A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS OF

TAMAKA SHWASA.

By

MADHUSUDHANAN.I.K., B. A. M. S.

Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore,

Karnataka in partial fulfillment of the regulations for the award of the degree of

DOCTOR OF MEDICINE (AYU)

IN KAYA CHIKITSA

GUIDE:

DR.G. SRINIVASA ACHARYA., M.D. (AYU)

Asst. Professor, S. D. M. C. A., Udupi

CO-GUIDE

DR.SHRILATHA KAMATH.T., M.D. (AYU)

Lecturer , S. D. M. C. A., Udupi.

DEPARTMENT OF POST GRADUATE STUDIES IN KAYACIKITSA S. D. M. COLLEGE OF AYURVEDA, UDUPI – 574 118

2005 - 2006

I

Rajiv Gandhi University of Health Sciences

DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled “Clinical study to evaluate the effect of

Vamana and Shatyadi Curna in patients of Tamaka Shwasa” is an above-board

research work carried by me under the guidance of Dr.G.Shrinivasa Acharya., M.D.

(Ayu) and co-guidance of Dr.Shrilatha Kamath.T., M.D. (Ayu).

MADHUSUDHANAN.I.K.

B.A.M.S.

Date:

Place: Udupi.

II

Rajiv Gandhi University of Health Sciences

CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “A Clinical study to evaluate the effect of

Vamana and Shatyadi Curna in patients of Tamaka Shwasa” is an above-board

research work done by Madhusudhanan.I.K in partial fulfillment of the requirement for

the degree of M.D. (Ayu).

Signature of the Guide:

DR.G. SRINIVASA ACHARYA., M.D. (AYU)

Assistant Professor, S. D. M. C. A., Udupi.

Signature of the Co-Guide:

Date: DR.SHRILATHA KAMATH.T.M.D. (AYU)

Place: Udupi. Lecturer, S. D. M. C. A., Udupi.

DEPARTMENT OF POST GRADUATE STUDIES IN

KAYACIKITSA

III

Rajiv Gandhi University of Health Sciences

ENDORSEMENT BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A Clinical study to evaluate the effect of

Vamana and Shatyadi Curna in patients of Tamaka Shwasa” is an above-board

research work done by Madhusudhanan.I.K, under the guidance of Dr.G.Shrinivasa

Acharya., M.D., (Ayu) and co-guidance of Dr.Shrilatha Kamath.T., M.D. (Ayu).

Signature of the H.O.D. Signature of the Principal

Dr. U. N. Prasad, M.D. (Ayu) Dr.K.Balakrishna Bhat., B.S.A.M

Professor and H.O. D., PRINCIPAL

Department of P.G Studies in Kayachikitsa. S. D. M.C.A, S.D.M.C.A, UDUPI.

S. D. M.C.A, S.D.M.C.A, UDUPI.

Date:

Place: Udupi.

IV

COPYRIGHT

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 academic / research purpose.

MADHUSUDHANAN.I.K

B.A.M.S

Date:

Place: Udupi.

© Rajiv Gandhi University of Health Sciences, Karnataka

V

ACKNOWLEDGEMENT

I sincerely express my indebtedness and deep sense of gratitude to rendered

teacher and guide Dr.G.Shrinivasa Acharya, Assistant Professor, Department of

Kayachikitsa, S.D.M. College of Ayurveda, Udupi, for his valuable guidance and help in

completing this work successfully. I would like to put on record the affection and care

with which my esteemed Guide directed me during the study.

I express my deep sense of gratitude to my teacher and Co-guide

Dr. Shrilatha Kamath.T, Lecturer, Department of Kayachikitsa, S.D.M. College of

Ayurveda, Udupi, for her support and guidance throughout the study.

I am ever grateful to Dr. U. N. Prasad, Prof. and H.O.D. of Kayachikitsa

department S.D.M. College of Ayurveda, Udupi for his encouragement, support and

helpful suggestions.

I am greatly indebted to our respected principal Dr.K.Balakrishna Bhat for

supporting me in every walk of my P.G education at Udupi.

I wish to offer my sincere thanks to Dr.K.Ramachandra Rao. Prof & Dean of

the PG department S.D.M. College of Ayurveda, Udupi for his support.

I express my special thanks to Dr.Ramdas Hedge, practitioner, Bajagoli,

Karkala for his cherished support and help.

I express my sincere thanks to S.D.M. Education Society Ujire, for giving me an

opportunity for my Post Graduation Education.

I am grateful to Dr.Prasanna.N.Mogasale, Dr.V.K.Shridhar Holla, Dr.Jonah,

Dr.Veerakumar, Dr.Lavanya, S.D.M. College of Ayurveda, Udupi.

I express my truthful thanks to Dr.Y. N.Shetty, Superintendent, Dr.Deepak S. M.,

Deputy Superintendent and Dr.C.S.Hegde of the S.D.M. Ayurveda Hospital, Udupi.

I am grateful to Dr.Muralidhar.B, Dr.Mohanan S.D.M.Ayurvedic pharmacy for

providing me the drug compounds of my study to specifications

MADHUSUDHANAN.I.K.

VI

TABLE OF CONTENTS

LIST OF TABLES

LIST OF FIGURES

LIST OF ABREVIATIONS

Page No

PREFACE 1

OBJECTVES 7

PART – I: CONCEPTUAL CONTRIVE

Chapter I – Historical Glimpse 8

Chapter II – Etymology of Tamaka Shwasa 13

Nidana 15

Samprapti 22

Prabhedas 25

Poorvaroopa 26

Roopa 28

Modern Perpetuation 31

Upashaya – Anupashaya 39

Sadhya – Asadhyata 40

Vyavacchedaka Nidana 41

Chikitsa 44

Pathya – Apathya 47

Chapter III - Drug Review 51

PART – II: CLINICAL STUDY

Methodology 62

Observations and Results 70

Part – III: DISCUSSION 106

Part – IV: CONCLUSION 117

SUMMARY 119

BIBILOGRAPHY 122

ANNEXURE- PROFORMA

VII

LIST OF TABLES:

Page No.

1. Nidana of Shwasa / Tamaka Shwasa 15

2. Vyanjaka hetu of Tamaka shwasa. 19

3. Poorvaroopa of Shwasa Roga 26

4. Roopa of Tamaka Shwasa 29

5. Characteristic features of Extrinsic and Intrinsic asthma. 34

6. Upashaya and Anupashaya in Tamaka Shwasa 39

7. Difference between five varieties of Shwasa. 42

8. Pathya in Tamaka Shwasa 47

9. Apathya in Tamaka Shwasa 49

10. Ingredients of Shatyadi Curna. 51

11. Criteria to assess Vamana Karma. 63

12. Samsarjana karma. 64

13. Age group Incidence of patients 71

14. Sex Incidence of patients 72

15. Marital status of patients. 73

16. Distribution according to their religion. 74

17. Habitat Incidence 75

18. Socio economic status 76

19. Occupation 77

20. Habits of the patient. 78

21. Dietary habits 79

VIII

22. Analysis of Deha Prakriti. 80

23. Analysis of Sara. 81

24. Analysis of Samhanana. 82

25. Satvataha analysis. 83

26. Satmya analysis of patients 84

27. Analysis of state of Agni 85

28. Analysis of state of Koshta. 86

29. Analysis of Bala of the patients. 87

30. Maniki criteria. 88

31. Laingiki criteria. 89

32. Vegiki criteria. 90

33. Assessment of Anthiki. 91

34. Assessment of complication during Vamana karma. 92

35. Effect on severity of Tamaka Shwasa. 93

36. Effect on severity of Tamaka shwasa during the course of treatment. 93

37. Effect on Breathlessness of Tamaka Shwasa. 94

38. Effect on Breathlessness of Tamaka shwasa during the course of treatment. 94

39. Effect on Speech of Tamaka Shwasa. 95

40. Effect on Cough of Tamaka Shwasa. 96

41. Effect on Sputum of Tamaka Shwasa. 96

42. Effect on Body Position of Tamaka Shwasa. 97

43. Effect on Respiratory Rate of Tamaka Shwasa. 98

44. Effect on Expansion of Chest of Tamaka Shwasa. 98

IX

45. Effect on Laboured breathing of Tamaka Shwasa 99

46. Effect on Breath sounds of Tamaka Shwasa. 99

47. Effect on Heart Rate of Tamaka Shwasa. 100

48. Effect on Mental status of Tamaka Shwasa. 100

49. Effect of Vamana & Shatyadi Curna on absolute values of spirometer 101

50. Effect of Vamana& Shatyadi Curna over the predicted percentage of spirometer.102

51. Effects on mean FVC value during the course of treatment. 103

52. The overall effects 104

X

LIST OF FIGURES

Page No.

1. Incidence of age. 71

2. Incidence of sex. 72

3. Marital status. 73

4. Distribution according to their religion 74

5. Habitat Incidence 75

6. Socio-economic status 76

7. Occupation 77

8. Habits of the patients. 78

9. Dietary habits 79

10. Analysis of Deha Prakriti. 80

11. Analysis of Sara. 81

12. Analysis of Samhanana. 82

13. Satvataha analysis of patients. 83

14. Analysis of Satmya in patients. 84

15. Analysis of state of Agni. 85

16. Analysis of state of Koshta. 86

17. Analysis of Bala of patients. 87

18. Maniki criteria. 88

XI

19. Laingiki criteria. 89

20. Vegiki criteria. 90

21. Assessment of Anthiki. 91

22. Assessment of complication during Vamana karma. 92

23. Effect on severity during the course of the treatment. 93

24. Effect on severity. 94

25. Effect on Breathlessness during the course of the treatment. 95

26. Effect on Breathlessness. 95

27. Effect on Speech and Cough. 96

28. Effect on Sputum and Body Position. 97

29. Effect on Respiratory Rate and Expansion of Chest. 98

30. Effect on Laboured breathing and Breath sounds. 99

31. Effect on Heart Rate and of mental status. 100

32. Effect of Vamana and Shatyadi Curna on absolute values of spirometer. 101

33. Effect of Vamana and Shatyadi Curna on predicted percentage of spirometer 102

34. Effect on mean FVC value during the course of the treatment. 103

35. The overall effect. 104

XII

ABSTRACT Since time immemorial man has been in constant endeavor to find the solutions

for the life threatening and agonizing disorders, which afflicts the human race. One of

such condition is ‘‘Tamaka shwasa ’’, which is known by the name Bronchial Asthma in

modern parlance, wherein remissions and exacerbations are the typical features, leaving

the patient in pathetic situation. Hence the management of this acute respiratory condition

is the long quest in the medical fraternity of all types. There are plenty of medicines are

explained for Tamaka shwasa in Ayurveda. It is proved that combined Sodhana and

Samana therapy is more effective and by Vamana, there is removal of doshas from the

body in the form of histamine. Hence the present study is designed to evaluate the role of

Shodhana therapy in the form of Vamana followed by Samana in the form of Shatyadi

Curna in patients of Tamaka shwasa.

This is a single blind clinical study with pre test and post test design where in 20

patients suffering from Tamaka shwasa of either sex between the age group of 16 and 60

years were subjected to the trial. These patients were treated with vamana followed by

oral administration of Shatyadi Curna in a dose of 5g TID with 10ml of madhu for

30days. Therapeutic effect of the treatment was assessed based on specific subjective and

objective parameters including Spirometric evaluations. Results obtained were analyzed

for the statistical significance by adapting paired‘t’ test.

Marked remission of the symptoms of Tamaka shwasa was observed in almost all

the patients included in this study. The assessment of the overall effect of Vamana and

Shatyadi Curna in these patients revealed that 60% of the patients had complete

remission of the symptoms, another 30 % had moderate remission, and the remaining

10 % of patients showed average remission of the illness.

XIII

Key words: Tamaka shwasa; Vamana karma; Shatyadi Curna; Bronchial Asthma.

XIV

Preface

PREFACE

A healthy body and healthy mind is the aim of all health care systems.

Ayurveda is one such system that prevailed since 5,000 years. It was considered the most

advanced and scientifically proven in those days. It still continues to shine. The present

millennium has shown us numerous disorders and we know that the changes in

atmosphere and living conditions are among the causes. The prime cause of any disease

is faulty food and faulty behavioral habits. What modern science describes allergy is

already seen in the ancient books in precise form under different diseases like Sheetapitta,

Udarda, Kota, Visarpa, Kushta, Tamaka shwasa etc

Allergy is a hypersensitivity reaction to an antigen, which may be food

proteins, pollen grains, dusts, fumes, chemical compounds etc. There are seven types of

Deha prakritis described in Ayurveda. Every individual is different from the other and

hence even the tolerance and intolerance to edible and environmental factors also

depends on the Prakriti of an individual. There is a detailed description available in

Ayurveda regarding the Ahara or the diet. Each component of diet or Ahara has been

given the respective names, property and uses. Acharyas have already described Virudha

–Ahara (Contra -indicated food combinations), Aachara Rasayana, Dinacharya and

Ritucharya.

Those who take Hitahara i.e Proper diet regularly are immune to many

diseases, but on the contrary it is not necessary to have immunity against diseases every

time. Charaka has mentioned three causes of disease in the person, those who fall ill after

having regular Hitahara. These three causes are: Kalaviparyaya (change in season),

Prajnaparadha (behavioral mistakes) and Asatmyatha of Sabdha, Sparsha, Rupa, Rasa

and Gandha (hypersensitivity). Those who take faulty diet (Ahitahara) do not fall ill

instantly as the causative factors are not able to vitiate doshas in each and every person

due to the different immunity power of every individual.

Individuals whose body is either very corpulent or too emaciated or having

improperly developed muscle, blood and bone or weak or nourished with unwholesome

food (Avara Satmya) or accustomed to consume less food or having weak mental power

are unable to resist diseases. Thus immunity and resistance of an individual are dependent

upon their body configuration, nature of the food intake, nature of the tissues formed and

1

Preface

emotional or mental status. Chakrapani has classified Vyadhisahatva. An individual

developes 'Vyadhisahatva' by two ways viz. Vyadhibala virodhitvam and

Vyadhyutpadaka Pratibandhaktvam.

Tamaka shwasa,a pranavaha srotovikara is such a disease which effects

an individual due to Atma Asatmya and reduced vyadhi pratibandakatvam. Altered food

habits, environmental pollutions etc are the prime causative factors of this dreadful

disease, which has its impact especially during night hours and is episodic in nature,

which is known by the name Bronchial asthma in modern parlance.

Bronchial asthma is chronic debilitating disease of varied etiology.

Various causative factors such as allergies due to dust, fumes and pollen grains along

with genetic factors have been studied and investigated. The growing environmental

pollution with rapid and extensive industrialization is also responsible for aggravation of

this disease. The alarming rise in the incidence of this disease in metropolitan cities has

posed a serious problem.

As stated by W.H.O, 100-150 million of global population is suffering from

Bronchial asthma, out of which 1/10th is of Indian and the prevalence of Asthma is

increasing everywhere. It occurs at all ages but predominantly in the early life. About

one-half of cases develop before age 40 and another third occurs after the age 40.In

childhood there is a 2:1 male female preponderance but the sex ratio equalizes by age 30.

Shwasa and Kasa are found to be predominant features of tamaka shwasa.

The principle pathology is the avarodha of pranavayu. The predominant morbidity of vata

and kapha dosha, stemming out from pittasthana, afflicting Rasadhatu, disturbing the

functioning of pranavaha srotas, these pathological events collectively leads to the

occurrence of Tamaka shwasa.

Vatahara as well as Kaphahara chikitsa is the sheet anchor of the treatment

of Tamaka shwasa. Planning of effective, safe and economical medications in combating

this lingering disease is the major concern of the medical field. It is an established fact

that sequential administration of shodhana, samana,brumhana and rasayana chiktisa

2

Preface

effectively aborts the attacks, brings about complete remission of symptoms as well as

prevents the episodes of tamaka shwasa.

In patients suffering from tamaka shwasa, who are physically strong, the

shodhana cikitsa forms the first line of treatment as it helps in clearing the obstruction of

pranavaha srotas by kapha dosa. Patient who is in vegavastha should be first subjected to

Lavana taila abhyanga followed by Nadi, Sankara or Prasthara sweda on the chest and

back.By these procedures kapha which has become stagnated and inspissated in the

srotas, get softened and liquefied, which then is easily expelled out by the procedure of

vamana karma. After vamana karma the small amount of kapha dosa which still present

in the srotas is then cleared by the administration of Doomapana.

Few research works has been carried out in different institutions in India are

listed below.

Research works on Clinical evaluation of a compound drug Shatyadi curna in the

treatment of Bronchial asthma.1

A dissertation work entitled Clinical evaluation of Therapeutic regimen in the

treatment of Tamaka shwasa (Bronchial asthma) with special reference to Vamana

Karma.2

In a single blind comparative clinical study, 20 patients suffering from Tamaka

shwasa were subjected to Manashiladi Doomapana once a day for 7 days,

Pushkaramoolasava 35ml qds for another 7 days and Pushkaramoolasava 35ml qds for 14

days in different groups. The study shows addition of dhumapana is more efficacious

than oral medication alone.3

40 patients suffering from Tamaka shwasa were subjected to Vamana and

Kunjalikriya followed by Samanaushadi Shringyadi choorna.The study showed that

Vamana is effective than Kunjalikriya in Tamaka shwasa.4

A single blind comparative clinical study were 21 patients are divided into two

groups and treated with Katphala 1500 mg tid in the first group and Placebo 1000 mg tid

for the period of 1 month. The study shows marked improvement in patients treated with

Katphala.5

3

Preface

In a single blind comparative clinical study, 56 Patients suffering from Tamaka

shwasa were treated with Chitrakadyavalehya 10gms bid for 1 month and Durjalajeta

Rasa 250mg bid with Pushkaramoolasava 15ml tid for 1 month in different groups. The

therapeutic effects shows complete remission of symptoms in patient treated with

Chitrakadyavalehya.6

Research work on therapeutic effect of VARDHAMANA PIPPALI in patients

suffering from TAMAKASHWASA.It was a single blind comparative clinical study,20

patients are treated with Vardhamana Pippali tab bid for 19 days and Pippali 500 mg bid

for 19 days in different groups. The study shows more efficacies in patient treated with

Vardhamana Pippali.7

A single blind comparative clinical study on efficacy of trial drug sirisarista in

TS. Here the patients were divided in three groups and treated with sirisarista prepared

with different methods. The study shows remission of symptoms of Tamaka shwasa in all

the three groups.8

Single blind clinical studies on 20 patients suffering from tamaka shwasa were

treated with 25 mg of Ajasthi bhasma with 5ml of honey tid for 1 month. The result

showed remission of symptoms.9

The research work titled Clinical study evaluating the effect of Haridra

Dhoomapana and samana chikitsa in patients of Tamaka shwasa. It was a single blind

comparative clinical study, 20 patients are treated with Haridra Dhumapana for 7 days

and SKR 250 mg tid for 10 days in the first group and SKR 250 mg tid for 10 days in the

second group. The result shows moderate remission of symptoms in 20% of patients.10

A single blind clinical study on 20 patients suffering from Tamaka shwasa was

treated with Talasindhoora Rasa 125mg bd with Madhu for 30 days. The result shows

70% symptomatic relief.11

The research work entitled- A clinical study on the effect of Kala in Sadyovamana

w.s.r.to Tamaka shwasa (Bronchial Asthma). It was a single blind comparative clinical

study in which 20 patients were divided into two groups. In the first group patient is

administered Sadyovamana during the Kaphakala and in the second group, Sadyovamana

is administered other than Kaphakala. The results of this study clearly indicate that Sadyo

4

Preface

Vamana has definite role in the management of acute attack of Tamaka shwasa and it can

be performed at any time whenever the patient comes, irrespective of Kaphakala.12

The research work on Vamana Karma in patients suffering from TAMAKA

SHWASA. The study shows the lowering of the blood level of Histamine remains

sustained for several weeks after Vamana therapy. It also proved that the Vamana Karma

is having mast cell stabilizing effect and it stabilizes the histamine production

mechanism.13

Clinical trials in regards to the efficacy of shodhana in tamaka shwasa in

different Ayurvedic research centers in and around India can just be numbered. Further

the assessment criteria in these works were limited to subjective and objective criteria

with out involving the spirometric evaluation of the system. There are 100’s of medicines

mentioned in the classics for the treatment of Tamaka shwasa and are claimed to be

effective. Very few of such herbal or herbo mineral combinations are proved by the

method of Randomized Clinical Trail. Hence there is a dire requirement of exploring the

efficacy of remaining herbo/herbo-mineral compounds. Keeping these factors in view

the present study is planned to know the therapeutic effect of `Vamana’ and samana with

‘Shatyadi Curna’.

The present study is entitled - A clinical study to evaluate the effect of

Vamana and Shatyadi Curna in patients of Tamaka Shwasa comprises of four parts.

● Conceptual study ● Clinical study ● Discussion ● Summary and conclusion.

The Conceptual study consists of three chapters. The first chapter begins

with the historical review of Tamaka shwasa and Vamana karma. There after the

definition, etymological derivation, clinical manifestations, pathogenesis, prognosis and

general principles of treatment of Tamaka Shwasa and brief description about Vamana

karma are discussed in the second chapter. The third chapter consists of detailed

description about Shatyadi Curna. The composition and the properties of the individual

herbs used in the preparation of Shatyadi Curna and Vamana dravya are also explained

here.

The materials and methods of the present work with complete description

of the assessment criteria are described in the second part of dissertation. The descriptive

5

Preface

statistical analysis of the sample taken for the study is methodically elaborated. The

observation, results and their statistical analysis are presented in order with tables and

graphs.

The third chapter entitled Discussion includes the critical analysis of the result

obtained in the present study.

The fourth chapter named Summary and Conclusion comprises the conclusions

drawn from the present clinical research work.

6

Objectives

OBJECTIVES 1. To carry out a comprehensive literary study about Tamaka shwasa. 2. To evaluate the effect of vamana and Shatyadi Curna in relieving the symptoms of

Tamaka shwasa.

7

Historical glimpse

HISTORICAL GLIMPSE OF SHWASA ROGA The History of Indian medical literature comprises the entire corpus of Sanskrit

medical texts from the earliest times to the present, thus covering roughly two millennia.

According to early Vedic literature, Ayurveda was supposedly first passed on by Lord

Brahma to sage Bharadvaja. Bharadvaja in turn taught it to other sages, one among who

was Punarvasu Atreya. Atreya taught Ayurveda to his six disciples namely, Agnivesha,

Bhela, Jatukarana, Parasara, Harita and Ksharapani. These disciples, on the basis of their

own understanding of the subject, composed treatises and read them before the expert

sages. The sages whole-heartedly approved these works and blessed the authors. The

treatises became popular and proved helpful in mitigating human suffering. At present

the system is well set to re-orient itself to modern scientific parameters. Simultaneously,

it is well poised for much greater, effective utilization so as to enable the country to reach

its goals of Health for all and regulate population growth. In the present situation,

Medical Scientists are researching Ayurveda remedies for lifestyle related diseases,

degenerative and psychosomatic disorders.

PRAGVEDIK KALA (BEFORE 5000 BC)

There is no evidence about the knowledge of Shwasa during the pragvedic or

pre historic period.

VEDIC KALA:

The word 'Prana' is used frequently in all four Vedas. Madanaphala is used in the

treatment of poison.

YAJURVEDA:

A clear cut description of respiration available as

“Vatam pranena Nasike" ATHARVAVEDA:

A clear description regarding Shwasa is found in the fourth sukta of first kanda of

Atharvaveda. The word Prana has been used many times. Chapter "Prana vidya" mainly

deals with physiology & importance of respiration.

Prana is considered as a cause of birth & death.

“Prano mrityu pranastakama.

8

Historical glimpse

SATAPATHA BRAMHANA:

The normal rate of respiration given as

• Prana vayu-100 x100+800=10,800/24 hours

• Apana vayu-100x100+800=10,800/24 hours

Thus total number of respiration in a day is 21,600, in one hour it is 900 & in one

minute it will be fifteen.

UPANISHAD KALA:

Word Shwasa is used first time in Upanishad.

AMANASKOPANISHADA:

The word Shwasa is used for respiration and its derangement leads to death

BRIHADARANYAK UPANISHAD:

Prana is called as 'Ayasa' as well as 'Angirasa' which controls the whole body.

Hence any part of body dries up when Prana leaves body.

CHANDOGYOPANISHAD:

Prana is called as Angira as Prana nourishes all parts of body; it is also called as

Brihaspati & Ayasya.

YOGA CHUDAMANDYA UPANISHAD:

Here word Hikka, Kasa & Shwasa are mentioned. These are mentioned as a result

of deranged Vayu 'Prana Vyatyaya Karmata.

GARUDA PURANA:

Scientific description of Shwasa is available in Garuda purana. Dhanvantari has

quoted in first verse that now he will reveal the Nidanas of Shwasa. Vamana Dravyas like

Dhamargava, Madanaphala Indrayava are explained.

SAMHITHA KALA:

CHARAKA SAMHITA:

Seventeenth chapter of Chikitsasthana revised by Drudhabala provides complete

description of Shwasa Roga with its Etiology, Pathology, Symptomatology, Complication

& the treatment. Samprapti of Tamaka Shwasa & Symptomatology has been described in

detail. Shwasa is also mentioned as Symptom & Complication of many diseases. Shwasa

9

Historical glimpse

is mentioned as a fatal disease that kills patient very quickly. 14 Its origin is mentioned as

Pittasthana. 15

Dushti lakshana of Pranavaha srotas are depicted by Charaka in

vimanasthana. 16 The treatment of pranavaha srotas is mentioned as similar to Shwasa,

Root of Pranavaha Srotasa is mentioned as Hridaya & Mahasrotas. 17

SUSHRUTA SAMHITA:

Sushruta has described Shwasa Roga in 51st chapter of Uttaratantra. It includes

Nidanapanchaka along with Chikitsa. But Pittasthana is not mentioned as origin of

Shwasa Roga. Bhaktdvesha, Aasyavairasya were added as Purvarupa as compared with

Charaka. 18

ASHTANGA HRIDAYA AND ASHTANGA SANGRAHA

Vriddha Vaghata has described Kasa as Nidanarthakara roga for Shwasa for the

first time. 19 Shwasa is described in two separate chapters in Nidanasthana &

Chikitsasthana.

Vagbhata has described Etiopathogenesis of Shwasa in fourth chapter of Nidhana

while treatment is mentioned in fourth chapter of Chikitsasthana. Involvement of Prana,

Anna &Udakavaha Srotas in the pathogenesis has been clearly mentioned 20 Aaamashaya

is referred as Udbhavasthana of Shwasa, he has also mentioned Kasa as Nidanarthakara

Roga of Shwasa 21

KASHYAPA SAMHITA:

In Sutrasthana chapter 25 “Vedana Adhyaya” it is mentioned that child suffering

from disease Shwasa exhales warm air. The word Tamaka Shwasa is found in

Khilasthana 10th chapter while mentioning the management. Earlier no any scholar has

mentioned this reference of Tamaka Shwasa.

BHELA SAMHITA

No description regarding Shwasa Roga is available in this incompletely available

text. But word Shwasa is mentioned as symptom & complication of some disorders.

10

Historical glimpse

HARITA SAMHITA:

In Haritasamhita, 14th chapter of Tritiyasthana deals with management of

Shwasa. In this chapter detail description of Etiology, Pathology, and Lakshana &

Management is mentioned.

MEDIEVAL PERIOD

MADHAV NIDANA:

In 12th chapter Shwasa is described under the title of Hikka Shwasa Nidhanam.

Here Panchanidhana of Shwasa is mentioned.

INDU:

Shashilekha is the commentary of Ashtanga sangraha written by Indu. He

explained origin of Shwasa Roga from kasa as

`kasa Adhikibutva eva karana shwasasya’ 22

CHIKITSA KALIKA:

Tisatacharya described Chikitsa of Shwasa after the chapter of Pandu Roga. Here

Panduroga is described as Nidararthakara Roga for Shwasa.

KALYANAKARAKA:

In 16th parichhed “Shwasadhikara” of this text, the writer Ugradityacharya

contributed some new recipe for the treatment of Shwasa Roga.

CHAKRADATTA:

12th chapter deals with management of Shwasa along with Hikka. He mentioned

some simple remedy for Shwasa.

AYURVED DIPIKA:

Chakrapani has explained Aamashaya as pittasthana & it is mainly related with

upper part of Pittasthana. Also involvement of Udakavaha Srotas is clearly mentioned by

Chakrapani.23

MADHUKOSHA:

Though there is no reference of Pittasthana in Madhava Nidana,Vijayrakshita has

quoted the charkas reference of Pittasthana in 12th chapter.

BHAVA PRAKASHA:

“Astangachurana” is new remedy prescribed by him for Shwasa.

11

Historical glimpse

YOGARATNAKARA:

He described Shwasa Nidana after Hikka. He has quoted many references from

Charaka & Sushruta. He described that Shwasa is having more variety due to variation in

combination of Dosha. 24 In management he has advised Mrudu sweda.

SHARANGDHARA SAMHITA:

Sharangdhara classified five types of Shwasa in Purvakhand chapter 7 without

giving much detail. He has prescribed various recipes for management of Shwasa.

SHODHAL

12th chapter of Gadanigraha deals with Nidana & Chikitsa of Shwasa Roga along

with Hikka. But there is no reference regarding Pittasthana.

VANGASENA:

Vangsena has described Shwasa Roga in separate chapter entitled “Shwasa

rogadhikar” just after Hikkadhikara.

RASA RATNA SAMUCCHAYA:

Vagbhata has described Shwasa under 13th chapter along with Raktapitta, Kasa

and Hikka, Shwasa is explained after Kasa. In pathogenesis, Aamashaya is considered as

a seat of origin. Here only involvement of Anna, Udaka & Ashruvaha Srotas has been

mentioned but no reference regarding Pranavaha Srotas is available. 25

VRINDA MADHAVA:

He described Shwasa in 12th chapter entitled "Hikka Shvaasadhikara"

BHAISAJYA RATNAVALI Govinda Das describes Shwasa in 16th chapter of this book with different therapeutic

formulations.

In a nut shell, the description regarding Tamaka shwasa is not found in prevedic

or Vedic period. In Vedas there is plenty of reference available regarding the

physiological aspect as well as pathological aspect of Pranavaha srotas. The word Shwasa

is used in the first time in Upanishad. Later in Samhitha period onwards there is abundant

information available regarding the disease Tamaka shwasa. The Vamana Karma is

explained in detail in all the samhithas. Based on the above information the present

literary work has been carried out.

12

Etymology

ETYMOLOGY OF SHWASA:

The word Shwasa is derived form the root word 'shwas' by applying Ghanj

pratyaya. 26 Shwasa denotes air and respiration. In physiological condition the word 'Shwasitam'

means prana in commentary by Hemachandra.

According to Shabdastoma mahanidhi the word Shwasa is derived from 'Shwasa'

Dhatu by applying 'ghanj' pratyaya.

In Halayudha kosha the word 'Shwasa' is derived from 'Shwasa' Dhatu by adding

'lu' pratyaya which means Inspiration and both phases of respiration.

In Vaidyaka Shabdasindhu the word “Shwasa” specially indicates disease

manifested in hollow space.

ETYMOLOGY OF TAMAKA SHWASA:

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

TAMAKA:

1. The word "Tamaka" is derived from the root "Tam" means oppression of chest 27

2. Tamaka 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 means - Udveda, Tivrata, Krodha, Tosha, Tamtmahata and a type of

Shvasa Roga.

4. Tamaka - Tamyati Atra Tama VA

It is described as a one variety of disease Shvasa in Vachaspatyama.

5. Tama Tamyati Anena Iti Tama

The word Tama denotes Andhakara, Nishacharma, Divantaka,

Dinantarama and Andhakam according to Halayudha kosha.

SHWASA:

The word Shwasa is used to denote the respiration and exchange of air in

the body. It is used in both Physiological as well as Pathological conditions in the human

life. Therefore the disease in which the respiration and exchange of air get disturbed is

known as Shwasa.

13

Etymology

"Shvasastu Vastrika Adhmana sama vatordha Gamita"

The expiration of air,which produces sound similar to the one generated

while blowing the air with a blower by the black smith is termed as Shwasa. 28

Shurutha quotes,

Vihaya Prakritim Vayu Prano atha Kapha Samyutah.

Shvasayatyurdhvago bhutva tam Shwasam Parichakshate"

When “Prana Vayu" does not performing its normal physiological functions

(vitiated) and becomes defiles (Viguna), obstructed by Kapha and moves in opposite

direction i.e. upward and unable to perform normal functions the condition is known as

Shwasa Roga. 29

"Shvasa iti Abhihito Viparita Pranavayu Upari Pratipannah

Sleshmana Saha Nipidyatram Tam Shvasa".

It means due to obstruction of Kapha Pratiloma gati of Prana Vayu occurs,

this condition is known as Shwasa (Kalyanakara).

TAMAKA SHWASA:

Tamaka Shwasa is defined as,

“Visheshat Durdina Tamyethi Shwasaha SA Tamaka Mataha”

The Shwasa which occurs especially during durdina is called as Tamaka Shwasa30

“Tamakascha Asou Shwasacha Tamaka Shwasa”

The attack of Shwasa, which occurs mainly during the night time, is called as

Tamaka Shwasa.

14

Nidana

NIDANA Every individual constitution has its own unique balance of vata, pitta, and

kapha according its own nature. The internal environment is governed by vata, pitta and

kapha, which are constantly reacting to the external environment. The wrong diet habits,

,lifestyle ,incompatible food combinations, seasonal changes, repressed emotions and

stress factors can all act either together or separately to change the balance of vata,pitta

and kapha.

Tamaka Shwasa is mentioned as Kashtasadya or Yaapya vyadhi. Nidana

has got much importance in such diseases which remain for longer period. Vyadhi goes

on as long as patients get exposed to these Nidana. Hence their thorough knowledge is

essential to avoid Nidana. In Ayurvedic texts, Nidana of Tamaka Shwasa as such are not

mentioned separately but Nidana of Shwasa roga in general are given.

The nidhanas are mainly of two types.

1. Bahya (extrinsic) 2.Abhyantara ( intrinsic)

1. Bahya nidanas like Rajas, Dhuma etc are the external factors responsible for

causation of the disease

2. Abhyantara nidanas includes Dosas. In Tamaka Shwasa, Kapha and Vata are the

main Dosas, which are the internal factors for the causation of this disease.

Tamaka shwasa can be produced by one or more etiological factors. The

following table shows the various nidhanas of Tamaka shwasa.

Table No.1 Showing the nidhana of Shwasa/ Tamaka shwasa.

Factors C. S31 S.S32 A.H33 A.S34 M.N35

Vata-Prakopa Ahara

Rukshanna - Ununctuous food + + - - +

Visamashana - Irregular food habit + + - - +

Adhyashana - Habit of eating - + - - -

15

Nidana

frequently

Anasana - Observation of fast for

long

- + - - +

Dvandvatiyoga-Mutually contradicting

foods

+ - - - -

Sheetashana - Cold foods - + - - +

Visha – Poison + + - - +

Sheetapana - Cold drinks - + - - +

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 + - - - -

16

Nidana

Amaksira - Unboiled milk + - - - -

Utkleda - Kaphakara food + + - - +

Vishtambhi + + - - +

Vata-Prakopa Vihara

Rajas - Dust / Pollen + + + + +

Dhuma - Smoke + + + + +

Vata - Cold breeze + + + + +

Sheeta Sthana - Cold places + + - - +

Sheeta ambu - Cold water + + + + +

Ativyayama - Excessive exercises + + - - +

Gramyadharma-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

Ushna – Hot - - - + -

17

Nidana

Kapha-Prakopa Vihara

Abhishyandi Upacara -

Administration of substances which

obstruct the channels

+ - - - +

Divasvapna - Day sleeping - - - - -

Vata prakopa janya-Vyadhi / Avastha Sambandhi Nidana

Anaha + - - - -

Dourbalya + - - - -

Atisara + - - - +

Kshaya - + - - -

Ksataksaya + - - - -

Udavarta + - - - -

Visucika + - - - -

Panduroga + + + + -

Visha sevana + + + + -

Vibandha + - - - -

Pittaja

Rakta pitta + - - - -

Jwara + - - - +

Kaphaja

Kasa - - + + -

Amapradosa + + - - -

Chardi + - + + -

Pratisyaya + - - - -

Amatisara - - + + -

18

Nidana

Vyanjaka hetu is stimulating, precipitating or aggravating cause. It also

causes aggravation of the symptoms in an already generated disease or these cause

the precipitation of the samprapti of a disease. The knowledge of this hetus is useful

in preventing the actual formation of diseases by taking care to avoid such factors.

VYANJAKA HETUS IN TAMAKA SWASA

Table No.2.Vyanjaka hetu of Tamaka shwasa:

Vyanjaka hetu CS36 SS37 AH38

Megha (clouds) + - +

Ambu (water) + + +

Pragvata + - +

Sleshma Vardhaka Ahara-vihara + - +

1. Megha: Cloudy atmosphere leads to Kapha & Vata Prakopa which is the

prime doshas in the etiopathogenesis.

2. Ambu: The dooshitha or rutu vipareetha jala which produces

Shwasa.39

3. Pragvata: The Pragvata which is having Abhishyandhi guna which

Produces Shwasa.40

4. Sleshmala ahara-vihara: This produces Kapha vruddhi.

Tamaka shwasa is not affected to the entire person who is exposed

to the above said etiological factors because of ATMA SATMYA of an individual.It

effects an individual because of his ATMA ASATMYA.

19

Nidana

“Satmyam yajjanmanaha prabruthi sahatmanabhyastham taccha sareere

Auchityadabhyasthatvadupasete sukhavaham bhavathi” 41

The above is an important ancient Ayurvedic phrase which highlights the

role of atma in satmya. Charakacharya explains Atma satmya in the context of Ahara

vidhi vidana. Chakrapani gives commentary for this as

‘Atmana iti padenaiva atmasatmyam pratipurusham jayate’ 42

ATMA SATMYA is one which varies individual to individual.

The causative factors of disease in living being is classified into two

groups namely,

1. Sadharana karana – those common to living being in general.

2. Asadharana karana –those specific to individuals.

`Tatra asadharanam pratipurusha niyatam’ 43

This type of causative factors is like vitiation of vata

etc.,which specifically affect certain individuals.

The intolerance (asatmya) happens when the body can no longer accept

the changes and an adverse reaction occurs.This Asatmya or intolerance are explained

in modern parlance is the concept of Allergy.

Intolerance and allergy are both conditions of hypersensitivity, a

reaction of the body to factors that it can no longer deal with in a healthy way. One of

the root causes of this intolerance is imbalanced agni in the dhatu level.

In most cases the inherent constitution predisposes the allergy proneness.

That is, there is usually a correspondence between a person’s constitution and the

tendency of a particular system to develop hypersensitivity. Hypersensitivity refers to

20

Nidana

pathologic processes that result from immunologically specific interactions between

antigens (exogenous or endogenous) and humoral antibodies or sensitized

lymphocytes.

The etiological factors either in the form of the faulty dietetic habits,

behavioral errors, or due to the insult by the environmental factors causing morbidity

of kapha and vata dosa, or disturbing the functioning of pranavaha srotas leads to the

establishment of the lingering disease tamaka shwasa. Due to the detrimental effects

of nidhana there occurs accumulation of the kapha dosa in the pranavaha srotas,

which in turn obstructs the free passage of the pranavayu leading to prana vilomata

and that is how the attack of tamaka shwasa is begins.

21

Samprapti

SAMPRAPTI

Samprapti is the knowledge of the onset, duration and progress of a disease.

In Charaka Samhita the samprapti of Tamaka shwasa has been explained under three

occasions. First one regarding the common samprapti of Shwasa and Hikka, where as the

second one is vishista samprapti of shwasa and third one is samprapti of Tamaka shwasa.

Though the first two are common to all varieties they are much essential to understand

the samprapti of Tamaka shwasa. While considering the samprapti of shwasa, Acharyas

describes various stages. Vata and kapha are the major doshas involved in the process of

pathogenesis.

I. Common samprapti of Hikka and Shwasa.

II. Specific samprapti of Shwasa.

III. Samprapti of Tamaka Shwasa.

I.Common samprapti of Hikka and Shwasa 44

The kupitavayu which circulates in the pranavaha srotas stimulates

urasthakapha and produces Shwasa and Hikka rogas.

Here the vayu which is obstructed by kapha makes the dusti of prana,udaka, and

annavaha srotas, and occupies a place in the urapradesha and causes Shwasa and Hikka

roga.

II. Specific samprapti of Shwasa 45

This is the common samprapti of all 5 types of Shwasa. When the kapha along

with vata obstructs the srotas the obstructed vayu trying to overcome the obstruction

moves in all directions resulting in shwasa.

The term “kapha purvaka” in the samprapti means “kapha samyukta” i.e.,

along with Kapha. “Vishawakvraajathi”denotes “Sarvato gacchathi” i.e., moves in all

direction,it seems better to restrict it to the pranavaha srotas.

In Tamaka Shwasa, pranavaha srotas gets obstructed by kapha and vata

dosha.Here, Kapha has a major role in this process. The trapped vata moves all over the

uras resulting in swasa kricchata.

III Samprapti of Tamaka Shwasa 46

This samprapti is particularly related to Tamaka shwasa. It is continuation of the

previous samprapti as it states “pratilomam ca yada vayu”.

22

Samprapti

It states when the vayu attains pratilaomagati in srotas,it influences greeva and

shira and due to this, secretion of kapha takes place resulting in peenasa. This again

causes obstruction and as a result of these “Ghurgurkha” (wheezing) manifests along with

increased rate of respiration.

Vagbhata has considered as the afflication of annavaha and udakavaha srotas

along with the afflication of pranavaha srotas. Even Chakrapani has considered the

involvement of udakavaha srotas, but Gangadhara has clearly ruled out the involvement

of srotas other than pranavaha srotas.

Charaka mentioned pranavaha srotodusti alone in the samanya samprapti.

In the vishista samprapti of Shwasa he has included annavaha and udakavaha srotas.

Moreover in a patient suffering from shwasa less manifestations pertaining to annavaha

and udakavaha srotas are observed. Interstingly Charaka and other author explain

Tamaka shwasa to be kaphavatatmaka in its presentation and pittasthana is its origin 47.

According to most of the authors including Chakrapani, pittastana refers to amashaya

particularly adhoamashaya. Chakrapani commenting on this says “pittasya urdhwastana

sambandha” i.e., pitta has got relation with urdhwastana probably the uras. Moreover

Charaka has mentioned the moola for pranavaha srotas as hridaya and mahasrotas.

Pittastana i.e., adhoamashaya is the part of mahasrotas. Thus we can make an attempt to

explain the relation between the pittastana and pranavaha srotas.

The morbid Kapha dosha and the Rasa Dhatu are invariably involved in the

samprapti of Tamaka Shwasa. Since these two factors are of same category, in the

pathogenesis they favour one another. That is why the illness tends to progress in a rapid

manner and also cause severe morbidity.

Hridaya is considered as one among the mula of Pranavaha Srotas. For the same

reason in a patient suffering from Tamaka Svasa in a long run, there is every risk of

extension of pathogenesis damaging the Hridayamarma 48. This adds to the poor

prognosis of the illness for evident reasons.

23

Samprapti

Samprapti Ghataka:

Factors involved in the generation of Samprapti of Tamaka Shwasa are

elaborated in the following lines.

1. Dosa – Pranavayu, Udanavayu, Avalambaka Sleshma.

2. Dushya – Rasa Dhatu.

3. Srotas – Pranavaha, Udakavaha, Annavaha, Swedavaha.

4. Srotodusti Lakshana – Atipravrutti, Sanga, Vimarga gamana

5. Udbhava Sthana – Pitta sthana, Adhoamasaya.

6. Sanchara Sthana – Sarva sareera.

7. Vyakta sthana– Uras.

8. Rogamarga – Abhyantara.

24

Prabhedas

PRABHEDAS OF TAMAKA SHWASA

Both the Vata and Kapha have been considered to be the chief Dosas

involved in the pathogenesis of Tamaka Shwasa. Pratamaka and Santamaka are

considered to be the varients of Tamaka shwasa.

On the basis of association with Pitta dosha,Tamaka shwasa can be classified in to

Pratamaka and Santamaka. Even though, the Kapha and Vata are predominant doshas in

Tamaka Shwasa, Pitta is equally vitiated in this allied condition 49

The Pratamaka that occurs as a result of Udavarta, Rajasevana, Ajeerna,

Klinnakya and by Vegadharana. Here the Tamaka shwasa Laxanas associated with Jwara

and Moorcha. 50

Santamaka is further variant of Pratamaka according to Chakrapani . Gangadhara

considered it as an Upadrava of Pratamaka. If a patient of Pratamaka Shwasa feel

darkness around him or sinks into unconsciousness due to Tamadosha of Manas, it is

considered as Santamaka 51.

In both these conditions though Kapha and Vata are the predominant dosha, the

Pitta dosha also has main role in the pathogenesis of this disease. Hence it will get

relieved by Sheetopachara.

25

Poorvaroopa

POORVAROOPA The poorvaroopa is the stage in which the prakupita dosha having

extended and spreaded over to parts other than their own due to srotovaigunya,leading to

dosha dushya sammurchana.

Laxanas are the prominent diagnostic key of the disease. In this stage the

dosha dushya sammurchana would have been completed, and the onset of disease would

have commenced. But before the onset of disease, some symptoms may develop. They

give idea about the forth coming disease. Such symptoms are called as poorvaroopas. No

specific poorvaroopa has been explained for Tamaka shwasa but the poorvaroopa

explained in the context of shwasa holds good for Tamaka shwasa.

Table.No.3. Poorvaroopa of Tamaka shwasa.

Symptoms C.S52 S.S53 A.H54 M.N55

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 - - + +

26

Poorvaroopa

Among the above said lakshana, some of them are due to

vataprakopa few due to kapha prakopa and some other due to agnimandya and

ama. Out of these symptoms parshwashoola,hridaya peedana and pranasya

vilomata can be considered as the samanya poorvaroopa of tamaka

shwasa.Rest of others can be considered as vishista poorvaroopa. The study

of poorva roopa helps the early detection of the disease, which is very

important particularly in episodic disease such as Tamaka shwasa to start the

treatment immediately. It is helps to prevent the aggravation of the disease.

27

Roopa

ROOPA The symptomatology of the disease is called as Roopa. It is defined as “Vyadhi

bhodakameva lingam roopam”. The symptoms and signs which exhibits as a result of the

disease manifestation in the body is called as Roopa. The signs and symptoms appear in

the stage of 5th phase of kriyakala. By the knowledge of roopa one can diagnose the

disease properly and plan the treatment accordingly.

In this disease,one can observe the pranavaha srotodushti laxanas.ie, 56

1.Atisrushtam – Prolonged expiration (Expiratory dyspnoea)

2.Atibaddham – Too restricted respiration (Inspiratory dyspnoea)

3.Kupitam – Painful or exacerbated dyspnoea.

4.Alpalpam – Breathing with interruptions (Distinct pause)

5.Abheekshnam – Continuous breathing or continuous dyspnoea.

6Sasabdam – Gurkuraka – With different auscultatory sounds such as crepitation ,

rhonchi,wheezing etc.

7.Sasoolam – Painful breathing.

The roopa of Tamaka shwasa is well explained in the classics which are

listed below.

28

Roopa

Table No.4.Roopa of Tamaka shwasa:

Sl. No.

Symptoms C.S57 S.S58 A.S59 A.H60

1 Pinasa – running nose, sneezing, stuffiness of the nose

+ + + +

2 Shwasa – dyspnoea + + + + 3 Tivravega Shwasa – rapidity of breathing + + + + 4 Amuchyamane Tu Bhrisham – severe

breathlessness if sputum is not expectorated out.

+ + + +

5 Vimokshante Sukham – slight relief in breathlessness on spitting out the sputum.

+ + + +

6 Anidra – breathlessness disturbs sleep. + - - - 7 Sayanah Shwasa Piditaha – discomfort worsens

on lying. + + + +

8 Aseeno Labhate Soukhyam – feels easy to breathe in sitting position.

+ + + +

9 Pratamyati Ati Vegat – deterioration of conciousness

+ - + +

10 Kasa – Cough + + + + 11 Pramoham Kasamanascha – frequent

deterioration of consciousness during paroxysm of cough

+ - + +

12 Kanta Ghurghuraka – rattling + - - - 13 Kantodhwamsa – soreness of the throat + - - - 14 Utshoonaksa –oedema around the eyes. + - + + 15 Vishuskasya – dryness of mouth + - + + 16 Lalata Sweda – sweating in the forehead + + + + 17 Meghaihi Abhivardhate – cloudy weather

worsens the attack + - + +

18 Sheeta Ambu – cold water + - + +

19 Pragvata – breeze + - + + 20 Sleshmala – Kaphakara + - + + 21 Usnabhinandate – likes hot thing + - + + 22 Aruchi – anorexia - + + + 23 Trishna – excessive thirst - + + + 24 Vepathu – tremors - - + + 25 Vamathu – expectoration - + - -

29

Roopa

On clean observation of the symptoms of Tamaka shwasa it can be inferred

that only few symptoms like swasakricchatta, gurguraka, pranapeedana and kasa seems to

be the main symptoms while other symptoms just explain the above said features, their

effects and complication. Among the symptoms Shwasa,Kasa,Pinasa,Pratamyati Ati

vegat are related to Pranavaha srotas. Aruchi is related to Annavaha srotas.

Trishna,Vishushkasyata it indicative of Udakavaha srotas involvement.Lalata sweda

represents involvement of Swedavaha srotas. If the person is having Tivra shwasavega,

Anidra, Vishushkasyata indicates the predominance of Vata Dosha.The symptoms like

Pinasa,Amuchyamana kapha,Kanta ghurghuratha and Kasa indicates the predominance of

Kapha Dosha

In modern science wheezing is considered as one of the important feature of

the bronchial asthma.In Ayurveda gurguraka is one of the major symptom in Tamaka

shwasa. Gurguraka occurs mainly due to avarodha in the pranavaha srotas by kapha.

So the study of symptoms improves the chance of obtaining the right

diagnosis and obtaining prompt and correct treatment.

30

Bronchial Asthma

BRONCHIAL ASTHMA

DEFINITION:

Asthma is a disease of airways that is characterized by increased responsiveness of the

tracheobronchial tree to a multiplicity of stimuli. It is manifested physiologically by a

widespread narrowing of the air passages, which may be relieved spontaneously or as

result of therapy. 61

PREVALENCE

Asthma is very common; it is estimated that 4 to 5% of the population of the USA is

affected. Similar figures have been reported from other countries. Bronchial Asthma

occurs at all ages but predominantly in early Life. About one-half of cases develop before

Age – 10 and another third occur before age 40.In childhood, there is a 2:1 male / Female

preponderance but the sex ratio equalizes by age 30. The prevalence of asthma is

increasing by age worldwide. The reasons for this increase clear, but may include:

• Increased exposure to air-bone allergens, particularly house-dust mites.

• Exposure to occupational allergens.

• Increased urbanization, and hence exposure to adjustments such as dietary-

components and pollutants.

• Reduced exposure to bacterial and viral infection in early infancy.

ETIOLOGY

From an etiologic standpoint, asthma is a heterogeneous disease. It is useful for

epidemicologic and clinical purpose to classify asthma by the principle stimuli that are

associated with acute episodes.

The etiological factors of Bronchial Asthma can be divided into two groups.

1. Predisposing factors.

2. Precipitating factors.

31

Bronchial Asthma

(1) Predisposing factors

The most important factors predisposing to asthma is “Atopy”. This codition

characterized by excessive production of IgE in response to allergens.

The term ‘Atopic’ – is applied to people with a history of allergic illness

that often develop in the first few years of life. The prevalence of asthma increase

with increasing serum IgE concentrations, and the majority of Asthma patients

express IgE directed to inhale allergens. Atopic diseases such as asthma tend to run in

families, with heritability accounting for up to 50% of the clinical expression.

Gender:

Childhood Asthma is more common in boys than in girls until the age of about 10

years, when the difference disappears. There is some evidence that this difference is

due to differences in allergen sensitivity between boys and girls.

Bronchial Hyper responsiveness:

In all types of Asthma an underlying problem seems to lie in an abnormal reactivity

of the airways, that is they narrow excessively in response to stimuli which would not

affect normal subjects.

This temporary increase in reactivity occurs because such infection

dendue the tracheal and bronchial mucosa exposing sensory receptors in the mucosa.

However, neurological reflexes are only a part of the responsiveness of airways.

(2) Precipitating factors

Precipitating factors which are important in bronchial asthma are:

Infections,inhaled allergens,dusts,environmental pollution foods

occupation, psychological, hormonal, gastro – esophageal reflux are the

commonest factors claimed as precipitating acute attacks of Bronchial Asthma.

32

Bronchial Asthma

PATHOGENESIS

The exposure of etiological factors on respiratory tract produces airway

sensitization. This airway sensitization predisposes the airways to narrow in response to a

variety of stimuli. This episodic airway narrowing and resilient reduced airflow constitute

an asthma attack.

Pathological features are apparent in the airways even mild asthmatic but are more

marked in moderate and severe asthmatics pathology of the Asthmatic airway. The

airway obstruction is caused by contraction of Bronchial smooth muscle, plugging of

airways by mucus and shed epithelial cells, and airway wall edema. With sub epithelial

collagen deposition by myofibroblasts, hyperplasia of mucus glands and hypertrophy of

bronchial muscle the bronchial mucosa is infiltrated by activated T – cells eosinophils

and mast cells.

- Areas of epithelial damage / shedding

- Sub-epithelial fibrosis

- Mucus plugging of small airways in sever Asthma

- Mucus gland hyperplasia

- Bronchial smooth muscle Hypertrophy

- Characteristic Inflammatory cell Infiltrate, espacially of eosinophils and T –

lymphocytes, with evidence of mast cell are de-granulation.

CLASSIFICATION OF ASTHMA

In modern Medicine also various classification of Bronchial Asthma are

described which can be explained as follows:

Etiological Classification:

According to etiological asthma has been divided into two basic type:

(1). Extrinsic [Allergic, Atopic ] Asthma.

(2) Intrinsic [Idiosyncratic, Non Atopic] Asthma.

33

Bronchial Asthma

34

(1) Extrinsic Asthma:

This has identifiable external triggering factors, such as specific allergens. It is

common in young people and is associated with positive immediate skin – prick tests

and a personal or family history of asthma, hay fever and eczema.

(2) Intrinsic Asthma:

This is more common in older patients. There are no obvious triggering stimuli other

than respiratory infection and often, there is less reversibility, with more long –

standing airflow obstruction of some degree.

Table.No.5. Characteristic Features of Extrinsic and intrinsic Asthma.

Extrinsic Intrinsic

Starts in childhood. Often starts in adulthood.

Eczema and Rhinitis often present Often persistent symptoms.

Positive skin tests to common allergens Negative skin tests

Precipitating factors evident from history No obvious precipitating factor

except infection

Episodic Aspirin – sensitive

Positive family History Subjects usually Intrinsic

IgE frequently raised Normal or Low IgE

Prognosis favorable Prognosis poor

(3) Mixed Asthma:

Many patients may not come into either of the groups, but shows features of both

groups. Sometime asthmatics to start with, have seasonal Asthma and later pass on to

this stage of perennial Asthma. Initially triggered by non-atopic factors such as

exercise, infection, psychic disturbance etc.

Bronchial Asthma

CLINICAL MANIFESTATIONS

The classic symptoms of Asthma are intermittent reversible attacks of

dyspnoea, wheezing and a sense of chart tightness, cough and increase in sputum volume

and viscosity. Sometimes the patient describes a sensation of chocking in the neck, or

tightness in the chest, rather than wheezing. Sometimes the cough is given more

emphasis than wheezing, particularly then it occurs at night.

Age of onset: Asthma may occur for the first time at any age. Males predominate in

childhood and females in later life. In childhood, extrinsic factors and associated atopy

are much likely to be encountered than later in life.

Patterns of Variability in Asthma

The Acute Attack:

Distressing wheezing of more or less acute onset is the hallmark of asthma. The

majority of patients have such attack at some time and often to them as ‘spasms’.

The patient sits or stands, bracing shoulders with the hands on the knees or on

the arms of a chair. The expression is one of preoccupation with the business of

breathing. Both are wheezy, examination reveals over-inflation of the chest, use of

accessory muscles of respiration and marked recession of the lower part of the chest

during inspiration. There is tachycardia and usually pulsus paradoxus; cyanosis may be

present. Ausculation usually reveals universal inspiratory and expiratory Rhonchi.

Sometimes in very severe acute Asthma, wheezing is unimpressive or absent. Most attack

subsides spontaneously in minutes but some are prolonged for hours despite treatment.

Unconsciousness is occasionally encountered in an acute attack. Sometimes

actual asphyxia may be accompanied by impairment of venous return due to over-

inflation.

Chronic Asthma:

Some patients have persistent symptoms, which may be mild or severe. There is virtually

always a characteristic diurnal variability.

35

Bronchial Asthma

Diurnal Variation

Diurnal variation in symptoms is one of the most important diagnostic features of

Asthma; it is seen in chronic Asthma as well as during exacerbations. The main elements

are:

Morning tightness:

The patients notice tightness and wheezing usually within seconds of

waking and this may take minutes or hours to subside, coughing exacerbates

symptoms.

Nocturnal attacks:

Attacks at night are also characteristic of Asthma. The patients generally

wake between 2 and 3 a.m. with tightness, cough and wheezing dyspnoea. He or she may

get up and sit by on open window. Nocturnal attacks may be prolonged or repeated. Such

episodes are commonly misdiagnosed as ‘paroxysmal Nocturnal’ dyspnoea due to left

ventricular failure.

Seasonal variation

Marked seasonal variation is characteristic of extrinsic Asthma.

Aggravation in the winter month is common and probably due to two factors - frequent

upper respiratory tract infection and house dust mite sensitivity.

Physical signs:

[A] During Attack

(1) On Inspection:

The chest seems to be maintained in a position of inspiration, but little expansion

with short inspiration.

- Accessory muscle such as sterno – mastoid salanius and pectoralis are in

continuous action to add breathing.

- Jugular vein distended.

- The lips, cheeks, nails and later the skin as a whole become cyanosed.

(2) On palpation :

- Expansion of chest diminished

- Vocal fremitus diminished

36

Bronchial Asthma

(3) On percussion :

- Note is hyper – resonant especially so when after many attack, emphysema also

supervenes.

(4) On Auscultation :

The Inspiratory effort is shortened and may hardly be audible.

- Expiration Prolonged.

- High pitched musical Rhonchi with prolonged expiration replaces the normal

Vascular murmurs.

- In severe asthma airflow may be insufficient to produce Rhonchi and a ‘silent

chest’ in such patients is an ominous.

Pulmonary function test in Asthma: (PFT):

Measurement of lung function by spirometer or peak flow meters are

quite useful in that one can measure the degree of obstruction present, document

its reversible nature, and demonstrate the airway hyperresponsiveness so

characteristic of this disease. Furthermore the performance of forced vital

capacity manoeuver is very helpful in the evaluation of acute asthmatic attack and

also very helpful in following the response to therapy in both chronic and acute

situations. Spirometers provide a description of how well lungs are functioning.

Spirometer measure vital capacity (VC), FVC (forced Vital Capacity) and timed

measurement such as FEVI [Forced Expiratory Volume one second]

This is the best single measure of long function far assessing airflow limitation or

Asthma severity.

Description of PFT

(A) VC – Vitalcapacity:

Early Investigators of pulmonary function confined themselves to the

measurement of ventilatory reserve. The VC is affected by factors like

age, sex, height, and weight. It is reduced in restrictive type of lung

disease.

37

Bronchial Asthma

(B) Forced Vital capacity:

The Value is same as that of Vital capacity but in obstructive diseases like

Asthma, Bronchitis, FVC is reduced more than that of VC.

(C) Forced Expiratory Volume in one second:

This value is proportionately decreased along with VC in restrictive types

of long disease. But it is more than the loss in FVC in obstructive type of

disease.

(D) Forced Expiratory Volume one second Percentage:

This Index is proportion of FEVI to that of FVC. This Index is of use in

differentiating between restrictive and obstructive type of long disease.

- The FEV1% is the percent of the VC that is expired in one second.

FEV1% = (FEV1/FVC) X 100

Normally the FEV1% is greater than 75%- 80% of the FVC, <80%

indicates airways obstruction

Patients with restrictive lung disease have a reduced VC but are able to

achieve relatively high flow rates; therefore their FEV1% exceeds 80%

Patients with obstructive lung disease having low flow rates results of

their high airway resistance; consequently their FEV1% is abnormally

low.

Bronchodilator Reversibility = FEVI (B.T) – FEV1 (A.T.) %

FEV1 (BT)

-Change in FEV1 20% or more indicates significantly reversible

airway obstruction.

38

Upashaya and Anupashaya

Upashaya and Anupashaya A judicious application of aushadhi, anna and vihara when it produces relief in the

symptoms is called as upashaya. When it aggravates the symptoms it is called as

anupashaya. It is trial and error treatment.

In Tamaka swasa upashaya and anupashaya have been explained while

mentioning the lakshanas of the disease, these are as follows.

Table.No.6.Upashaya and Anupashaya in Tamaka Shwasa 62.

Upashaya Anupashaya

Ushna Ahara Vihara. Sheeta Ahara Vihara, Sheeta Ambu-cold

water.

Aseeno Labhate Soukhyam – feels

comfortable to breath in sitting position.

Shayanasya Shvasa Piditaha – discomfort

worsens on lying.

Vimokshante Sukham –slight relief in

breathlessness on spitting out the sputum.

Presence of Kapha in the Pranavaha srotas

worsens difficulty in breathing.

Dry sunny weather relieves the symptoms. Meghaihi Abhivardhate – cloudy weather

worsens the attack.

Quiet atmosphere is favorable. Pragvata – breeze.

Clear atmosphere, devoid of smoke and

dust helps in reducing the symptoms.

Exposure to dust or smoke worsens the

attack of Tamaka Shvasa.

Factors, that reduces the Kapha vitiation

brings out relief.

Sleshmala - Kapha aggravating factors add

to the disease.

The Upashaya which provides diagnostic aid for diseases. Apart from these the

general chikitsa sootra also can be considered as Upashaya and the nidana of a disease

itself can be considered as Anupashaya.

39

Sadhyasadhyata

Sadhyasadhyata Sadhyasadhyata gives the clear picture about the prognosis of the disease i.e.,

whether the disease is easily curable, difficult to cure or incurable. It depends upon the

nature of the disease. A physician who can distinguish between curable and incurable

disease and initiate treatment in time with the full knowledge can certainly accomplish

his object. 63

Most of the time tamaka shwasa is considered to be a yapya vyadhi 64.If it

occurs in strong person and the patient is able to take medicine, where the symptoms are

not fully manifested and when the patient is not having any other complications and is

newly devoloped, it is curable. On severe attack of Tamaka shwasa if treatment is given

inadequate and is delayed it becomes fatal.

According to classics,if Tamaka shwasa is nava (early stage) or if it is treated in

beginning or if the patient having good strength it is Sadhya. If it is in durbala rogi (weak

patient) or if it is associated with Jwara and Murcha then it is considered to be asadhya.

When the Tamaka Shwasa runs a chronic course, Acharya Charaka opines that

there occurs depletion of Rasa and the other Dhatu debilitating the patient. Treatment is

always easy in a physically strong patient as he can tolerate the stress of Sodhana therapy.

When the person is debilitated due to long standing Tamaka Shwasa more energetic

treatment like Sodhana is impossible, thus posing problems in planning the radical

treatment in a physically debilitated patient.

Based on the above information it is very important to educate the patient

about his illness. This makes the patient to co-operate with the physician which is very

important in the long term management.

40

Vyavacchedaka nidana

VYAVACCHEDAKA NIDANA (DIFFERENTIAL DIAGNOSE)

According to Charaka, a wise physician should properly recognize the

disease by the methods of Aptopasdesa,Prathyaksha and Anumana before giving

medicine. One who is well versed in the specific nature of the disease as well as the

therapies required, never become doubtful in his work.65 The following disorders which

are having similar features of Tamaka shwasa.

Kaphaja kasa

Rajayakshma

Maha shwasa

Urdhva shwasa.

Chinna shwasa.

Kshudra shwasa

These are as follows

Kaphaja Kasa66

In Kaphaja kasa bahula, madhura, snigda ghana kapha, nisteevana is present. It is

also associated with mandagni, aruchi, chardi, peenasa, utklesha, gourava, lomaharsha,

ashyamadurya, kleda, sadana and vaksharuk, swasa is not present in this condition.

Rajayakshma67

Though shwasa can also present in Rajayakshma. The associated symptoms like

Karshya Jwara, Raktasteevana, Angamarda, Atisara, etc., can be seen unlike shwasa.

41

Vyavacchedaka nidana

Table No.7 . Showing the difference between 5 varieties of shwasa68

Symptoms Tamaka

shwasa Maha shwasa Urdhwa

shwasa Chinna shwasa Kshudra

shwasa

Shwasa vega. Ateeva teevra

vega.

Ucchaiswasiti. Deergham

swasiti,

Urdhwam

swasiti,

Adhashwasa

nirodha.

Shwasiti

vicchinnam.

Rooksha

ayasodbhava

shwasa.

Shabda Gurguraka. Matta

vrishabhavat.

__ __ __

Consciousness Pramoha. Pranasta

jnana vijnana.

Pramoha. Moorcha. __

Netra Uchritaksha Vibhranta

lochana,

Vikrutakshi.

Urdwadrushti

Vibrantaksha.

Viplutaksha,

Raktaikalochana

__

Shoola Sayane

parshwa

shoola.

__ Vedanarta Marmacheda

rugardita.

No Indriya

vyatha

Vak Kricchrat

shaknoti

bhashitum.

Visheerna vak __ Pralapa. __

Asya Vishuska. __ Shuska. Parishuska. __

Sweda Lalata sweda. __ __ __ __

Miscellaneous __ Baddha mutra

varcha.

Arati. Anaha, Ajeerna. Precipitated

by vyayama

and Ahara .

No much

distress.

Sadhyasadyata Yapya,

Sadhya(Nava)

Asadhya. Asadhya. Asadhya. Sadhya.

42

Vyavacchedaka nidana

So Proper identification of disease in the sadhyavastha itself is absolutely

important, because Charakacharya opines that, all though incurable diseases never

become curable on the contrary curable diseases may become either difficult to cure or

incurable. Thus, a disease becomes easily curable, when it in its initial stages, where as it

become extremely difficult to cure or even becomes incurable in its advanced stages.69

43

Chikitsa

CHIKITSA:

The term chikitsa is derived from the root kit rogaapanayane i.e. to adopt

measures for the removal of the pathological factors involved in the disease. The mere

removal of the causative factors (of disease) may not always result in the total removal of

the disease as such. The effects of the disease may still continue to incriminate. Hence in

the real sense, chikitsa is not only aimed at the radical elimination of the causative factors

of the disease; but also it is planned for the restoration of doshic equilibrium.

Among five varieties of Shwasa Urdhva, Maha and Chinna Shwasa are

mentioned as Asaadhya and hence treatment in these occasions is not fruitful. Kshudra

Shwasa is a trivial condition and does not require any energetic treatment.

Tamaka Shwasa is identified as Yaapya /Kashtasaadya, and in which

treatment has to be continued for a prolonged period with meticulous care of the patient.

The different therapeutic measures to be adopted in this illness for the best remission or

cure of the illness is elaborated in the following lines

In the Tamaka Shwasa following modalities have applied

(1) Shodhana (2) Shamana (3) Bruhmana (4) Rasayana.

MANAGEMENT IN VEGAVASTHA & AVEGAVASTHA:

Observing the treatment modality explained by Acharya for Tamaka shwasa we

can interpret them as measures during the vegavastha and during Avegavastha. By

considering the atyayika avastha of disease one can plan the treatment.The following

treatment can be preferred during the vegavastha.

DURING VEGAVASTHA

SNEHANA 70:

Patient who is in vegavastha should be first anointed with Lavana taila over the chest

and back for 30 minutes. In Snehadhaya 71Charaka 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 Dosha sanghata Vichedakara property.

44

Chikitsa

Taila is having Ushna property, alleviates vata, and does not increase Kapha and is better for

Abhyanga.72In Shwasa Grathita Kapha is present; hence to break this Vikrita dosha sanghata,

Salavana Sneha is useful. How this Sneha penetrates all Dhatu’s and pacifies Dosha is mentioned

by Dalhana

SWEDANA73:

After Snehana, the patient is subjected to sudation either by methods of Nadi

Sweda,Prastara sweda or Sankara sweda by using Dasamoola Kwatha for another 30

minutes.Ushna Guna of Swedana helps to liquify the Kapha. Also heat applied by Sweda

is carried from skin to internal organ through blood. Blood is only the medium in body to

transfer heat from outer environment to internal organs.

By this the grathitha kapha dosha get liquefied and srotas becomes mardhava.

It also causes downward movement of Vayu.

KAPHA UTKLESHANA:

After attaining samyak svinna laxana, the patient should be given to eat snigdha

ahara or matsya or sookara mamsa or dadhisara .By these ahara, the kapha becomes

pravruddha. Then the patient should be given with Vamana Yoga i.e., Pippli, Saindhava,

and Honey.

VAMANA KARMA IN TAMAKA SHWASA74:

Vitiated vata dosha causes increase in the stiffness of the air passages;

simultaneously there occures accumilation of the kapha dosha in the same pranavaha

srotas.These two pathological events obstruct the free passage of air resulting in

shwasa.The vamana karma expels the accumilated liquified sputum from the air passage

easily.Thus the free movement of air is restored.

These procedures by way of eliminating the kapha as well as reducing the

constriction of the pranavaha srotas ensures free passage of the pranavayu.

45

Chikitsa

TREATMENT IN BETWEEN THE ATTACK( AVEGAVASTHA):

After the attack of Shwasa ,the treatment which reduce the khavaigunya is to

be administerd.The Brumhana and Rasayana treatment is to be administerd to prevent the

further attack.

1.Virechana Karma – Therapeutic purgation.

2.Brumhana Chikitsa – Regimen nourishing the body

3.Rasayana Chikitsa – Rejuvenating the Pranavaha Srotas and body.

OTHER TREATMENTS IN TAMAKA SHWASA:

Samana Chikitsa – Internal medication causing remission of the illness.

Pratisyaya Chikitsa – Treatment of Rhinitis.

Kasaroga Chikitsa – Treatment of Kasaroga.

Kaphahara Chikitsa – Pacification of vitiated Kapha Dosa.

Vatahara Chikitsa – Elimination of vitiated Vata Dosa.

Manasa Dosha Chikitsa –Correction of emotional disturbances.

Kapha Vilayana Chikitsa –Liquefaction of the sputum.

Srotomardavakara Chikitsa – Softening of the channels of respiration.

Kaphanissaraka Chikitsa – Expectoration of sputum.

Kasaghna Chikitsa – Treatment of cough.

46

Pathyapathya

PATHYA AND APATHYA According to Charaka, the drug and regimen which do not adversely affect the

body and mind are regarded as Pathya; those which adversely affect them are considered

to be Apathya 75

Ayurveda can guide every individual in the proper choice of diet, living

habits and exercises to restore balance in the body, mind and consciousness, thus

preventing disease from gaining a foothold in the system.

Every individual must know his constitution, so that he can use opposite

qualities of food, exercise, and environment and if possible job also to achieve perfect

health.

Panchakarma is ineffective if special detoxification diet is not given along

with the treatments.

Following Pathya should be followed by a person who is suffering from

Tamaka shwasa.

Table.No.8.Pathya in Tamaka shwasa.

Pathya Ahara C .S76 S .S77 A .H78 Y.R79 B.R80

I Shaali Dhanya

Purana Shali + - - + + Tandula - - - + +

II Vrihi Dhanya

Shashtika + - + + +

III Shooka Dhanya

Yava + - + + + Godhuma + - + + +

IV Shimbi

Mudga + - + - - Kulatha - - + + +

V Shakha Varga

Guduchi + - - + + Patola - - - + +

47

Pathyapathya

Vartaka - - + + + Rasona - - - + + Bimbi - - - + + Vastuka - - - - + Moolaka + - + - + Potaki - - - - + Shigru + - - - - Kasamarda + - - - -

VI Mamsa Varga

Janghala - - - + + Shasha + - - + + Titira - - - + + Bhuka - - - + + Lava - - - + + Dhanva - - - + + Shuka - - - + + Mruga Dwija - - - + +

VII Phala Varga

Jambira - - - + + Draksha + + - + + Mathulunga + + + - + Amalaka + + + - - Bilwa + + + - -

VIII Madhya Varga

Sura - + - + + Varuni - - + - -

IX Madhu Varga

Madhu + + + + +

X Mootra Varga

Gomutra - - - - +

XI Dugdha Varga

Aja Kshira - - - + +

48

Pathyapathya

XII Ghrta Varga

Purana sarpi - + - + + Ajasarpi - - - + +

XIII Krtanna Varga

Yusha + - + - - Yavagu + - - - - Peya + - + - - Sathu - - + - - Varuni - - + - -

Pathya Vihara

Virechana + - - + + Swedana + - - + + Dhumapana + - - + + Prachardana - - - + + Swapanam Diva - - - + +

Table No.9 – Apathya in Tamaka Svasa:

Apathya Aahara

I Shimbi Dhanya

Nishpava + - - + - Masha + - - + - Tila + - - - - Sarshapa - - - + +

II Shaaka Varga

Kanda - - - + +

III Mamsa Varga

Jalaja + - - - - Anupa + - - - + Pishita + - - - - Matsya - - - + +

49

Pathyapathya

IV Dadhi Varga

Dadhi + - - - -

V Kshira Varga

Kshira + - - + + Mahisha Kshira + - - - -

VI Grita Varga

Mahisha Gritha - - - + +

VII Krtanna Varga

Tailabhrsta Nishpava - - - - + Pistanna + - - - - Pinyaka + - - - -

Apathya Vihara

Sheeta Snana + + + - - Raja + + + + + Dhuma + + + + + Anila + + + + + Vyayama + + - - - Bhara - + - - + Adhwa - + - - + Vegaghata - + - - - Apatharpana + + - - - Marmaghata + - + + + Sooryatapa - - - - + Daurbalya + - - - - Aanaha + - - - - Abhighata - + - - - Strigamana - + - - - Vegavarodha-Mootra, Udgara, Chardi, Trushna, Kasa

- + - - -

So according to our text,the Pathya is having great role before planning the

treatment. Acharya says if one follows Pathya, the treatment is not necessary for him, if

one don’t follow Pathya the given medicine will not work in him.

50

Drug review

DRUG REVIEW

A number of formulations have been recommended in Ayurvedic classics for the

treatment of tamaka shwasa addition to Panchakarma Chikitsa. Vata and Kapha dosha are

the predominanant doshas in the pathogenesis of Tamaka shwasa. Vatahara and

Kaphahara therapies are the preferable treatment in this alarming disease. Similar

qualities of drugs are the contents of the herbal combination Shatyadi curna. In the

present clinical trial madanaphaphaladi yoga is used for the vamana karma, lavana taila

for the abhyanga, dasamula kwatha for the nadi sveda and satyadi churna is prescribed as

samana medication. The details of the ingredients of these medicinal combinations are

detailed below.

SHATYADI CURNA 81

Table.No.10.Ingredients of Shatyadi curna.

INGRADIENTS QUANTITY

1.SHATI 1 part.

2.BHARANGI 1 part.

3.VACA 1 part.

4.SUNTI 1 part.

5.PIPPALI 1 part.

6.MARICA 1 part.

7.PATHYA(HAREETAKI) 1 part.

8.RUCHAKA(SOUVARCALA LAVANA) 1 part.

9.KATPHALA 1 part.

10.TEJOVATHI 1 part.

11.PUSHKARAMOOLA 1 part.

12.SHRINGI(KARKATA SHRINGI) 1 part.

51

Drug review

1.Shati: Botanical name – Curcuma zedoaria.

Family - Zingiberaceae.

Rasa - Katu,Tikta.

Guna - Laghu, Teekshna.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kapha vata shamaka.

Karma - Kaphagna,Shwasahara.

2. Bharangi:

Botanical name – Clerodendrum serratum

Family - Verbenacea

Rasa - Tikta, Katu.

Guna - Laghu, Rooksha.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kapha vata shamaka

Karma - Kaphagna,Shwasahara,Kasahara.

3.vacha: Botanical name – Acorus calamus.

Family - Araceae.

Rasa - Katu,Tikta.

Guna - Laghu, Tikshna.

Veerya - Ushna.

Vipaka - Katu.

Prabhava - Medhya.

Doshagna- Kaphavatashamaka, Pitta vardhaka

Karma - Kasahara,Shwasahara,Kantya.

52

Drug review

4. Shunti: Botanical name – Zingiber officinale

Family - Zingiberaceae.

Rasa - Katu.

Guna - Laghu, Snigdha.

Veerya - Ushna.

Vipaka - Madhura

Doshagna- Kapha vata shamaka

Karma - Kaphagna,Shwasahara.

5. Maricha: Botanical name – Piper nigrum.

Family - Piperaceae.

Rasa - Katu.

Guna - Laghu, Teekshna.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kapha vata shamaka.

Karma - Kaphagna,Kapha nissaraka.

6. Pippali: Botanical name – Piper longum

Family - Piperaceae.

Rasa - Katu.

Guna - Laghu,Snigda,Teekshna.

Veerya - Anushna sheeta.

Vipaka - Madhura

Doshagna- Kapha vata shamaka.

Karma - Shwasahara,Kasahara.

53

Drug review

7. Pathya (Hareetaki): Botanical name – Terminalia chebula.

Family - Combretaceae.

Rasa - Panca rasa lavana varjita ,Kashaya pradhana

Guna - Laghu, Rooksha.

Veerya - Ushna.

Vipaka - Madhura.

Doshagna- Tridoshagna.

Karma - Shwasahara,Kasahara.

8. Ruchaka (Sauvarchala lavana): Chemical name-Unaqua sodium chloride.

Rasa – Lavana,Katu

Guna - Laghu,Vishada,Sookshma,Snigda

Veerya - Ushna

Vipaka - Madhura

Doshagna- Vata Pittahara.

Karma- Rocana,Deepana,Pacana,Anulomana, Hrudya.

9. Katphala: Botanical name – Myrica esculenta.

Family - Myricaceae.

Rasa - Kashaya, Tikta, Katu.

Guna - laghu, Teekshna.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kapha vata shamaka.

Karma - Shwasahara,Kasahara.

54

Drug review

10. Tejovathi: Botanical name – Zanthoxylun armatum.

Family - Rutaceae.

Rasa - Katu,Tikta.

Guna - Laghu,Rooksha,Tikshna.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kapha vata shamaka,Pitta vardhaka.

Karma - Shwasahara,Kasahara.

11. Pushkaramoola: Botanical name – Inula recemosa.

Family - Compositae.

Rasa - Tikta, Katu.

Guna - Laghu, Tikshna.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kapha vata shamaka.

Karma - Shwasahara,Kasahara.

12. Shringi (Karkata shringi): Botanical name – Pistacia integerrima.

Family - Anacardaceae.

Rasa - Kashaya, Tikta.

Guna - Laghu, Rooksha.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kapha vata shamaka.

Karma - Shwasahara,Kasahara.

55

Drug review

All above mentioned 12 drugs are taken in equal quantity and

made in to fine powder form separately, and all the drugs are mixed together uniformely.

This combination of churna is known as `Shatyadi curna’ and is packed in air tight

containers.

Matra - 5gm tid.

Anupana – Madhu(10ml)

Amayika Prayoga - Shwasa, Kasa.

VAMANA DRAVYA:

1.Madhanaphala: Botanical name –Randia spinosa.

Family - Rubiaceae.

Rasa - Kashaya,Madhura,Tikta.

Guna - Laghu, Rooksha.

Veerya - Ushna.

Vipaka - Katu.

Prabhava- Vamaka.

Doshagna- Kapha vata shamaka.

Karma - Kapha nissaraka.

2.vacha: Botanical name – Acorus calamus.

Family - Araceae.

Rasa - Katu,Tikta.

Guna - Laghu, Tikshna.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kaphavatashamaka, Pitta vardhaka.

Karma - Shwasahara,Kasahara,Kantya.

56

Drug review

3.Saindava(Rock salt): Chemical formula – NaCl2

Rasa - Lavana.

Guna - Laghu.

Veerya - Seetha.

Vipaka - Madhura.

Doshagna- Tridhosha samaka.

Karma- Rocana,Deepana,Avidahi,Hrudya.

4.Madhu: Rasa - Kashaya.

Guna - Guru,Rooksha.

Veerya - Seetha.

Vipaka - Madhura.

Doshagna- Kapha samaka,

Vatakaraka.

Karma- Sandana,Chedana.

5.Yastimadhu: Botanical name – Glycyrrhiza glabra.

Family - Laguminosae.

Rasa - Madhura.

Guna - Guru,Snigdha.

Veerya - Seetha

Vipaka - Madhura.

Doshagna- Vatapittahara.

Karma - Kapha nissaraka,Kantya.

57

Drug review

6.Ksheera: Rasa - Madhura.

Guna - Mrudhu,Snigdha etc

Veerya - Seetha.

Vipaka - Madhura.

Doshagna- Tridhosha samaka.

Karma- Jeevaneeya,Rasayana

DRAVYAS USED IN SNEHANA AND SWEDANA Tila taila mixed with saindava lavana is used for snehana and for swedana,the

Dasamoola kwatha is used.

1. Tila taila: Rasa - Madhura,Kashaya Anurasa.

Guna - Sookshma,Vyavayi.

Veerya – Ushna.

Doshagna- Vatagna,Pittavardhaka, Kapha samaka.

Karma- Baddhavinmootraghna, Twachya, Medya, Deepana.

2.Bilva Botanical name – Aegle marmelos.

Family - Rutaceae.

Rasa - Kashaya,Tikta.

Guna - Laghu, Rooksha.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kaphavatashamaka.

Karma - Kaphagna.

58

Drug review

3.Agnimantha. Botanical name – Premna mucronata.

Family - Verbenaceae.

Rasa - Tikta,Katu,Kashaya,Madhura.

Guna - Rooksha,Laghu.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kaphavata shamaka.

Karma - Kaphagna.

4.Syonaka. Botanical name – Oroxylum indicum.

Family - Bignoniaceae.

Rasa - Madhura,Tikta,Kashaya.

Guna - Laghu, Rooksha.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kaphavatashamaka.

Karma - Kaphagna.

5.Kasmarya. Botanical name – Gmelina arborea.

Family - Verbenaceae.

Rasa - Tikta,Kashaya,Madhura.

Guna - Guru.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Tridosha shamaka.

Karma - Sandhaniya,Balya.

59

Drug review

6.Patala. Botanical name – Stereospermun suaveolens.

Family - Bignoniaceae.

Rasa - Tikta,Kashaya.

Guna - Laghu, Rooksha.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Tridosha shamaka.

Karma - Kaphagna,Hikka nigraha.

7.Salaparni. Botanical name – Desmodium gangeticum.

Family - Laguminaceae.

Rasa - Madhura,Tikta.

Guna - Guru,Snigdha.

Veerya - Ushna.

Vipaka - Madhura.

Doshagna- Tridosha shamaka.

Karma - Kapha nissaraka.

8.Prishnaparni. Botanical name – Uraria picta.

Family - Laguminaceae.

Rasa - Madhura,Tikta.

Guna - Laghu, Snigdha.

Veerya - Ushna.

Vipaka - Madhura.

Doshagna- Tridosha shamaka.

Karma - Kapha nissaraka.

60

Drug review

9.Bruhathi. Botanical name – Solanum indicum.

Family - Solanaceae.

Rasa - Katu,Tikta.

Guna - Laghu,Rooksha,Tikshna.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kaphavata shamaka.

Karma - Kaphagna,Shwasahara,Kasahara.

10.Kantakari. Botanical name – Solanum surattense

Family - Solanaceae.

Rasa - Tikta,Katu.

Guna - Laghu,Rooksha,Tikshna.

Veerya - Ushna.

Vipaka - Katu.

Doshagna- Kaphavatashamaka.

Karma - Kaphagna,Shwasahara,Kasahara.

11.Gokshura. Botanical name – Tribullus terrestris.

Family - Zygophyllaceae.

Rasa - Madhura.

Guna - Guru,Snigdha.

Veerya - Seetha.

Vipaka - Madhura.

Doshagna- Vata Pittashamaka.

Karma - Kapha nissaraka.

There fore the present study is aimed towards the understanding of the

probable action of Vamana and Shatyadi Curna in the effective management of Tamaka

Shwasa.

61

Methodes

Methodes: Aim and Objectives :

To evaluate the effect of vamana and shatyadi choorna in relieving the

symptoms of Tamaka shwasa.

Source of Data :

20 patients diagnosed as Tamaka shwasa were taken for the study from IPD

of S.D.M. Ayurveda Hospital, Udupi.

Inclusion criteria:

Patients with pratyatma Lakshana of Tamaka shwasa.

Age group between 16 and 60 years.

Patients having the history more than 6 months

Patients selected irrespective of sex, religion, occupation etc.

Exclusion criteria:

Tamaka shwasa associated with complications like emphysema and

corpulmonale.

Severe attack of Tamaka shwasa.

Patients suffering from other systemic disorders.

Patient on steroid treatment

Investigations:

Blood: Hb%, TC, DC, ESR.

Spirometric pulmonary function test.

Design:

This is a single blind clinical study with pre test and post test design where

in 20 patients suffering from Tamaka shwasa of either sex between the age group

of 16 and 60 years were selected for the study.

A special Performa prepared with all points of history taking, physical

signs and laboratory investigations to confirm the diagnosis as mentioned in our

classics as well as allied sciences. These patients were subjected to vamana karma

followed by oral administration of Shatyadi choorna in a dose of 5g TID with

10ml of madhu for 30 days.

62

Methodes

Interventions:

First day - On the chest and back, Lavana taila Abhyanga for 30

minutes followed by Dasamula kwatha nadi sveda for another 30 minutes. Patient

is advised to take stomach full of curd rice for dinner.

Second day - On the chest and back, Lavana taila Abhyanga for 30

minutes followed by dasamula kwatha nadi sweda for another 30 minutes. This is

carried out in the early morning. Followed this, swedana,the patient is posted for

vamana karma at around 7.30 am.To begin with,approximately 600ml of milk

followed by madhanaphala yoga. The patient is observed for vomiting. Vomiting

usually begins within one muhurtha and in some patients in whom the initiation of

vomiting is not observed, vomiting was induced by approximate amount of

yastimadhu phanta.The vamana karma is then assessed as discussed below.

CRITERIA FOR ASSESSMENT OF VAMANA:

Table.No.11.Criteria for assessment of Vamana.

Shuddhi Avara Shuddhi

Madhyama

Shuddhi Pravara Shuddhi

Vaigiki 4 Vega 6 Vega 8 Vega

Maniki 1 Prastha(648ml) 1 ½

Prastha(972ml)

2 Prastha(1296ml)

Antiki Pittanta

Laingiki Signs of symptoms of Samyak Vamana.

Hrut,Parshva,Moordha,Indriya,Marga suddhi,Laghutha.

After the vamana karma, doomapana is advised. Then the patient is

shifted to the ward and is advised to take complete rest. Samsarjana krama is then

followed for about 5 days starting from the evening of the vamana day as shown

in the table below.

63

Methodes

Table.No.12.Samsarjana karma.

Days Ahara

On the day of vamana - evening peya

2nd day - morning peya

- afternoon peya

- evening vilepi

3rd day - morning vilepi

- afternoon Vilepi

-evening Akruta Yoosha

4th day - morning Kruta Yoosha

- afternoon Kruta Yoosha

- evening Akruta Mamsa rasa

5th day - morning Kruta Mamsa rasa

- afternoon Kruta Mamsa rasa

- evening Samanya Bhojana

From third day onwards for 28 days - Shatyadi Curna is orally

administered in a dose of 5g tid with10ml of madhu.

Pathya and Apathya:

All the 20 patients taken for the study were advised to avoid Cold

items ,exposure to cold, dust etc.

Criteria of Assessment:

Adopting the scoring method, symptoms of the illness like breathlessness,

cough, sputum etc and physical signs like respiratory rate, heart rate, expansion of

chest as well as Spiro metric parameters was taken as assessment criteria in this

study. Patients were observed for change in the severity of symptoms on 1st, 2nd,

7th, 14th, 21st, and 30th day of treatment. Results are analyzed by adapting the

paired t test.

64

Methodes

Severity of Tamaka Svasa:

1. Mild intermittent-

• Symptoms-symptoms <2 times a week.

• Asymptomatic and normal PEF between exacerbations, brief exacerbation

(few hours to few days), and intensity may vary.

• Night time symptoms < 2 times a month.

• Lung function – FEV, or PEF 60% to 80% predicted, PEF

variability>20%

2. Mild persistent-

• Symptoms- symptoms > 2 times a week but < 1 time a day, exacerbation

may affect activity.

• Night time symptoms > 2 times a month

• Lung function - FEV, or PEF 80% predicted PEF variability 20% to 30%.

3. Moderate persistent-

• Symptoms - Daily symptoms, daily use of inhaled short acting beta2

agonist, exacerbations affects activity, exacerbations>2 times a week, may

last for few days.

• Lung Functions - FEV or PEV 60% to 80% predicted, PEF variability >

30%.

4. Severe Persistent-

• Continual symptoms, limited.

• Physical activity affected with frequent exacerbation.

• Night time symptoms – frequent.

• Lung function - PEV or PEF < 60% of predicted, PEF variability > 30%

65

Methodes

Breathlessness:

1. Mild - Breathlessness with activity.

2. Moderate - With talking.

3. Severe - At rest.

4. Impending respiratory failure-Breathlessness at rest.

Speech:

1. Mild - Sentences.

2. Moderate – Phrases.

3. Severe - Words.

4. Impending respiratory failure - Mute.

Cough:

1. Morning bouts or after exercise - Do not disturb work.

2. Continuous cough during day and morning - Disturbing work.

3. Continuous day morning and night cough - Disturbs activity.

4. Continuous day, night and sleep and activity disturbed.

Sputum:

1. Less than 2.5ml/day.

2. 2.5 ml to 1.5ml/day

3. 15 to 25ml/day

4. > 25ml/day.

Body position:

1. Mild - Able to recline.

2. Moderate - Prefers sitting.

3. Severe - Unable to recline.

4. Impending respiratory failure - Unable to recline.

66

Methodes

Respiratory Rate:

1. Mild - >10/min

2. Moderate - >20/min

3. Severe - After > 30/min

4. Impending respiratory failure > 30/min

Laboured breathing:

1. Mild - Usually no use of accessory muscles.

2. Moderate - Commonly use of accessory respiratory muscles.

3. Severe - Usually use of accessory respiratory muscles.

4. Impending respiratory failure - Paradoxical thoraco-abdominal movement.

Breath sounds:

1. Mild - Moderate wheezing at mid to end expiration.

2. Moderate - Loud wheeze through out expiration.

3. Severe - Loud inspiration and expiratory wheezes.

4. Impending respiratory failure - Little air movement without wheezes (silent

chest).

Heart rate:

1. Mild – 100/min

2. Moderate- 100-120/min.

3. Severe > 120/min

4. Impending respiratory failure - Relative bradycardia.

Mental status:

1. Mild - May be agitated.

2. Moderate - Usually agitated.

3. Severe - Always agitated.

4. Impending respiratory failure - Confused or drowsy.

67

Methodes

Spirometric Tests:

Computerized electronic kit micro spirometer was used in this study for

assessing pulmonary ventilation capacity. The technical features of this spirometer

included-

• Flow meter: Bi-directional digital turbine.

• Range for flow measurement: 0.03 - 20 l/s

• Range for volume measurement 10l

• Accuracy of measurement 3% or 50 ml

• Dynamic Resistance @ 12 l/s < 0.7 cmH2O/l/s

The interpretation of the predicted values for spirometric lung volumes was

calculated following the ERS 93 criteria (Official Statement of the European

Respiratory Society, The European Respiratory Journal Volume 6, Supplement 16,

and March 1993.) following is the list of spirometric tests, included in the present

study on Tamaka Shwasa.

Symbol UM Parameter

-------------------------------------------------------------------------------------------------------

---

FVC l (btps) Forced Expiratory Vital Capacity

FEV1 l (btps) Forced Expiratory Volume in 1 second

PEF l/sec Peak Expiratory Flow

FEV1/FVC% FEV1 as a percentage of FVC

68

Methodes

Assessment of Overall effect:

For assessing the overall effect of the treatment, the total scores of criteria of

assessment of Tamaka Shwasa after the treatment was considered. As per the reduction in

the total scores of the overall effect is calculated as under:

Complete remission – Total score is 0 after the treatment.

Moderate remission – Reduction in more than 60% of the initial score.

Average remission – Reduction in score between 30 to 60%.

Unchanged – Reduction less than 30% of the initial score.

In a nutshell this assessment criteria incorporates almost all the

subjective as well as objective clinical manifestations of the illness Tamaka Shwasa.

69

Observation and results

OBSERVATION AND RESULTS

In the present study, 20 patients suffering from Tamaka Shwasa fulfilling the

inclusion criteria were registered.

Following details of 20 patients studied in this work is given in this chapter–

- Descriptive statistical analysis of the patients.

- Analysis of the symptomatology of Tamaka Shwasa before and after treatment

- Statistical analysis of Spiro metric results.

Descriptive Statistical analysis:

The detail of descriptive analysis in regards to age, sex, marital status etc of 20

patients suffering from Tamaka shwasa is elaborated in the following paragraph.

Distribution of patients according to age:

Analysis of age incidence of the 20 patients suffering from Tamaka Shwasa

showed more number of patients between the age group of 26 to 30 years. Details of the

age incidence is given in table no. 13

70

Observation and results

Table NO. 13 – Distribution of 20 Patients in Different Age Groups:

Age(yrs) No.of patients %

16-20 2 10

21-25 3 15

26-30 5 25

31-35 1 5

36-40 2 10

41-45 3 15

46-50 1 5

51-55

2 10

56-60 1 5

Figure No.1 – Incidence of Age:

0

5

10

15

20

25

%

16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60Age

71

Observation and results

Distribution of Patients according to sex:

In this study 75% of females were registerd in comparison to 25% of males. The

following table 13 shows the details.

Table no 14- Distribution of 20 patients according to their sex:

Sex No.of patients %

Male 5 25

Female 15 75

Figure No.2 – Incidence of Sex:

0

10

20

30

40

50

60

70

80

%

SEX

MaleFemale

72

Observation and results

Distribution of Patients according to marital status:

The married patient ratio was more compared to the unmarried patient ratio. The

following table no. 14 shows the details.

Table No.15 – Marital status of 20 patients:

Status No.of patients %

Married 13 65

Unmarried 7 35

Figure No.3 - Marital status:

0

10

20

30

40

50

60

70

%

Marital status

MarriedUnmarried

73

Observation and results

Distribution of Patients according to religion:

Most of the patients are Hindus in the present study. The sample includes 85%

of Hindus, while Muslims and Christians were only 5% and 10% respectively.

Table No.16- Distribution according to their Religion:

Religion No.of patients % Hindu 17 85 Muslim 1 5 Christians 2 10 Jains 0 0 Others 0 0

Figure No.4 – Distribution according to their religion :

0102030405060708090

%

Religion

HinduMuslimChrstainJainsOthers

74

Observation and results

Distribution of Patients according to habitat: The present study includes more number of patients from rural area. The detailed description available in the following table. Table No.17 – Habitat incidence:

Habitat No. of patient % Urban 1 5 Rural 19 95

Figure No.5 – Habitat Incidence:

0

20

40

60

80

100

%

Habitat

RuralUrban

75

Observation and results

Distribution of Patients according to socio-economic status:

Among the selected patients maximum belonged to lower class status. The

detailed descriptions are shown in the following table.

Table No.18. Socio- economic Status:

Social status No. of patients %

Low 11 55

Middle 9 45

Upper 0 0

Figure No.6. Socio- economic Status:

0

10

20

30

40

50

60

LowMediumUpper

76

Observation and results

Distribution of Patients according to occupation:

In the present study maximum numbers of patients were House wives and

agriculturists.

Table No. 19 – Occupation:

Occupation No. of patients %

Business 0 0

House wife 4 20

Employee 2 10

Agriculturist 4 20

Student 1 5

Others 9 45

Table No.7 – Occupation

45

05

1015202530354045

%

Occupation

HousewifesEmployeesAgriculturistsStudentsBussinessOthers

77

Observation and results

Distribution of Patients according to habits: Most of the patients had no habits. The following table gives the details. Table No.20.Habits of the patient:

Habits No. of patients %

Smoking 1 5 Alcoholic 1 5 Tobacco chewing 3 15 Snuff 1 5 Others 0 0 No habits 14 70

Table No.8 - Habits of the patient:

0

1020

30

40

50

60

70

%

Habits

SmokingAlcoholTubaco chSnuffNo habits

78

Observation and results

Distribution of Patients according to dietary habits: Maximum number of patients registered for the study used to take mixed diet. Table No.21 – Dietary habits:

Diet No.of patient % Vegetarian 3 15 Mixed 17 85

Figure No.9 - Dietary habits:

0

20

40

60

80

100

%

Dietary Habits

VegitarianMixed

79

Observation and results

Distribution of Patients according to prakruthi: In the prakruthi analysis, Vatapitta constitution was observed maximum in the present study. Table No.22.Analysis of Deha Prakruthi:

Prakruthi No.of patients % Vatapitta 14 70 Vatakapha 4 20 Pittakapha 2 10 Tridoshaja 0 0

Figure No.10. Analysis of Deha Prakruthi:

0

10

20

30

40

50

60

70

%

Deha prakrruthi

VPVKPKTD

80

Observation and results

Distribution of Patients according to sara:

All the patients took for the study comes under Madhyamasara.The details given

in the following table.

Table No. 23 - Analysis of Sara:

Sara No. of patients % Pravara 0 0 Madhyama 20 100 Avara 0 0

Figure No.11- Analysis of Sara:

0

20

40

60

80

100

%

Sara

Pravara

Madhyama

Avara

81

Observation and results

Distribution of Patients according to samhanana:

In the present study, patients of Madhyama Samhanana were 95% while5% of

Patients had Pravara Samhanana. The same is further detailed in the table23.

Table No.24 - Analysis of Samhanana in 20 patients of Tamaka Shwasa:

Samhanana No. of patients. %

Pravara 1 5

Madhyama 19 95

Avara 0 0

Figure No.12 - Analysis of Samhanana in 20 patients of Tamaka Shwasa:

0

20

40

60

80

100

%

Samhanana

PravaraMadhyamaAvara

82

Observation and results

Distribution of Patients according to satva:

In 80% of the patient showed Madhyama satva, where as Pravara and

Avara satva are 10%each.

Table No.25 – Satvataha analysis of the patients:

Satva No.of patients. %

Pravara 2 10

Madhyama 16 80

Avara 2 10

Figure No.13 - Satvataha analysis of patients:

01020304050607080

%

Satvataha

PravaraMadhyamaAvaa

83

Observation and results

Distribution of Patients according to satmya:

In 90% of the patients Madhyama Rasa Satmya was observed. Pravara

Satmya was recorded in just 5% of patients. Remaining patients i.e. 5 % revealed Avara

Satmya. Complete details of analysis of Satva in 20 patients is given in the table no.25

Table No.26- Analysis of Satmya in patients of Tamaka Shwasa:

Satmya No. of patients. %

Pravara 1 5

Madhyama 18 90

Avara 1 5

Figure No. 14 - Analysis of Satmya in patients of Tamaka Shwasa:

0

20

40

60

80

100

%

Satmya

PravaraMadhamaAvara

84

Observation and results

Distribution of Patients according to agni:

In the analysis of Agni, 70% of patients are said to be having Samagni. The

patients having Vishamagni and Tikshnagni were 20%,10% respectively. No patients are

suffering from Mandagni.

Table No.27 - Analysis of state of Agni :

Agni No. of patients. %

Sama 14 70

Vishama 4 20

Tikshna 2 10

Manda 0 0

Figure No. 15 - Analysis of state of Agni:

010203040

506070

%

Agni

SamaVishamaTikshna

85

Observation and results

Distribution of Patients according to koshta:

A maximum of 65% of patients comes under Madhyama koshta,where as 25% of

patients are belonging to Krura koshta and 10% are of Mrudu koshta.The details are given

below.

Table.No.28.Analysis of state of Koshta.

Koshta No.of patients. %

Krura 5 25

Madhyama 13 65

Mrudu 2 10

Figure No. 16 - Analysis of state of Koshta :

0

10

20

30

40

50

60

70

%

Koshta

KruraMadhyamaMridu

86

Observation and results

Distribution of Patients according to bala:

It was observed that 65% of the patients were of Madhyama Bala, 35% of

Avara Bala and no patients of Pravara Bala was found in this study.The details detailed

in the table 28.

Table No. 29 - Analysis of Bala of the patients:

Bala No.of patients. %

Pravara 0 0

Madhyam 13 65

Avara 7 35

Figure No. 17 - Analysis of Bala of the patient:

0

10

20

30

40

50

60

70

%

Bala

PrvaraMadhyamaAvara

87

Observation and results

Amount of shodhana achieved in 20 patients according to maniki criteria Among 20 patients 50% of patent had Pravara Suddhi, 45% madhyama suddhi, and 5% of patient had avara suddhi. Table.No.30. Maniki Criteria.

Suddhi No.of patients. %

Pravara. 1 5

Madhyama. 10 50

Avara. 9 45

Figure No.18. Maniki criteria.

The following graph shows the details about the amount of sodhana achieved

by 20 patients.

0

10

20

30

40

50

%

Mana

PravaraMadhyamaAvara

88

Observation and results

Degree of shodhana achieved in patients according to lingiki criteria.

Among the 20 patients,18 patients had Samyak vamana laxana like Hrut,

,Parshwa,Moordha,Indriya,Marga - suddhi and laghutha. The following table gives the

clear idea about Laingiki of Vamana karma.

Table.No.31. Laingiki criteria.

Linga. No.of patients. %

Samyak 18 90

Atiyoga. 2 10

Ayoga. 0 0

The Atiyoga laxana like Trushna, Balahani developed in two patients.

The following graph shows the visual picture.

Figure No.19. Laingiki criteria.

0

10

20

30

40

50

60

70

80

90

%

Linga

SamyakAtiogaAyoga

89

Observation and results

Measure of shodhana achieved according to the vegika criteria.

Among the 20 patients, 9 patients had pravara vega,11 patients had madhyama

vega and no patients had avara vega.

Table.No.32. Vegiki criteria.

Vega No of patients %

Pravara 9 45

Madhyama 11 55

Avara 0 0

The following graph represents the vegiki suddhi.

Figure No.20. Vegiki criteria.

0

10

20

30

40

50

60

%

Vega

PravaraMadhyamaAvara

90

Observation and results

Stage of shodhana achieved according to anitiki criteria.

In the present study all the 20 patients had Pittanta features. Details listed below.

Table.No.33.Assessment of Anthiki.

Anthiki No of patients %

Kapha 0 0

Pitta 20 100

The following graph shows the detailed picture regarding antiki.

Figure No.21. Assessment of Anthiki.

0

20

40

60

80

100

%

Anta

KaphaPitta

91

Observation and results

Incidence of untoward symptoms in patients subjected to vamana karma During the Vamana karma 4patients developed atisara,no other patients

had any other type of complications. Detailed descriptions are listed below.

Table.No.34.Assessment of complication during Vamana karma.

Complications No.of patients % Atisara 4 20 Other complications 0 0 No complications 16 80

The following graph shows the schematic representation of complications

during Vamana karma.s

Figure No.22.Assessment of complication during Vamana karma.

010203040

50607080

%

Complications

No compications

Atiara

Othercomplications

92

Results

93

EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS OF TAMAKA SHWASA. Effect on severity.

The severity of Tamaka shwasa which was 2.450 before the treatment

reduced to 0.0500 after the treatment. The change that occurred with the treatment is

greater than would be expected by chance; there is a statistically significant change

(P = <0.001).The following table shows the details.

Table No.35. Effect on Severity.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.450 (±0.1050)

0.0500 (±0.224)

2.400 1.046 0.234 10.258

<0.001

Table.No.36. Effect on Severity during the course of treatment

Mean score AT BT

Day 1 (S.D)

Day 2 Day3 Day7 Day14 Day21 Day30

2.450 (±0.1050)

0.1000 (±0.308)

0.150 (±0.366)

0.200 (±0.523)

0.350 (±0.745)

0.250 (±0.550)

0.0500 (±0.224)

The following figure shows the effect on Severity of tamaka shwasa during

the course of treatment

Figure.No.23. Effect on Severity during the course of treatment 0.05

0.250.35

0.20.150.1

2.45

0

0.5

1

1.5

2

2.5

3

Mea

n

D1 D2 D3 D7 D14 D21 D30

Severity

Results

Figure No.24 .Effect on Severity. 2.45

0.05

0

0.5

1

1.5

2

2.5

Severity

BTAT

Effect on Breathlessness. An assessment of Breathlessness of Tamaka shwasa before and after treatment

showed reduction in the mean score from 2.450 to 0.0500.Analysis of this data shows

statistically significant treatment.

Table No.37. Effect on Breathlessness.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.450 (±0.826)

0.0500 (±0.224)

2.400 0.821 0.184 13.077

<0.001

Table.No.38. Effect on Breathlessness during the course of treatment

Mean score AT BT

Day 1 (S.D)

Day 2 Day3 Day7 Day14 Day21 Day30

2.450 (±0.826)

0.0500 (±0.224)

0.1000 (±0.308)

0.200 (±0.523)

0.350 (±0.745)

0.250 (±0.639)

0.0500 (±0.224)

94

Results

Figure.No.25. Effect on Breathlessness during the course of treatment

The following figure shows the effect on Breathlessness of tamaka shwasa

during the course of treatment

0.050.25

0.35

0.10.05

2.45

0.2

0

0.5

1

1.5

2

2.5

3

D1 D2 D3 D7 D14 D21 D30

Mea

n

Breathlessness

Figure No.26 .Effect on Breathlessness.

2.45

0.05

0

0.5

1

1.5

2

2.5

Breathlessnss

BTAT

Effects on Speech:

Patient’s ability to speak was significantly improved after the treatment. Before

the treatment ,mean speech score was 2.250.It reduced to 0.0500

After the treatment. The change is statistically significant.

Table No.39. Effect on Speech. Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.250 (±0.851)

0.0500 (±0.224)

2.200 0.834 0.186 11.804

<0.001

95

Results

Effects on Cough:

Before the treatment the symptoms of cough was 2.450, and reduced in to 0.300

after the treatment. This change is statistically highly significant.

Table No.40. Effect on Cough.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.450 (±0.999)

0.300 (±0.571)

2.150 1.040 0.233 9.245 <0.001

Figure No.27 .Effect on Speech and Cough. 2.25

0.05

2.45

0.3

0

0.5

1

1.5

2

2.5

Speech Cough

BTAT

Effect on Sputum

The study shows marked reduction in the sputum after the treatment. Before the

treatment the mean score of sputum was 2.000,was brought down to 0.150 after the

treatment.

Table No.41. Effect on Sputum.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.000 (±0.973)

0.150 (±0.130)

1.850 1.089 0.244 7.594 <0.001

96

Results

Effect on Body position With regards to the comfortable posture of the patient during the attack, a

reduction was seen in the mean body position score from 2.050 before the treatment to

0.0500 after the treatment. Here the change that occurred with the treatment is greater

than would be expected by chance; there is a statistically significant change (P = <0.001)

Table No.42. Effect on Body position.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.050 (±0.605)

0.0500 (±0.224)

2.000 0.649 0.145 13.784

<0.001

Figure No.28 .Effect on Sputum and Body position.

2

0.15

2.05

0.05

0

0.5

1

1.5

2

2.5

Sputum Body position

BTAT

Effect on Respiratory rate

The biophysical Parameters like respiratory rate was decreased 1.500 from

2.150, which was statistically highly significant (P <0.001).

97

Results

Table No.43. Effect on Respiratory rate.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.150 (±0.366)

1.500 (±0.513)

0.650 0.587 0.131 4.951 <0.001

Effect on Expansion of chest

The expansion of chest has shown highly significant in statistical analysis. The

improvement was from 2.775 to 4.200.

Table No.44. Effect on Expansion of chest. Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.775 (±0.803)

4.200 (±1.005)

1.425 1.139 0.255 -5.596 <0.001

Figure No.29 .Effect on Respiratory rate and Expansion of chest.

2.151.5

2.775

4.2

0

1

2

3

4

5

Respiratory rate Expansion of chest

BTAT

Effect on Laboured breathing. There is marked improvement in the mean score of laboured breathing. The

mean difference observed was 1.450 after the treatment. Which was statistically highly

significant (P <0.001).

98

Results

Table No.45. Effect on Laboured breathing.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

1.700 (±0.865)

0.250 (±0.550)

1.450 0.887 0.198 7.310 <0.001

Effect on Breath sounds

The study shows marked reduction in the breathsounds.It was reduced from 1.700 to

0.250 after treatment,which was statistically highly significant (P <0.001).

Table No.46. Effect on Breath sounds.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

2.100 (±0.641)

0.0500 (±0.224)

2.050 0.605 0.135 15.158

<0.001

Figure No.30 .Effect on Laboured breathing and Breath sounds.

1.7

0.25

2.1

0.05

0

0.5

1

1.5

2

2.5

Laboured breathing Breath sounds

BTAT

99

Results

Effect on Heart rate.

An assessment of the heart rate of the patient before and after the treatment

revealed reduction in the scores from 0.250 to 0.0500.This change is statistically highly

significant.(P = 0.104)

Table No.47. Effect on Heart rate.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

0.250 (±0.550)

0.0500 (±0.224)

0.200 0.523 0.117 1.710 P=0.104

Effect on Mental status. Mental status has shown improvement by 0.250 after the treatment. The mean

mental status score initially was 0.300 which then reduced to 0.0500 after the treatment.

The change that occurred with the treatment is not great enough to exclude the possibility

that the difference is due to chance (P = 0.056)

Table No.48. Effect on Mental status.

Mean Paired ‘t’ test

B.T (S.D)

A.T (S.D)

DIFFERENCE IN MEANS

S.D. S.E.M.

‘t’ P

0.300 (±0.657)

0.0500 (±0.224)

0.250 0.550 0.123 2.032 P=0.056

Figure No.31 .Effect on Heart rate and Mental status.

0.3

0.05

0.25

0.05

0

0.05

0.1

0.15

0.2

0.25

0.3

BT AT

Heart rate Mental status

100

Results

THE SPIROMETRIC RESULTS

Marked Spiro metric value changes can be seen before the treatment and

after the treatment. All the changes shows statistically highly significant. The mean value

of FVC changes from 2.153 to 2.742 after the completion of the treatment.

Table no.49.Effect of Vamana and Shatyadi Curna on Spirometric Parameters of

assessment in patients suffering from Tamaka shwasa.

Parameters

B.T (mean & ±SEM)

A.T (mean ±SEM)

S.D

S.E

‘t’

P

FVC Forced vital

Capacity

2.153 (± 0.191)

2.742 (±0.160)

0.352 0.0787 -7.490 P=<0.001

FEV1 Forced Exp Volume in 1 sec

1.104 (±0.0878)

1.857 (±0.137)

0.426 0.0953 -7.901 P=<0.001

PEF Peak expiratory Flow

1.251 (±0.0118)

3.590 (±0.311)

1.407 0.315 -7.430 P=<0.001

Figure no-32. Effect of Vamana and Shatyadi Curna on Spirometric Parameters of

assessment in patients suffering from Tamaka shwasa.

2153 2.742

1.104

1.857

1.251

3.59

0

1

2

3

FVC FEV1 PEF

BTAT

101

Results

The mean percentage value of predicted, in which the FVC value was

66.026 before treatment and is changed to 86.430 after the completion of the treatment.

The change that occurred with the treatment statistically significant change.

Table No.50. Effect of Vamana and Shatyadi Curna over the predicted percentage

in patients suffering from Tamaka shwasa.

Parameters B.T (mean & ±SEM)

A.T (mean ±SEM)

S.D

S.E

‘t’

P

FVC Forced vital Capacity

66.025 (±4.100)

86.430 (±3.713)

13.373 2.990 -6.824 <0.001

FEV1 Forced Exp Volume in 1 sec

41.065 (±2.379)

66.030 (±2.906)

12.141 2.715 -9.196 <0.001

PEF Peak expiratory Flow

18.515 (±1.666)

53.000 (±4.139)

19.852 4.439 -7.769 <0.001

FEV1/FVC% FEV1 as % of FVC

65.650 (±3.414)

81.105 (±3.265)

17.823 3.985 -3.878 P=0.001

Figure No-33. Effect of Vamana and Shatyadi Curna over the predicted percentage

in patients suffering from Tamaka shwasa.

66.025

86.43

41.065

66.03

18.515

53

65.65

81.105

0102030405060708090

FVC FEV1 PEF FEV1/FVC

BTAT

102

Results

Table.No.51.Effect on mean FVC value during the course of treatment

FVC Mean value

AT BT Day 1 (SEM)

Day 2 Day3 Day7 Day14 Day21 Day30

2.153 (± 0.191)

2.484 (±0.161)

2.445 (±0.166)

2.737 (±0.173)

2.655 (±0.180)

2.672 (±0.183)

2.742 (±0.160)

The following figure shows FVC value during 1st day(before treatment),2nd day(on the day of vamana),3rd ,7th ,14th ,21st ,and 30th day. Figure.No.34. Effect on mean FVC value during the course of treatment 2.7422.6722.6552.737

2.4452

2.153

0

0.5

1

1.5

2

2.5

3

D1 D2 D3 D7 D14 D21 D30

Mea

n

FVC

OVER ALL EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS

OF TAMAKA SHWASA:

In the overall effect of Vamana and Shatyadi curna indicate that 60% of patient showed complete remittance of the disease,30% of patient showed moderate remission ,where as 10% of patients showed average remission, while no change is not observed in this study.

103

Results

Table no-52. Over all effect:

Effect. No. of patients. %

Complete remission 12 60

Moderate remission 6 30

Average remission 2 10

No remission 0 0

Figure No.35.Over all effect.

60

30

10

0

0

10

20

30

40

50

60

Com remimod remiave remno rem

104

Discussion

DISCUSSION

Introduction:

Tamaka shwasa,a pranavaha srotovikara is such a disease which effects an

individual due to Atma Asatmya. Altered food habits, environmental pollutions etc are

the prime causative factors of this dreadful disease, which has its impact especially

during night hours and is episodic in nature, which is known by the name Bronchial

asthma in modern parlance.

Bronchial Asthma characterized by increased responsiveness of trachea and

bronchi to various stimuli and manifested by acute recurrent or chronic attack of

widespread bronchi- bronchiolar narrowing, variable in severity and usually of brief

duration.

As stated by W.H.O, 100-150 million of global population is suffering from

Bronchial asthma, out of which 1/10th of Indian population and the prevalence of Asthma

is increasing everywhere. It occurs at all ages but predominantly in the early life. About

one-half of cases develop before age 40 and another third occurs after the age 40.In

childhood there is a 2:1 male female preponderance but the sex ratio equalizes by age 30.

The indulgence of etiological factors leads to the morbidity of Vata Dosa and

Kapha Dosa. These morbid Dosa stemming out from the Pittasthana afflict the Rasa

Dhatu involving the Pranavaha Srotas, Udakavaha Srotas as well as Annavaha Srotas.

Within the Pranavaha Srotas the morbid Dosa cause stiffness of the channels impeding

the free passage of Prana Vayu. Further the abnormal accumulation of the Sleshma in the

Pranavahasrotas also adds to the obstruction. The combined effect of these pathological

events is obstruction to the Pranavayu manifesting as Pranavilomata. Difficulty in

breathing with paroxysmal productive cough with typical exacerbations and remissions

are the predominant clinical manifestations of Tamaka Svasa which occur in episodes.

In patients suffering from tamaka shwasa, who are physically strong, the shodhana

chikitsa forms the first line of treatment as it helps in clearing the obstruction of

pranavaha srotas by kapha dosa. Patient who is in vegavastha should be first subjected to

Lavana taila abhyanga followed by Nadi, Sankara or Prasthara sweda on the chest and

106

Discussion

back. .By these procedures kapha which has become stagnated and inspissated in the

srotas, get softened and liqueied, which then is easily expelled out by the procedure of

vamana karma.After vamana karma the small amount of kapha dosa which is still present

in the srotas is then cleared by the administration of Doomapana.

Clinical trials in regards to the efficacy of shodhana in tamaka

shwasa in different Ayurvedic research centers in and around India can just be numbered.

Further the assessment criteria in these works were limited to subjective and objective

criteria with out involving the spirometric evaluation of the system. There are 100’s of

medicines mentioned in the classics for the treatment Tamaka shwasa and are claimed to

be effective. Very few of such herbal or hebomineral combinations are proved by the

method of Randomized Clinical Trail. Hence there is a dire requirement of exploring the

efficacy of remaining herbo/herbo-mineral compounds. Keeping these factors in view

the present study is planned to know the therapeutic effect of `Vamana’ and shamana

with `Shatyadi Curna’.

The description regarding Tamaka shwasa is not found in prevedic or Vedic

period. In Vedas there is plenty of reference available regarding the physiological aspect

as well as pathological aspect of Pranavaha srotas. The word Shwasa is used in the first

time in Upanishad. Later in Samhitha period onwards there is abundant information

available regarding the disease Tamaka shwasa. The Vamana Karma is explained in

detail in all the samhithas.

The etiological factors either in the form of the faulty dietetic habits, behavioral errors, or

due to the insult by the environmental factors causing morbidity of kapha and vata dosa,

or disturbing the functioning of pranavaha srotas leads to the establishment of the

lingering disease tamaka shwasa.

In most cases the inherent constitution predisposes the allergy proneness.

That is, there is usually a correspondence between a person’s constitution and the

tendency of a particular system to develop hypersensitivity. Hypersensitivity refers to

pathologic processes that result from immunologically specific interactions between

107

Discussion

antigens (exogenous or endogenous) and humoral antibodies or sensitized lymphocytes.

This concept of hypersensitivity is described as atma asatmya in Ayurveda

Patient suffering from Tamakshwasa exhibits following symptoms and signs.

• Patient cannot breath properly, breaths with great difficulty ,tries to loosen

clothings at neck chest and waist, gets increased perspiration.

• There is typical whistling sound (sound of pigeon – Kapotkujanavat dhwani)

while breathing.

• Patient feels better and less trouble in breathing while in a sitting posture.

• There exists great difficulty in breathing in lying down position.

• Patient feels better with hot articles (hot water for drinking, oil massage of luke

warm oil to chest and then there after fomentation with hot water bag).

The fundamental treatment method of Samsodhana, Samsamana and

Nidana parivarjana mentioned in Ayurvedic classics, if administered judiciously, the

desired results can be achieved. In the present context, the re-validation of ancient

Ayurvedic or traditional compound preparations which can optimize the functions of

respiratory tract by reversing the inflammatory responses and imparting the Balam

of the system is important. The results of such preparations can be expected better

in combination with appropriate sodhana therapy.

The principles of treatment that are adapted in Tamaka Svasa include Sodhana,

Samana, Brumhana and Rasayana chikitsa. Observing the treatment modality explained

by Acharya for Tamaka shwasa we can interpret them as measures during the vegavastha

and during Avegavastha. By considering the atyayika avastha of disease one can plan the

treatment. Liquefaction of the Sleshma, expectoration of the sputum and Srotomardava

chikitsa forms the key treatment during the attack of the illness. This is achieved by

Lavana taila abhyanga and Nadisweda to the chest and back, Kapha utklesana Ahara, and

then Vamana which then followed by Dhumapana and Shamana treatment.

Samsodhana measures comprehend their own vital role in the management of

Tamaka shwasa amplifying the role of Doshapratyanika Chikitsa. Vamana is the popular

therapy adopted when kapha laxanas are dominant, keeping in mind the roga and the

rogibala. Vamana karma is very helpful to bring down the gurutwa and to relieve kapha

108

Discussion

which is occluding the pranavaha srotas. In between the attacks the treatment is planned

to prevent the further attacks, to eliminate the Kha-vaigunyata, and to improve the

immunity of the Pranavaha srotas. This is achieved by Virecana karma, Brmhana cikitsa

and Rasayana cikitsa.

Vata and Kapha dosha are the major pathological entity in the manifestation of

Tamaka shwasa. The Vata dosha attains Tiryak gati and produces the features like

shwasakrichrata,shwasochwasa,parshwasoola etc.The vitiated Kapha dosha produces

obstruction in the pranavaha srotas and produces Gurguratha sound. Here the

management should be directed towards Vata and Kapha dosha. The formulations like

Shatyadi curna contains Shati, Bargi, Vacha, Vyosha, Pathya, Ruchaka

lavana,Katphala,Tejovati,Pushkaramoola and Shringi, some of the very frequently used

drugs in Shwasa. Further more what is very important is that the efficacy of these drugs

in Tamaka shwasa, individually also has a research back-up. Obviously there is a

definite scope to speculate that a formulation constituting all the above twelve drugs must

find a rightful place in the management of Tamaka shwasa.

Hence the present study on this background was taken up to evaluate the

efficiency of Vamana and Shatyadi curna in patients of Tamaka shwasa.

Plan of the Study:

This is a single blind pretest posttest design ,clinical study .20 patients

between the age group 16 to 60 years suffering from Tamaka shwasa were taken for the

study from OPD and IPD of SDM college of Ayurveda Hospital,Udupi. The signs and

symptoms of Tamaka shwasa and Spiro metric parameters were mainly considered for

the diagnosis. As a routine, Hematological investigations were carried out in all the

patients taken for the study. The selected 20 patients were treated with Vamana in the

form of shodhana and shatyadi curna 5 gms tid with 10 ml of honey as shamana for the

period of one month.

109

Discussion

General description of Patients:

Age: 1 The present study includes the patients belonged to the age group of 16 to

60 years excluding children, and therefore it does not reflex the high incidence of this

disease in children. The present study includes maximum number of patients in the age

group of 26 to 30 years. The probable cause for increased incidence in this age group

may be because of high exposure towards the changing external environment & mental

factors which is related to their profession. Sex: The illness does not show any predilection for sex, in the present sample

taken for the study 75 % of the patients were females. This only indicates a sampling

variation due to the small size of the sample.

Marital status: 65 % of the patients recorded in this study were married. Once again

it is known that marriage has no relation with the causation or predisposition to the illness

Tamaka Shwasa. It may be possible that the responsibility of running family was one of

the causes for patients which may cause more stress, irregularity of diet & mithya vihara

sevana.

Religion: 85% of the patients in this sample were Hindus. The predominance of

Hindu caste in and around Udupi is reflected in this sample. The high incidence of illness

in Hindus in this study cannot predict anything because it is the demographic area which

plays major role in it.

Habitat incidence: Though the illness is most common in urban dwellers, the

present study shows higher incidence about 95% in rural people. This only reflects

predominance of rural population in and around Udupi.

Socio economic status: 55%of patients belonged to low class and another 45% of

middle class. About socio-economic status of patients, maximum numbers of patients

were of lower middle class. Inadequate health care and polluted environment may be

contributory in the causation of illness.

Occupation: Many of the patients were engaged beedi works and have risk of exposure

to dust, which is known to produce asthmatic type of symptoms. This shows the relation

between dust and Tamaka shwasa.

110

Discussion

Addiction of the patients: Though the smoking has incriminatory effect on the

respiratory system, badly affecting its defense mechanism, only 5% of patients registered

in the study, showed addiction to cigarette or beedi smoking. Since this addiction is

common in males and the sample taken for the study showed predominance of females,

so the incidence of smoking was low in the study.

Dietary habits: 85% of the patients registered in this study had mixed dietary habit.

Vegetarian, non vegetarian or mixed dietary habit has no role in predisposing the illness

Tamaka Shwasa. Even though maximum number of patients showed mixed diet, this

preponderance is only reflective of dietary habit of the population and the present sample

is the representative of this population

Deha prakruthi: Vata Pitta Prakriti was observed in a maximum of 70% of the patients.

20 % of the patients showed Vata Kapha Prakriti and10% of Pitta Kapha Prakruthi. None

of the patients showed Sama Prakriti in this study

Sara,Samhanana: All the patients were belongings to madhyama sara, 95 % of the

patients had Madhyama samhanana. In persistent cases the disease causes dhatu kshaya.

Probably the co-relation between disease & influencing of these factors cannot be proved

scientifically.

Satva,Satmya: Madhyama satva was observed in 80% of patients, prepondarence of

madhyama satva with incidence in 90% of patients was observed. Physical and emotional

stress is known precipitating factors for causation of the disease.

Agni: Analysis of the Agni in 20 patients suffering from Tamaka Svasa revealed that

70% of the patients had Samagni. Though the Pittasthana is involved in the pathogenesis

of Tamaka Svasa the state of Agni does reflect the same to a larger extent in this Study.

Koshta: In the present study the sample showed that 65% of patients had

madhyama koshta, 25% and 10% of patients were belonging to krura and mrudu koshta

respectively.

Shareera pramana,Vyayama shakthi: 65% of patient had madhyama pramana and

vyayama shakthi,35% of patients belongings to avara variety. Probably, it may be due to

111

Discussion

nature of the disease, as paroxysmal attacks in this disease person unable to do heavy

works. Patient always feels better in sitting position.

Therapeutic effect of medications:

By adapting standard methods, the subjective symptoms and objective signs are

scored. Patients were assessed before and after the treatment to know the favorable

response. Computerized Spiro meter was used to assess the lung functions.

Effect on severity:

Reduction in the severity of the illness was recorded in all the patients treated

with Vamana and Shatyadi Curna. Improvement shows statistically highly significant

(P<0.001). The different in mean was 2.400 after the completion of the research work.

Effect on Breathlessness:

The symptom Breathlessness was reduced from 2.450 to 0.0500 .Difference in

means after the treatment was 2.400.So this study shows reduction in the obstruction to

the passage of Pranavayu, results in reduction in Prana vilomata. The result shows

statistically highly significant (P<0.001).

Effect on Speech:

An assessment of the speech showed good improvement in the symptom. The

difference in mean score of speech was 2.250 to 0.500. More to say, ability to speak

continuously in a sentence depends upon the ventilation capacities. As the ventilation

capacity reduces, the speech will be reduced to single words. In the present study as

speech shows an improvement, it implies that ventilation capacities have increased

following treatment. This is only possible by the removal of obstruction in the Pranavaha

Srotas. Improvement shows statistically highly significant (P<0.001).

Effect on Cough:

Marked remission in severity of cough was observed in patients treated with

Vamana and Shatyadi curna the mean difference was 2.150 after the treatment. Cough is

a defense mechanism of the Pranavaha srotas. The presence of which is indicative of

irritating Sleshma in the Srotas. The medicines administered when expels this sputum or

112

Discussion

reduces production of the sputum in the Srotas then only the remission of the cough is

possible. In the above patients the reduction in the cough implies its tenacious sputum is

liquefied by the medicine and its expectoration is easy. The medication is also effective

in reducing the production of sputum in the Pranavaha srotas.

Effect on Sputum:

The amount of sputum reduced in patients treated with Vamana and Shatyadi

curna. The mean score was 2.000 and is reduced to 0.150.The reduction in the amount of

sputum is indicative of reduced secretion of Sleshma in the Pranavaha srotas.

Effect on Body position:

There was marked improvement in the body position from 2.050 to 0.0500. The

difference in mean recorded was 2.000. Improvement shows statistically highly

significant (P<0.001).The body position is indicative of severity of the illness. In severe

attacks of Tamaka Shwasa the patient will not be able to lie down. The improvement seen

indicates reduction in the airway obstruction as well as improved ventilation.

Effect on Respiratory Rate:

Best favorable response was observed in the respiratory rate of the patients during

the attack of breathlessness. Difference in mean score of rate of respiration was 0.650.

Rate of respiration is directly proportional to the severity of the illness. Reduction in the

rate of respiration indicates improvement. Thus the reduced respiratory rate suggests

remission of the severity of Tamaka Shwasa. Statistical analysis shows these change is

not by chance (P< 0.001).

Effect on Expansion of chest:

The mean score of expansion of the chest increased by 1.425.Improvement in

the ventilatory function of the respiratory system is the root cause for increase in the

expansion of the chest.

Effect on Labored breathing:

The ability to breath showed marked improvement in this study. The mean score

of labored breathing has reduced by 0.250 from the initial score of 1.700 before the

treatment. This shows correction of Pranavilomata.

113

Discussion

Effect on Breath sounds:

The mean score of severity of breath sounds have shown reduction in the

symptoms of Tamaka shwasa. The effect of Vamana and Shatyadi curna has therapeutic

effects like Sroto -mardavata, Kapha vilayana and Kapha nissaraka. These therapeutic

effects reduce the airway resistance. This in turn is reflected in the form of reduced added

sounds during respiration. The study shows statistically highly significant (P<0.001).

Effect on Heart rate:

The heart rate has shown a definite reduction after the treatment. The change that

occurred with the treatment is not great enough to exclude the possibility that the

difference is due to chance (P = 0.104).Heart rate is directly proportional to the severity

of the Tamaka Shwasa.

Effect on Mental state:

There was improvement in the mental status of the patients after the treatment.

The study shows improvement in the score from 0.300 before treatment to 0.0500 after

the treatment. The change that occurred with the treatment is not great enough to exclude

the possibility that the difference is due to chance (P = 0.056).

Spirometric evaluation:

The Spirometric parameters like FVC, FEV1, PEF, and FEV1/FVC were assessed

before and after the treatment. The result sowed that there was an increase in the lung

volumes following the treatment with Vamana and Shatyadi curna. The absolute value of

the FVC which was 2.153 before the treatment, which was raised to 2.742 following the

medication. This improvement shows statistically highly significant (P=<0.001). An

increase in the percentage prediction of the lung volumes was seen in patient treated with

Vamana and Shatyadi curna. The percentage prediction of FVC was 66.025 before

treatment that rose to 86.430 after the treatment.

The FEV1 showed marked improvement in the absolute value from1.104 to

1.857.The percentage prediction of this was 41.065 before the treatment and which

114

Discussion

elevated to 66.030 following Vamana and Shatyadi curna. All the spirometric values that

showed increase following medication was also found to be statistically significant as

assessed by paired t- test (P<0.001).

The PEF value shows marked improvement after the completion of the

treatment. The initial score was 1.251 and is increased in to 3.590 after the treatment. The

percentage value of this was 18.515 before the treatment and was increased markedly to

53.000.

The Spirometric value of FEV1/FVC% also showed significant improvement.

The initial percentage was 65.650 and is improved in to 81.105 after the treatment. The

change that occurred with the treatment is greater than would be expected by chance;

there is a statistically significant change (P = 0.001)

These improvements shows the reduction of airway resistance corroborating

the results observed in the signs and symptoms of Tamaka Shwasa.

In the overall effect of Vamana and Shatyadi curna indicate that 60% of

patient showed complete remittance of the disease, 30% of patient showed moderate

remission, where as 10% of patients showed average remission, while no change was not

observed in this study.

The treatment was given in the patients for duration of one month. None of

the patients developed any untoward symptoms or any side effects during the course of

the treatment and therefore these medicines in therapeutic dosage are very safe.

In the above said observation indicate that patient have shown improvement in

all the criteria of assessment of Tamaka shwasa. Stiffness of the Pranavaha Srotas,

accumulation of Sleshma leading to Prana vilomata is the basis of pathology of Tamaka

Shwasa. The therapeutic effects like Srotomardava, Kaphavilayana, Kaphanissarana

Kasaghna etc clears the air passage and also widened them. The medicine administered in

the present study have shown all these therapeutic effects and in that sense,this will be a

good suggestive treatment of Tamaka shwasa. The spirometric evaluation of the lung

volumes also showed in both absolute value as well as predicted values confirming the

rectification of Prana vilomata.

115

Discussion

After thorough analysis, it may be concluded that Vamana is effective in the

acute management of Tamaka Shvasa when Dosha is in Utklishtha stage and it can be

adopted any time when the patient needs. Thus it is one of the ideal Panchakarma

procedure in the management of acute attack of Bronchial Asthma. The Kapha Vatahara

drug used in the present study shows marvelous effect on Tamaka shwasa. In the overall

assessment it was seen that 60% of patients had complete relief, 30% patients had

moderate relief and 10% of patients had average relief. If one follows Rasayana therapy

after this, surely there will be complete remission of the illness.

It is very clear from the above discussion that the present study has a definite

role in the management of recurrent episodes of Tamaka Shwasa. The efficacy and safety

profile of the study drug was excellent in curing the symptoms of Tamaka Shwasa.

116

Conclusion

Conclusions

1. Vamana karma followed by the oral administration of Shatyadi curna is very

effective in reducing the severity of tamaka shwasa. The severity of Tamaka

shwasa which was 2.450 before the treatment reduced to 0.0500 after the

treatment. The improvement after the treatment is proved to be statistically highly

significant.

2. In the treated patients the assessment of symptoms before and after the treatment

that included breathlessness, cough, sputum, breath sounds, labored breathing

ability of the patient to speak, body position, rate of respiration all showed

definite reduction in severity. Also the improvement following the treatment

proved to be statistically highly significant.

3. Reduction in the obstruction of the pranavaha srotas is indicated by the

improvement in the chest expansion in treated patients. The improvement found

to be statistically highly significant.

4. Incriminatory effect of the illness on the pranavaha srotas mula ie hridaya is

indicated by the heart rate. Heart rate returning to normal following the treatment

proves the clearance of hrdaya upasosana effect of the illness.

5. Puraka Kumbhaka Recaka aspect of the pranavayu unravels its functional status.

The same is being expressed by the different lung volumes like FVC FEV1,

FEV1/FVC % PEF and is assessed by the spirometry. The marked improvement

in the lung volumes following the treatment reflects improvement in the

functional status of pranavayu. Or else to say the clearance of obstruction in the

pranavaha srotas achieved by the treatment rendered free movement of pranavayu

with in the pranavaha srotas.

6. The patients have shown improvement in all the criteria of assessment of tamaka

shwasa. In case of tamaka shwasa, the medicines administered should have the

therapeutic effects like Srotomardavakarana, Kaphaharana, Kaphavilayana,

Kaphanissarana and Kasaghna. These therapeutic effects clear the air passages

and also widen them. The ultimate effect will be reduction in the airway

117

Conclusion

resistance - the basic pathology of the tamaka shwasa. The medicines

administered have shown all these therapeutic effects and the severity of the

illness therefore has markedly reduced. In that sense, this will be a complete

treatment of tamaka shwasa.

7. The total regimen of 30 days is definitely effective in combating the illness and

also equally safe.

118

Summary

SUMMARY Tamaka shwasa,a pranavaha srotovikara is such a disease which effects an

individual due to Atma Asatmya. Altered food habits, environmental pollutions etc are

the prime causative factors of this dreadful disease, which has its impact especially

during night hours and is episodic in nature, which is known by the name Bronchial

asthma in modern parlance.

As stated by W.H.O, 100-150 million of global population is suffering

from Bronchial asthma, out of which 1/10th of Indian population and the prevalence of

Asthma is increasing everywhere. It occurs at all ages but predominantly in the early life.

About one-half of cases develop before age 40 and another third occurs after the age

40.In childhood there is a 2:1 male female preponderance but the sex ratio equalizes by

age 30.

In patients suffering from tamaka shwasa, who are physically strong, the

shodhana chikitsa forms the first line of treatment as it helps in clearing the obstruction of

pranavaha srotas by kapha dosa. Patient who is in vegavastha should be first subjected to

Lavana taila abhyanga followed by Nadi, Sankara or Prasthara sweda on the chest and

back. .By these procedures kapha which has become stagnated and inspissated in the

srotas, get softened and liqueied, which then is easily expelled out by the procedure of

vamana karma.After vamana karma the small amount of kapha dosa which is still present

in the srotas is then cleared by the administration of Doomapana.

Clinical trials in regards to the efficacy of shodhana in tamaka shwasa in

different Ayurvedic research centers in and around India can just be numbered. Further

the assessment criteria in these works were limited to subjective and objective criteria

with out involving the spirometric evaluation of the system. There are 100’s of medicines

mentioned in the classics for the treatment Tamaka shwasa and are claimed to be

effective. Very few of such herbal or hebomineral combinations are proved by the

method of Randomized Clinical Trail. Hence there is a dire requirement of exploring the

efficacy of remaining herbo/herbo-mineral compounds.

119

Summary

Keeping these factors in view the present study is planned to know the

therapeutic effect of `Vamana’ and shamana with `Shatyadi Curna’.

This is a single blind pretest posttest design ,clinical study .20 patients

between the age group 16 to 60 years suffering from Tamaka shwasa were taken for the

study from OPD and IPD of SDM college of Ayurveda Hospital,Udupi. The signs and

symptoms of Tamaka shwasa and Spiro metric parameters were mainly considered for

the diagnosis. As a routine, Hematological investigations were carried out in all the

patients taken for the study. The selected 20 patients were treated with Vamana in the

form of shodhana and shatyadi curna 5 gms tid with 10 ml of honey as shamana for the

period of one month.

Obervation and Results:

The present study includes maximum number of patients in the age group of

26 to 30 years, the sample includes 75 % of females patients, 65 % of the patients were

married, 85% of the patients were Hindus, about 95% patients from rural area, 55%of

patients belonged to low class, many of the patients were engaged beedi works, only 5%

of patients showed addiction to cigarette or beedi smoking., 85% of the patients had

mixed dietary habit.

Vata Pitta Prakriti, madhyama sara, madhyama samhanana, madhyama satva

was observed in a maximum no.of the patients. Most of the patients had Samagni, and

madhyama koshta. The pramana and vyayama shakthi was also madhyama in maximum

no.of patients.

Reduction in the severity of the illness was recorded in all the patients

treated with Vamana and Shatyadi Curna. Improvement shows statistically highly

significant

The symptom Breathlessness was also reduced This shows reduction in the

obstruction to the passage of Pranavayu, results in reduction in Prana vilomata.

120

Summary

There was significant improvement seen in other Spiro metric parameters

These improvements shows the reduction of airway resistance corroborating the results

observed in the signs and symptoms of Tamaka Shwasa.

In the overall effect of Vamana and Shatyadi curna indicate that 60% of

patient showed complete remittance of the disease, 30% of patient showed moderate

remission, where as 10% of patients showed average remission, while no change was not

observed in this study.

The treatment was given in the patients for duration of one month. None of

the patients developed any untoward symptoms or any side effects during the course

of the treatment and therefore these medicines in therapeutic dosage are very safe.

Vamana is effective in the acute management of Tamaka Shvasa when

Dosha is in Utklishtha stage and it can be adopted any time when the patient needs.

Thus it is one of the ideal Panchakarma procedure in the management of acute attack

of Bronchial Asthma. The Kapha Vatahara drug used in the present study shows

marvelous effect on Tamaka shwasa. In the overall assessment it was seen that 60%

of patients had complete relief, 30% patients had moderate relief and 10% of patients

had average relief. If one follows Rasayana therapy after this, surely there will be

complete remission of the illness.

.

121

Bibilography

BIBLIOGRAPHY

1. Tripathi.B.N et al; Clinical evaluation of a compound drug Shatyadicurna in the

treatment of Bronchial asthma (unpublished Doctoral dissertation,Banarus Hindu

University,Varanasi,1979).

2. Prasanna kumar G.U et al ;Clinical evaluation of Therapeutic regimen in the

treatment of Tamaka shwasa (Bronchial asthma) with special reference to

Vamana Karma(unpublished Doctoral dissertation,Banarus Hindu

University,Varanasi,1994).

3. Prasanna.N.Mogasale et al; A Clinical study evaluating the effect of Manashiladi

Dhooma in Tamaka Swasa. (Unpublished Doctoral dissertation,Rajiv Gandhi

University of Health Science,Karnataka,2000).

4. Pandurang et al; A comparative study on the effect of Vamana and Kunjala Kriya

in Tamaka Shwasa (unpublished Doctoral dissertation, Rajiv Gandhi University

of Health Science,Karnataka,2001).

5. Jaram singh et al ;Comprehensive study of Katphala(Myrica esculenta Buch-

Ham).w.r.t Tamaka Shwasa.Katphala in Tamaka shwasa (unpublished Doctoral

dissertation,Gujarat Ayurved University,Jamnagar- 2001).

6. Anil kumar Rai.D et al ;Evaluation of therapeutic effects of Chitrakadi Avalehya

in patients of Tamaka Shwasa – A Clinical study (unpublished Doctoral

dissertation, Rajiv Gandhi University of Health Science,Karnataka 2001-2002).

7. Usharani et al ;Pharmacological and comparative clinical study of Pippali and

Vardhamana Pippali in the management of Tamaka Shwasa(unpublished Doctoral

dissertation, Rajiv Gandhi University of Health Science,Karnataka – 2003)

122

Bibilography

8. R. Murulidhar et al; A comparative pharmaceutico-pharmco clinical study of

different samples of Shirisharishta and its Shwasahara effect. (unpublished

Doctoral dissertation,Gujarat Ayurved University,Jamnagar- 2004s).

9. Vinayachandra Shetty.B et al ; Aja-Asthi Bhasma nirmana and its therapeutic

effect on Tamaka Shwasa (unpublished Doctoral dissertation, Rajiv Gandhi

University of Health Science,Karnataka – 2004)

10. Pradeep et al ;Clinical study evaluating the effect of Haridra doomapana and

samana cikitsa in the management of Tamaka svasa (unpublished Doctoral

dissertation, Rajiv Gandhi University of Health Science,Karnataka – 2004)

11. Sunil. S. Jain et al ;Preparation of Talasindoora Rasa and its clinical study in

Tamaka shwasa (unpublished Doctoral dissertation, Rajiv Gandhi University of

Health Science,Karnataka – 2005)

12. Achintya Kumar Deb et al A study on the effect of kala in Sadyo Vamana with

special reference to Tamaka shvasa -Bronchial Asthma(unpublished Doctoral

dissertation, Rajiv Gandhi University of Health Science,Karnataka – 2005)

13. Prof R H Singh; Vamana Karma in patients suffering from TAMAKA

SHWASA. Banarus Hindu University (Panchakarma therapy book by

Prof.R.H.Singh).

14. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.533

15. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.533

123

Bibilography

16. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Vimana sthana

5th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.250.

17. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Vimana sthana

5th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.250.

18. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

Acharya, Uttaratantra 51st chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.761

19. Vridha Vagbhata, Ashtanga samgraha, Shashilekha commentary of Indu, edited by

Dr.D.V. Pandithrav and Vaidya Ayodya Pandey, 1st volume Nidana sthana 4th chapter,

edited on 1991, Central council for Research in Ayurveda and Siddha,

Newdelhi,Pp.659, Page no.580.

20. Vagbhata, Ashtanga Hrudaya, Sarvanga Sundari commentary of Arunadatta and

Ayurveda Rasayana commentary of Hemadri, edited by Bhisayacharya Harisastri

Paradkar Vaidya, Nidan sthana, 4th chapter, reprinted on 2000, Krishnadas Achademy,

Varanasi, Pp.956, Page no.472

21. Vagbhata, Ashtanga Hrudaya, Sarvanga Sundari commentary of Arunadatta and

Ayurveda Rasayana commentary of Hemadri, edited by Bhisayacharya Harisastri

Paradkar Vaidya, Nidan sthana, 4th chapter, reprinted on 2000, Krishnadas Achademy,

Varanasi, Pp.956, Page no.472

22. Vridha Vagbhata, Ashtanga samgraha, Shashilekha commentary of Indu, edited by

Dr.D.V. Pandithrav and Vaidya Ayodya Pandey, 1st volume Nidana sthana 4th chapter,

edited on 1991, Central council for Research in Ayurveda and Siddha,

Newdelhi,Pp.659, Page no.580.

124

Bibilography

23. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535

24. Yoga Ratnakara, edited by Dr. Indradev Tripathi and Dr. Daya Shankar Tripathi,

shwasa rogadhyaya, first edition 1998, Krishnadas Achademy, Varanasi, Pp.894, Page

no.342

25. Rasa Ratna samuchchaya of Vagbhatacharya by Dr.Indra deva Tripathi edited by

Dr.Kapil Deo Gin,1st edition 1998,Chaukamba Sanskrit Bhavan,Varanasi,Pp- 418,Page

no.153.

26. Shabdakalpadruma edited by srivaradhaprasadavasuna and sriharicharanavasuna,5th

part,Nag publishers,Delhi,Pp- 555,Page no.179.

27. Sir monier Williams,A Sanskrit - English Dictionary,Delhi,Motilal banarusidas,1st

edition,1999,Pp – 1333,Page no.1105.

28. Acharya Madhavakara,Madhava nidanam with madhukosha Sanskrit commentary by

Acharya Vijaya Rakshit and Shrikanta Datt,Edited by Dr.Ravidatt Tripady,1st Volume

12th chapter,1st Edition – 1993 published by Varanaseya Sanskrit sansthan.Pp-597,Page

no.363.

29. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

Acharya, Uttaratantra 51st chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.761

30. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

125

Bibilography

Acharya, Uttaratantra 51st chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.762

31. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.533

32. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

Acharya, Uttaratantra 50st chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.758.

33. Vagbhata, Ashtanga Hrudaya, Sarvanga Sundari commentary of Arunadatta and

Ayurveda Rasayana commentary of Hemadri, edited by Bhisayacharya Harisastri

Paradkar Vaidya, Nidan sthana, 4th chapter, reprinted on 2000, Krishnadas Achademy,

Varanasi, Pp.956, Page no.472

34. Vridha Vagbhata, Ashtanga samgraha, Shashilekha commentary of Indu, edited by

Dr.D.V. Pandithrav and Vaidya Ayodya Pandey, 1st volume Nidana sthana 4th chapter,

edited on 1991, Central council for Research in Ayurveda and Siddha,

Newdelhi,Pp.659, Page no.580.

35. Acharya Madhavakara,Madhava nidanam with madhukosha Sanskrit commentary by

Acharya Vijaya Rakshit and Shrikanta Datt,Edited by Dr.Ravidatt Tripady,1st Volume

12th chapter,1st Edition – 1993 published by Varanaseya Sanskrit sansthan.Pp-597,Page

no.355.

36. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535.

126

Bibilography

37. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

Acharya, Sutrasthana 45th chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.198.

38. Vagbhata, Ashtanga Hrudaya, Sarvanga Sundari commentary of Arunadatta and

Ayurveda Rasayana commentary of Hemadri, edited by Bhisayacharya Harisastri

Paradkar Vaidya, Nidan sthana, 4th chapter, reprinted on 2000, Krishnadas Achademy,

Varanasi, Pp.956, Page no.473.

39. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

Acharya, Sutrasthana 45th chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.198.

40. Vridha Vagbhata, Ashtanga samgraha, Shashilekha commentary of Indu, edited by

Dr.D.V. Pandithrav and Vaidya Ayodya Pandey, 1st volume Sutra sthana 12th chapter,

edited on 1991, Central council for Research in Ayurveda and Siddha,

Newdelhi,Pp.659, Page no.192.

41. Vridha Vagbhata, Ashtanga samgraha, Shashilekha commentary of Indu, edited by

Dr.D.V. Pandithrav and Vaidya Ayodya Pandey, 1st volume Sutra sthana 10th chapter,

edited on 1991, Central council for Research in Ayurveda and Siddha,

Newdelhi,Pp.659, Page no.161.

42. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Vimana sthana

1st chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.237.

127

Bibilography

43. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Vimana sthana

3rd chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.240.

44. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.533.

45. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535.

46. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535.

47. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.533

48. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.533

49. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535.

50. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535.

128

Bibilography

51. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535.

52. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.533

53. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

Acharya, Uttaratantra 51st chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.761.

54. Vagbhata, Ashtanga Hrudaya, Sarvanga Sundari commentary of Arunadatta and

Ayurveda Rasayana commentary of Hemadri, edited by Bhisayacharya Harisastri

Paradkar Vaidya, Nidan sthana, 4th chapter, reprinted on 2000, Krishnadas Achademy,

Varanasi, Pp.956, Page no.472.

55. Acharya Madhavakara,Madhava nidanam with madhukosha Sanskrit commentary by

Acharya Vijaya Rakshit and Shrikanta Datt,Edited by Dr.Ravidatt Tripady,1st Volume

12th chapter,1st Edition – 1993 published by Varanaseya Sanskrit sansthan.Pp-597,Page

no.363.

56. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Vimana sthana

5th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.250.

57. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535

129

Bibilography

58. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

Acharya, Uttaratantra 51st chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.762

59. Vridha Vagbhata, Ashtanga samgraha, Shashilekha commentary of Indu, edited by

Dr.D.V. Pandithrav and Vaidya Ayodya Pandey, 1st volume Nidana sthana 4th chapter,

edited on 1991, Central council for Research in Ayurveda and Siddha,

Newdelhi,Pp.659, Page no.581.

60. Vagbhata, Ashtanga Hrudaya, Sarvanga Sundari commentary of Arunadatta and

Ayurveda Rasayana commentary of Hemadri, edited by Bhisayacharya Harisastri

Paradkar Vaidya, Nidan sthana, 4th chapter, reprinted on 2000, Krishnadas Achademy,

Varanasi, Pp.956, Page no.473.

61. Harrison`s principles of Internal Medicicine;Volume 2,edited by

Casper,Braunwald,Fauci,Hauser,Longo,Jameson,16th edition,2005,Pp – 2603,Page no-

1508.

62. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535

63. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Sutra sthana 10th

chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.66

64. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.536

130

Bibilography

65. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Vimana sthana

4th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.249.

66. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

18th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.540

67. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

8th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.461.

68. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.535

69. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Nidana sthana

5th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.219.

70. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.536.

71. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Sutra sthana 13th

chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.87.

72. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Sutra sthana 13th

chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.82.

131

Bibilography

73. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.536.

74. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.536.

75. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Sutra sthana 25th

chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.133.

76. Agnivesha, Charaka samhitha, revised by Charaka and Dridabala with Ayurveda dipika

commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Chikitsa sthana

17th chapter, 5th edition-2001, Chaukambha Sanskrit sansthan, Pp.738, Page no.537

77. .Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and

Nyayachandrika Panchika commentary of Gayadasa, edited by Yadavji Trikamji

Acharya, Uttaratantra 51st chapter, reprint 1998 edition, Krishnadas Achademy,

Varanasi, Pp.824, Page no.764.

78. Vagbhata, Ashtanga Hrudaya, Sarvanga Sundari commentary of Arunadatta and

Ayurveda Rasayana commentary of Hemadri, edited by Bhisayacharya Harisastri

Paradkar Vaidya, Chikitsa sthana, 4th chapter, reprinted on 2000, Krishnadas

Achademy, Varanasi, Pp.956, Page no.605.

79. Yoga Ratnakara, edited by Dr. Indradev Tripathi and Dr. Daya Shankar Tripathi,

shwasa rogadhyaya, first edition 1998, Krishnadas Achademy, Varanasi, Pp.894, Page

no.346.

132

Bibilography

80. Baishajya Ratnavali,edited by Shri.Rajeshwara data Shastry,17th edition –

2002,Chaukamba Samskrit Samsthana,Varanasi,Pp.891,Page no.339.

81. Yoga Ratnakara, edited by Dr. Indradev Tripathi and Dr. Daya Shankar Tripathi,

shwasa rogadhyaya, first edition 1998, Krishnadas Achademy, Varanasi, Pp.894, Page

no.344.

133

Proforma

S.D.M AYURVEDA HOSPITAL, KUTHPADY, UDUPI

A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS OF TAMAKA SHWASA

Name: Social Status: L/M/U Age: Serial No: Sex: OPD/IPD No: Place of Birth: U/R Bed No: Date of Birth: DOA: Marital Status: M/UM/W/D DOD: Place: U/R Diagnosis: Religion: M/Ch/J/Others Postal Address: Occupation: Business/House wife/Employees/ Agriculturist/Student/Others Main Complaints: Shwasa/Kasa/Kapha Nistivana/Rakta Nistivana/Pratishyaya/Kshavathu/Nasanaha/Nasa Rakta Srava/Shirasula/Kantakandu/Kapha Shtivana/Wheezing/Urashula/Jwara. Duration:- days/months/years. History of present illness:

A. Shwasa:

1.History of -Amadosa/Anaha/Atisara/Chardi/Udavartha/Visucika/Alasaka/Sharira Rukshata/Atyapatarpana/Daurbalya/Raktapitta/Panduroga/Jwara/Marmaghata/ Vishasevana/Shudhyatiyoga/Kasa/Kshatakshaya/Pratishyaya. Duration:-for the last days/months/years. 2.Mode of onset and course: Shigrotpatti/Chirotpatty,Ashukari/Chirakalasthayi,Nirantara/Santata/Savegavan, Progressive/Exacerbation and remission,Nocturnal episodes,Shwasa induced by-aspiration of food,Oropharyngeal contents/Foreign body,Shwasa precipitated by Ruksa Ahara/Ayasa/Raja/Dhuma,Attacks once/Twice a week/Month/Year, Individual attacks last in-response to Ayurvedic/Allopathic treatment. 3.Character: Pranavilomata(laboured expiration),Sudhirga SaShabdha Shwasa(loud prolonged expiration),Sudhirga Urdhwa Shwasa Nishwasarahita(prolonged expiration with no or little inspiration), Sudhirga Urdhwa Shwasa Nishwasayukta(prolonged expiration followed by inspiraton),Chinna Shwasa(Phase of respiration and no respiration occurring alternatively),Sense of fatigue in the chest/Vague discomfort in the chest/Sense of suffocation or chocking/Undue awareness of breathing and

134

Proforma

an uncomfortable/Abnormal form of breathing observed in unconscious patient/Breathlessness. 4.Severity: Mridu-good functional ability,Daruna-poor functional ability or confined to bed, Present at rest/Develops with gentle activity like undressing or walking on level ground/develops during moderate exertion such as climbing the stairs/Develops on strenuous exercise/Breathlessness disturbs sleep. 5.Aggravating factors/Precipitating factors: Amuchyamana Slesma/Shayana Avasta/Megha/Ambu/Pragvata/Sheeta/Slesmala Ahara Vihara/Raja/Dhuma/Ratri Samaya/Swapataha Vruddhi/Manodosa. Spontaneous exertion/Bout of coughing/Emotional stress/Anxiety/Lateral decubitus/Allergens-plants debris/Pollen/Feather/Animal dandruff/Moulds. Aspirin/Indomethacin/Drug allergies. 6.Relieving factors: Slesma Nistivana/Ushna Upacara/Asine Sukhanubhava. 7.Associated phenomena: Pranasta jnana/Pranasta vijnana/Murccha/Moha/Vibranta lochana/Vikritaksi/Urdhwa dristi/Raktaika lochana/Utsunaksa/Vikritanana. Jwara/Arati/Marma Cheda Ruk/Vedanarta/Lalata Sweda/Kampa. Kantodhwamsa/Kasa/Pratishyaya/Shirasula/Kanta Gurgurata. Mutradaha/Mutrarodha/Hypotension/Pruritis Chardi/Atisara/Skin flushing/Urticaria Wheezing/Stuffiness of nose/Running nose/Sneezing/Throat irritation/Soreness of throat/Chest pain/Palpitation/Sweating. 8.Seasonal Variation: Sheeta Kale Vruddhi/Varsha Kale Vruddi/Aniyamita-nonseasonal/Worst during summer season.

B.Kasa:

1.Duration: for the last days/weeks/months/years 2.mode of onset:Shigrotpatti/chirotpatti/asukari/chirakalastayi. 3.History of:

Shukapurna Galasyata,Kantakandu,Aruchi/Hridaye aswasthatha,Bhojana vimarga gamana,Shwasa vikruti,Pratishyaya,Kshavathu,Sleshmapraseka,Mukhamadhurya,Anannabhilasha,Hrillasa,Dosadarshanam,Mukhashopha,Padashopha,Pandu,Streekamata,Swapna darshana.

135

Proforma

Madhura,Amla, Katu,Kashaya,Kshara ahara,Ruksha,Snigdha,Sheeta,Ushna ahara,Vidahi ahara, Alpashana,Praamitashana,Abhishyandi ahara,Ati vyayama,Bharavahana,Atiadhwa,Yuddha,Aticheshtata,Swapna. 4. Course: Nirantara/Santata/Savegavan/Progressive. Duration of episode symptom free period 5. Type: Shushka kasa/Ardra kasa/Bhinna kansyopama dhwani/Short paroxysmal/Metallic/Brassy/Bovine/Hoarse/Harsh cough. 6. Time: On rising in the morning, Going to bed at night, Change in posture left to right lateral position, Night hours, Nonspecific. 7. Severity: Kasa vega- tamodarshana, Jyothi darshana, Mahavega kasa, Mahadhwani kasa,Kshoba, Moha. Fainting, Vomiting, Exertion. 8. Aggravating factors: Cold food articles, Change in temperature. 9. Relieving factors: Kapha nishtivana, Snigdha ahara, Amla ahara, Ushna ahara. 10. Seasonal variation: Worst during – Rainy,Winter,Spring,Summer seasons. 11. Associated with : Hrit shula, Shira shula, Parshwa shula, Prishta graha, Parva bheda, Kanta ruk. Swarabhedha, Urashushkata, Kanta shushkata, Vaktra shosha, Urodhoomayana, Peenasa, Shwasa. Romaharsha, Santapa, Peeta netra, Trushna, Daha, Moha, Bhrama, Gourava, Dourbalya, Krishata, Balakshaya.Tiktasyata, Aruchi, Mandagni, Chardi, Utklesha, Madhurasyata, Bahwashi. Bhinnasamhata varcha, Rakta mootra. Prasanna vaktratwa, Akasmath ushna sheeta iccha, Srimad darshana.

B. Sputum:

1.Duration: for the last days/weeks/months/years 2.Amount : Bahu,Alpa ml in 24 hrs

136

Proforma

3.Character: Snigdha, Tanu, Ghana, Gratita, Kutita, Puyopama, Picchila, Watery, . Mucoid, Muco purulent, Purulent.Frothy,Shiny, Translucent, Casts. 4.Colour: Pitta, Samsrita, Sashonita, Harita, Lohita, Shyava, Shweta. Colour less,

Haemorrhagic, Whitish, Yellowish,Greenish,Rusty,Anchovy sause, Pink,Grey. 5. Odour: Visragandhi, Durgandhi, Lohagandhi, Offensive, Non-offensive,

Nauseating, Purulent. 6.Taste: Madhura, Lavana, Nauseating. 7. Brought out by: Coughing, Clearing the throat, Changing the body position,

Vomiting, Sneezing D.Sneezing: 1.Duration: for the last days/weeks/months/years 2.Mode of onset: Sudden/Gradual/Insidious. 3.Severity: As in a bout/Annoying/Exhausting. 4.Course:Episodic/Persistent/Progressive/Irregular. 5.Aggravating/Inducing factors:

Exposure to dust/Pollen/Moulds/Animal danders.Cold water/Tender coconut/Fruits/Ice- creams/Cold beverages. Sudden change in the atmospheric temperature/Morning hours/Cold weather.

6.Associating Symptom: Rhinorrhoea/Stiffiness of nose/Itching of nasal mucosa/Itching in

conjunctiva/Itching in auditory meatus/Lacrimation. E.Rhinorrhoea: 1.Duration: for the last days/weeks/months/years 2.Course:Recurrent/Progressive/Irregular/Persistant. 3.Character:Watery/Mucoid/Mucopurulent/Purulent/Blood stained frank blood. 4. Aggravating factors:

Exposure to dust/Pollen/Moulds/Animal danders.Cold food articles/Morning hours/Cold weather.

137

Proforma

5. Associating Symptom: Sneezing/Stuffiness of nose/Nasal itching /Itching in conjunctiva/Irritation in auditory meatus/Lacrimation/Excoriation of nares

F.Shirasula: 1. Duration: for the last days/weeks/months/years 2. Mode of onset: Sudden/Gradual/Insidious/Progressive/Recurrent/Waxing and

waning/Clock like regularity. Frequency: in a week/month. 3.Character:Dull and aching, Deeply located,Throbbing,Bursting,Boring,Shooting, Darting, Constant band like pressure,Burning,Stinging,Smarting 4.Localisation:Unilateral,Bilateral,Deeply located,Frontal,Occipital,Vertical, Temporal. 5.Time of onset: Early morning, Evening,Nocturnal,Mid morning,Momentory, . Premenstrual,After a period of inactivity -Single attack over a period of hours/days. 6.Severity:Mild,Moderate,Allows routine work, Awakes at night, Prevents sleep, Dim environment,Rest,Sleep 7.Associated with: Respiratory symptoms, Pain and restriction of neck movement,

Nausea,Vomiting,Visual disturbance,Anxiety,Depression,Nasal obstruction, Nasal discharge, Fits.

G.Chest pain: 1. Duration: for the last days/weeks/months/years 2. Mode of onset: Sudden/Gradual/Insidious/Episodic. 3.Site:Mid sternal,Substernal,Sub mammary,Precordial,Left infra mammary, Left

Supra mammary,Spinal,Breast. 4.Type:Pressing,Constricting,Heaviness,Burning,sharp,Boring,Deep,Dull,

Steady,Unwavering,Superficial,Synchronous to heart beat. 5.Radiation:Shoulder,Tip of shoulder,arms,neck,jaw,along the course of

intercostals nerve,back,abdomen. 6.Aggravating/Precipitating

factors:Effort,Excitement,Fatigue,Overeating,Recumbency,Swallowing,

138

Proforma

Coughing,Sneezing,Staining,Lying on the affected side, Breathing, Twisting the trunk, Contraction of muscle, Food intake.

7.Relieving factors:Rest,Sublingual nitrates, Leaning forward, Sitting posture,

Lying on the affected side, Food intake. 8.Duration:Few seconds,minutes,hours,days. 9.Associated:Symptoms:Palpitation,Sighing,Sweating,Dyspnoea,Haemoptysis, Fatigue, Morning stiffness. H.Fever: 1. Duration: for the last days. 2. Mode of onset and course: : Sudden/Gradual/Insidious/Stepladder fashion/ Recurrent. 3. Type:Continous/Remittent/Quotidian/Tertian/Quartan/Irregular. 4. Severity:Mild,Moderate,Severe 5. Difervescence:Crisis,Lysis 6.Associated symptoms: Rigor, Chill, Convulsions ,Delirium, Headache,

Bodyache, Anorexia, Respiratory symptoms, Urinary symptoms .

I. Itching:

1. Duration: For the last days/weeks/months/years

2. Mode of onset: Sudden/Gradual/Insidious. 3.Course:Episodic/persists for days/months. Frequency months. 4.Site:Generalised,Localized, Diffuse,Circumscribed.

5.Associated with: Wheal, Papule, Vesicle,Erythema,Oozing, Crust, Scaling, Pigmentation, Lichenification .

6.Precipitating factors: Spontaneous, Food……………. Contact with substances……………… drugs………… 7.Associated symptoms: Fever

139

Proforma

Past history: H/O Tonsillectomy, Tuberculosis, Sinusitis, Skin allergy . Treatment history: Ayurvedic: Sodhana-Snehana, Swedana, Vamana, Virechana. Samana…………….. duration Medicines- Response State on discontinuing- Allopathic:Route-Oral,Parenteral,Inhalers. Regular,Irregular,SOS use. Bronchodilators,Antihistamines,Steroids,Expectorant, Nasal decongestants,Others. Duration- Hospitalisation Response:

Personal History: Occupation: Work hours Exercise:Minimum,Moderate,Heavy. Hours of rest in a day: Appetite-Good/Poor/Moderate,State during the attack Diet:Veg/Nonveg//Mixed. Break fast…….

Mid morning- Lunch- Dinner- Snacks in the evening – Fruits- Regular/Occasional;Cold water-Regular/Occasional; Cold beverages- Regular/Occasional;Butter milk/Curds- Regular/Occasional;spicy food-

140

Proforma

Regular/Occasional;Fried items- Regular/Occasional;Ice cream-- Regular/Occasional;Cucumber- Regular/Occasional; Bowel:Formed, Unformed, Hard,Smooth,Watery, Mucous,with blood,Color-Regular ,Constipated. Once in……..days. Painful defaecation,Mass per rectum Sleep: Sound,Disturbed,Good-at night,Difficulty in falling asleep,Staying asleep Daytime naps-If disturbed-reason. Habits: Duration Regular Stopped Relationship Comments Occasional Reduced with Amount Continued Symptoms Smoking Alcohol Coffee Tea Snuff Tobacco Others

Obstetric History:

No of delivery………..Normal……….Surgical intervention……………. Abortions…………Last delivery………

Gynecological History:

Menstrual cycle…………Regular/Irregular. Menarche age……………Bleeding days………… Menorrhagia,Metrorrhagia,Dysmenorrhoea,Leucorrhoea. Menopause……………

General Examination:

Dashavidha Pareeksha-

1.Prakrititaha-Doshaja 2.Sarataha- 3.Samhananataha- 4.Vyayamashaktitaha-

141

Proforma

5.Vayataha- 6.Pramanataha-Height…….Weight… … 7.Satvataha- 8.Abhyavaharana Shaktitaha- 9Jarana Shaktitaha- 10.Deshataha-Jata Samvruddha Vyadhita

Astasthana Pareeksha- 1.Nadi- 2.Mala 3.Moothra- 4.Jihwa- 5.Sabda- 6.Sparsha- 7.Drik- 8.Akruti-

Rogi Pareeksha:

• Built-Slender,Lanky,Muscular,Stocky,Obese. • Nourishment-Good,Fair,Poor. • Nails-Pink,Pallor,Bluish • Conjunctiva-Pink,Pallor,Bluish. • Cyanosis-Extremities-upper,lower;Buccal mucosa,Lips,Conjunctiva. • Deformities • JVP-Raised,Only during expiration,Pulsation. • Oedema-Foot,ankle,leg,sacral,hands,face.Pitting/Non-pitting. • Nasal discharge-Watery,Mucoid,Purulent, Blood stained, Mucosal

alasation, Polyp, Hypertrophy of turbinates, Atrophy, Ulceration, Activa, Alae nasi.

• Sinuses- Frontal, Maxillary • Teeth-Caries

142

Proforma

• Gums-Spongy, Bleeding, Unhealthy • Pharynx- Inflammed,Adenoids • Tonsils- Enlarged, Inflamed, Folliculous

Lymph nodes- (palpable, enlarged,number, overlying skin, consistency, mobility, matting, adherence to skin ) 1) Pre auricular

2) Posterior auricular 3) Occipital 4) Submental 5) Submaxillary 6) Superficial cervical 7) Deep cervical 8) Inferior deep cervical 9) Tonsilar

10) Axillary 11) Inguinal

Pulse- /min,Regular,Irregular,Full, Weak, Bounding, Anacrotic, Dicrotic, . Arterial wall thickening. B.P-----------mm of Hg Inspiration……..Expiration ………… Temperature………. Skin

• Size and Shape of the chest-Bilaterally symmetrical, Elliptical, Conical, Long and flat, Alar chest, Ricketic chest, Harrisons sulci, Funnel chest,, Barrel chest, Local retraction, Kyphosis, Scoliosis, Local bulging.

• Diameter- Transverse, Antero posterior

• Expansion of chest • Movement of chest – Symmetrical, Reduced in left/right side,

Synchronicity of movement, Delayed movement in left, right. Inspiratory retraction of interspace exaggerated, Diminished, right , left, Movement of costal margins during inspiration, outward inward, Over action of accessory muscles.

• Rate of respiration………../min

143

Proforma

• Rhythm-Regular, Irregular, Periodic breathing, Prolonged inspiration, Prolonged both phase, Kussmaul’s respiration, Ataxic breathing, Apneustic breathing, Catch in breathing

• Type –Abdominal, Thoracic, Abdomino-thoracic, Thoraco-abdominal,

Pursed lip breathing, Shallow breathing

• Sternomastoid sign

• Distended chest veins

• Oedema-Unilateral,Bilateral

• Respiratory Movements – Symmetrical, Diminished in left/right , Accentuated in left/right, Asynchronised, Delayed in left/right, Diaphragmatic movement, Normal, Absent, Paradoxicol

Symptoms BT AT1 AT2 AT7 AT14 AT21 AT30 Severity Breathlessness Speech Cough Sputum Body position Respiratory rate Expansion of chest

Laboured breathing

Breath sounds Heart rate Mental status FVC FEV1 PEF FEV1/FVC% Broncho dilators

144

Proforma

VAMANA KARMA: Drugs: Pippali- gms. Time- Vaca- gms. B.P- mm of Hg. Saindava- gms. Pulse- /min. Madhu- Ksheera- Yastimadhu Phanta- Vamana Nireekshana:

Vaigiki

No.of Vegas-

Maniki

Total input = Total output = Extra =

Antiki

Kapha, Pitta, Anila

Laingiki

Hrut, Parsva, Moordha, Indriya, Marga - Shudhi, Laghuta.

Tatkaleena paschat karma- B.P- mm of Hg. Pulse- /min. Doomapana- Samsarjana-

145

Proforma

Investigations: Hbgm%- TC- DC- ESR- ECG- RESULTS: DISCUSSION: Signature of the Co- Guide Signature of Guide Signature of Scholar

146

Proforma

DEPARTMENT OF P. G. STUDIES IN KAYACHIKITSA

S.D.M. COLLEGE OF AYURVEDA & HOSPITAL, UDUPI.

Clinical Trial : A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CHOORNA IN TAMAKASHWASA.

Guide:Dr.G.Shrinivasa Acharya.M.D(Ayu) Co-Guide:Dr.Shrilatha Kamath.T.M.D(Ayu) Researcher:Dr.Madhusudhanan.I.K

PATIENT CONSENT FORM

I exercising my free power of choice, hereby give

my complete consent to be included as a subject in the Clinical trail on ‘ A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CHOORNA IN TAMAKASHWASA. I have been informed to my satisfaction by the attending Doctor, the purpose

of the Clinical trail and the nature of therapeutic procedures follow-up and probable

complications. I am also ready to undergo necessary Laboratory Investigations to monitor

and safeguard my body functions. I am also aware of my right to opt out the trail at any

time during the course of the trail without having to give the reason of doing so.

----------------------------------- --------------------------- Signature of the Doctor Signature of the Patient / Guardian ( Dr.Madhusudhanan.I.K)

147