby reducing intra-abdominal pressure.

Virechana may also help in reducing the absorption of histamine like substances & other toxic material from intestine there by prevevts broncho spasm

As virechan is regarded as best treatment for raktha & pitta .it is raktha prasaadaka,promotes healthy raktha.hence it relives or atleast reduces the sevierity of the effects of allergy.thus reduces attaks of asthma.

GENERAL INSTRUCTION TO BE FOLLOWED:

• To take light diet according to Agni Bala.• To avoid occupational Asthma, worker should use face mask, when

they are working in factories, cotton mills or at places where there is Dust, fumes etc.

• Deep breathing exercise should be followed.• Diet during evening should be taken three hours before going to bed.• Avoid direct exposure to external environment after use of Air

conditioning.• Use of warm clothes in winter season.

NOT TO BE FOLLOWED:

• Over eating and taking milk at bed time.• Fried, chilly, too cold, sour, heavy preparations.• Cold and damp places.• Fasting for a longer period.• Seating in frosty, smoky and congested places for a longer period.• Rukshanna particularly toast, popcorn etc.• Jalaja, Anupa, Mansa, Dadhi, Aamaksheera, due to Guru and

Abhisyandi property.• Bread, Burger, Pizza, Cheezes, Paneera etc is used which are having

Srotorodhaka property.• Contact with those pet animals, which do not suit the individual.• Direct exposure to Prag-vata

PATHYAPATHYA –PATHYA –

Ahara –1. Shuka varga – purana yava, godhooma, shashtika dhanya, raktashali2. Shami dhanya – kulattha.3. Mamsa varga – shasha, tittira, shuka, dvija (birds), daksha(kukkuta).4. Shaka varga – patola, tanduliya, vastuka, vartaka.5. Phala varga – dadima, jambira, draksha, amalaki, bimbiphala,bilva.6. Madya varga – sura.7. Gorasa varga – aja dugdha.8. Kritanna varga – yava, saktu9. Ahara upayogi varga – aja ghritam, purana ghritam, madhu,mamsa rasa, pippali, hingu, kanji, rasona.10. Jala varga – ushna jala of pokhara.

Vihara –Vamana karma, virechana karma, swedana and dhoomapana.

Pathya varga:Purana sastik, Rakta Sali dhanya, wheat, Yava, Mudga,Meat of Rabbit, peacock, Titar, lava, Kukkuta, etc, Kantakari,Jeevantisaka, Bimbiphala, suksma ela, Marica, Sunti, Draksa, Lausun,Purana ghrta, Aja dudgha, Aja ghrta, Gomutra, Sura, hot water, honey,etc.

APATHYA –

JARAM SINGH-KATPHALA-TAMAKA SHWASA-DG-2001IPGT&R, JAMNAGAR, GUJARAT,PDF CREATED BY DR GIRISH KJ, girideepa@yahoo.co.in

Ahara –1. Mamsa varga – matsya.2. Shaka varga – sarshapa.3. Phala varga – kanda4. Jala varga - dushita jala, cold drinks.5. Gorasa varga – bhedi dugdha & ghrita.6. Kritanna varga – ruksha anna & pana, shitala & guru padartha.Vihara –Purva vata sevana, vegavarodha, raktamokshana, raja, dhoomaand gramyadharma etc

Apathya Varga :Beans, Anupa mamsa (fish), manda Saka (potato)mustard, Masa, unboiled milk, cold water, curd, Tail, fried food , etc asahara. Supression of Mutravega, long journey, lifting heavy weight,cinta etc as vihara

• Yogaasanas

• Jala nethi• Sootra nethi• Kapalabathi• Vamana douthi

• Ardha chakrasana• Paschimottasana• Bhujangasana• Danuraasana• Surya bhedan pranayam

• Tadasan• Vajrasan• Shavasan• sashankasan

Medications……

• Vasa gritha• Vasa kantakaari gritha (these have natural steroids)• Samerpanng ras• Tallasindura• Yastimadhu• Mahalaxmivilas ras• Pravala

• Chyavanprasha lehya• Vasa kantakari lehya• Agastya rasayan• Abhraka basma• Shrungi basma• Spravala basma• Vasarista• Kanakaasava• Somaasava

Thanks to all…