Upload
ayurmitra-ksrprasad
View
1.717
Download
7
Embed Size (px)
DESCRIPTION
EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA SWASA By KALMATH. BASAYYA. LINGAYYA, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103
Citation preview
EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI
IN THE MANAGEMENT OF TAMAKA SWASA By
KALMATH. BASAYYA. LINGAYYA
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fu
Ayurved
KaUnde
Dr. V.
Dr. Shiva RamM.D. (Ayu) (Osm), C
DepartmPost Graduate St
D.G. MELMALAGI AYURV
lfillment of the degree of
a Vachaspati M.D. In
yachikitsa r the Guidance of
Varadacharyulu M.D. (Ayu) (Osm)
a Prasad Kethamakka .O.P. (German) M.A., [Ph.D] (Jyotish)
ent of Kayachikitsa udies & Research Center EDIC MEDICAL COLLEGE, GADAG 2003-2006
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF
ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA
SWASA” is a bonafide research work done by KALMATH. BASAYYA. LINGAYYA in
partial fulfillment of the requirement for the post graduation degree of “Ayurveda
Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,
Bangalore, Karnataka.
Dr. Shiva Rama Prasad Kethamakka
M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish)
Co- Guide
Professor in Kayachikitsa
DGMAMC, PGS&RC, Gadag
Date:
Place: Gadag
Dr. V. VARADACHARYULUM.D. (Ayu) (Osm)
GuideProfessor & HOD
Dept. of Kayachikitsa
PGS&RC
Date:
Place: Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
Endorsement by the H.O.D, principal/ head of the institution
This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF
ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA
SWASA” is a bonafide research work done by KALMATH. BASAYYA. LINGAYYA under
the guidance of Dr. V. VARADACHARYULU, M.D. (Ayu) (Osm), Professor & HOD and
Dr. Shiva Rama Prasad Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D]
(Jyotish), Professor in Kayachikitsa Co- Guidance, in partial fulfillment of the requirement for
the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev
Gandhi University of Health Sciences, Bangalore, Karnataka.
.
DP
(Dr. G. B. Patil) Principal,
DGM Ayurvedic Medical College, Gadag
Date: Place:
(Dr. V. Varadacharyulu)Professor & HOD
Dept. of Kayachikitsa PGS&RC
ate: lace: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled EVALUATION OF THE
EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF
TAMAKA SWASA is a bonafide and genuine research work carried out by me under the
guidance of Dr.V.Varadacharyulu M.D.(Ayu) and Dr. Shiva Rama Prasad
Kethamakka, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa Co-
Guidance, DGMAMC, PGS&RC, Gadag.
Date
Place
KALMATH. BASAYYA. LINGAYYA
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or
electronic format for the academic / research purpose.
Date
Place
KALMATH. BASAYYA. LINGAYYA
© Rajiv Gandhi University of Health Sciences, Karnataka
i
i
Acknowledgement
I express my deep gratitude to my Guide Dr. V.V.Varadacharyulu M.D. (Ayu)
Goldmedalist, professor and H.O.D and my Co-guide, Dr. Shiva Rama Prasad
Kethamakka, M.D.(Ayu),M.A.Ph.D., Professor, PG Dept, Kayachikitsa for their time to
time help and critical suggestions associated with expert guidance at the completion of
this dissertation.
I express my obligation to my beloved princ pal Dr.G.B.Patil, for his
encouragement as well as providing all necessary facilities for this research work. I
extend my gratitude to Dr. R.V.Shettar, M.D, lecturer, Dept. of KC (PG), Sri Nanda
Kumar, Statistician and Librarian Sri Mundinamani, and assistant Sureban for their
encouragement, as well as timely suggestions at this research work.
I express my acknowledgement to my parents who are responsible for my
existence and success Smt Basamma and Shri Lingayya along with my relatives who are
helpful to me at each and every step of development.
I extend my gratitude to Dr. G.Purushottamacharyulu, Dr.M.C.Patil, Dr.
Mulgund, Dr. G.S. Hiremath, Dr.P.Shivaramudu, Dr.S.H.Doddamani, Dr.
G.Danappagoudar, Dr. S.N.Belawadi, Dr.J.Mitti, Dr.Nidugundi, Dr. Samudri, Dr.
Kubersankh.who helped me time to time.
I extend my gratitude to my U.G. Teachers Dr. B.G. Swam , Dr. C.S. Hiremath,
Dr. S.A. Patil, Dr. R.K. Gacchinamath, Dr. V.M. Malagoudar, Dr. V.M. Sajjanar, and Dr.
U. V. Purad, who gave support and inspiration during my studies. I grateful to my teacher
Dr. S.B. Govindappanavar,Asst. Registrar, RGUHS, Bangalore.
I would like to mention the support and inspiration provided by professor S. B.
Shetter Rtd. Principal, Professor Mallikar un,Rtd. Principal, Shri. V.B. Shetter, Prof.
Siddu yapalparavi, Shri. Basavaraj Ganavari, and Shri. Shyamsundar Rao..
j
t
I express my sincere thanks to my colleagues and friends, Ratnakumar, Mouli,
Aswin, Uday Kumar, Venkareddi, , Hugar, Jayraj, Swami, Ganti, Pradeep, Sajjan,
Ashok,, Shiba, Jigulur, Umesh, G.G.Patil, Sarvi, Subin, sathish, Febin, Joshi, Shyju,
Shajil, Renjith, Srinivasa Reddy, Ravi, Pattanashetti, Koteshwar, V.S. Hiremath, Santosh
Yadahalli, Santoji, Jaggal, Suvarna, Lingaraddi, Suresh Hakkandi, Manjunath Akki,
Anand, Payapagoudar, Sharanu, Anita, Sobagin, Meenakshi, Inamdar, Sunitha and other
P.G. Scholars for their support.
I acknowledge my patients for their whole hearted consent to participate in this
clinical trial. I express my thanks to all the persons who have helped me directly and
indirectly with apologies for my inability to identify them individually.
(B.L. Kalma h)
EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA SWASA
Abstract
By KALMATH. BASAYYA. LINGAYYA
Tamaka Swasa vis-à-vis bronchial asthma patients were diagnosed on the basis of
symptomatology explained by Bruhatrayee (subjective parameter) and objective
parameters fixed on contemporary scientific descriptions and parameters. Out of the 67
patients of Tamaka Swasa 65 (97.01%) were undertaken for the study. The remaining 50
(76.93%) patients of Tamaka Swasa fulfilling the criteria of diagnosis and inclusive
criteria were included in the study. Hindu religion patients were more (92%) recorded.
Out of the symptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patients
initially are relieved 58%. Another symptom found for all patients is Ghurgurukatwam is
relieved for the 50% of patients in the study. Kasa a symptom appeared for 47 patients
initially relived 61.7% in the study. 39 patients of Urahpeeda corrected at the end of
study by 58.97%. Greevashirasangraha (16 patients) and Kantodhwamsham (12 patients)
are the other two symptoms of assessment got relief with 43.75 and 58.33 percentages
respectively. At the Objective Parameters assessment in Tamaka Swasa in the study of
Ardhedashemaniya Swasaharavati five objective parameters are assessed are enlisted in
the table 43. The result in the study ascertains the best activity of the Ardhedashemaniya
Swasaharavati over the Tamaka Swasa vis-à-vis Asthma. After through study of the
entire parameters and materials available for the assessment of results it was drawn a
conclusion of results as - 27 (54%) well responded, 11 (22%) moderately responded, 7
(14%) poorly responded and 5 (10%) patients not responded and the 12 patients
discontinued in the study, were not considered for the result declaration.
Ardhedashemaniya Swasaharavati is very economic safe and effective drug hence it can
be employed in all cases of Tamaka Swasa and it can be used as preventive type of
medication. This Ardhedashemaniya Swasaharavati is new therapeutic option for
optimizing the asthma control.
PEFR, BHT, TS, BA, CS, SS, AH, AS, MN, Lung Function Test,
Contents of
EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI
IN THE MANAGEMENT OF TAMAKA SWASA By
KALMATH. BASAYYA. LINGAYYA
Chapter Content Pages
1 Introduction 1 to 9
2 Objectives 10 to 13
3 Review of literature 14 to 87
4 Methods 88 to 100
5 Results 101 to 151
6 Discussion 152 to 174
7 Conclusion 175 to 175
8 Summary 176 to 179
9 Bibliographic References I to IX
10 Annex – Case sheet 1 to 6
- 1 -
Tables of EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA
SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA SWASA By
KALMATH. BASAYYA. LINGAYYA SN Title of Table Page
Number 1 Showing Nidana of Swasa / Tamaka Swasa 36 2 Showing Poorvaroopa of Shwasa Roga: 60 3 Shows lakshanas of Tamaka Swasa 65 4 Vyavacchedaka Nidana in Tamaka Swasa 67 5 Showing Pathya in Tamaka Swasa 78 6 Showing Apathya Aahara in Tamaka Swasa 79 7 Showing Apathya Vihara in Tamaka Swasa 80 8 Pharmacological properties of Ardhedashemaniya Swasaharavati 87 9 Demographic Data 102 10 Distribution of patients by Age gender - 104 11 Result of Ardhedashemaniya Swasaharavati in trail patients by
Age 105
12 Distribution of patients by Gender in Tamaka Swasa 106 13 Distribution of patients by Religion and gender identification 108 14 Result Distribution of patients by Religion 109 15 Distribution of patients by occupation 110 16 Distribution of patients by Economic status 112 17 Distribution of patients by diet in Tamaka Swasa 113 18 Distribution of patients by presenting complaints 115 19 Presenting Associated features 116 20 Distribution of patients by Mode of on set 118 21 Distribution of patients by course 119 22 Distribution of patients by frequency 120 23 Distribution of patients by duration of attack 121 24 Distribution of patients by periodicity 122
- 2 -
25 Distribution of patients by preceding factors 123 26 Distribution of patients by aggravating factors 124 27 Distribution of patients by comfor posture t 125 28 Distribution of patients by Dosha Kshaya lakshana 126 29 Distribution of patients by Dosha vruddhi Prakruti 127 30 Distribution of patients by Ahara Nidana 128 31 Distribution of patients by Vihara Nidana 129 32 Distribution of patients by Anya / Vyadhi Avasta sambandha
Nidana 130
33 Distribution of patients by Sro as t 130 34 Distribution of patients by Poorva Roopa 131 35 Distribution of patients by Chief complaints and Associated
complaints 132
36 Distribution of patients by History of present illness 133 37 Distribution of patients by Dosha Vruddhi Lakshana 135 38 Distribution of patients by Dosha Kshaya Lakshana 136 39 Distribution of patients by Ahara Nidana 138 40 Distribution of patients by Vihara Nidana 139 41 Distribution of patients by Anyavyadhi avasta sambandhi 140 42 Subjective parameters assessment in Tamaka Swasa 142 43 Objective Parameters assessment in Tamaka Swasa 143 44 Cumulative effect in percentages obtained through subjective and
objective Parameters for Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis bronchial Asthma
146
45 Result of Ardhedashemaniya Swasaharavati in Tamaka Swasa 147 46 Statistical analysis of Objective parameters 148 47 Statistical analysis of Subjective parameters 149 48 Objective parameters Baseline comparison in Ardhedashemaniya
Swasaharavati in TS 150
- 3 -
Figures and Photos of EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA
SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA SWASA By
KALMATH. BASAYYA. LINGAYYA SN Title of Figures and photos Page
Number 1 Upper and Lower Respiratory System 20
2 The Bronchi and Lobules of the Lung 21
3 Gross Anatomy of the Lungs 23
4 The Bronchi and Lobules of the Lung 25
5 Pressure changes during inhalation and exhalation 29
6 Ageing and the decline in Respiratory performance 31
7 Schematic representation of Tamaka Swasa Samprapti 51
8 Cross section of the lung in Tamaka Swasa i.e. Asthma 58
9 Ingredients of Ardhedashemaniya Swasaharavati 81
10 Distribution of patients by Age – Gender 104
11 Result of Ardhedashemaniya Swasaharavati in trail patients by
Age
105
12 Distribution of patients by Gender in Tamaka Swasa 106
13 Resul Distribution of patients by Gender in Tamaka Swasa t 107
14 Distribution of patients by religion in Tamaka Swasa 108
15 Result Distribution of patients by Religion in Tamaka Swasa 109
16 Distribution of patients by Occupation 110
17 Result of patients by occupation in Tamaka Swasa 111
18 Resul Distribution of patients by Economic status t 112
19 Distribution of patients by diet in Tamaka Swasa 113
20 Result Distribution of patients by diet in Tamaka Swasa 114
- 4 -
21 Distribution of patients by presenting complaints 115
22 Distribution of patients by Associated features of Tamaka Swasa 117
23 Distribution of patients by Mode of on se t 118
24 Distribution of patients by course 119
25 Depicting the frequency episodes in Tamaka Swasa 121
26 Depicting the duration of attack in Tamaka Swasa 122
27 Depicting the periodici y in Tamaka Swasa t 123
28 Depicting the preceding factors in Tamaka Swasa 124
29 Depicting the aggravating factors in Tamaka Swasa 125
30 Depicting the comfort posture in Tamaka Swasa 126
31 Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa 148
- 5 -
Chapter 1
Introduction From childhood as children we play with the conditions and are exposed to dust
mites, fungi, and other allergens as a part of game or unnoticing. Human bodies produce
chemicals known as antibodies and there by the immunity is enriched. But the same
allergens concurs any individual common problem is respiratory tract infection along with
difficulty in respiration. The function of antibodies in the body is to fight off the invasion of
materials from the environment. However, the release of antibodies also inflames the
bronchi and bronchioles. The more often a child is exposed to allergens, the more serious the
response becomes. This condition is known as atopy i.e. “A genetically determined state of
hypersensitivity to environmental allergens. Type I allergic reaction is associated with the
IgE antibody and a group of diseases, principally asthma, hay fever, and atopic dermatitis”,
is thought to occur in anywhere from 30 to 50 percent of the general population.
The lungs, which are exposed to the external environment needs a protection
especially in the “World of Heat and Dust”. The human body is continuously under the
influence of environmental changes subjected to environmental pollution. Our urbanized life
style and industrialization etc. compound the problem. As a result of smoke (dhooma) and
dust (raja) Pranavaha srotodusti occurs, and terminates into the disease Tamaka Swasa other
wise Asthma 1.
Atmospheric pollution
The effect of indoor and outdoor air pollution on allergic disease has received
considerable attention. Environmental pollutants have been reported to contribute to the
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
1
prevalence of allergic disease, the precipitation of allergic symptoms, and their intensity
(Ollier & Davies, 1994). Both epidemiological and experimental studies have demonstrated
that a variety of atmospheric substances including sulfur dioxide (SO) 2, nitrogen dioxide
(NO2), ozone (O3) and particles influence the induction and elicitation phases of the
allergic response. Effects have included adjuvant activity for allergen-specific IgE
production, modulation of mediator release from inflammatory cells, and irritant effects
on effector organs of the allergic response 2.
The question of whether environmental factors may be involved in the observed
increase in the prevalence of allergy is a matter of controversy 3. There is no doubt that
pollutants such as suspended particles, automobile exhaust, ozone, sulfur dioxide and nitric
oxides can be measured in rather high concentrations in the air of many countries that show
an increasing prevalence of atopic diseases. However, some of these pollutants, like sulfur
dioxide, have shown a decrease in air concentrations during the last decades.
In a controlled prospective trial comparing different living areas with various
degrees of air pollution in western and eastern Germany, striking differences were shown
with regard to the prevalence of respiratory atopic diseases, with higher values for western
compared to East-Germany 4. In contrast to atopic respiratory diseases, there was a trend to
higher prevalence rates of atopic eczema in eastern Germany. In the same study there was
evidence of an increased risk of developing atopic eczema after exposure to natural allergens
as well as air pollutants from outdoor and indoor sources 5. These observations made now
are affirmed long back in Ayurveda.
A common condition of transportation in flights or working as crew in them is
problematic for people those have respiratory problem. This situation is stated form Oxford
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
2
Textbook of Medicine as “People with respiratory disease (Asthma) often have difficulty in
assessing its true severity and aircrew with the condition may fly unaware of how severe it
is. Exacerbations of asthma are often precipitated by upper respiratory infections. If such an
exacerbation occurs when the aircrew member is overseas, there is considerable pressure on
the individual to fly; alternatively, serious disruption of flight scheduling may result. An
acute episode of asthma in flight is likely to interfere seriously with the flying task and has
been reported to result in loss of control of the aircraft. Aircrews with very mild, intermittent
asthma requiring only occasional treatment are fit to fly. Those with more continuous
symptoms requiring regular suppressive medication, inhaled steroids, or cromoglycate are fit
for restricted licensing provided their asthma is well controlled. Those whose symptoms
persist in spite of medication or who have very reactive airways with unexpected attacks are
unfit to fly”.
Living cells need energy for maintenance, growth, defense, and replication. Our cells
obtain that energy through aerobic mechanisms that require oxygen and produce carbon
dioxide. Many aquatic organisms can obtain oxygen and excrete carbon dioxide by diffusion
across the surface of the skin or in specialized structures, such as the gills of a fish. Such
arrangements are poorly suited for life on land, because the exchange surfaces must be very
thin and relatively delicate to permit rapid diffusion. In air, the exposed membranes
collapse, evaporation and dehydration reduce blood volume, and the delicate surfaces
become vulnerable to attack by pathogenic organisms. Our respiratory exchange surfaces are
just as delicate as those of an aquatic organism, but they are confined to the inside of the
lungs-in a warm, moist, protected environment. Under these conditions, diffusion can occur
between the air and the blood 6.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
3
It is a fact that the mentions of Charaka, that the Air as a fundamental unit of
external environment is a unique factor of biological activity providing the strength and
consciousness becomes a criteria of living activity through respiration 7. Pranavata and
Apanavata are responsible for breathing out and breathing in, which is an important day to
day experiences of life 8.
Pranavaha Srotas, the origin is Hrudaya as well as Mahasrotas. Chakrapani
commenting on this stated that a special air known as Prana is related intimately to this
Srotas 9.
Therefore, it is clear that the specific air known as Prana is breathed into the
respiratory system during the act of inspiration. The normalcy of Pranavata suggests health
in the body 10, 11, 12. The abnormality of respiration indicates disease, and its cessation marks
death 13, 14, 15. This unique sign of life is affected in the disease Tamaka Swasa 16. And this
Pranavata vikaruti lead to the Swasa 17 if it is neglects. This leads to the emergency
condition, 18 later on death.
Tamaka Swasa is a disease, characterized by Swasa kricchata, Ghurghurakatwa,
Kasa, Peenasa etc., with patient feels as if entering darkness. During the paroxysm which is
due to where on holy association of Vata with Kapha obstructing the passages of Pranavata
leads to excitement of Vata to produce upward movement or abnormal expiratory dyspnoea.
Which vary in severity and frequency from person to person is in an individual, they may
occur from hour to hour and day to day.
Bronchial asthma is a disease. Characterized by variable air flow obstruction, air way
inflammation and bronchial hyper responsiveness, the disease manifests wide variations on
air way obstruction over a short period of time until recently, bronchospasm was considered
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
4
cardinal feature of asthma but now in addition to bronchospasm, air way inflammation is
recognized as an essential component of the disease 19.
Need and significance of the study
The world health organization estimated in 1998 that asthma affect 155 million
people world wide, based on data collected in epidemiological studies in more than 80
countries. Asthma rate has increased significantly in recent decade which is increased 50%
every decade 20 worldwide, deaths from this condition have reached over 180,000 annually.
Asthma is not just a public problem for developed countries. In developing countries,
however, the incidence of the disease varies greatly. India has an estimated 15-20 million
asthmatics.
Economic burden
Mortality due to asthma is not comparable in size to the day to day effects of the
disease. Although largely avoidable, asthma tends to occur in epidemics and affects young
people. The human and economic burden associated with this condition is severe. World
wide the economic costs associated with asthma are estimated to exceed those of TB and or
AIDS combined 21.
Above mentioned all points shows its severity of incidence and prevalence rate is
crucial that we should gain more insight into its causation and management. WHO
recognizes asthma as a disease of major health, public health importance and plays a unique
role in the co-ordination of international efforts against the disease.
The international action is needed to stimulate research into the causes of asthma, to
develop new control strategies and treatment techniques and develop and implement an
optimal strategy for its management and prevention increase public awareness of the disease
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
5
Drugs
The management of asthma is two fold, i.e. pharmacological and non
pharmacological. First one includes the bronchodilators, anti inflammatory corticosteroids,
and anti histamines. Inflammatory is the now target of therapy and the role of inhaled.
Corticosteroids have been formerly established in long term therapy. NAEP 1991 suggests
minimizing the toxicities of oral steroids. Non-pharmacological is the education 22.
The goal of asthma treatment has shifted from symptom relief to disease control this
can be achieved through usage of prophylactic category of medicaments.
Asthma is considered to increase direct and indirect medical expenditures. So reduce
the cost of treatment also to prevent the disease. Ayurveda suggest the cost effective
management from different treatment modalities.
Sequential administration of the snehana, swedana,shodhana, dhumapana, shamana,
Rasayana, diet etc., line of treatment forms the complete treatment of Tamaka Swasa
expounded in the Ayurvedic literature 23.
Among these procedure shamana line of treatment that includes oral administration
of medicines is of utmost importance as the administration is very easy and also effective.
Plenty of research works have been carried out in relation to shaman treatment as
directed in Ayurveda and their therapeutic effect is proved. Many more herbal combinations
are described on Ayurveda, and therapeutic effect in is yet to be explored.
Ardhedashemaniya Swasaharavati is one such herbal combination, includes the shati,
puskaramula, bhumyamalaki, amlavetasa and tulasi. Which were taken from Dashemaneeya
Swasahara gana of Charaka Samhita in Shadvirechanashatasritadhyaya 24.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
6
The efficacy of Dhashemaneeya Swasahara dravyas are still to be proved by modern
research methods. By looking at the individual herbal constituents, (easy availability in the
market cost effective all the drugs which suit for disintegration of pathology of TS) it
appears that this combination should be very effective in combating the attack of Tamaka
Swasa.
Therefore the present work is planned to evaluation and efficacy of
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa (bronchial asthma)
REVIEW OF PREVIOUS WORKS:
1. 1962, Haridra Vigyanam - Action of Haridra on Tamaka Shwasa and Eosinophilia -
Singh Rajpal, G.A.U., Jamnagar
2. 1971, Dhatoor Multwaka Swarasa Bhavita Kajjali on Tamaka Shwasa Roga - Patel
K. K., G.A.U., Jamnagar
3. 1974, Arkapatri Swarasa Bhavita Rasasindoor in Tamaka Shwasa - Somanandon G.
G.A.U., Jamnagar
4. 1976, Bharangi Nagarayoh Kalkam Tamakae - Sharma D. P. G.A.U., Jamnagar
5. 1979, Study of effect of Shwasahar Kwath during acute attack of Tamaka Shwasa
and Dipaniya Kwatha during interval of attack.- Mehata P. S. G.A.U., Jamnagar
6. 1981, Tamaka Shwasa Men Bharangiguda Ki Karmukata –Sharma C. B., N. I. A.
7. 1982, Tamaka Shwasa Ki Shastrokta Chikitsa - Pathade C. N. G.A.U., Jamnagar
8. 1983, A comparative study of Bhumyamalaki and Kapittha in the management of
Tamaka Shwasa - Thaker L. V. G.A.U., Jamnagar
9. 1984 - A study of Dhumapana with its clinical evaluation on tamaka shwasa” - by
Dr.Hariprakash. H.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
7
10. 1984, Studies on the Samprapti of Tamaka Shwasaroga and its management with
Katuki Vati and Gojihvadighanavati - Tamboli P. K. G.A.U., Jamnagar
11. 1985, A Clinical study on the systemic effect of Vamana Karma W.S.R. to Tamaka
Shwasa - Kabra P. R. G.A.U., Jamnagar
12. 1986, Astasanskarita Evam Samanya Shodhita Parada Se Nirmita Shwasakuthara
Rasa Ka Tamaka Shwasa Roga Par Tulanatmaka Adhyayana. - Modh K. G. G.A.U.,
Jamnagar
13. 1987, Clinical management of Tamaka Shwasa with reference to it's attack -
Singhald A. K. G.A.U., Jamnagar
14. 1988, Comparative study of media in the preparation of Tamra Bhasma W.S.R. to
Tamaka Shwasa. - Vododkar D. S. G.A.U., Jamnagar
15. 1988, Studies on Mutrala Dravya W.S.R. to Tamaka Shwasa - Chara R. K. G.A.U.,
Jamnagar
16. 1989, A Critical study on Shati W.S.R. to Tamaka Shwasa - Suthar R. D. G.A.U.,
Jamnagar
17. 1991, Role of Virechana and Rasayana in the prevention and cure of Tamaka
Shwasa - Modh K. G. G.A.U., Jamnagar
18. 1993 - Study on Tamaka Shwasa - by Dr. Saraswati. H.
19. 1994, A clinical study of Ginger and Guda in the management of Nija Swayathu
and Tamaka Shwasa - Shah V. V. G.A.U., Jamnagar
20. 1995, A clinical study on standardization of Vamana Karma W.S.R. to its
effect on respiratory function tests in the patients of Tamaka Shwasa -
Patnayaka Krishna. G.A.U., Jamnagar
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
8
21. 1995-Tamaka Swasa with Gouripashana - by Dr. Jayaraj. R.
22. 1998 - The role of Rasayana in tamaka shwasa with special reference to the effect of
Bharangiharitaki avalehya - by Dr. Ashok. M. Iti. .
23. 1999 - A study on the role of upavasa in the management of tamaka Swasa by Dr. K.
Ajithanarthindra
24. 2000- Evaluate the efficacy of Manashiladi dhoomayoga on tamaka shwasa by
Dr.Prasanna. N. Mogasale
25. 2001, A comparative and pharmaco-clinical study of vasarishta and vasakasava in
the management of Shwasa, Dr. Kulkarni Shailaja.
26. 2001, A Comprehensive study of Katphala (Myrica esculenta Buch - Ham.) with special
reference to Tamaka shwasa - Jaram Singh G.A.U., Jamnagar
27. 2001 - The Evaluation of the effect of Padmapatradi yoga in Tamaka Swasa,
R.D.Suresh. RGUHS, Bangalore
28. 2002, A comprehensive study of Plant Acalypha indica. Linn. And efficacy in
Tamaka Shwasa - Asmita Shinde. G.A.U., Jamnagar
29. 2002, Clinical Study on the effect of Pippalyavaleha and Virecana karma in the
Management of Tamaka Shwasa - Sangeetha G.A.U., Jamnagar
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction
9
Chapter – 2
Objectives of Study
The present study intended to focus on the disease evaluation i.e., Tamaka Swasa
vis-à-vis. Bronchial asthma and the management with Ardhedashemaniya Swasaharavati
used as a shamanaoushadi.
The Dashemaniya Swasahara gana is mentioned in shadvirechana shatasritadhya
of Charaka Samhita Sutrasthana. Among ten drugs we have selected five drugs, which
are prepared into choorna form then subjected to same dravya kwath bhavana three times,
finally made it in vati which weighing about 500 mg for this vati we named it as
Ardhedashemaniya Swasaharavati. Hypothetically this has the best therapeutic efficacy
on the Tamaka Swasa vis-à-vis bronchial asthma.
In this regard the objectives proposed in the study are discussed under the
headings.
1) To assess the effect of selected Ardhedashemaniya compound in Tamaka Swasa
The condition Tamaka Swasa characterized by recurrent attacks of Swasa
kricchrata, and ghurgurakatwa along with other symptoms like –
1. Kasa (cough)
2. Duhkhena Kapha nissaranam (Expectoration)
3. Peenasa (Coryza)
4. Kruchrena bhasate (Dysphonoea)
5. Kantodhwamsham (Hoarseness of voice)
6. Greevashirasangraha (Headache & Stiffness)
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives
10
7. Urah Peeda (Chest Pain)
8. Shayane Swasa peedita (Discomfort at supine), etc.
Tamaka Swasa and its management through various methods are possible viz.
Ahhyanga Swedana, Virechana, Vamana, Dhoomapana, Shamana, Kapha nissarana,
srotomardavatu, Vata kaphahar Kapha vilayana, kasagnee, bruhamana effects will be
very effective in combating the Tamaka Swasa. Considering the same the
Ardhedashemaniya compound having almost all of these therapeutic effects is opted for
this study.
Administrating of Ardhedashemaniya compound in this disease may be helpful as
Shodhana and Shamana types of effect, which supports the Shodhana and Shamana
principles of treatment of Tamaka Swasa. As the disease is episodic therefore, distinct
planning of the treatment is required during the attack and in between the attacks.
Liquefaction and elimination of sleshma sheet anchor of the treatment. There by thus
removes the obstructing (Snehana Swedana followed dhomapana) shleshma from the
Pranavaha Srotas, and allowing the free movement of Pranavata.
This gives relief in the symptoms of Swasa kricchrata, preventing the attacks
removing the khavaigunyata and improving the resistance of the disease.
So, the Ardhedashemaniya compound comprises the Vata Kapha pacification
effect in nature and by which it reduces the recurrent attacks of breathlessness, and
wheezing and features and its duration along with frequency and nature of the disease.
The effect of Ardhedashemaniya compound in Tamaka Swasa is evaluated by
means of studying the subjective parameters such as Swasa kricchrata, and Ghrgurukatwa
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives
11
(wheeze) etc., with specified parameters in comparison to that of baseline data to that of
final data.
The understanding of the study from base line data to the final data differences
after the drug administration to the patients those who are included by preset parameters
of exclusion and inclusion criteria.
2) To assess the lung functions (Peak Expiratory Flow Rate) improvement by
Ardhedashemaniya compound in Tamaka Swasa
Tamaka Swasa vis-à-vis bronchial asthma is characterized by spastic contraction
of the smooth muscle on the bronchiole, which causes extremely difficult breathing. This
is due to localized edema in the walls of the small bronchioles as well secretion of thick
mucus in to the bronchiolar lumens and spasm of the bronchiolar smooth muscle
therefore air way resistance increases greatly.
The bronchiolar diameter becomes more reduced during expiration than during
inspiration in Tamaka Swasa (Bronchial Asthma) because the increased intrapulmonary
pressure during expiratory effort compresses the out sides of the bronchioles. Because the
bronchioles are already partially occluded, further occlusion resulting from the external
pressure creates especially severe obstruction during expiration. So the Tamaka Swasa
patient usually can inspire quite adequately but has great difficulty expiring.
The functional residual capacity and the residual volume of the lung become
greatly increased during the asthmatic attack because of the difficulty in expiring air from
the lungs.
The clinical measurements show great reduced maximum expiratory rate and
timed expiratory volume. So in this study the lung function assessment is recorded with
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives
12
the help of Peak Expiratory Flow Rate. The readings are taken before the administration
of the drug and every 15 days once, after the treatment schedule and follow up.
The Peak Expiratory Flow Rate or a lung function test is done to document the
severity of air flow obstruction and to establish bronchodilator responsiveness. The
measurement of Peak Expiratory Flow Rate is useful for monitoring and assessing
variations in lung function and providing information about allergies and environmental
factors or asthma triggers.
The drug Ardhedashemaniya compound hypothetically stated that it improves the
lung function, because the individual drugs of Ardhedashemaniya are having anti
inflammatory. Bronchodilator, expectorant, anti histamine, anti viral, etc., properties
there by disintegrates the pathology of Tamaka Swasa.
By these actions the drug which reduces the functional residual capacity and
residual volume of the lung and improves the expiratory effort all these should be
assessed by Peak Expiratory Flow Rate.
This can be understood that when using Peak Expiratory Flow Rate measurement
(lung function assessment) to judge response to treatment or severity of exacerbation. It is
useful to compare the measurement to patient base line. This base line is usually regarded
as the norm or personal (Best Peak Expiratory Flow Rate) for the individual patient.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives
13
Chapter -3
Literary review Most of the times Tamaka Swasa (asthma) guidelines of recommendations and
assessing Swasa complications with their control according to a series of criteria based on
symptoms and pulmonary function is difficult. Swasa treatment should aim at minimizing
Tamaka Swasa symptoms, rescue bronchodilator needs, and exacerbations, while optimizing
pulmonary function. Many methods for assessing airway inflammation non-invasively have
been developed, but they are not currently integrated into the assessment of asthma control
globally. Studies or surveys on asthma generally use an "all or none" approach or a strictly
qualitative evaluation of asthma control, without specific quantification of its magnitude or
degree compared with optimal goals. Other means of assessing these parameters include
evaluating or scoring each separate component of asthma control and comparing the effects
of treatment or interventions on these specific parameters.
In current practice of Ayurveda, however, both patients and physicians assess Swasa
control globally, although there is no simple, practical method for truly quantifying it. This
may contribute to an overestimate of the adequacy of asthma control by the Ayurvedic
physician, and even more so by the patient, and may consequently contribute to the poor
asthma control observed in the asthmatic population.
Quantification of control with tools such as the validated questionnaire developed by
researchers has been welcomed, providing a most interesting way to assess asthma control.
However, busy clinicians may not have the time or personnel required for administering such
questionnaires, and the scoring system used may not necessarily be meaningful to the
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
14
practitioner and the patient. But for a researcher amount of literature and derived questions,
through understanding of Samprapti (pathogenesis) is valuable for the further scopes of
development in the field.
HISTORICAL REVIEW
PREVEDIC AND VEDIC PERIOD:
The available literatures of Pre-vedic and Vedic period reveal that the physiology of
respiration, the role of Prana in respiration, the concept of Apanavata are mentioned at a
number of occasions. Akin to the present understanding in Rigveda, the word Prana is coined
to describe the act of respiration. Some of the references like Pranadvayu jayate 25,
ayumapranaha 26 reveal the same. In Yajurveda also, the process of respiration, the act of
inspiration, the effort of expiration and involvement of Prana Vayu in respiration are
elaborated. Few to mention here are - vatam pranena nasike 27 pranasya apyathatvam 28.
Further, in Atharvaveda, the word Matarishwa is coined to denote the Pranavayu. The
concept of respiration and the role of Pranavayu in respiration is also clearly described in the
last treatise among the Vedas. vatoprana ucyata 29- this is one of the lines from the
Atharvaveda revealing the Prana Vayu and the concept of respiration.
UPANISHATH KALA:
The act of inspiration and expiration is mentioned as the prime physical sign of life in
Amanaskopanishath. Further, the opinion of absence of respiration suggesting the death is
also described. The line from this Upanishad goes like this - svasocchvasatmaka prana 30 and
avasocchusa hinastu niscitam muktaevasaha
In Brhadaranyakopanishath the Prana is referred by the names Angirasa and Ayusya.
The function of controlling the body mechanisms are attributed to Prana Vayu in this book.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
15
In the Chandogyopanishath, the Prana has been named as Angeera and Brhaspati. The role of
Prana in nourishing the body is elaborated here 31.
The diseased conditions of Pranavaha srotas that includes Hikka, Shwasa and Kasa
are described and the role of deranged Vata in its causation is explained in Yoga
Chudamanyam.
The organ of respiration is compared to the bird Crane; the two wings of the bird
representing the organ of respiration, the trunk indicating the heart, and the neck of the bird
symbolically expressing the wind pipe are discussed in detail in Hamsopanishath.
SAMHITA PERIOD:
Charaka Samhita: The detailed description of Swasa and its five varieties are found in
17th chapter of Chikitsa. The elaborate explanation of etiological factors,
pathogenesis, premonitory symptoms, clinical manifestations as well as complete
radical treatment of Swasa is given here. Pratamaka and Santamaka Swasa, the
variant forms of Tamaka Swasa are also described in Charaka Samhita 32.
Susruta Samhita: The whole description of Swasa roga, its types and the treatment is
available in Susruta Samhita 33.
Bhela Samhita: Swasa as a symptom is mentioned in Bhela Samhita. In the form of
complication of many disorders Shwasa is described in this treatise 34.
Harita Samhita: Etiopathogenesis, line of treatment and dietetics of Kasa Roga are
described at full length in Harita Samhita. The relevant descriptions are available in
the 12th chapter of third Sthana of this work; where in Swasa is not available 35.
Kasyapa Samhita: In Khila Sthana, the brief description of Swasa Roga with its
treatment is described along with Kasa Roga 36.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
16
Ashtanga Hridaya and Ashtanga Sangraha: In both Nidana Sthana and Chikitsa
Sthana the relevant description of Swasa Roga is available in these books 37.
Madhava Nidana: 12th chapter deals with the diagnostic aspect of the Swasa Roga in
this book of Madhava Nidana 38.
MEDIEVAL PERIOD:
Chakradatta: Chakrapanidatta’s description of Swasa Roga available in this book is in
accordance with the Brihatrayi. His treatise describes Swasa Chikitsa in the 12th
chapter along with Hikka Roga 39.
Arunadatta: Arunadutta commentator, in his commentary titled Sarvangasundara on
Ashtanga Hridaya, Arunadatta has mentioned the etiological factors of Swasa and has
opined the predominant involvement of Kapha Dosha in the etiopathogenesis of
Swasa Roga 40.
Kalyanakaraka: The description of herbo-mineral combinations that may be
prescribed in patients suffering from Swasa Roga is unique in this text book.
Ayurvedarasayana: Indu discuss the aggravated Kapha as the cause of Swasa.
Bhavaprakasha and Yogaratnakara: Both these works describe the Swasa Roga at full
length and this is in accordance with the description available in Brihatrayi 41, 42.
Nirukti of Tamaka Swasa
The word Tamaka Swasa (TS) is composed of two words. They are Tamaka and
Swasa.
The word ‘Tamaka’ is derived from the dhatu (root) “Tamaka glanu” with “Kwip”
pratyaya. It means; to choke, darkness, be suffocated 43. It is also defined as “Tamyati
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
17
iti Tamaka”- “tama eva Tamaka” in Shabdakalpadruma, which means dark curtains
i.e. ‘tama’ occurs, in Tamaka Swasa 44.
The word ‘Swasa’ is derived from the dhatu “Swas” with “gahs” pratyaya. It means
to breathe 45
The word Tamaka Swasa means difficulty in breathing; which occurs mainly during
night hours.
Tamaka Swasa vis-à-vis Bronchial Asthma is a condition of the lungs in which there
is widespread narrowing of airways, varying over short periods of time either
spontaneously or as a result of treatment, due in varying degrees to contraction
(spasm) of smooth muscle, edema of the mucosa, and mucus in the lumen of the
bronchi and bronchioles; these changes are caused by the local release of spasmogens
and vasoactive substances (e.g., histamine, or certain leukotrienes or prostaglandins)
in the course of an allergic process 46.
Paribhasha of Tamaka Swasa
The attack of Swasa with tamapravesha which occurs specially during durdina
is called as Tamaka Swasa. i.e. “Visheshyaddurdine tammyethi Swasa ha sa
tamako mataha” 47.
Vijayarakshita the commentator of Madhavanidana explained as “Swasastu
bastrikadmana samavatordwa gamitha”. I.e. sounds similar to the sound of
bellow of blacksmith 48.
Dalhana 49 and Chakrapani 50 commented Tamah praveshana which refers to
the darkness or black curtains in front of the eyes.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
18
The features or the clinical picture of TS; looks identical with the features of
Bronchial Asthma (BA) and resembles for a greater extent.
Definition
The American thoracic society defined BA as a clinical syndrome characterized by
increased responsiveness of the trachio-bronchial tree to a variety of stimuli, which is
manifested physiologically by generalized airway obstruction which varies in severity over
short periods of time either spontaneously or as a result of treatment 51.
In current medical diagnosis and treatment 1999- Asthma is defined as a chronic
inflammatory disorder of the airway. Airway inflammation contributes to airway hyper
responsiveness, airflow limitation, respiratory symptoms (which include recurrent episodes
of wheeze, breathlessness, chest tightness and cough particularly during the night and early
morning).
The word “asthma” is derived from Greek, which means hard drawn breath or
panting. Asthma is a disease of airways i.e., characterized by increased responsiveness of the
trachea bronchial tree to a multiplicity of stimuli. Asthma is manifested physiologically by a
wide spread narrowing of air-passages, and clinically dysponea, cough and wheezing, it is an
episodic disease. Its prevalence, is a very common disorder and it is estimated that 4-5% of
the world population 52.
Relevant information from Shareera
Respiratory System
The respiratory system is responsible for supplying oxygen to the blood and
expelling waste gases, of which carbon dioxide is the primary constituent, from the body.
The upper structures of the respiratory system are combined with the sensory organs of smell
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
19
and taste (in the nasal cavity and the mouth) and the digestive system (from the oral cavity to
the pharynx). At the pharynx, the specialized respiratory organs diverge into the airway.
The larynx, or voice box, is located at the head of the trachea, or windpipe. The trachea
extends down to the bronchi which branch off at the tracheal bifurcation to enter the hilus of
the left or right lung. The lungs contain the narrower passageways, or bronchioles, which
carry air to the functional unit of the lungs, the alveoli. There, in the thousands of tiny
alveolar chambers, oxygen is transferred through the membrane of the alveolar walls to the
blood cells in the capillaries within. Likewise, waste gases diffuse out of the blood cells into
the air in the alveoli, to be expelled upon exhalation. The Diaphragm, a large, thin muscle
below the lungs, and the inter-costal and abdominal muscles are responsible for contracting
and expanding the thoracic cavity to effect respiration. The ribs serve as a structural support
for the whole thoracic arrangement, and pleural membranes help provide lubrication for the
respiratory organs so that they are not chafed during respiration.
Figure -1
Upper and Lower Respiratory System
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
20
Trachea
The trachea, or windpipe, is the upper section of the airway, separated from the
pharynx by the larynx. It is composed of ribbed cartilage which extends about four inches
down to the bronchi of the lungs. Resting flatly against the esophagus, the trachea can
extend slightly during swallowing, breathing, or bending the neck. It is lined with a mucous
layer and cilia which help to filter out dust. The constant action of these cilia carry mucous
and debris upward into the pharynx, where upon it is swallowed. When the upper trachea or
pharynx become blocked so as to cut off the airway, as from swelling of the tissues, a small
incision is made in the throat and into the trachea, in an operation called a tracheotomy,
which allows air to pass into the windpipe.
Figure -2
The Bronchi and Lobules of the Lung
A rdhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 21Bronchus
The bronchi are the tubes which carry air from the trachea to the inner recesses of the
lungs, where it can transfer oxygen to the blood in small air sacs called alveoli. Two main
bronchi, the right and left bronchus, branch off of the low end of the trachea in what is called
the tracheal bifurcation. One bronchus extends into each of the right and left lung. The
bronchi continue to divide into smaller passageways, called bronchioles, forming a tree-like
network of branches which extends throughout the spongy lung tissue. The exterior of the
bronchi are composed of elastic, cartilaginous fibers and feature annular reinforcements of
smooth muscle tissue. The bronchi are able to expand during inspiration, to allow the lungs
to expand, and contract during expiration as air is exhaled.
Upper Lobe
The right and left lung feature fissures divide the overall structures into smaller
lobes. The left lung (the body's left, the viewer's right) has one horizontal fissure which
divides it into two lobes (upper and lower). The right lung has one horizontal fissure and one
oblique fissure, dividing the right lung into three lobes (upper, middle, and lower). Because
of this third lobe, the right lung is larger than the left, extending further down in the
abdominal cavity. The right and left lung are each enclosed in a pleural sac and are separated
by the mediastinum, a membrane which extends from the vertebral column in back to the
sternum in front.
Middle Lobe
The right and left lung feature fissures divide the overall structures into smaller
lobes. The left lung (the body's left, the viewer's right) has one horizontal fissure which
divides it into two lobes (upper and lower). The right lung has one horizontal fissure and one
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
22
oblique fissure, dividing the right lung into three lobes (upper, middle, and lower). Because
of this third lobe, the right lung is larger than the left, extending further down in the
abdominal cavity. The right and left lung are each enclosed in a pleural sac and are separated
by the mediastinum, a membrane which extends from the vertebral column in back to the
sternum in front.
Figure - 3
Gross Anatomy of the Lungs
Ardhedashe
maniya Swasaharavati in the management of Tamaka Swasa – Literary review 23Lower Lobe
The right and left lung feature fissures divide the overall structures into smaller
lobes. The left lung (the body's left, the viewer's right) has one horizontal fissure which
divides it into two lobes (upper and lower). The right lung has one horizontal fissure and one
oblique fissure, dividing the right lung into three lobes (upper, middle, and lower). Because
of this third lobe, the right lung is larger than the left, extending further down in the
abdominal cavity. The right and left lung are each enclosed in a pleural sac and are separated
by the mediastinum, a membrane which extends from the vertebral column in back to the
sternum in front.
Alveoli
The alveoli are the tiny sacs at the ends (or "leaves") on the bronchial tree. Each
small bronchiole divides into half a dozen or so alveolar ducts, which are the narrow inlets
into alveolar sacs. Each alveolar duct subdivides, leading into three or more alveolar sacs.
Each large alveolar sac is like a grape cluster which contains ten or more alveoli. Because the
membrane separating the alveolus and the capillary network which carries blood over them is
very thin and semi-permeable, oxygen can transfer from the air into the blood cells within the
capillaries. Likewise, carbon dioxide and other waste gases can transfer out of the blood and
into the air to be exhaled from the lungs. The alveoli are particularly susceptible to infection,
as they provide bacteria and viruses a perfect place to grow. This accounts for the tendency
for a chest cold or other lung problem to advance into pneumonia and pneumonitis, both
potentially dangerous conditions in which the innermost parts of the lungs become infected
and inflamed, diminishing air flow and oxygen transport.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
24
Figure - 4
The Bronchi and Lobules of the Lung
FUNCTIONS OF
The respiratory sy
1. Providing
blood.
2. Moving a
3. Protecting
environme
invasion b
4. Producing
5. Providing
superior p
Ard
THE RESPIRATORY SYSTEM
stem has five basic functions:
an extensive area for gas exchange betw
ir to and from the exchange surfaces of the l
respiratory surfaces from dehydration,
ntal variations and defending the respirator
y pathogens.
sounds involved in speaking, singing, and n
olfactory sensations to the CNS from t
ortions of the nasal cavity.
hedashemaniya Swasaharavati in the management o
een the air and the circulating
ungs.
temperature changes, or other
y system and other tissues from
onverbal communication.
he olfactory epithelium in the
f Tamaka Swasa – Literary review 25
In addition, the capillaries of the lungs indirectly assist in the regulation of blood
volume and blood pressure, through the conversion of angiotensin I to angiotensin II 53.
Tamaka Swasa vis-à-vis Asthma
Asthma affects an estimated 3-6 percent of the population. There are several forms of
asthma, but each is characterized by unusually sensitive and irritable conducting
passageways. In many cases, the trigger appears to be an immediate hypersensitivity reaction
to an allergen in the inspired air. Drug reactions, air pollution, chronic respiratory infections,
exercise, or emotional stress can also induce an asthmatic attack in sensitive individuals.
The most obvious and potentially dangerous symptoms include -
(1) The constriction of smooth muscles all along the bronchial tree,
(2) Edema and swelling of the mucosa of the respiratory passageways, and
(3) Accelerated production of mucus.
The combination makes breathing very difficult. Exhalation is affected more than
inhalation; the narrowed passageways often collapse before exhalation is completed.
Although mucus production increases, mucus transport slows, and fluids accumulate along
the passageways. Coughing and wheezing then develop. The broncho-constriction and mucus
production occurs in a few minutes, in response to the release of histamine and
prostaglandins by mast cells. The activated mast cells also release interleukins, leukotrienes,
and platelet-activating factors. As a result, over a period of hours, neutrophils and eosinophils
migrate into the area. The area then becomes inflamed, further reducing airflow and
damaging respiratory tissues. Because the inflammation compounds the problem,
antihistamines alone are often unable to control a severe asthmatic attack.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
26
When a severe attack occurs, it reduces the functional capabilities of the respiratory
system. Peripheral tissues gradually become oxygen starved, a condition that can prove fatal.
Asthma fatalities have been increasing in recent years.
Pulmonary Lobules
The connective tissues of the root of each lung extend into the lung's parenchyma.
The fibrous partitions, or trabeculae, contain elastic fibers, smooth muscles, and lymphatic
vessels. The trabeculae branch repeatedly, dividing the lobes into ever smaller compartments.
The branches of the conducting passageways, pulmonary vessels, and nerves of the lungs
follow these trabeculae.
The finest partitions or interlobular septa (septum, a wall) divide the lung into
pulmonary lobules, each supplied by branches of the pulmonary arteries, pulmonary veins,
and respiratory passageways. The connective tissues of the septa are in turn continuous with
those of the visceral pleura, the serous membrane covering the lungs.
RESPIRATORY PHYSIOLOGY
The general term respiration refers to two integrated processes: external respiration
and internal respiration. The precise definitions of these terms vary from reference to
reference. In this discussion, external respiration includes all the processes involved in the
exchange of oxygen and carbon dioxide between the interstitial fluids of the body and the
external environment. The goal of external respiration, and the primary function of the
respiratory system, is to meet the respiratory demands of living cells. Internal respiration is
the absorption of oxygen and the release of carbon dioxide by those cells. We shall consider
the biochemical pathways responsible for oxygen consumption and carbon dioxide
generation by mitochondria, often called cellular respiration.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
27
Our discussion of respiratory physiology focuses on four integrated steps involved in
external respiration:
1. Pulmonary ventilation, or breathing, which involves the physical movement of air
into and out of the lungs.
2. Gas diffusion across the respiratory membrane between the alveolar air spaces and
the alveolar capillaries.
3. The storage and transport of oxygen and carbon dioxide between the alveolar
capillaries and capillary beds in other tissues.
4. The exchange of dissolved gases between the blood and the interstitial fluids.
Abnormalities affecting any one of these steps will ultimately affect the gas
concentrations of the interstitial fluids and thereby cellular activities as well. If the oxygen
content declines, the affected tissues will become oxygen-starved. Hypoxia, or low tissue
oxygen levels, places severe limits on the metabolic activities of the affected area. For
example, the effects of coronary ischemia result from chronic hypoxia affecting cardiac
muscle cells. If the supply of oxygen is cut off completely, the condition of anoxia is results.
Anoxia kills cells very quickly. Much of the damage caused by strokes and heart attacks is
the result of localized anoxia.
Respiratory Reflexes
The activities of the respiratory centers are modified by sensory information from:
1. Chemo-receptors sensitive to the PCO2, pH, and/or PO2 of the blood or CSF.
2. Changes in blood pressure in the aorta or carotid sinuses.
3. Stretch receptors that respond to changes in the volume of the lungs.
4. Irritating physical or chemical stimuli in the nasal cavity, larynx, or bronchial tree.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
28
5. Other sensations, including pain, changes in body temperature, and abnormal visceral
sensations.
Information from these receptors alters the pattern of respiration. The induced
changes have been called respiratory reflexes.
Figure – 5
Pressure changes during inhalation and exhalation
Hypercap
Hy
hypercapn
bodies an
blood-bra
ni
p
ia
d
in
a and Hypocapnia
ercapnia is an increase in the PCO2 of arterial blood. The central response to
is triggered by the stimulation of chemo-receptors in the carotid and aortic
reinforced by stimulation of CNS chemo-receptors. Carbon dioxide crosses the
barrier quite rapidly, so a rise in arterial PCO2 almost immediately elevates CSF
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 29
CO2 levels, lowering the pH of the CSF and stimulating the chemoreceptive neurons of the
medulla oblongata.
These receptors stimulate respiratory centers to increase the rate and depth of
respiration. Breathing becomes more rapid, and more air moves into and out of lungs with
each breath. Because more air moves into and out of the alveoli each minute, alveolar
concentrations of carbon dioxide de-cline, accelerating the diffusion of carbon dioxide from
the alveolar capillaries. Thus homeostasis is restored.
If the rate and depth of respiration exceed the demands for oxygen delivery and
carbon dioxide removal, the condition of hyperventilation exists. Hyperventilation will
gradually lead to hypocapnia, an abnormally low PCO2. If the arterial PCO2 drops below
normal levels, chemoreceptor activity decreases and the respiratory rate fall. This situation
continues until the PCO2 returns to normal and homeostasis is restored.
The most common cause of hypercapnia is hypoventilation. In hypoventilation, the
respiratory rate remains abnormally low and is insufficient to meet the demands for normal
oxygen delivery and carbon dioxide removal. Carbon dioxide then accumulates in the blood.
AGING AND THE RESPIRATORY SYSTEM
Many factors interact to reduce the efficiency of the respiratory system in elderly
individuals. Three examples are -
1. As age increases, elastic tissue deteriorates throughout the body. This deterioration
reduces the compliance of the lungs, lowering the vital capacity.
2. Chest movements are restricted by arthritic changes in the rib articulations and by
decreased flexibility at the costal cartilages. The stiffening and reduction in chest
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
30
movement effectively limit the respiratory minute volume. This restriction contributes
to the reduction in exercise performance and capabilities with increasing age.
3. Some degree of emphysema is normally found in individuals over age 50. However,
the extent varies widely with the lifetime exposure to cigarette smoke and other
respiratory irritants. The respiratory performance of individuals who have never
smoked with individuals who have smoked for varying periods of time.
After through discussion of the concern organ anatomical and physiological
perceptions it is relevant to understand the Tamaka Swasa vis-à-vis Asthma from the
classical Ayurvedic texts and also of modern parlance 54.
Figure – 6
Ageing and the decline in Respiratory performance
PRANAVAHA SRO
Tamaka Swasa
Physiology of Prana
detail.
Ardheda
T
v
s
AS
is a disease of Pranavaha Srotas. Therefore detailed Anatomy and
aha Srotas (Respiratory system) is essential to study the disease in
hemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 31
Chakrapani had clearly stated that this Srotas is related to a special "Vata" called
“prana 55. Adhamalla, the commentator of Sharangadhara Samhita had also explained that
Pranavata is the Vayu in which the life is located 56. The word "prana" is derived from the
Sanskrit root "An" with a prefix "Pra". "An" means to breathe, to live 57. The word "prana"
of Pranavaha Srotas should not be misunderstood as Pranavata, one of the five subdivisions
of Vata. The act of respiration is one of the functions of Pranavata 58 but the function of
Pranavaha Srotas is only respiration.
According to Charaka, the moola (source or origin) of Pranavaha Srotas is Hridaya and
maha srota 59. (The word Moola here indicates that the organs mentioned as moolas of srotas
are capable of bestowing strength and efficacy or even influences that particular srotas). But
Sushruta considered hridaya and rasavahini dhamanis as the moola 60. A patantara was
mentioned in the Nirnayasagar press of Susruta Samhita as "Pranavahini dhanianya" instead
of "rasavahini dhamanis".
Here the word "Hridaya" requires explanations. This word is derived from three
Sanskrit roots "Hri", "Da" and "ya", which respectively mean Harana, Dana and Ayana.
These three words respectively mean receipt, giving away and moving for the continuous
activity to execute the two earlier functions. The word 'Ayana" indicates path, way or
through which movement of materials takes place. Therefore it is evident that the
designation "hridaya" denotes only the functional aspect of an organ but not its anatomical
location. The anatomical identity can be decided only on the basis of the substance / material
conveyed by it.
In the light of the above-mentioned definition and other explanations, there are certain
organs, which can qualify for the designation of "Hridaya' of these, three are important.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
32
1. Pupphusam or a lung, which takes in and gives out the air by continuously
functioning/ moving for the vital respiratory act.
2. Hridaya (or thoracic heart), which receives and ejects the blood (Rasa- Rakta
complex) by continuous contractions and relaxations for the maintenance of the
circulation to perform the preenana and jeevana kriyas to the body tissues.
3. The manas or mind, located in the Mastishka, receiving the information about the
indriyarthas from the sense organs and giving out the instructions of the Buddhi
regarding the requisite action to the karmendriyas or other musculature. This
action of the Manas correlate, the functions of the cognitive and connective
organs.
These are the other organs that qualify to be designated as "Hridaya". But the
anatomical identification is mainly based on the substance dealt by that organ. Based on the
explanation of Chakrapani that the pranavaha Srotas 61 is concerned with the visishta vayu
known as Prana, the puppusha have to be accepted as the moola of these srotases. The word
"Mahasrotas", which according to Charaka is one of the two moolas of pranavahasrotases,
indicates that it is a large tube and large in diameter.
As the "Pranavata” is a corporeal substance, the mahasrotas should be a patent
structure (but not Koshta). Therefore the mahasrotas associated with pupphusa (lungs) is the
trachea, its two branches, bronchi and their further branching into bronchioles to the alveoli.
All these structures participate in the act of respiration (the movement of the visishta Vata).
Charaka seems to indicate what Sharangadhara opined is that only the external respiration
comprising of inspiration and expiration with the absorption of visishta Prana vayu (oxygen)
and removal of the carbon dioxide from the body as a whole 62.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
33
The internal or tissue respiration consisting of the gaseous exchange between the cells
and their fluid medium is equally important for the jeevanakriya. Susruta seemed to have
indicated this aspect by stating that the Hridaya (in this context, the thoracic heart) and
Rasavahini dhamanis are the moolas of the Pranavaha srotases. These two moolas require
some explanation.
Nidana Panchaka of Tamaka Swasa
An attempt has been made to review the Nidana panchaka of Tamaka Swasa, those
are Nidana, Samprapti, poorvaroopa, roopa, upashaya, and Chikitsa from various classical
texts and contemporary explanation regarding the (Asthma) aetiology, pathophysiology of
the Bronchial Asthma (Tamaka Swasa) also be reviewed from various texts and recent
journals website for better understand the disease aspect as well as treatment aspect of the
Tamaka Swasa.
Nidana of Tamaka Swasa
The disease of Tamaka Swasa has its own etiological factors and Nidanottara karanas
Charaka has claimed. A single etiological factor may produce a single disease or many
etiological factors may produce the single disease 63 contemporary sciences also reveals the
bronchial asthma is heterogeneous disease 64. Various Authors of Ayurvedic texts 65 to 69 have
been mentioned the general etiological factors of the Swasa which are also considered for the
Tamaka Swasa. But aggravating factors like meghambu(rainy season) sheeta sthana(cold
place) and preceding factors like peenasa (common cold) kasa(cough) are clearly explained
in the pathology of Tamaka Swasa 70, 71. Nidana (etiological factors) are classified into
mainly two groups 72. The general etiological factors of Swasa roga also divide into two
categories, viz. – Bahya and Abhyantara.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
34
Bahya karana like raja sevena vayu sevana, (acharajanya) karana considered as
aharajanya. Abhyantara Karana are also responsible for the cause of Swasa such as – Ama
Dosha, Vibandha, Rooksha bhojana, etc.
Chakrapani has classified Nidana of Swasa under three categories 73.
1. Vataprokopaku gana - The Aetiological factors which vitiate the Vata Dosha are
grouped ex.-raja sevana dhumapana
2. Kapha prokopaka gana - The Aetiological factors which vitiate the Kapha Dosha are
grouped ex-nishpava, mash
3. Agnimandhya karaka and Ama utpadaka Nidana are also grouped. Agnimadyakara
nidanas are for diminish the Agni there by Ama takes place. The most of the disease
are due to Ama dosha only i.e. amay. Ex-Ama ksheer Jalaja Mamsa 74.
Other classification has been made fewer than four headings 75, Ahara sambandi, Vihara
sambandi, Nidanarthakara and Agantu sambani.
1. Ahara sambandi nidanas – in this category the etiological factors related to food, drinks
are grouped. Example: sheeta jala sevan, sheeta ashana (intake of cold foods) etc 76.
2. Vihara sambandi nidanas – in this category the etiological factors like external activities
of person exposed to vayu sevan, shetasthan are grouped.
3. Nidanarthakara (avastha sambhandhi) – the different physiological and pathological
conditions which play a very important role in manifestation of Tamaka Swasa. Ex-
pandu, kasa, atisara, pratisyaya jwara etc 77.
4. Agantu nidanas – in this classification injuries and trauma related factors are mentioned
ex-marmaghata, like stanarohita 78, stanamoola apasthamba, Sirama –vishalyagna 79
marma.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
35
Like wise again grouped under three headings –
1) Asatmendriyartha samyoga, 2) Parinama and 3) Prajnaparadha
ASATMENDRIYARTHA SAMYOGA
In Tamaka Swasa asatmendriyartha plays an important role in the causation of
Tamaka Swasa. Mainly Ghranendriya, Rasanendriya and Sparsanendriya and their samyoga
with Asatmyaartha will precipitate Tamaka Swasa immediately. Affect of allergy and atopy
has discussed in modern science as Aetiological factors. Nidana of Tamaka Swasa like raja,
dhuma sevana, anoopa mamsa sevana may be considered in this category.
PRAJNAPARADHA
Either conscious or unconscious indulgence in harmful activities causes disease.
These prajnaparadha like atimaithun, atyadhika padayatra, adhika vyayam will cause Tamaka
Swasa.
PARINAMA
Parinama means the effect of climatic condition. This is very well observed that
paroxysmal attacks of Tamaka Swasa during specific time and season. Example: night,
winter season, cloudy climate and rainy season.
Table No: 1 Showing Nidana of Swasa / Tamaka Swasa
Factors CS 80 SS 81 AH 82 AS 83 MN 84
Vata-Prakopa Ahara Rukshanna - Ununctuous food + + - - + Visamashana - Irregular food habit + + - - + Adhyashana - Habit of eating frequently - + - - - Anasana - Observation of fast for long - + - - + Dvandvatiyoga - Mutually contradicting foods
+ - - - -
Sheetashana - Cold foods - + - - + Visha – Poison + + - - + Sheetapana - Cold drinks - + - - +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
36
Pitta-Prakopa Ahara Tilataila - Gingely oil + - - - - Vidahi - Food causing burning sensation + + - - + Katu -Spicy food - - - + - Usna - Hot food - - - + - Amla - Sour - - + - - Lavana - Salt - - + + -
Kapha-Prakopa Ahara Nispava - Dolichos lablab + - - - - Masa - Vigna radiatus + - - - - Pistanna – Pastries + - - - - Saluka - Rhizome of lotus + - - - - Guru dravyas - Heavy food + + - - + Jalajamamsa - Meat of aquatic animals + - - - - Anupa mamsa - Meat of marshy animals + - - - - Dadhi – Curds + - - - - Amaksira - Unboiled milk + - - - - Utkleda - Kaphakara food + + - - + Vistambhi + + - - +
Vata-Prakopa Vihara Rajas - Dust / Pollen + + + + + Dhuma - Smoke + + + + + Vata - Cold breeze + + + + + Sheeta Sthana - Cold places + + - - + Sheeta ambu - Cold water + + + + + Ativyayama - Excessive exercises + + - - + Gramya dharma - Excessive sexual intercourses
+ - - - +
Apatarpana - Emaciating techniques + - + - + Shuddhi Atiyoga - Excessive purification + + - - + Kantha/Urah pratighata - Injury to throat/chest
+ - - - +
Bharakarshita - Emaciation due to lifting heavy weights
+ + - - +
Adhwahata - Excessive walking + + - - + Karmahata - Excessive-work + + - - + Veganirodha - Suppression of urges - - - + - Abhighata - Injury - + + + - Marmabhighata–Injury to vital structures + - - - +
Pitta-Prakopa Vihara Usna – Hot - - - + -
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
37
Kapha -Prakopa Vihara Abhishyandi Upacara - Administration of substances which obstruct the channels
+ - - - +
Divasvapna - Day sleeping - - - - -
Vataja-Vyadhi / Avastha Sambandhi Nidana
Anaha + - - - -
Dourbalya + - - - -
Atisara + - - - +
Kshaya - + - - -
Ksataksaya + - - - -
Udavarta + - - - -
Visucika + - - - -
Panduroga + + + + -
Visa Sevana + + + + -
Vibandha + - - - -
Pittaja Vyadhi / Avastha Sambandhi Nidana
Rakta pitta + - - - -
Jwara + - - - +
Kaphaja Vyadhi / Avastha Sambandhi Nidana
Kasa - - + + -
Amapradosa - + - - -
Chardi + - + + -
Pratisyaya + - - - -
Amatisara - - + + -
Aetiology of Asthma
Aetiological factors of asthma are of two types. Some factors called inducing factors
can set initial development of asthma, whereas some other factors provoke an episode in
predisposed individuals suffering from asthma and these are called provoking or trigger
factors 85.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
38
1) INDUCING FACTORS
Genetic factors are important to determine why asthma occurs in a particular
individual. Asthma occurs more commonly in relatives of atopic individuals and therefore
atopy has been recognized as an important risk factor for developing asthma. A distinct gene
for atopy on chromosome 11q has been identified 86. The frequent clinical observation that
asthma runs in families has been supported by many more formal investigations 87.
The genetics of production of total serum IgE have studied. In such studies
consideration has to be given to the following factors since each has been shown to effect of
IgE levels allergic exposure, parasitic infection age, gender, and smoking. A correlation was
found between the total serum IgE of parents and children, suggesting the involvement of
one or more genes. However agreement on the model of inheritance blocking linkage of loci
for total serum IgE and BHx to chromosome has been reported 88. A gene for IgE response
with maternal inheritance was identified at chromosome. High level of IgE in cord blood
appears to be strong indicator of subsequent development of atopic disease 89. Further it is
likely that different genes and different environmental factors contribute to asthma in
different populations. The chromosome 5 contains a 1l-4 gene cluster, which is closely linked
inheritance of an increased IgE response and to increased bronchial asthma 90.
2) PROVOKING FACTORS
a) Atopy and allergy
The association between asthma and allergy has long been recognized. It has been
reported that 75 to 85 percent of patients with asthma have positive immediate skin reactions
to common inhalant allergens. There are at least 6 major evidences to prove that asthma is
due to exposure to allergens.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
39
1. Most people with asthma are atopic, which can be measured by skin tests or with
measurements of specific IgE.
2. Challenge with allergens in atopic asthmatics increases the severity of the disease.
3. Occupational asthma is known to be caused by allergens and sensitisers
4. It has been shown that subjects with apparently intrinsic asthma have higher levels of
circulating IgE than the non-asthmatic population.
5. Improvement in the symptomatology occurs on allergen withdrawal which proves the
causal relationship between the two.
6. Population studies have clearly demonstrated association between atopy and asthma 91.
Taken together these facts are strong evidence for the role of atopy in asthma. The
most important are house dust mites, grass pollens, animal proteins, and moulds. Danders
from these animals like dog, cats, horses, and other pet animals contribute greatly to the
allergenic components of house dust 92.
b) Food and drinks
Atopic asthmatics may occasionally notice that their symptoms are provoked by certain
foods or drinks. The foods most frequently suspected are milk, eggs, fish, cereals, nuts and
chocolates, but very many others have been described 93. Indians are reported to be more
sensitive and broncho-constrict to Ice and cola drinks 94. Food preservatives also provokes
attacks of asthma, such as benzoates, sodium nitrate and sodium metabisulphite, anti-
oxidants, the yellow food colorings agents such as tartrazine 95.
Food allergies are common triggers for asthma and their symptoms are provoked by
certain foods. The allergens are compared with asatmya sevana in Ayurveda. These factors
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
40
are discussed under Asatmendriyartha samyoga Nidana. Our Acharya's have mentioned
dhuma, raja, jalaja and anoopa mamsa sevena etc are inducing asthma.
c) Infection
The observations have suggested that viral infections may be intimately involved in the
development of asthma. The viral respiratory illnesses may produce their effect by causing
epithelial damage, producing specific immunoglobulin IgE antibodies directed against
respiratory viral antigens and enhancing mediator release. Interestingly in recent years, it is
also observed that some infections are protective of bronchial asthma. Viral or bacterial
infections during the first three years of life may serve a protective function against the
development of allergic disease. Multiple Infections occur during the first few years of life,
high concentrations of these Th 1 Cytokines could inhibit the release of Th 2 Cytokines, there
by turning the mucosal immune response away from allergen sensitization 96. The viruses
usually responsible are influenza, rhinovirus, and respiratory syncytial virus, together with
bacterium Mycoplasma pneumonia 97. The role of infections in causation of Tamaka swasa is
not mentioned but effects of viral infections like kasa, prathishyaya, jwara have mentioned as
Nidana of Tamaka Swasa are also included in Nidanarthakara roga Karanas 98.
d) Drug 99
About 5 to 20 percent of adults with asthma will experience severe and even fatal
exacerbations of broncho-constriction after ingestion of aspirin or NSAIDS. Although the
exact mechanism is not known, it is non-immunologic and probably depends on inhibition of
cyclooxygenase. Other drugs include beta-blocker drugs; eye drop preparations of this class
like nadolol drugs can also induce asthma. Recently inhaled verapamil, a calcium channel
blocker has been reported to induce severe bronchospasm in mild asthma.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
41
e) Exercise
Exercise induced asthma" is often used to describe the asthma of persons in whom
exercise is the predominant or even the only identified trigger to air flow obstruction.
Exercise induced broncho-constriction is one manifestation of the asthmatic diathesis;
untreated EIA can limit and disrupt normal life.
Airway narrowing develops within 2 to 3 minutes after cessation of exercise. It
generally reaches its peak about 5 to 10 minutes after cessation of activity and usually
resolves spontaneously in the next 30 to 90 minutes or with bronchodilators 100. A rapid
change to warm, moist air post exercise tends to worsen the development of airflow
obstructions 101.
In contrast to asthma in general, EIA is due to smooth muscle contraction. The key
aspects of the triggering stimulus are the level of ventilation during exercise and the
temperature / water content of the inspired air 102. To reduce / avoid EIA, avoidance of cold /
dry environment is preferable. The role of exercise (Vyayama) is well recognized in
Ayurveda.
f) Occupational factors
With increased industrialization, simple chemicals and organic compounds have been
used more often with a consequent increase in new respiratory hazards, particularly
occupational asthma. Over 250 agents have been recognized to cause occupational asthma
103. Occupations like veterinarians, laboratory workers, formers, processing, pharmaceuticals,
painter, and hospital workers are more prone for occupational asthma 104.
Occupational asthma can be mediated by any of the several mechanisms. They
include, reflex vagal broncho-constriction in response to an irritant effect on specific
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
42
receptors, inflammatory broncho-constriction secondary to toxic concentration of gases or by
immunologic mechanisms 105. Typically, the symptoms initially occur towards the end of the
working day and in the evening, and are relieved at weekends and on holiday 106.
Some of the aetiological factors mentioned under vihara category can be incorporated
with occupational factors mentioned by modern literature. They are sheetastana,
bharavahanam, adhwagamana, etc.
g) Rhinitis & Sinusitis
A possible relation between sinusitis and activation of asthma has been postulated
recently. It is also likely that nasal and sinus pathology can aggravate asthma, particularly if
there is uncontrolled drainage of mucoid or muco-purulent material down the nasopharynx
where it can contribute to cough and irritability of larynx.
It is now being appreciated that allergic rhinitis and bronchial asthma are considered
as one air way, and one disease 107. It is estimated that 60 to 70 percent of patients who have
asthma have also co-existing allergic rhinitis. Traditional therapies originally indicated for
allergic rhinitis and asthma are being reassessed to explore their potential utility in both these
condition 108.
These Nidana are well recognized by our Acharyas. They have mentioned Pratishyaya
and Peenasa like rogas. They have predisposing or sometimes accompanying with the
Tamaka Swasa.
h) Gastro-esophageal reflux (GOR) 109, 110
Two separate mechanisms are involved in the gastro-esophageal reflux and asthma
relationship -
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
43
i) Reflex vagal broncho- constriction occur secondary to stimulation of sensory nerve
fibres in the lower oesophagus. This mechanism is supported by the findings that
acid infusion of the oesophagus in asthmatic patients leads to increased airway
resistance that rapidly reverses with antacids.
ii) The second proposed mechanism is micro-aspiration, a high prevalencerate of
hiatus hernia and gastroesophageal reflux in patients with bronchial asthma
A number of reports are available in medical literature on the relationship between
gastro esophageal reflux and pulmonary disease. In Ayurveda, the disease is being
mentioned as Amashaya (pittastana) samudbhava 111 and findings also support this
explanation.
i) Psychological factors 112
There has been a great deal of controversy regarding the cause and effect relationship
of asthma and psychological factors. Many of patients with asthma acknowledge that
exacerbations are provoked by psychological events, such as shock, excitement,
bereavement, depression. Other psychological problems like recent family loss, disruption,
recent unemployment, and schizophrenia. Occasionally, psychological illness, family
disputes or marital disharmony may be major factors in the aetiology of intractable asthma.
Definite emotional factors are not mentioned in the nidanas of Swasa. But their role in
disease development is well approved by Ayurveda. The above mentioned nidanas mainly
vitiate Vata which has important role in Tamaka Swasa.
j) Pollution 113
Pollution with particulate matter adds to the allergenicity of aeroallergens. Passive
smoking is known to be a risk factor.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
44
SAMPRAPTI OF TAMAKA SWASA
Samprapti is a process from Dosha-vaishamya up to the manifestation
of disease Study of Samprapti is very important, because it is mentioned as Samprapti
vighatanameva Chikitsa" i.e., the disintegration of Samprapti completes the treatment 114.
Samprapti explains the complete disease process which starts immediately after Nidana
sevana, by the way the Dosha vitiated and where by vitiating doosya leading to Dosha -
doosya sammurchana, producing a disease. It includes the explanation about the
derangement of Dosha and pathological changes that takes place in the disease process and
also mode of manifestation of clinical features.
SAMANYA SAMPRAPTI
Vata located in the Uras after afflicting the Pranavaha Srotas, get aggravated and
stimulates Kapha which is located in uras 115.
It is observed that,
1. The Dosha-involved are Vata and Kapha.
2. Srotas involved is Pranavaha Srotas.
3. Vata is the main factor.
Again Samprapti explained as, the disease originate from the Pittastana, and are
caused by simultaneous aggravation of Kapha and Vata. They adversely affect the Hridaya
and all the Rasadi Dhatu. Here the disease originate from Pittastana, here implies Amashaya,
where the disease originate. Both Vata and Kapha simultaneously aggravated. Hrudaya and
rasadi dhatu are also affected in this disease.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
45
VISISTA SAMPRAPTI OF SWASA
The visista Samprapti of Tamaka Swasa says, Vata predominantly associated with
Kapha, obstructs the Srotas, the obstructed Vata trying to overcome the obstruction and
moves in all direction, resulting the disease i.e., Swasa 116.
In the above reference in first line the word 'Kapha purvaka' has been used.
Chakrapani says it means 'Kapha pradhana' i.e. predominance of Kapha. Also here Srotas
word being said. The commentator considered the pranavaha and udakavaha srotas
involvements in this disease 117. In second line "vishug vrajati" is being used. For this
Gangadhara opines that "sarva shareera gacchati." Chakrapani says the meaning of this word
is "Sarvata gacchati" i.e., moves in all direction. It is better to considered movement in chest
only 118.
In short it can be summarizes like -
1. Mainly Pranavaha srotas gets obstructed by Kapha, by which Vata
aggravated due to srotosanga. Also vitiation of Udakavaha and
Annavaha Srotas are to be considered.
2. Kapha Dosha is predominant.
3. Vata moves all over the chest resulting in Swasa.
SAMPRAPTI PARTICULARLY RELATED TO TAMAKA SWASA
Vata moving in the reverse direction pervades the Srotas (channel) afflicts the shira and
griva, and stimulates Kapha causes Tamaka Swasa Vyadhi 119.
Vagbhata has mentioned Samprapti of Tamaka Swasa similar to that of Charaka, but he
has directly mentioned the vitiation of Pranavaha, Annavaha and Udhakavaha Srotas 120. The
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
46
disease originates from Amashaya. Susruta states that the deranged Vata attains 'urdwa gati '
and along with Kapha produces Swasa. It is almost similar to that of Charaka's explanation.
It is more acceptable almost in all cases Pranavaha and Udakavaha Srotas are involved,
but in rare cases involvement of Annavaha Srotas is also seen. The disease originates from
Amashaya, and Annavaha Srotas moola is Amashaya. In all cases in vitiated states the
moola stana's of Srotas are also vitiated.
The udbhava stana Amashaya still needs more explanation. Water loss through
respiration is common, and vitiated Udakavaha Srotas symptoms are appeared in this disease.
Thus the Samprapti of Tamaka Swasa is complex one. It can be summarized as
follows, in first three Kriyakala i.e. Sanchaya, Prakopa and Prasara. The physiological
derangement takes place due to exposure to aetiological factors (Nidana sevana). These
three levels occur in doshic level only. Here the doshic general symptoms appear i.e.
Dosha Sanchaya or Dosha prakopa lakshanas in Tamaka Swasa,
1. Vata prakopa (dushti) occurs due to vatika Nidana sevana
2. Kapha prakopa (dushti) occurs due to Kaphakara Nidana
3. Agnimandya and subsequently Ama utpatti occurs due to
Agnimandyakara Nidana and as sequele to dosha prakopa.
Samprapti explained, indicate that both Vata, Kapha are mainly involved, though
Kapha is predominant in obstruction of Pranavaha Srotas where by causing Vata prakopa.
In later stages the physiological derangements leads to pathological manifestations.
These three Kriyakalas more gravies because Vyadhi vinischaya, Vyadhi lakshanas, Vyadhi
avasta (prognosis) are being done.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
47
Stana samshraya in Tamaka Swasa
Here the predromal symptoms of Tamaka Swasa are manifested. In this stage the
doshas which are already aggravated and circulating throughout the body affects the tissues
of pranavaha srotas, where the khavaigunya occurs. This Khavaigunya better understood
with modern science prevalence. Due to stana samshraya of doshas in Pranavaha Srotas gets
obstructed (srotosanga) and Vata moves in all directions.
Vyakta in Tamaka Swasa
The sroto sanga due to Kapha and Ama Dosha in Pranavaha Srotas causes vimarga
gaman of Pranavata; where by the lakshanas of Tamaka Swasa will be manifested.
Bhedavastha in Tamaka Swasa
The pathological process which is already ongoing in a patient reaches this stage if
the patients suffer from long time or uncontrolled disease. In long term permanent
irreversible air flow obstruction takes place in affected Dhatu and Srotas, also affect
srotomoolas, as a result complication arises in this stage.
Obstructive phenomena in Pranavaha Srotas:
By the influence of etiological factors there occurs independent vitiation of Pranavata
as well as Kapha Dosha. The morbid Pranavata, by virtue of its Ruksa, Sita and Khara
qualities tends to harden and narrow the Pranavaha Srotas. This narrowing as well as
hardening hinders the free passage of Pranavata in the Pranavaha Srotas 121. In Charaka
Samhita, this aspect of pathogenesis is explained while dealing with the therapeutics. In this
context it is said that Srotomardava Chikitsa has to be done by way of Snehana and Swedana
to reduce the obstruction 122.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
48
Stiffness of the Pranavaha Srotas is not the only cause of obstruction. Quite similar to
the other Srotas, secretion of the Kapha is the natural process. In Tamaka Swasa there occurs
abnormal secretion and accumulation of Kapha in the Pranavaha Srotas obstructing it. This
obstruction prevents smooth and free flow of Prana Vata causing the Prana Vilomata the
prime pathology of Tamaka Swasa. The obstruction and the resultant Prana Vilomata results
in turbulent breathing causing audible wheezing. This is the cardinal symptom of Tamaka
Swasa.
Rapid breathing is another effect of obstruction in the Pranavaha Srotas as opined in
Charaka Samhita. In an adult normal person the rate of respiration is said as 15 per minute. In
patients suffering from Tamaka Swasa this may go up to 40 per minute.
Another effect of obstruction in the Pranavaha Srotas is the Kantha Gurghuraka. The
Sleshma accumulated in the Kantha region obstructing the Pranavayu causes bubbling and
the resultant sound is Kantha Gurghuraka 123.
Samprapti Ghataka's of Tamaka Swasa
Dosha Pranavata, Udanavata,
Avalambhakakapha, Pachakapitta
Dushya Rasa
Agni Jataragni, Rasadhatwagni.
Ama Jataragnijanya and dhatwagnijanya.
Srotas Pranavaha srotas directly, indirectly Udakavaha,
Annavaha and Rasavaha Srotas.
Srotodusti prakara Sanga, vimargagamana.
Udbhava sthana Amasaya (Stomach).
Sanchara Pranavaha srotas.
Adhistana Uras, Pranavaha srotas.
Vyakta sthana Uras (lungs).
Roga marga Abhyantara
Vyadhi swabhava Chirakari (chronic).
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
49
Physiological Swasa has two components and are named as Praswasa and Niswasa.
The ability of the Swasa may be improved by specific pulmonary exercise. This is popularly
known as Pranayama. The assessment of chest expansion, which is approximately 4 to 5 cm
roughly, expresses the ventilatory capacity. Further the understanding of the Pranayama
gives way to think about the ventilation 124 capacities. The following lines give the
description of the same.
The maximum amount of air that may be inhaled is known as Puraka. This refers to vital
capacity and the spirometric evaluation of FVC quantifies the Puraka. In a normal individual
FVC may reach up to 3000 ml. Inhaled air is then held for a maximum period with no
movement of inhalation and exhalation and this is known as Kumbhaka. This may be easily
quantified by the breath holding time. In a normal adult the average breath holding time is
estimated as 50 to 70 seconds. Further this may be improved by another 20 seconds by
practicing pulmonary exercise.
Further exhaling with maximum force is known as Recaka. The capacity of the
Recaka can be evaluated by the spirometry. By assessing the FVC, FEV1 one can quantify
the Recaka. More over the 40 mm test and the expiratory blast test also quantify the capacity
of Recaka activity 125. Further the distance covered by the exhaling air during Recaka
exercise is told as 12 Angula. And this is appreciated by the movement of insects that come
along the way of exhaling air. The same in the present day is quantified by the Snider’s test.
In Tamaka Swasa, as there is obstruction in the Pranavaha Srotas, there will be
reduction in the ventilatory capacity affecting the Puraka, Kumbhaka and Recaka. Reduction
in these ventilarory capacities can be understood by assessing FVC, FEV1, PEF and FVC /
FEV1.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
50
Figure – 7
Schematic representation of Tamaka Swasa Samprapti
NIDANA SEVANA
SANCHAYA AGNIMANDYA DOSHA DUSHTI (Vata & Kapha dusti)
AMARASOTPATTI
PRAKOPA
MALAROOPA KAPHA
PRASARA PARIBHRAMANA PRATILOMAGATI OF VATA
PRANAVAHA SROTOGAMANA
KAPHA makes AVARANA to PRANAVATA STHANA
SANSHRAYA
PRANA try to overcome the AVARANA
VYAKTAVASTHA SWASA (swasavarodha, shwasativriddhi, Ghurghurkam etc.)
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
51
PATHOPHYSIOLOGY OF BRONCHIAL ASTHMA
The hallmark of the disease is the air flow obstruction. Most of asthma is of allergic
origin. It is viewed as sum of three features,
i.The early asthmatic reaction (EAR)
ii.The late asthmatic reaction (LAR) and
iii.Bronchial hyper-responsiveness, with varying contribution from each.
Three factors narrow airway caliber to limit the flow.
1) Airway smooth muscle contraction
2) Gland and epithelial secretions and exudation into the airway lumen, and
3) Inflammatory oedema and vasodilatation (hyperemia).
EARLY ASTHMATIC REACTION (EAR)
In atopic persons, an early response, this begins at 15 minutes and characterised by
smooth muscle contraction, exudation of plasma, and mucous production.
This reaches its peak in about 30 minutes and resolves within 90 to 180 minutes. This
early reaction is IgE dependent and is the result of IgE binding to the mast cells by its Fc
portion and to specific antigens by its F(ab) portion.This results in the release of preformed
and newly generated mediators.This early responce is being accounted for by the release of
histamine 126.
LATE ASTHMATIC REACTION (LAR) AND BRONCHIAL HYPERREACTIVITY (BHR)
The LAR is also characterized by the release of inflammatory mediators into the same
fluids. However, during this phase there is striking infiltration of inflammatory cells with
activation of these cells which include eosinophils, neutrophils and lymphocytes. This LAR
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
52
is thought to be a primary mechanism responsible for airway (bronchial hyper
responsiveness.
The BHR is an exaggerated branchocontriction of smooth muscles and airway
narrowing on exposure to small quantity of nonallergic stimulant that usually does not
provoke such a reaction in normal subjects. The BAL fluid from these subjects contains
increased eosinophils, eosinophilic cationic protein, CD4+ T lymphocytes, macrophages,
monocytes, basophils and neutrophils. Mucosal oedema and vasodilatation are the important
components of airway obstruction during the LAR.
Bronchial asthma is now established as an inflammatory disease of the airways
associated with inflammatory cell infiltration, epithelial damage, and sub epithelial fibrosis.
Presence of increased number of eosinophils in the sputum and peripheral blood of patients
with bronchial asthma has been known for many years. It is also reported subsequently that
eosinophils and mast cells increase quantitatively during exacerbations of asthma 127.
INFLAMMATORY CELLS IN ASTHMA
MAST CELLS
Normal human respiratory tract contains large numbers of mast cells beneath the
bronchial epithelium and alveolar walls. Increased numbers of mast cells and histamine (a
product of mast cells) have been found in broncho-alveolar lavage fluid obtained from the
patients with bronchial asthma. These cells are derived from CD3 4-+ positive cells in the
bone marrow. A large number of biologically active molecules, both preformed i.e.,
histamine, proteases and newly synthesized are released from the mast cell-during the
allergic reaction when its high affinity, IgE receptors are cross-linked with antigen. All mast
cells have secretary granules that contain large amounts of histamine, proteoglycans, heparin,
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
53
and protease's. These preformed substances are exocytosed from the cell after immunologic
activation. The mast cells play an important role in the development of LAR in addition to
its primary role in EAR.
EOSINOPHILS 128
Eosinophils development is dependent on T-cell function. The IL-5 specifically
stimulates eosinophil differentiation. They have receptors for IgG, IgA and IgE on their cell
surface. These cells are able to produce many mediators that are responsible for the
disordered airway function characteristic of asthma. These substances includes, Platelet
activating factor, LTB4, LTC4, PGE2,15-HETE, Oxygen radicals, four cytotoxic proteins
MBP,ECP,EPO, EDN.
All these mediators are released by activated eosinophils. The release of these mediators
results in bronchoconstriction, epithelial damage and recruitment and priming of other
inflammatory cells. Another molecule present in the eosinophils is the CharcotLeydon
crystal protein that possesses lysophospholipase activity.
LYMPHOCYTES 129
The production of IgE by B lymphocytes, there are a number of evidences to prove
that these cells play important roles in this disease.
i. T lymphocytes secrete lymphokines, IL-4, and interferon -y that closely regulate IgE
ii. production by B lymphocytes, while IL-4 stimulates, inter feron-7 inhibits lgE
synthesis,
iii. T Cells are attracted to the bronchial mucosal surface to the site of inflammation by
specific receptors both on themselves and on the mucosal capillary and endothelial
venules.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
54
MONOCYTES AND MACROPHAGES
A subpopulaton of peripheral blood monocytes and alveolar macrophages are IgE
receptor positive. The macrophage IgE receptor (IgEFcR) has a low affinity for IgE
compared to that of the mast cell. It has been demonstrated that active macrophages are
present at the air surface interface of human airways as well as in alveoli. Therefore, it is
possible that these cells interact with inhaled allergen.
BASOPHILS
Basophils are histamine releasing cells in the late phase reaction of asthma unlike
mast cells, which release histamine in the early phase reaction.
ADHESION MOLECULES
Adhesion molecules are considered to be important in the causation of airway
inflammation although the specific mechanism is still under investigation.
INFLAMMATORY MEDIATORS IN ASTHMA
LEUKOTRIENES
Their involvement principally in bronchial asthma includes severe airway obstruction,
i.e., bronchoconstriction, oedema and increased secretion of bronchial mucus from sub-
mucosal gland secretion. The recent development and usefulness of leukotriene receptor
antagonists and synthesis inhibitors in bronchial asthma further emphasizes the role of this
leukotriene in the pathogenesis of this condition.
MAST CELL PROTEASES
As much as 70% of the weight of mast cell consists of proteases that are
enzymatically active at neutral pH. There cells express a complex array of proteases which
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
55
consist of serine proteases, tryptases and chymase. These enzymes regulate neuropeptide
regulation in the airways, smooth muscle contraction and submucosal gland secretion.
HISTAMINE
Histamine induces broncho-constriction, increases epithelial and vascular
permeability, and increases the secretion of mucous glycoproteins.
PROSTAGLANDINS
PGD2 and PGF2(x are very potent broncho-constrictor agents.
PLATELET ACTIVATING FACTOR (PAF)
PAF has attracted attention as an important mediator of bronchial asthma. It is an
important mediator involved in the bronchial hyper responsiveness in addition to having
action of bronchial construction, stimulation of eosinophil and eodsinophil accumulation in
the airway induction of airway micro-vascular leakage and oedema and increased airway
secretions.
BRADYKININ
It also important inflammatory mediator, bradykinin mediates its effect, through BKI
and BK2 receptors.
NITRIC OXIDE
In patient with bronchial asthma the peak or mixed expired NO is about 50% higher.
Expired concentrations of NO reflect the inflammatory microenvironment of the asthmatic
airway wall.
NEUROPEPTIDES IN ASTHMA
There is increasing evidence that abnormal neurogenic mechanisms and
neuropeptides contributing in the pathophysiology of bronchial asthma. Autonomic nerves
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
56
regulate airways smooth muscle tone, mucous secretion, blood flow, vascular permeability
and migration and release of inflammatory cells. Neuropeptides are small aminoacid
components that are localized to neurons. Neuropeptides such as VIP (Vasoactive intestinal
peptide)has been identified in various inflammatory cells including eosinophits, mast cells,
and mononuclear and polymorpho nuclear leucocytes. Once release peptides act as either of
neurotransmitters, hormones or mediators. Their widespread distribution and different
physiological effects make neuropeptides excellent candidates to play important roles in
asthma.
Pathology of Asthma
The morphologic changes in asthma have been described principally in patients dying
of status asthmatics, but it appears that the pathology in non-fatal cases is similar.
Grossly the lungs are over distended because of overinflation. The most striking
macroscopic finding is occlusion of bronchi and bronchioles by the thick tenacious mucous
plugs. Histologically the mucous plugs contain whorls of shed epithelium, which give rise to
the well known Curschmann-spirals. Numerous Eosinophils and Charcot Leyden crystals are
present; the latter are collections of crystalloid made up of Eosinophilic membrane protein.
The other characters are -
1) Thickening of the basement membrane of the bronchial epithelium.
2) Oedema and an inflammatory infiltrate in the bronchial walls with a prominence of
Eosinophils which form 5 to 10% of the cellular infiltrate.
3) An increase in size of the sub mucosal glands,
4) Hypertrophy of the bronchial wall muscle, a reflection of prolonged broncho
constriction.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
57
Though the Samprapti of Tamaka Swasa is inadequate to explain in some aspects of
physiological and pathological manifestation, starts due to Nidana sevan to disease
development. The knowledge helps in poorva roopa, roopa, Chikitsa and Vyadhi vinischaya.
The analysis pathophysiology of Tamaka Swasa, found that Ayurveda emphasized the
Pranavaha Srotas, where as modern science pointed out bronchiols and other inflammatory
cells and mediators.
Figure – 8
Cross section of the lung in Tamaka Swasa i.e. Asthma
POORVA-ROOPA
The poorva roopa
sthana samshraya.
are of two types.
Agnimandya and A
Ardhe
defined as the premonitory symptoms, which appears immediately after
In this stage of clinical manifestation of the disease premonitory features
The poorva roopa of Tamaka Swasa are due to Vata Kapha prakopa,
ma. The vitiated Kapha and Vata Dosha first settled in Amashaya and
dashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 58
produce symptoms like adhmana, anaha, arati, bhaktadwesa. It may persist for long period
before the manifestation of Tamaka Swasa. As Dosha lodged in Pranavaha Srotas Tamaka
Swasa is manifested with episodic attacks. Between the attacks patient may be free from
symptoms of respiratory illness.
Before each attack some premonitory symptoms like parshwashoola, pranavilomata
and shankanistoda are manifested. The premonitory symptoms are visista type; hence they
persist during attack also.
In modern science, premonitory symptoms are not mentioned but some of preceding
symptoms which are explained in clinical presentation of asthma can be interpreted as
premonitory symptoms. Most patients will complain of the onset of an attack of bronchial
asthma following allergic pharangitis in the form of sore throat, pain in the throat, itching,
sneezing, running nose or a blocked nose. Viral infection of upper airways is another
important preceding event in many patients of bronchial asthma. Further allergic rhinitis
has been recognized as a risk factor for asthma.
The study of poorva roopa helps in early detection of diseases; appropriate treatment
can be started immediately and succeeded in preventing the disease or at least to
minimizing its severity 130.
To sum up, the vitiated Doshas stemming out from the Adhoamasaya circulates in the
Uras, Kantha and Siras. Consequently, these Doshas getting localized in the Pranavaha
Srotas produces symptoms like Parshva Shoola, Hridaya Peedana and Prana Vilomata, before
the actual onset of breathlessness. The poorva roopa are explained by different authors are
listed in table following.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
59
Table No. 2
Showing Poorvaroopa of Shwasa Roga
Symptoms C.S 131 S.S132 A.H 133 M.N 134
Anaha – distension of abdomen + + + +
Adhmana – fullness of the abdomen - - - +
Arati – restlessness - + - -
Bhaktadwesa – aversion to take food - + - -
Vadanasya vairasya – abnormal taste in the mouth - + - -
Parshwa shoola – pain in the sides of the chest + + + +
Peedanam hridayasya – tightness of the chest + + + +
Pranasya vilomata – obstruction to expiration + - + +
Shankha nistoda – temporal headache - - + +
Roopa (Lakshana) of Tamaka Swasa
In our classics there are number of symptoms being explained but it does not mean that
all the symptoms are to be present in every patient, for some patients very few symptoms
may be present but some are with many symptoms. The symptomatology can be rearranged
according to severity of the symptoms.
In modern science, clinical presentations of bronchial asthma are heterogeneous, falling
into every age group from infancy to old age, and the spectrum of signs and symptoms
various in degree of severity from patient to patient, as well as within each patient, overtime.
Detailed clinical history taking is very important in clinical diagnosis of bronchial asthma.
The pattern of symptoms may be perennial, seasonal, or perennial with seasonal
exacerbations. The symptomatology is generally episodic, although may be continuous or
continuous with acute exacerbation 135.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
60
Out of symptoms of Tamaka Swasa mentioned in the table, ati-teerva vega Swasa,
ghurghur shabda, kasa, shleesma are the direct manifestation of the disease process hence,
they considered to be main symptoms of Tamaka Swasa.
In modern science, the usual symptom includes cough, wheezing, shortness of breath,
chest tightness and modest degree of sputum production 136. Ghurghurka (wheezing) occurs
due to avarodha in Pranavaha Srotas due to Kapha. A wheeze is generated by vibration in
the wall of an airway on the point of closer due to smooth muscle contraction (sankocha) 137.
The srotorodha is one of the important manifestations of Samprapti of Tamaka Swasa. But in
modern science it is, often said - that entire wheeze is not asthma, because of the following
reason. Presence of rhonchi is a characteristic finding in asthma and will be present in most
patients. However neither its presence nor absences will confirm or exclude bronchial
asthma. Rhonchi may be heard in many other condition including chronic bronchitis,
pulmonary oedema, bronchial stenosis, foreign body aspiration, upper airway obstruction and
pulmonary emboli 138.
Swasa is produced due to obstruction in Pranavaha Srotas. In normal circumstances
one is not aware of respiration. Here the patient finds difficulty to breath and increased in
rate of respiration to compensate oxygen requirement. Dyspnoea can be due to obstruction to
the flow of air into and out of the lungs; Atiteerva vega Swasa is the pratyatma lakshana of
Tamaka Swasa.
Kasa (cough) is also one of the important symptoms of Tamaka Swasa. It is due to
irritation in the airways (Pranavaha Srotas) and also it is an effort to expel the Kapha
(sputum) secreted in the airways.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
61
Greeva - shiraso- urasa sangraham these due to over inflation of the lungs and patient
feels a sort of discomfort or ache or pain in the bilateral sides of the chesta 139.
Some symptoms are very peculiar to a particular disease; there existence confirmed the
diagnoses and these are called pratyatma lakshanas of that particular disease. In our classics
there is no direct reference of pratyatma lakshanas of Tamaka Swasa. As already mentioned
above in comparison with modern science, usual symptoms of asthma are considered to be
pratyatma lakshanas of Tamaka Swasa.
Rest of the features of Tamaka Swasa includes the explanation of the above said
features, their effects and complications. Other symptoms are associated with upper
respiratory track infection.
Kastena-shlesma nisharanam i.e. difficulty in expectoration, caused due to the over
inflated lung, with both large and small airways being filled with plugs comprising of a
mixture of mucus, serum proteins, inflammatory cells and cell debris 140 . After the expulsion
of sputum patients feel relief i.e., shlesma vimokshanthe sukham. This is because of
expectoration, the plugging of the airways cleared off and make easy for respiration. Patient
likes hot things i.e., ushnam abhinandate. The hot things help in liquefying the plug
(sputum) and become easy to expectorate.
Shayanasya Swasa peeditha i.e., dyspnoea increases in lying down posture. This is due
to lying down position, the diaphragm is raised and reducing the lungs volume. The
secretion in the lungs tends to obstruct the airways in this position. Shayanasya sameerina
parswe avagrihnati, this is due to intercostals are put into maximum efforts to compensate the
diaphragmatic breathing which is ineffective due to tense diaphragm. As a result patient
feels a sort of griping sensation in the sides of the chest.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
62
Aasenolabhate soukhyam i.e., due to sitting position diaphragm is lowered and
secretion of airways will not obstruct the airways completely. There will be more space for
gaseous exchange. Hence patient feels relatively comfortable in this position.
Kricchena bhashate i.e., dysphonoea, during episodic attack of Tamaka Swasa patient
can hardly speak anything. This is due to dyspnoea and also due to tenacious mucous may be
coated in the throat including vocal cords.
Nalabhate nidra i.e. Anidra Patients does not get proper sleep. This is due to
characteristic attacks of dyspnoea during night hours (Nocturnal attacks). This is because of
lowest level of serum adrenalise and cortisol and highest levels of histamine during night
hours could be responsible for nocturnal episodes in asthmatic individua 141. Also changes
the body temperature i.e. lowering of temperature and increased accumulation of secretion in
the respiratory track during sleep may be additional factors. The symptoms aggravates
during cloudy weather, after consuming cold water etc., these factors increase Vata and
Kapha by their sheeth guna leading to increased obstruction i.e., in other way increases
broncho-constriction 142.
If the disease becomes severe certain ominous features will be developed, the patient
may go into syncope during the bouts of coughing i.e., pramoham kashamanascha. In case
increased respiratory distress i.e., pratamyati, patient becomes motionless i.e., sannirudyate,
some times patient may develop loss of consciousness i.e. pramoham. The patient develop
the wide opening of the eyes i.e., Ucchita akshata, sweating of the forehead i.e., lalata sweda,
dryness of mouth due to air hunger i.e., vishukasyata, excessive thurst i.e., trishna, tremors
i.e. kampa, malaise i.e., angamarda. Patient takes short breaths and puts all his efforts in
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
63
breathing i.e., muhurswasa mushuschaiva avadhamyate. Also sometimes patient is present
with jwara (fever) this is because of upper respiratory infection or viral infection.
All patients with bronchial asthma are at risk of developing severe asthma attack,
which places them at risk of developing respiratory failure. These disorders refer to as status
asthmatics. In most cases, severe life threatening asthma develops against a background of
poorly controlled disease.
All features above discussed can be compared to status asthmatics and complications
of asthma in modern science. However in 10 % to 20% of cases fatal or near fatal asthma,
the onset appears to be sudden and unexpected, such episode are called "sudden asphyxia
asthma". Acute severe asthma said to "run to type" meaning there by, if hypercapnia
develops during one severe attack i.e. likely reverse in subsequent episodes 143.
The clinical features of status asthmaticus include increased breathlessness, cough,
wheezing, and chest tightness. The patient is typically anxious, breathless, fatigued, sitting
upright in bed and is preoccupied with task of breathing. Clinical signs include tachypnoea,
tachycardia, hyper inflated lungs, wheeze, use of accessory muscles pulses paradoxus and
diaphoresis 144. The clinical features which are mentioned included severe or fatal asthma
with complication of bronchial asthma. Hypoxia results in the manifestation of features like
tachycardia, sweating, wide pulses, pressure and cyanosis. Lakshana Table is followed.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
64
Table No. 3 Shows lakshanas of Tamaka Swasa
SL Vega Kaleena Lakshanas Cs SS AH YR BP MN No 1 Ghur-Ghur Shabda (Wheezing) + + + + + + 2 Ati-Teerva Vega Swasa (Acute dyspnoea) + + + + + + 3 Kasa (Cough) + + + + + + 4 Muhur-Swasa(Rapid Inspiration) + - I + + -+ + 5 Greeva-Shiraso-Urasa Sangraham (Pain/stiffness + + + + + + in head, neck and chest) 6 Kastena-Shlesma Nihsarnam (Difficult + + + + + + Expectoration) 7 Shleshma-Vimokshanthe Sukham (Relief after + + + + + - Expectoration) + 8 Ushnam-Abhinandate (Liking hot things) + - + + + 9 Shayanasya-Swasa Peeditha, Aseena Labhate- + + + + + + Soukhyam (Discomfort in lying down posture, comfortable in sitting posture) 10 Shayanasya Sameerana Parshve Grahnati + - + + + + (Discomfort in sides of the chest on lying down posture) 11 Kricchen-Bhasate (Dysphonoea) + - - + + + 12 Na-Labhate Nidra (Sleeplessness) + - - + + + 13 Megha, Ambu, Sheeta, Pragrath, Shlesmadalancha + - + + + + Pravradati (Increase after exposure to cloudy whether, cold water, Kaph-kara ahara) 14 Pramoham Kashamanascha (Fainting during + - + + + + cough) 1 15 Pratamyati (feels much distressed) + + + + + + 16 Sannirudyathi (Steady voluntary movements) + - + + + 17 Uchita Akshata (Wide-open eyes) + - + + + + 18 Lalata Sweda (Sweety forehead) + + + + + + 19 Vishu Kasyata (Dryness of mouth) + + + + + 20 Trishna (Excessive thirst) + + - - - 21 Kampha (Tremors) + - + - - - 22 Anqamarda (Malaise) + + - - - - 23 Mushira avadhamyati (Puts all efforts to breath) + - + + + + 24 Jwara (Fever) + - + 25 Pratishyaya (Coryza + - + + + + 26 Brashamartha (Maximum distress) + - + + + + 27 Aruchi (Anorexia) - + + 28 Kantaddvamsha (Hoarseness of voice) + + + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
65
VYAVACCHEDAKA NIDANA (differential diagnosis)
While making diagnosis of Tamaka Swasa the following diseases which are having
similar symptamatology haves to be excluded. They are other types of Swasa roga and
kaphajakasa. Features are shown in the table 145.
Kaphaja kasa
In kaphajakasa mandagni, aruchi, chardi, peenas, uthklesha, gourava, romharsha,
madurya in mouth. snigda, nistevana kapha, samprapti in uras. According to modern science,
the following diseases should be differentiated from bronchial asthma 146.
i.Chronic bronchitis
ii.Pulmonary emphysema
iii.Congestive heart failure
iv.Pulmonary embolism
v.Mechanical obstruction of the airways
vi.Pulmonary infiltration's with eosinophilia
vii.Cough due to drugs (Beta-blockers, AIE inhibitors)
The signs and symptoms of the disease are 147
1) Chronic Bronchitis: The clinical signs are persistent cough productive of copious
sputum. For many years, no other respiratory functional impairment present. But
eventually dyspnoea on exertion develops. Cyanosis and hemoptysis are present. X-
rays shows the features of increased bronchovascular markings.
2) Pulmonary emphysema: Increasing breathlessness with wheezing but no cough or
sputum. Chest is barrel shaped, percussion note hyper-resonant. Auscultatory
finding is slowing of forced expiration. X-rays shows hyper-translucency, low flat
diaphragm.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
66
3) Congestive heart failure: Weakness, fatigue, oedema, restlessness, insomnia, cough,
dyspnoea, orthopnoea, anorexia, nausea. Signs raised JVP, liver enlargement,
peripheral cyanosis.
4) Pulmonary embolism: Sever chest pain, dyspnoea, shock, elevation of temperature,
increased level of serum, lactic, dehydrogenase. X-rays shows pulmonary infarct, as
a wedge shaped infiltrate.
TABLE No - 4
Vyavacchedaka Nidana in Tamaka Swasa
Symptoms Tamak-Swasa Maha-Swasa Urdwa Swasa Chinna-Swasa Kshudra
Swasa Swasa Ateerva vega Uchaiti Deergam
Urdhwam Vichhinnam Rooksha
ayaasodbhava Shabda Ghurgurukatw
am Matta vrisha bhavat
Conscious ness
Pramoha Pranas Hta jnanavignance
Pramoha Murcha
Netra Uchritaksha Vibrantalochana
Urdhvadrishti and vibrantaksa
Viplutaksha, raktaika lochana
Shoola Parshwa shoola
Vedanartha Marmachedha rugarditha pralapa
No indriyavyatha
Vak Kricchena bhasate
Vishirna vak Pralapana
Asya Vishu kasyate Shuskasya Parishuskasya Sweda Lalata sweda Sadya asadyatha
Yapya/sadya Asadya Asadya Asadya Sadya
Upadrava of Tamaka Swasa
Upadarava are the complications of a disease occur at the end of stage of disease. An
observational finding in symptomatology of Tamaka Swasa includes upadrava even. We can
consider hridaya vikriti as one of upadrava because hridaya is moola of Pranavaha Srotas.
The complications of bronchial asthma are pneumothorax, pneumomediastinum,
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
67
subcutaneous emphyseam, pneumopericardium, myocardial infarction, mucus plugging,
atelectassis, electrolyte imbalance, dehydration, myopathy, lactic acidosys, and hypoxic brain
injury etc.
Arista lakshanas
Arista Lakshanas are the features or symptoms which occur just before death. In other
words they are the definite signs towards death. This Swasa is also fatal because all the
patients at the end will suffer from Swasa. As Tamaka swasa has been said as sadhya in its
initial stages to take up for the treatment, the Arista lakshanas all to be examined. The
patient presenting with deergha uchwasa and hriswa nishwasa are the arista lakshanas of
Tamaka Swasa 148. The swasa complicated with atisara, jwara, hikka, chardi, medrashotha
and shotha are said to be arista lakshanas 149. The swasa with jwara, chardi, trishna, atisara,
and shopha are said to be arista lakshana 150. The colour of the skin is also changed to blue
due to Swasa, which is explained in varna context of arista. This can be explained as the
central and peripheral cyanosis, which is manifested in the superficial skin and mucous
membrane due to hypoxemia.
Sadhyasadhyata
Ayurveda is advised to assess the prognosis i.e., Sadhyasadhyata of the disease before
starting the treatment. For the sadhyasadhyata of Tamaka Swasa, Charaka has said it is
yapya, but it becomes sadhya only in its early stages 151. Also said, it is sadhya, when its
signs and symptoms are not fully manifested and if the patient is strong 152. Susruta has said
that Tamaka swasa is kastasadhya but becomes asadhya in durbala rogi 153. According to
vagbhata Tamaka swasa is yapya but can be sadhya if it is treated in the beginning and if it
occurs in strong person 154.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
68
In modern science mentioned, it was long believed that the prognosis for asthma
originating in infancy or childhood was good, and that in most patients the symptoms would
resolve by the age of puberty. In fact an asthma symptom persists in 30 to 80 % of adult
patients. Although epidemiological studies have shown a fair chance of either remission or
reduction in asthma symptoms between the ages of 10 and 20 years, no definite information
is available about progression of asthma through childhood and adolescence.
The assessment of sadya- asadyatha is very important to physician to undertake patient
for the treatment. If a patient come to physician in his later stages i.e., worsened conditions
of a disease, a wise physician should not take for treatment. With sadhyaasadyatha physician
can convenience the patients and their relatives about the prognosis of the disease. Here
patient education important in such yapya disease. This makes the patients co-operation with
physician for long term treatment.
UPASHAYA –
Factors relieving the severity of disease –
Asino labhate saukhyam (sitting posture gives relief).
Shleshma vimokshe sukham (expectoration of kapha gives relief).
Ushnabhinandati (liking toward hot things).
ANUPASHAYA –
Factors aggravating the severity of the disease –
Sheeta pana (cold drinks).
Sheeta vata (cold weather).
Guru bhojana (heavy eatables).
Vyayama (exercise).
Shayane shwasavriddhi (sleeping or lying down intensify shwasa).
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
69
Chikitsa in Tamaka Swasa
The effective treatment of Tamaka Swasa can not be unified, as the pathology
involves multiple varying factors. Vitiated Vata and Kapha Dosha stemming out from the
Pitta Sthana, afflicting the Rasa Dhatu in the Pranavaha Srotas produces the illness.
Therefore, the procedures aimed at the rectification of the imbalances of Vata Dosha, as well
as Kapha Dosha forms the sheet anchor of treatment of Tamaka Swasa which is individually
quite opposite. Thus, the unique pathogenesis poses complexity in planning the treatment.
The final treatment planned should pacify the Vata as well as Kapha Dosha effectively,
simultaneously not causing any further addition to the imbalance of Vata and Kapha Dosha.
With the due consideration of this, following principles of treatment are advocated in the
Ayurvedic classics.
1. Abhyanga and Swedana –Application of the oil over the chest followed by sudation.
2. Vamana – Therapeutic emesis
3. Dhoomapana – Therapeutic inhalation of the smoke from the burning herbs
4. Virechana Karma – Therapeutic purgation
5. Pratisyaya Chikitsa – Treatment of rhinitis
6. Kasaroga Chikitsa – Treatment of Kasaroga
7. Vatahara Chikitsa – Elimination of vitiated Vata Dosha
8. Kaphahara Chikitsa – Pacification of vitiated Kapha Dosha.
9. Manasa Dosha Chikitsa –Correction of emotional disturbances
10. Kapha Vilayana Chikitsa –Liquification of the sputum
11. Srotomardavakara Chikitsa – Softening of the channels of respiration
12. Kaphanissaraka Chikitsa – Expectoration of sputum
13. Kasaghna Chikitsa – Treatment of cough
14. Rasayana Chikitsa – Rejuvenating the Pranavaha Srotas and body
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
70
Judicial employment of these therapeutic procedures brings about maximum relief to
the patient suffering from Tamaka Swasa. The details of these procedures are given in the
following paragraphs.
Abhyanga and Swedana:
Treatment of Tamaka Swasa differs both during the attack and in between the attacks.
During the episode of Tamaka Swasa, the Dosha are in a state of provocation and contrary to
this, in between the attacks the Doshas are silent and are not apparent, thus demanding
different treatment. To make it more clear, the treatment is planned during the attack to
negate the effect of Samprapti. In contrast to this, in between the attacks, the treatment is
planned to prevent the initiation of new Samprapti thereby, forming the complete treatment
of Tamaka Swasa 155.
Pranavilomata is a pathological event during an episode of Tamaka Swasa and is said
to be due to the tenacious Kapha obstructing the passage of Pranavata. Bringing it out by
liquefying the sputum is the principle and first treatment of this condition. This can be
achieved by Abhyanga and Swedana over the chest thereby allowing the free passage of
Pranavata. Charaka has prescribed application of oil added with rock salt over the chest
followed by sudation in the form of Nadi, Prastara or Sankara Sweda 156.
Vamana Karma:
The Clinical presentation in patients suffering from Tamaka Shwasa is not uniform.
Some patients present with symptoms suggestive of dominant Vata Dosha and are
characterized mostly by dry cough and prominent wheezing. In such patients, Vamana
Karma is not the ideal choice. Yet, other patients present with symptoms suggestive of
dominance of Kapha Dosha, which is characterized by paroxysmal productive cough, where
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
71
the sputum is tenacious, bouts of distressing paroxysmal cough brings out small amounts of
sticky sputum and this is associated with breathlessness. In such patients, with the
predominant vitiation of Kapha Dosha, Vamana Karma is most ideal. This renders clarity of
the Pranavaha Srotas and thereby allowing free passage of the Pranavata.
The procedure of Vamana Karma is advisable only in patients who are physically
strong and can tolerate the strain of Vamana Karma. The mild form of Vamana is always
advisable in all patients of Tamaka Swasa and it can be repeated during every attack 157.
In children, spontaneous vomiting is a natural defense mechanism that clears the
passage of respiratory tract. Here, act of vomiting along with emptying the stomach, also
includes forced expiration that clears the respiratory passage.
After subjecting the patient to Abhyanga and Nadi Sweda over the chest, in the
evening, the patient is allowed to take the food that provocateur the Kapha Dosha - like
meals with curds or fish. This Kaphotkleshana procedure renders easy elimination of the
Kapha Dosha by the Vamana procedure, which is carried out on the immediate next day, in
the morning hours 158.
Dhoomapana:
This is another procedure also aimed at eliminating the Kapha Dosha from the Srotas.
Dhoomapana is advised after the Vamana karma and it eliminates some amount of Kapha
Dosha that is still left out after the Vamana karma. Or else, if the minimum Kapha Dosha in
the Srotas as in Vata dominant cases or in cases of milder attacks, Dhoomapana may be
performed alone without prior Vamana karma. Further, in debilitated patients, where
putrefactive procedure is not possible, Dhoomapana alone helps in the elimination of Kapha
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
72
Dosha. Added to this, the drugs used in Dhoomapana also reduces spasm or stiffness of
Pranavaha Srotas bringing about Srotomardavata that ensures free passage of Vata Dosha.
Improvement from the respiratory distress can be spontaneously seen, as
expectoration is improved and made easy. Also, it produces broncho-dilatation, bringing
maximum relief to the patient. Here, the medicines are directly delivered into the system and
hence response is prompt and immediate. The procedure is akin to the inhalers prescribed by
the modern counterparts. Procedure can be repeated regularly depending upon the
requirement 159. Occasionally, due to irritant cough, breathlessness may worsen in some
patient. This is mostly seen if the patient cannot smoke smoothly, and is especially true in
females and children.
Virechana Karma:
Abnormal response of patients for simple factors like dust is said to be due to
Khavaigunyata of the Pranavaha Srotas. In the modern counterpart, this is described as
hypersensitivity or allergy of the respiratory system. This may be said as Khavaigunyata, or
else called as Asatmyata or even may be named as faulty Vyadhikshamatva. And the fact is
that, the patient unfavorably responds to simple factors like dust, atmospheric change, or
food. The friendly environment in which the patient has to live becomes hostile to him and is
like the enemy of the patient. The interaction in such a situation between the patient and the
environment is just like the two mirrors facing each other. The mirrors facing each other
produce infinite number of images and quite similar to this, the patient suffers from
innumerable attacks of Tamaka Swasa.
The answer for such a nature of illness is Virechana karma and Rasayana Chikitsa.
Charaka pronounced this as “Tamake Tu Virechanam” 160.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
73
The Virechana procedure may not be of much use during the attack of Tamaka
Swasa. But when employed in between the attack, prevents the attacks of Swasa, reduces its
severity, minimizes the duration of illness. Even in some patients, this procedure in
combination with Rasayana Chikitsa brings about complete cure.
After Virechana, Samasarjana Karma is advised for about 3 to 5 days. By this
procedure, Doshas in Tamaka Swasa get eliminated, as is told in the classics, Doshas
stemming out from Pitta Sthana is best eliminated by Virechana procedure. It is worth
mentioning here that, Vata Dosha is the predominant Dosha involved in the Samprapti of
Tamaka Swasa. Virechana normalizes the course of Vata Dosha and thus helps in the
reversal of the Vilomagati of Pranavata. Distension of the abdomen, constipation and such
other symptoms may be associated in some patients and these symptoms are best treated by
this procedure.
Pratishyayahara Chikitsa:
Charaka opines that, Pratishyaya is a cause of Tamaka Swasa. Sneezing, running
nose, stuffiness of the nose are the prominent symptoms that associates Tamaka Swasa. In a
typical attack, the patient develops these upper respiratory tract symptoms. Within hours,
following this, the patient develops wheezing. This chronological order of symptom
manifestation is more suggestive of Pratishyaya Roga as the cause of Tamaka Swasa. In such
patients, along with other medicines of Tamaka Swasa, the Pratishyayahara Chikitsa should
be adopted. By this planning of the treatment, one can draw maximum favorable results 161.
Kasa Roga Chikitsa:
Kasa Roga is another disease said to predispose Tamaka Swasa. The clinical course in
this case, could be the initial development of productive cough, with or without manifestation
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
74
of fever. Characteristically, sputum is muco-purulent or yellowish. Within a day or two,
breathlessness and wheezing follows. This unique evolution of symptoms is very much
indicative of Kasa Roga, precipitating Tamaka Swasa. Therefore, addition of treatment of
Kasa Roga in patients of Tamaka Swasa is thus justified 162.
Vatahara Chikitsa:
Vata Dosha as well as Kapha Doshas is invariably involved in the pathogenesis of
Tamaka Swasa. But relative dominance and accordingly the clinical picture of these two
doshas may vary in individual patients. Minimal cough, when present, mostly dry,
insignificant amount of sputum, prominent breathlessness and wheezing, all are suggestive of
dominance of Vata Dosha. In such case, Tamaka Swasa Chikitsa should mainly include
measures to pacify the Vata Dosha to get best results 163.
Kaphahara Chikitsa:
In patients of Tamaka Swasa, relative dominance of Kapha Dosha is characterized by
paroxysmal productive cough with profuse whitish sputum. Associated breathlessness is
comparatively lesser than the Vata dominant variety. In such a clinical state, measures to
pacify the Kapha Dosha are a better approach in the treatment of Tamaka Swasa 164.
Manasa Dosha Chikitsa:
Patients’ expression of anxiety may not be in the eyes, face or their activity, but it
may be through the Pranavaha srotas in the form of Swasa. The absolute cause is related to
the mind but its reflection is through the Pranavaha srotas. In such clinical presentation,
additions of Manasa Dosha Chikitsa are more beneficial 165.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
75
Kapha vilayana Chikitsa:
Tenacious sputum is most distressing to the patients of Tamaka Swasa. Here
exhausting bouts of paroxysmal cough, fail to bring out rubbery sputum. In such patients,
typical sound of productive cough is diagnostic. Liquefaction of the sputum by oral
administration of specific medicines brings more comfort to the patients 166.
Srotomardavakara Chikitsa:
Stiffness, constriction or to say spasm is responsible for the breathlessness and the
musical sounds in patients of Tamaka Swasa. Charaka has advised Srotomardavakara
Chikitsa to relieve the detrimental effect of Vata Dosha 167.
Kaphanissaraka Chikitsa:
Effective removal of Sleshma secreted in the Pranavaha Srotas forms the principal
treatment of Tamaka Swasa. Symptomatic approach with expectorant treatment is desired
when the mucoid sputum is disturbing 168.
Kasa Laksanika Chikitsa:
Exhausting dry cough is observed in most of the patients of Tamaka Swasa. Here, the
respiratory tract secretions are minimal but the irritation in the throat is most disturbing. It is
true that bouts of irritant cough leads to worsening of breathlessness. In these conditions,
Kasaghna Chikitsa minimizes the suffering of breathlessness, thus improving the total
efficiency of the treatment 169.
Brimhana and Rasayana Chikitsa
The difference in response to atmospheric changes in a normal person, in contrast to
patients of Tamaka Swasa, where in atmospheric changes reflects as disease in patients is
said to be due to Khavaigunyata, an abnormality of the Pranavaha Srotas. This can be
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
76
rectified by Vyadhihara Rasayana. This Rasayana treatment is much helpful to reduce the
further attacks of Asthma. Also, in due course, improves the defense mechanism of
Pranavaha Srotas, reduces the tendency of abnormal reaction to simple factors in the
surrounding. Further, in the long run, this disease causes emaciation of the body. This can be
corrected by the Brimhana Chikitsa. This adds to the benefit 170.
To sum up, sequential administration of Abhyanga and Swedana over the chest, diet
increasing the tendency of Kapha to get eliminated, Vamana, Dhoomapana followed by
Shamana Chikitsa is the sheet anchor of treatment of Tamaka Swasa during an episode.
Virechana followed by Vyadhihara Rasayana and Brimhana Chikitsa forms the ideal
treatment in between the attack. These procedures are very much efficacious in remitting the
symptoms as well as preventing the attack of Tamaka Swasa. Vatahara Chikitsa, Kaphahara
Chikitsa, Pratishyayahara Chikitsa, Kasaroga Chikitsa, Manasa Dosha Chikitsa,
Kaphavilayana Chikitsa, Kaphanissaraka Chikitsa, Srotomardavakara Chikitsa, and
Kasaghna Chikitsa are the principles of Shamana treatment.
Pathya – Apathya in Tamaka Swasa
A number of predisposing factors initiate an attack of Tamaka Swasa or may worsen
the episode, if the patients are already in the symptomatic phase. As discussed earlier, in a
patient who has reduced immune mechanism of the Pranavaha Srotas, which is described as
Khavaigunyata or Asathmyata, exacerbation or else initiation of an attack of the Swasa, is
likely. Hence, understanding of Pathya as well as Apathya gains importance both in
preventing as well as planning the treatment. Mainly the factors that influence the balance of
Vata and Kapha Dosha are either Pathya or Apathya as per their role in pacifying or else
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
77
aggravating these Doshas respectively. Following table depicts the list of Pathya and
Apathya factors in Tamaka Swasa.
Table No.5
Showing Pathya in Tamaka Swasa
Pathya Ahara C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175
Purana Shali + - - + + Shaali Dhanya Tandula - - - + +
Vrihi Dhanya Shashtika + - + + + Yava + - + + + Shooka Dhanya Godhuma + - + + + Mudga + - + - - Shimbi Kulatha - - + + + Guduchi + - - + + Patola - - - + + Vartaka - - + + + Rasona - - - + + Bimbi - - - + + Vastuka - - - - + Moolaka + - + - + Potaki - - - - + Shigru + - - - -
Shakha Varga
Kasamarda + - - - - Janghala - - - + + Shasha - - - + + Titira - - - + + Bhuka - - - + + Lava - - - + + Dhanva - - - + + Shuka - - - + +
Mamsa Varga
Mruga Dwija - - - + + Jambira - - - + + Draksha + + - + + Mathulunga + + + - + Amalaka + + + - -
Phala Varga
Bilwa + + + - - Sura - + - + + Madhya Varga Varuni - - + - -
Madhu Varga Madhu + + + + + Mootra Varga Gomutra - - - - + Dugdha Varga Aja Kshira - - - + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
78
C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175
Purana sarpi - + - + + Ghrita Varga Ajasarpi - - - + + Yusha + - + - - Yavagu + - - - - Peya + - + - - Sathu - - + - -
Krtanna Varga
Varuni - - + - - Virechana + - - + + Swedana + - - + + Dhoomapana + - - + + Prachardana - - - + +
Pathya Vihara
Swapanam Diva
- - - + +
Table No.6
Showing Apathya Aahara in Tamaka Swasa
Apathya
C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175
Nishpava + - - + - Masha + - - + - Thila + - - - -
Shimbi Dhanya
Sarshapa - - - + + Shaaka Varga
Kanda - - - + +
Jalaja + - - - - Anupa + - - - + Pishita + - - - -
Mamsa Varga
Matsya - - - + + Dadhi Varga
Dadhi + - - - -
Kshira + - - + + Kshira Varga Mahisha Kshira + - - - - Grita Varga
Mahisha Gritha - - - + +
Tailabhrsta Nishpava
- - - - +
Pistanna + - - - -
Krtanna Varga
Pinyaka + - - - -
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
79
Table No.7
Showing Apathya Vihara in Tamaka Swasa
C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175
Sheeta Snana + + + - - Raja + + + + + Dhooma + + + + + Anila + + + + + Vyayama Karma + + - - - Bhara - + - - + Adhwa - + - - + Vegaghata - + - - - Apatharpana + + - - - Rakta srava - - - - - Pragvata - - - - - Marmaghata + - + + + Sooryatapa - - - - + Daurbalya + - - - - Aanaha + - - - - Abhighata - + - - - Strigamana - + - - - Vegavarodha-Mootra, Udgara, Chardi, Trushna, Kasa
- + - - -
In a nut shell, the factors that help in maintenance of normalcy of Vata Dosha and
Kapha Dosha, both during the symptomatic and asymptomatic period are considered as
Pathya. Added to this, the factors that favour the normal physiological functioning of
Pranavaha Srotas, is popularly known by the name Pathya. In contrast to this, the factors
either related to food or behavior that can affect the balance of the Vata and Kapha Doshas
are regarded as Apathya. Any factor that has detrimental effect on the Pranavaha Srotas is
listed as Apathya. Strict observation of the Pathya and Apathya prevents an episode of the
illness in patients who are asymptomatic. Likewise, Pathya and Apathya have great influence
in modifying the severity of the illness during the acute attack of breathlessness.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
80
Figure - 9
Drug Review
The pharmaco dynamics and kinetics of the individual herbs of composition
“Ardhedashemaniya Swasaharavati” is very efficacious result in hypothesis are studied
from various contexts of textual references from different Samhita of Ayurveda and
reviewed to found with its relevance to the present day study 176
Trial Drugs composition 177, 178, 179, 180
The combination will be equal parts of Ardhedashemaniya Swasaharavati is as
follows.
1. Shati : Hedychium spicatum
2. Pushkaramool : Inula recemosa
3. Amlavetas : Garcinia pedunculata
4. Tulasi : Ocimum sanctum
5. Bhumyamalaki : Phyllanthus urinaria
All the herbs will be identified and collected from local area. Good
Manufacturing Practice will be followed for preparation of vati. The individual details of
the composition are as under.
1) Shati (Hedychium spicatum – Zingiberaceae)
Description: Woodland, Sunny Edge, By Walls, By South Wall, By West Wall, Forest
clearings, shrubberies, 1800 - 2800 meters 181, Perennial growing to 1.5m by 0.7m. It is
hardy to zone 8 and is frost tender. It is in flower in October. The scented flowers are
hermaphrodite (have both male and female organs). We rate it 1 out of 5 for usefulness.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
81
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
82
The plant prefers light (sandy), medium (loamy) and heavy (clay) soils. The plant prefers
acid, neutral and basic (alkaline) soils. It cannot grow in the shade. It requires moist soil.
Actions & Uses: Ca minative; Digestive; Emmenagogue; Expectorant; Stimulant;
Stomachic; Tonic; Vasodilator. The rootstock is carminative, emmenagogue, expectorant,
stimulant, stomachic and tonic. It is useful in the treatment of liver complaints, and is also
used in treating vomiting, diarrhoea, inflammation, pains and snake bite 182 and a wide
range of references and details of research into the plants chemistry 183. It is digestive,
stomachic and vasodilator. It is used in the treatment of indigestion and poor circulation
due to thickening of the blood 184. The rootstock yields 4% essential oil. This oil, which
has a scent somewhat like hyacinths, is so powerful that a single drop will render clothes
highly perfumed for a considerable period. The dried root is burnt as incense and notable
anti histamine activity 185. Rhizomes possess anti-inflammatory and analgesic activity.
The anti-inflammatory activity was localised mainly in the hexane fraction from which
one of the pure active constituents, hedychenone has been isolated. The analgesic activity
was more prominent in the benzene fraction. Some other minor active constituents are
also present which may contribute to the total activity of the rhizomes.
r
2) Pushkarmoola (Inula racemosa - Compositae family)
Part used: Roots, Root powder
Description: Pushkaramoola grows in the hilly regions in the northwestern Himalayas.
The plant is a stout herb about 150 cms tall. It bears a large inflorescence in a racemose
arrangement. The stem is grooved and very hairy. Leaves are elliptical, large (46 cms)
and have long petioles. The fruits are 4 mm long and bearded with long hairs.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
83
Chemical constituents: On extraction of the plant with hexane and isolation, the
compounds obtained are dihydroisoalantolactone, isoalantolac-tone and alantolactone 186.
Alantolacton, Isoalantolactone, Dihydroalantolactone, Dihydroisoalantolactone, Beta
sitosterol, Daucosterol, Inunolide are found in Pushkarmoola.
Actions & Uses: The extract showed potent, anti-inflammatory, antipyretic and
antispasmodic effect against bronchial spasm induced by histamine,5-hydroxytryptamine,
and various plant pollens Zea mays, Helioptelia & and Acacia Arabica 187.
The essential oil of 1 racemosa was tested for antibacterial and anti- fungal
activity. It is moderately effective against S. aureus, Ps aeruginosa, B.subtillis, mildly
against E. coli and B. anthracis 188. Alantolactone and isoalantolactone exhibited
antidermatophytic activity. Antifungal activity of these two compounds against two ring-
worm fungi was comparable to that of Nystatin but inferior to that of Amphotericin B 189.
In Ayurvedic practice, it is mainly used as an expectorant and bronchodilator. It
has been used in the treatment of tuberculosis and topically in the treatment of skin
diseases 190. It is used for cardiovascular system, angina, and dyspnoea.
Animals given Inula had smaller increases in SGOT, LDH, CPK, CAMP, cortisol,
pyruvate, lactate, and glucose than those in an untreated control group 191. 200 patients
with ischemic heart disease were used in the trial. Twenty-five percent of the subjects had
no chest pain, and patients experiencing dyspnea fell from 80 percent at the beginning of
the study to 32 percent 192. In another trial, all subjects had improvement in ST-segment
depression on ECG. However, the improvement was greater for those who were given
Pushkaramoola 193.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
84
3) Amlavetasa 194 (Garcinia pedunculata - Roxburgh) Indian Rhubarb
Description: Yields a yellow fruit having an acidulous taste and it is 20 meters height,
leaves 15-30 cms in length, androcium is bigger than gynaecium
Chemical constituents: Anthraquinone derivatives such as chrysophanic acid
(=chrysophanol), emodin, aloe-emodin, rhein & physcion, with their O-glycosides such
as glucorhein, chrysophanein, glucoemodin; sennosides A-E, reidin C & others. Tannins;
Action and Uses: Amlavetas is stomachic, bitter, tonic, cathartic. Purgative, alterative,
hemostatic, antipyretic, anthelmintic, stomachic, bitter tonic, cathartic, laxative, atonic
indigestion Constipation (with fevers, ulcers, infections), diarrhea, Pitta dysentery,
jaundice, liver disorders. Rhubarb Root has a purgative action for use in the treatment of
constipation, but also has an astringent effect following this. It therefore has a truly
cleansing action upon the gut, removing debris and then astringing with antiseptic
properties as well.
4) Tulasi (Ocimum Sanctum – Labiatae) Basil
Parts Used: Leaf, Herb, Panchanga
Chemical constituents: Volatile oils (up to 28 percent methyl cinnamate)
Description: An annual plant found wild in the tropical and subtropical regions of the
world. The bushy stem grows to 1 to 2 feet high. The toothed leaves are often purplish
hued. The flowers vary in color from white to red, sometimes with a tinge of purple,
appear from June to September. The plant emits a spicy scent when bruised.
Actions and Uses: Antispasmodic, appetizer, carminative, galactagogue, stomachic,
demulcent and expectorant along with anti viral property. The tea made from the leaves
of the basil plant is used for nausea, gas pains, and dysentery. Tea made with basil and
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
85
peppercorns is a folk remedy to reduce fever. Basil is antispasmodic, appetizer,
carminative, galactagogue, and stomachic. Basil is vary useful for ailments affecting
stomach and the related organs. It is used for stomach cramps, gastric catarrh, vomiting,
intestinal catarrh, constipation, and enteritis. It had been sometimes used for whooping
cough as an antispasmodic. It is Antibacterial, antiseptic, antispasmodic, diaphoretic,
febrifuge, nervine. Used in Coughs, colds, fevers, headaches, lung problems, abdominal
distention, absorption, arthritis, colon (air excess), memory, nasal congestion, nerve
tissue strengthening, purifies the air; sinus congestion, clears the lungs, heart tonic; it
frees ozone from sun's rays and oxygenates the body, cleanses and clears the brain and
nerves; relieves depression and the effects of poisons; difficult urination, prevents the
accumulation of fat in the body (especially for women after menopause), obstinate skin
diseases, arthritis, rheumatism, first stages of many .cancers, builds the immune system.
Tulsi contains trace mineral copper (organic form), needed to absorb iron.
5) Bhumyamalaki (Phyllanthus niruri)
Parts Used: Leaves, root, whole plant
Description: Bhumyamalaki is a perennial herb found in Central and Southern India, to
Sri Lanka. It can grow to 12-24 inches in height and blooms with many yellow flowers.
All parts of the plant are employed therapeutically.
Chemical constituents: Phyllanthus primarily contains lignans (e.g., phyllanthine and
hypophyllanthine), alkaloids, and bioflavonoids (e.g., quercetin). While it remains
unknown as to which of these ingredients has an anti-viral effect, research shows that this
herb acts primarily on the liver. This action in the liver confirms its historical use as a
remedy for jaundice.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
86
Actions and Uses: Bhumyamalaki is having various actions based on the properties. All
the parts are used in different disorders. Used as Kapha Pitta Shamaka Vatakrit, it is
Yakrit uttejaka, Deepana, Pachana, Anulomana, Ruchikaraka, Balya, Puranatisara hara.,
Rakta shodhaka, Sthambhaka, Pandu Rakta Pitta hara Atiraktasravahara., Swasaghna,
Kshaya roga hara., Mutrala., Putradayaka, Garbhasaya shodhahara., Vishama jwaraghna,
Niyatakalika Jwara Pratibandhaka and is also Vishahara, Nidrakaraka, Kshathapaha,
Netra roga hara.
Preparation of the Ardhedashemaniya Swasaharavati
All the drugs of this vati are well identified with the help of taxonomist and
dravya guna experts. The alaphashuska drugs are taken, than processed in to churna form
and messed into the fine cloth (vastragalitha). It is well documented that bhavans
increases the potency of the drugs, the effect of the kwathas also superimposed over the
composition. The kwatha is prepared from these drugs only. And three bhavanas was
given. Then it is made in the form of vati weighing about 500mg.
Advantages to prepare in the form of vati
1. they are easy to carry
2. they are easy to swallow
3. patient cannot experience unpleasant taste
4. they donot require any measurement dose
5. an accurate amount of medicament and prolonged stability to medicament
6. The in compatibility of medicaments and their deterioration due to environmental
factors.
Table – 8
Pharmacological properties of Ardhedashemaniya Swasaharavati
Name and Latin name
Part used Gana Rasa Guna Veerya Vipaka Doshagnatha
Dose in gm
Shati
(hedychim spicatum)
Kanda Swasahara,
hikkahara
Katu, Tikta,
kasaya
Laghu,
tikshna
Ushna Katu Kapha
Vata hara
1-3
Pushkara moola
(inula recemosa)
Moola Swasahara Tikta, katu Laghu,
tikshna
Ushna Katu Kapha
Vata
1-3
Amlavetasa
(garcinenia
pedenculata)
Phala Swasa hara
,deepaneya,
hrudya
Amla Laghu,
ruksha,
tikshna
Ushna Amla Kapha
Vata
1-3
Tulasi
(ocimum sanctum)
Patra, pushpa,
beja, moola
Swasa hara Katu, Tikta Laghu,
ruksha
Ushna Katu Kapha
Vata
1-3
Bhumyamalaki
(phyllantus niruri)
Panchanga Swasa hara,
kasa hara
Tikta,
kasaya,
madhura
Laghu,
ruksha
Seeta Madhura Kapha
pita
3-6
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review
87
Chapter – 4
Methods
The clinical study is based on the classical explanations with scientific well
designed research protocols, which enumerates the patient before to administrate the trial
drug to after effects in comparison.
Criteria for selecting drugs
1. The above mentioned drugs, which are taken from the Dashemaniya Swasa hara
gana of Charaka Samhita.
2. The pharmacological actions of the individual drugs are swasahara, hikka nigraha,
kasaharas which are mentioned in different gana/varga
3. The trial drug, Ardhedashemaniya Swasaharavati is selected according to the
pharmacological action and properties of individual drugs.
4. Ardhedashemaniya Swasaharavati is purely herbal, they are cheaper and easily
available as in the local market
5. Ardhedashemaniya Swasaharavati is very easy to process and vati making
6. Ardhedashemaniya Swasaharavati is very easy to dispense.
7. Among the ten drugs mentioned only five are selected in the study by considering
the following facts –
In different contexts the texts referred these group of herbs are potent
All of these are considered for multi dimensional actions
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
88
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
89
All these yields results not only to Swasa but also to the Parshwa shoola,
Kasa, etc, which are associative of Tamaka Swasa
The said combination is hypothetically effective in reversal of Samprapti i.e.
the patho-physiological normalcy induction
Criteria for quantity of the drug
All the drugs which are selected and taken from Dasheminiya gana has
pharmacological action against Swasa with therapeutic effects which are the equitant so it
is considered to under take in equal quantity of the Ardhedashemaniya Swasaharavati
ingredients.
Methods followed in trail
1) Method of Research design
The trail is an observational clinical study. In this Patients were taken in
randomized selection.
2) Posology of Trial drug
3 gm/day 195 in divided dose or 6 vati per day in divided dose – flexible acc
rogabala
3) Anupana of Trial drug
Hot water because it is pathya 196 for Tamaka Swasa
4) Study duration of Trial drug
Ardhedashemaniya Swasaharavati observational clinical trial study was conducted
for 30 days. The medicine was dispensed for 15 days to all patients and advised to report
for every 15 days interval, asked to note the nature, frequency and other symptoms of their
disease and noted during their visits.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
90
5) Follow up of Trial drug
Ardhedashemaniya Swasaharavati trail offered a further follow up 15 days was
done. The effect of yoga was analyzed according to clinical and functional response before
and after the treatment with 15 days intervals is compared to that of follow up data. In
further the final declaration of the trail drug effect and result is done on the basis of the
follow up data.
6) Source of data of Trial drug
The data was collected from the patients suffering from Tamaka Swasa in the OPD
of post graduation and research center DGM Ayurvedic medical college Gadag. The
method of the present study consists of following headings.
a) selection of the patient
b) examination of the patient
c) criteria of assessment
a) Selection of the patient
Patients of Tamaka Swasa (bronchial asthma) fulfilling the criteria of diagnosis
were selected in the present study. Patients were distributed randomly for the study, based
on present inclusion and exclusion criteria. Patients were excluded, as they are
discontinuous at the treatment or unable to fulfill the study design.
i) Inclusion criteria
Patients with symptoms of Tamaka Swasa are included with classical
symptoms enumerated at the classical texts under the lime light of contemporary
medical context. The symptoms of inclusion are as under.
Teevra vega Swasa (Dyspnoea)
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
91
Kasa (cough)
Duhkhena Kapha nissaranam (Expectoration)
Ghurghuratwam (Wheezing)
Peenasa (Coryza)
Kruchrena bhasate (Dysphonoea)
Kantodhwamsham (Hoarseness of voice)
Greevashirasangraha (Headache & Stiffness)
Urah Peeda (Chest Pain)
Shayane Swasa peedita (Discomfort at supine)
ii) Exclusion criteria
Patients other than exclusion criteria are included in the study of
Ardhedashemaniya Swasaharavati trail. The specified exclusions are as under with
their causes.
i. Patients with infective disease and status asthmatics cases are excluded –
as the superseded infection hampers the study and misleads.
ii. Patients with other systemic disease and status asthmatics cases are
excluded - as the drug effect could not be assessed specifically relevant
symptoms and possible misleads are suggestive of exclusion.
iii. Patients below 15 years are excluded from the study – as the children are
exposed recurrently to the dust at play and not possible to under take
response as they are subjected for growth.
iv. Patients above 65 years are excluded from the study – these elderly are
subjected for degeneration thus excluded from study.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
92
v. Patients undertaking medication – intervenes the effect of the trail drug,
so such additive medications are prohibited in the study.
vi. Pregnant and lactating women are also excluded from the study – as the
placental barrier components may be there in the compound which may
harmful, even though Ayurvedic herbals are safe in this part as a routine
Pregnant and lactating women are excluded from the study.
b) Examination of the patient
Patient through examination is necessary to obtain clear picture of disease and also
the effect of trail drug - Ardhedashemaniya Swasaharavati. For that the following methods
are obtained in the study.
b-1) Physical signs of asthmatic patients –
A. During attack – 197
i. On Inspection – Accessory muscles e.g. sternomastoid, scalenus and
pectorals are in continual action to aid breathing.
Barrel shape chest is common with prolonged expiration
Jugular vein is distended
With each short breath there is marked sucking in of “supra clavicular
hallows”.
The lips, cheeks and nail beds and later the skin as a whole becomes
cyanosed in severe conditions
ii. On palpation – Expansion of chest diminished.
Vocal frematus diminished.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
93
iii. On percussion – Note the hyper resonant, especially after many attacks,
emphysema also supervenes.
iv. On auscultation – The inspiratory effort is shortened and may hardly be
audible.
Expiration prolonged with rapid inspiration
High – pitched musical rhonchi with prolonged expiration replaces the
normal vesicular murmurs.
Expiration phase is unduly prolonged and wheezy
In severe asthma airflow may be insufficient to produce rhonchi and a
silent chest is an ominous (arishta) sign
B. Between attacks –
There are usually no physical signs between attacks except in patients with chronic
asthma, who are seldom without rhonchi. Prolonged asthma in elder may be complicated
with emphysema, but severe asthma starting in childhood usually causes ‘pigeon chest’
deformity.
b-2) Diagnosis measurements
The signs and symptoms of Tamaka Swasa mentioned in Ayurveda and modern
science were the main basis of diagnosis and criteria for assessing the response to the
treatment. Assessments of results were made according to clinical and functional
improvement observed in the study. Clinical assessment was made on the body change in
the severity of the symptoms and for clinical assessment symptoms viz. Swasakricchata,
kasa, dukhena kapha nissaranam, ghurguratwam, Uraha peeda and shayaneswasapeedit,
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
94
which are allotted grades according to their severity or to that of normalcy. The grades are
followed as under.
Swasa kricchrata 0 – Normal - no symptoms 1 – Mild – breathless with activity, frequency 1 to 2 times/week 2 – Moderate – breathless with talking, frequency 2 to 4 times/week 3 – Severe – breathless at rest, frequency 4 to 6 times/week, limited activity
Kasa 0 – Normal - no cough 1 – Mild - morning bouts or after exercise - don’t disturb work 2 – Moderate - continuous cough during day and morning disturbing work 3 – Severe - continuous and night cough disturb activities
dukhen kapha nissaranu
0 – Normal - no phlegm 1 – Mild - less than 2.5 ml/day without pain 2 – Moderate - 2.5 ml to 15 ml/day with mild pain 3 – Severe - 15 to 25 ml/day with pain
Ghurghurtwam
0 – Normal - no wheezing 1 – Mild - moderate wheezing at mid to end respiration, brief, not more than 1 to 2 times/week 2 – Moderate - loud wheeze through out expiration, not more than 2 to 4 times/week 3 – Severe - loud inspiration and expiration wheeze, more than 4 to 6 times/week
Peenasa
0 – Normal - no common cold & cough 1 – Mild - initially present or occasionally 2 – Moderate - continuous day with cough 3 – Severe - continuous day and night
Krucchana bhasate
0 – Normal - difficult to speak 1 – Mild - able to speak in sentences 2 – Moderate - able to speak in phrases 3 – Severe - able to speak in words
Kantodwamsa
0 – Normal - no hoarseness of voice 1 – Mild - 0 or 1 bout while speaking sentence 2 – Moderate - 1 or 2 bout while speaking phrase 3 – Severe - associated with words and phrase
Greeva shira samgrah
0 – Normal – no symptoms 1 – Mild - occasionally 2 – Moderate - 1 to 2 times in a week. 3 – Severe - 2 to 4 times or often
Uraha peeda
0 – Normal - no chest tightness 1 – Mild - able to tolerate the tight or pain 2 – Moderate - Persists during cough + mild differs 3 – Severe - feels difficulty to tolerate pain and tightness
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
95
Shayanasy Swasa peedita
0 – Normal – no discomfort 1 – Mild - < 1 or 2 time/month 2 – Moderate - 2 time/week 3 – Severe - > 3 or frequently
Functional assessments like Peak Expiratory Flow Rate, Breath Holding Time are
considered in the study along with Absolute Eosinophilic Count to know the effect of
therapy on Eosinophilic activity in the study. The functional units of these parameters are
taken to consideration according to their normal values.
Grade 0 No symptoms of Swasa - Asthma
Grade 1 Mild – the patients of mild asthma are defined as those with one or more of the following –
Brief wheezing no more often than 1 – times/week
Exacerabations of cough
Breathless with activity
Infrequent nocturnal cough
Nocturnal asthma < 1-2times/month
PEER> 80% of base line data (when asymptomatic) predicted variability < 20%
Grade 2 Moderate asthma –
Symptoms 1-2 times/week
exacerbation that may as 1-several days
occasional emergency care
PEER 60-80% of base line 20-30% variability
Grade 3 Severe asthma
Daily wheezing
limited activity level
exacerbations that are often severe
frequent nocturnal symptoms
hospitalization 1 or 2 times/1 year or
emergency
PEER < 60% of base line/predicted variability >30%
The Swasa vis-à-vis bronchial asthma can be defined as mild, moderate and severe
based on the disease symptoms. This enables the clinician to put the disease in a specified
category for the overall assessment of asthma patient. As the severity of bronchial asthma,
defined by the national asthma education program 198 (NAEP) expert panels of 1991 is as
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
96
below mentioned is considered in the present study. The characteristics are generalized and
as the asthma is highly variable with these characters may overlap some times.
b-3) Assessment measures and Laboratory-investigations
The following investigations are under taken to fulfill the criteria of inclusions and
exclusions. The effective parameters which are considered for the assessment are as under.
a) Breath holding time (BHT)
Breath holding time (BHT) 199 is a simple test which can provide useful information
in health and disease of the lungs. Breath in can be held for variable period of time by
different individuals depending upon the functional states of lungs development of
respiratory muscles practice, age, and sex. The normal BHT after deep inspiration may
vary from 40 seconds to over a minute. The BHT decreases in many diseases such as
chronic bronchitis emphysema, asthma, etc.
Procedure:
Ask the patient to take a deep breath and count the time in seconds
b) Peak expiratory flow rate 200
In any lung disease such as asthma patients, PEFR values are decreased. This
PEFR measurement has many benefits in clinical medicine. It provides simple,
quantitative and reproducible measures of airway obstruction. PEFR has a very good
correlation with FEVI. This simple objective measurement of lung function helps detecting
early deterioration of lung function.
Measurement of PEFR is valuable in medical care settings to, asses the severity of
asthma as a basis for making treatment decisions, for increasing or decreasing the
medicaments. It monitors response to therapy during an acute exacerbation. With this we
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
97
can diagnose exercise induced asthma. To asses the overall success of ant therapy
concerned to lung function, the PEFR is more useful.
The Wright’s peak flow meter, introduced in 1959 is a simple, portable device used
for measuring the ventilatory function of lungs. This instrument measures the maximum
flow rate or peak flow rate, which is achieved during a single forced expiration. This
estimation is useful in distinguishing reversible (asthma) from irreversible (emphysema)
disease. The peak flow meter, which measures PEER is of special value cases of asthma
where the effectiveness of the treatment with bronchodilatory can be quickly evaluated.
Procedure
Step 1) ask patient to hold the PEFR in position
Step 2) let the patient take a deep breath in
Step 3) patient keep the PEFR instrument in the mouth with out any leakage
of air from sides in to the flow meter with a sharp blast
Step 4) the movement of the needle on the dial indicates the PEER in
liters/minute, which is to be noted
Taken 3 readings at one minute intervals and recorded the average of higher
readings brought to the needle back to zero by pressing the button located near the mouth
piece normal. Range of PEFR is 350-500liters/minute.
c) Erythrocytes sedimentation rate
Erythrocytes sedimentation rate 201 is measures in the graduated tubes under
Westergren’s method (pipette method). This facilitates to understand possible presence of
organic disease or to follow the course of the disease. It is universally accepted that it is a
good prognostic method in clinical laboratory.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
98
Procedure:
Steps 1) draw the sufficient blood sample from patient vein
Step 2) add anti coagulant to the blood
Steps 3) suck the blood in to the ESR tube
Step 4) note the point of sedimentation on graduated tube
d) Hemoglobin % 202
The hemoglobin content of whole blood is reported in terms of grams of Hb per 100
ml of whole blood (g/dl). Normal ranges are 14-18 g/dl in males and 12-16 g/dl in females.
Hemoglobin is responsible for the cell's ability to transport oxygen and carbon dioxide.
This is estimated with the Shali’s method in general, which will show the Hb% in grams/
dl.
e) Absolute Eosinophilic count 203
Eosinophils attack objects that have already been coated with antibodies. They are
phagocytic cells and will engulf antibody-marked bacteria, protozoa, or cellular debris.
However, their primary mode of attack involves the exocytosis of toxic compounds,
including nitric oxide and cytotoxic enzymes, onto the surface of their targets. Eosinophils
are important in the defense against large multicellular parasites, such as flukes or parasitic
worms, and they increase in number dramatically during a parasitic infection. Because they
are also sensitive to circulating allergens (materials that trigger allergies), eosinophils
increase in number during allergic reactions as well. Eosinophils are also attracted to sites
of injury, where they release enzymes that reduce the degree of inflammation and control
its spread to adjacent tissues.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
99
This test is being done to all the patients before and after the treatment. To study the
effect of Ardhedashemaniya Swasaharavati on Eosinophils, considering normal range of
Eosinophils in peripheral blood as up to 250 cells, the AEC examination is performed.
The following are investigations were done prior to the study according to the need
either to make an exclusion or inclusion in to the study, which are commonly undertaken
for the lung disease.
a) Blood TC & DC
b) Radiological X-ray of chest (if necessary) and
c) Sputum examination (if necessary)
c) Criteria of assessment
Over all assessment of results are done considering the cumulative
subjective and objective parameters assessments. As the disease is not
totally curable in the scheduled time span of the study, the grades of
assessment made for the results declaration are as follows -
1. Not responded –
i. Patient not at all relieved with symptoms or
ii. PEER was not shown any improvement
iii. BHT not improved
iv. AEC not shown any significant reduction
v. not responded to the treatment by any means
2. Poor responded –
i. Incomplete Symptomatic relief for the patient,
ii. PEFR ≥ 150 L/min
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods
100
iii. BHT > 10 sec
iv. AEC reduced but not in normal limits
3. Moderately responded –
i. Symptomatic relief for the patient is witnessed
ii. Relived with symptoms, while medicine is continued
iii. Shown PEFR improvements with the PEER ≥ 250 to 350 L/ min
iv. BHT ≥ 20 sec
v. AEC comes back in to normal limits
vi. Moderate symptoms within follow up schedule
4. Well responded
i. Patient relieved with symptoms after discontinuous of medicine even in
follow up schedule
ii. No further attacks reported even after exposure to aggravating factors
iii. Peak expiratory flow rate shows ≥ 350 L/min
iv. BHT comes to normal limits i.e. 40 sec
v. AEC reduces to normal limits
CHAPTER-5 RESULTS
Present study registers 65 patients, out of 135 approached patients. The
percentages of patients undertaken from the scrutinised are 48.14%. Out 135 patients, 67
(49.62%) were Tamaka Swasa patients and the rest of 68 (50.38%) patients were having
respiratory tract problem but not a condition of Tamaka Swasa. Out of the 67 patients of
Tamaka Swasa 65 (97.01%) patients were undertaken for the study. Out of 65 patients 15
(23.07%) patients were discontinued hence their data has not been included in the
assessment. The remaining 50 (76.93%) patients of Tamaka Swasa viz. Bronchial
Asthma, fulfilling the criteria of diagnosis and inclusive criteria were included in the
study. Peak Expiratory Flow Rate (PEFR) and Breath Holding Time (BHT) are
considered as an objective for the inclusion in the present study.
All the patients were examined before and after the trail, according to the case
sheet format given in the annex. Both the subjective and objective criteria were recorded.
The data recorded are presented under the following headings.
A. Demographic data
B. Evaluating disease Data
C. Result of the Ardhedashemaniya Swasaharavati in Tamaka Swasa and
D. Statistical analysis of the subjective (clinical) and objective parameters
A) Demographic data:
The details of Age, Gender, Religion, and Occupation etc. of the 50 patients are as
follows.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
101
Table – 9 Demographic Data
SN OPD Age Gender Religion Occupation Economical status
Food habits Result
1 5154 32 M Hindu Active High middle Mixed Diet WR 2 5285 38 F Hindu Sedentary High middle Vegetarian WR
3 5395 55 M Hindu Active Middle Vegetarian MR
4 5402 48 F Hindu Active High middle Mixed Diet WR 5 5541 50 M Muslim Labor Poor Mixed Diet WR 6 5642 34 M Hindu Sedentary High middle Vegetarian WR
7 5648 24 F Hindu Active High middle Vegetarian WR
8 18 53 F Muslim Active Middle Mixed Diet NR 9 45 50 M Hindu Active Middle Vegetarian MR
10 63 18 F Hindu Labor Poor Mixed Diet MR 11 201 58 M Hindu Active Middle Mixed Diet WR 12 812 55 F Hindu Active Middle Vegetarian PR
13 527 27 M Hindu Active High middle Mixed Diet WR 14 530 22 M Hindu Active High middle Vegetarian WR
15 562 53 F Hindu Active Middle Vegetarian NR
16 566 33 M Hindu Active High middle Vegetarian WR
17 572 23 M Hindu Labor Poor Vegetarian WR
18 605 50 M Hindu Active Middle Vegetarian MR
19 606 50 M Hindu Sedentary High middle Mixed Diet NR 20 611 24 M Hindu Active Middle Mixed Diet WR 21 624 60 M Hindu Active Middle Vegetarian PR
22 626 35 M Hindu Labor Middle Mixed Diet WR 23 676 24 M Hindu Active High middle Mixed Diet MR 24 677 45 M Hindu Active Middle Vegetarian PR
25 681 19 M Hindu Active High middle Vegetarian WR
26 748 42 F Hindu Active High middle Mixed Diet WR 27 749 45 M Hindu Active Middle Vegetarian WR
28 774 21 F Hindu Active High middle Vegetarian WR
29 775 50 F Hindu Sedentary High middle Vegetarian MR
30 955 50 M Hindu Active Middle Vegetarian PR
31 994 22 M Hindu Active Middle Mixed Diet WR 32 995 24 F Hindu Active Middle Vegetarian WR
33 1001 15 F Hindu Active High middle Vegetarian WR
34 1497 48 F Hindu Active Middle Vegetarian PR
35 1498 51 F Hindu Active Middle Vegetarian MR
36 2210 50 F Hindu Active Middle Vegetarian PR
37 2310 45 M Hindu Active Middle Vegetarian WR
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
102
38 2283 45 M Muslim Labor Poor Mixed Diet WR 39 2332 40 M Hindu Active Middle Mixed Diet WR 40 2333 45 F Muslim Labor Poor Mixed Diet MR 41 2334 38 M Hindu Active Middle Vegetarian WR
42 2381 39 F Hindu Active High middle Vegetarian MR
43 2380 26 M Hindu Active Middle Mixed Diet WR 44 2398 50 F Hindu Labor Poor Mixed Diet PR 45 2399 55 M Hindu Labor Poor Mixed Diet MR 46 2433 47 M Hindu Active Middle Vegetarian MR
47 2481 56 M Hindu Active High middle Vegetarian NR
48 2493 46 F Hindu Labor Poor Vegetarian WR
49 2494 52 M Hindu Active Middle Vegetarian NR
50 2541 52 M Hindu Labor Poor Vegetarian WR
F = Female, M = Male, WR = Well Responded, MR = Moderately Responded,
PR = Poor Responded, NR = Not Respond,
A1) distribution of patients by Age
Age – gender distributions Observation and Results:
An interval of 10 has considered from the ages 15 to 65 as discussed in the
methods. In the study it is revealed that Tamaka Swasa is continued from the ages of 15
onwards and as the age advances the samples are settled with Tamaka Swasa. At the
older age group of 55-65 only 3 (6%) patients are reported. Where in 45-55 and 35-45
age groups reported with 20 (40%) and 10 (20%) patients in each group respectively. 15-
25 age group reported with the 11 (22%) patients with the symptoms of Tamaka Swasa
vis-à-vis Asthma. It is interested to note that the active age group patients of 25-35 age
groups reported only 6 (12%) patients. The tabulations are depicted as under.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
103
Table- 10
Distribution of patients by Age- gender
Male patients Female patients Total patients Age
Number % Number % Number %
15 -25 6 12 5 10 11 22
25- 35 6 12 0 0 6 12
35 – 45 6 12 4 8 10 20
45 – 55 10 20 10 20 20 40
55 – 65 3 6 0 0 3 6
Total 31 19 50
Graph – 10
Distribution of patients by Age – Gender
Her
the manage
65
60
64 10
10
30
0 2 4 6 8 10
15 -25
25- 35
35 – 45
45 – 55
55 – 65
DISTRIBUTION OF PATIENTS BY AGE - GENDER
Female 5 0 4 10 0
Male 6 6 6 10 3
15 -25 25- 35 35 – 45 45 – 55 55 – 65
e in this study an attempt is made to understand the male female responses to
ment with respect to that of the age groups.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 104
Table- 11
Result of Ardhedashemaniya Swasaharavati in trail patients by Age
Age
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
15 -25 11 22 9 18 2 4 0 0 0 0
25- 35 6 12 6 12 0 0 0 0 0 0
35 – 45 10 20 7 14 2 4 1 2 0 0
45 – 55 20 40 4 8 7 14 5 10 4 8
55 – 65 3 6 1 2 0 0 1 2 1 2
Total 50 100 27 54 11 22 7 14 5 10
Graph – 11
Result of Ardhedashemaniya Swasaharavati in trail patients by Age
Obs
patients in 2
one (2%) pa
(14%) patie
Result of Ardhedashemaniya Swasaharavati in trail patients by Age
1
0
1
5
0 0 0
4
9
7
6
4
0
2
7
2
00
1 1
0
1
2
3
4
5
6
7
8
9
10
15 -25 25- 35 35 – 45 45 – 55 55 – 65
Well Responded
ModerateResponded Poor Responded
Not Responded
ervations of well-responded group has 9 (18%) patients in the 15-25 interval, 6 (12%)
5-35 interval, 7 (14%) patients in 35-45 interval, 4 (8%) patients in 45-55 interval and
tient in the interval of 55-65. Out of the moderately responded group it is found that 7
nts out of 11 patients are from 45-55 age groups. At the category of poor responded
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 105
out of 7 patients 5 (10%) are from the same group i.e. 45-55 age groups. The rest of the
percentages and patients results are tabulated in the table number 11. The observation of this
study suggests that the Tamaka Swasa effects to that of 45-55 and 15-25 ages. The pictorial
representation is as above.
A2) Distribution of patients by Gender
Table- 12
Distribution of patients by Gender in Tamaka Swasa
Gender
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
Male 31 62 18 36 6 12 3 6 3 6
Female 19 38 9 18 5 10 4 8 2 4
Total 50 100 27 54 11 22 7 14 5 10
Graph - 12
Distribution of patients by Gender in Tamaka Swasa
Distribution of patients by Gender in Tamaka Swasa
Male62.00%
Female 38.00%
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 106
The male female ratio in the study is approximately 2:1 patients. The percentage
of the distribution does not show any gender differentiation to get this respiratory disease
in specific, except a small lean towards male population. The observations are 31 Patients
i.e. (62%) male and 19 patients i.e. (38%) were female.
Graph - 13
Result Distribution of patients by Gender in Tamaka Swasa
A3) dist
F
Christia
commun
Muslim
(52%) p
respond
observe
Result of patients by Gender in Tamaka Swasa
18
9
6
5
3
4
3
2
0 5 10 15 20
Male
Female
Not Responded
Poor Responded
Moderate Responded
Well Responded
ribution of patients by Religion
or the convenience of the study, the religion groups are noted as Hindu, Muslim,
n and Others. The maximum number of patients are noticed from the Hindu
ity as the ratio of community at the study area is more i.e. 46 (92%) along with
patients 4 (8%). At the results observed, out of 46 (92%) of Hindu patients, 26
atients Well responded, 9 (18%) patients moderately responded, 7 (14%) Patients
ed poor and 4 (8%) patients not responded. On the other hand the results
d at Muslim community are, out of 4 (8%), 2 patients fall under the category of
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 107
well responded and one each in moderately responded and not responded respectively.
The tabulation and graphical representation is as under.
Table- 13
Distribution of patients by Religion and gender identification
Male patients Female patients Total patients Religion
Number % Number % Number %
Hindu 29 58 17 34 46 92
Muslim 2 4 2 4 4 8
Christian 0 0 0 0 0 0
Others 0 0 0 0 0 0
Total 31 62 19 38 50 100
Graph – 14
Distribution of patients by religion in Tamaka Swasa
Distribution of patients by religion in Tamaka Swasa
Christian 0.00%
Hindu92.00%
Muslim8.00%
Others0.00%
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 108
Table- 14
Result Distribution of patients by Religion
Religion
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
Hindu 46 92 26 52 9 18 7 14 4 8
Muslim 4 8 2 4 1 2 0 0 1 2
Christian 0 0 0 0 0 0 0 0 0 0
Others 0 0 0 0 0 0 0 0 0 0
Total 50 100 27 54 11 22 7 14 5 10
Graph - 15
Result Distribution of patients by Religion in Tamaka Swasa
Result Distribution of patients by Religion in Tamaka Swasa
26
2
0
0
9
1
0
0
7
0
0
0
4
1
0
0
0 5 10 15 20 25 30
Hindu
Muslim
Christian
Others Not Responded
Poor Responded
Moderate Responded
Well Responded
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 109
A4) Distribution of patients by Occupation
Table- 15
Distribution of patients by occupation
Occupation
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
Sedentary 4 8 2 4 1 2 0 0 1 2
Active 36 72 19 38 7 14 6 12 4 8
Labour 10 20 6 12 3 6 1 2 0 0
Total 50 100 27 54 11 22 7 14 5 10
Graph - 16 Distribution of patients by Occupation
At
responded
treatment.
responded
PATIENTS BY OCCUPATION
Active72.00%
Sedentary8.00%
Labour20.00%
the results observed, out of 4 (8%) of sedentary patients, 2 (4%) patients well
, 1 (2%) patient moderately responded and 1 (2%) patient not responded to the
At the active group, out of 36 (72%) patients, 19 (38%) patients well
, 7 (14%) patients moderately responded, 4 (8%) patients not responded and 6
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 110
(12%) patients poorly responded. At the results are observed, out of 10 (20%) of Labour,
6 (12%) patients well responded, 3 (12%) patients moderately responded and 1 (2%)
patient poorly responded to the Ardhedashemaniya Swasaharavati. The pictorial
representation is as follows.
Graph – 17 Result of patients by occupation in Tamaka Swasa
A5) Distri
At
responded
and no pa
patients a
poorly res
(34%) pat
patients m
Result of patients by occupation in Tamaka Swasa
2
19
6
1
7
3
0
6
1
1
4
0
0 5 10 15 20
Sedentary
Active
Labour
Not Responded
Poor Responded
Moderate Responded
Well Responded
bution of patients by economic status
the results observed, out of 9 (18%) of poor patients, 5 (10%) patients are well
, 3 (6%) patients are moderately responded, 1 (2%) patient is poorly responded
tient is not responded. Out of 24 (48%) of Middle class patients, 10 (20%)
re well responded, 5 (10%) patients moderately responded, 6 (12%) patients
ponded and 3 (6%) patients are not responded. From higher middle class 17
ients reported and out of them 12 (24%) patients are well responded, 3 (6%)
oderately responded and 2 (4%) patients are not responded. No patients are
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 111
reported from the higher class of classification. The tabulation and pictorial graph is
expressed as here.
Table- 16
Distribution of patients by Economic status
Economic
status
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
Poor 9 18 5 10 3 6 1 2 0 0
Middle 24 48 10 20 5 10 6 12 3 6
Higher Middle 17 34 12 24 3 6 0 0 2 4
Higher 0 0 0 0 0 0 0 0 0 0
Total 50 100 27 54 11 22 7 14 5 10
Graph- 18
Result Distribution of patients by Economic status
5
10
12
0
3
5
3
01
6
0 00
32
00
2
4
6
8
10
12
14
Poor Middle Higher Middle Higher
Result by economical statusPatients
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 112
A6) Distribution of patients by diet
Table- 17 Distribution of patients by diet in Tamaka Swasa
Age
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
Vegetarian 29 58 16 32 6 12 4 8 3 6
Mixed diet 21 42 11 22 5 10 3 6 2 4
Total 50 100 27 54 11 22 7 14 5 10
The vegetarian and mixed diet ratio in the study is approximately 1:1 patients.
The percentage of the distribution does not show any diet differentiation to get this
respiratory disease in specific, except a small lean towards vegetarian population. The
observations are 29 Patients i.e. (58%) vegetarian and 21 patients i.e. (42%) were mixed
diet practitioners.
Graph - 19 Distribution of patients by diet in Tamaka Swasa
Distribution of patients by diet in Tamaka Swasa
Vegetarian 58.00%Mixed diet
42.00%
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 113
Graph - 20
Result Distribution of patients by diet in Tamaka Swasa
Not Responded
A
response
(6%0 pa
populati
respond
treatmen
B) Data
B1) Dis
A
under th
complai
Teevra v
Result of patients by Gender in Tamaka Swasa
16
11
6
5
4
3
3
2
0 2 4 6 8 10 12 14 16 18
Vegetarian
Mixed diet
Poor Responded
Moderate Responded
Well Responded
s the results observed, out of 29 (58%) vegetarians, 16 (32%) patients well
, 6 (12%) patients moderately responded, 4 (8%) patients poorly responded and 3
tients not responded to the management. As the results observed in mixed diet
on, out of 21 (42%), 11 (22%) patient well response, 5 (10%) patients moderately
ed, 3 (6%) patients poorly responded and 2 (4%) patients not responded to the
t.
related to the disease.
tribution of patients by presenting complaints
s the above table explains about the different symptoms evaluated at the study
e heading of Tamaka Swasa vis-à-vis Bronchial Asthma with the presenting
nts are foot forth here. The first and fore most complaint in Tamaka Swasa is
ega Swasa – Swasa Kruchrata (Dyspnonea) and Ghurghuratwam (Wheezing).
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 114
Table- 18
Presenting complaints Patients %
Teevra vega Swasa – swasa Kruchrata (Dyspnonea) 50 100
Ghurghuratwam (Wheezing) 50 100
Kasa (cough) 47 94
Duhkhena Kapha nissaranam (Expectoration) 43 86
Urah Peeda (Chest Pain) 39 78
Shayane Swasa peedita (Discomfort at supine) 37 74
Peenasa (Coryza) 33 66
Kruchrena bhasate (Dysphonoea) 22 44
Greevashirasangraha (Headache & Stiffness) 16 32
Kantodhwamsham (Hoarseness of voice) 12 24
Graph – 21
Distribution of patients by presenting complaints
Distribution by Presenting Complaints
Shayane Swasa peedita
37
Urah Peeda 39
Greevashirasangraha
16
Kruchrena bhasate 22
Kantodhwamsham
12
Peenasa 33
Kasa (cough), 47
Duhkhena Kapha nissaranam, 43
swasa Kruchrata 50
Ghurghuratwam, 50
0
10
20
30
40
50
60
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 115
All the patients in the study (100%) reported the above symptoms. The next most
common complaint is Kasa (cough) followed with Duhkhena Kapha nissaranam
(Expectoration). Only 12 patients (24%) reported with the Kantodhwamsham
(Hoarseness of voice). The other complaints such as Peenasa (Coryza) (33 patients –
66%), Kruchrena bhasate (Dysphonoea) (22 patients – 44%), Greevashirasangraha
(Headache & Stiffness) (16 patients – 32%), Urah Peeda (Chest Pain) (39 patients – 78%)
and Shayane Swasa peedita (Discomfort at supine) (37 patients – 74%) are reported in the
study. The tabulation and graphical representation is expressed above.
B2) Distribution of patients by Associated features
Table- 19
Presenting Associated features Patients Percentage
Muhur Swasa (frequent respiration) 28 56
Anidra (disturbed sleep) 26 52
Angamarda (Malaise) 23 46
Vishukasyata (Dryness of mouth) 20 40
Aruchi (Anorexia) 18 36
Lalata sweda 16 32
Muhuchaiva dhamyati (puts all effort to breath) 15 30
Trushna (Thirst) 14 28
Jwara (fever) 8 16
Pratamyati or Bhrushamarta (distressed) 7 14
Kampa (Tremors) 5 10
Vamathu (nausea) 3 6
Pramoha (fainting) 0 0
As many as features are associated with the study Tamaka Swasa vis-à-vis
Asthma with the associated complaints are foot forth here. Many complaints of
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
116
associative are not observed in the study. Muhur Swasa (frequent respiration), Anidra
(disturbed sleep), Angamarda (Malaise), Vishukasyata (Dryness of mouth), Aruchi
(Anorexia), Lalata sweda, Muhuchaiva dhamyati (puts all effort to breath), Trushna
(Thirst), Jwara (fever), Pratamyati or Bhrushamarta (distressed), Kampa (Tremors),
Vamathu (nausea) and Pramoha (fainting) are the associated listed below show their
involvement in the most frequently presented to the least along with the percentages.
Graph –22
Distribution of patients by Associated features of Tamaka Swasa
B3) Dis
T
under. O
8 (16%)
(4%) pa
Distribution of patients by Associated features
Vamathu 3
Pramoha 0
Kampa 5
Pratamyati or Bhrushamarta
7
Jwara8
Lalata sweda, 16 Trushna
14
Muhuchaiva dhamyati
15
Aruchi 18
Anidra 26
Angamarda 23
Muhur Swasa 28
Vishukasyata 20
0
5
10
15
20
25
30
tribution of patients by mode of on set
he modes of onset of the Tamaka Swasa vis-à-vis asthma results observed are as
ut of 38 (76%) of Gradual onset patients, 22 (44%) patients are well responded,
patients are moderately responded and 6 (12%) patients poorly responded and 2
tients are not responded. Out of 12 (24%) of sudden onset patients, 5 (10%)
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 117
patients are well responded 3 (6%) patients are moderately responded, 1 (2%) patients
poorly responded and 3 (6%) patients not responded.
Table- 20
DISTRIBUTION OF PATIENTS BY MODE OF ON SET
Onset
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
Gradual 38 76 22 44 8 16 6 12 2 4
Sudden 12 24 5 10 3 6 1 2 3 6
Total 50 100 27 54 11 22 7 14 5 10
Graph –23
Distribution of patients by Mode of on set
PATIENTS BY MODE OF ON SET
Gradual 76.00%
Sudden24.00%
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 118
B4) Distribution of patients by course
Table- 21
Distribution of patients by course
course
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
Episodic 30 60 20 40 7 14 2 4 1 2
Continuous 11 22 4 8 1 2 3 6 3 6
Initially episodic
9 18 3 6 3 6 2 4 1 2
Total 50 100 27 54 11 22 7 14 5 10
Graph – 24
Distribution of patients by course
observ
PATIENTS BY COURSE
Initially episodic18.00%
Episodic 60.00%
Continuous22.00%
The course distributions of the Tamaka Swasa vis-à-vis Asthma results are
ed as under. It classified under three headings as Episodic, Continuous and initially
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 119
episodic. Out of 30 (60%) of Episodic course patients, 20 (40%) patients are well
responded 7 (14.2%) patients are moderately responded, 2 (4%) patients are poorly
responded and 1 (2%) patient is not responded. Out of 11 (22%) of Continuous course
patients, 4 (8%) patients are well responded 1 (2%) patient are moderately responded, 3
(6%) patients poorly responded and 3 (6%) patients not responded. Out of 9 (18%) of
initially episodic course patients, 3 (6%) patients are well responded, 3 (6%) patients are
moderately responded, 2 (4%) patients are poorly responded and 1 (2%) patient is not
responded to the management. The graphical expression is as above.
B5) Distribution of patients by frequency
Table -22
Distribution of patients by frequency
Frequency
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
Few Hours 14 28 4 8 2 4 5 10 3 6
Few Days 27 54 15 30 8 16 2 4 2 4
Few Weeks 9 18 8 16 1 2 0 0 0 0
Total 50 100 27 54 11 22 7 14 5 10
The distributions of frequency are observed as much (27) patients with few days
interval of frequency of episode. The graphical expression is as under.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
120
Graph – 25
Depicting the frequency episodes in Tamaka Swasa
B6) Di
Duratiattack
Contin
Interm
Subsidwith mediciTotal
with in
14
27
9
0
5
10
15
20
25
30
Few Hours Few Days Few Weeks
Depicting the Frequency episodes in Tamaka Swasa
stribution of patients by duration of attack
Table -23
Distribution of patients by duration of attack
on of
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
uous 10 20 5 10 1 2 2 4 2 4
ittent 32 64 20 40 9 18 2 4 1 2
es
ne
8 16 2 4 1 2 3 6 2 4
50 100 27 54 11 22 7 14 5 10
The distributions of duration observed in the study is as much as (32) patients
termittent duration of attack. The graphical expression is as under.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 121
Graph – 26
Depicting the duration of attack in Tamaka Swasa
B7) Di
Period
Season
Irregul
Perenn
Total
with ir
10
32
8
05
10152025
3035
Continuous Intermittent Subsides withmedicine
Depicting the duration of attack in Tamaka Swasa
stribution of patients by periodicity
Table -24
Distribution of patients by periodicity
icity
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
al 11 22 6 12 2 4 2 4 1 2
ar 30 60 16 32 7 14 4 8 3 6
ial 9 18 5 10 2 4 1 2 1 2
50 100 27 54 11 22 7 14 5 10
The distributions of duration observed in the study is as much as (30) patients
regular periodicity. The graphical expression is as under.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 122
Graph – 27
Depicting the periodicity in Tamaka Swasa
B7) Di
Precedfactors
Cough
Sneezicough Sneezicough nasal iNasal with coSneeziNasal
Nasal
Total
11
30
9
0
5
10
15
20
25
30
Seasonal Irregular Perennial
Depicting the periodicity in Tamaka Swasa
stribution of patients by preceding factors
Table -25
Distribution of patients by preceding factors
ing
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
11 22 6 12 4 8 0 0 1 2
ng with 21 42 12 24 3 6 3 6 3 6
ng, with
rritation
12 24 5 10 4 8 3 6 0 0
irritation ugh
3 6 3 6 0 0 0 0 0 0
ng, irritation
2 4 1 2 0 0 0 0 1 2
irritation 1 2 0 0 0 0 1 2 0 0
50 100 27 54 11 22 7 14 5 10
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 123
The distributions of duration observed in the study are as much as (21) patients
with Sneezing with cough followed with (11) patients of only cough. The graphical
expression is as under.
Graph – 28
Depicting the preceding factors in Tamaka Swasa
B9) Di
Aggravfactors
Dust
Smoke
Dust &
Total
Cough,11
Sneezing with cough, 21 Sneezing, cough
with nasal irritation,
12Nasal irritation
with cough , 3
Sneezing, Nasal irritation,
2 Nasal irritation, 1
0
5
10
15
20
25
Depicting the preceding factors in Tamaka Swasa
stribution of patients by aggravating factors
Table -26
Distribution of patients by aggravating factors
ating
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
17 34 8 16 5 10 1 2 3 6
6 12 4 8 0 0 2 4 0 0
smoke 27 54 15 30 6 12 4 8 2 4
50 100 27 54 11 22 7 14 5 10
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 124
The distributions of duration observed in the study are as much as (27) patients
with dust and smoke followed with (17) patients of only dust. The graphical expression is
as under.
Graph – 29
Depicting the aggravating factors in Tamaka Swasa
B10) D
Comfopostur
Sitting
ForwabendinSittingForwaBendinTotal
Cough,11
Smoke,
Dust_Smoke, 27
6
0
5
10
15
20
25
30
Depicting the aggravating factors in Tamaka Swasa
istribution of patients by comfort posture
Table -27
Distribution of patients by comfort posture
rt e
Tot
al n
o of
pa
tien
ts
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
% P
oor
Res
pond
ed
%
Not
R
espo
nded
%
24 48 14 28 7 14 2 4 1 2
rd g
5 10 3 6 0 0 2 4 0 0
& rd g
21 42 10 20 4 8 3 6 4 8
50 100 27 54 11 22 7 14 5 10
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 125
The distributions of duration observed in the study are as much as (24) patients
felt comfort with sitting followed with (21) patients with Sitting and Forward Bending of
comfort. The graphical expression is as under.
Graph – 30
Depicting the comfort posture in Tamaka Swasa
Sitting &
B11) D
observ
Vata
Angas
Alpabhahitam
Chesta
Vyamo
Sleshmvruddh
Sitting, 24 Forward bending,
5
Forward Bending, 21
0
5
10
15
20
25
Depicting the comfort Posture in Tamaka Swasa
istribution of patients by Dosha Kshaya lakshana
The Shareerika Prakruti distributions of the Tamaka Swasa vis-à-vis Asthma
ations are as under. It classified under three headings as Vata, Pitta, Kapha,
Table - 28 Pts % Pitta Pts % Kapha Pts %
ada 4 8 Mandagni 23 46 Bhrama 0 0
ashite
0 0 Shareera sheetatwam
32 64 Urah shoonyata
0 0
heenata 0 0 Prabha hani 0 0 Shira soonyata
0 0
ha 0 0 Hridrava 0 0
a i
0 0 Sandhi saidhilya
0 0
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results 126
B12) Distribution of patients by Dosha vruddhi Prakruti
Table- 29 Vata Vruddhi
Lakshana Pts % Pitta Vruddhi
Lakshana Pts % Kapha
Vruddhi Lakshana
Pts %
Karshya 17 34 Peeta mootrata
0 0 Agni sadana 23 46
Karshnya 19 38 Peetanetra 0 0 Praseka 18 34
Ushna
kamitwa
38 76 Peetavit
0 0 Alasya
20 40
Kampa 5 10 Peetatwak 0 0 Swetangata 16 32
Anaha 14 28 Adhikshudha 0 0 Sheetangata 32 64
Shakrudgraha 12 24 Adhidaha 9 18 Gowrava 22 44
Balabhrmsha 6 12 Slathangata 0 0
Nidrabhramsha 26 52 Swasa 50 100
Pralapa 0 0 Kasa 47 94
Bhrama Atinidra
Out of the Dosha Kshaya Angasada (4 pts) of Vata and Shareera sheetatwam of
Pitta lakshana are observed. But at the Dosha vruddhi lakshana maximum of Kapha
lakshana and the pratyatma niyata lakshana of the disease Swasa is observed 50 patients
along with the Kasa of 47 patients. Nidra bhramsha (Vata) is observed with 26 patients
and ushna kamitwa for 38 patients. Anidra of Pitta and Nidra rahityata of Vata more or
less mimic and are observed as 9 patients in the study. Sheetangata of Kapha symptom is
observed for the 32 patients along with gowrava (22) and swetangata (16) patients.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
127
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
128
B13) Distribution of patients by Ahara Nidana
Table -30
Vata Pts % Pitta Pts % Kapha Pts %
Visamashana (V) 14 28 Tilataila (P) 0 0 Pistanna (K) 11 22
Adhyashana (V) 12 24 Vidahi (P) 0 0 Nispava (K) 0 0
Anasana (V) 5 10 Saluka (K) 0 0
Sheetashana (V) 0 0 Guru dravyas (K) 40 80
Visha (V) 0 0 Jalajamamsa (K) 7 14
Sheetapana (V) 36 72 Anupamamsa (K) 17 34
Rukshanna (V) 34 68 Abhishyandi (K) 41 82
Masa (K) 27 54
Dadhi (K) 39 78
Vistambhi (K) 5 10
Amaksira (K) 0 0
It is observed those 40 patients under take Guru dravyas, 41 patients Abhishyandi
padartha, and 39 patients Dadhi, in their food, which is Kapha kara Ahara. Sheeta (36)
and Rooksha (34) anna, which is Vata kara ahara consumed by patients also listed here.
The percentage and the number of patients enrolled to the Ahara Nidana are tabulated in
the table – 30.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
129
B14) Distribution of patients by Vihara Nidana
Table -31
Vihara Pts % Vihara Pts %
Rajas (V) 50 100 Abhighata (V) 0 0
Vata (V) 50 100 Dhuma (V) 23 46
Sheeta Sthana (V) 30 60 Apatarpana (V) 5 10
Sheeta ambu (V) 0 0 Bharakarshita (V) 5 10
Ativyayama (V) 11 22 Adhwahata (V) 20 40
Kanthapratighata (V) 0 0 Urahpratighata (V) 0 0
Karmahata (V) 6 12 Marmabhighata(V) 0 0
Veganirodha (V) 9 18 Usna (P) 0 0
Shuddhi Atiyoga (V) 0 0 Abhishyandi Upacara (K) 0 0
Gramya dharma (V) 0 0 Divasvapna (K) 0 0
It is observed that exposure to rajas and Vata is common among all 50 patients of
the study. Seta stnana, Dhooma, adwavata, Ati Vyayama, veganirodha, Karmahata,
apatarpana and Bharakarshita Vihara Nidana took the place of aetiology is tabulated in
the table – 31.
B15) Distribution of patients by Anya / Vyadhi Avasta sambandha Nidana
Out of the other symptoms scrutinized, Vibandha, Anaha, Panduroga, Dourbalya
of Vata lakshana are found in the study. At the same time Kasa and Pratishyaya which
are of Kapha lakshana and also lakshana of Tamaka Swasa show remarkable listing.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
130
Jwara, which is Pitta lakshana also found as one of the avasta sambandha Nidana here.
The tabulation is as under.
Table - 32
Distribution of patients by Anya / Vyadhi Avasta sambandha Nidana
Lakshana pts % Lakshana pts % Lakshana pts %
Ksataksaya 0 0 Atisara 0 0 Visucika 0 0
Udavarta 0 0 Vibandha 9 18 Panduroga 4 8
Vat
a
Kshaya 0 0 Anaha 11 22 Dourbalya 4 8
Pit
ta Rakta Pitta 0 0 Jwara 5 10
Kasa 47 92 Amapradosa 0 0 Chardi 3 6
Kap
ha
Pratisyaya 28 56 Amatisara 0 0
B16) Distribution of patients by Srotas
Table – 33
Distribution of patients by Srotas
Lakshana pts % Lakshana pts %
Pranavaha Atisrustam 38 76 Ati badhdama 12 24
Kupitam 32 64 Abheekhnam 27 54
Alpalpa 38 76 Sashoolam 22 44
Annavaha Aruchi 19 38 Ajeerna 14 28
Chardi 3 6 Anannabhilasha 2 4
Udakavaha Jihwashosha 14 28 Talushosha 4 8
Ostashosha 11 22 Pipasa 14 28
The enlisted symptoms pertaining to that of the Srotas examination observations
are put forth here. The chief Srotas involved in the Tamaka Swasa is Pranavaha Srotas.
Out of the vitiated symptoms of the Pranavaha Srotas almost all symptoms are observed
here and specifically Atisrusta and Alpalpa found for as many as 38 patients.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
131
Involvement of the Annavaha Srotas could not be ruled out as it is the udbhava stana. In
the Annavaha Srotas Aruchi and Ajeerna found for many. Udakavaha Srotas involvement
is established by the Jihwa sosha and Pipasa complaints of the patients. There were no
patients with out having either of the vitiated symptoms of the three Srotas which are said
to have the pathological involvement in the study. The symptoms involved patients with
percentages shown in the table 34 above.
B17) Distribution of patients by Poorva Roopa
Table -34
Distribution of patients by Poorva Roopa
Poorva Roopa Patients Percentage
Hrutpeeda 18 36
Kshudra Swasa 15 30
Shankha bheda 15 30
Shoola 0 0
Pranavilomata 28 56
Vaktra vairasya 0 0
Parshwashoola 26 52
Vibandha 9 18
Anaha 11 22
Arati 24 48
Bhakta dwesha 19 38
Admana 0 0
Out of the many told poorva Roopa, Prana vilomata, Parshwa shoola, Arati,
Hrutpeeda, shankha peeda and Kshudra Swasa are found to be more generalized. The
patients at the later course of the treatment period were not expressed. The tabulated
symptoms are depicted above in the table -34.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
132
Table No-35 Distribution of patients by Chief complaints and Associated complaints
SN OPD S
was
a kr
uchr
ata
Kas
a
Ghr
gura
twa
Pee
nasa
Sha
yane
sw
asa
peed
ita
Kru
chre
na b
hash
ita
Ura
h pe
eda
Gre
eva
shir
a sa
mgr
aha
Kan
todh
wam
sha
Ani
dra
Pra
tam
yati
Aru
chi
Vis
huka
syat
i
Lal
ata
swed
a
Tru
shna
Ang
amar
da
Kam
pa
Jwar
a
Pra
moh
a
Vam
athu
Muh
ursw
asa
Duh
khen
akap
ha n
issa
rana
ma
Muh
ucha
vsad
amya
ti
1 5154 + + + + + + + + + + 2 5285 + + + + + + + + + 3 5395 + + + + + + + + + + + + + 4 5402 + + + + + + + + + + + + + + + 5 5541 + + + + + + + + + + + + + + + + + + + 6 5642 + + + + + + + + + + 7 5648 + + + + + + + + + + + + + + 8 18 + + + + + + + + + + + + + + + + + + 9 45 + + + + + + + + + + + + + + + 10 63 + + + + + + + + + + + + + + + + 11 201 + + + + + + + + + + + + 12 812 + + + + + + + + + + 13 527 + + + + + + + + 14 530 + + + + + + + + + + 15 562 + + + + + + + + + + + + 16 566 + + + + 17 572 + + + + + + + + + + 18 605 + + + + + + + + + + 19 606 + + + + + + + + + + 20 611 + + + + + + + + 21 624 + + + + + + + + + + + + + + + + 22 626 + + + + + + + + + 23 676 + + + + + + + + + + 24 677 + + + + + + + + + + + + 25 681 + + + + + + + 26 748 + + + + + + + + + 27 749 + + + + + + + + + + + + 28 774 + + + + + + + + + 29 775 + + + + + + + + + + + + + + + 30 955 + + + + + + + + + + 31 994 + + + + + + + + + + + + + 32 995 + + + + + + + + + 33 1001 + + + + + + + + + + + + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
133
34 1497 + + + + + + + + + + 35 1498 + + + + + + + + + + + 36 2210 + + + + + + + + + + + 37 2310 + + + + + + + + + + + + 38 2283 + + + + + + + + + 39 2332 + + + + + + + + + 40 2333 + + + + + + + + + + + 41 2334 + + + + + + + + + + 42 2381 + + + + + + + + + + 43 2380 + + + + + + + + 44 2398 + + + + + + + + + + + 45 2399 + + + + + + + + + + 46 2433 + + + + + + + + 47 2481 + + + + + + + + + + 48 2493 + + + + + + + 49 2494 + + + + + + + + + 50 2541 + + + + + + +
Table No-36 Distribution of patients by History of present illness
Mod
e of
on
set
Cou
rse
Fre
quen
cy
of a
ttac
k
Dur
atio
n of
att
ack
Per
iodi
city
Pre
cedi
ng
fact
ors
Spu
tum
Agg
rava
tin
g fa
ctor
s
Com
fort
po
stur
e at
at
tack
Ser
ial N
umbe
r
OPD
Sud
den
Gra
dual
Epi
sodi
c
Con
tinu
ous
Init
iall
y ep
isod
ic
Few
day
s
Few
hou
rs
Few
wee
ks
Con
tinu
ous
Inte
rmit
tent
Sub
side
s w
ith
med
icin
e
Sea
sona
l
Irre
gula
r
Per
inea
l
Sne
ezin
g
Nas
al ir
rita
tion
Cou
gh
Non
pur
ulen
t
Pur
ulen
t
Dus
t
Sm
oke
Pet
s
Pol
lens
Sit
ting
Lyi
ng
Sta
ndin
g
For
war
d be
ndin
g
1 5154
+ + + + + + + + + + +
2 5285 + + + + + + + + + + + 3 5395 + + + + + + + + + 4 5402 + + + + + + + + + + + 5 5541 + + + + + + + + + + + + +6 5642 + + + + + + + + + + +7 5648 + + + + + + + + + + + 8 18 + + + + + + + + + + +9 45 + + + + + + + + + +10 63 + + + + + + + + + + +11 201 + + + + + + + + + + +12 812 + + + + + + + + + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
134
13 527 + + + + + + + + + + + 14 530 + + + + + + + + + + +15 562 + + + + + + + + + + + +16 566 + + + + + + + + + + +17 572 + + + + + + + + + + + + 18 605 + + + + + + + + + + +19 606 + + + + + + + + + + + +20 611 + + + + + + + + + + + +21 624 + + + + + + + + + + + 22 626 + + + + + + + + + + +23 676 + + + + + + + + + 24 677 + + + + + + + + + + + + 25 681 + + + + + + + + + + + 26 748 + + + + + + + + + + + 27 749 + + + + + + + + + + + +28 774 + + + + + + + + + + + + 29 775 + + + + + + + + + + 30 955 + + + + + + + + + + + +31 994 + + + + + + + + + 32 995 + + + + + + + + 33 1001 + + + + + + + + + + +34 1497 + + + + + + + + + + + + + +35 1498 + + + + + + + + + +36 2210 + + + + + + + + + + + +37 2310 + + + + + + + + + + + 38 2283 + + + + + + + + + 39 2332 + + + + + + + + + + +40 2333 + + + + + + + + + + + + 41 2334 + + + + + + + + + + + +42 2381 + + + + + + + + + + + 43 2380 + + + + + + + + + + + +44 2398 + + + + + + + + + +45 2399 + + + + + + + + + + 46 2433 + + + + + + + + + + + + +47 2481 + + + + + + + + + +48 2493 + + + + + + + + + + + 49 2494 + + + + + + + + +50 2541 + + + + + + + + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
135
Table - 37 Distribution of patients by Dosha Vruddhi Lakshana
Vata vruddhi lakshana Pittavruddhi
lakshana Kapha vruddhi lakshana
SN
OPD
Kar
shya
Kar
shny
a
Usn
a ka
mit
wa
Kam
pa
Ana
ha
shak
rut g
raha
m
Bal
abhr
amsh
a
Nid
ra b
hram
sha
Pra
lapa
Bhr
ama
Pee
ta m
ootr
ata
Pee
ta n
etra
Pet
a vi
t
Pee
ta tw
ak
Adh
ika
kshu
dha
Ati
dah
a
Agn
isad
ana
Pra
seka
Ala
sya
Sw
etas
ngat
a
She
etan
gata
Gow
rava
Sla
than
gata
Sw
asa
Kas
a
Ati
nidr
a
1 5154 + + + + + + + + + + + 2 5285 + + + + + + + + + + 3 5395 + + + + + + + 4 5402 + + + + + + + 5 5541 + + + + + + + + + + + 6 5642 + + + 7 5648 + + + + + + + + + + 8 18 + + + + + + 9 45 + + + + + + 10 63 + + + + + + + + + 11 201 + + + + + + 12 812 + + + + + + + + + + 13 527 + + + 14 530 + + + + + + 15 562 + + + + + + 16 566 + + + 17 572 + + + + + + + + 18 605 + + + + + + + + 19 606 + + + + + + + + + 20 611 + + + + + + + 21 624 + + + + + + + 22 626 + + + + + + 23 676 + + + + + + + + + + + 24 677 + + + + + + + + + + 25 681 + + + + + + + 26 748 + + + + + + + + + 27 749 + + + + + + + + + 28 774 + + + + + + 29 775 + + + + + + + + + + + 30 955 + + + + + + + + + + 31 994 + + + 32 995 + + + + + + + + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
136
33 1001 + + + + + + + + 34 1497 + + + + + + + + 35 1498 + + + + + 36 2210 + + + + + + + + + 37 2310 + + + + + + + 38 2283 + + + + + + + + + + + 39 2332 + + + + + + 40 2333 + + + + + + + 41 2334 + + + 42 2381 + + + + + + + + + + + + 43 2380 + + + + + + 44 2398 + + + + + + + + + + + + 45 2399 + + + + + + + + 46 2433 + + + + + + + + 47 2481 + + + + + + + + 48 2493 + + + + + + + + + 49 2494 + + + + + 50 2541 + + + + + + + + +
Table - 38 Distribution of patients by Dosha Kshaya Lakshana
Vata Kshaya lakshana Pitta Kshaya
lakshana Kapha Kshaya lakshana
SN
OPD
Ang
asad
a
Alp
a bh
ashi
te h
itam
Che
sta
heen
ata
Vya
moh
a
Shl
eshm
a vr
uddh
i
Man
dagn
i
Sha
reer
a sh
eeta
ta
Pra
bhah
ani
Bhr
ama
Ura
h sh
oony
ata
Shi
ra s
hoon
yata
Hru
drav
a
San
dhi s
hait
hily
a
1 5154 + + 2 5285 + + 3 5395 + + 4 5402 5 5541 + + 6 5642 7 5648 + + + 8 18 + + 9 45 10 63 + + 11 201 + + 12 812 + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
137
13 527 14 530 + + 15 562 + + 16 566 17 572 + + 18 605 + + 19 606 + + 20 611 + 21 624 22 626 + 23 676 + + + 24 677 25 681 + + 26 748 + 27 749 + + 28 774 + 29 775 + + 30 955 + + 31 994 32 995 33 1001 34 1497 + + 35 1498 + + 36 2210 37 2310 + + 38 2283 + + 39 2332 + 40 2333 + 41 2334 42 2381 + + 43 2380 44 2398 + + 45 2399 46 2433 + + 47 2481 + 48 2493 + + 49 2494 50 2541 +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
138
Table - 39 Distribution of patients by Ahara nidana
Vata Pitta Kapha
SN
OPD V
isha
mas
hana
Adh
yasa
na
Ana
shan
a
She
eta
snan
a
Vis
ha
She
etap
ana
Roo
ksha
nna
Til
a ta
ila
Vid
hahi
Pis
tann
a
Mas
ha
Nis
hpav
a
Dad
hi
Sha
look
a
Vis
tam
bhi
Gur
udra
vya
Am
a ks
heer
a
Jala
ja m
amsa
Ano
opa
mam
sa
Abh
ishy
andi
1 5154 + + + + + + + + 2 5285 + + + + + + + + + 3 5395 + + + + + + 4 5402 + + + + + + + + + 5 5541 + + + + + + + + + + 6 5642 + + + + + + + + + 7 5648 + + + + + + + + + 8 18 + + + + + + + + 9 45 + + + + + 10 63 + + + + + + + + 11 201 + + + + + + + + 12 812 + + + + 13 527 + + + + + + + 14 530 + + + + + 15 562 + + 16 566 + + + + + 17 572 + + + + 18 605 + + + + + + 19 606 + + + + + + + 20 611 + + + + + 21 624 + + + + + + 22 626 + + + + + 23 676 + + + + + + 24 677 + + 25 681 + + 26 748 + + + + + + + + 27 749 + + + + + 28 774 + + + + + + 29 775 + + + + + 30 955 + + + + + + 31 994 + + + + 32 995 + + + + 33 1001 + + + + + 34 1497 + + + 35 1498 + + + + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
139
36 2210 + + + + 37 2310 + + + + + + + 38 2283 + + + + + 39 2332 + + + + + 40 2333 + + + + + + + 41 2334 + + + 42 2381 + + + + + + 43 2380 + + + + + + + 44 2398 + + + + + + 45 2399 + + + + + 46 2433 + + + + + 47 2481 + + + + + 48 2493 + + + + + + 49 2494 + + + + + + 50 2541 + + + + + +
Table - 40 Distribution of patients by Vihara Nidana
SN
OPD
Raj
a se
vana
Vay
u se
vana
Ati
vyay
ama
Abh
igha
ta
Dho
oma
Apa
tarp
ana
Bha
raka
rsha
ta
Adh
wah
ata
Kan
tapa
rati
ghat
a
Kar
mah
ata
Veg
anir
odha
Sud
dhi a
tiyo
ga
Gra
mad
harm
a
Ura
h pr
atig
hata
Mar
mab
high
ata
Abh
shya
ndi
uapa
char
a
Diw
asw
apna
1 5154 + + + 2 5285 + + + + + + 3 5395 + + + + 4 5402 + + + + + + 5 5541 + + + + + + 6 5642 + + + 7 5648 + + + + + + + 8 18 + + + 9 45 + + + + + 10 63 + + + + + 11 201 + + + 12 812 + + 13 527 + + 14 530 + + 15 562 + + + 16 566 + + + + + 17 572 + + + + + + 18 605 + + + + + + + 19 606 + + 20 611 + + + 21 624 + + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
140
22 626 + + + + + 23 676 + + + 24 677 + + + 25 681 + + 26 748 + + 27 749 + + + + + + 28 774 + + + 29 775 + + + + + + + 30 955 + + 31 994 + + + 32 995 + + + + 33 1001 + + 34 1497 + + 35 1498 + + + 36 2210 + + + + 37 2310 + + + + 38 2283 + + + + + + 39 2332 + + 40 2333 + + + + 41 2334 + + + + 42 2381 + + + + 43 2380 + + 44 2398 + + + + + 45 2399 + + + + 46 2433 + + + + 47 2481 + + + 48 2493 + + + + 49 2494 + + + + 50 2541 + +
Table - 41 Distribution of patients by Anyavyadhi avasta sambandhi
SN
OPD
Ksh
ata
ksha
ya
Ksh
aya
Ana
ha
Dou
rbal
ya
Uda
vart
a
Vib
andh
a
Pan
duro
ga
Rak
tapi
tta
Jwar
a
Kas
a
Pra
tish
yaya
Am
apra
dosh
aja
vyad
hi
Am
atis
ara
Cha
rdi
Vis
huch
ika
1 5154 2 5285 + + 3 5395 + 4 5402 + + 5 5541 + + 6 5642 + 7 5648 + + +
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
141
8 18 + 9 45 + 10 63 + 11 201 12 812 13 527 14 530 + 15 562 16 566 + 17 572 + 18 605 + + 19 606 20 611 21 624 + 22 626 23 676 + 24 677 + 25 681 26 748 + 27 749 28 774 + 29 775 + 30 955 31 994 32 995 + 33 1001 + 34 1497 + + 35 1498 36 2210 37 2310 + 38 2283 39 2332 + 40 2333 41 2334 + + 42 2381 43 2380 44 2398 + 45 2399 46 2433 + 47 2481 48 2493 49 2494 50 2541
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
142
C) Result of the Ardhedashemaniya Swasaharavati in Tamaka Swasa vis-à-vis Asthma
C1) Assessment of Subjective parameters in Tamaka Swasa
Table- 42 Subjective parameters assessment in Tamaka Swasa
Presenting complaints
Pat
ient
s B
efor
e
%
Pat
ient
s A
fter
%
Pat
ient
s re
liev
ed
%
Teevra vega Swasa (Dyspnonea)
50 100 21 42 29 58
Kasa (cough)
47 94 18 36 29 61.7
Duhkhena Kapha nissaranam (Expectoration)
43 86 20 40 23 53.48
Ghurghuratwam (Wheezing)
50 100 25 50 25 50
Peenasa (Coryza)
33 66 15 30 18 54.54
Kruchrena bhasate (Dysphonoea)
22 44 10 20 12 54.54
Kantodhwamsham (Hoarseness of voice)
12 24 5 10 7 58.33
Greevashirasangraha (Headache & Stiffness)
16 32 9 18 7 43.75
Urah Peeda (Chest Pain)
39 60 16 20 23 58.97
Shayane Swasa peedita (Discomfort at supine)
37 70 14 28 23 59.45
All the subjective parameters which are declared for the assessment of the
Ardhedashemaniya Swasaharavati are tabulated here in the table 42. Out of the
symptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patients initially are
relieved 58%. Another symptom found for all patients is Ghurgurukatwam is relieved for
the 50% of patients in the study. Kasa a symptom appeared for 47 patients initially
relived 61.7% in the study. Next best appeared symptom is Duhkhena Kapha nissaranam
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
143
for the 43 patients noticed relieved for the 53.48% of patients. Shayane Swasa peedita is
the next symptom with 37 patients found corrected at the end by 59.45%. 39 patients of
Urahpeeda corrected at the end of study by 58.97%. Peenasa, a symptom of the
Pranavaha Srotas always found associated with the Tamaka Swasa found for 33 patients
got through by the end with 54.54% of relief. Greevashirasangraha (16 patients) and
Kantodhwamsham (12 patients) are the other two symptoms of assessment got relief with
43.75 and 58.33 percentages respectively. The tabulation is as expressed above.
C2) Assessment of Objective Parameters in Tamaka Swasa
At the Objective Parameters assessment in Tamaka Swasa in the study of
Ardhedashemaniya Swasaharavati five objective parameters are assessed are enlisted in
the table 43. All these are of disease oriented and specific to assess the
Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis Bronchial Asthma.
The table is followed as under.
Table - 43
Objective Parameters assessment in Tamaka Swasa
Breath Holding Time
Peak Exploratory Flow Rate
Erythrocyte Sedimentation
Rate Hemoglobin %
Absolute Eosinophilic
Count SN
OPD
Before After Before After Before After Before After Before After 1 5154 10 24 180 350 10 8 10 11 500 3002 5285 8 20 150 360 10 10 9 10.2 450 2503 5395 8 15 125 290 14 10 10.4 12 500 3504 5402 10 20 200 380 8 6 9.6 10.4 450 2505 5541 12 22 160 350 10 10 9.2 10 500 3506 5642 12 20 180 370 10 8 12 12 550 3507 5648 10 20 150 370 10 10 10.8 11.2 500 2508 18 5 5 90 90 14 12 9.6 11 600 6009 45 8 14 140 250 8 10 11.4 12.6 550 35010 63 10 18 125 250 10 6 9.4 10.4 550 30011 201 10 22 140 350 12 10 10 11.8 500 30012 812 8 12 120 160 12 8 11 12.2 550 450
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
144
13 527 12 25 180 360 10 10 12 13 500 25014 530 10 21 150 350 8 10 11.2 12 500 35015 562 6 6 80 80 12 14 10.4 11.8 650 60016 566 8 20 160 350 10 6 9 10.6 500 25017 572 10 20 180 380 7 10 12 12.8 550 35018 605 7 15 120 270 8 8 12 13 500 35019 606 5 6 70 80 14 12 10 10 600 60020 611 14 30 240 450 8 6 12.6 13 500 25021 624 6 10 100 160 10 10 12.8 12 550 45022 626 12 25 200 380 8 8 9.8 11 500 25023 676 8 15 145 320 6 10 11.2 12.4 500 35024 677 5 10 120 180 12 10 10 11 450 35025 681 10 22 160 380 10 8 11 12.6 500 25026 748 12 22 150 380 10 10 10.6 11 550 35027 749 14 30 180 400 10 8 11 12.4 500 25028 774 10 20 140 350 8 10 9.2 10.4 550 35029 775 8 14 120 280 8 8 8 9.6 500 35030 955 8 12 100 150 12 12 12 12.6 550 45031 994 10 18 170 360 10 5 10.6 11 500 25032 995 10 20 150 380 8 8 12 13 500 25033 1001 12 22 160 370 10 10 8 9 500 35034 1497 8 12 90 140 12 10 11.2 12 600 50035 1498 10 18 125 250 10 8 12.2 11.8 550 35036 2210 6 10 110 170 10 10 12 12 550 45037 2310 12 25 200 350 8 6 8.2 10.4 500 25038 2283 10 22 140 360 12 8 10 11.8 500 25039 2332 10 20 170 350 10 10 10.6 12 500 35040 2333 7 16 130 300 10 8 9 9.8 550 35041 2334 10 24 150 380 6 6 10.4 12.2 500 25042 2381 8 15 135 250 8 10 12.8 13.2 500 35043 2380 10 18 140 360 12 10 11.2 12.8 500 25044 2398 6 10 100 130 14 12 10.4 11 550 40045 2399 8 14 160 280 10 10 11 12.6 550 35046 2433 7 18 130 300 8 6 9.2 10.4 500 35047 2481 5 5 80 90 15 14 10 10 650 55048 2493 10 25 160 370 10 8 12 13.2 500 25049 2494 5 8 90 80 12 12 11 10.8 550 50050 2541 12 20 140 350 10 10 10 10.8 500 250
Total 452 875 7085 14490 504 459 529 575.8 26200 17350Mean 9.04 17.5 141.7 289.8 10.08 9.18 10.58 11.51 524 347
SD 2.381 6.171 35.36 103.5 2.088 2.057 1.232 1.093 43.14 100.2
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
145
Out of the assessments of objective parameters it is clearly understood that the
Breath Holding Time (BHT) means are compared and observed that a lot of 8.46 suggests
that the lung capacity is enriched. This is conformed by the second significant test Peak
Expiratory Flow rate (PEFR). In the PEFR readings it is clear once again that the
difference is as wide as 148.1, almost more than 50% improvement. Oxygen is the most
essential to live and that is carried by the Red Blood Corpuscles and Haemoglobin. The
Hb% in the blood are studied as one of the parameter has 0.93 variance of mean shows
that the drug even has the effect over the increasing the haemoglobin and RBC. The next
best prognostic and also estimating objective parameter is the Erythrocyte Sedimentation
Rate; record the marked decrease, which is a significant of disease regression, is 0.9
difference to that of baseline data to the final data. As many as Pranavaha Srotas
symptoms are seen along with the Tamaka Swasa needs the Absolute Eosinophilic Count
as the parameter is studied here and observed that 177 mean AEC decrease.
C3) Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa vis-à-vis Asthma
The result in the study ascertains the best activity of the Ardhedashemaniya
Swasaharavati over the Tamaka Swasa vis-à-vis Asthma. For the convenience the results
are grouped as four categories, viz. Well-Responded (WR), Moderately Responded
(MR), Poorly Responded (PR) and Not-responded (NR). All these patients are studies
with the cumulative percentages obtained through subjective and objective Parameters is
as under.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
146
Table – 44 Cumulative effect in percentages obtained through subjective and objective Parameters for
Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis bronchial Asthma
OPD
Sw
asa
Kru
chra
te
Kas
a
Duh
khen
akap
hani
ssa
rana
m
Ghr
guru
katw
a
Ura
hpee
da
Sha
yane
sw
asa
pe
edita
PE
FR
BH
T
ES
R
AE
C
Tota
l
Per
cent
age
Res
ult
5154 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 5285 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 5395 2 3 2 2 3 3 2 2 1 2 22 73.33 MR 5402 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 5541 3 3 2 3 2 2 3 2 3 3 26 86.66 WR 5642 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 5648 3 3 3 2 3 3 3 2 3 3 28 93.33 WR
18 0 0 0 0 0 0 0 1 0 0 1 3.33 NR 45 2 2 2 2 2 2 2 2 3 3 22 73.33 MR 63 2 3 2 2 3 2 2 1 3 1 21 70 MR
201 3 3 2 2 3 3 3 2 3 3 27 90 WR 812 1 0 1 1 3 3 1 1 2 1 14 46.66 PR 527 3 3 3 3 3 3 3 3 3 2 29 96.66 WR 530 3 3 3 2 3 3 3 2 3 2 27 90 WR 562 0 1 0 0 3 0 0 1 0 1 6 20 NR 566 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 572 3 3 2 2 3 3 3 2 3 2 26 86.66 WR 605 2 1 2 2 3 3 2 2 3 2 22 73.33 MR 606 0 0 1 0 0 0 1 0 1 0 3 10 NR 611 3 3 3 3 3 3 3 3 3 3 30 100 WR 624 1 0 1 1 0 0 1 1 3 1 9 30 PR 626 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 676 1 2 1 1 3 3 2 2 2 2 19 63.66 MR 677 1 1 0 1 3 2 1 1 2 1 14 46.66 PR 681 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 748 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 749 3 3 3 3 3 3 3 3 3 3 30 100 WR 774 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 775 2 1 1 2 3 1 2 2 3 2 19 63.33 MR 955 1 1 0 1 2 1 1 1 0 1 9 30 PR 994 3 3 3 3 3 3 3 2 2 3 28 93.33 WR 995 3 3 3 3 3 3 3 2 3 3 29 96.66 WR
1001 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 1497 1 1 0 1 3 3 1 1 2 1 14 46.66 PR 1498 2 1 2 1 3 3 2 2 3 2 21 70 MR 2210 0 1 0 3 3 1 1 1 3 1 14 46.66 PR 2310 3 3 3 3 3 3 3 2 3 3 29 96.66 WR
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
147
2283 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2332 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 2333 2 2 2 2 2 3 2 2 3 2 22 73.33 MR 2334 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2381 1 2 2 1 2 1 2 2 3 2 18 60 MR 2380 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2398 1 1 1 0 3 0 1 2 1 1 11 36.66 PR 2399 2 2 2 2 2 3 2 2 2 2 21 70 MR 2433 2 3 2 3 1 3 2 2 2 2 22 73.33 MR 2481 0 0 0 0 0 0 0 0 0 1 1 3.33 NR 2493 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2494 0 1 0 0 0 0 0 1 0 1 3 10 NR 2541 3 3 3 3 3 3 3 2 3 3 29 96.66 WR
As par the discussions made and the results observed in the study of
Ardhedashemaniya Swasaharavati, the results are declared as under keeping the all
subjective and objective parameter developments in view. After through study of the
entire parameters and materials available for the assessment of results it was drawn a
conclusion of results as - 27 (54%) well responded, 11 (22%) moderately responded, 7
(14%) poorly responded and 5 (10%) patients not responded and the 12 patients
discontinued in the study, were not considered for the result declaration. The tabulated
result and pi-diagram graphical expression is as under.
Table-45 Result of Ardhedashemaniya Swasaharavati in Tamaka Swasa
Result Number of patients Percentage
Well Responded 27 54
Moderately Responded 11 22
Poorly Responded 7 14
Not Responded 5 10
Total 50 100
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
148
Graph – 31
Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa
D) Statistical analysis of the Subjective and Objective parameters
D1) Objective parameters
Table – 46
Statistical analysis of Objective parameters
Objective Parameters
Mean SD SE Z-Value p-Value Significance
PEFR 147.7 73.59 10.407 14.19 < 0.01 HS
BHT 8.84 4.037 0.57 15.48 < 0.01 HS
AEC 178.00 69.73 9.81 18.14 < 0.01 HS
ESR 1.9 2.032 0.287 6.608 < 0.01 HS
HS = Highly Significant
Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa
Not Responded10.00%
Moderately Responded
22.00%
Well Responded54.00%
Poorly Responded14.00%
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
149
D2) Subjective parameters Ardhedashemaniya Swasaharavati in Tamaka Swasa
Table – 47 Statistical analysis of Subjective parameters
Subjective parameters
Mean SD SE Z-Value p-Value
sign
ific
ance
Teevra vega Swasa (Dyspnonea)
1.58 0.731 0.103 15.33 < 0.01 HS
Kasa (cough)
1.4 0.832 0.117 11.88 < 0.01 HS
Duhkhena Kapha nissaranam (Expectoration)
1.18 0.774 0.109 10.77 < 0.01 HS
Ghurghuratwam (Wheezing)
1.44 0.704 0.099 14.45 < 0.01 HS
Peenasa (Coryza)
0.68 0.74 0.104 6.49 < 0.01 HS
Kruchrena bhasate (Dysphonoea)
0.38 0.567 0.08 4.73 < 0.01 HS
Kantodhwamsham (Hoarseness of voice)
0.16 0.42 0.05 2.68 < 0.01 HS
Greevashirasangraha (Headache & Stiffness)
0.22 0.418 0.059 3.71 < 0.01 HS
Urah Peeda (Chest Pain)
0.68 0.767 0.108 6.263 < 0.01 HS
Shayane Swasa peedita (Discomfort at supine)
0.58 0.537 0.076 7.623 < 0.01 HS
HS = Highly Significant
Individually all the parameters shows highly significance, as p value is <0.01. But
in the subjective parameters Swasakruchrata, Ghrgurukatwa, Kasa and Duhkhena
kaphanissaranam shows highly significance than the Urahpeeda, Shanasya Swasa peedita
(comparing Z values).
In the objective parameters AEC, BHT and PEFR show high significance that the
ESR (by comparing Z value). The parameter PEFR shows more variation. The mean net
effect of AEC is more before and after treatment. The subjective parameter
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
150
Swasakruchrata and Ghrgurukatwa, mean net effect is more. The parameter Kasa shows
more variation and the Shayanasya Swasa peedita show less variation (by comparing
mean and SD).
Here we assume that if sample size is more than or equal to 30 the sampling
distribution will follow normal distribution with specified mean and SD for respective
parameters.
As sample size is more that 30 we use the technique of paired t-test to find out the
effect of the drug before and after the treatment. Here instead of the t-table value we used
the Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is a large sample test to find
the p-value.
D3) Objective parameters Baseline comparison Ardhedashemaniya Swasaharavati in TS
Table -48
Objective parameters Baseline comparison in Ardhedashemaniya Swasaharavati in TS
Parameters Mean SD SE Z-Value p-Value Significance
BT 141.7 35.36 5.00 PEFR
µ o = 350 AT 289.8 103.53 14.64 4.11 <0.01 HS
BT 9.04 2.38 0.36 BHT
µ o = 40 AT 17.5 6.17 0.872 25.8 <0.01 HS
BT 524 43.141 6.101 AEC
µ o = 250 AT 347 100.2 14.17 6.84 <0.01 HS
BT 10.08 2.088 0.295 ESR
µ o = 10 AT 9.18 2.057 0.29 2.82 <0.01 HS
HS = Highly Significant
Further the analysis is done by using large sample test with specified mean value.
The parameter PEFR show high significance as p value is < 0.01 after the treatment. The
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results
151
population mean is 350 litres/ minute. The mean effect after the treatment is improved
with more variance.
The parameter BHT show high significance as p value is < 0.01 after the
treatment where the population mean is 40 seconds. The mean effect BHT after the
treatment is more than the before with more variance.
The parameter AEC show high significance as p value < 0.01 after the treatment
for population mean 250 cells / cubic millimetre. The mean value after the treatment is
reduced than the before treatment with more variance which is towards normal.
The parameter ESR show high significance as p value is < 0.01 after the treatment
where the population mean is 10 millimetre /hour. There is reduction in mean value of
ESR after the treatment with less variance than the before treatment (by comparing mean
and SD).
Chapter- 6 Discussion
Tamaka Swasa is a chronic disease of Pranavaha Srotas and it is characterized by
Swasa kricchrata or tevra vega Swasa, ghurghurakatwa, kasa, shayanasya Swasa peedita,
uraha peeda, peenasa, etc with patient feels as if entering dark ness during the paroxysm
which is due to where un holy association of Vata with Kapha obstructing the passage of
Pranavata leads to a excitement of Vata to produce up ward movement or abnormal
expiratory dyspnoea. Which vary in severity and frequency from person to person is in an
individual they may occur from hour to hour and day to day. The entity of disease is well
known to Ayurvedic word since the time immemorial. The well established detail
description of aetio-pathogenesis and treatment is found in our Ayurvedic literature.
The contemporary medical science also has a vast description of bronchial asthma
parallel to Tamaka Swasa earlier concept about bronchial asthma that is broncho spastic
disease have changed in recent years where as it is proved that it is an inflammatory
disease.
The national asthma education program panel states that asthma is a complex
syndrome of reversible airway obstruction, airway inflammation and bronchial hyper
irritability that occurs following exposure to stimuli such as allergens viral respiratory
infections, vigorous exercise, cold air, cigarette smoke, and air pollutants.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
152
The acceptable definition of bronchial asthma is still remains elusive. And the
means of interaction are not understood by modern community. According to global
initiative for asthma the working definitions of asthma is a chronic inflammatory disorder
of the airways. In susceptible individuals this inflammation causes recurrent episodes of
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
153
wheezing, breathlessness, chest tightness, and cough particularly at night or in the early
morning. These symptoms are usually associated with widespread but variable airflow
limitation that is at least partly reversible either spontaneously or with treatment. The
inflammation also causes as associated with increased in airway responsiveness to a
verity of stimuli.
The recent survey of the WHO reveals that 155 million people world wide and
asthma has increased significantly i.e., 50% every decade. India has an estimated 15-20
million asthmatics. The concept of Tamaka Swasa and concept of bronchial asthma
seems to quite similar to the description given by contemporary medical world. The
aetio-pathogenesis, aetiological factors symptoms, prognosis has been explained vividly
and these are all equivalent to the description of asthma giving by contemporary medical
science.
Ayurvedic authors has been clarified and its prognosis and its chronisity. Till to
day which is been truth and eternal modern world also has a same opinion regarding this,
they stated that asthma cannot be cured but could control.
Keeping the above fact in view it was decided to go through detailed available
Ayurvedic literature. The Ardhedashemaniya Swasaharavati is a combination of 5 drugs
out of 10 herbs told by Charaka swasahara gana from shad-vireechana shatasriteeya
chapter.
Discussion improves the knowledge and discussion with science becomes base
establishment of the concept. Thus discussion is the most essential phase of any research
work. Keeping this in view, the facts which have emerged from the study can be studied
in five ways. They are -
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
154
1. Discussion on demographic data
2. Discussion on disease Tamaka Swasa
3. Discussion on probable mode of action of Ardhedashemaniya
Swasaharavati over subjective and objective parameters
4. Assessment of Ardhedashemaniya Swasaharavati over subjective
and objective parameters
5. Limitations of the study
6. Recommendations
1) Discussion on demographic data
The efficacy of any drug can not be proved unless it is subjected to clinical trials
and analyzed statistically. The trial drug Ardhedashemaniya Swasaharavati is considered
for the evaluation in Tamaka Swasa (bronchial asthma). The clinical study was conducted
on 50 patients in a single group. In the foregone pages observations were made
systematically presented. These discussions will be done over respective data and
observations.
a) Relevancy of Age and Gender
Age is a factor of asserting the Dosha impact in the human. In this study the drug
over different age groups of the patients were enumerated, ages taken from 15 years to
65years and 10 years interval period was given in each group for study purpose.
Maximum numbers of patients were observed in 45-55 years of age. The effect of
Ardhedashemaniya Swasaharavati, over these patients i.e., 45-55 years out of 20 patients
4 patients responded very well. But this is very less comparatively 15-25 age group out of
11(22%) patients 9 (18%) responded well. It clearly shows that age factor also plays
important role. 100% effect was observed in 25-35 age groups. It is observed that among
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
155
20 patients (40%) from 45-55 age groups male and female patients are equally
distributed. In this disease out of 50 patients 31 patients’ male, 19 patients were female.
Out of 31male patients 18 patients responded well, where as in female out of 19, 9
patients responded well.
b) Relevancy of Religion
Out of the 50 patients, 46 patients were Hindus and the rest 4 were Muslims. This
is due to the increased dominance of Hindus in this area, where the trail is undertaken.
Out of 46 patients 26 patients responded well. 9 patients were moderately responded. 7
patients were poorly and 4 patients not responded. Among 4 Muslim patients 2 patients
responded well and moderately 2 patients responded.
c) Relevancy of Occupation
It was observed that out of 50 patients 4 patients (8%) were leading sedentary life
style. 36 patients (72%) were active and rest 10 patients (20%) are labour. As the activity
of a person is having a say on Tamaka Swasa and the labour people are more susceptible
for asthma the observations made were supportive. The results of these major group
active patients are for discussion, at this maximum out of 36 patients (72%) 19 patients
well responded to the treatment. By which prove the efficacy of Ardhedashemaniya with
its properties against the disease.
d) Relevancy of Socio-economical status
In any research, a socio economic condition plays an important role. Some times
it could be one of the reasons. Here Tamaka Swasa is a condition corresponded to the
high frequency of affect and prevalence, is based upon the food habits and living style
referred to the socio economic conditions. Drugs may not be sufficient to fulfill the needs
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
156
of diseased and need better food and life style also for the benefit of patients. Out of 50
patients, 24 patients (48%) were belongs to the middle class. 17 patients (34%) were
higher middle and 9 patients (18%) poor class. It is very obvious that 12 patients
responded well from the higher middle class and 10 patients from middle at the same
time. 2 patients from higher middle and 3 patients from middle not responded to the
treatment. It was noted that 9 patients were belongs to poor class among 9 patients, 5
patients were responded well though they are poor but patient noticed that they followed
good regimen i.e. Pathya. This study shows that even though socio economical status has
mild impact over the disease but more importance should be given to be dietary
restrictions and Pathya and Apathya.
e) Food habits
Out of 50 patients 29 patients (58%) were vegetarians 21 (42%) were consuming
mixed diet. The percentage of the distributaries does not show any diet differentiation to
get this disease, because verity of vegetables are allergens and some foods like fish, milk,
eggs, yeasts, wheat, etc., are also responsible for the disease, this may be the reason,
dietary regimens were less impact over the disease, the effect of drug responded well.
The observations made in this study support the above view.
2) Discussion on disease Tamaka Swasa
The discussion on Tamaka Swasa vis-à-vis Asthma can be divided under 4 headings.
i. Etiological considerations (Nidana)
ii. Patho-physiological concepts (Samprapti)
iii. Symptomatic evaluations (Lakshana)
iv. Treatment concepts (Chikitsa)
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
157
i) Etiological considerations
Tamaka Swasa is a type of Swasa according to Charaka explained the etiological
factors in general. But Chakrapani commenting the Nidana of Swasa he has grouped like
Vata prakopaka, Kapha prakopaka gana as Nidana of Tamaka Swasa. In Vata Kapha
prokopaka gana, sheeta vayu, sheeta sthana, sheeta jala sevana, all are having similar
character and causes gunatwa vriddhi of Vata Kapha Dosha. Vata Rooksha gana vriddhi
cause hardening of bronchial walls due to rooksha quality of diet and regimen. The
excessive intake of above said factors like dadhi, masha, amakshera, etc., leads to Kapha
vruddhi. The jalaja mamsa, etc., are also factors by which guru guna and picchila guna
increased. Adhysana, vishamashana, causes agnimandya as a result Ama production takes
place. Ama and Kapha having similar character mix together causing blocking the
bronchial airways. (srotosanga) dhatukshaya also leads to Vata prokopa in terms of
excessive exercise and bharavahana.
The out door and in door (vihar Nidana) allergens exposure have increased
asthma morbidity. Allergy can incriminated as asatmya in Ayurveda. Asatmya has been
defined as which is not accepted by the body allergy can defined as an aquired
hypersensitivity to a substance. Raja doohma are well known allergens which are capable
of producing bronchospasm. Rajah can be compared dhooli, which is considered as dust
animal dander, pollen etc., dust and smoke causes bronchospasm by releasing the
mediators like histamine from mast cells. Certain foods cause allergies manifestations in
certain individuals. Finally by summarizing all the etiological factors we can assume that
some factors produce Dosha vruddhi some factors causes’ dushya dusti and reaming
causes the srotovaigunya.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
158
ii) Discussion on patho-physiological concepts
Tamaka Swasa Samprapti can be discussed according to Nidana. By the above
mentioned Nidana, vitiated Vata enters to Pranavaha Srotas cause rookshyata, and
katinyata of the srotomarga resulting the srotosanga. The Vata exaggerated in Pranavaha
Srotas only due to srotosanga due to localized increase of Kapha. Because of obstruction
in Pranavaha Srotas Vata changes its direction (vimarga gamana) results in sankocha.
On the contrary modern science explained the above fact as follows.
1) Narrow airway caliber to limit the flow in airway by smooth muscle contractions
2) Gland and epithelial secretions and exudation in to the airway lumen and
3) Inflammatory oedema
The involvement of Srotas in this disease is mainly the Pranavaha Srotas. But in
the poorva roopa the involvement of Annavaha Srotas and in severity of the disease the
Udakavaha also involved. Ayurveda explained the symptoms related to Annavaha Srotas
like anaha, admana, parshawashoola, hritpeeda bhakta dwesha arati and vibhanda.
It has been found that maximum patients suffer from agnimandya, giving raise to
Ama utpatti leading to faulty production of prasadarasa, and more production of mala
rupa Kapha leading to vitiation of Rasa vaha Srotas. The moola of Pranavaha Srotas is
mahasrotas and hridaya. Ama Rasa produced in Amashaya produces dusti of Pranavaha
Srotas and Annavaha Srotas so symptoms of Annavaha are occurred. Modern science
explained the premonitory symptoms of respiratory system. (Pranavaha Srotas) like
pharyngitis, sore throat, pain in the throat itching sneezing running nose, viral infection of
upper airway, nasal irritation etc., which is due to allergic manifestation and infection.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
159
iii) Symptomatic evaluations
The clinical presentation of Tamaka Swasa, are heterogeneous. The spectrum of
signs and symptoms varies in degree of severity from patient to patient from child to old
age. Patients may be free from symptoms in between the attack. The vegakaleena
symptoms Swasa kricchruta or teevra vega Swasa, ghurguraktwa kasa, dukhena Kapha
nissarana, uraha peeda.
The pratiloma Vata gets obstructed by Kapha in Pranavaha Srotas. It causes the
ghurghura shabda. But contemporary science wheeze is not considered as confirmatory
sign in asthma. Because wheeze can be heard from many others conditions including
chronic bronchitis, pulmonary oedema, bronchial stenosis, foreign body aspiration upper
airway obstruction and pulmonary embolism, which is generated by vibration in the wall
of an airway on the point of closer due to smooth muscle contraction.
The next symptom is occurred due to obstruction caused by Kapha in the passage
of Vata and an attempt is made for its expulsion and this is presented as kasa, where in
relief is felt by expulsion of shelshma i.e., shelsma vimokshante sukham. Some patients
experience dry cough in the manifestation of asthma. Cough is reflux action which is
produced by the irritation of bronchial mucosa muhurswasa and alpalpa Swasa can occur
due to increase the rate of respiration to compensate the oxygen requirement because
oxygen saturation is reduced in bronchial asthma.
Parshwa shoola is due to over inflation of the lung due to shlesma vruddhi and
patient feels a sort of discomfort or ache, or pain in the bilateral sides of the chest. All the
patients of Tamaka Swasa are at risk of developing teevra Tamaka Swasa the symptoms
like pratamyati (feels distress) pramoha (faint) kampa (tremors) these can occur in the
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
160
acute stage indicating sudden asphyxic asthma, which is due to bronchospasm and
impaired oxygen supply to the brain and accumulation of carbolic acid in the blood
producing respiratory acidosis.
The sadhyasadyata is depending upon age and immuno-status. Ayurveda
emphasized asthma originating in childhood is sadhya, who is having strength (uttama
bala) and alpakaleena naveena Vyadhi according to Charaka. Susruta stated that durbala
patients for bad prognosis. Vagbhata states that uttam rogibala is for good prognosis.
The course of Tamaka Swasa is not uniform with periods of exacerbation and
remission which varies from days to weeks to months to years. Therefore the
management requires to continuous care approach to the symptoms.
iv) Treatment concepts
The management of Tamaka Swasa depends on the Dosha predominance and
physical stage of the patient. Therefore the treatment modalities classified according to
patient like kaphadhika, vatadhika, balawana, and durbala. Vata and Kapha involve in the
pathogenesis of Tamaka Swasa. So the treatment modalities depend upon state of
vitiation of Dosha in the disease process. The therapy which alleviates both the Dosha
should be adopted. When both Dosha are aggravated in equal ratio but reverse modalities
is followed when Dosha are involved in different ratio. The drugs which are Vata
kaphagna vatanulomaka, properties should be used as shamanoushadhi depending upon
body strength treatment varies as karshan Chikitsa indicated for balavana and brumhana
shamana treatment for durbala and vrudha patients.
Our science has given more importance to the shodana therapy also. It is stated
that vamana should be done in Kapha predominant disease. Where as vireechana also
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
161
indicated. For durbala and vatadhika patients’ shamana tarpana, mamsasevana, are
mentioned.
Susruta stated that Nidana parivarjan is must in management of the disease. Step
wise approach is management of Tamaka Swasa can be designed depending upon the
severity of the disease condition quick relief medications quoted in acute symptoms by
means of Nasya and dhomapana sadvrutta is power full to for helping the patients to gain
motivation and skill to control asthma
3) Probable mode of action of Ardhedashemaniya Swasaharavati
Ardhedashemaniya Swasaharavati is combinations of five drugs with properties
are Vata kaphagna, laghu, ruksha, tikshna, ushna virya and vatanulomaka. Herbs are
selected according to Charaka explanation.
As disease is mainly Kapha vatatmaka in nature and agnimandya as its roots. The
drugs are acting over these Dosha by their properties. The gunas of the drugs are laghu,
teekshana, rooksha, which are antagonistic to the gunas of Kapha Dosha there by drugs
are normalizing or super imposing the Kapha Dosha. The veerya of these drugs in ushna
except Bhumyamalaki, which is having Kapha pittahara property as the disease is
pittasthana samudbhava.
The veerya of these drugs is Ushna, where as that of Vata is Sheeta. These drugs
are normalizing the prakopita Vata Dosha by veerya, and vitiated Pranavaha Srotas,
which is corrected by all these drugs. As they are under the Swasa hara heading and
kasahara hikkahara gana, Srotodusti other wise sanga, is relieved by Ushna properties of
drugs and swasahara property. Adhistana is Amashaya is seat of Kapha (urdwa) and Pitta
(adho) as the drugs are katu, Tikta kashaya Rasa pradhana for Kapha, and kashaya Tikta
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
162
madhura rasapradhana, where by acting over the Pitta and madhura, and amla Rasa
pradhana where by acting over Vata Dosha and restoring the normal functioning of
Amashaya by these properties Samprapti vighatana is taking place.
Also many clinical and experimental studies were being conducted on these drugs
either single or in combination and showed their efficacy in Tamaka Swasa vis-à-vis
bronchial asthma treatment. Combined effect of all drugs with same properties may have
acted on the disease Tamaka Swasa and support Charaka explains the combination herbs
provides more sustained therapeutic effect than using individually. The pharmacological
properties pertained to that of the present research is enlisted here.
Shati Swasa hara - (CSu 4/37), Hikka hara - (CSu 4/30), Shotha hara,
Vedanastapana, Jwarahara, Kasa hara - (Kayadeva Nighantu –
1393),
Pushkaramoola Swasa hara, Kasa hara, Hikka hara, Parshwa shoolahara - (CSu
20/40 & AS Su 30/2)Shophaghna , Panduhara – (Dhanvamtari
Nighantu -154)
Amlavetasa Bhedaneeya, Deepaneeya, Anulomaneeya, Vata shleshma hara –
(AS Su 13/2, CSu 25/40, 27/ Phalavarga)
Tulasi Hikka, Kasa Swasa hara, Parshwashoolahara, Kaphavataghna (CSu
27/169, SSu 46/all)
Bhumyamalaki Kasahara (CSu 4/36), Kapha Pitta hara, Pandughna, Swasa hara,
Trushna Daha nasha (Kayadeva NIghantu – 250)
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
163
According to modern science, bronchial asthma is a chronic inflammatory
disorder in which many cells play a role like mast, Eosinophils, and T-lympocytes. The
inflammation also causes an associated increase in airway hyper-responsiveness to
stimuli. The pharmacological therapy is needed to treat reversible air flow obstruction
and airway hyper responsiveness. Medications include bronchodilators and anti-
inflammatory agents and antihistamine inflammation is the now target of therapy.
A recent research carried out on these drugs the pharmacological action of all the
drugs is as follows.
1. Shati – it is proved as a anti inflammatory analgesic, expectorant, extract has
notably anti histamine activity and laxative vasodilator
2. Pushkaramoola – Anti-inflammatory, expectorant, analgesic, antipyretic,
antispasmodic activity. (Effect against bronchial spasm induced by histamine, 5
hydroxy tryptamind and various plant pollens). So it is also having anti histamine
activity anti bacterial, and anti fungal activity bronchodialator.
3. Amlavetasa – it is stomachic, bitter tonic, purgative and antipyretic,
4. Tulasi – Demulcent, expectorant, antipyretic antiviral (leaf extract)
antispasmodic carminative, antibacterial and nervine tonic (nerve tissue
strengthening) it frees oxygen from sun rays and oxygenates the body, which
builds the immune system.
5. Bhumyamalaki – Anti viral (phyllunthes primarly contains eg. – phyllanthine
and hypophyllanthine) alkoloids and bio flavonoids while it remains un known as
to which of these ingredients has anti viral effect appetizer, digestive, laxative,
carminative.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
164
By above said pharmacological action may be these drugs acting in bronchial
asthma. Mechanism of action of this Ardhedashemaniya Swasaharavati is not clear but
the drugs are known of their bronchodilator, anti inflammatory, antihistamine activity
expectorant. Antiviral, antibacterial analgesic etc., as explained above, here proposing the
following mechanism of action may be hypothetical presume they are -
1. Mechanism of Bronchodilators
a) By relaxing bronchial smooth muscle
b) By reducing the bronchial hyperactivity
c) Also by improving the respiratory functions by increasing the
strength and reducing the fatigue of the respiratory muscle
2) Anti inflammatory mechanism
As the inflammation is the target of therapy, the pharmacological action i.e., anti-
inflammatory action can be interpreted for these drugs.
An acute anti inflammatory action medicated via inhibition of micro vascular leakage
Prevention of the direct migration and activation of inflammatory cells
Human airway smooth muscle cells express before receptor from the trachea to the
terminal bronchioles. This drugs as function antagonists can prevent and reverse the
effects of all bronco constriction, with substance like histamine and endothelies.
3) Anti histamine
Hyper-responsiveness of airways by histamine can be interpreted as Vata
prokopa. The drugs probably acting as Vatahara other wise anti histamine property by
reducing the hyper responsiveness of airways is substantiated.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
165
These agents block the acute bronco constricting effect produced by inhaled
histamine. They have also bronchodilator action
4) Immuno-modulatary mechanism
As the recurrence of the disease is because of lessened immunity, the
pharmacological action i.e., immunomodulatory can be interpreted by the combination of
these drugs. i.e., synergetic action which is as follows.
1. Eliminates the toxic metabolites and pollutants.
2. Preventing recurrent infection expelling the damaged cells
3. Nourishes and maintains the cell life.
4. Encouraging growth of new cells.
Above all explanation with comparative to contemporary medical science we tried
to propose the probable mode of action of these drugs.
4. Assessment of Ardhedashemaniya Swasaharavati over subjective and objective
parameters
a) Mode of action of Ardhedashemaniya Swasaharavati over subjective parameters
1. Teevra vega Swasa (Dyspnoea) Swasakrichrata: In this study 100% patients i.e.,
out of 50,50patients reported this complaint after the treatment 21 patients were
not relieved completely. But severity and frequency attack were reduced. Rests of
29 (58%) patients are relieved by their symptoms within the follow up schedule. It
was observed that maximum patients were belongs to mild and moderate degree
of Swasa kricchrata.
Above mentioned data clearly shows that there is an effect of
Ardhedashemaniya Swasaharavati over this subjective parameter. This is due to
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
166
the trial drug is having such qualities like bronchodilator, anti-inflammatory, anti
histamine, demulcent – immuno-modulator effect, as the Swasa kricchrata is
result of the broncho-constriction (srotosanga), hyper-responsiveness of the
airway due to inflammation and other patho-physiological causes. Like increased
secretion of bronchial mucus airway smooth muscle contraction, gland and
epithelial secretions and exudation in the air way lumens etc.,
2. Kasa (cough): In this study out of 50 patients 47 patients (74%) were given the
history of cough. Out of 47 patients 29 patients (61.7%) were relieved by their
symptom. Remaining 18 (36%) were not relieved but maximum patients migrates
severe to mild degree of cough.
Kasa is due to irritation in the Pranavaha Srotas and another cause it is an
effort to expel the Kapha. (malaroopa) secreted in the Pranavaha Srotas. The trial
drug is having antagonistic quality like expectorant immuno-modulator,
demulcent by these action subsides the kasa. The effect of drug
Ardhedashemaniya swasahara vati is proved on this subjective parameter.
3. Duhkhena Kapha nissaranam (Expectoration): In this study out of 50 patients 43
patients were got difficult expectoration. This is due to the over inflated lung with
both large and small airways being filled with plugs comprising mixer of mucus.
The drug disintegrates this pathology by its demulcent bronchodilator and
expectorant actions. The mucus plugs smoothened by its demulcent property.
Then arrowed airway try to dilate by its bronchodilator action expels out by its
expectorant property. By this mechanism plugging of airways cleared of and
make easy for respiration.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
167
Out of 43 patients 23 (46%) patients improved a lot 20 patients (40%)
improved severe to moderate to mild degree of expectoration. This study shows
the there is a drug effect over this subjective parameter.
4. Ghurghuratwam (Wheezing): The study shows that 50% of patients responded
well out of 50 patients 25 patients (50%) improved severe to moderate to mild.
This ghurgurakatwa occurs due to avarodha in Pranavaha Srotas due to Kapha. A
wheeze is generated by vibration in the wall of an airway on the point of closer
due to smooth muscle contraction. The drug which clears the srotorodha by the
virtue of its actions. Anti inflammatory bronchodilator expectorant thee by it may
improves the mucociliary clearance. This study shows that there is a effect of
Ardhedashemaniya Swasaharavati over this parameter.
5. Peenasa (Coryza): In this study out of 50 patients (100%) 33 (66%) patients were
suffering from this symptom considered one of the symptoms of Tamaka Swasa
and it is also preceding factor of this disease. Which induces the allergen induced
inflammation and it is also caused by viral infections and specific allergens. Out
of 33 patients (66%) 18 patients (54.54%) improved a lot. remaining 15 patients
were improved moderate to minima. The drug which may inhibit stimulation of
IgE machinism there by prevents the hyper secretion and hyper responsiveness of
the airways, by its immunomodulatory, anti histamine antiviral activity. The study
shows that the effect of trial rug proved on this parameter
6. Kruchrena bhasate (Dysphonoea): In this study out of 50 (100%) patients 22
(44%) patients were reported these symptoms. This is due to the dyspnoea, and
also due to tenacious mucous may be coated in the throat including vocal cords.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
168
This is relived by the drug which is smoothened the mucus and expels out by its
properties. There by it clears the passage of the airways and subsides the
symptom. Out of 22 patients (44%),10 patients (20%) were got minimal
improvement where as 12 (24%) patients were got well response out of 22
patients at the end 54.54% got relived . this study shows that there is a effect of
trial drug over this parameter.
7. Kantodhwamsham (Hoarseness of voice): Out of 50 patients only 12(24%)
patients were reported out of 12 patients 5 (10%) patients minimal improved and
7 patients responded well at the end 58.33% were relived from the symptom. This
is the effect of obstruction on the Pranavaha Srotas is the kantadwamsam. The
shlesma accumulated in the kanta region obstructing the Pranavata causes the
bubbling and resultant sound in kanta Pradesh. The result which is achieved by
the action of the trail drug which is having Kapha hara sroto mardavakar,
expectorant, etc. qualities.
8. Greevashirasangraha (Headache & Stiffness): Out of 50 only 16 patients were
reported this symptom. Out of 16 (32%) patients 7 (43.75%) patients result at the
end of treatment. These may due to over inflammation of the lungs and patient
feels some sort of discomfort t or ache or pain. Which is relieved by the drug
action i.e., antiinflammatory analgesic quality of drug taken care of this.
9. Urah Peeda (Chest Pain): In this study out of 50 patients 39 patients were reported
uraha peeda. This is because of over inflation of lungs and patient feels some sort
of discomfort or ache or pain in the bilateral sides of the chest. The drug
Ardhedashemaniya Swasaharavati acted very effectively on this parameter. The
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
169
analgesic and antiinflammatory actions relieves the pain or ache, the
bronchodilator and expectorant qualities clears the airway passage.
The data shows that out of 39 patients 23 patients i.e., 58.97% were
relieved from the chest pain. 16 patients were got minimal improvement. This
study shows that there is an effect of trial drug over this parameter
10. Shayane Swasa peedita (Discomfort at supine): In this study out of 50 patients 37
(74%) patients were reported for this symptom. This is due to lying down position
the diaphragm is raised and reducing the lung volume. It may occur at any time or
during the attack or night time. If it is night time because of the lowest serum
adrenaline and cortisol and highest level of histamine during night hours could be
the responsible for nocturnal episodes of asthma.
The trial drug improves lung volume by its bronchodilator and anti
inflammatory and expectorant effect. The trial drug also having anti histamine
activity there by it compensate the level of histamine may be the these action at
the end of the study out of 37 patients 23 patients were relieved i.e. 59.45% and
remaining 14 patients responded moderate to mild.
b) Mode of action of Ardhedashemaniya Swasaharavati over objective parameters
i. Breath Holding Time: Breathing can be held for variable period of time by
different individuals upon the functional status of lungs, development of
respiratory muscles. This BHT is a simple test which provides useful in
formation in health and disease of the lung.
In this study breath holding time were assessed before and after the
treatment. All 50 patients breath holding time recorded, this is highly
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
170
variable person to person for that purpose we made eight group of
intervals each interval shows 5 seconds difference. It was observed that
maximum patients i.e. 35 (70%) were belongs to 5-10 group of interval
and 5 patients were belongs to 0-5 interval and 10 (20%) belongs to 10-15
intervals.
This is because of there is a broncho constriction, and bronchioles
already partially occluded and there is a increased functional residual
capacity and residual volume of the lung. This is reason why patients can
not hold the breath long time.
After the completion of treatment schedule again BHT has been
documented maximum patients were shows less than 20 or 20 seconds i.e.
16 (32%) patients. 13 (23%) were belongs to 20-25 seconds group of
interval and only 2 (4%) patients in 25-30 seconds group of intervals. All
these considered as markedly improvement comparatively before
treatment. 10(20%) patients and 7(14%) patients were belongs to 10-15
group and 5-10 group intervals respectively. These 7(14%) patients and 2
(4%) were remains 5-10, 0-5 group of intervals respectively.
This study shows that there is effect of the trail drug over this
parameter.
ii. Peak expiratory flow rate: The Wright peak flow meter which measures
PEFR is of special value in cases of asthma where the effectiveness of the
treatment with bronchodilator can be evaluated.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
171
In this study the lung function assessment was recorded with help
of this measurement. The readings were taken before and after the
treatment for the analytical study purpose we made eight groups of
intervals each interval difference is 50 lit/minute. (The normal PEFR 350
lit/minute.
It was observed that maximum patients i.e., 24 (48%) were belongs
to 100-150 group of intervals. 16 (32%) were observed in 150-200 group
of intervals 9 (18%) patients were belongs to 50-100 group of intervals.
Only one patient was belongs to the 200-250 groups of intervals.
These clinical measurements shows greatly reduced maximum
expiratory rate and timed expiratory volume. This is because of the
functional residual capacity and residual volume of the lung becomes
greatly increased during the asthmatic attack there by the difficulty in
expiring air from the lung. The bronchial diameter becomes more reduced
than during expiration than during inspiration. This is because the
increased intrapulmonary pressure during expiratory effort compresses the
out sides of the bronchioles. Because the bronchioles are already partially
occluded further occlusion resulting from the external pressure creates
especially severe obstruction during expiration. So the Tamaka Swasa
patient usually can inspire quite adequately but great difficult expiration.
After the treatment it is observed that maximum patients i.e., 17 (34%)
patients were belongs to 350-400 group of intervals 9 (18%) patients and
one patient belongs to 300-350 and > 400 group of intervals all these
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
172
shows markedly improvement. 7 (14%) patients and 4 (8%) patients were
belongs to 250-300 and 200-250 group of intervals respectively and shows
moderately responded. 3(6%) and 4(8%) patients were belongs to 100-150
and 150-200 group of intervals respectively and shows poorly responded.
5 (10%) patients not responded to the treatment.
This study shows the lung function improvement. The drug
Ardhedashemaniya Swasaharavati it improves the lung function.
Ardhedashemaniya Swasaharavati acts as anti inflammatory, analgesic
bronchodilator, expectorant. Anti histamine anti viral, antibacterial,
demulcent, etc., there by it clears the broncho construction reduces the
inflammation and airway hyper responsiveness.
Thus it improves the bronchiolar diameter decreases the
intrapulmonary pressure reduces the functional residual capacity and
residual volume of the lung and improves the expiratory rate.
iii. Erythrocytes Sedimentation Rate: This test is being done before and after
treatment there are minimal changes in the values of ESR. This facilitates
to understand the possible presence of organic disease or to follow the
course of the disease. This is universally accepted that it gives prognostic
value. So the effect of Ardhedashemaniya Swasaharavati has very less
impact over the parameter.
iv. Absolute Eosinophilic Count: this test is being done to all the patients
before and after treatment. It was observed that maximum patients i.e.,
27(54%) patients were belongs to 450-500 cells/ cu mm group of intervals.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
173
15 patients (30%) observed 500-550 cells/ cu mm group of intervals. 3
(6%) and 2 (4%) patients from 550-600 and >600 group of intervals
respectively.
Eosinophils are phagocytes particularly effective in the elimination
of parasite. They also participate in hyper sensitivity reactions. Especially
in lungs Eosinophils play an important role, in the asthmatic inflammatory
reaction which is being characterized by cellular infiltration rich in
activated Eosinophils increase in number during allergic reactions as well.
After the treatment the maximum i.e., 19(38%) and 17 (34%)
patients were belongs to 300-350 and 200-250 group of intervals
respectively. 3 patients were belongs to 250 300 group of intervals and
shows that thee is a markedly reduced the number of Eosinophils. 3 (6%)
patients remain same 1 patient 500-550 and 1 (2%) from 350-400 cells/cu
mm group of intervals. In this group minimal reduction of Eosinophils
were seen. It is proved that the effect of Ardhedashemaniya Swasaharavati
on Eosinophils.
5) Statistical discussion of parameters
Individually all the parameters shows highly significance, as p value is <0.01. But
in the subjective parameters Swasakruchrata, Ghrgurukatwa, Kasa and Duhkhena
kaphanissaranam shows highly significance than the Urahpeeda, Shanasya Swasa peedita
(comparing Z values). In the objective parameters AEC, BHT and PEFR show high
significance that the ESR (by comparing Z value). The parameter PEFR shows more
variation.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion
174
Further the analysis is done by using large sample test with specified mean value.
The mean effect of PEFR, BHT after the treatment is improved with more variance. The
mean value of AEC after the treatment is reduced than the before treatment with more
variance which is towards normal. The parameter ESR show high significance as p value
is < 0.01 after the treatment where the reduction in mean value after the treatment is with
less variance than the before treatment.
As sample size is more that 30 we use the technique of paired t-test to find out the
effect of the drug before and after the treatment. Here instead of the t-table value we used
the Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is a large sample test to find
the p-value.
6) Limitations of the study –
1. The sample size was small to generalize the result
2. Drug is being a compound form it was difficult to draw its direct mode of action.
3. Samples are selected incidentally.
7) Future scope for the further study
Long standing administration can also suggested.
Pharmaco-dynamics of these drugs should be tried in different level and also
to study the effect of other inflammatory cells.
To study its effect with the help of Spirometry
Immunological study can be done by comparing IgG and IgE levels.
Long standing administration can also be suggested.
Muhur muhur Aushadhi sevana in Tamaka Swasa can be tried
Chapter – 7 Conclusion
A close perusal of the observation and interference for that can be drawn to the
following conclusion.
By studying literature Tamaka Swasa can be compared with bronchial
asthma.
The Ardhedashemaniya Swasaharavati is very effective in reducing the
subjective parameters of this study. And statistically highly significant i.e.,
p- value < 0.01
Ardhedashemaniya Swasaharavati increasing the lung function i.e. the
PEFR and BHT. Which are statistically highly significant i.e., p <0.01
There is no relationship between the therapeutic effect of
Ardhedashemaniya Swasaharavati gender and economical status.
The individual drugs of Ardhedashemaniya Swasaharavati are acting as a
bronchodilator anti inflammatory anti histamine and immuno modulator and
expectorant.
Ardhedashemaniya Swasaharavati is very economic safe and effective drug
hence it can be employed in all cases of Tamaka Swasa.
It can be used as preventive type of medication
This Ardhedashemaniya Swasaharavati is new therapeutic option for
optimizing the asthma control.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Conclusion
175
Chapter – 8 Summary
The W.H.O. recognizes Tamaka Swasa vis-à-vis Asthma as a disease of major
public health importance and plays a unique role. The international action is
needed to stimulate research into the causes of asthma to develop new control
strategies and treatment techniques and develop an optimal strategy for its
management and prevention which increases public awareness of this disease.
Tamaka Swasa is selected for research study to arrive at a specific, economic,
and more effective, without side effects in the management, also selected the
research to find out a new therapeutic option for optimizing asthma control.
Keeping in the mind to establish the effect of Shamana therapy i.e.,
Ardhedashemaniya Swasaharavati on Tamaka Swasa (Bronchial asthma) is
studied here.
Initially at the dissertation Historical review, Vyutpatti, Nurukti, Paribhasha,
Nidana, Lakshana, Sadhyasadhaya, Chikitsa, and Pathypathya of the Tamaka
Swasa as well as the contemporary medical descriptions are detailed as par
available information. About the components of the drug, latest researches on
these individual herbs are procured.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary
176
The research design was a pre-test and post test with an observational study of
50 cases incidentally selected for the study. Patients were diagnosed on the
basis of symptomatology explained by Bruhatrayee (subjective parameter) and
objective parameters fixed on contemporary scientific descriptions and
parameters.
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary
177
Out of the 67 patients of Tamaka Swasa 65 (97.01%) were undertaken for the
study. Out of 65 patients 15 (23.07%) patients were discontinued hence their
date has not been included in the assessment. The remaining 50 (76.93%)
patients of Tamaka Swasa vis-à-vis bronchial asthma fulfilling the criteria of
diagnosis and inclusive criteria were included in the study. PEFR and BHT
are considered as an objective for the inclusion in the present study.
In this study recorded observations were analyzed, it reveled that 62% were
males in 31 patients, 38% were female (19 patients and more number of
patients were belongs to 45-55 age group i.e., 20 (40%) patients. Hindu
religion patients were more (92%) recorded. More patients were belongs to
middle economical status, the dietary distribution does not show any
differentiation.
All the subjective parameters which are declared for the assessment of the
Ardhedashemaniya Swasaharavati are tabulated here in the table 42. Out of
the symptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patients
initially are relieved 58%. Another symptom found for all patients is
Ghurgurukatwam is relieved for the 50% of patients in the study. Kasa a
symptom appeared for 47 patients initially relived 61.7% in the study. Next
best appeared symptom is Duhkhena Kapha nissaranam for the 43 patients
noticed relieved for the 53.48% of patients. Shayane Swasa peedita is the next
symptom with 37 patients found corrected at the end by 59.45%. 39 patients
of Urahpeeda corrected at the end of study by 58.97%. Peenasa, a symptom of
the Pranavaha Srotas always found associated with the Tamaka Swasa found
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary
178
for 33 patients got through by the end with 54.54% of relief.
Greevashirasangraha (16 patients) and Kantodhwamsham (12 patients) are the
other two symptoms of assessment got relief with 43.75 and 58.33
percentages respectively. The tabulation is as expressed above.
At the Objective Parameters assessment in Tamaka Swasa in the study of
Ardhedashemaniya Swasaharavati five objective parameters are assessed are
enlisted in the table 43. All these are of disease oriented and specific to assess
the Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis
Bronchial Asthma. The table is followed as under. The objective parameters,
PEFR AEL, BHT, show high significance then the ESR, the PEFR shows
more variation. All are shows statistically high significance i.e., P value is
<0.01.
Out of the assessments of objective parameters it is clearly understood that the
Breath Holding Time (BHT) means are compared and observed that a lot of
8.46 suggests that the lung capacity is enriched. This is conformed by the
second significant test Peak Expiratory Flow rate (PEFR). In the PEFR
readings it is clear once again that the difference is as wide as 148.1, almost
more than 50% improvement. Oxygen is the most essential to live and that is
carried by the Red Blood Corpuscles and Haemoglobin. The Hb% in the
blood are studied as one of the parameter has 0.93 variance of mean shows
that the drug even has the effect over the increasing the haemoglobin and
RBC. The next best prognostic and also estimating objective parameter is the
Erythrocyte Sedimentation Rate; record the marked decrease, which is a
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary
179
significant of disease regression, is 0.9 difference to that of baseline data to
the final data. As many as Pranavaha Srotas symptoms are seen along with the
Tamaka Swasa needs the Absolute Eosinophilic Count as the parameter is
studied here and observed that 177 mean AEC decrease.
As sample size is more that 30 we use the technique of paired t-test to find out
the effect of the drug before and after the treatment. Here instead of the t-table
value we used the Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is a
large sample test to find the p-value.
The result in the study ascertains the best activity of the Ardhedashemaniya
Swasaharavati over the Tamaka Swasa vis-à-vis Asthma. For the convenience
the results are grouped as four categories, viz. Well-Responded (WR),
Moderately Responded (MR), Poorly Responded (PR) and Not-responded
(NR). All these patients are studies with the cumulative percentages obtained
through subjective and objective Parameters is as under.
As par the discussions made and the results observed in the study of
Ardhedashemaniya Swasaharavati, the results are declared as under keeping
the all subjective and objective parameter developments in view. After
through study of the entire parameters and materials available for the
assessment of results it was drawn a conclusion of results as - 27 (54%) well
responded, 11 (22%) moderately responded, 7 (14%) poorly responded and 5
(10%) patients not responded and the 12 patients discontinued in the study,
were not considered for the result declaration. The tabulated result and pi-
diagram graphical expression is as under.
Bibliographic Reference
1) Petersdorf R.G. ed, Harrison’s Principles of Internal Medicine, Vol-2, 14th ed, 1998, Inida, McGraw Hill, New York, pp 1419-26
2) Behrendt et al., 1995, (sections 5.13 and 5.14), www.niaid.nih,gov 3) Ring et al., 1995b; Behrendt et al., 1995; Vos et al., 1996, www.niaid.nih,gov 4) Von Mutius, 1992; Schlipköter et al., 1992; Behrendt et al., 1993, 1996; Ring
et al., 1995, www.niaid.nih,gov 5) Ring et al., 1995; Krämer et al., 1996; Schäfer et al., 1996, www.niaid.nih,gov 6) Martini, Fundamentals of anatomy and physiology, 4th ed, 1998, Prentice Hall
Inc, New Jersey, pp 815 7) Ganga Sahay Pande ed, Charka Samhita Sutra 25/40, 6th ed. 2000, Choukumbha
Samskrut Samstan, Varanasi, pp 318-20 K.R. Sriknta Murty ed, Astanga Sangraha Sutra, 13/2, 1st ed, 1996,
Choukumbha Samskrut Pratistan, Varanasi, pp 271 8) Ganga Sahay Pande ed, Charka Samhita Shareera 1/70 Chakrapani, 6th ed. 2000,
Choukumbha Samskrut Samstan, Varanasi, pp 705 9) Ibid, Vimana, 5/8, pp 592 10) Satya Narayan Shastri, Charka Samhita Chikitsa 28/5, 1st ed. 2001, Choukumbha
Bharati Academy, Varanasi, pp 775 11) Ambika Datta Shastri, Susruta Samhita Nidana 1/12, 13th edition, 2000,
Choukumbha Sanskrit Samsthana, Varnasi, p 12) K.R. Sriknta Murty ed, Astanga Hridaya Sutra, 12/4, 3rd ed, 1996, Krishnadas
Academy, Varanasi, pp 166 13) Ganga Sahay Pande ed, Charka Samhita Sutra 17/116, 6th ed. 2000, Choukumbha
Samskrut Samstan, Varanasi, pp 248 14) Satya Narayan Shastri, Charka Samhita Chikitsa 17/68, 1st ed. 2001, Choukumbha
Bharati Academy, Varanasi, pp 518 15) K.R. Sriknta Murty ed, Astanga Sangraha Nidana, 4/-, 1st ed, 1996, Choukumbha
Samskrut Pratistan, Varanasi, 16) Satya Narayan Shastri, Charka Samhita Chikitsa 17/17 Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 510 17) Ambika Datta Shastri, Susruta Samhita Nidana 1/13, 13th edition, 2000,
Choukumbha Sanskrit Samsthana, Varnasi, p 18) Satya Narayan Shastri, Charka Samhita Chikitsa 17/18 Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 510 19) Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association
of physicians of India, Mumbai, pp 291 20) http://www.globalburdenasthma.com 21) http://www.who.int/en 22) wwwNAEP 23) Satya Narayan Shastri, Charka Samhita Chikitsa 17/70-72 Chakrapani, 1st ed.
2001, Choukumbha Bharati Academy, Varanasi, pp 518
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
I
24) Ganga Sahay Pande ed, Charka Samhita Sutra 4/37, 6th ed. 2000, Choukumbha Samskrut Samstan, Varanasi, pp 67
25) R.G. Sastry, Vedom me Ayurveda (10-90-13), 1956, Madanmohanlala Ayurvedic Trust, , New Delhi
26) Ibid, Rigveda, 1-66-1 27) Ibid, Yajurveda 15-2 28) Ibid, 16-15 29) Ibid, Atharvaveda, 11-15, 19-6/7 30) Amaniskopanishad, 1-33 31) Chandopanishad, 1:2:10/11/12 32) Satya Narayan Shastri, Charka Samhita Chikitsa 17/1-149 Chakrapani, 1st ed.
2001, Choukumbha Bharati Academy, Varanasi, pp 508-31 33) Ambika Datta Shastri, Susruta Samhita Uttara 51/13, 13th edition, 2000,
Choukumbha Sanskrit Samsthana, Varnasi, p 372-82 34) P.V.Sharma, Bhela Samhita, 1st ed., 2005,Varanasi: Chaukhambha
Vishwabharati; 35) Ramavalamba shastri, Hareeta Samhita, 1st ed, 1985, Prachya Prakashan, Varanasi 36) Satyapala Bhishagacharya, Kashyapa Samhita, Khila stana, 10/138-40, 4th ed,
1988, Chaukhambha Sanskrit samstan, varanasi, 37) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/1-31, 3rd ed, 1996, Krishnadas
Academy, Varanasi, pp 37, K.R. Sriknta Murty ed, Astanga Hridaya Chikitsa, 4/1-59, 2nd ed, 1996,
Krishnadas Academy, Varanasi, pp 37, pp 245 K.R. Sriknta Murty ed, Astanga Sangraha Nidana, 4/1-35, 1st ed, 1996,
Choukumbha Samskrut Pratistan, Varanasi, pp 168-72 Ibid, Chikitsa, 4/1-74, pp 306-34
38) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 12/27-41, 15th ed, 1985, Choukumbha Samskrut samstan, Varanasi, pp 290-301
39) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Chikitsa, 17/1, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 533-39
40) Sadashiva Shastri Paradkar, Arunadatta, Sarvangasundari, Astanga Hridaya, Nidana, 4/1-30, 1st ed, 2002, Choukumbha Surabharati Prakashan, Varanasi, pp 472-76
41) Brahma Shankara Shastri, Yogaratnakara, Swasadhikara, 1-8 sl, 5th ed, 1993, Choukumbha Sanskrit samsthan, Varanasi, pp 427-37
42) Brahma Shankara Mishra, Bhavaprakasha, 14 ch, 5th ed, 1980, Choukumbha oriental, Varanasi, pp 150-66
43) V. S. Apte, The student Sanskrit to English dictionary, 1st ed, 1965, Shantilal Jain, New Delhi,
44) Raja Radhakanta Dev, Shabda Kalpa Druma, part-2, 2nd ed, 1967, Choukumbha Sanskrit seeris office, Varanasi,
45) V. S. Apte, The student Sanskrit to English dictionary, 1st ed, 1965, Shantilal Jain, New Delhi,
46) Stedman’s medical dictionary V 4, 22nd ed, 1974, Williams Wilkins co, Baltimore,
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
II
47) Ambika Datta Shastri, Susruta Samhita Uttara 51/8, 15th edition, 2002, Choukumbha Sanskrit Samsthana, Varnasi, p 374
48) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 26th ed, 1996, Choukumbha Samskrut samstan, Varanasi,
49) Yadavji Trikamji Acharya, Dulhana, Nibandha Sangraha, Susruta Samhita Uttara, 39/88, 8th ed, 2005, Choukumbha Orientalia, Varanasi, pp 678
50) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Chikitsa, 17/61, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 535
51) R.L. Souhami, J. Moxham ed, TB of Medicine, 1st ed, 1990, Churchill living stone, Edenburg, pp 485
52) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed, 1989, Blackwell scientific publications, New Delhi, pp 660
53) Martini, Fundamentals of anatomy and physiology, 4th ed, 1998, Prentice Hall Inc, New Jersey, pp 822-834
54) Ibid, pp 835-857 55) Ganga Sahay Pande ed, Charka Samhita Vimana 5/8, 6th ed. 2000, Choukumbha
Samskrut Samstan, Varanasi, pp 592 56) Sailaja srivatsava, Sharangadhara Samhita, Poorvakhanda, 5/8, 2nd ed, 1998,
Choukumbha Orientalia, Varanasi, pp 37 57) V. S. Apte, The student Sanskrit to English dictionary, 1st ed, 1965, Shantilal Jain,
New Delhi, 58) Satya Narayan Shastri, Charka Samhita Chikitsa 28/6, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 775 59) Ganga Sahay Pande ed, Charka Samhita Vimana 5/8, 6th ed. 2000, Choukumbha
Samskrut Samstan, Varanasi, pp 592 60) Ambika Datta Shastri, Susruta Samhita Shareera 9/12, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, p 71 61) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka
Samhita Vimana, 5/8, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 251
62) Sailaja srivatsava, Sharangadhara Samhita, Poorvakhanda, 5/51, 2nd ed, 1998, Choukumbha Orientalia, Varanasi, pp 45
63) Ganga Sahay Pande ed, Charka Samhita Nidana 8/24, 6th ed. 2000, Choukumbha Samskrut Samstan, Varanasi, pp 582
64) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi, pp 29
65) Satya Narayan Shastri, Charka Samhita Chikitsa 17/11-16, Chakrapani, 1st ed. 2001, Choukumbha Bharati Academy, Varanasi, pp 509-10
66) Ambika Datta Shastri, Susruta Samhita Uttara 50/3-5, 15th edition, 2002, Choukumbha Sanskrit Samsthana, Varnasi, p 365
67) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/1, 2nd ed, 1996, Krishnadas Academy, Varanasi, pp 37
68) K.R. Sriknta Murty ed, Astanga Sangraha Nidana, 4/2-8, 1st ed, 1996, Choukumbha Samskrut Pratistan, Varanasi, pp 168-69
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
III
69) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 12/15, 15th ed, 1985, Choukumbha Samskrut samstan, Varanasi, pp 289
70) Satya Narayan Shastri, Charka Samhita Chikitsa 17/62, Chakrapani, 1st ed. 2001, Choukumbha Bharati Academy, Varanasi, pp 513
71) Sadashiva Shastri Paradkar, Arunadatta, Sarvangasundari, Astanga Hridaya, Nidana, 4/10, 1st ed, 2002, Choukumbha Surabharati Prakashan, Varanasi, pp 473
72) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 1/5, 15th ed, 1985, Choukumbha Samskrut samstan, Varanasi,
73) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Chikitsa, 17/10-16, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 553
74) ibid, Nidana, 1/5 Chakrapani, pp 194 75) Ranjit Roy deshai, Nidana Chikitsa Hastamalak, 3rd ed, 1985, Baidyanath
Ayurveda Bhavan Ltd, Nagpur, pp 675 76) Satya Narayan Shastri, Charka Samhita Chikitsa 17/4, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 508 77) Sadashiva Shastri Paradkar, Arunadatta, Sarvangasundari, Astanga Hridaya,
Nidana, 4/1, 1st ed, 2002, Choukumbha Surabharati Prakashan, Varanasi, pp 472 78) Ambika Datta Shastri, Susruta Samhita Shareera 6/25, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, p 45 79) Sadashiva Shastri Paradkar, Arunadatta, Sarvangasundari, Astanga Hridaya,
Shareera, 4/50-56, 1st ed, 2002, Choukumbha Surabharati Prakashan, Varanasi, pp 415
80) Satya Narayan Shastri, Charka Samhita Chikitsa 17/11-16, Chakrapani, 1st ed. 2001, Choukumbha Bharati Academy, Varanasi, pp 509-10
81) Ambika Datta Shastri, Susruta Samhita Uttara 50/3-5, 15th edition, 2002, Choukumbha Sanskrit Samsthana, Varnasi, p 365
82) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/1, 2nd ed, 1996, Krishnadas Academy, Varanasi, pp 37
83) K.R. Sriknta Murty ed, Astanga Sangraha Nidana, 4/2-8, 1st ed, 1996, Choukumbha Samskrut Pratistan, Varanasi, pp 168-69
84) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 12/15, 15th ed, 1985, Choukumbha Samskrut samstan, Varanasi, pp 289
85) Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association of physicians of India, Mumbai, pp 291
86) Ibid, pp 292-3 87) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed,
1989, Blackwell scientific publications, New Delhi, pp 675 88) www.niaid.nih,gov, Ig related allergy, sec 3-4, 1-2, sherrpi et al. 1994 89) www.niaid.nih,gov, Ig related allergy, sec 3-4, Cookson et al. 1989 90) Manian, Genetics of Asthma, www.niaid.nih,gov, National Instiyute of Allergy &
Infectious disease, J. Chest, 1997 91) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,
pp 10 92) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed,
1989, Blackwell scientific publications, New Delhi, pp 676-79
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
IV
93) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995; Page No. 336
94) Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association of physicians of India, Mumbai, pp 292
95) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed, 1989, Blackwell scientific publications, New Delhi, pp 680
96) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi, pp 15
97) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed, 1989, Blackwell scientific publications, New Delhi, pp 682
98) Satya Narayan Shastri, Charka Samhita Chikitsa 17/13, Chakrapani, 1st ed. 2001, Choukumbha Bharati Academy, Varanasi, pp 509-10
99) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi, pp 16
100) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed, 1989, Blackwell scientific publications, New Delhi, pp 681
101) Fadden MC, Post external airway re warming and thermally induced asthma – new insight in to Patho-physiology and possible pathogenesis, J. Chin. Invest. 1986
102) Fadden MC, N. Gng, Observations on the initiative stimulus, J. Medicine, 1984 103) Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association
of physicians of India, Mumbai, pp 292 104) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed,
1989, Blackwell scientific publications, New Delhi, pp 682-3 105) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,
pp 18 106) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed,
1989, Blackwell scientific publications, New Delhi, pp 681 107) Grossman, One airway one disease, J. Chest, 1997, www.niaid.nih.com 108) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,
pp 21 109) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed,
1989, Blackwell scientific publications, New Delhi, pp 681 110) Pounce Gastro-eneterology Research, Ju;y 2005, www.niaid.nih.com 111) Satya Narayan Shastri, Charka Samhita Chikitsa 17/8, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 509-10 112) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,
pp 22 113) American Thoracic Society, J. Xgene Medicine, 2005, www.niaid.nih.com 114) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 1/20, 15th ed, 1985,
Choukumbha Samskrut samstan, Varanasi, pp 115) Satya Narayan Shastri, Charka Samhita Chikitsa 17/137, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 510 116) Ibid, 17/45, pp 515
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
V
117) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Chikitsa, 17/45, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 535
118) Ibid, 17/17, pp 533 119) Satya Narayan Shastri, Charka Samhita Chikitsa 17/56, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 516 120) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/3, 2nd ed, 1996, Krishnadas
Academy, Varanasi, pp 367 121) Satya Narayan Shastri, Charka Samhita Chikitsa 17/8, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 374 122) Ibid, 17/71, pp 518 123) Ibid, 17/56, pp 516 124) Arthur. C, Gutyton ed, TB of Medical Physiology, 9th ed, 1996, Prism Books pvt.
Ltd, pp 481 125) Ibid, pp 482, 542 126) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995;
Page No. 336-8 127) Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th
ed. India: Mcgraw Hill, New York, 1998.p 1419 -1426. 128) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995;
Page No. 337-8 129) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,
pp 45 130) Ganga Sahay Pande ed, Charka Samhita Nidana 1/8, 6th ed. 2000, Choukumbha
Samskrut Samstan, Varanasi, pp 466 131) Satya Narayan Shastri, Charka Samhita Chikitsa 17/18-20, Chakrapani, 1st ed.
2001, Choukumbha Bharati Academy, Varanasi, pp 510 132) Ambika Datta Shastri, Susruta Samhita Uttara 51/6, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, p 374 133) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/5, 2nd ed, 1996, Krishnadas
Academy, Varanasi, pp 38 134) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 12/16, 15th ed, 1985,
Choukumbha Samskrut samstan, Varanasi, pp 290 135) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,
pp 66 136) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995;
Page No. 338 137) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed,
1989, Blackwell scientific publications, New Delhi, pp 688 138) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,
pp 67 139) Ibid, pp 66 140) Ibid, pp 63 141) Ibid, pp 53 142) Ibid, pp 66
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
VI
143) Anthony Seaton, Douglas Seton, Crofton & Douglas Respiratory disease, 4th ed, 1989, Blackwell scientific publications, New Delhi, pp 676, 685
144) Ibid, pp 786 145) Satya Narayan Shastri, Charka Samhita Chikitsa 17/55-68, Chakrapani, 1st ed.
2001, Choukumbha Bharati Academy, Varanasi, pp 534-9 146) Bahara. D, Bronchial Asthma, 2000, Jypee Br. Medical publishers, New Delhi,
pp 72 147) CRW Edwords, Davidson’s Principles of Practice of Medicine, 17th edition, 1995;
Page No. 287, Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association
of physicians of India, Mumbai, pp 293 148) Ganga Sahay Pande ed, Charka Samhita Indriya 8/25, 6th ed. 2000, Choukumbha
Samskrut Samstan, Varanasi, 149) Ambika Datta Shastri, Susruta Samhita Sutra 31/20, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, 150) K.R. Sriknta Murty ed, Astanga Hridaya Shareera, 5/76, 2nd ed, 1996, Krishnadas
Academy, Varanasi, pp 447 151) Satya Narayan Shastri, Charka Samhita Chikitsa 17/62, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, 152) Ibid, 17/68-69, pp 518 153) Ambika Datta Shastri, Susruta Samhita Uttara 51/14, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, p 378 154) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 4/10, 2nd ed, 1996, Krishnadas
Academy, Varanasi, pp 38 155) Satya Narayan Shastri, Charka Samhita Chikitsa 17/71, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 518 156) Ibid, 17/72-3, pp 518 157) Ibid, 17/89, pp 521 158) Ibid, 17/74-76, pp 519-520 159) Ibid, 17/77-80, pp 519 160) Ibid, 17/121, pp 525 161) Satya Narayan Shastri, Charka Samhita Chikitsa 26/134-43, Chakrapani, 1st ed.
2001, Choukumbha Bharati Academy, Varanasi, 162) Ambika Datta Shastri, Susruta Samhita Uttara 51/43, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, 163) Ibid, 51/48, pp 381 164) Satya Narayan Shastri, Charka Samhita Chikitsa 17/148, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 529 165) Ambika Datta Shastri, Susruta Samhita Uttara 51/15, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, 166) Satya Narayan Shastri, Charka Samhita Chikitsa 17/72, Chakrapani, 1st ed. 2001,
Choukumbha Bharati Academy, Varanasi, pp 518 167) Ibid, 17/73, pp 518 168) Ibid, 17/74, pp 518 169) Ambika Datta Shastri, Susruta Samhita Uttara 51/43, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, p 380
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
VII
170) Satya Narayan Shastri, Charka Samhita Chikitsa 17/92, Chakrapani, 1st ed. 2001, Choukumbha Bharati Academy, Varanasi, pp 521
171) Ibid, 17/47, pp 529 172) Ambika Datta Shastri, Susruta Samhita Uttara 51/46-47, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, p 381 173) K.R. Sriknta Murty ed, Astanga Hridaya Chikitsa, 4/25, 2nd ed, 1996, Krishnadas
Academy, Varanasi, pp 249 174) Brahma Shankara Shastri, Yogaratnakara, Swasadhikara, 1-8 sl, 5th ed, 1993,
Choukumbha Sanskrit samsthan, Varanasi, pp 435-36 175) Ambikadatta Shastri, Govindadas, Bhaishajya Ratnavali, 6th ed, 1981,
Choukumbha Samskrut Pratistan, Varanasi, pp 339 176) Ganga Sahay Pande ed, Charka Samhita Sutra 25/40, 2nd ed. Choukumbha
Samskrut Samstan, Varanasi, 1983. pp 218-20 177) P.V. Sharma, Dravya guna vignyana, Vol 2, Chukumba Bharati academy,
Varanasi, 2001, pp 292-93,296-97,338-40,513-16,640-41. 178) P.V.Sharma, Dhanvantri nighantu 1/60-61, 65-66, 2/93-94, 3/83-84, 4/45-46,
Chukumba Sanskrit samsthana, Varanasi, 1982 pp 26, 27, 87, 129, 106. 179) P.V.Sharma, Kaideva nighantu, 1/1392-93, 1320-22, 3192-24, 1551-55, 247-50,
Chukumba orientalia, varnasi, 1979, pp 258, 244, 61, 633, 49 180) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,
Bombay, 1996, pp 608,683,565,865,949 181) Phillips. R. and Rix. M. Bulbs Pan Books 1989 ISBN 0-330-30253-1 182) Chopra. R. N., Nayar. S. L. and Chopra. I. C. Glossary of Indian Medicinal Plants
(Including the Supplement). Council of Scientific and Industrial Research, New Delhi. 1986
183) Medicinal P ants of Nepall Dept. of Medicinal Plants. Nepal. 1993 - Terse details of the medicinal properties of Nepalese plants, including cultivated species and a few imported herbs.
184) [Tsarong. Tsewang. J. Tibetan Medicinal Plants Tibetan Medical Publications, India 1994 ISBN 81-900489-0-2, A nice little pocket guide to the subject with photographs of 95 species and brief comments on their uses.
185) Genders. R. Scented Flora of the World. Robert Hale. London. 1994 ISBN 0-7090-5440-8, An excellent, comprehensive book on scented plants giving a few other plant uses and brief cultivation details. There are no illustrations.
186) Purmhothaman, K. K. et al.: J. Res. Ind. Med. 7: 39 (1972) 187) Singh, N. et al.: J. Res. Ind. Med. Yoga & Homeo. ll: 3 (1976) 188) Mishra, S. H. et al.: ind. Drugs, p.141 (1979) 189) Tripathi, V. D. et al.. Ind. J. Pharm. Sci. 40: 129 (1978) 190) Kirtikar, K. M. and B. D. Basu: Indian Medicinal Plants, Bishen Singh
Mahendrapal Singh, Dehradun (1985) 191) Patel V, Banu N, Ojha JK, et al. Effect of indigenous drug (Pushkarmula) on
experimentally induced myocardial infarction in rats. Act Nerv Super 1982; Suppl 3:387-394
192) Singh RP, Singh R, Ram P, Batliwala PG. Use of Pushkar-Guggul, an indigenous antiischemic combination, in the management of ischemic heart disease. Int J Pharmacog 1993; 31:147-160
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
VIII
193) Tripathi SN, Upadhyaya BN, Guptha VK. Beneficial effect of Inula racemosa (Pushkarmoola) in angina pectoris: a preliminary report. Ind J Physiol Pharmac 1984; 28:73-75
194) Botanical Magazine t., 1847. Of G. indica, Bentley and Trimen, Med. Plants, 32 195) Sailaja srivatsava, Sharangadhara Samhita, Poorvakhanda, 6/1, 2nd ed, 1998,
Choukumbha Orientalia, Varanasi, pp 173 196) Ambika Datta Shastri, Susruta Samhita Uttara 45/39-40, 15th edition, 2002,
Choukumbha Sanskrit Samsthana, Varnasi, p 171 197) Aspi F Golwal, Golwal Physical Diagnosis, 8th ed, 1999, Media Promotors and
Publishers pvt. Ltd. Mumbai, pp 346 - 375 198) NAEP, 1991, Guidelines for the diagnosis and management of asthma,
www.niaid.nih.gov 199) Ibid, www.niaid.nih,gov 200) Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association
of physicians of India, Mumbai, pp 294 201) Ramnik Sood, Medical Lab Technology, 4th ed, 1994, Jaypee Brothers, New
Delhi, pp 194-95 202) Ibid, pp 184-85 203) Ibid, pp 234
Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References
IX
SPECIAL CASE SHEET FOR THE EVALUATION OF “ARDHEDASHEMANEEYA SWASAHARAVATI” IN TAMAKA `’SWASA
POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) SHRI. D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG
Guide: Dr .V. Varadacharyulu Co-Guide: Dr. K.S.R. Prasad
Scholar: B.L.Kalmath
1) Name of the Patient Sl.No
2) Sex Male Female OPD No
3) Age Years IPD No
4) Religion Hindu Muslim Christian Other
5) Occupation Sedentary Active Labor
6) Economical status Poor Middle Higher middle Higher class
7) Address
Pin
8) Birth data Place of Birth
AM Date Month Year Time
Hours Minutes PM
9) Selection Included Excluded
10) Schedule dates Initiation completion
11) Result Well
Responded
Moderately
Responded
Not
responded
Discontinued
INFORMED CONSENT
I Son/Daughter/Wife of
am exercising my free will, to participate in above study as a subject. I have been informed to
my satisfaction, by the attending physician the purpose of the clinical evaluation and nature of
the drug treatment. I am also aware of my right to opt out of the treatment schedule, at any
time during the course of the treatment.
Patient's Signature
If the patient have status Asthmatics or under modern medication or Pregnant and lactating women or of 3 years-chronic symptoms are excluded.
1
12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints Duration Remarks
1 Teevra vega Swasa (Dyspnonea) 2 Kasa (cough) 3 Duhkhena Kapha nissaranam (Expectoration) 4 Ghurghuratwam (Wheezing) 5 Peenasa (Coryza) 6 Kruchrena bhasate (Dysphonoea) 7 Kantodhwamsham (Hoarseness of voice) 8 Greevashirasangraha (Headache & Stiffness) 9 Urah Peeda (Chest Pain) 10 Shayane Swasa peedita (Discomfort at supine) 13) ASSOCIATED COMPLAINTS Associated Complaints Duration Remarks
1 Anidra (disturbed sleep)
2 Pratamyati or Bhrushamarta (distressed)
3 Aruchi (Anorexia) 4 Vishukasyata (Dryness of mouth)
5 Lalata sweda 6 Trushna (Thirst) 7 Angamarda (Malaise) 8 Kampa (Tremors) 9 Jwara (fever) 10 Pramoha (fainting) 11 Vamathu (nausea) 12 Muhur Swasa (frequent respiration) 13 Muhuchaiva dhamyati (puts all effort to breath) 14) HISTORY OF PRESENT ILLNESS Mode of onset - sudden / Gradual Course episodic/ continuous/ initially episodic Frequency of attack few hours / few days / few weeks Duration of attack continuous / intermittent / subsides with medication Mode of progress Typical / Rapid / Longtime non progressive Periodicity seasonal / irregular / perennial Preceded by sneezing / nasal irritation/ cough Sputum non purulent / purulent Aggravating factors dust/ food/ smoke/ pets / pollens Comfort posture at attack sitting/ lying/ standing/ forward bending
15) Occupational History if any
2
16) PERSONAL HISTORY
Food habits Vegetarian Mixed diet
Taste preferred Sweet Sour Salty Pungent Bitter Astringent
Agni Sama Vishama Manda Teekshna
Kosta Mrudu Madhyama Krura
Nidra Day Night Sound Disturbed
Addictions Tobacco Alcohol Drugs
Bowel habits Normal Loose Constipated
Menstrual History Regular Irregular Amenorrhea Menopause
Family history – Specify if any has the same disease
Other system medications Bronchodialtors Treatment history Cortico steroids Other medicines RS Since how long
History of past illness
17) EXAMINATION (a) Vitals
Temperature ºF Pulse / min Respiration rate / min
Height Cms Weight Kg Blood pressure mmHg
(b) General
Oedema Present Absent Icterus Present Absent
Pallor Present Absent Cyanosis Present Absent
Clubbing Present Absent Palpable lymph nodes
Present Absent
(c) Respiratory system
Shape Normal / Kyphosis / Scoliosis/ Flattening/ over inflation Movement Normal / Reduced Resp. Rhythm Normal / Abnormal Respiration Thoracic/ Abdominal / Thoraco abdominal Accessory muscles Not involved / Involved / Inter coastal spaces Visible veins Absent / present
Dar
shan
a
Venous pulses Normal / Raised Tracheal position Centrally placed / Deviated Pain / Tenderness Swelling Vocal fremitus Shape Symmetrical / Asymmetrical Sp
arsh
ana
Lymph nodes Not palpable / palpable at Akotana Normal / Resonant / Hyper Resonant / Dull
Type of breath Broncho-vesicular/ Vesicular / Bronchial Vocal resonance Normal / Increased/ Decreased/ Absent
Shra
vana
Resp. Sound Rales/ Ronchi/ Crepitating/ Plural Rub /
3
(d) Dosha Examination (Ayurvedic)
Desham (Deha) Bhumi Jangala Anupa Sadharana Vata Pitta Kapha
Karshya Peeta mootrata Agni sadana
Karshnya Peetanetra Praseka
Ushna kamitwa Peetavi t Alasya
Kampa Peetatwak Swetangata
Anaha Adhikshudha Sheetangata
Shakrudgraha Adhidaha Gowrava
Balabhrmsha Slathangata
Nidrabhramsha Swasa
Pralapa Kasa
(a) Dosha Vruddhi
Bhrama At in idra
Vata Pitta Kapha
Angasada Mandagni Bhrama Alpabhashite
ahitam Shareera sheetatwam Urah
shoonyata
Chesta heenata Prabha hani Shira soonyata
Vyamoha Hridrava
(b) Dosha Kshaya
Sleshma vruddhi Sandhi saidhi lya
Nadi V P K VP VK PK VPK
Prakruti V P K VP VK PK VPK
Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya
Nadi Dosha Pravrutti Gati Varna Purnata Gandha
Spandana Kathinya
Mutra
Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa
Mala
Shabda Sparsha Sheeta Ushna
Ast
asth
ana
Drik Akruti
4
(e) Srotas Lakshana Status Lakshana Status Pranavaha Atisrustam Ati badhdama Kupitam Abheekhnam Alpalpa Sashoolam Annavaha Aruchi Ajeerna Chardi Anannabhilasha Udakavaha Jihwashosha Talushosha Ostashosha Pipasa
18) Tamaka Swasa Nidana Visamashana (V) Tilataila (P) Pistanna (K) Masa (K)
Adhyashana (V) Vidahi (P) Nispava (K) Dadhi (K)
Anasana (V) Saluka (K) Vistambhi (K)
Sheetashana (V) Guru dravyas (K) Amaksira (K)
Visha (V) Jalajamamsa (K)
Sheetapana (V) Anupa mamsa (K)
Aha
ra
Rukshanna (V) Abhishyandi (K)
Rajas (V) Abhighata (V) Kanthapratighata (V) Urahpratighata (V) Vata (V) Dhuma (V) Karmahata (V) Marmabhighata(V) Sheeta Sthana (V) Apatarpana (V) Veganirodha (V) Usna (P) Sheeta ambu (V) Bharakarshita
(V) Shuddhi Atiyoga (V) Abhishyandi
Upacara (K) Vi
hara
Ativyayama (V) Adhwahata (V) Gramya dharma (V) Divasvapna (K) Ksataksaya Atisara Visucika
Udavarta Vibandha Panduroga
Vata
Kshaya Anaha Dourbalya
Pitta Rakta pitta Jwara
Kasa Amapradosa Chardi
Any
a / V
yadh
i Ava
sta
sam
band
ha
Kapha
Pratisyaya Amatisara
19) Tamaka Swasa Poorvaroopa
Poorvaroopa Status Poorvaroopa Status
Hrutpeeda Parshwashoola
Kshudra Swasa Vibandha
Shankha bheda Anaha
Shoola Arati
Pranavilomata Bhakta dwesha
Vaktra vairasya Admana
5
20) Tamaka Swasa Vikalpa Samprapti
Santamaka Pratamaka
Udavarta Jwara
Rajaobhighata Moorcha
Ajeerna
Vata nirodha
21) Upashaya and Anupashaya
Asheene labhate sowkhyam Sleshma vimokshante sukham Upashaya
Usnamchaivabhinandate Shayanasya sameerane parshwe
ghrnnati
Anupashaya Shayanasya Swasa peedita Meghambu sheeta pragwata
22) INVESTIGATIONS (Objective parameters)
Investigations for screening Before After
Sputum examination (if necessary)
Chest-X-Ray (if necessary)
Objective parameters
Breath holding time /sec /sec
Peak expiratory flow rate L/m L/m
Erythrocytes sedimentation rate mm/1st Hour mm/1st Hour
Hemoglobin % Gm% Gm%
Absolute eosinophilic count /cumm /cumm
23) Treatment schedule of “ARDHEDASHEMANEEYA SWASAHARAVATI” Schedule Investigator’s observation
Day 1
Day 15
Day 30
Day 45
(Final Follow up) 45th day Investigators Note:
Signature of Guide
(Dr .V. Varadacharyulu)
Signature of Co-Guide
(Dr. K. Shiva Rama Prasad)
Signature of Scholar
(B.L.Kalmath)
6
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA
BANGALORE
Proforma for registration of subject for dissertation
1) Name of the candidate and
address (in block letters)
: KALMATH. BASAYYA.LINGAYYA
IRAKAL GADA POST KOPPAL TQ. DIST
2) Name of the institute : Sri D.G. Melmalagi Ayurvedic Medical College,
Post graduation & Research Centre,
Gadag - 582103
3) Course of study and subject : AYURVEDAVACHASPATHI (M.D.)
KAYACHIKITSA
4) Date of admission : October 2003
5) Title of the topic : EVALUATION OF THE EFFICACY OF
ARDHEDASHEMANIYA SWASA HARA VATI IN
THE MANAGEMENT OF TAMAKA SWASA
6. Brief Review of Intended Work
6.1 Need for Study:
The human body is continuously under the influence of environmental changes
subjected to environmental pollution. Our urbanized life style and industrialization1 compound
the problem.
As a result of smoke and dust Pranavaha srotodushti occurs and terminates in to the
diseases like Kasa, Swasa, Rajayakshma, etc. Among these Tamaka Swasa (Bronchial
Asthma) is very common disease of Pranavaha srotas2.
The world health organization (WHO) estimated in 1998 that Asthma affects 155 million
people world wide, based on data collected in epidemiological studies in more than 80
countries. These are estimating as Bronchial Asthma may affect as many as 300 million of
population worldwide. Asthma rate has increased significantly in recent decade. The number of
1
disability adjusted life years (DALYs) lost due to Asthma worldwide has been estimated at 15
million per year. Asthma accounts for around 1% of all DALYs lost worldwide reflecting the high
prevalence and severity of the disease. It is crucial that we should gain more insight in to its
causation and management3.
Even though the scientific world has conducted extensive studies but couldn’t find a safe
and effective medicine for this disease. Ayurveda treat this disease confidently and increase the
quality of life in individuals and contributive several modalities of management. Amongst herbal
combination is said to be the best. Tamaka Swasa management has shifted from symptomatic
relief to disease control this can be achieved through usage of prophylactic category of
medicaments.
Asthma is considered to increase direct and indirect medical expenditures, so to reduce
the cost of treatment also to prevent the disease. Ayurveda suggest cost effective management
of Tamak Swasa. To fulfill the ideology 5 herbs are selected from Swasa hara Dashemaniya of
Charaka as Ardhedashemaniya Yoga4.
6.2 Review of Literature:
The elaborated descriptions of Tamaka Swasa Nidana, Poorvaroopa, Roopa,
Sadhya, Asadhyata and Chikitsa are reviewed from Bhruhatryees 5,6,7. The definition of Tamaka
Swasa enumerated in Susruta Samhita very well. Susruta 8 defined it as “ÌuÉvÉåwÉå SÒÌSïlÉå iÉÉqrÉÌiÉ xuÉÉxÉÉ
xÉ iÉqÉMüqÉiÉå” which means that the attack of Swasa with iÉqÉ:mÉëuÉåvÉ (Darkness) occurs specially
during Durdina. Durdina means or compared with aggravating season or climate “
Vijayarakshita interpreted as it is a condition where the air is expired out by producing sound.
Apart from above said references of Tamaka Swasa Laghutrayee references along with
other classical references of Madhava nidana9, Yogaratnakar10, Bhavaprakasha 11,
chakradatta12, Vangasen13, and Bhaishajya Ratnavali14 explained Tamaka Swasa disease and
treatment in detail.
2
The etiology, pathology and the management of Bronchial asthma has been considered
as the Tamaka Swasa of the contemporary and reviewed from various texts of contemporary
medicine textbooks viz. Davidson’s TBM 15, Harrison’s TBM16, API text book of medicine17.
The pharmaco dynamics and kinetics of the individual herbs of composition have very
efficacious result in hypothesis are studied from various contexts of textual references from
different Samhita of Ayurveda and reviewed to found with its relevance to the present day
study18.
6.3 Objective of the Studies: -
1. To assess the effect of selected Dashemaniya compound in Tamaka Swasa
2. To assess the lung function’s improvement by Dashemaniya compound in
Tamaka Swasa
7. Material and Methods:
7.1 Source of Data
a. Patients: suffering from Tamaka Swasa will be selected from postgraduate
Studies and research center, Dept of Kayachitsa OPD and IPD of DGM Ayurvedic
Medical College & Hospital by Pre-set inclusion & exclusion criteria.
b. Literary: Literary aspect of study will be collected from classical Âyurvedic texts
and contemporary texts with updated recent medical journal.
c. Trial Drugs19,20,21,22 : The combination will be equal parts of Ardhedashmaniya
Swasahara yoga is as follows.
1. Shati : Hedychium spicatum
2. Pushkaramool : Inula recemosa
3. Amlavetas : Garcinia Pedunculata
4. Tulasi : Ocimum sanctum
5. Bhumyamalaki : Phyllanthus Urinaria
All the herbs will be identified and purchased from local area. Good
Manufacturing Practice will be followed for preparation of vati.
3
7.2 Method of collection of data:
a. Study designs: Observational Clinical Study
b. Sample: Minimum 50 patients are taken in randomized selection.
c. Exclusion Criteria: The following were the criteria to exclude the patients of Tamaka Swasa
from the study.
1. Patients with infective disease or other systemic disease and status Asthmatics
cases are excluded.
2. Patients below 14 years & above 60 years are excluded from the study.
3. Patients undertaking modern medication are excluded.
4. Pregnant and lactating women are also excluded.
d. Inclusion Criteria:
1. Patients other than exclusion criteria are included
2. Patients with symptoms of Tamaka Swasa are included
a. Teevra vega Swasa (Dyspnonea)
b. Kasa (cough)
c. Duhkhena Kapha nissaranam (Expectoration)
d. Ghurghuratwam (Wheezing)
e. Peenasa (Coryza)
f. Kruchrena bhasate (Dysphonoea)
g. Kantodhwamsham (Hoarseness of voice)
h. Greevashirasangraha (Headache & Stiffness)
i. Urah Peeda (Chest Pain)
j. Shayane Swasa peedita (Discomfort at supine)
4
e. Criteria of Diagnosis:
1. The symptoms and signs of Tamaka Swasa mentioned in Ayurvedic
texts in comparison with contemporary medical science
2. Objective parameters with relevance investigations mentioned in
contemporary texts will be the basis of diagnosis.
f. Posology : 3gm/day in divided doses/24 hrs
g. Study Duration: 30 Days
h. Follow up : 15 days
i. Assessment of Result: Subjective and objective parameters of base line data to after
treatment data comparison is done for the assessment of results. Results are assessed from
subjective and objective parameters of pre declared.
j. Subjective Parameters:
a. Teevra vega Swasa (Dyspnonea)
b. Kasa (cough)
c. Duhkhena Kapha nissaranam (Expectoration)
d. Ghurghuratwam (Wheezing)
e. Peenasa (Coryza)
f. Kruchrena bhasate (Dysphonoea)
g. Kantodhwamsham (Hoarseness of voice)
h. Greevashirasangraha (Headache & Stiffness)
i. Urah Peeda (Chest Pain)
j. Shayane Swasa peedita (Discomfort at supine)
k. Objective Parameters 23 : 1. Peak expiratory flow rate.
2. Erythrocytes sedimentation rate.
3. Absolute eosinophilic count.
5
l. Statistical assessment: The paired “t” test, unpaired “t” test and non-parametric test are
used to test the hypothesis. If “P” < 0.05, the test is highly significant.
7.3 Investigation for exclusion:
1. Sputum examination (if necessary)
2. Chest-X-Ray (if necessary)
7.4 Ethical Clearance : Obtained, certificate enclosed
References :
1. Petersdorf R.G editor, Harison principles of internal medicine,Vol-2, 252 ch. 14th ed. India:
Mcgraw Hill, New York, 1998.p 1419 to 1426.
2. Satya Narayan Shastri, Charka Samhita Chikitsa 17/13, 17, 22nd ed. Choukumbha Bharati
Academy, Varanasi, 1996. pp 509-10
3. http://www.globalburdenasthma.com,
4. Ganga Sahay Pande ed, Charka Samhita Sutra 4/37, 2nd ed. Choukumbha Samskrut
Samstan, Varanasi, 1983. pp 67
5. Ambika Datta Shastri, Susruta samhita Uttar Tantra 51/8, 13th edition, Choukumbha
Sanskrit samsthana, Varnasi, 2000, p 374
6. Satya Narayan Shastri, Charka Samhita Chikitsa 17/1-6, 55-62, 68-83, 121, 147-48, 155,
22nd ed. Choukumbha Bharati Academy, Varanasi, 1996. pp 508-531
7. Ambika Datta Shastri, Susruta samhita Uttar Tantra 51/1-6, 8-10, 14-15, 13th edition,
Choukumbha Sanskrit samsthana, Varnasi, 2000, p 372-378
8. Srikanta Murty, Astanga Hrudayam Nidana 4/6-10, Chikitsa 4/1-51, 2nd ed, Chukumba
orientalia, Varanasi, 1995, pp 38, 245-54
9. Shri Sudarshan Shastri ed, Madhava Nidana, Vol-1, 12/27-41, 15th ed, Madhukosh
commentary, Chukumba Sanskrit samsthan, Varanasi, 1985, pp 290-301
10. Vaidya Shri Laxmi Pathishastri ed, Yogaratnakara, Swasa Adhikara, 1-8 sloka, 5th edition,
Chukumba Sanskrit samsthan, Varanasi, 1993, pp 427-37
6
11. Brahmsankar Misra, Bhava Prakash, 14th chapter, 5th edition, Chukumba orientalia,
Varanasi, 1980, pp 150-166
12. P.V.Sharma ed, Chakradatta, Hikkaswasa Chikitsa 12/1-30, 5th edition, Chukumba
publishers, Varanasi, 1998, pp 149-153
13. Shri Shaligramaj Vaishy, Vangasena, Swasa roga, 1-86, khemaraja shri Krishnadas
prakashana, Mumbai, 1996, pp 265-71
14. Ambikadatta Shastri, Bhaishajya Ratnavali, Hikka swasa Chikitsa, 16/1-139, 2nd ed,
Chukumba Samskruta samstan, Varanasi, 1981, pp 329-339
15. C.R.W Edwards ed, Davidson’s Principals and Practice of the medicine,6th chapter- Disease
of Respiratory system, 17th edition, Churchil Living stone, Edinburg, 1995, pp 336-344
16. Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th ed. India:
Mcgraw Hill, New York, 1998.p 1419 -1426.
17. G.S.Sainani ed, API text book of medicine, sec-6, 7th chapter, 6th edition, Association of
physician of India, Mumbai, 1999, pp 226-30
18. Ganga Sahay Pande ed, Charka Samhita Sutra 25/40, 2nd ed. Choukumbha Samskrut
Samstan, Varanasi, 1983. pp 218-20
19. P.V. Sharma, Dravya guna vignyana, Vol 2, Chukumba Bharati academy, Varanasi, 2001,
pp 292-93,296-97,338-40,513-16,640-41.
20. P.V.Sharma, Dhanvantri nighantu 1/60-61, 65-66, 2/93-94, 3/83-84, 4/45-46, Chukumba
Sanskrit samsthana, Varanasi, 1982 pp 26, 27, 87, 129, 106.
21. P.V.Sharma, Kaideva nighantu, 1/1392-93, 1320-22, 3192-24, 1551-55, 247-50, Chukumba
orientalia, varnasi, 1979, pp 258, 244, 61, 633, 49
22. K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan, Bombay, 1996,
pp 608,683,565,865,949
23. G.S.Sainani ed, API text book of medicine, sec-3, 2nd 3rd 4th chapters, 6th edition, Association
of physician of India, Mumbai, 1999, pp 214-20
7
9. Signature of the Candidate: -
KALMATH.B.L
10. Remarks of the Guide
11. Name and Designation
11.1 Guide : Dr.V.VARADACHARYULU M.D.(Ayu) Professor and HOD P.G.S. & R.C.D.G.M.A.M.C. Gadag
11.2 Signature :
11.3 Co-Guide : Dr.SHIVA RAMA PRASAD KETHAMAKKA M A (Jyo) M.D.(K.C) (OSM) READER IN KAYACHIKISTA P.G.S & R.C. D.G.MA.M.C. Gadag.
11.4 Signature :
11.5 Head of the Department : Dr.V.VARADACHARYULU M.D.(Ayu) Professor and HOD P.G.S. & R.C.D.G.M.A.M.C. Gadag 11.6 Signature :
12 Remarks of Chairman & Principal:
21.1 Signature : Dr. G.B. Patil
Principal /CMO
8