Kaphaketuras kaphajakasa rs003-gdg

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Preparation and Physico-Chemical Analysis of Kapha ketu rasa and its Clinical efficacy on Kaphaja kasa” - Dr. Pattanashetti. R.B, Department of rasashastra, Post graduate studies and research center, …

Preparation and Physico-Chemical Analysis of Kapha ketu rasa and its Clinical efficacy on Kaphaja kasa” - Dr. Pattanashetti. R.B, Department of rasashastra, Post graduate studies and research center, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag

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  • 1. PREPARATION AND PHYSICO-CHEMICAL ANALYSIS OF KAPHAKETU RASA AND ITS CLINICAL EFFICACY ON KAPHAJA KASA By Ravikumar B. Pattanashetti. Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M.D. In RASASHASTRA Under the guidance of Dr. Dilipkumar. B.M.D. (Rasashastra) And co-guidance of Dr. Girish N. Danappagoudar.M.D. (Rasashastra) DEPARTMENT OF RASASHASTRA, POST GRADUATE STUDIES AND RESEARCH CENTER,SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG – 582103. 2005
  • 2. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled“Preparation and Physico-Chemical analysis of Kaphaketu rasa andits clinical efficacy on Kaphaja kasa” is a bonafide and genuineresearch work carried out by me under the guidance ofDr. Dilipkumar. B. M.D. (Rasashastra). Asst. Professor, Post graduatedepartment of Rasashastra and Co-guidance of Dr. Girish N.Danappagoudar, M.D. (Rasashastra), Lecturer, Post graduate department ofRasashastra.Date:Place: Gadag Ravikumar B. Pattanshetti.
  • 3. SHRI D. G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF RASASHASTRA CERTIFICATE BY THE CO – GUIDE This is to certify that the dissertation entitled “Preparation andPhysico - Chemical analysis of Kaphaketu rasa and its clinicalefficacy on Kaphaja kasa” is a bonafide research work done byRavikumar B. Pattanshetti in partial fulfillment of the requirement forthe degree of Ayurveda Vachaspathi. M.D. (Rasashastra).Date:Place: Gadag Dr. G. N. DanappagoudarM.D. (Rasashastra). Lecturer, Department of Rasashastra, Post Graduate studies and research center DGM Ayurvedic Medical College. Gadag
  • 4. ENDORSEMENT BY THE H.O.D, PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Preparation andPhysico-Chemical analysis of Kaphaketu rasa and its clinicalefficacy on Kaphaja kasa” is a bonafide research work doneby Ravikumar B. Pattanshetti under the guidance ofDr. Dilipkumar. B.M.D. (Rasashastra), Asst. Professor, Post graduatedepartment of Rasashastra and Co-guidance of Dr. Girish N.Danappagoudar. M.D. (Rasashastra), Lecturer, Post graduate department ofRasashastra.Dr. M. C. Patil, M. D. (Ayu.) Dr. G. B. Patil.Professor and H. O. D. Principal,Post graduate Dept. of Rasashastra. DGMAMC,Gadag.DGMAMC, Gadag.Date : Date:Place: Gadag Place: Gadag
  • 5. COPYRIGHT Declaration by the candidate I herby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and disseminatethis dissertation / thesis in print or electronic format for academic /research purpose.Date:Place: Gadag Ravikumar B. Pattanshetti © Rajiv Gandhi University of health Sciences, Karnataka
  • 6. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasa Acknowledgement First and foremost, I salute almightily God who is omnipresent, omniscient andomnipotent. He is the possessor of the ocean of knowledge and wisdom - to which I would like tocontribute a drop in the form of my dissertation. As it is said, each and every drop goes to make anocean, so this is my humble endeavor towards its goal of wisdom. It gives me inexpressible pleasure to offer my sincere thanks to all those who haverendered their wholehearted support, guidance and Co-operation in completing the thesis work. My deep sense of gratification is due for my parents who are the architects of my career.The culture, discipline and perseverance, which I could imbibe, is solely because of theirpainstaking, upbringing and strong moral support. I am extremely happy to express my deepest sense of gratitude to my beloved and respectedHOD and Prof. Dr. M. C. PatilMD.(Rasashastra) whose sympathetic, scholarly suggestions andguidance at every step have inspired me not only to accomplish this work but in all aspects. I express my deep gratitude to my respected guide Dr. Dilipkumar B. MD.( Rasashastra) for hiscritical suggestions and expert guidance for the completion of thesis. I am extremely grateful to my co-guide Dr. G. N. Danappagowdar,MD. (Rasashastra) underwhose guidance, inspiration, supervision and valuable suggestions, I have been able to completethis research work. Principal, Dr. G. B. Patil, D. G. Melmalgi Ayurvedic Medical College, Gadag, who’svaluable suggestions during the course of my academic career has shown me the way of perfectness.I convey my sincere gratitude to our beloved Principal. It is Dr. S. H. Doddamani MD (Ayu) and Dr. Jagadish Mitti, MD (Rasashastra) who helped me inevery step of this thesis work and supplied the information’s wherever necessary. I will remembertheir service with deep sense of gratitude for ever. I take this opportunity to thank HOD’s, of other departments Dr.VaradhacharyuluMD(Ayu), Dr. PurushothamacharyuluMD(Ayu) and Dr. G. V. MulgundMD(Ayu). Fortheir inspiration and valuable suggestions. I am grateful to all the PG, teachers Dr. K. S. R. PrasadMD.(AYU), Dr.ShivaramuduMD.(AYU), Dr. R. Y. ShettarMD.(AYU), Dr. Kuber SankMD.(AYU), Dr. SantoshBelvadiMD.(AYU), Dr. MulkiPatil, Dr. Yasmin, MD.(AYU), Dr. Shashidhar NidagundiMD.(AYU), andDr. D. M. Patil MD.(AYU), for their valuable inputs and suggestions. Acknowledgement - I
  • 7. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasa I extend my immense gratitude to Dr. R. K. Gacchinmath, Dr. G. S. Hiremath, Dr. S. A.Patil, Dr. U. V. Purad, Dr. B. G. Swami, Dr. Paraddi and other teaching staff who helped duringmy study. I take this opportunity to thank Dr. Chandur, Lecturer J. T. Pharmacy College, Gadag,who extended valuable support by conducting analytical procedures. My sincere thanks are extended to Dr. Basavaraj SaraganachariMD.(AYU), for hisinspiration and valuable suggestions. I would like to express my sincere thanks to Mr. V. M. Mundinamani, Librarian andAsst. Librarian Mr. S. B. Sureban for providing valuable books in time throughout the study. I am thankful to Mr. P. M. Nanadakumar, Statistician, who helped me in StatisticalAnalysis. I extend my sincere thanks to my seniors Dr. Srinivas Reddy, Dr. Hanumanth Gowdaand Dr. Shankar Gowda for their guidelines and timely rendered help. I can not move further before thanking to my beloved friend Dr. Varsha who have sharedall the moments of joy and sorrow with me continuously during my Post Graduate studies. I feel proud in expressing my sincere gratitude to my best friends Dr. Naganur, Dr.Hosalli, Mr. Sanjeev, Mr. Mahantesh,, Smt. Manjula, Dr. Vinod, Dr. Mahadev, Dr. Gurav, Dr.Pampanagowda, Dr. Seema. M. B., who not only helped me but stood by me during hours of stressand dejection. I take this moment to express my thanks to all my Post Graduate colleagues Dr.Santhoji, Dr. Jaggal, Dr. V. S. Hiremath, Dr. Koteshwar, Dr. Joshi, Dr. Chetan and JuniorColleagues Dr. Ganti, Dr. Pradeep, Dr. Sobagin,, Dr. Sasvihalli,, Dr. Teggi,, Dr. Sharanu, Dr.Anand, Dr. Suvarna, Dr. Anitha, Dr. M. S. Hiremath, Dr. Lingareddi,, Dr. Vijay, Dr. Umesh,Dr. Jagadish and Dr. Anand Doddamani. I am very much thankful to my room mates Dr. Kalmath,, Dr. Nagaraj, Dr. Santosh,,Dr. Venkareddi,, Dr. Jayaraj, Dr. Hugar, and Dr. Ramesh for their help and co-operation.. I am very much thankful to Raghu S. K. and Raju S. K., Net Nota Cyber Café, Gadag fortheir timely help in typing and bringing out this computer print. Last but not least, I thank to the patients who are pillars of my research work and to allthose names my memory fails to recollect. Dr. Ravikumar B. Pattanashetti. Acknowledgement - II
  • 8. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasa ABSTRACTBackground: In Ayurvedic literature, the classification of the disease Kasa has been donemainly on the basis of the nature of sputum. In Kaphaja Kasa patient expectoratesBahula (copious), Snigdha (unctuous), Sandra (viscid) and Swetha (white) colouredsputum. The reason for which is the hyper secretion of mucous in Pranavaha Srotas(Respiratory system). Kaphaja Kasa is one among Pranavaha Srotodusti vyadhi.Kaphaketu Rasa is a formulation which combats the Pranavaha Srotodusti vyadhis(Respiratory disorders) especially Kaphaja Kasa. Hence this study has beenundertaken.Objectives: Preparation of Kaphaketu rasa Physico – chemical analysis of Kaphaketu rasa. To evaluate the clinical efficacy of Kaphaketu rasa in the selected cases of Kaphaja kasa patients.METHODS: Pharmaceutical Study: Tankana Shodhana. Shankha Shodhana and Marana According to Rasatarangini Vatsanabha ShodhanaAnalytical study : Kaphaketu rasa is subjected for Physico-chemical analysis likeAssay for Boron and Calcium, Acid insoluble ash, Loss on drying at 110oC, Loss onignition at 450oC, Organoleptic characters, Friability test, Disintegration time,Weight variation, Size variation, pH study, Solubility t, Test for alkaloids etc., Acknowledgement - III
  • 9. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasaClinical study : 30 patients of Kaphaja Kasa with confirmed diagnosis were selectedby Simple random technique. Subjective and Objective parameters were consideredfor assessment.Results : Kaphaketu rasa reducing signs and symptoms of Kaphaja Kasa which isconfirmed by the value of Subjective and Objective parameters has the statistical “p”value < 0.001. At the completion of study data was scrutinized and results were obtained bystatistically analyzing the data given to subjective and objective finding before andafter treatment. In this study it was observed and analyzed that, the effect of“Kaphaketu rasa” was statistically significant and it is suggested that this formulationhas significant role in the management of Kaphaja Kasa.Interpretation and Conclusion: The dravyas which are mentioned in Shodhana ofVatsanabha and Shankha, neutralizes the toxic properties and converts them intotherapeutically effective form. Shankha Marana: Ayurvedic Bhasama Pareeksha and modern physico- chemical analysis are the confirmative tests for the complete formation of bhasma and its genuinety. The Bhavana dravya Ardraka helps in subsiding the disease and also enhance the property of Kaphaketu rasa. Anupana also takes role in subsiding the disease by helping quick absorption of drugs. Kaphaketu rasa is one of the best formulation for Kaphaja Kasa.Key words: Kaphaketu rasa, Kaphaja kasa, Pranavaha srotas, Lungs, Chronicbronchitis, Vati Kalpana, Tankana, Shankha, Vatsanabha, Pippali. Acknowledgement - IV
  • 10. Effect of Arohana Snehapana on Samedarakta ABBREVIATIONSR. T. Rasa TaranginiA. P. Ayurveda PrakashaR. S. S. Rasendra Sara SangrahaR. A. RasamritaR. J. N. Rasa Jala NidhiY. R YogaratnakarB. P. Bhava PrakashaR. N. Raja NighantuD. N. Dhanvantari NighantuK. N. Kaideva NighantuMa. Ni. Madanapala NighantuN. A. Nighantu AdarshaS. N Shodala NighantuC.S. Charaka SamhitaS.S Sushruta SamhitaA.S. Astanga SangrahaA.H. Astanga HridayaM. N Madhava NidanaG. N. Gadha NigrahaI.M.M Indian Materia Medica Abbreviations- VII
  • 11. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa LIST OF TABLESSl. No. Tables Pages 1 Showing the contents of kaphaketu rasa 5 2 Showing synonyms of Tankana 6 3 Showing the Tankana Shodhana according to different authors 9 4 Showing the Karma of Shudda Tankana according to different 9 authors 5 Showing the Rogaghnata of Shudda Tankana according to different 10 authors 6 Showing synonyms of Shankha 14 7 Showing of Rogaghnata of Shankha 16 8 Showing synonyms of Pippali 19 9 Showing actions of Pippali 21 10 Showing Indications of Pippali 21 11 Showing Synonyms of Vatsanabha 23 12 Showing types of Vatsanabha 25 13 Vatsanabha shodhana according to different authors 26 14 Showing Pharamacological Properties of Ingredients of 30 Kaphaketurasa 15 Showing the Samanya nidana of Kasa 42 16 Showing the Poorvaroopa of kasa 43 17 Showing roopa of Kaphaja kasa according to different Acharyas 44 18 Showing interrelation between Lakshanas and Dosha, Vikalpa, 47 Dushya, Srotas and Sthana in Kaphaja Kasa 19 Showing quantity of Tankana before and after Shodhana 67 20 Showing quantity of Shankha before and after Shodhana 69 21 Showing quantity of Shankha Before and After Marana 71 22 Showing Qty of Vatsanabha Before and After Shodhana 73 23 Showing Qty of Pippali Before and After Churnikarana 74 24 Showing Qty of Vatsanabha Before and After Churnikarana 75 25 Showing the Age Incidence 91 26 Showing the sex incidence 92 27 Showing the Religion 92 28 Showing Occupational Incidence 92 29 Showing socio – economical status of patients 93 30 Showing incidence of Habitat 93 31 Showing the chief complaints of the patients 94 32 Showing the incident of Chronic respiratory disorders in the family 94 33 Showing the condition of work place 95 34 Showing the incident of history of recurrent URTI 95 35 Showing the mode of on set of disease 96 36 Showing the course of the disease 96 37 Showing the periodicity of cough 96 38 Showing various types of sputum in cough 97 39 Showing the incidence of Aggravating factors 97 40 Showing incidence of smoking 98 List of Tables - VIII
  • 12. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa41 Showing food habits in patients 9842 Showing consuming dominant rasa in food 9943 Showing the incidence of Vyasana 9944 Showing the incidence of Nidra 9945 Showing the type of Agni of Kaphaja kasa patients 10046 Showing type of Khosta 10047 Showing exposure to any aggravating factors during working hours 10048 Showing whether symptoms produced during working hours 10149 Showing whether the symptoms reduce by change of place 10150 Showing Prakruti of patients 10151 Showing the Vyayam shakti of kaphaja kasa patients 10152 Showing Aharashakti of Kaphaja kasa patients 10253 Showing the Satmya of the Kaphaja kasa patients 10254 Showing Satwa of Kaphaja kasa patients 10255 Showing Sara of patients 10256 Showing pramana of Kaphaja kasa patients 10357 Showing the incidence by Samahana 10358 Showing the effect of the disease over routine activities 10359 Showing the observed symptoms of Pranavaha Srotas symptoms 10360 Showing the observed symptoms of Rasavaha srotas symptoms 10461 Showing the observed nidanas in Kaphaja kasa 10462 Showing the observed purva roopas in Kaphaja kasa 10463 Showing the number of patients with Kasa 10564 Showing the number of patients with Nishteevana 10565 Showing the number of patients with Uraha Vankshana 106 Sampoornmiva66 Showing the number of patients with Quantity of Sputum (morning 106 bout)67 Showing the ESR before and after treatment 10768 Showing the AEC, TC, DC values before and after treatment 10869 Showing statistical analysis of subjective parameters 10970 Showing statistical analysis of objective parameters 10971 Showing the overall result 110 List of Tables - IX
  • 13. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa LIST OF MASTER CHARTSSl. No. Master chart Pages 1 Showing over all assessment of the response to “kaphaketu rasa” 111 based on assessment criteria. 2 Showing the Assessment of grading of parameters of “Clinical 112 efficacy of Kaphaketu rasa in Kaphaja kasa LIST OF FLOW CHARTSSl. No. Flow Charts Pages 1 Illustrating the classification of Kasa according to different factors 40 2 Showing the samprapti of kaphajakasa 45 3 Showing Pathogenesis of Chronic Bronchitis 59 LIST OF GRAPHSSl. No. Graphs Pages 1 Showing the sex incidence 92 2 Showing socio – economical status of patients 93 3 Showing the condition of work place 95 4 Showing the incident of history of recurrent URTI 95 5 Showing the periodicity of cough 96 6 Showing the incidence of Aggravating factors 97 7 Showing incidence of smoking 98 8 Showing the overall result 110 LIST OF PHOTOGRAPHS Sl. No. Photographs 1 Showing Tankana, Shankha Shodhana and Marana 2 Showing Vatsanabha, Pippali Churnikarana and final product List of Tables - X
  • 14. CONTENTSINTRODUCTION 1- 3OBJECTIVES 4REVIEW OF LITERATURE 5 - 92 DRUG RIVIEW 5 - 34 HISTORICAL RIVIEW 8 - 32 NIRUKTI AND PARIBHASHA OF SNEHA 8-9 MAHA SNEHAS 11 CLASSIFICATION OF SNEHA AND SNEHANA 12 -18 SNEHANA YOGYAYOGYA 18 - 22 SNEHA PRAKARSHA KALA 22 - 23 SHODHANANGA SNEHANA VIDHI 23 - 32 KARMUKATA OF SHODHANANGA SNEHANA 33 - 38 MEDA 39 - 42 CONCEPT OF LIPIDS 43 - 68 SAMEDARAKTA AND HYPERLIPIDAEMIA 69 - 84 DRUG REVIEW 85 - 92 Contents - V
  • 15. Methodology 64 - 90 Pharmaceutical Study 64 - 76 Analytical Study 77 - 84 Clinical Study 85 - 90Results 91 - 112 Observations 91 - 104 Results 105 - 112Discussion 113 -128Conclusion 129 -130Summary 131 -133Bibliographic References 134 -150Annexure Contents - VI
  • 16. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasa Ayurvedic is a system of indigenous medicine which systematizes and appliesthe knowledge about health and disease. Health is the supreme foundation of virtue,wealth, enjoyment and salvation. Diseases are the destroyers of health, goodness andeven life itself. In Ayurveda, Acharyas have explained different charyas in order to maintainthe health. The diseases are manifested mostly because of neglecting the laws ofnature. In this modern era, urbanization have paved way for many developments, butthe hazards caused by the same can not be ignored. Quality of life on earth isdeteriorating day by day due to pollution and urbanization. Toxic substances liberated from the industries, inhalation of polluted air, in theform of smoke etc is responsible for the disease of Pranavaha srotas (Respiratorysystem). In Ayurveda the fundamental unit of living activity is said to be breathing,one of basic activity of Pranavahasrotas is exchange of gases, 16 times per minutemaking it one of the most vulnerable site for disease. The lungs with their greatersurface area (500 m2) are directly open to the external environment. Thus, structural,functional or microbiological changes within the lungs can be closely related toepidemiological, environmental, occupational, personal and social factors. Thus theprimary respiratory diseases are responsible for a major burden of morbidity andultimately death. As a result of dhuma & raja the main cause of Pranavaha srotodusthi have become unavoidable making Kasa the most common disease to the extentof 60% of total disease being recorded. Kaphaja kasa is one of the most common ailment afflicting Pranavaha srotas(Respiratory system). This condition has been considered to be the cutting edge ofthe doshic type of kasa, which if neglected or mismanaged, may result in poorprognostic conditions such as Kshataja, Kshayaja Kasa and Tamaka swasa etc., which Introduction - 1
  • 17. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasaare very difficult to manage. This shows the importance of early intervention of thistype of Kasa, is of paramount importance in the field of medicine. Till today it hasbeen a challenging pathological condition of the Respiratory system. Modern medical science is using Bronchodilators, Expectorants andCorticosteroids to manage Respiratory disorders which are causing many adverseeffects and suppressing the immunity. In the meanwhile Ayurvedic treatment regimens have gained muchimportance due to less adverse effects, but they are very time consuming. Thesignificance of Rasashastra and Bhaishajya Kalpana becomes evident in such asituation. The branch deals with techniques for developing new formularies, whichare more potent and at the same time cost effective and also suitable to themodernized life style. Several Herbo-mineral preparations have been described in Rasashasta. Thesecombinations are mutually complimenting. The ingredients can enhance one or eachothers absorption, assimilation, bio-availability, therapeutic activity etc. They mayalso reduce one or each others adverse reactions, toxicities. To conclude the exactPharmacokinetics and Pharmacodyanamics of herbo-mineral complexes is verylaborious. To arrive at a particular conclusion, the facilities and the sophistication atthis level of research are inadequate. Kaphaketu rasa is one among such a Herbo-mineral Khalvirasayana which ishaving commonly available drugs in it and is cost effective too. Different varieties ofKaphaketu rasa are explained in several Rasa texts with slight difference in theiringredients. But in this present study which has been mentioned in the 24th chapterVishopavishadi Vijnaniya of Rasatarangini has been under taken. Introduction - 2
  • 18. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasa There are so many yogas recommended for Kaphaja Kasa by looking itphysicians may get confused in which particular Avastha of the disease, these are tobe prescribed, so this present study is undertaken to confirm in what stage Kaphaketurasa is effective and its overall efficacy on Kaphaja Kasa. The study also presents the observation of the incidents of factors associatedwith a disease such as sex, age and social class of patient, occupation, past history ofrecurrent upper respiratory tract infection, severity, chronicity of disease, course ofthe disease and relation with smoking etc.PLAN OF STUDY:Introduction: Introducing the subjects putting emphasis on its importance and necessity in the present time.Review of Literature: The detailed classical Ayurvedic literature and relevant modern literature about the drugs Tankana, Shankha, Vastanabha, Pippali, and about the disease Kaphaja Kasa were reviewed.Pharmaceutical Study: In this, the method of preparation of Kaphaketu rasa and various Pharmaceutical processing of ingredients of Kaphaketu rasa was incorporated.Analytical Study: This includes Physico-chemical analysis of Kaphaketu rasa.Clinical Study: This includes Clinical evaluation of Kaphaja Kasa patients.Discussion: In this, it has been tried to found out possible explanations for its effects over observations, findings and results of various studies.Conclusion and Summary: In this part summary of whole study along with certain conclusions drawn was presented. Introduction - 3
  • 19. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasaThe objectives of the study were as follows :Preparation of Kaphaketu rasa.Physico-chemical analysis of Kaphaketu rasa.To evaluate the clinical efficacy of Kaphaketu rasa in the selected cases ofKaphaja kasa patients. Objectives - 4
  • 20. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaDRUG REVIEW: Rasa shastra is a branch of Ayurveda deals with drugs and efficaciousformulations, mode of preparation of different formulations under Khalvi rasayana,Kupipakwa rasayana, Pottali rasayana and Parpati rasayana. The Kaphaketu rasacomes under Khalvi rasayana. Kaphaketu rasa is a Khalvirasayana with a unique Herbo-mineralcombinations of drugs to treat Kaphaja kasa. Even though the name suggests that it isa ras preparation, it does not contain Rasa (Parada) as an ingredient. It was foundmentioned in various rasa shastra classics. We get more than one preparation in thename of Kaphaketurasa. The author of Bhaishajya ratnavali also explained Kaphaketu rasa with similaringredient but three bhavana of Ardraka swarasa, Vatis of gunja matra, Ardrakaswarasa as anupana1 and one more preparation in the name of Brihat Kaphaketu rasa2was explained. In Rasendra Sara Sangraha Kaphaketu rasa is explained under KapharogaChikitsa3 and it has same ingredients as explained in Rasatarangini. The Kaphaketurasa mentioned under Karanaroga Chikista4 have ingreadients like Trikatu, Hijjalabeeja, Shankha Bhasma, Vatsanabha and it is found recommended in Karna puya,Karna nada, Karna antaha shotha. For the present work, that which has beenmentioned in the 24th Chapter of Rasatarangini has been selected5.CONTENTS OF KAPHAKETU RASATable No.1 showing the contents of kaphaketu rasa Drug Botanical / Scientific Name Quantity Shoditha Tankana Borax 1 part Shankha Bhasma Calyx of Conch shell 1 part Shoditha Vatsanaha Aconitum ferox Wall 1 part Pippali Piper longum Linn 1 part Ardraka (Swarasa) (For Bhavana ) Zingiber officinale Rosc Q. S. Drug Review - 5
  • 21. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa TANKANA Tankana is mentioned in all the Brahatrayees. It is one among ksharatraya andKsharapanchaka. In Rasendrasarasangraha6, Anandakanda7, Ayurveda prakasha8,Tankana is included under uparasa varga. After 8th century A. D. it has been used asan antidote of Vatsanabha in Rasashastra and used in Paradajaranakarma9.Vernacular Name:10Sanskrit : Tankana, Rasashodhana Telagu : VeligaramuHindi : Suhaga Tamil : VenkaramEnglish : Borax Marathi : Tankana KharaKannada : Biligara Gujarathi : Tankana KharaSynonyms : Table No. 2 Showing synonyms of Tankana 11, 12, 13 Synonyms R.T A.P R.S.S Tankana + Tanka + Tanga + Tangana + Dravaka + Tankana kshara + + Tanka kshara + Ranga kshara + Ranga + Rangada + Loha shodhana + Soubhagya + Sita kshara + Shweta kshara + Tankaka + Kshara raja + Dhatu dravaka + Karamana + Pachana + Dravi + Louha vishuddhi + Drug Review - 6
  • 22. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaOccurrence: It occurs as natural deposit.Crude Borax is found in masses by evaporation ofwater, on shores of dried lakes in India and Tibet. It is also obtained from the mud oflakes surrounded by hills in Nepal and from Searle’s Lake in California14. In Nepal, Iran, Puga etc., Tankana occurs as crystals and as crystalline cementbetween sand grains around salt lakes. It occurs also as bedded deposits, inter layeredwith sedimentary rock15.Varieties: Varieties of Tankana on the basis of appearance:16 Tankana Sphatikabha Gudaprabha Pandura (Alam like) (Jaggery like) (Pale coloured) Varities of Tankana on the basis of occurance:17 Tankana Khanija Kritrima Varities of Tankana on the basis of availability:18 Tankana Sonari Choukiya Rasajalanidhi mentioned two types of Tankana:19 Tankana Pinda Shadama (Pale white Colour) (Pure White Colour) Drug Review - 7
  • 23. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaEvil effects of Ashuddha Tankana :20 The therapeutic use of Ashuddha Tankana causes vomiting and delusionsGrahayagrahyata :21 The Tankana which is clear, transparent, crystalline with bluish tinge is thebest.Nirmalikarana :22 If Tankana is mixed with dust, sand etc, impurities, then it is subjected toNirmalikarana. Take 1 part of Tankana choorna, 24 parts of water(1:24), mix welland fitter it. After some time, decant supernant water and subject it to teevragni tillwater evaporates. Take down the patra when it is little bit wet in the bottom and dryit. In this way Nirmalikarana is done. It is used in the place of Boric acid but after aShodhana only internal use can be done.Necessity of Shodhana :23 • The impure Tankana causes complications like vomiting & delusions. • If it is mixed with dust, sand etc., impurities,.Shodhana : Actually, grahya variety of Tankana does not contain any impurity except forthe water content of it, which can cause heaviness in the body after its intake.Therefore, practically Tankana is merely fried over the stove and evaporating thewater content which is termed as Shodhana. Drug Review - 8
  • 24. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Table No. 3 Showing the Tankana Shodhana according to different authors.24,25, 26,27,28,29,30, 31Sl. Shodhana Process R. T. A. P. R. A R. J. N. R. S. S. Y. R. B. R. R. S. I. M. M.No.1 Fried in a pan till it becomes flower like. + + - - - + - -2 Fried on a iron pan. - - + - - - - -3 Mixed with water, next day decanted, filtered - - + + - - - - and heated on fire.4 Mixed with 24 parts of water filtered through cloth and boiled on intense fire when it + - - - - - - - becomes paste like removed from fire and dried.5 Purifies by being steeped for a night in Kanjika - - - - + - - + and dried in sun6 i. Purified by being steeped for over night in Jambhiraswarasa - - - - - - + - ii. By keeping it inside Gomaya Pharmacological properties:32 Rasa : katu Guna : Rooksha, Teekshna, Usna, Sara Veerya : Ushna Vipaka : Amla Doshagnata : Vatakaphashamaka Table No. 4 Showing the Karma of Shudda Tankana according to different authors 33, 34, 35, 36 , 37, 38, 39 Sl. Karma R. T. A. P. R. A R J. N. R S. S. B.R.R. S. Y. R. No. 1 Hridya + + + - + - + 2 Vishagna + + + + + + + 3 Deepaka + + + + + - + 4 Balya + - + - + - - 5 Rojahpravarthaka / Streepushpa janana + - + - + - - 6 Moodagarbhapravarthaka + - + - + - - 7 Shoolaghna - - - - - + - 8 Vatapittakara - - - + - - - 9 Dravani - - - - - + - 10 Bhedi - - - - - + - Drug Review - 9
  • 25. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaTable No. 5 Showing the Rogaghnata of Shudda Tankana according to differentauthors : 40 Sl.No. Rogaghnata R. T. A. P. R. A R. J. N. R. N. B. R. R. S. Y. R.1 Kasa + - + + + - -2 Swasa + - + + + - -3 Adhmana + - + - - - -4 Vrana + - + - - - -5 Gulma - - - - - + -6 Shoola - - - - - + -7 Jwara - - - - - + -8 Visha - + - + - + +9 Rajorodha - - - + - - -10 Kshaya - - - - + - -Matra : 1-2 rattiAnupana : Madhu, Ghrita or according to diseaseYoga : Anand Bhairava rasa Mruitunjaya rasa Sarvangasundara rasa Ardhanarishwara rasaMODERN VIEWBorax: Tankana is identified as Borax and it is composed of Boric Acid and Soda.41 Ithas a reputation as a germicide. It is primarily a bacteriostatic, not only used by themedical profession in the form of ointments and irrigating solutions, but also thecompound become a common item in house hold cabinets and nurseries.42Physical properties:43Chemical composition - Na2B4O710H20.Crystal structure - Monoclinic prisms, often dull on the surface or Crystalline tough masses or in the form of translucent irregular masses, on exposer to air it becomes opaque. Drug Review - 10
  • 26. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaColour - White sometimes with blue or gray tingeStreak - WhiteSolubility - Sparingly soluble in cold water more soluble in hot water.Hardness - 2 – 2.5Sp – gravity - 1.71 It’s aqueous solutions show an alkaline reaction. When heated it graduallylooses its water of crystallization, swells up and finally becomes a fused glassy mass. Keeping it in sun, looses its transparency because of evaporation of water. Itis odourless, saline in taste efflorescent in dry air. Soluble in 25 parts of water andinsoluble in 90% Alcohol. It is soluble in 1% glycerin.44Standard:45 Borax contains not less than 99% and not more than the equivalent of 103% ofNa2B4O710H20. Arsenic limit 5 parts per million, Led limit 5 parts per million,complies also with limit tests for Chloride, Sulphate and Iron.Preparation of Borax:46 Most of the Borax is prepared from the natural Borax of lake Borax or fromminerals like Colemanite (Ca2B60115H20), Boracite (2Mg3B8O15Mgcl2) etc. In the preparation of Borax, minerals such as Colemaite are ground to a finepowder and boiled with Sodium carbonate solution for three hours. 15 parts of minerals + 10 parts of Na2Co3 +60 parts of water. 2(2Cao,3B2O3)+3Na2Co3 = 3Caco3 +CaO +3Na2 B4O7 The solution is filtered and allowed to crystalline for 3 days in vats. Thus theBorax is drained, broken up and packed in Kgs. Drug Review - 11
  • 27. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaToxic effects:47 Acute poisoning of Borax poisoning begins with nausea, vomiting anddiarrhoea, regardless of the route of administration. The body temperature falls, andan erythematous rash similar to that of scarlet fever develops. This is followed bydesquamation, not only in the areas of the rash but also of mucous membranes.Absorption, Distribution and Excretion: It is readily absorbed from the gastrointestinal tract, serous cavities andinflammed skin. It does not penetrate the intact skin. Excretion is primarily by thekidney; approximately 50% of a given dose is excreted within 24 hours. Relativelylarge amounts are localized in the brain, liver and kidney.Action:48 Diuretic, Emmengogue, Astringent, Antacid, Local sedative and Antiseptic.Uses:49 1. It is used as germicide and primarly as a bacteriostatic 2. It is used in few commercial dermatological preparations, and also used as ophthalmic ointment 3. Fiberglass for insulation and textiles. 4. Flame retardant for fabric and wood. 5. It is used as a flux in bronzing and in silvering. 6. It is also used in making enamel and in leather tanning. Drug Review - 12
  • 28. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa SHANKHA Shankha is known to Indians since many days. Charaka explained shankha in27th Chapter of Sutrasthana under Varishiya varga.50 Sushruta also explained it invarious places as a medicinal use. Rasarnavakar is the person who explained orconsidered it under Shukla varga. It is a molluscan species and it is also identified as sacred chank or conch. It islarge massive elegant shell with a fine pear shaped spire and a wide opening of mouthwhich is prolonged into a narrow spout. It has an external lustrous yellowish brown horny layer and beneath it has athick layer, chiefly formed of Calcium carbonate.51Vernacular name: 52Sans : Shankha Tamil : SankaEnglish : Conch shell Telugu : SehkhamHindi : Shankh Kannada : ShankhaBengali : SankhChemical composition: Calcium carbonate (CaC03)Source:53 Indian Ocean coasts. It is the outer covering of “Molluska group” of aquaticanimal which are seen in sea. It is collected from the sea, and put in boiling water.The animal which is present inside dies and the outer portion is shanka, it is sold inmarket. Chanks are gregarious and exclusively marine animals occurring in largenumbers on muddy sand bottom Thirteen meters in depth in Tamil Nadu shores andAndaman waters. Drug Review - 13
  • 29. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaSwaroopa : 54 The Shankha having Vrinta, Snigdha, Sukshma Mukha, Sundara, Nirmala andGuru in nature is considered to be the best.Characters:55 It is a porcelaneous shell of an oblang or conical form. The oblong form isbulged in the middle and tapering at each end the conical variety is peculiar. Theupper portion is like corkscrew, twisted and tapering at the end. The base is broad,the interior is hallow. The surface is hard & dull white colour. The upper surface ishighly tuberuleted, the under surface shining, very brittle and translucent.Synonyms : Table No. 6 Showing synonyms of Shankha 56, 57, 58, 59 Sl. No. Synonyms R. T. A. P. B. R. R. S. R. S. S. 1 Shankaka + - - - 2 Kambu + + + + 3 Trirekha + - - - 4 Samudraja + + + - 5 Sunada + - - - 6 Deerganada + - - - 7 Kamboja + - - - 8 Kshudra - + + - 9 Shankanaka - + + - 10 Pavana dhwani - - - + 11 Mahanada - - - + 12 Haripriya - - - +Varieties:60 Two varieties of Shankha are mentioned in Ayurveda prakash. One isDakshinavartha and another Vamavartha. Dakshinavartha is said to be more sacred,uttama and is widely used for medicinal purposes. Vamavartha is madhyama can alsobe used for medicinal purposes. Fig. 5 Showing the types of Shankha Shankha Dakshinavartha Vamavartha Drug Review - 14
  • 30. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaShodhana :61, 62, 63 The Shankha is made into pieces and these are tied into pottali and boiled inJambira Swarasa for 4 yamas ie., 12 hours approximately. After that pottali shouldbe removed and pieces should wash with hot water. SwedanaJayanthi Swarasa Dolayantra Δ 3 hours 3 hoursTanduliya drava Dolayantra Δ swedana 3 hoursKanji Dolayantra Pachana ½ YamaNimbukamla Dolayantra PachanaAmla dravya + Dolayantra Kanji Δ SwedanaMarana of Shankha:64, 65, 66 Pieces of shuddha Shankha are dried well, then these are placed in sharavasamputa, after that sandibhandhana should be done. After complete drying it issubjected to gajaputa. After obtaining from puta the backed pieces are powdered. Itis then given the Bhavana of Kumari Swarasa and once again subjected to gajaputa.Such 2-3 putas yield good white bhasma of Shankha. The pieces of Shodhita Shankha are put into the fire and subjected forsamyaga laghu puta till the they becomes bloomed. One pala of Shankha, killed by being heated in a blind crucible is to be rubbedby means of a rod with half a masha of Tankana and used in medicines. Drug Review - 15
  • 31. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaPharmacological properties:67Rasa : Katu rasa (Kshara)Guna : Laghu, HimaVeerya : SheetaKarma : Grahi, Balya, Vilekhana, Agnideepana, Vishagna, Varnya, Hridya.Rogaghnata Table No. 7 Showing of Rogaghnata of Shankha 68, 69, 70, 71, 72, 73 Rogaghnata R. T. A. P. R. S. S B. R. R. S R. N. Y. R.Amlapitta + - + - + -Grahani + + - + + +Parinama shoola + - - - - -Tarunya pidika + + - + - +Netrapushpahara - + - - + +Gulma - - + - - -Kapha Swasa - - + - - -Meha - - + - + -Udara shoola - - + - + -MODERN VIEWCalcium carbonate : Calcium carbonate occurs in large quantities in nature as chalk, marble andlime stone. However enough CaCO3 is absorbed to cause systemic and renal effectsbut it has mainly considered to be the non systemic antacid.74Absorption & Excretion:75CaCO3 Ca+2 + CO3-2 H3O+ H2CO3 H20 + CO2 The calcium cations formed in reaction and present as the water solublecalcium chloride salt can be either absorbed or precipitated as the insoluble calciumphosphate salt in the intestine or as insoluble calcium soaps from the hydrolyzedglycerides resulting from digested food. Calcium excretion varies directly with thecreatinine clearance. Drug Review - 16
  • 32. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaPreparation:76 It is obtained in the laboratory by the action of soluble carbonate on a calciumsalt or by passing CO2 through lime water. CaCl2 + Na2CO3 CaCO3 + 2NaCl Ca(OH)2 + CO2 CaCO3 + H2OUntoward effects: 77 The constipating effects and chalky taste of Calcium carbonate are clinicallydisadvantages, Belching occurs in same individuals the liberation of CO2. Nausea isan occasional complaint, mere seriously infrequent instances of hyper calcimia withalkalosis, caleinosis and azotemia occur during chronic Calcium carbonate usage.Contraindications : Patients with renal disease, history of calculi, gastrointestinal haemorrhage,hypretension or dehydration and electrolyte imbalance due to excessive vomiting.Properties :78 1. It is soluble in water containing Carbon dioxide forming calcium bicarbonate. CaCO3 + H2O + CO2 Ca(HCO3)2 2. It is fine, white, odorless, tasteless, fluffy, microcrystalline powder which is stable in air. 3. It is insoluble in alcohol, water and dissolves with effervescence in diluted acetic, diluted hydrochloric and diluted nitric acids.Uses : 1. It is used an Diuretic, Emmenogogue, Astringent, Antacid and Local sedative and Antiseptic. 2. For the manufacture of lime. 3. As a flux in the smelting of ores. 4. In the preparation of tooth pastes and face powder. Drug Review - 17
  • 33. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa PIPPALI Charaka and Shushruta have quoted pippali among the Dashemaniya gana. Itis quite interesting to know that Vagbhata did not mention it in any of his Vargas.However he used it in therapeutics extensively. Pippali should not be administered continuously for a long time without therestrictions mentioned in Rasayana vidhi.79Family : PiperaceaeBotanical name : Piper longum Linn.Vernacular Names :80Hindi : Pipala, Pimpli Malayalam : TippaliEnglish : Long pepper Punjab : PipalTelugu : Pippaller Nepal : PipalmolTamil : Pipli Kannada : HippaliMarathi : PipaliGujathi : PiparaGana:Charaka : Deepaniya81, Kanthya82, Asthapanopaga83, Shirovirechanopaga84, sheetaprashamana85, Shula prashamana86, Kasahara87, Hikkanigrahana88, Triptighna89.Sushruta : Pippalyadi90, Amalakyadi91. Astanga sangrahakara also quoted Pippali in Pippalyadi gana and Nyagrodhadi gana92.Distribution and Habitat:93 This plant is indigenous to hotter parts of India like north-eastern and southernIndia and Ceylon. It is found growing wild in the west coast and as undergrowth inthe evergreen forests of the Western Ghats from Konkan to Kerala. Drug Review - 18
  • 34. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaSynonyms: Table No. 8 showing synonyms of Pippali 94, 95, 96, 97, 98, 99 Synonyms B. P. K. N. N. A. R. N. D. N. Ma. Ni. Magadhi + + + + + + Shoundi + + - + + + Vaidehi + + + + - + Chapala + + + + + + Kana + + + + + - Krishna + + + + + - Upakulya + + - + + + Teekshna tandula + + + + + Magadha - - - - - + Vishwa - - - - - + Kola + - - + + - Kukara - - - + - - Katu beeja - - - + - - Korangi - - - + - - Tikta tandula - - - + - - Magadodbhava - - - + - - Ushana - - - + + -Botanical Description:100, 101. Piper longum is an aromatic glabrous under shrub, with erect or subscandentnodose stem and slender branches.Leaves: Simple, alternate, entire, glabrous, 5.9 cm x 3.5 cm, subaerte, cordate at the base, seven veined that vary in shape and mode of attachment even in the same plant.Flowers: In pendulant spikes, straight, unisexual, spikes of small or minute chamydeous densely or closely packed.Male: Larger and slender,Female: 1.3 – 2.5 cm x 4-5 mm diam. Flowering nearly throughout the year.Fruits: Very close clusters of small grayish green or darker grey beries, when ripe yellowish orange in colour. Drug Review - 19
  • 35. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaExternal morphologyof fruits: Fruits are small about 2-5 mm in diameter grayish green or nearly blackish when ripe and are partially sunk in the fleshy axis of the spike. The fruiting spikes are 2.5 to 3 cm long and 2.5 to 3.5 mm thick.Chemical composition:102 It contains Essential oil, piperine, piplartine, piperlongurminie,piperlonguminine, pipernonaline, pipercide, sesamin, - sitosterol, four aristolactams,starch, fatty oil, gum caryophiline, mono and sequiterpenses etc.Verities Showing varities of Pippali Sushruta & Charaka – Two types 103,104 Pippali Gajapippali Classification of pippali on the basis of availability105 Pippali Gajapippali Simhali Vanapippali Classification on the basis of availability in market 106 Choti BadiParts used : Fruit & root or the dried unripe fruits as well as root are used.Dosage : Phala churna: ½ - 1 gm.Pharmcologoical properties 107,108 Dried fruit Fresh fruit Rasa Katu Rasa Katu Guna Laghu, Snigdha Guna Guru, Snigdha Veerya Anushna Veerya Sheeta Vipaka Madhura Vipaka Madhura Doshagnata VataKaphahara Drug Review - 20
  • 36. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaActions ;Table No. 9 showing actions of Pippali Actions D. N R. N N. A B. P. Ma. Ni K. N Ruchya - - - - - + Sara - - - - - + Vrishya - + + + + + Rasauana + + + + + Deepani - + + + + + Pachani - - - - - + Hridhya - - - - - + Pittala - - - - - + Amadosha hara + - - - - - Rechani - - - + + + Sara - - - - - + Infusion is stimulant carminative and alternative tonic more powerful thanblack pepper, also aphrodisiac, diuretic, vormifuge and emenogogue. Externallyrubeficient root is stimulant109.Indications: 110,111,112,113,114,115 Table No. 10 showing Indications of Pippali Indications D. N R. N N. A B. P. Ma. Ni K. N Kasa - + + + + + Swasa - + + + + + Udara + - + + + + Jwara + + + + + + Kusta - - + + - - Meha - - + + - + Gulma - - + + + Arsha - - + + + Pliha - - + + + Trishna + - - - - - Krimi + - - - - - Kshaya - + - - - - Pipper longum or piperine shows to posses bio aviablity enhancing activitywith various structurally and therapcutically diverse drugs. It may hypothesize thatpiperine bioavaibility enhancing property may be attributed to increased absorption,which may be due to alteration in membrane lipid dynamics and change inconfirmation of enzymes in the intestine.116 Drug Review - 21
  • 37. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa VATSANABHA Vatsanabha is known to Ayurvedic pharmacopoiea since very early times.Among the Bhrihatrayees Charakra mentioned under “Sthavara vishas”.117 It isdescribed under 13 varieties of “Kanda vishas” by Sushruta.118 Vagbhata preferredthe name ‘Visha’ to denote Vatnsanabha and used in the treatment of Gandamala,Kustha, Timira etc.119, Sharangadhara and Bhavamishra delinated Vatsanabha in their texts whilealmost all Nighantus mentioned it. Rajanighantu included it in the pancha mahavisha.The utility of Vatsanabha definitely increased after the development of Rasa Shastra. Aconite is one of the oldest known drugs and aconite is a Greek word meaningarrow. The arrows were coated with this poison and used. It is of two different kindsviz., poisonous and non – poisonous. Among the poisonous varieties both Aconitumferox and Aconitum chasmanthum are used as Vatsanabha in India.Family : RanunculaceaeBotanical Name : Aconitum feroxGana:Charaka Samhita - Sthavara vishasSushruta samhita - Kanda vishasDhanvantari Nighantu - Mishraka vargaBhavaprakash Nighantu - Dhatvadi vargaRaja Nigahantu - Pippalyadi vargaKaidev Nighantu - Visha vargaShodala Nighantu - Chandanadi varga Drug Review - 22
  • 38. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaVernacular names:120Hindi - Bachanag, mitha vishaEnglish - Monks hood, aconite.Kannada - BachanagMarathi - BachanagTelagu - NabhiGujarathi - BasnagMalayalam - VatsanabhiPunjabi - MohariBengali - KathvishAssami - Vish.Synonyms: Table No. 11 showing Synonyms of Vatsanabha 121, 122, 123, 124, 125 Synonyms D. N. R. N. B. P. N. A. B.R.R.SAmruta + +Visha + + + + +Ugra + +Mahoushada + +Garala + + + + +Marana + +Naga + +Stokaka + +Pranaharaka + +Kshweda + + +Distribution and Habitat:126 It grows in Eastern temperate and sub alpine regions of the Himalayas,Eastward of Kumaon, Nepal, Kashmir & Sikkim. Drug Review - 23
  • 39. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaBotanical Description :127 It is a erect perennial herb, stem erect with or without a slender hypogenousbase.Leaves : Scattered, distant, excepting the lowest 2-3 which are usually decayed at the time of flowering up to seven glabrous or the upper most very sparingly hairy.Petioles : Slender, the lower are upto 25 cm long and much dialted at the base, upper most very short.Inflorescence : A loose raceme, 10-25 cm long often with slender, erect, few flowered additional branches from the leafy base.Seeds : Obovoid to obopyramidal, 2.6-3 mm long, winged along the rhaphe, transversely lamellae undulate on the faces, lamellae undulate.Chemical constituents:128 Roots contain toxic alkaloids, pseudoaconitine along with bikhaconitine,chasma conitine, indaconitrine, verotroyl pseudaconitine and diacetylpseudoaconitine. Four lipoalkaloids viz liposeudo aconitine, lipoyanaconitine, lipoindaconitineand lipbikhaconitine and four acorine viz. vertroylpseudaconine, anisoylyunaconine,benzyolindaconine and veratroylbikhaconine are also reported.Varities:I. Sushruta quoted about four varieties of Vatsanabha. Rasa vagbhata and Yogaratnakara have elaborated four varieties, the colour and properties of each varieties are given129 Drug Review - 24
  • 40. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Table No. 12 Showing types of Vatsanabha Sl. No. Bheda Varna Guna 1 Brahmana Pandu Rasayana 2 Kshatriya Rakta Dehapushtikara 3 Vaishya Peeta Kushtaghna 4 Shudra Krishna Dhatu karmaII. In Rasatarangini only three varities are described on the basic of colour.130 1. Krishna (Blakish) 2. Kapisha (Browinsh yellow) 3. Pandu varna (yellowish grey) They are considered as superior to each other in the same order.III. According to Ayurveda prakasha two varities 131 1. Shukla 2. Krishna Among these two Krishna variety is having property of Laghu and Ashukari.It is used Roganashanartha, Parada jaranartha and as Rasayana.Identification:132 Rasavagbhata mentioned certain characteristics for identification. Vatsanabhahaving pandura Varna (yellowish grey colour). Its roots are similar to navel of calfand is not more than five angulis in length and circumference is 1-2.5 angulis they areSthula (bulky tuber), Snigdha (smooth), Guru (heavy in weight), Nava (newlyharvested), Phala pakanta grahya (collected after fruits have dried up), Kitadiabhakshita (not affected by insects). In Bhavapraksha133 it is mentioned that its leavesand root resemble the leaves of sindhuvara and navel of the calf respectively.Shodhana: The impure form of Vatsanabha may produce Daha, Moha, Hridgati Rodhanaand Marana eventually.134 Therefore purification is essential135. Drug Review - 25
  • 41. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaTable No. 13 Vatsanabha shodhana according to different authors.136-137-138-139-140 Sl. Shodhana process R. T. R. A. D.G.V Y. R. R. J. N No. 1 Kept in cow’s urine in + + - - + strong sunlight for 3 days 2 Swedana in Ajadugdha + + - - - for 1 yama 3 Swedana in Surabhi + + - + - payas (cows milk) for 1 or 2 yama 4 Kept in cow’s urine for 3 - - + + - days then Swedana in a cow’s milk or goat’s milk for 3 hrs 5 Swedana in dolayantra - - - - + containing Triphala kashaya and Aja ksheera 6 Swedana in dolayantra - - - - + containing cow’s urine.Contraindications: 141 • Vatsanabha should not be used in rainy season and on the cloudy days. • It is contraindicated in Krodhi, Pitta predominant, Klibya, Kings, when feeling hungry or thirsty, Bhrama, Sun stroke, after walking for long distance, pregnant women, children, old age, emaciated individuals, marma rogas etc., • Sleep during day time, exposure to fire and heat are also forbidden. • Diet restricted rich in pungent, sour and salt tastes.Toxic effects: 142 The toxic effects of Vatsanabha viz, Greevasthambha, peeta vin mutra netratva(deep yellowish discolouration of stools, urine and conjunctiva). The other toxiceffects are Twak vikara, Vepathu, Daha, Phenodgama, Jadata and Marana. Drug Review - 26
  • 42. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaAnti-dotes: 143 Over dosage with Vatsanabha may produce the above symptoms. Differentanti-dotes have been mentioned for the management. • Tankana (Borax) is considered to be the main antidote. Usually equal quantity of Vatsanabha and Tankana are recommended to nullify toxic effects of it144. If Tankana is not available maricha may be used in a double the quantity of Vasthanabha. • Cow’s ghee is considered as one of the best anti-dotes for Vasthanabha. 145Modern View: 146 Most of the aconite varities are found to be poisnous. The main activeprincipal resulting in toxic effects is aconitine. The symptoms of poisoning occurimmediately or within a few minutes after consumption of root. First, buringsensation is experienced from moth to stomach followed by tingling and numbnessoin the mouth, tongue and pharynx. This is followed by salivation, nausea, vomitingand diarrhea. Later, dryness of mouth and the patients will be unable to swallow. Other symptoms include head ache, giddiness, pallor, profused sweating, sub-normal temperature, weakness of limbs, inability to stand or walk, cramps andconvulasions may also occur. The pupils contract and dilate alternately, but remain dialted at the later stage.Dimness of vision and diplopia may cusue. The pluse becomes slow, feeble andirregular. Blood pressure will be low and the patients complain of breathlessness.Finally death may occur due to paralysis of heart or respiratory centres or even both.Treatment: • Gastric lavage with warm water and weak solution of potassium permanaganate. Drug Review - 27
  • 43. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa • Powerderd charcoal to diminish solubility. • Atropine 0.5-1 mg. • Artificial respiration may also be usefulCollection : The collection of root is preferred during winter.Part used : RootDosage : 1/8th ratti i.e, 15mg approximately or 60 – 125 mg.Fatal dose : 1-2 gm of root.Fatal period : 3-6 hours.Pharmacological properties: 147Rasa : MadhuraGuna : Laghu, ruksha, teekshana, vyavayi, vikashiVirya : UshnaVipaka : MadhuraDoshagnata : Tridosha shamaka, especially Vatakapha shamakaAction : Yogavahi, Shoola prashamaka, Mootrala, Balya, Rasayana, Madakari. 148 Vatsanabha has Diaphoretic, Diuretic, Antidiabetic, Antiphlogistic and Antipyretic action. 149Uses : Jwara, Swasa, Kasa, Bhagandhara, Aganimandya, Gulma, Pandu, Vrana, Arsha and Vatarakta. 150 Drug Review - 28
  • 44. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa ARDRAKAFamily : ZingiberaceaeKula : Ardraka KulaSynonyms: 151 Sringaver Gulma moola Katubhadra Moolajam Ardrika Kandalam AnupajamChemical composition : 152 Volatile oil, starch, fat, protein, fibre, inorganic, material, residualmoisture, an acrid resinous matter phenolic kentones of oleoresins.Parts used : RhizomeDosage : Ardraka Swarasa 5-10 mlPharmacological Properties: 153Rasa : KatuGuna : Guru, Rooksha, TeekshnaVeerya : UshnaVipaka : KatuDoshagnata : Kaphavata ShamakaAction : Agnideepaka, Ruchya, Jihwa kantha vishodhaka, Kasa SwasaharaUses : It is useful in Agnimandya, Swasa, Kasa, Jalodara, Sheeta pitta etc., Drug Review - 29
  • 45. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Table No. 14 showing Pharamacological Properties of Ingredients of KaphaketurasaIngredient Rasa Guna Veerya Vipaka Doshaghnata KarmaTankana Katu Rooksha, Ushna Katu Vatakaphahara Jwarahara, Teekshna Depana, Stavaravishnapaha, RuchyaShankha Katu Laghu, Anushna Pittahara Vilekhana, Grahi, Hima Depana, BalyaPippali Katu Laghu, Ushna Madhura Vatakaphahara Deepana, Snigdha, Rasayana, Vrishya TeekshnaVatsanabha Madhura Laghu, Ushna Madhura Vatakaphahara Rasayana, Rooksha, Madakari, Teekshna, Swedajanana, Vyavayi, Grahi, Balya. VikashiArdraka Katu Rooksha, Ushna Madhura Vatakapahara Deepana, Pachana, Guru Anulomana, Amadoshahara Drug Review - 30
  • 46. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa JAMBEERAFamily : RutaceaeLatin : Citrus limonSynonyms : Danta Shata, Jambala, Jamba.Habit : Northern India, cultivated in countries like Inida, spain, Italy, Australia California etc.,Macroscopic character: 154Colour : Fresh outer surface, bright green yellow, internally white.Dried : Outer surface is yellow and inner surface pithy white.Odour : Strong, fragnant, aromatic and Characteristic.Taste : Aromatic, bitter.Chemical constituents : Volatile oil, hesperiden, pectin, calcium oxalate and bitter substances,Limonene, citral, geranyl acetate and terpineol.Pharmacological Properties: 155Rasa : AmlaGuna : Guru, TeekshnaVeerya : UshnaVipaka : AmlaDoshagnata : Vatashlesma ShamakaUses : Kasa, Hritpida, Shoola, Chardi, Trishna, Ashyavairashya, Agnimandya, Krimgna, Swasa. It is a carminative and stimulant and oil is used as perfuming and flavouring agent. Drug Review - 31
  • 47. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa KUMARIFamily : LilliaceaeLatin : Aloe veraSynonyms : Picha sambhruta Kshara boodesh Bala VishalaHabit : North Africa, India, China.Chemical constituents: 156 Crystals of Aloin glueosides present in Aloe vera are the active principles.Other than this it contains volatile oil and resin.Pharmacological Properties: 157Rasa : KatuGuna : Guru, Snigdha, PicchilaVeerya : SheetaVipaka : TiktaDoshagnata : KaphapittaharaUses : Gulma, Pliha, Kaphajwara, Visphota, Vishahara, Kustagna, Swasa, Pittaja kasa. Aloe is used as a purgative effect is mainly on colon. Drug Review - 32
  • 48. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa GOMUTRA Gomutra is used as medicine since good old days. Acharyas have prescribedthe treatment for various diseases, by the use of cow’s urine. Charaka has prescribedGomutra in Katuskanda in Charaka chikitsasthana158 and sustruta shirovireechanaadhyaya. 159 Urine of animals like, Sheep, Goat, Cow, Buffalow, Elephant, Camel, Horse,Ass, Ox, and Human are used as medicine. In these cows urine contains ammonia inconcentrated form, is frequently used for purification of drugs and minerals.Sanskrit : MutraHindi : PesabEnglish : Urine.Synonyms : Gomutra, Gojala, Goambu, Godrava160.Pharmacological Properties:Rasa : Katu, Tikta, Kashaya, Madhura, Lavana.Guna : Teekshna, Ushna, LaghuVeerya : UshnaVipaka : KatuDoshagnata : Kaphavata shamaka, pitta prakopaUses : Internally as laxative, diuretic, and used in the preparations of various medicines like Punarnava mandura, Marichadi tail etc., it is also recommended by Chakradatta as a vechicle for castor oil given as purgative. 161 Drug Review - 33
  • 49. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa MADHUSynonyms : Madhu Makshika vanta Maakshika Varativanta Kshaudra Bhringavanta Saaraga PushparasodhbhavaVarieties : 162 Maakshika Chaatra Bhramara Ardya Kshaudra Aouddhalaka Pautika DaalaHabitat : Some dwell in forests and build their home (hive) attached to the branches oftall trees, some build them inside the crevices of the trees.Composition : 163 Dextrose, Levulose, Wax, volatile oils, proteids, mucilage, colouring matter,formic acid, some other substances contained are pollen dust, ethesealoil, variousphosphates, lime, Iron etc.,Pharmacological Properties: 164Rasa : Madhura, KashayaGuna : Laghu, Rooksha, SookshmaVeerya : SheetaVipaka : Katu, MadhuraDoshaghnata : Kaphapitta ShamakaAction : Yogavahi, Chakshushya, Deepaka, Swarya, Krimighna, Vranashodhaka, Vranaropaka and Vatakara.Uses : It is useful in Raktapitta, Kasa, Swasa, Prameha, Krimi, Kusta, Arsha, Atisara, and also as anupana in many diseases. Drug Review - 34
  • 50. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa PRANAVAHA SROTAS Kaphaja kasa is a disease of Pranava srotas. Therefore detailed anatomy andphysiology of Pranavha srotas is essential to know the disease in detail. The word‘prana is derived from Sanskrit root ‘An’ with a prefix ‘pran’ means to breath, to live.Chakrapani had clearly stated that this srotas is related to a special “Vayu” calledprana”. The word ‘Prana’ of Pranavata srotas should not be misunderstood aspranavata one of the five subdivisions of vata. The act of respiration is one of thefunction of Pranavata but the function of pranvaha srotas is only respiration. According to Charaka the moola of Pranvaha srotas is hridaya and mahasrotas165. Based on the explaination of Chakarapani the Pranavaha srotas is concernedwith the visishta vayu known as prana, the puppusa have to be accepted as the moolaof this srotas. The Mahasrotas associated with puppusa is the trachea, its twobranches, bronchi further branching to bronchioles. All these structures participate inthe act of respiration. The reference from Charaka samhita seen to indicated only theexternal respiration comprising of inspiration & expiration with the absorbtion ofvisishta pranavayu and removal of the carbon dioxide from the body as whole. Due todhatukshaya, vegasandharana, raukshya, vyayaama, kshudita causes the dushti ofpranavaha srotas.Pranavaha srotodusthi lakshanas:- The Pranavaha srotodusthi lakshanas indicatesthe changes in the respiration. They are Atisrishtam, Atibaddam, Kupitam, Alpalpam,Abhikshanam, Sashabdam, Sashoola166. Injury to Pranavaha Srotas produces thesymptoms like Akroshana, Vinamana, Mohana, Bhramana, Vepana and Maranam.Kasa is a symptom in almost all diseases caused by the vitiation of Pranavaha srotas.Kasaroga, Swasaroga, Hikkaroga & Rajayakshma are the diseases caused by thevitiation of the Pranavaha srotas. Disease Review - 35
  • 51. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaHISTORICAL REVIEWDescription of Kasa in different eras: It would be quite judicious to review the reference of Kasa which is availablefrom vedic period to modern period167.VEDA KALA: Kasa has been mentioned as a disease in Atharvana veda where in, thesynonyms and management have been described. There are some Mantras (Hymns)to be recited to get rid of the disease Kasa. Earlier to this, in Rigveda there are fewreferences are available for Kasa and its management.PURANA KALA: Garuda purana - contains detailed reference of Abhrata Kasa, Vatasa Kasaand Sumna Kasa & its management.SAMHITA KALA: We get an elaborate description of the disease, symptoms, its etiology,pathogenesis, complications and its treatment in different samhitas. The detailed description of Kasa is seen in Charaka samhita, where in itsbhedas, description of individual nidana of five varieties of Kasa, Samprapti,Lakshanas, Sadhyasadhyata and Chikitsa have been mentioned. Chakrapani datta, arenowned commentator of Charaka Samhita has commented on the description ofkasa169. Sushruta mentioned Kasa not only as a disease entity, but also as symptom.Healso explained its Bhedas, individual Lakshanas, Samprapti and Chikitsa169. The Kasa has been classified into eight varieties along with detaileddescription of the disease & treatment aspect by Hareeta170. Reference of Kasa is also Disease Review - 36
  • 52. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasafound in Kashyapa samhita in the context of Urhogata roga as one of itscomplication171.MADYAMA KALA Vriddha vagbhata in 400 AD, given detailed description of Kasa its Nidana,Bheda, Samprapti, Lakshana, Sadhyasadhyata and Chikitsa172 Arunadatta and Indu the commentators of Ashtanga Hridaya and AshtangaSangraha has commented on Kasa173. In 800AD Madhavakara has described the nidana aspect of Kasa in his treatiseMadhavanidana. Vijayarakshita and Shri Kanthadatta have commented on it174. Description of Kasa is also found in Gadanigraha175, Rajanighantu176,.Sharangadhara (14th Century A. D.)177 Bhava mishra (15th Century A. D.)178 has alsodescribed Kasa and its management. Numerous references can be seen inYogaratnakar 179 , Rasaratna samucchaya180 etc.ADHUNIKA KALA Description of Kasa, its line of treatment with therapeutic measures to controlKasa, important yogas for Kaphaja Kasa are explained in Yogaratnakar, BhaishajyaRatnawali 181 in 19th century. Almost all the 20th century authors like vaidya YadavajiTrikamji, Acharya Vidhyadhara shukla, Shivacharana Dhyani, Kaviraja RamarakshaPathak have described the disease kasa under the heading of Pranavaha srotodhustivikara.UTPATTI, PARIBHASHA & PARYAYA In ayurveda Kasa is explained as a separate disease entity with the explanationof specific nidana panchaka and treatment. The Kasa which is produced bypredominantly vitiated Kapha is called as Kaphaja Kasa. Disease Review - 37
  • 53. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaUTPATTI: Kaphaja Kasa consists of two words “Kapha” and “Kasa”. The word Kapha isderived from the root Ke, meaning Shirasi Kena Jalena va palathi, that which isproduced in the Shiras and nourished by jala182. The Synonym Shleshma which is used frequently, as the term Kapha, isderived from the root “Shlish alingane” meaning of Shlish being to embrace or tokeep together183. Three derivations are available for the word Kasa in “Shabda anushasana ofPanini”. 1. One more derivation of the term Kasa is from the root Kasi, which means gati and shasanayoti. The meaning of two words being movement and punishment184. 2. Second derivation is from the root Kas, the meaning of Kas is gatou, movement. Commentator Chakrapani derived the word Kasa from the root kas and meaning of Kas is gati Shatanayoti, means falling movement185. 3. The word Kasa is masculine gender and taken from the root Kasri, meaning “Shabda Katsanyam” i.e., “unpleasant sound”. Commentator Gangadhara used Kasri dhatu for derivation of Kasa. Meaningof it is kushabda, bhinna swara, broken sound186.NIRUKTI: The term kapha has been defined as “Kena jalena phalathi ithi kapha”. That isto say Kapha is the product of water187. Charaka has defined kasa as “Shushka va sa kapho va kasanath kasaha” meansrelease of obstructed vayu resulting in the production of abnormal sound in theprocess which may be productive or dry188. Disease Review - 38
  • 54. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Sushruta defines kasa as “it is the disease associated with a typical sound thatof sound obtained from broken bronze vessel” 189. Dalhana commented over this aswhile expelling of dusta prana vayu it makes sound ‘saghosha’ called as kasa190. In Madhukosa commentary kasa is defined as “Kasati shirokanthat urdhvagachati vyariti” means in which upward movement of vayu even above kantha andshira pradesha191.Definition of Cough: • A sudden explosive forcing of air through the glottis by an effect to expel mucous or the forigen matter from the bronchial tubes or larynx. • To free air through the glottis by series of expiratory efforts.PARYAYAS : Paryaya of kasa mentioned in Atharnava veda are Kasaha,Kasa & Kasika Kasika - means it is a roga vishesha, which produces a peculiar sound i.e. kas shabda192.BHEDAS : Starting from “Garuda purana”, all Acharyas of Brihatrayees,Laghutrayees,Yogaratnakara, Gadanigraha & Bhelasamhita opined that there are only five types ofkasa as1. Vataja Kasa 2. Pittaja Kasa 3. Kaphaja Kasa4. Kshataja Kasa 5. Kshayaja Kasa Depending upon the nature of kasa it can be classified into two importantvarieties193 1. Ardra kasa (Kaphaja Kasa). 2. Shushka kasa (Vataja kasa) Disease Review - 39
  • 55. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaFlow Char No. 1 illustrating the classification of Kasa according to differentfactors KASA BHEDAAccording to According to According to According toKarma Bheda Dosha Bheda Nature of Kasa sadhyasadhyataNija Agunthaja Shushka Ardra Sadhya AsadhyaAccording to different Acharyas According to Hareeta197Vataja Kasa194 195 196 Vataja KasaPittaja Kasa Pittaja KasaKaphaja Kasa Kaphaja KasaKshayaja kasa Vatapittaja KasaKshataja kasa Shleshma pittaja Kasa Raktaja Kasa Kshayaja Kasa Disease Review - 40
  • 56. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaNIDANA Kasa is the most commonest disease of Pranavaha srotodushti vikara. Nidanafor manifestation of Kasa is categorized broadly into two main divisions. 1. General causative factor (samanya nidana) 2. Specific causative factor (vishesha nidana) General etiological factors are responsible for the manifestation of all varietiesof the Kasa where as specific etiological factors are responsible for the specificvariety of Kasa. Acharya Charaka is the only author who has mentioned separate etiologicalfactors for different varities of Kasa. Rest of the authors viz . Sushruta, Vagbhata,Bhavamishra, Madhavakara, Yogaratnakara have explained general nidana for allvarieties of kasa . For better understanding nidanas of Kasa, can be broadly classified into twogroups. Aharaja nidanaRooksha ahara sevana Atikashaya rasa aharasevanaAtisheethahara sevana Alpa Ahara sevanaKatu, Ushna Amla ahara atisevana. Guru, snigdha, madhura ahara atisevanaBhojyanam Vimargagamana Viharaja nidanaDhooma sevana Atisamsarga of surya & agniRaja Sevana Diva swapnaShrama Alpa cheshtanaVegavarodha Vega udeernaRatrijagarana Disease Review - 41
  • 57. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaKaphaja kasa vishesha nidana: The Nidanas like Guru, Abhishyandi, Madhura, Picchila, Snigdha aharasevana, Ratrijagarana, Diwaswapna, Himasnana and Madyapana198 Table No. 15 Showing the Samanya nidana of Kasa199 200 201 202 203 Nidana S.S B.P M.N Y.R G.N Dhumopaghatha + + + + + Raja sevana + + + + + Shrama + + + + + Bhojanasya vimargagamana + + + + + Vegavarodha + + + + + Hasya, Prahasya - - - - - Anila Sannirodha - - - - - Vega Udeerana - - - - - Ratri Jagarana - - - - - Diva Swapna - - - - - Dhatukshayakaraka nidana - - - - - Avarana - - - - - Rukshanna Shevana + + + + + Atiushna guru ahar sevana - - - - - Asatmya, Katu, Amla, Lavana, Sheeta - - - - - Snigdha, Utkledi ahara sevanaFollowing are the commentaries available for NidanaDhumopagata- the smoke which causes damage on entering nose & mouthRajasevana – The dust which enters nose & mouth.Bhojana vimargagamana- when the food is consumed hastly followed by fast andforceful diglutation causes vimarga gamana of bhojana.Utkledi – The kledatwa produced in Rakta and Mamsa. Disease Review - 42
  • 58. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaPOORVA ROOPA: As no specific poorva roopa are mentioned, general Poorva roopasexplained in the context of Kasa can be considered.They are as follows:1. Shuka purnagala2. Kanthe Kandu3. Bhojyanama avarodha4. Aruchi Apart from these Sushruta has mentioned few more poorva roopas likeSwashabdha vaishamya, Agnisada, Gala talu lepa. Table No. 16 showing the Poorvaroopa of kasa204 205 206 207 208 209 210 Poorvaroopa C. S. S. S. A. S. A. H. M. N. B. P. G. N.Shukapurna gala + - + + + + +Shukapurna asya + - - - + + +Kanthe kandu + + + + + + +Bhojyanam + + - - + + +avarodhaGalatalu lepa - + - - + - -Arochaka - + + + + - -Agnisada - + - - + - -Hridaya aswasthata - - + - - - -Asya vairasya - - + - - - - Disease Review - 43
  • 59. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaROOPA Roopa is the stage of pathogenesis where in manifestation of the symptoms areproduced due to dosha dushya sammurchana that is vyaktavastha.Table No. 17 Roopa of Kaphaja kasa according to different Acharyas 211 212 213 214 215 216 217 Roopa C.S S.S A.S A.H M.N B.P G.N Buhula, Madhura, Snigdha, Ghana + - - - - - - Sandra - + - - + + + Bahula, Ghana, Snigdha Sweta - - + + - - - Ghana, bahula - - - - - - - Grathita - - - - - - - Kapha poorna deha Uraha vankshana sampoornmiva + - - - - - - Rasamano hi ruk vaksha + - - - - - - Uro alpa rujatwa - - + - - - - Hridaya stimita - - + - - - - Swara bheda - - - - - - - Pinasa + - + - - - - Utklesha + - - - - - - Chardi + - + - - - - Aruchi + + + - + - + Ashya madhuryatha + - - - - - - Shira shoola - + - - + - + Mandagni + - - - - - - Gourava + + + - + - + Jadhyata - - - - - - - Angasada - + - - - - - Romaharsha + - + - - - - Mukhalepa - + - - - - - Kanthe kandu - - - - - - + Disease Review - 44
  • 60. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Flow Chart No. 2 Showing the samprapti of kaphajakasa218 Khavaigunya Nidanarthakara Kapha prakopakaUtpadaka Nidana roga nidana Kapha Vriddhi Agnimandya Amarasa Khavaigunya Prakupita kapha Dusta rasadhatu Malarupi kapha vriddhi Sanga Vata avarodha Vata prakopaka Vata vimarga gamana karana Kaphaja kasa Disease Review - 45
  • 61. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaSAMPRAPTI GHATAKA: The importance of the knowledge of the pathogenic process is to break thesammurchana of dosha and dushya. Along with dosha and dushya rest of thesamprapti ghataka’s like agni, ama, srotas etc., also having role in the manifestationand progress of the disease. For the break down of the samprapti, a clear knowledgeabout the various ghatakas are important. The samprapti ghataka of kaphaja kasa areas followsDosha - Kapha, vataDushya - RasaAgni - Jatharagni mandya, - Rasadhatwagni mandyaAma - Jatharagni mandhya janyaUdbhavasthana - AmashayaSancharasthana - RasayaniAdhishtana - UrasSrotas - Pranavaha, RasavahaDustiprakara - SangaVyadhi marga - Abhyantara Disease Review - 46
  • 62. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Table No. 18 showing interrelation between Lakshanas and Dosha, Vikalpa, Dushya, Srotas and Sthana in Kaphaja Kasa. Lakshanas Dosha Vikalpa Dushya Srotas Sthana1 Kapha stivana K Drv R P Uras2 Kasamano hi ruk vaksha V Kar R P Uras3 Uro alpa rujathwam V Kar R P Uras4 Hridaya stimita K Sheeta G R P Uras5 Uraha vankshana K Kar R P Uras sampoorn miva6 Kanthe kandu K Kar R P Uras7 Swara bheda K Drv R R Kanta8 Peenasa K Drv R P Nasa9 Mukhalepa K Picchila G R A Mukha10 Utklesha K Kar R A Amashaya11 Chardi K Drv R A Amashaya12 Ashyamadhurya K Drv R A Mukha13 Shirashula V Kar R A Shiras14 Mandagni K Manda G R A Amashaya15 Gourav K Guru G R R Sarvasharira16 Angasada V Manda G R R Sarvasharira17 Romaharsha V Sheeta G R R Sarvasharira18 Kledata K Snigdha G R R Sarvasharira Note : V = Vata K = Kapha R = Rasa, P = Pranavaha A = Annavaha Drv = Dravyataha Kar = Karmataha G = Gunataha Disease Review - 47
  • 63. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaUPASHAYA AND ANUPASHAYA: In classics there is no direct reference about Upashaya and Anupashaya ofkaphaja kasa. Acharya Charaka had mentioned the drugs which are having Katu,Ruksha and Ushna quality and Kaphahara properties to be admistered in kaphaja kasa.In Kaphaja kasa if pitta dosha is associated then tikta rasa drayas will act as Upashaya219. The substances which are having Guru, Snigdha, Abhishandhi and Madhurarasa act as Anupashaya. Diva swapana also act as Anupashaya.UPADRAVA: According to Charaka if Kaphaja Kasa is associated with pitta dosha, thenTamakaswasa would occur220. Upadravas are the complications produced at the end stage of diseases. ForKaphaja kasa no specific upadravas have been explained in classics. In Ashtangahridaya221, Yogaratnakara222 and Bhavaprakasha223, general Upadravas for Kasa rogahas been explained i.e if Kasa is neglected then it gives rise to Shwasa, Kshaya,Jwara,Chardi, Arochaka,Swarabheda,Peenasa, Yakshma like disorders. So it shouldnever be neglected and should be treated at an earliest.SADHYASADHYATA: Most of the authors of Ayurveda have described the Sadhyasadhyata of kasaaccording to the variety, chronicity of disease, age and strength of the patient. According to Acharya Charaka224 and Vagbhata225, the kasa that is manifestedby single dosha is sadhya. The kasa if it is manifested due to involvement of two ormore doshas, kshataja, kshayaja Kasa and all varities of Kasa in an aged person areyapya. Disease Review - 48
  • 64. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa According to Yogaratnakara226 any variety of Kasa which is recentlymanifested is sadhya, only when chikista chatushpada holds good. If patientexpectorate puyayukta, aruna, shyava, harita, peeta, neela coloured sputum andassociated with complications like Shwasa, Kshaya, Vamana and Swarabanga thensuch Kasa is said to be incurable.ARISHTA LAKSHANA:227 When Kasa patient spits large quantity of Kapha, having the colour of blue, yellow or red, suggests the definite sign of death. If kasa patient is with mamsakshina, balakshina and if he develops romaharsha, shotha, sandramutrata and jwara is asadhya, and ends in death. 228 In a Kasarogi, where extreme dhatukshaya and Balakshaya are seen and if this patient gets temptation during noon hours and along with this, if dreadful cough is present then it is an arishta lakshana. A persistent vomiting in a kasarogi is a definite sign of death. If Kasarogi develops Atisara, Jwara, Hikka, Chardi and Shotha in medra and vrushana, then patient is sure to die. A person suffering from kasa, when exhibits associated diseases like Jwara, Vamana, Trishna, Atisara and Shopha, then it is definite sign of death. When Kasarogi exhibits the prodromal symptoms like Koshta shula, Hikka and Chardi the death is sure. Disease Review - 49
  • 65. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaVYAVACHEDAKA NIDANA:229 Before confirming the diagnosis of Kaphaja kasa it has to be differentiatedfrom other diseases which mimic some specific symptoms of Kaphaja kasa. Kasaassociated with kapha shteevana is presenting symptom of Kaphaja kasa, which isalso seen in other disorders like Vataja kasa, Pittaja kasa, Kshataja kasa, Kshayajakasa and Rajayakshma. So it is necessary to differentiate kaphaja kasa from the abovesaid disorders.Vataja Kasa: The cardinal feature of Vataja kasa is dry cough. But in some conditionpatient expectorates small quantity of sputum with difficulty. Along with thisUrashoola, Parshva shoola, Mukha shuskata are present. These symptoms are absentin Kaphaja kasa, so it can be ruled out.Pittaja Kasa : The cardinal feature of Pittaja kasa is peeta kaphashteevanayukta kasa. Jwarais another important lakshana. Along with these pitta vriddhi lakshanas like Trishna,Daha, Urodhoomayana are present. In kaphaja kasa these symptoms are absent so itcan be ruled out.Kshatasa kasa: The cardinal feature of Kshataja kasa is shonitayukta kaphastheevana.Urahashoola is the another important symptom. The nature of pain is pricking type,tenderness in Uras, Jwara, Shwasa and Paaraavata eva kujana are associatedsymptoms. As these symptoms are absent in kaphaja kasa. So differentiated. Disease Review - 50
  • 66. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaKshayaja Kasa: The cardinal feature of Kshayaja Kasa is durghanda, harita, rakta and puyauktakaphashteevana. The patient is Krisha and is associated with Jwara, Urahashula,Irregular bowel habits. So the absence of these symptoms in Kaphaja kasa, rules outthe disease.Rajayakshma230: The nature of shteevana in Rajayakshma is Picchila, Bahula and colour isharita, sweta or peeta. The samanya lakshana of Rajayakshma are Amsaparshwaabhitapa, Karapada santapa and Jwara, which are not present in Kaphaja kasa. Sodifferentiated.CHIKITSA:231, 232Following are the principles treatment of Kaphaja Rasa : If the person is strong, Vamana is the first line of treatment. After that, the drugs which are having katu, ruksha, ushna and kaphakara properties to be administered, yavanna is diet in such patients. Depending upon the condition Vamana, Virechana, Shirovirechana, Vairechanika dhumapana and Kavalagraha are the line of treatment.The drugs which are having Katu and Kaphahara properties which especially make vishoshana of kapha are useful. Commenting on this Dalhana has explained that the drugs which are laghu, ruksha and bhojana in little quantity act as vishoshana. Acharya Charaka explains Virukshana is the main principle in Ardra kasa. According to Yogaratnakara, Vamana and Langhana are the two main principles of treatment of Kaphaja kasa. After that, yusha prepared with yava and katu tikta dravya is to be administered. Disease Review - 51
  • 67. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaPATHYA AND APATHYA:233, 234 Treatment procedure for any disease without the diet will not be complete.The diet and drugs, which are favourable to the body and mind and do not produceany adverse effects are considered as Pathya and opposite to it are Apathya. In Brihatrayee there is no direct references about Pathya and Apathya. Thereis direct mentioning of Pathya and Apathya in Yogaratnakara and in Bhaishajyaratnavali.PATHYA:Ahara Suka danya varga - Shastikashali, Yava, Laja ,GodhumaShamidhanya varga - Mudga,Kulatha MashaMamsarasa varga - Gramya mamsa,Jangala mamsa.Gorasa varga - Ksheera, Gritha,TakraJalavarga - UshnajalaPhalavarga - Bimbi ,BijapuraMadhu varga - MadhuIkshu varga - Guda padarthaTaila varga - Tila taila, sarshapataila,BilvatailaSthavara varga - Jivanthi ,Gostani, Maricha, Shunti, Mulaka Balamula, Kasamarda, Yusha with Kulatha and Mulaka, Laghu annaAPATHYA:AharaRasa : Madhura rasaGuna : Snigdha, Guru,PichilaAnna : Pistanna ,PayasaVihara : Maithuna,Dhumasevana. Disease Review - 52
  • 68. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM 235Structures of the respiratory system: Respiratory organs include the nose, pharynx, trachea, bronchi and lungs.They act with cardiovascular system to supply oxygen (O2) and remove carbondioxide (CO2) from the blood.Nose : The external portion of the nose is made of cartilage and skin and is lined withmucous membrane. Openings to the exterior are the external nares. The internalportion of the nose communicates with the Paranasal sinuses and Nasopharynxthrough the internal nares. The nasal cavity is divided by septum. The anteriorportion of the cavity is called the vestibule. The nose warms, moistens and filters airand function in olfaction and speech.Pharynx : The pharynx is a muscular tube lined by a mucous membrane. Theanatomic regions are the Nasopharynx, Oropharynx and Laryngeopharynx. TheNasopharynx functions in respiration. The Oropharynx and Laryngeopharynxfunction both in digestion and respiration.Larynx : The Larynx (voice box) is a passage that connects the Pharynx with theTrachea. It contains the thyroid cartilage (Adam’s apple), the epiglottis, whichprevents food from entering the Larynx; the cricoid cartilage, which connects theLarynx and Trachea and the paired Arytenoids, Corniculate and Cuneiform cartilages.The Larynx contains vocal folds, which produce sound as they vibrate.Trachea : The Trachea (wind pipe) extends from the Larynx to the primary Bronchi.It is composed of C- Shaped rings of cartilage and smooth muscle and is lined withpseudostratified ciliated epithilium. Two methods of obstruction in the airways aretracheotomy and intubation. Disease Review - 53
  • 69. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaBronchi : The Bronchial tree consists of the Trachea, Primary Bronchi, Secondarybronchi, Tertiary bronchi, Bronchioles and Terminal Bronchioles. Walls of bronchicontain rings of cartilage. Walls of bronchioles contain plates of decreasing cartilageand increasing smooth musles.Lungs : Lungs are paired organs in the thoracic cavity. The pleural membranceencloses them. The parietal pleura is the superficial layer that covers the thoraciccavity of the lungs. The visceral pleura is the deep layer that covers the lungs. Theright lung has three lobes separated by two fissures and depression, the cardiac notchsecondary branch supply segments of lung tissue called brancho pulmonary segments. Each broncho pulmonary segment consists of lobules, which containlymphatics, arterioles, venules, terminal bronchioles, respiratory bronchioles, alveolarducts, alveolar sacs and alveoli. Alveolar walls consist of type I alveolar cells type IIalveolar cells and alveloar macrophages. Gas exchanges occurs across the alveolar –capillary (respiratory) membrance.Pulmonary ventilation Pulmonary ventilation, or breathing, consists of inspiration and expiration.The movement of air into and out of the lungs depends on pressure changes governedin part by Boyle’s law, which states that the volume of a gas varies inversely withpressure, assuming that temperature is constant. Inspiration occurs when alveolarpressure falls below atmospheric pressure. Contraction of the diaphragm and externalintercostals muscles increases the size of the thorax. Thus decreasing thenintrapleural pressure so that the lungs expand. Expansion of the lungs decreasesalveolar pressure so that air moves along the pressure gradient from the atmosphereinto the lungs. During forced inspiration, accessory muscles of inspiration are alsoused. Disease Review - 54
  • 70. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Expiration occurs when alveolar pressure is higher than atmospheric pressure.Relaxation of the diaphragm and external intercostals muscles results in elastic recoilof the chest wall and lungs. Which increases intrapleural pressure. Lung volumedecreases, and alveolar pressure increase. So that air moves from the lungs to theatmosphere. Forced expiration employs contraction of the internal intercostals andabdominal muscles. Normal quiet breathing is termed as “Euponea”. Other patternsare costal breathing and diaphragmatic breathing. Modified respiratory movementssuch as coughing, sneezing, singing, yawning, crying, laughing and hiccough are usedto express emotions and to clear the airways.EXCHANGE OF OXYGEN AND CARBON DIOXIDEExternal respiration and internal respiration: In internal and external respiration, O2 and CO2 diffuse from areas of theirhigher partial pressures. External (pulmonary) respiration is the exchange of gasesbetween alveoli and pulmonary blood capillaries. It depends on partial pressuredifferences, a large surface area for gas exchange and a small membrane and the rateof airflow into and out of the lungs. Internal (tissue) respiration is the exchange ofgases between tissue blood capillaries and tissue cells.Control of respiration: The respiratory centre consists of medullary rhythmicityarea, pneumotaxic area, and aphneustic area. The inspiratory area has an intrinsicexcitability (auto rhythimicity) that sets the basic rhythm of respiration. Thepneuotaxic and apneustic areas coordinate the transition between inspiration andexpiration. Respiration may be modified by a number of factors, including corticalinfluences; the inflation reflex, chemical stimuli, such as O2 and CO2 and H+ levels,neural changes due to movement blood pressure changes, the limbic systemtemperature, pain and irritatin to the airways. Disease Review - 55
  • 71. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaCHRONIC BRONCHITIS 236 Chronic bronchitis is a clinical disorder charecterised by productive cough dueto excessive mucus secretion in the bronchial treenot caused by localbronchopulmonary disease on most of the days for atleast three months of the year,for atleast two consecutive years. Both sexes and all ages may be affected but it ismost frequent in middle aged men. 237EPIDEMIOLOGY Chronic bronchitis is a common Respiratory disease. These has beenincreasing evidence in recent years of a relatively high prevalence in developingcountries. Prevalence rates for Chronic bronchitis in the age group 40 – 64 yrs in menwas 17% and in women 8%. Chronic bronchitis is the fourth leading cause of death in the United States andis the only one of the 10 leading causes of death for which mortalility rate is stillraising. Mortality rate is much higher in males than females, and increase withincreasing urbanization. The highest mortality is in the winter. Cigarette smoking isthe most important factor associated with the occurrence of mucous hyperscerectionand air flow obstructive diseases. Patients with Bronchitis are more likely to have a family history of chestdiseases and the hereditary tendency being stronger in female than in male patients.There is higher prevalence of Chronic bronchitis among persons with a lowersocioeconomic status and in those with a history of low birth weight. Disease Review - 56
  • 72. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa 238AETIOLOGY Chronic bronchitis develops in response to the long continued action ofvarious types of irritants on the bronchial mucosa. The most important of these istobacco smoking, but others include dust, smoke and fumes occurring as specificoccupational hazards or as part of a general atmospheric pollution in industrial citiesand towns. Infection is sometimes a precipitating factor in the onset of Chronicbronchitis but its role is in aggravating the established condition.Smoking: Smoking is the most common single factor leading to Chronic bronchitis.Cigarette smokers have about 10 times risk than non smokers, of dying from Chronicbronchitis. It has been predominantly related to the inhalation of tobacco smoke and ismore prevalent among chain smokersAir pollution: Air pollution may be domestic, urban or occupational. In comparing withsmoking, urban air pollution is less harmful, Dust exposure at work has beenconsidered as an important etilogical factor of respiratory diseases. Exposure to dustof vegetable origin appears more likely to cause Chronic bronchitis than exposure tomost mineral dusts.Infection : Most of the times viral infection is responsible for exacerbation of Chronicbronchitis. The frequency of lower respiratory tract infection is much higher in aperson who is recurrently suffering from cold. Disease Review - 57
  • 73. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaHereditary: Recent studies have shown that relatives of Chronic bronchitis subjects have ahigher prevalence of Bronchitis. But the underlying defect that constitutes geneticpredisposing is unknown.Excerbation: Patients with Chronic bronchitis often relate excerbations of their disease toclimatic factors. Particularly extreme varitations in humidity and temperature. 239PATHOGENESIS The aetiological factors induce some pathological conditions in thetrachiobronchial tree. There are two sets of factors which are important in the genesisof Chronic bronchitis. 1. Chronic irritation by inhaled substances. 2. Microbiologic infections.Cigarette smoking remains the paramount influence over Chronic bronchitis. The hallmark and earliest feature of Chronic bronchitis is hyperserection of mucus, which starts in the large airways and is associated with hypertrophy of the submucosal glands in the trachea and bronchi. These changes contributes excessive mucus production but not to airway obstruction. If Chronic bronchitis persists there is also an increase in the number of goblet cells in the surface epithelium of large bronchi and a marked increase in goblet cells of small bronchi and bronchioles. It is this excessive mucus production by goblet cells in small airways that contributes to airway obstruction. It is thus possible that airway irritants cause mucus hypersecretion by stimulation of neurohormonal pathways. Disease Review - 58
  • 74. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa The alterations in the small airways of the lung (small bronchi and bronchioles, less than 2 to 3 mm in diameter) are the physiologically important and perhaps earliest manifestations of chronic airway obstruction. Histological studies in the lungs of smokers disclose goblet cell metaplasia with mucous plugging of bronchiolar lumen, clustering of pigmented alveolar macrophages, inflammatory infiltration and fibrosis of the bronchiolar wall. The role of infection appears to be secondary. cigarette smoke probably predisposes to infection in more than one way,.It interfere with ciliary action of the respiratory epithelium, may cause direct damage to airway epithelium and inhibits the ability of bronchial and alvealor leukocytes to clear bacteria.Virus can also cause exacerbations of Chronic bronchitis. 240CLINICAL FEATURES The main symptoms of Chronic bronchitis are cough, expectoration anddyspnoeaSymptoms of Chronic bronchitis:Cough : Constant or paroxysmal, worse in winter or on exposure to cold winds or sudden change in temperature.Expectoration : Variable, may be little, thin and mucoid or thick or frothy, mucoid and sticky. May become mucopurulent during attacks of acute bronchitis in winter.Dyspnoea : In advanced cases, breathing becomes quick and wheezing present even at rest.Fever : Absent except in acute exacerbation.Haemoptysis : Ususally in the form of streaks. Disease Review - 59
  • 75. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaSigns of Chronic bronchitis : Build-Usually short & stocky Cyanosis rarely with clubbing. Signs of airway obstruction, prolonged expiration, contraction of expiratory muscles of respiration, pursing of lips during expiration & jugular venous distension during expiration due to excessive swings of intrathoracic pressure. Widespread rhonchi of variable pitch usually most marked in expiration. Crepitations at lung bases in patients with excessive bronchial secretions. Both wheezing and crepitations may be altered in character by coughing. 241TREATMENT It is found that one clinical form of Chronic bronchitis can transform intoanother. Long standing simple Chronic bronchitis convert into Mucopurulentbronchitis if infection joins.So the treatment of Chronic bronchitis in the early stagesis necessary.Steps in management: Smoking cessation Avoidance of atmospheric pollution Bronchodilators Expectorants and mucolytics Antibiotics and Corticosteroids 242COMPLICATIONS Preumotharax may occur following a bout of cough. Respiratory failure and chronic cor-pulmonale are end stage complications. The incidence of lung cancer is also higher. Disease Review - 60
  • 76. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Complications are directly connected with infections, Pneumonia, Bronchiectasis, Bronchospasm and Asthama. Complications connected with evolution of Bronchitis are Lung emphysema, diffuse fibrosis, Pulmonary failure and development of right ventricular failure. 243PROGNOSIS: Most favourable prognosis is in cases with simple Chronic bronchitis. In restof the varieties complete recovery is hardly possible. The least favourable prognosisis in Obstructive Chronic bronchitis and with complications.PREVENTION: Avoidance of smoking, adequate control of atmospheric pollution in industry.Use of ideal cooking fuel and prompt treatment of recurrent bronchopulmanoryinfections help in the prevention of this disease. Even in established cases,implementation of these measures helps in preventing further deterioration of lungfunction. 244DIFFERENTIAL DIAGNOSIS: Simple and recurrent mucopurulent Chronic bronchitis is by definition, adiagnosis based on exclusion of other pathologies. In non smokers presenting withchronic cough, a specific cause can often be identified. So the following possibilitiesshould be considered. Pulmonary Tuberculosis Mucopurulent Chronic bronchitis Obstructive Chronic bronchitis Bronchiectasis Bronchogenic Carcinoma Disease Review - 61
  • 77. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa 245INVESTIGATIONS: During the initial stage of Chronic bronchitis the laboratory and instrumentalfindings can be normal. But these findings can become very informative at certainstages of Chronic bronchitis. They are used to reveal complications, to determine theactivity of inflammation, to differentiate the disease from the other diseases withsimilar clinical symptoms.Sputum examination: The sputum is usually mucoid and frothy and becomes mucopurulent orpurulent during acute exacerbations. Sputum culture and sensitivity helps inmanagement.Blood examinations: The White cell count may be raised. In the acute phase, indices aremoderately increased and leucocyte counts are moderately high, Eosinophilia ispossible. It usually suggests allergic lesions.Urine: Routine urine examinations are also in normal limits.Chest X-ray: Most of the cases of Chronic bronchitis are having normal posterior anteriorchest radiograph. In same patients PA view X-ray of the chest shows over inflationwith increased brochiovascular markings, suggestive of thickening of bronchi. Disease Review - 62
  • 78. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaFlow Chart No.3 Showing Pathogenesis of Chronic Bronchitis Atmospheric Smoking Recurrent R. T. I. Pullution Irritation in Metaplasia of Bronchial Tree epithelium Stimulation of Loss of ciliated Secretion epithelium Serous gland Retension of secretion hyperplasia (chronic bronchitis) Infection Inflammation of mucosa Inflammation of mucasa Broncho spasm Spread of infection to distal bronchi Collapse of small brochi Obstruction Disease Review - 63
  • 79. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaMethodology was studied mainly under three headings I. Pharmaceutical Study II. Analytical Study III Clinical StudyI. PHARMACEUTICAL STUDY: Pharmaceutical study consists of identification, selection, processing of rawdrugs and preparation of Kaphaketu rasa. Preparation of medicines involves various processes like Shodhana, Marana inaccordance with physical, chemical and pharmacological properties of the drug and itsclinical purpose. In Rasashastra texts, we get more than one preparation in the name ofKaphaketu rasa in different contexts, with variation of ingredients. In this particularstudy which has been mentioned in the context of Vishopavishadi vijnaniyachaturvinshastarang of Rasatarangini has been selected.The following ingredients and equipments are necessary for this study. Vatsanabha Tankana Shankha Pippali Ardraka Equipments like Mortar, Pestle, Ulukalayantra, Spatula, Vessels, Cloth etc., Pharmaceutical Study - 64
  • 80. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaMETHOD OF PREPARATION: The method of preparation of Kaphaketu rasa is done under these steps. 1 Identification & collection of raw drugs. 2 Tankana Shodhana 3 Shankha Shodhana 4 Shankha Marana 5 Vatsanabha Shodhana 6 Pippali choornikarana 7. Vatsanabha churnikarana 8 Ardraka swarasa 9. Mixing of Ingredients 10. Preparation of Kaphaketu rasa.Date of commencement of practical : 16/08/2004Date of completion of practical : 18/09/20041. IDENTIFICATION AND COLLECTION OF RAW DRUGS. The identification and collection of raw drugs are necessary because withoutthese we can’t assure the quality of formulations. So this section of study deals withIdentification and collection of raw drugs of Kaphaketu rasa. Pharmaceutical Study - 65
  • 81. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaDate of commencement : 16 /08 /2004Date of completion :17 / 08/ 2004 The local herbo – mineral drug shop dealer was requested to get the particularor good quality of raw drugs and those were certified by the concerned departmentswith their classical grahya and agrahya lakshanas. In Ayurveda certain drugs will cause adverse effects or will be with lesstherapeutic effect, if administered in impure state. So proper purification is necessaryto combat the probable adverse effects by reducing its toxicity.2. TANKANA SHODHANA :Date of commencement : 19/08/2004Date of completion : 19/08/2004Reference : Rasatarangini 13 / 77 -78.Materials: Dravya Mana Tankana 300 gms Iron pan, Stove, Khalvayantra etc.Method of purification: 300 gms of ashuddha Tankana was taken in a clean and dry Khalva yantra and pounded well to prepare fine powder. Each time about 5 gms of fine powder of Tankana was taken in an iron pan and fried under mild fire. Pharmaceutical Study - 66
  • 82. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Initially it liquefies and on continuous heating it turned into white opaque substance due to evaporation of water. The frying was continued until Tankana get completely bloomed and disappearance of sounds like crepitations. The product thus obtained was taken out and allowed to cool itself then powdered and preserved in an air tight glass container.Observations : During frying, initially it liquefied and then it produced sounds like crepitation. The Tankana after frying become bloomed and turned into white opaque substance. The weight of the Tankana was reduced after frying due to evaporation of water content. i.e reduced to almost half of its initial weight.Precautions : To avoid loss wide pan should be used. Each time small quantity of Tankana powder is used to avoid spilling out of material. It should be fried under mild fire.Results : Table No. 19 Showing quantity of Tankana before and after Shodhana Dravya Before Shodhana (in gms) After shodhana (in gms) Loss Tankana 300 170 130 Pharmaceutical Study - 67
  • 83. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa3. SHODHANA OF SHANKHADate of commencement : 21/08/2004Date of completion : 21/08/2004Reference : Rasatarangini 12 / 7.Materials : Dravya Mana Shankha 210 gms Jambira nimbu swarasa Yathavashyaka Dolayantra, Stove, Cloth, Iron rod, thread, Ulukala Yantra etc.Method of purification: The extracted Jambira nimbu swarasa was kept ready. 210 gms of Shankha was taken and made into small pieces. The pieces of Shankha were tied in cloth and Pottali was prepared. The Pottali was immersed in Dolayantra with the help of iron rod containing Jambira nimbu swarasa. The Dolayantra was subjected for heating on mild fire which was maintained throughout. Required amount of Jambira nimbu swarasa was added frequently in Dolayantra to avoid burning of drug. The procedure was continued for three hours. Then Pottali was taken out from Dolayantra and the Shankha pieces were thoroughly washed with hot water. The pieces of Shankha were dried well. Pharmaceutical Study - 68
  • 84. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaObservations: After few minutes of heating the Jambira nimbu swarasa started to over flow. The colour change of the Shankha pieces to white was observed.Precautions: The Pottali was immersed in Dolayantra in such a manner that, it should not touch the patra on any side and whole drug should be in contact with liquid. Mild fire was maintained through out. To avoid overflow of swarasa, small quantity of swarasa was added frequently.Results : Table No. 20 Showing quantity of Shankha before and after Shodhana Before Shodhana After Shodhana Dravya Loss (in gms) (in gms) Shankha 210 200 104. MARANA OF SHANKHADate of commencement : 24/08/2004Date of completion : 07/09/2004Reference : Rasatarangini 12 / 17 -19. Pharmaceutical Study - 69
  • 85. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaMaterials : Dravya Mana Shankha 200 gms Kumari Swarasa Yathavashyaka Khalvayantra, Ulukalayantra, Sharava samputas,Mud, Cloth, etc.,Method of Marana: The dried Shodhita Shankha pieces were taken and put into the sharava and was closed by another Sharava. Sandhi bandhana was done with the cloth smeared with mud and dried well. The pit was digged measuring 30 angulas in length, breadth and height. 700 vanopalas were kept in the pit and sharava samputa was placed over it. Again 300 vanopalas were kept over the Sharava samputa. Then subjected to Gaja puta by igniting the fire. After swanga sheeta the sharava was taken outside and smeared mud was removed carefully. Then the pieces of Shankha were powdered well and Kumari Swarasa bhavana was given and chakrikas were prepared and dried. Once again these chakrikas were subjected to Gajaputa as explained above. As it did not passed Bhasma pareeksha, it was once again subjected to Gajaputa for the third time, where it attained the Samyak Bhasma laxanas. Sharavasamputa was removed and chakrikas were powdered well and kept in air tight container. Pharmaceutical Study - 70
  • 86. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaObservations : After first Gajaputa, Shankha pieces colour changed to Gray colour. After second Gajaputa, Shankha pieces colour changed to Grayish white. After third Gajaputa, Shankha pieces colour changed to white Essential Bhasma pareekshas were observed like Rekha purnata,Uttama etc.after third Gajaputa.Precautions : Sandhi bandhana should be done properly. Chakrikas were prepared and kept in Sharava before subjecting to Gaja puta. Gajaputa should be given until it should pass the essential Bhasma pareeksha.Results : Table No. 21 Showing quantity of Shankha Before and After Marana Before Marana Gaja putas After Marana Loss st 200 gms 1 Gaja puta 192 gms 8 gms 2nd Gaja puta 178 gms 14 gms rd 3 Gaja puta 160 gms 18 gms Total weight loss after marana 40 gms Pharmaceutical Study - 71
  • 87. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa5. VATSANABHA SHODHANADate of commencement : 09/09/2004Date of completion : 12/09/2004Reference : Rasa tarangini 24 / 77-78.Equipments : Ulakalayantra, Vessel, Cloth etc.,Ingredients and quantity : Dravya Mana Vatsanabha 250 gms Gomootra YathavashyakaMethod of purification: 250 gms of roots of Vatsanabha were taken and made into small pieces and washed well to remove the impurities (external). The pieces of Vatsanabha were tied in cloth and Pottali was prepared. This pottali was kept in a clean wide mouthed vessel. Gomutra was added, till the Vatsanabha gets completely immersed in it. This vessel is kept under sunlight whole day. Next day the previous Gomutra was removed and fresh Gomutra was added and kept under sunlight. This process was repeated for three days. Then Vatsanabha pieces were washed with hot water and the outer layer was removed. The pieces of Vatsanabha were dried under sunlight. Pharmaceutical Study - 72
  • 88. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa Observations: After soaking in Gomutra it became soft and colour of Gomutra changed to dark brown. After drying Vatsanabha became black in colour. The Vatsanabha pieces becomes mrudu after shodhana. Tingling sensation was not felt after Shodhana. After peeling of outer layer it had pandura varna inside. Precautions: Daily Gomutra should be replaced and fresh Gomutra must be used. A clean wide mouthed vessel was used to avoid over flow of Gomutra. Initially pounding should be done slowly to avoid loss of material. Test for Vatsanabha Shodhana : It becomes so soft as it can be pierced by a pin. It does not produce tingling or numbness when kept over the tongue. Results : Table No. 22 Showing Qty of Vatsanabha Before and After Shodhana Before Shodhana After Shodhana Dravya Loss Observations (in gms) (in gms)Vatsanabha 250 180 70 Colour-Gray Smell -Gomutra gandha. Touch-Fine Taste-Tikta Pharmaceutical Study - 73
  • 89. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa6. PIPPALI CHURNIKARANADate of commencement : 13/09/2004Date of completion : 13/09/2004Materials : Dravya Mana Pippali 250 gms Ulukhala yantra,Cloth. etcMethod of preparation: The Grahya 250 gms of pippali churnikarana was done in Ulukalayantra andsieved through cloth and stored in clean air tight bottle.Observations: Pippali converts into brown coloured fine powder.Result : Table No. 23 Showing Qty of Pippali Before and After Churnikarana Before After Dravya Churnikarana Churnikarana Loss Observations (in gms) (in gms)Pippali 250 190 60 Colour-Dark green Smell -Aromatic. Touch-Fine Taste-Pungent Pharmaceutical Study - 74
  • 90. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa7. VATSANABHA CHURNIKARANADate of commencement : 15/09/2004Date of completion : 16/09/2004Materials : Dravya Mana Vatsanabha 250 gms Ulukhala yantra,Cloth. etcMethod of preparation: The Grahya 250 gms of Vatsanabha churnikarana was done in Ulukalayantraand sieved through cloth and stored in clean air tight bottle.Observations: Vatsanabha converts into Gray coloured fine powder.Precautions: Vatsanabha should be dried properly before churnikarana.Result: Table No. 24 Showing Qty of Vatsanabha Before and After Churnikarana Before Churnikarana After Churnikarana Dravya Loss (in gms) (in gms) Vatsanabha 180 160 20 Pharmaceutical Study - 75
  • 91. Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa8. PREPARATION OF ARDRAKA SWARASA 1kg of Ardraka was thoroughly washed with water to remove the mud from it.Outer skin was removed cut into pieces and crushed well. This Ardraka kalka wassqueezed well using clean cloth to get swarasa. This is used for bhavana process. Dravya Dravyamana Ardraka 1 kgTotal quantity of Swarasa expressed from 1 kg of Ardraka is 600ml9. MIXING OF INGREDIENTS 150 gms of each powdered Shodhita Vatsanabha, Tankana, Shankha &Pippali were taken in Khalva yantra, mixed thoroughly.Result : Total quantity of dravyas obtained after mixing : 600 gms10. PREPARATION OF KAPHAKETU RASA:Date of commencement: 18/09/2004 Date of completion : 18/09/2004Materials : Dravya Dravyamana Shodhita Vatsanabha 150 gms Shodhita Tankana 150 gms Pippali Choorna 150 gms Shankha Bhasma 150 gms Ardraka Swarasa YathavashyakaMethod: The whole mixture was kept in Khalvayantra, Adraka swarasa wasadded to it and mixed with the powder using a spatula till the powder becomessufficiently wet. Mardana was done till consistency obtained so that vatis can beprepared out of it. Then vatis of ½ ratti (62.5 mg) each were prepared.Result: 630 gms of Kaphaketu rasa was obtained. Pharmaceutical Study - 76
  • 92. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaII. ANALYTICAL STUDY To know the marker components, physico chemical properties and to identifythe composition of products, the analysis of the drug according to the modernparameters is necessary. Though, Ayurveda is having its unique analytical approachtowards drugs. But in present era there is a necessity of understanding a drug based onmodern methodology of analysis also. In this section of the study, we have tried togive the inferences for the analysis. The study was done at Ministry of mines and Indian Bureau of mines,Bangalore, K. L. E. Society’s College of Pharmacy, Gadag and Bangalore test house,Bangalore.The study has been divided into two parts 1. Physical Analysis 2. Chemical Analysis1. PHYSICAL ANALYSIS a) Organoleptic characters Colour - Ash gray Smell - Faint odour Touch - Smooth b) Analysis Determination of Disintegration time: Procedure: One pill was introduced into each tube of the Disintegration Apparatus. Disc was added to each tube. The assembly was suspended in a beaker containing water at 37oC and apparatus was operated. The time was noted down with the help of a stop clock. The time taken for all the tablets to disintegrate completely is disintegration time. Disintegration time = 19 minutes. Analytical Study - 77
  • 93. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaDetermination of PH valueProcedure : the PH value of the sample was determined by a Digital pHMeter. One percent solution was prepared, as the sample was dry solid in theform of pills. The pills was powdered. One gram of the sample was weighedaccurately and dissolved in 100 ml of water and pH was noted in the DigitalpH meter. pH 1% solution = 9.90Loss on drying:Procedure : Digest pure quartz sand that passes through No. 40 and 60 sieveswith hydrochloric acid, wash acid free, dry and ignite preserved in a stoppedbottle. Place 25-30 gms prepared sand and short glass rod in a nickel orstainless steel dish about 55ml diameter and 40 mm deep filtered with cover.Dry thoroughly, cover dish, cool in desiccators. Drying gives yield about 1 gmof dry matter, mix with a few ml of water and transfer quantitatively to thedish containing prepared sand with aid of water. Mix the sample thoroughlywith the sand. Dry at a temperature not more than 700 0C. Under pressure not morethan 50 mm of Hg. Making trail washing at 2 hours intervals towards end ofdrying period until successive weighing should not differ by more than 2 mg.Calculate the total solid form the loss of weight on drying. Loss on drying at 110 0C : 12.09 % Analytical Study - 78
  • 94. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaIdentification of Alkaloids:System:Silica Gel 60 F 254 Merck pre-coated plates.Mobile phase:Chloroform : Methanol (90:10)Location reagent :Dragendroff’s Reagent.Procedure : Weigh about 2.0 grm of the sample into a separating flask. Addabout 20 ml water. Basify with dilute ammonia and extract with twoquantities 25 ml of Chloroform. Filter through anhydrous Sodium Sulphate.Evaporate the chloroform layer to the residue obtained. Add about 1 ml ofMethanol. Shake well to dissolve and spot about 10 μl solution on the TLCplate. Elute the plate with Mobile Phase to 3/4th of the plate. Dry the plate at105oC and spray the plate with Dragendroff’s reagent. It alkaloids are present,brownish red sports are obtained.Brownish red spots were obtained in the sample solution. Test for presence of Alkaloid : PresentDetermination of total ash :Procedure : Take about 2 gms accurately weighed, ground drug in apreviously traced silica dish, previously ignited and weighed. Scatter theground dry in a fine even layer on the bottom of the dish. Incinerate bygradually increasing the heat not exceeding dull red heat (450oC) until freefrom carbon. Cool and weigh. Calculate the percentage of ash with referenceto the air dried drug. Total ash : 32.91% Analytical Study - 79
  • 95. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaSolubility testProcedure : About one gram of the sample was weighed and dissolved in 10ml of the solvents. When the sample did not dissolve, an excess of solvent by10 ml quantity upto 100 ml was added and noted that the sample was sparinglysoluble in Chloroform (1 grm of sample in 100 ml chloroform) and slightlysoluble in water, 1 M Hydrochloric acid and alcohol (1 grm of sample in 600ml of the solvent).Solubility Water : Slightly soluble Chloroform : Sparingly soluble 1M Hydrochloric acid : Slightly soluble Alcohol : Slightly solubleWeight variation of tablets :Procedure : The average weight is determined by weighing 20 tablets. Thetablets are also weighed for each case is calculated and expressed inpercentage. Not more than two of the tablets deviate from the average weightby a greater percentage. No tablet deviate by more than that percentage. If 20 tablets are not available 10 may be assessed for thedetermination, not more than one which deviate from the average weight bygreater percentage. Weight variation in percentage (n=10) = 8.10% Analytical Study - 80
  • 96. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaHardness test: If the finished vati is too hard, it may not disintegrate in the requiredperiod of time and if the vati is too soft, it may not stand during packing andtransporting. Therefore, it is necessary to check hardness of tablets. The tablets or vatis can be roughly determined by holding the Vati ortablet in between the fingers of the hand and throwing it lightly on the floor.If it does not break it indicates that the proper hardness has been obtained.Procedure (Monsanto hardness test) : It is a small portable hardness tester,which was manufactured and introduced by Monsanto Chemical Company. Itconsists of a spring which can be compressed by moving the screw knobforward. The tablet to be tested is held between a fixed and a moving jaw andreading of the indicator was adjusted to zero. The force applied to the edge ofthe tablet is gradually increased by moving the screw knob forward until thetablet breaks. The reading is noted from the scale which indicates the pressurerequired in kg or lb to break the tablet. Hardness of 6 kg or more will producetablets of highly compact nature. Hardness in Kg (n = 10) = 3.5 + 0.5Friability: Friability test is performed to evaluate the ability of the tablet towithstand abrasion in packing, handling and transporting. The instrumentused for the this test is known as “Friability test apparatus”.Procedure : It consists of a plastic chamber which is divided into two partsand revolves at a speed of 25 rpm. A number of tablets are weighted and Analytical Study - 81
  • 97. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa placed in the tumbling chamber which is rotated for four minutes for 100 revolutions. During each revolution the tablets fall from a distance of 6 inches to undergo shock. After 100 revolution the tablets are again weighed and loss in weigh indicates the friability. The acceptable limit of weight loss should not be more than 0.8%. Friability in percentage = 0.64 % Determination of acid insoluble ash Procedure : Boil the ash obtained in the process described under determination of total ash for a minutes with 25 ml of dilute hydrochloric acid. Collect the insoluble matter on an ashless filter paper. Wash with hot water and ignite. Weigh it and calculate the percentage of acid insoluble ash with reference to the air dried drug. Acid insoluble ash in percentage = 1.31.2. CHEMICAL ANALYSIS : Qualitative reactions: Borate : The mixture obtained by the addition of sulphuric acid and alcohol (95%) to a borate when ignited, burns with a flame tinged with green. Calcium : i) Solutions of calcium salts, when treated with ammonium carbonate solution, yield a white precipitate which after boiling and cooling the mixture, is insoluble in ammonium chloride solution. Analytical Study - 82
  • 98. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa ii) Solutions of calcium salts when treated with ammonium oxalate solution, yield a white precipitate which is soluble in hydrochloric acid and insoluble in acetic acid. iii) Calcium salts, when moistured with hydrochloric acid and introduced on a platinum wire into the flame of a Bunsen burner, give a brick red colour to the flame.Quantitative estimations:Borate:Weigh accurately 2 gm of the material and extract with distilled waterexhaustively. Made water extract in a 250 ml volumetric flask, Pipette out 25ml of the solution and titrate with standard 0.1 NHCl using methyl orange asindicator. To another 25 ml of the solution, add the quantity of standardhydrochloric acid determined in the previous titration. Cover the beaker orconical flask with a clock glass or fisher beaker cover, heat to simmeringtemperature here for 10 minutes to expel carbon dioxide (prolonged vigorousboiling may cause loss of boric acid which is volatile in steam), cool thesolution to room temperature and adjust sufficient standard sodium hydroxidesolution to restore the transition colour of original indicator. Then introduceabout 2 gm of mannitol and shake until dissolved. Add a few drops ofphenolphthalein and titrate with standard 0.1 N carbonate free sodiumhydroxide to the first permanent faint pink colour. Add a further 0.5gm ofmannitol ; if the solution becomes colourless, add more standard sodiumhydroxide until the pink colour reappears. Repeat the process until the Analytical Study - 83
  • 99. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaaddition of mannitol has no effect, up on the end point of both the titrationcalculate the percentage of Na2B4C7 in the sample from the results.Calcium:i) In the absence of organic matter. The sample is dissolved in dilute hydrochloric acid. The solution isfiltered and filtrate is made up to volume in a volumetric flask.ii) In the presence of organic matter. Ignite a suitable quantity of sample, accurately weighed, in a porcelaincrucible at 500 – 550oC until the residue is white or nearly so. Moisture with5-10ml hydrochloric acid, boil for two minutes, evaporate to dryness and heaton steam bath for 3 hours to render Sio2 insoluble. Moisture the residue with 5ml of hydrochloric acid, boil for two minutes, add 50 ml of water, heat on thewater bath for a few minutes, filter and wash thoroughly (The residue may bereserved if necessary for the determination of Sio2). Analytical Study - 84
  • 100. GOVERNMENT OF INDIA MINISTRY OF MINES INDIAN BUREAU OF MINES REGIONAL ORE DRESSING LABORATORYNo. K – 23011/4/Chem/2001-2002Analy/Bng/OD BANGALORE, Date : 20.01.05From: The Suptdg. Officer (Ore Dressing), Indian Bureau of Mines.To : Dr. R. B. Pattanashetti, Final M. D. D. G. M. Ayurvedic Medical College & Hospital Gadag. Kalasapur Road, Shivananda Nagar, Gadag – 582 103. Sub : CHEMICAL ANALYSIS RESULTS OF AYURVEDIC SAMPLE (KAPHAKETU RASA) Ref : YOUR letter No. DGM / AMC / MD / 04-05/016 Dated : 11.10.2004Sir,The chemical analysis results of above referred samples is given below as desired by you. Value in percentage Acid Insoluble Ca 1.31 5.34 Yours faithfully, (D. J. Tahalramani) Sr. Chemist For Suptdg. Officer (Ore Dressing) Indian Bureau of MinesAddress :The Superintending Officer, Regional Ore Dressing Laboratory, Indian Bureau of Mines, 29, IndustrialSuburb, 2nd Stage, Tumkur Road, Goruguntapalaya, BANGALORE – 560 022.Ph. No : 080 – 233 79 824, Fax. No. 080 – 23375360 / 23373287, E-mail : rodlbng@vsnl.net
  • 101. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaCLINICAL STUDY : Ayurveda believes in the concept that every individual differ from each other.Drug working in patients of particular disease may not be so effective in anotherperson of a same disease. Though kaphaketu rasa is claimed to be useful inkaphajakasa, but in what type, in which avastha of patients and to what extent thisdrug is effective is not confirmed. Hence the clinical evaluation and to assess thetherapeutic effect of Kaphaketu rasa in the management of Kaphaja kasa was studied.Efficacy can be determined by finding out the difference between the baseline dataand assessment data. The materials and methods of the present study consist of following headings. 1. Selection of patients 2. Research design, Source of data, Sampling method 3. Administration of drug 4. Study duration 5. Examination of patients 6. Parameters of assessment 7. Statistical analysis1. SELECTION OF PATIENTS : 30 patients of Kaphaja kasa with confirmed diagnosis were selected out of 37patients, of which 5 patients were discontinued, 2 patients were excluded due to theirage factor. Thus ultimately 30 patients of Kaphaja kasa were selected after screeningwith inclusion and exclusion criteria. Clinical Study - 85
  • 102. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa a) Inclusion criteria Patients between the age of 16 years and 60 year of either sex. Patients with classical signs and symptoms of Kaphaja kasa were considered for selection. Patients were selected after the thorough clinical examination and laboratory investigation. b) Exclusion criteria Patients with complication of Kasa i.e., Chronic obstructive Bronchitis, Tuberculosis, Bronchiectasis, Lung abscess, pulmonary edema resulting from cardiac & renal disease have been excluded. Patients with severe form of other systemic disorders. Pregnant women and lactating mothers.c) Diagnostic criteria: Diagnosis was made on the basis of symptamatology and laboratory findings. Presence of prominent feature ie., cough with expectoration (productive cough). Presence of three or more symptoms of Kaphaja kasa.2) RESEARCH DESIGN, SOURCE OF DATA, SAMPLING METHOD : a) Research Design: The research design suited for this study is prospective randomized clinical trial in a single group. b) Source of data and sampling methods: A total of 30 patients suffering from Kaphaja Kasa of either sex and with an age group of 16 – 60 years were selected incidentally at random from Clinical Study - 86
  • 103. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa the special camps conducted at the post graduate out patient department of D. G. M. Ayurvedic medical college and hospital, Gadag. The patients were registered and treated as out patients for the present study with the help of a special Proforma prepared for the study. The proforma is affixed in the appendix of this dissertation. c. Sample size : 30 patients of Kaphaja Kasa. d. Posology : ½ ratti (62.5mg) of Kaphaketu rasa twice a day. e. Anupana : Madhu3. ADMINISTRATION OF DRUG: The Kaphaketu rasa prepared in Department of Rasa Shastra DGMAMC,Gadag was used for clinical study.Route of administration: Kaphaketu rasa was administered orally.4 STUDY DURATION: The total duration of the study was 5 weeks. Patients were advised to visit thehospital after every week to observe the changes. The assessment was made beforeand after treatment.Intervention: The patients were assessed before and after treatment as per assessment criteria. The nature of the study was explained to the patients in detail and pretreatment consent was taken. The patients have rights to withdraw from the study at any time. Patients data was maintained confidentially. Clinical Study - 87
  • 104. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa 5. EXAMINATION OF THE PATIENTS: It will be based on Dashavidha pareeksha. Each patient was examined in terms of basic parameters such as. Physical examination: Size and shape of the chest, respiratory movements, rate, rhythm and type of respiration, diaphragmatic movement. Enlarged lymph nodes, visible pulsation, sternmastoid sign, position of apex thrust.Patients were subjected to laboratory investigations: Blood for - TC, DC, ESR - mandatory, Hb % - as required. Sputum test for AFB - Only in suspected cases. Radiogram of chest - only in suspected cases. Urine routine – as required. 6. PARAMETERS OF ASSESSMENT: The patients were examined, at the end of every week over a period of 36 days that constituted total 5 assessments. Medicine was dispensed for 3 weeks. After that 2 visits for follow up. The changes observed in the subjective parameters i.e., signs and symptoms were assessed by adopting suitable scoring method and the objective parameters by adopting proper lab investigations. • For the purpose of assessment the signs and symptoms were graded as follow i) Kasa (cough) Grade o No Complaints - 0 o Intermittent cough - 1 o Constant cough - 2 o Worsened cough - 3 Clinical Study - 88
  • 105. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaii. Nishteevana (Expectoration) o No Expectoration - 0 o Thick expectoration - 1 o Mucoid & sticky expectoration - 2 o Mucopurulent - 3iii. Uraha vankshana sampoornamiva o No feeling of Heaviness - 0 o Heaviness relieved completely With expectoration -1 o Heaviness relieved slightly With expectoration -2 o Heaviness not relieved with Expectoration -3• Comparing the objective parameter values of Quantity of sputum, TC, DC, ESR and AEC before and after treatment.• Quantity of sputum was graded as below: o No sputum -0 o Less than 2.0ml -1 o 2.0 – 4.9 ml -2 o 5.0 to more ml -3 Clinical Study - 89
  • 106. Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasaOVERALL ASSESSMENT OF THE TREATMENT: To assess the overall effect, results are classified into four groups as below.Well responded: i. Absence of all signs and symptoms. ii. Total blood picture in normal range. iii. After treatment no aggravation of symptoms after exposure to nidana.Moderately responded i. Absence of all signs and symptoms. ii. Total blood picture reduced abnormality. iii. After treatment no aggravation of symptoms after exposure to nidana.Responded i. Reduction in severity of signs and symptoms. ii. Total blood picture in reduced abnormality. iii. After treatment aggravation of symptoms after exposure to nidana.Not responded i. Reduction of severity of signs and symptoms is not specific. ii. No reduction or increase in abnormality of total blood picture. iii. After treatment aggravation of symptoms after exposure to nidana..7. STATISTICAL ANALYSIS: Statistical analysis was done for subjective and objective parametersbefore and after treatment. Analysis was done by calculating Mean, StandardDeviation (S.D), Standard Error (S.E), t-Value and P- Value at 0.001 level. Clinical Study - 90
  • 107. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaOBSERVATIONS: In the present study 30 individuals were registered to evaluate the efficacy ofKaphaketu Rasa in Kaphaja Kasa The prevalence of age, sex, socioeconomic status,Vyayama Shakti etc. were observed. The observed datas recorded in proforma beforeand after treatment were divided into three sections for better under standing.SECTION I – DEMOGRAPHIC DATASECTION II – DATA RELATED TO DISEASESECTION III – DATA RELATED TO RESULTS.SECTION I – DEMOGRAPHIC DATA:DATA RELATED TO AGE INCIDENCE:Table No. 25 Showing the Age Incidence Age Group (in Years) No. of Patients Percentage 16-25 5 16.66 26-35 13 43.33 36-45 5 16.66 46-55 7 23.33 56-65 - 00.00 The patients selected for the study were between the age group 16-60 years.Maximum number of 13 (43.33%) patients were between the age group of 26 -35years, followed by 7 (23.33%) patients between the age group of 46-55 years,5 (16.66%) patients each in 16 - 25 & 36-45 years respectively. Results - 91
  • 108. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDATA RELATED TO SEX INCIDENCE :Table No. 26 Showing the sex incidence Sex No. of Patients Percentage Male 20 66.66 Female 10 33.33 The sex incidence of the disease was more in male patients i.e.20 (66.66%)were affected.Graph 1 33% Male Female 67%DATA RELATED TO RELIGION :Table No. 27 Showing the Religion Religion No. of Patients Percentage Hindu 25 83.33 Muslim 4 13.3 Christian 1 3.33 It was observed that in this study maximum 25 (83.33%) patients werebelonging to Hindu religion, 4 (13.3%) patients were Muslim and 1 (3.33%) patientwas Christian religion.DATA RELATED TO OCCUPATION :Table No. 28 Showing Occupational Incidence Occupation No. of Patients Percentage Student 6 20 Labour 9 30 Executive 3 10 Sedentary 6 20 House Wife 6 20 Maximum number of 9 (30%) patients were affected in labour group, 6 (20%)patients each in student, Sedentary and House Wife respectively, 3 (10%) patientswere executives. Results - 92
  • 109. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDATA RELATED TO SOCIO – ECONOMICAL STATUS :Table No. 29 Showing socio – economical status of patients Economical Status No. of Patients Percentage Poor Class 12 40.00 Middle Class 13 43.33 Higher Class 4 13.30 It was observed that 13 (43.33%) patients were belonged to Middle class, 12(40%) patients were belonged to poor class and 4 (13.3%) patients were belonged tohigher class.Graph 2 43.33% 40% 45 40 35 30 Poor Class 25 Middle Class 13.3% 20 Higher Class 15 10 5 0 No. of PatientsDATA RELATED TO HABITAT :Table No. 30 Showing incidence of Habitat Habitat No. of Patients Percentage Urban 18 60 Rural 12 40 It was found that maximum 18 (60%) patients were affected with Kaphajakasa were from Urban and 12 (40%) patients were from Rural. Results - 93
  • 110. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaSECTION II - DATA RELATED TO DISEASE :DATA RELATED TO CHIEF COMPLAINTS :Table No. 31 Showing the chief complaints of the patients Chief Complaints No. of Patients Percentage Kasa 30 100 Bahula Madhura, Ghana 30 100 Snigdha Kapha Ashya Madhuryata 19 63.33 Kapha poorna Deha 17 56.66 Urahavankshana 30 100 sampoornamiva Gourava 19 63.33 Peenasa 10 33.33 Mandagni 17 56.66 Aruchi 13 43.33 Kleda 09 30.00 Chardhi 03 10.00 Utklesha 07 23.33 Shiroruja 08 26.66 Romaharsha 05 16.66 It was observed that maximum 30 (100%) patients had Kasa, Bahulamadhura, Gaha snighdha Kapha, Urahavankshana Samvorpnamiva, 19 (63.33%)patients had Ashya maduryata, Gourava and 17 (56.66%) patients had kapha poornadeha and mandagni.DATA RELEATED TO FAMILY HISTORY :Table No. 32 Showing the incident of Chronic respiratory disorders in the family Incident of Chronic No. of Patients Percentage respiratory disorders In family 13 43.33 Not in family 17 56.66 Out of 30 patients 13 (43.33%) patients had family history of the Chronicrespiratory disorder and 17 (56.66%) patients, there was no family history. Results - 94
  • 111. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDATA RELEATED TO CONDITION OF WORK PLACE :Table No. 33 Showing the condition of work place Condition of environment No. of Patients Percentage Polluted 16 53.33 Non Polluted 14 46.66 Out of 30 patients 16 (53.33%) patients were working in polluted environmentand 14 (46.66%) patients were working in non polluted environment.Graph 3 46.66% Non Polluted 53.33% Polluted 42 44 46 48 50 52 54 No. of PatientsDATA RELEATED TO RECURRENT URTI :Table No. 34 Showing the incident of history of recurrent URTI Incident No. of Patients Percentage History of recurrent URTI 17 56.66 No history of recurrent URTI 13 43.33 It was noticed that among 30 patients, 17 (56.66%) patients had a recurrenthistory of respiratory tract infection where as 13 (43.33%).did not have the history.Graph 4 56.66% 60 43.33% 50 40 History of recurrent URTI 30 No history of recurrent URTI 20 10 0 No. of Patients Results - 95
  • 112. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDATA RELEATED TO MODE OF ON SET OF DISEASE :Table No. 35 Showing the mode of on set of disease Mode of on set of disease No. of Patients Percentage Sudden 10 33.33 Gradual 18 60.00 Insidious 02 06.66 The mode of onset of disease was considered to be gradual in 18 (60.00%)patients, sudden in 10 (33.33%) and Insidious in 2 (6.66%) patients.DATA RELEATED TO COURSE OF THE DISEASE:Table No. 36 Showing the course of the disease Course No. of Patients Percentage Progressive 24 80 Recurrent 06 20 Maximum number i.e 24 (80%) patients had progressive course and 6(20%)patients had recurrent course of the disease.DATA RELEATED TO PERIODICITY:Table No. 37 Showing the periodicity of cough Periodicity No. of Patients Percentage Seasonal 23 76.66 Irregular 02 6.66 Perineal 05 16.66 It was observed that the periodicity of the cough was seasonal in 23 (76.66%),Irregular in 2 (6.66%) & perineal in 5 (16.66%) patients. 76.66%Graph 5 80 70 60 50 40 30 No. of Patients 6.66% 16.66% 20 10 0 Seasonal Irregular Perineal Results - 96
  • 113. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDATA RELEATED TO SPUTUM:Table No. 38 Showing various types of sputum in cough Nature of Sputum No. of Patients Percentage Thin Mucoid 03 10 Thick frothy 03 10 Mucous and sticky 16 53.33 Muco purulent 08 26.66 16 (53.35%) patients had mucous and sticky sputum, 8(26,.66%) patients hadmucoporulent and 3 (10%) patients each had thin mucoid and thick frothy sputumrespectively.DATA RELATED TO AGGRIVATING FACTORS:Table No. 39 Showing the incidence of Aggravating factors Aggravation factors No. of Patients Percentage Smoke 4 46.66 Dust 13 43.33 Cold weather 08 10.00 Sheetahara 04 16.66 Pollens 02 20.00 Cosmetics 01 3.33 Drugs 02 26.66 It was observed that maximum patients had attack of cough when theyexposed to smoke, Air pollution, dust etc.Graph 6 46.66% 50 43.33% 45 40 Smoke 35 26.66% Dust 30 20% Cold weather 25 16.6% Sheetahara 20 10% Pollens 15 Cosmetics 10 3.33% Drugs 5 0 No. of Patients Results - 97
  • 114. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDATAS RELATED TO PERSONAL STATUS :DATA RELATED TO SMOKING :Table No. 40 Showing incidence of smoking Incidence No. of Patients Percentage Smokers 13 43.33 Non Smokers 17 56.66 Among 30 patients, 17(56.66%) patients were non smokers and 13 (43.33%)were smokers.Graph 7 56.66% No. of Patients 43.33% Non Smokers Smokers 0 20 40 60DATA RELATED TO NATURE OF FOOD :Table No. 41 Showing Nature of Food in patients Nature of Food No. of Patients Percentage Veg 23 76.66 Mixed 07 23.33 It was observed that maximum 23 (76.66%) patients were vegetarians and 7(23.33%) patients were having mixed diet. Results - 98
  • 115. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDATA RELATED TO DOMINANT RASA IN FOOD :Table No. 42 Showing Dominant rasa in food Dominant rasa No. of Patients Percentage Madhura 15 50.00 Amla 06 20.00 Lavana 02 6.66 Katu 06 20.00 Tikta 00 00.00 Kashaya 01 3.33 It was observed that maximum 15 (50%) patients consume Madhura rasadominant ahara, 6 (20%) patients Amla, 2 (6.66%) patients Lavana, 06 (20%) patientsKatu, 1 (3.33%) patients Kashaya rasa dominant ahara.DATA RELATED TO INCIDENCE OF VYASANA :Table No. 43 Showing the incidence of Vyasana Vyasana No. of Patients Percentage Tea 10 33.33 Coffee 02 6.66 Tobacco 10 33.33 Alcohol 09 30.00 It was observed that 10 (33.33%) patients had addicted to tea and 02(6.66%)patients to coffee consumption, 10(33.33%) patients tobacco chewing and 09(30%)patients had addicted to alcohol.DATA RELATED TO INCIDENCE OF NIDRA :Table No. 44 Showing the incidence of Nidra Nidra No. of Patients Percentage Sama 02 6.66 Vishama 17 56.66 Alpanidra 11 36.66 Anidra 00 00.00 It was observed that in Kaphaja kasa patients maximum number i.e., 17(56.66%) had Vishama nidra, 11 (36.66%) patients had Alpanidra, 2(6.66%) patientshad Sama nidra. Results - 99
  • 116. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDATA RELATED TO AGNI :Table No. 45 Showing the type of Agni of Kaphaja kasa patients Dominant rasa No. of Patients Percentage Samagni 00 00.00 Mandagni 17 56.66 Vishamagni 11 36.66 Teekshnagni 02 6.66 Regarding status of Agni, Mandagni seen in 17 (56.66%) patients followed byVishamagni in 11(36.66%) patients, Teekshnagni in 02 (6.66%) patients.DATA RELATED TO KOSTA :Table No. 46 Showing type of Kostha Kostha No. of Patients Percentage Mrudu 17 56.66 Madhyama 10 33.33 Kroora 03 10.00 Out of 30 Kaphaja kasa patients maximum number i.e., 17 (56.66%) patientshad Mrudu Kostha, 10(33.33%) patients had Madhyma Kostha and 03 (10.00%)patients had Mrudu kostha.DATA RELATED TO EXPOSURE :Table No. 47 Showing exposure to any aggravating factors during working hours Exposure No. of Patients Percentage Yes 16 53.33 No 14 46.66 It was observed that 16 (53.33%) patients were exposed to aggravating factorsand 14 (46.66%) were not exposed to aggravating factors during working hours. Results - 100
  • 117. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaTable No. 48 Showing whether symptoms produced during working hours Symptoms produced No. of Patients Percentage Yes 13 43.33 No 17 56.66 17 (56.66%) patients had not produced symptoms and 13 (43.33%) patientswere produced symptoms during working hours.Table No. 49 Showing whether the symptoms reduce by change of place Symptoms reduced No. of Patients Percentage Yes 09 30 No 21 70 In 21(70%) patients no reduction of symptoms by change of place. In 9 (30%)patients symptoms were reduced after change of place.DATA RELATED TO DASHAVIDHA PAREEKSHA :Table No. 50 Showing Prakruti of patients Prakruti No. of Patients Percentage Vata kapha 17 56.66 Kapha pitta 10 33.33 Vata pitta 03 10.00 Out of 30 Kaphaja kasa patients maximum number i.e., 17 (56.66%) patientshad Vata kapha, 10 (33.33%) patients had Kaphapitta and 03 (10.00%) had Vatapitta.Table No. 51 Showing the Vyayam shakti of kaphaja kasa patients Vyayam shakti No. of Patients Percentage Pravara 09 30.00 Mahyama 17 56.66 Avara 04 13.33 It was observed that maximum number of patients 17 (56.66) had madhyamaVyayam shakti. Results - 101
  • 118. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaTable No. 52 Showing Aharashakti of Kaphaja kasa patients Aharashakti No. of Patients Percentage Pravara 07 23.33 Madhyama 19 63.33 Avara 04 13.33 It was observed that maximum number patients 19(63.33%) had madhyama Ahara shakti.Table No. 53 Showing the Satmya of the Kaphaja kasa patients Satmya No. of Patients Percentage Pravara 05 16.66 Madhyama 19 63.33 Avara 06 20.00It was observed that maximum number of patients 19(63.33%) had madhyam Satmya.Table No. 54 Showing Satwa of Kaphaja kasa patients Satwa No. of Patients Percentage Pravara 09 30.00 Madhyama 15 50.00 Avara 06 20.00 It was observed that maximum number of patients 15 (50%) had madhyam Satwa.Table No. 55 Showing Sara of patients Sara No. of Patients Percentage Pravara 07 23.33 Madhyama 21 63.33 Avara 02 6.66 It was observed that maximum number of patients 21 (63.33%) had madhyam Sara. Results - 102
  • 119. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Table No. 56 Showing pramana of Kaphaja kasa patients Pramana No. of Patients Percentage Pravara 14 46.66 Madhyama 15 50.00 Avara 01 3.33 It was observed that maximum 15 (50%) patients were having Madhyama Pramana. Table No. 57 Showing the incidence by Samhanana Samhanana No. of Patients Percentage Pravara 05 16.66 Madhyama 20 66.66 Avara 05 16.66 It was observed that maximum number 20 (66.66%) patients were had Madhyama Samhanana. EFFECT OF THE DISEASE OVER ROUTINE ACTIVITIES : Table No. 58 Showing the effect of the disease over routine activities Affect over routine activities No. of Patients Percentage Severely affected 03 10.00 Moderately affected 18 60.00 Mildly affected 09 30.00 Not affected 0 0 It was observed that the maximum number 18 (60%) patients had moderately affected and for 3(10%) patients had severely affected and 09 (30%) patients had mildly affected over routine activities. INVOLVEMENT OF SROTASES: Table No. 59 Showing the observed symptoms of Pranavaha Srotas symptomsSl No. of Sl No. of Symptoms Percentage Symptoms PercentageNo. Patients No. Patients1 Alpalpam 00 00.00 4 Atisristam 06 202 Atibaddam 08 26.66 5 Abeekshnam 00 003 Kupitam 14 46.66 6 Sashoolam 00 00 Results - 103
  • 120. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Table No. 60 Showing the observed symptoms of Rasavaha srotas symptomsSl No. of Sl No. of Symptoms Percentage Symptoms PercentageNo. Patients No. Patients 1 Ashrudda 0 00 9 Jwara 08 26.66 2 Aruchi 20 66.66 10 Tama 02 6.66 3 Ashyavairashyatha 18 60.00 11 Pandutva 06 20.00 4 Arasagnata 00 00 12 Sada 0 0.00 5 Hrillasa 03 10.00 13 Krishangata 01 3.33 6 Gourava 17 56.66 14 Agninasha 12 40.00 7 Tandra 06 20.00 15 Tripti 00 00 8 Angamarda 09 30.00 16 Hridroga 00 00 It was observed that mainly Pranavaha srotas is vitiated in Kaphajakasa and Rasavaha srotas is also vitiated in this disease. DATA RELATED TO NIDANA : Table No. 61 Showing the observed nidanas in Kaphaja kasaSl No. of Sl No. of Symptoms Percentage Symptoms PercentageNo. Patients No. Patients 1 Bojyanama 03 36.66 7 Doomopghata 09 30.00 Vimaargagamana2 Guruabhishandi 17 56.66 8 Rajasewana 04 13.33 ahara sevana3 Madhura rasa 15 50.00 9 Veganam 12 40.00 sevana avarodha4 Sheetahara 9 30.00 10 Diwaswpna 11 36.66 sevana5 Asatmya ahara 11 36.66 11 Vyayama 11 36.66 sevana6 Snigdhahara 17 56.66 12 Kshavathu 04 13.33 sevana dharana It was observed that maximum 17 (56.66%) patients had nidana factors as guru abhishandi ahara sevana Snigdha ahara sevana. DATA RELATED TO POORVA ROOPA : Table No. 62 Showing the observed purva roopas in Kaphaja kasa Sl .No. Purva Rupa No. of Patients Percentage 1 Shookapoorna galashyata 12 40.00 2 Kanthe Kandu 10 33.33 3 Bojyanam avarodha 08 26.66 4 Arochaka 13 43.33 5 Galatalu lepa 15 50 6 Agni sada 17 56.66 7 Swashabda vaishamya 10 33.33 Results - 104
  • 121. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaSECTION III - DATA RELATED TO RESULTS : Clinical condition of all patients was assessed before and after the response totreatment. The subjective parameters like Kasa, Nishteeavana, UrahavankshanaSampoornmiva, were assessed before and after treatment and objective parameterslike quantity of sputum, TC, DC, ESR & AEC were checked out before and aftertreatment.ASSESSED PARAMAETERSSUBJECTIVE PARAMETERS:1. KASA Table No. 63 Showing the number of patients with Kasa S No. Degree of Kasa B. T. % A. T. % 1 Nil 0 0 24 80 2 Mild 2 6.66 6 20 3 Moderate 17 56.66 0 0 4 Severe 11 36.66 0 0 Total 30 100 30 100 It was observed that 17 (56.66%) patients had moderate attack, 11 (36.66%)patients had severe attack and 2 (6.66%) patients had mild attack of Kasa before thetreatment. After treatment 6 (20.00%) patients were left with mild degree of kasa and24 (80%) patients were completely relieved. The improvement is statistically showedhighly significant. (P < 0.001).2. NISHTEEVANA (EXPECTORATION) Table No. 64 Showing the number of patients with Nishteevana S No. Degree of Nishteevana B. T. % A. T. % 1 Nil 0 0 24 80 2 Mild 3 10 6 20 3 Moderate 19 63.33 0 00 4 Severe 7 23.33 0 00 Total 30 100 30 100 Results - 105
  • 122. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Before treatment 19(13.3%) patients had moderate, 7(23.33%) patients hadsevere and 3(10%) patients had mild degree of Nishteevana. After treatment 6(20.00%) patients were left with mild degree of Nishteevana and 24 (80%) patientswere completely relieved. The improvement is statistically showed highly significant.(P < 0.001).3. URAHA VANKSHANA SAMPOORNMIVA Table No. 65 Showing the number of patients with Uraha Vankshana Sampoornmiva Degree of Uraha S No. B. T. % A. T. % Vankshana Sampoornmiva 1 Nil 0 0 24 80 2 Mild 0 0 6 20 3 Moderate 12 40 0 0 4 Severe 18 60 0 0 Total 30 100 30 100 Before treatment 18(60%) patients had severe, 12(40%) patients had moderatedegree of Uraha Vankshana Sampoornmiva symptom. After treatment 6 (20.00%)patients were left with mild degree of Uraha Vankshana Sampoornmiva symptom and24 (80%) patients were completely relieved. The improvement is statistically showedhighly significant. (P < 0.001).OBJECTIVE PARAMETERS:1. QUANTITY OF SPUTUM (MORNING BOUT) Table No. 66 Showing the number of patients with Quantity of Sputum (morning bout) S No. Quantity of Sputum B. T. % A. T. % 1 Nil 0 0 24 80 2 Mild 0 0 6 20 3 Moderate 8 26.66 0 00 4 Severe 22 73.33 0 00 Total 30 100 30 100 Results - 106
  • 123. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Before treatment 22 (73.33%) patients had severe, 8(26.66%) patients hadmoderate quantity of Sputum. After treatment 6 (20.00%) patients were left with mildquantity of Sputum and 24 (80%) patients were completely relieved. Theimprovement is statistically showed highly significant. (P < 0.001).2. ERYTHROCYTE SEDIMENTATION RATE (E. S. R.) It was observed that there was reduction in the count of Erythrocytes in theobjective parameter ESR shows more significant than other parameters. Table No. 67 Showing the ESR before and after treatment E. S. R Sl No. BT AT Sl No. BT AT 1 49 16 16 26 10 2 21 09 17 41 12 3 30 08 18 34 09 4 18 06 19 35 21 5 23 10 20 22 11 6 28 09 21 27 07 7 25 14 22 20 12 8 31 19 23 37 18 9 33 18 24 33 17 10 37 16 25 34 16 11 17 05 26 28 09 12 32 15 27 34 16 13 24 08 28 31 14 14 29 13 29 30 11 15 19 06 30 36 16 Before Treatment no patients and after treatment 12 (40%) patients were liedin the range 0-10 ESR level. Before Treatment 4 (13.33%) patients and aftertreatment 17 (56.66%) patients were lied in the range 11-20 ESR level. BeforeTreatment 12 (40%) patients and after treatment 1 (3.33%) patients were lied in therange 21-30 ESR level. Before Treatment 12 (40%) patients were lied in the range31-40 and 2 (6.66%) patients were lied in the range 41 – 50 ESR level. Results - 107
  • 124. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa3. BLOOD INVESTIGATIONS AEC, TC, DC BEFORE AND AFTER TREATMENT Table No. 68 Showing the AEC, TC, DC values before and after treatment AEC TC DC OPD NO. P E B. T. A. T. B. T. A. T. B.T. A.T B.T A.T 2563 840 630 12500 10500 74 66 08 06 2564 492 410 7500 6800 68 60 04 03 2618 570 435 10100 9200 69 53 06 04 2620 365 312 5980 5450 62 50 03 02 2621 484 442 6432 6028 65 63 05 04 2656 360 310 7846 7205 68 59 06 03 2660 480 436 5830 5403 60 54 07 04 2706 376 325 8342 7900 67 58 06 02 2940 710 690 10936 10400 72 67 09 08 3010 515 436 9584 8675 76 61 05 01 3017 510 445 4770 4347 56 51 05 02 3036 490 432 7863 7020 68 52 05 03 3165 330 328 6735 5976 56 61 04 04 3169 556 555 5988 5535 68 62 06 03 3170 488 430 5020 4786 60 55 05 02 3171 499 415 8256 7935 64 58 06 04 3178 825 705 12439 10635 68 66 09 09 3332 345 305 6786 6100 69 62 06 02 3333 435 430 9835 8842 71 66 05 03 3344 537 510 6652 6136 67 65 08 06 3345 585 458 6800 6333 62 49 06 05 3381 370 340 5089 4675 58 51 05 04 3432 770 695 10680 10080 69 69 08 07 3436 356 320 8496 7800 63 60 06 03 3448 496 430 8798 7912 67 59 07 05 3457 445 450 6783 5985 64 57 06 04 3565 330 330 8670 8500 70 66 05 02 3576 930 860 10534 10024 69 68 07 06 3592 735 555 7346 6670 59 53 06 03 3609 880 740 11330 10266 71 69 07 07 AEC = Absolute Esinophil Count BT= Before treatment TC = Total Count AT = After treatment DC = Differential Count Results - 108
  • 125. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa STATISTICAL ANALYSIS Table No. 69 Showing statistical analysis of subjective parametersSl. Subjective parameters Mean S. D. S. E. t-value p-value RemarksNo.1 Kasa 2.1 0.480 0.087 24.137 < 0.001 H. S.2 Nisteevana 2.0 0.643 0.117 17.09 < 0.001 H. S.3 Uraha Vankshana Sampoornamiva 2.4 0.498 0.090 26.40 < 0.001 H. S. Table No. 70 Showing statistical analysis of objective parameters Sl. Objective parameters Mean S. D. S. E. t-value p-value Remarks No.1 E.S.R. 17.2 5.44 0.993 17.32 < 0.001 H. S.2 T.C 693.5 396.77 72.44 9.573 < 0.001 H. S.3 D. C. P 5.866 3.471 0.633 9.266 < 0.001 H. S. E 2.0 1.174 0.214 9.345 < 0.001 H. S.4 A.E.C 68.83 50.77 9.269 7.371 < 0.001 H. S.5 Quantity of Sputum 2.533 0.571 0.104 24.35 < 0.001 H. S. Individually the subjective parameters shows most significant than the objective parameters. Assume that Kaphaketu rasa is not responsible for changes in the readings of patients before and after the treatment. To test the hypothesis we use unpaired t-test. In the subjective parameters ‘Nishteevana’ symptom shows more significant than others. The parameter kasa (cough) and Uraha Vankshana Sampoornamiva have the same effect in the group. The parameter kasa (cough) has less variation than the other. [From table No. 1 by comparing t-value, co-efficient of variation and p<0.001]. In the objective parameter the ESR shows more significant than other parameter with stable effect within the group. The parameter ‘quantity of the sputum’ have uniform affect in the group with high mean net effect. The parameter TC, DC approximately have the same effect on the patients. The parameter TC has more net mean effect with more variation. The parameter AEC does not have uniform effect on the patient within the group. [From table No. 2 by comparing t-value, co-efficient of variation and p<0.001]. Results - 109
  • 126. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDISTRIBUTION OF PATIENTS BY RESULTS : Table No. 71 Showing the overall result Sl .No. Results No. of Patients Percentage 1 Well responded 15 50.00 2 Moderately responded 09 30.00 3 Responded 06 20.00 4 Not responded 00 00.00 Total 30 100.00 It was observed that 15 (50.00%) patients were well responded, 9(30%)patients were moderately responded & 6 (20%) patients were responded to thetreatment.Graph 8 0% 20% 50% 30% Well responded Moderately responded Responded Not responded Results - 110
  • 127. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa MASTER CHART 1 : SHOWING OVER ALL ASSESSMENT OF THE RESPONSE TO “KAPHAKETU RASA” BASED ON ASSESSMENT CRITERIA. OPD Reduction of symptoms in % and E.S.R in hour Sl. No. No. S-1 S-2 S-3 S-4 E.S.R. Results 1 2563 80% 80% 80% 80% 16 R 2 2564 100% 100% 100% 100% 9 W.R 3 2618 100% 100% 100% 100% 8 W.R 4 2620 100% 100% 100% 100% 6 W.R 5 2621 100% 100% 100% 100% 10 W.R 6 2656 100% 100% 100% 100% 9 W.R 7 2660 100% 100% 100% 100% 14 M.R 8 2706 100% 100% 100% 100% 19 M.R 9 2940 80% 80% 80% 80% 18 R 10 3010 100% 100% 100% 100% 16 M.R 11 3017 100% 100% 100% 100% 05 W.R 12 3036 100% 100% 100% 100% 15 M.R 13 3165 100% 100% 100% 100% 08 W.R 14 3169 100% 100% 100% 100% 13 W.R 15 3170 100% 100% 100% 100% 06 W.R 16 3171 100% 100% 100% 100% 10 W.R 17 3178 80% 80% 80% 80% 12 R 18 3332 100% 100% 100% 100% 09 W.R 19 3333 100% 100% 100% 100% 21 M.R 20 3344 100% 100% 100% 100% 11 W.R 21 3345 100% 100% 100% 100% 07 W.R 22 3381 100% 100% 100% 100% 12 W.R 23 3432 80% 80% 80% 80% 18 R 24 3436 100% 100% 100% 100% 17 M.R 25 3448 100% 100% 100% 100% 16 M.R 26 3457 100% 100% 100% 100% 09 W.R 27 3565 100% 100% 100% 100% 16 M.R 28 3576 80% 80% 80% 80% 14 R 29 3592 100% 100% 100% 100% 11 M.R 30 3609 80% 80% 80% 80% 16 RS-1 = Kasa, ESR = Erythrocyte Sedimentation RateS-2 = Nisteevana WR = Well RespondedS-3= Uraha Vankshana Sampoorana, MR = Moderately RespondedS-4 = Quantity of Sputum, R = Responded . Results - 111
  • 128. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaMASTER CHART 2 : SHOWING THE ASSESSMENT OF GRADING OF PARAMETERS OF “CLINICAL EFFICACY OF KAPHAKETU RASA IN KAPHAJA KASA” Kasa Nisteevana UVS Q. S. Sl. OPD No. NO. BT AT FU BT AT FU BT AT FU BT AT FU 1 2563 3 1 1 2 1 1 3 1 1 3 1 1 2 2564 2 0 0 2 0 0 2 0 0 3 0 0 3 2618 2 0 0 2 0 0 3 0 0 3 0 0 4 2620 1 0 0 2 0 0 3 0 0 2 0 0 5 2621 2 0 0 2 0 0 2 0 0 3 0 0 6 2656 3 0 0 3 0 0 3 0 0 3 0 0 7 2660 2 0 0 1 0 0 3 0 0 3 0 0 8 2706 2 0 0 2 0 0 2 0 0 3 0 0 9 2940 3 1 1 2 1 1 3 1 1 3 1 1 10 3010 3 0 0 3 0 0 2 0 0 3 0 0 11 3017 1 0 0 2 0 0 3 0 0 2 0 0 12 3036 3 0 0 3 0 0 3 0 0 2 0 0 13 3165 2 0 0 1 0 0 2 0 0 3 0 0 14 3169 2 0 0 2 0 0 2 0 0 2 0 0 15 3170 2 0 0 2 0 0 2 0 0 3 0 0 16 3171 2 0 0 2 0 0 2 0 0 3 0 0 17 3178 3 1 1 3 1 1 3 1 1 3 1 1 18 3332 3 0 0 3 0 0 3 0 0 2 0 0 19 3333 3 0 0 2 0 0 3 0 0 3 0 0 20 3344 2 0 0 1 0 0 2 0 0 3 0 0 21 3345 2 0 0 2 0 0 2 0 0 2 0 0 22 3381 2 0 0 2 0 0 3 0 0 3 0 0 23 3432 3 1 1 2 1 1 3 1 1 2 1 1 24 3436 2 0 0 2 0 0 3 0 0 3 0 0 25 3448 2 0 0 2 0 0 2 0 0 3 0 0 26 3457 2 0 0 3 0 0 3 0 0 3 0 0 27 3565 2 0 0 3 0 0 2 0 0 2 0 0 28 3576 3 1 1 2 1 1 3 1 1 3 1 1 29 3577 2 0 0 2 0 0 3 0 0 3 0 0 30 3609 3 1 1 3 1 1 3 1 1 3 1 1 BT = Before Treatment AT = After Treatment ESR = Erythrocyte Sedimentation Rate QS = Quantity of Suptum UVS = Uraha Vankshana Sampoornmiva FU = Follow Up Results - 112
  • 129. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaDiscussion is studied under the following headings. Discussion on Drugs Discussion on Disease Discussion on Pharmaceutical Study. Discussion on Analytical Study. Discussion on Observation and ResultsDRUGS:TANKANA: Tankana is classified into various categories depending upon the physicalappearance, generally white (sphatikabha) variety is used. The Tankana(Sphatikabha)which is clear, transparent, crystalline with a bluish tinge is the best because as it mayhave less impurities and more percentage of Na2B4O710H2O compared to othervarieties which is having more therapeutic value. Tankana is available in ore form as well as in natural form. It is moreavailable in shores of dried lakes in India and Tibet in natural form. Now a days it isartificially prepared in Laboratories also. Prior to administration it should be subjectedto Nirmalikarana and Shodhana because Tankana have external impurities and maycauses complications like Chardhi and Bhranti. Actually Grahya variety of Tankanadoes not contain any impurities except water content, which may cause heaviness inthe body after comsuming. Hence Tankana was fried over stove to evaporate thewater content. As Tankana may rich in Kshara guna and also used more in various yogas.Hence Tankana may have synonyms like ksharashresta and kshararaja. Discussion - 113
  • 130. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Tankana had the property to dissolve many metal oxides to form borates oflow melting points and used for extracting the metals as a flux. By this property,Tankana had synonyms like Dravaka, Dravi, Dhatudravaka, and Lohavishodhaka. InAdarsha nighantu, Tankana is considered as antidote for vishas. Due to Rooksha, teekshna, ushna guna, Tankana does chedhana of vitiatedKapha. By these Pharmacological properties of the Tankana, it mitigates vitiatedkhapa. and subsides the kaphaja kasa. It also has an reputation as germicide and usedprimarily as Bacteriostatic.SHANKHA : Rasarnavakar is the person who considered Shankha under Shukla varga may be ofits white colour. Shankha is the outer covering of “Molluska group” of aquaticanimal which are seen in sea. It is collected from the sea, and put in boiling water.The animal which is present inside dies and the outer portion is Shankha. It has anexternal lustrous yellowish brown horny layer and beneath it has a thick layer, chieflyformed of Calcium carbonate. As Shankha produces melodious sound for long time.Hence it may had synonymslike Sunada, Dheerghanada, Pavana dhwani and Mahanada. As Dhakshinavarthashankha is sacred and Uttama. Hence widely used for medicinal purposes thanVamavartha shankha. Tankana, Pippali, Vatsanabha have teekshna ,ushna guna, katu rasa and Ushnaveerya. Due to these properties they may produce gastric irritation, but this isprevented by Shankha as it contains Calcium carbonate which is best choice ofantacid. Due to its Laghu guna and katu rasa, mitigates vitiated Kapha and helps incuring the Kaphaja kasa. Discussion - 114
  • 131. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaVATSANABHA :Charaka has considered Vatsanabha as one of the Stavara visha. But Sushrutaconsidered it under Kanda visha. Among Stavara vishas, Kanda visha and moolavisha are commonly used as they are claimed to be more potent. Vatsanabha plant not allow to grow other plants nearer to it because of itspoisonous constituent i.e Aconitine. Due to this character it is called as Visha andGarala. Aconite is a Greek word meaning arrow. The arrows were coated with thispoison and used. Hence the name Aconitine. If Vatsanabha is administered in proper dose after purification does highly beneficialeffects to the body and even life saving too.Hence it is known as Amruta. Rasa vagbhata mentioned that the Vatsanabha having sthoola, snigdha, guru,naveena, pandura varna inside, phalapakanta grahya can be considered as Grahya.This may be due to the less toxic effects compared to other varieties and have moretherapeutic effect. Due to its pharmacological properties like Laghu, Ruksha, Teekshna, Vyavayi,Vikasi guna, Ushna veerya and Katu vipaka does srotovishodhana .By that it removesairway obstruction. PIPPALI: Charaka and Sushruta have extensively used the pippali in variousformulations. It is effective in the treatment of Pranavaha srotas. It is popularly knownas Magadhi. This is the name of place where the availability of Pippali is more. It is mentioned that, Pippali should not be used in excessive quantities, maightbe due to its Teekshna, Ushna guna which causes increase in the Pitta. However it Discussion - 115
  • 132. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasamay be used as Rasayana, but it is clarified that the restriction is limited in diet andnot for medicinal usage. Due to Pharmacological properties like Laghu, Snigdha guna, Katu rasa,Anushna veerya, it acts as Vatakaphahara by that it subsides Kasa, Swasa, Jwara,Krimi, Meha etc. The crude extract of Piper longum as well as Piplartine suppressed the ciliarymovements of the esophagus of frog. These findings suggest that therapeutics efficacyin reliving cough reflex and it has immuno modulatory property also.SELECTION OF KAPHAKETU RASA : Kaphaketu rasa is a herbomineral preparation mentioned in Rasagrantha’s and indicated in Kasa & Swasa. Acharya Charaka has mentioned that the drugs which are having Katu, Ruksha and Ushna properties are beneficial in Kaphaja Kasa and the ingredients of Kaphaketu rasa are also having all the prescribed properties. In Kaphaja Kasa the excessively secreted mucous given limitation to the flow of Vata. So the drugs which are having Kaphadravaka, Kaphanissaraka and Kaphavatahara properties are beneficial. In the ingredients of Kaphaketu rasa, Tankana is Kaphadravaka, Shankha is Kaphavatahara, Vatsanabha, and Pippali having Kaphachedhaka property. The 20th century authors have mentioned about Kshara prayoga in Kaphajakasa because of its Kshaana (liquefying) property and most of them having mentioned about Kantakari, Apamarga, Yavakshara and Chitramula kshara but their preparation is a complex procedure where as Discussion - 116
  • 133. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Tankana is an easily available Kshara and is one of the ingredient of Kaphaketu rasa. Kaphaketu rasa have four ingredients which are easily available and the method of preparation is very easy.With all these reasons the drug Kaphaketu rasa has been selected for the study.PROBABLE MODE OF ACTION OF KAPHAKETU RASA: The materials in the nature including the human body as well as drugs arecomposed of Panchamahabutas. In drug composition these Mahabhutas are known byinference on the basis of their properties like Rasa, Guna, Virya, Vipaka, Prabhavaetc., which are inherent in the drug on which the Pharmacodynamics depends. Due to indulgence in the etiological factors, the shleshma secreted in excessivequantity produces obstruction to Anila gati, resulting in the production of KaphajaKasa. After analyzing the each ingredients of Kaphaketurasa it was found thatmajority of them were having Katu rasa, Ushnaverya, Laghu guna, Katu vipaka,Kaphavata Shamaka. By these properties it subsides malarupi kapha and clears theairway obstruction. By this it subsides the Kaphja kasa. Pippali has the property of Ushna Guna, Katurasa, Anushnaveerya, Katuvipaka, Kaphavata Shamaka. It is Deepaka, pachaka, kasa, Shwasahara, JwaraharaRasayana. Pippali contains active principle Piperine, it acts as bio availabilityenhancer. It acts as anti inflammatory and immunomodulator. Extract of Pippali isrich in vit A & E, it reduces tissue injury and free oxygen radical scavengers. Bythese properties it reduces Kapha, inflammation of respiratory tract and clears the airpassage. Discussion - 117
  • 134. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Vatsanabha has the property of Ushna Guna. Yogavahi, Katu tiktaKashayarasa, Katu vipaka, Ushnaveerya, Kaphavata Shamaka. It does Deepana,Pachana. Shoolahara, Jwarahara, Kasa, Shwasahara, Rasayana . Vatsanabha contain active principles like aconitin, pseudoaconitine, these actsas diaphoretic, anit inflammatory, analgesic. By these properties it reduces kapha,inflammation and fever. Tankana posess the properties like Teekshna, Laguruksha guna, Katu rasa,Katu vipaka, Ushnaveerya, Kaphavatashamaka. It acts as Deepana, Lekhana, kasaSwasahara. Chemically it is Borax. It acts as Germicide, Astringent andBacteriostatic in action. By these properties it reduces the Kapha, Checks the growthof microorganisms thus it reduces the infection. Shankha has the properties like Katu rasa, Laghu guna, by these properties itsubsides vitiated Kapha. By virtue of the properties of ingredients, Kaphaketu rasa breaks the sampraptiand reduces Kapha dosha, relieves airway obstruction. In this way it helps insubsiding the Kaphaja kasa.DISEASE: In Ayurvedic literature the classification of the Kasa appears to have beendone mainly on the basis of the nature of sputum. In Kaphahaja Kasa there is hypersecretion of mucous (shleshma vriddhi) in Pranavaha srotas. This produces restrictionto anila gati (airflow), naturally to expel the excessive secreted mucous, Kasa isproduced. Discussion - 118
  • 135. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Common etiological factors, Samprapti have been described for Kasa by otherauthors, but Charaka is the only person who has described specific etiological factorslike Guru, Snigdha, Madhura Ahararasa sevana and Vishista samprapti for KapahjaKasa. In Kaphaja Kasa at the site of dosha dushya sammurchana, hypertrophiedcells secret malarupi Kapha and the retention of malarupi Kapha in Pranavaha srotasleads to sanga. The Kapha which is secreted excessively, due to the homologousproperties will produce Agni mandya due to mandaguna. The obstruction to the anila gati causes involuntary reflex and is designed toremove the excessive secreted Kapha in Pranavaha srotas. It consists of contractionof respiratory muscles against a closed glottis, with resultant rise in thoracic pressure,followed by opening of the glottis and forced expiration with very high flow rates andproduction of Ksita Shada which is associated with Kapha. No specific Purvarupas have been explained for Kaphaja Kasa. so the generalPurvaroopa of Kasa are considered here. Bahula, Snigdha Sandra, Ghana, Sweta, Madhura Stivanayukta Kasa are themain laxanas of Kaphaja Kasa. So the pratyatmaka laxanas of Kapahaja Kasa isBahula, Shweta and snigdha Steevana In Kaphaja Kasa snigdha, Madhura, Shita dravays are considered asAnupashaya dravyas and Katu, Ruksha, Ushna dravyas are considered as Uphashayadravyas. Discussion - 119
  • 136. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Only Astanga hridaya and Yogaratanakar had mentioned about complicationsof Kaphaja Kasa. Acharya Charaka clearly mentioned that if any Variety of Kasa isnot treated properly, then it will convert into Kshayaja Kasa. Chikitsa is one which is capable to carry out Samprapti vighatana. So inKaphaja Kasa Acharya Charaka has mentioned Vamana as the first line of treatment.After that, the drugs having Katu, Ruksha and Ushna properties should beadministered.ANALYTICAL STUDY: Though Ayurveda is having its unique analytical approach towards drugs inpresent era, there is a necessity of understanding a drug based on modernmethodology of analysis also. So there is a need to evaluate the drugs with variousparameters. All the physical properties of Kaphaketu rasa found, will fall in thespecification of Ayurvedic Pharmacopoeia of India. So the Kaphaketu rasa preparedwas genuine because of the normal physical properties. The time required for 5 tablets to disintegrate is not more than 15 minutes.The sample Kaphaketu rasa shows 19 minutes to disintegrate by this it is evident thatthe Kaphaketu rasa has slow absorption in the gut. The PH (1% solution) of the Kaphaketu rasa is 9.90. This shows the alkalinityof the sample. It may be due to Tankana kshara which is alkaline in nature. Loss anddrying at 1100 C is 6.78%. This shows the moisture content present in the Kaphaketu Discussion - 120
  • 137. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasarasa. Test for presence of alkaloid was carried out. It was found that alkaloids arepresent in it. Total ash value for the sample is 32.91%. This shows the amount of Inorganicmaterial present in it. The acid insoluble ash value for the sample is 1.31%. The lowacid insoluble ash values facilitate the easy absorption of drug. Kaphaketu rasa is slightly soluble in water, 1 M Hydrochloric acid andAlcohol and sparingly soluble in chloroform. This shows slow absorption ofKapaketu rasa in the gut. It is desirable that all vatis should be uniform in weight. Thedifference of weight in vatis can lead to variation in doses. If there is any weightvariations that should fall within the prescribed limits. Weight variation is + 10% forvatis weighting 120 mg or less. For our sample weight variation is 8.10% which fallswithin normal range. If the finished vati is too hard it may not disintegrate in required period of timeand if the vati is too soft may not with stand during packing and transporting.Hardness of 4 kg is considered suitable for handling the vatis. The hardness ofKaphaketu rasa falls within the range i.e., 3.5 + 0.5,which shows quick disintegrationof the vati and suitable for handling. The acceptable limits of weight loss in friability test should not be more than0.8%. The friability of Kaphaketu rasa sample is 0.64%. This shows the ability ofvatis to withstand abrasion in packing, handling and transporting. Discussion - 121
  • 138. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa When the sample is subjected to test assay for Boron and Calcium, the valueobtained indicates that sample contains 3.52%, 5.34% organic Boron and Calciumrespectively.PHARMACEUTICAL STUDY : The raw drugs were subjected to purification and processed one by one andpreparation of Kapahketu rasa was carried out as mentioned in Vishopavishadhi,Vijnaniya chaturvinshastrang of Rasatarangini. Shodhana process is aimed to remove harmful impurities present in the drugsand it also helps in removing the impurities caused by the association of othermaterials and also converts mineral drugs into suitable forms for further treatmentwith Marana process. By Marana process the drugs are reduced into fine particles.So that these could be observed easily into the system and mix with Raktadi dhatusand produce their desired effects without producing toxic effects. Tankana Shodhana was done by frying the fine powder in an iron pan. Duringfrying initially it liquefied and produced crackling sounds. After continuous frying itbecame bloomed and turn into white opaque substance. The weight of Tankanabefore Shodhana was 300 gms. After Shodhana 170 gms, loss of weight was 170 gmsmight be due to evaporation of water molecules. Shankha Shodhana was done by Swedana in dolayantra with Jambhira nimbuSwarasa, which may helps in quick absorption. The pottali was immersed indolayantra in such a manner that it should not touch the patra otherwise their may bechance of burning of cloth and Shankha pieces coming out. After that it was washedwith hot water, by that external impurities like sand, mud etc can be removed. Discussion - 122
  • 139. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Kumari was selected as a bhavana dravya for Shankha marana as it is a goodbinding agent and is also have Kaphapittashamaka property, helps in subsidingKaphaja Kasa which is a resultant of vitiated Kapha. So the Kumari was selected forMarana. After subjecting for first Gajaputa to Shankha pieces, Colour change ofShankha from white to gray and weight loss of 8 gms was observed and the Shankhapieces became brittle so that they can be powdered easily. Shankha pieces werepowdered, Mardana was done with Kumari Swarassa and Chakrikas were preparedand subjected for second Gajaputa, weight loss of 14 gms.was observed. Theobtianed Bhasma was subjected for Bhasma pareeksha, but did not passed. So it wasonce again subjected for third Gajaputa. Only then Shankha bhasma passed theRekhapoornatva, Shlakshanatwa, Varitara etc tests and there was 18 gms weight loss.There was weight loss after every Gajaputa, might be due to reduction in the particlesize and it may also due to procedures like mardhana etc. Vastanabha shodhana was done by keeping it under sunlight in Gomutra. Aftersoaking in Gomutra Vatsanabha became soft and colour of Gomutra changed to darkbrown. It may be due to release of some toxic substances. It is believed that thetoxicity of Vastanabha decreased by treating it with Gomutra and after exposure tosunlight brought about a partial change of toxins aconitine and pseudoaconitine intothe less poisonous substance called Benzel aconine and Vertoroyl aconite. Duringpounding of Vatsanabha ugragandha was produced may be due to Vyavayi, Vikasi,Teekshna gunas of it. Before Shodhana it was 250 gms, after shodhana it was 150gms. This loss is due to removal of layer and also during powdering. Discussion - 123
  • 140. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa After mixing the ingredients homogeneously, marhana with Ardraka swarasawas done till it attains sticky nature so that vatis can be prepared. The ingredientstaken before were 600 gms in weight. After weight was increased to 630 gms. It wasbecause of Ardraka swarasa which contains fibrous and starch materials.CLINICAL STUDY: The sample for the study included all the patients with confirmed diagnosis ofKaphajakasa who attended the OPD of DGMAMC, Gadag. Even though there weredifferent types of Kasa, the study was mainly confined to the cases of Kaphajakasa.38 Patients were selected for the study out of which 8 patients did not reported for thefollow up. The study group thus included only 30 patients received ½ ratti B. D.Kaphaketurasa for 21 days.Age: The research study comprised of more number of patients between the agegroup 26 – 35 yrs. There is no age specification mentioned in the diseaseKaphajakasa. The incidence of Kasa may occur in any ageSex: In the present clinical trial there were 20 male patients and 10 female patients.The significance of this figure is doubtful. Because it is recorded that males are 10times more prone to be affected than females. In this study male and female ratio isless. The ratio varied in this because of small sample size so definite figure of ratiocould not be arrived at.Religion: Although more patients were from Hindu religion, there is no relation ofreligion in the causation of disease Kaphaja Kasa.Marital Status: The maximum number of patients were married, this is because ofthe group of the patients who approached for the treatment. Discussion - 124
  • 141. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaOccupation: It was observed that more number of patients belongs to labour groupfollowed by, housewife, secondary and students. This is because more chance ofexposure to allergens like dust, smoke, house dust mite, pollens etc. Many patientsadmitted that symptoms are going to disappear by change of place. It clearly showstheir exposure to allergens in their occupation.Socio – Economical Status: Most of the patients belong to middle and poor socioeconomic status.Chief complaints: Kasa, Bahula Madhura Ghanasnighda Kapha, UrahavankshanaSompurnamiva (100%) were present in all the patients. Ashya madhuryata, Gourava(63.33%) were the next dominating symptoms followed by Kapha poorna deha,Mandagni (56.66%), Aruchi (43.33%).Family History: The orthodox science believes that relatives of Bronchitispatients have higher prevalence of chronic respiratory disorder. In the present clinicaltrail also it was observed that more number (43.33%) of patients had the familyhistory of chronic respiratory disorders.Work place: Atmospheric pollution or dust exposure at work place has beenconsidered as an important etiological factor of respiratory disease. In the presentstudy also it was observed that more (53.33%) number of patients were working inpolluted area.History of recurrent URTI: The frequency of Chronic bronchitis is much higherin a person who is recurrently suffering from cold. Acharya Sushruta explained that ifprathishyaya is untreated it leads to Kasa. In this study 56.66% of cases had historyof recurrent URTI. Discussion - 125
  • 142. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaChronicity: Maximum number of patients 14 (46.66%) belonged to the group of upto 2yrs chronicity. This shows the relative resistance to modern drugs.Mode of onset: The mode of onset was gradual in 18 (60%) cases and Suddenin 10 (33.33%) cases. Patients with sudden onset, having history of rapid and severeform of infection. There is no sharp division between these two groups, but nearly allthe patients felt that their symptoms had either developed gradually over months oryears or else had appeared suddenly after a acute respiratory infection.Course of the disease: Course of the disease was progressive in 24 patients andrecurrent in 6 patients. In progressive cases intensity of disease was mild and later itbecome worse and most of the days they were having symptoms. In the patientshaving a recurrent course, the disease develops at intervals, means they were havingsymptoms for less period in the course of the disease.Periodicity of cough: Maximum numbers of 23 (76.66%) cases were havingseasonal periodicity. This shows dependency of disease over season.Sputum: Most of the patients 16 (53.33%) showed the mucous and sticky typeof sputum followed by 8 (26.66%) cases with mucopurulent sputum. Charakacharyamentioned that Kapha should be Bahula, Snigdha, Ghana in nature in Kaphaja Kasa.This can be taken as mucous and sticky.Aggravating factors: Smoke, dust, pollens etc are considered to be aggravatingfactors for the disease. In the present study also more number of patients hadaggravating factors like smoke 14(46.66%), 13 (43.33%) dust, etc. This holds goodas concerned to the modern literature. Discussion - 126
  • 143. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaSmoking: The numbers of smokers were 13(43.33%). Most of them weresmoking 10-15 cigarettes or 25-30 beedies /day and more than half of the smokers feltthat smoking aggravates their symptoms.Nidra: Maximum patients had disturbed sleep. It is because of cough whichdisturbs their sleep pattern.Agni & Kosta: Most of the patients had mandagni. Because as excessive Kaphaleads to mandagni. In Kaphaja Kasa, Kapha is the main dosha and in this study17(56.66%)patients were mrudu (Kapha pradhana) kosta.Exposure: 16 (53.33%) patients were exposure to aggravating factors duringworking hours. In those 9(30%) patients showed reduction in symptoms by changeof place. This clearly shows their exposure to allergens during working.Prakriti: The sharaeerika prakriti of the patients were analyzed based on themajor physical and behavioral features. In this study it was found that Vatakapha,Kapha pittaja prakriti persons were more and were more prone to get Kaphaja kasa asKapha is dominant in them.Nidana: In this study 13(43.33%) patients were smokers and 16(53.33%)patients were working in polluted area. So the dhuma and raja constitutes major rolein production of Kaphajakasa. More than 50% of patients had a history of recurrentupper respiratory tract infection. Hence it can be considered as nidanarthakarana rogaand Sheeta, Singdha ahara aggravate the condition still more. Discussion - 127
  • 144. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaPuravaroopa: Most of the patients were found Kanta Kandu, Arochaka,Agnisada, Shooka Poorna Galshayata, Galatalulepa as Purvaroopa. Rests of thePoorvaroopas were not found.Roopa: All most all patients were presented with complaint of Kasa,Nisteevana, Vrahavankshana sampoorna miva (100%). About 19(63.33%) patientscomplained of Ashymaduryata, Gourava and 17(56.66%) patients were complained ofMandagni, Kaphapoorna deha followed by Aruchi in 13(43.33%0 and peensa in10(33.33%) patients.RESULTS: ♦ In all the cases appetite was increased from 3rd day onwards and in most of the cases it has been observed that almost all patients were relieved of symptoms of Kaphaja kasa within the 15 days after the commencement of treatment. ♦ Clinical improvement was noticed in almost all patients of Kaphja kasa with the administration of Kaphaketu rasa. There was significant reduction in the subjective parameters like Kasa, Nisteevana and symptom Urahavankshana sampoornamiva at p value < 0.001. Erythrocyte sedimentation rate was also reduced significantly at p value <0.001. Though there was a decrease in Total leukocyte count, Absolute eosinophil count, they were not statistically significant. Discussion - 128
  • 145. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaLIMITATIONS: Sample size was very small. The period of study and follow up was limited. Analysis of only final product was done.RECOMMENDATION FOR FUTURE STUDY: Kaphaketu rasa and other yogas mentioned for Kaphaja kasa can be studied comparatively. Comparative study of different modes of preparation of Kaphaketu rasa can be studied. Analytical estimation can be done at various stages of the preparation of Kaphaketu rasa. Present study pattern can be continued in the form of prospective clinical study with increased sample size. Conclusion - 129
  • 146. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in KaphajakasaCONCLUSIONThe following conclusions can be drawn from the study: Kaphaketu rasa is highly effective in reducing the signs and symptoms of Kaphaja Kasa. Ingredient of Kaphaketu rasa are in unique combination for samprapthi vighatana of kaphaja kasa. Kaphaketu rasa is having expectorant and Mucolytic action. Kaphaketu rasa is effective in reducing E.S.R levels, which are statistically highly significant at P < 0.001. Kaphaketu rasa assays shown 3.52% w/w boron, 5.34% w/w Calcium. Kaphaja kasa is one of the Pranavaha srotodusthi vyadhi in which Nishteevana (hyper secretion of mucous) is the predominant feature. The disease kaphaja Kasa can be correlated with simple and recurrent Chronic bronchitis. It can be recommended that Kaphaketu rasa can be employed in Naveean kaphaja kasa which showed highly encouraging results. Conclusion - 130
  • 147. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Kaphaja kasa has been considered to be the cutting edge of the doshic type ofKasa, which if neglected or mismanaged, may result in poor prognostic conditions ofKshataja and Kshayaja kasa, which are very difficult to be repaired and patient needsimmediate relief due to its chronicity. Hence in Kaphaja kasa quick relief is essential.Keeping this in mind to establish the effect of a herbomineral preparation Kaphaketu rasaon Kaphaja kasa and to observe and identify the preliminary stage of Kaphaja kasa, thepresent study entitled “Preparation, Physcio- chemical analysis of Kaphaketu rasa and itsclinical efficacy on Kaphaja kasa”, was selected for the study. Need of the study, hypothesis, objectives and plan of the study is discussed inintroduction.OBJECTIVES • Preparation of Kaphaketu rasa. • Physico-chemical analysis of Kaphaketu rasa. • To evaluate the clinical efficacy of Kaphaketu rasa in the selected cases of Kaphaja kasa patients. The review of literature relating to the research topic was done from bothAyurveda and Modern texts.The historical review, utpatti, nirukti, paribhasha, bheda,nidana, sadhysadhyata, chikitsa and pathyapathya of the disease Kaphaja kasa andChronic bronchitis has been reviewed. An effort has been made to gather referencesrelated to Kaphaja kasa, Kaphaketu rasa and review of the ingredients in the preparation. Summary - 131
  • 148. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Pharmaceutical study includes Identification and collection of raw drugs, TankanaShodhana , Shankha Shodhana, Shankha Marana, Vatsanabha Shodhana, Pippalichoornikarana, Vatsanabha churnikarana, preparation of Ardraka swarasa andPreparation of Kaphaketu rasa. The analytical study was conducted for Kaphaketu rasa. In that the Phycsico-chemical analysis like Organoleptic characters, Size variation,. Weight variation, Totalash value, Acid insoluble ash, Loss on drying at 110oC, PH study, Test for alkaloids,Solubility test, Disintegration time, Friability, Assay for Borona and calcium etc., weredone for Kaphaketu rasa. The clinical study includes selection of patients, Research design, Source of data,Sampling method, Administration of drug, Study duration, Examination of patients,Parameters of assessment and Statistical analysis. Individually the subjective parameters showed most significant than the objectiveparameters. In the subjective parameter ‘Nishteevana’ symptom showed more significantthan others and Kasa, Uraha vankshanasampoornamiva symptoms showed significantresults. In the objective parameter the ESR showed more significant than otherparameter with stable effect within the group. The parameter ‘quantity of the sputum’have uniform affect in the group with high mean net effect. The parameter TC has morenet mean effect with more variation. The parameter AEC does not have uniform effecton the patient within the group. The statistical analysis revealed that Kaphaketu rasashowed highly significant in relieving the symptoms and reducing the ESR count. Summary - 132
  • 149. Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa Discussion was done on the various aspects of drug Kaphaketu rasa, diseaseKaphaja kasa, Pharmaceutical study, Analytical study, on demographic data like sexincidence, age incidence, occupation incidence, smoking incidence, chronicity of disease,past history of recurrent URTI. The rationality behind the Shodhana, Marana andprobable mode of action of Kaphaketu rasa were also discussed. On the basis of results finally this study concluded that Kaphaketu rasa by virtueof its ingredients properties, does the Samprapti vighatana and subsides the Kaphajakasa. Summary - 133
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  • 167. SPECIAL CLINICAL TRIAL PERFORMA FOR KAPHAJA KASA POST GRADUATE AND RESEARCH CENTER (RASASHASTRA) SHRI D. G. M. AYURVEDIC MEDICAL COLLEGE, GADAG.Guide : Dr.B.Dilip Kumar M.D (Rasashastra) R. B. Pattanashetti P.G.ScholarCo-guide: Dr.G.N.Danappagoudar. M.D.(Rasashastra) Sl.No.1.Name of the patient: O.P.D. No.2.Father’s Name/ Husband’s Name: D.O.I. D.O.C3.Age: yrs Male Female4. Sex:5. Religion: Hindu Muslim Christian Others Married Unmarried8.Marital status:6.Educational status: Labour Student Executive Sedentary7.Occupation7.Economical status : Poor Middle Higher8.Marital status: Married Unmarried9.Address: Tel- Well responded Moderately responded Not responded Discontinued10. Result: Consent: I -------- -------- Son / Daughter / Wife of----------- Exercise my free will in the said study, I have been informed to my satisfaction by attending the purpose of the clinical evaluation and nature of drug treatment. I am also aware of my right to quit at any time during the schedule. Patient’s Signature
  • 168. A) PRADHANA VEDANA Sl.No. Complaints P/A Duration 7th 14th 21st F7 F15 1 Kasa 2 Nishteevana a.Ghana kapha b.Snigdha ghana kapha c.Bahula snigdha Ghana kapha 4 Uraha vanksha sampoornamiva 5 Kapha poorna deha 6 Asya madhurata 7 Mandagni 8 Aruchi 9 Gourava 10 Peenasa 11 Utklesha 12 Lomaharsha 13 Kleda 14 ShirorujaB) ANUBANDHA VEDANA (SAVADHI) :C) VEDANA VRITTANTA:SPECIFIC ENQUIRES IN FOLLOWING HEADINGS:Condition of work place: Polluted Non pollutedMode of onset: Sudden Gradual InsidiousCourse: Episodic Continuous Initially episodicDuration: Dry Productive DayCough: On rest On activity NightIn case of productive cough Thin mucoid (Ghana kapha) Thick frothy (Ghana kapha)Nature of sputum : Mucous & sticky (Snigdha Ghana) Muco purulent ( Bahula snigdha Ghana)
  • 169. Aggravating Dust Food Smoke Animals Pollens factors: Cosmetics Drugs Weather Sheeta ahara OthersD) POORVA VYADHI VRITTANTA. History of recurrent URTI Yes NoE) CHIKITSA VRITTANTA:F) KOUTUMBIKA VRITTANTA: Incidence of chronic respiratory disorder In family Not in familyG) OCCUPATIONAL HISTORY o Work involving any mental strain. Yes No o Exposure to any aggravating factors during working hours. Yes No o Whether symptoms produced during working hours. Yes No o Whether symptoms relieved by change of place. Yes NoH) PRASUTI VRITTANTA: If the patient is female Abortions Operation Rutusrava vrittanta Age of menarche Age of menopause Artava pravritti Day Sama Alpa AdhikaH) VAYAKTIKA VRITTANTA: 1) Ahara: Vegetarian Mixed diet Dominant Rasa in food 2) Vyasana: Smokers Non smokers Coffee Tobacco Alcohol Tea
  • 170. 3) Nidra: Vishama Alpa Anidra Sama 4) Jataragni bala: Mandagni Vishamagni Teekshnagni Samagni 5) koshta Mridu Madhyama TeekshnaI) ROGI PAREEKSHA:ASHTASTHANA PAREEKSHA: Nadi Shabdha Mala Sparsha Mootra Drika Jivha AkrutiSAMANYA PAREEKSHA: Pulse rate bpm Blood Pressure mm of Hg Respiration rate /min Height Cms o Temparature F Weight Kg Heart rate /minDASHAVIDHA PAREEKSHA: 1)Shareera prakriti: V P K VP KP VK VPK 2)Manasa prakriti: V P K VP KP VK VPK 3) Sara: Pravara Madhyama Avara 4) Samhanana: Pravara Madhyama Avara 5) Satmya: Pravara Madhyama Avara 6) Satwa: Pravara Madhyama Avara 7)Vyayama shakti: Pravara Madhyama Avara 8) Vaya: Bala Youvana Vrudda 9) Desha: Jangala Anupa Sadharana 10) Akriti:
  • 171. J. SYSTEMIC EXAMINATION: RESPIRATORY SYSTEM EXAMINATION.I) DARSHANA Nasa: Polyps Inflammation Mukha:(mouth). Kantha:(neck): Lymph nodes: Tonsilar: Normal Enlarged Peritonsilar. Normal Enlarged Cervical. Normal Enlarged Accessory Muscles: Normal Overactive Engorged viens: Present Absent Uraha: (Chest) Shape: Normal Abnormal Respiration rate Character Rhythm Chest movements: Abdominal Thoracic Thoraco abdominalII) SPARSHANA:(PALPATION): Trachea: Central Shifted to Supraclavicular LN: Normal Enlarged Axillary LN: Normal Abnormal Chest expansion: Measurment Expiration Inspiration Vocal fremitus: Normal Increased Decreased Tenderness: Present AbsentIII) AKOTANA:(PERCUSSION): Normal note Dull note Strong dull note Hyper resonant note
  • 172. IV) SHRAVANA:(ASCULATION): Breath sounds: Intensity: Normal Reduced Increased Type of breathing: Vesicular Bronchial Broncho vesicular If branchial type: Tubular Cavernous Amphoric Vocal resonance: Normal Increased Decreased Absent Added sounds: Rales P/A If present Fine Course Rhonchi P/A If present Inspiration Expiration Pleural rub Present Absent Stridor: Laryngeal P A Tracheal P A2) CARDIOVASCULAR SYSTEM:3) GASTRO INTESTINAL SYSTEM:4) OTHER SYSTEMS:5) EXAMINATION OF SROTAS:-1) Symptomatology of disordered Pranavaha srotas: 1 Atisristam 4 Alpalpam 2 Atibaddam 5 Abheeksham 3 Kupitam 6 Sashoolam
  • 173. 2) Symptomatology of disordered Rasavaha srotas: Sl.No Symptoms P/A Sl.No. Symptoms P/A 1 Asradda 9 Jwara 2 Aruchi 10 Tama 3 Asyavairasyam 11 Pandutwa 4 Arasajnata 12 Sada 5 Hrillasa 13 Krishangata 6 Gourava 14 Agninasha 7 Tandra 15 Trupti 8 Angamarda 16 HridrogaVIKRITITAHA PAREEKSHA:NIDANA: Sl.No. Ahara P/A Sl.No. Vihara P/A 1 Bojyamana Vimargagamana 1 Dhoompaghata 2 Guru Abhishyandi 2 Raja sevana Ahara sevana 3 Madura rasa sevana 3 Veganam avarodha 4 Sheetahara sevana 4 Diwa swapna 5 Asatmyahara sevana 5 Avyayama 6 Snigdha ahara sevana 6 Kshavathu dharanaPOORVA ROOPAM: Shookapooma Galasyata Arochaka Kante Kandu Galatalu lepa Bhojyanam avarodha Agnisada SwaraROOPA: Kasa with ghana kapha Gourava. Bahula madhura snigdha kapha. Peenasa. Kapha poorna deha Shiroruja Aruchi. Utklesha.SAMPRAPTI: Dosha Dushya Adhistana Srotas Srotodusti Rogamarga
  • 174. UPASHAYA & ANUPASHAYA: Upashaya AnupashayaUPADRAVA: Jwara Hrillasa Kshaya Arochaka SwarabhedaARISTA LAKSHANAS:SADHYASADHYATA:LAB INVESTIGATIONS: Before After DC Before After Hb % gm % gm % N % % ESR mm/h mm/h E % % RBS mg/dl mg/dl B % % TC % % M % % AEC Cells/Cumm Cells/Cumm L % % Sputum for AFBURINE ROUTINE: Before After Albumin Microscopic SugarX-ray reading: Chest PA view: Before : After :CHIKITSA: YOGA : KAPHA KETU RASA a) Posology - 1/2 ratti (62.5mg) bid b) Anupama - Madhu DURATION OF TREATMENT : 21 days . FOLLOW UP -15 days
  • 175. PATHYA:APATHYA:ASSESSMENT OF RESULTS:SUBJECTIVE PARAMETERS: Sl.No. Complaints 0st day 7th day 15 days 21st F15 1 Kasa 2 Nishteevana 3 Urahavankshana sampoorna miva 4 Quality of sputumOBJECTIVE PARAMETERS: Sl.No Investigation 0th day 21st day 1 ESR 2 TC 3 DC 4 AEC Aggrivation of Symptoms after exposure to Present Absent NidanaInvestigator’s note:Signature of Co - Guide Signature of Guide
  • 176. For the purpose of assessment the signs and symptoms were graded as follow i) Kasa (cough) Grade o No Complaints - 0 o Intermittent cough - 1 o Constant cough - 2 o Worsened cough - 3 ii. Nishteevana (Expectoration) o No Expectoration - 0 o Thick expectoration - 1 o Mucoid & sticky expectoration - 2 o Mucopurulent - 3 iii. Uraha vankshana sampoornamiva o No feeling of Heaviness -0 o Heaviness relieved completely With expectoration -1 o Heaviness relieved slightly With expectoration -2 o Heaviness not relieved with Expectoration -3 • Comparing the objective parameter values of Quantity of sputum, TC, DC, ESR and AEC before and after treatment. • Quantity of sputum was graded as below: o No sputum -0 o Less than 2.0ml -1 o 2.0 – 4.9 ml -2 o 5.0 to more ml -3