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“EVALUATION OF EFFICACY OF HARITAKI PHALA CHURNA IN THE MANAGEMENT OF TAMAKA SWASA”

BY

ANAND.M.DODAMANI

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the degree of Ayurveda Vachaspati M.D.

In

DRAVYA GUNA

Under the Guidance of

Dr. KUBER. SANKH .MD (AYU)

Department of Dravya Guna

Post Graduate Studies & Research Centre,

D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG - 582103

2004-2007

Ayurmitra

TAyComprehended

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “Evaluation of efficacy

of Haritaki phala churna in Tamakaswasa”is a bonafide and genuine

research work carried out by me under the guidance of

Dr. Kuber Sankh M D (AYU) Asst. Professor in Dept of Dravya Guna,

DGMAMC, PGS&RC, Gadag

Date: Anand.M.Dodamani

Place: Gadag

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH

CENTRE

GADAG-582103

This is to certify that the dissertation entitled “Evaluation of Efficacy of Haritaki

phala churna in Tamakaswasa” is a bonafide research work done by

Anand.M.Dofamani. in partial fulfillment of the requirement for the post graduation

degree of “Ayurveda Vachaspati M.D. (Dravya Guna)” Under Rajiv Gandhi

University of Health Sciences, Bangalore, Karnataka.

Date:

Place: Gadag Guide: Dr. KUBER SANKH

M.D. (Ayu) Asst.Professor

Dept. of Dravya Guna

DGMAMC, PGS&RC, GADAG

© Copy right

Declaration by the candidate

I here by declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and

disseminate this dissertation/ thesis in print or electronic format for the

academic / research purpose.

Date : ANAND.M.DODAMANI.

Place : Gadag

© Rajiv Gandhi University of Health Sciences, Karnataka

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTRE

GADAG, 582 103

Endorsement by the H.O.D,Principal / Head of the Institution

This is to certify that the dissertation entitled “Evaluation of efficacy of

Haritaki phala churna in Tamakaswasa” is a bonafide research work done by

Anand.M.Dodamani under the guidance of Dr. KUBER SANKH, MD (AYU)

Asst.Professor in Dept of Dravya Guna, in partial fulfillment of the requirement for

the post graduation degree of “Ayurveda Vachaspati M.D. (Dravya Guna)” Under

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

(Dr. G. B. PATIL) Principal,

DGM Ayurvedic Medical College, Gadag

Date:

Place: GADAG

(Dr. G. V. MULAGUND) Professor & HOD

Dept. of Dravya Guna PGS&RC.

Date: Place: GADAG

ABSTRACT

Tamaka Swasa vis-a- vis Bronchial Asthma is one of the most distressing disease

and is quite common in all the socio-economic strata in all the age groups and almost all

over the world. The ancient sages knew the entity of this disease from very beginning.

The Objective of the study is - To evaluate the efficacy of Haritaki Phala Churna

in the management of Tamaka Swasa.and To evaluate the Bronchodilatory effect of

Haritaki Phala Churna. Through pulmonary function test – Peak Expiratory Flow Rate.

Method:

In this Prospective Clinical study 30 patients are selected from suffering from Tamaka

Swasa. The study duration is 60 days In Tamaka Swasa there is predominance of Kapha

Vata Dosha, here Haritaki is Tridosha Shyamaka action and Ushna veerya property.

Haritaki Phala Churna is implemented in this clinical study. With dose of 3 gms in

divided dose with Ushna Jala Anupana. Efficacy was assessed by the difference of before

and after treatment from the subjective and objective parameters.

Results:

Teevra vega Swasa and Ghurgurukatwam is pratyatma niyata lakshana of Tamaka Swasa

observed 100% in all patients.Statistically all subjective and objective parameters show

Highly significance.

Haritaki Phala Churna doesn’t cause any untoward effect. Thus Haritaki

Phala Churna in Tamaka Swasa is the best-recommended drug with their requisite action.

Key words:

Haritaki, Tamaka Swasa, Asthma, Swasa Roga, PEFR, BHT, AEC.

III

CONTENTS

Page No

1. Introduction 1-3

2. Objectives 4

3. Literature Review

a) Drug Review 5-35

b) Disease Review 36-72

4. Methodology 73-86

5. Results 87-119

6. Discussion 120-128

7. Conclusion 129-131

8. Summary 132-134

9. Bibliographic References 135-149

10. Annexure 1-7

IV

ABBREVIATIONS

A.H. Asthanga Hridhaya

A.S. Asthanga Samgraha

ARM.N Abhidana Ratnamala Nigantu.

B.P. Bhavaprakash

B.P. N. Bhavaprakash Nighantu

B.R. Bhaishajya Ratnavali

B.S. Bhela Samhita

C.Chi. Charaka Samhita Chikitsa sthana

C.D. Chakradatta

C.S. Charaka Samhita

D.N. Dhanvantari Nighantu

D.G. Dravya Guna by P.V.Sharma

G.N. Gada nigraha

I.M.M Indian Materia Medica

I.M.P. Indian Medicinal Plants.

K.N. Kaiyadev Nighantu

M.N. Madanapala Nighantu.

Mao.N Maoushadhi Nighantu

N.A. Nighantu Adarsha.

R.N. Raja Nighantu

R.T. Rasa tarangini

SH.N Shaligrama Nigantu

S.S. Sushruta Samhita

Y.R. Yoga Ratnakara

V

LIST OF TABLES

Table No List of Table Page No

Table - 1 Paryaya of Haritaki according to different authors 9-10

Table -2 Gana and Varga of Haritaki according to different authors 11-12

Table - 3 Rasa of Haritaki according to different authors 14

Table - 4 Guna of Haritaki according to different authors 14

Table - 5 Veerya of Haritaki according to different authors 14

Table - 6 Vipaka of Haritaki according to different authors 14

Table - 7 Dosha Karma of Haritaki according to different authors 16

Table - 8 Actions of Haritaki according to different authors 16-17

Table - 9 Prayoga of Haritaki according to different authors 18-19

Table - 10 Contraindications of Haritaki according to different authors 20

Table - 11 Vishishta Yoga of Haritaki 22-24

Table - 12 Prayojya Anga of Haritaki according to different authors 33

Table – 13 Nidana of Tamaka Swasa 41-43

Table – 14 Poorva Roopa of Tamaka Swasa 44

Table – 15 Roopa of Tamaka Swasa 45-46

Table – 16 Vyavachedika Nidana of Tamaka Swasa 56

Table – 17 Types of Asthma 61-62

Table – 18 Pathya in Tamaka Swasa 67-70

Table – 19 Apathya in Tamaka Swasa 71-72

Table – 20 Table showing the demographic data 87-88

Table – 21 Distribution of patients by age 89

VI


Table – 22 Results of patient by age 89

Table – 23 Results of patient by gender 90

Table – 24 Distribution of patients by Religion 91

Table – 25 Results of Patient by Religion 92

Table – 26 Distribution of patients by Occupation 92

Table – 27 Results of patients by Occupation 93

Table – 28 Distribution of patient by Economical status 94

Table – 29 Results of patients by Economic status 94

Table – 30 Distribution of patient by Food Habits 95

Table – 31 Distribution of patient by Presenting Complaints 97

Table – 32 Distribution of patient by Associated features 99

Table – 33 Results of patients by mode of onset 101

Table – 34 Distribution of patients by frequency of attack 102

Table – 35 Distribution of patients by Duration of attack 102

Table – 36 Distribution of patient by mode of progress 102

Table – 37 Distribution of patient by Periodicity 103

Table – 38 Distribution of patient by Preceding Factors 103

Table – 39 Distribution of patients by aggravation factors 103

Table – 40 Distribution of patients by Comfort Posture at attack 104

Table – 41 Distribution of patients by Agni 104

Table – 42

Distribution of patients by Bowel habits 104

VII


Table – 43 Distribution of patients by Addiction 105

Table – 44 Distribution of patients by Prakruti 105-106

Table – 45 Distribution of patients by Dosha Vruddhi 106-107

Table – 46 Distribution of patients by Dosha Kshaya 108

Table – 47 Distribution of patients by Ahara Nidana 109

Table – 48 Distribution of patients by Vihara Nidana 110

Table – 49 Distribution of patients by Anya Nidana 111

Table – 50 Distribution of patients by Srotas 112

Table – 51 Distribution of patients by Poorva Roopa 113

Table – 52 Subjective parameter assessment 114

Table – 53 Showing Objective parameters 115-116

Table – 54 Statistical Assessment of Subjective Parameters 117

Table – 55 Statistical Assessment of Objective Parameters 118

Table – 56 Over all assessment and Result 119

VIII

LIST OF GRAPHS

Graph No List of Graph Page No

Graph -1 Distribution of patient by Age – Gender 90

Graph –2 Distribution of patients by Religion 91

Graph –3 Distribution of patients by Occupation 93

Graph -4 Distribution of patients by Economic status 95

Graph –5 Distribution of patient by Food Habits 96

Graph –6 Distribution of patients by presenting complaints 98

Graph -7 Distribution of patient by Associated features 100

Graph –8 Distribution of patients by mode of onset 101

Graph –9 Over all assessment and Result of Clinical trail 119

IX

ACKNOWLEDGEMENT

This is a moment of great pleasure and contentment for me as the last phase in

completion of this research work

I am deeply indepted to our beloved Principal Dr.G.B.Patil. For his constant

encouragement during the entire phase of the study

I take this glorious opportunity to knowledge with deep sense of gratitude to

Dr.G.V.Mulagund. Professor, H.O.D.Department of postgraduate studies research

Dravyaguna Shri D.G.M.A.M.C.Gadag. For his valuable guidance and close supervision

throughout the dissertation work

I express my deep sense of gratitude to my guide Dr.Kuber Sankh. Lecturer

Department of Dravyaguna Shri D.G.M.A.M.C.Gadag. For his constant encouragement

throughout this dissertation work

I also take this opportunity with deep sense of gratitude to Dr.G.S.Hiremath.

Professor Department of Dravyaguna Shri D.G.M.A.M.C.Gadag.

I express my heartly gratitude to Dr.S.B.Nidagundi.lecturer Department of

Dravyaguna Shri D.G.M.A.M.C.Gadag. I am very much thanks full to Dr.Veena kori,

lecturer Department of Dravyaguna Shri D.G.M.A.M.C.Gadag. I thank to department of

Dravyaguna, teaching and non-teaching staff for providing the necessary facilities to

carry out this work.

I wish to convey thanks to my respected HOD’s of other dept Dr.

V.Varadacharyalu,Dr.Purushottamacharyulu,Dr.M.C.Patil,and lecturers Dr.K.S.R.Prasad,

Dr. Shivaramudu, Dr. Shashidhar Doddamani, Dr.R.V.Shetter, Dr.Girish Danappagoudar,

Dr. Santosh Belavadi, Dr Jagadish Mitti, Dr.Mulkipatil, Dr.Shankargouda.

Acknowledgement I

My Sincerely thanks to P.M.Nandakumar Statistician,Sri.V.M.Mundinamani

Librarian for their timely help during my study I wish to thank R.M.O and all the

physicians and other staff of the hospital and all my patients for their co-operation during

my clinical study.

I am very much thankfull to my roommates Dr. Umesh Kumbar,

Dr.Vijay.G.Hiremath, Dr.Sharanu.Angadi, Dr.Jagadish Handiganoor, Dr.Linagareddy

Biradar, Shivu, Naveen & Manjunath for supporting me in preparing the dissertation right

from beginning to end.

My sincere thanks to my colleaguesDr.C.B.Inamdar, Dr.S.S.sajjanar,Dr.Ashok Bi

ngi,Dr.AshwinDev,Dr.KrishnaJigalur,Dr.AshokM.G,Dr.K.S.Hiremath, Dr.S.S.Gangur,

Dr.V.M.kataraki,Dr.Suvarna,Dr.Anita.Dr.Ashwini vastrad, Dr.Shivalilakudari, Dr.Shalini

Sharma, Dr.Shivakumar. Somlapur, Dr.Savita Bhat, Dr.Jaya Malgoudar, Dr.Kalavati

Pethlur, Dr.Mukta Arali

I am thankful to my friends Santosh Meti, Amith Das, Vinay Achalkar for their kind

co-operation and encouragement during the course of this study.

I express my deepest gratitude to my parents Sri.M.B.Dodamani, Smt.G.M.Dodamani

Sri.L.Udaykumar, Smt.Shoba Udaykumar,Sri.S.G.Babaleshwar. My brothers Sunil and

Anil and my wife Smt.Laxmi.A.Dodamani

Who have inspired me to continue my PG Study with their constant moral

support.Finally my sincere thanks to who are nearer and dearer to me for their

encouragement and help during the course of this study.

Anand.M.Dodamani

Acknowledgement II

Introduction

Introduction

Ayurveda, the Indian System of Medicine, can easily be said the mother of all the

systems of medical sciences. When we peep in to the history of medical sciences, the

records of this system of medicine are the oldest to find. It is in Vedas – the ancient most

literature of human world that details of Ayurveda System of Medicine are found.

Breathing is one of the normal physiological functions of body starts with birth and

ends with death. Pranavata and Apanavata are responsible for the breathing in and

breathing out. 1To and fro air through the Pranavaha Srotas is the vital sign of Prana.2

Normalcy of breathing in and breathing out suggests health and abnormality

indicates diseases and its cessation indicates death.3 This is the unique sign of life, is

affected in the diseases of Tamaka Swasa.4 The disease Tamaka Swasa has been

mentioned in the classics. Its similarities with the bronchial asthma according to the

contemporary sciences are well known.

Tamaka Swasa is one of the most distressing disease and is quite common in all the

socio-economic strata in all the age groups and almost all over the world. The entity of

this disease was known to the ancient sages from very beginning.

The human being appears to be afflicted with more diseases than any other animal

species. There can be little doubt then that he, very early, sought to alleviate his

sufferings from injury and disease by taking advantage of plants growing around him. In

the past, almost all the medicine s used were from the plants, the plant being man’s only

chemist for ages.

The Samhitas classified drugs in different ways based on the features of

morphology, pharmacological action and on the basis of the therapeutic effect in clinical

Evaluation of Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa 1

Introduction

conditions. The classification of Charaka Samhita under dashemani points to use of ten

single drugs having specific therapeutic potential. Sushruta Samhita and Ashtanga

Hridaya have also made classification of drugs in the form of ganas to groups listing a

number of drugs with specific therapeutic potentials. Further, these drug group (gana) in

toto can be utilized or by removing a few from them or by adding a few more also with

immense therapeutic advantage suited to the clinical conditions.

According to Acharya Charaka (Chi.S.1/33) Haritaki is explained in the

management of Tamaka Swasa and many nighantukaras explained Haritaki having the

Swasa Hara property. The present work “ Evaluation of Efficacy of Haritaki Phala

Churna in the Management of Tamkaswasa” is planned to assess its therapeutic effect

in cases of shwasa roga.

Because of the faulty methods of living, scarcity of balanced diet and various other

reasons the incidence of Tamaka Swasa is increasing day by day. There is no satisfactory

treatment available in contemporary sciences. It was because of these facts that decision

was taken to take up this problem for intensive study.

Tamaka Swasa some times severe and fatal also. It is the serious public health

problem in the countries through out the world. Nearly 5-to10% of the world population

at some stage during life suffers from asthma. 5 The disease can occur at any age and

affects 5% of adults and 7-10% children commonly.6


Introduction

Between 100 and 150 million people around the globe, suffer from asthma and this

number is rising. Worldwide, deaths from this condition have reached over 180,000 7

yearly. Tamaka Swasa is also generally comes in proximal attacks and one has to manage

the attack immediately.8 Tamaka Swasa if not treated properly it will kill the patient like

the fire burns the dried bush even though it is a Yapya Vyadhi, it becomes Sadhya if it is

Navothitha.9

There is a feeling among the common masses that shwasa roga will go only when

shwasa (prana) goes away. Shwasa is considered krichhra sadhya or difficult to cure. In

this condition Kapha, the predominant dosha causes obstruction in the Pranavaha srotas,

thereby disturbing the movement of Vata. Consequently Vata is aggravated and its

pratilomagati takes place, which results in shwasakashtata. Pranavaha srotas, Annavaha

srotas and Udakavaha srotas are also involved in the Tamaka shwasa, a condition, which

in modern parlance is known as bronchial asthma.

Bronchial asthma is characterized by paroxysms of dyspnoea, accompanied by

wheezing, resulting from narrowing of the bronchial airways by muscle spasm, mucosal

swelling or viscid secretion. The airflow obstruction causes mismatching of alveolar

ventilation and perfusion and increases the work of breathing. Being more marked during

expiration it also causes air to be trapped in the lungs. The narrowed bronchi can no

longer effectively clear mucus by the act of coughing and in patients with severe acute

asthma; many of the smaller bronchi become obstructed by inspissated and often very

tenacious mucus. 10


Objectives

Objectives

Tamaka Swasa vis-a vis Asthma and allergies, such as atopic disease (i.e, bronchial

asthma, allergic rhinitis, atopic dermatitis and allergic contact dermatitis), are common

medical problems. Tamaka Swasa and its management through various methods are

possible viz. Abhyanga Swedana, Virechana, Vamana, Dhoomapana, Shamana, Kapha

nissarana, Srotomardavata, vata kaphahara, kapha vilayana, Kasagnee, Brumhana effects

will be very effective in combating the Tamaka Swasa. Considering the above the

Haritaki Phala Churna as a shamanoushadhi is under taken for the trail that has all of

these therapeutic effects is opted for this study.

The present study intended to focus on the disease evaluation of efficacy of Haritaki

Phala Churna in the Management of Tamaka Swasa vis-à-vis. Bronchial asthma.

Hypothetically Haritaki Phala Churna is the best therapeutic efficacy on the Tamaka

Swasa (Bronchial Asthma).

In this regard the objectives proposed in the study are-

1. To evaluate the efficacy of Haritaki Phala Churna in the management of

Tamaka Swasa.

2. To evaluate the Bronchodilatory effect of Haritaki Phala Churna.


Disease Review

Disease Review

Nirukti:

The word Tamaka Shwasa composed of two conjoint words. They are Tamaka

and Shwasa. The word Tamaka is derived from the Dhatu (root). “Tamaka glanou” with

Kwip Pratyaya (syllable). It suggests to choke, darkness, be suffogatted (Apti dicti).

It is also defined as “Tamayati iti Tamaka”.122

“Tama eva Tamaka” in Shabdha Kalpa dhruma.

It means where “Tama” occurs that is Tamaka.

The word Shwasa is derived form the dhatu. ‘Swas’ with ‘Gahs’ pratyaya. It

means to breath (Apti).

In shabdhartha kousthubha, it is stated that ‘Shwasathi iti Shwasa’. It means to

breath, by which respiratory movements takes place. 123

The word Tamaka Shwasa is formed by Karmadhareya Samasa as “Tamakaccha

Aska Shwasacha Tamaka Shwasa’. It means difficulty in breathing which occurs mainly

during night hours. 124

Paribhasha:

Susruta: Defines “Tamaka Shwasa as Vischeshat durdine tamyethi Shwasaha” as

“Tamaka Shwasa”. It means the attack of Shwasa with tamapravesha which occurs

especially during “Durdhina”.

The meaning of durdhina is not explained in this context. But in Charaka Samhita

it is stated that symptoms aggravated during cloudy days. 125


Disease Review

Vijaya Rakshita: Explains Tamaka Shwasa as:

“Shwasasthu bhasthrikadmana Samavathordwa gamani”.

It means it is a disease where in the expiration of air produces a sound similar to

the sound of bellow of blacksmith.

HISTORICAL REVIEW

PREVEDIC AND VEDIC PERIOD:

The description of Prana Vayu as well as Apana Vayu and its role in the act of

respiration is available in literatures of Prevedic and Vedic period. Few references to

mention from Rigveda - Pranadvayu jayate (10-90-13), 126 Ayumapranaha (1-66-1), 127 in

these citations the word Prana is used to refer the act of respiration. At a number of

occasions the mentioning of the word Hridaya is seen in Rigveda. This Hridaya is

considered as the Mula of Pranavaha Srotas in Ayurveda. Quite similar to this few more

references from Yajurveda like Vatam Pranena Nasike 128 (Yaju 15-2) Pranasya

Apyathatvam 129 (Yajur 16-15), these lines express the act of respiration and effort of

expiration in regards to Prana Vayau. Further in Atharvaveda, Pranavayu is referred by

the name Matarishwa. “Vatoprana Ucyata” is a line from Atharvaveda that express the

role of Pranavayu in respiration. 130 Pundarika is the word used to describe the Hridaya in

Atharvaveda. Pundarika refers to the blossom of Nelumbo nucifera and the shape of this

blossom simulates the Hridaya.

UPANISHATH KALA:

The detailed account of respiration; inspiration and expiration the two phases of

respiration all are available in the Upanishats. Inhaling and exhaling the air is mentioned

as the sign of life in Amanaskopanishath. The original reference in this regard goes like


Disease Review

this - Svasocchvasatmaka Prana (am-1-33) and Avasocchusa Hinastu Niscitam

Muktaevasaha. Angira and Brihaspati are the two names used in Chandogyopanishath

referring to Pranavayu. 131 Added to this Pranavayu is said to nourish the body (CHA

1:2:10/11/12).

Yogachudamanyam is another treatise in which the diseases related to Pranavaha

Srotas like Hikka, Swasa and Kasa are elaborated to some extent.

The cardio respiratory system is compared to the bird Crane; the two wings of the

bird representing the lung, the trunk indicating the heart, and the neck of the bird

symbolically expressing the windpipe are discussed in detail in Swetaswatara

Upanishat.132

The rate of respiration is said to be 21600 per day in Varahopanisat. Similar

references are also available in other Upanishats.

SAMHITA PERIOD:

Caraka Samhita:

The full account of the illness Swasa Roga is elaborated in the 17th chapter of

Cikitsa Sthana in Caraka Samhita. The text includes the Nidana, Samprapti, Purvarupa,

Rupa, Sadhyasadhyata and Cikitsa of the Swasa Roga. Santamaka and Pratamaka Swasa

are told as variant forms of Tamaka Swasa. Swasa is also cited as a symptom of many

other diseases like Pandu, Udara, and Karshya etc. Few prescriptions of Dhumapana in

Tamaka Swasa are also available in this Caraka Samhita and are worth mentioning. 133


Disease Review

Susruta Samhita:

Even in Susruta Samhita elaboration of etiology, types, pathogenesis, clinical

manifestation as well as treatment is made. 134

Bhela Samhita: Harita Samhita: 135, 136

Falling in line with Caraka and Susruta Samhita, even in Bhela and Harita

Samhita vivid description of the etiology, types, signs and symptoms as well as treatment

is elaborated at full length.

Kashyapa Samhita:

Explanation related to Swasa Roga is restricted to brief description in the Khila

Sthana of Kashyapa Samhita 137

Ashtanga Hridaya and Ashtanga Sangraha: 138, 139

In these treatises the Nidana aspect of the illness is described in the Nidana

Sthana, like wise therapeutic aspect of the Swasa Roga is elaborated in the Cikitsa

Sthana. The interrelation between Kasa Roga and Swasa Roga in the causation is stressed

in these works.

Madhava Nidana:

Swasa Roga is elaborated in the 12th chapter of Madhava Nidana. The description

includes the etiology, pathogenesis, types, symptomatology as well as prognosis of the

Swasa Roga. 140


Disease Review

MEDIEVAL PERIOD:

Cakrapanidatta: On the basis of the information available in Brihatrayi, the illness Swasa

Roga is described in Cakradatta. 141

Arunadatta: In his nowel work, a commentary on Astangahridaya, Aruna Datta has

stressed the importance of Vata and Kapha Dosha in the pathogenesis of Swasa Roga.

Further he opined that Kasa Roga in due course may precipitate Swasa Roga and like

wise the Swasa Roga may also lead to the occurrence of Kasa Roga.

Ayurvedarasayana: Morbid Kapha Dosha is incriminated to cause the illness Swasa

according to Indukara.

Bhavaprakasha 142 and Yogaratnakara: 143 In these two texts the description of Swasa

Roga at full length is based on the Bhrihatrayi. The Pathya- apathya of the Swasa Roga is

also mentioned in these works. The addition of herb mineral compounds in the treatment

of Swasa Roga is unique.


Disease Review

Nidana of Tamaka Swasa

Table –13 Nidana of Tamaka Swasa 144-148 S.No Nidana C.S S.S A.H M.N G.N

A) Ahara Sambandhi

1 Sheetapana + + + + +

2 Shaata ashana - + - + +

3 Guru bhojana + + - + +

4 Abhishyandi bhojana + + - + +

5 Rooksha bhojana + + - + +

6 Vidahi ahara + + - + +

7 Vistambi ahara + + - + +

8 Adyashana + + - - -

9 Sleshmala ahara + - - - -

10 Jalaja mamsa + - - - -

11 Anupa mamsa + - - - -

12 Ama ksheera + - - - -

13 Dadhi + - - - -

14 Shaluka + - - - -

15 Masha + - - - -

16 Nishpava + - - - -

17 Vishamashana + + - - -

18 Pinyaka + - - - -

19 Tila taila + - - - -


Disease Review

20 Pista padartha + - - - -

21 Ama rasa - + - - -

B) Vihara Sambandhi

24 Sheeta vata sevana + + + + +

25 Raja sevana + + + + +

26 Dooma sevana + + + + +

27 Vyayama + + + + +

28 Vega dharana + + - + +

29 Sheeta sthana - + - + +

30 Bhara vahana - + + + +

31 Atapa sevana - - - + +

32 Abhishyandhi upachara + - - - -

33 Sheetashana - + - - -

34 adhwagamana + - - - -

35 Dwandwa sevana + - - - -

B) Vyadhi/Avastha

Sambandhi

36 Apatharpana + + - + +

37 Atisara + - + + +

38 jwara + - + + -

39 Chardi + - + - -

40 Kasa - + + - -


Disease Review

41 Pandu + - + - -

42 Rookshana + - - - -

43 Anaha + - - - -

44 Vibandha + - - - -

45 Amapradosha + + - - -

46 Shuddhi atiyoga + - - - -

47 Pratishyaya + - - - -

48 Kshata kshaya + - - - -

49 Dourbalya + - - - -

50 Vishoochika + - - - -

51 Udavarta + - - - -

52 Raktapitta + - - - -

D) Agantu Karana

53 Marmaghata + + + - -

54 Visha + - + - -

55 Kantorasa pratighata + - - - -

E) Kala

56 Durdina - + - - -

57 Meghacchadita dina + - + + +


Disease Review

Poorva Roopa of Tamaka Swasa

Table – 14 Poorva Roopa of Tamaka Swasa 149-153

S.No Poorva Roopa C.S S.S A.H M.N G.N

1 Anaha + + + + +

2 Adhmana - - - + +

3 Arathi - + - - -

4 Bhaktadwesha - + - - -

5 Hritpeeda + + + + +

6 Kantha Gurutwa + - - - -

7 Kashaya Vadanata + - - - -

8 Parshwa Shoola + + + + +

9 Prana Vilomata + - + - -

10 Shankha Toda - - + + +

11 Uro Guruta + - - - -

12 Vaktra Vairashya - + - + +


Disease Review

Roopa (Lakshana) of Tamaka Swasa

Table – 15 Roopa of Tamaka Swasa 154-158

S.N Laxanas C.S S.S A.H M.N G.N

1 Swasa (Dyspnoea) + + + + +

2 Ghurughuraka (Wheezing) + + + + +

3 Prana prapeedana (Discomfort) + + + + +

4 Kasa (Cough) + + + + +

5 Pratamyati (Loss of consciousness) + + + + +

6 Sannirudyati (Immobilized) + - - + +

7 Pramoha + + + + +

8 Shleshma vamokshante labhate sukham + + + + +

9 Kantodwamsa (Throat irritation) + - - + +

10 Krichrena bhashitam (Difficulty in

speech)

+ - - + +

11 Na labhate nidra (Sleeplessness) + - - + +

12 Shayanasya swasa peedita (Discomfort in

lying down posture)

+ + + + +

13 Parshwa shoola (Sides pain) + - + + +

14 Ushna abhinandana (Like hot thing) + - + + +

15 Uchritaksha (Wide opened eyes) + + + + +

16 Lalat sweda (sweating on forehead) + + + + +

17 Brushramarthi (Maximum distress) + - + + +

18 Shushkasyata (Dryness of mouth) + - + + +


Disease Review

19 Muhar swasa, Muhuschiva avadhamyati

(Short breath with all effort to breath)

+ + + + +

20 Megha, Ambu, Sheeta,

Pragwaha,Shleshmalancha pravardhanti

(Increase after exposure to kaphakaraka

ahara)

+ - + + +

21 Pratishyaya (Normal discharge) + - + + +

22 Aruchi (Anorexia) - + + - -

23 Trishna (Excessive thirst) - + + - -

24 Vepathu (Tremors) - - + - -

25 Vamathu (Expectoration) - + - - -

26 Ghoshena Mahate - + - - -


Disease Review

Samprapti (Pathogenesis) of Tamaka Swasa

Swasa Roga Samprapti

Charaka opines that the Vitiated Kapha along with vitiated Vata obstructs the

Srotas; the obstructed Vayu tries to over come the obstruction and moves in all the

direction resulting in Swasa. 159

Sushruta says the pranavayu goes against its individual (Prakruti) combines

with Kapha causing Swasa Roga. 160

Bhavamishra 161 and Yogaratnakar,s 162 opinion regarding Samprapti coincides

with Charaka, Madhavakara,s 163 corresponds with Sushruta.

Vagbhata 164 further emphasized that the Annavaha Srotas is also involved

and hence the production Kapha in Amashaya is affected. Thus Swasa Roga is regarded

as Amashaya Samudbhava.

Tamaka Swasa Samprapti

Vata Dosha and Kapha Dosha are invariably involved in the pathogenesis of

Tamaka Swasa. 165 Imbalance of Vata Dosha is best treated by Snigdha line of

treatment.166 Whereas, vitiated Kapha Dosha is treated by Ruksha line of treatment. 167

Theoretically, when both Vata and Kapha Dosha are vitiated mutually, contradictory

therapeutic procedures have to be employed, thus posing a practical problem in planning

the final treatment. Kapha Dosha and Rasa Dhatu both belong to the same category in

relation to their properties. 168 It is a general principle of pathogenesis, that the Dosha and

the Dhatu belonging to the same category have a natural tendency to rapidly progress in

the process of pathogenesis. 169


Disease Review

Similar to this in Tamaka Swasa also,Kapha Dosha that afflicts the Rasa Dhatu

contributes to the rapid development of the illness. Further, during the course of the

illness, the Hridaya Marma is said to be afflicted.170This adds to the severity of illness.

Put together, the mutual contradictory treatment, involvement of Dosha and

Dushya belonging same category, as well as affliction of Hridaya Marma explains in the

acute onset, chronic course and severity of the illness.

The normal upward course of the Pranavata is obstructed by the abnormally

stiff Pranavaha Srotas. Secondly, like the other Srotas, secretion is the natural process

seen in the Pranavaha Srotas. Here Kapha is the normal secretion and the vitiated

Pranavata abnormally increases it. In further it adds to the obstruction of the passages and

Pranavata leading to Prana vilomata. Narrowing of the Pranavaha Srotas together with

the accumulation of Sleshma obstructs the smooth flow of Pranavata. Prana vilomata and

resulting turbulent breathing lead abnormal audibility of respiration or to say this

procedure Wheezing. Charaka opines that the obstruction to the passage of Pranavata also

leads to rapid breathing. 171

Vitiated Prana Vata irritates the causing increased secretion and

manifestation like Peenas Kshawathu etc. 172

Further the prasena of Kapha in Pranavaha Srotas more particularly in Kanta

(neck) region obstructs the Pranavata. The Pranavata passing through this Kapha, causes

bubbling and a peculiar sound, which is called as Kanta Ghurughuruka is, produced. 173

It is said that this Sleshma is thick, sticky and tenacious and contributes to the

Pranavaha Srotas. Excessively secreted tenacious Sleshma is expectorated out with much

difficulty during the bouts of coughing. 174


Disease Review

Productive cough is another effect of obstruction of Pranavata in the Pranavaha

Srotas. As the cough brings out the sleshma, obstruction to the Pranavata is minimized,

leading to temporary relief in breathlessness to the patient. 175

Other than the usual presentation, involvement of Pitta Dosha may be seen in

certain patient of Tamaka Swasa.176When this is the case the over all presentation of the

Tamaka Swasa is also changed accordingly.The frequent episodes of Tamaka Swasa are

related to the exposure to cold, cloudy days, and heavy breeze and/ or such other factors

that are provocative to Vata and Kapha Dosha, which is the usual presentation in Tamaka

Swasa. 177 If the association of Pitta Dosha is present this nature of the illness is reversed

and hence exposure to these factors may bring about remittance of symptoms in the

patient. This unique nature of the illness is attributed to Pitta Dosha involvement. These

symptoms like Jwara, Murcha are suggestive of Pitta vitiation. Such a varient form of

Tamaka Swasa with the typical symptoms of Pitta Dosha is called as Pratamaka and

Santamaka Swasa. 178

The imbalance of Vata and Kapha Dosha afflicts the Rasa Dhatu in the

pathogenesis of Tamaka Swasa.during the attack of Tamaka Swasa almost all the

symptoms of Kapha Dosha vitiation are mediated through the Rasa Dhatu. Among the list

of symptoms: productive cough, sputum etc are the symptoms pathogenic of Rasa Dhatu

abnormality. Moreover, abdominal symptoms like Anaha, etc are also the result of

incriminated Rasa Dhatu.179 As the disease runs a chronic course, the vitiated Vata Dosha

dries up the circulating Rasa Dhatu contributing to the weakness and emaciation in the

patient.


Disease Review

Schematic diagram of Samprapti of Tamaka Swasa

NIDANA SEVANA

SANCHAYA AGNIMANDYA DOSHA DUSHTI (VATA & KAPHA

DUSHTI)

PRAKOPA AMARASOTPATTI

MALAROOPA KAPHA

PRASARA PARIBHRAMANA PRATILOMAGATI OF VATA

PRANAVAHA SROTOGAMANA

STHANA

KAPHA makes AVARANA to PRANA VAYU

SANSHRAYA

PRANA try to overcome the AVARANA

VYAKTAVASTHA SHWASA (shwasavarodha, shwasativriddhi, Ghurghurkam etc.)


Disease Review

Smprapti Ghataka

Dosha : Charaka – Kapha, Vata

: Sushruta- Dominance of Kapha

: Arunadatta – Both Kapha and Vata are involved

Dushya : Rasa

Srotas : Pranavaha, Udakavaha, Annavaha

Srotodushti : Atipravrutti

Utpatti sthana : Vagbhata – amashaya

: Charaka – Pitta sthana

Sanchara sthana : Urah Kantha Siras

Vyaktatha sthana : Urahas

Rogamarga : Abhyantara

Adhisthana : Shareerika

Samprapti Bhedas

For the complete understanding of the disease, Samprapti can be classified as

Sankhya, Pradanya, Vidhi, Vikalpa, Bala and Kala. 180

In the disease Tamaka Swasa also detail study of Hetu Samprapti, Lakshana

and Sadhyasadhyata can be elaborated in the framework of Samprapti bhedas as-


Disease Review

1) Sankhya Samprapti

The Tamaka Swasa is categorized under pancha bheda of Swasa.181Tamaka

Swasa doesn’t have direct classification to fit in the Sankhya Samprapti, but have

Pratamaka and Santamaka as avastha bhedas. 182

2) Pradhanya Samprapti

Charaka has considered Tamaka Swasa, as Kaphavatatmaka Vyadhi. 183 Where as

Madhavakara has considered it as Kapha pradhana.184its Samprapti indicates the

KaphaPradhanyata, as per the clinical course of the disease and principles of treatment

both Kapha and Vata seems to be Pradhana. 185 Vata holds prime importance in the

management.

3) Vidhi Samprapti

Under Vidhi Samprapti, Tamaka Swasa can be classified in different categories as,

Ashukari, 186 Yapya, 187 and Krichra sadhya. 188 According Charaka Hikka and Swasa are

Ashukari, Ghora, and Sheeghra Pranaharaka.

Further he explained with chronicity as more than one year are considered as

Yapya and of duration less than one year in the durbala rogi, as Krichra sadhya. Achary

Sushruta has considered Tamaka Swasa as Krichra sadhya; and Asadhya in durbala rogi.

4) Vikalpa Samprapti.

Observing of Tamaka Swasa Samprapti, lakshana, Upashsaya and Anupashayas

presence of vikriti in Pranavata and is aggravated by the properties such as Sheet, Ruksha

gunas and increase in its Chala guna. 189 Similarly Urosthitha Avalambhaka Kapha gets

aggravated by Guru, Snigdha, Sheeta, and Abhishyandhi gunas and becomes Ghana and

Pichchila.


Disease Review

5) Bala Samprapti

Bala of Vyadhi depends on virulence of the hetus, presence of Poorva roopa in

the course development of disease or in developed form. And also it depends on the

involvement of different Srotases, Rogamarga and vital parts of the body. Hence the bala

of the Vyadhi differs for individual patients, thus the Tamaka Swasa is considered as

Krichra Sadhya, Yapya and Ashukari Vyadhi by various authors. 190

6) Kala Samprapti

The name of disease itself indicates of the nature of disease with respect to the

time factor. It is episodic, paroxysmal and mostly nocturnal in its nature. Some times it is

even observed that the symptoms get aggravated in the early morning, and with respect to

seasons it aggravates in the winter and autumn due to cold climate. 191

Upashaya of Tamaka Swasa

Any of the Dravya bhuta (Oushadhi, Ahara etc.) or Adravyabhuta (Vihara)

Upacharas leads to Sukhanubandha is defined as Upashaya. 192 Sleshma Vimokshana is

considered as Upashaya in Tamaka Swasa, 193 which can be achieved by mechanical

process such as coughing etc, by pharmacological measures such as administering

Sleshmavilayana dravyas.

The Dravyas possessing Ushna guna i.e. properties can be administered as

Upashaya in Tamaka Swasa. 194 Non-pharmacological procedures such as change of

position; relives from the severity for short period. 195


Disease Review

Anupashaya of Tamaka Swasa.

Ahara, Vihara, and Oushadhi aggravates the condition of the Tamaka Swasa are

called as Anupashaya of Tamaka Swasa. They are Asatmya to the Vyadhi. 196 Meghambu

sheetapragvatai sleshmalaischa abhivardheyate is considered as Anupashaya. 197 “

Nachapinidramlabhate Shayanahasvasapeeditaha” indicates the aggravation of the

disease in the recumbent position. 198

Upadrava of Tamaka Swasa.

There is an direct reference regarding the upadravas of Tamaka Swasa mentioned

in ‘Trishna Chikitsa’ is Trishna appears as upadrava in Jwara, Kshaya, Swasa etc. 199

Aristha of Tamaka Swasa.

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

Tamaka Swasa, where as in reference with different contexts Aristha laxana for Swasa

can be established. At the time of death whatever the disease he may suffer, ultimately he

will die with Hikka and Swasa. 200

It is mentioned that the person producing unnatural sounds with heavy breath,

suffering with Atisara, Trishna, Shushkasyata and loss of body strength is definitely

going to die. 201 The person whose Urdhwa swasa is rapid, throat occluded by Kapha;

reduction in strength, complexion and food intake is not going to survive for longer

period. 202 The person taking long inspiration and gives of short expiration gets fainted;

such person is stated to die within short period.203


Disease Review

Sadhyasadhyata of Tamaka Swasa.

Tamaka Swasa, which is chronic of more than one year, is considered as Yapya

and of duration less than one year in the durbala rogi, as Krichrasadhya.204 If Tamaka

Swasa is Navovita (newly developed) it is Sadhya (curable). 205 Sushruta has considered

Tamaka Swasa as Krichrasadhya Vyadhi and Asadhya in Durbala rogi.206 According to

Vagbhata Tamaka Swasa is Yapya, but can be Sadhya if it is treated in early stages in the

strong persons.207


Disease Review

Vyavachedaka nidana of Tamaka Swasa

Differential Diagnosis between panchavidha Swasa

Table –16 Vyavachedaka nidana of Tamaka Swasa 208

Lakshana Tamaka Swasa Maha Swasa Urdhwa Swasa Chinna Swasa Kshudra

Swasa

Swasa Ateva teevra vega

swasa

Uchaihi Swasati Dheergam swasati,

Urdhwam swasati,

adhoswasa nirodha

Swasate

vichinnam

Ruksha

aayasottha

Swasa

Shabda Ghur-ghurak Matta vrashabho

vatt

Consciousness Pramoha Pranastha jnana

vijnana

Pramoha Moorcha

Netra Uchritaksha Vibhranta

lochana and

vivrataksha

Urdhvadristhi and

vibhrantaksha

Viplutaksha,

raktaika

lochana

Shula Shayanasya

parshvagraha

Vedanarta Marmachedavat

rugarditaha

Vak Kruchrakrichnoti

bhashitaha

Viksheena vak Pralapana

Asya Vishushkasya Shushkasya Parishushkasya

Sweda Lalata sweda Sarva daihika

Upashaya Sleshma

vimokshana

Sadhyasadhyata Yapya Asadhya Asadhya Asadhya Sadhya


Disease Review

CHIKITSA

The effective treatment of Tamaka Shwasa cannot be united, as its pathology

involves multiple varying factors as vitiated Vata and Kaphadosha stemming out from the

Pittasthana, afflicting the Rasadhatu in Pranavaha Srotas produces the illness. Therefore

the treatment aimed at the rectification of the imbalances of Vatadosha as well as

Kaphadosha, forms the sheet anchor of treatment of Tamaka Shwasa which is

individually quite opposite. Thus, the unique pathogenesis posses complexity in planning

the treatment. The final treatment planned should pacify the Vata dosha as well as

Kaphadosha effectively. Simultaneously not causing any further addition to the

imbalance of Vata and Kaphadosha, with the due consideration of this, following

principles of treatment for Tamaka shwasa are advocated in the Ayurvedic classics.

Abhyanga and Swedana:

Treatment of Tamaka Shwasa differs both during the attack and in between the

attacks. During the episode of Tamaka Shwasa, the Doshas are in a state of provocation

and contrary to this, in between the attacks the Doshas are silent and are not apparent.

Thus demanding different treatment to make it more clear, the treatment is planned

during the attack to negate the effect of Samprapthi. In contrast to this, in between the

attack, the treatment is planned to prevent the initiation of new Samprapthi thereby

forming the complete treatment of Tamaka Shwasa.209

Prana vaya vilomata is a pathological event during an episode of Tamaka Shwasa

and is said to be due to tenacious Kapha obstructing the passage of Pranavayu. Bringing

it out by liquifying the sputum is the principle and first treatment of this condition. This


Disease Review

can be achieved by Abhyanga and Swedana over the chest thereby allowing the free

passage of Pranavayu.

Acharya Charaka has prescribed application of oil added with rock salt over the

chest followed by sudation in the form of Nadi, Prastara and Sankara Sweda.

Vamana Karma:

The clinical presentation is patients suffering from Tamaka Shwasa are not

uniform. Some patients present with symptoms suggestive of dominant Vata Dosha and

are characterized mostly by dry cough and prominent wheezing. In such patients,

Vamana Karma is not ideal choice. Yet, other patients presents with symptoms

suggestive of dominance of Kaphadosha, which is characterized by paroxysmal

productive cough, where the sputum is tenacious, bouts of distressing paroxysmal cough

brings out small amount of sticky sputum and this is associated with breathlessness. In

such patients, with the predominant vitiation of Kaphadosha, Vamana Karma is most

ideal. This renders clarify of the Pranavaha Srotas and thereby allowing free passage of

the Pranavayu.

The procedure of Vamana Karma is advisable only in patients who are physically

strong and can tolerate the strain of Vamana Karma. The mild form of Vamana is always

advisable in all patients of Tamaka Shwasa and it can be repeated during every attacks.

After subjecting the patient to Abhyanga and Nadi Sweda over the chest, in the

evening, the patient is allowed to take food that provocates the Kaphadosha like meals

with curds or fish. This Kaphotklesha procedure renders easy elimination of Kaphadosha

by Vamana procedure, which is carried out on the immediate next day, in the morning

hours.210


Disease Review

Dhoomapana:

This is another procedure also aimed at eliminating the Kaphadosha from the

Srotas. Dhoomapana is advised after the Vamana Karma and it eliminates some amount

of Kaphadosha that is still left out after the Vamana Karma or else, if the Kaphadosha in

the Srotas is minimum, as in Vata dominant cases or in cases of milder attacks.

Dhoomapana may be performed alone without prior Vamana Karma. Further, in

debilitated patients, where prefactory procedure is not possible. Dhoomapana alone helps

in the elimination of Kaphadosha. Added to this, the drugs used in Dhoomapana also

reduces spasm or stiffness of Pranavaha Srotas bringing about Srotomardavata that

ensures free passage of Vatadosha.211

Virechana Karma:

Abnormal response of patients for simple factors like dust is said to be due to Kha

vaigunyata of the Pranavaha Srotas. In the modern counterpart, this is described as

hypersensitivity or allergy of the respiratory system. This may be said as Khavaigunyata

or else called as Asatmyata or even may be named as faulty Vyadhi Kshamatva, and the

fact is that, the patients unfavourably respond to simple factors like dust, atmospheric

change or food.

The answer for such a nature of illness is Virechana Karma and Rasayana

Chikitsa. Charaka pronounced this as “Tamaketu Virechanum”212 when employed in

between the attacks, prevents the attack of Shwasa, renders its severity, minimizes the

duration of illness. Even in some patients, this procedure in combination with Rasayana

Chikitsa brings about complete cure.


Disease Review

After Virechana, Samsarjana Karma is advised for about 3 to 5 days. This

procedure eliminates Doshas in Tamaka Shwasa eliminated as is told in the classics.

Virechana procedure eliminates Doshas stemming out from Pittasthana is. It is worth

mentioning here that, Vata Dosha is the predominant Dosha involved in the Samprapti of

Tamaka Shwasa, Virechana normalizes the course of Vata Dosha and thus helps in the

reversal of Vilomagati of Pranavayu. Distension of abdomen, constipation and such other

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

procedure.

Brimhana and Rasayana Chikitsa:

The difference in response to atmospheric changes in a normal person, in contrast

to patients of Tamaka Shwasa, where in atmospheric changes reflects as disease in patient

is said to be due to Khavaigunyata an abnormality of the Pranavaha Srotas. This can be

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

subsiding the attack of Asthma.

Also in due course, improves the defence mechnism of Pranavaha Srotas, reduces

the tendency of abnormal reaction to simple factors in the surroundings. Further, in the

long run, the disease cause emaciation of the body. this can be corrected by the Brimhana

Chikitsa. This adds to the benefit.213

To sum up, sequential administration of Abhyanga and Swedana over the chest,

and increasing the tendency of Kapha to get eliminated Vamana and Dhoomapana

followed by Shamana Chikitsa is the sheet anchor of treatment of Tamaka Shwasa during

an episode.


Disease Review

Virechana followed by Vyadhihara Rasayana and Brihmana Chikitsa forms the

ideal treatment in between the attacks. These procedures are very much effacacious in

eliminatig the symptoms as well as preventing the attack of Tamaka Shwasa.

BRONCHIAL ASTHMA

Definition:

Bronchial asthma is a disease characterised by hyper reactive airways, leading to

episodic, reversible broncho constriction, owing to increased responsiveness of the

tracheo-bronchial tree to various stimuli.214

Types:215

In western science for the epidemiological and clinical purpose asthma is broadly

classified into 2 varieties but because of the unclear pathological and clinical distinction,

a third variety is added. They are,

1) Allergic asthma or extrinsic asthma.

2) Idiosyncratic asthma or Intrinsic asthma.

3) Mixed variety.

Table- 17 Types of Asthma

Sl. Extrinsic Intrinsic

1) Immune reaction type 1 hyper sensitivity Non immune abnormal autonomic

regulation of airways.

2) Family history of hyper sensitivity is

common

No family history


Disease Review

3) Usually starts in childhood Starts in adult life

4) Proceeded by infantile eczema and hyper

sensitivity to food

No evidence of atopy

5) Predisposition to form IgE antibodies IgE antibodies may be found but no

particular predisposition

6) Recognisable allergens like pollens,

dandruff, house dust, mite, etc.

No recognisible allergens

7) Attacks often diminish in later years Attacks increases in severity as years

passes

8) Chronic bronchitis seldom develops Associated with nasal polyps chronic

bronchitis

9) Emphysema unusual Emphysema commonly develops

10) No drug sensitivity Drug sensitivity may develop

(Aspirin, Pencilin, etc.)

11) Increased level of IgE found in serum Normal level of IgE in serum

12) Positive response to skin provocation test Negative skin provocation test

Clinical features: Cardinal symptoms of all these types of asthma are

1) Dyspnoea

2) Wheeze

3) Cough

4) Sensation of chest tightness.216


Disease Review

Pathogenesis of Asthma: This can be expalined under two heading.

i) Atopic Asthma

ii) Non-atopic Asthma.

Atopic Asthma can be explained in two phases

i) Early phase Reaction

ii) Late phase Reaction.

Early phase Reaction:

This occurs in case of airborne antigen, The reaction occurs 1st in sensitised mast

cells on the mucosal surface. So, mediators released from the mast cells i.e. is histamine,

leukotriens, cytokinease, etc. So, these mediatiors opens the mucosal intercellular tight

junction, more antigen entered into submucosal mast cells. In addition direct stimulation

of sub epithelial vagal receptors provokes bronchial constriction through central and local

reflexes. This occurs within a minute after the stimulation and is called the acute or

immediate reaction or response. IgE triggered reaction includes release of both primary

and seconday mediators.

The primary mediators are Histamine and Leukotriens B4. The Histamine causes

broncho constriction by direct and cholinergic reflex action. Increased venular

permiability and increases the secretion. Leukotriens B4, which attracts eosonophils and

neutrophils.


Disease Review

The secondary mediators are, Leukotreins C4, D4 and E4, extremely potent

mediators which causes prolonged broncho constriction and increased vascular

permiability and increases mucus secretion. Prostoglandin D2, which causes broncho

constriction and as well as increased permiability and increased mucus secretions.

Platelete activating factor. which causes aggregation of platelets and release of histamin

and serotonin from the mast granules.

In late phase reaction, it starts after 4-8 hours later and may persist for 12-24

hours. It is mediated by leukocytes i.e. eosonophils, neutrophils and lymphocytes. These

are released by the chemotactic fatcors and cytokines, derived from the mast cells during

acute phase response or by other mediators produced by the chronic inflammatory cells

already present in asthmatic patient. These leukocytes releases a mediators that stimulates

the late reaction. Histamine releasing factor produced by various cell types i.e. Basophils,

Neutrophils, Eosonophils. Basophilis causes broncho construction and edema.

Neutrophils causes further inflammatory injury. Eosonophils causes epithelial damage

and airway constructions.

Non-atopic Asthma:

It is non-allergic, microbial antigen play a role. Here there will be a hyper

sensivity to microbial antigen. “Viruses induces inflammation of the respiratory mucosa

lowers the threshold of the sub epithelial vagal receptors to irritants. So, inhaled air

pollutants such as So2, ozone, No2, etc. contribute to chronic airway inflammation and

hyper reactivity.217


Disease Review


Disease Review

Differential Diagnosis:

COPD: History of cigaratte smoking, chronic cough, sputum production (i.e. is in chronic

bronchitis) and dyspnoea (in emphysema), rhonchi, decreased intensity of breath sounds

and prolonged expiration on physical examination. airway limitation on pulmonary

function tests.

Left heart failure (Cardiac asthma): Usually there will be a history of paroxysmal

nocturnal dyspnoea with cardiac abnormality or hypertension or other signs of cardiac

failure. The sputum will be wateryfrothy crackles are more than wheeze. Basal

crepitation is observed on physical exmaination.


Disease Review

PATHYAPATHYA

In a patient suffering from Tamaka Swasa certain predisposing factors are said to

initiate an attack of the illness. Or else, if the patient is in an attack of breathlessness

these predisposing factors are likely to worsen the attack. Further in the long run, there

occurs deterioration of the immune mechanism of the Pranavaha Srotas there by

increasing risk of frequent attacks of the Tamaka Swasa on exposure to trivial factors.

There fore it is mandatory to identify and avoid these incriminatory factors to get

maximum relief. Thus it is important to know the Pathya and Apathya in patients of

Tamaka Swasa. The following tables show the list of Pathya and Apathya of Tamaka

Swasa.

Table -18 Pathya in Tamaka Swasa: 218-222

Pathya Ahara C .S. S .S. A .H. Y.R. B.R.

I Shaali Dhanya

Purana Shali + - - + +

Tandula - - - + +

II Vrihi Dhanya

Shashtika + - + + +

III Shooka Dhanya

Yava + - + + +

Godhuma + - + + +

IV Shimbi

Mudga + - + - -


Disease Review

Kulatha - - + + +

V Shakha Varga

Guduchi + - - + +

Patola - - - + +

Vartaka - - + + +

Rasona - - - + +

Bimbi - - - + +

Vastuka - - - - +

Moolaka + - + - +

Potaki - - - - +

Shigru + - - - -

Kasamarda + - - - -

VI Mamsa Varga

Janghala - - - + +

Shasha + - - + +

Titira - - - + +

Bhuka - - - + +

Lava - - - + +

Dhanva - - - + +

Shuka - - - + +

Mruga Dwija - - - + +


Disease Review

VII Phala Varga

Jambira - - - + +

Draksha + + - + +

Mathulunga + + + - +

Amalaka + + + - -

Bilwa + + + - -

VIII Madhya Varga

Sura - + - + +

Varuni - - + - -

IX Madhu Varga

Madhu + + + + +

X Mootra Varga

Gomutra - - - - +

XI Dugdha Varga

Aja Kshira - - - + +

XII Ghrta Varga

Purana sarpi - + - + +

Ajasarpi - - - + +

XIII Krtanna Varga

Yusha + - + - -

Yavagu + - - - -

Peya + - + - -


Disease Review

Sathu - - + - -

Varuni - - + - -

Pathya Vihara

Virechana + - - + +

Swedana + - - + +

Dhumapana + - - + +

Prachardana - - - + +

Swapanam Diva - - - + +


Disease Review

Table –19 Apathya in Tamaka Swasa:

Apathya Aahara

I Shimbi Dhanya

Nishpava + - - + -

Masha + - - + -

Thila + - - - -

Sarshapa - - - + +

II Shaaka Varga

Kanda - - - + +

III Mamsa Varga

Jalaja + - - - -

Anupa + - - - +

Pishita + - - - -

Matsya - - - + +

IV Dadhi Varga

Dadhi + - - - -

V Kshira Varga

Kshira + - - + +

Mahisha Kshira + - - - -

VI Grita Varga

Mahisha Gritha - - - + +

VII Kritanna Varga

Tailabhrsta Nishpava - - - - +

Pistanna + - - - -

Pinyaka + - - - -

Apathya Vihara

Sheeta Snana + + + - -

Raja + + + + +


Disease Review

Dhuma + + + + +

Anila + + + + +

Vyayama Karma + + - - -

Bhara - + - - +

Adhwat - + - - +

Vegaghata - + - - -

Apatharpana + + - - -

Marmaghata + - + + +

Sooryatapa - - - - +

Daurbalya + - - - -

Aanaha + - - - -

Abhighata - + - - -

Strigamana - + - - -

Vegavarodha-Mootra,

Udgara, Chardi, Trushna, Kasa

- + - - -

The diet, behavioral as well as environmental factors that helps in homeostasis of

Vata and Kapha Dosha both during and in-between the attacks are considered as Pathya

in Tamaka Swasa. The patient is encouraged to follow these Pathya. Contrary to this,

factors related to food, behavior or environment that incriminates the Vata and Kapha

Dosha or Pranavaha Srotas is identified as Apathya in Tamaka Swasa. These have to be

strictly avoided by the patient suffering from Tamaka Swasa. Strict observation of the

Pathya and avoidance of Apathya minimizes the severity of the illness, reduces the

frequency of the attacks and helps in early recovery from the illness.


Drug Review

Drug review

Historical review of Haritaki

Among the earliest references, Panini described it for the management of dysurea /

anurea and constipation (Mootra Purisha Nirodha) – (Pa.Ga. 4/4/53).

Haritaki is one of the important as well as commonest herbs used by folk, household

and traditional medicine. Its fruit rind is used in medicine and is one of the ingredients

in Triphala.

It is mainly indicated for constipation, Respiratory problems, certain Skin disorders,

Eye disease etc. charaka highlighted its Rasayana properties in Chikitsa sthana. He

specially stated Haritaki as best among the herbs to be used regularly (Haritaki

Pathyanam Ch.Su.25.)

Sushruta in his Samhitha Sutrasthana mentioned that Haritaki can be used for bringing

about chemical reaction i.e. Rasakriya. Sushruta in his Samhitha Sutrasthana

mentioned that Haritaki can be used as a pad or pill i.e. Varthi.

Vagbhata in his Samhitha in 10th Chapter 31st sloka mentioned Haritaki under Kashaya

varga.

Vagbhata in his Samhitha mentioned Haritaki in the context of treatment, which

reduces Medas.

Shivadatta described Haritaki plant by making simile with Vasa leaves (Vasadalo

drumo adristhaha phalam tasya Haritaki).


Drug Review

There are references about Haritaki in almost all Nighantu’s. A story has been told in

Bhavaprakasha Nighantu, Raja Nighantu about the origin of the drug, Haritaki.

Dakshaprajapati asks Ashvini Kumara’s about Haritaki, questioning them. Where

the Haritaki was born, what are its features, Colourrs, types etc.

Ashvini Kumara’s say that when Lord Indra was drinking Amruta the drops of

Amruta that fell down to earth grew as Haritaki plant. (B.P.Ni.1-3).

And also Bhavaprakasha explains importance of Haritaki as follows-

As mother is supreme and she always make Hita to their children’s, like that

Haritaki is best for humans. It will not cause any harm to the body. Some times mother

may become angry but use of Haritaki does not make any complication, hence

Haritaki is supreme than mother.

Whose mother is not there, those can be consider Haritaki as a mother like

That, Bhavaprakasha given prime importance for Haritaki.


Drug Review

Synonyms and its meanings

1) Abhaaya----“Na bhayam asyaha iti ||” (Bh.D)

It relives fear against all the disease.

2) Avyatha---- “Na vyatha yasyaha iti ||” (Bh.D)

“Na vyathayati iti va | (Ni.A)

Its usage will provide relief from many Diseases.

3) Kayastha---- “ Kayaha tishtati anaya iti |” (Bh.D)

“ Kaye tishtati iti va nishphala na bhavati ityarthaha |” (Ni.A)

Once used internally, it does not go waste i.e it definitely.

Provides relief any disease.

4) Chetaki---- “ Chetayati anaya srotaha shuddhe |” (Ni.A)

It will do the Sroto Sudhi.

5) Pathya-----“ Pathoanapeta iti |

Pathi sadhu iti pathya hita ityarthaha ||” (Ni.A)

It is useful for all the Srotas (Channels).

6) Putana-----“ Pootam karoti iti | Virechanatwat |” (Ni.A)

It purifies (puta or pavitra) the body through the process of

Purgation.

7) Shreyashi—“ Ati prashasta iti | Shreyaskartwat |” (Ni.A)

It is renouned for its good Qualities /

Properties.

8) Shiva------“ Shivam (Mangalam) karoti iti |” (Bh.D)

It brings good fortunes.


Drug Review

9) Haritaki----“Harasya Bhavane jata Hareeta cha swabhavataha |

Sarvaroganscha cha Harate ten Khyata Haritaki ||” (D.N, M.N.)

Its utpanna in shivasya nivasasthana i.e. Himalaya parvatha.

Swarupatha it is Haritha varna and cures all types of roga, thus

It is prasidha by the name Haritaki.

“Harate prasabham Vyadhin Bhuyastarati yadvapuhu |

Haritaki tu sa prokta tatra keerdiptivachakaha ||” (R.N).

The Haritaki is one, which forcibly removes the disease from

Ones body. The Ki Shabdha is Deepti Vachaka.

“Dehe sanga malanam harati bahutaram sa haritabhyabhikhya||”

(P.N).

Haritaki, the name because it does nirharana of vibaddha mala

of Shareera.

10) Haimavati— “ Himavati jata | Tatrai jataha | (Bh.D)

It grows on Himavati parvata.

11) Amruta ------- The drug which having the nectar like properties.

12) Rechani ------ It does the purgation.


Drug Review

Synonyms of Haritaki

Table – 1 Paryaya (Synonyms) according to different authors 11-18.

Sl

No

Synonyms

D.N

M.N

R.N

K.N

BP.N

Mao.N

ARM.N

SH.N

1 Haritaki + + + + + + + +

2 Abhaya + + + + + + + +

3 Pathya + + + + + + + +

4 Kayastha - + + + + + - +

5 Putana + + + - + + - +

6 Amruta + + + - + - - +

7 Haimavati + + + + + + - +

8 Avyatha + - + - + + - +

9 Chetaki + + - - + + - +

10 Shreyasi - + + + + + + +

11 Shiva + - + + + + + +

12 Vayastha - + - - + + - +

13 Vijaya + + + + + + + +

14 Jivanti - - + - + - + -

15 Rohini + + + - + + - +

16 Jaya + + + - - + + -

17 Prapathya + + + + - - + -

18 Jivapriya - - + - - + - +


Drug Review

19 Bhishagvara - - + - - + - +

20 Pranada + - + + - - + -

21 Jivaya - - + - - + - -

22 Nandini + + - - - - - -

23 Amogha - + - - - - - -

24 Jeevaneeya - + - - - - - -

25 Divya - - + - - - - -

26 Shaka - - - - - + - -

27 Balya - - - - - + - -

28 Sudha - - - - - + - -

29 Bhishagpriya - - - - - + - -

30 Chetanika - - + - - - - -

31 Jeevanika - - + - - - - -

32 Devi - - + - - - - -

33 Rechani - - - - - - + -


Drug Review

Classifications:

Classification is the basis of development of every branch of science. The 1st

attempts on classification of drugs was seen in the Vedas on the basis of leaf, flowers,

fruits, stem, etc. and as per the availability, property and action the Dravyas has been

classified into several Vargas.

In the Samhitas drugs are classified more systematically and scientifically. The

classifications in Samhitas are based on the source of drugs, properties and action, etc.

Table- 2. GANA AND VAARGA ACCORDING TO DIFFERENT CLASSICS

Sl.No CLASSICS GANA

1 Charaka samhita Arshoghna gana

Kusthaghna gana

Kasahara gana

Jwarahara gana

Prajasthapana gana

Virechanopaga gana

2 Sushruta samhita Mustadi gana

Triphala gana

Amalakyadi gana

Parushakadi gana

3 Bhavaprakasha nighantu Haritakyadi varga

4 Madanapal nighantu Haritakyadi varga

5 Kaiyadeva nighantu Aoushadhi varga


Drug Review

6 Dhanavantari nighantu Guduchyadi varga

7 Priya nighantu Haritakyadi varga

8 Raja nighantu Amradi varga

9 Shaligrama nighantu Haritakyadi varga

10 Mahaoushadhi nighantu Phaladi varga

11 Nighantu adarsha Haritakyadi varga


Drug Review

TYPES OF HARITAKI

Seven types of Haritaki 19-21

1. Vijaya

2. Rohini

3. Putana

4. Amruta

5. Abhaya

6. Jeevanti

7. Chetaki

Two types of Haritaki 22

1. Haritakki

2. Bala haritaki

Three types of Haritaki 23

1. Neeraja or Jalaja

2. Vanaja

3. parvateeya

Three types of Haritaki 24

1. Sukahali haradee (Guj)\ Badi harada (Hindi)/ Ilelekabali (Parsi)

Two tola in weight rounded Haritaki place- Bombay

2. Harad (Guj)/ Ilelaha Asfar (Arabi)/ ilela Jarda(Parsi)

it is used for colour.

3. 3.Himaja (Guj)/ Jouhada, Chote harre (Hindi)/ Balaharada (Marati)/ Ilale

shyaha(Parsi).


Drug Review

PROPERTIES ACCORDING TO DIFFERENT AUTHORS

Table – 3.RASA 25-36

S.N

o

Rasa C.S S.S AH.S B.N K.N D.N P.N R.N M.N S.N N.A Mou.

N

1 Lavana

Varjita

Pancha

rasa

+

-

-

+

+

+

+

+

+

+

+

+

2 Kashaya

Amla

-

+

-

-

-

-

-

-

-

-

-

-

3 kashaya - - + - - - - - - - - -

Table – 4.GUNA 37-46

S.No Guna C.S S.S AH.S B.N D.N P.N M.N S.N Mou.N K.N

1 Laghu + - - - - + - - - -

2 Laghu

Ruksha

- + + + + - + + + +

Table – 5.VEERYA 47-56

S.No Veerya C.S S.S AH.S B.N K.N P.N M.N S.N NA Mou.N

1 Ushna + + + + + + + + + +

Table – 6.Vipaka 57-64

S.No Vipaka S.S AH.S B.N K.N M.N S.N NA Mou.N

1 Madhura

+ + + + + + + +


Drug Review

Probable Mahabhuta dominance of Haritaki, according to Rasapancaka

1) Rasa → Pancarasa, Kasaya dominance (Lavanavarjita)

Kasaya → Prthvi + Vayu

Tikta → Akasa + Vayu

Katu → Agni + Vayu

Amla → Prthvi + Agni

Madhura → Prthvi + Jala

Thus, total picture of Mahabhuta dominance, according to Rasa

Prthvi - 3 + Jala - 1 + Agni - 2 + Vayu - 3 + Akasa - 1

According to Guna

1) Laghu → Agni + Vayu + Akasa

2) Ruksa → Agni + Vayu

According to Virya

Usna → Agni

According to Vipaka

Madhura → Prthvi + Jala

Therefore, total Picture of Mahabhuta Dominance, according to Rasa Pancaka

Prthvi - 4 + Jala -2 + Agni - 5 + Vayu - 5 + Akasa - 2

So, Agni and Vayu Mahabhutas are showing equal dominancy according to

Rasa Pancaka


Drug Review

Table – 7.Dosha Karma 65-73

S.No DoshaKarma S.S AH.S BP.N K.N D.N M.N S.N N.A P.N

1 Tridosha hara - - + + + + + + +

2 KaphaPitta hara + - - - - - - - -

3 KaphaVata hara - + - - - - - - -

Table – 8.ACTIONS 74-84

S.N Action C.S S.S AH B.N K.N D.N P.N R.N M.N S.N Mou.

N

1 Doshanulomana + - - + - - + - - - +

2 Deepana + + + + + - + - + + +

3 Pachana + - + - + - + - - - -

4 Ayushyam + - + - + - - - - - +

5 Poustika + - - - - - - - - - -

6 Vayassthapana + - + - + - - - - + -

7 Medhya - + + + + + - - + + +

8 Smrutibuddhi balaprada + - - - + - - - + - -

9 Kapha praseka + - - - - - - - - - -

10 Chaksusya - + - + + + - - + + +

11 Bhedhana - + - - - - - - - - -

12 BuddhiInndriya

balaprada

- - + - - + + - - + -

13 Rasayana - - - + + - - + + + +


Drug Review

14 Brunhana - - - + + - - - + - +

15 Vrushya - - - - - - - - + - -

16 Malasaraka - + + - - - + - + + -

17 Bahurogaprashamani - - - - - - + - - - -

18 Yogavahini - - - - - - - + - + -

19 Lekhana - - - - - + - - - + -

20 Vatanulomana - - - - - + - - - + -

21 Hriddya - - - - - - - - - + -

22 Smrutikaraka - - - - - - - - - + -

23 Balya - - - - - - - - - + -

24 Netra rujapahara - - - - - - + - - -

25 Rechani - - - - - - + - - -

26 Santarpanakruta roga

hara

- - - - - + - - - - -

27 Sarva roga prashamana + - - - - - - - - - -


Drug Review

Table – 9.PRAYOGA OF HARITAKI 85-94

S.No Uses C.S SU.S A.H.S B P.N K.N M.N P.N S.N Mao.N D.N

1 Kushta + + + + + + - + + +

2 Gulma + - + + + + + + + -

3 Udavarta + - - - - - + - - -

4 Shosha + - + - + - - + - -

5 Pandu + - + - + - + + - -

6 Mada + - - - - - - - - -

7 Arsha + - + + + + + + + -

8 Grahani + - + + + + - - + -

9 Puranajwara + - + - + - - + - -

10 Vishamajwara + - + + + + - + + -

11 Hridroga + - + + + + - + - +

12 Shiroroga + - + - + - - + + -

13 Atisara + - + - + - - + - -

14 Arochaka + - + - + - - - - -

15 Kasa + - + + + + + + + -

16 Prameha + - + + + + - + + +

17 Anaha + - + + + + - + + -

18 Pleeharoga + - + + + + - + + -

19 Udararoga + - - + - + + - + -

20 Yakritvikara - - - + - - - - + -

21 Swararoga + + + + + + + + + -

22 Vaivarna + - + - + - - - - -

23 Kamala + - + + + + - + + -

24 Vruna - + - - + + - + + +

25 Krimiroga + + + + + + - + + -

26 Shotha + + + + + + + + + +

27 Tamaka swasa + - - - - - - - - -

28 Karnaroga - - - - - - - + - -


Drug Review

29 Chardi + - - + - + - - + +

30 Swasa - - + + + + - + + -

31 Klaibhya + - - - - - - - - -

32 Angavasad + - - - - - - - - -

33 Srotovibhanda + - + + + + - - + -

34 Netraroga - + + - + - - + - -

35 Medoroga - - + - - - - - - -

36 Urusthamba - - + - + - - + - -

37 Adhmana - - - + + + - - + -

38 Trishna - - - + - - - - - -

39 Hikka - - - + - + - + + -

40 Kandu - - - + - + - - - -

41 Shoola - - - + + + - + + -

42 Ashmari - - - + - - - + + -

43 Mootrakriccha - - - + - - - - + +

44 Mootraghata - - - + - - - + + -

45 Moha - - - - + - - - - -


Drug Review

Table – 10Contraindications of Haritaki 95-99 S.N Contraindication C.S D.N. B.P.N R.N. S.N.

1 Ajeerna + - - - -

2 Ruksabhujaha + - - - -

3 Atimaithuna + - - - -

4 Madirapana + - - - -

5 Vishakarshita + - - - -

6 Kshata + - - - -

7 Trishna + + - + -

8 Krusha shareera + - - + +

9 Mukhashosha - + - - -

10 Hanusthambha - + - + -

11 Galagraha - + - + -

12 Navajwara - + - + -

13 Ksheena - + - - -

14 Jeerna (old age) - - - + -

15 Garbhini - + + + +

16 Adhwati - - + - +

17 Kinna - - + - +

18 Balavarjita - - + - +

19 Ruksha - - + - +

20 Langana karshita - - + - +

21 Pittadhika - - + - +

22 Vimukta raktastva - - + - +

23 Shosha - - - + -


Drug Review

Rutu Haritaki 100-102

Rutu Haritaki is explained on the basis of different Anupana in different Rutus.

These Anupana’s helps to increase the Rasayana property of Haritaki.

Varsha --- Saindavalavana

Sharad --- Sharkara

Hemanta --- Shunti

Shishira --- Pippali

Vasanta --- Madhu

Greeshma ---Gudha


Drug Review

Table – 11.Vishishta yoga of Haritaki

S.N Vishishta yoga Indication Reffernce

1 Agastya Haritaki Promotes complexion, Cough, Dyspnoea,

Hiccup,

Fever,Arsha,Grahani,Coryza,Hridroga.

Ch.Chi.18/57-

62

2 Haritaki Leha Dyspnoea, All type of Cough Ch.Chi.18/16

8-169

3 Abhayarishta Arsha,Grahaniroga,Panddu,Hridroga,

Gulma,Udararoga,Kushta,Shopha,Kamala

,Sweta pradara,Jwara.

Ch.Chi.14/13

8-143

4 Triphaladi Kashaya Laxative,Pitta&Kaphaja Jwara. Ch.Chi.3/208

5 Triphaladi Churna Numbness,Kushta Ch.Chi.7/68-

69

6 Triphaladi Grita Kushta,Visarpa,Vatarakta,Gulma,Vidradi. Ch.Chi.7/136-

139

7 Triphaladi Taila Apasmara Ch.Chi.10/43

8 Triphaladyarishta Arsha,Pandu,ssShopha, Ch.Chi.12/39-

40

9 Haritakyadi Yoga All type of Shopha Ch.Chi.12/22

10 Triphaladya Lauha Pandu,Kushta,Jwara,Kamala,Spleenomeg

aly.

Ch.Chi.16/99

11 Haritakyadi Kashaya Prameha Ch.Chi.6/27

12 Haritakyadi Grita Hridroga, Abdomen pain, Back pain Ch.Chi.26/73


Drug Review

13 Trayushanadi Grita Kasa,Jwara,Gulma,Kamala,Arsha,Urhaks

hata.

Ch.Chi.17/39-

42

14 Abhayadi Kwatha Shotha,Jwara,Daha,Visarpa,Trishna,Visha

dosha

B.R. 42/11

15 Abhayadi Kwatha Kaphaja Jwara,Malabhedhaka, B.R. 5/148

16 Abhayadi Guggulu Snayu and Mastishka sambandi

rogas,Sarvarogahara

B.R.101/18-

22

17

Abhaya Vati JeernaJwara,Pleehavridhi,Udararoga,Vato

dara,Ajeerna,

Kamala,Panduroga,Kumbakamala

B.R.40/94-97

18 Abhayadi Churnam Smaronmada B.R.77/2-3

19 Abhaya Lavana All type of Koshta vikara,Yakrit Pleeha

vriddi,Udara roga,

Anaha,Gulma,Asthilagranthivridhi,Agima

ndya,Shirashoola,Hridroga,Ashmari

B.R.41/32-40

20 Pathyadi Yoga Parinama shoola B.R.30/76

21 Pathyadi Kwatha Amayukta jeernajwara, B.R.5/67

22 Pathyadi Churnam Kaphatisara B.R.7/49

23 Triphala Rasayana Rasayana,Jwara B.R73/5-6

24 Pathya Rasayanam For long life up to 100 years B.R73/17

25 Pathya Vati Mukhadurganda B.R61/122

26 Chiitraka Haritaki Pachakagnivridhi, Ksaya, Kasa, Peenasa,

Krimi,

B.R.63/25-28


Drug Review

Gulma, Udavarta, Swasa

27 Vyagra Haritaki Kshaya, kshata, peenasa, swasa,

Rajayakshma, Kasa

B.R.15/169-

172

28 Dashamoola Haritaki

29 Danti Haritaki Virechana, Pleehavridhi, shotha,

gulmavikara,

Panduroga,grahanivikara,Utklesha,Visha

majwara,Kushta, Aruchi

B.R32/81-85

30 Triphaladi Kwatha Kaphajajwara, Amadosha B.R.5/139

36 Triphala Guggulu All type of Vruna B.R.47/51

31 Triphaladi Lepam Kesharanjana B.R.60/69

32 Triphala mandooram Amlapittashoola B.R56/97

33 Triphala yoga Mada, Murcha, Kamla, Unmada B.R.21/7

34 Triphala Rasayanam Jara&Vyadhi nashaka B.R.73/5-6

35 Triphala leham Amavata, Panduroga, Halimaka,

Parinamashoola,

Shotha, Vishamajwara

B.R.29/99-

101


Drug Review

MODERN REVIEW OF THE DRUG HARITAKI

Botinical name – Terminalia Chebula

Terminalia- Proceeding from the extremity at the end;

Chebula- Distorted from of the word Kabul. 103

Vernacular names 104

English – chebulia, Black myrobalans

Hindi - harre,Harda, Harada, Hada.

Marathi - Hirada, Bala hirada.

Baangaali- Haritaki, Gaachcha, Harra.

Gujarati- Haaraade, Himaja.

Kaannada- Anileya, Alalekai, Harra, Karaakkayi.

Pharsian- Ilelaj, Asfar, Ilelejarda, Ilailaha.

Arabi- Aahaleelaj, Asfar, Eahaleelaj, Kavali, Asvad.

Telagu- Kaaraakkaaya, Charaka, Chetaka, Karitaki.

Tamil- Kadukkai.

Malayalam- Kaatukka, Divya, kayastha, Putanam.

Panjab- Har, Halelu, hurh, Harrar.

Oriya- Horidra, Haritoli, Jongihoridra, Karedha, Harisu.

Sind- Har.

Urdu- Haaaejarad.

Gond- Kara, Harro, Hor.

Sikkim- Han, Silimakanga.

Udi- Karratha, Harida, Kaaredu.


Drug Review

Assam- Hilikha, sillika.

Portugusee – Mirabolanos.

Nepal – Harra, Herro.

Konkani – Ordo.

Chinese – He Li Le, Pi Li Le, P’o Lo Te.

Lepcha – Salim-kung, Silim.


Drug Review

CLASSIFICATION OF HARITAKI

Haritaki has been mentioned in various Ganas due to its manifold actions by

different authors. They have been listed below. 105

• Kingdom---------- Plant Kingdom.

• Subking ---------- Phanerogams.

• Division----------- Spermatophyta.

• Sub Division------ Angeosperms.

• Class--------------- Dicotyledonae.

• Sub Class--------- Polypetalae.

• Series------------- Calyciflorae.

• Order------------- Myrtales.

• Family------------ Combretaceae.


Drug Review

FAMILY FUTERS

COMBRETACEAE 106

Trees or Shrubs, erect or climbing.

Leaves alternate or opposite, coriaceoous or membranous, simple, entire;

Petiole often glandular at the top;

Stipules 0.

Flowers usually hermaphrodite, rarely unisexual or poly gamous.

Calyx bracteolate at the base; tube adnate to the ovary and prolonged above it; limb 4-

5 (rarely 6-8) –fid or –partite, its lobes valvate in bud, deciduous or persistent.

Corolla 0, or Petals inserted on the calyx, alternate with its lobes, valvate in bud.

Stamens inserted with the petals, some times alternate with them, some times double

their number, of which the alternate 5 or inserted higher than and opposite to the

petals;

Filaments free, filiform or subulate.

Ovary inferior, 1-celled, usually crowned with a disk;

Ovules 1-7 (usually 2-4), pendulous from the apex of cell;

Style terminal;

Stigma usually simple.

Fruit usually indehiscent, coriaceoous or drupaceous, ovoid angular, frequently

winged, crowned in CALYCOPTERIS by the greatly enlarged calyx.

Seed 1, exalbuminous; cotyledons large, plaited or convolute.

Genera -16.

Species – 480. Distribution – Tropical and sub tropical regions


Drug Review

GENUS

TERMINALIA LINN. 107

Trees. Leaves alternate or suboposite, frequently crowded at the ends of the branches,

often with glands on the petiole or at the base of the mid rib beneath.

Flowers green or white rarely coloured, small, spicate (the spikes sometimes

panicled), hermaphrodite or often the upper flowers on the spikes male and the lower

hermaphrodite.

Calyx – tube ovoid or cylendric, constricted above the ovary; limb of 5 short valvate

triangular lobes, soon deciduous.

Petals 0.

Stamens 10, inserted on the calyx- lobes (the epigynous disk within them densely

hairy), biseriate, the 5 lower opposite the calyx teeth, the 5 upper longer and alternate

with the calyx teeth; filaments subulate or filliform, exserted.

Ovary inferior, 1-celled;

Ovules 2-3, pendulous from the apex of the cell;

Style subulate, often thickened and villous at the base;

Stigma simple.

Fruit ovoid, various in size and texture, smooth or angular or 2-5 winged, indehiscent,

coriaceoous.

Seed solitary, exalbuminous; cotyledons convolute.

Species 120- Tropics.


Drug Review

SPECIES

TERMINALIA CHEBULA RETZ. 108

A moderate sized or large deciduous tree, attaining 25-30 m. in height. Leaf – buds,

branchlets and youngest leaves with soft, shining, generally rust- coloured hairs.

Leaves 7-20 cm. by 4-8 cm., glabrous or nearly so when mature, not clustered, distant,

alternate or sub opposite, elliptic- oblong, acute, rounded or cordate at base,

penninerved, secondary nerves 6-8 pairs, arching, prominent; Petioles 2-5.cm long,

pubescent, usually with 2 glands near the top. Flowers all hermaphrodite, 4mm.

across, sessile, dull-white or yellow, with an offensive smell. Spikes sometimes

simple, usually in short panicles, terminal and in the axils of the uppermost leaves;

Bracts exceeding the flowers, subulate or lanceolate, hairy, consicuous among the

buds but soon deciduous. Calyx campanulate, 3mm. long, flat at the base expanding a

little towards the mouth, glabrous outside, hairy within; Teeth 5, short, some times

obscure. Drupe pendulous, 2-4 cm. long, ellipsoid or obovoid from a broad base,

glabrous, more or less 5-ribbed, when dry yellowish green; Stone oblong, bony, very

thick, obscurely angled.

Bark 6-mm. thick, dark brown with many generally shallow vertical cracks.

Wood very hard, brownish grey with a greenish or yellowish tinge, with irregular

small dark purple heartwood, close-grained.

Distribution: Throughout the greater part of India, Burma and Ceylon, up to 5,000ft.

In the Himalayan and up to 6,000 ft. Travancore. 109


Drug Review

Chemical composition

Myrobalon fruits are an important source of tannin. Depending upon the geographical

source, they vary in tannin content and fruits collected from Madras are very rich in

tannin. The approximate analyses of the fruits is as follows

Moisture -10%, Tannin – 25-32%;

Water - insoluble matter – 40-50%

The tannins of myrobalan are of pyrogallol type (hydrolysable tannins), which on

hydrolysis yield chebulic acid and d-dalloyl glucose. Chebulagic, chebulinic, ellagic

and gallic acids are the other contents of myrobalan. Myrobalan also contains glucose

and sorbitol (about 3.5%). During the maturation of the tree, the amount of tannin

decreases, where as the acidity of fruits increases. 110

Tanins –

Tannic acid is used as an astringent for mucous membrane of mouth and throat,

and employed for soar throat and receding gums. It is also used in treatment of piles in

the form of suppositers. Tannic acid is also used as an antidote for poisoning due to

alkaloids, heavy metals and some glycosides.111


Drug Review

PHYTOCHEMISTRY:

Following principles are isolated from Haritaki fruit (Terminalia Chebula).

Extract

Colour – Yellow Red

PH - 3-3.7

Tannin – 20-45%

Chebulinic acid – 30%

Gallic acid – Traces

Resin - Traces

Mucilage – Trace

Brownish Yellow colouring maths – Traces

Anthrax Quininin like purgative principle – Trace

Total moisture – 10%

Total Non Tannius – 13.9-16.4%

Total unsolubles – 41.1-50.1%

Seed: Oil resembling almond oil –50%

Ash of Bark: Potash and Tannins 112


Drug Review

Table – 12 PARTS USED

Haritaki Fruit 113-116 Fruit,

bark117

Dried fruits,

Immature fruits 118

Fruit, Bark, and

Seed oil. 119


Drug Review

Cultivation and Collection.

It is found growing at an altitude of 1800 m. it is not cultivated and fruits are

collected from wild grown forest plants.120

Trade and Commerce.

During 93 – 94, 94 –95 and 95 –96 India has exported Myrobalan fruit extract

to the extent of about Rs. 218 lakhs, Rs. 325 lakhs and Rs. 284 lakhs, respectively. 121

Its fruit is sold in the rate of Rs. 40 – 50 per Kg. The fruit powder retail price is Rs.

40-60 per Kg.


Drug Review

Latest research work done showing different actions of Haritaki:

1) Anti oxidant and free radical scavenging activities of terminalia chebula

(G.I.O.P.S., K.M. University, Taiwan)

2) Inhibitory action of water-soluble fraction of terminalia chebula on systemic

and local anaphylaxis (college of pharmacy, chonbuk, South Korea)

3) Antibacterial activity of terminalia chebula against helicobacter pylori (Dept of

Microbiology of Biological Sciences, Tehran, Iran)

4) Inhibition of cancer cell growth by crude extract and the phenolics of

terminalia chebula (Dept. of Chemistry, University of Turk, Finland)

5) Inhibition of HIV-1 integrase by galloyl glucoses from terminalia chebula

(Ahn. M. J., Kim Cr. Lee JS)

6) Potential of the aqueous extract of terminalia chebula as an anticaries agent

(Bombay College of Pharmacy, Mumbai).

7) Animutagenecity of hydrolysable tannins from terminalia chebula in

salmonella typhimurium (Guru Nanak Dev University, Amritsar)

8) Immunosuppressive effects of gallic acid and chebulagic acid on CTL

mediated cytotoxicity (Tokyo Institute of Technology, Yokohama, Japan)


Methodology

Methodology

Tamaka Swasa is a Pranavaha srotojanya vikara, where cold, dust, smoke and

excessive work are the causative factors for it. The severity of the disease is seen during

condition like Meghavarana, Sheeta rutu, Sheeta sthana and excessive intake of Sheeta

jala and purva dishagata vayu according to Ayurveda. In most of atopic subject allergy

out of many factors including exercise, infection and emotional upsets provokes attacks

of Tamaka Swasa.

All age groups of people are prone to get this condition, but it is commonly seen in

early age groups, as Kapha is predominanant and at the late ages as the Vata

dominance.as this disease is Kapha Vata pradhana, and Pitta Sthana samudbhava,

Haritaki is said to be a Tridosha Shyamaka and according to Astang Hridaya Uttaratantra

in Agrya Dravyas Haritaki is a best medicine for Vata Kapha disorders. Protocol of this

study relieves avarodha of Vata by Kapha, Vata Kapha Shyamaka or Tridosha Shyamaka

Dravyas acts on Tamaka Swasa. It is necessary to discuss the materials and methods in

detail.

Materials and Methods

Method of collection of data

1) Patients:

Patients suffering from Tamaka Swasa will be selected from Department of

Dravyaguna Post Graduation Studies and Research OPD of D G Melmalagi

Ayurvedic Medical College and Hospital by present inclusion and exclusion

Criteria.


Methodology

2) Literary:

Literary aspects of study is collected from classical Ayurvedic and modern texts,

Which is discussed widely in literary review.

3) Study design:

Prospective clinical trial

4) Sample size:

Minimum of 30 patients irrespective of sex is under taken in the study.

5) Exclusion Criteria:

1. Patients suffering from any systemic or congenital diseases are excluded

Because, it is very difficult to assess the disease condition with other

Systemic disorders and congenital disease associated.

2. History above 10 years of period are excluded because, commonly history

Above 10 years are chronic asthmatic patients, which falls under the COPD

Conditions, difficult for treatment and also assessment.

3. Patient below 18 years and above 60 years are excluded because, study

restricted only to adults, the drug efficacy cannot be assessed in full length.

4. Status asthmatics are excluded because this condition is chronic and needs

hospitalization with supervision.

5. Pregnant and lactating women are excluded because, Haritaki is contra

indicated in pregnant women.


Methodology

6) Inclusion Criteria:

1. Patients having stated lakshana as per Ayurvedic classics are included

Because, they are the prime subjective parameters of assessment.

2. Patients between 18 to 60 years irrespective of sex are included because,

restriction of the study.

3. History below 10 years are included because, the disease said as Kasta sadhya

from the Ayurvedic classics.

7) Criteria of Diagnosis:

The sign and symptoms of Tamaka Swasa mentioned in the Ayurvedic texts and

objective investigations mentioned in contemporary texts are the criteria for the

diagnosis.

8) Posology:

Haritaki Phala Churna – 3 gms / per day in divided doses

500 mg 1 capsule = 2 capsule TID.

Anupana – Sukoshna jala.

9) Study Duration:

45 Days.

10) Follow up:

15 Days.

11) Assessment of Results:

Results are assessed from subjective and objective parameters of base line data

of before and after treatment as discussed in the result section. The cumulative of the

drug over disease and the body are considered here.


Methodology

12) Subjective parameters:

As explained in classical Ayurvedic texts and modern texts the subjective

Parameters are noted here under are vividly discussed in the literary review –

1. Teevra vega Swasa – Swasa Krichrata (Dyspnonea).

2. Kasa (Cough).

3. Dukhena Kapha nissaranam (Expectoration).

4. Ghurghuratwam (Wheezing).

5. Peenasa (Coryza).

6. Kruchrena bhasate (Difficulty in speech).

7. Kantodhwamsham (Hoarseness of voice).

8. Greevashirasangraha (headache & Stiffness).

9. Urah Peeda (Chest pain).

10. Shayane Swasa peedita (Discomport at supine).

13) Objective parameters:

As explained in different texts the objective parameters are noted here under

are vividly discussed in the context of examination of patient in the same

chapter

1. Peak expiratory flow rate.

2. Breath holding time.

3. Absolute Eosinophil counts.

4. Erythrocyte sedimentation rate.

5. Chest X-Ray.


Methodology

14) Statistical analysis:

The parameters, Subjective and Objective parameters are tested with the

paired, and un-paired T- test and non-parametric test used for the testing of hypothesis. If

p<0.05, the test is highly significant.

15) Examination of a Tamaka Swasa Patient vis-à-vis asthma:

1) Demographic data:

The patient identity is diagnosing the disease as Ayurveda specific the Sadhya

and Asadhya based on age and relative factors such as Desha, Kala etc. thus Name, Age,

Gender, Occupation, Economical status, Birth data and Food habits are recorded in the

demographic data of the case sheet along with the consent signed.

2) Chief complaints (Subjective Parameters) and Associated complaints:

The symptoms enumerated in the classical textbooks and contemporary systems

are detailed for the studies are noticed here under the pre prescribed grades of

declaration. The detailed discussion is made in the literary review. The grades of

observation are as follows.

Swasa Kricchrata - 0 – Normal – No symptoms.

Teevra vega Swasa - 1 – Mild – breathless with activity, frequency 1-2 times/ week

2 – Moderate – breathless with talking, frequency 2-4

times / week.

3 – Severe – breathless at rest, frequency 4 to 6 times/week,

limited activity.

Kasa - 0 – Normal – No cough.

1 – Mild – morning bouts or after exercise-don’t disturb work.


Methodology

2 – Moderate – continuous cough during day and morning

disturbing work.

3 – Severe – continuous and night cough disturb activities.

Dukhena kapha 0 – Normal – no phlegm.

Nissaranam 1 – mild – less than 2.5 ml/day without pain.

2 – Moderate – 2.5 ml to 15 ml/day with mild pain.

3 – Severe – 15 to 25 ml/day with pain.

Ghurghurthwam - 0 – Normal – No wheezing.

1 – Mild – moderate wheezing at mid to end respiration, brief,

not more than 1 to 2 times / week.

2 –moderate – loud wheezes through out expiration, not more

than 2 to 4 times / week.

3 – Severe – loud inspiration and expiration wheeze, more than

4 to 6 times / week.

Peenasa - 0 – Normal – no common cold & cough.

1 – mild – initially present or occasionally.

2 –moderate – continuous days with cough.

3 – Severe - continuous day and night.

Krucchena bhasate – 0 – Normal – difficult to speak.

1 – Mild – able to speak in sentences.

2 – Moderate – able to speak in phrases.

3 – Severe – able to speak in words.

Kantodwamsa 0 – Normal – hoarseness of voice.


Methodology

1 – Mild – 0 or 1 bout while speaking sentence.

2 – Moderate – 1 or 2 bout while speaking phrase.

3 – Severe – associated with words and phrase.

Greeva shira 0 – Normal – no symptoms.

Sangraha - 1 – Mild –occasionally.

2 – Moderate – 1 to 2 times in a week.

3 – Severe – 2to 4 times or often.

Uraha peeda - 0 – Normal – no chest tightness.

1 – Mild – able to tolerate the tight or pain.

2 – Moderate – persists during cough + mild differs.

3 – Severe – feels difficulty to tolerate pain and tightness.

Shayanasya Swasa 0 – Normal – no discomfort.

Peedita - 1 – Mild - < 1 or 2 time / month.

2 – Moderate – 2 time / week.

3 – Severe - > or frequently

3) History of present illness:

At the history of present illness, Mode of onset, Course, Frequency of attack,

Duration of attack, Mode of progress, Periodicity, Preceded by what factors, Sputum,

Aggravating factors and Comfort posture at attack are discussed as listed in the annex-1

(Case Sheet).

4) Personal history:

The personal history is discussed as – Food habits with reference to taste, Taste

preferred, Agni, Kosta, Nidra, Addictions, Bowel habits, Menstrual history, Family


Methodology

history – specific if any has the same disease, Treatment history and History of past

illness.

5) Examination of Patients (RS):

The sequence of the Respiratory Examination done in two position 1) Patient

supine or seated, examining anteriorly and patient in sitting position, examining

posteriorly along with the standard inspection, palpation, percussion and auscultation.

Apart from these under the headings of Darshana, Sparshana, Akotana, Shravana are sub

classified with symptoms for convenience of study. They are as follows –

Patient supine or seated, examining anteriorly

Inspection:

Respiratory rate, depth.

Muscle use.

Respiratory distress.

Chest wall anomalies.

Palpation:

Tracheal position.

Thoracic excursion.

Abdominal, costal paradox.

Percussion:

Auscultation:


Methodology

Patient in sitting position, examining posteriorly

Inspection:

Anomalies of spine and back.

Palpation:

Thoracic excursion.

Percussion:

Diaphragmatic excursion.

Auscultation:

Breath sounds, adventitious sounds

Transmission of sounds.

Darshana (Inspection) Shape

Movement

Resp. Rhythm

Respiration

Accessory muscles

Inter coastal spaces

Visible veins

Venous pulses

Sparshana (Palpataion) Tracheal position

Pain / Tenderness

Swelling

Vocal fremitus

Shape


Methodology

Lymph nodes

Akotana (Percussion) As dull, resonant etc

Shravana (Auscltation) Type of breath

Vocal resonance

Respiratory Sounds

6) Ayurvedic examination

In Ayurvedic examination Dosha Vrudhi, Kshaya lakshanas are examined along

with the Desha vidha and Astasthsna pareeksha. The emphasis of the Agni is made

specially. The Srotas is important to examine for the disease diagnosis, as it is one of the

Samprapti Ghataka. Thus the Pranavaha, Annavaha and Udakavaha Srotases are

examined with their vitiated symptoms.

7) Observation of Pancha Lakshana Nidana

The Pancha Lakshana Nidana i.e. Nidana, Poorva rupa, Lakshana along with the

Upashaya and Anupashaya are examined according to the classical references as detailed

in the annex-1.

8) Investigation and Objective parameters

The investigations and objective parameters considered in the study are –

a) Breath holding time

b) Peak expiratory flow rate

c) Absolute eosinophilic count

d) Erythrocytes sedimentation rate


Methodology

a) Breath holding time

Breath in can be held for variable period of time by different individuals

depending upon the functional states of lungs development of respiratory muscles

practice, age, and sex etc. the normal BHT after deep inspiration may vary from 40

seconds to over a minute. The BHT decreases in many diseases such as chronic

bronchitis emphysema, asthma, and etc. of lung disease.

Procedure:

Breath holding time (BHT) is a simple test, in which, ask the patient to take

a deep breath and count the time in seconds.

Grading of BHT

BHT Grades are declared for sake of final assessment is as follows.

Grade 0 30 and above

Grade 1 30 to 20

Grade 2 20 to 10

Grade 3 10 and below.

b) Peak expiratory flow rate

The Wright’s peak flow meter, introduced in 1959 is a simple, portable device.

PEFR has a very good correlation with FEVI and for measuring the ventilatory

functions of lungs. This simple objective measurement of lung function helps

detecting early deterioration of lung function. Measurement of PEFR is valuable in

medical care settings to measure response to therapy during an acute exacerbation.

Out of function, the PEFR is more useful.


Methodology

Procedure

Step 1) ask patient to hold PEFR in position

Step 2) let the patient take a deep breath in

Step 3) patient keep the PEFR instrument in the mouth with out any

Leakage of air from sides in to flow meter with a sharp blast

Step 4) the movement of the needle on the dial indicates the PEFR in

Liters / minute, which is to be noted

Taken 3 readings at one minute intervals and recorded the average of higher

readings brought to the needle back to zero by pressing the button located near the

mouth piece. Normal range of PEFR is 350 – 500 liters/ minute.

Grading of PEFR

PEFR Grades are declared for the sake of final assessment is as follows.


Grade 1 350 to 250

Grade 2 250 to 150

Grade 3 150 and below

c) Absolute Eosinophilic count

Eosinophils are important in the defence against parasites, worms, and to any

infection. Because they are also sensitive to circulating allergens (materials that

trigger allergies), Eosinophils increase in number allergic reactions as well. Thus the

Absolute Eosinophils Count is a good parameter to study the Asthma. Normal range

of AEC is 40 to 440.


Methodology

Grading of AEC

AEC Grades are declared for the sake of final assessment it as follows.

Grade 0 240 and below

Grade 1 240 to 440

Grade 2 440 to 640


d) Erythrocytes Sedimentation Rate

Westergren’s method (pipette method) Erythrocytes sedimentation rate

measures in the graduated tubes facilitate to understand possible presence of organic

disease. It is universally accepted that it is a good prognostic method in clinical

laboratory.

Procedure:

Step 1) draw the sufficient blood sample from patient vein

Step 2) add anti coagulant to the blood

Step 3) suck the blood in to the ESR tube

Step 4) note the point of sedimentation on graduated tube

d) Chest X- Ray

X – Ray taken during an acute attack of uncomplicated Asthma resembles

those of patients with pulmonary emphysema.

9) Differential diagnosis

It is observed that the Tamaka Swasa for the differences of diagnosis as told

in Ayurveda texts viz. Santamaka and Pratamaka with its stipulated symptoms.


Methodology

10) Result declaration

Result declaration is made upon the cumulative assessment of the parameters.

Out of Subjective parameters, Teevravega Swasa, Kasa and Uraha peeda were

considered. At the Objective parameters BHT, PEFR and AEC are considered. The

result is declared as Well Responded, Moderately Responded, Poorly Responded and

Not Responded categories. The discontinued patients were not considered for the

result declaration.


Results

Results

Table showing the demographic data

Table – 20 showing the demographic data S.No OPD Age Gender Religion Occupation Economical

Status

Food

Habits

Result

1 5043 30 Male Hindu Active HM Veg MR

2 5046 38 Female Hindu Active Middle Veg MR

3 5050 38 Male Hindu Active Middle Veg MR

4 5053 48 Male Hindu Sedentary Middle Mix PR

5 5054 49 Male Hindu Sedentary Middle Veg PR

6 5055 30 Male Hindu Active Middle Mix WR

7 5052 49 Male Hindu Active Middle Mix PR

8 5056 29 Male Hindu Active HM Mix MR


10 5060 38 Male Hindu Active Middle Mix MR


12 5061 49 Female Hindu Sedentary Middle Veg NR

13 5062 36 Male Hindu Labor Poor Veg MR

14 5064 43 Female Hindu Labor Poor Veg PR

15 5077 47 Male Hindu Sedentary Middle Mix PR

16 5079 20 Female Hindu Labor Middle Veg WR

17 5075 48 Male Muslim Sedentary HM Mix PR


Results

18 5081 37 Male Hindu Labor Poor Mix MR

19 5084 43 Male Hindu Active Middle Mix PR

20 5085 41 Female Hindu Active Middle Veg PR

21 5087 46 Female Hindu Labor Poor Mix PR

22 5088 49 Male Hindu Labor Poor Mix NR

23 5089 39 Female Hindu Active Poor Mix MR

24 5092 33 Male Hindu Active Middle Mix MR

25 5093 48 Male Hindu Labor Poor Mix PR

26 5095 49 Male Hindu Sedentary Middle Mix NR

27 6000 48 Male Muslim Labor Poor Mix PR

28 6001 46 Female Hindu Active Middle Veg PR

29 6008 49 Female Hindu Labor Poor Mix NR

30 6010 50 Male Muslim Sedentary Middle Mix NR


Results

Distribution of patients by age

Table –21 Showing Distribution of patients by age

Age Male % Female % Total %

20 – 30 5 16.66 1 3.33 6 20

30 – 40 5 16.66 2 6.66 7 23.33

40 – 50 11 36.66 6 20 17 56.66

Total 21 70 9 30 30 100

Resulting of patient by age

Table –22 Showing Resulting of patient by age

Age

Tota

l no

of

patie

nts

%

Wel

l R

espo

nded

% M

oder

atel

y R

espo

nded

%

Po

orly

R

espo

nded

%

Not

R

espo

nded

%

Total 30 100 4 13.33 9 30 12 40 5 16.67

20 – 30 6 20 2 6.66 3 10 1 3.33 0 0

30 – 40 7 23.33 1 3.33 2 6.66 3 10 1 3.33

40 – 50 17 56.66 1 3.33 4 13.33 8 26.67 4 13.33


Results

Resulting of patient by gender

Table –23 Showing Resulting of patient by gender G

ende

r

Tota

l no

of

patie

nts

%

Wel

l R

espo

nded

% M

oder

atel

y R

espo

nded

%

Po

orly

R

espo

nded

%

Not

R

espo

nded

%

Male 21 70 3 10 6 20 9 30 3 10

Female 9 30 1 3.33 3 10 3 10 2 6.66

Total 30 100 4 13.33 9 30 12 40 5 16.67

Graph –1 Distribution of patient by Age – Gender Pictorial presentation

5

1

5

2

11

6

02468

1012

20 - 30 30 - 40 40 - 50

Male

Female


Results

Distribution of patients by Religion

Table –24 Showing Distribution of patients by Religion Religion Male % Female % Total %

Hindu 18 60 9 30 27 90

Muslim 3 10 0 0 3 10

Christian 0 0 0 0 0 0

Others 0 0 0 0 0 0

Total 21 9 30 100

Graph 2 Distribution of patients by Religion

Muslim

Christian

Other

Hindu


Results

Results of Patient by Religion Table –25 Showing Results of Patient by Religion Religion

Tota

l no

of

patie

nts

%

Wel

l R

espo

nded

% M

oder

atel

y R

espo

nded

%

Po

orly

R

espo

nded

%

Not

R

espo

nded

%

Hindu 27 90 3 10 9 30 11 36.67 4 13.33

Muslim 3 10 1 3.33 0 0 1 3.33 1 3.33

Christian 0 0 0 0 0 0 0 0 0 0

Others 0 0 0 0 0 0 0 0 0 0

Total 30 4 9 12 5

The results of Religion category as depicted in the table are encouraging. Here we

observe an over all well responded 4 patients with moderately responded 9 patients out of

30 patients.

Distribution of patients by Occupation

Table –26 Showing Distribution of patients by Occupation

Occupation Male % Female % Total %

Sedentary 6 20 1 3.33 7 23.33

Active 10 33.33 4 13.33 14 46.66

Labor 5 16.67 4 13.33 9 30

Total 21 70 9 30 30


Results

Graph -3 patients by Occupation

Labor

Active

Sedentary

Sedentary

Active

Labor

Results of patients by Occupation Table –27 Showing Results of patients by Occupation

Occ

upat

ion

Tota

l no

of

patie

nts

%

Wel

l R

espo

nded

% Mod

erat

ely

Res

pond

ed

%

Po

orly

R

espo

nded

%

Not

R

espo

nded

%

Sedentary 7 23.33 0 0 1 3.33 3 10 3 10 Active 14 46.66 3 10 4 13.33 6 20 1 3.33 Labor 9 30 1 3.33 4 13.33 3 10 1 3.33 Total 30 4 9 12 5 The results of Occupation category as depicted in the table are encouraging. Here

we observe an over all well responded 4 patients with moderately responded 9 patients

out of 30 patients. A maximum 12 patients are exhibited with poor response and in the

not responded as per the occupation differentiation as tabulated above.


Results

Distribution of patient by Economical status.

Table –28 Showing Distribution of patient by Economical status

Economical

status

Male % Female % Total %

Poor 5 16.67 4 13.33 9 30

Middle 13 43.33 5 16.67 18 60

Higher Middle 3 10 0 0 3 10

Higher 0 0 0 0 0 0

Total 21 9 30

Results of patients by Economic status

Table –29 Showing Results of patients by Economic status

Economical Status

Tota

l no

of

pa

tient

s

%

Wel

l R

espo

nded

% M

oder

atel

y R

espo

nded

%

Po

orly

R

espo

nded

%

Not

R

espo

nded

%

Poor 9 30 1 3.33 3 10 4 13.33 1 3.33

Middle 18 60 3 10 5 16.67 7 23.33 3 10

Higher

Middle

3 10 0 0 1 3.33 1 3.33 1 3.33

Higher 0 0 0 0 0 0 0 0 0 0

Total 30 4 9 12 5


Results

The results of Occupation category as depicted in the table are encouraging. Here we

observe an over all well responded 4 patients with moderately responded 9 patients out of

30 patients. A maximum 12 patients are exhibited with poor response and in the not

responded as per the occupation differentiation as tabulated above.

Graph-4 patients by Economic status

9

18

3

002468

1012141618

Poor Middle Highermiddle

Higher

Distribution of patient by Food Habits Table –30 Showing Distribution of patient by Food Habits Food Habits

Male % Female % Total %

Vegetarian 4 13.33 6 20 10 33.33 Mixed diet 17 56.67 3 10 20 66.67 Total 21 9 30


Results

Graph – 5 Distribution of patient by Food Habits

0 5 10 15 20 25

Vegitarian

Mixed Diet

Data Related to the Disease Distribution of patients by presenting complaints

As explained in the literary review, the symptoms that are taken as subjective

parameters are evaluated as this study under the heading of Tamaka Swasa vis-à-vis

Bronchial Asthma with the presenting complaints are put forth here. The first and fore

most complaint in Tamaka Swasa, Teevra vega Swasa – Swasa Kruchrata (Dyspnonea)

Ghurghuratwam (Wheezing) with all patients involved. 27 patients are included with the

Dukhena Kapha nissaranam (Expectoration) and Kasa (Cough). Later to that the

symptoms Peenasa (Coryza), Uraha peeda (Chest pain), Shayane Swasa peedita

(Discomfort at supine) and Kruchrena bhasate (Difficulty in speech) are also seen

enlisted in the table below.


Results

Presenting Complaints

Table –31 Showing Presenting Complaints

Presenting Complaints Patients %

Teevra vega Swasa (Dyspnonea) 30 100

Kasa (Cough) 27 90

Dukhena Kapha nissaranam (Expectoration) 27 90

Ghurghuratwam (Wheezing) 30 100

Peenasa (Coryza) 25 83.33

Kruchrena bhasate (Difficulty in speech) 18 60

Kantodhwamsham (Hoarseness of voice) 9 30

Greevashirasangraha (Headache and Stiffness) 17 56.67

Uraha peeda (Chest pain) 23 76.67

Shayane Swasa peedita (Discomfort at supine) 24 80


Results

Graph –6 Graphical presentation of patients by presenting complaints

3027 27

3025

18

9

1723 24

05

101520253035

Dyspnonea

Cough

Expec

toration

Wheezin

g

Coryza

Difficu

lty in

spee

ch

Hoarsen

ess o

f voice

Haedac

he & Stiff

ness

Chest p

ain

Discomfort

at su

pine


Results

Distribution of patients by Associated features

Table –32 Showing Distribution of patients by Associated features

Presenting Associated features Patients Percentage

Anidra (Disturbed sleep) 14 46.67

Pratamyati or Bhrushamatra (Distressed) 6 20

Aruchi (Anorexia) 9 30

Vishukasyata (Dryness of mouth) 12 40

Lalata sweda (Sweat over forehead) 8 26.67

Trushna (Thirst) 9 30

Angamarda (Malaise) 16 53.33

Kampa (Tremors) 2 6.67

Jwara (Fever) 4 13.33

Pramoha (Fainting) 0 0

Vamathu (Nausea) 3 10

Muhur Swasa (Frequent respiration) 16 53.33

Muhuchaiva dhamyati (Puts all effort to breath) 7 23.33

Muhur Swasa along with Anidra and Angamarda are the major Associated

symptoms observed. Pramoha and Kampa are the symptoms seldom witnessed. Other

wise all symptoms are some or the other time expressed by the patients. All the

observations pertained, are the enlisted in the above table. The pictorial expression is as

follows below,


Results

Graph - 7 Graphical presentation of patient by Associated features

14

69

12

8 9

16

24

03

16

7

02468

1012141618

Ani

dra

Prat

amya

ti or

Bhr

usha

mat

ra

Aru

chi

Vish

ukas

yata

Lala

ta s

wed

a

Trus

hna

Ang

amar

da

Kam

pa

Jwar

a

Pram

oha

Vam

athu

Muh

ur s

was

a

Muh

ucha

iva

dham

yati

Distribution of patients by Mode of On set

As the mode of onset is observed more gradual onset patients are listed. In this

study sudden onset patients express only response to the management, enlisted below.


Results

Results of patients by mode of onset

Table –33 Showing Results of patients by mode of onset

Mode of Onset

Tota

l no

of

patie

nts

%

Wel

l R

espo

nded

% M

oder

atel

y R

espo

nded

%

Po

orly

R

espo

nded

%

Not

R

espo

nded

%

Gradual 23 76.67 4 13.33 8 26.67 8 26.67 3 10

Sudden 7 23.33 0 0 1 3.33 4 13.33 2 6.67

Total 30 4 9 12 5

Graph – 8 of patients by mode of onset

23

7

0

5

10

15

20

25

Gradual Sudden

It is observed that people of episodic are more than that of either continuous or

initially episodic patients in this study as enlisted and expressed in the Graph.


Results

Distribution of patients by frequency of attack

Table –34 Showing Distribution of patients by frequency of attack

Frequency Patient Percentage

Few hours 2 6.67

Few Weeks 9 30

Few days 19 63.33

Total 30 100

Distribution of patients by Duration of attack

Table –35 Showing Distribution of patients by Duration of attack

Duration Patient Percentage

Continuous 4 13.33

Intermittent 13 43.33

Subsides with medication 13 43.33

Total 30 100

Distribution of patient by mode of progress

Table –36 Showing Distribution of patient by mode of progress

Mode of progress Patient Percentage

Typical 11 36.67

Rapid 6 20

Long term progress 13 43.33

Total 30 100


Results

Distribution of patient by Periodicity

Table –37Showing Distribution of patient by Periodicity

Periodicity Patient Percentage

Seasonal 7 23.33

Irregular 18 60

Permanent 5 16.67

Total 30 100

Distribution of patient by Preceding Factors

Table –38 Showing Distribution of patient by Preceding Factors

Preceding Factors Patient Percentage

Sneezing 9 30

Nasal irritation 5 16.67

Cough with Nasal irritation 16 53.33

Total 30 100

The listed tables are expressive of the contents. In this Distribution of patient by

mode of progress and Distribution of patient by Periodicity to Distribution of patient by

Preceding Factors it is expressed that the typical progress, irregular periodicity and cough

and sneezing as precipitating factors of the Tamaka Swasa. Thus the statements drown at

the observations are supportive to the pathogenesis of the disease Tamaka Swasa.

Distribution of patients by aggravation factors

Table –39 Showing Distribution of patients by aggravation factors

Aggravation factors Patient Percentage

Dust 7 23.33

Smoke 4 13.33

Both of above 19 63.33

Total 30 100


Results

Distribution of patients by Comfort Posture at attack

Table –40 Showing Distribution of patients by Comfort Posture at attack

Comfort Posture Patient Percentage

Sitting 14 46.67

Lying 3 10

Sitting & Forward bending 13 43.33

Total 30 100

The listed tables are expressive of the contents. In this Distribution of patients by

aggravation factors and Distribution of patients by Comfort Posture at attack it is

expressed that the dust and smoke are the aggravating factors and where in the sitting

posture offers the comfort to the patients of Tamaka Swasa. Thus the statements drown at

the observations are supportive to the pathogenesis of the disease Tamaka Swasa.

Distribution of patients by Agni

Table –41 Showing Distribution of patients by Agni

Agni Patient Percentage

Samagni 6 20

Vishamagni 8 26.67

Mandagni 16 53.33

Total 30 100

Distribution of patients by Bowel habits

Table –42 Showing Distribution by Bowel habits of patients

Bowel habits Patient Percentage

Constipation 11 36.67

Loose 0 0

Normal 19 63.33

Total 30 100


Results


Agni and Distribution of patients by Bowel habits it is expressed that the Mandagni

patients are predominately susceptible for Tamaka Swasa along with normal bowel

habits. Thus the statements drown at the observations are supportive to the pathogenesis

of the disease Tamaka Swasa.

Distribution of patients by Addiction

Table –43 Showing Distribution of patients by Addiction

Addiction Patient Percentage

Tobacco 5 16.67

Alcohol 1 3.33

Alcohol + Tobacco 7 23.33

Drugs 0 0

Total 13 43.33


Addiction it is expressed that the addictions are the aggravating factors in which alcohol

and tobacco-consuming patients of male category are recorded. Thus the statements

drown at the observations are supportive to the pathogenesis of the disease Tamaka

Swasa.

Distribution of patients by Prakruti

Table –44 Showing Distribution of patients by Prakruti

Prakruti Patient Percentage

Vata 2 6.67

Pitta 0 0

Kapha 1 3.33

Vata Pitta 5 16.67


Results

Vata Kapha 17 56.67

Pitta Kapha 5 16.67

Tridosha 0 0

Total 30 100


Prakruti it is expressed that the prakruti impact over the Tamaka Swasa. In which Vata

Kapha patients of category are recorded maximum. Thus the statements drown at the

observations are supportive to the pathogenesis of the disease Tamaka Swasa.

Distribution of patients by Dosha Vruddhi

Table –45 Showing Distribution of patients by Dosha Vruddhi

Dosha Dosha Vruddhi Patient Percentage

Karshya 6 20

Karshnya 9 30

Ushna kamitwa 21 70

Kampa 3 10

Anaha 5 16.67

Shakrudgraha 3 10

Balabhramsha 2 6.67

Nidrabhramsha 19 63.33

Pralapa 0 0

Vata

Bhrama 0 0

Peeta mootrata 0 0

Peetanetra 0 0

Peetavit 0 0

Peetatwak 0 0

Adhikshudha 4 13.33

Pitta

Adhidaha 0 0

Agni sadana 11 36.67


Results

Praseka 6 20

Alasya 13 43.33

Kapha Swetangata 7 23.33

Sheetangata 21 70

Gowrava 12 40

Slatangata 0 0

Swasa 30 100

Kasa 28 93.33

Atinidra 0 0


Dosha Vruddhi it is expressed that the Dosha Vruddhi impact over the Tamaka Swasa. In

which Vata lakshana patients of category are recorded maximum with Ushna kamitwa

and Nidrabhramsha. Pitta predominant symptoms noted are Adhika kshudha. Kapha

related symptom Swasa is the pratyatma niyata lakshana seen in all patients along with

Kasa, Sheetangata and Alasya. Thus the statements drown at the observations are

supportive to the pathogenesis of the disease Tamaka Swasa.


Results

Distribution of patients by Dosha Kshaya

Table –46 Showing Distribution of patients by Dosha Kshaya

Dosha Dosha Kshaya Patient Percentage

Angasada 5 16.67

Alpabhashite ahitam 0 0

Chesta heenata 0 0

Vyamoha 0 0

Vata

Sleshma Vruddhi 0 0

Mandagni 16 53.33

Shareera sheetatwam 21 70

Pitta

Prabha hani 0 0

Bhrama 0 0

Uraha shoonyata 0 0

Shira shoonyata 0 0

Hridrava 0 0

Kapha

Sandhi saithilya 0 0


Dosha Kshaya, it is expressed that the Dosha kshaya impact over the Tamaka Swasa. In

which Vata lakshana patients of category are recorded with Angasada. Pitta preminant

symptoms noted are Shareera sheetatwam and Mandagni. Kapha related symptoms are

not seen in any patients. Thus the statements drown at the observations are supportive to

the pathogenesis of the disease Tamaka Swasa.


Results

Distribution of patients by Ahara Nidana

Table –47 Showing Distribution of patients by Ahara Nidana

Dosha Ahara Nidana Patient Percentage

Vishamasana 5 16.67

Adhyasana 9 30

Anasana 1 3.33

Sheetashana 0 0

Visha 0 0

Sheetapana 27 90

Vata

Rukshanna 25 83.33

Tilataila 0 0

Pitta Vidahi 0 0

Pistanna 5 16.67

Nispava 0 0

Saluka 0 0

Guru dravyas 20 66.67

Jalajamamsa 8 26.67

Anupa mamsa 10 33.33

Abhishyandi 22 73.33

Masa 6 20

Dadhi 21 70

Vistambhi 4 13.33

Amakshira 0 0

The listed tables are expressive of the contents. In this Distribution of patients by Ahara

Nidana it is expressed that the Ahara Nidana impact over the Tamaka Swasa. In which

Vata Ahara Nidana consuming patient of category Sheeta pana and Rookshanna are

recorded with Adhyasana. Pitta Ahara are not seen. Kapha related Nidana are


Results

Abhishyandi and Dadhi. Thus the statements drown at the observations are supportive to


Distribution of patients by Vihara Nidana

Table –48 Showing Distribution of patients by Vihara Nidana

Vihara Nidana Patient Percentage

Rajas (V) 30 100

Vata (V) 30 100

Sheeta sthana (V) 0 0

Sheeta ambu (V) 13 43.33

Ativyayama (V) 8 26.67

Abhighata (V) 0 0

Dhuma (V) 12 40

Apatarpana (V) 3 10

Bharakarshita (V) 1 3.33

Adhwahata (V) 9 30

Kanthapratighata (V) 0 0

Karmahata (V) 0 0

Veganirodha (V) 6 20

Shuddhi Atiyoga (V) 0 0

Gramya dharma (V) 0 0

Urahapratighata (V) 0 0

Marmabhighata (V) 0 0

Ushna (P) 0 0

Abhishyandi Upachara (K) 0 0

Divaswapna (K) 5 16.67


Vihara Nidana it is expressed that the Vihara Nidana impact over the Tamaka Swasa. In

which Vata Vihara Nidana consuming patients of category Rajas and Vata are recorded


Results

with Sheetambu sevana and Karmahata. Pitta Vihara are not seen. Kapha related Vihara

Nidana is Divaswapna. Thus the statements drown at the observations are supportive to


Distribution of patients by Anya Nidana

Table –49 Showing Distribution of patients by Anya Nidana

Dosha Anya Nidana Patient Percentage

Kshatakshaya 0 0

Udavarta 0 0

kshaya 0 0

Atisara 0 0

Vibandha 11 36.67

Anaha 5 16.67

Visuchika 0 0

Panduroga 0 0

Vata

Dourbalya 2 6.67

Rakta pitta 0 0

Pitta Jwara 4 13.33

Kasa 28 93.33

Pratishyaya 19 63.33

Amapradosha 0 0

Amatisara 0 0

Kapha

Chardi 5 16.67

The listed tables are expressive of the contents. In this Distribution of

patients by Anya Nidana, it is expressed that the Anya Nidana impact over the Tamaka

Swasa. In which Vata Anya Nidana consuming patients of category Vibandha and Anaha

are recorded with Dourbalya. Pitta Anya nidana only Jwara is recorded. Kapha related

Anya Nidana are Kasa and Pratishyaya along with Chardi for 5 patients. Thus the


Results

statements drown at the observations are supportive to the pathogenesis of the disease

Tamaka Swasa.

Distribution of patients by Srotas

Table –50 Showing Distribution of patients by Srotas

Srotas Patient Percentage

Atisrustam 21 70

Kupitam 17 56.67

Alpalpa 21 70

Ati badham 10 33.33

Abheeknam 15 50

Pranavaha

Sashoolam 12 40

Aruchi 12 40

Chardi 5 16.67

Ajeerna 11 36.67

Annavaha

Anannabhilasha 5 16.67

Jihwashosha 6 20

Ostashosha 6 20

Talushosha 4 13.33

Udakavaha

Pipasa 16 53.33

The listed tables are expressive of the contents. In this Distribution of

patients by Srotas, it is expressed that the Srotas examination in Tamaka Swasa. In which

Pranavava Srotas symptoms are predominant in patients as Atisrusta, Alpalpa,


Results

Abheeshana and sashoola. On the other hand symptoms of Annavaha Srotas also

expressed as Aruchi and Ajeerna. Out of Udakavaha Srotas Pipasa is predominant. Thus

the statements drown at the observations are supportive to the pathogenesis of the disease

Tamaka Swasa.

Distribution of patients by Poorva Roopa

Table –51 Showing Distribution of patients by Poorva Roopa

S.No Poorva Roopa Patient Percentage

1 Hrutpeeda 7 23.33

2 Kshudr Swasa 9 30

3 Shakha bheda 12 40

4 Shoola 3 10

5 Pranavilomata 18 60

6 Vaktra vairasya 0 0

7 Parhwashoola 13 43.33

8 Vibandha 11 36.67

9 Anaha 5 16.67

10 Arati 13 43.33

11 Bhakta dwesha 15 50

12 Admana 0 0


Poorva Roopa, it is expressed that the Poorva Roopa examination in Tamaka Swasa. In

which Prana vilomata, Parshwa shoola, Arati and Bhakta dwesha are predominant.


Results

Occasionally Ksudra swasa and Shankha Bheda are also observed along with other

symptoms enlisted in the tabular statements drawn at the observations are supportive to


Subjective parameter assessment

Table –52 Showing Subjective parameter assessments

Subjective parameter Patients

Before

%

Patients

After

%

Patients

Relived

%

Teevra vega Swasa

(Dyspnonea)

30 100 22 73.33 8 26.67

Kasa (Cough) 27 90 20 66.67 7 23.33

Dukhena Kapha

nissaranam

(Expectoration)

27 90 22 73.33 5 16.67

Ghurghuratwam

(Wheezing)

30 100 22 73.33 8 26.67

Peenasa (Coryza) 25 83.33 17 56.67 8 26.67

Kruchrena bhasate

(Difficulty in speech)

18 60 9 30 9 30

Kantodhwamsham

(Hoarseness of voice)

9 30 5 16.67 4 13.33

Greevashirasangraha

(Headache and

Stiffness)

17 56.67 13 43.33 4 13.33

Uraha peeda (Chest

pain)

23 76.67 15 50 8 26.67

Shayane Swasa peedita

(Discomfort at supine)

24 80 16 53.33 8 26.67


Results

Objective parameters

Table –53 Showing Objective parameters

PEFR BHT AEC ESR

S.No

OPD B A B A B A B A

Result

1 5043 150 270 14 25 500 400 10 8 MR

2 5046 130 260 12 23 500 400 8 6 MR

3 5050 160 290 15 25 450 300 12 10 MR

4 5053 120 250 11 22 450 350 8 10 PR

5 5054 70 160 8 15 650 550 16 14 PR

6 5055 210 370 22 36 450 300 12 12 WR

7 5052 150 240 13 20 500 450 14 12 PR

8 5056 190 350 15 28 550 450 12 14 MR

9 5058 180 380 18 32 550 400 10 8 WR

10 5060 180 290 15 24 550 450 14 12 MR

11 5059 220 380 25 35 450 350 12 8 WR

12 5061 120 230 12 20 600 500 8 6 NR

13 5062 160 310 12 25 550 450 12 10 MR

14 5064 130 300 12 26 550 450 14 12 PR

15 5077 110 200 11 18 550 450 10 6 PR

16 5079 280 400 25 38 450 400 10 8 WR

17 5075 90 140 8 14 650 600 14 14 PR

18 5081 200 310 18 28 500 400 8 9 MR

19 5084 140 240 14 22 500 450 16 14 PR


Results

20 5085 100 170 10 16 600 550 12 10 PR

21 5087 70 150 7 13 650 650 12 14 PR

22 5088 110 190 10 16 600 600 10 10 NR

23 5089 150 270 12 23 500 400 12 12 MR

24 5092 190 350 15 28 550 450 12 14 MR

25 5093 130 200 11 17 600 550 8 6 PR

26 5095 180 240 14 20 450 400 14 10 NR

27 6000 170 260 14 18 550 550 8 8 PR

28 6001 190 280 15 23 550 450 10 12 PR

29 6008 160 240 12 20 550 500 12 10 NR

30 6010 110 190 10 16 600 550 10 8 NR


Results

Statistical Assessment of Subjective Parameters

Table –54 Showing Statistical Assessments of Subjective Parameters

Subjective Parameters Mean SD SE t Value P value Remarks

Teevra vega Swasa

(Dyspnonea)

1.033 0.182 0.332 3.11 <0.005 HS

Kasa (Cough) 0.866 0.434 0.079 10.96 <0.001 HS

Dukhena Kapha nissaranam

(Expectoration)

0.633 0.556 0.1015 6.236 <0.001 HS

Ghurghuratwam (Wheezing) 1.096 0.597 0.108 10.148 <0.001 HS

Peenasa (Coryza) 0.6 0.498 0.0909 6.6 <0.001 HS

Kruchrena bhasate

(Difficulty in speech)

0.433 0.495 0.0909 4.76 <0.001 HS

Kantodhwamsham

(Hoarseness of voice)

0.266 0.492 0.0806 3.3 <0.005 HS

Greevashirasangraha

(Headache and Stiffness)

0.4 0.498 0.0909 4.4 <0.001 HS

Uraha peeda (Chest pain) 0.566 0.504 0.092 6.152 <0.001 HS

Shayane Swasa peedita

(Discomfort at supine)

0.566 0.504 0.092 6.152 <0.001 HS


Results

Statistical Assessment of Objective Parameters

Table –55 Showing Statistical Assessments of Objective Parameters

Subjective

Parameters

Mean SD SE t Value P value Remarks

PEFR 111.67 39.22 7.166 15.58 <0.001 HS

BHT 9.2 2.998 0.545 16.88 <0.001 HS

AEC 83.33 37.9 6.919 12.04 <0.001 HS

ESR 1.833 1.053 0.192 9.546 <0.001 HS

Statistical report of Haritaki Phala Churna in Tamaka Swasa

Among the Objective Parameter all the parameter shows highly significant (as

p<0.001). But there is mostly highly significant in the parameter BHT and PEFR, where

all AEC and ESR shows less significant. The parameter PEFR having more net mean

effect with more variation, where as the parameter ESR having less net mean effect with

less variance (By comparing t-value-value).

Among the Subjective parameters all the parameter shows highly significant, there is

more highly significant in the parameter Kasa and Ghurghuratwam (by comparing p-

value and t-value). The parameter Uraha peeda and Shayane Swasa peedita having equal

significant. The parameter Ghurghuratwam shows high net mean effect with more

variance where as the parameter Kantodhwamsam is having less net mean effect with less

variance (by comparing p-value, t-value, mean and variance).


Results

Over all assessment and Result of the Haritaki Phala Churna inTamaka Swasa

Table –56 Showing Over all assessment and Result

Category Patient Percentage

Well Responded 4 13.33

Moderate Responded 9 30

Poor Responded 12 40

Not Responded 5 16.67

Total 30 100

Graph - 9 Over all assessment and Result of Clinical trail

Moderate respondedPoor

responded

Not responded

Well responded


Discussion

DISCUSSION

In this study the Evaluation of Efficacy of Haritaki Phala Churna in the

management of Tamaka Swasa A prospective clinical study is done.

Tamaka Swasa is one of the important diseases pertaining to the respiratory

disorder. It affects the people of all age groups. It is the serious public health problem in

the countries through out the world. Nearly 5 to 10 % of the world population. The

disease can occur at any age and affects 5 % of adults and 7 – 10 % children commonly.

Between 100 and 150 million people around the globe, suffer from asthma and

this number is rising. Worldwide, deaths from this condition have reached over 180,000

yearly. India has an estimated 15 – 20 million asthmatics; in India rough estimates

indicate a prevalence of between 10 % and 15 % and 15 % in 5 –11 year old children.

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

a unique role in the co – ordination of international efforts against the disease.

International action needed to:

• Increase public awareness of the disease to make sure patients and health

professionals recognize the disease and are aware of the severity of associated

problems;

• Organize and co – ordinate global epidemiological surveillance to monitor global

and regional trends in asthma;

• Develop and implement an optimal strategy for its management and prevention

(many studies have shown that this will result in the control of asthma in most

patients); and


Discussion

• Stimulate research into the causes of asthma to develop new control strategies and

treatment techniques.

Out of the above policies of WHO, the ancient Ayurveda, a medical system of India

places lots of management modalities to neutralize the effect of Tamaka Swasa, a

demon in the present air polluted society. The present trail entitled “ Evaluation of

Efficacy of Haritaki Phala Churna in the management of Tamaka Swasa” is an

optimal strategy to develop and implement a perfect treatment to the Tamaka Swasa

as research stimulation into the causes of asthma.

The Haritaki Phala is used in this study it is considered in Arshoghna gana,

Kusthaghna gana, Kasahara gana, Jwarahara gana, Prajasthapana gana,

Virechanopaga gana. By Charaka, Mustadi gana, Triphala gana, Amalakyadi gana,

Parushakaadi gana. By Sushruta, having Lavana varjita Kashaya pradhana

pancharasa, Ushna Veerya, Laghu Ruksha Guna, Madhura Vipaka, it supports in

treating the Tamaka Swasa.

In Tamaka Swasa there is predominance of Kapha Vata Dosha, here Haritaki is

Tridosha Shyamaka. Haritaki Phala Churna is implemented in this clinical study.

Every possible aspect of the drug Haritaki, botanically known as Terminalia

Chebula Linn. Has been described in drug review section –1. Starting from historical

review various aspects concerning drug Haritaki has been covered. But the less

reference in the Vedic period and the Haritaki is well described at Samhita and

Nighantu period.

Various synonyms have been discussed with their interpretation and classification

considering different aspects. Virtually there is no controversy in drug Haritaki.


Discussion

Brief botanical description of the Terminalia Chebula Linn. Is found in flora of

particular zone and in Indian medicinal plants by Kirtikar & Basu.

Almost all the Nighantukaras described similar Rasa panchaka and rogaghnata.

Properties of the drug Haritaki according to different texts have been described in

a nutshell; other than medicinal uses of Haritaki have been described under separate

heading.

Different preparations in which Haritaki is one of the constituents described are

given with reference.

There is specific Nidana for Tamaka Swasa is not mentioned in classics as it is a

sub type of Swasa roga same nidana are applicable to Tamaka Swasa also. We cannot

find a clear view regarding the patho-physiological changes occurring due to specific

type of Tamaka Swasa Nidana. Chakrapani commenting on the Nidana verses as he

explains about vata prakopaka gana and Kapha prakopaka gana, which are responsible

for the development of Tamaka Swasa.

Nidana parivarjana i.e. prevention of etiological factors as a part of supportive

therapeutic measures of the treatment is idol any time. Especially as Tamaka Swasa

patients are very much exposed to the different verities of the subjects at different times

and places in the atmosphere particularly air and dust, it is very much necessary to

evaluate.

As per the Tamaka Swasa Samprapti is concerned the vitiated Kapha Dosha along

with Vata Dosha obstructs the Srotas to secrete Kapha from Pranavaha Srotas. Here the

Kapha is the normal secretion and is abnormally increased by the vitiated Pranavata.

Further this action adds to the obstruction of the passage where Pranavata gets the Prana


Discussion

vilomata. Narrowing of the pranavaha srotas along with accumulation of Kapha in it

obstructs the smooth flow of Pranavata. Prana vilomata is resultant with turbulent

breathing which leads to abnormal audibility of respiration even to out side or to say

produces wheezing.

In Tamaka Swasa the course of the illness starts from Hridaya said to be afflicted

adds the severity of illness. Kapha Dosha (Dosha) and Rasa Dhatu (Dushya) belonging to

the same category and affliction of Hridaya indicates the acute onset chronic course and

severity of illness.

• Prana vilomata: it is observed as 59.9% it is suggest that the symptom is related to

Prana, Pranavaha srotas and the obstructive phenomenon of it.

• Bhakta dwesha: it is observed as 52.3% patients having symptom Bhakta dwesha

it is suggest that the disease is Amashaya samutha, producing Ahara dwesha.

• Arati and Parshwa shoola: these are observed as 43.3%

• Shankha Bheda: It is a pain condition occurred because of Prana Urdhwa gati and

there by observed as 40%.

• Vibandha: it is observed as 36.6% is because of the Prana Vata Urdhwa gati in

Tamaka Swasa.

Lakshana in Tamaka Swasa:

• Teevra Vega Swasa and Ghurgurukatwam is pratyatma niyata lakshana of

Tamaka Swasa observed 100% in all patients.

• Kasa and dukhene Kapha nissarnam observed almost all i.e.90%.


Discussion

• Peenasa is a relevant disease associated and also a symptom, observed 83.3%.

• Shayane Swasa peeditam, which is causing inconvenience in Tamaka Swasa, is

seen 80% suggests the blockage of Kapha while sleeping.

• Uraha peeda i.e. chest pain is observed as 76.6% as the chest is the seat of disease.

Samprapti Ghataka

• Agni: as Agni is observed it is found that 53.3% of patients are subjected for the

Agnimandya or Mandagni. It is explained in Ayurveda the Mandagni is the root

cause of development of disease and Ama.

• Prakruti: Many patients are of Vata Kapha Prakruti observed in the study 56.6%.

The disease manifest to the people with Vata Kapha people as the disease is of

Kapha Vata Dosha predominant.

• Prana vaha Srotas: 70% of patients are reported with prime symptom of

Pranavaha sroto dushti are Atisrustam and Alpalpam. The adhistana of the vyadhi

is uras i.e. chest in terms of pranavaha srotas, thus the symptoms pertained to that

of pranavaha srotas is relevant.

• Annavaha Srotas: Symptoms observed in this are Aruchi 40% Ajeerna 36.6%. All

the disease manifestation as it is discussed from GIT and that too from stomach.

The importance of Annavaha srotas and Amashaya is relevant with symptoms of

Aruchi exhibited to state the disease is Amashaya samudbhava.

• Udakavaha Srotas: In this category Pipasa is 53.3%. The other symptoms are

Jihwa sosha and Oshtasosha are 20%. The air ventilation is naturally through


Discussion

nasal cavity but when it is not possible gives rise to oral breathing, which causes

the Jihwa sosha, which is a Udakavaha Srotas symptom.

• Onset of disease: The onset is observed, as gradual in many patients is 76.6%. It

suggests that the disease in chirakari and takes the long time to manifest its

symptoms.

• Frequency of attack: it is observed that few day onset is 63.6% in patients.

• Mode of progress: The disease development is long term progress as observed

43.3% in patients.

• Periodicity: An irregular periodicity is observed in the study with 60%.

• Preceding factors: these are sneezing, nasal irritation and cough out of cough is in

53.3% of patient.

• Aggravating factors: Dust and Smoke are observed as the aggravating factors

63.3% of patient.

• Comfort posture: the Comfort posture recorded for the patients are sitting is

46.6%.

Age: More prevalence i.e.56.6% is observed in the category of 50-60 age group. As

observations are noticed it is clearly evidential that the higher age group people are

prone to get this disease because of the decreased lung capacity in terms of Vata

Dosha predominance.

Gender: The male female ratio pf the study is 2:1. it is because of Male dominant

society observing and moving or exposing to the etiology much more than that of


Discussion

Females who are staying at home. Out of which no much gender specifications were

observed as per results are concerned.

Religion: Most of the cases are of Hindu community with 90%. The rest are of

Muslim community with 10%. It may not discriminate the community. As results are

observed 3 patients of well responded are from Hindu community. 1 patients of well

responded are from Muslim community. This may be because of the dietetics (Jalaja

and Anupa Mamsa ) followed at this community.

Occupation: At the study 46.6% of patients show Active Occupation suggests that

people who are exposure to the external atmosphere with pollution are getting the

disease Tamaka Swasa.

Economical status: Middle class people are always recorded much in any study

because of incapability of getting corporate treatment. Here in this study it is 60%.

Dietetic Habits: It is observed that mixed diets practitioners are 66.67%. Mixed diet

practice impacts the result and creates Ama in the body and aggravates the Kapha.

Effect of Haritaki Phala Churna in Tamaka Swasa

The Ayurvedic methods of determining the properties of drugs are evolved from

the observations of their actions and reactions on human beings. The action of drug is

decided in Ayurveda on the basis of Rasa panchaka of drug used and the response of the

body thereupon. Therefore, it is necessary to study carefully the structural units of the

human organism as well as that of drug and also the process of interaction between the

ultimate units of drug and organism. Since in Ayurveda there is no difference between

the physical or pharmacological properties of drug constituents and bodily elements. That


Discussion

is to say, the same laws that regulate the vegetable life are also to be found operating in

animals. Also confirms one of the major principles advocated. Also confirms one of the

major principle advocated by Acharya Charaka –

This is fundamental principle by the application of which mechanism of action of

drug in the body after use could be explained. Here ‘pravrittirubhayasya tu’ may means

interaction in between the properties or ultimate units of body and to that of drug after

their recognition as samanya or vishesha in that particular bio-organic unit and then

effects are produced accordingly i.e. the samanya results increase in their samanya

elements and vishesha decreases.

The other principle of treatment is samprapti vighatana means to dismantle the

samprapti ghatakas of the disease.

In the present study we have assessed the drug Terminalia Chebula (Haritaki) in

Tamaka shwasa. In Tamaka shwasa initially vitiation of jatharagni occurs, leading to

amarasotpatti causing kapha provocation, obstructing natural function of vata resulting in

disease Tamaka shwasa.

Acharya Charaka has clearly stated describing chikitsa of Tamaka shwasa –

Whatever drug, food or drink is alleviative of kapha and vata, and have ushna property

and regulative of the movements of vata, is beneficial for patients afflicted with shwasa.

(C.Ci.17/142).

Haritaki is having ushna veerya and capable of curing shwasa, aruchi etc.

diseases.


Discussion

Charaka also explained that vipaka is potent than rasa, but veerya is even potent

than vipaka (C.Su 26/72).

So keeping in view above explanation, it is presumed that by virtue of ushna

veerya of the test drug Haritaki, it alleviates kapha and vata both, thereby helping in

samprapti vighatana process of Tamaka shwasa. The drug is also efficient in curing

aruchi that means, it also improves the state of jatharagni, the root cause of the disease. In

this way the probable mode of action of Haritaki can be explained.

As per charaka chikitsa 1/33. Haritaki having the Kapha prasekam property and

also Haritaki contains Tannins. Tannic acid is used as an astringent for mucous

membrane of mouth and throat, and employed for soar throat and receding gums.

These properties are much beneficial in treating the Tamaka Swasa.

Haritaki having the Anulomana property in Tamaka Swasa Kapha is Avarana to

Vata and Viloma gati of Pranavata is takes place. Haritaki does the Anulomana of

Vata and helps treat in the Tamaka Swasa.


Conclusion

CONCLUSION

Tamaka Swasa is one of the most distressing diseases and is quite common

among all the socio economic strata in all age groups.

Haritaki (Terminalia Chebula) have the effect on Tamaka Swasa.with dose of

3 gms/day for 60 days Haritaki Phala Churna doesn’t cause any untoward

effect in patients.

Haritaki is said to be a multi purpose useful drug and many Nighantukaras

explains Haritaki is a Sarva Rogahara. Because of it’s having the Rasayana

property.

The Rutu Haritaki will help for to increase the Rasayana property of Haritaki.

As mother is supreme and she always make Hita to their children’s, like that

Haritaki is best for humans. It will not cause any harm to the body. Some

times mother may become angry but use of Haritaki does not make any

complication, hence Haritaki is supreme than mother.

Specific Nidana for Tamaka Swasa is not mentioned in classics as it is a sub

type of Swasa roga same Nidana are applicable to Tamaka Swasa also.

Lakshana (Roopam) of Tamaka Swasa corresponds Vata as well as Kapha

Dosha.

The imbalance of Vata and Kapha Dosha afflicts the Rasa Dhatu in the

pathogenesis of Tamaka Swasa. During the attack of Tamaka Swasa almost all

the symptoms of Kapha Dosha vitiation are mediated through the Rasa Dhatu.


Conclusion

If the Tamaka Swasa is Navovita it is as Sadhya. Sushruta has mentioned

Tamaka Swasa as Krichrasadhya vyadhi and Asadhya in durbala rogi.

Therefore, the Haritaki Phala Churna aimed at the rectification of the

imbalances of Vata Dosha, as well as Kapha Dosha forms the sheet anchor of

treatment of Tamaka Swasa, which is individually opposite.

Beside the treatment, the patients of Tamaka Swasa must follow the regime of

Pathya and Apathya.

Teevra Vega Swasa and Ghurgurukatwam is pratyatma niyata lakshana of

Tamaka Swasa observed 100% in all patients.

Vibandha is observed as 36.6% in patients. Is because of the Prana Vata

Urdhwa gati in Tamaka Swasa.

An effort is made to uproot the ailment in this trail ultimately observed with

the less percentage of maximum relief patients suggests that the Haritaki

Phala Churna is a good choice of palliative medicament in Tamaka Swasa.

Well-responded patients are 4 with 13.3% and Moderately responded patients

are 9 i.e.30%. Poor responded patients are 12 i.e. 40% and 5 patients i.e.

16.6% of Not responded.

Statistically all subjective and objective parameters show Highly significance.

With the above observations it is clear that the Haritaki is used in the study for

the Tamaka Swsa is effective at their functional area to relieve Kapha from

the Pranavaha Srotas.


Conclusion

Scope of further study

• To achieve the aims and objectives of study the maximum work is to

be done to present this clinical study. Even though there is wider scope

to study further.

• In larger samples the study reveals the good sort of results.

• Long standing administrations of medicaments required for long

standing disease.


Summary

SUMMARY

The present study entitled “A Comprehensive study of Haritaki (Terminalia

Chebula Retz.) With special reference to Tamaka Shwasa”, has been carried out to assess

the Shwasahara potential of the drug Haritaki. The whole work has been divided into six

sections viz. Drug review, Disease review, Clinical study, Discussion, Summary and

Conclusion.

Apart from these, a brief preface to the subject is given in the beginning of

the thesis, explaining the priorities of selection of the drugs and the disease, aims and

objects with plan of study.

The first section deals with the comprehensive approach about the drug

Haritaki (Terminalia Chebula Retz.) viz. historical background, review of previous work

on Haritaki, classification, nirukti of word Haritaki, probable origin of the word Haritaki,

synonyms, interpretation and classification of synonyms, vernacular names, botanical

description of the plant, chemical properties and pharmacology of the drug, Rasa

panchaka and guna karmas, properties, therapeutic & other uses, official part, dose

fixation, in Brihattrayi and Laghuttrayi, cultivation, Haritaki on internet and taste

thresholds.

Haritaki finds its mention since Samhita period. Charaka described under

Arshoghna, Kusthaghna, Kasahara, Jwarahara,Prajasthapana and Virechanopaga

deshamani ganas. Acharya Sushruta, Vagbhata and in most of the Nighantus, Haritaki is

advised in the treatment of Shwasa, Aruchi etc. No clinical work on Haritaki as single

drug is reported.


Summary

Thirty-three synonyms of the Haritaki attributed in various granthas, in

which some important are Abhaya, Kayastha, Chetaki, Pathya, Shreyashi, and Amruta.

The fruit of Haritaki is used as medicine; is described by most of authors having

Laghu, Ruksha guna, Lavana varjita Kashaya pradhana pancha rasa, ushna veerya,

Madhura vipaka and Tridosha shamaka

In most of medicinal plant literature, Haritaki has been advised in the treatment of Swasa,

Kasa,Arsha, Gulma, Kushta,Swararoga, Grahaniroga etc. Haritaki is described one of the

constituents of many compounds like Triphala, Agasthya Haritaki, Abhayarishta, Vyagra

Haritaki, Abhayadhi kwatha etc.

In second section, named disease review, there is brief description of the disease

Tamaka Shwasa, covering all the aspects viz. historical review of the disease, review of

the previous work, classification of Shwasa, Nidana, Poorva rupa, Roopa, Samprapti of

Tamaka Shwasa, Upshayanupashaya, Sadhyasadhyata, Chikitsa, Pathyapathya.

In modern parlance Tamaka Shwasa has been correlated with bronchial

asthma. It is a disease characterized by difficulty of breathing, recurring at intervals

accompanied by wheezing, sense of constriction in chest, cough and expectoration. In

this disease there is forceful expiration.

In Ayurvedic classics Tamaka Shwasa has been described due to Vata-

Kapha vitiation causing obstruction to prana vayu and ultimately difficulty in breathing.

In the treatment of Tamaka Shwasa Charaka explained that whatever the drugs, foods and

drinks are alleviative of Kapha and Vata as well as having ushna property and regulating

the movement of Vata are beneficial.


Summary

The fourth section deals with the clinical study. The aim of the clinical

study was to assess the Shwasahara potential of Haritaki, which has been advocated by

most Nighantukaras. Total of 30 patients of Tamaka Shwasa were selected randomly

from O.P.D. of D.G.M.ayurvedic Medical College post graduation dept of Dravya Guna

Vignana. All 30 patients were administered Haritaki Phala choorna capsules in a dose of

1 gm. t.i.d for 45 days. In beginning and end of the treatment, pathological investigations

were carried out.

In this section, observations and then analysis of vital data’s, viz. age, sex

occupation, family history, history of past illness, Nidana, Poorva roopa, Roopa etc. and

effect of drug on cardinal signs and symptoms and overall effect of the therapy were

carried out. The study resulted in 13.33% patients well responded, 30% patients

moderately responded, 40% patients are poorly responded and 16.6% patients not

responded. The outcome of the clinical study confirmed the Shwasahara potential of the

trial drug Haritaki.

The fifth section deals with the discussion on the results obtained from

different studies, in correlation to conceptual study along with logical reasoning to the

significant findings.

The sixth section designated for the summary and conclusion, includes the

ongoing summary as well as the conclusion drawn as under –


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Shloka 51/8-10. pp 762.




Sanskrit samsthana Varanasi,1985.Shloka 12/27-34, pp 296-7.


Samsthana Varanasi, 1969. Shloka 11/29-38. pp 363-4.



Choukambha Surabharati prakashana,Varanasi,1992.Shloka 17/17.pp 533.


Bibliography





161) Bramha shankara. Mishra.editied,Vidyotine commentary on Bhavaprakasha,

Madhyama khanda Swasarogaadhikara,13th chapter,2nd ed, Kashi Samskrit

series –130,Choukambha Sanskrit samsthan ,Varanasi. Shloka 14/4, pp 161.


Sanskrit Samshtana Varanasi, 1998.pp 427.


Sanskrit samsthana Varanasi,1985.Shloka 12/4, pp 283.








167) Ibid, 13/10, pp 183.

168) Ibid, 11/8, pp 156.

169) Yadavaji Trikamji Acharya edited, Charaka Samhita, Sutra, Chakrapani,



170) Ibid, Chikitsa 17/8-9, pp 533.

171) Ibid, 17/17, pp 533.

172) Ibid, 17/55, pp 535.






Bibliography

174) Yadavaji Trikamji Acharya edited, Charaka Samhita, Chikitsa, Chakrapani,

Ayurveda deepika, Choukambha Ayurvijnan Grandhamala. -34,reprint

Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/57pp 535.

175) Ibid, 17/58, pp 535.

176) Ibid, 17/63-4, pp 535.

177) Ibid, 17/62, pp 535.

178) Ibid, 17/63, pp536.

179) K.R.Srikanth murthy ed.Astanga Hridaya, Sutra 3rd ed.Krishnadas academy


180) Yadavaji Trikamji Acharya edited, Charaka Samhita, Nidana, Chakrapani,


Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 1/11, pp 196.

181) Ibid, Chikitsa, 17/63-64, pp 536.

182) Ibid, Sutra, 19/4, pp 110.

183) Ibid, Chikitsa, 17/8, pp 533.

184) Yadhunadhan Upadyaya, Madhava Nidhana, vol 1st, 15th ed, Choukambha

Sanskrit samsthana Varanasi, 1985.Shloka 12/12, pp 286.




186) Ibid, 17/68, pp 536.

187) Ibid, 17/62, pp 535.

188) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Dalhana

commentary, Dalhana Nibandha Sangraha, Choukambha Ayurvijnana

Grandhamala-42, 1st ed, Reprint, Published by Choukambha Surabharati

prakashan, Varanasi, 1994, Shloka 51/13. pp 762.

189) Yadhunadhan Upadyaya, Madhava Nidhana,vol 1st ,15th ed, Choukambha

Sanskrit samsthana Varanasi,1985.Shloka 12/17, pp 290-2.





Bibliography

191) Antony Seaton, et.al, Crofton and Dougla’s Respiratory diseases, Chapter 26,

edited by Neil O. Brein, Published by oxford university press, New Delhi, 4th

edition, 1989, pp 682.

192) Yadhunadhan Upadyaya, Madhava Nidhana,vol 1st ,Madhukosha 15th ed,

Choukambha Sanskrit samsthana Varanasi,1985.Shloka 1/8, pp 44.




194) Ibid, 17/60, pp 535.

195) Ibid, pp 535.

196) Yadhunadhan Upadyaya, Madhava Nidhana, vol 1st, 15th ed, Choukambha

Sanskrit samsthana Varanasi, 1985.Shloka 1/9, pp 53.




198) Ibid, 17/59, pp535.

199) Ibid, 22/17, pp 567.

200) Ibid, 17/7, pp 533.

201) Ibid, Indriya, 7/24, pp 366.

202) Ibid, 7/25, pp 366.

203) Ibid, 8/15, pp367.

204) Ibid, Chikitsa, 17/62, pp 535.

205) Ibid, 17/58, pp 535.





207) K.R.Srikanth murthy ed. Astanga Hridaya, Nidana,3rd ed.Krishnadas academy



Bibliography



Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/49-67,

pp 534-6.

209) Ibid, 17/71, pp 537.

210) Ibid 17/75, pp 538.







Choukambha Surabharati prakashana, Varanasi, 1992.Shloka 17/121,

pp 542.

213) Ibid, 17/147-150, pp 561-2.

214) Harrions, principles. Of Internel Medicine,. Fouci, Brauwald, Isselbacher, Wilson, Martin, Kasper.et.al.editor.Vol 2nd 14thedition.Singapore:International edition; 1988. pp 1419.

215) Ibid, pp 1420.

216) Ibid, pp 1420.

217) Ibid, pp 1420.

218) Satya Narayana Shastri, Charaka Samhita Chikitsa, 1st ed, Choukambha Bharati

Academy, 2001. Shloka 17/47, pp529.

219) Ambika Datta Shastri, Susruta Samhita Uttara, 15th edition, Choukambha

Sanskrit Samsthana, 2002. Shloka 51/46-47,pp 381.

220) K.R.Srikanth murthy ed. Astanga Hridaya, Chikitsa, 2nd ed, Krishnadas

Academy, Varanasi, 1996. Shloka 4/25, pp 249.


Sanskrit Samshtana Varanasi, 1993. Shloka 1-8 pp 435-36.

222) Ambikadatta Shastri, Govindadas, Bhaishajya Ratnavali, 6th ed, Choukambha

Sanskrit Pratistan, Varanasi, 1981. Shloka 16/132-6, pp 339.


Annexure Special case sheet for the evaluation of efficacy of HARITAKI PHALA CHURNA IN THE MANEGEMENT OF TAMAKA SWASA POST GRADUATE STUDIES AND RESEARCH CENTER (DRAVYAGUNA) SHRI. D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG

Guide: Dr.Kuber Sankh M.D,(Ayu)

Scholar:

Anand.M.Dodamani

1) Name of the patient

Sl.No

2) Sex Male

Female

OPD.No

3) Age Years

IPD.No

4) Religion

Hindu

Muslim

Chistian

Other

5) Occupation

Sedentary

Active

Labor

6) Economical status

Poor

Middle

Higher middle

Higher class

7) Address Pin 8) Birth data

Date

Month

Year

9) Selection

Included

Excluded

10) Schedule dates

Initiation

Completion

11) Result

Well Responded

Moderately Responded

Not Responded

Discontinued

INFORMED CONSENT I________________________Son/Daughter/Wife of__________________________________ Am exercising my free will, to participate in above study as a subject. I have been informed to my satisfacation,by the attending physician the purpose of the clinical evaluation and nature of the drug treatment. I am also aware of my right to opt out of the treatment schedule, at any time during the course of the treatment. Patient’s Signiture


Annexure 12) CHIEF COMPLAINTS (Subjective parameter)

13) ASSOCIATED COMPLAINTS

Sl.no

Complaints Before After Follow-up

1 Teevra Vega Swasa (Dyspnoea) 2 Kasa (Cough) 3 Duhkhena Kaaapha nissaranam (Expectoration) 4 Ghurughurutwam (Wheezing) 5 Peenasa (Coryza) 6 Kruchrena bhasate (Difficulty in speech) 7 Kantodhwamsham (Hoarseness of voice) 8 Greevashirasangraha (Headache & Stiffness) 9 Uraha Peeda (Chest pain) 10 Shayane Swasa peedita (Discomfort at supine)

S.No

Associated Complaints Before After Follow-up

1 Anidra (Disturbed sleep) 2 Pratamyati or Bhrushamatra (Distressed) 3 Aruchi (Anorexia) 4 Vishukasyata (Dryness of mouth) 5 Lalata sweda (Sweat over forehead) 6 Trushna (Thirst) 7 Angamarda (Malaise) 8 Kampa (Tremors) 9 Jwara (Fever) 10 Pramoha (Fainting) 11 Vamathu (Nausea) 12 Muhur Swasa (Frequent respiration) 13 Muhuchaiva dhamyati (Puts all effort to breath)

14) HISTORY OF PRESENT ILLNESS Mode of onset Sudden / Gradual Course Episodic/Continuous/Initially episodic Frequency of attack few hours/few days/few weeks Duration of attack continuous/intermittent/subsides with medication Mode of progress Typical/Rapid/Long time non progressive Periodicity Seasonal/Irregular/Perennial Preceded by Sneezing/Nasal irritation/Cough/Talking Sputum Non purulent / Purulent Aggravation factors Dust/Food/Smoke/Pets/Pollens/Stress Comfort posture at attack Sitting/Lying/Standing/Forward bending 15) Occupational history if any


Annexure

16) PERSONAL HISTORY

Food habits Vegitarian Mixed diet Taste preferred Sweet Sour Salty Pungent Bitter Astringent Agni Sama Vishama Manda Teekshna Kosta Mrudu Madhyama Krura Nidra Day Night Sound Disturbed Addictions Tobacco Alcohol Drugs Bowel habits Normal Loose Constipated Menstrual History Regular Irregular Amenorrhea Menopause Family history – Specific if any has the same disease

Other system medications Bronchodilators Treatment history

Cortico steroids Other medicines RS Since how long

History of past illness 17) EXAMINATION (a) Vitals

Temperature F Pulse /min Respiration rate /min Height Cms Weight Kg Blood pressure mmHg

(b) General Oedema Present Absent Icterus Present Absent Pallor Present Absent Cyanosis Present Absent Clubbing Present Absent Palpable lymph

nodes Present Absent

(c) Respiratory system Shape Normal/Kyphosis/Scoliosis/Flattening/Over inflation Movement Normal / Reduced Resp. Rhythm Normal / Abnormal Respiration Thoracic / Abdominal / Thoraco abdominal Accessory muscles Not involved / Involved / Inter coastal spaces Visible veins Absent / Present

Dar

shan

a

Venous pulses Normal / Raised Tracheal position Centrally placed / Deviated Pain / Tenderness Swelling Vocal fremitus Shape Symmetrical / Asymmetrical

Spar

shan

a

Lymph nodes Not palpable / Palpable at Akotana Normal / Resonant / Hyper resonant / Dull

Type of breath Broncho-vesicular / Vesicular / Bronchial

Sh rav

an aVocal resonance Normal / Increased / Decreased / Absent


Annexure

Resp. Sound Rales / Ronchi / Crepitating / Plural Rub / (d) Dosha Examination (Ayurvedic)

Desham (Deha) Bhumi Jangala Anupa sadharrna Vata B A Pitta B A Kapha B AKarshya Peeta mootrata Agni sadana

Karshnya Peetanetra Praseka Ushna kamitwa Peetavit Alasya Kampa Peetatwak Swetangata Anaha Adhikshudha Sheetangata Shakrudgraha Adhidaha Gourava Balabramsha Slathangata Nidrabhramsha Swasa Pralapa Kasa

(a) Dosha Vruddi

Bhrama Atinidra Vata B A Pitta B A Kapha B AAngasada Mandagni Bhrama Alpabhasite ahitam

Shareera sheetatwam

Urah shoonyata

Chesta heenata Prabha hani Shira Shoonyata

Vyamoha Hridrava

(b) Dosha kshaya

Sleshma vruddi Sandhi saidhilya

Nadi V P K VP VK PK VPK Prakruti V P K VP VK PK VPK Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyama samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Ahara Shakti Uttama Madhyama Alpa Vyayama Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya

Nadi Dosha Pravrutti Gati Varna Purnata Gandha Spandana Kathinya

Mutra

Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa

Mala

Ata

stas

than

a

Shabda Sparsha Sheeta Ushna


Annexure

Drik Akruti (e) Srotas Before After Before After Pranavaha Atisrustam Ati badhdama Kupitam Abheekhnam Alpalpa Sashoolam Annavaha Aruchi Ajeerna Chardi Anannabhilasha Udakaavaha Jihwashosha Talushosha Ostashosha Pipasa 18) Tamaka swasa nidana

Visamasana (V) Tilataila (P) Pistanna (K) Masa (K) Adhyasana (V) Vidahi (P) Nispava (K) Dadhi (K) Anasana (V) Saluka (K) Vistambhi(K) Sheetashana(V) Guru dravyas(K) Amaksira (K) Visha (V) Jalajamamsa (K) Sheetapana (V) Anupamamsa (K)

Aha

ra

Rukshanna (V) Abhishyandi (K) Rajas (V) Abhighata (V) Kanthapratighata(V) Urahpratighata(V) Vata (V) Dhuma (V) Karmahata (V) Marmabhighata(V)Sheetasthana(v) Apatarpana(V Veganirodha (V) Ushna (P) Sheeta ambu (V)

Bharakarshit (V)

ShuddhiAtiyoga(V) Abhishyandi upachara (K)

Vih

ara

Ativyayama(V) Adhwata(V) Gramya dharma (V) Divaswapna (K)

Kshatakshaya Atisara Visuchika

Udavarta Vibandha Panduroga Vata Kshaya Anaha Dourbalya

Pitta Raktapitta Jwara Kasa Amapradosa Charddi

A

nya

/Vya

dhi

av

asth

a

Kapha Pratisyaya Amatisara

19) Tamaka Swasa Poorvaroopa BT AT BT AT Hrutpeeda Parshwshoola Kshudra Swasa Vibandha Shankha bheda Anaha Shoola Arati Pranavilomata Bhakta dwesha Vaktra vairasya Admana


Annexure

20) Tamaka Swasa Vikalpa Samprapti Santamaka Pratamaka Udavarta Jwara Rajaobhighata Moorcha Ajeerna Vata nirodha 21)Upashaya andAnupashaya

Asheena labhate sowkyam Sleshma vimokshante sukham Upashaya Ushnam chaivabhinandate Shayanasya sameerane

parshwe ghranati

Anupashaya Shayanasya swasa peedita Meghambu sheeeta pragwata 22) INVESTIGATIONS (Objective parameters) Investigation for screening Sputum examination (if necessary) Chest X-Ray (if necessary) Erythrocyte Sedimentation Rate Absolute Eosinophilic Count Peak Expiratory Flow Rate 23) Assessment A) Disease assessment

1) Subjective parameters Before After Follow-up

comment

1 Teevra Vega Swasa (Dyspnonea) 2 Kasa (Cough) 3 Duhkhena kapha nissaranam (Expectoration) 4 Ghurghuratwam (Wheezing) 5 Peenasa (Coryza) 6 Kruchrena bhasate (Difficulty in speech) 7 Kantodhwamsham (Hoarseness of voice) 8 Greevashirasangraha (Headache & Stiffness) 9 Uraha Peeda (Chest pain) 10 Shayane Swasa peedita (Discomfort at

supine)


Annexure

2) Objective parameter Before After Follow-up

1 Walking time Sec/100feet Sec/100feet Sec/100feet

2 Breath holding time /sec /sec /sec

3 Peak Expiratory Flow Rate L/m L/m L/m

4 Erythrocyte Sedimentation Rate Mm/1stHour Mm/1stHour Mm/1stHour

5 Absolute Eosinophilic Count /cumm /cumm /cumm

6 Hemoglobin % Gm% Gm% Gm%

24) Treatment schedule of “Haritaki Phala Churna in Tamaka Swasa” schedule Investigator’s observation Day 1 Day 15 Day 30 follow up Day 45 (final follow up) Investigator’s Note:

Signature of guide (Dr. Kuber Sankh M.D.(Ayu))

Signature of Scholar (Anand.M.Dodamani.)


Documents

Amakaswasa#dg05 gdg