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A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS OF TAMAKA SHWASA. By MADHUSUDHANAN.I.K, DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S. D. M. COLLEGE OF AYURVEDA, UDUPI
Citation preview
A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS OF
TAMAKA SHWASA.
By
MADHUSUDHANAN.I.K., B. A. M. S.
Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore,
Karnataka in partial fulfillment of the regulations for the award of the degree of
DOCTOR OF MEDICINE (AYU)
IN KAYA CHIKITSA
GUIDE:
DR.G. SRINIVASA ACHARYA., M.D. (AYU)
Asst. Professor, S. D. M. C. A., Udupi
CO-GUIDE
DR.SHRILATHA KAMATH.T., M.D. (AYU)
Lecturer , S. D. M. C. A., Udupi.
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACIKITSA S. D. M. COLLEGE OF AYURVEDA, UDUPI – 574 118
2005 - 2006
I
Rajiv Gandhi University of Health Sciences
DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled “Clinical study to evaluate the effect of
Vamana and Shatyadi Curna in patients of Tamaka Shwasa” is an above-board
research work carried by me under the guidance of Dr.G.Shrinivasa Acharya., M.D.
(Ayu) and co-guidance of Dr.Shrilatha Kamath.T., M.D. (Ayu).
MADHUSUDHANAN.I.K.
B.A.M.S.
Date:
Place: Udupi.
II
Rajiv Gandhi University of Health Sciences
CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “A Clinical study to evaluate the effect of
Vamana and Shatyadi Curna in patients of Tamaka Shwasa” is an above-board
research work done by Madhusudhanan.I.K in partial fulfillment of the requirement for
the degree of M.D. (Ayu).
Signature of the Guide:
DR.G. SRINIVASA ACHARYA., M.D. (AYU)
Assistant Professor, S. D. M. C. A., Udupi.
Signature of the Co-Guide:
Date: DR.SHRILATHA KAMATH.T.M.D. (AYU)
Place: Udupi. Lecturer, S. D. M. C. A., Udupi.
DEPARTMENT OF POST GRADUATE STUDIES IN
KAYACIKITSA
III
Rajiv Gandhi University of Health Sciences
ENDORSEMENT BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A Clinical study to evaluate the effect of
Vamana and Shatyadi Curna in patients of Tamaka Shwasa” is an above-board
research work done by Madhusudhanan.I.K, under the guidance of Dr.G.Shrinivasa
Acharya., M.D., (Ayu) and co-guidance of Dr.Shrilatha Kamath.T., M.D. (Ayu).
Signature of the H.O.D. Signature of the Principal
Dr. U. N. Prasad, M.D. (Ayu) Dr.K.Balakrishna Bhat., B.S.A.M
Professor and H.O. D., PRINCIPAL
Department of P.G Studies in Kayachikitsa. S. D. M.C.A, S.D.M.C.A, UDUPI.
S. D. M.C.A, S.D.M.C.A, UDUPI.
Date:
Place: Udupi.
IV
COPYRIGHT
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic / research purpose.
MADHUSUDHANAN.I.K
B.A.M.S
Date:
Place: Udupi.
© Rajiv Gandhi University of Health Sciences, Karnataka
V
ACKNOWLEDGEMENT
I sincerely express my indebtedness and deep sense of gratitude to rendered
teacher and guide Dr.G.Shrinivasa Acharya, Assistant Professor, Department of
Kayachikitsa, S.D.M. College of Ayurveda, Udupi, for his valuable guidance and help in
completing this work successfully. I would like to put on record the affection and care
with which my esteemed Guide directed me during the study.
I express my deep sense of gratitude to my teacher and Co-guide
Dr. Shrilatha Kamath.T, Lecturer, Department of Kayachikitsa, S.D.M. College of
Ayurveda, Udupi, for her support and guidance throughout the study.
I am ever grateful to Dr. U. N. Prasad, Prof. and H.O.D. of Kayachikitsa
department S.D.M. College of Ayurveda, Udupi for his encouragement, support and
helpful suggestions.
I am greatly indebted to our respected principal Dr.K.Balakrishna Bhat for
supporting me in every walk of my P.G education at Udupi.
I wish to offer my sincere thanks to Dr.K.Ramachandra Rao. Prof & Dean of
the PG department S.D.M. College of Ayurveda, Udupi for his support.
I express my special thanks to Dr.Ramdas Hedge, practitioner, Bajagoli,
Karkala for his cherished support and help.
I express my sincere thanks to S.D.M. Education Society Ujire, for giving me an
opportunity for my Post Graduation Education.
I am grateful to Dr.Prasanna.N.Mogasale, Dr.V.K.Shridhar Holla, Dr.Jonah,
Dr.Veerakumar, Dr.Lavanya, S.D.M. College of Ayurveda, Udupi.
I express my truthful thanks to Dr.Y. N.Shetty, Superintendent, Dr.Deepak S. M.,
Deputy Superintendent and Dr.C.S.Hegde of the S.D.M. Ayurveda Hospital, Udupi.
I am grateful to Dr.Muralidhar.B, Dr.Mohanan S.D.M.Ayurvedic pharmacy for
providing me the drug compounds of my study to specifications
MADHUSUDHANAN.I.K.
VI
TABLE OF CONTENTS
LIST OF TABLES
LIST OF FIGURES
LIST OF ABREVIATIONS
Page No
PREFACE 1
OBJECTVES 7
PART – I: CONCEPTUAL CONTRIVE
Chapter I – Historical Glimpse 8
Chapter II – Etymology of Tamaka Shwasa 13
Nidana 15
Samprapti 22
Prabhedas 25
Poorvaroopa 26
Roopa 28
Modern Perpetuation 31
Upashaya – Anupashaya 39
Sadhya – Asadhyata 40
Vyavacchedaka Nidana 41
Chikitsa 44
Pathya – Apathya 47
Chapter III - Drug Review 51
PART – II: CLINICAL STUDY
Methodology 62
Observations and Results 70
Part – III: DISCUSSION 106
Part – IV: CONCLUSION 117
SUMMARY 119
BIBILOGRAPHY 122
ANNEXURE- PROFORMA
VII
LIST OF TABLES:
Page No.
1. Nidana of Shwasa / Tamaka Shwasa 15
2. Vyanjaka hetu of Tamaka shwasa. 19
3. Poorvaroopa of Shwasa Roga 26
4. Roopa of Tamaka Shwasa 29
5. Characteristic features of Extrinsic and Intrinsic asthma. 34
6. Upashaya and Anupashaya in Tamaka Shwasa 39
7. Difference between five varieties of Shwasa. 42
8. Pathya in Tamaka Shwasa 47
9. Apathya in Tamaka Shwasa 49
10. Ingredients of Shatyadi Curna. 51
11. Criteria to assess Vamana Karma. 63
12. Samsarjana karma. 64
13. Age group Incidence of patients 71
14. Sex Incidence of patients 72
15. Marital status of patients. 73
16. Distribution according to their religion. 74
17. Habitat Incidence 75
18. Socio economic status 76
19. Occupation 77
20. Habits of the patient. 78
21. Dietary habits 79
VIII
22. Analysis of Deha Prakriti. 80
23. Analysis of Sara. 81
24. Analysis of Samhanana. 82
25. Satvataha analysis. 83
26. Satmya analysis of patients 84
27. Analysis of state of Agni 85
28. Analysis of state of Koshta. 86
29. Analysis of Bala of the patients. 87
30. Maniki criteria. 88
31. Laingiki criteria. 89
32. Vegiki criteria. 90
33. Assessment of Anthiki. 91
34. Assessment of complication during Vamana karma. 92
35. Effect on severity of Tamaka Shwasa. 93
36. Effect on severity of Tamaka shwasa during the course of treatment. 93
37. Effect on Breathlessness of Tamaka Shwasa. 94
38. Effect on Breathlessness of Tamaka shwasa during the course of treatment. 94
39. Effect on Speech of Tamaka Shwasa. 95
40. Effect on Cough of Tamaka Shwasa. 96
41. Effect on Sputum of Tamaka Shwasa. 96
42. Effect on Body Position of Tamaka Shwasa. 97
43. Effect on Respiratory Rate of Tamaka Shwasa. 98
44. Effect on Expansion of Chest of Tamaka Shwasa. 98
IX
45. Effect on Laboured breathing of Tamaka Shwasa 99
46. Effect on Breath sounds of Tamaka Shwasa. 99
47. Effect on Heart Rate of Tamaka Shwasa. 100
48. Effect on Mental status of Tamaka Shwasa. 100
49. Effect of Vamana & Shatyadi Curna on absolute values of spirometer 101
50. Effect of Vamana& Shatyadi Curna over the predicted percentage of spirometer.102
51. Effects on mean FVC value during the course of treatment. 103
52. The overall effects 104
X
LIST OF FIGURES
Page No.
1. Incidence of age. 71
2. Incidence of sex. 72
3. Marital status. 73
4. Distribution according to their religion 74
5. Habitat Incidence 75
6. Socio-economic status 76
7. Occupation 77
8. Habits of the patients. 78
9. Dietary habits 79
10. Analysis of Deha Prakriti. 80
11. Analysis of Sara. 81
12. Analysis of Samhanana. 82
13. Satvataha analysis of patients. 83
14. Analysis of Satmya in patients. 84
15. Analysis of state of Agni. 85
16. Analysis of state of Koshta. 86
17. Analysis of Bala of patients. 87
18. Maniki criteria. 88
XI
19. Laingiki criteria. 89
20. Vegiki criteria. 90
21. Assessment of Anthiki. 91
22. Assessment of complication during Vamana karma. 92
23. Effect on severity during the course of the treatment. 93
24. Effect on severity. 94
25. Effect on Breathlessness during the course of the treatment. 95
26. Effect on Breathlessness. 95
27. Effect on Speech and Cough. 96
28. Effect on Sputum and Body Position. 97
29. Effect on Respiratory Rate and Expansion of Chest. 98
30. Effect on Laboured breathing and Breath sounds. 99
31. Effect on Heart Rate and of mental status. 100
32. Effect of Vamana and Shatyadi Curna on absolute values of spirometer. 101
33. Effect of Vamana and Shatyadi Curna on predicted percentage of spirometer 102
34. Effect on mean FVC value during the course of the treatment. 103
35. The overall effect. 104
XII
ABSTRACT Since time immemorial man has been in constant endeavor to find the solutions
for the life threatening and agonizing disorders, which afflicts the human race. One of
such condition is ‘‘Tamaka shwasa ’’, which is known by the name Bronchial Asthma in
modern parlance, wherein remissions and exacerbations are the typical features, leaving
the patient in pathetic situation. Hence the management of this acute respiratory condition
is the long quest in the medical fraternity of all types. There are plenty of medicines are
explained for Tamaka shwasa in Ayurveda. It is proved that combined Sodhana and
Samana therapy is more effective and by Vamana, there is removal of doshas from the
body in the form of histamine. Hence the present study is designed to evaluate the role of
Shodhana therapy in the form of Vamana followed by Samana in the form of Shatyadi
Curna in patients of Tamaka shwasa.
This is a single blind clinical study with pre test and post test design where in 20
patients suffering from Tamaka shwasa of either sex between the age group of 16 and 60
years were subjected to the trial. These patients were treated with vamana followed by
oral administration of Shatyadi Curna in a dose of 5g TID with 10ml of madhu for
30days. Therapeutic effect of the treatment was assessed based on specific subjective and
objective parameters including Spirometric evaluations. Results obtained were analyzed
for the statistical significance by adapting paired‘t’ test.
Marked remission of the symptoms of Tamaka shwasa was observed in almost all
the patients included in this study. The assessment of the overall effect of Vamana and
Shatyadi Curna in these patients revealed that 60% of the patients had complete
remission of the symptoms, another 30 % had moderate remission, and the remaining
10 % of patients showed average remission of the illness.
XIII
Key words: Tamaka shwasa; Vamana karma; Shatyadi Curna; Bronchial Asthma.
XIV
Preface
PREFACE
A healthy body and healthy mind is the aim of all health care systems.
Ayurveda is one such system that prevailed since 5,000 years. It was considered the most
advanced and scientifically proven in those days. It still continues to shine. The present
millennium has shown us numerous disorders and we know that the changes in
atmosphere and living conditions are among the causes. The prime cause of any disease
is faulty food and faulty behavioral habits. What modern science describes allergy is
already seen in the ancient books in precise form under different diseases like Sheetapitta,
Udarda, Kota, Visarpa, Kushta, Tamaka shwasa etc
Allergy is a hypersensitivity reaction to an antigen, which may be food
proteins, pollen grains, dusts, fumes, chemical compounds etc. There are seven types of
Deha prakritis described in Ayurveda. Every individual is different from the other and
hence even the tolerance and intolerance to edible and environmental factors also
depends on the Prakriti of an individual. There is a detailed description available in
Ayurveda regarding the Ahara or the diet. Each component of diet or Ahara has been
given the respective names, property and uses. Acharyas have already described Virudha
–Ahara (Contra -indicated food combinations), Aachara Rasayana, Dinacharya and
Ritucharya.
Those who take Hitahara i.e Proper diet regularly are immune to many
diseases, but on the contrary it is not necessary to have immunity against diseases every
time. Charaka has mentioned three causes of disease in the person, those who fall ill after
having regular Hitahara. These three causes are: Kalaviparyaya (change in season),
Prajnaparadha (behavioral mistakes) and Asatmyatha of Sabdha, Sparsha, Rupa, Rasa
and Gandha (hypersensitivity). Those who take faulty diet (Ahitahara) do not fall ill
instantly as the causative factors are not able to vitiate doshas in each and every person
due to the different immunity power of every individual.
Individuals whose body is either very corpulent or too emaciated or having
improperly developed muscle, blood and bone or weak or nourished with unwholesome
food (Avara Satmya) or accustomed to consume less food or having weak mental power
are unable to resist diseases. Thus immunity and resistance of an individual are dependent
upon their body configuration, nature of the food intake, nature of the tissues formed and
1
Preface
emotional or mental status. Chakrapani has classified Vyadhisahatva. An individual
developes 'Vyadhisahatva' by two ways viz. Vyadhibala virodhitvam and
Vyadhyutpadaka Pratibandhaktvam.
Tamaka shwasa,a pranavaha srotovikara is such a disease which effects
an individual due to Atma Asatmya and reduced vyadhi pratibandakatvam. Altered food
habits, environmental pollutions etc are the prime causative factors of this dreadful
disease, which has its impact especially during night hours and is episodic in nature,
which is known by the name Bronchial asthma in modern parlance.
Bronchial asthma is chronic debilitating disease of varied etiology.
Various causative factors such as allergies due to dust, fumes and pollen grains along
with genetic factors have been studied and investigated. The growing environmental
pollution with rapid and extensive industrialization is also responsible for aggravation of
this disease. The alarming rise in the incidence of this disease in metropolitan cities has
posed a serious problem.
As stated by W.H.O, 100-150 million of global population is suffering from
Bronchial asthma, out of which 1/10th is of Indian and the prevalence of Asthma is
increasing everywhere. It occurs at all ages but predominantly in the early life. About
one-half of cases develop before age 40 and another third occurs after the age 40.In
childhood there is a 2:1 male female preponderance but the sex ratio equalizes by age 30.
Shwasa and Kasa are found to be predominant features of tamaka shwasa.
The principle pathology is the avarodha of pranavayu. The predominant morbidity of vata
and kapha dosha, stemming out from pittasthana, afflicting Rasadhatu, disturbing the
functioning of pranavaha srotas, these pathological events collectively leads to the
occurrence of Tamaka shwasa.
Vatahara as well as Kaphahara chikitsa is the sheet anchor of the treatment
of Tamaka shwasa. Planning of effective, safe and economical medications in combating
this lingering disease is the major concern of the medical field. It is an established fact
that sequential administration of shodhana, samana,brumhana and rasayana chiktisa
2
Preface
effectively aborts the attacks, brings about complete remission of symptoms as well as
prevents the episodes of tamaka shwasa.
In patients suffering from tamaka shwasa, who are physically strong, the
shodhana cikitsa forms the first line of treatment as it helps in clearing the obstruction of
pranavaha srotas by kapha dosa. Patient who is in vegavastha should be first subjected to
Lavana taila abhyanga followed by Nadi, Sankara or Prasthara sweda on the chest and
back.By these procedures kapha which has become stagnated and inspissated in the
srotas, get softened and liquefied, which then is easily expelled out by the procedure of
vamana karma. After vamana karma the small amount of kapha dosa which still present
in the srotas is then cleared by the administration of Doomapana.
Few research works has been carried out in different institutions in India are
listed below.
Research works on Clinical evaluation of a compound drug Shatyadi curna in the
treatment of Bronchial asthma.1
A dissertation work entitled Clinical evaluation of Therapeutic regimen in the
treatment of Tamaka shwasa (Bronchial asthma) with special reference to Vamana
Karma.2
In a single blind comparative clinical study, 20 patients suffering from Tamaka
shwasa were subjected to Manashiladi Doomapana once a day for 7 days,
Pushkaramoolasava 35ml qds for another 7 days and Pushkaramoolasava 35ml qds for 14
days in different groups. The study shows addition of dhumapana is more efficacious
than oral medication alone.3
40 patients suffering from Tamaka shwasa were subjected to Vamana and
Kunjalikriya followed by Samanaushadi Shringyadi choorna.The study showed that
Vamana is effective than Kunjalikriya in Tamaka shwasa.4
A single blind comparative clinical study were 21 patients are divided into two
groups and treated with Katphala 1500 mg tid in the first group and Placebo 1000 mg tid
for the period of 1 month. The study shows marked improvement in patients treated with
Katphala.5
3
Preface
In a single blind comparative clinical study, 56 Patients suffering from Tamaka
shwasa were treated with Chitrakadyavalehya 10gms bid for 1 month and Durjalajeta
Rasa 250mg bid with Pushkaramoolasava 15ml tid for 1 month in different groups. The
therapeutic effects shows complete remission of symptoms in patient treated with
Chitrakadyavalehya.6
Research work on therapeutic effect of VARDHAMANA PIPPALI in patients
suffering from TAMAKASHWASA.It was a single blind comparative clinical study,20
patients are treated with Vardhamana Pippali tab bid for 19 days and Pippali 500 mg bid
for 19 days in different groups. The study shows more efficacies in patient treated with
Vardhamana Pippali.7
A single blind comparative clinical study on efficacy of trial drug sirisarista in
TS. Here the patients were divided in three groups and treated with sirisarista prepared
with different methods. The study shows remission of symptoms of Tamaka shwasa in all
the three groups.8
Single blind clinical studies on 20 patients suffering from tamaka shwasa were
treated with 25 mg of Ajasthi bhasma with 5ml of honey tid for 1 month. The result
showed remission of symptoms.9
The research work titled Clinical study evaluating the effect of Haridra
Dhoomapana and samana chikitsa in patients of Tamaka shwasa. It was a single blind
comparative clinical study, 20 patients are treated with Haridra Dhumapana for 7 days
and SKR 250 mg tid for 10 days in the first group and SKR 250 mg tid for 10 days in the
second group. The result shows moderate remission of symptoms in 20% of patients.10
A single blind clinical study on 20 patients suffering from Tamaka shwasa was
treated with Talasindhoora Rasa 125mg bd with Madhu for 30 days. The result shows
70% symptomatic relief.11
The research work entitled- A clinical study on the effect of Kala in Sadyovamana
w.s.r.to Tamaka shwasa (Bronchial Asthma). It was a single blind comparative clinical
study in which 20 patients were divided into two groups. In the first group patient is
administered Sadyovamana during the Kaphakala and in the second group, Sadyovamana
is administered other than Kaphakala. The results of this study clearly indicate that Sadyo
4
Preface
Vamana has definite role in the management of acute attack of Tamaka shwasa and it can
be performed at any time whenever the patient comes, irrespective of Kaphakala.12
The research work on Vamana Karma in patients suffering from TAMAKA
SHWASA. The study shows the lowering of the blood level of Histamine remains
sustained for several weeks after Vamana therapy. It also proved that the Vamana Karma
is having mast cell stabilizing effect and it stabilizes the histamine production
mechanism.13
Clinical trials in regards to the efficacy of shodhana in tamaka shwasa in
different Ayurvedic research centers in and around India can just be numbered. Further
the assessment criteria in these works were limited to subjective and objective criteria
with out involving the spirometric evaluation of the system. There are 100’s of medicines
mentioned in the classics for the treatment of Tamaka shwasa and are claimed to be
effective. Very few of such herbal or herbo mineral combinations are proved by the
method of Randomized Clinical Trail. Hence there is a dire requirement of exploring the
efficacy of remaining herbo/herbo-mineral compounds. Keeping these factors in view
the present study is planned to know the therapeutic effect of `Vamana’ and samana with
‘Shatyadi Curna’.
The present study is entitled - A clinical study to evaluate the effect of
Vamana and Shatyadi Curna in patients of Tamaka Shwasa comprises of four parts.
● Conceptual study ● Clinical study ● Discussion ● Summary and conclusion.
The Conceptual study consists of three chapters. The first chapter begins
with the historical review of Tamaka shwasa and Vamana karma. There after the
definition, etymological derivation, clinical manifestations, pathogenesis, prognosis and
general principles of treatment of Tamaka Shwasa and brief description about Vamana
karma are discussed in the second chapter. The third chapter consists of detailed
description about Shatyadi Curna. The composition and the properties of the individual
herbs used in the preparation of Shatyadi Curna and Vamana dravya are also explained
here.
The materials and methods of the present work with complete description
of the assessment criteria are described in the second part of dissertation. The descriptive
5
Preface
statistical analysis of the sample taken for the study is methodically elaborated. The
observation, results and their statistical analysis are presented in order with tables and
graphs.
The third chapter entitled Discussion includes the critical analysis of the result
obtained in the present study.
The fourth chapter named Summary and Conclusion comprises the conclusions
drawn from the present clinical research work.
6
Objectives
OBJECTIVES 1. To carry out a comprehensive literary study about Tamaka shwasa. 2. To evaluate the effect of vamana and Shatyadi Curna in relieving the symptoms of
Tamaka shwasa.
7
Historical glimpse
HISTORICAL GLIMPSE OF SHWASA ROGA The History of Indian medical literature comprises the entire corpus of Sanskrit
medical texts from the earliest times to the present, thus covering roughly two millennia.
According to early Vedic literature, Ayurveda was supposedly first passed on by Lord
Brahma to sage Bharadvaja. Bharadvaja in turn taught it to other sages, one among who
was Punarvasu Atreya. Atreya taught Ayurveda to his six disciples namely, Agnivesha,
Bhela, Jatukarana, Parasara, Harita and Ksharapani. These disciples, on the basis of their
own understanding of the subject, composed treatises and read them before the expert
sages. The sages whole-heartedly approved these works and blessed the authors. The
treatises became popular and proved helpful in mitigating human suffering. At present
the system is well set to re-orient itself to modern scientific parameters. Simultaneously,
it is well poised for much greater, effective utilization so as to enable the country to reach
its goals of Health for all and regulate population growth. In the present situation,
Medical Scientists are researching Ayurveda remedies for lifestyle related diseases,
degenerative and psychosomatic disorders.
PRAGVEDIK KALA (BEFORE 5000 BC)
There is no evidence about the knowledge of Shwasa during the pragvedic or
pre historic period.
VEDIC KALA:
The word 'Prana' is used frequently in all four Vedas. Madanaphala is used in the
treatment of poison.
YAJURVEDA:
A clear cut description of respiration available as
“Vatam pranena Nasike" ATHARVAVEDA:
A clear description regarding Shwasa is found in the fourth sukta of first kanda of
Atharvaveda. The word Prana has been used many times. Chapter "Prana vidya" mainly
deals with physiology & importance of respiration.
Prana is considered as a cause of birth & death.
“Prano mrityu pranastakama.
8
Historical glimpse
SATAPATHA BRAMHANA:
The normal rate of respiration given as
• Prana vayu-100 x100+800=10,800/24 hours
• Apana vayu-100x100+800=10,800/24 hours
Thus total number of respiration in a day is 21,600, in one hour it is 900 & in one
minute it will be fifteen.
UPANISHAD KALA:
Word Shwasa is used first time in Upanishad.
AMANASKOPANISHADA:
The word Shwasa is used for respiration and its derangement leads to death
BRIHADARANYAK UPANISHAD:
Prana is called as 'Ayasa' as well as 'Angirasa' which controls the whole body.
Hence any part of body dries up when Prana leaves body.
CHANDOGYOPANISHAD:
Prana is called as Angira as Prana nourishes all parts of body; it is also called as
Brihaspati & Ayasya.
YOGA CHUDAMANDYA UPANISHAD:
Here word Hikka, Kasa & Shwasa are mentioned. These are mentioned as a result
of deranged Vayu 'Prana Vyatyaya Karmata.
GARUDA PURANA:
Scientific description of Shwasa is available in Garuda purana. Dhanvantari has
quoted in first verse that now he will reveal the Nidanas of Shwasa. Vamana Dravyas like
Dhamargava, Madanaphala Indrayava are explained.
SAMHITHA KALA:
CHARAKA SAMHITA:
Seventeenth chapter of Chikitsasthana revised by Drudhabala provides complete
description of Shwasa Roga with its Etiology, Pathology, Symptomatology, Complication
& the treatment. Samprapti of Tamaka Shwasa & Symptomatology has been described in
detail. Shwasa is also mentioned as Symptom & Complication of many diseases. Shwasa
9
Historical glimpse
is mentioned as a fatal disease that kills patient very quickly. 14 Its origin is mentioned as
Pittasthana. 15
Dushti lakshana of Pranavaha srotas are depicted by Charaka in
vimanasthana. 16 The treatment of pranavaha srotas is mentioned as similar to Shwasa,
Root of Pranavaha Srotasa is mentioned as Hridaya & Mahasrotas. 17
SUSHRUTA SAMHITA:
Sushruta has described Shwasa Roga in 51st chapter of Uttaratantra. It includes
Nidanapanchaka along with Chikitsa. But Pittasthana is not mentioned as origin of
Shwasa Roga. Bhaktdvesha, Aasyavairasya were added as Purvarupa as compared with
Charaka. 18
ASHTANGA HRIDAYA AND ASHTANGA SANGRAHA
Vriddha Vaghata has described Kasa as Nidanarthakara roga for Shwasa for the
first time. 19 Shwasa is described in two separate chapters in Nidanasthana &
Chikitsasthana.
Vagbhata has described Etiopathogenesis of Shwasa in fourth chapter of Nidhana
while treatment is mentioned in fourth chapter of Chikitsasthana. Involvement of Prana,
Anna &Udakavaha Srotas in the pathogenesis has been clearly mentioned 20 Aaamashaya
is referred as Udbhavasthana of Shwasa, he has also mentioned Kasa as Nidanarthakara
Roga of Shwasa 21
KASHYAPA SAMHITA:
In Sutrasthana chapter 25 “Vedana Adhyaya” it is mentioned that child suffering
from disease Shwasa exhales warm air. The word Tamaka Shwasa is found in
Khilasthana 10th chapter while mentioning the management. Earlier no any scholar has
mentioned this reference of Tamaka Shwasa.
BHELA SAMHITA
No description regarding Shwasa Roga is available in this incompletely available
text. But word Shwasa is mentioned as symptom & complication of some disorders.
10
Historical glimpse
HARITA SAMHITA:
In Haritasamhita, 14th chapter of Tritiyasthana deals with management of
Shwasa. In this chapter detail description of Etiology, Pathology, and Lakshana &
Management is mentioned.
MEDIEVAL PERIOD
MADHAV NIDANA:
In 12th chapter Shwasa is described under the title of Hikka Shwasa Nidhanam.
Here Panchanidhana of Shwasa is mentioned.
INDU:
Shashilekha is the commentary of Ashtanga sangraha written by Indu. He
explained origin of Shwasa Roga from kasa as
`kasa Adhikibutva eva karana shwasasya’ 22
CHIKITSA KALIKA:
Tisatacharya described Chikitsa of Shwasa after the chapter of Pandu Roga. Here
Panduroga is described as Nidararthakara Roga for Shwasa.
KALYANAKARAKA:
In 16th parichhed “Shwasadhikara” of this text, the writer Ugradityacharya
contributed some new recipe for the treatment of Shwasa Roga.
CHAKRADATTA:
12th chapter deals with management of Shwasa along with Hikka. He mentioned
some simple remedy for Shwasa.
AYURVED DIPIKA:
Chakrapani has explained Aamashaya as pittasthana & it is mainly related with
upper part of Pittasthana. Also involvement of Udakavaha Srotas is clearly mentioned by
Chakrapani.23
MADHUKOSHA:
Though there is no reference of Pittasthana in Madhava Nidana,Vijayrakshita has
quoted the charkas reference of Pittasthana in 12th chapter.
BHAVA PRAKASHA:
“Astangachurana” is new remedy prescribed by him for Shwasa.
11
Historical glimpse
YOGARATNAKARA:
He described Shwasa Nidana after Hikka. He has quoted many references from
Charaka & Sushruta. He described that Shwasa is having more variety due to variation in
combination of Dosha. 24 In management he has advised Mrudu sweda.
SHARANGDHARA SAMHITA:
Sharangdhara classified five types of Shwasa in Purvakhand chapter 7 without
giving much detail. He has prescribed various recipes for management of Shwasa.
SHODHAL
12th chapter of Gadanigraha deals with Nidana & Chikitsa of Shwasa Roga along
with Hikka. But there is no reference regarding Pittasthana.
VANGASENA:
Vangsena has described Shwasa Roga in separate chapter entitled “Shwasa
rogadhikar” just after Hikkadhikara.
RASA RATNA SAMUCCHAYA:
Vagbhata has described Shwasa under 13th chapter along with Raktapitta, Kasa
and Hikka, Shwasa is explained after Kasa. In pathogenesis, Aamashaya is considered as
a seat of origin. Here only involvement of Anna, Udaka & Ashruvaha Srotas has been
mentioned but no reference regarding Pranavaha Srotas is available. 25
VRINDA MADHAVA:
He described Shwasa in 12th chapter entitled "Hikka Shvaasadhikara"
BHAISAJYA RATNAVALI Govinda Das describes Shwasa in 16th chapter of this book with different therapeutic
formulations.
In a nut shell, the description regarding Tamaka shwasa is not found in prevedic
or Vedic period. In Vedas there is plenty of reference available regarding the
physiological aspect as well as pathological aspect of Pranavaha srotas. The word Shwasa
is used in the first time in Upanishad. Later in Samhitha period onwards there is abundant
information available regarding the disease Tamaka shwasa. The Vamana Karma is
explained in detail in all the samhithas. Based on the above information the present
literary work has been carried out.
12
Etymology
ETYMOLOGY OF SHWASA:
The word Shwasa is derived form the root word 'shwas' by applying Ghanj
pratyaya. 26 Shwasa denotes air and respiration. In physiological condition the word 'Shwasitam'
means prana in commentary by Hemachandra.
According to Shabdastoma mahanidhi the word Shwasa is derived from 'Shwasa'
Dhatu by applying 'ghanj' pratyaya.
In Halayudha kosha the word 'Shwasa' is derived from 'Shwasa' Dhatu by adding
'lu' pratyaya which means Inspiration and both phases of respiration.
In Vaidyaka Shabdasindhu the word “Shwasa” specially indicates disease
manifested in hollow space.
ETYMOLOGY OF TAMAKA SHWASA:
Tamaka Shvasa comprises of two words i.e. Tamaka and Shvasa.
TAMAKA:
1. The word "Tamaka" is derived from the root "Tam" means oppression of chest 27
2. Tamaka shows the different meanings of Tam i.e. to choke, to be suffocated, to be
exhausted, to be unease, and to be distressed.
3. Tamaka means - Udveda, Tivrata, Krodha, Tosha, Tamtmahata and a type of
Shvasa Roga.
4. Tamaka - Tamyati Atra Tama VA
It is described as a one variety of disease Shvasa in Vachaspatyama.
5. Tama Tamyati Anena Iti Tama
The word Tama denotes Andhakara, Nishacharma, Divantaka,
Dinantarama and Andhakam according to Halayudha kosha.
SHWASA:
The word Shwasa is used to denote the respiration and exchange of air in
the body. It is used in both Physiological as well as Pathological conditions in the human
life. Therefore the disease in which the respiration and exchange of air get disturbed is
known as Shwasa.
13
Etymology
"Shvasastu Vastrika Adhmana sama vatordha Gamita"
The expiration of air,which produces sound similar to the one generated
while blowing the air with a blower by the black smith is termed as Shwasa. 28
Shurutha quotes,
Vihaya Prakritim Vayu Prano atha Kapha Samyutah.
Shvasayatyurdhvago bhutva tam Shwasam Parichakshate"
When “Prana Vayu" does not performing its normal physiological functions
(vitiated) and becomes defiles (Viguna), obstructed by Kapha and moves in opposite
direction i.e. upward and unable to perform normal functions the condition is known as
Shwasa Roga. 29
"Shvasa iti Abhihito Viparita Pranavayu Upari Pratipannah
Sleshmana Saha Nipidyatram Tam Shvasa".
It means due to obstruction of Kapha Pratiloma gati of Prana Vayu occurs,
this condition is known as Shwasa (Kalyanakara).
TAMAKA SHWASA:
Tamaka Shwasa is defined as,
“Visheshat Durdina Tamyethi Shwasaha SA Tamaka Mataha”
The Shwasa which occurs especially during durdina is called as Tamaka Shwasa30
“Tamakascha Asou Shwasacha Tamaka Shwasa”
The attack of Shwasa, which occurs mainly during the night time, is called as
Tamaka Shwasa.
14
Nidana
NIDANA Every individual constitution has its own unique balance of vata, pitta, and
kapha according its own nature. The internal environment is governed by vata, pitta and
kapha, which are constantly reacting to the external environment. The wrong diet habits,
,lifestyle ,incompatible food combinations, seasonal changes, repressed emotions and
stress factors can all act either together or separately to change the balance of vata,pitta
and kapha.
Tamaka Shwasa is mentioned as Kashtasadya or Yaapya vyadhi. Nidana
has got much importance in such diseases which remain for longer period. Vyadhi goes
on as long as patients get exposed to these Nidana. Hence their thorough knowledge is
essential to avoid Nidana. In Ayurvedic texts, Nidana of Tamaka Shwasa as such are not
mentioned separately but Nidana of Shwasa roga in general are given.
The nidhanas are mainly of two types.
1. Bahya (extrinsic) 2.Abhyantara ( intrinsic)
1. Bahya nidanas like Rajas, Dhuma etc are the external factors responsible for
causation of the disease
2. Abhyantara nidanas includes Dosas. In Tamaka Shwasa, Kapha and Vata are the
main Dosas, which are the internal factors for the causation of this disease.
Tamaka shwasa can be produced by one or more etiological factors. The
following table shows the various nidhanas of Tamaka shwasa.
Table No.1 Showing the nidhana of Shwasa/ Tamaka shwasa.
Factors C. S31 S.S32 A.H33 A.S34 M.N35
Vata-Prakopa Ahara
Rukshanna - Ununctuous food + + - - +
Visamashana - Irregular food habit + + - - +
Adhyashana - Habit of eating - + - - -
15
Nidana
frequently
Anasana - Observation of fast for
long
- + - - +
Dvandvatiyoga-Mutually contradicting
foods
+ - - - -
Sheetashana - Cold foods - + - - +
Visha – Poison + + - - +
Sheetapana - Cold drinks - + - - +
Pitta-Prakopa Ahara
Tilataila - Gingely oil + - - - -
Vidahi - Food causing burning
sensation
+ + - - +
Katu -Spicy food - - - + -
Usna - Hot food - - - + -
Amla - Sour - - + - -
Lavana - Salt - - + + -
Kapha-Prakopa Ahara
Nispava - Dolichos lablab + - - - -
Masa - Vigna radiatus + - - - -
Pistanna – Pastries + - - - -
Saluka - Rhizome of lotus + - - - -
Guru dravyas - Heavy food + + - - +
Jalajamamsa - Meat of aquatic
animals
+ - - - -
Anupa mamsa - Meat of marshy
animals
+ - - - -
Dadhi – Curds + - - - -
16
Nidana
Amaksira - Unboiled milk + - - - -
Utkleda - Kaphakara food + + - - +
Vishtambhi + + - - +
Vata-Prakopa Vihara
Rajas - Dust / Pollen + + + + +
Dhuma - Smoke + + + + +
Vata - Cold breeze + + + + +
Sheeta Sthana - Cold places + + - - +
Sheeta ambu - Cold water + + + + +
Ativyayama - Excessive exercises + + - - +
Gramyadharma-Excessive sexual
intercourses
+ - - - +
Apatarpana - Emaciating techniques + - + - +
Shuddhi Atiyoga - Excessive
purification
+ + - - +
Kantha/Urah pratighata - Injury to
throat/chest
+ - - - +
Bharakarshita - Emaciation due to
lifting heavy weights
+ + - - +
Adhwahata - Excessive walking + + - - +
Karmahata - Excessive-work + + - - +
Veganirodha - Suppression of urges - - - + -
Abhighata - Injury - + + + -
Marmabhighata–Injury to vital
structures
+ - - - +
Pitta-Prakopa Vihara
Ushna – Hot - - - + -
17
Nidana
Kapha-Prakopa Vihara
Abhishyandi Upacara -
Administration of substances which
obstruct the channels
+ - - - +
Divasvapna - Day sleeping - - - - -
Vata prakopa janya-Vyadhi / Avastha Sambandhi Nidana
Anaha + - - - -
Dourbalya + - - - -
Atisara + - - - +
Kshaya - + - - -
Ksataksaya + - - - -
Udavarta + - - - -
Visucika + - - - -
Panduroga + + + + -
Visha sevana + + + + -
Vibandha + - - - -
Pittaja
Rakta pitta + - - - -
Jwara + - - - +
Kaphaja
Kasa - - + + -
Amapradosa + + - - -
Chardi + - + + -
Pratisyaya + - - - -
Amatisara - - + + -
18
Nidana
Vyanjaka hetu is stimulating, precipitating or aggravating cause. It also
causes aggravation of the symptoms in an already generated disease or these cause
the precipitation of the samprapti of a disease. The knowledge of this hetus is useful
in preventing the actual formation of diseases by taking care to avoid such factors.
VYANJAKA HETUS IN TAMAKA SWASA
Table No.2.Vyanjaka hetu of Tamaka shwasa:
Vyanjaka hetu CS36 SS37 AH38
Megha (clouds) + - +
Ambu (water) + + +
Pragvata + - +
Sleshma Vardhaka Ahara-vihara + - +
1. Megha: Cloudy atmosphere leads to Kapha & Vata Prakopa which is the
prime doshas in the etiopathogenesis.
2. Ambu: The dooshitha or rutu vipareetha jala which produces
Shwasa.39
3. Pragvata: The Pragvata which is having Abhishyandhi guna which
Produces Shwasa.40
4. Sleshmala ahara-vihara: This produces Kapha vruddhi.
Tamaka shwasa is not affected to the entire person who is exposed
to the above said etiological factors because of ATMA SATMYA of an individual.It
effects an individual because of his ATMA ASATMYA.
19
Nidana
“Satmyam yajjanmanaha prabruthi sahatmanabhyastham taccha sareere
Auchityadabhyasthatvadupasete sukhavaham bhavathi” 41
The above is an important ancient Ayurvedic phrase which highlights the
role of atma in satmya. Charakacharya explains Atma satmya in the context of Ahara
vidhi vidana. Chakrapani gives commentary for this as
‘Atmana iti padenaiva atmasatmyam pratipurusham jayate’ 42
ATMA SATMYA is one which varies individual to individual.
The causative factors of disease in living being is classified into two
groups namely,
1. Sadharana karana – those common to living being in general.
2. Asadharana karana –those specific to individuals.
`Tatra asadharanam pratipurusha niyatam’ 43
This type of causative factors is like vitiation of vata
etc.,which specifically affect certain individuals.
The intolerance (asatmya) happens when the body can no longer accept
the changes and an adverse reaction occurs.This Asatmya or intolerance are explained
in modern parlance is the concept of Allergy.
Intolerance and allergy are both conditions of hypersensitivity, a
reaction of the body to factors that it can no longer deal with in a healthy way. One of
the root causes of this intolerance is imbalanced agni in the dhatu level.
In most cases the inherent constitution predisposes the allergy proneness.
That is, there is usually a correspondence between a person’s constitution and the
tendency of a particular system to develop hypersensitivity. Hypersensitivity refers to
20
Nidana
pathologic processes that result from immunologically specific interactions between
antigens (exogenous or endogenous) and humoral antibodies or sensitized
lymphocytes.
The etiological factors either in the form of the faulty dietetic habits,
behavioral errors, or due to the insult by the environmental factors causing morbidity
of kapha and vata dosa, or disturbing the functioning of pranavaha srotas leads to the
establishment of the lingering disease tamaka shwasa. Due to the detrimental effects
of nidhana there occurs accumulation of the kapha dosa in the pranavaha srotas,
which in turn obstructs the free passage of the pranavayu leading to prana vilomata
and that is how the attack of tamaka shwasa is begins.
21
Samprapti
SAMPRAPTI
Samprapti is the knowledge of the onset, duration and progress of a disease.
In Charaka Samhita the samprapti of Tamaka shwasa has been explained under three
occasions. First one regarding the common samprapti of Shwasa and Hikka, where as the
second one is vishista samprapti of shwasa and third one is samprapti of Tamaka shwasa.
Though the first two are common to all varieties they are much essential to understand
the samprapti of Tamaka shwasa. While considering the samprapti of shwasa, Acharyas
describes various stages. Vata and kapha are the major doshas involved in the process of
pathogenesis.
I. Common samprapti of Hikka and Shwasa.
II. Specific samprapti of Shwasa.
III. Samprapti of Tamaka Shwasa.
I.Common samprapti of Hikka and Shwasa 44
The kupitavayu which circulates in the pranavaha srotas stimulates
urasthakapha and produces Shwasa and Hikka rogas.
Here the vayu which is obstructed by kapha makes the dusti of prana,udaka, and
annavaha srotas, and occupies a place in the urapradesha and causes Shwasa and Hikka
roga.
II. Specific samprapti of Shwasa 45
This is the common samprapti of all 5 types of Shwasa. When the kapha along
with vata obstructs the srotas the obstructed vayu trying to overcome the obstruction
moves in all directions resulting in shwasa.
The term “kapha purvaka” in the samprapti means “kapha samyukta” i.e.,
along with Kapha. “Vishawakvraajathi”denotes “Sarvato gacchathi” i.e., moves in all
direction,it seems better to restrict it to the pranavaha srotas.
In Tamaka Shwasa, pranavaha srotas gets obstructed by kapha and vata
dosha.Here, Kapha has a major role in this process. The trapped vata moves all over the
uras resulting in swasa kricchata.
III Samprapti of Tamaka Shwasa 46
This samprapti is particularly related to Tamaka shwasa. It is continuation of the
previous samprapti as it states “pratilomam ca yada vayu”.
22
Samprapti
It states when the vayu attains pratilaomagati in srotas,it influences greeva and
shira and due to this, secretion of kapha takes place resulting in peenasa. This again
causes obstruction and as a result of these “Ghurgurkha” (wheezing) manifests along with
increased rate of respiration.
Vagbhata has considered as the afflication of annavaha and udakavaha srotas
along with the afflication of pranavaha srotas. Even Chakrapani has considered the
involvement of udakavaha srotas, but Gangadhara has clearly ruled out the involvement
of srotas other than pranavaha srotas.
Charaka mentioned pranavaha srotodusti alone in the samanya samprapti.
In the vishista samprapti of Shwasa he has included annavaha and udakavaha srotas.
Moreover in a patient suffering from shwasa less manifestations pertaining to annavaha
and udakavaha srotas are observed. Interstingly Charaka and other author explain
Tamaka shwasa to be kaphavatatmaka in its presentation and pittasthana is its origin 47.
According to most of the authors including Chakrapani, pittastana refers to amashaya
particularly adhoamashaya. Chakrapani commenting on this says “pittasya urdhwastana
sambandha” i.e., pitta has got relation with urdhwastana probably the uras. Moreover
Charaka has mentioned the moola for pranavaha srotas as hridaya and mahasrotas.
Pittastana i.e., adhoamashaya is the part of mahasrotas. Thus we can make an attempt to
explain the relation between the pittastana and pranavaha srotas.
The morbid Kapha dosha and the Rasa Dhatu are invariably involved in the
samprapti of Tamaka Shwasa. Since these two factors are of same category, in the
pathogenesis they favour one another. That is why the illness tends to progress in a rapid
manner and also cause severe morbidity.
Hridaya is considered as one among the mula of Pranavaha Srotas. For the same
reason in a patient suffering from Tamaka Svasa in a long run, there is every risk of
extension of pathogenesis damaging the Hridayamarma 48. This adds to the poor
prognosis of the illness for evident reasons.
23
Samprapti
Samprapti Ghataka:
Factors involved in the generation of Samprapti of Tamaka Shwasa are
elaborated in the following lines.
1. Dosa – Pranavayu, Udanavayu, Avalambaka Sleshma.
2. Dushya – Rasa Dhatu.
3. Srotas – Pranavaha, Udakavaha, Annavaha, Swedavaha.
4. Srotodusti Lakshana – Atipravrutti, Sanga, Vimarga gamana
5. Udbhava Sthana – Pitta sthana, Adhoamasaya.
6. Sanchara Sthana – Sarva sareera.
7. Vyakta sthana– Uras.
8. Rogamarga – Abhyantara.
24
Prabhedas
PRABHEDAS OF TAMAKA SHWASA
Both the Vata and Kapha have been considered to be the chief Dosas
involved in the pathogenesis of Tamaka Shwasa. Pratamaka and Santamaka are
considered to be the varients of Tamaka shwasa.
On the basis of association with Pitta dosha,Tamaka shwasa can be classified in to
Pratamaka and Santamaka. Even though, the Kapha and Vata are predominant doshas in
Tamaka Shwasa, Pitta is equally vitiated in this allied condition 49
The Pratamaka that occurs as a result of Udavarta, Rajasevana, Ajeerna,
Klinnakya and by Vegadharana. Here the Tamaka shwasa Laxanas associated with Jwara
and Moorcha. 50
Santamaka is further variant of Pratamaka according to Chakrapani . Gangadhara
considered it as an Upadrava of Pratamaka. If a patient of Pratamaka Shwasa feel
darkness around him or sinks into unconsciousness due to Tamadosha of Manas, it is
considered as Santamaka 51.
In both these conditions though Kapha and Vata are the predominant dosha, the
Pitta dosha also has main role in the pathogenesis of this disease. Hence it will get
relieved by Sheetopachara.
25
Poorvaroopa
POORVAROOPA The poorvaroopa is the stage in which the prakupita dosha having
extended and spreaded over to parts other than their own due to srotovaigunya,leading to
dosha dushya sammurchana.
Laxanas are the prominent diagnostic key of the disease. In this stage the
dosha dushya sammurchana would have been completed, and the onset of disease would
have commenced. But before the onset of disease, some symptoms may develop. They
give idea about the forth coming disease. Such symptoms are called as poorvaroopas. No
specific poorvaroopa has been explained for Tamaka shwasa but the poorvaroopa
explained in the context of shwasa holds good for Tamaka shwasa.
Table.No.3. Poorvaroopa of Tamaka shwasa.
Symptoms C.S52 S.S53 A.H54 M.N55
Anaha – distension of abdomen + + + +
Adhmana – fullness of the
abdomen - - - +
Arati – restlessness - + - -
Bhaktadwesa – aversion to take
food - + - -
Vadanasya vairasya – abnormal
taste in the mouth - + - -
Parshwa shoola – pain in the
sides of the chest + + + +
Peedanam hridayasya – tightness
of the chest + + + +
Pranasya vilomata – obstruction
to expiration + - + +
Shankha nistoda – temporal
headache - - + +
26
Poorvaroopa
Among the above said lakshana, some of them are due to
vataprakopa few due to kapha prakopa and some other due to agnimandya and
ama. Out of these symptoms parshwashoola,hridaya peedana and pranasya
vilomata can be considered as the samanya poorvaroopa of tamaka
shwasa.Rest of others can be considered as vishista poorvaroopa. The study
of poorva roopa helps the early detection of the disease, which is very
important particularly in episodic disease such as Tamaka shwasa to start the
treatment immediately. It is helps to prevent the aggravation of the disease.
27
Roopa
ROOPA The symptomatology of the disease is called as Roopa. It is defined as “Vyadhi
bhodakameva lingam roopam”. The symptoms and signs which exhibits as a result of the
disease manifestation in the body is called as Roopa. The signs and symptoms appear in
the stage of 5th phase of kriyakala. By the knowledge of roopa one can diagnose the
disease properly and plan the treatment accordingly.
In this disease,one can observe the pranavaha srotodushti laxanas.ie, 56
1.Atisrushtam – Prolonged expiration (Expiratory dyspnoea)
2.Atibaddham – Too restricted respiration (Inspiratory dyspnoea)
3.Kupitam – Painful or exacerbated dyspnoea.
4.Alpalpam – Breathing with interruptions (Distinct pause)
5.Abheekshnam – Continuous breathing or continuous dyspnoea.
6Sasabdam – Gurkuraka – With different auscultatory sounds such as crepitation ,
rhonchi,wheezing etc.
7.Sasoolam – Painful breathing.
The roopa of Tamaka shwasa is well explained in the classics which are
listed below.
28
Roopa
Table No.4.Roopa of Tamaka shwasa:
Sl. No.
Symptoms C.S57 S.S58 A.S59 A.H60
1 Pinasa – running nose, sneezing, stuffiness of the nose
+ + + +
2 Shwasa – dyspnoea + + + + 3 Tivravega Shwasa – rapidity of breathing + + + + 4 Amuchyamane Tu Bhrisham – severe
breathlessness if sputum is not expectorated out.
+ + + +
5 Vimokshante Sukham – slight relief in breathlessness on spitting out the sputum.
+ + + +
6 Anidra – breathlessness disturbs sleep. + - - - 7 Sayanah Shwasa Piditaha – discomfort worsens
on lying. + + + +
8 Aseeno Labhate Soukhyam – feels easy to breathe in sitting position.
+ + + +
9 Pratamyati Ati Vegat – deterioration of conciousness
+ - + +
10 Kasa – Cough + + + + 11 Pramoham Kasamanascha – frequent
deterioration of consciousness during paroxysm of cough
+ - + +
12 Kanta Ghurghuraka – rattling + - - - 13 Kantodhwamsa – soreness of the throat + - - - 14 Utshoonaksa –oedema around the eyes. + - + + 15 Vishuskasya – dryness of mouth + - + + 16 Lalata Sweda – sweating in the forehead + + + + 17 Meghaihi Abhivardhate – cloudy weather
worsens the attack + - + +
18 Sheeta Ambu – cold water + - + +
19 Pragvata – breeze + - + + 20 Sleshmala – Kaphakara + - + + 21 Usnabhinandate – likes hot thing + - + + 22 Aruchi – anorexia - + + + 23 Trishna – excessive thirst - + + + 24 Vepathu – tremors - - + + 25 Vamathu – expectoration - + - -
29
Roopa
On clean observation of the symptoms of Tamaka shwasa it can be inferred
that only few symptoms like swasakricchatta, gurguraka, pranapeedana and kasa seems to
be the main symptoms while other symptoms just explain the above said features, their
effects and complication. Among the symptoms Shwasa,Kasa,Pinasa,Pratamyati Ati
vegat are related to Pranavaha srotas. Aruchi is related to Annavaha srotas.
Trishna,Vishushkasyata it indicative of Udakavaha srotas involvement.Lalata sweda
represents involvement of Swedavaha srotas. If the person is having Tivra shwasavega,
Anidra, Vishushkasyata indicates the predominance of Vata Dosha.The symptoms like
Pinasa,Amuchyamana kapha,Kanta ghurghuratha and Kasa indicates the predominance of
Kapha Dosha
In modern science wheezing is considered as one of the important feature of
the bronchial asthma.In Ayurveda gurguraka is one of the major symptom in Tamaka
shwasa. Gurguraka occurs mainly due to avarodha in the pranavaha srotas by kapha.
So the study of symptoms improves the chance of obtaining the right
diagnosis and obtaining prompt and correct treatment.
30
Bronchial Asthma
BRONCHIAL ASTHMA
DEFINITION:
Asthma is a disease of airways that is characterized by increased responsiveness of the
tracheobronchial tree to a multiplicity of stimuli. It is manifested physiologically by a
widespread narrowing of the air passages, which may be relieved spontaneously or as
result of therapy. 61
PREVALENCE
Asthma is very common; it is estimated that 4 to 5% of the population of the USA is
affected. Similar figures have been reported from other countries. Bronchial Asthma
occurs at all ages but predominantly in early Life. About one-half of cases develop before
Age – 10 and another third occur before age 40.In childhood, there is a 2:1 male / Female
preponderance but the sex ratio equalizes by age 30. The prevalence of asthma is
increasing by age worldwide. The reasons for this increase clear, but may include:
• Increased exposure to air-bone allergens, particularly house-dust mites.
• Exposure to occupational allergens.
• Increased urbanization, and hence exposure to adjustments such as dietary-
components and pollutants.
• Reduced exposure to bacterial and viral infection in early infancy.
ETIOLOGY
From an etiologic standpoint, asthma is a heterogeneous disease. It is useful for
epidemicologic and clinical purpose to classify asthma by the principle stimuli that are
associated with acute episodes.
The etiological factors of Bronchial Asthma can be divided into two groups.
1. Predisposing factors.
2. Precipitating factors.
31
Bronchial Asthma
(1) Predisposing factors
The most important factors predisposing to asthma is “Atopy”. This codition
characterized by excessive production of IgE in response to allergens.
The term ‘Atopic’ – is applied to people with a history of allergic illness
that often develop in the first few years of life. The prevalence of asthma increase
with increasing serum IgE concentrations, and the majority of Asthma patients
express IgE directed to inhale allergens. Atopic diseases such as asthma tend to run in
families, with heritability accounting for up to 50% of the clinical expression.
Gender:
Childhood Asthma is more common in boys than in girls until the age of about 10
years, when the difference disappears. There is some evidence that this difference is
due to differences in allergen sensitivity between boys and girls.
Bronchial Hyper responsiveness:
In all types of Asthma an underlying problem seems to lie in an abnormal reactivity
of the airways, that is they narrow excessively in response to stimuli which would not
affect normal subjects.
This temporary increase in reactivity occurs because such infection
dendue the tracheal and bronchial mucosa exposing sensory receptors in the mucosa.
However, neurological reflexes are only a part of the responsiveness of airways.
(2) Precipitating factors
Precipitating factors which are important in bronchial asthma are:
Infections,inhaled allergens,dusts,environmental pollution foods
occupation, psychological, hormonal, gastro – esophageal reflux are the
commonest factors claimed as precipitating acute attacks of Bronchial Asthma.
32
Bronchial Asthma
PATHOGENESIS
The exposure of etiological factors on respiratory tract produces airway
sensitization. This airway sensitization predisposes the airways to narrow in response to a
variety of stimuli. This episodic airway narrowing and resilient reduced airflow constitute
an asthma attack.
Pathological features are apparent in the airways even mild asthmatic but are more
marked in moderate and severe asthmatics pathology of the Asthmatic airway. The
airway obstruction is caused by contraction of Bronchial smooth muscle, plugging of
airways by mucus and shed epithelial cells, and airway wall edema. With sub epithelial
collagen deposition by myofibroblasts, hyperplasia of mucus glands and hypertrophy of
bronchial muscle the bronchial mucosa is infiltrated by activated T – cells eosinophils
and mast cells.
- Areas of epithelial damage / shedding
- Sub-epithelial fibrosis
- Mucus plugging of small airways in sever Asthma
- Mucus gland hyperplasia
- Bronchial smooth muscle Hypertrophy
- Characteristic Inflammatory cell Infiltrate, espacially of eosinophils and T –
lymphocytes, with evidence of mast cell are de-granulation.
CLASSIFICATION OF ASTHMA
In modern Medicine also various classification of Bronchial Asthma are
described which can be explained as follows:
Etiological Classification:
According to etiological asthma has been divided into two basic type:
(1). Extrinsic [Allergic, Atopic ] Asthma.
(2) Intrinsic [Idiosyncratic, Non Atopic] Asthma.
33
Bronchial Asthma
34
(1) Extrinsic Asthma:
This has identifiable external triggering factors, such as specific allergens. It is
common in young people and is associated with positive immediate skin – prick tests
and a personal or family history of asthma, hay fever and eczema.
(2) Intrinsic Asthma:
This is more common in older patients. There are no obvious triggering stimuli other
than respiratory infection and often, there is less reversibility, with more long –
standing airflow obstruction of some degree.
Table.No.5. Characteristic Features of Extrinsic and intrinsic Asthma.
Extrinsic Intrinsic
Starts in childhood. Often starts in adulthood.
Eczema and Rhinitis often present Often persistent symptoms.
Positive skin tests to common allergens Negative skin tests
Precipitating factors evident from history No obvious precipitating factor
except infection
Episodic Aspirin – sensitive
Positive family History Subjects usually Intrinsic
IgE frequently raised Normal or Low IgE
Prognosis favorable Prognosis poor
(3) Mixed Asthma:
Many patients may not come into either of the groups, but shows features of both
groups. Sometime asthmatics to start with, have seasonal Asthma and later pass on to
this stage of perennial Asthma. Initially triggered by non-atopic factors such as
exercise, infection, psychic disturbance etc.
Bronchial Asthma
CLINICAL MANIFESTATIONS
The classic symptoms of Asthma are intermittent reversible attacks of
dyspnoea, wheezing and a sense of chart tightness, cough and increase in sputum volume
and viscosity. Sometimes the patient describes a sensation of chocking in the neck, or
tightness in the chest, rather than wheezing. Sometimes the cough is given more
emphasis than wheezing, particularly then it occurs at night.
Age of onset: Asthma may occur for the first time at any age. Males predominate in
childhood and females in later life. In childhood, extrinsic factors and associated atopy
are much likely to be encountered than later in life.
Patterns of Variability in Asthma
The Acute Attack:
Distressing wheezing of more or less acute onset is the hallmark of asthma. The
majority of patients have such attack at some time and often to them as ‘spasms’.
The patient sits or stands, bracing shoulders with the hands on the knees or on
the arms of a chair. The expression is one of preoccupation with the business of
breathing. Both are wheezy, examination reveals over-inflation of the chest, use of
accessory muscles of respiration and marked recession of the lower part of the chest
during inspiration. There is tachycardia and usually pulsus paradoxus; cyanosis may be
present. Ausculation usually reveals universal inspiratory and expiratory Rhonchi.
Sometimes in very severe acute Asthma, wheezing is unimpressive or absent. Most attack
subsides spontaneously in minutes but some are prolonged for hours despite treatment.
Unconsciousness is occasionally encountered in an acute attack. Sometimes
actual asphyxia may be accompanied by impairment of venous return due to over-
inflation.
Chronic Asthma:
Some patients have persistent symptoms, which may be mild or severe. There is virtually
always a characteristic diurnal variability.
35
Bronchial Asthma
Diurnal Variation
Diurnal variation in symptoms is one of the most important diagnostic features of
Asthma; it is seen in chronic Asthma as well as during exacerbations. The main elements
are:
Morning tightness:
The patients notice tightness and wheezing usually within seconds of
waking and this may take minutes or hours to subside, coughing exacerbates
symptoms.
Nocturnal attacks:
Attacks at night are also characteristic of Asthma. The patients generally
wake between 2 and 3 a.m. with tightness, cough and wheezing dyspnoea. He or she may
get up and sit by on open window. Nocturnal attacks may be prolonged or repeated. Such
episodes are commonly misdiagnosed as ‘paroxysmal Nocturnal’ dyspnoea due to left
ventricular failure.
Seasonal variation
Marked seasonal variation is characteristic of extrinsic Asthma.
Aggravation in the winter month is common and probably due to two factors - frequent
upper respiratory tract infection and house dust mite sensitivity.
Physical signs:
[A] During Attack
(1) On Inspection:
The chest seems to be maintained in a position of inspiration, but little expansion
with short inspiration.
- Accessory muscle such as sterno – mastoid salanius and pectoralis are in
continuous action to add breathing.
- Jugular vein distended.
- The lips, cheeks, nails and later the skin as a whole become cyanosed.
(2) On palpation :
- Expansion of chest diminished
- Vocal fremitus diminished
36
Bronchial Asthma
(3) On percussion :
- Note is hyper – resonant especially so when after many attack, emphysema also
supervenes.
(4) On Auscultation :
The Inspiratory effort is shortened and may hardly be audible.
- Expiration Prolonged.
- High pitched musical Rhonchi with prolonged expiration replaces the normal
Vascular murmurs.
- In severe asthma airflow may be insufficient to produce Rhonchi and a ‘silent
chest’ in such patients is an ominous.
Pulmonary function test in Asthma: (PFT):
Measurement of lung function by spirometer or peak flow meters are
quite useful in that one can measure the degree of obstruction present, document
its reversible nature, and demonstrate the airway hyperresponsiveness so
characteristic of this disease. Furthermore the performance of forced vital
capacity manoeuver is very helpful in the evaluation of acute asthmatic attack and
also very helpful in following the response to therapy in both chronic and acute
situations. Spirometers provide a description of how well lungs are functioning.
Spirometer measure vital capacity (VC), FVC (forced Vital Capacity) and timed
measurement such as FEVI [Forced Expiratory Volume one second]
This is the best single measure of long function far assessing airflow limitation or
Asthma severity.
Description of PFT
(A) VC – Vitalcapacity:
Early Investigators of pulmonary function confined themselves to the
measurement of ventilatory reserve. The VC is affected by factors like
age, sex, height, and weight. It is reduced in restrictive type of lung
disease.
37
Bronchial Asthma
(B) Forced Vital capacity:
The Value is same as that of Vital capacity but in obstructive diseases like
Asthma, Bronchitis, FVC is reduced more than that of VC.
(C) Forced Expiratory Volume in one second:
This value is proportionately decreased along with VC in restrictive types
of long disease. But it is more than the loss in FVC in obstructive type of
disease.
(D) Forced Expiratory Volume one second Percentage:
This Index is proportion of FEVI to that of FVC. This Index is of use in
differentiating between restrictive and obstructive type of long disease.
- The FEV1% is the percent of the VC that is expired in one second.
FEV1% = (FEV1/FVC) X 100
Normally the FEV1% is greater than 75%- 80% of the FVC, <80%
indicates airways obstruction
Patients with restrictive lung disease have a reduced VC but are able to
achieve relatively high flow rates; therefore their FEV1% exceeds 80%
Patients with obstructive lung disease having low flow rates results of
their high airway resistance; consequently their FEV1% is abnormally
low.
Bronchodilator Reversibility = FEVI (B.T) – FEV1 (A.T.) %
FEV1 (BT)
-Change in FEV1 20% or more indicates significantly reversible
airway obstruction.
38
Upashaya and Anupashaya
Upashaya and Anupashaya A judicious application of aushadhi, anna and vihara when it produces relief in the
symptoms is called as upashaya. When it aggravates the symptoms it is called as
anupashaya. It is trial and error treatment.
In Tamaka swasa upashaya and anupashaya have been explained while
mentioning the lakshanas of the disease, these are as follows.
Table.No.6.Upashaya and Anupashaya in Tamaka Shwasa 62.
Upashaya Anupashaya
Ushna Ahara Vihara. Sheeta Ahara Vihara, Sheeta Ambu-cold
water.
Aseeno Labhate Soukhyam – feels
comfortable to breath in sitting position.
Shayanasya Shvasa Piditaha – discomfort
worsens on lying.
Vimokshante Sukham –slight relief in
breathlessness on spitting out the sputum.
Presence of Kapha in the Pranavaha srotas
worsens difficulty in breathing.
Dry sunny weather relieves the symptoms. Meghaihi Abhivardhate – cloudy weather
worsens the attack.
Quiet atmosphere is favorable. Pragvata – breeze.
Clear atmosphere, devoid of smoke and
dust helps in reducing the symptoms.
Exposure to dust or smoke worsens the
attack of Tamaka Shvasa.
Factors, that reduces the Kapha vitiation
brings out relief.
Sleshmala - Kapha aggravating factors add
to the disease.
The Upashaya which provides diagnostic aid for diseases. Apart from these the
general chikitsa sootra also can be considered as Upashaya and the nidana of a disease
itself can be considered as Anupashaya.
39
Sadhyasadhyata
Sadhyasadhyata Sadhyasadhyata gives the clear picture about the prognosis of the disease i.e.,
whether the disease is easily curable, difficult to cure or incurable. It depends upon the
nature of the disease. A physician who can distinguish between curable and incurable
disease and initiate treatment in time with the full knowledge can certainly accomplish
his object. 63
Most of the time tamaka shwasa is considered to be a yapya vyadhi 64.If it
occurs in strong person and the patient is able to take medicine, where the symptoms are
not fully manifested and when the patient is not having any other complications and is
newly devoloped, it is curable. On severe attack of Tamaka shwasa if treatment is given
inadequate and is delayed it becomes fatal.
According to classics,if Tamaka shwasa is nava (early stage) or if it is treated in
beginning or if the patient having good strength it is Sadhya. If it is in durbala rogi (weak
patient) or if it is associated with Jwara and Murcha then it is considered to be asadhya.
When the Tamaka Shwasa runs a chronic course, Acharya Charaka opines that
there occurs depletion of Rasa and the other Dhatu debilitating the patient. Treatment is
always easy in a physically strong patient as he can tolerate the stress of Sodhana therapy.
When the person is debilitated due to long standing Tamaka Shwasa more energetic
treatment like Sodhana is impossible, thus posing problems in planning the radical
treatment in a physically debilitated patient.
Based on the above information it is very important to educate the patient
about his illness. This makes the patient to co-operate with the physician which is very
important in the long term management.
40
Vyavacchedaka nidana
VYAVACCHEDAKA NIDANA (DIFFERENTIAL DIAGNOSE)
According to Charaka, a wise physician should properly recognize the
disease by the methods of Aptopasdesa,Prathyaksha and Anumana before giving
medicine. One who is well versed in the specific nature of the disease as well as the
therapies required, never become doubtful in his work.65 The following disorders which
are having similar features of Tamaka shwasa.
Kaphaja kasa
Rajayakshma
Maha shwasa
Urdhva shwasa.
Chinna shwasa.
Kshudra shwasa
These are as follows
Kaphaja Kasa66
In Kaphaja kasa bahula, madhura, snigda ghana kapha, nisteevana is present. It is
also associated with mandagni, aruchi, chardi, peenasa, utklesha, gourava, lomaharsha,
ashyamadurya, kleda, sadana and vaksharuk, swasa is not present in this condition.
Rajayakshma67
Though shwasa can also present in Rajayakshma. The associated symptoms like
Karshya Jwara, Raktasteevana, Angamarda, Atisara, etc., can be seen unlike shwasa.
41
Vyavacchedaka nidana
Table No.7 . Showing the difference between 5 varieties of shwasa68
Symptoms Tamaka
shwasa Maha shwasa Urdhwa
shwasa Chinna shwasa Kshudra
shwasa
Shwasa vega. Ateeva teevra
vega.
Ucchaiswasiti. Deergham
swasiti,
Urdhwam
swasiti,
Adhashwasa
nirodha.
Shwasiti
vicchinnam.
Rooksha
ayasodbhava
shwasa.
Shabda Gurguraka. Matta
vrishabhavat.
__ __ __
Consciousness Pramoha. Pranasta
jnana vijnana.
Pramoha. Moorcha. __
Netra Uchritaksha Vibhranta
lochana,
Vikrutakshi.
Urdwadrushti
Vibrantaksha.
Viplutaksha,
Raktaikalochana
__
Shoola Sayane
parshwa
shoola.
__ Vedanarta Marmacheda
rugardita.
No Indriya
vyatha
Vak Kricchrat
shaknoti
bhashitum.
Visheerna vak __ Pralapa. __
Asya Vishuska. __ Shuska. Parishuska. __
Sweda Lalata sweda. __ __ __ __
Miscellaneous __ Baddha mutra
varcha.
Arati. Anaha, Ajeerna. Precipitated
by vyayama
and Ahara .
No much
distress.
Sadhyasadyata Yapya,
Sadhya(Nava)
Asadhya. Asadhya. Asadhya. Sadhya.
42
Vyavacchedaka nidana
So Proper identification of disease in the sadhyavastha itself is absolutely
important, because Charakacharya opines that, all though incurable diseases never
become curable on the contrary curable diseases may become either difficult to cure or
incurable. Thus, a disease becomes easily curable, when it in its initial stages, where as it
become extremely difficult to cure or even becomes incurable in its advanced stages.69
43
Chikitsa
CHIKITSA:
The term chikitsa is derived from the root kit rogaapanayane i.e. to adopt
measures for the removal of the pathological factors involved in the disease. The mere
removal of the causative factors (of disease) may not always result in the total removal of
the disease as such. The effects of the disease may still continue to incriminate. Hence in
the real sense, chikitsa is not only aimed at the radical elimination of the causative factors
of the disease; but also it is planned for the restoration of doshic equilibrium.
Among five varieties of Shwasa Urdhva, Maha and Chinna Shwasa are
mentioned as Asaadhya and hence treatment in these occasions is not fruitful. Kshudra
Shwasa is a trivial condition and does not require any energetic treatment.
Tamaka Shwasa is identified as Yaapya /Kashtasaadya, and in which
treatment has to be continued for a prolonged period with meticulous care of the patient.
The different therapeutic measures to be adopted in this illness for the best remission or
cure of the illness is elaborated in the following lines
In the Tamaka Shwasa following modalities have applied
(1) Shodhana (2) Shamana (3) Bruhmana (4) Rasayana.
MANAGEMENT IN VEGAVASTHA & AVEGAVASTHA:
Observing the treatment modality explained by Acharya for Tamaka shwasa we
can interpret them as measures during the vegavastha and during Avegavastha. By
considering the atyayika avastha of disease one can plan the treatment.The following
treatment can be preferred during the vegavastha.
DURING VEGAVASTHA
SNEHANA 70:
Patient who is in vegavastha should be first anointed with Lavana taila over the chest
and back for 30 minutes. In Snehadhaya 71Charaka has mentioned properties of Salavana Sneha.
It supervenes within short period of time because both of them are having Sukshma property
hence having greater penetration power. It is also having Dosha sanghata Vichedakara property.
44
Chikitsa
Taila is having Ushna property, alleviates vata, and does not increase Kapha and is better for
Abhyanga.72In Shwasa Grathita Kapha is present; hence to break this Vikrita dosha sanghata,
Salavana Sneha is useful. How this Sneha penetrates all Dhatu’s and pacifies Dosha is mentioned
by Dalhana
SWEDANA73:
After Snehana, the patient is subjected to sudation either by methods of Nadi
Sweda,Prastara sweda or Sankara sweda by using Dasamoola Kwatha for another 30
minutes.Ushna Guna of Swedana helps to liquify the Kapha. Also heat applied by Sweda
is carried from skin to internal organ through blood. Blood is only the medium in body to
transfer heat from outer environment to internal organs.
By this the grathitha kapha dosha get liquefied and srotas becomes mardhava.
It also causes downward movement of Vayu.
KAPHA UTKLESHANA:
After attaining samyak svinna laxana, the patient should be given to eat snigdha
ahara or matsya or sookara mamsa or dadhisara .By these ahara, the kapha becomes
pravruddha. Then the patient should be given with Vamana Yoga i.e., Pippli, Saindhava,
and Honey.
VAMANA KARMA IN TAMAKA SHWASA74:
Vitiated vata dosha causes increase in the stiffness of the air passages;
simultaneously there occures accumilation of the kapha dosha in the same pranavaha
srotas.These two pathological events obstruct the free passage of air resulting in
shwasa.The vamana karma expels the accumilated liquified sputum from the air passage
easily.Thus the free movement of air is restored.
These procedures by way of eliminating the kapha as well as reducing the
constriction of the pranavaha srotas ensures free passage of the pranavayu.
45
Chikitsa
TREATMENT IN BETWEEN THE ATTACK( AVEGAVASTHA):
After the attack of Shwasa ,the treatment which reduce the khavaigunya is to
be administerd.The Brumhana and Rasayana treatment is to be administerd to prevent the
further attack.
1.Virechana Karma – Therapeutic purgation.
2.Brumhana Chikitsa – Regimen nourishing the body
3.Rasayana Chikitsa – Rejuvenating the Pranavaha Srotas and body.
OTHER TREATMENTS IN TAMAKA SHWASA:
Samana Chikitsa – Internal medication causing remission of the illness.
Pratisyaya Chikitsa – Treatment of Rhinitis.
Kasaroga Chikitsa – Treatment of Kasaroga.
Kaphahara Chikitsa – Pacification of vitiated Kapha Dosa.
Vatahara Chikitsa – Elimination of vitiated Vata Dosa.
Manasa Dosha Chikitsa –Correction of emotional disturbances.
Kapha Vilayana Chikitsa –Liquefaction of the sputum.
Srotomardavakara Chikitsa – Softening of the channels of respiration.
Kaphanissaraka Chikitsa – Expectoration of sputum.
Kasaghna Chikitsa – Treatment of cough.
46
Pathyapathya
PATHYA AND APATHYA According to Charaka, the drug and regimen which do not adversely affect the
body and mind are regarded as Pathya; those which adversely affect them are considered
to be Apathya 75
Ayurveda can guide every individual in the proper choice of diet, living
habits and exercises to restore balance in the body, mind and consciousness, thus
preventing disease from gaining a foothold in the system.
Every individual must know his constitution, so that he can use opposite
qualities of food, exercise, and environment and if possible job also to achieve perfect
health.
Panchakarma is ineffective if special detoxification diet is not given along
with the treatments.
Following Pathya should be followed by a person who is suffering from
Tamaka shwasa.
Table.No.8.Pathya in Tamaka shwasa.
Pathya Ahara C .S76 S .S77 A .H78 Y.R79 B.R80
I Shaali Dhanya
Purana Shali + - - + + Tandula - - - + +
II Vrihi Dhanya
Shashtika + - + + +
III Shooka Dhanya
Yava + - + + + Godhuma + - + + +
IV Shimbi
Mudga + - + - - Kulatha - - + + +
V Shakha Varga
Guduchi + - - + + Patola - - - + +
47
Pathyapathya
Vartaka - - + + + Rasona - - - + + Bimbi - - - + + Vastuka - - - - + Moolaka + - + - + Potaki - - - - + Shigru + - - - - Kasamarda + - - - -
VI Mamsa Varga
Janghala - - - + + Shasha + - - + + Titira - - - + + Bhuka - - - + + Lava - - - + + Dhanva - - - + + Shuka - - - + + Mruga Dwija - - - + +
VII Phala Varga
Jambira - - - + + Draksha + + - + + Mathulunga + + + - + Amalaka + + + - - Bilwa + + + - -
VIII Madhya Varga
Sura - + - + + Varuni - - + - -
IX Madhu Varga
Madhu + + + + +
X Mootra Varga
Gomutra - - - - +
XI Dugdha Varga
Aja Kshira - - - + +
48
Pathyapathya
XII Ghrta Varga
Purana sarpi - + - + + Ajasarpi - - - + +
XIII Krtanna Varga
Yusha + - + - - Yavagu + - - - - Peya + - + - - Sathu - - + - - Varuni - - + - -
Pathya Vihara
Virechana + - - + + Swedana + - - + + Dhumapana + - - + + Prachardana - - - + + Swapanam Diva - - - + +
Table No.9 – Apathya in Tamaka Svasa:
Apathya Aahara
I Shimbi Dhanya
Nishpava + - - + - Masha + - - + - Tila + - - - - Sarshapa - - - + +
II Shaaka Varga
Kanda - - - + +
III Mamsa Varga
Jalaja + - - - - Anupa + - - - + Pishita + - - - - Matsya - - - + +
49
Pathyapathya
IV Dadhi Varga
Dadhi + - - - -
V Kshira Varga
Kshira + - - + + Mahisha Kshira + - - - -
VI Grita Varga
Mahisha Gritha - - - + +
VII Krtanna Varga
Tailabhrsta Nishpava - - - - + Pistanna + - - - - Pinyaka + - - - -
Apathya Vihara
Sheeta Snana + + + - - Raja + + + + + Dhuma + + + + + Anila + + + + + Vyayama + + - - - Bhara - + - - + Adhwa - + - - + Vegaghata - + - - - Apatharpana + + - - - Marmaghata + - + + + Sooryatapa - - - - + Daurbalya + - - - - Aanaha + - - - - Abhighata - + - - - Strigamana - + - - - Vegavarodha-Mootra, Udgara, Chardi, Trushna, Kasa
- + - - -
So according to our text,the Pathya is having great role before planning the
treatment. Acharya says if one follows Pathya, the treatment is not necessary for him, if
one don’t follow Pathya the given medicine will not work in him.
50
Drug review
DRUG REVIEW
A number of formulations have been recommended in Ayurvedic classics for the
treatment of tamaka shwasa addition to Panchakarma Chikitsa. Vata and Kapha dosha are
the predominanant doshas in the pathogenesis of Tamaka shwasa. Vatahara and
Kaphahara therapies are the preferable treatment in this alarming disease. Similar
qualities of drugs are the contents of the herbal combination Shatyadi curna. In the
present clinical trial madanaphaphaladi yoga is used for the vamana karma, lavana taila
for the abhyanga, dasamula kwatha for the nadi sveda and satyadi churna is prescribed as
samana medication. The details of the ingredients of these medicinal combinations are
detailed below.
SHATYADI CURNA 81
Table.No.10.Ingredients of Shatyadi curna.
INGRADIENTS QUANTITY
1.SHATI 1 part.
2.BHARANGI 1 part.
3.VACA 1 part.
4.SUNTI 1 part.
5.PIPPALI 1 part.
6.MARICA 1 part.
7.PATHYA(HAREETAKI) 1 part.
8.RUCHAKA(SOUVARCALA LAVANA) 1 part.
9.KATPHALA 1 part.
10.TEJOVATHI 1 part.
11.PUSHKARAMOOLA 1 part.
12.SHRINGI(KARKATA SHRINGI) 1 part.
51
Drug review
1.Shati: Botanical name – Curcuma zedoaria.
Family - Zingiberaceae.
Rasa - Katu,Tikta.
Guna - Laghu, Teekshna.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kapha vata shamaka.
Karma - Kaphagna,Shwasahara.
2. Bharangi:
Botanical name – Clerodendrum serratum
Family - Verbenacea
Rasa - Tikta, Katu.
Guna - Laghu, Rooksha.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kapha vata shamaka
Karma - Kaphagna,Shwasahara,Kasahara.
3.vacha: Botanical name – Acorus calamus.
Family - Araceae.
Rasa - Katu,Tikta.
Guna - Laghu, Tikshna.
Veerya - Ushna.
Vipaka - Katu.
Prabhava - Medhya.
Doshagna- Kaphavatashamaka, Pitta vardhaka
Karma - Kasahara,Shwasahara,Kantya.
52
Drug review
4. Shunti: Botanical name – Zingiber officinale
Family - Zingiberaceae.
Rasa - Katu.
Guna - Laghu, Snigdha.
Veerya - Ushna.
Vipaka - Madhura
Doshagna- Kapha vata shamaka
Karma - Kaphagna,Shwasahara.
5. Maricha: Botanical name – Piper nigrum.
Family - Piperaceae.
Rasa - Katu.
Guna - Laghu, Teekshna.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kapha vata shamaka.
Karma - Kaphagna,Kapha nissaraka.
6. Pippali: Botanical name – Piper longum
Family - Piperaceae.
Rasa - Katu.
Guna - Laghu,Snigda,Teekshna.
Veerya - Anushna sheeta.
Vipaka - Madhura
Doshagna- Kapha vata shamaka.
Karma - Shwasahara,Kasahara.
53
Drug review
7. Pathya (Hareetaki): Botanical name – Terminalia chebula.
Family - Combretaceae.
Rasa - Panca rasa lavana varjita ,Kashaya pradhana
Guna - Laghu, Rooksha.
Veerya - Ushna.
Vipaka - Madhura.
Doshagna- Tridoshagna.
Karma - Shwasahara,Kasahara.
8. Ruchaka (Sauvarchala lavana): Chemical name-Unaqua sodium chloride.
Rasa – Lavana,Katu
Guna - Laghu,Vishada,Sookshma,Snigda
Veerya - Ushna
Vipaka - Madhura
Doshagna- Vata Pittahara.
Karma- Rocana,Deepana,Pacana,Anulomana, Hrudya.
9. Katphala: Botanical name – Myrica esculenta.
Family - Myricaceae.
Rasa - Kashaya, Tikta, Katu.
Guna - laghu, Teekshna.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kapha vata shamaka.
Karma - Shwasahara,Kasahara.
54
Drug review
10. Tejovathi: Botanical name – Zanthoxylun armatum.
Family - Rutaceae.
Rasa - Katu,Tikta.
Guna - Laghu,Rooksha,Tikshna.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kapha vata shamaka,Pitta vardhaka.
Karma - Shwasahara,Kasahara.
11. Pushkaramoola: Botanical name – Inula recemosa.
Family - Compositae.
Rasa - Tikta, Katu.
Guna - Laghu, Tikshna.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kapha vata shamaka.
Karma - Shwasahara,Kasahara.
12. Shringi (Karkata shringi): Botanical name – Pistacia integerrima.
Family - Anacardaceae.
Rasa - Kashaya, Tikta.
Guna - Laghu, Rooksha.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kapha vata shamaka.
Karma - Shwasahara,Kasahara.
55
Drug review
All above mentioned 12 drugs are taken in equal quantity and
made in to fine powder form separately, and all the drugs are mixed together uniformely.
This combination of churna is known as `Shatyadi curna’ and is packed in air tight
containers.
Matra - 5gm tid.
Anupana – Madhu(10ml)
Amayika Prayoga - Shwasa, Kasa.
VAMANA DRAVYA:
1.Madhanaphala: Botanical name –Randia spinosa.
Family - Rubiaceae.
Rasa - Kashaya,Madhura,Tikta.
Guna - Laghu, Rooksha.
Veerya - Ushna.
Vipaka - Katu.
Prabhava- Vamaka.
Doshagna- Kapha vata shamaka.
Karma - Kapha nissaraka.
2.vacha: Botanical name – Acorus calamus.
Family - Araceae.
Rasa - Katu,Tikta.
Guna - Laghu, Tikshna.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kaphavatashamaka, Pitta vardhaka.
Karma - Shwasahara,Kasahara,Kantya.
56
Drug review
3.Saindava(Rock salt): Chemical formula – NaCl2
Rasa - Lavana.
Guna - Laghu.
Veerya - Seetha.
Vipaka - Madhura.
Doshagna- Tridhosha samaka.
Karma- Rocana,Deepana,Avidahi,Hrudya.
4.Madhu: Rasa - Kashaya.
Guna - Guru,Rooksha.
Veerya - Seetha.
Vipaka - Madhura.
Doshagna- Kapha samaka,
Vatakaraka.
Karma- Sandana,Chedana.
5.Yastimadhu: Botanical name – Glycyrrhiza glabra.
Family - Laguminosae.
Rasa - Madhura.
Guna - Guru,Snigdha.
Veerya - Seetha
Vipaka - Madhura.
Doshagna- Vatapittahara.
Karma - Kapha nissaraka,Kantya.
57
Drug review
6.Ksheera: Rasa - Madhura.
Guna - Mrudhu,Snigdha etc
Veerya - Seetha.
Vipaka - Madhura.
Doshagna- Tridhosha samaka.
Karma- Jeevaneeya,Rasayana
DRAVYAS USED IN SNEHANA AND SWEDANA Tila taila mixed with saindava lavana is used for snehana and for swedana,the
Dasamoola kwatha is used.
1. Tila taila: Rasa - Madhura,Kashaya Anurasa.
Guna - Sookshma,Vyavayi.
Veerya – Ushna.
Doshagna- Vatagna,Pittavardhaka, Kapha samaka.
Karma- Baddhavinmootraghna, Twachya, Medya, Deepana.
2.Bilva Botanical name – Aegle marmelos.
Family - Rutaceae.
Rasa - Kashaya,Tikta.
Guna - Laghu, Rooksha.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kaphavatashamaka.
Karma - Kaphagna.
58
Drug review
3.Agnimantha. Botanical name – Premna mucronata.
Family - Verbenaceae.
Rasa - Tikta,Katu,Kashaya,Madhura.
Guna - Rooksha,Laghu.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kaphavata shamaka.
Karma - Kaphagna.
4.Syonaka. Botanical name – Oroxylum indicum.
Family - Bignoniaceae.
Rasa - Madhura,Tikta,Kashaya.
Guna - Laghu, Rooksha.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kaphavatashamaka.
Karma - Kaphagna.
5.Kasmarya. Botanical name – Gmelina arborea.
Family - Verbenaceae.
Rasa - Tikta,Kashaya,Madhura.
Guna - Guru.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Tridosha shamaka.
Karma - Sandhaniya,Balya.
59
Drug review
6.Patala. Botanical name – Stereospermun suaveolens.
Family - Bignoniaceae.
Rasa - Tikta,Kashaya.
Guna - Laghu, Rooksha.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Tridosha shamaka.
Karma - Kaphagna,Hikka nigraha.
7.Salaparni. Botanical name – Desmodium gangeticum.
Family - Laguminaceae.
Rasa - Madhura,Tikta.
Guna - Guru,Snigdha.
Veerya - Ushna.
Vipaka - Madhura.
Doshagna- Tridosha shamaka.
Karma - Kapha nissaraka.
8.Prishnaparni. Botanical name – Uraria picta.
Family - Laguminaceae.
Rasa - Madhura,Tikta.
Guna - Laghu, Snigdha.
Veerya - Ushna.
Vipaka - Madhura.
Doshagna- Tridosha shamaka.
Karma - Kapha nissaraka.
60
Drug review
9.Bruhathi. Botanical name – Solanum indicum.
Family - Solanaceae.
Rasa - Katu,Tikta.
Guna - Laghu,Rooksha,Tikshna.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kaphavata shamaka.
Karma - Kaphagna,Shwasahara,Kasahara.
10.Kantakari. Botanical name – Solanum surattense
Family - Solanaceae.
Rasa - Tikta,Katu.
Guna - Laghu,Rooksha,Tikshna.
Veerya - Ushna.
Vipaka - Katu.
Doshagna- Kaphavatashamaka.
Karma - Kaphagna,Shwasahara,Kasahara.
11.Gokshura. Botanical name – Tribullus terrestris.
Family - Zygophyllaceae.
Rasa - Madhura.
Guna - Guru,Snigdha.
Veerya - Seetha.
Vipaka - Madhura.
Doshagna- Vata Pittashamaka.
Karma - Kapha nissaraka.
There fore the present study is aimed towards the understanding of the
probable action of Vamana and Shatyadi Curna in the effective management of Tamaka
Shwasa.
61
Methodes
Methodes: Aim and Objectives :
To evaluate the effect of vamana and shatyadi choorna in relieving the
symptoms of Tamaka shwasa.
Source of Data :
20 patients diagnosed as Tamaka shwasa were taken for the study from IPD
of S.D.M. Ayurveda Hospital, Udupi.
Inclusion criteria:
Patients with pratyatma Lakshana of Tamaka shwasa.
Age group between 16 and 60 years.
Patients having the history more than 6 months
Patients selected irrespective of sex, religion, occupation etc.
Exclusion criteria:
Tamaka shwasa associated with complications like emphysema and
corpulmonale.
Severe attack of Tamaka shwasa.
Patients suffering from other systemic disorders.
Patient on steroid treatment
Investigations:
Blood: Hb%, TC, DC, ESR.
Spirometric pulmonary function test.
Design:
This is a single blind clinical study with pre test and post test design where
in 20 patients suffering from Tamaka shwasa of either sex between the age group
of 16 and 60 years were selected for the study.
A special Performa prepared with all points of history taking, physical
signs and laboratory investigations to confirm the diagnosis as mentioned in our
classics as well as allied sciences. These patients were subjected to vamana karma
followed by oral administration of Shatyadi choorna in a dose of 5g TID with
10ml of madhu for 30 days.
62
Methodes
Interventions:
First day - On the chest and back, Lavana taila Abhyanga for 30
minutes followed by Dasamula kwatha nadi sveda for another 30 minutes. Patient
is advised to take stomach full of curd rice for dinner.
Second day - On the chest and back, Lavana taila Abhyanga for 30
minutes followed by dasamula kwatha nadi sweda for another 30 minutes. This is
carried out in the early morning. Followed this, swedana,the patient is posted for
vamana karma at around 7.30 am.To begin with,approximately 600ml of milk
followed by madhanaphala yoga. The patient is observed for vomiting. Vomiting
usually begins within one muhurtha and in some patients in whom the initiation of
vomiting is not observed, vomiting was induced by approximate amount of
yastimadhu phanta.The vamana karma is then assessed as discussed below.
CRITERIA FOR ASSESSMENT OF VAMANA:
Table.No.11.Criteria for assessment of Vamana.
Shuddhi Avara Shuddhi
Madhyama
Shuddhi Pravara Shuddhi
Vaigiki 4 Vega 6 Vega 8 Vega
Maniki 1 Prastha(648ml) 1 ½
Prastha(972ml)
2 Prastha(1296ml)
Antiki Pittanta
Laingiki Signs of symptoms of Samyak Vamana.
Hrut,Parshva,Moordha,Indriya,Marga suddhi,Laghutha.
After the vamana karma, doomapana is advised. Then the patient is
shifted to the ward and is advised to take complete rest. Samsarjana krama is then
followed for about 5 days starting from the evening of the vamana day as shown
in the table below.
63
Methodes
Table.No.12.Samsarjana karma.
Days Ahara
On the day of vamana - evening peya
2nd day - morning peya
- afternoon peya
- evening vilepi
3rd day - morning vilepi
- afternoon Vilepi
-evening Akruta Yoosha
4th day - morning Kruta Yoosha
- afternoon Kruta Yoosha
- evening Akruta Mamsa rasa
5th day - morning Kruta Mamsa rasa
- afternoon Kruta Mamsa rasa
- evening Samanya Bhojana
From third day onwards for 28 days - Shatyadi Curna is orally
administered in a dose of 5g tid with10ml of madhu.
Pathya and Apathya:
All the 20 patients taken for the study were advised to avoid Cold
items ,exposure to cold, dust etc.
Criteria of Assessment:
Adopting the scoring method, symptoms of the illness like breathlessness,
cough, sputum etc and physical signs like respiratory rate, heart rate, expansion of
chest as well as Spiro metric parameters was taken as assessment criteria in this
study. Patients were observed for change in the severity of symptoms on 1st, 2nd,
7th, 14th, 21st, and 30th day of treatment. Results are analyzed by adapting the
paired t test.
64
Methodes
Severity of Tamaka Svasa:
1. Mild intermittent-
• Symptoms-symptoms <2 times a week.
• Asymptomatic and normal PEF between exacerbations, brief exacerbation
(few hours to few days), and intensity may vary.
• Night time symptoms < 2 times a month.
• Lung function – FEV, or PEF 60% to 80% predicted, PEF
variability>20%
2. Mild persistent-
• Symptoms- symptoms > 2 times a week but < 1 time a day, exacerbation
may affect activity.
• Night time symptoms > 2 times a month
• Lung function - FEV, or PEF 80% predicted PEF variability 20% to 30%.
3. Moderate persistent-
• Symptoms - Daily symptoms, daily use of inhaled short acting beta2
agonist, exacerbations affects activity, exacerbations>2 times a week, may
last for few days.
• Lung Functions - FEV or PEV 60% to 80% predicted, PEF variability >
30%.
4. Severe Persistent-
• Continual symptoms, limited.
• Physical activity affected with frequent exacerbation.
• Night time symptoms – frequent.
• Lung function - PEV or PEF < 60% of predicted, PEF variability > 30%
65
Methodes
Breathlessness:
1. Mild - Breathlessness with activity.
2. Moderate - With talking.
3. Severe - At rest.
4. Impending respiratory failure-Breathlessness at rest.
Speech:
1. Mild - Sentences.
2. Moderate – Phrases.
3. Severe - Words.
4. Impending respiratory failure - Mute.
Cough:
1. Morning bouts or after exercise - Do not disturb work.
2. Continuous cough during day and morning - Disturbing work.
3. Continuous day morning and night cough - Disturbs activity.
4. Continuous day, night and sleep and activity disturbed.
Sputum:
1. Less than 2.5ml/day.
2. 2.5 ml to 1.5ml/day
3. 15 to 25ml/day
4. > 25ml/day.
Body position:
1. Mild - Able to recline.
2. Moderate - Prefers sitting.
3. Severe - Unable to recline.
4. Impending respiratory failure - Unable to recline.
66
Methodes
Respiratory Rate:
1. Mild - >10/min
2. Moderate - >20/min
3. Severe - After > 30/min
4. Impending respiratory failure > 30/min
Laboured breathing:
1. Mild - Usually no use of accessory muscles.
2. Moderate - Commonly use of accessory respiratory muscles.
3. Severe - Usually use of accessory respiratory muscles.
4. Impending respiratory failure - Paradoxical thoraco-abdominal movement.
Breath sounds:
1. Mild - Moderate wheezing at mid to end expiration.
2. Moderate - Loud wheeze through out expiration.
3. Severe - Loud inspiration and expiratory wheezes.
4. Impending respiratory failure - Little air movement without wheezes (silent
chest).
Heart rate:
1. Mild – 100/min
2. Moderate- 100-120/min.
3. Severe > 120/min
4. Impending respiratory failure - Relative bradycardia.
Mental status:
1. Mild - May be agitated.
2. Moderate - Usually agitated.
3. Severe - Always agitated.
4. Impending respiratory failure - Confused or drowsy.
67
Methodes
Spirometric Tests:
Computerized electronic kit micro spirometer was used in this study for
assessing pulmonary ventilation capacity. The technical features of this spirometer
included-
• Flow meter: Bi-directional digital turbine.
• Range for flow measurement: 0.03 - 20 l/s
• Range for volume measurement 10l
• Accuracy of measurement 3% or 50 ml
• Dynamic Resistance @ 12 l/s < 0.7 cmH2O/l/s
The interpretation of the predicted values for spirometric lung volumes was
calculated following the ERS 93 criteria (Official Statement of the European
Respiratory Society, The European Respiratory Journal Volume 6, Supplement 16,
and March 1993.) following is the list of spirometric tests, included in the present
study on Tamaka Shwasa.
Symbol UM Parameter
-------------------------------------------------------------------------------------------------------
---
FVC l (btps) Forced Expiratory Vital Capacity
FEV1 l (btps) Forced Expiratory Volume in 1 second
PEF l/sec Peak Expiratory Flow
FEV1/FVC% FEV1 as a percentage of FVC
68
Methodes
Assessment of Overall effect:
For assessing the overall effect of the treatment, the total scores of criteria of
assessment of Tamaka Shwasa after the treatment was considered. As per the reduction in
the total scores of the overall effect is calculated as under:
Complete remission – Total score is 0 after the treatment.
Moderate remission – Reduction in more than 60% of the initial score.
Average remission – Reduction in score between 30 to 60%.
Unchanged – Reduction less than 30% of the initial score.
In a nutshell this assessment criteria incorporates almost all the
subjective as well as objective clinical manifestations of the illness Tamaka Shwasa.
69
Observation and results
OBSERVATION AND RESULTS
In the present study, 20 patients suffering from Tamaka Shwasa fulfilling the
inclusion criteria were registered.
Following details of 20 patients studied in this work is given in this chapter–
- Descriptive statistical analysis of the patients.
- Analysis of the symptomatology of Tamaka Shwasa before and after treatment
- Statistical analysis of Spiro metric results.
Descriptive Statistical analysis:
The detail of descriptive analysis in regards to age, sex, marital status etc of 20
patients suffering from Tamaka shwasa is elaborated in the following paragraph.
Distribution of patients according to age:
Analysis of age incidence of the 20 patients suffering from Tamaka Shwasa
showed more number of patients between the age group of 26 to 30 years. Details of the
age incidence is given in table no. 13
70
Observation and results
Table NO. 13 – Distribution of 20 Patients in Different Age Groups:
Age(yrs) No.of patients %
16-20 2 10
21-25 3 15
26-30 5 25
31-35 1 5
36-40 2 10
41-45 3 15
46-50 1 5
51-55
2 10
56-60 1 5
Figure No.1 – Incidence of Age:
0
5
10
15
20
25
%
16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60Age
71
Observation and results
Distribution of Patients according to sex:
In this study 75% of females were registerd in comparison to 25% of males. The
following table 13 shows the details.
Table no 14- Distribution of 20 patients according to their sex:
Sex No.of patients %
Male 5 25
Female 15 75
Figure No.2 – Incidence of Sex:
0
10
20
30
40
50
60
70
80
%
SEX
MaleFemale
72
Observation and results
Distribution of Patients according to marital status:
The married patient ratio was more compared to the unmarried patient ratio. The
following table no. 14 shows the details.
Table No.15 – Marital status of 20 patients:
Status No.of patients %
Married 13 65
Unmarried 7 35
Figure No.3 - Marital status:
0
10
20
30
40
50
60
70
%
Marital status
MarriedUnmarried
73
Observation and results
Distribution of Patients according to religion:
Most of the patients are Hindus in the present study. The sample includes 85%
of Hindus, while Muslims and Christians were only 5% and 10% respectively.
Table No.16- Distribution according to their Religion:
Religion No.of patients % Hindu 17 85 Muslim 1 5 Christians 2 10 Jains 0 0 Others 0 0
Figure No.4 – Distribution according to their religion :
0102030405060708090
%
Religion
HinduMuslimChrstainJainsOthers
74
Observation and results
Distribution of Patients according to habitat: The present study includes more number of patients from rural area. The detailed description available in the following table. Table No.17 – Habitat incidence:
Habitat No. of patient % Urban 1 5 Rural 19 95
Figure No.5 – Habitat Incidence:
0
20
40
60
80
100
%
Habitat
RuralUrban
75
Observation and results
Distribution of Patients according to socio-economic status:
Among the selected patients maximum belonged to lower class status. The
detailed descriptions are shown in the following table.
Table No.18. Socio- economic Status:
Social status No. of patients %
Low 11 55
Middle 9 45
Upper 0 0
Figure No.6. Socio- economic Status:
0
10
20
30
40
50
60
LowMediumUpper
76
Observation and results
Distribution of Patients according to occupation:
In the present study maximum numbers of patients were House wives and
agriculturists.
Table No. 19 – Occupation:
Occupation No. of patients %
Business 0 0
House wife 4 20
Employee 2 10
Agriculturist 4 20
Student 1 5
Others 9 45
Table No.7 – Occupation
45
05
1015202530354045
%
Occupation
HousewifesEmployeesAgriculturistsStudentsBussinessOthers
77
Observation and results
Distribution of Patients according to habits: Most of the patients had no habits. The following table gives the details. Table No.20.Habits of the patient:
Habits No. of patients %
Smoking 1 5 Alcoholic 1 5 Tobacco chewing 3 15 Snuff 1 5 Others 0 0 No habits 14 70
Table No.8 - Habits of the patient:
0
1020
30
40
50
60
70
%
Habits
SmokingAlcoholTubaco chSnuffNo habits
78
Observation and results
Distribution of Patients according to dietary habits: Maximum number of patients registered for the study used to take mixed diet. Table No.21 – Dietary habits:
Diet No.of patient % Vegetarian 3 15 Mixed 17 85
Figure No.9 - Dietary habits:
0
20
40
60
80
100
%
Dietary Habits
VegitarianMixed
79
Observation and results
Distribution of Patients according to prakruthi: In the prakruthi analysis, Vatapitta constitution was observed maximum in the present study. Table No.22.Analysis of Deha Prakruthi:
Prakruthi No.of patients % Vatapitta 14 70 Vatakapha 4 20 Pittakapha 2 10 Tridoshaja 0 0
Figure No.10. Analysis of Deha Prakruthi:
0
10
20
30
40
50
60
70
%
Deha prakrruthi
VPVKPKTD
80
Observation and results
Distribution of Patients according to sara:
All the patients took for the study comes under Madhyamasara.The details given
in the following table.
Table No. 23 - Analysis of Sara:
Sara No. of patients % Pravara 0 0 Madhyama 20 100 Avara 0 0
Figure No.11- Analysis of Sara:
0
20
40
60
80
100
%
Sara
Pravara
Madhyama
Avara
81
Observation and results
Distribution of Patients according to samhanana:
In the present study, patients of Madhyama Samhanana were 95% while5% of
Patients had Pravara Samhanana. The same is further detailed in the table23.
Table No.24 - Analysis of Samhanana in 20 patients of Tamaka Shwasa:
Samhanana No. of patients. %
Pravara 1 5
Madhyama 19 95
Avara 0 0
Figure No.12 - Analysis of Samhanana in 20 patients of Tamaka Shwasa:
0
20
40
60
80
100
%
Samhanana
PravaraMadhyamaAvara
82
Observation and results
Distribution of Patients according to satva:
In 80% of the patient showed Madhyama satva, where as Pravara and
Avara satva are 10%each.
Table No.25 – Satvataha analysis of the patients:
Satva No.of patients. %
Pravara 2 10
Madhyama 16 80
Avara 2 10
Figure No.13 - Satvataha analysis of patients:
01020304050607080
%
Satvataha
PravaraMadhyamaAvaa
83
Observation and results
Distribution of Patients according to satmya:
In 90% of the patients Madhyama Rasa Satmya was observed. Pravara
Satmya was recorded in just 5% of patients. Remaining patients i.e. 5 % revealed Avara
Satmya. Complete details of analysis of Satva in 20 patients is given in the table no.25
Table No.26- Analysis of Satmya in patients of Tamaka Shwasa:
Satmya No. of patients. %
Pravara 1 5
Madhyama 18 90
Avara 1 5
Figure No. 14 - Analysis of Satmya in patients of Tamaka Shwasa:
0
20
40
60
80
100
%
Satmya
PravaraMadhamaAvara
84
Observation and results
Distribution of Patients according to agni:
In the analysis of Agni, 70% of patients are said to be having Samagni. The
patients having Vishamagni and Tikshnagni were 20%,10% respectively. No patients are
suffering from Mandagni.
Table No.27 - Analysis of state of Agni :
Agni No. of patients. %
Sama 14 70
Vishama 4 20
Tikshna 2 10
Manda 0 0
Figure No. 15 - Analysis of state of Agni:
010203040
506070
%
Agni
SamaVishamaTikshna
85
Observation and results
Distribution of Patients according to koshta:
A maximum of 65% of patients comes under Madhyama koshta,where as 25% of
patients are belonging to Krura koshta and 10% are of Mrudu koshta.The details are given
below.
Table.No.28.Analysis of state of Koshta.
Koshta No.of patients. %
Krura 5 25
Madhyama 13 65
Mrudu 2 10
Figure No. 16 - Analysis of state of Koshta :
0
10
20
30
40
50
60
70
%
Koshta
KruraMadhyamaMridu
86
Observation and results
Distribution of Patients according to bala:
It was observed that 65% of the patients were of Madhyama Bala, 35% of
Avara Bala and no patients of Pravara Bala was found in this study.The details detailed
in the table 28.
Table No. 29 - Analysis of Bala of the patients:
Bala No.of patients. %
Pravara 0 0
Madhyam 13 65
Avara 7 35
Figure No. 17 - Analysis of Bala of the patient:
0
10
20
30
40
50
60
70
%
Bala
PrvaraMadhyamaAvara
87
Observation and results
Amount of shodhana achieved in 20 patients according to maniki criteria Among 20 patients 50% of patent had Pravara Suddhi, 45% madhyama suddhi, and 5% of patient had avara suddhi. Table.No.30. Maniki Criteria.
Suddhi No.of patients. %
Pravara. 1 5
Madhyama. 10 50
Avara. 9 45
Figure No.18. Maniki criteria.
The following graph shows the details about the amount of sodhana achieved
by 20 patients.
0
10
20
30
40
50
%
Mana
PravaraMadhyamaAvara
88
Observation and results
Degree of shodhana achieved in patients according to lingiki criteria.
Among the 20 patients,18 patients had Samyak vamana laxana like Hrut,
,Parshwa,Moordha,Indriya,Marga - suddhi and laghutha. The following table gives the
clear idea about Laingiki of Vamana karma.
Table.No.31. Laingiki criteria.
Linga. No.of patients. %
Samyak 18 90
Atiyoga. 2 10
Ayoga. 0 0
The Atiyoga laxana like Trushna, Balahani developed in two patients.
The following graph shows the visual picture.
Figure No.19. Laingiki criteria.
0
10
20
30
40
50
60
70
80
90
%
Linga
SamyakAtiogaAyoga
89
Observation and results
Measure of shodhana achieved according to the vegika criteria.
Among the 20 patients, 9 patients had pravara vega,11 patients had madhyama
vega and no patients had avara vega.
Table.No.32. Vegiki criteria.
Vega No of patients %
Pravara 9 45
Madhyama 11 55
Avara 0 0
The following graph represents the vegiki suddhi.
Figure No.20. Vegiki criteria.
0
10
20
30
40
50
60
%
Vega
PravaraMadhyamaAvara
90
Observation and results
Stage of shodhana achieved according to anitiki criteria.
In the present study all the 20 patients had Pittanta features. Details listed below.
Table.No.33.Assessment of Anthiki.
Anthiki No of patients %
Kapha 0 0
Pitta 20 100
The following graph shows the detailed picture regarding antiki.
Figure No.21. Assessment of Anthiki.
0
20
40
60
80
100
%
Anta
KaphaPitta
91
Observation and results
Incidence of untoward symptoms in patients subjected to vamana karma During the Vamana karma 4patients developed atisara,no other patients
had any other type of complications. Detailed descriptions are listed below.
Table.No.34.Assessment of complication during Vamana karma.
Complications No.of patients % Atisara 4 20 Other complications 0 0 No complications 16 80
The following graph shows the schematic representation of complications
during Vamana karma.s
Figure No.22.Assessment of complication during Vamana karma.
010203040
50607080
%
Complications
No compications
Atiara
Othercomplications
92
Results
93
EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS OF TAMAKA SHWASA. Effect on severity.
The severity of Tamaka shwasa which was 2.450 before the treatment
reduced to 0.0500 after the treatment. The change that occurred with the treatment is
greater than would be expected by chance; there is a statistically significant change
(P = <0.001).The following table shows the details.
Table No.35. Effect on Severity.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.450 (±0.1050)
0.0500 (±0.224)
2.400 1.046 0.234 10.258
<0.001
Table.No.36. Effect on Severity during the course of treatment
Mean score AT BT
Day 1 (S.D)
Day 2 Day3 Day7 Day14 Day21 Day30
2.450 (±0.1050)
0.1000 (±0.308)
0.150 (±0.366)
0.200 (±0.523)
0.350 (±0.745)
0.250 (±0.550)
0.0500 (±0.224)
The following figure shows the effect on Severity of tamaka shwasa during
the course of treatment
Figure.No.23. Effect on Severity during the course of treatment 0.05
0.250.35
0.20.150.1
2.45
0
0.5
1
1.5
2
2.5
3
Mea
n
D1 D2 D3 D7 D14 D21 D30
Severity
Results
Figure No.24 .Effect on Severity. 2.45
0.05
0
0.5
1
1.5
2
2.5
Severity
BTAT
Effect on Breathlessness. An assessment of Breathlessness of Tamaka shwasa before and after treatment
showed reduction in the mean score from 2.450 to 0.0500.Analysis of this data shows
statistically significant treatment.
Table No.37. Effect on Breathlessness.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.450 (±0.826)
0.0500 (±0.224)
2.400 0.821 0.184 13.077
<0.001
Table.No.38. Effect on Breathlessness during the course of treatment
Mean score AT BT
Day 1 (S.D)
Day 2 Day3 Day7 Day14 Day21 Day30
2.450 (±0.826)
0.0500 (±0.224)
0.1000 (±0.308)
0.200 (±0.523)
0.350 (±0.745)
0.250 (±0.639)
0.0500 (±0.224)
94
Results
Figure.No.25. Effect on Breathlessness during the course of treatment
The following figure shows the effect on Breathlessness of tamaka shwasa
during the course of treatment
0.050.25
0.35
0.10.05
2.45
0.2
0
0.5
1
1.5
2
2.5
3
D1 D2 D3 D7 D14 D21 D30
Mea
n
Breathlessness
Figure No.26 .Effect on Breathlessness.
2.45
0.05
0
0.5
1
1.5
2
2.5
Breathlessnss
BTAT
Effects on Speech:
Patient’s ability to speak was significantly improved after the treatment. Before
the treatment ,mean speech score was 2.250.It reduced to 0.0500
After the treatment. The change is statistically significant.
Table No.39. Effect on Speech. Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.250 (±0.851)
0.0500 (±0.224)
2.200 0.834 0.186 11.804
<0.001
95
Results
Effects on Cough:
Before the treatment the symptoms of cough was 2.450, and reduced in to 0.300
after the treatment. This change is statistically highly significant.
Table No.40. Effect on Cough.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.450 (±0.999)
0.300 (±0.571)
2.150 1.040 0.233 9.245 <0.001
Figure No.27 .Effect on Speech and Cough. 2.25
0.05
2.45
0.3
0
0.5
1
1.5
2
2.5
Speech Cough
BTAT
Effect on Sputum
The study shows marked reduction in the sputum after the treatment. Before the
treatment the mean score of sputum was 2.000,was brought down to 0.150 after the
treatment.
Table No.41. Effect on Sputum.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.000 (±0.973)
0.150 (±0.130)
1.850 1.089 0.244 7.594 <0.001
96
Results
Effect on Body position With regards to the comfortable posture of the patient during the attack, a
reduction was seen in the mean body position score from 2.050 before the treatment to
0.0500 after the treatment. Here the change that occurred with the treatment is greater
than would be expected by chance; there is a statistically significant change (P = <0.001)
Table No.42. Effect on Body position.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.050 (±0.605)
0.0500 (±0.224)
2.000 0.649 0.145 13.784
<0.001
Figure No.28 .Effect on Sputum and Body position.
2
0.15
2.05
0.05
0
0.5
1
1.5
2
2.5
Sputum Body position
BTAT
Effect on Respiratory rate
The biophysical Parameters like respiratory rate was decreased 1.500 from
2.150, which was statistically highly significant (P <0.001).
97
Results
Table No.43. Effect on Respiratory rate.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.150 (±0.366)
1.500 (±0.513)
0.650 0.587 0.131 4.951 <0.001
Effect on Expansion of chest
The expansion of chest has shown highly significant in statistical analysis. The
improvement was from 2.775 to 4.200.
Table No.44. Effect on Expansion of chest. Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.775 (±0.803)
4.200 (±1.005)
1.425 1.139 0.255 -5.596 <0.001
Figure No.29 .Effect on Respiratory rate and Expansion of chest.
2.151.5
2.775
4.2
0
1
2
3
4
5
Respiratory rate Expansion of chest
BTAT
Effect on Laboured breathing. There is marked improvement in the mean score of laboured breathing. The
mean difference observed was 1.450 after the treatment. Which was statistically highly
significant (P <0.001).
98
Results
Table No.45. Effect on Laboured breathing.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
1.700 (±0.865)
0.250 (±0.550)
1.450 0.887 0.198 7.310 <0.001
Effect on Breath sounds
The study shows marked reduction in the breathsounds.It was reduced from 1.700 to
0.250 after treatment,which was statistically highly significant (P <0.001).
Table No.46. Effect on Breath sounds.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
2.100 (±0.641)
0.0500 (±0.224)
2.050 0.605 0.135 15.158
<0.001
Figure No.30 .Effect on Laboured breathing and Breath sounds.
1.7
0.25
2.1
0.05
0
0.5
1
1.5
2
2.5
Laboured breathing Breath sounds
BTAT
99
Results
Effect on Heart rate.
An assessment of the heart rate of the patient before and after the treatment
revealed reduction in the scores from 0.250 to 0.0500.This change is statistically highly
significant.(P = 0.104)
Table No.47. Effect on Heart rate.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
0.250 (±0.550)
0.0500 (±0.224)
0.200 0.523 0.117 1.710 P=0.104
Effect on Mental status. Mental status has shown improvement by 0.250 after the treatment. The mean
mental status score initially was 0.300 which then reduced to 0.0500 after the treatment.
The change that occurred with the treatment is not great enough to exclude the possibility
that the difference is due to chance (P = 0.056)
Table No.48. Effect on Mental status.
Mean Paired ‘t’ test
B.T (S.D)
A.T (S.D)
DIFFERENCE IN MEANS
S.D. S.E.M.
‘t’ P
0.300 (±0.657)
0.0500 (±0.224)
0.250 0.550 0.123 2.032 P=0.056
Figure No.31 .Effect on Heart rate and Mental status.
0.3
0.05
0.25
0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
BT AT
Heart rate Mental status
100
Results
THE SPIROMETRIC RESULTS
Marked Spiro metric value changes can be seen before the treatment and
after the treatment. All the changes shows statistically highly significant. The mean value
of FVC changes from 2.153 to 2.742 after the completion of the treatment.
Table no.49.Effect of Vamana and Shatyadi Curna on Spirometric Parameters of
assessment in patients suffering from Tamaka shwasa.
Parameters
B.T (mean & ±SEM)
A.T (mean ±SEM)
S.D
S.E
‘t’
P
FVC Forced vital
Capacity
2.153 (± 0.191)
2.742 (±0.160)
0.352 0.0787 -7.490 P=<0.001
FEV1 Forced Exp Volume in 1 sec
1.104 (±0.0878)
1.857 (±0.137)
0.426 0.0953 -7.901 P=<0.001
PEF Peak expiratory Flow
1.251 (±0.0118)
3.590 (±0.311)
1.407 0.315 -7.430 P=<0.001
Figure no-32. Effect of Vamana and Shatyadi Curna on Spirometric Parameters of
assessment in patients suffering from Tamaka shwasa.
2153 2.742
1.104
1.857
1.251
3.59
0
1
2
3
FVC FEV1 PEF
BTAT
101
Results
The mean percentage value of predicted, in which the FVC value was
66.026 before treatment and is changed to 86.430 after the completion of the treatment.
The change that occurred with the treatment statistically significant change.
Table No.50. Effect of Vamana and Shatyadi Curna over the predicted percentage
in patients suffering from Tamaka shwasa.
Parameters B.T (mean & ±SEM)
A.T (mean ±SEM)
S.D
S.E
‘t’
P
FVC Forced vital Capacity
66.025 (±4.100)
86.430 (±3.713)
13.373 2.990 -6.824 <0.001
FEV1 Forced Exp Volume in 1 sec
41.065 (±2.379)
66.030 (±2.906)
12.141 2.715 -9.196 <0.001
PEF Peak expiratory Flow
18.515 (±1.666)
53.000 (±4.139)
19.852 4.439 -7.769 <0.001
FEV1/FVC% FEV1 as % of FVC
65.650 (±3.414)
81.105 (±3.265)
17.823 3.985 -3.878 P=0.001
Figure No-33. Effect of Vamana and Shatyadi Curna over the predicted percentage
in patients suffering from Tamaka shwasa.
66.025
86.43
41.065
66.03
18.515
53
65.65
81.105
0102030405060708090
FVC FEV1 PEF FEV1/FVC
BTAT
102
Results
Table.No.51.Effect on mean FVC value during the course of treatment
FVC Mean value
AT BT Day 1 (SEM)
Day 2 Day3 Day7 Day14 Day21 Day30
2.153 (± 0.191)
2.484 (±0.161)
2.445 (±0.166)
2.737 (±0.173)
2.655 (±0.180)
2.672 (±0.183)
2.742 (±0.160)
The following figure shows FVC value during 1st day(before treatment),2nd day(on the day of vamana),3rd ,7th ,14th ,21st ,and 30th day. Figure.No.34. Effect on mean FVC value during the course of treatment 2.7422.6722.6552.737
2.4452
2.153
0
0.5
1
1.5
2
2.5
3
D1 D2 D3 D7 D14 D21 D30
Mea
n
FVC
OVER ALL EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS
OF TAMAKA SHWASA:
In the overall effect of Vamana and Shatyadi curna indicate that 60% of patient showed complete remittance of the disease,30% of patient showed moderate remission ,where as 10% of patients showed average remission, while no change is not observed in this study.
103
Results
Table no-52. Over all effect:
Effect. No. of patients. %
Complete remission 12 60
Moderate remission 6 30
Average remission 2 10
No remission 0 0
Figure No.35.Over all effect.
60
30
10
0
0
10
20
30
40
50
60
Com remimod remiave remno rem
104
Discussion
DISCUSSION
Introduction:
Tamaka shwasa,a pranavaha srotovikara is such a disease which effects an
individual due to Atma Asatmya. Altered food habits, environmental pollutions etc are
the prime causative factors of this dreadful disease, which has its impact especially
during night hours and is episodic in nature, which is known by the name Bronchial
asthma in modern parlance.
Bronchial Asthma characterized by increased responsiveness of trachea and
bronchi to various stimuli and manifested by acute recurrent or chronic attack of
widespread bronchi- bronchiolar narrowing, variable in severity and usually of brief
duration.
As stated by W.H.O, 100-150 million of global population is suffering from
Bronchial asthma, out of which 1/10th of Indian population and the prevalence of Asthma
is increasing everywhere. It occurs at all ages but predominantly in the early life. About
one-half of cases develop before age 40 and another third occurs after the age 40.In
childhood there is a 2:1 male female preponderance but the sex ratio equalizes by age 30.
The indulgence of etiological factors leads to the morbidity of Vata Dosa and
Kapha Dosa. These morbid Dosa stemming out from the Pittasthana afflict the Rasa
Dhatu involving the Pranavaha Srotas, Udakavaha Srotas as well as Annavaha Srotas.
Within the Pranavaha Srotas the morbid Dosa cause stiffness of the channels impeding
the free passage of Prana Vayu. Further the abnormal accumulation of the Sleshma in the
Pranavahasrotas also adds to the obstruction. The combined effect of these pathological
events is obstruction to the Pranavayu manifesting as Pranavilomata. Difficulty in
breathing with paroxysmal productive cough with typical exacerbations and remissions
are the predominant clinical manifestations of Tamaka Svasa which occur in episodes.
In patients suffering from tamaka shwasa, who are physically strong, the shodhana
chikitsa forms the first line of treatment as it helps in clearing the obstruction of
pranavaha srotas by kapha dosa. Patient who is in vegavastha should be first subjected to
Lavana taila abhyanga followed by Nadi, Sankara or Prasthara sweda on the chest and
106
Discussion
back. .By these procedures kapha which has become stagnated and inspissated in the
srotas, get softened and liqueied, which then is easily expelled out by the procedure of
vamana karma.After vamana karma the small amount of kapha dosa which is still present
in the srotas is then cleared by the administration of Doomapana.
Clinical trials in regards to the efficacy of shodhana in tamaka
shwasa in different Ayurvedic research centers in and around India can just be numbered.
Further the assessment criteria in these works were limited to subjective and objective
criteria with out involving the spirometric evaluation of the system. There are 100’s of
medicines mentioned in the classics for the treatment Tamaka shwasa and are claimed to
be effective. Very few of such herbal or hebomineral combinations are proved by the
method of Randomized Clinical Trail. Hence there is a dire requirement of exploring the
efficacy of remaining herbo/herbo-mineral compounds. Keeping these factors in view
the present study is planned to know the therapeutic effect of `Vamana’ and shamana
with `Shatyadi Curna’.
The description regarding Tamaka shwasa is not found in prevedic or Vedic
period. In Vedas there is plenty of reference available regarding the physiological aspect
as well as pathological aspect of Pranavaha srotas. The word Shwasa is used in the first
time in Upanishad. Later in Samhitha period onwards there is abundant information
available regarding the disease Tamaka shwasa. The Vamana Karma is explained in
detail in all the samhithas.
The etiological factors either in the form of the faulty dietetic habits, behavioral errors, or
due to the insult by the environmental factors causing morbidity of kapha and vata dosa,
or disturbing the functioning of pranavaha srotas leads to the establishment of the
lingering disease tamaka shwasa.
In most cases the inherent constitution predisposes the allergy proneness.
That is, there is usually a correspondence between a person’s constitution and the
tendency of a particular system to develop hypersensitivity. Hypersensitivity refers to
pathologic processes that result from immunologically specific interactions between
107
Discussion
antigens (exogenous or endogenous) and humoral antibodies or sensitized lymphocytes.
This concept of hypersensitivity is described as atma asatmya in Ayurveda
Patient suffering from Tamakshwasa exhibits following symptoms and signs.
• Patient cannot breath properly, breaths with great difficulty ,tries to loosen
clothings at neck chest and waist, gets increased perspiration.
• There is typical whistling sound (sound of pigeon – Kapotkujanavat dhwani)
while breathing.
• Patient feels better and less trouble in breathing while in a sitting posture.
• There exists great difficulty in breathing in lying down position.
• Patient feels better with hot articles (hot water for drinking, oil massage of luke
warm oil to chest and then there after fomentation with hot water bag).
The fundamental treatment method of Samsodhana, Samsamana and
Nidana parivarjana mentioned in Ayurvedic classics, if administered judiciously, the
desired results can be achieved. In the present context, the re-validation of ancient
Ayurvedic or traditional compound preparations which can optimize the functions of
respiratory tract by reversing the inflammatory responses and imparting the Balam
of the system is important. The results of such preparations can be expected better
in combination with appropriate sodhana therapy.
The principles of treatment that are adapted in Tamaka Svasa include Sodhana,
Samana, Brumhana and Rasayana chikitsa. Observing the treatment modality explained
by Acharya for Tamaka shwasa we can interpret them as measures during the vegavastha
and during Avegavastha. By considering the atyayika avastha of disease one can plan the
treatment. Liquefaction of the Sleshma, expectoration of the sputum and Srotomardava
chikitsa forms the key treatment during the attack of the illness. This is achieved by
Lavana taila abhyanga and Nadisweda to the chest and back, Kapha utklesana Ahara, and
then Vamana which then followed by Dhumapana and Shamana treatment.
Samsodhana measures comprehend their own vital role in the management of
Tamaka shwasa amplifying the role of Doshapratyanika Chikitsa. Vamana is the popular
therapy adopted when kapha laxanas are dominant, keeping in mind the roga and the
rogibala. Vamana karma is very helpful to bring down the gurutwa and to relieve kapha
108
Discussion
which is occluding the pranavaha srotas. In between the attacks the treatment is planned
to prevent the further attacks, to eliminate the Kha-vaigunyata, and to improve the
immunity of the Pranavaha srotas. This is achieved by Virecana karma, Brmhana cikitsa
and Rasayana cikitsa.
Vata and Kapha dosha are the major pathological entity in the manifestation of
Tamaka shwasa. The Vata dosha attains Tiryak gati and produces the features like
shwasakrichrata,shwasochwasa,parshwasoola etc.The vitiated Kapha dosha produces
obstruction in the pranavaha srotas and produces Gurguratha sound. Here the
management should be directed towards Vata and Kapha dosha. The formulations like
Shatyadi curna contains Shati, Bargi, Vacha, Vyosha, Pathya, Ruchaka
lavana,Katphala,Tejovati,Pushkaramoola and Shringi, some of the very frequently used
drugs in Shwasa. Further more what is very important is that the efficacy of these drugs
in Tamaka shwasa, individually also has a research back-up. Obviously there is a
definite scope to speculate that a formulation constituting all the above twelve drugs must
find a rightful place in the management of Tamaka shwasa.
Hence the present study on this background was taken up to evaluate the
efficiency of Vamana and Shatyadi curna in patients of Tamaka shwasa.
Plan of the Study:
This is a single blind pretest posttest design ,clinical study .20 patients
between the age group 16 to 60 years suffering from Tamaka shwasa were taken for the
study from OPD and IPD of SDM college of Ayurveda Hospital,Udupi. The signs and
symptoms of Tamaka shwasa and Spiro metric parameters were mainly considered for
the diagnosis. As a routine, Hematological investigations were carried out in all the
patients taken for the study. The selected 20 patients were treated with Vamana in the
form of shodhana and shatyadi curna 5 gms tid with 10 ml of honey as shamana for the
period of one month.
109
Discussion
General description of Patients:
Age: 1 The present study includes the patients belonged to the age group of 16 to
60 years excluding children, and therefore it does not reflex the high incidence of this
disease in children. The present study includes maximum number of patients in the age
group of 26 to 30 years. The probable cause for increased incidence in this age group
may be because of high exposure towards the changing external environment & mental
factors which is related to their profession. Sex: The illness does not show any predilection for sex, in the present sample
taken for the study 75 % of the patients were females. This only indicates a sampling
variation due to the small size of the sample.
Marital status: 65 % of the patients recorded in this study were married. Once again
it is known that marriage has no relation with the causation or predisposition to the illness
Tamaka Shwasa. It may be possible that the responsibility of running family was one of
the causes for patients which may cause more stress, irregularity of diet & mithya vihara
sevana.
Religion: 85% of the patients in this sample were Hindus. The predominance of
Hindu caste in and around Udupi is reflected in this sample. The high incidence of illness
in Hindus in this study cannot predict anything because it is the demographic area which
plays major role in it.
Habitat incidence: Though the illness is most common in urban dwellers, the
present study shows higher incidence about 95% in rural people. This only reflects
predominance of rural population in and around Udupi.
Socio economic status: 55%of patients belonged to low class and another 45% of
middle class. About socio-economic status of patients, maximum numbers of patients
were of lower middle class. Inadequate health care and polluted environment may be
contributory in the causation of illness.
Occupation: Many of the patients were engaged beedi works and have risk of exposure
to dust, which is known to produce asthmatic type of symptoms. This shows the relation
between dust and Tamaka shwasa.
110
Discussion
Addiction of the patients: Though the smoking has incriminatory effect on the
respiratory system, badly affecting its defense mechanism, only 5% of patients registered
in the study, showed addiction to cigarette or beedi smoking. Since this addiction is
common in males and the sample taken for the study showed predominance of females,
so the incidence of smoking was low in the study.
Dietary habits: 85% of the patients registered in this study had mixed dietary habit.
Vegetarian, non vegetarian or mixed dietary habit has no role in predisposing the illness
Tamaka Shwasa. Even though maximum number of patients showed mixed diet, this
preponderance is only reflective of dietary habit of the population and the present sample
is the representative of this population
Deha prakruthi: Vata Pitta Prakriti was observed in a maximum of 70% of the patients.
20 % of the patients showed Vata Kapha Prakriti and10% of Pitta Kapha Prakruthi. None
of the patients showed Sama Prakriti in this study
Sara,Samhanana: All the patients were belongings to madhyama sara, 95 % of the
patients had Madhyama samhanana. In persistent cases the disease causes dhatu kshaya.
Probably the co-relation between disease & influencing of these factors cannot be proved
scientifically.
Satva,Satmya: Madhyama satva was observed in 80% of patients, prepondarence of
madhyama satva with incidence in 90% of patients was observed. Physical and emotional
stress is known precipitating factors for causation of the disease.
Agni: Analysis of the Agni in 20 patients suffering from Tamaka Svasa revealed that
70% of the patients had Samagni. Though the Pittasthana is involved in the pathogenesis
of Tamaka Svasa the state of Agni does reflect the same to a larger extent in this Study.
Koshta: In the present study the sample showed that 65% of patients had
madhyama koshta, 25% and 10% of patients were belonging to krura and mrudu koshta
respectively.
Shareera pramana,Vyayama shakthi: 65% of patient had madhyama pramana and
vyayama shakthi,35% of patients belongings to avara variety. Probably, it may be due to
111
Discussion
nature of the disease, as paroxysmal attacks in this disease person unable to do heavy
works. Patient always feels better in sitting position.
Therapeutic effect of medications:
By adapting standard methods, the subjective symptoms and objective signs are
scored. Patients were assessed before and after the treatment to know the favorable
response. Computerized Spiro meter was used to assess the lung functions.
Effect on severity:
Reduction in the severity of the illness was recorded in all the patients treated
with Vamana and Shatyadi Curna. Improvement shows statistically highly significant
(P<0.001). The different in mean was 2.400 after the completion of the research work.
Effect on Breathlessness:
The symptom Breathlessness was reduced from 2.450 to 0.0500 .Difference in
means after the treatment was 2.400.So this study shows reduction in the obstruction to
the passage of Pranavayu, results in reduction in Prana vilomata. The result shows
statistically highly significant (P<0.001).
Effect on Speech:
An assessment of the speech showed good improvement in the symptom. The
difference in mean score of speech was 2.250 to 0.500. More to say, ability to speak
continuously in a sentence depends upon the ventilation capacities. As the ventilation
capacity reduces, the speech will be reduced to single words. In the present study as
speech shows an improvement, it implies that ventilation capacities have increased
following treatment. This is only possible by the removal of obstruction in the Pranavaha
Srotas. Improvement shows statistically highly significant (P<0.001).
Effect on Cough:
Marked remission in severity of cough was observed in patients treated with
Vamana and Shatyadi curna the mean difference was 2.150 after the treatment. Cough is
a defense mechanism of the Pranavaha srotas. The presence of which is indicative of
irritating Sleshma in the Srotas. The medicines administered when expels this sputum or
112
Discussion
reduces production of the sputum in the Srotas then only the remission of the cough is
possible. In the above patients the reduction in the cough implies its tenacious sputum is
liquefied by the medicine and its expectoration is easy. The medication is also effective
in reducing the production of sputum in the Pranavaha srotas.
Effect on Sputum:
The amount of sputum reduced in patients treated with Vamana and Shatyadi
curna. The mean score was 2.000 and is reduced to 0.150.The reduction in the amount of
sputum is indicative of reduced secretion of Sleshma in the Pranavaha srotas.
Effect on Body position:
There was marked improvement in the body position from 2.050 to 0.0500. The
difference in mean recorded was 2.000. Improvement shows statistically highly
significant (P<0.001).The body position is indicative of severity of the illness. In severe
attacks of Tamaka Shwasa the patient will not be able to lie down. The improvement seen
indicates reduction in the airway obstruction as well as improved ventilation.
Effect on Respiratory Rate:
Best favorable response was observed in the respiratory rate of the patients during
the attack of breathlessness. Difference in mean score of rate of respiration was 0.650.
Rate of respiration is directly proportional to the severity of the illness. Reduction in the
rate of respiration indicates improvement. Thus the reduced respiratory rate suggests
remission of the severity of Tamaka Shwasa. Statistical analysis shows these change is
not by chance (P< 0.001).
Effect on Expansion of chest:
The mean score of expansion of the chest increased by 1.425.Improvement in
the ventilatory function of the respiratory system is the root cause for increase in the
expansion of the chest.
Effect on Labored breathing:
The ability to breath showed marked improvement in this study. The mean score
of labored breathing has reduced by 0.250 from the initial score of 1.700 before the
treatment. This shows correction of Pranavilomata.
113
Discussion
Effect on Breath sounds:
The mean score of severity of breath sounds have shown reduction in the
symptoms of Tamaka shwasa. The effect of Vamana and Shatyadi curna has therapeutic
effects like Sroto -mardavata, Kapha vilayana and Kapha nissaraka. These therapeutic
effects reduce the airway resistance. This in turn is reflected in the form of reduced added
sounds during respiration. The study shows statistically highly significant (P<0.001).
Effect on Heart rate:
The heart rate has shown a definite reduction after the treatment. The change that
occurred with the treatment is not great enough to exclude the possibility that the
difference is due to chance (P = 0.104).Heart rate is directly proportional to the severity
of the Tamaka Shwasa.
Effect on Mental state:
There was improvement in the mental status of the patients after the treatment.
The study shows improvement in the score from 0.300 before treatment to 0.0500 after
the treatment. The change that occurred with the treatment is not great enough to exclude
the possibility that the difference is due to chance (P = 0.056).
Spirometric evaluation:
The Spirometric parameters like FVC, FEV1, PEF, and FEV1/FVC were assessed
before and after the treatment. The result sowed that there was an increase in the lung
volumes following the treatment with Vamana and Shatyadi curna. The absolute value of
the FVC which was 2.153 before the treatment, which was raised to 2.742 following the
medication. This improvement shows statistically highly significant (P=<0.001). An
increase in the percentage prediction of the lung volumes was seen in patient treated with
Vamana and Shatyadi curna. The percentage prediction of FVC was 66.025 before
treatment that rose to 86.430 after the treatment.
The FEV1 showed marked improvement in the absolute value from1.104 to
1.857.The percentage prediction of this was 41.065 before the treatment and which
114
Discussion
elevated to 66.030 following Vamana and Shatyadi curna. All the spirometric values that
showed increase following medication was also found to be statistically significant as
assessed by paired t- test (P<0.001).
The PEF value shows marked improvement after the completion of the
treatment. The initial score was 1.251 and is increased in to 3.590 after the treatment. The
percentage value of this was 18.515 before the treatment and was increased markedly to
53.000.
The Spirometric value of FEV1/FVC% also showed significant improvement.
The initial percentage was 65.650 and is improved in to 81.105 after the treatment. The
change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = 0.001)
These improvements shows the reduction of airway resistance corroborating
the results observed in the signs and symptoms of Tamaka Shwasa.
In the overall effect of Vamana and Shatyadi curna indicate that 60% of
patient showed complete remittance of the disease, 30% of patient showed moderate
remission, where as 10% of patients showed average remission, while no change was not
observed in this study.
The treatment was given in the patients for duration of one month. None of
the patients developed any untoward symptoms or any side effects during the course of
the treatment and therefore these medicines in therapeutic dosage are very safe.
In the above said observation indicate that patient have shown improvement in
all the criteria of assessment of Tamaka shwasa. Stiffness of the Pranavaha Srotas,
accumulation of Sleshma leading to Prana vilomata is the basis of pathology of Tamaka
Shwasa. The therapeutic effects like Srotomardava, Kaphavilayana, Kaphanissarana
Kasaghna etc clears the air passage and also widened them. The medicine administered in
the present study have shown all these therapeutic effects and in that sense,this will be a
good suggestive treatment of Tamaka shwasa. The spirometric evaluation of the lung
volumes also showed in both absolute value as well as predicted values confirming the
rectification of Prana vilomata.
115
Discussion
After thorough analysis, it may be concluded that Vamana is effective in the
acute management of Tamaka Shvasa when Dosha is in Utklishtha stage and it can be
adopted any time when the patient needs. Thus it is one of the ideal Panchakarma
procedure in the management of acute attack of Bronchial Asthma. The Kapha Vatahara
drug used in the present study shows marvelous effect on Tamaka shwasa. In the overall
assessment it was seen that 60% of patients had complete relief, 30% patients had
moderate relief and 10% of patients had average relief. If one follows Rasayana therapy
after this, surely there will be complete remission of the illness.
It is very clear from the above discussion that the present study has a definite
role in the management of recurrent episodes of Tamaka Shwasa. The efficacy and safety
profile of the study drug was excellent in curing the symptoms of Tamaka Shwasa.
116
Conclusion
Conclusions
1. Vamana karma followed by the oral administration of Shatyadi curna is very
effective in reducing the severity of tamaka shwasa. The severity of Tamaka
shwasa which was 2.450 before the treatment reduced to 0.0500 after the
treatment. The improvement after the treatment is proved to be statistically highly
significant.
2. In the treated patients the assessment of symptoms before and after the treatment
that included breathlessness, cough, sputum, breath sounds, labored breathing
ability of the patient to speak, body position, rate of respiration all showed
definite reduction in severity. Also the improvement following the treatment
proved to be statistically highly significant.
3. Reduction in the obstruction of the pranavaha srotas is indicated by the
improvement in the chest expansion in treated patients. The improvement found
to be statistically highly significant.
4. Incriminatory effect of the illness on the pranavaha srotas mula ie hridaya is
indicated by the heart rate. Heart rate returning to normal following the treatment
proves the clearance of hrdaya upasosana effect of the illness.
5. Puraka Kumbhaka Recaka aspect of the pranavayu unravels its functional status.
The same is being expressed by the different lung volumes like FVC FEV1,
FEV1/FVC % PEF and is assessed by the spirometry. The marked improvement
in the lung volumes following the treatment reflects improvement in the
functional status of pranavayu. Or else to say the clearance of obstruction in the
pranavaha srotas achieved by the treatment rendered free movement of pranavayu
with in the pranavaha srotas.
6. The patients have shown improvement in all the criteria of assessment of tamaka
shwasa. In case of tamaka shwasa, the medicines administered should have the
therapeutic effects like Srotomardavakarana, Kaphaharana, Kaphavilayana,
Kaphanissarana and Kasaghna. These therapeutic effects clear the air passages
and also widen them. The ultimate effect will be reduction in the airway
117
Conclusion
resistance - the basic pathology of the tamaka shwasa. The medicines
administered have shown all these therapeutic effects and the severity of the
illness therefore has markedly reduced. In that sense, this will be a complete
treatment of tamaka shwasa.
7. The total regimen of 30 days is definitely effective in combating the illness and
also equally safe.
118
Summary
SUMMARY Tamaka shwasa,a pranavaha srotovikara is such a disease which effects an
individual due to Atma Asatmya. Altered food habits, environmental pollutions etc are
the prime causative factors of this dreadful disease, which has its impact especially
during night hours and is episodic in nature, which is known by the name Bronchial
asthma in modern parlance.
As stated by W.H.O, 100-150 million of global population is suffering
from Bronchial asthma, out of which 1/10th of Indian population and the prevalence of
Asthma is increasing everywhere. It occurs at all ages but predominantly in the early life.
About one-half of cases develop before age 40 and another third occurs after the age
40.In childhood there is a 2:1 male female preponderance but the sex ratio equalizes by
age 30.
In patients suffering from tamaka shwasa, who are physically strong, the
shodhana chikitsa forms the first line of treatment as it helps in clearing the obstruction of
pranavaha srotas by kapha dosa. Patient who is in vegavastha should be first subjected to
Lavana taila abhyanga followed by Nadi, Sankara or Prasthara sweda on the chest and
back. .By these procedures kapha which has become stagnated and inspissated in the
srotas, get softened and liqueied, which then is easily expelled out by the procedure of
vamana karma.After vamana karma the small amount of kapha dosa which is still present
in the srotas is then cleared by the administration of Doomapana.
Clinical trials in regards to the efficacy of shodhana in tamaka shwasa in
different Ayurvedic research centers in and around India can just be numbered. Further
the assessment criteria in these works were limited to subjective and objective criteria
with out involving the spirometric evaluation of the system. There are 100’s of medicines
mentioned in the classics for the treatment Tamaka shwasa and are claimed to be
effective. Very few of such herbal or hebomineral combinations are proved by the
method of Randomized Clinical Trail. Hence there is a dire requirement of exploring the
efficacy of remaining herbo/herbo-mineral compounds.
119
Summary
Keeping these factors in view the present study is planned to know the
therapeutic effect of `Vamana’ and shamana with `Shatyadi Curna’.
This is a single blind pretest posttest design ,clinical study .20 patients
between the age group 16 to 60 years suffering from Tamaka shwasa were taken for the
study from OPD and IPD of SDM college of Ayurveda Hospital,Udupi. The signs and
symptoms of Tamaka shwasa and Spiro metric parameters were mainly considered for
the diagnosis. As a routine, Hematological investigations were carried out in all the
patients taken for the study. The selected 20 patients were treated with Vamana in the
form of shodhana and shatyadi curna 5 gms tid with 10 ml of honey as shamana for the
period of one month.
Obervation and Results:
The present study includes maximum number of patients in the age group of
26 to 30 years, the sample includes 75 % of females patients, 65 % of the patients were
married, 85% of the patients were Hindus, about 95% patients from rural area, 55%of
patients belonged to low class, many of the patients were engaged beedi works, only 5%
of patients showed addiction to cigarette or beedi smoking., 85% of the patients had
mixed dietary habit.
Vata Pitta Prakriti, madhyama sara, madhyama samhanana, madhyama satva
was observed in a maximum no.of the patients. Most of the patients had Samagni, and
madhyama koshta. The pramana and vyayama shakthi was also madhyama in maximum
no.of patients.
Reduction in the severity of the illness was recorded in all the patients
treated with Vamana and Shatyadi Curna. Improvement shows statistically highly
significant
The symptom Breathlessness was also reduced This shows reduction in the
obstruction to the passage of Pranavayu, results in reduction in Prana vilomata.
120
Summary
There was significant improvement seen in other Spiro metric parameters
These improvements shows the reduction of airway resistance corroborating the results
observed in the signs and symptoms of Tamaka Shwasa.
In the overall effect of Vamana and Shatyadi curna indicate that 60% of
patient showed complete remittance of the disease, 30% of patient showed moderate
remission, where as 10% of patients showed average remission, while no change was not
observed in this study.
The treatment was given in the patients for duration of one month. None of
the patients developed any untoward symptoms or any side effects during the course
of the treatment and therefore these medicines in therapeutic dosage are very safe.
Vamana is effective in the acute management of Tamaka Shvasa when
Dosha is in Utklishtha stage and it can be adopted any time when the patient needs.
Thus it is one of the ideal Panchakarma procedure in the management of acute attack
of Bronchial Asthma. The Kapha Vatahara drug used in the present study shows
marvelous effect on Tamaka shwasa. In the overall assessment it was seen that 60%
of patients had complete relief, 30% patients had moderate relief and 10% of patients
had average relief. If one follows Rasayana therapy after this, surely there will be
complete remission of the illness.
.
121
Bibilography
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53. Sushrutha, Sushrutha samhita, Nibandhasamgraha commentary of Daldanacharya and
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133
Proforma
S.D.M AYURVEDA HOSPITAL, KUTHPADY, UDUPI
A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CURNA IN PATIENTS OF TAMAKA SHWASA
Name: Social Status: L/M/U Age: Serial No: Sex: OPD/IPD No: Place of Birth: U/R Bed No: Date of Birth: DOA: Marital Status: M/UM/W/D DOD: Place: U/R Diagnosis: Religion: M/Ch/J/Others Postal Address: Occupation: Business/House wife/Employees/ Agriculturist/Student/Others Main Complaints: Shwasa/Kasa/Kapha Nistivana/Rakta Nistivana/Pratishyaya/Kshavathu/Nasanaha/Nasa Rakta Srava/Shirasula/Kantakandu/Kapha Shtivana/Wheezing/Urashula/Jwara. Duration:- days/months/years. History of present illness:
A. Shwasa:
1.History of -Amadosa/Anaha/Atisara/Chardi/Udavartha/Visucika/Alasaka/Sharira Rukshata/Atyapatarpana/Daurbalya/Raktapitta/Panduroga/Jwara/Marmaghata/ Vishasevana/Shudhyatiyoga/Kasa/Kshatakshaya/Pratishyaya. Duration:-for the last days/months/years. 2.Mode of onset and course: Shigrotpatti/Chirotpatty,Ashukari/Chirakalasthayi,Nirantara/Santata/Savegavan, Progressive/Exacerbation and remission,Nocturnal episodes,Shwasa induced by-aspiration of food,Oropharyngeal contents/Foreign body,Shwasa precipitated by Ruksa Ahara/Ayasa/Raja/Dhuma,Attacks once/Twice a week/Month/Year, Individual attacks last in-response to Ayurvedic/Allopathic treatment. 3.Character: Pranavilomata(laboured expiration),Sudhirga SaShabdha Shwasa(loud prolonged expiration),Sudhirga Urdhwa Shwasa Nishwasarahita(prolonged expiration with no or little inspiration), Sudhirga Urdhwa Shwasa Nishwasayukta(prolonged expiration followed by inspiraton),Chinna Shwasa(Phase of respiration and no respiration occurring alternatively),Sense of fatigue in the chest/Vague discomfort in the chest/Sense of suffocation or chocking/Undue awareness of breathing and
134
Proforma
an uncomfortable/Abnormal form of breathing observed in unconscious patient/Breathlessness. 4.Severity: Mridu-good functional ability,Daruna-poor functional ability or confined to bed, Present at rest/Develops with gentle activity like undressing or walking on level ground/develops during moderate exertion such as climbing the stairs/Develops on strenuous exercise/Breathlessness disturbs sleep. 5.Aggravating factors/Precipitating factors: Amuchyamana Slesma/Shayana Avasta/Megha/Ambu/Pragvata/Sheeta/Slesmala Ahara Vihara/Raja/Dhuma/Ratri Samaya/Swapataha Vruddhi/Manodosa. Spontaneous exertion/Bout of coughing/Emotional stress/Anxiety/Lateral decubitus/Allergens-plants debris/Pollen/Feather/Animal dandruff/Moulds. Aspirin/Indomethacin/Drug allergies. 6.Relieving factors: Slesma Nistivana/Ushna Upacara/Asine Sukhanubhava. 7.Associated phenomena: Pranasta jnana/Pranasta vijnana/Murccha/Moha/Vibranta lochana/Vikritaksi/Urdhwa dristi/Raktaika lochana/Utsunaksa/Vikritanana. Jwara/Arati/Marma Cheda Ruk/Vedanarta/Lalata Sweda/Kampa. Kantodhwamsa/Kasa/Pratishyaya/Shirasula/Kanta Gurgurata. Mutradaha/Mutrarodha/Hypotension/Pruritis Chardi/Atisara/Skin flushing/Urticaria Wheezing/Stuffiness of nose/Running nose/Sneezing/Throat irritation/Soreness of throat/Chest pain/Palpitation/Sweating. 8.Seasonal Variation: Sheeta Kale Vruddhi/Varsha Kale Vruddi/Aniyamita-nonseasonal/Worst during summer season.
B.Kasa:
1.Duration: for the last days/weeks/months/years 2.mode of onset:Shigrotpatti/chirotpatti/asukari/chirakalastayi. 3.History of:
Shukapurna Galasyata,Kantakandu,Aruchi/Hridaye aswasthatha,Bhojana vimarga gamana,Shwasa vikruti,Pratishyaya,Kshavathu,Sleshmapraseka,Mukhamadhurya,Anannabhilasha,Hrillasa,Dosadarshanam,Mukhashopha,Padashopha,Pandu,Streekamata,Swapna darshana.
135
Proforma
Madhura,Amla, Katu,Kashaya,Kshara ahara,Ruksha,Snigdha,Sheeta,Ushna ahara,Vidahi ahara, Alpashana,Praamitashana,Abhishyandi ahara,Ati vyayama,Bharavahana,Atiadhwa,Yuddha,Aticheshtata,Swapna. 4. Course: Nirantara/Santata/Savegavan/Progressive. Duration of episode symptom free period 5. Type: Shushka kasa/Ardra kasa/Bhinna kansyopama dhwani/Short paroxysmal/Metallic/Brassy/Bovine/Hoarse/Harsh cough. 6. Time: On rising in the morning, Going to bed at night, Change in posture left to right lateral position, Night hours, Nonspecific. 7. Severity: Kasa vega- tamodarshana, Jyothi darshana, Mahavega kasa, Mahadhwani kasa,Kshoba, Moha. Fainting, Vomiting, Exertion. 8. Aggravating factors: Cold food articles, Change in temperature. 9. Relieving factors: Kapha nishtivana, Snigdha ahara, Amla ahara, Ushna ahara. 10. Seasonal variation: Worst during – Rainy,Winter,Spring,Summer seasons. 11. Associated with : Hrit shula, Shira shula, Parshwa shula, Prishta graha, Parva bheda, Kanta ruk. Swarabhedha, Urashushkata, Kanta shushkata, Vaktra shosha, Urodhoomayana, Peenasa, Shwasa. Romaharsha, Santapa, Peeta netra, Trushna, Daha, Moha, Bhrama, Gourava, Dourbalya, Krishata, Balakshaya.Tiktasyata, Aruchi, Mandagni, Chardi, Utklesha, Madhurasyata, Bahwashi. Bhinnasamhata varcha, Rakta mootra. Prasanna vaktratwa, Akasmath ushna sheeta iccha, Srimad darshana.
B. Sputum:
1.Duration: for the last days/weeks/months/years 2.Amount : Bahu,Alpa ml in 24 hrs
136
Proforma
3.Character: Snigdha, Tanu, Ghana, Gratita, Kutita, Puyopama, Picchila, Watery, . Mucoid, Muco purulent, Purulent.Frothy,Shiny, Translucent, Casts. 4.Colour: Pitta, Samsrita, Sashonita, Harita, Lohita, Shyava, Shweta. Colour less,
Haemorrhagic, Whitish, Yellowish,Greenish,Rusty,Anchovy sause, Pink,Grey. 5. Odour: Visragandhi, Durgandhi, Lohagandhi, Offensive, Non-offensive,
Nauseating, Purulent. 6.Taste: Madhura, Lavana, Nauseating. 7. Brought out by: Coughing, Clearing the throat, Changing the body position,
Vomiting, Sneezing D.Sneezing: 1.Duration: for the last days/weeks/months/years 2.Mode of onset: Sudden/Gradual/Insidious. 3.Severity: As in a bout/Annoying/Exhausting. 4.Course:Episodic/Persistent/Progressive/Irregular. 5.Aggravating/Inducing factors:
Exposure to dust/Pollen/Moulds/Animal danders.Cold water/Tender coconut/Fruits/Ice- creams/Cold beverages. Sudden change in the atmospheric temperature/Morning hours/Cold weather.
6.Associating Symptom: Rhinorrhoea/Stiffiness of nose/Itching of nasal mucosa/Itching in
conjunctiva/Itching in auditory meatus/Lacrimation. E.Rhinorrhoea: 1.Duration: for the last days/weeks/months/years 2.Course:Recurrent/Progressive/Irregular/Persistant. 3.Character:Watery/Mucoid/Mucopurulent/Purulent/Blood stained frank blood. 4. Aggravating factors:
Exposure to dust/Pollen/Moulds/Animal danders.Cold food articles/Morning hours/Cold weather.
137
Proforma
5. Associating Symptom: Sneezing/Stuffiness of nose/Nasal itching /Itching in conjunctiva/Irritation in auditory meatus/Lacrimation/Excoriation of nares
F.Shirasula: 1. Duration: for the last days/weeks/months/years 2. Mode of onset: Sudden/Gradual/Insidious/Progressive/Recurrent/Waxing and
waning/Clock like regularity. Frequency: in a week/month. 3.Character:Dull and aching, Deeply located,Throbbing,Bursting,Boring,Shooting, Darting, Constant band like pressure,Burning,Stinging,Smarting 4.Localisation:Unilateral,Bilateral,Deeply located,Frontal,Occipital,Vertical, Temporal. 5.Time of onset: Early morning, Evening,Nocturnal,Mid morning,Momentory, . Premenstrual,After a period of inactivity -Single attack over a period of hours/days. 6.Severity:Mild,Moderate,Allows routine work, Awakes at night, Prevents sleep, Dim environment,Rest,Sleep 7.Associated with: Respiratory symptoms, Pain and restriction of neck movement,
Nausea,Vomiting,Visual disturbance,Anxiety,Depression,Nasal obstruction, Nasal discharge, Fits.
G.Chest pain: 1. Duration: for the last days/weeks/months/years 2. Mode of onset: Sudden/Gradual/Insidious/Episodic. 3.Site:Mid sternal,Substernal,Sub mammary,Precordial,Left infra mammary, Left
Supra mammary,Spinal,Breast. 4.Type:Pressing,Constricting,Heaviness,Burning,sharp,Boring,Deep,Dull,
Steady,Unwavering,Superficial,Synchronous to heart beat. 5.Radiation:Shoulder,Tip of shoulder,arms,neck,jaw,along the course of
intercostals nerve,back,abdomen. 6.Aggravating/Precipitating
factors:Effort,Excitement,Fatigue,Overeating,Recumbency,Swallowing,
138
Proforma
Coughing,Sneezing,Staining,Lying on the affected side, Breathing, Twisting the trunk, Contraction of muscle, Food intake.
7.Relieving factors:Rest,Sublingual nitrates, Leaning forward, Sitting posture,
Lying on the affected side, Food intake. 8.Duration:Few seconds,minutes,hours,days. 9.Associated:Symptoms:Palpitation,Sighing,Sweating,Dyspnoea,Haemoptysis, Fatigue, Morning stiffness. H.Fever: 1. Duration: for the last days. 2. Mode of onset and course: : Sudden/Gradual/Insidious/Stepladder fashion/ Recurrent. 3. Type:Continous/Remittent/Quotidian/Tertian/Quartan/Irregular. 4. Severity:Mild,Moderate,Severe 5. Difervescence:Crisis,Lysis 6.Associated symptoms: Rigor, Chill, Convulsions ,Delirium, Headache,
Bodyache, Anorexia, Respiratory symptoms, Urinary symptoms .
I. Itching:
1. Duration: For the last days/weeks/months/years
2. Mode of onset: Sudden/Gradual/Insidious. 3.Course:Episodic/persists for days/months. Frequency months. 4.Site:Generalised,Localized, Diffuse,Circumscribed.
5.Associated with: Wheal, Papule, Vesicle,Erythema,Oozing, Crust, Scaling, Pigmentation, Lichenification .
6.Precipitating factors: Spontaneous, Food……………. Contact with substances……………… drugs………… 7.Associated symptoms: Fever
139
Proforma
Past history: H/O Tonsillectomy, Tuberculosis, Sinusitis, Skin allergy . Treatment history: Ayurvedic: Sodhana-Snehana, Swedana, Vamana, Virechana. Samana…………….. duration Medicines- Response State on discontinuing- Allopathic:Route-Oral,Parenteral,Inhalers. Regular,Irregular,SOS use. Bronchodilators,Antihistamines,Steroids,Expectorant, Nasal decongestants,Others. Duration- Hospitalisation Response:
Personal History: Occupation: Work hours Exercise:Minimum,Moderate,Heavy. Hours of rest in a day: Appetite-Good/Poor/Moderate,State during the attack Diet:Veg/Nonveg//Mixed. Break fast…….
Mid morning- Lunch- Dinner- Snacks in the evening – Fruits- Regular/Occasional;Cold water-Regular/Occasional; Cold beverages- Regular/Occasional;Butter milk/Curds- Regular/Occasional;spicy food-
140
Proforma
Regular/Occasional;Fried items- Regular/Occasional;Ice cream-- Regular/Occasional;Cucumber- Regular/Occasional; Bowel:Formed, Unformed, Hard,Smooth,Watery, Mucous,with blood,Color-Regular ,Constipated. Once in……..days. Painful defaecation,Mass per rectum Sleep: Sound,Disturbed,Good-at night,Difficulty in falling asleep,Staying asleep Daytime naps-If disturbed-reason. Habits: Duration Regular Stopped Relationship Comments Occasional Reduced with Amount Continued Symptoms Smoking Alcohol Coffee Tea Snuff Tobacco Others
Obstetric History:
No of delivery………..Normal……….Surgical intervention……………. Abortions…………Last delivery………
Gynecological History:
Menstrual cycle…………Regular/Irregular. Menarche age……………Bleeding days………… Menorrhagia,Metrorrhagia,Dysmenorrhoea,Leucorrhoea. Menopause……………
General Examination:
Dashavidha Pareeksha-
1.Prakrititaha-Doshaja 2.Sarataha- 3.Samhananataha- 4.Vyayamashaktitaha-
141
Proforma
5.Vayataha- 6.Pramanataha-Height…….Weight… … 7.Satvataha- 8.Abhyavaharana Shaktitaha- 9Jarana Shaktitaha- 10.Deshataha-Jata Samvruddha Vyadhita
Astasthana Pareeksha- 1.Nadi- 2.Mala 3.Moothra- 4.Jihwa- 5.Sabda- 6.Sparsha- 7.Drik- 8.Akruti-
Rogi Pareeksha:
• Built-Slender,Lanky,Muscular,Stocky,Obese. • Nourishment-Good,Fair,Poor. • Nails-Pink,Pallor,Bluish • Conjunctiva-Pink,Pallor,Bluish. • Cyanosis-Extremities-upper,lower;Buccal mucosa,Lips,Conjunctiva. • Deformities • JVP-Raised,Only during expiration,Pulsation. • Oedema-Foot,ankle,leg,sacral,hands,face.Pitting/Non-pitting. • Nasal discharge-Watery,Mucoid,Purulent, Blood stained, Mucosal
alasation, Polyp, Hypertrophy of turbinates, Atrophy, Ulceration, Activa, Alae nasi.
• Sinuses- Frontal, Maxillary • Teeth-Caries
142
Proforma
• Gums-Spongy, Bleeding, Unhealthy • Pharynx- Inflammed,Adenoids • Tonsils- Enlarged, Inflamed, Folliculous
Lymph nodes- (palpable, enlarged,number, overlying skin, consistency, mobility, matting, adherence to skin ) 1) Pre auricular
2) Posterior auricular 3) Occipital 4) Submental 5) Submaxillary 6) Superficial cervical 7) Deep cervical 8) Inferior deep cervical 9) Tonsilar
10) Axillary 11) Inguinal
Pulse- /min,Regular,Irregular,Full, Weak, Bounding, Anacrotic, Dicrotic, . Arterial wall thickening. B.P-----------mm of Hg Inspiration……..Expiration ………… Temperature………. Skin
• Size and Shape of the chest-Bilaterally symmetrical, Elliptical, Conical, Long and flat, Alar chest, Ricketic chest, Harrisons sulci, Funnel chest,, Barrel chest, Local retraction, Kyphosis, Scoliosis, Local bulging.
• Diameter- Transverse, Antero posterior
• Expansion of chest • Movement of chest – Symmetrical, Reduced in left/right side,
Synchronicity of movement, Delayed movement in left, right. Inspiratory retraction of interspace exaggerated, Diminished, right , left, Movement of costal margins during inspiration, outward inward, Over action of accessory muscles.
• Rate of respiration………../min
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Proforma
• Rhythm-Regular, Irregular, Periodic breathing, Prolonged inspiration, Prolonged both phase, Kussmaul’s respiration, Ataxic breathing, Apneustic breathing, Catch in breathing
• Type –Abdominal, Thoracic, Abdomino-thoracic, Thoraco-abdominal,
Pursed lip breathing, Shallow breathing
• Sternomastoid sign
• Distended chest veins
• Oedema-Unilateral,Bilateral
• Respiratory Movements – Symmetrical, Diminished in left/right , Accentuated in left/right, Asynchronised, Delayed in left/right, Diaphragmatic movement, Normal, Absent, Paradoxicol
Symptoms BT AT1 AT2 AT7 AT14 AT21 AT30 Severity Breathlessness Speech Cough Sputum Body position Respiratory rate Expansion of chest
Laboured breathing
Breath sounds Heart rate Mental status FVC FEV1 PEF FEV1/FVC% Broncho dilators
144
Proforma
VAMANA KARMA: Drugs: Pippali- gms. Time- Vaca- gms. B.P- mm of Hg. Saindava- gms. Pulse- /min. Madhu- Ksheera- Yastimadhu Phanta- Vamana Nireekshana:
Vaigiki
No.of Vegas-
Maniki
Total input = Total output = Extra =
Antiki
Kapha, Pitta, Anila
Laingiki
Hrut, Parsva, Moordha, Indriya, Marga - Shudhi, Laghuta.
Tatkaleena paschat karma- B.P- mm of Hg. Pulse- /min. Doomapana- Samsarjana-
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Proforma
Investigations: Hbgm%- TC- DC- ESR- ECG- RESULTS: DISCUSSION: Signature of the Co- Guide Signature of Guide Signature of Scholar
146
Proforma
DEPARTMENT OF P. G. STUDIES IN KAYACHIKITSA
S.D.M. COLLEGE OF AYURVEDA & HOSPITAL, UDUPI.
Clinical Trial : A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CHOORNA IN TAMAKASHWASA.
Guide:Dr.G.Shrinivasa Acharya.M.D(Ayu) Co-Guide:Dr.Shrilatha Kamath.T.M.D(Ayu) Researcher:Dr.Madhusudhanan.I.K
PATIENT CONSENT FORM
I exercising my free power of choice, hereby give
my complete consent to be included as a subject in the Clinical trail on ‘ A CLINICAL STUDY TO EVALUATE THE EFFECT OF VAMANA AND SHATYADI CHOORNA IN TAMAKASHWASA. I have been informed to my satisfaction by the attending Doctor, the purpose
of the Clinical trail and the nature of therapeutic procedures follow-up and probable
complications. I am also ready to undergo necessary Laboratory Investigations to monitor
and safeguard my body functions. I am also aware of my right to opt out the trail at any
time during the course of the trail without having to give the reason of doing so.
----------------------------------- --------------------------- Signature of the Doctor Signature of the Patient / Guardian ( Dr.Madhusudhanan.I.K)
147